PAEDIATRIC SURGERY. UKRAINE

Application of robotic surgery in the treatment of splenic cysts in children

А.О. Dvorakevych — 2025-12-28

Splenic cysts are the most common benign neoplasms of this organ. Minimally invasive interventions for diseases of the spleen are becoming increasingly popular. The availability of robotic platforms allows us to qualify patients with the presented pathology for robotic surgical interventions.

Aim - to compare the results of surgical treatment of splenic cysts (robotic and laparoscopic) in children.

Materials and methods. From 2021 to 2025, 29 children with splenic cysts of various localization and sizes were operated. Patients were divided into two groups: laparoscopic (n=16) and robotic (n=13). The comparison groups are equivalent in structure. The age of the patients is from 4 to 17 years (average 12.0±3.2 years). Surgical interventions were performed using the robotic platforms "Da Vinci S" and "Da Vinci Si" and the laparoscopic system from the company Karl Storz. In total, 26 (90%) partial splenectomies and 3 (10%) total splenectomies were performed due to recurrence of splenic cysts that occupied more than 90% of the organ volume.

Results. The average duration of surgical intervention was 1.9±0.3 h in the robotic group and 2.24±0.4 h in the laparoscopic group. The conversion rate in both groups was 0%. The average duration of hospitalization was shorter in the robotic group (4.0±1.0 days versus 5.0±1.2 days). No recurrences were detected during the observation period, however, 1 operation in the robotic group was performed for recurrence after laparoscopic fenestration of the cyst with transition to laparotomy (performed in another clinic).

Conclusions. In summary, it can be noted the optimality of using robotics in operations on the spleen, especially for cysts of large size and complex anatomical localization (hiatus, upper-posterior surface of the spleen). Long-term results indicate the effectiveness of the method as such, which guarantees the absence of disease recurrence.

The study was conducted in accordance with the principles of the Declaration of Helsinki. Informed consent was obtained from the children's parents.

The authors declare no conflict of interest.

Clinical and hemodynamic predictors of regenerative success in patients with purulent-inflammatory soft tissue infections and type 2 diabetes: a prognostic model

M.H. Bohachuk — 2025-12-28

Surgical management of purulent-inflammatory soft tissue diseases (PISTD) in patients with comorbid type 2 diabetes mellitus (T2DM) remains a critical challenge for modern healthcare. The fundamental problem is the formation of a "regenerative plateau" - a state of metabolic stagnation where the healing process stalls in a prolonged inflammatory phase.

Aim - to enhance the surgical treatment efficacy in patients with PISTD and T2DM by implementing a synergistic therapeutic protocol based on muramyl peptide-derived immunomodulators and prostaglandin E1 (PGE1) analogues.

Materials and methods. A prospective clinical study included 148 patients with PISTD and T2DM, randomized into a Control group (CG, n=72) and a Main group (MG, n=76) receiving systemic muramyl peptide immunocorrection and PGE1 therapy. Microcirculation was evaluated using laser Doppler flowmetry (LDF), and wound dynamics were assessed via computer planimetry. Statistical analysis was performed using Statistica 12.0 software (p≤0.05).

Results. It was established that in the MG, clinical resolution of local edema and pain syndrome occurred 1.57 times faster than in the CG (p≤0.05), and body temperature normalization was 1.69 times faster. The use of PGE1 helped eliminate capillary sludge syndrome, ensuring a 59.3% reduction in wound area by day 10 and a decrease in the length of hospital stay (9.4±1.3 days in the MG vs 16.1±2.2 days in the CG). The obtained data indicate that the synergistic strategy can effectively overcome metabolic stagnation.

Conclusions. The integrated use of muramyl peptides and PGE1 significantly improves PISTD treatment outcomes by synchronizing regional blood flow with a targeted immune response.

The study was conducted in accordance with the principles of the Declaration of Helsinki. Informed consent was obtained from all participants.

The author declares no conflict of interest.

