Pediatr. Surg. Int. [JOURNAL]
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200 papers
Evaluating the need for omentectomy during laparoscopic placement of tunneled peritoneal dialysis catheters in pediatrics: a multicenter comparative study.
Shehata MA, Khirallah MG, Al Nafesa A … +4 more , Bawazir OA, AlFadda TI, Aljubab A, Aboelyazeed AM
Pediatr Surg Int · 2026 May · PMID 42118170 · Publisher ↗
PURPOSE: To evaluate whether routine omentectomy improves outcomes during laparoscopic placement of peritoneal dialysis (PD) catheters in children. METHODS: This multicenter retrospective study included children ≤ 5 year...
PURPOSE: To evaluate whether routine omentectomy improves outcomes during laparoscopic placement of peritoneal dialysis (PD) catheters in children. METHODS: This multicenter retrospective study included children ≤ 5 years who underwent laparoscopic PD catheter insertion (2022-2025). Patients were divided into non-omentectomy (Group A, n = 169) and omentectomy (Group B, n = 182). The primary outcome was catheter survival at 12 months. Secondary outcomes included complications, operative time, and hospital stay. RESULTS: A total of 351 patients were analyzed. Catheter survival at 12 months was similar between Group A and Group B (84.0% vs. 86.8%, p = 0.45), with no difference in long-term survival (log-rank p = 0.32). Catheter failure rates were comparable (6.5% vs. 6.0%, p = 0.86). Non-surgical interventions for catheter dysfunction occurred in 8.9% of Group A and 8.8% of Group B (p = 0.97), with a success rate of 83.9%. Omental wrapping occurred only in Group A (7.1%) but did not affect overall outcomes. Early and late complications, including peritonitis and obstruction, were similar between groups. Operative time was significantly shorter without omentectomy (45.2 ± 9.1 vs. 66.3 ± 10.8 min, p < 0.001), while hospital stay was comparable. CONCLUSION: Routine omentectomy does not improve catheter outcomes but increases operative time. A selective approach may be sufficient in pediatric PD catheter placement.
Trainee involvement in laparoscopic pyloromyotomy does not compromise outcomes: evidence from a longitudinal institutional experience.
Martinho S, Nóbrega S, Barroso C … +1 more , Correia-Pinto J
Pediatr Surg Int · 2026 May · PMID 42113259 · Full text
PURPOSE: To evaluate whether supervised pediatric surgery trainees can safely perform laparoscopic pyloromyotomy (LP) and to assess the influence of trainee participation within the institutional learning curve. METHODS:...
PURPOSE: To evaluate whether supervised pediatric surgery trainees can safely perform laparoscopic pyloromyotomy (LP) and to assess the influence of trainee participation within the institutional learning curve. METHODS: A retrospective single-center cohort included all infants undergoing LP between June 2011-2025. Cases were categorized as specialist- or trainee-performed (eight pediatric surgery specialists, three supervised trainees). Baseline characteristics, operative variables, surgery-related complications, incomplete pyloromyotomy, postoperative recovery, reintervention, and readmission were compared. Temporal trends and institutional CUSUM analysis were performed. RESULTS: Seventy-seven infants were included (45 specialist-operated, 32 trainee-operated). Baseline characteristics were similar. Operative time was longer for trainees (45 versus 40 min, p = 0.037). Surgery-related complications occurred in 11.1% of specialist cases and in none of the trainee cases (p=0.07). All five complications (two wound infections, one incisional omental exteriorization, and two mucosal perforations) occurred with specialists. One incomplete pyloromyotomy occurred (trainees). The composite adverse outcome rate was 11.1% (specialists) versus 3.1% (trainees) (p = 0.39). Feeding progression, length of stay, reoperations and readmissions were comparable. CUSUM analysis demonstrated no adverse drift after trainee integration. CONCLUSION: Supervised trainees safely performed LP with outcomes comparable to specialists. Slightly longer operative time did not impact recovery. Early trainee involvement did not compromise patient safety or institutional performance.
Efficacy of modified tubularized incised plate urethroplasty for hypospadias.
Li N, Zhang S, Li L … +8 more , Liu P, Liu Y, Chen C, Li J, Wang B, Hao L, Wei Y, Fan Y
Pediatr Surg Int · 2026 May · PMID 42113229 · Publisher ↗
PURPOSE: To evaluate the clinical outcomes of tubularized incised plate urethroplasty (TIPU) combined with dissection of the urethral plate and distal urethral mobilization in children with mid-to-distal hypospadias. MET...
PURPOSE: To evaluate the clinical outcomes of tubularized incised plate urethroplasty (TIPU) combined with dissection of the urethral plate and distal urethral mobilization in children with mid-to-distal hypospadias. METHODS: This retrospective study included 183 pediatric patients with hypospadias who underwent primary repair between March 2021 and March 2023. Patients were divided into two groups according to the surgical technique: the modified TIPU group (mTIPU, n = 86) and the conventional TIPU group (cTIPU, n = 97). Baseline characteristics, perioperative parameters, postoperative complications, penile appearance scores, and uroflowmetry parameters were compared between the two groups. RESULTS: Baseline characteristics were comparable between the two groups (all P > 0.05). The mTIPU group had a longer operative time and a greater estimated blood loss (EBL) than the cTIPU group (both P < 0.05). However, no statistical difference was observed in the overall incidence of postoperative complications between the groups (P > 0.05). At the 2-year follow-up, patients in the mTIPU group demonstrated higher penile appearance scores for perceived penile straightness and overall appearance (both P < 0.05). In addition, the maximum urinary flow rate (Qmax) and the average urinary flow rate (Qave) were higher, and the duration of micturition was shorter in the mTIPU group compared to the cTIPU group (all P < 0.001), while voided volume did not differ significantly between the two groups (P > 0.05). CONCLUSION: In children with mid-to-distal hypospadias, TIPU combined with urethral plate dissection and distal urethral mobilization may improve postoperative penile appearance and urinary flow parameters. No statistical difference in postoperative complication rates was observed between the two techniques.
