European Journal of Pediatric Surgery最新文献

{"title":"Esophageal Atresia Repair in Germany: Utilization Patterns, Hospital Characteristics and Costs.","authors":"Lucas Wennemann, Jochen Blaser, Sören Wiesner, Jan Zeidler, Mikal Obed, Johannes Weidner, Adan Chari Jirmo, Jens Dingemann, Nagoud Schukfeh","doi":"10.1055/a-2676-2933","DOIUrl":"https://doi.org/10.1055/a-2676-2933","url":null,"abstract":"<p><p>Thoracoscopic esophageal atresia (EA) repair is a demanding procedure. It provides long-term benefits for patients including better cosmesis and less musculoskeletal sequelae compared with open surgery. Besides technical challenges, there is concern that thoracoscopy increases treatment costs. However, surgical treatment of EA in Germany is not centralized with more than 90 pediatric surgical units offering treatment for 200 expected EA patients yearly. Our aim was to evaluate the rate of thoracoscopic EA repair regarding characteristics of treating hospitals, surgical approach and treatment costs in Germany.Insurance claims data (January 2020 to June 2024) from six health insurance companies representing about one-third (28.5 million) of the German population were analyzed. The database was queried for specific ICD-10-GM (International Statistical Classification of Diseases and Related Health Problems, 10th revision, German Modification) and OPS (Operationen- und Prozedurenschlüssel) coding. Characteristics of treating hospitals, length of hospital stay and medical treatment costs were assessed.A total of 149 reconstructive procedures for EA were analyzed. Eleven esophageal anastomoses were performed thoracoscopically (7%). All thoracoscopic procedures were performed in a specialized center. Mean length of hospital stay for open and thoracoscopic surgery was 76 versus 79 days, respectively (<i>p</i> > 0.05). Mean treatment costs were 142,741 € versus 150,238 €, respectively (<i>p</i> > 0.05).Thoracoscopic EA repair remains the exception in Germany. Thoracoscopy is exclusively performed in specialized hospitals. Length of hospital stay and treatment costs are comparable to open surgery, assumingly due to only uncomplicated patients without comorbidities being considered for thoracoscopy. We recommend surgical treatment in specialized centers to enable surgical advantages to all patients with EA.</p>","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144980323","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":"From Bench to Bedside: Eupatilin Activates Antioxidant Defenses and Reduces Fibrosis in Experimental Cholestasis.","authors":"Wei-Lu Wang, Yan Chen, Paul Kwong Hang Tam","doi":"10.1055/a-2676-2832","DOIUrl":"https://doi.org/10.1055/a-2676-2832","url":null,"abstract":"<p><p>The aim of this study is to explore the protective effects and mechanisms of Eupatilin, a peroxisome proliferator-activated receptor α (PPARα) agonist, on cholestatic liver disease induced by common bile duct ligation (BDL) in mice.We selected Balb/c mice (both male and female) aged 6 to 8 weeks for the common BDL procedure (ethical approval number: MUST-FDCT-20241114001). The groups include the BDL group and the BDL+ Eupatilin group, with three mice in each group. Once the mice developed jaundice postsurgery (5 days), they were treated with Eupatilin via gavage at a dosage of 20 mg/kg daily for a period of 8 days. On day 13, ocular blood was collected, and liver tissues were extracted for histopathological examination with H&E staining, Sirius Red staining, and subsequent RNA sequencing. Statistical differences among the parameters were evaluated using a <i>t</i>-test.Eupatilin reduces the liver weight/body weight ratio by 41% and ameliorates liver necrosis and fibrosis in Balb/c mice. It could decrease alanine transaminase ( <i>p</i> = 0.0498), aspartate aminotransferase (<i>p</i> = 0.0077), while maintaining ALB (Albumin) and γ-GT (gamma-glutamyl transferase) within normal ranges. RNA sequencing analysis revealed that antioxidant genes (acetaldehyde dehydrogenase 2 [<i>Aldh2</i>] and superoxide dismutase 1 [<i>Sod1</i>]) might be the targets of Eupatilin action.We found that Eupatilin can upregulate antioxidant genes (<i>Aldh2</i>; <i>p</i> = 0.0107) and <i>Sod1</i> (<i>p</i> = 0.0208) of Balb/c mice, thereby ameliorating BDL damage in mice with cholestatic liver disease.