Journal Of Pediatric Surgery[JOURNAL]
Sun
200 papers
Neurodevelopmental outcomes and long-term quality of life in esophageal atresia: A narrative review.
Doucet KM, Coronado J, Karasko D … +3 more , Dao DT, Zendejas B, Bajic D
J Pediatr Surg · 2026 Jul · PMID 42019759 · Publisher ↗
Esophageal atresia (EA) is a rare congenital anomaly characterized by esophageal discontinuity, frequently associated with tracheoesophageal fistula (TEF) and other congenital malformations. Advances in neonatal surgery,...
Esophageal atresia (EA) is a rare congenital anomaly characterized by esophageal discontinuity, frequently associated with tracheoesophageal fistula (TEF) and other congenital malformations. Advances in neonatal surgery, perioperative care, and critical care have substantially improved survival, shifting the focus to neurodevelopmental outcomes, long-term health, and quality of life-topics explored in this review. We summarize findings from original prospective and retrospective studies examining developmental trajectories, psychosocial outcomes, and quality of life. This review aims to (1) support informed clinical counseling and physician-family communication, (2) guide multidisciplinary and lifelong follow-up, and (3) identify knowledge gaps that warrant more systematic, longitudinal, and multicenter investigation to optimize outcomes for children born with EA.
A novel gastrostomy tube anchor dressing designed to stabilize and prevent tube dislodgements.
Halpern AI, Wright SL, Salvador T … +8 more , Saruwatari MS, Arkowitz DW, Paralikar A, Feng C, Williams K, Petrosyan M, Monfaredi R, Sandler AD
J Pediatr Surg · 2026 Jul · PMID 42019758 · Publisher ↗
BACKGROUND: Gastrostomy tube dislodgement in the pediatric population can be a common occurrence, ranging from 10% to 43% over the lifetime of the tube. In response, we developed a low-profile gastrostomy anchor dressing...
BACKGROUND: Gastrostomy tube dislodgement in the pediatric population can be a common occurrence, ranging from 10% to 43% over the lifetime of the tube. In response, we developed a low-profile gastrostomy anchor dressing placed at the insertion site while enabling feeding port access and capturing drainage. This article describes our novel dressing: its development, useability and safety, impact on dislodgments, and patient and caregiver feedback. METHODS: Multiple dressing design iterations were conceived until we settled on the dressing described. After initial prototype completion, laboratory shock force testing was conducted and analyzed. IRB-approved pilot clinical studies were conducted between November 2023 and December 2025. Descriptive statistics were then performed, comparing our study patient outcomes to retrospective data on patients who utilized standard dressings following gastrostomy tube placement at our institution between August 2019 and August 2024. RESULTS: Our prototype gastrostomy tube anchor dressing exhibited improved securement, increasing the shock force needed to displace the gastrostomy tube in laboratory-based testing (p < 0.001 with or without balloon inflation). The dressing was well-received by patients and caregivers. As compared to the retrospective cohort of 755 patients, there were reduced tube dislodgements at 30 (10.7% vs 20.3%), 60 (17.9% vs 25.4%), and 90 (17.9% vs 27.8%) days postoperatively in the 28 patients who utilized the novel prototype dressing. CONCLUSIONS: We describe a novel gastrostomy tube anchor dressing designed to reduce tube dislodgements. Our prototype dressing tested successfully and was well-liked by patients and caregivers. A finalized device and large-scale production with long-term follow-up studies are needed.
Comparison of robotic and laparoscopic liver resection for pediatric liver tumor: A multicenter study.
Wang B, Xia X, Wang Y … +13 more , Tang C, Gong Y, Huang L, Du Q, Zhu D, Zhou W, Li Z, Jin Z, Liu Y, Tang Y, Zhang G, Tang S, Zheng Z
J Pediatr Surg · 2026 Jul · PMID 42009125 · Publisher ↗
OBJECTIVE: To compare perioperative outcomes between robotic liver resection (RLR) and laparoscopic liver resection (LLR) in pediatric patients undergoing hepatectomy for liver tumors. METHODS: This multicenter retrospec...
