BACKGROUND: Bar rotation and migration remain common challenges in pectus excavatum repair using traditional Nuss bars. The PurePectus system (KLS Martin), a titanium-based construct, is designed to mitigate these issues...BACKGROUND: Bar rotation and migration remain common challenges in pectus excavatum repair using traditional Nuss bars. The PurePectus system (KLS Martin), a titanium-based construct, is designed to mitigate these issues by enhancing bar stability with bilateral connector plates. We report early outcomes following its implementation. METHODS: We conducted a retrospective review of patients who underwent pectus excavatum repair using the PurePectus system between September 2023 and January 2025. Demographic, operative, radiographic, hospitalization, and postoperative data were collected and analyzed. RESULTS: A total of 111 patients underwent repair using the PurePectus system. Mean age was 15 ± 2.0 years (range 12-22). All patients underwent sternal elevation, thoracoscopic mediastinal dissection, and cryoablation. Across the cohort, 84 patients (76.6%) received two bars, 27 patients (24.3%) received three bars. For patients receiving two bars, the mean operative time was 112.8 ± 24 min (range 61-193); for three bars, 135.5 ± 27 min (range 93-216). Connector use ranged from 3 to 8 per case. The median hospital stay was 1 night (range 1-7). No postoperative complications, including bar migration, rotation, infection, or reoperation, were observed during a 16-month follow-up period. CONCLUSION: The PurePectus system introduces new technical considerations, such as precise connector measurement and intraoperative bar alignment. In this first series, early outcomes were favorable, with no added complications and smooth integration into existing workflows.
BACKGROUND: Previous studies suggest discrepancy between North American and European centres in use of extracorporeal life support (ECLS) in infants with congenital diaphragmatic hernia (CDH). The impact of this on outco...BACKGROUND: Previous studies suggest discrepancy between North American and European centres in use of extracorporeal life support (ECLS) in infants with congenital diaphragmatic hernia (CDH). The impact of this on outcomes is unknown. We aimed to compare indications, management and outcomes of infants with CDH receiving ECLS between North American and European centres. METHODS: ECLS organisation (ELSO) prospective registry study including infants with CDH receiving ECLS over 11 years starting January 2012. Outcomes were mortality, ECLS-related complications and length of inpatient stay. Propensity score weighted analysis adjusted for differences in infant and disease-related factors. RESULTS: There were 3,087 infants, with 2382 (77.1%) infants treated in North American centres while 705 (22.9%) were treated at European centres with similar birth demographics. Case volume per year was less for those treated in North American centres compared to European centres (4 [IQR 2-7, range 1-34] vs 5 [IQR 3-15, range 1-35] cases per year, p < 0.001). Unadjusted mortality was greater in North American infants (OR 1.40 [95% CI 1.18 to 1.66]) but similar after propensity score matching and adjustment for treatment factors (OR 0.93 [95% CI 0.70 to 1.22]). After propensity matching and adjustment, complication rate (OR 1.51 [1.15 to 1.97]) was greater and length of stay in survivors was longer (mean difference 38.6 [29.4 to 47.7] days) in North America. CONCLUSIONS: Infants with CDH selected for ECLS had greater physiological derangement in North America than Europe and several differences were identified in management strategies. Further work is required to explore reasons for the increased ECLS-related complication rate and length of stay observed in North American infants.
