Súhrn Detská chirurgia je lekárska špecializácia, ktorá sa zameriava na diagnostiku, liečbu a pooperačnú starostlivosť o deti s vrodenými a získanými anomáliami a chorobami. Cieľom detských chirurgov je zabezpečiť, aby deti dostali najlepšiu možnú starostlivosť a aby sa minimalizovali riziká a komplikácie spojené s chirurgickými zákrokmi. Súčasní detskí chirurgovia čelia mnohým výzvam, vrátane malému počtu detí s vrodenými vývojovými chybami; ekonomické tlaky a snaha o zvýšenie efektivity vedú k znižovaniu času stráveného na jednotlivých operáciách, čo môže obmedzovať možnosť dôkladného tréningu mladých chirurgov. Tieto výzvy vyžadujú inovatívne prístupy a neustále zlepšovanie vzdelávacích a tréningových metód. Minimálne invazívna chirurgia sa stala významnou súčasťou detskej chirurgie, prinášajúc benefity ako rýchlejšie zotavenie, menšie operačné rany a nižšie riziko infekcie. Avšak, minimálne invazívna detská chirurgia je technicky náročná a vyžaduje excelentnú technickú zručnosť. Potreba udržiavať a zlepšovať chirurgické zručnosti vyžaduje neustály tréning. Súčasné vzdelávacie metódy sa čoraz viac spoliehajú na simulačné technológie, aby sa zlepšila kvalita a bezpečnosť tréningu s čo najnižším rizikom pre pacientov. Integrácia technológie 3D tlače a obrazových dát z CT a MR skenov priniesla nové možnosti na tvorbu vysoko realistických simulačných modelov pre minimálne invazívnu chirurgiu. Tieto modely presne replikujú prostredie, s ktorým sa stretávame napr. pri novorodeneckej chirurgii. V tomto článku uvádzame vlastné skúsenosti s vývojom a tvorbou 3D tlačených syntetických modelov určených na tréning torakoskopickej operácie atrézie pažeráka s tracheoezofageálnou fistulou. Cieľom tohto súhrnného článku je poskytnúť aktuálny prehľad literatúry venujúcej sa syntetickým 3D tlačeným modelom určeným pre tréning minimálne invazívnej detskej chirurgie.

Summary Pediatric surgery is a medical specialty focused on the diagnosis, treatment, and postoperative care of children with congenital and acquired anomalies and diseases. The goal of pediatric surgeons is to ensure that children receive the best possible care while minimizing the risks and complications associated with surgical procedures. Contemporary pediatric surgeons face many challenges, including a decline in the number of children with congenital developmental defects, economic pressures, and efforts to increase efficiency, leading to reduced time spent on individual surgeries. This can limit the opportunity for thorough training of young surgeons. These challenges require innovative approaches and continuous improvement in educational and training methods. Minimally invasive surgery has become a significant part of pediatric surgery, offering benefits such as faster recovery, smaller surgical wounds, and lower risk of infection. However, minimally invasive pediatric surgery is technically demanding and requires excellent technical skills. The need to maintain and improve surgical skills demands ongoing training. Current educational methods increasingly rely on simulation technologies to enhance the quality and safety of training without risk to patients. The integration of 3D printing technology and imaging data from CT and MRI scans has opened new possibilities for creating highly realistic simulation models for minimally invasive surgery. These models accurately replicate the environment encountered in procedures like neonatal surgery. In this article, we present our experience with the development and creation of 3D-printed synthetic models designed for training thoracoscopic surgery of esophageal atresia with tracheoesophageal fistula. The aim of this review article is to provide an up-to-date overview of the literature on synthetic 3D-printed models designed for training in minimally invasive pediatric surgery.

• MeSH
• Models, Anatomic MeSH
• Esophageal Atresia surgery   MeSH
• Child MeSH
• Humans MeSH
• Minimally Invasive Surgical Procedures * education   MeSH
• High Fidelity Simulation Training MeSH
• Simulation Training * MeSH
• Imaging, Three-Dimensional MeSH
• Check Tag
• Child MeSH
• Humans MeSH

BACKGROUND: In recent decades, magnetic resonance imaging (MRI) has gained prominence as a standard diagnostic method for preoperative assessment in patients with anorectal malformations and a colostomy, with the potential to replace the classic fluoroscopic distal pressure colostogram (FDPC). Three MRI techniques are available: MRI-distal pressure colostogram with gadolinium (MRI-DPCG) or saline (MRI-DPCS) instillation into the colostomy and native MRI without colostomy instillation. OBJECTIVE: To evaluate and compare the diagnostic accuracy of MRI (native MRI, MRI-DPCG and MRI-DPCS) in the preoperative workup of boys with an anorectal malformation and a colostomy and to compare it to FDPC. MATERIALS AND METHODS: Sixty-two boys with preoperative MRI using one of the three approaches and 43 with FDPC met the inclusion criteria for this retrospective study. The presence and localization of rectal fistulas according to the Krickenbeck classification were evaluated and compared with intraoperative findings. RESULTS: The accuracy of fistula detection for MRI in general (regardless of the technique), MRI-DPCS, MRI-DPCG, native MRI and FDPC was 95% (59/62, P<0.001), 100% (12/12, P=0.03), 100% (30/30, P<0.001), 85% (17/20, P=0.41) and 72% (31/43, P=0.82), respectively. The accuracy of describing fistula type in patients with a correctly detected fistula using these methods was 96% (45/47, P<0.001), 100% (9/9, P<0.001), 100% (23/23, P<0.001), 87% (13/15, P<0.001) and 67% (13/21, P=0.002), respectively. CONCLUSION: MRI is a reliable method for detecting and classifying fistulas in boys with an anorectal malformation and a colostomy and can be considered the modality of first choice for preoperative workup.

