Journal of pediatric surgery最新文献

{"title":"Non-operative Versus Operative Management of Perianal Abscess in Infants: A 10-year Retrospective Study at Two Centres in the United Kingdom.","authors":"J J Neville, K Humpleby, C Healy, N J Hall, M P Stanton","doi":"10.1016/j.jpedsurg.2024.162101","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2024.162101","url":null,"abstract":"<p><strong>Background: </strong>Perianal abscess (PA), with or without fistula-in-ano (FIA) is common in infants. Treatment options include incision and drainage under general anaesthesia or non-operative treatments, such as antibiotics and/or aspiration under local anaesthetic, which avoid the risks of surgery. Current management is based on surgeon preference due to a poor underlying evidence base. In this study we aimed to compare outcomes for non-operative and operative management of infant PA.</p><p><strong>Methods: </strong>10-year retrospective review (2012-2022) of infants aged ≤12 months presenting with PA to two paediatric surgery centres in the United Kingdom. Clinical features, management and outcome data were extracted from electronic records.</p><p><strong>Results: </strong>116 infants were identified; 113/116 (97 %) were male. Median age at presentation was 2 (IQR 1-6) months. Initial management was non-operative in 73/116 (63 %) and operative in 43/80 (37 %). Median follow-up was 3 (IQR 2-6) months. Recurrence occurred in 49/116 (42 %) at a median time of 1 (IQR 0-3) month and was significantly higher in the non-operative compared to the operative group (39/73 [53 %] versus 10/43 [23 %], p = 0.001). Operative management was independently associated with a reduced risk of PA recurrence (OR 0.25 [95 % confidence interval 0.09-0.68], p = 0.007). Further surgery was performed in 26/73 (36 %) in the non-operative group and 7/43 (16 %) in the operative group (p = 0.026). Subsequent FIA rates were not significantly different (23/73 [32 %] versus 8/43 [19 %], p = 0.129).</p><p><strong>Conclusions: </strong>In this study, PA recurrence and the requirement for further operative intervention were significantly higher when a PA was initially managed non-operatively, although subsequent FIA rates were similar.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 3","pages":"162101"},"PeriodicalIF":2.4,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142854390","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":"Unnecessary Scans Lead to Unnecessary Re-scans: Evaluating Clinical Management of Low and Intermediate Risk Pediatric Traumatic Brain Injuries.","authors":"Rachel Rivero, Isabelle L Curran, Zane Hellmann, Madeleine Carroll, Matthew Hornick, Daniel Solomon, Michael DiLuna, Patricia Morrell, Emily Christison-Lagay","doi":"10.1016/j.jpedsurg.2024.162097","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2024.162097","url":null,"abstract":"<p><strong>Background: </strong>The Pediatric Emergency Care Applied Research Network (PECARN) guidelines provide an algorithm to select patients with mild head trauma at highest risk for clinically important traumatic brain injury (ciTBI) in whom computed tomography (CT) would facilitate management. Failure to follow PECARN criteria exposes children to unnecessary radiation and contributes to increasing hospital costs, length of stay, and parental anxiety. We sought to evaluate the subsequent allocation of resources to low and intermediate risk group patients who underwent an initial Head CT - which was not indicated by PECARN guidelines but which identified cranial or intracranial injury.</p><p><strong>Methods: </strong>We conducted a retrospective review of children ≤16 years old with head injury (GCS ≥14) between 2016 and 2021. Children with neurological deficits, penetrating head trauma, anticoagulation, or non-accidental trauma were excluded. Demographics, imaging results, PECARN risk category, and need for neurosurgical intervention were collected.</p><p><strong>Results: </strong>There were 70 low risk patients who had positive findings on CT, however none demonstrated clinically significant progression on repeat imaging that necessitated medical or surgical intervention. Of 319 intermediate risk patients with evidence of skull fracture or intracranial injury on CT, only one required intervention. The decision to intervene was made based on clinical changes and was not influenced by repeat imaging.</p><p><strong>Discussion: </strong>Despite PECARN guidelines, cross-sectional imaging remains overused. Identification of small foci of clinically non-actionable intracranial bleeding in patients who do not meet initial PECARN criteria frequently prompts further cross-sectional imaging without benefit. This suggests that routine interval imaging may not be necessary in the neurologically stable child with low-risk injury.