Pediatr Surg Int
· 2026 Feb · PMID 41721883
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BACKGROUND: Postoperative hypoxemia is a critical complication in pediatric (≤ 18 years) patients undergoing non-cardiac surgeries with endotracheal intubation, which will potentially lead to poorer outcomes. Despite its...BACKGROUND: Postoperative hypoxemia is a critical complication in pediatric (≤ 18 years) patients undergoing non-cardiac surgeries with endotracheal intubation, which will potentially lead to poorer outcomes. Despite its clinical significance, systematic approaches to ascertain prevalence and risk factors are lacking. Thus, our study aims to conduct a systematic review and meta-analysis to assess the prevalence of postoperative hypoxemia in pediatric patients following endotracheal intubation for non-cardiac procedures and to identify associated risk factors. METHODS: A comprehensive search of PubMed, Ovid, Embase, Web of Science, and Cochrane Library was conducted from inception to November 30, 2024, using terms related to children, postoperative, and hypoxemia. Observational and interventional studies reporting postoperative hypoxemia in pediatric patients undergoing non-cardiac surgeries with endotracheal intubation were included. Two reviewers independently extracted data. Random-effects meta-analysis estimated pooled prevalence. Subgroup analyses examined age, publication year, and geographic region. Meta-regression examined surgical types. The primary outcome was the overall incidence of postoperative hypoxemia. The secondary outcomes were the risk factors related to postoperative hypoxemia. RESULTS: A total of 37 studies involving 14,597 patients were identified. The pooled prevalence of postoperative hypoxemia was 10.1% (95% CI: 0.066–0.142). Infants (< 1 year) had a higher prevalence than older children (17.5% vs. 7.4%; p = 0.025). Studies published before 2010 reported higher rates (15.4–20.6%) than post-2010 studies (5.5–6.7%). No significant variations were observed across World Health Organization regions, World Bank income classifications or surgical types. CONCLUSIONS: This study provides a global estimation of postoperative hypoxemia prevalence in pediatric patients undergoing non-cardiac surgeries with endotracheal intubation. Standardizing the definition of hypoxemia in future research is crucial to enhance comparability and clinical relevance. TRIAL REGISTRATION: The review protocol was registered in advance with PROSPERO (ID CRD42025631572), date of registration: Dec 26 2024.
Pediatr Surg Int
· 2026 Feb · PMID 41721863
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PURPOSE: Anorectal malformations exist across a spectrum of abnormalities involving the rectum, distal anus, genital and urinary tracts, and occur in approximately one in 5,000 live births. The purpose of this study was...PURPOSE: Anorectal malformations exist across a spectrum of abnormalities involving the rectum, distal anus, genital and urinary tracts, and occur in approximately one in 5,000 live births. The purpose of this study was to investigate intersectional reporting, mental health co-morbidities, and psychosocial experiences of adults born with anorectal malformation. METHODS: A systematic quantitative literature review was utilized to collect and analyze data. Articles were required to discuss population demographics, mental health comorbidities, or psychosocial experiences associated with anorectal malformation in adulthood. A total of 94 articles were found suitable for review. RESULTS: Patient ethnicity, culture, sexuality, and spirituality were significantly underrepresented. Mental health co-morbidities such as anxiety and depression were discussed but rarely transitioned to intervention. Psychological challenges included psychosexual anxiety and limited professional knowledge. Sociological challenges included navigating health services and social settings. Literature prioritized continence outcomes that diminished psychosocial complexities. CONCLUSIONS: The intersectionality, mental health concerns, and psychosocial experiences of adults born with anorectal malformation remain largely unknown. Allied health professionals such as social workers can improve ongoing support provision, with interventions that enhance psychosocial functioning and emotional wellbeing.
