PAEDIATRIC SURGERY. UKRAINE

A rare case of a large tumour located under the facial nerve trunk

O.O. Tymofieiev — 2023-12-28

Aim: to introduce a technique of total parotidectomy sparing the facial nerve branches based on a clinical case.

The article presents a clinical case of a large parotid tumour located under the facial nerve trunk, the stages of its surgical removal, and the postoperative course.

Parotidectomy is one of the most complicated operations in maxillofacial surgery. When performing this surgical intervention, a surgeon must observe the principles of ablastics, consider individual peculiarities of the facial nerve anatomy structure and relations of nerve and tumour, and be ready to expand the scope of the operation from subtotal to total parotidectomy.

Conclusions. To improve the treatment outcomes of patients with benign parotid tumours and to reduce the number of such postoperative complications as paresis and paralysis of the mimetic muscles caused by facial nerve injury, one should know and follow the technique of parotidectomy, especially in the case of a neoplasm located under the trunk or branches of facial nerve.

The research was adhered to the principles of the Declaration of Helsinki. The patient informed consent was obtained for the study.

No conflict of interests was declared by the authors.

Efficacy and safety of continuous intravenous lidocaine administration as a component of intraoperative analgesia and postoperative intensive care in extensive liver resections

R.A. Zatsarynnyi — 2023-12-28

Purpose - to improve the effectiveness and determine the safety of intraoperative analgesia and postoperative intensive care for extensive liver resections with intravenous lidocaine compared with traditional analgesia and the use of epidural anesthesia.

Materials and methods. 108 patients of 18 years of age and older who underwent extensive liver resection were examined and analyzed. The studied patients were stratified into three groups, depending on the choice of intra- and postoperative analgesia: the Group I (22 patients) - intravenous lidocaine administration + traditional intra- and postoperative analgesia, the Group II (73 patients) - epidural anesthesia (EDA) in the thoracic spine + traditional intra - and postoperative analgesia, the Group III (13 patients) - control, which used only traditional intra- and postoperative analgesia.

Probability of differences was assessed using Student’s t-test, non-parametric Mann-Whitney U-test, Pearson’s χ² test.

Results. The blood lidocaine concentration in 2 hours after surgery was higher in the Group II (2.37±1.08 μg/ml) compared to the Group I (1.84±1.16 μg/ml). The values for 14 hours after the intervention did not differ (2.62±2.56 μg/ml - in the Group I, 2.85±1.25 μg/ml - in the Group II). In some cases, the local anesthetic content exceeded the toxic level without corresponding clinical symptoms. Intravenous lidocaine administration led to a decrease pain intensity within 4 days after surgery by almost 1.5 times, epidural administration - by 1.5-2 times compared to the standard analgesia, and was also accompanied by a lengthening of the time interval until the first injection of narcotic analgesics from 86.9±68.2 min to 394.3±666.5 and 553.2±52.8.5 min, respectively.

Changing the route of local anesthetic administration from epidural to intravenous led to decrease intraoperative volume of infusion therapy from 9.4±2.5 ml/kg/h to 7.4±1.3 ml/kg/h, as well as to reduction of the norepinephrine dose to eliminate hypotension by 1.3 times.

Lidocaine administration attenuated the intensity of the systemic inflammatory response syndrome, which was manifested by a reduction in the concentration of IL-1, IL-4, IL-10 compared to multicomponent analgesia without a statistical difference with the epidural route of lidocaine administration.

Conclusions. The use of lidocaine as an adjuvant in traditional intra- and postoperative analgesia for extensive liver resection reduces pain intensity and the degree of systemic inflammatory response syndrome. Changing the method of using lidocaine from epidural to intravenous leads to more stable intraoperative blood circulation, reduction the volume of infusion therapy and the need for sympathomimetic support without increasing blood concentration, and in the proposed method is an attractive alternative to epidural analgesia.

The research was carried out in accordance with the principles of the Declaration of Helsinki. The study 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 interests was declared by the authors.

