Journal of pediatric surgery最新文献

{"title":"Implementation of a “Same Night” Appendectomy (SNAppy) Discharge Protocol: A Quality Improvement Initiative","authors":"Joshua K. Ramjist ,&nbsp;Benjamin Carr ,&nbsp;Kimberly Aitken Menezes ,&nbsp;Conor McDonnell ,&nbsp;Augusto Zani ,&nbsp;Annie Fecteau","doi":"10.1016/j.jpedsurg.2025.162218","DOIUrl":"10.1016/j.jpedsurg.2025.162218","url":null,"abstract":"<div><h3>Purpose</h3><div>Appendectomy is curative for appendicitis and prolonged hospitalization is unnecessary for un-complicated disease. We implemented a protocol to expedite discharge of patients post-appendectomy.</div></div><div><h3>Methods</h3><div>Using multiple plan-do-study-act (PDSA) cycles, the protocol functions in three phases of care. Pre-operatively, expectations for discharge are established, antibiotics and acetaminophen are administered. Intra-operatively, a foley catheter is avoided and the maximum dose of local analgesic, routine skin prophylaxis, ondansetron and ketorolac are administered. Post-operatively, patients with stable vital signs, pain controlled, tolerating liquids and able to mobilize are discharged. The primary outcome measured was length of stay (LOS) post-procedure. Counterbalance measures were unexpected return to the emergency department (ED) and in-patient bed utilization. Impact of PDSA cycles was quantified using statistical process control charts and Mann Whitney U test. All statistical tests were 2-sided and <em>P</em> value ≤ 0.05 deemed to be statistically significant.</div></div><div><h3>Results</h3><div>A total of 332 patients were identified over a 2-year period, 147 pre-protocol implementation, 185 afterwards. The median age was 9 years old (IQR:6–11), procedure duration 40 min (IQR 29–53). The median post-op LOS pre-protocol was 11.2 h (IQR: 7.1–16.2) compared to 1.5 h (IQR: 1.1–4.2) after implementation (P &lt; 0.00001). There were 10 returns to the ED pre-protocol (6.8 %) and 17 after implementation (9.2 %), (p = 0.65). Pre-protocol, no patients were discharged directly from the OR compared to 68 % after implementation. There was no difference in ED LOS (median 9:03 vs 9:14, p &lt; 0.48).</div></div><div><h3>Conclusion</h3><div>Implementation of the SNAppy protocol significantly reduced the post-operative LOS and inpatient bed utilization without increasing ED returns.</div></div><div><h3>Level of evidence</h3><div>III.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 4","pages":"Article 162218"},"PeriodicalIF":2.4,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143367789","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":"Gastroesophageal Reflux and Gastrointestinal Symptoms After Metabolic and Bariatric Surgery in Adolescents: An 8-year Follow-up Analysis","authors":"John B. Rode ,&nbsp;Suhail A. Zeineddin ,&nbsp;Jane C. Khoury ,&nbsp;Todd M. Jenkins ,&nbsp;Stephanie R. Sisley ,&nbsp;Anita P. Courcoulas ,&nbsp;Justin R. Ryder ,&nbsp;Marc P. Michalsky ,&nbsp;Thomas H. Inge","doi":"10.1016/j.jpedsurg.2025.162215","DOIUrl":"10.1016/j.jpedsurg.2025.162215","url":null,"abstract":"<div><h3>Importance</h3><div>Vertical sleeve gastrectomy (VSG) and Roux-en-Y gastric bypass (RYGB) are the most commonly performed metabolic and bariatric surgery (MBS) procedures in adolescents and adults. Despite their safety and effectiveness, there is concern over postoperative gastrointestinal symptoms (GIS), especially gastroesophageal reflux symptoms (GERS), in those undergoing VSG.</div></div><div><h3>Objective</h3><div>To evaluate the long-term prevalence of GIS in adolescents who underwent RYGB or VSG.</div></div><div><h3>Design, setting, and participants</h3><div>This is a prospective, multicenter, observational cohort study at five academic referral centers in the United States. Patients were enrolled from February 28, 2007, through December 30, 2011. The analysis included 228 adolescents: 161 RYGB and 67 VSG followed prospectively for 8 years.</div></div><div><h3>Main outcomes and measures</h3><div>Patient-reported GIS before surgery and across 8 years of postoperative follow-up were assessed. We dichotomized postoperative symptom severity and analyzed the data using general linear mixed models.