Pediatr. Surg. Int. [JOURNAL]
Sun
200 papers
A scoring model based on risk factors for prediction of intussusception recurrence in pediatric patients.
Yan J, Xie S, Guo W … +8 more , Liu X, Ma X, Cai Q, Shen X, Wang J, Tuo W, Yuan C, Yao C
Pediatr Surg Int · 2026 Apr · PMID 41925745 · Full text
PURPOSE: This study aimed to identify risk factors for recurrent intussusception in children and establish a recurrence prediction model based on follow-up data. METHODS: A retrospective analysis was performed on pediatr...
PURPOSE: This study aimed to identify risk factors for recurrent intussusception in children and establish a recurrence prediction model based on follow-up data. METHODS: A retrospective analysis was performed on pediatric patients with intussusception who underwent air enema in our hospital from 2014 to 2019. Regression analysis was used to screen for recurrence-associated risk factors, and their hazard ratios (HR) were utilized to construct the prediction model. RESULTS: A total of 91 recurrent cases and 182 non-recurrent controls were enrolled. Hematochezia, fever, anti-inflammatory treatment, red blood cell distribution width coefficient of variation (RDW-CV), and thrombin time (TT) were confirmed as independent risk factors. The model showed a sensitivity of 72.5%, specificity of 83%, and an area under the curve (AUC) of 0.84. Children with early hematochezia (complicated with fever/anti-inflammatory exposure), RDW-CV ≥ 15.8, or TT ≥ 18.5s were categorized as high-risk for recurrence. CONCLUSION: Hematochezia, fever, anti-inflammatory treatment, RDW-CV, and TT are independent predictors of pediatric intussusception recurrence. The constructed model has favorable predictive performance and clinical utility.
Risk factors for recurrence following surgical treatment of pediatric hepatic hydatid disease.
Zouari M, Belhajmansour M, Hbaieb M … +5 more , Laadhar M, Issaoui A, Jarboui O, Dhaou MB, Mhiri R
Pediatr Surg Int · 2026 Apr · PMID 41925739 · Publisher ↗
BACKGROUND: Postoperative recurrence remains a major challenge following surgical treatment of pediatric hepatic hydatid disease, particularly in endemic regions. The aim of this study was to identify predictors of posto...
BACKGROUND: Postoperative recurrence remains a major challenge following surgical treatment of pediatric hepatic hydatid disease, particularly in endemic regions. The aim of this study was to identify predictors of postoperative recurrence in children undergoing surgery for hepatic hydatid disease. METHODS: This retrospective observational cohort study included consecutive children who underwent surgical treatment for hepatic hydatid disease between 1 January 2010 and 31 December 2024. Postoperative recurrence was defined as the appearance of new hydatid cysts in the liver or abdominal cavity during follow-up after an initial disease-free period. RESULTS: A total of 115 children were included, with a median age of 8 years and a nearly equal sex distribution. Postoperative recurrence occurred in 21 patients (18.3%) after a mean interval of 3.1 ± 1 years. Recurrence was hepatic, intraperitoneal, or combined. In univariate analysis, preoperative fever, elevated eosinophil count, prolonged operative duration, and omentoplasty were associated with recurrence. In multivariate analysis, two factors emerged as independent predictors: peripheral blood eosinophil count > 1 × 10⁹/L (OR 11.94, 95% CI 2.86-49.83; p = 0.001) and operative duration > 150 min (OR 7.29, 95% CI 1.66-31.96; p = 0.008). CONCLUSION: Recurrence after pediatric hepatic hydatid surgery remains frequent. Beyond operative duration, eosinophilia emerges as a novel and independent predictor of recurrence, suggesting a potential role for biological markers in perioperative risk stratification and long-term follow-up.
Video-assisted thoracoscopic blebotomy for spontaneous pneumothorax treatment using the no-knife endoscopic stapler.
Kim S, Grisotti G, Idowu O
Pediatr Surg Int · 2026 Mar · PMID 41882149 · Full text
BACKGROUND: A standard treatment for pneumothorax due to bleb rupture is thoracoscopic blebectomy, often combined with pleurodesis to reduce recurrence risk. However, pleurodesis can cause significant postoperative pain....
BACKGROUND: A standard treatment for pneumothorax due to bleb rupture is thoracoscopic blebectomy, often combined with pleurodesis to reduce recurrence risk. However, pleurodesis can cause significant postoperative pain. This study evaluates the efficacy of the no-knife endoscopic stapler blebotomy without pleurodesis using video-assisted thoracoscopic surgery (VATS) for spontaneous pneumothorax. METHODS: We conducted a retrospective chart review of patients treated with no-knife endoscopic stapler blebotomy for spontaneous pneumothorax at UCSF Benioff Children’s Hospital Oakland from 2020 to 2024. The procedure involved using the no-knife endoscopic stapler for blebotomy without performing pleurodesis. Post-procedure air leaks were monitored with a chest tube. We analyzed postoperative chest tube duration, pain levels, and recurrence rates. RESULTS: The study included eight male patients with a median age of 17 (range 15-19). Apical blebs were identified thoracoscopically in all patients and stapled off using the no-knife stapler. No intraoperative or postoperative complications occurred. The median postoperative chest tube duration was 2 days (range 1-3). The mean pain score on postoperative day 1 was 1.3 (range 0-10). Over a median follow-up of 24 months (range 6-36), no pneumothorax recurrence was observed. CONCLUSION: No-knife endoscopic stapler thoracoscopic blebotomy is a safe and effective procedure. Avoiding pleurodesis reduces postoperative pain and morbidity. LEVEL OF EVIDENCE: Level 4, Observational study.
