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Jimenez-Gomez J, Güizzo JR, Betancourth Alvarenga J, Santiago Martínez S, Gaspar Perez M, Pina Perez S, Beltrán VP, Loverdos I, Esteva Miró C, Jimenez Arribas P, Sanchez Vazquez B, San Vicente Vela B, Álvarez García N, Nuñez García B. Correlation of Prenatal and Postnatal Diagnosis in Umbilical-Portal-Systemic Venous Shunts. Eur J Pediatr Surg 2023; 33:90-95. [PMID: 36610389 DOI: 10.1055/s-0042-1760379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Umbilical-portal-systemic venous shunts (UPSVS) are rare anomalies in the development of the fetal venous system. There are several postnatal and prenatal classifications of hepatic venous anomalies but the link between them is missing. We aimed to review the prenatal to postnatal diagnosis correlation in UPSVS at our center. METHODS It is a retrospective study of patients diagnosed with UPSVS between 2019 and 2021 at our institution. Demographic, obstetric, genetic, and neonatal data were reviewed with special focus on prenatal and postnatal ultrasounds. RESULTS A total of seven patients were diagnosed with UPSVS at a median of 24 (20-34) weeks of gestational age. All patients were male and 62% were Caucasian. None of the patients had chromosomopathies or cardiac anomalies. One patient had renal ectopia, another one had a single umbilical artery, and a third one suffered from intrauterine growth retardation. An umbilico-systemic shunt (USS) was found in two patients and a ductus venosus-systemic shunt (DVSS) in the rest. Patients with USS were diagnosed postnatally with intrahepatic portosystemic shunts. One of the DVSS patients was transferred to another hospital and the other four had normal postnatal cardiac ultrasounds, with normal abdominal ultrasounds in two patients and lack of postnatally abdominal control in the other two. All babies were found to be doing well at a median follow-up of 1 month (0-24). CONCLUSION There is a knowledge gap in the natural history of UPSVS between fetal and neonatal life. Building bridges between prenatal and postnatal research is mandatory in order to understand these rare anomalies.
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Affiliation(s)
- Javier Jimenez-Gomez
- Department of Pediatric Surgery, Hospital de Sabadell, Sabadell, Barcelona, Spain
| | | | | | | | - Mireia Gaspar Perez
- Department of Pediatric Surgery, Hospital de Sabadell, Sabadell, Barcelona, Spain
| | - Silvia Pina Perez
- Department of Obstetrics and Gynecology, Hospital de Sabadell, Sabadell, Barcelona, Spain
| | | | - Inés Loverdos
- Deparment of Pediatrics, Hospital de Sabadell, Sabadell, Barcelona, Spain
| | - Clara Esteva Miró
- Department of Pediatric Surgery, Hospital de Sabadell, Sabadell, Barcelona, Spain
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Betancourth Alvarenga JE, Santiago Martínez S, Jiménez Gómez SJ, San Vicente Vela MB, Gaspar Pérez M, Álvarez García N, Güizzo JR, Jiménez Arribas P, Esteva Miró C, Núñez García B. Management of splenic and/or hepatic pseudoaneurysm following abdominal trauma in pediatric patients. Cir Pediatr 2022; 35:80-84. [PMID: 35485756 DOI: 10.54847/cp.2022.02.16] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Splenic and hepatic pseudoaneurysm (PA) is a rare arteriovenous injury that may occur following abdominal trauma. The most frequent complication of PA is late rupture, which can lead to hemodynamic instability. The objective of this study was to describe our experience in the management of visceral PA. MATERIAL AND METHODS A retrospective study of patients under 15 years of age with blunt abdominal trauma associated with splenic and/or hepatic injury treated from 2012 to 2020 was carried out. PA formation and management were analyzed. All patients underwent CT-scan, which allowed trauma grade to be established, and also control contrast-enhanced ultrasonography (CEUS) in the first week following trauma. If PA was confirmed, angiography ± percutaneous embolization were performed. RESULTS A total of 32 patients with blunt trauma were included. Mean age was 8.7 ± 3.2 years (2-15 years). 68.7% (n = 22) of patients were male. Median trauma grade was grade III (grades II-IV). 33.3% (n = 5/15) of patients developed splenic PA, and 5.8% (n = 1/17) of patients developed hepatic PA, with mean diagnostic time being 3.7 ± 3 (3-8) days. PA formation was associated with higher severity scores, with a mean difference of 15.6 ± 5.3 (95% CI: 4.37:26.14 p < 0.008). All PA cases - except for one, which required urgent splenectomy - were treated with embolization (85.7%) (n = 5/6). CONCLUSION Visceral PA is underdiagnosed, with an incidence higher than reported. Imaging studies (CEUS) are required prior to discharge in the presence of severe trauma. Treatment remains controversial, but we recommend percutaneous embolization, with splenectomy being reserved for unstable patients.
