Aim - to analyze the clinical features and diagnostic outcomes of congenital diaphragmatic hernias (CDH) detected after the neonatal period and to develop a diagnostic algorithm for them. Materials and methods. A retrospective review of medical records was conducted for 27 children aged 1.5 months to 13 years with late-diagnosed CDH who were treated at the Department of Pediatric Surgery.The study analyzed the patients’ age and sex, the type and location of the hernia, clinical manifestations, associated congenital anomalies, and the results of diagnostic and therapeutic procedures. For diagnosis, X-ray, ultrasound, and endoscopic methods were used, as well as computed tomography and magnetic resonance imaging when indicated. Statistical analysis of the results was performed using descriptive statistics. Results. Late-diagnosed CDH were identified in 27 (15.9%) of 170 children with CDH, specifically Bochdalek’s hernia in 21 (77.8%) patients and Morgagni’s hernia in 6 (22.2%). Clinical manifestations were varied and nonspecific, with respiratory and gastrointestinal symptoms — or a combination thereof — predominating. The primary diagnostic method was plain radiography of the chest and abdomen in two projections. When X-rays were insufficiently informative, contrast-enhanced X-ray studies, ultrasound, computed tomography, or magnetic resonance imaging were used. Based on the results obtained, a diagnostic algorithm for late-detected CDH was developed. Conclusions. Late-diagnosed CDH are characterized by a polymorphic clinical picture, which often leads to a delay in diagnosis. The primary diagnostic method is a chest and abdominal X-ray in two projections, while additional imaging methods are used as indicated to confirm the diagnosis and plan surgical intervention. The proposed diagnostic algorithm makes it possible to optimize the evaluation of children with suspected CDH, shorten the time to diagnosis, and timely determine the indications for surgical treatment. The study was conducted in accordance with the principles of the Declaration of Helsinki. Informed consent was obtained from the parents or legal guardians of the children participating in the study. The authors declare no conflict of interest.
Wilms’ tumor is the most common malignant renal tumor in children and remains a significant challenge in pediatric oncologic surgery despite high survival rates. The lack of standardized noninvasive methods for the quantitative assessment of imaging data limits the accurate prediction of disease course, risk of recurrence, and bilateral renal involvement. Aim - to analyze current scientific evidence on the application of radiomics in pediatric Wilms’ tumor and to evaluate its diagnostic and prognostic potential for clinical practice. Radiomics is based on the extraction of quantitative textural, morphological, and intensity features from computed tomography images, enabling an objective assessment of tumor heterogeneity. Recent studies demonstrate high effectiveness of radiomics in the differential diagnosis of Wilms’ tumor and other pediatric renal tumors, as well as in predicting treatment response, recurrence risk, and survival outcomes. Conclusions. The integration of radiomic markers with clinical, radiological, and pathomorphological data facilitates the implementation of a personalized treatment approach, contributing to the optimization of surgical tactics and the improvement of long-term outcomes in children with nephroblastoma. The authors declare no conflict of interest.
Ingestion of foreign inedible bodies is a common cause of visits to emergency departments in children, 75% of whom are children under 4 years of age. About 98% of foreign body ingestions are accidental. Aim - to analyze current literature data and our own clinical observations on foreign objects in the stomach and intestines in children in order to improve diagnostics and choose the optimal treatment tactics. In the clinical departments over 20 years, 57 patients aged from 1.5 to 17 were treated. Bezoars of the stomach and intestines in 12 (21.05%), of which trichobezoars in 7 (12.28%) and phytobezoars in 5 (8.77%), and were treated surgically. Intestinal magnets in 4 (7.02%), of which single ones in 2 (3.51%) came out naturally, and 2 (3.51%) were operated on. Batteries of the stomach and intestines in 8 (14.04%), of which 3 (5.27%) were removed endoscopically, and 5 (8.77%) came out naturally. Sewing needles in 9 (15.79%) and glass fragments in 4 (7.02%) came out naturally. A rectal balloon (lacquer) in 1 (1.75%) male patient was removed during an anaesthetic examination. Stomach and intestinal coins in 11 (19.30%), of which 1 (1.75%) was removed endoscopically, and 10 (17.54%) passed naturally. Toy fragments in 7 (12.28%) passed naturally. Rubber, glass, straw and cellophane fragments in the intestine in 1 (1.75%) patient were removed surgically against the background of intellectual impairment. Conclusions. Our own studies showed that in 64.92% of children, foreign bodies in the gastrointestinal tract were evacuated naturally, while in 35.08% of cases, endoscopic or surgical removal was required. The presence of a history of complaints of swallowing foreign objects, regardless of the manifestations, requires a survey radiography of the chest and abdomen. Foreign objects of the button battery are subject to urgent removal. Two or more magnets that were swallowed not simultaneously are subject to removal without waiting for perforation and peritonitis. The study was conducted in accordance with the principles of the Declaration of Helsinki. Informed consent was obtained from the children's parents. The authors declare that there is no conflict of interest.
