Pediatr. Surg. Int. [JOURNAL]
Sun
200 papers
Interrupted vs. continuous suture urethroplasty in tubularised incised plate hypospadias: an updated systematic review & meta-analysis.
Amin F, Imtiaz A, Nadeem H … +4 more , Ishfaq A, Afzal T, Zahra FT, Fatima R
Pediatr Surg Int · 2026 Jun · PMID 42240839 · Publisher ↗
PURPOSE: The optimal suturing technique for urethral tubularisation during tubularised incised plate (TIP) urethroplasty remains debated. This systematic review and meta-analysis compared perioperative and postoperative...
PURPOSE: The optimal suturing technique for urethral tubularisation during tubularised incised plate (TIP) urethroplasty remains debated. This systematic review and meta-analysis compared perioperative and postoperative outcomes of interrupted versus continuous suturing techniques in paediatric hypospadias repair. METHODS: A systematic literature search was performed in PubMed, Cochrane Library, Embase, Scopus, and ClinicalTrials.gov from inception to December 2025 in accordance with PRISMA guidelines. Randomised controlled trials and observational studies comparing interrupted and continuous suturing during paediatric TIP urethroplasty were included. Outcomes assessed were urethrocutaneous fistula, surgical site infection, meatal stenosis, urethral stricture, glans dehiscence, overall complications, urinary stream outcomes, operative time, and reoperation rates. Risk of bias was evaluated using the Cochrane Risk of Bias 2.0 tool and the ROBINS-I. A random-effects meta-analysis supplemented by influence diagnostics and Hartung-Knapp adjustment for heterogeneous outcomes, were conducted using R version 4.5.2, with results expressed as odds ratios (ORs) or mean differences (MDs) and corresponding 95% confidence intervals (CIs). RESULTS: Fifteen studies involving 2625 paediatric patients were included, with 800 undergoing interrupted suturing and 1,825 continuous suturing. No statistically significant differences were observed between techniques for urethrocutaneous fistula (OR 0.65, 95% CI 0.38-1.11), surgical site infection (OR 0.61, 95% CI 0.25-1.48), meatal stenosis (OR 0.98, 95% CI 0.54-1.80), urethral stricture (OR 1.08, 95% CI 0.29-3.97), overall complications (OR 0.75, 95% CI 0.48-1.17), or glans dehiscence (OR 0.77, 95% CI 0.36-1.63). Operating time showed no clinically meaningful difference operative time (MD 3.77 min, 95% CI - 3.69 to 11.24, Hartung-Knapp adjusted). CONCLUSION: Continuous and interrupted suturing techniques during TIP urethroplasty demonstrate comparable complication rates and functional outcomes. These findings suggest that suturing technique may be selected based on surgeon preference and experience; however, large, well-designed multicentre randomised trials are required to further inform clinical practice.
A novel compound heterozygous variant in DNAH2: preliminary evidence of a potential genetic modifier for persistent cloaca in a Chinese family.
Wang C, Wu H, Wang L … +7 more , Liu T, Wu L, Ye Y, Yan Y, Long L, Li S, Chen Z
Pediatr Surg Int · 2026 Jun · PMID 42228139 · Publisher ↗
BACKGROUND: Persistent cloaca (PC), the most severe subtype of congenital anorectal malformations (ARMs) in female infants with an incidence of 1/50,000 live births, has poorly understood etiology. METHODS: The study enr...
BACKGROUND: Persistent cloaca (PC), the most severe subtype of congenital anorectal malformations (ARMs) in female infants with an incidence of 1/50,000 live births, has poorly understood etiology. METHODS: The study enrolled 12 Chinese PC patients (4 trio families, 8 unrelated individuals), performed whole exome sequencing (WES) via the CG Black Bird platform, extracted genomic DNA from peripheral blood and cryopreserved surgical specimens, annotated variants using databases (dbSNP, gnomAD) and tools (SIFT/PolyPhen2), assessed pathogenicity by 2015 ACMG/AMP Guidelines, and validated via Sanger sequencing. We generated Dnah2⁻/⁻ mice and silenced DNAH2 in human mesenchymal stem cells (hMSCs) to detect SHH pathway proteins. RESULTS: A novel DNAH2 compound heterozygous variant (p.Ser312Thr, p.Arg573Cys, inherited from asymptomatic parents) was identified in one trio, both classified as Variants of Unknown Significance (VUS). Dnah2⁻/⁻ mice showed vaginal atresia and features consistent with ciliary dysfunction; DNAH2 silencing in hMSCs reduced Smo (53.1%), Gli2 (66.4%). CONCLUSION: The first report of the DNAH2 compound heterozygous variant in Chinese PC patients suggests DNAH2 should be considered a candidate susceptibility gene for PC (limited by small sample, conflicting evidence, model flaws), providing a preliminary basis for cilia-associated gene research in PC.
Meteorological factors and the risk of complicated appendicitis in pediatric patients: a nationwide multicenter study from Turkey.
