Chylothorax in children is a fairly rare but at the same time serious pathology. Accumulation of a large amount of fluid in the pleural cavity leads to the development of respiratory, cardiovascular failure, and even death. In some children, this process can be initiated even before birth. The main components in the treatment of chylothorax are as follows: conservative measures aimed at reducing the amount of chyle, paracentesis, and drainage of the pleural cavity, mini-invasive surgery. To date, universal approaches to the management of patients with chylothorax have not been fully developed, there are no common diagnostic algorithms, terms, and optimal treatment tactics. There are only a few publications on this issue in literature, which are descriptive in nature and based on a small number of observations. The low prevalence of chylothorax in newborn infants, different etiology, various pathogenetic mechanisms of the disease make it difficult to conduct large-scale randomized trials in this area that would fully meet the modern requirements of evidence-based medicine. In this article, the authors demonstrate a multidisciplinary approach to treating a child with congenital chylothorax.

The pathology of the esophagus is diverse, therefore, disorders of the structural and functional state of the esophagus require different approaches both in the diagnosis of its pathology and in treatment. The review presents data on innovative diagnostic methods for the pathology of the cardio-esophageal transition in pediatric patients. The methods used were literature search in the databases PubMed, Medlit, RSCI, Scopus, Web of Science, EMBASE. Modern ideas about the neurophysiology of the gastroesophageal transition, the mechanisms of its antireflux function, and the pathogenesis of various pathologies of this anatomical localization, mainly gastroesophageal reflux disease (GERD), are described in both infants and school children. The features of the clinical picture of GERD depending on the age of the patient and the nature of the reflux agent are presented. The phenotypes of reflux disease are determined. The characteristics and modifications of existing original methods for studying the cardio-esophageal transition (both their advantages and disadvantages) are described in detail. The approaches to the possible optimization of management of this group of patients are proposed.

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.

The aim of the study is to demonstrate a differentiated approach to recurrent cryptorchidism treatment. Materials and methods. Over the past five years (since 2015), the staff of the Department of Pediatric Surgery of A.I. Evdokimov Moscow State University of Medicine and Dentistry, performed surgical treatment of 20 children aged 2-17 years with recurrent cryptorchidism (22 testicles). Relapse of cryptorchidism on one side was diagnosed in 18 patients. Two patients had a bilateral cryptorchidism recurrence, these children had a combined pathology in the form of Prader-Willi syndrome. In 3 children, surgical treatment at their place of residence was performed two or more times. As a preoperative preparation to increase the elasticity of blood vessels and to lengthen them, a course of human chorionic gonadotropin (hCG) hormone therapy was carried out according to the scheme. The exception was children over the age of 6-7 as administration of hCG at this age can provoke an earlier onset of puberty. Intraoperatively, in 15 children, the testicle was fixed in the scrotum according to the method of Shemaker, Herzen, and others. In 5 children with abdominal cryptorchidism, the testicle was not descended into the scrotum and was fixed in the inguinal canal due to a deficiency in the length of the spermatic cord (SC). On examination, a testicle in the middle or lower third of the inguinal canal was found in 10 patients, at the root of the scrotum - in 7. In 5 patients, the testicle was not detected. The average period between the first and repeated surgery was 3 years (from 4 months to 8 years). Upon admission, all patients underwent a clinical examination, ultrasound examination of the inguinal canals, and a study of the hormonal profile if indicated. Results. After revision of the inguinal canal, 17 testicles were successfully re-descended using the Shemaker technique. Of these, 16 testicles were fixed in the scrotum, 1 testicle - at the root of the scrotum. During the second operation, the vaginal process of the peritoneum was found in 7 children. Laparoscopically-assisted orchipexy was performed in 3 patients. Orchiectomy was performed in 5 cases due to testicular atrophy. The duration of the surgery was 55-120 minutes. There was no intraoperative blood loss. In the long-term postoperative period (after a year or more), postoperative testicular atrophy was not detected.