European Journal Of Pediatric Surgery[JOURNAL]
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200 papers
Anorectal Malformations Associated with Hirschsprung Disease: Insights from a Large Cohort of 2,341 ARM Patients in a Single-Center Retrospective Study.
Xiao X, Feng W, Zhu J … +7 more , Fan L, Xiang C, Wang Z, Hou J, Liu W, Guo Z, Wang Y
Eur J Pediatr Surg · 2025 Oct · PMID 40118113 · Publisher ↗
Anorectal malformation (ARM) and Hirschsprung disease (HSCR) are common congenital gastrointestinal defects, but their co-occurrence is rare. This retrospective study analyzed the clinical characteristics of patients wit...
Anorectal malformation (ARM) and Hirschsprung disease (HSCR) are common congenital gastrointestinal defects, but their co-occurrence is rare. This retrospective study analyzed the clinical characteristics of patients with ARM associated with HSCR for early diagnosis and treatment guidance to reduce the occurrence of severe complications.A single-center retrospective cohort analysis from 2010 to 2024 identified 2,341 patients with ARM and 1,721 with HSCR. The histopathologic assessment included hematoxylin and eosin (H&E) staining and immunohistochemical staining.Seven patients (0.3%) out of 2,341 cases of ARM were diagnosed with concurrent HSCR, three males (42.9%) and four females (57.1%). Seven cases are rectoperineal fistula. All cases developed constipation with abdominal distension within 1 month to 1 year after anoplasty, even following aggressive bowel management. Barium enema showed obvious transition zones, and anorectal manometry revealed absent rectoanal inhibitory reflex in seven cases. All patients underwent the Swenson procedure. The mean duration of postoperative follow-up was 7.5 ± 2.8 years. Seven cases had no constipation, no soiling, voluntary bowel movements by Krickenbeck classification, and excellent continence by the Rintala scoring system in recent follow-up.The association between ARM and HSCR may be rarer than previously reported. Low-type ARM and short or rectosigmoid aganglionosis appeared more common in these cases. Persistent postoperative constipation and abdominal distension unresponsive to conservative treatment should raise suspicion for HSCR, prompting timely diagnostic evaluations. Postoperative bowel function needs to be interpreted carefully, and prospective studies are needed to confirm these findings and guide standardized care.
Risk Factors for 30-day Mortality in Patients with Surgically Treated Necrotizing Enterocolitis: A Multicenter Retrospective Cohort Study.
Pijpers AGH, Imren C, van Varsseveld OC … +10 more , Schattenkerk LDE, Keyzer-Dekker CMG, Hulscher JBF, Kooi EMW, van den Akker CHP, van Schuppen J, Taal HR, Twisk JWR, Derikx JPM, Vermeulen MJ
Eur J Pediatr Surg · 2025 Aug · PMID 40118095 · Full text
Necrotizing enterocolitis (NEC) is a leading cause of death in very preterm born infants. The most severe variant is NEC totalis (NEC-T), where necrosis of the small intestines is so extensive that curative care is often...
Necrotizing enterocolitis (NEC) is a leading cause of death in very preterm born infants. The most severe variant is NEC totalis (NEC-T), where necrosis of the small intestines is so extensive that curative care is often withdrawn. Mortality and NEC-T are difficult to predict before surgery, complicating counseling and decision-making. This study's aim was to identify preoperative risk factors for overall 30-day mortality and NEC-T in preterm born infants with surgical NEC.This multicenter retrospective cohort study included preterm born infants (<35 weeks) surgically treated for NEC between 2008 and 2022. NEC-T was defined as necrosis of the majority of small intestine, leading to a surgical open-close procedure without curative treatment. Preoperative risk factors for 30-day postoperative mortality, NEC-T, and mortality without NEC-T were assessed using multivariable logistic regression analyses.Among the 401 patients included, the 30-day mortality rate was 34.2% (137/401), of which 18.7% (75/401) involved NEC-T. Significant risk factors for mortality were male sex (odds ratio [OR]: 2.53; 95% confidence interval [CI]: 1.54-4.16), lower birthweight (OR: 0.91; 95% CI: 0.86-0.96/100 g), portal venous gas (PVG) on abdominal radiograph (OR: 1.89; 95% CI: 1.11-3.20), need for cardiovascular support between NEC diagnosis and surgery (OR: 3.26; 95% CI: 2.02-5.24), and shorter time between diagnosis and surgery (OR: 0.74; 95% CI: 0.65-0.84). Similar risk factors were found for NEC-T. In patients without NEC-T, the need for cardiovascular support (OR: 2.33; 95% CI: 1.33-4.09) and time between diagnosis and surgery (OR: 0.77; 95% CI: 0.64-0.91) were significant.Male sex, lower birthweight, PVG, cardiovascular support, and a short interval between NEC diagnosis and surgery are preoperative risk factors for 30-day mortality and NEC-T. Preoperative cardiovascular support and a shorter time interval between diagnosis and surgery are also risk factors for mortality without NEC-T.II.
International Comparison of Surgical Management Practices for Necrotizing Enterocolitis in Neonates: Insights from Cohorts in the Netherlands and Finland.
Lahr BE, van Varsseveld OC, Klerk DH … +3 more , Pakarinen M, Koivusalo A, Hulscher JBF
Eur J Pediatr Surg · 2025 Aug · PMID 40101789 · Full text
Surgical management of necrotizing enterocolitis (NEC) can result in significant morbidity and mortality. Surgical management varies in the absence of international evidence-based guidelines. We aimed to gain insight int...
