Journal of pediatric surgery最新文献

{"title":"Thread- Reinforced Encapsulation Devices (THRED) for Therapeutic Stem Cell Delivery.","authors":"Fikir M Mesfin, Jasmine Lee, Sharon Joseph, Krishna Manohar, Chelsea E Hunter, W Christopher Shelley, John P Brokaw, Guanglon Jiang, Jianyun Liu, Chang-Hyun Gil, Minglin Ma, Troy A Markel","doi":"10.1016/j.jpedsurg.2026.163196","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2026.163196","url":null,"abstract":"<p><strong>Introduction: </strong>Mesenchymal stem cells (MSCs) have been studied as potential therapeutic agents for various diseases. However, their widespread application has been limited, in part, due to the concern for tumorigenic transformation and lack of longevity in host environments secondary to immune-mediated destruction. Therefore, we set out to study an MSC encapsulation and delivery method with potential application in the treatment of intestinal ischemic diseases.</p><p><strong>Method: </strong>Human vertebra bone adherent mesenchymal stem cells (vBA-MSCs) were encapsulated in an alginate-derived Thread Reinforced Encapsulation Device (THRED). The encapsulated cells were then tested for viability, ability to retain cell surface markers, and ability to synthesize and release cytokines. Furthermore, a mouse ischemia-reperfusion model was used to test the therapeutic potential of encapsulated MSCs.</p><p><strong>Results: </strong>vBA-MSCs were successfully packaged in the experimental cell encapsulation device. Encapsulated MSCs remained viable and functional while retaining their cell surface markers. Furthermore, encapsulated MSCs improved mouse intestinal injury scores following intestinal ischemia and reperfusion injury.</p><p><strong>Discussion: </strong>The THRED is a viable option to deliver mesenchymal stem cells during therapy. Further studies are needed to elucidate the ideal number of cells and the length of time needed to deliver optimal therapy.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"163196"},"PeriodicalIF":2.5,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147856271","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":"TRISOMY 21 AND POSTOPERATIVE OUTCOMES AFTER ESOPHAGEAL ATRESIA REPAIR: A PROPENSITY SCORE MATCHING STUDY.","authors":"Nicole J Bertaux, Charbel Chidiac, Latoya A Stewart, Daniel S Rhee, Shaun M Kunisaki","doi":"10.1016/j.jpedsurg.2026.163194","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2026.163194","url":null,"abstract":"<p><strong>Purpose: </strong>Trisomy 21 (T21) is frequently associated with congenital heart disease and other comorbidities that may influence outcomes following esophageal atresia (EA) repair. The independent effect of T21 on postoperative mortality remains unclear. We sought to evaluate outcomes following EA repair in patients with and without T21.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using the NSQIP-P database (2012-2020) of patients undergoing EA repair. Primary outcome was 30-day postoperative mortality. Secondary outcomes included postoperative complications, 30-day readmission, reoperation, and length of stay (LOS). Propensity score matching (10:1) balanced cohorts by age, operative weight, cardiac risk factors, and presence of tracheoesophageal fistula. Multivariable logistic regression identified predictors of mortality.</p><p><strong>Results: </strong>Among 2,229 patients, 49 (2.2%) had T21. Compared to non-T21 patients, those with T21 were older at repair (21 vs. 2 days, p<0.001) and had a longer LOS (30 vs. 20 days, p=0.008). Rates of reoperation, readmission, and overall complications were similar. After matching, T21 was independently associated with increased 30-day mortality (OR 10.2, 95% CI 2.23-46.75; p=0.003). Operative weight was also associated with mortality (OR 0.29, 95% CI 0.09-0.94; p=0.40). Trisomy 21 was not associated with overall complications, but a higher rate of VTE (OR 5.16, 95% CI 1.2-22.24; p=0.028) was identified in these patients.</p><p><strong>Conclusion: </strong>Trisomy 21 is a risk factor for 30-day mortality following EA repair. These findings inform perioperative risk stratification and preoperative counseling in this high-risk population.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"163194"},"PeriodicalIF":2.5,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147856302","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":"Oncologic Outcomes of Parenchyma-Sparing Resection for Hepatoblastoma.","authors":"Brian T Hickner, Andres F Espinoza, Prakash M Masand, Dolores H Lopez-Terrada, Valeria R Smith, Sarah S Kappa, Ekene A Onwuka, Jed G Nuchtern, Sanjeev A Vasudevan","doi":"10.1016/j.jpedsurg.2026.163195","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2026.163195","url":null,"abstract":"<p><strong>Purpose: </strong>Surgery is the cornerstone of therapy for hepatoblastoma (HB). While standard resection (SR) via hemi-hepatectomy and trisectionectomy has traditionally been the preferred surgical approach, parenchyma-sparing resection (PSR) has become increasingly popular. We sought to compare the characteristics and outcomes of patients who underwent PSR versus SR.</p><p><strong>Methods: </strong>Single-institution retrospective cohort study of HB patients who underwent hepatectomy from February 8, 2012 to August 12, 2024. Patients with metastasis at diagnosis, who underwent transplant, or who received simultaneous SR and PRS were excluded. Primary outcomes included 5-year event-free (EFS) and overall survival (OS). Secondary outcomes included margin status, transfusion requirement, operative time, postoperative liver dysfunction, reoperation, and biliary complications.