Journal Of Pediatric Surgery[JOURNAL]
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200 papers
Long-term effectiveness of transversus abdominis single muscle flap repair for large congenital diaphragmatic hernia.
Duchesne C, Verdier E, Aquilina L … +7 more , Gaillot T, Le Bouar G, Beuchee A, Azzis O, Fremond B, Habonimana E, Arnaud AP
J Pediatr Surg · 2026 May · PMID 42092587 · Publisher ↗
AIM: Surgical repair of large congenital diaphragmatic hernia (CDH) remains a challenge. Although many different procedures are described, none has become a 'gold standard'. This study aimed to evaluate long-term results...
AIM: Surgical repair of large congenital diaphragmatic hernia (CDH) remains a challenge. Although many different procedures are described, none has become a 'gold standard'. This study aimed to evaluate long-term results of the single muscle flap repair to avoid using a prosthetic patch. MATERIALS AND METHODS: After institutional review board approval (#15.92), we conducted a retrospective study including all neonates who underwent single transversus abdominis muscle flap repair as first-line treatment for large CDH between 1995 and 2023 in our institution. Survivors were assessed clinically for growth, hernia recurrence, surgical complications, abdominal deformities, chest wall deformities and scoliosis. Data are reported as medians with ranges. RESULTS: Twenty-seven patients underwent surgical repair at a median age of 29 h of life (4-96). All had an antenatal diagnosis, and 25 (92.6%) were left-sided defects. Twenty-two patients survived to hospital discharge and were available for long-term follow-up. At a median follow-up of 8.9 years (0.5-19.1), no diaphragmatic hernia recurrence was observed. Minor donor-site abdominal wall bulging occurred in 5 patients (23.8%), and 1 patient (4.5%) developed an abdominal wall hernia. Adhesive bowel obstruction requiring surgery occurred in 5 patients (22.7%). Pectus deformities were observed in 7 patients (33.3%). Thoracogenic scoliosis occurred in 7 patients (33.3%), with surgical treatment required in one case. CONCLUSION: Single transversus abdominis muscle flap repair provides durable closure of large congenital diaphragmatic hernia defects with no recurrence at long-term follow-up and acceptable morbidity. This technique represents a reliable alternative to prosthetic patch repair for large diaphragmatic defects.
Should we continue to follow the swallow? Limited value of routine preoperative upper gastrointestinal (UGI) series in pediatric and adolescent metabolic and bariatric surgery patients.
Lim J, Kim AG, Vidmar AP … +6 more , Vu MH, Samakar K, Martin MJ, Abel SA, Belteton GF, Wong HJ
J Pediatr Surg · 2026 May · PMID 42092586 · Publisher ↗
BACKGROUND: Hiatal hernia is frequently encountered intraoperatively during metabolic and bariatric surgery (MBS) in adults with relatively poor diagnostic accuracy on preoperative imaging. However, data on pediatric MBS...
BACKGROUND: Hiatal hernia is frequently encountered intraoperatively during metabolic and bariatric surgery (MBS) in adults with relatively poor diagnostic accuracy on preoperative imaging. However, data on pediatric MBS populations is limited. We aimed to determine the prevalence of hiatal hernias in a pediatric bariatric cohort and evaluate the utility of preoperative upper gastrointestinal (UGI) series. METHODS: We conducted a retrospective review of 94 patients who underwent preoperative UGI series and sleeve gastrectomy from November 2023 to July 2025. Primary outcomes were the prevalence of hiatal hernias on UGI, concordance between UGI and intraoperative findings, and associations with reflux symptoms. RESULTS: Hiatal hernia was identified in one patient (1.1%) on preoperative UGI series, which was consistent with intraoperative findings of a hiatal hernia in the same patient who underwent repair. Gastroesophageal reflux was identified on UGI in 19/90 patients (21%). Of 7 patients (7.4%) who had reflux symptoms preoperatively, only 3 had reflux on UGI. Three months postoperatively, 4/90 patients (4.4%) reported reflux symptoms, 2 of whom had preoperative symptoms and reflux on UGI. CONCLUSIONS: The prevalence of hiatal hernias in the pediatric MBS population is exceedingly low, and preoperative UGI findings failed to demonstrate meaningful findings. This suggests that UGI is not a useful predictive tool in this setting and routine preoperative evaluation for hiatal hernias may not be warranted.
Repeat pelvic osteotomy improves the management of failed bladder closure in cloacal exstrophy.
Crigger CB, Mayeux E, Yang J … +6 more , Johnson MM, Heap D, Nasr I, DiCarlo H, Sponseller PD, Gearhart JP
J Pediatr Surg · 2026 May · PMID 42092585 · Publisher ↗
PURPOSE: The authors evaluated the operative benefits of repeat pelvic osteotomy in patients with cloacal exstrophy (CE) undergoing secondary or tertiary bladder closures. METHODS: CE patients undergoing secondary or ter...
