Pediatr. Surg. Int. [JOURNAL]
Sun
200 papers
Image defined risk factor(s) and outcomes for abdominal neuroblastoma: a surgical perspective from a Thailand National Cancer Centre.
Thamsopitt B, Junhasavasdikul T, Eng-Chaun S … +2 more , Losty PD, Thanachatchairattana P
Pediatr Surg Int · 2026 Apr · PMID 41964766 · Full text
PURPOSE: To evaluate the impact of IDRFs on surgical outcomes, complications, and survival in abdominal neuroblastoma (ANB). METHOD: Retrospective study of patients (< 15 years) with ANB stage L2 or higher treated over t...
PURPOSE: To evaluate the impact of IDRFs on surgical outcomes, complications, and survival in abdominal neuroblastoma (ANB). METHOD: Retrospective study of patients (< 15 years) with ANB stage L2 or higher treated over two decades at a university centre in Thailand. RESULTS: Among fifty patients, 94% had high-risk neuroblastoma. Preoperative tumour encasement of the celiac axis (CA) or origin of SMA was more frequent in incomplete resection (33% vs. 9%, p = 0.04). Complications were greater in children with abdominal aorta/IVC tumour encasement (58% vs. 27%, p < 0.03) and adjacent organ infiltrative tumours (42% vs. 7%, p < 0.04). Visceral organ injuries correlated with vascular/infiltrating IDRFs. Tumours invading CA/SMA carried less risk (%) of vascular injury (r =- 0.28, p = 0.04). Only tumour encasement of the SMA at the mesenteric root predicted disease progression (r = 0.35, p = 0.01). Incomplete resection was associated with higher risks (%) of disease progression. Two- and five-year survival rates were 80.6% and 52.1%, respectively. CONCLUSION: Vascular IDRFs especially mesenteric root encasement were linked to risk of visceral organ injury and disease progression. Awareness of risks may reduce vascular injury during operation though incomplete resection influenced disease progression. Survival outcomes are comparable to Southeast Asia Regions.
Modified thoracoscopic anastomosis of esophageal atresia with tracheoesophageal fistula.
Shun-Lin X, Shi-Ting L, Wei-Bing C … +1 more , Bing L
Pediatr Surg Int · 2026 Apr · PMID 41964708 · Publisher ↗
OBJECTIVE: This study aims to evaluate the modified thoracoscopic esophageal anastomotic methods in cases with esophageal atresia with tracheoesophageal fistula (EA-TEF). METHODS: From January 2019 to August 2024, a tota...
OBJECTIVE: This study aims to evaluate the modified thoracoscopic esophageal anastomotic methods in cases with esophageal atresia with tracheoesophageal fistula (EA-TEF). METHODS: From January 2019 to August 2024, a total of 12 consecutive infants with type 3 EA-TEF underwent modified thoracoscopic esophageal anastomosis in our department. The modified methods (Group A) included: (1) posterior wall anastomosis performed using two mattress sutures with 5 − 0 PDS; (2) subsequently, the anterior wall anastomosis was completed with continuous locked stitches using 5 − 0 PDS. The outcomes were compared with those of the conventional group (Group B, n = 15), who underwent traditional esophageal anastomosis with interrupted sutures during the same period. RESULTS: In Group A, the operative time was 123.7 ± 12.0 min (range, 105–135 min), while in Group B, the operative time was 145.7 ± 13.5 min (range, 135–185 min). A significant difference was observed in operative time between the two groups (P < 0.001). The duration of the esophageal anastomosis is 36.0 ± 3.9 min (range 22–45) in group A, 44.4 ± 4.1 min (range, 38–52) in group B (P<0.001). In Group A, two patients experienced small leaks; similarly, three patients in Group B demonstrated small leaks, there was no significant difference between the two groups (P>0.05). Five cases formatted stricture needed dilation in group A, and four cases in group B (P>0.05). CONCLUSION: The modified method is an effective and safe technique in EA-TEF capable of minimizing the operative time without increasing morbidity and mortality.
Should all pyloromyotomies for infantile hypertrophic pyloric stenosis be performed by pediatric surgeons?
Perkins J, Rodriguez J, Park S … +2 more , Herman R, Miyata S
Pediatr Surg Int · 2026 Apr · PMID 41964665 · Full text
PURPOSE: Pyloromyotomies for infantile hypertrophic pyloric stenosis in academic centers are generally performed by pediatric surgeons (PS), while in non-specialized centers these are performed by general surgeons (GS)....
