Journal of pediatric surgery最新文献

{"title":"Implementation of a Competency-Based Training Program in Pediatric Surgery: A Pilot Study","authors":"Rebecca Moreci , Brianna Spencer , Brian Fallon , Calista Harbaugh , Benjamin Zendejas , Brian W. Gray , Samuel Alaish , Jose Diaz-Miron , Peter Ehrlich , Samir Gadepalli , Erika Newman , Gurjit Sandhu , Ronald Hirschl","doi":"10.1016/j.jpedsurg.2025.162257","DOIUrl":"10.1016/j.jpedsurg.2025.162257","url":null,"abstract":"<div><h3>Introduction</h3><div>Current surgical trainees experience less autonomy in their training than prior generations. Intentionally integrating graduated autonomy into the educational development of fellows would enhance trainee competence while providing the safety net of fellowship programming. The objective of this study was to pilot a competency-based training (CBT) approach for pediatric surgery fellowship programs.</div></div><div><h3>Methods</h3><div>A CBT approach was developed at a single pediatric surgery fellowship program. Three goals were identified for the development of the CBT structure: 1) demonstrate flexibility for trainees to gain knowledge and skills at individualized paces, 2) readily identify and address knowledge gaps, and 3) facilitate increased autonomy for fellows while in training, in areas where competence has been successfully assessed. The CBT program consisted of five components: operative evaluations, a communication assessment tool (CAT), entrustable professional activities (EPAs), oral exams, and video reviews. Once a fellow completed the minimum requirements of each component, they proceeded to the final review at the clinical competency committee (CCC) meeting. For this pilot, we tracked the changes that were made to the program over the first few years as well as progression of the first six fellows and their participation in the various components.</div></div><div><h3>Results</h3><div>Between 2017 and 2023, six pediatric surgery fellows were evaluated by fourteen pediatric surgery faculty. Three fellows progressed through the pilot program with three procedures (Laparoscopic Appendectomy, Laparoscopic Inguinal Hernia Repair, and Laparoscopic Pyloromyotomy), while the other three fellows progressed through the program with these three initial and two additional procedures (Laparoscopic Gastrostomy Tube Placement and Open Malrotation Repair). The median number of each component completed was: 5 CATs, 101 operative evaluations, 4 oral exams, and 3 video reviews. Fellows achieved competency for 1–4 procedures. From semi-structured interviews, fellows appeared overall satisfied with their experience of the CBT program, stating that these additional sets of tasks and requirements were a helpful thought exercise, provided an extra layer of structure to the curriculum, created a culture of independence and autonomy, and gave added purpose to the first year of training. The principal strength of the program was the structured format leading to graduated autonomy. All fellows reported feeling very prepared to move into a faculty role following graduation from fellowship training.</div></div><div><h3>Conclusion</h3><div>Competency-based training may allow for identification of specific gaps in knowledge, skills or abilities and support progressive autonomy among trainees prior to fellowship graduation. Generating further validity evidence and engaging in implementation research are necessary for quality improveme","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 5","pages":"Article 162257"},"PeriodicalIF":2.4,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143681009","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 Prognostic Impact of Defect Size Based on Body Surface Area in Omphaloceles","authors":"Bade Toker Kurtmen,&nbsp;Dilnur Sevinc,&nbsp;Emine Burcu Cigsar Kuzu","doi":"10.1016/j.jpedsurg.2025.162264","DOIUrl":"10.1016/j.jpedsurg.2025.162264","url":null,"abstract":"<div><h3>Introduction</h3><div>This study addresses the existing gaps in understanding the cases with omphalocele by investigating the potential prognostic impact of the ratio between omphalocele diameter-and -body surface area (BSA), particularly in premature and low birth weight neonates.</div></div><div><h3>Material and methods</h3><div>Data retrieved from the hospital files of 25 patients with omphalocele related to their gestational histories, demographics, anthropometric data, comorbidities, defect diameters, and prognoses were retrospectively analyzed. BSA was calculated using the Haycock Formula. Binary logistic regression analysis performed identified mortality-associated factors.