Pediatr. Surg. Int. [JOURNAL]
Sun
200 papers
Elective interval appendectomy following non-operative management for uncomplicated acute appendicitis: a feasible same-day discharge strategy in children.
Abiko R, Goto H, Fukada A … +14 more , Iwakami T, Shimizu M, Yoneda Y, Motoyama Y, Cazares J, Koga H, Kitajima M, Futagawa A, Innami Y, Okada Y, Ponsky T, Nagakawa Y, Ohashi N, Yamataka A
Pediatr Surg Int · 2026 Jul · PMID 42397443 · Publisher ↗
PURPOSE: Reliable predictors of recurrence after non-operative management (NOM) for pediatric uncomplicated acute appendicitis (UCAA) are lacking. Patients and families often face uncertainty and anxiety about recurrence...
PURPOSE: Reliable predictors of recurrence after non-operative management (NOM) for pediatric uncomplicated acute appendicitis (UCAA) are lacking. Patients and families often face uncertainty and anxiety about recurrence. We evaluated elective interval appendectomy (E-IA) after NOM, focusing on same-day discharge (SDD). METHODS: We retrospectively reviewed patients aged ≤ 18 years who underwent laparoscopic E-IA after successful NOM for UCAA between 2017 and 2025. UCAA was defined as ultrasound grade I/IIa appendicitis without perforation, abscess, or diffuse peritonitis. Characteristics, perioperative outcomes, histopathology, and patient/family and staff satisfaction were analyzed. RESULTS: A total of 120 patients underwent E-IA (SDD, n = 40; inpatient management, n = 80). Median age was 13.0 years; fecalith was present in 25 patients (20.8%). Median interval from scheduling to surgery was 48.5 days and operative time was 38.0 min. Complications occurred in 3 patients (2.5%), with no unplanned visits or readmissions. SDD was successful in 39/40 patients (97.5%). Recurrence before E-IA occurred in 5 patients (4.2%); all improved with repeat NOM and underwent E-IA. Patient/family and staff satisfaction were 83.3% and 89.3%, respectively. All specimens showed either acute inflammatory findings or chronic/resolving reparative changes, with none classified as histologically normal. CONCLUSIONS: E-IA after NOM for UCAA was associated with low morbidity and SDD feasibility, suggesting a potentially new treatment concept for UCAA.
Predictors of organ injury in pediatric bicycle handlebar trauma: a single-center retrospective study.
Duman-Kucukkuray M, Sagsoz N, Serttürk F … +1 more , Caglar O
Pediatr Surg Int · 2026 Jul · PMID 42397438 · Publisher ↗
PURPOSE: Bicycle handlebar injuries in children can cause severe internal trauma despite a seemingly low-energy mechanism. External signs are unreliable indicators of underlying organ damage, and independent clinical pre...
PURPOSE: Bicycle handlebar injuries in children can cause severe internal trauma despite a seemingly low-energy mechanism. External signs are unreliable indicators of underlying organ damage, and independent clinical predictors of organ injury have not been systematically evaluated. METHODS: A retrospective review was performed of patients under 18 years presenting with bicycle handlebar injuries to a tertiary pediatric surgery center (June 2023-December 2025). Firth penalized-likelihood logistic regression was used to identify independent predictors of abdominal organ injury, and diagnostic performance metrics were calculated for key clinical findings. RESULTS: Fifty-one patients were included (mean age 10.5 ± 2.7 years; 90.2% male). Seventeen patients (31.4%) sustained organ injuries. Abdominal pain (43.1%) and chest pain (9.8%) were the most common symptoms. On multivariable analysis, abdominal pain was an independent predictor of abdominal organ injury (adjusted OR = 11.00; 95% CI 2.31-52.33; p < 0.001; AUC = 0.78). Chest pain was recorded in 5 patients and accompanied thoracic injury in all of them. The handlebar sign was present in 45.1% but was not a significant predictor overall; however, upper abdominal bruise location was associated with organ injury in 77.8% of cases, whereas no organ injury occurred with lower abdominal bruising. Ten patients (19.6%) required surgery. No mortality was observed. CONCLUSION: Abdominal pain was an independent predictor of abdominal organ injury. Upper abdominal bruise location was associated with a high rate of organ injury and may serve as a localizing sign, and chest pain reflected thoracic injury. These results support a symptom and anatomy-guided triage approach for pediatric handlebar trauma. LEVEL OF EVIDENCE: IV (Retrospective study).
Can urinary exosomal lncRNAs HOTAIR and MALAT1 predict surgical need and outcomes in unilateral antenatal hydronephrosis?
Ergül RB, Küçükgergin C, Selvi I … +5 more , Aydın AF, Seçkin Ş, Dönmez Mİ, Ziylan O, Oktar T
Pediatr Surg Int · 2026 Jul · PMID 42397434 · Publisher ↗
PURPOSE: Antenatal hydronephrosis is the most common prenatal urinary tract abnormality, and some cases, mainly due to ureteropelvic junction obstruction, require surgery. Noninvasive biomarkers are needed to improve dia...
