PAEDIATRIC SURGERY. UKRAINE

Medical errors and surgical negligence in the 21st century: challenges for the global health care system

O.K. Tolstanov, S.M. Martsyniak, V.F. Rybalchenko — Sun, 28 Sep 2025 00:00:00 +0300

The article presents a literature review on medical errors and surgical negligence in the 21st century.

Aim - to summarize current scientific data on the nature, causes, and consequences of medical errors and surgical negligence in the 21st century, as well as to identify ways to prevent them and minimize risks to patients.

The analyzed data demonstrate that the incidence of such cases has not shown a significant decline over time. According to most studies, scientific and technological progress has not substantially reduced the number of clinical errors or misjudgments. The main cause of medical errors is most often identified as communication breakdowns between patients, their relatives, and medical staff - both physicians and nurses. Of particular importance is the comprehensive approach to studying not only the errors themselves but also the underlying factors contributing to them. The experience of professional associations, particularly in the United States and Germany, is noteworthy: these organizations not only maintain registries of medical errors but also analyze their causes and develop preventive strategies.

It is considered reasonable that a similar association should operate in Ukraine, aimed not only at documenting medical errors but also at studying their causes, developing preventive measures, and providing professional and legal support for health care practitioners involved in litigation.

The authors declare no conflict of interest.

Complications by the surgical treatment of sacrococcygeal teratoma and ways of its prevention

A.A. Pereyaslov, O.M. Nykyforuk, L.Y. Hyzha, R.I. Dats — Sun, 28 Sep 2025 00:00:00 +0300

Sacrococcygeal teratoma (SCT) is the germ-cell tumor that originated from the sacrococcygeal region and contained all three germ layers. Surgery is the cornerstone of the management of this tumor. By that, surgical removing of giant hypervascular SCT accompanied by the high risk of pre- and intra-operative complications, first the bleeding.

Аim - to analyze the possible complications on the surgery of SCT and ways of its prevention.

The presence of giant highly vascularized SCT is the main predisposing factor of the arising of bleeding during surgery. Early closure of the feeding arteries of the tumors is essential for the prevention of uncontrollable bleeding. Laparoscopic ligation of the median sacral arteria consisted as the method of prevention of intra-operative bleeding in children with SCT, which performed directly before the main stage of tumor removing. Another method that can prevent significant blood loss is the endovascular intervention - preoperative embolization of tumors’ feeding vessels. However, both methods included limited number of patients and required further investigations.

Conclusions. Intra-operative bleeding is the life-threating complication in case of removing of giant sacrococcygeal teratoma. Preoperative embolization and laparoscopic ligation of feeding vessels of tumor considered as the main methods for the bleeding prevention during surgery. By that, these methods required further study, due to the limited case reports.

No conflict of interests was declared by the authors.

Do general anesthetics affect children's neurocognitive development?

L.D. Tantsiura, A.V. Biliaiev, I.M. Yachnyk — Sun, 28 Sep 2025 00:00:00 +0300

General anesthesia is a necessary component not only for surgical interventions, but also for diagnostic tests, as well as painful procedures. At the same time, there are many reports about the negative effects of general anesthetics on neurocognitive development in children.

The aim is to summarize and highlight current global evidence on the general anesthetic neurotoxicity in newborns and young children. The most vulnerable period is the age of two to four years, when active neurogenesis and synaptogenesis occur. Exposure of general anesthetics in this period can be especially dangerous. In this regard, the FDA issued a message about the possibility of a negative impact of general anesthesia in young children and pregnant women in the third trimester of pregnancy. At the same time, this category of patients may face life-threatening conditions, when surgery and anesthesia are necessary. Therefore, health care professionals need to balance the benefits and risks when planning operations in young children and pregnant women, especially in children under three years of age and the expected duration of the operation is more than three hours. Current global evidence shows a negative effect of general anesthesia in neonatal period on behavior and learning in late childhood. However, anesthesia exposure was not associated with deficits of general intelligence. Such data were found in neonates and young children.

Conclusions. Probably, the anesthesia outcomes are influenced not only by general anesthetics, but also by careful planning, provision of anesthesia by qualified experienced medical stuff, high level of clinical organization to ensure safety and correct patient management.

The authors declare no conflict of interest.