Babu R, Heera T, Arunprasad D
… +1 more, Sangeetha G
Pediatr Surg Int
· 2026 Feb · PMID 41721851
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BACKGROUND/AIM: Anatomical classifications of posterior urethral valves (PUV) have limited prognostic utility. We evaluated a Renal & Bladder Status (RBS) grading system, based on early post-treatment renal function and...BACKGROUND/AIM: Anatomical classifications of posterior urethral valves (PUV) have limited prognostic utility. We evaluated a Renal & Bladder Status (RBS) grading system, based on early post-treatment renal function and bladder morphology, in predicting long-term outcomes. METHODS: A retrospective review of 254 boys treated for PUV between 2003 and 2023 was performed. RBS-0 included non-classical/ suspected valves; RBS-1 classical PUV with preserved renal/bladder function (nadir creatinine <1 mg/dl and bladder contour normal); RBS-2 impaired but recoverable renal/bladder function (nadir creatinine <1 mg/dl and bladder contour improves) after fulguration; and RBS-3 persistent dysfunction (nadir creatinine >1 mg/dl or bladder contour abnormal/ persistent VUR) despite treatment. Primary outcome was progression to end-stage renal disease (ESRD); secondary outcome was valve bladder (VB). Kaplan-Meier survival and Cox proportional hazards models assessed predictors of ESRD. RESULTS: ESRD occurred in 0% of RBS-0, 6.3% of RBS-1, 12.2% of RBS-2, and 51.7% of RBS-3 (p < 0.001). VB developed in 0%, 4.7%, 8.8%, and 41.3% respectively (p < 0.001). At 10 years, ESRD-free survival was 95% (RBS-0), 85% (RBS-1), 65% (RBS-2), and 35% (RBS-3) (log-rank p < 0.001). On multivariable Cox analysis, RBS-2 (HR 3.1, 95% CI 1.4-6.8), RBS-3 (HR 6.7, 95% CI 3.2-14.0), nadir creatinine > 1 mg/dL (HR 2.5, 95% CI 1.5-4.2), and high-grade VUR (HR 1.9, 95% CI 1.1-3.4) independently predicted ESRD, while age at presentation was not significant. CONCLUSION: RBS grading, incorporating early renal and bladder recovery after treatment, provides prognostic information and enables early risk stratification in PUV. Larger prospective multi-center studies are warranted to validate RBS grading.
Harumatsu T, Nagano A, Sugita K
… +13 more, Tabata Y, Nishida N, Kedoin C, Tsuruno Y, Murakami M, Yano K, Onishi S, Yamada K, Yamada W, Kawano T, Torikai M, Kaji T, Ieiri S
Pediatr Surg Int
· 2026 Feb · PMID 41721831
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PURPOSE: To investigate associated anomalies and the postoperative defecation function in female patients with low-type anorectal malformations (ARMs), focusing on comparing anovestibular fistula (AVF) with other subtype...PURPOSE: To investigate associated anomalies and the postoperative defecation function in female patients with low-type anorectal malformations (ARMs), focusing on comparing anovestibular fistula (AVF) with other subtypes. METHODS: Patient data were collected between 1984 and 2021. Eighty-seven female patients with low-type ARMs were enrolled after excluding one undetermined case. Associated anomalies, operative procedures, and the long-term defecation function were analyzed and compared between the AVF and non-AVF groups. RESULTS: AVF was the most common subtype (52.9%), followed by anocutaneous fistula (21.8%), covered anal stenosis (11.5%), anovulvar fistula (10.3%), and covered anal complete (3.4%). Upper urinary tract anomalies and VACTERL association were significantly more frequent in AVF (17.4% and 13.0%) than in non-AVF. Specific associations were identified: trisomy 21 with covered anal complete (100%), perineal groove with anocutaneous fistula (10.5%), and MRKH syndrome with AVF (2.2%). Chronologically, non-AVF low-type ARMs achieved "excellent" evacuation scores at 6 years, whereas AVF patients typically achieved this by 9 years. Individual defecation parameters reached full scores by 7 years in all subtypes except AVF, where constipation persisted beyond 11 years. CONCLUSION: The postoperative defecation function in female patients with low-type ARMs demonstrates differential improvement patterns, with AVF requiring extended management until at least 9 years.
