European Journal of Pediatric Surgery最新文献

{"title":"International Comparison of Surgical Management Practices for Necrotizing Enterocolitis in Neonates: Insights from Cohorts in the Netherlands and Finland.","authors":"Bineta E Lahr, Otis C van Varsseveld, Daphne H Klerk, Mikko Pakarinen, Antti Koivusalo, Jan B F Hulscher","doi":"10.1055/a-2536-4468","DOIUrl":"https://doi.org/10.1055/a-2536-4468","url":null,"abstract":"<p><p>Surgical management of necrotizing enterocolitis (NEC) can result in significant morbidity and mortality. Surgical management varies in the absence of international evidence-based guidelines. We aimed to gain insight into practice variation between expert centers in the Netherlands and Finland.Bicentric retrospective cohort study including all infants treated surgically for NEC (Bell's stage ≥IIA) in two centers in the Netherlands and Finland between 2000 and 2021. Main outcomes were preoperative, intraoperative, and 3-month postoperative characteristics.We included 191 patients (122 Dutch and 69 Finnish). Median gestational age and birth weight were lower in Finnish patients (median [min.-max.]: 25 + 4/7 [23 + 0/7-39 + 0/7] vs. 28 + 2/7 [23 + 6/7-41 + 6/7], <i>p</i> < 0.001, and 795 g [545-4,000] vs. 1,103 g [420-3,065], <i>p</i> < 0.001). Indication for surgery was mostly pneumoperitoneum in Finnish patients (56.5% vs. 37.7%; <i>p</i> = 0.02) versus clinical deterioration on conservative treatment in Dutch patients (51.6% vs. 23.2%; <i>p</i> < 0.001). A fixed-bowel loop was also more often an indication in Finland (20.3% vs. 3.3%; <i>p</i> < 0.001. Ostomy creation was more common in Finnish patients (92.8% vs. 53.3%; <i>p</i> < 0.001) and primary anastomosis in Dutch patients (29.5% vs. 4.4%; <i>p</i> < 0.001). Open-close procedures occurred in 13.9% of Dutch cases, versus 1.4% of Finnish cases (<i>p</i> = 0.004). Mortality at 3 months was comparable when excluding open-close procedures (24.8% vs. 19.1%; <i>p</i> = 0.46).We observed varying populations, indications for surgery, and surgical approaches in NEC between the Netherlands and Finland. The occurrence of open-close procedures is 10-fold higher (13.9% vs. 1.4%) in the Netherlands compared to Finland. Long-term outcomes remain to be studied. These results point toward significant practice variation and strengthen the need for European management guidelines.</p>","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143659828","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":"Comparative Outcomes of Surgical Techniques for Congenital Diaphragmatic Eventration in Children: A Multicenter Retrospective Cohort Analysis.","authors":"Khalid Alzahrani, Lymeymey Heng, Naziha Khen-Dunlop, Nicoleta Panait, Erik Hervieux, Lucie Grynberg, Abbo Olivier, Frédéric Hameury, Frédéric Lavrand, Olivier Maillet, Aurore Haffreingue, Anne Lehn, Stephan de Napoli-Cocci, Edouard Habonimana, Jean-Luc Michel, Louise Montalva, Quentin Ballouhey, Arnaud Fotso Kamdem, Jean-François Lecompte, Antoine Line, Anna Poupalou, Pierre Meignan, Loren Deslandes, Guillaume Podevin, Françoise Schmitt","doi":"10.1055/a-2540-3862","DOIUrl":"10.1055/a-2540-3862","url":null,"abstract":"<p><p>This study compares various surgical approaches for treating congenital diaphragmatic eventration (CDE) in children to identify the most effective and safest method.We conducted a retrospective analysis of a multicentric cohort of pediatric patients operated on for CDE between 2010 and 2021. The different surgical approaches, including robot-assisted thoracoscopic surgery (RATS), and their outcomes were compared (Clinical Trials NCT04862494).One hundred and twelve patients, aged 12 (5-21) months, underwent diaphragmatic plication. Thoracoscopy or RATS was performed in 69 (62%) cases, posterolateral thoracotomy (PLT) in 15 (13%), and an abdominal approach in 28 (25%), based on surgeons' choice. Symptom relief was achieved in 88% of patients, and 90% showed radiographic improvement. There were 31 peri- or early postoperative complications (28%), mainly including pleural effusions, infections, and lobar atelectasis, and 8 recurrences of eventration (7%), with no significant correlation between these complications and the surgical approach. Compared to other approaches, thoracotomy multiplied the duration of intravenous analgesia by three (96 h vs. 36 h, <i>p</i> < 0.0001) and hospital stay length by two (8 vs. 4 days, <i>p</i> = 0.002). RATS, although comparable to thoracoscopy in short-term outcomes, had a higher incidence of perioperative hepatic injuries and long-term complications, including persistent symptoms in all five patients and chest wall deformities in two.Diaphragmatic plication via a minimally invasive thoracic approach may be the best treatment option for cases of symptomatic CDE. Further research is required to establish potential added risks of RATS as compared to thoracoscopy in this indication.