Pediatr. Surg. Int. [JOURNAL]
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200 papers
Comparative analysis of three fecal continence scoring systems in anorectal malformations: inter-score agreement and prognostic factors.
Bairamovi G, Özden Ö, Binokay H … +1 more , Tuncer R
Pediatr Surg Int · 2026 Jun · PMID 42323755 · Full text
PURPOSE: To evaluate inter-score correlation and categorical agreement among the Kelly, Holschneider, and Templeton fecal continence scores in patients with anorectal malformations (ARM), and to identify predictors of po...
PURPOSE: To evaluate inter-score correlation and categorical agreement among the Kelly, Holschneider, and Templeton fecal continence scores in patients with anorectal malformations (ARM), and to identify predictors of poor continence. METHODS: In this retrospective single-center cohort, 110 surgically treated ARM patients (2007-2017) were assessed at latest follow-up using all three scores. Correlation was tested with Spearman analysis, categorical agreement with weighted kappa, and independent risk factors with multivariable logistic regression for each scoring system. RESULTS: Correlations were moderate across all pairs (ρ = 0.52-0.68; p < 0.001). Agreement was substantial between Kelly-Holschneider (κ = 0.652) and Holschneider-Templeton (κ = 0.684), but moderate between Kelly-Templeton (κ = 0.595). Poor continence rates differed by instrument (Kelly 18.2%, Holschneider 10.9%, Templeton 17.3%). Independent predictors of poor continence varied by scoring system: weak anal tone and fecal incontinence for Kelly, urinary incontinence for Holschneider, and male sex and systemic pathology for Templeton. CONCLUSION: Although the three scores are correlated, clinically meaningful categorical discordance exists. Single-score assessment may therefore be misleading. Combined use of multiple validated continence scores with objective functional assessment is recommended for comprehensive ARM follow-up.
Comprehensive assessment of risk factors for postoperative urinary tract infection following pediatric pyeloplasty.
Batra NV, Adaniya KH, Mahenthiran AK … +10 more , Eardley Z, Cain MP, Kaefer M, Meldrum KK, Misseri R, Rink RC, Roth JD, Whittam BM, Szymanski KM, Dangle PP
Pediatr Surg Int · 2026 Jun · PMID 42323748 · Full text
PURPOSE: Variable patterns of perioperative management and postoperative drainage following pyeloplasty are utilized at our institution. We reviewed our patient population and practices to assess risk factors for postope...
PURPOSE: Variable patterns of perioperative management and postoperative drainage following pyeloplasty are utilized at our institution. We reviewed our patient population and practices to assess risk factors for postoperative urinary tract infection (UTI) following pediatric pyeloplasty. METHODS: Electronic health records of patients who underwent open or robotic pyeloplasty from 2018 to 2023 were retrospectively reviewed. Demographics, perioperative characteristics, and postoperative UTI within 30 days were evaluated. Postoperative UTI was defined as symptomatic and requiring antibiotic therapy. Patients with concurrent conditions elevating risk for UTI and asymptomatic patients with positive cultures were excluded. Univariate and multivariate statistical analysis were performed. RESULTS: 295 patients underwent pyeloplasty with median age of 13 months (IQR 3-91). Eleven (4%) patients had febrile UTI within 30 days of surgery. On univariate analysis, female gender (p = 0.007) and UTI history (p = 0.045) were significantly associated with risk for postoperative UTI. On multivariate analysis, only female gender (OR 4.5, 95% CI 1.2-17.3, p = 0.026) remained significantly associated. No other variables, including type of postoperative drainage and nephrostomy tube drainage prior to surgery, were associated with increased risk. CONCLUSION: Female gender and UTI history were significant predictors of postoperative UTI following pediatric pyeloplasty. This knowledge may help inform parents during preoperative counseling.
ERAS (enhanced recovery after surgery) protocol improves recovery in surgical management of pediatric non-cirrhotic portal hypertension: evaluating results of pre and post-ERAS implementation.
Hasan S, Çeltik Ü, Ergün O
Pediatr Surg Int · 2026 Jun · PMID 42323737 · Full text
PURPOSE: Standardized perioperative pathways for pediatric non-cirrhotic portal hypertension (PHT) requiring complex portosystemic shunt surgery remain scarce. Enhanced Recovery After Surgery (ERAS) protocols aim to redu...