PURPOSE: The authors evaluated the operative benefits of repeat pelvic osteotomy in patients with cloacal exstrophy (CE) undergoing secondary or tertiary bladder closures. METHODS: CE patients undergoing secondary or tertiary closures between 1975 and 2025 were identified. Primary pelvic osteotomy was defined as a patient's first osteotomy. Repeat osteotomy refers to the patient's subsequent osteotomy performed at the time of reclosure. Patient demographics, surgical factors, and outcomes were collected. RESULTS: Among 35 secondary closures, 19 succeeded while 16 failed. A longer interval between primary and secondary closures (1.72 years vs. 0.64 years, p= 0.0031) as well as primary and repeat osteotomies (4.23 years vs. 0.86 years, p = 0.037) was associated with higher success of secondary closures compared to failure. Primary and repeat osteotomies were significantly associated with secondary closure success while secondary closures without osteotomies had higher failure rates (p= 0.02). For secondary closures, 8 patients did not receive an osteotomy. Regarding the type of osteotomy, combined vertical and transverse anterior innominate osteotomies were associated with higher successes in secondary closures (n = 16, 61.11% vs. n = 1, 11.11%), whereas posterior iliac only osteotomies were more likely to result in failure (n = 5, 27.78% vs. n = 7, 77.78%, p= 0.02). Regarding immobilization techniques, the use of Buck's traction with external fixation for secondary bladder closure resulted in higher success rates, while the use of Spica casting, resulted in higher failure rates (n = 16, 63.16% vs. n = 13, 25%, p= 0.02). Secondary closure success was significantly higher at the authors' institution compared to outside hospitals with (n = 13, 68.42% vs. n = 6, 31.58%, p= 0.0016). CONCLUSION: Repeat pelvic osteotomy enhanced secondary closure success in CE patients. Osteotomy techniques using combined vertical and transverse anterior innominate osteotomies, as well as the use of Buck's traction with external fixation, were particularly beneficial. These findings suggest that repeat osteotomy along with appropriate immobilization can enhance surgical outcomes in complex CE management of secondary bladder closures. TYPE OF STUDY: Treatment Study. LEVEL OF EVIDENCE: Level III.
Surgical approach to the management of biliary atresia in the United States.
Stetson A, Sescleifer AM, Kahan AM … +10 more , Kunisaki SM, Alaish SM, Padilla B, Lal DR, Tiao G, Corbitt N, Slidell MB, Eastern Pediatric Surgery Network Collaborators, Midwest Pediatric Surgery Consortium Collaborators, Western Pediatric Surgery Research Consortium Collaborators
J Pediatr Surg · 2026 May · PMID 42092584 · Publisher ↗
BACKGROUND: The Kasai portoenterostomy (KPE) is the only option to achieve native liver survival for patients with biliary atresia and yet technical variations exist. We surveyed members of three American pediatric surge...
BACKGROUND: The Kasai portoenterostomy (KPE) is the only option to achieve native liver survival for patients with biliary atresia and yet technical variations exist. We surveyed members of three American pediatric surgery research consortia regarding their approach to the KPE. METHODS: Members from the Eastern Pediatric Surgery Network (EPSN), Midwestern Pediatric Surgery Consortium (MWPSC), and Western Pediatric Surgery Research Consortium (WPSRC) developed the survey which was distributed via REDCap to consortia member institutions. RESULTS: The survey was completed by 44/45 institutions. KPE is performed by pediatric surgeons at 41 sites (93%), a transplant surgeon at one (2%), and both at two (5%). Twenty-six sites (59%) transected into the liver capsule, 10 (23%) into the liver, two (5%) into the fibrous cord, and 6 (14%) reported variance. One site (2%) reported use of cautery in addition to sharp dissection for porta hepatis transection. The most common length for the Roux limb was 25-35 cm (16, 36%), with 14 sites (32%) creating a Roux limb < 25 cm, eight sites (18%) > 35 cm, and 6 sites (14%) responding that length varies between surgeons. Surgical diagnosis with intraoperative cholangiogram (IOC) was always performed at 33 sites (75%), and twenty-eight sites (64%) obtain both preoperative percutaneous and intraoperative biopsies. Two sites (5%) offer partially laparoscopic KPE. CONCLUSION: In the first survey of American surgical practices for KPE, we found consensus regarding some technical aspects of the operation. However, the responses to most questions demonstrated variability. Future studies will analyze how technical variations impact national KPE outcomes.
Assessing the value of postnatal echocardiograms prior to congenital duodenal obstruction repair.
Wright JG, Hameedi SG, Texter K … +7 more , Hovell ME, Schafer CG, Inamdar AJ, Kamr A, Sbragia L, Ogunleye OK, Olutoye OO
J Pediatr Surg · 2026 May · PMID 42082098 · Publisher ↗
BACKGROUND: Congenital duodenal obstruction (CDO) is surgically repaired in the immediate postnatal period; however, its association with congenital heart disease warrants preoperative evaluation of cardiac physiology. G...