PURPOSE: Antenatal hydronephrosis is the most common prenatal urinary tract abnormality, and some cases, mainly due to ureteropelvic junction obstruction, require surgery. Noninvasive biomarkers are needed to improve diagnosis and guide management. To evaluate urinary exosomal long non-coding RNAs, specifically MALAT1 and HOTAIR, as biomarkers for predicting surgical necessity in children with unilateral antenatal hydronephrosis, and to develop an AI-based predictive model. METHODS: This retrospective case-control study included 88 children (38 requiring pyeloplasty, 26 non-obstructive dilatation, 24 controls). Urinary exosomes were isolated, and lncRNA expression was quantified by RT-qPCR. Clinical variables included anteroposterior pelvic diameter and split renal function. Diagnostic performance was assessed by ROC analysis and logistic regression. A SVM model was developed integrating biomarker and clinical data, with 5-fold cross-validation and an interactive Shiny web application for clinical translation. RESULTS: Preoperative MALAT1 and HOTAIR levels were significantly elevated compared to non-obstructive dilatation and controls and decreased after surgery (p < 0.001). MALAT1 remained an independent predictor of surgical intervention (OR = 1.272, p < 0.001) in multivariate analysis, alongside APD and SRF. MALAT1 showed an AUC of 0.745 (cut-off: 9.06), and HOTAIR an AUC of 0.685 (cut-off: 11.76). The SVM model achieved 91.9% accuracy, 89.5% sensitivity, 95.8% specificity, and an AUC of 0.951. CONCLUSIONS: Urinary exosomal MALAT1 and HOTAIR are promising noninvasive biomarker for predicting surgical need in pediatric ureteropelvic junction obstruction. Integration with clinical parameters in an SVM-based model enhances diagnostic precision, and the development of a freely accessible web application supports real-time individualized risk prediction.
An interim analysis of the standard care (stoma bags) and double-diapers in pediatric patients with stomas at a tertiary hospital in South Africa.
Van Straten SK, Scribante J, Botes A … +9 more , De Witt R, Lamprecht CH, Papavarnava A, Oelofse HG, Rockman C, Bebington C, Bloem D, Dyamara L, Brisighelli G
Pediatr Surg Int · 2026 Jul · PMID 42397433 · Full text
PURPOSE: In resource-limited settings, commercial stoma bags are often unavailable for pediatric colostomy patients, necessitating affordable and accessible alternatives for colostomy care. This is an interim analysis of...
PURPOSE: In resource-limited settings, commercial stoma bags are often unavailable for pediatric colostomy patients, necessitating affordable and accessible alternatives for colostomy care. This is an interim analysis of a study comparing standard of care (stoma bags (SB)) with double-diaper (DD) in patients with colostomies at the Johannesburg Pediatric Colorectal Clinic (JPCC) at Chris Hani Baragwanath Academic Hospital, South Africa. METHODS: A prospective, randomized descriptive study enrolled children < 3 years with newly created colostomies whose caregivers consented; participants were randomized via REDCap to SB or DD and followed up at routine visits until colostomy closure. RESULTS: Of 45 screened patients, 40 were enrolled; 22 (55%) were female, with a mean (SD) age of 110.15 (151.22) days and weight of 4.57 (1.51) kg. Most had anorectal malformations (30, 75%), end colostomies (24, 60%), and 29 (72.5%) had sigmoid colostomies. At analysis, 23 (58.97%) underwent closure. At enrolment, 19 (47.50%) were randomized to SB and 21 (52.50%) to DD; 28 (71.79%) remained in their assigned group, while 12 (29.27%) crossed over due to guardian preference (7, 38.89%) or healthcare provider recommendation (11, 61.11%). Baseline mean (SD) peristomal skin scores (using the OST scoring system) were 0.83 (1.99) for the SB group compared to 2.31 (3.61) (worse) for the DD group (p = 0.402). Follow-up scores among those remaining in their groups were: SB group 0.55 (1.54) and DD group 1.7 (2.51) (p = 0.002). Patients who crossed over had mean (SD) scores of 1.42 (2.46) at enrollment and 2.05 (2.63) at follow-up. Mean (SD) clinic visits were 3.92 (2.47) for the SB group, 5.73 (3.87) for the DD group, and 7.75 (2.83) for the mixed group (p = 0.01). When supplies were depleted, 12 (28.57%) returned for more of their respective product, while 29 (69.05%) purchased diapers. Care givers out-of-pocket expenditure as lower in SB 1 (6.7%) and 5 (29.4%) in DD group (p = 0.01). Patients who remained in the SB group reported satisfaction with bag quality 10 (66.7%), compared to those who crossed over 4 (26.7%) (p = 0.02). CONCLUSION: Diapers are an accessible alternative to commercial stoma bags for patients with colostomies.
Failed ultrasound-guided hydrostatic reduction in pediatric intussusception: surgical-pathological characterization of failure phenotypes under a standardized protocol.
Zhang G, Sun M, Guo H … +6 more , Huang P, Feng X, Bian H, Duan X, Yang J, Zheng K
Pediatr Surg Int · 2026 Jul · PMID 42397408 · Full text
BACKGROUND: Ultrasound-guided hydrostatic reduction (UGHR) represents the first-line treatment for pediatric intussusception. However, treatment failure remains a persistent clinical challenge, driven largely by unrecogn...
