PAEDIATRIC SURGERY. UKRAINE

Forensic medical analysis of child mortality due to mechanical trauma in peaceful and wartime: impact on improving surgical care

2025-04-02T22:47:34+03:00

Child mortality due to mechanical trauma is a significant issue in forensic medical practice. It necessitates attention to the specifics of injuries and the organization of medical care. Firearm and explosive injuries impose additional demands on surgical care.

Aim: to study the structure and causes of child mortality due to mechanical trauma based on forensic medical data, analyze changes in mortality rates before and after the onset of the full-scale military invasion, and develop proposals for improving pediatric surgical care by integrating forensic medical data into clinical practice.

Materials and methods. The data from the Bureau of Forensic Medical Examination of Ukraine for 2019-2022 on violent child mortality, including mortality from mechanical trauma, were used. Pediatric mechanical injuries with potential surgical consequences were analyzed in detail during both the pre-war and wartime periods to determine the possibilities for surgical treatment under modern conditions.

Results. The decrease in the violent death rates among children in 2022 was attributed to factors such as evacuation and difficulties in registering deaths under wartime conditions, particularly in temporarily occupied territories. Changes in the structure of mortality from mechanical trauma can contribute to the improvement of surgical care through the integration of forensic medical data into clinical practice. The increase in firearm and explosive injuries requires advancements in medical care methods under wartime conditions, especially in pediatric surgery. The reduction in vehicle-related injuries suggests the need to reallocate medical resources to the treatment of injuries typical of wartime.

Conclusions. The decrease in violent deaths among children in 2022 is primarily due to a general reduction in Ukraine's population. However, the sharp rise in firearm and explosive injuries directly linked to active hostilities and constant shelling of medical facilities indicate the urgent need to enhance medical care methods under combat conditions, particularly in pediatric surgery.

Clinical case of congenital vagina and cervical malformations in adolescent girl

2025-04-03T20:54:49+03:00

Congenital malformations of the female genital organs consist of a group of various deviations from normal anatomical structure. Management of the congenital abnormalities of the female genital tract depends on the type of malformation and includes both endoscopic and conventional surgeries.

The aim of this study was to present the case of congenital vaginal atresia associated with cervical atresia in adolescent female patient, in which hysterectomy was performed.

Clinical case. During surgery, due to the acute appendicitis in a female patient with mental retardation, the uterine congenital malformation was suspected. After further investigation, the diagnosis of vaginal and cervical aplasia was established. She received conservative therapy (peroral contraceptives), but there were disturbances in the medication regime that caused the necessity of rehospitalization and emergent surgery – hysterectomy with the right-side tubectomy and left-side adnexectomy. The postoperative course was uncomplicated.

Conclusion. Girls of prepubertal and pubertal age with primary amenorrhea and cyclic abdominal pain should always consulted by a gynecologist in order to confirm/exclude malformations of uterus and genital tracts, their timely treatment, and prevention of possible complications. The choice of surgical treatment for vaginal atresia combined with cervical atresia should be individual in each case, bearing in mind associated pathology and social status of the child.

The research was carried out in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of the institution mentioned in the work. The informed consent of the patients was obtained for the research.

No conflict of interests was declared by the authors.

A clinical case of tuberculous rib damage as an etiological cause of chest neoplasm in an early age child

2025-04-03T21:11:58+03:00

Extrapulmonary tuberculosis is as one of the etiological causes of chest neoplasms in early age children, which does not have marker risk factors for its induction in the human body and specific symptoms. This leads to a significant amount case of hypodiagnosis and the choice of wrong treatment tactics by a pediatric surgeon.

Aim - to analyze the causes of untimely diagnosis and the peculiarities of the diagnostic and therapeutic tactics of neoplasms of tuberculous etiology on the example of a clinical case from one's own practice.

