Journal of pediatric surgery最新文献

{"title":"A six-day window: Tracheostomy timing and short-term outcomes in severe pediatric traumatic brain injury.","authors":"Alexander S Mina, Jeffrey W Chen, Duc T Nguyen, Kenneth Nobleza, Adam M Vogel, Howard I Pryor","doi":"10.1016/j.jpedsurg.2026.163376","DOIUrl":"10.1016/j.jpedsurg.2026.163376","url":null,"abstract":"<p><strong>Background: </strong>Early tracheostomy in pediatric patients with severe traumatic brain injury (TBI) is associated with reduced ventilator dependence and complications. However, the optimal timing of tracheostomy remains poorly defined. This study utilized a national trauma database to examine how the timing of tracheostomy is associated with critical care outcomes in children with severe TBI.</p><p><strong>Methods: </strong>We performed a retrospective cohort study using the Trauma Quality Improvement Program (TQIP) database (2019-2023). Inclusion criteria were age <18 years, severe TBI (GCS ≤8 and AIS Head ≥3 or ICD-10 code for intracranial injury), and tracheostomy placement. We first used LOWESS curves and a series of zero-inflated negative binomial (ZINB) models across candidate cut-offs to empirically identify a timing threshold, then applied propensity score matching (PSM) to compare Early Tracheostomy (≤6 days from admission) and Late Tracheostomy (>6 days). Primary outcomes were ventilator-free and ICU-free days.</p><p><strong>Results: </strong>Of 15,934 children with severe TBI identified, 1181 met the inclusion criteria and underwent tracheostomy (191 Early, 990 Late). LOWESS and ZINB analyses across candidate cut-offs identified Day 6 as an exploratory inflection point beyond which the incremental benefit of earlier tracheostomy diminished. Applying this threshold, PSM yielded a balanced cohort of 294 patients (147 pairs). The Early cohort demonstrated significantly higher median ventilator-free days (16.0 vs. 9.0, p < 0.001) and ICU-free days (11.0 vs. 4.0, p < 0.001). ZINB regression confirmed a higher rate of accumulating ventilator- and ICU-free days (IRR 1.47, 95% CI 1.31-1.66; IRR 1.46, 95% CI 1.27-1.67) compared with the Late cohort.</p><p><strong>Conclusion: </strong>Early tracheostomy was associated with significantly reduced mechanical ventilation duration, shorter hospital stays, and a higher likelihood of home discharge. These findings suggest that tracheostomy within the first 6 days of admission is associated with improved short-term outcomes in pediatric severe TBI.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"163376"},"PeriodicalIF":2.3,"publicationDate":"2026-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148794761","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 utility of serum Mac-2 binding protein glycosylation isomer as a noninvasive marker for liver fibrosis in biliary atresia.","authors":"Sung Min Lee, So Young Shin, Younghyun Na, In Geol Ho, Jung-Tak Oh, Yeong Eun Kim, Hong Koh, Haesung Yoon, Mi-Jung Lee, Kyong Ihn","doi":"10.1016/j.jpedsurg.2026.163409","DOIUrl":"10.1016/j.jpedsurg.2026.163409","url":null,"abstract":"<p><strong>Background: </strong>Hepatic fibrosis influences treatment decisions and clinical outcomes in biliary atresia (BA). As liver biopsy is invasive and unsuitable for serial assessments, noninvasive biomarkers are required. This study aimed to evaluate serum Mac-2 binding protein glycosylation isomer (M2BPGi) as a noninvasive biomarker by assessing its correlation with histopathologic fibrosis in children with BA.</p><p><strong>Methods: </strong>This prospective, exploratory diagnostic accuracy study enrolled 135 children who were assigned to one of the following three groups: BA with liver transplantation, BA with Kasai portoenterostomy, and choledochal cysts (control group). Intraoperative tissue was staged using METAVIR (stages F0-F4). The preoperative M2BPGi level and aspartate aminotransferase-to-platelet ratio index, Fibrosis-4 index, and S-index were compared across stages using receiver-operating characteristic (ROC) analysis with Youden-derived cutoffs.