Surgical management of necrotizing enterocolitis (NEC) can result in significant morbidity and mortality. Surgical management varies in the absence of international evidence-based guidelines. We aimed to gain insight into practice variation between expert centers in the Netherlands and Finland.Bicentric retrospective cohort study including all infants treated surgically for NEC (Bell's stage ≥IIA) in two centers in the Netherlands and Finland between 2000 and 2021. Main outcomes were preoperative, intraoperative, and 3-month postoperative characteristics.We included 191 patients (122 Dutch and 69 Finnish). Median gestational age and birth weight were lower in Finnish patients (median [min.-max.]: 25 + 4/7 [23 + 0/7-39 + 0/7] vs. 28 + 2/7 [23 + 6/7-41 + 6/7], < 0.001, and 795 g [545-4,000] vs. 1,103 g [420-3,065], < 0.001). Indication for surgery was mostly pneumoperitoneum in Finnish patients (56.5% vs. 37.7%; = 0.02) versus clinical deterioration on conservative treatment in Dutch patients (51.6% vs. 23.2%; < 0.001). A fixed-bowel loop was also more often an indication in Finland (20.3% vs. 3.3%; < 0.001. Ostomy creation was more common in Finnish patients (92.8% vs. 53.3%; < 0.001) and primary anastomosis in Dutch patients (29.5% vs. 4.4%; < 0.001). Open-close procedures occurred in 13.9% of Dutch cases, versus 1.4% of Finnish cases ( = 0.004). Mortality at 3 months was comparable when excluding open-close procedures (24.8% vs. 19.1%; = 0.46).We observed varying populations, indications for surgery, and surgical approaches in NEC between the Netherlands and Finland. The occurrence of open-close procedures is 10-fold higher (13.9% vs. 1.4%) in the Netherlands compared to Finland. Long-term outcomes remain to be studied. These results point toward significant practice variation and strengthen the need for European management guidelines.
Solving Complex Pediatric Surgical Case Studies: A Comparative Analysis of Copilot, ChatGPT-4, and Experienced Pediatric Surgeons' Performance.
Gnatzy R, Lacher M, Berger M … +11 more , Boettcher M, Deffaa OJ, Kübler J, Madadi-Sanjani O, Martynov I, Mayer S, Pakarinen MP, Wagner R, Wester T, Zani A, Aubert O
Eur J Pediatr Surg · 2025 Oct · PMID 40043742 · Publisher ↗
The emergence of large language models (LLMs) has led to notable advancements across multiple sectors, including medicine. Yet, their effect in pediatric surgery remains largely unexplored. This study aims to assess the...
The emergence of large language models (LLMs) has led to notable advancements across multiple sectors, including medicine. Yet, their effect in pediatric surgery remains largely unexplored. This study aims to assess the ability of the artificial intelligence (AI) models ChatGPT-4 and Microsoft Copilot to propose diagnostic procedures, primary and differential diagnoses, as well as answer clinical questions using complex clinical case vignettes of classic pediatric surgical diseases.We conducted the study in April 2024. We evaluated the performance of LLMs using 13 complex clinical case vignettes of pediatric surgical diseases and compared responses to a human cohort of experienced pediatric surgeons. Additionally, pediatric surgeons rated the diagnostic recommendations of LLMs for completeness and accuracy. To determine differences in performance, we performed statistical analyses.ChatGPT-4 achieved a higher test score (52.1%) compared to Copilot (47.9%) but less than pediatric surgeons (68.8%). Overall differences in performance between ChatGPT-4, Copilot, and pediatric surgeons were found to be statistically significant ( < 0.01). ChatGPT-4 demonstrated superior performance in generating differential diagnoses compared to Copilot ( < 0.05). No statistically significant differences were found between the AI models regarding suggestions for diagnostics and primary diagnosis. Overall, the recommendations of LLMs were rated as average by pediatric surgeons.This study reveals significant limitations in the performance of AI models in pediatric surgery. Although LLMs exhibit potential across various areas, their reliability and accuracy in handling clinical decision-making tasks is limited. Further research is needed to improve AI capabilities and establish its usefulness in the clinical setting.
Comparative Outcomes of Surgical Techniques for Congenital Diaphragmatic Eventration in Children: A Multicenter Retrospective Cohort Analysis.
Alzahrani K, Heng L, Khen-Dunlop N … +22 more , Panait N, Hervieux E, Grynberg L, Olivier A, Hameury F, Lavrand F, Maillet O, Haffreingue A, Lehn A, de Napoli-Cocci S, Habonimana E, Michel JL, Montalva L, Ballouhey Q, Fotso Kamdem A, Lecompte JF, Line A, Poupalou A, Meignan P, Deslandes L, Podevin G, Schmitt F
Eur J Pediatr Surg · 2025 Oct · PMID 39965756 · Publisher ↗
This study compares various surgical approaches for treating congenital diaphragmatic eventration (CDE) in children to identify the most effective and safest method.We conducted a retrospective analysis of a multicentric...
