[Using various methods of intraoperative hemostasis in laparoscopic genitourinary surgery in children].

AIM: To improve treatment results of children undergoing laparoscopic genitourinary surgery by optimizing intraoperative hemostasis. MATERIALS AND METHODS: The study comprised 110 children with various genitourinary diseases. The study group included 70 children who underwent laparoscopic surgery with optimized hemostasis with the use of an automated electrosurgical vessels ligation device LigaSure. Forty children who received standard intraoperative hemostasis with mono- or bipolar coagulation made up a control group. RESULTS: The operative time was significantly shorter with the optimized method of hemostasis than when using mono- and bipolar coagulation [77.02 min versus 112.5 min (p<0.05)]. The blood loss in the study group was also significantly lower than in the control group [17.9 and 34.2 ml, respectively (p<0.05)] due to precise control and final hemostasis. There were no intraoperative complications and conversion to open surgery in patients in the optimized hemostasis group, whereas in the control group two complications were observed. CONCLUSION: Laparoscopic urogenital surgery with the optimized hemostasis using the automated electrosurgical vessels ligation device LigaSure in children is optimal due to the minimal injury to the coagulated tissues, the ability to forgo clipping and ligation of the vessels, which results in shorter operative time and reduced intraoperative blood loss.

[Laparoscopic and open heminephrectomy in children: results comparison].

UNLABELLED: Objectives. To compare the results of laparoscopic and open heminephrectomy for kidneys duplication in children. Materials and methods. 42 patients underwent laparoscopic heminephrectomy and 20 patients underwent open heminephrectomy for non-functioning kidney moiety. Transperitoneal access with 3-4 trocars was used in the first group. Retrospective analysis of demographic, intra- and postoperative parameters, developed complications was performed. RESULTS: The mean operative duration was 127 minutes (90-205) and 120 minutes (100-219) in laparoscopic and open surgery groups, respectively. There were not intraoperative complications and need for conversion in laparoscopic group. Two children required additional surgery for perirenal cyst and ureteric stump inflammation. Hemotransfusion after open surgery was performed in 2 cases. Complications included pleural sine laceration and complete function loss of remaining moiety. The mean hospital stay was 7.2 days (5-12) and 11.5 days (8-17) in laparoscopic and open surgery groups, respectively. CONCLUSIONS: Laparoscopic transperitoneal heminephrectomy can be successfully used in children. Duration of laparoscopic and open interventions is comparable. But hospital stay is less in case of laparoscopic interventions.

[The endotoxine aggression in the pathogenesis of postoperative complications in children with Hirsprung disease].

Signs of disseminated intravascular clotting (DIC), which were considered the laboratory sign of the subcompensated endotoxine aggression, were detected in 20 children with the Hirsprung disease, aged 3 months - 11 years. Under the influence of the operation stress the subcompensated DIC transformed to the acute decompensated reaction, which led to early complications, such as anastomosistis with tendency to the insufficiency or stenosis, enterocolitis, etc. The study revealed not only the straight connection between the postoperative complications and endotoxine aggression, but the necessity of preoperative preparation, directed on the decrease of the intestinal endotoxin level and normalization of antiendotoxin immunity.

[The laparoscopic adrenalectomy in children].

22 children with tumors or other surgical diseases of the adrenal glands were operated on laparoscopically. Children aged from 5 months to 17 years. Operation lengths varied from 45 to 190 minutes. There were no lethal outcomes, conversions and serious complications of the procedure. Authors consider the laparoscopic adrenalectomy to be the safe and widely appropriate method for the use in juvenile cathegory of patients.

[Clinique--pathogenetic features of postcholecystectomy syndrome in children].

UNLABELLED: Years of experience observing children with GSD made possible to determine the clinical course and to clarify some of mechanisms of postcholecystectomical syndrome formation in children. Material and methods. There were observed 148 children who underwent cholecystectomy at the age of 3 to 15 years. There were 44 boys and 104 girls. Diagnosis refined was conducting by ultrasonography, magnetic resonance imaging. Degree of biliary insufficiency was assessed based on dynamic of gepatobilliarscintigraphy. The clinical picture of disease was assessed according to age and sex of the child. RESULTS: We described the clinical course and pathogenetic mechanisms of postcholecystectomical syndrome in children in the age aspect. Based on the results of our research, were found ways of correction of postcholecystectomical syndrome in children with cholelithiasis.

