Journal of Pediatric Surgery Open最新文献

{"title":"Laparoscopic total proctocolectomy and ileal pouch-anal anastomosis in one or more stages in Familial Adenomatous Polyposis: A single center's experience","authors":"Paula Lorena Roumieu,&nbsp;Juan Siffredi,&nbsp;Victor Di Benedetto,&nbsp;María Marcela Bailez","doi":"10.1016/j.yjpso.2025.100202","DOIUrl":"10.1016/j.yjpso.2025.100202","url":null,"abstract":"<div><h3>Introduction</h3><div>Laparoscopic total proctocolectomy (LTPC) and ileal pouch-anal anastomosis (IPAA) is our first choice for the treatment of Familial Adenomatous Polyposis (FAP). The surgeries were planned in one or multiple stage procedures depending on the clinical condition and intraoperative evaluation of the patient. We present our experience in the last 9 years comparing single and staged procedures.</div></div><div><h3>Methods</h3><div>The medical records of patients with FAP treated between 2014 and 2023 were analyzed. The surgical indication was agreed upon by an interdisciplinary committee according to the clinical management guidelines for FAP. The surgical technique used had been previously presented. Patients were divided into 3 groups (G) according to the number of surgical stages and compared operative time, initiation of oral feeding, hospital stay, perioperative morbidity and long-term functional outcomes.</div></div><div><h3>Results</h3><div>19 patients with a mean age of 12.7 years were included: Eight were treated in one stage (G1), 5 in two (G2) and 6 in three or more (G3). Operative time in G1, G2 and G3 was 386.3, 384.6 and 270.5 mins respectively. Initiation of oral feeding was 5.5 days in G1, 5.0 in G2 and 5.5 in G3. The median hospital stay in the first stage was 15.5 days in G1, 8 days in G2 and 22 days in G3. Early complications included anastomotic dehiscence, operative site infection, and intra-abdominal collection, and late complications included intestinal occlusion and anastomotic stricture. The average follow-up was 26 months. All patients are continent. Ten are on a hypofermentative diet and 4 of them use loperamide.</div></div><div><h3>Discussion</h3><div>LTPC / IPAA is a proven method for the treatment of FAP in the pediatric age, safe and reproducible. Non-significant difference between group 1 and 2 concluded that procedure without protective ileostomy is not associated with greater morbidity. A multidisciplinary team is required as well as advanced laparoscopic training.</div></div>","PeriodicalId":100821,"journal":{"name":"Journal of Pediatric Surgery Open","volume":"10 ","pages":"Article 100202"},"PeriodicalIF":0.0,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143420197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effectiveness of per-oral carbohydrate and electrolyte solution for enhanced recovery after surgery (ERAS) in pediatric surgery: A randomized clinical trial","authors":"Andi Ade Wijaya Ramlan ,&nbsp;Christopher Kapuangan ,&nbsp;Raihanita Zahra ,&nbsp;Rahendra Rahendra ,&nbsp;Komang Ayu Ferdiana ,&nbsp;Titis Prawitasari ,&nbsp;Willy Yant Kartolo ,&nbsp;Ivana Firman ,&nbsp;Andana Haris ,&nbsp;Nathasha Brigitta Selene","doi":"10.1016/j.yjpso.2025.100200","DOIUrl":"10.1016/j.yjpso.2025.100200","url":null,"abstract":"<div><h3>Introduction</h3><div>Preoperative fasting in children is necessary to prevent aspiration pneumonia, but prolonged fasting can lead to hypoglycemia, dehydration, electrolyte imbalance, and postoperative nausea and vomiting (PONV). Preoperative carbohydrate loading, part of Enhanced Recovery After Surgery (ERAS), may alleviate discomfort and improve recovery.</div></div><div><h3>Methods</h3><div>This controlled trial randomized 137 children aged 1 to 12 years undergoing elective surgery lasting &lt;6 h into two groups: Carbohydrate-Electrolyte (CE) fluid (<em>n</em> = 67) and clear water (CW) (<em>n</em> = 70). Participants received 50 mL/kg of the assigned fluid following the standard 6–4–1 fasting regimen (solid food, breast milk, clear fluids). Primary outcomes included comparisons of blood glucose and electrolyte levels before and after induction. Secondary outcomes assessed preoperative anxiety, thirst, hunger, PONV, emergence delirium (ED), and pain scores.