Ранні та віддалені результати після операції Soave-Boley при хірургічному лікуванні агангліозу кишечника у дітей

Abstract

Introduction. Сolon agangliosis (CA) belongs to a group of severe congenital malformations of the colon that can only be treated by surgical approach. The Soave-Boley technique is one of the most physiological and technically acceptable among pediatric surgeons from from all over the world. Aim – evaluate the early and long-term results of surgical treatment of CA in children by Soave-Boley method. Materials and methods. We analysed surgical treatment of 774 children with various forms of CA aged from birth to 18 years for the period from 1980 to 2020, using the Soave-Boley method by the formation of the primary colo-anal anastomosis by manual (suture) and mechanical (stapler) method. Results. All patients survived. Early postoperative surgical complications were seen in 19 (2.45%) of 774 children operated by Soave-Boley method: in 15 – after the formation of the primary colo-anal anastomosis by manual (sutures) method and 4 – after the imposition of a colo-anal anastomosis by mechanical (stapler) method. Long-term postoperative complications were noted in 15 (1.94%) of 774 children operated by Soave-Boley method: 14 – with a manual (suture) and 1 – with a mechanical (stapler) colo-anal anastomosis. Re-operation was successfully performed in 30 (3.87%) patients with reconstructing colo-anal anastomosis manually with Soave-Boley method after initial correction of CA in other clinics by other methods. Periodic episodes of soiling were seen in the remote period in 47 (6.07%) of 774 operated children which was treated conservatively. The success of the Soave-Boley technique is confirmed by a much lower number of early (2.45%) and long-term (1.94%) postoperative surgical complications, compared with those after the use of other methods of open surgical correction – 17.52% and 16.35%, respectively. Conclusions. Soave-Boley operation with colo-anal anastomosis by manual (suture) and mechanical (stapler) methods in comparison with other methods is the most effective method of radical correction of CA as open surgical approach in children of different age groups as single staged or double staged interventions. According to the technical capabilities and results of the early and long period, the Soave-Boley technique with colo-anal anastomosis by manual (ligature) method is the operation of choice for both primary and re-surgical correction of CA compared to any other methods. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of participating institution. No conflict of interest was declared by the authors. Key words: agangliosis, colon, children, surgical treatment, results.