[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.

[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.