Pediatric Surgery International最新文献

{"title":"Retained gallstones after laparoscopic cholecystectomy in kids: a systematic review.","authors":"Mohammed Al Blooshi, Humaid Al Zaabi, Fatima Al Harmoodi, Mariam Al Shamsi","doi":"10.1007/s00383-025-06113-8","DOIUrl":"10.1007/s00383-025-06113-8","url":null,"abstract":"<p><p>Pediatric laparoscopic cholecystectomy (LC) is increasingly common, but the incidence and clinical implications of retained or spilled gallstones in children remain incompletely characterized. We performed a systematic review of MEDLINE, Embase, Scopus, Web of Science, Google Scholar, and gray literature through 2024, including 12 studies (1057 pediatric LCs). Gallbladder perforation with visible stone spillage occurred in 4.3% (95% confidence interval [CI] 2.9-6.1%) of cases, and clinically significant retained-stone complications-primarily intra-abdominal or port-site abscesses and common bile duct stones-were observed in 1.7% (95% CI 0.9-3.0%). All such complications were successfully managed using endoscopic retrograde cholangiopancreatography, laparoscopic, or percutaneous approaches. Although most spilled stones remain asymptomatic, late presentations up to two years after LC underscore the importance of meticulous retrieval, explicit documentation of spillage, and early imaging for suspicious postoperative symptoms. Existing evidence is constrained by small sample sizes, retrospective designs, and limited follow-up. Nevertheless, it suggests that while gallstone spillage and retention are uncommon in pediatric LC, they can lead to significant morbidity if overlooked. Larger, prospective multicenter registries with standardized definitions, extended follow-up, and robust outcome measures are warranted to clarify true incidence, identify modifiable risk factors, and refine preventive strategies, ultimately improving safety for children undergoing cholecystectomy.</p>","PeriodicalId":19832,"journal":{"name":"Pediatric Surgery International","volume":"41 1","pages":"229"},"PeriodicalIF":1.6,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12289815/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144699156","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":"Intraoperative quantitative analysis of intestinal perfusion by ICG fluorescence in Hirschsprung disease: a single-center retrospective cohort study.","authors":"Zhen Zhang, Ya Gao, Ya Ma, Ruijie Zhou, Yong Chen, Long Li, Qian Jiang, Qi Li","doi":"10.1007/s00383-025-06068-w","DOIUrl":"https://doi.org/10.1007/s00383-025-06068-w","url":null,"abstract":"<p><strong>Objective: </strong>Postoperative complications at the coloanal anastomosis site following surgery for Hirschsprung disease (HSCR) can significantly impact bowel function recovery in children. Indocyanine green (ICG) fluorescence imaging provides a real-time, quantitative assessment of perfusion, potentially improving surgical outcomes. This study aims to evaluate the effectiveness of an ICG-based quantitative perfusion analysis strategy compared to conventional visual assessment in determining anastomotic site selection.</p><p><strong>Methods: </strong>This single-center retrospective study included consecutive patients with histologically confirmed HSCR who underwent surgery between January 2023 and January 2024. Following vascular arcade ligation and transanal pull-through, anastomotic site selection was guided either by conventional visual assessment (Visual Group) or ICG fluorescence angiography with quantitative perfusion analysis (ICG Group). We chose the specific ICG perfusion parameters (Fmax > 30 AU, Tmax < 30 s) as safe anastomotic site thresholds. Postoperative complications, functional outcome and perianal ultrasound findings were assessed during follow-up.</p><p><strong>Results: </strong>A total of 167 patients were included, with 34 in the ICG Group and 133 in the Visual Group. Both groups had comparable baseline characteristics. While no significant differences were observed in postoperative bowel movement recovery or major anastomotic complications, perianal ultrasound at 5-7 days postoperatively revealed significantly reduced anastomotic inflammation in the ICG Group. Follow-up analysis showed that the ICG Group had a shorter hospital stay (7 days, IQR 7-8 vs. 8 days, IQR 7-10.5, p = 0.003), as well as a higher percentage of HAEC-free patients (78.1% for ICG vs. 56.8% for Visual) compared to the Visual Group.</p><p><strong>Conclusion: </strong>Quantitative ICG fluorescence imaging provides a more precise and objective approach for anastomotic site selection in HSCR surgery. This strategy may reduce postoperative anastomotic inflammation and HAEC. Further studies are needed to validate its long-term clinical benefits and establish standardized protocols for pediatric colorectal surgery.