OBJECTIVE: To investigate the clinical features, diagnosis, and treatment of Congenital Pulmonary Airway Malformation (CPAM) or Pulmonary Sequestration (PS) combined with ipsilateral Foregut Cyst (FC), and to analyze its...OBJECTIVE: To investigate the clinical features, diagnosis, and treatment of Congenital Pulmonary Airway Malformation (CPAM) or Pulmonary Sequestration (PS) combined with ipsilateral Foregut Cyst (FC), and to analyze its association with the Bronchopulmonary Foregut Malformation (BPFM) spectrum. METHODS: A single-center retrospective study was conducted. Among 775 children with surgically and pathologically confirmed CPAM/PS between January 2018 and July 2025, 20 cases with coexisting ipsilateral FC were selected. Their clinical, imaging, and pathological data were systematically analyzed, and the rate of preoperative imaging missed diagnosis of FC was assessed. RESULTS: The incidence of CPAM/PS with ipsilateral FC was 2.58% (20/775). The median age of the children was 11 months, with a prenatal detection rate of 70%. The overall missed diagnosis rate for FC on preoperative CT was 20% (4/20), and this rate was significantly higher in the PS group (44.44%, 4/9) compared to the CPAM group (0%, P = 0.033). All cases showed ipsilateral distribution. Pathological analysis revealed that PS was more frequently associated with esophageal cysts (7/9), while CPAM was more often associated with bronchogenic cysts (12/13); this association was statistically significant (P = 0.017). All children successfully underwent thoracoscopic surgery. The average postoperative hospital stay was (5.55 ± 2.72) days, with no recurrence during follow-up. CONCLUSION: The co-occurrence of CPAM/PS with ipsilateral FC is not rare and is prone to preoperative missed diagnosis, particularly when associated with PS. The constant ipsilateral distribution and the specific pathological type association (PS-esophageal cyst, CPAM-bronchogenic cyst) strongly support a common embryological origin from the foregut, providing significant clinical evidence for classifying such combined malformations within the BPFM spectrum. Recognizing these characteristics is crucial for guiding comprehensive preoperative evaluation and definitive one-stage surgical management.
BACKGROUND: Early diagnosis is the most critical determinant of native liver survival in infants with biliary atresia (BA). Accurate differentiation of BA from other neonatal cholestatic disorders remains particularly ch...BACKGROUND: Early diagnosis is the most critical determinant of native liver survival in infants with biliary atresia (BA). Accurate differentiation of BA from other neonatal cholestatic disorders remains particularly challenging within the first 28 days of life, a period during which clinical and biochemical features are often nonspecific. This study aimed to develop and validate a minimalist, highly interpretable diagnostic model that integrates serum matrix metalloproteinase-7 (MMP-7) with routinely available clinical parameters to facilitate early BA diagnosis in neonates. METHODS: This retrospective diagnostic study enrolled neonates ≤28 days of age admitted for conjugated hyperbilirubinemia between 2021 and 2025. The final cohort consisted of 50 infants (29 BA, 21 non-BA) with complete data for four pre-specified variables: stool color, gamma-glutamyl transferase (GGT), direct bilirubin (DBIL), and serum MMP-7. Complete-case analysis was used (no imputation). Two interpretable models-a logistic regression and a random forest classifier-were developed. To ensure robust performance estimation, we performed repeated stratified 5-fold cross-validation (50 repeats; 250 iterations). A single 70/30 train-test split was retained solely for illustrative purposes. Performance was assessed using the area under the receiver operating characteristic curve (AUROC), accuracy, sensitivity, specificity, and decision curve analysis (DCA). RESULTS: Serum MMP-7 levels were significantly higher in BA infants compared to controls (66.6 ± 25.4 vs. 19.2 ± 16.7 ng/mL, P < 0.001) and remained the strongest independent predictor in multivariable analysis (adjusted odds ratio 1.13 per ng/mL increase, P = 0.002). In repeated cross-validation, the logistic regression model achieved a mean AUC of 0.978 ± 0.047, sensitivity 0.955 ± 0.096, specificity 0.922 ± 0.134, and F1-score 0.949 ± 0.072, consistently outperforming random forest (mean AUC 0.951 ± 0.087). The single hold-out test set produced perfect discrimination for logistic regression (AUC = 1.00, 100% sensitivity and specificity), illustrating its potential but representing an optimistic upper bound. MMP-7 was the dominant contributor in both models (logistic regression standardized coefficient = 1.819; random forest Gini importance = 0.515). DCA confirmed positive net benefit across clinically relevant thresholds. To enable bedside use, we provide the explicit logistic regression equation and two types of nomograms. CONCLUSIONS: In this single-center cohort of neonates aged ≤28 days, a minimalist logistic regression model integrating serum MMP-7 with three routine parameters demonstrated excellent and stable discriminative performance (mean AUC 0.978) and is readily deployable as a formula or nomogram. The observed performance estimates, while robust in internal cross-validation, are likely optimistic and require external validation in large, prospective multicenter cohorts before widespread clinical implementation. If confirmed, this model could advance BA diagnosis into the first month of life and improve native liver survival.
