LAPAROSCOPIC SANTULLI INTESTINAL ANASTOMOSIS IN AN INFANT WITH CYSTIC FIBROSIS
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, 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, Rasputin A.A. ,   Irkutsk City Ivano-Matreninskaya Children's Clinical Hospital, Irkutsk, Russia, Baradieva P.J. ,   Irkutsk City Ivano-Matreninskaya Children's Clinical Hospital, Irkutsk, Russia, Zvonkov D.A. ,   Irkutsk City Ivano-Matreninskaya Children's Clinical Hospital, Irkutsk, Russia, Ochirov Ch.B. ,   Irkutsk City Ivano-Matreninskaya Children's Clinical Hospital, Irkutsk, Russia, Mochalov M.N. ,   Irkutsk City Ivano-Matreninskaya Children's Clinical Hospital, Irkutsk, Russia, Cheremnov V.S. ,   Irkutsk City Ivano-Matreninskaya Children's Clinical Hospital, Irkutsk, Russia, Poloyan S.S. ,   Irkutsk Oblast Regional Children's Clinical Hospital, Irkutsk, Russia, Sandakov Ya.P. ,   Irkutsk State Medical Academy of Postgraduate Education, Branch of the Russian Medical Academy for Continuous Professional Education, Irkutsk, Russia, Kapuller V.M. ,   Assuta Ashdod Medical Center with the Ben Gurion University's Medical School, Ashdod, Israel
Published: November 2021

The aim of the study was to evaluate the technical feasibility of performing a Santulli-type side-toend inter-intestinal anastomosis in infants with cystic fibrosis (CF) using laparoscopy. A clinical case of a 3-month-old child with CF who was operated on in the neonatal period for meconium ileus is presented. The baby's gestational age was 32 weeks. The primary operation consisted of the formation of a terminal enterostomy. In the postoperative period, a malabsorption syndrome was noted, accompanied by a lack of growth. As a temporary measure to restore nutritional status, a Santulli-style side-to-end laparoscopic intestinal anastomosis was performed. The observed child was found to have the F508del mutation in both alleles of the CFTR gene. The patient's weight at the time of the Santulli anastomosis construction was 2900 g, the age – 3 months. During the operation, there were no difficulties associated with the mobilization of the separated segments of the ileum. The duration of the surgical intervention was 70 min. Enteral nutrition was started on the 3rd day after the operation. The recovery period for intestinal transit through the rectum was 15 days. The postoperative period was uneventful. The duration of hospitalization was 18 days. No electrolyte imbalance or excessive fluid loss or underweight associated with enterostomy was observed. Over the next 6 months, the normalization of age-related weight and height parameters was achieved, after which the continuity of the digestive tract was restored by closing the terminal enterostomy. Currently, the patient has minimal respiratory symptoms and is receiving adequate CF therapy with pancreatic enzyme replacement therapy included with each meal. The initial experience of performing laparoscopic Santulli inter-intestinal anastomosis in an infant with CF presented in the study showed the possibility and reproducibility of this technique, expanding the boundaries of laparoscopy in pediatric practice. The decision to close the enterostomy in these patients should be deferred until a full diet is introduced and should be made in conjunction with a pediatrician specializing in the treatment of CF.