European Journal of Pediatric Surgery最新文献

{"title":"EUPSA CONNECT: A New Global Mentorship Initiative for Career Development and Well-Being in Pediatric Surgery.","authors":"Lucas Wennemann, Michele Bosisio, Marco Pistone, Nicole Santucci, Giuseppe Speziale, Marta Gazzaneo, Carmen Mesas-Burgos, Rene Wijnen, Jose Luis Peiro, Francesco Fascetti-Leon, Rim Kiblawi, Stefano Giuliani, Sonia Pérez-Bertólez, Richard Keijzer, Paolo De Coppi, Elke Zani-Ruttenstock","doi":"10.1055/a-2968-7989","DOIUrl":"10.1055/a-2968-7989","url":null,"abstract":"<p><strong>Aim: </strong>Recognizing that mentorship plays a central role in supporting the scholarly and professional development of early career pediatric surgeons, EUPSA (European Pediatric Surgeons' Association) launched the first, international mentorship initiative within pediatric surgery in Europe in 2024. One year after implementation, we aimed to evaluate whether EUPSA CONNECT has a positive impact on participants.</p><p><strong>Methods: </strong>Following Executive Board approval, baseline (October 2024) and follow-up (December 2025) data were collected from 71 mentor-mentee pairs (58% female, 34 countries). Participant experience and program impact were assessed using validated survey questionnaires. Pre- and postintervention differences and gender-related effects were analyzed using Welch's <i>t</i>-tests, with effect sizes reported as Cohen's d.</p><p><strong>Results: </strong>In total, 149 participants completed the questionnaires (48% mentees). Mentors had a median of 23 years of professional experience (interquartile range [IQR]: 14-28.5). Participants completed a median of 3 (IQR: 1-4.5), up to 12 mentorship sessions. One year after initiation, participants reported a reduced work-related burden (1.71 vs. 1.51; d = 0.09; <i>p</i> = 0.092) and self-condemnation (2.85 vs. 2.66; d = 0.06; <i>p</i> = 0.24). Female participants continued to report higher physical and emotional exhaustion, greater self-condemnation, and lower self-compassion and self-care than males (<i>p</i> < 0.05; d = 0.56-0.78). Mentees reported clearer career goals, improved communication, and collaboration skills, accompanied by achievements such as securing new positions, completing overseas rotations, and academic productivity. Overall, 88.1% would recommend EUPSA CONNECT.</p><p><strong>Conclusions: </strong>EUPSA CONNECT shows high engagement and satisfaction, with improved experience of work demands and self-valuation. Participants further reported benefits in professional development and resilience, highlighting the potential of structured mentorship. Persistent gender differences highlight the need for targeted, equity-focused strategies.</p>","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149076798","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":"Practice Variability in Anorectal Malformations Management across Europe: A TEPS-EUPSA Survey with Analysis of Center Volume Effects.","authors":"Agnieszka Wiernik, Marta Gazzaneo, Ophelia Aubert, Julio César Moreno-Alfonso, Jonathan Hencke, Meike S Hofer, Ivo de Blaauw, Rene Wijnen, Judith Lindert","doi":"10.1055/a-2965-8002","DOIUrl":"10.1055/a-2965-8002","url":null,"abstract":"<p><p>This study aimed to evaluate management strategies for anorectal malformations (ARMs) across Europe and assess the impact of institutional case volume on clinical decision-making.A cross-sectional online survey developed within the Trainees in European Pediatric Surgery (TEPS) and endorsed by the European Paediatric Surgeons' Association (EUPSA) Network Office was distributed among pediatric surgeons involved in ARM care. The questionnaire addressed diagnostic workup, surgical management, perioperative care, and long-term follow-up. European responses were analyzed and compared by institutional case volume.A total of 94 responses from 21 countries were analyzed. Substantial variability was observed across all domains of care. Ultrasound-based screening and invertogram were widely used, whereas high-pressure distal colostography was variably applied. Magnetic resonance imaging (MRI) and vaginoscopy were used more selectively. Primary neonatal repair in cases with the rectum located <1 cm from the perineal skin was commonly performed, and staged reconstruction was most frequently undertaken at 3 to 6 months. Non-divided stomas were more frequently used in high-volume centers (<i>p</i> = 0.002), with increasing center volume associated with higher odds of their use (odds ratio [OR] 2.98, 95% confidence interval [CI] 1.51-5.87, <i>p</i> = 0.002). Routine anal dilations were reported by 44.7% of respondents and were less common in high-volume centers (<i>p</i> = 0.005); increasing volume was associated with lower odds of routine dilation (OR 0.38, 95% CI 0.20-0.72, <i>p</i> = 0.003).ARM management across Europe remains highly variable. Institutional case volume is associated with practice differences, particularly in stoma configuration and postoperative dilation strategies.