Inguinal hernias are the most common anterior abdominal wall hernias, and postoperative pain remains a major factor affecting recovery and quality of life. Mechanical mesh fixation contributes to pain-related morbidity. Anatomical three-dimensional (3D) meshes used during laparoscopic transabdominal preperitoneal hernioplasty (TAPP) without additional fixation may reduce tissue trauma without increasing recurrence rates. Aim - to evaluate the clinical effectiveness and safety of non-fixation TAPP hernioplasty compared with the fixation technique. Materials and methods. A single-center comparative study included 156 patients: the control group (CG, n=87) underwent TAPP with mesh fixation (tackers or sutures); the study group (SG, n=69) underwent TAPP with non-fixation implantation of an anatomical 3D mesh. Pain was assessed using a visual analogue scale (VAS). Recurrence, chronic pain lasting >3 months, operative time, length of hospital stay, early complications, and quality of life according to the Short Form-36 questionnaire (SF-36; 0-100 points) were analyzed. Results. In the SG, operative time was reduced by 9.8% (61.5±9.3 vs 68.2±11.4 min; p<0.001), and hospital stay was shortened by 30.8% (1.8±0.5 vs 2.6±0.9 days; p<0.001). VAS pain scores were lower by 42.9% on day 1 and by 48.4% on day 3 (p<0.001). Opioid requirements decreased by 64.8% (10.1% vs 28.7%; p=0.006). No recurrences were detected in the SG (0% vs 2.3%), and the incidence of chronic pain decreased by 87.8% (1.4% vs 11.5%; p=0.02). SF-36 scores for physical functioning, role physical functioning, bodily pain, and social functioning were higher in the SG (p≤0.01). Conclusions. Non-fixation TAPP using anatomical 3D meshes is effective and safe: it provides 100% recurrence-free outcomes, reduces chronic pain by 87.8%, opioid use by 64.8%, and hospital stay by 30.8%. 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 aforementioned institution. Informed consent was obtained from the patients for the study. The authors declare no conflict of interest.
Aim - to assess the knowledge, attitudes, and practices of healthcare professionals and patients regarding the implementation of a care bundle for the prevention of surgical site infections (SSI), including the use of pre-operative chlorhexidine bathing. Materials and methods. Between July and August 2025, a knowledge, attitudes, and practices (KAP) study was conducted among 76 healthcare workers and 161 patients. Aim-specific questionnaires were developed for both groups. Results. Overall, the intervention was perceived positively. Among healthcare workers, 96.1% believed that the practice either facilitated pre-operative preparation or did not increase workload. Only one patient (0.6%) reported skin dryness or irritation associated with the use of 4% chlorhexidine soap. Additionally, 92.1% of healthcare workers and 89.4% of patients believed that pre-operative bathing could improve surgery outcomes. However, 35.6% of healthcare workers assumed that patients were not interested in learning about the evidence supporting the procedure. Conclusions. The positive perception of pre-operative bathing with 4% chlorhexidine supports scaling up of the intervention and continued institutional support. Monitoring SSI incidence rates and using surveillance data may help improve adherence among healthcare personnel and patients to the recommended bathing protocol. The demand for 4% chlorhexidine soap in Ukraine, with the wider implementation of enhanced bathing practices, may encourage domestic manufacturers to produce such soap for use in healthcare facilities. The authors declare no conflict of interest.
