No abstract

No abstract

Introduction In recent years, pain protocols for pectus excavatum (PE) have incorporated cryoanalgesia through thoracoscopic approach. Since 2019, ultrasound-guided percutaneous cryoanalgesia (PCr) has been applied at our institution, either on the same day as the Nuss procedure or 48 hours before surgery. We carried out a preliminary retrospective review of patients with PE in whom PCr prior to surgery was performed at our institution between 2019 and 2021. Materials and Methods Two groups were evaluated: PCr on the same day (PCrSD) and PCr 48 hours before surgery (PCr48). Despite PCr, patients were treated with “patient-controlled analgesia” (PCA) with opioids for at least 24 hours, switching to conventional intravenous analgesia and oral analgesia in the following days. Demographic, clinical-radiological variables, PCA opioid use, pain grade according to the visual analog scale (VAS), and length of stay (LOS) were compared between the groups. A total of 20 patients were included (12 with PCrSD and 8 with PCr48), without significant differences in demographics or clinical-radiological variables. The overall median time of PCr was 65 minutes (55–127), with no differences between the groups. Results PCr48 group presented with significantly lower median number of hours of continuous PCA (24 vs. 32 hours; p = 0.031), lower median number of rescue boluses (11 vs. 18; p = 0.042), lower median VAS in the early postoperative hours (2 vs. 5.5; p = 0.043), and lower median LOS (3.5 vs. 5 days). Conclusion PCr performed 48 hours prior to surgery is more effective in terms of PCA requirements, VAS, and LOS when compared with cryoanalgesia on the same day.

No abstract

No abstract

We describe the unusual case of a female patient with a history of two mature teratomas non-correlated in terms of location and occurrence. A 12-year-old girl presented at our consultation as a result of a growing tumor in the hypogastric region, with no further clinical signs. She had undergone surgery neonatally due to a mature cystic sacrococcygeal teratoma, which was fully removed. No clinical sequelae were noted and no additional treatment was required over a 10-year follow-up. Radiological examination showed a large 20 × 12 × 18 cm cystic mass extending from the pelvic region to the lower hemiabdomen, associated with two similar small formations adjacent to the right ovary. Tumor markers were negative, and a laparoscopic right salpingoophorectomy was carried out, with an excellent postoperative progression. Pathological examination revealed it was, again, a mature cystic teratoma. The genetic study ruled out causation in this respect.

Introduction: After pediatric left lateral segment (LLS) liver transplantation for small children, primary abdominal wall closure may not be possible or not recommended. Reduction of the graft, using a monosegment graft or deferred wall abdominal closure are possible alternatives. We describe our results with sequential abdominal closure (SAC) with polytetra-fluoroethylene mesh in pediatric LLS recipients. Method: Retrospective review of patients who received LLS and CAS with polytetra-fluoroethylene mesh between 2010 and 2021. The mesh was placed and fixed with continuous polypropylene suture to the wall on both sides of the incision. Mesh flap approaches were performed in the PICU under sedation, with ultrasound control before and after, without requiring intubation. The mesh was removed in the operating room under general anesthesia after complete approximation of the flaps. The data were recorded from the patients' medical records after approval by the ethics committee. Results: Of 198 who received an LLS, 86 (43.4%) required a SAC. Mean age was 2±3.1 years and mean weight 9.2±5.4 Kg. LLS was obtained from living donors (54.6%) and split (45.4%) with a mean graft weight of 324.1 grams. The graft weight/recipient weight ratio was 3.9±1.4%. The mesh was removed after 8.2±3.4 days, requiring 3.2±1.6 sequential approaches per patient. Six surgical wound infections and five wound dehiscence during the process were recorded. No systemic infection related to the mesh or compartment syndrome occurred. The mesh was directly removed in 81.4%, while 18.6% were reoperated for complications (vascular, biliary or intestinal) prior to its removal. After definitive closure, one (1.2%) patient had partial dehiscence and six (7%) suffered surgical wound infections. No grafts were lost due to sac procedure-related causes. The median follow-up time was 53 (15-84.3) months. Conclusion: SAC with polytetra-fluoroethylene mesh offers a reproducible and safe solution for difficult or not advisable abdominal closure after pediatric liver transplantation of LLS. The presence of the mesh during the immediate postoperative period represents an advantage for the review of the graft status and possible complications in the immediate postoperative period. Hyper-reduction of the graft or the use of a monosegment could be avoided in most cases.

Objective. To describe a basic training program in microsurgery and to analyze the learning curve through the process, including improvement in operating times and functional outcome.Materials and methods. Our learning program included basic, transitional, and experimental models. The experimental model included tail vein cannulation, intestinal resection and anastomosis, dissection, division and anastomosis of the cava and aorta. Wistar rats (66.7% male; 406.9 ± 38.9 grams) were used. The program adhered to the 3R principle and obtained animal welfare committee approval.Results. Mean tail vein cannulation time was 2.4 ± 1.2 minutes. Mean intestinal resection and jejunocolic anastomosis time was 14.8 ± 2.7 minutes and 10.4 ± 3 minutes, respectively. All anastomoses were functionally valid. Mean vessel dissection time was 22.9 ± 7.7 minutes, aortic artery anastomosis was 17.2 ± 7.1 minutes, and vena cava anastomosis was 25.9 ± 7.3 minutes. 66.7% of vena cava anastomoses were functionally valid vs. 88.9% for the aorta. The time required for all procedures decreased after the third attempt, except for vena cava anastomoses, which remained similar in all 9 procedures. Conclusions. Our model demonstrated that the procedures were suitable for trainer progression in terms of surgical time and functional outcome. Microsurgical training would benefit from standardized programs to optimize results.