Pediatric Surgery International最新文献

{"title":"Megameatus intact prepuce: a systematic review of surgical techniques and long-term outcomes.","authors":"Abubakr Elawad, Ahmed Haroon, Jamil Ahmad, Jude Alsbeti, Sami Cherigui, Seem Arar, V V S Chandrasekharam, Tariq O Abbas","doi":"10.1007/s00383-024-05898-4","DOIUrl":"10.1007/s00383-024-05898-4","url":null,"abstract":"<p><p>Megameatus intact prepuce (MIP) presents with diverse phenotypes that complicate the management of this rare but complex hypospadias variant. Current data on optimal treatment methods and patient outcomes are sparse, unintegrated, and therefore challenging to implement clinically. A comprehensive systematic review of the existing literature on MIP was conducted according to PRISMA guidelines. Electronic databases including PubMed, Embase, and Scopus were searched for relevant articles published up to [2024]. Key aims were to assess the safety and efficacy of different surgical interventions, and synthesize corresponding outcomes reported in the literature. The search yielded 18 articles meeting the inclusion criteria, representing a total of 524 enrolled patients across multiple geographic regions. Diagnosis of MIP typically involves clinical examination, imaging studies, and urological evaluation. Surgical management options included preputial reconstruction, urethroplasty, and meatal advancement with glanuloplasty. Reported outcomes varied, with success rates ranging from [77.1-100%]. Long-term follow-up data on functional and cosmetic outcomes were limited. Megameatus intact prepuce presents diagnostic and management challenges due to low prevalence and variable presentation. This systematic review presents a current understanding of MIP diagnosis, surgical techniques, and patient outcomes. Future studies should assess the long-term functional outcomes of different surgical approaches, and investigate the underlying genetic and environmental factors contributing to the diverse clinical manifestations of MIP.</p>","PeriodicalId":19832,"journal":{"name":"Pediatric Surgery International","volume":"41 1","pages":"17"},"PeriodicalIF":1.5,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11614969/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142771194","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":"Bowel perforation in neonates with Hirschsprung disease: a case series and literature review.","authors":"Zhaozhou Liu, Yanan Zhang, Dayan Sun, Yongwei Chen, Weihong Guo, Jingbin Du, Jinshi Huang","doi":"10.1007/s00383-024-05907-6","DOIUrl":"https://doi.org/10.1007/s00383-024-05907-6","url":null,"abstract":"<p><strong>Background: </strong>Bowel perforation is a severe complication of Hirschsprung disease (HD) that necessitates prompt diagnosis and aggressive management to reduce mortality and morbidity. This study aimed to provide insights into the clinical management of neonatal HD cases complicated by bowel perforation.</p><p><strong>Methods: </strong>A retrospective review was conducted on neonates diagnosed with HD and bowel perforation at Beijing Children's Hospital from January 2007 to January 2024. Inclusion criteria included neonates ≤ 28 days old with confirmed HD diagnosis based on postoperative histology. Data collected included perinatal history, patient characteristics, HD classification, clinical presentations, surgical interventions, and outcomes. Statistical analysis was performed using SPSS 26.0.</p><p><strong>Results: </strong>Among 300 neonates diagnosed with HD, 18 (6.0%) developed preoperative bowel perforation. Most perforations were in the proximal ganglionic bowel, with short-segment HD (7/18, 38.9%) and long-segment HD (9/18, 50.0%) being most common. All patients received timely surgical intervention upon the discovery of bowel perforation, with 94.4% (17/18) requiring stoma creation. Postoperative complications included stoma retraction, Hirschsprung disease-associated enterocolitis, and adhesive bowel obstruction, but no mortality was reported.</p><p><strong>Conclusion: </strong>The incidence of preoperative bowel perforation in neonates with HD was 6.0%, primarily in cases of short-segment and long-segment HD. Perforations were mainly located in the proximal ganglionic segments. Prompt surgical intervention, particularly stoma creation, resulted in favorable outcomes for most patients.