World Journal of Pediatric Surgery最新文献

{"title":"Thoracic metastasis of a pediatric posterior fossa group A ependymoma: a rare case and literature review.","authors":"Xiaoxiao Ma, Yu Zhang, Hekui Lan, Bingjie He, Chunjin Wu","doi":"10.1136/wjps-2025-001083","DOIUrl":"10.1136/wjps-2025-001083","url":null,"abstract":"<p><p>Ependymomas are rare central nervous system tumors, with posterior fossa group A (PFA) ependymomas representing an aggressive pediatric subtype. While cerebrospinal fluid dissemination is well recognized, hematogenous spread and extracranial metastasis remain exceedingly rare and poorly understood. A 7-year-old child presented with symptoms of increased intracranial pressure and was found to have a mass in the fourth ventricle. Histopathology confirmed an ependymoma with features of the PFA subtype, including high marker of proliferation Kiel 67 index, glial fibrillar acidic protein and epithelial membrane antigen positivity, loss of trimethylation of lysine 27 on histone H3 and chromosome 1q gain (three copies). The patient underwent subtotal resection followed by craniospinal radiotherapy, local boost and six cycles of adjuvant chemotherapy with cisplatin, temozolomide and bevacizumab. Subsequently, progressive respiratory symptoms led to the discovery of pleural effusion and mediastinal metastases. Thoracoscopic biopsy confirmed metastatic ependymoma with immunophenotypic concordance to the primary tumor. Management included systemic chemotherapy, surgical resection and localized thoracic radiotherapy. This case reveals the rare occurrence of extracranial metastasis in pediatric PFA ependymoma and emphasizes the challenges of incomplete resection and atypical dissemination. A focused review of 14 pediatric PFA ependymoma cases highlights the importance of molecular profiling, close surveillance and recognition of non-traditional metastatic pathways in high-risk disease.</p>","PeriodicalId":23823,"journal":{"name":"World Journal of Pediatric Surgery","volume":"9 1","pages":"e001083"},"PeriodicalIF":1.3,"publicationDate":"2026-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12820817/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146031076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gut microbiome in biliary atresia.","authors":"Vandana Jain","doi":"10.1136/wjps-2025-001068","DOIUrl":"10.1136/wjps-2025-001068","url":null,"abstract":"<p><p>Biliary atresia (BA) is a progressive cholangiopathy of infancy and the leading cause of pediatric liver transplantation. Despite surgical intervention with the Kasai portoenterostomy, long-term outcomes remain poor, with many patients progressing to cirrhosis. Emerging evidence implicates the gut microbiota-a dynamic ecosystem crucial to immune development and liver homeostasis-in BA pathogenesis and clinical progression. This review synthesizes current literature on gut microbiota composition in BA before and after the Kasai procedure, highlighting consistent patterns of dysbiosis, including pathobiont expansion and depletion of beneficial microbes such as <i>Bifidobacterium</i>. The review explores associations between microbial profiles and clinical outcomes-highlighting potential mechanisms involving bile acid metabolism, microbial translocation, and immune modulation. Further understanding of gut-liver-microbiota interactions in BA may inform microbiome-targeted therapies to improve native liver survival.</p>","PeriodicalId":23823,"journal":{"name":"World Journal of Pediatric Surgery","volume":"9 1","pages":"e001068"},"PeriodicalIF":1.3,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12781990/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145953084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnosis and management of neuroblastoma in children.","authors":"Sarah Braungart, Paul D Losty","doi":"10.1136/wjps-2025-001127","DOIUrl":"10.1136/wjps-2025-001127","url":null,"abstract":"<p><p>Neuroblastoma constitutes the most common extracranial solid tumor encountered in children under 5 years of age. The clinical course is highly variable, ranging from spontaneous tumor regression in very young infants to a highly aggressive disease in older children. 5-year survival of > 90% in low and intermediate-risk disease compares to < 60% in those with high-risk neuroblastoma despite recent genetic and clinical advances. Treatment strategies vary significantly in intensity depending on the aggressiveness of disease with surgery playing a pivotal role in the management. A solid understanding of different risk groups, individualized management, and outcomes is important for pediatric surgeons to achieve best outcomes, and provide highest quality advice at the multidisciplinary tumor board meeting. This article offers a narrative update on the diagnosis and management of neuroblastoma in childhood and highlights some of the key controversies in the surgical management of the disease.