Pediatr Surg Int
· 2026 Mar · PMID 41779048
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PURPOSE: To present the management experience of patients with cloacal malformation treated between 2008 and 2023, evaluating intestinal and urinary function and long-term quality of life. METHODS: Retrospective case ser...PURPOSE: To present the management experience of patients with cloacal malformation treated between 2008 and 2023, evaluating intestinal and urinary function and long-term quality of life. METHODS: Retrospective case series of surgically corrected cloaca patients between 2008 and 2023. Follow-up assessed intestinal and urinary outcomes and quality of life using the PEDsQL™ 4.0 scale. RESULTS: Twenty-three patients were included: 52.2% with a long and 47.8% with a short common channel. In the short-channel group, 81.8% had associated malformations. Total urogenital mobilization via posterior sagittal approach was performed in 63.6%, with 54.5% postoperative complications. Constipation affected 70%, fecal continence reached 40%, and urinary continence 54.5%. Mean PEDsQL scores were 67.9/85.8 (parent/patient). In the long-channel group, 91.6% had associated anomalies. Urogenital mobilization with abdominal approach was required in 58.3%, and complications occurred in 66.6%. Constipation affected 50%, fecal continence was 50%, and urinary continence 27.2%. Mean PEDsQL scores were 68.9/68.7 (parent/patient). CONCLUSION: Cloacal malformation is a rare, complex anomaly often associated with renal defects. Surgical management demands multidisciplinary care. Long-term outcomes show variable continence, but quality of life remains acceptable, particularly in less severe cases.
Pediatr Surg Int
· 2026 Feb · PMID 41764122
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PURPOSE: After decades of increase, gastroschisis prevalence in the United States has recently declined. We aim to use birth certificate data to explore trends in maternal age and smoking as possible contributors, and to...PURPOSE: After decades of increase, gastroschisis prevalence in the United States has recently declined. We aim to use birth certificate data to explore trends in maternal age and smoking as possible contributors, and to examine national racial and ethnic patterns in gastroschisis prevalence. METHODS: A retrospective cross sectional database review was performed on three national datasets: American College of Surgeons National Surgical Quality Improvement Program- Pediatric® (ACS NSQIP-P®), Healthcare Cost and Utilization Project National Inpatient Sample (HCUP-NIS), and Center for Disease Control and Prevention Wide-ranging ONline Data for Epidemiologic Research (CDC WONDER) for racial and ethnic trends in gastroschisis from 2016-2023. Maternal age and tobacco use were extracted from CDC WONDER. RESULTS: Gastroschisis prevalence significantly declined among infants born to mothers aged 15-29. Maternal tobacco use also declined in both affected and unaffected births, with a significant drop in the population attributable risk from smoking. The proportion of White (but not Black or Asian/Pacific Islander) infants with gastroschisis declined in ACS NSQIP-P®. HCUP-NIS and CDC WONDER demonstrated constant racial proportions but an overall decline in cases. Both ACS NSQIP-P® and CDC WONDER showed an increasing proportion of Hispanic infants with gastroschisis as non-Hispanic cases decreased. CDC WONDER demonstrated disparate changes in prevalence by race and decreasing (though not equally) prevalence in Hispanic and non-Hispanic ethnicities. CONCLUSION: Shifting maternal age demographics and declining maternal tobacco use are likely two reasons for the recent gastroschisis prevalence decline. The decline varies by race and ethnicity, suggesting multifactorial influences on disease prevalence.