Kulice EC, Bostancı SA, Bayram S … +24 more , Genişol İ, Dörterler ME, Cesur E, Tangül SU, Çelik N, Dündar K, Sağ S, Erdoğan M, Bilir C, Altuğ E, Aydın E, Okay G, Çin ES, Ertuğrul MA, Mansıroğlu AK, Khalilova P, Özdemir AY, Yıldız S, Öztürk ÜT, Balcı SK, Arda MS, Şencan A, Karagüzel G, Şenel E
Pediatr Surg Int · 2026 Jun · PMID 42223685 · Publisher ↗
OBJECTIVE: The aim of this study was to evaluate the effects of meteorological variables on the development of complicated appendicitis in pediatric patients with acute appendicitis in Turkey and to determine whether the...
OBJECTIVE: The aim of this study was to evaluate the effects of meteorological variables on the development of complicated appendicitis in pediatric patients with acute appendicitis in Turkey and to determine whether these associations differ across NUTS (Nomenclature of Territorial Units for Statistics) regions. MATERIALS AND METHODS: This multicenter retrospective study included 4361 pediatric patients who underwent surgery for acute appendicitis in different NUTS regions of Turkey between 2023 and 2024. Patients were classified as uncomplicated (71.4%) or complicated (28.6%) appendicitis. Meteorological data, including temperature, humidity, atmospheric pressure, precipitation, and wind speed corresponding to the patients' operation dates, were obtained from the Turkish State Meteorological Service database. Statistical analyses included descriptive statistics, chi-square test, point-biserial correlation, ROC analysis, and univariable logistic regression. Statistical significance was set at p < 0.05. RESULTS: No significant nationwide association was observed between meteorological variables and the development of complicated appendicitis (p > 0.05). However, regional analyses demonstrated significant differences. In the Aegean region, increases in temperature, atmospheric pressure, and wind speed were associated with 2.3%, 1.7%, and 35.1% reductions in the risk of complicated appendicitis, respectively. In contrast, increases in atmospheric pressure and wind speed were associated with an increased complication risk in the Western Anatolia and Western Black Sea regions. In the Eastern Black Sea region, atmospheric pressure, and in Southeastern Anatolia, humidity and precipitation showed positive associations with complicated appendicitis risk. CONCLUSION: Although meteorological variables were not associated with complicated appendicitis at the nationwide level, regional analyses revealed significant associations. These findings suggest that regional meteorological conditions may influence the risk of complicated appendicitis in children.
Transfer dynamics of pediatric thoracic trauma patients across Türkiye.
Deniz MS, Ciflik KB, Ozdemir Ciflik B … +2 more , Yetik Aras A, Ozcan UA
Pediatr Surg Int · 2026 May · PMID 42213152 · Publisher ↗
OBJECTIVES: Although pediatric thoracic injuries constitute only a small proportion of all childhood injuries, the risk of morbidity and mortality is increased due to the anatomical and physiological characteristics of c...
OBJECTIVES: Although pediatric thoracic injuries constitute only a small proportion of all childhood injuries, the risk of morbidity and mortality is increased due to the anatomical and physiological characteristics of children. Early diagnosis and timely referral to appropriate centers are critically important, particularly in hospitals with limited advanced imaging, thoracic surgery, and intensive care facilities. This study aims to comprehensively evaluate the interhospital transfer characteristics of pediatric patients with thoracic trauma in Turkey. METHODS: The patients' age, gender, nationality, referring-receiving province and region, referral time, distance, and ICD-10 codes were retrospectively evaluated. RESULTS: A total of 313 patients were examined (78% male; mean age, 11.2 ± 5.8 years). The most common diagnosis was pneumothorax (27.2%). The vast majority of transfers were by road (98.1%), within the province (82.7%), outside working hours (78%), and on weekdays (70.9%). A significant proportion of air transfers were performed during working hours (p = 0.023). No significant relationship was found between diagnoses and either the transfer route or the transfer time. The distance was significantly longer for out-of-province transfers (p < 0.001). Although significance was detected between the transferring and receiving regions and the direction of transfer, it disappeared in subgroup analyses. CONCLUSION: Regulating the criteria for the use of air ambulance services is crucial for strengthening national trauma systems, regionalizing pediatric trauma management, and increasing timely access to advanced trauma centers.
Long-term ovarian function, follicular development, and atrophy after pediatric ovarian torsion.
Uzun AGK, Senel E
Pediatr Surg Int · 2026 May · PMID 42207319 · Publisher ↗
BACKGROUND: Ovarian torsion is a surgical emergency that can threaten ovarian viability and future fertility. Long-term functional recovery and predictors of postoperative atrophy remain incompletely defined in children....
