PAEDIATRIC SURGERY. UKRAINE

The level of pain sensitivity in people with different body weight: does it have an impact on surgical operations?

S.D. Khimich, I.O. Malyshevskyi, R.M. Chornopyshchuk, O.V. Katelian — Fri, 28 Mar 2025 00:00:00 +0200

The aim: to determine the level of pain sensitivity in people with different body weight using our own improved algometer.

Materials and methods. The study involved 227 healthy people (110 men and 117 women) aged 19 to 78 years. The Group I consisted of 101 people with a body mass index (BMI) from 18.5 to <25.0. The Group II included 91 people with overweight and grade 1 obesity (BMI 25.0 to 35.0). The Group III included 36 patients with grade 2 (35.0 to <40.0) and grade 3 obesity (>40.0). The level of pain sensitivity was measured using a special original device.

Results. People in the Group I did not feel pain when pressing on the needle with a force of 13.3±2.6 g, the Group II - with a force of 20.5±4.0 g, and participants from the Group III - 29.8±8.2 g. The feeling of moderate pain was observed at the level of 36.6±3.4 g in the Group I, at the level of 51.7±4.0 g and 59.0±8.9 g in the Groups II and III, respectively. The severe pain in the Group I was recorded at 64.1±5.7 g; in the Group II - at 89.8±6.7 g; and in the Group III - at 101.3±13.0 g.

Conclusions. With increasing body weight and obesity, the threshold of pain sensitivity increases, i.e., with increasing obesity, people are more resistant to mechanical pain stimulation. Obese people are 1.5-2 times more resistant to mild, moderate, and severe mechanical stimulation than people with normal body weight. Reduced pain sensation in obese people may be one of the reasons for the masked development of purulent inflammatory processes of soft tissues, acute inflammatory, oncological, and destructive processes of internal organs.

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 university. The informed consent was obtained from the patients.

The authors declare no conflict of interest.

Perinatal diagnosis and surgical correction of intralobar sequestration associated with cystic-adenomatous malformation of right lung, in a newborn

Fri, 28 Mar 2025 00:00:00 +0200

Aim - to analyze and describe the experience of surgical treatment of symptomatic intralobar pulmonary sequestration associated with cystic-adenomatous malformation of the lower lobe of the right lung in a newborn child based on a clinical case.

Clinical case. A unique clinical case of treatment of symptomatic intralobar pulmonary sequestration associated with cystic-adenomatous malformation of the lower lobe of the right lung in a newborn child is presented. Features of perinatal support, preoperative preparation, and surgical intervention are described, which are important elements of optimizing the treatment of children with this life-threatening pathology.

Conclusions. A scientifically based, differentiated approach is needed in the diagnosis and treatment of pulmonary sequestration, which includes: early (up to 22 weeks of gestation) complex prenatal diagnosis, to choose a rational pregnancy management tactic; examination of the fetus, with an assessment of its general condition, the dynamics of the pathological process during gestation; delivery of a pregnant woman according to the obstetric situation; postnatal diagnosis; preoperative preparation and surgical treatment in the conditions of a multifunctional perinatal center. Ultrasound with Doppler mapping is the leading method of prenatal diagnosis of pulmonary sequestration for choosing rational tactics of pregnancy management, as well as fetal examination. With symptomatic intralobar pulmonary sequestration and associated cystic-adenomatous malformation, within one lobe of the lung, it is advisable to perform a simultaneous operation: correction of both lung defects by lobectomy in the neonatal period, which prevents possible complications and gives good functional results.

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

The authors declare no conflict of interest.

Eventration/relaxation of the diaphragm due to birth trauma. Reinnervation in addition to plication. Long-term distant results of diaphragm function restoration

Fri, 28 Mar 2025 00:00:00 +0200

Aim - retrospective analysis of the catamnesis observation of children with eventration/relaxation of the diaphragm due to birth trauma with surgical reinnervation and plication.