Yamada K, Perea Paizal J, Canovai E
… +9 more, Orens C, Marcoccio I, Durkin N, Caciolli L, Ieiri S, Eaton S, Mantero S, De Coppi P, Pellegrini M
Pediatr Surg Int
· 2026 Feb · PMID 41718830
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PURPOSE: Oesophageal substitution following atresia repair, caustic damage or cancer of the oesophagus can be challenging. We and others are working on engineering oesophageal tissue using a combination of decellularised...PURPOSE: Oesophageal substitution following atresia repair, caustic damage or cancer of the oesophagus can be challenging. We and others are working on engineering oesophageal tissue using a combination of decellularised oesophagi and cell injection. So far this has been achieved using highly operator-dependent techniques. This study aimed to establish a reproducible method for cell delivery into scaffolds. METHODS: To improve consistency, a stereotaxic robotic platform was adapted to deliver a suspension of porcine gelatin and cells in a 1:1 ratio. The scaffold was mounted on a 3D-printed rod linked to a stepper motor, enabling automated 36° rotation for circumferential coverage. Two circumferential rows, each rotated 36°, with 3 - 2 points at 3-mm intervals, ensured even seeding. Injection depth was calibrated to target the inner layer. RESULTS: Cells injected robotically remained viable, with no significant difference from manual injection. Post-injection analyses confirmed cell viability and distribution within the scaffold. CONCLUSION: Automated robotic injection provides a reliable, reproducible alternative to manual methods, reducing operator bias.
Pediatr Surg Int
· 2026 Feb · PMID 41706216
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PURPOSE: Giggle incontinence is a bladder storage disorder characterized by uncontrolled voiding during or immediately after laughter. Many children are refractory to available therapies or experience considerable side-e...PURPOSE: Giggle incontinence is a bladder storage disorder characterized by uncontrolled voiding during or immediately after laughter. Many children are refractory to available therapies or experience considerable side-effects. This study aimed to determine the efficacy of intravesical Botox injections in the management of giggle incontinence. METHODS: A retrospective review of all children who received 200iU intravesical botulinum toxin-A for giggle incontinence over twelve years was performed. All children experienced complete bladder emptying during or immediately after laughter as their primary complaint, with or without a related voiding disorder. Outcomes were characterised as: “no response” (0–49% reduction), “partial response” (50–99% reduction), or “complete response” (100% reduction). RESULTS: A total 34 procedures (range: 1–5) in 17 children were included. Median age at first treatment was 11 years (range: 6-17y). Complete response occurred in 65% of patients and partial response in 18%. Of those who experienced complete response, 55% (6/11) had no relapse of symptoms with a median duration of follow-up of 5 years (IQR 3.5-6.5y). CONCLUSION: Giggle incontinence is a rare but significant condition with marked impact on quality of life. This is the first study describing the use of intravesical Botox injection in this population, demonstrating safety and efficacy with a sustained response to treatment in many patients.
Gang S, Shisong Z, Hongxiu X
… +4 more, Rui G, Huashan Z, Sai H, Yunpeng Z
Pediatr Surg Int
· 2026 Feb · PMID 41706210
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PURPOSE: To evaluate the safety and feasibility of unilateral total pneumonectomy in pediatric patients and analyze postoperative quality of life outcomes. METHODS: A retrospective analysis was conducted on 10 pediatric...PURPOSE: To evaluate the safety and feasibility of unilateral total pneumonectomy in pediatric patients and analyze postoperative quality of life outcomes. METHODS: A retrospective analysis was conducted on 10 pediatric patients who underwent unilateral total pneumonectomy between January 2018 and October 2024. Clinical characteristics, intraoperative parameters, and complications were recorded. Cardiopulmonary function was assessed preoperatively and at 3, 6, and 12 months postoperatively using spirometry and echocardiography. Quality of life was evaluated using the PedsQL 4.0 questionnaire at 1-year follow-up. RESULTS: The cohort included congenital pulmonary malformations (n=6) and neoplastic diseases (n=4). Seven patients underwent thoracoscopic surgery and three had open procedures. No intraoperative complications or perioperative mortality occurred. Mean operative time was 230±76 minutes with minimal blood loss. Pulmonary function significantly declined at 3 months but recovered to 60–80% of baseline by 12 months. Cardiac function remained stable throughout. Quality of life was moderately high, though physical and emotional domains showed greater impairment compared to social and academic functioning. CONCLUSION: Unilateral total pneumonectomy is safe and feasible in carefully selected pediatric patients, with minimal perioperative morbidity. Despite significant initial decline, pulmonary function demonstrates satisfactory compensation within one year, and most patients achieve moderately high quality of life, supporting the procedure’s utility in pediatric thoracic surgery.