Murphy AJ, Chen Y, Cameron DB
… +14 more, Geiger EJ, Ramsey D, Green DM, Howell RM, Kieran K, Krull KR, Meacham LR, Ness KK, Oeffinger KC, Yasui Y, Armstrong GT, Chow EJ, Weldon CB, Weil BR
J Pediatr Surg
· 2026 Jul · PMID 41921603
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OBJECTIVE: Evaluate late effects in survivors of childhood pelvic sarcoma by disease origin (bony vs. soft-tissue) and local control modality (bone surgery, pelvic organ resection, radiotherapy). METHODS: Among 5-year pe...OBJECTIVE: Evaluate late effects in survivors of childhood pelvic sarcoma by disease origin (bony vs. soft-tissue) and local control modality (bone surgery, pelvic organ resection, radiotherapy). METHODS: Among 5-year pediatric pelvic sarcoma survivors, we assessed long-term outcomes including late (>5 years) mortality, graded chronic health conditions (CHCs), subsequent malignant neoplasms (SMNs), physical function/activity, cancer-related pain, and pregnancy/siring a pregnancy. Associations with disease origin and local control modality were analyzed using cumulative incidence and Cox or multivariable logistic regression. RESULTS: Among 745 eligible survivors, the 35-year cumulative incidence of late all-cause and health-related mortality was 25.7% (95%CI = 22.1%-29.3%) and 12.2% (95%CI = 9.4%-15.1%), vs. 2.5% (95%CI = 1.3%-3.7%) and 1.4% (95%CI = 0.5%-2.4%) in matched US population. Cumulative incidence of severe/life-threatening CHCs was 47.6% (95%CI = 43.0%-52.1%) for survivors vs. 12.2% (95%CI = 11.3%-13.2%) for siblings. Cumulative incidence of SMNs was 7.6% (95%CI = 5.0%-10.2%). Bone sarcomas were associated with increased all-cause mortality (HR = 1.92, 95%CI = 1.16-3.17), health-related mortality (HR = 2.12, 95%CI = 1.03-4.38), and CHCs (HR = 2.55, 95%CI = 1.65-3.95) vs. soft-tissue sarcomas. Analyzing all survivors, radiotherapy was associated with increased CHCs (HR = 2.42, 95%CI = 1.53-3.81), multiple CHCs (HR = 2.27, 95%CI = 1.03-4.97), functional impairment (OR = 2.21, 95%CI = 1.30-3.74), and pain (OR = 2.29, 95%CI = 1.33-3.93). Bone surgery was associated with functional impairment (OR = 2.64, 95%CI = 1.30-5.37), performance limitations (OR = 2.12, 95%CI = 1.19-3.79), and pain (OR = 2.59, 95%CI = 1.37-4.89). Pelvic organ resection was associated with decreased pregnancy (OR = 0.25, 95%CI = 0.10-0.63). CONCLUSIONS: Late effects differed by pelvic sarcoma origin (bone vs. soft-tissue) and local control modality. The associations between local control choices and late effects in this study can guide counseling of patients and families at the time of diagnosis, treatment, local control, or after completion of therapy. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT01120353.
