Vol 14, No 3 (2024)

BACKGROUND: Open reimplantation has been considered the gold standard treatment for pathologies of the ureterovesical segment. In 2000, studies that presented results of the use of laparoscopic and vesicoscopic techniques for ureteral reimplantation in children began to emerge.

AIM: This study aimed to retrospectively analyze the results and complications of minimally invasive interventions in children with obstructive megaureter using various ureteral reimplantation techniques.

MATERIALS AND METHODS: Data from 369 patients (385 ureters) operated on in 12 clinics were included. The median age of the patients was 6 months (4; 7.8), and 39 (10.7%) patients had concomitant pathology of the ureter and bladder. Cohen’s vesicoscopic operation, extravesical transverse reimplantation, Lich–Gregoir dissection, and psoas-hitch reimplantation were conducted on 189, 148, 27, and 21 ureters, respectively, and ureteral diameter remodeling was performed in 23.6% of patients. The Mann–Whitney U-test, Kruskal–Wallis test, Fisher’s exact test, and binary logistic regression model were used to assess the statistical significance of the studied variables.

RESULTS: The median operation time was 140 minutes (110; 170). Obstruction was eliminated in 375 of 385 ureters (97.4%), regardless of the type of reimplantation, and vesicoureteral reflux developed in 35 (9.1%) ureters. Intraoperative (3) and postoperative complications (22) were present in 0.8% and 6% of cases, respectively. Reoperations were performed in 31 patients (8%). The statistically significant predictors of reimplantation outcome were tunnel orientation, infant age, and ureteral diameter.

CONCLUSIONS: Minimally invasive ureteral reimplantation for obstructive megaureter is safe for children, with efficacy comparable to open surgery, and with few complications.

BACKGROUND: Damage to the spleen is the leading cause of abdominal trauma in children. This often becomes the main indication for splenectomy. This article addresses concerns on the safety of conservative treatment of these injuries in children. Most studies have found that asplenization results in the complete loss of the immunological and hematological functions of the spleen. Thus, spleen-preserving surgeries are crucial to prevent post-splenectomy hyposplenism and associated life-threatening complications.

AIM: This study aimed to develop a mathematical model using logistic regression to determine aggregate variables associated with the possibility of surgical treatment and identify safe shock index parameters for the conservative treatment of traumatic splenic ruptures in children.

MATERIALS AND METHODS: This prospective study included 91 patients with traumatic splenic rupture: 80 (87.9%) children received conservative treatment and 11 (12.1%) underwent surgical treatment. The age of the children was 11 (8; 13) years; there were 3.3 times more boys (70 versus 21). To assess the need for surgical treatment, an analysis of categorical variables was conducted using a mathematical model using logistic regression.

RESULTS: Increased shock index (β = −0.264 ± 0.083; t(86) = −3.191; p = 0.002) and the need for blood transfusion (β = 0.464 ± 0.089; t(86) = 5.218; p = 0.001) were cumulative factors associated with a high possibility of surgical treatment of splenic ruptures in children. With the combination of parameters of increased shock index and blood transfusion for surgical treatment, moderate sensitivity was determined at 85.7% (95% CI: 52.1–99.6; p = 0.001) and a positive predictive value at 75% (95% CI: 34.9–96.8). In the absence of these factors, the probability of conservative treatment of children with splenic ruptures reached 100% (specificity: 97.5%; 95% CI: 91.1–99.7; p = 0.001). When summarizing the identified parameters, the area under the curve was 0.941 ± 0.026 (95% CI: 0.872–0.980), and the assessment of the model’s suitability showed a positive test (χ² = 32.7; p = 0.264). In nonoperative treatment, the frequency of identified cumulative factors was 2.5% (n = 2). Safe shock index parameters for successful conservative treatment of splenic ruptures in children have been determined: SIPA <1.1 (age up to 6 years), <0.85 (7–12 years), and <0.83 (over 13 years).

CONCLUSIONS: An increased shock index and the need for blood transfusion are combined factors that determine the high probability of surgical treatment for traumatic ruptures of the spleen in children. In nonoperative treatment, the frequency of identified cumulative factors was 2.5%, which indicates a strong argument for justifying the safety of conservative therapy.

BACKGROUND: Neonatal sepsis remains a critical concern. Thus, predictors of infection development and generalization should be determined.

AIM: This study aimed to determine novel neutrophil surface biomarkers for early prediction of the infections in newborns.

