Pediatric Surgery International最新文献

{"title":"Minimizing variance in pediatric patients after repair of anorectal malformations.","authors":"Leigh Selesner, Ryan Bigej, Sara Alturky, Cortnie Vaughn, Colin Gause, Sanjay Krishnaswami, Elizabeth Fialkowski","doi":"10.1007/s00383-025-06051-5","DOIUrl":"https://doi.org/10.1007/s00383-025-06051-5","url":null,"abstract":"<p><strong>Purpose: </strong>A standardized anorectal malformation (ARM) perioperative protocol was implemented across two pediatric tertiary hospitals. The protocol addressed antibiotic duration, feeding advancement, VACTERL workup, and wound management. We aim to evaluate complications, length of stay (LOS), and protocol compliance.</p><p><strong>Methods: </strong>Introduced in June 2020, data from a 24-month protocol cohort (after a 6-month transition) were compared to a 24-month control cohort. Outcomes included demographics, compliance, complications and LOS.</p><p><strong>Results: </strong>Forty-five patients were included (control: 26, protocol: 19). Most were diagnosed with rectoperineal fistula (53%), 42% had significant cardiac disease, and 44% underwent prior colostomy. VACTERL workup was completed in 89%. Thirty-five patients underwent posterior sagittal anorectoplasty, and 10 cutback anoplasty. Median postoperative LOS was unchanged (control: 2 days; protocol: 2 days, p=0.80). Total LOS showed no difference (control: 3 days, protocol: 2 days, p = 0.51). No wound infections occurred. Wound dehiscence occurred in 1 control and 2 protocol patients (p=0.57). Compliance was 53% with deviations attributed to early diet initiation (n=4), incomplete VACTERL workup (n=2), and wound care (n=2).</p><p><strong>Conclusion: </strong>A standardized ARM perioperative protocol is feasible across institutions. It maintained excellent outcomes, including short LOS and few complications, though the small sample limited statistical power.</p>","PeriodicalId":19832,"journal":{"name":"Pediatric Surgery International","volume":"41 1","pages":"150"},"PeriodicalIF":1.5,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144183410","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 \"Incidence of urethrocutaneous fistula after distal and midshaft hypospadias repair does not differ among patients treated with or without a protective second‑layer: single tertiary centre experience''.","authors":"Nihat Karabacak, Serhat Gürocak, Mustafa Özgür Tan","doi":"10.1007/s00383-025-06046-2","DOIUrl":"https://doi.org/10.1007/s00383-025-06046-2","url":null,"abstract":"","PeriodicalId":19832,"journal":{"name":"Pediatric Surgery International","volume":"41 1","pages":"149"},"PeriodicalIF":1.5,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144174312","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":"Can we do less? A review of imaging practices for evaluating cervical spine injuries in pediatric blunt trauma patients.","authors":"Humza Thobani, Cody Dalton, Kathleen R Ehresmann, Shawn Larson, Faraz A Khan, Saleem Islam","doi":"10.1007/s00383-025-06053-3","DOIUrl":"https://doi.org/10.1007/s00383-025-06053-3","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to investigate whether a validated clinical decision tool or other clinical features at presentation could predict cervical spine injury in a cohort of children who were selected for cervical spine imaging following blunt trauma.</p><p><strong>Methods: </strong>We conducted a retrospective review of all patients < 18 years presenting to our institution with blunt trauma who underwent cervical spine imaging over a 3-year period. Relevant data on patients' clinical presentation, imaging, management and outcomes were compiled. The NEXUS screening tool was retroactively applied to all patients. Univariable and multivariable logistic regression was conducted to identify independent predictors of CSI.</p><p><strong>Results: </strong>1,321 patients presented with blunt trauma, out of which 484 underwent cervical spine imaging and were included in our study. Computerized tomography (CT) scans were conducted in most patients (n = 447, 92.4%). NEXUS risk stratification failed to identify 9 CSIs and had an overall sensitivity of 80.4%. Out of all the possible risk factors we investigated, only chest/torso trauma was found to be significantly associated with CSI on multivariate regression.</p><p><strong>Conclusion: </strong>We were unable to identify a screening tool or predictive model which could be used to further reduce imaging practices at our institution without missing clinically significant CSIs.</p>","PeriodicalId":19832,"journal":{"name":"Pediatric Surgery International","volume":"41 1","pages":"147"},"PeriodicalIF":1.5,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144161217","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":"The role of ultrasonography in detecting and classifying anorectal malformations in neonates: a retrospective study of 30 cases.","authors":"Qiong-Zhu Liu, Luo-Ning Bao, Lu Liang, Xiao-Yan Zhu, Mei Liu","doi":"10.1007/s00383-025-06054-2","DOIUrl":"https://doi.org/10.1007/s00383-025-06054-2","url":null,"abstract":"<p><strong>Background: </strong>Anorectal Malformations, a common congenital anomaly of the gastrointestinal tract, is caused by the defect or delay of hindgut development in the embryo.