ENDOSURGICAL TREATMENT OF DIGESTIVE TRACT ATRESIAS – BREAKTHROUGHS IN PEDIATRIC SURGERY OF THE XXI CENTURY
Authors:   Irkutsk Oblast Regional Children's Clinical Hospital, Irkutsk, Russia, Kozlov Yu.A. ,   Irkutsk State Medical Academy of Postgraduate Education, Branch of the Russian Medical Academy for Continuous Professional Education, Irkutsk, Russia,   Irkutsk State Medical University, Irkutsk, Russia, Poloyan S.S. ,   Irkutsk Oblast Regional Children's Clinical Hospital, Irkutsk, Russia,   Irkutsk State Medical University, Irkutsk, Russia, Bregel L.V. ,   Irkutsk Oblast Regional Children's Clinical Hospital, Irkutsk, Russia,   Irkutsk State Medical Academy of Postgraduate Education, Branch of the Russian Medical Academy for Continuous Professional Education, Irkutsk, Russia,   Irkutsk State Medical University, Irkutsk, Russia, Kovalkov K.A. ,   Kemerovo Oblast Regional Children’s Clinical Hospital, Kemerovo, Russia, Ochirov Ch.B. ,   Kemerovo Oblast Regional Children’s Clinical Hospital, Kemerovo, Russia, Mochalov M.N. ,   Irkutsk City Ivano-Matreninskaya Children's Clinical Hospital, Irkutsk, Russia, Kapuller V.M. ,   Faculty of Medicine with the Ben-Gurion University of the Negev (BGU), Ashdod, Israel, Narkevich A.N. ,   Krasnoyarsk State Medical University named after Prof. V.F. Voino-Yasenetsky, Krasnoyarsk, Krasnoyarsk Krai, Russia
Published: May 2022

The paper reports the findings of well-known and new endosurgical operations to restore the lumen of various sections of the digestive tract in atresia, starting with the esophagus and ending with the colon, and a comparative analysis of the minimum invasive and traditional treatment of these anomalies has been carried out. Materials and methods of research: a multicenter retrospective cohort study presents the results of 540 cases of anastomoses performed in newborns with atresia of various segments of the digestive tract in 3 surgical centers located in Irkutsk, Kemerovo and Krasnoyarsk. The study covers the period from January 2002 to July 2020. Patients were divided into two groups: Group I – 238 patients who underwent endosurgical correction of atresia; Group II – 302 patients who underwent anastomoses using open surgery. The selected groups did not significantly differ by gender, birth weight, age at the time of surgery and the gestation period. Depending on the level of intestinal segment connectivity, all patients were distributed as follows: esophagus – 239 (44.2%); duodenum – 211 (39.1%); small intestine – 70 (13.0%); colon – 20 (3.7%) patients. In the final part of the study the demographic data of patients, intra- and postoperative parameters, as well as complications during treatment were statistically analyzed. Results: patients of the compared groups had the same demographic parameters. Statistically significant differences were discovered in the analysis of operative intervention timelapse between endosurgical and open interventions (70.0 [55.0; 90.0] min versus 95.8 [75.0; 115.0] min, p<0.001). The beginning of enteral nutrition and the transition time for full enteral nutrition were statistically significantly lower in the group of minimally invasive surgery compared to open access (4.5 [2.5; 7.0] against 8.0 [4.5; 11.0 ] days, р<0.001; and 8.0 [5,5; 12,5] days versus 12.0 [7.5; 18.0] days, p<0.001). The mortality in the open surgery group was 6.6 [4.1; 10.0] %, which is statistically significantly different from mortality in the laparoscopy group (0 cases, p<0.001). The reasons for mortality were the concomitant conditions: prematurity, sepsis, congenital heart defects. Conclusion: the study shows that endosurgical anastomoses can be safely and successfully performed even in newborns. Thoracoscopy and laparoscopy, as demonstrated in the study, contribute to the accelerated restoration of patients after surgery and favorable course of the postoperative period.