Vol 9, No 2 (2019)

Cover Page

Full Issue


Research Work in the Russian Association of Pediatric Surgeons: Principal Outcomes and Establishment of a Research Council

Morozov D.A.


Introduction. Development of pediatric surgical science is an essential part of preservation and strengthening of the entire speciality and ‘pediatric surgical sovereignty’. A report entitled The State and Perspectives of Research Studies in Pediatric Surgery was presented in 2015.

Purpose. To analyze the status of principal outcomes of research work done by the Russian Association of Pediatric Surgeons in 2015–2018 and justify the necessity in a coordinating institution (Research Council of the Association).

Material and methods. Data obtained from 32 academic teams of the country such as department staff, post-graduate and post-doctoral students, Ph. D. and doctoral papers, publication in journals (including Scopus indexed and foreign journals), patents, scientific papers in Russia and abroad, grants, multicenter and international scientific programs).

Results. The potential was found to be high: 15 doctoral papers and 64 Ph. D. papers, over 1,200 scientific publications in Russian journals (14.4% in Scopus) and 67 full-text articles published abroad, over 1,600 scientific papers in Russia and 235 papers on foreign recognized forums. The Research Council of the Russian Association of Pediatric Surgeons has been reconstructed since 2019; initiated coordination of work within the framework of task and expert groups.

Conclusion. High potential should be used in the new strategy development: planning of scientific efforts in the country, its quality control, support of multi-center studies and cluster functioning, strengthening of fundamental science, full integration into the world scientific space.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2019;9(2):8-19
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Case reports

Intussusception of the bowel in a child malrotation

Svarich V.G., Lisitsyn D.A., Islentiev R.N., Perevozchikov E.G., Kagantsov I.M.


Introduction. During treatment of intussusception, the greatest difficulties occur when the disease is combined with other disorders and malformations.

Materials and methods. Clinical observation on treatment in a child with bowel intussusception and malformation is presented. The course of the disease was rather difficult for exact diagnosis. Control of conservative disinvagination was inconclusive. During a surgery, a malrotation was detected. This affected the diagnostic and therapeutic tactics. The second component of obstruction represented by the abdominal adhesive process was also found and removed.

Results. The conducted surgery allowed to confirm the effectiveness of the given conservative treatment, detect the concurrent pathology and remove the mechanical obstruction.

Conclusion. The presented observation clearly demonstrates difficulties in exact diagnosis and control of conservative disinvaginaton when intestinal invagination is combined with congenital malrotation. As a result, the outcome of conservative disinvaginaton could be significantly controlled, commissure or the second component of invagination was removed and an exact diagnosis was made.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2019;9(2):73-78
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Laparoscopic removal of an isolated duplication intenstinal cyst in a child

Koinov Y.Y., Gramzin A.V., Pavlushin P.M., Krivosheenko N.V., Chikinev Y.V.


A rare clinical case of an isolated intestinal duplication cyst in a 6-year-old child with unclear clinical picture of alimentary dyspepsia is described in the work. Surgical cyst laparoscopic removal resulted in convalescence. The article presents review of literature devoted to treatment of this pathology.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2019;9(2):79-83
pages 79-83 views

Surgical aspects of treating a child with histiocytosis of the lungs

Stalmakhovich V.N., Sapukhin E.V., Li I.B., Kaygorodova I.N., Dmitrienko A.P., Ursulenko E.V., Dyukov A.A.


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.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2019;9(2):84-90
pages 84-90 views

Complications of solid pseudopapillary pancreatic tumors

Tursunov K.T., Myrzakhmet S.A., Yakovidi-Koneva A.S., Mamyrasyl A.M., Abdrakhmanov D.S.