</div></div><div><h3>Results</h3><div>Most (84 %) of the patients with omphalocele, required mechanical ventilation, and the median hospital stay was 19 days. There was no significant correlation between defect diameter or defect diameter-to-BSA ratio and hospital stay. Mortality rate in these patients was 24 %, with a significantly higher mean (±SD) defect diameter-to-BSA ratio in non-survivors compared to survivors (467.9 ± 54.8 vs. 283.1 ± 24.8; p = 0.002). Logistic regression analysis identified the defect diameter-to-BSA ratio as a significant predictor of mortality (p = 0.023, Exp(B) = 1.038, 95 % CI: 1.005–1.072). Other variables, including defect size, cardiac anomalies, and solid organ presence in the sac, were not significant predictors.</div></div><div><h3>Conclusion</h3><div>This study underscores the superior prognostic value of the defect diameter-to-BSA ratio for omphalocele patients, surpassing conventional markers such as defect diameter, cardiac anomalies, and the presence of solid organs in the sac.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 5","pages":"Article 162264"},"PeriodicalIF":2.4,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143609842","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":"Standardised Functional Assessment in Females With Low Anorectal Malformation to Determine Need for Surgery","authors":"Judith Lindert,&nbsp;Joe I. Curry","doi":"10.1016/j.jpedsurg.2025.162263","DOIUrl":"10.1016/j.jpedsurg.2025.162263","url":null,"abstract":"<div><h3>Background</h3><div>The indications for surgical treatment in females with anterior anus remain controversial. We analysed the clinical outcomes in two groups: those who underwent surgery and those who received conservative treatment. We propose a standardized assessment, focusing on functional aspects, to determine the necessity of surgical intervention.</div></div><div><h3>Methods</h3><div>A retrospective chart review was conducted on 24 girls who underwent examination under anesthesia (EUA) for an abnormal anal opening between June 2008 and March 2022. All patients were treated by a single surgeon at a tertiary pediatric surgery center.</div><div>The mean age at EUA was 8 months, with children requiring surgery being younger (mean age: 6.5 months) than those who did not need surgery (mean age: 12.5 months). The mean anal size, measured using a Hegar dilator, was significantly larger in non-surgical cases (mean Hegar size: 13, p = 0.002). The ability of the sphincter to close the anus was observed in 56 % of children who did not require surgery but was absent in all those who underwent surgery (p = 0.028).</div><div>Surgical intervention was deemed unnecessary when the anal opening was appropriate for the child's body weight and the anus closed upon contraction. During long-term follow-up (mean duration: 59 months), no additional surgeries were required. Previous treatments and bowel function at the last follow-up were also documented.</div></div><div><h3>Results</h3><div>None of the patients managed conservatively went on to need any further surgical input.</div></div><div><h3>Conclusion</h3><div>In our series, patients who underwent surgery had a significantly smaller anal orifice (relative to age) on calibration and were more likely to have an orifice that did not close upon sphincter stimulation.</div><div>When the anal opening is functionally adequate in size and the sphincter can close it—regardless of its anatomical position within the sphincter—a conservative approach is recommended. Notably, none of the patients managed conservatively required surgery later. Families need to be councelled that constipation may happen in the operated as well as in the non operated group.