PAEDIATRIC SURGERY. UKRAINE

Analysis of early and immediate results of 180 robotic operations in adults and children

Sat, 28 Jun 2025 00:00:00 +0300

Аim - to analyze our experience of performing robotic surgeries to assess the quality of surgical care.

Materials and methods. 180 robotic surgeries were performed using the da Vinci S and Si during 2020-2024. There were 108 adult patients, 72 children. The age of adults ranged from 18 to 72 years (mean - 45±3.7), children - from 10 months to 17 years (mean - 8±3.2).

Results. Among adult patients, 21 (19.4%) robotic operations were performed on the esophagus and stomach, 35 (32.4%) on urological ones, 9 (8.3%) on intestinal tumors, 13 (12.0%) on diseases of the liver, gallbladder, spleen, 8 (7.4%) on gynecological pathologies, 15 (14.0%) on hernias of the anterior abdominal wall, 7 (6.5%) on urgent surgical pathologies. The spectrum of surgical interventions in childhood is somewhat different. Thus, in the structure of diseases, diseases of the urinary system prevail - 43 (59.7%). 27 (37.5%) on abdominal and pelvic organs were performed. Among abdominal operations, interventions on the spleen prevailed - a total of 11 (15.3%) operations. One operation outside the abdominal cavity was also performed: robotic thoracoscopic thymectomy and external lymph node biopsy. A reduction in the duration of the operation and hospital stay, the absence of complications and conversions, an easing of the rehabilitation period for patients, and a reduction in the physical load on the members of the operating team were noted.

Conclusions. The experience of the center demonstrates that robotic surgery in Ukraine is beginning to gain momentum, indicating good qualitative and quantitative indicators.

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.

Sacrococcygeal teratomas in children: optimization of the preoperative period and surgical treatment tactics

O.K. Sliepov, O.V. Perederii — Sat, 28 Jun 2025 00:00:00 +0300

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

Materials and methods. A retrospective analysis of medical records of 46 children with SCT who underwent surgical correction of the defect in the period 1981-2023 was performed. The main criteria for the tactics of preoperative preparation and surgical treatment of newborns and older children with SCT were studied.

Results. A strategy for preoperative preparation of newborns with giant SCT, with a predominance of the cystic/solid component, was developed. A strategy for preoperative preparation of newborns with SCT complicated by profuse bleeding was developed. The timing of surgical intervention for different forms of SCT was determined. Surgical tactics for tumor resection were developed and improved.

Conclusions. With a predominance of the cystic component of SCT, a series of decompression punctures of cysts is performed. In the presence of a giant SCT of mixed or solid structure - endovascular occlusion of the feeding vessels. In case of uncomplicated SCT, it is advisable to perform the operation at the beginning of the late neonatal period (8-10 days). In case of complicated SCT, emergency surgical intervention is performed immediately after birth. Circumferential access is the “gold standard” for resection of large and giant external components of SCT. Local devascularization of SCT is an important factor in preventing intraoperative bleeding. In case of moderate SCT, it is advisable to use sagittal skin grafting, V-shaped skin grafting - for large tumors, and plastic surgery using the “rotated Mercedes” technique - for giant SCT.

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

The authors declare no conflict of interest.

Quantitative morphological study of age-related features of structural restructuring of endothelial cells of arteries and veins of the prostate gland at ethanol intoxication

M.S. Hnatjuk, S.Y. Zaporozhan, S.O. Nesteruk, L.V. Tatarchuk — Sat, 28 Jun 2025 00:00:00 +0300

Ethanol is one of the most common vascular toxins that directly damages endothelial cells and provokes microcirculatory disorders. The prostate gland, as a component of the male reproductive system, is highly sensitive to toxic influences, while its vascular bed is especially vulnerable to chronic ethanol exposure. Studying age-related remodeling of endotheliocytes under normal conditions and during ethanol intoxication is crucial for understanding the pathogenesis of prostate lesions. These data are also important for pediatric urology and surgery, since many pathological processes in adulthood originate from vascular dysfunctions developing at a younger age.

Аim - to investigate, using morphometric methods, the age-related features of structural remodeling of endothelial cells in the arterial and venous systems of the prostate gland in experimental animals exposed to prolonged ethanol intoxication.