BACKGROUND: Ultrasound-guided hydrostatic reduction (UGHR) represents the first-line treatment for pediatric intussusception. However, treatment failure remains a persistent clinical challenge, driven largely by unrecognized pathological lead points (PLPs) before intervention. Large-cohort studies with complete surgical and pathological verification of all failed cases under a unified protocol remain scarce, leaving the true etiology and clinical phenotype of UGHR failure incompletely defined. PURPOSE: To define the distinct clinicopathological phenotype and surgical findings associated with UGHR treatment failure in a fully verified patient cohort, and to evaluate the safety and efficacy of the standardized protocol within which these failures occurred. METHODS: We conducted a retrospective cohort study of 2,882 children with acute intussusception managed with a standardized UGHR protocol (fixed pressure parameters, real-time ultrasound monitoring, predefined termination criteria) between 2021 and 2025. All 32 patients with failed reduction underwent mandatory emergency surgical exploration and histopathological examination, establishing a "surgical truth" dataset for comprehensive failure characterization. Analyses were intentionally descriptive and centered on deep phenotyping of this fully verified failure cohort rather than predictive modeling across the entire study population. RESULTS: The standardized protocol achieved an overall success rate of 98.89% (2,850/2,882) with zero intra-procedural perforations. Among the 32 failure cases, 21(65.63%) were secondary intussusception caused by PLPs, most commonly Meckel diverticulum(n = 10) and Burkitt lymphoma (n = 4). A consistent high-risk phenotype was identified in PLP-related failures: age > 36 months (52.4%), symptom duration > 24 h (81.0%), bloody stool (61.9%), peritoneal fluid (71.4%), and atypical anatomical subtypes (ileoileocolic or small bowel intussusception). Notably, 91.7% (11/12) of children aged > 36 months in the failure cohort had a confirmed PLP. CONCLUSION: A rigorously standardized UGHR protocol is highly effective and safe for pediatric intussusception. Most treatment failures are attributable to occult PLPs, which cluster within a recognizable high-risk clinical phenotype. The extremely high PLP rate in older children with failed reduction (11/12, 91.7% in > 36 months) suggests a clinically relevant age-associated consideration for surgical suspicion, though based on a small subgroup. Integrating standardized protocol implementation with phenotype-guided surgical triage optimizes the balance between non-operative success and timely identification of underlying pathology.
Finite element-guided optimization of personalized vacuum bell devices for pectus excavatum: an exploratory retrospective clinical study.
Jiang S, Ye X, Zhang F … +6 more , Chen H, Liu Y, Liu L, Shen W, Yan M, Liu Z
Pediatr Surg Int · 2026 Jul · PMID 42390767 · Publisher ↗
BACKGROUND: Vacuum bell (VB) therapy is a noninvasive option for pectus excavatum (PE), but the clinical value of device optimization remains unclear. This study used finite element analysis (FEA) to guide VB design opti...
BACKGROUND: Vacuum bell (VB) therapy is a noninvasive option for pectus excavatum (PE), but the clinical value of device optimization remains unclear. This study used finite element analysis (FEA) to guide VB design optimization and retrospectively evaluated the outcomes of the final customized devices in pediatric PE. METHODS: Two finite element models (VB1 and VB2) were constructed from three-dimensional chest wall point-cloud data. Their deformation and stress distributions were compared to derive structural optimization principles. The final clinical devices were customized accordingly. We retrospectively analyzed 69 pediatric patients with PE treated at a single center between January 2024 and December 2025. Three-dimensional scanning was used to assess thoracic dimensions and sternal depression depth. RESULTS: FEA showed that deformation was concentrated at the center of the polycarbonate observation window, whereas peak stress occurred at the junction between the window and the silicone ring, identifying this region as a key target for optimization. In the clinical cohort, 68/69 patients (98.55%) showed measurable correction of anterior chest wall depression, and 29/69 (42.03%) achieved excellent or good outcomes. Thoracic transverse diameter, longitudinal diameter, and sternal depression depth were all significantly reduced after treatment (all P < 0.05). CONCLUSIONS: FEA-guided optimization may improve VB structural stability and negative-pressure regulation. The optimized customized devices showed favorable objective morphological outcomes in pediatric PE.
Age and seasonality in Hirschsprung-associated enterocolitis risk: a longitudinal cohort study.
Alzate-Ricaurte S, Bielicki I, Ketzer J … +5 more , Kaar J, Martin H, Peña A, De la Torre L, Bischoff A
Pediatr Surg Int · 2026 Jul · PMID 42384215 · Publisher ↗
PURPOSE: Hirschsprung-associated enterocolitis (HAEC) remains a major cause of morbidity, with poorly defined triggers and limited modifiable risk factors. Given the roles of immune immaturity and mucosal dysfunction in...
PURPOSE: Hirschsprung-associated enterocolitis (HAEC) remains a major cause of morbidity, with poorly defined triggers and limited modifiable risk factors. Given the roles of immune immaturity and mucosal dysfunction in HAEC pathogenesis, this study evaluated whether age is associated with HAEC risk, and whether seasonal variation consistent with viral exposure is present. METHODS: A retrospective cohort study was conducted including patients with HD treated at Children's Hospital Colorado (2008-2021). A piecewise exponential Poisson regression model estimated age-specific HAEC incidence rates, adjusting for Trisomy 21 and length of aganglionosis. Seasonal distribution was assessed using an exact binomial test comparing cold (October-March) versus warm months. RESULTS: Among 217 patients, 96 HAEC episodes were identified in 53 patients (24.4%). HAEC incidence was highest in the first year of life and declined progressively with age, with an 88% reduction in patients older than 36 months (RR 0.12, 95% CI 0.07-0.22, p < 0.001). Additionally, 60.4% of episodes occurred during cold months, exceeding expected distribution (p = 0.03). CONCLUSION: HAEC risk is strongly age-dependent, with a marked reduction after 36 months, supporting a role for immune maturation in disease susceptibility. The observed seasonal pattern suggests that viral exposures may act as triggers in susceptible patients.
Neonatal single-site divided colostomy in anorectal malformation.
Olsbø S, Austrheim AI, Hoel AT … +1 more , Bjørnland K
Pediatr Surg Int · 2026 Jun · PMID 42371163 · Full text
PURPOSE: To evaluate outcomes of a single-site divided colostomy in neonates with anorectal malformations (ARM). METHODS: A retrospective review was conducted of neonates with ARM undergoing colostomy creation between 20...