Results of surgical treatment of anorectal malformations in children

O.D. Fofanov — 2025-12-28

The problem of treating anorectal malformations (ARM) in children remains relevant, which is due to their high frequency, combination with other developmental defects, and a significant number of functional disorders that occur in operated children.

Aim - to study the immediate and long-term results of treatment of children with ARM and improve the correction of postoperative complications.

Materials and methods. Examination and treatment of 37 children operated on for ARM, 18 boys and 19 girls, were conducted. In addition to general clinical examination methods, anoscopy and rectoscopy were performed in operated children, examination using a myotester, and transanal ultrasound. The severity of fecal incontinence (FI) was determined by the Cleveland scale. The study of quality of life (QoL) in operated children was carried out by questionnaire.

Results. Early postoperative complications after various stages of treatment, requiring reoperation, occurred in 5 children (13.51%). Good functional results of ARM correction were in 23 patients (62.16%); satisfactory in 13 children (35.14%) and unsatisfactory in one child (2.7%). The most common long-term functional disorders in operated children in the long-term period were FI of various degrees (from minor fecal smearing to significant fecal incontinence), which was detected in 14 patients (37.84%) and constipation (9 children, 24.32%). These patients received a complex of treatment, which included a bowel management program and minimally invasive surgical correction of anal sphincter insufficiency using a bulk-forming gel.

Conclusions. The total frequency of early postoperative complications in children operated on for ARM was 13.51%. Remote functional disorders of the colon and rectum of varying severity occurred in 62.16% of patients. The most frequent remote functional disorders in operated children were FI and postoperative constipation. The use of a complex of treatment and prevention of these disorders led to a significant improvement in defecation control and QoL of patients.

The study was conducted in accordance with the Declaration of Helsinki. The protocol was approved by the local ethics committee. Written informed consent was obtained from the children’s legal guardians.

The authors declare no conflict of interest.

Liver вiopsy in predicting morphological changes after liver transplantation in children

H.V. Kurylo — 2025-12-28

Subclinical histopathological changes in the transplanted liver are a common issue after liver transplantation, as they often progress without clinical manifestations and may not be detected by standard laboratory tests.

Aim - to evaluate histopathological changes in liver grafts in pediatric recipients after transplantation and their association with clinical and biochemical parameters.

Materials and methods. The study included 48 children after liver transplantation under dynamic follow-up at a single transplant center. Liver biopsies were performed according to long-term follow-up protocols. Histological analysis was conducted using the Ishak score to assess fibrosis, inflammatory activity, cholestasis, bile duct injury, and steatosis. Standard liver function tests (alanine aminotransferase, aspartate aminotransferase, total bilirubin, gamma-glutamyl transpeptidase) were analyzed for correlations with morphological changes.

Results. Histopathological changes were detected in 44 (92.1%) patients, even in the absence of abnormal laboratory values or clinical symptoms. Fibrosis was the most common finding (mean Ishak score 3.2±1.4). Portal inflammatory infiltrates were present in 54.2% of patients, cholestasis in 43.8%, steatosis in 37.5%, and bile duct injury in 31.3%. Correlation between laboratory markers and morphological changes was weak and statistically insignificant.

Conclusions. Subclinical histopathological changes in transplanted livers after transplantation are frequent and diverse. Liver biopsy remains critical for early detection of structural alterations and optimization of immunosuppressive therapy, even when laboratory tests are normal.

The research was carried out in accordance with the principles of the Declaration of Helsinki. Informed consent of the child and child's parents was obtained for the research.

The authors declare no conflict of interest.

Surgical management strategy for liver tumors in children

О.О. Кalinchuk — 2025-12-28

In childhood, liver tumors are quite rare. Liver tumors account for slightly more than 1% of all malignant neoplasms in children. They account for about 5-6% of abdominal tumors. Among abdominal tumors, liver tumors rank third in frequency after neuroblastoma and Wilms' tumor. A third of liver tumors are benign tumors, the other two thirds are malignant.

