Department of Pediatric Surgery
MEDICAL AND ADVISORY WORK
- Responsible person: Metlenko Oleksandr Volodymyrovych
The staff of the department of pediatric surgery Bogomolets National Medical University provides extensive medical and consulting assistance to basic and non-basic institutions. Every year, the number of patients consulted, treated and operated by the staff of the department increases. More than 5,000 consultations are carried out annually by the staff of the department, almost 2500 operations are performed, which is almost 40% of the operations performed in clinics. Most interventions belong to the category of increased complexity. Almost 50 trips have been made via the Sanitary aviation system to the regions of Ukraine and other hospitals in Kyiv with the implementation of surgical interventions.16 out of 17 employees of the department have the highest medical qualification category.
The main directions of surgical work done in the department of Pediatric Surgery are diagnostics and correction of wide range congenital anomalies and pathologies of respiratory tract, digestive tract, developmental disorders and diseases of the musculoskeletal system, parenchymatic organs, vascular malformations. Highly lethal congenital malformations of newborns, which have a high proportion in infant mortality, are operated. The staff of the department of pediatric surgery has vast experience in correction of congenital malformations and diseases of the respiratory system and gastrointestinal tract in an open and endoscopic way. Most of the pathologies are operated using the organ preserving principle.
For the first time in Ukraine, the department has established surgical (including endoscopic) treatment of tracheal stenosis of different genesis in infants. Surgical treatment of lung aplasia was performed for the first time in the world. Ways to correct lung congenital defects and diaphragmatic hernias have been improved.
ASSOCIATED CONGENITAL TRACHEAL STENOSES.
CORRECTION WITH USE OF CARDIOPULMONARY BYPASS
- Dubrovin1, D. Krivchenya1, E. Rudenko1, V. Lazoryshynets3, I. Yemets4, Ia. Truba3, V. Prytula1, Z. Synelnykova2, G. Khanes2
1Bogomolets National Medical University; 2National Specialized Children Hospital “OHMATDYT”; 3Amosov National Institute of Cardiovascular Surgery; 4Center for Pediatric Cardiology and Cardiac Surgery,
“Bridging bronchus” stenosis diagnosis and correction
Congenital “bridging bronchus” stenosis (Boy K., age 10 months). A-Chest CT with con-trast enhancement, frontal reconstruction. Right tracheal bronchus, congenital stenosis of the suprabifurcation segment of the trachea as “bridging bronchus”. The length of the ste-nosis is 0.8 cm (13.3 % of the whole tracheal length), the lumen is narrowed by 70%. B, C– diagram of tracheal anatomy and reconstruction of tracheal bifurcation (red arrows indi-cate lines of incisions and anastomosis). D – endophoto of the trachea at the stenotic zone; dashed arrow indicates tracheal bronchus. E, F – intraoperation photos: tra-cheal bronchus (1), “bridging bronchus” and tracheal bifurcation (2), tracheal anastomosis (3). G – endophoto of reconstructed tracheal bifurcation 4 years after surgery. Left main bronchus (solid arrow), reconstructed right main bronchus (dashed arrow), right upper lobe (former tracheal) bronchus/
Main results. Six patients aged 8 to 20 (13.0±1.9) months were included to study. The length of stenosis var-ied from 0.8 to 4.0 cm (2.3±0.5 cm) that was 13.3-83% (44.0±11.2%) of tracheal length. The grade of trache-al narrowing ranged from 60 to 80% (66.7±2.8%). Two patients had bridging bronchus stenosis, another 2 had long segment stenosis. Associated malformations were following: pulmonary artery sling (n=4), VSD (n=2), right lung agenesis (n=1), aberrant right subclavian artery (n=2) and duodenal atresia and cloacal form of anorectal malformation (n=1). Four (67%) patients survived simultaneous surgical correction and have good result for 0.5-8 years. Two (33%) patients died within early postoperative period because of acute res-piratory distress.
Department of pediatric surgery is the base as leading centers for the treatment of esophageal stenosis. Endoscopic methods of esophageal recanalization are widely implemented in practice. Modern variants of organ preserving technique for esophagus plastics, including their own development, have been proposed and widely used in its pathology of congenital and acquired genesis. Thoracic and laparoscopic methods of correction of malformations and diseases of the esophagus are widely used.
The employees of the department are innovators of colorectal pediatric surgery. Treatment options (using laparoscopic methods) for different forms of Hirschsprung’s disease have been proposed and implemented, and diagnostics of functional disorders in colostasis has been improved. The reconstructive and plastic operations at extensive resections of a colon are developed.
Pull-through procedure for Hirschsprung’s disease
The staff developed methods of segmental organ preserving operations in diseases of the spleen, suggested effective methods of treatment of cystic lesions of parenchymatic organs of the abdominal cavity, using miniinvasive and laparoscopic techniques.
The department of Pediatric Surgery is the leading center for surgical treatment of digestive tract bleeding in Ukraine, and the only one that provides full assistance to patients with portal hypertension. For children with this pathology, modern endoscopic treatments and shunting surgery options are used.
The Department of Pediatric Surgery is the leading center for the correction of scoliosis and deformity of the chest (funnel chest, pigeon chest) in Ukraine. Thoracoscopic techniques are widely used in correction.
More than 45 operations are performed every year for severe spinal deformities (congenital and idiopatic) in children. All methods of treatment (surgical, minimally invasive, “growing” constructions, conservative) are used.
Girl T., Congenital scoliosis . Neurofibromatosis.. A – before treatment, B – 1 year after treatment.
More than 50 operations are performed every year for chest deformity in children. All methods of treatment (surgical, minimally invasive, conservative) are used.
Patients from all over the country with vascular abnormalities (vascular tumors and malformations) are treated at of the department of pediatric surgery. All modern methods of treatment (surgical, endovascular, sclerotherapy, conservative) are used.
Girl F., cystic lymphatic malformation of head and neck. A – before treatment, B – 2 years after staged treatment.