['Conservative' organ-sparing approach for ovarian torsion in children]. / Organosokhraniaiushchee 'konservativnoe' lechenie perekruta pridatkov matki u detei.

AIM: To improve the outcomes in children with ovarian torsion. MATERIAL AND METHODS: Three clinical observations of patients with ovarian torsion are presented. Duration of the disease was 3-4 days. All children underwent organ-sparing surgery including untwisting followed by ovariopexy. RESULTS: All children were examined in early and late postoperative period (up to 5 years) after organ-sparing procedures. Ultrasonic picture of the ovaries including structure and dimensions corresponded to age, the follicles were determined. CONCLUSION: 'Conservative' approach allows to preserve anatomical structure and potential for reproductive function.

[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'.

[Laparoscopic operations for chronic duodenal obstruction in children].

Brief literature review devoted to chronic duodenal obstruction is presented in the article. We described an experience of treatment of 5 children with mechanical form of chronic duodenal obstruction. Duodenal stenosis was observed in 2 patients. Arteriomesenteric compression caused chronic duodenal obstruction in other children. Duodenal obstruction was cured using laparoscopy in all cases. Thus enteroalimentation has been started in early terms and intensive care unit stay and hospital stay was reduced.

[Surgical treatment of Hirschprung's disease total form in children].

It was analyzed the treatment results of 24 patients under the age of 2 years with total aganglionosis for the period from 2000 to 2013. Each of these patients underwent several surgical interventions (on the average 7.8±2.1). All children were operated radically. It was performed ileojejunorectal anastomosis at transitional fold of peritoneum in patients with concomitant short bowel syndrome. Soave's operation was done in 14 patients including by using of laparoscopic technique in 3 cases. Inflammatory complications (paraproctitis) developed in 2 children on maceration background. Perirectal fistula was observed in 1 patient subsequently. In long-term period liquid stool incontinence persisted up to 6 months in 28% of children. In terms of more than 1 year stool incontinence was observed in 12.6% of patients. Increased growth of D-lactate-producing gram-positive anaerobes was revealed during microbiological investigation of feces in 35% of patients in long-term period. Increased growth was accompanied by systemic acidosis and infectious enteritis clinically. Course monthly treatment with antibacterial drugs (Alpha-Normix, Trichopolum, Gentamicin) was prescribed in patients with short bowel syndrome and high frequent of enteritis recurrence. Treatment was used In terms from 6 to 12 months of longer if it was necessary. It was concluded that timely diagnosis and right tactic in neonatal period leads to decrease significantly the number of complications, vain interventions and to improve treatment outcomes. Our experience shows that the best results of surgical treatment were observed in children aged from 2.5-3 years when a child can control urination and defecation. The most mistakes are caused by wrong or failed morphological investigation of large bowel.

[Video-assisted surgery of Hirschsprung's disease in children].

Results of the laparoscopic treatment of 36 patients with Hirschsprung's disease were analyzed. The majority of patients were the newborns or before 12 months old. The use of laparoscopy permitted a full-fledged topical diagnostics, aganglionosis zone identification, gut mobilization and voiding. Laparoscopic method also allowed to decrease the ICU stay in 3,1 times and start breastfeeding earlier, lessen the pelvic floor intraoperative traumatization and decrease the level of commissural and inflammatory complications. Good and excellent functional results were achieved in 93,7% of children, stenosis of the anastomotic area was registered postoperatively in 2 patients.

[Laparoscopic surgery and postoperative adhesions in children].

Data of 568 patients, aged from 3 weeks to 14 years, with acute adhesive bowel obstruction, treated during 1981--2007 yy. are analyzed. Most often previous laparotomy was performed on account of appendicitis, predominately complicated with peritonitis--in 52,2% of patients. Obstruction, caused by intestinal invagination was observed in 19,4%, malformation--9,3%, tumor--2,3%, other--1,7%. The treatment results of appendicular peritonitis and intestinal invagination are studied. Two comparative groups of patients with appendicular peritonitis, 100 children each, were treated laparoscopically and traditionally. The laparoscopic method allows to stop pain and endotoxicosis earlier, faster gastrointestinal function recovery, decrease of complication in the laparoscopical group rates and hospital-stay period on 30,8%. 100 children with intestinal invagination were operated laparoscopically and 50 patients were experienced a traditional <> operation. There were no complications, but 2 cases of postoperative adhesive obstruction in the <> group. The average hospital stay was 2,5 times shortened in the laparoscopical group.

[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.

