Journal of pediatric surgery最新文献

{"title":"Fulminant Necrosis of the Colon Associated With Antegrade Continence Enemas.","authors":"Antti I Koivusalo, Mikko P Pakarinen","doi":"10.1016/j.jpedsurg.2025.162277","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2025.162277","url":null,"abstract":"","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"162277"},"PeriodicalIF":2.4,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143719768","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":"Hirschsprung-associated Enterocolitis Action Plan: A Pictographic Tool for Caregivers of Children With Hirschsprung Disease","authors":"Elizaveta Bokova ,&nbsp;Ismael Elhalaby ,&nbsp;Bobby Dow ,&nbsp;Patrick T. Reeves ,&nbsp;Rebecca M. Rentea","doi":"10.1016/j.jpedsurg.2025.162269","DOIUrl":"10.1016/j.jpedsurg.2025.162269","url":null,"abstract":"<div><h3>Background</h3><div>Hirschsprung-associated enterocolitis (HAEC) is a life-threatening complication of Hirschsprung disease (HD), with significant morbidity and mortality rates. Early diagnosis and treatment are critical, and caregivers play a key role in detecting HAEC, performing colonic irrigations, and seeking timely medical care. This study validates an HAEC action plan designed to assist caregivers in managing HAEC at home.</div></div><div><h3>Methods</h3><div>A caregiver-focused HAEC Action Plan was developed following the National Institute of Health (NIH) 5-step “Clear &amp; Simple” approach. It included patient-specific information, symptom pictographs, and a stepwise HAEC management protocol. Previously validated pictograms were used with the permission of the original institution. Additionally, 6 unvalidated pictograms were used. Readability was assessed using multiple formulas. Caregivers and the community evaluated the newly used pictograms' validity and action plan's comprehension, quality, and usefulness using the Consumer Information Rating Form (CIRF). Understandability and actionability were evaluated by librarians using the Patient Education Materials Assessment Tool. Clinicians validated its suitability using the modified Suitability Assessment of Materials (SAM) instrument.</div></div><div><h3>Results</h3><div>The 6 new pictograms were validated. Readability was acceptably below the 6th-grade level. Overall CIRF score reached 91.5 % (superior). Understandability, actionability, and suitability were rated at 91 %, 91 %, and 82.5 %, respectively. Suggested improvements included using clearer pictograms, unit adjustments, additional details on irrigation duration, improved text visibility, and translation of the tool into other languages.</div></div><div><h3>Conclusions</h3><div>The HAEC Action Plan is a clear, user-friendly tool for guiding caregivers in the early recognition and management of HAEC. Once employed in clinical practice, it has the potential to reduce HAEC-associated morbidity and mortality in children with HD.</div></div><div><h3>Level of Evidence</h3><div>N/A.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 6","pages":"Article 162269"},"PeriodicalIF":2.4,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143684931","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 Double J Stent (DJS) Placement Before Pediatric ESWL on Complications and Stone-free Rates","authors":"Efe Bosnali ,&nbsp;Nazim Mutlu ,&nbsp;Kutlucan Cakmak ,&nbsp;Enes Malik Akdas ,&nbsp;Engin Telli ,&nbsp;Abdullah Enes Baynal ,&nbsp;Muhlis Unal ,&nbsp;Hakkıcan Yuvak ,&nbsp;Kerem Teke ,&nbsp;Onder Kara","doi":"10.1016/j.jpedsurg.2025.162274","DOIUrl":"10.1016/j.jpedsurg.2025.162274","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Pediatric urolithiasis remains a significant health problem in certain regions worldwide. Extracorporeal shock wave lithotripsy (ESWL) is the preferred treatment for upper urinary tract stones smaller than 20 mm in children due to its ease of application and efficacy. However, the utility of double J stenting (DJS) before ESWL in pediatric patients is still debatable. This study aims to evaluate the impact of DJS placement prior to ESWL on children's complication and stone-free rates (SFRs).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Objectives&lt;/h3&gt;&lt;div&gt;To determine the effect of pre-ESWL double J stent (DJS) application on stone-freeness and complications in the pediatric age group.