Vol 14, No 2 (2024)

BACKGROUND: A unified system for assessing the severity of congenital clubfoot in newborns and young children worldwide remains to be established. “Rigidity” of foot deformity refers to the degree of “resistance” of foot tissues during manual correction of elements of the deformity and is often used in subjective severity of foot deformity assessment. However, there is no objective quantitative assessment for the degree of foot rigidity.

AIM: The study aimed to introduce a novel clinical sign — ”rigidity of foot deformation”, which enables objective assessment of the severity of foot deformity in congenital clubfoot.

MATERIALS AND METHODS: Before applying the first plaster cast, a clinical dynamometric examination was performed on 350 feet of 229 children, followed by a mathematical calculation of the foot rigidity index. Statistical analysis was performed using the nonparametric Mann–Whitney U-test and Spearman’s rank correlation coefficient. Differences were considered significant at p < 0.05.

RESULTS: Significant differences were found in all clinical and dynamometric parameters between congenital clubfoot of I–II, III, and IV degrees (p ≤ 0.05). Generally, the higher the degree of deformity, the more effort required to eliminate it, the smaller angle of simultaneous correction, and the higher index of foot rigidity. The results of Spearman’s correlation analysis of clinical dynamometric examination indicators in children with congenital clubfoot of I–II degree may indicate the mobile nature of the foot deformity; III degree, a rigid version of the deformity; and IV degree, an extremely rigid degree of deformity.

CONCLUSIONS: Rigidity of the foot deformity is a crucial clinical sign that characterizes the severity of the foot deformity, which has a quantitative characteristic — the rigidity index. Initial data on foot rigidity enables objective assessment of the severity of the deformity and selecting an individual approach to its elimination when applying staged plaster casts using the Ponseti method.

BACKGROUND: Anemia can be diagnosed before surgery, occur during surgical treatment, and develop and worsen in the postoperative period in children with surgical diseases. Anemia is associated with increased morbidity, severe complications, and even death after surgical treatment.

AIM: This study aimed to determine the frequency and indications for transfusion of red blood cell-containing components in the perioperative period in children in the first months of life.

MATERIALS AND METHODS: This cohort study included 187 children from the G.N. Speransky Children’s Hospital No. 9. The hemoglobin, hematocrit, and red blood cell levels were studied as well as the volume of intraoperative blood loss, hemodynamic parameters, the presence of hemorrhagic syndrome, and the use of adrenomimetics in the perioperative period. The stage of the perioperative (pre, intra, or post) period at which the transfusion of erythrocyte-containing components was conducted was recorded. Statistical data analysis was performed using the statistical computing environment R 4.3.0.

RESULTS: The average age of the children at the time of surgery was 41 (16.5–63) days [5.9 (2.4–9) weeks]. Sixty-four (34.2%) children were in their first month of life, 72 (38.5%) in their second month, and 51 (27.3%) in their third month, and 76 (40.6%) children were premature. The surgeries were emergent and urgent in 102 (54.5%) children and planned in 85 (45.5). The hemoglobin, hematocrit, and erythrocyte levels at which erythrocyte-containing components were transfused were 82 (77–90) g/l, 25% (22%–28%), and 2.8 (2.3–3.0) × 10¹²/l, respectively. The volume of erythrocyte-containing components was 54.0 (32.9–74.4) ml (10–30 ml/kg/child’s body weight). The need for and duration of artificial pulmonary ventilation in the postoperative period were 31 (72.1%) cases and 48.5 (22.5–190) hours, respectively, in contrast to children who did not receive transfusions of red blood cell-containing components—57 (39.6%) cases and 40 (22–96) hours. The indication for transfusion was anemia of varying degrees; however, 74.4% of children received adrenergic agonists simultaneously with transfusion to stabilize hemodynamics: dopamine monotherapy in 23 (74.2%) and combinations of dopamine and norepinephrine in 8 (25.8%) at 10 (8–12) mcg/kg/min and 0.2 (0.15–0.4) mcg/kg/min, respectively.

CONCLUSION: The frequency of use of red blood cell-containing components was 23%. Threshold values for transfusion of erythrocyte-containing components Hb, Ht, and erythrocytes were 82 (77–90) g/l, 25% (22%–28%), and 2.8 (2.3–3.0) × 10¹²/l, respectively.