[Changes of motor-evacuatory function of the gastrointestinal tract after surgery in children with acute appendicitis].

A new method of computed phonoenterography (CPEG) evaluates objectively motor-evacuatory function of the gastrointestinal tract. Comparative study of changes in motor-evacuatory function of the intestine was carried out according to CPEG data in 60 children aged from 6 to 15 years after traditional surgery with Volkovich-Dyakonov incision, and after endovideosurgical appendectomy for plegmonous and gangrenous appendicitis. Inflammation of the appendix leads to inhibition of intestinal motor function. Low surgical trauma in endovideosurgical appendectomy promotes faster recovery of intestinal peristalsis according to CPEG.

[Videolaparoscopic nephrectomy and nephrouretherectomy in children]. / Videolaparoskopicheskaia nefréktomiia i nefroureteréktomiia u detei.

The experience with 72 laparoscopic nephrectomies and nephrouretherectomies in children aged from 13 days to 14 years is reviewed. 51 children were under 3 years of age, 2 patients - under 1 month of life. Pathological changes of the kidneys with complete loss of function were indications for endoscopic surgery. Complex of examinations in the preoperative period included repeated USE, cystography, urography, scintigraphy, angiography. Time of surgery was 30-150 min (45 min, on the average). Blood loss during surgery was less than 50-60 ml and didn't require hemotransfusion. There were no complications during surgery. Fast recovery of physical activity after surgery, a decrease of hospital stay were seen. There were no postoperative complications and lethality. Laparoscopic nephrectomy and nephrouretherectomy are low-traumatic, safe and effective surgeries in children of any age in different diseases of the kidneys.

[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.

[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.

[Laparoscopic splenectomy in congenital hemolytic anemia in children]. / Laparoskopicheskaia splenéktomiia pri vrozhdennoi gemoliticheskoi anemii u detei.

Experience of 48 laparoscopic splenectomies in children aged from 3 to 14 years with congenital hemolytic anemia is analyzed. The main stages of laparoscopic splenectomy were the following: isolation of the inferior pole of the spleen, transection of the gastro-splenic ligament, transection of the splenic vascular trunk (with endostapler or intracorporeal ligature), dissection of the splenic ligaments, removal of the organ (with endoscopic sac or morcellator). One-stage cholecystectomy for cholelithiasis was performed in 11 patients. Time of surgery was 110-115 minutes, on the average. One-stage cholecystectomy prolonged surgery by 30-40 minutes. There were no intraoperative and postoperative complications. Conversion to open surgery was necessary in 2 cases because of endostapler failure. Patients were discharged on the 5-8th day after surgery. Physical activity restored completely 10-14 days after surgery. There were no lethal outcomes. Excellent cosmetic results were achieved in all the patients. Laparoscopic splenectomy in congenital hemolytic anemia is safe, sparing and effective endoscopic surgery in childhood.

[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.

[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.

[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.

[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 ligation of testicular veins for varicocele in children. A report of 180 cases.

BACKGROUND: The technique of the laparoscopic treatment of varicocele in children is described, and its outcome is discussed. METHODS: A total of 180 patients from 6 to 14 years of age were studied. All of them had left-sided varicocele; 10 of them were recurrences after treatment by other methods. Varicocele was diagnosed on physical examination and confirmed by Doppler ultrasonography. The laparoscopic procedure included obligatory dissection and preservation of the spermatic artery and tinted lymphatic vessels, followed by double ligation of the spermatic veins. RESULTS: There were no intraoperative or postoperative complications and only one case of recurrence (0.6%). CONCLUSION: The suggested technique for laparoscopic varix ligation is a highly effective and reliable method for the treatment of pediatric varicocele. It provides the minimal invasiveness of the approach, effective microsurgical quality of visualization, and dissection with guaranteed preservation of the spermatic artery and lymphatic vessels, along with very low rates of complication and recurrence.

Laparoscopy in the treatment of intussusception in children.

PURPOSE: The technique and outcome of minimally invasive laparoscopic treatment of various forms of intussusception in children after ineffective attempt at conservative treatment are described. METHODS: Ninety-eight patients from 2 months to 11 years of age were analyzed. RESULTS: Suggested scheme of surgical treatment using laparoscopic technique was successful in 64 patients (65.3%), and conversion to open procedure occurred in 34 (34.7%). There was no mortality or intraoperative complications in our series. CONCLUSION: Practically every form of intussusception without bowel necrosis, including the most complex forms, can be reduced now using modern videolaparoscopic equipment and atraumatic instruments.