Pediatric Surgery International最新文献

{"title":"Treatment of isolated lymphatic malformation with the herbal medicine \"Eppikajyutsuto\": a retrospective multicenter study.","authors":"Naoki Hashizume, Takafumi Kawano, Koshiro Sugita, Motofumi Torikai, Shun Onishi, Daisuke Masui, Saki Sakamoto, Hideaki Egami, Satoshi Ieiri, Tatsuru Kaji","doi":"10.1007/s00383-025-06161-0","DOIUrl":"10.1007/s00383-025-06161-0","url":null,"abstract":"<p><strong>Purpose: </strong>The present study analyzed the clinical efficacy of the herbal medicine \"Eppikajyutsuto\" (TJ-28) for isolated lymphatic malformation (LM).</p><p><strong>Methods: </strong>LM patients treated with TJ-28 monotherapy were retrospectively reviewed using medical records at three pediatric surgery departments from 2009 to 2023. All patients underwent ultrasound or/and magnetic resonance imaging before and after treatment. The isolated LM lesions were classified as macrocystic, microcystic, and mixed cystic according to the International Society for the Study of Vascular Anomalies classification. The LM volume index (LVI) was defined as the longitudinal length (mm) x width (mm) x depth (mm). The degree of reduction ratio (LVI ratio) was defined as the post-administration LVI divided by the pre-administration LVI.</p><p><strong>Results: </strong>Thirty-three cases (15 males, 18 females) of LM treated with TJ-28 were enrolled. Data are presented as median (range). The median age started treatment was 20 (0, 112) months. The median treatment duration was 12 (1-81) months. Of 28 patients, LVI ratio was calculated. Eighteen cases had macrocystic LM, 2 cases had microcystic LM and 8 cases had mixed macro-microcystic LM. There were significant differences between the pre-administration and post-administration LVI 32118 [1425, 1125000] mm³ vs 5087 [0, 50000] mm³, p < 0.001). Classified ISSVA: there were significant differences between the pre-administration and post-administration LVI of macrocystic (n = 18) (33,646 [3080, 1125000] mm³ vs 4937.5 [0, 50000] mm³, p < 0.001) and mixed macro-microcystic LM cases (n = 8) (37,952 [1425, 124488] mm³ vs 5134 [24, 41040] mm³, p = 0.0078). For microcystic LM cases (n = 2), there were no significant differences between the pre-administration and post-administration LVI (17,420 [5600, 29240] mm³ vs 30,180.5 [4550, 55811] mm³, p = 0.500). The median LVI ratio was 0.20 (0-1.91). The median LVI ratio of macrocystic LM was 0.21 (0-1.05) and the median LAI ratio of mixed macro-microcystic LM was 0.19 (0-1.01). Microcystic LM cases did not improve.</p><p><strong>Conclusions: </strong>This study demonstrates the beneficial effects of TJ-28 for macrocystic LM and mixed macro-microcystic LM.</p><p><strong>Level of evidence: </strong>A prognosis study of level IV.</p>","PeriodicalId":19832,"journal":{"name":"Pediatric Surgery International","volume":"41 1","pages":"257"},"PeriodicalIF":1.6,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144874546","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":"Indicators of the number of surgeries and severity in pediatric patients with severe burns: a retrospective comparative study.","authors":"Ting He, Ran Liu, Nannan Wang, Dongsheng Hu, Zhichen Lin, Chao Wang, Jinsong Meng, Song Li, Guoan Lin, Rong Xiao, Tiantian Yan","doi":"10.1007/s00383-025-06148-x","DOIUrl":"10.1007/s00383-025-06148-x","url":null,"abstract":"<p><strong>Purpose: </strong>Children with severe burns accounts for a considerable proportion of emergency department admissions. Surgical interventions are often indispensable for such pediatric patients. However, healthcare providers may encounter issues such as a high risk of perioperative complications and guardian's refusal of surgery. This study aims to identify early predictive indicators associated with the number of surgeries, recognize high-risk patients, and provide data support for clinical decision-making.</p><p><strong>Methods: </strong>The clinical data of 102 pediatric patients with total burn surface area  ≥ 30% from January 2014 to December 2024 were evaluated. Patients were stratified into three groups based on whether they underwent surgery and the number of surgeries received. The associations among age, gender, cause of injury, total burn surface area, burn index (BI), length of hospital stay, and various laboratory indicators were assessed across the groups.</p><p><strong>Results: </strong>Total burn surface area (OR: 1.071, 95% CI 1.015-1.130, P = 0.012), BI (OR: 1.398, 95% CI 1.196-1.635, P = 0.000) and white blood cell (WBC) counts (OR: 1.043, 95% CI 1.004-1.083, P = 0.031) were significantly correlated with the number of surgeries. Total burn surface area (OR: 1.074, 95% CI 1.016-1.135, P = 0.012), BI (OR: 1.376, 95% CI 1.174-1.612, P = 0.000) and WBC counts (OR: 1.045, 95% CI 1.004-1.087, P = 0.031) also emerged as independent risk factors for the number of surgeries for children with severe burns.