[Laparoscopic heminephrouretherectomy in children with double kidney].

The article revises the first experienced of laparoscopic geminephrouretherectomy in our country. 5 children aged 3-14 years were operated on. In 1 case of double ureter the laparoscopic ureterectomy was performed, the rest 4 patients experienced geminephrouretherectomy (2 left and 2 right).The operative time was 100-180 minutes. There were no intra- and postoperative complications. All children were discharged on 6-12th postoperative day. Follow-up examination verified perfect cosmetic and functional results.

[Life quality of children with hematological diseases after laparoscopic splenectomy].

Problems of assessment of life quality of children with benign hematological diseases (hereditary microspheric anemia, thalassemia, idiopathic thrombocytopenic purpura) after laparoscopic cholecystectomy are discussed. The standard SF-36 scale was used before and after endoscopic surgery. It is demonstrated that after reasonable laparoscopic splenectomy almost all parameters of life quality are improved. Improvement of physical parameters argues for small surgical trauma and slight postoperative period after laparoscopic splenectomy.

[Optimization of laparoscopic splenectomy at children].

Treatment results of 130 patients aged 1 to 16 years with benign hematological diseases (congenital microspheric anemia--93 patients, thalassemia--18, severe idiopathic thrombocytopenic purpura--19) who has undergone laparoscopic cholecystectomy due to concomitant cholelithiasis. Optimization of surgical techniques permitted to achieve excellent functional and cosmetic results, to reduce operation time to 35-110 min (64.67+/-10.07 min on average), volume of hemorrhage to 30-110 ml (62.91+/-14.46 ml on average), to avoid intraoperative and postoperative complications. It is concluded that laparoscopy is the method of choice for the treatment of children with benign hematological diseases required splenectomy despite the age of child, spleen size, including the children with severe disorders of hemostasis system.

[Laparoscopic operations for simple cysts of kidneys at children].

Results of treatment of 62 children aged 1 to 15 years with non-parasitic cysts of kidneys using mini-invasive laparoscopic technologies are analyzed. Laparoscopic operations with original technique have been performed at all the patients with various cysts sizes (from 3 to 13 cm across diameter) and localization (including 12 cases of peripelvic cysts). The time of surgery ranged 25 to 110 min (43 min on average); there were no conversions to open surgery, intraoperative and postoperative complications. The follow-up ranged from 1 to 3 years, there were no cases of cyst recurrence, and the functional and cosmetic results were excellent. It is concluded that laparoscopic method should be regarded as "gold standard" for the treatment of non-parasitic kidneys cysts at children that permits to achieve the stable positive results regardless of patient age, size and localization of cyst.

[Urgent laparoscopic surgeries in children of the first year of life].

One hundred and ninety-two urgent laparoscopic operations in 179 infants (including 31 newborn infants) were performed. Indications for surgery were intestinal obstruction (108 children), acute diseases of abdominal organs (61), and gynecological diseases (10). The rate of conversion in 3 groups was 10.9, 4.6% and 0, respectively. In all the cases conversion was performed due to technical difficulties, there were no intrasurgical complications, diagnostic value of the method reached 100%. Combined laparoscopic surgeries were performed in 25.1% cases. Intestinal invagination was the most frequent cause of laparoscopy. Comparative analysis of open (28) and laparoscopic (85) desinvagination demonstrated the advantages of the latter one both during and after surgery. Laparoscopy is the useful method for diagnosis and treatment of acute abdominal disease requiring urgent surgery in infants.

[Laparoscopic operation for Hirschsprung's disease in children].

Experience in the treatment of 5 children aged 6 months to 14 years with different types of aganglionosis of the colon using laparoscopic endorectal bringing down of the colon (like Coabe surgery) is analyzed. In all the cases this method permitted mobilization and resection of the intestine (to 60 cm), bringing down intact intestine on the perineum with simultaneous coloanal anastomosis. Duration of the surgery ranged from 120 to 240 min, postoperative hospital stay did not exceed 8 days. Functional and cosmetic results were excellent. The method is characterized by combination of advantages of classical Coabe operation with minimal surgical trauma of laparoscopic mobilization of the colon.

