Paediatric Surgery. Ukraine最新文献

{"title":"Tactics of surgical treatment of congenital spinal deformities in children","authors":"A. Levytskyi, O. Burianov, I. Benzar, T. Omelchenko, M.O. Ovdii","doi":"10.15574/ps.2022.75.26","DOIUrl":"https://doi.org/10.15574/ps.2022.75.26","url":null,"abstract":"Progress in spinal surgery during the second half of the twentieth century was made possible by a deeper study of the three-dimensional nature of the normal and pathological architecture of the spine. The problem of complex spinal deformities remains one of the most important in clinical vertebrology. In Ukraine, more than 9,000 children need surgery for scoliosis spinal deformities. Of these, more than 15% of children have congenital scoliosis deformities. Purpose - to conduct a retrospective analysis of the results of surgical treatment of congenital spinal deformities in children. Materials and methods. A retrospective analysis of the results of treatment of 36 patients (from 9 to 12 years) with congenital spinal deformities who received treatment at the Department of Pediatric Surgery of the Bogomolets National Medical University (National Children's Specialized Hospital «OHMATDYT», Kyiv) in the period from 2008 to 2018. Patients were divided into two groups: I (staged treatment) - 18 children who received treatment using halo-gravity traction (HGT), followed by spinal instrumentation; II (one-time treatment) - 18 children who underwent surgical correction with osteotomies (4-6 levels according to Ponte, VCR osteotomy at 1-2 levels). Results. Two groups of patients were studied. According to HGT, the main arc deformation improved to 55±25%. HGT - complications were observed in 12% (transient neurological disorders). In patients who underwent spinal instrumentation without prior traction complications were observed in 37% of patients (neurological transient disorders in the form of spinal cord dysfunction). In children with congenital spinal deformities, simultaneous implantation of the structure in comparison with staged treatment with HGT increases the risk of neurological deficits by 25%, HGT allows greater correction and adapt the spinal cord to further correction. Conclusions. In the surgical treatment of congenital spinal deformities, HGT reduces the risk of neurological complications, reduces the time of surgery and the amount of blood loss, allows us to get better results of correction. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors. Keywords: halo-gravitational traction, scoliotic deformation, surgical treatment.","PeriodicalId":166002,"journal":{"name":"Paediatric Surgery. Ukraine","volume":"28 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129938192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment of lymphatic malformations in children: 10 years of experience","authors":"I. Benzar, A. Levytskyi, D. Diehtiarova, O. Godik, O. Dubrovin","doi":"10.15574/ps.2022.75.5","DOIUrl":"https://doi.org/10.15574/ps.2022.75.5","url":null,"abstract":"Purpose is to identify the factors that determine the clinical features of the LMs, their complications and the choice of treatment options. Materials and methods. 225 children with LMs who underwent treatment since 2011 to 2020 were enrolled. They were grouped according to ISSVA 2018 classification. Clinical presentation, treatment options, complications and outcomes were analyzed. One-variant analysis using Pearson’s χ2 test was used to evaluate qualitative data. Results. 214 (95.1%) patients had cystic LMs, 11 (4.9%) had combined LMs. 129 (57.3%) LMs were cervicofacial, 17 (11.9%) patients developed airways compression and 6 (4.2%) required tracheostomy. 8 (3.6%) patients developed 10 lymphatic leaks episodes, 3 were lethal. 112 (86.8%) patients with cervicofacial, 5 (11.6%) abdominal, 10 (84.6%) axillar, and 12 (92.2%) extremities LMs underwent sclerotherapy. Surgical resections prevailed in abdominal LMs, 32 (74.5%), versus 4 (3.1%) cervicofacial LMs. 10 (4.4%) patients with combined and complicated cystic LMs underwent systemic sirolimus therapy. Results of treatment were excellent in 116 (51.6%) patients, good in 82 (36.4%), satisfactory in 23 (10.2%), and unsatisfactory in 4 (1.8%), with 4 mortalities caused by sepsis (n=1) and by massive lymph leakage (n=3). Conclusions. The most life-threatening LMs complications are airways compression and uncontrollable lymphatic leakages. Several approaches were used, including surgery, sclerotherapy, and target therapy. Surgery is optional for abdominal LMs but potentially harmful in cervicofacial. Treatment of combined LM is continuous and requires a combination of different methods. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors. Keywords: lymphatic malformations, children, sclerotherapy, target therapy.","PeriodicalId":166002,"journal":{"name":"Paediatric Surgery. Ukraine","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122803924","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnosis and treatment of fecal incontinence after surgical correction of congenital anocolorectal pathology in children","authors":"V. Fofanov, A. Yurtseva, O. Fofanov, I. Didukh, L.G. Bubniv","doi":"10.15574/ps.2022.75.66","DOIUrl":"https://doi.org/10.15574/ps.2022.75.66","url":null,"abstract":"Fecal incontinence (FI) in children is a serious medical and social problem. FI leads to severe limitations in a child’s development and social adaptation. Pediatric surgeons mainly deal with the mechanical type of FI that occurs after surgical correction of anorectal malformations (ARM) or Hirschsprung's disease (HD). Violation of defecation control is observed in 53-89% of patients who underwent surgery for ARM and HD. Purpose - to study the causes and effectiveness of the proposed complex treatment of FI in children operated on for HD and ARM. Materials and methods. Clinical examination and treatment of 92 children with congenital pathology of the distal colon and anus (55 (59.78%) patients with HG and 37 (40.22%) with ARM) was carried out at the Pediatric Surgery Clinic of Ivano-Frankivsk National Medical University. Among the surveyed children were 64 boys and 28 girls (ratio - 2.29:1). In terms of age, newborns and children of the first year of life predominated among those who underwent primary surgery - 57 (61.95%) children. FI of varying severity was detected in 48 (52.17%) patients operated on for HD and ARM at different terms after surgical correction - from 6 months to 3 years. The types, causes, and severity of FI in each child were studied. In addition to conventional clinical and instrumental studies, patients underwent anoscopy and rectoscopy, transanal ultrasound, anorectal manometry. The severity of AI was assessed on a S.D. Wexner score. Results. FI occurred in 34 (70.8%) children after HD correction and in 14 (29.2%) patients after ARM surgery. True FI was found in 33 (68.75%) children. Pseudoincontinence was detected in 15 (31.25%) patients it was more common in patients operated on for HD. For conservative treatment of patients with FI a Bowel Management Program was implemented. In 24 (50.0%) patients treated according to this program, the control of defecation was significantly improved, the incontinence severity index was significantly reduced according to the Wexner score. In true AI due to severe anal sphincter damage, we performed minimally invasive surgical correction of postoperative insufficiency or congenital defect of the internal sphincter of the anus using a volume-forming implant in 14 (29.17%) children. Immediate and long-term results of the operation were good, which was reflected in improved control of defecation, a significant increase of basal pressure and a decrease of the incontinence severity index. Conclusions. Tactics of the FI treatment depends on the cause and severity. The implementation of the Bowel Management Program can significantly improve the control of defecation and improve the quality of life of patients. In case of insufficiency of the internal anal sphincter, minimally invasive correction by anal submucosal implantation of a volume-forming gel is effective. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Lo","PeriodicalId":166002,"journal":{"name":"Paediatric Surgery. Ukraine","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115709797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical case of urethral doubling with preservation of function and single bladder","authors":"V. Dihtiar, D. Vernihora, L.M. Haritoniuk, M. Boyko, A.V. Obertynskyi","doi":"10.15574/ps.2022.75.101","DOIUrl":"https://doi.org/10.15574/ps.2022.75.101","url":null,"abstract":"Urethral doubling is a rare congenital anomaly of the urinary system that is more common in boys. Less than 500 clinical cases of this disease have been described in the literature, which may signal a lack of awareness among physicians. Although there are many considerations regarding the embryology of this anomaly, the etiopathogenesis of its various forms remains unclear. Sometimes doubling of the urethra is combined with other malformations, such as epispadias, hypospadias, exstrophy of the bladder, anorectal malformation, doubling of the bladder and others. In this article, we present a clinical case of a 9-year-old boy with urethral duplication and additional urethral epispadias. We found the main and additional urethra, which goes on dorsal side of the penis and led to curvature of the penis and urinary incontinence. During the operation, urethrocystoscopy was performed before the main stage, and a complete doubling of the type 2-A urethra was established according to the Effman classification, after which the additional urethra was excised as far as the pubic bones. Urethral duplication is a rare anomaly, with several forms of clinical presentation, often accompanied by other anomalies, and sometimes with difficult diagnosis. The treatment of urethral duplication should be individualized, according to its type. In this case we find urethral