Vol 11, No 4 (2021)

BACKGROUND: Surgical treatment of proximal forms of hypospadias in children is still a complex and largely unsolved problem. The large number of postoperative complications following reconstructive surgery for proximal forms of hypospadias supports scientific interest in this issue.

AIM: This study aimed to conduct a retrospective comparative analysis of the effectiveness of two types of urethroplasty. We compared fundamentally different approaches to the formation of the artificial urethra, surgical techniques that use a different type of movement, and blood supply of the plastic materials — a flap and a graft.

MATERIALS AND METHODS: The study included 113 primary patients with proximal hypospadias aged 8 months to 15 years who underwent surgery between 2013 and 2019 and were divided into two comparison groups. Group 1 included 53 (46.9%) boys; a single-stage urethroplasty was performed by the onlay-tube method, where a longitudinal skin flap of the dorsal surface of the penis was used as a plastic material. Group 2 included 60 (53.1%) patients; two-stage urethroplasty was performed by the Bracka method, where the plastic material for the formation of the artificial urethra was a preputial graft in 44 (73.3%) patients and a graft of the oral mucosa in 16 (26.7%) patients.

RESULTS: When comparing the surgical results in the form of the number of complications requiring repeated surgical interventions under anesthesia to eliminate them, corresponding to Clavien–Dindo 3B complications, a significant difference was obtained in the study groups. The surgical results were significantly better when performing the two-stage Bracka method.

CONCLUSIONS: In the surgical treatment of proximal forms of hypospadias in children, the two-stage Bracka method, where the plastic material for the formation of the artificial urethra is a preputial or mucosal graft, significantly reduced the number of postoperative complications.

BACKGROUND: Laparoscopy in the treatment of abdominal echinococcosis is accompanied by complications. Therefore, studies on optimizing surgical approaches that reduce intra- and postoperative complications in liver echinococcosis are extremely relevant.

AIM: This study aimed to assess the possibility of using three-dimensional (3D) technologies in children with abdominal echinococcosis to determine whether it can increase the efficiency of laparoscopic treatment and reduce complications.

MATERIALS AND METHODS: A prospective analysis was conducted from 2013 to 2019 among 43 children with isolated liver echinococcosis who underwent multiport laparoscopic echinococcectomy. In the preoperative period, 25 patients from the main group used a complex of modern 3D technology: creating a 3D reconstruction of a liver with a parasitic cyst and then printing a 3D model of an organ with vessels and bile ducts.

RESULTS: The use of virtual computer visualization with the 3D reconstruction of the parasitic cyst and adjacent blood vessels with bile ducts made it possible to produce a 3D liver model. This approach provided the possibility of personalized laparoscopic access and precision in performing surgeries. Postoperatively, residual cavity (n = 1, 4.0%) was observed in the main group and biliary fistula and residual cavity (n = 2, 11.1%) in the comparison group

CONCLUSIONS: Thus, the use of 3D technologies in children with abdominal echinococcosis can increase the efficiency of laparoscopic treatment and reduce the number of early and late complications.

BACKGROUND: Staged treatment of small bowel diseases involves the formation of an enterostomy. Bishop–Koop T-anastomosis and Mikulicz double-barreled enterostomy with compression clamp are widely applied. The disadvantages of Mikulicz’s can be eliminated using a clip of titanium nickelide with shape memory instead of a clamp.

AIM: This study aimed to evaluate the efficacy and safety of a titanium nickelide device in double-barreled enterostomy and compare the results of treatment with a T-anastomosis.

MATERIALS AND METHODS: The study included newborns and infants. The clip was applied on 9–58 days postoperatively. Differences were accepted as significant at p < 0.05.

