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

БИОПСИИ В ОНКОЛОГИИ И ГЕМАТОЛОГИИ ДЕТСКОГО ВОЗРАСТА

The literature review explores surgical diagnostic approaches in pediatric oncology and hematology. Various methods of biopsy, technical aspects, advantages, accuracy, rate of compications and application area are presented.В обзоре представлены современные проблемы и достижения в диагностике новообразований в детской онкологии и гематологии при помощи биопсии, рассматриваются технические особенности, преимущества, информативность, частота осложнений и область применения различных методов биопсии

Операции сосудистого шунтирования в лечении детей с внепеченочной портальной гипертензией (обзор литературы)

In children with extrahepatic portal hypertension (EPHT), the most frequent and life-threatening complication is bleeding from varicose veins of the esophagus and stomach. Therefore, the main task of HSV treatment is to prevent bleeding from the veins of the upper gastrointestinal tract. The most effective treatment is portosystemic bypass surgery, with effectiveness of 94%97%. However, the use of these operations is limited precisely by a decrease in portal liver perfusion and development of portosystemic encephalopathy. This study aimed to analyze domestic and foreign publications devoted to the surgical treatment of portal hypertension and the development of portosystemic encephalopathy during the postoperative period. A systematic search was carried out in PubMed, Web of Science, Scopus, MEDLINE, eLibrary, RSCI, and Cyberleninka; 345 references were analyzed, 110 articles were reviewed, and 97 publications on the surgical treatment of portal hypertension were selected for the review. The development of portosystemic encephalopathy during the postoperative period often occurs after the imposition of total portosystemic bypass surgery. To reduce the risk of developing portosystemic encephalopathy, selective shunts have been developed, which to some extent preserve the PPP. With distal splenorenal anastomosis, the frequency of portosystemic encephalopathy is 10%15%. An intermediate position is occupied by a side-to-side splenorenal anastomosis, which has signs of selective surgery. The results of the analysis of literature sources showed that discussions are still underway regarding the choice of the optimal treatment strategy for patients with EPHT, place and role of endoscopic methods for the prevention of gastrointestinal bleeding, and mesoportal shunt in the treatment of patients with EPHT. Nevertheless, the majority of world experts consider mesoportal shunt to be the most optimal operation for the primary and secondary prevention of varicose bleeding and other HSV complications. If it is impossible to perform, selective bypass surgery of the distal splenorenal anastomosis can be an alternative to a mesoportal shunt.У детей с внепеченочной портальной гипертензией самым частым и опасным для жизни осложнением является кровотечение из варикозно расширенных вен пищевода и желудка. Поэтому основная задача лечения внепеченочной портальной гипертензии предотвращение кровотечений из вен верхних отделов желудочно-кишечного тракта. Наиболее эффективным лечением можно считать операции портосистемного шунтирования, эффективность которых достигает 9497 %. Тем не менее применение этих операций ограничено именно из-за снижения портальной перфузии печени и развития портосистемной энцефалопатии. Цель исследования проанализировать отечественные и зарубежные публикации, посвященные хирургическому лечению портальной гипертензии и развитию портосистемной энцефалопатии в послеоперационном периоде. Систематический поиск проведен в базах данных PubMed, Web of Science, Scopus, MEDLINE, eLibrary, РИНЦ, Cyberleninka. Анализу подвергнуты 345 ссылок, просмотрено 110 статей, отобрано 97 публикаций по хирургическому лечению портальной гипертензии. Развитие в послеоперационном периоде портосистемной энцефалопатии часто возникает после наложения тотальных портосистемных шунтов. Для снижения риска развития портосистемной энцефалопатии были разработаны селективные шунты, которые в той или иной степени сохраняют портальную перфузию печени. При дистальном спленоренальном анастомозе частота портальной перфузии составляет менее 1015 %. Промежуточное положение занимает спленоренальный анастомоз бок-в-бок, который обладает признаками селективной операции. Результаты анализа источников литературы показали, что до сих пор ведутся дискуссии относительно выбора оптимальной стратегии лечения пациентов с внепеченочной портальной гипертензией, места и роли эндоскопических методов профилактики кровотечений желудочно-кишечного тракта, а также мезопортального шунта при лечении пациентов с внепеченочной портальной гипертензией. Тем не менее большинство мировых экспертов считают наложение мезопортального шунта наиболее оптимальной операцией для первичной и вторичной профилактики варикозного кровотечения и других осложнений внепеченочной портальной гипертензии. А при невозможности ее выполнения операция селективого шунтирования дистального спленоренального анастомоза может служить альтернативой выполнению мезопортального шунта