Vol 12, No 4 (2022)

Original Study Articles

The results of treatment of newborns with right-sided and left-sided intrathoracic localization of the liver with diaphragmatic hernia

Mokrushina O.G., Razumovskiy A.Y., Yudina E.V., Afukov I.I., Shumikhin V.S., Smirnova S.V., Zilbert E.V., Petrova L.V., Erokhina N.O., Halafov R.V., Svetlichnaya T.O.


BACKGROUND: The right-sided congenital diaphragmatic hernia is the rare pathology. Results of diagnostics, prognosis and treatment usally published as a collection of cases.

AIM: Comparition of treatment results of congenital diaphragmatic hernia with the liver as its content in dependancy of the side.

MATERIALS AND METHODS: We present a retrospective analysis of 50 newborn patients with congenital diaphragmatic hernia. Patiens were divided in two groups, first — with right-sided (19 patients), and second — with left-sided hernia (31 patients). Groups were compared by gender and weigth. Comparition criteria was the results of prenatal and postnatal diagnostics, intraoperative data, postoperative period, complications and outcomes.

RESULTS: We found predominance of prenatal diagnosis in the second group (48% vs 84%, p = 0,001). The lung-to-head circumference ratio were the same in both groups (0,52 in first, 0,46 in second, p = 0,058). Chance to use thoracoscopic approach in the second group was higer in 5,7 times (48% vs 84%). Postoperative period was easier in the group of right-sided congenital diaphragmatic hernia: artificial ventilation lasted on average 8 days (min 3; max 28) versus 11 (min 4; max 50) days in the first group (p = 0,036).

Hospital stay was significantly lower in the second group — 18 days (min 12; max 28), versus 50 days in the first group (min 13; max 64), p = 0,011. Recovery chance in patients with right-sided hernia was higher (45% vs 79%, confidence interval 0,059–0,814).

CONCLUSIONS: Every type of diaphragmatic hernia, including right-sided location, need to be the subgect of research of high compitantive center. Prognostic criteria for right-sided congenital diaphragmatic hernia require furter advanced study, wich is possible only in case of concentration of patients in the same center.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2022;12(4):401-410
pages 401-410 views

One-stage transcrotal orchidopexy in bilateral inguinal cryptorchidism in children

Akramov N.R., Khaertdinov E.I., Pospelov M.S., Rakhmatullaev A.A., Isroilov A.A.


BACKGROUND: The frequency of cryptorchidism varies and depends on gestational age, affecting 1.0–4.6% of full-term and 1.1–45% of preterm newborns. Treatment of this defect is currently surgical. Orchiopexy is one of the frequent surgical aids in the practice of a pediatric surgeon and a pediatric urologist. The need for bilateral inguinal cryptorchidism to perform several incisions or separate operations on each side by time forces pediatric surgeons to continue searching for the optimal way to correct bilateral cryptorchidism.

AIM: To determine the possibilities of fixation of both testicles with bilateral cryptorchidism in a physiological position in the scrotum through a single surgical approach with fewer complications and improved cosmetic result in comparison with the previously proposed methods.

MATERIALS AND METHODS: From 2012 to 2021, we treated 92 male children with bilateral inguinal cryptorchidism. All boys underwent the developed method of single-stage transcrotal bilateral orchiopexy, accompanied, if necessary, by laparoscopic assistance using the method of single-acar laparoscopic access.

RESULTS: The results of treatment of 92 children with bilateral inguinal cryptorchidism (184 gonads) in several clinics using this method are presented. Thanks to the improvement of the technology of orchiopexy in the form of single-acar laparoscopic assistance in cases that do not allow the testicle to be freely lowered into the scrotum, the number of complications associated with surgical access, such as pronounced postoperative edema and inflammation of the postoperative wound area, decreased to 1.62% of cases, and there were no relapses of the disease and persistent inguinal hernias.