Principles of anatomical reconstruction of the pelvic floor during surgical treatment of congenital malformations – sacrococcygeal teratoma in children (literature analysis and own recommendations)

O.D. Fofanov — Sun, 28 Sep 2025 00:00:00 +0300

Aim - to identify key factors and basic principles of surgical technique that influence the functional outcome in the reconstruction of pelvic floor structures during the surgical treatment of sacrococcygeal teratomas (SCT) in children.

The literature review was conducted using PubMed, Elsevier, and textbooks. Key factors influencing the functional outcome of pelvic floor structure restoration during surgical treatment of pelvic floor tumors were identified. Specific changes in the sacrococcygeal region caused by tumor growth were described. Ways to optimize surgical technique for anatomical restoration of pelvic floor structures after pelvic floor tumor resection in children were analyzed. The anatomical type of the tumor, the severity of the growth of the SCT, the degree of pathological influence and germination into the surrounding structures, the severity of dysplastic changes in the musculoskeletal and nervous system are key factors that affect the functional outcome in the reconstruction of pelvic floor structures and determine the individual differentiated strategy in the surgical removal of SCT.

Gentle anatomical dissection of the teratoma within the tumor capsule, maximum preservation of nerves and muscle fibers, identification of altered anatomical structures, and reconstruction of their normal anatomy, respectively, are the main principles of the surgical technique for anatomical reconstruction of the pelvic floor in the surgical treatment of SCT.

The author declares that there is no conflict of interest.

Gynaecomastia in focus: peculiarities of clinical manifestations, classifications, diagnostics, and treatment

Sun, 28 Sep 2025 00:00:00 +0300

The article presents literature data from recent years regarding the aetiology, classification, peculiarities of diagnostics, and treatment of gynaecomastia.

Aim - to systematize current data on the etiopathogenesis, classification, and diagnostic methods of gynecomastia, and to develop an evidence-based algorithm for a multidisciplinary approach to patient examination and the selection of optimal surgical treatment strategies based on clinical experience.

Gynaecomastia represents a complex problem that includes determining the aetiopathogenetic mechanisms and the duration of the disease. Comprehensive diagnostics include laboratory tests to determine hormone levels (specifically testosterone, estradiol, prolactin, cortisol, triiodothyronine, thyroxine, thyroid-stimulating hormone), and biochemical blood parameters (liver function tests). The list of instrumental examinations includes ultrasound examination of the mammary glands, mammographic examination of the mammary glands, ultrasound examination of the thyroid gland, testicles, and abdominal cavity. In case of ineffectiveness of therapeutic treatment, surgical treatment is performed, namely subcutaneous mastectomy, liposuction, and a combination of these methods.

Clinical cases illustrating the medical pathway of patients from the stage of presentation to the clinic to surgical treatment are provided.

Conclusions. Gynecomastia is a complex pathology that requires a multidisciplinary diagnostic algorithm, including hormonal profile assessment (testosterone, estradiol, prolactin, thyroid-stimulating hormone), evaluation of parenchymal organ function (liver, kidneys), and instrumental screening (ultrasound and mammography). The choice of treatment strategy depends on the stage of the disease.

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

No conflict of interests was declared by the authors.

In vivo experimental models in scientific research on current issues of Crohn's disease and other inflammatory bowel diseases

D.S. Soleiko, V.P. Prytula — Sun, 28 Sep 2025 00:00:00 +0300

The relevance of scientific research into the pathophysiology, diagnostics, and treatment of Crohn's disease (CD) and other inflammatory bowel diseases (IBD) is due to the increase in morbidity in all age groups and geographical regions. In vivo experimental studies are an integral part of multi-vector scientific research.

Aim - determination the role of species characteristics of biological objects, characterisation of the methods of induction of the pathological process in experimental reproduction and research of topical issues of CD and other IBD.

Based on the analysis of professional literature sources, the advantages that determine and disadvantages that limit the use of biological species in experimental studies are analyzed and presented. Methods of modeling diseases, induction substrates and pathophysiological changes in the experimental inflammatory process of the intestine are considered. Ethical norms that limit and regulate the use of representatives of biological species in experimental studies in vivo are highlighted. The features of experimental biological objects that contribute to the spontaneous onset of the disease, induction and development of morphological changes, disruption of the integrity and focal destruction of the epithelial intestinal barrier, local pathological immune changes, expression of pro-inflammatory cytokines, quantitative and qualitative changes in the microbiome are determined. Practical results of scientific research using each biological species are presented. The relevance of using biological objects in experimental studies of current issues of CD, other IBD forms is argued based on compliance with ethical standards, the possibility of simultaneous research of several problems in the conditions of one model, proven economic efficiency and compliance with the principles of evidence-based medicine. The need for further search for the optimal biological species and method of induction of experimental intestinal inflammation in accordance with the form of the disease and the defined research tasks is determined.

