Vol. 5 No. 2 (2026): March-April
14-32
2025-04-30
Open Access

Hepatobiliary Surgery and Liver Transplantation in Children: Structure, Logistics, and Clinical Outcomes of the Department of Minimally Invasive Surgery and Transplantation of the National Children’s Medical Center

Konstantin O.Semash
Timur A.Dzhanbekov
Mansur M.Nasirov
Qosimjon M.Umarov
DOI: https://doi.org/10.56121/MSU-2026-2-00008

Received: 2026-05-19 08:07:44

Published: 2025-04-30

PDF (Russian)
Crossmark Crossmark

Abstract

Aim. To evaluate the organizational structure, logistics, spectrum of surgical interventions, and clinical outcomes of the Department of Minimally Invasive Surgery and Transplantation of the National Children's Medical Center, a specialized pediatric center of the Republic of Uzbekistan.


Materials and Methods. The study included 259 pediatric patients consecutively treated in the department between 2020 and 2026. Data from patients with biliary atresia, choledochal cysts, echinococcosis, extrahepatic portal hypertension, congenital portosystemic shunts, malignant liver tumors, as well as patients who underwent liver transplantation and pancreatoduodenal resections were analyzed. Clinical characteristics, intraoperative parameters, complications, and follow-up outcomes were evaluated.


Results. The most common conditions were echinococcosis (n = 91), biliary atresia (n = 56), choledochal cysts (n = 54), and extrahepatic portal hypertension (n = 17). Among patients with echinococcosis, liver involvement predominated (n = 67), whereas lung involvement (n = 13), combined lesions (n = 6), and involvement of the spleen, diaphragm, and pelvis were less frequent. Open surgery was performed in 68.1% of patients, laparoscopic surgery in 28.6%, and video-assisted thoracoscopic surgery in 3.3%. Recurrence of echinococcosis was observed in 7.7% of patients and was predominantly associated with poor adherence to postoperative albendazole therapy. Twelve living donor liver transplantations were performed in children aged 5 months to 16 years. The main indications for transplantation were biliary atresia, autoimmune hepatitis, Wilson disease, and Caroli disease. The mean operative time was 523.8 ± 117.0 minutes, and the median blood loss was 200 mL. Vascular complications occurred in 25% of recipients, whereas no biliary complications were observed. Recipient and graft survival reached 100% throughout the follow-up period. All donors were first- or second-degree relatives; Grade II complications according to the Clavien–Dindo classification occurred in 16.7% of donors, with no donor mortality.


The cohort also included 20 patients with primary malignant liver tumors (hepatoblastoma and hepatocellular carcinoma) managed through a multidisciplinary approach in collaboration with the pediatric oncology service. The extent of liver resection was determined according to the PRETEXT classification. Experience with extended right hemihepatectomy in infants aged 5–11 months demonstrated R0 resection in all cases, with a mean intraoperative blood loss of 120 mL and no perioperative mortality. Liver transplantation was considered for unresectable tumors according to established oncological selection criteria.


Among 17 patients with extrahepatic portal hypertension, all underwent preoperative wedged angiography. A Rex shunt was performed in one patient, a Warren shunt in five patients, and devascularization procedures in two patients. Two patients required reoperation because of shunt thrombosis and stenosis. Between 2023 and 2026, five pancreatoduodenal resections were performed: four for solid pseudopapillary neoplasms of the pancreas and one for insulinoma. One patient developed a gastroenteric anastomotic fistula, while another experienced recurrent insulinoma requiring subtotal pancreatectomy. All patients were discharged and remained under outpatient follow-up. In addition, four patients with congenital portosystemic shunts were treated.


Conclusion. The experience of the National Children's Medical Center demonstrates the feasibility of establishing a comprehensive pediatric hepatobiliary surgery and liver transplantation program in a middle-income country. An integrated patient referral system, a multidisciplinary approach, and international collaboration enabled excellent survival outcomes and facilitated the development of a national referral center for pediatric HPB surgery in Central Asia.