OBJECTIVE: To compare perioperative outcomes between robotic liver resection (RLR) and laparoscopic liver resection (LLR) in pediatric patients undergoing hepatectomy for liver tumors. METHODS: This multicenter retrospective study included 77 pediatric patients who underwent RLR or LLR for liver tumors located in anterolateral (segments II, III, IVb, V, VI) or posterior (segments IVa, VII) segments between January 2015 and January 2025 across four tertiary centers. Baseline demographics, tumor characteristics, and perioperative outcomes were analyzed. Propensity score matching (PSM) was performed to minimize selection bias. RESULTS: A total of 77 cases met the study criteria, of which 30 underwent RLR (39.0%) and 47 (61.0%) underwent LLR. After 1:1 PSM was performed (30 RLR vs. 30 LLR). RLR was associated with a shorter operative time [175 min (IQR:120, 256) vs. 245 min (IQR:180, 295); P <0.05], lower rates of Intraoperative blood transfusion[8 of 30(26.7%) vs. 16 of 30(53,3%); P <0.05], less blood loss [30.0 mL (IQR:18.8, 82.5) vs. 50 mL (IQR:30, 120); P <0.05], and lower rates of Pringle maneuver application [6 of 30(20.0%) vs. 17 of 30(56.7%); P <0.05]. On subset analysis of 38 patients with hepatoblastoma, of which 13 underwent RLR (34.2%) and 25 (65.8%) underwent LLR. After 1:1 PSM was performed (13 RLR vs. 13 LLR). RLR was associated with significantly shorter operative time [185 min (IQR:170, 210) vs. 270 min (IQR:255, 283); P <0.05], less blood loss [40 mL (IQR:25, 58) vs. 100 mL (IQR:75, 125); P <0.05], and lower rates of Pringle maneuver application [2 of 13(15.4%) vs. 9 of 13(69.2%); P <0.05] compared to LLR group. On the open conversion rates, post operative stay, postoperative complications, morbidity, mortality, and oncological outcomes were similar between RLR and LLR groups in the overall PSM cohort (P >0.05). CONCLUSION: For hepatectomy in children with liver tumors such as hepatoblastoma, RLR is noninferior to LLR, with potential advantages in selected outcomes. Its benefits are manifested by shorter operative times, less blood loss, and a reduced need for intraoperative blood transfusion and vascular occlusion of hepatic portal.
Comparing laparoscopic versus open elective ladd procedures in pediatric patients: A 10-year review of the NSQIP-pediatric database.
Turpin AG, Asti L, Rachwal B … +1 more , Minneci PC
J Pediatr Surg · 2026 Jul · PMID 42002252 · Publisher ↗
PURPOSE: To investigate changes in the proportion of Ladd procedures being performed laparoscopically over time and compare 30-day outcomes between laparoscopic and open Ladd. METHODS: Patients <18 years who underwent an...
PURPOSE: To investigate changes in the proportion of Ladd procedures being performed laparoscopically over time and compare 30-day outcomes between laparoscopic and open Ladd. METHODS: Patients <18 years who underwent an elective Ladd procedure between 2013 and 2022 in the National Surgical Quality Improvement Program (NSQIP)-Pediatric database were included. Changes in the proportion of patients undergoing a laparoscopic approach over time were evaluated overall and in subgroups (age <1 and ≥1 year) using Cochran-Armitage tests. Comparison of 30-day outcomes between laparoscopic and open Ladd were performed using propensity score matched (PSM) cohorts. RESULTS: Of the 1563 included patients, 66% had an open procedure and 34% a laparoscopic procedure. The proportion of patients undergoing laparoscopic Ladd significantly increased from 24% in 2013 to 40% in 2022 (p < 0.0001), similar increases were seen in patients ≥1 year and <1 year of age. After PSM, median post-operative length of stay was longer in the open group [6 days, interquartile range (IQR) 3-11 vs. 3 days, IQR 2-7, p < 0.0001]. Patients who underwent an open Ladd were more likely to require a transfusion post-operatively (6.0% vs. 1.8%, p = 0.003). CONCLUSIONS: Elective Ladd procedures being performed laparoscopically has increased over time across all pediatric age groups. In a matched cohort, laparoscopic Ladd is associated with decreased length of stay and lower risk of transfusion requirements. The increased use of laparoscopic Ladd warrants additional rigorous investigation to compare longer term outcomes.
It's not about the dent: Anteroposterior insufficiency in pectus excavatum.
Notrica DM, Jaroszewski DE, Osman A … +2 more , Padilla B, McMahon LE
J Pediatr Surg · 2026 Jul · PMID 42002251 · Publisher ↗
BACKGROUND: Pectus Excavatum (PEx) is an anterior chest wall deformity associated with sternal depression. Minimal invasive repair of PEx (MIRPE) and open pectus repair depend on anterior ribs to elevate the sternal defe...
BACKGROUND: Pectus Excavatum (PEx) is an anterior chest wall deformity associated with sternal depression. Minimal invasive repair of PEx (MIRPE) and open pectus repair depend on anterior ribs to elevate the sternal defect. Many PEx patients, however, have inadequate anteroposterior (AP) distance to support a complete repair. The quantity and frequency of AP insufficiency (API) in a PEx surgical population is reported. METHODS: A retrospective analysis of 100 pectus excavatum (PEx) patients with a CT or MRI Haller Index >3.2 was performed. Demographics, Haller Index (HI), Correction Index (CI), and maximum AP distances (APmax) from a line level with the spine to the highest anterior rib (pectus ridge) were measured. Predicted APmax = 40% the transverse diameter based on prior studies. The quantity of API was defined as the predicted APmax - actual APmax. RESULTS: Median age was 15.2 years; 62% male. The median HI was 4.8, and CI was 32%. PEx patients had a median APmax of only 78% predicted [IQR 70, 84]. The median absolute lack of AP distance in PEx patients was 2.2 cm [IQR 1.4,2.9]. CONCLUSION: Inadequate AP distance is common in patients with PEx. Pectus repair that elevates the sternum only to the level of the pectus ridge would fail to normalize the AP distance in most patients, despite correction of the visible indentation. Technical corrections with convex bars lifting the ribs and sternum above the pectus ridge are necessary to normalize the AP distance and relieve cardiac compression in patients with API.
