Vol 12, No 3 (2022)

Original Study Articles

Prediction Model for Contralateral Hip Dislocation in Cerebral Palsy Patients with Unilateral Hip Dislocation: A Scoring System to Guide Decision Making

Tangadulrat P., Adulkasem N., Suganjanasate K., Wongcharoenwatana J., Ariyawatkul T., Eamsobhana P., Chotigavanichaya C.


BACKGROUND: Cerebral palsy (CP) patients commonly present with unilateral hip dislocation. However, the decision for concurrent prophylaxis surgery on the contralateral hip in this condition is still controversial.

AIM: This study aims to explore the prognostic factors for contralateral hip dislocation and develop a scoring system.

MATERIALS AND METHODS: Data on CP patients with unilateral hip dislocation between January 2005 to January 2019 were reviewed. We explored the difference of preoperative parameters between the group in which the contralateral hip is eventually dislocated or remains stable. A multivariable logistic regression analysis was performed to develop a model for predicting contralateral hip dislocation.

RESULTS: Seven of included 30 patients (23.3%) developed contralateral hip dislocation. Pre-operative contralateral hip’s Reimer’s Migration Index (RMI), Acetabular Index (AI), Lateral Center Edge Angle of Wiberg (CEA), and Pelvic obliquity (PO) were significantly different (p = 0.049, 0.019, 0.030 and 0.038 respectively). The multivariable logistic regression analysis reveals that RMI > 25% (mOR 36.66, 95% CI 1.13–1185.50, p = 0.042) and age <9 years old (mOR = 22.55, 95% CI 0.76–665.37, p = 0.071) are significant predictors. Both parameters were included in the model, which revealed an AuROC of 0.84 (95% CI 0.69–0.99). Each factor was assigned a score of 1. There was no contralateral hip displacement in patients with a score of 0. Two out of 15 patients (28.6%) with a score of one developed contralateral hip displacement. Five out of eight (71.4%) patients with a score of 2 developed contralateral hip dislocation.

CONCLUSIONS. Significant predictors for contralateral hip dislocation in CP patients are RMI >25% and age <9 years old. The proposed scoring system might help guide the surgeon’s decision to perform contralateral prophylactic surgery.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2022;12(3):289-300
pages 289-300 views

Postoperative complications in children with Crohn’s disease: an analysis of risk predictors

Shcherbakova O.V., Shumilov P.V.


BACKGROUND: Crohn’s disease is an incurable progressive condition of the gastrointestinal tract in which up to 90% of patients undergo one or more surgical interventions during their lifetime. Despite the active development and implementation of new surgical techniques for the treatment of Crohn’s disease, the incidence of postoperative complications remains high, i.e., up to 25%–30%. Until now, the influence of various factors on the outcomes of surgical interventions and the choice of differentiated techniques for the surgical treatment of children with Crohn’s disease remain highly debatable.

AIMS: To study and identify possible risk factors for postoperative complications in children and adolescents with Crohn’s disease.

MATERIALS AND METHODS: A retrospective nonrandomized clinical study included 164 pediatric patients (boys, n = 106, 65%) with complicated forms of Crohn’s disease. Early results of surgical interventions on the intestines were analyzed (up to 30 days after surgery). Postoperative complications were noted in 15% of cases after the initial surgery (20/133). In half of the cases (66/133) re-interventions on the intestines were performed at different times after the initial surgery, of which postoperative complications were detected in 14% of the cases (9/66). To determine risk factors in dichotomous variables, contingency tables were constructed with the calculation of the odds ratio (OR) and their 95% confidence interval (95% CI). Differences were recognized as statistically significant at p < 0.05.

RESULTS: The following predictors of postoperative complications were identified: penetrating Crohn’s disease with strictures (OR 5,1; 95% CI 1,73–14,8; p = 0,0047), intestinal fistulas (OR 5; 95% CI 1,73–14,8; р = 0,0047), fibrosis in intestinal mucosal biopsy (OR 8,9; 95% CI 1,22–53; p = 0,0093), steroid therapy before surgery (OR 14,6; 95% CI 1,08–135; р = 0,0105), onset of CD in <6 years of age (OR 10,8; 95% CI 1,16–137; р = 0,0177), combination of CD of any localization with lesions of the upper gastrointestinal tract (OR 13,8; 95% CI 1,01–143; р = 0,0247), severe hypoalbuminemia (OR 9,62; 95% CI 1,04–122; p = 0,0228) and no specific therapy for Crohn’s disease after surgery (OR 10,8; 95% CI 1,16–137; p = 0,0177).

