Search

Introduction. The transoral endoscopic surgery performed through the natural orifices of the human body can reduce the rate of complications associated with surgical procedures and general anesthesia.The aim of the present study was to reveal potentials in restoring the duodenal patency using NOTES technologies.Material and methods. The researchers assessed outcomes of surgical treatment of 4 patients with partial congenital duodenal obstruction who were operated on in two medical institutions of the Siberian Federal District: Ivano-Matreninsky Children’s Clinical Hospital in Irkutsk 2 patients and Maternity and Childhood Center in Krasnoyarsk 2 patients. The trial period lasted over the past 5 years, since January 2015. Two endoluminal techniques for restoring the duodenal patency were used balloon dilatation of stenosis and endoscopic membranotomy. In the final part of the study, demographic data, intraand postoperative parameters and treatment outcomes were analyzed.Results. All endoscopic procedures were successfully completed without conversion to laparotomy. In average, it took 25 minutes to restore the lumen of the duodenum (range 20-30 minutes). One patient showed moderate bleeding from the destroyed membrane after balloon dilatation which was stopped by electrocoagulation. Patients’ follow-up revealed that in one of them the disease returned one month later after the balloon dilatation. Repeated balloon dilation relieved the patient of the disease symptoms.Conclusion. Endoluminal techniques for treating congenital partial duodenal obstruction are feasible and can be successfully performed in most patients. Our experience has shown that this surgery can be done by both balloon dilatation and by endoscopic membranotomy.

Introduction. This study describes authors’ experience in performing laparoscopic pyeloplasty in infants whose age does not exceed 3 months of life, and compares pre- and postoperative results of these surgeries in order to answer the question - does the laparoscopic technology for the treatment of hydronephrosis in newborns and infants provide acceptable results based on improving kidney morphology and function? Material and methods. 105 children, aged 3 months, were enrolled into this retrospective study who for 8 years, since 2012, have been laparoscopically operated on for congenital hydronephrosis. Because of bilateral renal damage, a total of 110 surgeries were performed, including simultaneous pyeloplasty in 5 patients. All patients had dismembered pyeloplasty with the Anderson-Hynes technique via transparietal laparoscopic access. Indications for surgery were: decreased renal function with obstruction signs of urine outflow from the pelvis confirmed by radioisotope renography; a combination of reduction of parenchyma thickness and increase of pelvis diameter at serial ultrasound studies; or a combination of these pathologies with urinary tract infection. During the trial, the following parameters were recorded: demographic data, findings of perioperative diagnostic examinations, surgical details, recovery process after surgery and long-term consequences. Results. The average age of patients was 50.24 days. Of 105 patients, 60 (57.14%) were less than 1 month old, and the remaining 45 (42.86%) were 1-3 months old. Gender distribution in groups was as follows: m / f = 73:32. Unilateral operations on the left kidney were in 61.82% patients, on the right kidney - in 33.64% patients. 4.54% patients had bilateral pyeloplasty. Average duration of surgery was 73.07 minutes (40-120 minutes). The average length of hospital stay was 4.19 days (2-9 days). At the early postoperative period, 4 (3.6%) patients developed postoperative complications - urinoma formation. A comparison of pre- and postoperative renal morphometry findings by ultrasound and Doppler ultrasound examination showed a significant decrease of renal pelvis dimensions and improved renal blood flow. The pelvis size decreased in average from 23.5 to 5.5 mm (p = 0.001), and RI from 0.72 to 0.64 (p = 0.001). Functioning of the operated kidney, as showed by the radioisotope renography, improved from 34 to 45.27 (p = 0.001). Long-term follow-up observation revealed one relapse of the disease (0.9%) - stenosis of pyeloureteral anastomosis which required a repeated laparoscopic pyeloplasty. One patient (0.9%)/ who was under follow-up observation for 36 months, had deterioration and loss of kidney function without signs of renal obstruction at the level of pyeloureteral segment which required laparoscopic nephrectomy. Thus, taking into account one relapse and loss of kidney function in one patient, we can state that the effectiveness of laparoscopic pyeloplasty in our study was 98.2%. Conclusion. Summarizing results of the applied laparoscopic pyeloplasty in the youngest group of patients whose age does not exceed 3 months of life, it can be stated that the minimally invasive approach contributes to normalizing morphological and functional parameters of kidney.

To summarize data of a multiple-center study of the treatment of duodenal atresia in 3 children's hospitals of the Siberian Federal District.We analyzed postoperative outcomes in 211 patients with duodenal atresia. All patients underwent surgery at various hospitals of the Siberian Federal District: Ivano-Matreninsky Children's Clinical Hospital in Irkutsk (expert hospital) - 120 patients; Center for Maternal and Child Welfare in Krasnoyarsk (learning hospital No. 1) - 51 patients; Kemerovo Regional Children's Clinical Hospital (learning hospital No. 2) - 40 patients. The study has been carried out for 15 years (from January 2005 and to December 2019). Patients were divided into 2 cohorts: group I - 88 patients (laparoscopic formation of duodenal anastomosis); group II - 123 patients (surgery via laparotomy). Demographic data, intra- and postoperative parameters and complications were analyzed.Preoperative parameters were similar in both groups. Significant between-group differences were found for surgery time (70 vs. 90 min;Laparoscopic correction of duodenal atresia can be safely performed by experienced endoscopic surgeons from different centers united by the same ideology of endoscopic surgery. Laparoscopy ensures less duration of surgery, faster postoperative recovery, less mortality, incidence of early and late postoperative complications.Представлены обобщенные данные мультицентрового лечения дуоденальной атрезии в 3 детских госпиталях Сибирского федерального округа.Изучены итоги хирургического лечения 211 больных дуоденальной атрезией из различных лечебных учреждений Сибирского федерального округа: Ивано-Матренинская детская клиническая больница Иркутска (экспертный госпиталь) — 120 пациентов; Центр материнства и детства Красноярска (обучающийся госпиталь №1) — 51 пациент; областная детская клиническая больница г. Кемерово (обучающийся госпиталь №2) — 40 пациентов. Исследование проводили на протяжении 15 лет, с января 2005 г. по декабрь 2019 г. Больных распределили на две группы: в 1-й — анастомоз двенадцатиперстной кишки выполнили лапароскопически (Сравниваемые группы имели одинаковые дооперационные параметры. Обнаружены статистически значимые различия в длительности операции между лапароскопическими и открытыми процедурами (70 мин против 90 мин;Лапароскопическая реконструкция дуоденальной атрезии может быть безопасно выполнена опытными эндоскопическими хирургами из разных центров, объединенных одной идеологией выполнения эндохирургических операций. При сопоставлении итогов лечения лапароскопический доступ демонстрирует результаты, превосходящие результаты открытой хирургии, включая сокращение длительности операции, ускоренное послеоперационное восстановление пациентов, снижение летальности, а также частоты ранних и поздних послеоперационных осложнений.