Pediatric Surgery International最新文献

{"title":"Strong agreement between self-administered and interview-obtained bowel function score in patients with Hirschsprung disease and anorectal malformation.","authors":"Remi Andre Karlsen, Anders Telle Hoel, Kristin Bjørnland","doi":"10.1007/s00383-025-06207-3","DOIUrl":"https://doi.org/10.1007/s00383-025-06207-3","url":null,"abstract":"<p><strong>Background: </strong>The Bowel Function Score (BFS) questionnaire is the most widely utilized tool for assessing bowel function in patients with Hirschsprung disease (HD) or anorectal malformation (ARM). However, the questionnaire has not undergone a formal validation process. This study aimed to compare self-administered responses with those obtained during clinical consultations to determine whether patients can reliably report their bowel function when completing the questionnaire independently.</p><p><strong>Methods: </strong>\"Patients with HD or ARM and/or with their parents, completed the BFS questionnaire prior to their outpatient clinic visit. During consultations, the questionnaires were reviewed, with any missing or unclear responses addressed and adjustments recorded. The agreement between self-administered and interview-obtained BFS scores was assessed using the intraclass correlation coefficient (ICC).\"</p><p><strong>Results: </strong>A total of 103 questionnaires with 721 answered questions were evaluated. The agreement between self-administered and interview-based BFS scores was found to be nearly perfect (ICC) 0.96. The question recording frequency of defecation, was the only item that did not demonstrate perfect agreement.</p><p><strong>Conclusion: </strong>This study supports the use of the self-administered BFS questionnaire as a reliable tool for assessing bowel function in HD and ARM patients in both clinical practice and research.</p>","PeriodicalId":19832,"journal":{"name":"Pediatric Surgery International","volume":"41 1","pages":"312"},"PeriodicalIF":1.6,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145233234","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":"Diverse clinical features of symptomatic Meckel's diverticulum: a multicenter study of 151 consecutive pediatric patients from the Western Balkans.","authors":"Zlatan Zvizdic, Blagoje Grujic, Asmir Jonuzi, Edin Husaric, Vlatka Martinovic, Aleksandar Brkovic, Nikola Rakocevic, Amir Halilbasic, Valentina Lasic, Denis Pasalic, Emir Begagic, Semir Vranic","doi":"10.1007/s00383-025-06197-2","DOIUrl":"10.1007/s00383-025-06197-2","url":null,"abstract":"<p><strong>Purpose: </strong>Symptomatic Meckel's diverticulum (MD) has various clinical presentations and can be easily misdiagnosed. This multicenter study examines the clinical characteristics, management, and outcomes of patients across five academic pediatric surgery centers in Bosnia & Herzegovina and Serbia.</p><p><strong>Methods: </strong>We retrospectively included all pediatric patients (< 18 years) who were surgically and histopathologically confirmed to have symptomatic MD between 2011 and 2020. Demographics, clinical and radiological features, surgical treatment approaches, histopathologic findings, and outcomes were collected and analyzed.</p><p><strong>Results: </strong>Among 151 patients (80.1% male), the median age was 6.7 years (IQR 1.5-10.8). Presentations included intestinal obstruction (38.4%), GI bleeding (37.8%), and peritonitis (23.8%); 63.6% had multiple symptoms. A technetium-99 m scan was positive in 80.7% of bleeding cases. Laparotomy was performed in 72.2%, laparoscopy in 23.2%, and conversion in 4.6%. Partial small bowel resection was required in 80.8%, versus diverticulectomy in 19.2% (p < 0.001). Ectopic mucosa was found in 55.6% (gastric 48.3%, pancreatic 2.6%, both 4.6%; p = 0.05), significantly more common in males (p < 0.001). Postoperative complications occurred in 3.2%, with no mortality.</p><p><strong>Conclusions: </strong>Symptomatic MD displays highly variable clinical presentations. It is often underdiagnosed preoperatively, particularly without GI bleeding, emphasizing the need for high clinical suspicion and tailored surgical approaches.