European Journal of Pediatric Surgery最新文献

{"title":"Effects of Low-Pressure CO2 Insufflation on Cerebral and Splanchnic Oxygenation in Neonates Undergoing Laparoscopic Pyloromyotomy.","authors":"Silvia Ceccanti, Alice Cervellone, Oscar Mazzei, Maria Vittoria Pesce, Denis A Cozzi","doi":"10.1055/a-2561-0523","DOIUrl":"10.1055/a-2561-0523","url":null,"abstract":"<p><p>Pathophysiological effects of abdominal CO₂ insufflation on cerebral and splanchnic oxygenation in neonates and infants undergoing laparoscopy remain poorly investigated. We investigated laparoscopic pyloromyotomy as a paradigm to determine such changes in this specific population.Single-center, prospective cohort of 28 infants undergoing laparoscopic pyloromyotomy at the mean age of 30.9 ± 10.6 days. The pneumoperitoneum was set at 6 to 8 mmHg. Regional cerebral oxygen saturation (cSO₂) and splanchnic oxygen saturation (sSO₂) were measured by near-infrared spectroscopy. End-tidal carbon dioxide (EtCO₂) levels, heart rate, body temperature, systemic blood pressure, and urine output were also recorded. Data (mean ± SD) were collected intraoperatively at 0, 15, and 30 minutes and compared to baseline values for each patient using the <i>t</i>-test.A significant decrease in cSO₂ was recorded only at the beginning of surgery, while sSO₂ significantly decreased from 15 intraoperative minutes (-7.1% ± 7.2; <i>p</i> = 0.0009) until the end of insufflation, followed by an increasing trend, although still below the baseline values (-6.5% ± 11.2; <i>p</i> = 0.01). EtCO₂ increased significantly from the initial 15 intraoperative minutes, reaching a maximum of 42.6 ± 8.9 mmHg at 30-minute intervals. Urine output significantly decreased within the first 4 postoperative hours.Laparoscopic pyloromyotomy using low-pressure CO₂ insufflation (6-8 mmHg) maintains stable cerebral oxygenation in neonates and infants, while splanchnic oxygenation and urine output experience temporary, reversible reductions. These findings suggest that low-pressure pneumoperitoneum is a safe and effective approach in neonatal laparoscopy, with minimal oxygenation and metabolic risks.</p>","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":" ","pages":"400-406"},"PeriodicalIF":1.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144056757","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":"Thoracoscopic Repair of Recurrent CDH is Associated with a Significantly Lower Complication Rate and Shorter ICU and Hospital Stay: A Prospective, Propensity Score-Matched Analysis.","authors":"Lydia Beck, Christel Weiss, Christoph Mohr, Richard Martel, Michaela Klinke, Jin Rhee, Katrin Zahn, Thomas Schaible, Michael Boettcher, Julia Elrod","doi":"10.1055/a-2590-5512","DOIUrl":"10.1055/a-2590-5512","url":null,"abstract":"<p><p>Congenital diaphragmatic hernia (CDH) is a malformation that significantly impacts neonatal morbidity and mortality. Recurrence after surgical repair remains a potentially life-threatening long-term complication. Conventionally, recurrent CDH has been managed through open surgery. However, thoracoscopic repair (TR) represents a novel alternative for recurrent CDH as it has reduced the length of hospital stay and mortality rate in the primary CDH repair.A prospective, propensity score-matched analysis was conducted on pediatric patients who underwent recurrent CDH repair at the University Hospital Mannheim between 2013 and 2023, to compare the outcomes of laparotomy versus TR. Patients were categorized based on the surgical technique employed. Comparative analysis, including propensity scoring, encompassed outcome measures such as duration of ICU and hospital stays, rate of complications, and operative duration.In total, 703 patients were treated for CDH, of whom 69 children underwent laparotomy (56) or TR (16) for CDH recurrence. After propensity score matching, TR group demonstrated a significantly shorter duration of surgery (178 [93-311] versus 225 [113-450] min, <i>p</i> = 0.042), reduced ICU stay (0 [0-10] versus 1 (0-69) days, <i>p</i> = 0.011), and decreased overall hospital stay (6 [3-34] versus 12 [7-40] days, <i>p</i> = 0.001). Moreover, the postoperative complications were significantly lower in the TR group (21.43% versus 73.68%, <i>p</i> = 0.003).TR for recurrent CDH repair is associated with shorter operation times, reduced ICU and overall hospital stays, and fewer complications compared with laparotomy. These findings suggest that TR may be preferable for the management of recurrent CDH, warranting larger randomized controlled studies to confirm the long-term safety and efficacy of this approach.</p>","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":" ","pages":"417-425"},"PeriodicalIF":1.