Russian Journal of Pediatric Surgery

BACKGROUND: The article describes the authors’ experience in providing a specialized surgical care to 247 children-victims with open soft tissue and bone injuries resulting of earthquakes in Pakistan (2005), Indonesia (2006 and 2009), Haiti (2010), Nepal (2015), and Myanmar (2025). The paper presents principles for formation, deployment and operation of a mobile specialized pediatric team from the Clinical & Research Institute of Emergency Pediatric Surgery and Trauma—Dr. Roshal's Clinic (Moscow, Russia) in disaster-affected regions. It describes the process of establishing specialized pediatric surgical centers at undamaged healthcare facilities and concentrating the most severe cases there. The study identifies errors made during the primary and specialized care provision before the arrival of the mobile pediatric team. The effectiveness of curative techniques for open soft tissue and bone injuries with complicated wound healing processes has been analyzed.

AIM: To improve strategies and tactics for surgical treatment of children during mass casualty events after earthquakes.

METHODS: A prospective non-randomized clinical study was conducted, analyzing diagnostic results and comprehensive surgical treatment outcomes in 247 pediatric patients with open injuries sustained during earthquakes across various countries.

RESULTS: All clinical cases have demonstrated favorable treatment outcomes, including stable fixation of bone fragments, restoration of normal limb length, and complete fracture consolidation.

CONCLUSION: This trial summarizes the authors’ experience on providing specialized surgical care to children in earthquake-affected zones, with a particular focus on medical evacuation organization and adaptation of treatment protocols to disaster situations. The developed strategy for specialized surgical care and comprehensive approach to managing open soft tissue and bone injuries yielded significant clinical results. Early reconstructive and plastic surgical interventions ensured anatomical integrity restoration and functional recovery in all pediatric patients, providing satisfactory rehabilitation potential for their future life.

BACKGROUND: Over its long history, Hirschsprung’s disease surgery has undergone significant changes: traumatic trait of the applied techniques decreased due to the introduction of laparoscopy, surgical stages at the perineum and pelvis became less aggressive due to the rational use of various electrosurgical equipment, the desire to eliminate the disease in one-stage intervention arose. However, for a number of objective reasons, in some situations, disease treating requires step-by-step correction through preliminary ostoma surgery and a series of subsequent surgical interventions.

AIM: To analyze the effectiveness of preventive stomas in various parts of the intestinal tube in patients with an established diagnosis of congenital colon agangliosis.

METHODS: A single-center retrospective study of 111 medical records of children with Hirschsprung’s disease treated in the department of neonatal surgery and surgical department No 1 of the City Ivano-Matreninsk Children’s Clinical Hospital in Irkutsk was conducted from 2001 (January) to 2024 (December).

RESULTS: Of the observed series, 79/111 (71.2%) cases of stage-by-stage treatment of degenerated agangliosis using preliminary stomatology were analyzed, 32 patients were excluded from the analysis due to simultaneous surgical correction of the defect. In 44,3% (n=35), the formation of stom at the place of the child’s primary treatment. Indications for stomy: age―69 (87.3%), the extent of agangliosis―19 (24.1%), decompensated form―18 (22.8%), repeated interventions―55 (69.6%), inability to treat and prepare enemas―9 (11.4%), Hirschsprung-associated enterocolitis―16 (20.3%). Distribution in relation to intestinal segments: ileostomy―55 (69.6%), colostomy above the level of agangliosis―20 (25.3%), sigmostomy to the transit zone―4 (5.1%). According to the method of formation: double―68 (86.1%), terminal―7 (8.9%), T-shaped (Bishop-Koop)―4 (5.1%). The age of children at the time of stomy is from 2 days to 14 years old. The closure was carried out as an independent final stage after reconstruction in 96.2% of cases.

CONCLUSION: The analyzed results have demonstrated that intestinal stomas in the treatment of colon agangliosis is a forced and preventive measure. Indications for stoma formation are most often the following: defect shape, initial somatic background, severity of chronic fecal intoxication equivalents, repeated surgical interventions, concomitant pathology, inability to prepare the intestine for reconstructive interventions by conservative methods.

BACKGROUND: A large number of surgical techniques have been proposed for treating pilonidal cysts, but a gold standard has not yet been selected. However, minimally invasive methods, in particular laser ones, are gaining popularity. The purpose of the study is to evaluate the effectiveness of treating pilonidal cysts using laser thermal destruction.

AIM: To evaluate the efficiency of treating pilonidal cysts with laser thermal destruction.

METHODS: A comparative non-randomized trial included 190 children with pilonidal cysts without abscessing who underwent surgical treatment in 2019–2024. 70 participants from the prospective part of the trail (studied group) had laser thermal destruction of their pilonidal cysts and fistulous openings under local anesthesia at outpatient settings. 120 participants in the retrospective part were divided into two comparison groups: in patients from Group 1 (n=50), pilonidal cysts and fistulous openings were excised, postoperative wounds were sutured tightly along the intergluteal cleft; in Group 2 (n=70), minimally invasive treatment (destruction) of the pilonidal cyst and fistulous openings without wound suturing was done. Evaluation criteria were: age, body mass index, gender, cyst size by ultrasound examination, surgery duration; length of hospital stay, antibacterial therapy and wound healing, as well as pain severity after surgery by the visual analog scale (VAS) and frequency of complications and relapses.