5q-spinal muscular atrophy (5q-SMA) is a genetically determined neuromuscular disorder characterized by progressive muscle weakness and the development of secondary orthopedic complications. Despite the rapid expansion of disease-modifying therapies, the structure and prevalence of orthopedic manifestations across different clinical types of SMA remain insufficiently systematized. Aim - to analyze the characteristics of orthopedic pathology in patients with 5q-SMA types I-III and to evaluate its distribution according to functional motor status. Materials and methods. A retrospective multicenter observational study was conducted at two tertiary referral centers between 2015 and 2025. Patients with genetically confirmed 5q-SMA were included. The presence of scoliosis, chest wall deformities, joint contractures, foot deformities, and hip dislocation was assessed. Motor function was evaluated using age- and phenotype-appropriate scales. Statistical analysis was performed using appropriate parametric and non-parametric methods; statistical significance was set at p<0.05. Results. Orthopedic pathology was identified in the majority of patients regardless of SMA type. The prevalence of scoliosis, lower limb contractures, and foot deformities differed significantly between clinical types. Scoliosis and contractures were most frequently observed in patients with SMA type II, while foot deformities were more common in types II and III. No statistically significant difference in the prevalence of hip dislocation across SMA types was found. Functional motor status was associated with differences in the structure and distribution of specific orthopedic manifestations. Conclusions. The pattern of orthopedic involvement in 5q-SMA is associated with both the clinical phenotype and preserved motor function. These findings support the need for individualized orthopedic surveillance strategies in children with SMA, taking into account their functional motor status. The study was conducted in accordance with the principles of the Declaration of Helsinki. Informed consent was obtained from the children's parents. The authors declare no conflicts of interest.
The distribution, morphological features, clinical presentation, diagnosis and treatment of a rare pathology in children - diffuse large B-cell lymphoma (DLBCL) of the appendix, which is a type of non-Hodgkin lymphoma of the appendix (NHL), are analyzed. NHL is a very rare neoplasm and accounts for about 0.015% of all lymphomas of the digestive tract. Only isolated cases of NHL in children have been described in the literature. Aim - to study the prevalence, clinical features, diagnosis and treatment of DLBCL in children based on literature data and clinical observation. A clinical case of this tumor in a 17-year-old adolescent is presented. The boy was admitted to the surgical department of the Ivano-Frankivsk Regional Children's Clinical Hospital in a moderately severe condition with complaints of abdominal pain, vomiting, fever up to 38°C and weakness. The onset of symptoms occurred 8 hours prior to admission. An objective examination revealed symptoms of acute appendicitis. An ultrasound examination of the abdominal organs revealed an increase in size and infiltration of the appendix. During the operation, an appendix with a tumor-like formation at the apex and enlarged mesenteric lymph nodes were found. A dense, immobile volumetric formation was also found in the retroperitoneal space on both sides of the spine. An appendectomy was performed en bloc with the tumor. One of the most altered lymph nodes and a fragment of the greater omentum were taken for biopsy. After the operation, a computed tomography scan of the abdominal cavity was performed. In the abdominal cavity, closer to the aortic bifurcation, a volumetric formation measuring 27×27×49 mm with a heterogeneous structure, was found. A spherical shadow measuring 26×33×24 mm was found caudal to the mass. Histological and immunohistochemical examination of the appendix and lymph node revealed characteristic changes of DLBCL. The postoperative course was without complications. The wound healed by primary tension. For further specialized treatment, the child was referred to the oncology center at their place of residence. Conclusion. As evidenced by the presented clinical case, DLBCL of the appendix does not have specific clinical manifestations, manifesting itself with symptoms of acute appendicitis, the diagnosis is made on the basis of histopathological examination, and the disease may simultaneously affect other organs or lymph nodes. The study was performed in accordance with the principles of the Declaration of Helsinki. Informed consent of the patient and his parents was obtained for the research. The authors declare no conflict of interest.
