Vol 11, No 1 (2021)

ОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯ

Long-term results of treatment of newborns and infants with necrosis and perforation of the stomach and duodenum

Skopetc A.A., Karavaeva S.A., Nemilova T.K.

Abstract

INTRODUCTION: Necrosis and perforation of the stomach and /or duodenum in newborns and infants is a rare but severe disease with high mortality. There are many theories about the etiology and pathogenesis of the necrosis and perforation of the stomach and duodenum in children of this age. Various treatment options are described, but neither foreign nor Russian publications have assessed the long-term results of the treatment of patients with perforation of the stomach and duodenum during the first year of life and the quality of their life.

AIM: This study aimed to analyze the results of treatment of newborns and infants with perforation of the stomach and duodenum and to assess their long-term quality of life.

MATERIALS AND METHODS: The study analyzes the long-term results of treatment of 21 children, aged 2–12 yrs, with perforation of the stomach and duodenum. The volumetric evacuation function of the stomach and duodenum and the child’s nutritional status were assessed. A survey of patients and their parents was also carried out to assess the quality of life of the child using questionnaires from the EuroQol Research Foundation version EQ5D-Y.

RESULTS: The volumetric evacuation function of the stomach and duodenum recovered completely. The nutritional status of 16 (76%) children corresponds to their age. According to the results of the analysis of the questionnaire of the quality of life, eight patients aged >8 yrs and 15 parents consider the health profile of children as the best (71%), the parents of one patient assess the health profile of their child as satisfactory, and five mothers of children with neurological deficits rated as unsatisfactory.

CONCLUSION: Owing to the high adaptation capacity of the newborn and infants of the first year of life, most of the examined patients have a good quality of life and a normal nutritional status. The volumetric evacuation function of the stomach and duodenum recovered in all patients within 1–3 yrs after surgery.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2021;11(1):7-16
pages 7-16 views

Substantiation of organ-preserving surgical treatment of children with nonparasitic spleen cysts

Belyaeva A.V., Rozinov V.M., Polyaev Y.A., Belyaeva O.A., Bondar Z.M.

Abstract

BACKGROUND: The urgency of surgical treatment of children with nonparasitic spleen cysts is determined by the lack of consensus in the professional community, lack of regulatory documents governing the treatment of these patients, frequency of postoperative complications, and unfavorable outcomes.

AIM: This study aimed to improve the efficiency and safety of organ-preserving minimally invasive interventions in children with nonparasitic spleen cysts based on the development of a multifactorial preoperative planning system and substantiation of an algorithm for choosing the optimal surgical strategies.

MATERIALS AND METHODS: Results of surgical treatment of 60 children aged 2–18 yrs with nonparasitic spleen cysts are presented. The spleen cyst volume varied from 3 ml to 1000 ml (Me 50 ml). Preoperative examination included clinical examination, laboratory diagnostics, ultrasonography, computed tomography or magnetic resonance imaging, and angiography of the spleen vessels. The range of surgical technologies included percutaneous puncture (n = 2) and percutaneous puncture drainage (n = 28), followed by sclerosing of the cyst with 96% ethyl alcohol, combined interventions, supplemented by superselective embolization of the spleen arteries feeding the pathological formation (n = 15), laparoscopic fenestrations of cysts with physical de-epithelialization of the inner lining (n = 14), and laparoscopic resection of the spleen pole (n = 1).

RESULTS: The analysis of postoperative complications was carried out depending on the chosen technology of surgical treatment. The follow-up period of 44 patients varied from 6 mon to 3 yrs, which made it possible to reveal the regularities of the reduction of residual cyst cavities and the course of the regeneration processes with an objective assessment of the volumetric characteristics of the spleen. Obliteration of the residual cyst cavities was observed in 79.1% of the patients during the first month after surgery. Subsequent total obliteration of the residual cyst cavities was observed within 1 yr after surgery in 91.7% of children and residual pathological formations persisted in five patients, which accounted for 8.3% of clinical observations. The volume of residual cysts ranged from 1.2% to 10.0% of the initial value, which was regarded as a satisfactory treatment result.

CONCLUSION: Results of a retrospective multivariate analysis made it possible to develop an algorithm for substantiating surgical techniques, providing a radical cure for 95.5% of children with nonparasitic spleen cysts.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2021;11(1):17-26
pages 17-26 views

A complex soft tissue reconstruction of distal phalanges in children

Alexandrov A.V., Goncharuk P.V., Idris L.Y., Rybchenok V.V., Smirnov A.A.

Abstract

BACKGROUND: Injuries of distal phalanges are the most common type of hand trauma in children. The problem of coverage of soft tissue defects of distal phalanges remains. Many methods of coverage of distal phalanges defects have been developed. There is no generally accepted approach or an algorithm in treatment of adults and children with such type of trauma.

