Journal Of Pediatric Surgery[JOURNAL]
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200 papers
Predictors of residual fragments and hemorrhagic complications after pediatric mini-percutaneous nephrolithotomy: A retrospective cohort analysis of 371 renal units.
Kizilay E, Tosun H, Akinsal EC … +3 more , Sonmez G, Baydilli N, Demirci D
J Pediatr Surg · 2026 Jun · PMID 42250627 · Publisher ↗
PURPOSE: Pediatric renal stone surgery aims to achieve complete stone clearance with minimal perioperative morbidity. Mini-percutaneous nephrolithotomy (mini-PCNL) is widely used for larger stones, yet factors influencin...
PURPOSE: Pediatric renal stone surgery aims to achieve complete stone clearance with minimal perioperative morbidity. Mini-percutaneous nephrolithotomy (mini-PCNL) is widely used for larger stones, yet factors influencing postoperative residual fragments and bleeding risk in children are not fully clarified. This study evaluated outcomes after pediatric mini-PCNL and identified predictors of residual fragments and bleeding-related morbidity in a large single-center cohort. MATERIALS AND METHODS: This single-center retrospective cohort included 371 renal units in children treated with mini-PCNL (2011-2024) using 14-20 French (Fr) access sheaths. Stone-free rate (SFR) was defined as 0-mm residual fragments on 1-month kidney-ureter-bladder (KUB) radiography and ultrasonography (US). Computed tomography (CT) was not routinely performed and was obtained only when clinically indicated, which may have resulted in underestimation of very small residual fragments. Multivariable logistic regression evaluated predictors of 1-month residual fragments and bleeding-related morbidity. RESULTS: One-month SFR was 79.2% (294/371) and increased to 88.4% (328/371) by 3 months after auxiliary procedures. Staghorn morphology was associated with residual fragments (aOR 5.01, 95% CI 1.86-13.51); operative time was also associated (aOR 1.12 per 10-min increase, 95% CI 1.04-1.20). Complications occurred in 12.9%, mainly low-grade according to the Clavien-Madadi classification, with no grade IV-V events. Transfusion was required in 2.2% (8/371). Bleeding-related morbidity increased with operative time (aOR 1.16 per 10-min increase, 95% CI 1.07-1.25). Compared with 14 Fr, 20 Fr demonstrated a nonsignificant trend toward higher odds of bleeding-related morbidity (aOR 3.20, 95% CI 0.93-11.05), whereas 16 Fr showed no statistically significant association (aOR 1.75, 95% CI 0.56-5.47). CONCLUSION: With a stringent 0-mm stone-free definition, mini-PCNL provided high clearance rates and low major morbidity in this large pediatric cohort. Staghorn stones remained the strongest predictor of residual fragments. Prolonged operative time was consistently associated with increased bleeding-related morbidity, while the use of 20 Fr access demonstrated only a modest, nonsignificant elevation in bleeding risk.
Urologic outcomes in children with closed spinal dysraphism with and without untethering of the spinal cord.
Avellan C, Pakkasjärvi N, Palomäki M … +3 more , Karppinen A, Helenius I, Taskinen S
J Pediatr Surg · 2026 Jun · PMID 42248351 · Publisher ↗
PURPOSE: Closed spinal dysraphism (CSD) comprises a heterogeneous group of congenital anomalies that may remain asymptomatic or present with neurological and urological dysfunction. This study aimed to evaluate long-term...
PURPOSE: Closed spinal dysraphism (CSD) comprises a heterogeneous group of congenital anomalies that may remain asymptomatic or present with neurological and urological dysfunction. This study aimed to evaluate long-term urological outcomes in children with isolated CSD and to compare outcomes between patients managed conservatively and those who underwent spinal cord untethering (SCU). METHODS: We conducted a retrospective cohort study of children with CSD treated at Helsinki University Hospital between 1990 and 2015. RESULTS: Forty-three patients were followed for a median of 11.0 years. Urological symptoms were common, and at some point during follow-up, 21 patients (49%) required urological treatment. At the end of follow-up, 27 patients (63%) required no ongoing urological treatment. Before SCU or during conservative treatment, 82% (32/39) of patients older than three years achieved volitional voiding, and 72% (28/39) were continent; 18% required clean intermittent catheterization (CIC), and 19% (7/39) received bladder-directed therapy. Twenty patients underwent neurosurgical spinal cord untethering, most often due to progressive symptoms. Seventeen patients (85%) had volitional voiding preoperatively, whereas only 10 patients (50%) voided volitionally at the last follow-up after SCU (p = 0.02). At the last follow-up, there was no significant difference in the need for urological treatment between conservatively treated patients and those who underwent SCU. All patients had normal kidney function at the last follow-up. CONCLUSIONS: A substantial proportion of children with CSD require urological treatment during long-term follow-up. Despite postoperative changes in bladder function, long-term urological treatment needs were similar between conservatively managed patients and those who underwent SCU.
Report of pediatric colorectal and pelvic reconstruction conference.