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Affiliation(s)
- J E Betancourth Alvarenga
- Pediatric Surgery Department. Parc Taulí Healthcare Corporation Consortium. Sabadell, Barcelona (Spain)
| | - S Santiago Martínez
- Pediatric Surgery Department. Parc Taulí Healthcare Corporation Consortium. Sabadell, Barcelona (Spain)
| | - S J Jiménez Gómez
- Pediatric Surgery Department. Parc Taulí Healthcare Corporation Consortium. Sabadell, Barcelona (Spain)
| | - M B San Vicente Vela
- Pediatric Surgery Department. Parc Taulí Healthcare Corporation Consortium. Sabadell, Barcelona (Spain)
| | - M Gaspar Pérez
- Pediatric Surgery Department. Parc Taulí Healthcare Corporation Consortium. Sabadell, Barcelona (Spain)
| | - N Álvarez García
- Pediatric Surgery Department. Parc Taulí Healthcare Corporation Consortium. Sabadell, Barcelona (Spain)
| | - J R Güizzo
- Pediatric Surgery Department. Parc Taulí Healthcare Corporation Consortium. Sabadell, Barcelona (Spain)
| | - P Jiménez Arribas
- Pediatric Surgery Department. Parc Taulí Healthcare Corporation Consortium. Sabadell, Barcelona (Spain)
| | - C Esteva Miró
- Pediatric Surgery Department. Parc Taulí Healthcare Corporation Consortium. Sabadell, Barcelona (Spain)
| | - B Núñez García
- Pediatric Surgery Department. Parc Taulí Healthcare Corporation Consortium. Sabadell, Barcelona (Spain)
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Núñez García B, Álvarez García N, Aquino-Esperanza J, Esteva Miró C, Pérez-Gaspar M, Jiménez Gómez J, Betancourth Alvarenga JE, Santiago Martínez S, Jiménez-Arribas P, Güizzo JR. Efficacy and Safety of Taulinoplasty Compared with the Minimally Invasive Repair of Pectus Excavatum Approach to Correct Pectus Excavatum. J Laparoendosc Adv Surg Tech A 2021; 31:1402-1407. [PMID: 34847730 DOI: 10.1089/lap.2021.0216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Background: Minimally invasive repair of pectus excavatum (MIRPE) technique is the current most used surgical method for pectus excavatum (PE) correction. To avoid MIRPE-required invasion of the mediastinum or pleural cavity, we developed taulinoplasty approach as an alternative option for the reduction of the sunken chest. Materials and Methods: This is a single-center unblind nonrandomized prospective pilot study, involving 26 MIRPE and 23 taulinoplasty patients. The primary safety endpoint was the presence of surgical complications, and the primary efficacy endpoint was Haller index measured postoperatively in taulinoplasty patients. Secondary endpoints were intensive care unit (ICU) and hospital length of stay (LOS), duration of surgical procedure, and postoperative pain management. Chi-square, Mann-Whitney, or Student "t" tests were used for comparison as appropriate. Results: There were no difference in median age (14.5 and 14 years), Haller index (4.63 and 4.17), or comorbidities. MIRPE and taulinoplasty procedures showed no difference regarding major or minor surgical complications. The efficacy endpoint of taulinoplasty was measured 5.5 (1.5-12) months after the procedure, exhibiting a significant reduction in the Haller index [4.17 (3.7-4.7) at baseline and 3.7 (2.9-4.1) postoperatively, P = .03]. Taulinoplasty required less surgical time (60.4 ± 15.5 versus 70.7 ± 15.9 minutes, P < .01); shorter ICU and hospital LOS (P < .01, respectively); and required fewer days of peridural, intravenous, and oral analgesia (P < .01, respectively). Conclusions: In this pilot study, taulinoplasty technique was as safe as the MIRPE approach and effective for the correction of PE, reducing surgical time, ICU and hospital LOS, and achieving better postoperative pain control.