</p>","PeriodicalId":19832,"journal":{"name":"Pediatric Surgery International","volume":"41 1","pages":"311"},"PeriodicalIF":1.6,"publicationDate":"2025-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12496298/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145228482","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":"Nutritional status and surgical outcomes in patients with esophageal atresia: findings from Turkish Esophageal Atresia Registry.","authors":"Tutku Soyer, Süleyman Arif Bostancı, Çiğdem Ulukaya Durakbaşa, Coşkun Özcan, İlhan Çiftçi, Gülnur Göllü, Ayşe Parlak, Emine Burcu Ciğşar Kuzu, Berat Dilek Demirel, İbrahim Akkoyun, Binali Fırıncı, Gül Şalcı, Olga Devrim Ayvaz, Akgün Oral, Hüseyin İlhan, Gürsu Kıyan, Ali Ekber Hakalmaz, Ayşe Karaman, Fatma Saraç, Şeref Selçuk Kılıç, Osman Uzunlu, Abdülkerim Temiz, Esra Özçakır, Başak Erginel, Abdullah Yıldız, Ali Onur Erdem, Serpil Sancar, Alev Süzen, Ahmet Atıcı, Seyithan Özaydın, Ebru Yeşildağ, Mehmet Ali Özen, Osman Dağ","doi":"10.1007/s00383-025-06216-2","DOIUrl":"https://doi.org/10.1007/s00383-025-06216-2","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the relationship between nutritional status and surgical outcomes in patients with esophageal atresia (EA) from the Turkish Esophageal Atresia Registry (TEAR).</p><p><strong>Methods: </strong>Between 2015 and 2024, 713 patients with the complete data of neonatal period and first year of life were included. According to FENTON, growth charts and patients were grouped as small for gestational age (SGA, < 10 percentiles), medium SGA (percentiles = 10-20), appropriate for gestational age (AGA, percentiles = 20-90) and large for gestational age (LGA, percentiles > 90) at birth. The z scores for height-for-weight were reevaluated at 6th and 12th months of age.</p><p><strong>Results: </strong>Among 713 patients, 56% were boys. 23.7% of patients were SGA. There was no difference among groups for demographic features, outcomes, and mortality (p > 0.05). Patients with SGA had a higher rate of karyotype anomalies (23.1%, p < 0.05). At the 6th month, 20% of patients had improved nutritional status, 46.2% unchanged, and 33.5% worsened. At the 12th month, it was 31.6%, 50.2%, and 18.3%, respectively. 32.8% of the SGA patients had severe malnutrition at the 6th month, while this rate decreased to 10.2% at the end of the first year of life. Patients with worsened nutritional status had a significantly higher rate of mortality (10.2%) than patients with unchanged and improved nutritional status (3.7%, 2%, respectively, p < 0.05). There was no statistical difference between nutritional status and surgical outcomes at the 6th and 12th months (p > 0.05).</p><p><strong>Conclusions: </strong>The incidence of SGA was significantly higher in EA patients with karyotype anomalies. While 20% of patients improved nutritional status at the 6th month, only one-third of patients improved nutritional status at the end of the first year. Closer follow-up is needed in patients with EA to avoid malnutrition, which can lead to poor growth, developmental delay, and impaired immune function.</p>","PeriodicalId":19832,"journal":{"name":"Pediatric Surgery International","volume":"41 1","pages":"310"},"PeriodicalIF":1.6,"publicationDate":"2025-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145228441","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":"Exploring potential sex differences in Hirschsprung disease: a national cohort study of diagnostic patterns and early postoperative outcome.","authors":"Linnea Söderström, Christina Graneli, Kristine Hagelsteen, Anna Gunnarsdottir, Jenny Oddsberg, Pär-Johan Svensson, Helena Borg, Matilda Bräutigam, Elisabet Gustafson, Anna Löf Granström, Pernilla Stenström, Tomas Wester","doi":"10.1007/s00383-025-06213-5","DOIUrl":"10.1007/s00383-025-06213-5","url":null,"abstract":"<p><strong>Purpose: </strong>There are limited data to show how sex impacts the early clinical course of patients with Hirschsprung disease (HSCR). This study aimed to explore potential sex related disparities in the preoperative, surgical, and early postoperative course of HSCR patients.</p><p><strong>Methods: </strong>This retrospective study analyzed data of HSCR patients who underwent pull-through surgery at pediatric surgery centers in Sweden from July 1st, 2013, to June 30th, 2023. Male and female patients were compared regarding diagnostics, surgical treatment, unplanned procedures under general anesthesia or readmissions within 90 days after pull-through, and complications (Clavien-Madadi grade ≥ 3) up to 30 days after pull-through.</p><p><strong>Results: </strong>A total of 197 patients were included from four treating centers (158 males, 39 females). Females had a higher prevalence of familial disease (28.2% vs. 8.2%; p < 0.01) and RET gene mutations (15.4% vs. 2.5%; p = 0.02). No differences were observed in age at biopsy, need for re-biopsy, preoperative stoma rates, or age at diagnosis. Time from diagnosis to pull-through was longer in females (median 48.5 vs. 28 days; p = 0.02), but age at pull-through did not differ. No significant differences were found in postoperative hospital stay, severe complications within 30 days, nor unplanned procedures, HAEC, or readmissions within 90 days.