[Endoscopic treatment of intestinal malrotation in newborns and infants]. / Endokhirurgicheskoe lechenie mal'rotatsii kishechnika u novorozhdennykh i mladentsev.

AIM: To compare treatment of intestinal malrotation in newborns and infants using laparoscopy and laparotomy. MATERIAL AND METHODS: For the period from January 2004 to December 2013 34 Ladd's procedures were performed. Children were divided into 2 groups by 17 patients: laparoscopic (group I) and open treatment (group II). RESULTS: Both groups had similar demographic and other preoperative parameters. There were significant differences in duration of operation between both groups (61 vs. 70 minutes). Nutrition was initiated earlier after mini-invasive treatment (1.5 days vs. 3 days) and the time need for full enteral nutrition was also less (4.2 days vs. 6.9 days). Hospital-stay was shorter in group I (7.7 vs. 10.2 days). Number of early postoperative complications was similar in groups. Incidence of remote complications was higher in laparotomy group but the differences were not significant. CONCLUSION: Our results showed that endoscopic correction of congenital anomalies of intestinal rotation provides better postoperative results than open surgery and can be widely used in young children.

[Training curves for endosurgical interventions in neonates and infants].

AIM: To demonstrate training curves for endosurgical interventions in neonates and infants. MATERIAL AND METHODS: It was analyzed duration of thoracoscopic reconstruction of esophageal atresia (31 patients) and laparoscopic Nissen fundoplication (61 patients) performed for the period from January 2005 to December 2012. Graphs and tables reflecting correlation between duration and number of operations were framed. RESULTS: Figures demonstrate reducing duration of surgery with increase of endosurgical interventions number. CONCLUSION: Our data revealed that time necessary for minimally invasive procedures in infants and neonates decreases in process of experience accumulation.

[Button gastrostomy in children].

For the period January 2002 to December 2013 it was performed 84 interventions for introduction of gastrostomy tube. The first group included 24 open operations and the second group had 60 laparoscopic operations by using of button devices MIC-KEY (Kimberly-Clark, Roswell, USA) in neonates and infants. Statistically significant difference was not observed during comparison of demographic data of patients. Differences in groups were found in statistical analysis of intra- and postoperative parameters (p<0.05). Mean duration of surgery in the first group was 37.29 min, in the second group - 23.97 min. Time to start of feeding and transition to complete enteral nutrition was less in patients who underwent laparoscopic surgery than after open intervention (10.5 and 19.13 hours, 23.79 and 35.88 hours respectively; p<0.05). It was revealed augmentation of hospital stay in the 1st group in comparison with the 2(nd) group (11.71 and 7.09 days respectively; p<0.05). Frequency of postoperative complications was 18.33% in the 2(nd) group and 24% - in the 1st group (p<0.05). The authors consider that button devices are simply and effective technique of gastrostomy establishment in children. It is associated with minimal surgery duration and allows to start early enteral nutrition in comparison with open techniques.

[Single laparoscopic approach in newborns and infants].

The aim of this investigation is evidence of opportunity of single laparoscopic approach using during operations in newborns and infants. The authors have an experience of 274 single-port operations performed from January 2009 to December 2013. Success of single laparoscopic approach has been demonstrated in patients with inguinal hernia, congenital hypertrophic pyloric stenosis, feeding violations, ovarian cyst and multi-cystic kidney dysplasia.

[Thoracotomy and thoracoscopy in the treatment of patent arterial duct in infants weighing less than 2500 g].

BACKGROUND: Thoracoscopic clipping of the patent ductus arteriosus is an alternative to conventional surgical closure via thoracotomy in low birth weight infants. The aim of this study is to compare of these two groups of patients for the last 11 years. METHODS: We reported the data of 127 small children's who underwent standard transaxillary thoracotomy (101 patients - Group I) and video-assisted thoracoscopic surgery for patent ductus arteriosus clipping (26 patients - Group II). The two groups were compared for patients demographics, operative report and postoperative parameters. RESULTS: The groups were similar in terms of demographics and preoperative parameters. There was significant difference in mean operative time between open and thoracoscopic procedure (44.65 min vs 38.46 min; p<0.05). Duration of care in neonatal intensive unit and length of hospital stay were significantly shorter in the Group II (16.44 d vs 8.77 d; p<0.05 and 40.13 d vs 33.65 d; p<0.05). Early complication rates were equivalent between groups (6.93% vs 3.85%; p>0.05). Rate of long-term complications was dominated in the thoracotomy group (19.80% vs 0%; p=0127). CONCLUSION: Thoracoscopic ligation of the patent ductus arteriosus in infants less than 2500 g gave results better than open surgery.