Materials and methods. The study was conducted on 60 mature male white rats divided into four groups: intact animals aged 6 and 24 months, and ethanol-intoxicated rats of the same age. Histological preparations of the prostate gland were analyzed using hematoxylin-eosin and special stains (van Gieson, Mallory, Masson, toluidine blue, silver impregnation). Morphometric parameters included cell and nuclear area, nuclear-cytoplasmic index, and the proportion of damaged cells.

Results. In intact rats, age-related atrophic changes were observed in prostate endotheliocytes, with an 8.2% reduction in cell area and an 8.8% reduction in nuclear area. Chronic ethanol intoxication caused more pronounced alterations: in 6-month-old rats, cell area decreased by 28.1%, and in 24-month-old rats by 29.7%. The proportion of damaged endothelial cells in the arterial system increased 11.8-fold in young animals and 12.2-fold in older animals, while in the venous system the increase was 9.4-fold and 9.8-fold, respectively. Morphological examination revealed vascular wall thickening, intimal proliferation, mucoid swelling, fibrinoid necrosis, elastofibrosis, and dystrophic as well as necrobiotic changes of endotheliocytes, confirming endothelial dysfunction.

Conclusions. Prolonged ethanol exposure leads to age-dependent remodeling of prostate endothelial cells, manifested by cell atrophy, decreased nuclear size, imbalance of nuclear-cytoplasmic relationships, and a sharp increase in the proportion of damaged cells. The findings expand current understanding of endothelial dysfunction mechanisms in alcohol-related pathology and provide a morphological basis for developing preventive and therapeutic strategies for urogenital diseases, including in pediatric urology and surgery.

The experiments with laboratory animals were provided in accordance with all bioethical norms and guidelines.

The authors declare no conflict of interest.

Urogenital vascular anomalies in female patients: diagnostic challenges and modern views on treatment

I.M. Benzar, R.V. Mamedov — Sat, 28 Jun 2025 00:00:00 +0300

Localization of vascular anomalies (VA) in the urogenital region of girls is rare but clinically significant, as it may cause pain, swelling, bleeding, hygiene difficulties, as well as fertility disorders and psychological problems.

Aim - to analyze the clinical course, visualization methods, and treatment of urogenital VA in girls in order to optimize diagnostic approaches and improve treatment outcomes.

Materials and methods. A retrospective single-center study included 171 case histories of patients under 18 years (2015-2023). Parameters assessed: type and localization of VA, imaging data (ultrasound, magnetic resonance imaging - MRI), clinical manifestations, and treatment results. Statistical analysis was performed using R-statistics v.4.2.2; Pearson’s χ² test was applied, with p<0.05 considered significant.

Results. Vascular tumors were diagnosed in 16 (9.4%) out of patients, of whom 9 (56.3%) had infantile hemangiomas of the urogenital area complicated by ulceration. Systemic β-blocker therapy was effective in all cases. Urogenital vascular malformations (VM) were diagnosed in 17 (25.4%) girls: 5 (29.4%) isolated and 12 (70.6%) extended. Excellent outcomes were achieved after radical excision (n=1), local sclerotherapy (n=2), and combined treatment (n=1). Good results were observed in 9 (52.9%) patients after staged or combined interventions, including sclerotherapy with mTOR inhibitors (n=5). A statistically significant difference in treatment efficacy was revealed depending on anomaly type (χ²=8.56; p=0.0034).

Conclusions. Isolated urogenital VM account for 29.4%, which justifies MRI of the pelvis and lower extremities to assess lesion extent. When radical excision is not feasible, sclerotherapy alone or in combination with mTOR inhibitors is effective, leading to lesion reduction, pain relief, cessation of lymphorrhea, and improvement of patients’ quality of life.

This study was conducted in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the local ethics committee of the institution. Informed consent was obtained from all patients (parents or legal guardians).

The authors declare no conflict of interest.

Simultaneous minimally invasive repair of combined defects of the abdominal wall in children

O.S. Maksymenko, R.B. Lysenko, O.S. Osipov, R.B. Savchenko, V.H. Hryn — Sat, 28 Jun 2025 00:00:00 +0300

Nowadays, minimally invasive closure of abdominal wall defects is becoming more popular and is considered an alternative to open methods of their treatment.

Aim: to evaluate the effectiveness of simultaneous repair of combined abdominal wall defects in children using a minimally invasive technique.

