Journal of pediatric surgery最新文献

{"title":"Perioperative Planning for Expedited Operative Evaluation of Suspected Biliary Atresia.","authors":"Asher Liu, Joan Lee, Ruba Azzam, Grace Mak, Brady Still, Baddr A Shakhsheer","doi":"10.1016/j.jpedsurg.2026.163541","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2026.163541","url":null,"abstract":"","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"163541"},"PeriodicalIF":2.3,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137277","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":"One-year outcomes for patients undergoing antegrade continence enema procedures without prior rectal enema therapy: a Pediatric Colorectal and Pelvic Learning Consortium study.","authors":"Kathryn McNevin, Paul L McClure, Hira Ahmad, Jeffrey Avansino, Samuel Rice-Townsend, Kelly Austin, Andrea Badillo, Juan L Calisto, Casey M Calkins, Rachel C Crady, Megan M Durham, Julie R Fuchs, Christopher Gayer, Julia E Grabowski, Jamie C Harris, Charles R Hong, Akemi L Kawaguchi, Ankur Rana, Ron W Reeder, Rebecca M Rentea, Michael D Rollins, Nelson Rosen, Payam Saadai, Cristine S Velazco, Richard J Wood, Caitlin A Smith","doi":"10.1016/j.jpedsurg.2026.163528","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2026.163528","url":null,"abstract":"<p><strong>Purpose: </strong>Antegrade continence enemas (ACE) delivered through surgically placed channels help achieve social continence in children with colorectal disorders. Historically, a successful rectal enema program was required before ACE creation, but high-volume centers increasingly perform ACE upfront, particularly for patients intolerant of rectal enemas. This study describes a cohort of patients who underwent upfront ACE for bowel management within a multicenter consortium of high-volume pediatric colorectal centers, with 30-day and one-year outcomes.</p><p><strong>Methods: </strong>We retrospectively evaluated patients who underwent a primary ACE channel at institutions participating in a multicenter pediatric colorectal consortium (2017-2025), excluding those with a redo ACE or a pre-existing ostomy.</p><p><strong>Results: </strong>Among 171 patients who underwent upfront ACE (median age 7.0 years), diagnoses included anorectal malformation (54.4%), functional constipation (36.3%), and Hirschsprung disease (9.9%); approximately one-third had an associated psychiatric or neurodevelopmental diagnosis. Most had already failed oral laxative therapy (71.3% vs 37.6% of the 402 patients treated with rectal enemas before ACE). Complication rates were low at 30 days (6.4%) and one year (11.1%), comparable to those of the prior-enema cohort. At one year, 90.0% (117/130) were still using ACE flushes as their primary bowel management, and 6.4% (11/171) had discontinued flushes, none because of an inability to manage constipation or incontinence. Toilet-based stooling, which is the denominator from which the registry records stool accidents, was achieved in 70.5%, similar to the prior-enema cohort (74.6%). Among patients who stooled in a toilet, 56.0% reported no stool accidents.</p><p><strong>Conclusion: </strong>Upfront ACE was associated with low complication rates and successful bowel management at one year, with 90.0% continuing ACE flushes and no discontinuations attributable to failure of bowel management. These outcomes were achieved within established multidisciplinary colorectal programs and may not be reproducible in settings without comparable longitudinal support. Further investigation is needed to assess long-term success and compliance and to identify populations who would benefit most from this approach.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"163528"},"PeriodicalIF":2.3,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137318","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":"Does it Fit? Testing a Novel Pediatric Surgical Risk Calculator in Africa.","authors":"Alan Zambeli-Ljepović, Samuel Negash, Rahwa Amha Kinfe, Samuel Mesfin Girma, Architha Kannan, Chisom Udeigwe, Doruk Ozgediz, Tihitena Negussie Mammo, Samuel Gashu, Felix Alakaloko, Justina Seyi-Olajide, Emmanuel Ameh","doi":"10.1016/j.jpedsurg.2026.163524","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2026.163524","url":null,"abstract":"<p><strong>Background: </strong>Low- and middle-income countries (LMICs), particularly Sub-Saharan Africa, experience a high burden of surgical disease and a disproportionately high postoperative morbidity and mortality. Although machine learning based pediatric surgical risk calculators (SRCs) have been developed to support clinical decision making, most are derived from high-income settings and may not generalize well to LMIC populations. We previously developed a pediatric surgical risk calculator using multinational LMIC data; however, its performance in independent African cohorts remains unknown.