A solid pseudopapillary tumor of the pancreas is a very rare tumor of unclear histogenesis. Its frequency is 1–2% of the total number of exocrine tumors and about 5% of cystic tumors of the pancreas. Only 130 mainly publications related to separate clinical observations of this pathology are available in medical literature. We found no works describing the complicated course of a solid pseudopapillary tumor of the pancreas in children. The article describes a clinical case with a probable complicated, life threatening course of a solid pseudopapillary pancreatic tumor in children due to peptic erosion of tissues and vessels with capsular rapture.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2019;9(2):91-96
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Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2019;9(2):121-123
pages 121-123 views


К 50-летию Шерали Рахмоновича Султонова


Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2019;9(2):124-125
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Original Study Articles

Endosurgical treatment of premature infants with inguinal hernias

Kozlov Y.A., Krasnov P.A., Baradieva P.J., Zvonkov D.A., Ochirov C.B.


Introduction. An inguinal hernia is a serious surgical issue in premature infants as this is one of the reasons leading to increased lethality and longer treatment duration. The purpose of the study was to estimate the possibility and effectiveness of endosurgical treatment of inguinal hernias in premature infants.

Material and methods. 705 patients with inguinal hernias aged 0–3 months have been treated at the Center for Surgery of Newborns in Irkutsk during the last 15 years from January 2004 to December 2018. The gestational age of 51 infants was less than 37 weeks. All the patients underwent laparoscopic hernia repair with extracorporeal ligation. During the final stage of the study, demographic data, intra- and postoperative results were compared.

Results. The experience of treating 51 premature infants with inguinal hernias was analyzed. The children were distributed into groups as follows: 1,500–2,500 g for 35 patients, 1,000–1,500 g for 14 patients, less than 1,000 g for 2 patients. The average weight and age was 1,870 g/36.9 days for children with low body weight, 1148.3 g/48.9 days for children with very low body weight and 810 g/69 days for children with extremely low body weight. The average surgery duration ranged from 28.8 min to 35 min. According to the results of the study, increased gestational age and body weight decreases the risk of postoperative apnea from 100% to 11.8%.

Conclusion. It must be noted that minimally invasive surgeries are less traumatic and effective interventions when treating premature infants with inguinal hernias. In infants with premature hernias, a surgery is always associated with the risk of postoperative apnea and AVL dependent on the body weight and gestational age.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2019;9(2):20-28
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Peculiarities of surgical treatment of children with ulcerous necrotic enterocolitis

Babich I.I., Melnikov Y.N.


Ulcerous necrotic enterocolitis is the most severe disease in newborns. In this disorder, lethality reaches 45% in average. It significantly increases when gestational age is reduced reaching 100% and results in peritonitis in children with extremely low body weight (less than 1,000 g). Though surgeons agree upon indications to surgery, approach to the management and surgical treatment of patients with progressive necrotic enterocolitis is still rather contradictory today.

Purpose: to improve treatment outcomes in patients with ulcerous necrotic enterocolitits developing the determination method of local necrosis area and level of intestinal resection.

Materials and methods: the work was done at the clinics of pediatric surgery of Rostov State Medical University based on the Regional Children’s Clinical Hospital where 58 patients underwent treatment for ulcerous necrotic enterocolitits from 2010 to 2017. In all cases, viability of the entodermal canal was determined using our developed determination method of local necrosis area and level of intestinal resection. Decision on Russian grant dated April 5, 2019 based on application No. 2017143990 dated December 14, 2017.

Results: the developed determination method of local necrosis area timely determines necrosis of the intestinal wall at the stage of preperforation until the signs of peritonitis when the intestine is resected with enteroanastamosis. This method also determines the optimal level of intestinal resection within healthy tissues.

Conclusions: the method improves the outcomes of surgical treatment and quality of life of patients suffering from this disease and reduces the time of rehabilitation.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2019;9(2):29-34
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Extracorporeal hemocorrection in treatment of meningococcal septic shock in children

Serednyakov K.V., Lobzin Y.V.


Purpose: to estimate the effectiveness of extracorporeal hemocorrection in treatment of refractory meningococcal septic shock in children.

Methods: patients with generalized form of meningococcal infection, multi-organ system failure and refractory septic shock admitted to the resuscitation department of Children’s Clinical Research Center for Infectious Diseases of the Federal Medical and Biological Agency of Russia underwent extracorporeal hemocorrection (polymyxin adsorption, continuous veno-venous hemofiltration, continuous veno-venous hemodiafiltration). MultiFiltrate apparatus was used (Fresenius Medical Care, Germany).

