Sergei G. Bondarenko, S. Agzamkhodjaev, A. Boyko, G. I. Kuzovleva
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 13 months, due to the increase in APD from 17.56.0 to 27.98.2 (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.
{"title":"The shape of the kidney pelvis in the fetus with hydronephrosis grade III as a predictor of surgical treatment in postnatal period","authors":"Sergei G. Bondarenko, S. Agzamkhodjaev, A. Boyko, G. I. Kuzovleva","doi":"10.17816/psaic1238","DOIUrl":"https://doi.org/10.17816/psaic1238","url":null,"abstract":"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. \u0000AIM: 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. \u0000MATERIALS 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. \u0000RESULTS: 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 13 months, due to the increase in APD from 17.56.0 to 27.98.2 (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. \u0000CONCLUSIONS: 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.","PeriodicalId":437552,"journal":{"name":"Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care","volume":"51 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132207200","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}
L. Korobova, N. Matinyan, O. Merkulov, V. Korolev, V. Lazarev, T. A. Ovchar, Vasilii P. Akimov, E. A. Kovaleva
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 III 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.
{"title":"Methods of local anesthesia in postoperative anesthesia of oncosurgical operations on the nasopharynx in children","authors":"L. Korobova, N. Matinyan, O. Merkulov, V. Korolev, V. Lazarev, T. A. Ovchar, Vasilii P. Akimov, E. A. Kovaleva","doi":"10.17816/psaic1276","DOIUrl":"https://doi.org/10.17816/psaic1276","url":null,"abstract":"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. \u0000AIM: 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. \u0000MATERIALS 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 III 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. \u0000RESULTS: 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. \u0000CONCLUSIONS: 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.","PeriodicalId":437552,"journal":{"name":"Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126252415","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}
A. Stepanov, M. N. Sukhov, K. H. Vasilyev, Yrii A. Polyaev, R. V. Garbuzov, A. I. Golenishchev, K. Y. Ashmanov, I. P. Lyvina, A. A. Demushkina, A. A. Tereshina
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. Conclusion. 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.
{"title":"Congenital portosystemic shunts: surgical treatment experience","authors":"A. Stepanov, M. N. Sukhov, K. H. Vasilyev, Yrii A. Polyaev, R. V. Garbuzov, A. I. Golenishchev, K. Y. Ashmanov, I. P. Lyvina, A. A. Demushkina, A. A. Tereshina","doi":"10.17816/psaic1295","DOIUrl":"https://doi.org/10.17816/psaic1295","url":null,"abstract":"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. \u0000The 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. \u0000Conclusion. 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.","PeriodicalId":437552,"journal":{"name":"Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care","volume":"22 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123728531","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}
N. R. Akramov, E. I. Khaertdinov, M. S. Pospelov, Akmal A. Rakhmatullaev, Abrozhon A. Isroilov
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. AIMS: 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.
{"title":"One-stage transcrotal orchidopexy in bilateral inguinal cryptorchidism in children","authors":"N. R. Akramov, E. I. Khaertdinov, M. S. Pospelov, Akmal A. Rakhmatullaev, Abrozhon A. Isroilov","doi":"10.17816/psaic1302","DOIUrl":"https://doi.org/10.17816/psaic1302","url":null,"abstract":"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. \u0000AIMS: 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. \u0000MATERIALS 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. \u0000RESULTS: 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. \u0000CONCLUSIONS: 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.","PeriodicalId":437552,"journal":{"name":"Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care","volume":"57 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130622148","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}
BACKGROUND: To date, N.F. Filatov Childrens Hospital has great experience in the surgical correction of pectus excavatum in children. For 22 years, 1000 minimally invasive repair procedures of pectus excavatum were performed in the thoracic surgery department. Despite the satisfactory and excellent outcomes of the surgical correction of pectus excavatum, the search for alternative nonsurgical methods of treating this pathology continues. In world practice, a vacuum bell is used as a conservative treatment. However, its effectiveness and indications are still in question. AIM: To evaluate the first experience of using a vacuum bell in the treatment of pectus excavatum in children. MATERIALS AND METHODS: A vacuum bell is a device consisting of sight glass, silicone ring, and manual pump, lifting chest wall deformities through a vacuum. The device is selected individually depending on the growth and shape of the ventral surface of the chest. According to instructions, the vacuum bell should be used a minimum of 1 h per day. All patients underwent a standardized assessment of the results of treatment every 36 months: measuring the depth of deformation, visual treatment control, analysis of photo documentation, and questionnaires. RESULTS: In the N.F. Filatov Childrens Hospital from 2015 to 2021, treatment results of 35 children using vacuum bell for 636 months were analyzed. Patients were divided into two groups depending on the percentage of deformation correction. The first group included 23 (65.7%) patients, and the percentage of correction was 50%. The second group included 12 (34.3%) patients, and the percentage of correction was 50%. In these groups, the main differences in the age of treatment initiation, regularity of use, and time of daily use have influenced the results. In the first and second groups, the average ages were 8.7 2.69 and 13.7 3.56 years, and the average daily use times were 5.7 2.04 and 3.6 1.61 h/day, respectively. CONCLUSIONS: Vacuum bell therapy is an effective and safe method for correcting pectus excavatum in children, and in some cases, it can be an alternative to surgical treatments.
