Vol 9, No 4 (2019)

Cover Page

Full Issue


Pediatric Surgery: History and Modernity (V Forum of Russian Pediatric Surgeons)

Rozinov V.M., Suvorov S.G., Gorbachev O.S., Petlakh V.I., Erokhina N.O.


The work summarizes the V Forum of pediatric surgeons of Russia, held in Ufa, September 3–5, 2019. For the first time, the annual largest scientific event of domestic pediatric surgeons was held outside the capital. The Forum was attended by over 600 delegates, including specialists from 10 foreign countries and representatives of all federal districts of the Russian Federation. The scientific program of the Forum was represented by symposia (14), round tables (4), the video session “How I Do It,” master classes (2) and a competition of young scientists. A workshop was held on topical issues of pediatric surgery. The report contains brief results of the analysis of the organization of the Forum and the scientific content of the reports.
Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2019;9(4):116-122
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Editorial a.



Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2019;9(4):135-136
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Stanislav Yakovlevich Doletsky – 100th Birth Anniversary

Volodko E.A., Sokolov Y.Y.


The article is dedicated to the memory of Stanislav Yakovlevich Doletsky, an outstanding pediatric surgeon, academician of the USSR Academy of Medical Sciences. The description of the life, creative, scientific and educational path of the creator of his own school of pediatric surgeons is presented. A characteristic of the main studies on the pathogenesis of congenital diseases of organs and systems from the perspective of a pediatric surgeon and pediatrician is given – the concept of growth imbalance and maturation dysfunction in newborns and infants. The main literary works are indicated.
Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2019;9(4):123-129
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Surgery lessons

Geldt V.G.


Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2019;9(4):130-132
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Stanislav Yakovlevich Doleckij…

Doleckaya L.


Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2019;9(4):133-134
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Original Study Articles

Social and economic aspects of treatment of the children with short bowel syndrome

Khasanov R.R., Gumerov A.A., Wessel L.M.


For many years, organizing and giving parenteral feeding, clinical manifestations of the underlying disease, use of costly drugs and complex expensive methods of examination and treatment have been associated with significant social and economic impact on the families with children suffering from short bowel syndrome. Allocation of resources among families with these children hasn’t been examined in Russia recently. Purpose. To estimate social and economic factors that influence the family with children affected by short bowel syndrome. Methods. Adult members of the families with the affected children born and living in Russia were questioned. 8 families were surveyed in 2014, 8 families – in 2019. Results. Complex social and economic aspects of treating children with short bowel syndrome in Russia were found during the conducted study. Comparative analysis of social and economic factors made it possible to estimate changes in ‘patient-social environment’ relationships within five years, briefly describe the scope of the work performed, delineate unsolved problems and discuss the measures needed to solve the problems. Conclusion. To solve social and economic problems associated with SBS, it is necessary to promote further development and expansion of the existing network of specialized centers dealing with treatment of these patients based on large pediatric hospitals in cities and federal districts of the Russian Federation. The Russian register of patients with short bowel syndrome composed by the Russian association of pediatric surgeons is a key link necessary to improve the quality of diagnostics and treatment of patients with SBS and to develop the state system of funding and provision of the patients with parenteral nutrition. A complex approach that requires participation of the state, federal clinics, charity institutions, creation of specialized centers, and local involvement of doctors will improve treatment outcomes of patients with SBS.
Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2019;9(4):27-34
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Citrulline as a biomarker of short bowel syndrome in children

Marakhouski K.Y., Svirsky A.A., Makhlin A.M., Shmeleva N.D., Kuvaeva Z.I., Korzuk E.B.


