V. A. Novozhilov’s research while affiliated with Irkutsk State Medical University and other places

There is no consensus on total colorectal agangliosis in children and two modalities are most often to use: Duhamel procedure and endorectal ileoanal anastomosis. The paper presents the experience of ileocolonic pouch in these patients. An original modified technique is described. All patients underwent previous diversion, more often terminal ileostomy. The follow-up was 0.6–8 years, the late results were estimated.

Pilonidal cyst (pilonidal disease, epithelial coccygeal course, epithelial-coccygeal cyst) is a disease common among adolescents, most often asymptomatic and detected during a preventive examination. As a rule, diagnosis does not cause difficulties and is based on examination and ultrasound imaging of the cyst. During examination, fistulous passages are visualized - primary fistulous openings along the median line in the intervertebral fold. Complaints, as a rule, appear when inflammatory changes are added, the severity of which can vary from acute abscess formation to a sluggish process. However, under the guise of this pathology, diseases may occur that require a completely different diagnostic and therapeutic approach. The differential diagnostic range includes diseases that may manifest themselves by the presence of fistulous openings, the presence of bulky formations, pain and inflammation in the sacrococcygeal region. These include acute and chronic paraproctitis, rectal fistulas, osteomyelitis of the sacrum and coccyx, presacral (caudal) volumetric formations (teratomas, epidermal cysts, dermoid), diseases from the group of latent spinal dysraphism. Errors in diagnosis and, as a result, incorrect patient management tactics lead to serious consequences, therefore, if there are doubts about the diagnosis, the examination should be supplemented by magnetic resonance imaging of the lumbosacral spine.

Introduction. The issues of safe formation of primary intestinal anastomosis (PIA) in conditions of peritonitis and impaired intestinal hemoperfusion in children remains relevant. The “classic ban” on PIA in conditions of inflammation or ischemia is often passed down from generation to generation of surgeons without clear reasoning, scientific proofs, and understanding of the pathogenesis of complications. However, in a number of clinical situations, a pediatric or newborn surgeon is forced to use PIA approach when understanding and predicting the risks of complications of this surgical technique become important. This position requires clarification and scientific justification in modern clinical guidelines. Objective. To determine potential risk factors for complications of intestinal anastomosis in conditions of peritonitis and impaired intestinal hemoperfusion in children. Materials and methods. The first stage was a comparative analysis of intestinal anastomosis outcomes in newborns and older children according to the data of the chief pediatric surgeons of 75 constituent entities of the Russian Federation, including the DPR and LPR (2021–2022). Also, the outcomes of intestinal anastomosis in groups of patients with “presence” and “absence” of peritonitis and impaired intestinal hemoperfusion were assessed. The second stage was a multivariate analysis of clinical and laboratory signs in 11 children from different clinics of the Russian Federation. The PIA management in the conditions of peritonitis and impaired intestinal hemoperfusion in these patients was complicated by anastomotic failure or stenosis. Results. PIA in conditions of peritonitis and impaired intestinal hemoperfusion was performed in 1207 children (26.48% of all intestinal anastomosis). Death was recorded in 21 (1.74%) patients, failure — also in 21 (1.74%), stenosis requiring reconstruction — in 42 (4.1%). The factor “presence of peritonitis and impaired intestinal hemoperfusion” in all children was determined to significantly increase only the incidence of intestinal anastomotic stenosis, requiring subsequent reconstruction (χ2 test = 12.102; p < 0.01), and in newborn patients all differences in outcomes were statistically confirmed: mortality — χ2 test = 23.235; p < 0.01, failure — χ2 test = 29.790; p < 0.01, stenosis — χ2 test = 42.344; p < 0, 01. In newborns the risk of death, anastomotic failure, and stenosis in conditions of peritonitis or impaired intestinal hemoperfusion has also been scientifically proven to be significantly higher (p < 0.01) than in the group of older children. Multivariate analysis of data of patients treated by PIA in conditions of peritonitis or impaired intestinal hemoperfusion showed hypotension, hypovolemia, anemia, hypoalbuminemia, respiratory failure, and comorbidity to be recorded in the majority of patients. These patients required volume fluid therapy, transfusion therapy, and cardiotonic/vasopressor therapy.

