Journal of pediatric surgery最新文献

{"title":"Outcomes of Vacuum-Assisted and Conventional Wound Management in Pediatric Abdominal Surgery: A Retrospective Study From a Resource-Limited Setting.","authors":"Vaibhav Pandey, Shashi Prakash Mishra, Marripati Bhanumurthy Kaushik, Manish Khobragade, Sunil Kumar Singh Gaur, Ruchira Nandan","doi":"10.1016/j.jpedsurg.2025.162495","DOIUrl":"10.1016/j.jpedsurg.2025.162495","url":null,"abstract":"<p><strong>Background: </strong>Complicated abdominal wounds following pediatric laparotomy, particularly in cases of enterocutaneous fistulae, trauma, or re-exploration, present significant management challenges, especially in resource-limited settings. Despite evidence supporting vacuum-assisted closure (VAC) therapy in adults, its use in pediatric populations remains limited.</p><p><strong>Aim: </strong>This study aimed to evaluate and compare the outcomes of vacuum-assisted and conventional wound management techniques in pediatric abdominal surgery within a resource-constrained environment.</p><p><strong>Methods: </strong>A retrospective observational study was conducted at a tertiary pediatric surgical centre in Northern India from January 2016 to December 2024. A total of 43 children (0-18 years) with complicated postoperative abdominal wounds were included. Patients were divided into two groups: Group 1 (n = 19) underwent traditional wound closure, while Group 2 (n = 24) received wound management using VAC therapy or simple wound manager systems. Primary outcomes were time to wound healing and incidence of wound-related complications. Secondary outcomes included hospital stay, re-exploration, and spontaneous fistula closure.</p><p><strong>Results: </strong>The wound manager group showed a slightly longer median healing time (15 vs. 12 days) but had zero re-explorations compared to three cases in the traditional group (p = 0.0011). VAC therapy led to earlier granulation (median 6 vs. 10 days), greater complete epithelialization (80 % vs. 40 %, p = 0.04), and spontaneous closure in 20 % of enterocutaneous fistulas. Four patients continued VAC therapy at home without complications.</p><p><strong>Conclusion: </strong>VAC and simple wound manager systems are effective in managing complex pediatric abdominal wounds, reducing the need for reoperation and enhancing healing outcomes. Their adoption in low-resource settings could significantly improve pediatric surgical care.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"162495"},"PeriodicalIF":2.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144765020","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":"Collaboration First: Rethinking the Surgery-First Approach for Pediatric Choledocholithiasis.","authors":"Diana G Lerner, Tom Lin, Petar Mamula, Douglas S Fishman, Nadia Ibrahimi, David A Vitale, Quin Liu, David Troendle, Michael Wilsey","doi":"10.1016/j.jpedsurg.2025.162715","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2025.162715","url":null,"abstract":"","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"162715"},"PeriodicalIF":2.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145225532","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":"Operating Without Direct Supervision During Pediatric Surgery Fellowship: When, How, and Why?","authors":"Gerald Gollin, Erika A Newman, Erin E Rowell, Stefan Scholz, Paul K Waltz, Grace Z Mak, Pramod Puligandla","doi":"10.1016/j.jpedsurg.2025.162711","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2025.162711","url":null,"abstract":"<p><strong>Background: </strong>There is concern that finishing pediatric surgical fellows may not be ready for independent practice due to a lack of operating without direct supervision during their training. The adoption of Entrustable Professional Activities (EPAs) as an assessment metric further highlights the need to evaluate practices and policies regarding fellow operative autonomy.</p><p><strong>Methods: </strong>A survey was distributed to the 59 pediatric surgical training program directors (PDs) in North America. PDs were asked about their program's policies and criteria regarding when a fellow may operate without direct supervision. Respondents were queried about a range of procedures as to whether their recent fellows had operated without direct supervision in situations in which the attending surgeon was not scrubbed but available in the operating room or not in the operating room at all. PDs were asked if any malpractice case resulted from an operation in which a fellow operated without direct supervision.</p><p><strong>Results: </strong>Surveys were completed by 44 (75%) PDs. Few programs reported protocols or criteria to determine eligibility for indirectly supervised operating. None require specific parental consent when a fellow functions as a teaching assistant. Most PDs reported that fellows operated iwithout an attending surgeon scrubbed for basic procedures such as laparoscopic appendectomy. However, only a small minority recalled a fellow operating i with only another trainee on complex cases like esophageal atresia repair. One malpractice suit was reported.