Material and methods. A retrospective analysis of laparoscopic closure of combined abdominal wall defects was conducted in 13 children (11 boys and 2 girls), using a single-port technique in 10 cases and with the insertion of an additional working port in 3 others. The duration of surgery, the occurrence of intraoperative, early and late postoperative complications were determined.

Results. The average operation time was 30±3.54 min. In all patients, a multimodal anesthetic approach was used, and the treatment was performed within the day-case surgery. We did not observe any intraoperative or postoperative complications, both in the early and late postoperative period. The scar in the left lateral area is almost imperceptible, and the scar in the umbilical area seems to be a natural embryonic scar. Patients were observed for 1-2 years after surgery - no recurrence of hernias was detected.

Conclusion. Minimally invasive simultaneous repair of combined abdominal wall defects in children has the following advantages: excellent visual control, the ability to assess the contralateral inguinal ring and repair its defect when detected, reduced surgical and anesthetic time, ideal cosmetic and excellent economic results.

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

No conflict of interests was declared by the authors.

The influence of VDR gene polymorphisms on the state of the skeletal system in children with gastroduodenal pathology

Kh.B. Nakonechna — Sat, 28 Jun 2025 00:00:00 +0300

Bone health, which is formed during childhood, largely depends on bone mineral density (BMD). Gastroduodenal pathology in children can impair nutrient absorption, which affects BMD. Genetic factors, particularly polymorphisms of the vitamin D receptor (VDR) gene, play a significant role in the regulation of BMD.

Aim - to study the relationship between BMD indicators and the ApaI and TaqI polymorphisms of the VDR gene in children with diseases of the gastroduodenal area.

Materials and methods. A total of 146 children aged 6 to 17 years with gastroduodenal pathology (main group) and 38 apparently healthy children (control group) were examined. BMD was determined using ultrasound densitometry. Genotyping of the ApaI and TaqI polymorphisms of the VDR gene was performed for 104 children from the main group and all children in the control group using the polymerase chain reaction method. Statistical processing of the research results was carried out using the application software packages for statistical analysis of medical and biological research data: «Microsoft Excel», «IBM SPSS Statistics V27» and «Statistica Version 10».

Results. A statistically significant decrease in the median BMD was found in the main group of children compared to the control group - respectively 84% versus 92,5%. A statistically significant difference was recorded in the distribution of genotypes of the ApaI polymorphism between the main and control groups with a predominance of the aa genotype in the main group. Among patients with gastroduodenal pathology, a statistically significant difference was established between subgroups based on BMD levels and the ApaI and TaqI polymorphisms. The AA and Aa genotypes of the ApaI polymorphism and the TT genotype of the TaqI polymorphism were associated with reduced BMD, whereas the aa (ApaI) and tt (TaqI) genotypes were associated with normal BMD indicators.

Conclusions. Children with gastroduodenal pathology have a high risk of decreased BMD. The AA and Aa genotypes of the ApaI polymorphism and the TT genotype of the TaqI polymorphism of the VDR gene are genetic predictors of reduced BMD in this patient cohort, while the aa (ApaI) and tt (TaqI) genotypes exhibit a protective effect.

The author declares no conflict of interest.

Spleen volume as a non-invasive predictor of complicated portal hypertension: clinical significance and diagnostic potential

Sat, 28 Jun 2025 00:00:00 +0300

Portal hypertension (PH) is a common complication of liver cirrhosis, leading to the development of esophageal and gastric varices (GOV), ascites, and hypersplenism. One of the most prevalent manifestations of complicated portal hypertension (CPH) is splenomegaly (SMG), observed in 80-90% of patients. Spleen volume (SV) is considered an integrated marker of splanchnic hemodynamics and a potential predictor of the severity of PH.

Aim - to investigate the prevalence of SMG in patients with diagnosed CPH and to evaluate its predictive value for the presence of GOV.

Materials and methods. A total of 187 patients with acquired chronic liver disease (ACLD) (fibrosis or cirrhosis) and clinically significant portal hypertension (CSPH) with confirmed grade II-III GOV were included, along with 46 healthy controls (CG). SV was measured by ultrasound B-mode by determining three linear dimensions and using automated calculation. The Child-Pugh score was used to assess liver functional status. For evaluating the prediction model parameters of GOV, ROC analysis with calculation of AUC was applied.