</p><p><strong>Methods: </strong>We conducted an external validation study of a previously developed pediatric surgical risk calculator using prospective data from children undergoing surgery at four tertiary referral hospitals in Ethiopia and Nigeria between July 2024 and February 2025. Model performance was assessed by evaluating discrimination (area under the receiver operating characteristic curve) and calibration (slope and intercept). Predicted risk was stratified into low, intermediate, and high-risk categories to enhance clinical applicability. Model recalibration was performed to optimize performance in the external cohort.</p><p><strong>Results: </strong>A total of 1,670 pediatric surgical patients were included from the four hospitals. In-hospital mortality was 6.8%. Mortality varied significantly by site, age, weight, sex, prematurity, preoperative sepsis, transfusion, supplemental oxygen use, antibiotic use, ASA class, type of surgery (emergent vs elective), need of ICU postoperatively and reoperation. The risk prediction model had good discrimination overall with an area under the curve (AUC) of 0.84, outperforming ASA classification alone (AUC = 0.77). Discrimination remained high for general pediatric surgery cases (AUC=0.83) and was highest for emergency cases (AUC = 0.89), but was low in neonates (AUC = 0.64). The model demonstrated systematic miscalibration, which improved following logistic calibration. Patients were stratified into meaningful risk categories, which reliably distinguishes between low-and-hgih risk patients (LR=0.1 and LR=5.4 respectively). However, 66.5% fall in the intermediate risk group which is not useful in decision making (LR=1.0).</p><p><strong>Conclusion: </strong>The pediatric surgical risk calculator demonstrated good performance in the African context, with improved clinical utility following recalibration and risk stratification. Reduced performance in neonates suggests the need to incorporate additional risk factors and potentially separate models for this subgroup. Future efforts should focus on supporting the use of the SRC in risk communication, clinical decision making, and resource prioritization.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"163524"},"PeriodicalIF":2.3,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137321","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":"Comparative analysis of cytoskeletal proteins and the sarcoglycan complex in the cremaster muscle of patients with retractile and undescended testis.","authors":"Fabiola Cassaro, Giuseppinella Melita, Angelo Favaloro, Ilenia Papaleo, Socrate Pallio, Ivan Barbera, Pietro Impellizzeri, Carmelo Romeo, Salvatore Arena","doi":"10.1016/j.jpedsurg.2026.163529","DOIUrl":"10.1016/j.jpedsurg.2026.163529","url":null,"abstract":"<p><strong>Introduction: </strong>The cremaster muscle plays a crucial role in testicular mobility and thermoregulation. Structural and functional alterations of this muscle have been implicated in the pathophysiology of undescended testis. Previous studies have demonstrated a significant impairment of the cytoskeleton in cremasteric smooth muscle cells in patients with cryptorchidism. This alteration may explain the muscular dysfunction involved in testicular descent. The aim of this study was to assess and quantify the expression of sarcoglycans, as well as the anchoring proteins vinculin and talin, in the cremaster muscle of children with undescended testis.</p><p><strong>Materials and methods: </strong>Cremaster muscle samples were obtained from pediatric patients undergoing surgery for undescended testis, retractile testis, or inguinal canal pathologies (control group). Immunofluorescence analysis was used to evaluate the expression of alpha-, beta-, gamma-, delta-, and epsilon-sarcoglycans, as well as talin and vinculin. Signal intensity was quantified and compared among the groups.</p><p><strong>Results: </strong>All analyzed markers showed significantly higher expression in the retractile group, followed by the control group and, lastly, the undescended testis group. The differences among groups were statistically significant (p < 0.05), with a consistent trend: retractile > control > undescended.</p><p><strong>Conclusions: </strong>The molecular profile of the cremaster muscle in patients with undescended testis shows poorer structural preservation compared to the other groups, with reduced expression of sarcolemmal and anchoring proteins relative to the retractile and control groups. This molecular pattern suggests a structural and functional impairment of the cremaster muscle, rendering it non-retractile. These findings support the concept that undescended testis is not merely an anatomical variant or a retractile testis awaiting descent, but rather a condition characterized by more profound structural alterations.