RESULTS: Since 2000, enterostomy was performed in 79 children: 12 (15.2%) had T-anastomoses, 44 (55.7%) had double-barreled stomas, and 18 (40.9%) had a titanium nickelide clip. In the study groups, stomas were applied for ileus, atresia, and aganglionosis. In the group of double-barreled enterostomies with a clip, the stoma was closed later (p = 0.027) and the operation time was short (p = 0.013). In the T-anastomosis group, parenteral nutrition was required for a longer period (p = 0.018). Self-removal of the clip and appearance of the stool occurred on days 5 and 1–3. Compression anastomosis was obtained in 83.3% and stoma closure outside in 73.3%. With a double-barreled enterostomy, hepatic failure (p = 0.018) and anastomosis dysfunction (p = 0.046) were less common. T-anastomosis revealed an increase in the incidence of CDC II (p = 0.013) and III (p = 0.015) complications.

DISCUSSION: The results reflect the safety of the presented method in comparison with the T-anastomosis, since the operation time and duration of the parenteral nutrition are reduced, invasive treatment is less often required for complications, and anastomosis dysfunction rarely occurs.

CONCLUSIONS: Double-barreled enterostomy with a compression clip is an effective and safe alternative to T-anastomosis in children aged <1 year. The formed compression anastomosis allows closure of the stoma by suturing its outer part. The conditions for the formation of the anastomosis are the patency of the distal sections and bowel diameter ≥1 cm.

BACKGROUND: The safety of interhospital transfer of newborns remains one of the most important issues of emergency neonatology. Assessment of risks associated with transfer is the basic concern of pre-transport preparation.

AIM: This study aimed to assess and compare the predictive value of the KSCHONN, National Therapeutic Intervention Scoring System (NTISS), and TRIPS scales in predicting the risks associated with the interhospital transfer of newborns.

MATERIALS AND METHODS: The cohort study included data from 604 visits of the transport team. The KSHONN, NTISS, and TRIPS scales were used in the assessments, the therapeutic actions of the transport team during transfer were evaluated, and mortality during the first day after assessments was analyzed. The area under the receiver operating characteristic curve (AUC ROC) was calculated for the KSCHONN, NTISS, and TRIPS scales in relation to the therapeutic actions of the transport team and first-day mortality.

RESULTS: The predictive values of the KSHONN and TRIPS scales for additional infusion reflected AUC ROC values of 0.877 (0.436–1.317) and AUC ROC 0.889 (0.468–1.311), respectively. The AUC ROC value for predicting catecholamine dose adjustment or appointment and correction of ventilation for all three scales was less than 0.8. The predictive value of all three scales in the prediction of death on the day after the assessment of the transport team is high, and the TRIPS scale had the highest AUC ROC [0.988 (0.977–0.999)], which was significantly higher than that for the NTISS scale 0.875 (0.790–0.959) (p = 0.004). The KSHONN scale demonstrated a better predictive value for daily mortality [0.984 (0.861–1.003)] in comparison with NTISS (p = 0.001). The risk ratio of the daily mortality in the group of patients with an assessment of 9–4 points according to KSHONN in comparison with patients with an assessment of 6–8 points was 17.73 (0.88–355.8).

CONCLUSIONS: The evaluated scales predict patient death within a day after the assessment of the transport team with good accuracy, and the KSHONN and TRIPS scales predict the need for additional infusion during transfer. However, none of the scales predict other actions of the team associated with the deterioration of the patient’s condition during transfer with the required accuracy.

Birth trauma of the liver with the development of subcapsular hematoma and hemoperitoneum is reported extremely rarely. The slow enlargement of the hematoma also results in delayed development of bleeding symptoms. Noticeable clinical manifestations appear simultaneously when the hematoma ruptures into the abdominal cavity. Later, the symptoms develop very quickly that doctors failed to understand the root cause of the bleeding. The diagnosis is established only during autopsy. When conservative therapy is ineffective, open surgery is conducted; however, the surgery is associated with a high risk of unfavorable outcomes. Herein, we present a clinical case demonstrating successful treatment with endovascular embolization of a vessel due to bleeding from a giant subcapsular hematoma of the liver in a newborn.