The clinical case is presented the diagnostic and treatment tactic in a patient aged 1 year 3 months with a chest neoplasm of tuberculous genesis, the analysis of which made it possible to determine the reasons for untimely diagnosis and incorrect treatment tactics at the initial stage. The need for a multimodal imaging approach to chest neoplasms, in order to determine its etiology and possible changes in other organs, is presented and substantiated. The effectiveness of complex laboratory diagnostics, which includes molecular genetic research methods, in the case of suspected tuberculous etiology of the inflammatory process, was determined. The possible options and volume of surgical resection of the rib in the case of tuberculous destruction were analyzed.

The research was carried out in accordance with the principles of the Declaration of Helsinki. Parents' informed consent was obtained for children's participation in the study.

The authors declare no conflict of interest.

Bezoars of gastro-intestinal tract in children

2025-04-03T21:31:30+03:00

Bezoars are indigestible substances that accumulated in the lumen of digestive canal. Among various types of bezoars, trichobezoar is the most frequent form, which revealed in stomach and often associated with psychiatric disorders. Rapunzel syndrome is a rare form of bezoar that included the presence of bezoar in stomach that extending through the pylorus, with the potential to extend up to the cecum. Due to the relatively rarity of this entity, there are no generally established guidelines for its diagnostic and management.

Аim - summarizing the own experience of the treating children with bezoars, including with Rapunzel syndrome.

Clinical cases. Five patients (4 girls and one boy) that were treated at Lviv reginal children’s clinical hospital «OHMATDYT» for 1997-2024 years were included in this study. Pain syndrome and presence of palpable mass at the upper parts of abdomen was noted in all patients, by that the weight loss was revealed only in one patient. Four patients were hospitalized for the emergent condition – signs of intestinal obstruction. For the diagnosis establishment, the endoscopy was applied in two patients, ultrasonography – in two patients, and computed tomography – in one patient. All patients were operated with the applying of laparotomic approach: in three patients were revealed trichobezoar, including two cases of Rapunzel syndrome, in one patient bezoar consisted of a cluster of chewing gum, and in one patient – undigested pieces of cotton tissue, which were not only in the stomach, but also in the small intestine. Endoscopy and computed tomography are the main instrumental methods for the confirmation of bezoar diagnosis. The endoscopic or laparoscopic removing of bezoar can be applied in selected patients, but the main method of treatment is open surgery. The consultation and treatment of psychiatric is required at the follow-up.

Conclusions. Clinical course of bezoars during long time may be asymptomatic, by that the main clinical appearance are the pain or discomfort in epigastric region and the presence of the dense mass at the projection of stomach.

The research was carried out in accordance with the principles of the Declaration of Helsinki. Informed consent of the patients was obtained for the research.

No conflict of interests was declared by the authors.

Rapunzel syndrome in an adolescent child: clinical case

2025-04-03T22:11:26+03:00

Gastrointestinal bezoars in children are a rather rare pathology. Rapunzel syndrome is characterized by a large trichobezoar in the stomach with a tail that extends beyond the pylorus into the small intestine, causing mechanical obstruction of the small intestine. Some cases of bezoars remain undiagnosed for a long time, since complaints or objective changes are nonspecific.

Aim- to raise awareness of Rapunzel syndrome as a rare pathology of the digestive system in children.

Clinical case. The analysis of a retrospective clinical review of one case of surgical intervention for a large gastric bezoar. The patient's gender and age, composition and size of the bezoar, clinical, laboratory and instrumental changes, surgical tactics and scope of intervention were analyzed. The problem of diagnosing and treating rare diseases of the digestive tract remains relevant. The medical record of a 14-year-old teenager with Rapunzel syndrome was analyzed. Symptoms of the pathology were lack of appetite, abdominal pain, nausea, vomiting, weight loss, bad breath, and an objective examination of the abdomen revealed the formation of a dense consistency. After surgical treatment, the patient recovered without complications.

Conclusions. Rapunzel syndrome is a rare cause of digestive symptoms in children, such as abdominal pain, anorexia, or weight loss. Raising awareness of the risk factors for this condition is crucial for early diagnosis.