The authors declare that there is no conflict of interest.

Ureterocystoneostomy in the treatment of the obstructive complications of the vesicoureteral reflux endoscopic correction in children

Sun, 28 Sep 2025 00:00:00 +0300

Aim - to report the results of the ureteroneocystostomy in the treatment of the obstructive complications of the vesicoureteral reflux (VUR) endoscopic correction in children.

Materials and methods. The results of intra- and extravesical open ureteroneocystostomy (UCNS) variants (6 and 6 cases, respectively) in the treatment of the obstructive complications of the vesicoureteal reflux endoscopic correction were analyzed in 12 children (5 boys, 7 girls, aged 2- 8 yrs. In all cases UO was unilateral. The ultrasonographic (US) data and the results jf the intravenous pyelography (IVP) was considered as UO parameters. The renospecific enzymes activity levels (N-acetyl-β-D-glucosaminidase - NAG, its termostable isoform NAG B and β-galactosidase (β-Gal) were utilized as markers of kidney function deterioration degree. All mentioned above markers analyzed before and 6 months after surgery.

Results. In all 12 cases surgeries were performed successfully with no intraoperative or postoperative complications. The significant decrease in upper urinary tract dilation, increased parenchyma thickness were estimated as well as the renospecific enzymes activity levels in 6 months.

Conclusions. UCNS is a reliable technique in ureteral patency restoration in secondary UO after vesicoureteral reflux endoscopic correction in children. The lesser bladder trauma is considered to be the advantage in extravesical surgery.

The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies.

No conflict of interests was declared by the authors.

Personalized preservation extraperitoneoscopic radical prostatectomy in high-risk prostate cancer patients

Y.A. Nakonechnyi, Yu.O. Mytsyk, A.Y. Nakonechnyi, A.Ts. Borzhievskyi — Sun, 28 Sep 2025 00:00:00 +0300

Radical prostatectomy (RP) remains one of the most common treatment approaches for localized prostate cancer (PCa). In recent years, it has been increasingly utilized in cases of high-risk prostate cancer (HR-PCa), where achieving an optimal balance between oncological control and functional outcomes is essential.

Aim - to describe and assess the safety and feasibility of personalized preservation extraperitoneoscopic radical prostatectomy (PP-ERP) in patients with HR-PCa.

Materials and methods. PP-ERP was performed in 21 well-informed HR-PCa patients. All patients underwent meticulous preoperative planning based on multiparametric magnetic resonance imaging with a picture quality score ≥4, utilizing 3D modeling. Imaging was interpreted by an experienced, sub-specialized radiologist. The PRECE nomogram was also utilized for surgical planning and for shared decision-making with the patient regarding the extent of tissue preservation. Urinary continence (UC), erectile function (EF), and biochemical recurrence (BCR) were assessed during the follow-up period.

Results. Using the described approach, extraprostatic extension (EPE) was accurately identified preoperatively in 95.2% of cases. At 12 months postoperatively, UC and EF were preserved in 95.2% and 61.9% of patients, respectively, according to the established criteria. Positive surgical margins were observed in 23.8% of cases, and BCR occurred in 19% at 24 months.

Conclusions. PP-ERP with precise surgical planning appears to be a safe and feasible approach for selected HR-PCa patients, offering encouraging functional and oncological outcomes.

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. The informed consent was obtained from all patients.

The author declares no conflict of interest.

Endoscopic variceal bleeding prophylaxis in children with cirrhotic portal hypertension

O.S. Godik — Sun, 28 Sep 2025 00:00:00 +0300

Cirrhotic portal hypertension (CPH) is an increase in intravascular pressure in the portal vein due to increased resistance of the liver parenchyma in so-called "cirrhotic liver diseases". In the context of the pretransplantation period, endoscopy is focused on the prevention or management of bleeding from esophageal varices, which are present in 40-60% of patients with CPH.

