European Journal Of Pediatric Surgery[JOURNAL]
Sun
200 papers
Impact of Azygos Vein Preservation on Postoperative Outcomes in Esophageal Atresia: A Systematic Review and Meta-Analysis from the Pediatric Surgery Meta-Analysis (PESMA) Study Group.
Heitsman CG, Azizoğlu M, Gazzaneo M … +11 more , Kamci TO, Escolino M, Klyuev S, Karakas E, Risteski T, Pérez-Bertólez S, Marenco Gutierrez MF, Pederiva F, Chiarenza SF, Mutanen A, Esposito C
Eur J Pediatr Surg · 2026 Jan · PMID 41558660 · Publisher ↗
This study aimed to evaluate whether preservation of the azygos vein influences postoperative outcomes in infants undergoing repair of esophageal atresia with tracheoesophageal fistula (EA-TEF).A systematic review and me...
This study aimed to evaluate whether preservation of the azygos vein influences postoperative outcomes in infants undergoing repair of esophageal atresia with tracheoesophageal fistula (EA-TEF).A systematic review and meta-analysis were conducted using six major databases, identifying all relevant studies published up to January 2025. Seven studies met the inclusion criteria, including five randomized controlled trials and two retrospective analyses. Outcomes assessed were anastomotic leaks, esophageal strictures, chest infections, and mortality.Across studies, azygos vein preservation was generally associated with fewer postoperative complications compared with ligation. Preservation of the azygos vein appeared to reduce the risk of anastomotic leak, chest infection, and mortality, while also showing a trend toward fewer strictures. However, the strength of evidence was limited by study heterogeneity, small sample sizes, and variation in surgical techniques.This systematic review and meta-analysis suggest that preserving the azygos vein may be beneficial in reducing major postoperative complications. Nevertheless, because most included studies were small and of mixed quality, these findings should be interpreted with caution. Larger, high-quality randomized trials are needed to confirm whether azygos vein preservation directly improves clinical outcomes.
Weight Loss and Durability of Gastric Banding in Adolescents with Severe Obesity; 8-year Follow-up of a Randomized Controlled Trial.
Boom F, Talib A, Roebroek YGM … +4 more , Paulus GF, Winkens B, Bouvy ND, Herum LWEV
Eur J Pediatr Surg · 2026 Jan · PMID 41554512 · Publisher ↗
OBJECTIVE: Metabolic and bariatric surgery is an established treatment for severe obesity. Laparoscopic adjustable gastric banding (LAGB) was once considered a promising option for adolescents. However, long-term data in...
OBJECTIVE: Metabolic and bariatric surgery is an established treatment for severe obesity. Laparoscopic adjustable gastric banding (LAGB) was once considered a promising option for adolescents. However, long-term data in this population are lacking. We aimed to evaluate the long-term effectiveness of LAGB in adolescents extending beyond 3 years postoperatively. METHODS: Adolescents with severe obesity were randomly assigned to the intervention group (LAGB and multidisciplinary lifestyle intervention [MLI]) or the control group (MLI), with annual follow-ups for 3 years. We conducted a follow-up analysis of this cohort after 8.6 years (range: 5.0-12.5). RESULTS: A total of 59 patients were randomized (29 LAGB + MLI and 30 MLI only). Early differences in weight loss were observed during the first 2 years, but no significant difference persisted after 8.7 years (mean difference body mass index: 1.8 kg/m, 95% CI: -3.2, 6.8). The band removal rate was high (52%). CONCLUSION: After nearly 9 years, LAGB resulted in minimal weight loss and had a high removal rate in adolescents with severe obesity. Our study was limited by loss to follow-up, self-reported weights, and crossover. Nonetheless, these findings confirm the lack of efficacy that has led to the global decline in LAGB procedures and underscore the shift toward more effective surgical procedures.
Novel Bedside Ligation for Staged Closure of Congenital Portosystemic Shunts: A Single-Center Experience in 20 Children.
Chen S, Zhao H, Xie Z … +5 more , Mei D, Guo C, Chen Q, Chu J, Yan Z
Eur J Pediatr Surg · 2026 Jan · PMID 41544938 · Publisher ↗
To report our institutional experience with a portal venous pressure (PVP)-guided surgical strategy for congenital portosystemic shunts (CPSs) and introduce a novel bedside ligation technique for staged shunt closure.We...