Aim - to analyze the surgical tactics used for liver tumors in children.

Materials and methods. A retrospective study of 25 children with liver tumors who were treated in 2023-2025 was conducted. Observation of operated children is carried out in dynamics.

Results. Benign tumors accounted for 84%, malignant - 16%. Surgical interventions were performed in 84% of patients using laparoscopic (56%), open (12%) and robotic (16%) techniques. In 44% of cases, ICG navigation (indocyanine fluorescence, ICG - Indocyanine Green) was used. No relapses were detected, liver function was preserved.

Conclusions. Benign neoplasms prevail in the structure of liver tumors in children. Minimally invasive surgical treatment methods, in particular robotic surgery, demonstrate better perioperative results compared to open interventions in children with liver tumors. The use of ICG navigation increases the accuracy of surgical interventions.

The study was performed in accordance with the principles of the Declaration of Helsinki. Informed consent of the parents was obtained.

The authors declare no conflict of interest.

Experience with laparoscopy in the surgical treatment of acute appendicitis in children

M.I. Chavarha — 2025-12-28

Acute appendicitis (AA) is the most common cause of emergency surgical interventions in children. Laparoscopic appendectomy (LA) has gradually become the first-choice method due to its effectiveness and the minimized postoperative period.

Aim - to analyze the surgical technique, advantages, and indications for LA, clinical outcomes, efficacy, safety, complications, and postoperative recovery in the surgical treatment of AA in children.

Materials and methods. Medical records of inpatients, surgical protocols, histological examination results, and postoperative course dynamics were analyzed in 699 pediatric patients with AA who underwent a total of 701 surgical interventions. Of these, 600 (85.6%) were laparoscopic appendectomies (LA), 18 (2.6%) were conversions, 81 (11.6%) were open appendectomies (OA), and 2 (0.3%) were relaparotomies.

Results. The use of LA made it possible to gradually replace OA in over 91% of AA cases, while conversion rates ranged from 0 to 4.8% due to destructive forms and anatomical anomalies. Over the course of refining the LA technique, the average operation time decreased from 67.8 to 37.4 minutes, and postoperative treatment duration was reduced from 4.3 to 2.1 days. Destructive forms of AA accounted for 83.2% of cases, and peritonitis was present in 19.5% (58.0% of which were treated with LA). Intraoperative complications during LA (11.2%) mainly included omental injuries. The most common early postoperative complication following LA was the presence of the phrenicus symptom, and relaparotomy was performed in 0.3% of cases. Abdominal cavity drainage was performed in 5.7% of operations. All patients were discharged in a recovered state.

Conclusions. LA has become the first-line method for surgical treatment of AA in children, performed in over 91% of cases, leading to reduced operation time and shorter postoperative recovery compared to OA. A well-considered laparoscopic assessment of the specific intraoperative situation allows for a justified decision to convert, thereby preventing critical complications during and after surgery.

The study was conducted in accordance with the principles of the Declaration of Helsinki. Informed consent was obtained from the children's parents.

The authors declare no conflict of interest.

Calcaneal lengthening osteotomy in the treatment of flexible flatfoot in children

A.P. Lіabakh — 2025-12-28

Aim - to analyze the skialogical, functional, and clinical results of calcaneal lengthening osteotomy in children with flexible flatfoot (FF).

Material and methods. The retrospective study includes 10 patients (17 cases) with FF who underwent calcaneal lengthening osteotomy by the Evans-Mosca technique. All patients had the shortening of the m. triceps surae. The age of patients ranged from 8 to 16 years (mean 12±0.7 years); there were 9 boys and 1 girl. Evaluation of the results was carried out on the dynamics of vertical and horizontal talo-1^st-metatarsal angles (TMA), os calcis inclination angle (CIA), AOFAS scale (hindfoot and ankle), Foot Function Index (17-I FFI, Italian version), VAS (pain) in terms of 2 to 4 years.

