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Introducción. La heterotaxia es un fallo en el desarrollo embrionario para la consecución de una simetría izquierda-derecha .Objetivo. Presentación de un caso de heterotaxia y mostrar una vía de abordaje para la fundoplicatura. Material y métodos. Niña con síndrome de heterotaxia-poliespleniacon reflujo gastroesofágico y dolor abdominal recurrente. Se decide realizar tratamiento antirreflujo laparoscópico con funduplicatura tipo Nissen con acceso derecho al hiato y a los pilares diafragmáticos. Conclusiones. Está en discusión la cirugía en este tipo de síndromes, indicándose únicamente en los casos de dolor abdominal recurrente, cuadros suboclusivos o cuando existe un diagnóstico de reflujo gastroesofágico; el dilema está entre el abordaje laparoscópico o la laparotomía clásica. La mayor dificultad del abordaje laparoscópico es la centralización de un hígado grande y la colocación del estómago a la derecha a pesar de que el hiato esofágico se sitúe normalmente en el lado izquierdo (AU)

Introduction. Heterotaxy is a failure in embryonic development to achieve left-right symmetry. Objective. To report a case of heterotaxy and show a surgical approach for fundoplication. Material and methods. A girl with heterotaxy-polysplenia syndrome with gastroesophageal refl ux and recurrent abdominal pain. It was decided to perform laparoscopic antire flux treatment with Nissen fundoplication with approach by the right side of the diaphragmatichiatus and pillars. Conclusions. Surgery is being discussed in these syndromes, indicatingonly in cases of recurrent abdominal pain, subocclusive lesions or when diagnosis of gastroesophageal refl ux is done. The dilemma is between laparoscopic or classical laparotomy. The main difficulty of the laparoscopic approach is the enlarged liver and stomach placement right despite the esophageal hiatus is normally on the left side (AU)

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INTRODUCTION: Heterotaxy is a failure in embryonic development to achieve left-right symmetry. OBJECTIVE: To report a case of heterotaxy and show a surgical approach for fundoplication. MATERIAL AND METHODS: A girl with heterotaxy-polysplenia syndrome with gastroesophageal reflux and recurrent abdominal pain. It was decided to perform laparoscopic antireflux treatment with Nissen fundoplication with approach by the right side of the diaphragmatic hiatus and pillars. CONCLUSIONS: Surgery is being discussed in these syndromes, indicating only in cases of recurrent abdominal pain, subocclusive lesions or when diagnosis of gastroesophageal reflux is done. The dilemma is between laparoscopic or classical laparotomy. The main difficulty of the laparoscopic approach is the enlarged liver and stomach placement right despite the esophageal hiatus is normally on the left side.

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INTRODUCTION: Horseshoe kidney (HK) is the most common renal fusion anomaly. Urological anomalies (UA) occurs in 52% of HK. The objective of this paper is to know if it's necessary to follow up for a long time the asymptomatic cases of HK with UA. MATERIAL AND METHODS: We reviewed retrospectively 39 cases of children in whom HK was diagnosed in our hospital during 1990 to 2007. The following features have been taken into account: sex, age at diagnosis, associated anomalies, treatment, postoperative complications, results and time of follow-up. RESULTS: The mean age at diagnosis was 3 years. 18 patients (46.1%) had associated urological anomalies: 9 hydronephrosis, vesicoureteral reflux 6 and 3 kidney duplication. 10 cases of them (55%) were surgically treated: 6 pyeloplasty, 2 endoscopic reflux, one upper pole heminephrectomy and one ureteroneocystostomy. 3 hydronephrosis and 3 vesicoureteral reflux were managed conservatively. The ureteropelvic junction obstruction (UJO) was caused by a crossing lower-pole vessel in four cases (67%) and two by a high ureteral insertion. Three of this cases of obstruction (50%) were adquired over the time (along 5-7 years from diagnosis of hydronephrosis). There were no complications and the mean time of follow up has been 3.6 years (range: 2-6 years). CONCLUSIONS: We think that all HK associated with UA should be controlled, as above 50% are subsidiaries of surgical correction. The hydronephrosis can be obstructive over the time and it could be necessary to check them for a long time.

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Introducción. El riñón en herradura (RH) constituye la anomalía más frecuente dentro del grupo de las anomalías de fusión renal, con una incidencia variable según las series del 13 al 24%. Un 52% presentan anomalías urológicas asociadas. El objetivo de la comunicación es mostrar cuándo deben ser tratadas. Material y métodos. Hemos estudiado retrospectivamente los casos clínicos de 39 niños diagnosticados de RH y controlados en nuestro hospital en el período de 1990-2007. En cada caso hemos analizado los siguientes parámetros: sexo, edad al diagnóstico, tipo de anomalía asociada, tratamiento, complicaciones postoperatorias, resultados y tiempo de seguimiento. Resultados. Hubo un claro predominio de los niños con 32 (..) (AU)