Efficacy of lobectomy versus segmentectomy for congenital lung malformations: a systematic review and meta-analysis.
Mohamed SF, Abouegla M, Abouzeid M … +5 more , Aljaradi A, Shahin A, Taha A, Eltaieb M, Askar A
Pediatr Surg Int · 2026 Mar · PMID 41879907 · Full text
BACKGROUND: Congenital lung malformations (CLMs) are uncommon anomalies characterized by a broad clinical spectrum, from asymptomatic cases to severe respiratory distress. Surgical resection is often indicated; neverthel...
BACKGROUND: Congenital lung malformations (CLMs) are uncommon anomalies characterized by a broad clinical spectrum, from asymptomatic cases to severe respiratory distress. Surgical resection is often indicated; nevertheless, the optimal extent of resection is still debated, especially regarding lobectomy versus lung-sparing segmentectomy. OBJECTIVE: This systematic review and meta-analysis aimed to compare the efficacy and safety of lobectomy versus segmentectomy in pediatric patients with CLMs. METHODS: We searched databases, including PubMed, Scopus, Web of Science, and Cochrane, to identify papers comparing lobectomy with segmentectomy in pediatric patients with CLMs. The main outcome was the duration of hospital stay (LOS). Secondary outcomes included operative time, chest tube removal duration, pulmonary function indices, and postoperative complications. Random-effects meta-analyses were applied. RESULTS: Nine retrospective observational studies involving infants and children were included. Meta-analysis showed no significant difference in LOS between lobectomy and segmentectomy (MD - 0.20, 95% CI - 0.83 to 0.44; p = 0.547). Operative time was significantly shorter with lobectomy (MD - 18.45, 95% CI - 27.21 to - 9.68; p < 0.0001). Chest tube removal time did not differ significantly between groups. Across all pulmonary function outcomes, no statistically significant differences were observed. Overall postoperative complications were similar between procedures (OR 0.96, 95% CI 0.58-1.61; p = 0.883). CONCLUSIONS: Lobectomy and segmentectomy demonstrate no differences in hospital duration, complications, or pulmonary function; nevertheless, lobectomy provides a shorter surgical time and diminished early air leakage without affecting overall postoperative results. High-quality, prospective studies are essential for clarifying long-term outcomes to improve surgical decision-making.
Long-term efficacy and learning curves of Cohen and modified Glenn-Anderson pneumovesicoscopic ureteral reimplantation for primary obstructive megaureter: a retrospective cohort study with meta-analysis.
Pan H, Wang R, Jiang M … +7 more , Li S, Kong X, Liu J, Liu X, Lin T, Wei G, He D
Pediatr Surg Int · 2026 Mar · PMID 41879891 · Publisher ↗
OBJECTIVE: To compare the long-term efficacy and safety of Cohen versus modified Glenn-Anderson pneumovesicoscopic ureteral reimplantation and to define the learning curves for both procedures. METHODS: A single-center r...
OBJECTIVE: To compare the long-term efficacy and safety of Cohen versus modified Glenn-Anderson pneumovesicoscopic ureteral reimplantation and to define the learning curves for both procedures. METHODS: A single-center retrospective cohort study (2007-2021) included 75 children with primary obstructive megaureter (POM) (Cohen: n = 27; modified Glenn-Anderson: n = 48). Primary outcomes were reoperation rates and ureteral recovery (diameter < 7 mm) during long-term follow-up. Cumulative sum (CUSUM) analysis was used to model learning curves based on operative time. A meta-analysis of 10 studies (529 patients) established a benchmark success rate. RESULTS: After a mean follow-up of 99.0 (Cohen) and 75.7 (modified Glenn-Anderson) months, reoperation-free rates were 92.6% and 95.8%, respectively (P > 0.05), with no significant differences in complication rates or functional improvement. CUSUM analysis indicated a learning phase of 22 cases for Cohen and 19 cases for modified Glenn-Anderson, with operative time decreasing by over 30% upon mastery. The meta-analysis yielded a pooled reoperation-free rate of 99.4%. CONCLUSIONS: Both techniques demonstrate comparable long-term safety and efficacy for POM. The modified Glenn-Anderson technique offers a valid alternative that preserves the ureter's anatomical course. Achieving procedural proficiency requires approximately 20 cases. While global success rates are high, long-term follow-up is crucial for detecting late complications.
Risk factors and nomogram construction of postoperative complications of hepatic cystic echinococcosis in children and surgical treatment selection.
Yonten S, Tan X, Wang J … +12 more , Panden, Kinzi T, Lhamo T, Yangzom S, Dondan, Pan S, Huang L, Zhang W, Zheng C, Liao J, Tsering P, Zhao Y
Pediatr Surg Int · 2026 Mar · PMID 41865362 · Publisher ↗
OBJECTIVE: To explore the independent risk factors for postoperative complications in children undergoing radical surgery for hepatic cystic echinococcosis (HCE), thereby optimizing surgical strategies and perioperative...