Rentea RM, Short SS, Smith CA … +2 more , Durham MM, Rideout DA
J Pediatr Surg · 2026 Jun · PMID 42248350 · Publisher ↗
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Postoperative pain after low-pressure versus standard-pressure laparoscopic surgery in children. A randomized clinical trial.
Neeser HR, Gerwinn T, Forschbach VC … +4 more , Thomas J, Both CP, von Felten S, Moehrlen U
J Pediatr Surg · 2026 Jun · PMID 42248349 · Publisher ↗
BACKGROUND: Children still suffer from substantial pain after laparoscopic surgery. It has been hypothesized that low-pressure pneumoperitoneum reduces postoperative pain after laparoscopic surgery. However, this has not...
BACKGROUND: Children still suffer from substantial pain after laparoscopic surgery. It has been hypothesized that low-pressure pneumoperitoneum reduces postoperative pain after laparoscopic surgery. However, this has not yet been studied in school-aged children. Our objective was to determine whether low-pressure pneumoperitoneum (LPP) reduces postoperative abdominal pain compared to standard-pressure pneumoperitoneum (SPP) in children undergoing laparoscopic appendectomy for acute appendicitis. METHODS: Single-center, parallel-group, superiority randomized controlled trial including children aged 5-17 years undergoing laparoscopic appendectomy. Patients with four-quadrant peritonitis, intraabdominal abscess on ultrasound, or insufficient local language skills to assess postoperative pain were excluded. Patients were randomized to laparoscopic appendectomy with LPP (8 mmHg; intervention arm) or SPP (12 mmHg; control arm). The primary outcome was postoperative abdominal pain intensity, measured using the revised Faces Pain Score on the first postoperative day. Secondary outcomes were shoulder pain intensity, operative time, length of stay, surgeon-rated intraoperative view, analgesic use, intra- and postoperative complications. RESULTS: Of 250 randomized patients, 191 completed the study per protocol (LPP n = 81, SPP n = 110). Median age was 11.55 years and median weight 40 kg. Contrary to our hypothesis, LPP was associated with higher postoperative abdominal (odds ratio [OR] 1.74, 95% CI 1.01-3.00) and shoulder pain scores (OR 2.11, 95% CI 0.84-5.31) compared to SPP. Shoulder pain was more intense on the right side in both groups (OR 7.81, 95% CI 3.92-15.55). Intraoperative view was rated as superior by surgeons during SPP. There were no significant differences between groups regarding all other secondary outcomes. CONCLUSIONS: In children undergoing laparoscopic appendectomy, LPP does not reduce postoperative pain compared to SPP.
Shifting pediatric operative experience in the era of fellowship expansion: A national analysis of residents, fellows, and the match.
Clinker C, Trinh AT, Agu O … +2 more , Reynolds E, Wieck MM
J Pediatr Surg · 2026 May · PMID 42218994 · Publisher ↗
BACKGROUND: Pediatric surgery remains a highly competitive subspecialty. Prior work has shown declining operative experience for pediatric surgery fellows, but the broader impact of the increasing number of pediatric sur...
BACKGROUND: Pediatric surgery remains a highly competitive subspecialty. Prior work has shown declining operative experience for pediatric surgery fellows, but the broader impact of the increasing number of pediatric surgery fellowships on residents' exposure to and interest in pediatric surgery has not been characterized at the national level during this time period. METHODS: Public ACGME case log summaries for graduating general surgery residents and pediatric surgery fellows (Academic years [AY] 2003-2004 to 2024-2025) were merged with ACGME program counts and NRMP fellowship data (match years 2004-2025). We defined two eras based on national trends in the number of accredited pediatric surgery fellowship programs/positions: 1. Expansion era (AY 2003-2004 to 2011-2012) when the number increased rapidly, and 2. Plateau era (AY 2012-2013 to 2024-2025), when the number was relatively stable. We calculated annual resident/fellow pediatric case averages, total national pediatric volume, and resident share, fill rates, and applicants per 100 general surgery graduates. We also analyzed ACGME pediatric index procedures per graduate year, overall, and by era. Trends were assessed with linear regression; era differences were assessed with two-sample tests and procedure-level Wilcoxon tests (α = 0.05). RESULTS: From 2003 to 2025, general surgery graduates performed fewer pediatric surgery cases, with the mean declining from 40.1 to 23.1 (-0.84 mean cases per graduate by graduation year; p < 0.001) and lower volumes in the plateau era compared with the expansion era (25.5 vs 35.2; p < 0.001). In contrast, mean cases per fellow increased over time from 979.8 to 1221 (p = 0.0003), and mean volumes were higher in the plateau era than in the expansion era (1317.9 vs 1125.7; p = 0.005). Residents' share of total pediatric operative volume also decreased, from 48.6% in the expansion era to 36.4% in the plateau era (p = 0.004). for both low and high complexity cases. As fellowship positions increased, the number of fellowship applicants rose only modestly, so applicants per 100 general surgery graduates declined slightly. CONCLUSIONS: As the number of pediatric surgery fellowships increased and then stabilized, general surgery residents experienced a substantial decline in pediatric operative experience, while fellows saw an overall increase in mean case volume although this effect was variable depending on the type of case. Fellowship fill rates remained consistently high, but a smaller proportion of general surgery residents applied over time. These findings support re-examining how pediatric operative experience is distributed across training pathways given its relevance to ongoing discussions on workforce size and distribution, access to pediatric surgical care, and maintenance of competencies.
