Ana Lain - Academia.edu (original) (raw)

Papers by Ana Lain

Frontiers in Pediatrics, Dec 4, 2017

The purpose of this study is to describe the development of an external 3dimensional (3D) scanner... more The purpose of this study is to describe the development of an external 3dimensional (3D) scanner as a noninvasive method for imaging chest wall deformities. It allows objective assessment, reconstruction of the area of interest, and evaluation of the severity of the deformity by using external indexes. external 3D scanning system: The OrtenBodyOne scanner (Orten, Lyon, France) uses depth sensors to scan the entire 3D external body surface of a patient. The depth sensors combine structured light with two classic computer vision techniques: depth from focus and depth from stereo. The data acquired are processed and analyzed using the Orten-Clinic software. Materials and methods: To investigate the performance of the device, a preliminary prospective study (January 2015-March 2016) was carried out in patients attending our hospital chest wall deformities unit. In total, 100 patients (children and young adults) with pectus excavatum or pectus carinatum, treated by surgery or non-operative methods were included. In patients undergoing non-operative treatment, external 3D scanning was performed monthly until complete correction was achieved. In surgically treated patients, scanning was done before and after surgical correction. In 42 patients, computed tomography (CT) was additionally performed and correlations between the Haller index calculated by CT and the external Haller index using external scanning were investigated using a Student's test (r = 0.83). conclusion: External scanning is an effective, objective, radiation-free means to diagnose and follow-up patients with chest wall deformities. Externally measured indexes can be used to evaluate the severity of these conditions and the treatment outcomes.

Journal of pediatric endoscopic surgery, Feb 28, 2020

Aim To describe our initial experience in laparoscopic-assisted gastric pull-up via posterior med... more Aim To describe our initial experience in laparoscopic-assisted gastric pull-up via posterior mediastinal route in comparison with our historic experience performed by open laparotomy gastric pull-up via retrosternal route. The results of the two approaches were evaluated in this study. Materials and methods Between 2000 and 2017, we conducted a retrospective review of all patients that had undergone gastric transposition for esophageal atresia (EA) and long caustic strictures when preservation of the native esophagus was not possible. Results A total of 17 pediatric patients underwent gastric pull-up transposition as esophageal replacement technique. The patients were divided into two groups. Group A (2000-2015) consisted of 11 patients that underwent open laparotomy gastric pull-up via the retrosternal route. Three Group A patients had EA Type I, two had EA Type II, five had EA Type III, and one long caustic stricture. Associated anomalies included VACTERL association in two cases, Down syndrome in one case and intestinal malrotation in one case. The mean age at surgery was 2.2 years and the mean follow-up was 9.3 years. All patients were able to achieve oral feeds. Group B (2016-2018) consisted of six patients that underwent laparoscopic-assisted gastric transposition via posterior mediastinal pathway. Three had EA Type I, two had EA Type III, and one had a long caustic esophageal stricture. Associated anomalies included a single case of VACTERL association. Previous surgeries included two thoracotomies and two esophagostomies in patients with EA/TEF and one gastro-jejunal anastomosis in a patient with pyloric total disconnection after pyloric balloon dilatation for caustic esophageal and pyloric stricture. All patients underwent gastrostomy. Laparoscopic procedure was successfully completed in all patients without conversion. The mean follow-up in Group B was 27 months. All patients were able to establish oral feeds. Conclusion Laparoscopic-assisted gastric pull-up as esophageal replacement technique is safe and has few complications. Slight modifications of the technique such as pyloric dilation reduce laparoscopic surgical time.

European Journal of Pediatric Surgery, Nov 3, 2015

Introduction We describe a two-port laparoscopic technique to create a colostomy in the descendin... more Introduction We describe a two-port laparoscopic technique to create a colostomy in the descending colon with separated stomas for newborns with anorectal malformations. Material and Methods Six patients with an anorectal malformation underwent this procedure in the early-neonatal period. The surgical technique was performed with two ports, which allows for an accurate inspection of the abdominal contents. The first loop of the sigmoid colon is grasped through the first port and exteriorized while the attachments to the left retroperitoneum and direction of the loop are checked with the scope introduced in the second port. The division of the colon is performed extracorporally, the colon irrigated of meconium, and the distal colon moved to the second port incision. Both stomas are then fixed to the abdominal wall. Results The time of the procedure ranged from 50 to 90 minutes. A Mullerian duplication was noted in one case. Oral intake was started during the first 12 to 24 hours. No complications were seen during or after the procedure. Conclusions This technique allows for the precise localization of the colostomy with direct visualization, provides for the inspection of the internal genitalia, eliminates the incision between the two stomas and its complications, allows for painless stoma bag changes immediately after surgery, avoids twisting of the colostomy, and permits a cosmetically pleasing incision at the colostomy closure.

