[Robot-assisted choledochal cyst resection in a child]. / Robot-assistirovannaya rezektsiya kisty kholedokha u rebenka.

The generally accepted method for choledochal cysts is total resection of cystic extrahepatic bile ducts and gallbladder followed by biliodigestive anastomosis. Minimally invasive interventions have recently become the «gold¼ standard in pediatric hepatobiliary surgery. However, laparoscopic resection of choledochal cysts has certain disadvantages related to difficult positioning of instruments in narrow surgical field. The disadvantages of laparoscopy can be compensated by surgical robots. A 13-year-old girl underwent robot-assisted resection of hepaticocholedochal cyst, cholecystectomy and Roux-en-Y hepaticojejunostomy. Total anesthesia time was 6 hours. Laparoscopic stage took 55 min, docking of robotic complex - 35 min. Robotic stage of surgery required 230 min, removal of cyst and suturing the wounds - 35 min. Postoperative period was uneventful. Enteral nutrition was started after 3 days, and drainage tube was removed after 5 day. The patient was discharged after 10 postoperative days. The follow-up period was 6 months. Thus, robot-assisted resection of choledochal cysts in children is possible and safe.

[Multicenter study of the effectiveness of antiscar therapy in patients at different age periods]. / Mul'titsentrovoe issledovanie effektivnosti protivorubtsovoi terapii u patsientov razlichnykh vozrastnykh grupp.

OBJECTIVE: Was to evaluate the effectiveness of anti-scar treatment with Contractubex gel in children and adults. MATERIAL AND METHODS: A group of researchers based on clinical hospitals and university medical clinics carry out the multicenter study to evaluate the effectiveness of anti-scar treatment with Contractubex gel containing cepalin, allantoin and heparin, with its early appointment in groups of children from 12 to 18 years old and adults from 21 to 35 years old. The study included data from 216 patients. Patients of both age groups were initially divided into two: the main and control ones with an equal distribution according to the type of surgical intervention (hernia repair and appendectomy), age, gender, and anamnestic data. The dynamic observation was carried out using two rating scales - filled out by a doctor (Vancouver scale) and a patient (author's rating scale in the Scar Diary mobile application). RESULTS: Based on the results of the analysis of the data obtained, a high efficiency of the use of Contractubex gel at the early stages of scar formation among patients of the main group in comparison with the control was revealed. By 90 days, the treatment result according to the Vancouver scale was 0,16±0,1 points in the main group and 0,39±0,2 points in the control group. At the same time, with a dynamic scale for assessing the cicatricial process, there was a significant (p<0.05) improvement in the main group (0,2±0,06 points) compared with the control group (0,6±0,17 points). In addition, was noticed the strong commitment to anti-scar treatment in pediatric patients. CONCLUSIONS: The work confirms the undoubted need for anti-scar treatment in the early stages of scar formation after surgical interventions, which accelerates the psychophysical rehabilitation of patients after surgery and improves the quality of life.

[Multi- and single-port laparoscopic surgery in the treatment of hydatid liver disease]. / Mnogoportovaya i odnoportovaya laparoskopiya v lechenii ekhinokokkoza pecheni.

OBJECTIVE: To compare the effectiveness of multi-port and single-port laparoscopic surgery in the treatment of hydatid cyst of the liver. MATERIAL AND METHODS: There were 25 children with solitary hydatid cyst of the liver (CL-CE2) who underwent surgery in 2013-2017. Mean age was 10.1±2.05 years. There were 17 boys and 8 girls. Patients were divided into 2 groups: group 1 (multi-port laparoscopy) - 19 patients, group 2 (single-port laparoscopic surgery) - 6 patients. RESULTS: Duration of ultrasound-assisted laparoscopy (G11 generator) was significantly shorter in the group 1 compared with group 2 (62.2±5.4 vs. 85.3±9.7 min, p<0.05). Intraoperative complications were absent. Biliary fistula in postoperative period was observed in 1 (5.3%) patient of the group 1. External drainage was effective. Residual cavity in 6 months after laparoscopic resection was observed in 1 (16.7%) patient of the group 2. Recurrent liver echinococcosis was not recorded. CONCLUSION: Hydatid cyst (CL-CE2) of the liver is an indication for laparoscopic echinococcectomy. Multi-port laparoscopy is characterized by reduced duration of surgery and postoperative morbidity compared with single-port procedures.

