Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care

BACKGROUND: Sublobar lung resections in children include wedge (nonanatomic) resection and anatomic segmentectomy. Segmentectomy is used less frequently due to its technical complexity and the lack of objective patient selection criteria. This study aims to address this gap. The authors evaluated whether patient-specific 3D models can standardize preoperative anatomical assessment and thereby support selection of the optimal extent of resection in pediatric patients.

AIM: This study aimed to determine the impact of preoperative 3D modeling on surgical strategy and outcomes in minimally invasive lung resections in children and to identify anatomical and clinical predictors of the extent of resection.

METHODS: The study included 32 children (0–17 years) who underwent minimally invasive lung resection for congenital malformations or benign neoplasms (2020–2025). Patients were divided into a 3D modeling group (n = 16) and a standard computed tomography–based planning group (n = 16). Outcomes assessed included type of resection, complications, operative time, and concordance between planned and performed resection. Stepwise logistic regression was used to identify predictors of the extent of resection. In an additional analysis, patients were stratified by type of resection (wedge resection, segmentectomy, lobectomy). Quantitative parameters derived from 3D models—such as lesion-to-lobe volume ratio, zoning, and number of involved segments—were used to refine surgical planning algorithms.

RESULTS: 3D-based planning significantly increased the likelihood of performing segmentectomy (odds ratio ≈ 25; p = 0.001), while maintaining high concordance between planned and performed procedures without increasing complication rates. The most significant quantitative predictor of resection extent was the lesion-to-lobe volume ratio (optimal threshold 0.205; AUC = 0.922). The type of resection was also associated with age, number of affected segments, and anatomical location.

CONCLUSION: 3D modeling facilitated more frequent use of segmentectomy without increasing complications. The lesion-to-lobe volume ratio and anatomical factors may be used to guide selection of resection type. Incorporation of quantitative 3D parameters may improve the quality of preoperative planning in pediatric lung resections.

BACKGROUND: Vesicoureteral reflux is one of the most important risk factors for the development of urinary tract infections in children, leading to renal parenchymal injury. Assessment of the severity of vesicoureteral reflux based on imaging modalities does not always correlate with the reflux grade, which complicates the selection of patient management strategies.

AIM: The work aimed to evaluate the feasibility of using cluster analysis for stratification of the degree of structural and kidney function damage in children with vesicoureteral reflux based on imaging data.

METHODS: The study included 101 patients (143 renal units) aged 1 month to 7 years. Renal imaging methods were used, including Doppler ultrasound, static renal scintigraphy, and excretory urography. Clustering of the diagnostic dataset was performed using the TwoStep cluster method (SPSS Statistics, version 23.0; IBM, USA), which allows for simultaneous analysis of quantitative and qualitative variables. The optimal number of clusters was determined using the silhouette coefficient.

RESULTS: Cluster analysis identified four clusters of renal units (RUs): cluster 1, with no changes in renal structure, hemodynamics, or function (34 RUs); cluster 2, with minor changes and early signs of nephrosclerosis (55 RUs); cluster 3, with moderate impairment (45 RUs); and cluster 4, with pronounced changes in the renal parenchyma (9 RUs). A trend toward an increase in the number of renal units in clusters 3 and 4 with increasing grade of vesicoureteral reflux was observed: at grades 1–2, clusters 1 and 2 predominated; at grade 3, clusters 2 and 3; and at grades 4–5, cluster 4 predominated.

CONCLUSION: Cluster analysis of imaging data enabled stratification of the severity of kidney damage in children with vesicoureteral reflux using a multidimensional analytical approach.

BACKGROUND: The persistent number of postoperative complications in abdominal surgery, such as peritonitis and adhesive small bowel obstruction, necessitates the development of effective prophylactic means, specifically biodegradable polymeric coatings.

AIM: This study aimed to assess the dynamics of 4-hydroxy-L-proline in tissues in subcutaneous placement of biodegradable polymeric membranes in a chronic in vivo experiment.

