European Journal Of Pediatric Surgery[JOURNAL]
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200 papers
Lateral Release in Neonatal Congenital Diaphragmatic Hernia Is Associated with Faster Recovery Compared to Abdominal Wall Patch Repair: A Preliminary Prospective Cohort Study.
Riebesell K, Elrod J, Thees P … +8 more , Martel R, Mohr C, Weiss C, Schaible T, Riemer C, Dietze N, Boettcher M, Klinke M
Eur J Pediatr Surg · 2026 Jun · PMID 40997855 · Publisher ↗
BACKGROUND: Open repair of congenital diaphragmatic hernia (CDH) in neonates often requires surgical reconstruction of the abdominal wall. Lateral release (LR) of the abdominal wall fascia, a novel technique avoiding pro...
BACKGROUND: Open repair of congenital diaphragmatic hernia (CDH) in neonates often requires surgical reconstruction of the abdominal wall. Lateral release (LR) of the abdominal wall fascia, a novel technique avoiding prosthetic patches, offers potential advantages. However, data comparing its outcomes to traditional patch repair are limited. MATERIALS AND METHODS: A preliminary prospective cohort study was conducted at the University Medical Center Mannheim from 2021 to 2024, including neonates undergoing CDH surgery with abdominal wall reconstruction via direct closure, LR, or patch repair based on intraoperative surgeon decision. Perioperative, postoperative, and short-term outcome data were analyzed during our standardized follow-up protocols and compared between groups. RESULTS: Among 77 eligible neonates, 11 underwent patch repair and 10 received LR. Baseline characteristics between groups were comparable. The median follow-up was 391 days in the patch group and 215 days in the LR group ( = 0.1971). The LR group had significantly shorter median intubation duration, neonatal intensive care unit stay, and overall length of stay compared with the patch group (32.0 days vs. 43.0 days, = 0.0445; 33.5 days vs. 66.0 days, = 0.0309; 68.0 days vs. 97.0 days, = 0.0435). There were no significant differences in recurrence rates, short-term complications, or motor developmental outcomes. CONCLUSION: LR appears to be associated with shorter hospital stays and faster recovery, without an increase in perioperative or long-term complications. While these findings suggest potential benefits of LR, they must be interpreted with caution due to the limited sample size. Further randomized, multicenter studies with larger cohorts, including long-term assessment of complications, are needed to confirm its efficacy and refine clinical guidelines.
Intercostal Nerve Cryoablation for Postoperative Pain Control After the Nuss Procedure in Children: A Systematic Review and Meta-Analysis.
Marques D, Vieira R, Fragoso A … +1 more , Tuna T
Eur J Pediatr Surg · 2026 Jun · PMID 40992428 · Publisher ↗
INTRODUCTION: Nuss procedure is the standard technique for pectus excavatum repair. Despite its minimally invasive nature, this procedure is associated with significant postoperative pain and high opioid consumption. Int...
INTRODUCTION: Nuss procedure is the standard technique for pectus excavatum repair. Despite its minimally invasive nature, this procedure is associated with significant postoperative pain and high opioid consumption. Intercostal nerve cryoablation (INC) has emerged as an adjunct to multimodal analgesia (MMA) to improve pain control, reduce opioid use, and shorten length of stay (LOS). This systematic review aims to assess INC outcomes following the Nuss procedure in pediatric patients. MATERIALS AND METHODS: A systematic search was conducted in PubMed, Web of Science, Scopus, and Cochrane Library databases through December 2024. Studies comparing INC with standard MMA, with or without thoracic epidural, in pediatric patients undergoing the Nuss procedure were included. The primary outcome was LOS, and the secondary outcomes were opioid consumption, postoperative pain, complications, operative time, and hospitalization costs. Risk of bias was determined using the National Institutes of Health assessment tool. Meta-analysis was performed using R software. RESULTS: Eleven studies met the inclusion criteria, comprising 922 patients (476 INC and 446 control). INC significantly reduced LOS (-2.2 days; 95% CI: -2.8 to -1.8) at the expense of increased operating room time (+23 minutes; 95% CI: 10-39). Qualitative analysis showed reduced opioid use and comparable pain scores and complication rates with INC, while its impact on costs was conflicting. CONCLUSION: INC reduces LOS and opioid use in pediatric patients undergoing the Nuss procedure without increasing complications. Further studies are needed to assess long-term safety and cost-effectiveness.
Impact of VACTERL Association and Chromosomal Anomalies on Outcomes After Esophageal Atresia Repair: Insights from the EUPSA Registry.
Soyer T, Pederiva F, Dalena P … +5 more , Pio L, Kakar M, Hall NJ, Morini F, Esophageal Atresia Registry participants
Eur J Pediatr Surg · 2026 Jun · PMID 40992427 · Publisher ↗
OBJECTIVE: Although VACTERL association is a recognized entity in patients with esophageal atresia (EA), its impact on surgical outcomes remains unclear. This study aimed to evaluate the influence of VACTERL association...