BACKGROUND: Objective criteria for predicting successful conservative management of pediatric non-perforated appendicitis (NPA) remain elusive. We examined whether ultrasonographic (US) grading can predict treatment outc...BACKGROUND: Objective criteria for predicting successful conservative management of pediatric non-perforated appendicitis (NPA) remain elusive. We examined whether ultrasonographic (US) grading can predict treatment outcomes. METHODS: We retrospectively analyzed patients aged <16 years who were diagnosed with NPA at a single tertiary pediatric referral center between January 2014 and December 2023. All patients initially received conservative management according to the institutional policy. Emergency surgery was conducted only when clinical symptoms failed to improve or when US findings suggested disease progression. Patients were classified into four US grades (I, IIa, IIb, and III) according to the appendiceal wall integrity and perfusion on power Doppler ultrasonography. The primary outcomes were the success of conservative management (discharge without surgery) and length of hospital stay. Multivariable regression analysis identified factors linked to hospitalization duration. RESULTS: In total, 247 patients were included. The overall success rate of the conservative management was 95.5%, and those for grades I, IIa, IIb, and III were 100%, 98.8%, 93.4%, and 84.2%, respectively. The median hospital stay increased with the grade (0, 3, 4.5, and 9 days). In the multivariable analysis, the US grade was independently linked to the hospital stay. Compared with Grade I, the ratios were 1.50 (IIa), 2.36 (IIb), and 3.44 (III). Furthermore, appendiceal diameter was correlated with a longer stay. CONCLUSIONS: In this single-center retrospective cohort, US grading may help stratify short-term outcomes of conservative management and length of hospital stay in NPA. Our results suggest that conservative management may be acceptable for Grade IIb, whereas earlier surgery may warrant consideration for Grade III.
BACKGROUND/PURPOSE: Pectus excavatum (PE) is the most common chest wall deformity in youth. Although often considered cosmetic, studies report cardiopulmonary consequences (e.g., right-ventricular compression, conduction...BACKGROUND/PURPOSE: Pectus excavatum (PE) is the most common chest wall deformity in youth. Although often considered cosmetic, studies report cardiopulmonary consequences (e.g., right-ventricular compression, conduction abnormalities) that may vary with age. The minimally invasive Nuss procedure is now predominant. Objective assessment of PE's functional burden and the benefits of surgery is clinically important. To compare pre- and postoperative cardiac status in PE patients and quantify physiologic burden and surgical benefit. METHODS: Single-center cohort of 175 patients undergoing chest wall reconstruction (retrospective 2010-2020; prospective from 2020). Preoperative work-up included pediatric surgery, pulmonology, cardiology, and CT-based Haller index. Patients with abnormal preoperative cardiology underwent postoperative reassessment (n = 61). Associations were tested with Chi-square and McNemar's tests (significance set at p < 0.05). RESULTS: Patients were 86.3% male; mean age 16.1 years. By Haller index: severe 61.1%, moderate 16.6%, mild 22.3%; 59.4% were asymmetric. Psychological distress was reported by 63.6%. Preoperatively, 70% showed cardiac abnormalities-valvular lesions 46.3% (81/175, predominantly mitral prolapse), right-ventricular compression 33.1% (58/175), and incomplete right bundle-branch block 17.7% (31/175). Postoperatively (n = 61), right-ventricular compression resolved in all; some ECG anomalies persisted; valvular abnormalities remained in five. PE severity correlated with the presence of any cardiac abnormality, but not with psychological distress; severity did not correlate with individual abnormality types. CONCLUSIONS: Cardiac abnormalities are common in young patients with PE and are more frequent in severe deformity. Surgical correction yields marked early improvement in structural cardiac abnormalities, supporting routine cardiac evaluation and follow-up in all patients considered for PE repair. LEVEL OF EVIDENCE: III.