PURPOSE: Pyloromyotomies for infantile hypertrophic pyloric stenosis in academic centers are generally performed by pediatric surgeons (PS), while in non-specialized centers these are performed by general surgeons (GS). This cross-sectional study aims to address the paucity of data comparing the safety between PS and GS when performing a pyloromyotomy within NSQIP-P participating institutions. METHODS: Data from 2012 to 2020 was obtained from the ACS-National Surgical Quality Improvement Program Pediatric (NSQIP-P) database. All patients who underwent pyloromyotomy by GS or PS were included. Patients who underwent other concurrent procedures were excluded. Demographics and postoperative outcomes were compared. Bivariate analyses and multivariable logistic regression were performed with a P-value < 0.05 being considered statistically significant. RESULTS: A total of 18,453 pyloromyotomies were identified. Of these, 731 (4%) of cases were performed by GS and 17,722 (96%) by PS. The analysis indicated that several patient characteristics (weight, race, ASA class, comorbidities) and intra- and post-operative characteristics (operative length and hospital length of stay) were significantly different between groups. After adjusting for known risk factors, post-operative complications, re-admission rate, mortality and rate of re-operation were statistically similar between GS and PS. General surgeons were more likely to perform the operation via an open approach compared to pediatric surgeons (Adjusted OR 1.24 for Open vs. Laparoscopic, 95% CI 1.04-1.49). No significant difference was found in conversion rates (Adjusted OR 1.45 for Conversion to Open vs. Laparoscopic, 95% CI 0.68-3.08). CONCLUSION: Our findings suggest no difference in 30-day outcomes within NSQIP-P pediatric-focused institutions. However, these results may not generalize to community or non-participating hospitals due to potential misclassification of surgeon specialty and selection bias. LEVEL OF EVIDENCE: III.
Testicular atrophy rate in single-stage versus two-stage fowler-stephens orchidopexy: a systematic review and meta-analysis.
Sisodiya RS, Acharya H, Agrawal V … +4 more , Tiwari A, Chanchlani R, Sharma DB, Tomar A
Pediatr Surg Int · 2026 Apr · PMID 41964663 · Publisher ↗
BACKGROUND: Managing intra-abdominal testes is particularly challenging, especially when short testicular vessels require division. Fowler–Stephens orchiopexy remains the standard approach in such cases, but whether it i...
BACKGROUND: Managing intra-abdominal testes is particularly challenging, especially when short testicular vessels require division. Fowler–Stephens orchiopexy remains the standard approach in such cases, but whether it is more effective when performed in a single or two stages remains uncertain. This review aims to provide a clear, updated comparison of testicular atrophy rates following single-stage (SS) versus two-stage (TS) FSO. METHODS: A systematic search of PubMed/MEDLINE and Google Scholar was conducted until May 2025 in accordance with PRISMA 2020 guidelines. Studies comparing SS-FSO and TS-FSO in boys with intra-abdominal testes were included. The primary outcome was postoperative testicular atrophy. Risk of bias was assessed using the RoB-2 and ROBINS-I tools. Meta-analysis was performed in JASP using log risk ratios under random- and fixed-effect models, with heterogeneity, prediction intervals, and publication bias evaluated using established statistical methods. RESULTS: Twenty-two studies involving 743 testes met the inclusion criteria. Atrophy rates were consistently higher after SS-FSO (3–20%) than after TS-FSO (0–12%). The combined analysis indicated that TS-FSO significantly reduced the risk of atrophy (log RR 0.50; 95% CI 0.15–0.84; p = 0.005), corresponding to approximately a 40–50% relative risk reduction. All studies showed a similar trend, with no heterogeneity (I²=0%). The prediction interval also supported TS-FSO, and funnel plot assessments revealed no evidence of publication bias. Overall, the certainty of evidence was rated as low due to confounding in observational studies and the limited number of high-quality trials. CONCLUSION: This review demonstrated that TS-FSO provides a more reliable reduction in testicular atrophy than SS-FSO for intra-abdominal testes requiring vessel division. Although much of the evidence is observational, the consistency and robustness of the findings support TS-FSO as the preferred method. Carefully planned prospective studies are crucial for refining patient selection criteria and facilitating personalised surgical decision-making.
Pediatric retrograde intrarenal surgery: does age matter?
Ograk H, Keskin H, Kahraman O … +3 more , Horozcu H, Tekgül S, Dogan HS
Pediatr Surg Int · 2026 Apr · PMID 41954888 · Publisher ↗
OBJECTIVE: The aim of this study was to evaluate the outcomes of retrograde intrarenal surgery (RIRS) in the pediatric population and to investigate the factors affecting surgical success. MATERIALS AND METHODS: The medi...