Clinical cases. Two children were followed up and analyzed, both born with full relaxation of the diaphragm dome on the right side, Erb-Duchenne plexitis, hydrocephalic syndrome due to hypoxic-ischemic brain injury, and pneumonia. The diagnosis was established in the early neonatal period, and the severity of respiratory disorders required respiratory support (mechanical ventilation of the lungs) and intensive therapy in the newborn intensive care unit. The clinical cases presented demonstrate a rare pathology of birth paralysis of the diaphragm dome due to damage to the phrenic nerve. The patients were treated surgically by means of reventration of the diaphragm dome using the plication method with simultaneous reinnervation. These surgical interventions had a 100% success rate among the patients.

Conclusions. Diaphragmatic eventration is a rare pathology accompanied by respiratory disorders, severe respiratory failure requiring mechanical ventilation with subsequent surgical intervention to restore diaphragm function. Correction of the diaphragm eventration using the plication method with simultaneous reinnervation is the most effective surgical method of treatment in newborns.

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 studies.

No conflict of interest was declared by the author.

High-flow nasal oxygenation as a method of anesthetic management of patients with «difficult airways»: clinical cases

V.R. Mishchuk, A.A. Pereyaslov, F.B. Yurochko — Fri, 28 Mar 2025 00:00:00 +0200

Surgical treatment of children with pathologies of the oral cavity and upper respiratory tract creates difficulties for both the surgeon and the anesthesiologist.

Aim - to show the effectiveness of high-flow nasal oxygenation in preventing hypoxia in patients with "difficult airway" during surgical interventions in the oral cavity.

Clinical cases. Two clinical cases are presented: the first patient with post-traumatic ankylosis of the temporomandibular joint, the second with macroglossia on the background of Beckwith-Wiedemann syndrome, who underwent oral surgery. Given the anatomical features of the patients, classical intubation of the trachea under direct laryngoscopy was impossible for them. Both patients underwent fiberoptic intubation of the trachea under the STRIVE Hi (Spontaneous Respiration Using Intravenous Anesthesia and High-Flow Nasal Oxygen) anesthesia technique. High-flow nasal oxygenation was used as the main method of respiratory support. Despite the long period of hypoventilation and apnea, both patients had normal oxygenation and ventilation parameters (SpO₂ 99-98%, EtCO₂ 47-48 mm Hg)

Conclusions. High-flow nasal oxygenation is an effective method of oxygenation and prevention of hypoxia during the anesthetic management of "difficult airways" in children. Earlier onset of desaturation and hypercapnia in children is associated with young age and smaller functional residual lung capacity.

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

The authors declare no conflict of interest.

A rare observation of resection of giant sacrococcygeal teratoma complicated by massive bleeding in a newborn child

V.P. Soroka — Fri, 28 Mar 2025 00:00:00 +0200

Aim - is to analyze and describe the experience of surgical treatment of giant sacrococcygeal teratoma (SCT) complicated by massive bleeding in a newborn child.

Clinical case. A rare clinical observation of resection of giant sacrococcygeal teratoma complicated by massive bleeding in a newborn child is presented.

Conclusions. In the presence of negative prognostic factors associated with the risk of hemodynamic and hemorrhagic complications, it is advisable to consider the possibility of surgical treatment in the early neonatal period to prevent fatal consequences. A 2-stage surgical treatment tactic for life-threatening massive bleeding is described, which allowed to eliminate a formidable complication, stabilize the child's condition, ensure effective preoperative preparation and perform subsequent radical resection of the tumor with a good postoperative result.

The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patient was obtained for conducting studies.

No conflict of interests was declared by the authors.

The value of indicators of the harmony of the development of the sacrococcygeal spine in children with disorders of the function of the pelvic organs

A.A. Savitska, V.S. Konoplitskyi, Yu.Ye. Korobko — Fri, 28 Mar 2025 00:00:00 +0200

Disorders of the function of the pelvic organs in the pediatric population in the form of chronic constipation, a frequent disorder of the gastro-intestinal tract, common throughout the world. Up to 1/3 of children aged 6 to 12 years testify to the presence of chronic constipation. The normal functioning of the bladder directly depends on its innervation, including the sacral parasympathetic center, so any developmental anomaly or dysplasia of the sacral spine can be accompanied by its dysfunction, one of the manifestations of which can be vesicoureteral reflux.

Аim - to evaluate the value of the sacral index in the norm and in pediatric patients suffering from chronic defecation disorders of various genesis and vesicoureteral reflux, to determine the prognostic value and frequency of sacral dysplasia depending on the pathology.

