Complicaciones en cirugía laparoscópica renal en la edad pediátrica: análisis de nuestra experiencia y revisión de la literatura
Complications in laparoscopy renal surgery in pediatric age: Analysis of our experience and literature review
Alberto Pérez-Lanzac de Lorca
, Andrés Gómez Fraile**, Adolfo Aransay Bramtot**, Daniel Cabezalí Brabancho**, Francisco López Vázquez**, Jesús Castiñeiras Fernández*
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alblorca@yahoo.es
Dr. Alberto Pérez-Lanzac de Lorca Servicio de Urología Hospital Universitario Virgen Macarena Avda. Dr. Fedriani, 3 - 41071 Sevilla. Tel.: 955 008 265
Dr. Alberto Pérez-Lanzac de Lorca Servicio de Urología Hospital Universitario Virgen Macarena Avda. Dr. Fedriani, 3 - 41071 Sevilla. Tel.: 955 008 265
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Hospital Universitario Virgen Macarena. Sevilla, España" "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Sección de Urología Pediátrica y Servicio de Cirugía Pediátrica. Hospital Materno-Infantil 12 de Octubre. Madrid, España" "etiqueta" => "<span class="elsevierStyleSup">**</span>" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "1" "correspondencia" => "Dr. Alberto Pérez-Lanzac de Lorca Servicio de Urología Hospital Universitario Virgen Macarena Avda. Dr. Fedriani, 3 - 41071 Sevilla. Tel.: 955 008 265" ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Complications in laparoscopy renal surgery in pediatric age: Analysis of our experience and literature review" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2009-03-01" "fechaAceptado" => "2009-04-01" "PalabrasClave" => array:2 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec89012" "palabras" => array:3 [ 0 => "Laparoscopia" 1 => "Infancia" 2 => "Complicaciones" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec89011" "palabras" => array:3 [ 0 => "Laparoscopy" 1 => "Childhood" 2 => "Complications" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle">Introducción</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">El desarrollo de la cirugía mínimamente invasiva en la edad pediátrica ha sido más lento que en la edad adulta ya que sus ventajas no son tan claras. El aprendizaje y las complicaciones presentadas durante este periodo, así como el tipo de material utilizado han sido los factores que han contribuido a este hecho. Objetivo: Mostrar nuestra experiencia y las complicaciones presentadas en la cirugía laparoscópica de exéresis renal, añadiendo una revisión bibliográfica de las publicadas en esta edad hasta la fecha.</p> <span class="elsevierStyleSectionTitle">Material y Métodos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio retrospectivo de nuestros casos clínicos en que practicamos cirugía renal laparoscópica extirpativa. Encontramos 56 casos desde Enero de 2003, en que se implantó, hasta Septiembre del 2008. Hubo 36 niños (64%) y 20 niñas (36%). La edad media de intervención fue de 3,6 años. Analizamos el diagnóstico principal, la situación que condujo a la intervención así como el tipo de cirugía efectuada, vía de abordaje, tiempo utilizado, tiempo de ingreso, complicaciones y tratamiento aplicado. Los resultados se analizaron mediante el programa estadístico SPSS® (SPSSCorp, Chicago, Illinois). La revisión bibliográfica se efectuó en las bases de datos MEDLINE, EMBASE y COCHRANE. Los trabajos seleccionados fueron revisados por dos investigadores. Series que contuvieran adultos fueron excluidas.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se han efectuado 42 nefrectomías (75%), 13 heminefrectomías (23%) y 1 quistectomía (2%). En 5 casos (9%) utilizamos la retroperitoneoscopia y en 51 (91%) la vía transperitoneal. El tiempo medio quirúrgico fue de 118+/-0,75 min, para las nefrectomías, de 192+/-1,07 min., para las nefrectomías parciales, 111+/-0,64 min para las nefroureterectomías y de 240 minutos para la quistectomía. La estancia media ha sido de 3,18 (2-6) días para las nefrectomías, 5,91 (3-11) días para las nefrectomías parciales, 3 días (2-4) para las nefroureterectomías y 6 días para la quistectomía. Hemos tenido 8 complicaciones (14%): 2 reconversiones por sangrado y dificultad técnica y 6 postoperatorias (3 fueron menores, fiebre durante el postoperatorio y 3 mayores (2 Urinomas y un pseudoaneurisma, requiriendo 2 intervenciones y una colocación de catéter doble J). La evolución ha sido buena en todos los casos. En la revisión bibliográfica se seleccionaron 47 artículos con un nivel de evidencia IIIB (Oxford Centre for Evidence-based Medicine). El número de nefrectomías encontrado ha sido de 347 pacientes. Las causa más frecuente de reconversión fueron los problemas vasculares y las complicaciones variaron de ninguna hasta el 37%.</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La cirugía laparoscópica ha demostrado ser una técnica segura y fiable en el tratamiento de la patología renal benigna de la edad pediátrica con buenos resultados. Actualmente sus indicaciones se están ampliando a procesos de reconstrucción, donde muestran unos resultados prometedores, y a procesos oncológicos seleccionados.