Keywords

List of references

  1. Larghi Laureiro Z, Angelico R, Rigamonti A, Saffioti MC, Maritato S, Grimaldi C, Spada M. Minimally invasive hepatopancreatic and biliary surgery in children: a large centre experience and review of the literature. HPB (Oxford). 2022 Jun;24(6):857-867. https://doi.org/10.1016/j.hpb.2021.10.013.

  2. Khudaybergenova A, Alimov A, Sabirov D. Development of liver transplantation in Uzbekistan. Science and Innovation. 2025;4(7):69-74. https://doi.org/10.5281/zenodo.16732807.

  3. Semash K, Voskanov M. Diagnostic challenges and treatment approaches for hydatid cysts in atypical localizations. World J Nephrol. 2025;14(3):107955. https://doi.org/10.5527/wjn.v14.i3.107955.

  4. Semash K, Dzhanbekov T, Akbarov M, Mirolimov M, Usmonov A, Razzokov N, Primov Z, Gaybullaev T, Yigitaliev S. Implementation of a living donor liver transplantation program in the Republic of Uzbekistan: a report of the first 40 cases. Clin Transplant Res. 2024;38(2):116-127. https://doi.org/10.4285/ctr.24.0013.

  5. Vuohijoki A, Ristolainen L, Leppilahti J, Kivivuori SM, Hurri H. Impact of joint commission international accreditation on occupational health and patient safety: A systematic review. PLoS One. 2025 Jun 17;20(6):e0325894. https://doi.org/10.1371/journal.pone.0325894x.

  6. Semash K. Evaluation and Management of Living Donors in the Setting of Living Donor Liver Transplant Program in the Republic of Uzbekistan. Exp Clin Transplant. 2024 Sep;22(9):664-674. https://doi.org/10.6002/ect.2024.0148.

  7. Semash K. Post-liver transplant biliary complications. Russian Journal of Transplantology and Artificial Organs. 2024;26(3):72-90. https://doi.org/10.15825/1995-1191-2024-3-72-90.

  8. Semash K.O., Dzhanbekov T.A., Akbarov M.M. Vascular complications after liver transplantation: contemporary approaches to detection and treatment. A literature review. Russian Journal of Transplantology and Artificial Organs. 2023;25(4):46-72. https://doi.org/10.15825/1995-1191-2023-4-46-72.

  9. Davenport M. Updates in Biliary Atresia: Aetiology, Diagnosis and Surgery. Children. 2025; 12(1):95. https://doi.org/10.3390/children12010095.

  10. Semash K, Nasirov M, Dzhanbekov T, Khudaybergenova A. Laparoscopic Kasai portoenterostomy for biliary atresia: first experience from Central Asia. Front Pediatr. 2025;13:1666539. https://doi.org/10.3389/fped.2025.1666539.

  11. Davenport M, Betalli P, D'Antiga L, Cheeseman P, Mieli-Vergani G, Howard ER. The spectrum of surgical jaundice in infancy. J Pediatr Surg. 2003;38(10):1471-9. https://doi.org/10.1016/s0022-3468(03)00498-6.

  12. Ishibashi H, Shimada M, Kamisawa T, Fujii H, Hamada Y, Kubota M, Urushihara N, Endo I, Nio M, Taguchi T, Ando H; Japanese Study Group on Congenital Biliary Dilatation (JSCBD). Japanese clinical practice guidelines for congenital biliary dilatation. J Hepatobiliary Pancreat Sci. 2017;24(1):1-16. https://doi.org/10.1002/jhbp.415.

  13. Lee KH, Tam YH, Yeung CK, Chan KW, Sihoe JD, Cheung ST, Mou JW. Laparoscopic excision of choledochal cysts in children: an intermediate-term report. Pediatr Surg Int. 2009;25(4):355-60. https://doi.org/10.1007/s00383-009-2343-9.

  14. Wen Z, Liang H, Liang J, Liang Q, Xia H. Evaluation of the learning curve of laparoscopic choledochal cyst excision and Roux-en-Y hepaticojejunostomy in children: CUSUM analysis of a single surgeon's experience. Surg Endosc. 2017;31(2):778-787. https://doi.org/10.1007/s00464-016-5032-5.