OBJECTIVE: Although VACTERL association is a recognized entity in patients with esophageal atresia (EA), its impact on surgical outcomes remains unclear. This study aimed to evaluate the influence of VACTERL association and chromosomal anomalies (VACTERL-CA) on the surgical outcomes of EA patients, offering novel insights into risk stratification. METHODS: All patients enrolled in the European Pediatric Surgeons' Association (EUPSA) Esophageal Atresia Registry (EAR) between July 2014 and December 2017 were included. Patients were classified into two groups: those with VACTERL-CA and those without these anomalies (non-VACTERL). Groups were compared for demographics, associated malformations, surgical approach, complications, and outcomes. RESULTS: Among 372 patients, 22% ( = 82) were classified as VACTERL-CA. This group had significantly lower gestational age (35.9 weeks vs. 37.1 weeks, = 0.004), birth weight (2,312 g vs. 2,663 g, < 0.001), and APGAR scores at 5 and 10 minutes ( = 0.005). Surgical strategies, including rates of primary anastomosis (88% in both groups), did not differ. Anastomotic leak and stricture rates were similar; however, recurrent fistula was more common in VACTERL-CA (4.9% vs. 1.0%, = 0.023). Overall mortality was higher in VACTERL-CA (14.6% vs. 5.2%, = 0.003), largely due to associated anomalies such as cardiac or neurologic conditions, whereas EA-related mortality was more frequent in non-VACTERL (1% vs. 0%). Sepsis was also more frequent in VACTERL-CA (10.9% vs. 4.5%, = 0.033). In multivariate analysis, low birth weight (adjusted odds ratios [aOR]: 0.95 per 100 g, = 0.010) and cardiac malformations (aOR: 2.33, = 0.002) were independently associated with VACTERL-CA. CONCLUSION: EA patients with VACTERL-CA represent a high-risk subgroup characterized by prematurity, major cardiac defects, and increased sepsis risk. These findings highlight the need for early cardiac screening, standardized infection-prevention bundles, and tailored multidisciplinary care to improve survival and reduce preventable complications.
Explainable AI: Ethical Frameworks, Bias, and the Necessity for Benchmarks.
Verhoeven R, Bouisaghouane W, Hulscher JB
Eur J Pediatr Surg · 2026 Jun · PMID 40987434 · Full text
Artificial intelligence (AI) is increasingly integrated into pediatric healthcare, offering opportunities to improve diagnostic accuracy and clinical decision-making. However, the complexity and opacity of many AI models...
Artificial intelligence (AI) is increasingly integrated into pediatric healthcare, offering opportunities to improve diagnostic accuracy and clinical decision-making. However, the complexity and opacity of many AI models raise concerns about trust, transparency, and safety, especially in vulnerable pediatric populations. Explainable AI (XAI) aims to make AI-driven decisions more interpretable and accountable. This review outlines the role of XAI in pediatric surgery, emphasizing challenges related to bias, the importance of ethical frameworks, and the need for standardized benchmarks. Addressing these aspects is essential to developing fair, safe, and effective AI applications for children. Finally, we provide recommendations for future research and implementation to guide the development of robust and ethically sound XAI solutions.
Single-Stage Double-Face Preputial Island Flap versus Two-Stage Byars' Flap Repair for Severe Proximal Hypospadias: A Prospective Randomized Study.
El-Raheb BM, Guirguis NN, Elghandour MM … +2 more , Radwan AB, ElDebeiky M
Eur J Pediatr Surg · 2026 Jun · PMID 40957607 · Publisher ↗
BACKGROUND: The optimal approach for repairing severe hypospadias remains debated. In our institution, the single-stage double-face preputial island flap (DFPIF) has been employed to reduce the number of procedures and c...
BACKGROUND: The optimal approach for repairing severe hypospadias remains debated. In our institution, the single-stage double-face preputial island flap (DFPIF) has been employed to reduce the number of procedures and costs. Given the resource-limited context, an evidence-based comparison of repair techniques was warranted to inform cost-effective surgical decision-making. PATIENTS AND METHODS: A prospective randomized study was conducted on 36 patients with proximal hypospadias and chordee >30 degrees, treated between 2022 and 2025. Patients were randomly allocated to Group A (DFPIF) or Group B (Byars' flap) using a computer-generated block randomization with allocation concealment. All surgeries were performed by the same team. Patients were followed for 12 months. Groups were compared regarding complications, functional, and cosmetic outcomes. Functional outcomes were assessed using parent-reported urinary stream and erection, with objective chordee assessment under anesthesia. Cosmetic results were evaluated using the Hypospadias Objective Scoring Evaluation (HOSE) score and a 10-point parental satisfaction scale. Outcomes were assessed by a blinded team member who was not involved in the operative procedures. Data were analyzed by a blinded analyst. RESULTS: Thirty-six patients were included, with 18 patients in each group. There was no statistically significant difference in complications, except for partial wound dehiscence, which was higher in group A ( = 0.041). Functional and cosmetic outcomes, as well as parental satisfaction, did not differ significantly. CONCLUSION: While both techniques achieved acceptable early outcomes, the double-face flap group showed higher rates of partial wound dehiscence. Further studies with larger samples and longer follow-up are required to determine long-term efficacy and safety.
Musculoskeletal Pain in Pediatric Surgeons: Prevalence, Impact, and Prevention-A Cross-Sectional Survey Study.