</p><p><strong>Results: </strong>M2BPGi increased progressively with fibrosis stage and outperformed all comparators. M2BPGi discriminated advanced fibrosis (stage ≥ F3) (area under the ROC curve [AUC], 0.953) and cirrhosis (stage F4) (AUC, 0.986). The optimal Youden-derived cutoff index (COI) of 3.02 showed strong performance (stage ≥ F3: 87.8% sensitivity and 96.5% specificity; F4: 97.6% sensitivity and 93.6% specificity). A rule-out COI threshold of 0.81 achieved 100% sensitivity and a negative predictive value for stage ≥ F3.</p><p><strong>Conclusion: </strong>M2BPGi is an accurate noninvasive biomarker for hepatic fibrosis in BA that may support clinical decision-making regarding fibrosis surveillance and transplantation timing.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"163409"},"PeriodicalIF":2.3,"publicationDate":"2026-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148794768","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":"Pull-through, diversion, or irrigation? Management of neonatal Hirschsprung disease in U.S. Children's hospitals.","authors":"Simone Carlson Hyman, Sophia Mv Schermerhorn, Romeo Ignacio, Gerald Gollin","doi":"10.1016/j.jpedsurg.2026.163410","DOIUrl":"10.1016/j.jpedsurg.2026.163410","url":null,"abstract":"<p><strong>Purpose: </strong>Both neonatal pull-through and staged repair after rectal irrigations have become accepted strategies for Hirschsprung disease (HD) in newborns. Staged pull-through may be associated with better continence, although its impact on the incidence of Hirschsprung associated enterocolitis (HAEC) is not clear. We assessed variations in the management of neonatal HD and evaluated outcomes after neonatal versus staged pull-through.</p><p><strong>Methods: </strong>The Pediatric Health Information Systems (PHIS) database was used to identify patients diagnosed with HD at less than 30 days of age at U.S. children's hospitals between 2017 and 2024 who underwent pull-through by 180 days. Operations performed within 10 days of diagnostic rectal biopsy were classified as primary pull-through procedures. Patients who underwent pull-through beyond that and had an enterostomy or not comprised the comparison groups. The incidence and severity of HAEC and incontinence was determined.</p><p><strong>Results: </strong>Inclusion criteria were met in 662 patients, 44% of whom had a neonatal pull-through. Individual hospitals reported neonatal pull-throughs in 0-79% of cases. Patients managed with a staged pull-through without diversion had a similar incidence of HAEC and antibiotic duration as those who had a neonatal pull-through. Patients initially managed with diversion had more frequent and severe HAEC.</p><p><strong>Conclusion: </strong>There was substantial variation among hospitals in the frequency of neonatal pull-through and diversion for HD. Staged repair without diversion was associated with a similar overall incidence of enterocolitis as neonatal pull-through. Given the continence benefits established in prior studies, staged pull-through may represent a preferable strategy for neonates with short-segment HD.</p><p><strong>Type of study: </strong>Retrospective observational cohort study.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"163410"},"PeriodicalIF":2.3,"publicationDate":"2026-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148794618","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":"Tracheopexy for Severe Tracheobronchomalacia in Children with Bronchopulmonary Dysplasia: A Two-Center Study of Patient Characteristics and Outcomes.","authors":"William Law, Hester F Shieh, Rebecca Leslie-Roberts, Farokh Demehri, Brian Fallon, Somala Mohammed, Joana Machry, Russell Jennings, Gary Visner, Jonathan Levin, Benjamin Zendejas, Charles J Smithers","doi":"10.1016/j.jpedsurg.2026.163404","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2026.163404","url":null,"abstract":"<p><strong>Purpose: </strong>The aim of this study was to characterize clinical phenotypes of children with severe tracheobronchomalacia (TBM) and bronchopulmonary dysplasia (BPD), report our experience with surgical management, and review outcomes.</p><p><strong>Methods: </strong>We retrospectively reviewed children <3 years old with BPD undergoing surgical management of severe TBM at two pediatric airway centers from 2015-2026 for clinical characteristics, surgical details, and post-operative outcomes.