PURPOSE: Standardized perioperative pathways for pediatric non-cirrhotic portal hypertension (PHT) requiring complex portosystemic shunt surgery remain scarce. Enhanced Recovery After Surgery (ERAS) protocols aim to reduce surgical stress and optimize postoperative recovery. This study evaluates the impact of ERAS implementation on outcomes in children undergoing shunt procedures for PHT. METHODS: A retrospective cohort study was conducted over 18 years. Patients were divided into two groups: Group I (pre-ERAS,2006-2016) and Group II (post-ERAS,2016-2024). Demographics, surgical type, time to oral feeding, mobilization, drain usage, ICU stay, hospital stay, and 30-day readmissions were analyzed. RESULTS: A total of 103 patients (M/F: 50/53; mean age 8.4 ± 5 years) underwent shunt surgery. Fifty-one were treated before and 52 after ERAS implementation. Distal splenorenal shunt was most common (n = 74), followed by Rex shunt (n = 20) and other procedures (n = 9). ERAS was associated with significantly earlier oral feeding (1.1 vs.1.6 days, p = 0.007), earlier mobilization (1.15 vs.1.6 days, p = 0.046), markedly reduced drain use (1.9% vs. 23.5%, p = 0.001), shorter ICU stay (1.48 vs.1.9 days, p = 0.03), and nearly halved hospital stay (4.6 vs.8.5 days, p = 0.001). Thirty-day readmissions were similar. CONCLUSION: ERAS implementation in pediatric PHT surgery is feasible, safe, and associated with substantially improved recovery and standardized perioperative care.
Correction: Thoracoscopic staged repair for type A and type B esophageal atresia: outcomes from a tertiary center.
Natalia N, Jiri S, Jitka S … +4 more , Coufal S, Bartosova T, Michal R, Alena K
Pediatr Surg Int · 2026 Jun · PMID 42322440 · Full text
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Clinical characteristics and predictors for the presence of pediatric intussusception secondary to pathological lead points.
Yu YY, Wei YX, Ren ZZ … +3 more , Guan MK, Huang HY, Huang XZ
Pediatr Surg Int · 2026 Jun · PMID 42322436 · Publisher ↗
PURPOSE: To analyze the clinical characteristics and identify independent predictors of intussusception secondary to pathological lead points (PLPs). METHODS: We conducted a retrospective study of children surgically tre...
PURPOSE: To analyze the clinical characteristics and identify independent predictors of intussusception secondary to pathological lead points (PLPs). METHODS: We conducted a retrospective study of children surgically treated for intussusception between 2010 and 2025. Patients were categorized into PLPs and non-PLPs groups. Demographic, clinical, laboratory, imaging, surgical, and pathological data were compared between the groups. RESULTS: Of 575 children included, 126 (21.9%) had PLPs and 449 (78.1%) were idiopathic. PLPs encompassed a range of etiologies, including Meckel's diverticulum, intestinal duplications, polyps, tumors, and inflammatory conditions. Multivariable logistic regression identified seven independent predictors: older age (OR = 1.023, 95% CI: 1.014-1.032; p < 0.001), the absence of hematochezia (OR = 0.472, 95% CI: 0.268-0.832; p = 0.009), the absence of vomiting (OR = 0.480, 95% CI: 0.242-0.954; p = 0.036), recurrence (OR = 2.313, 95% CI: 1.185-4.513; p = 0.014), small-intestinal intussusception (OR = 2.505, 95% CI: 1.370-4.581; p = 0.003), elevated thrombocytocrit (PCT) (OR = 23.850, 95% CI: 4.902-116.014; p < 0.001), and the presence of ascites (OR = 2.002, 95% CI: 1.209-3.315; p = 0.007). CONCLUSIONS: Older age, hematochezia, vomitus, recurrence intussusception, small-intestinal intussusception, thrombocytocrit and ascites are independent predictors of PLPs and may aid in risk stratification and guide the decision for surgical intervention.
Design and validation of a novel low-cost open paediatric inguinal herniotomy simulator.
Bapna T, Robinson SJA, Ljuhar D … +2 more , Pacilli M, Nataraja RM
Pediatr Surg Int · 2026 Jun · PMID 42322368 · Full text
BACKGROUND: Simulation-based education is a valuable tool in paediatric surgery. Inguinal hernias are a common paediatric surgical presentation with an incidence of 1-5% in full-term infants. While previous simulators ha...