Results. The operation caused a pronounced cosmetic, radiological, and functional effect. All patients and their parents were satisfied with the result of the surgery. There is an improvement in radiological parameters on average: vertical TMA from 21,9 to 1,9°; horizontal TMA from 21,1 to 3°; CIA from 6,8 to 15,3°. The dynamics of the foot function by average: increasing by AOFAS scale from 69,3 to 95,1; improvements for FFI from 14,9 to 2%; reduction of pain by VAS from 3,8 to 0,8. Effective foot extension increased from 0,5 to 8,9°. The difference between the averages was significant (p˂0,001).

Conclusion. Os calcis lengthening osteotomy is an effective operation in the treatment of symptomatic FF in children, which provides a significant reduction in pain, good clinical and radiological results. The advantages of os calcis lengthening osteotomy are simple surgical techniques and a low risk of neurovascular complications.

The study was conducted in accordance with the Declaration of Helsinki. The protocol was approved by the Local Ethics Committee. Written informed consent was obtained from the children’s legal guardians.

The authors declare no conflict of interest.

The role of intraoperative neurophysiological monitoring in pediatric patients during surgical treatment of idiopathic scoliosis

K.S. Kurysko — 2025-12-28

Iatrogenic spinal cord injury leading to paraplegia is a rare but severe complication. Its prevalence during correction of spinal deformities, according to estimates by the Scoliosis Research Society to be at least 1%. Intraoperative neurophysiological monitoring (IONM) is widely used for real-time feedback on spinal cord function to alert the surgical team about potentially reversible neurological deficits, allowing early detection of intraoperative spinal cord injury, which enables early intervention, leading to a better prognosis.

Aim - to determine the significance of the sensitivity and specificity of motor evoked potentials for predicting and preventing neurological deficits during surgical treatment of idiopathic scoliosis in children.

Materials and methods. The study included 90 patients diagnosed with idiopathic scoliosis of the thoracolumbar spine. We analyzed the following modalities of intraoperative neurophysiological monitoring (IONM) - free run electromyography and motor evoked potentials (MEP), with measurement of the amplitude of the motor response. When the MЕP amplitude decreased by more than 70% from the baseline, or completely disappeared on one or both sides, all patients underwent measures according to the MЕP loss protocol, which was modified by us.

Results. Changes in motor evoked potential were observed in 22 (24.4%) cases. Postoperative transient neurological deficit was observed in 10 (11%) patients, which regressed within 2-3 weeks after surgery. In our calculations, MEP method sensitivity was 100%, specificity was 85%, positive predictive value was 45.5%, and negative predictive value was 100%.

Conclusions. Intraoperative neurophysiological monitoring using MEP is effective for predicting and preventing threatening neurological deficits during surgical treatment of idiopathic scoliosis in children. MEP monitoring has high sensitivity and specificity for detecting new spinal cord injuries in pediatric patients undergoing surgery for idiopathic scoliosis. Application of measures according to the MEP signal loss protocol is effective in reducing the number of patients with postoperative iatrogenic neurological deficit who have changes in MEP indicators during the intraoperative period.

The study was conducted in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the local ethics committee of the institution. Informed consent was obtained from patients for the study.

The authors declare no conflict of interest.

Surgical correction of congenital diaphragmatic eventration in children

O.K. Sliepov — 2025-12-28

Aim - to optimize the surgical correction of congenital diaphragmatic eventration (CDE) by improving diaphragmatic plastic surgery using original instrumentation.

Materials and methods. A retrospective and prospective study of medical records of 29 children with CDE was conducted over the past 30 years. To evaluate the results of treatment, clinical, radiological and statistical methods were used. The presence or absence of relapses, as well as intra- and postoperative complications, were determined.

Results. In diaphragmatic plastic surgery in children with CDE, the following methods were used: triplication ("manual"), using P-like and knotted sutures in 8 (42.1%) patients; triplication using original diaphragmatic clamps - in 5 (26.3%) children; "coat" type duplication, with partial resection of the eventrated diaphragm - in 4 (21.1%); resection of the eventrated part of the diaphragm with its "joint-to-joint" plastic surgery in 2 (10.5%) patients.