Morandi A, Jenetzky E, Midrio P
… +8 more, van der Steeg H, Iacobelli BD, Miserez M, Gorter RR, Prato AP, Amerstorfer E, Leva E, ARM-Net Consortium
Pediatr Surg Int
· 2026 Feb · PMID 41762249
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PURPOSE: While colostomy is the standard stoma in patients with anorectal malformations (ARM), indications for ileostomy remain poorly defined. Our aim was to evaluate indications and outcomes of ileostomy in patients wi...PURPOSE: While colostomy is the standard stoma in patients with anorectal malformations (ARM), indications for ileostomy remain poorly defined. Our aim was to evaluate indications and outcomes of ileostomy in patients with ARM. METHODS: A retrospective study was conducted selecting patients from ARM-Net Consortium registry who received ileostomy between 2007 and 2024. Additionally, a literature review was conducted to contextualize findings. RESULTS: Among 2,994 patients, 21 (0.7%) underwent ileostomy. Data was available for 15 patients. Ileostomy was used mainly in complex malformations (N = 9), including cloacal exstrophy (6), pouch colon (2), and variant of OEIS complex without exstrophy (1). Ileostomy was performed before anorectal repair in 73%, during in 13.5%, and after in 13.5%. Other indications were concomitant bowel pathology, post-operative complications, and protective stoma during reconstruction. Ileostomy-related complications occurred in 40% of patients, 27% being grade IIIB according to Clavien-Madadi. Closure was performed in 87%, while some patients received permanent stoma. In the literature ileostomy was mentioned only in case reports or small case series. CONCLUSION: Ileostomy is a selective surgical option in the management of ARM, with a high complication rate. It should be reserved for complex malformations or complicated cases where a colostomy is unsuitable, insufficient or unfeasible.
Purnomo E, Nugrahaningsih DAA, Yubaidi DB
… +4 more, Apriliana S, Yatalaththov FG, Wijayaningsih RA, Gunadi
Pediatr Surg Int
· 2026 Feb · PMID 41758387
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PURPOSE: Biliary atresia (BA) is a progressive fibro-inflammatory cholangiopathy and the leading cause of neonatal cholestasis and pediatric liver transplantation. Mesenchymal stem cell (MSC)-derived secretome has emerge...PURPOSE: Biliary atresia (BA) is a progressive fibro-inflammatory cholangiopathy and the leading cause of neonatal cholestasis and pediatric liver transplantation. Mesenchymal stem cell (MSC)-derived secretome has emerged as promising acellular alternative to cell therapy. This study evaluated the potential of hypoxia-conditioned umbilical cord MSC (HU-UCMSC) secretome in rat model of biliary fibrosis induced by bile duct ligation (BDL). METHODS: Twenty-four male Sprague-Dawley rats were randomized into six groups: Sham, BDL, BDL + vehicle, and BDL treated with HU-UCMSC secretome at doses of 100, 200, and 400 μL. Serum biochemical markers and hepatic gene expression were analyzed using photometry and RT-qPCR. Histopathology and fibrosis fraction area were evaluated by Sirius Red staining. RESULTS: HU-UCMSC secretome produced dose-dependent hepatoprotection, significantly reducing SGOT, SGPT, and total bilirubin levels compared with untreated BDL rats. Histologically, collagen deposition and fibrosis fraction area were markedly reduced. Gene expression analysis showed significant downregulation of PDGF, α-SMA, and TNF-α, with context-dependent modulation of TGF-β and VEGF. CONCLUSION: Hypoxia-conditioned UC-MSC secretome improved hepatic function and mitigated fibrosis in the BDL model through suppression of profibrotic and inflammatory mediators. These findings support HU-UCMSC secretome as a safe, cell-free therapeutic candidate for biliary atresia and related pediatric cholestatic liver diseases.