Axiological dimensions of medical deontology in pediatric surgery

V.O. Dubinina — 2023-12-28

The achievements of contemporary medicine, application of advanced technologies and comprehensive therapeutic and diagnostic investigations are not limited to broadening the range of professional opportunities for pediatric surgeons but also require further rationalization of the axiological discourse of medical deontology.

Purpose. The article aims at theoretical and methodological substantiation of the axiological principles of medical deontology in pediatric surgery.

The theoretical and methodological foundation of the scientific research includes the theory of creative development and self-improvement of an individual, the theory of education and personal development in changing socio-cultural conditions, concepts of humanization of education, conceptual approaches to the general theory of activity and philosophical theories of values.

The professional activities of medical workers in pediatric surgery inevitably include the process and result of a deontological dominant, manifested in the profound understanding by the medical experts of their professional and human duties, and in a high moral and ethical responsibility for the quality of their professional activities.

Conclusions. Philosophy and axiology constitute the worldview and methodological basis of medical deontology, particularly in surgery. The genesis of knowledge about moral and ethical principles and the professional duty of a pediatric surgeon is presented in the form of a logical chain: philosophy - axiology - deontology - medical deontology - deontology in surgery - deontology in pediatric surgery. The process of forming the deontological competence of medical professionals in pediatric surgery will be successful if the organization of deontological training for future healthcare providers is based on principles of humanism, in compliance with the requirements of the social environment, and implemented in the educational process through a productive mechanism.

No conflict of interests was declared by the authors.

Analysis of the modern treatment protocols for complicated and uncomplicated infantile hemangiomas. Literature review and own data

O.V. Bogomolets — 2023-12-28

Infantile hemangioma (IH), a benign tumor of the vascular endothelium, is the most common type of vascular pathology of the infant’s skin, which grows and significantly increases in size mostly during the first 12 months of a child's life. Statistics indicate that IH affects up to 10% of newborns and children aged <1 year. The proliferative activity of IHs during the first year of a child's life differs significantly and could mislead parents and doctors. Lack of timely treatment at an early stage leads to an increase in the size of the tumor and high risks of cosmetic defects. Thus, the proliferation of IH can cause a gross deformation of the skin and a dysfunction of nearby organs.

Purpose - to analyze modern data on the treatment of patients with complicated and uncomplicated hemangiomas, to study international experience and compare it with own observations and own experience, and to improve patient treatment protocols.

In this review, we analyzed 19 articles involving more than 2400 children with different types of IH, compared different treatment protocols, their outcomes, and complications, and demonstrated our methods, results, and clinical cases.

It may be resumed that β-blockers are “first-line” drugs for local and systemic treatment of IHs, as they allow slowing of the proliferation and activating resorption of the tumor without cosmetic defects or complications. Treatment of IH in babies following modern treatment protocols should be carried out non-surgically, without operations, anesthesia, scars, or cosmetic defects. Ulceration is the most common complication of IHs and the result of the late start of the treatment and thus could be prevented by the timely beginning of the therapy.

No conflict of interests was declared by the authors.

Tissue expansion as a stimulator of angiogenesis

O.A. Zhernov — 2023-12-28

Angiogenesis is the process of formation of new blood vessels in tissues and organs, which occurs with the participation of many factors. Angiogenesis can be influenced by various factors, such as mechanical tissue stretching, hypoxia, infections, inflammation, and others. Understanding these mechanisms can be important for the development of new approaches to the treatment of various diseases associated with angiogenesis disorders. The process of angiogenesis plays an important role in various physiological and pathological conditions, such as wound healing, tissue regeneration, tumor development, and others. Regulation of angiogenesis can be used for the treatment of diseases associated with a lack of blood circulation. Knowledge about angiogenesis can also be useful for planning and conducting surgery, to increase the efficiency of the surgery, which can help significantly reduce the risk of complications, and avoid repeated interventions.

Purpose - to search and analyze the recent publications to identify trends in the direction of influence on vascular growth.

The search for publications was carried out in well-known global scientometric databases, the range of which spanned more than 10 years. Published results of many years of research, factors and methods of influence on angiogenesis were found and analyzed.