Robotic surgery for pediatric foregut cysts resection: A preliminary investigation and comparative study with the thoracoscopic surgery.
Gao Y, Han X, Tan Z … +4 more , Liang L, Huang T, Zhang J, Xia J
J Pediatr Surg · 2026 May · PMID 42203143 · Publisher ↗
OBJECTIVE: Resection of foregut cysts in children is technically challenging. Video-assisted thoracoscopic surgery (VATS) is currently the most commonly adopted surgical approach. This study aimed to compare the safety a...
OBJECTIVE: Resection of foregut cysts in children is technically challenging. Video-assisted thoracoscopic surgery (VATS) is currently the most commonly adopted surgical approach. This study aimed to compare the safety and efficacy of robot-assisted thoracoscopic surgery (RATS) and VATS for the treatment of pediatric foregut cysts. METHODS: This single-center, retrospective study enrolled pediatric patients with foregut cysts who underwent RATS or VATS from January 2020 to June 2025. Demographic characteristics, intraoperative features and postoperative outcomes were analyzed and compared between the two groups. RESULTS: A total of 66 patients met the inclusion criteria, with 39 patients in the RATS group and 27 patients in the VATS group. No significant differences were observed between the two groups in age, sex, weight, cyst type, maximal cyst diameter, effective operative time (excluding setup time) and intraoperative blood loss (P = 0.779, P = 0.508, P = 0.901, P = 0.497, P = 0.814, P = 0.528 and P = 0.327, respectively). Total operative time was significantly longer in the RATS group (P = 0.021). Compared with the VATS group, patients in the RATS group demonstrated significantly lower intensive care unit (ICU) admission, lower 24-h drainage volume, shorter postoperative hospital stay, shorter chest tube duration and lower incidence of postoperative complications (P < 0.01, P = 0.036, P = 0.012, P = 0.01 and P = 0.019, respectively). However, the overall hospitalization costs in the RATS group were significantly higher than those in the VATS group (P < 0.01). CONCLUSION: RATS is a safe and effective treatment for pediatric foregut cysts and is associated with improved outcomes compared with VATS. LEVEL OF EVIDENCE: LEVEL III.
Letter to the Editor Comment on: Subclavian approach without ultrasound guidance is safe and effective for pediatric central venous access.
Pacilli M, Spencer TR, Alexandrou E … +2 more , Crocoli A, Pittiruti M
J Pediatr Surg · 2026 May · PMID 42203142 · Publisher ↗
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Lipopolysaccharide-binding protein as a biomarker in the diagnosis of necrotizing enterocolitis.
Zou P, Hou L, Wei P … +17 more , Song K, Lu J, Zeng J, Liu Y, Zhong X, Chen L, Huang Y, Ouyang Y, Nong T, Tian Y, Li W, Li L, He Q, Xia H, Zhong W, Liu Z, Lan C
J Pediatr Surg · 2026 May · PMID 42203141 · Publisher ↗
OBJECTIVES: Necrotizing enterocolitis (NEC) is a life-threatening gastrointestinal disease of neonates. This study aimed to identify Lipopolysaccharide-binding protein (LBP) as a potential biomarker for the diagnosis of...
OBJECTIVES: Necrotizing enterocolitis (NEC) is a life-threatening gastrointestinal disease of neonates. This study aimed to identify Lipopolysaccharide-binding protein (LBP) as a potential biomarker for the diagnosis of NEC through multi-omics analyses and validation. METHODS: We analyzed LBP expression differences in NEC using transcriptomic data from our cohort (intestinal tissue samples from NEC cases and controls) integrated with a public gene expression dataset (GSE46619). Correlations between LBP and common clinical biomarkers (C-reactive protein (CRP), platelet count (PLT), white blood cell count (WBC), lymphocyte count) were evaluated using Spearman's correlation. Receiver operating characteristic (ROC) curve analysis was performed to assess the diagnostic performance of LBP alone and in combination with other biomarkers. Gene Ontology (GO) enrichment analysis was conducted to explore biological processes associated with LBP. RESULTS: LBP protein was significantly upregulated in NEC compared to controls, increasing with greater disease severity (stage III > stage II > stage I),and LBP expression showed strong positive correlations with inflammatory cytokines IL-6 and IL17RA in the transcriptomic analysis (P < 0.001). In contrast, other LBP-related proteins (BPI, CETP, PLTP) showed no significant difference between NEC and controls. LBP levels correlated positively with CRP (R = 0.7702, P < 0.0001) and negatively with lymphocyte count (R = -0.7269, P < 0.0001), while correlations with WBC and PLT were weak. In ROC analysis, LBP yielded an area under the curve (AUC) of 0.8252 for diagnosing NEC, with 64.1% sensitivity and 90.91% specificity, outperforming WBC, PLT, and other routine markers. Combining LBP with CRP improved the diagnostic AUC to 0.8834. Moreover, LBP levels and diagnostic accuracy were highest in advanced NEC stages (AUC for stage III 0.9702). GO enrichment suggested that LBP is involved in regulation of cellular responses to biological stimuli and immune cell movement, reflecting its role in the innate immune response. CONCLUSION: LBP is significantly elevated in both the intestinal tissue and plasma of NEC patients and demonstrates high diagnostic sensitivity for the disease. Moreover, LBP shows strong diagnostic performance in assessing both NEC onset and disease progression, and its combination with routine hematological parameters may further enhance early identification and improve clinical management of NEC.