The child was born in a settlement of the Arkhangelsk Region and weighed 3480 grams. A vacuum extractor was used to assist the weak mother during delivery. The child was in a critical condition and suffered from asphyxia. Mechanical ventilation was used. At 10 h after birth, the child was taken to a specialized neonatal center of Arkhangelsk (the helicopter flight took 2.5 h). The intensive therapy continued. Negative dynamics followed. At 25 h after birth, hemodynamic indexes decreased. X-ray and ultrasound investigations of the abdominal cavity revealed a large hematoma in the liver. It occupied the entire area of the right liver lobe. Abdominal bleeding was diagnosed. The child was taken to the X-ray department. The newborn underwent urgent endovascular embolization of the right hepatic artery. The bleeding was stopped, and the child’s condition was stable. On follow-up at age 1 year and 5 months, the child’s development was in accordance with age, and blood biochemical parameters were within normal limits. Ultrasound data revealed well recovery of the liver structure.

With extensive birth trauma of the liver, minimally invasive surgery, i.e., endovascular embolization of vessels, can be considered an alternative option to surgical treatment.

Diagnosis and treatment of esophageal injuries remain the most difficult problems in pediatric urgent surgery with high mortality rates. Restoration of function in severe multiple-organ disorders associated with the development of mediastinitis and sepsis in children requires a multidisciplinary approach and the search for alternative treatment methods that help close the esophageal defect and prevent inflammation. These methods include a constant negative pressure system.

Severe polytrauma led to the development of local inflammation and mediastinitis. The formed esophageal fistula with clinical sepsis required multistage surgical treatment and support of several specialists. At the Regional Children’s Clinical Hospital No. 1 in Vladivostok, at the first stage of treatment, the mediastinum and soft tissues of the neck were drained, which made it possible to stop the spread of inflammation and stabilize the patient’s condition. The effectiveness of the second stage of surgical treatment using the VAC system was noted in the first 48 h, in the form of a significant reduction in local inflammation and elimination of skin maceration. The VAC system provided adequate drainage of the wound cavity and promoted wound cleansing and growth of granulation tissue. Dissociation of the fistula by applying a gastrostomy made it possible to create favorable conditions for the healing of the esophageal defect and ensure adequate enteral nutrition for the patient.

Damage to the esophagus with the development of mediastinitis and sepsis are critical conditions; therefore, treatment outcomes depend on early diagnosis and timely surgical treatment. A full-fledged surgical treatment in a specialized hospital helps eliminate complications of damage to effectively restore functions and lead to patient recovery.

This review aimed to analyze and organize information on the treatment of newborns with bowel malrotation. A systematic review was conducted using the databases PubMed, Web of Science, Google Scholar, Scopus, and eLibrary and journals of Pediatric Surgery, Russian Bulletin of Pediatric Surgery, Anesthesiology and Reanimatology, and Pediatric Surgery from 2010 to 2020. The search terms were as follows: malrotation, neonatal, infant, newborn, intestinal malrotation, malrotation, neonatal period, Ledd’s syndrome, and midgut volvulus. All journal issues were reviewed for the selected period.

Following the screening of published articles, six full-text articles that met the selection criteria were included in the systematic review. A total of 191 patients with bowel malrotation that received various treatments were described: 98 patients underwent defect correction by laparoscopy and 93 patients underwent laparotomy. Bloating was found in 103 children. Reoperations were performed on 18 newborns because of relapse. Complications in the postoperative period were noted in 25 cases, and treatment of 16 children was fatal. No study was performed following a high methodological level.

To date, studies on the surgical treatment of newborns with bowel malrotations are limited. In addition, none of the studies were conducted at a high methodological level. The lack of randomized controlled trials can be compensated for by closer collaboration between medical clinics, collection of a larger evidence base based on the analysis of the results of cohort and case–control studies, and examination of the reasons for the variability of results among centers.