MATERIALS AND METHODS: This observational, single-center, prospective, selective, uncontrolled, unblinded experimental study included 261 newborns, with a mean postconceptual age of 38.7 (38.4–39.0) weeks and a mean gestation age of 38.0 (37.7–38.2) weeks. Blood samples were collected into vacutainers on hospitalization day 1. Patients were enrolled between April 2022 and December 2023. The primary endpoints were length of stay in the ICU and total length of hospitalization in patients with normal and decreased values of CD16 and CD10 neutrophils and HLA-DR monocytes. The expression of CD16 on CD62L^high neutrophils, total neutrophil CD10, and monocyte HLA-DR were evaluated by flow cytometry.

RESULTS: We assessed infants in the “control” (n = 96), “localized infection” (n = 95), and “generalized infection” (n = 70) subgroups. In all patients, a decrease in CD16 was associated with an increase in the median ICU stay from 4 to 8 days (p = 9.33 × 10^–8) and total stay from 14 to 22 days (p = 1.58 × 10^–7). A decrease in CD10 was associated with an increase in median ICU stay from 4 to 8 days (p = 3.01 × 10^–6) and in the total stay from 14 to 19 days (p = 2.78 × 10^–5). A decrease in monocytic HLA-DR was associated with a longer ICU and total hospital stay: 4 vs 8 days (p = 7.16 × 10^–5) and 14 vs 21 days (p = 4.03 × 10^–5), respectively. The median ICU stay in patients with a decrease in CD16 but normal CD10 was 4 days, whereas a decrease in both indicators was associated with prolonged hospital stay to 11 days (p = 2.13 × 10^–5). The median hospital stay in patients with decreased CD16 but normal CD10 was 16 days, whereas the drop of both markers was related with increase of hospitalization stay to 23 days (p = 3.36 × 10^–6). In the “localized infection” subgroup, low CD16 was associated with an increased median ICU stay from 4 to 6 days (p = 0.010) and the median hospital stay from 13 to 19 days (p = 4.14 × 10^–4). In the “generalized infection” subgroup, decreased CD10 was related with prolongation of the median ICU stay from 7 to 11 days (p = 0.011) and the median total duration of hospitalization from 19 to 27 days (p = 0.037).

CONCLUSIONS: A decrease in CD10 and CD16 on the neutrophils at the start of clinical is an unfavorable prognostic factor of infectious and septic complications in newborns.

Crohn’s disease is an inflammatory bowel disease with a chronic recurrent course and a high risk of complications. Crohn’s disease prevalence has been increasing. Despite the era of biological therapy and new therapeutic approaches in the treatment of Crohn’s disease, the role of surgical treatment remains high. This study aimed to analyze the current trends and approaches of surgical treatment localized lesions of ileocecal zone in children with Crohn’s disease. The scientific databases eLibrary, GoogleScholar, MEDLINE, and Embase were searched. The search time interval was 2017–2024. In several recent articles, a trend toward early ileocecal resection in patients with Crohn’s disease was noted. According to some studies in adults, this approach is an alternative option for medical treatment. The advantages of early surgical approach includes decreased surgical complication level, improving the quality of life and reducing the cost of treatment. The timing of early surgical intervention varies. Notably, Crohn’s disease in children has more aggressive character, and early surgical intervention may not only create a therapeutic window of opportunity to control Crohn’s disease but also contribute to improving the long-term results of Crohn’s disease treatment. The role of surgical technique is being studied (the need to include a mesentery with fat wrapping into a resection area or not), the effect of the type of anastomosis on relapse of Crohn’s disease. Analysis of the safety of Kono-S anastomosis and its impact on development recurrence has shown a number of advantages over traditional anastomosis. However, its application in the practice of pediatric surgeons remains isolated. Similar studies are required in children to determine the optimal strategy for the treatment of Crohn’s disease in ileocecal region (determining the role of surgical treatment and type of anastomosis in achieving long-term and deep remission), preventing recurrence of Crohn’s disease and repeated intestinal resections.

Complications of intestinal malrotation commonly manifest in the first months of life. However, cases of diagnosis in later age, including in adults, have been described. The clinical presentation is highly variable, and a significant amount of time often passes before the accurate diagnosis is made. This study presents a clinical case of a 17-year-old girl with chronic duodenal obstruction caused by isolated malrotation and fixation of the duodenum. Considering the patient’s comorbidities and developmental disorders, the diagnostic search was significantly challenging. In this situation, surgery involves mobilization of the duodenum and correction of the pathological fixation. However, considering the significant changes in the duodenal wall and the combined pathology, duodenojejunostomy was performed. Despite the additional surgical intervention, the postoperative period was characterized by prolonged gastric–duodenal stasis. Adequate diet, frequent feeding with a mixture, maximal “verticalization,” and activation of the patient played a key role in alleviating anastomositis and motor disturbances after the operation. Thus, using a strictly individualized approach to treat adolescents with a complex of surgical and therapeutic pathology and psychiatric disorders results in a satisfactory treatment outcome.