BACKGROUND: Simulation-based education is a valuable tool in paediatric surgery. Inguinal hernias are a common paediatric surgical presentation with an incidence of 1-5% in full-term infants. While previous simulators have been created for adult inguinal hernias and laparoscopic paediatric inguinal hernias, there are limited models for the open paediatric procedure. We aimed to create and validate a simulator for a paediatric open inguinal hernia repair. METHODS: Essential procedural steps of an open inguinal herniotomy were determined, and a low-cost paediatric simulator was developed. Novices (medical students) and experts (paediatric surgeons) were recruited. A questionnaire on an 11-point Likert-type scale assessed face validity, content validity, and functional task alignment. Median scores > 7.0/10.0 were deemed valid. The total number and type of procedural errors were assessed to determine construct validity. Statistical analysis included Fisher's exact test, a p-value < 0.05 was considered significant. RESULTS: A total of 34 participants were recruited (expert:10, novice:24). The simulator received favourable median scores in the following content validity domains: useful for surgical trainees (7.0/10.0), useful to train open surgical skills (7.5/10.0), and logical flow of procedural steps (9.0/10.0). It was not deemed a valuable training tool for experts (2.0/10.0). The simulator had median scores below 7.0/10.0 for face validity domains, including its tissue and visual realism. Construct validity was demonstrated by novices making more errors on the simulator, p = 0.02. CONCLUSIONS: This low-cost open inguinal herniotomy simulator demonstrated content validity, construct validity, and a high degree of functional task alignment.
Ultrasonographic and serum biomarkers for diagnosis of biliary atresia.
Bertrand Simões BC, Siviero I, Penna CRR … +3 more , Di Puglia EBM, da Silva SVC, Manso JEF
Pediatr Surg Int · 2026 Jun · PMID 42313216 · Full text
PURPOSE: Biliary atresia (BA) is the main cause of neonatal cholestasis and the leading indication for pediatric liver transplantation. Early diagnosis is essential for timely intervention and improved outcomes. This stu...
PURPOSE: Biliary atresia (BA) is the main cause of neonatal cholestasis and the leading indication for pediatric liver transplantation. Early diagnosis is essential for timely intervention and improved outcomes. This study evaluated accessible biomarkers for the diagnosis of BA, including serum gamma-glutamyl transferase (GGT) and ultrasonographic (US) parameters. METHODS: This retrospective study included infants with suspected BA treated between 2014 and 2024, at a tertiary pediatric center in Brazil. Serum GGT levels and US parameters were analyzed and the diagnosis was confirmed by surgical findings. Diagnostic accuracy was assessed using a ROC curve and logistic regression. RESULTS: Sixty-seven infants were included, of whom 45 (67.2%) had confirmed BA. Median serum GGT levels were higher in BA cases (607 U/L) than in non-BA cases (243 U/L). ROC analysis identified a cutoff value of 311 U/L, with a sensitivity of 82.2% and specificity of 68.2%. US parameters were present in all BA cases, with 100% sensitivity and 86% specificity (p < 0.001). Combining GGT with abnormal US findings increased specificity to 95.5%. CONCLUSION: Ultrasonographic parameters alone, as well as their combination with elevated serum GGT levels, demonstrated high diagnostic value for identification of biliary atresia in infants with neonatal cholestasis.
Do pediatric patients with cerebral palsy have worse outcomes after anti-reflux esophageal surgery?
Tiyaamornwong S, Sirichamratsakul K, Chiengkriwate P … +2 more , Chanpong A, Sangkhathat S
Pediatr Surg Int · 2026 Jun · PMID 42295425 · Publisher ↗
PURPOSE: To evaluate and compare short-term and two-year outcomes, particularly aspiration pneumonia-free survival, after fundoplication in pediatric patients with and without cerebral palsy (CP). METHOD: The study revie...
PURPOSE: To evaluate and compare short-term and two-year outcomes, particularly aspiration pneumonia-free survival, after fundoplication in pediatric patients with and without cerebral palsy (CP). METHOD: The study reviewed outcomes after fundoplication in pediatric patients performed between 2004 and 2025 at a university hospital in Thailand, focusing on aspiration pneumonia-free survival. Statistical analyses used log-rank test and Cox proportional hazards model. RESULTS: During the study, 85 cases underwent surgery. Diagnoses included gastroesophageal reflux (84.7%) and hiatal hernia (10.9%). Forty-five cases (52.9%) had CP, with significantly higher rates of co-occurring epilepsy (OR 33.9) and recurrent pneumonia (OR 3.6). Post-procedure, first-year pneumonia episodes were similar (median 0 occurrence in the CP group and 0.5 occurrence in the non-CP, p = 0.473). The mean interval to first pneumonia was longer in CP (418 days) than in non-CP (209 days, p = 0.049). One-year overall survival was 69.6%. One-year pneumonia-free survival in CP (50.4%) did not differ from non-CP (51.5%, p = 0.29). CONCLUSION: Despite a higher comorbidity burden and nutritional support needs, fundoplication outcomes in pediatric patients with CP were comparable to those without CP. These findings suggest fundoplication is an equally effective and safe surgical option for anti-reflux management in pediatric patients with CP.
Appendiceal location in Japanese children with acute appendicitis: pelvic predominance and diagnostic and operative implications.