Materials and methods. The study was designed according to the "case-control" scheme. The survey included 338 patients aged 3 to 14 years who were undergoing inpatient examination and treatment in the conditions of the Vinnytsia Regional Pediatric Clinical Hospital during 2020-2024. Micturition cystography, by taking pictures in direct and lateral projections. No pathology was detected in 40 children, which allowed them to be classified as normal. In 265 patients, radiological signs of organic genesis were determined (dolichosigma, dolichocolon, megacolon, etc.) vesicoureteral reflux of degrees I - II - III was found among 33 examined.

Results. The main method of assessing the harmony of the structure of the sacral department was and remains a physical examination and hardware radiographic methods of visualization of anatomical structures, however, the calculated indices of the development of the sacrococcygeal spine can be used as an additional diagnostic and prognostic criterion for the course of the pathology of the pelvic organs, as well as as a prognostic factor in determination of drug treatment and selection of children for operative correction of pathology.

Conclusions. Recognizing the consequences of traumatic damage to the coccyx and its possible type of physiological variant of the structure, which is important in the overall assessment of the development of the sacrococcygeal spine, must be carried out before each calculation of the sacral curvature in an individual order.

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

The authors declare no conflict of interest.

Anatomical features of the gallbladder, its shape and location of the a. cystica in laparoscopic operations for gallbladder pathology in children

O.B. Bodnar, V.S. Khashchchuk, L.I. Vatamanesku, R.Yu. Randiuk, A.O. Bodnar — Fri, 28 Mar 2025 00:00:00 +0200

На сьогодні значно збільшилася кількість дітей із хворобами жовчного міхура (ЖМ), які підлягають лапароскопічній холецистектомії. Виникнення патології часто пов’язане з анатомічними особливостями ЖМ та a. cistica.

Мета - дослідити анатомічні особливості ЖМ та a. cistica при виконанні лапароскопічних оперативних втручань із приводу хвороб ЖМ для визначення предикторів жовчнокам’яної хвороби в дітей.

Матеріали і методи. За період 2022-2024 рр. прооперовано 16 дітей віком від 8 до 17 років із приводу патології ЖМ. Вивчено клінічну картину, дані додаткових методів дослідження, перебіг оперативного втручання, анатомічні особливості, результати гістологічного дослідження.

Результати. За даними лапароскопічної холецистектомії в дітей спостерігалися різноманітні аномалії ЖМ, форми й міхурової артерії. Розглядаючи анатомічні аномалії ЖМ у дітей, виявили, що без аномалій було лише 31,25% дітей, інтрапечінковий ЖМ відзначався у 12,5%, ЖМ за типом «пісочного годинника» - у 15,0%, ЖМ рухомий із брижою - у 25,0%, подвоєння ЖМ - у 6,25%. Отже, у 68,75% дітей спостерігалися анатомічні передумови виникнення його хвороб. Найчастіше (25,0%) виявлялися грушоподібна та форма ЖМ із перетяжками (25,0%). Не було форми у 12,5%. Булавоподібна та яйцеподібна форми відзначалися у 18,75% і 18,75%, відповідно. Класичний варіант артерії спостерігався у 50,0%. A. cystica проходила високо у воротах печінки у 25,0%, з боку ложа ЖМ - у 6,25%, пересікала загальний жовчний протік у 6,25%, подвоєння печінкової артерії - у 12,5%. За даними гістологічного дослідження, інтрамуральний мікролітіаз виявлявся у 56,25%, кишкова метаплазія - лише у 6,25%.

Висновки. Анатомічні аномалії ЖМ при калькульозному холециститі та поліпозі виявлено в 68,75% дітей. Передумовами для виникнення хвороб ЖМ є також форма (перетяжки ЖМ призводять до виникнення калькульозу більше за інші форми). Некласичний варіант розташування a.cystica (50,0%) спричиняє розвиток патології ЖМ. Інтрамуральний мікролітіаз у 56,25% свідчить про нефункціонування ЖМ і необхідність його видалення.

Дослідження виконано згідно з принципами Гельсінської декларації. Протокол дослідження ухвалено локальним етичним комітетом інституту. На проведення досліджень отримано інформовану згоду батьків, дітей.