</p><p><strong>Type of study: </strong>Retrospective cohort study.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 2","pages":"162097"},"PeriodicalIF":2.4,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142854273","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":"Malignant Hyperthermia in Pediatric Surgery: Essential Awareness and Crisis Management.","authors":"Caitlin J Cain-Trivette, Anjan Saha, Christopher Nemeh, Alexander V Chalphin, Teeda Pinyavat, William Middlesworth","doi":"10.1016/j.jpedsurg.2024.162082","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2024.162082","url":null,"abstract":"","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"162082"},"PeriodicalIF":2.4,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142807138","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":"Intraureteral Instillation of Indocyanine Green for Intraoperative Identification of the Ureter During Laparoscopy.","authors":"H Kodikara","doi":"10.1016/j.jpedsurg.2024.162100","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2024.162100","url":null,"abstract":"","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"162100"},"PeriodicalIF":2.4,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846871","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":"Congenital Tracheal Stenosis With Complete Cartilage Rings: Proposal of A Multidisciplinary and Tailored Surgical Approach.","authors":"Luca Genova Gaia, Andrea Moscatelli, Oliviero Sacco, Vittorio Guerriero, Francesca Rizzo, Francesco Santoro, Michele Torre","doi":"10.1016/j.jpedsurg.2024.162085","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2024.162085","url":null,"abstract":"<p><strong>Introduction: </strong>Congenital Tracheal Stenosis (CTS) with complete cartilaginous rings is a rare but potentially life-threatening condition in paediatric patients. Currently, the most common approach is slide tracheoplasty (ST) with sternotomy under cardiopulmonary bypass (CPB). Intending to make the procedure less invasive and consider the variety of associated conditions, we have tailored the approach to our patients, who were treated by a multidisciplinary airway team.</p><p><strong>Methods: </strong>Patients with CTS treated surgically between 2012 and 2022 at Gaslini Institute were enrolled. Preoperative, surgical and postoperative details were collected and analysed retrospectively. All patients had angio-computerized tomography (CT) scan, echocardiography and bronchoscopy with bronchography before surgery. Each patient and each procedure have been discussed at Airway Team meetings.</p><p><strong>Results: </strong>Among 20 patients with CTS, 15 underwent ST and 5 tracheal resection and anastomosis (TRA). 60 % were younger than 12 months. 30 % patients had previous tracheal/cardiac surgery. Combined cardiac surgery was performed in 8 patients. 4 patients were approached with cervicotomy and extracorporeal membrane oxygenation (ECMO). Mortality within 30 days was 5 %. 8 patients (40 %) needed endoscopic dilatation after the surgery and 1 underwent revision surgery. No patient had tracheostomy after the surgery. We did not find a higher rate of mortality and morbidity in patients who had cervicotomy and ECMO.</p><p><strong>Conclusion: </strong>We propose a multidisciplinary and tailored approach for patients with CTS. After evaluating each patient through detailed preoperative studies, including bronchography, the team can choose alternatives to the traditional ST under CPB, such as TRA, cervical approach, and ECMO.</p><p><strong>Level of evidence: </strong>Level IV.</p><p><strong>Type of study: </strong>Original Article.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 3","pages":"162085"},"PeriodicalIF":2.4,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142829026","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":"Neighborhood Disadvantage and Injury Mechanism, Severity, and Outcomes in Pediatric Trauma.","authors":"Emily K Myers, Keren Eyal, Jose L Diaz-Miron, Kaci L Pickett-Nairne, Jaclyn E Orehova, Sarah C Vangi, Mark B Malham, Lauren R S Hill, Kathleen M Adelgais, Jonathan L Hills-Dunlap, Marina L Reppucci, Shannon N Acker","doi":"10.1016/j.jpedsurg.2024.162084","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2024.162084","url":null,"abstract":"<p><strong>Background: </strong>Traumatic injuries remain the leading cause of death in children aged 1-14. Previous research demonstrates a link between lower socioeconomic status (SES) and higher pediatric injury morbidity and mortality. There is scant research exploring the relationship between neighborhood disadvantage and pediatric trauma. This study utilizes Area Deprivation Index (ADI) to understand the relationship between pediatric traumatic injury mechanisms, severity, and outcomes and neighborhood disadvantage.