BACKGROUND: Ovarian torsion is a surgical emergency that can threaten ovarian viability and future fertility. Long-term functional recovery and predictors of postoperative atrophy remain incompletely defined in children. OBJECTIVE: To evaluate long-term follicular development and ovarian atrophy after pediatric ovarian torsion and to assess the influence of torsion severity and surgical approach. METHODS: We retrospectively reviewed records of patients aged 0-18 years treated for ovarian torsion at our center between August, 2019 and August, 2022. Data included age group, laterality, symptom timing, torsion degree, operative technique, pathology, postoperative ultrasound follicular presence, and atrophy. Statistical tests were performed using IBM SPSS Statistics v25. A ROC analysis was used to explore rotation thresholds associated with atrophy. Statistical significance was defined as p < 0.05. RESULTS: Forty-three patients were included; torsion was more frequent on the right ovary. Detorsion alone was performed in 17 patients, detorsion plus oophoropexy in 16, oophorectomy in 2, and salpingo-oophorectomy in 8. Among patients with postoperative ultrasound follow-up, follicular development was observed in 90% of those undergoing oophoropexy, with no significant difference compared with those without oophoropexy (p = 0.46). Atrophy was more frequent in torsions with 720 or more twisted ovaries (p = 0.01). ROC analysis suggested 900 degrees as a clinically relevant cut-off for increased atrophy risk. CONCLUSION: In this single-center cohort, ovarian-sparing surgery achieved high follicular recovery. Torsion rotation severity was strongly associated with postoperative atrophy, with higher risk beyond approximately 900 degrees. Oophoropexy did not adversely affect follicular development, while its protective effect against atrophy remains uncertain.
Incidence and management of meatal stenosis in paediatric patients following circumcision for Lichen Sclerosus et atrophicus.
Balfour J, Elkassaby A, Mostafa MS
Pediatr Surg Int · 2026 May · PMID 42207313 · Publisher ↗
INTRODUCTION: Lichen sclerosus et atrophicus (LS), often known as Balanitis Xerotica Obliterans, is a common indication for paediatric circumcision. LS is associated with scarring of the foreskin and glans, with meatal s...
INTRODUCTION: Lichen sclerosus et atrophicus (LS), often known as Balanitis Xerotica Obliterans, is a common indication for paediatric circumcision. LS is associated with scarring of the foreskin and glans, with meatal stenosis a possible complication. This study aimed to assess the incidence of meatal stenosis among patients undergoing circumcision for LS and assess the risk factors and management of meatal stenosis. METHODS: A retrospective case note review was undertaken of all patients under the age of 16 in NHS Grampian undergoing circumcision for LS from 2017 to 2022. Demographics, intervention and outcome data was collected. RESULTS: 131 male patients, with a median age of 9-years-old, underwent circumcision for LS over a 5-year period. Histology was sent for 122 patients of which 117(95.9%) was positive for LS. 15/117 (12.8%) patients were diagnosed clinically with meatal stenosis post-operatively. 9/117(7.7%) patients underwent uroflow studies. 4 patients were managed conservatively after normal uroflows. 11 patients (9.4%) required surgical intervention. 5 patients underwent meatal dilatation. However, 2 patients required further meatoplasty after initial dilatation. 6 patients underwent primary meatoplasty. 42(35.9%) patients were prescribed topical steroids pre-operatively and 21(17.9%) post-operatively. Fischer's exact test and a Pearson Chi square indicated a significant link between post-operative steroid use and meatal stenosis. However, this is likely due to prescribers favouring steroid use in patients with significant LS of the glans associated with meatal stenosis. CONCLUSION: Meatal stenosis following circumcision for LS is a common finding with an incidence of 12.8% in our study. 73.3% (11/15) of these patients required further surgical management with meatal dilatation and/or meatoplasty. Meatal dilatation was successful in 3/5 patients. Meatoplasty was successful in 6/6 patients. Steroid use was hard to assess due to large variation amongst prescribers. Formulation of a guideline for steroid use in LS patients would help provide consistent care to patients. Further controlled studies would be required to confirm whether peri-operative steroid use is useful for prevention of meatal stenosis following LS.
Bowel and bladder outcomes in patients with anorectal malformations and sacral agenesis: a retrospective cohort study.
Theeuwes JN, de Beaufort CMC, McDonald CJ … +7 more , Bakker DP, van Schuppen J, Kuijper CF, Flores OEA, de Jong JR, Kremer MEB, Gorter RR
Pediatr Surg Int · 2026 May · PMID 42207205 · Full text
PURPOSE: Patients with anorectal malformation (ARM) and associated sacral agenesis (SA) are at increased risk of long-term bowel and bladder dysfunction, but outcome data to guide early counselling and follow-up remain l...
PURPOSE: Patients with anorectal malformation (ARM) and associated sacral agenesis (SA) are at increased risk of long-term bowel and bladder dysfunction, but outcome data to guide early counselling and follow-up remain limited. We aimed to evaluate bowel and bladder outcomes in patients with concurrent ARM and SA, with a focus on transanal irrigation (TAI) and clean intermittent catheterization (CIC) use. METHODS: In this retrospective single-center cohort study, all patients with ARM and SA born between January 2000 and January 2024 were included. SA was diagnosed radiologically and classified using Pang's classification. The primary outcome was TAI and/or CIC use. Secondary outcomes included fecal incontinence (≥ 4 years), urinary incontinence (≥ 5 years), and neurogenic bladder. RESULTS: In total, 41 patients were included, with a median age at follow-up of 11.2 years. Of 33 patients ≥ 4 years, 22 (66.7%) used TAI during follow-up, primarily for fecal incontinence. Fecal incontinence was present in 26.3% of current TAI users versus 71.4% of non-users (p = .015). CIC was initiated in 18 of 41 patients (43.9%), mostly due to urodynamically confirmed neurogenic bladder. TAI and CIC use were associated with ARM complexity, but not with radiological SA severity. CONCLUSION: Patients with concurrent ARM and SA represent a high-risk group for long-term bowel and bladder dysfunction, and many require structured bowel and/or bladder management. These findings support anticipatory counselling and multidisciplinary follow-up.