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study design&lt;/h3&gt;&lt;div&gt;This retrospective study included 277 renal units from 268 pediatric patients (≤18 years) treated with ESWL at Kocaeli University between 2006 and 2024. Patients were divided into two groups: those with (DJS+) and without (DJS–) pre-ESWL stenting. Demographic and clinical data, including outcomes and complications, were compared between the groups using univariate analyses. The Clavien-Dindo grading system was used to evaluate complications after ESWL. Multiple logistic regression analysis was performed to determine the factors affecting the risk of steinstrasse (SS) formation.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;A total of 277 renal units were included in the study: 33 (13.1 %) with pre-ESWL DJ stents and 244 (86.9 %) without stents. 150 (54.1 %) of the patients were male, and the mean age was 7.32 ± 4.8. The mean stone size was 9.7 ± 3.3 mm. The DJS + group (33 RUs) and DJS– group (244 RUs) showed no significant difference in SFR (60.6 % vs. 68.4 %, p = 0.36) and complication rates (15.2 % vs. 14.3 %, p = 0.79). A total of 40 (14.4 %) cases had complications following ESWL. Of these complications, 24 (8.7 %) were major (Clavien Grade 3) and 16 (5.8 %) were minor (Clavien Grade 1–2). In addition, DJS placement did not reduce the risk of steinstrasse (SS) formation (p = 0.97). Multiple logistic regression identified stone size as the only independent predictor of SS formation (OR: 1.13, 95 % CI: 1.01–1.26, p = 0.02).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Discussion&lt;/h3&gt;&lt;div&gt;Unlike adult studies, studies reporting the effects of pre-ESWL ureteral stent placement in children are limited. To our knowledge, the present study has the highest number of patients in the literature evaluating the effects of pre-ESWL ureteral stent use on success and complications in treating urolithiasis with ESWL in the pediatric population. In addition, the findings of our study may contribute to the literature due to the limited number of studies investigating the effect of ureteral stents before ESWL in the pediatric age group and their small sample size.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;This study showed that pre-ESWL DJS application in the pediatric age group did not increase ESWL success, had no effect on post-ESWL complications and did not preven","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 5","pages":"Article 162274"},"PeriodicalIF":2.4,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674091","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":"Inequities and Progress in Testicular Torsion Care Following a US News & World Report Metric: A Retrospective Cohort Study","authors":"Ahmed Souid ,&nbsp;Maithili Gopalakrishnan ,&nbsp;Michael Basin ,&nbsp;Glenn Cannon ,&nbsp;Anthony Tracey ,&nbsp;Matthew Mason ,&nbsp;Andrew Osten ,&nbsp;Jeffrey Villanueva","doi":"10.1016/j.jpedsurg.2025.162273","DOIUrl":"10.1016/j.jpedsurg.2025.162273","url":null,"abstract":"<div><h3>Background and objectives</h3><div>Pediatric testicular torsion is a surgical emergency with known health disparities. The US News and World Report is an American media company that ranks colleges and hospitals based on annually published criteria. Hospitals that complied with the US News and World Report’s (USNWR) Speed in Treating Testicular Torsion (SiTTT) metric saw improved surgical testicular salvage rates, but the metric’s impact in mitigating inequities in testicular torsion is unstudied.</div></div><div><h3>Methods</h3><div>A retrospective cohort study of patients 1–18 years of age presenting with testicular torsion was performed using the Pediatric Health Information System database. Hospitals were classified based on their SiTTT score at the metric’s onset in 2015: they were labeled complete-scoring if they achieved the maximum score and partial-scoring otherwise. Surgical testicular salvage was defined as orchiopexy without concomitant orchiectomy. Testicular salvage rates were compared based on various socioeconomic variables including race between the pre-metric (2010–2015) and post-metric (2015–2019) periods with both univariate and adjusted, multivariate analyses.