Introduction. Horseshoe kidney (HK) is the most common renal fusion anomaly. Urological anomalies (UA) occurs in 52% of HK. The objective of this paper is to know if it’s necessary to follow up for a longtime the asymptomatic cases of HK with UA. Material and methods We reviewed retrospectively 39 cases of children in whom HK was diagnosed in our hospital during 1990 to 2007. The following features have been taken into account: sex, age at diagnosis, associated anomalies, treatment, postoperative complications, results and time of (..) (AU)

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Introducción. Los tumores renales son raros en niños menores de 6 meses, siendo el nefroma mesoblástico congénito el más frecuente en este grupo de edad. Presentamos 4 casos tratados en nuestro hospital en los últimos años. Material y métodos. Analizamos la edad, sexo, forma de presentación así como el diagnóstico y tratamiento de los 4 casos, revisando la literatura. Resultados. La edad de presentación osciló entre 0-6 meses. En nuestra serie el sexo que predominó fue el femenino. La clínica ha sido de masa abdominal en todos los casos, asociando hipertensión arterial en 2 de ellos. La ecografía ha sido el método de sospecha diagnóstica, en 2 de ellos deforma prenatal. El diagnóstico se completó con resonancia magnética. El tratamiento fue quirúrgico realizándose cirugía abierta en 3 casos y cirugía laparoscópica en el restante. La evolución ha sido favorable. Conclusión. La baja frecuencia de este tumor limita la experiencia en el diagnóstico y tratamiento. El tratamiento estándar es la nefrectomía radical con márgenes libres. La terapia coadyuvante en enfermedad recurrente puede ser considerada aunque existen pocos estudios. La cirugía laparoscópica comienza a constituir una alternativa al tratamiento clásico de estos tumores, ya que permite la extirpación con buenos márgenes de seguridad (AU)

Background. Renal tumors are rare in infants less than 6 months of age, being congenital mesoblastic nephroma the most frecuent in this age group. We reported 4 cases treated in our hospital in the last years. Methods. We analyze age, sex, the clinical presentation as well as diagnosis and treatment. Results. Range of age at diagnosis was 0-6 months. In our study the predominant sex was female. Clinical presentation was abdominal mass in all of cases with hypertension (HTA) in two of them. Scan ultrasound has been the method of dignostic, that was completed with Magnetic Resonance Imaging (MRI). The tretament was open surgery in three cases and laparoscopic on the last. All patients are alive with no evidence of disease. Conclusions. Low frecuency of this tumor limit the experience ondiagnostic and treatment. Standard treatment is nephroureterectomy radical with free margins. Adjuvant therapy should be considered in recurrent disease although exists few studies. Laparoscopic surgery should be an alternative to clasical treatment since permits excision with good security margins (AU)

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INTRODUCTION: It's reported that the laparoscopic orchiopexy without vessel transection at one stage (LO1S) is the recommended technique for the testis located near to the internal ring (IR) and orchiopexy in two stages according to Fowler Stephens (2SFSO) for the testicles located far away to the IR .The dilemma arises in those testicles situated on the border between the two procedures. We reported our experience in the management of this disease and analyze our results. MATERIAL AND METHODS: From 2005 to 2007, we have operated to 61 patients and 74 intra-abdominal testes by laparoscopy. The techniques used were the LOIS and the Fowler Stephens orquidopexy with a first stage laparoscopic and a second one inguinal. Differents features have been taken into account retrospectively. RESULTS: Of the 74 testes operated, 16 (21.6%) were located less than 1 cm from IR (group I), 43 (58.2%) between 1 and 2 cm from IR (Group II) and 15 (20, 2%) more than 2 cm from IR. Group I: In all cases were treated with LOIS procedure. We obtained good results in 13 testes (81.2%). Two testes (12.6%) grew less than the other side and one testicle (6.2%) rose to the inguinal canal and it needed new orchiopexy. Group II: In 31 cases (72.1%) was performed a 2SFSO and in 12 (27.9%) a LOIS. Of the 31 testes intervened by 2SFSO in 22 (71.5%) was obtained good results, 6 cases (19.5%) atrophied, 2 tests (6%) grew less than the other side and one testicle rose to upper scrotum (3%) Of the 12 testes in whom the LOIS were performed in 6 (50%) achieved good results, three rose to upper scrotum (25%), one testicle (8.3%) rose to inguinal canal (8.3%) and two cases grew less than the other side (16.7%). Group III: In the 15 tests were treated with 2SFSO procedure. 10 testicles (66%) had a good result. 3 (20%) decreased in size and 2 (14%) orchiectomy was performed by severe atrophy. CONCLUSIONS: The LOIS offers good results for testis located near to the IR. The most frequent complication of this technique is the ascend of the testes and the most one in the 2SFSO is the testicle atrophy. The surgeon's experience will play an important role in the final decision on the technique ideal in the intra-abdominal testis situated on the border between the two procedures.