CONCLUSIONS: The development of surgical strategy in the preoperative period based on the identification of reliable predictors of adverse outcomes helps reduce the risk of postoperative complications. This improves the early outcomes of surgical treatment of children with complicated forms of Crohn’s disease.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2022;12(3):301-310
pages 301-310 views

First experience of using a vacuum bell in the treatment of pectus excavatum in children

Shominova A.O., Mitupov Z.B., Razumovsky A.Y.


BACKGROUND: To date, N.F. Filatov Children’s Hospital has great experience in the surgical correction of pectus excavatum in children. For 22 years, >1000 minimally invasive repair procedures of pectus excavatum were performed in the thoracic surgery department. Despite the satisfactory and excellent outcomes of the surgical correction of pectus excavatum, the search for alternative nonsurgical methods of treating this pathology continues. In world practice, a vacuum bell is used as a conservative treatment. However, its effectiveness and indications are still in question.

AIM: To evaluate the first experience of using a vacuum bell in the treatment of pectus excavatum in children.

MATERIALS AND METHODS: A vacuum bell is a device consisting of sight glass, silicone ring, and manual pump, lifting chest wall deformities through a vacuum. The device is selected individually depending on the growth and shape of the ventral surface of the chest. According to instructions, the vacuum bell should be used a minimum of 1 h per day. All patients underwent a standardized assessment of the results of treatment every 3–6 months: measuring the depth of deformation, visual treatment control, analysis of photo documentation, and questionnaires.

RESULTS: In the N.F. Filatov Children’s Hospital from 2015 to 2021, treatment results of 35 children using vacuum bell for 6–36 months were analyzed. Patients were divided into two groups depending on the percentage of deformation correction. The first group included 23 (65.7%) patients, and the percentage of correction was >50%. The second group included 12 (34.3%) patients, and the percentage of correction was <50%. In these groups, the main differences in the age of treatment initiation, regularity of use, and time of daily use have influenced the results. In the first and second groups, the average ages were 8.7 ± 2.69 and 13.7 ± 3.56 years, and the average daily use times were 5.7 ± 2.04 and 3.6 ± 1.61 h/day, respectively.

CONCLUSIONS: Vacuum bell therapy is an effective and safe method for correcting pectus excavatum in children, and in some cases, it can be an alternative to surgical treatments.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2022;12(3):311-318
pages 311-318 views

Dynamics of the testicle volume after scrotal and trans-inguinal orchiopexy in children aged 6–18 months

Kogan M.I., Makarov A.G., Sizonov V.V.


BACKGROUND: Currently, scrotal and inguinal approaches are widely used for the treatment of low-positioned palpable forms of cryptorchidism. In the literature, available data demonstrate the comparability of the results obtained after using both techniques; however, the effectiveness reported in the literature was obtained based on rough criteria, such as the presence or absence of atrophy and malposition of the testis in the postoperative period.

AIM: To study the dynamics of the testicular volume in the postoperative period after performing scrotal and trans-inguinal orchiopexy.

MATERIALS AND METHODS: The study was based on the experience of treating 139 patients with palpable unilateral, low-positioned testis, aged up to 18 months, who underwent surgery within the period from 2010 to 2020. The low-positioned ones were those testicles that, during traction, could be descended beyond the superficial inguinal ring; however, the testis did not descend into the scrotum. By mechanical sampling, the patients were divided into two groups. Group I included 69 (49.6%) boys (median age, 17 [15–17] months) who used scrotal access, whereas group II included 70 (50.4%) patients (median age, 15 [14–17] months) with trans-inguinal access. The volume of the undescended testis was determined in both groups before surgery and after 1, 3, and 12 months.

RESULTS: Patients who had testicular atrophy and malposition that developed after surgery, wound infection, and hematoma, and did not show up for at least one of the scheduled examinations were excluded from the study. After applying the exclusion criteria, 22 boys remained in group I and 29 boys in group II. The volume of a normal testicle before surgery was 2.09 cm3 [1.25; 2.58] group I and 1.69 cm3 [1.41; 2.22] in group II (p = 0.537). In group I, a significant increase was found in the testicular volume from 0.5 cm3 [0.4; 0.8] before surgery to 1.3 cm3 [0.7; 1.8] (p < 0.001) a year after orchiopexy. In group II, the testicular volume increased from 0.6 cm3 [0.3; 0.8] before surgery to 0.7 cm3 [0.4; 1.0] after surgery.