Association of surgical antibiotic prophylaxis with postoperative outcomes following pediatric gastrostomy tube placement: A propensity score overlap weighted analysis.
Khan MO, Thobani H, Ahmad S … +7 more , Iqbal B, Tahan D, Ehsan AN, Rao AG, Tirrell T, Islam S, Khan FA
J Pediatr Surg · 2026 Jul · PMID 41999972 · Publisher ↗
BACKGROUND: Surgical antimicrobial prophylaxis (SAP) before gastrostomy tube placement is supported by guidelines but evidence regarding its efficacy in preventing surgical site infections (SSIs) in children is conflicti...
BACKGROUND: Surgical antimicrobial prophylaxis (SAP) before gastrostomy tube placement is supported by guidelines but evidence regarding its efficacy in preventing surgical site infections (SSIs) in children is conflicting and largely extrapolated from adult data. This study aims to analyze the association between SAP and postoperative outcomes in children undergoing G-Tube placement. METHODS: We conducted a retrospective multicenter cohort study using the ACS NSQIP-Pediatric database (2021-2024) to identify children undergoing gastrostomy tube insertion. Patients with contaminated/dirty wound classifications or concurrent surgeries were excluded. The primary exposure was preoperative SAP, and propensity score overlap weighting was utilized to balance covariates like race, age, and ASA classification to estimate the association between SAP and 30-day SSI, unplanned readmission, and reoperation. Associations after overlap weighting were reported as adjusted odds ratio (AOR) while baseline comparisons were done using Wilcoxon rank sum test, Chi-squared test and Fisher's exact test as appropriate. A p value of less than 0.05 was considered significant. RESULTS: A total of 14,109 patients were included (mean age 2.7 ± 4.0 years), of whom 13,408 (95.0%) received SAP and 701 (5.0%) did not. Cefazolin was the most common agent (94.7%). White (8,246, 58%) was the most common race, though significant baseline differences existed in race/ethnicity between the SAP and no-SAP groups (p < 0.001). Unadjusted 30-day SSI rates were 4.7% for the SAP group and 4.4% for the no-SAP group (p = 0.8). In the weighted analysis, SAP was not associated with a reduction in SSIs (AOR 1.01, 95% CI 0.69-1.46), unplanned readmissions (AOR 0.93, 95% CI 0.70-1.22), or reoperations (AOR 0.78; 95% CI 0.48-1.27). Sub-analysis stratified by risk profile further confirmed no statistically significant benefit from prophylaxis in reducing infectious complications. CONCLUSIONS: Routine surgical antibiotic prophylaxis appears not to be associated with improved short-term outcomes or reduced infection rates following pediatric gastrostomy tube placement. These findings support reevaluation of institutional protocols to potentially reduce unnecessary antibiotic exposure without compromising patient safety.
Trap-door approach for complex pediatric thoracic inlet tumors with vascular encasement: Safety and resection outcomes.
Deng X, Li C, Wu C … +1 more , Wang S
J Pediatr Surg · 2026 Apr · PMID 41999971 · Publisher ↗
BACKGROUND/PURPOSE: Minimally invasive techniques are increasingly used for pediatric thoracic disease; however, tumors at the cervicothoracic junction (CTJ) remain technically demanding when they involve major vessels a...
BACKGROUND/PURPOSE: Minimally invasive techniques are increasingly used for pediatric thoracic disease; however, tumors at the cervicothoracic junction (CTJ) remain technically demanding when they involve major vessels and densely packed neural structures. We assessed the perioperative safety and oncologic adequacy of the Trap-door cervicothoracic thoracotomy for these complex lesions and sought to clarify its role in the contemporary era. METHODS: We retrospectively reviewed 25 consecutive children (median age, 5.1 years; range, 1.3-14.5) who underwent CTJ or upper mediastinal tumor resection using the Trap-door approach at a single high-volume center from December 2021 to June 2025. Demographics, imaging features (including image-defined risk factors), operative metrics, extent of resection, and perioperative complications were collected and summarized. RESULTS: Neuroblastoma was the most frequent diagnosis (n = 15, 60%). Preoperative imaging showed major vascular encasement in 60% of patients. Gross total resection (GTR) was achieved in 24 patients (96%). Median operative time was 234 min (range, 54-456), and median estimated blood loss was 50 mL (range, 5-600). No perioperative deaths occurred. Postoperative morbidity was mainly pulmonary (52%), followed by Horner syndrome (28%) and transient recurrent laryngeal nerve dysfunction (8%). CONCLUSIONS: The Trap-door approach offers broad and controllable exposure for complex CTJ tumors, enabling high rates of complete macroscopic resection with acceptable morbidity. As minimally invasive options expand, this open incision remains important for bulky tumors with vascular encasement, where secure vascular control and oncologic clearance outweigh cosmetic considerations. LEVEL OF EVIDENCE: Level IV (retrospective case series).