</p><p><strong>Results: </strong>Forty-nine children met criteria (77.6% male). The median gestational age was 25.7 weeks [24, 26.9], birth weight 0.7 kg [0.5, 0.8], and corrected gestational age at operation 4.4 months [2.3, 10.2]. Most had grade 3 BPD (79.6%). The primary surgical indications included severe respiratory events (n=30, 61.2%), chronic high ventilator support (n=6, 12.2%), and positive pressure dependence (n=13, 26.5%). Posterior tracheopexy and bronchopexy was performed in most patients (95.9% and 87.8%). There were no major surgical complications or procedure-related mortalities. The median follow-up was 1.7 years [0.2, 3.8]. The median PEEP decreased from 11 cmH₂O [9, 15] pre-operatively to 7 cmH₂O [0, 9] at 3 months, p<0.001. The majority of patients with severe pre-operative respiratory events no longer experienced these events post-operatively (63.3%). Among patients without a tracheostomy pre-operatively, a group in whom tracheostomy might otherwise be expected, only 21.7% required one. Conversely, 19.4% of those who had a tracheostomy were decannulated by the end of follow-up.</p><p><strong>Conclusions: </strong>Tracheopexy in a highly selected cohort of children with BPD and severe TBM was safe, associated with weaning of respiratory support, and decreased frequency of severe respiratory events.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"163404"},"PeriodicalIF":2.3,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148794629","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 treatment for postoperative Clostridioides difficile infection in Pediatric Surgery patients.","authors":"Omar Obaid, Kristine L Griffin, Elizabeth F Schneider, Amy Leber, Joshua R Watson, Guliz Erdem, Eunkyung Song, Gail E Besner, Brian D Kenney","doi":"10.1016/j.jpedsurg.2026.163390","DOIUrl":"10.1016/j.jpedsurg.2026.163390","url":null,"abstract":"<p><strong>Purpose: </strong>Our hospital was an outlier for postoperative Clostridioides difficile infection (CDI) on the 01/2022 NSQIP-Pediatric Semiannual Report. We instituted a QI initiative to improve testing methods in our hospital and decrease the postoperative CDI treatment rate.</p><p><strong>Methods: </strong>Surgical patients eligible for NSQIP-Pediatric sampling from 01/2022-07/2025 were analyzed to identify patients treated for CDI within 30 days of surgery. Prior to project initiation, screening tests were often used without confirmatory assays. In 01/2022, an initiative to increase confirmatory testing for patients screening positive for CDI was begun. The prior confirmatory assay in use was a send-out lab that required a new fecal sample and had long turn-around time (5 days). In-house EIA-based confirmatory testing was developed in 06/2024, and it was automatically deployed using the same stool sample. The turn-around time was 2-4 h, allowing for delay of therapy until confirmation.</p><p><strong>Results: </strong>We identified 16,926 NSQIP-Pediatric eligible patients, and 55 were treated for CDI. Ten patients (18%) were treated despite negative confirmatory testing. With education, confirmatory testing decreased from 82% to 62%, but CDI treatment decreased from 0.58% to 0.26% over the first 18 months. With the implementation of in-house automatic EIA testing, the CDI treatment rate decreased further to 0.07% over the subsequent 12 months.</p><p><strong>Conclusion: </strong>Confirmatory cytotoxin testing in an in-house automatic fashion allows accurate treatment of patients with active CDI instead of colonization. Utilization of a QI tool focused on diagnostic and antibiotic stewardship can successfully decrease system-wide healthcare resource utilization and costs, while improving patient care. Reducing inappropriate treatment of colonized patients lowered the NSQIP-P-defined CDI rate without an increase in missed or delayed diagnoses, fulminant CDI, or CDI requiring surgery.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"163390"},"PeriodicalIF":2.3,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148794321","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 the post surgical ooze: Utilizing a perioperative guideline to decrease transfusion needs following congenital diaphragmatic hernia repair on ECMO.","authors":"Kathleen Heller, Meriam J Avades, Navin Bhopal, Mohammed Elkhwad, Patrick McGovern, Sharad Menon, Mark S Molitor","doi":"10.1016/j.jpedsurg.2026.163405","DOIUrl":"10.1016/j.jpedsurg.2026.163405","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate changes in post-operative transfusion requirements of infants undergoing congenital diaphragmatic hernia (CDH) repair on ECMO following implementation of a perioperative guideline.