PURPOSE: To evaluate outcomes of a single-site divided colostomy in neonates with anorectal malformations (ARM). METHODS: A retrospective review was conducted of neonates with ARM undergoing colostomy creation between 2012 and 2024 at a tertiary referral center. The technique used a divided colostomy with the proximal limb raised ~ 1.5 cm above skin level and a narrowed distal mucous fistula within the same opening, allowing coverage with a single stoma bag. The distal bowel was irrigated at surgery. Complications were classified using the Clavien-Madadi (CM) system. RESULTS: Sixty-one patients (79% male) were included, operated at a median age of 1 (1-3) day. Postoperative complications occurred in 12 (20%) patients. Two (3%) had CM IIIb complications (parastomal hernia and misidentification of bowel limbs). Urinary tract infection (CM II) developed in 6 (10%) patients; three with rectourethral fistula (one with vesicoureteral reflux), two with cloaca, and one without a fistula. Additional complications included granulation tissue requiring treatment (1) and wound infections requiring antibiotics (3). Major dressing difficulties were reported in 5 (8%) patients, while 20 (33%) had minor to moderate issues managed conservatively. CONCLUSION: Single-site divided colostomy is a safe technique with predominantly minor complications, minimal scarring, and no observed fecal overflow.
Lobectomy versus lung-sparing resection for congenital pulmonary airway malformation (CPAM): a single-center comparative study.
Paraboschi I, Pierucci UM, Ardenghi C … +10 more , Marinaro M, Ceresola M, Durante E, Baroni S, Zirpoli S, Ghezzi M, Izzo F, Mandelli A, Costanzo S, Pelizzo G
Pediatr Surg Int · 2026 Jun · PMID 42371134 · Full text
AIM: To compare perioperative and long-term outcomes of lobectomy versus lung-sparing resection in children undergoing surgery for congenital pulmonary airway malformation (CPAM). METHODS: A retrospective single-center s...
AIM: To compare perioperative and long-term outcomes of lobectomy versus lung-sparing resection in children undergoing surgery for congenital pulmonary airway malformation (CPAM). METHODS: A retrospective single-center study was conducted including children who underwent primary surgical resection for postnatally confirmed CPAM between 2005 and 2024. Patients with other congenital lung lesions, bilateral disease, syndromic conditions, or incomplete data were excluded. Perioperative variables, postoperative outcomes, redo surgery, and chest wall anomalies were compared between lobectomy and lung-sparing resections. Continuous variables were analyzed using the Mann-Whitney U test and categorical variables using Fisher's exact test. RESULTS: Thirty-one children were included (22 lobectomies, 9 lung-sparing resections), with a median age at surgery of 8 months. Operative time (207 vs. 149 min, p = 0.0425) and anesthesia time (371 vs. 230 min, p = 0.0171) were significantly longer for lobectomy. Intraoperative complications occurred in 10% of patients, with no significant difference between groups. Postoperative complications were less frequent after lobectomy (19% vs. 44%), although not statistically significant (p = 0.1954). Redo surgery was required exclusively after lung-sparing resections (33% vs. 0%, p = 0.0207). Length of hospital stay and NICU/PICU stay were comparable. At a median follow-up of 71 months, chest wall deformities were observed less often after lobectomy (22% vs. 43%, p = 0.3554). CONCLUSIONS: Despite longer operative and anesthesia times, lobectomy provided more definitive disease control, with a significantly lower need for redo surgery compared with lung-sparing resection. Lobectomy remains the most reliable surgical option for CPAM in children, while lung-sparing approaches should be reserved for carefully selected cases.
A comparative analysis of retroperitoneal small-incision open pyeloplasty and laparoscopic pyeloplasty for infantile hydronephrosis.
Liu L, Li Y, Meng Q … +6 more , Xu H, Chen Z, Wang X, Liu X, Li X, Xu G
Pediatr Surg Int · 2026 Jun · PMID 42371133 · Publisher ↗
BACKGROUND: With the development of minimally invasive surgery, laparoscopic pyeloplasty has become the mainstream surgery for ureteropelvic junction obstruction(UPJO), while open surgery is used less frequently. However...
BACKGROUND: With the development of minimally invasive surgery, laparoscopic pyeloplasty has become the mainstream surgery for ureteropelvic junction obstruction(UPJO), while open surgery is used less frequently. However, in regions where endoscopic techniques are not yet well-developed or in very young infants, open pyeloplasty still plays a significant role. This study aims to evaluate the clinical efficacy and safety of the retroperitoneal small-incision open pyeloplasty in infants by comparing it with laparoscopic pyeloplasty. METHODS: This retrospective cohort enrolled 117 infants diagnosed with UPJO and underwent pyeloplasty at the Department of Urology of Tianjin Children's Hospital between December 2019 and June 2025. These patients were divided into two groups according to the operation method. Open pyeloplasty (OP) and laparoscopic pyeloplasty (LP) were performed on 47 and 70 of these 117 patients, respectively. The clinical characteristics and follow-up data of these cohorts were retrospectively collected and analyzed. Statistical analyses were performed using GraphPad Prism 10.6.0. Normality of continuous variables was assessed by the Shapiro-Wilk test. Comparisons between the laparoscopic and open pyeloplasty groups were performed using the unpaired Student's t-test (for normally distributed data) or the Mann-Whitney U test (for non-normally distributed data). Categorical variables were analyzed using the chi-square test, with Fisher's exact test applied when expected cell counts were less than 5. A two-tailed p-value < 0.05 was considered statistically significant. RESULTS: A total of 117 pediatric patients were included in the study, with 47 infants in the OP group, and 70 in the LP group. The operative time (93.79 ± 22.38 vs. 155.13 ± 33.07 min, P < 0.0001), time of postoperative meal intake(1.23 ± 0.57 vs. 2.17 ± 0.79 day, P < 0.0001), and hospitalization expenses (33041 ± 2394 vs. 53645 ± 1968 yuan, P < 0.0001) were significantly shorter in OP group than in LP group, whereas the duration of postoperative hospital stay(19.40 ± 4.45 vs. 12.68 ± 3.63 day, P < 0.0001), the postoperative transfusion rate ( 6 vs. 0, P = 0.005) were significantly lower in the LP group than in the OP group. No significant differences were observed between the two groups with respect to age, side, SFU grade, follow-up duration, rate of diarrhea, or reintervention rate. The ureteral stent was removed at the mean of 12.98 ± 3.86 postoperative days, and the nephrostomy tube at 17.75 ± 13.48 postoperative days. In contrast, the peritoneal cavity drainage tube was removed at 3.41 ± 2.14 postoperative days, while the double-J tube was removed via ureteroscopy at 70.68 ± 16.81 postoperative days( P < 0.0001 ). Postoperative urine cultures were positive in 38 patients of the LP group compared to 7 cases in the OP group. Furthermore, 8 patients in LP group were diagnosed with acute pyelonephritis and required hospitalization for treatment. Both surgical procedures significantly reduced postoperative APD (all P < 0.001). The OP group presented a higher preoperative baseline APD than the LP group (P = 0.010). Nevertheless, no significant intergroup difference was observed in postoperative APD levels (P = 0.593). Additionally, the difference in APD reduction between the two groups was marginally non-significant (P = 0.055). CONCLUSIONS: At our center, retroperitoneal small-incision open pyeloplasty required shorter operative times than LP, avoiding DJ stent placement and potentially reducing the risk of postoperative urinary tract infections. While both procedures are effective for UPJO in selected infants, neither can be universally regarded as superior, and treatment decisions should be individualized based on patient characteristics.