Koga S, Noguchi S, Kondo T
Pediatr Surg Int · 2026 Jun · PMID 42295424 · Publisher ↗
PURPOSE: Appendiceal location may affect the diagnosis and surgical management of acute appendicitis. However, pediatric-specific data remain limited. This study evaluated appendiceal location in Japanese children with a...
PURPOSE: Appendiceal location may affect the diagnosis and surgical management of acute appendicitis. However, pediatric-specific data remain limited. This study evaluated appendiceal location in Japanese children with acute appendicitis and examined its clinical implications. METHODS: In total, 105 pediatric patients who underwent laparoscopic or laparoscopic-assisted appendectomy between January 2015 and March 2024 were retrospectively reviewed. Appendiceal location was classified using a modified Wakeley classification based on intraoperative laparoscopic findings. Clinical presentation, ultrasonographic identification rate, and surgical outcomes were compared among groups. RESULTS: The pelvic position was the most common appendiceal location (51.4%), followed by the retrocecal position (20.0%). Approximately 87.6% of patients underwent ultrasonography. The retrocecal group had a significantly lower identification rate than the other location groups (61.1% vs. 85.1%, p = 0.041). The retrocecal group had a significantly longer surgical duration than the pelvic group (median: 90 vs. 58 min, p = 0.010). The clinical presentation and postoperative complications did not differ significantly among the groups. CONCLUSION: In this cohort of Japanese children with acute appendicitis, the pelvic position was the most common appendiceal location. The retrocecal position was associated with lower ultrasonographic identification rates and a longer surgical duration, indicating greater diagnostic and technical challenges.
Machine learning in the diagnosis of Hirschsprung disease: a systematic review and meta-analysis.
Liu H, Zhou Y, Wang X … +5 more , Wang C, Guo S, Sun M, Li S, Wang Y
Pediatr Surg Int · 2026 Jun · PMID 42295411 · Publisher ↗
PURPOSE: To evaluate current evidence on machine learning (ML) for the diagnosis of Hirschsprung disease (HSCR) and summarize its diagnostic performance and potential clinical utility. METHODS: PubMed, Web of Science, Co...
PURPOSE: To evaluate current evidence on machine learning (ML) for the diagnosis of Hirschsprung disease (HSCR) and summarize its diagnostic performance and potential clinical utility. METHODS: PubMed, Web of Science, Cochrane Library, and Scopus were systematically searched (January 2016-November 2025) for studies applying ML to HSCR diagnosis. Study quality was assessed using QUADAS-2. Findings were narratively synthesized, with exploratory meta-analysis performed where feasible. RESULTS: Eleven studies were included, with substantial heterogeneity in design, data modalities, and outcomes. Three barium enema-based studies were eligible for meta-analysis, showing pooled sensitivity of 0.857 (95% CI 0.738-0.936), specificity of 0.880 (95% CI 0.790-0.941), and an area under the curve of 0.927. In rectal biopsy-based studies, ML-assisted approaches appeared to reduce interpretation time, while evidence for improved diagnostic performance remains limited and heterogeneous. CONCLUSION: ML may have potential value in supporting HSCR diagnosis, particularly when combined with imaging and clinical data. In histopathology, ML appears more likely to serve as an assistive tool to improve efficiency and potentially enhance diagnostic performance rather than replace expert interpretation. Further prospective multicenter studies are needed before routine clinical implementation.
Enrolment criteria for surgical plication in pediatric diaphragmatic eventration: a systematic review of the literature.
Borgogni R, Baldassarra A, Cazzuffi A … +3 more , Persichetti Proietti D, Michelini ME, Vella C
Pediatr Surg Int · 2026 Jun · PMID 42295394 · Publisher ↗
PURPOSE: Diaphragmatic eventration (DE) is an uncommon but clinically significant condition in children. Although diaphragmatic plication is widely performed in symptomatic patients, standardized criteria guiding surgica...
PURPOSE: Diaphragmatic eventration (DE) is an uncommon but clinically significant condition in children. Although diaphragmatic plication is widely performed in symptomatic patients, standardized criteria guiding surgical indication remain poorly defined. This review aimed to identify the clinical-radiological parameters most consistently used to select pediatric surgical candidates. METHODS: We performed a literature search for English-language studies (2000-2025) reporting pediatric DE cases. Studies limited to radiology, genetics, or unrelated diaphragmatic disorders were excluded. Extracted data included demographics, clinical presentation, surgical criteria, approach, and outcomes. RESULTS: 19 studies involving 893 surgically treated pediatric patients were included. Median age was 12 months (mean ± SD: 21.4 ± 28.7), with a male/female ratio of 1.68:1. Symptoms were reported in 18/19 studies (94.7%), with respiratory distress and pulmonary infection as most frequent ones (78.9% each), followed by GI symptoms (21%). Surgical criteria were described in 18/19 (94.7%): unspecified symptomatic patients (57.9%), respiratory distress (31.6%), recurrent infection (31.6%), ventilatory dependence (10.5%), and, in asymptomatic patients, progressive radiological elevation. Minimally-invasive approaches were reported in 52.3%. Postoperative mortality was 1.6% (14/893). CONCLUSIONS: Respiratory compromise, ventilatory dependence, recurrent infections, progressive radiological elevation are the most reported indications. Evidence remains retrospective and heterogeneous, highlighting the need for standardized, evidence-based criteria.
