Features preoperative preparation and postoperative treatment of chronic colostasis in children with congenital colon

Abstract

The article presents an algorithm of preoperative preparation and postoperative rehabilitation of children who have been operated on for chronic colostasis. Objective . To develop the algorithm preoperative and postoperative rehabilitation of children operated on for congenital colon. Material and methods . During the period from 2006 to 2015 at the Department of Pediatric Surgery Bukovina State Medical University at the clinic of pediatric surgery (Chernivtsi) with chronic stasis of large intestine not ganglion genesis was operated on 43 children aged 2 to 18 years.To assess the effectiveness of the proposed treatment, the children were divided into two groups, group I (preoperative and postoperative treatment in the traditional way) - Comparative (21 children), II group (offered improved treatment) - research (22 children). The clinical course was allocated on compensated ,decompensated and subcompensated form of colostasis . Results and discussion . The indications for surgical treatment of congenital colon were - disease progression (increase in the duration of constipation, increased pain and symptoms of fecal toxicity), clinical recurrent bowel obstruction, lack of effect of conservative therapy for 1 year, subject to - the presence of dolichosigma in children older than 5 years ,Payra disease in children older than 13 years. Performed surgical interventions. At case of dolichosigma transanal endorectal down the colon with colo-recto-abouchement by Soave-Boley (n = 6); sigmoidectomy with colo-ascendo-abouchement “end to end” with the formation of the distal copula of colon (n = 10); the intersection of the left colo-diaphragma copula; sigmoidectomy, lowering of colon with descendo-recto-abouchement by Soave-Krivchenia (n = 2); the intersection of the left colo-diaphragma copula, sigmoidectomy with colo-recto-abouchement “end to end” with and formation of the distal copula of colon (n = 11). Disease Payra - resection of the transverse colon and overlay anastomosis “end to end”, and fixation of the left bend colon to the back-side of the abdominal wall in the physiological place (n = 13) Cyilaiditi's syndrome - withdrawal from subphrenic space right parts of colon, resection of the colon right bend with ascendo-transperso-abouchement “end to end” and right-hand colon fixing of ascendo-transperso-bend, hepatopexy (n=1). Conclusions . It is expected that the success of surgical treatment of children with chronic colostasis due to congenital colon depends on the individual chosen method of surgery, preoperative preparation and postoperative treatment. Deleting a particular segment of the colon and the child's need to adapt the organism to new physiological conditions anatomical existence of the colon is the basis for the choice of methods of preoperative preparation and postoperative rehabilitation of children with chronic colostasis. In the preoperative period in children with congenital colon appropriate to include retrograde and orthograde cleaning the colon, diet, and medication support for the proposed algorithm. The complex postoperative rehabilitation measures appropriate to add: intravenous infusions of ozonated physiological NaCl solution at a concentration of 2.5 mkg / l and intrarectally electrical stimulation when faecal incontinence.