[Use of a laryngeal mask during combined regional anesthesia in children].

For intraoperative anesthesia, the authors applied central regional blocks. A laryngeal mask was used to maintain free airways patency. The purpose of this study was to provide evidence for the effectiveness of a laryngeal mask used under combined regional anesthesia and to establish whether the mask could be employed for artificial ventilation during laparoscopy in children.

[Sacral proctoplasty in the treatment of anorectal malformations in children]. / Sakralnaia proktoplastika v lechenii anorektalnykh porokov razvitiia u detei.

The paper describes novel procedures for sacroperineal, sacroabdominoperineal and posterosagittal proctoplasties during radical correction of various types of anorectal malformations and their sequelae in children of all age groups, including neonates. Some technical features of their performance are considered and the outcomes of treating 84 children are analyzed. The proposed scheme for surgical treatment allows one to achieve good and satisfactory late functional results in 80 per cent of patients with anorectal atresias and incontinence of feces.

[Laparoscopic appendectomy in pediatric patients: experience of 2300 operations]. / Laparoskopicheskaia appendéktomiia u detei: opyt 2300 operatsii.

The experience of 2300 laparoscopic appendectomies in children aged between 7 days and 14 years is presented. Uncomplicated forms of acute appendicitis were observed in 1611 patients (70.1%). Complicated forms were observed in 689 (29.9%) patients: general peritonitis in 196, local peritonitis--in 334, periappendicular abscess--in 122 and friable infiltrate--in 37 patients. Laparoscopic appendectomy according to F. Götz modified and adapted by us to children's age was used for all variants of the appendix location, including atypical. Optimal surgical approaches for children of early age and children over 3 years were developed. All laparoscopic interventions were completed endosurgically. Only in 15 (0.65%) patients the transition to open surgical operation was carried out on a diagnostic phase of the laparoscopic appendectomy for contraindications (solid infiltration, general peritonitis with multiple abscesses, intestine paresis with need of decompression). On comparative estimation of the laparoscopic and traditional appendectomies the indisputable advantages of the endoscopic technique are proved: more smooth course of the postoperative period, reduction of complications' number, reduction of hospital stay. Laparoscopic appendectomy is the most effective technique for the treatment of acute appendicitis complicated forms. Mean operative time was 65 min (range 42-120 min). Total amount of the postoperative complications in this group decreased almost 3 times. Frequency of such serious intraabdominal complications as acute commissural ileus decreased 3.5 times, infiltrates and abscesses of the abdominal cavity--2 times. Suppuration of the anterior abdominal wall was extremely rare. Mean hospital stay reduced almost 2 times. Intraoperative complications and lethality was not observed.

[Laparoscopic operations in acute adhesive intestinal obstruction in children]. / Laparoskopicheskie operatsii pri ostroi spaechnoi kishechnoi neprokhodimosti u detei.

Results of treatment of 148 children suspected for acute adhesive intestinal obstruction (AAIO) after laparoscopy are analyzed. Age of the patients ranged from 3 weeks to 14 years. There were 90 (61.4%) boys and 58 (38.6%) girls. Diagnosis of AAIO was confirmed in 129 patients (other diseases were revealed in 19 children). Laparoscopic adhesiotomy was impossible in 13 cases because of contraindications (necrosis of strangulated intestine, abscess-forming infiltration, general adhesive process). Laparoscopy was performed by specially developed technique decreasing the risk of examination in the conditions of adhesive process. The contraindications to laparoscopic adhesiotomy were developed. Laparoscopy permitted to remove the obstruction in 79.8% patients with AAIO. There was one intraoperative complication--colon injury in the area of earlier spontaneously closed fistula (laparotomy and suturing of colon's defect were performed). Postoperative period after laparoscopic operations was easier than after open operations: physical activity of the patients recovered quickly, number of postoperative complications decreased more than 3 times, hospital stay reduced more than 2 times. There were no lethal outcomes.

[Video-laparoscopic surgeries in Meckel diverticulum in children]. / Videolaparoskopicheskie operatsii pri patologii divertikula Mekkelia u detei.

