Repeated surgery for reccurent varicocele in children

The frequency of varicocele recurrences after surgery is an extremely variable quantity (0,5-35%). Most studies show that microsurgical inguinal or subinguinal ligation of veins provides significantly fewer relapses (0,5-3,7%). During the period 2009 - 2016, we treated 14 patients 12,5-17 years age with recurrent varicocele. At 4 ones previously produced retroperitoneal ligation of testicular veins by open access, 9 - laparoscopic ligation. In 13 cases, laparoscopic ligation of residual testicular vein was performed. In 1 patient relapse was occurred after an open ligation of testicular vein. Based on angiography results with measurement of venous pressure in the left renal vein we had decided to hold subinguinal microsurgical ligation veins. 4 months after that operation varicocele grade 3 relapsed again. We performed laparoscopic revision and clipping of the residual veins and simultaneous microsurgical ligation of expanded venous plexus in the scrotum by skrototomy through the Vesling`s line. Follow-up of 14-42 months demonstrate an absence of recurrence. In 2 patients in the development of a hydrocele occurred in the earl postoperative period, which disappeared after 4.5 and 8 months spontaneously. Another patient after repeated laparoscopic procedure suggests decrease of volume of the left testis by 35% relative to the right. Conclusion. According our experience we can recommend laparoscopic ligation of residual testicular veins as good choice in children with relapse of varicocele

Laparoscopic herniorrhaphy in children with acute inflammatory diseases of the abdominal cavity

Institutul de Cercetări științifice în Chirurgia Pediatrică, Universitatea Națională de Cercetări Medicale „N.Pirogov”, Moscova, Rusia, Al XII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova cu participare internațională 23-25 septembrie 2015Introducere: Prezența unui proces inflamator-distructiv acut în cavitatea abdominală este pe larg considerată ca o contraindicație pentru herniorafia laparoscopică simultană. Material și metode: În perioada 2010-2012, 240 de copii cu vîrsta 5-14 ani, au fost spitalizați cu manifestările clinice ale abdomenului acut și au fost supuși intervențiilor chirurgicale urgente. În timpul laparoscopiei la 29 pacienți (18 băieți și 11 fete) a fost depistat processus vaginalis persistent (PVP): în 25 de cazuri unilateral și în 4 cazuri - bilateral. Nouăsprezece copii din acest lot au fost diagnosticați cu formele distructive ale apendicitei acute (în 6 cazuri complicate cu peritonită locală), 5 – cu pelvioperitonită, 4 – cu limfadenită mezenterică acută și 1 copil – cu apoplexie ovariană. La toți pacienții au fost efectuate intervenții simultane – asanarea focarului inflamator și ligaturarea subcutanată endo-asistată (SEAL) a PVP. Rezultate: Nu a fost înregistrat nici un caz de conversie. După intervenția de asanare a focarului inflamator (apendicectomie, rezecție de ovar, etc.) a fost efectuată SEAL conform metodei modificate de autori. Durata SEAL nu a depășit 6 minute pentru hernia unilaterală și 9 minute în cazuri bilaterale. Postoperator toți copii au primit un tratament standard. În toate cazurile evoluția postoperatorie a fost favorabilă. Complicații abdominale sau la nivelul canalului inghinal nu au fost înregistrate. Examenul ultrasonor și testele de laborator au confirmat rezolvarea completă a procesului inflamator. Toți pacienții au fost externați complet recuperați. Concluzii: Herniorafia laparoscopică simultană la copiii cu procese acute inflamatorii în cavitatea abdominală nu este urmată de elevarea riscului complicațiilor postoperatorii.Introduction: The presence of an acute inflammatory and destructive process in the abdominal cavity is commonly a contraindication to the one-stage laparoscopic herniorrhaphy. Material and methods: From 2010 to 2012, 240 children, 5-14 years of age, were admitted to hospital with a clinical picture of acute abdomen and all of them were urgently operated on. During laparoscopy in 29 patients (18 boys and 11 girls) a persisted processus vaginalis (PPV) was found: unilateral in 25 cases and bilateral in 4 cases. In 19 children from this group destructive forms of acute appendicitis (in 6 cases complicated by local peritonitis) were diagnosed as well as 5 – pelvioperitonitis, 4 – acute mesenteric lymphadenitis, and 1 – ovarian apoplexy. All patients underwent simultaneous procedures – both inflammatory focus treatment and subcutaneous endo-assisted ligation (SEAL) of PPV. Results: There was no conversion in any case. After the intervention for treatment of inflammatory focus (appendectomy, ovarian resection, etc.) the SEAL was performed according to our modification. SEAL duration was not more than 6 minutes for unilateral hernia and 9 minutes for bilateral. Postoperatively, all children received a standard therapy. In all cases the postoperative period was favorable. Complications in abdominal cavity or inguinal canals were not registered. Ultrasound examination and blood tests confirmed a complete relief of the inflammatory process. All patients were discharged with full recovery. Conclusions: Simultaneous laparoscopic herniorrhaphy in children with acute inflammation in the abdominal cavity does not increase the risk of postoperative complications

