ЛАПАРОСКОПИЧЕСКАЯ ФУНДОПЛИКАЦИЯ НИССЕНА У НЕДОНОШЕННЫХ ДЕТЕЙ, НАХОДЯЩИХСЯ В УСЛОВИЯХ ПАЛАТЫ ИНТЕНСИВНОЙ ТЕРАПИИ

Abstract

The present study focuses on registration of early postoperative changes based on a comparison of the clinical parameters of respiratory and nutritional support after laparoscopic Nissen fundoplication in premature infants in an intensive care unit. Materials and methods of research: a retrospective continuous single-center study was carried out. In the course of the study, the medical records of all infants with a body weight of less than 2500 g and gestational age less than 37 weeks, who underwent laparoscopic antireflux procedures, were studied for the period from January 2012 to December 2019. 25 patients met this criteria, 12 (48%) of which were female and 13 (52%) were male. Standard laparoscopic procedure was Nissen fundoplication. At the final stage of the study, perioperative data and complications that occurred in the early and longterm follow-up period were studied. Results: the average weight of patients was 1560.0±450.4 g (median 1600.0 [1200.0; 1950.0] g). Infants with gastroesophageal reflux were on various modes of respiratory therapy: 50% – mechanical ventilation (MV), 50% – oxygen therapy. The average duration of operation was 35.4±8.2 min (median 35.0 [30.0; 40.0] min). The average daily weight gain before and after surgery, measured during the first 28 days after surgery, was 15.3±2.1 g/day, respectively (median 15.0 [14.0; 16.0] g/day) and 24.9±1.8 g/day (median 25.0 [24.0; 26.0] g/day) (p<0.001). The assessment of the severity of lung disease based on the determination of the concentration of O2 in the inhaled mixture (FiO2) before surgery and 7 days after it, a statistically significant (p<0.001) decrease in the child's body oxygen demand for adequate gas exchange from 34.4±3,9% (median 35.0 [30.0; 37.5]%) to 23.1±3.4% (median 21.0 [21.0; 25.0]%). The need for invasive MV significantly decreased from 68 [47; 85]% up to 20 [7; 41]% (p<0.001), in noninvasive MV – from 32 [15; 54]% up to 20 [7; 41]%, but this decrease was statistically insignificant (p=0.084). The ability to breathe spontaneously appeared in 60% of patients (0 [0; 14]% versus 60 [39; 79]%; p=0.002). Postoperative complications included recurrent reflux was in one patient (4 [0; 20]%), which required repeated fundoplication in the long-term follow-up period. Conclusions: thus, laparoscopic antireflux surgery is possible in premature infants. These surgical procedures are well tolerated by infants and can improve their quality of life.