</p><p><strong>Conclusion: </strong>The total burn surface area and BI are associated with the number of surgeries and severity of illness in pediatric patients with severe burns. WBC counts serve as an early adjunctive indicator for surgical burden, though further validation is needed to account for confounding variables. These findings facilitate the rapid identification of high-risk patients who may require transfer to hospital with specialized resources and the development of tailored treatments.</p>","PeriodicalId":19832,"journal":{"name":"Pediatric Surgery International","volume":"41 1","pages":"253"},"PeriodicalIF":1.6,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12361330/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144874542","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":"The diagnostic performance of ultrasound features for biliary atresia: a systematic review and updated meta-analysis.","authors":"Qianhui Yang, Yanran Zhang, Yu Meng, Shaowen Liu, Jianghua Zhan","doi":"10.1007/s00383-025-06118-3","DOIUrl":"10.1007/s00383-025-06118-3","url":null,"abstract":"<p><p>Previous meta-analyses have evaluated the diagnostic performance of various ultrasound (US) features in differentiating biliary atresia (BA) from infantile cholestasis, but none have specifically addressed the accuracy of these features in differentiating cystic biliary atresia (CBA) from infants with jaundice and porta hepatis cysts. We searched PubMed, Embase, Web of Science, Cochrane, China National Knowledge Infrastructure, China Biology Medicine, Wanfang, and VIP databases for articles that evaluated the US features of BA. We pooled effect estimates and constructed summary receiver operating characteristic curves, along with meta-regression and subgroup analysis. The summary sensitivity and specificity for TCS in differentiating BA from infantile cholestasis and CBA from infants with jaundice and porta hepatis cysts were 49.6% (95% CI 48.2%-51.0%) and 70.3% (95% CI 62.7%-77.2%), respectively, and 95.5% (95% CI 94.9%-96.1%) and 99.6% (95% CI 98.0%-100.0%) for the latter. For porta hepatis cysts, sensitivity and specificity were 17.1% (95% CI 13.7%-21.1%) and 84.2% (95% CI 72.1%-92.5%) in differentiating BA, and 99.0% (95% CI 97.4%-99.7%) and 91.3% (95% CI 82.8%-96.4%) for cyst size (length) in distinguishing CBA. For US-guided PTCC, sensitivity and specificity were 100.0% (95% CI 94.9%-100.0%) and 90.6% (95% CI 84.1%-95.0%) for differentiating BA from infantile cholestasis. TCS remains the relatively higher accurate and widely accepted conventional US feature for differentiating BA from infantile cholestasis and CBA from infants with jaundice and porta hepatis cysts. Porta hepatis cysts have the highest specificity for diagnosing BA, with size (length) aiding in distinguishing CBA. The undetected proportions of gallbladder abnormalities-related features were quite variable. Other US features, such as HSF, CBD, and liver stiffness, can support BA diagnosis. While US-guided PTCC is effective in certain cases, its clinical application is limited by technical complexity and patient requirements. Furthermore, artificial intelligence, especially deep learning, holds promising potential for improving the accuracy of BA diagnosis.</p>","PeriodicalId":19832,"journal":{"name":"Pediatric Surgery International","volume":"41 1","pages":"251"},"PeriodicalIF":1.6,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144874545","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":"What evaluation criteria for prophylactic innominate artery transection were appropriate in the neurologically impaired patients who require laryngotracheal separation?","authors":"Naruki Higashidate, Naoki Hashizume, Yoshinori Koga, Daisuke Masui, Saki Sakamoto, Tomohiro Kurahachi, Hiroki Yoshida, Tatsuru Kaji","doi":"10.1007/s00383-025-06150-3","DOIUrl":"10.1007/s00383-025-06150-3","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to analyze laryngotracheal separation (LTS) outcomes and evaluate the efficacy of the evaluation criteria for prophylactic innominate artery transection (PIAT) in neurologically impaired patients.</p><p><strong>Methods: </strong>67 patients who underwent LTS were reviewed. They were divided into three groups: patients without a tracheostomy tube (TT) (Group 1), patients with a TT but without PIAT (Group 2) and patients with TT and PIAT (Group 3). The length between the dorsal edge of the sternum and ventral edge of the vertebra (D-to-V), tracheal flattening ratio (TFR), and mediastinum-thoracic anteroposterior ratio (MTR), as evaluation criteria for PIAT based on the previous studies were measured.