[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.

[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.

[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.

[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.