Tannuri ACA, Abe Takahasi BN, de Almeida Estrambk G
… +7 more, Ortega Ramos GR, Saraiva Santos ME, de Lima Silva M, Marques Dos Anjos R, Troici VC, Reis Freitas JL, Tannuri U
BACKGROUND: Esophageal atresia (EA) is frequently associated with congenital heart disease (CHD) and chromosomal anomalies, mainly Down syndrome (DS). While these conditions affect outcomes following primary repair, thei...BACKGROUND: Esophageal atresia (EA) is frequently associated with congenital heart disease (CHD) and chromosomal anomalies, mainly Down syndrome (DS). While these conditions affect outcomes following primary repair, their specific impact on esophageal substitution procedure remains poorly defined. This study aimed to evaluate the influence of CHD and chromosomal anomalies on surgical outcomes following esophagocoloplasty for failed repair of EA patients. METHODS: Retrospective study including patients who underwent esophagocoloplasty between January 2015 and January 2025 at a single center divided into 4 groups: HD (CHD and DS), D (isolated DS), H (isolated CHD) and C (isolated EA). Demographic, clinical and surgical data, postoperative complications, length of stay, and mortality were analyzed. RESULTS: 105 patients were included (mean age 31.2 months; 57.1% male). VACTERL-associated anomalies were present in 53.3% of patients, with CHD being the most frequent (33.3%). DS was identified in 7.6% of the cohort. Postoperative complications occurred in 40% of cases, (87.9% minor complications). Multivariate analysis demonstrated that CHD was independently associated with impaired postoperative weight gain (OR = 3.62; p = 0.008). DS was not associated with major complications or mortality, although a trend toward an increased risk of sepsis was observed. Overall mortality was 0.95% (one case). No significant differences in the incidence of major complications among the study groups were observed. CONCLUSIONS: CHD negatively affected postoperative nutritional recovery but did not increase major morbidity or mortality in esophagocoloplasty patients. Chromosomal anomalies did not compromise overall surgical safety, supporting the feasibility of esophagocoloplasty in this complex patient population.
OBJECTIVE: To explore the unique clinical characteristics of biliary atresia (BA) combined with cytomegalovirus (CMV) infection and its impact on early and late prognosis after Kasai portoenterostomy (KPE). METHODS: This...OBJECTIVE: To explore the unique clinical characteristics of biliary atresia (BA) combined with cytomegalovirus (CMV) infection and its impact on early and late prognosis after Kasai portoenterostomy (KPE). METHODS: This was a retrospective study involving children diagnosed with BA and treated with KPE at the Children's Hospital of Jiangxi Province from January 2017 to October 2023. Based on the presence or absence of CMV infection, the patients were divided into a CMV infection group and a CMV non-infection group. The follow-up period ended on October 1, 2025, with a minimum follow-up duration of >2 years. Data were collected and analyzed, including basic characteristics, core disease features, core laboratory indicators, treatment-related indicators, surgical success within 3 months postoperatively, and native liver survival status after more than 2 years. RESULTS: A total of 70 BA patients were included, with 19 in the CMV infection group and 51 in the CMV non-infection group. In the CMV infection group, 31.6% (6/19) had successful operation, while in the non-infection group, 47.1% (24/51) had successful operation. In the CMV infection group, 78.9% (15/19) experienced native liver failure (NLF), whereas in the non-infection group, 51.0% (26/51) experienced NLF. Differential analysis showed significant differences between the CMV infection group and the non-infection group in terms of age at admission, surgical age, hepatomegaly, surgical weight, GLO levels, AST levels, DBIL levels, gallbladder ejection fraction, postoperative antiviral treatment (P < 0.05), while no significant differences were found in gender, ALB, ALP, ALT, GGT, PLT, splenomegaly, BASM, other associated malformations, BA anatomical classification, early postoperative cholangitis, and total postoperative steroid dose (P > 0.05). Univariate and multivariate analyses showed that CMV infection is an independent risk factor for long-term NLF postoperatively (HR = 1.998, 95% CI:1.008,3.994, P = 0.047), but it had no significant effect on the short-term success rate of KPE (OR = 2.118, 95% CI: 0.644, 6.967, P = 0.217). Kaplan Meier plotter showed that the cumulative incidence of NLF events was significantly higher in the CMV infection group, and the median native liver survival time was significantly shorter (Log-Rank P < 0.05). CONCLUSION: Although CMV infection does not affect the early success rate of KPE, it is an independent risk factor for long-term NLF, significantly reducing the long-term survival rate of native liver in BA patients. Therefore, in the future, CMV status can be used as an important indicator for risk stratification and long-term follow-up of BA patients.