Results: application of extracorporeal hemocorrection technique in the therapy of refractory meningococcal septic shock reduced the mortality from 44.4% to 25%.

Conclusion: effectiveness of extracorporeal hemocorrection when treating patients with refractory meningococcal septic shock is established. A small number of examined patients is a limitation of the study.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2019;9(2):35-40
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Comparative analysis of using balanced and normal saline solutions as an intraoperative therapy in newborns

Nasser M.M., Kucherov Y.I., Zhirkova Y.V.


The purpose of the study was to compare the values of acid base balance, electrolytic and hemodynamic parameters in newborns depending on the composition of intraoperative infusion therapy. The study was done in 60 newborns who were given Staerofundin ISO basic infusion (10 ml/kg/hour) in group I (n=31) and normal saline solution in group II (n=29) during a surgery.

Results: following the surgery, no differences in pH values were observed between the groups, moderate metabolic disturbances were found. In Group II, levels of bicarbonates decreased from 22.2 to 20.5 (р=0.047). By the end of the surgery, normal electrolyte composition was found more frequently in group I (29%) as compared to group II (20%). Hypopotassemia (34.5% and 22.6%), hyperpotassemia (44.8% and 25.8%) and hyperchloremia (63% and 51.7%) were found more frequently in group II as compared to group I, respectively. To achieve the target level of blood pressure, the bolus was injected to 29% (n=9) of children from group I and 17.2% (n=5) of children from group II. Adrenergic agonists were used in 42% of children from group I and 27.6% of children from group II (р=0,038). There were no differences between the cumulative doses.

Conclusion. Sterofundin and normal saline solution demonstrated equivalent values of effectiveness and produced similar effect on the values of acid base balance, electrolytic and hemodynamic parameters during the intraoperative period in newborns.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2019;9(2):41-49
pages 41-49 views

A criterion of choice for surgical intervention in children with appendicular peritontis

Sleptsov A.A., Savina V.A., Varfolomeev A.R., Nikolaev V.N., Petukhov E.I., Zuev A.L., Erdyneev T.E.


Purpose: to select the surgical approach in appendicular peritonitis using the peritonitis index and laparoscopic intraoperative assessment of abdominal inflammation intensity.

Methods and materials: experience of treating 186 patients with appendicular peritonitis is presented. Retrospective analysis of medical records of 186 patients with complicated appendicitis in 2011–2014 was performed. It was accompanied by prospective analysis substantiating the criteria for laparoscopic intraoperative assessment of the intensity of abdominal inflammatory changes in 2015 to 2018.

Results. In our study, there were 98 cases (52.6%) of local peritonitis in the total structure of peritonitis (186 cases). 57 cases (30.6%) of diffuse peritonitis were observed. Among patients with acute appendicitis (1863 cases) during the examined period, local peritonitis was found in 5.2% of patients, diffuse peritonitis – in 3.05% of patients.

Conclusion: criteria assessing the intraoperative severity of peritonitis enabled to decrease the rate of laparotomy from 9.1% to 6.45%.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2019;9(2):50-56
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Tolerability and safety of strong opioid analgesics in children and adolescents with incurable oncological diseases

Pshonkin A.V., Serkova I.V., Zhukov N.V., Shukin V.V., Polevichenko E.V., Spiridonova E.A.


Relevance. One of the basic tasks of palliative medical care is to control pain in an incurable patient. To administer strong opioid analgesics as basic pain management in terminal patients, a treating physician must understand the risk of opioid-related adverse effects. According to the World Health Organization, the occurrence of the pain syndrome and importance of correct analgesic therapy in children and adolescents with incurable oncological diseases are underestimated.

Purpose. To improve the quality of palliative medical care provided to children and adolescents with incurable oncological diseases.