OBJECTIVE: The aim of this study was to evaluate the outcomes of retrograde intrarenal surgery (RIRS) in the pediatric population and to investigate the factors affecting surgical success. MATERIALS AND METHODS: The medical records of pediatric patients who underwent RIRS at Hacettepe University Hospital between 2014 and 2023 were retrospectively reviewed. Patient age, stone number, stone size, stone location, stone density measured in Hounsfield units (HU), presence of hydronephrosis, preoperative and postoperative double-J stent (DJS) placement, and use of a ureteral access sheath (UAS) were analyzed in relation to stone-free rates at 6 weeks and final stone-free outcomes. RESULTS: A total of 59 patients (62 renal units) who underwent 64 surgical procedures were included in the study. The mean age of the cohort was 7.48 ± 5.5 years. High-grade hydronephrosis was present in 40.6% of patients, and multiple stones were detected in 33.9% preoperatively. Residual stones were observed in 43.7% of patients in the early postoperative period, while the final stone-free rate was 64.1%. A trend toward a higher residual stone rate was observed in patients with stone density ≥ 700 HU (p = 0.10). Although the use of a ureteral access sheath appeared to reduce the need for additional intraoperative procedures, it did not significantly improve stone-free rates (p = 1.00). Ureteral access sheath placement was significantly more common in patients aged ≥ 5 years (p = 0.021). Postoperative febrile urinary tract infection occurred more frequently in patients younger than 5 years of age (p = 0.025). CONCLUSION: RIRS is a feasible and effective treatment option for pediatric urolithiasis, providing acceptable stone-free rates with low complication rates. However, special attention should be paid to postoperative febrile urinary tract infections, particularly in patients younger than 5 years.
Allergic diseases are more common in children with congenital surgical anomalies or necrotizing enterocolitis compared to the general population.
Tanaka R, Farjam G, Doi T … +2 more , Lum Min SA, Keijzer R
Pediatr Surg Int · 2026 Apr · PMID 41954767 · Publisher ↗
PURPOSE: This study aimed to assess whether a history of congenital surgical anomaly (CSA) or necrotizing enterocolitis (NEC) increased the prevalence of allergic diseases. METHODS: We performed a retrospective study of...
PURPOSE: This study aimed to assess whether a history of congenital surgical anomaly (CSA) or necrotizing enterocolitis (NEC) increased the prevalence of allergic diseases. METHODS: We performed a retrospective study of children with CSA or NEC from 1991 to 2022. We calculated odds ratios (ORs) of rhinitis, dermatitis, asthma, food and drug allergy, conjunctivitis, urticaria and allergic gastroenteritis identified by ICD-9-CM and ICD-10-CA codes in cases versus date-of-birth matched controls. RESULTS: We identified a total of 1168 cases and 11,648 controls. Asthma (OR = 1.62, p < 0.01) and allergic gastroenteritis (OR = 6.66, p < 0.01) were more common in all cases compared to all controls. We compared each surgical anomaly separately: asthma prevalence was higher in esophageal atresia (OR = 3.62, p < 0.01) and NEC cases (OR = 2.69, p < 0.01), while allergic gastroenteritis was higher in congenital diaphragmatic hernia (OR = 13.35, p = 0.04), gastroschisis (OR = 25.91, p = 0.02), Hirschsprung disease (OR = 43.64, p < 0.01), intestinal atresia (OR = 8.86, p = 0.03) and NEC cases (OR = 10.34, p = 0.01). CONCLUSION: We demonstrated that congenital surgical anomaly patients have a higher risk of asthma and allergic gastroenteritis than the general population. Individual congenital surgical anomalies have specific increased prevalence of certain allergic diseases. Early detection and personalized management of these allergic diseases may reduce long-term incidence and improve treatment.
The Impact of Body Mass Index and Presenting Institution on Diagnostic Imaging for Children Undergoing Appendectomy.
Katz OL, Wu J, Coakley BA
Pediatr Surg Int · 2026 Apr · PMID 41954750 · Publisher ↗
PURPOSE: Children with excess weight experience disparities in healthcare delivery. We sought to investigate whether pediatric obesity is associated with differences in appendicitis workup and whether these vary by prese...