Keese D, Friedmacher F, Rolle U
… +4 more, Neeser H, Gerwinn T, Tharakan SJ, Möhrlen U
Pediatr Surg Int
· 2026 Feb · PMID 41758316
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PURPOSE: Postoperative anal dilation after surgery for Hirschsprung disease (HD) still remains common practice. This study aimed to evaluate the benefit of routine dilations compared with a single postoperative calibrati...PURPOSE: Postoperative anal dilation after surgery for Hirschsprung disease (HD) still remains common practice. This study aimed to evaluate the benefit of routine dilations compared with a single postoperative calibration. METHODS: Patients who underwent HD surgery within the first year of life at the University Children’s Hospital Zurich or the University Hospital Frankfurt were retrospectively reviewed. Two groups were compared: those with serial postoperative dilations (PD) and those with a single calibration (PC). Primary outcomes included anastomotic stricture, Hirschsprung-associated enterocolitis (HAEC), and constipation/fecal incontinence. RESULTS: A total of 91 patients were included—46 (51%) in the PD group and 45 (49%) in the PC group. Strictures occurred in 5 patients (10.9%) with PD and 9 (20%) with PC (p = 0.259). HAEC developed in 5 (10.9%) PD and 6 (13.3%) PC patients (p = 0.718). Rates of constipation/fecal incontinence were similar (p = 0.67). CONCLUSION: Routine postoperative anal dilation after HD surgery does not significantly reduce the incidence of strictures, HAEC, or constipation/fecal incontinence. Single postoperative calibration appears sufficient to determine whether further dilation is necessary.
Pediatr Surg Int
· 2026 Feb · PMID 41758282
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BACKGROUND: Pilonidal Sinus Disease (PSD) is an acquired inflammatory condition with no standard treatment. We evaluated our initial experience with Pediatric Endoscopic Pilonidal Sinus Treatment (PEPSiT). METHODS: We re...BACKGROUND: Pilonidal Sinus Disease (PSD) is an acquired inflammatory condition with no standard treatment. We evaluated our initial experience with Pediatric Endoscopic Pilonidal Sinus Treatment (PEPSiT). METHODS: We retrospectively reviewed all PEPSiT cases from May 2021-January 2025. Data collected included demographics, presentation, comorbidities, BMI, surgical time, anesthesia, hospital stay, complications, healing, recurrence, and follow-up (median, range). RESULTS: Thirty-two patients (18 males) underwent PEPSiT, median age 15 years (11-18), BMI 26.6 kg/m² (16.7-51.6). None had prior surgery for PSD. Three had comorbidities (two with type 1 diabetes, one with Hemophilia B). Median operative time was 39 min (19-58). All were day surgery procedures; 28 under sedation/local and 4 under general anesthesia. Median healing was 3 months (1-24). Complications included one granuloma (treated with silver nitrate) and one hematoma. All resumed normal activities the next day. Median follow-up was 9 months (1-52). Three recurrences were successfully treated with redo-PEPSiT. CONCLUSION: Our outcomes suggest that PEPSiT is a safe, effective option for PSD. However, larger prospective studies are needed.
Pediatr Surg Int
· 2026 Feb · PMID 41758271
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BACKGROUND: Early identification of high-risk surgical neonates is essential in resource-limited settings. Risk stratification tools such as the Score for Neonatal Acute Physiology with Perinatal Extension II (SNAPPE II)...BACKGROUND: Early identification of high-risk surgical neonates is essential in resource-limited settings. Risk stratification tools such as the Score for Neonatal Acute Physiology with Perinatal Extension II (SNAPPE II) are widely used in neonatal intensive care units but have not been validated in surgical neonatal populations in sub-Saharan Africa. This study evaluated outcomes and the prognostic utility of SNAPPE II in surgical neonates. METHODS: A 5-year retrospective cohort study was conducted including neonates admitted under general paediatric surgery to the neonatal intensive care unit at Nelson Mandela Children's Hospital. SNAPPE II scores were calculated within 12 h of admission. Associations between SNAPPE II and mortality were assessed using relative risk, odds ratios, and receiver operating characteristic (ROC) analysis. RESULTS: 380 neonates were analysed. Overall mortality was 22.6%, with sepsis accounting for 65.1% deaths. SNAPPE II demonstrated strong prognostic performance: scores > 20 were associated with markedly increased mortality (relative risk 9.2, odds ratio 43.7), and no neonates survived with scores ≥ 40. ROC analysis showed excellent discrimination (AUC 0.88), with an optimal cut-off of 25. CONCLUSION: SNAPPE II reliably predicts mortality in surgical neonates and supports early triage, rational resource allocation, and informed family counselling in resource-limited neonatal surgical units.
