[Laparoscopic decompression of celiac trunk in children]. / Laparoskopicheskaia dekompressiia chrevnogo stvola pri kompressionnom stenoze u detei.

MATERIAL AND METHODS: For the period 2013-2016 four patients were treated at the Filatov Children's City Clinical Hospital #13. There were 2 children aged 14 years and 2 children aged 17 years. All patients have been diagnosed via anamnesis, complaints, pulse-wave doppler sonography, contrast-enhanced MDCT and angiography. After comprehensive examination 3 patients underwent laparoscopic decompression of celiac trunk. In all cases celiac trunk compression was predominantly caused by median arcuate ligament of the diaphragm combined with neurofibrotic tissue of celiac plexus. RESULTS: All patients were discharged after laparoscopic decompression of celiac trunk. Intra- and postoperative complications, as well as cases of conversion were absent. Mean time of surgery was 65 minutes. In all cases postoperative period was smooth (4 days on the average). Two patients underwent follow-up examination in long-term postoperative period: pulse-wave doppler sonography, contrast-enhanced MDCT and angiography. In both cases reduced severity, incidence and duration of pain syndrome were observed. CONCLUSION: Clinical examples show some problems in diagnosis and treatment of compressive stenosis of celiac trunk due to rarity of pathology especially in childhood. Nevertheless, combination of abdominal ischemia and celiac trunk stenosis confirmed by instrumental diagnosis is indication for surgical treatment.

[Endosurgical treatment of the bile duct lesions in children].

UNLABELLED: Question of feasibility of laparoscopic Kasai procedure and laparoscopic hepaticojejunostomy for biliary atresia (the BA) and choledochal cysts (the CC) in children has been a subject of discussion for a long time and still remains unsolved. AIM: To improve the results of surgery for biliary tract malformations (the BTM) in children using laparoscopic technique. MATERIALS AND METHODS: The are 55 patients with BA and CC, who were performed endosurgical operations, and 37 patients, who were performed traditional open surgical procedures. During this study we worked out and put into laparoscopic practice some new methods. We've made an analysis of technical features of liver transplantation after laparoscopic and traditional Kasai's operation in BA. RESULTS: The duration of laparoscopic Kasai procedure was significantly longer than open surgery (p < 0.05). In CC the duration was the similar (p > 0.05). There was no any urgent surgical complication after laparoscopic Kasai procedure in contrast to open surgery. We observed significantly fewer complications (40%) after laparoscopic hepaticojejunostomy than after traditional hepaticojejunoduodenostomy (84.6%, p < 0.05). The average length of stay in ICU and duration of analgesia after laparoscopy was significantly lower than after open surgery (p < 0.05). Comparing the efficiency of endosurgery and traditional operations using coloration of stool, decreasing of bilirubin level and the presence of indications to liver transplantation criteria we didn't find any significant difference (p > 0.05). CONCLUSION: At the same efficiency of laparoscopic and open reconstructive surgery for BA and CC the first has a number of incontrovertible advantages. Our experience allows us to recommend laparoscopic procedures to perform for the correction of BTM in children.

[Treatment of bronchiectasis in children].

The thoracoscopic and traditional thoracotomic surgical access for bronchiectesis treatment in children were compared. The first (thoracoscopic) group included 18 children. The control (thoracotomic) group included 26 patients. The mean operative time in the 1st group was 78.3±31 min; pleural draining lasted for 1.3 days and postoperative hospital stay was 9.93±2.08 days. The mean operative time in the 2nd group was 81.7±35.1 min; pleural draining lasted for 3.3 days and postoperative hospital stay was 14.4±3.4 days. Conversion was needed in 4 cases. Therefor, the thoracoscopic surgery proved to be much more preferable in children because of its' minimal invasiveness.

[The surgical correction of vascular tracheal rings in children].

The aortic arch and its branches anomalia compound 1-3.8% of all vessel inborn diseases. The treatment of such anomalia as tracheal vessel ring aims the liquidation of esophageal and tracheal compression. The authors introduce their experience of thoracoscopic tracheal vessel rings resection in 6 children. The time of the operation was 145±15min. There were no conversions to the traditional open surgery. The result was excellent in 4 of 6 children, who were completely releaed of tracheal obstruction symptoms. The rest 2 children demonstrated mild respiratory symptoms, cuased by the tracheomalation.

