Risk factors for occurrence of complications in intestinal anastomosing in conditions of peritonitis and disorders of intestinal hemoperfusion in children

Introduction. The issues of safe formation of primary intestinal anastomosis (PIA) in conditions of peritonitis and impaired intestinal hemoperfusion in children remains relevant. The “classic ban” on PIA in conditions of inflammation or ischemia is often passed down from generation to generation of surgeons without clear reasoning, scientific proofs, and understanding of the pathogenesis of complications. However, in a number of clinical situations, a pediatric or newborn surgeon is forced to use PIA approach when understanding and predicting the risks of complications of this surgical technique become important. This position requires clarification and scientific justification in modern clinical guidelines. Objective. To determine potential risk factors for complications of intestinal anastomosis in conditions of peritonitis and impaired intestinal hemoperfusion in children. Materials and methods. The first stage was a comparative analysis of intestinal anastomosis outcomes in newborns and older children according to the data of the chief pediatric surgeons of 75 constituent entities of the Russian Federation, including the DPR and LPR (2021–2022). Also, the outcomes of intestinal anastomosis in groups of patients with “presence” and “absence” of peritonitis and impaired intestinal hemoperfusion were assessed. The second stage was a multivariate analysis of clinical and laboratory signs in 11 children from different clinics of the Russian Federation. The PIA management in the conditions of peritonitis and impaired intestinal hemoperfusion in these patients was complicated by anastomotic failure or stenosis. Results. PIA in conditions of peritonitis and impaired intestinal hemoperfusion was performed in 1207 children (26.48% of all intestinal anastomosis). Death was recorded in 21 (1.74%) patients, failure — also in 21 (1.74%), stenosis requiring reconstruction — in 42 (4.1%). The factor “presence of peritonitis and impaired intestinal hemoperfusion” in all children was determined to significantly increase only the incidence of intestinal anastomotic stenosis, requiring subsequent reconstruction (χ2 test = 12.102; p < 0.01), and in newborn patients all differences in outcomes were statistically confirmed: mortality — χ2 test = 23.235; p < 0.01, failure — χ2 test = 29.790; p < 0.01, stenosis — χ2 test = 42.344; p < 0, 01. In newborns the risk of death, anastomotic failure, and stenosis in conditions of peritonitis or impaired intestinal hemoperfusion has also been scientifically proven to be significantly higher (p < 0.01) than in the group of older children. Multivariate analysis of data of patients treated by PIA in conditions of peritonitis or impaired intestinal hemoperfusion showed hypotension, hypovolemia, anemia, hypoalbuminemia, respiratory failure, and comorbidity to be recorded in the majority of patients. These patients required volume fluid therapy, transfusion therapy, and cardiotonic/vasopressor therapy.