</p><p><strong>Conclusion: </strong>The early clinical course of HSCR patients does not appear to be sex dependent. Although females had a longer interval from diagnosis to pull-through, their age at pull-through was comparable to males. As expected, a higher proportion of females reported familial disease and had a verified RET-mutation.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":19832,"journal":{"name":"Pediatric Surgery International","volume":"41 1","pages":"309"},"PeriodicalIF":1.6,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12494626/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145213388","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":"Initiation of oral intake in neonates with surgical necrotizing enterocolitis: a road map.","authors":"Mazen Omar Kurdi, Mohamed Ali Shehata, Nagi Ibrahim Eldessouki, Ahmed Mukhtar, Heidi Al-Wassia, Maha Bamehrez, Mohammad Gharieb Khirallah","doi":"10.1007/s00383-025-06202-8","DOIUrl":"https://doi.org/10.1007/s00383-025-06202-8","url":null,"abstract":"<p><strong>Purpose: </strong>Necrotizing enterocolitis (NEC) is a severely life-threatening gastrointestinal emergency in newborns, especially when surgical intervention is needed. The ideal time for resuming oral feeding after surgery is still unclear, leading to variations in practice and prolonged parenteral nutrition. This study aims to develop and validate a scoring system to determine the best time to reintroduce oral feeding in neonates following surgical NEC.</p><p><strong>Methods: </strong>A multicenter retrospective study was conducted from 2016 to 2024, including 500 neonates with surgical NEC (Bell's Stage III-IV). Patients were divided into early (5 days), intermediate (8-14 days), and delayed (≥ 15 days) feeding groups. A predictive score was constructed on 100 patients using eight preoperative, intraoperative, and postoperative variables. Validation was performed on an independent cohort of 400 patients.</p><p><strong>Results: </strong>The scoring system demonstrated strong predictive accuracy (AUC = 0.967). Variables such as localized pneumatosis, absence of portal venous gas, higher platelet count, no second-look laparotomy, and early normalization of nasogastric aspirates and lab parameters were significantly associated with early feeding tolerance (p < 0.05). Validation confirmed reproducibility across cohorts without NEC recurrence or feeding-related complications.</p><p><strong>Conclusion: </strong>We present a validated, clinically practical scoring system to guide early oral intake initiation after NEC surgery. It enables stratified decision-making, reduces reliance on parenteral nutrition, and enhances postoperative recovery.</p>","PeriodicalId":19832,"journal":{"name":"Pediatric Surgery International","volume":"41 1","pages":"307"},"PeriodicalIF":1.6,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145207364","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":"Initial adaptation and surgical performance of the hinotori™ robotic system among pediatric surgeons with minimal robotic exposure.","authors":"Serena Iwabuchi, Yuichi Okata, Yasuyuki Kameoka, Harunori Miyauchi, Shohei Yoshimura, Yuki Komyo, Keisuke Kajihara, Yumiko Nakai, Yuko Bitoh","doi":"10.1007/s00383-025-06212-6","DOIUrl":"10.1007/s00383-025-06212-6","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to evaluate the ability of the hinotori™ system to mitigate technical and ergonomic challenges in pediatric laparoscopy by comparing usability, suturing precision, and stress responses with that of conventional laparoscopy in a simulated infant abdomen.</p><p><strong>Methods: </strong>Ten pediatric surgeons with limited robotic experience performed peg transfer and suturing in a 1,400-mL box model simulating a 6-month-old abdomen, using robotic-assisted (Robo) and laparoscopic (Lap) approaches in a crossover design. Performance was assessed using the Fundamentals of Laparoscopic Surgery (FLS) score and the A-Lap Mini platform, which evaluates suturing accuracy across five domains. Physiological stress (heart rate and salivary amylase levels) and subjective fatigue (Chalder Fatigue Scale and visual analog scale) were recorded.</p><p><strong>Results: </strong>Peg-transfer FLS scores were comparable between Robo and Lap (497.5 vs 531), with progressive improvement across Robo trials. Robotic suturing demonstrated greater air-leak resistance, smaller wound openings, and fewer internal collisions. Stress and fatigue indices did not differ significantly, although trends favored Robo.