  15. Semash K.O., Dzhanbekov T.A., Nasyrov M.M., Monakhov A.R., Gadzhieva P.M., Masyutin S.A. Pediatric liver transplantation in Uzbekistan: first clinical case and outcome analysis. Russian Journal of Transplantology and Artificial Organs. 2025;27(4):67-73. https://doi.org/10.15825/1995-1191-2025-4-67-73.

  16. Semash K, Dzhanbekov T. Large-for-size syndrome prophylaxis in infant liver recipients with low body mass. World J Transplant. 2025;15(1):99452. https://doi.org/10.5500/wjt.v15.i1.99452.

  17. Konstantin S, Timur D, Mansur N, Bakhtiyorjon U, Navruz Q, Bakhtiyor K. Neurological Complications After Pediatric Liver and Kidney Transplantation: A Comprehensive Review of Acute Symptomatic Seizures. Pediatr Transplant. 2026;30(5):e70341. https://doi.org/10.1111/petr.70341. Erratum in: Pediatr Transplant. 2026;30(6):e70366. https://doi.org/10.1111/petr.70366.

  18. Lucas B, Ravishankar S, Pateva I. Pediatric Primary Hepatic Tumors: Diagnostic Considerations. Diagnostics (Basel). 2021;11(2):333. https://doi.org/10.3390/diagnostics11020333.

  19. Semash K, Dzhanbekov T, Islomov S. Case Report: Major right-sided hepatectomies in infants in Uzbekistan: a case series. Front Pediatr. 2025;12:1495165. https://doi.org/10.3389/fped.2024.1495165.

  20. Semash KO, Dzhanbekov TA. Primary outcomes after major anatomical liver resections in infants at the National Children’s Medical Center. Pirogov Russian Journal of Surgery. 2025;(4):86 94. (In Russ.) https://doi.org/10.17116/hirurgia202504186.

  21. de Ville de Goyet J, D'Ambrosio G, Grimaldi C. Surgical management of portal hypertension in children. Semin Pediatr Surg. 2012;21(3):219-32. https://doi.org/10.1053/j.sempedsurg.2012.05.005.

  22. Yuldashev RZ, Aliev MM, Maksudov MF, Khaydarov UO, Shokhaydarov S. Angiographic patterns of portal venous system in children with extrahepatic portal hypertension and its etiological and clinical relevance. Pediatr Surg Int. 2023;39(1):97. https://doi.org/10.1007/s00383-023-05384-3.

  23. de Ville de Goyet J, Alberti D, Falchetti D, Rigamonti W, Matricardi L, Clapuyt P, Sokal EM, Otte JB, Caccia G. Treatment of extrahepatic portal hypertension in children by mesenteric-to-left portal vein bypass: a new physiological procedure. Eur J Surg. 1999;165(8):777-81. https://doi.org/10.1080/11024159950189573.

  24. Young V, Rajeswaran S. Management of Portal Hypertension in the Pediatric Population: A Primer for the Interventional Radiologist. Semin Intervent Radiol. 2018;35(3):160-164. https://doi.org/10.1055/s-0038-1660794.

  25. Rozhkova V, Burlaka A, Kvasivka O, Lisnyy I, Beznosenko A, Kopchak K, Cheverdiuk D, Lukashenko A. Pediatric pancreatectomy for neoplasms: indications, outcomes, and implementation of minimally invasive surgery in a Ukrainian tertiary center. BMC Pediatr. 2025;25(1):441. https://doi.org/10.1186/s12887-025-05802-6.

  26. Zdanowicz K, Daniluk J, Lebensztejn DM, Daniluk U. The Etiology of Cholelithiasis in Children and Adolescents-A Literature Review. Int J Mol Sci. 2022;23(21):13376. https://doi.org/10.3390/ijms232113376.

