Relapses after laparoscopic fundoplication for the treatment of gastroesophageal reflux in children are a serious challenge to pediatric surgery. Modified Nissen laparoscopic fundoplication developed and implemented in N.F.Filatov Children’s City Hospital ensures a two-fold decrease in the frequency of repeated surgery and increases treatment efficacy up to 92%. We undertook a retrospective study of 345 patients with the statistical analysis of its results. The results of modified surgery and evaluation of statistically significant risk factors of relapses were confirmed by multifactorial logistic regressive analysis. It was shown that the choice of surgery is an independent risk factor of relapses. Other factor influencing the outcome of primary surgery is hiatal hernia. Such patients make up a group at risk of relapse.

Thoracoscopic and traditional access for the treatment of lung hydatidosis in children was compared. 56 children, who composed the 1st (control) group, were operated on with the open access. The 2nd (main) group, consisted of 22 patients, operated on thoracoscopically. The issue holds the thorough description of the operative technique. The mean operative time was 61.2±7.4 min for the thoracoscopic operation, the mean pleural drainig time was 2.5±0.7 days. The mean postoperative hospital stay was 12±3.5 days. For the patients of the control group, the operative time was 86.4±25.2 min, draining time was 4±1.2 days and hospital stay was 18.4±8.2 days. There were no conversion cases. 3 patients of the "thoracoscopic" group developed postoperative pneumonia and bronchial fistula. Considering the strict following the principles of antiparasitic treatment, the endoscopic treatment of lung hydatidosis proved to be a method of choice for the surgical treatment of lung hydatidosis in children.

В статье описаны клинические наблюдения 27 детей в возрасте от 1 дня до 10 лет с кистозно-аденоматозной мальформацией легких. В зависимости от метода оперативного вмешательства дети были распределены на 2 группы. В контрольную, 1-ю группу вошли 3 детей, оперированных традиционным торакотомным способом. В основную, 2-ю группу, вошли 24 пациента, которые были оперированы торакоскопическим способом. У детей основной группы средняя продолжительность операции составила 58,5 ± 13 мин, средняя продолжительность дренирования плевральной полости – 3,7 сут, а послеоперационной госпитализации – 12,5 сут. У пациентов контрольной группы средняя продолжительность дренирования плевральной полости составила 5 сут, послео-перационной госпитализации – 17, 3 сут. Средняя продолжительность операции в контрольной группе – 65 ± 5 мин.Полученные результаты свидетельствуют о том, что торакоскопические операции при кистозно-аденоматозной маль-формации легких являются реальной альтернативой открытым операциям, так как обладают всеми преимуществами минимально инвазивных вмешательств. Эти операции позволяют осуществить вмешательства любой сложности, сни-зить количество послеоперационных осложнений, ускорить реабилитацию пациентов и избежать тяжелых анатомо-функциональных последствий, связанных с проведением торакотомии.ключевые слова: торакоскопические опеации, кистозно-аденоматозная мальформация легкого, детиA total of 62 children aged 1-10 yr with cystic adenomatous lung malformation were available for examination. 24 patients of group 1 were treated by traditional thoracotomy, 38 patients of group 2 by the thoracoscopic technique. In group 1 mean duration of surgery and drainage of pleural cavity was 65+-5 min and 5 days respectively. In group 2 mean duration of surgery and drainage of pleural cavity was 58.5+-13 min and 3.7 days. Mean hospital stay of the patients of these groups was 12.5 and 17.3 days after surgery. These findings show that thoracoscopy is a real alternative to open operations for the treatment of cystic adenomatous lung malformation. This miniinvasive procedure is suitable for interventions of any complexity , it reduces the frequency of postoperative complications, accelerates rehabilitation and permits to avoid serious anatomic and functional disorders associated with thoracotomy. Key words: thoracoscopic operations, cystic adenomatous lung malformations, children

Thoracoscopic and traditional methods of treatment of the inborn and acquired lung diseases in children were comparatively analyzed. The main group, operated on thoracoscopically, consisted of 30 patients. The control group, operated on thoracotomically, consisted of the same number of children. Both groups were comparable to the age, gender, diagnostic algorithm, risk and preoperative prepare. Traumaticity of the operation and postoperative period were assessed. Thoracoscopic method proved to have indisputable advantages.

26 – рассечения диафрагмы в перикардиальной части, что минимизирует повреждение волокон левого диафрагмального нерва. Тем самым доступ снижает потенциальный риск пареза и релаксации мышцы диафрагмы с развитием дыхательной недостаточности в раннем послеоперационном периоде, что в 13–35% случаев увеличивает продолжительность нахождения больного на искусственной вентиляции легких, требует наложения трахеостомы и препятствует активному ведению больного [4, 11], а также снижает риск формирования в позднем послеоперационном периоде грыж передней брюшной стенки и стойкого болевого синдрома.

