European Journal Of Pediatric Surgery[JOURNAL]
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200 papers
Research Involvement and Gender Disparities Among Pediatric Surgeons: A Multinational Survey.
Santiago-Martínez S, Aziz DAA, Bjørland K … +17 more , Correa C, Gagilyte R, Ellul S, Hernández E, Arribas PJ, Lindert J, Nah SA, Pos L, Reusens H, Schmedding A, Sharma S, Stefanescu MC, Souhem T, Vasconcelos-Castro S, Vercauteren C, Bisimwa WA, Zaman A
Eur J Pediatr Surg · 2026 Apr · PMID 40614769 · Publisher ↗
There is a lack of background regarding knowledge about the involvement of pediatric surgeons (PSs) in scientific activities. We aimed to investigate scientific activity among PSs worldwide.An anonymous online questionna...
There is a lack of background regarding knowledge about the involvement of pediatric surgeons (PSs) in scientific activities. We aimed to investigate scientific activity among PSs worldwide.An anonymous online questionnaire in English collected demographic data, time spent on research, participation in scientific conferences, publications, and funding for conference attendance. Co-authors distributed it through national and international pediatric surgery societies and groups to reach their members.A total of 526 PSs responded (57% female). About 55% of those surveyed reside in Europe. Most worked in university hospitals (61%), 9% at a university faculty, and 0.8% in a research facility. Only 23% were engaged in research, with similar rates for females (21%) and males (26%) (NS).Additional time out of working hours was required for research, particularly among female PSs. Full compensation for research was reported by 10% of females and 29% of males ( < 0.02). Around 73% had attended at least one local, regional, national, or international scientific conference (75% of females vs. 70% of males, NS), while 84% had no funding for at least one event (87% of females vs. 80% of males, NS). Scientific paper was presented by 69% at some conference. At least one scientific paper was published by 20% (17% of females vs. 23% of males, NS).Research involvement among PSs is limited, with unpaid work and funding gaps, particularly among women. Potential solutions include improving research training, structured mentorship (especially for women), institutional support for protected research time, and equitable access to funding opportunities.
Artificial Intelligence Enhances Diagnostic Accuracy of Contrast Enemas in Hirschsprung Disease Compared to Clinical Experts.
Vargova P, Varga M, Izquierdo-Hernández B … +8 more , Gutierrez-Alonso C, Gonazlez-Esgueda A, Cobos-Hernández MV, Fernandez-Atuan R, Gonzalez-Ruiz Y, Bragagnini-Rodriguez P, Del-Peral-Samaniego M, Corona-Bellostas C
Eur J Pediatr Surg · 2026 Feb · PMID 40592491 · Publisher ↗
Contrast enema (CE) is widely used in the evaluation of suspected Hirschsprung disease (HD). Deep learning is a promising tool to standardize image assessment and support clinical decision-making. This study assesses the...
Contrast enema (CE) is widely used in the evaluation of suspected Hirschsprung disease (HD). Deep learning is a promising tool to standardize image assessment and support clinical decision-making. This study assesses the diagnostic performance of a deep neural network (DNN), with and without clinical data, and compares its interpretation with that of pediatric surgeons and radiologists.In this retrospective study, 1,471 CE images from patients <15 years were analyzed, with 218 images used for testing. A DNN, pediatric radiologists, and surgeons independently reviewed the testing set, with and without clinical data. Diagnostic performance was assessed using ROC and PR curves, and interobserver agreement was evaluated using Fleiss' kappa. Rectal biopsy served as the reference standard.The DNN achieved high diagnostic accuracy (area under the receiver operating characteristic curve [AUC-ROC] = 0.87) in CE interpretation, with improved performance when combining anteroposterior and lateral images (AUC-ROC = 0.92). Clinical data integration further enhanced model sensitivity and negative predictive value. The super-surgeon (majority voting of colorectal surgeons) outperformed most individual clinicians (sensitivity 81.8%, specificity 79.1%), while the super-radiologist (majority voting of radiologists) showed moderate accuracy. Interobserver analysis revealed strong agreement between the model and surgeons (Cohen's kappa = 0.73), and overall consistency among experts and the model (Fleiss' kappa = 0.62).Artificial intelligence-assisted CE interpretation achieved higher specificity and comparable sensitivity to that of the clinicians. Its consistent performance and substantial agreement with experts support its potential role in improving CE assessment in HD.
Success of Antegrade Continence Enema (ACE) in Pediatric Patients with Impaired Fecal Control.
Tervahartiala M, Koivusalo A, Pakarinen M
Eur J Pediatr Surg · 2026 Apr · PMID 40592490 · Publisher ↗
We aimed to describe long-term outcome, treatment success, and complications of antegrade continence enema (ACE) procedures considering underlying etiologies and associated disorders.Overall, 180 patients undergoing ACE...