</p><p><strong>Methods: </strong>In 2021, a multidisciplinary team created a guideline for perioperative management of CDH repair on ECMO, including guidance on pre-operative lab values, antifibrinolytic dosing, transfusion recommendations, and anticoagulation titration. CDH repairs on ECMO from 2010 to 2024 were divided into Pre- and Post- Guideline groups. A retrospective cohort study comparing Pre- and Post- Guideline outcomes was performed utilizing descriptive statistics for analysis.</p><p><strong>Results: </strong>Twenty-seven infants underwent CDH repair on ECMO within the study period: 16 Pre and 11 Post guideline implementation. Gestational age, weight, and day of life at cannulation did not differ. The Post group had higher Vasoactive-Inotropic Scores (Pre:10.5 versus Post:17.5, p = 0.01) and underwent repair sooner after ECMO cannulation (Pre:3 (1,8) versus Post:1 (1,2) days, p = 0.02). At 24-h post-operatively, pRBC transfusions were lower in the Post group (Pre:121 (51,210) versus Post:60 (31, 90) mL, p = 0.03) and platelet transfusions (Pre:93 (60,133) versus Post:50 (30,81) mL, p = 0.004). Re-operation for re-bleeding occurred in 19% of infants Pre versus 9% of infants Post, p = 0.62. Rate of intraventricular hemorrhages trended lower in the Post group (Pre:44% versus Post:9%, p = 0.09). ECMO cannula clotting rates were similar. 13% of infants Pre and 55% of infants Post survived to hospital discharge, p = 0.03.</p><p><strong>Conclusion: </strong>Implementation of a perioperative guideline for procedures on ECMO was associated with reduced transfusion requirement and improved survival of these high-risk patients.</p><p><strong>Level of evidence: </strong>Level 3 evidence.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"163405"},"PeriodicalIF":2.3,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148794802","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":"Development of a gastroschisis teaching model to enable surgical task sharing in Uganda.","authors":"Wigdan S Hissein, Anthony N Eze, OyinOluwa G Adaramola, Phillip J Hsu, Shannon Barter, Olivia McGinnis, Felix Oyania, Tamara N Fitzgerald","doi":"10.1016/j.jpedsurg.2026.163406","DOIUrl":"10.1016/j.jpedsurg.2026.163406","url":null,"abstract":"<p><strong>Introduction: </strong>Gastroschisis mortality is less than 5% in high-income countries, but remains 60-95% in Africa, partly due to absence of prenatal diagnosis and delayed presentation. Midwives are usually the first point of contact and pediatricians often encounter these babies before surgeons. With training, these healthcare providers may be able to serve as task-sharers by initiating resuscitation, applying silos and directing babies to a pediatric surgeon.</p><p><strong>Methods: </strong>A low-cost, non-perishable gastroschisis model was developed that is suitable for hands-on training. The model was piloted with nurses, midwives, pediatricians and pediatric surgeons in Uganda and Rwanda. The model was created using a plastic teaching doll, which replicates newborn anatomy and contains a hollow torso, necessary for securing the simulated intestines. A 3 cm defect was created on the anterior abdominal wall of the doll, to the right of the umbilicus. Glue, borax, paint, poly tubing, and mesh fabric were used to create a model of eviscerated intestines.</p><p><strong>Results: </strong>Modifications were implemented in response to feedback from pediatric surgeons in the U.S. and Uganda. The final cost was $45 per doll. A hands-on training program was conducted in three regions of Uganda, Rwanda and Kenya where 160 nurses, midwives and pediatric resident physicians learned to place silos for gastroschisis. Evaluation based on participant feedback demonstrated high satisfaction with the model and perceived usefulness for learning gastroschisis management.