</div></div><div><h3>Results</h3><div>We identified 3950 cases of testicular torsion: 2335 in complete-scoring hospitals and 1615 in partial-scoring hospitals. Only partial-scoring hospitals improved significantly in salvage rate (pre-metric 61.0 % vs post-metric 67.5 %, <em>p</em> &lt; 0.01). Subgroup analysis revealed the largest benefit in patients with economic or communicative barriers such as those with complex chronic conditions (pre-metric 35.3 % vs post-metric 61.1 %, <em>p</em> &lt; 0.05). No minority races had statistically significant improvement after the metric, and salvage rate gap between White and all other races increased (pre-metric 4.3 % vs post-metric 10.0 %, <em>p</em> &lt; 0.05).</div></div><div><h3>Conclusions</h3><div>Patients with communicative or economic barriers showed improved equity after efforts to comply with a third-party metric, but disparities persisted for minority races. Future studies may better classify the mediators of this association.</div></div><div><h3>Type of study</h3><div>Retrospective Cohort Study.</div></div><div><h3>Level of Evidence</h3><div>Level IV: Evidence from well-designed case–control or cohort studies.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 5","pages":"Article 162273"},"PeriodicalIF":2.4,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143619147","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":"Comparison of Video-assisted Surgery and Open Surgery for Mediastinal Tumor Resection in Pediatric Population: A Systematic Review and Meta-analysis","authors":"Rachid Eduardo Noleto da Nobrega Oliveira ,&nbsp;Isabella Cabianca Moriguchi Caetano Salvador ,&nbsp;Felipe S. Passos ,&nbsp;Lucas Antônio Fernandes Torres ,&nbsp;Maria Tereza Camarotti","doi":"10.1016/j.jpedsurg.2025.162271","DOIUrl":"10.1016/j.jpedsurg.2025.162271","url":null,"abstract":"<div><h3>Background</h3><div>The surgical management of mediastinal tumors in pediatric patients presents unique challenges due to the anatomical and physiological characteristics of this population. Video-assisted thoracoscopic surgery (VATS) has gained prominence as a minimally invasive alternative to open thoracotomy and median sternotomy (OT), offering potential benefits such as reduced postoperative pain and shorter recovery times. However, the relative effectiveness and safety of VATS compared to OT remain under debate.</div></div><div><h3>Methods</h3><div>We conducted a systematic review and meta-analysis following PRISMA guidelines, including retrospective studies comparing VATS and OT in pediatric patients undergoing mediastinal tumor resection. Statistical analyses were performed using random effects models, and heterogeneity was assessed with Cochran's Q-test and I² statistics.</div></div><div><h3>Results</h3><div>Seven studies comprising 333 pediatric patients (41.7 % undergoing VATS and 58.2 % OT) met the inclusion criteria. VATS was associated with significantly reduced LOS (MD -3.23 days; 95 % CI: −5.57 to −0.89; p &lt; 0.01), complications (OR 0.40; 95 % CI: 0.19 to 0.82; p = 0.01), intraoperative blood loss (MD -22.40 mL; 95 % CI: −38.59 to −7.22; p &lt; 0.01), and intraoperative blood transfusion (OR 0.08; 95 % CI: 0.03 to 0.21; p &lt; 0.01). No significant differences were observed between VATS and OT for recurrence (OR 0.37; 95 % CI: 0.08 to 1.75; p = 0.21) or mortality (OR 0.25; 95 % CI: 0.06 to 1.04; p = 0.06).</div></div><div><h3>Conclusion</h3><div>The results of this meta-analysis, including 333 pediatric patients, suggest that VATS is associated with significant reductions in LOS, complication rates, intraoperative blood loss, and transfusion requirements compared to OT, without compromising oncological outcomes. VATS can be performed safely with a low LOS, but more complex tumors will still require open surgery.</div></div><div><h3>Trial Registry</h3><div>International Prospective Register of Systematic Reviews; Nº: CRD42025634968; URL: <span><span>https://www.crd.york.ac.uk/prospero/</span><svg><path></path></svg></span>.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 5","pages":"Article 162271"},"PeriodicalIF":2.4,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143619159","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 Acellular Dermal Matrix in Improving Clinical Outcomes in Pediatric Burns: A Systematic Review and Meta-Analysis of Randomized Controlled Trials","authors":"Jiaqi Lou ,&nbsp;Xiaoyu Zhu ,&nbsp;Ziyi Xiang ,&nbsp;Jingyao Song ,&nbsp;Neng Huang ,&nbsp;Guoying Jin ,&nbsp;Shengyong Cui ,&nbsp;Youfen Fan ,&nbsp;JiLiang Li","doi":"10.1016/j.jpedsurg.2025.162270","DOIUrl":"10.1016/j.jpedsurg.2025.162270","url":null,"abstract":"<div><h3>Background</h3><div>This latest systematic review and meta-analysis aim to examine the efficacy of acellular dermal matrix (ADM) in pediatric burns.