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Introducción. La orquidopexia laparoscópica en un tiempo (OL1T)para los testes muy próximos al orificio inguinal interno (OII) y la orquidopexia en dos tiempos según Fowler Stephes (OFS) para los testículos lejanos al OII parecen estar bien definidas. La disyuntiva surge en aquellos testículos situados en la frontera entre ambos procedimientos. Presentamos nuestra experiencia en el tratamiento de esta patología y analizamos los resultados obtenidos. Material y métodos. Entre los años 2005 y 2007 hemos intervenido a 61 pacientes y 74 testículos intraabdominales mediante laparoscopia. Las técnicas empleadas fueron la OL1T y la OFS con un primer tiempo laparoscópico y un segundo inguinal. Hemos analizado diferentes parámetros de manera retrospectiva. Resultados. De los 74 testículos operados, 16 (21,6%) se localizaron a menos de 1 cm del OII (grupo I), 43 (58,2%) entre 1 y 2 cm del OII (grupo II) y 15 (20,2%) a más de 2 cm del OII. Grupo I: Todos los casos se intervinieron mediante OL1T. Se obtuvo buen resultado en 13 testes (81,2%). Dos testes (12,6%) se desarrollaron menos que el teste contralateral y un teste (6,2%) ascendió al canal (..) (AU)

Introduction. It´s reported that the laparoscopic orchiopexy without vessel transection at one stage (LO1S) is the recommended technique for the testis located near to the internal ring (IR) and orchiopexy in two stages according to Fowler Stephens (2SFSO) for the testicles located far away to the IR .The dilemma arises in those testicles situated on the border between the two procedures. We reported our experience in the management of this disease and analyze our results. Material y methods. From 2005 to 2007, we have operated to 61patients and 74 intra-abdominal testes by laparoscopy. The techniques used were the LO1S and the Fowler Stephens orquidopexy with a first stage laparoscopic and a second one inguinal. Differents features have been taken into account retrospectively. Results. Of the 74 testes operated, 16 (21.6%) were located less than 1 cm from IR (group I), 43 (58.2%) between 1 and 2 cm from IR(Group II) and 15 (20, 2%) more than 2 cm from IR. Group I: In all cases were treated with LO1S procedure. We obtained good results in 13 testes (81.2%). Two testes (12.6%) grew less than (..) (AU)

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BACKGROUND: Renal tumors are rare in infants less than 6 months of age, being congenital mesoblastic nephroma the most frecuent in this age group. We reported 4 cases treated in our hospital in the last years. METHODS: We analyze age, sex, the clinical presentation as well as diagnosis and treatment. RESULTS: Range of age at diagnosis was 0-6 months. In our study the predominant sex was female. Clinical presentation was abdominal mass in all of cases with hypertension (HTA) in two of them. Scan ultrasound has been the method of dignostic, that was completed with Magnetic Resonance Imaging (MRI). The tretament was open surgery in three cases and laparoscopic on the last. All patients are alive with no evidence of disease. CONCLUSIONS: Low frecuency of this tumor limit the experience on diagnostic and treatment. Standard treatment is nephroureterectomy radical with free margins. Adjuvant therapy should be considered in recurrent disease although exists few studies. Laparoscopic surgery should be an alternative to clasical treatment since permits excision with good security margins.

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The neonatal duodenal pathology has been diagnosed and treated with open surgery for many years. The use of minimally invasive techniques is widely use today on pediatric surgery, but its use on neonatal pathology poses a challenge. We have conducted a study of the 8 neonatal patients with duodenal obstruction that were operated with a laparoscopy in our hospital between 2001 and 2007. The analyzed parameters were the gender, prenatal diagnostic, type of duodenal malformation, weight at birth, hospitalization stay, start of feeding, complications and follow-up. In our sample (6 girls and 2 boys) the 62.5% of the cases was diagnosed after a prenatal ultrasound scan. The duodenal malformations discovered were 5 atresias, 2 webs and 1 anular pancreas. In all the cases, the feeding started by means of a trans-anastomotic probe 48 hours postoperatives. There were 3 complications: one re-surgery and 2 stenosis of anastomosis. The average hospitalization stay was of 27 days with a mean follow-up of 3 years. We think that laparoscopy is a good method for the treatment of the neonatal duodenal pathology, although the scarce volume of our sample does not allow us to generalize the technique.