</p><p><strong>Conclusion: </strong>Pediatric surgeons with minimal robotic experience achieved higher suturing precision using hinotori™, suggesting intuitive usability and potential safety-related benefits in training. Owing to the small sample size, absence of resident-level validation, and lack of formal performance-stress correlation, confirmation in larger cohorts is warranted.</p>","PeriodicalId":19832,"journal":{"name":"Pediatric Surgery International","volume":"41 1","pages":"308"},"PeriodicalIF":1.6,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12491376/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145207395","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":"Intussusception around jejunal feeding tubes in pediatric patients: a retrospective two-center experience and management strategies.","authors":"Nariman Mokhaberi, Omid Madadi-Sanjani, Lina Armbrust, Merle Körner, Johannes Görges, Daniel Tegtmeyer, Sebastian Schulz-Jürgensen, Konrad Reinshagen, Christian Tomuschat","doi":"10.1007/s00383-025-06209-1","DOIUrl":"10.1007/s00383-025-06209-1","url":null,"abstract":"<p><strong>Introduction: </strong>Jejunal feeding via endoscopic, fluoroscopic, or surgical tube placement is widely used in pediatrics. A rare complication is intussusception around the jejunal feeding tube (JFT), which can cause obstruction or bowel ischemia. This study evaluated risk factors and management strategies.</p><p><strong>Methods: </strong>We retrospectively reviewed all children undergoing JFT placement or revision at two centers (2014-2025). Patient and procedural data were analyzed.</p><p><strong>Results: </strong>Among 58 patients (163 procedures), 7 children (12%) developed 8 episodes of intussusception. Median age at placement was 1 year (IQR 5); intussusception occurred a median of 1.16 years later (IQR 4.38). Five episodes resolved spontaneously, 2 by hydrostatic reduction, and 1 during unrelated surgery. Neurological impairment was present in 62% of patients. Kaplan-Meier analysis showed the highest risk within 1-2 years post-placement. Events occurred after endoscopic (6/43), surgical (1/13), and fluoroscopic (1/2) placements, with no clear link to technique.</p><p><strong>Conclusion: </strong>Intussusception around a JFT is rare but clinically significant. It should be suspected in children with abdominal pain, bilious vomiting, or feeding intolerance. Most cases can be managed non-surgically; our algorithm supports ultrasound diagnosis, observation or hydrostatic reduction, and surgery only for ischemia or failed conservative treatment.</p>","PeriodicalId":19832,"journal":{"name":"Pediatric Surgery International","volume":"41 1","pages":"306"},"PeriodicalIF":1.6,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12491077/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145207406","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":"Anatomical variations of the inguinal canal and their impact on laparoscopic hernia repair in male children: a visual classification study.","authors":"Pari Khalilova, Ergun Ergun, Asmer Davudova, Ufuk Ates, Gulnur Gollu, Meltem Bingol-Kologlu, Murat Cakmak","doi":"10.1007/s00383-025-06194-5","DOIUrl":"https://doi.org/10.1007/s00383-025-06194-5","url":null,"abstract":"<p><strong>Purpose: </strong>The anatomy and variations of the inguinal canal significantly influence outcomes of laparoscopic inguinal hernia (IH) repair in pediatric patients. Male anatomy, with the spermatic cord and vascular structures, presents greater surgical complexity and risk. Although laparoscopy improves anatomical visualization, few studies have explored its impact on pediatric outcomes.</p><p><strong>Materials and methods: </strong>This retrospective study analyzed 158 male children who underwent laparoscopic IH repair between November 2019 and December 2023. Data included age, hernia side, internal ring shape, inferior epigastric artery (IEA) configuration, lipoma, and peritoneal band presence.</p><p><strong>Results: </strong>Of 207 hernias, 59.5% were right-sided and 40.5% left-sided. Age significantly correlated with IEA prominence (χ² = 13.367, p = 0.0096) and lipoma presence (χ² = 21.330, p = 0.0063). The most common IEA configuration was \"Common Wall\"; the \"Distant\" type increased with age. Hematomas were the most frequent complication (13.53%), especially in infants (1-12 months). The \"Intersection\" IEA configuration was associated with higher complication rates.</p><p><strong>Conclusions: </strong>IEA and inguinal canal variations are key determinants in pediatric laparoscopic IH repair outcomes. Awareness of these anatomical features, especially in infants, can help reduce complications. Further research may aid in refining surgical approaches and enhancing safety.