duplication type IIa, which has been treated as classic epispadias. Therefore, in child with congenital malformation of penis need to perform obsrvetion like urethrography, cystoscopy. The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors. Key words: urethral substitution, epispadias.","PeriodicalId":166002,"journal":{"name":"Paediatric Surgery. Ukraine","volume":"106 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123448872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Necrotizing enterocolitis in preterm infants with poor outcome: causes, risk factors for mortality, histological changes of the intestinal lining","authors":"O. Yablon, N. Chornopyshchuk, P. Rusak, A. Konoplitska","doi":"10.15574/ps.2022.74.70","DOIUrl":"https://doi.org/10.15574/ps.2022.74.70","url":null,"abstract":"Despite advances in the diagnosis and treatment of necrotizing enterocolitis (NEC), the associated morbidity and mortality rates remain high. Purpose - to establish risk factors for mortality of necrotizing enterocolitis in preterm born infants, as well as to analyze histological changes of the intestinal lining. Materials and methods. The course of NEC in 21 preterm neonates who died of this disease (group 1, n=21) over a period of 3 years was analyzed. To establish risk factors for mortality rate health indicators of children in group 1 were compared with the course of NEC in children who survived with similar stages of the disease (group 2, n=43). The following research methods were used: general clinical, laboratory, instrumental, histological and statistical. Results. Our data show that the main causes of severe stages of NEC in preterm infants is infection, often in combination with severe asphyxia. The identified risk factors for mortality allowed to establish that the risk of death for children with NEC was associated with: male sex (OR=4.675; χ2=7.679; p=0.006) - increases the risk for mortality by 4 time; inflammatory changes in the placenta (OR=6.139; χ2=10.501; p=0.002) - increases the risk by 6 times; red blood cell transfusion in children (OR=8.262; χ2=8.557; p=0.004) - increases the risk by 8 times; thrombocytopenia (OR=4.320; χ2=4.866; p=0.028) - increases the risk by 4 time; the developmen of multiple organ system failure (OR=12.364; χ2=17.578; p<0.001) and DIC syndrome (OR=10.725; χ2=14.592; p<0.001) - increases the risk by 12 and 11 times, respectively; the positive symptoms - oedema of the anterior abdominal wall (OR=14.025; χ2=19.258; p<0.001) and vasodilation of the anterior abdominal l wall (OR=5.333; χ2=5.444; p=0.02) - increases the risk by 14 and 5 times, respectively; the intestinal pneumatosis on abdominal when x-ray detected (OR=6.840; χ2=6.867; p=0.009) and the peritoneal effusion detected by abdominal ultrasound (OR=8.750; χ2=14.448; p<0.001) - increases the risk of mortality by 7 and 9 times, respectively. During histological examination of the intestinal wall with NEC lymphohistiocytic infiltration of submucosa indicates perinatal hypoxia and its crucial role in the thanatogenesis of the disease, while polymorphonuclear segmental neutrophil infiltration is associated with perinatal infection. In 15 children (71.4%) changes of both types were noted, which indicates mixed etiology of intestinal lesions. Conclusions. Study results confirmed that necrotizing enterocolitis is a serious disease of newborns with a high mortality rate. The severe forms of NEC occur against the background of infection in combination with hypoxia. The obtained risk factors for the mortality rate of NEC allow to improve the prognosis of the course of this disease, will provide an opportunity to identify children who need increased attention of doctors to the treatment and further management of these patients with the use of preventive techno","PeriodicalId":166002,"journal":{"name":"Paediatric Surgery. Ukraine","volume":"67 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115606379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultrasonography in the diagnosis of acute appendicitis in girls","authors":"Y. Korobko, V. Konoplitskyi, V.P. Fedus","doi":"10.15574/ps.2022.74.40","DOIUrl":"https://doi.org/10.15574/ps.2022.74.40","url":null,"abstract":"Acute appendicitis is the most common cause of abdominal pain, which requires immediate surgical intervention in children and is a truly urgent pathology of the gastrointestinal tract. Preliminary diagnosis is made primarily on the basis of clinical data, however, in the course of further examination an integral part of the diagnostic process are additional research methods such as general blood tests, ultrasound examination of the abdominal cavity. Purpose - to determine the complex diagnostic significance of the ultrasound method of research in patients with abdominal pain. Materials and methods. A retrospective analysis of 200 medical records of inpatients treated at the Vinnytsia regional clinical hospital (Ukraine) for appendicitis in 2021 was conducted. Our study was