BACKGROUND: Congenital duodenal obstruction (CDO) is surgically repaired in the immediate postnatal period; however, its association with congenital heart disease warrants preoperative evaluation of cardiac physiology. Given the availability and accuracy of prenatal echocardiography, we sought to determine the value of an additional postnatal preoperative echocardiogram. METHODS: A retrospective cohort study was conducted via chart review on patients diagnosed with CDO at a tertiary children's hospital from January 2013 to December 2023. Echocardiogram findings were reviewed, and defects were divided based on primary physiology. RESULTS: Of the 90 patients with CDO, 31 (34%) patients had an associated cardiac anomaly-20 (65%) shunting lesions, 7 (23%) conotruncal anomalies, and 1 (2%) each had: single ventricle physiology, partial anomalous pulmonary venous return (PAPVR), and a vascular ring. Forty (44%) patients had an associated syndrome or chromosomal abnormality. Prenatal echocardiogram had a positive predictive value of 100% [80-100%], negative predictive value of 78% [58-100%], sensitivity of 75% [53-89%], and specificity of 100% [82-100%] for finding the described anomalies (p < 0.0001). Of the 38 patients who had both prenatal and postnatal echocardiograms, 5 (13%) had a ventricular septal defect identified postnatally that was not seen prenatally. There were no false positive findings prenatally. CONCLUSION: In the presence of a prenatal echocardiogram, a postnatal echocardiogram is unlikely to identify a clinically significant additional cardiac anomaly that may impact CDO repair. Our data suggests that surgical repair of CDO need not be delayed for a postnatal echocardiogram if a prenatal echocardiogram was performed.
Exploring health literacy and clinical outcomes among caregivers of children undergoing gastrostomy tube placement.
Easwaran L, Dawson-Gore CC, Meraz AI … +3 more , Mata C, Diaz-Miron JL, Acker SN
J Pediatr Surg · 2026 Apr · PMID 42069244 · Publisher ↗
BACKGROUND: Surgical gastrostomy tubes (G-tubes) are common pediatric surgery procedures; however, they require caregiver perioperative education for appropriate management. One factor that has not been well explored is...
BACKGROUND: Surgical gastrostomy tubes (G-tubes) are common pediatric surgery procedures; however, they require caregiver perioperative education for appropriate management. One factor that has not been well explored is the impact of caregiver health literacy on the effectiveness of G-tube education. This study aimed to understand caregiver health literacy levels and associated clinical outcomes to inform design of future education interventions. METHODS: A prospective cohort analysis was performed for caregivers of children who underwent initial G-tube placement from 11/2024-7/2025. Data collection included demographic information, assessment of sociodemographic factors, assessment of health literacy using the validated Parental Health Literacy Activities Test (PHLAT-8) score, and presence of complications and health resource utilization 30 days after surgery. Descriptive statistics were reported. PHLAT-8 scores were compared by education and annual household income level. Poisson and logistic regression models were used to predict clinical outcomes. RESULTS: Of the 86 eligible caregivers approached, 49 consented to participate in the study. The median PHLAT-8 score was 6 (IQR 6-8). Higher scores were associated with higher attained education levels and higher annual household income (p < 0.05 for both). There was no association between PHLAT-8 scores and health utilization or complications 30 days after surgery. CONCLUSION: All caregivers in our study demonstrated adequate health literacy. In contrast to prior data, this series did not find any differences in health care utilization or complication rates based on parental health literacy, indicating our population may have appropriate literacy levels to understand the management of pediatric G-tubes. LEVEL OF EVIDENCE: III.
Staged controlled bowel expansion prior to serial transverse enteroplasty in preterm neonates with short bowel syndrome: A safe and feasible strategy to enable intestinal reconstruction.
Mammoo S, Alshahwani N, Mancha MA … +4 more , Ali M, Baghazal H, Brisseau G, Khalil B
J Pediatr Surg · 2026 Apr · PMID 42066894 · Publisher ↗
BACKGROUND: Preterm neonates with short bowel syndrome represent one of the most challenging populations in pediatric intestinal rehabilitation. Autologous intestinal reconstruction is frequently delayed in this group be...
BACKGROUND: Preterm neonates with short bowel syndrome represent one of the most challenging populations in pediatric intestinal rehabilitation. Autologous intestinal reconstruction is frequently delayed in this group because insufficient bowel dilation precludes safe lengthening, prolonging dependence on parenteral nutrition and increasing the risk of intestinal failure-associated liver disease, sepsis, and growth failure. METHODS: We conducted a retrospective single-center cohort study of preterm neonates with short bowel syndrome managed with a standardized protocol of controlled bowel expansion (CBE) followed by serial transverse enteroplasty (STEP) between 2018 and 2025. Eligible patients had pediatric intestinal failure requiring parenteral nutrition for ≥60 consecutive days. Primary outcomes were bowel length gain and achievement of enteral autonomy. Secondary outcomes included complications and resolution of intestinal failure-associated liver disease (IFALD). RESULTS: Nine preterm neonates were included (median gestational age 27 weeks [IQR, 25-28]; median birth weight 880 g [IQR, 820-1080]; underlying aetiology predominantly necrotizing enterocolitis [78%]). Baseline bowel length was a median of 33 cm (18% of expected for gestational age). During the CBE phase, bowel length increased by a median of 20 cm (IQR, 14.5-30), allowing progression to definitive STEP after a median expansion period of 27 weeks (IQR, 18.1-33). STEP provided an additional median gain of 20 cm (IQR, 14-40), with a cumulative median gain of 54.5 cm (IQR, 42-61) and a final bowel length of 61% of expected. Eight of nine patients (88%) achieved full enteral autonomy at a median of 29.3 weeks post-STEP (IQR, 24.1-52.5). IFALD resolved in all affected patients, and no mortality or post-STEP surgical complications occurred. CONCLUSIONS: In preterm neonates with short bowel syndrome, CBE was incorporated as part of a staged surgical pathway prior to STEP, during which bowel length increased. This approach was feasible and was associated with progression to STEP, with high rates of enteral autonomy observed in the cohort. These findings suggest that CBE may serve as a preconditioning strategy to enable timely reconstruction in a population traditionally considered unsuitable for early lengthening. Prospective multicentre studies are warranted to validate these outcomes and standardize patient selection.