To date, the questions of the impact on angiogenesis remain open, which calls for further research and study of new methods and improvement of existing ones, since knowledge about the mechanisms of angiogenesis can help to develop new methods of treatment and prevention of various diseases.

No conflict of interests was declared by the authors.

A comparative analysis of the scrotal skin surface thermal reaction in surgical treatment of patients with vaginal peritoneal process pathology using different techniques

A.V. Havryliuk — 2023-12-28

The vaginal peritoneal process pathology constitutes a widespread problem in the pediatric population. Pathology of the vaginal peritoneal process is 6 times more common among boys. The observations point out a possible array of male complications (scrotal edema, postoperative hydrocele, iatrogenic testicular refraction) occurring on the background of violation of the integrity of soft tissues, blood and lymphatic vessels. The analysis of local body reactions (namely, the temperature of the surface of the scrotal skin) in response to the pathology as well as its treatment was continued in the current study.

Purpose - to detect the dynamic change of the scrotum skin surface temperature study with a view to comparing different methods of treating pathology of the vaginal peritoneal process.

Materials and methods. The study included 122 boys under the age of 18 who have been treated for pathology of the vaginal peritoneal process (inguinal hernia, hydrocele testis) at the pediatric surgery clinic of National Pirogov Memorial Medical University, Vinnytsya, Ukraine. A VEGA NC600 non-contact infrared thermometer was used to measure the scrotal skin surface remotely on the day of hospitalisation, on the first postoperative day and on the seventh postoperative day.

Results. The general dynamics of scrotal skin surface temperature, both on the pathological and healthy sides, are as follows: a slight increase in scrotal skin temperature in response to surgery is observed on the first postoperative day, followed by a subsequent decrease to preoperative levels.

Conclusions. The study of the dynamic temperature changes of the scrotum skin surface in the case of correction of the vaginal peritoneal process pathology using various methods demonstrated that one of the local reactions of the body to the surgery was a slight increase of the average data on the side of the surgical intervention on the first day, followed by a decrease in the preoperative average level. A similar temperature response was recorded on the healthy side.

The research was adhered to the principles of the Declaration of Helsinki. The research protocol was agreed by the Local Ethics Committee of the mentioned institution. The patients' informed consent was obtained for the study.

No conflict of interests was declared by the authors.

Omphalocele - regarding management and treatment tactics

P.S. Rusak — 2023-12-28

An omphalocele is an abdominal defect covered by a membranous sac consisting of three layers: peritoneum, jelly of the ventricle and amnion as the outer layer. The vessels of the umbilical cord flow into the top of the pouch, which usually contains the herniated abdominal contents: intestines, liver, spleen, bladder and/or gonads. The pouch covers and protects the herniated organs from harmful external influences.

Purpose - to improve care for patients with omphalocele, improve their life quality by updating treatment standards using the experience of other countries around the world.

A literature review is provided and personal experience is highlighted - 2 clinical cases with a diagnosis of omphalocele. Both underwent operative treatment. All children recovered and were discharged from the clinic.

Depending on the clinical manifestations, the size of the defect and the content of the hernia sac, the term and tactics of treatment differ.

Conclusions. The discussion about the tactics of omphalocele treatment depending on the size is still relevant. Clinical recommendations for the management of omphalocele remain only recommendations, and in each individual case, the decision regarding the terms and methods of treatment remains with the surgeon. It is necessary to remember the possibility of entrapment, which forces the surgeon to perform urgent surgical intervention.

No conflict of interests was declared by the authors.

The structural rearrangement of testicular arteries in case of chronic ethanol intoxication

S.O. Nesteruk — 2023-12-28

Prolonged poisoning of the body with ethanol damages almost all its organs and systems. Structural changes in testicular arteries under the influence of chronic ethanol intoxication have not been fully studied.

Purpose - to analyze the morphometric parameters of the small caliber arteries of the right and left testicles of rats in case of chronic ethanol intoxication.