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BACKGROUND: The management of asymptomatic patients with congenital cystic adenomatoid malformation (CCAM) is controversial. This report evaluates the video-assisted thoracoscopic (VAT) lobectomy in children with this malformation, and the different intraoperative complications and their resolution are discussed. METHODS: Six patients with CCAM underwent video-assisted thoracoscopic lobectomy. All the patients were under one year and all of them were asymptomatic at the diagnosis. The procedures were performed with single lung ventilation and the chest was insufflated with a low flow and pressure to complete collapse of the lung. We used 3 or 4 thoracoscopic ports depending on the difficulty of the dissection. A bipolar sealing device was the preferred mode of vessel ligation and bronchi were closed with interrupted sutures. The following features have been taken into account: age at diagnosis, localization, surgical technique, complications, hospital stay, results, and time of follow-up. RESULTS: Four lesions were on the right lower lobe (66.7%) and two (33.3%) in the middle lobe. All the procedures were completed thoracoscopically. Chest tubes were left in all cases. Two patients (33.3%) showed postoperative hemothorax but it didn't need blood transfusion. Mean hospital stay was 6 days. At the moment all the patients are asymptomatic with and the mean time of follow-up has been 2 years and 8 months. CONCLUSIONS: VAT lobectomy avoids the long-term morbidity associated to an open thoracotomy and therefore it is a safe and efficacious technique in asymptomatic children with CCAM. Moreover, a greater number of cases are necessary to validate and to improve the technique.

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La patología duodenal neonatal ha sido diagnosticada y tratada concirugía abierta durante muchos años. El uso de técnicas mínimamente invasivas es común hoy en día en la cirugía pediátrica, pero su utilización en neonatos supone un reto. Hemos realizado un estudio de 8 pacientes diagnosticados de obstrucción duodenal congénita que fueron intervenidos por vía laparoscópica en nuestro Hospital entre el 2001 y 2007.Los parámetros analizados fueron el sexo, diagnóstico prenatal, tipo de malformación duodenal, peso medio al nacimiento, tiempo quirúrgico, estancia hospitalaria, inicio de la alimentación, complicaciones y seguimiento. En nuestra muestra (6 niñas y 2 niños) el 62,5% fue diagnosticado tras ecografía prenatal. Las malformaciones duodenales halladas fueron5 atresias, 2 membranas y 1 páncreas anular. En todos ellos se inició la alimentación por sonda transanastomótica a las 48 horas posquirúrgicas. Hubo 3 complicaciones: una reintervención y 2 estenosis de la anastomosis. La estancia media hospitalaria fue de 27 días con un seguimiento medio de 3 años. Pensamos que la laparoscopia es un buen método para tratar la patología duodenal neonatal, aunque el escaso volumen de nuestra serie nos impide generalizar la técnica (AU)

The neonatal duodenal pathology has been diagnosed and treated with open surgery for many years. The use of minimally invasive techniques is widely use today on pediatric surgery, but its use on neonatal pathology poses a challenge. We have conducted a study of the 8 neonatal patients with duodenal obstruction that were operated with a laparoscopy in our hospital between 2001 and 2007. The analyzed parameters were the gender, prenatal diagnostic, type of duodenal malformation, weight at birth, hospitalization stay, start of feeding, complications and follow-up. In our sample (6 girls and 2 boys) the 62.5% of the cases was diagnosed after a prenatal ultrasound scan. The duodenal malformations discovered were 5 atresias, 2 webs and 1 anular pancreas. In all the cases, the feeding started by means of a trans-anastomotic probe 48 hours postoperatives. There were 3 complications: one re-surgery and 2 stenosis of anastomosis. The average hospitalization stay was of 27 days with a mean follow-up of 3 years. We think that laparoscopy is a good method for the treatment of the neonatal duodenal pathology, although the scarce volume of our sample does not allow us to generalize the technique (AU)

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Introducción. El tratamiento de los pacientes asintomáticos con malformación adenomatoidea quística (MAQ) es controvertido. En este trabajo evaluamos la lobectomía por vía toracoscópica en pacientes condicha malformación analizando los diferentes aspectos técnicos, las complicaciones y su resolución. Material y métodos. Hemos intervenido 6 pacientes con diagnóstico de MAQ mediante toracoscopia. Todos los pacientes eran menores de un año y en ningún caso habían presentado síntomas. Se realizó toracoscopia con intubación selectiva y neumotórax controlado a baja presión y bajo flujo. Empleamos 3 ó 4 trócares en función de la dificultad de la disección. Para el control de la vascularización pulmonar utilizamos un sellador térmico y el cierre de los bronquios se realizó mediante sutura intracorpórea. Se han analizado los siguientes parámetros: edad, localización de lesión, técnica quirúrgica, complicaciones postquirúrgicas, estancia hospitalaria, resultado final y tiempo de seguimiento. Resultados. La lesión se localizó en lóbulo inferior derecho en cuatro ocasiones (66,7%) y en lóbulo medio en dos (33,3%) En los seis casos la lobectomía fue completada por vía toracoscópica con éxito. Dos pacientes (33,3%) presentaron hemotórax en el postoperatorio inmediato, que no precisó transfusión ni drenaje. El ingreso medio fue de 6días. Actualmente todos los pacientes están asintomáticos, con un tiempo de seguimiento medio de 2 años y 8 meses. Conclusión. El menor número de complicaciones y efectos secundarios de la lobectomía toracoscópica frente a la toracotomía convencional hacen de esta técnica una opción terapéutica válida y eficaz para el tratamiento de los pacientes asintomáticos con MAQ. No obstante, es necesario un mayor número de casos para validar y perfeccionar completamente la técnica (AU)