Автори заявляють про відсутність конфлікту інтересів.

Acute surgical diseases with abdominal pain syndrome in pubertal girls

O.G. Yakymenko, R.I. Zozulyak, B.G. Bobrov — Fri, 28 Mar 2025 00:00:00 +0200

Aim - to study the prevalence and structure of acute surgical diseases with abdominal pain syndrome (ABS) among girls of pubertal age to develop algorithms for timely recognition and treatment.

Materials and methods. A retrospective analysis of 255 cases of hospitalization of girls aged 11-17 years diagnosed with ABS in Vinnytsia region for the period from 2018 to 2023 was conducted. The data processing was performed using medical statistics.

Results. The most common diagnosis among girls with ABS was acute appendicitis (69.4% of cases), while gynecological diseases (ovarian cysts, salpingitis) accounted for 27%. It was noted that the proportion of gynecological diseases increased in 2022-2023, especially among girls aged 14-17 years. It was found that in 53.85% of cases the diagnosis was delayed for more than 4 hours, which indicates the complexity of differential diagnosis.

Conclusions. The increase in cases of gynecological pathologies with ABS among pubertal girls indicates the need for in-depth interdisciplinary diagnosis. The data obtained indicate the importance of developing algorithms for the timely recognition and treatment of ABS in young patients.

The study was conducted in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the Local Ethics Committee for all participants. Informed consent was obtained from patients.

There was no conflict of interest.

Ways to improve the results of surgical treatment of patients with acute complications of malignant processes of the stomach

P.V. Ivanchov, O.B. Kostenko — Fri, 28 Mar 2025 00:00:00 +0200

Aim - to study and analyze the structure of acute surgical complications of malignant stomach (MS); to develop an optimal algorithm of surgical tactics in patients with acute complications of MS in emergency care; criteria for choosing emergency and early-delayed surgical procedures.

Materials and methods. The materials of the study were the results of a comprehensive examination and treatment of 452 patients with acute complications of MS who were inpatients at the Kyiv City Clinical Hospital No.12, for the period from 2014 to 2023. In the first period of the study, a retrospective analysis of the medical history and treatment results of 245 patients with acute complications of malignant gastric syndrome who were treated in clinics from 2014 to 2018 was conducted - the control group. Based on the analysis, an optimized surgical tactic was developed for the appointment with acute complications of malignant gastric diseases, which in the second period of the study was implemented in clinical practice for the treatment of 207 patients with acute complications of STDs who were in the clinic from 2019 to 2023. - the main group.

Results. An optimized algorithm of surgical tactics was developed in patients with MS complicated by bleeding, the key point of which is the performance of emergency endoscopy, where endoscopic hemostasis is effective or not effective, and in this regard, we get the opportunity to divide all patients into 2 groups regarding the choice of the timing of surgical intervention. The starting point for perforations of the gastrointestinal tract is the performance of emergency radiography and endoscopy with the determination of the localization and morphological characteristics of the perforation substrate and the conduct of preoperative preparation in the intensive care unit or on the operating table. Due to compliance with the tactics of clinical and endoscopic monitoring, in the second period, the overall mortality rate is reduced by almost half - by 5.2%, and postoperative mortality - by 3.5%.

Conclusions. An algorithm of surgical tactics in patients with complicated gastrointestinal tract has been developed, which involves compliance with active-extraction tactics with the use of clinical and endoscopic monitoring for bleeding and stenosis and active preoperative preparation with minimizing the volume of emergency surgical intervention for perforations of the disease.

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

The authors declare no conflict of interest.

Morphometric features of the structural organisation of rabbit large intestine crypts after colotomy using polycaprolactone thread modified with L-arginine

Fri, 28 Mar 2025 00:00:00 +0200

The study of the morphological characteristics of large intestine tissues sutured with various surgical threads under experimental conditions is highly relevant, timely, and holds significant promise for both theoretical and practical medicine, particularly in the field of paediatric abdominal surgery.

The aim is to determine the morphometric parameters of the structural organization of large intestine crypts during experimental colotomy using polycaprolactone thread modified with L-arginine (PCL-MA).

