The issue of programmed relaparotomy in children
Introduction. The high mortality in advanced forms of intestinal obstruction and peritonitis, the complexity of managing these children in the postoperative period, the need for rehabilitation and re-audit of the abdomen, caused by the emergence of such treatment as programmed relaparotomy.
Relaparotomy - a therapeutic manipulation, when the healing process is incomplete. Without adequate sanitation of the abdominal cavity, which can not always be held during the first surgery, the patients can not be cured by antibiotics therapy and infusion therapy. Usually a second operation is imminent, but it is carried out in the worst conditions: the severity of the patient's condition due to intoxication and complications of abdominal abscesses, necrosis of part of the colon, and so on.
Indications to imposition of laparostomy are sufficiently developed. However, specialists have different opinions to the technical side of the overlay treatment.
Purpose of the study. Identify the underlying causes and the results of programmed relaparotomies in children with diffuse purulent fibrinous peritonitis and intestinal obstruction in children.
Materials and methods. The article made an analysis of 43 programmed relaparotomy to 22 children, representing 1.95 relaparotomies an average of one child. All children, which is holding sanation by surgery, performed a median laparotomy, which allows for full and secure access to all the abdomen.
In the study group 8 children (36.36%) were held by one relaparotomy, 4 children (18.18%), two relaparotomy, 3 children (13.63%) three relaparotomy.
The largest number of relaparotomies one child was 5. Two children (9.09%) in this group died.
Results. All relaparotomy were conducted in the period from 24 to 48 hours. In 20 cases (except newborns) was performed tubazh of intestine.
After 2 relaparotomy with programmed the third relaparotomy, the joints performed in order to avoid the eruption through the PVC pipe. Analyzing the data, we concluded that it is sufficient sanations 2-3, depending on the clinical situation. However, the treatment of children running in the background peritonitis syndrome of multiple organ failure requires an individual approach, depending on the result of treatment, severity of the disease may have increased sanations to 5 or more.
During the tubazh of bowel, the transanal gave preference to total tubazh or tubazh of intestines through tseko or appendikostomy.
It was made: 40% (8) transanal tubazh of bowel 9 (45%) - through appendikostomy and 5 (25%) - through tsekostomy. The advantage of such "retrograde" tubazh there is the fact that the appearance of even the minimum contents of the intestinal lumen motility is on the move, but not against the establishment of the probe. Another advantage is that the probe does not interfere with the external breathing, no casting of intestinal contents into the airway. In two cases, one tsekostomy and one appendikostomy (14.28%) were conducted deferred operation to close the stoma in all other cases, the stoma closed independently in the period from 2 to 22 days.
Conclusions. 1. Using programmed relaparotomies in children leads to a reduction in mortality and allows to achieve satisfactory results in the treatment of acute surgical pathology in children. 2. Tubazh of intestinies is mandatory manipulation during programmed relaparotomy in children. 3. Duration of tubazh and technology of its implementation should be adapted to the intraoperative situation.