[Comparative study of surgical and endosurgical treatment of generalized appendicular peritonitis in children]. / Sravnitel'noe izuchenie rezul'tatov lecheniia rasprostranennykh form appendikuliarnogo peritonita u detei, operirovannykh laparoskopicheskim i traditsionnym khirurgicheskim sposobom.

The aim of the study was to evaluate the efficacy of endosurgery for generalized appendiceal peritonitis in children. Laparoscopic appendectomy (LA) was used as a procedure of choice in all forms of peritonitis and its complications. Original three-trocar approach and modified Gotz technique were applied. From 1991 to 2002 LA was performed in 4024 children aged from 7 days to 16 years, in 298 (5.8%) patients generalized peritonitis was diagnosed current. Prospective comparative randomized study includes 200 patients with generalized appendicular peritonitis. Contraindications were in 7% cases, rate of conversion to open surgery--2.1%. Duration of surgery was 61.7 +/- 24 min in laparoscopic group (LG) vs 73.2 +/- 31 min in open surgery group (OG). Patients of LG demonstrated earlier repair of many functions. There were no lethal outcomes. Rate of minor surgical complications was 10% in LG and 21% in OG (p < 0.05), major complications--13 and 16% (p = 0.55), respectively. There was no difference in rate of abscess formation (4%). Rate of pneumonia was 1% in LG and 3% in OG (p < 0.05), rate of critical conditions--2 and 4% (p = 0.067). Hospital stay was 15.7 +/- 3.1 days in LG and 21.2 +/- 3.8 days in OG. It is concluded that laparoscopic approach could be successfully used in more than 90% cases of generalized appendicular peritonitis. Endosurgery has many advantages over open surgery. LA demonstrates the best benefits in generalized peritonitis.

[Initial experience with laparoscopic appendectomy in children]. / Pervyi opyt laparoskopicheskoi appendéktomii u detei.

The article generalizes the first experience in successful laparoscopic appendectomies in children carried out by the method suggested by F. Götz et al. which we modified and adapted to pediatric practice. In all cases of acute appendicitis the laparoscopic manipulation began with the diagnostic stageo by performing two abdominal punctures with small-diameter trocars. Laparoscopic appendectomy was undertaken only in recognized destructive appendicitis. It was conducted 205 times in children 2 to 14 years old in various localization of the vermiform process, including subhepatic and retroperineal. Complicated forms of appendicitis were encountered in 52 patients. Nineteen children had generalized purulent appendicitis, 18 had circumscribed peritonitis, and 11 children had a loose infiltrate and signs of circumscribed peritonitis. A peri-appendicular abscess was found in the remaining 4 children. All endoscopic operations were completed successfully. In 205 endoscopically removed vermiform processes the clinical and morphological signs were in full agreement, with the exception of one case in which secondary inflammatory changes were determined in the process when the clinical diagnosis was phlegmonous appendicitis. Six complications occurred in the postoperative period: abdominal infiltrate in two patients, which was cured by nonoperative measures, and an abdominal abscess in another two patients (one was treated by laparoscopic drainage and the other by laparotomy). Early adhesive obstruction developed in two cases and was removed laparoscopically. Fatal outcomes and complications connected with laparoscopy were not encountered.

[Changes in the osteoarticular system after completion of the treatment of congenital hip dislocation in children and adolescents]. / Izmeneniia v kostno-sustavnom apparate posle zaversheniia lecheniia vrozhdennogo vyvikha bedra u detei i podrostkov.

There have been analyzed the results of the treatment of congenital femur dislocation in 189 children. It has been stated that the results of treatment are in direct relation with the timely commencement of treatment, dysplasia expression of pelvic and femur components, adequacy of the treatment methods to the pathology nature, observation of the orthopedics regimen and rehabilitation treatment. There have been detected the group of children, in which in spite of the treatment applied in total accordance with the rules of orthopedics, have been noticed the changes of the degenerative-dystrophic nature both on the side of dislocation and in the remote parts of skeleton. The obtained data are to be taken into consideration for vocational orientation of adolescents and at the stage of dispensary observation in order to compile the plans of rehabilitation treatment.

[Current trends and problems in surgery for Hirschsprung's disease in children]. / Sovremennye tendentsii i problemy v khirurgii bolezni Girshprunga u detei.

The authors discuss the results of 211 operations for Hirschsprung's disease with special reference to the optimal terms for surgery, questions of medical policy and remote results. The remote results were studied in 102 patients. Excellent results were obtained in 63% of cases, good--in 28% and in 9% the results were satisfactory. The authors make special accent on residual functional disorders and necessary rehabilitation measures till full recovery of the patient.