</div></div><div><h3>Results</h3><div>Adolescents undergoing either VSG or RYGB demonstrated significant increases in abdominal pain (10 % vs. 17 %), bloating (8 % vs. 20 %), and constipation (3 % vs. 9 %) between baseline and 8 years (p &lt; 0.05). Following RYGB, the prevalence of GERS was not statistically significantly different between baseline (12 %) and 8 years (13 %) (p &gt; 0.05). Following VSG, however, GERS increased from 9 % preoperatively to 27 % at 8 years (p &lt; 0.05). In adjusted analyses, VSG was associated with higher odds of GERS at 8 years (adjusted odds ratio 2.67 [1.57–4.55, 95%CI]).</div></div><div><h3>Conclusions and relevance</h3><div>GERS represents a considerable concern pre- and post-MBS in adolescents, especially after VSG. Appropriate patient selection along with counseling and objective monitoring for pathologic consequences of gastroesophageal reflux after MBS are warranted.</div></div><div><h3>Trial registration</h3><div>Clinicaltrials. gov Identifier: NCT00474318.</div></div><div><h3>Type of study</h3><div>Prospective, multicenter, observational cohort.</div></div><div><h3>Level of evidence</h3><div>Level II.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 4","pages":"Article 162215"},"PeriodicalIF":2.4,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143377651","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":"Social Determinants of Health Influence on Survival in Wilms Tumor, Neuroblastoma, and Hepatoblastoma","authors":"Colleen P. Nofi ,&nbsp;Bailey K. Roberts ,&nbsp;Erin G. Brown ,&nbsp;Barrie S. Rich ,&nbsp;Meera Kotagal ,&nbsp;Richard D. Glick","doi":"10.1016/j.jpedsurg.2025.162216","DOIUrl":"10.1016/j.jpedsurg.2025.162216","url":null,"abstract":"<div><h3>Background</h3><div>The influence of social determinants of health (SDOH) on childhood cancer outcomes is complex and understudied. This study aimed to elucidate the influence of socioeconomic status (SES) and race on survival in Wilms tumor (WT), neuroblastoma (NB), and hepatoblastoma (HB).</div></div><div><h3>Methods</h3><div>National Cancer Database was queried from 2004 to 2020 for pediatric patients (aged 0–18) with WT, NB, and HB. A SES composite score was created by combining quartiles for median household income and percent no high school degree (with higher scores reflecting greater disadvantage). Kaplan–Meier analyses and Cox regressions were performed to determine influencers on survival.</div></div><div><h3>Results</h3><div>This study included 5218 patients with WT, 5851 with NB, and 1311 with HB. The distribution of race for WT, NB, and HB was 59 %, 65 %, and 55 % White non-Hispanic, and 18 %, 11 %, and 11 % Black non-Hispanic patients, respectively. Kaplan–Meier analyses revealed disparate outcomes with higher SES scores having worse survival for WT (p = 0.002) and NB (p = 0.011). In multivariable analysis of children with WT: age, higher SES score, comorbidities, tumor size, and bilateral and metastatic disease were associated with worse survival. For NB: age, urbanicity, higher SES score, Black non-Hispanic race/ethnicity, tumor size, metastatic disease, and chemotherapy were associated with worse survival. For HB: age, comorbidities, and metastatic disease were associated with worse survival.</div></div><div><h3>Conclusion</h3><div>After controlling for patient and tumor characteristics, there are significant associations between SDOH and worse survival for patients with WT and NB. Identification of social risk factors is critical for closing equity gaps and improving outcomes for children with solid tumors.</div></div><div><h3>Level of evidence</h3><div>Level III.</div></div><div><h3>Type of study</h3><div>Retrospective.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 4","pages":"Article 162216"},"PeriodicalIF":2.4,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143394842","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":"Management, Trends, and Recommendations for Intra-abdominal Lymphatic Malformations: A Single-Center Retrospective Review","authors":"Emily Vore ,&nbsp;Jo Cooke-Barber ,&nbsp;Joseph Brungardt ,&nbsp;Gregory Tiao ,&nbsp;Adrienne Hammill ,&nbsp;Kiersten Ricci ,&nbsp;Manish Patel ,&nbsp;Roshni Dasgupta","doi":"10.1016/j.jpedsurg.2025.162223","DOIUrl":"10.1016/j.jpedsurg.2025.162223","url":null,"abstract":"<div><h3>Background</h3><div>Intra-abdominal lymphatic malformations (ILM) are vascular anomalies that arise from the mesentery, omentum, or retroperitoneum. These may present with abdominal symptoms or may be incidentally discovered on imaging. There is not a clear consensus on management or prognosis. The aim of this study is to describe and characterize common presentations, treatments, and outcomes.