Risk factors for recurrence of congenital diaphragmatic hernia in the era of minimally invasive surgery.
Terui K, Nagata K, Yamoto M … +12 more , Sato Y, Okuyama H, Maruyama H, Yokoi A, Kim K, Umeda S, Toyoshima K, Koike Y, Miyake Y, Kawaguchi Y, Sato Y, Usui N
J Pediatr Surg · 2026 Jul · PMID 41999970 · Publisher ↗
PURPOSE: To elucidate the long-term incidence and risk factors of congenital diaphragmatic hernia (CDH) recurrence in the era of minimally invasive surgery (MIS). METHODS: In a Japanese CDH Study Group database between 2...
PURPOSE: To elucidate the long-term incidence and risk factors of congenital diaphragmatic hernia (CDH) recurrence in the era of minimally invasive surgery (MIS). METHODS: In a Japanese CDH Study Group database between 2006 and 2023, we included 1,115 patients with CDH who underwent surgery for diaphragmatic repair, with follow-up data available for up to 12 years of age. The following variables were assessed as potential risk factors for recurrence: right-sided hernia, large diaphragmatic defect (international classification C and D), liver herniation, stomach herniation, patch use, and MIS without conversion. RESULTS: A total of 134 recurrences occurred in 98 patients. The cumulative recurrence rate was 11.4% at 10 years of age. In multivariate analyses, large diaphragmatic defect (adjusted odds ratio [OR], 2.26; 95% confidence interval [CI], 1.14-4.47), liver herniation (adjusted OR, 2.39; 95% CI, 1.27-4.47), and MIS without conversion (adjusted OR, 2.56; 95% CI, 1.19-5.50) were significant risk factors. In patients with both non-large diaphragmatic defects and non-liver herniation, the cumulative incidence of recurrence was significantly higher for MIS than for open surgery (p = 0.0288). Patch use was significantly more common in open surgery than in MIS without conversion (45% vs. 18%, p < 0.0001), especially in patients with international classification C diaphragmatic defects (84% vs. 27%, p < 0.0001). CONCLUSION: Herein, the recurrence rate was 11.4%. A large defect size, liver herniation, and MIS without conversion were independent risk factors for CDH recurrence. In MIS for severe CDH, aggressive patch use and appropriate conversion to open surgery may mitigate recurrence.
Artificial intelligence in rare pediatric solid tumor research and clinical care: A scoping review.
Happ MF, Lindsay CV, Onyeji C … +6 more , Soto AL, Harb MG, Kaplan S, Gomez SM, Blinman T, Tracy ET
J Pediatr Surg · 2026 Jul · PMID 41999969 · Publisher ↗
BACKGROUND: Clinical and research advances for children with solid tumors are limited by their rare nature. Artificial intelligence (AI) and machine learning (ML) hold potential for advancing diagnosis, risk stratificati...
BACKGROUND: Clinical and research advances for children with solid tumors are limited by their rare nature. Artificial intelligence (AI) and machine learning (ML) hold potential for advancing diagnosis, risk stratification, and treatment in rare diseases where individual patients contribute high-dimensional data. This review characterizes current AI/ML applications in rare pediatric solid tumors. METHODS: PubMed, Embase, and Web-of-Science Core Collection databases were queried for relevant articles published before February 10, 2025. Eligible studies applied AI/ML methods to study rare tumors in pediatric populations (≤19 years). Articles were evaluated for tumor diagnosis, AI/ML methods, clinical applications, comparators, effectiveness, and interpretability. RESULTS: Twenty-three studies (2009-2025) were included. Hepatoblastoma (12/23) and pediatric thyroid cancers (4/23) were most frequently studied. Supervised learning predominated (20/23), followed by unsupervised (9/23), deep learning (4/23), and hybrid/ensemble models (6/23). Applications included diagnosis (12/23), prognosis (10/23), and risk stratification (9/23). Twenty studies reported effectiveness measures, with many models achieving AUCs >0.85. In comparative analysis (17/23), AI/ML often equaled or exceeded expert consensus, traditional models, or alternative algorithms. Eight studies reported external validation. CONCLUSIONS: Current AI/ML research in rare pediatric extra-cranial solid tumors focuses on diagnosis, risk stratification, and prognosis, often outperforming traditional methods. Future work should prioritize external validation and clinical applicability.