</p>" ] "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle">Introduction</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The development of the minimally invasive surgery in pediatric age has been slower than in the adult age since their advantages are not so clear. The learning curve and the complications presented during this period, as well as the type of material used has been the factors that have contributed to this fact.</p> <span class="elsevierStyleSectionTitle">Objective</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">We collected our experience and the complications presented in renal laparoscopic exegesis surgery, adding a review of the published literature to date. Materials and Methods: Retrospective study of our clinical cases in that we practiced laparoscopic renal exegesis surgery. We collected 56 cases from January 2003, when it was implanted, to September 2008. We had 36 boys (64%) and 20 girls (36%). The mean age was 3.6 years. We analyzed principal diagnosis, the situation that conducted to the surgery and the type of surgery performed, time of surgery, hospital stay and complications with their solution. The results were analyzed by the statistical program SPSS® (SPSSCorp, Chicago, Illinois). The literature review was practiced in MEDLINE, EMBASE and COCHRANE database. The selected works were reviewed by two investigators. Series containing adults were excluded.</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">We perfomed 42 nephrectomies (75%), 13 heminephrectomies (23%) and 1 quistectomy (2%). 5 cases (9%) were done by retroperitoneoscopy and 51 cases (91%) transperitoneally. The mean operative time was 118+/-0,75 min, for nephrectomies; 192+/-1,07 min, for partial nephrectomies, 111+/-0,64 for nephroureterectomies and 240 min for quistectomía. The mean hospital stay was 3.18 min (2-6) days for nephrectomies; 5.91 (3-11) days for partial nephrectomies, 3 days (2-4) for nephroureterectomies and 6 days for the quistectomy. We had 8 complications (14%): 2 conversions for bledding and technical difficulty and 6 postoperative complications (3 were minor complications, postoperative fever and 3 mayor (2 Urinomas and one pseudoaneurism, requiring 2 interventions and one catheter double J placement). The evolution has been satisfactory in all cases. In the bibliographic review 47 articles with a level of evidence IIIB were selected (Oxford Centers for Evidence-based Medicine). The main reasons to conversion to open surgery were vascular problems and the complication rate change from anyone to 37%.</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Laparoscopic surgery has proved to be a secure and feasible technique in the treatment of benign renal pathology in pediatric age with satisfactory results. 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| 2019 Septiembre | 0 | 9 | 9 |
| 2019 Agosto | 0 | 9 | 9 |
| 2019 Julio | 0 | 13 | 13 |
| 2019 Junio | 0 | 13 | 13 |
| 2019 Mayo | 0 | 44 | 44 |
| 2019 Abril | 0 | 58 | 58 |
| 2019 Marzo | 0 | 13 | 13 |
| 2019 Febrero | 0 | 7 | 7 |
| 2019 Enero | 0 | 9 | 9 |
| 2018 Diciembre | 0 | 6 | 6 |
| 2018 Noviembre | 0 | 23 | 23 |
| 2018 Octubre | 0 | 23 | 23 |
| 2018 Agosto | 0 | 12 | 12 |
| 2018 Julio | 0 | 16 | 16 |
| 2018 Junio | 0 | 2 | 2 |
| 2018 Marzo | 0 | 1 | 1 |
| 2018 Febrero | 1 | 4 | 5 |
| 2018 Enero | 6 | 3 | 9 |
| 2017 Diciembre | 5 | 4 | 9 |
| 2017 Noviembre | 6 | 10 | 16 |
| 2017 Octubre | 7 | 15 | 22 |
| 2017 Septiembre | 5 | 12 | 17 |
| 2017 Agosto | 6 | 7 | 13 |
| 2017 Julio | 10 | 5 | 15 |
| 2017 Junio | 10 | 12 | 22 |
| 2017 Mayo | 16 | 14 | 30 |
| 2017 Abril | 16 | 14 | 30 |
| 2017 Marzo | 11 | 43 | 54 |
| 2017 Febrero | 7 | 8 | 15 |
| 2017 Enero | 1 | 5 | 6 |
| 2016 Diciembre | 18 | 8 | 26 |
| 2016 Noviembre | 21 | 11 | 32 |
| 2016 Octubre | 36 | 16 | 52 |
| 2016 Septiembre | 22 | 12 | 34 |
| 2016 Agosto | 13 | 8 | 21 |
| 2016 Julio | 18 | 1 | 19 |
| 2016 Junio | 18 | 27 | 45 |
| 2016 Mayo | 27 | 42 | 69 |
| 2016 Abril | 18 | 41 | 59 |
| 2016 Marzo | 17 | 22 | 39 |
| 2016 Febrero | 12 | 25 | 37 |
| 2016 Enero | 20 | 39 | 59 |
| 2015 Diciembre | 13 | 24 | 37 |
| 2015 Noviembre | 11 | 18 | 29 |
| 2015 Octubre | 21 | 24 | 45 |
| 2015 Septiembre | 15 | 15 | 30 |
| 2015 Agosto | 12 | 6 | 18 |
| 2015 Julio | 9 | 8 | 17 |
| 2015 Junio | 5 | 6 | 11 |
| 2015 Mayo | 8 | 10 | 18 |
| 2015 Abril | 11 | 18 | 29 |
| 2015 Marzo | 15 | 20 | 35 |
| 2015 Febrero | 2 | 11 | 13 |
| 2015 Enero | 7 | 5 | 12 |
| 2014 Diciembre | 7 | 9 | 16 |
| 2014 Noviembre | 6 | 9 | 15 |
| 2014 Octubre | 13 | 3 | 16 |
| 2014 Septiembre | 12 | 3 | 15 |
| 2014 Agosto | 11 | 1 | 12 |
| 2014 Julio | 11 | 3 | 14 |
| 2014 Junio | 9 | 7 | 16 |
| 2014 Mayo | 3 | 1 | 4 |
| 2014 Abril | 2 | 5 | 7 |
| 2014 Marzo | 6 | 1 | 7 |
| 2014 Febrero | 6 | 5 | 11 |
| 2014 Enero | 6 | 2 | 8 |
| 2013 Diciembre | 8 | 3 | 11 |
| 2013 Noviembre | 11 | 9 | 20 |
| 2013 Octubre | 8 | 13 | 21 |
| 2013 Septiembre | 4 | 13 | 17 |
| 2013 Agosto | 5 | 30 | 35 |
| 2013 Julio | 4 | 3 | 7 |
| 2009 Mayo | 326 | 0 | 326 |
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