Journal of pediatric surgery最新文献

{"title":"Complications After Surgery for Anorectal Malformations: An ARM-Net consortium Registry Study","authors":"H.J.J. van der Steeg ,&nbsp;I.C. Hageman ,&nbsp;A. Morandi ,&nbsp;E.E. Amerstorfer ,&nbsp;C.E.J. Sloots ,&nbsp;E. Jenetzky ,&nbsp;P. Stenström ,&nbsp;I. Samuk ,&nbsp;M. Fanjul ,&nbsp;P. Midrio ,&nbsp;E. Schmiedeke ,&nbsp;B.D. Iacobelli ,&nbsp;I. de Blaauw ,&nbsp;I.A.L.M. van Rooij","doi":"10.1016/j.jpedsurg.2025.162403","DOIUrl":"10.1016/j.jpedsurg.2025.162403","url":null,"abstract":"<div><h3>Objective</h3><div>Establishing the incidence and types of complications following surgical intervention for ARM, primarily after reconstruction. Patient- and treatment-related risk factors were also determined.</div></div><div><h3>Background</h3><div>Postoperative complications of ARM surgery vary widely, with data predominantly derived from single-center retrospective studies with limited number of patients. Whether factors such as ARM type, associated congenital anomalies, prior enterostomy, or type of reconstructive surgery affect complication incidence remains unclear.</div></div><div><h3>Methods</h3><div>This multicenter cohort study was performed using the ARM-Net registry with prospectively collected data. Enterostomy-related and post-reconstructive complications in patients who underwent reconstructive surgery before the age of five years were recorded. Patients with more than 25 % missing data, unknown sex, ARM type, or reconstruction date, or without (information on) reconstruction or complications, were excluded. Multivariable analyses identified independent risk factors for the development of complications.</div></div><div><h3>Results</h3><div>A total of 2,043 patients were eligible for analysis. Complications after enterostomy formation and closure occurred in 25 % and 12 % of patients, respectively. Post-reconstructive complications occurred in 25 % of patients, with wound complications comprising half of the complications. In a multivariable analysis, recto-bladder neck fistula, any associated anomaly, and the LAARP procedure were identified as independent risk factors for post-reconstructive complications. In contrast, anoplasty and mini-PSARP reduce the risk of complications.</div></div><div><h3>Conclusions</h3><div>Post-reconstructive complications in ARM patients are common, and certain patient- and treatment-related characteristics affect postoperative outcomes. These results aid counselling and clinical decision-making, and may guide the operative planning of ARM types that are amenable to several different surgical approaches.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 9","pages":"Article 162403"},"PeriodicalIF":2.4,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248402","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: Bringing Diagnostic Accuracy Back Into Focus: The Case of APRi in Biliary Atresia.","authors":"Javier Arredondo Montero","doi":"10.1016/j.jpedsurg.2025.162402","DOIUrl":"10.1016/j.jpedsurg.2025.162402","url":null,"abstract":"","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"162402"},"PeriodicalIF":2.4,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248401","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":"Complications and Long-term Outcomes of Patients With Cloacal Malformation After Bowel Neovagina Creation","authors":"Kristine L. Griffin ,&nbsp;Wendy Jo Svetanoff ,&nbsp;Megan A. Read ,&nbsp;Shruthi Srinivas ,&nbsp;Geri Hewitt ,&nbsp;Richard J. Wood ,&nbsp;Chelsea A. Kebodeaux","doi":"10.1016/j.jpedsurg.2025.162396","DOIUrl":"10.1016/j.jpedsurg.2025.162396","url":null,"abstract":"<div><h3>Introduction</h3><div>Up to 60 % of patients with a cloacal malformation have a Mullerian anomaly. In cases where the vagina is absent or cannot reach the perineum, an intestinal neovagina is often created. The complications and outcomes of this are not well described. We aimed to describe the gynecologic outcomes of patients who underwent neovagina creation followed at our institution.