Introduction. Currently, long-term outcomes after surgical treatment of pilonidal disease are not always satisfactory. In particular, relapses can reach 40% by different authors and pose a big problem for operating surgeons. Repeated surgical interventions are technically more complicated, often require extensive excision and often lead to rough scars, which worsen cosmetic results. The minimally invasive Gips method has no abovementioned disadvantages and can be used in pilonidal cyst relapses. Purpose. To assess the Gips surgery effectiveness in relapses of pilonidal cysts in children.Material and methods. 7 children with relapses of pilonidal cysts have been treated with Gips technique in the surgical department of Ivano-Matreninskaya Children's Clinical Hospital (Irkutsk) since January 2020. All surgeries were performed by the generally accepted Gips technique: local infiltration anesthesia with 1% lidocaine solution; fistula excision with a trepan-circular knife and curettage of the pathological cavity. Then, wounds were processed openly with gauze tampons until complete healing.Results. Gender – 71.4% boys and 28.6% girls. The average age is 16.5 years (12–17 years). Previously performed surgical interventions: excision of the pilonidal cyst – 4 and Gips procedure – 3. Restoration of motor activity – on the first day after surgery. Duration of NSAIDs therapy – 2 days after the procedure. No early postoperative complications were registered. The average length of hospital stay – 4.75 days. Complete healing of postoperative wounds – 4.1 weeks, in average. Catamnesis – 9.5 months , in average; early relapses - in one patient (14.3%).Conclusion. Minimally invasive intervention for treating pilonidal cysts by the Gips technique can be used both in primary and recurrent forms of the disease. The discussed technique provides good cosmetic results and has a minimal number of postoperative complications.

The experience of complications treatment after surgery for Hirschsprung’s disease using posterior sagittal transanal approach is presented. It allows to obtain a sufficient overview of the main anatomical structures of the small pelvis in a “frozen pelvis” situation, helping to avoid their damage at the scar tissue changes.

Introduction . The modern stage of medical science is marked by the search for and improvement of methods for the treatment of malformations and surgical diseases of the colon in childhood. Variants of surgical interventions for Hirschsprung's disease have undergone an obvious evolution. The development of medical technologies has led to the widespread introduction of minimally invasive endoscopic surgical interventions, often performed without the formation of stomas in various parts of the intestinal tube. The accumulated experience of clinics, the obtained long-term results of treatment are subject to reflection and the development of common approaches in choosing an operative strategy for correcting this malformation. The purpose of this study was to conduct a comparative analysis of various minimally invasive approaches in the treatment of Hirschsprung's disease used in the Ivano-Matreninskaya City Children's Clinical Hospital in Irkutsk. Material and method . We used a retrospective analysis of 96 records of an inpatient with a histologically verified diagnosis of congenital colon agangliosis. The exclusion group consisted of cases of total colon agangliosis. Results . In 86.7% of cases, the disease was presented as a short aganglionic segment localized in the rectosigmoid junction, which was an indication for transanal endorectal reduction in 100% (10) and laparoscopically assisted intervention in 80% (16) of cases. An extended aganglionic segment was an indication for video-assisted reduction in 20% of cases. The mean operation time was 118 min in the LAEPT group versus 140 min in the TAEPT group. Intraoperative complications and lethality were not observed. 83.33% were examined in follow-up, the follow-up period was over 2 years. Persistent constipation requiring the use of laxatives, cleansing enemas, course physiotherapy was noted in 3.3% of the LAEPT group and 6.7% of the TAEPT group. The incidence of Hirschsprung-associated colitis in the late postoperative period in the LAEPT and TAEPT groups was 3.3% (1) and 10% (3), respectively. Conclusion . Minimally invasive methods of surgical treatment of Hirschsprung's disease have excellent results, both cosmetically and functionally, and can claim to be the “gold standard” for the correction of this defect. Both methods have their obvious advantages and disadvantages, dictating a personalized approach to the choice of technological method in each specific case.