Aim - to analyze our experience of bleeding control by means of endoscopic options in children with CPH, optimizing the timing for procedures and ways to reduce the recurrent bleeding in the course of pretransplant management.

Materials and methods. A total of 303 case histories were analyzed retrospectively in the period from January 2011 to December 2023; 63 (22.4%) patients with CPH were identified. Patients were divided into 2 groups: a prospective study (n=43; 68.2%) and a control group (n=20; 31.8%).

Results. The most common causes of CPH were: idiopathic fibrosis (n=17; 26.9%), and biliary atresia (n=12; 19.1%). High-grade esophageal varices were revealed in 46 (73.1%) children, and 19 (30.1%) children had bleeding episodes. 20 patients underwent endoscopic band ligation. The endoscopic band ligation allowed for the reduction of the varices to grade I in 5 (25.0%) patients, while no significant influence on patients with high-grade varices number was achieved. Endoscopic sclerotherapy was performed in 6 (13.9%) children without a significant effect on the varices grade.

Conclusion. Endoscopic band ligation allowed for the reduction of the varices grade in a small number of patients in the prospective study group. Endoscopic sclerotherapy is useful where a ligation device cannot be transferred through the esophagus, though it did not significantly affect the number of patients with high-grade esophageal varices. In children with CPH screening endoscopy is mandatory, especially for those who are listed for liver transplantation.

The 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 mentioned in the paper. The informed consent of parents (or their guardians) and children was obtained for the study.

The author declares no conflict of interest.

Value of clinical, laboratory, and ultrasonographic data for the diagnostic hypertrophic pyloric stenosis in newborns

A.A. Pereyaslov, B.Y. Malovanyy, O.E. Borova-Halay, O.M. Nykyforuk — Sun, 28 Sep 2025 00:00:00 +0300

Infantile hypertrophic pyloric stenosis (IHPS) characterized by the narrowing of pyloric channel that determined the appearance of nonbilious vomiting and requires the surgery. Non-specific clinical symptoms of the disease in the early neonatal period caused some challenges of the IHPS diagnosis, which determined the necessity of complex evaluation results of clinical, laboratory, and ultrasonographic (USG) data.

Aim - to analysis of correlation of US parameters with clinical and laboratory data at HPSN.

Materials and methods. This study based on the analysis of medical file record of 39 newborns that were operated at 2020-2024 years due to IHPS. Diagnosis established on the base of results of clinical, laboratory, and USG investigation. In this study, all patients were separated on three groups: 1^st - without disorders of electrolytes balance, 2^nd - with mild, and 3^rd - with severe imbalance. Ultrasonographically measured pyloric muscle thickness (PMT), pyloric canal length (PCL), pyloric diameter (PD), pyloric rate (PR) - PMT divided by PD, and pyloric index (PI) - PMT multiplied by PCL. Results of the study were evaluated by the statistical program StatPlus: mac, AnalystSoft Inc. (version v8).

Results. Infants with an existing imbalance had higher values of all USG parameters of the pyloric canal compared to patients without an imbalance, however this difference was significant only for PCL. Analysis of the relationship between the duration of the disease and changes in electrolyte balance and pyloric canal size showed a direct correlation with levels of base excess (BE), pH, PCL, and PI, but chloride and sodium level were inversely correlated. Presence of olive sign associated by the increased all pyloric canal dimensions, however this increase was not statistically significant.

Conclusions. Electrolyte imbalance appeared in patients with hypertrophic pyloric stenosis, by that it may be absent in some of them. Levels of BE, chloride, sodium, pH, and some of pyloric canal indices, such as PCL and PI, in patients with severe imbalance clear correlated with disease duration. Clinical signs of pyloric clear correlate with base excess, indices of PCL and PI, and in case of severe imbalance the clear correlation of all pyloric canal dimensions, except its diameter, were noted.

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 centre of children’s healthcare hospital «OHMATDYT». The informed agreement of parents was obtained for conducting the study.

The authors declare no conflict of interest.

Diagnosis of acute appendicitis in children using anal sphincteromanometry

I.V. Ksonz, D.V. Khmilevskyi, Ie.M. Hrytsenko, V.I. Ksonz, O.O. Kurtash — Sun, 28 Sep 2025 00:00:00 +0300

The problem of acute appendicitis (АА) early diagnosis in children of different age groups remains relevant. According to the updated WSES 2020 Jerusalem guidelines for the diagnosis and treatment of АА in children, there is currently no reliable data to suggest the best diagnostic pathway.