Perineal body-sparing transsphincteric anorectoplasty (TSARP) for rectovestibular fistula: Mid-term functional outcomes from a single center.
Demirel BD, Dağdemir Ezber B, Yağız B
Pediatr Surg Int · 2026 Jun · PMID 42295374 · Full text
PURPOSE: This study aimed to evaluate the mid-term functional and cosmetic outcomes of perineal body-sparing trans-sphincteric anorectoplasty (TSARP) in patients with anal atresia and rectovestibular fistula. METHODS: Pa...
PURPOSE: This study aimed to evaluate the mid-term functional and cosmetic outcomes of perineal body-sparing trans-sphincteric anorectoplasty (TSARP) in patients with anal atresia and rectovestibular fistula. METHODS: Patients with anal atresia and rectovestibular fistula who underwent perineal body-sparing TSARP between 2018 and 2024 were retrospectively reviewed. All procedures were performed by a single pediatric surgeon. Demographic data, presence of colostomy, perioperative complications, postoperative first-feeding time, and functional outcomes were recorded. Functional outcomes in patients were assessed using the Krickenbeck classification. RESULTS: Twenty-six patients underwent perineal body-sparing TSARP. One-stage repair was performed in 16 patients (61.5%), whereas 10 (38.5%) had a protective colostomy. The median age at operation was 40 days (range 2 days-7 months). Posterior vaginal wall injury occurred in two patients and was repaired uneventfully. Two patients developed wound infection that resolved with local wound care. The mean follow-up duration was 3.25 years. Among 18 patients older than 3 years old, voluntary bowel control was present in 15 patients (83.3%). Constipation occurred in seven patients, and no patient developed soiling. CONCLUSION: Perineal body-sparing TSARP appears to be a safe and effective technique for rectovestibular fistula, providing low complication rates with satisfactory functional and cosmetic outcomes.
Staged compressive dressing method for primary giant omphalocele repair: a low-cost and successful strategy.
Hakalmaz AE, Özcan R, Karagöz A … +4 more , Rahimli T, Emre Ş, Kendigelen P, Tekant GT
Pediatr Surg Int · 2026 Jun · PMID 42295371 · Full text
PURPOSE: In giant omphalocele cases, small abdominal cavity leads to high intraabdominal pressure during closure, making repair challenging. This study aimed to evaluate our staged compressive dressing technique and its...
PURPOSE: In giant omphalocele cases, small abdominal cavity leads to high intraabdominal pressure during closure, making repair challenging. This study aimed to evaluate our staged compressive dressing technique and its outcomes. METHODS: Eighteen giant omphalocele cases treated with staged compressive dressing/primary closure between 2014 and 2024 were retrospectively reviewed. All cases received compressive dressing every other day with wet sterile gauze and transparent adhesive surgical drapes from the first postnatal day until surgery to reduce intra-sac organs. Primary closure was performed after organ reduction. RESULTS: Eighteen cases (Female/Male: 10/8) were included. Mean gestational age was 36.8 ± 1.7 weeks, birth weight 2988 ± 603 g. Major cardiac anomaly was present in 16.7% and liver herniation in 83.3%. Mean defect diameter was 6.0 ± 1.2 cm. Mean time to surgery was 6.4 ± 5.1 days. Primary repair was successfully performed in all cases (100%). Operation was delayed in patients with cardiac anomaly (13.0 ± 9.2 vs. 5.3 ± 3.4 days, p = 0.012). Seven patients (38.9%) had prolonged hospitalization (> 20 days). One patient with cardiac anomaly died postoperatively. Mean hospital stay was 22.2 ± 11.0 days . CONCLUSION: In this single-center retrospective study, the staged compressive dressing technique appeared to be a feasible, simple, and potentially cost-effective method for giant omphalocele management. While we achieved primary closure in all cases without prosthetic materials, these findings require validation through larger multicenter studies and comparative trials before definitive conclusions can be drawn about superiority over alternative methods.
Challenges and outcomes in the management of rectal atresia and stenosis: a comprehensive review.