Surgical management of pilonidal sinus disease in pediatric population: An updated systematic review and meta-analysis.
Saleem MM, Usmani SUR, Hashmi MR … +7 more , Abbas H, Abbas S, Wasif MH, Irfan Q, Shahzad M, Novotny NM, Robinson JR
J Pediatr Surg · 2026 Jul · PMID 41999968 · Publisher ↗
BACKGROUND: Pilonidal disease (PD) is a chronic inflammatory condition of the natal cleft that commonly affects pediatric population, leading to high morbidity, frequent recurrences, and impaired quality of life. Despite...
BACKGROUND: Pilonidal disease (PD) is a chronic inflammatory condition of the natal cleft that commonly affects pediatric population, leading to high morbidity, frequent recurrences, and impaired quality of life. Despite various surgical approaches, no consensus exists on the optimal technique, and pediatric-specific evidence is limited. OBJECTIVES: To compare recurrence, wound complications, and recovery outcomes across surgical techniques in patients ≤18 years with PD. METHODOLOGY: A systematic search of MEDLINE, Cochrane, and Google Scholar (inception-Dec 2024) identified 59 studies (N = 5075). Data on recurrence, wound complications, healing time, operative time, hospital stay, return to daily activities (ADL), pain scores, and reoperation rates were extracted. Random-effects models were used for pooled estimates. Subgroup analyses and meta-regression explored heterogeneity and impact of follow-up duration. Study quality was assessed using the Newcastle-Ottawa Scale and ROB-2. RESULTS: Open healing showed the highest recurrence (20.1%) and moderate wound complication rates (16.2%), with healing times up to 98 days. Midline primary closure had a recurrence rate of 17.5%, the highest wound complication rate (43.5%), and a reoperation rate of 29.8%. Off-midline closures had the lowest recurrence (10.2%) and moderate complications (19.5%), with healing times as short as 8 days. Minimally invasive techniques (MITs), particularly PEPSiT, demonstrated low recurrence (11.4%), minimal complications (6.5%), short operative times (17-50 min), early return to ADL (1-3 days), and low postoperative pain (VAS 0-2). Adjunctive laser epilation improved outcomes across all techniques. Meta-regression showed longer follow-up was associated with lower recurrence in most groups, except open healing. CONCLUSION: Off-midline closure and minimally invasive strategies, especially when combined with laser epilation, offer superior outcomes in recurrence, complications, and recovery.
Age-stratified outcomes after laparoscopic inguinal hernia repair in children: A large single-center cohort study.
Yu B, Liu S, Song Z
J Pediatr Surg · 2026 Jul · PMID 41997495 · Publisher ↗
BACKGROUND: Age-related differences in presentation and outcomes after laparoscopic inguinal hernia repair (LIHR) remain incompletely characterized. We evaluated age-stratified perioperative characteristics and recurrenc...
BACKGROUND: Age-related differences in presentation and outcomes after laparoscopic inguinal hernia repair (LIHR) remain incompletely characterized. We evaluated age-stratified perioperative characteristics and recurrence after LIHR. METHODS: We conducted a retrospective single-center cohort study of consecutive children undergoing LIHR, stratified as <6 months, 6-12 months, 1-2 years, 2-5 years, and >5 years. The primary outcome was recurrence, while secondary outcomes included incarceration, hernia laterality, operative time, occult contralateral hernia detection, conversion to open surgery, complications, and length of stay. RESULTS: Among 8941 children, incarceration occurred in 2.1%, bilateral hernia in 47.6%, and occult contralateral hernia was detected in 39.2%. Incarceration decreased with age (15.6% in <6 months vs 0.6-0.7% in >2 years; P < 0.001), and bilateral hernia was most frequent in <6 months (74.6%; P < 0.001). Median operative time decreased from 31 min (<6 months) to 26 min (>5 years; P < 0.001). Occult contralateral hernia was most common in <6 months (52.7%; P < 0.001). Conversion was highest in <6 months (0.8%) and absent in >5 years (P = 0.009). Recurrence was 1.3% (113/8941), with none in <6 months and increasing to 2.1% in >5 years (P < 0.001). Male sex (HR 2.974, 95% CI 1.708-5.176) and unilateral presentation (HR 5.141, 95% CI 2.931-9.017) independently predicted recurrence. CONCLUSIONS: Infants, especially those <6 months, had higher rates of incarceration and bilateral disease, more frequent occult contralateral findings, and greater operative complexity. Recurrence after LIHR was low overall, absent in <6 months, and increased with age, supporting age-stratified counseling, operative planning, and follow-up.
Disaster preparedness for children with medical complexity: Aligning policy, technology, and care systems with clinical reality.