To report our institutional experience with a portal venous pressure (PVP)-guided surgical strategy for congenital portosystemic shunts (CPSs) and introduce a novel bedside ligation technique for staged shunt closure.We retrospectively reviewed 20 children who underwent surgical CPS closure between 2013 and 2023. The surgical approach was determined by intraoperative PVP during temporary shunt occlusion. One-stage ligation was performed when PVP remained < 25 mm Hg, whereas shunts with PVP ≥ 25 mm Hg were banded for staged closure using either bedside ligation or endovascular completion.Fourteen patients (70%) underwent one-stage closure (median PVP: 22.0 mm Hg, interquartile range [IQR]: 18.0-22.5), and six (30%) required two-stage closure (median PVP: 28.0 mm Hg, IQR: 25.8-29.5). Among the latter, five achieved complete shunt occlusion through the bedside technique, avoiding reoperation or readmission. The primary composite outcome-radiologic closure, fasting blood ammonia normalization, and absence of severe complications-was achieved in all 20 patients (100%) at 1-year follow-up. Significant intrahepatic portal vein (IPV) remodeling was observed, with median left and right IPV diameters increasing from 1.4 and 1.6 to 4.8 and 5.0 mm, respectively (both < 0.0001). The overall complication rate was 15% (3/20), all Clavien-Dindo Grades I to II.In children with CPSs unsuitable for endovascular closure, a PVP-guided surgical strategy appears safe and effective. For those requiring two-stage closure due to elevated PVP, bedside ligation after Endoloop banding provides a feasible, less invasive alternative to reoperation. However, larger studies are needed to confirm its safety and efficacy.
Is Preoperative Antimicrobial Prophylaxis Necessary in Testicular Torsion Surgery? Results from the National Surgical Quality Improvement Program Pediatric.
Stone A, Gopalakrishnan M, Tracey A … +2 more , Mason M, Villanueva J
Eur J Pediatr Surg · 2026 Jan · PMID 41539327 · Publisher ↗
OBJECTIVE: This study aimed to evaluate the impact of surgical antimicrobial prophylaxis (SAP) on testicular torsion surgery (TTS) postoperative outcomes using data from the National Surgical Quality Improvement Program...
OBJECTIVE: This study aimed to evaluate the impact of surgical antimicrobial prophylaxis (SAP) on testicular torsion surgery (TTS) postoperative outcomes using data from the National Surgical Quality Improvement Program Pediatric (NSQIP-P). Across multiple studies, NSQIP-P has proven increased sensitivity in recording postoperative complications compared with similar databases. METHODS: The 2021-2023 NSQIP-P participant user and SAP files were queried for all TTSs. Patients with unrecorded SAP administration data ( = 2,725) were excluded. Postoperative events were then compared between subjects who did or did not receive SAP. Primary outcomes included rates of surgical site infection (SSI), 30-day readmission, and 30-day reoperation. SPSS statistical software was used to perform comparative statistical analyses between groups. RESULTS: A total of 614 patients were included in the study and divided into Group 1 (+SAP, = 322) and Group 2 (-SAP, = 292). In the +SAP group, there was no observation of SSI, but one case resulted in 30-day readmission and reoperation. Another 30-day readmission and 30-day reoperation were noted, as well. In the -SAP, there was one observation of a deep incisional SSI who was readmitted. There were no 30-day reoperations in this group. There was no statistical significance in outcomes between the two groups. CONCLUSION: To date, this is the first study assessing the impact of SAP in torsion-reduction surgeries using the NSQIP-P database. There is a low frequency of postoperative complications with this procedure. Our study suggests limited utility of SAP with this surgery despite continued use.
Editorial Overview: Highlights from the 26th EUPSA Congress, Dubrovnik, 2025.
Mutanen A, Lacher M
Eur J Pediatr Surg · 2026 Feb · PMID 41525784 · Publisher ↗
Abstract loading — click title to view on PubMed.
Development of a Clinical Predictive Score for Bracing Outcomes in Children with Pectus Carinatum: A Single-center Retrospective Study.
Wang H, He Y, Lin M … +6 more , Liao J, Li L, Zeng J, Yang Q, Lin Z, Liang J
Eur J Pediatr Surg · 2026 Jan · PMID 41512909 · Publisher ↗
BACKGROUND AND OBJECTIVES: Pectus carinatum (PC) is a common chest wall deformity, but there is currently a lack of predictive models and tools for forecasting deformity improvement with compressive orthotic bracing (COB...
BACKGROUND AND OBJECTIVES: Pectus carinatum (PC) is a common chest wall deformity, but there is currently a lack of predictive models and tools for forecasting deformity improvement with compressive orthotic bracing (COB) therapy. This study aimed to identify key factors influencing treatment outcomes, and to develop and integrate a predictive efficacy scoring tool with a clinical decision pathway to provide evidence-based treatment recommendations for pediatric PC patients. METHODS: In this retrospective study, 182 pediatric PC patients evaluated and followed using three-dimensional scanning were enrolled. A multiple linear regression model was developed to create and validate a predictive efficacy scoring tool, which subsequently informed the establishment of a treatment decision pathway. RESULTS: The predictive model identified smaller initial external thoracic width ( < 0.001, β = - 0.644), older age at treatment initiation ( = 0.04, β = 0.271), good compliance ( = 0.008, β = 0.188), and favorable chest wall morphology ( = 0.033, β = 0.152) as independent predictors of deformity improvement. The model was optimized into a predictive efficacy scoring tool (Score = Expected %dEHI + 4.761). Comparison between the good response (score > 0) and poor response (score ≤ 0) groups confirmed the tool's excellent discriminative ability (8.348 vs. 15.320, < 0.001). CONCLUSION: Treatment recommendations were derived by integrating the scoring tool with the decision pathway: children with score > 0 are strongly recommended to continue bracing; those with score ≤ 0 due to poor compliance should receive intensified supervision, while those with score ≤ 0 due to other factors should be counseled on possible surgery; children under 4 years require personalized recommendations integrating the score, symptoms, and parental preferences. However, as a single-center retrospective study without a control group and with subjective compliance assessment, future prospective multicenter studies are required to validate the model's generalizability.