PURPOSE: Respiratory complications are a major source of morbidity in esophageal atresia (EA), yet predictors of short- and long-term respiratory outcomes are not well defined. This study aimed to identify perioperative...PURPOSE: Respiratory complications are a major source of morbidity in esophageal atresia (EA), yet predictors of short- and long-term respiratory outcomes are not well defined. This study aimed to identify perioperative factors associated with respiratory morbidity in EA/TEF patients. METHODS: We conducted a retrospective cohort study of 242 EA patients treated at a single tertiary center from 2005 to present. Short-term respiratory morbidity was defined as the need for supplemental respiratory support at 30 days postoperatively from primary EA repair. Long-term morbidity was determined based on a composite outcome that consisted of: tracheostomy, secondary tracheopexy, recurrent pneumonia, chronic pulmonary disease, or ongoing respiratory support at last follow-up. Preoperative factors including gestational age, birthweight, syndromic diagnoses, congenital heart disease and long-gap atresia, were evaluated using univariate and multivariable logistic regression. RESULTS: Of the 242 patients, 167 had complete short- and long-term follow-up; 48 (28.7%) required respiratory support at 30 days following EA repair. Prematurity, birthweight <2 kg, and syndromic EA (VACTERL, CHARGE/Other, trisomy) were independently associated with short-term respiratory morbidity (p < 0.01). Among these 167 patients, 77 (46.1%) developed chronic respiratory morbidity. Early postoperative respiratory status, specifically the need for supplemental respiratory support at 30 days, was the only independent predictor of long-term morbidity (OR 4.69, 95% CI 1.54-15.48). CONCLUSION: Preoperative characteristics predict short-term respiratory morbidity but do not reliably predict long-term outcomes. Notably, early postoperative respiratory status is the key determinant of chronic respiratory morbidity. Recognition of at-risk patients may guide postoperative management and follow-up strategies. LEVEL OF EVIDENCE: IIb.
BACKGROUND: Adolescent gynecomastia is associated with psychological distress. However, current literature evaluating the impact of surgical intervention has largely relied on single-center design and patient-reported ou...BACKGROUND: Adolescent gynecomastia is associated with psychological distress. However, current literature evaluating the impact of surgical intervention has largely relied on single-center design and patient-reported outcomes, leaving clinically diagnosed psychiatric trends unstudied. This study evaluated whether mastectomy for persistent gynecomastia is associated with differences in incident psychiatric diagnoses among adolescents. METHODS: A retrospective cohort study using the Pediatric Health Information System (PHIS) database from 2004 to 2025 was performed. Adolescent males diagnosed with gynecomastia with ≥3 years of follow-up and no prior psychiatric history were included. The primary outcome was incident psychiatric diagnoses (anxiety, depression, eating disorders, or suicidal ideation/self-harm). Propensity score matching (1:2) was performed to balance demographics, socioeconomics, and obesity. Time-varying Cox proportional hazards models were used to account for operative timing. RESULTS: Of 2605 patients, 130 (5.0%) underwent mastectomy. After propensity score matching, 390 were analyzed (130 surgical; 260 control) with a 4.33-year median follow-up. The surgical cohort demonstrated significantly lower incidence of overall psychiatric morbidity (7.7% vs. 20.0%, p = 0.003), anxiety (5.4% vs. 13.1%, p = 0.031), and suicidal ideation/self-harm (0.8% vs. 6.2%, p = 0.028). Time-varying modeling confirmed mastectomy was associated with a 71% lower risk for incident anxiety (HR 0.29; 95% CI, 0.09-0.94; p = 0.039) and a 54% lower risk for overall psychiatric morbidity (HR 0.46; 95% CI, 0.21-0.99; p = 0.049). CONCLUSIONS: Among adolescents with gynecomastia and no prior psychiatric diagnosis, mastectomy is associated with significantly lower rates of incident psychiatric morbidity compared to nonoperative management. For the appropriately selected patient, surgical intervention may have psychosocial implications beyond physical correction.