Conclusions. Surgical correction of congenital diaphragmatic eventration is an effective method of treating this pathology. The main method of diaphragmatic plastic surgery in CDE is its plication (duplication or triplication method). In cases of traumatic injury to the eventrated diaphragm or in the presence of a pronounced connective process between it and adjacent herniated organs or with the lung, it is advisable to resect the changed areas of the eventrated diaphragm with suturing of its edges. The developed modification of the triplication method, using original diaphragmatic clamps, allows to restore the physiological contour of the diaphragm, ensure the safety of the operation, reduce its duration and simplify the technique of surgical intervention. The open method of diaphragmatic plastic surgery for CDE, using thoracotomy, in 100% of cases prevented the development of recurrent eventration and was accompanied by a good effect after surgery.

The study was conducted in accordance with the principles of the Declaration of Helsinki. Informed consent was obtained from the children's parents.

The authors declare no conflict of interest.

Comparative analysis of secondary prophylaxis strategies for esophageal variceal bleeding in clinically manifest portal hypertension: a 12-year single-center study

S.M. Kozlov — 2025-12-28

Recurrent variceal bleeding remains a leading cause of mortality in patients with portal hypertension (PH). Standard secondary prophylaxis strategies (SP), including non-selective β-blockers (NSBB) and endoscopic injection sclerotherapy (EIS), demonstrate suboptimal anti-recurrence efficacy.

Aim - to determine the optimal SP method for esophageal variceal bleeding (EVB) by comparing long-term outcomes of partial splenic artery embolization (PSE) versus NSBB and EIS-based strategies.

Materials and methods. This prospective and retrospective study included 514 patients who survived at least one EVB episode. SP efficacy was analyzed in three groups: NSBB monotherapy (n=243), EIS+NSBB (n=151), and PSE+NSBB (n=120). The efficacy evaluation criteria were survival and EVB recurrence rates within 12 months.

Results. During the 12-month follow-up, survival was significantly higher in the PSE group (0.87) than in the NSBB (0.73) and EIS (0.64) groups (p < 0.001), respectively. Recurrence-free status at one year was achieved in 56.2% of PSE patients, versus 35.0% in EIS and 24.3% in NSBB. All-cause mortality was lowest after PSE (13.3%) and highest in the EIS group (37.1%).

Conclusions. PSE provides significantly higher SP efficacy compared to standard strategies, offering an effective minimally invasive treatment for high-risk patients with clinically significant PH.

The study was conducted in accordance with the principles of the Declaration of Helsinki. The study approved by the Local Ethics Committee. Informed consent was obtained from all patients. The authors declare no conflict of interest.

Anatomical features of diaphragmatic defects of various sizes and their significance in congenital diaphragmatic hernia in newborns

O.K. Sliepov — 2025-12-28

Studying the anatomical characteristics of diaphragmatic defects of various types and sizes in congenital diaphragmatic hernia (CDH) is crucial for improving surgical strategies and optimizing treatment for these patients.

Aim - to analyze the anatomical features of diaphragmatic defects of varying sizes in CDH in newborns as a key factor in developing surgical strategies for this congenital malformation.

Materials and methods. We analyzed the anatomical features of diaphragmatic defects of varying sizes in 58 newborns with CDH who were treated between 2013 and 2025. Depending on the size of the diaphragmatic defect, newborns with CD were divided into 2 groups: Group I - 38 (65.5%) infants with small and medium-sized diaphragmatic defects (types A and B), Group II - 20 (34.5%) patients with large and total diaphragmatic defects (types C and D). The following were examined intraoperatively: the side and location of the diaphragmatic defect, the presence of a hernial sac, and the nature of the hernial contents. Herniation was assessed: loops of the small and large intestines, stomach, spleen, pancreas (partially or completely), left/right kidney, liver (partially or completely), greater omentum, gallbladder. Particular attention was paid to the presence of a posterior rim of the diaphragmatic defect.