CONCLUSIONS: The article describes a new method of single-stage transcrotal orchiopexy with laparoscopic assistance and statistically substantiates its use in bilateral inguinal cryptorchidism, which allows fixing both testicles in a physiological position in the scrotum at any position of the testicles in the inguinal region with fewer complications and improved cosmetic result in comparison with the previously proposed methods.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2022;12(4):411-418
pages 411-418 views

The shape of the kidney pelvis in the fetus with hydronephrosis grade III as a predictor of surgical treatment in postnatal period

Bondarenko S.G., Agzamkhodjaev S.T., Boyko A.V., Kuzovleva G.I.


BACKGROUND: Fetal hydronephrosis is one of the most common malformations of the urinary system. The main goal of prenatal diagnostics is to identify a risk group with a dilatation of the renal collecting system due to mechanical obstruction of the pelvic-ureteral segment.

AIM: The aim of the study is to definition of a prenatal risk group with a high probability of early surgical intervention in the postnatal period based on an assessment of the predictor properties of the pelvis shape in hydronephrosis grade III.

MATERIALS AND METHODS: A prospective analysis of the results of prenatal ultrasound examination of 77 fetuses (82 renal units) with grade III hydronephrosis (SFU classification) was carried out. The anteroposterior diameter of the pelvis was measured in millimeters at the level of the kidney gate. With the ellipsoid shape of the pelvis, the compression ratio of the ellipse was calculated as the ratio of the small semi-axis of the ellipse to its large semi-axis. All parameters were recorded in the third trimester of pregnancy. The study included cases of hydronephrosis with parenchymal thickness not differing by more than two sigma deviations from the standard value. The first ultrasound examination in the postnatal period was performed during the first month of life and then at 3, 6 and 12 months.

RESULTS: Prenatally, 57 kidneys had an elliptical pelvis and 25 funnel-shaped. The anteroposterior diameter of ellipsoid (16.5 [13; 20]) and funnel-shaped pelvis (15.0 [13; 17.8]) did not differ statistically significantly (p = 0.39). 36 (43.9%) patients were operated on, 29 of them were operated at the age of 1–3 months, due to the increase in APD from 17.5±6.0 to 27.9±8.2 (p = 0.001) and the transition of hydronephrosis to the IV degree by 1 month of life. The remaining 7 children had gradual progression of hydronephrosis and were operated at the age of 12 months and older. In 56.1%, resolution, regression or stabilization of hydronephrosis were noted during dynamic observation lasting 1 year. With a single-variant analysis, it was found that the configuration of the pelvis and the compression ratio of the ellipse statistically significantly correctly predicted the progression of hydronephrosis and the probability of surgery at 69.5% and 80.5%, respectively. At the same time, the compression ratio had a higher sensitivity and specificity.

CONCLUSIONS: Fetal hydronephrosis with a funnel-shaped configuration of the pelvis, has a functional nature and regresses after birth during the first year of life. The antenatal ellipsoid configuration of the pelvis, approaching the circumference, is a statistically significant predictor of surgical intervention due to the progression of hydronephrosis due to external causes of obstruction.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2022;12(4):419-428
pages 419-428 views

Factors contributing to the late diagnosis of appendicitis in children: the results of a retrospective study

Yanitskaya M.Y., Kharkova O.A., Markov N.V., Zolotarev N.V.


BACKGROUND: The diagnosis of acute appendicitis in children is often established late, which leads to complications, lethal outcomes are recorded.

AIM: To identify and analyze the factors contributing to the late diagnosis of acute appendicitis in children.

MATERIALS AND METHODS: A retrospective analysis of 279 case histories of children was carried out. The duration of symptoms is divided into “time 1” (before hospitalization) and “time 2” (from hospitalization to surgery). Patients were divided into two groups: 1st — with destructive uncomplicated appendicitis (phlegmonous, gangrenous), 2nd — with complicated appendicitis (unrestricted peritonitis, infiltrate, abscess). The causes of late hospitalization, symptoms indicated in the case histories, examinations performed, postoperative complications were analyzed. The diagnosis was established on the basis of intraoperative data, histological examination.