[Hybrid surgery for the treatment of ovarial cysts in newborns].

The aim of this study was to evaluate the effect of hybrid technology (laparoscopy and open surgery) for treatment of ovarian cysts in small babies and infants. Between January 2002 and November 2012, we have performed 11 operation for neonatal ovarian cysts repaired through standard circumumbilical incision (Group I) and 16 operation with using combined hybrid laparoscopic-assisted technique (Group II). The circumumbilical incision utilized at our institution is a classic Bianchi procedure. The hybrid approach combined 2 technique - laparoscopic and open. The trocar for optic telescope was inserted through a circumumbilical incision. The one working instrument was introduced into the peritoneal cavity direct through umbilicus. Afterwords, ovarian cyst was deflated with using transabdominal needle aspiration, delivered by an extended umbilical incision and enucleated as in standard open surgery. The two groups were compared for patients demographics, operative report and early postoperative outcomes. All procedures were performed successfully with no complications rate. There were no differences in the preoperative parameters between the two groups. The differences between groups for operative and postoperative results were statistically significant (p<0.05). The mean operative time in Group I was 30.91 min. In contrast, the mean duration of the operation in the Group II was 21.56 min. The mean time to beginning and time of full enteral feeding for patients with hybrid approach were significantly shorter as for patients with umbilical incision (4.06 hours vs 10.91 hours; 13 hours vs 20.55 hours). Prolonged mean postoperative hospital stay were registered in patients of the Group I (6.36 days vs 3.19 days; p<0.05). The postoperative course and follow up was uneventful in the all patients. The experience described in this study confirms that hybrid operation can be applied for treatment of neonatal ovarian cysts with outcomes better than standard open surgery.

[The use of staplers for intestinal anastomosis in newborns].

The comparative experience of mechanical and manual intestinal anastomoses in newborns was analyzed. The main group (mechanical suture) consisted of 23 patients; the group of control consisted of 21 little patients. The mechanical intestinal suture was performed with the use of linear endoscopic stapler with 2.5 mm high staples. There were no differences in age and body weight between the two groups. The mean operative time was 77.4 min for the 1st group, whereas for the 2nd group it was 56.4 min. There were no significant difference in time before enteral feeding after the operation - 6.7 days on average. The hospital stay time was also identical (13.3 vs. 14.1 days). Postoperative period was uncomplicated in both groups. Thus, the use of mechanical stapler for intestinal anastomosis allows shorten the operative time, though preserving the same results of hospital stay and enteral feeding beginning.

[Pain syndrome after gynecological operations]. / Bolevoi sindrom posle ginekologicheskikh operatsii.

The structure of the pain syndrome was studied in 110 patients on day 2 after surgery. A total of 76 parameters ware analyzed by 8 signs. Different combinations of the pain parameters, a negligible variability of the parameters of the pain intensity, depth of its site, and type, as well as the subjective sensations of the patients were distinguished, related to the patients' psychologic type. Opiate analgesia was associated with polymorphism of the pain syndrome. Transcutaneous electroanalgesia was sufficiently effective, promoting a narrowing of the range of pain parameters.

[Analgesic transcutaneous electric nerve stimulation following surgery of the abdominal organs]. / Protivobolevaia chreskozhnaia élektroneirostimuliatsiia posle operatsii na organakh briushnoi polosti.

