Молодежный инновационный вестникМолодежный инновационный вестник2415-7805Федеральное государственное бюджетное образовательное учреждение высшего образования "Воронежский государственный медицинский университет имени Н.Н. Бурденко" Министерства здравоохранения Российской Федерации8217UnclassifiedANALYSIS AND COMPARATIVE CHARACTERISTICS OF DELAYED EFFECTS OF LAPAROSCOPIC AND OPEN METHODS IN THE TREATMENT OF PERITONITIS IN CHILDRENShcherbakovaVictoria Andreevnavik224sher@yandex.ruhttps://orcid.org/0000-0002-0410-4355Voronezh State Medical University named after N. N. Burdenko2912202312237403101202314022023Copyright © 2023, Shcherbakova V.A.2023<p>Relevance. Almost every day, a pediatric surgeon faces the question of choosing a treatment method for such a complex pathology as peritonitis. Since in addition to eliminating the source of peritonitis and a favorable course of the postoperative period, the doctor's goal is to have good delayed consequences of surgery, taking into account the age of patients. The purpose of the work was to evaluate the effectiveness of the use of endovideosurgical technologies in the treatment of peritonitis in children, namely, the analysis and comparative characteristics of the delayed effects of laparoscopic and open methods in the treatment of diffuse and total forms of childhood peritonitis in the CSTO No. 2 Voronezh in the period from 01.2017 to 01.2021. Methods. Using data from the hospital archive of the CSTO No. 2 in Voronezh, a sample of case histories (in the amount of 100 pieces) of patients treated for peritonitis was taken. One of the criteria for including a medical history in the sample included the use of a specific treatment technique, namely 50 histories laparoscopic intervention, 50 - laparotomy. Then, according to the phone data, we sent questionnaires, the answers to which served as the basis of this study. During the evaluation of the results, statistical analysis methods were used using the statistical software package "IBM SPSS". As a result, we were able to compare these methods in the issue of delayed consequences of surgical intervention. Results. During the study, questionnaires of 62 patients were obtained and analyzed, the results of which are presented in this paper. Conclusion. Based on the data of our work, we can conclude that by examining and comparing the catamnesis of patients who underwent surgical treatment for peritonitis, a greater number of delayed negative consequences occur after laparotomy, which indirectly suggests that the laparoscopic technique is more gentle and suitable for children.</p>peritonitislaparoscopylaparotomydelayed effectsперитонитлапароскопическое лечениелапаротомияотсроченные последствия<p>Relevance. Pediatric peritonitis is rightfully considered one of the most dangerous and insidious acute surgical pathologies in pediatric surgery. The problem of peritonitis does not lose its relevance, despite the improvement of classical techniques, as well as the introduction of new methods of treatment. According to a number of authors, peritonitis can still be the cause of such formidable complications in children as sepsis and multiple organ failure syndrome [1]. Undoubtedly, with timely treatment, the mortality rate is reduced to almost zero, however, upon admission at a late date or in the absence of a pediatric surgical service, the tactics of treating pediatric peritonitis requires improvement of existing techniques. To date, there are a large number of methods of sanitation this is laparotomy with drainage of the abdominal cavity and laparostomy, but still pediatric surgeons mostly prefer laparoscopic sanitation of the abdominal cavity. Many factors contribute to this. The main advantages of this method are the possibility of early activation of patients due to less traumatic access, as well as fewer postoperative complications [2]. Of course, laparoscopy is not an ideal method of treating peritonitis, and in some cases it has disadvantages, such as the inability to adequately sanitize the peritoneal cavity with very massive bacterial contamination, in the presence of multiple adhesions, fibrous overlays or intestinal paresis - and then laparotomy is the method of choice. However, in addition to the advantages of the postoperative period, minimally invasive interventions, according to the literature, have more favorable delayed consequences. Patients who have undergone open surgery, in the future, talk about a decrease in school functioning, due to the difficulties that arise periodically when walking, lifting weights, performing physical exercises. All this brings emotional discomfort to children [3].The purpose of the study. In our previous publications, we proved the advantages of laparoscopic treatment of peritonitis over open surgery (laparotomy). In this work, we tried to evaluate the long-term results (catamnestic way) in patients operated laparoscopically and laparotomically.Materials and method For the study, a sample of case histories was taken from the hospital archive of the CSTO No. 2 in Voronezh, dated from January 2017 to January 2021. The inclusion criteria were: transferred treatment for diffuse or total form of peritonitis. Two groups of patients were compared in the first, treatment was carried out using endovideosurgery, in the second laparotomy was the method of choice. The study design is a retrospective cohort study. The sample consisted of 100 case histories, 50 of which with laparoscopic surgery, 50 with open laparotomy. We sent a questionnaire to the phone number indicated on the title page of the medical history, in which respondents were asked to answer three questions. 