Journal of pediatric surgery最新文献

{"title":"Management and Outcomes of Jejunoileal atresia Within the United Kingdom","authors":"George S. Bethell ,&nbsp;Belinda Hughes ,&nbsp;Roma S. Varik ,&nbsp;Clara Chong ,&nbsp;Nigel J. Hall ,&nbsp;Ancuta Muntean ,&nbsp;Sara Gozzini ,&nbsp;Anas Fagelnor ,&nbsp;Ibrahim Mustafa ,&nbsp;Amir Amin ,&nbsp;Ashwini Joshi ,&nbsp;Riyad Peeraully ,&nbsp;Charlotte Melling ,&nbsp;Eden Cooper ,&nbsp;Ingo Jester ,&nbsp;Amulya Saxena","doi":"10.1016/j.jpedsurg.2025.162334","DOIUrl":"10.1016/j.jpedsurg.2025.162334","url":null,"abstract":"<div><h3>Background</h3><div>Jejunoileal atresia (JIA) is seen in 0.7 per 10,000 births and requires early surgical intervention to restore gastrointestinal continuity. Many intra-operative techniques exist to manage the atresia depending on anatomy encountered and proximal bowel dilatation. Existing studies are predominantly single centre experiences. This study aims to report contemporary management and outcomes of JIA in the United Kingdom (UK) and explore how operative technique is associated with outcome.</div></div><div><h3>Methods</h3><div>Multicentre UK based observational study over 5 years with follow-up to 1 year post surgery. Outcomes were time to full enteral feeds, length of stay, unplanned reoperation, number of general anaesthetics, development of short bowel syndrome and mortality. These outcomes were stratified by infant related, disease related and surgical technique related factors.</div></div><div><h3>Results</h3><div>There were 159 infants with JIA from seven tertiary paediatric surgical units. JIA was suspected antenatally in 92 (57.8 %) infants and associated congenital anomalies were seen in 47 (29.6 %) infants. Age at surgery was 2 (0–70) days and primary anastomosis was undertaken in 114 (71.7 %) procedures most commonly (87.9 %) via end-to-end anastomosis. Primary anastomosis was associated with shorter duration to full enteral feeds (21 vs 60 days, p = 0.001), shorter length of stay (28 vs 78 days, p &lt; 0.001), fewer general anaesthetics (1 vs 3, p &lt; 0.001) and lower mortality (0.9 vs 11.1 %, p = 0.002) than enterostomy formation. Overall, unplanned reoperation was required in 27 (17.0 %) infants primarily for intestinal obstruction (n = 21/27).</div></div><div><h3>Conclusions</h3><div>These data provide contemporary outcomes by atresia type and highlight obstructive complications are frequent in this cohort. These data support primary anastomosis in JIA.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 7","pages":"Article 162334"},"PeriodicalIF":2.4,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143882103","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adolescent and Parent Perceptions of the American College of Surgeons Safe and Effective Pain Control Brochure","authors":"Marjorie N. Odegard ,&nbsp;Rachel C. Ceasar ,&nbsp;Adaeze U. Obinelo ,&nbsp;Donia N. Hijaz ,&nbsp;Alvina Rosales ,&nbsp;Sumeet K. Bhanvadia ,&nbsp;Matthew Kirkpatrick ,&nbsp;Eugene Kim ,&nbsp;Lorraine I. Kelley-Quon","doi":"10.1016/j.jpedsurg.2025.162331","DOIUrl":"10.1016/j.jpedsurg.2025.162331","url":null,"abstract":"<div><h3>Objective</h3><div>The <em>American College of Surgeons Safe and Effective Pain Control After Surgery for Children and Teens</em> brochure highlights the risks of prescription opioid use for adolescents undergoing surgery and outlines safe use, storage, and disposal principles. Understanding how diverse patient populations use this brochure will enable providers to deliver guideline-consistent opioid education. In this study, we solicited feedback about the brochure from adolescents who underwent surgery and their parents.</div></div><div><h3>Methods</h3><div>We recruited adolescents aged 13–20 years who underwent surgeries commonly associated with opioid prescriptions and their parents from a previous longitudinal survey-based cohort study measuring postoperative opioid use. Recruitment was balanced for race/ethnicity, health literacy, and language preference. We held four virtual focus groups that included English-speaking adolescents, adolescents who spoke Spanish at home, parents who preferred participation in English, and parents who preferred to participation in Spanish (n = 15). Qualitative thematic analysis of the groups’ feedback was performed.