[High-tech methods in pediatric surgery].

Scientific and technical progress resulting in the introduction of high technologies in medicine radically changed the concept of surgical treatment of children. It is currently based on low-traumatic and minimally invasive methods for surgical intervention. High-tech surgical interventions implies the availability of modern sophisticated equipment and adequate anesthesiological support with comprehensive intraoperative monitoring all vitally important parameters. In the postoperative period, part of the patients need adequate (sometimes long-term) parenteral feeding with the application of long-term Broviak catheters and Space B-Braun systems. The use of this equipment in our Centre makes possible surgical treatment of children at a qualitatively new (low-traumatic and minimally invasive) level and reduce the duration of surgery by 50% compared with traditional methods.

Hemostasis in children with dysbacteriosis in chronic constipation.

The purpose of the study was to investigate hemostasis in children with dysbacteriosis disturbance in chronic constipation. The disturbance of factors in the inner mechanism of blood coagulation (VII, IX, XI, XII) in compensated chronic constipation was defined based on the reduction in colon bacillus levels. We observed hypocoagulation caused by the reduced activity of the prothrombin complex factors, disaggregate thrombocytopathy, and endotheliosis with fibrinolysis inhibition in subcompensated chronic colostasis with continuous reduction of colon bacillus levels and pathogenic microflora appearance. In decompensated colostasis there was an increase in pathogenic microorganisms and a continuous reduction of colon bacillus levels. In hemostasis there was a factor deficiency in inner (XII, XI, IX, VIII) and outer (II, V, VII, X) blood coagulation mechanisms. Fibrinolysis inhibition, endotheliosis development with thrombocyte aggregation, and microthrombosis formation were determined. Thus, in children with chronic constipation, there was a marked reduction in the amount of colon bacillus, which led to the reproduction of pathogenic bacteria. We also observed chronometric hypocoagulation with the inner (XII, XI, IX, VIII) and outer (II, V, VII, X) mechanisms of blood coagulation, at the base of which there is the deficiency of vitamin K-dependent factors (II, VII, IX, X) and a slightly marked disturbance in the final stage of coagulation. In thrombocyte vascular hemostasis, thrombocytopathy was observed with increased adenosine-5-diphosphate aggregation and the inhibition of the inner mechanism with fibrinolysis and endotheliosis.

The peculiar features of changing the hemostasis in children with chronic constipation.

Our purpose was to study the peculiarities of changing the hemostasis in children with chronic constipation. In the course of our investigation of hemostasis in children with chronic constipation, we found chronometric hypocoagulation with impairment of internal (XII, XI, IX, VIII) and external (II, V, VII, X) mechanisms of blood clotting, at the base of which is a deficit of vitamin K-dependent factors (II, VII, IX, X) and a slight impairment of the final stage of coagulation. In thrombocytovascular hemostasis, thrombocytopathy demonstrated increased adenosine-5-diphosphate aggregation and suppression of the internal route of fibrinolysis and endotheliosis. We must point out that all these changes lead to impairment of microcirculation in the form of thromboses, particularly in the submucous and mucous membrane vessels, which is confirmed by the morphologic findings. In the compensated form, chronometric hypocoagulation with a deficit of II, IX, and X factors is noted. In the subcompensated form, hypocoagulation increases, and the deficit of V and VII factors is in part the cause. Endotheliosis and the increase of the thrombogenesis dynamics are noted in the thrombocytovascular section. In the decompensated form, there is marked hypocoagulation. Low activity of antithrombin III leads to high content of fibrinmonomeasured complexes in combination with reduction of the thrombocytes quantity and to hypercoagulation. The present changes are confirmed by the morphologic research methods of studying the vascular channel of the large intestine wall, where organized thrombi and a marked plethora of neutrophil tissue infiltration are often revealed.