Pediatric surgery. Postoperative treatment of children with umbilical cord hernias (the most important)

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Pediatric surgery. Postoperative treatment of children with umbilical cord hernias (the most important)

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31. Postoperative treatment of children with hernias of the umbilical cord

Character postoperative treatment depends on the general condition of the child, his age and the method of surgical intervention.

In the first 2-3 days after the operation, all children are given prolonged epidural anesthesia, an elevated position is created.

Humidified oxygen is constantly supplied to the flask. Prescribe broad-spectrum antibiotics (5-7 days), cardiac drugs (according to indications) and physiotherapy. Produce 1-2 times a week transfusion of blood or plasma.

Children with small and medium hernias begin to feed through the mouth 6 hours after the operation (in more severe cases - after 10-12 hours), in doses of 10 ml every 2 hours, adding 5 ml with each feeding. Fluid deficiency is replenished by intravenous drip. By the end of the 2nd day, the child should receive a normal (by body weight and age) amount of breast milk; applied to the chest on the 3-4th day. Skin sutures are removed on the 8-10th day.

Children with large hernias after stage I of a two-stage operation are given parenteral nutrition for 48 hours. From the beginning of day 3, they begin to give 5-7 ml of a 5% glucose solution through the mouth, then expressed breast milk every 2 hours, 10 ml.

The total daily amount of fluid administered per os and intravenously should not exceed the age dosage, taking into account the child's body weight. Gradually increasing the amount of breast milk, by the 8th day the child is transferred to normal feeding (expressed milk). Apply to the mother's breast on the 12-14th day.

Children are given daily control dressings and careful wound care. The sutures are removed on the 9-12th day, depending on the degree of tension of the edges of the surgical wound.

In cases of surgical interventions on the intestine, the child is prescribed a diet indicated after resection of the intestine in a newborn.

The most significant problem in the management of the postoperative period during stage I of a two-stage intervention or radical correction is the child's adaptation to high intra-abdominal pressure. This adaptation is facilitated by a set of measures, which includes oxygen barotherapy, prolonged epidural blockade and a late start of feeding the child. In premature infants after the first stage of correction of large hernias, if signs of circulatory disorders in the lower extremities appear on the operating table, it is advisable to use prolonged nasotracheal intubation for 2 days. It reduces dead space and reduces ventilation disturbances due to the high standing of the diaphragm and the restriction of its mobility. Oxygen therapy should be carried out in the same cases with repeated sessions every 12-24 hours for 12 days.

From the day of admission, broad-spectrum antibiotics begin to be administered. A change of antibiotics is necessary after 6-7 days, depending on the results of sowing of purulent discharge and the sensitivity of microbes.

Authors: Drozdov A.A., Drozdova M.V.

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