A national analysis of social drivers of health and post-operative outcomes in previously healthy children.
Stephens CQ, Highet A, Yap A … +13 more , Saito JM, Barry D, Shui AM, Wilson NA, Cockrell H, Wakeman D, Berman L, Cairo S, Greenberg S, Linden AF, Kohler J, Tsao K, Vu L
J Pediatr Surg · 2026 May · PMID 42203140 · Publisher ↗
INTRODUCTION: To better understand the relationships between social drivers of health (SDoH) and pediatric surgical outcomes, we examined neighborhood-based SDoH and surgical outcomes in a national cohort of children wit...
INTRODUCTION: To better understand the relationships between social drivers of health (SDoH) and pediatric surgical outcomes, we examined neighborhood-based SDoH and surgical outcomes in a national cohort of children with low baseline surgical risk. METHODS: Multicenter, retrospective cohort study of healthy (American Society of Anesthesiologists Class I and II) children <18 years old undergoing surgery at 8 National Surgical Quality Improvement Program-Pediatric hospitals (1/1/2016-12/31/2021). We investigated associations between three validated SDoH indices [Social Vulnerability Index (SVI), Area Deprivation Index (ADI), and Child Opportunity Index (COI)] and serious postoperative complication; presentation to the emergency department (ED) for surgical care; hospital length of stay (LOS); and surgical site infection (SSI). All indices were re-scaled to present decile change for analysis. Multivariable regression models controlled for age, sex, racialization, pre-operative comorbidities, and hospital proximity (fixed effects) and hospital site (random effect). RESULTS: 38,514 healthy children underwent surgical procedures during the study period. We found significant associations between increasing deciles of both COI and SVI and odds of ED admission (COI: OR 1.018, 95% CI 1.008-1.027, p < 0.001; SVI: OR 1.022, 95% CI 1.013-1.031, p < 0.001). While no significant associations were found between any SDoH index and SSI or serious complications, increased LOS was associated with both ADI (IRR 1.011, 95% CI 1.004-1.017, p < 0.001) and COI (IRR 1.009, 95% CI 1.004-1.015, p < 0.001). CONCLUSION: Children from more disadvantaged neighborhoods more frequently present through the ED preoperatively and experience longer LOS. Future work should investigate the potential drivers of these disparities in access and healthcare utilization.
Comparing neighborhood deprivation metrics in pediatric trauma: Is there a better predictor?
Myers EK, Pickett-Nairne K, Eyal K … +3 more , Adelgais K, Diaz-Miron J, Acker SN
J Pediatr Surg · 2026 May · PMID 42190871 · Publisher ↗
BACKGROUND: Neighborhood deprivation (ND) impacts pediatric trauma, the leading cause of mortality in children. The aim of this work was to compare the association of three common neighborhood deprivation metrics (NDMs)...
BACKGROUND: Neighborhood deprivation (ND) impacts pediatric trauma, the leading cause of mortality in children. The aim of this work was to compare the association of three common neighborhood deprivation metrics (NDMs) with pediatric trauma mechanisms and injury severity. METHODS: This was a retrospective analysis of trauma patients ≤18-years-old presenting to a single level 1 pediatric trauma center from 1/2016 to 12/2021. NDMs utilized were the Area Deprivation Index (ADI), Childhood Opportunity Index (COI), and Social Vulnerability Index (SVI). Patients were divided into NDM quintiles. Descriptive statistics were used to compare the baseline characteristics of the study population. Univariable regression models were fit to examine the association with pediatric trauma mechanisms and severity. The area under the curve (AUC) was calculated and compared with a contrast test. The same analysis was performed for multivariable regressions. RESULTS: Higher ND patients were younger, more often of Black race or Hispanic/Latinx ethnicity, and had government/Medicaid insurance. A higher percentage of auto-pedestrian, motor vehicle collisions (MVC), non-accidental trauma (NAT)/assault/neglect, and penetrating injuries occurred at high ND. Models incorporating COI had the highest predictive ability for MVC, sports, and ICU length-of-stay (LOS) ≥ 3 days. Models incorporating ADI had the highest predictive ability for Intensive Care Unit (ICU) admission, and Injury Severity Score (ISS) > 15. These differences in predictive ability persisted on multivariable analysis for sports, ISS >15, and ICU LOS ≥3 days. CONCLUSIONS: The NDMs were all associated with differences in injury mechanism/severity and can be used as ND markers in future pediatric trauma research. TYPE OF STUDY: Retrospective cross-sectional analysis. LEVEL OF EVIDENCE: Level IV.
