European Journal of Pediatric Surgery最新文献

{"title":"A Multimodal Animal-Tissue Simulation Model for Training Single-Stage Hypospadias Repair Techniques: A Descriptive Proof-of-Concept Study.","authors":"Jonathan Aichner, Ganesh Vythilingam, Tobias Jhala, Philipp O Szavay, Navroop Johal, Sabine Zundel","doi":"10.1055/a-2889-0027","DOIUrl":"10.1055/a-2889-0027","url":null,"abstract":"<p><strong>Introduction: </strong>Although hypospadias is a common condition and pediatric urology fellowship training programs exist, they have recently been described as insufficient to mediate the necessary skills to master hypospadias surgery. Simulation-based education is increasingly promoted, but training is limited by simulators that typically focus on a single surgical technique. We aimed to develop and demonstrate a single adaptable simulator capable of simulating the six commonly used single-stage hypospadias repair methods.</p><p><strong>Methods: </strong>A model made from lamb tenderloin and chicken skin was used to simulate the six most common single-stage repair techniques: The Meatal-based Flap (Mathieu), the Tubularized Preputial Island Flap, the Island Onlay, the Meatal Advancement and Glanduloplasty (MAGPI) technique, the Koyanagi-Nonomura technique, and the Yoke repair technique. Simple adaptations were employed to modify the model, including sulcus and meatal repositioning, as well as suture- and resection-based skin adaptations.</p><p><strong>Results: </strong>The model could be adapted to simulate six major hypospadias correction techniques on one single platform. The model required minimal resources and preparation, making it accessible and cost-effective.</p><p><strong>Conclusion: </strong>With the animal tissue model presented, the simulation of six commonly used single-stage reconstruction techniques on one adaptable, easily accessible platform becomes possible. Formal validation studies are warranted prior to their incorporation into standardized training curricula.</p>","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":" ","pages":"433-439"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148165705","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":"Bar-Related Infections After Minimally Invasive Repair of Pectus Excavatum: A 25-Year Single-Center Retrospective Cohort Study.","authors":"Hendrik van Braak, Erika P M van Elzakker, Sjoerd A de Beer, Matthijs W N Oomen, Sander Zwaveling, Lodewijk W E van Heurn, Justin R de Jong","doi":"10.1055/a-2888-9665","DOIUrl":"10.1055/a-2888-9665","url":null,"abstract":"<p><strong>Introduction: </strong>This study aims to evaluate the incidence and characteristics of Nuss bar infections, identify factors associated with infection, and present our institutional management considerations.</p><p><strong>Methods: </strong>We conducted a single-center retrospective cohort study of patients undergoing the Nuss procedure between 1999 and 2024 at Amsterdam Pectus Center. All patients had a minimum follow-up of 6 months. Primary outcomes included incidence and management of infections. Secondary outcomes included infection characteristics (early- [<30 days] vs. late-onset [>30 days], superficial vs. deep), diagnostics, microbiology, factors associated with infection (sex, age, type of anesthesia, number of bars, bar dislocation, stabilizer position, use of sutures), impact on bar removal, incidence of allergies and terra firma-forme dermatosis.</p><p><strong>Results: </strong>Of 695 patients, 4.0% (<i>n</i> = 28/695) developed Nuss bar infections, at a median of 2.0 (0.0-13.5) months postoperative, presenting with erythema, pain, and exudate. Over time, infections shifted from early- to late-onset (<i>p</i> = 0.03). Deep infections (71.4%, <i>n</i> = 20/28) more often required surgery (<i>p</i> = 0.007); superficial infections were managed with a wide range of antibiotics. Bar dislocations (5.6%, <i>n</i> = 39/695) and stabilizer plate loosening (1.0%, <i>n</i> = 7/695) required reoperation and were associated with infections (<i>p</i> = 0.001). Operative time for bar removal was longer in infected patients (52.0 [32.0-68.0] vs. 35.0 [26.0-49.0] minutes, <i>p</i> = 0.03). One case of cobalt allergy was identified. Terra firma-forme dermatosis (0.4%, <i>n</i> = 3/695) was treated with alcohol wipes.