From 1992 to 2001 laparoscopic diagnosis and treatment of various pathologic changes of Meckel diverticulum were carried out in 58 children aged from 3 weeks to 14 years. Bleeding from the diverticulum was in 33 patients, diverticulitis--in 21, intestinal obstruction--in 4 patients. Diagnostic laparoscopy was performed carefully with trochars of small diameters (3-5 mm). Conversion to open operation was necessary in 2 patients due to inflammation in the diverticulum and adjacent parts of the intestine. Circulatory resection of the intestine with the diverticulum in the limits of healthy tissues was performed. All 33 patients with intestinal bleeding were examined with 99mTc before surgery. Only 15 (45.4%) patients demonstrated pathologic accumulation of radionuclide in the zone of the diverticulum. Laparoscopic resection of the diverticulum was performed in 56 patients. Three methods of endoscopic resection were used: with suture device Endo-Gia-30 (31 patients), with application of Roeder's loop on the base of the diverticulum when it was 1-1.5 cm wide maximum (23), with suturing of intestine with two-layer intracorporel endoscopic suture (2). All the started laparoscopic operations were finished successfully. There were no conversions to open surgery. Mean time of surgery was 45 min. There were no intraoperative complications. In postoperative period one patient showed acute adhesive intestinal obstruction which was treated with laparoscopy. Mean hospital stay was 6.1 bed-days. There were no lethal outcomes. Cosmetic effect was excellent in all the cases.

[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.

[Laparoscopy in the treatment of intestinal invagination in children]. / Laparoskopiia v lechenii invaginatsii kishki u detei.

The experience with laparoscopy in diagnosis and treatment of intestinal invagination in 142 children aged from 2 months to 11 years (study group) is reviewed. Endoscopic desinvagination was performed when conservative (pneumoirrhigoscopy) treatment was ineffective or hospitalization of patients was late. The invaginate was straightened out under video-control with two atraumatic forceps-graspers introduced into abdominal cavity and simultaneous pumping of air into the large intestine. This method permitted to cure completely intestinal invagination in 126 (88.7%) patients without laparotomy. In the control group (50 children aged from 3 months to 2 years) traditional surgery (laparotomy) was performed. Mean time of laparoscopic desinvagination was 32.6 min, time of surgery in the control group - 65 min. Postoperative complications in the study group were 5 times more rare than in the control. Mean time of hospitalization in the study group was decreased 3 times compared with the control. There were no lethal outcomes in both groups. Laparoscopic desinvagination is safe and high-effective procedure in the treatment of intestinal invagination in children.

[Laparoscopic surgery in children--current possibilities and perspectives]. / Laparoskopicheskaia khirurgiia u detei--sovremennye vozmozhnosti i perspektivy.

Experience in use of different laparoscopic methods in 6046 children who needed urgent and elective surgeries are analyzed. Urgent surgeries were performed in 3292 children for acute appendicitis and it complications, acute adhesive intestinal obstruction, invagination, trauma of abdominal organs, pathological changes of Meckel diverticulum, urgent inflammatory and non-inflammatory gynecological diseases. In this group endosurgery was successful in 3120 (94.8%) patients, conversion to open surgery was necessary in 5.2% cases (172 patients). Laparoscopic cholecystectomy, splenectomy, nephrectomy, surgeries for cysts of parenchymatous organs, benign cysts and tumors of abdominal cavity and retroperitoneal space, varicocele, syndrome of unpalpable testes and abdominal cryptorchism were performed as elective surgeries in 2754 patients. Endosurgical methods to minimized number of complications (1.1% or 29 patients in the whole group), conversion to open surgery was necessary in 10 (0.4%) cases. Laparoscopic methods in many cases are the "gold standard" in elective and urgent surgery in children.

[Diagnosis and treatment of abdominal trauma in children]. / Diagnosticheskaia i lechebnaia taktika pri abdominal'noi travme u detei.

Treatment of 79 children with injuries of abdominal and retroabdominal organs was analyzed. Results of diagnosis and treatment were evaluated in 3 groups: group 1--29 children treated conservatively; group 2--20 patients in whom total hemostasis was achieved during laparoscopy; group 3--30 children who have undergone open operations. Non-invasive and minimally invasive diagnostic methods permitted to avoid surgery in 46.4% patients. Efficacy of polymeric knitted netted material and Surgicell) for hemostasis in parenchymatous organs was demonstrated experimentally in rats.