The main stages of formation and ossification of the human upper limb bones during the embryonic and early fetal periods have been determined. The temporal framework and morphological changes significant for the diagnosis of normal and pathological fetal development have been outlined. Aim - to identify the specific features of the formation and development of the bones of the upper limb during the embryonic and pre-fetal periods of human ontogenesis in order to assess osteogenesis under normal conditions and to diagnose forms of ossification anomalies and skeletal dysplasias. Materials and methods. The study was based on serial histological sections of 17 human embryos and early fetuses aged 4-12 weeks (parieto-coccygeal length: 5.0-79.0 mm). Microscopy and three-dimensional reconstruction were used to analyze morphological features of upper limb bone development. Results. The morphogenesis of human upper limb bones was examined during the embryonic (4-6 weeks) and early fetal (7-12 weeks) periods. The stages of appearance and remodeling of cartilaginous and osseous primordia, along with changes in their shape and topography, were identified. The onset of ossification and the growth patterns of the diaphyses and epiphyses of the humerus, ulna, and radius were determined. Conclusions. The formation of the upper limb bones follows a well-defined sequence, beginning with the development of cartilaginous models, followed by gradual differentiation and ossification. Primary ossification centers appear in the diaphyses at 8-9 weeks, coinciding with intensive limb growth. The identified developmental patterns may be applied in medico-biological expertise and for refining the normal parameters of prenatal development. No conflict of interest was declared by authors.
In the public health system, the quality of medical care is defined as a set of characteristics that reflect how well healthcare services meet the needs of both adult and paediatric populations and comply with current standards. To objectively evaluate the effectiveness of care provided to children in a surgical department, a quality control system is implemented. Its purpose is to ensure an unbiased assessment and improvement of the effectiveness of diagnostic and treatment services for children. Aim - to provide an overview for the medical staff of the paediatric surgical department regarding the procedure for quality control of medical care for children, the methods of its assessment, and the outcomes, with the aim of improving treatment effectiveness and the professional level of the medical personnel. The assessment and control of the quality of surgical care for children is carried out through the application of methods of external and internal quality control of medical care, self-assessment by healthcare workers, clinical audit, and monitoring of quality indicators. External quality control of medical care is carried out by state executive authorities within the framework of their powers established by legislation (accreditation/certification). The system of internal quality control of medical care includes three levels: 1) head of the department, senior nurse of the department; 2) deputy head of the healthcare facility responsible for the relevant area; 3) medical council on internal quality control of medical care. Quality assessment is carried out using a system of qualitative and quantitative metrics known as quality indicators. High-quality medical care for a child is achieved when the resources of the surgical department and the healthcare facility as a whole are organised to ensure maximum effectiveness and safety, fully addressing the child’s medical needs and providing prevention and treatment in accordance with the highest standards. Conclusion. The medical staff of the pediatric surgical department are obligated to provide high quality medical care to children, as quality care protects what is most important - the children’s health, and ensures the reputation of the hospital and increase competitiveness. The author declares no conflict of interest.