OBJECTIVE: To explore the independent risk factors for postoperative complications in children undergoing radical surgery for hepatic cystic echinococcosis (HCE), thereby optimizing surgical strategies and perioperative management. METHOD: A retrospective study was conducted on 36 children with HCE admitted to Lhasa People’s Hospital between January 2018 and January 2024. Based on the occurrence of complications, patients were divided into groups. Preoperative clinical and imaging data were analyzed using univariate and multivariate logistic regression to identify independent risk factors, and a predictive nomogram was developed. RESULT: 47.2% of the children chose excision of hepatic hydatid internal capsule, and 33.3% chose modified radical resection. Multivariate analysis revealed that cyst area per unit weight was an independent predictor of postoperative complications in children with HCE (p < 0.05). ROC curve analysis indicated that when the cyst area per unit body weight and the number of involved liver segments jointly predicted complications, the AUC was 0.853. CONCLUSION: The established preoperative risk assessment model effectively identifies high-risk pediatric patients, facilitating tailored surgical planning and perioperative interventions. For children with HCE in remote regions, internal capsule excision or modified radical resection remain viable and appropriate surgical treatment options.
"It's a journey": Psychosocial perspectives on parenting a young child with esophageal atresia.
Cole L, Micalizzi R, Bennett J … +10 more , Woods K, Cardoni L, Frain L, Mohamed A, Yasuda J, Ngo P, Widenmann A, Slater G, Zendejas B, Dellenmark-Blom M
Pediatr Surg Int · 2026 Mar · PMID 41865350 · Publisher ↗
BACKGROUND: Esophageal atresia (EA) is a rare congenital condition often accompanied by lifelong medical challenges. The complex and ongoing needs of children with EA place substantial demands on their parents. The purpo...
BACKGROUND: Esophageal atresia (EA) is a rare congenital condition often accompanied by lifelong medical challenges. The complex and ongoing needs of children with EA place substantial demands on their parents. The purpose of this study was to explore the psychosocial experiences of parents caring for a child with EA during early childhood. METHODS: A qualitative descriptive design was employed involving five focus groups with 22 parents of children aged 0–7 years with EA. Manifest content analysis with an inductive approach was used. Data saturation was achieved across and within groups. RESULTS: Three major categories emerged: 1) A journey that changes over time, capturing the evolving emotional and practical challenges that parents faced; 2) Emotional experiences, highlighting a range of emotional responses navigated by parents and 3) Impact on family and social life, describing the strained family dynamics, altered social interactions, and parents’ feelings of isolation. CONCLUSION: Parenting a young child with EA presents profound emotional and social challenges that extend well beyond the neonatal period. Integrated mental health services, peer support initiatives, and comprehensive, family-centered multidisciplinary care should be considered standard components of EA management, given the profound and lasting impact of the condition on family functioning and well-being.
Developing the research roadmap together: a report from the patient-centered outcome research institute (PCORI) and pediatric surgical oncology research collaborative (PSORC).
Ehrlich PF, Tracy ET, Rich B … +6 more , Lal DR, Lautz TB, Glick RD, Brown EG, Panoch J, Dasgupta R
Pediatr Surg Int · 2026 Mar · PMID 41865349 · Full text
OBJECTIVE: Patient-Centered Outcomes Research (PCOR) and Comparative Effectiveness Research (CER) focusing on pediatric cancer surgery are insufficient. To address this need, the authors aimed to create an evidence-based...
OBJECTIVE: Patient-Centered Outcomes Research (PCOR) and Comparative Effectiveness Research (CER) focusing on pediatric cancer surgery are insufficient. To address this need, the authors aimed to create an evidence-based PCOR agenda for children with solid tumors. METHODS: Between September 2021 and October 2022, the Pediatric Surgical Oncology Research Collaborative (PSORC) advocacy group, composed of 25 physicians and 25 nonmedical patient/parent stakeholders, developed a research agenda culminating in an in-person meeting. Stakeholders included parents of children treated for solid tumors, survivors of childhood cancers, patient advocates, and pediatric oncology (medical and surgical) providers. A multisource five-component framework was used to develop the roadmap: (1) Education, (2) Topic Generation, (3) Gap Analysis and Systematic Review, (4) Value of Information (VOI) Analysis, and (5) Peer Review. Topic generation involved both physician and stakeholder meetings, focus groups, generating a word cloud, and a survey sent to 48 solid tumor disease and advocacy support groups representing over 1000 families. VOI analysis and peer review were conducted in person with 50 participants (25 stakeholders/25 physicians). Descriptive and thematic results are presented. RESULTS: A systematic review identified only a single surgical PCOR report addressing pediatric solid tumors. Gap analysis demonstrated that surgeons’ goals focused primarily on improving surgical outcomes, whereas stakeholders’ concerns centered on surgeon skill/expertise, second opinions, pain, healing, and communication. The word cloud session identified several key issues: lack of family resources, pain, enhanced recovery, and communication. Important thematic PCOR questions from the survey focused on patient/family lack of knowledge, overwhelming predicaments, immediate surgical treatment options, and shared decision-making between families and surgeons. VOI analysis, peer review, and voting inferred that the primary PCOR agenda should aim to develop a question aid for families/caregivers that increases parent knowledge, engagement, and comfort with cancer surgery and tests the impact of shared decision-making for second opinions to increase parent comfort and participation in the child’s cancer treatment. CONCLUSIONS: Surgical PCOR is lacking and needed to enhance interactions between surgeons and patients/families with pediatric solid tumors. There is a significant discrepancy in the topics and prioritization of PCOR between pediatric surgeons and families. Identifying, understanding, and addressing gaps between patients/families and surgeons may lead to a robust patient-informed research agenda.