Results. The mean area of the diaphragmatic defect in patients in Group II was significantly larger than in Group I. No significant differences were found between the groups in the frequency of hernial sac presence or the frequency of left-sided and right-sided diaphragmatic defects. Posterior-lateral localization of the defect was significantly more common in patients in Group I. Posterior-medial localization was observed predominantly in patients in Group II. Partial or complete herniation of the liver and stomach into the thoracic cavity was significantly more common in patients in Group II.

Conclusions. In diaphragmatic defects of types A and B, the location of the CDH is significantly more often posterolateral. The size of the diaphragmatic defect did not influence the side of the CDH, nor the anatomical features of its posterior muscular rim. In large and total diaphragmatic defects, herniation of the stomach and liver into the thoracic cavity occurs significantly more frequently. Studying the anatomical features of diaphragmatic defects of various types and sizes in CDH is of great importance for optimizing the surgical treatment of this critical developmental defect.

The study was conducted in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the local ethics committee of the aforementioned institution. Informed consent was obtained from patients for the study.

The authors declare no conflict of interest.

Biocompatibility and mechanisms of aseptic inflammation in the use of suture materials in surgery

O.S. Maksymenko — 2025-12-28

Any suture material intended for medical use must be characterized by a high level of biological compatibility. Biocompatibility is generally considered to be a material's ability to interact harmoniously with living tissue, its "affinity" with the body, which minimizes negative immune and inflammatory reactions.

Aim - to evaluate contemporary suture materials in terms of their physical and mechanical properties, biocompatibility, and effects on body tissues, as well as to determine the advantages of synthetic absorbable materials compared with traditional natural threads.

The analysis was conducted based on contemporary literature sources available in the PubMed, Scopus, Web of Science databases and experimental and clinical data concerning the use of suture materials in surgery. At the current stage of development of surgical practice, suture material must demonstrate a high level of biological activity, and, first of all, demonstrate the ability to resist infectious agents. The best thread should have the following basic properties: have the highest possible tensile strength, have knot stability in dry and wet conditions, have a relative elongation of the thread within 25±10% and a minimally high Young's modulus, be atraumatic, have an optimal thread surface texture, have balanced hydrophilicity, have non-pyrogenic properties, and cause a minimal tissue reaction of the local immune system during absorption.

Conclusion. Synthetic suture materials (both absorbable and non-absorbable) represent an optimal choice for contemporary surgery due to their high biocompatibility, predictable mechanical properties, controlled resorption, and minimal tissue reaction. Their use contributes to improved surgical outcomes and a reduced incidence of postoperative complications.

No conflict of interests was declared by the authors.

Neurovascular disorders in supracondylar fractures of the distal humerus in children and adolescents

A.F. Levytskyi — 2025-12-28

Supracondylar fracture of the distal humerus (SFDH) is a common traumatic injury in pediatric practice, accounting for about 60% of fractures in the elbow joint. Complications caused by nerve and vascular damage can be primary or secondary, arising during the treatment of fractures. Nerve damage occurs in 5.8-14% of children, and the frequency of vascular injuries ranges from 3.2% to 14.3%. A distinction is made between a “pink, pulseless, perfused hand” and a “pale, cold, pulseless hand.” Both cases require urgent treatment. However, a number of issues remain debatable regarding the content, nature, and scope of such treatment, as well as the timing of its implementation.

Aim - to determine the current tactics for treating neurovascular disorders in SFDH in children and adolescents. The research methodology is based on the recommendations of the "Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines".