</p>","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143451112","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":"Solving Complex Pediatric Surgical Case Studies: A Comparative Analysis of Copilot, ChatGPT-4 and Experienced Pediatric Surgeons' Performance.","authors":"Richard Gnatzy, Martin Lacher, Michael Berger, Michael Boettcher, Oliver Johannes Deffaa, Joachim Kübler, Omid Madadi-Sanjani, Illya Martynov, Steffi Mayer, Mikko P Pakarinen, Richard Wagner, Tomas Wester, Augusto Zani, Ophelia Aubert","doi":"10.1055/a-2551-2131","DOIUrl":"https://doi.org/10.1055/a-2551-2131","url":null,"abstract":"<p><strong>Introduction: </strong>The emergence of large language models (LLMs) has led to notable advancements across multiple sectors, including medicine. Yet, their effect in pediatric surgery remains largely unexplored. This study aims to assess the ability of the AI models ChatGPT-4 and Microsoft Copilot to propose diagnostic procedures, primary and differential diagnoses, as well as answer clinical questions using complex clinical case vignettes of classic pediatric surgical diseases.</p><p><strong>Methods: </strong>We conducted the study in April 2024. We evaluated the performance of LLMs using 13 complex clinical case vignettes of pediatric surgical diseases and compared responses to a human cohort of experienced pediatric surgeons. Additionally, pediatric surgeons rated the diagnostic recommendations of LLMs for completeness and accuracy. To determine differences in performance we performed statistical analyses.</p><p><strong>Results: </strong>ChatGPT-4 achieved a higher test score (52.1%) compared to Copilot (47.9%), but less than pediatric surgeons (68.8%). Overall differences in performance between ChatGPT-4, Copilot, and pediatric surgeons were found to be statistically significant (p <0.01). ChatGPT-4 demonstrated a superior performance in generating differential diagnoses compared to Copilot (p<0.05). No statistically significant differences were found between the AI models regarding suggestions for diagnostics and primary diagnosis. Overall, recommendations of LLMs were rated as average by pediatric surgeons.</p><p><strong>Conclusion: </strong>This study reveals significant limitations in the performance of AI models in pediatric surgery. Although LLMs exhibit potential across various areas, their reliability and accuracy in handling clinical decision-making tasks is limited. Further research is needed to improve AI capabilities and establish its usefulness in the clinical setting.</p>","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143568929","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":"Outcomes and Complications of Chait Trapdoor Cecostomy in Pediatric Patients with Therapy-Resistant Constipation and Fecal Incontinence: A 14-Year Retrospective Study.","authors":"Charlotte Anne Louise Jonker, Ilan Koppen, Marc A Benninga, Justin R de Jong, Ramon Gorter","doi":"10.1055/a-2511-9184","DOIUrl":"10.1055/a-2511-9184","url":null,"abstract":"<p><strong>Aim of the study: </strong> To assess the incidence and types of complications and patient-reported outcomes in pediatric patients with therapy-resistant constipation or fecal incontinence (FI) without constipation who underwent Chait Trapdoor™ cecostomy (CTC). The findings contribute to the discussion on selecting the optimal antegrade continence (ACE) procedure for this population.</p><p><strong>Materials and methods: </strong> A retrospective review was conducted on all pediatric patients with therapy-resistant constipation or FI without constipation who underwent a CTC procedure at our tertiary referral center between 2009 and 2023. Postoperative complications were classified using the Clavien-Madadi classification. At their most recent follow-up in 2023, patients reported satisfaction with their CTC.