</div></div><div><h3>Methods</h3><div>Relevant articles were retrieved from Pubmed, Embase, Cochrane, Web of science, China National Knowledge Infrastructureris, VIP Database for Chinese Technical Periodicals and Wanfang database. The primary outcome was the healing time, and secondary outcomes were the skin graft survival rate, reoperation, complications, numbers of dressing change, incidence of scarring, scar areas and scar scores. Data were pooled and expressed as relative risk (RR), mean difference (MD) and standardized mean difference (SMD) with a 95 % confidence interval (CI).</div></div><div><h3>Results</h3><div>12 studies with 884 patients were included in this systematic review and meta-analysis. The pooled data from all included studies demonstrated that the patients who have applied ADM treatment had significantly reduced healing time (MD = −3.13; 95 % CI: −4.99 to −1.26; <em>p</em> &lt; 0.001, I² = 94.0 %), complications (RR = 0.40; 95 % CI: 0.20–0.79, <em>p</em> = 0.008, I² = 25 %), numbers of dressing change (MD = −4.41; 95 % CI: −7.46 to −1.37, p = 0.005, I² = 97 %) and incidence of scarring (RR = 0.38; 95 % CI: 0.18–0.78, p = 0.009, I² = 77 %) compared to those who have not applied ADM treatment. There were no significant differences in skin graft survival rate, reoperation, scar areas and scar scores between the two groups.</div></div><div><h3>Conclusion</h3><div>ADM may accelerate wound healing, reduce complications and dressing changes, and inhibit scarring in pediatric burns, however, due to the high level of heterogeneity and methodological differences among the included studies, these results should be interpreted with caution. Further research with standardized protocols and larger, more diverse patient populations is needed to confirm these findings.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 5","pages":"Article 162270"},"PeriodicalIF":2.4,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143609840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to Editor: A Scoping Review of the Diagnosis and Operative Management of Water Bead Ingestion by Children.","authors":"Elizabeth Reynolds, A Francois Trappey, Sarah N Bowe, Brentley Lindsey, Patrick T Reeves","doi":"10.1016/j.jpedsurg.2025.162266","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2025.162266","url":null,"abstract":"","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"162266"},"PeriodicalIF":2.4,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Efficacy of Arthroscopic Minimally Invasive Treatment in Children With Congenital Muscular Torticollis: A Retrospective Study","authors":"Xiao-Wei Wang ,&nbsp;Zi-Ming Yao ,&nbsp;Di-Ming Zhou ,&nbsp;Yi-Jun Yang ,&nbsp;Dong Guo ,&nbsp;Lei Zhang","doi":"10.1016/j.jpedsurg.2025.162268","DOIUrl":"10.1016/j.jpedsurg.2025.162268","url":null,"abstract":"<div><h3>Objectives</h3><div>The purpose of the study was to assess the clinical efficacy of arthroscopic treatment strategy in children with congenital muscular torticollis (CMT).</div></div><div><h3>Methods</h3><div>A retrospective study was carried out in patients diagnosed with CMT from October 2020 to March 2023, of the 98 subjects who met the inclusion criteria, 52 subjects underwent arthroscope-assisted treatment and 46 subjects treated with traditional open operation were recruited for the study. Clinical follow-up evaluation was evaluated using the modified Cheng scoring. Besides, the intraoperative and postoperative complications were recorded.</div></div><div><h3>Results</h3><div>There was no statistically significant difference regarding gender proportion, surgical treatment age, and affected side (<em>P</em> &gt; 0.05) between the two groups of patients. Besides, the difference on the operation duration between the two groups was not significant (<em>P</em> &gt; 0.05). However, the incision length and postoperative hospitalization time in the arthroscope-assisted group were significantly shorter than those of the traditional open surgery group (<em>P</em> &lt; 0.05). During the follow-up period, the torticollis deformity was effectively corrected and the postoperative scars were almost invisible in the arthroscope-assisted group. Based on the Cheng’s scoring system, 50 (96.2 %) patients displayed excellent or good clinical results, and 2 (3.8 %) had fair outcomes in the arthroscope-assisted group, and the mean overall scores was comparable to the open surgery group (<em>P</em> &gt; 0.05).