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<article article-type="research-article" dtd-version="1.3" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xml:lang="ru"><front><journal-meta><journal-id journal-id-type="publisher-id">rosped</journal-id><journal-title-group><journal-title xml:lang="ru">Российский педиатрический журнал имени М.Я. Студеникина</journal-title><trans-title-group xml:lang="en"><trans-title>M.Ya. Studenikin Russian Pediatric Journal</trans-title></trans-title-group></journal-title-group><publisher><publisher-name>ФГАУ «НМИЦ здоровья детей» Минздрава России</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.46563/1560-9561-2025-28-5-344-349</article-id><article-id custom-type="edn" pub-id-type="custom">abzxig</article-id><article-id custom-type="elpub" pub-id-type="custom">rosped-1823</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="ru"><subject>ОРИГИНАЛЬНЫЕ СТАТЬИ</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="en"><subject>ORIGINAL ARTICLES</subject></subj-group></article-categories><title-group><article-title>Модифицированная операция Делорма при хирургическом лечении ректального пролапса у детей с аноректальными мальформациями</article-title><trans-title-group xml:lang="en"><trans-title>Modified Delorm procedure for surgical treatment of rectal prolapse in children with anorectal malformations</trans-title></trans-title-group></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-2029-7820</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Гусев</surname><given-names>Алексей Андреевич</given-names></name><name name-style="western" xml:lang="en"><surname>Gusev</surname><given-names>Aleksey A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Канд. мед. наук, врач — детский хирург отделения общей и плановой хирургии ФГАУ «НМИЦ здоровья детей» Минздрава России; вед. науч. сотр. лаб. научных основ торакоабдоминальной хирургии НИИ детской хирургии ФГАУ «НМИЦ здоровья детей» Минздрава России; доцент каф. детской хирургии с курсом анестезиологии и реанимации Института подготовки медицинских кадров ФГАУ «НМИЦ здоровья детей» Минздрава России</p><p>e-mail: gusev@nczd.ru</p></bio><bio xml:lang="en"><p>MD, PhD, pediatric surgeon, Department of General and Elective Surgery, Research Institute of Pediatric Surgery, National Medical Research Center for Children’s Health, Moscow; leading researcher at the Laboratory of the Scientific Foundations of Thoracoabdominal Surgery of the Research Institute of Pediatric Surgery of the Federal State Budgetary Educational Institution "NMIC of Children's Health" of the Ministry of Health of the Russian Federation; Associate Professor of the Department of Pediatric Surgery with a course in Anesthesiology and Intensive Care at the Institute of Medical Personnel Training of the Federal State Budgetary Educational Institution "NMIC of Children's Health" of the Ministry of Health of the Russian Federation, 119991, Russian Federation</p><p>e-mail: gusev@nczd.ru</p></bio><email xlink:type="simple">gusev@nczd.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-0132-5662</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Окулов</surname><given-names>Евгений Алексеевич</given-names></name><name name-style="western" xml:lang="en"><surname>Okulov</surname><given-names>Evgeniy A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Канд. мед. наук, врач детский хирург, отделение общей и плановой хирургии ФГАУ «НМИЦ здоровья детей» Минздрава России; вед. науч. сотр. лаб. научных основ торакоабдоминальной хирургии НИИ детской хирургии ФГАУ «НМИЦ здоровья детей» Минздрава России</p><p>e-mail: shark.evgen@yandex.ru</p></bio><email xlink:type="simple">shark.evgen@yandex.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-8563-6002</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Дьяконова</surname><given-names>Елена Юрьевна</given-names></name><name name-style="western" xml:lang="en"><surname>Dyakonova</surname><given-names>Elena Yu.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Доктор мед. наук, и.о. руководителя НИИ детской хирургии ФГАУ «НМИЦ здоровья детей» Минздрава России; зав. отделением общей и плановой хирургии НИИ детской хирургии ФГАУ «НМИЦ здоровья детей» Минздрава России; зав. каф. детской хирургии с курсом анестезиологии и реанимации Института подготовки медицинских кадров ФГАУ «НМИЦ здоровья детей» Минздрава России</p><p>e-mail: rytella@mail.ru</p></bio><email xlink:type="simple">rytella@mail.