Results. SMG (SV >314 cm³) was detected in 98% of patients with GOV and in none of the CG. The mean SV in the study group was 5.8 times higher than in CG (853.3±404.3 vs.146±56.9 cm³), with median values of 765 cm³ and 140 cm³, respectively (p<0.0001). The area under the ROC curve (AUC) for SV as a predictor of GOV was 0.995, with a sensitivity of 98.9% and specificity of 100% at the cut-off point of 293 cm³.

Conclusions. The high prognostic value of SV as an independent predictor of the presence of GOV in patients with ACLD and CPH has been confirmed. No association between SV and the degree of the liver dysfunction was established.

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.

The authors declare no conflict of interest.

Analysis of infection prevention and control programs in Ukrainian healthcare institutions providing transplantation services: challenges and priorities

A.V. Aleksandrin, D.M. Koval — Sat, 28 Jun 2025 00:00:00 +0300

Transplantation services in Ukraine are a rapidly developing area of healthcare. It is important to ensure the implementation of best practices in infection prevention and control (IPC) at the national and institutional levels to minimize the risk of complications. Healthcare-associated infections (HAIs) are common adverse event in transplant settings due to the various risk factors patients face, including immunosuppression, long and complex surgical procedures, and a number of other factors.

Аim - to analyze the IPC programs in Ukrainian healthcare institutions providing transplantation services.

Materials and methods. To assess the implementation of IPC programs at the facility level, a special questionnaire was developed for 31 centers and ten visits were conducted to transplant centers to analyze current practices.

Results. The following key components of IPC are best implemented in most hospitals: IPC environment, IPC materials and equipment, IPC guidelines. HAIs surveillance, multimodal strategies, monitoring of IPC practices, and IPC training in most of the transplant centers assessed need improvement. Not all health care facilities have access to 24-hour bacteriological laboratory services. In over 30% of transplant centers, reprocessing of medical equipment is carried out in inadequate conditions. 58% of operating rooms meet ISO (International Organization for Standardization) cleanroom class 6 requirements, 75% of patient rooms meet cleanroom standards.

Conclusions. The analysis of the IPC program in Ukrainian healthcare institutions providing transplantation services demonstrated heterogeneity in the implementation of IPC measures and significant challenges that healthcare institutions are facing. Priority areas for the development of the IPC program in transplant centers in Ukraine were identified.

No conflict of interests was declared by the authors.

Organization of medical care for pregnant women, fetuses and children with critical congenital malformations in a multifunctional perinatal center

O.V. Trokhymovych — Sat, 28 Jun 2025 00:00:00 +0300

Aim - to develop a concept for providing medical care to pregnant women, their fetuses and children with complex congenital malformations in a multifunctional perinatal center, to assess postoperative mortality of patients with critical congenital malformations.

Materials and methods. A retrospective analysis of medical records of 437 children was performed, and the levels of postoperative mortality in patients with complex and critical congenital malformations who underwent surgical correction of the defect in the conditions of the SI «Ukrainian center of maternity and childhood of the NAMS of Ukraine» were studied, in the period from 1981 to 2025.

Results. The proposed concept of organizing medical care for pregnant women, fetuses and newborns made it possible to reduce the mortality of newborns with congenital malformations: in congenital small bowel obstruction from 37.5% to 11.4% (with high obstruction) and from 56.3% to 26.3% (with low). In diaphragmatic hernia, a decrease in postoperative mortality was noted from 56.6% to 9.7%. In gastroschisis, the total postoperative mortality with both uncomplicated and complicated forms decreased from 63.0% to 14.4%, since 2018 - 0%.

Conclusions. The development and implementation of the concept of organizing medical care for pregnant women, fetuses and children with critical congenital malformations in the conditions of a multifunctional perinatal center made it possible to significantly reduce postoperative mortality of patients and achieve mortality values identical to the results of leading world clinics.

No conflict of interests was declared by the author.

Topographical and anatomical relationships of nerves and arteries in the muscles of the little finger in human fetuses

I.G. Biryuk — Sat, 28 Jun 2025 00:00:00 +0300

Currently, hand surgeries require detailed description of blood supply characteristics and sources of innervation of individual hand muscles and knowledge of intramuscular distribution characteristics of nerves and arteries.

Аim - to investigate the topographical and anatomical relationships of nerves and arteries in the muscles of the little finger in human fetuses.