</p>","PeriodicalId":19832,"journal":{"name":"Pediatric Surgery International","volume":"41 1","pages":"15"},"PeriodicalIF":1.5,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142771221","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":"Yes-associated protein is dysregulated in human congenital diaphragmatic hernia patients during mid and end gestation.","authors":"Yuichiro Miyake, Marietta Jank, Daywin Patel, Arzu Ozturk, Ophelia Aubert, Xingbin Ai, Atsuyuki Yamataka, Richard Keijzer","doi":"10.1007/s00383-024-05912-9","DOIUrl":"https://doi.org/10.1007/s00383-024-05912-9","url":null,"abstract":"<p><strong>Background: </strong>Yes-associated protein (YAP) is implicated in congenital diaphragmatic hernia (CDH). This study aims to investigate the abundance of YAP and its inactive form, phosphorylated YAP (p-YAP), in fetal human lung tissues from CDH cases compared to control cases at mid-gestation and end-gestation.</p><p><strong>Methods: </strong>Immunofluorescence was performed to assess the abundance of YAP and p-YAP in lung tissues from human CDH and control fetuses who died from causes other than CDH. Additionally, the impact on cellular differentiation was evaluated by assessing the expression of Homeodomain-only protein X (HOPX) and Surfactant protein C (SPC).</p><p><strong>Results: </strong>Immunostaining revealed a higher abundance of YAP and p-YAP in both mid-gestation and end-gestation lung tissues. Notably, the abundance of p-YAP was increased in CDH tissues compared to controls, indicating higher levels of the inactive form of YAP in CDH. HOPX and SPC staining showed CDH tissues had a higher number of SPC-positive cells and fewer HOPX-positive cells at end-gestation.</p><p><strong>Conclusions: </strong>Our findings suggest that in CDH, YAP is predominantly present in its inactive form, p-YAP, potentially disrupting normal lung development and differentiation. This underscores the potential involvement of YAP dysregulation in the pathogenesis of CDH.</p>","PeriodicalId":19832,"journal":{"name":"Pediatric Surgery International","volume":"41 1","pages":"16"},"PeriodicalIF":1.5,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142770874","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":"Predicting risk factors for postoperative intestinal stenosis in neonates with necrotizing enterocolitis: development and assessment of a predictive nomogram.","authors":"Yang Chen, Ling Zhou, Qianghui Liao, Dong Xiao, Ledao Zhu, Jinlong Yao, Jiashu Liu, Xuling Zhang, Xiaopeng Ma, Feng Ren, Zhiyong Wang","doi":"10.1007/s00383-024-05916-5","DOIUrl":"https://doi.org/10.1007/s00383-024-05916-5","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to develop and validate an intestinal stenosis prediction model for postoperative newborns with neonatal necrotizing enterocolitis (NEC).</p><p><strong>Methods: </strong>Clinical information was collected on neonates who had undergone anastomosis or enterostomy because of NEC. The least absolute shrinkage and selection operator regression was applied to identify risk factors included in the model for postoperative intestinal stenosis. Multivariate logistic regression analysis was used to develop a predicting model regression based on the selected variables. Then internal validation was assessed using the bootstrapping validation. The accuracy and applicability of the model are assessed by C-index, calibration and decision curve.</p><p><strong>Results: </strong>Predictors incorporated into the model were a weight on admission, hematochezia, duration of abnormal C-reactive protein, lactate, intestinal peristalsis vanish, operation methods and duration of surgery. The regression equation was logit (P) = -0.001X₁ + 1.566X₂ + 0.185X₃ + 0.304X₄ + 1.34X₅ - 2.932X₆ + 0.015X₇ - 3.193, where X₁ was weight on admission (g), X₂ was hematochezia (yes = 1, no = 0), X₃ was duration of abnormal C-reactive protein (days), X₄ was lactate (mmol/L), X₅ was intestinal peristalsis vanish (yes = 1, no = 0), X₆ was primary anastomosis (yes = 1, no = 0), X₇ was duration of surgery (min). The model displayed good discrimination with a C-index of 0.879 (0.827,0.932) by random sampling for 1000 times. The calibration curve excluded the overfitting performance, and the decision curve confirmed the clinical application capacity of the model.</p><p><strong>Conclusion: </strong>This nomogram of intestinal stenosis incorporating the use of weight on admission, hematochezia, duration of abnormal C-reactive protein, lactate, intestinal peristalsis vanish, operation methods and duration of surgery could be conveniently used to facilitate the intestinal stenosis risk prediction in postoperative-NEC-patients.</p>","PeriodicalId":19832,"journal":{"name":"Pediatric Surgery International","volume":"41 1","pages":"14"},"PeriodicalIF":1.5,"publicationDate":"2024-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11608343/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142769964","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":"Characteristics, progression, management, and outcomes of NEC: a retrospective cohort study.","authors":"Maher Shahroor, Mohamed Elkhouli, Kyong-Soon Lee, Agostino Pierro, Prakesh S Shah","doi":"10.1007/s00383-024-05918-3","DOIUrl":"https://doi.org/10.1007/s00383-024-05918-3","url":null,"abstract":"<p><strong>Background: </strong>Necrotising enterocolitis (NEC) in preterm infants is associated with high morbidity and mortality. In most neonates, it is a progressive disease from medical NEC (mNEC) to surgical NEC (sNEC); however, in some, it presents as sNEC from onset.