This study compares various surgical approaches for treating congenital diaphragmatic eventration (CDE) in children to identify the most effective and safest method.We conducted a retrospective analysis of a multicentric cohort of pediatric patients operated on for CDE between 2010 and 2021. The different surgical approaches, including robot-assisted thoracoscopic surgery (RATS), and their outcomes were compared (Clinical Trials NCT04862494).One hundred and twelve patients, aged 12 (5-21) months, underwent diaphragmatic plication. Thoracoscopy or RATS was performed in 69 (62%) cases, posterolateral thoracotomy (PLT) in 15 (13%), and an abdominal approach in 28 (25%), based on surgeons' choice. Symptom relief was achieved in 88% of patients, and 90% showed radiographic improvement. There were 31 peri- or early postoperative complications (28%), mainly including pleural effusions, infections, and lobar atelectasis, and 8 recurrences of eventration (7%), with no significant correlation between these complications and the surgical approach. Compared to other approaches, thoracotomy multiplied the duration of intravenous analgesia by three (96 h vs. 36 h, < 0.0001) and hospital stay length by two (8 vs. 4 days, = 0.002). RATS, although comparable to thoracoscopy in short-term outcomes, had a higher incidence of perioperative hepatic injuries and long-term complications, including persistent symptoms in all five patients and chest wall deformities in two.Diaphragmatic plication via a minimally invasive thoracic approach may be the best treatment option for cases of symptomatic CDE. Further research is required to establish potential added risks of RATS as compared to thoracoscopy in this indication.
Evaluating Access and Efficacy of Pelvic Floor Physical Therapy in Pediatric Hirschsprung Disease.
Srinivas S, Driesbach S, Su M … +8 more , Bahhur A, Thomas E, Trimble C, Zahora P, Bergus K, Gasior AC, Halaweish I, Wood RJ
Eur J Pediatr Surg · 2025 Aug · PMID 39933734 · Publisher ↗
In patients with Hirschsprung disease (HD), pelvic floor physical therapy (PFPT) is recommended for persistent incontinence or constipation refractory to other treatment, but there are no studies on utilization of PFPT....
In patients with Hirschsprung disease (HD), pelvic floor physical therapy (PFPT) is recommended for persistent incontinence or constipation refractory to other treatment, but there are no studies on utilization of PFPT. We aimed to assess clinical and sociodemographic factors associated with successful establishment of PFPT and outcomes following PFPT.We performed a single-institution, retrospective chart review of patients with HD referred to PFPT between 2020 and 2023, involving both exercise and biofeedback. Data were collected on clinical factors, sociodemographics, and symptoms before and after PFPT. Those who "saw PFPT," defined as at least one in-person appointment, were compared to those who did not see PFPT; symptoms were also compared. A -value of 0.05 was considered significant.There were 83 patients, of which 37 (44.6%) saw PFPT. There were no differences in age, transition zone, prior interventions, or symptoms. Half of the patients who saw PFPT only completed an initial visit; one-fifth completed the series. Most common reason for failure to see PFPT was scheduling issues. Patients who failed to see PFPT had financial stressors (42.5% vs. 16.1%, = 0.02) and required formal support systems (28.2% vs. 3.3%, = 0.02). In patients seeing PFPT, incontinence significantly improved (81.1% before vs. 40.5% after, = 0.001).Although PFPT is recommended in children with HD, those with financial stressors or scheduling issues may have barriers to access. However, those who see PFPT have improved symptoms. This suggests a need for improved accessibility of pediatric PFPT to children with HD, such as integration of PFPT into colorectal clinics.
Diagnostic Accuracy of Uroflowmetry for Urethral Strictures in Pediatric Hypospadias: TIP versus Non-TIP Outcomes.
Ru W, Liu H, Zhou J … +5 more , Hu Q, Yang W, Hu L, Chen G, Yan X
Eur J Pediatr Surg · 2025 Aug · PMID 39933733 · Full text
This study aimed to evaluate the diagnostic accuracy of uroflowmetry in detecting pediatric urethral strictures following tubularized incised plate (TIP) and non-TIP urethroplasty.A retrospective cohort study was conduct...
This study aimed to evaluate the diagnostic accuracy of uroflowmetry in detecting pediatric urethral strictures following tubularized incised plate (TIP) and non-TIP urethroplasty.A retrospective cohort study was conducted on children who underwent primary hypospadias repairs from June 2016 to June 2023 at our institution. Patients were categorized into the TIP and the non-TIP groups. Urethral calibration and uroflowmetry were used to evaluate urethral patency following urethroplasty. Data on demographic characteristics, perioperative information, uroflowmetry results, urethral calibration outcomes, and postoperative complications were collected.The relationship between calibration and uroflowmetry and the diagnostic accuracy of uroflowmetry for urethral strictures were analyzed.A total of 62 cases were included, with 38 in the TIP group and 24 in the non-TIP group. Ten patients were diagnosed with urethral strictures. The maximum urinary flow rate (Q) exhibited a higher area under the curve (AUC) than the average urinary flow rate (Q) in both the TIP and non-TIP groups. The Q in the non-TIP group demonstrated a higher AUC than in the TIP group (non-TIP: AUC = 0.94, cutoff = 6.65 ml/s, sensitivity = 100%, specificity = 81.0%; TIP: AUC = 0.80, cutoff = 5.75 ml/s, sensitivity = 100%, specificity = 58.1%). A significant quadratic correlation was found between Q and urethral calibration (non-TIP: = 14.72 * Q, = 0.96; TIP: = 14.76 * Q, = 0.88). The Q nomogram interval ≤ -3 standard deviation was a significant predictor for non-TIP urethral strictures (kappa = 0.70).Uroflowmetry, particularly Q, shows promise as a noninvasive screening tool for detecting urethral strictures after hypospadias repair. It has high diagnostic accuracy in non-TIP cases but limited utility in TIP cases.
Distal Humeral Coronal Shear Fractures in Children and Adolescents: Need for Cross-Sectional Imaging and a Revised Classification.
