Применение имплантов в коррекции диафрагмальной грыжи у новорожденныхThe use of implants for surgical treatment of congenital diaphragmatic hernia in newborns Врожденная диафрагмальная грыжа (ВДГ) -патология, которая требует обязательной хирургической коррек-ции. При значительных дефектах диафрагмы, например аплазии ее купола, зачастую возникает необходимость в использовании имплантационных материалов. До сих пор нет единой точки зрения по вопросу выбора имплан-та. В статье представлены результаты сравнительного анализа лечения новорожденных (n = 40) с левосторонней ложной ВДГ. Всем пациентам была выполнена торакоскопическая пластика купола дифрагмы. По типу использо-ванного имплантационного материала детей разделили на две группы: для первой (n = 16) применяли синтетичес-кие импланты «Экофлон» («НПК "Экофлон"», Россия), для второй (n = 24) -биологические импланты Permacol (Tissue Science Laboratories, Великобритания). Результаты исследования показали преимущества биологичес-кого импланта: время операции при его использовании было меньше (106 мин против 144 мин при использова-нии «Экофлона», p <0,05); число рецидивов -также меньше (28 % против 54 %, однако p >0,05); случаев от-торжения импланта не было (при использовании «Экофлона» у двух пациентов началось воспаление, p <0,05).Congenital diaphragmatic hernia (CDH) is an absolute indication for surgical treatment. In case of extensive defects of the diaphragm, such as diaphragmatic aplasia, the use of implants is required. So far, there is no unanimous opinion on the type of the implant. The article presents a comparative analysis of treatment of 40 newborns with left pseuso-CDH. All patients received thoracoscopic repair of the diaphragmatic cupula. The patients were divided into two groups according to the type of the implant: 16 newborns received Ecoflon synthetic implants (Ecoflon Scientific and Production Complex, Russia) and 24 newborns received Permacol biologic implants (Tissue Science Laboratories, UK). The study demonstrated the advantage of the biologic implant over the synthetic one: the surgery took less time (106 minutes compared to 144 minutes with Ecoflon, p <0.05); relapses were also more rare (28 % and 54 %, respectively; however, p was >0.05); no implant rejection was observed (with Ecoflon, two patients responded with inflammation, p <0.05).Ключевые слова: новорожденные, врожденная диафрагмальная грыжа, торакоскопия, имплант, имплантационный материал, «Экофлон», Permacol
BACKGROUND: The right-sided congenital diaphragmatic hernia is the rare pathology. Results of diagnostics, prognosis and treatment usally published as a collection of cases. AIM: Comparition of treatment results of congenital diaphragmatic hernia with the liver as its content in dependancy of the side. MATERIALS AND METHODS: We present a retrospective analysis of 50 newborn patients with congenital diaphragmatic hernia. Patiens were divided in two groups, first with right-sided (19 patients), and second with left-sided hernia (31 patients). Groups were compared by gender and weigth. Comparition criteria was the results of prenatal and postnatal diagnostics, intraoperative data, postoperative period, complications and outcomes. RESULTS: We found predominance of prenatal diagnosis in the second group (48% vs 84%, p = 0,001). The lung-to-head circumference ratio were the same in both groups (0,52 in first, 0,46 in second, p = 0,058). Chance to use thoracoscopic approach in the second group was higer in 5,7 times (48% vs 84%). Postoperative period was easier in the group of right-sided congenital diaphragmatic hernia: artificial ventilation lasted on average 8 days (min 3; max 28) versus 11 (min 4; max 50) days in the first group (p = 0,036). Hospital stay was significantly lower in the second group 18 days (min 12; max 28), versus 50 days in the first group (min 13; max 64), p = 0,011. Recovery chance in patients with right-sided hernia was higher (45% vs 79%, confidence interval 0,0590,814). CONCLUSIONS: Every type of diaphragmatic hernia, including right-sided location, need to be the subgect of research of high compitantive center. Prognostic criteria for right-sided congenital diaphragmatic hernia require furter advanced study, wich is possible only in case of concentration of patients in the same center.
An abscess of the round ligament of the liver in children, as a result of an inflammatory process, often leading to necrosis, is an extremely rare occurrence. Formations in the round ligament of the liver must be differentiated from liver tumors, which can be diagnosed using instrumental research methods. In the available literature on the abscess of the round ligament of the liver, the authors speak about the preference for complete excision of the ligament. However, analyzing the experience (5 clinical examples are given) of the surgical clinic of the N. F. Filatov Children’s City Clinical Hospital (Moscow, Russia), the most preferable and safe are puncture and drainage of the abscess cavity from the anterior abdominal wall under visual control of manipulation using a laparoscope.
Background. Ureterocele is a cystic dilatation of the distal ureter. Orthotopic ureterocele is relatively rare form of this disease, and it is commonly diagnosed in female children. The clinical picture of orthotopic ureterocele is usually not significant, and the management variants are unclear. Clinical case description. Ultrasound has revealed dilatation in the distal part of the left ureter (up to 6.5 mm) and cyst formation (diameter of 8 mm, thick walls) in the bladder in 8-months-old boy. The retrograde voiding cystourethrogram has shown no signs of vesicoureteral reflux. The evaluation of the voiding rhythm was performed: the volume of residual urine was > 30%, it indicates the infravesical obstruction. The child underwent diagnostic cystourethroscopy, transurethral resection of the ureterocele, intubation ureteral catheter in the left ureter (all procedures was performed under general anesthesia). There were no enlargements of calices-pelvis system and ureters 12 months after surgery according to urinary system ultrasound. Clinical urine test with no inflammatory changes. Voiding rhythm was without pathology.Conclusion. The widespread implementation of high-tech and minimally invasive methods of diagnosis and management allow us to achieve timely detection and provide effective treatment for children with ureterocele.
