THE RESULTS OF LAARP PROCEDURE OF SANORECTAL MALFORMATIONS / Мэс засал

Introduction: The number of patientswith various types of Anorectal malformations(AMR) are constantly increasing by ourdata. We estimate an average 10 incidenceof ARM per year and it is as twice increasedas compared to 5 patients in 1996-2000.Thepurpose of this study was to determine anincidence, types of ARM and evaluate theresults of PSARP procedure using Kelly’sscoring system.Materials and methods: A total 124patients were retrospectively reviewed andanalyzed.There were 38 patients with ARMwithout fistula, 86 patients with fistula, withprevalence of perineal fistula, 2 cloacas, 6with rectal stenosis, 7 with ectopic anus and2 with acquired atresia due to postoperativesevere anal stenosis.Results: 63 patients underwent colostomyprocedure during neonatal age, 31 patientsunderwent primary operations, 73 patientsunderwent PSARP procedure as a secondaryoperation between 4 months to 1 year ofage and 6 patients underwent redo PSARPprocedure at 8-10 years of age.One patientwith 2 cm of common channel of cloacaunderwent total urogenital mobilization at 2years of age.In 9 patients PSARP procedurewas combined with laparoscopy (LAARPprocedure with ligation of bladderneck andprostatic fistula), in 4 with laparotomy. 6patients underwent buginage of perinealfistula followed by primary PSARPprocedure.Another 6 patients underwentPSARP procedure and closure of colostomyat the same time.In 21 patients we observed6 types of complications such as severeanal stenosis acquired atresia, mislocatedanus, constipation, soiling, and recurrenceof rectouretral fistula and mortality duringneonatal age.Conclusion: The favorable results ofPSARP procedure were achieved in 71.4% ofpatients using Kelly’s clinical scoring system.Usage of Laparoscopy during abdominalstage is favorable, while it allows closureof colostomy at the same time. There is apotential for increasing of primary PSARPprocedure as though there is a prevalence oflow type malformations with perineal fistula.

RESULT OF KASAI OPERATION, CHILDREN LIVER TRANSPLANTATION IN MONGOLIA / Мэс засал

Introduction: Biliary Atresia is a fibroobliterativedisorder of the intra andextrahepatic bile ducts in infancy, which isgoing progressively cholestatic liver disease.The failed Kasaiportoenterostomy requiresliver transplantation. The goal of this studyis to show the outcome of Kasai operation,recent improvement and correlation the datato overseas.Methods and Materials: This study wasconducted in the department of generalsurgery of National Center for Maternal andChild Health of Mongolia between 2010 and2016 on a total of 66 infancies with biliaryatresia.Results: Patient diagnosed with biliaryatresia, which performed Kasai operationwithin first 2 months the outcome is verygood early and late post-operation period.There were 3 patients with 10 year survival, 4patients with 5-10 year and 28 patients with5 year survival after Kasai operation. The mostcomport age for liver transplantation is 1 yearlater after Kasai operation in Mongolia. Livertransplantation programme is necessary forMongolian pediatric surgery, and we thoughtour team was assembled.Conclusion: The children with biliary atresiaperform the Kasai operation within 2 monthsthe outcome is very good. Children with biliaryatresia often experience long wait times fortransplant unless exception points are grantedto reflect severity of disease.In Mongolia livertransplantation done in 2 child.

LAPAROSCOPIC ECHINOCOCCECTOMY IN CHILDREN / Мэс засал

Introduction: In Mongolia laparoscopicsurgery starts 25 years ago, in our center /NCMCH/ we start laparoscopic surgery fromOctober 2013.Materials and metods: The articleanalyzes the results of treatment of 2patients 16 years old girl and 14 yearsold boy, who underwent laparoscopicechinococcectomy. Abdominal ultrasoundshowed solitary echinococcosis in VII liversegment, diameters is 9.8cm and 7.4cm.The echinococcus cysts were removed bylaparoscopy. In residual cavity of echinococcuscyst was performed laparoscopic coagulationof the inner wall of the fibrous capsulewithout drainage. After laparoscopic liverechinococcectomy postoperative period wasmuch more favorable than after traditionalechinococcectomy.Results: to evaluate the therapeutictactics and ways to improve the eliminationof residual cavities after laparoscopicechinococcectomy of liver in children.Conclusions: The hospital stay in thepostoperative period was 3 bed days.Laparoscopic echinococcectomy is goingwithout postoperative complications,without residuals, reduce the duration ofpostoperative hospital stays.

