Pediatric Surgery International最新文献

{"title":"The impact of pathological cyst wall changes on congenital biliary dilatation in infancy.","authors":"Takeshi Shirai, Toshiharu Matsuura, Akihiko Tamaki, Shohei Maeda, Yukihiro Toriigahara, Yoshiaki Takahashi, Koichiro Yoshimaru, Kenichi Kohashi, Yoshinao Oda, Tatsuro Tajiri","doi":"10.1007/s00383-026-06685-z","DOIUrl":"https://doi.org/10.1007/s00383-026-06685-z","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to evaluate the impact of pathological changes in bile duct cysts on the clinical and liver pathological findings in early infantile patients with congenital biliary dilatation (CBD).</p><p><strong>Method: </strong>In patients with CBD who underwent definitive surgery ≤ 4 months of age, the clinical and liver pathological findings were analyzed according to the presence or absence of inflammatory and fibrotic changes on the luminal side of the bile duct cyst.</p><p><strong>Results: </strong>Among the 14 patients with infantile CBD, 8 had inflammatory cell infiltration (iCBD), and 4 of these 8 patients showed the formation of a collagen layer together. In the remaining six patients, no infiltration of inflammatory cells or formation of collagen layers was observed (non-iCBD). In the iCBD group, the preoperative liver biochemistry levels were higher, the cyst amylase levels were lower, and the degree of liver fibrosis was more severe than those in the non-iCBD group, with significant differences. In comparisons of iCBD patients, there were no differences in the preoperative liver biochemistry levels, cyst amylase levels, and severity of liver fibrosis between the presence and absence of a collagen layer.</p><p><strong>Conclusion: </strong>Inflammatory and fibrotic changes in the bile duct cysts due to obstructive cholestasis may affect the clinical and liver histopathological differences in early infantile CBD after birth.</p>","PeriodicalId":19832,"journal":{"name":"Pediatric Surgery International","volume":"42 1","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149207378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of fecal continence and bowel function scoring systems following anorectal malformation repair: a systematic review.","authors":"Jiepin Wang, Junxiang Wang, Yuting Zhang, Dong Xiao, Chi Zhang, Xiuliang Wang, Haozhong Xu, Jianxiong Mao","doi":"10.1007/s00383-026-06654-6","DOIUrl":"https://doi.org/10.1007/s00383-026-06654-6","url":null,"abstract":"<p><strong>Purpose: </strong>Multiple instruments are used to assess fecal continence and bowel function after anorectal malformation (ARM) repair, but their comparability is uncertain. This systematic review examined inter-system agreement and differences in the findings produced when two or more scoring systems were applied to the same ARM cohort.</p><p><strong>Methods: </strong>MEDLINE, Embase, and Web of Science were searched from inception through 26 April 2026. Original studies applying at least two named fecal continence or bowel function scoring systems to the same ARM cohort were eligible. Risk of bias was assessed using an adapted QUADAS-2 framework. Because comparable agreement estimates were sparse, results were synthesized narratively (PROSPERO: CRD420261377404).</p><p><strong>Results: </strong>Fifteen studies published from 2012 to 2025, with individual sample sizes of 20-267 participants, were included. Krickenbeck was used in 14 studies (93%) and Kelly in nine (60%). Only one study, based on 39 parent-reported assessments, reported numerical inter-system agreement estimates; weighted κ values for four score pairs ranged from 0.256 to 0.343. Other studies described category discordance or differences in group-level findings. In one cohort, Kelly did not identify a between-group difference detected by Krickenbeck and Rintala. In another small cohort, Kelly continence and the Krickenbeck constipation domain favored different surgical groups, although they assessed different outcome constructs. Blinding between instrument administrations was unreported in 12 studies.</p><p><strong>Conclusion: </strong>The limited available evidence suggests that commonly used ARM bowel function instruments may yield non-equivalent information, but it is insufficient to establish their interchangeability or the superiority of any single system. Krickenbeck is currently the most frequently used instrument. Prospective comparative studies using standardized administration and appropriate agreement analyses are needed before a universal core instrument can be recommended.