BackgroundIn patients with Hirschsprung's disease (HD), persistent obstructive symptoms may develop after surgery. The causes of mechanical obstruction may be a retraction of the pulled-through bowel due to insufficient mobilization of the mesentery or impaired blood supply in the area of the coloanal anastomosis in the case of excessive ligation of the supplying vessels. Leakage and stenosis are formidable complications and require repeated surgical intervention.ObjectiveThe purpose of this study is to describe our experience and short-term results of the developed method: mobilization of the descending colon for its pull-through during the surgical treatment of the children with HD, which allows ensuring good mobility to the descending colon and maintaining blood supply at the same time.MethodsThe medical records of 20 patients with rectosigmoid HD, who underwent parietal mobilization of the descending colon with preservation of the marginal artery, sigmoid arteries, and ligation of the left colon artery, were reviewed. This method is aimed at increasing the mobility of the brought-down bowel and maintaining the blood supply to the distal part of the brought-down bowel not only from the superior mesenteric artery but also from the lower one.The SPSS Statistics 26.0 package was used for statistical analysis. To describe the analyzed data with a normal distribution, the mean values and the error of the mean were used. To determine the differences, Student’s t-test was used, and the differences were considered significant at a significance level of p < 0.05.ResultsIn all patients, the postoperative period was uneventful, without complications. The patients were discharged for outpatient treatment on average on the seventh day after the surgery. In all cases, there were no signs of anastomotic leakage or stricture on follow-up after 6–12 months.ConclusionThe method of mobilization of the colon in the rectosigmoid form of HD, parietal mobilization of the descending part of the colon preserving the marginal artery, sigmoid arteries, and ligating the left colon artery, can reduce the risk of complications by eliminating the tension of the descending colon.
The observation is described the successful treatment of the child with VATER association. We made the correction of esophageal atresia with lower trachea-oesophageal fistula, anal atresia withrectourethral fistula. Performed surgical operations: retrosternal esophagoplasty the stomach, gastrooesophageal anastomosis in the neck with an antireflux mechanism, anosphincteroplasty.Keywords: gastro-oesophageal anastomosis with forming invaginatedantireflux mechanism -antireflux operation, VATER association. J Clin Med Kaz 2016; 3(41):30-33 автор для корреспонденции: Оспанов М.М., заведующий отделение хирургии и трансплантологии №1 Филиала Корпоративного фонда «UniversityMedicalCenter» Национальный научный центр материнства и детства. Адрес: Астана, проспект Туран 32. Тел 87017302309, е-mail-оsmar.59@mail.ru VATER аССоциацияСы Бар Балада инвагинациялық антирефлюкСтік МеханизМді құраСтыруМен өңешті аСқазанМен ауыСтыру оспанов М.М., ольховик ю.М., рустемов д.з. утебалиев р.С.«University Medical Center» Корпоративті қоры, Ұлттық ана мен бала ғылыми зерттеу орталығы, №1 хирургия және трансплантология бөлімі, Астана, Қазақстан Тұжырымдама Бақылауда баланың VATER ассоциациясын емінің табысты нәтижесі сипатталған. Балаға кезеңді түрде төменгі кеңірдек-өңештік жыланкөзімен өңештің атрезиясына, үрпі-тікішек жыланкөзімен анустың және тік ішектің атрезиясына түзету жасарылған. Өткізілген операциялар -өңешті асқазанмен ретростерналдік ауыстыру, мойында антирефлюкстік механизммен гастроэзофагеалдік анастамозы, аносфинктеропластикасы.Маңызды сөздер: инвагинациялық антирефлюкстік механизмді құрастырумен гастроэзофагеалдық анастомозы-VATER ассоциациясы.Случай заМещения пищевода желудкоМ С форМированиеМ инвагинационного антирефлюкСно-го МеханизМа у реБенка С VATER аССоциацией оспанов М.М., ольховик ю.М., рустемов д.з. утебалиев р.С.Корпоративный фонд «UniversityMedicalCenter», Национальный научный центр материнства и детства, отделение хирургии и трансплантологии №1,Астана, Казахстан Резюме В наблюдении описывается успешный результат лечения ребенка сVATER ассоциацией. Ребенку поэтапно проведена коррекция атре-зии пищевода с нижним трахеопищеводным свищем, атрезии ануса и прямой кишки с ректоуретральным свищом. Выполнены операции -Ретростернальное замещение пищевода желудком, гастроэзофагеальный анастомоз на шее с антирефлюксным механизмом. Аносфин-ктеропроктопластика Ключевые слова: гастроэзофагеальный анастомоз с формированием инвагинационного антирефлюксного механизма -VATER ас-социация.
Introduction: The treatment of long-gap esophageal atresia (LGEA) remains an important issue for pediatric surgeons. There are several methods of treating LGEA with various advantages and disadvantages. Thoracoscopic esophageal elongation using internal traction sutures has been developed more recently. Therefore, we wanted to report on our first experience in treating such pathology using staged thoracoscopic internal traction. Objective: To share our first experience in the treatment of LGEA using staged thoracoscopic internal traction. Methods: Three children with LGEA were treated at the University Medical Center “National Scientific Center for Maternal and Child Health” in the Pediatric Surgery Department, Nur-Sultan, Kazakhstan, using the method of staged thoracoscopic internal traction. Results: At the age of 3–4 months, 3 patients were operated on successfully using staged thoracoscopic internal traction. In any case, converting to an open thoracotomy was not needed and no anastomotic leakage was observed. In 2 cases, stenosis occurred that was treated by dilatation at least twice, 1 child had no stenosis. Conclusions: Thoracoscopic internal traction technique for LGEA was performed for the first time in Kazakhstan that showed its safety and possible future use in the surgical treatment of this congenital malformation.
Background: Perioperative anaphylaxis is one of the most challenging complications in anesthesiology. The key role is to determine the causative agent of the reaction. Neuromuscular agents are ones of the most common causes of anaphylaxis. Skin tests including prick and intradermal reaction tests are gold standard for definite diagnosis.Case presentation: We present a case of a child undergone several operations due to congenital esophageal atresia. Later on, attempts to perform a definitive repair failed because of perioperative anaphylaxis. Allergic skin tests were performed and rocuronium was found to be positive and atracurium -negative. The operation was successfully performed with atracurium. Conclusion:In patients who have gone through multiple surgeries the risk of anaphylaxis development is higher. The most common cause is considered to be neuromuscular blocking agents. In our case, after thorough examination of the anesthesiology cards, rocuronium and pipecuronium were defined as causes of anaphylaxis in our patient, so the surgery was done with atracurium which had been seen negative on a skin prick test. Eventually, the surgical procedure was performed successfully.
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