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casos&#44; pHmetr&#237;a con reflujo &#225;cido en 33 &#40;44&#44;0&#37;&#41;&#44; gammagraf&#237;a con afectaci&#243;n pulmonar en 8 &#40;10&#44;7&#37;&#41;&#44; impedanciometr&#237;a con reflujo en 4 &#40;5&#44;3&#37;&#41; y tr&#225;nsito esof&#225;gico con hallazgo de hernia de hiato en 11 &#40;14&#44;7&#37;&#41;&#46; El principal motivo de la intervenci&#243;n incluy&#243; el mal control sintom&#225;tico con tratamiento m&#233;dico&#44; la presencia de hernia de hiato sintom&#225;tica y los lactantes con EAL&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Se realizaron 72 FN y 3 re-Nissen&#44; de las cuales 49 &#40;65&#44;3&#37;&#41; fueron FNL&#44; 23 &#40;30&#44;7&#37;&#41; FNC y 3 &#40;4&#44;0&#37;&#41; casos precisaron reconversi&#243;n de un abordaje laparosc&#243;pico a uno abierto &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46; El 10&#44;7&#37; ten&#237;an una gastrostom&#237;a previa a la FN y en el 16&#44;0&#37; se realiz&#243; la gastrostom&#237;a durante la FN&#46; Durante la intervenci&#243;n quir&#250;rgica de un caso mediante abordaje convencional y otro laparosc&#243;pico se perfor&#243; accidentalmente el es&#243;fago durante la disecci&#243;n del mismo&#44; lo que fue manejado con cierre simple con sutura reabsorbible&#46; No se reportaron otras complicaciones intraoperatorias&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">El seguimiento medio fue de 26 meses &#40;IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 20&#44;8-31&#44;2&#41;&#46; El 36&#37; presentaron complicaciones&#44; siendo m&#225;s frecuente en la FNC&#58; raz&#243;n de las ventajas &#40;OR&#41; de 3&#44;30 &#40;IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 1&#44;1-9&#44;6&#41;&#46; En general las complicaciones m&#225;s frecuentes en la FNC incluyeron 2 &#40;2&#44;7&#37;&#41; estenosis esof&#225;gicas tratadas mediante dilataciones neum&#225;ticas con bal&#243;n de alta presi&#243;n&#44; 2 &#40;2&#44;7&#37;&#41; evisceraciones que requirieron un cierre primario&#44; y un caso de suboclusi&#243;n intestinal que respondi&#243; favorablemente al manejo conservador&#46; En la FNL&#44; 4 &#40;5&#44;3&#37;&#41; estenosis esof&#225;gicas tratadas mediante dilataciones neum&#225;ticas con bal&#243;n de alta presi&#243;n&#46; Con relaci&#243;n a los menores de 2<span class="elsevierStyleHsp" style=""></span>a&#241;os&#44; no encontramos diferencias en el n&#250;mero de complicaciones o reintervenciones&#44; aunque el tiempo de hospitalizaci&#243;n fue mayor en este grupo de edad que en el resto de los pacientes &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46; Durante el seguimiento se reportaron 6 &#40;8&#37;&#41; casos de disfagia&#44; 4 &#40;5&#44;3&#37;&#41; casos de epigastralgia&#47;pirosis&#44; 2 &#40;2&#44;7&#37;&#41; casos de intestino irritable que mejor&#243; progresivamente con tratamiento m&#233;dico&#44; y un &#40;1&#44;3&#37;&#41; caso de dificultad para canalizar gases &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">Se reportaron 8 &#40;10&#44;7&#37;&#41; fallecimientos durante el seguimiento&#46; Todos presentaban encefalopat&#237;a de base &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">tabla 5</a>&#41;&#46; En el primer mes despu&#233;s de la intervenci&#243;n fallecieron 2 &#40;2&#44;7&#37;&#41;&#58; el primero por disfunci&#243;n respiratoria progresiva y el segundo por una muerte s&#250;bita del lactante&#46; Los dem&#225;s presentaron una supervivencia media de 46<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>22<span class="elsevierStyleHsp" style=""></span>meses despu&#233;s de la intervenci&#243;n&#46; La causa de muerte incluy&#243; 4 casos de insuficiencia respiratoria progresiva asociada a procesos infecciosos y 2 casos asociados a complicaciones de su patolog&#237;a neurol&#243;gica de base&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">Finalmente&#44; 49 &#40;64&#44;0&#37;&#41; pacientes refirieron ausencia de s&#237;ntomas sin necesidad de tratamiento m&#233;dico de base o precisando medicamento solo de rescate&#44; y 12 &#40;15&#44;8&#37;&#41; refirieron mejor&#237;a global de los s&#237;ntomas con disminuci&#243;n de las necesidades de medicamentos&#46; Fue preciso realizar una nueva funduplicatura en 3 &#40;4&#44;2&#37;&#41; pacientes&#58; un caso&#44; intervenido previamente de forma convencional con recidiva sintom&#225;tica de la hernia de hiato&#44; requiri&#243; rehacer la FNC m&#225;s cierre del defecto herniario&#59; el segundo caso estaba intervenido previamente de forma laparosc&#243;pica y present&#243; recidiva sintom&#225;tica de la hernia de hiato&#44; requiriendo rehacer una FNL m&#225;s cierre del defecto herniario&#59; el &#250;ltimo caso era una paciente que hab&#237;a sido intervenida inicialmente en otra instituci&#243;n &#40;FNL&#41; y que acudi&#243; a nuestro centro por sintomatolog&#237;a respiratoria importante&#44; decidi&#233;ndose rehacer la FN por v&#237;a laparosc&#243;pica&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Durante el seguimiento se realiz&#243; una encuesta dirigida a los padres o tutores responsables del paciente&#44; valorando el resultado obtenido con la intervenci&#243;n quir&#250;rgica con respecto a la calidad de vida&#44; encontrando que el 81&#37; de los familiares refieren un resultado &#171;muy bueno&#187;&#44; sobre todo en los pacientes que presentaban sintomatolog&#237;a respiratoria&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discusi&#243;n</span><p id="par0065" class="elsevierStylePara elsevierViewall">La FN es un procedimiento quir&#250;rgico realizado frecuentemente para el tratamiento de la enfermedad por RGE en ni&#241;os&#44; incluyendo los menores de 2<span class="elsevierStyleHsp" style=""></span>a&#241;os<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">1</span></a>&#46; En la actualidad se considera que la FN es segura y eficaz para el control de los s&#237;ntomas&#44; mejorar la calidad de vida y que presenta una tasa de recidiva baja en los primeros 10<span class="elsevierStyleHsp" style=""></span>a&#241;os<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">2-4</span></a>&#46; El manejo del RGE suele ser un tratamiento escalonado que se inicia con cambios higienicodiet&#233;ticos y tratamiento supresor de la acidez g&#225;strica enfocados al control de los s&#237;ntomas&#44; reservando la cirug&#237;a para los casos refractarios<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">5&#44;6</span></a>&#46; Los s&#237;ntomas predominantes suelen ser los digestivos&#44; aunque los pacientes con cl&#237;nica respiratoria suelen obtener mejor control de los s&#237;ntomas despu&#233;s de la FN<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">7</span></a>&#46; Hay que tener consideraci&#243;n especial por los pacientes con d&#233;ficit neurol&#243;gico asociado&#44; ya que suelen asociar alteraciones de la degluci&#243;n y RGE que no se controla con el tratamiento conservador<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">8-10</span></a>&#46; Los pacientes con hernia de hiato&#44; lactantes con episodios aparentemente letales o crisis recurrentes de apneas suelen ser candidatos al tratamiento quir&#250;rgico&#44; con buenos resultados<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">11</span></a>&#46; Sin embargo&#44; la indicaci&#243;n para realizar la FN depende del criterio de cada cirujano o instituci&#243;n&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">En la actualidad se considera que la FNL es el abordaje de elecci&#243;n en ni&#241;os<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">11</span></a>&#46; Algunas consideraciones para el abordaje abierto incluyen las intervenciones abdominales previas&#46; En nuestra serie&#44; se opt&#243; por la FNC en los pacientes portadores de gastrostom&#237;a&#59; en 3 casos se inici&#243; de forma laparosc&#243;pica&#44; pero las adherencias debidas a la cirug&#237;a previa obligaron a la reconversi&#243;n&#46; Tambi&#233;n se opt&#243; a la cirug&#237;a en aquellos con antecedente de cirug&#237;a abdominal por malformaciones del tubo digestivo&#44; incluyendo atresia de es&#243;fago y atresia duodenal&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Se considera que la FNL es equivalente a su contraparte la FNC en efectividad para resolver la sintomatolog&#237;a asociada al RGE<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">2-5&#44;12</span></a>&#46; Sin embargo&#44; en varias publicaciones se plantea que