Testicular torsion is generally a rare condition; however, its risk is significantly increased in patients with cryptorchidism. Testicular torsion occurs approximately 10 times more frequently in patients with cryptorchidism compared to those with descended testes. Aim - to evaluate and compare the long-term morphofunctional status of the testes and fertility parameters in young men who underwent either elective orchiopexy in childhood or orchiopexy complicated by torsion of the undescended testis. Materials and methods. Data from 37 men (aged 18-25) with a history of unilateral inguinal cryptorchidism were analyzed. Group I consisted of 28 patients after elective orchiopexy, and Group II included 9 individuals whose condition was complicated by testicular torsion. Intratesticular blood flow (Doppler ultrasound) and ejaculate parameters were evaluated. Results. In young men, worse blood flow parameters were recorded after the treatment of torsion (Group II) than after elective surgery. Specifically, a significant increase in the resistance index in intratesticular arteries was diagnosed in both groups compared to healthy controls: 0.72 (0.66; 0.75), and 0.76 (0.62; 0.79), versus 0.67 (0.59; 0.7). The criteria for effective treatment of testicular diseases are their adequate functional capacity - fertility and hormonal function. A particular impairment in patients with torsion of an undescended testis was noted in the percentage of spermatozoa with normal morphology - 5.05% (3.15; 8.2) and 30.1% (15.1; 58.9). The orchiopexy only group had a statistically significantly better result, although it also did not reach the normal range - 27.2% (17.3; 45.5). Conclusions. It is necessary to prioritize early diagnosis of testicular torsion in cryptorchidism and implement immediate surgical intervention to prevent irreversible parenchymal damage. Even timely surgical treatment for torsion of an undescended testis significantly worsens the morphofunctional characteristics of the testicles in this congenital condition. Early orchiopexy in patients with cryptorchidism minimizes the risk of torsion. Given the severe complications arising from testicular torsion, it is advisable to perform prophylactic fixation of the contralateral testis as a planned procedure for patients with a history of this pathology. 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 institution mentioned in the work. The authors declare no conflict of interest.
One of the features of the war in Ukraine is attacks on the civilian infrastructure with a large number of casualties, including children. Aim - to assess the effectiveness of specialized medical care provided to wounded children in a multidisciplinary hospital within a combat zone and to determine the role of negative pressure wound therapy in the comprehensive treatment of war injuries. Materials and methods. A retrospective review was conducted on twelve consecutive children with war-related trauma admitted between February 25 and April 1, 2022. Patient demographics, mechanism of injury, anatomic location, mode of transportation, triage category, vital signs, diagnostic and treatment procedures performed, clinical outcome, and length of hospital stay were analyzed. Results. The patients’ age ranged from 3 month to 15 years. The mechanisms of injury were mine explosion injuries (50.0%) and bullet or shrapnel wounds from the shelling of the vehicle during the evacuation (50.0%). The majority of the patients sustained extremity injuries (66.7%), and had lesions in more than one anatomical region (50.0%). Four patients were triaged into the red zone, seven to the yellow zone, and one to the black zone. In the yellow zone, in addition to the physical examination, investigations included the Focused Assessment with Sonography for Trauma (FAST) protocol (75.0%), computed tomography of the head and neck (25.0%), and clinical blood tests. The main feature of the fire wounds was a large area of soft tissue defect (58.3%), necessitating Negative Pressure Wound Therapy with various regimens. The treatment outcomes included discharge with recovery in 4 (33.3%) patients, evacuation to a safe place for further treatment in 6 (50.0%) patients, and 2 (16.7%) patients died. Conclusions. The multidisciplinary children hospital in the combat zone can provide effective specialized care for injured children by adhering to the principles of triage and zoning. Utilizing negative pressure wound therapy following radical debridement and copious irrigation provides optimal healing conditions and prevents infectious complications. The authors declare that there is no conflict of interest.
Early recovery of urinary continence (UC) remains one of the major functional challenges after radical prostatectomy (RP). Posterior support of the vesicourethral anastomosis has been proposed to improve early continence outcomes. However, its effectiveness in extraperitoneoscopic RP (ERP), particularly in patients with excess body weight, remains insufficiently defined. Aim - to evaluate the impact of a modified posterior support technique of the vesicourethral anastomosis (PS-VUA) on UC recovery after ERP, stratified by waist circumference (WC). Materials and methods. This prospective study included 106 patients with non-metastatic prostate cancer (PCa) who underwent ERP. Patients were divided into two groups according to the use of PS-VUA: PS-0 (no posterior support, n=53) and PS-1 (posterior support performed, n=53). A predefined subgroup analysis was conducted according to WC: <102 cm (WC-0) and ≥102 cm (WC-1). UC was evaluated over a 12-month follow-up period after surgery. Results. The PS-1 group demonstrated significantly higher UC rates at 1, 3, and 6 months postoperatively compared with the PS-0 group. Among patients with WC-1, the PS-VUA was associated with significantly improved UC rates at 1, 3, 6, and 9 months. In contrast, no significant differences were observed in patients with WC-0. Conclusions. PS-VUA accelerates early UC recovery after ERP, particularly in patients with WC-1. 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 institution mentioned in the work. The authors declare no conflict of interest.