  27. Semash KO, Salakhitdinov ShN, Nasyrov MM, Dzhanbekov TA, Yusubov AD, Umarov BYa, Sabirov JR. Endovascular closure of a large intrahepatic portosystemic shunt in a 3-month-old infant: the first case in Uzbekistan and literature review. Pirogov Russian Journal of Surgery. 2026;(6):121 126. (In Russ.) https://doi.org/10.17116/hirurgia2026061121.

  28. Semash K, Salakhitdinov S, Nasirov M, Dzhanbekov T, Yusubov A, Umarov B. Endovascular closure of a large intrahepatic portosystemic shunt in a three-month-old infant: a case report and literature review. Front Pediatr. 2026;14:1862205. https://doi.org/10.3389/fped.2026.1862205.

  29. Semash K, Akhmedov A, Dzhanbekov T, Umarov Q, Dustmurodov J. Implementation of a pediatric kidney transplantation program in Uzbekistan: Feasibility and early outcomes. World J Transplant. 2025 Dec 18;15(4):107728. https://doi.org/10.5500/wjt.v15.i4.107728. PMID: 41357399; PMCID: PMC12679264.

  30. Semash K, Dzhanbekov T, Nasirov M, Monakhov A, Gadzhieva P. Bortezomib as a Potential Treatment for Recurrent Autoimmune Hepatitis Following Pediatric Liver Transplantation. Pediatr Transplant. 2025 Jun;29(4):e70082. https://doi.org/10.1111/petr.70082. PMID: 40304093.

  31. Semash K, Dzhanbekov T, Nasirov M, Subanov A, Umarov B. Venous reconstruction in living donor liver transplantation: lessons learned from a new national program in a resource-limited setting. Transpl Int. 2026;39:15985. https://doi.org/10.3389/ti.2026.15985.

  32. Semash K, Dzhanbekov T, Nasirov M, Syrkina A, Umarov B. Neurological recovery after liver transplantation in a severely disabled adolescent with Wilson disease: a 1-year follow-up case report. Front Pediatr. 2026;14:1862229. https://doi.org/10.3389/fped.2026.1862229.

  33. Semash K, Salimov U, Dzhanbekov T, Sabirov D. Liver Graft Machine Perfusion: From History Perspective to Modern Approaches in Transplant Surgery. Exp Clin Transplant. 2024;22(7):497-508. https://doi.org/10.6002/ect.2024.0137. PMID: 39223808.

  34. Ibadov R, Semash K, Usmonov A, Ibragimov S, Popov A, Lishchenko A, et al. Near-Infrared Spectroscopy (NIRS) for Early Postoperative Monitoring of Graft Oxygenation in Living Donor Liver Transplantation: A Prospective Observational Study. Clin Transplant. 2026;40(6):e70589. https://doi.org/10.1111/ctr.70589.

  35. Semash K, Dzhanbekov T. Laparoscopic donor hepatectomy: Are there obstacles on the path to global widespread? Laparosc Endosc Robot Surg. 2024;7(3):123-127. https://doi.org/10.1016/j.lers.2024.12.002.

  36. Semash K. Robotic surgery in living liver donors and liver recipients. Laparosc Endosc Robot Surg. 2024. https://doi.org/10.1016/j.lers.2024.06.003.

About the Authors

Konstantin O.Semash
doctorsemash@gmail.com
National Children's Medical Center
Timur A.Dzhanbekov
house-md@mail.ru
National Children's Medical Center
Mansur M.Nasirov
mansoornasyrov@gmail.com
National Children's Medical Center
Qosimjon M.Umarov
Qosimjon81@mail.ru
National Children's Medical Center

License

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

How to Cite

1.
Hepatobiliary Surgery and Liver Transplantation in Children: Structure, Logistics, and Clinical Outcomes of the Department of Minimally Invasive Surgery and Transplantation of the National Children’s Medical Center. MSU [Internet]. 2025 Apr. 30 [cited 2026 Jun. 30];5(2):14-32. Available from: https://fdoctors.uz/index.php/journal/article/view/263
Crossref
Scopus
Google Scholar
Europe PMC

Similar Articles

You may also start an advanced similarity search for this article.


ISSN 2181-3612 (Online)