</p>","PeriodicalId":23823,"journal":{"name":"World Journal of Pediatric Surgery","volume":"9 1","pages":"e001127"},"PeriodicalIF":1.3,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12778254/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145935354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Esophageal atresia with and without tracheoesophageal fistula: a 2016-2024 single-center cohort study in Saudi Arabia stratified by gap length.","authors":"Kamal Ali, Norah S Alsabty, Abdulrahman Altuwaym, Saud Al Jadaan, Mohammed Al Namshan, Nawaf Alharbi, Abdulaziz Homedi, Ibrahim Ali, Saif Alsaif","doi":"10.1136/wjps-2025-001114","DOIUrl":"10.1136/wjps-2025-001114","url":null,"abstract":"<p><strong>Objective: </strong>To describe phenotype, perioperative events, and early morbidity among infants with esophageal atresia with or without tracheoesophageal fistula (EA/TEF), and to evaluate how gap length relates to postoperative and follow-up outcomes.</p><p><strong>Methods: </strong>A retrospective single-center cohort study was conducted in a tertiary neonatal and pediatric surgery service, Riyadh, Saudi Arabia. All infants with EA/TEF managed between January 1, 2016 and December 31, 2024. Clinical data include early clinical anastomotic leak (≤14 days), recurrent fistula, anastomotic stricture and time-to-event outcomes including hospital length of stay, time to full oral feeding, duration of postoperative ventilation and duration of parenteral nutrition. Follow-up outcomes included respiratory morbidity and feeding support requirements.</p><p><strong>Results: </strong>Sixty-seven infants were included; gross type C was most frequent (73.1%). Gap length was assessable in 63 non-H-type cases, with 31.7% classified as long-gap EA. Survival to discharge was 86% after excluding three trisomy 18 infants managed palliatively. Primary repair was achieved in 67.2% overall but in only 10% of long-gap infants, among whom staged repair or gastric pull-up predominated. Early anastomotic leak occurred in 26.9%, recurrent fistula in 14.9% and anastomotic stricture in 32.8%. In multivariable logistic regression, long-gap EA was the only independent predictor of stricture (adjusted odds ratio (OR) 4.44; 95% confidence interval (CI) 1.27 to 15.55; <i>p</i>=0.020). Recovery was substantially longer for long-gap infants: median hospital stay 186 <i>vs.</i> 53 days (<i>p</i><0.001) and time to full oral feeding 209 <i>vs.</i> 29 days (p<0.001). At follow-up (<i>n</i>=55), 34.5% required gastrostomy, 20% had feeding aversion, 36.4% experienced recurrent respiratory infections, and 10.9% had tracheomalacia.</p><p><strong>Conclusions: </strong>Gap length was the principal determinant of anastomotic stricture and prolonged recovery after EA/TEF repair. These data provide a baseline for ongoing quality improvement and support early referral of long-gap cases to specialized multidisciplinary centers with structured follow-up programs.</p>","PeriodicalId":23823,"journal":{"name":"World Journal of Pediatric Surgery","volume":"8 6","pages":"e001114"},"PeriodicalIF":1.3,"publicationDate":"2025-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12766815/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145913131","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fibrotic liver injury in biliary atresia: long-term implications.","authors":"Maria Hukkinen, Mikko P Pakarinen","doi":"10.1136/wjps-2025-001098","DOIUrl":"10.1136/wjps-2025-001098","url":null,"abstract":"<p><p>Normalization of serum bilirubin after Kasai portoenterostomy (KPE) is a prerequisite for long-term native liver (NL) survival. Following a successful KPE, fibrotic liver injury progresses variably, although a significant proportion of patients show decreasing histological liver fibrosis during follow-up. Eventually, the great majority of patients develop cirrhosis and clinical manifestations of portal hypertension (PH), while liver malignancies and pulmonary complications of PH occur infrequently. Accurate prediction of liver fibrosis remains challenging. Development of reliable noninvasive biomarkers of liver fibrosis would improve patient management and benefit performance of interventional trials. Although successful KPE modifies liver gene expression profile, molecular signature of active fibrogenesis and ductular reaction (DR) persists. Successful KPE reduces the abundance of activated myofibroblasts and macrophages, whereas cholangiocytes tend to increase. Progression of long-term fibrotic liver injury is tightly connected with DR, which is associated with serum bile acids. While serum bile acids are predictive of portal fibrosis and NL survival, there are ongoing randomized clinical trials evaluating the efficacy of bile acids lowering therapies on KPE outcomes. A better understanding of disease mechanisms underpinning progression of liver injury and clinical complications following successful KPE is needed for the development of novel adjuvant therapies, improvement of follow-up, and optimizing outcomes.