</div></div><div><h3>Conclusions</h3><div>Within the limitations of the study, arthroscope-assisted minimally invasive treatment represents a promising and effective surgical option for children with CMT.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 5","pages":"Article 162268"},"PeriodicalIF":2.4,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143609843","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":"Gender Differences in Adolescent Pilonidal Disease","authors":"Ashley Stoeckel,&nbsp;Gheed Murtadi,&nbsp;Kathleen Renzi,&nbsp;Madelyn McArthur,&nbsp;Rachael Cohen,&nbsp;David P. Mooney","doi":"10.1016/j.jpedsurg.2025.162267","DOIUrl":"10.1016/j.jpedsurg.2025.162267","url":null,"abstract":"<div><h3>Background</h3><div>Pilonidal disease is a common, disruptive condition in adolescents. We studied the effects of pilonidal disease on adolescents by gender.</div></div><div><h3>Study design</h3><div>Prospectively collected data on demographics, mental health comorbidities, disease severity, hirsutism, disease-related quality of life impact, interventions, and outcomes were retrieved from a Pilonidal Care Clinic REDCap database and were analyzed by gender.</div></div><div><h3>Results</h3><div>Of 1356 patients with pilonidal disease, 562 (41 %) were female and 794 male. Average age at disease onset was 14.8 years for females and 16.9 years for males (<em>p</em>-value &lt;0.001). The incidence of mental health comorbidities was similar in females compared to males (17 % vs 16 %; <em>p</em>-value = 0.268) but females had a higher incidence of diagnosed anxiety (15 % vs 10 %; <em>p</em>-value = 0.005). Females were less likely to be hirsute than males (32 % vs 79 %; <em>p</em>-value &lt;0.001), and were more likely to have fine hair in their gluteal crease (51 % vs 5 %; <em>p</em>-value &lt;0.001). Females presented with lower disease severity than males (mild: 68 % vs 47 %, moderate: 22 % vs 33 %, and severe: 3 % vs 10 %; <em>p</em>-value &lt;0.001), and were less likely to have undergone prior operation (3 % vs 8 %; <em>p</em>-value &lt;0.001). However, disease-related quality of life impact was more severe for females than males in 5 of 6 domains examined including: pain (5 vs 3; <em>p</em>-value &lt;0.001), embarrassment (4 vs 3; <em>p</em>-value = 0.021), ability to play sports (2 vs 1; <em>p</em>-value = 0.01), disruption of routine (4 vs 3; <em>p</em>-value = 0.024) and disturbance to school, work, or activities (3 vs 2; <em>p</em>-value = 0.004). More females underwent pit picking on their first clinic visit (33 % vs 27 %; <em>p</em>-value = 0.011) and incision and drainage (6 % vs 3 %; <em>p</em>-value = 0.01), with similar rates of laser follicle ablation (53 % vs 55 %; <em>p</em>-value = 0.45).</div></div><div><h3>Conclusion</h3><div>The prevalence of pilonidal disease is much higher in females than previously reported. Pilonidal disease has different impacts on females than males including: earlier onset, higher incidence of anxiety, and greater disease-related impact on quality of life, despite lower disease severity on presentation. Tolerance of clinic treatments is comparable between genders.</div></div><div><h3>Type of study</h3><div>Retrospective, cohort study.</div></div><div><h3>Level of Evidence</h3><div>III.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 5","pages":"Article 162267"},"PeriodicalIF":2.4,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143609841","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":"Implementation of a Competency-Based Training Program in Pediatric Surgery: A Pilot Study","authors":"Rebecca Moreci ,&nbsp;Brianna Spencer ,&nbsp;Brian Fallon ,&nbsp;Calista Harbaugh ,&nbsp;Benjamin Zendejas ,&nbsp;Brian W. Gray ,&nbsp;Samuel Alaish ,&nbsp;Jose Diaz-Miron ,&nbsp;Peter Ehrlich ,&nbsp;Samir Gadepalli ,&nbsp;Erika Newman ,&nbsp;Gurjit Sandhu ,&nbsp;Ronald Hirschl","doi":"10.1016/j.jpedsurg.2025.162257","DOIUrl":"10.1016/j.jpedsurg.2025.162257","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;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.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;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.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;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.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;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}