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144059667","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":"Single-Stage Double-Face Preputial Island Flap versus Two-Stage Byars' Flap Repair for Severe Proximal Hypospadias: A Prospective Randomized Study.","authors":"Barsoom M El-Raheb, Nader N Guirguis, Mostafa M Elghandour, Ahmed B Radwan, Mohamed ElDebeiky","doi":"10.1055/a-2702-1917","DOIUrl":"10.1055/a-2702-1917","url":null,"abstract":"<p><p>The optimal approach for repairing severe hypospadias remains debated. In our institution, the single-stage double-face preputial island flap (DFPIF) has been employed to reduce the number of procedures and costs. Given the resource-limited context, an evidence-based comparison of repair techniques was warranted to inform cost-effective surgical decision-making.A prospective randomized study was conducted on 36 patients with proximal hypospadias and chordee >30 degrees, treated between 2022 and 2025. Patients were randomly allocated to Group A (DFPIF) or Group B (Byars' flap) using a computer-generated block randomization with allocation concealment. All surgeries were performed by the same team. Patients were followed for 12 months. Groups were compared regarding complications, functional, and cosmetic outcomes. Functional outcomes were assessed using parent-reported urinary stream and erection, with objective chordee assessment under anesthesia. Cosmetic results were evaluated using the Hypospadias Objective Scoring Evaluation (HOSE) score and a 10-point parental satisfaction scale. Outcomes were assessed by a blinded team member who was not involved in the operative procedures. Data were analyzed by a blinded analyst.Thirty-six patients were included, with 18 patients in each group. There was no statistically significant difference in complications, except for partial wound dehiscence, which was higher in group A (<i>p</i> = 0.041). Functional and cosmetic outcomes, as well as parental satisfaction, did not differ significantly.While both techniques achieved acceptable early outcomes, the double-face flap group showed higher rates of partial wound dehiscence. Further studies with larger samples and longer follow-up are required to determine long-term efficacy and safety.</p>","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145076830","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":"IMPACT OF VACTERL ASSOCIATION AND CHROMOSOMAL ANOMALIES ON OUTCOMES AFTER ESOPHAGEAL ATRESIA REPAIR: INSIGHTS FROM THE EUPSA REGISTRY.","authors":"Tutku Soyer, Federica Pederiva, Paolo Dalena, Luca Pio, Mohit Kakar, Nigel J Hall, Francesco Morini","doi":"10.1055/a-2708-2852","DOIUrl":"https://doi.org/10.1055/a-2708-2852","url":null,"abstract":"<p><strong>Aim: </strong>Although VACTERL association is a recognized entity in patients with esophageal atresia (EA), its impact on surgical outcomes remains unclear. This study aimed to evaluate the influence of VACTERL association and chromosomal anomalies (VACTERL-CA) on the surgical outcomes of EA patients, offering novel insights into risk stratification.</p><p><strong>Methods: </strong>All patients enrolled in the European Pediatric Surgeons' Association (EUPSA) Esophageal Atresia Registry (EAR) between July 2014 and December 2017 were included. Patients were classified into two groups: those with VACTERL association and/or chromosomal anomalies (VACTERL-CA) and those without these anomalies (Non-VACTERL). Groups were compared for demographics, associated malformations, surgical approach, complications, and outcomes Results: Among 372 patients, 22% (n=82) were classified as VACTERL-CA. This group had significantly lower gestational age (35.9 vs. 37.1 weeks, p=0.004), birth weight (2312 g vs. 2663 g, p<0.001), and APGAR scores at 5 and 10 minutes (p=0.005). Surgical strategies, including rates of primary anastomosis (88% in both groups), did not differ. Anastomotic leak and stricture rates were similar; however, recurrent fistula was more common in VACTERL-CA (4.9% vs. 1.0%, p=0.023). Overall mortality was higher in VACTERL-CA (14.6% vs. 5.2%, p=0.003), largely due to associated anomalies such as cardiac or neurologic conditions, whereas EA-related mortality was more frequent in Non-VACTERL (1% vs. 0%). Sepsis was also more frequent in VACTERL-CA (10.9% vs. 4.5%, p=0.033). In multivariate analysis, low birth weight (aOR 0.95 per 100 g, p=0.010) and cardiac malformations (aOR 2.33, p=0.002) were independently associated with VACTERL-CA.</p><p><strong>Conclusion: </strong>EA patients with VACTERL-CA represent a high-risk subgroup characterized by prematurity, major cardiac defects, and increased sepsis risk. These findings highlight the need for early cardiac screening, standardized infection-prevention bundles, and tailored multidisciplinary care to improve survival and reduce preventable complications.