BACKGROUND: Purpose: Accurate preoperative classification of anorectal malformations (ARM) guides surgical planning, yet cross-table radiography may misclassify anatomy. We compared the diagnostic performance of transper...BACKGROUND: Purpose: Accurate preoperative classification of anorectal malformations (ARM) guides surgical planning, yet cross-table radiography may misclassify anatomy. We compared the diagnostic performance of transperineal ultrasound (TPUS) and radiography, with emphasis on cases where these modalities disagreed. METHODS: Retrospective review of neonates with ARM who underwent both TPUS and radiography before intervention (2018-2020). Patients in whom physical examination alone provided definitive classification were excluded. Classifications were validated against intraoperative findings. Primary outcome was diagnostic accuracy; discordance patterns were analyzed to identify which modality performed better when clinical uncertainty existed. RESULTS: Among 61 neonates (17 with anatomy amenable to primary perineal repair, 26 rectourethral bulbar, 18 higher lesions by intraoperative findings), TPUS showed higher sensitivity for identifying anatomy amenable to primary repair compared with radiography (100% vs 17.6%, p < 0.001). Overall accuracy was 90.2% for TPUS versus 73.8% for radiography (p = 0.041). In 21 discordant cases, TPUS was correct in 15 (71.4%, 95% CI: 47.8-88.7%) and radiography in 5 (23.8%, 95% CI: 8.2-47.2%); one case was misclassified by both modalities. Among the 15 cases where TPUS was correct but radiography incorrect, 14 were lesions amenable to primary repair that radiography had systematically misclassified as requiring multi-stage approaches. CONCLUSIONS: When TPUS and radiography disagree, TPUS shows higher accuracy, particularly for identifying anatomy amenable to primary perineal repair. Radiography tended to overestimate complexity in this diagnostically challenging subset. Incorporating TPUS into the diagnostic evaluation may support more informed surgical decision-making. LEVEL OF EVIDENCE: III (Retrospective diagnostic study).
BACKGROUND: Gastrostomy tube dislodgement is a common postoperative complication in children, with reported rates of dislodgement from 10% to 43%. Understanding, and ultimately reducing, gastrostomy tube dislodgements an...BACKGROUND: Gastrostomy tube dislodgement is a common postoperative complication in children, with reported rates of dislodgement from 10% to 43%. Understanding, and ultimately reducing, gastrostomy tube dislodgements and their consequences can help decrease the significant morbidity from this complication. We quantified the incidence, contributing factors, and complications after gastrostomy tube dislodgements at our institution. METHODS: We conducted a single-institution retrospective review of children who underwent initial laparoscopic gastrostomy tube placement between August 2019 and August 2024. We performed descriptive statistics of demographic and surgical data, univariate analysis, and multivariable logistic regression, with the primary outcome of gastrostomy tube dislodgement. We defined statistical significance as p < 0.05. RESULTS: Among 755 patients who underwent laparoscopic gastrostomy tube placement, 275 (36.4%) had a tube dislodgement and 21 (2.8%) required reoperation due to dislodgement. Dislodgements that occurred within 30 days postoperatively were nearly three times as likely to require operative intervention (10.0% vs. 3.5%, OR 3.10, 95% CI 1.28-7.54; p = 0.04). Dislodgement rates were similar between the transfacial temporary fixation technique (TTFT) and the subcutaneous stay suture technique (SSST) (37.1% vs 33.4%, respectively; p = 0.81). However, patients who underwent placement via the TTFT had an increased risk of return to the OR after dislodgement (6.1% vs. 0.0%, p = 0.02). CONCLUSION: Gastrostomy tube dislodgement is a common occurrence. While the TTFT and SSST laparoscopic techniques are associated with similar gastrostomy tube dislodgement rates, TTFT is associated with an increased rate of return to the OR after dislodgement. Surgeons should consider SSST as a means to minimizing morbidity after dislodgement.