AIM: This study aimed to reveal the most universal method of coverage of distal phalanges defects in children using various reconstruction methods that are used at the Department of Reconstructive Microsurgery of Filatov State Children Hospital.

MATERIALS AND METHODS: From 2019 to 2020, 70 children with defects of distal phalanges were treated. The coverage of defects was performed by using a flap (n = 23), cross-finger flap (n = 5), V-Y advancement flap (n = 28), reverse-flow homodigital island flap (n = 11), and full-thickness skin graft (n = 3). Results of the defect coverage were evaluated by objective (difference between the lengths of the operated and contralateral phalanges, two-point discrimination test, presence/absence of stiffness in the distal interphalangeal joint) and subjective (definition of cold intolerance, Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire) criteria.

RESULTS: The largest difference between the lengths of the operated and contralateral phalanges was obtained in V-Y plasty. The two-point discrimination sensitivity was the highest in V-Y plasty and a little less with island flap. Cold intolerance was the most common complication of homodigital island flap. Results of the DASH survey was the best in the homodigital island flap and full-thickness skin graft.

CONCLUSION: Based on the analysis of the experience of surgeries to close soft tissue defects of the nail phalanges, the best results were obtained with reverse-flow homodigital island, which is considered as the most versatile and reliable approach.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2021;11(1):27-38
pages 27-38 views

Morphometric analysis of the intercellular substance of hypertrophic scars after anti-scar treatment

Minaev S.V., Grigorova A.N., Vladimirova O.V., Ivchenko A.A., Lavreshin P.M., Vladimirov V.I., Timofeev S.I., Gobedzhishvili V.V.

Abstract

AIM: This study aimed to assess the formation of scar tissue after burns under the influence of an anti-scar gel. Understanding of the processes involving scars and the morphofunctional features of the tissue at different stages of development allows targeted selection of therapy and prevention of scars.

MATERIALS AND METHODS: We conducted a comparative prospective analysis from 2005 to 2020. Of which two groups were identified. In group 1 (n = 47), burns were treated according to the standard scheme without the use of modern wound coverings. In group 2 (n = 41), early primary prevention of pathological scarring was performed, where the Contractubex gel was applied to the area of burn injury from the moment of epithelialization. Histological examination included the analysis of skin biopsies in the area of damage before and after conservative treatment.

RESULTS: Histological examination showed quantitative changes in the cellular composition of the scar tissue in all groups. The average quantitative index of the fibroblast activity was significantly reduced in group 2 using Contractubex gel. Thickness of collagen fibers, according to the morphometric analysis, is most reduced in all layers of the dermis in group 2 (p < 0.05). In group 1, collagen fibers are represented as nodular clusters; in some areas of the reticular layer of the dermis, fibers have a more fragmented appearance. In group 2, the use of Contractubex leads to a significant decrease in the level of tumor growth factor-β in the papillary and reticular layers of the dermis.

CONCLUSION: The use of Contractubex gel in the early prevention of pathological scarring significantly reduces the need for subsequent reconstructive surgical interventions

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2021;11(1):39-46
pages 39-46 views

EXCHANGE OF EXPERIENCE

Surgical approaches to the third ventricle of the brain in children

Gorelyshev S.K., Medvedeva O.A.

Abstract

AIM: This study aimed to describe and analyze the advantages and disadvantages of various surgical approaches to neoplasms of the third ventricle of the brain in children.

MATERIALS AND METHODS: This study analyzed surgical interventions to the third ventricle in 657 patients, performed at the Academician N.N. Burdenko of the Research Institute of Neurosurgery from 1998 to 2018. These included 375 patients with intra-extraventricular craniopharyngiomas and 282 patients with gliomas of the third ventricle and chiasm. The patients’ age ranged from 3 mon to 18 years old.

RESULTS: The anterior transcallosal approach provides access to the anterior horn and bodies of the lateral ventricles, as well as the third ventricle. The transfornical approach provides more opportunities for access to both the anterior and posterior parts of the third ventricle; however, it has a high risk of trauma to the fornix. The subchoroidal approach provides a very good view of the posterior parts of the third ventricle, especially of the pineal region; however, it has even greater restrictions on viewing its anterior parts. When compared with the transcallosal approach, the transfrontal approach can be used more safely in the absence of hydrocephalus (if the tumor is located in the anterior horn). No specific complications were inherent in a particular approach (seizures were registered in 1%, transient hemiparesis was noted in 10%, and transient memory impairments were revealed in 5% of cases).

CONCLUSION: The use of a transcallosal approach is safe even in infants. The transcortical approach is recommended mainly for large tumors of the lateral ventricles, and the transcallosal approach should be used for small tumors of the third ventricle. No specific complications were inherent in a particular approach, and the choice was determined by the assessment of the exact location of the tumor and calculation of the most relevant trajectory for its achievement as well as the aim (biopsy or radical removal). Analysis of magnetic resonance imaging and neuronavigation are significant in the selection of surgical approaches.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2021;11(1):47-54
pages 47-54 views

Minimally invasive surgery of faecal incontinence with autologous fat injection in children

Pinigin A.G., Kuzmichev P.P., Marochko N.V., Ermolaeva V.A., Berezutskiy S.N.