The effect of continuous antinociceptive transcutaneous electrical neurostimulation (TENS) has been studied in 94 patients after abdominal surgery. The analysis of the clinical findings and sinus heart rhythm has demonstrated a strong enough analgesic effect of TENS, which was accompanied by a considerable, more than 4-fold, reduction in narcotic analgesics requirements, lower incidence of functional urination disturbances, intestinal paresis, retention of the regulating role of the autonomous nervous system, stable hemodynamics and on the whole a more smooth and safe course of the early postoperative period.

[Intravenous anesthesia using a combination of calypsol and the calcium antagonist finoptin]. / Vnutrivennaia anesteziia pri sochetannom primenenii kalipsola i antagonista kal'tsiia finoptina.

The effect of a calcium antagonist finoptin on the course of general calypsol anesthesia was studied in 85 patients with abdominal surgery. A potentiating effect of finoptin on hypnotic component of anesthesia has been established. In the post-anesthesia period the effect was strengthened by fentanyl. Central hemodynamic parameters were retained on a stable level which was close to baseline. Stimulating hemodynamic effect of calypsol was smoothed out.

[Condition of the anal sphincter in patients with anorectal anomalies based on electromyographic data]. / Sostoianie naruzhnogo sfinktera priamoi kishki u bol'nykh s anorektal'nymi anomaliiami po dannym élektromiografii.

The condition of the sphincter ani externus muscle was studied on basis of electromyographic examination of 130 patients with anorectal developmental anomalies who were treated at the clinic during the period between 1984 and 1988. It is noted that electromyography allows the electrical activity of the muscle to be appraised authentically. The authors emphasize that malposition of the sphincter ring and its anomalous relationship with the surrounding structures was encountered in the preoperative period in 47.4% of children with developmental anomalies of the anorectal zone. This circumstance must be taken into account in choosing the site to which the rectum will be brought down during the operative intervention. Examination of 54 patients with clinical functional disorders in the late-term periods after surgical correction showed pathology of the sphincter ani externus muscle to be the principal etiological factor in the development of these disorders; it was revealed in 87.3% of cases.

[Anatomical causes of functional failures after surgery of anorectal malformations]. / Anatomicheskie printsipy funktsional'nykh neudach v khirurgii anorektal'nykh porokov razvitiia.

The authors observed 54 patients with clinico-functional disorders who had been operated upon for anorectal anomalies. The complex program of examination of these patients shows that the leading etiological moment in the development of different complications is pathology of the external sphincter of the rectum which was observed in 87.3% of children.

[Use of nitroglycerin to prevent arterial hypertension during general anesthesia using ketamine]. / Primenenie nitroglitserina dlia profilaktika arterial'noi gipertenziipri obshchei anestezii ketaminom.

Central hemodynamics was studied in 82 patients during surgery performed under various types of general intravenous ketamine anesthesia. Ketamine was shown to have a stimulating effect on hemodynamics both alone and in combinations with droperidol and diazepam. Single intravenous injection (0.25 mg) or drip infusion (0.3 micrograms/(kg.min) of nitroglycerin effectively prevented arterial hypertension, decreased peripheral vascular resistance and myocardial oxygen demand.

[Electrophysiologic and anatomic parallels in the status of the external rectal sphincter in healthy children and in those with anorectal developmental abnormalities]. / Elektrofiziologicheskie i anatomicheskie paralleli sostoianiia naruzhnogo sfinktera priamoi kishki zdorovykh detei s anorektal'nymi porokami razvitiia.

Electromyography was used to examine the external rectal sphincter in 44 neonate patients and in 24 patients aged 2 months to 3 years with different anorectal developmental abnormalities. The same examinations were performed in the control groups: in 30 normal neonates, in 15 premature (grade I-II) neonates, and in 64 normal children aged 1 to 14 years. According to the data of comparative morphometry, a study was made of the autopsy material of the external rectal sphincter from 15 full-term stillborns and 16 premature (grade I-II) stillborns as well as from 11 infants with anorectal developmental abnormalities who died within the first days after birth without any surgical intervention. It is concluded that in patients with anorectal developmental abnormalities, the contractility of the external rectal sphincter is considerably lower than in the respective weight groups of normal children and that such patients demonstrated the lack of the normal time-course of changes in its increase with age.