Аim - determine the effectiveness of AA diagnosis in children using anal sphincteromanometry.

Materials and methods. 107 children underwent pressure measurement in the anal canal. Patients undergoing anal sphincteromanometry were divided into 2 groups homogeneous in age and gender. Group I consisted of 52 children who were hospitalised with АА with an Alvarado and PAS scales of 8-10 points (probable АА). Group II consisted of 57 children who were hospitalised with suspected AA and an Alvarado scale of <5 points and a PAS scale of 1-3 points, in whom AA diagnosis was excluded.

Results. In group I children, the resting pressure was 65.87±1.52 mmHg, pressure at palpation of the right hypochondrium 90.2±2.93 mmHg, pressure at determination of the Blumberg’s sign 100.67±4.68 mmHg, pressure during palpation on the left side 90.87±2.69 mmHg. In group II children, the resting pressure was 40.63±1.99 mmHg, and did not change significantly during abdominal palpation. On the 5th day of the postoperative period, the operated children underwent a control determination of anal sphincteromanometry, which demonstrated a significant decrease in anal pressure.

Conclusions. Anal sphincteromanometry, combined with objective examination and other additional examination methods, increases the effectiveness of AA diagnosing in children.

The study was performed in accordance with Helsinki Declaration principles. 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.

Clinical and histological predictors of biliary injury in children with autoimmune liver diseases: development of pediatric biliary indices

M.B. Dyba, V.S. Berezenko, T.D. Zadorozhna — Sun, 28 Sep 2025 00:00:00 +0300

Differentiation between hepatocellular and biliary phenotypes of autoimmune liver diseases (AILD) in children remains challenging due to the lack of validated pediatric scoring systems for biliary injury, which complicates the diagnosis of immune-mediated cholangiopathies.

Aim - to develop pediatric histological and non-invasive biochemical indices to predict the biliary phenotype of AILD in children.

Materials and methods. Children with autoimmune hepatitis (AIH), autoimmune sclerosing cholangitis (ASC), and primary sclerosing cholangitis (PSC) were included. Liver biopsy specimens were evaluated using the Ishak scoring system and the Nakanuma classification. For development of the histological biliary index, 69 children with AILD were analyzed (AIH - n=25; ASC+PSC - n=44). For development of the pediatric non-invasive biliary index, 128 children were included (AIH - n=52; ASC+PSC - n=76). Prediction models were constructed using multivariable logistic regression analysis.

Results. Two multivariable logistic regression models were developed: a non-invasive biochemical model and a histology-based model. The non-invasive pediatric biliary index included sex, alanine aminotransferase (ALT), the gamma-glutamyltransferase to aspartate aminotransferase ratio (GGT/AST), and total cholesterol, and demonstrated good discriminatory performance (AUC=0.84; 95% confidence interval [CI]: 0.77-0.90). The histological biliary index included sex, the GGT/AST ratio, ductopenia, ductular fibrosis, and cholangitis activity, and showed excellent discriminatory performance (AUC=0.95; 95% CI: 0.88-0.99).

Conclusions. The proposed pediatric biliary indices improve diagnostic accuracy for immune-mediated cholangiopathies in children, enable early identification of small bile duct injury, and support more robust stratification of patients according to the biliary phenotype of AILD.

The study was conducted in accordance with the Declaration of Helsinki and approved by the local ethics committee. Written informed consent was obtained from patients or their legal guardians. The authors declare no conflict of interest.

Liver biopsy in the differential diagnosis of cholestatic diseases in infants

H.V. Kurylo, O.V. Shchur, O.Ya. Kovalyk — Sun, 28 Sep 2025 00:00:00 +0300

Liver biopsy (LB) is the most reliable source in the diagnosis of cholestatic liver diseases, the most informative in the prognosis of organ functioning after Kasai operation.

Aim - to establish the terms, conditions, age, and methods of LB in young children with cholestatic liver diseases to determine the differential diagnostic informativeness of histological studies.

Materials and methods. 118 children with jaundice aged 1.5-4.5 months underwent morphological examination of LB to verify the diagnosis.