</p>","PeriodicalId":23823,"journal":{"name":"World Journal of Pediatric Surgery","volume":"8 6","pages":"e001098"},"PeriodicalIF":1.3,"publicationDate":"2025-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12766845/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145913108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical decision-making in neonatal gastrointestinal surgical emergencies: comparison between ChatGPT and human clinicians.","authors":"Seyoon Kim, Dongho Choi, Joonhyuk Son","doi":"10.1136/wjps-2025-001117","DOIUrl":"10.1136/wjps-2025-001117","url":null,"abstract":"<p><strong>Background: </strong>Neonatal gastrointestinal surgical emergencies (NGSEs) require rapid decisions to prevent morbidity and mortality. This study assessed the potential use of ChatGPT in supporting clinical decision-making for NGSEs.</p><p><strong>Methods: </strong>The challenging NGSE cases (ileal atresia, midgut volvulus, Hirschsprung disease, meconium ileus, and pseudo-obstruction) were converted into structured short-answer questions including histories and radiologic images. Questions covered differential diagnosis, diagnostic plan, management plan, final diagnosis, and surgical plan. Each case was scored out of 10 (maximum 50). Scenarios were presented to 10 general surgery (GS) residents, 10 GS attendings, and 10 pediatric surgery (PS) attendings. GPT-4o was tested with 10 iterations per case. Group scores were compared using appropriate statistical tests.</p><p><strong>Results: </strong>A total of five cases were involved. GPT-4o achieved a mean score of 44.95 (89.9%), higher than GS residents (27.05, <i>p</i><0.001) and GS attendings (28.35, <i>p</i><0.001), but lower than PS attendings (47.70, <i>p</i>=0.021). Subgroup analysis showed GPT-4o matched PS attendings in management, final diagnosis, and surgical planning, but scored lower in differential diagnosis (87.8% <i>vs.</i> 92.8%, <i>p</i>=0.0479) and diagnostic plan (75.0% <i>vs.</i> 93.8%, <i>p</i><0.001). Compared with GS residents and attendings, GPT-4o performed significantly better across all categories except diagnostic plan.</p><p><strong>Conclusions: </strong>GPT-4o demonstrated performance comparable to PS attendings in key management domains, while clearly surpassing GS residents and attendings overall. These findings suggest that GPT-4o may have potential as a supplementary decision-support tool for NGSEs, although clinical use requires further validation in real-world settings.</p>","PeriodicalId":23823,"journal":{"name":"World Journal of Pediatric Surgery","volume":"8 6","pages":"e001117"},"PeriodicalIF":1.3,"publicationDate":"2025-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12742057/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145850870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laparoscopic management of congenital gastric muscular layer defect and gastric perforation: a case series.","authors":"Ying Wu, Xin Guo, Xiaoxia Wu, Baohong Zhao, Yuanyuan Jin, Wenyue Liu, Hongxia Ren","doi":"10.1136/wjps-2025-001090","DOIUrl":"10.1136/wjps-2025-001090","url":null,"abstract":"<p><p>This study aimed to evaluate the feasibility and efficacy of laparoscopic management in neonates diagnosed with congenital gastric muscular layer defects and gastric perforation. A retrospective analysis was conducted on four male neonates (median gestational age: 36.79 weeks; median birth weight: 2460 g) who underwent laparoscopic repair at Shanxi Provincial Children's Hospital between January 2022 and October 2024. All neonates presented with symptoms of vomiting, feeding intolerance, and abdominal distension, with preoperative imaging confirming pneumoperitoneum. Laparoscopic surgery was successfully completed in all cases without conversion to open surgery. The median operative time was 102 min, and no surgery-related complications such as anastomotic leakage or hemorrhage were observed. One neonate was transferred to the department of internal medicine due to postoperative feeding difficulties, failure, and persistent oxygen dependence. The median hospital stay was 27.5 days. At the 6-month postoperative follow-up, three neonates exhibited satisfactory growth and development, while one exhibited mild growth delay. Our findings indicate that laparoscopic repair offers significant advantages, including mitigated surgical trauma, quicker recovery, and lower incidence of intestinal adhesion. Provided that surgical indications are strictly assessed and the surgeon possesses proficient laparoscopic skills, it is feasible for specialized surgeons to manage this disease using laparoscopy.