Materials and methods. The study was conducted on 35 sexually mature, non-purebred domestic rabbits aged 9-10 months, in accordance with all bioethical standards. The animals were divided into a control group (5 individuals) and an experimental group (30 individuals). In the control group, all stages of surgical access and sampling of intact caecal wall tissue were carried out. The rabbits in the experimental group underwent colotomy, followed by suturing of the large intestine with PCL-MA. To achieve the aim, histological, semi-thin serial sectioning, morphometric, and statistical methods were employed.

Results. The study showed that when using PCL-MA sutures, due to L-arginine on its surface, the number and functioning of absorptive enterocytes are restored from the 21^st day of the experiment. The reaction of goblet cells in the crypts contributes to the formation of a protective mucosal barrier, which is manifested in an increase in their number (from day 3^rd to day 14^th of the experiment) and the presence of a significant number of cells in the stage of degranulation. Restoration and normalization of the functions of mucosal exocrinocytes of the perivulnar area were observed after the 21^st day of the experiment.

Conclusions. Poorly differentiated cells located within the crypts play a key role in the regeneration of the large intestine following surgery, as their proliferation contributes to the restoration of the cellular pool. The application of PCL-MA sutures exerts a positive influence on the processes of differentiation and the formation of undifferentiated cells within the crypts.

No conflict of interests was declared by the authors.

Liver transplantation in children: pre-transplantation preparation tactics

H.V. Kurylo — Fri, 28 Mar 2025 00:00:00 +0200

Liver transplantation (LT) from a living related donor is the only life-saving option for children with congenital liver diseases such as biliary atresia, Alagille syndrome, progressive familial intrahepatic cholestasis, and Byler disease, as well as metabolic disorders and acute or chronic liver failure. The development of LT from living related donors significantly reduces the waiting time for a donor organ. The success of the procedure largely depends on the quality of pre-transplantation preparation (PTP) of both donor and recipient.

Aim - to study the features of PTP in children with cholestatic liver diseases for successful LT.

Materials and methods. 37 children with biliary atresia underwent PTP between 2005 and 2023. In 36 cases, LT was performed using a living related donor; in one case, split-liver transplantation (SPLIT-LT) was used. PTP lasted 3–6 months and included infection focus sanitation, correction of congenital anomalies, emergency status assessment, and evaluation of physical and psycho-emotional development. All examinations followed current international standards.

Results. All transplantations were successful. After PTP, improvements were observed in hematological parameters, functional and neuropsychological development, and reduced anxiety levels. All transplant centers acknowledged the high quality of PTP; no child was refused transplantation due to inadequate preparation. The key readiness criteria were a compensated clinical state and a safe bacterial environment.

Conclusions. Compliance with regulatory standards and protocols for PTP ensures successful pediatric LT and protects donor health. PTP improves hematological, somatic, and psycho-emotional indicators, reduces risks, and increases the effectiveness of transplantation. Our experience with PTP aligns with international standards.

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.

No conflict of interest was declared by the author.

Treatment outcomes and prevention of variceal bleeding in the esophagus and stomach in patients treated for chronic hepatitis C

Fri, 28 Mar 2025 00:00:00 +0200

In patients with chronic hepatitis C (CHC) who have achieved a sustained virological response (SVR), the risk of developing clinically significant portal hypertension (CSPH) persists. It may be complicated by variceal bleeding (VB) from the gastroesophageal varices, which is associated with high mortality. The development of effective secondary prevention strategies is a relevant scientific challenge with significant practical and social value.

Aim - to evaluate the safety and effectiveness of endovascular splenic artery embolization (SAE) as a method of secondary prophylaxis in patients with CSPH after CHC treatment.

Materials and methods. The study involved 34 patients with ≥1 episode of esophageal VB who underwent SAE. We assessed safety and efficacy (based on bleeding recurrence), as well as hematological, biochemical, and ultrasonographic parameters before SAE and at a 12-month follow-up. Liver function was evaluated using Child-Pugh and MELD scores. All patients received standard-dose nonselective beta-blockers (NSBBs) and ursodeoxycholic acid.

Results. No deaths occurred within 12 months post-SAE. The recurrence rate decreased tenfold (from 2.71 to 0.26 episodes per patient). Spleen volume decreased from 811 cm³ to 479 cm³; platelet count increased (from 78.5 to 143)×10³/µL; hemoglobin and thrombocrit levels also improved. Child-Pugh and MELD scores showed positive dynamics.