</p><p><strong>Conclusion: </strong>Bar dislocation and stabilizer plate loosening are associated with Nuss bar infections. We present our institutional management considerations based on retrospective data and experience, requiring prospective validation. Accurate diagnostics, tailored antibiotic therapy, and consideration of alternative diagnoses remain essential.</p>","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":" ","pages":"385-392"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13597110/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148207084","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":"Pneumatic Balloon Dilation versus Heller's Myotomy in Pediatric Achalasia: A Systematic Review and Meta-Analysis.","authors":"Marcella M Constante, Kayla D Santos, Letizia Corbi, Agata Grochowska, Ashwin Pimpalwar","doi":"10.1055/a-2879-1317","DOIUrl":"10.1055/a-2879-1317","url":null,"abstract":"<p><p>The optimal surgical treatment for achalasia in children remains controversial. Pneumatic balloon dilation (PBD) and Heller's myotomy (HM) are the most commonly used interventions, but comparative evidence is limited and based mainly on small observational studies.This study aimed to compare clinical outcomes of PBD and HM in children with achalasia through a systematic review and meta-analysis.PubMed, EMBASE, and Cochrane were searched through June 2025. Comparative studies evaluating PBD and HM in patients younger than 18 years were included. Outcomes of interest included symptom recurrence, reoperation, gastroesophageal reflux disease (GERD), and complications. Random-effects models were used due to expected heterogeneity.Nine observational studies comprising 317 patients were included (PBD: 184; HM: 133). HM was associated with lower odds of reoperation (odds ratio [OR] = 11.01; 95% confidence interval [CI]: 6.01-20.17; <i>p</i> = 0.0001) and symptom recurrence (OR = 8.00; 95% CI: 1.65-38.75; <i>p</i> = 0.0098). PBD was associated with a lower risk of GERD (OR = 0.14; CI: 0.02-0.98; <i>p</i> = 0.0477). No significant differences were observed in perforation rates. All studies were retrospective cohorts with heterogeneous reporting of techniques and outcomes, and some analyses were based on a limited number of studies.HM was associated with lower recurrence and reoperation rates, while PBD showed a lower risk of GERD. However, evidence is limited by small observational studies, with heterogeneity in treatment techniques, outcome definitions, and follow-up durations. Results should be interpreted cautiously, and prospective multicenter studies are needed to determine the optimal treatment strategy.</p>","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":" ","pages":"361-370"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148240729","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":"Management Strategy is Not Predictive of Mortality after Blunt Aortic Injury in Children.","authors":"Kara Kennedy, Rosa Hwang, Lindsay Master, Keith Baxelbaum, April Giannotti, Lei Wang, Michael Nance, Alexander Fairman","doi":"10.1055/a-2941-3556","DOIUrl":"https://doi.org/10.1055/a-2941-3556","url":null,"abstract":"<p><strong>Introduction: </strong>To improve treatment algorithms for blunt aortic injury (BAI) in the endovascular era, we investigate predictors of mortality and compare outcomes by management strategy.</p><p><strong>Methods: </strong>The Trauma Quality Program national database was queried for BAI in patients ≤ 18 years from 2016 to 2022. Survivors, emergency department (ED) mortalities, and inpatient mortalities were compared. Predictors of inpatient mortality were identified via logistic regression. Outcomes were compared by management strategy (non-operative [NOM], endovascular [EM], vs. operative [OM]). Comparisons were performed via Kruskal-Wallis or chi-square tests. <i>p</i>-Values < 0.05 were considered significant.