Introduction. Currently, the most successful option for treating benign hematological diseases of the spleen in children is splenectomy. Material and methods. In the article, the authors present their 25-year clinical experience in performing laparoscopic splenectomy in children with various diseases of the spleen. They discuss different techniques for surgical treatment of spleen diseases, features of preoperative preparation, current literature data. Results. The accumulated experience in laparoscopic surgeries for spleen removal, application of modern electrosurgical equipment and instruments for extracting tissues from the abdominal cavity have significantly reduced surgical time, improved cosmetic outcomes and quality of life of patients in the postoperative period. Somatostatin, prescribed right before the surgery and at the early postoperative period, prevents development of pancreatitis and erosive bleeding from the stump of the spleen pedicle in the vast majority of patients. Conclusion. The obtained catamnestic data demonstrate that laparoscopic surgery for spleen removal has its advantages. It is a safe, little-traumatic, effective and cosmetically good option for surgical spleen management in children.

Introduction. Bullous lung disease (BLD) is one of the most common lung diseases in childhood. BLD frequent complication is primary spontaneous pneumothorax. According to some authors, 88–92% of pneumothorax cases occur in BLD patients; therefore, to study this pathology is of a clinical interest.Material and methods. The article describes a case report of bullous lung disease in a teenage athlete. The article also presents modern data on BLD etiology, pathogenesis and treatment. The established diagnosis was confirmed by laboratory and instrumental findings.Results. The child had thoracoscopic resection of the lung. Assessment of catamnestic findings shows the radical nature of surgical intervention. Conclusion. The obtained clinical experience of thoracoscopic lung resection confirms advantages of the applied minimally invasive surgical treatment which are accelerated rehabilitation period and less postoperative complications.

Introduction. Nephroblastoma is the third most common solid tumor in childhood, accounting for 7–8% of the total number of solid tumors in children. Currently, there is no unequivocal position of oncosurgeons regarding laparoscopic nephrectomy in patients with nephroblastomas; the cases described in the world literature are rare.Purpose. To find out the effectiveness of laparoscopic kidney resection in children with nephroblastoma.Materials and methods. The authors describe two clinical cases of laparoscopic nephrectomy in patients with nephroblastoma, including one-stage bilateral laparoscopic nephrectomy for bilateral nephroblastoma.Results. At the time of article writing, the two patients were in clinical and instrumental remission for 6 and 11 months, respectively.Conclusion. Indications for laparoscopic kidney resections in nephroblastoma: stage I, peripheral location of the tumor node with predominant extrarenal growth, response to chemotherapy, absence of the cystic component of the tumor.

Introduction. Currently, surgical complications in Crohn’s disease is still one of the most serious problems in pediatric surgery. An intensive development of video endoscopic surgery contributes to the active introduction of this technology in pediatric coloproctological practice. Crohn’s disease is still one of the most complex pathologies in pediatric gastroenterology, and surgical treatment of its complications is a disputable issue among pediatric surgeons. Up to now, there are no clear indications to surgery in the refractory form of Crohn’s disease, no standardized terms and types for surgical intervention, as well as no optimal variants of surgical access.Material and methods. A retrospective analysis of patients who had been treated surgically at departments of abdominal and emergency surgery in two pediatric hospitals in Moscow (Morozovskaya and Izmailovskaya ) was carried out. 39 children with Crohn’s disease, aged 4–17 year, were included in the study. All patients had standard clinical examination: clinical examination with anamnesis, laboratory and instrumental diagnostics.Results. The obtained results have shown that laparoscopic interventions have a number of advantages, such as less traumatic surgery, reduced exposure to anesthesia and shorter intestinal stimulation, less stay in ICU, shorter hospitalization as well as more rapid rehabilitation period.Conclusion. The performed assessment of outcomes after surgical treatment of children with complicated Crohn’s disease helped to develop indications for the selection of surgical technique in the ileocecal form. Thus, the obtained results improved outcomes in children with complicated Crohn’s disease because of the outlined indications for surgery and surgical tactics when minimally invasive techniques are more preferable.