Kraus R, Esser M, Schmal H … +5 more , Bergmann F, Trück M, Kirschner HJ, Kaiser MM, Lieber J
Eur J Pediatr Surg · 2025 Aug · PMID 39933732 · Publisher ↗
The classification of fractures is necessary to ensure a reliable means of communication for clinical interaction, research, and education. Distal humeral coronal plane shear fractures (CSFs) are very rare in the growing...
The classification of fractures is necessary to ensure a reliable means of communication for clinical interaction, research, and education. Distal humeral coronal plane shear fractures (CSFs) are very rare in the growing-age population, despite that multiple classification schemes exist.The aim of this study was to assess the inter- and intrarater reliability of the four most commonly used CSF classifications and their role in guiding treatment decisions in everyday clinical practice.Fifty-one patients with CSFs were retrospectively analyzed in a multicenter study. Of these, X-rays in two planes of 20 randomly selected CSFs were given to eight independent raters for classification according to Dubberley, Bryan and Morgan, Murthy, and AO. Cohen's kappa statistic was used to assess interrater agreement and intrarater consistency. Intraclass correlation coefficient (ICC) estimates and 95% confidence intervals (CIs) were calculated. Reliability values were classified as excellent (ICC ≥0.8), substantial (ICC 0.61-0.80), moderate (ICC 0.41-0.6), fair (ICC 0.2-0.4), slight (ICC 0.00-0.2), and poor (ICC <0.00).All patients received x-rays in two planes initially. Cross-sectional imaging was added in 76.5% of cases (CT 58.8%, MRI 11.7%, both 5.9%). Interrater reliabilities were classified as fair for Dubberley (ICC 0.354; 95% CI 0.198, 0.573) and Bryan and Morgan (ICC 0.357; 95% CI 0.200, 0.576), slight for AO (ICC 0.226; 95% CI 0.100, 0.434), and poor for Murthy (ICC -0.012; 95% CI -0.063, 0.102). The Dubberley subtype showed slight agreement at lower ICC values (ICC 0.024, 95% CI -0.041, 0.161). The intrarater agreement was moderate to substantial for most of the eight raters and did not differ between the four classification systems. The rate of surgical treatment was 49/51 patients.The most commonly used classification schemes for CSFs failed to achieve a substantial agreement among the raters. This is probably because the fracture patterns of CSF in adolescence and high adulthood differ significantly. An adaptation of the classification for pediatric and adolescent patients is necessary, but only for scientific purposes. Classification is not necessary for the clinical management of patients, as virtually all patients require surgical treatment.
Phrenic Nerve Reconstruction in Pediatric Diaphragm Paralysis: Outcomes and Techniques.
Kaufman MR, Lu C, Staab V … +1 more , Bauer T
Eur J Pediatr Surg · 2025 Aug · PMID 39933731 · Publisher ↗
Symptomatic diaphragm paralysis in the pediatric patient is an uncommon condition. This study aims to evaluate the outcomes and technique of phrenic nerve reconstruction and its application to pediatric patients with uni...
Symptomatic diaphragm paralysis in the pediatric patient is an uncommon condition. This study aims to evaluate the outcomes and technique of phrenic nerve reconstruction and its application to pediatric patients with unilateral and bilateral diaphragm paralysis at a single institution. The objective of this study is to demonstrate the application of a well-studied reconstructive technique in a population of patients not previously studied.A retrospective review of pediatric patients between 2012 and 2022 with symptomatic diaphragm paralysis treated with phrenic nerve reconstruction. Nine patients with a median age of 10 years were offered surgical treatment. The etiology of their paralysis included: birth trauma, congenital cervical anomaly, mediastinal neoplastic disease, cervical spinal cord injury, and acute flaccid myelitis. Measures of postoperative improvement include: fluoroscopic sniff testing, pulmonary function testing, electromyography/nerve conduction testing, ultrasound evaluation, and ventilator requirements.One hundred percent of patients with unilateral paralysis demonstrated improvement, defined as improvements in dyspnea, orthopnea, fatigability, and decreased respiratory infections. This was corroborated by sniff testing, pulmonary function testing, and electrodiagnostic evaluation. In 80% of patients, there was recovery of diaphragm excursion on the chest fluoroscopy, and a 10% or greater improvement in pulmonary spirometry (forced expiratory volume in 1 second, FEV1, and forced vital capacity, FVC) percent predicted values. In patients with bilateral diaphragm paralysis, 75% demonstrated improvement in sniff testing, ultrasound findings, and ventilator requirements. One of four patients with bilateral paralysis and chronic ventilator dependency did not improve. There were no postoperative complications defined as hematoma, wound infection, pleural effusion, pneumonia, sepsis, nerve injury, or hardware malfunction seen during follow-up.Phrenic nerve reconstruction in pediatric patients demonstrates potential as a safe and effective surgical option for symptomatic diaphragm paralysis. In patients with unilateral paralysis, this intervention consistently improved respiratory function. In patients with bilateral paralysis, the results were variable but showed promise in facilitating ventilator weaning when performed early. These findings underscore the importance of early surgical intervention. Larger, multicenter studies are needed to validate its long-term potential.
Editorial Overview: Highlights from the 25th EUPSA Congress, Bologna, 2024.
Mutanen A, Lacher M
Eur J Pediatr Surg · 2025 Feb · PMID 39855253 · Publisher ↗
Abstract loading — click title to view on PubMed.
