In Ivano-Matreninskaya children’s clinical hospital (Irkutsk) for the first time in the world of surgical practice surgery of a child with pyloric stenosis with the use of oral endoscopic myotomy (POEMS). The results of the operation were presented by the head of the Center for surgery and neonatal resuscitation companies, the main children’s surgeon of the Siberian Federal district Yuri Kozlov at the Congress in Holland “30 years of pediatric endoscopic surgery in the world” (Utrecht, September 6-7).
“Pyloric stenosis is a congenital intestinal obstruction that occurs as a result of the hypertrophy of the muscles. The standard operation is to simply dissect the muscle layer, not touching mucous membranes. In our hospital in the year running up to 25 similar laparoscopic procedures”, – told the portal Medvestnik.ru Yuri Kozlov. Idea of using the transoral technique has arisen with the surgeon after observing the operations in adult patients with achalasia cardia.
“This technique appeared in 2010 in Japan, the first operation performed Professor haruhiro Inoue (Haruhiro Inoue) from the Center of digestive diseases at the Northern hospital, Showa University, Yokohama city. She immediately took the world of adult surgery, because it was not accompanied by the smallest cuts and punctures in contrast to laparoscopy. This is an outpatient procedure in which a does not occur, respiratory and hemodynamic shifts” – explains Yuri Kozlov. He invited the colleague – head of the Department of endoscopy at Saint Petersburg state medical University Alexander Smirnov for help in carrying out the operation.
Before the surgeons stood a double task: not only to meet the newborn, the weight of which was 4200 gr. operation using technology for adult patients, but “move” it from the esophagus to the lower gastrointestinal tract. “I got an idea to apply this technique in the treatment of lower parts of the stomach in pyloric stenosis. The cause of the disease in this case is the same as that in achalasia cardia, is unexplained muscle hypertrophy. For several months we discussed technical details, was looking for necessary endoscopic instruments. All POEMS in the world are “adult” tools are other endoscopes, electrodes”, – said the head of the Centre for neonatal surgery.
The first operation successfully took place in August, it lasted an hour. “We are faced with certain difficulties. Obviously requires modification of electrosurgical instruments, devices for imposing of clips, you may need to add another optical system, shares the results of Yuri Kozlov. – We see prospects for the treatment not only of pyloric stenosis, but also other diseases of children with transoral operations.”