</p><p><strong>Conclusion: </strong>We describe a training model for gastroschisis silo placement that can be made from readily available materials. Further research is underway to assess clinical impact.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"163406"},"PeriodicalIF":2.3,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148794542","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 and outcomes of paediatric non-parasitic splenic cysts: A multi-centre retrospective cohort study and systematic review.","authors":"Ashley Wiseman, Alexander Sterlin, Diren Zozan Caliskan, Renos Jeropoulos, Samantha Chippington, Dhanya Mullassery, Kirsty Brennan","doi":"10.1016/j.jpedsurg.2026.163407","DOIUrl":"10.1016/j.jpedsurg.2026.163407","url":null,"abstract":"<p><strong>Background: </strong>Non-parasitic splenic cysts (NPSCs) are rare in children, and optimal management remains controversial. We evaluated management and outcomes of paediatric NPSCs through a retrospective cohort study and systematic review.</p><p><strong>Methods: </strong>All children with NPSCs at two tertiary paediatric centres over 10 years were retrospectively reviewed. Following PRISMA guidelines, a systematic review was also conducted. Outcomes included cyst resolution or recurrence, complications, splenic preservation rates.</p><p><strong>Results: </strong>45 patients with NPSCs were analysed in the retrospective cohort: 14 antenatally detected, 18 incidental, 13 symptomatic. Overall, 28/45 (62%) patients were observed, 12/45 (27%) underwent interventional radiology (IR) procedures and 5/45 (11%) surgery. All antenatally detected cysts were observed. Incidentally diagnosed NPSCs requiring further intervention were larger (median 8.2 cm, IQR 7-11; p < 0.001). Symptomatic patients undergoing IR or surgical procedures had no significant difference in median cyst size (13 cm vs 14.2 cm; p = 0.850). IR patients required a median of 3 procedures (IQR 2-4) to reach cyst resolution. Postoperative recurrences were mainly after laparoscopic deroofing (2/3). The systematic review included 31 studies (532 patients). 104 patients (20%) were observed, 53 (10%) underwent IR procedures and 369 (70%) surgery. Symptomatic patients underwent IR or surgical interventions, with subsequent surgery required in 11/53 IR patients (20.7%). Surgical technique varied, with cyst recurrence highest after deroofing (12%) versus 0.7% after partial splenectomy.</p><p><strong>Conclusion: </strong>Most asymptomatic NPSCs can be observed. For larger, symptomatic NPSCs, IR interventions are feasible but frequently require repetition. Partial splenectomy appears to provide durable spleen-preserving outcomes.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"163407"},"PeriodicalIF":2.3,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148794536","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":"Posterior urethral valves in children: Achieving renal preservation through integrated multidisciplinary care in a resource-limited region.","authors":"Mathula Hettiarachchi, Shenal Thalgahagoda","doi":"10.1016/j.jpedsurg.2026.163392","DOIUrl":"10.1016/j.jpedsurg.2026.163392","url":null,"abstract":"<p><strong>Introduction: </strong>Posterior urethral valves (PUV) remain the leading cause of congenital obstructive uropathy and chronic kidney disease (CKD) in male children. Outcomes vary widely across healthcare systems, with end-stage renal disease (ESRD) rates of 10-25% reported in international series. We present a single-centre PUV cohort, examining renal preservation, surgical outcomes, and the prognostic impact of detection timing.</p><p><strong>Methods: </strong>A retrospective review of 120 consecutive patients with PUV managed between 2018 and 2024 was conducted. Patients were stratified by antenatal versus postnatal detection. The primary outcome was renal functional status at last follow-up, classified according to CKD stage. Secondary outcomes included procedural burden, urinary diversion requirement, and predictors of poor renal outcome.