ЦЕЛЬ ИССЛЕДОВАНИЯ Представить опыт применения лапароскопических операций у детей с солидной псевдопапиллярной опухолью (СПО) поджелудочной железы. МАТЕРИАЛ И МЕТОДЫ В Морозовской ДГКБ за период с 2012 г. по 2021 г. лапароскопические операции по поводу СПО поджелудочной железы были проведены 16 пациентам. У 12 пациентов опухоль располагалась в области хвоста поджелудочной железы, у 4 пациентов — в теле поджелудочной железы. Было выполнено 12 дистальных и 4 центральных резекций поджелудочной железы. РЕЗУЛЬТАТЫ Длительность операции варьировала от 80 до 200 мин (в среднем 95 мин). Во всех случаях интраоперационная кровопотеря не превышала 100 мл и не требовала гемотрансфузии ни в одном случае. У 1 (6,25%) пациента, которому выполнялась лапароскопическая центральная резекция поджелудочной железы, в ходе оперативного вмешательства была выполнена конверсия в лапаротомию. Общие сроки послеоперационного пребывания в стационаре составили 10—14 сут (в среднем 12 дней). Катамнез прослежен у всех пациентов в сроки от 3 мес до 5 лет. Во всех случаях проводили плановое циклическое обследование (ультразвуковой скрининг, компьютерная томография с внутривенным контрастированием), при котором ни в одном случае не выявлено рецидива заболевания. ЗАКЛЮЧЕНИЕ Лапароскопические операции у детей с СПО в области хвоста и тела поджелудочной железы выполнимы при условии наличия в клинике достаточного опыта малоинвазивной и панкреатической хирургии. В руках опытного хирурга лапароскопическая дистальная резекция поджелудочной железы может стать предпочтительным методом лечения СПО у детей.

The paper discusses the topical issues of prevention of complications during puncture and catheterization of internal jugular veins (IJV) in children. Variants of anatomical organization of major vessels in the region of IJV puncture identified through ultrasound examination both at the time of screening and prior to IJV catheterization, which explain the high risk of complications during this manipulation, are described. The main directions for prevention of possible perforation of the vein posterior wall entailing injuries of anatomical substructures (branches of the carotid artery, vagus nerve) are given. The proprietary methodology of safe step-by-step catheterization of principal veins is provided. Reduction of the risk of complications during internal jugular vein catheterization thanks to usage of all steps described above has been convincingly demonstrated. Key words: intensive care in children, ultrasound examination, venous access, internal jugular vein catheterization

Introduction. Fecal incontinence of various origins still remains a complex medical and social problem that reduces both the quality of life and the chance of child’s full integration into the modern society. Antegrade enema, originally described by Malone, consists of creating an appendicostomy or neoappendicostomy of the ileum, which allows to irrigate the entire colon in order to empty the colon and rectum. As a result, children stay clean from 24 to 72 hours. Thus, surgical intervention can significantly improve the quality of life of children suffering of incontinence. Laparoscopic access minimizes surgical trauma and shortens rehabilitation period.Purpose. To analyze the obtained outcomes after treating children with laparoscopic umbilical appendicostomy.Material and methods. We report our own results obtained after performing laparoscopic umbilical appendicostomy in 3 children at the Federal Scientific and Clinical Center for Children and Adolescents, FMBA of Russia. Two children had neurological disorders of the pelvic organ; the third child suffered a severe combined injury, which led to the development of gross scarring changes in the sphincter area with a complete loss of its contractility. All children underwent laparoscopic umbilical appendicostomy. The article describes in detail all the stages of preoperative preparation and surgical intervention.Results. The duration of surgery ranged from 60 to 80 minutes. An appendicostomy intubator was left for 1 month in all cases. Hospital stay ranged from 8 to 11 days. The catamnesis was traced for 3–7 months. Therapeutic effect was assessed by children’s parents as satisfactory; the child remained clean for 12–18 hours, which contributed to socialization and significantly improved the quality of life. Conclusion. Performing laparoscopic umbilical appendicostomy is a relatively affordable technique. Our own experience has proven its effectiveness. Laparoscopic access minimizes surgical trauma, reduces rehabilitation time, and brings excellent cosmetic results. Malone surgery in children should be considered as a method of choice.

