Kvashnina A. Diagnosis, prognosis and prevention of postoperative peritoneal adhesions in children

The dissertation solves the relevant issue of pediatric surgery – improvement of the effectiveness of diagnosis, prognosis and prevention of postoperative peritoneal adhesions in children with surgical diseases of the abdominal cavity. The peculiarities of the clinical course, diagnosis and treatment of postoperative adhesions of the peritoneum in different age groups were studied. The analysis of the clinical and anamnestic features of the primary disease has defined the leading risk factors and developed a mathematical regression model for predicting the development of post-operative intestinal obstruction in children. Also the main clinical and paraclinical signs correlating with strangulation have been identified and therefore can be used to justify early surgical tactics in children with late adhesion obstruction. The influence of geno- and phenotypic features of the child on the individual inclination to the development of postoperative adhesion-related complications was evaluated. The influence of the rapid acetylation genotype, determined by the genetic polymorphism of the N-acetyltransferase 2 gene and the presence of stigmata of nonspecific connective tissue dysplasia, on excessive postoperative adhesion formation has been proven. The experimental phase of research studied the effect of intraoperative application of anti-adhesive gels based on cross-linked sodium hyaluronate on the formation of peritoneal adhesions both in aseptic conditions and in the presence of peritonitis, depending on the composition of the agent and the method of its application. Based on the obtained data, a method of intraoperative barrier prevention was proposed and its safety and effectiveness were demonstrated both for primary adhesion prevention and after adhesiolysis, by analyzing immediate and long-term results.