Journal of pediatric surgery最新文献

{"title":"A multicenter retrospective analysis by the Korean association of pediatric surgeons comparing laparoscopic and open surgical repair of congenital duodenal obstruction","authors":"Jinyoung Park ,&nbsp;Dayoung Ko ,&nbsp;Eun-jung Koo ,&nbsp;Hyunhee Kwon ,&nbsp;Ki Hoon Kim ,&nbsp;Dae Yeon Kim ,&nbsp;Seong Chul Kim ,&nbsp;Soo-Hong Kim ,&nbsp;Wontae Kim ,&nbsp;Hae-Young Kim ,&nbsp;Hyun-Young Kim ,&nbsp;So Hyun Nam ,&nbsp;Jung-Man Namgoong ,&nbsp;Junbeom Park ,&nbsp;Taejin Park ,&nbsp;Min-Jung Bang ,&nbsp;Jeong-Meen Seo ,&nbsp;Ji-Young Sul ,&nbsp;Joonhyuk Son ,&nbsp;Joohyun Sim ,&nbsp;Jeong Hong","doi":"10.1016/j.jpedsurg.2026.162948","DOIUrl":"10.1016/j.jpedsurg.2026.162948","url":null,"abstract":"<div><h3>Background</h3><div>This multicenter retrospective study aimed to compare key perioperative outcomes such as operative time, time to full enteral feeding, hospital stay duration, postoperative complications, and mortality, between laparoscopic and open surgical repair of congenital duodenal obstruction (CDO) performed by members of the Korean Association of Pediatric Surgeons (KAPS).</div></div><div><h3>Methods</h3><div>A national survey conducted between 2021 and 2023 provided data from 75 patients. Demographic characteristics, associated anomalies, anatomical types, surgical approach, and postoperative outcomes were compared between the laparoscopic (n = 36) and open (n = 39) groups.</div></div><div><h3>Results</h3><div>Among the 75 patients (30 males, 45 females; male-to-female ratio 1:1.5), no significant differences were observed between groups in sex, birth weight, or gestational age. Surgical procedures included 66 duodenoduodenostomies, four duodenojejunostomies, two gastrojejunostomies, two web excisions with duodenoplasty, and one segmental duodenal resection. Laparoscopic repair was associated with longer operative times (<em>p</em> = 0.005). Time to full enteral feeding was comparable in both groups (<em>p</em> = 0.117). Hospital stay was significantly shorter in the laparoscopic group (<em>p</em> = 0.012). Postoperative complications and mortality did not differ between groups; no deaths occurred.</div></div><div><h3>Conclusion</h3><div>Laparoscopic repair can be considered a safe and effective alternative to open surgery for selected patients with CDO, assuming adequate surgical expertise.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"61 5","pages":"Article 162948"},"PeriodicalIF":2.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146046822","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 use of the acellular dermal matrix in microtia reconstruction to decrease donor site morbidity after temporo-parietal fascia harvest","authors":"Maria Ida Rizzo ,&nbsp;Jacopo Maria Frattaroli ,&nbsp;Francesca Nascimben ,&nbsp;Marco Cirillo ,&nbsp;Marta Umbaca ,&nbsp;Marta Cajozzo ,&nbsp;Gaetano Paolo Dicorato ,&nbsp;Francesca Grussu ,&nbsp;Rossella Angotti ,&nbsp;Simone Faustino Marino ,&nbsp;Francesco Molinaro ,&nbsp;Giorgio Spuntarelli ,&nbsp;Urbano Urbani ,&nbsp;Mario Zama","doi":"10.1016/j.jpedsurg.2025.162753","DOIUrl":"10.1016/j.jpedsurg.2025.162753","url":null,"abstract":"<div><h3>Purpose</h3><div>To determine whether and how the use of an acellular dermal matrix (ADM) underneath a scalp flap after temporal fascia harvest reduces postoperative donor-site complications in microtia surgery.</div></div><div><h3>Methods</h3><div>This case‒control study included patients with congenital microtia who underwent primary ear reconstruction with porous polyethylene implants between 2018 and 2021. Group No-ADM patients (2018–2019), Group ADM patients (2020–2021). The skin quality outcomes of the scalp flap after temporal fascia harvest were analysed through pinch tests and ultrasound imaging. Aesthetical and psychosocial outcomes were tested with standardized questionnaires that were administered to the patients and their parents.</div></div><div><h3>Results</h3><div>20 patients (60 % male), 8 (40 %) in the No-ADM group and 12 (60 %) in the ADM group. Re-do surgery rate was higher in the No-ADM group than in the ADM group (17.5 % vs 5 %; p &lt; 0.05). The pinch test was used to assess the recovery of tissue elasticity in the 100 % ADM group, and it was negative in the 75 % No-ADM group (p &lt; 0.05). The median US thickness was 4.87 mm in the No-ADM group and 4.48 mm in the ADM group (p = 0.37). Aesthetic analysis revealed higher satisfaction levels among patients in the ADM group than in those in the non-ADM group. There was no significant difference in terms of quality of life between the two groups.