Selecting a treatment method for proximal hypospadias in children remains challenging. This systematic review compares the outcomes of treating proximal hypospadias with the Duckett and Bracka techniques. Literature sources published between 2008 and 2023 were searched through PubMed, Google Scholar, and eLibrary using the following keywords in English: “proximal hypospadias,” “repair OR urethroplasty,” and “outcomes OR complications.” For Russian-language sources, the keywords were “proximal hypospadias,” “urethroplasty,” “complications,” “Duckett operation,” and “Bracka operation,” After screening, four full-text articles met the inclusion criteria and were included in this review. Data from 385 patients was analyzed: 218 underwent Duckett repair and 167 underwent Bracka repair. The overall complication rate in the postoperative period was 31.11% and 10.18% for Duckett and Bracka operation, respectively. No study has been performed at a high methodological level. Currently, studies comparing single-stage and staged surgeries for proximal hypospadias are lacking. It is crucial to conduct multicenter or comparative studies that involve closer collaboration between clinics, include a larger number of patients, and have a longer followup period.

Upper urinary tract duplication remains one of the most challenging pediatric urology conditions. Various operative methods are used in the treatment of children with this pathology; however, reoperation rate remains high. This study aimed to investigate a case of successful robot-assisted laparoscopic ureteroureterostomy and discuss the technical aspects of this procedure and review known series of robotic ureteroureterostomy. The authors retrospectively reviewed the medical history of a child with duplication of the right kidney, accompanied by reflux of urine into the lower segment collecting system. Surgical intervention was performed using robot-assisted technology. Using computed tomography and voiding cystourethrography, duplex kidney with vesicorenal reflux into the lower segment was diagnosed. The surgical technique used was ureteroureterostomy. The donor ureter was divided in the area of the intended anastomosis. Then, a surgical incision was made in the recipient ureter, the length of which was equal to the diameter of the donor ureter. After preparation of the ureters, an end-to-side anastomosis was performed. The operation was successfully performed without intraoperative difficulties or complications and lasted for 140 minutes. The robot installation time (docking time) was 20 minutes, and the main console time was thus 120 minutes. The patient started feeding on the same day after the operation. The drainage tube was removed after a control ultrasound examination on postoperative day 2. The stent remained in the recipient ureter until its removal 6 weeks after surgery. The duration of follow-up was 6 months. The patient was asymptomatic throughout the control period. Repeated ultrasound examination performed after surgery showed a decrease in the anteroposterior diameter of the lower segment pelvis to 5 mm. Blood flow in the upper and lower segments of the right kidney was not impaired. The advantages of the robotic approach, including improved instrument dexterity and 3D visualization, make it a safe and effective alternative to open or laparoscopic surgery in children.

Choledochal cysts are congenital cystic dilatations of the extrahepatic and/or intrahepatic bile ducts. Diagnosis and choice of treatment tactics for this pathology often cause difficulties. A case report of a choledochal cyst in a 2-year-old patient with symptoms of recurrent jaundice, cholangitis, and pancreatitis, which required laparoscopic cholecystostomy and cholangiography during preparation for radical surgery, was retrospectively analyzed. The child was re-admitted to the pediatric surgical department with complaints of hyperthermia up to 39°C, resumption of periodic abdominal pain, nausea, and increased icterus of the sclera and skin. Laboratory and ultrasound examination indicated biliary and pancreatic hypertension. Choledochal cyst, cholestasis syndrome, acute cholecystopancreatitis was diagnosed. Owing to the existing clinical symptoms and laboratory and ultrasound data, laparoscopic cholecystostomy was urgently performed. Against the background of conservative therapy, within 2 days after laparoscopic cholecystostomy, clinically, laboratory and according to control ultrasound examination, biliary and pancreatic hypertension were stopped. The child underwent cholangiography through a cholecystostomy without additional anesthesia, which revealed a fusiform dilatation of the common hepatic and bile ducts. After 2 weeks of drug treatment against the background of laparoscopic cholecystostomy, the child underwent excision of the common bile duct cyst, and cholecystectomy with hepatic enteroanastomosis on a Roux-en-Y loop. The postoperative period was smooth. No other complaints or complications were noted within 24 months. In the reported case, recurrent obstructive jaundice was caused by a choledochal cyst. Laparoscopic cholecystostomy enabled the quick and successful relief of biliary hypertension, preparation of the patient for radical surgical treatment, and safe informative cholangiography through cholecystostomy. Hepatic enteroanastomosis with a disconnected loop according to Roux-en-Y was an effective surgical treatment method for choledochal cyst.

