Experience of surgical correction of congenital high intestinal obstruction in newborns

Objective: The article presents data, selection criteria, and results of surgical treatment of children with congenital high intestinal obstruction (CHIO) who were hospitalized with this pathology in the neonatal intensive care unit (ICU) for surgical pathology at the National Center for Maternal and Child Health in Bishkek, Kyrgyzstan.The purpose of the study was to develop approaches of diagnosis, surgical treatment, and postoperative management of newborns with CHIO and reduction of postoperative complications.Methods: From 2016 to 2024, 58 newborns with CHIO were admitted to the ICU for newborns with surgical pathology as duodenal obstruction, which included complete duodenal membrane, duodenal atresia, compression of the duodenum by the ring-shaped head of the pancreas, atresia of the initial section of the jejunum, and embryonic adhesions that compressed the duodenum.Results: Multiple birth defects were detected in newborns with CHIO, with combined congenital heart defects and Down syndrome noted in 22 (38%) patients.All children underwent preoperative preparation, which included correction of metabolic, hemodynamic disorders, normalization of body temperature and adequate diuresis.The algorithm of diagnostic examinations included clinical-laboratory and radiologic methods, such as X-ray passage of the gastrointestinal tract and irrigography of the large intestine, ultrasonography and ultrasound examination of internal organs.On radiological examination, the presence of ``double bubble`` sign, characterized by two air bubbles in the stomach and dilated part of the duodenum.All newborns underwent surgery: bypass gastrojejunostomy with Brown's anastomosis, duodenotomy, end-to-end small intestine anastomosis and separation of congenital embryonic adhesions.The mortality rate at 3 months after surgery was 3.4%. Conclusion:The study allowed for a thorough approach to the issues of surgical correction of CHIO in newborns.Analysis of clinical data showed that individual selection of surgical intervention tactics, taking into account the anatomical and physiological characteristics of the patient, timely diagnosis, and subjective postoperative management contribute to a reduction in the frequency of complications and mortality in the early postoperative period.Thus, timely diagnosis of fetal malformations during the antenatal period allows for the determination of treatment tactics and improvement of postoperative outcomes.CHIO in newborns requires various types of surgical intervention on the gastrointestinal tract, and a well-established algorithm for surgical correction of a specific type of congenital intestinal obstruction will improve the treatment outcomes for newborns with this pathology.