We aimed to describe long-term outcome, treatment success, and complications of antegrade continence enema (ACE) procedures considering underlying etiologies and associated disorders.Overall, 180 patients undergoing ACE procedure at our institution during 1997-2019 were included in this retrospective study. Treatment success was defined as patient staying clean.The main underlying etiologies included spina bifida ( = 65, 36%), anorectal malformations ( = 58, 32%), Hirschsprung disease ( = 25, 14%), and functional constipation ( = 7, 4%). The most common complications were stomal leakage ( = 39, 22%), stenosis ( = 38, 21%), infection ( = 35, 19%), and granuloma/mucosal prolapse of the stoma ( = 34, 19%), and 29% ( = 52) of the patients reported functional problems. Overall, 48% of the patients ( = 87) experienced at least one ACE-related complication. At the latest follow-up, 61% of the patients were using ACE ( = 110), of whom 86% stayed clean ( = 95). Overall, ACE treatment was successful in 81% of patients ( = 144), defined as being clean with ACE in current use or after discontinuing ACE treatment as unnecessary. In total, 31% of the patients had stopped using ACE as unnecessary ( = 45). Spina bifida patients were least likely to discontinue ACE usage ( = 9, 14%), followed by anorectal malformation patients ( = 17, 29%), while 32% of Hirschsprung patients ( = 8) and 71% of constipation patients ( = 5) discontinued ACE as unnecessary.As previous studies have also shown, we demonstrated that ACE treatment can be successfully utilized in majority of children with impaired fecal control. Two-thirds of patients continued ACE treatment over 5 years of whom 86% patients were staying clean.
Postnatal Outcomes and Surgical Implications of Somatex™ Thoracoamniotic Shunting for CPAM: A Multicenter Experience.
Kohaut J, Oetzmann von Sochaczewski C, Heydweiller AC … +4 more , Jimenez-Cruz J, Oelgeschlaeger C, Berg C, Dübbers M
Eur J Pediatr Surg · 2025 Dec · PMID 40550255 · Publisher ↗
Intrauterine thoracoamniotic shunting in fetuses with congenital pulmonary airway malformation (CPAM) was first described using Cook™ or Rocket™ shunts. With the availability of the Somatex™ intrauterine shunt, a new dev...
Intrauterine thoracoamniotic shunting in fetuses with congenital pulmonary airway malformation (CPAM) was first described using Cook™ or Rocket™ shunts. With the availability of the Somatex™ intrauterine shunt, a new device with the supposed advantages of less invasive placement and less frequent dislocations, pediatric surgeons and neonatologists are increasingly confronted with a new cohort of patients. Data on postnatal findings and the impact on surgical management are scarce.We conducted a multicenter retrospective study of all children born after prenatal treatment with a Somatex™ thoracoamniotic shunt for suspected CPAM. We analyzed the clinical and respiratory conditions of the children at birth as well as shunt locations, removal procedures, and timing of surgery.Twelve patients were included. 8/12 patients presented postnatally with pneumothorax, necessitating in all cases the placement of a chest tube. In 6/12 patients, the removal of the Somatex™ shunt had to be done surgically, bedside removal was possible in 5 patients. One patient was born without the shunt due to intrauterine dislocation. All patients were operated on using a muscle-sparing thoracotomy, at ages ranging from 1 to 42 days; only one could be discharged before surgery. One patient underwent emergency surgery. With a median follow-up of 19 months, 11/12 patients survived.Despite the small number of patients and the retrospective aspect of this study, our observations showed that intrauterine treatment of CPAM with the Somatex™ shunt is frequently associated with postnatal complications. Neonatologists and pediatric surgeons must be aware of the high rate of pneumothorax and the presumable necessity of early surgical intervention.
Early versus Delayed Inguinal Hernia Repair in Preterm Neonates: An Updated Systematic Review and Meta-Analysis.
Vasconcellos DCMDS, Viana MFF, Miranda NCD … +3 more , Marimpietri FS, Silva MG, Pereira L
Eur J Pediatr Surg · 2025 Dec · PMID 40494567 · Publisher ↗
Inguinal hernias are common among preterm neonates in the neonatal intensive care unit (NICU), affecting up to 30% of all preterms. The timing of surgical repair remains controversial due to concerns about respiratory im...