Physician guideline for pediatric palliative ECMO discontinuation.
Melnyk B, Cain-Trivette CJ, Gerall C … +2 more , Lindeman M, Middlesworth W
J Pediatr Surg · 2026 Jul · PMID 42066893 · Publisher ↗
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Letter to the Editor comment on: Progression of esophageal atresia associated Barrett's esophagus in adulthood - Is endoscopic surveillance worth it?
Yasuda JL, Chang D, Ngo P … +2 more , Manfredi MA, Zendejas B
J Pediatr Surg · 2026 Apr · PMID 42066892 · Publisher ↗
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Outcomes of pediatric median arcuate ligament release: A single-center experience.
Halpern AI, Byrd CE, Kovler ML … +3 more , Newman T, Petrosyan M, Kane TD
J Pediatr Surg · 2026 Apr · PMID 42061607 · Publisher ↗
INTRODUCTION: Median arcuate ligament syndrome (MALS) is a rare condition caused by compression of the celiac artery by the median arcuate ligament. The surgical treatment for MALS is a median arcuate ligament release (M...
INTRODUCTION: Median arcuate ligament syndrome (MALS) is a rare condition caused by compression of the celiac artery by the median arcuate ligament. The surgical treatment for MALS is a median arcuate ligament release (MALR). While outcomes of MALR are well described in adults, pediatric data remain limited. Leveraging our extensive institutional experience, we sought to address this gap by reporting the largest single-institution cohort of pediatric patients undergoing MALR at a standalone children's hospital. METHODS: We performed a single-institution retrospective review of all patients who underwent laparoscopic MALR between January 2013 and December 2024 at a standalone children's hospital. We performed descriptive statistics and univariate analyses, with the primary outcome measure of freedom from treatment failure after MALR, defined as any symptom improvement after MALR without symptom recurrence. RESULTS: Median arcuate ligament release was performed in 286 patients. Median age at surgery was 17.1 years. All cases were performed laparoscopically with one conversion to an open operation (0.3%). Mean postoperative length of stay was 1.5 days. Freedom from treatment failure was achieved in 61.2% of patients. Complications occurred in 2.4% of patients. CONCLUSION: Our single-institution retrospective review describes the largest series of MALR at a freestanding children's hospital. We demonstrate a 61.2% freedom from treatment failure rate with minimal complications, supporting MALR as a safe therapeutic option for pediatric MALS. However, the substantial rate of postoperative symptom persistence or recurrence highlights the need for careful patient selection and thorough preoperative counseling regarding expected outcomes.
Surgical outcomes and complications of sacrococcygeal teratoma in neonates and infants: A systematic review and meta-analysis stratified by tumor characteristics and surgical approach.
Alizadeh H, Khosravi R, Khosravi H
J Pediatr Surg · 2026 Apr · PMID 42061606 · Publisher ↗
BACKGROUND: Sacrococcygeal teratoma (SCT) is the most common congenital tumor in neonates and infants. Despite advances in surgical management, reported outcomes remain heterogeneous, particularly regarding mortality, re...
BACKGROUND: Sacrococcygeal teratoma (SCT) is the most common congenital tumor in neonates and infants. Despite advances in surgical management, reported outcomes remain heterogeneous, particularly regarding mortality, recurrence, and long-term functional complications. To synthesize contemporary evidence on surgical outcomes and postoperative complications of SCT in neonates and infants through a systematic review and meta-analysis. METHODS: A comprehensive search of PubMed/MEDLINE, Embase, Web of Science, Scopus, and Cochrane Central was conducted from January 2000 to February 2026 in accordance with PRISMA 2020 guidelines. Observational studies reporting postoperative outcomes of SCT resection in patients aged ≤12 months were included. Primary outcomes were overall mortality and tumor recurrence. Secondary outcomes included wound complications, urinary dysfunction, and bowel dysfunction. A random-effects meta-analysis of proportions was performed using the DerSimonian-Laird method with Freeman-Tukey double arcsine transformation. Heterogeneity was assessed using the I statistic. RESULTS: Twenty-one studies comprising 1399 patients met the inclusion criteria. The pooled overall mortality rate was 5% (95% CI 3-6%; I= 0%). Tumor recurrence occurred in 9% of cases (95% CI 7-11%; I= 22%). Wound complications were observed in 23% (95% CI 15-31%; I= 86%). The pooled rates of urinary and bowel dysfunction were 15% (95% CI 10-20%; I= 82%) and 21% (95% CI 14-29%; I= 88%), respectively. Mortality demonstrated minimal heterogeneity, whereas complication outcomes showed substantial variability across studies. CONCLUSIONS: Surgical management of SCT in neonates and infants is associated with favorable survival outcomes but considerable morbidity and a notable risk of recurrence. These findings underscore the importance of meticulous surgical technique, routine coccygectomy, and prolonged multidisciplinary follow-up. Standardized outcome reporting and prospective studies are needed to improve risk stratification and optimize long-term care.