PURPOSE: Children with excess weight experience disparities in healthcare delivery. We sought to investigate whether pediatric obesity is associated with differences in appendicitis workup and whether these vary by presenting institution. METHODS: The American College of Surgeons National Surgical Quality Improvement Program-Pediatrics (NSQIP-P) database was retrospectively surveyed for patients undergoing appendectomy from 2018 to 2022. Patients < 2 or > 18 years, non-binary sex, missing body mass index (BMI) data, or those with biologically implausible BMI percentiles were excluded. 72,749 patients met the inclusion criteria. Multivariate regression analysis was performed to assess the effect of BMI category and presenting institution on preoperative imaging. RESULTS: Children with excess weight are more likely to undergo CT (overweight: aOR 1.23[95%CI 1.17–1.28], obese: 1.61[1.54–1.69], severely obese: 2.41[2.27–2.57]) and less likely to undergo ultrasound (overweight: 0.82[0.78–0.86], obese 0.66[0.63–0.70], severely obese: 0.47[0.44–0.50]). There is a significant interaction between BMI category and presenting institution (CT: p < 0.0001, ultrasound: p = 0.0013), with a more pronounced relationship seen at NSQIP-P institutions. CONCLUSIONS: Diagnostic evaluation for pediatric appendicitis varies by BMI category and presenting institution. Children with excess weight, particularly those presenting to non-NSQIP-P institutions, are more likely to undergo CT and less likely to receive ultrasound, increasing risk for long-term negative health consequences.
Preterm delivery promotes a high primary reduction in simple gastroschisis and the exit-like technique may improve the outcomes.
Ammann R, Moreno A, Elton A … +3 more , Gloria Ibáñez C, López V, Montedonico S
Pediatr Surg Int · 2026 Apr · PMID 41954742 · Publisher ↗
PURPOSE: The aim of this study was to analyze the rate of primary closure and to compare the post-operative results of the classic technique with the exit-like technique in preterm newborns with simple gastroschisis. MET...
PURPOSE: The aim of this study was to analyze the rate of primary closure and to compare the post-operative results of the classic technique with the exit-like technique in preterm newborns with simple gastroschisis. METHODS: Observational, analytical, retrospective cohort study including patients diagnosed with simple gastroschisis that were divided into: Group I: preterm newborns undergoing primary closure and Group II: preterm newborns undergoing an exit-like surgical treatment. MAIN RESULTS: A total of 58 patients were included. 55/58 (95%) had a primary closure. The median days on mechanical ventilation was three days for group I and one day for group II (p < 0.001). The duration of parenteral nutrition was 19,7±9.9 days and 18.4±7.2 days for groups I and II respectively (p = ns). The time to full enteral feeding was 23 ± 9,9 days and 18,9 ± 5.8 days for groups I and II respectively (p = 0,02). The length of hospital stay was 28 ± 11 days in group I and 24± 8 days in group II (p = ns). The complication rate was similar in both groups. CONCLUSIONS: Preterm delivery resulted in a high rate of primary closure. The exit-like technique avoids endotracheal intubation, general anesthesia, mechanical ventilation and shortens the time to full enteral feeding in simple gastroschisis.
Genital and urinary tract malformations, associated morbidity, and need for urogenital surgery among children with esophageal atresia: a retrospective cohort study.
Svensson E, Eriksson F, Hagander L … +3 more , Omling E, Ellebæk MB, Salö M
Pediatr Surg Int · 2026 Apr · PMID 41954661 · Full text
PURPOSE: Genital malformations are increasingly recognized when a VACTERL is present, but remain insufficiently described in children with esophageal atresia (EA). This study aimed to determine the prevalence and spectru...
PURPOSE: Genital malformations are increasingly recognized when a VACTERL is present, but remain insufficiently described in children with esophageal atresia (EA). This study aimed to determine the prevalence and spectrum of genital and urinary tract malformations in children with EA, and to describe associated morbidity, need for additional surgery, and association with Gross classification. METHODS: Retrospective cohort study including all children undergoing surgery for EA at a tertiary center of pediatric surgery between 2012-2023. Children deceased within five days of birth were excluded. Data were collected from medical records and analyzed using Chi and Fisher's exact tests. RESULTS: Ninety-three children were included. Genital and urinary tract malformations occurred in 12 (12.9%) and 18 (19.4%) children. In children with a VACTERL association, the prevalence was 29% (9/31) and 51.6% (16/31), respectively. Urinary tract infections, neurogenic bladder, and intermittent catheterization were more common in children with a genital or urinary tract malformation. Additional urogenital surgery was required in 50% of affected children. There was no significant association with Gross classification. CONCLUSION: Genital and urinary tract malformations are common in EA, contributing to morbidity and need for additional surgery. Screening for genital malformations should be considered, especially when a VACTERL association is present.
Analysis of neuromuscular blockade use and prognosis in resuscitation of isolated congenital diaphragmatic hernia: data from Japanese CDH Study Group.