Holler AB, König TT, Schock A … +1 more , Muensterer OJ
Eur J Pediatr Surg · 2026 Feb · PMID 40902620 · Publisher ↗
Recent studies show that at least three-quarters of surgeons who perform minimally invasive surgery suffer from musculoskeletal pain and discomfort. This problem may compromise surgical performance, patient outcomes, and...
Recent studies show that at least three-quarters of surgeons who perform minimally invasive surgery suffer from musculoskeletal pain and discomfort. This problem may compromise surgical performance, patient outcomes, and career longevity. Because of small patient dimensions, pediatric surgery is associated with a different set of ergonomic challenges than adult surgery.A 59-item questionnaire was sent to all practicing pediatric surgeons in Germany. It contained a general assessment of demographics, practice setting, operative volume, types of operations performed, and compensatory interventions, followed by the validated Nordic Questionnaires for the analysis of musculoskeletal symptoms (NMQ). Responses were collected and statistically evaluated to identify risk factors for musculoskeletal complications.A total of 152 pediatric surgeons participated in the survey. Among the participants, 21% were trainees, 58% attendings, and 21% chiefs of service. The median time in practice was 18 years (range: 0 to 38 years). Musculoskeletal pain was reported by 75%, and was most prevalent in the neck/cervical (80%), shoulder (56%), and lower back/lumbar region (71%). Footrests or steps were used by 88%, intraoperative breaks were employed by 49%, and 96% of respondents sometimes operated in a sitting position. The only significant factor for musculoskeletal pain was number of years in practice.Musculoskeletal pain among pediatric surgeons is common and increases with years in practice. Although many pediatric surgeons incorporate ergonomic measures in their daily activities, these are far from being implemented universally. More awareness and research on the prevention of long-term musculoskeletal sequelae in pediatric surgery is necessary.
Prenatal Intervention in High-Risk CPAM: Postnatal Outcomes After Fetal versus Standard Surgery: A Propensity Score Matched Study.
Klinke M, Elrod J, Martel R … +5 more , Schaible T, Nientiedt T, Boettcher J, Kohl T, Boettcher M
Eur J Pediatr Surg · 2026 Apr · PMID 40865916 · Publisher ↗
Congenital pulmonary airway malformation (CPAM) is a rare fetal lung anomaly characterized by cystic lesions that can impede lung development. While smaller lesions may remain asymptomatic and are managed postnatally, la...
Congenital pulmonary airway malformation (CPAM) is a rare fetal lung anomaly characterized by cystic lesions that can impede lung development. While smaller lesions may remain asymptomatic and are managed postnatally, larger lesions can cause severe complications such as mediastinal shift and hydrops fetalis. Fetal surgery may be indicated in these cases. This study analyzed whether fetal surgical intervention affects outcomes of subsequent postnatal surgery in CPAM patients.A retrospective single-center cohort study was conducted on pediatric patients treated for CPAM between January 2010 and August 2024. Patients were divided into two groups: those with prenatal surgical intervention and those treated with postnatal surgery only. Propensity score matching based on gestational age, gender, birth weight, and lesion volume ratio yielded 23 matched patients: 14 in the fetal surgery group and 9 in the control group. Baseline characteristics, type of fetal intervention, intraoperative, and long-term postoperative outcomes were assessed. Multivariable regression was performed to account for confounding variables.Among 179 identified patients, 23 were included after propensity score matching: 14 in the fetal surgery group and 9 in the standard postnatal surgery group. Baseline characteristics were balanced, except for significantly higher disease severity in the fetal surgery group (hydrops 69% vs. 0%, < 0.001; mediastinal shift 93% vs. 33%, = 0.001). Alcohol ablation was the most common fetal intervention; however, various other prenatal procedures were also performed, with most patients undergoing multiple interventions. Tendencies but no significant differences were found in primary outcomes, including mortality (15% vs. 0%, = 0.26) and recurrence (29% vs. 0%, = 0.18). Secondary outcomes such as ventilation duration and intensive care stay were longer in the fetal surgery group, but not statistically significant.Despite higher baseline disease severity, patients who underwent fetal intervention showed postnatal outcomes comparable to those with less severe CPAM. Fetal surgery did not appear to adversely affect surgical recovery. These findings should be interpreted with caution but may support the selective use of prenatal intervention in high-risk cases and underscore the need for further research to refine both prenatal strategies and postnatal care.
Impact and Citation Trends of Surveys Endorsed by the EUPSA Network Office in Pediatric Surgery: A Bibliometric Analysis.
Doktor F, Hall NJ, Mesas-Burgos C … +8 more , Zani-Ruttenstock E, Pederiva F, Sukhotnik I, Dingemann J, Pio L, Kakar M, Gorter R, Soyer T
Eur J Pediatr Surg · 2026 Apr · PMID 40865915 · Publisher ↗
The European Pediatric Surgeons' Association (EUPSA) Network Office regularly endorses surveys that address controversial topics in pediatric surgery. However, the scientific impact of these within the medical literature...