Rare variants in TTC7A, ROCK2 and LIMK2 suggest a role for the ROCK-signaling pathway in isolated intestinal malrotation.
Salehi Karlslätt K, Pettersson M, Lagerstedt-Robinson K … +3 more , Ullberg U, Lindstrand A, Nordenskjöld A
Pediatr Surg Int · 2026 May · PMID 42185554 · Full text
PURPOSE: This study aimed to identify genetic variants contributing to the development of early-diagnosed isolated intestinal malrotation. METHODS: We conducted Genome sequencing on ten young children diagnosed with midg...
PURPOSE: This study aimed to identify genetic variants contributing to the development of early-diagnosed isolated intestinal malrotation. METHODS: We conducted Genome sequencing on ten young children diagnosed with midgut volvulus due to intestinal malrotation who presented no other malformations or comorbidities. Our analysis focused on a panel of 442 genes previously associated with intestinal development, malrotation, ciliopathies and/or situs abnormalities. RESULTS: In one male patent we discovered two heterozygous variants in TTC7A, c.433G > A p.(Ala145Thr) and c.1057G > A p.(Glu353Lys). Carrier testing revealed that he inherited both variants from his mother with a mild intestinal rotation abnormality. Additionally, we identified inherited variants in two other male participants, c.1802 A > T p.(Asp601Val) in ROCK2 and, c.884 G > A p.(Arg295His) in LIMK2. These genes are part of a shared signaling pathway previously shown to cause intestinal malrotation in Xenopus when inhibited. CONCLUSION: Our findings suggest the potential involvement of TTC7A, ROCK2 and LIMK2-genes in the pathogenesis of intestinal malrotation; through the ROCK-signaling pathway.
Does anhepatic phase duration affect diaphragmatic hernia after pediatric liver transplantation? A single-center experience analyzed from a pool of nearly 2000 cases.
Mou Z, Dong C, Sun C … +8 more , Zheng W, Yang Y, Wang Z, Han C, Xie E, Zhang G, Wang K, Gao W
Pediatr Surg Int · 2026 May · PMID 42177721 · Publisher ↗
BACKGROUND: Diaphragmatic hernia (DH) is one of the rare complications without the confirmed risk factors following pediatric liver transplantation (pLT). PURPOSE: To analyze the clinical characteristics and risk factors...
BACKGROUND: Diaphragmatic hernia (DH) is one of the rare complications without the confirmed risk factors following pediatric liver transplantation (pLT). PURPOSE: To analyze the clinical characteristics and risk factors of DH after pLT. METHODS: A retrospective analysis of 15 DH cases after pLT among 1,863 cases of pLT from January 2014 to June 2024 was conducted. Using propensity score matching (PSM), DH patients (n = 15) were matched 1:3 with non-DH recipients (n = 45). DH cases were stratified into early-onset (≤ 3 months, n = 6) and late-onset (> 3 months, n = 9) groups according to the interval from LT surgery to DH diagnosis. Comparative analyses were performed to characterize DH and identify risk factors. RESULTS: DH incidence was approximately 0.8% in our cohort, with most of cases within 12 months post-pLT. The clinical features of DH were primarily digestive or respiratory symptoms, and prognosis was favourable after repairing surgery. After PSM, the DH and non-DH groups were well balanced with respect to baseline covariates. Compared to non-DH recipients, DH patients had longer time in both anhepatic phase and ICU stay duration (P < 0.05). Late-onset DH patients had longer anhepatic and operative times than early-onset patients (P < 0.05). No significant differences were found in growth parameters between DH and non-DH groups, and DH defect locations or GRWR between early-onset and late-onset groups. CONCLUSION: Despite low incidence, DH post- pLT is a multi-factorial complication, and re-operation is necessary for all cases. Prolonged anhepatic phase may be a risk factor. Preventive measures, such as meticulous intraoperative manipulation, expedited surgical procedures, and the minimization of iatrogenic injuries, should be conscientiously adopted in pLT.
Low stricture rate with protocol-driven management of deep caustic esophageal burns in children: a prospective cohort study.
Sarsenova VV, Bissaliyev BN, Tussupkaliyev AB … +2 more , Baubekov ZT, Dosmagambetov SP
Pediatr Surg Int · 2026 May · PMID 42177679 · Publisher ↗
PURPOSE: To evaluate early clinical outcomes and stricture formation in children with deep caustic esophageal burns managed using a standardized, injury-adapted protocol. METHODS: This prospective single-center study inc...