The research was carried out in accordance with the principles of the Declaration of Helsinki. Parents' informed consent was obtained for children's participation in the study.

The authors declare no conflict of interest.

Prediction of difficult laparoscopic cholecystectomy as the principle of improvement of the results of surgery (review)

2025-04-03T20:15:42+03:00

At present, laparoscopic cholecystectomy (LC) has become the «gold standard» of acute and chronic cholecystitis treatment and one of the frequent operations performed in general surgery. All these complications characterized LC as difficult, however, there is no consensus regarding the definition of the difficulty of LC.

The aim of this review is to find a consistent and reliable system for predicting intraoperative complications to improve outcomes of LC.

Difficult LC (DLC) is defined as the surgical removal of the gallbladder in conditions when changes in the organ itself, adjacent structures, or the patient’s specific condition prevent its smooth, quick, and comfortable removal during surgery. The definition of DLC varies considerably depending on the experience of the surgical team. With the improvement of technique and skills of LC, the criteria of complexity of surgery and choice of «salvage procedure» have changed.

Preoperative prediction of DLC is extremely important for the choice of adequate treatment and decreases the frequency of intra- and postoperative complications. Various preoperative factors, laboratory data, and results of imaging investigation methods, which are connected with cholecystitis, anatomical changes, previous abdominal surgery, surgeon experience, and comorbidities may determine unfavorable outcomes of surgical procedures. Multiple predictive systems (scales), which combine clinical, laboratory data, and imaging parameters were elaborated to improve the accuracy of preoperative identification of DLC, including elective and emergent surgical procedures, merged personal history-related factors with clinical and imaging factors. These models were more useful than considering each significant factor separately.

Another important preoperative factor that determines the outcome of treatment is the stratification of patients in whom conversion is possible.

Conclusions. Various international studies propose preoperative systems of value for solving the problem of DLC. At the same time, it is extremely important to develop a scale adapted to the characteristics of each population to optimize the efforts of surgeons and improve the overall quality of medical and surgical care. With the improvement skills of LC, the markers of difficulty of surgery change influenced on prognostic value of proposed models. The present prospective cohort studies with validated indicators of difficult surgery may suggest further identification of the best systems for predicting the severity of intervention to improve treatment outcomes.

No conflict of interests was declared by the authors.

Postural disorders in children. Modern views on classification, diagnosis, treatment and rehabilitation

2025-04-03T20:34:37+03:00

The increase in the incidence of postural disorders among the modern pediatric population is due to socio-economic, environmental problems, lack of physical activity, lack of healthy lifestyle skills, and emotional overload in the course of everyday life. Postural changes lead to a decrease in the child's physical and functional capacity, which negatively affects his physical development and the ability to manifest individual physical qualities of life.

The aim is highlightmodern views on classification, diagnosis, treatment and rehabilitationPostural disorders in children.

Violations of posture lead to the formation of structural deformations of the spine and pain syndromes with the realization of pathological motor and static stereotypes. Against this background, functional joint blockades and myofascial pain syndrome develop, which change the biomechanics of the spine, which contributes to the development of degenerative-dystrophic changes in the intervertebral discs and ligamentous-articular apparatus. That osteochondrosis, persistent pain syndrome, and the formation of herniated intervertebral discs, which occur in 60-80% of the adult working population and can lead to disability, develop in the future. In addition, posture disorders lead to changes in the topography of the thoracic and abdominal organs, insufficient excursion of the diaphragm and a decrease in the gradient of intrathoracic and intra-abdominal pressure, which negatively affects the functions of the respiratory, cardiovascular, nervous and central nervous systems. That posture is not innate, but is formed during the entire preschool period and is finally fixed at school age. Therefore, the problem of the earliest possible correction of its possible deviations and violations becomes obvious and urgent. The existing stages of the course of posture pathology indicate that the earlier its defects are identified and the causes that cause various deviations are eliminated, the easier it is to correct them.