</p><p><strong>Conclusion: </strong>There is substantial variability in fellow operative autonomy among pediatric surgical training programs. Few programs have established protocols to determine trainee readiness for independent operating and parental consent for teaching assistant cases is not typically obtained.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"162711"},"PeriodicalIF":2.5,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145206662","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":"Pediatric Achalasia and Peroral Endoscopic Myotomy (POEM): Ten-Year Outcomes for 101 Children at a Single Institution.","authors":"Mikael Petrosyan, Mark L Kovler, Jill Rafie, Geetanjali Bora, Anil Darbari, Rebecca Chavez, Timothy D Kane","doi":"10.1016/j.jpedsurg.2025.162697","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2025.162697","url":null,"abstract":"","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"162697"},"PeriodicalIF":2.5,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145191842","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":"Long term functional outcomes and health-related quality of life in patients with esophageal atresia - A tertiary centre experience.","authors":"Venus Tsz Ling Kum, Carol Wing Yan Wong, Kenneth Kak Yuen Wong","doi":"10.1016/j.jpedsurg.2025.162698","DOIUrl":"10.1016/j.jpedsurg.2025.162698","url":null,"abstract":"<p><strong>Purpose: </strong>This study evaluates the clinical outcomes and compares the quality of life in esophageal atresia patients over the past two decades.</p><p><strong>Method: </strong>Medical records of all esophageal atresia (EA) patients who received surgical repair between 1997 and 2022 in a tertiary center were reviewed to assess for associated anomalies and complications. Both patients and parents were invited to participate in health-related quality of life (HRQOL) studies either in person, via phone or online. The Pediatric Quality of Life Inventory Generic (Peds-QL) Core Scale Version 4.0 and Gastrointestinal Quality of Life Index (GIQLI) were used as generic and system-specific assessment tools respectively. Numeric values were expressed in medians (interquartile range).</p><p><strong>Results: </strong>A total of 31 patients were eligible for the study. The median birth weight was 2.47 kg (1.93-3.08). The smallest patient had a birth weight of 1.36 kg. Primary repair was performed in 28 (90.3 %) patients. Anastomotic leak was reported in two (6.45 %) patients, both of them requiring revision surgery. Repeated endoscopic dilatation was required in 11 (35.5 %) patients and seven (22.6 %) required anti-reflux procedures. For the HRQOL assessment, our cohort of patients showed an overall score of 76.1 (62-93.5), physical score of 90.6 (68.8-100) and psychosocial score of 63.3 (56.7-91.7) when using the generic Peds-QL questionnaire. When using the system-specific GIQLI, they scored 120 (106.8-128). EA patients show significantly poor HRQOL as reflected in both generic and system-specific questionnaires.</p><p><strong>Conclusion: </strong>Long term survivors of esophageal atresia demonstrated inferior HRQOL compared to normal population in both generic and system-specific assessment tools. Life-long follow-up and monitoring are essential in order to provide holistic care to these patients.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"162698"},"PeriodicalIF":2.5,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145191799","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":"Summary of the 71st British Association of Paediatric Surgeons Conference Bruges, Belgium (25th- 27th June 2025).","authors":"Mark Davenport","doi":"10.1016/j.jpedsurg.2025.162699","DOIUrl":"10.1016/j.jpedsurg.2025.162699","url":null,"abstract":"","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"162699"},"PeriodicalIF":2.5,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145191857","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":"Where have all the fundoplications gone? A look at changes in national practice in England (April 2012-March 2024).","authors":"Ferzine Mohamed, Anindya Niyogi, Mark Davenport","doi":"10.1016/j.jpedsurg.2025.162702","DOIUrl":"10.1016/j.jpedsurg.2025.162702","url":null,"abstract":"<p><strong>Aim of the study: </strong>Fundoplication (FP) and transgastric jejunal tubes (GJ) are treatments for gastro-oesophageal reflux disease (GORD) where medical management has failed. GJ is less invasive than FP but requires regular radiological replacement of the tubes. We aim to assess trends in paediatric FP and GJ in England.</p><p><strong>Method: </strong>Data were obtained from the NHS England digital platform for procedures and interventions using OPCS-4 codes G24.3 [antireflux fundoplication using abdominal approach] and Y51.2 [approach to organ through gastrostomy] from April 2012 to March 2024 for children ≤15 years. Spearman's correlation and traditional model forecasting were performed on SPSS v29. Age-based subgroup analysis was also performed [<1, 1-4, 5-9, 10-14, 15 years].