Surgical nodal staging in rhabdomyosarcoma of the bladder and/or prostate with or without nodal or metastatic spread. A report from the European Paediatric Soft-Tissue Sarcoma Study Group (EpSSG).
Smeulders N, Gaze MN, Guérin F … +22 more , Rogers T, Terwisscha van Scheltinga S, DeCorti F, Chisholm J, Slater O, Minard-Colin V, Coppadoro B, Zanetti I, Craigie R, Burrieza GG, Dall'Igna P, Fajardo RD, Lim P, Chargari C, Espenel S, Luis Huertas AL, Cho A, Nguyen T, Rees H, Bisogno G, Merks JHM, Martelli H
J Pediatr Surg · 2026 Jul · PMID 42055245 · Publisher ↗
BACKGROUND: Risk stratification of rhabdomyosarcoma (RMS) requires accurate staging, with histological nodal assessment being of critical importance for specific tumour sites. This report explores the value of surgical n...
BACKGROUND: Risk stratification of rhabdomyosarcoma (RMS) requires accurate staging, with histological nodal assessment being of critical importance for specific tumour sites. This report explores the value of surgical nodal staging in bladder-prostate rhabdomyosarcoma (BP-RMS). PROCEDURE: Patients with BP-RMS enrolled in the RMS2005 and MTS2008 trials (2005-2016) were reviewed for the staging methodology and outcome. RESULTS: Significant differences in 5-year overall and progression-free survival were observed for the 224 patients with BP-RMS of different Tumour-Node-Metastasis (TNM) stages (p < 0.0001). Nodal staging was by imaging in all but 7/224 (3.1%) patients at presentation. Despite the opportunity for nodal sampling at surgery in 175 patients, no nodes were obtained in 120/175 (68.6%). Nodal sampling at surgery after 4-8 chemotherapy cycles in 48 patients, identified tumour in 6/37 (16.2%) patients considered N0 by imaging (all aged <10 years with favourable histology >5 cm tumours) and observed no tumour in 8/11 (72.7%) deemed N1, prompting changes to local therapy in 9/14 (64.3%). Overall, surgical nodal assessment did not impact on local/nodal progression/relapse (12/55, 21.8%) as compared to staging by imaging alone (29/166, 16.9%, p = 0.548; data missing for 3 patients). Pathological nodal assessment also failed to show benefit on locoregional events for patients with significantly poorer outcome, namely those aged ≥10 years (p = 0.446) or with unfavourable histology (p = 0.613). The specific targeting of nodal basins by radiotherapy showed no impact on outcome (p = 1.000). CONCLUSIONS: In contrast to other sites, surgical nodal sampling, undertaken in 24.6% (in 3.1% at diagnosis), does not significantly impact outcome of BP-RMS, despite imaging-pathological discordance prompting changes to treatment for affected patients.
Intraoperative ultrasound in nephron-sparing surgery for paediatric renal tumours: A single-centre cohort study.
Bebi C, Watson T, Mantovani A … +11 more , Brok J, Meshaka R, Ashworth E, Chowdhury T, Duncan C, Sebire N, Hutchinson JC, Cherian A, Mushtaq I, Cho A, Smeulders N
J Pediatr Surg · 2026 Jul · PMID 42055244 · Publisher ↗
BACKGROUND: Nephron-sparing surgery (NSS) for paediatric renal tumours seeks maximal parenchymal preservation. However, incomplete tumour excision often requires additional therapy impacting renal function. We evaluate t...
BACKGROUND: Nephron-sparing surgery (NSS) for paediatric renal tumours seeks maximal parenchymal preservation. However, incomplete tumour excision often requires additional therapy impacting renal function. We evaluate the impact of intraoperative ultrasound on histological margins during NSS (US-NNS). METHODS: All patients offered US-NSS (2016-2025) were recorded prospectively and compared to all historical NSS cases (2000-2016) undertaken without ultrasound (non-US-NSS). On-table US was performed by a consultant radiologist using a linear-array transducer on the renal capsule. NSS sought a rim of normal parenchyma and was used for multiple lesions when needed. Data included demographics, histology, surgical margins, and kidney/specimen volumes. Using the formula d1 × d2 × d3 × 0.523, pathological specimen volumes were subtracted from the pre-operative MRI renal unit volumes to determine the percentage of preserved parenchyma. Fisher's exact test compared margin positivity for malignant lesions. RESULTS: The cohorts comprised 128 non-US-NSS in 51 patients (median age 28 months) and 39 US-NSS in 20 patients (median age 15.5 months). Histology for the 128 non-US-NSS were 64 Wilms tumours (WT), 13 equivocal WT, 51 non-malignant lesions, and for the 39 US-NSS 14 WT, 1 equivocal WT, 3 renal cell carcinoma (RCC), and 21 non-malignant lesions. The median specimen volumes per renal unit was 12.00 cm (IQR 4.01-28.5 cm) vs 8.93 cm (IQR 3.34-17.89 cm), and median preserved parenchyma per renal unit was 84.56% (IQR 62.71%-97.17%) vs 90.74% (IQR 74.20%-96.67%) in non-US-NSS vs US-NSS. Positive margins for malignant lesions occurred in 27/75 (36%) non-US-NSS, and in 0/18 US-NSS (p < 0.001). CONCLUSION: Intraoperative ultrasound for NSS eliminated positive margins for malignant lesions while maintaining high parenchymal preservation.