Yokoi A, Ohfuji S, Terui K … +15 more , Nagata K, Sato Y, Maruyama H, Toyoshima K, Sato Y, Yamoto M, Kim K, Masumoto K, Okazaki T, Inamura N, Koike Y, Yazaki Y, Kawaguchi Y, Okuyama H, Usui N
Pediatr Surg Int · 2026 Apr · PMID 41954655 · Publisher ↗
PURPOSE: Neuromuscular blocking agents (NMBAs) may reduce lung compliance and affect long-term outcomes in congenital diaphragmatic hernia (CDH). This study investigated the association between NMBA use during CDH resusc...
PURPOSE: Neuromuscular blocking agents (NMBAs) may reduce lung compliance and affect long-term outcomes in congenital diaphragmatic hernia (CDH). This study investigated the association between NMBA use during CDH resuscitation and outcomes, including neurodevelopmental impairment (NDI) and sensorineural hearing loss (SNHL). METHODS: We retrospectively analyzed 438 isolated CDH cases from the Japanese CDH Study Group registry (2006–2021), comparing those who received NMBAs at 5 min post-birth with those who did not. Outcomes included mortality, hospital stay, weaning from ventilation, NDI, and SNHL at discharge and at 1.5, 3, and 6 years. Cox proportional hazards models assessed prognosis in prenatally classified mild and moderate-to-extreme groups. RESULTS: NMBA recipients (n = 138) had more severe prenatal findings, higher 5-min intubation rates, greater early oxygenation index, and longer hospital stays (55 vs. 46 days, p < 0.01). Mortality was higher but not significant (19% vs. 13%, p = 0.09). Adjusted hazard ratios for NDI and SNHL showed no significant associations overall or by severity group. CONCLUSIONS: NMBA use in CDH resuscitation was not significantly associated with mortality, NDI, or SNHL. Further studies evaluating NMBA duration and cumulative exposure are needed to clarify its potential impact on outcomes.
Lobectomy vs. sublobar resection for congenital pulmonary airway malformations: a 10-year NSQIP-pediatric review.
Harvey CJ, Underhill J, Lee PM … +5 more , Waldron B, Puapong D, Johnson S, Woo RK, Tabak B
Pediatr Surg Int · 2026 Apr · PMID 41945161 · Publisher ↗
PURPOSE: To directly compare clinical outcomes associated with lobectomy versus sublobar resections (segmentectomy or wedge resection) for pediatric congenital pulmonary airway malformations (CPAMs). METHODS: A retrospec...
PURPOSE: To directly compare clinical outcomes associated with lobectomy versus sublobar resections (segmentectomy or wedge resection) for pediatric congenital pulmonary airway malformations (CPAMs). METHODS: A retrospective review of the National Surgical Quality Improvement Program-Pediatrics (NSQIP-P) was conducted from 2014 to 2023 to identify patients with CPAMs who underwent sublobar resection or lobectomy. Outcomes included operative time, 30-day mortality, and postoperative complication rates. RESULTS: Lobectomy (n = 1,865; 88%) was performed far more often than sublobar resection (n = 245; 12%) (p < 0.0001). Children who underwent sublobar resection were 8.5 months older (mean age 25.0 vs. 16.5 months) (p < 0.01) and larger by 2.1 kg (mean weight 12.3 vs. 10.2 kg) (p < 0.05) on average. There was no difference in mortality (0.4% sublobar vs. 0.1% lobectomy) (p = 0.31). Segmentectomy was associated with significantly fewer 30-day complications compared to lobectomy (OR 0.08, p < 0.0001), primarily due to a decreased rate of postoperative blood transfusion (OR 0.12, p < 0.01). Sublobar resections had shorter operative times compared to lobectomy (133.6 ± 82.7 vs. 191.2 ± 85.9 min) (p < 0.0001). VATS was utilized more often than open surgery for both lobectomy (57.8%) and sublobar resections (54.7%) and was associated with lower 30-day complication rates (OR 0.58, p < 0.01) and total hospital length of stay (-1.48 days, p < 0.0001) after lobectomy. CONCLUSION: Lobectomy is performed far more often than sublobar resection for the treatment of CPAMs in the United States. Sublobar resection is associated with shorter operative time. Anatomic sublobar resection (segmentectomy) is associated with decreased 30-day complication rates.
Machine learning-based prediction model for risk factors associated with conversion to open surgery in pediatric laparoscopic radical resection of choledochal cysts.