</div></div><div><h3>Conclusions</h3><div>ADM use decreases local morbidity after facial harvest in the temporoparietal region. The greater thickness of the skin in the No-ADM group despite the absence of the ADM was probably due to greater fibrogenesis, which was limited by the ADM in the ADM group. In conclusion, ADM reduces the risk of postoperative subcutaneous scar adhesions.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"61 5","pages":"Article 162753"},"PeriodicalIF":2.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145422016","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":"Thoracoscopic near-infrared localization and division of H-type tracheoesophageal fistulas in newborns: A case series","authors":"Xun Guo ,&nbsp;Yao Liu ,&nbsp;Qiang Yu ,&nbsp;Qianlong Liu ,&nbsp;Xiang Ji ,&nbsp;Chunlin Miao ,&nbsp;Peng Li","doi":"10.1016/j.jpedsurg.2026.162949","DOIUrl":"10.1016/j.jpedsurg.2026.162949","url":null,"abstract":"<div><h3>Purpose</h3><div>Congenital H-type tracheoesophageal fistula (H-TEF) is a rare congenital esophageal malformation. Treatment involves minimally invasive surgery; however, accurate fistula localization remains challenging. Real-time imaging via near-infrared (NIR) thoracoscopy facilitates the distinction between different tissue structures. Therefore, we aimed to evaluate the clinical efficacy of the NIR-thoracoscopic simple clip method for treating congenital H-TEFs in neonates.</div></div><div><h3>Methods</h3><div>Neonates with H-TEFs underwent thoracoscopic NIR localization using indocyanine green (ICG) injection, followed by clipping and division. The inclusion criteria were: (1) H-TEF confirmed by esophagography and/or bronchoscopy, (2) fistula below T2 level, (3) birth weight ≥2.0 kg, and (4) parental consent. The exclusion criteria were: (1) severe cardiopulmonary malformations/coagulopathy, (2) prior TEF repair, and (3) surgical contraindications. After successful general anesthesia, the patient was placed in the supine position, and ICG (0.1 mg/mL) was injected into the fistula lumen under bronchoscopic guidance. The patient was then moved to the right supine position for the thoracoscopic surgery.</div></div><div><h3>Results</h3><div>Six neonates (male: 4, female: 2; median operative age: 7 days, range: 3–15 days; birth weight: 2.8 kg, range: 2.1–3.5 kg). They presented with dyspnea (6/6), cyanosis during feeding (6/6), and persistent pulmonary infection (4/6). The median operative time was 65 min (range: 53–77 min), and blood loss was &lt;5 mL. Transient hoarseness occurred in one patient (resolved in 7 days). No recurrences or strictures were observed during follow-up (median, 18 months).</div></div><div><h3>Conclusion</h3><div>Preoperative bronchoscopic ICG injection facilitates NIR thoracoscopic localization and dissection of intrathoracic H-TEFs in newborns.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"61 5","pages":"Article 162949"},"PeriodicalIF":2.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146093332","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":"Preservation of the azygos vein versus ligation of the azygos vein during surgical repair of esophageal atresia-tracheoesophageal fistula-a systematic review and meta-analysis","authors":"Usama Shahid ,&nbsp;Khadija Jameel ,&nbsp;Areeba Sajid ,&nbsp;Eesha Baig ,&nbsp;Ummulkiram Hasnain ,&nbsp;Barka Sajid ,&nbsp;Vania Saqib ,&nbsp;Shajie Ur Rehman Usmani","doi":"10.1016/j.jpedsurg.2026.162929","DOIUrl":"10.1016/j.jpedsurg.2026.162929","url":null,"abstract":"<div><h3>Introduction</h3><div>Esophageal atresia-tracheoesophageal fistula (EA-TEF) is amongst the most common life-threatening developmental anomalies. For the surgical repair of esophageal atresia-tracheoesophageal fistula (EA-TEF), several interventional modifications have been suggested. One such modification is the preservation of the azygos vein, a key draining vein for the esophagus and surrounding structures. However, there is no clear consensus on the subject.</div></div><div><h3>Objective</h3><div>To evaluate whether preservation of the azygous vein offers clinical benefits compared with its ligation during primary repair of esophageal atresia.