</p><p><strong>Results: </strong>62 patients [F/M = 25/37, Group 1 (n = 27), Group 2 (n = 29), and Group 3 (n = 6)] were analyzed. Three patients in Group 3 underwent PIAT after LTS due to intratracheal granuloma and minor bleeding. The TFR in Group 3 was significantly lower than that in Group 1 and 2 (p = 0.0236, 0.0054). The proportions of patients who met the criteria for PIAT were 5cases (8.06%) assessed by D-to-V, 21cases (33.87%) by TFR, and 37cases (59.68%) by MTR.</p><p><strong>Conclusion: </strong>D-to-V would be the efficient criteria for PIAT and low TFR and MTR patients should be followed up carefully.</p>","PeriodicalId":19832,"journal":{"name":"Pediatric Surgery International","volume":"41 1","pages":"250"},"PeriodicalIF":1.6,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144874547","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":"Prognosis and surgical experience of inner foreskin free grafting for the treatment of penile divided nevus in children.","authors":"Meng He, Guannan Wang, Ning Li, Zhenwu Li, Defu Lin, Chao Liu","doi":"10.1007/s00383-025-06158-9","DOIUrl":"10.1007/s00383-025-06158-9","url":null,"abstract":"<p><strong>Background: </strong>This study analyzes the outcomes of 15 children who underwent inner foreskin free grafting for penile divided nevus to propose a grading system for evaluating post-operative appearance and share key surgical techniques and experiences.</p><p><strong>Methods: </strong>Clinical data were collected from children diagnosed with penile divided nevus between July 2023 and January 2025. The appearance was graded based on the color match between the penis and the transplanted skin, as well as whether the grafted skin was flat.</p><p><strong>Results: </strong>A total of 15 children with penile divided nevus were enrolled, with an average age of 9.6 ± 3.0 years (ranging from 3 to 16 years). The size of the nevus on the penis ranged from 1 × 0.5 cm to 3 × 2 cm, and the nevus on the inner foreskin ranged from 1 × 0.5 cm to 3 × 2 cm. Pathological analysis confirmed junctional nevi in 3 children and compound nevi in 12 children. All grafts showed good viability with postoperative follow-ups 5.8 ± 3.0 months. Ten cases were classified as grade I in terms of appearance, 1 case as grade II, 3 cases as grade III, and 1 case as grade IV. In one case, newly developed pigmented nevi were observed around the grafted area and in the coronal sulcus at 1 month postoperatively.</p><p><strong>Conclusion: </strong>The free skin grafting technique using inner foreskin for the treatment of penile divided nevus has a high skin graft survival rate. Preoperative separation of preputial adhesions and performing the surgery after complete keratinization of the glans and inner foreskin are essential.</p>","PeriodicalId":19832,"journal":{"name":"Pediatric Surgery International","volume":"41 1","pages":"252"},"PeriodicalIF":1.6,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144874544","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":"Alterations in gut microbiota and insights into the colonic function by clodronate: a study using short bowel syndrome rat model.","authors":"Ayaka Nagano, Yudai Tsuruno, Koshiro Sugita, Shun Onishi, Yumiko Tabata, Chihiro Kedoin, Masakazu Murakami, Keisuke Yano, Toshio Harumatsu, Takafumi Kawano, Nao Hasuzawa, Masatoshi Nomura, Tatsuru Kaji, Satoshi Ieiri","doi":"10.1007/s00383-025-06155-y","DOIUrl":"10.1007/s00383-025-06155-y","url":null,"abstract":"<p><strong>Introduction: </strong>Previous research suggests that clodronate, a vesicular nucleotide transporter inhibitor, may suppress intestinal failure-associated liver disease (IFALD) in short bowel syndrome (SBS). The present study investigated the effects of clodronate on the gut microbiota and colonic barrier in SBS rat model.</p><p><strong>Purpose: </strong>Sprague-Dawley rats underwent 90% small bowel resection and then were randomized into three groups (n = 8 each): SBS/TPN (Control), SBS/TPN with low-dose clodronate (Low, 20 mg/kg/day), and SBS/TPN with high-dose clodronate (High, 60 mg/kg/day). After 7 days, fecal and colon samples were collected to analyze the gut microbiota, histological findings, gene expression of tight junction, and inflammatory markers.</p><p><strong>Results: </strong>While alpha diversity showed no significant differences between the groups, high-dose clodronate-induced heterogeneity in the bacterial community structure. At the phylum level, the Firmicutes/Bacteroidota ratio significantly decreased in the High group. The crypt depth at distal colon was significantly deepest in the High group (p = 0.01). The Claudin-1 expression decreased significantly in the Low group in proximal colon (p = 0.019). The NLRP3 and IL-6 expressions in proximal colon showed significant differences among the groups (NLRP3: p < 0.001, IL-6: p = 0.021).