Conclusions. In patients successfully treated for CHC, the risk of progression of portal hypertension and the occurrence of life-threatening complications in the form of VB is not eliminated. SAE is a safe and effective method for secondary prevention of VB in patients with CHC who have achieved SVR.

The authors declare no conflict of interest.

Pancreaticoduodenal resection with venous resection: experience of a high-profile center in Ukraine

Fri, 28 Mar 2025 00:00:00 +0200

Aim - to evaluate the feasibility and safety of venous resections (VR) during pancreatoduodenectomy (PD) in patients with malignant tumors of the periampullary region.

Materials and methods. A retrospective cohort study was conducted, including 111 patients who underwent PD for malignant tumors of the periampullary region between 2018 and 2023. Patients were divided into two groups: with and without VR. Statistical analysis was performed to compare mean values and assess postoperative complications using the Clavien-Dindo classification.

Results. Mean blood loss, operative time, rates of complications, delayed gastric emptying, postoperative pancreatic fistula, hospital and 30-day mortality did not differ significantly between the groups. Median overall survival was 22 months in the VR group and 37 months in the non-VR group; the 5-year survival rates were 22.2% and 35.9%, respectively.

Conclusions. PD with VR is a safe and feasible procedure for patients with tumor invasion of major veins. The inclusion of VR does not significantly increase risks or worsen postoperative outcomes.

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

The authors declare no conflict of interest.

Advantages of using modern minimally invasive technologies in acute surgical pathology of the abdominal cavity

O.O. Lozytsky, V.V. Gonchar, V.P. Prytula, I.V. Karol — Fri, 28 Mar 2025 00:00:00 +0200

Minimally invasive technologies are gaining popularity in Ukraine due to their high treatment efficiency, low number of complications, and high cost-effectiveness. A significant problem in modern Ukrainian medicine is the use of laparoscopic equipment of different generations, which can lead to diagnostic and medical errors and prevent the expected results.

Aim - to analyze the prevalence of minimally invasive treatment methods in Ukrainian hospitals; to study, divide minimally invasive equipment into groups depending on its time of origin and capabilities, assess the advantages and disadvantages of each group and the possibility of using minimally invasive equipment, taking into account the technical generation in Ukrainian hospitals.

A literature review was conducted using Medline, PubMed and scientific literature. We analyzed the development of minimally invasive and robotic surgery and articles reporting data on their application.

Conclusions. The growing popularity of minimally invasive technologies and robotic surgery in Ukraine leads to the emergence of new equipment in Ukrainian hospitals. There is a problem of the emergence of various equipment in the absence of standardization of indications and contraindications for surgical interventions depending on the equipment of a particular hospital in Ukraine.

No conflict of interest was declared by the authors.

Intracorporeal square-to-slip knot technique for vesicourethral anastomosis with single-layer anatomical reconstruction and anterior urethral sphincter preservation

Y.A. Nakonechnyi — Fri, 28 Mar 2025 00:00:00 +0200

Radical prostatectomy (RP) remains the gold standard for prostate cancer (PCa) treatment. In recent years, the number of RP procedures has increased, alongside the number of high-risk PCa (HR-PCa) patients choosing this treatment. Consequently, improving functional outcomes while maintaining oncological safety is crucial for this patient group. The rapid development of minimally invasive RP methods has yielded promising new techniques and approaches. However, vesicourethral anastomosis (VUA) continues to be one of the most sophisticated and challenging aspects of the operation.

Aim: to describe and evaluate the safety and efficacy of a VUA technique using intracorporeal square-to-slip knots (IKS), single-layer anatomical reconstruction (SLAR), and anterior smooth muscle urethral sphincter preservation (AUS-P) during extraperitoneoscopic RP (ERP) in terms of urinary continence (UC).

Materials and methods. This study included 36 patients with localized HR-PCa who underwent ERP in 2022 and 2023. The bladder neck preservation (BNP), puboprostatic ligaments (PPL-P), and maximal functional urethra length (MFUL-P), as well as VUA with IKS technique, SLAR and AUS-P, were performed in all cases.

