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Introduction. We present the first case of pediatric ileocystoplasty using a purely robotic approach in Spain. Case report. 12-year-old male with neurogenic bladder of low capacity and high pressures. After failure of conservative treatment, bladder augmentation with ileum patch was decided upon. Surgery was carried out using a purely robotic approach with 4 robotic and 2 accessory ports. Surgery duration was 380 minutes in total, without intraoperative complications. He was discharged 2 weeks after cystographic control. During 32-months follow-up, he has remained continent. Discussion. The minimal invasion, surgical precision and ergonomics made the robotic approach an optimal option for complex surgical techniques. Given the little availability of the robot and the low pediatric volume, its standardization is a challenge. Our accumulated experience is consistent with the current literature and shows promising surgical and esthetic results. We hope this case report will contribute to the divulgation and progressive introduction of robotic surgery in our daily lives. [ABSTRACT FROM AUTHOR]

Objective. To study gastroesophageal reflux (GER) in children undergoing gastrostomy in a single pediatric institution. Materials and methods. A retrospective study of patients undergoing gastrostomy from 2000 to 2017 was carried out. Demographic data, clinical data, progression, and complications were recorded. GER was considered positive in patients with clinical signs requiring antisecretory treatment, prokinetic treatment, or anti-reflux surgery to control symptoms. Results. 207 patients with a median age of 2 years [R: 0.25-18] were included. Neurological impairment was the most frequent underlying condition (74%). Swallowing difficulty and undernourishment were the main surgical indications for gastrostomy. Prior to gastrostomy, 96 out of 207 patients (46%) showed GER symptoms. Combined fundoplication and gastrostomy was performed in 41 (43%) patients with preexisting GER, 6 of whom showed GER worsening (4 required redo fundoplication). 5 complications following fundoplication were noted - gastric perforation, sustained Dumping syndrome, and gastroesophageal stenosis. 55 out of 96 (57%) patients with preexisting GER underwent gastrostomy alone. Clinical signs disappeared in 16 of them (29%) and improved or stabilized in 19 (35%). GER worsening occurred in 20 patients (36%), with subsequent fundoplication being required in 10 cases. In patients with no previous clinical signs (111 out of 207), GER symptoms occurred following gastrostomy in just 18 cases (16%), and only 2 patients required fundoplication. Conclusions. In our experience, routine anti-reflux surgery combined with gastrostomy is not justified. Individualized fundoplication should be considered in case of medical treatment failure. Further studies with an adequate design are required to establish which patients could really benefit from this procedure. [ABSTRACT FROM AUTHOR]