</p><p><strong>Results: </strong>Overall renal function was preserved (normal or mild impairment) in 84 of 120 patients (70.0%; 95% CI 61.0-77.9), with 77 patients (64.2%; 95% CI 55.3-72.3) achieving normal renal function. Mild impairment (CKD stage 1-2) was present in 7 patients (5.8%), moderate impairment (CKD stage 3) in 29 (24.2%), and severe impairment/ESRD in 7 (5.8%). ESRD occurred in 7 patients (5.8%; 95% CI 2.4-11.6). Antenatal detection was achieved in 58 patients (48.3%). Despite earlier diagnosis and intervention, the antenatal group demonstrated lower rates of normal renal function (53.4% vs 74.2%; absolute difference 20.8%; OR 0.40, 95% CI 0.19-0.84; p = 0.008), lower rates of preserved renal function (58.6% vs 80.6%; OR 0.34, 95% CI 0.15-0.78; p = 0.009), higher procedural burden (mean 3.29 vs 2.13 procedures; p < 0.001), and greater requirement for urinary diversion (24.1% vs 4.8%; p < 0.001). On multivariable analysis, severe oligohydramnios (OR 4.2, 95% CI 1.8-9.7), dense occluding valves (OR 3.1, 95% CI 1.4-6.8), Grade V VUR (OR 2.8, 95% CI 1.2-6.5), and urinary diversion requirement (OR 2.4, 95% CI 1.1-5.3) were independent predictors of poor renal outcome. A total of 323 procedures were performed.</p><p><strong>Conclusion: </strong>This cohort demonstrates that systematic, multidisciplinary PUV management is associated with favorable renal outcomes even in a resource-limited setting. The paradox of antenatal detection, where earlier identification is associated with worse outcomes, reflects inherent disease severity rather than treatment inadequacy. These findings highlight the importance of disease-severity stratification and early aggressive surgical intervention.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"163392"},"PeriodicalIF":2.3,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148794611","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":"Operative planning in esophageal atresia with right arch-based vascular rings: A referral-center experience.","authors":"Abdimajid Mohamed, Valeria E Ruiz-Santana, Alex Huang, Rosa S Kim, Daniel Castellanos, Lianne Cole, Brian P Fallon, Somala Mohammed, Farokh R Demehri, Christopher Baird, Benjamin Zendejas","doi":"10.1016/j.jpedsurg.2026.163401","DOIUrl":"10.1016/j.jpedsurg.2026.163401","url":null,"abstract":"<p><strong>Purpose: </strong>Esophageal atresia (EA) with complete vascular ring (VR) presents complex airway, esophageal, and vascular challenges. We reviewed our referral-center experience to characterize morbidity, patterns of reoperation, and operative planning considerations.</p><p><strong>Methods: </strong>We reviewed children with EA and VR managed between 2017 and 2025. Patients were categorized as primary or referred (prior management elsewhere). Data included anatomy, imaging, operative approach, and outcomes.</p><p><strong>Results: </strong>Twenty-four patients were identified (83% type C EA). VR subtypes included right aortic arch with aberrant left subclavian artery (RAA + ALSCA 71%), double aortic arch (17%), and right aortic arch with left ligamentum (13%). Echocardiography was concordant with operative findings in 70%, discordant in 10%, and missed a VR in 20%. Twenty patients (84%) were referred; 75% required reoperation. Referred patients had prior or active leak (42%), refractory stricture (60%), recurrent fistula (28%), dysphagia (90%), and vocal fold movement impairment (53%). Reoperation addressed airway pathology (e.g. tracheomalacia) or vascular compression (n = 10), EA-related complications (n = 8), and incomplete EA or VR repair (n = 4). We identified and describe a new entity: \"trapped esophagus\" (n = 3) characterized by extrinsic vascular compression of an EA anastomosis positioned within an unrepaired VR (RAA + ALSCA) without intrinsic stricture, leading to dysphagia and requiring reoperation. Four patients underwent multidisciplinary primary EA + VR concurrent repair at our institution, without complications.</p><p><strong>Conclusion: </strong>EA + VR can be associated with high morbidity and need for reoperation. Patients with EA + right arch on echocardiography could benefit from pre-operative cross-sectional imaging and multidisciplinary planning to consider primary EA + VR concurrent repair, taking into consideration reasons for reoperation.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"163401"},"PeriodicalIF":2.3,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148794569","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}