Selective non-operative management of post-appendectomy abscesses in children: a comprehensive systematic review and pairwise meta-analysis.
Grochowska A, Hinduja KK, Marques ALA … +10 more , Mena LHF, Argyris V, de Paula AEC, Neto FES, Rosas A, Akbari Z, Sah H, Rodriguez ME, Loor CS, Pimpalwar A
Pediatr Surg Int · 2026 May · PMID 42113215 · Publisher ↗
Post-appendectomy intra-abdominal abscess remains a common complication following pediatric appendicitis. Although drainage has traditionally been considered standard treatment, increasing evidence suggests selected pati...
Post-appendectomy intra-abdominal abscess remains a common complication following pediatric appendicitis. Although drainage has traditionally been considered standard treatment, increasing evidence suggests selected patients may be successfully managed with antibiotics alone. A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines and registered in PROSPERO (CRD420251075191). PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched through June 20, 2025. Eligible studies included pediatric patients (0-18 years) with post-appendectomy abscess managed with antibiotic vs. invasive drainage. The primary outcome was failure of first-line treatment requiring escalation. Secondary outcomes included recurrence and length of hospital stay. Ten observational studies involving 363 pediatric patients were included (152 drainage, 211 conservative). Treatment success was 80.9% with drainage and 89.1% with antibiotics. Pooled analysis demonstrated no statistically significant difference in treatment success (RR 1.00; 95% CI 0.95-1.05) or recurrence (RR 0.99; 95% CI 0.57-1.74). Drainage was associated with longer hospital stays (MD 3.40 days; 95% CI 0.65-6.14; p = 0.02). Subgroup analyses demonstrated consistent findings. All included studies demonstrated a serious risk of bias due to confounding by indication. An antibiotics-first approach appears viable for clinically stable pediatric patients, achieving comparable outcomes with shorter hospitalization.
Macrophage subtypes distinguish the hepatic lobule from portal area as sites of inflammation and fibrosis in liver of patients with biliary atresia.
Tsuruno Y, Muraji T, Ohtani H … +15 more , Masuya R, Sugita K, Tohma M, Yanai T, Tabata Y, Nishida N, Kedoin C, Nagano A, Murakami M, Yano K, Onishi S, Harumatsu T, Kawano T, Bitoh Y, Ieiri S
Pediatr Surg Int · 2026 May · PMID 42113063 · Publisher ↗
PURPOSE: Biliary atresia (BA) has potential immune-mediated pathogenesis involving CD4 + Th1 and Th17 cells. We therefore examined antigen-presenting cells to elucidate their etiopathogenetic mechanisms. METHODS: This st...
PURPOSE: Biliary atresia (BA) has potential immune-mediated pathogenesis involving CD4 + Th1 and Th17 cells. We therefore examined antigen-presenting cells to elucidate their etiopathogenetic mechanisms. METHODS: This study cohort included 17 patients with BA and 15 controls (8 normal controls [NCs] and 7 clinical inflammation controls [CICs]). We focused on CD86 macrophages, which are antigen-presenting cells. We performed double immunohistochemistry for CD86/CD68, with double-positive and CD68-single-positive cells representing M1 and non-M1 macrophages, respectively. Macrophage subsets were morphometrically analyzed in the hepatic lobule (HL), portal area (PA), and interface (IF) and investigated in relation to clinical data. RESULTS: In the BA group, M1 macrophages in all regions and non-M1 macrophages in the IF and PA were significantly increased compared to those in the NC group. Notably, M1 macrophages often clustered in the IF, and non-M1 macrophages in the PA showed a small spindle-shaped morphology. Non-M1 macrophages in the IF showed a significant positive correlation with alanine aminotransferase, direct bilirubin, and fibrotic area. CONCLUSIONS: M1 macrophages were detected as the major population in the HL and IF in BA, whereas non-M1 macrophages in the PA were correlated with hepatic fibrosis. CD86 and CD86 macrophages immunologically distinguish HL with IF from PA in BA.
Effect of anticholinergics vs. alpha-1 blockers vs. combination therapy on bladder function in patients with posterior urethral valve after transurethral fulguration: a pilot randomized controlled trial.
Singhai P, Malik MA, Mahajan JK
Pediatr Surg Int · 2026 May · PMID 42113043 · Publisher ↗
PURPOSE: To identify preliminary efficacy signals of anticholinergics, alpha-1 blockers, and their combination on bladder and renal function in boys with bladder dysfunction following posterior urethral valve (PUV) ablat...