Machine learning-based prediction of surgical timing and discharge in infantile hypertrophic pyloric stenosis a multimodal predictive approach.
Genisol I, Boztaş AE, Koska İÖ … +1 more , Sencan A
Pediatr Surg Int · 2026 Mar · PMID 41865327 · Publisher ↗
AIM: This study aims to develop and internally validate machine learning models to predict surgical timing and discharge duration in patients with infantile hypertrophic pyloric stenosis (IHPS), using admission clinical,...
AIM: This study aims to develop and internally validate machine learning models to predict surgical timing and discharge duration in patients with infantile hypertrophic pyloric stenosis (IHPS), using admission clinical, biochemical, and ultrasonographic data. MATERIALS AND METHODS: A retrospective analysis was conducted on 55 IHPS cases who underwent pyloromyotomybetween 2015 and 2025. Demographic characteristics, biochemical parameters (blood gas, electrolytes, bilirubin, and urinalysis), and ultrasonographic measurements (pyloric wall thickness, transverse diameter, length, pyloric index [wall thickness/length], and pyloric volume [π/6 × length × diameter²]) were evaluated. Three datasets were constructed to assess different variable combinations: (1) demographic and imaging variables, (2) demographic and laboratory variables, and (3) a combined dataset including all variables. The target outcomes were: (a) surgery performed within 2 days of admission, and (b) discharge within 3 days postoperatively. Class imbalance was addressed using SMOTE and class-weighting strategies. For each algorithm (support vector machine [SVM] and random forest [RF]), four model types were created: standard, SMOTE-enhanced, class weight-adjusted, and ensemble (including extra trees). Models were trained using 4-fold cross-validation repeated 10 times. Performance metrics included F1 score, accuracy, sensitivity, and ROC AUC. Feature selection was performed using the LASSO method to identify the most predictive variables. RESULTS: ROC AUC values ranged between 0.59 and 0.73 across datasets, indicating moderate discrimination. Pyloric wall thickness and arterial blood gas pH emerged as the strongest predictors of early surgery, whereas pyloric transverse diameter and urine specific gravity were most strongly associated with early discharge. CONCLUSION: Machine learning models demonstrated moderate and exploratory predictive performance for early perioperative outcomes in IHPS. These findings should be interpreted as hypothesis-generating rather than decision-guiding and require external validation before clinical implementation.
A national database study of adjuvant steroids following Kasai portoenterostomy for biliary atresia.
Liang NE, Thobani H, Moturu A … +8 more , Suh E, Islam S, Fell GL, Hyun JS, Sylvester KG, Chao SD, Dunn JCY, Khan FA
Pediatr Surg Int · 2026 Mar · PMID 41865321 · Publisher ↗
OBJECTIVE: Adjuvant steroids in the treatment of BA remains controversial. We sought to characterize variations in steroid use and their effect on postoperative outcomes in a multi-institutional cohort of BA patients. ST...
OBJECTIVE: Adjuvant steroids in the treatment of BA remains controversial. We sought to characterize variations in steroid use and their effect on postoperative outcomes in a multi-institutional cohort of BA patients. STUDY DESIGN: PHIS was queried for all patients between 2017 and 2024 who were diagnosed with BA and underwent KPE. Patients who received ≥ 3 contiguous days of steroids within 7 days of KPE were considered to have received postoperative steroids. The primary outcome was native liver survival, calculated using Kaplan-Meier analysis. RESULTS: 504 patients from 37 hospitals with a median age of 52 days (IQR: 35-69 days) met inclusion criteria. 139 patients (28.6%) received adjuvant steroids. The steroid-treated cohort had a significantly longer postoperative LOS (P < 0.001) and high-volume-KPE hospitals were significantly more likely to use adjuvant steroids (P < 0.001). The majority of patients were started on steroids on POD#0. 5 hospitals utilized steroids in > 50% of their patients after KPE. Kaplan-Meier analysis showed no difference in two-year native liver survival. CONCLUSION: In this large multi-institutional cohort study, steroids were used early, with significant intra-hospital variation, and were associated with increased postoperative LOS and higher KPE volume. Larger multi-institutional studies with standardized steroid dosage regimens and extended long-term follow up are needed. LEVEL OF EVIDENCE: III.
Save the ovary: evaluating the diagnostic accuracy of the pediatric risk of malignancy index (PRMI) to prevent unnecessary oophorectomy in girls.
