[PEG versus LAP: towards a safer technique for long-term enteral nutrition]

OBJECTIVE

To compare the outcomes and complications between laparoscopic gastrostomies (LG) and percutaneous endoscopic gastrostomies (PEG).

METHODS

Retrospective review of 79 patients who had their gastrostomies inserted in our hospital (2010-2017). We compared surgical techniques, minor and major complications.

RESULTS

A total of 24 LG (14 males) and 55 PEG (29 males) were performed. The mean age was 4.77 [0.15-15.56] years for LG and 5.37 [0.12-16.58] years for PEG. The median time of presentation of complications was 59 [2-975] days. No statistical differences were found in minor complications between both techniques; however, minor complications were more frequent in LG (54.16% in LG versus 34.55% in PEG), mainly, overgranulation and peristomal leakage. A statistically significant association was found between patients with oncological comorbidity and minor complications (p<0.05).A statistically significant association was found between major complications and PEG (4.17% in LG versus 21.82% in PEG), p=0.045. The major complications were one tube dislodgement in the LG group, and 9 Buried-Bumper syndrome, one colon interposition without perforation, one colon perforation, one omentum interposition, two tube dislodgements and one small bowel perforation in PEG group.

CONCLUSIONS

Given the statistically significant association between major complications and the PEG group, being the higher frequency and severity of these complications with this technique evident; we consider the LG a safer technique. However, studies with larger number of patients and multicentric are necessary.

[Analysis of hypertrophic pyloric stenosis: size does matter]

OBJECTIVES

To analyze the correlation between pyloric size and evolution of patients surgically treated for infantile hypertrophic pyloric stenosis (IHPS).

PATIENTS AND METHODS

We realized a retrospective study of 109 patients undergoing IHPS in 5 years. We analyzed by χ2 test if a correlation between evolution time, age and postoperative vomiting and gastroesophageal reflux disease (GERD), and pyloric muscle thickness (group A > 4.5 mm and group B ≤ 4.5 mm) and pyloric channel length (group A ≥ 20 mm and group B < 20 mm) exists.

RESULTS

There is a statistically significant correlation between longer evolution history (>48 h) and pyloric length ≥ 20 mm and between age (> 30 days) and muscle thickness > 4.5 mm (p= 0.022 and p= 0.009, respectively). Also, 38.5% of 109 patients had postoperative emesis 2 days after surgery and 13.8% had GERD for a median time of 8.27 months (1-12 months), showing that there is a statistically significant correlation (p= 0.007) between pyloric channel length ≥ 20 mm and postoperative emesis. It was not observed correlation between pyloric thickness and length and GERD.

CONCLUSIONS

It has been observed that there is correlation between pyloric length ≥ 20 mm and postoperative emesis. However, it has not been observed regarding the pyloric muscle thickness. A longer preoperative evolution and age > 30 days are correlated to channel length ≥ 20 mm and muscle thickness > 4.5 mm, respectively.

[Long-term evolution of detorsion of the testes after acute scrotum]

OBJECTIVES

To assess the long-term evolution of the testicles preserved after testicular torsion (TT).

MATERIAL AND METHODS

We realized a prospective study by ultrasound of patients diagnosed TT that underwent orchidopexy. We reviewed 85 patients treated for acute scrotum (2004-2014), finding 49TT. We excluded from the study 15 perinatal torsions, 14 orchiectomies and 5 patients who refused to participate. We analyzed 15 patients, comparing testicular volumes between affected and contralateral testes, and the difference in volume between the two testes of the 15 cases with 14 control patients (Mann-Whitney U test).

RESULTS

15 patients underwent surgery at a mean age of 10,7 years, with an average time of 6 hours evolution [0,7-24]. The control ultrasound was performed at a mean age of 14,7 years, after a mean time of 47 months after the episode, finding a medium volume of the affected and contralateral testicle of 9,3 cc and 12,6 cc, respectively (p = 0,683). The median of the difference between the volumes was 0'8 cc [0,1-12,80]. In the control group, ultrasounds were performed at a mean age of 16 years, with an average volume of 6,64 cc on right testicle and 6,26 cc on the left, and median volume difference of 0,34 cc [0,05-4,59]; with no statistically significant difference (p = 0,270) between testicular volume differences of cases and controls.

CONCLUSION

Testicular orchidopexy in patients with TT with less than 6 hours of evolution does not affect the long-term testicular growth, compared with the contralateral testis growth and testes of the normal population.

[Intestinal stomas. Are they as simple as they seem?]

OBJECTIVES

To examine the morbidity and mortality of the formation and closure of enterostomies.

METHODS

Retrospective study between 2000-2014 of patients younger than 14 years old who underwent an enterostomy. We evaluated: surgical technique, underlying pathology, general and stoma complications, sex, age and weight at the time of formation. At the closure we evaluated: surgical technique, age, weight, hemoglobin, hematocrit and albumin, as well as complications.

RESULTS

We performed 120 enterostomies in 114 patients: 69 (57.5%) colostomies, 43 (35.8%) ileostomies and 8 (6.7%) yeyunostomy. The most frequent causes were: anorectal malformation (45/69), necrotizing enterocolitis (24/43) and intestinal atresia (4/8) respectively. 39 (32.5%) complications related to the stoma (colostomy 21, Ileostomy 15, Yeyunostomy 3; p= 0.845), 11 (9.2%) required surgery (colostomy 8, Ileostomy 2, Yeyunostomy 1; p= 0.439), and 17 (14.2%) general complications (colostomy 9, Ileostomy 7, Yeyunostomy 1; p= 0.884). We found a higher rate of complications requiring surgery in loop enterostomy 8/38 (21.1%), separated 3/54 (5.3%) or double-barrel 0/25 (p= 0.007). We closed 96 (80%), presenting complications in 14; yeyunostomy 4/6 (66.7%), colostomies 5/59 (8.5%), ileostomies 5/31 (16.1%) (p= 0.001). Hematocrit and hemoglobin below age average, and albumin under normal values are associated with complications when closing enterostomies (p< 0.05). Six patients (25%) who didn't went to closure died as a result of the underlying pathology and 5 (20.8%) of other causes.

CONCLUSION

The formation and closing of enterostomies remains a procedure with a high rate of complications. However, there are no clear risk factors, excepting the use of loop enterostomy and lower albumin, hemoglobin or hematocrit at the time of closure.