Pediatr Surg Int
· 2026 Feb · PMID 41746383
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Appendicitis represents a prevalent medical condition among pediatric and adolescent populations, often necessitating emergency surgical procedures. For nearly two hundred years, the management of appendicitis has been c...Appendicitis represents a prevalent medical condition among pediatric and adolescent populations, often necessitating emergency surgical procedures. For nearly two hundred years, the management of appendicitis has been conceptualized as a surgical challenge. In contemporary practice, minimally invasive techniques enable appendix removal with reduced anesthetic and operative risks, as well as shorter hospitalization. Nevertheless, both anesthesia and surgical interventions carry potential adverse effects, such as surgical site infections, hemorrhage, herniation, and visceral injury. Furthermore, postoperative convalescence may lead to absence from educational or occupational activities, accompanied by considerable medical expenditures. Recent high-quality evidence in adults and children supports a shift away from routine surgical intervention toward nonoperative strategies for managing this condition. Studies involving adult patients have confirmed that non-surgical treatment of acute appendicitis is both safe and effective. Similarly, in pediatric cases characterized by acute appendicitis, initial conservative management has been associated with a lower incidence of complications, reduced recovery time, and decreased medical expenses, while circumventing surgical risks. There have been multiple prospective clinical trials including a recent multicenter international trial comparing surgery and nonoperative management. It has been established what the safety and effectiveness of non-operative management is and how it compares to surgery. Both are safe and effective options with different risks and benefits period; future studies should focus on pathway specific improvements for non-operative management or for surgery. This review evaluates the clinical outcomes and safety of three therapeutic strategies: traditional appendectomy, endoscopic retrograde appendicitis therapy (ERAT), and conservative pharmacological management.
Pediatr Surg Int
· 2026 Feb · PMID 41746370
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PURPOSE: Rectal dilatation is common in anorectal malformations (ARMs), predisposing patients to postoperative defecation dysfunction. However, studies of diagnostic criteria and risk factors are lacking. METHODS: This r...PURPOSE: Rectal dilatation is common in anorectal malformations (ARMs), predisposing patients to postoperative defecation dysfunction. However, studies of diagnostic criteria and risk factors are lacking. METHODS: This retrospective study enrolled 100 male patients with intermediate/high-type ARMs who underwent high-pressure distal colostogram (HPC) prior to anoplasty. The recto-sacral index (RSI), defined as the maximum diameter of the rectal pouch divided by the height of the second sacral vertebra, was developed and measured. Patients were categorized based on intraoperative and pathological findings of rectal dilatation. Demographic and fistula-related factors were compared between groups. Receiver operating characteristic (ROC) curve analysis was used to determine the optimal RSI cutoff for diagnosing rectal dilatation. RESULTS: The incidence of rectal dilatation and the recto-sacral index (RSI) varied significantly according to ARMs type (P = 0.001 and P < 0.001, respectively), being highest in rectovesical and rectoprostatic (high-type) fistulas. A higher RSI was also associated with the absence of meconium per urethra (P = 0.029) and longer fistula length (P = 0.039). The RSI was significantly larger in the dilatation group (2.54 ± 0.09) than in the non-dilatation group (1.89 ± 0.05, P < 0.001). ROC analysis identified an RSI cutoff of > 2.34 for diagnosing rectal dilatation, with an area under the curve of 0.841 (95% CI: 0.762-0.921, P < 0.001). CONCLUSION: Rectovesical/prostatic fistulas, longer fistula, and no history of meconium per urethra may be predictive risk factors for rectal dilatation in male patients with ARMs. The RSI > 2.34 serves as a reliable and objective imaging-based criterion for preoperative identification of rectal dilatation.
