[Treatment of complications following esophageal electrochemical burns by batteries in children]. / Taktika lecheniya oslozhnenii elektrokhimicheskogo ozhoga pishchevoda batareikoi u detei.

OBJECTIVE: To determine the optimal treatment of patients with complications of esophageal electrochemical burns by batteries. MATERIAL AND METHODS: There were 75 children with esophageal electrochemical burns by batteries between 2010 and 2019. All children underwent X-ray of the cervical spine, chest and abdomen, esophagoscopy with removal of the battery, tracheoscopy. Complications occurred in 39 children: TEF - 21, esophageal stenosis - 19, laryngeal paresis - 14, esophageal perforation - 3. Patients with TEF were divided into 2 groups: clinically stable children without respiratory failure and severe illness with respiratory failure including mechanical ventilation. Group I consisted of 6 children, four of them underwent laparoscopic Nissen fundoplication and gastrostomy. Group II consisted of 15 children. In acute period, 3 children underwent laparoscopic fundoplication and gastrostomy, 8 ones - TEF ligation, 4 patients - tracheal repair with esophageal flap and esophageal extirpation. Patients with esophageal stenosis underwent bougienage. Patients with esophageal perforation required therapy. Tracheostomy was necessary for respiratory failure and bilateral laryngeal paresis. Lateralization procedures were performed in patients with negative course of disease. RESULTS: In the 1st group, spontaneous closure of TEF was found in 3 children after fundoplication and gastrostomy. One child underwent thoracoscopic disconnection of TEF after reduction of fistula. In the 2nd group, fundoplication resulted spontaneous closure of fistula after 2-5 months. In 4 children, recanalization of the fistula or esophageal failure were observed in acute period after TEF ligation. CONCLUSION: Laparoscopic fundoplication and gastrostomy are optimal for TEF and can result complete or partial spontaneous closure of TEF. If radical procedure is necessary in acute period, tracheal repair with esophageal flap and extirpation of the esophagus with subsequent coloesophagoplasty should be considered.

[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.

[Efficiency of minilaparotomy in the treatment of choledochal malformation in children]. / Otsenka effektivnosti mini-laparotomii pri lechenii mal'formatsii obshchego zhelchnogo protoka u detei.

OBJECTIVE: To evaluate an effectiveness of minilaparotomy in the treatment of choledochal malformation (CM) in children. MATERIAL AND METHODS: The study included children with CM who underwent surgery from January 2010 to May 2020. All patients were divided into 3 groups depending on surgical approach: minilaparotomy (ML), laparoscopy (LS) and laparotomy (LT). We analyzed surgery time, early postoperative outcomes and cosmetic results. RESULTS: There were 99 patients with CM for 10 years. ML was performed in 39 patients, LS - in 51 patients, and LT - in 9 patients. Significantly (p-value <0.001, Kruskal-Wallis test with Dunn paired comparison test, p<0.05) less surgery time was observed in ML group. According to Clavien-Dindo classification of surgical complications, we found a significant prevalence of complications in the LS group (p - 0.018, Kruskal-Wallis test). Moreover, LS was characterized by insignificant (p>0.05) predominance of the most severe complications requiring multiple redo surgeries. CONCLUSION: Currently, open surgery is a "gold standard" in the treatment of children with CM. LS is not preferred in children with CM. ML ensures favorable early outcomes in children with CM.

[Advantages of Kasai procedure through minimally invasive approach in children with biliary atresia (in Russian only)]. / Preimushchestva mini-dostupa pri vypolnenii operatsii Kasai u detei s biliarnoi atreziei.

AIM: To compare early and long-term results of different surgical interventions in children with biliary atresia. MATERIAL AND METHODS: Retrospective analysis included medical records of children with biliary atresia who were treated at the Filatov Munitsipal Children's Hospital and National Medical Research Center for Obstetrics, Gynecology and Perinatology from 2000 to 2018. There were 91 patients. All patients were divided into three groups. Group 1 - conventional Kasai procedure (n=24), group 2 - laparoscopic Kasai surgery (n=45), group 3 - Kasai procedure through minimally invasive approach (n=22). Groups were comparable. RESULTS: Duration of Kasai procedure through minimally invasive approach was 69±12,97 min that was significantly less than in groups 1 and 2 (p1,3=0,006085; p2,3=0,000024). ICU-stay was minimal in group 3 (1.27±0.55 days, p1,3<0,05; p2,3<0,05). Abdominal drainage time was maximal in group 2 (11.28±6.37 days) and minimal in group 3 (5.86±2.39 days, p2,3=0.0002). Early and 2-year postoperative surgical efficiency was similar in all groups. There were no surgical complications in group 3. In group 2 one child had gastrointestinal bleeding followed by successful medication. There were 3 surgical complications in group 3: adhesive intestinal obstruction, small and large intestine perforation and 2 cases of gastrointestinal bleeding. There was one lethal outcome in the first group. Overall annual survival in children with native liver was 81.8%, 2-year - 51.7%. CONCLUSION: Kasai procedure through minimally invasive approach is justified and rational method with certain benefits of open and laparoscopic interventions and can be considered as a method of choice in treatment of children with biliary atresia.

[Differentiated approach to the treatment of large hernial defects of the anterior abdominal wall in children (clinical observations)]. / Lechenie obshirnykh gryzhevykh defektov perednei briushnoi stenki u detei.

AIM: To present an experience of treatment of children with large hernial defects of the anterior abdominal wall. MATERIAL AND METHODS: This article describes management of 43 children with large (n=31) and giant (n=12) ventral hernia who were at N.F. Filatov Children´s City Hospital #13 for the period 2005-2015. All patients underwent surgical correction using local tissues in 'edge to edge' fashion (n=23), aponeurosis dublication of 'coat floors' type (n=14) and biological implant 'Permacol' (n=6). Etiological causes of ventral hernias in children were comprehensively analyzed. Optimal time for surgical treatment and features of viscero-abdominal disproportion were discussed. CONCLUSION: Early restoration of anatomical and functional structures of the anterior abdominal wall is necessary for good cosmetic result and prevention of recurrent ventral hernia. We presented three clinical examples of commonly used surgical procedures in children including anterior abdominal wall repair using biological material 'Permacol'.

[Thoracoscopic operations for neurogenic tumors in children].

AIM: To present an overall experience of endoscopic operations in children with neurogenic tumors in two medical institutions. MATERIAL AND METHODS: Thoracoscopic excision of tumors was performed in 19 children aged 1 month-7.5 years (mean 1.5 years) in two clinics for the period 2010-2014. In 9 children (47.3%) age did not exceed 1 year. In our study ganglioneuroma was diagnosed in 9 cases, ganglioneuroblastoma--in 2 patients, neuroblastoma stage I--in 8 cases. All patients were under observation and treated according to NB2004 protocol. Tumor's diameter ranged from 1 to 6 cm (mean 4.9±1.9 cm). Mean duration of surgery was 62±22 minutes. There were no any intraoperative complications. Early postoperative period in all patients after endoscopic surgery was more favorable than in those after open operations. Any local recurrences were not observed for the follow-up period. RESULTS: Thoracoscopic operations can become more preferable method in treatment of children with neurogenic tumors if great vessels are not involved into neoplastic process and limited volume of tumor is absent.