CONCLUSIONS: Scrotal access in the treatment of a palpable, low-positioned undescended testis in children aged 6–18 months provides a greater increase in the volume of the operated testicle in a year compared with trans-inguinal access 1 year after surgery. The results suggest that transcrotal access has some advantages over trans-inguinal access.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2022;12(3):319-326
pages 319-326 views

Surgical treatment of children with pilonidal cysts

Smirnov A.N., Golovanev M.A., Poverin G.V.


BACKGROUND: Pilonidal cyst (other names: pilonidal disease and epithelial coccygeal tract) is a common congenital pathology and most often manifested in adolescence.

AIM: To determine the optimal treatment and diagnostic measures that lead to a reduction in complications and improvement in the quality of life of sick children with pilonidal cysts.

MATERIALS AND METHODS: Case histories of 310 children with pilonidal cysts who were treated at the N.F. Filatov Children’s City Clinical Hospital (Moscow) and Republican Children’s Clinical Disease in Izhevsk in 2013–2018 were analyzed. The patients (95%) were predominantly adolescents. The patients were divided into four groups: group 1 (n = 78), acute inflammation of the cyst; group 2 (n = 75), cyst without signs of inflammation; group 3 (n = 125), cyst with chronic inflammation; group 4 (n = 32), disease relapse. For diagnosis, clinical and ultrasound examination was conducted for uncomplicated cysts. The surgery was performed after fistulography and consisted of cyst excision to the sacral fascia with tight tightening or installation of an aspiration drain. Surgical intervention was preceded by laser treatment in the surgical field.

RESULTS: The severity of infiltration of the surrounding tissues in the postoperative period, depending on the drainage of the wound, was significantly different. More pronounced infiltrative changes were noted in patients with drainage and, accordingly, later terms of wound healing. Following double epilation with a neodymium laser, the frequency of postoperative purulent inflammatory complications was reduced (7.3%). The excision of the pilonidal cyst 1 month after acute inflammation with wound closure and involvement of the sacral fascia without drainage was the most effective.

CONCLUSIONS: Ultrasound examination is a highly informative method that allows for determining the parameters of uncomplicated cysts. Laser epilation in the preoperative period helps reduce purulent inflammatory complications.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2022;12(3):327-335
pages 327-335 views

Effectiveness of urethral endosphincteroplasty in children with urinary incontinence, myelodysplasia, and epispadias

Demidov A.A., Mlynchik E.V.


BACKGROUND: Periurethral injections of various materials in the treatment of stress urinary incontinence have been known since 1938. In the literature, we could not find reports of endosurgical correction of urinary incontinence as the main method of treatment in children with myelodysplasia and epispadias and a pathogenetically based examination algorithm to predict the result of the injection, taking into account the endoscopic technique and volume of the injected drug.

AIM: To present an assessment of long-term results, i.e., correction of stress urinary incontinence in children with myelodysplasia and epispadias, after endoimplantation of a stable synthetic volume-forming polymer.

MATERIALS AND METHODS: The study analyzed 38 patients (5–17 years old) with urinary incontinence with myelodysplasia and epispadias: boys and girls with epispadias (n = 9 and n = 3, respectively) and with myelodysplasia (n = 10 and n = 16), respectively. For diagnostic purposes, clinical and instrumental (excretory urography, cystography, cystoscopy, uroflowmetry, electrophysiological, and urodynamic) examination methods were used. To correct incontinence, intra- and paraurethral endoinjections of a “stable” polyacrylamide mesh polymer with silver ions were performed.

RESULTS: According to the literature, the effectiveness of the intraurethral administration of stable implants with urinary incontinence in catamnesis for up to 12 months reached 50%; with longer follow-up, positive results did not exceed 40% of observations. In this study, complete retention of urine was achieved in 25 (66%) children. Satisfactory result (incontinence in the afternoon up to 40 mL) was observed in 8 (21%) children, and unsatisfactory in 5 (13%) children.