RESULTS: There were no statistically significant differences in gender, age, body mass index, surgery duration, and postoperative complications. Patients in the studied group had low postoperative pain (2±1 point; p <0.001), the least number of (abs. 15.8%, 8.5% in the group; p=0.01), and did not require hospitalization. In Group 1, there were rapid wound healing (14±7 days; p <0.001), with the highest level of postoperative pain (3.5±0.5 points; p <0.001), the longest antibacterial therapy (5±2 days; p <0.001), prolonged hospital stay (6.5±2.5 days; p <0.0001), as well as the highest number of relapses (abs. 47.4%, 28% in the group; p=0.01). In Group 2―the longest wound (31.1±3.9 days; p <0.001), the lowest percentage of relapses (abs. 38.6%, in the group 21.4%; p=0.01). The size of pilonidal cyst of 50 mm by ultrasound examination in the studied group predicted a high probability of relapses.

CONCLUSION: Laser thermal destruction of pilonidal cysts and fistulous openings in children is a promising method with low level of complications and relapses.

Recently, there has been an increase in the number of neuroendocrine tumors in children. As a rule, such tumors are asymptomatic, thus leading to the spread of atypical foci. Carcinoid neuroendocrine tumors of the gastrointestinal tract can be localized in any part, but the most common location is appendix. Neuroendocrine tumors of the appendix in children are often manifested with the clinical picture of acute appendicitis, which necessitates a special oncological vigilance in relation to malignant processes of the altered appendix.

The article describes three clinical cases of diagnosis, treatment, and catamnesis of appendix carcinoids identified during laparoscopic appendectomy and histological examination. All patients were urgently admitted for inpatient treatment at the Children's Republican Clinical Hospital of Saransk in 2021–2024 with clinical symptoms of acute abdominal pain. Due to timely diagnostics and treatment, laparoscopic appendectomy was a proper and sufficient approach in all cases for adequate recovery.

Thus, histological examination of an altered appendix is an extremely important diagnostic tool not only for the final verification of the diagnosis, but also for the exclusion of atypical changes. If there the morphological picture of carcinoid, additional diagnostic steps are needed to provide early diagnosis and timely treatment of metastatic areas.

On September 21, 2025, Doctor of Medical Sciences, Professor, and member of the editorial board of the journal Pediatric Surgery, Azamat M. Shamsiev, will celebrate his 80-year anniversary.

Professor Shamsiev is a founder and the first head of the Department of Pediatric Surgery No 2 at the Samarkand State Medical University (SamSMU), as well as a founder of the Samarkand Research Center for Pediatric Surgery—a multidisciplinary specialized clinic. He implemented a very complicated surgical techniques into the regional practice for treating congenital defects of the heart, chest, lungs, liver, genitourinary and digestive systems. Prof. Shamsiev was the first in Uzbekistan who also implemented an international credit-modular system in the educational process of universities, introduced electronic distance learning technologies, and significantly strengthened the university material and technical infrastructure.

Professor A.M. Shamsiev is distinguished by kindness and responsiveness, integrity and fairness, love for people and a desire to help them. Due to his broad scientific horizons, as well as rich clinical experience, Azamat Mukhitdinovich earned credibility among pediatric surgeons not only in Uzbekistan, but also far beyond its borders, and his pedagogical talent contributed to the achievements of his students, many of whom became leading pediatric surgeons and researchers.

Currently, prof. Shamsiev successfully combines administrative, clinical, and scientific activities. He is an honorary member of several international associations and scientific societies.

On August 1, 2025, Alexey Borisovich Okulov, MD, Professor, member of the Editorial Board of the Journal of Pediatric Surgery, died at the age of 88. Alexey Borisovich Okulov’s professional career was inextricably linked with St. Vladimir’s Children’s City Clinical Hospital (formerly I.V. Rusakov City Clinical Hospital No. 2) and the Russian Medical Academy of Continuing Postgraduate Education (formerly the Central Institute for Advanced Medical Education). Alexey Borisovich Okulov was, without exaggeration, a living legend of the Russian school of pediatric surgery and was one of the first in the development of a number of its areas―laparoscopy, neuroendocrine surgery, urology and andrology. Thus, based on the results of his work in the field of reproductology, a new direction was identified―pediatric androgynecology―and a new specialty―pediatric urologist-andrologist, which was subsequently included in the official list of positions of medical and pharmaceutical workers by order of the Ministry of Health of the Russian Federation. According to colleagues, he was a charming, modest, thoughtful and reliable man, a great hard worker, but the reviews of patients and their parents speak best about his talent as a doctor: “an excellent surgeon”, “an experienced, knowledgeable doctor”, “attentive, fatherly kind”, as well as gratitude for his golden hands. Alexey Borisovich went through a wonderful life path and left us a rich surgical legacy.