</p>","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145139658","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":"Explainable AI: Ethical Frameworks, Bias, and the Necessity for Benchmarks.","authors":"Rosa Verhoeven, Wiam Bouisaghouane, Jan Bf Hulscher","doi":"10.1055/a-2702-1843","DOIUrl":"https://doi.org/10.1055/a-2702-1843","url":null,"abstract":"<p><p>Artificial intelligence (AI) is increasingly integrated into pediatric healthcare, offering opportunities to improve diagnostic accuracy and clinical decision-making. However, the complexity and opacity of many AI models raise concerns about trust, transparency, and safety, especially in vulnerable pediatric populations. Explainable AI (XAI) aims to make AI-driven decisions more interpretable and accountable. This review outlines the role of XAI in pediatric surgery, emphasizing challenges related to bias, the importance of ethical frameworks, and the need for standardized benchmarks. Addressing these aspects is essential to developing fair, safe, and effective AI applications for children. Finally, we provide recommendations for future research and implementation to guide the development of robust and ethically sound XAI solutions.</p>","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145132937","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":"Latest Developments in Artificial Intelligence and Machine Learning Models in General Pediatric Surgery.","authors":"Hesham Elsayed, Georg Singer, Tristan Till, Holger Till","doi":"10.1055/a-2689-8280","DOIUrl":"10.1055/a-2689-8280","url":null,"abstract":"<p><p>Artificial intelligence (AI) and machine learning (ML) models rapidly transform health care with applications ranging from diagnostic image interpretation, predictive modeling, personalized treatment planning, real-time intraoperative guidance, and outcome prediction. However, their implementation in general pediatric surgery remains limited due to the rarity and complexity of pediatric surgical conditions, small and heterogeneous datasets, and a lack of formal AI training and competencies among pediatric surgeons.This narrative review explores the current landscape of AI and ML applications in general pediatric surgery, focusing on five key conditions: appendicitis, necrotizing enterocolitis, Hirschsprung's disease, congenital diaphragmatic hernia, and biliary atresia. For each, we summarize recent developments, including the use of AI in image analysis, diagnostic support, prediction of disease severity and outcome, postoperative monitoring, and histopathological evaluation. We also highlight novel tools such as explainable AI models, natural language processing, and wearable technologies.Recent findings demonstrate promising diagnostic and prognostic capabilities across multiple conditions. However, most AI/ML models still require external validation and standardization. The review underscores the importance of collaborative, multicenter research based on joint datasets as well as targeted AI education for pediatric surgeons to fully explore the benefits of these technologies in clinical practice.AI and ML offer significant potential to improve pediatric surgical care, but broader implementation will require multicenter collaboration, a robust dataset, and targeted AI education for pediatric surgeons.</p>","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144980417","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":"Impact and Citation Trends of Surveys Endorsed by the EUPSA Network Office in Pediatric Surgery: A Bibliometric Analysis.","authors":"Fabian Doktor, Nigel J Hall, Carmen Mesas-Burgos, Elke Zani-Ruttenstock, Federica Pederiva, Igor Sukhotnik, Jens Dingemann, Luca Pio, Mohit Kakar, Ramon Gorter, Tutku Soyer","doi":"10.1055/a-2690-9595","DOIUrl":"10.1055/a-2690-9595","url":null,"abstract":"<p><p>The European Pediatric Surgeons' Association (EUPSA) Network Office regularly endorses surveys that address controversial topics in pediatric surgery. However, the scientific impact of these within the medical literature remains unclear. To address this gap, we conducted a bibliometric analysis of all published EUPSA-endorsed surveys.Surveys endorsed by the EUPSA Network Office were reviewed for topic, journal, participation, bibliometric indicators (total number of citations and citations per article and year), and citing countries. Simple linear regression was used to determine citation time trends.Between 2013 and 2024, at least one survey was published each year (<i>R</i> ² = 0.26; <i>p</i> = 0.1). Most commonly, surveys were published in the European Journal of Pediatric Surgery (<i>n</i> = 15), and the most common survey topics included general pediatric (<i>n</i> = 7), thoracic (<i>n</i> = 4), and colorectal (<i>n</i> = 3) surgery. The average number of participants per survey was 167 ± 53, with 75% (range: 54-89%) European responses. The most cited surveys addressed esophageal atresia, necrotizing enterocolitis, and Hirschsprung's Disease. The median number of citations per survey was 11 (range: 1-160), with a median of 6 citations per year (range: 0-26). The total number of citations from all EUPSA Network Office-endorsed surveys increased over time (<i>R</i> ² = 0.75; <i>p</i> = 0.0006), and the average citation per article and year was consistent (<i>R</i> ² = 0.09; <i>p</i> = 0.34). Citations originated from 63 countries, mostly from the United States (<i>n</i> = 75), Germany (<i>n</i> = 64), and China (<i>n</i> = 44).Despite inherent limitations of survey-based research, the growing bibliometric impact of EUPSA Network Office-endorsed surveys highlights their scientific merit as an important tool for exploring current pediatric surgical practices, which will inform future multi-institutional studies.</p>","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144980287","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":"Prenatal Intervention in High-Risk CPAM: Postnatal Outcomes After Fetal versus Standard Surgery: A Propensity Score Matched Study.","authors":"Michaela Klinke, Julia Elrod, Richard Martel, Thomas Schaible, Tobias Nientiedt, Johannes Boettcher, Thomas Kohl, Michael Boettcher","doi":"10.1055/a-2690-9682","DOIUrl":"10.1055/a-2690-9682","url":null,"abstract":"<p><p>Congenital pulmonary airway malformation (CPAM) is a rare fetal lung anomaly characterized by cystic lesions that can impede lung development. While smaller lesions may remain asymptomatic and are managed postnatally, larger lesions can cause severe complications such as mediastinal shift and hydrops fetalis. Fetal surgery may be indicated in these cases. This study analyzed whether fetal surgical intervention affects outcomes of subsequent postnatal surgery in CPAM patients.A retrospective single-center cohort study was conducted on pediatric patients treated for CPAM between January 2010 and August 2024. Patients were divided into two groups: those with prenatal surgical intervention and those treated with postnatal surgery only. Propensity score matching based on gestational age, gender, birth weight, and lesion volume ratio yielded 23 matched patients: 14 in the fetal surgery group and 9 in the control group. Baseline characteristics, type of fetal intervention, intraoperative, and long-term postoperative outcomes were assessed. Multivariable regression was performed to account for confounding variables.Among 179 identified patients, 23 were included after propensity score matching: 14 in the fetal surgery group and 9 in the standard postnatal surgery group. Baseline characteristics were balanced, except for significantly higher disease severity in the fetal surgery group (hydrops 69% vs. 0%, <i>p</i> < 0.001; mediastinal shift 93% vs. 33%, <i>p</i> = 0.001). Alcohol ablation was the most common fetal intervention; however, various other prenatal procedures were also performed, with most patients undergoing multiple interventions. Tendencies but no significant differences were found in primary outcomes, including mortality (15% vs. 0%, <i>p</i> = 0.26) and recurrence (29% vs. 0%, <i>p</i> = 0.18). Secondary outcomes such as ventilation duration and intensive care stay were longer in the fetal surgery group, but not statistically significant.Despite higher baseline disease severity, patients who underwent fetal intervention showed postnatal outcomes comparable to those with less severe CPAM. Fetal surgery did not appear to adversely affect surgical recovery. These findings should be interpreted with caution but may support the selective use of prenatal intervention in high-risk cases and underscore the need for further research to refine both prenatal strategies and postnatal care.