BACKGROUND: Suction is frequently used on chest tubes draining parapneumonic effusions, but its impact on clinical progression remains uncertain. While suction may expedite drainage, it might also delay healing by perpet...BACKGROUND: Suction is frequently used on chest tubes draining parapneumonic effusions, but its impact on clinical progression remains uncertain. While suction may expedite drainage, it might also delay healing by perpetuating leaks or pneumothorax. This study used Markov modeling to assess the effect of suction on transitions between clinically meaningful states. METHODS: With REB approval, we reviewed the charts of 81 children who had 95 chest tubes placed for parapneumonic effusions between 2014 and 2024. Necrotizing pneumonia patients were excluded. Six clinical states were categorized as: Drainage (>2 mL/kg/day), Dry (≤2 mL/kg/day), Leak (bubbling), Pneumothorax, Resolved and Video-Assisted Thoracoscopic Surgery. Suction was recorded as either absent or present. A semi-Markov model, adjusting for time spent in each state, was used to evaluate the impact of suction on state transitions. Hazard ratios (HR) and p-values were estimated. RESULTS: Suction decreased the rate of moving from the Dry state to the Resolved state (HR = 0.40, p = 0.002), suggesting that suction was associated with a delay in clinical improvement once the effusion had cleared. Suction did not affect the likelihood of moving from other clinically important states toward resolution. CONCLUSION: While suction is believed to promote faster clearance of parapneumonic effusions, it may slow recovery after the effusion has been evacuated. These findings support the early use of suction with discontinuation once the effusion resolves. Further prospective studies are warranted to refine suction strategies in pediatric parapneumonic effusions.
PURPOSE: Trisomy 21 (T21) is frequently associated with congenital heart disease and other comorbidities that may influence outcomes following esophageal atresia (EA) repair. The independent effect of T21 on postoperativ...PURPOSE: Trisomy 21 (T21) is frequently associated with congenital heart disease and other comorbidities that may influence outcomes following esophageal atresia (EA) repair. The independent effect of T21 on postoperative mortality remains unclear. We sought to evaluate outcomes following EA repair in patients with and without T21. METHODS: We conducted a retrospective cohort study using the NSQIP-P database (2012-2020) of patients undergoing EA repair. Primary outcome was 30-day postoperative mortality. Secondary outcomes included postoperative complications, 30-day readmission, reoperation, and length of stay (LOS). Propensity score matching (10:1) balanced cohorts by age, operative weight, cardiac risk factors, and presence of tracheoesophageal fistula. Multivariable logistic regression identified predictors of mortality. RESULTS: Among 2229 patients, 49 (2.2%) had T21. Compared to non-T21 patients, those with T21 were older at repair (21 vs. 2 days, p < 0.001) and had a longer LOS (30 vs. 20 days, p = 0.008). Rates of reoperation, readmission, and overall complications were similar. After matching, T21 was independently associated with increased 30-day mortality (OR 10.2, 95% CI 2.23-46.75; p = 0.003). Operative weight was also associated with mortality (OR 0.29, 95% CI 0.09-0.94; p = 0.40). Trisomy 21 was not associated with overall complications, but a higher rate of VTE (OR 5.16, 95% CI 1.2-22.24; p = 0.028) was identified in these patients. CONCLUSION: Trisomy 21 is a risk factor for 30-day mortality following EA repair. These findings inform perioperative risk stratification and preoperative counseling in this high-risk population.