</div></div><div><h3>Methodology</h3><div>A comprehensive review of the literature was conducted across PubMed, Cochrane Library (CENTRAL), ScienceDirect, and Google Scholar for eligible studies from inception till July 2025. Eligible studies included were Randomized Controlled Trials (RCTs) and non-Randomized Control Trials (non-RCTs) comparing surgical correction of EA-TEF in neonates with Azygous vein ligation vs preservation. Quality assessment was done using Cochrane RoB-2 and ROBINS-I, while Eggers Begg test was used for Publication bias. Data was pooled using a Random-effects model, and heterogeneity was assessed via I² statistics.</div></div><div><h3>Results</h3><div>Nine studies, six RCTs, two retrospective studies, and one prospective study, including a total of 955 newborns, met the inclusion criteria. The analysis indicated that preservation of the azygos vein was associated with decreased incidence infections (RR = 0.34; 95 % CI: 0.22 to 0.52; P &lt; 0.001), and mortality (RR = 0.46; 95 % CI = 0.27 to 0.77; P = 0.003). However, no significant difference in operative time, anastomotic leakage, incidence of tracheoesophageal fistula and esophageal stricture were identified between the two groups.</div></div><div><h3>Conclusion</h3><div>Preservation of the azygos vein during esophageal atresia repair appears to reduce mortality and postoperative infections. However, further high-quality multicenter studies are needed to confirm these benefits.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"61 5","pages":"Article 162929"},"PeriodicalIF":2.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145989751","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":"Surgery through the spectrum: Behavioral and analgesic outcomes in children with autism","authors":"Ryan T. Davis,&nbsp;Darina Malinova,&nbsp;Ryan D. Rosen,&nbsp;Rachael M. Galvin,&nbsp;Kelli N. Patterson,&nbsp;Elika Ridelman,&nbsp;Christina Shanti","doi":"10.1016/j.jpedsurg.2026.162969","DOIUrl":"10.1016/j.jpedsurg.2026.162969","url":null,"abstract":"<div><h3>Background</h3><div>Children with autism spectrum disorder (ASD) may experience communication differences and sensory sensitivities relevant to perioperative care. Evidence comparing perioperative outcomes and opioid prescribing practices in this population is limited. We evaluated the perioperative course and discharge opioid prescribing patterns in children with ASD versus matched neurotypical peers undergoing ambulatory surgery.</div></div><div><h3>Methods</h3><div>We conducted a retrospective matched cohort study (June 1, 2015–June 1, 2025) of children &lt;18 years undergoing ambulatory surgery at a tertiary pediatric hospital. ASD patients were matched 1:2 with neurotypical controls by age, sex, American Society of Anesthesiologists (ASA) classification, and procedure type. Communication and behavioral characteristics reflected documented history; controls were selected to exclude neurodevelopmental diagnoses. Outcomes included perioperative agitation, recovery time, unplanned admission, and discharge opioid prescribing. Opioid doses were converted to morphine milligram equivalents (MME). Group comparisons used chi-square/Fisher exact and Wilcoxon rank-sum tests.</div></div><div><h3>Results</h3><div>Forty-five ASD patients and 90 controls were included. Preoperative agitation (11.1 % vs 1.1 %) and benzodiazepine use (11.1 % vs 1.1 %) were more common in the ASD group (p = 0.016). Pain scores, recovery duration, and postoperative analgesic use were similar. Unplanned admission occurred only in the ASD group (6.7 % vs 0 %, p = 0.02), exclusively for agitation. ASD patients were less likely to receive an opioid prescription (13.3 % vs 31.1 %, p = 0.03), with comparable MME among those prescribed (p = 0.82).</div></div><div><h3>Conclusions</h3><div>Children with ASD undergoing ambulatory surgery demonstrate similar postoperative pain outcomes and comparable opioid doses when prescribed. Higher perioperative agitation and unplanned admissions support individualized preparation and sensory-aware strategies to promote equitable recovery.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"61 5","pages":"Article 162969"},"PeriodicalIF":2.