</p><p><strong>Conclusion: </strong>Clodronate-induced alterations in the gut microbiota may contribute to IFALD suppression, albeit with potentially adverse effects on the colonic barrier.</p>","PeriodicalId":19832,"journal":{"name":"Pediatric Surgery International","volume":"41 1","pages":"254"},"PeriodicalIF":1.6,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144874540","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":"Aggressive enema and surgery for meconium-related ileus in extremely low-birth-weight infants.","authors":"Kenji Santo, Yuichi Takama, Marie Todo, Hisashi Yagi, Shuto Ikeda, Yuko Tanaka, Hiroyuki Ichiba, Masafumi Kamiyama","doi":"10.1007/s00383-025-06151-2","DOIUrl":"10.1007/s00383-025-06151-2","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate the effectiveness of an aggressive treatment strategy for meconium-related ileus (MRI) in extremely low birth weight infants (ELBWIs).</p><p><strong>Methods: </strong>Since April 2018, we have implemented a novel protocol, incorporating early Gastrografin injection, aggressive enema therapy, and early surgery without perforation (ES). Among 362 ELBWIs treated at our institute over the past 15 years, 91 with MRI were included in this study. We compared patient demographics, treatment details, and outcomes between the \"Old\" group (O, n = 56; treated before March 2018) and the \"New\" group (N, n = 35; treated after April 2018).</p><p><strong>Results: </strong>The O group showed higher perforation rates (21.4%; 12/56) than those of the N group (2.9%, 1/35) (p = 0.014). The surgical rates were 21.4% (12/56) and 14.3% (5/35) in the O and N groups, respectively (p = 0.581), while the ES rates were 0% (0/56) and 11.8% (4/35), respectively (p = 0.02). The N group had a significantly higher overall survival rate (100%, 35/35) than the O group (87.5%, 49/56) (p = 0.041). In the O group, all seven deaths were related to perforation.</p><p><strong>Conclusions: </strong>Our aggressive MRI treatment was associated with reduced perforation rates and improved survival outcomes, demonstrating its effectiveness.</p>","PeriodicalId":19832,"journal":{"name":"Pediatric Surgery International","volume":"41 1","pages":"248"},"PeriodicalIF":1.6,"publicationDate":"2025-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144862343","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":"Laparoscopic surgery for lumbar hernia in children.","authors":"Chen Zhen, Wang Xiaofang, Li Yadong, Wei Yandong, Liu Shuli, Ye Mao, Liu Chao, Zhang Zhen, Zhang Jun","doi":"10.1007/s00383-025-06152-1","DOIUrl":"10.1007/s00383-025-06152-1","url":null,"abstract":"<p><strong>Objective: </strong>To explore the safety, feasibility, and superiority of laparoscopic surgery in the treatment of lumbar hernia in children.</p><p><strong>Methods: </strong>Retrospective analysis of children with lumbar hernia who underwent surgical treatment at our hospital from March 2010 to March 2024.</p><p><strong>Inclusion criteria: </strong>(1) Definite diagnosis of lumbar hernia: symptoms of lumbar hernia, ultrasound or CT diagnosis of lumbar hernia; (2) Clear surgical indication: the child patient with lumbar hernia has shown no significant improvement for over a year; (3) Complete intraoperative and postoperative follow-up data; (4) No contraindications for surgery.</p><p><strong>Results: </strong>17 children with lumbar hernia were included in this study, and all the 17 cases were successfully performed laparoscopic surgery. No major intraoperative bleeding, intraoperative or postoperative blood transfusion, accidental injury, or perioperative mortality occurred during the surgery. The average surgical duration was 60.17 min, and an average hospital stay of 3 days. All pediatric patients were followed up for more than one year, and no serious complications were observed.</p><p><strong>Conclusion: </strong>Laparoscopic surgery is a safe and reliable method for the treatment of lumbar hernia in children. It has the advantages of minimal trauma, rapid recovery, and satisfactory cosmetic effect. It is worthy of clinical promotion.