• MeSH
• Anorectal Malformations * diagnostic imaging   surgery   MeSH
• Colostomy MeSH
• Humans MeSH
• Magnetic Resonance Spectroscopy MeSH
• Magnetic Resonance Imaging methods   MeSH
• Rectal Fistula * surgery   MeSH
• Rectum diagnostic imaging   surgery   abnormalities   MeSH
• Retrospective Studies MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH

INTRODUCTION: Postoperative constipation (PC) in patients with imperforate anus and perineal fistula (PF) has been reported in up to 60%. Histological studies of PF revealed innervation anomalies which seem to be one of the reasons for PC. Perioperative histologically controlled fistula resection (PHCFR) allows appropriate resection of PF and pull-down normoganglionic rectum at the time of posterior sagittal anorectoplasty (PSARP). MATERIALS AND METHODS: A total of 665 patients with anorectal malformations underwent surgery between 1991 and 2021. Of these, 364 presented PF; 92 out of them (41 F) were studied. Patients with sacral and spinal cord anomalies, neurological disorders, and cut-back anoplasty were excluded. PSARP was done on all patients. Hematoxylin-eosin staining and NADH Tetrazolium-reductase histochemical method were used. Four and more ganglion cells in the myenteric plexus represented a sufficient length of the resection. The continence was scored according to the modified Krickenbeck scoring system. Final scores ranged from 1 to 7 points. Values are given as median. RESULTS: A total of 65 (70.7%) patients presented an aganglionic segment in PF, and 27 patients presented hypoganglionosis. The median length of the resected fistula was 25 mm (interquartile range [IQR]: 20-30). The median total continence score was 7 (IQR: 6-7). Post-op constipation was observed in 6/92 (6.5%) patients. CONCLUSION: PHCFR diminished PC to 6.5% of patients.

• MeSH
• Anus, Imperforate * surgery   MeSH
• Child MeSH
• Infant MeSH
• Humans MeSH
• Infant, Newborn MeSH
• Perineum surgery   MeSH
• Postoperative Complications etiology   MeSH
• Child, Preschool MeSH
• Rectal Fistula * surgery   MeSH
• Rectum surgery   abnormalities   MeSH
• Retrospective Studies MeSH
• Treatment Outcome MeSH
• Constipation etiology   surgery   MeSH
• Plastic Surgery Procedures methods   MeSH
• Check Tag
• Child MeSH
• Infant MeSH
• Humans MeSH
• Male MeSH
• Infant, Newborn MeSH
• Child, Preschool MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

• MeSH
• Adult MeSH
• Fecal Incontinence * etiology   MeSH
• Hirschsprung Disease * complications   MeSH
• Humans MeSH
• Postpartum Period MeSH
• Pregnancy MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Pregnancy MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Case Reports MeSH

• MeSH
• Intestinal Atresia * surgery   diagnostic imaging   etiology   pathology   MeSH
• Duodenum abnormalities   surgery   diagnostic imaging   pathology   MeSH
• Humans MeSH
• Duodenal Diseases * surgery   diagnostic imaging   pathology   congenital   MeSH
• Infant, Newborn MeSH
• Check Tag
• Humans MeSH
• Infant, Newborn MeSH
• Publication type
• Review MeSH

• MeSH
• Intestinal Atresia * surgery   diagnostic imaging   classification   MeSH
• Humans MeSH
• Infant, Newborn MeSH
• Intestine, Small * abnormalities   surgery   diagnostic imaging   MeSH
• Check Tag
• Humans MeSH
• Infant, Newborn MeSH
• Publication type
• Review MeSH

• MeSH
• Intestinal Atresia * surgery   diagnostic imaging   MeSH
• Humans MeSH
• Infant, Newborn MeSH
• Prognosis MeSH
• Intestine, Large * abnormalities   surgery   diagnostic imaging   MeSH
• Check Tag
• Humans MeSH
• Infant, Newborn MeSH
• Publication type
• Review MeSH

• MeSH
• Digestive System Abnormalities diagnosis   epidemiology   MeSH
• Diagnosis, Differential MeSH
• Dilatation, Pathologic * diagnostic imaging   epidemiology   congenital   MeSH
• Humans MeSH
• Infant, Newborn MeSH
• Intestines * abnormalities   diagnostic imaging   MeSH
• Check Tag
• Humans MeSH
• Infant, Newborn MeSH
• Publication type
• Review MeSH