In-Office Pit Excision for Pilonidal Disease Using Needle-Free Local Anesthesia: A Minimally Invasive, Non-Operative Treatment Approach.
Stoeckel A, Renzi K, Murtadi G … +4 more , McArthur M, Jean Pierre T, Cohen R, Mooney DP
Eur J Pediatr Surg · 2025 Dec · PMID 41461191 · Publisher ↗
INTRODUCTION: Treatment of pilonidal disease traditionally involves an operation under general anesthesia, which may have a period of postoperative disability and a significant recurrence rate. We report a novel treatmen...
INTRODUCTION: Treatment of pilonidal disease traditionally involves an operation under general anesthesia, which may have a period of postoperative disability and a significant recurrence rate. We report a novel treatment for pilonidal disease performed in-office using a pneumatic lidocaine injection device, requiring no pain medication or activity restrictions-supporting a non-operative standard of care. METHODS: Patients with gluteal crease pits at our Pilonidal Care Clinic were offered pit excision as standard care. Prospective data on demographics, pain scores (0-10), and outcomes were collected in REDCap. Under sterile conditions, patients received 1% buffered lidocaine via pneumatic injection. Laser follicle ablation was followed by punch excision (1.5 or 2 mm) of full-thickness pit epithelium. Sinus tracts were probed but not excised. Patients were asked to wash the area twice daily, maintain normal activities, and return in 6 to 8 weeks. Patients requiring nidus incision and drainage (I&D) were excluded. RESULTS: About 130 patients underwent this technique between February and June 2024; 100 were included in the analysis (5 excluded for concurrent I&D, 25 lost to follow-up). Mean age was 18.1 years; 50% were male. At subsequent follow-up, 60% patients healed all pits, resolving their condition, with 64% (144/224) of all pits healed. Patients with three or more pits were more likely to need an additional pit excision. Mean procedure pain score was 1.6/10 (SD 1.21); no patient used pain medication or experienced disability. Ultimately, 88% of patients healed all of their pits. CONCLUSION: Pilonidal disease may be resolved non-operatively in a single outpatient clinic visit, without even a shot.
Effectiveness and Safety of Shortened Postoperative Antibiotic Regimens in Children with Perforated Appendicitis: A Systematic Review and Meta-Analysis.
Löfgren P, Berge E, de Wijkerslooth EML … +3 more , Jivegård L, Sjöström S, Wallerstedt SM
Eur J Pediatr Surg · 2026 Jun · PMID 41443239 · Full text
BACKGROUND: Postoperative antibiotic treatment of varying length is routinely used in perforated appendicitis to reduce the risk of complications. In the pediatric population, outcomes of shortened antibiotic regimens ha...
BACKGROUND: Postoperative antibiotic treatment of varying length is routinely used in perforated appendicitis to reduce the risk of complications. In the pediatric population, outcomes of shortened antibiotic regimens have not been specifically reviewed. METHODS: Medline, Embase, the Cochrane Library, and CINAHL were searched (October 2023): P, patients: Children with perforated appendicitis; I, intervention and C, comparison: Antibiotic regimen below (I) and above (C) a defined number of days; O, outcomes, focus: Patient risks and benefits. For the main outcome (intra-abdominal abscess), non-inferiority was assessed. RESULTS: Three randomized controlled trials (RCTs; 215 children) and one non-randomized study (288 children) fulfilled the PICO criteria. Regarding intra-abdominal abscess, pooling data from two RCTs (<5 vs. 5 days of intravenous antibiotics; 16 (17%) vs. 15 [15%] events) resulted in a wide 95% confidence interval (risk difference: -8 to 12 percentage points) not meeting the predefined non-inferiority margin of 7.5. One RCT (2 vs. 5 days of intravenous antibiotics) provided data regarding readmissions (9 vs. 7 events) and complications to antibiotic treatment (8 vs. 9 events). Two RCTs (<5 vs. 5 days of intravenous antibiotics) reported significantly shorter length of stay in the intervention group. CONCLUSION: This systematic review shows neither non-inferiority nor an increased risk of intra-abdominal abscess with a shortened postoperative antibiotic regimen. There may be no difference regarding readmission rates and treatment-related complications. Shorter regimens probably offer the advantage of reduced hospital stay. Due to substantial uncertainties, further RCTs are needed to define the optimal duration of antibiotics in children.
Gastro-Esophageal Reflux in Esophageal Atresia Patients Remains a Challenge: Results from a Systematic Review and Meta-Analysis.