</p><p><strong>Results: </strong>A total of 359 patients were included. The median age was 16 [IQR 12, 18] years. Of the total patients 298 (83%) underwent NOM, 21 (5.8%) OM, and 40 (11%) EM. Overall mortality was 27% (14% ED, 13% inpatient). On multivariable analysis, management style (endovascular: OR 0.39 [0.1, 1.25], <i>p</i> = 0.135, operative: OR 3.82 [0.76, 16.7], <i>p</i> = 0.082 vs. NOM), age (OR 1.03 [0.93, 1.14], <i>p</i> = 0.608), sex (OR 0.64 [0.27, 1.56], <i>p</i> = 0.323), location of aortic injury (thoracic vs. abdominal, OR 1.38 [0.56, 3.45], <i>p</i> = 0.491), and severity of aortic injury (OR 1.11 [0.45, 2.73], <i>p</i> = 0.883) were not significant predictors of inpatient mortality. Rather, Injury Severity Score (ISS) (OR 1.06 [1.03, 1.11], <i>p</i> = 0.001) and head injuries (OR 7.85 [2.92, 23.21], <i>p</i> < 0.001) were significant predictors of mortality.</p><p><strong>Conclusion: </strong>While limited by lack of detailed injury grading in this database study, after adjustment for age, sex, injury severity, head injuries, location of aortic injury, and severity of aortic injury, management strategy (endovascular, operative, non-operative) was not a significant predictor of inpatient mortality after BAI in this analysis. ISS and severe head injuries were predictive of mortality in these cases.</p>","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149018655","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":"Hypothermic-Oxygenated Perfusion in Pediatric Liver Transplantation: Beyond Graft Preservation, Facilitating Safer Surgeries in a Donor-Limited Environment.","authors":"Irene Dieguez Hernandez Vaquero, Rebeca Sanabria Mateos, Khalid Sharif, Evelyn Ong, Hector Vilca-Melendez, Alba Bueno Jimenez","doi":"10.1055/a-2941-3285","DOIUrl":"10.1055/a-2941-3285","url":null,"abstract":"<p><strong>Background: </strong>Pediatric liver transplantation (PLT) increasingly faces a landscape of limited and suboptimal donor grafts, alongside a rising proportion of complex recipients. Hypothermic-oxygenated perfusion (HOPE) mitigates ischaemia-reperfusion injury and may support graft function in this context.</p><p><strong>Objective: </strong>To evaluate feasibility and outcomes of backbench HOPE in complex PLT, compared with a historical cohort of static cold storage (SCS).</p><p><strong>Methods: </strong>Prospective cohort of 22 PLT recipients who received a HOPE-perfused liver graft between September 2024 and December 2025, compared with a historical cohort of 32 PLT recipients transplanted after SCS. Variables: donor/recipient/graft characteristics, surgical complexity markers, postoperative complications, and survival outcomes.</p><p><strong>Results: </strong>Recipients in both groups had a similar baseline profile, but the HOPE group showed a trend toward greater surgical complexity, with longer hepatectomy times (2.3 vs. 2.1 hours, <i>p</i> = 0.002). Cold ischaemia time was shorter (5.8 [5.1-6.7] vs. 8 [6.8-9.1] hours; <i>p</i> < 0.001). Median HOPE perfusion was 4.1 hours. Seventy-seven percent of the grafts were reduced/split on HOPE. Postoperative complications did not differ significantly between groups, and no biliary strictures occurred in the HOPE group compared with five in the SCS group. At 1 year, although patient survival was numerically lower in the HOPE group (77.3% vs. 90.6%, <i>p</i> = 0.200), all deaths occurred with functioning graft; and death-censored graft survival (95.5% vs. 96.8%, <i>p</i> = 0.880) was comparable.</p><p><strong>Conclusion: </strong>In a donor-limited environment with complex recipients, routine backbench HOPE showed graft outcomes and survival comparable to a historical SCS group. These findings suggest a potential role for HOPE beyond graft preservation, supporting surgical synchronization in complex PLT.</p>","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148920900","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 Repair of Primary Hiatal Hernia in Children: Systematic Review of Surgical Techniques and Outcomes.","authors":"Agnieszka Wiernik, Julio César Moreno-Alfonso, Hanna Garnier, Alexander Sterlin, Amit Beher, Soichi Shibuya, Amulya K Saxena","doi":"10.1055/a-2947-1085","DOIUrl":"10.1055/a-2947-1085","url":null,"abstract":"<p><strong>Objective: </strong>This systematic review analyzed laparoscopic repair of primary hiatal hernia (HH) in children, focusing on presentation, diagnosis, surgical techniques, and postoperative outcomes.</p><p><strong>Methods: </strong>Studies published between 2000 and 2025 on laparoscopic repair of primary pediatric HH were identified according to PRISMA guidelines (PROSPERO: CRD420261295203). Due to heterogeneity in study design and outcome reporting, a meta-analysis was not feasible. Data were summarized descriptively. Selected comparisons used Fisher's exact test and odds ratios (ORs) with 95% confidence intervals (CIs; <i>p</i> < 0.05).