</p>","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149026838","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":"Stress Exposure of Camera-Holders versus Primary Surgeons during Laparoscopic Surgery: Best Evidence Analysis.","authors":"Agnieszka Wiernik, Hanna Garnier, Ruta Dagilyte, Anne-Cécile Oster, Paulina Brauner, Amulya K Saxena","doi":"10.1055/a-2965-8071","DOIUrl":"10.1055/a-2965-8071","url":null,"abstract":"<p><p>The objective of this study was to evaluate and compare stress exposure between camera-holders (CHs) and primary surgeons (PSs) during laparoscopic surgery across cognitive, physiological, ergonomic, fatigue-related, and psychosocial domains.A best evidence review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Web of Science, Cochrane Library, Embase, and Scopus were searched for studies published between January 2000 and December 2025. Eligible studies reported objective or subjective stress-related outcomes in CHs and/or PSs during laparoscopic surgery. Methodological quality was assessed using the Joanna Briggs Institute critical appraisal tools. Owing to heterogeneity in study designs and outcome measures, findings were synthesized narratively.Seven heterogeneous studies met the inclusion criteria, with only one study specifically evaluating pediatric procedures. Available evidence suggested role-specific patterns of stress exposure. PSs generally reported higher subjective cognitive workload, whereas electroencephalography-based findings suggested comparable cognitive engagement between PSs and CHs. CH-related ergonomic findings included greater trapezius activation, asymmetric loading, non-neutral posture, and less favorable viewing angles. Musculoskeletal discomfort was reported in both roles, while one large cross-sectional study found greater intraoperative fatigue and psychosocial stress related to image control and negative verbal interactions among CHs. The single pediatric study identified less favorable viewing angles and greater procedural discomfort among CHs than PSs.Available evidence suggests that the CH role is an active and demanding component of laparoscopic surgery, with stressors that differ from those experienced by PSs. However, conclusions are limited by the small number of heterogeneous studies and the predominance of adult data. Pediatric evidence is particularly limited and currently relates mainly to ergonomic outcomes.</p>","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149026860","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":"European Paediatric Surgeons' Association Consensus Statement on the Management of Meconium Ileus.","authors":"Amulya K Saxena, Romilly K Hayward, Annika Mutanen, Naziha Khen-Dunlop, Hilmican Ulman, Richard Keijzer, Louise Montalva, Bethan Johnson, Stuart Hosie, Adinda Pijpers, Ramon Gorter","doi":"10.1055/a-2891-7849","DOIUrl":"10.1055/a-2891-7849","url":null,"abstract":"<p><strong>Introduction: </strong>The management of meconium ileus (MI) has yet to reach a unified consensus among pediatric surgeons, particularly regarding diagnostics and variants, conservative treatment strategies, surgical approaches, and clinical outcomes. This topic was therefore selected for the 2024 Consensus Session of the Annual Congress European Paediatric Surgeons' Association (EUPSA).</p><p><strong>Methods: </strong>A structured literature review was conducted across Cochrane, Medline, and EMBASE databases up to April 2024. Nine pediatric surgeons appointed by the European Paediatric Surgeons' Association (EUPSA) Consensus Committee reviewed the evidence and developed topic-specific recommendations relating to (1) diagnostics and variants, (2) Gastrografin® (Bracco Diagnostics Inc, Monroe Township, NJ) application and outcomes, and (3) surgery-related outcomes. Findings were presented at the 2024 EUPSA Annual Congress, with consensus statements formulated through iterative discussion and refinement, incorporating feedback from congress participants.