Inguinal hernias are common among preterm neonates in the neonatal intensive care unit (NICU), affecting up to 30% of all preterms. The timing of surgical repair remains controversial due to concerns about respiratory immaturity and the risk of hernia incarceration with delayed intervention. Previous meta-analyses were limited by methodological weaknesses, including heterogeneous populations and lack of randomized data. We aimed to provide an updated meta-analysis comparing outcomes associated with early versus late hernia repair in premature neonates based on more recent and rigorous evidence.A systematic review was conducted using PubMed, EMBASE, and Cochrane databases to identify studies comparing inguinal hernia repair (IHR) outcomes in preterm neonates during their initial NICU hospitalization (early repair) or after discharge (late repair). The review followed PRISMA guidelines, and statistical significance was defined as < 0.05.Of 1,860 studies screened, 8 met inclusion criteria (one randomized controlled trial and seven retrospective cohort studies), encompassing 1,624 patients. Among them, 881 neonates (54.2%) underwent early herniorrhaphy. Mean gestational age ranged from 26 to 29 weeks in the early repair group and from 26 to 33 weeks in the late repair group. There was no significant difference in the odds of incarceration between groups (odds ratios [OR]: 1.16; 95% confidence interval [CI]: 0.76-1.79; = 0.49; = 16%). Early repair was associated with a significantly higher risk of respiratory complications (OR: 3.73; 95% CI: 2.02-6.9; < 0.0001; = 0%) and hernia recurrence (OR: 3.59; 95% CI: 1.22-10.5; = 0.02; = 0%). No significant differences were observed in wound infections, testicular complications, readmissions, mortality, procedure duration, or reoperation rates.Early IHR during initial NICU hospitalization in preterm neonates significantly increases the risk of respiratory complications and hernia recurrence without reducing the risk of incarceration or other major surgical complications. These findings suggest that delaying herniorrhaphy until after NICU discharge, when clinically feasible, may optimize outcomes and minimize perioperative risks for this vulnerable population.
Thoracoscopic Aortopexy for Pediatric Tracheomalacia: Refining Technique Through Early Experience.
Zanini A, Mazzoleni S, Arcieri L … +5 more , Borruto FA, Somaini M, Montagnini L, Marianeschi SM, Macchini F
Eur J Pediatr Surg · 2025 Dec · PMID 40494566 · Publisher ↗
Aortopexy is the most common surgical intervention for pediatric tracheomalacia (TM). The thoracoscopic approach, despite being reported by a few authors, remains controversial due to the different reported techniques an...
Aortopexy is the most common surgical intervention for pediatric tracheomalacia (TM). The thoracoscopic approach, despite being reported by a few authors, remains controversial due to the different reported techniques and outcomes.We report a retrospective review of our preliminary experience with thoracoscopic aortopexy from 2023 to date. Patients' demographic data and symptoms were collected: age and weight at surgery, comorbidities, presence of brief resolved unexplained event (BRUE), dyspnea, chest infections, and barking cough. The study describes our surgical technique and its evolution. We analyzed the clinical outcome and endoscopic improvement, success and complication rate, operative time, and length of stay. We then compared our findings with the results of open and thoracoscopic aortopexy reported in the current literature.A total of 12 thoracoscopic aortopexies were performed on 10 patients (including two redo). The mean age and weight at operation were 3.2 years (range: 4 months-6 years) and 13.6 kg (range: 3.5-23), respectively. Two patients presented with BRUE, one with dyspnea, in the other cases the indications were recurrent pneumonia (more than six per year or three in 6 months). All patients underwent preoperative flexible bronchoscopy for the diagnosis of TM. The average estimated tracheal collapse was 86% (range: 70-95%). One intraoperative bleeding caused a conversion to open surgery, but no other complications occurred. All patients were extubated on the same day. Two cases required a redo due to suture tearing, and one of them required an additional posterior tracheopexy for persistent symptoms. The remaining patients had significant improvement on follow-up: success rate is 75%. Both patients requiring redo underwent aortopexy without pledgeted sutures or innominate artery (IA) suspension: these steps are associated with a success rate of 88.9% ( = 0.0182). Our refined technique now includes total thymectomy, pericardiotomy, pledgeted horizontal mattress sutures on the aorta, and the IA after full mobilization of the innominate vein.Thoracoscopic aortopexy appears to be a feasible and effective option for pediatric TM, particularly when replicating open surgical principles. Further research is needed to optimize the technique and improve the clinical results.
Clinical Utility of Indocyanine Green Fluorescence in Neonatal Surgery: A Single-Center Study and Systematic Review.
Castrillo A, Molino JA, Lopez-Fernandez S … +3 more , Martos M, López M, Guillén G
Eur J Pediatr Surg · 2025 Dec · PMID 40494565 · Publisher ↗
The use of indocyanine green (ICG) fluorescence in neonatal procedures is limited to specific pathologies, with variability in its application, highlighting the need to expand its indications and standardize administrati...
The use of indocyanine green (ICG) fluorescence in neonatal procedures is limited to specific pathologies, with variability in its application, highlighting the need to expand its indications and standardize administration protocols. We present our experience and review of the literature.Prospective assessment (2019-2023) of ICG-navigated neonatal surgeries. Administration routes included intravenous, endoluminal, and intracatheter. ICG dosages were variable according to the indication. The results were prospectively registered, focusing on its ability to achieve the desired goal. A systematic literature review identifying neonatal cases where ICG fluorescence was used for surgical assistance was conducted according to the PRISMA guidelines.ICG was used in 23 procedures. The average weight was 3.5 kg (SD = 1.4). Surgical procedures were: esophageal atresia repair (eight), intestinal anastomosis (five), Kasai portoenterostomy (five), H-type tracheoesophageal fistula closure (one), diaphragmatic plication (one), omphalocele repair (one) and resection of choledochal cyst (one), lymphatic malformation (one), and pyloric duplication (one). 52.2% were minimally invasive. ICG was useful in 21/23 (91.3%) procedures and was unsuccessful in two cases due to technical difficulties. There were no complications following the ICG injection. Eight studies reporting on 23 neonatal patients were selected for the review. The primary applications of ICG included angiography, cholangiography, lymphography, and visualization of the digestive tract.To date, this is the largest reported series of ICG-navigated neonatal surgeries. ICG proved to be safe and feasible in this population, allowing the identification of anatomical structures, facilitating decision-making, and minimizing the risk of complications. It is versatile for various procedures and approaches.
