[Laparoscopic phelps approach in children with inguinal hernia: a retrospective comparative study]. / Primenenie laparoskopicheskogo metoda phelps u detei s pakhovoi gryzhei.

OBJECTIVE: To evaluate the effectiveness of a new method of inguinal hernia repair in children (PHELPS) first proposed by the authors compared to another laparoscopic method (SEAL). MATERIAL AND METHODS: The study demonstrated the results of laparoscopic treatment of 729 patients with inguinal hernias. Of these, 255 patients underwent PHELPS procedure. Other 474 patients underwent SEAL procedure. The difference between both methods is that hernial ligature is passed around the hernial sac in case of PHELPS. SEAL procedure implies capture of tissues of anterior abdominal wall (muscles and aponeurosis) into this knot. We analyzed whether this factor can lead to less incidence of recurrence and hydrocele. RESULTS: Both groups were comparable by age, body weight and gender. Median of surgery time including correction of unilateral and bilateral hernia was similar (20.0 [10.0; 20.0] min versus 15.0 [15.0; 20.0] min; p=0.666). We found faster patient recovery after PHELPS procedure for inguinal hernia including much less doses of postoperative analgesia (1.0 [1.0; 1.0] versus 1.0 [1.0; 2.0]; p<0.001) and shorter hospital-stay (8.0 [8.0; 8.0] hours versus 8.0 [8.0; 9.0] hours; p=0.010). There were no significant differences in the incidence of postoperative hydrocele (0 versus 6; p=0.097). Nevertheless, recurrence rate differed significantly (0 versus 17; p=0.001). CONCLUSION: PHELPS procedure is characterized by lower incidence of recurrence and accelerated postoperative recovery compared to SEAL technique.

[Multiple-center study of laparoscopic and open treatment of duodenal atresia]. / Mul'titsentrovoe issledovanie laparoskopicheskogo i otkrytogo lecheniya duodenal'noi atrezii.

OBJECTIVE: To summarize data of a multiple-center study of the treatment of duodenal atresia in 3 children's hospitals of the Siberian Federal District. MATERIAL AND METHODS: We analyzed postoperative outcomes in 211 patients with duodenal atresia. All patients underwent surgery at various hospitals of the Siberian Federal District: Ivano-Matreninsky Children's Clinical Hospital in Irkutsk (expert hospital) - 120 patients; Center for Maternal and Child Welfare in Krasnoyarsk (learning hospital No. 1) - 51 patients; Kemerovo Regional Children's Clinical Hospital (learning hospital No. 2) - 40 patients. The study has been carried out for 15 years (from January 2005 and to December 2019). Patients were divided into 2 cohorts: group I - 88 patients (laparoscopic formation of duodenal anastomosis); group II - 123 patients (surgery via laparotomy). Demographic data, intra- and postoperative parameters and complications were analyzed. RESULTS: Preoperative parameters were similar in both groups. Significant between-group differences were found for surgery time (70 vs. 90 min; p<0.001). Initiation of feeding and complete enteral nutrition occurred significantly earlier after laparoscopy (3 vs. 7 days, p<0.001 and 8 vs. 12 days, p<0.001). Incidence of anastomotic leakage significantly differed in both groups (1 patient after laparoscopy and 9 patients after laparotomy, p=0.038). Mortality was absent in the laparoscopy group. In the laparotomy group, this value was 4.9% (p=0.036) and caused by concomitant conditions (prematurity, sepsis, heart defects). Late postoperative complications (adhesive intestinal obstruction, ventral hernias) were absent after laparoscopy and occurred in 5.7% of patients after laparotomy (p=0.023). CONCLUSION: Laparoscopic correction of duodenal atresia can be safely performed by experienced endoscopic surgeons from different centers united by the same ideology of endoscopic surgery. Laparoscopy ensures less duration of surgery, faster postoperative recovery, less mortality, incidence of early and late postoperative complications.