PURPOSE: To identify preliminary efficacy signals of anticholinergics, alpha-1 blockers, and their combination on bladder and renal function in boys with bladder dysfunction following posterior urethral valve (PUV) ablation, and to assess the feasibility of conducting a definitive randomized, controlled trial. STUDY DESIGN: In this single-center, prospective, randomized pilot trial boys under 12 years who had undergone cystoscopic valve ablation were randomized into three groups: anticholinergic therapy (Group I), alpha-1 blocker therapy (Group II), and combination therapy (Group III). The study was designed to detect within-group preliminary efficacy signals in urodynamic parameters following 6 months of pharmacotherapy. Secondary outcomes included changes in patient-reported symptom scores, renal function, and feasibility metrics. Between-group comparisons were performed as exploratory analyses. Feasibility and safety outcomes were analyzed in the intention-to-treat population, while efficacy analyses were conducted in participants who received intervention and had evaluable baseline and follow-up data. RESULTS: Thirty-five eligible patients were randomized (Group I, n = 12; Group II, n = 11; Group III, n = 12). and their clinical and biochemical analyses at baseline were recorded. Two deaths in Group II occurred prior to baseline urodynamics and pharmacotherapy initiation; efficacy analyses, therefore, included 33 patients (Group I, n = 12; Group II, n = 9; Group III, n = 12) with evaluable data. Urodynamic evaluation demonstrated favourable within-group trends: Group I showed a significant improvement in voided volume, while changes in voiding time, cystometric capacity (CC), static compliance, and maximum detrusor pressure (Pdetmax) were favourable but not uniformly statistically significant. Group II showed modest, favourable effects on Qmax, Time@Qmax, CC, and Pdetmax, with wide confidence intervals and no clear significant changes across most UDS measures. Group III demonstrated the most consistent favourable pattern, particularly for CC and Pdetmax, although most confidence intervals overlapped the null. Baseline-adjusted exploratory analyses did not demonstrate statistically significant between-group differences. Symptom scores improved across all groups. Feasibility outcomes were robust, with 81% recruitment, 91% urodynamic study completion, and 94% participant retention. CONCLUSION: This pilot trial demonstrates the feasibility of conducting urodynamic-guided pharmacotherapy studies in young boys with PUV-related bladder dysfunction. The observed within-group efficacy signals across all treatment arms-particularly with combination therapy-are hypothesis-generating and provide effect size and variability estimates to inform the design of a definitive randomized controlled trial.
Development of a machine learning-based prognostic prediction model and a web-based tool for pediatric hepatoblastoma: a Surveillance, Epidemiology, and End Results (SEER) database study.
Chen Z, Wei Y, Liu S … +1 more , Zhang J
Pediatr Surg Int · 2026 May · PMID 42105007 · Publisher ↗
BACKGROUND: Prognostic evaluation of pediatric hepatoblastoma (HB) remains challenging due to the low accuracy of traditional risk stratification models. This study aims to leverage the U.S. Surveillance, Epidemiology, a...
BACKGROUND: Prognostic evaluation of pediatric hepatoblastoma (HB) remains challenging due to the low accuracy of traditional risk stratification models. This study aims to leverage the U.S. Surveillance, Epidemiology, and End Results (SEER) database to develop and compare several machine learning-based survival models and create an online prediction tool for individualized survival probability estimation in children with HB. METHODS: A total of 614 pediatric HB patients diagnosed from 2000 to 2021 in the SEER database were identified and randomly split (7:3 ratio) into a training set (n = 429) and an internal hold-out validation cohort (n = 185). This split was selected to retain sufficient data for model development while preserving an adequate validation cohort for performance assessment. Least Absolute Shrinkage and Selection Operator (LASSO) regression analysis was used for feature selection, and three prognostic prediction models (Cox regression, random survival forest (RSF), and a deep learning-based survival (DeepSurv) neural network) were developed using the training data. Model performance was evaluated by Harrell's concordance index (C-index), time-dependent area under the receiver operating characteristic (ROC) curve (AUC) at 1, 3, and 5 years, and decision curve analysis (DCA). We also used SHapley Additive exPlanations (SHAP) analysis to interpret the RSF model. Based on RSF-derived risk scores, patients were classified into high-, intermediate-, and low-risk groups for survival analysis. Ultimately, a web-based tool was developed to enable real-time prediction of 1-, 3-, and 5-year survival probabilities using individual patient characteristics. RESULTS: In the validation cohort, the RSF model achieved the highest C-index (0.745), outperforming the DeepSurv (0.720) and Cox regression models (0.709). The RSF also yielded favorable 1-year, 3-year, and 5-year AUC values, and DCA indicated a greater net benefit across clinically relevant threshold probabilities. SHAP analysis highlighted distant-stage disease, surgical treatment status, and tumor extent as key factors influencing survival predictions. Kaplan-Meier curves stratified by the RSF risk groups showed significantly different survival outcomes among high-, intermediate-, and low-risk patients (log-rank P < 0.001 for all comparisons). The finalized online tool allows users to input patient characteristics and obtain estimated 1-year, 3-year, and 5-year survival probabilities, which may assist individualized prognostic assessment as an adjunctive reference. CONCLUSION: The RSF-based prognostic model showed favorable predictive performance compared with the Cox and DeepSurv models in this retrospective SEER-based cohort of pediatric HB. With interpretable model outputs and an accessible web-based interface, the model may serve as an adjunctive tool for individualized risk assessment. However, external validation and prospective evaluation are required before routine clinical implementation.