</div></div><div><h3>Methods</h3><div>A retrospective chart review was performed of non-solid organ ILM followed in tertiary vascular anomalies clinic. Descriptive statistics were used to analyze patient demographics, symptoms, treatment, treatment response, and complications.</div></div><div><h3>Results</h3><div>Fifty-six patients with ILM were identified. Thirty-seven percent had other associated lymphatic or vascular malformations including PIK3CA-related Overgrowth Syndrome (PROS), Generalized Lymphatic Anomaly, and Capillary Venous Lymphatic Malformation. Most patients present with abdominal symptoms (pain = 32 %, obstruction = 9 %, distention = 7 %). Symptomatic patients were treated with sirolimus (n = 22, 39 %), percutaneous drainage (n = 3, 5 %), sclerotherapy (n = 15, 27 %), and or surgery (up front surgery, n = 15, 27 %). Of those who underwent sclerotherapy, 67 % had resolution of symptoms while only 5 required subsequent surgery for persistent symptoms. Surgery was utilized for patients presenting with acute bowel obstruction and when sclerotherapy failed to resolve symptoms. Of those who underwent surgery, 32 % required bowel resection (n = 7) and one patient required an ostomy.</div></div><div><h3>Conclusion</h3><div>Most patients with ILM present with abdominal symptoms and have other associated vascular anomalies. Interventional procedures, such as sclerotherapy, and medical therapy with sirolimus are safe and effective and should be considered first-line therapies. Surgical resection should be reserved for failure of less invasive therapies and for acute bowel obstruction.</div></div><div><h3>Type of Study</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 4","pages":"Article 162223"},"PeriodicalIF":2.4,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143379458","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":"Clinical Characteristics and Postoperative Functional Outcomes in Children With Mowat-Wilson Syndrome and Hirschsprung's Disease: A Single-center Study","authors":"Tianran Cheng ,&nbsp;Zhen Zhang ,&nbsp;Ruijie Zhou ,&nbsp;Weike Liu ,&nbsp;Ping Xiao ,&nbsp;Lihua Wu ,&nbsp;Ya Ma ,&nbsp;Wenquan Niu ,&nbsp;Yong Chen ,&nbsp;Bo Li ,&nbsp;Agostino Pierro ,&nbsp;Long Li ,&nbsp;Qian Jiang ,&nbsp;Qi Li","doi":"10.1016/j.jpedsurg.2025.162217","DOIUrl":"10.1016/j.jpedsurg.2025.162217","url":null,"abstract":"<div><h3>Background</h3><div>Mowat-Wilson Syndrome (MWS) is a rare autosomal dominant genetic disorder. Approximately half of individuals with MWS present with Hirschsprung's Disease (HSCR). There is no nested case–control study that correlates with its prognosis. This study aimed to compare the mid-to-short-term postoperative prognosis between children with MWS-associated with HSCR and those with isolated HSCR.</div></div><div><h3>Methods</h3><div>A retrospective analysis was conducted on clinical data of HSCR patients who underwent surgery at a pediatric hospital from January 2016 to June 2023. Patients with MWS-associated HSCR were identified through confirmed mutations in the <em>ZEB2</em> gene. Propensity score matching (PSM) was used for comparative analysis.</div></div><div><h3>Results</h3><div>Among the identified cases, 11 had MWS-associated HSCR, and 1088 had isolated HSCR, with 44 HSCR-alone patients included in the control group after PSM. The case group comprised 7 males and 4 females, with a median age of 4 years and a median age at surgery of 3.96 months (IQR, 2.04–8.52). The study found no significant difference in the incidence of postoperative Hirschsprung-associated enterocolitis (HAEC) between the two groups, although severe abdominal distension symptoms were more prevalent in the case group. However, the median period of recurrent HAEC from the first to the last occurrence in the case group was longer at 18 months (IQR, 3–30) compared to 0 months (IQR, 0–6) in the control group. Additionally, the case group exhibited a higher rate of constipation and significantly poorer bowel function compared to the control group. Other mid-to-short-term complication rates were comparable between the two groups.</div></div><div><h3>Conclusions</h3><div>Children with MWS-associated HSCR face greater challenges in postoperative recovery, including a longer period of recurrent HAEC, more severe constipation, and poorer bowel function, highlighting the need for focused prevention and enhanced intestinal management in this patient population.