</p>","PeriodicalId":19832,"journal":{"name":"Pediatric Surgery International","volume":"42 1","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149195995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient experience and resource use analysis of balloon-retained vs. disc-retained gastro-jejunal tubes in children.","authors":"Muhammad Saad Ali, Saifullah Khan, Olugbenga Michael Aworanti","doi":"10.1007/s00383-026-06680-4","DOIUrl":"10.1007/s00383-026-06680-4","url":null,"abstract":"<p><strong>Purpose: </strong>Building on our previous work demonstrating that balloon-retained gastro-jejunostomy tubes (BGJ) avoid complications unique to disc-retained devices but require more frequent replacement, we evaluated caregiver experience and healthcare resource use to better inform tube selection in children.</p><p><strong>Methods: </strong>Families whose children had experienced both Freka® percutaneous endoscopic gastro-jejunostomy (FPEGJ) and BGJ completed a paired questionnaire assessing nine experience domains (0-5 Likert-type scales) with free-text comments. Scores were compared using the Wilcoxon signed-rank test and comments underwent thematic analysis. A 24-month NHS resource-use model compared staged FPEGJ followed by planned BGJ conversion with primary laparoscopic BGJ insertion using 2026/27 NHS Payment Scheme tariffs.</p><p><strong>Results: </strong>Twelve of thirteen eligible families responded(92.3%). Nine(75%) preferred BGJ and three had no preference. No questionnaire domain differed significantly, although BGJ showed trends towards greater comfort and easier daily care, while FPEGJ showed a trend towards less leakage. Families favoured BGJ because of its lower profile, avoidance of general anaesthesia (GA) for replacement and avoidance of buried bumper syndrome. Standard staged FPEGJ treatment cost £4,192 over 24 months compared with £6,024 for primary laparoscopic BGJ, saving £1,831(30.4%). Even with laparoscopic assistance, FPEGJ remained 22.1% less expensive. Routine BGJ exchanges were the principal cost driver.</p><p><strong>Conclusions: </strong>A staged FPEGJ-to-BGJ strategy appears to provide the best balance between caregiver experience and NHS resource use. However, disc-retained devices commit children to at least one future GA, the associated burden of which is not fully captured by cost analysis. BGJ with reliable 12-month durability may further reduce procedural burden and healthcare costs.</p>","PeriodicalId":19832,"journal":{"name":"Pediatric Surgery International","volume":"42 1","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13672259/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149196065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validation of PECARN as a clinical decision rule for CT imaging of children with blunt abdominal trauma: a single centre retrospective cohort study.","authors":"Jaime Tsz-Wing Tsang, Adrian Chi-Heng Fung, Carol Wing-Yan Wong, Celestine Wing-Yin Ng, Jeff Wing-Chiu Dai, Kenneth Kak-Yuen Wong","doi":"10.1007/s00383-026-06664-4","DOIUrl":"10.1007/s00383-026-06664-4","url":null,"abstract":"<p><strong>Background: </strong>Blunt traumatic injuries are the leading cause of morbidity and mortality in children. Contrast enhanced computed tomography (CT) is the best imaging tool for screening patients at risk of blunt abdominal injury. Concerns existed on potential overuse and the radiation risks. We aim at evaluating paediatric use of trauma CT scan.</p><p><strong>Methods: </strong>Children with traumatic injuries who attended a tertiary trauma centre from January 2000 to December 2024 were included to evaluate the use of trauma CT scan and patterns of paediatric abdominal trauma. We excluded those with penetrating or isolated head injury. The Pediatric Emergency Care Applied Research Network (PECARN) algorithm was applied retrospectively with the aim of validating the use of PECARN.</p><p><strong>Results: </strong>Total of 1138 paediatic trauma admissions were identified during the study period and 70% (n 802) had blunt trauma. 483 patients were included after excluding patients with isolated head injury and missing data. 90 days trauma related mortality was 0.7% with one patient died within 24 hours of admission. Overall Injury Severity Score (ISS) was 3.52±5.95 which appeared to increase with age (rho 0.289, p <0.01).111 patients received CT scan, among which 35 are whole body CT. Significant findings were detected in 30% of these scans, 25 required intervention. Patients with higher trauma index and lower GCS, trauma call activation, older aged at presentation were more likely to receive a scan (p<0.001). No pathology was missed in the no CT group. PECARN validation was performed on 200 patients, There were no missed scans and pathologies in PECARN negative patients. Sensitivity was 100%, specificity was 96.5%, negative predictive value was 100%.