1. Does the child have abdominal pain (ever) after discharge?2. Are there dyspeptic disorders nausea, vomiting, overeating, "heaviness in the stomach"?3. Are there any subjective complaints about the postoperative wound? (itching, pain, discomfort during exercise).We received feedback from 62 patients, and therefore the study sample was reduced to 62 (100%). In the group operated openly, we received 33 responses (53%), laparoscopically 29 text messages (47%). All the answers received were summarized and analyzed (percentages of correlated groups were calculated) in the IBM SPSS statistical data processing program (developed in the USA).The results obtained. As a result of the analysis and comparison of the results obtained, we found that the frequency of occurrence of long-term negative consequences of surgical intervention is significantly less when using the laparoscopic method of treatment of peritonitis. In the group of respondents who underwent laparoscopic intervention, only 2 (7%) out of 29 (100%) noted the presence of abdominal pain at any time after discharge, 93% said that there was no pain. At the same time, patients who underwent laparotomy followed by abdominal rehabilitation in 6 cases (18%) out of 33 (100%) noted the presence of pain both immediately after discharge and some time after, and only 27 (82%) did not complain of pain.We also interviewed patients regarding the presence of various dyspeptic disorders, such as nausea, vomiting, overeating, a feeling of "heaviness in the stomach". Those who underwent endovideosurgery noted their presence only in 3 response letters (10%), 26 people (90%) responded negatively. In the comparison group, 7 respondents (21%) confirmed the occurrence of these symptoms even after a considerable time after surgery (more than 3 weeks) and only 26 patients (79%) did not notice such disorders.Important, in our opinion, possible delayed negative consequences may also be complaints about a postoperative wound (scar) that occur in patients. Disturbing itching, pain, unpleasant subjective sensations during physical exertion can also worsen the quality of life of young patients. Here, the absolute number of children after laparoscopy responded negatively (100%), complaints about postoperative scars did not arise once after discharge from the hospital. However, after laparotomy, a certain number of children 12 (35.3%) noted itching and discomfort when playing sports or outdoor games, less often at rest, and only 21 (63.7%) denied these symptoms.Thus, surgical intervention, namely the chosen technique, definitely has an impact on the subsequent quality of life of young patients, even after a while after discharge. As can be seen, the laparoscopic method in assessing delayed consequences has an obvious advantage over open laparotomy.Discussion. In the course of our study, we found out catamnetically that a greater number of negative delayed consequences of surgical intervention in children for peritonitis occur when using the laparotomy method of treatment. The child's body is more susceptible to any medical interventions, which has a role in further postoperative life.In the course of the work, it was revealed that 18% of respondents, after laparotomy, face abdominal pain and unpleasant discomfort in their daily lives. In the future, this may affect the emotional background of the child, his socialization [3]. Also, some of the respondents -35.5% - after laparotomy are concerned about the postoperative wound itself, namely unpleasant sensations in the scar area.Also, various dyspeptic disorders can be an unpleasant delayed result of surgical intervention. At the same time, they bother children less often after laparoscopy, only 10%, compared with the second group of respondents 21%. Gastrointestinal disorders can also lead to a decrease in the child's quality of life, a change in his behavioral and emotional indicators.Taking into account these results, we can say that the problem of delayed consequences of surgical intervention for pediatric peritonitis, the choice of a specific surgical access and technique is relevant, important and requires further study, as it has a serious impact on the further development of the child, his psycho-emotional sphere.Conclusion. The data obtained indirectly demonstrate that laparoscopy in pediatric surgery in the treatment of diffuse and total forms of peritonitis is not only a safe and acceptable method in the absence of contraindications, but can also be the method of choice, since they have better delayed consequences compared to classical laparotomy.</p>1.Дифференцированный подход к лапароскопическому лечению перитонитов у детей / В. А. Вечеркин, В. П. Высоцкая, С. Н. Гисак [и др.] // Молодежный инновационный вестник. – 2016. – Т. 5. – № 1. – С. 15-17. – EDN ZCLZDX.2.Сыкал, Н. А. Программированная лапароскопия в лечении перитонита / Н. А. Сыкал // Медицина неотложных состояний. – 2013. – № 8(55). – С. 26-28. – EDN RUPGND.3.Токарева Ю. В., Новикова Л. Б. Качество жизни у детей, перенесших перитонит // Медицинский вестник Башкортостана. 2011. №5. URL: https://cyberleninka.ru/article/n/kachestvo-zhizni-u-detey-perenesshih-peritonit (дата обращения: 21.12.2022).