</p><p><strong>Results: </strong>Forty-three patients met inclusion criteria (21 PSR, 22 SR). More patients in the PSR group presented with pre-treatment extent of disease (PRETEXT) I tumors, multifocal disease or underwent upfront resection, whereas the SR group more frequently displayed aggressive histology. No events were observed in the PSR cohort at a median follow-up of 4.8 years, corresponding to 100% estimated 5-year EFS and OS. The estimated 5-year EFS and OS in the SR cohort were 87%; however when controlling for histology, the EFS and OS was equivalent to the PSR group. Two patients in the PSR group had microscopically positive resection margins compared to none in the SR group. PSR was associated with lower intra- and postoperative transfusion requirements, shorter operative times, and less severe postoperative liver dysfunction.</p><p><strong>Conclusion: </strong>In this single-institution retrospective study, PSR was associated with acceptable oncologic outcomes in spite of two patients having microscopically positive margins. In select patients with low PRETEXT stage, multifocal tumors, and favorable vascular relationships, PSR may represent a viable surgical option when technically feasible and within surgeon expertise.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"163195"},"PeriodicalIF":2.5,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147856643","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":"A Comparative Meta-analysis and Systematic Review of Gubernaculum Sparing versus Gubernaculum Excision Orchidopexy.","authors":"Tamara Jiryis, Roberto Iglesias Lopes, Caio Vinícius Suartz, Caio Felipe Araujo Matalani, Leonardo Olimpio Dias da Silva, Henrique Laurent Lepine, Nael Arabi, Fadi Zu'bi","doi":"10.1016/j.jpedsurg.2026.163180","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2026.163180","url":null,"abstract":"<p><strong>Background: </strong>Cryptorchidism is one of the most common congenital abnormalities and it is associated with impaired fertility, increased malignancy risk, and testicular atrophy. Orchidopexy is the standard treatment for intra-abdominal testes, but the optimal surgical approach remains debated, particularly regarding the role of gubernacular sparing.</p><p><strong>Objectives: </strong>To compare gubernaculum-sparing and gubernaculum-excision orchidopexy for abdominal cryptorchidism in pediatric patients, focusing on postoperative testicular atrophy rates.</p><p><strong>Materials and methods: </strong>A systematic review and meta-analysis were conducted according to PRISMA guidelines and registered in PROSPERO. A comprehensive search was performed in PubMed, Embase, Cochrane Library, and Web of Science for studies published up to February 2025. Eligible studies compared gubernaculum-sparing orchidopexy (GS) and gubernaculum-excision orchidopexy (GE) in patients with intra-abdominal testis. The primary endpoint was testicular atrophy rate, and secondary outcomes included postoperative testicular growth.</p><p><strong>Results: </strong>Three studies, including 195 patients, met the inclusion criteria. No significant baseline difference in testis size was observed (MD = -41.3 mm³; 95% CI -192.9-110.4). The pooled analysis showed significantly lower atrophy rates with gubernaculum-sparing orchidopexy versus excision (OR = 0.07; 95% CI 0.01-0.91; I² = 80.8%; p = 0.0225). No significant differences in testis size were found at 3 months (MD = 11.7 mm³; 95% CI -45.9-69.4) or 6 months (MD = 0.4 mm³; 95% CI -52.7-53.5), with negligible heterogeneity (I² = 0%). All included studies were rated as low-to-moderate risk of bias.</p><p><strong>Conclusions: </strong>This systematic review and meta-analysis demonstrated that gubernaculum sparing during laparoscopic orchidopexy for intra-abdominal testis is associated with lower testicular atrophy rates and comparable postoperative testicular growth. These findings suggest that maintaining gubernacular integrity may help preserve collateral blood supply and optimize testicular viability.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"163180"},"PeriodicalIF":2.5,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147856692","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":"The Effect of Suction on Chest Tube Progression in Children with Parapneumonic Effusions.","authors":"Olugbenga Awolaran, Fouad Youssef, Megan Skakum, Bj Hancock, Anna C Shawyer, Richard Keijzer, Suyin A Lum Min","doi":"10.1016/j.jpedsurg.2026.163189","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2026.163189","url":null,"abstract":"<p><strong>Background: </strong>Suction is frequently used on chest tubes draining parapneumonic effusions, but its impact on clinical progression remains uncertain. While suction may expedite drainage, it might also delay healing by perpetuating leaks or pneumothorax. This study used Markov modeling to assess the effect of suction on transitions between clinically meaningful states.</p><p><strong>Methods: </strong>With REB approval, we reviewed the charts of 81 children who had 95 chest tubes placed for parapneumonic effusions between 2014 and 2024. Necrotizing pneumonia patients were excluded. Six clinical states were categorized as: Drainage (>2 ml/kg/day), Dry (≤2 ml/kg/day), Leak (bubbling), Pneumothorax, Resolved and Video-Assisted Thoracoscopic Surgery. Suction was recorded as either absent or present. A semi-Markov model, adjusting for time spent in each state, was used to evaluate the impact of suction on state transitions. Hazard ratios (HR) and p-values were estimated.