PURPOSE: To evaluate early clinical outcomes and stricture formation in children with deep caustic esophageal burns managed using a standardized, injury-adapted protocol. METHODS: This prospective single-center study included children with endoscopically confirmed Zargar grade IIB-IIIA esophageal burns. All patients were managed according to a predefined protocol including early endoscopic assessment, temporary withdrawal and controlled reintroduction of oral feeding, systemic corticosteroid therapy, and avoidance of routine prophylactic dilation. The primary outcome was clinically significant esophageal stricture. RESULTS: A total of 31 patients were included. Clinically significant esophageal stricture developed in 3 patients (9.7%), which is markedly lower than the 40-70% rates reported for comparable deep injuries in previous studies. All strictures occurred within five weeks and were successfully treated with endoscopic dilation. No cases of esophageal perforation, emergency surgery, or mortality were observed. CONCLUSION: Protocol-driven early management was associated with a low stricture rate and favorable short-term outcomes. These findings suggest that standardized early care and structured endoscopic surveillance may contribute to improved outcomes in children with deep caustic esophageal injury.
Long-term outcomes of liver transplantation in biliary atresia: a 20-year single-center study.
Beyzaei Z, Shamsaeefar A, Ghatei K … +6 more , Kazemi K, Nikeghbalian S, Dehghani M, Malekhosseini SA, Jalali M, Geramizadeh B
Pediatr Surg Int · 2026 May · PMID 42171791 · Publisher ↗
BACKGROUND: Pediatric liver transplantation is the definitive treatment for end-stage liver disease, including cirrhosis secondary to biliary atresia (BA). Understanding long-term outcomes and factors influencing surviva...
BACKGROUND: Pediatric liver transplantation is the definitive treatment for end-stage liver disease, including cirrhosis secondary to biliary atresia (BA). Understanding long-term outcomes and factors influencing survival is essential for optimizing care. METHODS: We performed a retrospective, single-center analysis of pediatric patients (< 18 years) who underwent liver transplantation for biliary atresia between March 2000 and June 2023 at Abu-Ali Sina Hospital, Shiraz University of Medical Sciences. Clinical and laboratory data of patients were retrieved from electronic medical records. RESULTS: A total of 160 patients were included, with a mean age at transplantation of 4.5 ± 0.8 years. The cumulative 20-year graft survival rate was 63.8%. Patient survival was 80% at 6 months and 64.4% at 5 years post-transplantation. Mortality was predominantly concentrated within the first 90 days following transplantation, with sepsis, pneumonia, and hemorrhage representing the leading causes of early death. Chronic rejection, although less frequent, remained a significant contributor to late graft loss. Notably, the decline in overall survival was largely driven by early post-transplant mortality, with survival curves demonstrating relative stabilization beyond the initial high-risk period. After adjustment for graft type and recipient sex, no statistically significant differences in graft or patient survival were observed. These findings are consistent with accumulating evidence that, in experienced centers, living donor liver transplantation (LDLT) and deceased donor liver transplantation (DDLT) yield comparable long-term outcomes. CONCLUSIONS: Pediatric liver transplantation offers durable long-term outcomes, with early postoperative care being critical. Both LDLT and DDLT showed similar trends in outcomes in this cohort, although no definitive differences could be established. Prospective, multicenter studies are warranted to further clarify factors influencing long-term outcomes.
Peritoneal drainage in spontaneous intestinal perforation: a 20-year single center review.
Dantes G, Keane O, Amaniera I … +4 more , Buchanan M, He Z, Alemayehu H, Bhatia AM
Pediatr Surg Int · 2026 May · PMID 42168716 · Publisher ↗
PURPOSE: Spontaneous intestinal perforation (SIP) is a morbid condition of low-birth-weight neonates. Peritoneal drainage (PD), as opposed to upfront laparotomy (LP), is favored for SIP. However, PD management is neither...
PURPOSE: Spontaneous intestinal perforation (SIP) is a morbid condition of low-birth-weight neonates. Peritoneal drainage (PD), as opposed to upfront laparotomy (LP), is favored for SIP. However, PD management is neither standardized nor thoroughly understood. We reviewed our experience of PD in infants with SIP. METHODS: Neonates treated for SIP between 07/2004 and 03/2023 were reviewed. Patients with NEC or death immediately following PD were excluded. Patients treated with a PD that required LP within 30 days were considered salvage laparotomy (SL). RESULTS: A total of 235 neonates were included. The median gestational age and birth weight were 25.0 weeks (IQR: 24.1, 26.3) and 720 g (IQR: 620, 865). Ninety-three (39.6%) patients required SL at a median of 9 days (IQR: 5, 14) from PD. Indications for failure included recurrent pneumoperitoneum (52%), clinical deterioration (20%), and ongoing feculent drain output (14%). At SL, 8.4% of patients were found to have NEC. SL patients had extended length of stay: 113 days (IQR: 86, 153) vs. 67 days (IQR: 38, 115), p < 0.001. CONCLUSION: PD is an important tool in the management of SIP, however SL is not uncommon (39%) and has clinical significance. Prospective data to improve PD management is needed.
Gastroesophageal reflux in congenital diaphragmatic hernia survivors: objective diagnostics reveal clinically relevant disease beyond reported symptoms.
Elrod J, Klensch K, Khasanov R … +5 more , Weis M, Klinke M, Riemer C, Boettcher M, Martel R
Pediatr Surg Int · 2026 May · PMID 42154300 · Full text
PURPOSE: While gastroesophageal reflux disease (GERD) is a frequent comorbidity in congenital diaphragmatic hernia (CDH), there is no consensus about a standardized screening strategy within the speciality. Reported prev...