Effects of growth factor application on germ cell architecture and oxidative stress handling in a rat model of testicular torsion-detorsion.
Menon R, Saxena R, Elhence P … +7 more , Nayak P, Sharma T, Pathak M, Rathod KJ, Jadhav AS, Nayak S, Sinha A
J Pediatr Surg · 2026 Apr · PMID 42044739 · Publisher ↗
PURPOSE: Testicular torsion is a surgical emergency in paediatric population, in which delayed intervention often leads to irreversible ischaemic injury. Oxidative stress plays a key role in testicular damage. Although s...
PURPOSE: Testicular torsion is a surgical emergency in paediatric population, in which delayed intervention often leads to irreversible ischaemic injury. Oxidative stress plays a key role in testicular damage. Although several experimental therapies have been explored, the effect of local growth hormone (GH) application needs to be further defined. This study evaluated the impact of local GH on testicular morphology and oxidative stress parameters following torsion-detorsion in a rat model. METHODS: Eighteen male Wistar rats were randomly assigned to three groups (n = 6 each): sham, torsion, and local GH. Torsion was induced in the torsion and GH groups, followed by detorsion. In the GH group, 2 IU of recombinant human GH loaded onto a gelatin hydrogel was applied locally to the testis immediately after detorsion. After 24 h, the testes were harvested for histopathological and biochemical analyses. Histological injury was graded using the Cosentino score, and antioxidant parameters, including superoxide dismutase, catalase, glutathione peroxidase, glutathione reductase, and reduced glutathione, were measured spectrophotometrically. RESULTS: The median Cosentino score was significantly higher in the torsion group than in the sham and GH-treated groups, indicating improved preservation of testicular architecture following GH application. In contrast, the oxidative stress-handling capacity was impaired in the GH group, with significantly reduced levels of reduced glutathione, catalase, and glutathione peroxidase, along with diminished total superoxide handling capacity. CONCLUSION: Local application of growth hormone after torsion-detorsion preserved testicular architecture and reduced histological injury compared with the torsion group. This protective effect was not associated with an increase in the antioxidant enzyme activity.
Deep learning-based Wilms tumor segmentation to create 3D models for surgical planning: Implementation in the clinical workflow.
Buser MAD, de Groot NT, Simons DC … +6 more , Littooij AS, Wijnen MHWA, van de Ven CP, van den Heuvel-Eibrink MM, Fitski M, van der Steeg AFW
J Pediatr Surg · 2026 Jul · PMID 42044738 · Publisher ↗
BACKGROUND AND AIM: Creating 3D models based on pre-operative MRI of patients with a Wilms tumor (WT) can aid surgical planning. However, creating these models requires manual delineation (segmentation) of the MRI imagin...
BACKGROUND AND AIM: Creating 3D models based on pre-operative MRI of patients with a Wilms tumor (WT) can aid surgical planning. However, creating these models requires manual delineation (segmentation) of the MRI imaging. Deep learning can automate this, but most validations of these segmentation methods are retrospective. This article prospective evaluation of a WT segmentation method in a clinical workflow aimed at creating 3D models for surgical planning. METHODS: A deep learning-based segmentation method was developed and retrospectively validated on a dataset of 56 patients. This method, based on nnU-Net, segmented both kidney and tumor and was implemented within the current clinical workflow. It was tested prospectively on 10 consecutive patients with WT. The performance of this method was quantified using the Dice score between the automated and corrected segmentations, the time required for the various steps of the clinical workflow and an analysis of segmentation errors. RESULTS: In 2/10 patients the automated segmentation was sufficient to be used directly. In 8/10 patients the automated segmentation needed corrections (with a median correction time of 11 min). The median Dice score for kidney was 1.00 (range: 0.58-1.00) and for tumor 0.98 (range: 0.00-1.00). The segmentation errors identified most often were an under-segmentation of tumor borders (n = 3) and the incorrect identification of the tumor/kidney border (n = 3). CONCLUSION: The implementation of an automated segmentation method for creating 3D models of patients with a WT is feasible in current clinical workflows. In 20% of the patients, no corrections were needed and for most other patients, corrections could be applied in less than 15 min. CLINICAL TRIAL REGISTRATION: None.
Incidence, predictive factors, and proposed classification of wound complications in pediatric extremity bone sarcoma patients following extirpative surgery.
Qureshi AA, Kennedy CC, Gupta R … +7 more , Schroeder MJ, Nieveras M, Han-Yin Lin S, Vasko A, Bjorklund KA, Scharschmidt T, Barker JC
J Pediatr Surg · 2026 Apr · PMID 42036066 · Publisher ↗
PURPOSE: There is a limited understanding of postoperative wound complications in osteosarcoma (OS) and Ewing sarcoma (ES) patients. Delays in adjuvant chemotherapy protocols due to such complications may significantly c...