Results. All LB met the standard (≥10 portal tracts). In 64 (54.2%) children histological examination revealed characteristic signs of biliary atresia (BA): characteristic features - ductal proliferation, fibrosis, inflammation, obliteration. Percutaneous LB at the age of 30 days provides diagnostic accuracy, confirmed by cholangiography and postoperative LB. Primary familial intrahepatic cholestasis (PFIC) is characterized by ductopenia, lobular infiltration, and hepatocyte necrosis. Tactics after 45-60 days of life become more complicated - laparoscopic LB with cholangiography and possible transition to Kasai operation (KO) is recommended if conditions are available.

Conclusions. LB is a key method in the differential diagnosis of neonatal cholestasis, especially when BA is suspected. In 92.1% of our patients, LB verified BA, which is consistent with the literature data. In cases of non-atresic forms of cholestasis, the morphological picture is less specific, so LB should be supplemented with genetic testing. The patient's age has a critical impact on informativeness: up to the 14^th day of life - low diagnostic value, on the 30^th day - the optimal period for performing LB. Conditions for effectiveness: high-quality biopsy (≥10 portal tracts), choice of the correct technique (puncture or laparoscopic), qualified morphological analysis in combination with clinical and laboratory data. These results emphasize the importance of timely and high-quality LB for determining further treatment tactics, including surgical intervention or molecular diagnostics.

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

The authors declare no conflict of interest.

Peculiarities of liver foreign bodies (metal fragments) removal of gunshot origin depending on their location

Sun, 28 Sep 2025 00:00:00 +0300

Aim - to determine the possibility and expediency of removing foreign bodies of the liver (metal fragments) of gunshot origin, located in the VII-VIII segments of the liver, using thoracoscopy and ferromagnetic instruments.

Materials and methods. Wounded patients with gunshot-related foreign bodies (FB) in the liver were randomized into two groups. The main group (82 observations) was formed in the period 2022-2025 and used the proposed methods of FB diagnosis and removal; the comparison group (80 observations) was formed in 2014-2022 and used traditional methods of FB diagnosis and removal. A clinical analysis was conducted using two wounded patients who underwent the removal of foreign bodies (metal fragments) from the liver. To access the VII-VIII segments of the liver, thoracoscopy and diaphragmotomy were used. Identification of fragments was carried out under visual control and intraoperative use of an electron-optical transducer. Removal of metal fragments was carried out with ferromagnetic tools.

Results. Taking into account the peculiarities of the location of metal fragments in the VII-VIII segments of the liver, the absence of bleeding and bilious removal of fragments at the previous stages of medical care, the removal of fragments was not carried out. The use of thoracoscopy, diaphragmotomy, intraoperative visualization, the use of an electron-optical converter, and the removal of fragments with the help of ferromagnetic instruments made it possible to complete the surgical intervention in a minimally invasive way, without complications in the postoperative period.

Conclusion. The use of thoracoscopy with a diaphragmotomy when metal fragments of gunshot origin are located in the VII-VIII segments, with subsequent removal of fragments using magnetic surgical instruments, allows for avoiding laparotomy and completing the surgical intervention in a minimally invasive way.

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.

Assessment of the functional state of the remnant left liver lobe in living related donors

I.O. Kotenko, O.G. Kotenko — Sun, 28 Sep 2025 00:00:00 +0300

Aim - to comprehensively evaluate the functional adaptation and state of the remnant left liver lobe in living related donors following right hemihepatectomy for transplantation by assessing the dynamics of key blood laboratory parameters in the early postoperative period.

Materials and methods. The study included 30 somatically healthy living related liver donors aged 22-52 years who underwent standard right hemihepatectomy for transplantation. The following laboratory parameters were assessed: alanine aminotransferase (ALT), aspartate aminotransferase (AST), total and direct bilirubin, albumin, international normalized ratio (INR), interleukin-6 (IL-6), and C-reactive protein (CRP). Biochemical analyses were performed preoperatively and on days 1, 2, 3, 5, and 7 of the postoperative period, respectively.

Results. In the early postoperative period, a significant but transient increase in transaminases, total and direct bilirubin, IL-6, CRP, and INR levels was recorded, with gradual normalization by days 5-7. The highest increase in AST was observed on the first day after resection (more than an 18-fold increase compared to the preoperative level). Albumin levels decreased until day 3, after which a trend towards normalization was maintained. Peak values of IL-6 and CRP were observed on days 1-2 of the postoperative period; such dynamics correspond to the transient functional load on the remnant liver lobe and the initiation of active parenchymal regeneration processes. No clinical signs of acute liver failure were recorded in the examined patients.