Feasibility and Challenges of Pyeloureteral Magnetic Anastomosis Device in Domestic Pigs: A Stepwise Approach with Extended Observation.
Kubiak R, Hornok Z, Csukas D … +2 more , Ferencz A, Cserni T
Eur J Pediatr Surg · 2025 Aug · PMID 39832767 · Publisher ↗
OBJECTIVE: The pyeloureteral anastomosis remains the most challenging part of pyeloplasty. A purpose-built anastomotic device could simplify this step and potentially improve outcomes. The concept of a pyeloureteral mag...
OBJECTIVE: The pyeloureteral anastomosis remains the most challenging part of pyeloplasty. A purpose-built anastomotic device could simplify this step and potentially improve outcomes. The concept of a pyeloureteral magnetic anastomosis device (PUMA) was proven in minipigs, but only in short term. Our aim was to test the PUMA in domestic pigs and achieve a prolonged follow-up period. METHODS: Five female domestic pigs underwent laparoscopy and ligation of the left ureter. Four weeks later, laparoscopic implantation of the PUMA was planned. Removal of the device and a retrograde contrast study were scheduled after another 4 weeks. The experiment was terminated when the animals could no longer be properly cared for due to their weight. RESULTS: Due to unexpected smaller ureteric diameters, a modified PUMA could only be successfully inserted in pig number 3 (49 kg). Four weeks later, the device was found to be dislocated, but the anastomosis remained patent. After modifying the study protocol, the PUMA was successfully implanted in pigs number 4 (96 kg) and 5 (68 kg) 8 weeks after ureteric ligation. Pig 4 developed malignant hyperthermia and died. In pig 5, the magnets were removed 4 weeks later. After an additional 8 weeks, the animal reached 135 kg and was terminated. The anastomosis remained patent and preserved its diameter. CONCLUSION: Despite limitations, our study successfully demonstrated that the PUMA can achieve a patent ureteric anastomosis in domestic pigs. This suggests a potential for minimally invasive ureteric anastomosis in clinical settings. Further research is needed to optimize the technique and validate its effectiveness in humans.
Anorectal Malformation with Rectoperineal Fistula in Males Treated with a Posterior Rectal Advancement Anoplasty: Report of Early Outcomes.
Xu TO, Samuk I, Feng C … +3 more , Wood RJ, Badillo A, Levitt MA
Eur J Pediatr Surg · 2025 Apr · PMID 39805313 · Publisher ↗
OBJECTIVE: A novel modification of the cutback procedure, a posterior rectal advancement anoplasty (PRAA) for select male patients with an anorectal malformation and a rectoperineal fistula was recently described, which...
OBJECTIVE: A novel modification of the cutback procedure, a posterior rectal advancement anoplasty (PRAA) for select male patients with an anorectal malformation and a rectoperineal fistula was recently described, which incised only within the limits of the sphincteric ellipse and eliminated an anterior rectal dissection and thus avoiding any possibility of a urethral injury. This report provides longer-term postoperative outcomes after PRAA. METHOD: A retrospective, single-institution study was performed examining male patients with a rectoperineal fistula between January 2020 and December 2023. PRAA was done only if the rectoperineal fistula was located within the anterior extent of the sphincteric ellipse, which was true for all patients encountered during this study period. We assessed postoperative outcomes, length of stay, time to first feeding, and early stooling patterns. RESULTS: Eighteen patients underwent PRAA at a median age of 5.4 months (range 1 day-8 months) with a median follow-up of 14 months (range 4-40). Seven patients (39%) were repaired within the first month of life. Thirteen (72%) were repaired primarily and five (28%) had a diverting ostomy placed before referral. There were no instances of wound dehiscence, rectal prolapse, or urethral injury. Two (11%) patients developed an anal stricture requiring dilation or Heineke-Mikulicz anoplasty. All patients resumed feeds on postoperative day one. Median discharge was on postoperative day one (range 1-6). Fifteen (83%) were utilizing laxatives at their most recent follow-up. CONCLUSION: The PRAA avoids any potential urethral injury or perineal dehiscence has a low rate of anal stenosis (11%) and appears to be applicable to all male patients with a rectoperineal fistula. The technique allows for early return to diet and discharge and can be safely done in the neonatal period or in a delayed fashion without the need for a stoma. LEVEL OF EVIDENCE: Level III.
Outcomes and Complications of Chait Trapdoor Cecostomy in Pediatric Patients with Therapy-Resistant Constipation and Fecal Incontinence: A 14-Year Retrospective Study.
Jonker CAL, Koppen I, Benninga MA … +2 more , Jong JR, Gorter R
Eur J Pediatr Surg · 2025 Aug · PMID 39788548 · Publisher ↗
AIM OF THE STUDY: To assess the incidence and types of complications and patient-reported outcomes in pediatric patients with therapy-resistant constipation or fecal incontinence (FI) without constipation who underwent...