BACKGROUND: Cryptorchidism is one of the most common congenital abnormalities and it is associated with impaired fertility, increased malignancy risk, and testicular atrophy. Orchidopexy is the standard treatment for int...BACKGROUND: Cryptorchidism is one of the most common congenital abnormalities and it is associated with impaired fertility, increased malignancy risk, and testicular atrophy. Orchidopexy is the standard treatment for intra-abdominal testes, but the optimal surgical approach remains debated, particularly regarding the role of gubernacular sparing. OBJECTIVES: To compare gubernaculum-sparing and gubernaculum-excision orchidopexy for abdominal cryptorchidism in pediatric patients, focusing on postoperative testicular atrophy rates. MATERIALS AND METHODS: A systematic review and meta-analysis were conducted according to PRISMA guidelines and registered in PROSPERO. A comprehensive search was performed in PubMed, Embase, Cochrane Library, and Web of Science for studies published up to February 2025. Eligible studies compared gubernaculum-sparing orchidopexy (GS) and gubernaculum-excision orchidopexy (GE) in patients with intra-abdominal testis. The primary endpoint was testicular atrophy rate, and secondary outcomes included postoperative testicular growth. RESULTS: Three studies, including 195 patients, met the inclusion criteria. No significant baseline difference in testis size was observed (MD = -41.3 mm; 95% CI -192.9-110.4). The pooled analysis showed significantly lower atrophy rates with gubernaculum-sparing orchidopexy versus excision (OR = 0.07; 95% CI 0.01-0.91; I= 80.8%; p = 0.0225). No significant differences in testis size were found at 3 months (MD = 11.7 mm; 95% CI -45.9-69.4) or 6 months (MD = 0.4 mm; 95% CI -52.7-53.5), with negligible heterogeneity (I= 0%). All included studies were rated as low-to-moderate risk of bias. CONCLUSIONS: This systematic review and meta-analysis demonstrated that gubernaculum sparing during laparoscopic orchidopexy for intra-abdominal testis is associated with lower testicular atrophy rates and comparable postoperative testicular growth. These findings suggest that maintaining gubernacular integrity may help preserve collateral blood supply and optimize testicular viability.
PURPOSE: Surgery is the cornerstone of therapy for hepatoblastoma (HB). While standard resection (SR) via hemi-hepatectomy and trisectionectomy has traditionally been the preferred surgical approach, parenchyma-sparing r...PURPOSE: Surgery is the cornerstone of therapy for hepatoblastoma (HB). While standard resection (SR) via hemi-hepatectomy and trisectionectomy has traditionally been the preferred surgical approach, parenchyma-sparing resection (PSR) has become increasingly popular. We sought to compare the characteristics and outcomes of patients who underwent PSR versus SR. METHODS: Single-institution retrospective cohort study of HB patients who underwent hepatectomy from February 8, 2012 to August 12, 2024. Patients with metastasis at diagnosis, who underwent transplant, or who received simultaneous SR and PRS were excluded. Primary outcomes included 5-year event-free (EFS) and overall survival (OS). Secondary outcomes included margin status, transfusion requirement, operative time, postoperative liver dysfunction, reoperation, and biliary complications. RESULTS: Forty-three patients met inclusion criteria (21 PSR, 22 SR). More patients in the PSR group presented with pre-treatment extent of disease (PRETEXT) I tumors, multifocal disease or underwent upfront resection, whereas the SR group more frequently displayed aggressive histology. No events were observed in the PSR cohort at a median follow-up of 4.8 years, corresponding to 100% estimated 5-year EFS and OS. The estimated 5-year EFS and OS in the SR cohort were 87%; however when controlling for histology, the EFS and OS was equivalent to the PSR group. Two patients in the PSR group had microscopically positive resection margins compared to none in the SR group. PSR was associated with lower intra- and postoperative transfusion requirements, shorter operative times, and less severe postoperative liver dysfunction. CONCLUSION: In this single-institution retrospective study, PSR was associated with acceptable oncologic outcomes in spite of two patients having microscopically positive margins. In select patients with low PRETEXT stage, multifocal tumors, and favorable vascular relationships, PSR may represent a viable surgical option when technically feasible and within surgeon expertise.
