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Aim: The aim of this paper is to analyze our experience in different surgical techniques to perform a nephrectomy for benign renal diseases in children., Material and Methods: From 1993 to 2005 we have performed 98 nephrectomies. We have three groups of patients depending on the surgical technique: open nephrectomy (ON), transperitoneal laparoscopic nephrectomy (TLN) and retroperitoneal laparoscopic nephrectomy (RLN). ON was performed in 36 patients. Mean age was 3.3 years. TLN was performed in 39 patients. Mean age was 4.7 years old. RLN was performed in 23 patients. Mean age was 3.6 years old. Criteria to nephrectomy was a renographic function under 19%. We have compared the three surgical techniques in relation with surgical time and mean hospital stay., Results: Mean operative time was 126.2 minutes in ON, 132.3 minutes in TLN and 134.1 minutes in RLN. Mean stay was 5.02 days in ON, 2.35 days in TLN and 1.86 days in RLN. The median hospital stay of the ON group is significantly longer than that of NLT and NR groups (p < 0.05). However, there are no differences related to surgical time between all the groups., Conclusions: Nephrectomy may be performed for benign disease in children using less invasive surgical techniques. They are associated with minimal morbidity, minimal postoperative discomfort, improve cosmesis and a shorter hospital stay. However, we haven't found differences between TLN and RLN.

Objective: Retroperitoneal laparoscopy is well known as a surgical technique in adult patients. Its use in pediatric surgery is still-recent but, because of the good results, retroperitoncoscopy indications are getting more acceptance and widening indications. The aim of this work is to analyze our initial experience in retroperitoneal laparoscopy procedures in urological diseases at our centre., Patients and Methods: From July 2001 to February 2002 retroperitoneal laparoscopy has been used in 6 patients aged 6 months to 14 years. Surgical indications were: pyelolithotomy (lithiasis non-subsidiary to extracorporeal shock wave lithotripsy (n = 1); nephrectomy ofmulticystic dysplastic kidney (n = 4); and nephrectomy of atrophicpelvic kidney (n = 1)., Results: Mean operative time in nephrectomy has been 102 minutes, and 230 minutes in conservative surgery. All 5 patients nephrectomized were discharged 24 hours after operation with no postoperatory incidences. The patient operated on for pyelolithiasis (in which a external drainageand a pyelouretheral stent (pig-tail) was placed) remained one week until he could be discharged without drainage. The pig-tail stent was thrown out spontaneously three weeks later through the urethra. Follow up demonstrated no stenosis in this case and no complications in nephrectomy patients., Conclusion: Retroperitoneal laparoscopy is effective and safe in renal surgery and surpasses transperitoneal laparoscopy because its safety in reconstructive surgery avoiding urine leakage risk into the abdomen.

Laparoscopic is performed in adults for the treatment of benign renal diseases. It is widely accepted that laparoscopic surgery has more advantages than open surgery in many procedures such as nephrectomy, but there is no further experience in this technique. In pediatric urology laparoscopy has become an accepted approach for varicocele, non palpable testis, bladder augmentation, adrenalectomy and urinary diversion. We report our experience with 25 laparoscopic nephrectomies in children.

A six month old infant with dextrocardia, butterfly vertebrae and oesophageal atresia type I is reported. After surgical repair, she developed respiratory distress, needing ventilatory support. The bronchoscopy and bronchography demonstrated segmental tracheal stenosis. A resection of the stenotic segment was performed, and tracheal reconstruction with terminoterminal anastomosis. After a period of clinical improvement, respiratory distress came back and reestenosis was ascertained locating its level on the anastomosis. Three sessions of balloon dilation were ineffective and because that it's decided the introduction of a metallic self-expandable stent. After a transient relief, the patient had a bilateral pneumonia ending with the dead of the patient. In spite of the treatment used, it was not possible to accomplish solution in a middle or a large place. This constitutes a clear exponent of the complexity in the management of the congenital tracheal stenosis.

The short and thick bowel found in gastroschisis has been attributed to contact with amniotic fluid, among other factors. We designed an original animal model in order to isolate the effect of amniotic fluid on the fetal bowel. We created experimental gastroschisis in fetal rabbits. Extruded bowel was kept out of the amniotic sac in half of the operated fetuses. At term, seven days after surgery, 21 surviving fetuses--12 intra-amniotic (GIA) and nine extra-amniotic (GEA)--and 16 control littermates were harvested for study. Five parameters were measured in each animal: body weight, intestinal weight, intestinal length, bowel diameter and bowel wall thickness. We found no statistically significant difference in body weight, intestinal weight or bowel wall thickness. An enormous difference was found in intestinal length among the three groups. Bowel diameter was significantly different in the extreme groups (GIA and controls), with the intestine being more dilated in GIA than in GEA and controls. Gastroschisis in the absence of amniotic fluid has not been as damaging to the fetal intestine as "natural" intraamniotic gastroschisis.

Tympanometry and otoscopy has been carried out to determine the presence of middle ear disease on patients with cleft palate and the influence of corrective surgery. This explorations have been evaluated preoperatively and at one and six months postoperative follow-up. There is a high incidence of otitis media with effusion in patients with cleft palate, almost 60 per 100 in our study. The influence of cleft palate surgery repair has not revealed as a mayor factor on its resolution, although a visible benefit has been observed in the long term controls. We recommend a otorhinolaryngological follow-up in these patients.

Duration of treatment for acute leukemia is as long as 2 years. During this time, venous punctures are repeated every few days. The Port-a-Cath system allows a long-lasting but intermittent venous access. Since March 1987, 11 Port-a-Cath systems have been implanted in 11 children (age 3 to 14) with the diagnosis of high risk acute leukemia (9 ALL and 2 AML). The facial vein has been used in five instances, the external jugular vein in five, and the jugular vein in one case. Ten systems have had a good function. Seven are still in use, and the duration ranges from 450 to 47 days. Two children died because of their disease, their catheters still functioning. Two systems have been withdrawn, one for incorrected location and the other for cutaneous necrosis of the puncture site. Two more children developed reversible thrombosis. The Port-a-Cath system is useful in children affected by high risk acute leukemia, ameliorating their life quality and avoiding the need for repeated vein punctures.