PURPOSE: There is a limited understanding of postoperative wound complications in osteosarcoma (OS) and Ewing sarcoma (ES) patients. Delays in adjuvant chemotherapy protocols due to such complications may significantly compromise overall survival rates. We aim to 1) report the incidence and contributing factors of wound complications following extremity extirpative surgery in OS and ES and 2) propose a clinically relevant wound classification scheme. METHODS: A retrospective cohort study (Level of Evidence III) was conducted on extirpative surgeries for extremity bone sarcomas at a tertiary pediatric center over the past 16 years, ensuring a minimum follow-up period of 3 months. Patients were categorized based on whether they experienced postoperative wound complications. Fisher's exact test was employed to examine the demographic and clinical variables. Additionally, we present a new classification system aimed at accounting for any delays in the treatment protocol. RESULTS: Among 88 patients, 69.3% had OS (n = 61) and 30.7% had ES (n = 27). Median age was 12.5 (IQR:9-15), with 55.7% (n = 49) male. 87.5% (77/88) of surgeries were limb salvages and 12.5% (11/88) were amputations. Overall wound complication rate was 43.2% (n = 38). Reported classifications were grade I (14/38, 36.8%), grade II (4/38, 10.5%), and grade III (20/38, 52.6%). Median time to complication was 30.5 days (IQR: 7.0-50.0). Tibia and fibula sarcomas (71.0%, 22/31) were associated with wound complications; femoral sarcomas (70.0%, 28/40) were associated with an absence of wound complications (p < 0.001). Wound complications were higher in patients with both orthopedic and plastic surgery reconstruction compared to those without (65.0% vs 35.0%, p < 0.01). CONCLUSION: Postoperative wound complications occur in nearly half of pediatric patients with extremity bone sarcomas. Those with sarcomas in the tibia/fibula or who undergo combined orthopedic and plastic surgical reconstruction are particularly high risk. Our wound classification system reveals that grade III complications are most common, often leading to treatment delays. Accurate classification is essential for grasping the implications and enhancing patient outcomes. Larger studies are necessary to validate our system and findings.
Lung volume evaluation of modified Nuss procedure for pectus excavatum using three-dimensional computed tomography: A single-center retrospective analysis.
Xiong Y, Gu S, Li G … +2 more , Wang W, Wang X
J Pediatr Surg · 2026 Jul · PMID 42031102 · Publisher ↗
BACKGROUND: The Nuss procedure is widely used for Pectus excavatum (PE) repair. This study aimed to evaluate the efficacy of the modified Nuss procedure and identify prognostic factors by analyzing lung volume (LV) chang...
BACKGROUND: The Nuss procedure is widely used for Pectus excavatum (PE) repair. This study aimed to evaluate the efficacy of the modified Nuss procedure and identify prognostic factors by analyzing lung volume (LV) changes via three-dimensional computed tomography (3D-CT). METHODS: PE patients receiving the modified Nuss procedure between 2019 and 2022 were retrospectively reviewed. 3D-CT was performed preoperatively, postoperatively, and at 2-year postoperatively to measure the volume of each lung, lobe and segment. Chi-square test or Fisher's exact test was used for intergroup comparisons. Univariate and multivariate linear regression analyses were used to screen predictors. RESULTS: A total of 87 PE patients were included. Preoperative CT assessment showed a median Haller Index (HI) of 3.5. Postoperative LVs of most lobes and segments significantly decreased initially but improved markedly at 2 years postoperatively (P< 0.05). Significant improvement in the volumes of left lateral basal segment (LS9) and right lateral basal segment (RS9) were observed in patients with mild PE. Multivariate analysis revealed male gender, higher preoperative LV, and weight as positive predictors of long-term postoperative LV recovery, while higher HI and prolonged postoperative hospital stay were negative predictors. Higher HI was associated with a sustained negative effect on the recovery of multiple lung segments. CONCLUSIONS: The modified Nuss procedure provides segment-specific improvement in long-term LVs measured by 3D-CT in PE patients, with distinct recovery patterns related to HI. Severe PE can result in more extensive and potentially irreversible pulmonary parenchymal damage.
Subclavian approach without ultrasound guidance is safe and effective for pediatric central venous access.
Mayon L, Chiang YJ, Lee A … +5 more , Mahesri K, Tsao K, Speer AL, Lally KP, Austin MT
J Pediatr Surg · 2026 Jul · PMID 42031101 · Publisher ↗
BACKGROUND: The American College of Surgeons (ACS) recommends US guided internal jugular (IJ) approach for central venous access devices (CVADs); however, this is suboptimal in children. We use the subclavian without US...