Sterlin A, Garnier H, Vallejo G … +5 more , Monteiro JM, Moreno-Alfonso JC, Ulman H, Riccipetitoni G, Gazzaneo M
Eur J Pediatr Surg · 2026 Feb · PMID 41443238 · Publisher ↗
Although international guidelines address the management of esophageal atresia (EA), the optimal approach to gastroesophageal reflux disease (GERD) in this population remains controversial. This systematic review and met...
Although international guidelines address the management of esophageal atresia (EA), the optimal approach to gastroesophageal reflux disease (GERD) in this population remains controversial. This systematic review and meta-analysis aims to clarify the current management of GERD in children after EA repair, reporting the prevalence of GERD, indications, and effectiveness of medical and surgical therapies.A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. A literature search was performed in MEDLINE, Cochrane Database, and Web of Science. Studies involving patients under 18 years old with GERD following EA repair were included. Data were extracted on incidence, diagnostic approach, medical and surgical management, and outcomes.Out of 1,612 articles, 49 (5,613 patients) were included. Reporting diagnostic modality, pH-impedance was most frequently used. The pooled GERD incidence was 36.7% overall and 58.1% in type A/B EA. Postoperative anti-reflux medication was reported in 88% of patients; 53.8% of children receiving medical therapy subsequently required further procedures (anti-reflux surgery [ARS], feeding stoma, or total esophago-gastric dissociation). ARS was more common in type A/B than in type C/D cohorts. Resolution of symptoms after ARS was reported in 74.5% of patients. Complications following ARS occurred in 28.3%, with a 14.9% rate of redo fundoplication, and the highest incidence occurred in infants < 6 months. The data on timing and type of ARS were heterogeneous.GERD affected over one-third of EA patients, with higher prevalence in types A and B. Although proton pump inhibitor therapy is common, a large proportion required ARS, with higher complication rates in smaller children. These findings highlight the need for standardized diagnostic criteria and multicenter prospective registries with long-term follow-up to clarify optimal timing and technique.
Learning Curve and Early Outcomes of Thoracoscopic Anatomical Lesion Resection for Congenital Pulmonary Airway Malformation in Children: A Single-surgeon Experience.
Lin M, Liao J, Li L
Eur J Pediatr Surg · 2025 Dec · PMID 41418817 · Publisher ↗
OBJECTIVE: To investigate the key points in performing thoracoscopic anatomic pulmonary lesion resection procedures, as well as analyze the characteristics of the learning curve associated with the surgery. METHODS: We r...
OBJECTIVE: To investigate the key points in performing thoracoscopic anatomic pulmonary lesion resection procedures, as well as analyze the characteristics of the learning curve associated with the surgery. METHODS: We retrospectively collected clinical data and 1-year follow-up outcomes of children diagnosed with congenital pulmonary airway malformation (CPAM) who underwent thoracoscopic anatomic lesion resection in our hospital from January 2019 to December 2023. Perioperative and short-term follow-up results were analyzed and surgical experiences and insights were summarized. Furthermore, the cumulative sum (CUSUM) method was employed to plot the learning curve of a single surgeon performing thoracoscopic anatomic resection, and the impact of different phases on perioperative parameters and early follow-up outcomes was investigated. RESULTS: This study included 154 patients undergoing thoracoscopic anatomic lesion resection. Postoperative complications occurred in three patients (1.9%), and residual lesions were identified in four cases (2.6%). When a single surgeon's procedural volume exceeded 39 cases, marking the transition to the proficiency phase, significant reductions were observed in operative time, intraoperative blood loss, postoperative hospital stay, and postoperative mechanical ventilation duration compared with the learning phase (all < 0.05). No significant differences were found in postoperative drainage volume and chest tube duration. CONCLUSION: The key to thoracoscopic anatomic lesion resection lies in identifying the lesion boundaries and achieving precise dissection. Our study showed that this surgical approach is relatively safe and feasible for children with CPAM, with favorable perioperative and 1-year postoperative outcomes. Moreover, as surgeons progress to proficiency, perioperative outcomes improve and the incidence of residual lesions decreases. However, as a single-center study with a limited number of cases and due to a lack of long-term follow-up data, the safety and efficacy of this technique still require further validation through multi-center studies.
Acquired Diaphragmatic Hernia Following Pediatric Liver Transplantation: Incidence, Risk Factors, and Surgical Outcomes.
Pauer N, Richter N, Baumann U … +5 more , Junge N, Fortmann C, Obed M, Dingemann J, Kiblawi R
Eur J Pediatr Surg · 2026 Feb · PMID 41407288 · Publisher ↗
Acquired diaphragmatic hernia (ADH) is an uncommon yet relevant complication after pediatric liver transplantation (pLTx). True incidence and risk factors remain poorly defined, largely due to limited screening, heteroge...