Materials and methods. We studied 32 hand specimens from 16 human fetuses 81.0-375.0 mm parieto-coccygeal length (PCL) by macromicroscopic dissection, arterial vessel injection, and morphometry without external signs of anatomical abnormalities or congenital malformations of the fascial-muscular and vascular-nerve formations of the upper extremities. The author used his own method of sequential anatomical dissection of the vessels and nerves of the palmar part of the human hand.

Results. In the human fetus, each muscle of the little finger has a specific source of innervation and blood supply. As a rule, there are several sources of blood supply; they can be divided into the main - permanent and additional - non-permanent. In the human fetuses studied, the superficial branch of the ulnar nerve is involved in the innervation of the short palmar muscle. The abductor digitorum, short flexor digitorum, and oppositorum muscles of the little finger are innervated primarily by the deep branch of the ulnar nerve. Less commonly, the innervation of the abductor digitorum muscle is provided by the trunk of the ulnar nerve or its superficial branch, and the innervation of the short flexor muscle of the little finger is provided by the nerve branch of the abductor digitorum muscle. The main source of blood supply to the hypothenar muscles is the muscular branches of the ulnar artery, less often the deep branch of the ulnar artery, the palmar finger artery of the fifth finger, the IV palmar metacarpal artery, and a branch of the artery of the abductor muscle of the little finger. In the thickness of the abductor muscle of the little finger, there are arterial anastomoses and nerve connections. Individual arterial and nerve anastomoses in the form of loops were found in the thickness of the belly of the short palmaris muscle.

Conclusions. The gateway for the entry of nerves and arteries into the muscles of the little finger elevation is located in the proximal third of their abdomen, and the nerves and arteries usually accompany each other. Arterial anastomoses and nerve connections are found in the thickness of the muscles of the little finger elevation, which should be considered in practical work. The results obtained on the topographic and anatomical relationships of the nerves and arteries of the hypothenar muscles can be used by surgeons to anatomically justify incisions during myoplastic surgery with the greatest sparing of intramuscular nerves and arteries.

The study was conducted in accordance with the tenets of the Declaration of Helsinki. The study protocol was approved by the local ethics committee of the institution mentioned in the article.

No conflict of interests was declared by the author.

Clinical and morphologic aspects of noncompact left ventricular cardiomyopathy in the pediatric patient: a clinical case report

Sat, 28 Jun 2025 00:00:00 +0300

Left ventricular noncompaction cardiomyopathy (LVNC) is a rare genetic cardiomyopathy. The disease has a wide range of clinical manifestations, from asymptomatic conditions to serious cardiovascular complications, making its diagnosis and treatment difficult.

The aim of this study was to demonstrate the clinical and morphologic aspects of noncompact LVNC in a child and to analyze the current principles of diagnosis of this disease.

We present a clinical case of LVNC (spongy) in a child aged 3 years 9 months. Postmortem examination of the child's body was performed in the Pathology Department of the MNPE “Regional Clinical Hospital of the Ivano-Frankivsk Regional Council”. Histological sections of the heart were stained with hematoxylin and eosin and Van Gieson's picrofuchsin. Microscopic examination and photography of samples were performed using an Olympus CX23 light-optical microscope with an LC30 digital CMOS camera and cell Sens Entry software. The presented clinical case allowed us to identify the main pathomorphologic criteria of LVNC: hypertrabecular "spongy" myocardium, hypertrophy of muscle fibers, pleomorphism of cardiac myocytes, endocardial fibrosis, and small-focal myocardial sclerosis.

Despite the lack of standardized methods for diagnosing LVNC, ultrasound, echocardiography, magnetic resonance, and cardiac computed tomography are traditional and widely used. Genetic evaluation of cardiomyopathies is an important clinical priority. Genetic testing and phenotyping will allow appropriate treatment of specific LVNC targets, thereby improving survival, reducing morbidity, and improving quality of life.

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

No conflict of interests was declared by the authors.

Retrospective analysis of the course of ulcerative necrotizing enterocolitis in newborns (clinical cases)

Sat, 28 Jun 2025 00:00:00 +0300

Ulcerative-necrotizing enterocolitis (NEC) is one of the leading causes of mortality and urgent surgical interventions in the neonatal period. Improving diagnostic and treatment approaches for this condition remains an important and relevant objective to enhance clinical outcomes.

