RESUMEN
It was analyzed the treatment results of 24 patients under the age of 2 years with total aganglionosis for the period from 2000 to 2013. Each of these patients underwent several surgical interventions (on the average 7.8±2.1). All children were operated radically. It was performed ileojejunorectal anastomosis at transitional fold of peritoneum in patients with concomitant short bowel syndrome. Soave's operation was done in 14 patients including by using of laparoscopic technique in 3 cases. Inflammatory complications (paraproctitis) developed in 2 children on maceration background. Perirectal fistula was observed in 1 patient subsequently. In long-term period liquid stool incontinence persisted up to 6 months in 28% of children. In terms of more than 1 year stool incontinence was observed in 12.6% of patients. Increased growth of D-lactate-producing gram-positive anaerobes was revealed during microbiological investigation of feces in 35% of patients in long-term period. Increased growth was accompanied by systemic acidosis and infectious enteritis clinically. Course monthly treatment with antibacterial drugs (Alpha-Normix, Trichopolum, Gentamicin) was prescribed in patients with short bowel syndrome and high frequent of enteritis recurrence. Treatment was used In terms from 6 to 12 months of longer if it was necessary. It was concluded that timely diagnosis and right tactic in neonatal period leads to decrease significantly the number of complications, vain interventions and to improve treatment outcomes. Our experience shows that the best results of surgical treatment were observed in children aged from 2.5-3 years when a child can control urination and defecation. The most mistakes are caused by wrong or failed morphological investigation of large bowel.
Asunto(s)
Anastomosis Quirúrgica , Enfermedad de Hirschsprung , Intestino Grueso/cirugía , Laparoscopía , Complicaciones Posoperatorias , Anastomosis Quirúrgica/efectos adversos , Anastomosis Quirúrgica/métodos , Antibacterianos/uso terapéutico , Preescolar , Defecación , Enteritis/tratamiento farmacológico , Enteritis/etiología , Incontinencia Fecal/etiología , Femenino , Enfermedad de Hirschsprung/diagnóstico , Enfermedad de Hirschsprung/fisiopatología , Enfermedad de Hirschsprung/cirugía , Humanos , Lactante , Intestino Grueso/patología , Intestino Grueso/fisiopatología , Laparoscopía/efectos adversos , Laparoscopía/métodos , Masculino , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/terapia , Fístula Rectal/etiología , Síndrome del Intestino Corto/etiología , Resultado del TratamientoRESUMEN
The authors own the experience of treatment of 23 children with magnetic foreign bodies (MFB) of the gastrointestinal tract. They share the possibilities of diagnostics and surgical treatment of children on the vivid clinical examples. By MFB in the stomach, which do not leave the gastrointestinal tract naturally, the use of fibroesophagoduodenoscopy is recommended. The laparoscopy is helpful in case of the uncomplicated MFB in the intestine. The X-ray control of the complete foreign bodies evacuation is necessary.
Asunto(s)
Endoscopía Gastrointestinal/métodos , Cuerpos Extraños/diagnóstico , Tracto Gastrointestinal , Imanes , Radiografía Abdominal/métodos , Niño , Preescolar , Diagnóstico Diferencial , Femenino , Estudios de Seguimiento , Cuerpos Extraños/epidemiología , Humanos , Incidencia , Masculino , Federación de Rusia/epidemiologíaRESUMEN
Results of the laparoscopic treatment of 36 patients with Hirschsprung's disease were analyzed. The majority of patients were the newborns or before 12 months old. The use of laparoscopy permitted a full-fledged topical diagnostics, aganglionosis zone identification, gut mobilization and voiding. Laparoscopic method also allowed to decrease the ICU stay in 3,1 times and start breastfeeding earlier, lessen the pelvic floor intraoperative traumatization and decrease the level of commissural and inflammatory complications. Good and excellent functional results were achieved in 93,7% of children, stenosis of the anastomotic area was registered postoperatively in 2 patients.
Asunto(s)
Enfermedad de Hirschsprung/cirugía , Laparoscopía/métodos , Cirugía Asistida por Video/métodos , Preescolar , Femenino , Estudios de Seguimiento , Enfermedad de Hirschsprung/diagnóstico , Humanos , Lactante , Recién Nacido , Masculino , Radiografía Abdominal , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
Data of 568 patients, aged from 3 weeks to 14 years, with acute adhesive bowel obstruction, treated during 1981--2007 yy. are analyzed. Most often previous laparotomy was performed on account of appendicitis, predominately complicated with peritonitis--in 52,2% of patients. Obstruction, caused by intestinal invagination was observed in 19,4%, malformation--9,3%, tumor--2,3%, other--1,7%. The treatment results of appendicular peritonitis and intestinal invagination are studied. Two comparative groups of patients with appendicular peritonitis, 100 children each, were treated laparoscopically and traditionally. The laparoscopic method allows to stop pain and endotoxicosis earlier, faster gastrointestinal function recovery, decrease of complication in the laparoscopical group rates and hospital-stay period on 30,8%. 100 children with intestinal invagination were operated laparoscopically and 50 patients were experienced a traditional <
Asunto(s)
Laparoscopía/métodos , Peritonitis/prevención & control , Complicaciones Posoperatorias/prevención & control , Adherencias Tisulares , Adolescente , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , MasculinoRESUMEN
One hundred and ninety-two urgent laparoscopic operations in 179 infants (including 31 newborn infants) were performed. Indications for surgery were intestinal obstruction (108 children), acute diseases of abdominal organs (61), and gynecological diseases (10). The rate of conversion in 3 groups was 10.9, 4.6% and 0, respectively. In all the cases conversion was performed due to technical difficulties, there were no intrasurgical complications, diagnostic value of the method reached 100%. Combined laparoscopic surgeries were performed in 25.1% cases. Intestinal invagination was the most frequent cause of laparoscopy. Comparative analysis of open (28) and laparoscopic (85) desinvagination demonstrated the advantages of the latter one both during and after surgery. Laparoscopy is the useful method for diagnosis and treatment of acute abdominal disease requiring urgent surgery in infants.