</div></div><div><h3>Results</h3><div>Parents desired more procedure-specific guidance on administering opioids and more explicit directions about managing medication side effects. Adolescent participants reported that the phrasing of the brochure left them feeling alienated from its content. Both groups noted that the layout was lengthy, lacked representative images, and emphasized addiction and overdose risks to the point of making them question taking opioids at all. Finally, participants expressed learning new information about safe prescription opioid storage and disposal.</div></div><div><h3>Conclusions</h3><div>Adolescents undergoing surgery and their parents want a brief pain control brochure that contains actionable instructions regarding opioid side effects, is adolescent- and family-centered, and optimizes visual information.</div></div><div><h3>Type of Study</h3><div>Qualitative Focus Group.</div></div><div><h3>Level of Evidence</h3><div>Level 5.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 7","pages":"Article 162331"},"PeriodicalIF":2.4,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143878455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Study on the Outcome of Laparoscopic-assisted 2 Stage and 3 Stage Anorectoplasty","authors":"Haoyuan Zhang ,&nbsp;Jingmin Zhang ,&nbsp;Yan Zhou ,&nbsp;Long Li","doi":"10.1016/j.jpedsurg.2025.162326","DOIUrl":"10.1016/j.jpedsurg.2025.162326","url":null,"abstract":"<div><h3>Background</h3><div>The treatment of anorectal malformations (ARM) with laparoscopic-assisted anorectoplasty (LAARP) and concurrent colostomy closure remains contentious. This study sought to examine the mid-term outcomes of 2 stage and 3 stage LAARP.</div></div><div><h3>Methods</h3><div>This study encompassed 251 children who received LAARP at our center from June 2007 to December 2019; 32 children underwent 2 stage LAARP, while the remaining 219 children underwent 3 stage LAARP. A 1:4 propensity score matching (PSM) post hoc comparison was conducted between the two groups regarding complications and mid-term bowel function.</div></div><div><h3>Results</h3><div>Following PSM, 26 and 83 patients were incorporated into the two groups, exhibiting no significant differences in baseline data (P &gt; 0.05). The complication rate was greater in the 2 stage group compared to the 3 stage group (P = 0.002), and the occurrence of rectal prolapse was different between the two groups (50.0 % vs. 15.7 %, P = 0.000). The overall cost of the 2 stage group was comparable to that of the 3 stage group (Ɏ69,390 vs. Ɏ67,458, P = 0.697). The total postoperative hospitalization was identical across the two groups (P = 0.633). The median follow-up ages were 7.07 years and 5.97 years, respectively, with no significant difference in BFS (P = 0.730) or distribution between the two groups (P = 0.193). No difference in modified Krickenbeck scores after 3 months of bowel management (P = 0.569).</div></div><div><h3>Conclusions</h3><div>The 2 stage LAARP surgery of ARMs did not yield cost savings, decrease postoperative hospitalization, or enhance prognosis, while simultaneously elevating the occurrence of postoperative rectal prolapse and familial burden.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 7","pages":"Article 162326"},"PeriodicalIF":2.4,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143851596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laparoscopic-assisted Polypectomy: A Promising Minimally-invasive Solution for Endoscopically Irresectable Polyps in Children","authors":"Ayman Goneidy ,&nbsp;Andrew R. Ross ,&nbsp;Rebecca Roberts ,&nbsp;Warren Hyer ,&nbsp;Muhammad Choudhry","doi":"10.1016/j.jpedsurg.2025.162329","DOIUrl":"10.1016/j.jpedsurg.2025.162329","url":null,"abstract":"<div><h3>Aim of the study</h3><div>Small and large bowel polyps are commonly associated in children with Peutz-Jeghers syndrome (PJS) and juvenile polyposis Syndrome (JPS). A promising technique was described to identify polyps' locations laparoscopically without the need for concurrent endoscopy or digital palpation. The aim of this study is to report one center's experience in applying this laparoscopic-assisted polypectomy technique (LAPT).