Background. The management of asymptomatic patients with congenitalcystic adenomatoid malformation (CCAM) is controversial. This report evaluates the video-assisted thoracoscopic (VAT) lobectomy in children with this malformation, and the different intraoperative complications and their resolution are discussed. Methods. Six patients with CCAM underwent video-assisted thoracoscopic lobectomy. All the patients were under one year and all of them were asymptomatic at the diagnosis. The procedures were performed with single lung ventilation and the chest was insufflated with a low flow and pressure to complete collapse of the lung. We used 3 or 4thoracoscopic ports depending on the difficulty of the dissection. A bipolar sealing device was the preferred mode of vessel ligation and bronchi were closed with interrupted sutures. The following features have been taken into account: age at diagnosis, localization, surgical technique, complications, hospital stay, results, and time of follow-up. Results. Four lesions were on the right lower lobe (66.7%) and two(33.3%) in the middle lobe. All the procedures were completed thoracoscopically. Chest tubes were left in all cases. Two patients (33.3%)showed postoperative hem thorax but it didn´t need blood transfusion. Mean hospital stay was 6 days. At the moment all the patients are asymptomatic with and the mean time of follow-up has been 2 years and 8months.Conclusions. VAT lobectomy avoids the long-term morbidity associated to an open (..) (AU)

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Introducción. La litiasis urinaria es un problema poco frecuente en la infancia. La cirugía endourológica (CEU) juega un papel cada vez más importante en su tratamiento. Mostramos nuestra experiencia en el empleo de este tipo de cirugía. Material y métodos. En el periodo entre 1992- 2006 se ha empleado CEU para el manejo y extracción de urolitiasis en 18 niños (rango de edad: 2 años- 17 años). Hemos realizado un estudio retrospectivo descriptivo, analizando: tamaño de la litiasis, localización, tipo de procedimiento, complicaciones quirúrgicas, recidiva, resultado final y tiempo de seguimiento. Resultados. Se han realizado 21 procedimientos endourológicos: nueve ureterorrenoscopias (43%), 10 extracciones vesicales endoscópicas(47,5%) y dos nefrolitotomías percutáneas (9,5%). El tamaño medio dela litiasis ha sido de 2,75 cm en las litiasis vesicales y de 6,3 mm. en las ureterales. Un paciente presentó un cálculo coraliforme. La localización del cálculo fue: en riñón en 2 ocasiones (9,5%), en uréter proximal en 2 (9,5%), en uréter distal en 7 (33,3%), en vejiga en 9 (43%) y en uretra en una (4,7%). El 55 % de los casos presentaban anomalías urológicas asociadas (6 pacientes con vejiga neurógena, dos con extrofiavesical, uno con ureterocele y uno con megauréter primario. Un paciente con una litiasis vesical y tres con litiasis ureterales (22% de los casos)requirieron cirugía abierta para la extracción del cálculo. El 16,5% delos casos (3 pacientes) presentaron recidiva y precisaron un nuevo procedimiento endoscópico. Actualmente los pacientes se encuentran libres de litiasis en los controles periódicos realizados. El tiempo de seguimiento medio ha sido de 2 años y 6 meses (rango de 1-13 años).Conclusiones. La CEU es una opción terapéutica válida y eficaz para el manejo de cálculos en la vía urinaria del niño. El desarrollo de nuevo instrumental endoscópico para el ámbito pediátrico permitirá ampliarlos criterios de selección de los pacientes (AU)

Background. The urinary tract calculi in children is a very unfrequent problem in the pediatric age group. Endourology plays a major role in pediatric surgery. We reported our experience in endoscopic management of pediatric calculi.Methods. Eighteen children (age range: 2 year- 19 years) underwent endourology procedures for extraction of urinary tract lithiasis in theperiod from 1992 until 2006. We reviewed retrospectively the following features: calculi size, location, procedures, surgical complications, recurrent, results and time of follow-up. Results. Twenty-one endourolgy procedures were performed: nine ureteroscopies(43%), 10 bladder extractions (47.5%) and two percutaneous nephrolithotomies (9.5%). The mean size bladder stone was 2,75cm. and 6,3 mm. in the ureteral stones. A patient had stag horn calculi. The stone was located in distal ureter in 7 occasions (33.3%), in upper ureter in 2 (9.5%), in kidney in 2 (9.5%), in bladder in 9 (43%) and in urethra in one (4.7%). Ten cases (55, 5%) had urology associated anomalies:6 patients neurogenic bladder, two bladder exstrophy, one ureterocele and one diagnosed of primary megaureter. Four patients (22%)underwent open surgery for the extraction of the lithiasis: a patient with a bladder stone and three cases with ureteral calculi. Three patients (16,5%) had recurrence of stones and were successfully treated with endoscopy procedure again. By the moment all the patients are stone-free. The time of follow-up has been 2 years and 6 months (range: 1-13 years).Conclusions. The end urology is a safe and effective therapeutic option for the management of urinary tract calculi in children. With improvements in instrumentation and technology, it will be possible to expand the patients’ selection criterion (AU)