Collaborative Efforts in Pediatric Surgery: Lessons from European Randomized Controlled Trials.
van Hal ARL, Roman Galdran S, Wijnen RMH … +4 more , Leyh J, Lacher M, Vlot J, Madadi-Sanjani O
Eur J Pediatr Surg · 2025 Dec · PMID 40398495 · Full text
Conducting multicenter randomized controlled trials (RCTs) in pediatric surgery for rare congenital anomalies presents unique challenges, including low patient recruitment, complex regulatory landscapes, and variability...
Conducting multicenter randomized controlled trials (RCTs) in pediatric surgery for rare congenital anomalies presents unique challenges, including low patient recruitment, complex regulatory landscapes, and variability in care standards. This paper reflects on the experiences and lessons learned from the MUC-FIRE and STEPS-EA trials, supported by the European Reference Network for Rare Inherited and Congenital Anomalies (ERNICA), to provide guidance for future studies.A retrospective review was conducted on the design and execution of these trials, focusing on team composition, endpoint selection, patient recruitment strategies, regulatory compliance, and adaptive methodologies. Insights were derived from study protocols, monitoring reports, and the authors' experiences.Key factors contributing to trial success included multidisciplinary collaboration, leveraging existing research networks, and defining clear, measurable endpoints. Challenges such as recruitment delays, regulatory hurdles, and variations in care were mitigated through flexible protocols, proactive amendments, and stakeholder engagement. The COVID-19 pandemic amplified these difficulties, necessitating innovative strategies and extended timelines.The MUC-FIRE and STEPS-EA trials underscore the critical importance of international collaboration, adaptive strategies, and patient-centered approaches in overcoming the complexities of multicenter RCTs. Lessons from these experiences can inform the design and implementation of future trials, ultimately enhancing evidence generation and improving outcomes for children with rare congenital anomalies.
European Paediatric Surgeons' Association Consensus Statement on the Management of Giant Omphalocele.
Saxena AK, Hayward RK, Mutanen A … +7 more , Goneidy A, Ghattaura H, Gorter R, Weijnen R, Keijzer R, Soyer T, European Pediatric Surgeons' Association
Eur J Pediatr Surg · 2025 Oct · PMID 40389219 · Publisher ↗
Giant omphalocele management had not reached a consensus from the pediatric surgical perspective regarding conservative treatments, surgical approaches, and clinical outcomes. This topic was therefore selected for the 20...
Giant omphalocele management had not reached a consensus from the pediatric surgical perspective regarding conservative treatments, surgical approaches, and clinical outcomes. This topic was therefore selected for the 2023 Consensus Session of the European Paediatric Surgeons' Association (EUPSA).Literature review was conducted by seven EUPSA members, guided by a set of predefined areas relating to the management of giant omphalocele: (1) conservative management, (2) surgical management, and (3) outcomes. Members were assigned to specific topics, with discrepancies resolved through structured group discussion and further literature review. Consensus was reached through unanimous agreement among the contributing members. Each topic was presented with available evidence to congress participants. Comments from participants were accounted to formulate the final consensus statement.Giant omphalocele is appropriately defined as viscero-abdominal disproportion preventing primary closure. Regarding (1) , the "paint and wait" approach is recommended when anatomical constraints or high surgical risk preclude primary closure. Common painting agents include povidone-iodine and silver sulfadiazine, with Manuka honey gaining interest, though consensus on dosing, duration, and complications remains unclear. With regards to (2) , early closure favors biological meshes, while delayed closure appears most effective using native tissues. High mortality in delayed patch closure likely reflects a population with the most severe defects. Finally, (3) highlights key prognostic factors including chromosomal abnormalities, cardiac defects, and low birth weight, which may guide counseling, screening, and treatment. Limited data on ruptured omphalocele indicates towards increased mortality, necessitating prompt intervention. Complications following management are relatively rare and typically intervention-related, underscoring the need for long-term, multidisciplinary follow-up.A consensus statement on the management of giant omphalocele was developed based on current evidence and peer practice, though imitations relating to a scarcity of high-level evidence and significant heterogeneity across studies should be acknowledged. Despite these constraints, this consensus statement provides evidence-based guidance to support pediatric surgeons in informed decision-making for this pathology.
Thoracoscopic Repair of Recurrent CDH is Associated with a Significantly Lower Complication Rate and Shorter ICU and Hospital Stay: A Prospective, Propensity Score-Matched Analysis.