Siffredi JI, Álvarez L, Domínguez Márquez MV … +5 more , Ruíz J, Neder MD, Rocca AM, Bailez MM, Di Benedetto VP
Pediatr Surg Int · 2026 Jun · PMID 42295364 · Publisher ↗
PURPOSE: Rectal atresia (RA) and rectal stenosis (RS) are rare anorectal malformations (ARM), comprising 1-2% of all cases. No consensus exists regarding optimal surgical technique. This study evaluated surgical approach...
PURPOSE: Rectal atresia (RA) and rectal stenosis (RS) are rare anorectal malformations (ARM), comprising 1-2% of all cases. No consensus exists regarding optimal surgical technique. This study evaluated surgical approaches, complications, and long-term functional outcomes at a single referral center. METHODS: Retrospective review of RA or RS patients treated between 2003 and 2020. Surgical technique, complications, and bowel function were analyzed. Fecal continence was assessed using Krickenbeck classification. RESULTS: Eleven patients were included (7 RS, 4 RA), representing 1.2% of 900 ARM cases. Surgical techniques included posterior sagittal anorectoplasty (PSARP) in 4 (36.4%), transanal in 3 (27.3%), abdominoperineal pull-through in 2 (18.2%), and laparoscopic rectal web correction (LWC) in 2 (18.2%). Two patients required redo surgery. Ten of 11 patients were eligible for functional assessment; no true fecal incontinence was observed. Five (50%) required no bowel management; constipation was identified in five, including three with overflow soiling due to non-adherence. Median follow-up was 100.4 months (range 13-168). CONCLUSION: Despite surgical complexity, most patients achieved satisfactory outcomes. The high incidence of constipation, particularly in RS, underscores the need for long-term follow-up and early intervention. The laparoscopic rectal web correction offers a reproducible, sphincter-preserving technique for effective correction of rectal webs.
25 years of surgery in patients with congenital lung malformations: the Rotterdam experience.
Zuidweg MJP, Dossche LWJ, Wijnen RMH … +1 more , Schnater JM
Pediatr Surg Int · 2026 Jun · PMID 42295356 · Full text
OBJECTIVE: This single-center study aimed to evaluate surgical management of congenital lung malformations (CLM) and its associated perioperative results and short- and long-term outcomes. METHODS: We analyzed data from...
OBJECTIVE: This single-center study aimed to evaluate surgical management of congenital lung malformations (CLM) and its associated perioperative results and short- and long-term outcomes. METHODS: We analyzed data from patients who underwent surgical treatment for CLM. Data were collected within the framework of a structured, prospective longitudinal follow-up program. Length of hospital stay, age at surgery and drain days were analyzed as perioperative outcomes. Surgical approaches and complications were also described. RESULTS: We included 80 surgically managed patients with CLM over a 25-year period. Eighty-two percent of patients who underwent resection were symptomatic, with respiratory insufficiency (45%) being the primary reason for intervention. Other symptoms were: reduced exercise tolerance, dyspnea and persistent coughing. Reoperation was needed in 2.5% of cases. Median age at intervention was 108 days (IQR 21-463 ) Surgical approaches included thoracotomy (60%), thoracoscopy (29%), embolization (4%) and other interventions (7%). Median length of postoperative hospitalization was 6 days. During their most recent follow-up visit, 21% of the cohort experienced pulmonary symptoms. CONCLUSIONS: A minority of patients with CLM underwent surgical treatment, most of whom were symptomatic. Surgery had low rates of severe complications and a short postoperative stay. Our findings underscore the importance of a long-term management approach.
Association between post-Kasai cholangitis episodes, ursodeoxycholic acid regimen, and portal hypertension risk in biliary atresia: a multicenter cross-sectional study.
Yang Q, Meng Y, Li X … +11 more , Yang Y, Wu X, Yu P, Yan X, Wang B, Zhang Z, Zhang X, Yang T, Abudureyimu A, Gao W, Zhan J
Pediatr Surg Int · 2026 Jun · PMID 42287447 · Publisher ↗
BACKGROUND: To investigate the association between cholangitis and portal hypertension (PH) risk, and the efficacy of UDCA in native liver survivors after successful Kasai portoenterostomy (KPE). METHODS: A multicenter,...