The Plastibell® device is the most commonly used technique for routine male circumcision all over the globe. Aim - to assess the Plastibell® device utilization safety for circumcision procedures in Iraq, its applicability across different age groups, and the incidence of associated complications. Materials and methods. This is a retrospective study involving children who underwent circumcision using Plastibell® devices at the pediatric surgery clinic in Al Moosawi Private Hospital. The study was extended for 11 years and included 2041 boys. Three age groups were studied: neonates, infants 1-3 months old, and those older than three months. Results. In the cohort of 2041 children, the mean age was 38.65 days (range 1 day to 3.5 years). The majority of participants were neonates (72.7%), followed by infants aged 1-3 months (19.5%) and older infants (> 3 months, 7.8%). Most cases originated from Basrah city center (56.1%), followed by peripheral districts (43.2%) and other governorates (0.7%). Complications were encountered in 3.6% of cases, with bleeding being the most prevalent (1.4%), followed by delayed ring separation (1.1%), incomplete circumcision (0.7%), proximal ring migration (0.2%), and infection (0.2%). A significant association between age and complication rates was found, with older infants experiencing higher rates of complications compared to neonates and infants aged 1-3 months. Six patients (0.29%) were reported to have incomplete circumcision. Conclusion. This study underscores the safety of circumcision using Plastibell® rings in children, with minor complications being easily manageable. However, clinicians should be vigilant, particularly when performing the procedure in older infants, as they are at higher risk of experiencing complications. 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 institution mentioned in the work. The author declares no conflict of interest.
Estimated glomerular filtration rate (еGFR) plays a crucial role in management of pediatric patients; however, there is still a paucity of data regarding benefits of tailored use of eGFR equations in different subgroups of pediatric patients. Aim - to compare the eGFR of children using creatinine and cystatin C based equations, to evaluate clinical accuracy in diagnosing and staging pediatric chronic kidney disease (CKD). Materials and methods. The retrospective controlled study of 33 pediatric patients aged from 2 to 18 years was carried out over the period from 2023 to 2025. All patients underwent comprehensive clinical examination and work up to evaluate eGFR. Results. CKD in children under 25 equation (CKiD U25) creatinine or cystatin has shown moderate-to-strong positive correlation with CKiD U25 cystatin C-creatinine (rs=0.6791; rs=0.9334). Patients whose eGFR was estimated using CKiD U25 creatinine have 3,6 times the odds of being misdiagnosed than those estimated with CKiD U25 cystatin C. The proportion of females misdiagnosed with CKiD creatinine was significantly higher in comparison to CKiD cystatin C (37.5% (6/16); 6.2% (1/16), respectively, p=0.0322). Conclusions. The tailored approach of eGFR measurement should be utilized in pediatric practice using available validated eGFR equations. Female pediatric patients may significantly benefit from evaluating eGFR based on cystatin C or creatinine/cystatine C (Cre/Cys) combined equations. Utilizing the same CKiD U25 equation during the follow-up of pediatric patients in low-resource settings may prevent bias in CKD staging in the long-term management of pediatric patients with CKD. The research was carried out in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the Local Ethics Committee of participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors.