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Introducción. El manejo inicial de los pacientes con megauréter primario obstructivo no refluyente y mala función renal o con alto riesgo de deterioro de la función genera controversia. Presentamos nuestra experiencia en el empleo de catéteres doble J en dichos pacientes evaluando su utilidad para disminuir la dilatación ureteral, preservar la función renal o como medida transitoria para un futuro tratamiento quirúrgico. Material y métodos. Desde 1996- 2006 27 pacientes fueron diagnosticados de megauréter primario obstructivo no refluyente (MPONR). Los pacientes se clasificaron en dos grupos según el tratamiento inicial recibido: los que se manejaron de manera expectante y los tratados con catéter doble J durante 6 meses. Se reevaluó a los 12 meses del diagnóstico el primer grupo y a los tres meses de la retirada del catéter el segundo, interviniéndose aquellos pacientes que presentaron una curva de eliminación obstructiva en ese momento. Hemos analizado los siguientes parámetros: edad, sexo, la función renal previa y posterior al tratamiento, la morbilidad asociada a la colocación del catéter, la curva de eliminación renográfica después del manejo inicial, tipo de intervención en los pacientes operados, necesidad de modelaje, resultado final y tiempo de seguimiento. Resultados. Quince casos fueron tratados de manera expectante. A los 12 meses la curva de eliminación continuaba siendo obstructiva en 8 pacientes (53,3%), y en 7 mostraba un patrón no obstructivo(46,7%) La función renal empeoró en dos casos (15,4%), siendo en uno de ellos inferior al 10%. Ocho pacientes fueron intervenidos (53,3%), realizándose 7 ureteroneocistostomías y una nefrectomía. Cuatro casos precisaron modelaje ureteral (57,1%). Doce pacientes fueron manejados inicialmente mediante colocación de catéter doble J. En 5 casos (41,7%) hubo complicaciones asociadas a la colocación del catéter: 2 migraciones proximales, dos migraciones distales y una infección. A los 3 meses de la retirada del catéter 6 pacientes(50%) presentaban una curva de eliminación obstructiva, y el resto un patrón no obstructivo (50%). En uno de los pacientes con la función renal inicial menor del 40%, la función empeoró hasta hacerse menor del 10%. Seis pacientes precisaron tratamiento quirúrgico (50%), una nefrectomía y 5 ureteroneocistostomías, sin precisar en ningún caso modelaje. El tiempo de seguimiento ha sido de 2 años y 7 meses en el primer grupo y de 3 años y 3 meses en el segundo. Conclusiones. La morbilidad asociada a la colocación del catéter doble J y la no mejoría con respecto al grupo manejado de manera expectante hace necesario la creación de criterios más rigurosos para el empleo del catéter doble J como medida transitoria a una futura cirugía en los pacientes con MPONR (AU)

Background. Initial management of patients with primary nonrefluxing megaureter (PNRM) associated with impaired renal function or with high risk rate of decreased kidney function can be a dilemma. We present our experience in the use of double -J stent in these patients to evaluate the role as a method to decompressing the system, to prevent function loss or to temporize surgical treatment. Methods. In the period 1996 - 2006 27 patients were diagnosed of PNRM. The patients classified themselves in two groups according to the initial treatment received: those with conservative management and those managed with double- J stent insertion during 6 months. A complete reassessment was performed after one year from the diagnosis in the first group and three months after stent removal in the second one. Patients underwent uretereral replantation if, at assessment, an obstructed excretion pattern was found on diuretic testing. The following data have been studied in each case: age at diagnosis, sex, renal function previous and after the treatment, morbidity associated to the double-J stent insertion, excretion pattern on diuretic testing after initial management, surgical technique, ureteral tapering, outcome and time of follow-up. Results. 15 cases were managed with conservative conduct. After a 12 month period an obstructed excretion pattern was found on diuretic testing in eight patients (53, 3%), and an unobstructed one in seven (46.7%). The differential function of the affected kidney got worse in two cases (15, 4%), being in one of them less than 10%. Eight patients underwent a surgical intervention (53, 3%), in seven cases was performed ureteral reimplantation and in one case was performed a nefrectomy. Four cases needed ureteral tapering (57, 1%).Twelve patients were selected to undergo double- J stent insertion for al 6-month period. Stent-related complications developed in 5 cases (41, 7%), including upper migration in two cases, distal migration in two and breakthrough infections in one patient. At reassessment three months after stent removal, 6 patients (50%) presented an obstructive pattern and the other cases an unonobstructive pattern (50%). In one of the patients with impaired function, the kidney function got worse until becoming smaller than 10%. Six patients underwent surgical treatment (50%), a nefrectomy and 5 ureteral reimplantation. None case neededureteral tapering. Mean time of follow-up has been 7 months in the first group and 3 years and 3 months in the second one. Conclusions. Double- J stent insertion in patients with PNRM is associated with high morbidity and there weren´t differents in the final outcomes between both groups, therefore it´s necessary to create severe prognosis indicators to use the double-J stent as a method to temporize a surgical treatment (AU)