</p><p><strong>Conclusion: </strong>A significant portion of children had negative trauma CT scan and did not need intervention. Use of clinical decision rule is warranted in identifying children at lower risk to minimize unnecessary imaging.</p>","PeriodicalId":19832,"journal":{"name":"Pediatric Surgery International","volume":"42 1","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13669033/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149183604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Routine pulmonary wound closure after thoracoscopic sublobar resection for congenital lung malformations in children: impact on early recovery, one-year CT-based lung expansion, and the learning curve.","authors":"Jin-Xi Huang, Song-Ming Hong, Jun-Jie Hong, Jun-Feng Liu, Lin Qiu, Rui-Jin Zeng, Qiang Chen, Zeng-Chun Wang","doi":"10.1007/s00383-026-06668-0","DOIUrl":"https://doi.org/10.1007/s00383-026-06668-0","url":null,"abstract":"<p><strong>Background: </strong>The necessity of routine pulmonary parenchymal wound closure following thoracoscopic sublobar resection for congenital lung malformations (CLMs) in children remains uncertain. This study aimed to evaluate the association of routine wound closure with drainage-related recovery, perioperative outcomes, one-year computed tomography (CT)-based lung re-expansion, and the procedural learning curve.</p><p><strong>Methods: </strong>Consecutive children who underwent thoracoscopic sublobar resection for CLMs between January 2021 and March 2025 were retrospectively reviewed. The cohort was divided into a non-closure group and a routine-closure group according to wound management strategy. Pulmonary wound closure was performed using an absorbable barbed suture, generally proceeding from the peripheral or lower-tension side toward the central or higher-tension region. Irregular wounds were managed by initiating closure from multiple peripheral points converging centrally while preserving the natural axis of residual bronchi and vasculature. Outcomes included chest tube duration, drainage volume, prolonged air leak, chest tube reinsertion, postoperative hospital stay, perioperative complications, one-year CT-based volumetric indices, and closure-time learning curve metrics.</p><p><strong>Results: </strong>A total of 285 children were included, comprising 75 in the non-closure group and 210 in the closure group. Baseline characteristics were comparable between groups. Compared with the non-closure group, the closure group exhibited significantly shorter chest tube duration (0.87 ± 0.74 vs. 2.81 ± 1.99 days, P < 0.001), lower postoperative drainage volume (2.12 ± 0.70 vs. 7.21 ± 2.58 mL/kg/day, P < 0.001), reduced rates of prolonged air leak and drainage failure, and shorter postoperative hospital stay (5.63 ± 0.83 vs. 7.68 ± 2.10 days, P < 0.001). At one-year follow-up, CT-based volumetric assessment revealed no evidence that wound closure restricted residual lung re-expansion. Closure time decreased from approximately 22 min in the early phase to 11 min in the late phase, with learning curve inflection points identified at cases 47 and 135.</p><p><strong>Conclusions: </strong>Routine pulmonary wound closure following thoracoscopic sublobar resection for pediatric CLMs was associated with improved drainage-related recovery and shorter hospitalization, without compromising one-year lung re-expansion on CT. Although closure adds a procedural step, efficiency improved substantially with experience, demonstrating a quantifiable learning curve.</p>","PeriodicalId":19832,"journal":{"name":"Pediatric Surgery International","volume":"42 1","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149183278","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Childhood Inguinal, Femoral, and Abdominal Hernias in Low-Income Countries: Trends, Inequalities, and Projections to 2050.","authors":"Xinjia Gu, Zhihui Zheng, Jihua Zhu, Wenwen Lv, Taixiang Liu","doi":"10.1007/s00383-026-06663-5","DOIUrl":"https://doi.org/10.1007/s00383-026-06663-5","url":null,"abstract":"<p><strong>Purpose: </strong>To examine trends, Socio-demographic Index (SDI) associations, inequalities, and future burden of childhood inguinal, femoral, and abdominal hernia (IFAH) in low-income countries (LICs).</p><p><strong>Methods: </strong>GBD 2023 estimates for children aged 0-14 years in 25 LICs were analyzed for 1990-2023. Counts, crude rates, estimated annual percentage changes (EAPCs), age- and sex-specific patterns, SDI associations, concentration indices, population-rate decomposition, lower-quantile benchmarking, and projections to 2050 were assessed.