The influence of paediatric minimally invasive surgery on the hospital treatment duration

Purpose: to explore the possibility of shortening hospitalization after high complexity paediatric surgical operations. Materials and methods: in 2014 - 2017 47 children (1 - 17 years old) were operated. Children were discharged from the hospital after medical stabilization, further treatment on an outpatient basis. Results: 41 patients (19 boys and 22 girls) with abdominal pain were operated. In 23 cases were destructive forms of acute appendicitis. Of these, 8 patients with peritonitis (4 - generalized peritonitis). Cryptogenic peritonitis simulating acute appendicitis in 6 girls, 1 girl had torsion of ovarian cysts. In 1 case (3.5 year old) was a penetrating abdominal trauma and loops of the small intestine, in 2 - recurrent intestinal invagination. Also, 2 children with hydronephrosis completed by plastic ureteropelvic junction, 4 patients with vesicoureteral reflux was performed injection plastic of the ureteral orifice and detrusor injections with botulinum toxin. In all cases underwent endoscopic surgery without conversion to open surgery. Children with «emergency» diagnosis were discharged from the hospital on the 3,5 days (1-5,5 days), planned patients on the 4 days. One patient with hydronephrosis and 1 child with generalized peritonitis have the longest hospital stays (8 and 5,5 days respectively). In case with hydronephrosis accidental removal of ureteral stent was the cause of ureteropelvic anastomosis obstruction and prolonged hospitalization. In all cases further treatment on an outpatient basis were without complications. Conclusion: laparoscopic surgery in children certainly carries many advantages. These include less pain, rapid recovery, shorter hospital stay, less wound complications and better cosmetic result. The laparoscopic technique in comparison with medical and economic standard practically reduced the hospital stay period into halve without increasing of complications. Laparoscopic surgery in infants and young children will become more widely accepted

One-day hospitalization experience in children’s surgical department

Purpose: To analyze the effectiveness of stationary substitution technologies in pediatric surgery Materials and methods: 482 children with typical surgical diseases from 1 to 17 years old were operated in the period of 2014-2017. Different types of local and general anaesthesia were used for operations, including combination of intubation anaesthesia and mechanical ventilation. All patients were discharged home on the day of the operation. Results: 190 patients with phimosis were operated for the indicated period (of these, 86 under anesthesia, 104 under regional anesthesia). Also, 44 patients with hydrocele and spermatoceleswere operated under general anaesthesia, 21 - with cryptorchidism (including 5 - laparoscopic surgery), 53 - with umbilical hernia, 42 - with inguinal hernia (all by endoscopic method), 19 - with varicocele (17 laparoscopic surgery), 28 – syndrome of an acute scrotum, 30 with short frenulum of foreskin, 4 with cysts in the neck, 32 with benign tumors of different localization, 4 with vesicoureteral reflux, 15 with extensive tissue trauma. The average stay at the hospital, including the preoperative period was 4 hours. Also, 2 children with acute bronchospasm after extubationwere cured by conservative methods. 2 patients had bleeding from the wound in the early postoperative period, one of them required repeated anaesthesia and revision. Purulent-septic complications were notidentified. The pain syndrome was moderately expressed and successfully stopped at home by the use of non-narcotic analgesics. Conclusion: the most common operations in childhood can be performed within «one-day» hospitalization without increasing the incidence of postoperative complications

