RECONSTRUCTIVE FUNCTIONAL RESERVOIRS IN TREATMENT OF CHILDREN WITH AGANGLIONOSIS AFTER TOTAL COLECTOMY

The object of the study is to develop optimal reconstructive functional reservoirs for the treatment of children with aganglionosis after total colectomy. Since 1980 till 2020 we have been treating 53 children up to 3 years with aganglionosis after total colectomy using optimal reconstructive surgery technique lying in the formation of a functional intestinal reservoir. Colostomy was performed as the first stage of surgical treatment of all children. Effective ways of restoring the integrity of the intestinal tract after a total colostomy with creating of functionally advantageous circumstances for reservoirs formation were presented as "J" - reservoirs (n=2); ileotransplant with lateral ileo-ileoanastomosis (n=34); ileotransplant with lateral ileo-colonoastomosis (n=7); ileorectal primary anastomosis (n=1) or entero-enteroanastomosis with an invagination valve (n=8) or implantation of an ileocecal valve (n=1). The colostomy was closed after 3-4 months. There were no results in the postoperative period. After 3 months the frequency of defecation often is 10-15 times a day, and after 1 year it changes to 2-4 times a day. All the children survived. The results of functional tests are good. Bowl function is tolerable. The radiographs show a formed rectum with a sufficient reservoir and normal colonization. Restoration of integrity of the intestinal tract with the formation of functionally advantageous reservoir in the form of double ileo-colotransplant and ileo-ileotransplant "side-to-side" is the best option for reconstructive surgery performing in children with agangliosis after total colectomy. Formation of functionally advantageous reservoir prevents impaired water-electrolyte balance, improves normobiosis, improves formation and accumulation of feces, slows down passage through the digestive tract and prevents the development of other metabolic disorders. A modernized surgical approach, which lies in creation of various options for functionally advantageous reservoir in order to eliminate effects of colon absence in children, contributes to facilitating the postoperative period, accelerating rehabilitation, improving social adaptation and patients quality of life.