Shimizu S, Farjam G, Miyano G
… +2 more, Min SAL, Keijzer R
Pediatr Surg Int
· 2026 Feb · PMID 41739255
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PURPOSE: Breast milk is the recommended nutrition for infants and provides protection against infection. We evaluated whether similar benefits extend to individuals with congenital surgical anomalies. METHODS: We compare...PURPOSE: Breast milk is the recommended nutrition for infants and provides protection against infection. We evaluated whether similar benefits extend to individuals with congenital surgical anomalies. METHODS: We compared infectious events in patients with necrotizing enterocolitis or one of eight congenital surgical anomalies with age-matched controls from the general population. Feeding at discharge was categorized as exclusive breast milk, partial breast milk, or exclusive formula. Outcomes included gastroenteritis, respiratory infections, meningitis, and sepsis. Odds ratios (OR) for each outcome were estimated for cases and controls, and effect modification by case status was assessed. RESULTS: A total of 1168 cases (165 exclusively breast milk-fed) and 11,648 controls (6084 exclusively breast milk-fed) were included. Among cases, exclusive formula-feeding increased the odds of gastroenteritis (OR = 3.71, p = 0.008) and respiratory infections (OR = 2.04, p = 0.003), but not meningitis or sepsis. Among controls, formula-feeding increased the odds of all outcomes (gastroenteritis: OR = 1.78, respiratory infections: OR = 2.46, meningitis: OR = 4.22, sepsis: OR = 2.84; all p ≤ 0.003). Protective effects of breast milk were greater in controls. CONCLUSIONS: Exclusive breast milk feeding decreases the odds of long-term infectious disease outcomes, including in individuals with congenital surgical anomalies. These findings underscore the importance of supporting maternal and donor milk programs for vulnerable surgical populations.
Rinehardt HN, Martyn A, Kolodychak A
… +6 more, Takeda M, Thomas M, Liszewski L, Rutkowski A, Kreger A, Gittes GK
Pediatr Surg Int
· 2026 Feb · PMID 41739213
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PURPOSE: Choledochal cyst is a rare, congenital dilation of the hepatobiliary tree. Due to the associated malignancy risk, complete resection is recommended. There remains a risk of metachronous cholangiocarcinoma despit...PURPOSE: Choledochal cyst is a rare, congenital dilation of the hepatobiliary tree. Due to the associated malignancy risk, complete resection is recommended. There remains a risk of metachronous cholangiocarcinoma despite resection necessitating lifelong surveillance. Choledochal cysts are increasingly prevalent with an incompletely understood connection to carcinogenesis. We sought to develop a mouse model to reliably mimic human disease process of choledochal cyst. METHODS: Experimental transgenic mice were bred with a genotype of Pdx-Cre, TGFα, LSL-Kras G12D Mu/Wt. Control C57 mice were used as a comparison. Experimental and control mice underwent serial abdominal magnetic resonance imaging (MRI) from weaning to sacrifice. RESULTS: All experimental mice developed fusiform extrahepatic common bile duct dilation most consistent with Todani Type Ic (fusiform) choledochal malformation. Choledochal cyst was present on imaging modalities upon weaning. Maximum common bile duct (CBD) diameter by MRI demonstrated a significantly larger diameter in the experimental group compared to the control group at 10 weeks. CONCLUSION: All experimental mice with a genotype of Pdx-Cre, TGFα, LSL-Kras Mu/Wt developed a phenotype consistent with congenital choledochal cyst. This transgenic mouse model mimics the oncogenic nature of choledochal cyst and could be used to further study disease pathophysiology and novel interventions.