Materials and methods. 62 laboratory sexually mature male rats was performed. The animals were divided into two groups. The Group 1 (control) included 30 rats, the Group 2 (experimental) - 32 animals. The experimental rats, which were conducted to the experiment, were injected intragastrically with a 30% ethanol solution at the rate of 2 ml per 100 g of body weight for 28 days once a day. Animals were euthanized by heart bleeding under thiopental anesthesia. Histological micro-sections were made from the left and right testicles. Morphometrically, the outer and inner diameters of the arteries, media thickness, adventitia, Vogenvoort and Kernogan indices, the height of endotheliocytes, the diameter of their nuclei, the nuclear-cytoplasmic ratio in these cells, and the relative volume of damaged endotheliocytes were determined morphometrically in small-caliber arteries. Statistical processing of digital data was carried out using Excel (Microsoft, USA) and STATISTICA 6.0 (Statsoft, USA) software.

Results. It was established that in case of simulated experimental conditions of chronic ethanol intoxication, the investigated morphometric parameters of the arteries of the left and right testicles changed significantly. In case of chronic intoxication with ethanol in rats, pronounced structural rearrangement of testicular vessels, mainly small arteries, characterized by thickening of the blood vessel’s wall, narrowing of vessels’ lumen, rearrangement of endothelial cells, and an increase in the relative volume of the damaged cells of intima, is established, and is dominant in the left testis.

Conclusions. In case of chronic intoxication with ethanol the structural changes in testicular tissues are dominant in the left testis. Pronounced remodeling of small caliber testicular arteries causes endothelial dysfunction, deterioration of blood supply to the testicles, hypoxia, dystrophic and necrobiotic tissue changes, infiltrative and sclerotic processes, which are the pathomorphological basis of male infertility.

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

No conflict of interests was declared by the authors.

Optimisation of methods of diagnosis and correction of heel foot in children with cerebral palsy

O.A. Danylov — 2023-12-28

The main cause of heel foot is muscle imbalance due to dysfunction of the triceps femoris muscle. Literature data indicate the need to study issues related to changes in the anatomy and function of the foot flexor muscles and calcaneus and to determine indications for optimal methods of correction of heel foot.

Purpose - to study the anatomical and functional changes in the calf muscle and bones in children with heel foot to determine the optimal methods of diagnosis and correction of deformity.

Materials and methods. We analysed the results obtained during the treatment of 14 patients (28 cases) aged 11 to 17 years with cerebral palsy complicated by calcaneal foot formation. Two groups were formed: the main group of 6 patients (12 cases), in which posterior calcaneal osteotomy with Achilles tendon plasty and transposition of the tibialis anterior tendon was performed; the comparison group of 8 patients (16 cases), in which only soft tissue surgery was performed. The comparative group was divided into 2 subgroups, which differed in radiological parameters of Bohler and Kite Danilov angles: the subgroup A - 3 patients (6 cases), the subgroup B - 5 patients (10 cases). Clinical and radiological methods were used to examine patients.

Results. The structure and shape of the calcaneus change in the presence of heel foot, which leads to changes in the Danilov angle and the angles between the trabecular lines. Correction of the shape of the calcaneus is a prerequisite for creating optimal biomechanical gait conditions. Transplantation of the tibialis anterior tendon eliminates the pathological effect of its retraction; achilloplasty eliminates the functional deficiency of the triceps tendon.

Conclusions. The results of surgical correction on soft tissues showed effectiveness at Bohler, Kite <35⁰, Danilov <40⁰ angles. At higher values, it is necessary to supplement the intervention with a posterior calcaneal osteotomy.

The study was conducted in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the local ethics committees of all institutions participating in the study. Informed consent was obtained from the patients.

No conflict of interests was declared by the authors.