The thoracoscopic and traditional thoracotomic surgical access for bronchiectesis treatment in children were compared. The first (thoracoscopic) group included 18 children. The control (thoracotomic) group included 26 patients. The mean operative time in the 1st group was 78.3±31 min; pleural draining lasted for 1.3 days and postoperative hospital stay was 9.93±2.08 days. The mean operative time in the 2nd group was 81.7±35.1 min; pleural draining lasted for 3.3 days and postoperative hospital stay was 14.4±3.4 days. Conversion was needed in 4 cases. Therefor, the thoracoscopic surgery proved to be much more preferable in children because of its' minimal invasiveness.

Results of surgical treatment were comparatively analyzed in children with congenital lobar emphysema operated using traditional technique (1 group, 10 patients) and operated using thoracoscopic technique (2 group, 10 patients). In the first group average time of operation amounted 68 +/- 5,8 min., average time of plural drainage--3,3 days, average time of postoperative hospitalization--13,6 days and in the second group--62 +/- 15,6 min., 1,3 days and 7,4 days respectively. In the second group postoperative complications were not observed. In postoperative period one patient from the first group developed pneumothorax eliminated on the 5-th day after operation. Results of investigation indicate the advantages of thoracoscopic technique in treatment of children with lobar emphysema compared with traditional methods of treatment. Application of thoracoscopic technique in children with lobar emphysema is a serious alternative to traditional method due to slight postoperative period, lesser amount of complications and good cosmetic and functional results.

The aims of the study were: 1) to formulate up-to-date principles of coloesophagoplasty (CEP) and to compare methods of CEP; 2) to determine the optimal age for esophagoplasty in children with esophageal atresia; 3) to evaluate quality of life and long term results after esophagoplasty performed in childhood; 4) to present results of surgical treatment of pharynx stenosis in children. Over the last 50 years more than 2 thousand surgeries on the esophagus in children were performed including more than 600 operations of artificial esophagus creation. From 1995 in some patients we carried out extirpation of the esophagus with one-stage plastic operation coloesophagoplasty taken the transplant in the posterior mediastinum. From 1992 on the pharynx with free revascularized intestinal segment was performed in isolated stenosis of the pharynx. Case histories of 54 children aged from 3 months to 15 years were analyzed to compare methods of esophagoplasty when the esophagus was taken behind the sternum and in posterior mediastinum. Case histories of 27 children with atresia of the esophagus were analyzed for determination of optimal age for coloesophagoplasty. Responses to questionnaires were analyzed to evaluate quality of life. From 1980 ive hase operated 28 patients with scarry stenosis of the pharynx (isolated or in combination with esophageal stenosis). Current policy of surgical treatment of pharyngeal stenosis which is considered as surgery of choice-pharyngoplasty with a free intestinal transplant--is described. Development and clinical appliance of up-to-date principles of CEP permitted to reduce the number of complications and to decrease lethality from 3 to 0.5%. After introduction of antireflux cologastroanastomosis the number of complications due to reflux reduced. Extirpation of the esophagus may be valid in peptic stenosis, Barrett's metaplasia, tumors, portal hypertension or angiodisplasia, and in the majority of cases of scarry stenosis of the esophagus.

From 1995 to 2000 twenty-seven coloesophagoplasties were performed in children with esophageal atresia aged from 3 months to 2 years. Patients were divided into 2 groups depending on their age. Group 1 consisted of 13 children aged from 3 to 6 months (mean 5.5 months), group 2-14 children aged from 6 to 24 months (mean 13 months). Course of postoperative period and postoperative complications were the criteria of treatment results. All the parameters were similar in both groups. Postoperative diarrhea was seen more often in group 1. It is concluded that esophagoplasty in children with atresia must be performed as early as possible.

Barret's esophagus (BE) is a rare disease in children. It is caused by gastroesophageal reflux (GER). From 1996 to 1999 seventy-eighth children with GER were treated. Twenty-four-hour pH-metry and manometry of the esophagus, scintigraphy and contrast roentgenoscopy of the esophagus were used for diagnosis of GER. All the children underwent biopsy of mucosa membrane of distal esophagus. Morphologic examinations revealed BE in 16 (20.5%) children. Metaplasia of esophageal epithelium by intestinal type (IT) in combination with one by gastric type (GT) were revealed in 8 children, metaplasia by gastric type alone (epithelium of gastric and fundal parts of the stomach)--in 8 children. Six children with IT metaplasia of the esophagus with long strictures underwent extirpation of the esophagus with one-stage esophagoplasty. It esophageal stenosis is not long or is absent, fundoplication by Nissen (4 children) and drug therapy (6 children) are performed. It is concluded that in IT metaplasia of the esophagus with long peptic esophageal strictures resistant to bouginage extirpation of the esophagus with one-stage coloesophagoplasty is desirable. Other methods of treatment do not exclude probability of esophageal adenocarcinoma. These children should be followed up with esophageal biopsy each 6-12 months.