Factors associated with in-hospital mortality of neonates with anorectal malformations managed at a tertiary centre in uganda: a retrospective cohort study.
Elmi SMY, Iranya RN, Kakembo N … +2 more , Kabweru W, Makumbi T
Pediatr Surg Int · 2026 Jun · PMID 42371126 · Publisher ↗
BACKGROUND: Anorectal malformations (ARM) are common congenital anomalies among neonates presenting to paediatric surgical units in Uganda. Optimal care is often hindered by significant health system gaps. However, facto...
BACKGROUND: Anorectal malformations (ARM) are common congenital anomalies among neonates presenting to paediatric surgical units in Uganda. Optimal care is often hindered by significant health system gaps. However, factors influencing mortality among neonates with ARM in Uganda have not been formally evaluated. OBJECTIVE: To determine factors associated with in-hospital mortality among neonates admitted with anorectal malformations at a tertiary hospital in Uganda. METHODS: This retrospective cohort study included consecutive neonates with ARM managed at a single teaching hospital in Uganda from 2015 to 2023. Socio-demographic and clinical data were extracted and analysed. Modified Poisson regression was used to identify factors independently associated with in-hospital mortality. All analyses were two-sided (p < 0.05). Results are presented as incidence risk ratios (IRRs) with 95% confidence intervals (CIs). RESULTS: A total of 226 neonates with ARM were included. The median age at presentation was 3 days (IQR: 2-7). Males accounted for 139 (61.5%) cases. Most neonates presented with intestinal obstruction (60.2%), while 27.4% developed sepsis. The overall in-hospital mortality rate was 20.8% (95% CI: 15.7-26.7). Sepsis and the presence of one or more associated congenital anomalies were independently associated with increased mortality. CONCLUSION: In-hospital mortality among neonates with ARM in Uganda remains high. Sepsis and associated congenital anomalies are significant predictors of mortality in this population.
Bibliometric and clinical review of nuss bar stabilization techniques: a four-phase evolution toward lower bar displacement rates (1998-2025).
Chen M, Xie Y, Chen B … +1 more , Chen Q
Pediatr Surg Int · 2026 Jun · PMID 42371116 · Publisher ↗
PURPOSE: Bar displacement remains one of the most clinically significant complications of the Nuss procedure for pectus excavatum. To our knowledge, no bibliometric analysis has systematically mapped the research landsca...
PURPOSE: Bar displacement remains one of the most clinically significant complications of the Nuss procedure for pectus excavatum. To our knowledge, no bibliometric analysis has systematically mapped the research landscape of bar stabilization methods. This study combines bibliometric analysis with clinical systematic review to fill this gap. METHODS: A dual-database retrieval from Web of Science Core Collection (WoSCC) and PubMed identified publications on Nuss bar stabilization (1998-2025). Following PRISMA 2020 guidelines, 283 publications were included for bibliometric analysis using VOSviewer, CiteSpace, and R-bibliometrix, and 42 core studies were selected for clinical systematic review. Six fixation categories encompassing 19 techniques were analyzed. RESULTS: Publications showed exponential growth across four phases. The USA (31.1%) and South Korea (20.0%) led research output. Journal of Pediatric Surgery and Pediatric Surgery International were identified as Zone 1 core journals. Keyword burst detection revealed a shift from "wire fixation" (2003-2012) to "bridge fixation" and "zero displacement" (2015-2025). Displacement rates decreased from 15% (no stabilizer) to 0% in the largest single-center bridge-fixation series. CONCLUSION: Among the techniques reviewed, bridge fixation is associated with the lowest reported displacement rates across the approximately 6,500 patients in the 42 studies reviewed, achieving 0% in the largest single-center series (Level III evidence, predominantly retrospective data from a single high-volume center; one RCT available). Adequately powered multicenter trials and formal cost-effectiveness analyses are the field's most pressing needs.
Congenital hypoganglionosis: phenotype-based outcomes and evolution of diagnosis and management-a systematic review.
Nakamura H, Yamakawa H, Aoki N … +6 more , Tanaka R, Yoshimoto S, Okunobo T, Satake R, Puri P, Doi T
Pediatr Surg Int · 2026 Jun · PMID 42370961 · Publisher ↗
PURPOSE: Congenital hypoganglionosis (CH) is a rare enteric neuropathy characterized by reduced and small ganglion cells in the myenteric plexus. We aimed to systematically review the clinical outcomes and diagnostic evo...