</p>","PeriodicalId":19832,"journal":{"name":"Pediatric Surgery International","volume":"41 1","pages":"227"},"PeriodicalIF":1.5,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144691153","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 the current characteristics and management of congenital biliary dilatation with and without a fetal diagnosis: report of 231 consecutive cases from the Kyushu Pediatric Surgery Study Group in Japan over the past decade.","authors":"Masakazu Murakami, Keisuke Yano, Shohei Maeda, Takeshi Shirai, Yusuke Yamane, Taichiro Kosaka, Takafumi Kawano, Makoto Hayashida, Toshiharu Matsuura, Hiroto Eto, Motofumi Torikai, Yukihiro Tatekawa, Takeshi Yamanouchi, Taizo Hibi, Tatsuro Tajiri, Satoshi Ieiri","doi":"10.1007/s00383-025-06136-1","DOIUrl":"10.1007/s00383-025-06136-1","url":null,"abstract":"<p><strong>Purpose: </strong>The aim of this study is to investigate and to compare the current characteristics and management of congenital biliary dilatation (CBD) with and without fetal diagnosis (FD) based on a multicenter study at all institutions in Kyushu, Japan.</p><p><strong>Methods: </strong>A regional multicenter study was conducted among the institutions affiliated with the Kyushu Pediatric Surgery Study Group. Patients with CBD who underwent definitive surgery between 2014 and 2023 were enrolled.</p><p><strong>Results: </strong>All 28 affiliated institutions joined this multicenter study. There comprised 231 cases (Date collection rate: 100%), including 35 cases (15.2%) with an FD. Compared to cases without an FD, cases with an FD were significantly more frequently recognized in type Ia (p < 0.01), significantly less frequently recognized in type Ic (p = 0.04), and IV-A (p < 0.01), and showed a significantly lower frequency of preoperative cholangitis (p < 0.01) and pancreatitis (p < 0.01). Cases with an FD had significantly shorter operative times (p < 0.01). There were no significant differences in the frequency of postoperative and late postoperative complications between the patients with and without an FD.</p><p><strong>Conclusion: </strong>CBD cases with an FD were more likely to be type Ia and less likely to have preoperative symptoms than those without an FD, with a comparable risk of postoperative complications.</p>","PeriodicalId":19832,"journal":{"name":"Pediatric Surgery International","volume":"41 1","pages":"224"},"PeriodicalIF":1.6,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12283469/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144691128","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":"Long-term outcomes after thoracoscopic versus open surgery for congenital esophageal atresia: propensity-score overlap weighting analysis.","authors":"Yoshitsugu Yanagida, Shotaro Aso, Michimasa Fujiogi, Kaori Morita, Mai Kutsukake, Naohiro Takamoto, Kiyohide Fushimi, Jun Fujishiro, Hideo Yasunaga","doi":"10.1007/s00383-025-06135-2","DOIUrl":"10.1007/s00383-025-06135-2","url":null,"abstract":"<p><strong>Purpose: </strong>Congenital esophageal atresia requires neonatal surgery. Although short- and medium-term outcomes of thoracoscopic and open surgery have been investigated, long-term outcomes remain unclear. This study aimed to compare the long-term outcomes of these approaches using a Japanese national inpatient database.</p><p><strong>Methods: </strong>We identified neonates who underwent open or thoracoscopic surgery for congenital esophageal atresia between April 2016 and March 2022. Patients with prior palliative surgery were excluded. Propensity score overlap weighting analyses were used to compare the outcomes between the groups. The primary outcome was the long-term (1 year after definitive surgery) anastomotic strictures. Secondary outcomes included long- and medium-term (within 30 days to 1 year after definitive surgery) gastroesophageal reflux and medium-term anastomotic strictures.</p><p><strong>Results: </strong>Among 395 patients, 67 underwent thoracoscopic surgery and 328 underwent open surgery.　Propensity score overlap weighting analyses revealed no significant differences in long-term anastomotic stricture (5.8% vs. 8.7%; risk difference (RD), - 2.9%; 95% confidence interval (CI), - 10.9 to 5.1), long-term gastroesophageal reflux (2.9% vs. 3.0%; RD, -0.1%; 95% CI - 7.1 to 4.9), medium-term anastomotic stricture (29.4% vs. 18.8%; RD, 10.6%; 95% CI - 2.5 to 23.7), or medium-term gastroesophageal reflux (4.9% vs. 6.0%; RD, - 1.1; 95% CI -7 .1 to 4.9).