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 4","pages":"Article 162217"},"PeriodicalIF":2.4,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143377650","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":"Correlation of Genetic Mutation With Outcomes in Children With Hereditary Spherocytosis Undergoing Partial Splenectomy: A Multicentre Study","authors":"Joshua K. Ramjist ,&nbsp;Tamara Dubljevic ,&nbsp;Eveline Lapidus-Krol ,&nbsp;Rachael F. Grace ,&nbsp;Matthew M. Heeney ,&nbsp;Morohuntodun O. Oni ,&nbsp;Alison Towerman ,&nbsp;Andrew Davidoff ,&nbsp;Clifford Takemoto ,&nbsp;Rebeccah L. Brown ,&nbsp;Joseph Brungardt ,&nbsp;Makenzie Beaman ,&nbsp;Henry E. Rice ,&nbsp;Shari Nichols ,&nbsp;Payam Saadai ,&nbsp;Manuel Carcao ,&nbsp;Jacob C. Langer","doi":"10.1016/j.jpedsurg.2025.162229","DOIUrl":"10.1016/j.jpedsurg.2025.162229","url":null,"abstract":"<div><h3>Purpose</h3><div>Hereditary Spherocytosis (HS) is a common genetic hematological disorder causing a life-long hemolytic anemia, with sequela of hemolysis. Children with severe HS commonly undergo partial or total splenectomy (PS, TS); PS confers the theoretical advantage of maintaining splenic immune function, but may be associated with regrowth, ongoing hemolysis, and need for completion splenectomy. HS can be caused by 5 different pathogenic gene variants. A rare and severe form is caused by homozygous/compound heterozygous mutations in the SPTA1 gene, coding for alpha spectrin. We hypothesized this form of HS is associated with worse outcomes following PS.</div></div><div><h3>Methods</h3><div>Following REB approval, a retrospective chart review of children with HS undergoing PS between 2000 and 2023 was conducted across 7 sites in the USA and Canada. Pre- and post-operative hematological values and need for completion splenectomy were analyzed. P &lt; 0.05 was significant.</div></div><div><h3>Results</h3><div>Of 51 eligible patients, 10 had SPTA and 41 had non-SPTA1 HS. The SPTA1 group underwent PS at a younger age to non-SPTA1 (5.1 vs 9.6 yr, p = 0.003), and had lower pre-operative hemoglobin (86.2 vs 98.8 g/L, p = 0.04). There were no differences between groups regarding peri-operative surgical or hematological outcomes. The SPTA1 group required completion splenectomy at a higher rate than the non-SPTA1 group (70.0 % vs 24.4 %, p = 0.01).</div></div><div><h3>Conclusion</h3><div>Children with SPTA1 HS are more likely to require completion splenectomy following PS than children with other HS-causing mutations. These results support the role of genetic testing to permit an evidence-based individualized approach to patient selection for partial vs. total splenectomy.</div></div><div><h3>Level of evidence</h3><div>III.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 4","pages":"Article 162229"},"PeriodicalIF":2.4,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143474950","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 Relationship Between Socioeconomic Status and Omphalocele Prevalence","authors":"Lauren Colquitt ,&nbsp;Sathyaprasad Burjonrappa","doi":"10.1016/j.jpedsurg.2025.162225","DOIUrl":"10.1016/j.jpedsurg.2025.162225","url":null,"abstract":"<div><h3>Background</h3><div>The omphalocele is a congenital malformation associated with chromosomal abnormalities, however the exact etiology is unknown. Current research has found maternal obesity, diabetes, and African American race as risk factors for omphalocele development and may point to a social determinant of health causative factor. Here we investigate the socioeconomic characteristics of patients with an omphalocele diagnosis and consider epigenetics as the facilitator in its manifestation.</div></div><div><h3>Methods</h3><div>This cross-sectional study used data from the 2019 National Kids’ Inpatient Database to investigate patients with an omphalocele diagnosis, generating roughly 1400 data points where median household income (MHI), race, sex, and hospital region were investigated using chi-square analysis and held to a statistically significant p-value of &lt;0.05.