Reconstructive-plastic operations for restoring patency at different levels of subtotal resection of the colon in children with intestinal agangliosis

Abstract

Subtotal resection of the colon in intestinal agangliosis depends on the level of lesion and secondary decompensatory changes in the intestinal wall. Rational choice of reconstructive plastic surgery in such pathology is necessary to restore patency, normalize functional changes in the intestine and stabilize the general condition of patients. Purpose - to evaluate the results of reconstructive-plastic surgery to restore patency at different levels of subtotal resection of the colon in children with intestinal agangliosis. Materials and methods. We analyzed the surgical treatment of 182 children with intestinal agangliosis aged from 1 month to 8 years, who underwent reconstructive-plastic surgery to restore patency at different levels of subtotal resection of the colon. Results. In 58 (31.86%) patients after subtotal resection of the colon performed the pullthrough of the remaining segment of the colon on the left mesenteric sinus (lateral canal), in 51 (28.02%) - pullthrough of the remaining segment of the colon on the right mesenteric sinus in front of the terminal ileum, in 63 (34.62%) - pullthrough of the ascending colon or caecum on the right flank with a rotation of 180° and in 10 (5.50%) children - replacement of the left half of the colon with an ileograft with intrarectal pullthrough. In 161 (88.46%) cases good results were obtained, and in 21 (11.54%) patients - satisfactory functional results in the long term follow up. Conclusions. Restoration of intestinal patency after subtotal resection of the colon in children with intestinal agangliosis should be aimed at providing favorable conditions for anastomosis between the remaining part of the colon and rectum. If it is impossible to directly anastomose the remaining segments of the colon and rectum, it is advisable to replace the left half of the colon with an ileograft with its intrarectal pullthrough. Differential approach in the choice of reconstructive plastic surgery for subtotal resection of the colon allows to normalize functional changes in the intestine and stabilize the general condition of patients. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local ethics committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: agangliosis, intestine, children, surgical treatment, results.