</p><p><strong>Conclusions: </strong>Long-term outcomes did not differ significantly between thoracoscopic and open surgery for congenital esophageal atresia.</p>","PeriodicalId":19832,"journal":{"name":"Pediatric Surgery International","volume":"41 1","pages":"222"},"PeriodicalIF":1.6,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12283821/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144691154","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":"Antibiotic monotherapy vs dual-drug therapy in perforated appendicitis: single-center retrospective review.","authors":"Shai Stewart, Cory Nonnemacher, Seth Saylors, Nelimar Cruz-Centeno, Derek Marlor, Dae H Kim, Shawn St Peter, Tolulope A Oyetunji","doi":"10.1007/s00383-025-06129-0","DOIUrl":"https://doi.org/10.1007/s00383-025-06129-0","url":null,"abstract":"<p><strong>Background: </strong>There is no consensus on the optimal antibiotic regimen in perforated appendicitis. We aimed to evaluate the outcomes of patients with perforated appendicitis when treated with Piperacillin-Tazobactam (PT) monotherapy versus Ceftriaxone and Metronidazole (CM) dual-drug therapy. We hypothesized that there is no difference in the rate of intraabdominal abscess (IAA) formation with antibiotic monotherapy, as opposed to our institutional standard dual-drug therapy.</p><p><strong>Methods: </strong>Single institution retrospective review of children < 18 years old with perforated appendicitis from October 2019 to March 2020 and October 2021 to May 2022 at a free-standing pediatric hospital. The primary outcome was 30-day postoperative IAA formation.</p><p><strong>Results: </strong>One hundred and seventeen patients were identified during the study periods; N = 77 in the CM group and N = 40 in the PT group. No differences in symptom duration, postoperative length of stay (LOS), duration of intravenous antibiotic treatment, or discharge oral antibiotic treatment were identified. Compared to the PT group, those treated with CM had fewer IAA (13% vs 20%, P = 0.32) and fewer emergency room visits (14.3% vs 27.5%, P = 0.08) but did not have statistically significant differences. Multivariate logistic regression analysis did not find antibiotic choice to be a significant predictor for developing IAA [OR 1.78, P = 0.21].</p><p><strong>Conclusions: </strong>In children with perforated appendicitis, postoperative monotherapy with PT and standard dual-drug therapy with CM are equivalent with respect to IAA formation at our institution.</p>","PeriodicalId":19832,"journal":{"name":"Pediatric Surgery International","volume":"41 1","pages":"225"},"PeriodicalIF":1.5,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144691127","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":"Intradyadic analysis of child parent perceptions of penile appearance post-hypospadias repair using the Paediatric Penile Perception Score (PPPS) in a middle-income country setting.","authors":"Anand Sanmugam, Tharisinidevi Kunasekaran, Wei Sheng Tan, Srihari Singaravel, Yew-Wei Tan, Shireen Anne Nah","doi":"10.1007/s00383-025-06133-4","DOIUrl":"10.1007/s00383-025-06133-4","url":null,"abstract":"<p><strong>Purpose: </strong>Hypospadias affects roughly 1 in 125 live male births, yet subjective outcome assessment is infrequent. We compared child- and parent-reported cosmetic satisfaction after repair and quantified inter-rater agreement.</p><p><strong>Methods: </strong>In this cross-sectional study, all boys aged 7-15 years who attended follow-up at Hospital Sultanah Bahiyah, Malaysia (repairs 2017-2019), were invited. Each child-parent dyad independently completed the Paediatric Penile Perception Score (PPPS; four domains, 1 = very dissatisfied to 4 = very satisfied). Paired Wilcoxon tests examined child-parent differences. Concordance was analysed with Spearman's ρ and quadratic-weighted Cohen's κ.</p><p><strong>Results: </strong>Sixty-three dyads participated (median child age 10.6 years). Median satisfaction for every domain was 3 [IQR 2-3] in both cohorts. Children rated penile-skin appearance one Likert step lower than parents (median difference - 1; p = 0.033); no other paired differences reached significance. Correlations between raters were moderate (ρ = 0.49-0.61). Agreement was fair for penile skin (κ = 0.27) and moderate for meatus position (κ = 0.56, 95% CI 0.29-0.77), glans shape (κ = 0.43) and overall appearance (κ = 0.45).</p><p><strong>Conclusion: </strong>High overall satisfaction was reported despite surgical delays. Only moderate concordance emerged, with children less pleased with penile skin than their parents. Pre-operative counselling and longitudinal follow-up should explicitly address child-centred aesthetic concerns to enhance psychosocial well-being.