RESULTS: In the 1st group, time 1 and time 2 were significantly less than in the 2nd (p < 0.001; 0.028). Late presentation (>24 hours) in 21.9%, misdiagnosis in 12.2% of cases. In the hospital, the observation of the patient >12 hours in 21.1% of patients. The frequency of presence / absence of a description of clinical and laboratory signs of acute appendicitis is from 100 to 19.7%. The 2nd group was characterized by: duration of symptoms >24 hours, repeated vomiting (p < 0.001), febrile condition (p < 0.001), increase in neutrophils 90% (87–92%). Ultrasound examination with evaluation of the appendix — in 20.1% of cases with a diagnostic accuracy of 89.3%. Laparoscopic appendectomy in 53.2% Alvarado scores are significantly higher in 2nd group (8–10) than in 1st group (7–9, p < 0.001). In 1st group, complications were significantly less than 3.4% than in 2nd group — 22.7 % (p < 0.001).

CONCLUSIONS: Factors contributing to the late diagnosis of appendicitis in children are: late treatment, diagnostic errors at the prehospital stage, incomplete clinical examination and observation, insufficient use of laboratory and instrumental methods.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2022;12(4):429-440
pages 429-440 views

Respiratory parameters as a predictor of hospital outcomes in newborns requiring medical evacuation

Mukhametshin R.F., Kovtun O.P., Davydova N.S.


BACKGROUND: Assessment of the clinical condition, prediction of risks and possible outcomes during the transfer of newborns remains an important part of the work of transport teams. Respiratory disorders remain a significant indication for transfer to medical organizations of a higher level of care.

AIM: To study the predictive value of the parameters of respiratory support in newborns requiring medical evacuation for the outcomes of treatment.

MATERIALS AND METHODS: The observational, cohort, retrospective study included data from neonatal to patients on ventilators (286 newborns) in the period from August 1, 2017 to December 31, 2018. Anamnesis parameters, intensive care volume, respiratory support settings, and assessments on scales (KSHONN, NTISS, TRIPS) were evaluated. Analyzed: 24-hours mortality, 7 days mortality, hospital mortality, air leakage syndrome. The assessment and comparison of the predictive value of the parameters in relation to the hospital outcomes was performed.

RESULTS: The AUC ROC of SpO2/FiO2 for predicting 24-hours mortality was 0.984 [0.966–1.000], which is significantly higher than the ROC of the saturation oxygenation index (AUC 0.972 [0.949–0.995], p = 0.004). The area under the ROC of the 24-hours mortality on the TRIPS scale does not significantly differ from the saturation index of oxygenation (AUC 0.972 [0.949–0.995], p = 0.113) and the mean airway pressure (AUC 0.943 [0.884–1.000], p = 0.107). When predicting 7-day mortality, the saturation oxygenation index has AUC ROC (0.702 [0.549–0.854]) significantly lower than AUC ROC for SpO2/FiO2 (0.762 [0.638–0.887], p = 0.001). SpO2/FiO2 predicts total mortality with AUC ROC (0.759 [0.677–0.841]).

CONCLUSIONS: The mean airway pressure, saturation oxygenation index and SpO2/FiO2 have a high (AUC > 0,9) predictive value for 24-hours mortality, while only SpO2/FiO2 reliably predicts total mortality with AUC ROC > 0,7.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2022;12(4):441-452
pages 441-452 views

Methods of local anesthesia in postoperative anesthesia of oncosurgical operations on the nasopharynx in children

Korobova L.S., Matinyan N.V., Merkulov O.A., Korolev V. ., Lazarev V.V., Ovchar T.A., Akimov V.P., Kovaleva E. .


BACKGROUND: Postoperative analgesia should begin even in the operating room, so that at the time of awakening the patient does not experience pain and discomfort. The work is devoted to the problems of postoperative analgesia using local anesthesia techniques in oncosurgery of the nasopharynx in children.