Neonatal Kasai portoenterostomy for biliary atresia: Clinical characteristics and outcomes.
Tian Y, Chen S, Yu Chung PH … +7 more , Ye M, Liu C, Chen Y, Ji J, Li X, Tam PKH, Li L
J Pediatr Surg · 2026 May · PMID 42190870 · Publisher ↗
BACKGROUND & AIMS: Biliary atresia (BA) is a progressive cholangiopathy where prognosis is strongly linked to the timing of Kasai portoenterostomy (KPE). While early surgery is advocated, data specifically restricted to...
BACKGROUND & AIMS: Biliary atresia (BA) is a progressive cholangiopathy where prognosis is strongly linked to the timing of Kasai portoenterostomy (KPE). While early surgery is advocated, data specifically restricted to the neonatal period are limited. This study aims to evaluate the clinical characteristics and outcomes of infants undergoing KPE strictly within the neonatal window and to identify prognostic factors. METHODS: We conducted a multicenter retrospective study of 56 neonates who underwent KPE between 2014 and 2022. To assess the clinical impact of neonatal timing, a comparison cohort of 164 infants who underwent KPE at 29-90 days of age was also analyzed. The primary outcomes were jaundice clearance and native liver survival (NLS). RESULTS: The neonatal cohort achieved a jaundice clearance rate of 82.1%, which was significantly higher than the 73.2% observed in the non-neonatal comparison group (p < 0.05). NLS in the neonatal group remained excellent through 72 months. Within the neonatal cohort, earlier surgery correlated with higher clearance rates, supporting the "earlier is better" principle even in the first month of life. Exploratory analysis revealed that a preoperative biochemical profile of high Gamma-Glutamyl Transferase (GGT) and low Alanine Aminotransferase (ALT) was associated with the most favorable outcomes, with clearance rates exceeding 90%. CONCLUSION: KPE performed in the neonatal period was associated with a higher jaundice clearance rate compared with later intervention, while no significant difference in native liver survival was demonstrated during the present follow-up. A "high-GGT/low-ALT" profile may serve as an exploratory favorable prognostic marker in neonates. LEVEL OF EVIDENCE: Level II.
Colonic segment reversal: A potential surgical option for selected children with short bowel syndrome.
Zhao X, Zhi X, Han Y … +2 more , Lai D, Tou J
J Pediatr Surg · 2026 May · PMID 42190869 · Publisher ↗
OBJECTIVE: To evaluate the clinical value and efficacy of colonic segment reversal in children with short bowel syndrome (SBS). METHODS: A retrospective review was conducted on 11 children with SBS who underwent colonic...
OBJECTIVE: To evaluate the clinical value and efficacy of colonic segment reversal in children with short bowel syndrome (SBS). METHODS: A retrospective review was conducted on 11 children with SBS who underwent colonic segment reversal at our center between January 2016 and October 2025. Postoperative intestinal transit time, weaning rate from parenteral nutrition (PN), and growth parameters (weight-for-age z-score, WAZ), complications, and frequency of small intestinal bacterial overgrowth (SIBO) were evaluated. RESULTS: Eleven children (8 males, 3 females) underwent colonic reversal. The overall survival rate was 100% (11/11), and the PN weaning rate was 63.6% (7/11). The median time to PN weaning was 3 months. Postoperative intestinal transit time was prolonged compared with preoperative values (data available for 3 patients). The median preoperative WAZ was -1.85, which improved to -0.87 at 6 months postoperatively. Complications included one case of reversible intestinal obstruction and one case of anastomotic ulcer. The frequency of small intestinal bacterial overgrowth did not increase significantly. CONCLUSION: Colonic segment reversal is a safe and effective surgical option for selected children with SBS, particularly when residual small bowel length is extremely limited. Surgical strategies should be individualized, taking into account residual bowel length, motility, and anatomical conditions.
Is torsion of the undescended testis intrinsically associated with worse salvage? A matched cohort analysis.
Ahmad I, Khondker A, Rickard M … +5 more , Santos JD, Romao RLP, Pippi Salle JL, Lorenzo AJ, Chua ME
J Pediatr Surg · 2026 May · PMID 42177941 · Publisher ↗
BACKGROUND: Testicular torsion in undescended testes (UDT) has poor salvage rates, but it remains unclear if the cryptorchid state itself confers an intrinsic disadvantage. We aimed to compare testicular salvage between...
