BACKGROUND: Faecal incontinence as a result of chronic functional constipation is a common problem among children. This condition is socially unacceptable. There is no clear consensus of a universally accepted pathogenesis, diagnostics, and optimal treatment for this condition. New methods of surgical treatment are necessary for accelerated normalization of the retaining faeces process and resolution of faecal incontinence in children. THE AIM: The study was aimed to analyze the efficiency of the new minimally invasive surgery method of the anal sphincter complex restoring with autologous fat injection in children. MATERIALS AND METHODS: The examined group included 31 patients aged from 4 to 17. The patients had chronic constipation combined with faecal incontinence more than once per week. All of them had no lesions of the anal sphincter and pelvic floor muscles. All patients underwent outpatient and inpatient treatment from 2016 to 2019. Patients underwent computed tomographic colonography with virtual colonoscopy in addition to general clinical methods, ultrasound and irrigoscopy. Minimally invasive surgery with autologous fat injection was performed to correct anorectal angle in the following conditions: ineffective nonsurgical treatment for 4-6 months, lengthening of puborectalis muscles, increasing of the anorectal angle more than 100 degrees. RESULTS: We analyzed the complaints of the patients who underwent minimally invasive surgery. The study showed reducing of symptoms severity of chronic constipation up to complete normalization of defecation frequency after surgery (34.5%) in 3 months. The study also showed the complete absence of fecal incontinence in 3 months after this minimally invasive treatment in 83 per cent of children. CONCLUSION: The retrorectal injection of autologous fat leads to fast resolution of faecal incontinence, normalization of defecation frequency and improvement of the life quality as a result.

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Objective: The purpose of this study was to analyze the structure of morbidity and the results of treatment of children with EA in the Far Eastern Federal District.Methods: The retrospective analysis of the annual reports of pediatric surgeons of all 11 regions of the Far Eastern Federal District. Total 46 children with EA were born from 2019 to 2021, 1 child died because of severe comorbidity before surgery, 1 was operated in Moscow. 44 children having A, B, C, D types of EA by Gross were treated by regional surgeons.Results: 64% of children were boys and 36% - girls, half of the children were born prematurely, every fourth was fed before getting diagnosis. The most common form was EA with lower tracheoesophageal fistula (93%). Combined malformations were found in 60% of cases, the most frequent was cardiac anomaly. Anastomosis was applied in 86% of operated, the rest underwent staged procedures. 81% are alive after applying anastomosis, 33% after coloesophageal replacement. Thoracoscopic AP treatment is widely used in regions having much higher population density than the Far East, but there is a tendency to improve this indicator. As for our district, there are several ways to improve surgical care: concentration of patients of the same profile in one or two regional centers or involvement of leading Russian specialists in providing high-tech medical care.Conclusions: The peculiarities of the logistics of the region lead to the idea of creating a single Far Eastern multidisciplinary surgical center providing counseling, transportation, diagnostics and treatment of patients with congenital malformations at the modern level.

В настоящем обзоре литературы приводится короткая историческая справка, а также современные данные, посвященные методам хирургического лечения фекальной инконтиненции у детей. Описаны различные подходы к оперативному вмешательству, направленные на область сфинктеров и на досфинктерную зону. Затронуты современные аспекты миниинвазивного лечения, в частности, использования объемообразующих веществ в лечении фекальной инконтиненции. Ключевые слова: фекальная инконтиненция у детей, сфинктеропластика, леваторопластика, миниинвазивное хирургическое лечение.

Introduction. This article discusses the relevance of performing organ-preserving operations for traumatic skin and soft tissue defects in children. The author analyzes the traditional types of skin grafting procedures and their application in children. From the authors' point of view, the most acceptable skin grafting method is a displaced island flap on a neurovascular pedicle with direct blood flow. Materials and methods. The operating technique of lifting a displaced island flap on a neurovascular pedicle with direct blood flow is shown. The features of its implementation, the number of children, and their distribution by groups are shown. From 2016 to 2019, 15 children with traumatic defects of the distal phalanges of the fingers were operated on in the microsurgical Department of the Khabarovsk KKB No. 2 using a displaced neurovascular island flap on the leg with direct blood flow. The children ranged in age from four to 14 years. The number of children and the frequency of damage to the right and left hands was approximately the same. Results. Positive results of using this technique in the Department of Microsurgery of KKB No. 2 are presented. In all cases, it was possible to close the existing defects with the primary closure of the donor defect simultaneously; Sensitivity was preserved in all operated children, and movements in the finger joints were almost complete. Discussion. This flap method has undeniable advantages, although it is quite time-consuming and requires microsurgical skills, techniques, and appropriate equipment. The proposed skin grafting results are encouraging and satisfying for both doctors and children with parents. Conclusions. The authors recommend this skin grafting method for traumatic defects of the distal phalanges of the fingers in children.