Vol 12, No 1 (2022)

Description of the life and professional path of Girey Alievich Bairov, the founder of the Leningrad School of Pediatric Surgeons and the founder of Russian neonatal surgery. To the 100^th anniversary of the birth.

BACKGROUND: Duodenal atresia is one of the most common malformations of the intestine in newborns. Both open surgical interventions and the laparoscopic method eliminate duodenal obstruction.

AIM: This study conducts a comparative analysis of the results of treating newborns by these methods.

MATERIALS AND METHODS: This paper summarizes the experience of treating 185 newborns operated in the clinic for duodenal obstruction. Two groups of patients are presented: the first included 110 children operated on laparoscopically, the second included 75 patients operated on by the open method. Both groups are comparable regarding newborn anthropometric data, age at the time of surgery, and the presence of concomitant anomalies. The study considered indicators characterizing the surgical intervention and the course of the postoperative period.

RESULTS: In a series of studies, there were no differences between groups in interpreting the cause of obstruction (p = 0.184) and the presence of an incomplete turn (p = 0.134). Operating time in the laparoscopy group was higher than in the laparotomy group (75 min and 70 min, p < 0.001). However, the reduced duration of mechanical ventilation, earlier initiation of feeding, transition to complete enteral nutrition and reduced length of hospital stay suggest the benefits of laparoscopy over laparotomy for treating congenital duodenal obstruction (p < 0.001). The frequency of postoperative complications is not high in both groups (p = 0.634). The analysis results showed that laparoscopy does not complicate the intraoperative interpretation of organ relationships, provides a more favorable course during the postoperative period, and does not increase the number of postoperative complications.

CONCLUSION: The laparoscopic method improves medical efficiency in treating newborns with duodenal obstruction than open surgery.

BACKGRAUND: The treatment of girls with genital trauma is an urgent problem because of the increased frequency in cases in recent years. This study examines the treatment effectiveness in girls with various types of genital trauma.

MATERIALS AND METHODS: Case histories of 126 girls aged one to 17 years with external genital organ injuries and treated from 2016 to 2020 were studied. They included 120 (95%) patients with mechanical injuries and six (5%) girls with intravaginal electrochemical burns. The types of injuries, clinical picture, diagnostic methods, methods of surgical interventions, and treatment outcomes were studied.

RESULTS: The data obtained as a result of the analysis showed an increase in the number of injuries of the external genital organs in girls by 2.2 times, with a predominance of victims aged two to 10 years (69%). The structure of injuries was dominated by mechanical damage (95%) due to domestic and street injuries. Most injuries were localized in the external genital area, and deeper injuries accounted for 7.9%. Massive bleeding with the development of severe posthemorrhagic anemia was noted in 4.2% of cases. Surgical treatment was performed in 80.8% of cases. In cases of combined injuries with the rectum (2%), operations were performed jointly with surgeons. Mortality and postoperative complications were not observed. In six patients, one finger and five disc batteries, which caused electrochemical burns, were found and removed from the vagina. The treatment control of these injuries was performed with dynamic vaginoscopy. For more than six months, four girls had pronounced cicatricial changes.

CONCLUSION: Therapeutic tactics for mechanical injuries have shown effectiveness due to the absence of complications and a short hospital stay. The rehabilitation of patients with electrochemical burns requires further study since two-thirds of them have long-lasting cicatricial changes.

BACKGROUND: Currently, the treatment of children with atlantoaxial rotational block has no standard protocol. The proposed conservative methods are difficult and require long-term hospitalization, whereas surgical treatment is associated with a risk of complications.

AIM: This study aimed to develop and evaluate the effectiveness of the transpharyngeal closed reduction method for first cervical vertebral displacement in children.

MATERIALS AND METHODS: The study presents the analysis results of clinical cases of 46 children with atlantoaxial rotational fixation with types I–II subluxations by Fielding and Hawkins the CI transpharyngeal closed reduction method. The average age of the patients was 4.5 ± 2.6 years. The time of admission of patients after the disease onset varied from 1 to 30 days. The reduction technique consisted of the following elements: 1. A bracket is installed for traction behind the skull along the axis; 2. The surgeon pulls the bracket along the axis, while using the index finger of the other hand in the oropharynx fixes the anterior arch of the atlas, creating a fulcrum; 3. Rotational displacement of the atlas is eliminated by rotational movements with simultaneous traction along the axis; and 4. The anatomical position of the atlas and axis is controlled by an X-ray image intensifier.

RESULTS: Only in one case of recurrent dislocation was noted after 4 days. The efficiency of primary reduction was 97.8%. Pain syndrome on the visual analog scale was reduced by 62.3%. Neurological deficit recurrence was not noted. The average bed-day was 2.5 ± 1.3 days.

CONCLUSION: Transpharyngeal closed reduction method for first cervical vertebral displacement in children of the younger age group is effective for atlantoaxial rotational fixation treatment in early admitted patients, which determines the prospects for its wider application in the practice of specialized hospitals.

