Vol 7, No 4 (2017)

The article is devoted to the fi Russian United Meeting of the Sections of Surgery and Pediatric Diseases of the VIII Congress of the Russian Doctors in memory of N. I. Pirogov held in 1902 discussing the issues of pediatric orthopedics, treatment of appendicitis and angiomas in children. The outstanding role of the head physician of St. Olga’s pediatric hospital, fi private-docent in pediatric surgery of theMoscowImperialUniversity(1893-1896) and founder of pediatric surgery as a science Leontiy Petrovich Aleksandrov is stressed. A brief characteristic of the surgeons and pediatric doctors participating in the scientifi discussion such as E. V. Pavlov, V. I. Razumovsky, I. A. Praxin, K. H. Horn, T. P. Krasnobaev, A. A. Bobrov, A. A. Kisel, V. G. Tsege-vonManteuff and N. S. Korsakov is provided.

A case of successful chyloperitoneum therapy in a 5-month-old infant was analyzed. Clinical and laboratory picture of pathology, visual morphological changes in the abdomen are described and the peritoneal effusion using objective markers is evaluated. The complex therapy uses modern methods such as intestinal unloading, complete parenteral nutrition, correction of electrolyte and protein balance, octreotide (somatostatin synthetic analogue).

The surgical treatment results for 27 patients with omphalocele taken to the Ivan-Matryona Children’sClinicalHospitalinIrkutskfrom 2002 to 2017 were submitted. The study methodology consists in the comparative analysis of effectiveness of different surgical technologies including one-step (17 patients) and stage (10 patients) abdominal wall defect repair. ALV duration, time of transition to complete parenteral nutrition, hospital stay duration, gastroesophageal reflux occurrence, ventral hernia and lethality are used as comparison criteria. There are no significant differences between the groups of patients randomized by gestational age, afterbirth age and body weight. Significant disturbances by extubation period were stated (1.76 vs 5.4 days, p=0.0001).

A significant decreased transition time to complete enteral nutrition (20.53 vs 27.60 days, p=0.020) was observed in the group of one-stage defect closure. Fundoplication frequency was higher in those patients who underwent multistage surgeries (11.76% vs 30%, p=0.326). Ventral hernia formation frequency was also higher in the group of stage closure (8.57% vs 30%, p=0.128). Study results reveal the advantage of one-stage abdominal repair in surgical treatment of newborns with omphalocele.

Materials and methods: 472 case histories of patients with testicular torsion were analyzed. In 24 cases, there was a bilateral asynchronous testicular torsion. Preventive fixation of the contralateral gonad followed the first episode of torsion as per the original method.

Results: a more favourable course of contralateral testicular torsion was demonstrated in spite of the similar torsion degree due to the fastest appealibility as parents and patients are well informed. It is shown that the contralateral testicular fixation has no complications being an effective means of asynchronous torsion prevention.

Conclusion: preventive contralateral orchiopexy is indicated to all patients with testicular torsion as it effectively prevents the asynchronous torsion and has no complications.

In recent years, the number of patients with foreign bodies of the alimentary tract, which require hospital treatment, has increased signifi . In some cases, complications occur leading to fatal outcomes or requiring complex reconstructive surgeries. Purpose: to improve the results of treatment of patients with foreign bodies of the alimentary tract by developing diagnostic and therapeutic tactics.

Materials and methods: The subject of the study was 323 patients who were on treatment at the CSTO in Rostov-on-Don between 2010 and 2016. The main attention was paid to aggressive foreign bodies: alkaline batteries and magnets.

Results: Aggressive foreign bodies were removed as soon as possible under the FGDs. Alkaline batteries, if swallowed, caused electrochemical burns. The first degree burn was found in 12 patients (3.7%), in grade II in 8 patients (2.5%), in grade III in 10 (3.1%), in grade IV in 1 patient (0.3%). For foreign magnetic bodies, double-barreled ileostoma was excreted in 5 cases (1.5%), resection of the intestinal loops was performed in 3 cases (0.93%) with end-to-end anastomosis applied.

Conclusions: If aggressive foreign bodies are detected in the esophagus and stomach, the latter must be removed as soon as possible under the FGDs. Severe burns of the esophagus III–IV require treatment with the placement of a probe for enteral nutrition and the introduction of drugs through the mouth into the esophagus that accelerate regeneration. When identifying clinical and radiological predictors of peritoneal complications, it is necessary to move to active surgical tactics.

The work analyzes the results obtained during the treatment of 285 children with congenital hydronephrosis aged 3 months to 17 years. Hynes-Andersen caliceal plasty was performed in 200 patients, nephrectomy – in 56 patients and internal renal drainage (as the main method of treatment) – in 17 patients. 192 resected caliceal segments underwent a histological examination.

In 26 preparations (13.5%) of young children only inflammatory changes were discovered. This led to surveillance review of patients with hydronephrosis of all grades in young patients using small invasive endoscopic interventions aimed at the restoration of caliceal urodynamics. We used endoscopic appliances, urethral catheters and stents for preliminary bougienage and drainage of an affected organ with the examination of preliminary results.

Introduction. The survival rate of children with chronic intestinal failure (IF), a special case of which is short bowel syndrome (SBS), is increasing nowadays. The experience of a 4-stage system of care for children with chronic intestinal failure (IF) and short bowel syndrome (SBS) developed in Children’sCityHospital named after N. F. Filatov is presented. 

Objectives. The aim was to identify prognostic markers for intestinal adaptation (IA) in children with an extended (more than50 cm) resections of the intestine.

 Methods. The outcomes were evaluated in 75 children one year after resection and its relations to the preserved small intestine length, extension and cause of resection.

 Results. Survival of children after 1 and 3 years was 87–89%. The proportion of those who have reached IA was higher (38%) in children with more than60 cm remaining intestine in comparing to those who have less than30 cm and 30–60 cm of intestine (14.5–15%) (p <0.05. After combined resections of intestine and colon more children were dependent on PN (90%) then after intestinal (46%) or colon resections (41%) (p <0.05). Children with acute strangulation and intestinal malformations better achieved IA (50% and 44%) compared with those who underwent resection for necrotizing enterocolitis or diff intestinal neuroand myopathies (0% of IA by 1 year after resection) (р<0,05). By 1 year of following up (N=75) 25% achieved IA, 46% remained dependent on the PN, by 3 years (N=32) 44% achieved IA, 39% were dependent on PN. Conclusion. The remaining intestinal length, extension of resection and the underlying disease infl on 1-year prognosis in children with intestinal resections. Increasing in those who have achieved AI in the course of time allows to conclude that children with IF and SBS have a rehabilitation potential and the developed RP is eff in such patients.

Based on the data obtained during foreign studies, the article analyses the approaches and recommendations related to the safe and necessary resection width of soft-tissue sarcomas. Currently, there are no distinct criteria that can help a surgeon to evaluate the proper volume of resected tissue in a minimum risk of a local recurrence and provide for an adequate functional result considering the subsequent reconstructive and plastic methods.

Literature review is devoted to one of the most widely spread urogenital abnormalities such as megaloureter and to modern approaches to the methods of diagnosis and treatment of the pathology in infants, in particular. Domestic and foreign scientific literature was analyzed.