Beck L, Weiss C, Mohr C … +7 more , Martel R, Klinke M, Rhee J, Zahn K, Schaible T, Boettcher M, Elrod J
Eur J Pediatr Surg · 2025 Oct · PMID 40359992 · Publisher ↗
Congenital diaphragmatic hernia (CDH) is a malformation that significantly impacts neonatal morbidity and mortality. Recurrence after surgical repair remains a potentially life-threatening long-term complication. Convent...
Congenital diaphragmatic hernia (CDH) is a malformation that significantly impacts neonatal morbidity and mortality. Recurrence after surgical repair remains a potentially life-threatening long-term complication. Conventionally, recurrent CDH has been managed through open surgery. However, thoracoscopic repair (TR) represents a novel alternative for recurrent CDH as it has reduced the length of hospital stay and mortality rate in the primary CDH repair.A prospective, propensity score-matched analysis was conducted on pediatric patients who underwent recurrent CDH repair at the University Hospital Mannheim between 2013 and 2023, to compare the outcomes of laparotomy versus TR. Patients were categorized based on the surgical technique employed. Comparative analysis, including propensity scoring, encompassed outcome measures such as duration of ICU and hospital stays, rate of complications, and operative duration.In total, 703 patients were treated for CDH, of whom 69 children underwent laparotomy (56) or TR (16) for CDH recurrence. After propensity score matching, TR group demonstrated a significantly shorter duration of surgery (178 [93-311] versus 225 [113-450] min, = 0.042), reduced ICU stay (0 [0-10] versus 1 (0-69) days, = 0.011), and decreased overall hospital stay (6 [3-34] versus 12 [7-40] days, = 0.001). Moreover, the postoperative complications were significantly lower in the TR group (21.43% versus 73.68%, = 0.003).TR for recurrent CDH repair is associated with shorter operation times, reduced ICU and overall hospital stays, and fewer complications compared with laparotomy. These findings suggest that TR may be preferable for the management of recurrent CDH, warranting larger randomized controlled studies to confirm the long-term safety and efficacy of this approach.
Cryoanalgesia Plus Nerve Block Strategies versus Cryoanalgesia Alone in Patients with Pectus Excavatum Undergoing the Nuss Procedure: A Systematic Review and Meta-Analysis.
Santos K, Aoke K, Shelar V … +2 more , Lira M, Passos F
Eur J Pediatr Surg · 2025 Dec · PMID 40300759 · Publisher ↗
Cryoanalgesia (CA) has shown promise in managing postoperative pain in patients undergoing the Nuss procedure for pectus excavatum, but has a delayed onset. Adjunctive regional anesthesia, such as nerve blocks (NBs), may...
Cryoanalgesia (CA) has shown promise in managing postoperative pain in patients undergoing the Nuss procedure for pectus excavatum, but has a delayed onset. Adjunctive regional anesthesia, such as nerve blocks (NBs), may enhance early analgesia. Our meta-analysis aims to evaluate the comparative efficacy of combining CA with NB (CNB) versus CA alone.A literature search was conducted focusing on studies that compared CNB and CA alone for postoperative pain management following the Nuss procedure. RevMan 8.13.0 was used to calculate effect estimates reported as mean differences (MDs), with 95% confidence intervals (CIs).Three observational studies comprising a total of 161 patients were included. Of these, 71 patients (44.1%) received the combined treatment of CNB. CNB was associated with significantly shorter hospital stays (MD -0.51 days; 95% CI -0.80 to -0.21; < 0.05; = 0%), reduced postoperative opioid consumption (MD -0.74 OME/kg; 95% CI -1.16 to -0.32; < 0.05; = 35%), and lower postoperative pain scores on postoperative day (POD) 3 (MD -1.03 points; 95% CI -1.76 to -0.30; < 0.05; = 0%). No significant differences were observed in operative duration or postoperative pain scores on POD 0, 1, and 2.CNB may be associated with improved postoperative outcomes compared with CA alone in patients undergoing the Nuss procedure. However, given the small sample size and the observational nature of the included studies, further high-quality randomized controlled trials are needed to validate these findings and inform clinical practice.
Anatomical Correction and Early Outcomes of One-step Ventral and Dorsal Proctoplasty in Girls with Low Anorectal Malformations.
Vinit N, Glenisson M, Leroy J … +3 more , Sarnacki S, Crétolle C, Beaudoin S
Eur J Pediatr Surg · 2025 Dec · PMID 40245946 · Publisher ↗
Rectoperineal fistula (RPF) and rectovestibular fistula (RVF) are the most common forms of low anorectal malformations (ARMs) in girls, and lead to difficult stooling, thus demanding early surgical correction. This study...
