Relaparotomy in Children

Gritsenko E. N.

CLINICAL AND EXPERIMENTAL MEDICINE

Scentific article

The aim of the work to identify the main causes of performance сhildren relaparotomy. In the period from 2003 to 2013, in separate pediatric surgery carried 137 relaparotomies to 96 children. Age of patients was from newborn to 17 years, including children under 1 year, among them are children of the first month of life. The term “relaparotomy” determines any second operation aimed at eliminating the disease and (or) its complications or consequences of the operation, which is a mandatory part of the abdominal cavity opening at a time when the patient’s treatment is not completed. In 69 children relaparotomy performed for urgent indications – 88 (64. 2 %). Intraabdominal purulent-septic complications were the cause of an emergency RL in 47 children who underwent 54 surgical interventions. The main causes of septic complications were abscesses of the abdominal cavity – 18 (13. 1 %) cases, the failure of anastomoses of hollow organs – 15 (10. 9 %) cases of acute perforation of ulcers of the digestive tract – 14 (10. 2 %), peritonitis that continues – 6 (4. 4 %). Postoperative gastrointestinal obstruction occurred in 25 children, on which were performed 29 surgeries. The cause of obstruction in most cases were unification abdomen -17 (12. 4 %) cases. Internal postoperative bleeding was observed in 5 (3. 6 %) children: 4 – intraperitoneal bleeding in 1 child -intestinal bleeding. Volume of surgery depended on the nature of the complications that arise. During surgery liquidated source of peritonitis, gastrointestinal permeability restored, removed source of bleeding was carried out sanitation and drainage of the abdominal cavity. After an emergency RL died 9 children, mortality was 13 %. Planned RL was performed to 27 children. 18 children had a common form of peritonitis with significant periods of the disease. A complete reorganization of the abdominal cavity during the first operation in these children was proven impossible. In these cases, during surgery the decision on execution of programmed relaparotomy. Kids were performed from 1 to 6 programmed relaparotomy (8 cases performed relaparotomy 1 in 6 cases – 2, 2-3 relaparotomies in 1 case done 4 in 1 – 6). A total of 36 programmed relaparotomy performed. One child died later diagnosed with widespread peritonitis on a background of severe diabetes. Programmed relaparotomy with wide- spread peritonitis in children can help you control the pathological process in the abdominal cavity, allow time to remove intraabdominal complications arise. 4 children with acute intestinal obstruction during surgery had any doubts about the viability of the bowel area. To determine the tactics regarding bowel with questionable viability of using surgery «second-look», in which the re-examination of the intestine was performed 24 hours after the first operation. During this period, blood flow to the intestine or restored, or emerging area of necrosis with a clear demarcation line, but there are no effects of peritonitis. Indications for use tactics «second-look» doubted the viability of the intestine after surgical intussus- ceptum (1) strangulated adhesive intestinal obstruction (1), volvulus “midgut” and isolated small bowel volvulus in infants (2 cases). In 3 cases, the re-operation was recognized as a viable bowel. In 1 case, a newborn in operation «second-look» was ascertained total necrosis of the small intestine. Application of operations «second-look» avoids unnecessary resection of the bowel with questionable viability of acute intestinal obstruction, reduce the amount of resection in case of necessity, to perform an operation on more favorable terms, to improve long-term results. RL in childhood are most at risk transactions. 11children died, mortality was 11. 5 %. The highest mortality was in children under 1 year, 42 children of this age, who served RL, 9 from them died (mortality 21. 4 %).

intraabdominal purulent complications, intestinal obstruction, bleeding, relaparotomy, children

«Bulletin of problems biology and medicine» Issue 4 part 1 (113), 2014 year, 84-87 pages, index UDK 616. 381-053. 5-089