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Tendencies in neonatal surgery research are presented. Based on 187 cases, indications to preventive intestinal stomas creation in the newborns and also time of their closure are regarded. Surgical correction of malformation or treatment of acute process in the abdominal organs with intestinal stoma closing is finished to month 2-3 of childs life. The developed differential-diagnostic criteria of functional and organic lesion of ureteropelvic and ureterovesicular segments based on diuretic sonography permitted one to reveal early age pathology of urinary system and to correct it with surgical methods. The developed algorithm of diagnosis and treatment of newborns with eruct syndrome permits one to determine indications to surgery in 10% infants with gastroesophageal reflux.

The authors examined and treated 52 newborn babies and infants with Hirschsprung's disease. The total form was encountered in 25%, the subtotal in 23.1%, the rectosigmoid in 36.5%, the rectal in 9.6%, and the supraanal in 5.8% of cases. The clinical picture was characterized by retention of meconium (94.2%), regurgitation or vomiting (75%), abdominal distention (100%). Irrigography with calculation of the rectosigmoid ratio was conducted in 35 children, histochemical examination in 46, and histological examination in 38 children. Twenty-four (68.5%) children had the third phase of disturbed proportion of the intestinal bacteria with clinical manifestations of enterocolitis. Emergency decompression of the intestine for low acute intestinal obstruction was carried out in 27 newborn babies. Twenty children were subjected to radical surgery in the first 2-4 months of life. The choice of the operative method was guided by the form of the disease and the length of the aganglionic zone.

141 newborn with purulent surgical infection were under observation. In 73 the inflammatory process was not induced by Pseudomonas aeruginosa in 68 the infection was caused by the blue pus bacillus. Bacteriological and immunological examination was conducted, including that with the use of enzyme immunoassay, to monitor the optical density of anti-pyocyanea antibodies during the course of the disease. It was found that the serum of a healthy newborn baby contains antibodies to Pseudomonas pyocyanea and did no differ from that of healthy older children in the level of anti-pyocyanea antibodies. The increase of the level of anti-pyocyanea antibodies in response to infection with Pseudomonas pyocyanea is twice less in newborns than older children with this infection. The use of specific plasma is much more effective than the administration of nonhyperimmune plasma. The efficacy of treatment with anti-pyocyanea plasma is determined by the level of anti-pyocyanea antibodies produced in the patient as a result of plasmatherapy rather than the volume of the dose given for the course.

In 35 newborns and children at the age under 4 mos with Hirschsprung's disease, colonic microflora was studied. Disbacteriosis at phase 1 was revealed in 1 (2.9%) child, at phase 2--in 7 (20%), at phase 3--in 27 (77.1%). In acute form of Hirschsprung's disease, in 68.5% of cases, disbacteriosis at phase 3 with the signs of enterocolitis causing acute ileus was revealed. Intestinal perforation against background of enterocolitis developed in 8 cases.

The authors had 52 newborns and infants with Hirschsprung's disease under observation. The activity of tissue acetylcholinesterase (ASE) was tested by the Karnovsky-Ruts method in 35 cases. ACE activity was evaluated according to 5 types and a specific "newborn" type was set apart. A positive (42.9%) and weakly positive (28.6%) types of ACE activity prevailed in the neonatal period. Test for ACE activity performed in dynamics in 15 newborns showed gradual accumulation of ACE in the mucosa of the large intestine. In 6 (17.1%) babies a false-negative ACE activity was found, which was encountered in hypogangliosis and long-segmental forms. False-positive reactions were not encountered. Histochemical diagnosis made it possible to recognise Hirschprung's disease of the newborn in 82.9% of cases.

Twenty two newborns and 10 young children with acute form of the Hirschsprung's disease were observed. In 1/3 of the patients, the Hirschsprung's disease was associated with congenital anomalies. The patients were treated by means of the performance of histochemical (15 cases), histologic (23) investigations and irrigography (19). A complex of the diagnostic measures used permitted to establish a reliable diagnosis.

39 newborns with an acute form of Hirschsprung's disease were under observation: rectal form 18%, recto-sigmoid 28.2%, subtotal 25.6%, total 28.2%. Clinical manifestations appeared soon after the birth and were characterized by the impediment of the meconium discharge, vomiting or eructations, abdominal swelling. The evaluation of the validity of histochemical and histological diagnostic methods in infants and morphologic description of the tissue acetylcholinesterase activity are presented. Hypoganglionic form of the disease was found in 4 cases. Clinical and morphologic picture of the hypogangliosis in newborns is described.

On the basis of their clinical experience the authors consider the main cause of gastro-esophageal reflux-esophagitis in children up to three months of age to be dysfunction of the autonomic nervous system against the background of underdeveloped zone of cardia. Maximum conservative treatment is recommended and a complex of pathogenetic therapeutic measures is proposed. The remote results confirm the rightness of the tactics proposed.

Seventy children with obstructive cholangopathy were examined in the clinic in the recent 15 years: 48 children had "cholangiopathy of the newborn" and 22 had a cyst of the common bile duct. A total of 44 operations were carried out: on 22 infants with cholangiopathy of the newborn and on 22 with cysts of the common bile duct. The most informative methods for the diagnosis of cholangiopathy in children are as follows: ultrasonic scanning, laparoscopy, ERCPG, aspiration biopsy of the liver, and aspiration cholangiography under control of a laparoscope. Kasai's operation is the operation of choice in obstructive cholangiopathy of the newborn. The operation of choice in cysts of the common bile duct is cystectomy with choledocho- or hepaticojejunostomy on an isolated loop after Roux.

Electromyography was used to examine the external rectal sphincter in 44 neonate patients and in 24 patients aged 2 months to 3 years with different anorectal developmental abnormalities. The same examinations were performed in the control groups: in 30 normal neonates, in 15 premature (grade I-II) neonates, and in 64 normal children aged 1 to 14 years. According to the data of comparative morphometry, a study was made of the autopsy material of the external rectal sphincter from 15 full-term stillborns and 16 premature (grade I-II) stillborns as well as from 11 infants with anorectal developmental abnormalities who died within the first days after birth without any surgical intervention. It is concluded that in patients with anorectal developmental abnormalities, the contractility of the external rectal sphincter is considerably lower than in the respective weight groups of normal children and that such patients demonstrated the lack of the normal time-course of changes in its increase with age.

Resection of the intestine for different diseases was made in 136 children of the first month of life (side-to-side anastomosis was fulfilled in 88 of them). Of 250 children aged from 1 month to 14 years side-to-side anastomoses were created in 22. The analysis of the course of the postoperative period, remote results of the treatment and experimental data method enabled the authors to conclude that complications associated directly with side-to-side anastomosis result from errors in the technique of its creation.