la estancia hospitalaria&#44; el tiempo para iniciar la tolerancia y las complicaciones son menores en el grupo FNL<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">12</span></a>&#46; En nuestra experiencia la estancia se redujo sustancialmente&#44; y encontramos mayor riesgo de complicaciones postoperatorias en el grupo de las FNC&#46; Las complicaciones asociadas con mayor frecuencia a la FNC son las hernias incisionales&#44; alteraciones con el manguito de la funduplicatura<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">13</span></a>&#44; alteraciones de la motilidad intestinal&#44; estenosis esof&#225;gicas&#44; intubaci&#243;n prolongada y neumon&#237;as<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">10</span></a>&#46; Cabe mencionar en nuestra serie que de las estenosis esof&#225;gicas que requirieron dilataci&#243;n neum&#225;tica despu&#233;s de la FN&#44; 5 de ellas ya presentaban estenosis p&#233;ptica previas a la FN&#46; Hay que tener en consideraci&#243;n&#44; adem&#225;s&#44; las complicaciones asociadas a la gastrostom&#237;a y su manejo&#44; y los pacientes con alteraci&#243;n neurol&#243;gica asociada presentan m&#225;s complicaciones por su patolog&#237;a de base<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">9&#44;10</span></a>&#46; En nuestra serie todos los pacientes que fallecieron durante el seguimiento presentaban afectaci&#243;n neurol&#243;gica y la causa de muerte puede asociarse a su enfermedad de base&#44; a pesar de haber conseguido en la mayor&#237;a de los casos un control sintom&#225;tico adecuado&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Las recidivas del RGE se asocian a alteraciones cong&#233;nitas&#44; como la hernia diafragm&#225;tica y la atresia de es&#243;fago<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">8</span></a>&#59; adem&#225;s&#44; existe asociaci&#243;n con los pacientes con afectaci&#243;n neurol&#243;gica<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">11&#44;14&#44;15</span></a>&#46; La hernia de hiato fue la causa asociada a 2 de los 3 casos que precisaron una refunduplicatura&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Con la FN logramos el control subjetivo de la sintomatolog&#237;a en un alto porcentaje&#44; datos similares a los encontrados en los diferentes estudios<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">2</span></a>&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">En los &#250;ltimos 15<span class="elsevierStyleHsp" style=""></span>a&#241;os nuestro centro ha realizado con buenos resultados la FN para el control y tratamiento de RGE en ni&#241;os&#46; Los hallazgos encontrados son similares a los reportados en la literatura&#44; con un control sintom&#225;tico en la mayor&#237;a de los casos tratados&#44; baja morbilidad y baja incidencia de recidivas&#46; Los pacientes neurol&#243;gicos&#44; aquellos con episodios aparentemente letales y con antecedente de atresia de es&#243;fago representan una poblaci&#243;n susceptible al tratamiento quir&#250;rgico pero conllevan una alta morbilidad postoperatoria&#46; Ante estos hallazgos reconocemos que la FNL es una t&#233;cnica atractiva por su menor estancia&#44; menor morbilidad y buen control sintom&#225;tico&#44; consider&#225;ndola como primera opci&#243;n terap&#233;utica para el tratamiento quir&#250;rgico del RGE&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conflicto de intereses</span><p id="par0095" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introducci&#243;n</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">La funduplicatura de Nissen &#40;FN&#41; es la t&#233;cnica m&#225;s utilizada y con mejores resultados para tratar el reflujo gastroesof&#225;gico en ni&#241;os&#46; El abordaje laparosc&#243;pico &#40;FNL&#41; es seguro&#44; con baja morbilidad y alta tasa de &#233;xito&#44; aunque algunos casos precisan abordaje convencional &#40;FNC&#41; o abierto&#46; Nuestro objetivo es comparar los resultados entre la FNC y la FNL en nuestro centro&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material y m&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio retrospectivo de los pacientes &#60;<span class="elsevierStyleHsp" style=""></span>14<span class="elsevierStyleHsp" style=""></span>a&#241;os sometidos a FN entre 2000 y 2015&#46; Comparamos ambos abordajes&#58; complicaciones&#44; estancia hospitalaria y seguimiento&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se realizaron 75 FN&#59; 49 &#40;65&#44;3&#37;&#41; FNL&#44; 23 &#40;30&#44;7&#37;&#41; FNC y 3 &#40;4&#44;0&#37;&#41; reconversiones&#46; Se asoci&#243; gastrostom&#237;a por laparoscopia en el 10&#44;7&#37; y abierta en el 5&#44;3&#37;&#46; El 10&#44;7&#37; portaban gastrostom&#237;a previamente a la FN&#46; La edad media fue de 4<span class="elsevierStyleHsp" style=""></span>a&#241;os&#44; y el 68&#44;7&#37; fueron varones&#46; El 36&#37; presentaron alg&#250;n grado de encefalopat&#237;a&#44; el 14&#44;7&#37; hernia hiatal&#44; el 5&#44;4&#37; antecedente de atresia esof&#225;gica intervenida y el 5&#44;4&#37; al menos un episodio aparentemente letal&#46; No encontramos diferencias significativas en la duraci&#243;n de la intervenci&#243;n entre ambos abordajes&#46; El 36&#37; presentaron complicaciones&#44; m&#225;s frecuente en la FNC&#58; OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#44;30 &#40;IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 1&#44;1-9&#44;6&#41;&#46; La estancia disminuy&#243; en 9<span class="elsevierStyleHsp" style=""></span>d&#237;as en la FNL &#40;IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 5&#44;5-13&#44;5&#41;&#46; El seguimiento medio fue de 26<span class="elsevierStyleHsp" style=""></span>meses &#40;IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 20&#44;9-31&#44;6&#41;&#44; con 10&#44;7&#37; fallecimientos &#40;5 insuficiencias respiratorias&#44; una muerte s&#250;bita y 2 por su encefalopat&#237;a&#41;&#59; el 4&#44;2&#37; precisaron nueva funduplicatura&#44; el 15&#44;8&#37; mostraron mejor&#237;a sintom&#225;tica y el 64&#44;0&#37;&#44; ausencia de s&#237;ntomas&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La FNL es una t&#233;cnica adecuada para el tratamiento del reflujo gastroesof&#225;gico&#44; con menor morbilidad y menor estancia que la FNC&#44; por lo que se recomienda como primera opci&#243;n terap&#233;utica&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introduction</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Nissen fundoplication &#40;NF&#41; is the most used and effective technique for the treatment of gastroesophageal reflux in children&#46; The laparoscopic approach &#40;LNF&#41; is safe&#44; with low morbidity and high success rate&#44; although some cases require a conventional approach &#40;CNF&#41;&#46; The aim of the study is to compare the results between LNF and CNF in our centre&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material and methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A retrospective review was performed on patients &#60;<span class="elsevierStyleHsp" style=""></span>14<span class="elsevierStyleHsp" style=""></span>years after NF between 2000 and 2015&#46; A comparison was made of the complications&#44; hospital stay&#44; and follow-up for both approaches&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Of the total 75 NF performed&#44; 49 &#40;65&#46;3&#37;&#41; were LNF&#44; 23 &#40;30&#46;7&#37;&#41; CNF&#44; and 3 &#40;4&#46;0&#37;&#41; reconversions&#46; Concomitant laparoscopic gastrostomy was performed in 10&#46;7&#37;&#44; and open gastrostomy in 5&#46;3&#37; of cases&#46; Prior to NF&#44; 10&#46;7&#37; had a gastrostomy&#46; The mean age was 4 years and 68&#46;7&#37; were male&#46; Of the diagnoses&#44; 36&#37; had encephalopathy&#44; 14&#46;7&#37; hiatal hernia&#44; 5&#46;4&#37; oesophageal atresia&#44; and 5&#46;4&#37; an acute life-threatening event&#46; No differences were found in operation time&#46; More than two-thirds &#40;36&#37;&#41; had complications&#44; which were more frequent in the CNF &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#46;30&#44; 95&#37;<span class="elsevierStyleHsp" style=""></span>CI&#58; 1&#46;1-9&#46;6&#41;&#46; The hospital-stay decreased by 9 days in the LNF &#40;95&#37;<span class="elsevierStyleHsp" style=""></span>CI&#58; 5&#46;5-13&#46;5&#41;&#46; Mean follow-up was 26 months &#40;95&#37;<span class="elsevierStyleHsp" style=""></span>CI&#58; 20&#46;9-31&#46;6&#41;&#46; Mortality during follow-up was of 5&#46;3&#37; &#40;5 respiratory failure&#44; 1 sudden cardiac death&#44; and 2 due to complications of the encephalopathy&#41;&#44; 4&#46;2&#37; required re-fundoplication&#44; 15&#46;8&#37; had symptomatic improvement&#44; and 64&#46;0&#37; had absence of symptoms&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">The LNF is an effective technique for the treatment of gastroesophageal reflux&#44; with lower morbidity and shorter hospital stay than CNF&#46; It is recommended as the first surgical option&#46;</p></span>"