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-1370-6876</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Хворостов</surname><given-names>Игорь Николаевич</given-names></name><name name-style="western" xml:lang="en"><surname>Khvorostov</surname><given-names>Igor N.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Доктор мед. наук, проф., зав. хирургическим отделением № 1 ГБУЗ «Детская городская клиническая больница № 9 им. Г.Н. Сперанского» Департамента здравоохранения города Москвы</p><p>e-mail: ikhvorostov@gmail.com</p></bio><email xlink:type="simple">ikhvorostov@gmail.com</email><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0001-6892-6860</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Щукина</surname><given-names>Анна Александровна</given-names></name><name name-style="western" xml:lang="en"><surname>Shchukina</surname><given-names>Anna A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Канд. мед. наук, врач — детский хирург, отделение общей и плановой хирургии ФГАУ «НМИЦ здоровья детей» Минздрава России; вед. науч. сотр., лаб. научных основ торакоабдоминальной хирургии НИИ детской хирургии ФГАУ «НМИЦ здоровья детей» Минздрава России</p><p>e-mail: shchukina.aa@nczd.ru</p></bio><email xlink:type="simple">shchukina.aa@nczd.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-5900-1812</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Бекин</surname><given-names>Александр Сергеевич</given-names></name><name name-style="western" xml:lang="en"><surname>Bekin</surname><given-names>Aleksandr S.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Канд. мед. наук, врач — детский хирург, отделение общей и плановой хирургии НИИ детской хирургии ФГАУ «НМИЦ здоровья детей» Минздрава России; вед. науч. сотр., лаб. научных основ торакоабдоминальной хирургии НИИ детской хирургии ФГАУ «НМИЦ здоровья детей» Минздрава России</p><p>e-mail: aleksandr_bekin@mail.ru</p></bio><email xlink:type="simple">aleksandr_bekin@mail.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Романова</surname><given-names>Екатерина Алексеевна</given-names></name><name name-style="western" xml:lang="en"><surname>Romanova</surname><given-names>Ekaterina A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Канд. мед. наук, врач — детский хирург, отделение общей и плановой хирургии ФГАУ «НМИЦ здоровья детей» Минздрава России, сотр. науч. сотр. научно-методического отдела планирования и развития ФГАУ «НМИЦ здоровья детей» Минздрава России</p><p>e-mail: bnmg13@yandex.ru</p></bio><email xlink:type="simple">bnmg13@yandex.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Тарзян</surname><given-names>Арам Оганесович</given-names></name><name name-style="western" xml:lang="en"><surname>Tarzyan</surname><given-names>Aram O.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Канд. мед. наук, врач — уролог, отделение общей и плановой хирургии ФГАУ «НМИЦ здоровья детей» Минздрава России; ассистент каф. детской хирургии с курсом анестезиологии и реанимации Института подготовки медицинских кадров ФГАУ «НМИЦ здоровья детей» Минздрава России</p><p>e-mail: aram017@mail.ru</p></bio><email xlink:type="simple">aram017@mail.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0009-0002-3558-0706</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Евгенова</surname><given-names>Надежда Николаевна</given-names></name><name name-style="western" xml:lang="en"><surname>Evgenova</surname><given-names>Nadejda N.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Врач — детский хирург, отделение общей и плановой хирургии ФГАУ «НМИЦ здоровья детей» Минздрава России</p><p>e-mail: evgenova199878@mail.ru</p></bio><email xlink:type="simple">evgenova199878@mail.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0009-0007-8461-8092</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Мягков</surname><given-names>Александр Евгеньевич</given-names></name><name name-style="western" xml:lang="en"><surname>Myagkov</surname><given-names>Aleksandr E.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Врач — детский хирург, отделение общей и плановой хирургии ФГАУ «НМИЦ здоровья детей» Минздрава России</p><p>e-mail: al.myagkov7@yandex.ru</p></bio><email xlink:type="simple">al.myagkov7@yandex.ru</email><xref ref-type="aff" rid="aff-1"/></contrib></contrib-group><aff-alternatives id="aff-1"><aff xml:lang="ru"><institution>ФГАУ «Национальный медицинский исследовательский центр здоровья детей» Минздрава России</institution></aff><aff xml:lang="en"><institution>National Medical Research Center for Children’s Health</institution></aff></aff-alternatives><aff-alternatives id="aff-2"><aff xml:lang="ru"><institution>ГБУЗ «Детская городская клиническая больница № 9 им. Г.