conducted in the conditions on the basis of the analysis of medical records of inpatients. During the above-described period, ultrasound examination was performed in Vinnytsia regional clinical hospital in 200 girls with abdominal pain. Ultrasound examination was performed with Doppler scanning on ultrasound machines «SAMSUNG H 60» (South Korea) and «SAMSUNG» LS 22 EMU 1 HS (Seoul. Korea, 2016). The age distribution of girls was as follows: 0-3 years - 8 (4%) girls, 4-12 years - 86 (43%) children, 13-18 years - 106 (53%) girls. Results. Simultaneous comparison of the dynamics of local changes in the clinical picture, hemogram, the amount of endogenous intoxication and visual findings on ultrasound of the abdominal cavity avoids unwarranted surgery in patients with abdominal pain and direct the doctor to the correct tactical course in doubtful cases. Conclusions. Only a properly collected history, assessment of physical and clinical and laboratory parameters and data of laboratory methods of examination, the involvement of the necessary narrow specialists can avoid mistakes in the diagnosis of acute appendicitis in children. It is expedient and justified in the diagnostic assessment of the clinical picture in case of suspicion of acute appendicitis to compare the indicators of the total index of endogenous intoxication with the ultrasound method of appendix removal in the dynamics of the pathological process. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local ethics committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: ultrasound, appendicitis, diagnosis, surgery.","PeriodicalId":166002,"journal":{"name":"Paediatric Surgery. Ukraine","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125889433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Differentiated approach in the treatment of fractures of the distal humerus in children based on the use of bioabsorbable implants","authors":"M. Lyutkevych","doi":"10.15574/ps.2022.74.97","DOIUrl":"https://doi.org/10.15574/ps.2022.74.97","url":null,"abstract":"In the practice of pediatric traumatologists there are a number of complex problems in the treatment of fractures of the distal humerus, which require a differentiated approach: atraumatic anatomical reposition with minimal damage to active growth zones, minimal damage to articular cartilage during surgery, stable fixation and early rehabilitation. At present, the generally accepted methods of osteosynthesis (fixation with K - wires, metal screws, etc.) do not fully meet the requirements of modern pediatric traumatology. One of the newest methods of fixation in the treatment of fractures of this localization, which have significant advantages is the use of bioabsorbable implants (BAI). Purpose - to present a differential approach to the treatment of distal fractures of the humerus in children based on the use of bioabsorbable implants. Materials and methods. During the period from 2015 to 2021, 15 children aged 5 to 17 were treated at the Chernihiv Regional Children’s Hospital. Distribution by type of pathology: epiphyseal fracture of the humeral condyle head - 5, osteoepiphyseolysis of the lateral humerus condyle - 2, fracture of the medial epicondyle of the humerus - 8 cases. Damage to nerve and vascular structures was never diagnosed in this group of patients. At the preoperative stage, radiography of the elbow joint in standard projections for such injuries was used to diagnose the above injuries. In the course of surgery, bioabsorbable cannulated screws and Bioretec pins were used to fix the repositioned fragments. Results. In the process of surgery, standard approaches and repositioning techniques were used, according to the anatomical features of each fracture. The differentiated approach was to use cannulated screws in the case of osteosynthesis of extra-articular fractures (osteoepiphyseolysis of the medial epicondyle of the humerus) in older children (12 to 17 years), which allowed to create dosed compression of fragments and bioabsorbable perfect anatomical reposition. In 1 case there was a combined osteosynthesis: fixation of the metaphyseal fragment with a K - wires and synthesis of the intra-articular epiphyseal fragment with a bioabsorbent pin. Advantages of BAI: minimal damage to articular cartilage, preservation of congruence and anatomical shape of the articular surface at the site of implant placement (Pin), stable fixation and interfragmentary compression (autocompression property), intraoperatively received full range of motion in the joint. All patients received full consolidation in time according to the age of the injured child. The range of motion and function of the limb is completely restored. The children did not need repeated surgery. Conclusions. 1. The advantages of using bioabsorbable implants in cases of treatment of fractures of the distal humerus in children are demonstrated. 