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"163529"},"PeriodicalIF":2.3,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137340","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":"Early Post-Operative Gynecologic Complications of Persistent Cloaca Reconstruction: A Single-Institution Review of 45 Cloacal Reconstructions.","authors":"Carolyn D R Brookhart, Jasmine Nguyen, Allison C Mayhew, LiJin Joo, Eugénie Lehembre-Shiah, Jessica King, Melanie Bowser, Butool Hisam, Andrea Badillo, Christina Feng, Christina Ho, Marc A Levitt, Briony K Varda","doi":"10.1016/j.jpedsurg.2026.163522","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2026.163522","url":null,"abstract":"<p><strong>Study objective: </strong>To determine whether cloacal complexity, defined by common channel length, is associated with early introital or vaginal stenosis following primary cloacal repair.</p><p><strong>Methods: </strong>Retrospective analysis of a prospective cohort of patients with persistent cloaca treated at a quaternary-care children's hospital between January 2020 and May 2026. Patients who underwent primary cloacal repair with vaginal reconstruction and post-repair exam under anesthesia were included; those with cloacal exstrophy, cloacal variants, or prior repair at an outside institution were excluded. Complexity was defined by common channel length: moderate (<3 cm) or complex (≥3 cm). The primary outcome was any introital or vaginal stenosis at routine post-repair exam under anesthesia and vaginoscopy.</p><p><strong>Results: </strong>Of 68 primary repairs, 45 patients were included: 27 (60.0%) had moderate cloaca and 18 (40.0%) had complex cloaca. The median age at repair was 0.7 years (range 0.4-10.1 years). Introital or vaginal stenosis occurred in 40.0% (18/45); 5 patients had complete stenosis, all of whom had complex cloaca. Stenosis was far more common following reconstruction of complex cloaca (72.2% vs. 18.5%; p<0.001), with 11-fold higher odds (OR 11.44, 95% CI 2.77-47.17), an association that persisted after adjusting for urethral length (OR 10.08, 95% CI 2.09-48.67; p=0.004). Each 1 cm increase in common channel length was associated with 2.50-fold higher odds of stenosis (95% CI 1.49-4.17; p<0.001), which persisted after adjusting for urethral length (p=0.002). The rate of stenosis was highest following urogenital separation (61.5%), compared with total urogenital mobilization (15.4%) and introitoplasty (0.0%) (p=0.002). Stenosis was also associated with older age at repair (1.0 vs. 0.6 years, p=0.015), uterovaginal anomalies (53.1% vs. 7.7%; p=0.005), longitudinal vaginal septum resection (56.5% vs. 22.7%, p=0.021), and longer operative time (440 vs. 284 minutes, p=0.0001).</p><p><strong>Conclusions: </strong>Introital or vaginal stenosis was common (40.0%) in the early postoperative period following cloacal repair, and patients with complex cloaca had 11-fold higher odds of stenosis. These findings support anticipatory counseling and longitudinal gynecologic follow-up, particularly for patients with complex anatomy.</p><p><strong>Irb approval: </strong>Children's National Hospital, IRB Pro00015991.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"163522"},"PeriodicalIF":2.3,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149127886","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":"Mortality, bowel preservation, and surgical strategy in closing and closed gastroschisis: A systematic review and individual participant data meta-analysis.","authors":"Dikshit Chawla, Adin Belet, Tályta Pessoa, Sehajnoor Singh, Leo Yu, Ashwin Pimpalwar","doi":"10.1016/j.jpedsurg.2026.163520","DOIUrl":"10.1016/j.jpedsurg.2026.163520","url":null,"abstract":"<p><strong>Background: </strong>Closing and closed gastroschisis represent the most severe end of the gastroschisis spectrum, carrying high mortality and risk for short bowel syndrome (SBS). No individual participant data (IPD) meta-analysis exists, and the choice for opting an optimal surgical strategy, intracorporeal parking versus primary resection, is unresolved.</p><p><strong>Methods: </strong>We systematically searched PubMed, EMBASE, and the Cochrane Library (inception to June 2026) for studies reporting patient-level data on closing, closed, or vanishing gastroschisis, following the PRISMA-IPD guidelines. Individual data were pooled in one-stage generalized linear mixed models with each study as a random intercept. The primary outcome was survival to discharge.</p><p><strong>Results: </strong>Ninety-four patients from 36 IPD studies across 17 countries were analyzed; 3 further studies contributed aggregate data. Closing was defined as Perrone Types A-C (n = 67) and closed as Type D (n = 27). Overall mortality was 28.6%. Mortality rose across Perrone types A to D (0%, 3.6%, 27.3%, 59.3%; OR 5.30 per type; 95% CI 2.23-12.6; P = 0.0002). Closing (versus closed) gastroschisis (OR 0.10), residual bowel preservation (OR 0.03), greater residual bowel length, and intracorporeal parking (OR 0.13) were univariably associated with survival; male sex with death (OR 5.58). Intracorporeal parking was associated with lower mortality (10.5% versus 35.9%) and less SBS (31.6% versus 59.4%) than resection.