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17 &#40;22&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Gastrostom&#237;a previa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;10&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Gastrostom&#237;a durante la intervenci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;5&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;10&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Tiempo quir&#250;rgico &#40;horas&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#58;19 &#40;2&#58;01-2&#58;37&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#58;37 &#40;2&#58;26-2&#58;48&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hospitalizaci&#243;n &#40;d&#237;as&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&#44;42 &#40;10&#44;6-20&#44;3&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#44;82 &#40;4&#44;31-7&#44;32&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Seguimiento &#40;a&#241;os&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;1 &#40;0&#44;5-1&#44;7&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#44;0 &#40;1&#44;5-2&#44;6&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Complicaciones&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12 &#40;54&#44;5&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12 &#40;26&#44;7&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Reintervenciones&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;30&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;12&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "es" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Comparaci&#243;n entre la FNC y la FNL</p>"
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          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">FNC&#58; funduplicatura de Nissen convencional&#59; FNL&#58; funduplicatura de Nissen laparosc&#243;pica&#59; NS&#58; no significativo&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">&#60;2 A&#241;os&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Funduplicatura de Nissen</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16 &#40;21&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>FNC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10 &#40;13&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>FNL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;8&#44;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Afectaci&#243;n neurol&#243;gica</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;12&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Gastrostom&#237;a durante la intervenci&#243;n</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;25&#44;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Abierta&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;2&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Laparosc&#243;pica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;2&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Tiempo quir&#250;rgico &#40;horas&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#58;32 &#40;2&#58;06-2&#58;58&#41;<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Hospitalizaci&#243;n &#40;d&#237;as&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#44;8 &#40;6&#44;4-21&#44;1&#41;<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;018&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Complicaciones</span><a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;9&#44;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;2&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;9&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;8&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>HRB&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;9&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;8&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Epigastralg&#237;a&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;6&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Regurgitaci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">2 &#40;2&#44;7&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;4&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;2&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;4&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;2&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Estenosis esof&#225;gica&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;9&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;8&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Re-funduplicatura de Nissen&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;4&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2<a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">a</span></a> &#40;4&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "es" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">S&#237;ntomas del RGE durante el seguimiento &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>67&#41;</p>"
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          "leyenda" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">EAL&#58; episodio aparentemente letal&#59; FNC&#58; funduplicatura de Nissen convencional&#59; FNL&#58; funduplicatura de Nissen laparosc&#243;pica&#59; PCI&#58; par&#225;lisis cerebral infantil&#46;</p>"
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">N&#46;<span class="elsevierStyleSup">o</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Edad&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sexo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Tipo neuropat&#237;a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Otras patolog&#237;as&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Intervenci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Causa del fallecimiento&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Supervivencia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5<span class="elsevierStyleHsp" style=""></span>m&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">PCI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Sd&#46; polimalformativo&#44; EAL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">FNC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Muerte s&#250;bita del lactante&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8 d&#237;as&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Encefalopat&#237;a mitocondrial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">FNL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Deterioro neurol&#243;gico progresivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10 meses&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Sd&#46; West&#44; hidrocefalia cong&#233;nita&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Neumopat&#237;a por reflujo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">FNC &#40;reconversi&#243;n&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Insuficiencia respiratoria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21 d&#237;as&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6 a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Sd&#46; Lennox-Gastaut&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">FNC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Deterioro neurol&#243;gico progresivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">70 meses&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10 a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Encefalopat&#237;a posmeningitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">FNL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Insuficiencia respiratoria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">44 meses&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11 a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">PCI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Neumon&#237;a repetici&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">FNL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Shock s&#233;ptico&#44; insuficiencia respiratoria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">66 meses&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12 a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">PCI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">FNC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Distr&#233;s respiratorio&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">51 meses&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12 a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">PCI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Laringitis repetici&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">FNL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Insuficiencia respiratoria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">34 meses&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                0 => "xTab1378182.png"
