Intestinal anastomoses in newborns and children of early age in complicated clinical cases

Abstract

The application of intestinal anastomoses in newborns and young children under circumstances of multiple atresia, thrombohemorrhagic processes and infection of the abdominal cavity can be complicated by the development of inconsistency of the anastomoses. In the study, the analysis of the results of treatment of 385 children with intestinal anastomoses due to diverse intestinal pathology in newborns and young children over the last 5 years have been performed. All the patients have been on treatment at the Children’s Clinical Hospital of Kharkov National Medical University. We have gained the experience of application of the original anastomosis in 64 children, namely: with complex intestinal malformations (29), necrotizing enterocolitis (25), ulcerative necrotic enterocolitis (6), and other pathology of the abdominal cavity organs. Indications for use of the developed technique of intestinal anastomosis have been pathological processes complicating the course of the wound process and predicted long-term disorders of the digestive tract evacuation. The characteristic property of the anastomosis technique is a preliminarily semi-enclosed demucosation of the proximal intestinal loop with the excessively reserved seromuscular sheath, which allows to define clearly the limits of viability and isolate reliably the suture line long the whole length using the sutural or glue fixation by the demucosated part. The method does not prolong practically the time for application of the intestinal anastomosis in comparison with standard techniqies. One of the patients have undergone 7 anastomoses, five children - 3, and ten children - 2. In none of the cases of the “muff-shaped” anastomosis application has the dehiscence occured. The study of the autopsies has showed preserved viability of demucosated flaps. The analysis of long-term results using the developed method of intestinal anastomosis, taking into account a growing organism, has demonstrated absence of stenotic phenomena and passage problems in the connected segments of the intestine. Thus, the experience of application of muff-shaped anastomosis allows to make a conclusion about its high reliability in newborns and children of early age with complex surgical situations.