Mesfin FM, Lee J, Joseph S
… +9 more, Manohar K, Hunter CE, Shelley WC, Brokaw JP, Jiang G, Liu J, Gil CH, Ma M, Markel TA
J Pediatr Surg
· 2026 May · PMID 42102956
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INTRODUCTION: Mesenchymal stem cells (MSCs) have been studied as potential therapeutic agents for various diseases. However, their widespread application has been limited, in part, due to the concern for tumorigenic tran...INTRODUCTION: Mesenchymal stem cells (MSCs) have been studied as potential therapeutic agents for various diseases. However, their widespread application has been limited, in part, due to the concern for tumorigenic transformation and lack of longevity in host environments secondary to immune-mediated destruction. Therefore, we set out to study an MSC encapsulation and delivery method with potential application in the treatment of intestinal ischemic diseases. METHOD: Human vertebra bone adherent mesenchymal stem cells (vBA-MSCs) were encapsulated in an alginate-derived Thread Reinforced Encapsulation Device (THRED). The encapsulated cells were then tested for viability, ability to retain cell surface markers, and ability to synthesize and release cytokines. Furthermore, a mouse ischemia-reperfusion model was used to test the therapeutic potential of encapsulated MSCs. RESULTS: vBA-MSCs were successfully packaged in the experimental cell encapsulation device. Encapsulated MSCs remained viable and functional while retaining their cell surface markers. Furthermore, encapsulated MSCs improved mouse intestinal injury scores following intestinal ischemia and reperfusion injury. DISCUSSION: The THRED is a viable option to deliver mesenchymal stem cells during therapy. Further studies are needed to elucidate the ideal number of cells and the length of time needed to deliver optimal therapy.
BACKGROUND: Pulmonary metastasectomy can improve the survival of children with pulmonary metastases from solid tumors. However, preoperative imaging often suggests chest wall and/or mediastinal invasion, raising concerns...BACKGROUND: Pulmonary metastasectomy can improve the survival of children with pulmonary metastases from solid tumors. However, preoperative imaging often suggests chest wall and/or mediastinal invasion, raising concerns about resectability. Thus, we aimed to investigate associations between computed tomography (CT) findings and intraoperatively assessed chest wall or mediastinal invasion in children, adolescents, and young adults. METHODS: We retrospectively reviewed data on pulmonary metastasectomies performed between January 2015 and December 2024. Tumors considered radiographically suspicious for pleural contact or invasion on the most recent preoperative CT scan were included. Tumor invasiveness was classified according to gross intraoperative findings, including adhesion to surrounding structures, pleural thickening, and pleural dissemination. RESULTS: Fifty-seven metastatic lesions from 26 procedures in 20 patients showed CT findings suggestive of invasion. Based on intraoperative findings, lesions were classified as macroscopically invasive (n =18) or macroscopically non-invasive (n = 39). Multivariate analysis showed that a higher ratio of tumor-pleura contact length to tumor diameter was associated with invasion (p = 0.005; odds ratio, 7.48; 95% confidence interval, 1.83-30.60). However, this association did not reach statistical significance in a mixed-effects logistic regression analysis (p = 0.088). CONCLUSIONS: In this small retrospective cohort, a higher ratio of tumor-pleura contact length to tumor diameter was associated with intraoperatively assessed macroscopic chest wall or mediastinal invasion in patients undergoing pulmonary metastasectomy. These findings require validation in larger prospective studies.