BACKGROUND: Testicular torsion in undescended testes (UDT) has poor salvage rates, but it remains unclear if the cryptorchid state itself confers an intrinsic disadvantage. We aimed to compare testicular salvage between UDT and descended torsion while controlling for presentation variables. METHODS: In a single-institutional retrospective cohort (2010-2024), using propensity score matching, 25 UDT torsion cases were matched 1:2 to 129 descended torsion controls on age, ischemia time, and testicular volume. The primary outcome was salvage on post-operative imaging (≥50% volume of contralateral testis). Conditional and multivariable logistic regression was employed on the matched cohort to test for associations of clinical factors with testicular salvage. RESULTS: After matching, 69 patients were included (24 UDT; 45 descended). Baseline characteristics were balanced between groups, including age, ischemia time, and testicular volume. Salvage rates were lower between UDT and descended torsion (13% vs. 27%), although this did not reach statistical significance (p = 0.229). Conditional regression confirmed UDT status was not an independent predictor of salvage (OR 0.43, 95% CI 0.11-1.69; p = 0.231). In a multivariable model, only ischemia time independently predicted against salvage (OR 0.73 per hour, 95% CI 0.53-0.87; p = 0.011). Just 4% of UDT cases presented within 6 h of symptom onset. CONCLUSION: After controlling for presentation factors, salvage in UDT torsion was numerically lower than in descended torsion, although this difference did not reach statistical significance. We identified delayed intervention as the main driver of poorer outcomes in our cohort. Improving salvage requires heightened suspicion and expedited surgical referral for any boy with a history of cryptorchidism and acute inguinal pain.
Single-use, low-profile flexible ureterorenoscopy in paediatric lithiasis: Preliminary experience expanding the boundaries of ESPU recommendations.
Israel SD, Burgos L, Ortiz R … +3 more , Fernández-Bautista B, Ordóñez J, Angulo JM
J Pediatr Surg · 2026 May · PMID 42177014 · Publisher ↗
INTRODUCTION: Single-use flexible ureterorenoscopy (fURS) is a well-established practice today in adult patients with urological lithiasis. Its application in children is becoming more widespread thanks to the availabili...
INTRODUCTION: Single-use flexible ureterorenoscopy (fURS) is a well-established practice today in adult patients with urological lithiasis. Its application in children is becoming more widespread thanks to the availability of lower profile devices (<7Fr). Its indication remains limited in ESPU clinical guidelines. The aim of this study is to present our clinical experience and analyse the applicability of these guidelines in our practice. METHODS: A retrospective observational descriptive study was designed. Patients who underwent laser lithotripsy with single-use ureterorenoscopes during 2023-2024 were included. RESULTS: Eleven paediatric patients who underwent a total of 15 procedures were included. The mean age was 9.48 years (range: 2-16). The median stone size was 9 mm (range: 5-27). Six (40%) were located in the lower calyx. Up to 6 patients (40%) had multiple lithiasis and 3 of them (20%) had coraliform lithiasis. The most common composition was calcium oxalate in 7 cases (46.67%), followed by cystine in 5 (33.33%). Most were treated by Holmium laser lithotripsy assisted with 7.5 Fr ureterorenoscopes on a 10-12 Fr ureteral sheath. The mean hospital stay was 1.20 days (SD ± 0.56). The procedure was successful in 11 patients (73.33%). Four of them (26.67%) underwent reoperation due to the presence of residual stones larger than 5 mm on ultrasound. Complications were reported in 2 patients (13.33%), Clavien-Dindo categories I and III. CONCLUSION: Single-use fURS is an effective and safe alternative for the treatment of urological lithiasis in children. It has good results in terms of safety, recovery time, and stone removal, even in coral-shaped or lower calyx stones. These preliminary results suggest that single-use fURS may support an expansion of current ESPU indications, though larger prospective studies are needed to confirm these findings.
Long term outcomes of the antegrade continence enema in children with an anorectal malformation - A systematic review.
Lane R, Comella A, Trajanovska M … +1 more , King SK
J Pediatr Surg · 2026 May · PMID 42155890 · Publisher ↗
PURPOSE: The role of the antegrade continence enema (ACE) in children has been studied extensively; however, its role specifically in children with an anorectal malformation (ARM) is less clearly documented. This systema...
PURPOSE: The role of the antegrade continence enema (ACE) in children has been studied extensively; however, its role specifically in children with an anorectal malformation (ARM) is less clearly documented. This systematic review aimed to synthesise and evaluate existing data regarding long-term outcomes of ACE in children with ARM. METHODOLOGY: Two databases (Embase and MEDLINE) were reviewed. Studies were eligible if their population included children under the age of 18 with an ARM who underwent an ACE procedure. All studies from when the ACE was first described in April 1990, to April 2025, were considered. We excluded conference abstracts, non-English papers and studies with less than five children with ARM in the described population. RESULTS: After excluding duplicates, there were 456 relevant papers. Following abstract and full text screening, 19 papers were eligible for analysis. Most studies were case series, with two cross-sectional studies. The total number of children with ARM and ACE was 696. The type of ARM was specified in 205 of these patients. The type of ACE was reported for 317 patients. Although differences in continence definitions were found, continence data following the procedure were available from 16/19 studies with 404/479 patients reported to have faecal continence with ACE. There was insufficient data to subdivide the outcomes into either types of ACE or type of ARM. Complications were reported in seven studies; 128/474 patients experienced complications associated with their ACE. A total of 24 patients were reported to have ceased use of their ACE, 19 of whom no longer required it. Quality of life outcomes were commented on in four papers with overall improvement post ACE. CONCLUSION: This systematic review highlights the lack of reporting and subgroup analysis in the published literature regarding long-term outcomes of ACE use in children with ARM. These patients differ from those with chronic idiopathic constipation, neurogenic bowel or Hirschsprung disease and, therefore, require an independent assessment of the utility of the ACE. We urge authors to consider children with ARM as a separate group when reporting outcomes of ACE use in future studies.