PURPOSE: While gastroesophageal reflux disease (GERD) is a frequent comorbidity in congenital diaphragmatic hernia (CDH), there is no consensus about a standardized screening strategy within the speciality. Reported prevalence is heterogeneous, and the role of anti-reflux surgery remains controversial. This single-center study aimed to assess the reliability of symptom inquiry, age-dependent prevalence, the impact of GERD on thriving and lung function, and CDH-inherent predispositions. METHODS: Records of 1250 CDH-patients treated between 2000 and 2022 were reviewed. Associations of GER with symptoms, weight gain, and respiratory function were analyzed. A multivariate regression model was used to identify risk factors. RESULTS: Of 1250 patients, 916/964 survivors were followed for a median of 8.7 years [IQR 4.2-13.4]. Reflux-associated symptoms were reported in 18.0%. Esophagogastroduodenoscopy (EGD) was performed in 85 patients, pH-metry in 58 (50 pH-MII). Pathologic findings were detected in 5.2% of the patients. 115 contrast studies showed reflux in further 8.2%. Anti-reflux surgery was performed in 6.9%. Reported gastrointestinal symptoms were associated with higher 24 h-reflux count (74.9 ± 40.7 vs. 51.0 ± 32.8, p = 0.033). Weight gain correlated negatively with esophagitis severity (r=-0.25, p = 0.04) and acid exposure time (-0.41, p = 0.004). Obstructive lung function correlated with the endoscopic grade of esophagitis (r=-0.52, p = 0.04). Larger CDH-defect size and liver herniation were the only significant predisposing factors for GERD. CONCLUSION: CDH patients, especially those with large defects, are at high risk for GERD, which impairs thriving and lung function. Because symptoms poorly reflect objective findings, structured follow-up including EGD and pH-MII is essential.
Type of pledget and suture technique relative to esophageal tensile strength in long-gap esophageal atresia.
Schuh JM, Morelos AA, Olson HM … +6 more , Abebrese EL, Yan K, Zhang J, Freudinger BP, Jones DW, Salazar JH
Pediatr Surg Int · 2026 May · PMID 42154275 · Publisher ↗
PURPOSE: We aimed to investigate whether pledget presence, pledget composition, and full versus partial thickness suture technique affect the force esophageal tissue can withstand before tearing. METHODS: A right thoraco...
PURPOSE: We aimed to investigate whether pledget presence, pledget composition, and full versus partial thickness suture technique affect the force esophageal tissue can withstand before tearing. METHODS: A right thoracotomy was performed on 10 deceased fetal sheep, 110-114 days gestation. The esophagus was divided at the level of the carina and 2 cm of tissue was removed to mimic long-gap esophageal atresia. The pouches were sutured with horizontal mattress non-absorbable braided polyester suture using one of three methods: polytetrafluoroethylene (PTFE) pledgets, bovine pericardial pledgets, or no pledget, in full or partial thickness manner. Each suture was attached to a tensiometer and manually tightened at 50 gram-force / 30 s. Maximal force before esophageal tearing and time to tearing were measured. Results were compared using a linear mixed model. RESULTS: PTFE pledgets withstood significantly more force than pericardial pledgets (p = 0.029) and provided longer duration before tearing compared to no pledget (p = 0.017) and pericardial pledgets (p = 0.047). Full versus partial-thickness technique made no difference. CONCLUSION: In a deceased fetal lamb long-gap esophageal atresia model, PTFE pledgets improved tissue resistance to tearing (PTFE > pericardial) and prolonged stretch duration (PTFE > pericardial or no pledget). Suture thickness (full vs. partial) made no difference.
Appendicolith and inflammatory burden in pediatric acute appendicitis: an independent association.
Anayurt M, Sancar S, Dayı S … +2 more , Çınar F, Dokumacı N
Pediatr Surg Int · 2026 May · PMID 42149242 · Publisher ↗
PURPOSE: This study aimed to evaluate the radiological characteristics of appendicoliths detected on preoperative imaging and to assess their association with demographic, clinical, laboratory, surgical, and postoperativ...
PURPOSE: This study aimed to evaluate the radiological characteristics of appendicoliths detected on preoperative imaging and to assess their association with demographic, clinical, laboratory, surgical, and postoperative outcomes in children with acute appendicitis. METHODS: Data from 711 pediatric patients who underwent appendectomy for acute appendicitis between July 2019 and August 2024 were retrospectively analyzed. Patients were grouped according to the presence of appendicolith on preoperative imaging, and postoperative outcomes were compared. RESULTS: Appendicolith was detected in 124 (17.4%) patients; age and gender distribution were similar between groups. The rate of perforated appendicitis was significantly higher in patients with appendicoliths (47.6% vs. 23.5%; p < 0.001). CRP and WBC levels were significantly higher in the presence of appendicoliths (p < 0.001 for both). Appendicolith presence was associated with increased drain requirement (29.8% vs. 13.5%; p < 0.001) and longer postoperative hospital stay (median 5 vs. 4 days; p < 0.001). In multivariable analysis, appendicolith presence remained independently associated with perforation (adjusted OR: 2.53, 95% CI: 1.51-4.25). CONCLUSION: Appendicolith in pediatric acute appendicitis was associated with increased inflammatory burden and a higher likelihood of complicated disease. However, given the retrospective design, prospective studies are required to clarify its role in clinical decision-making.