BACKGROUND: The preserved cloaca is a particular type of anorectal anomaly. The combination of urological, genital, and rectal abnormalities makes radical reconstruction difficult. MATERIALS AND METHODS: This study examined operations performed in 50 patients with persistent cloaca treated from 2010 to 2021. Two groups are presented: the first with 35 children and a short canal (3 cm), and the second with 15 children and a long canal (3 cm). We examined the prognosis for bowel control, the type of operation, the need for vaginal reconstruction, complications after surgery, and the days of hospital stay. RESULTS: Anomalies of the Mllerian ducts in the second group (94%) were higher than in the first (36%) (p 0.001). The sacral index and myelodysplasia did not differ in both groups. The sacral index in the first group was 0.62 0.14, and in the second group, it was 0.58 0.14 (p = 0.520). Myelodysplasia in the first group was 33%, and in the second group, it was 38% (p = 0.744). Total urogenital mobilization (51%) was used in the first group, and abdominal reconstruction (54%) was used in the second group. Vaginal reconstruction was required in 28% of patients in the first group and 60% in the second group. Complications were 3.5 times more likely in the first group (60% versus 17% in the second) (p = 0.003). The length of hospital stay in patients in the second group was longer than that of patients in the first group. CONCLUSION: Our study data demonstrate that the reconstruction of a persistent cloaca requires individual planning of the operation, considering the length of the canal and the state of all structures forming the cloaca.
BACKGROUND: Duodenal atresia is one of the most common malformations of the intestine in newborns. Both open surgical interventions and the laparoscopic method eliminate duodenal obstruction. AIM: This study conducts a comparative analysis of the results of treating newborns by these methods. MATERIALS AND METHODS: This paper summarizes the experience of treating 185 newborns operated in the clinic for duodenal obstruction. Two groups of patients are presented: the first included 110 children operated on laparoscopically, the second included 75 patients operated on by the open method. Both groups are comparable regarding newborn anthropometric data, age at the time of surgery, and the presence of concomitant anomalies. The study considered indicators characterizing the surgical intervention and the course of the postoperative period. RESULTS: In a series of studies, there were no differences between groups in interpreting the cause of obstruction (p = 0.184) and the presence of an incomplete turn (p = 0.134). Operating time in the laparoscopy group was higher than in the laparotomy group (75 min and 70 min, p 0.001). However, the reduced duration of mechanical ventilation, earlier initiation of feeding, transition to complete enteral nutrition and reduced length of hospital stay suggest the benefits of laparoscopy over laparotomy for treating congenital duodenal obstruction (p 0.001). The frequency of postoperative complications is not high in both groups (p = 0.634). The analysis results showed that laparoscopy does not complicate the intraoperative interpretation of organ relationships, provides a more favorable course during the postoperative period, and does not increase the number of postoperative complications. CONCLUSION: The laparoscopic method improves medical efficiency in treating newborns with duodenal obstruction than open surgery.
Introduction. Surgical treatment of intestinal atresia with distal tracheoesophageal fistula involves resection of fistula and intestinal primary anastomosis. However, premature children often have complications associated with delayed anastomosis. Thus, an optimal surgical approach is not determined. Purpose. Analyzing treatment results in newborns with intestinal atresia and very low weight. Materials and methods. Treatments outcomes in infants with intestinal atresia and very low weight (less than 1500 g) from 2008 to 2017 were assessed retrospectively. The patients were divided into 2 groups: (1) fistula dressing and crossing with subsequent delayed anastomosis reconstruction and (2) primary anastomosis. Demographic, surgical and postoperative complications were compared. Results. 23 preterm children with IA/TEF were operated. Twelve patients (52%) underwent primary anastomosis, whereas 11 (48%) of them had a stepwise surgery. Anastomotic leak confirmed by esophagram was similar in both groups (17% and 18%). Stenosis was more common in step-wise surgery (83%) as compared to the group of primary anastomosis (27%) (р<0.05). The esophagus was preserved in two patients who underwent step-wise surgery. 4 patients had coloesophagoplasty. The postoperative period was similar in both groups. 6 patients (50%) from the step-wise group and 5 patients (45%) from the group of primary anastomosis died. Conclusion. Staging plasty of IA/TEF in newborns does not improve the quality of life. In this group, gastro- and esophagostomy exteriorization is a preferable surgical approach.
Introduction. The open Ladd surgery is a standard treatment of intestinal malrotation. After implementing laparoscopic techniques into clinical practice, the number of reports on successful treatment of this defect with minimally invasive laparoscopic techniques is growing. However, publications on such correction of the defect in newborns are rather scarce.Purpose. To improve management of newborns with intestinal malrotation.Material and methods. Retrospective and prospective analyses of 77 newborns with intestinal malrotation, treated in 2002–2020, have been made. The studied group included 35 newborns; the control group – 42. StatTech program was used for statistical data processing.Results. Groups were comparable in anthropometric indicators, gender composition, gestational age. The following differences were revealed during the study: laparoscopic surgery lasts longer than the open surgery. The intensive care period was uneventful in the studied group. Passage through the intestine was restored faster, enteral feeding started earlier in the laparoscopic group too. The number of bed days in patients operated with minimally invasive techniques was less , if to compare to the control group with open surgery. After the open surgery, children often required intestinal stimulation in order to restore passage through the gastrointestinal tract. The incidence of complications does not depend on the applied surgical technique. Relapses in both groups are comparable; the leading factor in developing relapses is violations of surgical techniques.
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