The search for literature sources was carried out using modern domestic and foreign databases, the depth of the search - over the last 5-7 years using the following terms: "supracondylar fractures of distal humerus in pediatric patients", "treatment", "neurovascular disorders". According to the results of the analysis of literary sources, the tactics of treating vascular complications are based on establishing the degree of their impairment, which is traditionally defined as a pink/pale hand without a pulse. In both cases, urgent reduction of fragments and internal fixation are recommended. Further tactics depend on the results of monitoring the state of blood supply, in the objectification of which three-phase Dopplerography plays an important role. With negative indicators and signs of compartment syndrome, urgent surgical intervention is indicated to determine the factors of vascular disorders and their elimination. The treatment of neurological disorders depends on the degree of sensory and motor disorders. In case of neurapraxia, expectant management is justified, while in case of neurotmesis, which is characterized by persistent neurological deficit, neurosurgical intervention is indicated.

Conclusions. Neurovascular complications in SFDH in children and adolescents occur in about 14% of cases, requiring urgent reduction and internal fixation of the fragments. Further treatment tactics for damage to nervous structures depend on the degree of sensory and motor disorders, and for vascular disorders - on the indicators of clinical and instrumental monitoring.

The authors have no conflicts of interest to declare.

The use of ex vivo, in vitro models, microfluidic devices, tissue engineering technologies, the determination of their ethical and deontological components in experimental studies of Crohn's disease and other inflammatory bowel diseases

D.S. Soleiko — 2025-12-28

Experimental studies of current issues of Crohn's disease (CD) and other inflammatory bowel diseases (IBD) are due to the increase in morbidity, the presence of unclear etiological factors, many links in pathogenesis, the lack of effective comprehensive treatment, preventive measures for the occurrence of diseases and the prevention of its surgical complications.

Aim - to determine the technological efficiency, compliance with ethical and deontological requirements, practical significance, specificity, effectiveness and prospects for using ex vivo, in vitro models, microfluidic devices, tissue engineering technologies (TET) in experimental studies of current issues of CD and other IBD.

Various in vivo studies have certain physiological, ethical and translational limitations, which forces scientists to imp lement new methods of experimental search, relying on the development of modern technologies. According to the results of scientific literature search, ex vivo, in vitro models are characterized, the use of microfluidic devices and TET is highlighted, the main provisions and problematic issues of the ethical and deontological component of experimental studies of Crohn's disease and other IBD are given. The advantages, disadvantages, and practical significance of experimental systems are presented.

Conclusions. The use of in vitro and ex vivo models provides the opportunity to reproduce and study physiological, pathological processes with a high level of specificity. The use of TET and microfluidics technologies allows to reduce the number of experimental animals. The use of human biological samples requires strict adherence to ethical, deontological and legal norms. The introduction of microfluidic devices and robotic platforms ensures high efficiency in the development of targeted therapy methods, determination and prediction of the therapeutic effect of medical drugs, research of physiological and pathological processes in Crohn's disease and other IBD. The integration of microfluidic systems with artificial intelligence and robotic platforms, the use of biological hydrogels and 3D-bioprinting technology allows the creation of multi-organ networks for relatively long-term experimental studies of IBD, registration and analysis of their results without violating the integrity of the experimental system.

The author declares that there is no conflict of interest.

Morphofunctional changes of the testis under the influence of exogenous factors: pathogenetic mechanisms and clinical significance

S.O. Nesteruk — 2025-12-28

Репродуктивне здоров’я чоловіків формується ще в дитячому і підлітковому віці та є надзвичайно чутливим до впливу екзогенних чинників. До таких чинників належать хімічні агенти (важкі метали, пестициди), фізичні фактори (гіпертермія, іонізуюче випромінювання, електромагнітні поля), психоактивні речовини та алкоголь. Вони викликають розвиток оксидативного стресу, апоптозу, порушення мікроциркуляції, деструкцію клітин Сертолі й Лейдіга, що призводить до зниження сперматогенної активності й формування гіпогонадизму.

Мета - узагальнити сучасні експериментальні й клінічні дані щодо морфологічних і функціональних змін яєчка під впливом екзогенних чинників з урахуванням вікових особливостей.