Conclusions. Therefore, congenital malformations of the spine and dysplastic scoliosis are an important problem of modern pediatrics and pediatric orthopedics due to the high risk of disability and impaired quality of life in the long term, which emphasizes the relevance and unsolved nature of the research topic and requires the further search for modern methods of diagnosis and correction , prevention and rehabilitation of pathology.

The authors declare no conflict of interest.

Biliary atresia: the path to diagnosis

2025-04-02T23:04:31+03:00

Biliary atresia (BA) is a congenital rapidly progressive inflammatory disease characterized by cholestasis, increasing destruction of the bile (intra-, extrahepatic) ducts and fibrosclerosis. If jaundice persists after two weeks of age, differential diagnosis is necessary among various diseases of the liver and biliary tract, but very often it remains late and difficult.

The cardinal solution for primary BA is liver transplantation (LT). Kasai operation (KO) - creation of a portojejunoanastomosis - a palliative solution that allows for a partial solution to the problem by the time of LT. When performing LT, the most progressive method is SPLIT-transplantation. Timely diagnosis and treatment (including LT) improves the quality of life (QOL), prevents irreversible changes in the child's body, the rapid development of multiple organ failure and the threat of early death.

Aim - to study the features of differential diagnosis of BA and the effectiveness of various surgical methods of its correction (before the onet of irreversible cirrhotic changes in the liver and multiorgan pathology).

Materials and methods. In 61 children with cholestasis aged 1.5-4.5 months to verify the diagnosis of BA, clinical, biochemical, instrumental examinations were performed in the dynamics before and after treatment, QOL was assessed, physical development (PD) and neuropsychological development (NPD) were assessed according to current orders of the Ministry of Health of Ukraine. Treatment included KO and LT.

Results. Against the background of treatment, biochemical and clinical indicators improved, the level of anxiety decreased. The dynamics of PD and NPD were positive. In 39 children with severe BA, these indicators did not normalize after 6 months, and LT in 37 of them was effective, as evidenced by the reliable normalization of all studied parameters.

Conclusions. Timely multidisciplinary differential diagnostics of BA with histological examination of liver biopsies contributes to the differentiated choice of surgical intervention before the onset of irreversible multiorgan changes in the organs and the death of the child. KO in most cases is a palliative surgical intervention that improves biochemical parameters, PD, NPD indicators. In some cases, KO operation is a sufficient method of surgical correction of BA and normalization of all studied parameters. LT is a modern and most effective method of correcting BA, which leads to the normalization of all studied indicators.

The research was carried out in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the local ethics committee of the institutions mentioned in the work. Parents' informed consent was obtained for children's participation in the study.

The author declares no conflict of interest.

Disorders of the oxidant-antioxidant system and energy metabolism indicators in children with adhesive intestinal obstruction depending on the severity of the adhesive process

2025-04-02T23:21:45+03:00

Aim - to study the state of free radical processes, antioxidant potential, and the balance of energy metabolism indicators in children operated on for postoperative adhesive intestinal obstruction (AIO) depending on the severity of the adhesion process (AP).

Materials and methods. The study was conducted in 49 children aged 7 to 17 years, operated on for postoperative AIO (the main group of patients). The control group consisted of 20 somatically healthy children of the same age. To study the state of lipid peroxidation (LP), the content of primary (diene conjugates (DC)) and secondary (thiobarbituric acid-active products (TBA-AP)) products of free radical processes in the blood serum were determined. To assess the state of antioxidant defense (AOD) in children, the activity of glutathione peroxidase (GP), glutathione transferase (GT) and glutathione reductase (GR), as well as the content of ceruloplasmin, were studied. To assess energy metabolism, we studied the content of ATP, lactate, pyruvate and lactate dehydrogenase (LDG).