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 5","pages":"Article 162263"},"PeriodicalIF":2.4,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143580564","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":"Comment on 'Respiratory Outcomes in Children Born With Esophageal Atresia With or Without Tracheoesophageal Fistula: A Retrospective Longitudinal Cohort Study'.","authors":"Bekir Erdeve, Tutku Soyer","doi":"10.1016/j.jpedsurg.2025.162265","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2025.162265","url":null,"abstract":"","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"162265"},"PeriodicalIF":2.4,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143597183","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: Factors Influencing Success in Endoscopic Treatment of Grade 4-5 Primary Vesicoureteric Reflux (VUR) in Infancy and Childhood.","authors":"Naser El-Mefleh, Osama Al-Omar","doi":"10.1016/j.jpedsurg.2025.162261","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2025.162261","url":null,"abstract":"","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"162261"},"PeriodicalIF":2.4,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586098","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":"Decreasing Length of Stay for Simple Gastroschisis: Analysis of the National Surgical Quality Improvement Program (NSQIP)","authors":"Erwin T. Cabacungan ,&nbsp;Amy J. Wagner ,&nbsp;Ruby Gupta","doi":"10.1016/j.jpedsurg.2025.162262","DOIUrl":"10.1016/j.jpedsurg.2025.162262","url":null,"abstract":"<div><h3>Background</h3><div>Gastroschisis (GS) is the most common abdominal defect in infants, yet lack of consensus has led to variations in its management and outcomes. Length of stay (LOS) is an important measure of surgical quality and efficiency in GS infants. LOS depends on clinical and patient-related factors such as simple (sGS) or complex (cGS), type of surgery, associated complications, and factors such as the use of standardized care protocols.</div></div><div><h3>Objectives</h3><div>To determine the annual trends in LOS for sGS and identify the predictors leading to these trends.</div></div><div><h3>Methods/design</h3><div>We conducted a retrospective cohort study of infants with sGS using the 2012–2022 NSQIP-Pediatrics dataset. Predictor variable for LOS was the year of admission divided into five groups. Demographics, preoperative risk factors, and postoperative complications and outcomes were collected.</div></div><div><h3>Results</h3><div>From 2012 to 2022, median LOS decreased by five days (30–25 days, p-value= &lt;0.001). We also found that there was a decrease sGS cases in NSQIP dataset (0.34/100 to 0.16/100 infants, p-value= &lt;0.001) was noted. There was an increasing percentage of sGS for Hispanic race, inborn, higher birthweight, and superficial incisional surgical site infection (sSSI), a trend towards increasing gestational age, but no differences in timing of surgery and unplanned readmission. Stratified Cox proportional model analysis revealed that gestational age of &lt;36 weeks, bleeding/transfusions [Hazard Ratio (HR) = 0.53, p &lt; 0.001] and nutritional support at discharge (HR = 0.27, p &lt; 0.001) were associated with significantly longer LOS.</div></div><div><h3>Conclusion</h3><div>The trends in LOS reduction in sGS infants point towards higher birth weight, later gestational age and more optimal management. It underscores the importance of utilizing national registry databases to better understand the outcomes. Despite these improvements, the observed variations in demographics and outcomes indicate a need for standardized care protocols and a better understanding of the factors influencing LOS.</div></div><div><h3>Level of Evidence</h3><div>Level II.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 5","pages":"Article 162262"},"PeriodicalIF":2.4,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143580563","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":"Fibrosis in Distal Rectum of Anorectal Malformation: A Clinicopathological Study","authors":"Siqi Li ,&nbsp;Shiru Ye ,&nbsp;Huan Li ,&nbsp;Meng Wang ,&nbsp;Yidi Chi ,&nbsp;Ruyue Gao ,&nbsp;Long Li","doi":"10.1016/j.jpedsurg.2025.162260","DOIUrl":"10.1016/j.jpedsurg.2025.162260","url":null,"abstract":"<div><h3>Background</h3><div>The distal rectum may have neuromuscular system abnormalities, which could be the causes of constipation of anorectal malformations (ARMs). This study aimed to characterize fibrosis in the distal rectum. To propose new hypotheses for the mechanism of constipation and provide histopathological evidence for the distal rectum resection during anorectoplasty.</div></div><div><h3>Methods</h3><div>Thirty intermediate/high-type ARMs patients were included in this study. The hematoxylin and eosin and Masson trichrome stains were used to conduct the histologic examination. The degree of fibrosis of intestinal wall at different distances from the end of the rectum were evaluated, and correlated with clinical features.