</p>","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144980427","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":"Musculoskeletal Pain in Pediatric Surgeons: Prevalence, Impact, and Prevention-A Cross-Sectional Survey Study.","authors":"Anne-Sophie B Holler, Tatjana T König, Alexandra Schock, Oliver J Muensterer","doi":"10.1055/a-2685-1328","DOIUrl":"https://doi.org/10.1055/a-2685-1328","url":null,"abstract":"<p><p>Recent studies show that at least three-quarters of surgeons who perform minimally invasive surgery suffer from musculoskeletal pain and discomfort. This problem may compromise surgical performance, patient outcomes, and career longevity. Because of small patient dimensions, pediatric surgery is associated with a different set of ergonomic challenges than adult surgery.A 59-item questionnaire was sent to all practicing pediatric surgeons in Germany. It contained a general assessment of demographics, practice setting, operative volume, types of operations performed, and compensatory interventions, followed by the validated Nordic Questionnaires for the analysis of musculoskeletal symptoms (NMQ). Responses were collected and statistically evaluated to identify risk factors for musculoskeletal complications.A total of 152 pediatric surgeons participated in the survey. Among the participants, 21% were trainees, 58% attendings, and 21% chiefs of service. The median time in practice was 18 years (range: 0 to 38 years). Musculoskeletal pain was reported by 75%, and was most prevalent in the neck/cervical (80%), shoulder (56%), and lower back/lumbar region (71%). Footrests or steps were used by 88%, intraoperative breaks were employed by 49%, and 96% of respondents sometimes operated in a sitting position. The only significant factor for musculoskeletal pain was number of years in practice.Musculoskeletal pain among pediatric surgeons is common and increases with years in practice. Although many pediatric surgeons incorporate ergonomic measures in their daily activities, these are far from being implemented universally. More awareness and research on the prevention of long-term musculoskeletal sequelae in pediatric surgery is necessary.</p>","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144994693","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":"MRI-based Stratification and Surgical Management of Hydrocolpos in Children and Adolescents.","authors":"Amr AbdelHamid AbouZeid, Hany Emad Elhady, Shaimaa Abdelsattar Mohammad, Mohammad Seada, Osama El-Naggar, Mostafa Mohamed Elghandour","doi":"10.1055/a-2680-6011","DOIUrl":"10.1055/a-2680-6011","url":null,"abstract":"<p><strong>Introduction: </strong> In this report we present a new anatomical stratification for vaginal obstruction (hydrocolpos) based on MRI findings while referring the level of obstruction to a fixed bony landmark (the pubic symphysis). This new approach can overcome the limitations of current classifications, which are prone to approximation errors during measurement and fail to account for variations in body mass across different age groups.</p><p><strong>Methods: </strong> Data of cases diagnosed with vaginal obstruction were retrospectively analyzed. Cases of cloaca with vaginal obstruction were excluded. MRI confirmed the diagnosis and enabled classification of the level of vaginal obstruction relative to the pubic symphysis in the mid-sagittal plane as low, intermediate, or high-opposite the lower, mid, or upper end of the pubic symphysis, respectively.</p><p><strong>Results: </strong> A total of 13 girls presented with vaginal obstruction during the period 2010 through 2024. Their age ranged between 1 month and 14 years (mean: 54 months; median: 18 months). Three cases presented in the neonatal period with antenatal diagnosis of hydrocolpos, while six cases were referred later during infancy/childhood from other centers. Another group of adolescent girls (four cases) presented with a clinical picture of cryptomenorrhea. The cause of vaginal obstruction was imperforate hymen in one, vaginal atresia in six, persistent urogenital sinus (five cases), and one case of obstructed hemi-vagina. In this series, six cases (46%) had features related to genetic syndromes (Bardet Biedl/ McKusick-Kaufman spectrum). Chronic parenchymatous renal disease was present in three cases among other syndromic features of Bardet Biedl syndrome, in addition to another case with obstructed left hemi-vagina that had absent left kidney (Herlyn-Werner-Wunderlich syndrome). Surgical techniques included simple excision of distal obstructing membrane (four cases), abdominal assisted vaginoplasty (two cases), vaginal pull-through (four cases), simple introitoplasty (one case), urogenital sinus mobilization (one case), and division of longitudinal vaginal septum for a case of obstructed hemi-vagina. Vaginal stenosis or retraction occurred in three cases with intermediate to high-level obstruction-two following abdominal assisted vaginoplasty and one after vaginal pull-through.</p><p><strong>Conclusion: </strong> MRI-based stratification of vaginal obstruction using the pubic symphysis as a reference provides a practical and reproducible approach for surgical planning.</p><p><strong>Type of study and level of evidence: </strong> This is a case series (level IV evidence).</p>","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144838696","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}