LAPAROSCOPIC NEEDLE-ASSISTED REPAIR OF INGUINAL HERNIA (LNAR) / Мэс засал

Introduction: In our hospital we didfirst laparoscopic surgery in October 2013with doctors from Samsung Medical Center,Seoul, Korea. In NCMCH we did about 3000operations per year, and about 400 of themtakes inguinal hernia. Bilateral and unilateralbig hernias has a lot of complications,like swelling, recurrence etc. Goals andobjectives:comparison between LNAR andstandard open technique of hernia repair.Calculate the outcome, hospital stay,recurrence, complications.Materials and Methods: We describeour technique and experience with thelaparoscopic needle-assisted repair of inguinalhernia (LNAR). We report retrospectively 42cases (hernias) from September 2014 toDecember 2015. We have 2 groups. In firstgroup we did standard open hernia repair in23 (54,7%)cases, in second group we didLNAR in 19 (45,3%) cases. Hernia repairis accomplished with a one port needleassistedtechnique. After identification of apatent processusvaginalis, the internal ringis encircled in an extraperitoneal plane usinga 22G-Touhy needle for placement of apurse-string suture, tied extracorporally, andburied beneath the skin. The technique wasstandardized for second group cases. Inguinalhernias were laparoscopically repaired in19patients (16 boys and 3 girls) age range1year to 16 years. All 19 cases had bilateralrepair. Mean operating time for bilateral was45 min. No complications in second group.For the first group we had 18 boys and 5girls same age range. Mean operating time1hour 20min.8 minor complications wereidentified(8 swelling) and 1 recurrence. Postoperativedata show our technique is safewith no complication. No recurrence.Results: First group: we had 18 boysand 5 girls,age range 1year to 16 years.Mean operating time1 hour 20min. 8 minorcomplications were identified (8 swelling)and 1 recurrence. Second group: we had16 boys and 3 girls, age range 1year to 16years. All 19 cases had bilateral repair. Meanoperating time for bilateral was 45 min. Nocomplications.Conclusions: In our technique meantime was shorter than in standard opentechnique. Post-operative data show ourtechnique is safe with no complication.No recurrence. Furthermore, laparoscopyobjectively identifies asymptomatic or occultcontralateral defect, uses a smaller incision,and eliminates dissection of the cordstructures potentially reducing the risk ofcord injury.

AIRWAY FOREIGN BODY DIAGNOSIS AND TREATMENT / Мэс засал

Introduction: The aim of this study was tostudy the pattern of foreign-body aspiration inthe tracheobronchial tree as well as the successrate of rigid bronchoscopy in children admittedto the National Center for Maternal and ChildHealth, Mongolia during 2012-2016.Materials and Methods: In this crosssectionaldescriptive study, the required datawere collected from the medical reports ofall children under the age of 13 years withsuspected foreign-body aspiration who wereadmitted and underwent explorative flexibleand rigid bronchoscopy during 2012-2016. Thedata was retrospective viewed.Results: Among 40 patients with aconfirmed aspiration, 57.5% (23) were malesand 42.5% (17) were females. 42.5% were1-3 years old. The most common complaints(symptoms) of patients were non-productivecough (82.5%), wheezing (52.5%) andrespiratory distress (22.5%). The mostfrequently aspirated foreign bodies were nuts(peanuts). In total, 57.5% of foreign bodieswere lodged in the right bronchial tree. In 100%of cases, the foreign body was completelyextracted by bronchoscope. The majority ofcases were admitted more than 24 hours afterthe occurrence of aspiration, and pneumoniawas the most common complication. In X-rayfindings Golitsknyekhta Yakobsona’s symptomswere in 10 /25%/ cases.Conclusion: Patient history, especiallyinitial suspicion of aspiration, coughing,wheezing and respiratory distress, can behelpful in the diagnosis of foreign-bodyaspiration. All foreign bodies were removed bybronchoscope /100%/ without complications.In X-ray findings Golitsknyekhta Yakobsona’ssymptoms were in 10 /25%/ cases.