</p><p><strong>Methods: </strong>We performed a single-center cross-sectional analysis of pediatric trauma patients aged 0-18 presenting to our Level 1 Pediatric Trauma Center from 2016 to 2021. Patients were stratified into quintiles by national ADI. Injury mechanisms and severity markers were analyzed across ADI quintiles. A subset analysis was also performed, comparing complications and outcomes across ADI quintiles for severely injured patients.</p><p><strong>Results: </strong>Children from areas of higher disadvantage experienced higher rates of injuries related to automobiles, non-accidental trauma (NAT)/assault/neglect, penetrating injuries, and thermal injuries (p < 0.001). Children from areas of low disadvantage incurred more injuries related to sports (p < 0.001) and falls (p = 0.002). Multiple markers of trauma severity increased with increasing neighborhood disadvantage. No differences were found in clinical outcomes in the subset of most severely injured children.</p><p><strong>Conclusions: </strong>Mechanisms and severity of traumatic injuries among children vary with degree of neighborhood disadvantage. Outcomes did not differ by ADI quintile in the most severely injured children. ADI may be a tool for identifying children at higher risk for certain injury mechanisms and more severe injuries and could be used to target injury prevention interventions to more vulnerable communities.</p><p><strong>Type of study: </strong>Retrospective cross-sectional analysis.</p><p><strong>Level of evidence: </strong>Level IV.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 3","pages":"162084"},"PeriodicalIF":2.4,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142854340","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":"Older Children Undergoing Inguinal Hernia Repair Have Higher Recurrence Rates Than Younger Children and Adults: A Nationwide Cohort Study.","authors":"John Sincavage, Gwyneth A Sullivan, Annie Fritsch, Zachary Palmisano, Mehul V Raval, Martin Blakely, Ami N Shah, Brian C Gulack","doi":"10.1016/j.jpedsurg.2024.162083","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2024.162083","url":null,"abstract":"<p><strong>Background: </strong>High ligation is the standard practice for inguinal hernia repair in children while adults undergo a floor repair. There is limited data to guide recommendations on the age at which floor repair should be considered. This is a hypothesis-generating study to understand the correlation of age and other factors with inguinal hernia recurrence in children.</p><p><strong>Materials and methods: </strong>Children aged 6-17 years who underwent inguinal hernia repair by a pediatric surgeon between 2010 and 2022 were identified in the PearlDiver Mariner database, as were adults aged 18-25 years treated by an adult surgeon. Kaplan-Meier survival analysis and Cox proportional hazards modeling was used to determine the risk of hernia recurrence by age, sex, and obesity status.</p><p><strong>Results: </strong>A total of 15,114 children and 20,863 adults were included. Children aged 16-17 years had a significantly increased five-year risk of hernia recurrence compared to children aged 6-10 years (2.5 % vs 0.8 %, adjusted hazard ratio [AHR]: 3.00, 95 % confidence interval [CI]: 1.98-4.56) as well as compared to the adult group (2.5 % vs 1.2 %, AHR 1.90, 95 % CI: 1.31-2.74). Obese males aged 14-17 years had the highest five-year rate of hernia recurrence of any group at 4.7 %.</p><p><strong>Conclusions: </strong>Children 16-17 years of age who underwent inguinal hernia repair with pediatric surgeons have an increased risk of hernia recurrence compared to younger children as well as compared to adults treated by general surgeons. We hypothesize that high ligations, commonly performed by pediatric surgeons, may be inappropriate in some groups of older children.</p><p><strong>Type of study: </strong>Cohort.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 3","pages":"162083"},"PeriodicalIF":2.4,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142854426","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":"Intra-peritoneal Povidone-iodine Irrigation Decreases Abscesses in a Perforated Appendicitis Murine Model.","authors":"Derek J Krinock, Krista Stephenson, David Irby, Chary Akmyradov, Melanie Barker, Zachary Waldrip, Marie Burdine, Lindsey L Wolf, Melvin S Dassinger, Deidre Wyrick","doi":"10.1016/j.jpedsurg.2024.162081","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2024.162081","url":null,"abstract":"<p><strong>Background: </strong>Children with perforated appendicitis frequently form post-operative intra-abdominal abscesses (IAA). Intra-peritoneal irrigation for prevention remains controversial. Using a perforated appendicitis murine model, we sought to determine the effect of intra-peritoneal irrigation on post-operative IAA and adhesion formation.