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Affiliation(s)
| | | | - José Aquino-Esperanza
- Institut d'Investigació i Innovació Parc Taulí I3PT, Sabadell, Spain.,CIBERES, Instituto de Salud Carlos III, Madrid, Spain.,Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain
| | - Clara Esteva Miró
- Department of Pediatric Surgery, Parc Taulí University Hospital, Sabadell, Spain
| | - Mireia Pérez-Gaspar
- Department of Pediatric Surgery, Parc Taulí University Hospital, Sabadell, Spain
| | - Javier Jiménez Gómez
- Department of Pediatric Surgery, Parc Taulí University Hospital, Sabadell, Spain
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Gaspar Pérez M, Núñez García B, Álvarez García N, Fillat-Gomà F, Coderch-Navarro S, Monill-Raya N, Esteva Miró C, Betancourth Alvarenga JE, Jiménez Gómez J, Santiago Martínez S, San Vicente Vela B, Jiménez-Arribas P, Güizzo JR. Initial experience with 3D printing in the use of customized Nuss bars in pectus excavatum surgery. Cir Pediatr 2021; 34:186-190. [PMID: 34606698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Pectus excavatum (PE) surgical repair according to Nuss procedure is based on the intrathoracic insertion of one (or more) metallic bars for anatomical defect repair. Number of bars, bar length, bar shape, and thoracic insertion site are established during surgery, according to patient morphology, CT-scan, and especially the surgeon's experience. OBJECTIVE To assess the usefulness of the design, simulation, and 3D printing of customized Nuss bars for each patient. MATERIAL AND METHODS A prospective descriptive study of all patients undergoing PE surgery under 3D printing from June to December 2019 was carried out. Curvature, bar length, and optimal intercostal space were designed based on diagnostic CT-scan, and they were 3D printed full size. The resulting model was reproduced preoperatively on the usual prosthetic material, sterilized, and kept until surgery. RESULTS The study cohort consisted of 6 patients. Median age was 15 years old (interquartile range: 14.25-15.25), median Haller index was 4.05 (interquartile range: 3.5-4.49), and repair index was 36.98% (interquartile range: 33.86-38.48%). A Nuss bar was introduced in all cases, without requiring removal or re-insertion. Median operating time was 79.5 minutes (interquartile range: 72.5-103). No postoperative complications were noted during follow-up (12 months). CONCLUSIONS The preoperative design of Nuss bars with customized shape and size facilitates surgical planning. It also allows for the most optimal and accurate morphological repair possible, according to patient anatomy, thus reducing the risk of requiring removal and/or re-insertion, and therefore, of surgical complications.