</p><p><strong>Results: </strong>In 2023, IFAH accounted for 253,424 incident cases, 377 deaths, and 67,970 disability-adjusted life years (DALYs). From 1990 to 2023, incident cases increased by 64.38% and DALYs by 22.18%, whereas deaths decreased by 6.60%. Incidence, mortality, and DALY rates declined, with EAPCs of -0.62%, -2.54%, and -1.75%, respectively. Infants accounted for 64.12% of deaths and 46.72% of DALYs. Mortality and DALY rates were inversely associated with SDI and became increasingly concentrated in relatively lower-SDI countries. Population growth offset gains associated with declining rates. By 2050, incident cases, deaths, and DALYs were projected to reach 305,947, 422, and 77,279.</p><p><strong>Conclusion: </strong>Childhood IFAH rates declined, but absolute burden remained substantial and may increase with population growth. Planning should prioritize infant care and LICs with high fatal and disabling burden.</p>","PeriodicalId":19832,"journal":{"name":"Pediatric Surgery International","volume":"42 1","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149183037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Genetic insights into pediatric congenital pulmonary airway malformations: a 13-year single-center experience.","authors":"Banu Ozdemir, Dogu Vurallı Bakkaloglu, Tugba Kalaycı, Zeynep Ozdemir, Secil Yuksel, Osman Hakan Kocaman, Z Oya Uyguner, Basak Erginel","doi":"10.1007/s00383-026-06666-2","DOIUrl":"10.1007/s00383-026-06666-2","url":null,"abstract":"<p><strong>Objective: </strong>With advancements in antenatal imaging techniques, congenital lung lesions are increasingly being diagnosed prenatally, resulting in a growing population of asymptomatic patients encountered by clinicians. However, the etiopathogenesis of these lesions remains unclear, and their malignant potential is not fully understood. In this study, we aimed to investigate the genetic alterations in congenital pulmonary airway malformations (CPAM) and assess their potential for malignant transformation.</p><p><strong>Methods: </strong>This study included patients under 18 years of age who underwent surgery for congenital pulmonary airway malformation at our institution between 2010 and 2023. Demographic and clinical characteristics were retrospectively analyzed. Lung resection specimens of patients diagnosed with CPAM were re-evaluated, and tissue sections were obtained. For patients operated before 2018, real-time PCR was performed using paraffin-embedded tissue blocks, while targeted next-generation sequencing was employed for cases after 2018 to detect variants in the KRAS gene. The collected data were analyzed using SPSS version 22.0.</p><p><strong>Results: </strong>Among 35 patients operated for CPAM, variants in the KRAS gene were detected in 8 patients (22.8%). The majority of cases with variants were diagnosed with type 1 CPAM (p < 0.05). The mean age at surgery was significantly lower in KRAS-positive patients (3.75 ± 2.66 months) compared with KRAS-negative patients (29.89 ± 53.68 months; p < 0.05). No evidence of malignant transformation was observed in any case.</p><p><strong>Conclusions: </strong>KRAS variants can be detected in a subset of pediatric CPAM cases, particularly in type 1 CPAM lesions. KRAS-positive patients underwent surgery at a significantly younger age, likely due to lesion characteristics and antenatal diagnosis. Although no malignant transformation was observed in our series, the presence of KRAS variants indicates a potential molecular predisposition to malignancy. Combining routine histopathological evaluation with targeted molecular analysis can improve risk stratification and guide clinical management. Larger prospective studies are needed to clarify the prognostic and therapeutic implications of KRAS positivity in CPAM.</p>","PeriodicalId":19832,"journal":{"name":"Pediatric Surgery International","volume":"42 1","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149183169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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 in reference to the article entitled 'Interval appendectomy practices for complicated appendicitis in children: a systematic review from the APSA Outcomes and Evidence-Based Practice Committee'.","authors":"Marko Bašković, Bianka Dujić, Sara Vuković","doi":"10.1007/s00383-026-06679-x","DOIUrl":"10.1007/s00383-026-06679-x","url":null,"abstract":"","PeriodicalId":19832,"journal":{"name":"Pediatric Surgery International","volume":"42 1","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149169957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors associated with lateral abdominal protrusion after congenital diaphragmatic hernia repair.","authors":"Yuki Noguchi, Daichi Sakai, Ririko Takemura, Masayuki Yoshida, Rei Matsuura, Satoshi Umeda, Noriaki Usui","doi":"10.1007/s00383-026-06674-2","DOIUrl":"10.1007/s00383-026-06674-2","url":null,"abstract":"<p><strong>Purpose: </strong>Lateral abdominal protrusion (LAP) is observed after congenital diaphragmatic hernia (CDH) repair. We developed an objective radiographic index and explored factors associated with LAP.