Н. Сперанского» Департамента здравоохранения г. Москвы</institution></aff><aff xml:lang="en"><institution>Children’s Municipal Clinical Hospital No. 9 named after G.N. Speransky</institution></aff></aff-alternatives><pub-date pub-type="collection"><year>2025</year></pub-date><pub-date pub-type="epub"><day>20</day><month>11</month><year>2025</year></pub-date><volume>28</volume><issue>5</issue><fpage>344</fpage><lpage>349</lpage><permissions><copyright-statement>Copyright &amp;#x00A9; Гусев А.А., Окулов Е.А., Дьяконова Е.Ю., Хворостов И.Н., Щукина А.А., Бекин А.С., Романова Е.А., Тарзян А.О., Евгенова Н.Н., Мягков А.Е., 2025</copyright-statement><copyright-year>2025</copyright-year><copyright-holder xml:lang="ru">Гусев А.А., Окулов Е.А., Дьяконова Е.Ю., Хворостов И.Н., Щукина А.А., Бекин А.С., Романова Е.А., Тарзян А.О., Евгенова Н.Н., Мягков А.Е.</copyright-holder><copyright-holder xml:lang="en">Gusev A.A., Okulov E.A., Dyakonova E.Y., Khvorostov I.N., Shchukina A.A., Bekin A.S., Romanova E.A., Tarzyan A.O., Evgenova N.N., Myagkov A.E.</copyright-holder><license xml:lang="ru" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>Данная работа распространяется под лицензией Creative Commons Attribution 4.0.</license-p></license><license xml:lang="en" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>This work is licensed under a Creative Commons Attribution 4.0 License.</license-p></license></permissions><self-uri xlink:href="https://www.rosped.ru/jour/article/view/1823">https://www.rosped.ru/jour/article/view/1823</self-uri><abstract><sec><title>Актуальность</title><p>Актуальность. Ректальный пролапс (РП) — одно из самых частых осложнений после коррекции аноректальных мальформаций (АРМ), которое развивается у 15–40% детей, значительно ухудшая качество жизни больных. Классическая операция Делорма у этих больных часто даёт неудовлетворительные результаты: частота рецидивов достигает 25–35%, а функциональные показатели континенции остаются низкими. Это обусловлено особенностями анатомии тазового дна и нарушениями нейромышечного аппарата аноректальной зоны у детей с АРМ. Цель работы: определить эффективность и безопасность модифицированной нами операции Делорма у детей с РП после коррекции АРМ.</p></sec><sec><title>Материалы и методы</title><p>Материалы и методы. Проведён проспективный анализ результатов применения модифицированной операции Делорма у 32 больных в возрасте 4–14 лет с полнослойным РП III–IV степени по классификации Altemeier. Все больные имели в анамнезе хирургическую коррекцию АРМ различных типов. Среди них 8 больных имели рецидивный РП после неудачных предшествующих операций. Модифицированная техника включала щадящую циркулярную демукозацию с сохранением подслизистого сосудистого сплетения, многоуровневую трёхэтапную пликацию мышечного слоя, формирование мышечной манжетки с дополнительной фиксацией к структурам тазового дна и создание подслизистого валика. Период послеоперационного наблюдения составил 10 мес.</p></sec><sec><title>Результаты</title><p>Результаты. Средняя продолжительность операции — 82 ± 15 мин. Послеоперационные осложнения (стеноз анального канала) развились у 3 больных. Функциональные результаты характеризовались значительным улучшением показателей континенции с исходных 3,4 ± 1,1 до 8,1 ± 1,3 балла через 6 мес по шкале Krickenbeck против 6,2 ± 1,4 балла для классической операции Делорма. При наблюдении до 10 мес рецидивов РП не отмечено ни у одного больного против 10–17% в 1-й год при использовании классической техники.</p></sec><sec><title>Заключение</title><p>Заключение. Нами показана высокая эффективность и безопасность модифицированной операции Делорма у детей с РП после коррекции АРМ. Методика имеет значительные преимущества перед классической техникой и может быть рекомендована для применения в специализированных центрах.</p></sec><sec><title>Участие авторов</title><p>Участие авторов: Гусев А.А., Окулов Е.А. — концепция и дизайн исследования; Гусев А.А., Окулов Е.А., Хворостов И.Н., Дьяконова Е.Ю., Щукина А.А., Бекин А.С., Романова Е.А., Тарзян А.О., Евгенова Н.Н., Мягков А.Е. — сбор материала, хирургическое лечение; Гусев А.А. — анализ данных, статистическая обработка. Все соавторы — утверждение окончательного варианта статьи, ответственность за целостность всех частей статьи.</p></sec><sec><title>Финансирование</title><p>Финансирование. Исследование не имело финансовой поддержки.