</div></div><div><h3>Results</h3><div>Chi-square analysis found a significant difference within MHI, race, sex, and region in omphalocele incidence. MHI quartiles were $1–47,999 (37 % of patients), $48,000–60,999 (23 %), $61,000–81,999 (22 %), and $82,000+ (18 %), Χ2 (3) = 24.973, p &lt; 0.001. Reported race included White (51.2 %), Black (22.3 %), Hispanic (17.7 %), Asian/Pacific Islander (2.9 %), Native American (0.3 %), and other (5.6 %), Χ2 (5) = 34.739, p &lt; 0.001. Males compromised 55.1 % of patients and Females 44.9 %, Χ2 (1) = 24.005, p &lt; 0.001. Hospital region included the Northeast (15.0 %), Midwest (21.4 %), South (45.2 %), and West (18.4 %), Χ2 (3) = 26.379, p &lt; 0.001.</div></div><div><h3>Conclusions</h3><div>This is the first study to show a lower MHI and Southern geographic region is associated with higher incidence of omphaloceles. Further research is necessary to determine the link between socioeconomic status and omphalocele development with epigenetics as the possible mechanism.</div></div><div><h3>Level of Evidence</h3><div>Retrospective Study.</div></div><div><h3>Level of Evidence</h3><div>III.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 4","pages":"Article 162225"},"PeriodicalIF":2.4,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143422356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Magnetic Compression Anastomosis for Anorectal Malformations: Feasibility and Efficacy in Swine Model and Clinical Observation","authors":"Zhibin Luo ,&nbsp;Shuiqing Chi ,&nbsp;Yun Zhou ,&nbsp;Yu Guo ,&nbsp;Mengxin Zhang ,&nbsp;Liying Rong ,&nbsp;Guoqing Cao ,&nbsp;Xiangyang Li ,&nbsp;Yiliang Lv ,&nbsp;Liang Li ,&nbsp;Shao-tao Tang","doi":"10.1016/j.jpedsurg.2025.162230","DOIUrl":"10.1016/j.jpedsurg.2025.162230","url":null,"abstract":"<div><h3>Background</h3><div>Patients with anorectal malformations (ARM) commonly experience post-operative bowel dysfunctions due to inherent neuromuscular dysplasia and surgical damage to extraluminal structures. Magnetic compression anastomosis (MCA) minimizes injury to the perirectal neurovascular bundle and sphincter muscles via an endoluminal approach. We evaluated the preclinical feasibility and healing efficacy of a novel MCA device in a swine model of ARM and applied the device to an ARM patient.</div></div><div><h3>Methods</h3><div>Two prototype MCA devices (8 mm and 10 mm diameter) were tested at piglets'abdominal wall tissue to evaluate suitable magnetic force to cause local ischemia and necrosis. Eight piglets underwent ARM modeling and were divided into MCA or hand-sewn (HS) anastomosis groups (n = 4 per group). After two weeks of monitoring, the piglets were sacrificed. Radiography assessed the MCA progression, and anastomosis integrity was evaluated through histology. The device was later modified and applied to an infant with intermediate ARM.</div></div><div><h3>Results</h3><div>The 10 mm MCA devices successfully aligned at the piglets'abdominal wall tissue, while the 8 mm MCA device failed. The 10 mm MCA devices were selected for rectoanal anastomosis in model and showed an average anal recanalization time of 8 days, with smooth anastomosis sites and no foreign body response. Minimal inflammation was seen in the MCA group compared to HS group. The modified MCA device was applied to the ARM patient, with successful anastomosis by postoperative day 8.</div></div><div><h3>Conclusion</h3><div>MCA is a safe and effective method for anastomosis in ARM, providing a foundation for further clinical applications.</div></div><div><h3>Level of evidence</h3><div>III.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 4","pages":"Article 162230"},"PeriodicalIF":2.4,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143350217","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":"Surgical Treatment of Perforated Necrotizing Enterocolitis and Spontaneous Intestinal Perforation in Extremely Low Birth Weight Premature Infants- Is Resection and Primary Anastomosis a Safe Option?","authors":"Ayah Alzamrooni ,&nbsp;Lisandro Luques ,&nbsp;Pattamon Sutthatarn ,&nbsp;Eveline Lapidus-Krol ,&nbsp;Priscilla P.L. Chiu","doi":"10.1016/j.jpedsurg.2025.162219","DOIUrl":"10.1016/j.jpedsurg.2025.162219","url":null,"abstract":"<div><h3>Introduction</h3><div>Necrotizing enterocolitis (NEC) and spontaneous intestinal perforation (SIP) lead to significant morbidity and mortality in extreme-low birth weight (ELBW) infants. This study examined surgical management and outcomes for these conditions.