Results. The statistical analysis indicated the safety of the modified VUA technique. The operative time (OT), estimated blood loss (EBL), and hospital stay (HS) medians were within the expected range. Only 15% of patients experienced postoperative complications, all of which were classified as grade I according to the Clavien-Dindo classification. No VUA stenosis was observed after 12 months. 80.6% of patients achieved UC within the first 3 months after urethral catheter removal (CR).

Conclusions. The ISK technique for VUA with SLAR and AUS-P appears to be a safe approach, with promising UC outcomes. Larger studies are needed to confirm the true UC benefits associated with this technique.

The author declares no conflict of interest.

The particularities of T-lymphocytes levels after the induction immunosuppressive therapy with stem cells in kidney transplant recipients

O.S. Voroniak, R.V. Salutin — Fri, 28 Mar 2025 00:00:00 +0200

Induction immunosuppressive therapy is used to prevent early kidney transplant rejection and has a positive effect on the kidney transplantation long-term results, but the chronic rejection remains the main cause of transplanted organs function failure in the late post-transplantation period. Previous studies showe positive effects of stem cells therapy in kidney transplantation - lower ischemic-reperfusion injury and improvement of the organs and tissues functional state.

Аim - to assess the dynamics of Т-lymphocytes after kidney transplantation with stem cells complex induction immunosuppressive therapy .

Materials and methods. The study group included 15 adult kidney transplant recipients who underwent first kidney allotransplantation from a living related donor with intravenous administration of (2-3)×10⁶/kg of body weight human umbilical cord blood stem cells in 2020-2023 along with standard immunosuppressive therapy. The comparison group consisted of 30 corresponding recipients who received standard immunosuppressive therapy. The immune status of the recipients was assessed based on the results of immunophenotyping of peripheral blood lymphocytes, which are involved in the work of transplantation immunity.

Results. In the study group we saw more pronounced decrease in the level of CD45+ lymphocytes, CD3+19- T-lymphocytes compared to the comparison group. During the first month after transplantation we saw significant decrease of the I-reg level in both groups, after which the indicators approached to the control group, but did not reach it. In the study group, significantly higher rates of T-reg cell recovery were observed from the 14^th day of observation.

Conclusions. The introduction of cord blood stem cells to recipients before kidney transplantation inhibits alloactivation of the immune system to donor antigens and contributes to the creation of a protolerogenic environment in the recipient's body, which allows to predict the long-term kidney transplant function of in the future.

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 patients was obtained for the research.

The authors declare no conflict of interest.

Biopsy of the transplanted kidney: current state of the issue (experience of the transplantation center)

Tue, 24 Jun 2025 00:00:00 +0300

Kidney transplant rejection is the main cause of graft dysfunction and kidney transplantation failure. Antibody-mediated rejection (AMR) and T-cell-mediated rejection (TCMR) are the most important causes of graft rejection. Other causes of graft loss include vascular thrombosis, urinary tract obstruction and nephrotoxicity of calcineurin inhibitors.

Aim - to present the experience of performing transplanted kidney biopsies in patients of different ages in a single transplantation center to study the feasibility of performing protocol biopsies.

Materials and methods. Since 2020, we have performed 332 kidney transplantations. Of these, 21 (6.3%) were kidney transplants in children. Over the past three years, 89 transplanted kidney biopsies have been histologically examined, of which 8 (9%) were pediatric. Among them, 10 (11.2%) were repeat (second).

Results. The vast majority of results were isolated AMR (67.6% before 14 days and 57.9% after 14 days). Suspected TCMR was observed in 10.6% of biopsies. 34 (38.2%) biopsies were performed in the first 14 days after transplantation. Among them, isolated active AMR was diagnosed in 23 (67.6%) cases, combined rejection was detected in five (14.7%) cases, microvascular inflammation (C4d negative) in three (8.8%) cases, active AMR combined with suspected TCMR was detected in two (5.8%) cases, and there were no signs of rejection in one (2.9%) case. Another 19 (21.3%) biopsies were performed between 14 and 100 days, where in 11 (57.9%) cases isolated AMR was diagnosed, in three (15.8%) cases a combination of AMR and suspected TCMR was detected, in two (10.5%) cases combined rejection was observed, in another two (10.5%) cases microvascular inflammation (C4d negative) was observed and in 1 (5.3%) case signs of immunological rejection were absent.