METHODS: The study materials comprised specimens of our own three-layer biodegradable polymeric coatings (three-layer polymeric films consisting of sodium carboxymethylcellulose, sodium alginate, and polyvinylpyrrolidone, differing by the added fluoroquinolone antibiotic and radiopaque agents; 5 experimental groups) and the implantable biopolymeric membrane ElastoPOB. Rats were subcutaneously implanted with these products. Animals were euthanized at different time points (days 7, 14, and 28), after which the concentration of 4-hydroxy-L-proline in the periprosthetic capsules was assessed according to the developed methodology.

RESULTS: The lowest 4-hydroxy-L-proline content at all observation time points (days 7, 14, and 28) was observed in group 1, whereas the maximum values were observed in group 4, especially on days 14 and 28. Intragroup analysis showed a significant increase in hydroxyproline levels in group 4 between day 7 and subsequent time points. The 4-hydroxy-L-proline content in group 1 was more than two-fold lower compared to control group 6 at all time points. The most pronounced hydroxyproline production was observed when examining specimens from group 4 at all time points. This indicates that the addition of levofloxacin and iohexol initiates collagenogenesis to a greater extent.

CONCLUSION: Overall, the obtained results indicate the possibility of using such polymeric membranes in intestinal surgery, namely for the prevention of intestinal anastomotic leakage as a mechanical means of covering the suture line and for performing barrier functions to prevent the development of adhesive small bowel obstruction.

BACKGROUND: Respiratory distress is a major critical condition in the neonatal period requiring management in the intensive care unit, while the volume and quality of therapeutic measures can have a significant impact on the outcome of the disease.

AIM: This study aimed to evaluate the effectiveness of intensive care interventions and to identify markers predicting the need for invasive mechanical ventilation in neonates with respiratory distress during the first day of life, depending on the underlying condition.

METHODS: This multicenter retrospective cohort study included data from 176 neonates. Inclusion criteria were 1) respiratory distress within the first 24 hours after birth and 2) requirement for any form of respiratory support. The median birth weight was 1605 [1065; 2180] g, and the median gestational age was 31.6 [29.0; 34.5] weeks.

RESULTS: The mortality rate was 3%. Invasive mechanical ventilation was required in 100 (55.6%) neonates; it was used in 100% of cases with meconium aspiration syndrome and in 68.8% and 81.5% of cases with infections specific to the perinatal period and asphyxia, respectively. The highest vasoactive–inotropic score was observed in neonates with infections specific to the perinatal period—2.5 [0.0; 10.0]—which was significant compared with neonates with neonatal respiratory distress syndrome and meconium aspiration syndrome (p = 0.046 and p = 0.046, respectively). The main predictors of the need for invasive mechanical ventilation were birth weight (cutoff 1395 g; sensitivity 88.8%, specificity 75.5%), gestational age (cutoff 30.55 weeks; sensitivity 84.4%, specificity 75.5%), Apgar score at 1 and 5 minutes (cutoff 5 and 6 points; sensitivity 82.2% and 84.4%, specificity 73.5% and 63.2%, respectively), and Silverman–Andersen score (cutoff 3 points; sensitivity 82%, specificity 64.4%).

CONCLUSION: Birth weight < 1395 g and gestational age < 30.5 weeks are the main predictors of the need for invasive mechanical ventilation during the first day of life in neonates with respiratory distress.

BACKGROUND: In recent years, minimally invasive gastrostomy using low-profile MIC-KEY gastrostomy tubes has been increasingly used to provide palliative care for children. Despite the advantages of minimally invasive gastrostomy placement, as with any surgical intervention, the rate of postoperative complications reaches 11.1%–46.9%. One of these complications is gastrostomy failure.

AIM: The work aimed to develop a method for preventing failure of minimally invasive gastrostomy in children receiving palliative care and to evaluate its effectiveness.