</div></div><div><h3>Methods</h3><div>A single institution retrospective review of patients ≥8 years old with cloacal malformation who underwent intestinal neovagina creation was performed. Demographics, surgical history, short-term complications, and long-term gynecologic outcomes were assessed.</div></div><div><h3>Results</h3><div>Forty patients were included. The median age at neovagina creation was 3.95 years (IQR 1.40, 7.61). Twelve patients (30 %) had uterine agenesis. Neovagina was colonic in 27 (67.5 %) and small bowel in 12 (30 %). Median age at most recent follow up was 9.7 years (IQR 7.6, 14.1).</div><div>There was no difference in 30-day complications, incidence of vaginal prolapse, introital stenosis, or graft stenosis between those undergoing small bowel vs colonic neovagina. Two patients had documented menstrual obstruction, and 11 patients reported bothersome vaginal discharge. Of those with neovagina prolapse, one small bowel (8.3 %) and two colonic grafts (7.4 %) required prolapse repair. One small bowel (8.3 %) and 7 colonic (26 %) patients underwent introitoplasty for stenosis. Of the 3 patients having penetrative sex, 2 reported dyspareunia. No patients have become pregnant.</div></div><div><h3>Conclusion</h3><div>Bowel neovaginas remain a suitable choice for patients with cloacal malformations in whom the vagina is absent or cannot reach the perineum.</div></div><div><h3>Level of Evidence</h3><div>IV.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 9","pages":"Article 162396"},"PeriodicalIF":2.4,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248403","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":"Simple vs. Complex Gastroschisis Outcomes: 30-Year Multicenter Review","authors":"Andreina Giron ,&nbsp;Peter T. Yu ,&nbsp;John Schomberg ,&nbsp;Habiba Aziz ,&nbsp;Zoe Flyer ,&nbsp;Saeed Awan ,&nbsp;Hira Ahmad ,&nbsp;Laura F. Goodman","doi":"10.1016/j.jpedsurg.2025.162398","DOIUrl":"10.1016/j.jpedsurg.2025.162398","url":null,"abstract":"<div><h3>Background</h3><div>Gastroschisis is a congenital abdominal wall defect that has increased in prevalence at birth globally over the past three decades. Despite advancements in neonatal care, gaps remain in understanding the long-term outcomes and factors driving differences between simple (SG) and complex gastroschisis (CG). Previous studies have highlighted disparities in morbidity and mortality between these two groups but lack consistent data over extended periods. This study aims to address these gaps by evaluating outcomes over a 30-year period, hypothesizing that differences in clinical outcomes exist between SG and CG.</div></div><div><h3>Methods</h3><div>A retrospective review of Cerner Real World Data (1998–2022) was conducted for neonates with gastroschisis. SG and CG were defined by operative procedures and comorbidities used in published studies and/or by author consensus. Outcomes were analyzed using descriptive statistics. Primary endpoints included mortality, length of stay (LOS), ventilator use, necrotizing enterocolitis (NEC), intestinal dysmotility, and gastroesophageal reflux disease (GERD).</div></div><div><h3>Results</h3><div>The study cohort comprised 331 neonates, with 255 categorized as simple gastroschisis and 76 as complex gastroschisis. Whites comprised 62 % of SG and 63 % of CG (p = 0.9). CG was associated with higher rates of prematurity (33 % vs. 22 %, p = 0.002), GERD (16 % vs. 11 %, p = 0.4), NEC (11 % vs. 0.4 %, p &lt; 0.0001), and dysmotility (11 % vs. 0 %, p &lt; 0.0001). CG was also associated with decreased routine discharge (80 % vs. 85 %, p &lt; 0.0001) and increased LOS (median 75 days [IQR: 29–130] vs. 33 days [IQR: 23–53], p &lt; 0.001). There was no significant difference in survival to discharge between the two groups.</div></div><div><h3>Conclusion</h3><div>This large, retrospective review demonstrates differences in outcomes between SG and CG. Fetal providers should counsel accordingly to optimally prepare families who are expecting a newborn with gastroschisis.</div></div><div><h3>Level of Evidence</h3><div>III.