Materials and methods. A retrospective and prospective study was carried out. 400 patients with incurable oncological diseases aged 0 months to 20 years (median 9 years) were included into the study from June 2014 to December 2017, in particular, 235 boys and 165 girls (189 patients with extracranial solid tumors, 117 patients with CNS tumors and 94 patients with hemoblastoses). The study was approved by the Independent Ethics Committee and the Council of Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology (Protocol No. 5 dated May 21, 2013). Of 284 patients with the pain syndrome, 227 (80%) of children and adolescents aged 0–20 years (median 12 years) used strong opioid analgesics (morphine hydrochloride, morphine sulfate and transdermal therapeutic system with fentanyl) for pain relief. Their dosage was set in accordance with WHO 2012 recommendations related to the management of persisting pain syndrome in children. To estimate the severity of adverse events (AE) when strong opioids were used (nausea, vomiting, constipation, skin itching, urinary retention and respiratory failure), the CTCAE (Common Terminology Criteria for Adverse Events) displays Grades 1 through 5. Opioid-induced hyperalgesia and opioid-induced neurotoxicity were estimated by clinical signs (absence or presence of a symptom).

Results. Of 227 patients, 59 (26%) patients had AE associated with the administration of strong opioid analgesics: 11.5% of cases for constipation, 7.5% cases for nausea, 4% of cases for pruritus, 2.2% of cases for urinary retention, 0.44% of cases for opioid-induced hyperalgesia, 0.44% of cases for opioid-induced neurotoxicity. No respiratory failure was noted when strong opioid analgesics were used. In the majority of cases (95%), the registered AE were mild and required no termination of therapy with opioid analgesics. Of 284 patients, 281 (98.9%) underwent analgesic therapy with complete pain management.

Conclusion. Strong opioid analgesics are safe and effective in children and adolescents with incurable oncological diseases.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2019;9(2):57-66
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Morphological changes of the testes in patients operated on cryptorchidism

Soloviev A.E., Soloviev A.A., Kyarimov I.A.


Purpose: to study the morphological changes of testis in patients who had cryptorchidism in childhood.

Methods. The examination results of 9 patients who underwent treatment for cryptorchidism and presented with infertility within marriage when they were 24–30 y. o. were studied. Clinical examination, ultrasound imaging of the scrotum, complete spermograms, hormonal studies, open biopsy of the testis with subsequent pathomorphological assessment of biopsy specimens were carried out.

Results: observation of 9 patients with azoospermia who had undergone a course of conservative and surgical treatment for cryptorchidism when they were 4–14 years, resulted in testicular atrophy leading to the decrease in the tissue mass of the organ and high level of FSH.

Conclusion: hormonal tests, ultrasound examinations and pathomorphological studies enable to estimate the extent of epitheliospermatogenic layer involvement.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2019;9(2):67-72
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Role of an anesthesiologist in pediatric X-ray diagnostics

Iakovleva E.S., Lazarev V.V., Diordiev A.V.


Purpose: analysis of modern data devoted to the issue of stress-free and safe magnetic resonance imaging in children using both non-drug methods and different agents for anesthesia along with their delivery systems.

Discussion. It is difficult to complete MRI in younger children due to some reasons and possible development of stress. The technique often requires the presence of an anesthesiologist, especially if patients present with neurological pathology. The article describes how to deal with this problem to ensure safety and comfort during the procedure at the X-ray diagnostic department.

Conclusions: a broad spectrum of non-drug methods is available and successfully used today. Different types of sedation and anesthesia ensure safety and comfort of a patient who undergoes an examination at the X-ray diagnostic department.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2019;9(2):97-104
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Coccygeal cysts in children (clinic, diagnostic and surgical treatment)

Poverin G.V., Evdokimov A.N.


The problem of surgical treatment of children with a pilonidal cyst is presented. The history of studying and evolution of theories clarifying etiology and pathogenesis of this pathology by Russian and foreign scientists is covered. The diagnostics of a coccygeal cyst is described. The classification of a disease is presented; it determines the treatment tactics depending on the stage of the disease. Criteria of an ideal surgery are defined. Types of surgical treatment and their use depending on the complexity of fistulas are found. Modern mini-invasive interventions and their advantages in the treatment of pilonidal cysts are described in detail.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2019;9(2):105-120
pages 105-120 views

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