Duchesne C, Bonnard A, Hameury F
… +18 more, Dariel A, Verot PL, De Marco L, Maldonado C, Irtan S, Guinot A, Schmitt F, Vinit N, Haffreingue A, Ballouhey Q, Lubet A, Carolina D, Aquilina L, Boudaoud N, Leroux S, Gottrand F, Sfeir R, Arnaud AP
AIM: Long-gap esophageal atresia (LGEA) represents a surgical challenge. Despite the increasing use of thoracoscopy over the past decades, its application in LGEAs remains limited. This study aimed to evaluate the morbid...AIM: Long-gap esophageal atresia (LGEA) represents a surgical challenge. Despite the increasing use of thoracoscopy over the past decades, its application in LGEAs remains limited. This study aimed to evaluate the morbidity and mortality rates of LGEA thoracoscopic repair in the early and mid-term in France over the study period. MATERIALS AND METHODS: After institutional ethical approval (#23.76), we conducted a multicenter, retrospective analysis of all patients who underwent a thoracoscopic repair for LGEA in France from 2010 to 2022. LGEA was defined following ERNICA 2021 consensus. We collected data related to the initial treatment and up to 1-year follow-up. Postoperative complications were categorized into early (<30 days) and late (>30 days) and were classified according to the Clavien-Dindo classification. RESULTS: Fifty patients were included: 24 Delayed Primary Anastomosis (DPA) and 26 tractions. The overall rate of post-operative complication was 82%. The primary early complications included anastomotic leaks 56%, prolonged drainage 40%, pneumothorax 20%, pneumonia 20% and stricture 16% with no difference between DPA and traction. The traction method had a longer postoperative length of stay (69 vs. 31 days, p < 0,002). The nutritional evolution of tractions was poorer, with 30,8% exclusive oral nutrition at one year (vs. 66,7% DPA, p = 0.018). CONCLUSION: This is the largest cohort of patients who underwent thoracoscopic surgery for LGEA. Although thoracoscopic management of LGEAs is associated with a high complication rate, DPA management was associated with a shorter postoperative hospital stay and better mid-term nutritional outcomes. We believe that LGEAs remain a surgical challenge and thoracoscopy should be reserved for expert surgeons.
Newgard CD, Babcock S, Lin A
… +15 more, Malveau S, Goldstick JE, Carter PM, Cook JNB, Salvi A, Wei R, Fallat ME, Kuppermann N, Jenkins PC, Mann NC, Diaz XN, Lundrigan AM, Beckstead R, Hagos B, Song X
OBJECTIVE: We used machine learning (ML) to develop firearm risk prediction models for injured children and adolescents admitted to U.S. trauma centers, including prediction of death after discharge among survivors of fi...OBJECTIVE: We used machine learning (ML) to develop firearm risk prediction models for injured children and adolescents admitted to U.S. trauma centers, including prediction of death after discharge among survivors of firearm injury. METHODS: We used a retrospective cohort of injured patients 0-17 years admitted to 982 trauma centers participating in the National Trauma Data Bank from 1/1/2014 to 12/31/2021, stratified by children (0-10 years) versus adolescents (11-17 years). We followed a subset of patients to one year (through 12/31/2022). We used ML to analyze 119 predictors and a primary outcome of firearm injury, and then 141 predictors to model a secondary outcome of death after discharge. RESULTS: There were 260,098 children (2785 [1.1 %] with firearm injuries) and 242,669 adolescents (22,318 [9.2 %] with firearm injuries). For children, the high specificity model had an area under the curve (AUC) 0.787 with 31.2 % sensitivity, specificity 95.3 %, and positive predictive value (PPV) 6.9 %. For adolescents, the model had an AUC 0.763, sensitivity 34.7 %, specificity 95.0 %, and PPV 41.3 %. High-yield predictors included Black race, Child Opportunity Index, and median household income. Post-discharge mortality among those surviving a firearm injury was 0.38 %, but deaths often occurred within one week of discharge, frequently from a repeat firearm injury, and were predicted by home neighborhood characteristics. CONCLUSIONS: Pediatric firearm injury risk stratification can be performed using information available during admission, which could guide injury prevention efforts. The first week after discharge following a firearm injury is high-risk for mortality, with risk influenced by neighborhood characteristics.
