[Multiple-center study of laparoscopic and open treatment of duodenal atresia]. / Mul'titsentrovoe issledovanie laparoskopicheskogo i otkrytogo lecheniya duodenal'noi atrezii.

OBJECTIVE: To summarize data of a multiple-center study of the treatment of duodenal atresia in 3 children's hospitals of the Siberian Federal District. MATERIAL AND METHODS: We analyzed postoperative outcomes in 211 patients with duodenal atresia. All patients underwent surgery at various hospitals of the Siberian Federal District: Ivano-Matreninsky Children's Clinical Hospital in Irkutsk (expert hospital) - 120 patients; Center for Maternal and Child Welfare in Krasnoyarsk (learning hospital No. 1) - 51 patients; Kemerovo Regional Children's Clinical Hospital (learning hospital No. 2) - 40 patients. The study has been carried out for 15 years (from January 2005 and to December 2019). Patients were divided into 2 cohorts: group I - 88 patients (laparoscopic formation of duodenal anastomosis); group II - 123 patients (surgery via laparotomy). Demographic data, intra- and postoperative parameters and complications were analyzed. RESULTS: Preoperative parameters were similar in both groups. Significant between-group differences were found for surgery time (70 vs. 90 min; p<0.001). Initiation of feeding and complete enteral nutrition occurred significantly earlier after laparoscopy (3 vs. 7 days, p<0.001 and 8 vs. 12 days, p<0.001). Incidence of anastomotic leakage significantly differed in both groups (1 patient after laparoscopy and 9 patients after laparotomy, p=0.038). Mortality was absent in the laparoscopy group. In the laparotomy group, this value was 4.9% (p=0.036) and caused by concomitant conditions (prematurity, sepsis, heart defects). Late postoperative complications (adhesive intestinal obstruction, ventral hernias) were absent after laparoscopy and occurred in 5.7% of patients after laparotomy (p=0.023). CONCLUSION: Laparoscopic correction of duodenal atresia can be safely performed by experienced endoscopic surgeons from different centers united by the same ideology of endoscopic surgery. Laparoscopy ensures less duration of surgery, faster postoperative recovery, less mortality, incidence of early and late postoperative complications.

[Training curves for endosurgical interventions in neonates and infants].

AIM: To demonstrate training curves for endosurgical interventions in neonates and infants. MATERIAL AND METHODS: It was analyzed duration of thoracoscopic reconstruction of esophageal atresia (31 patients) and laparoscopic Nissen fundoplication (61 patients) performed for the period from January 2005 to December 2012. Graphs and tables reflecting correlation between duration and number of operations were framed. RESULTS: Figures demonstrate reducing duration of surgery with increase of endosurgical interventions number. CONCLUSION: Our data revealed that time necessary for minimally invasive procedures in infants and neonates decreases in process of experience accumulation.