This review aims to summarize the existing literature on irritable bowel syndrome (IBS) in children and discuss the evolution of definitions and diagnostic criteria according to the Rome IV Criteria issued in 2016. The article also covers the main theories of IBS pathogenesis, including the role of surgical interventions and changes in the intestinal microbiota. There is an overview of current therapeutic approaches used for IBS treatment in accordance with the variety of etiopathogenetic factors. It has been shown that the use of probiotics, antidepressants, prokinetics, and antispasmodics can become a strategy for the prevention and management of IBS in children. Key words: children, irritable bowel syndrome, functional gastrointestinal disorders

Introduction. The basic technique for treating patients with liver neoplasms is a surgical one. Currently, there is a trend to decrease a traumatic impact. One of the options for this is to develop and to implement minimally invasive surgical techniques which make postoperative period and rehabilitation easier.Purpose. To find out the most optimal tactics for surgical treatment of children with liver tumors.Material and methods. In 2014-2020, 26 patients, aged 0-17 years, with liver tumors were treated in Morozov Children’s City Clinical Hospital. 16 boys (61.5%) and 10 girls (38.5%). 17 patients with hepatoblastomas (68%); 2 (8%) in twos - hepatocellular cancer, embryonic liver sarcomas and focal nodular hyperplasias; 1 (4%) by ones - adenoma and hamartomas. In the morphological picture, hepatoplastoma was the most common (16 patients). 25 liver resections were performed; in 5 out of them (20%) (patients aged 3-9 years) minimally invasive technologies were used.Results. Surgical time was significantly shorter in patients who were operated on with laparoscopic access (30–60 minutes), if to compare with laparotomic access (180-270 minutes). The volume of intraoperative blood loss in laparotomic access is more than 5 times larger than in laparoscopic access. In the group of patients operated on with the open access, intraoperative complications were noted in 2 (8%) cases: lethal outcome (4%) and injury of the extrahepatic biliary tract (4%).Conclusion. Laparoscopic techniques reduce surgical time and blood loss. They also prevent complications both during surgery and in the postoperative period, shorten the hospital stay and promote early patient’s mobilization and early enteral feedings as well as early chemotherapy; they reduce pharmpreparation loading and prepare conditions for radical surgery

Pediatric testicular masses are rare pathologies. Many physicians, facing such masses for the first time, have trouble choosing the algorithm of assessment and surgical treatment tactics. Extent of surgery and surgical approach depend directly on preoperative assessment results. The clinical case of the incident testicular mass surgical treatment in a 15-year-old boy is reported. The patient underwent laboratory and instrumental examination, the results of which confirmed a benign lesion. Based on the data obtained, the organ-sparing surgical approach was selected. An assessment algorithm, treatment tactics for testicular mass based on the data obtained, advisability and safety of the organ-sparing treatment approach are reported.

Introduction. Lymphatic malformations are relatively rare in childhood. Their occurrence depends on age and varies between 1/600000 to 1/2500000. By literature data , the only radical curative option for this pathology is surgery; however, the relapse rate amounts to 25%. Therefore, further studies on the management of this pathology are needed.Purpose. to present a rare clinical case of successful surgical treatment of a child with lymphatic mesentery malformation of the small intestine.Materials and methods. The authors discuss various approaches to therapy and surgical care; they also present modern literature data and discuss the relevance of sclerosing preparations for injections directly into the cystic cavity. A clinical case of 2-year-old child with lymphangioma of complex anatomical location is described. The authors analyze ways of surgical intervention, early postoperative course and correction of the developed complications.Results. Follow-up data were analyzed; the obtained results confrm a radical type of the performed surgery without worsening the quality of life.Conclusion. Lymphangiomas at diffcult anatomical locations require a special attention during examination and treatment; radical removal can be considered as an effective option for treating such children.