{"title":"First experience of using a vacuum bell in the treatment of pectus excavatum in children","authors":"Alena O. Shominova, Z. Mitupov, A. Razumovsky","doi":"10.17816/psaic1253","DOIUrl":"https://doi.org/10.17816/psaic1253","url":null,"abstract":"BACKGROUND: To date, N.F. Filatov Childrens Hospital has great experience in the surgical correction of pectus excavatum in children. For 22 years, 1000 minimally invasive repair procedures of pectus excavatum were performed in the thoracic surgery department. Despite the satisfactory and excellent outcomes of the surgical correction of pectus excavatum, the search for alternative nonsurgical methods of treating this pathology continues. In world practice, a vacuum bell is used as a conservative treatment. However, its effectiveness and indications are still in question. \u0000AIM: To evaluate the first experience of using a vacuum bell in the treatment of pectus excavatum in children. \u0000MATERIALS AND METHODS: A vacuum bell is a device consisting of sight glass, silicone ring, and manual pump, lifting chest wall deformities through a vacuum. The device is selected individually depending on the growth and shape of the ventral surface of the chest. According to instructions, the vacuum bell should be used a minimum of 1 h per day. All patients underwent a standardized assessment of the results of treatment every 36 months: measuring the depth of deformation, visual treatment control, analysis of photo documentation, and questionnaires. \u0000RESULTS: In the N.F. Filatov Childrens Hospital from 2015 to 2021, treatment results of 35 children using vacuum bell for 636 months were analyzed. Patients were divided into two groups depending on the percentage of deformation correction. The first group included 23 (65.7%) patients, and the percentage of correction was 50%. The second group included 12 (34.3%) patients, and the percentage of correction was 50%. In these groups, the main differences in the age of treatment initiation, regularity of use, and time of daily use have influenced the results. In the first and second groups, the average ages were 8.7 2.69 and 13.7 3.56 years, and the average daily use times were 5.7 2.04 and 3.6 1.61 h/day, respectively. \u0000CONCLUSIONS: Vacuum bell therapy is an effective and safe method for correcting pectus excavatum in children, and in some cases, it can be an alternative to surgical treatments.","PeriodicalId":437552,"journal":{"name":"Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care","volume":"5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127620344","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}
Pasin Tangadulrat, N. Adulkasem, Kuntalee Suganjanasate, J. Wongcharoenwatana, T. Ariyawatkul, Perajit Eamsobhana, C. Chotigavanichaya
BACKGROUND: Cerebral palsy (CP) patients commonly present with unilateral hip dislocation. However, the decision for concurrent prophylaxis surgery on the contralateral hip in this condition is still controversial. AIM: This study aims to explore the prognostic factors for contralateral hip dislocation and develop a scoring system. MATERIALS AND METHODS: Data on CP patients with unilateral hip dislocation between January 2005 to January 2019 were reviewed. We explored the difference of preoperative parameters between the group in which the contralateral hip is eventually dislocated