</div></div><div><h3>Results</h3><div>Blood glucose levels remained within normal limits with no significant differences between groups (<em>p</em> &gt; 0.05), with the CW group exhibiting lower mean glucose levels. Electrolyte levels were similar across groups. Preoperative anxiety, hunger, and postoperative pain showed no significant differences, while preoperative thirst was higher in the CW group (<em>P</em> = 0.040). ED occurred in 5.9 % of patients, with significantly lower scores in the CE group (<em>P</em> = 0.010). Postoperative nausea was more prevalent in the CW group (19.1 %) compared to the CE group (6 %) (<em>P</em> = 0.036).</div></div><div><h3>Conclusion</h3><div>Preoperative CE fluid administration stabilizes blood glucose and electrolyte levels while reducing preoperative thirst, postoperative nausea, and potentially ED compared to CW. These indicate that CE fluids may improve perioperative comfort and outcomes in pediatric patients.</div></div>","PeriodicalId":100821,"journal":{"name":"Journal of Pediatric Surgery Open","volume":"10 ","pages":"Article 100200"},"PeriodicalIF":0.0,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143454650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modified iris system: initial experience with a new technology for safety in hiatal surgery in pediatric patients","authors":"Joel Cazares ,&nbsp;Eduardo De la Rosa-Bustamante ,&nbsp;Jorge Colín-Garnica ,&nbsp;Arturo Guillen-Cárdenas ,&nbsp;Marbella Sepulveda-Valenzuela ,&nbsp;Miguel Torres-Salas ,&nbsp;Jorge Alberto Cantú-Reyes","doi":"10.1016/j.yjpso.2025.100201","DOIUrl":"10.1016/j.yjpso.2025.100201","url":null,"abstract":"<div><h3>Purpose</h3><div>We present our initial experience with a modified IRIS U-kit system (MIUS) (Stryker, USA) for real-time esophageal visualization during Nissen fundoplication (NF) surgery in pediatric patients, aiming to enhance safety and reduce complications, especially in cases involving esophageal dysmotility and neurological impairments.</div></div><div><h3>Methods</h3><div>A retrospective, experimental study from April to June 2023 including patients with Gastroesophageal Reflux Disease (GERD). The IRIS U-kit, originally designed for urology, was adapted to aid esophageal visualization. This system utilized an illuminated ureteral stent with optical fibers inserted into a feeding tube (bougie).</div></div><div><h3>Results</h3><div>Five pediatric patients with an average age of 6.2 years successfully underwent laparoscopic NF. Three patients had neurological impairments, one had trisomy 21, and one had no neurological issues. Using MIUS enabled real-time esophageal visualization throughout the surgery, even in challenging areas affected by periesophagitis. No complications were reported. All NF procedures, with or without additional interventions like gastrostomy and pyloroplasty, were completed safely.</div></div><div><h3>Discussion</h3><div>NF surgery in pediatric patients, especially those with neurological impairments, poses risks of complications including perforations. Real-time esophageal visualization using the MIUS proved valuable in enhancing surgical safety, preventing complications and as an educational tool for resident training.</div></div><div><h3>Conclusions</h3><div>The MIUS demonstrated feasibility and safety in NF surgery for pediatric patients, even in cases with esophageal dysmotility and neurological impairments without using endoscopy. This innovative approach has the potential to be applied in reoperations, Heller myotomies, and esophageal atresias. To our knowledge, this is the first successful use of the IRIS system in non-urological patients.</div></div>","PeriodicalId":100821,"journal":{"name":"Journal of Pediatric Surgery Open","volume":"10 ","pages":"Article 100201"},"PeriodicalIF":0.0,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143350377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Variations in pediatric intussusception management and outcomes across Aotearoa New Zealand: A national multicenter retrospective study","authors":"Brodie M. Elliott ,&nbsp;Georges K. Tinawi ,&nbsp;Jonathan M. Wells ,&nbsp;Shona Naera ,&nbsp;Andrew Weston ,&nbsp;Jacqueline Copland ,&nbsp;Shirin Gosavi ,&nbsp;Kristine Jung ,&nbsp;Udaya Samarakkody ,&nbsp;Samuel Haysom ,&nbsp;Rieke L. Meister ,&nbsp;Christopher I. Cassady ,&nbsp;Stephen Evans","doi":"10.1016/j.yjpso.2025.100198","DOIUrl":"10.1016/j.yjpso.2025.100198","url":null,"abstract":"<div><h3>Introduction</h3><div>Intussusception is a relatively common pediatric surgical pathology, but no standardized management guideline exists in Aotearoa New Zealand (AoNZ). We therefore aimed to conduct a national audit of intussusception management across AoNZ and describe any practice variations.