Rectoperineal fistula (RPF) and rectovestibular fistula (RVF) are the most common forms of low anorectal malformations (ARMs) in girls, and lead to difficult stooling, thus demanding early surgical correction. This study's aim was to assess early outcomes associated with one-step ventral and dorsal proctoplasty in RPF/RVF.All female infants who consecutively underwent one-step proctoplasty for RPF/RVF at our institution (2012-2022) were retrospectively included. Reviewed data included: age at procedure, congenital anomalies, fistula location, preoperative symptoms, intraoperative findings, operative time, postoperative complications, and bowel functional outcome. Success of the technique, defined as spontaneous bowel movement at last follow-up without anal dilation, was assessed. Secondary outcomes included resolution of preoperative symptoms, and Krickenbeck score and fecal continence in girls older than 3 years at last follow-up. No preoperative bowel preparation was necessary.None of the 77 included girls (median age at surgery: 3.2 months (2.3-7.3)) had prior colostomy. In every case, intraoperative findings included: ventral defect of the external anal sphincter, and abnormal attachment of the bulbospongiosus muscles to the fistula and posterior ledge, thus justifying both ventral and dorsal reconstructions. The median operative time was 34 min (27-38), and the median hospital stay was 2 days (2-3). Limited ventral skin dehiscence was the most common postoperative complication (31%), with limited effect on clinical outcome (one secondary anal stricture). No child required secondary colostomy or revision anoplasty. One child underwent secondary pull-through due to persistent megarectum. Preoperative symptoms resolved in 98% of cases. After a median follow-up of 27.6 months (9.8-48.3), all girls had spontaneous bowel movement and 21% had grade-2 constipation. The technique was successful in 97% of cases (two anal strictures treated with dilations).RPF/RVF in female share abnormal anatomical characteristics. One-step ventral and dorsal proctoplasty allows precise anatomical correction of low ARM in girls.
A Retrospective Assessment of Soft Tissue Interposition during Redo Surgery for Postoperative Hypospadias Repair-Related Complications.
Miyake Y, Seo S, Ishii J … +7 more , Takeda M, Yazaki Y, Ochi T, Miyano G, Koga H, Lane GJ, Yamataka A
Eur J Pediatr Surg · 2025 Dec · PMID 40245945 · Publisher ↗
To evaluate two established soft tissue interposition techniques used during redo surgery for selected posturethroplasty complications of hypospadias surgery.Patients with complications who had interposition of scrotal f...
To evaluate two established soft tissue interposition techniques used during redo surgery for selected posturethroplasty complications of hypospadias surgery.Patients with complications who had interposition of scrotal fat, tunica vaginalis fascia, or external spermatic fascia identified from all hypospadias patients presenting to a single institute treated by a single surgeon between 2003 and 2019 ( = 217) were reviewed retrospectively. Urethrocutaneous fistula repair and minor cosmetic corrections were excluded.Eight cases had 10 complications: residual penile curvature > 30 degrees ( = 5), urethral diverticulum > 15 mm ( = 3), urethral dehiscence ( = 1), and urethral stricture ( = 1). All were Japanese. Hypospadias was perineal/penoscrotal ( = 7) or midshaft ( = 1). Initial procedures performed in infancy were single-stage urethroplasty ( = 4) or multistage urethroplasty ( = 4). Ages at first soft tissue interposition during redo single-stage urethroplasty ( = 1) or multistage urethroplasty ( = 7; two-stage: = 4, three-stage: = 3) ranged from 4.2 to 46.5 years old. All had their neourethras covered and four also had their scarred urethral plates reinforced laterally. There have been no complications during a mean of 5.6-year follow-up after the last procedure (range: 3.4-8.3 years) and all expressed satisfaction with cosmetic and functional outcomes including standing urination. Tissues for interposition were harvested easily without injuring surrounding structures such as the vas deferens or testicular vessels, even though previous surgery had caused extensive adhesions and structural disruption.Unlike reinforcement with tunica dartos fascia, soft tissue interposition specifically boosts tissue thickness and perfusion at the operative site during redo surgery for technically challenging posturethroplasty complications.
The European Pediatric Surgical Audit: Improving Quality of Care in Rare Congenital Malformations.
Teunissen NM, Rossi D, Wouters MW … +3 more , Eaton S, van Heurn LWE, Wijnen R
Eur J Pediatr Surg · 2025 Oct · PMID 40233798 · Full text
Since 2019, the European Pediatric Surgical Audit (EPSA) has been the official registry of the European Reference Network for Inherited and Congenital Anomalies (ERNICA). The primary aim of this prospective patient regis...
Since 2019, the European Pediatric Surgical Audit (EPSA) has been the official registry of the European Reference Network for Inherited and Congenital Anomalies (ERNICA). The primary aim of this prospective patient registry is benchmarking (quality of) care for patients with rare congenital malformations throughout Europe. Data collected comprise baseline, treatment, and outcome variables, permitting calculation of disease-specific, hospital-level quality indicator results reflecting between-hospital variation. This practice and outcome variation is fed back as actionable information to clinicians on a web-based, real-time dashboard to help focus local and central improvement initiatives. Secondly, realizing joint research initiatives with quality improvement purposes through secondary data use will increase our knowledge of these rare conditions and optimize care. Currently, 27 hospitals in 15 European countries have connected to this unique, European-wide audit. Henceforward, the focus will be on the further expansion of hospitals and diseases, as EPSA aspires to become all-encompassing, including all European patients with congenital malformations.