Retrocaval location of the ureter in combination with aberrant renal vessels is a rare and complex urinary system malformation that requires careful verification. Currently, the most appropriate method for diagnosing retrocaval ureter is contrast-enhanced computed tomography. With the development of hydronephrosis or ureterohydronephrosis, the patient underwent laparoscopic ureteroplasty. Surgical treatment of retrocaval ureter involves resection of the altered ureter or pelvic–ureter segment with the formation of uretero-ureteral anastomosis or ureteropieloanastomosis anterior to the inferior vena cava. This article presents a successful laparoscopic ureteroplasty in a child with complex urodynamics of the urinary tract. Considering the presence of two levels of ureteral vascular crossing in the clinical example, pyelo-ureteral segment was performed to relocate the ureter in front of the inferior vena cava and aberrant inferior polar vessels. The patient was discharged in satisfactory condition to the outpatient stage of treatment, with subsequent hospitalization in the urological department. Retrocaval location of the ureter in combination with aberrant renal vessels is a rare congenital anomaly that requires prompt examination in a specialized clinic and an individual examination and treatment plan.

Commentary on the article Zavyalkin VA, Barskaya MA, Yukhimets SN “Differential approach to preoperative preparations for diffuse purulent peritonitis in children” published in the Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2024;14(1):57–68. (In Russ.) DOI: https://doi.org/10.17816/psaic1570

The traditional IX Forum of Pediatric Surgeons of Russia took place on November 9–11, 2023, at the Izmailovo Hotel, Moscow. The plenary session of the forum included the presentation of the S.D. Ternovsky Prize, “for his great contribution to the development of domestic pediatric surgery”, wherein Professor L.I. Budkevich gave an assembly speech “Combustiology of childhood — a first-person view” (online). Professor A.Yu. Razumovsky presented a report and historical documentary film dedicated to the 100th anniversary of the birth of Yuri F. Isakov during the plenary session. The report “Pediatric surgery of the Russian Federation. Figures and Facts” was delivered by Professor D.A. Morozov. The plenary session ended with a message from Professors E.V. Yudina and O.G. Mokrushina, “Antenatal diagnosis of congenital defects”. The video session “How I Do It” included 17 presentations with original medical technologies. The working meeting of the main freelance pediatric surgeons of the constituent entities of Russia and department heads of pediatric surgery was combined with a meeting of the specialized commission “Pediatric surgery” of the Ministry of Health of Russia and was chaired by D.A. Morozov and A.Yu. Razumovsky. The scientific program of the forum included symposia (14), round tables (4), a seminar, and a workshop. Overall, the scientific program included 169 reports, and 645 specialists participated in the forum in person. In total, 1,674 participants were registered at the forum. The total broadcast duration of the forum on the Internet was 49.5 hours. On the final day of the forum, a traditional competition of scientific research works of young scientists transpired. The IX Forum of Pediatric Surgeons of Russia was a scientific and practical event of a federal scale, showing, in an interactive format, the evolution and time frame of current problems of our specialty. The content of the reports and discussion results determined the vector of further scientific development and ways of introducing new organizational solutions and advanced medical technologies into clinical practice.

The paper describes the professional activities and merits of Professor Vadim G. Tsuman, an outstanding pediatric surgeon who made a huge contribution to the development of domestic pediatric surgery.

Information about the life path of a pediatric surgeon Professor Pavel N. Grebnev.

The editorial board regret that in the published abstract in Chinese, the name Sergey M. Stepanenko is translated in hieroglyphs, not in Latin. The editorial board is confident that the error could not significantly affect the perception of the work and interpretation of information by readers. The error has been corrected online, and the file of the article and issue have been updated.

The editorial board regret that in the published abstract in Chinese, the name Margarita A. Barskaya is translated in hieroglyphs, not in Latin. The editorial board is confident that the error could not significantly affect the perception of the work and interpretation of information by readers. The error has been corrected online, and the file of the article and issue have been updated.