Pediatric urethroscope versus flexible choledochoscope for removal of distal protein plugs and calculi in choledochal cyst: A prospective cohort study.
Jiang C, Shao Y, Chen W … +6 more , Gao R, Li Z, Yang K, Yang C, Li L, Diao M
J Pediatr Surg · 2026 May · PMID 42155889 · Publisher ↗
BACKGROUND: Choledochal cyst (CC) is a common congenital biliary malformation that occurs frequently in children. CC is often complicated by protein plugs, calculi, and other debris, predisposing patients to cholangitis,...
BACKGROUND: Choledochal cyst (CC) is a common congenital biliary malformation that occurs frequently in children. CC is often complicated by protein plugs, calculi, and other debris, predisposing patients to cholangitis, pancreatitis, and other adverse events. Thorough intraoperative removal of obstructive debris is critical for improving postoperative outcomes. At present, intraoperative endoscopy represents the main modality for removing distal obstructions; however, consensus regarding the comparative efficacy of pediatric urethroscope and flexible choledochoscope remains lacking. OBJECTIVE: To compare the clinical efficacy of pediatric urethroscope and flexible choledochoscope in removing distal obstructions in choledochal cysts, to provide evidence for rational selection of clinical therapeutic strategies. METHODS: A single-center prospective cohort study was conducted. A total of 123 pediatric patients with distal obstruction of choledochal cyst admitted to our center from June 2023 to June 2025 were enrolled and alternately allocated into the urethroscope group (62 cases) and the choledochoscope group (61 cases). Distal obstructive debris was removed using pediatric urethroscope and flexible choledochoscope, respectively. Intraoperative parameters, postoperative recovery, complication rates and follow-up outcomes were compared between the two groups. Subgroup analyses were performed according to operative age, cyst type and pancreatobiliary maljunction (PBM) classification. RESULTS: Baseline characteristics, PBM classification and anatomical variations were comparable between the two groups. The complete removal rate of distal obstructions was 100% in both groups, with no significant differences in postoperative hospital stay, drainage tube removal time, or complications such as bile leakage, bleeding and pancreatitis. Compared with the choledochoscope group, the urethroscope group had significantly shorter total operative time [194.5 (153.0, 234.0) min vs. 236.0 (176.0, 307.0) min, P = 0.006], markedly shorter time required for obstruction removal [5.0 (5.0, 7.0) min vs. 15.0 (11.0, 17.0) min, P < 0.001], and fewer total endoscopic insertions [1.0 (1.0, 2.0) vs. 4.0 (3.0, 5.0), P < 0.001]. Subgroup analyses confirmed that these advantages were more prominent in patients aged ≤3 years, those with cystic dilatation, and those with type B PBM. After a median follow-up of 15 months, no significant differences were observed in the rates of anastomotic stenosis, new intrahepatic stone formation or pancreatitis between the two groups. CONCLUSIONS: Both pediatric urethroscope and flexible choledochoscope demonstrate favorable safety profiles and complete clearance efficacy in removing distal obstructions in choledochal cysts. The pediatric urethroscope yields higher procedural efficiency and may be preferred in clinical practice, especially for centers that have recently adopted such procedures. The choice can be flexibly made according to the endoscopic equipment configuration of medical institutions.
Letter to the Editor Comment on; Surgical Risk, Operative Time, and Anesthesia Time Associated With Combining Tracheostomy and Gastrostomy Tube Placement Under a Single Anesthetic.
Prasad A, Bhuvan
J Pediatr Surg · 2026 May · PMID 42155888 · Publisher ↗
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Operative strategies for Hirschsprung disease presenting in adults: A systematic review.
Takeda M, Suzuki T, Miyano G
J Pediatr Surg · 2026 May · PMID 42144037 · Publisher ↗
AIM: To systematically review the surgical management of Hirschsprung disease in patients diagnosed or undergoing definitive surgical treatment in adulthood, and to identify factors influencing operative decision-making...
AIM: To systematically review the surgical management of Hirschsprung disease in patients diagnosed or undergoing definitive surgical treatment in adulthood, and to identify factors influencing operative decision-making in elective and emergency settings. MATERIALS AND METHODS: PubMed, Embase, Scopus, and Web of Science were searched. Studies reporting surgical management of histologically confirmed Hirschsprung disease in patients aged 18 years or older were included. Operative strategies and determinants of surgical decision-making were extracted. RESULTS: A total of 207 adult patients from 113 studies were included. Adult-specific factors were reported to influence treatment selection in 24 patients (12%). Elective surgical management was reported in 136 patients (66%) and included staged repair (48 [35%]), myectomy (37 [27%]), and one-stage repair (37 [27%]), whereas permanent stoma was rare (2 [1%]). Emergency surgery was required in 62 patients (30%). Operative strategy was strongly influenced by diagnostic recognition: when Hirschsprung disease was recognized preoperatively, stoma-based decompression was favored, whereas lack of recognition was associated with a higher rate of subtotal or total colectomy (39% vs 8%, P = 0.01). Restoration of intestinal continuity after extensive resection was uncommon. CONCLUSIONS: Adult Hirschsprung disease represents a distinct clinical context in which operative decision-making is shaped by adult-specific factors and surgeon experience, and differs between elective and emergency settings. Failure of diagnostic recognition is associated with a higher likelihood of inappropriate extensive bowel resection, potentially limiting subsequent reconstructive options.