or remains stable. A multivariable logistic regression analysis was performed to develop a model for predicting contralateral hip dislocation. RESULTS: Seven of included 30 patients (23.3%) developed contralateral hip dislocation. Pre-operative contralateral hips Reimers Migration Index (RMI), Acetabular Index (AI), Lateral Center Edge Angle of Wiberg (CEA), and Pelvic obliquity (PO) were significantly different (p = 0.049, 0.019, 0.030 and 0.038 respectively). The multivariable logistic regression analysis reveals that RMI 25% (mOR 36.66, 95% CI 1.131185.50, p = 0.042) and age 9 years old (mOR = 22.55, 95% CI 0.76665.37, p = 0.071) are significant predictors. Both parameters were included in the model, which revealed an AuROC of 0.84 (95% CI 0.690.99). Each factor was assigned a score of 1. There was no contralateral hip displacement in patients with a score of 0. Two out of 15 patients (28.6%) with a score of one developed contralateral hip displacement. Five out of eight (71.4%) patients with a score of 2 developed contralateral hip dislocation. CONCLUSIONS. Significant predictors for contralateral hip dislocation in CP patients are RMI 25% and age 9 years old. The proposed scoring system might help guide the surgeons decision to perform contralateral prophylactic surgery.
背景:脑瘫(CP)患者通常表现为单侧髋关节脱位。然而，在这种情况下，对侧髋关节同步预防性手术的决定仍然存在争议。目的:本研究旨在探讨对侧髋关节脱位的预后因素并建立评分系统。材料和方法:回顾2005年1月至2019年1月期间CP患者单侧髋关节脱位的数据。我们探讨了对侧髋关节最终脱位或保持稳定的两组术前参数的差异。采用多变量logistic回归分析建立对侧髋关节脱位预测模型。结果:30例患者中有7例(23.3%)发生对侧髋关节脱位。术前对侧髋remers移动指数(RMI)、髋臼指数(AI)、Wiberg外侧中心边缘角(CEA)、骨盆倾角(PO)差异有统计学意义(p分别为0.049、0.019、0.030、0.038)。多变量logistic回归分析显示，RMI 25% (more or 36.66, 95% CI 1.131185.50, p = 0.042)和9岁(more or = 22.55, 95% CI 0.766665.37, p = 0.071)是显著的预测因子。这两个参数均纳入模型，AuROC为0.84 (95% CI 0.690.99)。每个因素被赋予1分。评分为0的患者无对侧髋关节移位。评分为1分的15例患者中有2例(28.6%)发生对侧髋关节移位。5 / 8(71.4%)评分为2分的患者发生对侧髋关节脱位。结论。CP患者对侧髋关节脱位的重要预测因子RMI为25%，年龄为9岁。所提出的评分系统可能有助于指导外科医生决定是否进行对侧预防性手术。
{"title":"Prediction Model for Contralateral Hip Dislocation in Cerebral Palsy Patients with Unilateral Hip Dislocation: A Scoring System to Guide Decision Making","authors":"Pasin Tangadulrat, N. Adulkasem, Kuntalee Suganjanasate, J. Wongcharoenwatana, T. Ariyawatkul, Perajit Eamsobhana, C. Chotigavanichaya","doi":"10.17816/psaic1270","DOIUrl":"https://doi.org/10.17816/psaic1270","url":null,"abstract":"BACKGROUND: Cerebral palsy (CP) patients commonly present with unilateral hip dislocation. However, the decision for concurrent prophylaxis surgery on the contralateral hip in this condition is still controversial. \u0000AIM: This study aims to explore the prognostic factors for contralateral hip dislocation and develop a scoring system. \u0000MATERIALS AND METHODS: Data on CP patients with unilateral hip dislocation between January 2005 to January 2019 were reviewed. We explored the difference of preoperative parameters between the group in which the contralateral hip is eventually dislocated or remains stable. A multivariable logistic regression analysis was performed to develop a model for predicting contralateral hip dislocation. \u0000RESULTS: Seven of included 30 patients (23.3%) developed contralateral hip dislocation. Pre-operative contralateral hips Reimers Migration Index (RMI), Acetabular Index (AI), Lateral Center Edge Angle of Wiberg (CEA), and Pelvic obliquity (PO) were significantly different (p = 