[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.

[Surgical treatment of fecal incontinence in children]. / Khirurgicheskoe lechenie nederzhaniia kala v detskom vozraste.

The experience of the faeces incontinence treatment in 295 children (age ranged from 1 to 15 years) is presented. Several original operations for surgical correction of the sphincter ani asthenia are proposed. The authors think that radical correction of faeces incontinence in children is necessary as early as at the age 6 to 7 years that is at the beginning of social activity. Efficient use of the above methods of the rectum closing apparatus creation allowed to achieve good results in 77.3-85.7% of the children.