</p><p><strong>Methods: </strong>A survival operation was performed where cecal ligation and puncture was used to simulate perforated appendicitis. After 72 h, mice underwent a second operation where a distal cecectomy and intra-peritoneal irrigation was performed. Mice were assigned to a no irrigation group or one of four irrigation groups: normal saline, povidone-iodine (PVI), tacrolimus, or PVI followed by tacrolimus. At 2-weeks or 2-months after the second survival operation, mice were euthanized and IAAs were counted, measured, and cultured. Intra-peritoneal adhesion severity was graded on a 4-point scale. Statistical analysis compared IAA numbers and adhesion grade between the irrigation groups.</p><p><strong>Results: </strong>In the 2-week cohort, prevalence of IAA was 78 % (n = 129). Type of irrigation solution was associated with abscess development (p < 0.001). Pairwise comparisons demonstrated PVI alone decreased abscess count. PVI irrigation caused more severe adhesions while tacrolimus decreased adhesions and adhesion grade was dependent on irrigation solution (p < 0.001). In the 2-month cohort, similar responses were observed with decreased abscess numbers in the PVI group (p = 0.006) but increased adhesion burden (p = 0.002).</p><p><strong>Conclusion: </strong>Povidone-iodine irrigation decreases intra-abdominal abscess formation, but increases adhesion formation.</p><p><strong>Level of evidence: 1: </strong></p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 3","pages":"162081"},"PeriodicalIF":2.4,"publicationDate":"2024-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142807143","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":"Single Incision Laparoscopic Surgery for Malone Antegrade Continent Enema: Optimizing Outcomes in Pediatric Bowel Management.","authors":"Ismael Elhalaby, Irene Isabel P Lim, Elizaveta Bokova, Wendy E Lewis, Christine N Feira, Rebecca M Rentea","doi":"10.1016/j.jpedsurg.2024.162080","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2024.162080","url":null,"abstract":"<p><strong>Background: </strong>Malone antegrade continence enemas (MACE) are increasingly being used to manage severe constipation and fecal incontinence in children. Despite advances in minimally invasive pediatric colorectal surgery, single-incision laparoscopic surgery (SILS) for MACE creation remains relatively unexplored. This study, featuring the largest cohort to date, evaluates the feasibility, safety, and clinical outcomes of SILS MACE creation in children.</p><p><strong>Methods: </strong>A single-institution, retrospective review of pediatric patients who underwent SILS MACE creation for severe constipation and/or fecal incontinence between March 2022 and July 2024. Patient demographics, operative data, postoperative complications, and stooling patterns were assessed. Quantitative variables were analyzed using descriptive statistical methods.</p><p><strong>Results: </strong>Eighteen patients (10 males, 56 %) underwent SILS MACE creation at a mean age of 10 years (range 4-18) and a median BMI of 17.6 kg/m² (IQR 16.8-19.6). Preoperative diagnoses included anorectal malformation (n = 9, 50 %), functional constipation (n = 4, 22 %), neurogenic bowel (n = 3, 17 %), and Hirschsprung Disease (n = 2, 11 %). Median operative time was 51 min (IQR 38-67), Postoperative complications included channel prolapse (n = 3, 17 %) and wound infection (n = 2, 11 %). Two patients (11 %) required interventional radiology owing to Mini-ACE® button dislodgment and one patient (5 %) required operative revision for skin-level stenosis. At a median follow-up of 13 months (IQR 7-18), 16 patients (89 %) were clean for stool with successful management through antegrade flushes.</p><p><strong>Conclusion: </strong>SILS MACE creation is a safe, feasible, and effective minimally invasive approach for managing severe constipation and fecal incontinence in children. The technique demonstrates potential advantages in cosmetic results and comparable surgical outcomes, offering a viable alternative to the traditional multiport laparoscopic approach.</p><p><strong>Type of study: </strong>Original Research Article.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 3","pages":"162080"},"PeriodicalIF":2.4,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142813631","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":"Report of the 57th Annual Meeting of the Pacific Association of Pediatric Surgeons.","authors":"Patrick Ho Yu Chung, Mary Brindle","doi":"10.1016/j.jpedsurg.2024.162071","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2024.162071","url":null,"abstract":"","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"162071"},"PeriodicalIF":2.4,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142829024","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}