The article is devoted to the period of the author’s work in three leading teams of pediatric surgeons in Russia: 1) Department of Pediatric Surgery of the Leningrad Pediatric Medical Institute under the leadership of the Corresponding Member of the Russian Academy of Medical Sciences Professor G.A. Bairov. This part described the role of the student scientific circle in the upbringing and development of future pediatric surgeons and the merits and personal qualities of G.A. Bairov. 2) Department of Pediatric Surgery of the Central Order of Lenin of the Institute for Advanced Training of Doctors, which played a leading role in the professional training and improvement of surgeons who were involved in the treatment of children. This part presents the main forms of work with cadets and requirements for the teaching staff. Much attention is paid to the merits of the Head of the Department Academician of the Russian Academy of Medical Sciences S.Ya. Doletsky and his role in the development of pediatric surgery. 3) Department of Urology and Neuro-urology of the Moscow Research Institute of Pediatrics and Pediatric Surgery under the guidance of Prof. E.L. Vishnevsky, who made great contributions to pediatric urology and created a virtually new section of the specialty — pediatric neuro-urology..

Nutritional support for children with critical conditions is currently considered as the most important factor in the complex of therapy, which can prevent catabolism and risk of postoperative complications. Underestimation of the nutritional factor can lead to poor outcomes, such as a decrease in immunological resistance and the occurrence of postoperative complications.

Acute trauma in critically ill patients is characterized by metabolic and systemic responses, including an immune-inflammatory response that leads to immunosuppression and nosocomial infections. Parenteral nutrition is prescribed for patients in the intensive care unit who cannot be fed naturally to provide protein and energy substrates because of impaired homeostasis. The active use of arginine, glutamine, and omega-3 fatty acids is mainly indicated for patients with injuries and burns. Moreover, the discussion about the use of immune nutrition (arginine, glutamine, and omega-3 fatty acids) continues given the need for active use in intensive care. The article provides a review of the literature on the use of glutamine solution in parenteral nutrition for children. The article discusses modern approaches to prescribing parenteral nutrition with the additional use of glutamine solution, which has beneficial effects on the child’s body — increases the absorption function of the intestine, increases the thickness of the intestinal mucosa, helps maintain the morphological integrity of the intestine, and reduces intestinal permeability. Recent meta-analyses have shown the effect of glutamine-rich diets especially in patients with critical conditions. The addition of glutamine improves cellular processes and functioning of organs and systems. This leads to an improvement in immune competence, barrier function, and cessation of the inflammatory process. It is also a substrate for the formation of nitrite oxide and improves the formation of adenosine triphosphate in cells. Glutamine is an energy substrate for proliferative cells, including lymphocytes. In general, glutamine has a positive effect on many organs and systems, including the gastrointestinal systems, kidneys, lungs, heart, and liver. Immune nutrition has an anti-inflammatory effect, which helps prevent the development of acute phase response. In addition, it restores the indicators of protein metabolism in the early stages of parenteral nutrition. Therefore, the use of glutamine solution in total or complementary parenteral nutrition programs can optimize the quality of treatment for children.

The VII Forum of Russian Pediatric Surgeons was held in a hybrid format on October 21–23, 2021, in Moscow in the auditoriums of two children’s hospitals. The program of the plenary session of the forum included the presentation of the annual award S.D. Ternovsky “For a Great Contribution to the Development of Domestic Pediatric Surgery,” which was awarded to Professor V.G. Geldt. Within the framework of the forum, a symposium “Organization of pediatric surgical care in Russia” and a working meeting of the Russian Association of Pediatric Surgeons were held, at which the status of pediatric surgery as a specialty was discussed, and reports of members of the Presidium of the Russian Academy of Arts on the activities in 2019–2021 were heard. The video session “How I Do It” aroused the genuine interest of all participants both directly in the audience and online (1,045 people). A total of 1568 specialists from 15 countries took part in the forum. Within 4 days of the forum, 138 speakers presented 154 reports. On the final day of the forum, a traditional competition for research works by young scientists took place.

The Forum of Russian Pediatric Surgeons contributes to the broad promotion of innovative ideas and technologies and the integration of domestic specialists into the international professional space. All forum reports are available on the Internet.

The paper describes the professional activities and merits of the pediatric surgeon Azamat M. Shamsiev, in celebration of his anniversary.

The paper describes the professional activities and merits of the pediatric surgeon Dmitry Yu. Vybornov, in celebration of his anniversary.