</p><p><strong>Objective: </strong>To evaluate the rate, the timing of progression, different surgical approaches, and outcomes of mNEC and sNEC in preterm neonates.</p><p><strong>Design: </strong>A retrospective cohort study of preterm infants with diagnosis of NEC between 2010 and 2020 was conducted. Data on clinical presentation, NEC progression, treatment received, different surgical approaches, resource utilization, and outcomes were abstracted. Infants were classified into 3 groups: mNEC, mNEC that progressed to sNEC, and sNEC at presentation.</p><p><strong>Results: </strong>Among 208 included infants with NEC, 109 (52%) were mNEC, 66 (32%) progressed from mNEC to sNEC, and 33 (16%) presented with sNEC. Gestational age, birth weight, and postnatal age at NEC were inversely associated with the development of sNEC. mNEC progressed to sNEC occurred after a median of 2.5 (IQR 1-4.25) days. Ninety (91%) of sNEC patients underwent interventions: peritoneal drain only in 19 (21%), laparotomy in 59 (66%), or both in 12 (13%). In comparison with mNEC, those with sNEC infants had longer duration on antibiotics, inotropes, respiratory support, length of stay, and time to reaching full enteral feeds; and were more likely to have recurrent NEC episodes, BPD, and mortality.</p><p><strong>Conclusion: </strong>There is a high burden of illness for sNEC cases. Insight into the expected clinical course of sNEC patients can facilitate anticipatory management and provide a window of opportunity for timely interventions that may ameliorate the course of sNEC.</p>","PeriodicalId":19832,"journal":{"name":"Pediatric Surgery International","volume":"41 1","pages":"13"},"PeriodicalIF":1.5,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142755467","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":"Peter Paul Rickham: the Liverpool neonatal surgery unit 1953.","authors":"Paul D Losty","doi":"10.1007/s00383-024-05910-x","DOIUrl":"10.1007/s00383-024-05910-x","url":null,"abstract":"<p><p>This article highlights the evolution, birth and legacy of the world's first neonatal surgical unit established at Alder Hey Children's Hospital Liverpool in 1953. Peter Paul Rickham, a creative pioneering and innovative surgeon, is credited here as a major driving force that helped shape and progress the modern day development of neonatal surgery. Rickham's vision was realised by studying neonatal surgical disorders and the mortality rate of congenital anomalies in Mersey Region while working as a young senior registrar with Isabella Forshall. Rickham defined the extent of the problem(s) and set to work as a newly appointed consultant a vision for improving outcomes with the creation and establishment of a preeminent world leading neonatal surgical unit. Surgeons from all over the world travelled to work, learn and train with Rickham and the paediatric surgical staff team at Alder Hey in the subsequent years to follow. Neonatal anaesthesia greatly advanced by Jackson Rees a colleague working in Liverpool with Rickham allowed huge success to flourish-'the impossible became possible'. The neonatal surgical unit in Liverpool became the benchmark and prototype for units to develop around the world immediately resulting in improvement in the survival of newborn infants undergoing surgery from 22 to 74%. Rickham's contributions to neonatal and paediatric surgery are truly remarkable. Alder Hey hosts an international symposium and special dinner with Rickham family members as VIP guests in its calendar of events. A symposium highlight is the Rickham Lecture with the PPR Gold Medal awarded to an international renowned leader in the field of paediatric surgery and the surgical sciences.