</p></sec><sec><title>Конфликт интересов</title><p>Конфликт интересов. Авторы заявляют об отсутствии конфликта интересов. </p></sec><sec><title>Поступила 15</title><p>Поступила 15.09.2025Принята к печати 02.10.2025Опубликована 30.10.2025</p></sec></abstract><trans-abstract xml:lang="en"><sec><title>Relevance</title><p>Relevance. Rectal prolapse (RP) is one of the most frequent complications after correction of anorectal malformations (ARM), occurring in 15–40% of children and significantly impairing patients’ quality of life. In this patient population, the classic Delorme procedure often yields suboptimal outcomes: recurrence rates reach 25–35%, and continence function remains poor. This is attributable to the inherently abnormal pelvic floor anatomy and neuromuscular dysfunction of the anorectal region in ARM children.</p></sec><sec><title>Aim</title><p>Aim: to evaluate the efficacy and safety of a modified Delorme procedure, developed at the Research Institute of Pediatric Surgery, National Medical Research Center for Children’s Health, in children with rectal prolapse following correction of anorectal malformations.</p></sec><sec><title>Materials and methods</title><p>Materials and methods. We conducted a prospective analysis of outcomes after the odified Delorme procedure in thirty two patients aged of 4 to 14 years with full-thickness rectal prolapse of grade III–IV according to the Altemeier classification. All patients had a history of surgical correction of various types of ARM. Among them, 8 patients had recurrent prolapse after unsuccessful prior operations. The modified technique included a gentle circumferential mucosectomy with preservation of the submucosal vascular plexus, multilevel three-stage plication of the muscular layer, formation of a muscular cuff with additional fixation to pelvic floor structures, and creation of a submucosal bulwark. The postoperative follow-up period was up to 10 months.</p></sec><sec><title>Results</title><p>Results. The mean operative time was 82 ± 15 min. Postoperative complications (anal canal stenosis) occurred in 3 patients, compared to 20–35% reported in the literature for the classic technique. Functional outcomes showed a marked improvement in continence scores from a baseline of 3.4 ± 1.1 to 8.1 ± 1.3 ball at 6 months on the Krickenbeck scale, versus 6.2 ± 1.4 ball for the classic Delorme procedure. During the follow-up of up to 10 months, no recurrences of rectal prolapse were observed in any patient, compared to 10–17% within the first year with the classic technique.</p></sec><sec><title>Conclusion</title><p>Conclusion. Preliminary results demonstrate high efficacy and safety of the modified Delorme procedure in children with rectal prolapse after ARM correction. The method shows significant advantages over the classic technique and may be recommended for the use in specialized centers. Further research is required to assess long-term outcomes.</p></sec><sec><title>Contribution</title><p>Contribution: Gusev A.A., Okulov E.A. — study concept and design; Gusev A.A., Okulov E.A., Khvorostov I.N., Dyakonova E.Yu., Shchukina A.A., Bekin A.S., Romanova E.A., Tarzyan A.O., Evgenova N.N., Myagkov A.E. — data collection and surgical treatment; Gusev A.A. — data analysis and statistical processing. All co-authors — approval of the final version of the article, responsibility for the integrity of all parts of the article.</p></sec><sec><title>Acknowledgment</title><p>Acknowledgment. The study had no sponsorship.</p></sec><sec><title>Conflict of interest</title><p>Conflict of interest. The authors declare no conflict of interest.</p></sec><sec><title>Received</title><p>Received: September 15, 2025Accepted: October 02, 2025Published: October 30, 2025</p></sec></trans-abstract><kwd-group xml:lang="ru"><kwd>дети</kwd><kwd>ректальный пролапс</kwd><kwd>аноректальные мальформации</kwd><kwd>операция Делорма</kwd><kwd>детская колоректальная хирургия</kwd><kwd>анальная континенция</kwd><kwd>модифицированная хирургическая техника</kwd></kwd-group><kwd-group xml:lang="en"><kwd>children</kwd><kwd>rectal prolapse</kwd><kwd>anorectal malformations</kwd><kwd>Delorme procedure</kwd><kwd>pediatric colorectal surgery</kwd><kwd>anal continence</kwd><kwd>modified surgical technique</kwd></kwd-group></article-meta></front><back><ref-list><title>References</title><ref id="cit1"><label>1</label><citation-alternatives><mixed-citation xml:lang="ru">Wood R.J., Levitt M.A., Peña A. Anorectal malformations: current management and outcomes. Semin. Pediatr. 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