[Using various methods of intraoperative hemostasis in laparoscopic genitourinary surgery in children].

AIM: To improve treatment results of children undergoing laparoscopic genitourinary surgery by optimizing intraoperative hemostasis. MATERIALS AND METHODS: The study comprised 110 children with various genitourinary diseases. The study group included 70 children who underwent laparoscopic surgery with optimized hemostasis with the use of an automated electrosurgical vessels ligation device LigaSure. Forty children who received standard intraoperative hemostasis with mono- or bipolar coagulation made up a control group. RESULTS: The operative time was significantly shorter with the optimized method of hemostasis than when using mono- and bipolar coagulation [77.02 min versus 112.5 min (p<0.05)]. The blood loss in the study group was also significantly lower than in the control group [17.9 and 34.2 ml, respectively (p<0.05)] due to precise control and final hemostasis. There were no intraoperative complications and conversion to open surgery in patients in the optimized hemostasis group, whereas in the control group two complications were observed. CONCLUSION: Laparoscopic urogenital surgery with the optimized hemostasis using the automated electrosurgical vessels ligation device LigaSure in children is optimal due to the minimal injury to the coagulated tissues, the ability to forgo clipping and ligation of the vessels, which results in shorter operative time and reduced intraoperative blood loss.

[Nutritional management of kidney diseases in children].

The prevalence of various kidney diseases in children remains high in recent decades. Adequate nutrition management can enhance the effectiveness of drug treatment, slow the frequency of relapses andprevent the progression of the disease. The article is devoted to modern approaches to diet therapy in various kidney diseases in children with the defeat of tubular and glomerular appa ratus. For the first time the therapeutic diets for children with various kidney diseases are presented. Particular attention is paid to diet therapy in nephrotic syndrome (steroid-responsive and steroid-refractory). Dietary approaches with modern formulas for enteral nutrition in cases of steroid therapy complications in children with renal insufficiency (in predialysis stage and on dialysis) are described. Differentiated nutritional approaches for patients with different types of crystalluria are separately presented.