Telemedicine follow-up after pediatric esophageal atresia repair: parental satisfaction and safety outcomes.
Omarov T, Omarov T
Pediatr Surg Int · 2026 May · PMID 42133123 · Publisher ↗
PURPOSE: To evaluate parental satisfaction with telemedicine follow-up after EA repair and identify key technical and clinical predictors of high satisfaction. METHODS: Cross-sectional survey of 151 parent-child dyads wh...
PURPOSE: To evaluate parental satisfaction with telemedicine follow-up after EA repair and identify key technical and clinical predictors of high satisfaction. METHODS: Cross-sectional survey of 151 parent-child dyads who received telemedicine follow-up (video or telephone) within 30 days after EA repair between April 2022 and April 2025. Satisfaction was measured using an adapted Telehealth Usability Questionnaire (TUQ), and multivariable logistic regression identified independent predictors of high satisfaction (TUQ ≥ 4.0). Secondary outcomes included technical difficulties, unscheduled in-person clinic visits, emergency department presentations, and perceived reduction in healthcare burden. RESULTS: Mean TUQ satisfaction score was 4.28 ± 0.51, with 78.0% reporting high satisfaction. Video consultations (adjusted OR 2.74, 95% CI 1.39-5.41, p = 0.003) and absence of technical problems (adjusted OR 3.12, 95% CI 1.42-6.87, p = 0.004) were independent predictors of high satisfaction. Safety outcomes were favourable: 11.3% required unscheduled in-person visits and 6.0% presented to emergency departments within 30 days, with no significant differences between video and telephone consultations. CONCLUSION: Telemedicine follow-up after EA repair is associated with high parental satisfaction and acceptable short-term safety. Video capability and technical reliability are primary drivers of satisfaction.
Intraoperative NIR-II fluorescence imaging for assessment of bowel vascular morphology and inflammatory severity in Hirschsprung's disease.
Tian Y, Zhang Z, Li X … +4 more , Zeng H, Li Q, Li L, Hu Z
Pediatr Surg Int · 2026 May · PMID 42126680 · Publisher ↗
PURPOSE: To evaluate the feasibility of near-infrared II (NIR-II) fluorescence imaging for intraoperative assessment of vascular morphology and inflammatory severity at the planned anastomotic site in children with Hirsc...
PURPOSE: To evaluate the feasibility of near-infrared II (NIR-II) fluorescence imaging for intraoperative assessment of vascular morphology and inflammatory severity at the planned anastomotic site in children with Hirschsprung's disease (HD). METHODS: Seventeen children with HD underwent intraoperative indocyanine green fluorescence angiography during pull-through surgery. Capillary phantom experiments were performed to compare near-infrared I (NIR-I) and NIR-II imaging. Signal-to-background ratio (SBR), vessel delineation, and the association between fluorescence findings and histopathologic inflammatory grade were analyzed. Postoperative outcomes were explored in patients with complete follow-up. RESULTS: NIR-II imaging provided clearer visualization of arteries, veins, and deeper microvasculature than NIR-I, with a significantly higher SBR. NIR-II SBR was associated with histopathologic inflammatory grade, and an SBR < 1.17 was associated with severe mucosal inflammation. Long-term follow-up was available for 10 patients (40-66 months). Patients with less favorable postoperative outcomes showed numerically lower NIR-II SBR values, but these differences were not statistically significant. CONCLUSION: NIR-II fluorescence imaging improves intraoperative vascular visualization and shows promise for assessing inflammatory severity in HD. Its association with postoperative outcomes remains exploratory and requires validation in larger prospective studies.
Clinical outcomes and influencing factors of reoperation in biliary atresia.
Zhao J, Chen W, Hao X … +5 more , Gao R, Chi Y, Li S, Chen Y, Li L
Pediatr Surg Int · 2026 May · PMID 42126619 · Publisher ↗
BACKGROUND: To investigate the clinical characteristics and prognosis of patients with biliary atresia (BA) who undergo reoperation after initial Kasai portoenterostomy, and to evaluate the feasibility and clinical value...