First comparison of open, laparoscopic, and robot-assisted laparoscopic retroperitoneal pyeloplasty for pediatric ureteropelvic junction obstruction at a single institution.
Tanaka M, Koga H, Miyake Y … +9 more , Yoshida S, Suda K, Shibuya S, Ochi T, Fujiwara N, Arii R, Lane GJ, Miyano G, Yamataka A
J Pediatr Surg · 2026 May · PMID 42142829 · Publisher ↗
PURPOSE: Open retroperitoneal (OR), laparoscopic retroperitoneal (LR), and robot-assisted laparoscopic retroperitoneal (RR) pyeloplasty (PP) were compared for clinical effectiveness and safety in pediatric ureteropelvic...
PURPOSE: Open retroperitoneal (OR), laparoscopic retroperitoneal (LR), and robot-assisted laparoscopic retroperitoneal (RR) pyeloplasty (PP) were compared for clinical effectiveness and safety in pediatric ureteropelvic junction obstruction (UPJO) at a single institute. METHODS: A retrospective review of 80 eligible pediatric UPJO patients treated by PP from 2000 to 2022 (OR: n = 23, LR: n = 33, RR: n = 24) analyzed demographics, hospitalization details, complications (Clavien-Madadi classification), and pre-/postoperative renal function. "Improvement" was defined as postoperative status being at least 5% better than preoperative status. Total anastomotic time (TAT) and TAT/suture were calculated from intraoperative videos for LR and RR. RESULTS: Hospitalization was significantly shorter in RR compared to OR (median 8 [IQR 7-9.2] vs. 12 [IQR 9-16.5] days; p < 0.01). Seven cases had complications of Clavien-Madadi grade III or higher (OR: 2, LR: 3, RR: 2), but overall complication rates were not significantly different (OR: 35%, LR: 18%, RR: 17%; p = 0.24). Redo surgery for persistent UPJO was required in 4 cases (OR: 2, LR: 1, RR: 1). Although comparable at 24 months, RR demonstrated significantly higher 12-month functional improvement in both SRF (58.3% vs. 34.8% [OR] and 21.2% [LR]; p = 0.016) and GFR (70.8% vs. 39.1% and 27.3%; p = 0.004). TAT and TAT/suture were both significantly shorter with less variance in RR (p < 0.05, respectively). CONCLUSION: RR provides comparable safety and long-term functional success to OR and LR. However, robotic assistance significantly reduces anastomotic time compared to LR and facilitates earlier functional recovery at 12 months postoperatively.
What are we trying to teach? A content analysis of pediatric surgery rotation objectives in general surgery training.
Vaughn CR, Kochis MA, Mudreac A … +2 more , Patel K, Wieck MM
J Pediatr Surg · 2026 May · PMID 42134578 · Publisher ↗
PURPOSE: Pediatric surgery is mandatory for general surgery residents; however, no standardized curriculum exists. Written goals and objectives (G&O) can be useful to communicate expectations, but it is unclear how these...
PURPOSE: Pediatric surgery is mandatory for general surgery residents; however, no standardized curriculum exists. Written goals and objectives (G&O) can be useful to communicate expectations, but it is unclear how these are utilized in pediatric surgery. Our aim was to assess the content and quality of pediatric surgery educational curricula as expressed in orientation materials for general surgery residents. METHODS: We conducted a survey of ACGME-accredited programs and a mixed methods analysis of pediatric surgery orientation materials. Content was coded across 28 categories. G&O quality was rated using the adapted I-SMART framework encompassing specificity, importance, feasibility, and measurability, on a 0-3 scale/category. RESULTS: Documents were obtained from 17 programs (4.6%), ranging in size and location. Seven (41%) programs had a document dedicated to G&O, 4 (24%) had a section on G&O within an orientation document, and 6 (35%) lacked G&O. Overall quality of G&O was low, with an average total score of 5.0. Content analysis revealed a focus on knowledge of specific diseases (94% of programs), patient care (94%), and practical knowledge (88%). Least represented were cost awareness (18%), patient advocacy (18%), and critical thinking (24%). 35% of programs lacked G&O related to technical skills. CONCLUSIONS: The presence, quality, and content of G&O for residents on pediatric surgery rotations vary substantially. When provided, G&O often lacked a delineation of importance, a realistic plan to achieve the goals, and measurable outcomes. There is significant opportunity to optimize general surgery residents' education through high-quality G&O.
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