Lopez AJ, Fabersunne CC, Haddad K … +2 more , Lee H, Newton C
J Pediatr Surg · 2026 Jul · PMID 41997494 · Publisher ↗
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Plasma sodium as a predictor of perforation in acute appendicitis: A prospective multi-centre study.
Lindestam U, Norberg Å, Svensson JF … +13 more , Almström M, Andersson A, Lönnqvist PA, Ellebæk MB, Bjørn N, Rajabaleyan P, Drage IM, Stensrud KJ, Reismann M, Donà A, Middleton PJ, Meyer HM, Fläring U
J Pediatr Surg · 2026 Jul · PMID 41985623 · Publisher ↗
BACKGROUND: Non-operative treatment for acute appendicitis (AA) in children has gained acceptance as an alternative to surgery in selected cases. Accurate preoperative differentiation between perforated and non-perforate...
BACKGROUND: Non-operative treatment for acute appendicitis (AA) in children has gained acceptance as an alternative to surgery in selected cases. Accurate preoperative differentiation between perforated and non-perforated AA is increasingly important, as the former requires emergency surgery while the latter may be managed conservatively. Previous research has suggested that low plasma sodium concentration (P-Na) may serve as a reliable predictor of perforation. This study aimed to evaluate the association between P-Na and appendiceal perforation in a prospective, multicentre paediatric cohort. METHODS: Previously healthy children, aged 1-15 years, presenting with suspected AA who subsequently underwent appendectomy were enrolled at five paediatric surgical centres (Stockholm, Oslo, Berlin, Odense and Cape Town). Blood sampling on admission included concentration of C-reactive protein, plasma sodium concentration, white blood cell count and neutrophil count. RESULTS: 451 children met the inclusion criteria. Mean plasma sodium concentration on admission was lower in children with perforated AA as compared to non-perforated AA, mean 133.6 (standard deviation (SD) 4.0) mmol/l and 138.2 (SD 2.7) mmol/l respectively. A cut-off value of P-Na > 136 mmol/l resulted in an odds ratio of 0.11 (95% CI 0.07-0.17) for perforation. In a multivariate logistic regression analysis CRP and P-Na, respectively, were the strongest predictors of perforation. Combining the two resulted in an area under the curve of (AUC) of 0.86 in discriminating perforated AA from non-perforated AA. CONCLUSIONS: In this large, prospective, multicentre study, low P-Na was independently associated with an increased risk of perforated AA in children. The predictive value improved when combined with CRP.
Effect of vacuum bell therapy on subcutaneous fat of the chest wall in patients with pectus excavatum.
Zhang Q, Yu J, Zeng Q … +8 more , Zhang N, Yan D, Xu C, Liu D, Zhang X, Yang T, Wu Y, Chen C
J Pediatr Surg · 2026 Jul · PMID 41985622 · Publisher ↗
BACKGROUND: Vacuum bell therapy is increasingly used as a nonoperative treatment for pectus excavatum (PE). However, whether this intervention induces subcutaneous fat thickening and the mechanisms underlying such change...
BACKGROUND: Vacuum bell therapy is increasingly used as a nonoperative treatment for pectus excavatum (PE). However, whether this intervention induces subcutaneous fat thickening and the mechanisms underlying such changes remain uncertain. This study aimed to quantify vacuum bell-associated adipose tissue changes and clarify their clinical implications. METHODS: Patients with PE treated with vacuum bell therapy at our center between July 2022 and January 2024 underwent low-dose chest computed tomography at treatment initiation and after one year of therapy. Measured parameters included the Haller index (HI), correction index, anterior and lateral chest wall subcutaneous fat thickness, skeletal depression depth (SkD), and surface depression depth (SuD). The fat influence rate (FIR) was calculated to quantify device-related adipogenesis stimulation. Multiple regression analysis was performed to identify factors associated with changes in anterior chest wall fat thickness. RESULTS: Forty-seven patients were included, with a median age of 7.0 years (range: 1-14). The mean HI decreased from 3.6 ± 0.7 to 3.2 ± 0.5, with improvement observed in 35 patients (74.5%). Anterior chest wall fat thickness increased in 45 patients (95.7%), rising from 4.0 ± 2.1 mm to 7.6 ± 3.3 mm. The mean FIR was 95% (IQR: 39%). Improvement in surface depression (4.0 ± 3.3 mm) exceeded skeletal improvement (1.4 ± 3.8 mm), and no predictors reached statistical significance in regression analysis. CONCLUSIONS: Vacuum bell therapy is effective and induces substantial anterior chest wall fat thickening, indicating that cosmetic improvement results from a dual mechanism involving skeletal remodeling and adipose thickening. LEVEL OF EVIDENCE: Level III.
Risk factors for complications after Duckett urethroplasty: Guiding the timing of staged hypospadias repair in children.