Sukhotnik I, Ben-Shahar Y, Pollak Y
… +2 more, Kurland Y, Aharon A
Pediatr Surg Int
· 2026 Feb · PMID 41729301
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Extracellular vesicles (EVs) are released by most cells, including stem cells, into the extracellular environment and regulate cell function and tissue regeneration through cell-cell communication. The EVs derived from h...Extracellular vesicles (EVs) are released by most cells, including stem cells, into the extracellular environment and regulate cell function and tissue regeneration through cell-cell communication. The EVs derived from human placenta have a crucial role in regulating the maternal immune response for a successful pregnancy outcome. The purpose of the current study was to evaluate the effects of human villous trophoblasts (HVT)-derived EVs on structural intestinal adaptation, cell proliferation and apoptosis in a rat model of short bowel syndrome (SBS). HVT-EVs were isolated from cell media after 24 and 48 h of starvation (medium without serum) by subsequent centrifugation and ultracentrifugation (UC). HVT-EV protein content were screened by protein array. Male Sprague-Dawley rats were divided into four experimental groups: sham rats underwent bowel transection and re-anastomosis, sham-EV rats underwent bowel transection and re-anastomosis and were treated with HVT-EVs given intraperitoneally (IP) at a dose of 200ug/200ul once daily from postoperative day 3 through 14, SBS rats underwent a 75% small bowel resection and anastomosis, and SBS-EV rats underwent similar bowel resection and were likewise treated with HVT-EVs. Parameters of intestinal adaptation, enterocyte proliferation and enterocyte apoptosis were determined on postoperative day 15. Apoptosis/inflammatory-related protein levels were determined by ELISA (TNF-α) and immunohistochemistry (caspase-3). SBS rats demonstrated a significant increase in jejunal and ileal bowel (400%) and mucosal (250%) weight, jejunal (18%) and ileal (13%) villus height, ileal crypt depth (17%), cell proliferation rates in jejunum (45%) and ileum (54%) and concomitant increase in cell apoptosis in jejunum (400%) and ileum (500%) compared to sham animals. Treatment of SBS rats with HVT-EVs which contain proangiogenic proteins such as angiogenin and angiopoietin-1 resulted in additional increase in jejunal bowel weight (39%), ileal mucosal weight (25%), ileal villus height (23%) and jejunal crypt depth (14%) compared to SBS-nontreated animals. Enhanced adaptation in SBS-EVs rats was achieved by a mild increase in cell proliferation and a significant decrease in cell apoptosis rates (four-fold decrease in jejunum and ten-fold decrease in ileum) vs SBS-nontreated animals. Inhibited cell apoptosis in this group was accompanied by decrease in TNF-α and caspase-3 expression. In conclusion, in a rat model of SBS, parenteral HVT-EVs stimulate structural intestinal adaptation. Increased cell proliferation and decreased cell death via apoptosis (probably by the intrinsic pathway) appears to be responsible for the increased cell mass.
Kahan AM, Swendiman RA, Traynor MD
… +8 more, Yoder B, Yang M, Peterson K, Fenton SJ, Kastenberg ZJ, Veettil SK, Chaiyakunapruk N, Russell KW
Pediatr Surg Int
· 2026 Feb · PMID 41729300
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OBJECTIVE: This meta-analysis aimed to investigate the risk of recurrence after muscle flap repair versus patch repair in neonates with congenital diaphragmatic hernia (CDH). METHODS: Three electronic databases (PubMed,...OBJECTIVE: This meta-analysis aimed to investigate the risk of recurrence after muscle flap repair versus patch repair in neonates with congenital diaphragmatic hernia (CDH). METHODS: Three electronic databases (PubMed, EMBASE, and CENTRAL) were searched from inception until November 1, 2024, to identify studies that compared patch repair and muscle flap repair and reported recurrence rates or any other relevant secondary outcomes in neonates with CDH. Two reviewers independently extracted data and evaluated study quality using ROBINS-I. The primary outcome was the risk of recurrence presented as a risk ratio (RR) with 95% CI. Secondary outcomes included adhesive small bowel obstruction, scoliosis, and survival to discharge. Meta-analytic estimates were calculated with a random-effects model. RESULTS: Six retrospective cohort studies involving a total of 300 patients were included for meta-analysis. Meta-analysis suggested that muscle flap repair significantly reduced the risk for recurrence after repair of CDH compared to patch repair (RR, 0.30 (95% CI, 0.15 to 0.63), I2 = 0%). The finding remained robust after a sensitivity analysis excluding critically biased studies. Meta-analyses did not find any significant differences between muscle flap and patch repair for the secondary outcomes of small bowel obstruction (RR, 1.77 (95% CI, 0.56 to 5.56), I2 = 0%), scoliosis (RR, 1.54 (95% CI, 0.57 to 4.13), I2 = 0%), and survival to discharge (RR, 1.07 (95% CI 0.84 to 1.38), I2 = 0%). CONCLUSIONS: Our findings demonstrate that neonates with CDH undergoing muscle flap repair have a 70% decreased risk of recurrence compared to patch repair. Secondary analyses did not show statistically significant differences between the two groups.