0.049, 0.019, 0.030 and 0.038 respectively). The multivariable logistic regression analysis reveals that RMI 25% (mOR 36.66, 95% CI 1.131185.50, p = 0.042) and age 9 years old (mOR = 22.55, 95% CI 0.76665.37, p = 0.071) are significant predictors. Both parameters were included in the model, which revealed an AuROC of 0.84 (95% CI 0.690.99). Each factor was assigned a score of 1. There was no contralateral hip displacement in patients with a score of 0. Two out of 15 patients (28.6%) with a score of one developed contralateral hip displacement. Five out of eight (71.4%) patients with a score of 2 developed contralateral hip dislocation. \u0000CONCLUSIONS. Significant predictors for contralateral hip dislocation in CP patients are RMI 25% and age 9 years old. The proposed scoring system might help guide the surgeons decision to perform contralateral prophylactic surgery.","PeriodicalId":437552,"journal":{"name":"Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care","volume":"126 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129675961","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}
BACKGROUND: Periurethral injections of various materials in the treatment of stress urinary incontinence have been known since 1938. In the literature, we could not find reports of endosurgical correction of urinary incontinence as the main method of treatment in children with myelodysplasia and epispadias and a pathogenetically based examination algorithm to predict the result of the injection, taking into account the endoscopic technique and volume of the injected drug. AIM: To present an assessment of long-term results, i.e., correction of stress urinary incontinence in children with myelodysplasia and epispadias, after endoimplantation of a stable synthetic volume-forming polymer. MATERIALS AND METHODS: The study analyzed 38 patients (517 years old) with urinary incontinence with myelodysplasia and epispadias: boys and girls with epispadias (n = 9 and n = 3, respectively) and with myelodysplasia (n = 10 and n = 16), respectively. For diagnostic purposes, clinical and instrumental (excretory urography, cystography, cystoscopy, uroflowmetry, electrophysiological, and urodynamic) examination methods were used. To correct incontinence, intra- and paraurethral endoinjections of a stable polyacrylamide mesh polymer with silver ions were performed. RESULTS: According to the literature, the effectiveness of the intraurethral administration of stable implants with urinary incontinence in catamnesis for up to 12 months reached 50%; with longer follow-up, positive results did not exceed 40% of observations. In this study, complete retention of urine was achieved in 25 (66%) children. Satisfactory result (incontinence in the afternoon up to 40 mL) was observed in 8 (21%) children, and unsatisfactory in 5 (13%) children. DISCUSSION: Indications for endosphincteroplasty in children with stress incontinence having myelodysplasia and epispadias with a stable implant should be determined considering urodynamics, blood circulation, innervation, and functional (urethral profilometry) parameters in the detrusor-sphincters-pelvic floor system. CONCLUSIONS: In patients with myelodysplasia and epispadias with isolated insufficiency of urethral sphincters, surgical treatments can be performed independently, and their effectiveness can reach 70%.