Conclusions. In living liver donors after right hemihepatectomy, a pronounced short-term impairment of the functional state of the remnant left liver lobe is observed, which shows a clear tendency towards spontaneous normalization within the first week. The obtained results can be used to improve clinical monitoring of donors, predict the recovery of liver function, and optimize patient management tactics in the early postoperative period.

The 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 mentioned institution. Informed consent was obtained from the patients.

The authors declare no conflict of interest.

The role of transabdominal ultrasound examination in the diagnosis of acute calculous cholecystitis

P.O. Gerasymchuk, D.B. Fira, N.O. Dobrynska, A.V. Pavlyshyn — Sun, 28 Sep 2025 00:00:00 +0300

In the structure of emergency surgical care, acute calculous cholecystitis takes the second place, ahead of acute appendicitis and second only to acute pancreatitis. And therefore, the search and development of optimal approaches to the diagnosis and surgical treatment of acute calculous cholecystitis continues, with the development and improvement of the relevant recommendations and guidelines.

Aim - to assess the place and role of preoperative ultrasound examination in the diagnosis of acute calculous cholecystitis and predicting the results of early laparoscopic cholecystectomy.

Materials and methods. A retrospective analysis of the treatment of 685 patients with uncomplicated acute calculous cholecystitis during 2021-2024 was conducted. The location of the gallbladder, its size, thickness and condition of the walls, the nature of the contents, the presence of calculi in the gallbladder cavity and their mobility, the condition of the extrahepatic bile ducts, the presence or absence of infiltrates and fluid formations near the gallbladder were assessed. Statistical processing was performed using the statistical software package (SPSS) 20.0 for Windows.

Results. The main method of visualization of acute calculous cholecystitis was ultrasound, which was performed in 100% of patients, which allowed in most cases (93.8%), to diagnose the disease with its sonographic characteristics. Among the ultrasound symptoms that highest predict difficult laparoscopic surgery were: gallstone disease, thickened gallbladder wall, gallbladder neck stone and presence of pericholecystic fluid. They can be used in predicting the need for open surgery, as they are indicators of the fact that laparoscopy can be significantly complicated due to the development of an inflammatory-destructive process.

Conclusions. Ultrasound is a simple, non-invasive, widely available and highly informative method of the first line of visualization of acute calculous cholecystitis, which in 93.8% of cases allows to confirm the diagnosis with a general sensitivity of 93.4% and specificity of 82.3%. The presence of three or more ultrasound symptoms of acute calculous cholecystitis has almost 100% informativeness in its diagnosis.

The 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 mentioned in the paper. Informed consent of patients was obtained for the study.

The authors declare no conflict of interest.

Does the size of the diaphragmatic defect affect the severity of lung hypoplasia and prognosis in congenital diaphragmatic hernia in fetuses and newborns?

O.K. Sliepov, K.L. Znak, G.O. Grebinichenko, O.G. Shadrin — Sun, 28 Sep 2025 00:00:00 +0300

The effect of the size of the diaphragmatic defect on the clinical course of congenital diaphragmatic hernia (CDH) in fetuses and newborns remains insufficiently studied.

Aim - to determine the effect of the size of the diaphragmatic defect on the clinical course of CDH and prognosis in fetuses and newborns.

Materials and methods. Fifty-seven newborns with CDH were examined between 2013 and 2024. The children were divided into two groups according to the size of the diaphragmatic defect: I - small and medium (types A and B) - 38 (66.7%); II - large and total (types C and D) - 19 (33.3%) patients. The degree of lung hypoplasia was assessed using prenatal measurement of the lung-cranial index (LHR), observed/expected lung-cranial index (o/e LHR), and lung-thoracic index (L/T ratio). The presence of hypoplasia of the left heart chambers was diagnosed during the last prenatal ultrasound examination of the fetus before delivery and postnatal echocardiography. The severity of pulmonary hypertension, the presence of right-to-left shunting through open fetal communications, the use of special vasodilators, the duration of preoperative stabilization, and survival were assessed. The area of the diaphragmatic defect was measured intraoperatively.