Commentary on the article Surov R.V., Kagantsov I.M., Shmyrov O.S., Sizonov V.V., Volkova A.A., Zadykyan R.S., Kulaev A.V., Lasishvili M.N., Velskaya Yu.I. “Comparative analysis of the use of one-stage and two-stage urethroplasty in the treatment of children with proximal forms of hypospadias. Flap or graft?,” published in the Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2021;11(4):437–444. (In Russ.) DOI: https://doi.org/10.17816/psaic968

BACKGROUND: Short bowel syndrome is a medical and social problem characterized by high mortality and disability rates, controversial tactics, resource-intensive therapy, and lack of legal support. In 2016, the Russian Association of Pediatric Surgeons initiated the creation of the Federal Register of Children with Short Bowel Syndrome.

AIM: This study conducts an audit of the Register to identify the prevalence of the pathological syndrome, establish the causes of its formation and trends in transforming the therapeutic paradigm, determine the pattern, nature, and frequency of various complications, establish factors limiting its informativeness involving representatives of implementors and users, and justify changes increasing database organization and clinical significance.

MATERIALS AND METHODS: The Register has 334 patients registered. Of these, 23 children died, and five were removed from the Register at 18. The Quinta software package was used to collect, process, and manage geographically distributed data with information about patients’ data, identification of medical organizations, diagnosis, the content of therapeutic measures, and the structure of complications.

RESULTS: The Register contains data on patients from 71 regions of Russia. Bowel resections prevailed among the initial interventions due to necrotizing enterocolitis (18.0%) and intestinal atresia (17.4%). Reconstructive interventions (125), including serial transverse enteroplasty and spiral intestinal lengthening and tailoring techniques, were implemented in 37 and 24 cases. One hundred and eighty patients needed parenteral nutrition: 18 patients required total parenteral nutrition, and 162 patients needed partial parenteral nutrition. Enteral feeding was used in 193 cases, meeting the needs of 31 children and supplementing parenteral therapy for 162 children. The structural flaw of the Register is the absence of a section on palliative care.

CONCLUSIONS: The identified limitations of the Register indicate the need to improve the provided primary information, form a platform for supporting medical decisions, create a palliative care unit, and integrate with state health development programs.

BACKGROUND: Parry – Romberg syndrome or progressive hemifacial atrophy is a rare disease that is usually unilateral with soft and hard tissue atrophy. Surgical treatment is conducted in different ways and only with pronounced cosmetic and functional defects. Currently, no randomized trials and clinical recommendations are reported on the choice of surgical methods of Parry – Romberg syndrome intervention.

AIM: This study aimed to evaluate the effectiveness of the microsurgical method for correcting facial cosmetic defects in Parry – Romberg syndrome.

CASE REPORT: Clinical signs of Parry – Romberg syndrome appeared in a boy from the age of 11 years. The ongoing conservative treatment could not prevent the progression of atrophy of the right half of the face. At 16 years old, he underwent a microsurgical operation, the technique of which was as follows: a graft of the greater omentum on a vascular pedicle was laparoscopically taken from the abdominal cavity and placed in a prepared bed under the right cheek skin with an anastomosis formation of the temporal artery. The postoperative period was without complications. At the age of 2 and 4 years, small defects were eliminated by 2 ml lipofilling. The vascularized flap had a positive effect on the trophism of the surrounding tissues, and skin elasticity and color were completely restored. Currently, 9 years after the operation, the cosmetic results are good, and the patient does not experience psychological discomfort. Herein, presented the data of computed tomography, patient photographs, and operation stages.

CONCLUSION: The presented clinical case of a microsurgical operation by autotransplantation of the greater omentum in a patient with Parry – Romberg syndrome shows the effectiveness of this method, which was confirmed by a 9-year follow-up period.

The 30^th Annual Congress of the International Pediatric Endosurgery Group (IPEG) was held under the theme “Exploring new frontiers and innovative spaces.” The Congress was held in Los Angeles, USA on June 11 and 14, 2021, in a virtual format due to the ongoing coronavirus disease-2019 pandemic. More than 600 pediatric surgeons from all regions worldwide participated in the meetings.

This article provides a concise overview of the scientific and practical information presented at the forum. The Congress program included 273 scientific presentations, of which 11 were made by Russian surgeons. The priority topics covered almost all sections of pediatric surgery with a certain focus on the main directions of development of minimally invasive surgery and the consistent promotion of innovative technologies in pediatric surgery. The materials of the presented presentations contained statistical data of clinical trials, proposals for improving endosurgical techniques, and creating new surgical instruments, as well as scientific justification for the use of fundamentally new medical technologies.

The scientific and practical information presented at the Congress indicates that IPEG, on a global scale, continues its progressive movement toward the search for new frontiers in improving professional skills and innovative pediatric surgery development.

The paper describes the professional activities and merits of the pediatric surgeon Leonid A. Sitko, in celebration of his anniversary.

The paper describes the professional activities and merits of the pediatric surgeon Aleksey N. Smirnov in celebration of his anniversary.