Analysis of the occurrence of postoperative cognitive dysfunction with the use of morphine hydrochloride after hip arthroplasty under spinal anesthesia

M.V. Svirhun — 2023-12-28

Purpose - to analyze the state of cognitive function of patients according to the Mini Mental State Examination (MMSE) scale in points at different follow-up periods; to establish the relationship between the occurrence of postoperative cognitive dysfunction (POCD) and a single administration of morphine hydrochloride after hip arthroplasty under spinal anaesthesia in the early postoperative period

Materials and methods. The study was conducted on the basis of the Vinnytsia City Clinical Hospital of Emergency Medical Care with the participation of 120 patients. All patients were operated on for a hip fracture - hip joint replacement under spinal anesthesia. All patients in the postoperative period were evaluated for pain intensity according to the visual analog scale (VAS). In the early postoperative period, patients received: a combination of paracetamol and dexketoprofen. In case of insufficient effectiveness of paracetamol and dexketoprofen, which was assessed as the impossibility of maintaining the pain level according to VAS no more than 4 points, morphine hydrochloride 10 mg was used. The MMSE scale was used as one of the main evaluation scales for the dynamics of POCD. In this part of the work, patients were divided into two main groups depending on the dynamics of the cognitive deficit, which was determined by the MMSE scale during the entire period of observation, which generally divided the patients into two groups: «Without negative dynamics of cognitive functions» (n=85) and «With negative dynamics of cognitive functions» (n=35). Statistical processing was carried out using StatPlus programs according to parametric and non-parametric criteria, differences were considered significant at p<0.05.

Results. On the 7^th day after hip arthroplasty, the negative dynamics of cognitive function, compared to the data during hospitalization, remained in 68.6% of patients with morphine hydrochloride among them: in 41.6% of patients, mild cognitive disorders appeared in their absence at the stage of hospitalization, in 29.2% there was a transition from mild cognitive disorders to mild dementia and in another 29.2% - mild to moderate dementia (p=0.03).

Conclusions. The obtained data indicate that 92.3% of patients who had cognitive impairment at the time of discharge from the hospital received morphine hydrochloride, which may indicate a negative effect of the use of this drug on the cognitive functions of patients with hip arthroplasty on the background of a hip fracture.

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 interests was declared by the authors.

The role of variceal bleeding primary prophylaxis in the management of extrahepatic portal vein obstruction in children

O.S. Godik — 2023-12-28

Extrahepatic portal vein obstruction is a major cause of pediatric symptomatic portal hypertension and can lead to profuse variceal hemorrhaging.

Purpose - to evaluate the role of primary prophylaxis of the variceal bleeding in children with extrahepatic portal vein obstruction.

Materials and methods. A one-center prospective cohort clinical study involved 120 patients with extrahepatic portal vein obstruction who underwent primary or secondary variceal bleeding prophylaxis in 2016-2021. The laboratory, ultrasound, and endoscopy data before and after treatment were collected and evaluated.

Results. Variceal bleeding episodes occurred in 5.8% (n=3) of patients who underwent primary prophylaxis and rebleeding occurred in 27.9% (n=19) of those who underwent secondary prophylaxis. Bleeding episodes occurred less frequently in patients from primary prophylaxis group (p=0.013). In patients treated endoscopically (n=53, 44.17%) Variceal bleeding appeared less frequently (n=3, 5.66%) after treatment compared to patients who underwent surgery (n=67 (55.83%), 19 had rebleeding (28.35%)) (p=0.001). In 69.17% patients (n=83) esophageal varices eradication was achieved: in 53.01% (n=44) patients from the primary prophylaxis group and 46.99% (n=39) from the secondary prophylaxis group. Bleeding episodes occurred less frequently after the eradication achievement (p<0.001). The primary prophylaxis led to varices eradication more often than secondary (p=0.003). The varices recurrence episodes rates after the eradication achievement were not different between groups (p=0.51).

Conclusions. Primary prophylaxis can reduce the bleeding risk in extrahepatic portal vein obstruction with high risk of variceal bleeding. The prophylaxis by endoscopic variceal banding is an important bridge in the treatment for pediatric patients with portal hypertension that along with portosystemic shunting could potentially improve prophylactic treatment results.

The Committee on Clinical Investigation of Bogomolets National Medical University approved this study (Protocol No.141, 27.01.2021). All the studies were conducted according to implemented guidelines in consideration of GCP-ICH and Declaration of Helsinki. The written informed consent of all participants’ parents/guardians was achieved.

No conflict of interests was declared by the authors.