</p><p><strong>Results: </strong> The study included 62 children (median age 12 years [IQR 8-14; range 1-17], 42% male), with a median follow-up of 4 years (IQR 2-8, range 0-14). Underlying diagnoses were functional constipation (<i>n</i> = 39, 63%), spina bifida (<i>n</i> = 11, 18%), and anorectal malformations (<i>n</i> = 5, 8%). A total of 49/62 patients (79%) experienced 89 CTC-related complications. Minor complications (Clavien-Madadi I-II) affected 29 patients (47%) and most commonly included granulation. Major complications (Clavien-Madadi III-IV) requiring surgery occurred in 32% of patients. Despite these complications, 40/62 (65%) patients reported satisfaction with their CTC, as determined by partial or complete symptom resolution.</p><p><strong>Conclusions: </strong> Although complications were common, 65% of the patients reported satisfaction with their CTC. These findings emphasize the need for thorough patient selection, informed counseling on potential risks, and individualized management strategies to enhance outcomes.</p>","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959240","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":"Diagnostic Accuracy of Uroflowmetry for Urethral Strictures in Pediatric Hypospadias: TIP vs. Non-TIP Outcomes.","authors":"Wei Ru, Hongbo Liu, Juan Zhou, Qibo Hu, Weifeng Yang, Lizhe Hu, Guangjie Chen, Xiang Yan","doi":"10.1055/a-2536-4549","DOIUrl":"https://doi.org/10.1055/a-2536-4549","url":null,"abstract":"<p><strong>Introduction: </strong>To evaluate the diagnostic accuracy of uroflowmetry in detecting pediatric urethral strictures following Tubularized Incised-Plate (TIP) and non-TIP urethroplasty.</p><p><strong>Materials and methods: </strong>A retrospective cohort study was conducted on children who underwent primary hypospadias repairs from June 2016 to June 2023 at our institution. Patients were categorized into the TIP and the non-TIP groups. Urethral calibration and uroflowmetry were used to evaluate urethral patency following urethroplasty. Data on demographic characteristics, perioperative information, uroflowmetry results, urethral calibration outcomes, and postoperative complications were collected. The relationship between calibration and uroflowmetry and the diagnostic accuracy of uroflowmetry for urethral strictures were analyzed.</p><p><strong>Results: </strong>A total of 62 cases were included, with 38 in the TIP group and 24 in the non-TIP group. Ten patients were diagnosed with urethral strictures. The maximum urinary flow rate (Qmax) exhibited a higher area under the curve (AUC) than the average urinary flow rate (Qave) in both the TIP and non-TIP groups. The Qmax in the non-TIP group demonstrated a higher AUC than in the TIP group (non-TIP: AUC=0.94, Cut-off=6.65 ml/s, sensitivity=100%, specificity=81.0%; TIP: AUC=0.80, Cut-off=5.75 ml/s, sensitivity=100%, specificity=58.1%). A significant quadratic correlation was found between Qmax and urethral calibration (non-TIP: C2=14.72*Qmax, R2=0.96; TIP: C2=14.76*Qmax, R2=0.88). The Qmax nomogram interval ≤ -3 standard deviation was a significant predictor for non-TIP urethral strictures (Kappa=0.70).</p><p><strong>Conclusions: </strong>Uroflowmetry, particularly Qmax, shows promise as a non-invasive screening tool for detecting urethral strictures after hypospadias repair, with high diagnostic accuracy in non-TIP cases but limited utility in TIP cases.</p>","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143400938","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":"Evaluating Access and Efficacy of Pelvic Floor Physical Therapy in Pediatric Hirschsprung Disease.","authors":"Shruthi Srinivas, Sarah Driesbach, Madeline Su, Aymin Bahhur, Elizabeth Thomas, Casey Trimble, Pooja Zahora, Katherine Bergus, Alessandra C Gasior, Ihab Halaweish, Richard J Wood","doi":"10.1055/a-2536-4328","DOIUrl":"https://doi.org/10.1055/a-2536-4328","url":null,"abstract":"<p><p>Background In patients with Hirschsprung disease (HD), pelvic floor physical therapy (PFPT) is recommended for persistent incontinence or constipation refractory to other treatment, but there are no studies on utilization of PFPT. We aimed to assess clinical and sociodemographic