Conclusions. Signs of rejection of the transplanted kidney are more often observed in children, which requires an earlier approach to performing a biopsy (protocol biopsy option). In the first 100 days after transplantation, when performing a biopsy in patients with impaired graft function, in most cases, active AMR is detected. However, a fairly large proportion also accounts for cases of combined rejection, suspected TCMR and cases of absent immunological rejection, which confirms the appropriateness of using biopsy “on demand”.

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 mentioned institutions. Informed consent of the patients was obtained for the study.

The authors declare that there is no conflict of interest.

Epidemiology of upper extremity musculoskeletal injuries in children

Slawomir Kiepura, Julian Dutka — Fri, 28 Mar 2025 00:00:00 +0200

This study aimed to determine the epidemiology of upper extremity musculoskeletal injuries that require hospitalization in children and adolescents as a starting point for forming preventive recommendations and introduce measures to reduce morbidity and mortality.

Materials and methods. This was a retrospective analysis of epidemiological data collected from 602 children treated at the Paediatric Surgery Department from 2019-2023 with upper extremity fractures or dislocations. Age, sex, incident circumstances, fracture type, and associated damage were evaluated.

Results. Upper limb musculoskeletal injuries accounted for 16% of all hospital admissions due to injuries to different body parts. The median age of the participants was 9.6 years, ranging from 2 months to 17 years. The main causes of injuries were one-story falls (27%), second-story falls (21%), and traffic accidents (9%). The most common fractures involved the distal epiphysis of the radius and ulna (38.5%), the shafts of the bones of the forearm (26%), and the distal epiphysis of the humerus (15.6%). In the analyzed material, 38% of the children experienced fractures/dislocations at home and 31% experienced fractures/dislocations at school. 21% of fractures were sustained during sports activities.

Conclusion. Upper limb fractures and dislocations are the leading causes of hospitalization in children and adolescents in the surgical department. Upper extremity fractures and dislocations predominantly occur at home, at school, and in their surroundings, especially during sports activities. A one-story fall is the most common cause of these injuries. In traffic accidents, pedestrians usually suffer more complex injuries.

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

The authors declare no conflict of interest.

Mathematical model of three-dimensional determination of the degree of spine deformation in adolescent idiopathic scoliosis

V.S. Konoplitskyi, O.F. Tkach, Yu.Ye. Korobko — Fri, 28 Mar 2025 00:00:00 +0200

It is known that every fourth child in Ukraine has a posture disorder. According to the Public Health Center of the Ministry of Health of Ukraine, in 2019, 99,467 children were diagnosed with adolescent idiopathic scoliosis of varying degrees, and according to the Center for Medical Statistics of the Ministry of Health of Ukraine, only during preventive examinations in 2020, 92,322 children with adolescent idiopathic scoliosis were diagnosed with a peak of 0-17 years, among whom 45,553 were boys.

Аim - to make comprehensive assessment of the severity of spinal deformity in the sagittal, frontal, and axial planes, taking into account the primary scoliotic curvature in patients with adolescent idiopathic scoliosis.

Materials and methods. When creating a mathematical model, morphometric data obtained by linear measurements on radiographs in 45 patients of both sexes, with previously diagnosed scoliosis of the I-II degree, were taken into account. The age of the patients ranged from 10 to 18 years (mean age 15.2±0.45 years). Among the total number of patients, left-sided pathology was observed in 21 patients, and right-sided scoliosis was observed in 24 children, respectively. Measurements of the values of the selected anatomical factors were performed simultaneously on two two-dimensional X-ray images of the spine in the frontal and sagittal projections.

Results. It has been proven that visual analysis of the spatial orientation of the vertebrae in scoliotic deformation in adolescents based on two-dimensional radiographs is usually misleading and does not provide reliable data, since the results of flat images are unable to show the true frontal and lateral linear parameters of anatomical objects.

Conclusions. A mathematical model has been developed and proposed for determining the true magnitude of spinal curvature in adolescent idiopathic scoliosis by 3D reconstructive modeling of two-dimensional X-ray images in frontal and sagittal projections, which allows predicting the course of the pathology depending on the localization of the side of pathology formation.

The authors declare no conflict of interest.