AIM: The aim of the study to analyze the primary results of the use of local anesthesia methods in postoperative analgesia in pediatric oncosurgery of the nasopharynx.

MATERIALS AND METHODS: A study was conducted in the immediate postoperative period (16 hours) in ten patients, whose average age was 14 years with ENT surgical pathology. The physical status of the children corresponded to the I–II class according to the ASA classification. The patients were divided into two equal groups of 5 people: the 1st group included children who, for the purpose of postoperative analgesia at the end of the surgical intervention, underwent conduction anesthesia of the nose from three points according to Weisblat; the 2nd group (comparison group) is represented by patients in whom infraorbital anesthesia was used after surgery. Non-invasive monitoring of systolic and diastolic blood pressure, heart rate was carried out. The oxygen status was monitored by pulse oximetry.

RESULTS: The data obtained from the analysis of hemodynamic parameters, pain assessment by VAS (Visual Analog Scale) testified to the effectiveness of pain relief in patients in the study groups. The main hemodynamic parameters and pain assessment data for the groups were similar to each other and were within the reference values. There were differences in the duration of postoperative analgesia.

CONCLUSIONS: The proposed methods of postoperative analgesia make it possible to abandon the use of narcotic drugs, synthetic opioid analgesics, non-steroidal anti-inflammatory drugs, but not excluding analgesics — antipyretics. The positive first results of this study provide for the need for a further set of observations, possibly in different clinics due to the relative rarity of oncological pathology of the nasopharynx in childhood.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2022;12(4):453-460
pages 453-460 views


Fundamentals of photodynamic therapy, clinical practice and prospects for use in pediatric surgery. Review

Bataev S.M., Tsilenko K.S., Osipov A.N., Reshetnikov A.V., Bataev A.S., Sosnova S.P.


The paper provides a review of domestic and foreign literature on photodynamic therapy, which is mainly used by oncologists in the treatment of adult patients and is little known to pediatric surgeons. The aim of this work is to describe the history of the formation, principles and mechanisms of photodynamic therapy, the main groups of photo sensitizers, areas of clinical application and prospects for wider use in pediatric surgery.

Literature sources were searched in the databases in Russian eLibrary and English Medline and PubMed. The following keywords were specified for the search: photodynamic therapy, dysplasia, metaplasia, angiodysplasia, Barrett’s syndrome, children. 865 papers were found, of which 66 were fully consistent with the purpose of our study and were analyzed.

The data presented in the review of the literature indicate the high efficiency of the method of photodynamic therapy in the treatment of a number of diseases, mostly in oncology. In addition, the work contains theoretical calculations and separate reports on the effectiveness of the method in the treatment of dysplasia of varying degrees in children.

Taking into account the minimally invasiveness of the technique, the relative cheapness of photosensitizers and equipment for generating laser radiation, it is possible to create a basis for conducting research on the treatment of children with various dysplasias, epithelial metaplasia, and vascular malformations. Another promising direction is the development of technologies for the use of photodynamic methods for the treatment of severe forms of pyoinflammatory diseases in children.

In childhood surgery, there are nosological forms of diseases where the method of photodynamic therapy has the prospect of effective use. Limitations on the scope of this article do not allow for a detailed analysis of the existing experience in the use of photodynamic therapy in children, which will need to be done in subsequent works.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2022;12(4):461-472
pages 461-472 views

Case reports

Congenital portosystemic shunts: surgical treatment experience

Stepanov A.E., Sukhov M.N., Vasilyev K.G., Polyaev Y.A., Garbuzov R.V., Golenishchev A.I., Ashmanov K.Y., Lyvina I.P., Demushkina A.A., Tereshina A.A.


Congenital porto-caval shunts are rare and may have a different morphological structure (intra- and extrahepatic shunts, with or without portal blood flow). The main method of treating patients with this pathology is endovascular shunt occlusion. However, in some cases, this method is ineffective.