Effects of Low-Pressure CO2 Insufflation on Cerebral and Splanchnic Oxygenation in Neonates Undergoing Laparoscopic Pyloromyotomy.
Ceccanti S, Cervellone A, Mazzei O … +2 more , Pesce MV, Cozzi DA
Eur J Pediatr Surg · 2025 Oct · PMID 40233797 · Publisher ↗
Pathophysiological effects of abdominal CO insufflation on cerebral and splanchnic oxygenation in neonates and infants undergoing laparoscopy remain poorly investigated. We investigated laparoscopic pyloromyotomy as a pa...
Pathophysiological effects of abdominal CO insufflation on cerebral and splanchnic oxygenation in neonates and infants undergoing laparoscopy remain poorly investigated. We investigated laparoscopic pyloromyotomy as a paradigm to determine such changes in this specific population.Single-center, prospective cohort of 28 infants undergoing laparoscopic pyloromyotomy at the mean age of 30.9 ± 10.6 days. The pneumoperitoneum was set at 6 to 8 mmHg. Regional cerebral oxygen saturation (cSO) and splanchnic oxygen saturation (sSO) were measured by near-infrared spectroscopy. End-tidal carbon dioxide (EtCO) levels, heart rate, body temperature, systemic blood pressure, and urine output were also recorded. Data (mean ± SD) were collected intraoperatively at 0, 15, and 30 minutes and compared to baseline values for each patient using the -test.A significant decrease in cSO was recorded only at the beginning of surgery, while sSO significantly decreased from 15 intraoperative minutes (-7.1% ± 7.2; = 0.0009) until the end of insufflation, followed by an increasing trend, although still below the baseline values (-6.5% ± 11.2; = 0.01). EtCO increased significantly from the initial 15 intraoperative minutes, reaching a maximum of 42.6 ± 8.9 mmHg at 30-minute intervals. Urine output significantly decreased within the first 4 postoperative hours.Laparoscopic pyloromyotomy using low-pressure CO insufflation (6-8 mmHg) maintains stable cerebral oxygenation in neonates and infants, while splanchnic oxygenation and urine output experience temporary, reversible reductions. These findings suggest that low-pressure pneumoperitoneum is a safe and effective approach in neonatal laparoscopy, with minimal oxygenation and metabolic risks.
Publishing Trends, Motivations, and Obstacles Among Pediatric Surgeons: An International Survey on Research Dissemination and Peer Review Challenges.
Aubert O, Gazzaneo M, Moreno-Alfonso JC … +4 more , Ulman H, Garnier H, Ure B, Lacher M
Eur J Pediatr Surg · 2025 Oct · PMID 40185145 · Publisher ↗
OBJECTIVE: This study aims to assess publishing trends, motivations, preferences, and challenges among pediatric surgeons globally. METHODS: A cross-sectional survey was conducted among pediatric surgeons from multiple...
OBJECTIVE: This study aims to assess publishing trends, motivations, preferences, and challenges among pediatric surgeons globally. METHODS: A cross-sectional survey was conducted among pediatric surgeons from multiple countries, distributed through the Trainees of European Pediatric Surgery (TEPS) network and social media. The anonymous questionnaire contained 26 items focusing on journal preferences, motivations for publishing, obstacles faced, peer-review experiences, open access publishing, and methods of research dissemination. RESULTS: A total of 172 responses were collected from pediatric surgeons in 33 countries. Most respondents worked in tertiary hospitals (88%) and were consultants or senior attendings (49%). Over half (65%) had published at least one scientific paper in the last 3 years. PubMed was the primary search engine (82%), and pediatric surgical journals were the preferred outlets for publication (87%). Key motivations for choosing a journal were impact factor (22%) and scope (19%), while publication costs (38%) and slow review processes (22%) were the primary deterrents. Open access publication options were used by more than half of respondents, with a third spending less than €2,500 on fees. Social media, particularly Instagram, emerged as a popular platform for research dissemination. CONCLUSION: Pediatric surgeons prefer publishing in specialized journals, with impact factor and scope being key drivers of journal choice. Publication costs and the peer-review process are the most significant obstacles. Efforts to address these challenges, such as reducing fees and enhancing the review process, are crucial for facilitating research dissemination in pediatric surgery.
Association of Somatic KRAS Variants with Osteolysis in Arteriovenous Malformations.
San Basilio M, Rodríguez-Laguna L, Triana Junco P … +5 more , Martínez-Glez V, Ramirez-Amoros C, Delgado-Miguel C, Rodriguez-Arias JP, Lopez-Gutierrez JC
Eur J Pediatr Surg · 2025 Oct · PMID 40157373 · Publisher ↗
The genetic study of vascular anomalies provides a better understanding of their etiopathogenesis and allows the use of targeted therapies. Activating pathogenic variants promote cell proliferation by activating MAPK an...