Abstract

BACKGROUND: Faecal incontinence as a result of chronic functional constipation is a common problem among children. This condition is socially unacceptable. There is no clear consensus of a universally accepted pathogenesis, diagnostics, and optimal treatment for this condition. New methods of surgical treatment are necessary for accelerated normalization of the retaining faeces process and resolution of faecal incontinence in children.

THE AIM: The study was aimed to analyze the efficiency of the new minimally invasive surgery method of the anal sphincter complex restoring with autologous fat injection in children.

MATERIALS AND METHODS: The examined group included 31 patients aged from 4 to 17. The patients had chronic constipation combined with faecal incontinence more than once per week. All of them had no lesions of the anal sphincter and pelvic floor muscles. All patients underwent outpatient and inpatient treatment from 2016 to 2019. Patients underwent computed tomographic colonography with virtual colonoscopy in addition to general clinical methods, ultrasound and irrigoscopy. Minimally invasive surgery with autologous fat injection was performed to correct anorectal angle in the following conditions: ineffective nonsurgical treatment for 4-6 months, lengthening of puborectalis muscles, increasing of the anorectal angle more than 100 degrees.

RESULTS: We analyzed the complaints of the patients who underwent minimally invasive surgery. The study showed reducing of symptoms severity of chronic constipation up to complete normalization of defecation frequency after surgery (34.5%) in 3 months. The study also showed the complete absence of fecal incontinence in 3 months after this minimally invasive treatment in 83 per cent of children.

CONCLUSION: The retrorectal injection of autologous fat leads to fast resolution of faecal incontinence, normalization of defecation frequency and improvement of the life quality as a result.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2021;11(1):55-62
pages 55-62 views

Closed kidney injuries in children

Solovyov A.E.

Abstract

MATERIALS AND METHODS: Within 20 yrs, 76 children aged 2–8 yrs with kidney trauma were under observation, and 35 of them had associated trauma. Clinical, instrumental, and radiological methods were used in the diagnosis.

RESULTS: Of the 76 children with closed kidney trauma, 23 were diagnosed with kidney contusion, 14 with kidney injury with subcapsular hematoma, 16 with kidney injury with rupture of the capsule and perirenal urohematoma, 21 with kidney rupture and damage to the calyx–pelvic system, and 2 with traumatic hydronephrotic kidney. Conservative treatment was carried out in 49 (64.4%) children and surgical treatment in 28 (25.6%). In the long term, 28 children with kidney injuries and treated conservatively were examined. Complications were found in nine children: pyeloectasia, deformation of the calyx–pelvic system, pyelonephritis, and renal hypertension. Organ-preserving surgery was performed in 22 (28.9%) children and nephrectomy in 5 (6.6%) children. As long-term results: the function of the operated kidneys was satisfactory, some changes occurred in the calyx–pelvic systems, and no data for pyelonephritis was found.

CONCLUSION: Renal injuries with subcapsular rupture and perirenal urohematoma should be surgically treated to prevent severe long-term complications. In unclear cases, the choice can be a two-stage organ-preserving operation for the so-called crushing of the kidney.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2021;11(1):63-68
pages 63-68 views

CLINICAL OBSERVATIONS

Generalized tetanus in an 11-year-old boy: A case report

Kozlov A.A., Shevchuk I.V., Zavialov A.E., Emelyanov A.N.

Abstract

The study presents a case report of a generalized form of severe tetanus in an unvaccinated 11-year-old child. Pain and convulsive syndromes, respiratory failure, and damage to the gastrointestinal tract prevailed in the acute period. Antibiotic therapy, anti-tetanus serum, adequate pain relief, and anticonvulsant therapy were the leading treatments of the child. Moreover, the paper discusses literature data on the options for the clinical course and choice of treatment strategies. The lack of planned vaccination in children is unsafe.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2021;11(1):69-75
pages 69-75 views

Giant urinoma in a newborn boy with a posterior urethral valve: A сase report and review

Kagantsov I.M., Zadykyan S.S., Zadykyan R.S., Svarich V.G., Bairov V.G., Sukhotskaya A.A.