PURPOSE: Congenital hypoganglionosis (CH) is a rare enteric neuropathy characterized by reduced and small ganglion cells in the myenteric plexus. We aimed to systematically review the clinical outcomes and diagnostic evolution of CH in children. METHODS: A systematic review was conducted in accordance with PRISMA guidelines using PubMed and Web of Science (1978-2025). Of 396 identified records, 32 studies including 298 pediatric patients were analyzed. Disease extent was classified as diffuse/panintestinal, colon-limited, segmental, or unspecified. RESULTS: Among 298 patients, 144 (48%) were classified as diffuse/panintestinal, 25 (8%) as colon-limited, 22 (7%) as segmental, and 107 (36%) were unspecified. Among patients with diffuse/panintestinal disease for whom mortality data were available (n = 105), 28 deaths (26.7%) were documented, whereas no deaths were reported in colon-limited cases (0/24). Most diffuse cases presented in the neonatal period. Diagnostic methods evolved over time, with increasing use of quantitative HuC/D staining after 2020. Surgical management also shifted from resection-based procedures to phenotype-based strategies, including stoma formation and intestinal rehabilitation. CONCLUSION: Diffuse or panintestinal neonatal forms are associated with high mortality, whereas colon-limited disease is associated with favorable survival. Advances in diagnostic techniques have supported phenotype-based management. Extent-based stratification may improve outcomes in severe cases.
Late metachronous contralateral torsion after testicular torsion without contralateral orchiopexy: a mid- to long-term follow-up study.
Harada J, Mitsunari K, Kakita S … +12 more , Sakaguchi J, Mori S, Fukushima H, Kurata H, Matsuda T, Ito I, Araki K, Nakamura Y, Matsuo T, Ohba K, Mochizuki Y, Imamura R
Pediatr Surg Int · 2026 Jun · PMID 42360502 · Publisher ↗
PURPOSE: To evaluate the occurrence and timing of metachronous contralateral testicular torsion (CLTT) in patients with testicular torsion (TT) managed without contralateral orchiopexy (CLOP). METHODS: We retrospectively...
PURPOSE: To evaluate the occurrence and timing of metachronous contralateral testicular torsion (CLTT) in patients with testicular torsion (TT) managed without contralateral orchiopexy (CLOP). METHODS: We retrospectively reviewed patients who underwent emergency TT surgery without CLOP at our hospital between April 2013 and April 2025. Patients with less than 6 months of follow-up, extravaginal torsion, or prior scrotal surgery were excluded. Primary outcomes included CLTT occurrence and time to CLTT. RESULTS: Of 40 patients surgically treated for TT, 24 met inclusion criteria. Median age at surgery was 14.0 years; 75.0% had left-sided TT. A bell-clapper deformity on the affected side was identified in 33.3%. Nineteen patients underwent orchiopexy, and five underwent orchiectomy. The median follow-up duration was 75.3 months. CLTT occurred in 1 of 24 patients (4.2%; 95% CIs, 0.1-21.1%) at 55.3 months after the initial surgery. The patient experienced the initial TT at age 16 years and developed CLTT at age 21 years. CONCLUSION: CLTT can develop several years after the initial episode of TT, and it may occur in adulthood when CLOP is not performed at the time of adolescent onset. However, the small sample size and descriptive design preclude definitive conclusions.
Global prognostic factors for mortality and major postoperative morbidity in neonatal intestinal atresia in the modern surgical era: a systematic review and meta-analysis.
Khosravi R, Alizadeh H
Pediatr Surg Int · 2026 Jun · PMID 42348036 · Publisher ↗
BACKGROUND: Neonatal intestinal atresia remains a significant cause of morbidity and mortality despite advances in neonatal intensive care, anesthesia, and neonatal surgical management. This systematic review and meta-an...
BACKGROUND: Neonatal intestinal atresia remains a significant cause of morbidity and mortality despite advances in neonatal intensive care, anesthesia, and neonatal surgical management. This systematic review and meta-analysis aimed to identify and quantify global prognostic factors associated with mortality and major postoperative morbidity in the modern surgical era. METHODS: A comprehensive systematic literature review and meta-analysis was conducted in major databases from January 2000 to February 2026. Studies reporting mortality or major morbidity (anastomotic leak, unplanned reoperation, sepsis) after surgical repair of intestinal atresia in neonates were included. Data were pooled using a random-effects model. Subgroup and sensitivity analyses were performed to explore heterogeneity. Certainty of evidence was assessed with GRADE. RESULTS: Twenty-one studies comprising 2,040 neonates were included. The pooled mortality rate was 10% (95% CI 5-19%; I²=84%). Mortality was significantly higher in low- and middle-income countries and African studies (p < 0.001). Sensitivity analyses confirmed the robustness of the findings. The pooled unplanned reoperation rate was 15.1% (95% CI 12.7-17.6%; I²=31%) and anastomotic leak rate was 7.5% (95% CI 4.8-13.0%; I²=53%). Independent prognostic factors for adverse outcomes included prematurity (OR 4.9), low birth weight (OR 28.27), associated anomalies (OR 35.34), meconium peritonitis (OR 3.29), and surgical technique (primary anastomosis vs. Bishop-Koop). Sensitivity analyses confirmed robustness of the findings. Certainty of evidence was moderate for mortality and high for reoperation. CONCLUSION: In the modern era, mortality after neonatal intestinal atresia repair remains substantial, with marked disparities between high-income and low- and middle-income settings. Key modifiable and non-modifiable prognostic factors were identified that can inform risk stratification and clinical decision-making. Targeted, context-appropriate interventions in resource-limited settings are urgently needed to close the global survival gap.