Проведено систематичний аналіз сучасних наукових публікацій, індексованих у базах «PubMed», «Scopus», «Web of Science» і «Google Scholar». Встановлено, що дія кадмію, свинцю, органофосфатів, хронічного алкоголізму, опіоїдів і гіпертермії супроводжується типовими структурними змінами - вакуолізацією цитоплазми клітин Сертолі, набряком інтерстицію, атрофією звивистих канальців і редукцією клітин Лейдіга. Порушення терморегуляції, іонізуюча радіація та механічні травми додатково спричиняють руйнування гемато-тестикулярного бар’єра й активації імунного ушкодження гермінативного епітелію.

Висновки. Екзогенні чинники чинять універсальний негативний вплив на морфофункціональний стан яєчка, реалізуючись через оксидативний стрес, апоптоз і порушення ендокринної регуляції. Ці процеси набувають особливого клінічного значення в період росту й статевого дозрівання, що потребує підвищеної уваги до профілактики, ранньої діагностики та корекції уражень репродуктивної системи в дітей і підлітків.

Автор заявляє про відсутність конфлікту інтересів.

Postnatal aspects of pelvic organ dysfunction in children with developmental defects - sacrococcygeal teratomas, after their resection (literature review)

V.P. Soroka — 2025-12-28

Aim - to analyze the postnatal aspects of pelvic organ dysfunction in children following the resection of sacrococcygeal teratomas (SCT) and to identify measures for preventing negative functional outcomes in the long-term postoperative period.

A literature review was conducted using PubMed, Elsevier, and medical textbooks. The study analyzed pelvic organ innervation disorders in the long-term period after SCT resection, including fecal and urinary incontinence, constipation, neurogenic bladder, and sexual dysfunction. Key factors for preventing adverse long-term functional outcomes were identified: an individualized treatment strategy, early surgical intervention, radical tumor removal, and the restoration of the anatomical integrity of the pelvic floor and the physiological position of the anus and rectum. It was established that long-term follow-up and regular conservative treatment are reliable factors for improving the quality of life and preventing symptoms of impaired pelvic innervation.

Conclusions. All stages of care for newborns with SCT should be provided within a single multidisciplinary perinatal center. This approach ensures effective coordination between specialists, including obstetricians-gynecologists, pediatric anesthesiologists, neonatologists, pediatric oncologists, urologists, and proctologists.

The authors declare no conflict of interest.

Vesicourethral anastomosis modified posterior support in extraperitoneoscopic radical prostatectomy

Y.A. Nakonechnyi — 2025-12-28

Despite significant advances in surgical techniques for radical prostatectomy (RP), early urinary continence (UC) remains one of the clinical challenges. Multiple vesicourethral anastomosis (VUA) techniques, including anatomical reconstruction and suspension strategies, have been proposed to improve urinary continence outcomes. However, a clear consensus on the optimal approach has yet to be established.

Aim - to describe and evaluate the safety and feasibility of the modified posterior support of the vesicourethral anastomosis (PS-VUA) in the context of urinary continence (UC) after extraperitoneoscopic radical prostatectomy (ERP).

Materials and methods. This prospective study included 54 patients with non-metastatic prostate cancer (PCa) who underwent ERP. Patients were assigned into two equal groups (n=27 each) according to whether the PS-VUA was performed. Urinary continence (UC) was evaluated over a 12-month follow-up period after surgery.

Results. A statistically significant UC improvement was observed during the first 3 postoperative months in the group of patients who underwent PS-VUA (p<0.05). No statistically significant differences were observed between the study groups in terms of clinical characteristics, preservation volume, or postoperative complications (limited to Clavien-Dindo grade I-II events).

Conclusions. PS-VUA represents a safe and feasible surgical technique that may contribute to improved early UC outcomes following ERP in some groups of patients.

The study was conducted in accordance with the Declaration of Helsinki. The protocol was approved by the Local Ethics Committee. Written informed consent was obtained from all participants.

The author declares no conflict of interest.