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          "es" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Pacientes con afectaci&#243;n neurol&#243;gica que fallecieron durante el seguimiento</p>"
        ]
      ]
    ]
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      "titulo" => "Bibliograf&#237;a"
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          "identificador" => "bibs0005"
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              "identificador" => "bib0080"
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                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A randomized trial of laparoscopic versus open Nissen fundoplication in children under two years of age"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "D&#46; Papandria"
                            1 => "S&#46;D&#46; Goldstein"
                            2 => "J&#46;H&#46; Salazar"
                            3 => "J&#46;T&#46; Cox"
                            4 => "K&#46; McIltrot"
                            5 => "F&#46;D&#46; Stewart"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jpedsurg.2014.11.014"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Pediatr Surg&#46;"
                        "fecha" => "2015"
                        "volumen" => "50"
                        "paginaInicial" => "267"
                        "paginaFinal" => "271"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25638616"
                            "web" => "Medline"
                          ]
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                ]
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              "identificador" => "bib0085"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Four year follow-up of a randomised controlled trial comparing open and laparoscopic Nissen fundoplication in children"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Pacilli"
                            1 => "S&#46; Eaton"
                            2 => "M&#46; McHoney"
                            3 => "E&#46;M&#46; Kiely"
                            4 => "D&#46;P&#46; Drake"
                            5 => "J&#46;I&#46; Curry"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/archdischild-2013-304279"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Dis Child&#46;"
                        "fecha" => "2014"
                        "volumen" => "99"
                        "paginaInicial" => "516"
                        "paginaFinal" => "521"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24532685"
                            "web" => "Medline"
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              "identificador" => "bib0090"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Improvement in quality-of-life after laparoscopic Nissen fundoplication"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "G&#46;T&#46; Kappaz"
                            1 => "R&#46;A&#46; Sallum"
                            2 => "S&#46; Szachnowicz"
                            3 => "J&#46;R&#46; Rocha"
                            4 => "I&#46; Cecconello"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arq Gastroenterol&#46;"
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                        "volumen" => "51"
                        "paginaInicial" => "212"
                        "paginaFinal" => "216"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25296081"
                            "web" => "Medline"
                          ]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Fifteen-year outcome of laparoscopic and open Nissen fundoplication&#58; A randomized clinical trial"
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                        0 => array:2 [
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                          "autores" => array:3 [
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                            2 => "J&#46; Ovaska"
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                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.athoracsur.2011.08.066"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Thorac Surg&#46;"
                        "fecha" => "2012"
                        "volumen" => "93"
                        "paginaInicial" => "228"
                        "paginaFinal" => "233"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22098922"
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              "identificador" => "bib0100"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Outcomes of pediatric laparoscopic fundoplication&#58; A critical review of the literature"
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                        0 => array:2 [
                          "etal" => false
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Original
Manejo del reflujo gastroesofágico en niños. Funduplicatura de Nissen convencional y por laparoscopia en los últimos 15 años en un centro especializado
Management of gastroesophageal reflux in children. Single centre experience in conventional and laparoscopic Nissen fundoplication in the last 15 years
Josué Eduardo Betancourth-Alvarenga
Autor para correspondencia
josue185@gmail.com

Autor para correspondencia.
, José Ignacio Garrido Pérez, Aurora Lucía Castillo Fernández, Francisco Javier Murcia Pascual, Miguel Angel Cárdenas Elias, Alvaro Escassi Gil, Rosa María Paredes-Esteban
UGC Cirugía Pediátrica, Hospital Universitario Reina Sofía, Córdoba, España
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">La funduplicatura de Nissen &#40;FN&#41; es el procedimiento quir&#250;rgico m&#225;s realizado para el tratamiento del reflujo gastroesof&#225;gico &#40;RGE&#41; en ni&#241;os&#46; El abordaje laparosc&#243;pico &#40;FNL&#41; es una t&#233;cnica efectiva y segura para el tratamiento del RGE&#44; y actualmente es considerada la t&#233;cnica de elecci&#243;n&#46; En la mayor&#237;a de los casos el abordaje laparosc&#243;pico es factible y se considera como primera opci&#243;n terap&#233;utica&#44; aunque existen casos seleccionados que van a requerir una funduplicatura de Nissen convencional &#40;FNC&#41; o abierta&#46; Ambos abordajes permiten obtener buenos resultados&#44; mejorando la calidad de vida y el buen control de los s&#237;ntomas&#46; Nuestro objetivo es comparar los resultados obtenidos con ambas t&#233;cnicas en nuestro centro&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material y m&#233;todos</span><p id="par0010" class="elsevierStylePara elsevierViewall">Revisi&#243;n retrospectiva de la historia cl&#237;nica de 75 pacientes&#44; todos menores de 14<span class="elsevierStyleHsp" style=""></span>a&#241;os&#44; que fueron sometidos de forma consecutiva a una FN en nuestro centro entre febrero de 2000 y enero de 2015&#46; La FNC se realiz&#243; seg&#250;n la t&#233;cnica habitual por o bajo la supervisi&#243;n de 3 cirujanos&#44; y la FNL se realiz&#243; por o bajo la supervisi&#243;n de un cirujano&#46; El primer ayudante y el segundo ayudante en ambos abordajes pod&#237;a ser un cirujano infantil o residente de cirug&#237;a pedi&#225;trica de 5&#46;&#176; a&#241;o&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Las variables estudiadas incluyeron sexo&#44; edad&#44; diagn&#243;stico&#44; antecedentes quir&#250;rgicos&#44; s&#237;ntomas preoperatorios&#44; estudios de imagen y complementarios&#44; abordaje realizado&#44; tiempo de intervenci&#243;n&#44; complicaciones quir&#250;rgicas&#44; d&#237;as de hospitalizaci&#243;n&#44; seguimiento&#44; resultados de la intervenci&#243;n&#44; reintervenciones y