BACKGROUND: To investigate the clinical characteristics and prognosis of patients with biliary atresia (BA) who undergo reoperation after initial Kasai portoenterostomy, and to evaluate the feasibility and clinical value of the reoperation. METHODS: We retrospectively analyzed the clinical data of 19 patients with BA who underwent reoperation at Beijing Tsinghua Changgung Hospital from August 2022 to September 2025. Data collected included age at initial Kasai, jaundice clearance status after the first surgery, preoperative liver function and imaging findings, and reoperation techniques. Follow-up was conducted via outpatient visits, telephone calls, or WeChat. The primary outcome was anicteric native liver survival (total bilirubin < 2.0 mg/dL). Clinical characteristics and prognosis were analyzed. RESULTS: The median age at the initial Kasai and reoperation was 59 and 320 days. Of the 19 patients, 12 achieved jaundice clearance after the first surgery. Preoperative imaging before reoperation revealed intrahepatic cystic anechoic areas in 12 patients. Surgical techniques included intrahepatic cyst-jejunostomy (n = 8), re-anastomosis after resection of residual fibrous mass (n = 8), and hepatic duct enlargement plasty with re-anastomosis (n = 3). At a median follow-up of 494 days, eight patients (42.1%) maintained anicteric native liver survival. Univariate analysis identified initial postoperative jaundice clearance as the only significant prognostic factor (P = 0.013). Kaplan-Meier survival analysis showed that the two-year anicteric native liver survival rate after reoperation was 70.7% in the clearance group (median not reached), whereas the non-clearance group had a median survival of only 1.342 years, with a significant between-group difference in survival (χ²=6.572, p = 0.010). CONCLUSION: Successful initial postoperative jaundice clearance is a critical prognostic indicator for reoperation in BA. Reoperation effectively prolongs anicteric native liver survival in patients with prior clearance but recurrent jaundice, whereas it offers limited benefit to those without initial clearance, who should be prioritized for liver transplantation assessment.
Ileocecal valve preservation reduces parenteral nutrition duration and catheter-related bloodstream infections in pediatric short bowel syndrome: a retrospective cohort study.
Zhou Z, Wu Q, Feng H … +4 more , Lu L, Yan W, Cai W, Wang Y
Pediatr Surg Int · 2026 May · PMID 42118337 · Publisher ↗
OBJECTIVE: To evaluate the clinical significance of the ileocecal valve (ICV) in pediatric short bowel syndrome (SBS) regarding parenteral nutrition (PN) dependence, nutritional status, and complications. METHODS: A retr...
OBJECTIVE: To evaluate the clinical significance of the ileocecal valve (ICV) in pediatric short bowel syndrome (SBS) regarding parenteral nutrition (PN) dependence, nutritional status, and complications. METHODS: A retrospective cohort study was conducted at Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, involving 140 pediatric SBS patients. Patients were divided into ICV-preserved (n = 80) and ICV-absent (n = 60) groups. Outcomes assessed included PN weaning success, PN duration, intestinal failure-associated liver disease (IFALD), catheter-related bloodstream infections (CRBSI), deficiencies in vitamin D and trace elements, and liver function parameters. RESULTS: Compared with the ICV-absent group, ICV-preserved patients had a higher PN weaning success rate (88.0% vs. 71.2%, p = 0.015), a shorter median PN duration (107 vs. 160 days, p = 0.004), and a lower incidence of CRBSI (37.3% vs. 64.4%, p = 0.002). No significant difference was observed in IFALD incidence (42.7% vs. 57.6%, p = 0.086). Among ICV-absent patients, preservation of > 50% of the colon was associated with improved PN weaning success (77.8% vs. 50.0%, p = 0.045). Initial stoma creation (vs. primary anastomosis) was associated with higher rates of IFALD (56.1% vs. 38.5%, p = 0.047) and CRBSI (57.3% vs. 36.5%, p = 0.019). Vitamin D deficiency was highly prevalent (86.5%) with no significant difference between groups. CONCLUSION: ICV preservation in pediatric SBS is associated with reduced PN dependence and lower CRBSI risk, underscoring its clinical importance.
Transumbilical single-port appendectomy in children: a retrospective study.
Berto LG, da Silva CL, Durante MV … +2 more , de Nadai TR, Marton MA
Pediatr Surg Int · 2026 May · PMID 42118316 · Full text
OBJECTIVE: Acute appendicitis is the leading cause of abdominal surgery. This study evaluated outcomes of transumbilical single-incision laparoscopic appendectomy (TSILA) compared with conventional laparoscopy and open s...
OBJECTIVE: Acute appendicitis is the leading cause of abdominal surgery. This study evaluated outcomes of transumbilical single-incision laparoscopic appendectomy (TSILA) compared with conventional laparoscopy and open surgery. METHODS: A retrospective study of 550 pediatric patients (0-18 years) undergoing an appendectomy (2020-2023) at a tertiary center was conducted. Patients were stratified by technique and appendicitis grade (I-IV). Data were analyzed using Pearson's Chi-squared and ANOVA tests (p < 0.05). RESULTS: TSILA accounted for 34.5% of cases (n = 190) and showed shorter hospital stays (2.98 days) compared to conventional laparoscopy (4.23 days) and open surgery (5.58 days) (p < 0.001). Postoperative fever was lower with TSILA (7.9%) compared to conventional laparoscopy (12.7%) and open surgery (27.5%) (p < 0.0001). Wound infection rates were similar between TSILA and conventional laparoscopy, both lower than open surgery. Postoperative antibiotic use was lowest with TSILA (p < 0.0001). In Grade IV, TSILA showed shorter hospital stay, with no significant differences in complications or antibiotic use. CONCLUSIONS: TSILA is a safe option, associated with shorter hospital stays and reduced antibiotic use in Grades I-III. In advanced cases, benefits were limited to shorter hospitalization, with outcomes comparable to conventional techniques.
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