Minimal invasive operations in infants with congenital urinary tract disorders

Purpose.To rate retrospectively the results of using minimally invasive surgical operation in treatment of obstructive disorders in infants. Materials and methods. From 2007 to 2016 1057 patientes (257 boys and 614 girls) with a mean age of 5.5 month (range 1m – 5 years) were treated. The patients were classified on four groups: the first - 69 boys with posterior urethral valve associated urodynamics disorders; the second group – 67 patientes with duplication and ureterocele; the third group - 170 patientes with congenital nonrefluxing megaureter; the fouth - 751 patientes with VUR. In all cases minimal invasive surgeries were preferable: transurethral primary valve ablation; endoscopic incision ureterocele, one-J-stending megaureter, endoscopic correction of vesicoureteral reflux with bulking agents. Results. Transurethral resection of the posterior urethral valve was performed for all patients of the first group - for 56 (81,2%) in one step, for 13 (18,8%) in two steps. Transurethral resection of ureterocele was performed in 53 patients (79,1%) of the second group.132 patients in the third group was treated with stended of ureter, endoscopic correction of vesicoureteral reflux with bulking agents was performed for patients of the fourth group: collagen for 454 patients (605 ureters), Urodex for 122 patients (189 ureters) and Vantris for 76 patients (121 ureters). The patients were followed according with to a program with repeated US, renal scintigrams (DMSA), frequency/volume chart observation. These investigations were assessed in 4-8-12 and 24 weeks. Antibacterial prophylactics were given and recurrent UTIs were registered, In 76 cases (7,2% ) when the disorder wasn’t eliminated, minimal invasive reoperation or open surgeries were carry out. Conclusions. Minimal invasive surgical operations can be performed in babies. They allow to normalize urodynamics and high success rate can be achieved avoid complex reconstractiv operations

Результаты оперативного лечения омфалоцеле в сочетании с добавочной долей печени и пилоростенозом

Purpose. Presentation of clinical cases of rare combination of omphalocele with pylorostenosis in the postoperative period and additional liver lobe. Materials and methods. In National Medical Research Center for Childrens Health of health surgical ward of newborns and infants for the 2019 us operated 2 children who performed surgery involving intra-operative decision making about further surgical tactics. Results. the results of surgical treatment of newborns with omphalocele combined with hypertrophic pylorostenosis and extra liver lobe are presented. Conclusions. In patients with malformations of the anterior abdominal wall in the postoperative period, when regurgitation syndrome appears, it is necessary to make a differential diagnosis between the functional and organic causes of obstruction. When confirming the organic nature of the obstruction, surgical intervention is indicated. It is necessary to be able to timely and objectively assess the risks and expediency of the approach when choosing surgical tactics in each individual case.Цель. Представление клинических случаев редкого сочетания омфалоцеле с врожденным гипертрофическим пилоростенозом и добавочной долей печени. Материалы и методы. В хирургическом отделении новорожденных и детей грудного возраста ФГАУ НМИЦ здоровья детей Минздрава России в 2019 г. нами прооперировано 2 ребенка с омфалоцеле. У одного пациента интраоперационно выявлена добавочная доля печени в грыжевом мешке, у второго в послеоперационном периоде сформировалась высокая кишечная непроходимость, потребовавшая повторного оперативного вмешательства. Результаты. Представлены результаты хирургического лечения новорожденных с омфалоцеле, сочетаемого с врожденным гипертрофическим пилоростенозом и добавочной долей печени. Заключение. У пациентов с пороками развития передней брюшной стенки в послеоперационном периоде при появлении синдрома срыгиваний необходимо проводить дифференциальный диагноз между функциональными и органическими причинами обструкции. При подтверждении органического характера обструкции показано проведение оперативного вмешательства. При нестандартной интраоперационной картине необходимо уметь своевременно и объективно оценить риски и целесообразность подхода при выборе хирургической тактики в каждом индивидуальном случае