Purpose. To determine the diagnostic significance of blood citrulline level when estimating the short bowel syndrome (SBS) in children under 5 years old. To determine the blood citrulline level in children of different age. Methods. The examined group (N=31) included children under 5 who underwent small or small and large intestine resection and developed (15 children) or not developed (16 children) clinical signs of SBS. The control group included children who underwent no surgery on the GIT and had no congenital malformations and clinical signs of enteropathy (N=42). To determine the level of citrulline, overpressured high performance liquid column chromatography was used. Statistical analysis of the results was done with MedCalc® version 18.11.3. Results. Mean level of blood citrulline is 28.9 µmol/l in the examined group (95% CI 23.2–34.6) and 30.5 µmol/l in the control group (95% CI 25.0–35.1). Reliable data of the ratio between blood level citrulline and age of the child were obtained both among operated and non-operated children. The odds ratio of determining citrulline in blood was below 24.4 µmol/l in development of SBS clinical picture and amounted to 4.08 р < 0,05. Additional use of ROC analysis confirms the presence of interrelation between citrulline level and absence or presence of SBS clinical signs with 100% specificity and 43% sensitivity. The area under curve (categorical variable showing whether SBS is present or lacking) is 0,746, р = 0,005. Conclusion. Determination of serum citrulline as a diagnostic marker of short bowel syndrome in children under 5 found low sensitivity but high specificity. Thus, blood citrulline index can be used as a biomarker to diagnose SBS, to describe the course of SBS in detail and determine the risk of severe forms of this pathology in children under 5.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2019;9(4):35-42
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Staged thoracoscopic treatment of longgap esophageal atresia without the need for a gastrostomy

Kozlov Y.A., Rasputin A.A., Baradieva P.J., Ochirov C.B., Cheremnov V.S.


Introduction. Primary reconstruction of long gap esophageal atresia still represents a serious surgical issue. A variety of treatment options including preservation of native esophagus or its replacement for other segments of the digestive tract shows that the condition is difficult to treat and that a single approach is lacking. Until recently, all children with long gap esophageal atresia required a temporary gastrostomy to provide nutrition during lengthening of the existing esophagus. This study presents a new therapeutic approach when thoracoscopic elongation of the esophagus by traction can be performed without a gastrostomy. Materials and methods. Two cases of long gap esophageal atresia were reported in children who underwent treatment at the Center of Neonatal Surgery of Ivan and Matryona City Children’s Hospital in Irkutsk from 2017 to 2018. Internal sutures were applied using thoracoscopy with subsequent remote esophageal anastomosis that was also performed with the help of thoracoscopy. The treatment was estimated through the possibility of anastomosis application, anastomosis complications and interval of a patient’s transition to oral feeding. Results. The esophageal traction lasted 5 and 6 days, respectively. Both patients had native esophagus preserved without the need for a gastrostomy. Neither patient had anastomosis leakage. Feeding via the nasogastric tube started at days 6 and 7 after the surgery. Oral feeding was possible at days 30 and 35 after anastomosis construction. Anastomotic stenosis was developed in two patients and required 3 and 4 sessions of balloon dilatation. At 12-month follow-up, the patients’ food regimen was similar to that of their peers. Conclusions. The presented method of esophageal traction without the need for a gastrostomy must be considered as an alternative treatment strategy of long gap esophageal atresia.
Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2019;9(4):43-49
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Experience of laparoscopic drainage of posttraumatic intramural hematomas of duodenum in children

Sokolov Y.Y., Stonogin S.V., Korovin S.A., Tumanyan G.T., Allakhverdiyev I.S., Shapkina A.N., Kaufov M.H.


Purpose. To demonstrate that it is possible to perform minimally invasive laparoscopic interventions in children with extremely rare duodenal traumas resulting in a traumatic intramural duodenal hematoma. At the present stage, timely diagnostics and treatment of traumatic duodenal injuries resulting in a traumatic intramural duodenal hematoma relate to one of complex and rather complicated surgical issues. In the structure of all abdominal damages, the rate of duodenal traumas currently constitutes 1.2% only [1]. Single treatment cases of children with this pathology are described in the world medical literature. That’s why we decided to present our own observations devoted to this pressing issue of pediatric surgery. Materials and methods. We presented 2 rare clinical observations of posttraumatic intramural duodenal hematomas in children who had successful mini-invasive laparoscopic interventions. The mini-invasive surgical interventions were done using laparoscopic equipment by Karl Storz. Results. As shown in these clinical observations, recovery of duodenal posttraumatic hematoma using mini-invasive surgeries in children is possible and highly effective. Conclusions. Posttraumatic duodenal hematoma is treated with minimally invasive surgeries, high bowel obstruction is arrested as soon as possible, early enteral nutrition is initiated and the patient becomes active in the early postoperative period.
Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2019;9(4):50-56
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Comparative analysis of surgical treatment outcomes in children with solitary renal cysts