Acquired diaphragmatic hernia (ADH) is an uncommon yet relevant complication after pediatric liver transplantation (pLTx). True incidence and risk factors remain poorly defined, largely due to limited screening, heterogeneous imaging practices, and the absence of validated predictive models. This study aimed to determine the incidence, presentation, and risk factors for ADH and to compare surgical repair techniques and short-term outcomes of thoracoscopic versus open approaches.We performed a retrospective review of all children undergoing pLTx at our institution (2014 and 2024). Demographic and transplant-related data were analyzed in patients with and without ADH. Operative approach, postoperative recovery, and 6-month follow-up were assessed. Findings were placed into context by comparison with published series.Among 246 pediatric transplant recipients, 8 children developed ADH (3.3%). Two patients had bilateral defects; each side was repaired electively in separate, staged procedures. Counting each side as a distinct repair event yielded 10 ADH repair procedures for analysis. Children who developed ADH were significantly younger at transplantation (mean 9.7 months vs. 64.0 months, = 0.002) and had lower body weight (7.8 kg vs. 20.7 kg, = 0.004). Prior abdominal surgery was common (five-eighths). Seven patients received a left lateral segment graft (LLS); graft-to-recipient weight ratio was 3.8% versus 3.2% in non-ADH patients ( = 0.107). Most hernias were right-sided, with presentations ranging from respiratory symptoms to incidental imaging findings. Surgical repair was performed via laparotomy in six cases and thoracoscopy in four, with one conversion to thoracotomy. Short-term outcomes were favorable in both groups, with only one recurrence (after laparotomy) and no mortality during follow-up.ADH after pLTx occurred in a minority of recipients and was associated with younger age, low body weight, prior abdominal surgery, and LLS grafts. However, the specific contribution of these variables remains unclear. Persistent research gaps include the lack of standardized screening protocols, uncertainty regarding cumulative long-term risk, and the absence of predictive models to identify high-risk patients. Addressing these issues requires multicenter collaboration and prospective surveillance strategies. Thoracoscopic repair was feasible in selected patients and may be considered when suitable.
Anorectal Malformation with Rectoperineal Fistula in Females Treated with a Posterior Rectal Advancement Anoplasty: Report of Early Outcomes.
Xu T, Ryan JA, Jalles F … +5 more , Maya AM, Feng C, Wood RJ, Badillo A, Levitt MA
Eur J Pediatr Surg · 2026 Jun · PMID 41397483 · Publisher ↗
OBJECTIVE: The posterior rectal advancement anoplasty (PRAA) is a novel approach for females with rectoperineal fistulas in which the distal fistula tract lies within the anterior limit of the anal sphincter complex. PRA...
OBJECTIVE: The posterior rectal advancement anoplasty (PRAA) is a novel approach for females with rectoperineal fistulas in which the distal fistula tract lies within the anterior limit of the anal sphincter complex. PRAA eliminates the risk of vaginal injury and perineal body dehiscence while allowing for an appropriately sized and centered anal opening. This study aims to examine the complications and outcomes following PRAA. METHODS: A retrospective, single-institution study was performed of female patients with an anorectal malformation with a rectoperineal fistula between January 2020 and December 2023. PRAA was performed when the rectoperineal fistula was located within the anterior extent of the anal sphincteric ellipse. We assessed time to first feeding, length of stay, and early stooling patterns and complications. RESULTS: Twelve patients underwent PRAA at a median age of 171 days with a median follow-up of 5 months. None were previously diverted with an ostomy. There was no incidence of vaginal injury, wound dehiscence, rectal prolapse, or anal stricture. All were able to resume feeds immediately and were discharged home on postoperative day 1. On follow-up, all patients were stooling spontaneously, and nine (75%) were utilizing daily laxatives. CONCLUSION: The PRAA, specifically in female patients with rectoperineal fistula within the anterior limit of the sphincters, eliminates the risk of vaginal injury and perineal body dehiscence. This technique decreases the risk of rectal prolapse and anal stricture and allows patients to return to their regular diet and home quickly, after only 1 postoperative day. It can be done without the need for a colostomy. Longer-term data are needed to continue to explore functional outcomes.
Microsurgical Varicocelectomy with Spermatic Vein to Superficial Epigastric Vein Bypass in Adolescents.
Papes D, Cavar S, Pasini M … +7 more , Sabolic I, Antabak A, Jelčić I, Rosandic T, Sinjeri D, Skrljak Sosa D, Luetic T
Eur J Pediatr Surg · 2025 Dec · PMID 41386289 · Publisher ↗
A microsurgical venous bypass between the internal spermatic vein (ISV) and inferior epigastric vein was proposed five decades ago for varicocele treatment. Limitations of this technique include a large incision, transve...