Abstract

Posterior urethral valve is the most common cause of infravesical obstruction in male newborns. Spontaneous rupture of the urinary collecting system with urine extravasation is a rare complication in this group of children. We present a case of urinoma in a patient with a posterior urethral valve at 4 weeks of age with renal insufficiency. The transurethral destruction of the valve and evacuation of the urinoma contributed to the restoration of the urodynamics and recovery of renal function. Urinoma is a rare manifestation of this defect, and its significance for predicting the preservation of renal function has not been fully determined yet. Reports about the occurrence of urine extravasation in the posterior urethral valve and studying kidney function in the long-term period can clarify the significance of this spontaneous mechanism of urinary tract decompression.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2021;11(1):77-84
pages 77-84 views

Aplasia of the superior vena cava and persistent superior left vena cava in a 3-year-old child: Case report

Lazarev V.V., Linkova T.V., Negoda P.M., Shutkova A.Y., Gorelikov S.V., Naleyev A.A., Polanskaya M.V., Bykov M.V.

Abstract

BACKGROUND: Structural features of the patient’s vascular system can cause unintended complications when providing vascular access and can disorient the specialist in assessing the location of the installed catheter. This study aimed to demonstrate anatomical features of the vascular system of the superior vena cava and diagnostic steps when providing vascular access in a child.

CASE REPORT: Patient K (3 years old) was on planned maintenance of long-term venous access. Preliminary ultrasound examination of the superior vena cava did not reveal any abnormalities. Function of the right internal jugular vein under ultrasound control was performed without technical difficulties; a J-formed guidewire was inserted into the vessel lumen. X-ray control revealed its projection in the left heart, which was regarded as a technical complication, so the conductor was removed. A further attempt to insert a catheter through the right subclavian vein led to the same result. For a more accurate diagnosis, the child underwent computed angiography of the superior vena cava system. Congenital anomalies of the vascular system included aplasia of the superior vena cava and persistent left superior vena cava. Considering the information obtained, the Broviac catheter was implanted under ultrasound control through the left internal jugular vein without technical difficulties with the installation of the distal end of the catheter into the left brachiocephalic vein under X-ray control.

CONCLUSION: A thorough multifaceted study of the vascular anatomy helps solve the anatomical issues by ensuring vascular access and preventing the risks of complications.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2021;11(1):85-90
pages 85-90 views

REVIEW OF LITERATURE

Impaired fertility and sexual function in patients with anorectal malformations

Pimenova E.S., Korolev G.A., Romanova O.E.

Abstract

The review discusses sexual dysfunction and fertility problems in patients with anorectal malformations. Fertility problems in patients with rectal and pelvic abnormalities can develop against the background of concomitant genital malformations and after surgical interventions. Boys often have rectovesical or rectoteurethral (prostatic and bulbar) fistulas. In girls, anorectal malformations may be combined with vaginal atresia and uterine abnormalities leading to impossibility of pregnancy in the future. Psychological aspects have a large effect on sexual dysfunction. Poor results, such as fecal and urine incontinence, have direct influences on social adaptation. In assessing long-term results, multicenter studies have found that, at puberty, one-third of women and >10% of men had problems with their sexual function because of low self-esteem and impaired social adjustment. Anorectal malformations are not current problems in pediatric surgery. Patients need an interdisciplinary, personalized approach that includes timely diagnosis and surgical correction of defects, as well as detection and correction of disorders of anatomy of pelvic organs and internal and external genitalia.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2021;11(1):91-98
pages 91-98 views

HISTORY OF PEDIATRIC SURGERY

Pediatric surgeon and mentor Igor N. Grigovich

Nikitin S.S., Shevchenko I.Y., Husu E.P., Goldenberg I.G., Timonina A.V.

Abstract

This paper provides information about the life and work of Igor Nikolaevich Grigovich, Doctor of Medical Sciences, Professor, Honored Doctor of Russia, who is the founder of pediatric surgery in the Republic of Karelia and a scientist who made huge contributions to the development of surgical care for children of the Russian Federation.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2021;11(1):99-105
pages 99-105 views

It remains only to remember

Geldt V.G.

Abstract

This paper details memories about Igor N. Grigovich, a pediatric surgeon.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2021;11(1):107-108
pages 107-108 views

NECROLOGUE

In Memory of Sergey P. Sergeechev (13.10.1962–07.01.2021)

Murga V.V.

Abstract

This paper provides information about the sudden death from COVID-19 of Sergey P. Sergeechev, the head of the Department of Purulent Surgery of Tver Children’s Regional Clinical Hospital.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2021;11(1):109-110
pages 109-110 views

In Memory of Aleksey L. Valov (25.06.1962–31.01.2021)

Pokshubin A.B.

Abstract

This paper provides information about the sudden death of Aleksey L. Valov, the head of the Kidney Transplant Department of the Russian Children’s Clinical Hospital.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2021;11(1):111-112
pages 111-112 views

In Memory of Evgeny B. Kotik (01.07.1950–07.01.2021)

Gorbachev O.S.

Abstract

This paper provides information about the sudden death of Evgeny B. Kotik, the chief pediatric surgeon of Tula Region.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2021;11(1):113-114
pages 113-114 views

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