</p><p><strong>Results: </strong>The consensus addresses antenatal and postnatal diagnosis, differentiation between simple and complex MI, conservative management using contrast enemas, surgical strategies, and short- and long-term outcomes, particularly in relation to cystic fibrosis (CF). Key recommendations include the use of contrast enema as the primary diagnostic modality and first-line treatment in uncomplicated cases, with surgical intervention indicated for complicated MI or failed conservative management. Enterostomy remains a widely used surgical approach, with technique guided by intraoperative findings and patient factors. Recommendations regarding stoma reversal emphasize the role of multidisciplinary assessment and preoperative evaluation including CF workup and confirmation of distal bowel patency.</p><p><strong>Conclusion: </strong>A peer-reviewed consensus statement on the diagnosis and management of MI has been developed, informed by current evidence and expert practice. This statement provides pragmatic guidance in the diagnosis and management of MI, including the role of contrast enema in uncomplicated cases and surgical intervention for complicated disease. It is recognized by the EUPSA as a valuable resource to support pediatric surgeons in clinical decision-making for this pathology.</p>","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":" ","pages":"393-404"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148354820","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":"The Minimally Invasive Pilonidal Protocol: Low Short-Term Recurrence after Completion in a Single-Center Retrospective Cohort Study.","authors":"Gheed Murtadi, Anna Ghelfi, Rachael Cohen, Madelyn McArthur, Tayana Assomptia Jean Pierre, Ashley Stoeckel, Kathleen Renzi, Sophie Stone, Campbell Kennedy, David P Mooney","doi":"10.1055/a-2913-8222","DOIUrl":"10.1055/a-2913-8222","url":null,"abstract":"<p><strong>Background: </strong>The optimal treatment of pilonidal disease remains uncertain, with recurrence rates up to 30% after resection or sinusectomy. This retrospective single-center cohort study evaluates the recurrence rate after graduation from our Pilonidal Care Clinic's (PCC) Minimally Invasive Pilonidal Protocol (MIPP).</p><p><strong>Methods: </strong>We conducted a retrospective review of a single center's prospectively collected demographic and treatment data for patients with pilonidal disease who completed the MIPP between January 2021 and December 2024. Follow-up appointments were scheduled every 6 to 8 weeks, continuing until disease resolution and completion of laser ablation sessions. The analysis focused on patients who graduated. Patients still receiving care at study completion and those lost to follow-up were excluded. Recurrence was defined as any PCC visit after graduation with pilonidal disease on examination. Graduated patients who had not returned to the PCC were contacted via text message and queried about new symptoms since graduation.</p><p><strong>Results: </strong>Of the initial 884 patients, 8 patients presented for a second opinion only, 353 were lost to follow-up, and 226 were still receiving care, leaving the study group of 297 patients who completed the protocol and graduated. They graduated after an average of 6.4 PCC visits, two pit-picking procedures, and 5.3 laser epilations. The average disease duration before treatment was 11.4 months. The mean treatment duration was 12.3 months (standard deviation: 8), with a median of 10 months (interquartile range: 6-17). The follow-up period for these patients ranged from 4 to 55 months. Of the 297 graduates, 17 patients (5.7%) returned to the PCC with recurrence concerns; however, only 12 (4.0%) showed physical evidence of recurrence: 8 of them (66.7%) had new pits and 4 (33.3%) had both pits and a nidus. The other 5 showed no signs of pilonidal disease on examination. Recurrence occurred on average 16.3 months after graduating, and 9 of 12 patients with a recurrence were successfully regraduated; 3 were lost to follow-up. Among the 280 patients who did not revisit the clinic, 72 (25.7%) replied to the text survey: 68 (94.4%) of respondents remained disease-free, whereas 4 (5.6%) reported recurrence, 2 of whom sought medical care.</p><p><strong>Conclusion: </strong>Completion of the MIPP at this center is associated with a 4.0% recurrence rate within 16 months, with most recurrences mild and again resolved with minimally invasive care.