A microsurgical venous bypass between the internal spermatic vein (ISV) and inferior epigastric vein was proposed five decades ago for varicocele treatment. Limitations of this technique include a large incision, transverse fascia transection, delayed recovery, and mandatory venography to rule out external iliac vein compression (present in ∼10% of patients). To address these limitations, a modified microsurgical varicocelectomy with internal spermatic to superficial epigastric vein (SEV) bypass was developed and evaluated in this study.The ISV-SEV bypass was performed in all adolescents (≤18 years) undergoing microsurgical varicocelectomy between May 2021 and October 2023 for left testicular hypotrophy, pain, or oligospermia. The first 100 consecutive cases were analyzed. Outcomes included length of hospital stay, complications, recovery time, postoperative Doppler parameters (testicular volume, reflux, anastomosis patency), recurrence, and improvement in testicular volume and semen characteristics. Minimum follow-up was 12 months.Mean patient age was 15.5 ± 1.15 years. Main indications included hypotrophy (72%) and oligospermia (24%). Median operative time was 55 minutes (range 45-90). All patients were discharged within 24 hours. Median return to school and sports was 4.5 and 14 days, respectively. Testicular volume improved in 54/72 patients with hypotrophy. All oligospermic patients showed significant sperm count improvement (mean 15.2 to 88.2 million; < 0.0001). Rates of atrophy, hydrocele, hematoma, and recurrence were 0%, 0%, 2%, and 1%, respectively. Residual Doppler reflux or persistent varices were noted in 11 patients, but without clinical relevance.Microsurgical varicocelectomy with ISV-SEV bypass appears to be a safe and feasible technique in adolescent patients, with encouraging short-term outcomes regarding testicular volume recovery and semen parameters. Low complication and recurrence rates are promising, but further studies are needed to assess the benefit over standard techniques.
Artificial Intelligence in Pediatric Surgery-From Vision to Clinical Reality.
Till H, Gnatzy R
Eur J Pediatr Surg · 2026 Jun · PMID 41380722 · Publisher ↗
Abstract loading — click title to view on PubMed.
Emergency Laparotomy in the Neonatal Intensive Care Unit: A Systematic Review of Indications and Outcomes.
Sehdev S, O'Sullivan B, Blaise BJ … +3 more , Lee G, Selman A, Yardley I
Eur J Pediatr Surg · 2026 Feb · PMID 41365380 · Publisher ↗
Cotside laparotomy is often performed in critically ill neonates, but its indications over in-theatre laparotomy remain unclear. This is the first systematic review of published evidence, aiming to clarify the feasibilit...
Cotside laparotomy is often performed in critically ill neonates, but its indications over in-theatre laparotomy remain unclear. This is the first systematic review of published evidence, aiming to clarify the feasibility, safety, and indications for neonatal intensive care (NICU)-based laparotomy.A systematic review was conducted following PRISMA guidelines. Quantitative data on patient demographics and outcomes were extracted, and where possible, aggregated comparative analyses were performed. Qualitative thematic analysis was used to explore reported institutional experiences of cotside laparotomy.Eighteen studies were included, reporting data from 20 surgical sites across 10 countries, published from 1994 to 2024. Eight studies reported a comparator group of theatre-based laparotomies. In total, data on 418 cotside and 453 theatre laparotomies were included. Cotside cohorts had lower birthweight (approximately 1,305 g vs. 2,941 g, = 0.016) and gestational age (approximately 29.5 vs. 34.3 weeks, = 0.047). Postoperative adverse event rates were similar between neonates in each group (8.1%, 33/407 vs. 6.8%, 30/442; = 0.23, = 0.63), as was in-hospital mortality (24.1%, 98/407 vs. 25.3%, 112/442; = 0.15, = 0.70). Thematic analysis identified transfer-related events as a significant concern in babies operated in theatre, particularly endotracheal tube dislodgement and hypothermia, while cotside operating space constraints and disturbance to NICU activities were frequently cited issues. Decisions on surgical location were multifactorial and multidisciplinary, influenced by cardiorespiratory status and institutional factors. Formal institutional guidelines for cotside surgery were reported in only 33% (6/18) of studies.Emergency cotside laparotomy is safe and feasible. Despite consisting of a higher risk population, mortality and morbidity are comparable to theatre-based surgery. Avoiding the risks of transfer may confer additional benefit. Large-scale, prospective studies are needed to clarify the indications for cotside operating.
Pediatric Empyema in the Post-Pandemic Period: Evaluating Changing Trends in Microbiology, Investigations, Fibrinolysis, and Surgical Outcomes.
Cao KX, Xilas E, Seago I … +3 more , Abdelbary M, Jawaid W, Aslam A
Eur J Pediatr Surg · 2026 Jun · PMID 41365379 · Publisher ↗
INTRODUCTION: We present a retrospective analysis of our experience managing pediatric empyema, focusing on clinical, microbiological, radiological aspects, surgical and fibrinolytic outcomes over an 8-year period, encom...