</p>","PeriodicalId":19832,"journal":{"name":"Pediatric Surgery International","volume":"41 1","pages":"12"},"PeriodicalIF":1.5,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11604691/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142751301","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":"Prophylactic surgical drain placement with irrigation reduces abscess formation in patients with severe, uncontained, perforated appendicitis.","authors":"Michael A Stellon, Devashish S Joshi, Russell Herberg, Brittany Walker, Jessica Hellner, Kevin M Riggle, Hau D Le","doi":"10.1007/s00383-024-05892-w","DOIUrl":"10.1007/s00383-024-05892-w","url":null,"abstract":"<p><strong>Background: </strong>20-25% of perforated appendicitis cases are complicated by abscess formation. This study assesses whether prophylactic closed-suction surgical drain (SD) placement after irrigation can decrease postoperative abscess formation in patients with extensively contaminated, perforated appendicitis.Affiliations: Journal instruction requires country for affiliations; however, these are missing in all affiliations. Please verify if the provided country names are correct and amend if necessary.They're correct METHODS: A multicenter retrospective review was performed on pediatric patients with uncontained perforated appendicitis from January 1, 2020 to August 1, 2023. Limited irrigation was performed. All SDs were oriented towards the pelvis. Data were analyzed in four groups: (G1) SD and irrigation, (G2) only SD, (G3) only irrigation, (G4) neither SD nor irrigation.</p><p><strong>Results: </strong>One hundred and fifteen patients (44 in G1, 3 in G2, 21 in G3, 47 in G4) were included. The abscess rate was 5.1% (G1), 33.3% (G2), 33.3% (G3), and 37.0% (G4) (p = 0.001). No interventional radiology (IR) drains were placed in G1 and G2. SD duration was 4.1 ± 2.1 days in G1 and 2.7 ± 0.6 days in G2. IR drain duration was 14 ± 10.7 days in G3 and 8.3 ± 3.9 days in G4 (p < 0.001). There were no significant differences in total length of stay and antibiotic duration.</p><p><strong>Conclusions: </strong>Irrigation with prophylactic SD placement may prevent postoperative abscesses in patients with severe, uncontained, perforated appendicitis, but prospective data are needed.</p>","PeriodicalId":19832,"journal":{"name":"Pediatric Surgery International","volume":"41 1","pages":"11"},"PeriodicalIF":1.5,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142740060","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":"Feeding jejunostomy in children: safety, effectiveness and perspectives.","authors":"Valentina Forlini, Caterina Sacchetti, Paolo Gandullia, Stefano Avanzini, Girolamo Mattioli, Michela Cing Yu Wong","doi":"10.1007/s00383-024-05915-6","DOIUrl":"https://doi.org/10.1007/s00383-024-05915-6","url":null,"abstract":"<p><strong>Purpose: </strong>Jejunal feeding (JF) indications in children have recently increased. However, surgical jejunostomy (SJ) is reported to be subjected to a high complication rate. The aim of the study is to focus on safety, effectiveness, and complications of SJ and to identify those categories of patients who could most benefit from it.</p><p><strong>Methods: </strong>A retrospective analysis of all SJ performed at Giannina Gaslini Children's Hospital between 2014 and 2022 was performed. Data were collected regarding demographics characteristics, past medical history, surgical indications, surgical technique (Roux-en-y (REYJ), omega jejunostomy (OJ)), complications and nutritional outcomes.</p><p><strong>Results: </strong>Fourteen patients were included. Nine (64%) had severe neurological impairment. The most frequent indication for SJ was gastroesophageal reflux. REYJ was performed in five (36%) patients, OJ in nine (64%); no technique appears to be superior. One patient experienced a major long-term complication. After a follow-up of 40 months (range: 1-152), five (36%) patients discontinued JF: three (21%) successfully completed JF cessation, and two (14%) had their jejunostomy closed due to JF intolerance.</p><p><strong>Conclusions: </strong>Based on our experience and on data available in the literature, SJ should be recommended in selected patients as temporary procedure or as bridge treatment to prevent or at least delay more invasive surgeries.</p>","PeriodicalId":19832,"journal":{"name":"Pediatric Surgery International","volume":"41 1","pages":"10"},"PeriodicalIF":1.5,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142740058","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":"Chyme reinfusion practices in the neonatal population.","authors":"Alexandria H Lim, Georges Tinawi, Taylor Harrington, Emma Ludlow, Helen Evans, Ian Bissett, Celia Keane","doi":"10.1007/s00383-024-05904-9","DOIUrl":"10.1007/s00383-024-05904-9","url":null,"abstract":"<p><strong>Introduction: </strong>Chyme reinfusion therapy (CRT) is a safe and effective method to improve nutritional outcomes and promote intestinal adaptation in patients with stomas. This practice involves refeeding the proximal stoma output, down the distal limb, and mimics a state of intestinal continuity; thereby promoting growth and adaption of the distal bowel. Despite its promise, CRT in neonates is a relatively underutilised practice and can be of significant value in neonates with congenital bowel anomalies or necrotising enterocolitis. We aimed to identify the frequency, methodology and adverse effects associated with CRT in our neonatal population. We aimed to identify the frequency, methodology and adverse events associated with CRT in our neonatal population.