</p>","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":" ","pages":"420-424"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148457813","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":"International Variation in Pediatric Gastrostomy Insertion Techniques and Perioperative Management: A Survey of Members of the European Pediatric Surgeons' Association.","authors":"Matthew A Formstone, Fabian Doktor, Nigel J Hall","doi":"10.1055/a-2888-9719","DOIUrl":"10.1055/a-2888-9719","url":null,"abstract":"<p><strong>Aim: </strong>The objective of this study is to characterize contemporary international practice in pediatric gastrostomy insertion and perioperative management.</p><p><strong>Methods: </strong>A cross-sectional electronic survey was developed by the European Pediatric Surgeons' Association (EUPSA) Network Office and distributed through the EUPSA network between June 2024 and January 2025. The survey contained 32 primary questions and addressed multiple aspects of the perioperative gastrostomy pathway. Responses were analyzed descriptively. Categorical variables were compared using chi-square or Fisher's exact tests, and continuous variables using the Mann-Whitney U test. Comparisons were performed between European and non-European, and high- and low-/middle-income settings. A two-sided <i>p</i>-value < 0.05 was considered statistically significant.</p><p><strong>Results: </strong>A total of 181 pediatric surgical respondents from 132 cities across 59 countries were included. Of these, 117/181 (64.6%) completed the survey in full. Preferred primary gastrostomy insertion technique varied, with percutaneous endoscopic gastrostomy without laparoscopy preferred most frequently (59/137, 43.1%). Open gastrostomy was reported more frequently in low- and middle-income than high-income settings (11/35, 31.4% vs. 3/102, 2.9%; <i>p</i> < 0.001) and in non-European than European settings (12/45, 26.7% vs. 2/92, 2.2%; <i>p</i> < 0.001). Reported timing of postoperative gastrostomy use varied substantially; enteral feeding was initiated earlier in European than non-European settings and in high-income than low- and middle-income settings (median 8 vs. 24 hours for both comparisons; <i>p</i> < 0.001 for both).</p><p><strong>Conclusion: </strong>Pediatric gastrostomy practice varies substantially across the perioperative pathway, with important differences across geographic and economic settings. These findings highlight persistent uncertainty in key aspects of care and support the need for prospective outcome-based research, prioritization of key areas, and consensus development.</p>","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":" ","pages":"371-377"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148260646","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":"Surgical versus Non-Surgical Management of High-Grade Pediatric Pancreatic Trauma: A National TQIP Analysis Stratified by Hemodynamic Stability.","authors":"Alexander Brown, Ian Bundschu, Sanjan Kumar, Sukriti Prashar, Youssef Nasef, Alexandra Kata, Donald Plumley, Adel Elkbuli","doi":"10.1055/a-2889-0086","DOIUrl":"10.1055/a-2889-0086","url":null,"abstract":"<p><strong>Background: </strong>While non-surgical management is the mainstay of low-grade pancreatic trauma treatment, the optimal management of high-grade pancreatic trauma remains unclear. This study evaluates surgical versus non-surgical management and associated clinical outcomes in high-grade pancreatic trauma patients.</p><p><strong>Methods: </strong>This retrospective cohort study, utilizing the American College of Surgeons Trauma Quality Improvement Program Participant Use File (ACS-TQIP-PUF) database from 2017 to 2023, selected pediatric patients (<18 years) with high-grade pancreatic injuries (grade III-V) who underwent surgical versus non-surgical management, then stratified outcomes by hemodynamic status on arrival. Primary outcomes included 24-hour and in-hospital mortality. Secondary outcomes included non-operative management (NOM) failure rate, transfusion volume, complication rates, intensive care unit length of stay (ICU-LOS), and ventilator-free days (VFDs).</p><p><strong>Results: </strong>A total of 223 patients were included. In-hospital mortality occurred only in the surgical group (6.7% vs. 0%; <i>p</i> = 0.041); however, mortality events were infrequent and interpreted cautiously. The overall non-surgical management failure rate was 8.7%. Adjusted analyses demonstrated no statistically significant differences in total transfusion volume (β = 2.313, 95% CI: -15.351-19.976, <i>p</i> = 0.795, standard error [SE] = 8.894), ICU-LOS (β = - 1.871, 95% CI: -7.507-3.765, <i>p</i> = 0.510, SE = 2.829), or VFDs (β = - 4.315, 95% CI: -10.872-2.242, <i>p</i> = 0.191, SE = 3.249) between groups. Findings were consistent across hemodynamically stable and unstable subgroups.