Unraveling the molecular basis of clinical heterogeneity in Hirschsprung disease through gene expression analysis.
Isa MM, Syukri M, Muchlisin ZA … +9 more , Gunadi, Syahputra DA, Yusriadi T, Muzakkir Y, Kamarlis RK, Effendy Z, Setyadi A, Maghfirah S, Rinanda T
Pediatr Surg Int · 2026 May · PMID 42101681 · Publisher ↗
PURPOSE: To assess the association of RET, NRG1, SEMA3, and RARB gene variants with clinical phenotypes of Hirschsprung disease (HSCR) in a population with limited genetic data (Aceh, Indonesia). METHODS: This study empl...
PURPOSE: To assess the association of RET, NRG1, SEMA3, and RARB gene variants with clinical phenotypes of Hirschsprung disease (HSCR) in a population with limited genetic data (Aceh, Indonesia). METHODS: This study employed an observational analytical design with a cross-sectional approach. A total of 57 patients who underwent HSCR surgery were included. Demographic, clinical, and histopathological data were collected. Both a-ganglionic and ganglionic tissues from the colon or rectum were sampled from HSCR patients, along with control samples from each patient with anorectal malformation. mRNA expression of RET, NRG1, SEMA3, and RARB genes was measured using real-time PCR. RESULTS: Among the 57 patients, most were male (70.2%) and had short-segment HSCR (98.2%). NRG1 expression was significantly reduced in aganglionic colon tissue compared with controls (2.84-fold; p = 0.02). RET expression was markedly decreased in both aganglionic (3.23-fold; p = 0.02) and ganglionic tissues (3.89-fold; p = 0.02). Similarly, SEMA3 expression was significantly lower in aganglionic (3.05-fold; p = 0.03) and ganglionic tissues (2.94-fold; p = 0.04) relative to control colon. CONCLUSIONS: Reduced expression of NRG1, RET, and SEMA3 was observed in HSCR colon tissues, suggesting their involvement in disease pathogenesis among Acehnese patients.
Caregivers' perceptions of fluorescence-guided surgery (FGS) in pediatric oncology: a questionnaire-based study.
Paraboschi I, Pierucci UM, Marinaro M … +4 more , Di Franco C, di San Marco EC, Anna Maria EV, Pelizzo G
Pediatr Surg Int · 2026 May · PMID 42090012 · Full text
AIM: To quantitatively assess parental engagement, perceptions, and decision-making attitudes toward fluorescence-guided surgery (FGS) in pediatric solid tumors. METHODS: A structured questionnaire was administered to ca...
AIM: To quantitatively assess parental engagement, perceptions, and decision-making attitudes toward fluorescence-guided surgery (FGS) in pediatric solid tumors. METHODS: A structured questionnaire was administered to caregivers of children with Beckwith-Wiedemann syndrome in collaboration with the "Associazione Italiana Sindrome di Beckwith-Wiedemann", facilitating outreach to families within the national support network. Emotional responses (optimism, hope, confidence, anxiety, worry, and uncertainty) and perceived support were assessed using 5-point Likert scales (1 = not at all, 5 = extremely). The survey also explored prior awareness of FGS, perceived impact on surgical outcomes and recurrence risk, openness to clinical trial enrollment, concerns, and information needs. Data were analyzed descriptively; open-ended responses were thematically coded. RESULTS: Twenty-eight caregivers completed the survey. 86% of children had undergone tumor resection, predominantly for nephroblastoma (85%). Preoperative counseling was considered clear by 79% of caregivers, and perceived support from the medical team was high, with 68% reporting the maximum Likert score (5/5). Prior awareness of FGS was limited (11%); however, after explanation, acceptance was strong. Trust in surgical innovation was high (75% reporting maximum confidence), and 86% believed FGS could improve surgical safety and effectiveness. All respondents reported increased reassurance from the availability of technological support, and 71% perceived a potential reduction in recurrence risk. Emotional responses were predominantly positive, with high levels of confidence, hope, and optimism (75% maximum score), while anxiety, worry, and uncertainty were generally low. Qualitative analysis identified 3 main themes: strong trust and reassurance toward innovation, safety-related concerns focused on toxicity and long-term effects, and a clear need for transparent, detailed risk-benefit information prior to decision-making and potential clinical trial enrollment. CONCLUSIONS: Parents demonstrate high engagement and strong support for FGS, emphasizing the importance of transparent communication, shared decision-making, and active parent-patient involvement to facilitate clinical translation.
Implementation of enhanced recovery after surgery (ERAS) protocols for paediatric laparoscopic surgery: a single-center experience.
Shah S, Ramachandran R, Jain V … +4 more , Dhua A, Subramaniam R, Kaur P, Rewari V
Pediatr Surg Int · 2026 May · PMID 42081132 · Publisher ↗
PURPOSE: Implementation of Enhanced Recovery After Surgery (ERAS) protocols in paediatric surgery remains limited, despite proven benefits in adults. The barriers to implementation and protocol modifications requires com...