AIM OF THE STUDY: To assess the incidence and types of complications and patient-reported outcomes in pediatric patients with therapy-resistant constipation or fecal incontinence (FI) without constipation who underwent Chait Trapdoor™ cecostomy (CTC). The findings contribute to the discussion on selecting the optimal antegrade continence (ACE) procedure for this population. MATERIALS AND METHODS: A retrospective review was conducted on all pediatric patients with therapy-resistant constipation or FI without constipation who underwent a CTC procedure at our tertiary referral center between 2009 and 2023. Postoperative complications were classified using the Clavien-Madadi classification. At their most recent follow-up in 2023, patients reported satisfaction with their CTC. RESULTS: The study included 62 children (median age 12 years [IQR 8-14; range 1-17], 42% male), with a median follow-up of 4 years (IQR 2-8, range 0-14). Underlying diagnoses were functional constipation ( = 39, 63%), spina bifida ( = 11, 18%), and anorectal malformations ( = 5, 8%). A total of 49/62 patients (79%) experienced 89 CTC-related complications. Minor complications (Clavien-Madadi I-II) affected 29 patients (47%) and most commonly included granulation. Major complications (Clavien-Madadi III-IV) requiring surgery occurred in 32% of patients. Despite these complications, 40/62 (65%) patients reported satisfaction with their CTC, as determined by partial or complete symptom resolution. CONCLUSIONS: Although complications were common, 65% of the patients reported satisfaction with their CTC. These findings emphasize the need for thorough patient selection, informed counseling on potential risks, and individualized management strategies to enhance outcomes.
Indocyanine Green Fluorescence-Guided Surgery in Pediatric Hepatobiliary Procedures: A Feasibility Study for Improved Intraoperative Visualization.
T K J, Rathod KJ, Saxena R … +6 more , Pathak M, Jadhav AS, Nayak S, Varshney V, Soni SC, Sinha A
Eur J Pediatr Surg · 2025 Aug · PMID 39753146 · Publisher ↗
INTRODUCTION: Indocyanine green (ICG) fluorescence-guided surgery (FGS) is reported extensively in adult operations, but its safety and applications in pediatric populations remain to be comprehensively understood. The...
INTRODUCTION: Indocyanine green (ICG) fluorescence-guided surgery (FGS) is reported extensively in adult operations, but its safety and applications in pediatric populations remain to be comprehensively understood. The dose, administration protocols, and intraoperative imaging benefits in pediatric hepatobiliary operations are not clear. OBJECTIVES: This study aimed to identify the feasibility and applications of ICG FGS in hepatobiliary surgeries (for biliary atresia, choledochal cyst, and cholelithiasis) in children. METHODS: This is a prospective observational study conducted from January 2021 to December 2022. A standard ICG dose of 0.5 mg/kg/dose was administered intravenously to children undergoing operations for biliary atresia (18-24 hours), choledochal cyst (12-18 hours), and cholelithiasis (2-6 hours) before the operation. Intraoperative imaging features and adverse events were recorded. RESULTS: ICG FGS was performed in 17 patients. In biliary atresia ( = 9), liver fluorescence varied in each case, the gallbladder did not show fluorescence, and there was increasing fluorescence as we reached the right depth during the excision of fibrous biliary remnants. In choledochal cyst ( = 6) operations and cholecystectomy ( = 2), real-time imaging provided anatomical details of the biliary tree and helped in safe dissection. No ICG-related adverse events occurred. CONCLUSION: ICG FGS appears safe, feasible, and beneficial in pediatric hepatobiliary surgeries. For conditions like biliary atresia, choledochal cysts, and cholecystectomy, ICG facilitates safer surgical navigation and may reduce intraoperative complications. Future studies with standardized protocols and quantitative fluorescence assessment are needed to further refine its use and confirm its impact on surgical outcomes.
Optimizing Post-Kasai Management in Biliary Atresia: Balancing Native Liver Survival and Transplant Timing.
Madadi-Sanjani O, Uecker M, Thomas G … +5 more , Fischer L, Hegen B, Herrmann J, Reinshagen K, Tomuschat C
Eur J Pediatr Surg · 2025 Aug · PMID 39719262 · Publisher ↗
BACKGROUND: Kasai procedure (KPE) is a palliative intervention in infants with biliary atresia (BA) aiming to restore biliary drainage. While the measure of success in BA is the post-Kasai native liver survival (NLS), B...
BACKGROUND: Kasai procedure (KPE) is a palliative intervention in infants with biliary atresia (BA) aiming to restore biliary drainage. While the measure of success in BA is the post-Kasai native liver survival (NLS), BA remains the most frequent indication for liver transplantation in children. While a considerable amount of children fail to clear their jaundice following KPE, resulting in early liver failure and transplantation, some children become jaundice-free after "successful" KPE. However, sequelae of chronic liver disease might affect those children, becoming a later risk for NLS. While liver transplantation is inevitable in the majority of children, various salvage procedures have been recently described to maintain NLS. This article provides a comprehensive overview of procedures performed after KPE to prolong NLS in BA patients from early childhood to late adulthood and discusses their indications and limitations. METHODS: A literature-based search for surgical and radiological interventions performed in BA patients after KPE to prolong NLS (salvage procedures) was performed using PubMed. Data from case reports, retrospective studies, and registries were included. RESULTS: Fifteen studies included 794 patients who underwent post-KPE salvage procedures. The Oxford Centre for Evidence-Based Medicine levels were IIc to IV.Interventions included redo-Kasai's ( = 710) for cessation of bile flow post-KPE, surgical and radiological procedures ( = 14) for bile lakes, and recurrent cholangitis, shunt surgery ( = 49), and transjugular intrahepatic portosystemic shunt ( = 21) for portal hypertension in BA patients. Age at the time of salvage interventions varied considerably, including redo-Kasai's at 27 days of life and percutaneous biliary interventions in a 35-year-old. CONCLUSION: Salvage procedures can maintain NLS after KPE in BA patients with disease sequelae. However, indications remain scarce and liver transplantation is ultimately unavoidable in the majority of patients. While redo-Kasai numbers are globally decreasing with the advances in liver transplantation, procedures for bile lakes and portal hypertension can be viable options for patients with complications but otherwise stable liver function. Discussion on those procedures should be held by multidisciplinary expert teams, involving pediatric hepatologists, pediatric surgeons, and transplant surgeons to elaborate on the potential of maintaining NLS or proceeding with transplantation.