Liu P, Fan Y, Zhang S
J Pediatr Surg · 2026 Jul · PMID 41985621 · Publisher ↗
OBJECTIVE: To identify the risk factors for complications following the Duckett urethroplasty and to evaluate the predictive value for postoperative complications of both the risk factors and the predictive model incorpo...
OBJECTIVE: To identify the risk factors for complications following the Duckett urethroplasty and to evaluate the predictive value for postoperative complications of both the risk factors and the predictive model incorporating them, with the goal of guiding intraoperative decision-making regarding staged hypospadias repair in children. METHODS: A retrospective study was conducted involving 160 pediatric patients who underwent primary Duckett urethroplasty at our institution between January 2019 and January 2023. Univariate analysis was first performed to screen potential risk factors, followed by multivariate logistic regression to identify independent risk factors. Based on these independent risk factors, a predictive model was subsequently developed. Receiver operating characteristic (ROC) curve analysis was then applied to evaluate the predictive value of both the risk factors and the predictive model for complications following the Duckett urethroplasty. RESULTS: Multivariate logistic regression analysis identified the degree of penile curvature (OR = 3.272; 95% CI [1.133-9.453]) and urethral defect length (OR = 3.555; 95% CI [1.836-6.885]) as independent risk factors for postoperative complications. The developed predictive model was formulated as: Logit(P) = -5.5 + 0.988 × (degree of penile curvature) + 1.177 × (urethral defect length). Both the urethral defect length alone and the predictive model incorporating both urethral defect length and the degree of penile curvature showed high predictive value for complications following the Duckett urethroplasty. The area under the curve (AUC) for urethral defect length was 0.806 (P < 0.001, 95% CI: 0.737-0.875), with a Youden index of 0.625, a sensitivity of 88.9%, a specificity of 73.6%, and an optimal cutoff value of 3.45. The AUC for the predictive model combining penile curvature and urethral defect length was 0.810 (P < 0.001, 95% CI: 0.740-0.879), with a Youden index of 0.598, a sensitivity of 81.5%, a specificity of 78.3%, and an optimal cutoff value of 0.39. CONCLUSION: Both the predictive model integrating the degree of penile curvature with urethral defect length and the urethral defect length alone demonstrated high predictive value for complications following primary Duckett urethroplasty. Given that urethral defect length can be readily measured intraoperatively and offers strong clinical practicality, its use is recommended in practice for determining the timing of staged repair. Specifically, if the urethral defect length measures ≥3.5 cm after intraoperative correction of penile curvature, staged surgery should be considered in conjunction with the individual penile condition of the patient.
Clinical characteristics and mortality prediction in neonatal gastric perforation: Insights from a regional multicenter retrospective cohort study.
Fang Y, Pang M, Xu Y … +9 more , Cai S, Li Y, Wang L, Gao Y, Zhu J, Chen S, Zhu M, Lin Z, Fang M
J Pediatr Surg · 2026 Apr · PMID 41974396 · Publisher ↗
OBJECTIVE: To characterize the clinical features, identify prognostic factors, and develop a risk prediction model for poor outcomes in neonates with gastric perforation (NGP). METHODS: We retrospectively analyzed the cl...
OBJECTIVE: To characterize the clinical features, identify prognostic factors, and develop a risk prediction model for poor outcomes in neonates with gastric perforation (NGP). METHODS: We retrospectively analyzed the clinical, microbiological, surgical, and pathological data of 83 infants with NGP admitted between 2000 and 2024 to four major hospitals in southern China. Univariate and multivariate logistic regression analyses were used to identify independent risk factors. A nomogram prediction model was constructed and validated using ROC curves, calibration plots, decision curve analysis (DCA), and bootstrap resampling. RESULTS: The median age at onset was 2 days, with a median birth weight of 2370 g; 62.7% were preterm infants. The predominant clinical manifestations included abdominal distension (94.0%) and diminished bowel sounds (66.3%), while the mortality or treatment abandonment rate was 25.3%. Perforations were most frequently located along the greater curvature of stomach (66.7%). Histopathology revealed muscular layer defects in 73.8% of cases, which were not correlated with short-term outcomes. Multivariate analysis identified distal intestinal obstruction (OR = 6.22) and symptom-to-surgery interval ≥24 h (OR = 4.24) as independent predictors of poor prognosis. The resulting nomogram demonstrated robust discrimination (AUC = 0.845), good calibration, and satisfactory clinical utility. CONCLUSIONS: Neonatal gastric perforation remains a rare but life-threatening surgical emergency. Distal obstruction and symptom-to-surgery interval are key prognostic determinants. The proposed nomogram based on clinically accessible variables enables early identification of high-risk patients and may support timely clinical decision-making.
Language matters: Standardizing the terminology of persistent cloaca.