</p><p><strong>Methods: </strong>Seventy-three patients who underwent neonatal CDH repair between 2013 and 2023 were retrospectively evaluated. The standardized LAP index (SLAPI) was developed in the 2013-2018 cohort and validated in the 2019-2023 cohort. Candidate factors available before LAP detection were examined using univariable logistic regression, followed by exploratory Firth logistic regression. Intraobserver reliability was assessed by repeated measurement.</p><p><strong>Results: </strong>Visually identified LAP occurred in 19 patients (26.0%) at a median age of 35 days. In the development cohort, the SLAPI area under the curve was 1.00 (95% confidence interval [CI], 1.00-1.00). At the prespecified cutoff of ≥ 1.0, sensitivity and specificity were 91.7% and 100% in the development cohort and 100% and 100% in the validation cohort, respectively. In the adjusted analysis, prenatal stomach herniation grade 2-3 (odds ratio [OR], 6.67; 95% CI, 1.62-32.63) and observed-to-expected lung area-to-head circumference ratio per 10-percentage-point increase (OR, 0.54; 95% CI, 0.24-0.96) were associated with LAP. Intraobserver reliability was good (intraclass correlation coefficient, 0.885).</p><p><strong>Conclusion: </strong>SLAPI objectively documented LAP after CDH repair. Its clinical and functional significance requires further study.</p>","PeriodicalId":19832,"journal":{"name":"Pediatric Surgery International","volume":"42 1","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149168222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CT-guided methylene blue staining to facilitate thoracoscopic resection of intermediate-to-deep pulmonary metastases in pediatric patients.","authors":"Mikal Obed, Lucas Wennemann, Christin Linderkamp, Nathalie Pauer, Hoen-Oh Shin, Jens Vogel-Claussen, Jens Dingemann, Rim Kiblawi","doi":"10.1007/s00383-026-06675-1","DOIUrl":"10.1007/s00383-026-06675-1","url":null,"abstract":"<p><strong>Purpose: </strong>Thoracoscopic resection of pulmonary metastases offers a minimally-invasive approach but requires preoperative localization due to absent tactile feedback. CT-guided methylene blue staining (MBS) was implemented to facilitate resection of pulmonary metastases, including intermediate-to-deep lesions.</p><p><strong>Methods: </strong>We retrospectively analyzed pediatric patients (0-18 years) undergoing resection of pulmonary metastases (2007-2024). Lesion depth was classified as superficial (≤ 10 mm), intermediate (11-20 mm), or deep (> 20 mm). Primary endpoint was completeness of resection; secondary endpoints included perioperative and oncological outcomes. Subgroup analysis included patients with ≤ 2 pulmonary metastases.</p><p><strong>Results: </strong>Fifty-eight resections in 43 patients were included: 49 open, and 9 thoracoscopic following CT-guided MBS. Eleven lesions were stained prior to thoracoscopic resection: three superficial, seven intermediate, one deep lesion. All were resected with negative margins, without complications. Thoracoscopy following CT-guided MBS was associated with shorter operative times (65 vs. 157 min, p = 0.01), hospital stay (4.0 vs. 5.6 days, p = 0.01), and time-to-chemotherapy-resumption (2.25 vs. 18.6 days, p = 0.01). No differences were observed in pulmonary recurrence, disease-free interval, or six-month-survival.</p><p><strong>Conclusion: </strong>In pediatric patients with up to two pulmonary metastases, CT-guided methylene blue staining provided feasible preoperative localization, facilitating thoracoscopic wedge resection of superficial, intermediate and deep lesions without complications. Prospective multicenter studies should further evaluate efficacy and inclusion criteria.</p>","PeriodicalId":19832,"journal":{"name":"Pediatric Surgery International","volume":"42 1","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13658322/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149168470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}