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PURPOSE: Tracheobronchial stenting can aid in the management of pediatric airway problems. We reviewed our experience to determine the role of endoscopic airway stents in children. METHODS: Sixteen children (Age range: 10 days- 19 years) underwent 28 tracheobronchial stents in the period 1991-2006. The stent type chosen depended on patient age and location. All procedures were done under general anesthesia with bronchoscopy. The following features have been taken into account: etiology, obstruction diagnosis, stent type, localization,,associated anomalies, complications, results, and time of follow-up. RESULTS: Etiology of the tracheobronchial obstruction included tracheobronchiomalacia in 13 patients (81.3%), tracheal stenosis in 2 (12.5%) and glotic stenosis in one case (6.2%). The stent used were 15 Palmaz (53.5%), 7 Dumon (25%), 4 Montgomey (14.5%), 1 Poliflex (3.5%) and one Dynamic stent (3.5%). More than one stent were undertaken in seven cases (43.7%). 16 patients had tracheal stents, 11 children had bronchial stent and one infant a carinal stent. Five complications are reported (two patients developed granulation tissue, two stents migrated, and a child presented a left lung atelectasis) and five patients died (only one case related to tracheobronchial stenting). Results have been satisfactory in 14 patients (87.5%) and the mean time of follow-up has been two years and ten months (range 2 months- 12 years and 6 months). CONCLUSIONS: The tracheobronchial stenting in children may represent a valid treatment option for many sick children in particular circumstances. The long-term outcome remains uncertain but the medium-term outlook is encouraging.

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Introducción: La herniorrafía inguinal tiene una nueva alternativa, la vía laparoscópica. En este trabajo analizamos los resultados iniciales obtenidos mediante esta técnica en el tratamiento de la hernia inguinal, en nuestro hospital, evaluando las indicaciones y su eficacia. Material y métodos: Estudiamos 150 pacientes con diagnóstico de herniainguinal o crural. La técnica la efectuamos con tres trócares: unoumbilical de 5mm para la óptica y dos de 3 mm situados en ambos flancos. La reparación se realizó con bolsa de tabaco, sutura continua o puntos sueltos, utilizando siempre material irreabsorbible. Resultados: Las indicaciones fueron: hernia inguinal recidivada en el12%, hernia inguinal bilateral en el 28%, asociación de hernia inguinal unilateral y hernia umbilical en el 39%, hernia crural en el 4% y en el16% se reparó la hernia al ser encontrada incidentalmente. En la mayoría de los casos (137) el cierre del anillo inguinal se realizó mediante una sutura en bolsa de tabaco sin sección del peritoneo, en 11 se hizo una sutura continua y en 12 casos se cerró mediante puntos sueltos. No hubo reconversión en ningún caso. Se produjo hematoma por punción de los vasos espermáticos en 6 casos (1,4%). Inicialmente el ingreso fue de 1 a 2 días; actualmente lo hacemos de forma ambulatoria. Hemos tenido 2 casos de recidiva (1%) que fueron tratados por vía laparoscópica. Conclusiones: Aunque el número de pacientes tratados impide sacar unas conclusiones definitivas pensamos que el tratamiento laparoscópico de las hernias inguinocrurales, puede ofrecer ciertas ventajas sobre la vía abierta en casos seleccionados (AU)

Introduction: The inguinal hernia repair in the child has anew alternative, the laparoscopic repair. We study our initial results obtained with this technique. We evaluate the indications and the efficiency. Material and methods: 150 patients have been operated with an initial diagnosis of hernia inguinal or crural. Usually this technique is realized with three ports: we put the umbilical one (5mm) for the scope and two ports (3mm) placed in flanks. The repair was realized in purse string fashion or interrupted or no interrupted suture with non-absorbable suture (polipropylen) 3-4/0.Results: Indications of the herniorraphy were: (12 %) recurrent hernia, bilateral hernia (28 %), association inguinal hernia inguinal and umbilical(39 %), crural hernia (4 %) and in 16 % incidental hernia. Most of them (137) was treated in purse string fashion, (11) non interrupted suture and 12 interrupted suture. No conversion to open was require in any case. Haematoma for puncture of the spermatic vessels was seen in6 cases (1'4 %). Today we do this surgery in ambulatory way. We have had 2 recurrent hernias (1 %) that were treated again laparoscopicaly Conclusions: We can’t extract conclusion from this study because of the number of patients but we think that the laparoscopic treatment of inguinal hernias can offer advantages in selected cases (AU)