</p>","PeriodicalId":19832,"journal":{"name":"Pediatric Surgery International","volume":"41 1","pages":"223"},"PeriodicalIF":1.6,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12283461/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144691129","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":"Surgical treatment of first branchial cleft anomalies using retrograde facial nerve dissection technique.","authors":"Ji Won Kim, Moo Kyun Park, Myung-Whan Suh, Soon-Hyun Ahn, Seong Keun Kwon, Jungirl Seok, Yoon Kyung Jeon, Seongyeon Jung, Eun-Jae Chung","doi":"10.1007/s00383-025-06122-7","DOIUrl":"10.1007/s00383-025-06122-7","url":null,"abstract":"<p><strong>Purpose: </strong>First branchial cleft anomalies (FBCAs) are infrequent congenital malformations. In FBCAs removal surgery, due to the previous infection history and the anatomical proximity of the FBCAs tract to the facial nerve, postoperative recurrence and facial paralysis are not uncommon. This study aimed to assess the clinical feasibility and outcomes of FBCAs resection using the retrograde facial nerve dissection technique.</p><p><strong>Methods: </strong>This retrospective study included 19 patients (mean age, 6.3 ± 4.4 years) who underwent FBCAs excision via retrograde facial nerve dissection between 2017 and 2023. Data on demographics, operative details, histopathology, postoperative complications, and follow-up survey were reviewed.</p><p><strong>Results: </strong>Preoperative infection history was present in 94.7% of patients; 42.1% had prior incision and drainage and 15.8% had previous excision attempts. Complete resection was achieved in all cases without facial nerve palsy. No recurrence was observed during the follow-up periods (median, 23.9 ± 9.8 months). Postoperative pain and paresthesia showed clinical improvement, while cosmetic satisfaction was relatively limited.</p><p><strong>Conclusion: </strong>In FBCAs patients, the close proximity of the facial nerve and the adhesion between the tract and facial nerve pose significant challenges. Using retrograde facial nerve dissection is believed to enable complete removal and reduce postoperative facial nerve paralysis.</p>","PeriodicalId":19832,"journal":{"name":"Pediatric Surgery International","volume":"41 1","pages":"226"},"PeriodicalIF":1.6,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12283764/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144691155","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":"Volume-outcome relationship in corrective surgery for Hirschsprung's disease: a systematic literature review of direct evidence and an overview of indirect evidence.","authors":"Valeria Solari, Thomas Boemers, Eberhard Schmiedeke, Wolfram Trudo Knoefel, Michael Böttcher, Ekkehart Jenetzky, Miriam Wilms","doi":"10.1007/s00383-025-06117-4","DOIUrl":"10.1007/s00383-025-06117-4","url":null,"abstract":"<p><p>Hirschsprung's disease (HD) is a rare congenital condition requiring complex corrective surgery. We reviewed available direct evidence on the volume-outcome relationship for HD corrective surgery and assessed the applicability of indirect evidence based on GRADE (Grading of Recommendations Assessment, Development, and Evaluation) recommendations for rare diseases. Three retrospective cohort studies analysing the volume-outcome relationship for HD surgery met the inclusion criteria. In all studies, the high-volume threshold was below 12 HD corrective surgeries per year. No significant volume-outcome relationship was found for outcomes such as readmission or intestinal perforation. Faecal incontinence was not assessed. No risk-adjustment was performed. We applied the GRADE framework and explored indirect evidence from adult colorectal surgery, which shares technical similarities and complexity with HD corrective procedures. Multiple studies in adult colorectal surgery demonstrate a clear volume-outcome relationship, with improved outcomes mostly observed in centres performing more than 20 rectal resections annually. Direct evidence for a volume-outcome relationship in HD surgery cannot be established or refuted due to low caseloads and decentralization. Indirect evidence from adult colorectal surgery with comparable case complexity and the same core outcome parameters suggests the presence of a volume-outcome relationship in HD corrective surgery.