Wang Y, Wu X, Xu T … +3 more , Liu J, Lv Z, Ye G
Pediatr Surg Int · 2026 Apr · PMID 41928017 · Publisher ↗
OBJECTIVE: To identify risk factors for conversion to open surgery during laparoscopic choledochal cyst excision in pediatric patients and develop a predictive model using machine learning. METHODS: We retrospectively an...
OBJECTIVE: To identify risk factors for conversion to open surgery during laparoscopic choledochal cyst excision in pediatric patients and develop a predictive model using machine learning. METHODS: We retrospectively analyzed 214 children who underwent laparoscopic excision between 2015 and 2023. Patients were classified into laparoscopic (n = 173) or conversion (n = 41) groups. Seven machine learning models were developed and evaluated using AUC and decision curve analysis (DCA). SHAP analysis identified top predictors, which were validated via multivariable logistic regression. A nomogram was constructed and internally validated for discrimination, calibration, and clinical utility. RESULTS: GBM performed best (AUC = 0.897) with the highest net benefit on DCA. SHAP highlighted age, cyst wall thickening (≥ 3 mm), obstructive jaundice, cyst diameter, ALT, and history of perforation. Multivariable analysis confirmed age (OR = 1.022, 95% CI 1.01–1.04; P = 0.004), cyst wall thickening (OR = 15.024, 95% CI 5.03–49.48; P < 0.001), and obstructive jaundice (OR = 10.933, 95% CI 2.76–49.28; P = 0.001) as independent predictors. The nomogram achieved a C-index of 0.843 (95% CI 0.814–0.872), showed good calibration (P = 0.318), and demonstrated consistent performance in cross-validation and DCA. The optimal age cutoff was 27.5 months. CONCLUSION: Age > 27.5 months, cyst wall thickening, and obstructive jaundice are key predictors of conversion. The nomogram provides a clinically useful tool for preoperative risk stratification, pending external validation.
Technical feasibility should not outweigh long-term outcomes in biliary reconstruction for children.
Kassir R
Pediatr Surg Int · 2026 Apr · PMID 41927966 · Publisher ↗
The choice of biliary reconstruction after excision of choledochal malformations in children should prioritize long-term physiological outcomes over operative convenience. In response to the article by Kanojia et al. on...
The choice of biliary reconstruction after excision of choledochal malformations in children should prioritize long-term physiological outcomes over operative convenience. In response to the article by Kanojia et al. on the management of aberrant bile ducts at the porta hepatis during minimally invasive surgery, we wish to highlight that while hepaticoduodenostomy is technically attractive (particularly with laparoscopic and robotic platforms) evidence suggests it is associated with increased biliary reflux and reflux-related morbidity, especially in cases with complex hilar anatomy requiring multiple ductal anastomoses. In pediatric patients with a long life expectancy, these risks may have significant long-term consequences. We therefore emphasize that Roux-en-Y hepaticojejunostomy should remain the preferred reconstructive option in most children undergoing excision of choledochal malformations.
Reply to: Comment on "Single-staged in vivo co-transplantation of autologous muscular and urothelial micrografts as a composite tissue tube for urogenital reconstruction".
Clausen AG, Juul N, Amoushahi M … +2 more , Willacy O, Fossum M
Pediatr Surg Int · 2026 Apr · PMID 41927945 · Publisher ↗
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Ultrasonographic pouch-perineum distance integrated into the multimodal diagnostic algorithm enables accurate early classification and surgical planning for anorectal malformation: an 11-year two-center study.
Takada S, Uchida H, Hinoki A … +10 more , Shirota C, Makita S, Yasui A, Takimoto A, Kato D, Maeda T, Ishii H, Asai H, Ota K, Tainaka T
Pediatr Surg Int · 2026 Apr · PMID 41927944 · Full text
PURPOSE: Accurate early classification of anorectal malformations (ARM) is essential for selecting the initial surgical strategy. This study evaluated the diagnostic performance of ultrasonographic pouch-perineum distanc...