PURPOSE: Implementation of Enhanced Recovery After Surgery (ERAS) protocols in paediatric surgery remains limited, despite proven benefits in adults. The barriers to implementation and protocol modifications requires comprehensive detailing in paediatrics. We aimed to determine the practicality and safety of ERAS in paediatric laparoscopies at a tertiary-care center, addressing the context-specific barriers. METHODS: This was a prospective, single-arm, preliminary study. One hundred thirty-six children, aged 2-14 years, undergoing laparoscopy were enrolled. ERAS elements were implemented perioperatively. The outcomes analysed included protocol compliance, length of hospital stay (LOS), 30-day complications, readmission and mortality rates. The challenges to implementation were noted. RESULTS: Overall protocol compliance was 82.5 ± 12.4%. There was a significant correlation between adherence to components and LOS (r=-0.642 ; p < 0.01). Time to start liquids/solids and drain removal showed a significant correlation with LOS. No complications and 30-day readmissions were directly attributable to the fast-track concepts. There was no mortality. Key challenges included infrastructure, parental anxiety regarding early discharge and persistently motivating stakeholders to adhere the protocol. CONCLUSION: Implementing paediatric ERAS protocol is safe and feasible within a tertiary health-setting. A high degree of multidisciplinary commitment can successfully overcome the unique logistic and cultural barriers with an accelerated convalescence.
The efficacy and safety of extraluminal bronchial blockers in pediatric patients during one-lung ventilation for thoracoscopic surgery.
Wu K, Qiu YS, Li ZC … +1 more , Wang Y
Pediatr Surg Int · 2026 May · PMID 42081018 · Publisher ↗
BACKGROUND: This study aimed to evaluate the impact and safety of extraluminal bronchial blockers on ventilation parameters in pediatric patients undergoing one lung ventilation (OLV) for thoracoscopic surgery. We hypoth...
BACKGROUND: This study aimed to evaluate the impact and safety of extraluminal bronchial blockers on ventilation parameters in pediatric patients undergoing one lung ventilation (OLV) for thoracoscopic surgery. We hypothesized that, compared with endotracheal tube ventilation alone, the use of a bronchial blocker positioned outside the endotracheal tube can enhance lung collapse quality and improve ventilation efficiency without increasing the risk of complications. METHODS: In this prospective randomized controlled trial, a total of 128 pediatric patients who underwent OLV thoracoscopic surgery between February 2021 and February 2024 were enrolled and randomly assigned to two groups using a random number table method. The control group (n = 64) received ventilation via endotracheal tubes alone, while the study group (n = 64) received ventilation using extraluminal bronchial blockers. The primary outcome measures were the rate of satisfactory lung collapse. Secondary outcomes included arterial carbon dioxide pressure 20 min after OLV, surgical duration, intubation time, catheter dislodgement rate, and postoperative complications. RESULTS: The rate of excellent and good lung collapse was 100% in the study group, significantly higher than the 90.62% observed in the control group (p < 0.05). Airway pressure and partial pressure of carbon dioxide at 20, 40, and 60 min post-OLV were lower in the study group than in the control group, with significant between-group effects (η²ₚ = 0.54 and 0.24, respectively; p < 0.05). The study group demonstrated significantly shorter surgical duration and intubation times compared to the control group (p < 0.05), with mean differences of - 21.34 min [95% confidence interval (CI): - 32.68, -9.99] and - 1.17 min (95% CI - 1.41, - 0.93), respectively. The incidence of endotracheal tube displacement was lower in the study group (4.69%) than in the control group (17.19%), with a relative risk of 0.27 (95% CI 0.08, 0.92) (p < 0.05). No significant differences were detected between the groups in the incidence of postoperative sore throat, hoarseness, hypoxemia, or nausea and vomiting (p > 0.05). CONCLUSION: The use of an extraluminal bronchial blocker with an endotracheal tube allowed for improved lung collapse quality and more effective maintenance of ventilation efficiency during OLV in pediatric thoracoscopic surgery, while demonstrating a favorable safety profile.
Total versus partial fundoplication in children with gastroesophageal reflux disease: a systematic review and comparative meta-analysis of 2633 patients highlighting the trade-off between reflux control and postoperative dysphagia.
Fonseca PEO, Amador WFO, Scremin GM … +4 more , Mena LHF, Mayer S, Nijampurkar N, Pimpalwar A
Pediatr Surg Int · 2026 May · PMID 42080999 · Publisher ↗
INTRODUCTION: Gastroesophageal reflux disease (GERD) is a common condition in children requiring surgical intervention when medical therapy fails. Nissen (total) and Toupet (partial) fundoplications are the most frequent...
INTRODUCTION: Gastroesophageal reflux disease (GERD) is a common condition in children requiring surgical intervention when medical therapy fails. Nissen (total) and Toupet (partial) fundoplications are the most frequently performed antireflux procedures; however, their comparative effectiveness and safety in the pediatric population remain uncertain. METHODS: A systematic literature search was conducted in PubMed, Embase, and Cochrane CENTRAL from database inception to 2025. Eligible studies included randomized controlled trials and observational studies comparing total and partial fundoplication in patients younger than 18 years with GERD. Pooled risk ratios (RR) with 95% confidence intervals (CI) were calculated using random-effects models in R software. RESULTS: Eighteen studies including 2,633 children were analyzed. Total fundoplication was associated with a significantly higher risk of postoperative dysphagia compared with partial fundoplication (RR 1.69; 95% CI 1.07-2.68; p = 0.024; I²=12%; n = 1,154), corresponding to an absolute risk increase of 5.7% and a number needed to harm (NNH) of 17. No significant difference was observed in reflux recurrence (RR 0.72; 95% CI 0.21-2.42; p = 0.59; I²=71% n = 834), although event rates were numerically lower after total fundoplication (6.8% vs. 13.7%), corresponding to an absolute risk reduction of 6.9% (NNT = 15). Intraoperative complications (RR 1.11; p = 0.84), postoperative complications (RR 1.49; p = 0.12), reoperation rates (RR 0.95; p = 0.88), and mortality (RR 1.09; p = 0.74) were comparable between procedures. CONCLUSIONS: Total and partial fundoplication demonstrate similar effectiveness for reflux control and overall safety in pediatric GERD. However, total fundoplication is associated with a higher risk of postoperative dysphagia, suggesting that partial fundoplication may offer functional advantages in selected patients.