</p>","PeriodicalId":19832,"journal":{"name":"Pediatric Surgery International","volume":"41 1","pages":"305"},"PeriodicalIF":1.6,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145200571","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":"Mitrofanoff procedure in children: use of the appendix and VQZ plasty seems to minimize complications.","authors":"Adriana König, Ashley X Wiseman, Barbara Wildhaber, Isabelle Vidal, Jacques Birraux","doi":"10.1007/s00383-025-06204-6","DOIUrl":"10.1007/s00383-025-06204-6","url":null,"abstract":"<p><strong>Purpose: </strong>Variations around Mitrofanoff technique exist for continent catheterizable channel (CCC). The present study aims to analyze CCC complications within our patient cohort, in which the appendix was given preference to the maximum.</p><p><strong>Methods: </strong>Retrospective review of pediatric patients who had CCC surgery in our institution (2007-2019). A nine-item questionnaire was sent to assess current use of their CCC.</p><p><strong>Results: </strong>Among the 31 patient-cohort, appendix was used in 30, with a VQZ plasty in the right lower quadrant in 29. Postoperatively, seven CCC dysfunctions occurred in six patients between one month and nine years (four catheterization difficulties, one CCC stenosis at bladder level, one CCC incontinence, one parastomal hernia, no superficial stenosis). Of these complications, two were managed conservatively, two endoscopically, and three by open surgery. 21/23 surveys were returned: mean age of responders was 15 years, 97% used their CCC regularly, and none complained of CCC incontinence.</p><p><strong>Conclusion: </strong>This study shows a low revision rate for CCC dysfunction, with over half of the cases effectively managed through conservative or endoscopic means. It seems that following a stringent protocol with meticulous surgical technique and standardized postoperative care by a specialized nursing team reduces the risk of CCC complications.</p>","PeriodicalId":19832,"journal":{"name":"Pediatric Surgery International","volume":"41 1","pages":"304"},"PeriodicalIF":1.6,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12474596/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145150290","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":"International survey on the management of pectus excavatum: is there a consensus?","authors":"Ufuk Ateş, Ege Evin, Kutay Bahadır, Erdem Altınörgü, Selin Fırat, Murat Çakmak, Mustafa Yüksel","doi":"10.1007/s00383-025-06195-4","DOIUrl":"https://doi.org/10.1007/s00383-025-06195-4","url":null,"abstract":"<p><strong>Purpose: </strong>Pectus excavatum (PE) is the most common congenital chest wall deformity. While often perceived as a cosmetic issue, PE can impair cardiopulmonary function. Surgical correction has evolved from the Ravitch procedure to the minimally invasive Nuss technique, which offers reduced surgical risks and improved postoperative outcomes. However, diagnostic and therapeutic variability persists, highlighting the need for expert consensus.</p><p><strong>Methods: </strong>A 31-question web-based survey was distributed to CWIG members and PE specialists between November 2024 and January 2025. The survey explored five key domains: demographics, preoperative evaluation, surgical indications and timing, operative technique, and postoperative management. Responses from 100 international surgeons were analyzed.</p><p><strong>Results: </strong>The most common indications for surgery were severe deformity (88.9%), Haller index > 3.25 (78.8%), psychosocial distress (77.8%), and symptoms (77.8%). Technique selection was influenced by prior surgery (48%) and surgeon experience (45.9%). For complex cases, 90.8% preferred the double-bar technique. Most surgeons removed the bar within 2-3 years (86.6%). Postoperative pain was primarily managed with oral analgesics (64.6%) and IV pumps (47.5%). Early complications included pneumothorax (68.1%) and infections (62.8%); bar displacement (78%) was the most frequent late complication.</p><p><strong>Conclusion: </strong>Despite widespread adoption of the Nuss procedure, significant variation remains in PE management. These findings emphasize the need for standardized, evidence-based guidelines to optimize patient outcomes.</p>","PeriodicalId":19832,"journal":{"name":"Pediatric Surgery International","volume":"41 1","pages":"302"},"PeriodicalIF":1.6,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145114027","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}