</p><p><strong>Conclusions: </strong>In this first IPD meta-analysis of closing and closed gastroschisis, the Perrone classification strongly predicted mortality, and bowel-preserving intracorporeal parking was associated with better outcomes. Prospective international registries with standardized outcome definitions are needed.</p><p><strong>Prospero registration number: </strong>CRD420261448853.</p><p><strong>Reporting guideline: </strong>Preferred Reporting Items for Systematic Reviews and Meta-Analyses of Individual Participant Data (PRISMA-IPD, 2015).</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"163520"},"PeriodicalIF":2.3,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111119","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 century of progress: Evolving racial and ethnic diversity in U.S. and Canadian pediatric surgery training.","authors":"Andreina Giron, Raquel González, Colin Martin, Peter T Yu, April A Carlson, Shanquell Dixon, Laura Boomer, Lisa Marie Jackson, James Petrancosta, Nina Kosciuszek, Sophia Liu, Tawny Kim, Kristen A Calabro, Kenneth W Gow","doi":"10.1016/j.jpedsurg.2026.163516","DOIUrl":"10.1016/j.jpedsurg.2026.163516","url":null,"abstract":"<p><strong>Purpose: </strong>Diversity among pediatric surgery trainees plays a critical role in shaping the future workforce and the quality of care delivered to children. This study presents the first comprehensive analysis of all pediatric surgery graduates in the U.S. and Canada, evaluating racial and ethnic representation over time and identifying areas where progress remains limited.</p><p><strong>Methods: </strong>A retrospective review was conducted of all pediatric surgery fellowship graduates, both official and unofficial, across the U.S. and Canada from 1919 to 2025. Data sources included The Genealogy of North American Pediatric Surgery, APSA membership listings, and correspondence from program directors. The final cohort included 2235 graduates. Race and ethnicity were classified using a structured hierarchical review process based on public information, and self-identification when available; these included a combination of name analysis, photographs, professional affiliations, personal contacts, and the Namsor.app tool. Race and ethnicity were classified according to U.S. Census categories and graduates were grouped into five time periods to assess temporal trends. Graduates for whom the classification framework did not identify sufficient evidence of a prespecified minority racial or ethnic identity constituted the residual reference category ('no minority identity identified'). Chi-square and Fisher's exact tests were used for analysis, with significance set at p < 0.05.</p><p><strong>Results: </strong>Across 79 programs, 2235 graduates were identified (1673 men [74.9%], 562 women [25.1%]). Racial and ethnic diversity increased significantly over time (p < 0.0001). Asian representation increased from 1.8% to 15.4% (p < 0.001), Hispanic/Latino representation from 1.8% to 6.0% (p = 0.0017), and Black representation from 0.0% to 3.7% (p = 0.002). AI/AN representation remained negligible throughout the study period. Racial distribution differed significantly by sex (p < 0.001): Black pediatric surgeons were more likely to be female (4.8% vs 1.6%, p < 0.001), Asian pediatric surgeons were slightly more likely to be female (13.3% vs 10.5%, p = 0.0690), and Hispanic/Latino representation was similar between sexes (4.2% vs 4.4%, p = 0.8080).</p><p><strong>Conclusion: </strong>Pediatric surgery training in the U.S. and Canada has become increasingly diverse in terms of race and ethnicity. Notable gains among Asian, Hispanic/Latino, and Black surgeons reflect progress, though AI/AN representation remains nearly absent, and sex-based disparities persist. Continued efforts in equitable recruitment, mentorship, and career advancement are needed to ensure that the pediatric surgical workforce mirrors the diversity of the children and families it serves.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"163516"},"PeriodicalIF":2.3,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111190","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: \"Recto-perineal fistula - Do we need to fix it? Long-term outcomes of non-operative management\".","authors":"Mathilde Glenisson, Nicolas Vinit, Sylvie Beaudoin","doi":"10.1016/j.jpedsurg.2026.163512","DOIUrl":"10.1016/j.jpedsurg.2026.163512","url":null,"abstract":"","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"163512"},"PeriodicalIF":2.3,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111183","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":"Unfolding new horizons: Machine learning applications for pediatric intussusception - A systematic review and meta-analysis.","authors":"Letícia Rocha Campos, Solonas Symeou, Gisella Chiara Carpi, Dan Poenaru","doi":"10.1016/j.jpedsurg.2026.163518","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2026.163518","url":null,"abstract":"<p><strong>Background: </strong>Pediatric intussusception is among the most common surgical emergencies in early childhood. Ultrasonography is the diagnostic standard but remains operator-dependent, and no validated machine learning (ML) tools exist for triage or prognostic stratification. We systematically evaluated ML models for diagnosis and prognosis of pediatric intussusception.