Feasibility of left subcostal single-incision laparoscopic surgery for pediatric left retroperitoneal space-occupying lesions.
Yurui W, Zhenhua C, Meng C … +7 more , Yan Z, Hua Z, Yun S, Zexi L, Jing L, Yan Y, Qipeng Z
Pediatr Surg Int · 2026 Jun · PMID 42347968 · Publisher ↗
OBJECTIVE: To evaluate the technical feasibility, safety, and preliminary efficacy of left subcostal single-incision laparoscopic surgery (LS-SILS) in the right lateral position for various left retroperitoneal space-occ...
OBJECTIVE: To evaluate the technical feasibility, safety, and preliminary efficacy of left subcostal single-incision laparoscopic surgery (LS-SILS) in the right lateral position for various left retroperitoneal space-occupying lesions in children. METHODS: This single-center, retrospective, observational case series analyzed 12 consecutive pediatric patients with left retroperitoneal space-occupying lesions who underwent LS-SILS between January and December 2025. All procedures were performed through a 1.5-2.0 cm single incision in the left subcostal region with the patient positioned at approximately 70° right lateral decubitus. We used a disposable single-port multi-channel laparoscopic access device [Si Ai De (Xiamen) Medical Equipment Co., Ltd., China; model: IIIA-3B-35 × 100] and conventional straight laparoscopic instruments. Perioperative outcomes and pathological results were analyzed. RESULTS: All 12 procedures were successfully completed via the single incision without conversion to open surgery or additional trocar placement. Pathological diagnoses included: extralobar pulmonary sequestration (n = 6), solid pseudopapillary neoplasm of the pancreas (n = 2), adrenal neuroblastoma (n = 1), retroperitoneal mature teratoma (n = 1), lymphatic malformation with infection (n = 1), and adrenal mixed ganglioneuroblastoma with retroperitoneal metastasis (n = 1). Median operative time was 83.5 min, and median estimated blood loss was 7.5 mL. 9 patients resumed oral intake on the day of surgery, with a median postoperative hospital stay of 3 days. No pancreatic fistula occurred in the 2 pancreatic surgery patients. Notably, one patient with adrenal mixed ganglioneuroblastoma and retroperitoneal metastasis underwent complete single-stage resection of both lesions through the same incision, with uneventful recovery. CONCLUSIONS: LS-SILS in the right lateral position is a safe and feasible innovative minimally invasive technique for pediatric left retroperitoneal lesions. Through optimized positioning and incision design, it provides clear exposure and precise access to both left retroperitoneal and retroperitoneal lesions, demonstrating excellent technical expandability and significant clinical potential.
Mechanisms of recurrence after laparoscopic percutaneous extraperitoneal closure for pediatric inguinal hernia: a single-center video review study.
Sumida W, Ono Y, Mouri J … +1 more , Utsunomiya A
Pediatr Surg Int · 2026 Jun · PMID 42347881 · Publisher ↗
BACKGROUND: Laparoscopic assisted percutaneous extraperitoneal closure (LPEC) is widely used in Japan for pediatric inguinal hernia repair and associated with a low recurrence rate. This study aimed to investigate recurr...
BACKGROUND: Laparoscopic assisted percutaneous extraperitoneal closure (LPEC) is widely used in Japan for pediatric inguinal hernia repair and associated with a low recurrence rate. This study aimed to investigate recurrent cases to determine possible causes. METHODS: This study retrospectively reviewed patients who underwent reoperation for ipsilateral recurrence after the initial LPEC performed at our institution between 2009 and 2024. Recurrence was confirmed through 2025. Medical records and operative videos were analyzed to evaluate patient characteristics, interval to recurrence, operative findings, recurrence patterns, and reoperative procedures. Recurrence rates were also compared based on the suture material. RESULTS: In 1,894 patients, 11 recurrences (0.58%) occurred. No significant differences in age, sex, or side were observed. The median interval to recurrence was 32 months. The video review identified one technical error involving needle deviation into the muscle layer. Two cases were de novo-type recurrences. In nine cases, a central pinhole in the ligation ring suggested ligature loosening. Recurrence rates were lower with polyester sutures than with silk (0.16% vs. 0.79%), though not statistically significant (p = 0.28). CONCLUSIONS: LPEC demonstrated a low recurrence rate. Most recurrences were associated with inadequate ligation, and recurrence rates tended to be lower with polyester sutures.
Challenging the standard: comparison of outcomes between laparoscopically assisted anorectoplasty (LAARP) and posterior sagittal anorectoplasty (PSARP) in the correction of rectobulbar fistula in pediatric patients.
Carreño Sanchez MA, Ruiz J, Siffredi J … +5 more , Alvarez L, Cotignola L, Dominguez MV, Ayarzabal V, Di Benedetto V
Pediatr Surg Int · 2026 Jun · PMID 42347857 · Publisher ↗
BACKGROUND: Posterior sagittal anorectoplasty (PSARP) remains the standard surgical approach for rectobulbar fistula in patients with anorectal malformations (ARM). Laparoscopically assisted anorectoplasty (LAARP) has em...
