Catálogo de publicaciones - libros

The objective of pyeloplasty is to achieve a dependent, adequate calibrated watertight pelvi-ureteric junction. There are different techniques available to repair a PUJ obstruction. The dismembered Anderson-Hynes pyeloplasty is suitable for the majority of patients with PUJ obstruction. Use of double-J ureteral stents has virtually eliminated ureteral leaks and early obstructions.

Operative treatment of Crohn’s disease is aimed at management of complications of the disease that are refractory to medical treatment. Although permanent cure cannot be expected following surgery, many patients resume longer periods of full remission with a normal lifestyle. Proper surgical treatment in selected patients can also decrease or even abolish the need for immunosupressive and potentially harmful medication for months and years.

Perianal manifestations of Crohn’s disease are very common in children. These include skin tags, fissures and fistulas. In most cases perianal manifestations cause mild symptoms or are asymptomatic. conservative approach is warranted and surgical treatment should be considered only in severely symptomatic high rectoperineal or rectovaginal fistulas that do not respond to infliximab or increased immunosuppressive therapy. If surgery is required for a high perianal fistula resection of the mostly diseased usually left colonic segment and temporary bowel diversion may increase the success rate of the fistula repair. In very severe perianal disease, especially if it is associated with severe rectal manifestation, proctectomy may be the only possibility to guarantee a reasonable quality of life.

Between 1953 and 2001, a total of 321 patients with biliary atresia underwent surgery in our hospital. Among them, 43 patients underwent double-valved hepatic portoenterostomy (the valved procedure). Bile drainage after surgery was obtained in 95% of the cases. The incidence of post-operative cholangitis was 56% in the valved procedure. Of the cases treated by this procedure, 49% are still alive without jaundice after hepatic portoenterostomy alone, and 30% are alive after subsequent liver transplantation.

The combination of hepatic portoenterostomy with subsequent liver transplantation is the treatment of choice for patients with biliary atresia. It is important, however, to attempt to keep the patient’s own organ by continuing efforts to achieve the best possible results with hepatic portoenterostomy.

The authors’ current strategy for surgical treatment for patients with this disease include (1) early diagnosis, including prenatal diagnosis, (2) hepatic portoenterostomy without stoma formation, (3) close postoperative care, especially for prevention of postoperative cholangitis, (4) revision of hepatic portoenterosotmy only in selected cases who showed good bile drainage after the first procedure, (5) early liver transplantation in patients with absolutely failed hepatic portoenterostomy, (6) avoidance of laparotomy for the treatment of oesophageal varices and hypersplenism (injection sclerotherpy and splenic artery embolization), and (7) consideration of exploratory laparotomy or primary liver transplantation for patients with advanced liver disease at the time of referral.

We have performed a total of 92 Roux-en-Y hepaticojejunostomy (70 end-to-end anastomoses and 22 end-to-side anastomoses) using our cyst excision technique with intra-operative endoscopy, according to our recommendations for the procedure, and all patients are well without any complications after a mean follow-up period of 8.0 years (range 9 months to 16 years).

Cyst excision and Roux-en-Y hepatico-jejunostomy is the treatment of choice in both children and adults with choledochal cyst. Intra-operative endoscopy at the time of cyst excision is useful to prevent post-operative complications, especially those that develop in over time. Roux-en-Y hepatico-jejunostomy in children is different from that in adults, since the Roux-en-Y limb or blind pouch can grow and elongate as the child grows.

Our techniques for cyst excision and biliary reconstruction effectively prevent post-operative complications, and we recommend their use in children with choledochal cyst.

Duplication of the renal pelvis and ureters is the commonest anomaly of the upper urinary tract. It occurs in approximately 0.8% of the population and in 1.8–4.2% of pyelograms. Commonly these are asymptomatic. However, they can challenge the diagnostic acumen with a wide variety of manifestations.

Intra-operative haemorrhage should not occur and the most frequently encountered problem is trauma to the bile duct. The duct may be injured only in the near-total resections — incidence of 12%. The injury can occur intra-operatively and, if detected, repaired immediately by direct suture or by choledochoduodenostomy. Late stricture from ischaemia can occur weeks to months post-operatively and these too require drainage by choledocho-enterostomy. Other complications include wound sepsis, adhesion intestinal obstruction and prolonged ileus. The long-term requirements for insulin therapy and exocrine pancreatic replacement need to be carefully assessed.

The objective of pyeloplasty is to achieve a dependent, adequate calibrated watertight pelvi-ureteric junction. There are different techniques available to repair a PUJ obstruction. The dismembered Anderson-Hynes pyeloplasty is suitable for the majority of patients with PUJ obstruction. Use of double-J ureteral stents has virtually eliminated ureteral leaks and early obstructions.

The objective of pyeloplasty is to achieve a dependent, adequate calibrated watertight pelvi-ureteric junction. There are different techniques available to repair a PUJ obstruction. The dismembered Anderson-Hynes pyeloplasty is suitable for the majority of patients with PUJ obstruction. Use of double-J ureteral stents has virtually eliminated ureteral leaks and early obstructions.

The vast majority of patients treated with any one of the standard pull-through procedures achieve satisfactory continence and function with time. The attainment of normal continence is dependent on the intensity of bowel training, social background and respective intelligence of patients. Mental handicap, including Down syndrome, is invariably associated with long-term incontinence.

The vast majority of patients treated with any one of the standard pull-through procedures achieve satisfactory continence and function with time. The attainment of normal continence is dependent on the intensity of bowel training, social background and respective intelligence of patients. Mental handicap, including Down syndrome, is invariably associated with long-term incontinence.