2. The use of BAI allows to minimize damage to the growth zones and joint surface during osteosynthesis, provides stable fixation and inte","PeriodicalId":166002,"journal":{"name":"Paediatric Surgery. Ukraine","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121104265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical approach to treatment of asymmetric pectus excavatum in children","authors":"V. Zaremba, O. Danylov","doi":"10.15574/ps.2022.74.27","DOIUrl":"https://doi.org/10.15574/ps.2022.74.27","url":null,"abstract":"Objective. To improve the outcomes in patients with asymmetric pectus excavatum (APE) by developing and implementing our own differentiated modified Nuss procedure to correct different variants of this deformity; to analyse the treatment outcomes. Materials and methods. An original modified Nuss procedure to correct the following pectus excavatum (PE) types is described: asymmetric eccentric focal (ІІА1 according to Park) type; asymmetric eccentric broad-flat (Park ІІА2) type; asymmetric eccentric long canal (the Grand Canyon type or Park IIA3) type; asymmetric unbalanced (Park IIB) type; asymmetric combined (Park IIC) type. The essence of the proposed technique is that at the beginning of the operation, a gradual elevation of the anterior chest wall is carried out to a maximally approximated physiological position using two or more traction ligatures applied to the sternum and ribs. In the future, a horizontal position of the fixation bar is used for asymmetric eccentric focal, asymmetric eccentric broad-flat, and asymmetric eccentric long canal types; and an oblique position with a more dorsal location of the bar end on the less depressed side is used for asymmetric unbalanced and asymmetric combined types. In both bar position variants, the rigid subperiosteal fixation of the bar stabilizers to two ribs bilaterally is used. The results of treatment according to this modification were analysed in 24 patients with different variants of asymmetric PE. Results. The proposed differentiated approaches to performing the Nuss procedure made it possible to obtain excellent and good cosmetic and functional results. There were three postoperative complications: one case of delayed pneumothorax and two cases of asymmetric manubriocostal pectus carinatum: one case after treatment of an asymmetric unbalanced PE (Park IIB) type and one - after correction of an asymmetric combined (Park IIC) type. Both patients with pectus carinatum underwent non-surgical treatment using an individually tailored dynamic compression brace system with excellent cosmetic and functional outcomes. Conclusions. The several-point traction of the anterior chest wall allows to shape its physiological form in most cases; the rigid bar fixation according to the proposed schemes ensures the retention of the chest wall shape. In the vast majority of cases, the placement of one corrective bar is sufficient. For the asymmetric combined (Park IIC) type correction, the implantation of two corrective bars or the “sandwich technique” is indicated if the defect is significant. In case of postoperative pectus carinatum, successful non-surgical treatment using an individually tailored dynamic compression brace system is possible. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local ethics committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies. No con","PeriodicalId":166002,"journal":{"name":"Paediatric Surgery. Ukraine","volume":"83 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116608388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The main risk factors for reoperations in children with congenital diaphragmatic hernias","authors":"D. Kryvchenia, E. Rudenko, I. Shulzhyk","doi":"10.15574/ps.2022.74.20","DOIUrl":"https://doi.org/10.15574/ps.2022.74.20","url":null,"abstract":"Congenital diaphragmatic hernia (CDH) occurs with a frequency of 3.5 per 10,000 live births and occurs due to a fusion disorder of the closure of the pleuroperitoneal fold and transverse septum during 8-12 weeks of gestation. In an isolated variant of this pathology, mortality is quite high and there are a number of controversial issues. Even in the best specialized prenatal intensive care centers, the mortality rate reaches 30%. The use of new technologies in the treatment of CDH has increased the survival rate of patients, however, against this background, there is an increase in surgical problems associated with CDH. Purpose - to describe the structure and incidence of reoperations in children with CDH, depending on the access, identification of the main risk factors for reoperations, pathogenetic justification of optimal surgical access. Materials and methods. A retrospective cohort study of surgical correction of CDH in 104 infants who were operated on the basis of the NCH «OKHMATDYT» during 2000-2020 was conducted. To homogenize the group and to maximally exclude selection bias in order to identify risk factors, we include a group of patients with left-sided CDH in the study. Correction of the left-sided CDH was performed through the laparotomic approach in 51 