</p><p><strong>Methods: </strong>A ten-year retrospective cohort study was conducted using database searches at two major paediatric hospitals in New Zealand. All patients with suitable anatomy were identified, and data on CRT methodology and outcomes were recorded.</p><p><strong>Results: </strong>Of the 49 eligible neonates, 23 (47%) underwent CRT. Indications for CRT included high stoma output, malnutrition with poor weight gain, and routine refeeding prior to stoma reversal. A nasogastric feeding tube was inserted into the distal limb and collected chyme was reinfused via manual bolus or automated syringe driver. The median (IQR) weight gain increased from 13.9 (3.50-22.89) to 24.37 (19.68-29.99) g/day during CRT (p = 0.04). 18 infections requiring medical intervention but unrelated to CRT occurred in 13 patients (56%). Amongst our cohort, there was a high rate of non-infectious events, including peri-stomal skin irritation (60%), stoma prolapse (43%) and stomal bleeding (26%).</p><p><strong>Conclusion: </strong>CRT is an underutilised method of improving nutrition in neonates with intestinal failure. Premature neonates requiring double enterostomy formation are at high risk of infectious and non-infectious complications, but few of these are related to CRT. Standardised protocols providing clear eligibility criteria and detailed methodology for CRT are required to promote uniform utilisation of this practice.</p>","PeriodicalId":19832,"journal":{"name":"Pediatric Surgery International","volume":"41 1","pages":"7"},"PeriodicalIF":1.5,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142731580","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 different Kasai portoenterostomy techniques in the outcomes of biliary atresia: a systematic review and network meta-analysis.","authors":"Yanran Zhang, Shaowen Liu, Qianhui Yang, Rongjuan Sun, Jiaying Liu, Yu Meng, Jianghua Zhan","doi":"10.1007/s00383-024-05920-9","DOIUrl":"10.1007/s00383-024-05920-9","url":null,"abstract":"<p><strong>Background: </strong>Biliary atresia (BA) is a progressive disease affecting the bile duct structure and function, leading to poor outcomes without timely surgical intervention. Kasai portoenterostomy (KPE) is a commonly used treatment to restore bile flow. However, the success rate and postoperative outcomes of KPE vary with different surgical techniques, including laparoscopic, robot-assisted, and open approaches.</p><p><strong>Methods: </strong>Following the PRISMA guidelines, this study systematically searched PubMed, EMBASE, and Cochrane databases for literature on BA surgical techniques of KPE. Studies comparing two or all three techniques-laparoscopic, robot-assisted, and open-in terms of postoperative outcomes of KPE in BA patients were included. Utilizing the \"gemtc\" package in R version 4.3.3, NMA was conducted to compare postoperative clearance of jaundice (COJ) among different surgical techniques. We also performed traditional paired meta-analysis in which multiple surgical outcomes were compared.</p><p><strong>Results: </strong>According to the traditional definition of a successful KPE surgery, in terms of successful postoperative COJ, robotic-assisted Kasai portoenterostomy (RAKPE) shows advantage over open Kasai portoenterostomy (OKPE) and laparoscopic Kasai portoenterostomy (LKPE), while the outcomes between OKPE and LKPE are equivalent. However, statistically speaking, there is no significant difference among the three techniques. LKPE has a longer operation time and less intraoperative bleeding compared to OKPE. There are no statistically significant differences in hospital stay, cholangitis incidence, or liver survival rates at 6 months, 1 year, 2 years, or 5 years.</p><p><strong>Conclusion: </strong>The surgical success rates of KPE with various technical aids are similar, highlighting the need to consider individual patient conditions and cost when choosing a surgical technique. Effective postoperative management is vital for preventing complications and slowing liver fibrosis. Future research should focus on improving surgical techniques and postoperative care to enhance long-term outcomes for BA patients. For those who cannot maintain liver function with KPE, timely LT consideration is crucial.</p>","PeriodicalId":19832,"journal":{"name":"Pediatric Surgery International","volume":"41 1","pages":"6"},"PeriodicalIF":1.5,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142731583","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}