Results. It was found that the content of TBA-AP and DС in all sick children of the main group was increased compared to the indicators in healthy children. However, in severe AP, their level was significantly higher compared to the indicators in patients with mild AP. In all examined patients, depletion of AOD was established (significant decrease in the level of ceruloplasmin, GR, GT, GP). These changes were most pronounced in patients with severe AP. Also, significant disturbances in the content of energy metabolites were found in children with AIO (decrease in ATP and pyruvate levels, increase in lactate and LDG). A significant difference in the severity of these changes was established in children with mild and severe AP.

Conclusions. In the postoperative period, children with AIO were found to have activation of free radical processes, decreased antioxidant potential, and imbalance of energy metabolism indicators. The most significant disorders were found in children with severe degree of AP.

The research was carried out in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of the institution mentioned in the work. Informed consent of the patients was obtained for the research.

No conflict of interest was declared by the authors.

Probiotic disinfectants in the complex treatment of experimental peritonitis

2025-04-02T23:44:19+03:00

Aim - to investigate the effectiveness of probiotic disinfectants in the complex treatment of experimental peritonitis.

Materials and methods. The experimental study was performed on 45 white sexually mature rats, which were simulated with fecal peritonitis. The rats were divided into 3 groups of 15 animals. The treatment of rats in the group I (main) consisted of washing the abdominal cavity with a 5% solution of probiotic disinfectant, applying a probiotic disinfectant spray to the abdominal organs and a gel with probiotics to the surgical wound after its suturing. For the treatment of rats in thr group II (comparison group), a sorbent solution was used to wash the abdominal cavity. The treatment of rats in the group III (placebo control) consisted of washing the abdominal cavity with 0.9% NaCl. The content of medium-weight molecules (total), the toxin-binding capacity of serum proteins, and the functional activity of monocytes in the general NST test were studied. A pathomorphological study was also conducted.

Results. The use of the developed treatment in the experiment in animals of the group I contributed to a decrease in the content of medium-weight molecules and the restoration of the toxin-binding capacity of albumin already on the 5th day. These trends cause a decrease in the cytolytic activity of blood serum relative to its own leukocytes and the preservation of the functional capabilities of monocytes at an adapted level already on the 5th day. At the same time, on the 7th day, the indicators of the functional activity of monocytes corresponded to the reference values. In animals of the group II, the optimization of the studied indicators occurred only on the 7th day, but they did not correspond to the reference values. In the group III, the studied indicators were significantly reduced relative to the reference values throughout the study.

Conclusions. The results of the study demonstrate the effectiveness of using probiotic disinfectants for the sanitation of the abdominal cavity in animals with fecal peritonitis.

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 institution. When carrying out experiments with laboratory animals, all bioethical norms and recommendations were observed.

No conflict of interest was declared by the authors.

Angiography in the diagnosis of ulcerative gastroduodenal bleeding

2025-04-03T00:03:48+03:00

Acute Gastrointestinal Bleeding (AGIB) of Ulcerative Origin poses a life-threatening risk and requires a clear diagnostic and therapeutic strategy. If endoscopic hemostasis and conservative therapy are ineffective, an essential method is angiography of the stomach and duodenal vessels to identify the bleeding source and perform endovascular hemostasis.

Aim: to study the angiographic semiotics of AGIB of ulcerative origin to improve the efficiency of diagnosis and treatment; to assess the capabilities of superselective arteriography in determining the bleeding source and its impact on the choice of endovascular hemostasis tactics.

Materials and methods. The results of angiographic examination of the stomach and duodenal vessels in 17 patients with gastroduodenal ulcers complicated by AGIB were analyzed. All patients had a high surgical risk amid active bleeding. The examined parameters included direct angiographic signs and indirect signs.

Results. In 14 (82.4%) patients, who underwent angiography during active bleeding, the bleeding source was directly identified based on contrast extravasation, pseudoaneurysm, or intense contrast accumulation at the ulcer site. In 3 (17.4%) patients, only indirect signs (arterial spasm, hypervascularization, arteriovenous shunting) were noted.