mortalidad&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Posteriormente se realiz&#243; un an&#225;lisis por subgrupos en funci&#243;n del abordaje establecido &#40;FNL y FNC&#41;&#44; grupo de edad &#40;&#60;<span class="elsevierStyleHsp" style=""></span>2 y &#8805;<span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleHsp" style=""></span>a&#241;os&#41; y presencia o no de afectaci&#243;n neurol&#243;gica&#46; Se realizaron comparaciones entre los tiempos quir&#250;rgicos&#44; complicaciones quir&#250;rgicas y postoperatorias&#44; d&#237;as de ingreso hospitalario y resultados de las intervenciones durante el seguimiento&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Resultados</span><p id="par0025" class="elsevierStylePara elsevierViewall">Se intervino un total de 51 &#40;68&#44;0&#37;&#41; varones y 24 &#40;32&#44;0&#37;&#41; mujeres de entre un mes y 14 a&#241;os&#44; con una media de 5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;5 a&#241;os&#46; De estos pacientes&#44; 16 &#40;22&#44;7&#37;&#41; ten&#237;an una edad inferior a los 24 meses de vida&#44; con una edad media de 12<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7 meses&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Dentro de los antecedentes de mayor inter&#233;s&#44; 27 &#40;36&#37;&#41; asociaban una encefalopat&#237;a&#44; 11 &#40;14&#44;7&#37;&#41; hernia de hiato&#44; 4 &#40;5&#44;4&#37;&#41; atresia esof&#225;gica y 4 &#40;5&#44;4&#37;&#41; episodios aparentemente letales &#40;EAL&#41;&#46; Los s&#237;ntomas m&#225;s frecuentes antes de la intervenci&#243;n fueron los digestivos &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Las pruebas diagn&#243;sticas realizadas para la confirmaci&#243;n del RGE fueron la endoscopia digestiva con toma de biopsia y estudio anatomopatol&#243;gico compatible con esofagitis en 33 &#40;44&#44;0&#37;&#41; casos&#44; pHmetr&#237;a con reflujo &#225;cido en 33 &#40;44&#44;0&#37;&#41;&#44; gammagraf&#237;a con afectaci&#243;n pulmonar en 8 &#40;10&#44;7&#37;&#41;&#44; impedanciometr&#237;a con reflujo en 4 &#40;5&#44;3&#37;&#41; y tr&#225;nsito esof&#225;gico con hallazgo de hernia de hiato en 11 &#40;14&#44;7&#37;&#41;&#46; El principal motivo de la intervenci&#243;n incluy&#243; el mal control sintom&#225;tico con tratamiento m&#233;dico&#44; la presencia de hernia de hiato sintom&#225;tica y los lactantes con EAL&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Se realizaron 72 FN y 3 re-Nissen&#44; de las cuales 49 &#40;65&#44;3&#37;&#41; fueron FNL&#44; 23 &#40;30&#44;7&#37;&#41; FNC y 3 &#40;4&#44;0&#37;&#41; casos precisaron reconversi&#243;n de un abordaje laparosc&#243;pico a uno abierto &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46; El 10&#44;7&#37; ten&#237;an una gastrostom&#237;a previa a la FN y en el 16&#44;0&#37; se realiz&#243; la gastrostom&#237;a durante la FN&#46; Durante la intervenci&#243;n quir&#250;rgica de un caso mediante abordaje convencional y otro laparosc&#243;pico se perfor&#243; accidentalmente el es&#243;fago durante la disecci&#243;n del mismo&#44; lo que fue manejado con cierre simple con sutura reabsorbible&#46; No se reportaron otras complicaciones intraoperatorias&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">El seguimiento medio fue de 26 meses &#40;IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 20&#44;8-31&#44;2&#41;&#46; El 36&#37; presentaron complicaciones&#44; siendo m&#225;s frecuente en la FNC&#58; raz&#243;n de las ventajas &#40;OR&#41; de 3&#44;30 &#40;IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 1&#44;1-9&#44;6&#41;&#46; En general las complicaciones m&#225;s frecuentes en la FNC incluyeron 2 &#40;2&#44;7&#37;&#41; estenosis esof&#225;gicas tratadas mediante dilataciones neum&#225;ticas con bal&#243;n de alta presi&#243;n&#44; 2 &#40;2&#44;7&#37;&#41; evisceraciones que requirieron un cierre primario&#44; y un caso de suboclusi&#243;n intestinal que respondi&#243; favorablemente al manejo conservador&#46; En la FNL&#44; 4 &#40;5&#44;3&#37;&#41; estenosis esof&#225;gicas tratadas mediante dilataciones neum&#225;ticas con bal&#243;n de alta presi&#243;n&#46; Con relaci&#243;n a los menores de 2<span class="elsevierStyleHsp" style=""></span>a&#241;os&#44; no encontramos diferencias en el n&#250;mero de complicaciones o reintervenciones&#44; aunque el tiempo de hospitalizaci&#243;n fue mayor en este grupo de edad que en el resto de los pacientes &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46; Durante el seguimiento se reportaron 6 &#40;8&#37;&#41; casos de disfagia&#44; 4 &#40;5&#44;3&#37;&#41; casos de epigastralgia&#47;pirosis&#44; 2 &#40;2&#44;7&#37;&#41; casos de intestino irritable que mejor&#243; progresivamente con tratamiento m&#233;dico&#44; y un &#40;1&#44;3&#37;&#41; caso de dificultad para canalizar gases &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">Se reportaron 8 &#40;10&#44;7&#37;&#41; fallecimientos durante el seguimiento&#46; Todos presentaban encefalopat&#237;a de base &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">tabla 5</a>&#41;&#46; En el primer mes despu&#233;s de la intervenci&#243;n fallecieron 2 &#40;2&#44;7&#37;&#41;&#58; el primero por disfunci&#243;n respiratoria progresiva y el segundo por una muerte s&#250;bita del lactante&#46; Los dem&#225;s presentaron una supervivencia media de 46<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>22<span class="elsevierStyleHsp" style=""></span>meses despu&#233;s de la intervenci&#243;n&#46; La causa de muerte incluy&#243; 4 casos de insuficiencia respiratoria progresiva asociada a procesos infecciosos y 2 casos asociados a complicaciones de su patolog&#237;a neurol&#243;gica de base&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">Finalmente&#44; 49 &#40;64&#44;0&#37;&#41; pacientes refirieron ausencia de s&#237;ntomas sin necesidad de tratamiento m&#233;dico de base o precisando medicamento solo de rescate&#44; y 12 &#40;15&#44;8&#37;&#41; refirieron mejor&#237;a global de los s&#237;ntomas con disminuci&#243;n de las necesidades de medicamentos&#46; Fue preciso realizar una nueva funduplicatura en 3 &#40;4&#44;2&#37;&#41; pacientes&#58; un caso&#44; intervenido previamente de forma convencional con recidiva sintom&#225;tica de la hernia de hiato&#44; requiri&#243; rehacer la FNC m&#225;s cierre del defecto herniario&#59; el segundo caso estaba intervenido previamente de forma laparosc&#243;pica y present&#243; recidiva sintom&#225;tica de la hernia de hiato&#44; requiriendo rehacer una FNL m&#225;s cierre del defecto herniario&#59; el &#250;ltimo caso era una paciente que hab&#237;a sido intervenida inicialmente en otra instituci&#243;n &#40;FNL&#41; y que acudi&#243; a nuestro centro por sintomatolog&#237;a respiratoria importante&#44; decidi&#233;ndose rehacer la FN por v&#237;a laparosc&#243;pica&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Durante el seguimiento se realiz&#243; una encuesta dirigida a los padres o tutores responsables del paciente&#44; valorando el resultado obtenido con la intervenci&#243;n quir&#250;rgica con respecto a la calidad de vida&#44; encontrando que el 81&#37; de los familiares refieren un resultado &#171;muy bueno&#187;&#44; sobre todo en los pacientes que presentaban sintomatolog&#237;a respiratoria&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discusi&#243;n</span><p id="par0065" class="elsevierStylePara elsevierViewall">La FN es un procedimiento quir&#250;rgico realizado frecuentemente para el tratamiento de la enfermedad por RGE en ni&#241;os&#44; incluyendo los menores de 2<span class="elsevierStyleHsp" style=""></span>a&#241;os<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">1</span></a>&#46; En la actualidad se considera que la FN es segura y eficaz para el control de los s&#237;ntomas&#44; mejorar la calidad de vida y que presenta una tasa de recidiva baja en los primeros 10<span class="elsevierStyleHsp" style=""></span>a&#241;os<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">2-4</span></a>&#46; El manejo del RGE suele ser un tratamiento escalonado que se inicia con cambios higienicodiet&#233;ticos y tratamiento supresor de la acidez g&#225;strica enfocados al control de los s&#237;ntomas&#44; reservando la cirug&#237;a para los casos refractarios<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">5&#44;6</span></a>&#46; Los s&#237;ntomas predominantes suelen ser los digestivos&#44; aunque los pacientes con cl&#237;nica respiratoria suelen obtener mejor control de los s&#237;ntomas despu&#233;s de la FN<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">7</span></a>&#46; Hay