OBJECTIVES: To evaluate the feasibility, safety, and oncological outcomes of robotic-assisted surgery (RAS) for pediatric Wilms' tumour, including cases treated beyond current SIOP-RTSG UMBRELLA criteria for minimally in...OBJECTIVES: To evaluate the feasibility, safety, and oncological outcomes of robotic-assisted surgery (RAS) for pediatric Wilms' tumour, including cases treated beyond current SIOP-RTSG UMBRELLA criteria for minimally invasive surgery. SUBJECTS/PATIENTS AND METHODS: A retrospective review was conducted of all pediatric patients who underwent RAS for histologically confirmed Wilms' tumour at a tertiary referral centre between 2020 and 2024. Perioperative, pathological, and follow-up outcomes were analysed. Patients were stratified according to whether their tumours met or did not meet the SIOP-RTSG UMBRELLA 2016 criteria for minimally invasive surgery, and subgroup comparisons were performed. RESULTS: Nineteen children underwent robotic-assisted surgery. Median age at diagnosis was 55 months (IQR 17-80), and 74% received preoperative chemotherapy. Median tumour volume decreased from 503.0 mL to 220.5 mL following treatment (median regression 44.5%). Seventeen patients underwent radical nephrectomy, one partial nephrectomy, and one tumourectomy. Median operative time was 265 min. Lymph node sampling was performed in 95% of cases (median three nodes), and conversion to open surgery occurred in one patient (5%). Two postoperative complications were observed (Clavien-Madadi grade IB and IIIA), with no intraoperative adverse events. Final pathology showed stage I disease in 74% and intermediate-risk histology in 79% of patients. Two patients developed distant metastatic relapse (hepatic and pulmonary), with no local recurrence. At a median follow-up of 32 months, overall survival was 100%, and event-free survival at one and three years was 94.7% and 89.5%, respectively. Six patients (32%) had one or more formal contraindications to minimally invasive surgery; despite longer operative time and hospital stay, no significant differences were observed in complications, conversion rate, margin status, or recurrence. CONCLUSION: Robotic-assisted surgery for Wilms' tumour is feasible and oncologically safe in selected pediatric patients, including carefully chosen cases beyond current minimally invasive surgery criteria.
INTRODUCTION: Gastroschisis has historically been fatal in resource-limited settings, where lack of prenatal diagnosis, surgical neonatal care, and parenteral nutrition challenge replication of western care paradigms. We...INTRODUCTION: Gastroschisis has historically been fatal in resource-limited settings, where lack of prenatal diagnosis, surgical neonatal care, and parenteral nutrition challenge replication of western care paradigms. We present a Rwandan tertiary center's experience managing gastroschisis and outcomes before and after opening a neonatal surgical unit. METHODS: Patients with gastroschisis admitted to the main referral hospital in Rwanda were included. A neonatal surgery unit opened 3/2020. Data was collected from 1/2016-8/2022. Descriptive, bivariate, and multivariate statistics were performed. RESULTS: 338 patients with gastroschisis were studied. Incidence was estimated at 3.8/10,000 live births. 30.2% of patients survived, with mean length of stay of 28.6 (IQR 21-32) days. Survivors, compared to those who died, were born at older gestational age, had lower rates of complex gastroschisis, were more likely to undergo abdominal closure, and had enteral feeds started earlier. Survival was seen at gestational ages as young as 30 weeks and with birth weights as low as 1.5 kg. After opening a neonatal surgical unit, gastroschisis admissions increased 2.6-fold, and survival appeared to increase (22.8% vs. 32.9%, p = 0.076). CONCLUSION: Through development of pediatric surgical capacity and systems changes, gastroschisis is survivable in an LMIC setting. Establishment of a neonatal surgical unit was associated with the ability to handle higher volumes of gastroschisis patients, with consistent and improving outcomes. Challenges include treatment of complicated patients, including those with complex gastroschisis. Ongoing experience and prospective data collection will guide initiatives to improve gastroschisis outcomes in Rwanda and support innovation for neonatal care in resource-limited settings.