</p><p><strong>Results: </strong>Twenty-seven studies reporting 353 patients met the inclusion criteria. The evidence was of low certainty, consisting predominantly of case reports (<i>n</i> = 12) and case series (<i>n</i> = 10), with only five retrospective cohorts and no prospective studies. Estimated median age was 18.6 months (range 6 days to 16 years). Gastroesophageal reflux disease was the most common symptom. Laparoscopic repair was performed in all patients, with 1.4% conversion rate and one intraoperative complication. Recurrence occurred in 21/331 (6.3%). Patch-reinforced repair showed a non-significantly higher recurrence rate than primary repair (OR 2.63, 95% CI: 0.54-12.8; <i>p</i> = 0.24). Esophageal stenosis was the most frequent postoperative complication (<i>n</i> = 40/331; 12.1%) and was more common after Nissen-Rossetti than Thal fundoplication (OR 2.63, 95% CI: 1.11-6.25; <i>p</i> = 0.027), although heterogenous reporting and missing data limit this comparison.</p><p><strong>Conclusion: </strong>Laparoscopic repair of primary pediatric HH appears feasible, with low reported perioperative morbidity and acceptable recurrence rates, but evidence is low certainty. Fundoplication appears reasonable but the observed association of complete wraps with stenosis requires cautious interpretation. Current evidence does not support routine patch reinforcement.</p>","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148857830","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 Impact of Delayed Diagnosis on Outcomes in Hirschsprung Disease: A Comparative Analysis.","authors":"Hosnieya Labib, Lieke Beltman, Hafsa Ahmed, Joris J H T Roelofs, Patrick van der Voorn, Joost van Schuppen, Jaap Oosterlaan, L W Ernest van Heurn, Marc A Benninga, Joep P M Derikx","doi":"10.1055/a-2913-8011","DOIUrl":"https://doi.org/10.1055/a-2913-8011","url":null,"abstract":"<p><strong>Introduction: </strong>Hirschsprung disease (HD) is a congenital disease characterized by a lack of neural innervation of the distal bowel. This causes fecal stasis, which results in a wide variety of non-specific fecal obstructive symptoms. Identification of patients with HD can, therefore, be challenging, causing a delayed diagnosis. This may lead to complications such as Hirschsprung-associated enterocolitis (HAEC) and bowel perforation. Current evidence regarding the short postoperative and long-term outcomes in patients with delayed diagnosis is inconclusive. Therefore, the aims of this study were to examine (1) short-term postoperative complications, (2) long-term occurrence of HAEC, (3) requirement of interventions, (4) functional outcomes, and (5) quality of life comparing patients diagnosed with HD before and after 6 months of age.</p><p><strong>Methods: </strong>We retrospectively analyzed patients with HD undergoing surgery at our center between 2000 and 2022. Each patient diagnosed after 6 months of age was matched to two controls diagnosed before 6 months of age, controlling for potential confounders such as sex and length of aganglionosis. Functional outcomes and quality of life were assessed using the Hirschsprung/Anorectal Malformation Quality of Life Questionnaire and relevant items from the Groningen Defecation and Continence Scale. Outcomes also included the occurrence of HAEC and the need for interventions (laxatives, rectal irrigations, botulinum toxin injections). Statistical analyses included independent <i>t</i>-tests, Mann-Whitney U tests, chi-square tests, or Fisher's exact tests as appropriate. The follow-up duration was from the time of operation until follow-up.</p><p><strong>Results: </strong>Seventeen patients older than 6 months at the time of diagnosis were matched with 34 control patients. No significant differences between groups were found in the number of short-term postoperative complications (<i>p</i> = 0.166) and the long-term occurrence of HAEC (<i>p</i> = 0.569), laxative use (<i>p</i> = 0.771), rectal irrigation use (<i>p</i> = 0.156), number of botulinum toxin injections (<i>p</i> = 0.715), functional outcomes (<i>p</i> = 0.412), and quality of life (<i>p</i> = 0.783).