RESUMEN
PURPOSE: It has been suggested that routine division of short gastric vessels (SGVs) results in a more "floppy" Nissen fundoplication leading to improved outcomes, that is, less dysphagia and lower incidences of recurrent gastroesophageal reflux disease (GERD). The aim of this retrospective study was to assess whether laparoscopic Nissen fundoplication without division of SGVs (Rossetti modification) (laparoscopic Nissen-Rossetti fundoplication [LNRF]) is associated with acceptable clinical outcome in children. METHOD: The charts of 368 children who underwent LNRF between January 1996 and September 2004 by 1 primary surgeon were retrospectively reviewed. Children were divided into 2 groups: LNRF + gastrostomy (A) and LNRF alone (B). Mean follow-up period of all groups was 4.2 years. RESULTS: Laparoscopic Nissen-Rossetti fundoplication was completed in 99% (365/368). Mean operating time for group A was 74 minutes and 61 minutes for group B. None in group A required postoperative esophageal dilatation, and 9 in group B (22.5%) required 12 dilatations; 3.6% developed recurrent GERD, 3.7% in group A and 2.5% in group B. CONCLUSION: Laparoscopic Nissen-Rossetti fundoplication can be performed with acceptable long-term outcome in children, especially in the majority also requiring chronic gastrostomy access. Short-term, reversible dysphagia may be seen in a small percentage of children having fundoplication alone.
Asunto(s)
Fundoplicación/métodos , Reflujo Gastroesofágico/cirugía , Laparoscopía/métodos , Adolescente , Niño , Preescolar , Trastornos de Deglución/etiología , Trastornos de Deglución/cirugía , Femenino , Gastrostomía , Humanos , Lactante , Recién Nacido , Masculino , Recurrencia , Estudios Retrospectivos , Estómago/irrigación sanguínea , Resultado del TratamientoAsunto(s)
Embolización Terapéutica/métodos , Leucemia-Linfoma de Células T del Adulto/complicaciones , Arteria Esplénica , Rotura del Bazo/etiología , Rotura del Bazo/terapia , Angiografía , Niño , Tratamiento de Urgencia , Humanos , Leucemia-Linfoma de Células T del Adulto/genética , Masculino , Medición de Riesgo , Índice de Severidad de la Enfermedad , Rotura del Bazo/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Translocación Genética , Resultado del TratamientoRESUMEN
Infectious complications are not uncommon in children undergoing treatment for cancer. Abdominal pain, especially right lower quadrant pain secondary to appendiceal and cecal inflammation, is a major concern in immunocompromised hosts and a potential source of sepsis. The authors report the case of a child who developed acute perforative appendicitis requiring appendectomy while on preoperative chemotherapy for Wilms tumor, stage IV, favorable histology. Problems related to diagnosis and management of acute abdominal pain and infection in an immunocompromised child with an abdominal mass are discussed along with a review of the literature.