METHODS: From 2020 to 2024, 27 children with palliative status, body weight deficit, and indications for gastrostomy placement were admitted to the surgical department. At admission, all patients were assessed as being in severe condition. The cohort included 18 (66.7%) boys and 9 (33.3%) girls aged 1 month to 13 years. The inclusion criteria were children with palliative status and indications for gastrostomy placement. The study group included 16 children who underwent minimally invasive gastrostomy using the push technique with primary placement of a high-profile gastrostomy tube with external and internal retainers (MIC-KEY) in 2023–2024. After 6 months, the high-profile gastrostomy tube was replaced with a low-profile MIC-KEY gastrostomy tube of the required length and diameter. The control group included 11 children who underwent minimally invasive gastrostomy using the push technique with primary placement of a low-profile MIC-KEY tube in 2020–2022. In both groups, body weight and the length and diameter of the gastrostomy tract were measured at the time of gastrostomy placement and after 6 months.

RESULTS: In the study group, despite changes in gastrostomy tract parameters from baseline in some children (a decrease in length and an increase in diameter), no gastrostomy failure occurred, whereas in the control group, with similar parameter changes, the failure rate was 72.7%. The method of temporary external fixation of the low-profile gastrostomy tube allowed for a sufficiently long interval for delivery of an appropriately sized tube without gastrostomy failure. The use of an algorithm with primary placement of a high-profile gastrostomy tube followed by its planned replacement with a low-profile tube after 6 months in the formed gastrostomy tract may prevent gastrostomy failure and avoid financial losses.

CONCLUSION: The proposed algorithm for using MIC-KEY gastrostomy tubes for minimally invasive gastrostomy was found to be both effective and cost-efficient. The use of a technical approach with an elastic silicone tube eliminates play of the low-profile MIC-KEY gastrostomy tube and prevents gastrostomy failure.

In pediatric surgery, near-infrared fluorescence imaging using indocyanine green has become widespread. This report presents a new approach for intraoperative identification of extrahepatic bile duct anatomy during laparoscopic choledochal cyst resection and hepatoduodenostomy formation in a pediatric patient. A 10-month-old girl presented with episodes of restlessness accompanied by vomiting. On prenatal ultrasound, a cystic lesion was detected in the hepatic portal region, and its presence was subsequently confirmed on postnatal imaging. Contrast-enhanced computed tomography and magnetic resonance cholangiopancreatography revealed a Todani type Ib choledochal cyst measuring 2.2×1.6×1.6 cm. For intraoperative fluorescence navigation, indocyanine green (0.25 mg/kg) was administered intravenously 12 hours before surgery. The procedure consisted of laparoscopic cyst resection followed by hepatoduodenostomy creation. Operative time was 120 minutes. Fluorescence imaging clearly delineated the distal margin of the cyst within the pancreatic parenchyma and its proximal extent at the level of the common hepatic duct. Enteral feeding was initiated on postoperative day 2. No intraoperative complications occurred. Postoperatively, the patient showed improvement, with decreased bilirubin levels and liver enzyme activity. No evidence of anastomotic leakage was found during early follow-up. Hospital stay was 7 days. At 6 months of follow-up, the patient had no clinical or laboratory signs of obstructive jaundice or cholangitis. In conclusion, fluorescence imaging with indocyanine green is a safe and highly informative method for intraoperative identification and resection of a choledochal cyst.