Lung sequestration is a developmental anomaly in the form of a separate non-functioning fragment of lung tissue that does not communicate with the bronchial tree and is supplied with blood by the aorta or arteries of the large circulatory circle.

Lung sequestration is a developmental anomaly characterized by a separate nonfunctioning fragment of lung tissue that does not communicate with the bronchial tree and is supplied with blood by the aorta or arteries of the large circulatory circle. Lung sequestration accounts for 0.15%–6.4% of all lung malformations. This study presents a clinical case of a 7-month-old girl with extralobaric lung sequestration. The patient presented with complaints of cough; noisy, rapid breathing; and a history of gastroesophageal reflux. Gastroenterological pathology was excluded at the place of residence. During physical examination, wet wheezing was heard on both lungs, and the respiratory rate was 36 per minute. Chest X-ray showed a right-sided, upper-lobe pneumonia. Community-acquired right-sided, upper-lobe pneumonia, moderate form, was diagnosed. CT scan of the chest organs with contrast revealed a congenital malformation: tracheal bronchus and extralobar lung sequestration on the right. Indications for minimally invasive intervention were formulated. After surgical treatment, thoracoscopy showed an extrapulmonary sequester in the posterior hemithorax, with a feeding vessel from the thoracic aorta. Then, sequestrectomy was performed. In the postoperative period, positive dynamics was observed against the background of antibacterial, infusion, and symptomatic therapy. The patient was discharged in satisfactory condition. In children with long-term, recurrent lung infections, without positive dynamics against the background of conservative therapy and in the presence of respiratory disorders against the background of normal body temperature and absence of signs of inflammation in blood tests, congenital malformations of the respiratory tract should be excluded. Computed tomography with contrast enhancement and subsequent 3B reconstruction is the most appropriate method for diagnosing lung sequestration. Moreover, thoracoscopic resection of a separate nonfunctioning fragment of lung tissue is an effective minimally invasive surgical treatment method.

Thrombosis occurring in the neonatal period is a nosology with a large number of complications, often leading to disability and death. This article highlights the successful treatment of a newborn child with renal vein thrombosis using systemic thrombolysis. A clinical case of successful systemic thrombolysis in a full-term boy in the early neonatal period with thrombosis of the left renal vein and transition of the floating part of the thrombus to the inferior vena cava is presented. A child aged 3 days was admitted to the neonatal intensive care unit from a maternity hospital, where thrombosis was suspected. Gross hematuria was observed. Laboratory data revealed thrombocytopenia and increased levels of fibrinogen and D-dimer. Ultrasound showed a sharp increase in the volume of the left kidney, a diffuse change in its parenchyma, a sharp depletion of blood flow, and accumulation of fluid in the perinephric tissue on the left, and a thrombus was observed in the lumen of the left renal vein with the presence of a floating part extending into the inferior vena cava. Thrombolytic therapy with the drug alteplase was started in combination with an infusion of unfractionated heparin. Doses were selected based on coagulogram parameters. On day 2 of therapy, hematuria resolved. On day 4 of therapy, the alteplase infusion was completed, and heparin therapy was continued. On day 13, the child was switched to a low-molecular-weight-heparin therapy. Dynamic ultrasound revealed size reduction, recanalization and further thrombus lysis, and normalization of intrarenal blood flow and kidney size. No renal dysfunction was recorded during observation. The child was transferred to the further care unit at aged 14 days and was discharged home at the age of 25 days in satisfactory condition on ongoing anticoagulant therapy under outpatient supervision of a hematologist. During follow-up observation at aged 1.5 months of life, no clinical, laboratory, and ultrasound indicators of renal function disorders were noted. Currently, there are no approved recommendations and protocols for individual thrombosis in newborns, although this particular age group is due to the vulnerability of hemostasis to the development of a thrombotic process.

Commentary on the article by N.S. Bakaeva, D.A. Baranov, V.A. Vecherkin, V.A. Ptitsyn, P.V. Koryashkin, V.M. Gagloeva “Multiple recurrences of adnexal detorsion in a 9-year-old girl: case report”, published in the journal Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2024;14(3):441–449. DOI: https://doi.org/psaic1781

The Russian Educational Symposium of Pediatric Surgeons “Surgical Diseases of the Anterior Abdominal Wall in Children” was held in Samara on April 24, 2024. After the reports were discussed, a draft resolution of the symposium was adopted. Herein, its text is presented for familiarization of a wide range of specialists with subsequent adjustment for inclusion in federal clinical guidelines.

This article describes the professional activities and merits of pediatric surgeon Igor I. Babich in celebration of his anniversary.