PURPOSE: Accurate early classification of anorectal malformations (ARM) is essential for selecting the initial surgical strategy. This study evaluated the diagnostic performance of ultrasonographic pouch-perineum distance (PPD) measurement within a multimodal diagnostic algorithm for early ARM classification. METHODS: This two-center retrospective study included 156 patients with ARM who underwent definitive surgery between 2014 and 2024. The algorithm incorporated physical examination, meconium passage assessment, contrast imaging, and ultrasonographic PPD measurement. PPD was evaluated in patients without visible perineal fistulas. Final diagnosis was confirmed by contrast studies and intraoperative findings. RESULTS: The algorithm correctly classified ARM types in 155 of 156 patients (99.4%). Ultrasonographic PPD measurement was performed in 51 patients without visible perineal fistulas. In this subgroup, median PPD was significantly lower in L-ARM than in NL-ARM (6.5 vs. 15.0 mm, p < 0.001). ROC analysis showed excellent discrimination by PPD (AUC = 0.97); a 10-mm cutoff yielded 95.5% sensitivity and 89.7% specificity for distinguishing L-ARM from NL-ARM. CONCLUSION: Ultrasonographic PPD measurement is a useful adjunct in the early evaluation of neonatal ARM. When incorporated into a multimodal diagnostic algorithm, it can support classification in patients without visible perineal fistulas and may help guide timely surgical decision-making in selected cases.
Comment on: "Surgical resection of giant hepatoblastoma involving second and third hepatic portals" by Zhen et al.
Fuchs J, Branchereau S
Pediatr Surg Int · 2026 Apr · PMID 41927933 · Publisher ↗
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Pilonidal pit fibroblasts release cytokines that differ by sex and are altered by estrogen.
Chiu B, Flores-Galvez KO, Jo S … +1 more , Abrajano C
Pediatr Surg Int · 2026 Apr · PMID 41927853 · Publisher ↗
PURPOSE: Female pilonidal patients have higher pain scores than males. Pain is often at gluteal cleft pit, which consists of fibroblasts. Skin fibroblasts can express estrogen receptors that secrete cytokines. We hypothe...
PURPOSE: Female pilonidal patients have higher pain scores than males. Pain is often at gluteal cleft pit, which consists of fibroblasts. Skin fibroblasts can express estrogen receptors that secrete cytokines. We hypothesize that estrogen receptor binding on pilonidal pit fibroblast can release cytokines, resulting in pain. METHOD: Pilonidal pits were cultured. Triplicate fibroblast cultures in hormone-free media were treated with β-estradiol or control before media was collected and analyzed for 48 cytokines. Percentage change of cytokine level after estrogen was compared to those from control using Mann-Whitney test. RESULTS: Eight fibroblast cultures (4-males, 4-females) were established. Prior to estrogen, fibroblasts secreted eotaxin/CCL11, GROa, IL6, IL8/CXCL8, IL10/CXCL10, MCP-1/CCL2, VEGF-A. For males, estrogen on average changed eotaxin/CCL11 by 65%±73% compared to control, GROa 19%±17%, IL6 -2.0%±7.2%, IL8/CXCL8 56%±15%, IL10/CXCL10 7.9%±24%, MCP-1/CCL2 9.7%±8.5%, VEGF-A 9.9%±14%. For females, estrogen changed eotaxin/CCL11 by -2.0%±11% compared to control, GROa 22%±48%, IL6 90%±116%, IL8/CXCL8 5.3%±24%, IL10/CXCL10 -1.4%±4.1%, MCP-1/CCL2 18%±44%, VEGF-A -1.6%±10%. After estrogen stimulation, female fibroblasts increased IL6 and decreased eotaxin/CCL11 and IL8/CXCL8 secretion compared to males (p≤0.05). CONCLUSION: Pilonidal pit fibroblasts released cytokines which could contribute to pain symptoms. Estrogen increases IL6 release from female fibroblasts, providing a potential mechanism for females having higher pain intensity than males.
Pediatric semirigid ureteroscopy: instrument size matters.
Ograk H, Hizarci R, Çıtamak B … +3 more , Horozcu H, Tekgül S, Doğan HS
Pediatr Surg Int · 2026 Apr · PMID 41927797 · Publisher ↗
The aim of this study is to analyse the efficacy (stone free rate), safety (complication rates) and associated independent predictive factors (age, stone location, stone size, pre-stenting etc.) of semi-rigid URS in the...