</div></div><div><h3>Methods</h3><div>We performed a national 15-year retrospective, multicenter cohort study of all children treated for intussusception between 01 Jan 2007 and 01 Jan 2022 across AoNZ. We analyzed clinical and radiological data to determine inter-center variation, including treatment intent, subsequent management, and success rates.</div></div><div><h3>Results</h3><div>Six hospitals managed 529 children with intussusception. The median age at presentation was ten months (1m – 14.9y). Primary enema reduction was attempted in 88.5 % of cases, varying from 80 – 100 %. After post hoc exclusion of cases requiring resection, there was significant variation in enema reduction success (58.8 % – 100 %; <em>p</em> &lt; 0.001). The overall general anesthesia rate was 36 % (8 – 46 %), mostly from secondary operative management after failed enema reduction (8 – 38 %). Delay to enema reduction &gt;48 h was associated with a lower success rate (60.5 % vs 79.7 %; <em>p</em> &lt; 0.001) and with all four perforations (0.9 %). Enema success was more dependent on the prehospital duration of symptoms (25.8 h vs. 46.8 h; <em>p</em> &lt; 0.001) and prehospital transfer (68.7 % vs. 78.4 %; <em>p</em> = 0.012) than in-hospital delay to reduction (3.4 h vs. 3.6 h; <em>p</em> = 0.79).</div></div><div><h3>Conclusions</h3><div>We demonstrated a wide range of enema reduction success rates and subsequent operative management requirements across AoNZ. Prehospital delay in treatment was associated with the failure of enema reduction. Investigation into enema reduction practices and subsequent national care standardization is urgently recommended.</div></div>","PeriodicalId":100821,"journal":{"name":"Journal of Pediatric Surgery Open","volume":"10 ","pages":"Article 100198"},"PeriodicalIF":0.0,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143132148","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating intranasal sufentanil-ketamine for preoperative sedation in children: A case-control study","authors":"Abbas Ostadalipour ,&nbsp;Saghar Samimi ,&nbsp;Bita MalekianZadeh ,&nbsp;Nima Nazari ,&nbsp;Ebrahim Espahbodi ,&nbsp;Maziar Maghsoudloo ,&nbsp;Vina Goudarzi ,&nbsp;Parisa Kianpour ,&nbsp;Shahram Samadi ,&nbsp;Farhad Etezadi","doi":"10.1016/j.yjpso.2024.100190","DOIUrl":"10.1016/j.yjpso.2024.100190","url":null,"abstract":"<div><h3>Background</h3><div>Hospitalization and surgical procedures can cause significant emotional distress in children aged 3 to 7. This study aimed to assess the efficacy and safety of intranasal (IN) sufentanil-ketamine (SK) for preoperative sedation and evaluate parental satisfaction scores in children undergoing strabismus surgery under general anesthesia.</div></div><div><h3>Method</h3><div>This observational case study included sixty children aged 3 to 7 years with ASA physical status I/II at Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran. Participants were divided into two groups: those receiving IN SK group and those not receiving pre-anesthetic sedation (C group). The SK group received 0.5 µg/kg sufentanil and 0.5 mg/kg ketamine intranasally 20 min before anesthesia. Heart rate (HR), systolic blood pressure (SBP), and oxygen saturation (SpO2) were recorded at baseline and 15 min post-intervention. Sedation levels were assessed using the University of Michigan Sedation Scale (UMSS), and parental separation anxiety was evaluated using the Parental Separation Anxiety Scale (PSAS).