Search

The aims of the study were: 1) to formulate up-to-date principles of coloesophagoplasty (CEP) and to compare methods of CEP; 2) to determine the optimal age for esophagoplasty in children with esophageal atresia; 3) to evaluate quality of life and long term results after esophagoplasty performed in childhood; 4) to present results of surgical treatment of pharynx stenosis in children. Over the last 50 years more than 2 thousand surgeries on the esophagus in children were performed including more than 600 operations of artificial esophagus creation. From 1995 in some patients we carried out extirpation of the esophagus with one-stage plastic operation coloesophagoplasty taken the transplant in the posterior mediastinum. From 1992 on the pharynx with free revascularized intestinal segment was performed in isolated stenosis of the pharynx. Case histories of 54 children aged from 3 months to 15 years were analyzed to compare methods of esophagoplasty when the esophagus was taken behind the sternum and in posterior mediastinum. Case histories of 27 children with atresia of the esophagus were analyzed for determination of optimal age for coloesophagoplasty. Responses to questionnaires were analyzed to evaluate quality of life. From 1980 ive hase operated 28 patients with scarry stenosis of the pharynx (isolated or in combination with esophageal stenosis). Current policy of surgical treatment of pharyngeal stenosis which is considered as surgery of choice-pharyngoplasty with a free intestinal transplant--is described. Development and clinical appliance of up-to-date principles of CEP permitted to reduce the number of complications and to decrease lethality from 3 to 0.5%. After introduction of antireflux cologastroanastomosis the number of complications due to reflux reduced. Extirpation of the esophagus may be valid in peptic stenosis, Barrett's metaplasia, tumors, portal hypertension or angiodisplasia, and in the majority of cases of scarry stenosis of the esophagus.

Forty-seven video-surgical thoracic operations performed in children are analyzed. Age of children ranged from 4 days to 14.5 years, body weight--from 700 g to 54 kg. Two types of surgeries are singled out--thoracoscopic and video-assisted (when minithoracotomy was performed in addition to thoracoscopic technique). There were no severe complications during surgery. One child died due to non-diagnosed penumothorax on the 4th day after surgery. Problems of anesthesia and surgical technique in children are considered.

The experience of the faeces incontinence treatment in 295 children (age ranged from 1 to 15 years) is presented. Several original operations for surgical correction of the sphincter ani asthenia are proposed. The authors think that radical correction of faeces incontinence in children is necessary as early as at the age 6 to 7 years that is at the beginning of social activity. Efficient use of the above methods of the rectum closing apparatus creation allowed to achieve good results in 77.3-85.7% of the children.

The present status of gastroenterological laparoscopic surgery in Russia is comprehensively analyzed. Based on the generalized data obtained by 11 leading clinicians of the country, the authors in detail consider the feasibilities of endoscopic techniques of surgical gastroenterology, the proportion of each nosological entity in the total statistics of laparoscopic operations. A description is given of the following endoscopic interventions: cholecystectomy, choledocholithotomy, biliodigestive anastomoses, vagotomy, perforated ulcer suture, antireflux operations, gastrectomy, sigmoidectomy, right-sided hemicolectomy, rectal surgery, appendectomy, Meckel's diverticulum removal. By using the cumulative experience gained at short-term endoscopic surgery in Russia, the authors conclude that the new technique is promising during most surgical interventions in gastroenterology.

It is shown that Ultravist makes it possible to receive clear visualization of vessel channel in the zone "of interest" without changing functional conditions of heart vascular system and biochemical blood parameters (level of erythrocytes, bilirubine, urine nitrogen, activity of aspartataminotransferase). In concentration 30 mg/ml in vitro and in vivo Ultravist decreases a viscosity limit not affecting other rheological properties of blood. A mechanism of the found Ultravist effect and prospects of its application in practice for children are considered.

Three children with isolated cicatricial stenosis of the pharynx and cervical esophagus were subjected to operation for segmental plasty with a free intestinal segment (2 jejunal and one sigmoid). In all cases the segment was anastomosed with the side of the carotid and internal jugular vein on the neck under 3.2 magnification. No complications occurred. The results of the operation showed a high effectiveness of segmental plasty in stenosis of the cervical esophagus. In cicatricial stenosis of the pharynx, in addition to restoration of normal deglutition, breathing through the pharynx must be fully restored, which makes segmental reconstruction of the pharynx in children more difficult.

In the Clinic of Pediatric Surgery of the Russian State Medical University 310 operations for esophagoplasty were performed using segments of the small and large intestine. The 50-year progress in the creation of an artificial esophagus is characterized by gradual advancement from prethoracic plasty after Roux-Herzen-Yudin to the refined method of retrosternal coloesophagoplasty. The incidence of the characteristic postoperative complications reduced by 3 to 10 times, necrosis of the transplant was practically not encountered, the mortality reduced to 1.2%, and the functional results improved significantly.

Six operations for kidney autotransplantation into the ipsilateral iliac fossa were conducted on children aged from 2 to 14 years. In 2 children the operation was performed for a posttraumatic defect in the ureter of a considerable length. Severe neuromuscular dysplasia of the ureter in maintained function of the kidney was the indication for operating on 4 children. No complications occurred in 5 operations. One transplanted kidney had to be removed because of renal artery thrombosis resulting from damage inflicted to the endothelium during washing of the kidney. Operation for autotransplantation of the kidney is a permissible alternative of the traditional methods of replacement or plastics in long posttraumatic strictures and congenital developmental anomalies of the ureter.

Operations were carried out on 98 children with extrahepatic portal hypertension and on 6 with intrahepatic block and no signs of hepatocellular insufficiency. Mesenterico-caval H-shunt was formed in 78 children with the use of the internal jugular vein as the insert. The remaining children underwent formation of mesocaval anastomosis (8), distal spleno-renal shunt (4), portocaval anastomosis (1), Sugiura's operation (7). Among the operations 68 were planned, 12 emergency, and 18 preventive. The average age of the children was 6.5 years; 31 were under the age of 5 years and 19 under 3 years of age. The youngest child was aged 10 months, the H-shunt was successful. The results of the operation: thrombosis of the shunt 0%, portosystem encephalopathy 0%, recurrent hemorrhage 0%, lethality 1%. This is evidence of the expediency of performing shunting operations in early childhood.

Under analysis were results of treatment of posttraumatic strictures of the urethra in 34 children. A method of treatment of the urethra structures has been developed in experiments in dogs with the use of permanent magnet. Comparison of results of treatment of 2 groups of patients treated by traditional methods (19 patients) and by the proposed method (15 patients) has shown that using the new method is followed by two times less amount of recurrences and complications.

The authors dispose an experience with 250 surgical interventions with employment of abacterial insulators. The operations were carried out upon the abdominal organs, thorax, bones, vessels, urogenital organs etc. in neonates and elder children. A number of advantages of the surgical method with employment of abacterial insulators are ascertained.

Twenty children of different age suspected of Hirschsprung's disease were examined. The complex examination included contrast irrigography, electromyography and determination of tissue acetylcholinesterase. The reliable diagnosis was established in 10 children. The distal border of agangliosis was found and thus the methods of treatment could be chosen.