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 8","pages":"Article 162398"},"PeriodicalIF":2.4,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144234401","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":"Robot-assisted Surgery in Pediatric Patients: Results of a French Multicenter Study on 1401 Patients","authors":"Quentin Ballouhey ,&nbsp;Ciro Esposito ,&nbsp;Kiarash Taghavi ,&nbsp;Hubert Lardy ,&nbsp;Nicolas Berte ,&nbsp;Olivier Abbo ,&nbsp;Marc David Leclair ,&nbsp;Sarah Garnier ,&nbsp;Matthieu Peycelon ,&nbsp;Géraldine Hery ,&nbsp;Aurélien Scalabre ,&nbsp;Pierre Meignan ,&nbsp;Carmen Capito ,&nbsp;Pauline Lopez ,&nbsp;Sabine Sarnacki ,&nbsp;Laurent Fourcade ,&nbsp;Alexis P. Arnaud ,&nbsp;Thomas Blanc","doi":"10.1016/j.jpedsurg.2025.162397","DOIUrl":"10.1016/j.jpedsurg.2025.162397","url":null,"abstract":"<div><h3>Introduction</h3><div>Establishing a robotic program in pediatric surgery remains challenging, with evidence-based practices still evolving. Over the last five years, robot-assisted surgery (RAS) has become the standard approach for several pediatric indications. This study presents the first national analysis of pediatric RAS in France, aiming to evaluate indications, procedural trends, and technical considerations.</div></div><div><h3>Methods</h3><div>A retrospective, multi-institutional study was conducted across 11 French centers with active pediatric robotic programs over the period 2007–2020. Clinical and organizational data were collected through standardized questionnaires and centralized database analysis. A Surgical Complexity Score (SCS) was developed to classify procedures.</div></div><div><h3>Results</h3><div>A total of 1401 RAS procedures were performed, including 301 children &lt;15 kg and 93 &lt; 10 kg. Centers handled a median of 1.4 cases/month, with 91 types of procedures performed. The 5 most frequent procedures were pyeloplasty (34 %), nephrectomy (12.7 %), antireflux surgery (9.2 %), ureteral reimplantation (5.7 %), and biliary procedures (5.6 %). Over time, procedural complexity increased, with 204 cases classified as high complexity (SCS 3). A strong correlation was observed between center experience and inclusion of patients &lt;15 kg (r = 0.873; p = 0.0004), while conversion rates (3 %) were not influenced by experience. Twenty-four fellows were trained using standardized curricula and dual-console platforms.</div></div><div><h3>Conclusions</h3><div>Pediatric RAS has significantly grown in France, proving to be safe and feasible even in infants under 10 kg. Urology remains the main indication, followed by gastrointestinal and biliary surgery. Despite current limitations-especially instrument size-RAS offers advantages in precision, ergonomics, and surgical education. Future innovation may enhance its broader adoption in pediatric surgery.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 8","pages":"Article 162397"},"PeriodicalIF":2.4,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144234400","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":"Vascular Surgery in Children.","authors":"David H Rothstein, John V White, Regan F Williams, Dawn M Coleman","doi":"10.1016/j.jpedsurg.2025.162308","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2025.162308","url":null,"abstract":"","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"162308"},"PeriodicalIF":2.4,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144216161","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":"Blunt Brachial Arterial Injury in Pediatric Patients.","authors":"Muhammad-Saad Hafeez, David M Notrica, Claudie Sheahan, Regan F Williams, Mohammad H Eslami","doi":"10.1016/j.jpedsurg.2025.162200","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2025.162200","url":null,"abstract":"<p><p>Blunt brachial arterial injury (BBAI) is the most common vascular injury in pediatric patients. BBAI can lead to a spectrum of clinical signs and symptoms in the affected extremity, depending on the degree of occlusion and the robustness of the collateral circulation. The proper treatment ranges from expectant and conservative medical management to surgical revascularization. Although the management depends on the degree of ischemia, there is still controversy about the treatment algorithm for a pink pulseless hand following BBAI. Treatment of these pediatric vascular injuries often varies depending on the specialty of the surgeon involved. This manuscript reviews the current literature to summarize the pathophysiology, clinical presentation, diagnosis, evaluation, and best management for BBAI injury.