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146097263","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":"Diagnostic assessment of Hirschsprung disease using fluorescence confocal microscopy: A feasibility study","authors":"Yannick Braun ,&nbsp;Elise Gradhand ,&nbsp;Florian Friedmacher ,&nbsp;Barbara Walczak ,&nbsp;Henning C. Fiegel ,&nbsp;Till-Martin Theilen ,&nbsp;Udo Rolle ,&nbsp;Peter Wild ,&nbsp;Steffen Gretser","doi":"10.1016/j.jpedsurg.2026.162973","DOIUrl":"10.1016/j.jpedsurg.2026.162973","url":null,"abstract":"<div><h3>Introduction</h3><div>Hirschsprung disease (HD) is a congenital disorder marked by aganglionosis of intestinal nerve plexuses, leading to bowel obstruction. Determining the extent of the aganglionic segment is essential for successful surgical correction. Consequently, the extent of aganglionosis must be examined histologically. Fluorescence confocal microscopy (FCM) may serve as an alternative diagnostic modality. Using a laser to scan the unfixed specimen, it enables rapid intraoperative imaging without causing tissue alteration. This study assessed the feasibility and diagnostic accuracy of FCM in evaluating Hirschsprung disease in pediatric patients.</div></div><div><h3>Materials and methods</h3><div>Patients undergoing rectal biopsy, ostomy closure, or transanal endorectal pull-through (TERPT) at our center from January to August 2024 were included. Tissue samples were imaged by FCM followed by frozen section and formalin-fixed paraffin-embedded (FFPE) histology. Image quality, assessability of submucosal and myenteric plexuses, and diagnostic agreement with FFPE sections were investigated.</div></div><div><h3>Results</h3><div>A total of 34 samples from 8 patients were analyzed by FCM and FFPE, the 24 TERPT-derived samples were additionally analyzed by frozen section. Diagnostic agreement with FFPE was 78.5 % for FCM and 86.9 % for frozen sections (p = 0.49). Among fully assessable samples, FCM achieved 80.9 % agreement with FFPE compared to 86.4 % for frozen sections.</div></div><div><h3>Conclusion</h3><div>FCM is an easy-to-implement method for identifying normal and affected bowel in HD. It is used on unfixed specimens, preserving the tissue quality. Its diagnostic accuracy is comparable to that of frozen sections in assessable samples, and it is advantageous in cases where local access to expert pathologists is limited.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"61 5","pages":"Article 162973"},"PeriodicalIF":2.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146100386","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":"Mastering the learning curve with quality assurance: Outcomes of robot-assisted ureteral reimplantation in a pediatric cohort","authors":"Shi Shengkun ,&nbsp;Liu Xin ,&nbsp;Yin Xiaoming ,&nbsp;Gao Xiaofeng ,&nbsp;You Jia ,&nbsp;Yang Yi","doi":"10.1016/j.jpedsurg.2026.162941","DOIUrl":"10.1016/j.jpedsurg.2026.162941","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Robot-assisted extravesical ureteral reimplantation (REVUR) is a minimally invasive procedure for treating vesicoureteral reflux (VUR) and obstructive megaureter in children. Compared to traditional open surgery (OS) and laparoscopic surgery (LS), REVUR offers potential advantages in precision during dissection and suturing. However, its learning curve and clinical benefits require further validation within regional medical practice.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;div&gt;This study aimed to compare the perioperative outcomes and efficacy of REVUR, LS, and OS in pediatric patients with VUR or megaureter. Additionally, we used the cumulative sum (CUSUM) control chart to quantitatively analyze the learning curve and surgical quality of REVUR.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;This single-center retrospective cohort study included children (≤14 years old) who underwent primary ureteral reimplantation between January 2014 and January 2025. Patients were divided into three groups based on surgical technique: the OS group (n = 74, intravesical approach), the LS group (n = 35, intravesical approach), and the REVUR group (n = 53, extravesical approach). The primary outcome was the overall success rate, defined as meeting both radiographic and clinical success criteria. Multivariable regression models adjusted for baseline confounders. For the REVUR group, time-based CUSUM analysis evaluated the learning curve, while failure-based CUSUM charts enabled continuous surgical quality monitoring.