</p>","PeriodicalId":19832,"journal":{"name":"Pediatric Surgery International","volume":"41 1","pages":"221"},"PeriodicalIF":1.5,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12279607/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144675492","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":"Early versus delayed repair in patients with anorectal malformation with rectoperineal fistula: impact on short-term complications and midterm and long-term bowel function.","authors":"Xianming Xiao, Wei Feng, Chenzhu Xiang, Liang Yuan, Zhili Wang, Jinping Hou, Yi Wang","doi":"10.1007/s00383-025-06110-x","DOIUrl":"https://doi.org/10.1007/s00383-025-06110-x","url":null,"abstract":"<p><strong>Background: </strong>This study aims to investigate the impact of early versus delayed repair on early postoperative complications and midterm and long-term bowel function in ARM patients with rectoperineal fistula.</p><p><strong>Methods: </strong>A total of 568 ARM patients with rectoperineal fistula who underwent cutback anoplasty were identified at our hospital from 2015 to 2021. Early repair was defined as an anoplasty performed at or before 28 days of age. Delayed repair was defined as occurring after this period.</p><p><strong>Results: </strong>267 patients were finally enrolled, with 171 males and 96 females. 129 (48.3%) underwent early repair and 138 (51.7%) delayed repair. Early postoperative complication rates showed no significant difference between the two groups (0% vs. 0.7%, P = 1.000). No wound infections or dehiscence occurred in either group within 6 months postoperatively. The median Rintala score did not differ significantly between the early and delayed groups (20 vs. 20, P = 0.272). Based on the Krickenbeck classification, there were no significant differences between the groups regarding constipation, soiling, or voluntary bowel movements (P > 0.05).</p><p><strong>Conclusions: </strong>Early and delayed repair have no significant impact on early postoperative complications and midterm and long-term bowel function in ARM patients with rectoperineal fistula. Neonatal cutback anoplasty is safe and effective for stable patients without major comorbidities, offering a favorable prognosis.</p>","PeriodicalId":19832,"journal":{"name":"Pediatric Surgery International","volume":"41 1","pages":"220"},"PeriodicalIF":1.5,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144668173","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":"Exosomes derived from colostrum and mature human breast milk protect against experimental necrotizing enterocolitis.","authors":"Runnan Gao, Yingying Huang, Bo Li, Rong Zhang, Carol Lee, Mashriq Alganabi, Masaya Yamoto, Xueni Peng, Weijing He, Yun Cao, Agostino Pierro, Chun Shen, Haitao Zhu","doi":"10.1007/s00383-025-06043-5","DOIUrl":"https://doi.org/10.1007/s00383-025-06043-5","url":null,"abstract":"<p><strong>Objective: </strong>Human milk-derived exosomes can protect intestinal organoids from lipopolysaccharide induced injury. The aim of this study is to investigate effects of exosomes derived from different periods of lactation on intestinal injury caused by experimental necrotizing enterocolitis (NEC).</p><p><strong>Methods: </strong>Colostrum and mature milk from healthy lactating human mothers were collected and isolated exosomes using serial ultracentrifugation and filtration. NEC was induced in mice pups by hypoxia, gavage of feeding of formula, and lipopolysaccharide (LPS) administration between postnatal days 5 and 9. Breast-fed pups were used as controls. NEC groups received daily gavage feeding of formula with added phosphate-buffered saline (PBS), colostrum exosomes or mature breast milk exosomes. The distal ileum was examined for NEC histology, inflammatory cytokines, and intestinal regeneration abilities.</p><p><strong>Results: </strong>Compared to NEC group, administration of colostrum and mature milk exosomes in NEC mice resulted in a significant reduction in histological scores of intestinal tissues and decreased expression of inflammatory genes IL-6 and TNF-α. Furthermore, the expression of PCNA, as well as stem cell markers (Lgr5 and Olfm4), increased following exosome treatment, with a corresponding rise in the immunofluorescence staining of Ki67. Compared to mature breast milk exosomes, colostrum exosomes were more effective at enhancing enterocyte proliferation and intestinal regeneration.</p><p><strong>Conclusions: </strong>Human milk-derived exosome treatment decreases the severity of experimental NEC. Colostrum exosomes induce greater intestinal regeneration compared to mature breast milk exosomes.</p>","PeriodicalId":19832,"journal":{"name":"Pediatric Surgery International","volume":"41 1","pages":"218"},"PeriodicalIF":1.5,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144659823","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}