Stalmahovich V.N., Angarkhaeva L.V., Yakovchenko S.N.


Solitary renal cysts frequently occur in children. Minimally invasive methods of treatment are often used in this case. Effectiveness of their usage was not compared. Purpose. To improve renal solitary cyst treatment outcomes in children when using minimally invasive procedures. Materials and methods. Comparative analysis of puncture and sclerosing method of treatment (TG1 = 96 children) and laparoscopic excision of cysts with argon coagulation of the cystic mucous along the renal parenchyma (TG2 = 44 patients) was performed. US, MSCT, excretory urography were used to diagnose a disease and control treatment quality. Three 5 mm trocars were applied during surgery in TG2. In laparoscopy, port injection sites were selected depending on the renal cyst localization. Results. Puncture sclerosing treatment is advantageous by treatment duration (TG1=14.3 ±1.4 min, TG2= 26.6±2.3 min) and operational trauma of the abdominal wall (TG1=1–2 mm, TG2= 15 mm). Criteria of postoperative complications support laparoscopic treatment. It was found out in the long term that 7.29% of children from TG1 had a cicatricial deformity of the renal parenchyma and adjacent pararenal fat body. Conclusion: puncture sclerosing treatment of renal solitary cysts is more traumatic by the integrity of postoperative complications and remote treatment outcomes. It doesn’t provide for complete recovery following a single procedure.
Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2019;9(4):57-68
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Comparison of economic effectiveness of desflurane and sevoflurane in ENT surgery

Zolotareva L.S., Paponov O.N., Stepanenko S.M., Isakov A.V.


Purpose. To determine the clinical and economic effectiveness of using desflurane and sevoflurane as components of general balanced anesthesia when performing ENT surgeries in children. Methods. 132 cases of general anesthesia were analyzed during adeno- and/or tonsillotomy. The mean age of patients was 6.2±2.8 years. The average duration of anesthesia was 44.1±13.3 min. Direct medical costs, cost efficiency and budgetary impact were analyzed based on the weighted average prices in 2018. Results. In adeno- or tonsillotomy of mid-duration in children the cost of anesthesia support was 483.31 RUB for desflurane, and 283.48 RUB for sevoflurane. The expenditure difference amounted to 199.83 in favor of sevoflurane. Changing from desflurane to sevoflurane in 1,000 patients under 18 years old who require inhalation anesthesia will be accompanied by cost saving in the amount of 199,830 RUB. When the anesthetic concentration is changed, sevoflurane is also a less expensive technology in patients aged 1–3, 3–5 and 5–12 years old. While using the minimum recommended flows of fresh gas, the cost of anesthesia support will constitute 295.3 RUB for desflurane and 173.69 RUB for sevoflurane with the difference in favor of sevoflurane being 121,61 RUB for 44.1-min surgery with 3-min initial narcosis. Conclusion. Use of sevoflurane as a component of general combined balanced anesthesia in adeno- and/or tonsillotomy in children is more cost-efficient as compared to desflurane.
Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2019;9(4):69-77
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Diagnosis and Management of Inhalation Injuries in U. S. Children

Shahi N., Phillips R., Moulton S.L.