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"162200"},"PeriodicalIF":2.4,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144216160","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":"Screening Practices for Müllerian Anomalies in Patients With Known Renal or Urologic Anomalies: A Retrospective Chart Review.","authors":"Sofie Rosenberg, Kendra Hutchens, Lauryn Roth, Laurel Beaty, Vijaya M Vemulakonda, Veronica I Alaniz","doi":"10.1016/j.jpedsurg.2025.162393","DOIUrl":"10.1016/j.jpedsurg.2025.162393","url":null,"abstract":"<p><strong>Introduction/background: </strong>Approximately 20-40 % of females diagnosed with renal anomalies will have a coexistent Müllerian anomaly. Müllerian anomalies can have significant implications on reproductive health, however, no formal guidelines exist to direct screening practices for patients within this high-risk population.</p><p><strong>Objective: </strong>This study aims to establish a baseline incidence and description of pelvic imaging practices among female patients with renal anomalies at a tertiary children's hospital.</p><p><strong>Methods: </strong>Retrospective chart review of female patients aged 0-25 years with congenital renal anomalies who presented to a tertiary children's hospital between January 2015 and June 2022.</p><p><strong>Results: </strong>A total of 212 patients met inclusion criteria. The most common congenital renal anomaly diagnoses included multicystic kidney disease (61, 28.8 %), renal agenesis (39, 18.4 %), and renal dysplasia/hypoplasia (36, 17.0 %). The average age of renal anomaly diagnosis was 8.6 years (SD = 5.8, range 0-20). Within this patient population, 125 (59.0 %) received at least one pelvic imaging study and 75 (35.4 %) reported an evaluation of reproductive structures. The most common imaging modality that evaluated reproductive structures was pelvic ultrasound (59/75, 78.7 %), which occurred on average at age 13.7 (SD 4.7). Uterine or vaginal anomalies were identified in 22/75 (29.3 %) patients who had their reproductive anatomy evaluated on imaging. Only one imaging study was ordered for the indication of Müllerian anomaly screening.</p><p><strong>Discussion: </strong>Most female patients with renal anomalies do not receive imaging that evaluates reproductive anatomy. When imaging does occur, it is ordered for indications other than screening for Müllerian anomalies. Screening protocols need to be developed for early detection of Müllerian anomalies in this high-risk population.</p><p><strong>Conclusions: </strong>Findings demonstrate that female patients with renal anomalies are not consistently screened for Müllerian anomalies despite the known association between these anomalies. Lack of guidelines at our tertiary institution may delay diagnosis and treatment of these conditions.</p><p><strong>Study type: </strong>This study is a level 2 retrospective chart review.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"162393"},"PeriodicalIF":2.4,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144199441","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":"Assessment of Müllerian Patency in Patients With Cloacal Anomaly Using Saline Pertubation: A Retrospective Cohort Study","authors":"Taryn Wassmer ,&nbsp;Viktoriya Tulchinskaya ,&nbsp;Aimee Morrison ,&nbsp;Jason S. Frischer ,&nbsp;Lesley Breech","doi":"10.1016/j.jpedsurg.2025.162389","DOIUrl":"10.1016/j.jpedsurg.2025.162389","url":null,"abstract":"<div><h3>Purpose</h3><div>36–41 % of females with cloaca experience menstrual obstruction, which can result in significant morbidity. No established evaluation exists to determine the patency of the pre-pubertal Müllerian system. Saline pertubation (SP)-- cannulating the fallopian tubes and injecting sterile saline-- can be performed during other indicated abdominal procedures. This study sought to assess the sensitivity and specificity of SP in predicting future patency of the Müllerian system among females with cloaca.