</p><p><strong>Conclusion: </strong>Our findings suggest that delayed diagnosis does not impact short-term postoperative complications and the long-term occurrence of HAEC, requirement of intervention, functional outcomes, and quality of life between patients with delayed diagnosis of HD and patients diagnosed early in life. Future work should focus on identifying risk factors for poor outcomes, standardizing diagnostic criteria, and refining surgical strategies to improve care for all patients with HD.</p>","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148802307","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":"Interpretable Deep Learning Applied to Fluorescence Confocal Microscopy for Intraoperative Tissue Assessment in Pediatric Surgical Oncology.","authors":"Donatella Di Fabrizio, Agnese Sbrollini, Edoardo Bindi, Gaia Goteri, Laura Burattini, Giovanni Cobellis","doi":"10.1055/a-2936-0049","DOIUrl":"10.1055/a-2936-0049","url":null,"abstract":"<p><strong>Background: </strong>In pediatric surgical oncology, intraoperative tissue assessment is limited by small specimen size and the absence of real-time histopathology. Ex vivo fluorescence confocal microscopy (FCM) provides rapid histology like imaging of fresh tissue, yet interpretation relies on expert visual assessment. We tested the hypothesis that deep learning applied directly to ex vivo FCM images enables automated, accurate, and spatially interpretable tumor detection in pediatric specimens.</p><p><strong>Methods: </strong>FCM images were prospectively acquired during routine clinical activity from 42 children, yielding 141 surgical and biopsy specimens. For this analysis, anonymized mosaics were retrospectively collected and manually annotated as malignant, benign, or healthy tissue by expert, then decomposed into 256 × 256 pixel tiles at 0.5 µm per pixel. A convolutional neural network was trained, validated, and tested on stratified datasets. Performance metrics were calculated at the tile level using accuracy, sensitivity, specificity, and F1 score. Tile level activation heatmaps were generated to localize regions influencing predictions.</p><p><strong>Results: </strong>Overall, 243,659 tiles were analyzed, including 124,348 malignant, 48,441 benign, and 70,870 healthy tissue tiles. The independent testing dataset comprised 84,751 tiles. Malignant tissue was identified with 91.35% accuracy, 95.88% sensitivity, 86.28% specificity, and an F1 score of 92.13%. Healthy tissue achieved 94.41% accuracy and 95.58% specificity. Benign tissue showed 90.14% accuracy and 91.78% specificity. Heatmaps consistently highlighted at a cellular level the architectural distortion in malignant tiles.</p><p><strong>Conclusion: </strong>This work introduces the first pediatric integration of deep learning with ex vivo FCM, demonstrating the feasibility of rapid and interpretable tissue classification and providing the basis for future prospective intraoperative validation.</p>","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148727606","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":"Development of a Clinical Predictive Score for Bracing Outcomes in Children with Pectus Carinatum: A Single-center Retrospective Study.","authors":"Haonan Wang, Yunyu He, Minhua Lin, Jiachi Liao, Le Li, Jiahang Zeng, Qinglin Yang, Zefeng Lin, Jianhua Liang","doi":"10.1055/a-2782-7127","DOIUrl":"10.1055/a-2782-7127","url":null,"abstract":"<p><strong>Background and objectives: </strong>Pectus carinatum (PC) is a common chest wall deformity, but there is currently a lack of predictive models and tools for forecasting deformity improvement with compressive orthotic bracing (COB) therapy. This study aimed to identify key factors influencing treatment outcomes, and to develop and integrate a predictive efficacy scoring tool with a clinical decision pathway to provide evidence-based treatment recommendations for pediatric PC patients.</p><p><strong>Methods: </strong>In this retrospective study, 182 pediatric PC patients evaluated and followed using three-dimensional scanning were enrolled. A multiple linear regression model was developed to create and validate a predictive efficacy scoring tool, which subsequently informed the establishment of a treatment decision pathway.