</p>","PeriodicalId":23823,"journal":{"name":"World Journal of Pediatric Surgery","volume":"8 6","pages":"e001090"},"PeriodicalIF":1.3,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12716580/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145805630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transoral endoscopic thyroidectomy using the vestibular approach in pediatric patients: 5-year experience in a single center in Vietnam.","authors":"Hau Xuan Nguyen, Minh Quang Pham, Nhat Tan Nguyen, Hien Xuan Nguyen, Luc Van Tieu, Chi Huyen Do, Lien Thi Dam, Quang Van Le","doi":"10.1136/wjps-2025-001085","DOIUrl":"10.1136/wjps-2025-001085","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the clinical and oncological outcomes of transoral endoscopic thyroidectomy via the vestibular approach (TOETVA) in the management of pediatric patients with benign and malignant thyroid lesions in Vietnam.</p><p><strong>Methods: </strong>A cross-sectional study was performed on pediatric patients (≤18 years old) who underwent TOETVA for thyroid cancer and benign thyroid nodules between August 2019 to September 2024.</p><p><strong>Results: </strong>Of the 28 patients included in the study, 23 were female (82.1%), and 5 were male (17.9%) with a mean age of 15.86±2.45 years. Mean tumor size on ultrasound was 19.47±13.63 mm. TOETVA was completed successfully in all cases. Postoperative histopathological findings revealed benign lesions in 13 patients, differentiated thyroid carcinoma in 14 patients and non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) in one patient; central neck dissection (CND) was performed in 15 patients; nine of them had occult lymph node metastasis. Postoperative complications included transient hypoparathyroidism (3.6%) and vocal cord palsy (7.1%), all of which resolved. No permanent complications or recurrences were observed over a median follow-up of 26.5 months.</p><p><strong>Conclusions: </strong>TOETVA appears feasible for the treatment of thyroid nodules in children. However, larger prospective studies are needed to confirm these findings.</p>","PeriodicalId":23823,"journal":{"name":"World Journal of Pediatric Surgery","volume":"8 6","pages":"e001085"},"PeriodicalIF":1.3,"publicationDate":"2025-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12682162/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145709839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From adult centric to child specific: the Pediatric Scale for Quality of Recovery (PedSQoR) as a pioneering tool.","authors":"Shifan Zhu, Qian Chen, Daqing Ma","doi":"10.1136/wjps-2025-001104","DOIUrl":"10.1136/wjps-2025-001104","url":null,"abstract":"","PeriodicalId":23823,"journal":{"name":"World Journal of Pediatric Surgery","volume":"8 6","pages":"e001104"},"PeriodicalIF":1.3,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12684205/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145715919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Application of artificial intelligence in conjunction with clinical laboratory indicators to aid decision-making for surgical or conservative treatment of pediatric intestinal obstruction.","authors":"Min Zhan, Ting Xiong, Ming Luo, Manxin Hu, Leifeng Chen, Dan Nie, Mengjie Yu, Shouhua Zhang","doi":"10.1136/wjps-2025-001079","DOIUrl":"10.1136/wjps-2025-001079","url":null,"abstract":"<p><strong>Background: </strong>Management of pediatric intestinal obstruction remains clinically challenging, particularly regarding the selection between surgical and conservative approaches. This study aimed to develop artificial intelligence (AI) models to support treatment decision-making.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on clinical data from pediatric intestinal obstruction patients. The dataset was split via stratified sampling (70% training/ 30% test), preserving outcome distribution. Predictive models incorporating clinical indicators were developed using machine learning, with evaluation metrics including accuracy, F1-score, Kappa value, positive predictive value (PPV), negative predictive value (NPV), precision-recall curves, calibration plots and decision curve analysis (DCA).</p><p><strong>Results: </strong>Among 765 pediatric patients, 425 responded to conservative treatment while 340 required surgery. The Random Forest model demonstrated optimal performance in the test cohort (area under the curve: 0.953; sensitivity: 0.879; specificity: 0.901; accuracy: 0.892; F1-score: 0.878; Kappa value: 0.780; PPV: 0.878; NPV: 0.905). Calibration, precision-recall, and DCAs indicated favorable clinical applicability.</p><p><strong>Conclusion: </strong>Machine learning integration with clinical indicators shows potential as a decision-support tool for selecting surgical or conservative treatment in pediatric intestinal obstruction.</p>","PeriodicalId":23823,"journal":{"name":"World Journal of Pediatric Surgery","volume":"8 5","pages":"e001079"},"PeriodicalIF":1.3,"publicationDate":"2025-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12593502/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145483000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}