[Comparative analysis of the bile duct reconstruction methods in children with choledochal malformation]. / Sravnitel'nyi analiz sposobov rekonstruktsii zhelchnykh khodov pri mal'formatsii obshchego zhelchnogo protoka u detei.

OBJECTIVE: To compare various methods of bile duct reconstruction in children with choledochal malformation (CM). MATERIAL AND METHODS: There were 99 children with CM over 10-year period. Mini-laparotomy (ML), laparoscopy (LS) and laparotomy (LT) were used. We performed radical CM resection and bile duct reconstruction using Roux-en-Y hepaticojejunostomy (RYHJ) and hepaticoduodenostomy (HD). Surgery time, short-term and long-term postoperative outcomes were evaluated. RESULTS: ML was performed in 39 patients, LS - 51 patients, LT - 9 patients. In case of LS, hospital-stay was significantly lower after intracorporeal RYHJ formation compared to extracorporeal technique (p=0.02, Mann-Whitney U-test). Intracorporeal RYHJ requires more time (p=0.0003). Intestinal passage recovered 3 times faster in the ML RYHJ group compared to the LS RYHJ group (p=0.016, Mann-Whitney U-test). ML RYHJ was followed by significantly less duration of postoperative narcotic anesthesia compared to LS HD (3 vs. 4 days, p=0.02, Mann-Whitney U-test). In our study, ML RYHJ has an advantage over LS RYHJ regarding long-term outcomes. HD resulted higher incidence of severe postoperative pancreatitis (p=0.033) that required surgical correction (LT, p=0.043). CONCLUSION: ML RYHJ has some advantages over other methods of bile duct reconstruction. Therefore, we can currently recommend this method as a preferable one.

[Bio-impedancemetry in the evaluation of body water balance and hemodynamics at laparoscopic operations in children]. / Bioimpedansometriia v otsenke balanca vody organizma i gemodinamiki pri laparoskopicheskikh operatsiiakh u detei.

Bio-impedancemetry, based on the ability of tissues to carry electric current, was used to evaluate the water balance in the bodies of children at laparoscopic surgical interventions. The clinical cause of 67 anesthesias in children, aged 5 to 14, operated by using the laparoscopic technique was analyzed. It was established, through assessing a combination of changes in the studied indices, that the application of the pneumoperitoneum is the most significant factor in the pathogenesis of occurring changes. The stage in question was accompanied by maximal changes in the studied parameters: an increase in the body impedance, a decrease in the limb impedance, reduced cardiac discharge and stroke volume, a reduced cardiac beat rate (CBR) and a high arterial pressure (AP). The position of a patient on the surgical plate was another important factor affecting the changes in the studied parameters. After a prolonged stay in Fovler's position led to an outflow of fluid from the lower limbs in children, which was confirmed by a limb reduced impedance. After the horizontal position was recovered, the impedance went up.