</div></div><div><h3>Results</h3><div>The significant histopathological features of the rectal end were thickened intestinal wall, fibrosis in the submucosa and muscularis propria. All the end rectum had moderate/severe fibrosis, and 78 % of the 4–6 cm distal rectum had no or only mild fibrosis. The distal rectal fibrosis degree wasn't related to the ARMs type (<em>P</em> = 0.639), but was related to the rectal dilation degree (<em>P</em> = 0.026). The number of ganglion cells was correlated with the collagen plexus layer thickness (r = −0.537, <em>P</em> &lt; 0.001). The length and width of fistula were related to collagen deposition (r = 0.503, <em>P</em> = 0.028 and r = −0.618, <em>P</em> = 0.014).</div></div><div><h3>Conclusions</h3><div>The distal rectum of ARMs exhibited fibrosis, smooth muscle dysplasia, and reduced ganglion cells, which may have clinical consequences such as motility abnormalities and increased wall stiffness. The obstruction and dilation of the rectal end may be closely associated with fibrosis.</div></div><div><h3>Level of evidence</h3><div>Level III.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 5","pages":"Article 162260"},"PeriodicalIF":2.4,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143593624","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 of Splenic Vascular Anomalies: A Review of 17 Pediatric Cases at a Single Institution","authors":"Josephine L. Schmidt ,&nbsp;Michael B. Gyimah ,&nbsp;Bea B. Jeon ,&nbsp;Amir H. Pezeshkmehr ,&nbsp;Alex Chau ,&nbsp;Ionela Iacobas ,&nbsp;Kristy L. Rialon","doi":"10.1016/j.jpedsurg.2025.162254","DOIUrl":"10.1016/j.jpedsurg.2025.162254","url":null,"abstract":"<div><h3>Background</h3><div>Splenic Vascular Anomalies (SVA) are rare splenic masses seen in the pediatric population. There is limited information regarding the management and appropriate follow-up for these patients. The aim of this study was to review our experience and create an algorithm to help guide clinical care.</div></div><div><h3>Methods</h3><div>A retrospective review of pediatric patients diagnosed with SVA from 2011 to 2024 was performed. Clinical history and outcomes data were summarized descriptively. A Mann–Whitney U test was performed to compare SVA diameters between surgical and nonsurgical groups.</div></div><div><h3>Results</h3><div>Seventeen patients met inclusion criteria for this study. SVA was identified incidentally in 15 patients (88 %). The median maximal SVA diameter was 5.2 cm (range: 5–7 cm) for the six surgical patients and 3.6 cm (range: 1–5.7 cm) for the 11 nonsurgical patients (p = 0.009). Five patients (83 %) underwent total splenectomy, and one patient (17 %) underwent partial splenectomy. Indications for splenectomy included persistent abdominal pain, large size on imaging, and concern for splenic rupture. Preoperative imaging correlated with postoperative pathology in 4/6 (66 %) surgical patients. Among all patients, the median number of days between the first imaging study to identify the SVA and the last study monitoring the SVA was 632 days (range: 0–2337 days). The median change in SVA maximal diameter during that time was 0.05 cm (range: −1.6 – 0.9 cm).</div></div><div><h3>Conclusion</h3><div>SVA can be monitored with serial imaging and do not undergo rapid growth. Most operative interventions are performed based on SVA size (&gt;5 cm) and rarely on symptoms.</div></div><div><h3>Level of evidence</h3><div>4.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 5","pages":"Article 162254"},"PeriodicalIF":2.4,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143549701","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 Growing Spine, a Lifelong Footprint: Rethinking Carbon and the Socioeconomic Exposome in Paediatric Spine Surgery.","authors":"Christos Tsagkaris, Saverio Marmentini","doi":"10.1016/j.jpedsurg.2025.162256","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2025.162256","url":null,"abstract":"","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"162256"},"PeriodicalIF":2.4,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143567484","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 55th Annual Meeting of the Canadian Association of Pediatric Surgeons.","authors":"Alana L Beres","doi":"10.1016/j.jpedsurg.2025.162255","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2025.162255","url":null,"abstract":"","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"162255"},"PeriodicalIF":2.4,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143597187","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}