factors associated with successful establishment with PFPT and outcomes following PFPT. Methods We performed a single-institution, retrospective chart review of patients with HD referred to PFPT between 2020 - 2023, involving both exercise and biofeedback. Data were collected on clinical factors, sociodemographics, and symptoms before and after PFPT. Those who \"saw PFPT\", defined as at least one in-person appointment, were compared to those who did not see PFPT; symptomst were also compared. A p-value of 0.05 was considered significant. Results There were 83 patients, of which 37 (44.6%) saw PFPT. There were no differences in age, transition zone, prior interventions, or symptoms. Half of patients who saw PFPT only completed an initial visit; one fifth completed the series. Most common reason for failure to see PFPT was scheduling issues. Patients who failed to see PFPT had financial stressors (42.5% vs 16.1%, p=0.02) and required formal support systems (28.2% vs 3.3%, p=0.02). In patients seeing PFPT, incontinence significantly improved (81.1% before vs 40.5% after, p=0.001). Conclusion While PFPT is recommended in children with HD, those with financial stressors or scheduling issues may have barriers to access. However, those who see PFPT have improved symptoms. This suggests a need for improved accessibility of pediatric PFPT to children with HD, such as integration of PFPT into colorectal clinics.</p>","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143400951","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":"Phrenic Nerve Reconstruction in Pediatric Diaphragm Paralysis: Outcomes and Techniques.","authors":"Matthew Kaufman, Charles Lu, Victoriya Staab, Thomas Bauer","doi":"10.1055/a-2536-4405","DOIUrl":"https://doi.org/10.1055/a-2536-4405","url":null,"abstract":"<p><strong>Background: </strong>Symptomatic diaphragm paralysis in the pediatric patient is an uncommon condition. This study aims to evaluate the outcomes and technique of phrenic nerve reconstruction and its application to pediatric patients with unilateral and bilateral diaphragm paralysis at a single institution. The objective of this study is to demonstrate the application of a well-studied reconstructive technique in a population of patients not previously studied.</p><p><strong>Methods: </strong>A retrospective review of pediatric patients between 2012 and 2022 with symptomatic diaphragm paralysis treated with phrenic nerve reconstruction. 9 patients with a median age of 10 years old were offered surgical treatment. The etiology of their paralysis include: birth trauma, congenital cervical anomaly, mediastinal neoplastic disease, cervical spinal cord injury, and acute flaccid myelitis. Measures of postoperative improvement include fluoroscopic sniff testing, pulmonary function testing, electromyography/nerve conduction testing, ultrasound evaluation and ventilator requirements.</p><p><strong>Results: </strong>100% patients with unilateral paralysis demonstrated improvement, defined as improvements in dyspnea, orthopnea, fatigability, and decreased respiratory infections. This was corroborated by sniff testing, pulmonary function testing, and electrodiagnostic evaluation. In 80% of patients, there was recovery of diaphragm excursion on the chest fluoroscopy, and a 10% or greater improvement on pulmonary spirometry (Forced Expiratory Volume in 1 Second, FEV1, and Forced Vital Capacity, FVC) percent predicted values. In patients with bilateral diaphragm paralysis, 75% demonstrated improvement in sniff testing, ultrasound findings and ventilator requirements. 25% of the patients did not improve. There were no post-operative complications defined as hematoma, wound infection, pleural effusion, pneumonia, sepsis, nerve injury, or hardware malfunction seen during follow-up.</p><p><strong>Conclusion: </strong>Phrenic nerve reconstruction in pediatric patients demonstrates potential as a safe and effective surgical option for symptomatic diaphragm paralysis. In patients with unilateral paralysis, this intervention consistently improved respiratory function. In patients with bilateral paralysis, the results were variable but showed promise in facilitating ventilator weaning when performed early. These findings underscore the importance of early surgical intervention. Larger, multicenter studies are needed to validate its long-term potential.