Raza N, Jeve Y
Pediatr Surg Int · 2026 Mar · PMID 41848895 · Publisher ↗
PURPOSE: This study aimed to validate the diagnostic accuracy of the Pediatric Risk of Malignancy Index (PRMI) for distinguishing benign from malignant ovarian lesions in the pediatric and adolescent population, and to m...
PURPOSE: This study aimed to validate the diagnostic accuracy of the Pediatric Risk of Malignancy Index (PRMI) for distinguishing benign from malignant ovarian lesions in the pediatric and adolescent population, and to model its potential role in avoiding unnecessary oophorectomies. METHODS: We conducted a retrospective study of females aged ≤18 years who underwent oophorectomy with histopathology between 2006 and 2016 at a UK tertiary hospital. Only patients with preoperative imaging were included. PRMI scores were retrospectively calculated, with a cut-off ≥7 indicating high malignancy risk. Diagnostic performance was assessed against final histology using standard accuracy measures. RESULTS: Of 265 ovarian specimens, 44 met inclusion criteria; 9 (20.5%) were malignant and 35 (79.5%) benign. PRMI showed a sensitivity of 77.8% (95% CI 45.2-94.4%), specificity 74.3% (95% CI 56.4-86.4%), positive predictive value 43.8%, and negative predictive value 92.9%. Positive and negative likelihood ratios were 3.03 (95% CI 1.45-6.35) and 0.30 (95% CI 0.09-0.99), indicating moderate clinical utility. Notably, 79.5% of oophorectomies were performed for lesions that were ultimately proven benign. If PRMI had been used to guide management, 26/35 (74.3%) benign oophorectomies could potentially have been avoided. CONCLUSION: The PRMI demonstrated moderate accuracy and a high negative predictive value in this cohort, supporting its potential role as an adjunctive tool in preoperative risk stratification of pediatric ovarian masses. Greater emphasis on ovary-sparing strategies is warranted to mitigate long-term reproductive and hormonal consequences in young patients.
Fluorescence-guided laparoscopic hepatectomy with patient-specific 3D virtual reconstruction for pediatric focal nodular hyperplasia: a retrospective study.
Hu X, Qiu Z, Lin Y … +1 more , Lin J
Pediatr Surg Int · 2026 Mar · PMID 41848863 · Publisher ↗
BACKGROUND: Pediatric Focal Nodular Hyperplasia (FNH) presents diagnostic and therapeutic challenges. This study aimed to evaluate the safety and efficacy of a novel integrated approach combining preoperative three-dimen...
BACKGROUND: Pediatric Focal Nodular Hyperplasia (FNH) presents diagnostic and therapeutic challenges. This study aimed to evaluate the safety and efficacy of a novel integrated approach combining preoperative three-dimensional (3D) modeling with intraoperative indocyanine green (ICG) fluorescence navigation for laparoscopic resection of pediatric FNH. METHODS: We retrospectively analyzed a total of 10 pediatric patients with FNH who were included and underwent laparoscopic hepatectomy using this combined technique between June 2023 and August 2024. Preoperative contrast-enhanced CT/MRI data were used to generate patient-specific 3D liver models for surgical planning. Intraoperatively, ICG fluorescence was utilized for real-time lesion demarcation and margin assessment. Perioperative outcomes data were systematically collected and analyzed. RESULTS: All 10 procedures were successfully completed laparoscopically without conversion. Regarding perioperative safety, no major intraoperative complications occurred. Postoperatively, there were no major complications; minor adverse events were limited to transient, self-limiting elevations of liver enzymes. The mean operative time was 168.3 ± 9.5 min, with a mean estimated blood loss of 115.0 ± 20.0 ml. The mean postoperative hospital stay was 10.6 ± 1.3 days. The 3D models combing with ICG fluorescence can precisely delineated tumor margins, facilitating complete R0 resection in all cases. At 3-month follow-up, all patients exhibited normal liver function with no evidence of residual disease or recurrence. CONCLUSION: The integration of 3D virtual modeling and ICG fluorescence navigation is a safe and highly effective strategy for the laparoscopic management of pediatric FNH.
Factors determining the surgical outcomes in infantile hypertrophic pyloric stenosis at Muhimbili National Hospital, Tanzania.
Bakari RA, Mwanga A, Kitua D … +5 more , Kivuyo N, Chibwae A, Brighton M, Salim MS, Kibwana KS
Pediatr Surg Int · 2026 Mar · PMID 41838177 · Publisher ↗
BACKGROUND: Infantile hypertrophic pyloric stenosis (IHPS) is the most common surgical cause of non-bilious vomiting in infants, necessitating timely surgical intervention. Despite established treatment protocols, outcom...