Inhalation injuries are the leading cause of mortality in fire related deaths in children, who because of their small and fragile airways have a greater risk of mortality than their adult counterparts. Direct injury to the lung parenchyma can be caused by a combination of heat and chemical damage, and their secondary effects. Diagnosis. Fiberoptic bronchoscopy is the current diagnostic standard when determining the presence and severity of an inhalation injury Chest CT (computed tomography) has been described as an adjunct to identifying parenchymal lung damage in inhalation injury patients. Management. The benefits of high tidal volume ventilation in this patient population include decreased ventilation days, decreased ARDS, and decreased atelectasis [The goals of medical therapy in patients with an inhalation injury are: 1) decrease bronchospasm, and 2) decrease airway edema. Bronchodilators are the mainstay of medical therapy for inhalation injuries. Chest physiotherapy including suctioning, coughing techniques, and early mobilization can be beneficial for patients with inhalation injuries. Summary. Most children who sustain a major burn injury survive. Although those who sustain an inhalation injury are at greater risk for morbidity and mortality, modern modes of airway management and ventilatory support generally result in good outcomes.
Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2019;9(4):11-26
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Case reports

Non-invasive APV in a child with the syndrome of central alveolar hypoventilation

Gorshkov D.V., Novoseltsev D.V., Pritsan M.A., Petrova N.A., Kolbina N.Y., Shchekoldina M.S.


Introduction: the syndrome of congenital central alveolar hypoventilation (SCCAH) is characterized by disturbed autonomic control of breathing (most frequently, while sleeping) in the structure of the autonomic nervous system general dysfunction. SCCAH is an orphan disease. In Russia, 29 children were diagnosed the same in 2018 (based on data provided by the Association of parents who have children with SCCAH). Purpose: successful experience of using non-invasive pulmonary ventilation as a method of restoring the central respiratory function in a child with SCCAH is of clinical interest. Materials and methods: we present a clinical case of managing a child with genetically confirmed SCCAH from the pediatric department of anesthesiology and resuscitation at Almazov National Medical Research Center prior to discharge. Conclusion: in the presented case, stable gas exchange was achieved against the background of 18-day staged adaptation to non-invasive pulmonary ventilation while sleeping only. The adaptation was selected as a method of chronic respiratory support. The child was discharged from the hospital at the age of 4 months and 14 days in a stable condition having equipment for respiratory support and monitoring. In every case of SCCAH, selection of additional ventilation method must be individually tailored.
Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2019;9(4):78-87
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Hydrometrocolpos in a newborn

Shidakov I.H., Kalniyazov B.M.


Purpose. To demonstrate a clinical case of hydrometrocolpos in a newborn and present a related literature review. Material. Our patient was a neonate born from the 2 pregnancy complicated with anemia and acute respiratory failure during trimester 1 and 3, respectively. A congenital malformation of the right ovarian cyst was found during an antenatal examination done at week 32 of gestation. Delivery at term. Planned Cesarean section was performed at 39 weeks of pregnancy after a uterine scar. At birth, the child’s condition was found satisfactory, the odds ratio was 7–8 scores. Pathological prolapse of soft and elastic formation without local hyperemia and hyperthermia through the interlabial space was found during the primary examination; it was fluctuating on palpation. Echography detected a large mass with distinct borders in the cavity of the lesser pelvis and bilateral ureterohydronephrosis. The abnormality was treated as an ovarian cyst compressing the pelvic sections of both ureters and resulting in secondary ureterohydronephrosis. A gynecologist made a puncture of the mass, liquid content was obtained and it was diagnosed as follows: a congenital ovarian cyst? A vaginal cyst? Results. The patient was consulted by a pediatric surgeon following worsening of her condition and reoccurrence of symptoms at day 7. The child was diagnosed with an imperforate hymen resulting in hydrometrocolpos. Cruciate hymenotomy resolved the condition. The girl was discharged in a satisfactory condition. Conclusion. Hydrometrocolpos in neonates often results in diagnostic and therapeutic mistakes due to differences in differential diagnosis.
Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2019;9(4):88-93
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Laparoscopy in the management of a child with giant pseudocyst of the greater omentum

Razin M.P., Kulaeva A.S., Lapshin V.I., Baturov M.A.