Brookhart CD, Mayhew A, Badillo A … +2 more , Varda BK, Levitt MA
J Pediatr Surg · 2026 Jul · PMID 41974395 · Publisher ↗
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Enhanced recovery protocols for pediatric colorectal surgery demonstrate cost-effectiveness: An economic analysis to support programmatic development.
Luo W, Adams U, Tracy E … +6 more , Cappiello C, Mooney C, Akinkuotu AC, McLean SE, Charles AG, Phillips MR
J Pediatr Surg · 2026 Jul · PMID 41966323 · Publisher ↗
BACKGROUND: Enhanced recovery pathways (ERPs) after pediatric colorectal surgery have been shown to improve patient experience without compromising outcomes. ERPs for this population are also associated with reduced admi...
BACKGROUND: Enhanced recovery pathways (ERPs) after pediatric colorectal surgery have been shown to improve patient experience without compromising outcomes. ERPs for this population are also associated with reduced admission costs, but their economic impact in large populations is unclear. We present the first formal cost-effectiveness analysis of a pediatric colorectal surgery ERP from the payer perspective. METHODS: We compared the cost-effectiveness of an ERP versus standard care in a pediatric patient requiring colorectal surgery without additional comorbid conditions, using a Markov microsimulation model to estimate the incremental cost-effectiveness ratio for each intervention. We sourced costs and health utilities from the peer-reviewed literature and transition-state probabilities from institutional primary data. We modeled our analysis from a US payer perspective over a 30-day time horizon and a willingness-to-pay ratio of $100,000/quality-adjusted life-year (QALY) gained by either intervention. RESULTS: We simulated individual patient outcomes using published clinical outcomes for patients managed with and without an ERP (microsimulation). The statistical software evaluates the variability across 10,000 microsimulations and repeats the modeling 1,000 times (iterations). The software then reports the most likely outcome based on the summarized results. We found that our ERP was a cost-effective alternative to standard care in over 86% of iterations. On average, an admission with ERP costs $5,625 less and provides a health utility benefit of 0.002 QALY over 30 days compared to standard care. Our model was sensitive to the costs of acute-care hospital stays, celecoxib costs, and time to solid oral (PO) intake. CONCLUSIONS: In a first-of-its-kind cost-effectiveness analysis of ERPs for pediatric surgery, ERPs were both less costly and better for quality of life than standard care. These findings support the continued development and implementation of ERPs for pediatric patients requiring colorectal surgery, as well as the referral of such patients to centers with ERP programs.
Are purely cosmetic procedures appropriate for the management of pectus excavatum? A qualitative study of pediatric surgeons.
Savera NN, Shah AN, Kwong JZ … +6 more , Sullivan GA, Froehlich M, Kaiser K, Sullivan EE, Goldstein SD, Gulack BC
J Pediatr Surg · 2026 Jul · PMID 41951123 · Publisher ↗
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Longitudinal changes in senna-based laxative dosing in pediatric constipation: A single-center retrospective study.
Alzate-Ricaurte S, Melkonian V, De La Torre L … +6 more , Alzate Gallego ED, Ketzer J, Merritt A, Krause A, Peña A, Bischoff A
J Pediatr Surg · 2026 Jul · PMID 41951122 · Publisher ↗
BACKGROUND: Chronic constipation is a common and morbid condition, especially in children with idiopathic constipation and anorectal malformations. Bowel management programs often use senna-based laxatives; however, fami...
BACKGROUND: Chronic constipation is a common and morbid condition, especially in children with idiopathic constipation and anorectal malformations. Bowel management programs often use senna-based laxatives; however, families and providers often express concern about tolerance with long-term use. Evidence evaluating dosing changes in long-term senna use is limited. METHODS: Single-center retrospective longitudinal study including pediatric patients treated with senna-based laxatives between 2016 and 2023. Other laxatives, fecal incontinence, antegrade continence enemas, Hirschsprung disease or anorectal malformations with poor bowel control prognosis were excluded. Initial effective dose was determined at completion of bowel management week, timepoint two as the most recent follow-up. Dose was analyzed as total daily dose and mg/kg. Paired comparisons and linear mixed-effects models with patient-level random intercepts were used. RESULTS: 75 patients were included (mean age 8.79 ± 3.89 years; median follow-up 3.29 years). Total daily dose increased over time (median 45 mg-60 mg; p < 0.001), paralleling significant weight gain (median 21.6 kg-32.0 kg; p < 0.001). Weight-adjusted dosing was similar (median 1.89 vs. 1.88 mg/kg; p = 0.192). In mixed-effects models, patient weight was associated with dose, whereas follow-up duration was not. Timepoint was associated with increasing total daily dose but not weight-adjusted dose. CONCLUSIONS: Weight-adjusted senna dose remains similar over long-term follow-up. Increases in total daily dose can be attributed to patient growth and results are not suggestive of progressive therapeutic effect loss. These findings provide no evidence of tolerance with long-term senna use and support its role in pediatric bowel management programs.
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