{"title":"Effectiveness of urethral endosphincteroplasty in children with urinary incontinence, myelodysplasia, and epispadias","authors":"A. A. Demidov, E. Mlynchik","doi":"10.17816/psaic1000","DOIUrl":"https://doi.org/10.17816/psaic1000","url":null,"abstract":"BACKGROUND: Periurethral injections of various materials in the treatment of stress urinary incontinence have been known since 1938. In the literature, we could not find reports of endosurgical correction of urinary incontinence as the main method of treatment in children with myelodysplasia and epispadias and a pathogenetically based examination algorithm to predict the result of the injection, taking into account the endoscopic technique and volume of the injected drug. \u0000AIM: To present an assessment of long-term results, i.e., correction of stress urinary incontinence in children with myelodysplasia and epispadias, after endoimplantation of a stable synthetic volume-forming polymer. \u0000MATERIALS AND METHODS: The study analyzed 38 patients (517 years old) with urinary incontinence with myelodysplasia and epispadias: boys and girls with epispadias (n = 9 and n = 3, respectively) and with myelodysplasia (n = 10 and n = 16), respectively. For diagnostic purposes, clinical and instrumental (excretory urography, cystography, cystoscopy, uroflowmetry, electrophysiological, and urodynamic) examination methods were used. To correct incontinence, intra- and paraurethral endoinjections of a stable polyacrylamide mesh polymer with silver ions were performed. \u0000RESULTS: According to the literature, the effectiveness of the intraurethral administration of stable implants with urinary incontinence in catamnesis for up to 12 months reached 50%; with longer follow-up, positive results did not exceed 40% of observations. In this study, complete retention of urine was achieved in 25 (66%) children. Satisfactory result (incontinence in the afternoon up to 40 mL) was observed in 8 (21%) children, and unsatisfactory in 5 (13%) children. \u0000DISCUSSION: Indications for endosphincteroplasty in children with stress incontinence having myelodysplasia and epispadias with a stable implant should be determined considering urodynamics, blood circulation, innervation, and functional (urethral profilometry) parameters in the detrusor-sphincters-pelvic floor system. \u0000CONCLUSIONS: In patients with myelodysplasia and epispadias with isolated insufficiency of urethral sphincters, surgical treatments can be performed independently, and their effectiveness can reach 70%.","PeriodicalId":437552,"journal":{"name":"Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care","volume":"79 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127564406","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}
Aslamkhon M. Sharipov, Nuriddin D. Mukhiddinov, Rukhshona A. Rahmatova, S. A. Mazabshoev
Situs inversus totalis is an extremely rare anomaly in which the organs of the chest and abdominal cavity lie in the opposite direction. With complete transposition, clinical manifestations may be absent, and diagnostic and therapeutic problems may arise in the presence of other malformations or diseases. A 4-year-old girl was admitted for treatment in the hematology department of the National Medical Center of the Republic of Tajikistan, with complaints of nausea, periodic vomiting, lethargy, lack of appetite, malaise, and skin pallor. Owing to the ineffectiveness of conservative therapy, surgical treatment was recommended, i.e., splenectomy. During the preoperative examination, radiography and radiopaque examination of the organs of the gastrointestinal tract with barium sulfate revealed that the fundus and body of the stomach were located in the left half of the chest, and the heart was symmetrically deployed to the right. An ultrasound examination revealed signs of displacement of the liver to the left half of the abdomen, the spleen to the right, and the heart in the right half of the chest. The diagnosis was hiatal hernia on the left, situs inversus totalis, hereditary hemolytic anemia, fermentopathy, and G-6-PD deficiency. Laparoscopic surgery was performed, which included splenectomy, elimination of a hiatal hernia, chiatoplasty, and esophagogastrofundoplication with the creation of a Nissen cuff. The girl was discharged on day 10. On control examination after 6 and 12 months, she had no complaints and has grown and developed according to age. This clinical case is the first in the Russian literature to describe the treatment of a child with a hiatal hernia against the background of complete transposition of internal organs. This case highlights the need for imaging techniques for any unclear symptoms, especially in children with hereditary diseases. Minimally invasive intervention could contribute to a favorable outcome.