The European Pediatric Surgeons' Association (EUPSA) Network Office regularly endorses surveys that address controversial topics in pediatric surgery. However, the scientific impact of these within the medical literature remains unclear. To address this gap, we conducted a bibliometric analysis of all published EUPSA-endorsed surveys.Surveys endorsed by the EUPSA Network Office were reviewed for topic, journal, participation, bibliometric indicators (total number of citations and citations per article and year), and citing countries. Simple linear regression was used to determine citation time trends.Between 2013 and 2024, at least one survey was published each year ( = 0.26; = 0.1). Most commonly, surveys were published in the European Journal of Pediatric Surgery ( = 15), and the most common survey topics included general pediatric ( = 7), thoracic ( = 4), and colorectal ( = 3) surgery. The average number of participants per survey was 167 ± 53, with 75% (range: 54-89%) European responses. The most cited surveys addressed esophageal atresia, necrotizing enterocolitis, and Hirschsprung's Disease. The median number of citations per survey was 11 (range: 1-160), with a median of 6 citations per year (range: 0-26). The total number of citations from all EUPSA Network Office-endorsed surveys increased over time ( = 0.75; = 0.0006), and the average citation per article and year was consistent ( = 0.09; = 0.34). Citations originated from 63 countries, mostly from the United States ( = 75), Germany ( = 64), and China ( = 44).Despite inherent limitations of survey-based research, the growing bibliometric impact of EUPSA Network Office-endorsed surveys highlights their scientific merit as an important tool for exploring current pediatric surgical practices, which will inform future multi-institutional studies.
Latest Developments in Artificial Intelligence and Machine Learning Models in General Pediatric Surgery.
Elsayed H, Singer G, Till T … +1 more , Till H
Eur J Pediatr Surg · 2026 Apr · PMID 40858266 · Full text
Artificial intelligence (AI) and machine learning (ML) models rapidly transform health care with applications ranging from diagnostic image interpretation, predictive modeling, personalized treatment planning, real-time...
Artificial intelligence (AI) and machine learning (ML) models rapidly transform health care with applications ranging from diagnostic image interpretation, predictive modeling, personalized treatment planning, real-time intraoperative guidance, and outcome prediction. However, their implementation in general pediatric surgery remains limited due to the rarity and complexity of pediatric surgical conditions, small and heterogeneous datasets, and a lack of formal AI training and competencies among pediatric surgeons.This narrative review explores the current landscape of AI and ML applications in general pediatric surgery, focusing on five key conditions: appendicitis, necrotizing enterocolitis, Hirschsprung's disease, congenital diaphragmatic hernia, and biliary atresia. For each, we summarize recent developments, including the use of AI in image analysis, diagnostic support, prediction of disease severity and outcome, postoperative monitoring, and histopathological evaluation. We also highlight novel tools such as explainable AI models, natural language processing, and wearable technologies.Recent findings demonstrate promising diagnostic and prognostic capabilities across multiple conditions. However, most AI/ML models still require external validation and standardization. The review underscores the importance of collaborative, multicenter research based on joint datasets as well as targeted AI education for pediatric surgeons to fully explore the benefits of these technologies in clinical practice.AI and ML offer significant potential to improve pediatric surgical care, but broader implementation will require multicenter collaboration, a robust dataset, and targeted AI education for pediatric surgeons.
Esophageal Atresia Repair in Germany: Utilization Patterns, Hospital Characteristics and Costs.
Wennemann L, Blaser J, Wiesner S … +6 more , Zeidler J, Obed M, Weidner J, Jirmo AC, Dingemann J, Schukfeh N
Eur J Pediatr Surg · 2026 Feb · PMID 40840508 · Publisher ↗
Thoracoscopic esophageal atresia (EA) repair is a demanding procedure. It provides long-term benefits for patients including better cosmesis and less musculoskeletal sequelae compared with open surgery. Besides technical...
Thoracoscopic esophageal atresia (EA) repair is a demanding procedure. It provides long-term benefits for patients including better cosmesis and less musculoskeletal sequelae compared with open surgery. Besides technical challenges, there is concern that thoracoscopy increases treatment costs. However, surgical treatment of EA in Germany is not centralized with more than 90 pediatric surgical units offering treatment for 200 expected EA patients yearly. Our aim was to evaluate the rate of thoracoscopic EA repair regarding characteristics of treating hospitals, surgical approach and treatment costs in Germany.Insurance claims data (January 2020 to June 2024) from six health insurance companies representing about one-third (28.5 million) of the German population were analyzed. The database was queried for specific ICD-10-GM (International Statistical Classification of Diseases and Related Health Problems, 10th revision, German Modification) and OPS (Operationen- und Prozedurenschlüssel) coding. Characteristics of treating hospitals, length of hospital stay and medical treatment costs were assessed.A total of 149 reconstructive procedures for EA were analyzed. Eleven esophageal anastomoses were performed thoracoscopically (7%). All thoracoscopic procedures were performed in a specialized center. Mean length of hospital stay for open and thoracoscopic surgery was 76 versus 79 days, respectively ( > 0.05). Mean treatment costs were 142,741 € versus 150,238 €, respectively ( > 0.05).Thoracoscopic EA repair remains the exception in Germany. Thoracoscopy is exclusively performed in specialized hospitals. Length of hospital stay and treatment costs are comparable to open surgery, assumingly due to only uncomplicated patients without comorbidities being considered for thoracoscopy. We recommend surgical treatment in specialized centers to enable surgical advantages to all patients with EA.
From Bench to Bedside: Eupatilin Activates Antioxidant Defenses and Reduces Fibrosis in Experimental Cholestasis.