</p><p><strong>Objectives: </strong>This retrospective study aimed to analyze the ultrasonographic and clinical features of 30 neonates with anorectal malformations to provide guidance for clinical diagnosis and treatment.</p><p><strong>Material and methods: </strong>We selected 30 neonates with congenital anorectal malformations admitted to our hospital from January 2012 to June 2022. Each neonate underwent two-dimensional ultrasonography and lateral plain X-ray of the abdomen within 24 h before surgery, and we assessed the typical manifestations of anorectal malformations, categorized the cases into high, intermediate, and low types, and evaluated the incidence of anorectal malformations associated with other organ malformations. Comparisons were made between the three types of anorectal malformations in terms of associated anomalies.</p><p><strong>Results: </strong>Among the 30 neonates, typical manifestations of anorectal malformations were observed in all cases. Ultrasonographic evaluation revealed 6 cases of high anorectal malformations, 11 cases of intermediate anorectal malformations, and 13 cases of low anorectal malformations. The distribution of fistula types included 3 cases of perineal fistula, 2 cases of rectourethral fistula, 23 cases without fistula, and 2 cases of anorectal malformations. Additionally, congenital cardiac structural malformations were identified in 3.3% of the cases. Post-surgical outcomes indicated that 25 neonates were successfully cured and discharged, while 5 neonates experienced rectal retraction. The age at the time of the complete surgical correction (i.e., PSARP) ranged from 3 to 6 months for intermediate and high anal atresias. Notably, 5 neonates experienced rectal retraction post-surgery, which was successfully managed before discharge. Postoperative complications, such as incision infection, blood oozing, urinary extravasation, and fistula stenosis, were reported in 14 neonates.</p><p><strong>Conclusions: </strong>Infants with congenital anorectal malformations commonly present with abdominal distension, vomiting, and absence of meconium excretion, indicative of intestinal obstruction. Given the high mortality risk associated with anorectal malformations, early diagnosis and intervention are crucial. Effective communication between healthcare providers and patients' families enhances treatment success. Ultrasonography plays a significant role in the early diagnosis of anorectal malformations.</p>","PeriodicalId":19832,"journal":{"name":"Pediatric Surgery International","volume":"41 1","pages":"148"},"PeriodicalIF":1.5,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144174315","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 \"Long-term urinary and sexual outcomes in pediatric genitourinary rhabdomyosarcoma survivors: a qualitative study\".","authors":"Jia You, Man Liao, Gang Li","doi":"10.1007/s00383-025-06033-7","DOIUrl":"https://doi.org/10.1007/s00383-025-06033-7","url":null,"abstract":"","PeriodicalId":19832,"journal":{"name":"Pediatric Surgery International","volume":"41 1","pages":"146"},"PeriodicalIF":1.5,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144151507","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":"Rapid, objective intraoperative mapping of Hirschsprung disease with a portable electrochemical acetylcholine sensor.","authors":"Akash Bihari Pati, Ashish Mathur, Souradeep Roy, Suchanda Sahu, Pritinanda Mishra, Santosh Kumar Mahalik, Antony Tsai, Rajeev Tiwari, Kanishka Das","doi":"10.1007/s00383-025-06048-0","DOIUrl":"https://doi.org/10.1007/s00383-025-06048-0","url":null,"abstract":"<p><strong>Purpose: </strong>Surgical procedures for bowel aganglionosis require accurate identification of enteric ganglion cells and cholinergic nerve hypertrophy. Current intraoperative mapping through frozen section histopathology-histochemistry is time-consuming and demands skilled interpretation. This study explores an electrochemical sensor for objective, rapid intraoperative mapping of the aganglionic bowel segment via tissue acetylcholine (ACh) detection.</p><p><strong>Methods: </strong>An electrochemical biosensor was developed using nanostructured electrodes functionalized with acetylcholinesterase(AChE) and choline oxidase (ChOx) enzyme hybrids. Electrochemical analyses were conducted on homogenized intestinal biopsies obtained intraoperatively from ten patients, including eight diagnosed with Hirschsprung Disease (HSCR) and two with total colonic aganglionosis (TCA). Biopsy samples representing ganglionic, transitional, and aganglionic bowel segments were evaluated. The sensor quantified tissue ACh levels, a surrogate marker of cholinergic neuronal hypertrophy, by measuring the generated electrical current.