BACKGROUND: To investigate the association between cholangitis and portal hypertension (PH) risk, and the efficacy of UDCA in native liver survivors after successful Kasai portoenterostomy (KPE). METHODS: A multicenter, retrospective cross-sectional study was conducted at nine Chinese pediatric centers. Patient grouping was based on cumulative cholangitis episodes and UDCA regimens. RESULTS: After a median follow-up of 56 months, the overall incidence of PH was 23.63% (198/838). Recurrent cholangitis (≥ 3 episodes) was an independent risk factor for PH (OR = 4.25, 95% CI 2.61-6.92, P < 0.001), associated with poorer liver function recovery, greater spleen thickness, and lower peak velocity of the main portal vein. Continuous UDCA therapy significantly attenuated the PH risk induced by recurrent cholangitis (RERI: - 7.66). Among this high-risk subgroup, low-dose UDCA (≤ 10 mg/kg/day) constituted an independent protective factor (OR = 0.17, 95%CI 0.04-0.67, P = 0.015) and showed superior efficacy in reducing total bilirubin. These benefits were evident in children under 48 months, but no clear advantage observed beyond this age. CONCLUSION: Among native liver survivors with jaundice clearance, recurrent cholangitis (≥ 3 episodes) warrants long-term monitoring for PH. Continuous low-dose UDCA until 48 months is recommended for high-risk patients to improve outcomes.
Age-stratified outcomes of laparoscopic hiatal hernia repair with Nissen fundoplication in children: a single-center experience.
Bahadir K, Evin E, Sagpazar I … +6 more , Ekiyor E, Ergun E, Gollu G, Kologlu M, Cakmak M, Ates U
Pediatr Surg Int · 2026 Jun · PMID 42287417 · Full text
PURPOSE: To evaluate outcomes of laparoscopic hiatal hernia repair with Nissen fundoplication in children, comparing infants (≤ 12 months) and older children (> 12 months). METHODS: Pediatric patients who underwent lapar...
PURPOSE: To evaluate outcomes of laparoscopic hiatal hernia repair with Nissen fundoplication in children, comparing infants (≤ 12 months) and older children (> 12 months). METHODS: Pediatric patients who underwent laparoscopic hiatal hernia repair with Nissen fundoplication between 2008 and 2025 were retrospectively reviewed. Patients were classified by age at surgery into ≤ 12 months and > 12 months. Outcomes included postoperative complications, recurrence, length of hospital stay, and follow-up. RESULTS: Nineteen patients were included in this study (10 boys, 9 girls); of which 9 were ≤ 12 months and the remaining 10 were > 12 months. Age-stratified postoperative outcome comparisons were performed in 17 patients after exclusion of 2 patients (%10.5) with concomitant gastrostomy. Median age at repair was 20 months (IQR 5-58.5; 5 days-120 months) and median weight was 9.8 kg (IQR 5.1-17.5; 2.4-50.0 kg). Median length of stay was 4 days (IQR 3-5; 2-7 days), and median follow-up was 84 months (IQR 38.5-112; 4-205 months). Selective mesh reinforcement was used in 3 patients (15.8%) with wide hiatal defects and/or poor crural tissue quality. Postoperative complications occurred in 4 patients (21.1%). Recurrence occurred in 3 patients (15.8%) at 2, 4, and 9 months postoperatively. All underwent redo laparoscopic repair, and no further recurrence was observed during follow-up. CONCLUSION: Laparoscopic hiatal hernia repair with Nissen fundoplication appeared feasible in selected pediatric patients, including infants ≤ 12 months. In this small single-center cohort, recurrences occurred within the first postoperative year and were managed with redo laparoscopy. These findings should be interpreted cautiously and require confirmation in larger multicenter studies.
Early vs. delayed feeding after pediatric gastrointestinal surgery: a systematic review and meta-analysis.
Al Blooshi M
Pediatr Surg Int · 2026 Jun · PMID 42274810 · Full text
BACKGROUND: The adoption of early feeding after pediatric gastrointestinal surgery remains inconsistent due to concerns regarding anastomotic safety. METHODS: A systematic review and meta-analysis of randomized controlle...
BACKGROUND: The adoption of early feeding after pediatric gastrointestinal surgery remains inconsistent due to concerns regarding anastomotic safety. METHODS: A systematic review and meta-analysis of randomized controlled trials was conducted comparing early enteral feeding (initiation within 48 h) with delayed feeding in patients < 18 years undergoing intestinal anastomosis or stoma reversal. RESULTS: Eight trials comprising 704 patients (323 early feeding, 381 delayed) were included across neonatal and pediatric elective surgical populations. Early feeding significantly shortened hospital length of stay (mean difference - 3.53 days; 95% CI - 4.35 to - 2.71) and reduced time to full feeds (mean difference - 3.15 days; 95% CI - 3.89 to - 2.40). There was no significant difference in anastomotic leakage (log risk ratio - 0.36; 95% CI - 1.23 to 0.51; I²=0%) or postoperative vomiting (log risk ratio - 0.02; 95% CI - 0.41 to 0.38). Early feeding was also associated with fewer wound infections (log risk ratio - 0.85; 95% CI - 1.48 to - 0.22). CONCLUSIONS: Overall, early enteral feeding after pediatric gastrointestinal surgery appears safe and confers clinically meaningful benefits by accelerating nutritional recovery, reducing infectious complications, and shortening hospitalization, supporting its incorporation into pediatric postoperative care pathways.