</p>","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143400921","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":"Distal humeral coronal shear fractures in children and adolescents: Need for cross-sectional imaging and a revised classification.","authors":"Ralf Kraus, Michael Esser, Hagen Schmal, Florian Bergmann, Mike Trück, Hans Joachim Kirschner, Martin M Kaiser, Justus Lieber","doi":"10.1055/a-2536-4682","DOIUrl":"https://doi.org/10.1055/a-2536-4682","url":null,"abstract":"<p><strong>Background: </strong>The classification of fractures is necessary to ensure a reliable means of communication for clinical interaction, research, and education. Distal humeral coronal plane shear fractures (CSF) are very rare in the growing-age population, despite that multiple classification schemes exist.</p><p><strong>Objective: </strong>The aim of this study was to assess the inter- and intra-rater reliability of the 4 most commonly used CSF classifications and their role in guiding treatment decisions in everyday clinical practice.</p><p><strong>Materials and methods: </strong>51 patients with CSF were retrospectively analyzed in a multicenter study. Of these, X-rays in two planes of 20 randomly selected CSF were given to 8 independent raters for classification according to Dubberley, Bryan & Morgan, Murthy, and AO. Cohens Kappa statistic was used to assess inter-rater agreement and intra-rater consistency. Intra-class correlation coefficient (ICC) estimates and 95% confident intervals (CI) were calculated. Reliability values were classified as excellent (ICC ≥0.8), substantial (ICC 0.61-0.80), moderate (ICC 0.41-0.6), fair (ICC 0.2-0.4), slight (ICC 0.00-0.2), and poor (ICC <0.00).</p><p><strong>Results: </strong>All patients received x-rays in 2 planes initially. Cross-sectional imaging was added in 76.5% of cases (CT 58,8%, MRI 11,7%, both 5,9%). Inter-rater reliabilities were classified as fair for Dubberley (ICC 0,354; 95% CI 0,198; 0,573) and Bryan & Morgan (ICC 0,357; 95% CI 0,200; 0,576), slight for AO (ICC 0,226; 95% CI 0,100; 0,434), and poor for Murthy (ICC -0,012; 95% CI -0,063; 0,102). The Dubberley subtype showed slight agreement at lower ICC values (ICC 0,024; 95% CI -0,041; 0,161). Intra-rater agreement was moderate to substantial for most of the 8 raters, and did not differ between the four classification systems. The rate of surgical treatment was 49/51 patients.</p><p><strong>Conclusion: </strong>The most commonly used classification schemes for CSF failed to achieve a substantial agreement among the raters. This is probably because the fracture patterns of CSF in adolescence and high adulthood differ significantly. An adaptation of the classification for pediatric and adolescent patients is necessary, but only for scientific purposes. Classification is not necessary for the clinical management of patients, as virtually all patients require surgical treatment.</p>","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143400946","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":"Indocyanine Green Fluorescence-Guided Surgery in Pediatric Hepatobiliary Procedures: A Feasibility Study for Improved Intraoperative Visualization.","authors":"Jayakumar T K, Kirtikumar Jagdish Rathod, Rahul Saxena, Manish Pathak, Avinash S Jadhav, Shubhalaxmi Nayak, Vaibhav Varshney, Subhash Chandra Soni, Arvind Sinha","doi":"10.1055/a-2509-4463","DOIUrl":"10.1055/a-2509-4463","url":null,"abstract":"<p><strong>Introduction: </strong> Indocyanine green (ICG) fluorescence-guided surgery (FGS) is reported extensively in adult operations, but its safety and applications in pediatric populations remain to be comprehensively understood. The dose, administration protocols, and intraoperative imaging benefits in pediatric hepatobiliary operations are not clear.</p><p><strong>Objectives: </strong> This study aimed to identify the feasibility and applications of ICG FGS in hepatobiliary surgeries (for biliary atresia, choledochal cyst, and cholelithiasis) in children.</p><p><strong>Methods: </strong> This is a prospective observational study conducted from January 2021 to December 2022. A standard ICG dose of 0.5 mg/kg/dose was administered intravenously to children undergoing operations for biliary atresia (18-24 hours), choledochal cyst (12-18 hours), and cholelithiasis (2-6 hours) before the operation. Intraoperative imaging features and adverse events were recorded.