Bostancı SA, Erten EE, Akbaş İ
… +7 more, Balcı SK, Demir S, Ertürk A, Öztorun Cİ, Özmert S, Şenel E, Azılı MN
Pediatr Surg Int
· 2026 Feb · PMID 41729298
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PURPOSE: Selective lung ventilation (SLV) during thoracic surgery improves surgical exposure and prevents contamination of the contralateral lung. In pediatric pulmonary hydatid cyst surgery, bronchopulmonary fistulas co...PURPOSE: Selective lung ventilation (SLV) during thoracic surgery improves surgical exposure and prevents contamination of the contralateral lung. In pediatric pulmonary hydatid cyst surgery, bronchopulmonary fistulas complicate surgical visualization and repair, significantly increasing the risk of contamination. This study aimed to evaluate the effectiveness of SLV in terms of operative time, prolonged air leak, reoperation necessity, and hospital stay duration in pediatric thoracotomy cases performed for hydatid lung cysts. METHODS: This retrospective study included pediatric patients under 18 years of age who underwent thoracotomy for pulmonary hydatid cysts between 2014 and 2022. SLV was performed with double-lumen tubes in children aged seven years and older and with endobronchial blockers in younger children. Patients were grouped according to the type of ventilation (SLV or non-selective lung ventilation, NSLV), and variables such as cyst volume, operative time, postoperative complications, and hospital stay duration were compared. RESULTS: A total of 86 patients were analyzed, with 60 in the NSLV group (69.8%) and 26 in the SLV group (30.2%). Despite significantly larger cyst volumes in the SLV group (221.6 cm³ vs. 104.9 cm³, p = 0.048), SLV patients had notably shorter operative times (115.7 vs. 153.7 min, p = 0.001) and significantly reduced hospital stays (7.2 vs. 12.3 days, p = 0.05). No SLV-related complications such as atelectasis or infection were observed. CONCLUSION: This first pediatric-focused study demonstrates that SLV effectively reduces operative time and hospitalization without increasing complication rates, suggesting it as a reliable option in pediatric hydatid cyst surgery.
Sacco Casamassima MG, Alturki N, Nonnemacher C
… +4 more, Noel-MacDonnell JR, Dizdarevic E, Oyetunji TA, St Peter SD
Pediatr Surg Int
· 2026 Feb · PMID 41729297
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BACKGROUND: Optimal timing for surgical correction of congenital choledochal malformations (CCMs) remains controversial. This study aims to evaluate whether younger age at surgery is an independent risk factor for higher...BACKGROUND: Optimal timing for surgical correction of congenital choledochal malformations (CCMs) remains controversial. This study aims to evaluate whether younger age at surgery is an independent risk factor for higher morbidity. METHODS: The Pediatric Health Information System (PHIS) database (October 2015-September 2024) was queried to identify children aged ≤ 1 year undergoing definitive surgery for CCMs. Patient characteristics and outcomes of children aged ≤ 3 months (Group A) were compared with children > 3 months old (Group B). RESULTS: 267 patients (Group A:71, Group B:196) were identified. Younger children were more often transferred from other hospitals (p = 0.047), admitted urgently/emergently (p = 0.001), and underwent open bilioenteric reconstruction (p < 0.001). There were no differences in 90-day complications (Group A:19.7%, Group B:17.3%, p = 0.719) and postoperative procedures (18.3% vs. 14.3%; p = 0.444). Specifically, there were no differences in anastomotic revision (1.4% vs. 2%, p = 1.000) or endoscopic dilation (2.8% vs. 1.3%, p = 0.611). Within 90 days, younger children were more often readmitted (16.9% vs. 5.6%, p = 0.006). Six patients developed portal hypertension (Group A:7% and Group B:0.5%; p = 0.006), and one died from liver transplant complications. CONCLUSION: This study’s analysis of national surgical outcomes for CCMs supports the safety of early surgical intervention to prevent cyst-related complications and progression toward liver fibrosis.