INTRODUCTION: We present a retrospective analysis of our experience managing pediatric empyema, focusing on clinical, microbiological, radiological aspects, surgical and fibrinolytic outcomes over an 8-year period, encompassing the 2022-2023 United Kingdom invasive group A (iGAS) surge. This observational study aimed to test the hypothesis that the post-pandemic period has revealed a new pattern of microbes, disease patterns, and treatment effectiveness. MATERIALS AND METHODS: Case notes of children (<16 years) with thoracic empyema who had an intercostal drain between 2014 and 2023 were reviewed for demographic, imaging, microbiological, and operative findings. Periods were categorized as pre-pandemic (2015-2020), pandemic (2020-2021), and post-pandemic (2022-2023). RESULTS: From 86 cases, median ages fell from 9.9 years (pre-pandemic), 6.2 years (pandemic), to 4.4 years (post-pandemic). Pleural culture detected organisms in 27% while 16S PCR increased the yield to 90.7%. (43.4%) and (30.2%) predominated. Viral coinfection was associated with necrosis (45% vs. 24% without coinfection). Intrapleural fibrinolysis effectiveness fell from 81% pre-pandemic to 60% post-pandemic, with a concomitant rise in need for further surgery from 19% to 48%. Alongside these changes, the length of stay increased from 8 to 11 days (pre- vs. post-pandemic). There were no empyema-related deaths at our center over this study period. CONCLUSION: Post-pandemic empyema was characterized by younger age, a higher proportion of , and increased intrapleural fibrinolytics failure and surgery. These data support earlier surgical consultation for younger patients or those with viral coinfections, prospective evaluation of dual-agent fibrinolysis in children, and integration of 16S PCR into pleural workflows. Ongoing surveillance of empyema epidemiology is needed to optimize future management.
Artificial Intelligence in Pediatric Surgery: From Diagnostics and Preoperative Planning to Risk Stratification: A Comprehensive Review of Current Applications.
Gnatzy R, Feng X, Graefe D … +2 more , Deffaa OJ, Lacher M
Eur J Pediatr Surg · 2026 Jun · PMID 41314409 · Publisher ↗
OBJECTIVE: Artificial intelligence (AI) is increasingly explored in pediatric surgical care, yet its translation into diagnostics and preoperative planning lags behind adult surgery. Unlike prior reviews, this study prov...
OBJECTIVE: Artificial intelligence (AI) is increasingly explored in pediatric surgical care, yet its translation into diagnostics and preoperative planning lags behind adult surgery. Unlike prior reviews, this study provides a comprehensive synthesis across four domains, diagnostics, preoperative planning, risk stratification, and surgical error prevention, highlighting recent advances and unmet challenges. METHODS: A narrative review of PubMed/MEDLINE (2020-2025) identified peer-reviewed studies on AI in pediatric surgery. Eligible articles addressed one of the four domains and were assessed for methodology, clinical applicability, and relevance to pediatric surgical patients. RESULTS: Diagnostic imaging is the most advanced field, with deep learning models for fracture detection and bone age assessment achieving accuracies up to 95% and near-expert agreement, though external validation is scarce. Preoperative planning benefits from AI-driven segmentation, 3D reconstruction, and virtual reality, with reports of altered surgical strategy in up to 8% of oncology cases, but evidence of outcome benefit is limited. Risk models for appendicitis and congenital heart surgery often surpass clinical scores, yet fewer than 10% have undergone external validation. Tools for error prevention, such as intelligent checklists and workflow monitoring, remain at the proof-of-concept stage. Across domains, most studies are retrospective, single-center, and methodologically heterogeneous. CONCLUSION: AI demonstrates tangible potential to improve pediatric surgical diagnostics, planning, and safety. However, translation into clinical practice requires multicenter pediatric datasets, prospective validation, and transparent, interpretable models. By consolidating the most recent evidence across four domains, this review outlines both the opportunities and critical gaps that should be addressed for safe and effective adoption.
Age-Stratified Impact of Early Virtual Reality Intervention on Preoperative Anxiety in Children: A Randomized Trial.
Chocarro Amatriain G, Alonso-Allende TMC, Gallego OO … +17 more , Limousin IT, Fernandez RIG, Gutierrez AG, Martinez LA, Castro MPV, Estevez CMG, Tabares MIR, Mate MRG, Ipiñazar IG, Ajuria GN, Mendez LM, Rodriguez ES, Prieto NS, Aja ER, Castellanos AM, Santiago IC, Bruned JLB
Eur J Pediatr Surg · 2026 Feb · PMID 41297890 · Publisher ↗
Although it is known that virtual reality (VR) reduces presurgical anxiety, it has neither been stratified by age to determine its effect, nor has been applied before the day of surgery. This study has a novel age-strati...
Although it is known that virtual reality (VR) reduces presurgical anxiety, it has neither been stratified by age to determine its effect, nor has been applied before the day of surgery. This study has a novel age-stratified design offering VR months before surgery to address these unstudied issues.This was a unicentered, blinded clinical trial with parallel groups stratified by age (5-8 and 9-12 years), including major outpatient surgery patients. VR video showing the course of surgery was offered months before surgery. This study had ethical committee approval. The main variable was the modified Yale Preoperative Anxiety Scale (mYPAS) before entering the operating room. The Child Behavior Checklist (CBCL) measured basal anxiety and the Posthospitalization Behavior Questionnaire (PHBQ) measured behavior after 1 month. For comparison, Student's -test or Kruskal-Wallis test was used.Of 72 patients, 6 met exclusion criteria and 5 withdrew consent. Of the remaining 61, 56 completed mYPAS. The mYPAS decrease was significant for children aged 5 to 8 years (28.33 VIDEO vs. 35.83 non-VIDEO; = 0.042) (rank coefficient 0.45 [0.05-0.72]). In the children aged 9 to 12 years (32.91 vs. 33.33; = 0.864), a tiny correlation ( = 0.04 [0.38-0.45]) was found. A total of 96.67% of CBCLs ( = 58) scored normal. The 57 completed PHBQs had very low scores, both in non-VIDEO (0.00 [0.00-4.50]) and in VIDEO groups (0.00 [0.00-4.50]). No differences were found; neither globally ( > 0.05), nor depending on age (5-8 years, = 0.508/9-12 years, = 0.661).VR may reduce preoperative anxiety in younger children (5 to 8 years), though its effect in the entire group was borderline. Larger multicenter studies are needed to confirm age and timing benefits.