Results. The average area of the diaphragmatic defect in patients in the group II was significantly larger. In the group II patients, the degree of pulmonary hypoplasia was more pronounced than in the group I. With large and total diaphragmatic defects, pulmonary hypertension was significantly more pronounced than with small and medium defects. No significant difference in the use of special vasodilators was found between the groups. With large and total diaphragmatic defects, there is more frequent pronounced compression of the heart by abdominal organs herniated into the chest cavity, especially parenchymal organs. The average duration of preoperative stabilization of newborns with CDH with large and total diaphragmatic defects is significantly longer. The prognosis for newborns with large and total diaphragmatic defects is worse.

Conclusions. The size of the diaphragmatic defect significantly affects the degree of lung hypoplasia, the severity of pulmonary hypertension, the frequency of hypoplasia of the left heart, the duration of preoperative stabilization, and the survival of newborns, but does not affect the use of special vasodilators. When assessing the prognosis in newborns with CDH and planning their treatment tactics, it is important to take the above factors into account.

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

The authors declare no conflict of interest.

Prenatal diagnosis of sacrococcygeal teratoma: analysis of a case series

G.O. Grebinichenko, O.K. Sliepov, O.V. Perederii, O.M. Tarapurova — Sun, 28 Sep 2025 00:00:00 +0300

Aim - to characterize the data of pregnant women and the results of prenatal examinations in a case series of fetal sacrococcygeal teratoma, to determine typical anatomical variants and associated pathology.

Materials and methods. A retrospective analysis of the medical records of 32 pregnant patients who were diagnosed with sacrococcygeal teratoma in the fetus, and were examined in years 2013-2025. The most typical variants of tumor’s relative size and echo-structure were analyzed, as well as the rate of associated pathology, and the differences depending on the fetal sex and tumor size.

Results. Among 32 cases associated structural pathology was diagnosed in 15 (46.9%) fetuses, and was represented by malformations of other organs/systems, and by secondary local and systemic pathological changes due to teratoma. The mean maternal age was 27.9±6.1 years, the largest group was represented by women 25-29 years old (43.8%), the mean age of women with male fetuses was significantly higher than with female (32.3±6.7 and 26.5±5.5 years). Ultrasound features were highly variable, most often giant teratomas (40.6%) were diagnosed, tumors with solid-cystic and solid structure (43.8%), and type I according to Altman. Typical echo-structure in tumors of different sizes was characterized. Less than half of the patients (43.75%) were referred to the specialized department before 22 weeks of pregnancy, which is unsatisfactory for such a severe pathology.

Conclusions. Sacrococcygeal teratoma is a rare pathology that was most commonly diagnosed in fetuses of young women, was often associated with other malformations or led to secondary local and systemic pathological changes. Prenatally most severe anatomical variants were frequently diagnosed, such as giant teratomas, solid-cystic and solid tumors, which determines the importance of timely/early referral of pregnant women to specialized centers for further evaluation and optimal choice of management.

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

A rare case of treatment of a congenital malformation - a late-detected Bochdalek diaphragmatic hernia, which simulated the clinical picture of chronic coprostasis, in a 12-year-old child

V.P. Soroka, O.V. Trokhymovych — Sun, 28 Sep 2025 00:00:00 +0300

Aim - to analyze and describe the experience of treating a late-detected Bochdalek diaphragmatic hernia, which simulated the clinical picture of chronic coprostasis, in a 12-year-old child.

Clinical case. A rare case of treatment of a congenital malformation - a late-detected Bochdalek diaphragmatic hernia, which simulated the clinical picture of chronic coprostasis, in a 12-year-old child is presented. Congenital diaphragmatic hernia that was not diagnosed in the perinatal period can manifest in childhood or adolescence with nonspecific gastrointestinal symptoms, in particular in the form of chronic coprostasis. In patients with prolonged complaints of constipation, abdominal pain, or periodic bloating that do not respond to standard therapy, it is necessary to exclude not only functional but also organic causes, in particular congenital diaphragmatic anomalies.

Conclusions. The presence of an atypical clinical picture of PDG in older children creates a high risk of diagnostic errors, so clinicians should remain alert to this pathology even in the absence of respiratory symptoms. Imaging methods, especially computed tomography, are crucial for verifying diaphragmatic defects in cases of doubtful or chronic clinical manifestations. Timely surgical intervention in cases of late-detected DDH ensures a positive outcome and prevents the development of potentially fatal complications.

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

The authors declare no conflict of interest.