The article contains a description of six clinical examples of surgical treatment of congenital porto-systemic shunts in children. In the diagnosis of congenital portosystemic shunts, the leading role belongs to Doppler ultrasound, multislice computed tomography, and angiography. The indication for surgical treatment was the anatomical features of the shunt, which makes endovascular occlusion technically impossible. In one observation a wide Arantian duct was diagnosed, its open ligation was performed. In another case, the portal vein emptied directly into an aneurysmal dilatation, performed reconstructive plastic surgery on the vessels of the portal vein. In the next observation, a pronounced retrograde blood flow was determined along the dilated inferior mesenteric vein, blood was discharged through the sacral plexus into the internal iliac vein. The left internal iliac vein was isolated and ligated, the dysplastic inferior mesenteric vein was ligated and partially removed. In 2 patients, the portal vein flowed directly into the inferior vena cava in the area of aneurysmal expansion; an operation was performed — open ligation of the shunt. In one observation, a deep hypoplasia of the intrahepatic branches of the portal vein was diagnosed, and therefore the restoration of portal blood flow after the closure of the shunt is impossible. The child was sent to decide on a liver transplant.

Each case of congenital porto-caval shunts is unique. The surgeon determines the tactics directly during the operation, depending on the morphological structure of the organs, since the preoperative examination does not always give an unambiguous idea.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2022;12(4):473-487
pages 473-487 views

Pneumothorax in newborns with multisystem inflammatory syndrome associated with COVID-19: a case reports

Shangareeva R.K., Absalyamova N.T., Fedorova R.R., Tikhonova I.V., Mukhamedova R.K., Alibaev A.K., Minibaeva G.I.


Currently, there is more and more data on new manifestations of COVID-19, such as multisystem inflammatory syndrome in children, which occurs with severe complications, among which cases of pneumothorax have been recorded.

The article presents the experience of treating 4 newborns with a new coronovirus infection who were admitted to the clinic during 2021. In all clinical cases, children were born to mothers with a burdened obstetric history. All children had a positive RNA polymerase chain reaction for SARS-CoV-2. Children were admitted with signs of respiratory, cerebral insufficiency, gastrointestinal syndrome and metabolic disorders. The clinical picture and laboratory data corresponded to the definition of a multisystem inflammatory syndrome and was characterized not only by lung damage, but also by changes in other organs. Pneumothorax was diagnosed on days 15–21. In all children, a tension pneumothorax developed on the right, in the first two cases against the background of mechanical ventilation, in the remaining two with spontaneous breathing with additional oxygenation. In one case, the pneumothorax was bilateral. Drainage of the pleural cavity in three children was carried out according to Bulau and in one case with active aspiration. Pneumothorax resolved after 4–14 days. Computed tomography of the chest, performed during the period of rehabilitation treatment, shows pronounced sclerotic and bullous changes in the lung parenchyma. All patients were discharged from the hospital in a satisfactory condition.

Since in all the above cases, pneumothorax occurred in newborns with a burdened obstetric history of mothers, it is difficult to differentiate the occurrence of pneumothorax associated with the underlying disease, the course of labor, complications of therapy, from the disease associated with COVID-19. Stronger evidence is needed from larger datasets and rigorous analysis.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2022;12(4):489-503
pages 489-503 views

Spontaneous biliary perforation in a child: case report and review

Pavlushin P.M., Porshennikov I.A., Pavlik V.N., Tsyganok V.N., Gramzin A.V.


Spontaneous perforation of the external biliary tract is an extremely rare pathology in childhood, presented in the literature by description of clinical cases. To date, a unified approach to the treatment of children with this pathology has not been developed.

The paper presents a clinical case of spontaneous perforation of the anterior wall of the common hepatic duct in a child of seven months, with the development of bilioperitoneum against the background of obstruction of the common bile duct by bilirubin calculi.