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Affiliation(s)
- M Gaspar Pérez
- Pediatric Surgery Department. Parc Taulí University Hospital, Sabadell. Barcelona (Spain)
| | - B Núñez García
- Pediatric Surgery Department. Parc Taulí University Hospital, Sabadell. Barcelona (Spain)
| | - N Álvarez García
- Pediatric Surgery Department. Parc Taulí University Hospital, Sabadell. Barcelona (Spain)
| | - F Fillat-Gomà
- 3D Surgical Planning Lab. Parc Taulí University Hospital. Parc Taulí Research and Innovation Institute (I3PT). Universitat Autònoma de Barcelona, Sabadell, Barcelona (Spain)
| | - S Coderch-Navarro
- 3D Surgical Planning Lab. Parc Taulí University Hospital. Parc Taulí Research and Innovation Institute (I3PT). Universitat Autònoma de Barcelona, Sabadell, Barcelona (Spain)
| | - N Monill-Raya
- 3D Surgical Planning Lab. Parc Taulí University Hospital. Parc Taulí Research and Innovation Institute (I3PT). Universitat Autònoma de Barcelona, Sabadell, Barcelona (Spain)
| | - C Esteva Miró
- Pediatric Surgery Department. Parc Taulí University Hospital, Sabadell. Barcelona (Spain)
| | | | - J Jiménez Gómez
- Pediatric Surgery Department. Parc Taulí University Hospital, Sabadell. Barcelona (Spain)
| | - S Santiago Martínez
- Pediatric Surgery Department. Parc Taulí University Hospital, Sabadell. Barcelona (Spain)
| | - B San Vicente Vela
- Pediatric Surgery Department. Parc Taulí University Hospital, Sabadell. Barcelona (Spain)
| | - P Jiménez-Arribas
- Pediatric Surgery Department. Parc Taulí University Hospital, Sabadell. Barcelona (Spain)
| | - J R Güizzo
- Pediatric Surgery Department. Parc Taulí University Hospital, Sabadell. Barcelona (Spain)
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Núñez García B, Álvarez García N, Jiménez Gómez J, Betancourth Alvarenga JE, Esteva Miró C, Santiago Martínez S, Jiménez Arribas P, Güizzo JR. IMPACT OF COVID-19 ON PEDIATRIC SURGERY. Br J Surg 2021. [PMCID: PMC8194788 DOI: 10.1093/bjs/znab160.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION The pandemic caused by the SARS-CoV-2 virus has led to an unprecedented situation, with population lockdowns, congestion of healthcare resources, cancellation of scheduled surgical activity, fear of contagion, and delays in patient care. The objective of this study was to analyze its impact on pediatric surgical activity at a reference healthcare facility. MATERIAL AND METHODS A comparative study of activity in the pediatric surgery environment at a Spanish reference healthcare facility was carried out. It included outpatient consultations, scheduled surgeries, and activity at the emergency department during the lockdown period in Spain (March-May 2020) vs. the same 2019 period. Number of consultations and surgeries, type of surgery performed and/or cancelled, and stage of the pathologies treated were collected. RESULTS A 98% decrease in scheduled surgeries, an 84% decrease in healthcare burden from the pediatric emergency department, a 55.24% decrease in urgent surgeries, an 82% decrease in outpatient activity at external consultations, and a 94% decrease in inter-hospital referrals, along with a 66% increase in urgent pathology severity, were found. CONCLUSIONS The COVID-19 pandemic cancelled virtually all pediatric surgery activity, which caused treatment delays in severe pathologies and increased morbidity in regular urgent procedures.
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Affiliation(s)
- B Núñez García
- Corporación Sanitaria y Universitaria Parc Taulí Sabadell (Barcelona)
| | - N Álvarez García
- Corporación Sanitaria y Universitaria Parc Taulí Sabadell (Barcelona)
| | - J Jiménez Gómez
- Corporación Sanitaria y Universitaria Parc Taulí Sabadell (Barcelona)
| | | | - C Esteva Miró
- Corporación Sanitaria y Universitaria Parc Taulí Sabadell (Barcelona)
| | | | - P Jiménez Arribas
- Corporación Sanitaria y Universitaria Parc Taulí Sabadell (Barcelona)
| | - J R Güizzo
- Corporación Sanitaria y Universitaria Parc Taulí Sabadell (Barcelona)
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