</p>","PeriodicalId":19832,"journal":{"name":"Pediatric Surgery International","volume":"41 1","pages":"249"},"PeriodicalIF":1.6,"publicationDate":"2025-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144874543","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":"Pediatric surgical trainees and artificial intelligence: a comparative analysis of DeepSeek, Copilot, Google Bard and pediatric surgeons' performance on the European Pediatric Surgical In-Training Examinations (EPSITE).","authors":"Richard Gnatzy, Martin Lacher, Salvatore Cascio, Oliver Münsterer, Richard Wagner, Ophelia Aubert","doi":"10.1007/s00383-025-06104-9","DOIUrl":"10.1007/s00383-025-06104-9","url":null,"abstract":"<p><strong>Objective: </strong>Large language models (LLMs) have advanced rapidly, but their utility in pediatric surgery remains uncertain. This study assessed the performance of three AI models-DeepSeek, Microsoft Copilot (GPT-4) and Google Bard-on the European Pediatric Surgery In-Training Examination (EPSITE).</p><p><strong>Methods: </strong>We evaluated model performance using 294 EPSITE questions from 2021 to 2023. Data for Copilot and Bard were collected in early 2024, while DeepSeek was assessed in 2025. Responses were compared to those of pediatric surgical trainees. Statistical analyses determined performance differences.</p><p><strong>Results: </strong>DeepSeek achieved the highest accuracy (85.0%), followed by Copilot (55.4%) and Bard (48.0%). Pediatric surgical trainees averaged 60.1%. Performance differences were statistically significant (p < 0.0001). DeepSeek significantly outperformed both human trainees and other models (p < 0.0001), while Bard was consistently outperformed by trainees across all training levels (p < 0.01). Sixth-year trainees performed better than Copilot (p < 0.05). Copilot and Bard failed to answer a small portion of questions (3.4% and 4.7%, respectively) due to ethical concerns or perceived lack of correct choices. The time gap between model assessments reflects the rapid evolution of LLMs, contributing to the superior performance of newer models like DeepSeek.</p><p><strong>Conclusion: </strong>LLMs show variable performance in pediatric surgery, with newer models like DeepSeek demonstrating marked improvement. These findings highlight the rapid progression of LLM capabilities and emphasize the need for ongoing evaluation before clinical integration, especially in high-stakes decision-making contexts.</p>","PeriodicalId":19832,"journal":{"name":"Pediatric Surgery International","volume":"41 1","pages":"247"},"PeriodicalIF":1.6,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12334501/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144804524","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":"Management of gastroesophageal reflux disease following esophageal atresia surgery: a systematic review.","authors":"Seyede Marzie Fatemi Abhari, Fatemeh Aminolroaya, Fatemeh Moosaie, Amirali Ahrabi, Shiva Abedinzadeh, Naureen Rashid, Marzieh Hajibabaei, Amir Keyvan Sazgar","doi":"10.1007/s00383-025-06120-9","DOIUrl":"10.1007/s00383-025-06120-9","url":null,"abstract":"<p><p>Gastroesophageal reflux disease (GERD) is a prevalent complication following esophageal atresia (EA) repair, with high recurrence rates and frequent treatment failures despite advancements in medical and surgical management. Effective intervention is crucial to prevent symptom relapse and long-term morbidity. This systematic review, conducted using PubMed, Scopus, and Web of Science with additional manual reference screening, included 33 studies encompassing 6,167 patients. 27 studies were retrospective cohort analyses evaluating anti-reflux surgery (ARS) outcomes and complications, while a few assessed GERD prevalence and risk factors influencing ARS success or failure. GERD prevalence in EA patients ranges from 25 to 80%, with uncertain long-term efficacy of medical therapy and dietary modifications. Fundoplication, previously performed routinely, is now selectively recommended following a multidisciplinary evaluation to differentiate GERD from alternative causes such as esophageal dysmotility, aspiration, or recurrent fistulas. Approximately 40% of EA patients require ARS, yet failure rates range from 7.8% to 47%. Identified risk factors for failure include male sex, prior abdominal surgery, long-gap EA, and congenital diaphragmatic hernia. Laparoscopic fundoplication, though increasingly adopted, has higher failure rates than open Nissen fundoplication in complex cases. Despite surgical intervention, GERD recurrence remains a concern, necessitating long-term surveillance. While open Nissen fundoplication remains the gold standard, persistent symptoms highlight the need for large-scale, randomized controlled trials to refine GERD management and optimize surgical decision-making in this high-risk population.</p>","PeriodicalId":19832,"journal":{"name":"Pediatric Surgery International","volume":"41 1","pages":"246"},"PeriodicalIF":1.6,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144799838","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}