</p><p><strong>Results: </strong>The electrochemical analysis demonstrated significantly higher current levels in the aganglionic segments compared to ganglionic segments in 87.5% (7 out of 8) of HSCR patients. The mean peak currents observed in HSCR cases were 2.62 µA in aganglionic segments, 3.66 µA in transition segments, and 2.04 µA in ganglionic segments. In contrast, electrochemical patterns in patients diagnosed with TCA were atypical; ileal tissue samples from these patients generally yielded higher current measurements than colonic samples across all zones examined. Additionally, there was a progressive increase in tissue current values correlating positively with patient age.</p><p><strong>Conclusion: </strong>The electrochemical sensor effectively differentiated aganglionic from ganglionic zones in HSCR, suggesting its potential as a quick, objective tool for intraoperative bowel levelling. Further validation in larger cohorts is necessary to confirm the clinical utility.</p>","PeriodicalId":19832,"journal":{"name":"Pediatric Surgery International","volume":"41 1","pages":"144"},"PeriodicalIF":1.5,"publicationDate":"2025-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144143339","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":"Does nutritional education affect the nutritional status, growth, and development of children with pectus excavatum?","authors":"Meryem Kahrıman, Gözde Arıtıcı Çolak, Duygu Sağlam, Mustafa Yüksel, Sultan Aslanhan","doi":"10.1007/s00383-025-06045-3","DOIUrl":"10.1007/s00383-025-06045-3","url":null,"abstract":"<p><strong>Purpose: </strong>Pectus deformity can cause cardiovascular, gastrointestinal, and genitourinary anomalies depending on the severity of the deformity, and this can affect the nutritional status of patients. This study aimed to investigate the effect of nutritional education on nutritional status and anthropometric measurements in patients with moderate pectus excavatum (PE).</p><p><strong>Methods: </strong>This study included patients diagnosed with pectus disease between the ages of 9 and 16 years. A questionnaire was administered, which included items regarding demographic information, eating habits, and physical activity levels. All patients were provided with nutritional education, including healthy diet principles. Subsequently, anthropometric measurements, such as height and body weight, were recorded, and 24-h food recall was taken.</p><p><strong>Results: </strong>A total of 40 children [31 (77.5%) men, 9 (22.5%) women] diagnosed with PE and moderate deformity severity participated in the study. After the provision of nutritional education, the patients' body weight, WHO height and body mass index for age, as well as intake of energy, protein, and fat significantly increased.</p><p><strong>Conclusion: </strong>This study showed that nutritional education can improve the nutritional status of patients with moderate PE as it leads to an increase in anthropometric measurements and food/nutrient intake. Therefore, it would be beneficial to refer patients to a dietician to implement longer-term and improved educational models.</p>","PeriodicalId":19832,"journal":{"name":"Pediatric Surgery International","volume":"41 1","pages":"145"},"PeriodicalIF":1.5,"publicationDate":"2025-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12104103/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144143296","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":"Intestinal autonomy in extreme premature infants with short bowel syndrome: national experience.","authors":"Saleem Mammoo, Noora Alshahwani, Maraeh Angela Mancha, Hassan Baghazal, Mansour Ali, Guy Brisseau","doi":"10.1007/s00383-025-06036-4","DOIUrl":"10.1007/s00383-025-06036-4","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate the outcomes of premature neonates with short bowel syndrome (SBS) managed under a BEAR (Bowel Elongation and Advanced Rehabilitation) protocol.</p><p><strong>Methods: </strong>This was a retrospective cohort study of preterm patients with SBS, treated at Sidra Medicine between January 2018 and February 2024. Data were extracted from electronic medical records, including patient demographics, clinical history, surgical interventions, parenteral nutrition (PN) duration, and long-term outcomes. The BEAR protocol incorporated a multidisciplinary approach with structured intestinal rehabilitation, hepato-protective PN strategies, and staged surgical interventions to promote enteral autonomy.</p><p><strong>Results: </strong>A total of 20 premature neonates with SBS were analyzed, with a median gestational age of 28 weeks and a median birth weight of 860g. Necrotizing enterocolitis was the primary cause of SBS in 90% of cases. Of the cohort, 80% successfully weaned off PN, achieving enteral autonomy at a median corrected age of 19.7 months. Seven patients underwent serial transverse enteroplasty (STEP), with 6/7 successfully transitioning to full enteral feeding. The study demonstrated favorable survival rates and reduced PN-associated complications.</p><p><strong>Conclusion: </strong>The BEAR protocol provides a structured and effective approach to intestinal rehabilitation in premature neonates with SBS, facilitating early enteral autonomy and minimizing long-term PN dependence. These findings contribute valuable clinical insights into optimizing multidisciplinary management strategies for this high-risk population.