Shao Y, Ming A, Jiang C
… +4 more, Yang K, Yang C, Diao M, Li L
Pediatr Surg Int
· 2026 Feb · PMID 41697398
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BACKGROUND: The optimal timing of definitive surgery after external biliary drainage (EBD) for children with completely perforated congenital choledochal cysts (CCs) remains controversial. Prolonged EBD may increase the...BACKGROUND: The optimal timing of definitive surgery after external biliary drainage (EBD) for children with completely perforated congenital choledochal cysts (CCs) remains controversial. Prolonged EBD may increase the risk of drainage tube–related complications. This study compared the safety and efficacy of early (≤ 14 days) versus delayed (> 14 days) definitive surgery after EBD. METHODS: This study is a single-center retrospective cohort study that included all consecutive pediatric patients with complete perforation of choledochal cysts (CC) admitted between January 2018 and February 2025. According to the timing of surgical treatment, patients were divided into two groups: Group 1 consisted of patients who underwent short-term external biliary drainage (EBD), with definitive surgery performed within 14 days after EBD; Group 2 consisted of patients who underwent long-term EBD, with definitive surgery performed more than 14 days after EBD. The collected data included baseline characteristics of patients, diagnostic and therapeutic processes and data, EBD-related complications, postoperative recovery, laboratory parameters, and postoperative complications. All patients underwent single-incision laparoscopic hepaticojejunostomy (SILH), with conversion to open surgery performed when necessary. RESULTS: Thirty patients were included (Group 1, n = 10; Group 2, n = 20). No EBD-related complications occurred in Group 1, whereas 8 patients (40.0%) in Group 2 developed drainage tube–related complications (infection, dislodgement, obstruction, electrolyte disturbances, or dehydration; p = 0.029). Intraoperative findings and surgical outcomes were broadly comparable between groups, including operative duration and conversion to open surgery (all p > 0.05). Postoperative recovery metrics (time to full diet, postoperative drain removal, and length of hospital stay) and postoperative complication rates were also similar. CONCLUSION: In experienced centers, definitive surgery within 14 days after EBD appears to be safe and feasible for completely perforated choledochal cysts, and may reduce complications associated with prolonged drainage.
Pediatr Surg Int
· 2026 Feb · PMID 41697378
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PURPOSE: Pectus carinatum (PC) is a prevalent chest wall deformity mostly managed with orthotic bracing. Despite the effectiveness, research identifying specific predictors of treatment success remains limited. This stud...PURPOSE: Pectus carinatum (PC) is a prevalent chest wall deformity mostly managed with orthotic bracing. Despite the effectiveness, research identifying specific predictors of treatment success remains limited. This study evaluates clinical findings from external bracing to propose a reliable indicator for predicting successful outcomes. METHODS: A comprehensive assessment was conducted on a large cohort of patients presenting to a specialized clinic during 2019 to 2024 May. Evaluations included demographics, deformity characteristics, and the “initial force of correction” measured at first examination (1FOC). Patients complying with treatment received custom-made orthoses. During the first follow-up, the force of correction was re-measured (2FOC). RESULTS: Patients were mostly male and adolescent. While 1FOC correlated with age, the analysis revealed that neither patient age nor initial deformity severity were distinguishing factors between successful and unsuccessful outcomes. Instead, success was strongly associated with the chest wall’s early response to bracing. Specifically, patients who exhibited a significant reduction in FOC during their first follow-up visit were the most likely to achieve full correction. CONCLUSION: Orthotic success in PC depends largely on the chest wall’s dynamic response to treatment rather than static factors like age or initial severity. Consequently, external bracing should be offered to all motivated patients, using the first follow-up assessment as a critical guide for predicting long-term success.