BACKGROUND: Pilonidal disease (pilonidal cyst, epithelial coccygeal passage) is a chronic inflammatory disease of the sacrococcygeal region, common among young people, including adolescents, to a certain extent worsens the quality of life. Until now, the etiopathogenesis and surgical treatment methods of the disease have been the subject of wide discussion. AIM: The aim of the study was to evaluate the effectiveness of Gips operations in children with pilonidal disease. MATERIALS AND METHODS: A comparative analysis of 41 patients with pilonidal disease was conducted in the surgical department of the City Ivano-Matryoninsk Children's Clinical Hospital in Irkutsk from January 2020 to August 2021. Planned surgical treatment was performed in 22 patients with primary or recurrent pilonidal cysts, including 15 children using the M. Gips procedure. The comparison group consisted of patients who underwent wide excision of a complex of soft tissues bearing a pilonidal cyst, primary and secondary fistulous passages, followed by wound restoration with a storey suture. RESULTS: The patients comprised 72.7% boys and 27.3% girls with an average age of 15.6 1.5 years and average disease duration of 5.1 2.2 months. The average operation time was 12 4.2 minutes. The motor regime was resumed on the first day after the operation. Patient pain was relieved by administering non-steroidal anti-inflammatory drugs for the first two postoperative days. There were no early postoperative complications. The average hospital stay was 3.8 1.9 days. Complete healing by secondary intention was achieved after an average of 3.9 1.8 weeks. The average follow-up was 7 3.8 months, and 6.7% had early relapses. CONCLUSIONS: Minimally invasive sinusectomy according to the Gips procedure for treating pilonidal disease in adolescents is safe and effective, has a low recurrence rate, allows an early return to daily activities, and provides a good cosmetic result. However, the small number of observations requires further research.

Introduction. One of the actual problems of reconstructive colorectal surgery in childhood is a high frequency of complications after the initial reconstructive procedures for Hirschprung disease. Currently, in the clinical practice there is a wide range of surgical techniques, the combination of which allows to avoid serious outcomes leading to child’s disability. The choice of the volume of repeated surgeries is strictly individual, depending on the nature of complications, types of previously performed surgeries as well as on patient’s initial status. The key for developing a curative tactics is findings after instrumental and morphological examination which were obtained for previous interventions and which often require additional further clarification. Material and methods. In 2010–2021, in the Center of Pediatric Colorectal Anomalies (Irkutsk, Russia) redo endorectal pullthrough surgeries were performed in 18 patients with Hirschprung disease after previous correcting interventions. Surgeons made transanal resection in combination with posterior sagittal perineotomy. Indications for repeated surgical procedures, in most cases, were residual aganglionic segments and the constipation relapses – 11 (61,2%) patients; scar deformation and anus channel stenosis – 5 (27,8%) patients; stricture of coloanal anastomosis – 1 (5,5%) patient; scar stenosis of the neorectum with a rectobulbar fistula – 1 (5,5%) patient. Results. 13 (72,2%) patients had good clinical outcomes: no parents’ complaints, stable rhythms of defecation (from 1 to 4 times per day), feces contents (type 3–6 by Bristol scale of feces). In 4 (22,2%) cases, there was chronic constipation where defecation was 2–3 times a week with preserved defecation urgencies and rare episodes of anal overflow incontinence requiring conservative treatment under the bowel emptying program. One patient had a stricture of coloanal anastomosis which was corrected with its dissection and further dilatation. Conclusion. To confirm indications for redo surgeries, a comprehensive assessment of the colon and perineum with clinical, functional and morphological examination is required. Transanal pull-down is a relatively safe procedure which, in most cases, has good and satisfactory clinical postoperative results and which may be performed even after previous endorectal resections. The rehabilitation program after the discussed surgery is strictly personified and developed under close interaction of a surgeon and a gastroenterologist after assessing the state of the formed coloanal anastomosis and the distal part of the pulled-down intestine.