[Thoracoscopic treatment of esophageal atresia in infants].

Atresia of esophagus result in absolute lethality without surgical treatment. Posterolateral thoracotomy is a traditional access during such operations, however thoracoscopic methods esophageal atresia has come into practice. Since 2008 all infants (n=22) in our clinic with esophageal atresia have been operated on thoracoscopically. Conversion was performed in 3 observations, 2 children died. Anastomosis insufficiency was diagnosed in 3 patients. 11 children received gullet bougienage in different terms after the operation. Tracheoesophageal fistula recurrence was observed in 2 cases, both were successfully treated thoracoscopically.

[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.

[Method of continuous intravenous postoperative analgesia with promedol in newborn children]. / Posleoperatsionnoe obezbolivanie metodom postoiannoi vnutrivennoi infuzii promedola u novorozhdennykh detei.

Continuous intravenous infusion of promedol, 0.1 mg/kg, with additional boluses, 0.5 mg/kg, was used as postoperative analgesia in 20 newborns. Fifteen (25%) children were operated for congenital gastrointestinal defects or peritonitis, 2 children (10%)--for chylothorax, and tumor was eradicated in 3 (15%) children. On the basis of behavioral reactions, physiological indices (cardiac rate, arterial pressure, SpO2, and respiration rate/artificial pulmonary ventilation--APL) as well as of laboratory "stress" tests (blood glucose and cortisol and acid-base balance) it was proven that analgesia with continuous intravenous promedol infusion was effective. It was shown as possible to administer the promedol infusion in newborns while switching them from APL to independent breathing until the spontaneous breathing with constant positive pressure is ensured provided the pO2, pCO2 and SpO2 respiration indices are satisfactory.

[Optimization of diagnostic and therapeutic programs in modern neonatal surgery]. / Optimizatsiia diagnosticheskikh i lechebnykh programm v khirurgii novorozhdennykh na sovremennom étape.

Tendencies in neonatal surgery research are presented. Based on 187 cases, indications to preventive intestinal stomas creation in the newborns and also time of their closure are regarded. Surgical correction of malformation or treatment of acute process in the abdominal organs with intestinal stoma closing is finished to month 2-3 of childs life. The developed differential-diagnostic criteria of functional and organic lesion of ureteropelvic and ureterovesicular segments based on diuretic sonography permitted one to reveal early age pathology of urinary system and to correct it with surgical methods. The developed algorithm of diagnosis and treatment of newborns with eruct syndrome permits one to determine indications to surgery in 10% infants with gastroesophageal reflux.

[Hirschsprung's disease in newborns]. / Bolezn Girshprunga u novorozhdennykh.

The authors examined and treated 52 newborn babies and infants with Hirschsprung's disease. The total form was encountered in 25%, the subtotal in 23.1%, the rectosigmoid in 36.5%, the rectal in 9.6%, and the supraanal in 5.8% of cases. The clinical picture was characterized by retention of meconium (94.2%), regurgitation or vomiting (75%), abdominal distention (100%). Irrigography with calculation of the rectosigmoid ratio was conducted in 35 children, histochemical examination in 46, and histological examination in 38 children. Twenty-four (68.5%) children had the third phase of disturbed proportion of the intestinal bacteria with clinical manifestations of enterocolitis. Emergency decompression of the intestine for low acute intestinal obstruction was carried out in 27 newborn babies. Twenty children were subjected to radical surgery in the first 2-4 months of life. The choice of the operative method was guided by the form of the disease and the length of the aganglionic zone.

[Study of large intestinal microflora in newborns with Hirschsprung disease]. / Issledovanie mikroflory tolstoi kishki pri bolezni girshprunga u novorozhdënnykh.

In 35 newborns and children at the age under 4 mos with Hirschsprung's disease, colonic microflora was studied. Disbacteriosis at phase 1 was revealed in 1 (2.9%) child, at phase 2--in 7 (20%), at phase 3--in 27 (77.1%). In acute form of Hirschsprung's disease, in 68.5% of cases, disbacteriosis at phase 3 with the signs of enterocolitis causing acute ileus was revealed. Intestinal perforation against background of enterocolitis developed in 8 cases.

[Diagnostic and therapeutic tactics in various forms of cholangiopathies in children]. / Diagnosticheskaia i lechebnaia taktika pri razlichnykh formakh kholangiopatii u detei.

Seventy children with obstructive cholangopathy were examined in the clinic in the recent 15 years: 48 children had "cholangiopathy of the newborn" and 22 had a cyst of the common bile duct. A total of 44 operations were carried out: on 22 infants with cholangiopathy of the newborn and on 22 with cysts of the common bile duct. The most informative methods for the diagnosis of cholangiopathy in children are as follows: ultrasonic scanning, laparoscopy, ERCPG, aspiration biopsy of the liver, and aspiration cholangiography under control of a laparoscope. Kasai's operation is the operation of choice in obstructive cholangiopathy of the newborn. The operation of choice in cysts of the common bile duct is cystectomy with choledocho- or hepaticojejunostomy on an isolated loop after Roux.