</div></div><div><h3>Results</h3><div>There were no significant differences in demographics or baseline HR, SBP, and SpO2 between groups. However, the SK group had significantly higher sedation levels (<em>P</em> &lt; 0.001), with 83.4 % achieving satisfactory sedation compared to none in the C group. The SK group also had significantly more favorable parental separation scores (<em>P</em> = 0.001). Side effects were minimal, with nausea and vomiting in only one patient (3.3 %) in the SK group.</div></div><div><h3>Conclusion</h3><div>IN SK is effective and safe for preoperative sedation in children undergoing strabismus surgery. It provides satisfactory sedation and facilitates easier separation from parents with minimal side effects, making it a viable alternative for pediatric pre-anesthetic sedation.</div></div>","PeriodicalId":100821,"journal":{"name":"Journal of Pediatric Surgery Open","volume":"10 ","pages":"Article 100190"},"PeriodicalIF":0.0,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143132082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analgesia in pediatric abdominal surgery","authors":"Jan Geudens ,&nbsp;An Teunkens","doi":"10.1016/j.yjpso.2025.100199","DOIUrl":"10.1016/j.yjpso.2025.100199","url":null,"abstract":"<div><div>Adequate analgesia is a key component of pediatric abdominal surgery. Multimodal analgesia, using different pharmacological products and locoregional techniques, is increasingly used in clinical practice.</div><div>This study aims to provide a clear overview of the different modalities used in abdominal surgery in the pediatric population. We conducted a literature review in which relevant articles, which focused on the efficacy, side effects, and locoregional techniques of pharmacological products, were included and analyzed.</div><div>The combined use of classic analgesics (such as paracetamol and nonsteroidal anti-inflammatory drugs) or alpha-2 agonists together with opioids can ensure lower opioid use, which in turn reduces the risk of adverse effects. Various locoregional techniques, particularly the transversus abdominis plane block and quadratus lumborum block, have also been shown to be effective in abdominal surgery in the pediatric population. Age-specific differences in analgesic use were investigated, with the importance of correct weight-based dosing and proper monitoring of vital parameters being particularly crucial. Further research focusing on specific surgical procedures could identify the most indicated technique.</div><div>In conclusion, sufficient evidence supports the use of multimodal analgesia as the standard approach in pediatric abdominal surgery.</div></div>","PeriodicalId":100821,"journal":{"name":"Journal of Pediatric Surgery Open","volume":"10 ","pages":"Article 100199"},"PeriodicalIF":0.0,"publicationDate":"2025-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143132083","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prepubertal testicular tumors: Clinical characteristics and indications for testis-sparing surgery in a multicenter retrospective study","authors":"Shojiro Hanaki ,&nbsp;Shuichi Katayama ,&nbsp;Yasuo Nakahara ,&nbsp;Soichi Nakada ,&nbsp;Kohsuke Hitomi ,&nbsp;Takeshi Asai ,&nbsp;Shuichi Ishibashi ,&nbsp;Tsutomu Kanagawa ,&nbsp;Koji Aoyama","doi":"10.1016/j.yjpso.2025.100197","DOIUrl":"10.1016/j.yjpso.2025.100197","url":null,"abstract":"<div><h3>Objectives</h3><div>We aimed to clarify the characteristics of prepubertal testicular tumors and evaluate the suitability of testis-sparing surgery (TSS) for benign prepubertal testicular tumors, with a focus on clinical outcomes and tumor-specific factors that influence treatment decisions.</div></div><div><h3>Methods</h3><div>A retrospective study was conducted involving 34 patients under 14 years of age who were treated for testicular tumors at five institutions from 2001 to 2021. Clinical parameters were compared between benign and malignant groups, and additional parameters, such as testicular volume, tumor volume, and tumor volume ratio, were analyzed within the benign group.</div></div><div><h3>Results</h3><div>There were 18 cases in the benign group and 16 in the malignant group. The maximal tumor diameter was significantly larger in the malignant group (2.0 cm vs. 3.5 cm, <em>p</em> = 0.006). In the benign group, all cases in the TSS group had a tumor volume ratio &lt; 70 % and a maximal tumor diameter ≤ 2 cm (<em>p</em> = 0.006). No cases of testicular atrophy or recurrence were observed during a median follow-up of 60 months in the benign group.