</div></div><div><h3>Methods</h3><div>Prospective review of patients’ records was performed for patients &lt;18 years who underwent LAPT in a tertiary center over a 13-year period. Data collected included demographics, Diagnosis, post-operative complications, histopathology and follow-up. Patients &gt;18 years and/or those who had endoscopic polypectomy were excluded.</div></div><div><h3>Main results</h3><div>Seventeen patients underwent 19 LAPs between 2011 and 2024 at a Median age of 12 years. M:F = 3:14. Fourteen patients presented with PJS and 3 presented with JPS. All Patients underwent endoscopic assessment and were considered unsuitable for advanced-skill polypectomy based on size, location or risk of perforation from invaginated muscularis mucosa. LAPT was performed in 15 patients and laparoscopic-assisted right hemicolectomy in 2 presenting with cecal polyps. Polyps were easily identified intra-operatively with associated serosal indentation or previous tattooing. There were no conversions to open. Histopathology was benign, except in one JPS patient who had Tubulo-villous adenoma. Median hospital stay was 5 days. Patients were followed-up 6–8 weeks post-operatively and had no late complications.</div></div><div><h3>Conclusions</h3><div>LAPT is efficient and safe for excision of intestinal polyps that have a higher perforation risk if removed endoscopically. It eliminates the need for concurrent endoscopy or digital palpation.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 7","pages":"Article 162329"},"PeriodicalIF":2.4,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143842734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term Outcomes of Multi-institutional Minimally Invasive Appendiceal Onlay Ureteroplasty for Managing Complex Proximal Ureteral Strictures in Pediatric Patients","authors":"Hualin Cao ,&nbsp;Yangyang Wu ,&nbsp;Pin Li ,&nbsp;Xiaoyu Yi ,&nbsp;Xiaowei Zhang ,&nbsp;Hongshuai Jia ,&nbsp;Ruyue Jin ,&nbsp;Xiangling Deng ,&nbsp;Tian Tao ,&nbsp;Lifei Ma ,&nbsp;Xiaoguang Zhou ,&nbsp;Nini An ,&nbsp;Yanfang Yang ,&nbsp;Jianpeng Bi ,&nbsp;Qian Zhang ,&nbsp;Ji Li ,&nbsp;Yun Zhou ,&nbsp;Can Qi ,&nbsp;Jiawen Zhao ,&nbsp;Bowen Liu ,&nbsp;Huixia Zhou","doi":"10.1016/j.jpedsurg.2025.162316","DOIUrl":"10.1016/j.jpedsurg.2025.162316","url":null,"abstract":"<div><h3>Purpose</h3><div>We report the long-term outcomes of laparoscopic and robotic-assisted appendiceal onlay ureteroplasty (AOU) for complex proximal ureteral (CPU) strictures in children across multiple institutions.</div></div><div><h3>Methods</h3><div>Retrospective review of patients who underwent laparoscopic or robotic AOU for CPU between 2010 and 2020. Patient characteristics, perioperative surgical data, and follow-up data are described. The surgical approach was adjusted to the stricture length and location, involving a ventral incision or excision of the diseased ureter followed by repair with an onlay appendiceal flap. Success was established by the presence of symptomatic relief and the absence of obstruction on imaging assessments.</div></div><div><h3>Results</h3><div>Twenty-nine patients underwent minimally invasive AOU of CPU (12 laparoscopy, 17 robot-assisted). The median age at surgery was 48 months (IQR, 36.5–69.0). The median stricture length measured 4.0 cm (IQR, 3.3–5.0), operative time was 162.0 min (IQR, 137.0–178.0), and estimated blood loss was 25.0 ml (IQR, 20.0–30.0). No open conversions and intraoperative complications occurred. Ventral-side onlay ureteroplasty was performed in 14 (48.3 %) patients (including two onlay augmented pyeloplasty) and Dorsal-side reconstruction ureteroplasty was performed in 15 (51.7 %) patients. Overall, 18 patients had grade Ⅰ or Ⅱ Clavien-Dindo postoperative complications and one patient developed a grade Ⅲ complication. Surgical success was achieved in 28/29 (96.6 %) patients at a median follow-up of 6.0 years (IQR, 5.0–7.5).</div></div><div><h3>Conclusion</h3><div>Minimally invasive AOU is a safe, feasible, and effective technique for managing CPU strictures in children with good long-term outcomes.