que tener consideraci&#243;n especial por los pacientes con d&#233;ficit neurol&#243;gico asociado&#44; ya que suelen asociar alteraciones de la degluci&#243;n y RGE que no se controla con el tratamiento conservador<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">8-10</span></a>&#46; Los pacientes con hernia de hiato&#44; lactantes con episodios aparentemente letales o crisis recurrentes de apneas suelen ser candidatos al tratamiento quir&#250;rgico&#44; con buenos resultados<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">11</span></a>&#46; Sin embargo&#44; la indicaci&#243;n para realizar la FN depende del criterio de cada cirujano o instituci&#243;n&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">En la actualidad se considera que la FNL es el abordaje de elecci&#243;n en ni&#241;os<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">11</span></a>&#46; Algunas consideraciones para el abordaje abierto incluyen las intervenciones abdominales previas&#46; En nuestra serie&#44; se opt&#243; por la FNC en los pacientes portadores de gastrostom&#237;a&#59; en 3 casos se inici&#243; de forma laparosc&#243;pica&#44; pero las adherencias debidas a la cirug&#237;a previa obligaron a la reconversi&#243;n&#46; Tambi&#233;n se opt&#243; a la cirug&#237;a en aquellos con antecedente de cirug&#237;a abdominal por malformaciones del tubo digestivo&#44; incluyendo atresia de es&#243;fago y atresia duodenal&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Se considera que la FNL es equivalente a su contraparte la FNC en efectividad para resolver la sintomatolog&#237;a asociada al RGE<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">2-5&#44;12</span></a>&#46; Sin embargo&#44; en varias publicaciones se plantea que la estancia hospitalaria&#44; el tiempo para iniciar la tolerancia y las complicaciones son menores en el grupo FNL<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">12</span></a>&#46; En nuestra experiencia la estancia se redujo sustancialmente&#44; y encontramos mayor riesgo de complicaciones postoperatorias en el grupo de las FNC&#46; Las complicaciones asociadas con mayor frecuencia a la FNC son las hernias incisionales&#44; alteraciones con el manguito de la funduplicatura<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">13</span></a>&#44; alteraciones de la motilidad intestinal&#44; estenosis esof&#225;gicas&#44; intubaci&#243;n prolongada y neumon&#237;as<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">10</span></a>&#46; Cabe mencionar en nuestra serie que de las estenosis esof&#225;gicas que requirieron dilataci&#243;n neum&#225;tica despu&#233;s de la FN&#44; 5 de ellas ya presentaban estenosis p&#233;ptica previas a la FN&#46; Hay que tener en consideraci&#243;n&#44; adem&#225;s&#44; las complicaciones asociadas a la gastrostom&#237;a y su manejo&#44; y los pacientes con alteraci&#243;n neurol&#243;gica asociada presentan m&#225;s complicaciones por su patolog&#237;a de base<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">9&#44;10</span></a>&#46; En nuestra serie todos los pacientes que fallecieron durante el seguimiento presentaban afectaci&#243;n neurol&#243;gica y la causa de muerte puede asociarse a su enfermedad de base&#44; a pesar de haber conseguido en la mayor&#237;a de los casos un control sintom&#225;tico adecuado&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Las recidivas del RGE se asocian a alteraciones cong&#233;nitas&#44; como la hernia diafragm&#225;tica y la atresia de es&#243;fago<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">8</span></a>&#59; adem&#225;s&#44; existe asociaci&#243;n con los pacientes con afectaci&#243;n neurol&#243;gica<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">11&#44;14&#44;15</span></a>&#46; La hernia de hiato fue la causa asociada a 2 de los 3 casos que precisaron una refunduplicatura&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Con la FN logramos el control subjetivo de la sintomatolog&#237;a en un alto porcentaje&#44; datos similares a los encontrados en los diferentes estudios<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">2</span></a>&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">En los &#250;ltimos 15<span class="elsevierStyleHsp" style=""></span>a&#241;os nuestro centro ha realizado con buenos resultados la FN para el control y tratamiento de RGE en ni&#241;os&#46; Los hallazgos encontrados son similares a los reportados en la literatura&#44; con un control sintom&#225;tico en la mayor&#237;a de los casos tratados&#44; baja morbilidad y baja incidencia de recidivas&#46; Los pacientes neurol&#243;gicos&#44; aquellos con episodios aparentemente letales y con antecedente de atresia de es&#243;fago representan una poblaci&#243;n susceptible al tratamiento quir&#250;rgico pero conllevan una alta morbilidad postoperatoria&#46; Ante estos hallazgos reconocemos que la FNL es una t&#233;cnica atractiva por su menor estancia&#44; menor morbilidad y buen control sintom&#225;tico&#44; consider&#225;ndola como primera opci&#243;n terap&#233;utica para el tratamiento quir&#250;rgico del RGE&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conflicto de intereses</span><p id="par0095" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introducci&#243;n</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">La funduplicatura de Nissen &#40;FN&#41; es la t&#233;cnica m&#225;s utilizada y con mejores resultados para tratar el reflujo gastroesof&#225;gico en ni&#241;os&#46; El abordaje laparosc&#243;pico &#40;FNL&#41; es seguro&#44; con baja morbilidad y alta tasa de &#233;xito&#44; aunque algunos casos precisan abordaje convencional &#40;FNC&#41; o abierto&#46; Nuestro objetivo es comparar los resultados entre la FNC y la FNL en nuestro centro&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material y m&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio retrospectivo de los pacientes &#60;<span class="elsevierStyleHsp" style=""></span>14<span class="elsevierStyleHsp" style=""></span>a&#241;os sometidos a FN entre 2000 y 2015&#46; Comparamos ambos abordajes&#58; complicaciones&#44; estancia hospitalaria y seguimiento&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se realizaron 75 FN&#59; 49 &#40;65&#44;3&#37;&#41; FNL&#44; 23 &#40;30&#44;7&#37;&#41; FNC y 3 &#40;4&#44;0&#37;&#41; reconversiones&#46; Se asoci&#243; gastrostom&#237;a por laparoscopia en el 10&#44;7&#37; y abierta en el 5&#44;3&#37;&#46; El 10&#44;7&#37; portaban gastrostom&#237;a previamente a la FN&#46; La edad media fue de 4<span class="elsevierStyleHsp" style=""></span>a&#241;os&#44; y el 68&#44;7&#37; fueron varones&#46; El 36&#37; presentaron alg&#250;n grado de encefalopat&#237;a&#44; el 14&#44;7&#37; hernia hiatal&#44; el 5&#44;4&#37; antecedente de atresia esof&#225;gica intervenida y el 5&#44;4&#37; al menos un episodio aparentemente letal&#46; No encontramos diferencias significativas en la duraci&#243;n de la intervenci&#243;n entre ambos abordajes&#46; El 36&#37; presentaron complicaciones&#44; m&#225;s frecuente en la FNC&#58; OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#44;30 &#40;IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 1&#44;1-9&#44;6&#41;&#46; La estancia disminuy&#243; en 9<span class="elsevierStyleHsp" style=""></span>d&#237;as en la FNL &#40;IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 5&#44;5-13&#44;5&#41;&#46; El seguimiento medio fue de 26<span class="elsevierStyleHsp" style=""></span>meses &#40;IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 20&#44;9-31&#44;6&#41;&#44; con 10&#44;7&#37; fallecimientos &#40;5 insuficiencias respiratorias&#44; una muerte s&#250;bita y 2 por su encefalopat&#237;a&#41;&#59; el 4&#44;2&#37; precisaron nueva funduplicatura&#44; el 15&#44;8&#37; mostraron mejor&#237;a sintom&#225;tica y el 64&#44;0&#37;&#44; ausencia de s&#237;ntomas&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La FNL es una t&#233;cnica adecuada para el tratamiento del reflujo gastroesof&#225;gico&#44; con menor morbilidad y menor estancia que la FNC&#44; por lo que se recomienda como primera opci&#243;n terap&#233;utica&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introduction</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Nissen fundoplication &#40;NF&#41; is the most used and effective technique for the treatment of gastroesophageal reflux in children&#46; The laparoscopic approach &#40;LNF&#41; is safe&#44; with low morbidity and high success rate&#44; although some cases require