</p><p><strong>Conclusion: </strong>Non-surgical management may be a reasonable initial strategy in carefully selected pediatric patients with high-grade pancreatic trauma, with a low observed failure rate and comparable short-term resource utilization outcomes. However, findings should be interpreted cautiously within the constraints of a retrospective database study.</p>","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":" ","pages":"425-432"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148260632","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":"Population-Based Analysis of Prevalence, Associated Anomalies, and Mortality in Anorectal Malformations in Finland (2004-2017).","authors":"Alexander Salminen, Sandra Tötterman, Ilkka Helenius, Susanna Heiskanen, Johanna Syvänen, Teemu Kemppainen, Eliisa Löyttyniemi, Mika Gissler, Arimatias Raitio","doi":"10.1055/a-2915-1984","DOIUrl":"10.1055/a-2915-1984","url":null,"abstract":"<p><strong>Introduction: </strong>Anorectal malformations (ARMs) represent the most common form of congenital gastrointestinal malformations. ARMs range from mild anal stenosis to complex abnormalities involving the rectum, genitals, and urinary tract. The aim of this study is to investigate prevalence, mortality, and associated anomalies of ARMs in the Finnish population. This study offers comprehensive updated population-based estimates on stillbirths and terminations of pregnancy due to fetal anomalies (TOPFA).</p><p><strong>Materials and methods: </strong>The data were obtained on all live births, TOPFA, and stillbirths from registers maintained by the Finnish Institute for Health and Welfare and Statistics Finland. All individuals diagnosed with ARM between January 1, 2004 and December 31, 2017, were included in the study.</p><p><strong>Results: </strong>This population-based study identified 646 ARM cases, including 545 (84.4%) live births, 8 (1.2%) stillbirths, and 93 (14.4%) TOPFA. The total prevalence for ARM in Finland was 8.00 per 10,000 births, without significant variation in prevalence between 2004 and 2017. Neonatal mortality was 4.6% (<i>n</i> = 25), and infant mortality was 6.0% (<i>n</i> = 33). Neonatal and infant mortality were both associated with very low birth weight (<i>p</i> = 0.0001), prematurity (<i>p</i> = 0.0001), congenital heart defects (<i>p</i> = 0.02 and <i>p</i> < 0.001), and VACTERL (vertebral, anal, cardiac, tracheoesophageal, renal, limb; <i>p</i> = 0<i>.</i>0002 and <i>p</i> < 0.001, respectively). Postnatal survival rate for isolated ARM was 100%. Most commonly associated anomalies were urinary tract, heart, and limb malformations.</p><p><strong>Conclusion: </strong>The overall prevalence of ARMs has remained stable in the Finnish population. Neonatal and infant mortality remains a significant concern, particularly among patients with severe associated anomalies, highlighting the importance of systematic screening for co-occurring malformations.</p>","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":" ","pages":"414-419"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148457832","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":"Dynamic Compression System versus Self-Adjustable Bracing for Pectus Carinatum: Clinical Outcomes and Cost Comparison.","authors":"Sherif Emil, Yseult Gibert, Daphne Lew, Jean-Martin Laberge, Etienne St-Louis, Hussein Wissanji, Sophie Cayer, Piotr Duma, Jade Goyette, Marianne Toledo","doi":"10.1055/a-2887-9645","DOIUrl":"10.1055/a-2887-9645","url":null,"abstract":"<p><strong>Background: </strong>Bracing is the preferred treatment for pectus carinatum. However, few studies have compared outcomes of different bracing methods. We tested the hypothesis that the type of brace has no effect on outcomes.</p><p><strong>Methods: </strong>A retrospective study of children who underwent bracing during a 10-year period (2011-2021) at a multidisciplinary chest wall anomaly center was conducted. The characteristics and outcomes of patients treated with a pressure-guided orthotist-adjusted brace (FMF Dynamic Compression System [DCS]) were compared with those treated with a simpler, less costly, self-adjustable brace (Trulife). Pressure of correction (POC) was used to assess severity. A standardized follow-up protocol was used. Patients who were still in active bracing or had inadequate follow-up were excluded.