Meckelův divertikl (MD) je jednou z nejčastějších vrozených malformací gastrointestinálního traktu. Ve většině případů je asymptomatický, pouze ve 4 % se klinicky projeví, a to krvácením do gastrointestinálního traktu, střevní obstrukcí, zánětem či perforací. Krvácení pozorujeme nejčastěji u dětí do 2 let věku. U starších pacientů se projeví spíše zánětlivými komplikacemi. Níže prezentujeme kazuistiku 17letého chlapce, u kterého se MD projevil život ohrožujícím akutním krvácením do gastrointestinálního traktu (GIT). Na základě této kazuistiky jsme provedli retrospektivní studii malého souboru pacientů, hospitalizovaných na Klinice dětské chirurgie a traumatologie 3. LF UK a FTN (KDCHT FTN) s hlavní či vedlejší diagnózou MD za období od ledna 2012 do března 2023.

Meckel‘s diverticulum (MD) is one of the most common malformations of the gastrointestinal tract. Most cases are asymptomatic; clinical symptoms occur only in about 4% of patients, presenting as gastrointestinal bleeding, intestinal obstruction, inflammation, or perforation. Bleeding is most frequently observed in children under 2 years of age. Older patients tend to experience inflammatory complications. Here, we present the case report of a 17-year-old male patient with life-threatening acute gastrointestinal bleeding due to MD. Based on this case report, we performed a retrospective study of a small group of patients admitted to the Department of Pediatric Surgery and Traumatology, Third Faculty of Medicine, Charles University and Thomayer University Hospital in Prague (KDCHT FTN) between January 2012 and March 2023 with the primary or secondary diagnosis of MD.

• MeSH
• Abdominal Pain diagnostic imaging   etiology   therapy   MeSH
• Diagnosis, Differential MeSH
• Child MeSH
• Gastrointestinal Hemorrhage diagnostic imaging   etiology   therapy   MeSH
• Infant MeSH
• Humans MeSH
• Meckel Diverticulum * surgery   diagnostic imaging   MeSH
• Adolescent MeSH
• Child, Preschool MeSH
• Retrospective Studies MeSH
• Check Tag
• Child MeSH
• Infant MeSH
• Humans MeSH
• Adolescent MeSH
• Male MeSH
• Child, Preschool MeSH
• Female MeSH
• Publication type
• Case Reports MeSH

Východiska: Vaginální atrezie (VA) je vzácná malformace ženského genitálního traktu charakterizovaná nepřítomností nebo neúplným vývojem pochvy, často vedoucí k cyklickým bolestem břicha a zadržování menstruační krve u dospívajících pacientek. Vaginální atrezie je často doprovázena mnohočetnými orgánovými malformacemi. Tento stav představuje významné problémy v diagnostice a léčbě a vyžaduje multidisciplinární přístup. Popis případu: Uvádíme případ vrozené VA typu I u 13leté ženy s vrozenou biliární atrezií a malformací močového systému. Po počátečním hodnocení pacientka podstoupila incizi VA a laparoskopickou excizi cysty levého ovaria v celkové anestezii. Během 2měsíčního sledování pacientka udávala normální menstruační tok bez doprovodných bolestí břicha. Závěr: Tento případ podtrhuje složitost vrozené VA typu I souběžné s mnohočetnými orgánovými malformacemi. Včasná identifikace a správná strategie léčby jsou zásadní pro zajištění nejlepších možných výsledků u pacientky. K objasnění základních mechanizmů a zlepšení léčebných modalit pro takové případy je zapotřebí další výzkum.

Background: Vaginal atresia (VA) is a rare female genital tract malformation characterized by the absence or incomplete development of the vagina, often leading to cyclic abdominal pain and menstrual blood retention in adolescent patients. Vaginal atresia is often accompanied by multiple organ malformations. The condition poses significant challenges in diagnosis and management, requiring a multidisciplinary approach. Case description: Herein, we report a case of type I congenital VA in a 13-year-old female presenting with congenital biliary atresia and urinary system malformation. Upon initial evaluation, the patient exhibited VA incision and laparoscopic excision of a left ovarian cyst under general anesthesia. By the 2-month follow-up, the patient reported normal menstrual flow without accompanying abdominal pain. Conclusion: This case underscores the complexity of type I congenital VA concurrent with multiple organ malformations. Timely identification and proper management strategies are crucial for securing the best possible patient outcomes. Further research is warranted to elucidate the underlying mechanisms and improve treatment modalities for such cases.

• MeSH
• Biliary Atresia surgery   MeSH
• Diagnostic Imaging methods   MeSH
• Gynatresia * surgery   diagnosis   complications   MeSH
• Humans MeSH
• Urinary Tract embryology   pathology   MeSH
• Ovarian Cysts surgery   diagnosis   MeSH
• Liver Transplantation methods   MeSH
• Congenital Abnormalities * surgery   diagnosis   MeSH
• Check Tag
• Humans MeSH
• Female MeSH
• Publication type
• Case Reports MeSH