BACKGROUND: Infantile hypertrophic pyloric stenosis (IHPS) is the most common surgical cause of non-bilious vomiting in infants, necessitating timely surgical intervention. Despite established treatment protocols, outcomes vary widely based on clinical and demographic factors. AIM: This study aimed at assessing the factors determining the surgical outcomes in IHPS at Muhimbili National Hospital (MNH). METHODOLOGY: This was a retrospective cohort study of 100 infants with intra-operatively confirmed IHPS who underwent pyloromyotomy between 2015 and 2024. Data on demographics, clinical presentation, biochemical markers, surgical details, complications, and outcomes were analyzed. Chi-square and multivariate logistic regression were applied to determine associations, with p < 0.05 considered statistically significant. RESULTS: IHPS constituted 12.24% of all pediatric laparotomies. The median age was 45 days, with a male to female ratio of 4.3:1. Vomiting (100%), weight loss (17%), and visible gastric peristalsis (21%) were common presentations. Electrolyte imbalances were frequent: hypokalemia (64%), hyponatremia (58%), and hypochloremia (66%). Surgical complications occurred in 30% of infants, with a mortality rate of 6%. Significant factors associated with prolonged hospital stay included preterm birth (AOR = 8.05, p = 0.032) and low hemoglobin (p = 0.040). CONCLUSION: IHPS is a common and surgically manageable condition in infancy. However, preoperative factors such as prematurity and anemia significantly affect outcomes. Strengthening preoperative optimization could improve survival and reduce hospital stay.
Oral gastrografin protocol resolves worm-induced small bowel obstruction in children: a prospective cohort study.
Kabir M, Rahim S, Thalib HI … +3 more , Kabir H, Khan N, Ullah S
Pediatr Surg Int · 2026 Mar · PMID 41838172 · Publisher ↗
BACKGROUND: Worm-induced small bowel obstruction (SBO) is a common pediatric surgical problem in endemic regions, but the role of oral Gastrografin in this setting remains unclear. METHODS: We conducted a prospective coh...
BACKGROUND: Worm-induced small bowel obstruction (SBO) is a common pediatric surgical problem in endemic regions, but the role of oral Gastrografin in this setting remains unclear. METHODS: We conducted a prospective cohort study (December 2022–December 2024) at a single center in Pakistan. Children aged 5–18 years with radiological and clinical evidence of uncomplicated Ascaris-related SBO were included. Exclusions were complicated obstruction, rectal bleeding, hypersensitivity to Gastrografin, or refusal to participate. Participants received either standard conservative management (nil per os, nasogastric decompression, intravenous fluids, antibiotics, enemas, antispasmodics) or the same regimen plus Gastrografin 2 mL/kg via nasogastric tube (diluted 1:1 with saline). The primary outcome was hospital length of stay (LOS). Secondary outcomes were time to oral intake, pain resolution, passage of flatus and stool, laparotomy, and in-hospital complications. RESULTS: One hundred and twenty children were enrolled (60 per group). Baseline characteristics were similar. Gastrografin was associated with a shorter LOS (35 ± 15 vs. 60 ± 15 h; mean difference − 25.0, 95% CI − 30.4 to − 19.6; p < 0.001). Recovery milestones occurred earlier, including oral intake (30.2 ± 6.0 vs. 60.5 ± 15.6 h), pain resolution (14.2 ± 4.5 vs. 45.8 ± 12.4 h), passage of flatus (20.9 ± 9.0 vs. 48.8 ± 12.1 h), and stool (15.9 ± 8.0 vs. 48.8 ± 12.1 h) (all p ≤ 0.002). Laparotomy was infrequent (3/60 vs. 5/60; p > 0.05). No Gastrografin-related adverse events occurred under hydration protocols. CONCLUSIONS: In this cohort, oral Gastrografin as an adjunct to conservative care was associated with faster recovery and shorter hospitalisation without new safety concerns. Multicenter randomized studies are needed to confirm effectiveness and guide standardised protocols.
Flow efficiency of 3D-printed refeeding tubes in a simulated neonatal high-output stoma model.
Han E, Kim DE, Choi WY … +3 more , Go DG, Kim JY, Oh C
Pediatr Surg Int · 2026 Mar · PMID 41838169 · Publisher ↗
PURPOSE: Neonatal enterostomies often cause high-output losses of intestinal contents, leading to malabsorption, growth failure, and dependence on parenteral nutrition. Conventional refeeding relies on intermittent or co...
PURPOSE: Neonatal enterostomies often cause high-output losses of intestinal contents, leading to malabsorption, growth failure, and dependence on parenteral nutrition. Conventional refeeding relies on intermittent or continuous reinfusion and may entail contamination risk and technical difficulties. METHODS: This study introduces an indwelling tube refeeding approach that connects the proximal and distal bowel through a single continuous tube, enabling uninterrupted physiological flow. Using a bench-top in vitro model simulating a neonatal high-output stoma, nine three-dimensional -printed tubes (three diameters × three configurations) were tested at two infusion rates (100 and 50 mL/h). RESULTS: All 90 trials achieved continuous distal outflow without occlusion, confirming technical feasibility. Flow efficiency increased with tube diameter: at 100 mL/h, efficiencies were 95.2 ± 5.2% (9 mm), 62.5 ± 12.3% (7 mm), and 55.5 ± 8.6% (5 mm); a similar pattern was observed at 50 mL/h. Tube configuration and infusion rate had minimal effects on flow efficiency. CONCLUSION: This bench-top study demonstrates the feasibility of an indwelling bridging tube for continuous proximal-to-distal transfer in vitro. Although larger diameters achieved higher flow efficiency, smaller-caliber tubes occupying approximately 40% of the lumen still achieved > 56% efficiency in this model; however, clinical safety and efficacy require further biomechanical and in vivo validation.