AI in Robotic-assisted Pediatric Surgery: Current Applications and Future Directions.
Esposito C, Di Mento C, Del Conte F … +4 more , Tedesco F, Guglielmini R, Esposito G, Escolino M
Eur J Pediatr Surg · 2026 Jun · PMID 41086880 · Publisher ↗
BACKGROUND: Artificial intelligence (AI) is increasingly integrated into surgical practice, offering enhanced decision-making, precision, and workflow efficiency. In pediatric surgery, the convergence of AI and robotic-a...
BACKGROUND: Artificial intelligence (AI) is increasingly integrated into surgical practice, offering enhanced decision-making, precision, and workflow efficiency. In pediatric surgery, the convergence of AI and robotic-assisted platforms represents a promising frontier, addressing the unique anatomical, physiological, and technical challenges of operating on children. Aim of this review is to provide an overview of the current state of art of AI use in pediatric robotic-assisted surgery (RAS), outlining the available evidence, potential benefits, existing limitations, and prospective developments. MATERIALS AND METHODS: A literature-based search of PubMed and Scopus was performed to identify articles covering any aspect of AI application in pediatric RAS. Selection criteria included English language, pediatric patients (under 18 years of age), and AI application to pediatric RAS. Additionally, studies reporting AI applications in adult RAS or for surgical training, which were not primarily focused on pediatric surgery but presented potential translational applicability to pediatric RAS, were considered. RESULTS: A total of 746 papers published until July 2025 were collected. A total of 15 full-text articles were assessed for eligibility, meeting the inclusion criteria. The other studies were excluded because they did not address pediatric surgery, did not involve robotic-assisted procedures, or did not include applications of AI. CONCLUSION: Although RAS is well established in pediatric practice, the direct application of AI remains limited, with AI-like features such as machine vision and augmented reality serving mainly as supportive tools rather than autonomous decision-making systems. Nevertheless, emerging AI-like technologies and ongoing research hold promising potential for future applications in pediatric robotic surgery.
The Pediatric Surgeon's AI Toolbox: How Large Language Models Like ChatGPT Are Simplifying Practice and Expanding Global Access.
Tinajero CAC
Eur J Pediatr Surg · 2026 Jun · PMID 41086879 · Publisher ↗
INTRODUCTION: Pediatric surgeons face substantial administrative workload. Large language models (LLMs) may streamline documentation, family communication, rapid reference, and education, but raise concerns about accurac...
INTRODUCTION: Pediatric surgeons face substantial administrative workload. Large language models (LLMs) may streamline documentation, family communication, rapid reference, and education, but raise concerns about accuracy, bias, and privacy. This review summarizes practical, near-term uses with clinician oversight. MATERIALS AND METHODS: Narrative review of LLMs in pediatric surgical workflows and scholarly writing. Sources included MEDLINE/PubMed, Scopus, Embase, Google Scholar, and policy documents (WHO, FDA, EU). Searches spanned January 2015 to August 2025, English only. Peer-reviewed and multicenter studies were prioritized; selected high-signal preprints were labeled. Data screening and extraction were performed by the author; findings were synthesized qualitatively. RESULTS: Across studies, LLMs reduced drafting time for discharge letters and operative note registries while maintaining clinician-rated quality; they improved readability of consent forms and postoperative instructions and supported patient education. For decision support, general models performed well on structured medical questions, with stronger results when grounded by retrieval. Common limits included coding performance, case-nuance/temporal reasoning, variable translation outside high-resource languages, and citation fabrication without curated sources. Privacy risks stemmed from logging, rare-string memorization, and poorly scoped tool connections. Recommended controls included a clinician-in-the-loop "review and release" workflow, privacy-preserving deployments, version pinning, and ongoing monitoring aligned with early-evaluation guidance. CONCLUSION: When outputs are grounded in structured EHR data or curated retrieval and briefly reviewed by clinicians, LLMs can responsibly reduce administrative burden and support communication and education. Early adoption should target high-volume, low-risk, auditable tasks. Future priorities must include multicenter pediatric datasets, transparent benchmarks (accuracy, calibration, equity, time saved), and prospective studies linked to safety outcomes.
About
- Frequency
- Sun
- Papers found
- 200
- RSS feed
- Subscribe