Conclusions. The study of angiographic patterns of AGIB sources in patients with ulcer disease showed that superselective arteriograms were the most informative. Performing superselective arteriography with the identification of direct and indirect angiographic signs of bleeding allowed precise localization of the source in the celiac trunk or superior mesenteric artery, followed by appropriate endovascular hemostasis based on the angiographic findings.

The study was conducted in accordance with the principles of the Helsinki Declaration. The research protocol was approved by the local ethics committee of the institutions mentioned in the study. Informed consent was obtained from all participants.

The authors declare no conflict of interest.

The impact of the full-scale war in Ukraine on diagnostic and therapeutic approaches to acute calculous cholecystitis

2025-04-03T00:20:50+03:00

During the war, chronic and acute stress are added to the main etiological factors of acute cholecystitis.

Aim - to study the impact of the full-scale war in Ukraine on diagnostic and therapeutic approaches to the treatment of patients with acute calculous cholecystitis.

Materials and methods. 54 patients with acute calculous cholecystitis were treated. An algorithm of therapeutic and diagnostic approaches to acute calculous cholecystitis in the conditions of a full-scale war in Ukraine and negative psycho-emotional impact was developed.

Results. The «well-being» indicator in patients ranged within the low level of psycho-emotional state (25.12-28.18 points). The «activity» and «mood» indicators indicated an average level of psycho-emotional state and ranged from 31.41 to 39.21 points. The period from the onset of an attack of acute calculous cholecystitis to hospitalization of more than 24 hours was observed in 83.3% of cases. Diagnosis of acute calculous cholecystitis during martial law, preparation for surgical intervention required from 6 to 12 hours in 85.2% of patients. A destructive form of inflammation of the gallbladder was observed, which is characteristic of acute calculous cholecystitis. Clinical signs of anemia and the presence of an inflammatory process in the body were diagnosed in patients with acute calculous cholecystitis during wartime. There were no complications in patients with acute calculous cholecystitis who underwent surgery during martial law.

Conclusions. Patients with acute calculous cholecystitis in conditions of full-scale war in Ukraine had a low level of psychoemotional and psychosomatic health. Acute calculous cholecystitis in wartime has important pathogenetic differences and characteristic complications. Laparoscopic cholecystectomy is the gold standard for acute calculous cholecystitis. The study was performed in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the local ethics committee of the institutions mentioned in the work. Informed consent of the patients was obtained for participation in the study.

The authors declare the absence of a conflict of interest.

Postnatal diagnosis and strategy of preoperative care for newborns and older children with sacrococcygeal teratomas. Corrected article

2025-04-03T19:13:05+03:00

Aim - to determine the importance of postnatal diagnosis in the perinatal care of newborns, and older children with sacrococcygeal teratomas (SCT).

Materials and methods. A retrospective analysis of the medical records of 40 children with SCT who underwent surgical correction of the defect between 1981 and 2023 was performed. A study of the main criteria for postnatal diagnostic examination of newborns and older children with SCT was conducted.

Results. An algorithm for postnatal examination of newborns and older children with SCT has been developed. A classification of SCTs was developed, according to their size (volume), using postnatal ultrasound. Complicated forms of SCT in the preoperative period were diagnosed in 40% (n=16) of children. There were 2 cases of tumor recurrence. Survival after surgical correction of this pathology was 97.5% (n=39).

Conclusions. Delivery strategy and postnatal diagnosis are one of the main stages of perinatal care of newborns with sacrococcygeal teratomas and an important component of preoperative preparation of older children with SCT. The developed classification of SCTs according to their volume, when performing a postnatal ultrasound, has a prognostic importance in assessing the risk of developing SCT complications, depending on the volume of the tumor and its morphological structure. X-ray research methods provide a detailed description of the tumor process, contribute to effective management and the choice of optimal surgical tactics.

The authors declare no conflict of interest.