The genetic study of vascular anomalies provides a better understanding of their etiopathogenesis and allows the use of targeted therapies. Activating pathogenic variants promote cell proliferation by activating MAPK and PI3K signalling pathways, which have been associated with the pathogenesis of vascular anomalies, especially high-flow ones such as arteriovenous malformations (AVMs). AVMs' genomic landscape is extensive, and a genotype-phenotype correlation has not been shown. In this study, we aimed to prove an association between gene mutations and the presence of osteolysis in patients with AVMs. Herein, we present a clinical-molecular retrospective study of patients with AVMs, bone involvement, and pathogenic variants.A retrospective review of patients with AVMs and somatic variants followed by the Vascular Anomalies Unit at our institution was performed. All patients present bone involvement. We analyzed demographics, clinical features (AVMs location, phenotype), treatment received, and response to treatment. Previous imaging studies were used to assess bone involvement. Genetic studies were performed by high-throughput sequencing using a custom-designed panel.Of the 77 patients with AVMs currently followed in our clinic, 60 (77.9%) had genetic testing, and 19 (31.6%) presented a somatic activating variant and were therefore included in the study. There were 12 women and 7 men aged 10 to 79 years. When studying radiographies or CT scans, we found that all 19 patients associated osteolysis adjacent to the AVMs. Regarding the variants, the most frequent one was p.Gly12Asp, followed by p.Gln61His and p.Gly13Arg. Additionally, we reviewed imaging studies from the other 41 patients with AVMs and different pathogenic variants such as , , and , and did not find osteolysis.We have described for the first time the relationship between somatic, activating pathogenic variants and osteolysis in patients with AVMs. Early detection of these alterations in this type of patient should lead us to rule out bone involvement. Moreover, identifying these mutations may help guide targeted therapies, potentially preventing the development of osteolysis and improving patient outcomes.
Rising Multidrug-Resistant Pathogens in Pediatric Appendicitis: A Decade-Long Study from Southern Israel.
Melamed R, Ozalvo D, Sagi O … +5 more , Assi Z, Nahom A, Kezerle Y, Novack L, Shany E
Eur J Pediatr Surg · 2025 Oct · PMID 40148128 · Publisher ↗
Appendicitis is the most common indication for emergent abdominal surgery in childhood. Intravenous antibiotic therapy reduces infections-related complications. Epidemiological data concerning bacterial pathogens are imp...
Appendicitis is the most common indication for emergent abdominal surgery in childhood. Intravenous antibiotic therapy reduces infections-related complications. Epidemiological data concerning bacterial pathogens are important in tailoring antibiotic stewardship recommendations.This study aims to assess trends over the years in bacterial distribution, and sensitivities (specifically multidrug-resistant [MDR] Enterobacteriaceae) in surgical appendicitis among two different ethnic communities in southern Israel.This was an observational, single-center, retrospective study. Included were children less than 18 years of age with surgical appendicitis treated in Soroka University Medical Center between 2010 and 2020 that had a positive intraoperative intraperitoneal bacterial swab culture. Data were assessed using univariable and multivariable analyses including multiple linear regression and negative binomial regressions with time series analysis to compare between periods during the study while accounting for confounders.Overall, 1,858 specimens were available for analysis from 2,264 children with confirmed surgical appendicitis. Pathogenic bacteria were recovered in 684 (36.8%), with nearly half polymicrobial. MDR Enterobacteriaceae pathogens were more common in the Arab-Bedouin community as compared with the Jewish community (32.6% vs. 18.6%, < 0.001). Time series analysis detected an 8.7% significant increase in MDR pathogens per year ( = 0.003) with male children (10% per year [ = 0.016]), children younger than 12 years (10% per year [ = 0.014]), and children of the Arab-Bedouin community (8.7% per year [ = 0.025]) accounting for this increase in MDR isolates.MDR pathogens incidence has significantly increased between 2010 and 2020 and this should be considered in the choice of antibiotic therapies and antibiotic stewardship programs in the hospital and the community.
Cutting-Edge Pediatric Colorectal Surgery: A Half-Century of Innovations in Technique which have Transformed Care for Anorectal Malformation.
Xu TO, Ryan J, Levitt MA
Eur J Pediatr Surg · 2025 Apr · PMID 40127674 · Publisher ↗
The field of pediatric colorectal surgery has been transformed over the last 50 years with innovations that have dramatically improved surgical techniques, reduced complications, and improved patients' lives. Specific to...
The field of pediatric colorectal surgery has been transformed over the last 50 years with innovations that have dramatically improved surgical techniques, reduced complications, and improved patients' lives. Specific to anorectal malformations (ARMs), an innovative operation for their repair, the posterior sagittal anorectoplasty (PSARP), came in the 1980s and was relatively new compared to other operations for congenital problems which were mostly developed in the 1950s. Since that major advance, further cutting-edge surgical techniques have been developed and are reviewed here.
Development of European Consensus Guidelines and Evolution of Innovative Surgical Strategies for the Treatment of Anorectal Malformations.
Kremer MEB, Gorter RR, Tidman J … +2 more , Gosemann JH, de Blaauw I
Eur J Pediatr Surg · 2025 Apr · PMID 40127673 · Publisher ↗
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