BACKGROUND: Posterior sagittal anorectoplasty (PSARP) remains the standard surgical approach for rectobulbar fistula in patients with anorectal malformations (ARM). Laparoscopically assisted anorectoplasty (LAARP) has emerged as an alternative technique, although its role in rectobulbar fistula remains controversial. OBJECTIVE: To compare surgical and functional outcomes of LAARP and PSARP in pediatric patients with ARM and rectobulbar fistula. METHODS: A retrospective cohort study was conducted including male patients with rectobulbar fistula who underwent repair at a tertiary pediatric surgery center between 2000 and 2024. Patients were grouped according to surgical technique (LAARP vs. PSARP). Perioperative outcomes, postoperative complications, functional outcomes assessed using the Krickenbeck classification, and reintervention rates were analyzed. RESULTS: Fifty-three patients met inclusion criteria (19 LAARP, 34 PSARP). Patients undergoing LAARP were significantly younger at the time of repair (median 8 vs. 17 months, p = 0.006). Overall postoperative complication rates did not differ significantly between groups (26.3% vs. 47.0%, p = 0.158). Functional outcomes and late complications were comparable. A non-significant trend toward fewer postoperative complications was observed in the LAARP group. CONCLUSIONS: LAARP and PSARP provide comparable functional outcomes for rectobulbar fistula repair. LAARP appears to be a safe alternative in selected patients when performed in experienced centers.
The potential role of dynein heavy chain genes in the pathophysiology of undescended testis.
Kılıç S, Turkgenc B, Baltrak YA … +2 more , Güler GC, Köylü H
Pediatr Surg Int · 2026 Jun · PMID 42323797 · Full text
BACKGROUND: Failures of testicular descent may result in the condition known as an undescended testis (UDT). While mechanical and hormonal causes have been researched quite extensively, not much is known about the underl...
BACKGROUND: Failures of testicular descent may result in the condition known as an undescended testis (UDT). While mechanical and hormonal causes have been researched quite extensively, not much is known about the underlying genetics. Developmental processes dependent on ciliary function may involve outer dynein arm heavy chain genes. Its role in testicular descent has never been explored. This study attempts to investigate the potential role of Outer Dynein Arm Heavy Chain (ODNAH) genes in UDT. METHODS: 24 male juvenile UDT patients and 24 age-matched controls undergoing circumcision were included. Tissue samples from the preputial tissue and processus vaginalis were collected during orchiopexy and circumcision, respectively. RNA was extracted, converted to cDNA, and subjected to quantitative real-time PCR analysis for five ODNAH genes: DNAH5, DNAH8, DNAH9, DNAH11, and DNAH17 with GAPDH as a reference gene. The relative expression was computed using the 2 method. RESULTS: The mean age of the control group was 21.9 ± 19.4 months, while that of the UDT patient group was 24.5 ± 12.3 months. There was no significant difference in age between the groups (p = 0.06). DNAH9 expression was significantly higher when comparing UDT tissues to controls (p = 0.0021), with a 2.52-fold increase associated with its upregulation (Log2FC = 1.33). Only small, insignificant expression changes were evident for DNAH5, DNAH8, DNAH11, and DNAH17. Most patients shared a similar expression pattern for DNAH9, suggesting that it may play a role in the pathophysiology of UDT. CONCLUSION: These results suggest that DNAH9 may play a role in the molecular mechanisms underlying testicular descent. The finding of DNAH9 as a potential marker for disturbed germ cell development in cryptorchidism may represent an adaptive response to the aberrant microenvironment of UDT. These findings need to be verified by further studies, including expanded cohorts and functional analyses, to understand possible clinical relevance.
Long-term renal outcomes in children with posterior urethral valves: a systematic review and meta-analysis.
Hafizar, Wahyudi I, Situmorang GR … +2 more , Risky Raharja PA, Rodjani A
Pediatr Surg Int · 2026 Jun · PMID 42323785 · Publisher ↗
BACKGROUND: Posterior urethral valves (PUV) represent the most common cause of lower urinary tract obstruction in male infants and are a leading contributor to chronic kidney disease (CKD) in children. This systematic re...
BACKGROUND: Posterior urethral valves (PUV) represent the most common cause of lower urinary tract obstruction in male infants and are a leading contributor to chronic kidney disease (CKD) in children. This systematic review and meta-analysis aimed to synthesize and quantify the available evidence regarding the risk of long-term CKD in children with posterior urethral valves and to identify factors associated with adverse renal outcomes. METHODS: A systematic review and meta-analysis were conducted in accordance with PRISMA and MOOSE guidelines. PubMed, Embase, Web of Science were searched from inception to January 31, 2026 for observational studies evaluating long-term renal outcomes in pediatric patients with posterior urethral valves. Eligible studies reported CKD outcomes, renal function decline, end-stage kidney disease, or need for renal replacement therapy with corresponding effect estimates or extractable data. Two reviewers independently screened studies, extracted data, and assessed methodological quality using Joanna Briggs Institute appraisal tools. RESULTS: Nine cohort studies published between 1988 and 2024 met the inclusion criteria, representing pediatric populations from Europe, North America, South America, and Africa. Across studies, children with PUV demonstrated a substantial risk of long-term CKD, with many progressing to renal impairment or end-stage kidney disease during extended follow-up. Meta-analysis of within-study comparisons demonstrated that PUV children with adverse prognostic features (absence of pop-off mechanisms, elevated nadir creatinine, or established renal dysplasia) had a significantly higher risk of CKD compared with PUV children with more favorable prognostic profiles (pooled OR: 1.44, 95% CI: 1.20-1.73). Although effect sizes varied, the overall trend consistently indicated adverse renal outcomes. Studies identified important prognostic factors, including renal dysplasia, elevated nadir creatinine, bladder dysfunction, and delayed diagnosis, while the presence of pop-off mechanisms was frequently associated with improved renal prognosis. Substantial heterogeneity was observed among studies (I² = 89%). Funnel plot assessment suggested no significant publication bias. CONCLUSION: This systematic review and meta-analysis demonstrates that children with posterior urethral valves remain at significant risk for developing long-term chronic kidney disease despite advances in early diagnosis and management. Future prospective studies are needed to refine prognostic models, standardize outcome reporting, and evaluate strategies aimed at preserving renal function and improving long-term health outcomes.
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