Surgical treatment of a congenital malformation of the anorectal area: rectourethral fistula in children

2025-04-03T19:29:29+03:00

Rectourethral fistula (RUF) is a variant of congenital anorectal malformation (СARM) in boys, characterized by abnormal connection of atretic rectum with urethra.

Aim - to evaluate results of surgical treatment in boys with RUF, using a differentiated approach to diagnosis and treatment in isolated and associated forms.

Materials and methods. The study included 20 boys: 10 with rectoprostatic fistula and 10 with rectobulbar, representing 13.0% of all treated anorectal anomalies (n=154). An isolated form was diagnosed in 10.0% (n=2) of children, while 90.0% (n=18) had an associated form, of which 3 (16.7%) were complicated.

Results. At stage I, double-barrel separating colostomy was performed in 13 (65.0%) boys, double-barrel loop colostomy in 6 (30.0%) and final transversostomy in 1 (5.0%). In 2 children with esophageal atresia and lower tracheoesophageal fistula, separation of fistula and formation of primary esophageal anastomosis were performed after colostomy. In a child with duodenal atresia, an anastomosis was formed according to Kimura during colostomy removal. At stage II, posterior sagittal anorectoplasty was performed in 17 (85.0%) children; abdomino-perineal in 3 (15.0%), and in 1 (5.0%) child with sigmoid atresia, abdomino-perineal anorectoplasty with enterocyst, formation of transverse-sigmoid anastomosis and protective loop ascendostomy was performed. Stage III involved stoma closure in all patients.

Conclusions. Comprehensive diagnostics in newborns with RUF allows to identify associated developmental defects, especially those requiring staged and simultaneous operations. A differentiated approach to diagnostics, anorectoplasty methods, rehabilitation yielded good results in 68.4% and satisfactory in 31.6% of children.

The research was carried out according to principles of the Declaration of Helsinki, approved by Local Ethics Committee of the institution mentioned in the work. Informed consent of the patients was obtained for the research.

No conflict of interest was declared by author.

Optimization of transanal endoscopic microsurgery for resection of benign rectal tumors

2025-04-03T19:42:17+03:00

One of the effective methods for the surgical treatment of benign rectal tumors is transanal endoscopic microsurgery (TEM). Despite the high effectiveness of TEM in treating benign rectal tumors, recurrences are diagnosed in 3-26% of patients.

Aim - to increase the effectiveness of surgical treatment of benign rectal tumors by optimizing TEM.

Materials and methods. From 2007 to 2024, 153 patients with benign rectal tumors were operated on using TEM. The cohort included 80 men and 73 women aged 37-76 (mean age 56±20 years). Depending on the surgical method, the patients were divided into two groups. The first group - 75 patients who underwent classical TEM tumor resection. The second group - 78 patients who were operated on using an advanced TEM technique, which included preoperative marking of the mucous membrane around the tumor within healthy tissues using endoscopic refinement methods. Effectiveness control was conducted through morphological examination of the removed tumors and analysis of recurrence rates.

Results. In the first group, en-bloc tumor resection was performed in 62 (82.6%) patients, and fragmentation resection in 13 (17.4%) patients. Following en-bloc resections, R0 was achieved in 56 (90.3%) cases, and R1 in 6 (97%) patients. Local recurrence occurred in 11 (14.0%) patients. In the second group, en-bloc tumor resection was performed in 70 (89.7%) patients, and fragmentation resection in 8 (10.3%) patients. Following en-bloc resections, R0 was achieved in 69 (98.5%) cases, and R1 in one (1.5%) patient. Local recurrence was detected in 3 (3.8%) patients. In all cases of local recurrence, repeat TEM resection or endoscopic resection was performed.

Conclusions. Optimization of TEM resection for benign rectal tumors, incorporating preoperative determination of resection margins, improves treatment efficacy by 73.7% compared to the conventional technique and significantly reduces recurrence rates from 14.6% to 3.8%.