Journal of Laparoendoscopic & Advanced Surgical Techniques, Aug 1, 2020

Introduction: Thoracic surgery in children with coronavirus disease-19 (COVID-19) pulmonary disea... more Introduction: Thoracic surgery in children with coronavirus disease-19 (COVID-19) pulmonary disease is rare, as very limited virus-related lung lesions require intervention. However, some patients may suffer from other pulmonary abnormalities that can be worsened by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and they may consequently require lung surgery. COVID-19 affects the indications, surgical procedure, and postsurgical care of these patients. Background: We present a case of a 14-year-old girl with COVID-19 pulmonary disease and persistent air leak due to right apical bullae that required resection. Clinical, surgical, and safety implications are discussed. The role of thoracic minimally invasive surgery under COVID-19 conditions is also analyzed. Materials and Methods: The thoracoscopic procedure was scheduled earlier than normally expected. The surgery was performed in a COVID-19 reserved theatre with neutral pressure and only the necessary personnel was allowed inside. The use of the required personal protective equipment was supervised by an expert nurse before and after the intervention. Results: The surgeons used a three-port technique to resect the bullae with an endostapler and no mechanical pleural abrasion was added to the procedure. Electrocautery and CO2 insufflation were avoided, and a chest drain with a closed-circuit aspiration system was installed before removing the ports. The child was discharged home 3 days later after the removal of the chest drain. Conclusions: COVID-19 has an impact on the standard indications, surgical strategies and postoperative care of some conditions requiring intervention. Extra safety measures are needed in the operating room to limit the chance of transmission. Minimally invasive surgery for thoracic surgery remains safe if the current safety guidelines are followed closely.

Archives of Clinical and Medical Case Reports, 2021

Background/Purpose: The standard neonatal approach for a male newborn with an anorectal malformat... more Background/Purpose: The standard neonatal approach for a male newborn with an anorectal malformation (ARM) and no perineal fistula remains the opening of a diverting colostomy. Here we describe radiological improvements in

Frontiers in pediatrics, 2017

The purpose of this study is to describe the development of an external 3-dimensional (3D) scanne... more The purpose of this study is to describe the development of an external 3-dimensional (3D) scanner as a noninvasive method for imaging chest wall deformities. It allows objective assessment, reconstruction of the area of interest, and evaluation of the severity of the deformity by using external indexes. The OrtenBodyOne scanner (Orten, Lyon, France) uses depth sensors to scan the entire 3D external body surface of a patient. The depth sensors combine structured light with two classic computer vision techniques: depth from focus and depth from stereo. The data acquired are processed and analyzed using the Orten-Clinic software. To investigate the performance of the device, a preliminary prospective study (January 2015-March 2016) was carried out in patients attending our hospital chest wall deformities unit. In total, 100 patients (children and young adults) with pectus excavatum or pectus carinatum, treated by surgery or non-operative methods were included. In patients undergoing n...

European Journal of Pediatric Surgery, 2015

Anales de Pediatría, 2007

Analizar las causas de estridor en lactantes y qué tratamientos precisan. Material y métodos Un t... more Analizar las causas de estridor en lactantes y qué tratamientos precisan. Material y métodos Un total de 90 pacientes menores de un año con estridor (93,06 ؎ 82,4 días). Todos los pacientes fueron diagnosticados mediante fibrobroncoscopia. Resultados Un total de 33 pacientes provenían de las unidades de cuidados intensivos (UCI) pediátrica o neonatológica, 22 de la consulta de cirugía/pediatría y 26 de otros centros. Los diagnósticos fueron: 21 casos estenosis subglótica, 20 traqueobroncomalacia, 20 laringomalacias, 16 estenosis traqueales, cinco hemangiolinfangiomas cervicales, cuatro parálisis de cuerda vocal y tres edema de glotis. Requirieron tratamiento quirúrgico 46 casos (51,1 %): 14 por patologías funcionales y 32 por alteraciones anatómicas. Necesitaron reintervención 6 casos: cinco estenosis subglóticas y uno estenosis traqueal. El resultado fue bueno o muy bueno en 75 pacientes (83,4 %) y regular o malo en 8 pacientes (8,8 %). Fallecieron 7 pacientes (7,8 %), cuatro de ellos a causa de su cardiopatía congénita asociada, uno por sepsis fulminante, uno por neumonía y uno por dehiscencia de sutura en traqueoplastia anterior. Conclusión Según nuestros resultados, debería valorarse el estudio mediante fibrobroncoscopia en aquellos lactantes con estridor, ya que puede subyacer patología que requerirá tratamiento quirúrgico. La gravedad del estridor no siempre se correlaciona con la de la lesión. Existe patología potencialmente letal que requerirá un tratamiento precoz.

Journal of Pediatric Surgery, May 1, 2021

Objectives: Cardiac compression in pectus excavatum remains difficult to evaluate. We describe th... more Objectives: Cardiac compression in pectus excavatum remains difficult to evaluate. We describe the findings with intraoperative transesophageal echocardiography during pectus excavatum correction in pediatric patients. Methods: We studied right heart changes during surgical correction of pectus excavatum by transesophageal echocardiograph. Four-D echo was associated to assess morphology of the tricuspid annulus. Results: Twenty patients were included, mean age 13.5 (+/− 2.9). Mean preoperative Haller Index was 6.3 (+/− 2.63) and mean Correction Index 47.63% (+/− 12.4%). Preoperative transthoracic echocardiography at rest showed mild right heart compression in 6. Correction was gained by Nuss technique in 19, and Taulinoplasty in one. Initial transesophageal echocardiography showed compression of the right heart and deformation of the tricuspid annulus in all. During the sternal elevation, diameters of right atrium, ventricle and tricuspid annulus significantly improved: mean augmentation of right ventricle was 5.78 mm (+/− 3.56 p b 0.05), right atrium 6.64 mm (+/− 5.55 p b 0.05) and tricuspid annulus 6.02 mm (+/− 3.29 p b 0.05). The morphology of the tricuspid annulus in 4D normalized. Conclusions: Preoperative transthoracic echocardiography at rest underestimates right chamber compression in pediatric patients with pectus excavatum. Surgical correction improves diameters of the right ventricle, right atrium and tricuspid annulus and normalizes the morphology of the tricuspid annulus (4D). Level of evidence: Level III.