Aim - to analyze the clinical course, diagnostic approaches, and treatment strategies for newborns with ulcerative-necrotizing enterocolitis based on retrospective analysis and selected clinical case reviews.

Materials and methods. The analysis included data from 138 newborns with NEC who were treated at the departments during the period from 2013 to 2023. Of these, 34 (24.6%) underwent surgical intervention, and these cases were analyzed in more detail. A review of clinical cases of NEC in newborns was conducted. General clinical, laboratory, instrumental, histological, and statistical methods were used in the study.

Results. Among the 138 infants with NEC, 104 (75.4%) patients with the stage I or II received conservative treatment, while 34 (24.6%) underwent surgical intervention. A total of 25 infants (18.1%) died. The majority of the operated patients had the stage IIIA NEC (52.9%) or the stage IIIB NEC (41.2%). In 94.1% of the operated cases, the gestational age was less than 36 weeks, and in 79.4% the birth weight was under 2000 grams. The main laboratory findings in the stage IIIB NEC included elevated leukocytosis, anemia, decreased protein and albumin levels, and increased urea levels. Ultrasound and radiographic imaging confirmed the diagnosis and associated complications. Bacteriological monitoring revealed pathogenic microflora in 85.7% of patients with the stage IIIB NEC. The main surgical interventions included laparocentesis, laparoscopy, and laparotomy. Postoperative mortality was 23.5%. Two clinical cases of NEC were reviewed, highlighting several debatable management aspects.

Conclusions. Necrotizing enterocolitis (NEC) remains a severe complication of the neonatal period, requiring a multidisciplinary approach to diagnosis and treatment. The presented clinical cases demonstrate the necessity of an individualized approach to managing patients with NEC. There is no universal surgical strategy for treating NEC, further research is needed, particularly regarding the impact of maternal COVID-19 infection during pregnancy on newborns, especially concerning hemostatic disorders.

The authors declare no conflict of interest.

Anomalies of the genital organs development with menstrual blood outflow disorders in the practice of a pediatric surgeon

І.V. Ksonz, Ie.M. Grytsenko, L.M. Dobrovolska, Y.V. Pylypiuk, O.V. Ovchar — Sat, 28 Jun 2025 00:00:00 +0300

Early detection of genital malformations in girls, providing the timely and qualified medical care will help to preserve their reproductive health in future. However, the rarity of pathology and diversity of the clinical picture complicate timely diagnosis of genital abnormalities in children, leading to incorrect management tactics and unjustified surgical interventions.

Aim - to present your own experience in treating girls aged 11-13 years with imperforate hymen and OHVIRA syndrome. Painful abdominal syndrome and presence of tumor-like formation in abdominal cavity were the reasons for hospitalization.

Clinical cases. An 11-year-old girl was hospitalized with abdominal pain and urinary retention. The one month interval pain had been disturbing for 6 months. An ultrasound examination revealed a tumor-like mass in the pelvic cavity with a liquid content. Diagnostic laparoscopy revealed an enlarged uterus with dilated fallopian tubes up to 5-6 weeks of pregnancy. During the gynecological examination a non-perforated hymen was diagnosed. A 13-year-old teenage girl was hospitalized with cyclical pain in the lower abdomen and right hypochondrium associated with menstruation, which first appeared since menarche. Ultrasound examination revealed a liquid-contented tumor-like mass in pelvic cavity, absence of the right kidney. Multislice computed tomography revealed an agenesis of the right kidney, two separate uteri, the right uterus communicated with a right-sided ‘blind’ hematocolpos formed by vaginal membrane. OHVIRA syndrome was diagnosed. Teenage girls with above mentioned symptoms should be examined by a paediatric gynaecologist. If agenesis or other renal malformations are detected, girls in premenarcheal period should do gynecological examination to exclude OHVIRA syndrome.

The research was carried out in accordance with the principles of the Helsinki Declaration. Informed consent was obtained from parents (or guardians) and children.

No conflict of interests was declared by the authors.

A rare case of urethral caruncle in a 4-year-old girl

D.V. Shevchuk, A.O. Dvorakevych, V.M. Piets, A.A. Andrusevych — Sat, 28 Jun 2025 00:00:00 +0300

A urethral caruncle is a benign formation that usually originates from the posterior part of the urethra. Urethral caruncles are the most common benign tumors of the female urethra. Most of them occur in postmenopausal women, and they are rarely found in childhood. In general, only a little more than a dozen pediatric cases have been published in the literature.