Laparoscopic herniorrhaphy in children with acute abdomen

Background. The presence of an acute inflammatory and destructive process in the abdominal cavity is commonly a contraindication to the one-stage laparoscopic herniorrhaphy. Material and methods. From 2010 to 2017 986 children, 5-14 years of age, were admitted to hospital with a clinical picture of acute abdomen for surgical treatment. During laparoscopy in 53 patients (33 boys and 20 girls) a persisted processus vaginalis (PPV) was found: unilateral in 48 cases and bilateral in 5 cases. In 37 children from this group various destructive forms of acute appendicitis (in 10 cases complicated by local peritonitis with or without intraabdominal abscess and in 7 – by general peritonitis ) were diagnosed as well as 10 - pelvioperitonitis, 4 - acute mesenteric lymphadenitis, 1 - ovarian apoplexy, 1- torsion of omentum. All patients underwent simultaneous procedures - both inflammatory focus sanation and subcutaneous endo-assisted ligation (SEAL) of PPV. Results. There was no conversion in any case. When the inflammatory focus was reorganized (appendectomy, ovarian resection, etc.) SEAL was performed according to our modification. SEAL duration was not more than 8 minutes for unilateral hernia and 10 minutes for bilateral one. Postoperatively, all children received a standard therapy. In all cases the postoperative period was favorable. Complications in abdominal cavity or inguinal canals were not observed. Ultrasound examination and blood tests confirmed a complete relief of the inflammatory process. All patients were discharged with full recovery. Conclusion. Simultaneous laparoscopic herniorrhaphy in children with acute inflammation in the abdominal cavity does not increase the risk of postoperative complications

Focal nodular hyperplasia of the liver in a boy of 13 years old

Introduction. Focal nodular hyperplasia of the liver is one of the most common benign liver new growths. Most often the disease is manifested in women aged 30-40 years. The incidence ratio of women to men is 10: 1. The emergence of this pathology is associated with the response of hepatocytes to the local vasculature malformation. The indications for operative intervention are pain in the liver or progressive growth of the tumor. The operation is also recommended, when it is impossible to conduct differential diagnosis with other bulk liver diseases. Case report. The boy of 13 years old was find out to have the formation of liver 81x65x68 mm by size, that became the reason of hospitalization in our clinic. The patient didn’t complain about his state of health, the temperature of body was normal. The results of laboratory research methods were concordant to age norm. Existence of new growth in 6th and 7th hepatic segments projection was proofed by ultrasound and CT. We found out, that the formation was hypervasculared, located partially out of hepatical parenchyma and had clear contours with centrally localized dense fibrous tissue. Access was implemented by laparotomy high resection, hepatic duadenal ligament was niped and the tumor was removed by atypical resection of liver. Hemostasis is achieved by stitching, coagulation of the wound surface with an argon-plasma coagulator “PlasmaJet” and powdering by “PerClot”. The postoperative period passed without any complications, the patient was discharged in satisfactory condition on 7th day after surgery. Repeated inspection after 3 months has show satisfactory child’s condition again. No data for relapse of the disease there. Conclusion. The tactics of treating FNH of liver, that arose in childhood, presuppose surgical resection. This is due to the trend towards intensive growth of tumor in conditions of child’s organism

Application of the hydrosurgery system and plasmajet for thoracoscopic debridement of pleural cavity in children with fibrinothorax

