Clinical observations of minimal gastrostomy through minilaparotomy in palliative patients

Gastrostomy is used to feed palliative patients with dysphagia. Currently, the preference is given to percutaneous puncture methods of gastrostomy, which do not require general anesthesia. Percutaneous puncture techniques are possible only if the patency of the upper parts of the digestive tract still exists for the «pull method» and can require additional X-ray irradiation in case of the «push method». These operations require expensive disposable kits, which affects the prevalence and availability of the technique. Therefore, the use of an alternative minimally invasive gastrostomy through minilaparotomy is justified. Minimal-invasive pressure gastrostomy is known for a long time, and in combination with small access, it can be successfully used to provide nutrition for palliative patients with dysphagia. Most patients with dysphagia have a thin anterior abdominal wall, which allows using minimal access. It is important to choose the right place of the incision so that access is in the area of the formation of the fistula. To obtain additional diagnostic information one can use a radiography of the abdominal cavity, which shows the gas bubble of the stomach, and other high-tech methods: ultrasound, spiral computed tomography, etc. At the same time such patients do not require general anesthesia, it is possible to perform the operation under a local anesthesia. The article provides a detailed description of the technique of minimal invasive laparotomy gastrostomy and two clinical observations of palliative patients who underwent this operation

Дисфагия у пациентов педиатрических отделений реанимации и интенсивной терапии (обзор литературы)

The known negative consequences of intensive care unit stays, summarized as the post-intensive care syndrome (PICS) and including swallowing disorders (dysphagia) are also encountered in pediatric practice.Materials and methods. The non-systematic review of literature sources was carried out. Domestic publications were searched in the database on the elibrary website, foreign publications – in PubMed, Google Scholar, Cichrane Library, Cyberleninka, ResearchGate databases in the period of 1990–2023. When analyzed for the query «Dysphagia in Children», 1,496 results were found, «Post-intensive care syndrome in children» – 82 results. We analyzed 142 full-text publications describing the causes, mechanisms, and clinical presentation of dysphagia in children whose swallowing disorders occurred after hospitalization in intensive care units or were associated with severe somatic diseases.Results. The review analyzes the causes, features of diagnosis and treatment of dysphagia in pediatric patients with PIСS. 5 groups of causes in the structure of PIСS that can lead to the development of dysphagia were considered: infectious-trophic, vegetative-metabolic, neuromuscular, emotional-cognitivecomplications and decreased quality of life compared to the premorbid level. Complications associated with the development of dysphagia lead to increased length of stay in intensive care and hospitalization, lead to the development of malnutrition, aspiration pneumonia and other complications. The mechanisms of dysphagia development in children in intensive care units were analyzed. The main ways of dysphagia progression in pediatric practice are determined.Conclusion. Clarification of the causes and understanding of the mechanisms of dysphagia development in conjunction with the implementation of rehabilitation programs can contribute to the improvement of clinical outcomes in children who have undergone a critical condition in the immediate post-discharge period and in the future.Известные негативные последствия пребывания в отделениях интенсивной терапии, обобщенные в синдром последствий интенсивной терапии (ПИТ-синдром) и включающие нарушения глотания (дисфагию), встречаются и в детской практике.Материалы и методы. Проведен несистематический обзор источников литературы. Поиск отечественных публикаций проводили в базе данных на сайте Elibrary, зарубежных – в базах PubMed, Google Scholar, Сochrane librarу, Cyberleninka, ResearchGate в период 1990–2023 гг. При анализе по запросу «Dysphagia in Children» обнаружено 1 496 результатов, «Post-intensive care syndrome in children» – 82 результата. Проанализированы 142 полнотекстные публикации, описывающие причины, механизмы, клиническую картину дисфагии у детей, нарушение глотания у которых возникли после госпитализации в отделения реанимации и интенсивной терапии или связаны с тяжелыми соматическими заболеваниями.Результаты. В обзоре проанализированы причины возникновения, особенности диагностики и лечения дисфагии у пациентов педиатрического профиля с ПИТ-синдромом. Рассмотрены 5 групп причин в структуре ПИТ-синдрома, которые могут привести к развитию дисфагии: инфекционно-трофические, вегетативно-метаболические, нейромышечные, эмоционально-когнитивные осложнения и снижение качества жизни по сравнению с преморбидным уровнем. Ассоциированные с развитием дисфагии осложнения приводят к увеличению длительности пребывания в реанимации и стационаре, к развитию недостаточности питания, аспирационным пневмониям и другим осложнениям. Проведен анализ механизмов развития дисфагии у детей в отделениях интенсивной терапии. Определены основные пути прогрессирования дисфагии в педиатрической практике.Заключение. Выяснение причин и понимание механизмов развития дисфагии в совокупности с ранней диагностикой и реализацией восстановительных программ могут способствовать улучшению клинических исходов у детей, перенесших критическое состояние в ближайшем после выписки времени и в дальнейшем