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;A total of 162 patients were included. After adjusting for confounders—including age, VUR grade, and whether ureteral tapering was performed—no statistically significant differences were observed among the three groups in radiographic success rate (OR = 1.475, P = 0.318), clinical success rate (OR = 0.850, P = 0.744), or overall success rate (OR = 1.070, P = 0.827). However, compared to the OS and LS groups, the REVUR group had a significantly shorter postoperative hospital stay (P &lt; 0.001) and a shorter duration of catheterization (P &lt; 0.001), although total hospitalization costs were significantly higher (P &lt; 0.001). Learning curve analysis indicated that proficiency in REVUR was achieved after approximately 11 cases for non-tapered reimplantation and 9 cases for those requiring tapering. Quality monitoring via CUSUM charts showed that the failure rate remained within an acceptable range (overall failure rate 9.4 %) across 53 consecutive procedures, with the process under statistical control.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;In this study, REVUR via the extravesical approach achieved long-term success rates similar to those of OS and LS via the intravesical approach. REVUR was associated with faster postoperative recovery but incurred significantly higher costs. CUSUM analysis confirmed that the learning curve for REVUR is manageable and safe. Future prospective studies are needed to","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"61 5","pages":"Article 162941"},"PeriodicalIF":2.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146097227","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":"Efficacy of autologous intestinal reconstruction surgery on bowel dilatation in pediatric small bowel syndrome","authors":"Oona Nieminen ,&nbsp;Annika Mutanen ,&nbsp;Maria Hukkinen ,&nbsp;Reetta Kivisaari ,&nbsp;Mikko P. Pakarinen","doi":"10.1016/j.jpedsurg.2026.163002","DOIUrl":"10.1016/j.jpedsurg.2026.163002","url":null,"abstract":"<div><h3>Objectives</h3><div>Pediatric short bowel syndrome (SBS) may cause excessive bowel dilatation leading to worsened outcomes and autologous intestinal reconstruction (AIR) surgery. We addressed efficacy of AIR surgery by measuring duodenal, small bowel and colon dilatation in SBS children with and without AIR surgery in relation to parenteral nutrition (PN) dependency and healthy control patients.</div></div><div><h3>Methods</h3><div>SBS children having undergone AIR surgery (AIR+, n = 22) and those without AIR surgery (AIR-, n = 56) were included. Intestinal contrast series performed between 2002 and 2020 were analyzed to measure diameter of duodenum, small bowel, and colon, and their postoperative changes. Results were expressed as diameter ratio (DR) standardized to L5 vertebrae height. Previously established cutoff values for abnormal bowel dilatation in unoperated SBS patients and healthy controls were used for comparison.</div></div><div><h3>Results</h3><div>AIR+ patients had shorter remaining bowel and less frequently ileocecal valve (ICV) preserved. Preoperatively, only small bowel DR (SBDR) was weakly associated with the need for AIR surgery. SBDR decreased significantly (p &lt; 0.05) by 30 % after AIR surgery, while no significant decrease of DR was observed in duodenum or colon. Over half of AIR+ patients whose SBDR decreased after surgery (69 %), weaned off PN during median follow-up of 7.2 years (3.6-16). Patients with postoperative reduction of SBDR to the degree of unoperated SBS patients were more likely to wean off PN.</div></div><div><h3>Conclusions</h3><div>Our findings suggest that bowel dilatation is unreliable sole indication for AIR surgery, while effective postoperative reduction of dilatation was associated with weaning off PN.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"61 5","pages":"Article 163002"},"PeriodicalIF":2.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146132083","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":"Oral antibiotic exposure and the risk of overweight and obesity in children with vesicoureteral reflux","authors":"Takayuki Fujii,&nbsp;Nanami Harada,&nbsp;Hiroto Katami,&nbsp;Aya Tanaka,&nbsp;Ryuichi Shimono","doi":"10.1016/j.jpedsurg.2026.163003","DOIUrl":"10.1016/j.jpedsurg.2026.163003","url":null,"abstract":"<div><h3>Background</h3><div>Continuous antibiotic prophylaxis (CAP) is widely used in children with vesicoureteral reflux (VUR) to prevent recurrent urinary tract infections, but its long-term metabolic effects are uncertain. We evaluated whether oral antibiotic exposure is associated with overweight and obesity in young children with VUR.