DISCUSSION: Indications for endosphincteroplasty in children with stress incontinence having myelodysplasia and epispadias with a stable implant should be determined considering urodynamics, blood circulation, innervation, and functional (urethral profilometry) parameters in the detrusor-sphincters-pelvic floor system.

CONCLUSIONS: In patients with myelodysplasia and epispadias with isolated insufficiency of urethral sphincters, surgical treatments can be performed independently, and their effectiveness can reach 70%.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2022;12(3):337-350
pages 337-350 views

Comparative assessment of the predictive ability of the nSOFA and NEOMOD scales in preterm newborns

Idrisova R.G., Amirova V.R., Mironov P.I., Lekmanov A.U.


BACKGROUND: A life-threatening organ dysfunction is a strong predictor of in-hospital mortality and adverse outcomes in pediatric patients and full-term neonates. Predictors of outcomes of multiple-organ failure in preterm newborns have not yet been sufficiently determined.

AIM: To compare the discriminatory ability of neonatal sequential organ failure (nSOFA) and NEOMOD organ dysfunction scales as predictors of poor outcomes in very preterm newborns.

MATERIALS AND METHODS: This prospective observational study included 109 newborns with a birth weight of 1071 (772–1451) g and gestational age of 29 (26–32) weeks; 22 (20.4%) of them died.

RESULTS: The area under the receiver operating characteristic curve was 0.796 (95% confidence interval (CI) 0.763–0.827) for the nSOFA scale and 0.771 (95% CI 0.721–0.817) for the NEOMOD scale.

CONCLUSIONS. Both scales are suitable for measuring the severity of organ dysfunction in preterm newborns. nSOFA appears to predict mortality in preterm newborns.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2022;12(3):351-359
pages 351-359 views

Efficiency of intravenous infusion of ketamine and lidocaine as part of multimodal analgesia in the postoperative period in children

Bazylev V.V., Shcheglova K.T., Chuprov M.P., Magilevets A.I.


BACKGROUND: The improvement of multimodal anesthesia schemes is of clinical interest because of the possibility of reducing the doses of narcotic analgesics and the earlier mobilization of patients postoperatively.

AIM: To evaluate the efficiency of intravenous infusion of ketamine and lidocaine as adjuvants for multimodal analgesia in children aged <1 year after cardiac surgery.

MATERIALS AND METHODS: A prospective single-center study included 122 children aged <1 year, who divided into three groups: group 1, postoperative pain management included a combination of fentanyl and ketamine (n = 40); group 2 (n = 41), lidocaine infusion in combination with fentanyl; group 3 (n = 41), standard analgesia (fentanyl). The median ages at the time of surgery were 4.0, 4.5, and 4.0 months in groups 1, 2, and 3, respectively. Anatomical, demographic, clinical, and laboratory parameters were analyzed before surgery and early after surgery.

RESULTS: The pain intensity according to the Neonatal Infant Pain Scale did not differ among the groups at any stage of the study. The average dose of fentanyl was twice as high in group 3 at 1.6 mcg/kg/h compared with 0.5 mcg/kg/h in group 1 and 0.6 mcg/kg/h in group 2. Group 2 had a shorter duration of mechanical ventilation in an intergroup comparison. The side effects of lidocaine were not recorded, and hypersalivation was noted in 35% of the patients who were treated with ketamine.

CONCLUSIONS: Ketamine infusion as an adjuvant to multimodal analgesia provides an adequate analgesic effect without a significant effect on hemodynamics and allows a reduction in the dose of opioids. The intravenous infusion of lidocaine as a component of multimodal analgesia after cardiac surgery in children has an additional opioid-sparing effect and reduces the mechanical ventilation time. The use of lidocaine at a dose of 1 mg/kg/h is not accompanied by side effects.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2022;12(3):361-370
pages 361-370 views


Intraoperative methods for assessing blood loss: A review

Mezhevikina V.M., Lazarev V.V., Zhirkova Y.V.


Massive blood loss that develops during surgery is a common cause of life-threatening conditions and deaths in patients of any age.

This study aimed to analyze domestic and foreign publications that present methods for determining the volume of intraoperative blood loss.