</p><p><strong>Results: </strong>During the study period, 373 patients started bracing, with 241 (93.7% males) having sufficient data to assess outcomes (170 DCS, 71 Trulife). Bracing succeeded in 217 patients (90%). Of 24 patients who failed, the majority (17) were due to non-compliance. There were no significant differences in POC (DCS 5.27 ± 1.59 vs. Trulife 4.99 ± 1.62 psi, <i>p</i> = 0.219) or any other characteristics between the groups. Bracing success (DCS 89% vs. Trulife 93%, <i>p</i> = 0.329) and active bracing duration (5.41 ± 3.52 vs. 5.37 ± 4.28 months, <i>p</i> = 0.944) were similar between the two groups. Loss to follow-up was significantly higher in the Trulife group (40.7% vs. 23.7%). Use of the Trulife brace resulted in a cost savings of CAD 406,000.00.</p><p><strong>Conclusion: </strong>With the limitations of a retrospective study, a self-adjustable brace resulted in a similar success rate and bracing duration, when compared with a pressure-guided orthotist-adjusted brace, and was associated with substantial cost savings.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":" ","pages":"378-384"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148267192","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-Assisted Swenson-Like versus Soave Pull-Through in Hirschsprung Disease: A Randomized Comparative Study of Functional Outcomes.","authors":"Ashraf Hamed Seddek, Mohamed Abdelmaboud, Mohammad Daboos, Yousef Mohamed, Ibrahim El Gohary, Mohamed Abdel-Aziz","doi":"10.1055/a-2913-8311","DOIUrl":"10.1055/a-2913-8311","url":null,"abstract":"<p><strong>Background: </strong>In Hirschsprung disease (HD), the laparoscopic-assisted Yancey-Soave (LAYaSo) procedure retains an aganglionic muscular cuff, which may cause obstructive symptoms. The laparoscopic-assisted Swenson-like (LASwL) technique completely excises the aganglionic segment, potentially improving peristalsis. However, randomized evidence comparing these techniques with combined functional and quality-of-life outcomes is lacking.</p><p><strong>Aim: </strong>This study aimed to compare surgical, functional, and quality-of-life outcomes between LASwL and LAYaSo pull-through procedures in a randomized controlled trial.</p><p><strong>Methods: </strong>This prospective, single-center, randomized study included 110 children with HD at Al-Azhar University Hospitals (2020-2025). The inclusion criterion was biopsy-confirmed rectosigmoid HD. Exclusion criteria were ultrashort or total colonic aganglionosis, prior pull-through procedures, and major congenital anomalies. Patients were randomized to LASwL (<i>n</i> = 55) or LAYaSo (<i>n</i> = 55) using a computer-generated sequence and sequentially numbered, opaque, sealed envelopes (SNOSE). The primary outcome was the Rintala Bowel Function Score (BFS) at 2 years. Secondary outcomes included BFS at 1 year (exploratory), operative time, blood loss, hospital stay, Hirschsprung-associated enterocolitis (HAEC), and health-related quality of life (Pediatric Quality of Life Inventory [PedsQL] 4.0).</p><p><strong>Results: </strong>All procedures were completed laparoscopically without conversion. Mean total operative time was shorter for LASwL (145.5 ± 36.8 vs. 160.3 ± 28.6 minutes, <i>p</i> = 0.081), with a significantly shorter transanal phase (<i>p</i> = 0.019). At the primary endpoint of 2 years, BFS was significantly higher in the LASwL group (18.20 ± 1.80 vs. 17.10 ± 2.30, <i>p</i> = 0.037). HAEC rates were 14.5% versus 20.0% (<i>p</i> = 0.61), all mild/moderate. At 2 years, total PedsQL scores were comparable (88.6 ± 7.5 vs. 86.2 ± 8.4, <i>p</i> = 0.12), though social functioning was numerically higher in LASwL (<i>p</i> = 0.055). Three LAYaSo patients required redo surgery for cuff-related stricture.</p><p><strong>Conclusion: </strong>Both techniques are safe and effective. LASwL offers a modest but statistically significant advantage in bowel function at intermediate follow-up (1.1 points on the Rintala score) without a corresponding improvement in overall quality of life. LAYaSo was associated with a 5.5% risk of cuff-related stricture requiring reoperation. The limited clinical magnitude of the benefit supports individualized technique selection based on surgeon experience and patient factors. Single-center design and the need for longer follow-up are limitations of this study.</p>","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":" ","pages":"405-413"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148610566","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}