</div></div><div><h3>Methods</h3><div>A retrospective review of patients with cloaca at a single institution from 2005 to 2023 was conducted (IRB#2023–0617). Menstrual patency was defined by the absence of obstruction by imaging or symptoms within 2 years of menarche, or between ages 9–13 years in patients with amenorrhea.</div></div><div><h3>Results</h3><div>255 patients with cloaca were reviewed. In those who met inclusion criteria by age or pubertal status, 79 Müllerian structures underwent SP in 52 patients. 75 structures were found to be patent, and four were found to be obstructed by SP. Four structures with patency on SP later developed obstruction. One structure without patency by SP had subsequent patency. SP was found to have a sensitivity of 95.9 % (95 % CI of 88.6–99.1 %) and specificity of 20 % (95 % CI of 0.5 %–71.6 %) for menstrual patency. One patient, patent on SP, developed a tuboovarian abscess 10 years after intervention and two patients patent on SP developed hydrosalpinx 8–10 years later. In 150 cloaca patients who did not undergo SP, three patients developed tuboovarian abscesses, and 22.8 % (29/127) of unobstructed patients developed hydrosalpinx.</div></div><div><h3>Conclusions</h3><div>SP among individuals with cloaca has a high sensitivity to identify those who are low risk for obstruction.</div></div><div><h3>Study Type</h3><div>Retrospective Cohort Study.</div></div><div><h3>Level of Evidence</h3><div>Level 3.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 8","pages":"Article 162389"},"PeriodicalIF":2.4,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144187210","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":"Intestinal Dysmotility and the Risk of Volvulus Following Omega-jejunostomy Tube Placement in Children","authors":"Daniel J. Scheese,&nbsp;Charbel Chidiac,&nbsp;Cody Tragesser,&nbsp;Erica I. Hodgman,&nbsp;Clint D. Cappiello,&nbsp;Daniel S. Rhee,&nbsp;Samuel M. Alaish","doi":"10.1016/j.jpedsurg.2025.162395","DOIUrl":"10.1016/j.jpedsurg.2025.162395","url":null,"abstract":"<div><h3>Introduction</h3><div>Gastric dysmotility complicates enteral feeding in children, often requiring distal feeding access. While nasoduodenal and gastrojejunostomy tubes are common, frequent dislodgements necessitate hospital visits for fluoroscopic-guided replacement, exposing children to radiation and potential anesthesia risks. The omega-jejunostomy (OJ) tube was developed as a simpler alternative to roux-en-Y feeding jejunostomy, allowing easy at-home tube changes after tract maturation. Despite nearly two decades of use, OJ-tube placement remains poorly characterized. This study examines patient factors and outcomes following OJ-tube placement in children at a single center.</div></div><div><h3>Methods</h3><div>A retrospective review was conducted on 23 pediatric patients who underwent OJ-tube placement at an academic children's hospital (2016–2024). We analyzed demographic, perioperative, and outcome data, including volvulus incidence, reoperations, emergency department (ED) visits, and readmissions.</div></div><div><h3>Results</h3><div>Intestinal volvulus occurred in 17.4 % (n = 4), requiring emergent laparotomy. Patients with volvulus had longer hospital stays (12.0 vs. 3.5 days, <em>p</em> = 0.02) and higher 30-day readmission rates (100 % vs. 15.8 %, <em>p</em> = 0.004). Intestinal dysmotility was present in 75 % of volvulus cases, suggesting a predisposition (<em>p</em> = 0.07). ED visits occurred in 73.9 % of patients, primarily due to clogged (35.3 %) or dislodged tubes (29.4 %).</div></div><div><h3>Discussion</h3><div>OJ-tube placement is an effective feeding option but carries risks, including volvulus and frequent ED visits. Intestinal dysmotility may predispose patients to volvulus, warranting careful patient selection and monitoring. Improved caregiver education and mechanical complication management may reduce ED utilization. Further multicenter research is needed to assess volvulus risk in this population.</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 8","pages":"Article 162395"},"PeriodicalIF":2.4,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144191871","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}