The lack of clear algorithms for a differentiated approach to diaphragmatic defect repair leads to variability in surgical decision-making and complicates the comparison of treatment outcomes across pediatric surgery centers. Aim – to develop a differentiated approach to selecting repair techniques for diaphragmatic defects of different sizes in neonates with congenital diaphragmatic hernia (CDH). Materials and methods. A retrospective analysis of medical records of 61 neonates with CDH treated in 2013-2025 was performed. According to defect size, patients were divided into two groups: Group I – 40 (65.6%) children with small and moderate defects (types A and B), and Group II – 21 (34.4%) patients with large and total defects (types C and D). Anatomical features of defects, surgical repair methods, postoperative survival, and recurrence rates were analyzed. Results. The mean defect area was 10.82±2.87 cm² in Group I and 24.21±4.52 cm² in Group II. Posterolateral localization predominated in Group I (78.9%), whereas posteromedial defects were more frequent in Group II (30.0%). Primary repair using native diaphragmatic tissue was performed in all patients of Group I and in 52.3% of Group II. The remaining neonates with large defects underwent combined repair using a flap from the anterior abdominal wall (AAW) muscles. In three cases of diaphragmatic aplasia, complete reconstruction was achieved using an autologous AAW muscle graft. Postoperative survival was 97.5% in Group I and 76.2% in Group II. No hernia recurrence was observed among surviving patients. Conclusions. Primary repair using native tissue is the method of choice for small and moderate diaphragmatic defects. In large and total defects, reconstruction using AAW muscle flaps provides effective outcomes with no recurrence. A differentiated approach to surgical repair based on defect size improves outcomes of CDH treatment in neonates. The study was conducted in accordance with the Declaration of Helsinki. Informed consent was obtained from the patients’ legal representatives. The authors declare no conflict of interest.
Aim - to analyze information on modern surgical methods for the treatment of benign obstructions of the distal bile ducts leading to mechanical jaundice. The analysis of the literature allows us to conclude that such methods as endoscopic ultrasound drainage of the bile ducts, magnetic compression anastomosis and robotic surgery turned out to be promising in the surgical treatment of benign obstructions of the distal choledochus in patients with mechanical jaundice, especially when traditional approaches are complex or ineffective. They are less traumatic, more accurate and make it possible to perform more complex surgical interventions than traditional surgery. However, further large-scale studies with long-term follow-up are needed to definitively determine the place of these new methods in clinical practice. It is important to carefully assess the effectiveness and safety of each method, determine the optimal criteria for selecting patients and compare them with traditional approaches. Further advances in technology such as improved stents, magnet delivery systems, and artificial intelligence integration will also play an important role in improving the surgical treatment of benign distal bile duct obstructions and improving patient outcomes. Further research and collaboration between specialists are key to optimizing treatment strategies and improving the quality of life of patients with this complex pathology. The authors declare no conflict of interest.
Air guns, often mistakenly considered harmless, are capable of causing severe penetrating injuries in children, including damage to the lungs, pericardium, and heart. The increasing incidence of such injuries makes this issue highly relevant to pediatric surgery and traumatology. Aim - to summarize current data on the clinical presentation, diagnostics, complications, and treatment of pediatric gunshot chest injuries based on a literature review and a clinical case observation. Scientific publications (PubMed, Scopus, Google Scholar, Medline, 2018-2025) were analyzed, and a clinical case of a 10-year-old patient with an air gun chest injury complicated by hemopericardium and cardiac tamponade is presented. The most common causes of these injuries are accidental shootings during play, careless handling of weapons, and their accessibility to children. Clinical manifestations range from localized pain to severe respiratory and hemodynamic disturbances. Patient management should follow ATLS (Advanced Trauma Life Support): principles: airway protection, hemodynamic stabilization, and early diagnosis (extended focused assessment with sonography for trauma (eFAST), X-ray, computed tomography). In the reported case, an emergency sternotomy, pericardial drainage, and repair of the damaged structures under cardiopulmonary bypass were performed. The postoperative course was favorable. Conclusions. Air guns pose a potential threat to children’s lives due to the possibility of deep penetrating injuries. Rapid diagnosis, adherence to ATLS protocols, and timely surgical intervention determine the prognosis. The highest risk of fatal outcomes is observed in cases of cardiac or major vessel injury. Most children recover without long-term consequences when treated early. Prevention should include strict weapon storage control, increased parental awareness, and legislative restrictions on minors’ access to weapons. The study was conducted in accordance with the principles of the Declaration of Helsinki. Informed consent was obtained from the patients for the study. The authors declare no conflict of interest.