</p><p><strong>Methods: </strong>This PROSPERO-registered systematic review and meta-analysis (CRD420251073590) included studies evaluating ML models for pediatric intussusception diagnosis or prognosis reporting sensitivity, specificity, or AUC. Risk of bias was assessed with PROBAST. A bivariate random-effects model was applied to internally and externally validated datasets, with subgroup analyses by input modality.</p><p><strong>Results: </strong>Eleven studies (37 model variants; 36,863 patients) were included. Internally validated ultrasound (US) models (k=4) achieved pooled sensitivity 0.914 (0.829-0.959) and specificity 0.980 (0.939-0.994). Externally validated US models (k=3) showed sensitivity 0.946 (0.909-0.969) and specificity 0.958 (0.918-0.979). Abdominal radiograph (AXR) triage models performed lower externally (sensitivity 0.800 [0.725-0.859]; specificity 0.748 [0.662-0.819]), consistent with a screening role. Notably, AI assistance improved junior readers' specificity by 15.9 percentage points overall (up to 37.6 points for the most junior readers), and AI-assisted junior sonographers cut ultrasound examination time by 61% without loss of diagnostic accuracy. Possible publication bias was detected (Deeks' p=0.021). Prognostic AUCs ranged from 0.555 to 0.962.</p><p><strong>Conclusions: </strong>US-based ML models demonstrate high, externally robust diagnostic accuracy. AXR models suit screening but need further validation. No study reported clinical endpoint data. Multicenter prospective validation outside Asia and regulatory pathway development are required before implementation. Until then, AXR-based models should be positioned as an adjunct that raises suspicion, never as a gate that determines which child receives an ultrasound.</p><p><strong>Level of evidence: </strong>Level III - Systematic Review and Meta-Analysis of retrospective diagnostic accuracy studies.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"163518"},"PeriodicalIF":2.3,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111191","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":"Serious adverse events in pediatric surgery: A French nationwide study.","authors":"Aurélie Gerstner, Florian Martinet-Kosinski, Maud Chabaud, Marie Coniel, Virginie Rampal, Sébastien Frey, Jean Bréaud","doi":"10.1016/j.jpedsurg.2026.163519","DOIUrl":"10.1016/j.jpedsurg.2026.163519","url":null,"abstract":"<p><strong>Background: </strong>Adverse events (AE) are a major source of preventable morbidity and mortality in surgery. Pediatric surgery combines surgical complexity with vulnerabilities specific to childhood. However, specific data on AE in this field remain limited. This study aims to describe AE in pediatric surgery and to identify factors associated with serious adverse events (SAE).</p><p><strong>Methods: </strong>Using a national prospective clinician-reported database, all AE reported between June 2016 and August 2024 were analyzed. Event severity was classified according to the Clavien-Madadi grading system, with SAE defined as grades ≥ III. Contributing factors were assessed using the Association of Litigation And Risk Management systemic analysis framework. Statistical analyses were performed to identify factors associated with the occurrence of SAE.</p><p><strong>Results: </strong>A total of 706 A E were reported, mainly involving boy (71.0%) with a median age of 3 years (IQR, 1-10). Most AE occurred in the operating room (52.7%) during scheduled procedures (73.5%) and were considered preventable (94.3%). Eighteen percent of AE were classified as severe. Independent factors associated with SAE included older age (OR = 1.04, p = 0.037), complex clinical situation (OR = 2.62, p < 0.001), scheduled care (OR = 0.55, p = 0.010), and patient-related factors (OR = 1.62, p = 0.035). Infections were more frequent among SAE (12.8% vs 2.29%, p < 0.001). Overall mortality was 0.8%. Safety barriers failed in 56.7% of SAE.</p><p><strong>Conclusion: </strong>Serious adverse events in pediatric surgery mainly occur in unplanned, complex situations and are frequently preventable. Our study highlights patient-related vulnerabilities as major contributors to severity.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"163519"},"PeriodicalIF":2.3,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111173","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}