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 7","pages":"Article 162316"},"PeriodicalIF":2.4,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143843766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Immunosuppression on Complication Rates in Pediatric Gastrostomy Tube Placement","authors":"Faraz N. Longi ,&nbsp;Michela Carter ,&nbsp;Audra J. Reiter ,&nbsp;Lav Patel ,&nbsp;Mehul V. Raval ,&nbsp;Timothy B. Lautz","doi":"10.1016/j.jpedsurg.2025.162324","DOIUrl":"10.1016/j.jpedsurg.2025.162324","url":null,"abstract":"<div><h3>Introduction</h3><div>Immunosuppressed children are vulnerable to post-operative complications. The purpose of this study is to determine if children who are immunosuppressed at gastrostomy tube (G-tube) placement experience higher rates of post-operative complications than children with normal immune function.</div></div><div><h3>Methods</h3><div>Children ≤18 years-old who underwent G-tube placement at a high-volume tertiary children's hospital between June 2019–April 2022 were retrospectively identified. Patients who received chemotherapy or post-transplantation immunosuppressive therapy ≤3 months before or 30 days after G-tube placement were identified as the immunosuppressed cohort and 30-day postoperative complication rates were compared. Subset analysis was performed for immunosuppressed children who were neutropenic in the perioperative period.</div></div><div><h3>Results</h3><div>Thirty-one (5.6 %) of 553 children who underwent G-tube placement were immunosuppressed. Immunosuppressed patients were older (median [IQR] 48 [19–156] months vs. 9 [4–31] months, p &lt; 0.001). The majority underwent laparoscopic placement (71.1 %). There were significantly more PEG placements in the immunosuppressed cohort (22.6 % vs. 4.4 %, p &lt; 0.001). There was no difference in 30-day complication rate between the immunosuppressed and immunocompetent cohorts (29.0 % vs. 34.5 %, p = 0.53); however, there was a higher rate of return to OR for the immunosuppressed cohort (9.7 % vs. 2.7 %, p = 0.03). Subset analysis of the high-risk neutropenic subgroup (n = 13, 41.9 %) revealed no difference in complication rates compared to the non-neutropenic immunosuppressed subgroup.</div></div><div><h3>Conclusion</h3><div>G-tube placement in immunosuppressed patients, including those with perioperative neutropenia, appears to be safe with a comparable safety profile to G-tube placement in children with normal immune function, with the exception of a higher rate of return to the OR within 30 days.</div></div><div><h3>Study type</h3><div>Treatment study.</div></div><div><h3>Level of evidence</h3><div>Level III.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 7","pages":"Article 162324"},"PeriodicalIF":2.4,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143848633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implications of Isolated Free Fluid in Pediatric Trauma Patients","authors":"Robert Nelson,&nbsp;Stephanie Carmichael,&nbsp;Susan Taylor,&nbsp;Kristopher Lewis","doi":"10.1016/j.jpedsurg.2025.162328","DOIUrl":"10.1016/j.jpedsurg.2025.162328","url":null,"abstract":"<div><h3>Purpose</h3><div>The imaging finding of isolated free fluid in pediatric trauma patients is of unclear clinical significance. The study's purpose was to identify discriminatory features of isolated free fluid to determine which characteristics justify conservative management versus those concerning for radiologically occult injury, using a retrospective cohort study. We hypothesize that if free intraabdominal fluid is identified as an isolated finding in pediatric trauma patients by CT evaluation, then higher volume of fluid, fluid in more anatomic spaces, and more complex fluid may indicate a higher likelihood of an injury requiring surgical intervention.</div></div><div><h3>Materials and methods</h3><div>A retrospective cohort study was performed on 100 pediatric trauma patients with CT evidence of isolated free fluid between 2007 through 2020. Philips Tumor Tracker was used to determine fluid volume and density. Patients were divided into two groups: those without intraoperative evidence of injury (n = 93) and those with intraoperative evidence of injury (n = 7). Fluid volume, density, and pockets of fluid were compared between groups.</div></div><div><h3>Results</h3><div>Fluid volume, density, and number of fluid pockets were all statistically significantly different (p &lt; 0.05). Average fluid volume was 4 ± 6 mL in non-injured patients and 31 ± 29 mL in injured patients. The highest density fluid collection was 13 ± 10 HU in non-injured patients and 40 ± 12 HU in injured patients. Specifically, a cutoff value of 5 mL had 100 % negative predictive value. 