</p><p><strong>Results: </strong>The annual mean for FP was 286 (IQR: 193-371, SEM: 27), and for GJ it was 342 (IQR: 78-529, SEM: 62). Since 2012, FP has steadily decreased, while GJ has steadily increased. GJ has become more frequent than FP since 2017. Age-based subgroup analysis revealed similar trends across all age groups, except for infants under one year, where the FP decreased, while GJ remained stable and lower than FP. Spearman's test showed a strong negative correlation between FP and GJ (R = -0.83; P < 0.001). The forecasting analysis indicates that no FP will be performed on children in England after 2029 if the current trend continues.</p><p><strong>Conclusion: </strong>Currently, GJ is performed more frequently than FP, thereby increasing the cumulative number of children requiring regular tube replacements.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"162702"},"PeriodicalIF":2.5,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145191859","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":"Effects of virtual reality distraction on pain, stress, and heart rate during pediatric ingrown toenail surgery: A randomized controlled trial","authors":"Anna Felnhofer ,&nbsp;Andreas Goreis ,&nbsp;Lisa Weiss ,&nbsp;Jeremias Winder ,&nbsp;Sara Marceta-Pavlovic ,&nbsp;Francesca Palmisani ,&nbsp;Vito Giordano ,&nbsp;Michael Wagner ,&nbsp;Susanne Greber-Platzer ,&nbsp;Martin Metzelder ,&nbsp;Wilfried Krois ,&nbsp;Oswald D. Kothgassner","doi":"10.1016/j.jpedsurg.2025.162696","DOIUrl":"10.1016/j.jpedsurg.2025.162696","url":null,"abstract":"<div><h3>Objective</h3><div>Immersive virtual reality (VR) shows efficacy in reducing pediatric procedural pain and stress, yet studies remain heterogeneous and conflate stress with anxiety while neglecting physiological measures such as heart rate (HR). The role of goal-directed attention remains underexplored, as no studies have controlled for VR-interactivity to isolate its contribution under clinically relevant conditions. Thus, this RCT investigates the effects of goal-directed VR vs. free-interaction VR vs. standard-of-care (SoC) distraction (controls) on self-reported pain, stress, and HR during ingrown toenail surgery under local anesthesia in children and adolescents.</div></div><div><h3>Study design</h3><div>Sixty patients aged 10–17 years (M_age = 13.90, SD_age = 1.85, 23 % female) were randomized to either a (1) focused VR group with a specific task, or (2) an exploratory VR group without a task, or (3) a SoC-control group. Patients’ self-reported pain (VAS, primary outcome), self-reported stress and HR (both secondary), were analyzed using Linear Mixed Effect Models.</div></div><div><h3>Results</h3><div>Self-reported pain and stress followed expected trajectories across the perioperative period, with no overall benefit of VR. Exploratory VR was associated with higher self-reported pain during surgery and smaller post-surgical stress reductions. Both VR conditions significantly reduced HR during anesthesia (needle insertion phase) compared to controls, with this effect persisting into later surgical stages in the exploratory VR group.</div></div><div><h3>Conclusions</h3><div>While both VR conditions reduced physiological arousal, particularly during anesthesia, focused VR conferred modest benefits in self-reported pain and stress. Findings underscore the need to study cognitive task demands in VR-based distraction and suggest feasibility in pediatric surgery under local anesthesia.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 12","pages":"Article 162696"},"PeriodicalIF":2.5,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186170","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: Integrating mental health screening into pediatric trauma care","authors":"Jacoba Nugrahaningtyas Wahjuning Utami,&nbsp;Erfan Ramadhani,&nbsp;Agung Yuliyanto Nugroho,&nbsp;Nunung Nurhayati,&nbsp;Dwi Listiawati,&nbsp;Bakri,&nbsp;Ramtia Darma Putri","doi":"10.1016/j.jpedsurg.2025.162700","DOIUrl":"10.1016/j.jpedsurg.2025.162700","url":null,"abstract":"","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 12","pages":"Article 162700"},"PeriodicalIF":2.5,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186123","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":"Enhancing transparency in postoperative complication reporting: The Azizoglu-Pederiva complication-classification diagram within the Clavien-Madadi framework.","authors":"Mustafa Azizoglu, Federica Pederiva","doi":"10.1016/j.jpedsurg.2025.162701","DOIUrl":"10.1016/j.jpedsurg.2025.162701","url":null,"abstract":"","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"162701"},"PeriodicalIF":2.5,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186192","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}