ЛАПАРОСКОПИЧЕСКИЕ АНАСТОМОЗЫ ПРИ КИШЕЧНОЙ АТРЕЗИИ: НОВЫЕ ВЫЗОВЫ В ДЕТСКОЙ МИНИМАЛЬНО ИНВАЗИВНОЙ ХИРУРГИИ

Abstract

This scientific paper provides known and new endosurgical operations that were used to restore the intestinal lumen in case of atresia, and a comparative analysis of laparoscopic and open treatment of these anomalies was performed. Materials and methods of research: this scientific study presents the results of 301 cases of intestinal anastomoses performed in newborns with intestinal atresia in two surgical centers located in Irkutsk and Krasnoyarsk. The study covers a period of time of 15 years, starting from January 2005 and ending in July 2020. Patients were divided into 2 groups: group 1 – 112 patients who underwent laparoscopic treatment of intestinal atresia; group 2 – 189 patients who underwent intestinal anastomoses using laparotomy. Depending on the level at which the intestinal segments were connected, all patients were distributed as follows: duodenum – 211 (70.1%), small intestine – 70 (23.3%), colon – 20 (6.6% ) patients. In the final part of the study, demographic data, intra- and postoperative parameters, as well as treatment complications were statistically analyzed. Results: patients of the compared groups had the same demographic parameters. There were significant differences in operative time between laparoscopic and open procedures (60.0 [45.0; 83.8] min vs. 100.0 [72.5; 110.0] min; p<0.001). The start of feeding and the time to transition to full enteral nutrition were significantly shorter in the laparoscopy group compared with the open approach (3.0 [2.0; 5.0] vs. 7.0 [5.0; 8.0] days, p<0.001 and 7.0 [5.0; 10.0] versus 11.0 [8.0; 16.0] days, p<0.001). Mortality in the laparotomy group was 3.2 [1.2; 6.8]%, which had no statistically significant difference from mortality in the laparoscopy group (0 cases, p=0.088). Mortality was due to concomitant conditions (prematurity, sepsis, congenital heart defects). The incidence of all complications in the laparoscopy group (4.5 [1.5; 10.1]%) was statistically significantly less than in the open surgery group (14.3 [9.6; 20.1]%, p=0.008). Such postoperative complications as adhesive intestinal obstruction and ventral hernias were not registered in the laparoscopy group, and in the laparotomy group the incidence of obstruction was 3.7 [1.5; 7.5]% (p=0.048), incidence of ventral hernia – 3.7 [1.5; 7.5]% (p=0.048). Conclusion: the present study shows that laparoscopic intestinal anastomoses can be safely and successfully performed even in newborns. Laparoscopy, as demonstrated in the study, contributes to the accelerated recovery of patients and the favorable course of the postoperative period.