Pathomorphological and morphometric features of acute appendicitis in children with type I diabetes mellitus

O.G. Yakymenko — 2023-12-28

Metabolic disorders caused by chronic hyperglycemia in the gastrointestinal tract of patients with type I diabetes mellitus (T1DM) not only affect natural course of this disease but also modify clinical course of concomitant abdominal purulent-inflammatory diseases in children due to changes of the internal intestinal wall.

Purpose - to analyze pathomorphological and morphometric features of acute appendicitis in children with T1DM.

Materials and methods. We carried out a pathomorphological and morphometric case-control study of the surgical specimens (appendices and fragments of the peritoneum). Two groups were created: the Group I (n=11) - patients with acute appendicitis, peritonitis and T1DM; the Group II (n=24) - patients with acute appendicitis, peritonitis but without T1DM. Statistical analysis was performed using software package STATISTICA v.10.0 (StatSoft, USA).

Results. There were signs of diabetic angiopathy in the Group I and a significant number of inflammatory cells, represented by a large number of segmented nuclear leukocytes - 431±18.2 in 1 mm², plasma cells - 146±11.13 in 1 mm², lymphohistiocytic elements - 196±23,32 in 1 mm². The density of the inflammatory cell infiltrate was 773±36.2 cells in 1 mm².

Morphometric features of the Group II are as follows, number of segmented nuclear leukocytes - 228±15,7 in 1 mm², plasma cells - 112±10,41 in 1 mm², lymphohistiocytic elements - 132±21,2 in 1 mm². The density of the inflammatory cell infiltrate was 773±36.2 cells in 1 mm².

Conclusions. There is an increase in the density of the inflammatory cell infiltrate, the number of neutrophils, plasma cells, and lymphohistiocytic elements in samples of appendices and peritoneum in children with acute appendicitis and T1DM in comparison with the Group II (p˂0.001). Furthermore, those specimens feature presence of hyalinosis, thickening of the vascular wall and partial obliteration of small caliber vessels.

In the Group II (patients without T1DM), the parietal and visceral peritoneum had a large number of inflammatory elements and presence of macrophage elements upon normal histological structure of the microcirculatory vessels.

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 participating institution. The informed consent of the patient was obtained for conducting the studies.

No conflict of interest was declared by the authors.

Surgical aspects of treatment of perforated gastroduodenal ulcers with combined complications of penetration, stenosis and acute bleeding

P.V. Ivanchov — 2023-12-28

The problem of surgical treatment of perforation of gastroduodenal ulcers (GDU) remains relevant and difficult, despite the introduction of new schemes of anti-ulcer and eradication therapy. Algorithms of surgical approaches and tactics of surgical treatment of patients with perforated GDU in combination with other complications in various combinations have not been developed.

Purpose - to improve the results of surgical treatment of GDU with associated complications.

Materials and methods. The results of surgical treatment of patients with complicated GDU for the period from 2000 to 2022 are presented. In total, 353 (100%) patients with perforated GDU in combination with other complications (a combination of two or more complications) were operated on. There were 52 (14.7%) patients with gastric ulcer perforation, and 301 (85.3%) patients with duodenal perforation. There were 267 (75.6%) patients with a combination of two complications; with a combination of three complications in 78 (22.1%) patients; four - 8 (2.3%) patients. The combination of perforation with gastrointestinal bleeding was observed in 138 (39.1%) patients.

Results. The vast majority of patients (267 (75.6%)) had a combination of two complications. The number of patients with a combination of three complications was 78 (22.1%). The number of patients with a combination of all complications was insignificant - 8 (2.3%) people. The implementation of the developed algorithm made it possible to reduce the number of postoperative complications and mortality from 12% to 6.5%. The highest rate of complications and mortality was observed among patients with a combination of multiple (three and four) complications who underwent gastric resection - 3 (33.3%) patients, and the lowest mortality rate was observed among patients who underwent organ-preserving operations - 6 (2.8%) patients.

Conclusions. In patients with perforated GDU in combination with bleeding, the use of endoscopic hemostasis made it possible to stabilize the patient and better prepare him for surgical intervention, and reduce the number of postoperative complications and mortality rates by almost 2 times. The use of resection techniques was extremely limited and had the highest rate of complications and mortality. Implementation of the developed algorithm made it possible to optimize surgical tactics when combining perforation with other complications of GDU.