Beyond the Chest Wall: Examining the Relationship between Morphological Features and Psychosocial Distress in Pectus Excavatum Patients.
Janssen N, Daemen JHT, van Hulst LD … +5 more , Franssen AJPM, Coorens NA, Hulsewé KWE, Vissers YLJ, de Loos ER
Eur J Pediatr Surg · 2025 Jun · PMID 39719261 · Publisher ↗
INTRODUCTION: Pectus excavatum patients frequently experience psychosocial distress, yet the relationship with morphological features of the deformity remains unexplored. We hypothesize that certain morphological featur...
INTRODUCTION: Pectus excavatum patients frequently experience psychosocial distress, yet the relationship with morphological features of the deformity remains unexplored. We hypothesize that certain morphological features analyzed by 3D optical surface imaging contribute more prominently to the distress experienced by pectus excavatum patients as they impact the visible severity of the deformity. MATERIALS AND METHODS: Consecutive pectus excavatum patients who received three-dimensional optical surface imaging between August 2019 and November 2022 were included. Logistic regression analysis assessed the association between morphological features and psychosocial distress in which the distress was scored as a binary variable, based on a self-reported assessment. RESULTS: Among 215 patients, 55% reported psychosocial distress with multivariable analyses revealing greater depth and length of the deformity being significantly correlated with psychosocial distress. However, this prediction model demonstrated a moderate discriminative ability with an area under the receiver operating characteristic curve of 0.66 (95% confidence interval [CI], 0.59-0.73) for pectus depth and 0.58 (95% CI, 0.51-0.66) for pectus length. CONCLUSIONS: The morphological features of length and depth of the deformity are correlated with psychosocial distress. Nonetheless, these individual features are weak predictors due to their moderate discriminative ability. This underscores that other patient-related factors, such as personality traits, neuropsychological conditions, and other psychosocial influences, are likely to play a role in the occurrence of psychosocial distress. Future studies should investigate these variables alongside the incorporation of standardized instruments for measuring psychosocial distress to better understand and address the distress in this population.
Advancing Pediatric Robotic Colorectal Surgery: Trends, Outcomes, and Future Directions-A Comprehensive Review.
Pini Prato A, Lacher M
Eur J Pediatr Surg · 2025 Apr · PMID 39706224 · Publisher ↗
INTRODUCTION: Pediatric robotic colorectal surgery has rapidly evolved, offering enhanced precision and safety for treating complex conditions such as Hirschsprung disease (HSCR), anorectal malformations (ARMs), and inf...
INTRODUCTION: Pediatric robotic colorectal surgery has rapidly evolved, offering enhanced precision and safety for treating complex conditions such as Hirschsprung disease (HSCR), anorectal malformations (ARMs), and inflammatory bowel disease (IBD). This review analyzes recent trends, outcomes, and complications in robotic colorectal procedures for pediatric patients. MATERIALS AND METHODS: A systematic review was performed using PubMed, yielding 1,112 articles related to pediatric robotic colorectal surgery. After applying exclusion criteria, 35 papers were analyzed, focusing on patient characteristics, procedure types, and clinical outcomes. RESULTS: Since 2001, approximately 700 pediatric patients have undergone robotic colorectal procedures, with HSCR being the most commonly treated condition ( = 421). The review highlights that 1.7% of patients experienced Clavien-Dindo grade III complications, while 11.5% had grade I to II complications, indicating a favorable safety profile. The use of robotic platforms facilitated improved precision during perirectal dissection and reduced the risk of damage to adjacent structures, particularly in cases requiring complex pelvic dissections. Despite promising outcomes, the uptake of robotic colorectal surgery remains lower than that for urologic procedures due to challenges such as cost, instrument size, and specialized training. CONCLUSION: Robotic colorectal surgery in children is a safe and effective approach, particularly for complex conditions like HSCR, IBDs, and ARMs. While adoption is currently limited by cost and training requirements, ongoing advancements in technology and techniques promise to broaden its application and improve outcomes in pediatric surgery.
Intercostal Nerve Cryoablation as an Effective Pain Management Strategy in the Nuss Procedure: Reducing Opioid Use and Hospital Stay.
Santana L, Abels M, Driggers J … +1 more , Carvalho N
Eur J Pediatr Surg · 2025 Jun · PMID 39701138 · Publisher ↗
INTRODUCTION: Erector spinae plane (ESP) blocks, thoracic epidural, and patient-controlled analgesia (PCA) have all been used for perioperative pain management in the Nuss procedure without a consensus on what modality...