Introduction. Thoracoscopy became a favored modality in pediatric pleural empyema treatment. However, the factors affecting on outcome of thoracoscopic management remain unclear. Purpose of the study Demonstration of hydrosurgery system “Versajet” and the plasma unit “Plasmajet” during thoracoscopic treatment of children with pleural complications destructive pneumonia. Materials and methods. 377 patients with a pneumonia was treated at the Speransky Children’s Hospital in Moscow for the last 1 year. 62 patients (16.45%) from 377 required drainage of the pleural cavity. 14 patients from 1.6 to 15 years of age (mean, 3.2 ± 3.8) with pleural empyema were operated -Thoracoscopic pleural cavity sanitation with hydrosurgery system (Versajet-2) Hydrosurgery system is a surgical instrument based on the impact of high-speed jet of water on necrotic and inflamed tissues, combining the advantages of acute cleansing tissue and processing them by pulsating water jet. The design of the evacuation tube and its close proximity to the liquid jet creates a local vacuum, which effectively removes fibrin and liquid contents by Bernulli effect. Informed consent was obtained from parents, and the procedure received approval from the local ethics committee. Results. Recovery and rehabilitation was uneventful in 13 cases. 1 patient with empyema of the right pleural cavity and severe organic lesion of the central nervous system was treated in our hospital by thoracoscopic adhesiolysis. However, postoperative period was complicated by recurrence of pleural empyema and cortication of right lung. Rethoracoscopy was performed six days later after initial operation - thoracoscopic debridement of pleural cavity, decortications of the right lung by hydrosurgery system with good results after surgery. Mean operative time was 90 minutes (± 15 minutes). Drainage of the pleural cavity was removed 3-4 days after surgery. The childrens were discharged from the hospital on day 10 (± 1.2 days). After application of argon plasma coagulation has been achieved complete aerostasis in 2 patients, hemostasis - in 1 patient. Ultrasound and X-rays examination 4 months after surgery confirmed the absence of inflammation in the lung parenchyma and full lung reexpantion in all patients. Conclusions. Application Hydrosurgycal system during thoracoscopy, provide effective debridement of pleural cavity, decortications of the lung without damaging the lung parenchyma and create conditions for early rehabilitation of the compromised lung

ГИДРОХИРУРГИЧЕСКАЯ САНАЦИЯ ПЛЕВРАЛЬНОЙ ПОЛОСТИ У РЕБЕНКА С ЭМПИЕМОЙ ПЛЕВРЫ НА ФОНЕ ТЯЖЕЛОГО ОРГАНИЧЕСКОГО ПОРАЖЕНИЯ ГОЛОВНОГО МОЗГА

A treatment case of a child aged 14 y. o. with pleural empyema against the background of severe organic brain damage and resistant epilepsy was presented. Considering premorbid background, unsuccessful treatment attempts using drainage and thoracoscopic sanitation of the pleural cavity, the child underwent a recurrent thoracoscopic sanitation of the pleural cavity using a hydrosurgical unit. Treatment results show high effectiveness of this method in 3 stage pleural empyema when other treatment methods are less effective and there are limitations related to rehabilitation activities due to severe premorbid status of a child.Представлено описание случая лечения ребенка 14 лет с эмпиемой плевры возникшей на фоне тяжелого органического поражения головного мозга и некупируемой эпилепсии. Учитывая преморбидный фон, безуспешные попытки лечения методом дренирования и торакоскопической санации плевральной полости, ребенку была выполнена повторная торакоскопическая санация плевральной полости с использованием гидрохирургической установки. Результаты лечения демонстрируют высокую эффективность метода в III стадии эмпиемы плевры, когда прочие методы лечения менее эффективны и есть ограничения в проведении реабилитационных мероприятий, из-за тяжелого преморбидного статуса ребенка

ФОКАЛЬНАЯ НОДУЛЯРНАЯ ГИПЕРПЛАЗИЯ ПЕЧЕНИ У РЕБЕНКА 13 ЛЕТ

The article describes a clinical case of a child with hepatic focal nodular hyperplasia. The obtained good result is confirmed with clinical data and instrumental studies. This allows us to assume safely that radical surgery is possible in these patients. В статье приведен случай из клинической практики лечения ребенка с фокальной нодулярной гиперплазией печени. Полученный хороший результат, подтвержденный клиническими данными и инструментальными исследованиями, позволяет с уверенностью говорить о возможности радикального оперативного лечения данной категории больных.