Fluorescent navigation using indocyanine green (ICG) is a modern technology that allows improving intraoperative visualization and increasing the safety of laparoscopic interventions. In pediatric surgery, the experience of its use remains limited. Aim - to assess the effectiveness and safety of ICG use in laparoscopic, robotic surgical interventions in children compared with traditional laparoscopy. Materials and methods. A prospective study was conducted on 43 children who underwent laparoscopic interventions using ICG (2023-2025). The control group consisted of 45 children operated on without the use of ICG (2020-2025). The duration of the operation, blood loss, complications, and length of hospitalization were assessed. Results. The use of ICG provided better visualization of anatomical structures. In the ICG group, a decrease in blood loss, the frequency of complications, and the length of hospitalization were noted. Conclusions. ICG visualization enables more precise identification of tumor boundaries and other critical structures, reducing the risk of recurrence and complications, and helping to avoid unnecessary tissue removal and damage to healthy structures. ICG laparoscopy, as a minimally invasive surgical technique, allows for procedures with minimal intervention, thereby shortening the recovery period. The lack of standardization in the use of ICG technology in pediatric minimally invasive surgery calls for further analysis and data collection, including in pediatric robotic surgery. The use of ICG in miniinvasive surgery in children is a promising method that can improve treatment outcomes. 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 aforementioned institution. Informed consent was obtained from the patients for the study. The authors declare no conflict of interest.
The study of the embryogenesis of the diaphragm and lungs in normal conditions and in congenital diaphragmatic hernia (CDH) is of great importance for understanding the pathogenesis of this disease and improving the treatment of neonates with this critical developmental defect. Aim - to analyze the features of diaphragm and lung embryogenesis in normal conditions and in CDH, as well as the mechanisms of pulmonary hypertension development in newborns. The main stages of diaphragm formation were reviewed, including the development of the transverse septum, pleuroperitoneal folds, migration of myogenic precursor cells, and formation of the phrenic nerve. Abnormal embryogenesis leading to different types of CDH was analyzed, with particular attention to the role of genetic factors, defects in pleuroperitoneal folds, the transverse septum, and impaired myoblast migration. Normal lung development from the embryonic stage to alveolarization was described, along with the molecular mechanisms regulating this process. Special attention was given to CDH pathophysiology, particularly pulmonary hypoplasia, impaired alveolarization, and reduced gas exchange surface area. Mechanisms of pulmonary hypertension were analyzed, including pulmonary vascular remodeling, impaired vasoreactivity, and underdevelopment of the pulmonary vascular bed. Data from experimental animal models and clinical observations were summarized to explain the relationship between diaphragmatic defect, lung hypoplasia, and pulmonary hypertension. Conclusions. The study of diaphragm embryogenesis allows a better understanding of the mechanisms underlying CDH formation. Despite the identification of numerous genes associated with diaphragmatic defects, the pathogenesis of CDH remains incompletely understood. The relationship between impaired lung development and diaphragmatic defects requires further investigation. Understanding the mechanisms of pulmonary hypoplasia and pulmonary hypertension is crucial for developing new therapeutic approaches and improving outcomes in neonates with CDH. Author declares no conflict of interest.
Aim - to determine morphometrically and anatomically justified sites for laparoscopic port placement in pubertal girls by means of geometric modeling of the anterior abdominal wall regions and the construction of a numerical model based on the obtained anthropometric data. Materials and methods. A morphometric study was conducted in 112 girls aged 10-17 years without pathology of the musculoskeletal system, using mathematical modeling. Based on anatomical landmarks - the xiphoid process, umbilicus, iliac spines, and pubic symphysis - a triangular model of the anterior abdominal wall was constructed. Results. A significant increase in the area of the anterior abdominal wall was established in the older pubertal group, while symmetry between the right and left halves was preserved. The optimal placement of laparoscopic ports corresponded to the coordinates of the triangle centroids (y=9,73±0.05 cm). Conclusions. Geometric modeling allows standardization of port placement on the anterior abdominal wall in pubertal girls and may reduce the invasiveness of surgical intervention. 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 indicated institution. Informed consent was obtained from the patients for participation in the study. The authors declare no conflict of interest.