Aim - to describe a rare case of urethral caruncle in order to improve diagnostic and treatment methods.

Clinical case. The experience of treating a 4-year-old girl with a diagnosed urethral caruncle is described. The disease can cause bleeding, swelling and changes in the external genitourinary organs, but usually does not lead to serious urinary disorders. Conservative treatment did not bring improvement, so a decision was made to surgically remove the lesion. During the operation, the neoplasm was excised with the imposition of adaptive sutures and further referral for histopathological examination. Histological examination confirmed the diagnosis of urethral caruncle without signs of malignant changes. This case emphasizes the importance of timely diagnosis and the correct approach to the treatment of urethral caruncle, especially in children. Surgical removal is the most effective treatment method when conservative therapy does not give results. For a more accurate diagnosis, it is important to conduct differential diagnosis with other diseases, such as urethral prolapse. Since cases of caruncle in children are rare, further research is necessary to better understand the etiology of the disease and improve diagnostic and treatment methods.

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

There is no conflict of interest.

Clinical case of abscess of the posterior wall of the urinary bladder in a 3-year-old patient. Diagnostic and treatment tactics

D.S. Soleiko, N.P. Soleiko, O.M. Gorbatyuk, I.V. Sapryha, O.O. Kurtash — Sat, 28 Jun 2025 00:00:00 +0300

Intra-abdominal inflammatory formations of the abdominal cavity in children are a complication of inflammatory processes of various organs, one of which may be the bladder. Untimely determination of the anatomical localization of the inflammatory focus is one of the reasons for the incorrect diagnosis, hypodiagnosis, and the choice of treatment tactics that are not radical in relation to the etiology of the disease.

Aim - description of symptoms, determination of diagnostic measures and complex treatment of abscess of the bladder wall in children based on a clinical case.

The clinical case demonstrates the tactics of diagnosis and treatment in a 3-year-old patient with an abscess of the posterior wall of the bladder. Analysis of the course of the disease and the diagnostic and treatment process proved the reasons for determining the incorrect diagnosis, improperly etiology and localization of the inflammatory focus, the dynamics of the course of the disease, and treatment tactics at the first stage of treatment, which became the reason for the untimely surgical intervention. The need for multimodal diagnostic tactics in the visualization of inflammatory formations of the abdominal cavity is determined and proven. The diagnostic value and feasibility of using additional examination methods are analyzed. Differential diagnosis of bladder wall abscess with urachus anomalies is presented. Conservative and surgical treatment tactics are determined.

Conclusions. The structure of inflammatory infiltrates/abscesses of the abdominal cavity in children is polyetiological. One of the causes of the occurrence of an infiltrate/abscess of the abdominal cavity is the inflammatory process of the bladder wall. The presence of an infiltrative formation of the abdominal cavity requires multimodal diagnostic tactics immediately after determining the diagnosis and hospitalization - performing magnetic-resonance imaging (if it is impossible to perform it - computed tomography with contrast) and ultrasound of the abdominal organs, in order to determine its etiology, localization, nature and structure of pathological changes, the possible presence of abscessation, location relative to other anatomical structures. The presence of an infiltrate/abscess of the bladder wall requires differential diagnosis with complicated anomalies of the urachus, other developmental defects, tumor-like formations. The presence of a bladder wall abscess in a pediatric patient is an indication for perfoming fibroureterocystoscopy under general anesthesia to determine possible presence of changes in the mucosa, congenital malformations, and tumor-like formations of the bladder.

The research was carried out in accordance with the principles of the Helsinki Declaration. Informed consent was obtained from parents of the child.

The authors declare no conflict of interest.

Congenital diaphragmatic eventration in children

A.A. Pereyaslov, P.S. Rusak — Sat, 28 Jun 2025 00:00:00 +0300

Diaphragmatic hernia and eventration represent the most common disorders of the diaphragm. Congenital diaphragmatic eventration is a relatively rare pathology characterized by the partial or whole bulging of one or both hemidiaphragms without interruption of its integrity.

The aim of this study was to analyze the data of etiology, clinical presentation, diagnosis, and methods of surgery in case of diaphragmatic eventration.