INTRODUCTION: Erector spinae plane (ESP) blocks, thoracic epidural, and patient-controlled analgesia (PCA) have all been used for perioperative pain management in the Nuss procedure without a consensus on what modality produces the best outcomes. Intercostal nerve cryoablation (INC) is a relatively new modality that involves freezing the nerves to prevent pain during recovery. Our hypothesis is that using INC for the Nuss procedure will decrease opioid use, pain scores, and length of stay (LOS) but will increase cost compared with ESP block, thoracic epidural, and PCA. MATERIALS AND METHODS: This retrospective, observational study compared 108 patients who underwent the Nuss procedure at a pediatric acute care children's hospital in the southeast US. Patient charts were evaluated for significant differences in LOS, opioid use, and reported pain ratings based on type of analgesia administered: INC ( = 30), ESP block ( = 19), thoracic epidural ( = 41), and PCA ( = 18). Secondary variables included emergency department visits, readmissions, opioid refills, and various anesthetic and operative costs. Analysis of variance was performed on all outcome measures. RESULTS: Average LOS was significantly decreased in the INC group (2.9 days) compared with the thoracic epidural (4.7 days, < 0.05) and the PCA groups (3.7 days, < 0.05). Average cumulative opioid use was significantly decreased in the INC group (50.4 morphine milligram equivalents [MME]) compared with the thoracic epidural (117 MME, < 0.05) and PCA groups (172.1 MME, < 0.05). CONCLUSIONS: This study suggests that INC can be a viable and cost-effective option for reducing postoperative opioid consumption and LOS in Nuss procedure patients. Pain perception was lower in the INC group compared with the rest of the groups, except the epidurals, which were similar. However, the opioid consumption of the INC group was significantly lower than any other group. Despite the INC group having higher initial costs, it did not result in the highest total hospital charges, indicating its potential cost-effectiveness. There is a need for larger prospective randomized controlled trials to guide future research efforts.
Utility of Urine Dipstick Testing in Pediatric Appendicitis: Assessing its Role in Identifying Complicated Cases and Retrocecal Appendicitis.
Biehl CM, Elliver M, Gudjonsdottir J … +1 more , Salö M
Eur J Pediatr Surg · 2025 Aug · PMID 39701137 · Publisher ↗
BACKGROUND: Diagnosing appendicitis in children remains a challenge, and the role of urine dipstick is controversial. This study aimed to evaluate the association between abnormal urine dipstick results and appendicitis...
BACKGROUND: Diagnosing appendicitis in children remains a challenge, and the role of urine dipstick is controversial. This study aimed to evaluate the association between abnormal urine dipstick results and appendicitis, particularly appendicitis severity and appendix position. METHODS: A prospective cohort study was conducted from 2017 to 2021 at a tertiary hospital in Sweden. Children aged ≤ 15 years with suspected appendicitis were included. Logistic regression was used to assess associations between abnormal urine dipstick results and sex, age, peritonitis, body temperature, C-reactive protein, complicated appendicitis, and appendix position. RESULTS: A total of 311 children with suspected appendicitis were included, with 193 (62%) diagnosed with appendicitis. Among these, 80 (41%) had complicated appendicitis. There was no difference in appendicitis rate between children with positive and normal urine dipstick results. Among children with appendicitis, 119 (62%) had positive urine dipstick results: 49% ketones, 29% erythrocytes, 23% protein, 19% leukocytes, and 2% nitrite. Multivariable analysis revealed that female sex (adjusted odds ratio: 2.41 [95% confidence interval, CI: 1.21-4.80], = 0.013), retrocecal appendicitis (aOR: 2.39 [95% CI: 1.18-4.84], = 0.015), and complicated appendicitis (aOR: 2.27 [1.01-5.13], = 0.015) were significantly associated with abnormal urine dipstick results. Sensitivity and specificity of positive urine dipstick for complicated appendicitis was 56% (95% CI: 45-67%) and 64% (95% CI: 54-73%), respectively, with an area under the curve of 0.62 (95% CI: 0.54-0.70). Limitations in this study include potential unmeasured confounders such as hydration status and urinary tract infections. CONCLUSION: Abnormal urine dipstick results are common in children with appendicitis. Urine dipstick might help identify cases of complicated and retrocecal appendicitis.
Global Prevalence of Duodenal Atresia in Trisomy 21: A Systematic Review and Meta-Analysis.
Atiyat DK, Al-Nusair DA, Alhajahjeh A … +2 more , Al-Awadi MY, Aborajooh E
Eur J Pediatr Surg · 2025 Jun · PMID 39662883 · Publisher ↗
INTRODUCTION: Duodenal atresia is one of significant causes of neonatal intestinal obstruction. It often co-occurs with Down syndrome. This study is conducted to estimate the global prevalence of duodenal atresia in Dow...
INTRODUCTION: Duodenal atresia is one of significant causes of neonatal intestinal obstruction. It often co-occurs with Down syndrome. This study is conducted to estimate the global prevalence of duodenal atresia in Down syndrome patients and to investigate associated factors. METHODS: Conducting a systematic review with meta-analysis of 18 eligible studies reporting duodenal atresia prevalence in pediatric Down syndrome patients. Study quality is assessed using the Newcastle-Ottawa Scale. The subgroup analysis on region, study quality, publication year, and design is addressed. Gender-specific prevalence rates are examined. RESULTS: The pooled prevalence of duodenal atresia in Down syndrome is 3.0%, with significant heterogeneity. The Middle East reports a higher prevalence of 6.0%, while Latin America, India, and Canada exhibit a lower prevalence of 1.0%. High-quality studies demonstrate 2% prevalence, while moderate-quality studies report 4.0%. Gender analysis indicates a similar incidence for females and males at 3.0%. Prevalence varies with study design: case-control studies report 4.0%, cross-sectional studies report 2.0%, and prospective cohort studies report 2.0%. CONCLUSIONS: Duodenal atresia is common in Down syndrome patients, affecting 3.0% of the patients worldwide. Regional variations exist, necessitating further investigation. Gender does not significantly impact prevalence. This study highlights the need for region-specific research to enhance clinical decision-making for individuals with Down syndrome and duodenal atresia.
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