</p><p><strong>Results: </strong> ICG FGS was performed in 17 patients. In biliary atresia (<i>n</i> = 9), liver fluorescence varied in each case, the gallbladder did not show fluorescence, and there was increasing fluorescence as we reached the right depth during the excision of fibrous biliary remnants. In choledochal cyst (<i>n</i> = 6) operations and cholecystectomy (<i>n</i> = 2), real-time imaging provided anatomical details of the biliary tree and helped in safe dissection. No ICG-related adverse events occurred.</p><p><strong>Conclusion: </strong> ICG FGS appears safe, feasible, and beneficial in pediatric hepatobiliary surgeries. For conditions like biliary atresia, choledochal cysts, and cholecystectomy, ICG facilitates safer surgical navigation and may reduce intraoperative complications. Future studies with standardized protocols and quantitative fluorescence assessment are needed to further refine its use and confirm its impact on surgical outcomes.</p>","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142928834","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":"Optimizing Post-Kasai Management in Biliary Atresia: Balancing Native Liver Survival and Transplant Timing.","authors":"Omid Madadi-Sanjani, Marie Uecker, Gordon Thomas, Lutz Fischer, Bianca Hegen, Jochen Herrmann, Konrad Reinshagen, Christian Tomuschat","doi":"10.1055/a-2507-8270","DOIUrl":"10.1055/a-2507-8270","url":null,"abstract":"<p><strong>Background: </strong> Kasai procedure (KPE) is a palliative intervention in infants with biliary atresia (BA) aiming to restore biliary drainage. While the measure of success in BA is the post-Kasai native liver survival (NLS), BA remains the most frequent indication for liver transplantation in children. While a considerable amount of children fail to clear their jaundice following KPE, resulting in early liver failure and transplantation, some children become jaundice-free after \"successful\" KPE. However, sequelae of chronic liver disease might affect those children, becoming a later risk for NLS. While liver transplantation is inevitable in the majority of children, various salvage procedures have been recently described to maintain NLS. This article provides a comprehensive overview of procedures performed after KPE to prolong NLS in BA patients from early childhood to late adulthood and discusses their indications and limitations.</p><p><strong>Methods: </strong> A literature-based search for surgical and radiological interventions performed in BA patients after KPE to prolong NLS (salvage procedures) was performed using PubMed. Data from case reports, retrospective studies, and registries were included.</p><p><strong>Results: </strong> Fifteen studies included 794 patients who underwent post-KPE salvage procedures. The Oxford Centre for Evidence-Based Medicine levels were IIc to IV.Interventions included redo-Kasai's (<i>n</i> = 710) for cessation of bile flow post-KPE, surgical and radiological procedures (<i>n</i> = 14) for bile lakes, and recurrent cholangitis, shunt surgery (<i>n</i> = 49), and transjugular intrahepatic portosystemic shunt (<i>n</i> = 21) for portal hypertension in BA patients. Age at the time of salvage interventions varied considerably, including redo-Kasai's at 27 days of life and percutaneous biliary interventions in a 35-year-old.</p><p><strong>Conclusion: </strong> Salvage procedures can maintain NLS after KPE in BA patients with disease sequelae. However, indications remain scarce and liver transplantation is ultimately unavoidable in the majority of patients. While redo-Kasai numbers are globally decreasing with the advances in liver transplantation, procedures for bile lakes and portal hypertension can be viable options for patients with complications but otherwise stable liver function. Discussion on those procedures should be held by multidisciplinary expert teams, involving pediatric hepatologists, pediatric surgeons, and transplant surgeons to elaborate on the potential of maintaining NLS or proceeding with transplantation.</p>","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142886364","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}