COMPARATIVE ASSESSMENT OF SURGICAL TREATMENT OF COMPLICATIONS OF ULCERATIVE COLITIS IN CHILDREN.

Ulcerative colitis is an inflammatory disease of the colon, characterized by a chronic relapsing course, affecting only the colon with hemorrhagic-purulent inflammation of the mucous and submucosal layer of the intestinal wall, as well as the frequent development of local and systemic complications. The incidence of ulcerative colitis is increasing every year. Objective - improving the results of surgical treatment of ulcerative colitis in children through the use of laparoscopic and video-assisted technologies in clinical practice. The work carried out the analysis of the case histories of 75 (boys - 34, girls - 41) children with ulcerative colitis who were treated in surgical departments of Baku and Moscow - over a 12-year period - from 2010 to 2022. This study was a retrospective cohort analysis with prospective database completion. The main clinical group (Group 1) of the study included 53 children with ulcerative colitis (UC), who underwent surgical treatment for abdominal complications using minimally invasive laparoscopic techniques developed in the clinic. There were 25 boys (47.2%), girls - 28 (52.8%). The age of the children ranged from 4 to 17 years. It is characteristic that the main group of patients with UC consisted of adolescent children. Comparative Group 2 in our study included 22 children with UC - 9 boys (40.9%), girls 13 (59.1%), in whom surgical treatment of complications was carried out using previously generally accepted "open" surgical techniques - classical emergency and planned operations - colectomy and proctocolectomy - using wide laparotomy approaches. The technique of laparoscopic total proctocolectomy with direct ileoanal anastomosis, developed and adopted in our clinic, is an effective method of treatment for this serious disease, not inferior to "open" operations in any aspect of versatility, convenience, radicality, etc. Laparoscopic operations can be performed and indicated in almost all clinical situations in children with complicated inflammatory bowel diseases, for emergency indications and routinely, as well as during radical surgical treatment for ulcerative colitis. Endosurgical ostomy operations, total proctocolectomy, ileal retraction with the formation of ileoanal anastomosis are an effective and safe method of treatment in these complex groups of patients.

[Rehbein procedure for secondary megacolon in children]. / Operatsiia Rebeina pri vtorichnom megakolon u detei.

AIM: To evaluate the results of Rehbein procedure with extraperitoneal colorectal anastomosis combined with complex conservative treatment in children with secondary megacolon due to chronic constipation. MATERIAL AND METHODS: We carried out surgical interventions in 78 children aged 7-12 years with chronic colostasis resistant to conservative treatment. All patients underwent clinical, laboratory and instrumental examination. All patients were divided into 3 groups depending on type of surgery: group I - colon resection followed by intraperitoneal colorectal anastomosis (28 patients), group II - open Rehbein procedure (29 patients), group III - laparoscopic Rehbein procedure (21 patients). RESULTS: Absence of dyspeptic disorders and enterocolitis in remote postoperative period in patients receiving comprehensive treatment enhanced with new additions is the cause of improved outcomes. Type of surgery should be individualized in view of anatomical colon changes and secondary pathological conditions. Some pathological symptoms observed at preoperative period may be recurrent in long-term postoperative period due to wrong selection of surgery. The risk of recurrent chronic constipation is high after colon resection followed by intraperitoneal colorectal anastomosis. CONCLUSION: Rehbein procedure may be preferred for management of secondary megarectum and megasigma. Laparoscopic technique reduces surgical trauma and requires less postoperative analgesia.

[АNORECTAL DYSFUNCTION, OCCURRING AFTER SURGICAL TREATMENT OF HIRSCHPRUNG'S DISEASE AND ITS CORRECTION].

Results of examination and treatment of 12 children, operated on in various clinics for Hirschprung's disease, in whom chronic constipation and other signs of anorectal dysfunction have occurred, were analyzed. In 8 patients Duhamel-Bairov operation was conducted, in 2 ­ Soave-Lenyushkin operation, and in 2 ­ Soave-Boley operation. The main cause of postoperative chronic constipation occurrence after Duhamel operation is the colorectal septum preservation. The only one radical method of treatment of this complication is a transanal removal of colorectal septum. The cause of anastomotic narrowing after Soave-Boley operation was absence of myotomy intraoperatively and of bougienage ­ after it. Elimination of chronic constipation in such patients, using long-standing bougienage and complex conservative treatment. The main cause of chronic constipation and nocturnal encopresis after Soave-Lenyushkin operation was preservation of the tissue excess while doing resection of a large bowel stump and creation of the narrowed ring, looking like a pendent plica. Complete reconvalescence of such patients is possible in transanal method of excision of stenosing ring and conduction of complex treatment.

[The ileocoecal valve changes in chronic constipation in children].

There were analyzed the results of treatment of 574 children, suf fering anatomic anomalies of a large bowel, in whom a chronic constipation was revealed. In 61 patients the ileoceocal valve (IV) insufficiency was noted. To all the patients together with complex conservative treatment there was prescribed a preparation, containing magnesium orotat, for restoration of the IV insufficiency. In 56 (91.8%) patients conservative treatment was effective and in 5--surgical intervention was conducted as a consequence of ineffective conservative treatment. Negative correlation dependence was established between a patient age and results of treatment.