No conflict of interests was declared by the authors.

Treatment and prevention of adhesive intestinal obstruction in children

O.D. Fofanov — 2023-12-28

Despite the achievements of modern pediatric surgery, to date there is no single comprehensive approach to the treatment and prevention of adhesive intestinal obstruction (AIO), both primary (prevention of adhesions formation after primary surgery) and secondary (prevention of recurrence).

Purpose - to study the clinical effectiveness of treatment, primary and secondary prevention of postoperative intestinal adhesive obstruction in children.

Materials and methods. An examination and analysis of medical records of 119 children aged 5 months to 17 years who were treated at the Pediatric Surgery Clinic of Ivano-Frankivsk National Medical University over the past 10 years for post-operative AIO was carried out. In 35 (29.41%) children a positive effect was achieved from conservative treatment. The remaining 84 (70.59%) children were operated on.

Two groups of patients were formed: the comparison group - 38 (45.24%) children, who received traditional treatment, and the main group - 46 (54.76%) children, who were intraoperatively applied anti-adhesive gel to prevent recurrence of postoperative AIO.

Results. It was established that postoperative AIO occurred in only 1 (1.19%) child after laparoscopic intervention, in the rest of the children primary surgical interventions were performed by an open method. In the comparative assessment of the postoperative course in two groups of patients, we drew attention to a more favorable course in the children of the main group, which was manifested by a faster recovery of peristalsis, a decrease in the duration of gastric stasis, a faster appearance of independent defecation, and a shorter period of inpatient treatment. When comparing the results of treatment between groups of patients, it was established that the frequency of recurrences of AIO in the main group of patients was 5.44 times lower than in children of the comparison group, and the frequency of relaparotomy for recurrent AIO was 7.28 times lower than in patients of comparison group. We did not observe complications associated with the use of anti-adhesive gel. We did not notice a significant difference in the results of treatment between patients who were treated with anti-adhesive gel of different composition (based on carboxymethylcellulose and sodium hyaluronate).

Conclusions. The most effective method of primary prevention of postoperative adhesive intestinal obstruction is the use of laparoscopic primary surgical interventions. Intraoperative application of anti-adhesive gel is a highly effective and safe recurrence prevention method of adhesive intestinal obstruction in children.

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 the participating institution. The informed consent of the patient was obtained for conducting the studies.

No conflict of interests was declared by the authors.

Congenital ovarian cyst: diagnosis and treatment at neonatal period

E.F. Chaikivska — 2023-12-28

The indications and method of surgery in newborns with prenatally diagnosed ovarian cysts remain under discussion.

Purpose - to summarize own experience in the treatment of newborns with congenital ovarian cysts.

Materials and methods. This study based on the results of treatment of 15 newborns that were operated in I surgical department of Lviv Regional Children’s Clinical Hospital «OKHMATDYT» at 2010-2021 years. For the diagnose confirming, the US was applied in all newborns after birth.

The urgent hospitalization, immediately after birth, required 7 (46.7%) newborns and 4 (26.7%) newborns - during of the first month of life, by that 4 (26.7%) infants were hospitalized for elective surgery during six months after birth. The open surgery was applied in 9 (60%) patients and laparoscopic - in 6 (40%) patients. The postoperative mortality was 6.7%.

Results of the study were evaluated by the statistical program StatPlus: mac, AnalystSoft Inc. (version v8).

Results. Among of 54 fetuses, after the birth the presence of cyst was confirmed in 15 (27.8%) of newborns, which were operated.

Indications for urgent surgery immediately after birth (46.7% of newborns) was the presence of huge (>6 cm) cyst in abdomen, which in 2 newborns determined with respiratory disorders and in 2 newborns - intestinal obstruction. Increasing of the cyst’s size with the pain syndrome was the indication for the urgent surgery during of the first month of life (26.7% of infants) and the presence of cyst without tendency to decreasing of its size was the indication for elective surgery (26.7% of infants). Ovary-sparing surgery was succeeded only in 20% of patients and in 80% of patients performed adnexectomy.