[The endoscopic operations by solid thoracic tumors in children].

20 patients were operated thoracoscopically on the cause of the solid tumors of the pleural cavity. Patients were aged from 1 day of life to 17 years. Minimal size of the tumor was 3.1×3.5×4.0 sm; maximal 10×10×20 sm. The control group was created of 22 children with thoracic tumors, operated via thoracotomy. The postoperative period and outcomes were statistically better among patients, treated thoracoscopically.

[Laparoscopic cardiomyotomy for the treatment of achalasia of esophagus in children].

The experience of endosurgical treatment of 8 children, aged from 4 to 15 years, with cardiac achalasia was analyzed. Laparoscopic Heller's cardiomyotomy with gastropexy was performed in all cases. Esophageal mucosa was damaged in 2 patients. The lesion was closed laparoscopically, there were no conversions. Esophageal perforation was registered postoperatively in one patient. The study shows capabilities of endoscopic surgery in treatment of rare esophageal diseases in children.

[Endoscopic lung resection in children].

The experience of thoracic surgery department of a pediatric hospital Number13 is revised. The evolution of operative methods in minimally invasive thoracic surgery and most frequently used procedures in children lung surgery are described. The results of 26 thoracoscopic lung resections on account of inherited and acquired diseases are described. Actual problems of thoracoscopic surgery are discussed.

[Simple renal cysts in children: analysis of surgical treatment].

The results of solitary renal cysts (SRC) treatment in children have been analysed. Laparoscopic and puncture methods have been used. The algorithm of SRC patients' management is proposed. Ninety children with simple renal cysts aged 1 to 15 years were treated in Moscow city N.F. Filatov children's hospital N 13 in 1996-2007. The diagnosis was made basing on the findings of ultrasound investigation, computed tomography and radionuclide scintigraphy. Surgical treatment was applied only in case of large cysts (2.5 cm and more), connection with collective renal system and clinical manifestations. In small-size cysts and normal urodynamics the patients were followed up. Laparoscopic excision of the cyst was performed in 71 cases. The punctures were made under ultrasonic guidance with catchment or without it. The cyst content was aspirated with following sclerosing and administration of 96% ethanol into the cyst cavity. There were no postoperative complications. Good results (cyst disappearance) were achieved in 64 patients after laparoscopic and in 13 after paracentetic treatment; satisfactory results (cyst size reduction and relieve of clinical symptoms) were obtained in 6 children after laparoscopic and in 4 after percutaneous puncture. Laparoscopic treatment failed in 1 case of intraparenchymatous cyst which relapsed. It is recommended to begin treatment of simple renal cysts with use of the paracentetic method with catchment and following sclerosing proving positive results after original surgery.

[Portal hypertension at children: current aspects of portal-systemic bypass].

Overall 438 children with extrahepatic portal hypertension underwent surgical treatment. Portal-systemic bypass was performed at 383 patients, meso-portal bypass -- at 56. These surgical procedures were effective at 96.4% cases. All the children with bleeding recurrences were operated repeatedly. Meso-portal bypass not only prevents risk of bleeding but also reconstruct normal anatomy and physiology of portal system.

[Radical treatment of extrahepatic portal hypertension in children]. / Radikal'nyi metod lechenia vnepechenochnoi portal'noi gipertenzii u detei.

Results of radical correction of extrahepatic portal hypertension in 25 children are presented. It is demonstrated that this surgery is feasible in 38.5% patients with this disease. Feasibility of surgery is based on the results of revision of hepatic vessels after laparotomy. The existing diagnostic methods don't permit one to predict feasibility of this bypass variant before surgery. It is demonstrated that this surgery leads not only to elimination of hemorrhage risk but also to complete reconstruction of portal perfusion and cure of portosystemic encephalopathy and hyperdynamic cardial syndrome. Surgeries are successful at any age, and also in of hemorrhage peak.