patients (61%). Thoracotomy for left-sided EDH was used in 33 (39%) patients. Results. In the study group of patients, 14 (16.7%) reoperations were performed in this group at different times of the long-term period. The indications for reoperations were: adhesive intestinal obstruction - 3 (21.5%), inc. strangulated intestinal obstruction with bowel necrosis - 2 (14%), obstruction caused by malrotation - 1 (7%), gastroesophageal reflux - 4 (29.5%), recurrent hernia - 2 (14%), pectus excavatum - 1 (7%), spleen torsion - 1 (7%). The number of reoperations in the study group during a certain observation period was slightly higher in the thoracotomy group (18% versus 14%, p=0.80). More than half of repeated interventions were associated with acute intestinal obstruction, more often after laparotomy (35.7 versus 7%; p=0.16). In this group, 5 reoperations were performed, the cause of which was intestinal obstruction, in contrast to the thoracic group, where one patient was operated for malrotation. Reoperations for recurrent diaphragmatic hernia occurred only in the thoracotomy group in one patient with agenesis of the left diaphragm dome. Early postoperative mortality was found slightly higher in the laparotomy group (27.4% versus 18.1%; p=0.167). Conclusions. The optimal method of surgical treatment of large defects and agenesis of the dome is surgical correction of the diaphragm through a thoracotomy approach using a synthetic patch and thoracalization of the abdominal cavity. The abdominal approach has a high risk of reoperations, which is associated with the development of the adhesive process and the likelihood of the formation of ventral hernias due to viscero-abdominal imbalance. Th","PeriodicalId":166002,"journal":{"name":"Paediatric Surgery. Ukraine","volume":"3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125743447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Methods of microscopically controlled recurrence-free surgery of pigmented skin tumors in children","authors":"O. Pasichnyk, V. Konoplitskyi, V.P. Fedus, A. Sasiuk","doi":"10.15574/ps.2022.74.5","DOIUrl":"https://doi.org/10.15574/ps.2022.74.5","url":null,"abstract":"The high prevalence of pigmented skin neoplasms, due to the peculiarities of tumor progress, including melanoma of the skin, in the pediatric population, brings the problem of rational removal of pigmented skin objects in one of the most relevant. Given the existing complications and negative treatment results, it requires an immediate solution, taking into account the capabilities of modern equipment and minimally invasive treatment approaches to the treatment of this complex pathology. Purpose - to improve the quality of treatment of patients by clarifying the indications for surgical treatment of skin pigmented nevi and the method without recurrent removal. Materials and methods. The paper analyzes 550 clinical cases of melanocytic nevus of the skin of different localization in children of different ages who were hospitalized in the pediatric surgery clinic of Vinnytsya National Medical University M.I. Pirogov during 2009-2020. All observations were divided into two periods: retrospective (2009-2017) - 350 patients; prospective (2018-2020) - 200 patients. Among patients with a retrospective period, 11 patients were diagnosed with melanoma, and among children with a prospective period - 3 patients. Analysis of medical records revealed 18 (3.85%) cases of recurrent (prolonged) melanocyte nevi in children of different ages, 10 (55.56%) girls and 8 (44.44%) boys. Results. In the prospective study group 138 patients regardless of age and sex based on the obtained data on the optimal configuration of the postoperative wound and the most rational way to remove pigmented skin tumors, managed to avoid incomplete removal of the object with good aesthetic results. According to the data obtained, the index of validity of biopsies is needed to determine melanoma of the skin during the entire study period was 39.29. At the same time, for the retrospective period of observation index of validity of biopsies was in the range of 31.82, in the prospective period - 66.66, namely the decrease in the value of the index was 2.09 times, or 52.27%. Conclusions. The use in clinical practice of the proposed method of incisional biopsy has reduced the number of recurrences of the pathology by 5.2 times from 2.60% in retrospect to 0.50% in the prospective period (p<0.05). The rational individual approach to clarify the indications for surgical treatment of pigmented skin nevi allowed to reduce by 52.7% the index of validity of biopsies. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local ethics committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors. Key words: pigmented skin neoplasms, children, biopsy, recurrences.","PeriodicalId":166002,"journal":{"name":"Paediatric Surgery. Ukraine","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124633640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}