Introduction. Greater omentum cysts found in children belong to a rare pathology occurring as frequent as 1:23000. During the majority of observations, they are diagnosed during an ultrasound examination and abdominal computed tomography. However, in some cases it is impossible to restore an organ from which a cyst can originate using visual non-invasive methods. Purpose. This paper presents a clinical case of surgical treatment of a 7-year-old child with giant pseudocyst of the greater omentum. Materials and methods. The patient complained of periodic pains in the abdomen and increased abdominal size. The diagnosis was made following an abdominal ultrasound examination when a giant liquid formation (200×180×220 mm) was found. Subsequent MRI and CT tests of the abdomen gave a view of a cystic formation which was allegedly a cystadenoma of the left ovary. A cystic formation occupying the entire abdominal cavity was detected during a laparoscopy. Puncture and aspiration of 2.7 L of serous and hemorrhagic liquid were performed. It was found out that the formation originated from the greater omentum. The greater omentum was resected within healthy tissues along the mesocolonic border and cystic membranes were removed via a separate incision. Conclusion. When diagnosing large cystic abdominal formations, a final diagnosis of organ origin can sometimes be established during laparoscopy only when endosurgical treatment could be done (in the presence of a respective technique and educated specialists).
Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2019;9(4):94-98
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Crystalloid agents used in perioperative infusion therapy in children

Sulaimanova Z.D., Lazarev V.V.


Introduction. Today, it is proved that certain homeostatic shifts occur in patients during the intraoperative and postoperative (especially early) period. Success of conducted surgical treatment considerably depends not only on successful anesthesia and surgery but also on effective postoperative treatment. Proper management of an early postoperative period in children is of utmost importance due to physiological features of homeostasis, water-electrolyte metabolism and fluid composition regulation. The purpose was to confirm that infusion therapy aimed at homeostatic disorder correction is one of the main components of treatment during the postoperative period; infusion solution selected during the initial treatment is a key value to the expected therapy outcome. Materials and methods. Cyberleninka, PubMed, Medline, Crossref databases were used when analyzing literature. The search was not limited by the date of publication, the publications of the last decade were prioritized. Results. In the majority of cases, infusion therapy is given empirically as an exact idea of liquid status and its redistribution is lacking and proper selection of an optimal method of infusion therapy is necessary. The advantage of using a solution during the early postoperative period as initial therapy is an open issue. Solution of NaCl 0.9% is still being used though there were many reports describing its impact on electrolyte and acid-base blood balance. The use of balanced solutions has been moving to the forefront lately as they approach blood plasma composition the most. Along with conventional methods of infusion therapy, a domestic infusion solution of antihypoxic drugs is at our disposal at well, as it is capable to restore disturbed cellular energy. Conclusion. Thus, we have a variety of types and methods of infusion therapy. However, it is still unclear what type is the most effective in restoring the internal homeostasis as soon as possible reducing the rate of morbidity and mortality.
Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2019;9(4):99-107
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Destructive pneumonias in children

Vecherkin V.A., Toma D.A., Ptitsyn V.A., Koryashkin P.V.


Purpose. A complicated acute destructive pneumonia is one of the most severe purulent and septic diseases in children. The issue is pressing as a high level of lungs and pleura purulent morbidity among different age groups has been preserved till now. Materials and methods. The article reviews Russian and foreign literature addressing the issues of destructive pneumonia epidemiology, reviewing etiological aspects of the disease and analyzing the most frequent pathological agents which result in destructive pneumonia. Moreover, the authors’ views on pathogenesis and pathomorphology of this disease and its clinical signs are presented. Effectiveness of diagnostic research methods in diagnosis verification is comparatively assessed. A special attention is given to various methods of antibacterial therapy and prevention of this severe disease. Conclusions. The authors conclude that destructive pneumonia is a severe complication of pneumonia in children. S. pneumoniae and S. Aureus refer to its basic causative agents. Further studies need to establish the host-pathogen interaction, improve the microbiological diagnosis and optimize conservative and surgical treatment.
Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2019;9(4):108-115
pages 108-115 views

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