{"title":"Situs inversus totalis in combination with hiatal hernia and hereditary hemolytic anemia in a 4-year-old child: A case report","authors":"Aslamkhon M. Sharipov, Nuriddin D. Mukhiddinov, Rukhshona A. Rahmatova, S. A. Mazabshoev","doi":"10.17816/psaic1037","DOIUrl":"https://doi.org/10.17816/psaic1037","url":null,"abstract":"Situs inversus totalis is an extremely rare anomaly in which the organs of the chest and abdominal cavity lie in the opposite direction. With complete transposition, clinical manifestations may be absent, and diagnostic and therapeutic problems may arise in the presence of other malformations or diseases. \u0000A 4-year-old girl was admitted for treatment in the hematology department of the National Medical Center of the Republic of Tajikistan, with complaints of nausea, periodic vomiting, lethargy, lack of appetite, malaise, and skin pallor. Owing to the ineffectiveness of conservative therapy, surgical treatment was recommended, i.e., splenectomy. During the preoperative examination, radiography and radiopaque examination of the organs of the gastrointestinal tract with barium sulfate revealed that the fundus and body of the stomach were located in the left half of the chest, and the heart was symmetrically deployed to the right. An ultrasound examination revealed signs of displacement of the liver to the left half of the abdomen, the spleen to the right, and the heart in the right half of the chest. The diagnosis was hiatal hernia on the left, situs inversus totalis, hereditary hemolytic anemia, fermentopathy, and G-6-PD deficiency. Laparoscopic surgery was performed, which included splenectomy, elimination of a hiatal hernia, chiatoplasty, and esophagogastrofundoplication with the creation of a Nissen cuff. The girl was discharged on day 10. On control examination after 6 and 12 months, she had no complaints and has grown and developed according to age. \u0000This clinical case is the first in the Russian literature to describe the treatment of a child with a hiatal hernia against the background of complete transposition of internal organs. This case highlights the need for imaging techniques for any unclear symptoms, especially in children with hereditary diseases. Minimally invasive intervention could contribute to a favorable outcome.","PeriodicalId":437552,"journal":{"name":"Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130142336","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}
V. Bazylev, K. T. Shcheglova, M. P. Chuprov, A. I. Magilevets
BACKGROUND: The improvement of multimodal anesthesia schemes is of clinical interest because of the possibility of reducing the doses of narcotic analgesics and the earlier mobilization of patients postoperatively. AIM: To evaluate the efficiency of intravenous infusion of ketamine and lidocaine as adjuvants for multimodal analgesia in children aged 1 year after cardiac surgery. MATERIALS AND METHODS: A prospective single-center study included 122 children aged 1 year, who divided into three groups: group 1, postoperative pain management included a combination of fentanyl and ketamine (n = 40); group 2 (n = 41), lidocaine infusion in combination with fentanyl; group 3 (n = 41), standard analgesia (fentanyl). The median ages at the time of surgery were 4.0, 4.5, and 4.0 months in groups 1, 2, and 3, respectively. Anatomical, demographic, clinical, and laboratory parameters were analyzed before surgery and early after surgery. RESULTS: The pain intensity according to the Neonatal Infant Pain Scale did not differ among the groups at any stage of the study. The average dose of fentanyl was twice as high in group 3 at 1.6 mcg/kg/h compared with 0.5 mcg/kg/h in group 1 and 0.6 mcg/kg/h in group 2. Group 2 had a shorter duration of mechanical ventilation in an intergroup comparison. The side effects of lidocaine were not recorded, and hypersalivation was noted in 35% of the patients who were treated with ketamine. CONCLUSIONS: Ketamine infusion as an adjuvant to multimodal analgesia provides an adequate analgesic effect without a significant effect on hemodynamics and allows a reduction in the dose of opioids. The intravenous infusion of lidocaine as a component of multimodal analgesia after cardiac surgery in children has an additional opioid-sparing effect and reduces the mechanical ventilation time. The use of lidocaine at a dose of 1 mg/kg/h is not accompanied by side effects.