</div></div><div><h3>Conclusions</h3><div>TSS is a feasible option for benign prepubertal testicular tumors with favorable preoperative evaluation results, offering preservation of testicular function without compromising oncological safety. Parameters such as a maximal tumor diameter ≤ 2 cm and a tumor volume ratio &lt; 70 % may help determine the suitability of TSS and support clinical decision-making in pediatric testicular surgery.</div></div>","PeriodicalId":100821,"journal":{"name":"Journal of Pediatric Surgery Open","volume":"10 ","pages":"Article 100197"},"PeriodicalIF":0.0,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143132154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validation of the paediatric appendicitis risk calculator (pARC) in an Australian emergency department setting","authors":"Alexander Howes ,&nbsp;Sanjeev Khurana ,&nbsp;Jennie Louise ,&nbsp;Isabella Watts ,&nbsp;Rebecca Linke ,&nbsp;Amit Kochar","doi":"10.1016/j.yjpso.2025.100192","DOIUrl":"10.1016/j.yjpso.2025.100192","url":null,"abstract":"<div><h3>Study objective</h3><div>Our objective is to assess the performance of the Paediatric Appendicitis risk calculator (pARC) in quantifying the risk of appendicitis, in an Australian tertiary emergency department (ED) and to compare its performance with that of the Paediatric Appendicitis Score (PAS) and Alvarado score in predicting risk of appendicitis.</div></div><div><h3>Methods</h3><div>We conducted this prospective, observational cohort study from July 2021 to October 2022 in the Women's and Children's Hospital (WCH) ED in Adelaide, South Australia. Patients aged 5 to 18 presenting with abdominal pain ≤120 h, where appendicitis was a differential diagnosis, were eligible for enrolment. Our primary outcome was the histopathological diagnosis of appendicitis within 14 days of initial presentation. We reported performance characteristics and secondary outcomes by pARC risk strata and compared the receiver operator characteristic (ROC) curves of the PAS, Alvarado and pARC.</div></div><div><h3>Results</h3><div>We enrolled 675 patients with a mean age of 11.93 years, 51 % were female. Appendicitis was histologically diagnosed in 29.33 % of patients, with 13.6 % having perforated appendicitis. 51 % of patients had very low (&lt;5 %) or low (5 % to 14 %) predicted risk, 40.3 % had intermediate risk (15 % to 84 %), and 6.5 % had high risk (&gt;85 %). In the very-low- and low-risk groups, 6.4 % and 11 % of patients had appendicitis, respectively. The AUROC was 0.852 (95 % confidence interval (CI) 0.820 to 0.885) for the pARC compared with 0.80 (95 % CI 0.77 to 0.84) for the PAS, and 0.73 (95 % CI 0.69, 0.78) for Alvarado.</div></div><div><h3>Conclusion</h3><div>The pARC score has been validated as an appendicitis risk calculator which is as reliable as previous studies, in the study population, whilst outperforming the PAS and Alvarado scores.</div></div>","PeriodicalId":100821,"journal":{"name":"Journal of Pediatric Surgery Open","volume":"10 ","pages":"Article 100192"},"PeriodicalIF":0.0,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143132080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Volume-outcome relationship in pediatric blunt liver and spleen injuries: A multicenter retrospective cohort study","authors":"Susumu Matsushime ,&nbsp;Akira Kuriyama ,&nbsp;Morihiro Katsura","doi":"10.1016/j.yjpso.2025.100194","DOIUrl":"10.1016/j.yjpso.2025.100194","url":null,"abstract":"<div><h3>Background</h3><div>The relationship between the number of patients treated in a hospital and patient outcomes (“volume-outcome relationship”) has been reported. We aimed to examine the relationship between hospital case volume and complications, in-hospital mortality, and non-operative management (NOM) failure in pediatric blunt liver and/or spleen injuries (BLSIs).</div></div><div><h3>Methods</h3><div>This was a post-hoc analysis of a multicenter retrospective study that enrolled patients aged ≤16 years admitted for BLSIs with Abbreviated Injury Scale grade of at least ≥1 between January 2008 and December 2019. Participating hospitals were categorized into three groups of 33 % each, according to the annual pediatric trauma case volume. We used the Cochrane-Armitage test to determine a linear trend between the hospital case volume and each outcome.