96 % of non-injured patients had free fluid in only one location, while 85 % of injured patients had fluid in multiple locations. All of the injured patients had fluid pockets other than or in addition to the pelvis. Additionally, fluid in the central mesentery was found only in injured patients.</div></div><div><h3>Conclusion</h3><div>Small volume, simple fluid in the pelvis of pediatric male or premenstrual female patients should not raise concern for underlying injury, even in a trauma setting.</div></div><div><h3>Type of study</h3><div>Retrospective cohort study.</div></div><div><h3>Level of evidence</h3><div>Level III.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 7","pages":"Article 162328"},"PeriodicalIF":2.4,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143858784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postnatal Clinical Features and Surgical Strategies of Gastrointestinal Tract Duplications Diagnosed Prenatally","authors":"Linyan Wang ,&nbsp;Shuhao Zhang ,&nbsp;Meiyan Wang ,&nbsp;Yi Chen ,&nbsp;Yunzhong Qian ,&nbsp;Qingjiang Chen ,&nbsp;Zhigang Gao","doi":"10.1016/j.jpedsurg.2025.162325","DOIUrl":"10.1016/j.jpedsurg.2025.162325","url":null,"abstract":"<div><h3>Background</h3><div>There are few studies on systematic analysis of gastrointestinal tract (GIT) duplications diagnosed prenatally. This study aimed to investigate the postnatal clinical characteristics and surgical strategies of patients with GIT duplications diagnosed prenatally by analyzing the clinical data before and after delivery.</div></div><div><h3>Methods</h3><div>A retrospective study was performed on the clinical data of GIT duplications diagnosed prenatally who underwent surgery at our hospital from January 2016 to December 2023. We classified the patients into two groups, the asymptomatic (66 cases) and symptomatic group (16 cases), and compared them.</div></div><div><h3>Results</h3><div>A total of 82 patients were included. All cases were first prenatally diagnosed by ultrasound, with a median gestational age of 24 weeks, and 98.8 % of cases occurred in the second and third trimesters. The ileocecal region (50 %) was the most common site, followed by ileum, stomach, esophagus, duodenum, jejunum and colon. The median time of onset of symptoms was 0.6 months, with 56.3 % in the neonatal period. The complications included obstruction in 15 cases (93.8 %), infection in 3 cases (18.8 %) and perforation in 1 case (6.3 %). Thirty-eight (46.3 %) patients were complicated with other congenital anomalies, among which cardiac anomalies were the most common. The symptomatic group was treated earlier, the proportion of intraluminal type was higher, and the cyst diameter was significantly larger than the asymptomatic group. The proportion of open procedure was significantly higher in the symptomatic group, and the postoperative fasting time and hospital stay were longer. The incidence of complications and open procedure were higher in patients younger than 3 months.</div></div><div><h3>Conclusion</h3><div>Obstruction was the most common complication in prenatally diagnosed GIT duplication, and mostly occurred in neonatal period. Symptomatic patients need early intervention, asymptomatic patients can be closely observed and delayed resection, cyst diameter greater than 30 mm or intraluminal type can be considered early resection.</div></div><div><h3>Type of study</h3><div>Retrospective Comparative Study.</div></div><div><h3>Level of evidence</h3><div>Level III.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 7","pages":"Article 162325"},"PeriodicalIF":2.4,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lower Childhood Opportunity Index is Associated with Delayed Diagnosis of Anorectal Malformations.","authors":"Kristine L Griffin, Shruthi Srinivas, Megan A Read, Jeremy M Lun, Alessandra C Gasior, Richard J Wood, Ihab Halaweish","doi":"10.1016/j.jpedsurg.2025.162321","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2025.162321","url":null,"abstract":"<p><strong>Purpose: </strong>Delay in diagnosis of anorectal malformations (ARM) can potentially lead to adverse events. Perineal and rectovestibular fistulas are more likely to be missed on exam compared to other ARM subtypes. We aimed to identify which clinical factors and social determinants of health (SDOH) elements may be associated with missed diagnosis of these ARMs.