{"title":"Efficiency of intravenous infusion of ketamine and lidocaine as part of multimodal analgesia in the postoperative period in children","authors":"V. Bazylev, K. T. Shcheglova, M. P. Chuprov, A. I. Magilevets","doi":"10.17816/psaic1267","DOIUrl":"https://doi.org/10.17816/psaic1267","url":null,"abstract":"BACKGROUND: The improvement of multimodal anesthesia schemes is of clinical interest because of the possibility of reducing the doses of narcotic analgesics and the earlier mobilization of patients postoperatively. \u0000AIM: To evaluate the efficiency of intravenous infusion of ketamine and lidocaine as adjuvants for multimodal analgesia in children aged 1 year after cardiac surgery. \u0000MATERIALS AND METHODS: A prospective single-center study included 122 children aged 1 year, who divided into three groups: group 1, postoperative pain management included a combination of fentanyl and ketamine (n = 40); group 2 (n = 41), lidocaine infusion in combination with fentanyl; group 3 (n = 41), standard analgesia (fentanyl). The median ages at the time of surgery were 4.0, 4.5, and 4.0 months in groups 1, 2, and 3, respectively. Anatomical, demographic, clinical, and laboratory parameters were analyzed before surgery and early after surgery. \u0000RESULTS: The pain intensity according to the Neonatal Infant Pain Scale did not differ among the groups at any stage of the study. The average dose of fentanyl was twice as high in group 3 at 1.6 mcg/kg/h compared with 0.5 mcg/kg/h in group 1 and 0.6 mcg/kg/h in group 2. Group 2 had a shorter duration of mechanical ventilation in an intergroup comparison. The side effects of lidocaine were not recorded, and hypersalivation was noted in 35% of the patients who were treated with ketamine. \u0000CONCLUSIONS: Ketamine infusion as an adjuvant to multimodal analgesia provides an adequate analgesic effect without a significant effect on hemodynamics and allows a reduction in the dose of opioids. The intravenous infusion of lidocaine as a component of multimodal analgesia after cardiac surgery in children has an additional opioid-sparing effect and reduces the mechanical ventilation time. The use of lidocaine at a dose of 1 mg/kg/h is not accompanied by side effects.","PeriodicalId":437552,"journal":{"name":"Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care","volume":"44 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124109489","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}
BACKGROUND: Crohns disease is an incurable progressive condition of the gastrointestinal tract in which up to 90% of patients undergo one or more surgical interventions during their lifetime. Despite the active development and implementation of new surgical techniques for the treatment of Crohns disease, the incidence of postoperative complications remains high, i.e., up to 25%30%. Until now, the influence of various factors on the outcomes of surgical interventions and the choice of differentiated techniques for the surgical treatment of children with Crohns disease remain highly debatable. AIMS: To study and identify possible risk factors for postoperative complications in children and adolescents with Crohns disease. MATERIALS AND METHODS: A retrospective nonrandomized clinical study included 164 pediatric patients (boys, n = 106, 65%) with complicated forms of Crohns disease. Early results of surgical interventions on the intestines were analyzed (up to 30 days after surgery). Postoperative complications were noted in 15% of cases after the initial surgery (20/133). In half of the cases (66/133) re-interventions on the intestines were performed at different times after the initial surgery, of which postoperative complications were detected in 14% of the cases (9/66). To determine risk factors in dichotomous variables, contingency tables were constructed with the calculation of the odds ratio (OR) and their 95% confidence interval (95% CI). Differences were recognized as statistically significant at p 0.05. RESULTS: The following predictors of postoperative complications were identified: penetrating Crohns disease with strictures (OR 5,1; 95% CI 1,7314,8; p = 0,0047), intestinal fistulas (OR 5; 95% CI 1,7314,8; р = 0,0047), fibrosis in intestinal mucosal biopsy (OR 8,9; 95% CI 1,2253; p = 0,0093), steroid therapy before surgery (OR 14,6; 95% CI 1,08135; р = 0,0105), onset of CD in 6 years of age (OR 10,8; 95% CI 1,16137; р = 0,0177), combination of CD of any localization with lesions of the upper gastrointestinal tract (OR 13,8; 95% CI 1,01143; р = 0,0247), severe hypoalbuminemia (OR 9,62; 95% CI 1,04122; p = 0,0228) and no specific therapy for Crohns disease after surgery (OR 10,8; 95% CI 1,16137; p = 0,0177). CONCLUSIONS: The development of surgical strategy in the preoperative period based on the identification of reliable predictors of adverse outcomes helps reduce the risk of postoperative complications. This improves the early outcomes of surgical treatment of children with complicated forms of Crohns disease.