OBJECTIVE:To evaluate feasibility and advantages of laparoscopic access in children with retroperitoneal neurogenic tumors.MATERIAL AND METHODS:A comparative analysis of postoperative results was performed in 2 groups of patients with retroperitoneal neurogenic tumors without IDRF risk factors. Different surgical approaches were applied. The main group (laparoscopic access) consisted of 18 patients. The control group included 22 patients after laparotomy. We compared the following variables: surgery time, blood loss, postoperative need for analgesics, intraoperative and postoperative complications, timing of postoperative enteral feeding, postoperative hospital-stay and regional recurrence rate.RESULTS:Duration of laparoscopic and open surgery was similar (80.5 vs. 86.5 min, p>0.05). Intraoperative blood loss was significantly lower in the laparoscopy group (10 vs. 17 ml/kg, p<0.05). Two patients required conversion of laparoscopic approach. In laparotomy group, massive intraoperative bleeding occurred in 1 patient. Early postoperative period was more favorable in the main group compared to the control group. There were no local and metastatic recurrences in delayed postoperative period after laparoscopic surgery. One (4.5%) patient had metastatic recurrence after laparotomy. There were no regional recurrences in this group.CONCLUSION:Laparoscopic resection of neurogenic retroperitoneal tumors in children is feasible if great vessels are not involved in neoplastic process. Open surgery is preferable in patients with invasion of great vessels.

The central pancreatic resection is a complex organ-preserving surgical intervention used in patients with tumors located in the area of gland body. The laparoscopic access minimizes surgical trauma and shortens patients’ rehabilitation. The publication describes the first experience of laparoscopic central resection of the pancreas in a 13-year-old girl at the Morozovskaya City Children’s Clinical Hospital, Moscow.

Background. Lymphangiomas are non-specific malformations that develop from the lymphatic vessels. Usually, the disease is asymptomatic, but there may be complications requiring emergency care. In the literature there is no consensus about the method of choice in the treatment of these formations. Description of A Case Series. The article is devoted to the evaluation of the efficacy of surgical treatment of lymphangiomas in children. There are also several clinical cases showing mediastinal lymphangioma with a clinical picture of respiratory failure, lymphangioma of the abdominal cavity, imitating the symptoms of an acute abdomen and lymphangioma of a rare anatomical localization. The results of treatment of 48 children for the period from 2008 to 2017 were analyzed at «Morozov Children Municipal Clinical Hospital» (Moscow). The basis of treatment was the removal of education within healthy tissues. When the radical intervention was impossible in 5 (10.4%) children we used resection of the tumor with sparing coagulation of the surface of the formation. Infectious complications arose in 3 (6.3%), lymphorrhea — in 13 (27.1%) patients. Recurrences of lymphangiomas developed in 2 (4.2%) patients. In the case of lymphorrhea, expectant management and parenteral nutrition were used. The repeated operations were performed with recurrences. The catamnesis ranges from 6 months to 10 years. Conclusion. Radical removal of lymphangiomas of internal organs can be recommended to children of any age as an effective way to treat this disease.

Lymphangiomas are non-specific formations developing from the lymphatic vessels, occupying an intermediate position between the tumor and the developmental malformation. The most frequent localization of the pathology is the face and neck area (75%) and the axillary region (20%), less than 1% of cases are located in the mediastinum. According to the literature data, the only radical treatment is surgical, but there is a high prevalence rate of relapses (25%). This article is devoted to the analysis of the clinical case of the treatment of lymphangioma of the complex anatomical localization, reflecting the complexity of the diagnosis and radical relapse-free treatment of this pathology.

In the present work, there is presented an experience of phased surgical treatment of the perforation of the gall bladder in children of different age groups. Early diagnosis and timely surgical intervention being crucial in this pathology, allow increase the survival rate of patients. The complexity of the primary diagnosis and the rare occurrence of this pathology in our opinion make this publication to be relevant.