CASE REPORT. The disease began acutely with repeated vomiting, stool acholia, dark urine, and an increase in the size of the abdomen in a 7-month-old child. Examination in the hospital revealed ascites, cholecystitis and shadows of calculi in the projection of the hepatoduodenal ligament. According to the results of laparocentesis, bilioperitoneum was noted. The patient underwent laparotomy, 300 ml of serous-biliary effusion was removed from the abdominal cavity. On the anterior semicircle of the common hepatic duct there is a defect from which bile flows. Suturing of the perforation of the biliary tree, cholecystectomy and drainage of the external bile ducts through the stump of the cystic duct were performed. The cholangiostomy was removed after 1.5 months. Follow-up 1 year and 3 months, pathology is not determined during the examination.

CONCLUSIONS. Sewing up the site of primary perforation with drainage of the external biliary tract can help accelerate the reparative process with a decrease in the risk of developing a biliary fistula. Performing primary reconstructive interventions on the abdominal cavity compromised by bilioperitoneum, in our opinion, is too risky.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2022;12(4):505-512
pages 505-512 views

Chronic obstruction of the stomach as a result of congenital malformation in a child of 1 year 10 months. Case report

Schneider I.S., Tsap N.A., Gaydysheva E.V., Timoshinov M.Y., Ekimov M.N., Smirnova S.E.


Congenital malformation of the gastrointestinal tract in a rare case can cause partial obstruction and masquerade as functional disorders of the intestine for a long time. Atypical clinic of membranous gastric obstruction causes difficulties in diagnosis and determination of treatment tactics. The aim — to determine and present to the surgical community the features of diagnosis, surgical treatment, possible complications of a rare malformation of the stomach in children in the form of a stomach membrane.

The paper presents a clinical case of the stomach membrane in a child 1 year 10 months old with complaints of vomiting after each meal, bloating, lethargy for one month. The results of ultrasonography, X-ray examination with the passage of a contrast agent through the gastrointestinal tract, fibrogastroduodenoscopy established anatomical changes in the stomach in the form of pyloric stenosis up to 0.4–0.5 cm in diameter. Intraoperative revision of the stomach, supplemented by intraluminal endoscopic support, made it possible to reliably establish the presence of a perforated pyloric membrane. The membrane is radically cut along the entire circumference at the level of its base. The next postoperative period was uneventful. After 1.5 months, the child was again admitted to the pediatric surgical department on an emergency basis with a clinic of intestinal obstruction, including the child’s anxiety, repeated vomiting, and bloating. X-ray and endoscopic picture corresponded to the diagnosis of cicatricial stenosis of the pyloric part of the stomach. Taking into account the presence of cicatricial deformity, due to the high risk of complications during resection of the stenotic part of the stomach and the imposition of gastroduodenoanastomosis, a bypass retrocolic gastrojejunoanastomosis with Brown fistula was formed. When examining a child of a child in the late postoperative period, no complications were identified.

The presented clinical case confirms that congenital malformations of the gastrointestinal tract in the form of stenoses and membranes can have a long stage of compensation, their diagnosis is based on a comprehensive examination of the child using radiopaque and endoscopic studies.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2022;12(4):513-520
pages 513-520 views


Commentary on the article "Chronic obstruction of the stomach as a result of congenital malformation in a child of 1.10 months. Case report"

Sokolov Y.Y.


Commentary on the article Schneider IS, Tsap NA, Gaydysheva EV, Timoshinov MYu, Ekimov MN, Smirnova SE. “Chronic obstruction of the stomach as a result of congenital malformation in a child of 1.10 months. Case report” published in the Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2022;12(4):513–520. (In Russ.) DOI: https://doi.org/10.17816/psaic1283

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2022;12(4):521-524
pages 521-524 views


To the 75th Anniversary of Viktor V. Nesterov

Blandinsky V.F.


The paper describes the professional activities and merits of the pediatric surgeon Viktor V. Nesterov in celebration of his anniversary.

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2022;12(4):525-527
pages 525-527 views

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