Pediatr Surg Int
· 2026 Feb · PMID 41729294
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PURPOSE: Gastrostomy serves as an essential device for children with insufficient oral intake. Laparoscopic techniques are increasingly used and considered safe, although minor complications remain common. The purpose of...PURPOSE: Gastrostomy serves as an essential device for children with insufficient oral intake. Laparoscopic techniques are increasingly used and considered safe, although minor complications remain common. The purpose of this prospective observational study was to compare three different laparoscopic gastrostomy techniques and evaluate the incidence of complications at three months postoperatively. METHODS: Children < 18 years of age scheduled for gastrostomy at participating centers between 2014 and 2019 were included. Data on demographics, perioperative details, and three-month postoperative complications were collected. Three laparoscopic techniques were compared: Method A (intracorporeal double U-stitch), Method B (mini-laparotomy with fascial and stomach purse-string sutures), and Method C (extracorporeal double U-stitch combined purse-string suture). RESULTS: A total of 310 patients (median age: 27.0 months, median weight: 10.9 kg) from three centers were included. Three months postoperatively, the incidence of granuloma was significantly higher in Method B (89.7%) compared to Method A (59.3%) and Method C (35.2%) (p < 0.001). Method C had the lowest rates of granuloma, infection, leakage, and pain, while dislocation rates were similar across methods. CONCLUSION: Our findings suggest that a surgical technique with a small skin incision and less suture material positioned away from the gastrostomy site may help reduce postoperative complications, particularly granuloma.
Brierley SF, Dao KT, Eldredge RS
… +25 more, Acker S, Bain A, Barq RM, Byrd E, Chao SD, Clinker C, Diaz-Miron JL, Gillory L, Gopalan M, Hyman S, Ignacio RC, Kahan A, Keller B, Kelley-Quon LI, Kim S, Nicassio LN, Pandya S, Ritchey A, Rothstein DH, Scaife J, Schwab ME, Sun R, Ostlie DJ, Russell K, Padilla BE
Pediatr Surg Int
· 2026 Feb · PMID 41729240
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PURPOSE: This multicenter study aims to describe the rate of postoperative infectious complications following minimally invasive repair of pectus excavatum (MIRPE) and explore the various approaches to treatment of these...PURPOSE: This multicenter study aims to describe the rate of postoperative infectious complications following minimally invasive repair of pectus excavatum (MIRPE) and explore the various approaches to treatment of these infections. METHODS: A retrospective review of patients ≤ 21 years of age who underwent MIRPE between 7/2022 and 10/2023 across 10 children's hospitals was conducted. Patient demographics, clinical characteristics, operative details, and postoperative outcomes were collected and analyzed. RESULTS: A total of 523 pediatric patients met inclusion criteria; 450 (86.5%) were males. Postoperative infection occurred in 17 patients (3.3%): 5 superficial surgical site infections (SSI) (29.4%) and 12 deep bar infections (70.6%). There were no significant differences in demographics, clinical characteristics, or operative details between patients with and without postoperative infection, except for race. The proportion of patients with one, two or three bars differed between those with and without superficial SSIs (p = 0.002). There was no significant difference in number of bars placed for patients with or without bar infection. All but one postoperative deep bar infection (91.7%) were managed with bar salvage. CONCLUSIONS: The overall incidence of postoperative infectious complications after MIRPE is low. Most deep bar infections can be managed with antibiotics and washout, without need for bar replacement or early removal.