Wang WL, Chen Y, Tam PKH
Eur J Pediatr Surg · 2026 Feb · PMID 40834868 · Publisher ↗
The aim of this study is to explore the protective effects and mechanisms of Eupatilin, a peroxisome proliferator-activated receptor α (PPARα) agonist, on cholestatic liver disease induced by common bile duct ligation (B...
The aim of this study is to explore the protective effects and mechanisms of Eupatilin, a peroxisome proliferator-activated receptor α (PPARα) agonist, on cholestatic liver disease induced by common bile duct ligation (BDL) in mice.We selected Balb/c mice (both male and female) aged 6 to 8 weeks for the common BDL procedure (ethical approval number: MUST-FDCT-20241114001). The groups include the BDL group and the BDL+ Eupatilin group, with three mice in each group. Once the mice developed jaundice postsurgery (5 days), they were treated with Eupatilin via gavage at a dosage of 20 mg/kg daily for a period of 8 days. On day 13, ocular blood was collected, and liver tissues were extracted for histopathological examination with H&E staining, Sirius Red staining, and subsequent RNA sequencing. Statistical differences among the parameters were evaluated using a -test.Eupatilin reduces the liver weight/body weight ratio by 41% and ameliorates liver necrosis and fibrosis in Balb/c mice. It could decrease alanine transaminase ( = 0.0498), aspartate aminotransferase ( = 0.0077), while maintaining ALB (Albumin) and γ-GT (gamma-glutamyl transferase) within normal ranges. RNA sequencing analysis revealed that antioxidant genes (acetaldehyde dehydrogenase 2 [] and superoxide dismutase 1 []) might be the targets of Eupatilin action.We found that Eupatilin can upregulate antioxidant genes (; = 0.0107) and ( = 0.0208) of Balb/c mice, thereby ameliorating BDL damage in mice with cholestatic liver disease.
MRI-based Stratification and Surgical Management of Hydrocolpos in Children and Adolescents.
AbouZeid AA, Elhady HE, Mohammad SA … +3 more , Seada M, El-Naggar O, Elghandour MM
Eur J Pediatr Surg · 2026 Apr · PMID 40795933 · Publisher ↗
In this report we present a new anatomical stratification for vaginal obstruction (hydrocolpos) based on MRI findings while referring the level of obstruction to a fixed bony landmark (the pubic symphysis). This new appr...
In this report we present a new anatomical stratification for vaginal obstruction (hydrocolpos) based on MRI findings while referring the level of obstruction to a fixed bony landmark (the pubic symphysis). This new approach can overcome the limitations of current classifications, which are prone to approximation errors during measurement and fail to account for variations in body mass across different age groups.Data of cases diagnosed with vaginal obstruction were retrospectively analyzed. Cases of cloaca with vaginal obstruction were excluded. MRI confirmed the diagnosis and enabled classification of the level of vaginal obstruction relative to the pubic symphysis in the mid-sagittal plane as low, intermediate, or high-opposite the lower, mid, or upper end of the pubic symphysis, respectively.A total of 13 girls presented with vaginal obstruction during the period 2010 through 2024. Their age ranged between 1 month and 14 years (mean: 54 months; median: 18 months). Three cases presented in the neonatal period with antenatal diagnosis of hydrocolpos, while six cases were referred later during infancy/childhood from other centers. Another group of adolescent girls (four cases) presented with a clinical picture of cryptomenorrhea. The cause of vaginal obstruction was imperforate hymen in one, vaginal atresia in six, persistent urogenital sinus (five cases), and one case of obstructed hemi-vagina. In this series, six cases (46%) had features related to genetic syndromes (Bardet Biedl/ McKusick-Kaufman spectrum). Chronic parenchymatous renal disease was present in three cases among other syndromic features of Bardet Biedl syndrome, in addition to another case with obstructed left hemi-vagina that had absent left kidney (Herlyn-Werner-Wunderlich syndrome). Surgical techniques included simple excision of distal obstructing membrane (four cases), abdominal assisted vaginoplasty (two cases), vaginal pull-through (four cases), simple introitoplasty (one case), urogenital sinus mobilization (one case), and division of longitudinal vaginal septum for a case of obstructed hemi-vagina. Vaginal stenosis or retraction occurred in three cases with intermediate to high-level obstruction-two following abdominal assisted vaginoplasty and one after vaginal pull-through.MRI-based stratification of vaginal obstruction using the pubic symphysis as a reference provides a practical and reproducible approach for surgical planning.This is a case series (level IV evidence).
Evaluating Ex Vivo Fluorescence Confocal Microscopy for Intraoperative Diagnosis in Pediatric Surgery: A Feasibility Study.
