Vol 12, No 1 (2022)

Historical Articles

To the 100th anniversary of Girey A. Bairov (1922–1999)

Nemilova T.K.


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 100th anniversary of the birth.


Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2022;12(1):5-8
pages 5-8 views

Original Study Articles

Comparative evaluation of endosurgical and open intervention in newborns with duodenal obstruction

Mokrushina O.G., Razumovskiy A.Y., Shumikhin V.S., Levitskaya M.V., Nagornaya J.V., Smirnova S.V., Halafov R.V., Petrova L.V., Koshko O.V., Emirbekova S.K.


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.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2022;12(1):9-18
pages 9-18 views

Congenital hyperinsulinism: the significance of visual evaluation of positron emission tomography and the role of the surgeon in determining the limits of pancreatic resection

Sukhotskaya A.A., Bairov V.G., Mitrofanova L.B., Perminova A.A., Rijkova D.V., Nikitina I.L., Amidhonova S.A., Kagantsov I.M.


BACKGROUND: Congenital hyperinsulinism is a complex and multifaceted disease due to genetic disorders, some of which remain unknown.

AIM: This investigation shows the value of visual assessment and not just the definition of indices (standardized accumulation index and pancreatic index) when performing PET/CT to determine the surgical correction method of congenital hyperinsulinism.

MATERIALS AND METHODS: In 2017, Almazov NMRC implemented modern diagnostic capabilities for diagnosing pancreatic lesions: positron emission tomography with 18F-DOPA and intraoperative express biopsy of the pancreas.

RESULTS: From 2017 to October 2021, 48 children were operated on with congenital hyperinsulinism, including 30 with focal forms, in the Department of Pediatric Surgery at Almazov NMRC. This article shows the role of the surgeon, the importance of visual assessment, and not only the determination of indices (standardized accumulation index and pancreatic index) during positron emission tomography to determine the surgical correction method of congenital hyperinsulinism. The presented approach leads to 100% recovery in focal disease forms.

CONCLUSION: Partial pancreatectomy was performed in patients with focal forms, subtotal (95%) in atypical, and near total (98%–99%) in diffuse forms to cope with hypoglycemia due to congenital hyperinsulinism. The scope of surgical treatment for children with congenital hyperinsulinism is determined by the data of genetic examination, positron emission tomography, and intraoperative express biopsy.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2022;12(1):19-30
pages 19-30 views

External genital injuries in girls

Pavlenko N.I., Pisklakov A.V., Chuyan I.I.


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.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2022;12(1):31-40
pages 31-40 views

Non-invasive diagnostics of extrahepatic portal hypertension in children

Yuldashev R.Z., Aliev M.M., Shokhaydarov S.I., Tursunova D.B.


BACKGROUND: The primary method for diagnosing gastroesophageal bleeding in varicose veins of the esophagus and stomach in children is fibroesophagogastroduodenoscopy. This study investigates the possibilities of 2D shear wave elastography stiffness of the spleen to determine esophageal varicose veins in children with extrahepatic portal hypertension.

MATERIALS AND METHODS: A retrospective analysis of the effectiveness of the method of two-dimensional elastography by shear wave stiffness of the spleen was conducted in children with extrahepatic portal hypertension in 39 children (main group) and 11 healthy children (control group). All patients initially underwent fibroesophagogastroduodenoscopy followed by ultrasound, including 2D shear wave stiffness elastography of the spleen. Spleen stiffness was then compared with clinical symptoms, the degree of esophageal varices, and other sonographic parameters.

RESULTS: According to elastography data, the spleen stiffness index in children with extrahepatic portal hypertension was 43.98 ± 3.8 kPa, significantly higher than in the control group children (p = 0.006). Spleen stiffness measurements significantly correlated with the degree of esophageal varices in children with extrahepatic portal hypertension (r = 0.57, p = 0.0002). According to the endoscopy results in seven patients after vascular bypass surgery, esophageal varicose veins were not detected. Nevertheless, spleen stiffness in these children remained significantly higher than in the control group (27 ± 3.9 kPa and 18 ± 1.2 kPa, respectively, p = 0.05).

CONCLUSIONS: The study results indicate that 2D stiffness shear wave elastography of the spleen effectively assesses esophageal varices in children with extrahepatic portal hypertension. This method is also convenient to monitor the reduction of varicose veins after surgical treatment and is a possible alternative to endoscopy, especially in young children.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2022;12(1):41-50
pages 41-50 views

Transpharyngeal closed reduction displacement of the first cervical vertebra in children

Wan Z., Minasov T.B., Yakupova E.R., Ginoyan A.O., Saubanov R.A.


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.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2022;12(1):51-60
pages 51-60 views

Minimally invasive treatment of pilonidal cysts in children: the Gips procedure

Stepanova N.M., Novozhilov V.A., Mochalov M.N., Zvonkov D.A., Voropaeva A.V., Petrov E.M., Moroz S.V., Khaltanova D.Y., Namkhanov V.V.