Two faces of necrotizing enterocolitis: early and late-onset disease in preterm infants.
Di Fabrizio D, Bindi E, Acquaviva I … +4 more , Tavolario I, Burattini I, Cruccetti A, Cobellis G
Pediatr Surg Int · 2026 May · PMID 42080992 · Publisher ↗
BACKGROUND: Whether early-onset (EO-NEC) and late-onset necrotizing enterocolitis (LO-NEC) represent distinct entities remains debated. We compared clinical presentation, radiologic features, and surgical outcomes. METHO...
BACKGROUND: Whether early-onset (EO-NEC) and late-onset necrotizing enterocolitis (LO-NEC) represent distinct entities remains debated. We compared clinical presentation, radiologic features, and surgical outcomes. METHODS: In this retrospective study (2013-2023), neonates with Bell stage II-III NEC were stratified into EO-NEC (< 14 days) and LO-NEC (≥ 14 days). RESULTS: Fifty-seven infants were included: 37 (64.9%) EO-NEC and 20 (35.1%) LO-NEC. EO-NEC was associated with higher birth weight (1611 ± 767 vs. 1111 ± 377 g; p = 0.0017) and gestational age (31.4 ± 4.5 vs. 29.3 ± 2.7 weeks; p = 0.033). LO-NEC occurred more frequently in very-low-birth-weight infants (55% vs. 8%; p < 0.001) and showed higher rates of portal venous gas (70% vs. 30%; p = 0.005) and indomethacin-treated PDA (25% vs. 2.7%; p = 0.031). Intestinal perforation occurred exclusively in EO-NEC (27%; p = 0.01). Surgical intervention rates, intestinal resection lengths, and mortality were comparable. CONCLUSIONS: EO-NEC and LO-NEC differ in infant maturity and perinatal exposures but not in overall severity or mortality.
Application of an external drainage tube in pneumovesicoscopic ureteral reimplantation using the Politano-Leadbetter technique in children.
Meng Q, Xu H, Xu G … +2 more , Shi B, Gao W
Pediatr Surg Int · 2026 May · PMID 42080962 · Publisher ↗
PURPOSE: This study aimed to investigate the feasibility and advantages of enlisting an external drainage tube in pneumovesicoscopic ureteral reimplantation using the Politano-Leadbetter technique (PVUR-PL) in children....
PURPOSE: This study aimed to investigate the feasibility and advantages of enlisting an external drainage tube in pneumovesicoscopic ureteral reimplantation using the Politano-Leadbetter technique (PVUR-PL) in children. METHODS: A retrospective analysis was conducted on the clinical data of 90 pediatric patients who had undergone PVUR-PL at our institution from March 2024 to September 2025. Based on the stent placement method, the patients were divided into Group A (external drainage) or Group B (internal drainage). The two groups were compared in terms of postoperative parameters, including the incidence of leukocyturia, hematuria, febrile urinary tract infection (fUTI), and positive urine culture; hospitalization costs; duration of stent indwelling; and length of hospital stay. RESULTS: Statistically significant differences (p < 0.05) were observed between Groups A and B in terms of the incidence of postoperative leukocyturia, fUTI, and positive urine culture; hospitalization costs; duration of stent indwelling; and length of hospital stay. CONCLUSION: The application of external stent drainage in PVUR-PL is reliable and effective. Compared with internal drainage, it may offer potential benefits in terms of reducing the need for additional anesthesia, hospital stay, and costs. Furthermore, shortening the duration of stent indwelling may reduce the incidence of urinary tract infections. This method possesses significant potential for clinical application.
Anatomical location of small bowel atresia independently predicts preterm delivery: a two-center study in Southern Japan.
Harumatsu T, Tsuruno Y, Nagano A … +17 more , Sugita K, Tabata Y, Nishida N, Kedoin C, Murakami M, Yano K, Kurimoto T, Yara A, Otsuka H, Onishi S, Yamada K, Yamada W, Hirakawa E, Kawano T, Torikai M, Tokuhisa T, Ieiri S
Pediatr Surg Int · 2026 May · PMID 42080958 · Publisher ↗
PURPOSE: Small bowel atresia (SBA) presents with variable clinical features depending on anatomical location. We investigated the relationship between atresia location and preterm delivery. METHODS: We retrospectively re...
PURPOSE: Small bowel atresia (SBA) presents with variable clinical features depending on anatomical location. We investigated the relationship between atresia location and preterm delivery. METHODS: We retrospectively reviewed 58 patients who underwent surgery for SBA at two institutions between April 2000 and March 2024. Patients were divided into preterm (<37 weeks, n=28) and term (≥37 weeks, n=30) groups. Clinical characteristics, prenatal findings, anatomical location, and surgical outcomes were compared. A logistic regression analysis identified independent predictors of preterm delivery. RESULTS: Preterm infants showed lower birth weight (1988±731 g vs. 3062±395 g, p<0.001) and higher rates of prenatal diagnosis (85.7% vs. 60.0%, p=0.040), polyhydramnios (42.9% vs. 13.3%, p=0.018), and bowel dilatation (78.5% vs. 50.0%, p=0.031). The distance from the ligament of Treitz was shorter in preterm infants (31.6±31.5 cm vs. 103.6±39.9 cm, p<0.001). Jejunal atresia was more common in preterm infants (71.4% vs. 6.7%; p<0.001). A strong correlation was observed between birth weight and atresia distance (r=0.63, p<0.001). In a multivariable analysis, proximal atresia was an independent predictor of preterm delivery (adjusted OR 0.79 per 10 cm, 95% CI 0.65-0.96, p=0.018). CONCLUSION: Proximal SBA was independently associated with preterm delivery. Prenatal identification may facilitate appropriate perinatal management and parental counseling.
The pedfix technique: a new minimally invasive method of peritoneal dialysis catheter insertion with secure fixation to the abdominal wall-a preliminary experience.
Cascio S, Cascio M, Abdelraheem I
Pediatr Surg Int · 2026 May · PMID 42080947 · Full text
PURPOSE: Peritoneal Dialysis (PD) is the most common modality of renal replacement therapy in children with acute kidney injury (AKI). Various open and laparoscopic techniques for the placement of peritoneal dialysis (PD...
PURPOSE: Peritoneal Dialysis (PD) is the most common modality of renal replacement therapy in children with acute kidney injury (AKI). Various open and laparoscopic techniques for the placement of peritoneal dialysis (PD) catheter, with or without intra-abdominal fixation, have been described. The incidence of catheter migration after PD is 0-19%. We present a new, modified technique which minimizes the risk of catheter migration and blockage. MATERIALS AND METHODS: For 18 years a laparoscopic assisted PD catheter insertion has been used by the first author with a single 5 mm Port at the umbilicus using an inverted J incision and a Seldinger technique, with either a 14 or 16 Fr introducer kit. In October 2024, the technique was modified to include fixation of the catheter to the lower anterior abdominal wall using an Endoclose device (Autosuture, Covidien). RESULTS: Six patients- 4 boys, mean age at surgery 7.8 years- underwent PD catheter insertion using the modified technique. All patients were in End Stage Kidney Disease due to posterior urethral valves and renal dysplasia (2), nephronophthisis (1) renal dysplasia (1), focal segmental glomerulosclerosis (1) multi-cystic dysplastic kidney on one side and dysplasia on the contralateral side (1). All six cases underwent successful placement of a PD catheter. Four patients had no post-operative complications, one patient developed an incisional hernia at the Hasson port, while one patient required laparoscopic repositioning of the PD catheter and fixation to the abdominal cavity with a non-absorbable suture (2 - 0 Ethibond) at a mean follow up of 10.4 months. CONCLUSION: The Pedfix technique provides excellent cosmetic results, optimal pelvic visualization and fixation of the PD catheter to the lower anterior abdominal wall which minimizes the risk of catheter migration and blockage. These encouraging results need to be confirmed by a prospective study with longer follow up.
Long-term outcomes of suprasternal aortopexy in paediatric patients with tracheomalacia.
Unadkat A, Yardley I
Pediatr Surg Int · 2026 May · PMID 42080943 · Full text
PURPOSE: Tracheomalacia is characterised by dynamic tracheal collapse causing airway obstruction, particularly during expiration. In severe cases, surgical intervention with aortopexy may be required. This study reports...
PURPOSE: Tracheomalacia is characterised by dynamic tracheal collapse causing airway obstruction, particularly during expiration. In severe cases, surgical intervention with aortopexy may be required. This study reports long-term outcomes following suprasternal aortopexy, exploring predictors of operative success/failure. METHODS: All patients undergoing aortopexy between February 2016 and May 2019 were included. Electronic patient records were reviewed for demographics, associated conditions, preoperative symptoms, dynamic flexible bronchoscopy findings and postoperative outcomes. Outcomes were categorised by degree of symptom improvement or resolution. RESULTS: Twenty-eight patients (22 male, 78%) underwent aortopexy at a median age of 8 months (range 19 days-5 years 9 months) with follow-up of 6 years 7 months (range 5 years 2 months-8 years 9 months). Patients were stratified into oesophageal atresia/tracheoesophageal fistula, prematurity, syndromic and primary tracheomalacia groups. Short-term improvement occurred in 75%, with complete resolution in 46%. At long-term review, 82% improved and 64% were symptom-free. Respiratory infection was the most common persistent symptom. Syndromic patients had the poorest outcomes and no later improvement. CONCLUSIONS: Suprasternal aortopexy is a safe and durable treatment for tracheomalacia. While most patients improve early, further improvement may occur over time. Caution is warranted when considering aortopexy in children with underlying systemic syndromes.
Beyond the narrow passage: comparative outcomes of laparoscopic and robotic pyeloplasty in infants.
Saxena R, Aithal S, Moond C … +5 more , Nayak SR, Pathak M, Rathod KJ, Jadhav A, Sinha A
Pediatr Surg Int · 2026 Apr · PMID 42059977 · Publisher ↗
PURPOSE: To compare the outcomes of Laparoscopic pyeloplasty (LP) with those of Robot-Assisted Laparoscopic pyeloplasty (RALP) in infants. METHODS: A retrospective analysis of anteroposterior diameter, split renal functi...
PURPOSE: To compare the outcomes of Laparoscopic pyeloplasty (LP) with those of Robot-Assisted Laparoscopic pyeloplasty (RALP) in infants. METHODS: A retrospective analysis of anteroposterior diameter, split renal function success rate, reoperation rate, and complication rate was done. RESULTS: A total of thirty-nine patients and 42 units of kidneys underwent LP, while thirteen patients and 14 units underwent RALP. There was a significant improvement in APD and SRF in both groups. However, the percentage changes in APD and SRF were not significantly different in the LP and RALP groups. The mean operative time in RALP (182 ± 14.8 min) was significantly longer than the mean OT in the LP group (166 ± 21.5 min), with a p-value of 0.005. The success rates of infant pyeloplasty were 95.3% in the laparoscopic group and 93% in the robotic-assisted group, which are comparable with each other. CONCLUSION: The success rates, outcomes, length of stay, and complication rates were similar between the two techniques, although robot-assisted pyeloplasty was associated with a longer operative time. Thus, the minimally invasive surgery, both LP and RALP, can be safely performed in infants with comparable complication and success rates.
A multicenter study of school functioning in children with Hirschsprung disease in China: a cross-sectional propensity-score-matched analysis.
Huang HB, Xie H, Ji C … +6 more , Lu Y, Tang W, Yin Q, Yu M, Monteiro O, Tam PK
Pediatr Surg Int · 2026 Apr · PMID 42047820 · Publisher ↗
PURPOSE: To compare school functioning (SF) in children with Hirschsprung disease (HSCR) versus healthy controls. METHODS: A cross-sectional study of HSCR patients aged 7–14 years post-definitive surgery conducted across...
PURPOSE: To compare school functioning (SF) in children with Hirschsprung disease (HSCR) versus healthy controls. METHODS: A cross-sectional study of HSCR patients aged 7–14 years post-definitive surgery conducted across three Chinese centers (Oct 2024–May 2025) using a self-report survey. The survey employed three validated instruments: the SF domain of the PedsQL 4.0, the Delaware Bullying Victimization Scale and the Rintala Bowel Function Scale. RESULTS: After propensity-score-matching (1:1 matching, 207 vs. 207), HSCR students were found to perform significantly worse in Mathematics compared to controls (41.1% vs. 54.6% obtaining Grade A, p = 0.005), but not in Chinese. The overall SF scores in the HSCR group were significantly lower than those in controls [Median 95 (IQR 85–100) vs. 100 (90–100), respectively, p<0.001]. There was a higher prevalence of bullying in controls compared to HSCR participants, although the absolute number of bullying exposure was low (22 control and 8 HSCR out of 207 respectively). Risk factors for lower SF include ‘left-behind children’, unemployed mothers, and abnormal BF. CONCLUSIONS: Students with HSCR had lower BF and SF scores and were less likely to achieve high scores in Mathematics. We suggest that children with HSCR may benefit from targeted academic support, and greater parental engagement.
Laparoscopic vs robotic-assisted surgery for treating urachal anomalies in pediatric patients.
Esposito C, Del Conte F, Alberti D … +11 more , Di Mento C, Castagnetti M, Tedesco F, Guglielmini R, Boroni G, Bosisio M, Carraturo F, Till T, Coppola V, Esposito G, Escolino M
Pediatr Surg Int · 2026 Apr · PMID 42043607 · Full text
PURPOSE: To report a multicenter experience with minimally invasive surgery (MIS) for pediatric urachal anomalies and to compare laparoscopic versus robotic-assisted approaches. METHODS: A retrospective review was perfor...
PURPOSE: To report a multicenter experience with minimally invasive surgery (MIS) for pediatric urachal anomalies and to compare laparoscopic versus robotic-assisted approaches. METHODS: A retrospective review was performed of all patients with urachal remnants treated with MIS between January 2019 and January 2025. Demographic, perioperative, and outcome data were collected and analyzed. RESULTS: Twenty-three patients (13 males) with a median age of 5.9 years (range 6 months–14 years) underwent surgery for symptomatic urachal anomalies. Fifteen patients (65.2%) were treated laparoscopically and eight (34.8%) robotically. Complete excision was achieved in all cases. Median operative time was 45 min (range 33–73). A bladder catheter was maintained for 24 h postoperatively, and all patients were discharged within 48–72 h. Histopathology confirmed urachal remnants without evidence of malignancy. No intraoperative complications occurred. One minor postoperative complication (Clavien–Dindo I) was reported. Median follow-up was 2 years (range 5 months–6 years). CONCLUSION: MIS represents the gold standard for the treatment of urachal remnants. Both laparoscopy and robotic-assisted surgery are safe and effective. The robotic approach may offer ergonomic and technical advantages. Indocyanine green (ICG) fluorescence appears to facilitate lesion identification and guide dissection.
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