a conventional approach &#40;CNF&#41;&#46; The aim of the study is to compare the results between LNF and CNF in our centre&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material and methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A retrospective review was performed on patients &#60;<span class="elsevierStyleHsp" style=""></span>14<span class="elsevierStyleHsp" style=""></span>years after NF between 2000 and 2015&#46; A comparison was made of the complications&#44; hospital stay&#44; and follow-up for both approaches&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Of the total 75 NF performed&#44; 49 &#40;65&#46;3&#37;&#41; were LNF&#44; 23 &#40;30&#46;7&#37;&#41; CNF&#44; and 3 &#40;4&#46;0&#37;&#41; reconversions&#46; Concomitant laparoscopic gastrostomy was performed in 10&#46;7&#37;&#44; and open gastrostomy in 5&#46;3&#37; of cases&#46; Prior to NF&#44; 10&#46;7&#37; had a gastrostomy&#46; The mean age was 4 years and 68&#46;7&#37; were male&#46; Of the diagnoses&#44; 36&#37; had encephalopathy&#44; 14&#46;7&#37; hiatal hernia&#44; 5&#46;4&#37; oesophageal atresia&#44; and 5&#46;4&#37; an acute life-threatening event&#46; No differences were found in operation time&#46; More than two-thirds &#40;36&#37;&#41; had complications&#44; which were more frequent in the CNF &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#46;30&#44; 95&#37;<span class="elsevierStyleHsp" style=""></span>CI&#58; 1&#46;1-9&#46;6&#41;&#46; The hospital-stay decreased by 9 days in the LNF &#40;95&#37;<span class="elsevierStyleHsp" style=""></span>CI&#58; 5&#46;5-13&#46;5&#41;&#46; Mean follow-up was 26 months &#40;95&#37;<span class="elsevierStyleHsp" style=""></span>CI&#58; 20&#46;9-31&#46;6&#41;&#46; Mortality during follow-up was of 5&#46;3&#37; &#40;5 respiratory failure&#44; 1 sudden cardiac death&#44; and 2 due to complications of the encephalopathy&#41;&#44; 4&#46;2&#37; required re-fundoplication&#44; 15&#46;8&#37; had symptomatic improvement&#44; and 64&#46;0&#37; had absence of symptoms&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">The LNF is an effective technique for the treatment of gastroesophageal reflux&#44; with lower morbidity and shorter hospital stay than CNF&#46; It is recommended as the first surgical option&#46;</p></span>"
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#40;1&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Episodio aparentemente letal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#40;5&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Signos y s&#237;ntomas neurol&#243;gicos</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">8</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">&#40;10&#44;6&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Trastorno de la degluci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#40;6&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>S&#237;ndrome de Sandifer&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#40;4&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Patolog&#237;as asociadas</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">27</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">&#40;36&#44;0&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Hernia de hiato&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#40;14&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Atresia de es&#243;fago&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#40;5&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Estenosis esof&#225;gica &#40;p&#233;ptica&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#40;6&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Malformaciones card&#237;acas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#40;4&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Fibrosis qu&#237;stica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#40;2&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Atresia intestinal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#40;2&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">FNC&#58; funduplicatura de Nissen convencional&#59; FNL&#58; funduplicatura de Nissen laparosc&#243;pica&#59; NS&#58; no significativo&#46;</p>"
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                  \t\t\t\t\tvoid\n
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Convencional&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Laparosc&#243;pica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">49 &#40;65&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Sexo</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Var&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18 &#40;24&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33 &#40;44&#44;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mujer&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16 &#40;21&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Edad</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Meses&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">72&#44;6 &#40;57&#44;9-87&#44;3&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>A&#241;os&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#44;38 &#40;2&#44;4-6&#44;4&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#44;55 &#40;4&#44;3-6&#44;8&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#60; 2 a&#241;os&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10 &#40;13&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;8&#44;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17 &#40;22&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;5&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;10&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Tiempo quir&#250;rgico &#40;horas&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#58;37 &#40;2&#58;26-2&#58;48&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hospitalizaci&#243;n &#40;d&#237;as&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&#44;42 &#40;10&#44;6-20&#44;3&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#44;82 &#40;4&#44;31-7&#44;32&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Seguimiento &#40;a&#241;os&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;1 &#40;0&#44;5-1&#44;7&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#44;0 &#40;1&#44;5-2&#44;6&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Complicaciones&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12 &#40;26&#44;7&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Reintervenciones&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;12&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">FNC&#58; funduplicatura de Nissen convencional&#59; FNL&#58; funduplicatura de Nissen laparosc&#243;pica&#59; NS&#58; no significativo&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">&#60;2 A&#241;os&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Funduplicatura de Nissen</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16 &#40;21&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>FNC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10 &#40;13&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>FNL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;8&#44;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Afectaci&#243;n neurol&#243;gica</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;12&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Gastrostom&#237;a durante la intervenci&#243;n</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;25&#44;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Abierta&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;2&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Laparosc&#243;pica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;2&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Tiempo quir&#250;rgico &#40;horas&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#58;32 &#40;2&#58;06-2&#58;58&#41;<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Hospitalizaci&#243;n &#40;d&#237;as&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#44;8 &#40;6&#44;4-21&#44;1&#41;<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;018&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Complicaciones</span><a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;9&#44;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Reintervenciones</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;2&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab1378178.png"