</p><p><strong>Results: </strong>The predictive model identified smaller initial external thoracic width (<i>p</i> < 0.001, β = - 0.644), older age at treatment initiation (<i>p</i> = 0.04, β = 0.271), good compliance (<i>p</i> = 0.008, β = 0.188), and favorable chest wall morphology (<i>p</i> = 0.033, β = 0.152) as independent predictors of deformity improvement. The model was optimized into a predictive efficacy scoring tool (Score = Expected %dEHI + 4.761). Comparison between the good response (score > 0) and poor response (score ≤ 0) groups confirmed the tool's excellent discriminative ability (8.348 vs. 15.320, <i>p</i> < 0.001).</p><p><strong>Conclusion: </strong>Treatment recommendations were derived by integrating the scoring tool with the decision pathway: children with score > 0 are strongly recommended to continue bracing; those with score ≤ 0 due to poor compliance should receive intensified supervision, while those with score ≤ 0 due to other factors should be counseled on possible surgery; children under 4 years require personalized recommendations integrating the score, symptoms, and parental preferences. However, as a single-center retrospective study without a control group and with subjective compliance assessment, future prospective multicenter studies are required to validate the model's generalizability.</p>","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":" ","pages":"305-315"},"PeriodicalIF":1.8,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145947027","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":"Patient-Reported Long-Term Gastrointestinal Outcomes in Children with Omphalocele and Gastroschisis: A PedsQL GI Module Study.","authors":"Maaike Hogerwerf, Adinda G H Pijpers, Ramon R Gorter, Bart G P Koot, Ilan J N Koppen, Merit M Tabbers, Joep P M Derikx","doi":"10.1055/a-2817-6760","DOIUrl":"10.1055/a-2817-6760","url":null,"abstract":"<p><strong>Objective: </strong>Previous studies exploring long-term outcomes of patients with omphalocele and gastroschisis suggest an ongoing burden of gastrointestinal symptoms but also highlight substantial heterogeneity in methodology and outcomes measurement, limiting comparability. Therefore, the aim of this study was to systematically evaluate patient-reported long-term gastrointestinal symptoms, using a validated questionnaire, and compare the scores to those of healthy controls.</p><p><strong>Methods: </strong>All children treated for omphalocele and gastroschisis between 1999 and 2022 were invited to complete the Pediatric Quality of Life Inventory GI Module, consisting of twelve gastrointestinal domains. Parent proxy-reports or child self-reports were sent by mail, appropriate for the participants' age. The scores were compared with a predefined American healthy cohort (<i>n</i> = 513). Significance threshold was <i>p</i> < 0.004 (Bonferroni-corrected).</p><p><strong>Results: </strong>In total, 45/131 (34.4%) respondents completed the questionnaire, of whom 20 had omphalocele (50.0% male, median age 10.4 years [IQR: 6.4-16.4]), and 25 had gastroschisis (56.0% male, median age 9.9 years [IQR: 6.2-16.8]). Omphalocele patients reported a similar mean total score (86.5 [ ± 15.9] vs. 88.6 [ ± 12.9], <i>d</i> = 0.15, <i>p</i> = 0.566) and similar domain scores (<i>d</i> < 0.35, <i>p</i> > 0.01) compared with healthy controls. Gastroschisis patients also reported a similar mean total score compared with healthy controls (84.9 [SD ± 10.9], <i>d</i> = 0.31, <i>p</i> = 0.112). However, they scored worse on the domains \"gas and bloating\" (<i>d</i> = 0.78, <i>p</i> = 0.001), \"diarrhea\" (<i>d</i> = 0.74, <i>p</i> = 0.002), and \"constipation\" (<i>d</i> = 0.51, <i>p</i> = 0.026).</p><p><strong>Conclusion: </strong>Omphalocele patients reported a low burden of long-term gastrointestinal symptoms, indicating that routine follow-up may not be required. In contrast, gastroschisis patients reported a higher prevalence of gas and bloating, diarrhea, and constipation compared with healthy controls, highlighting the importance of early recognition and targeted management of these symptoms.</p>","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":" ","pages":"292-299"},"PeriodicalIF":1.8,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13375281/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147445690","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}