Notrica DM, Maxson T, Stottlemyre RL
… +13 more, Cohen AS, Bundrant N, Lawson KA, Eubanks JW, Ryan M, Letton RW, Bhatia A, Wyrick D, St Peter SD, Leys C, Ponsky T, Williams RF, Johnson JJ
BACKGROUND: The ATOMAC + guideline is an evidence-based guideline for management of pediatric blunt liver and/or spleen injury (BLSI) based on clinical signs of bleeding on arrival. METHODS: A prospective multi-instituti...BACKGROUND: The ATOMAC + guideline is an evidence-based guideline for management of pediatric blunt liver and/or spleen injury (BLSI) based on clinical signs of bleeding on arrival. METHODS: A prospective multi-institutional study of children aged ≤18 years with BLSI was conducted at 10 pediatric trauma centers. Unstable patients without computed tomography were added retrospectively. Demographic data, interventions, and outcomes were analyzed. RESULTS: Of 1029 children (median age 10.2 years) with BLSI, 713 (69%) had no signs of clinically significant bleeding upon arrival, and no initially stable patients required surgery for bleeding; 13 (1.8%) required abdominal surgery for other reasons. Of 316 patients with clinical signs of recent bleeding or ongoing bleeding on arrival, 10 patients died in the ED and 17 non-responders underwent surgery directly. Among 168 patients responding initially to transfusion, 22 underwent angiography and 60 went to surgery (9 after angiography). Of the 44 stabilized patients who received >40 mL/kg blood products, only 5 (11%) survived without intervention. Additionally, 37 (32%) transfused patients not meeting this threshold also underwent abdominal intervention. Overall mortality was 3.4% including 21% of 42 patients transfused >40 mL/kg or 4 units of blood. CONCLUSION: The frequency of laparotomy or laparoscopy in children with BLSI was 8.2%. Children with no clinical signs of bleeding upon arrival did not later bleed, but 1.6% of these patients ultimately required abdominal surgery for other injuries. Transfusion >40 mL/kg was strongly associated with intervention or death, but a substantial number of children who received less blood also required intervention.
OBJECTIVE: To evaluate the efficacy and safety of preoperative carbohydrate loading (PCL) in pediatric patients. METHODS: Following PRISMA 2020 guidelines, randomized controlled trials (RCTs) comparing PCL with fasting o...OBJECTIVE: To evaluate the efficacy and safety of preoperative carbohydrate loading (PCL) in pediatric patients. METHODS: Following PRISMA 2020 guidelines, randomized controlled trials (RCTs) comparing PCL with fasting or placebo in patients aged ≤18 years were searched across nine databases up to July 9, 2025. Outcomes included behavioral indices (anxiety, sedation, and mask acceptance), metabolic parameters (postoperative blood glucose, insulin, and insulin resistance), and postoperative nausea and vomiting (PONV). Data were pooled using a random-effects meta-analysis model, and sensitivity analyses were conducted. RESULTS: This meta-analysis of 14 RCTs (1428 pediatric patients) demonstrates that PCL provides multidimensional benefits for pediatric patients. It effectively improves cooperation during anesthesia induction (reducing anxiety and enhancing sedation) and stabilizes metabolic status (the compound carbohydrate solution reduces postoperative insulin levels and insulin resistance). Furthermore, PCL significantly reduces the incidence of PONV, with a pronounced preventive effect against moderate-to-severe episodes. Notably, while a standard carbohydrate solution carries a risk of elevating postoperative blood glucose, the compound carbohydrate solution demonstrates a more favorable metabolic safety profile. CONCLUSION: PCL provides multifaceted benefits in pediatric surgery. Different solution types are associated with distinct metabolic effect patterns, a factor warranting consideration in clinical application.