BACKGROUND: The American College of Surgeons (ACS) recommends US guided internal jugular (IJ) approach for central venous access devices (CVADs); however, this is suboptimal in children. We use the subclavian without US guidance for access in children and adolescents and young adults (AYAs) at a high-volume oncology center. STUDY DESIGN: We undertook a prospective observational study of patients ≤ 26 years undergoing CVAD placement between 1/1/15-9/30/23. US guidance was used in IJ but not in subclavian CVADs, and all procedures were performed by or under direct attending supervision following a standardized protocol. Adverse events (AEs) within 180 days were collected. Multivariate logistic regression model was applied to determine risk factors for predicting AEs. RESULTS: Seven hundred and thirteen patients were included. Overall AE rate was 25.7%. Ninety-nine patients had early AEs, and 84 had late AEs. Most common AEs included thrombosis (7.9%), migration (6.5%) and mechanical malfunction (6.9%). Central line-associated blood stream infection (CLABSI) rate was 4.1%. Most (83%, n = 590) CVADs were subclavian without US guidance, and pneumothorax and bleeding rates were extremely low (0.3% and 0.7%). IJ CVADs had increased CLABSI and thrombosis rates compared to subclavian (8.4% vs 3.5% and 16.8% vs 8.9%, p< 0.05). BMI ≥ 30 and steroid use were associated with all AEs (p< 0.001 and p= 0.003). CONCLUSION: Our results suggest utilizing the subclavian without US guidance is safe and effective for children and AYAs with cancer. This challenges the 2011 ACS recommendation for the use of US guidance in all CVAD placements.
Intraluminal bougienage-based elongation for native-preserving salvage in long-gap esophageal atresia.
Li S, Jiao J, Hua K … +7 more , Xie C, Zhao Y, Liao J, Wang D, Gu Y, Li Z, Huang J
J Pediatr Surg · 2026 Jul · PMID 42031100 · Publisher ↗
BACKGROUND: Preservation of the native esophagus is the preferred goal in long-gap esophageal atresia (LGEA); however, some infants remain unsuitable for anastomosis after spontaneous growth or failure of established len...
BACKGROUND: Preservation of the native esophagus is the preferred goal in long-gap esophageal atresia (LGEA); however, some infants remain unsuitable for anastomosis after spontaneous growth or failure of established lengthening strategies. METHODS: We retrospectively reviewed infants with LGEA who underwent intraluminal bougienage-based elongation followed by delayed anastomosis between July 2020 and July 2025. Patients were stratified by age at initiation of elongation (<3 months vs. ≥3 months) for descriptive comparison. Outcomes were compared, and multivariable linear regression analyses were performed as exploratory analyses to assess factors associated with operative duration and postoperative esophageal dilations. RESULTS: Twenty-six infants were included (≥3 months, n = 14; <3 months, n = 12). Native esophageal continuity was achieved in all patients. Infants aged ≥3 months had longer operative duration (211.3 ± 73.7 vs. 152.1 ± 47.1 min, p = 0.043) and more postoperative dilations (20.4 ± 15.3 vs. 8.4 ± 5.9, respectively; p = 0.016), while complication rates and costs were similar. In adjusted analyses, operative duration and dilations were associated with prior proximal esophageal mobilization (β = 10.51 min, p = 0.004; β = 15.11 sessions, p < 0.001), whereas age showed only borderline associations. After excluding infants with prior proximal esophageal mobilization, outcomes were comparable across age groups. CONCLUSIONS: Intraluminal bougienage-based elongation may serve as a native-preserving salvage or adjunctive strategy in selected infants with LGEA who remain unsuitable for anastomosis after spontaneous growth or prior interventions.
Opioid prescribing practices at discharge across common pediatric surgery procedures.
Lin AM, Asti L, Rachwal B … +1 more , Minneci PC
J Pediatr Surg · 2026 Jul · PMID 42025913 · Publisher ↗
INTRODUCTION: In 2020, the American Pediatric Surgical Association (APSA) released evidence-based recommendations for opioid prescribing after surgery, grouping procedures into opioid-free recovery (OFR) and opioid-free...
INTRODUCTION: In 2020, the American Pediatric Surgical Association (APSA) released evidence-based recommendations for opioid prescribing after surgery, grouping procedures into opioid-free recovery (OFR) and opioid-free recovery possible (OFRP). This study investigated rates and associated factors of opioids prescribing at discharge after common general surgery procedures based on APSA recommendations. METHODS: The American College of Surgeons National Surgical Quality Improvement Program-Pediatric (NSQIP-P; 2023) was queried for patients <18 years undergoing elective general surgery procedures. Within NSQIP-P, OFR procedures were inguinal hernia repair and pyloromyotomy and OFRP procedures were appendectomy, cholecystectomy, and Nuss procedure. Descriptive statistics on demographics and 30-day outcomes were compared. A logistic regression model was fit for predicting opioid prescription at discharge after OFR cohort and after appendectomy, cholecystectomy, and Nuss procedure respectively. RESULTS: Among 29,565 patients in the analysis, 1411 (4.8%) were classified as OFR and 28,154 (95.2%) were classified as OFRP. Within OFR procedures, 0.8% of cases were given opioid prescriptions. For OFPR procedures, 11.5% of patients were given at least one opioid prescription at discharge with 5.4% for appendectomy, 20.5% for cholecystectomy, and 85.8% for Nuss procedure. Factors associated with odds of an opioid prescription included race, ethnicity, co-morbidities, and operation length. CONCLUSION: For procedures where OFR is recommended, surgeons are doing well at minimally prescribing opioids at discharge. For procedures considered OFRP, approximately 10% of patients are receiving opioid prescriptions at discharge with variability by procedure and patient factors including race and ethnicity. Further investigation into these and hospital level factors is needed.
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