The aim of this study is to analyse the efficacy (stone free rate), safety (complication rates) and associated independent predictive factors (age, stone location, stone size, pre-stenting etc.) of semi-rigid URS in the paediatric population. In this study, 243 ureterorenoscopy (URS) operations performed in 238 renal units in a single centre between 2001 and 2023 were retrospectively examined. Age, sex, whether a procedure was performed before or after the surgery, whether DJ stent was placed preoperatively or postoperatively, stone size, number and location, size of the instrument used, lithotripsy method, postoperative stone-free rate and complications were examined as variables. 243 patients were included. The mean age at operation was 71.6 months (7–204). Most of the patients had distal 1/3 ureter stones (70%) and a single stone (n = 190, 78.2%). The median number of stones and stone size were 1.42 and 7.58 mm (ranged 1-22 mm) respectively. SFR at single session was 87.7%. Stone location (SFR of 90.5% in distal, 71.4% in proximal stones) and stone multiplicity (SFR of 90% in single, 79.2% in multiple) were the only factors affecting the success rate in univariate analysis, yet no factors were statistically significant in multivariate analysis. Intraoperative complication (all ureteral perforations) rate was 2.05% (n = 5) and postoperative complication (all pyelonephritis) rate was 4.5% (n = 11). Stone multiplicity is the only independent predictive factor for intraoperative complications with higher complication rates in multiple stones(p = 0.037), but it is not statistically significant in multivariate analysis. Stone location and instrument size (4.5F vs 8F) were the only factors significantly associated with postoperative complication rates. Semi-rigid URS is an effective and safe procedure in paediatric population. Stone location and size of the instrument are the main factors affecting the postoperative and total complication rate. Despite semi-rigid URS can technically be used in any ureteral stones, yet flexible URS should be considered due to increased risk of complications and decreased SFR in proximal stones. To minimize the complication rates, choosing appropriate size of the instrument is essential.
Unmasking the challenges: a qualitative study of barriers to training pediatric surgeons for minimally invasive surgery in Pakistan.
Fatima B, Auqil Z, Zafar Z … +3 more , Waheed MR, Bashir MK, Mujahid MUF
Pediatr Surg Int · 2026 Apr · PMID 41927753 · Publisher ↗
PURPOSE: The primary objective of this study was to explore the obstacles faced by both trainees and trainers in acquiring and teaching MIS skills. Through the identification of gaps between global advancements and local...
PURPOSE: The primary objective of this study was to explore the obstacles faced by both trainees and trainers in acquiring and teaching MIS skills. Through the identification of gaps between global advancements and local practice, this study aims to provide insights into enhancing pediatric surgical care in Pakistan. METHODS: This is a phenomenological qualitative study using semi-structured interviews conducted over a period of six months from March 2025 to August 2025, with approval from the institutional review board of King Edward Medical University. Braun and Clarke's six-step process of thematic analysis was followed. RESULTS: The participants consisted of seven expert-level pediatric surgeons performing minimally invasive procedures, with a mean experience of 17.5 years, and five young consultants in the early stages of MIS training. The key themes identified were outdated equipment and infrastructure, a shortage of trained mentors, gaps in institutional policies, and an overall limited willingness to learn and address ethical concerns. CONCLUSION: Pakistan, like other LMICs, lags in pediatric MIS. To keep up with the pace of integration and development of pediatric MIS, these barriers need to be addressed at the earliest by government support and funding for policy restructuring, equipment provision, scholarships, exchange programs, and quality control.
Investigation of ELF5, KIF18A, NPTX1 and COL23A1 genes in the pathophysiology of indirect inguinal hernia in children.
Genc E, Tartar T, Onalan E … +4 more , Bakal U, Sarac M, Kaymaz T, Kazez A
Pediatr Surg Int · 2026 Apr · PMID 41925903 · Full text
PURPOSE: In this study, we investigated the effect of ELF5, KIF18A, NPTX1 and COL23A1 genes in residual processus vaginalis (PV) the main factor in the development of indirect inguinal hernia (IIH) in children. METHODS:...
PURPOSE: In this study, we investigated the effect of ELF5, KIF18A, NPTX1 and COL23A1 genes in residual processus vaginalis (PV) the main factor in the development of indirect inguinal hernia (IIH) in children. METHODS: Cases operated for IIH in children aged 0–18 years between 2018 and 2021 constituted the study group, and cases with undescended testis without hernia the control group. Protein levels of KIF18A, which has the highest gene expression in tissue samples, were also analyzed by ELISA method. Polymorphisms of ELF5, KIF18A and COL23A1 genes with the highest level of expression change in blood and tissue samples were analyzed by qRT-PCR. Statistical analysis was performed. RESULTS: There were 186 patients in the study group and 26 patients in the control group. The results of ELF5, KIF18A and COL23A1 genes were significantly higher in the study group than in the control group. There was a statistically significant positive correlation between GAPDH and ELF5, KIF18A and NPTX1 in the study group. Also, a statistically significant positive correlation was found between KIF18A and ELF5 and between NPTX1 and ELF5 and COL23A1. CONCLUSION: The present study may be the first study conducted in human tissue samples that we could access in the literature in terms of the genetic factors. It was predicted that ELF5, KIF18A and COL23A1 genes may be counted among the effective factors in PV closure. This study may shed light on larger prospective genetic studies.
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