Phimosis is commonly encountered in pediatric surgical practice. Despite evidence supporting topical corticosteroids for phimosis, many clinicians believe they are ineffective in certain subgroups such as severe phimosis...Phimosis is commonly encountered in pediatric surgical practice. Despite evidence supporting topical corticosteroids for phimosis, many clinicians believe they are ineffective in certain subgroups such as severe phimosis or older children, leading to early circumcision. This study aimed to evaluate the effectiveness of topical corticosteroids across different severities and patient characteristics. We conducted a prospective multicenter cohort study across 12 Chilean hospitals between June 2023 and August 2024. Boys under 18 years old with phimosis grades 2 to 5 (Kikiros classification) were treated with 0.05% topical betamethasone twice daily for 8 weeks. Patients were followed up between 8 and 16 weeks. Resolution was defined as improvement to Kikiros grades 0-1. Variables related to treatment outcomes were assessed using univariate and multivariate logistic regression analyses. Out of 386 eligible patients, 235 completed follow-up and were included in the final analysis. Overall treatment success was 68%, with no significant differences across phimosis severity or age groups. The only factor significantly associated with treatment failure was altered preputial skin appearance (success rate: 72% with healthy skin vs. 29% with altered skin; p = 0.007). Other variables, including treatment adherence, age, symptoms, or prior balanitis, were not predictive of treatment failure. Topical corticosteroids are effective for treating phimosis in children, regardless of severity, age or other pre-treatment variables studied. Altered preputial skin appearance may predict lower response rates. These findings support broader implementation of conservative management and may help reduce unnecessary surgical interventions. LEVEL OF EVIDENCE: Level 2b, according to the Oxford Centre for Evidence-Based Medicine (2009).
BACKGROUND: Patients with esophageal atresia with or without tracheoesophageal fistula (EA-TEF) frequently require fundoplication to manage gastroesophageal reflux disease (GERD). Data is limited on whether fundoplicatio...BACKGROUND: Patients with esophageal atresia with or without tracheoesophageal fistula (EA-TEF) frequently require fundoplication to manage gastroesophageal reflux disease (GERD). Data is limited on whether fundoplication improves GERD-related outcomes and if outcomes vary by type of fundoplication. METHODS: This is a retrospective cohort study of patients <18 years-old who underwent EA-TEF repair and fundoplication at a single institution from January 2013 to September 2025. In the first aim, we compared GERD symptoms, medications, nutrition, and esophageal stricture dilation rate before and after fundoplication. In the second aim, we compared outcomes between partial and complete fundoplication at 12 months after surgery. RESULTS: Of 226 children with EA-TEF repair, 36 (15.9%) underwent fundoplication, with 14 (38.8%) complete and 22 (61.1%) partial fundoplication. The median age at fundoplication was 7.3 [3.7, 15.9] months. Most patients (69.4%) had Type C EA-TEF. The most common indication was refractory GERD (88.9%). There were no statistical differences in GERD-related symptoms - oral aversion, dysphagia, retching, and vomiting - and medication use when comparing pre-to post-fundoplication. Fundoplication significantly reduced the need for post-pyloric feeds (67% vs 11%, P < 0.001) and improved weight-for-age z-scores (-1.94 vs -1.03, P < 0.001). Fundoplication also decreased the need for stricture dilation (3.07 vs. 1.36 dilations/year, P = 0.001). There were no differences in outcomes between partial and complete fundoplication. Eight patients required fundoplication revision, four from each group. CONCLUSION: In our EA-TEF cohort, fundoplication facilitated conversion from post-pyloric to gastric feeds, decreased stricture burden, and improved nutritional status. Outcomes were not impacted by the type of fundoplication performed.