</div></div><div><h3>Methods</h3><div>A retrospective chart review of ELBW infants (birthweight &lt;1000 g) who had laparotomy for NEC or SIP managed with primary anastomosis (PA) and stoma formation (SF) at a single high-volume center from 2000 to 2022 was performed. Patient data included demographics, pre-operative status, operative findings, post-operative complications, and outcomes at discharge and at 12 months. Statistical analyses were performed using Fisher's exact test and the Mann–Whitney test.</div></div><div><h3>Results</h3><div>Of 132 patients included, 40 underwent PA and 92 underwent SF. SF patients had lower birth weights and older post-gestational age at surgery. SF patients exhibited higher pre-operative CRP and lower platelet counts. No significant differences were found in intra-operative findings. Post-operatively, SF patients had higher conjugated bilirubin levels, longer hospital stays, and longer times to full enteral feeds. Mortality rates were similar between groups. Nutritional outcomes at 12 months did not significantly differ. Micropreemies (weight &lt;750 g at surgery) had higher mortality and more comorbidities, but no significant differences were observed between PA and SF management cohorts.</div></div><div><h3>Conclusion</h3><div>PA is a safe alternative to SF for managing NEC and SIP in ELBW infants with shorter hospital stays and faster progression to full feeds but the severity of pre-operative illness may influence surgical decision. Further studies are needed to refine patient selection criteria and optimize surgical outcomes.</div></div><div><h3>Type of Study</h3><div>Clinical Research.</div></div><div><h3>Level of evidence</h3><div>Level III Retrospective Comparative Cohort Study.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 4","pages":"Article 162219"},"PeriodicalIF":2.4,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143350215","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":"Respiratory Outcomes in Children Born With Esophageal Atresia With or Without Tracheoesophageal Fistula: A Retrospective Longitudinal Cohort Study","authors":"Osamuyi Asemota ,&nbsp;Anna C. Shawyer ,&nbsp;Shaikh Iqbal ,&nbsp;Suyin A. Lum Min ,&nbsp;Richard Keijzer","doi":"10.1016/j.jpedsurg.2025.162220","DOIUrl":"10.1016/j.jpedsurg.2025.162220","url":null,"abstract":"<div><h3>Background</h3><div>The respiratory health of children born with esophageal atresia with or without tracheoesophageal fistula (EA/TEF) can be compromised.</div></div><div><h3>Purpose</h3><div>We aimed to study how respiratory outcomes in EA/TEF cases change with increasing age and over time.</div></div><div><h3>Methods</h3><div>We performed a retrospective cohort study of children with EA/TEF treated in our centre from 1991 to 2022 and compared their respiratory outcomes to those of date-of-birth matched controls. Respiratory outcomes up to 2022 were identified using International Classification of Diseases codes (ICD-9). Odds ratios (OR), rate ratios (RaR) and Cox proportional hazard models were used to compare acute respiratory infections (ICD-9:460-466), asthma (ICD-9:493), bronchitis (ICD-9:490-491), influenza (ICD-9:487-488), and pneumonia (ICD-9:480-486) between cases and controls.</div></div><div><h3>Results</h3><div>A total of 95 cases and 945 controls were included. Cases were more likely to have asthma (OR = 2.32, 95%CI = 1.51,3.58) and pneumonia (OR = 5.94, 95%CI = 2.37,3.65) compared to controls. Cases had more episodes of acute respiratory tract infections and bronchitis (RaR = 1.45, 95%CI = 1.32,1.58; RaR = 13.3, 95%CI = 11.2,15.9, respectively). Influenza was unaffected by EA/TEF status. By late adolescence, new or recurrent episodes of respiratory disorders were uncommon, except for acute respiratory tract infections which continued to recur more often in cases than controls into adulthood. EA/TEF survivors born in recent years experienced fewer respiratory complaints than those born in the remote past.</div></div><div><h3>Conclusion</h3><div>Although the respiratory outcomes of children with EA/TEF were worse than controls, survivors can expect improved pulmonary health as they approach maturity, and respiratory health is improving for the contemporaneous EA/TEF population.</div></div><div><h3>Level of Evidence</h3><div>Prognostic, Level III.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 4","pages":"Article 162220"},"PeriodicalIF":2.4,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143388397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}