Conclusions. By the antenatally revealing of ovarian cyst, the scheduled US control is required with the aim to monitoring of the dynamic of cyst size. The indications for the surgery in neonatal period are: 1) cysts with the diameter >4 cm; 2) clear suspicions for the complications (torsion, self-amputation, compression of abdominal organs); 3) enlargement of cyst size after the born. The choice of method of surgery determined by size and the character of cystic formation.

The research was carried out in accordance with principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of clinical hospital «OKHMATDYT». The informed agreement of parents was obtained for conducting the study.

No conflict of interests was declared by the authors.

Internship training in surgery of the 1st year of study at a medical university at the present stage

V.V. Mishchenko — 2023-12-28

Internship training in surgery is carried out according to individual curricula developed on the basis of the internship training program. A comprehensive approach to solving topical issues of internship training will allow to raise the professional level of future doctors and surgeons.

Purpose - to show the specifics of the training of interns of the 1^st year of study in accordance with individual curricula and the program of training in an internship in surgery.

11 interns are completing the 1^st year of training in the educational part of the surgical internship at the Department of Surgery of Odesa National Medical University.

During the 1^st year of internship in surgery, interns are trained in the educational part of the internship for 3 months (15.6 credits / 468 hours) from the following courses: Course 1. Organization of surgical services to the population. Course 3. Abdominal surgery. Course 7. Purulent surgical diseases. Course 8. Ambulatory surgery. Course 9. Thoracic surgery. Simulation training of surgical skills is an integral part of the surgical curriculum to acquire the necessary skills. The practical part of the internship takes 8 months (1248 hours). Acquired competencies / practical skills are reflected in the “Practice Diary”. The structure of the practical part of the internship determines the mastery level for each competency, practical skill, which is determined in the range from “A” to “C”: A: Has knowledge, describes. B: Assists. C: Performs under supervision.

Conclusions. During the first year of training in a surgery internship, the intern’s activities must be carefully monitored. The level of independent practice of an intern surgeon of the 1^st year of training is based on active involvement in providing assistance, providing formative feedback between clinical supervisors and supervisors. An intern surgeon of the 1^st year of training is considered competent in all aspects of professional activity if he can perform this activity independently.

No conflict of interests was declared by the authors.

Improving an integrated approach to the treatment of functional constipation in children

I.O. Krycky — 2023-12-28

Functional constipation in children has become a serious medical issue that needs to be addressed immediately. They can significantly limit children’s physical activity and social integration, which emphasizes the importance of providing them with effective care.

Purpose - to analyze and improve the results of the complex use of a lactulose-based drug and prophylactic phytocylinders with a lipophilic complex of rose hips and chamomile extract in the treatment of functional constipation in children.

Materials and methods. We examined 78 children with constipation over the past 3 years. They were divided into two groups. The first group included 36 (46.2%) patients, the second - 42 (53.8%). Patients of the first group received standard treatment according to the protocols of the Ministry of Health of Ukraine, patients of the second group received similar treatment and additionally lactulose in the form of syrup and a preparation based on prophylactic phytocylinders with a lipophilic complex of rose hips and chamomile extract during the course of treatment daily in the form of rectal suppositories.

Results. Most patients were female (60.2%), had average physical development parameters. The duration of constipation ranged from 1 to 3 months, and stool retention - from 3 to 5 days. At the beginning of the observation, there were complaints of changes in the shape and consistency of stools, painful defecation, flatulence, periodic abdominal pain, strong straining during defecation, fear or anxiety in children before the act of defecation. An analysis of anamnestic data showed that in one third of patients, constipation was observed during the transition from breastfeeding to artificial feeding.

Conclusions. The analysis of the addition to the complex of treatment of functional constipation, in addition to lactulose, of preparations based on prophylactic phytocylinders with a lipophilic complex of rose hips and chamomile extract is a safe and quite effective method of correcting these disorders in young children, as evidenced by the results obtained.

No conflict of interests was declared by the authors.