Evaluation of surgical outcomes of thoracoscopic esophageal atresia repair with and without preservation of azygos vein: a retrospective cohort study.
Brohi AR, Mengal N, Tabasum P … +7 more , Ali A, Imran H, Preena, Gayatri F, Memon H, Narwani P, Ain Q
Pediatr Surg Int · 2026 Mar · PMID 41838168 · Publisher ↗
BACKGROUND: Esophageal atresia is an incomplete formation of esophagus, resulting in discontinuity between proximal and distal segments. During the surgical repair, whether the azygos vein should be ligated or preserved...
BACKGROUND: Esophageal atresia is an incomplete formation of esophagus, resulting in discontinuity between proximal and distal segments. During the surgical repair, whether the azygos vein should be ligated or preserved is still up for debate. The study aims to compare the postoperative outcomes of esophageal atresia repair with and without preservation of azygos vein. METHODOLOGY: A retrospective cohort study was conducted at the Institute of Mother and Child Centre, Nawabshah, Pakistan, from 2010 to 2023. The study included neonates undergoing repair for esophageal atresia. Demographic, intraoperative, and postoperative data were reported. Comparative analysis was proceeded through an independent T-test/Mann-Whitney U test. Multivariate analysis was employed. Statistical analysis was undertaken using SPSS with significance dictated at p < 0.05. RESULT: Among 200 neonates, patients were segregated into Group A: preservation of azygos vein (n = 67) and Group B: ligation of azygos vein (n = 133). Group A demonstrated lower complication rates than group B. There were 5 (7.5%) vs. 25 (12.5%) cases of anastomotic leaks. (p = 0.034) and 4 (2%) vs. 22 (11%) cases of anastomotic strictures, (p = 0.036) in azygos vein preservation and ligation groups, respectively. However, azygos vein bleeding and mortality did not reach statistical significance. After adjustment for birth weight, gestational age, and congenital anomalies, azygos vein preservation was not independently associated with anastomotic leak. However, preservation was independently associated with reduced anastomotic strictures and lower mortality. CONCLUSION: Preservation of the azygos vein during esophageal atresia repair associated with reduced rate of anastomotic stricture and mortality. Prospective studies with large sample sizes are recommended to validate these findings.
Open versus laparoscopic reduction in the treatment of pediatric intussusception: an updated systematic review and meta-analysis.
Yao X, Lang Y, Chen Q … +2 more , Liu W, Zha S
Pediatr Surg Int · 2026 Mar · PMID 41838167 · Publisher ↗
PURPOSE: This systematic review and meta-analysis aim to compare the effectiveness and safety of laparoscopic reduction (LR) versus open reduction (OR) in the management of intussusception in infants and children. METHOD...
PURPOSE: This systematic review and meta-analysis aim to compare the effectiveness and safety of laparoscopic reduction (LR) versus open reduction (OR) in the management of intussusception in infants and children. METHODS: A comprehensive search of PubMed, Cochrane Library, and Scopus was conducted to identify studies comparing LR and OR for intussusception treatment in infants and children. A total of 15 studies with 1403 patients (595 in the LR group and 808 in the OR group) were included. Primary outcomes, including surgical time, time to oral feeding, hospital stay, bowel resection rates, recurrence rates, and overall complications, were analyzed using meta-analysis techniques. RESULTS: The analysis found no significant difference in surgical time between LR and OR (WMD = 1.19, 95% CI −15.79 to 18.17, P = 0.89), but LR was associated with significantly reduced time to oral feeding (WMD = −1.94, 95% CI −3.22 to −0.66, P = 0.003) and shorter hospital stays (WMD = −1.5, 95% CI −2.33 to −0.67, P = 0.0004). The rates of bowel resection and recurrence were similar between the two groups. LR was also associated with a lower overall rate of postoperative complications, though the difference did not reach statistical significance. CONCLUSIONS: Laparoscopic reduction appears to be at least non-inferior to open surgery, with potential benefits such as earlier oral feeding and shorter hospital stay. However, given the clinical and methodological heterogeneity, these findings should be interpreted cautiously, and further high-quality randomized trials are warranted.
Profiling circular RNAs in amniotic fluid and fetal lungs from congenital diaphragmatic hernia cases: insights into potential prognostic and diagnostic applications.
De Leon NS, Öztürk A, Russo FM … +8 more , Tse WH, McCallum C, Eyrikson B, Qiao J, Patel D, LeDuc R, Deprest JA, Keijzer R
Pediatr Surg Int · 2026 Mar · PMID 41838124 · Publisher ↗
PURPOSE: Circular RNAs (circRNAs), generated by backsplicing, are stable closed-loop RNAs. CircRNAs in amniotic fluid (AF) may serve as diagnostic and prognostic markers for Congenital Diaphragmatic Hernia (CDH). This st...