</div></div><div><h3>Results</h3><div>We identified 1406 patients with BLSIs who were treated at 83 hospitals; 44 (3.1 %) and 12 (0.9 %) patients experienced complications and NOM failure, respectively, with 21 cases (1.5 %) of in-hospital mortality. Hospitals were categorized into high- (28 hospitals), medium- (26 hospitals), and low-volume (29 hospitals) groups. No significant linear trend was observed between hospital volumes and complications (P <em>trend</em>=0.07), in-hospital mortality (P <em>trend</em>=0.67), or NOM failure (P <em>trend</em>=0.57). Sensitivity analyses using different group categorizations provided similar findings.</div></div><div><h3>Conclusions</h3><div>This study failed to confirm a volume-outcome relationship between annual pediatric trauma case volume and complications, in-hospital mortality, or NOM failure in pediatric BLSIs in Japan. The limited exposure of Japanese hospitals to pediatric trauma, lack of a system to certify pediatric trauma centers, and practice variations across hospital types potentially underlie these findings.</div></div>","PeriodicalId":100821,"journal":{"name":"Journal of Pediatric Surgery Open","volume":"10 ","pages":"Article 100194"},"PeriodicalIF":0.0,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143132081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Open versus thoracoscopic approach in the surgical treatment of congenital pulmonary airway malformations: A retrospective cross-sectional analysis and review","authors":"Jean Dai ,&nbsp;Jesse York ,&nbsp;Baylor Schexnayder ,&nbsp;Frankie Fike","doi":"10.1016/j.yjpso.2025.100193","DOIUrl":"10.1016/j.yjpso.2025.100193","url":null,"abstract":"<div><h3>Introduction</h3><div>Congenital pulmonary airway malformations (CPAMs) are rare developmental lung abnormalities that often require surgical intervention. This study aimed to compare resource utilization and in-hospital outcomes between open thoracotomy and thoracoscopic approaches for CPAM treatment.</div></div><div><h3>Methods</h3><div>We used the Kids' Inpatient Database (KID), the largest publicly available all-payer pediatric inpatient care registry, to identify patients under 20 years old who were treated with elective surgery for CPAM in 2016 and 2019. Patients were categorized into open thoracotomy or thoracoscopic groups based on International Classification of Disease, Tenth Revision (ICD-10) procedure codes. We analyzed differences in demographic characteristics, complications, total cost of stay, and length of hospital stay between the two groups.</div></div><div><h3>Results</h3><div>The study included 749 patients (436 thoracoscopic, 313 open). Demographic analysis revealed significant differences in sex distribution (<em>p</em> = 0.028) and race (<em>p</em> &lt; 0.001) between groups. The mean age was similar (thoracoscopic: 1.2 years, open: 1.7 years; <em>p</em> = 0.059). Complications were not significantly different between approaches. The thoracoscopic approach was associated with lower mean total cost of stay ($74,719 vs. $82,146; <em>p</em> = 0.037) and shorter mean length of stay (3.1 vs. 4.5 days; <em>p</em> &lt; 0.001) compared to the open approach (Table 1).</div></div><div><h3>Conclusion</h3><div>This study suggests that the thoracoscopic approach for CPAM treatment may offer advantages in terms of reduced hospital costs and shorter length of stay without significantly increasing complication rates. These findings could inform clinical decision-making and resource allocation in pediatric surgical care. Further research is needed to assess long-term outcomes and patient-reported measures between these approaches.</div><div>Type of study: retrospective cross-sectional analysis</div><div>Level of evidence: 4</div></div>","PeriodicalId":100821,"journal":{"name":"Journal of Pediatric Surgery Open","volume":"10 ","pages":"Article 100193"},"PeriodicalIF":0.0,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143132147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}