Di Fabrizio D, Mastroberti F, Tavolario I … +7 more , Bindi E, Ilari M, Marinelli M, Coccia P, Filosa A, Goteri G, Cobellis G
Eur J Pediatr Surg · 2026 Feb · PMID 40763816 · Publisher ↗
fluorescence confocal microscopy (FCM) is an emerging technology that enables real-time, high-resolution digital imaging of freshly excised tissues without requiring standard histological preparation. This study aims to...
fluorescence confocal microscopy (FCM) is an emerging technology that enables real-time, high-resolution digital imaging of freshly excised tissues without requiring standard histological preparation. This study aims to evaluate the diagnostic performance of FCM compared with conventional histology in a pediatric population with suspected oncological pathology.A total of 18 tissue samples from pediatric patients with suspected oncological lesions were analyzed using FCM. The results were compared with the definitive diagnoses obtained via conventional histology, serving as the gold standard. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated to assess the diagnostic accuracy. Cohen's kappa coefficient (Κ), 95% confidence interval (95% CI), and -value were computed to evaluate the interobserver agreement and the concordance between FCM and histology.FCM correctly identified 10 positive cases (true positives) and 7 negative cases (true negatives), with 1 false positive and no false negatives. Interobserver agreement was perfect, with a Cohen's kappa coefficient of 1.00 (95% CI: 0.81-1.00, < 0.001). Sensitivity was 100% (95% CI: 72.2-100%), specificity 87.5% (95% CI: 52.9-97.8%), PPV 90.9% (95% CI: 62.3-98.4%), and NPV 100% (95% CI: 64.6-100%). The Cohen's kappa coefficient was 0.89, indicating excellent agreement between FCM and histology (95% CI: 0.67-1.10, < 0.001). FCM provided rapid diagnostic results, significantly reducing turnaround time compared with conventional methods.FCM demonstrates exceptional diagnostic accuracy, with excellent sensitivity and specificity in evaluating pediatric specimens. Its ability to deliver reliable intraoperative results highlights its potential as a valuable adjunct to conventional histopathology in pediatric surgery. Larger studies are warranted to confirm these findings and establish their role in clinical practice.
Giant Omphalocele: Systematic Review of Pulmonary Complications and Implications for Neonatal Care.
Peixoto J, Neto J, Pissarra S … +4 more , Azevedo I, Soares H, Amaral R, Rocha G
Eur J Pediatr Surg · 2026 Apr · PMID 40675190 · Publisher ↗
The primary objectives were to know the prevalences of pulmonary hypoplasia (PH), persistent pulmonary hypertension of the newborn (PPHN), and mortality in newborn infants with giant omphalocele (GO). A secondary aim was...
The primary objectives were to know the prevalences of pulmonary hypoplasia (PH), persistent pulmonary hypertension of the newborn (PPHN), and mortality in newborn infants with giant omphalocele (GO). A secondary aim was to assess the prevalence of syndromes and other congenital anomalies (SCA) associated with GO.A systematic review according to PRISMA guidelines using MEDLINE/PubMed, Google Scholar, and Scopus platforms was performed. The search strategy combined indexed and in-process citations up to May 22, 2023.Out of 651 articles, 23 met the inclusion criteria, comprising 14 observational studies and 9 case reports. There was no uniformity in the criteria for diagnosing PH and PPHN among the studies. In the observational studies, the prevalence of PH varied between 18.5 and 54% (median: 26%); the prevalence of PPHN varied between 13 and 100% (median: 38.5%); and mortality varied between 4 and 50% (median 23.5%). SCA were reported in 58% of patients. In the case series, PH was present in 27.8% of the neonates, PPHN in 50%, and mortality occurred in 55.5%. About 55.5% had associated SCA. The association of SCA and preterm birth contributed significantly to increase the mortality rate.The reported prevalences of PH, PPHN, mortality, and SCA associated with GO are alarmingly high. Although the heterogeneity and limitations of the included studies prevent definitive prevalence estimates, the findings underscore the urgent need for standardized diagnostic criteria, better prenatal counseling, and management in highly specialized centers.
Postoperative Flank Bulge in Infants After Open CDH Repair: An Underreported Complication.
Obed M, Dingemann J, Ure B … +1 more , Kiblawi R
Eur J Pediatr Surg · 2026 Apr · PMID 40675189 · Publisher ↗
Flank bulge (FB) is a rare postoperative complication, most commonly following surgery with retroperitoneal access through flank incision. It is characterized by relaxation of anterolateral wall muscles with abnormal pro...
Flank bulge (FB) is a rare postoperative complication, most commonly following surgery with retroperitoneal access through flank incision. It is characterized by relaxation of anterolateral wall muscles with abnormal protrusion of the abdominal wall. The assumed pathomechanism is iatrogenic injury of the intercostal nerves T11/T12. During congenital diaphragmatic hernia (CDH) repair, dissection and sutures are necessary at this thoracic level. We aimed to assess the risk of FB in a consecutive series of patients after CDH repair.We retrospectively analyzed charts of all patients after CDH repair (2007-2024) with a follow-up of ≥3 months. FB was diagnosed during clinical follow-up examinations and defined as protrusion of abdominal wall with no sonographic evidence for hernia. Surgical variables and their association with FB were evaluated. For statistical analysis, Pearson's and Student's t-test were used. Multivariate logistic regression was performed to identify independent risk factors associated with FB development after CDH repair.Among 67 infants undergoing CDH repair with follow-up, 76% underwent open surgery and 48% required patch repair. Postoperative FB occurred in 11% of patients, exclusively following open repair with patch, and was significantly associated with rib sutures and higher birth weight. One-third of FB cases resolved spontaneously, while the remainder persisted, though without functional impairment.FB may be an underestimated complication after open CDH repair. Routine assessment of abdominal wall tone is recommended during follow-up after CDH repair. Larger studies are needed to clarify the clinical impact, patient-perceived level of disability, and long-term sequelae.