The literature sources were searched in PubMed, Scopus, Web of Science, MEDLINE, eLibrary, and Russian Science Citation Index databases. The search was conducted in Russian and English using the following keywords: intraoperative blood loss, severity of blood loss, methods for assessing blood loss, direct methods, and indirect methods. The literature review included five articles from PubMed, nine from Scopus, six from Web of Science, two from MEDLINE, six from eLibrary, and four from Russian Science Citation Index.

Massive blood loss is understood as a one-time loss according to some authors of >30% and according to others of >50% of the volume of the circulating blood or blood loss equal in volume to 2–3 mL/kg/min. Risk factors for the development of intraoperative complications such as massive blood loss are, in addition to surgical interventions, the features of surgical intervention, i.e., size of the incision, surgical duration, and anesthesia, which can increase blood loss. The intensity and degree of blood loss are very important in determining the indications for transfusion of blood components, replenishing the volume of circulating blood, and determining indications for intraoperative hemostasis, both medical and surgical. In neonates and young children, the risk of dangerous intraoperative blood loss is associated with anatomical and physiological features, i.e., a small volume of circulating blood and insufficiently mature compensatory mechanisms. In older children, a high risk of massive blood loss is associated with comorbidities, features of hemostasis, and use of drugs that slow down the blood coagulation process.

To date, several methods are available for assessing intraoperative blood loss, but only a few are used in routine clinical practice. Each method has advantages and disadvantages. One of the main disadvantages is the complexity of the mechanisms for assessing blood loss, for example, weighing surgical materials or the patient before and after surgery, determining hemoglobin in the liquid after soaking the used surgical materials, and calculating indices using formulas. Most often, the assessment of blood loss is conducted according to the clinical picture (pallor of the skin and mucous membranes, weak pulse, lowering blood pressure, etc.).

The results of the literature analysis showed insufficient research on determining the volume of intraoperative blood loss in pediatric practice, as evidenced by the small number of published scientific papers and the complete absence of randomized trials. Thus, further study of this problem is necessary.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2022;12(3):371-381
pages 371-381 views

Case reports

Situs inversus totalis in combination with hiatal hernia and hereditary hemolytic anemia in a 4-year-old child: A case report

Sharipov A.M., Mukhiddinov N.D., Rahmatova R.A., Mazabshoev S.A.


Situs inversus totalis is an extremely rare anomaly in which the organs of the chest and abdominal cavity lie in the opposite direction. With complete transposition, clinical manifestations may be absent, and diagnostic and therapeutic problems may arise in the presence of other malformations or diseases.

A 4-year-old girl was admitted for treatment in the hematology department of the National Medical Center of the Republic of Tajikistan, with complaints of nausea, periodic vomiting, lethargy, lack of appetite, malaise, and skin pallor. Owing to the ineffectiveness of conservative therapy, surgical treatment was recommended, i.e., splenectomy. During the preoperative examination, radiography and radiopaque examination of the organs of the gastrointestinal tract with barium sulfate revealed that the fundus and body of the stomach were located in the left half of the chest, and the heart was symmetrically deployed to the right. An ultrasound examination revealed signs of displacement of the liver to the left half of the abdomen, the spleen to the right, and the heart in the right half of the chest. The diagnosis was “hiatal hernia on the left, situs inversus totalis, hereditary hemolytic anemia, fermentopathy, and G-6-PD deficiency.” Laparoscopic surgery was performed, which included splenectomy, elimination of a hiatal hernia, chiatoplasty, and esophagogastrofundoplication with the creation of a Nissen cuff. The girl was discharged on day 10. On control examination after 6 and 12 months, she had no complaints and has grown and developed according to age.

This clinical case is the first in the Russian literature to describe the treatment of a child with a hiatal hernia against the background of complete transposition of internal organs. This case highlights the need for imaging techniques for any unclear symptoms, especially in children with hereditary diseases. Minimally invasive intervention could contribute to a favorable outcome.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2022;12(3):383-390
pages 383-390 views


To the 75th anniversary of Vladimir I. Petlakh

Rozinov V.M.


The paper describes the professional activities and merits of the pediatric surgeon, science editor of “Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care”, Vladimir I. Petlakh in celebration of his anniversary.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2022;12(3):391-392
pages 391-392 views

To the 50th Anniversary of Maksim P. Razin

Zheleznov L.M., Skobelev V.A.


The paper describes the professional activities and merits of the pediatric surgeon Maksim P. Razin in celebration of his anniversary.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2022;12(3):393-394
pages 393-394 views

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies