Pediatr. Surg. Int. [JOURNAL]
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200 papers
Assessment of intra-operative bowel perfusion in children using indocyanine green: an exploratory study investigating its effect on surgical management.
Neville JJ, Vincent E, Gazzaneo M … +6 more , Marinaro M, Nair A, Cirelli C, Privitera L, De Coppi P, Giuliani S
Pediatr Surg Int · 2026 Apr · PMID 42043594 · Full text
BACKGROUND: Intra-operative bowel perfusion assessment using indocyanine green (ICG) is an emerging technology that may improve outcomes in paediatric surgery. We aimed to investigate whether intra-operative perfusion as...
BACKGROUND: Intra-operative bowel perfusion assessment using indocyanine green (ICG) is an emerging technology that may improve outcomes in paediatric surgery. We aimed to investigate whether intra-operative perfusion assessment using ICG would change a surgeon's management plan in children undergoing elective stoma closure. METHODS: Four operative videos (two ileostomy and two colostomy closures) showing proximal and distal limbs of bowel immediately prior to anastomosis were independently assessed by paediatric surgeons. Prior to the intravenous injection of ICG, surgeons were asked if perfusion in each stoma limb was 'adequate' or 'poor', and whether they would complete an anastomosis. After injection of ICG, the same questions were repeated. Primary outcome was the proportion of surgeons who changed their plan after witnessing ICG administration. RESULTS: In all four stoma closures there were no operative complications and no adverse events related to ICG injection. Twenty-four surgeons participated in the study, resulting in 96 assessments. Twelve (50%) surgeons changed their management plan at least once after witnessing ICG administration. Nineteen surgeons (79%) considered ICG to be useful in this context. Surgeons stated ICG perfusion assessment was useful to confirm their visual assessment of bowel perfusion. Participants highlighted the lack of data linking intra-operative bowel perfusion assessment with ICG to surgical outcomes in children. CONCLUSIONS: Assessment of intra-operative bowel perfusion using ICG resulted in 50% of surgeons changing their management plan. The majority of surgeons believed that ICG was useful in this context. However, the relationship between ICG perfusion and clinical outcomes remains unknown.
Epidemiology and risk factors of congenital anomalies managed by the paediatric surgery unit at Greater Accra Regional Hospital: a three‑year review.
Obbeng ANE, Lee DN, Christian NA
Pediatr Surg Int · 2026 Apr · PMID 42043590 · Publisher ↗
PURPOSE: Congenital anomalies contribute substantially to neonatal morbidity and mortality in low‑ and middle‑income countries. Contemporary data on surgically managed anomalies in Ghana are limited. We aimed to quantify...
PURPOSE: Congenital anomalies contribute substantially to neonatal morbidity and mortality in low‑ and middle‑income countries. Contemporary data on surgically managed anomalies in Ghana are limited. We aimed to quantify the prevalence, spectrum, outcomes and maternal risk factors of congenital anomalies managed by the paediatric surgery unit at Greater Accra Regional Hospital (GARH). METHODS: NICU admissions at GARH between 1 June 2022 and 30 June 2025 were retrospectively reviewed. Neonates with congenital anomalies who were managed surgically were included. Demographics, anomaly types, outcomes and maternal factors were extracted. Prevalence was summarised descriptively, and logistic regression was used to identify maternal risk factors, reported as odds ratios (ORs) with 95% confidence intervals (CIs). RESULTS: Among 8 015 NICU admissions, 104 neonates (1.3%) required surgical management. Gastrointestinal anomalies predominated (67.3%), notably Hirschsprung’s disease or meconium plug syndrome (21.2%), anterior abdominal wall defects (19.2%) and anorectal malformations (11.5%). Overall mortality was 19.2%. Maternal age > 35 years, absent periconceptional folic acid supplementation and non‑facility births were significant risk factors. CONCLUSION: Surgically managed congenital anomalies at GARH were mainly gastrointestinal and carried high mortality. Promoting periconceptional folic acid use, antenatal screening, facility‑based deliveries and strengthening paediatric surgical capacity may reduce preventable neonatal deaths in Ghana.
Interval appendectomy practices for complicated appendicitis in children: a systematic review from the APSA Outcomes and Evidence-Based Practice Committee.
Sulkowski JP, Huerta CT, Tashiro J … +23 more , Diesen DL, Gulack BC, Christison-Lagay E, Russell KW, Alemayehu H, Polites SF, Hey MT, Chang HL, Beres AL, Ignacio RC, Lucas DJ, Kabagambe SK, Baird R, Kulaylat AN, Mansfield SA, Rentea RM, Pennell C, Rich BS, Yousef Y, Ricca R, Kelley-Quon L, Levene TL, American Pediatric Surgical Association Outcomes and Evidence-Based Practice Committee
Pediatr Surg Int · 2026 Apr · PMID 42043565 · Full text
BACKGROUND: This review summarizes considerations within the existing recent literature that guide the practice of interval appendectomy (IA) after initial non-operative management (NOM) of complicated appendicitis (CA)...
BACKGROUND: This review summarizes considerations within the existing recent literature that guide the practice of interval appendectomy (IA) after initial non-operative management (NOM) of complicated appendicitis (CA) in children. METHODS: A systematic review of English language articles published from 2000 to 2025 was conducted in Medline, Embase, and Cochrane Central Register of Controlled Trials to address four elements which could impact the decision for IA after NOM of CA: (1) the incidence of recurrent appendicitis; (2) the time period in which recurrence occurs; (3) the patient or disease-related risk factors which increase recurrence; and (4) the incidence of appendiceal neoplasms identified by IA. RESULTS: Of the 3,022 articles initially reviewed, 46 met inclusion criteria. Recurrence was reported in 2–50% of patients. When IA is pursued, the optimal timing remains undefined, although evidence suggests most recurrences occur within three to six months, so there may be potential benefit to performing IA within three months after the initial presentation. Risk factors for recurrent appendicitis are not well characterized, though the presence of an appendicolith may increase recurrence risk. Across studies, the incidence of appendiceal neoplasms was rare, with most studies not documenting any cases; all reported neoplasms were neuroendocrine tumors. CONCLUSION: Current evidence does not favor any single approach to IA, including routine IA, selective IA, or indefinite NOM; rather a shared-decision ought to be made between the surgeon and patient’s caregivers. Utilization and timing of IA must balance surgical risks with the risk of recurrent disease; however, the risk of neoplasm should not primarily drive management. LEVEL OF EVIDENCE: I−IIV.
Long-term outcomes after operative versus conservative management of congenital thoracic malformations: a propensity-matched cohort study.
Lambrecht S, Elrod J, Thater G … +8 more , Weis M, Weiß C, Mohr C, Wuebken L, Klinke M, Boettcher J, Boettcher M, Martel R
Pediatr Surg Int · 2026 Apr · PMID 42043561 · Full text
PURPOSE: Management of asymptomatic congenital thoracic malformations (CTMs) remains controversial. Early resection may prevent infection or malignancy and promote compensatory lung growth, but its long-term impact is un...
PURPOSE: Management of asymptomatic congenital thoracic malformations (CTMs) remains controversial. Early resection may prevent infection or malignancy and promote compensatory lung growth, but its long-term impact is unclear. This study compared long-term cardiorespiratory and psychosocial outcomes after operative versus conservative management of CTMs and evaluated open versus thoracoscopic surgery. METHODS: Children with congenital pulmonary airway malformation, pulmonary sequestration, or congenital lobar emphysema treated at a tertiary center between 2000 and 2023 were identified retrospectively. Operative patients underwent open or thoracoscopic resection, while conservatively managed children were followed radiologically. Prospective follow-up included the 6-minute run, pulmonary function testing, and psychosocial assessment. Propensity score matching adjusted for gestational age, birth weight, lesion extent, prenatal intervention, and associated congenital diaphragmatic hernia. RESULTS: Among 194 children (median follow-up 8.7 years), 162 underwent surgery and 32 were observed. Surgical patients showed smaller prenatal relative lung volume (51% vs. 79%, p = 0.02) and higher neonatal acuity (ICU admission 78% vs. 54%, p < 0.01). After matching, postnatal length of stay remained longer after surgery (15 vs. 6 days, p = 0.03). Thoracoscopy was associated with shorter postoperative stay, fewer complications and no mortality. Long-term fitness and quality of life were comparable between groups (p > 0.5). CONCLUSION: Surgical management of CTMs does not impair long-term exercise capacity or psychosocial outcomes. Minimally invasive resection appears safe and may be offered as a preventive option in asymptomatic patients.
Postoperative drain fluid amylase as an adjunctive marker of uncontained esophageal leaks in children.
Mohamed A, Leslie-Roberts R, Bennett J … +3 more , Mohammed S, Demehri F, Zendejas B
Pediatr Surg Int · 2026 Apr · PMID 42043467 · Publisher ↗
PURPOSE: Esophageal anastomotic leaks (AL) and perforations in children are associated with significant morbidity, and early recognition remains challenging. We evaluated postoperative drain fluid amylase levels in child...
PURPOSE: Esophageal anastomotic leaks (AL) and perforations in children are associated with significant morbidity, and early recognition remains challenging. We evaluated postoperative drain fluid amylase levels in children with and without esophageal leaks to explore its potential role as an adjunctive marker of clinically significant injury. METHODS: Single-institution retrospective study of children (0–18 years) undergoing esophageal surgery with postoperative drain fluid amylase testing (March 2023–October 2025). Patients were categorized based on the presence or absence of clinically or radiographically confirmed leak. Peak amylase values were analyzed by leak type (contained vs. uncontained). RESULTS: Seventy-five children were included, 64 without leak and 11 with anastomotic leak (n = 8) or perforation (n = 3). Median peak drain fluid amylase was 20 U/L (IQR 11–48) in children without a leak. Contained leaks demonstrated similarly low values (23.5 U/L [IQR 13–25.5]), whereas uncontained leaks and perforations showed markedly elevated levels (median 3423 U/L [IQR 1,776–4,026]). In one patient, amylase elevation preceded clinical deterioration by 24 h. CONCLUSION: Postoperative drain fluid amylase was elevated in clinically significant uncontained esophageal leaks and perforations but not in contained leaks. These findings suggest that drain fluid amylase may serve as an adjunctive marker of uncontained esophageal leaks in selected patients with drains in place. Prospective validation is required.
Thoracoscopic versus open congenital diaphragmatic hernia repair: a systematic review and meta-analysis by the Pediatric Surgery Meta-Analysis Study Group (PESMA).
Pérez-Bertólez S, Azizoglu M, Klyuev S … +12 more , Pederiva F, Escolino M, Sami B, Aydogdu B, Heitsman CG, Esposito C, Mutanen A, Shehata S, Conforti A, Lacher M, Muensterer O, Chiarenza F
Pediatr Surg Int · 2026 Apr · PMID 42014582 · Publisher ↗
PURPOSE: To compare outcomes of thoracoscopic repair (TR) versus conventional open repair (COR) for congenital diaphragmatic hernia (CDH) through a systematic review and meta-analysis. METHODS: PubMed, EMBASE, SCOPUS, an...
PURPOSE: To compare outcomes of thoracoscopic repair (TR) versus conventional open repair (COR) for congenital diaphragmatic hernia (CDH) through a systematic review and meta-analysis. METHODS: PubMed, EMBASE, SCOPUS, and Web of Science were searched up to August 2025 for comparative neonatal CDH studies. Randomized, prospective, and retrospective designs reporting at least one clinical outcome were included. Risk ratios (RR) with 95% confidence intervals (CI) were pooled using a random-effects model. The review followed PRISMA guidelines and was registered in PROSPERO (CRD420251128490). RESULTS: Nineteen studies involving 434 TR and 631 COR cases were included. Total recurrence was higher after TR (12.9% vs. 4.1%; RR 2.40; p = 0.0003). Primary repair recurrence showed the largest difference (12% vs. 0%; RR 4.39; p = 0.001), and patch repair recurrence remained higher in TR (21% vs. 11.5%; RR 1.98; p = 0.04). Bowel obstruction was lower after TR (6% vs. 14.6%; RR 0.52; p = 0.02). No significant differences were found for chylothorax, pneumothorax, pleural effusion, or bowel injury. Mortality was lower in TR (0.9% vs. 5.9%; RR 0.31; p < 0.0001), likely reflecting patient selection. CONCLUSION: TR is feasible in selected neonates and is associated with lower bowel obstruction and mortality but higher recurrence. Standardized criteria for selecting TR versus COR remain essential.
International disparities in biliary atresia outcomes.
Kassir R, Schneider G, Dubois R … +1 more , Rossignol G
Pediatr Surg Int · 2026 Apr · PMID 42012682 · Publisher ↗
The Japanese Biliary Atresia Registry, reported by Okubo et al., provides a comprehensive long-term perspective on biliary atresia (BA) across 3951 patients (1989–2023). With jaundice clearance rates exceeding 60% and 10...
The Japanese Biliary Atresia Registry, reported by Okubo et al., provides a comprehensive long-term perspective on biliary atresia (BA) across 3951 patients (1989–2023). With jaundice clearance rates exceeding 60% and 10-year native liver survival of 50.5%, outcomes in Japan remain consistently superior to those reported in Western cohorts. These disparities are likely multifactorial. BA represents a heterogeneous phenotype shaped by genetic, immunological, environmental, and developmental factors that may differ across populations. The lower prevalence of biliary atresia splenic malformation syndrome in Japan (2.2% vs. 8–15%) may partly contribute but does not fully explain the gap. Differences in management strategies, including earlier surgery, greater use of revision Kasai portoenterostomy, and adjuvant therapies, may also play a key role.
Robot-assisted versus conventional minimally invasive surgery in the treatment of paediatric neuroblastoma: a single-centre retrospective study.
Avanzini S, Reali S, Palo F … +4 more , Conte M, Sorrentino S, Spreafico F, Mattioli G
Pediatr Surg Int · 2026 Apr · PMID 42012535 · Full text
INTRODUCTION: Neuroblastoma is the most common extracranial solid tumour in childhood. Although minimally invasive surgery (MIS) is increasingly used in selected patients with neuroblastic tumours, comparative data betwe...
INTRODUCTION: Neuroblastoma is the most common extracranial solid tumour in childhood. Although minimally invasive surgery (MIS) is increasingly used in selected patients with neuroblastic tumours, comparative data between robot-assisted and conventional MIS are lacking. MATERIALS AND METHODS: A single-centre retrospective study was conducted on 84 patients who underwent minimally invasive resection of neuroblastic tumours between 2008 and 2025. Patients were divided into conventional MIS and robot-assisted surgery groups. Demographic data, tumour characteristics and surgical and oncological outcomes were compared. RESULTS: The robot-assisted group included a higher number of patients with Image-Defined Risk Factor (IDRF) ≥ 1 (57% vs. 8%). Robotic surgery was therefore preferentially employed in more complex cases, resulting in higher conversion rate and longer operative time. Despite the higher prevalence of patients with IDRF ≥ 1 in the robotic group, intraoperative and postoperative complication rates were comparable between groups. Notably, conversions were not performed for emergency reasons but were based on intraoperative decision-making. CONCLUSIONS: Robot-assisted surgery may safely expand selection criteria to selected patients with positive IDRFs, while maintaining oncological principles and without increasing intra and postoperative morbidity.
Analysis of terminal rectal fibrosis and expression of type I and type III collagen proteins in patients with mid-high anorectal malformations.
Li S, Wang M, Li H … +3 more , Chen W, Chi Y, Li L
Pediatr Surg Int · 2026 Apr · PMID 42012515 · Publisher ↗
BACKGROUND: Patients with intermediate and high-type anorectal malformations (ARMs) demonstrate moderate to severe fibrosis in the distal rectal wall, which may underlie postoperative defecation dysfunction. This study a...
BACKGROUND: Patients with intermediate and high-type anorectal malformations (ARMs) demonstrate moderate to severe fibrosis in the distal rectal wall, which may underlie postoperative defecation dysfunction. This study aims to systematically evaluate and quantitatively analyze collagen deposition patterns in the distal rectal wall, providing new insights into the mechanism of defecation disorders following anorectal reconstruction. METHODS: We conducted an integrated analysis of 30 intermediate/high-type ARMs patients utilizing histochemical staining, immunohistochemistry, and Western blot to quantitatively evaluate spatial extracellular matrix (ECM) composition and fibrotic architecture in the distal rectal wall. RESULTS: Microscopic examination revealed densely packed collagen fibers within the submucosal layer and prominent perineural collagen deposition surrounding the myenteric plexus in distal segments. Quantitative analysis demonstrated significantly greater perineural connective tissue thickness in distal versus proximal intestinal wall (P < 0.001). Both type I (P < 0.001) and type III (P = 0.039) collagen expression were significantly elevated in distal segments, with a notably increased type I/III collagen ratio (P = 0.014). CONCLUSION: The distal rectal wall in intermediate and high-type ARMs patients exhibits abnormal ECM deposition characterized by significantly increased type I and III collagen, with predominant type I collagen elevation. These findings suggest a mature, stiffened fibrotic phenotype with impaired tissue compliance and structural irreversibility. The distinctive collagen deposition profile identified in this study may be critically associated with the pathogenesis of postoperative defecation dysfunction in ARM patients.
Percutaneous laparoscopic-assisted gastrostomy outperforms surgical gastrostomy for temporary feeding in long-gap esophageal atresia: a comparative cohort study.
Li W, Li W, Huang M … +9 more , Ou Z, Huang G, Li Y, Meng S, Huang X, Gu J, Huang F, Chen J, Zeng T
Pediatr Surg Int · 2026 Apr · PMID 42001346 · Full text
OBJECTIVE: This study aims to compare the clinical efficacy of percutaneous laparoscopic-assisted gastrostomy (PLAG) and surgical gastrostomy (SG) for temporary gastrostomy in neonates with long-gap esophageal atresia (L...
OBJECTIVE: This study aims to compare the clinical efficacy of percutaneous laparoscopic-assisted gastrostomy (PLAG) and surgical gastrostomy (SG) for temporary gastrostomy in neonates with long-gap esophageal atresia (LGEA). METHODS: We conducted a retrospective analysis of 41 neonates diagnosed with LGEA who underwent temporary gastrostomy. Patients were retrospectively divided into two groups based on the year of surgery: the PLAG group (intervention group, n = 23,post-2020) and the SG group (historical control group, n = 18, pre-2020).We compared perioperative parameters, including postoperative fasting duration, gastrostomy closure rates, abdominal scar scores and complication rates between the two groups. RESULTS: No significant differences were found in baseline characteristics, including gender (p = 0.732), gestational age (p = 0.460), birth weight (p = 0.421), operative age (p = 0.165), Gross classification (p = 0.117), esophageal gap length (p = 0.081), or concomitant deformities (p = 0.767). The two groups showed no statistically significant differences in operative time (p = 0.067), intraoperative blood loss (p = 0.189), or postoperative fasting duration (p = 0.378). However, the PLAG group demonstrated clinically meaningful advantages in several outcomes, including significantly lower rates of gastrostomy closure (p < 0.001), improved cosmetic results (assessed by lower abdominal scar scores; p < 0.001), and reduced complication rates for stoma leakage (p < 0.001), peristomal dermatitis (p < 0.001), local infection (p < 0.001), and tube dislodgement (p = 0.003). No significant differences were noted in stomal hemorrhage (p = 0.083) or intra-abdominal fistula rates (p = 0.252). CONCLUSION: Compared to SG, PLAG offers significant advantages for temporary gastrostomy in LGEA, including lower closure requirements, improved cosmetic outcomes, and fewer overall complications. These findings support the broader clinical adoption of PLAG in this patient population.
Impact of image-defined risk factors on surgical outcomes in thoracic neuroblastic tumors.
Ardicli B, User IR, Ciftci AO … +6 more , Karnak I, Oguz B, Haliloglu M, Kutluk MT, Orhan D, Ekinci S
Pediatr Surg Int · 2026 Apr · PMID 42001342 · Publisher ↗
BACKGROUNDS: Thoracic neuroblastic tumors pose surgical challenges due to proximity to vital structures. Image-defined risk factors (IDRFs) aid in assessing surgical risks. This study evaluates their impact on surgical d...
BACKGROUNDS: Thoracic neuroblastic tumors pose surgical challenges due to proximity to vital structures. Image-defined risk factors (IDRFs) aid in assessing surgical risks. This study evaluates their impact on surgical decisions, resection extent, and complications. METHODS: Forty-one children undergoing surgery for thoracic neuroblastic tumors (2007–2020) were analyzed. Group A (n = 22) underwent neoadjuvant chemotherapy followed by surgery; Group B (n = 19) underwent upfront surgery. IDRFs (infiltrative, vascular, neurological, or extensive) were identified via imaging. Tumor volumes were calculated using ellipsoid approximation. Resections were classified as complete or incomplete, and complications graded by the Clavien-Dindo system and Comprehensive Complication Index. RESULTS: At diagnosis, 70% had IDRFs; median IDRF count was 4 in Group A vs. 0 in Group B (p < 0.001). Chemotherapy significantly reduced tumor volume and IDRF count (from 4 to 2, p < 0.001). Complete resection was achieved in 38 patients. Surgical complications occurred in 29.3% of patients. Neurological IDRFs were significantly associated with complications on univariate analysis and showed a strong, though not statistically significant, association in multivariable analysis. Two IDRF-negative patients developed Horner syndrome, both with upper mediastinal tumors, suggesting that upper mediastinal localization warrants careful surgical consideration. CONCLUSION: IDRFs are essential for planning thoracic neuroblastic tumor surgery. Neoadjuvant chemotherapy reduces tumor burden and IDRFs count, potentially lowering surgical risk. Upper mediastinal localization may require particular attention during surgical planning, even in the absence of classical IDRFs.
The effect of autologous platelet-rich treatment in hypospadias repair: a systematic review and meta-analysis.
Xiao KW, Zhan YX, Zhang C … +2 more , Huang GQ, Lu XB
Pediatr Surg Int · 2026 Apr · PMID 42001334 · Publisher ↗
BACKGROUND: Hypospadias is one of the most common male congenital anomalies and often requires a surgical approach. Several repair techniques have been developed to improve the outcomes, including the autologous platelet...
BACKGROUND: Hypospadias is one of the most common male congenital anomalies and often requires a surgical approach. Several repair techniques have been developed to improve the outcomes, including the autologous platelet-rich treatment (APT). There remains a controversy that whether the application of APT really benefits hypospadias repair. MATERIALS AND METHODS: The current study was performed based on the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020 guidelines and was registered. The systematic literature search was undertaken using PubMed, Embase, Web of Science and Cochrane Central Register of Controlled Trials databases to identify eligible studies published before May 2025. The primary outcomes included operative time, length of hospital stay, urethral fistula, meatal stenosis, urethral stricture, wound infection, glans dehiscence, bleeding and total complication rates. RESULTS: Totally 562 pediatric patients from 7 independent controlled trials including 5 randomized controlled trials (RCTs) were obtained for the final analysis. In the comparison between the APT group and non-APT group, no significant difference was found as regards operation time, hospital stay, glans dehiscence and urethral stricture. However, the APT group may exhibit potential benefits in urethral fistula (OR:0.51, 95%CI: 0.29–0.91, p = 0.02), meatal stenosis (OR:0.35, 95%CI: 0.14–0.90, p = 0.03), wound infection (OR:0.19, 95%CI: 0.07–0.46, p < 0.001) and total complications (OR:0.30, 95%CI: 0.16–0.55, p < 0.001). CONCLUSIONS: APT was an efficient and safe procedure in the management of hypospadias repair. Compared with non-APT group, the application of APT was associated with decreased postoperative complications including urethral fistula, meatal stenosis and wound infection. More RCTs with larger sample size are still needed.
Modified enhanced recovery after surgery protocol for pediatric complicated appendicitis in a Mexican tertiary hospital: a randomized clinical trial.
Calderón-Alvarado AB, Ambriz-González G, Fuentes-Orozco C … +13 more , Villaseñor-Rodriguez AR, Guzmán-Diaz JM, Jasso-García I, García-Romero RC, González-Muñoz SE, Castillo-Cardiel G, Cervantes-Guevara G, Cervantes-Pérez E, Ramírez-Ochoa S, González-Ojeda A, Vázquez-Sánchez SJ, Álvarez-Villaseñor AS, Moya-Ambriz HB
Pediatr Surg Int · 2026 Apr · PMID 41984227 · Publisher ↗
BACKGROUND/OBJECTIVES: Acute appendicitis often requires emergency surgery and leads to prolonged length of hospital stay (LOS). Enhanced recovery after surgery (ERAS) protocol promotes rapid recovery and shorter hospita...
BACKGROUND/OBJECTIVES: Acute appendicitis often requires emergency surgery and leads to prolonged length of hospital stay (LOS). Enhanced recovery after surgery (ERAS) protocol promotes rapid recovery and shorter hospital stays, revolutionizing the management of pediatric surgery. The aim of the study was to evaluate the safety and efficacy of an ERAS therapeutic protocol for postoperative management in children with complicated appendicitis compared with conventional treatment. METHODS: A single-blind, randomized controlled clinical trial was performed on patients diagnosed with complicated appendicitis between July 1 and December 31, 2022. Patients were randomly assigned to either the control group, which received conventional triple antibiotic treatment and oral feeding after restoring intestinal transit, or ERAS group, which received double antibiotic regimen, nausea prevention, and oral feeding 6 h after appendectomy. We analyzed LOS and the incidence of postoperative morbidity. The trial was registered at the Local Health Research and Ethics Committee (identifier R-2022-1302-056) and ClinicalTrials.gov ( https://www.clinicaltrials.gov/ ; identifier NCT05511194; 01/31/2023). RESULTS: Forty patients, 70% male, average age 8 years, were included. Twenty patients received ERAS protocol management, while 20 received conventional management. The ERAS group had a shorter average LOS (3.15 days vs. 5.20 days, p = 0.001). Postoperative minor morbidities were similar between the groups. CONCLUSION: The modified ERAS protocol reduced LOS and did not increase postoperative morbidity.
Anorectal malformation in adulthood: a systematic review of biological, psychological, and sociological outcomes and experiences.
Rane E, Bloom J, Chan XWC … +1 more , Harris P
Pediatr Surg Int · 2026 Apr · PMID 41984221 · Full text
PURPOSE: Anorectal malformations are congenital anomalies involving the rectum, anus, genital, and urinary tracts, and occur in approximately one in 5000 live births. A lack of transition from pediatric to adult health s...
PURPOSE: Anorectal malformations are congenital anomalies involving the rectum, anus, genital, and urinary tracts, and occur in approximately one in 5000 live births. A lack of transition from pediatric to adult health services means little is known about how this condition is experienced in adulthood. The purpose of this review was to discover biopsychosocial challenges and supports experienced by adults living with anorectal malformation. MATERIALS AND METHODS: A systematic quantitative literature review was the preferred method to collect and analyze data. Articles included in the review were sorted into purpose-built datasets, with data coded into biopsychosocial themes and patterns. RESULTS: The most frequently reported biological challenge was surgical intervention; the most frequently reported support was positively framed continence management. The most common psychological challenges were psychosexual concerns such as sexual anxiety, and the most common supports were interventions focused on improving self-perception. The most reported sociological challenge was navigating complex health systems, and the most reported support was forming meaningful relationships. CONCLUSION: Biopsychosocial outcomes experienced by adults born with anorectal malformation remain largely unknown. Social work and psychology can provide therapeutic interventions that enhance emotional wellbeing, psychosocial functioning, and patient-led care.
Trends and outcomes of thoracoscopic esophageal atresia and tracheoesophageal fistula repair: a retrospective analysis 2016-2022.
Woodward JM, Avila PC, Orellana A … +7 more , Tung K, Otero MT, Caines L, Bittner K, Kumar A, Harmon CM, Ham PB
Pediatr Surg Int · 2026 Apr · PMID 41984220 · Full text
PURPOSE: Thoracoscopic repair of esophageal atresia (EA) and tracheoesophageal fistula (TEF) is a technically demanding operation. We hypothesize thoracoscopic repair of EA with TEF over time has increased, with improved...
PURPOSE: Thoracoscopic repair of esophageal atresia (EA) and tracheoesophageal fistula (TEF) is a technically demanding operation. We hypothesize thoracoscopic repair of EA with TEF over time has increased, with improved or equivalent outcomes compared to open. METHODS: NSQIP-P identified patients < 30 days with EA and TEF who underwent repair of both defects from 2016 to 2022. Patients were categorized into (1) intention to treat (thoracoscopic/thoracoscopic converted to open); and (2) thoracoscopic only, both compared to open only patients. Coarsened exact matching was performed. Pre/post-match analysis utilized X2, Fisher’s exact, and Mann-Whitney-U tests. RESULTS: Overall, 1,188 patients were identified with 147 (12.4%) thoracoscopic only, 129 (10.8%) converted to open, and 912 (76.8%) open only. Thoracoscopic repair increased (2016–2022) for intention to treat (12.0% vs. 29.4%, p = 0.001) and thoracoscopic only (7.2% vs. 19.1%, p = 0.012) cohorts. Matched analysis identified thoracoscopic patients had reduced length of stay (p = 0.005) and longer operative time (< 0.01); however, no difference in other outcomes were identified (p > 0.05). CONCLUSION: Thoracoscopic repair of EA with TEF attempts have increased to roughly 30%, and it is associated with reduced length of stay and longer operative times without other outcome differences. This analysis affirms the short-term safety of thoracoscopic repair of EA and TEF. LEVEL OF EVIDENCE (I-V): Level III.
Outcomes and complications of different approaches for 1-2 cm upper tract stones in the paediatric population: bicentric retrospective analysis.
Bruniera M, Basso G, Botti S … +12 more , Grossele M, Gnech M, Berrettini A, Beltrami P, Montini G, Taroni F, Mancuso MC, Vidal E, Sangermano M, Longo G, Dal Moro F, Morlacco A
Pediatr Surg Int · 2026 Apr · PMID 41984213 · Full text
PURPOSE: To evaluate outcomes and complications of different surgical approaches for 10–20 mm internal stones in children, based on bicentric real-world experience. MATERIALS AND METHODS: We retrospectively analysed 96 p...
PURPOSE: To evaluate outcomes and complications of different surgical approaches for 10–20 mm internal stones in children, based on bicentric real-world experience. MATERIALS AND METHODS: We retrospectively analysed 96 patients treated between 2009 and 2022 at two tertiary referral centres. Data included demographics, stone characteristics, treatment (extracorporeal shockwave lithotripsy -SWL, retrograde surgery -RIRS, percutaneous nephrolithotomy – PCNL, surgery), complications, and stone-free rates. The primary outcome was stone clearance; complications were graded according to the Clavien-Dindo classification. Categorical variables were compared using Chi-square of Fisher’s exact test. RESULTS: Median age was 61 months (IQR 25–105). Nineteen patients (19.8%) had associated urological conditions. 50% had multiple stones. Treatments included SWL (17.7%), URS/RIRS (46.9%), PCNL (19.8%), and surgery (8.3%). Intraoperative complications occurred in 4.2%, early postoperative in 12.5%, and late complications in 11.5%. Stone clearance after the first procedure was achieved in 47.9%. Clearance rates were 58.8% for SWL, 47.8% for URS/RIRS, and 52.6% for PCNL. No statistically significant differences were observed in stone clearance or complication rates among treatments. CONCLUSIONS: All treatments demonstrated safety and efficacy for 10–20 mm pediatric intrarenal stones. Individualized treatment planning, considering stone burden and patient-specific factors, remains essential to optimize outcomes.
Genetic association analysis of lnc-AMFR-1:1 rs4784659 C > T and neuroblastoma susceptibility in Chinese pediatric patients.
Feng T, Su Y, Zhou C … +5 more , Zhang X, Liu J, Zhang W, He J, Huang X
Pediatr Surg Int · 2026 Apr · PMID 41984207 · Publisher ↗
BACKGROUND: Neuroblastoma, a neuroendocrine tumor of the sympathetic ganglia, is the leading solid extracranial malignancy in children. The lnc-AMFR-1:1 rs4784659 polymorphism in long noncoding RNA (lncRNA) has been repo...
BACKGROUND: Neuroblastoma, a neuroendocrine tumor of the sympathetic ganglia, is the leading solid extracranial malignancy in children. The lnc-AMFR-1:1 rs4784659 polymorphism in long noncoding RNA (lncRNA) has been reported to be associated with susceptibility to several cancers, but its role in neuroblastoma remains unclear. METHODS: We studied 402 patients with neuroblastoma and 473 cancer-free controls from Jiangsu Province to assess the association between lnc-AMFR-1:1 rs4784659 C > T and neuroblastoma susceptibility using odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: Analysis under any of the genetic models tested failed to reveal a significant link between the rs4784659 C > T polymorphism and neuroblastoma risk (CT vs. CC: adjusted OR = 0.96, 95% CI = 0.73–1.28, P = 0.799; TT vs. CC: adjusted OR = 1.40, 95% CI = 0.77–2.53, P = 0.273; TT/CT vs. CC: adjusted OR = 1.01, 95% CI = 0.77–1.33, P = 0.924; TT vs. CC/CT: adjusted OR = 1.41, 95% CI = 0.79–2.54, P = 0.245). Moreover, stratified analysis revealed no significant associations. CONCLUSION: This study provided no evidence of an association between the lnc-AMFR-1:1 rs4784659 C > T polymorphism and the risk of neuroblastoma. These findings warrant validation in larger and more diverse populations.
A single-center experience with orthotic bracing for children with pectus carinatum.
Hong SM, Hong JJ, Shi BX … +4 more , Shen HH, Cai JW, Huang JX, Hu XM
Pediatr Surg Int · 2026 Apr · PMID 41984090 · Publisher ↗
BACKGROUND: Bracing therapy is a first-line non-surgical treatment for pectus carinatum , but standardized protocols, measurement of initial corrective pressure, particularly regarding wearing intensity, are lacking. Thi...
BACKGROUND: Bracing therapy is a first-line non-surgical treatment for pectus carinatum , but standardized protocols, measurement of initial corrective pressure, particularly regarding wearing intensity, are lacking. This study compares the efficacy, compliance, and patient satisfaction between high-intensity and low-intensity bracing regimens in young children with pectus carinatum, utilizing three-dimensional surface scanning for objective assessment, and propose a standard measurement of initial corrective pressure. METHODS: From January 2021 to January 2025, 208 children under six years of age with pectus carinatum were enrolled and categorized into two groups based on daily brace-wearing time: a high-intensity group (>16 hours/day, n=98) and a low-intensity group (8–12 hours/day, n=110). All patients received orthotic braces. Treatment progress was monitored bimonthly using 3D scanning to measure the External Haller Index. Outcomes included correction success, treatment duration, complication rates, adherence, and patient/parent satisfaction assessed via the Pectus Carinatum Evaluation Questionnaire (PCEQ). RESULTS: Final success rates were comparable between the low-intensity and high-intensity groups (86.3% vs. 89.8%, p>0.05), with no significant difference in median correction time (7.5 ± 0.8 months vs. 7.3± 0.9 months, p=0.321). The high-intensity group showed significantly greater EHI improvement at the 2-month follow-up (1.24 ± 0.11 vs.1.18 ± 0.13, p<0.05), but this difference disappeared by 4 months(1.27± 0.08 vs.1.25 ± 0.09, p=0.093). The low-intensity group demonstrated significantly better treatment compliance (95.6% vs. 89.1%, p<0.05) and higher post-treatment satisfaction scores (4.5±0.3 vs. 4.2±0.4, p<0.05). Complication rates were low overall (7.2%) and predominantly mild, with slightly fewer complications in the low-intensity group. One case (0.5%) of recurrence was successfully managed with brief resumed bracing. CONCLUSION: A low-intensity bracing regimen achieves long-term correction efficacy comparable to a high-intensity regimen without prolonging treatment duration, while significantly improving patient compliance and satisfaction. The use of 3D scanning to standardize initial corrective pressure provides an objective benchmark for pressure adjustment. These findings support a paradigm shift towards patient-centered, low-intensity bracing strategies for pediatric PC, prioritizing tolerability and adherence to optimize overall outcomes.
Incarceration of epigastric hernia in children: a systematic review.
Faily S, Nezhentsev A, Bethell G … +1 more , Fouad D
Pediatr Surg Int · 2026 Apr · PMID 41964852 · Publisher ↗
PURPOSE: Paediatric epigastric hernias are usually superficial fascial defects in the linea alba containing extra-peritoneal fat only. We aimed to determine the frequency of incarceration of epigastric hernias in childre...
PURPOSE: Paediatric epigastric hernias are usually superficial fascial defects in the linea alba containing extra-peritoneal fat only. We aimed to determine the frequency of incarceration of epigastric hernias in children and the incidence of full thickness defects. METHODS: A systematic review was performed following PRISMA guidelines (PROSPERO: CRD42024622980). A literature search was undertaken using sources from the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE, Embase, Grey literature sources, references of included studies, all in English language only, using the keywords and variations of, “children”, “epigastric hernia”, “supraumbilical” and “paediatric”. Data extraction for each included study, included bibliographic details (authors, title, publication date), study design, study period, region of origin, number of children with epigastric hernia and incarcerated epigastric hernia and management of incarcerated epigastric hernia. RESULTS: Twenty-five reports were selected for full text screening and seven studies were included (between the years of 1975 to 2019) in the final systematic review and analysis. A total of 80 cases are described, 33 males and 47 females, with an average age at presentation for each series ranging between 2 and 9 years. Our systematic review found that no previous studies have reported paediatric cases of incarcerated, full thickness epigastric hernias. CONCLUSIONS: Epigastric hernias are commonly encountered in general surgery of childhood however studies of this disease are limited. Incarceration of epigastric hernias in children is rare and has only been reported previously to contain extra-peritoneal fat. LEVELS OF EVIDENCE: Level IV.
A pelvic floor muscle rehabilitation programme for pediatric patients undergoing colorectal surgery with sphincters involvement provides excellent results and more optimistic prognostic expectations.
Cantone E, Raffo R, Camillo S … +7 more , Tufano S, Sterpone R, Erculiani M, Mottadelli G, Di Matteo R, Bolgeo T, Pini Prato A
Pediatr Surg Int · 2026 Apr · PMID 41964786 · Publisher ↗
INTRODUCTION: A high prevalence of patients operated on for Hirschsprung disease (HSCR) and Anorectal Malformations (ARM) may suffer from faecal incontinence. This prospective interventional study was aimed at assessing...
INTRODUCTION: A high prevalence of patients operated on for Hirschsprung disease (HSCR) and Anorectal Malformations (ARM) may suffer from faecal incontinence. This prospective interventional study was aimed at assessing the possible benefits of paediatric pelvic floor muscle (PFM) rehabilitation in the treatment of such patients. MATERIALS AND METHODS: All consecutive paediatric patients with HSCR and ARM complaining of continence issues admitted between January 2021 and December 2023 have been included. PFM rehabilitation was carried out with a therapist-patient ratio of 1:1. Patients were assessed with Wexner and Rintala scales at different timepoints (T0 enrolment, T1 after rehabilitation and T2 1 year post-rehabilitation). RESULTS: A total of 49 patients (36 HSCR and 13 ARM) were enrolled. Median age was 10 years. Median Wexner score was 6 at T0, 5 at T1 and 2 at T2 with significant improvements both at T1 and T2. Median Rintala score was 11 at T0, 13 at T1, and 14 at T2 with significant improvements both at T1 and T2. The worse was the score at the beginning, the more evident was the improvement at subsequent timepoints. Similar results were achieved in HSCR and ARM. One third of patients using TAI at T0, reduced or abandoned it after PFM rehabilitation. DISCUSSION: This is the first prospective interventional study addressing PFM rehabilitation in paediatric patients after colorectal surgery. We demonstrated safety, tolerability, and effectiveness for both HSCR and ARM and demonstrated that effects last in the long-term reducing the likelihood of symptoms recurrence.
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