Round Ligament Management in Percutaneous Inguinal Hernia Repair: Comparative Outcomes Using the FLAIR Technique in Girls.
Shikha A, Zaghloul Z, Ahmed M … +2 more , Eltaeb K, Wong J
Eur J Pediatr Surg · 2026 Apr · PMID 40664365 · Publisher ↗
Fenestrated laparoscopic-assisted internal ring-rrhaphy (FLAIR) is a refined percutaneous technique for pediatric inguinal hernia repair. Although its outcomes have been reported in boys, its application in girls, partic...
Fenestrated laparoscopic-assisted internal ring-rrhaphy (FLAIR) is a refined percutaneous technique for pediatric inguinal hernia repair. Although its outcomes have been reported in boys, its application in girls, particularly in relation to round ligament management, remains underexplored. Whether to include or exclude the ligament during internal ring closure is still debated.This study evaluated the impact of round ligament management on surgical outcomes in girls undergoing FLAIR. A retrospective cohort of 69 hernias, operated on between July 2016 and December 2023, was reviewed. Patients were divided into two groups: those in whom the round ligament was included in the closure (Inclusion group) and those in whom it was deliberately spared (Exclusion group). Recurrence rates and postoperative complications were compared.All four recurrences (11%) occurred in the Inclusion group, while no recurrences were observed in the Exclusion group ( = 0.048). All recurrences occurred within 3 months postoperatively and were successfully reoperated using the exclusion technique, with no further recurrence during follow-up. No significant differences in other postoperative complications were identified between groups.FLAIR appears to be a safe and effective approach in girls, particularly when the round ligament is excluded from the closure. Exclusion was associated with zero recurrences and no increase in complications. These findings, observed over intermediate-term follow-up, suggest that sparing the round ligament may enhance repair integrity and potentially protect the ligament from entrapment, thereby preserving its anatomical function. Larger, multicenter studies with extended follow-up are needed to validate these results and guide pediatric hernia repair strategies.
Polydatin as a Potential Therapeutic in Pediatric Intestinal Volvulus: Evidence from an Experimental I/R Injury Model.
Arkan G, Öğüt B, Poyraz A … +1 more , Çavuşoğlu YH
Eur J Pediatr Surg · 2026 Feb · PMID 40664364 · Publisher ↗
Small bowel volvulus is a clinical condition that causes intestinal ischemia-reperfusion (I/R) injury, leading to severe tissue damage and high mortality rates. Polydatin, a natural stilbenoid polyphenol, has demonstrate...
Small bowel volvulus is a clinical condition that causes intestinal ischemia-reperfusion (I/R) injury, leading to severe tissue damage and high mortality rates. Polydatin, a natural stilbenoid polyphenol, has demonstrated anti-inflammatory and antioxidant properties. This study aimed to evaluate the protective effects of polydatin on I/R injury using an experimental small bowel volvulus model.A total of 24 healthy female Wistar albino rats were divided into four groups: Sham (Group 1), Polydatin (Group 2), I/R (Group 3), and Treatment (Group 4). In Group 1, no I/R procedure was applied, and intraperitoneal saline was administered. Group 2 received 20 mg/kg intraperitoneal polydatin without I/R. In Group 3, a 5-cm segment of the small intestine was twisted 360 degrees clockwise, leading to 2 hours of ischemia and 2 hours of reperfusion. Group 4 received 20 mg/kg intraperitoneal polydatin before reperfusion. Blood and intestinal tissue samples were collected for biochemical and histopathological analysis.Serum total antioxidant status (TAS) levels were significantly higher in the treatment group compared with the I/R group ( = 0.004). Serum total oxidant status (TOS) levels were significantly elevated in the I/R group compared with all other groups ( < 0.001) but were significantly reduced in the treatment group ( < 0.001). Tissue oxidative stress index (OSI) values were significantly lower in the treatment group compared with the I/R group ( = 0.004). Although serum OSI levels and tissue TAS and TOS values showed a favorable trend, they were not statistically significant. Histopathological evaluations revealed a marked reduction in tissue damage in the treatment group compared with the I/R group.Polydatin exerts protective effects against I/R injury in an experimental small bowel volvulus model by reducing oxidative stress and histopathological damage. These findings highlight its therapeutic potential and warrant further clinical research.
Beyond the AP View: The Diagnostic Value of Lateral Duodenal and Colonic Assessment in Pediatric Malrotation.
Karmazyn B, Wanner MR, Forbes-Amrhein MM … +5 more , Grayson BL, Marine MB, Jennings SG, Eckert GJ, Billmire DF
Eur J Pediatr Surg · 2026 Apr · PMID 40645779 · Publisher ↗
This study aimed to assess if the position of the duodenal-jejunal junction in the anteroposterior view can reliably diagnose malrotation and if atypical position of the duodenal-jejunal junction (medial to the left pedi...