Diaphragmatic eventration is divided into congenital and acquired, total and partial. Congenital diaphragmatic eventration may be an isolated malformation or associated with chromosomal disorders, other congenital malformations, or be part of various congenital syndromes and developed due to the intrauterine infection. Clinical presentation varied from an asymptomatic course to a life-threatening distress syndrome. Chest radiographs, ultrasonography, computed and magnetic resonance tomography are applied for the eventration diagnosis. The different methods (open and mini-invasive) and approaches (thoracotomy and laparotomy) for the management of diaphragmatic eventration were analyzed.

Conclusions. Diaphragmatic eventration in children can cause severe respiratory disorders, which determines the necessity for surgery. In asymptomatic children, follow-up observation is possible, but in case of the presence of respiratory symptoms, the surgery is indicated. The choice of surgery (open or mini-invasive) depends on surgeons’ skills and the localization of the eventration.

No conflict of interests was declared by the authors.

Additional spleens in children. Literature review and own clinical observations

Sat, 28 Jun 2025 00:00:00 +0300

Aim - to conduct a literature review analysis on accessory spleens in children and to establish the prevalence, number and localization, as well as modern visualization methods, features of the course and significant indications for surgical treatment.

Accessory spleens account for 10% to 30% of the population. The prevalence of additional spleens was established, which varied depending on the imaging method: verification using ultrasound, computer tomography, magnetic resonance imaging took place from 16.6% to 30.1%, intraoperative from 14.3% to 14.6%, and cadaveric from 0.6% to 9.1%. By the number of additional spleens, it was established that one additional spleen took place from 21.4% to 85%, and two or more from 25.0% to 64.3%. Additional spleens were localized in the splenic hilum from 41.7% to 75%, in lig.gastrolienale 15.0% to 54.0%. Surgical treatment - removal of the additional spleen is indicated only if it is complicated by volvulus, necrosis and suppuration, and isolated cases are described as clinical observations. There were 195 patients with additional spleens for 30 years, aged from 3 months to 18 years, of which 103 (52.82%) were male, 92 (47.18%) were female. Patients were divided into two groups: the first group 59 (30.26%) - inpatient surgical treatment of other ailments, the second group - 136 (69.74%), who were treated on an outpatient basis.

Conclusions. An additional spleen is a congenital anomaly that is usually asymptomatic, but can clinically manifest complications such as torsion, spontaneous rupture with bleeding, suppuration and cyst formation, which requires urgent examination and treatment, including surgical removal of the twisted additional spleen.

The authors declare no conflict of interest.

Comparative analysis of the use of 3D navigation and «free hand» technique in the surgical treatment of idiopathic scoliosis in children

K.S. Kurysko, A.F. Levytskyi — Sat, 28 Jun 2025 00:00:00 +0300

Posterior instrumentation technique and posterior fusion with pedicle screws is a standard operation for the correction of idiopathic scoliosis. Pedicle screws can be incorrectly placed even by the best, most experienced surgeons (1.7 to 15% of cases). Improving the accuracy of screw insertion can be achieved by using standardized methods of free-hand technique screw insertion and by using navigation systems

Aim - to determine the benefits of using optical enhancement technique with navigation based on intraoperative computed tomography is more effective than the free-hand technique in the placement of pedicle screws in the surgical treatment of idiopathic scoliosis in children.

Materials and methods. The study included 90 patients with a diagnosis of idiopathic scoliosis of the thoracolumbar spine. A total of 2127 pedicle screws were inserted during the surgical treatment of idiopathic scoliosis in children. The group A included 44 patients, who received 1059 pedicle screws using the «free-hand» technique. The group B included 46 patients, who received 1068 pedicle screws using 3D-navigation with optical amplification. The accuracy of screw placement was assessed on postoperative CT scans using the Gertzbein-Robbins scale. We compared the accuracy and safety of pedicle screw placement between the both groups.

Results. The group A's rate of 90.1% was significantly lower than that of the group B's 96.5%.

Conclusions. Intraoperative computer 3D-navigation compared to the “freehand” technique has the advantage of correctness and safety of pedicle screw placement, shortens surgical time, reduce intraoperative bleeding, the number of neurological postoperative complications, and also ensure the safety of the operation by identifying and quickly removing an incorrectly placed screw. Increasing the accuracy of screw placement allows for an increase in the range of surgical interventions of higher complexity and improving the correction rates of spinal deformities in idiopathic scoliosis 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 for all participants. The informed consent of the patients was obtained for the study.

The authors declare no conflict of interest.