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            0 => array:3 [
              "identificador" => "tblfn0015"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Comparaci&#243;n con &#62; 2 a&#241;os&#46;</p>"
            ]
            1 => array:3 [
              "identificador" => "tblfn0020"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Intervalo de confianza al 95&#37;&#46;</p>"
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            2 => array:3 [
              "identificador" => "tblfn0025"
              "etiqueta" => "c"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0025">Incluye complicaciones en postoperatorio y durante el seguimiento&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Funduplicatura de Nissen en menores de 2 a&#241;os &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>16&#41;</p>"
        ]
      ]
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            "identificador" => "at4"
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            "rol" => "short"
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        ]
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">FN&#58; funduplicatura de Nissen&#59; FNC&#58; funduplicatura de Nissen convencional&#59; FNL&#58; funduplicatura de Nissen laparosc&#243;pica&#59; HRB&#58; hiperreactividad bronquial&#59; RGE&#58; reflujo gastroesof&#225;gico&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">FN<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>67&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">FNC<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">FNL<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Asintom&#225;tico&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">48 &#40;71&#44;6&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16 &#40;72&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">32 &#40;73&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">S&#237;ntomas&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Disfagia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">6 &#40;9&#44;0&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;9&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;8&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>HRB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">6 &#40;9&#44;0&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;9&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;8&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Epigastralg&#237;a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">3 &#40;4&#44;5&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;6&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Regurgitaci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">2 &#40;2&#44;7&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;4&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;2&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Recidiva hernia hiato&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">2 &#40;2&#44;7&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;4&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;2&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Estenosis esof&#225;gica&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">6 &#40;9&#44;0&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;9&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;8&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Re-funduplicatura de Nissen&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">3 &#40;4&#44;5&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;4&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2<a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">a</span></a> &#40;4&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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            0 => array:3 [
              "identificador" => "tblfn0030"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0030">Un paciente trasladado de otro centro con FNL previa&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">S&#237;ntomas del RGE durante el seguimiento &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>67&#41;</p>"
        ]
      ]
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        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
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        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at5"
            "detalle" => "Tabla "
            "rol" => "short"
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        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">EAL&#58; episodio aparentemente letal&#59; FNC&#58; funduplicatura de Nissen convencional&#59; FNL&#58; funduplicatura de Nissen laparosc&#243;pica&#59; PCI&#58; par&#225;lisis cerebral infantil&#46;</p>"
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                0 => """
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">N&#46;<span class="elsevierStyleSup">o</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Edad&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Otras patolog&#237;as&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Intervenci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Causa del fallecimiento&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5<span class="elsevierStyleHsp" style=""></span>m&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">PCI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Sd&#46; polimalformativo&#44; EAL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">FNC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Muerte s&#250;bita del lactante&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8 d&#237;as&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Encefalopat&#237;a mitocondrial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">FNL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Deterioro neurol&#243;gico progresivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10 meses&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Sd&#46; West&#44; hidrocefalia cong&#233;nita&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Neumopat&#237;a por reflujo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">FNC &#40;reconversi&#243;n&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Insuficiencia respiratoria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21 d&#237;as&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6 a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Sd&#46; Lennox-Gastaut&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">FNC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Deterioro neurol&#243;gico progresivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">70 meses&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10 a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Encefalopat&#237;a posmeningitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">FNL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Insuficiencia respiratoria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">44 meses&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11 a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">PCI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Neumon&#237;a repetici&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">FNL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Shock s&#233;ptico&#44; insuficiencia respiratoria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">66 meses&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12 a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">PCI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">FNC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Distr&#233;s respiratorio&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">51 meses&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12 a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">PCI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Laringitis repetici&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">FNL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Insuficiencia respiratoria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">34 meses&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "es" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Pacientes con afectaci&#243;n neurol&#243;gica que fallecieron durante el seguimiento</p>"
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Información del artículo
ISSN: 16954033
Idioma original: Español
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