Khashchuk V. Surgical Treatment of Adhesive Disease at Children with Antiadhesive Measures (Experimental and Clinic Study)

The work is devoted to the problem of choosing the methods of surgical treatment, diagnostic and prognostic measures for children with adhesive disease (AD) when using antiadhesive means. The scientific novelty is that for the first time it was established that the main pathogenetic factor of AP is peritoneal damage of varying degrees – more layers of peritoneum are damaged, the number of adhesions, prevalence and density. Repeated surgical interventions contribute to the spread of AP and the formation of adhesive conglomerates. It is proved that adhesions are accompanied by dysfunction of the intestinal wall, which is involved in the AP. The gradation of abdominal AP according to IV degrees has been developed. Serum levels of HA and N-PC III were determined in order to predict the course of the postoperative period and determine the likelihood of AD recurrence. For the first time, an algorithm for surgical treatment of AD in children was proposed. For the first time in the surgical treatment of AD in children, it has been proposed to determine the LCCM of the small intestine with their release from adhesions and the use of barrier hydrogel based on SHD. It is proved that for the treatment and prevention of AD recurrence in children it is advisable to use the method of partial adhesiolysis (open or laparoscopic method) in combination with intraoperative use of SHD. For the first time, a device was developed to determine the position of the small intestine sphincter during abdominal surgery in order to determine the areas of the small intestine LCCM and the operation of partial adhesiolysis. The method of surgical treatment of AD in children with intestinal deserosation has been improved, ways of elimination depending on the extent of the lesion have been proposed (plastic with its own serous membrane, peritoneal flap of mesentery, resection for multiple deserosations). A method of administration of barrier antiadhesive solution which based on SHD according to the principle of «upper-lower peritoneal suturing» is proposed. The effectiveness and safety of SHD for the treatment of AD in children with open and laparoscopic surgery have been proven. In order to select the place of relaparotomy in open surgical operations and the location of trocars in laparoscopic operations in AD at children, it is proposed to assess the projection of the AP on the anterior abdominal wall. A method of surgical treatment of AD in children by partial adhesiolysis in combination with the antiadhesive solution based on SHD using has been developed and implemented in clinical practice. Tactics of ileo-ileoanastomosis formation in case of ileal necrosis in AD at children depending on the diameter of the distal part and the distance from the ileocecal valve are proposed.