</div></div><div><h3>Methods</h3><div>Using the TriNetX Research Network, we conducted a retrospective cohort study of children aged &lt;5 years diagnosed with VUR between 2005 and 2025. Patients were classified as antibiotic-exposed or unexposed based on prescription patterns, and propensity score matching balanced baseline covariates. Overweight and obesity were defined using body mass index (BMI) percentiles and diagnosis codes. We performed U.S.-only sensitivity and age-stratified analyses (&lt;1 year; 1–4 years) and calculated the number needed to harm (NNH).</div></div><div><h3>Results</h3><div>After matching, 2665 patients were included per group. In the primary cohort aged &lt;5 years, BMI percentile-defined overweight and obesity occurred in 60 (2.3 %) of antibiotic-exposed patients and 21 (0.8 %) of unexposed patients (hazard ratio [HR], 3.25; 95 % confidence interval [CI], 1.97–5.34; log-rank p &lt; 0.001). Results were similar using diagnosis code-based definitions (1.3 % vs. 0.6 %; HR, 2.30; 95 % CI, 1.27–4.17; log-rank p = 0.005). Associations persisted in U.S.-only analyses and were stronger in children aged &lt;1 year. The NNH for BMI-defined overweight/obesity was 69.</div></div><div><h3>Conclusions</h3><div>Early oral antibiotic exposure in children with VUR was significantly associated with increased risk of overweight and obesity. However, given the low absolute number of events, these findings should be interpreted cautiously and weighed against the potential benefits of CAP.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"61 5","pages":"Article 163003"},"PeriodicalIF":2.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146132076","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":"Exploring Health Literacy and Clinical Outcomes Among Caregivers of Children Undergoing Gastrostomy Tube Placement.","authors":"Lavanya Easwaran, Catherine C Dawson-Gore, Ana Ibarra Meraz, Claudia Mata, Jose L Diaz-Mirón, Shannon N Acker","doi":"10.1016/j.jpedsurg.2026.163178","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2026.163178","url":null,"abstract":"<p><strong>Background: </strong>Surgical gastrostomy tubes (G-tubes) are common pediatric surgery procedures; however, they require caregiver perioperative education for appropriate management. One factor that has not been well explored is the impact of caregiver health literacy on the effectiveness of G-tube education. This study aimed to understand caregiver health literacy levels and associated clinical outcomes to inform design of future education interventions.</p><p><strong>Methods: </strong>A prospective cohort analysis was performed for caregivers of children who underwent initial G-tube placement from 11/2024-7/2025. Data collection included demographic information, assessment of sociodemographic factors, assessment of health literacy using the validated Parental Health Literacy Activities Test (PHLAT-8) score, and presence of complications and health resource utilization 30 days after surgery. Descriptive statistics were reported. PHLAT-8 scores were compared by education and annual household income level. Poisson and logistic regression models were used to predict clinical outcomes.</p><p><strong>Results: </strong>Of the 86 eligible caregivers approached, 49 consented to participate in the study. The median PHLAT-8 score was 6 (IQR 6-8). Higher scores were associated with higher attained education levels and higher annual household income (p < 0.05 for both). There was no association between PHLAT-8 scores and health utilization or complications 30 days after surgery.</p><p><strong>Conclusion: </strong>All caregivers in our study demonstrated adequate health literacy. In contrast to prior data, this series did not find any differences in health care utilization or complication rates based on parental health literacy, indicating our population may have appropriate literacy levels to understand the management of pediatric G-tubes.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"163178"},"PeriodicalIF":2.5,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147816483","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}