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INTRODUCTION: Minimally invasive surgery (MIS) plays a major role in pediatric surgery. We reported our experience in MIS management of congenital diaphragmatic patology (CDP). PATIENTS AND METHODS: The authors collected date on children who underwent a MIS for CDP repair from 1998 until 2006. The following features have been taken into account: lesion type, approach, surgical technique, complications, hospital stay and time of follow-up. RESULTS: From 1998 until 2006 11 patients (age range: 2 days-6 years and 6 months) with CDP had undergone an attempt at MIS repair: 6 patients with posterolateral hernia (36.4%), 4 with Morgagni hernia ( 54.5%) and a congenital diaphragmatic eventration case (9%). Eight patients 8 (72.7%) were treated using laparoscopy and three cases using thoracoscopy. Three patients were treated as newborns (27.2%). Four patients presented complications (36.3%): two patients who were repaired initially laparoscopically were converted to a transabdominally approach and two patients had recurrent herniation, which were repaired with MIS. Actually all cases were asymptomatic with a mean time of follow-up of 1 year and 8 months (range: 3 months-two years). CONCLUSIONS: MIS is a feasible, safe, easy to perform and efficient approach to repair CDP but it needs selection criteria for successful outcome.

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Introducción. Las prótesis traqueobronquiales endoluminales (PTBE) constituyen una opción terapéutica válida en el manejo de los pacientes con patología estenosante de la vía aérea. Mostramos nuestra experiencia en su empleo, estableciendo los criterios para su utilización, y analizamos los resultados obtenidos. Material y métodos. En el periodo entre 1991- 2006 16 niños (rango de edad: 10 días- 19 años) han sido tratados con 28 PTBE. La elección del tipo de prótesis ha dependido de la edad y la localización de la lesión. La colocación de la prótesis y su control posterior se efectuó en todos los casos por medio de broncoscopia. Hemos analizado los siguientes datos: el tipo patología obstructiva, PTBE seleccionada, malformaciones asociadas, las complicaciones, resultado final y el tiempo de seguimiento. Resultados. La indicación de colocación de PTBE ha sido malacia traqueal y/o bronquial en 13 pacientes (81,3%), estenosis traqueal en 2 (12,5%) y estenosis glótica en un caso (6,2%). Se han utilizado las siguientes prótesis: 15 prótesis metálicas tipo Palmaz (53,5%), 7 de silicona tipo Dumon (25%), 4 tipo Montgomery (14,5%), 1 tipo Poliflex (3,5%) y una prótesis traqueobronquial tipo Dynamic (3,5%). En siete pacientes (43,7%) se colocó más de una prótesis. Se han colocado 16 traqueales, 11 bronquiales y una carinal. Cinco pacientes presentaron complicaciones (granuloma en dos casos, migración en 2 pacientes y atelectasia en un caso) y cinco pacientes han fallecido (1 por complicaciones relacionadas con la PTBE). Hemos obtenido un buen resultado en 14 pacientes (87,5%) con un tiempo medio de seguimiento de 2 años y 10 meses (rango 2 meses-12años y 6 meses). Conclusiones. La colocación de PTBE es una alternativa terapéutica válida en pacientes seleccionados. El resultado a corto y medio plazo es satisfactorio pero la evolución a largo plazo es todavía una incógnita (AU)

Purpose. Tracheobronchial stenting can aid in the management of pediatric airway problems. We reviewed our experience to determine the role of endoscopic airway stents in children. Methods. Sixteen children (Age range: 10 days- 19 years) underwent 28 tracheobronchial stents in the period 1991-2006. The stent type chosen depended on patient age and location. All procedures were done under general anesthesia with bronchoscopy. The following features have been taken into account: etiology, obstruction diagnosis, stent type, localization,,associated anomalies, complications, results, and time of follow-up. Results. Etiology of the tracheobronchial obstruction included tracheobronchiomalacia in 13 patients (81.3%), tracheal stenosis in 2 (12.5%) and glotic stenosis in one case (6.2%). The stent used were 15 Palmaz( 53.5%), 7 Dumon (25%), 4 Montgomey (14.5%), 1 Poliflex (3.5%) and one Dynamic stent (3.5%). More than one stent were undertaken in seven cases (43.7%). 16 patients had tracheal stents, 11 children had bronchial stent and one infant a carinal stent. Five complications are reported ( two patients developed granulation tissue, two stents migrated, and a child presented a left lung atelectasis) and five patients died (only one case related to tracheobronchial stenting) Results have been satisfactory in 14 patients (87.5%) and the mean time of follow-up has been two years and ten months (range 2 months- 12 years and 6 months). Conclusions. The tracheobronchial stenting in children may represent a valid treatment option for many sick children in particular circumstances. The long-term outcome remains uncertain but the medium- term outlook is encouraging (AU)

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