BACKGROUND: Pilonidal disease (pilonidal cyst, epithelial coccygeal passage) is a chronic inflammatory disease of the sacrococcygeal region, common among young people, including adolescents, to a certain extent worsens the quality of life. Until now, the etiopathogenesis and surgical treatment methods of the disease have been the subject of wide discussion.

AIM: The aim of the study was to evaluate the effectiveness of Gips operations in children with pilonidal disease.

MATERIALS AND METHODS: A comparative analysis of 41 patients with pilonidal disease was conducted in the surgical department of the City Ivano-Matryoninsk Children's Clinical Hospital in Irkutsk from January 2020 to August 2021. Planned surgical treatment was performed in 22 patients with primary or recurrent pilonidal cysts, including 15 children using the M. Gips procedure. The comparison group consisted of patients who underwent wide excision of a complex of soft tissues bearing a pilonidal cyst, primary and secondary fistulous passages, followed by wound restoration with a storey suture.

RESULTS: The patients comprised 72.7% boys and 27.3% girls with an average age of 15.6 ± 1.5 years and average disease duration of 5.1 ± 2.2 months. The average operation time was 12 ± 4.2 minutes. The motor regime was resumed on the first day after the operation. Patient pain was relieved by administering non-steroidal anti-inflammatory drugs for the first two postoperative days. There were no early postoperative complications. The average hospital stay was 3.8 ± 1.9 days. Complete healing by secondary intention was achieved after an average of 3.9 ± 1.8 weeks. The average follow-up was 7 ± 3.8 months, and 6.7% had early relapses.

CONCLUSIONS: Minimally invasive sinusectomy according to the Gips procedure for treating pilonidal disease in adolescents is safe and effective, has a low recurrence rate, allows an early return to daily activities, and provides a good cosmetic result. However, the small number of observations requires further research.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2022;12(1):61-68
pages 61-68 views


Commentary on the article “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?”

Rudin Y.E.


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

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2022;12(1):69-72
pages 69-72 views

Technical reports

Organizational and clinical potential of the Federal Register of children with short bowel syndrome

Rozinov V.M., Ampar F.B., Samorokovskaya M.V., Isakov M.A.


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.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2022;12(1):73-84
pages 73-84 views

Case reports

Microsurgical autotransplantation of the large omentum in a patient with Parry – Romberg syndrome: Case report

Bystrov A.V., Gassan T.A., Serebrennikova P.A., Myzin A.V.


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.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2022;12(1):85-92
pages 85-92 views

Anesthetic management of a repeatedly operated patient with extrahepatic portal hypertension: Сase report

Naleev A.A., Lazarev V.V., Linkova T.V., Tsypin L. .


BACKGROUND: The use of high doses of opioids and general anesthetics can cause unwanted side effects that directly affect the patient's recovery and his psycho-emotional and social well-being. In this regard, the general anesthesia method enables the dose reduction of general anesthetics and opioid analgesics. This is relevant, especially in children with concomitant thrombocytopenia, in whom epidural blockade is contraindicated.

CASE REPORT: This article describes using the alpha-2-adrenergic agonist, dexmedetomidine, for anesthesia in a 16-year-old girl during corrective surgery for extrahepatic portal hypertension after several previous operations. Using the selective alpha-2-adrenergic agonist, dexmedetomidine, for general anesthesia produced effective and stable pain relief intraoperatively and rapid recovery of spontaneous breathing and consciousness after anesthesia. The total dose of intraoperative consumption of fentanyl compared with previously performed anesthesia was less than two times, and sevoflurane by 30%, while maintaining adequate anesthetic protection.

CONCLUSION: During surgical interventions, it is impossible to perform epidural anesthesia in patients with thrombocytopenia with extrahepatic portal hypertension. The centrally acting alpha-2-agonist, dexmedetomidine, may be used to reduce the doses of anesthetics and opioid analgesics used.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2022;12(1):93-98
pages 93-98 views


Exploring new frontiers and innovative spaces: the 30th Congress of International Pediatric Endosurgery Group (IPEG)

Kotlovsky A.M., Poddubny I.V., Kozlov Y.A., Guelfand M.A., Ponsky T.A.


The 30th 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.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2022;12(1):99-104
pages 99-104 views


To the 85th Anniversary of Leonid A. Sitko

Pisklakov A.V.


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


Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2022;12(1):105-108
pages 105-108 views

To the 75th Anniversary of Kalust G. Franciyanc

Novoshinov G.V.


The paper describes the professional activities and merits of the pediatric surgeon Kalust G. Franciyanc, in celebration of his anniversary.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2022;12(1):109-110
pages 109-110 views

To the 70th Anniversary of Aleksey N. Smirnov

Golovanev M.A.


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

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2022;12(1):111-112
pages 111-112 views

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