Introduction. Endoscopic inguinal herniorrhaphy in children has become widespread, but there are no comparative results of using various technologies for its implementation. Material and methods. The results of 1136 laparoscopic herniorrhaphies in children for inguinal hernia throughout the period from 2006 to 2016 were analyzed. The first group (GL1) comprised 812 patients who underwent laparoscopic suturing of an inguinal hernia with intracorporeal purse-string suture. The second group (GL2) included 324 children, who were treated with the subcutaneous endoscopically assisted ligation (SEAL) technology - single-ported transcutaneous herniorrhaphy with laparoscopic assistance. Children were operated most often at the age from 1 year to 7 years. The average age of patients in the first group amounts of 4.6 years, in the second group - 4.5 years. All herniorrhaphies were performed standardly, with the use of the same instrumentation. Results. There were revealed such advantages of the use of the SEAL method as the time of training of beginning surgeons to the technique of endoherniorrhaphy is shorter by 2.5 times at the preclinical stage of training, at the stage of assisting and bringing the independent technique of its implementation to perfection; the duration of the operation is shorter due to the exclusion of the time for the introduction of the second/third port and the imposition of an intracorporeal node that presents the greatest difficulty for beginning surgeons; the number of intra- and early postoperative complications do not differ in both groups. The number of relapses is greater in GL2 children with large inguinal and scrotal hernias. The duration of hospitalization in groups did not differ. Conclusion. The use of SEAL technology is economically more profitable due to the relative simplicity of technique of herniorrhaphy and the minimal use of the number of endoscopic instruments. In large inguinal and scrotal hernias, it is more appropriate to use the traditional technique of imposing intracorporeal suture.

Objective: to present a case of successful treatment of rare severe lung lesions in a child.Methods: the article analyzes the result of the treatment of lung histiocytosis in a child aged 4 years. The clinical manifestation of the disease began with an increase in the parotid lymph nodes, otitis, pneumonia, and rapidly progressive respiratory failure. On the roentgenogram, bulle transformation of both lungs was noted. The severity of the disease was complicated by bilateral pneumothorax, the formation of bronchopleural fistulas. Histiocytosis of the lungs from Langerhans cells (GCR) was determined morphologically when examining tissue taken at thoracoscopy. Endoscopically, the lung was without signs of inflammation, with multiple subpleural air cavities. The child underwent chemotherapy (vinblastine, prednisone), repeated drainage of the pleural cavity with recurrent intense pneumothorax. For health reasons, a longitudinal sternotomy was performed, total decortication of the costal pleura on both sides (mechanical pleurodesis), which contributed to subsequent fixation of the lung to the chest wall and prevention of recurrent total stressed pneumothorax. Twice developed limited pneumothorax was stopped by drainage and chemical pleurodesis.Results: Against the background of ongoing complex therapy (drainage of the pleural cavity, mechanical and chemical pleurodesis, chemo- and antibacterial therapy), the condition improved (clinically and radiographically). The child was discharged on day 152 of treatment. On the control MSCT of the lungs, eight months after discharge, there are minimal signs of bullous transformation, and the symptoms of pneumosclerosis of both lungs are moderate. There are no manifestations of pulmonary hypertension.Conclusion: verification of the diagnosis of pulmonary GLC is very difficult. The complex treatment requires the participation of a wide range of doctors, including a pediatric surgeon.

Introduction. A combination of two rare congenital lung diseases - congenital cystic-adenomatous malformation of the lower lobe of the left lung and intralobar sequestration of the lung- is an extremely rare pathology in medical practice.Material and methods. The article describes a case of successful treatment of an 8-year-old child with cystic-adenomatous transformation of the lower lobe of the left lung in combination with intralobar sequestration. A child with chronic pneumonia was prescribed CT of his chest organs with intravenous contrast enhancement. A combination of cystic adenomatous malformation with intralobar sequestration of the lung was revealed at this examination. The sequestration zone was supplied with blood via the artery from the thoracic aorta, and the wide vein went towards the opposite hemithorax and flowed into the azygos vein. The patient had a planned surgery: left-sided lateral thoracotomy, lower lobectomy with ligation of additional vessels.Results. The early postoperative period was uneventful. Next year, there were no exacerbations of pneumonia. The child considers himself healthy. The histological report No. 31568 - 31577 confirmed type II cystic adenomatous malformation with sequestration of the lung.Conclusion. Modern diagnostic tools allow to put a correct diagnosis at the preoperative stage. In the described case, possible intraoperative complications were avoided because surgeons knew specific blood supply in the diseased area before surgery.

Introduction. Inflammatory myofibroblastic tumor (IMT) is a rare volumetric neoplasm in the childhood which originates from the mesodermal tissue , and by the classification of soft tissue tumors refers to the tumors with intermediate biological potential.Purpose. To present a case of rare volumetric formation in the lungs and mediastinum in children.Material and methods. The publication presents three clinical observations of children with IMT. In all three boys (aged 6, 8 and 15), tumors were localized in the right hemithorax: lower lobe of the lung (two children), upper anterior mediastinum (one) without a reliable organ accessory.Results. There were no specific clinical symptoms of the disease. In two children, the volumetric formation was found accidentally: in one child, a rounded tumor above the liver was found during an ultrasound examination of the abdomen; in the other one, during chest X-ray prophylactic examination. Only in one case, the lung tumor caused respiratory failure during exercise due to the complete atelectasis of the lower lobe and emphysema of the middle lobe which was caused by the growth of the tumor from the parenchyma of the lower lobe into the lumen of the lower lobe and intermediate bronchi. There were no significant shifts in clinical and biochemical blood tests. Cancer markers were negative. Surgery was indicated because of the volume formation topography which was confirmed by the multispiral computed tomography with vascular contrast and fibrobronchoscopy. Surgical volume – thoracotomy, lobtumorectomy (1 child); thoracotomy, pulmonotomy, tumorectomy (1 child); thoracoscopy, removal of the mediastinal tumor (1 child). The most technically difficult was mobilization and removal of the mediastinal tumor when it was separated from the superior vena cava and in the chest aperture where it was intimately fused with the brachiocephalic vein. The postoperative period was without complications. All children recovered.Conclusion. IMT of the thoracic organs is not a rare case. It is not possible to reliably verify the nature of the tumor process in the preoperative period. Surgical treatment is radical and, in some cases, endovideotechnologies may be applied.