PURPOSE: Circular RNAs (circRNAs), generated by backsplicing, are stable closed-loop RNAs. CircRNAs in amniotic fluid (AF) may serve as diagnostic and prognostic markers for Congenital Diaphragmatic Hernia (CDH). This study profiled AF circRNAs from CDH pregnancies to explore associations with CDH pathways and survival. METHODS: AF was collected from CDH pregnancies undergoing fetoscopic endoluminal tracheal occlusion (FETO) (n = 8; 4 survivors, 4 non-survivors). CircRNAs were profiled using the Arraystar Human circRNA Array V2. Differential expression was analyzed with limma in R and compared to our previously published data from CDH lungs. Parental genes underwent gene ontology and KEGG analyses, and selected circRNAs were validated by sequencing of backsplice junctions. RESULTS: A total of 10,760 circRNAs were detected in AF, 12,055 in mid-gestation lung, and 10,118 in late-gestation lung. In AF, 514 circRNAs were differentially expressed (False Discovery Rate (FDR) < 0.05) with overlapping circRNAs, including 24 with late-gestation lung and 4 with CDH-related genes. CircFOXP2 (12-19) and circSMARCC1 (16-14) were validated. Parental genes of these differentially expressed AF circRNAs were enriched in specific molecular and signaling pathways. CONCLUSIONS: AF circRNAs distinguish CDH survivors from non-survivors, mapping to genes and pathways critical for development, suggesting their diagnostic and prognostic potential.
Proteomic analysis reveals the pro-proliferative role of the LIN28B/HMGA2 axis in hepatoblastoma.
Shi J, Wu Y, Cheng C … +2 more , Wu Y, Wu Z
Pediatr Surg Int · 2026 Mar · PMID 41817622 · Publisher ↗
BACKGROUND: Hepatoblastoma (HB) is the most common malignant liver tumor in pediatric patients. Even though the 5-year survival rate of HB patients has reached 80%, the prognosis in patients with high-risk features remai...
BACKGROUND: Hepatoblastoma (HB) is the most common malignant liver tumor in pediatric patients. Even though the 5-year survival rate of HB patients has reached 80%, the prognosis in patients with high-risk features remain poor. This study aimed to establish the proteomic signature of HB to discover novel biomarkers and therapeutic targets. METHODS: HPLC-MS/MS coupled with bioinformatic analyses were performed to identify the differentially expressed proteins and related GO/KEGG pathways in HB tumor tissues. Molecular biology experiments in HepG2 and Huh6 cells were conducted to validate findings of proteomic results. RESULTS: Comparison of protein abundance profiles between HB tumors and normal adjacent liver tissues revealed high expression of HMGA2, IGFBP1, and LIN28B in HBs. GO/KEGG enrichment and protein-protein interaction analyses showed activation of RNA processing and the LIN28B/HMGA2 axis in HB tissue samples. Cellular and biochemical experiments confirmed that LIN28B expression was positively correlated with that of HMGA2, and that both promoted cell proliferation and tumor progression in the HB cell lines HepG2 and HUH6. CONCLUSIONS: In this study, we mapped the protein abundance profile of HB, identified a possible regulatory role and therapeutic potential of the LIN28B/HMGA2 axis, and provided database and foundation for future studies.
Laparoscopic versus open surgery for pediatric hepatic cystic echinococcosis in endemic regions: a meta-analysis supporting minimally invasive management.
Yonten S, Guo S, Wang J … +10 more , Panden, Kinzi T, Lhamo T, Yangzom S, Dondan, Pan S, Huang L, Zhang W, Tsering P, Li S
Pediatr Surg Int · 2026 Mar · PMID 41805984 · Publisher ↗
BACKGROUND: Hepatic cystic echinococcosis (HCE) imposes a significant health burden on children in endemic regions. This meta-analysis compares perioperative outcomes between laparoscopic (LS) and open surgery (OS) for p...
BACKGROUND: Hepatic cystic echinococcosis (HCE) imposes a significant health burden on children in endemic regions. This meta-analysis compares perioperative outcomes between laparoscopic (LS) and open surgery (OS) for pediatric HCE to inform surgical management strategies. METHODS: Following PRISMA guidelines, we systematically searched PubMed, CNKI, Wanfang, and VIP for studies (February 2019-April 2024) comparing LS and OS in children with HCE. Two reviewers independently screened studies, extracted data, and assessed quality using the Newcastle-Ottawa Scale. Pooled analysis was performed for operative time, blood loss, hospital stay, biliary complications, residual cavity effusion, and recurrence. RESULTS: Eleven studies involving 556 children (LS = 210, OS = 346) were included. LS was associated with significantly reduced intraoperative blood loss (SMD = -1.11, 95% CI: -1.36 to -0.86, P < 0.001) and shorter hospital stay (SMD = -1.12, 95% CI: -1.81 to -0.42, P = 0.002) compared to OS. Operative time was also shorter in the LS group (SMD = -0.36, 95% CI: -0.85 to 0.14, P < 0.001). There were no significant differences in rates of biliary complications (OR = 1.17, 95%CI 0.26-5.35, P = 0.083), residual cavity effusion (OR = 0.34, 95%CI 0.08-1.47, P = 0.149), or recurrence (OR = 0.57, 95%CI 0.21-1.56, P = 0.277). CONCLUSION: For selected pediatric HCE patients, laparoscopic surgery offers faster recovery with less surgical trauma and a comparable safety profile to open surgery. These findings support integrating minimally invasive techniques into pediatric surgical practice in endemic, resource-limited settings.
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