This study aimed to assess if the position of the duodenal-jejunal junction in the anteroposterior view can reliably diagnose malrotation and if atypical position of the duodenal-jejunal junction (medial to the left pedicle to midline) is associated with a low risk of narrow mesenteric root.Children diagnosed with intestinal rotational abnormalities (2007-2023) through upper gastrointestinal fluoroscopy (UGI) studies who underwent surgery were reviewed independently by two pediatric radiologists. Key observations included the duodenal-jejunal junction location in the anteroposterior view, duodenal position in the lateral view, jejunal loop position, and colon anatomy.Radiologists independently reviewed the UGI studies and disagreements between radiologists were resolved by consensus readings. Chi-square tests were used to compare the anatomical variables and the presence of surgically confirmed narrow mesenteric roots.Of the examined 79 children (mean age, 2 years), 60 (75.9%) underwent Ladd's procedure after confirming a narrow mesenteric root.According to the consensus, 77.1% of children with atypical duodenal-jejunal junction in the anteroposterior view had narrow mesenteric roots, and one had midgut volvulus. The likelihood of missing a surgically confirmed narrow mesenteric root was significantly lower ( = 0.0167) when considering the position of the duodenum in the lateral view, along with the jejunal loops and colonic position (0/3), compared with relying solely on duodenal-jejunal junction position in the anteroposterior view (29/37).The anteroposterior view alone is insufficient for diagnosing malrotation. Reviewing the lateral view of the duodenum, and when necessary, the colonic anatomy, reduces the risk of missing cases with surgically confirmed narrow mesenteric roots.
Evaluating the Empowerment Potential of an International Sexual Support Website for Patients with Anorectal Malformations and Hirschsprung Disease, their Parents and Healthcare Providers.
Spivack OKC, Schokker-van Linschoten IK, Spoel M … +6 more , Lemli A, Aminoff D, Pakarinen M, de Blaauw I, Ijsselstijn H, Petit-Steeghs V
Eur J Pediatr Surg · 2025 Dec · PMID 40633553 · Full text
Research indicates that the sexual support needs of patients with anorectal malformations (ARM) and Hirschsprung disease (HD) are often not addressed by patients, parents, and healthcare professionals (HPs) in their inte...
Research indicates that the sexual support needs of patients with anorectal malformations (ARM) and Hirschsprung disease (HD) are often not addressed by patients, parents, and healthcare professionals (HPs) in their interactions. An international support website was developed to empower stakeholders, by addressing identified barriers. This study aimed to explore the empowerment potential of this disease-specific tool.Two online surveys were disseminated between May 1 and October 1, 2023; one for HPs and another for patients/parents. The surveys sought to assess and understand the website's expected empowerment effect. Empowerment was conceptualized using patient/professional empowerment models. Data were descriptively analyzed.A total of 12 patients (ARM, = 11; HD, = 1), 17 parents (ARM, = 9; HD, = 8), and 20 HPs responded to the survey. HPs largely expected the website to have a positive empowerment effect, by providing a sense of meaning, information, support, and opportunities to learn and grow. Less of an effect was expected for "freeing up resources." For patients and parents, an empowerment effect was also expected, by generating the knowledge, skills, attitudes, and self-awareness necessary to influence their own behavior and by providing a sense of meaning and coherence. Respondents experienced the website positively, yet one patient and one parent considered the website "fully complete." Inclusivity, cultural sensitivity, and accessibility were highlighted as focus points.To increase the website's empowerment potential, attention should be paid to inclusivity, cultural sensitivity, and accessibility, as well as its implementation within the (institutional) contexts where patients, parents, and HPs interact.
Enhancing AI Readiness in Pediatric Surgery: Impact of a Targeted Workshop on Knowledge and Competencies.
Till H, Elsayed H, Singer G … +4 more , Obermüller B, Till T, Gnatzy R, Tschauner S
Eur J Pediatr Surg · 2026 Apr · PMID 40628455 · Full text
Despite an awareness of the transformative potential of artificial intelligence (AI) in health care, its development in pediatric surgery seems slow. One major reason may be a lack of formal AI training. This study asses...
Despite an awareness of the transformative potential of artificial intelligence (AI) in health care, its development in pediatric surgery seems slow. One major reason may be a lack of formal AI training. This study assesses the basic AI knowledge and the effectiveness of AI workshops (AI-WS).Four AI-WS were held at the International Academy of Pediatric Surgery 2024. Topics included AI principles, real-time algorithm training, and potential AI applications in pediatric surgery. Self-developed surveys consisting of eight pre-WS and nine post-WS questions were conducted, focusing on participants' AI competencies, usage, educational needs, barriers, and future perspectives.Out of 57 pediatric surgeons, 53 completed both surveys. None had formal AI training. Although 90% were familiar with AI in diagnostic imaging, most had only basic knowledge of AI technology. After the workshop, participants reported a significant increase in the general understanding of AI/machine learning (ML) ( < 0.001). 96% stated that they were better informed about AI/ML applications for clinical practice; 83% expressed interest in further AI training; 91% believed that AI will be more integrated into clinical practice; and over 80% anticipated that AI will improve patient outcomes.The AI-WS effectively enhanced pediatric surgeons' AI knowledge and their readiness to adopt AI technologies. Even though our study is limited by the relatively low sample size and a potential selection bias, our results still highlight the importance of targeted education in preparing health care professionals for AI integration. The long-term sustainability of knowledge gains, however, has to be examined in further studies.
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