The research was carried out in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of all institutions mentioned in the work. Informed consent of the women was obtained for the research.

The authors declare no conflict of interest.

Features of the managing boys with congenital lymphatic malformations of the urogenital region

2025-04-03T18:38:00+03:00

Lymphatic malformations (LM) of the urogenital region are rare but complex conditions causing cosmetic defects, hygiene difficulties, recurrent infections, and lymphorrhea, leading to significant patient distress.

Aim - to assess the clinical course, complications, and treatment outcomes of LM in the urogenital region in boys to optimize patient management.

Materials and methods. A retrospective analysis was conducted on the medical records of boys with LM of the urogenital region treated in inpatient settings between 2014 and 2023. The analysis covered the age of onset, clinical manifestations, anatomical localization, type of malformation, treatment methods, surgical interventions, and their outcomes.

Results. Among 259 patients, LM of the urogenital region was diagnosed in 17 (6.6%). Symptoms were congenital in 3 (17.6%) patients, appeared between 1-10 years in 7 (41.2%), and during adolescence in 7 (41.2%). LM types: lymphedema in 10 (58.8%) patients, with 7 (41.2%) also having lower limb lymphedema; cystic LM in 4 (23.5%) patients, including 2 (11.8%) cases with involvement of multiple anatomical regions; and central lymphatic channel anomalies in 2 (11.8%) cases. Conservative management of lower limb lymphedema was performed in 8 (47.1%) patients. Sclerotherapy for cystic LM of the perineal region had excellent (n=2) and good (n=2) outcomes. Surgical resection was performed in 9 (52.9%) patients (penile surgery in 2, scrotal surgery in 3, combined surgery in 4), with an age range of 11-17 (15±1.55) years. mTOR inhibitor therapy was given to 2 patients, yielding temporary improvement.

Conclusions. Main clinical manifestations included swelling 11 (64.7%), anatomical deformity 9 (52.9%), pain 2 (11.8%), lymphorrhea 2 (11.8%), and protein-losing enteropathy with hypoproteinemia 2 (11.8%). Cystic LM was treated with sclerotherapy, while penile and scrotal lymphedema required surgical resection, often combined with sclerotherapy or mTOR inhibitors.

The authors declare no conflict of interest.

PCA3 score prognostic value for identifying postoperative ISUP grades 4-5 in localized peripheral zone prostate cancer with a posterior tumor growth dominant pattern

2025-04-03T18:54:52+03:00

At present, the identification of high-risk groups of localized prostate cancer (PCa) is highly relevant. Our previous research demonstrated that prostate cancer antigen 3 (PCA3) scores depend on the tumor zone of origin (TZO) and the tumor growth dominant pattern (TGDP).

The aim: to assess the prognostic value of PCA3 score for identifying postoperative 4-5 grade group according to the International Society of Urological Pathology 2014 (ISUP) classification in patients with localized peripheral zone prostate cancer with posterior TGDP (pPZ-PCa).

Materials and methods. PCA3 scores and correlations were assessed and compared in different PCa patient groups and subgroups based on TZO, TGDP, and ISUP grade. Receiver operating characteristic curve (ROC) analysis was used to evaluate the diagnostic significance of the model and determine the optimal PCA3 score cutoff for identifying ISUP 4-5.

Results. The PCA3 scores showed a significant (p˂0.01) positive correlation (r=0.71) with ISUP grade in pPZ-PCa. PCA3 scores differed significantly (p<0.01) between ISUP 1-3 and 4-5 pPZ-PCa subgroups. ROC analysis demonstrated excellent performance with an AUC of 0.98 (95% CI: 0.95-0.99) for identifying ISUP 4-5 pPZ-PCa.

Conclusions. PCA3 scores demonstrated prognostic value for identifying postoperative ISUP 4-5 in pPZ-PCa.

The study was performed in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the Local Ethics Committee for all participants. The informed consent of the patient was obtained for conducting the studies.

No conflict of interests was declared by the authors.