</p><p><strong>Methods: </strong>A retrospective review was performed of all infants with perineal or rectovestibular fistulas seen at a single center from 2014 to 2023. Delayed diagnosis was defined as those made beyond the second day of life. Data were collected regarding birth hospital NICU acuity, location of diagnosis, clinical factors, adverse sequelae, and SDOH, including Child Opportunity Index (COI). Categorical variables were analyzed via Fisher's Exact Test. Ordinal variables were analyzed using Cochran-Armitage Test for Trend.</p><p><strong>Results: </strong>A total of 172 patients were diagnosed with perineal or rectovestibular fistula during the time period, of which 31.9% had delay in diagnosis (Table 1). There was no significant difference in acuity level of the birth hospital, race, ethnicity, insurance type, non-English language preference (NELP), or rural vs. urban setting between delayed and timely diagnosis. As COI increased in the cohort, there was a significant trend toward lower association with delayed diagnosis (Table 1). Those with delayed diagnosis were more likely to present with fecal impaction or have an unplanned pre-operative admission (p<0.001).</p><p><strong>Conclusion: </strong>In this study, patients with lower COI experienced higher likelihood of delayed diagnosis of ARM. Efforts should be made to improve prompt diagnosis in this at-risk population.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"162321"},"PeriodicalIF":2.4,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ovarian Torsion in Prepubertal Girls: Clinical Characteristics, Biological and Radiological Features, Reccurency Rate","authors":"Coralie Defert ,&nbsp;Audrey Cartault ,&nbsp;Aurore Haffreingue ,&nbsp;Pauline Clermidi ,&nbsp;Chloé Lefébure ,&nbsp;Adèle Olland ,&nbsp;Mathilde Glenisson ,&nbsp;Thomas Deleforterie ,&nbsp;Agate Bourg ,&nbsp;Pierre-Louis Vérot ,&nbsp;Elodie Haraux ,&nbsp;Marie Bousquet ,&nbsp;Françoise Schmitt ,&nbsp;Yannis Bonnin ,&nbsp;Mélina Bourezma ,&nbsp;Charlène Messelod ,&nbsp;Manon Zislin ,&nbsp;Olivier Hild ,&nbsp;Jean Breaud ,&nbsp;Alexis Belgacem ,&nbsp;Alexis P. Arnaud","doi":"10.1016/j.jpedsurg.2025.162317","DOIUrl":"10.1016/j.jpedsurg.2025.162317","url":null,"abstract":"<div><h3>Introduction</h3><div>The diagnosis of ovarian torsion is made with delay among pre-pubertal girls and the management after the surgical detorsion is poorly codified. We interested in the French experience during the last two decades.</div></div><div><h3>Methods</h3><div>Retrospective study in French pediatric surgery centers from January 2000 to December 2022 concerning girls who presented with at least 1 episode of ovarian torsion in the prepubertal period. Data collected included patient history, symptomatology, biological and imaging assessment at first episode, emergency surgery, follow-up including recurrence.</div></div><div><h3>Results</h3><div>Thirty centers participated and we included 502 girls diagnosed with ovarian torsion during a surgical procedure performed due to abdominal pain (with or without ovarian mass). The girls had a mean age of 7.9 years (±2.8) and a median age of 8.3 years (Q1 5.97; Q3 10.12) at the time of the first episode of torsion. Nausea or vomiting was present in 71 % of cases. Fever was present in 23 % of cases and was more displayed 24 h after the onset of abdominal pain (p &lt; 0.0001). Mean follow-up was 2.1 (±2.61) years. Only 42 out of 142 (30 %) girls with enlarged ovaries (&gt;97th percentile) were referred to the endocrinologist to assess the existence of hormonal anomalies. Of the 482 girls without oophoropexy after the first episode of torsion, 71 (14.7 %) experienced at least one recurrence. Among them: 10 (7.5 %) had an ovarian mass and 42 (55 %) enlarged ovaries.</div></div><div><h3>Conclusion</h3><div>Symptoms of ovarian torsion in pre-pubertal girls are not specific and clinicians should be aware of this insidious presentation in this group. These girls should be systematically referred to endocrinologists.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 6","pages":"Article 162317"},"PeriodicalIF":2.4,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}