背景:克罗恩病是一种无法治愈的胃肠道进行性疾病，高达90%的患者在其一生中接受过一次或多次手术治疗。尽管治疗克罗恩病的新手术技术正在积极发展和实施，但术后并发症的发生率仍然很高，即高达25% - 30%。到目前为止，各种因素对手术干预结果的影响以及选择不同的手术治疗儿童克罗恩病的技术仍然存在很大的争议。目的:研究和确定儿童和青少年克罗恩病术后并发症的可能危险因素。材料和方法:一项回顾性非随机临床研究纳入了164例患有复杂形式克罗恩病的儿童患者(男孩，n = 106, 65%)。对肠道手术干预的早期结果进行了分析(手术后30天)。初次手术后有15%的病例出现术后并发症(20/133)。半数病例(66/133)在初次手术后的不同时间对肠道进行了再次干预，其中14%的病例(9/66)发现了术后并发症。为了确定二分类变量中的危险因素，构建列联表，计算比值比(OR)及其95%置信区间(95% CI)。差异有统计学意义，p < 0.05。结果:确定了以下预测术后并发症的因素:穿透性克罗恩病合并狭窄(OR 5,1;95% ci 1,7314,8;p = 0.0047)，肠瘘(OR 5;95% ci 1,7314,8;r = 0.0047)，肠黏膜活检纤维化(OR 8,9;95% ci 1,2253;p = 0.0093)，术前类固醇治疗(OR 14,6;95% ci 1,08135;(r = 0,0105)， 6岁发病(OR = 10,8;95% ci 1,16137;r = 0,0177)，任何部位的CD合并上消化道病变(OR 13,8;95% ci为1,01143;严重低白蛋白血症(OR 9,62;95% ci 1,04122;p = 0.0228)，术后无特异性治疗克罗恩病(OR 10,8;95% ci 1,16137;P = 0,0177)。结论:在确定可靠的不良结局预测因素的基础上制定术前手术策略有助于降低术后并发症的风险。这提高了复杂形式克罗恩病儿童手术治疗的早期结果。
{"title":"Postoperative complications in children with Crohn’s disease: an analysis of risk predictors","authors":"O. Shcherbakova, P. Shumilov","doi":"10.17816/psaic1284","DOIUrl":"https://doi.org/10.17816/psaic1284","url":null,"abstract":"BACKGROUND: Crohns disease is an incurable progressive condition of the gastrointestinal tract in which up to 90% of patients undergo one or more surgical interventions during their lifetime. Despite the active development and implementation of new surgical techniques for the treatment of Crohns disease, the incidence of postoperative complications remains high, i.e., up to 25%30%. Until now, the influence of various factors on the outcomes of surgical interventions and the choice of differentiated techniques for the surgical treatment of children with Crohns disease remain highly debatable. \u0000AIMS: To study and identify possible risk factors for postoperative complications in children and adolescents with Crohns disease. \u0000MATERIALS AND METHODS: A retrospective nonrandomized clinical study included 164 pediatric patients (boys, n = 106, 65%) with complicated forms of Crohns disease. Early results of surgical interventions on the intestines were analyzed (up to 30 days after surgery). Postoperative complications were noted in 15% of cases after the initial surgery (20/133). In half of the cases (66/133) re-interventions on the intestines were performed at different times after the initial surgery, of which postoperative complications were detected in 14% of the cases (9/66). To determine risk factors in dichotomous variables, contingency tables were constructed with the calculation of the odds ratio (OR) and their 95% confidence interval (95% CI). Differences were recognized as statistically significant at p 0.05. \u0000RESULTS: The following predictors of postoperative complications were identified: penetrating Crohns disease with strictures (OR 5,1; 95% CI 1,7314,8; p = 0,0047), intestinal fistulas (OR 5; 95% CI 1,7314,8; р = 0,0047), fibrosis in intestinal mucosal biopsy (OR 8,9; 95% CI 1,2253; p = 0,0093), steroid therapy before surgery (OR 14,6; 95% CI 1,08135; р = 0,0105), onset of CD in 6 years of age (OR 10,8; 95% CI 1,16137; р = 0,0177), combination of CD of any localization with lesions of the upper gastrointestinal tract (OR 13,8; 95% CI 1,01143; р = 0,0247), severe hypoalbuminemia (OR 9,62; 95% CI 1,04122; p = 0,0228) and no specific therapy for Crohns disease after surgery (OR 10,8; 95% CI 1,16137; p = 0,0177). \u0000CONCLUSIONS: The development of surgical strategy in the preoperative period based on the identification of reliable predictors of adverse outcomes helps reduce the risk of postoperative complications. This improves the early outcomes of surgical treatment of children with complicated forms of Crohns disease.","PeriodicalId":437552,"journal":{"name":"Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133907951","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}
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