</p><p><strong>Results: </strong>Suction decreased the rate of moving from the Dry state to the Resolved state (HR=0.40, p=0.002), suggesting that suction was associated with a delay in clinical improvement once the effusion had cleared. Suction did not affect the likelihood of moving from other clinically important states toward resolution.</p><p><strong>Conclusion: </strong>While suction is believed to promote faster clearance of parapneumonic effusions, it may slow recovery after the effusion has been evacuated. These findings support the early use of suction with discontinuation once the effusion resolves. Further prospective studies are warranted to refine suction strategies in pediatric parapneumonic effusions.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"163189"},"PeriodicalIF":2.5,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147856287","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":"Preoperative computed tomography findings of chest wall or mediastinal invasion in pulmonary metastases among children, adolescents, and young adults.","authors":"Kazuki Shirane, Norihiko Kitagawa, Rento Morishima, Ryo Takahashi, Satoshi Tanaka, Takafumi Kondo, Hidehito Usui, Kyoko Mochizuki, Mio Tanaka, Kumiko Nozawa","doi":"10.1016/j.jpedsurg.2026.163183","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2026.163183","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary metastasectomy can improve the survival of children with pulmonary metastases from solid tumors. However, preoperative imaging often suggests chest wall and/or mediastinal invasion, raising concerns about resectability. Thus, we aimed to investigate associations between computed tomography (CT) findings and intraoperatively assessed chest wall or mediastinal invasion in children, adolescents, and young adults.</p><p><strong>Methods: </strong>We retrospectively reviewed data on pulmonary metastasectomies performed between January 2015 and December 2024. Tumors considered radiographically suspicious for pleural contact or invasion on the most recent preoperative CT scan were included. Tumor invasiveness was classified according to gross intraoperative findings, including adhesion to surrounding structures, pleural thickening, and pleural dissemination.</p><p><strong>Results: </strong>Fifty-seven metastatic lesions from 26 procedures in 20 patients showed CT findings suggestive of invasion. Based on intraoperative findings, lesions were classified as macroscopically invasive (n = 18) or macroscopically non-invasive (n = 39). Multivariate analysis showed that a higher ratio of tumor-pleura contact length to tumor diameter was associated with invasion (p = 0.005; odds ratio, 7.48; 95% confidence interval, 1.83-30.60). However, this association did not reach statistical significance in a mixed-effects logistic regression analysis (p = 0.088).</p><p><strong>Conclusions: </strong>In this small retrospective cohort, a higher ratio of tumor-pleura contact length to tumor diameter was associated with intraoperatively assessed macroscopic chest wall or mediastinal invasion in patients undergoing pulmonary metastasectomy. These findings require validation in larger prospective studies.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"163183"},"PeriodicalIF":2.5,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839409","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":"Letter to the Editor in Response to: Neurodevelopmental Outcomes and Long-term Quality of Life in Esophageal Atresia: A Narrative Review.","authors":"Xiaoqian Zhang, Guobin Liu","doi":"10.1016/j.jpedsurg.2026.163188","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2026.163188","url":null,"abstract":"","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"163188"},"PeriodicalIF":2.5,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839443","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":"Letter to the Editor Comment on: The Physiological Mirage: Why Oxygen Pulse Overstates Surgical Success in Pectus Excavatum.","authors":"Carla Mariana Vega, Luzia Toselli, Judith Ackerman, Ezequiel Travaglia, Sofia Grinenco, Ignacio Raggio, Gaston Bellia Munzon","doi":"10.1016/j.jpedsurg.2026.163186","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2026.163186","url":null,"abstract":"","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"163186"},"PeriodicalIF":2.5,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839414","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":"UDI Capture in Pectus Bar Implantation: A Pediatric Surgery Perspective on Device Traceability and Evidence Generation.","authors":"Alberto Jarrin Lopez, Rami Darawsheh, Hanmin Lee, Sunghoon Kim","doi":"10.1016/j.jpedsurg.2026.163185","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2026.163185","url":null,"abstract":"","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"163185"},"PeriodicalIF":2.5,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839423","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":"Letter to the Editor Comment on: Clinical characteristics and mortality prediction in neonatal gastric perforation: Insights from a regional multicenter retrospective cohort study.","authors":"Jie Li, Yemin Cao","doi":"10.1016/j.jpedsurg.2026.163182","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2026.163182","url":null,"abstract":"","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"163182"},"PeriodicalIF":2.5,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839430","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}