Interview with Jamoliddin SATTAROV, Assistant Professor of Pediatric Surgery and Pediatric Oncology, Tashkent Pediatric Medical Institute, Doctor of Children's Surgical Clinical Hospital No. 2, Tashkent.
- Tell us about the causes of congenital malformations in children that require surgery, including congenital diseases of the gastrointestinal tract.
- Congenital malformation is a disorder of the anatomical structure and, as a result, dysfunction of organs and systems. The wide variety of congenital defects and the different clinical manifestations at different ages make them difficult to diagnose accurately, which encourages surgeons to study congenital defects more thoroughly.
Congenital intestinal obstruction is more common in children due to malformations of the gastrointestinal tract. In fact, by 4 to 12 weeks the fetus has a firm hand grasp. However, during this period, the fetus may develop gastrointestinal defects due to various factors (external and internal).
For example:
Defects of the gastrointestinal tract: atresia, stenosis (narrowing of the intestine), membrane (complete or partial obstruction);
Defects caused by external compression of the intestines (pancreatic and annular pancreas, gastrointestinal tract hesitation, cystic lesions of the abdominal cavity);
bowel rotation (location) and fixation defects (Ledd's syndrome, small bowel twist, pathological bowel fixation, middle bowel twist, mesocolicoparietal hernia, incorrect rotation, failed rotation, reverse rotation);
meconium ileus and others can cause congenital intestinal obstruction.
The various forms of congenital intestinal obstruction most often occur in the neonatal period (infancy) and up to 3 months of age. At the same time, many congenital malformations, as well as adaptive disorders caused by additional somatic diseases, negatively affect the outcome of treatment.
Due to the complexity of the diagnosis of congenital intestinal obstruction in older children and adolescents, the development of life-threatening complications further complicates the surgical procedure and the postoperative period.
Fortunately, in the field of modern medicine in our country, too, high-quality diagnostics and treatment that meets international standards have been established, and the above-mentioned problems are being successfully addressed. For example, the Republican Perinatal Center recognizes the progress made in the diagnosis and treatment of congenital malformations. Also in the clinics of the Tashkent Pediatric Medical Institute, in particular, at the Department of "Children's Pediatric Surgery" scientific and practical research on congenital and acquired diseases is successfully conducted. Early diagnosis of congenital intestinal obstruction, ie detection in the womb and complex diagnostic methods and treatment are introduced in the regions of the country. In the field of treatment of congenital intestinal obstruction, the departments of neonatal surgery, pediatric surgery and gastroenterology use the results of research to train students, masters and clinical residents in the field of pediatric surgery.
- Sometimes surgery is needed to correct a congenital or acquired defect. The timing of the surgery is also important, isn't it?
- Yes, in this disease, surgical treatment is the main stage of treatment. It is especially important for children to have a clear timeline for this procedure.
There are both absolute and relative guidelines for performing surgery. The necessary instructions are given in cases where the patient's life may be endangered, such as acquired or congenital intestinal obstruction, destructive appendicitis, intestinal hernia, acute diseases of the abdomen.
Relative indications are given for routine surgical procedures, such as uncompressed hernias, hypospadias, polydactyly, congenital umbilical hernias, cysts, and so on. In this case, there is no need for emergency surgery.
The age of the child plays an important role in determining the time of surgery. However, if necessary, surgery can be performed on children of all ages, infants and even premature infants.
In the case of relative indications, the duration of surgery should be determined according to the plan, taking into account the nature of the disease and the age of the child. For example:
Congenital intestinal obstruction - after diagnosis;
Congenital leaks of the neck - from 2 years;
Funnel-shaped chest - from 5 years;
Congenital liver cysts - after diagnosis;
Jaundice and urinary tract leaks: complete - after diagnosis, non-conservative method operative with ineffectiveness for up to 6 months;
Umbilical hernia - from 6 months;
Abdominal white hernia - from 3 years;
Pylorostenosis - after diagnosis;
Gastrointestinal disorders - after diagnosis;
Girshprung's disease - from 1-2 years;
Atresia of the anus and rectum, leaky forms - from 6 to 12 months;
Megaureter - after diagnosis;
Renal dystopia - depending on clinical indications;
Hypospadias - from 1 year;
Epispadia - from 1-2 years;
Chow hernia - from 6 months;
Urinary incontinence - from 2 years;
Seed cysts - from 2 years;
Cryptorchidism - from 1 year.
Only in some cases (for example, umbilical hernia) is the surgical procedure delayed. This is because delays can lead to the disappearance of the disease or the creation of more favorable conditions for treatment.
- Are there additional responsibilities for parents in preparing children for surgery?
- Parents have additional responsibilities not only before the operation, but also for the next period. Tasks are determined by the patient's age, type of disease, period and course. It is important that if parents take their children to the right specialist in time and undergo a medical examination, we, the doctors, can accurately diagnose the disease and achieve a quick and effective treatment.
There are screening and perinatal centers in all regions of the country for the examination of pregnant women, and today it is important to contact them to identify birth defects and receive appropriate instructions in a timely manner. Then it will be possible to reduce the number of serious anomalies by determining the fate of the fetus (termination of pregnancy or permission to give birth).
It is best for parents to take timely action to prevent birth defects. To do this, it is necessary to follow a healthy lifestyle from an early age, to follow the principles of rational nutrition, to limit the unintentional use of drugs, to learn not to be indifferent to the health of the expectant mother and her future child. It is necessary to start this work before the fetus appears in the mother's body, to continue it during pregnancy, and to follow it even after the birth of the child.