</p>","PeriodicalId":19832,"journal":{"name":"Pediatric Surgery International","volume":"41 1","pages":"143"},"PeriodicalIF":1.5,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12103355/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144136209","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":"Approach to biliary tree clearance in pediatric patients undergoing cholecystectomy: insights from a tertiary hospital.","authors":"Tal Weiss, Yael Dreznik, Maya Paran, Dragan Kravarusic","doi":"10.1007/s00383-025-06037-3","DOIUrl":"10.1007/s00383-025-06037-3","url":null,"abstract":"<p><strong>Introduction: </strong>Despite the increasing rate of cholecystectomy in pediatric patients, no standardized protocols for perioperative biliary tree clearance in children exist and the applicability of adult guidelines to pediatric patients remains uncertain.</p><p><strong>Aim: </strong>To identify predictors for CBD stones in pediatric patients undergoing cholecystectomy and to evaluate the applicability of adult guidelines for children.</p><p><strong>Materials and methods: </strong>We conducted a retrospective study on pediatric patients who underwent cholecystectomy for cholelithiasis at a tertiary pediatric medical center from 2011 to 2024. Medical records were reviewed for demographic and clinical characteristics. Elevated bilirubin was defined as above 4 mg/dL with > 20% conjugated. The outcomes measured included the presence of CBD stones detected by ERCP or intraoperative cholangiography and post-cholecystectomy complications due to retained stones.</p><p><strong>Results: </strong>A total of 177 patients were included in the study, with a median age of 13.4 years (IQR 9, 16.4). Sixteen patients (9%) were diagnosed with CBD stones. Elevated bilirubin, dilated CBD, and filling defects on primary imaging were strongly associated with CBD stones (50.0% vs. 9.9%, p < 0.001, 62.5% vs. 9.3%, p < 0.001, 43.8% vs. 4.4%, p < 0.001). The 2019 ASGE guidelines had a sensitivity of 56.2% and a specificity of 91.1% for predicting CBD stones. Adjusting the guidelines to classify elevated bilirubin as an independent high-risk feature improved sensitivity to 68.8%, with a slight reduction in specificity to 87.6%.</p><p><strong>Conclusion: </strong>Our study suggests that the 2019 ASGE guidelines are applicable to children. Based on our findings and previous data, it seems reasonable to classify bilirubin elevation as an independent high-risk feature.</p>","PeriodicalId":19832,"journal":{"name":"Pediatric Surgery International","volume":"41 1","pages":"139"},"PeriodicalIF":1.5,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12092475/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144111096","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":"Determinants of surgical approach to pediatric appendicitis in Brazil.","authors":"Ayla Gerk, Paulo Henrique Moreira Melo, Mohsen Amoei, Shreenik Kundu, Luiza Telles, Justina O Seyi-Olajide, Dunya Moghul, Gabriel Schnitman, Cristina Camargo, David P Mooney, Joaquim Bustorff-Silva, Dan Poenaru","doi":"10.1007/s00383-025-06030-w","DOIUrl":"10.1007/s00383-025-06030-w","url":null,"abstract":"<p><strong>Introduction: </strong>Appendicitis is the most prevalent surgical emergency in children. This study explores the social and clinical determinants affecting the surgical approach for pediatric appendectomy in Brazil.</p><p><strong>Methods: </strong>All patients aged 0-16 years hospitalized and operated on for acute appendicitis in Brazil during 2022 were identified in the Brazilian national healthcare database. Data reviewed included patient demographics, hospital resources and location. Univariable and multivariable logistic regression models were used for statistical analysis.</p><p><strong>Results: </strong>We identified 24,088 patients, of which 8768 (36.4%) were female, with a mean age of 10 years. 9690 (40.2%) of patients were white and 14.398 (59.8%) were non-white (including brown, black, asian or indigenous). Geographically, more patients were from the Southeast region. 21,627 (89.8%) of cases were open appendectomies. On univariable analysis, factors significantly influencing the selection of laparoscopic appendectomy included being female, white race, and higher socioeconomic status. The severity of appendicitis did not significantly affect the surgical approach. On multivariable analysis, white race (OR 1.934, [1.759, 2.126]), advanced hospital facilities (OR 5.987, [5.395, 6.644]), and hospitals located in the wealthier Southern region (OR 4.277, [3.884, 4.710]) were significant predictors of a laparoscopic approach.</p><p><strong>Conclusion: </strong>The surgical approach for pediatric appendectomy in Brazil was determined by social determinants rather than by disease severity. The findings emphasize the need for targeted interventions to ensure equitable healthcare access and approaches in pediatric surgery.</p>","PeriodicalId":19832,"journal":{"name":"Pediatric Surgery International","volume":"41 1","pages":"141"},"PeriodicalIF":1.5,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144111098","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}