Fentanyl Utilization During Extracorporeal Membrane Oxygenation and Risk of Methadone Treatment Among Pediatric ECMO Survivors.
Barq RM, Ourshalimian S, Keane OA … +7 more , Nelson LP, Lakshmanan A, Lee HC, Kim E, Hintz SR, Kamerkar A, Kelley-Quon LI
Pediatr Surg Int · 2026 Jun · PMID 42257859 · Full text
INTRODUCTION: Single center studies suggest utilization of fentanyl during extracorporeal membrane oxygenation (ECMO) may be associated with a higher risk of opioid withdrawal. This study evaluated fentanyl use during EC...
INTRODUCTION: Single center studies suggest utilization of fentanyl during extracorporeal membrane oxygenation (ECMO) may be associated with a higher risk of opioid withdrawal. This study evaluated fentanyl use during ECMO and subsequent methadone or buprenorphine treatment among pediatric ECMO survivors in a large multi-center cohort. METHODS: This retrospective study included children < 18y treated at 41 U.S. children's hospitals in the Pediatric Health Information System between 2013 and 2023. Multivariable hierarchical regression was used to assess the relationship between fentanyl exposure on ECMO and likelihood of receiving methadone or buprenorphine after ECMO, adjusting for covariates including other opioid exposures. RESULTS: Overall, 4,365 children were included (55.5% male; 47.9% neonatal). Median duration of ECMO was 5 (IQR: 3-8) days. Fentanyl exposure was categorized into quartiles:0-1 days, 2 days, 3-4 days, and ≥ 5 days. On multivariable regression, children in the 3-4 days quartile (OR 1.32; 95% CI: 1.05-1.65) and ≥ 5 days quartile (OR 2.21; 95% CI: 1.71-2.85) were more likely to receive methadone or buprenorphine after ECMO compared to those in the 0-1 days quartile. On bivariate comparison, children who received fentanyl during ECMO were found to have prolonged ventilator dependence, TPN use, and post-ECMO length of stay. CONCLUSION: Patients receiving fentanyl while on ECMO had an increased risk of receiving methadone or buprenorphine treatment post-ECMO, suggesting a higher risk of opioid withdrawal in patients receiving fentanyl while on ECMO. Our findings underscore a need for expanded opioid stewardship initiatives to utilize alternative pain management and minimize fentanyl prescribing for children undergoing ECMO.
Comparison of non-invasive liver fibrosis indicators for biliary atresia.
Yang Y, Jiang J, Zhou J … +5 more , Chen D, Zhang J, Chen G, Dong R, Zheng S
Pediatr Surg Int · 2026 Jun · PMID 42257719 · Publisher ↗
PURPOSE: To compare the value of non-invasive liver fibrosis indicators, including serum matrix metalloproteinase-7 (MMP-7), APRI, collagen-related proteins [hyaluronic acid (HA), type IV collagen (IV-C), type III procol...
PURPOSE: To compare the value of non-invasive liver fibrosis indicators, including serum matrix metalloproteinase-7 (MMP-7), APRI, collagen-related proteins [hyaluronic acid (HA), type IV collagen (IV-C), type III procollagen N-terminal peptide (PIIIP), laminin] and shear wave elastography (SWE), in assessing liver fibrosis for biliary atresia (BA). METHODS: A retrospective cohort study was conducted in BA infants from July 2020 to December 2023. Liver fibrosis was classified according to the Batts-Ludwig criteria. RESULTS: A total of 471 BA infants were included. Serum MMP-7, HA, IV-C, PIIIP, laminin, and SWE all correlated with liver fibrosis, with correlation coefficients of 0.4, 0.28, 0.37, -0.15, 0.16, and 0.46 (all P < 0.01), respectively. For severe fibrosis, the AUROC was 0.675 (95% CI: 0.622-0.728) at a cutoff value of 58.98 ng/ml for MMP-7, 0.719 (95% CI: 0.664-0.775) at a cutoff value of 547.05 for IV-C, and 0.732 (95% CI: 0.667-0.796) at a cutoff value of 1.35 m/s for SWE. Among the combined models, IV-C + MMP-7 achieved the higher performance (AUROC 0.756, 95% CI 0.700-0.811). CONCLUSIONS: Non-invasive serum markers and SWE all showed moderate value for fibrosis assessment in BA. SWE may be a promising and useful non-invasive tool, while selected serum biomarker combinations may provide complementary value for identifying severe fibrosis.
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