A choledochal cyst is a rare congenital anomaly of the bile ducts. In recent years, surgical approaches to its treatment have evolved from laparotomy to laparoscopy and robot-assisted surgery. This article analyzes the clinical course of a 4-year-old girl diagnosed with a choledochal cyst. The patient’s main complaints were recurrent upper abdominal pain accompanied by a single episode of jaundice at age 3 years. At the time of admission, the patient’s symptom duration was 1.5 years. Preoperative evaluation included liver function tests, coagulation profile, ultrasound, and magnetic resonance cholangiopancreatography, which revealed a type I choledochal cyst measuring 27.3 mm in diameter. Robot-assisted choledochal cyst resection followed these principles: cyst dissection with clipping of the distal common hepatic duct, proximal cyst dissection with transverse transection at the level of the non-dilated common hepatic duct, and hepaticoduodenostomy creation. Operative time was 240 minutes: docking time, 20 minutes; console time, 220 minutes. Enteral nutrition was initiated on postoperative day 3, and full enteral nutrition was achieved on postoperative day 5. The child demonstrated successful postoperative recovery, with early transition to a full enteral diet and discharge for outpatient follow-up on postoperative day 7. At follow-up, the child had normal weight and height parameters, no pain, and normal bile duct diameter on liver ultrasound. Compared with laparoscopy, robot-assisted surgery for congenital choledochal cysts in children offers advantages including enhanced visualization and exceptional robotic instrument maneuverability, resulting in less tissue damage, greater precision in hepaticoduodenostomy creation, and faster patient recovery. This case demonstrates the potential of robot-assisted surgery for treating children with hepatobiliary pathology.

This commentary addresses the article by Kozlov Yu.A., Rozhanski A.P., Sapukhin E.V., Strashinsky A.S., Marchuk A.A., Ryakhina A.O., Semshchikova Yu.P., Makarochkina M.V., titled “Robot-Assisted Resection of a Common Bile Duct Cyst With Hepaticoduodenostomy in a Child: A Case Report,” published in the Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2026. Vol. 16, No. 1. P. 127–136. DOI: https://doi.org/10.17816/psaic1956. Based on the author’s own experience with similar laparoscopic procedures for choledochal cysts using hepaticoduodenostomy, a critical opinion is expressed regarding the appropriateness of this technique in children. Follow-up examinations revealed fasting bile accumulation in the stomach. Due to the impossibility of long-term outcome prediction with this procedure, the surgical team at the author’s clinic reverted to a Roux-en-Y loop.

In 2024, the Petrozavodsk University Publishing House issued a bibliographic index of the works of Professor Igor N. Grigovich. With the consent of the editors and with the support of the family members and colleagues of the outstanding pediatric surgeon, it was considered appropriate to present the introductory article to a wide audience of pediatric surgeons in the pages of a professional journal. Grigovich regarded Professor Girey A. Bairov as his teacher and implemented the principles of this scientific school at the Department of Pediatric Surgery of Petrozavodsk State University, where he worked for 40 years. Among Grigovich’s extensive scientific legacy, the monograph Rare Surgical Diseases of the Digestive Tract in Children stands out as a work that has no analogs to date. In the monograph Algorithms in Emergency Pediatric Surgery, which became a reference book for pediatric surgeons, all chapters reflect advanced national and foreign experience. For more than 20 years, Grigovich was among the first in the country to study and generalize such a socially significant phenomenon as child abuse. Grigovich demonstrated high professionalism both in the operating room and in the lecture hall. Communication with him inspired many students to choose the profession of a pediatric surgeon. This article describes not only the professional qualities and contribution of Grigovich to the development of national pediatric surgery but also his personality. Grigovich studied at medical universities in Leningrad and perhaps it was there, alongside his formal education, that he gained his first life experience of the Leningrad intelligentsia tradition. He developed this foundation further and raised it to an unparalleled height. The most accurate characterization of Grigovich’s personal qualities was given by one of his colleagues: “…a modest and intelligent aristocrat of pediatric surgery…”. He possessed literary talent; many of his articles and books represent an entire era in surgical literature and memoir writing. Grigovich actively participated in public life, appreciated music, poetry, and prose, and valued friendly communication with many people. All this reflects the multifaceted nature and magnitude of his personality and talent. The memory of Grigovich is enshrined both in his extensive creative legacy and in the name of the I.N. Grigovich Republican Children’s Hospital, an institution he helped establish and where he worked for many years.