</p>","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144980304","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 Ex Vivo Fluorescence Confocal Microscopy for Intraoperative Diagnosis in Pediatric Surgery: A Feasibility Study.","authors":"Donatella Di Fabrizio, Francesca Mastroberti, Irene Tavolario, Edoardo Bindi, Michele Ilari, Mario Marinelli, Paola Coccia, Alessandra Filosa, Gaia Goteri, Giovanni Cobellis","doi":"10.1055/a-2676-2999","DOIUrl":"10.1055/a-2676-2999","url":null,"abstract":"<p><p>Ex vivo fluorescence confocal microscopy (FCM) is an emerging technology that enables real-time, high-resolution digital imaging of freshly excised tissues without requiring standard histological preparation. This study aims to evaluate the diagnostic performance of FCM compared with conventional histology in a pediatric population with suspected oncological pathology.A total of 18 tissue samples from pediatric patients with suspected oncological lesions were analyzed using FCM. The results were compared with the definitive diagnoses obtained via conventional histology, serving as the gold standard. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated to assess the diagnostic accuracy. Cohen's kappa coefficient (Κ), 95% confidence interval (95% CI), and <i>p</i>-value were computed to evaluate the interobserver agreement and the concordance between FCM and histology.FCM correctly identified 10 positive cases (true positives) and 7 negative cases (true negatives), with 1 false positive and no false negatives. Interobserver agreement was perfect, with a Cohen's kappa coefficient of 1.00 (95% CI: 0.81-1.00, <i>p</i> < 0.001). Sensitivity was 100% (95% CI: 72.2-100%), specificity 87.5% (95% CI: 52.9-97.8%), PPV 90.9% (95% CI: 62.3-98.4%), and NPV 100% (95% CI: 64.6-100%). The Cohen's kappa coefficient was 0.89, indicating excellent agreement between FCM and histology (95% CI: 0.67-1.10, <i>p</i> < 0.001). FCM provided rapid diagnostic results, significantly reducing turnaround time compared with conventional methods.FCM demonstrates exceptional diagnostic accuracy, with excellent sensitivity and specificity in evaluating pediatric specimens. Its ability to deliver reliable intraoperative results highlights its potential as a valuable adjunct to conventional histopathology in pediatric surgery. Larger studies are warranted to confirm these findings and establish their role in clinical practice.</p>","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144790808","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":"286-294"},"PeriodicalIF":1.5,"publicationDate":"2025-08-01","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":"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":"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":"322-331"},"PeriodicalIF":1.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12245518/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility and Challenges of Pyeloureteral Magnetic Anastomosis Device in Domestic Pigs: A Stepwise Approach with Extended Observation.","authors":"Rainer Kubiak, Zita Hornok, Domokos Csukas, Andrea Ferencz, Tamas Cserni","doi":"10.1055/a-2507-8135","DOIUrl":"10.1055/a-2507-8135","url":null,"abstract":"<p><strong>Objective: </strong> The pyeloureteral anastomosis remains the most challenging part of pyeloplasty. A purpose-built anastomotic device could simplify this step and potentially improve outcomes. The concept of a pyeloureteral magnetic anastomosis device (PUMA) was proven in minipigs, but only in short term. Our aim was to test the PUMA in domestic pigs and achieve a prolonged follow-up period.</p><p><strong>Methods: </strong> Five female domestic pigs underwent laparoscopy and ligation of the left ureter. Four weeks later, laparoscopic implantation of the PUMA was planned. Removal of the device and a retrograde contrast study were scheduled after another 4 weeks. The experiment was terminated when the animals could no longer be properly cared for due to their weight.</p><p><strong>Results: </strong> Due to unexpected smaller ureteric diameters, a modified PUMA could only be successfully inserted in pig number 3 (49 kg). Four weeks later, the device was found to be dislocated, but the anastomosis remained patent. After modifying the study protocol, the PUMA was successfully implanted in pigs number 4 (96 kg) and 5 (68 kg) 8 weeks after ureteric ligation. Pig 4 developed malignant hyperthermia and died. In pig 5, the magnets were removed 4 weeks later. After an additional 8 weeks, the animal reached 135 kg and was terminated. The anastomosis remained patent and preserved its diameter.</p><p><strong>Conclusion: </strong> Despite limitations, our study successfully demonstrated that the PUMA can achieve a patent ureteric anastomosis in domestic pigs. This suggests a potential for minimally invasive ureteric anastomosis in clinical settings. Further research is needed to optimize the technique and validate its effectiveness in humans.</p>","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":" ","pages":"316-321"},"PeriodicalIF":1.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017172","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 versus 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":"10.1055/a-2536-4549","url":null,"abstract":"<p><p>This study aimed to evaluate the diagnostic accuracy of uroflowmetry in detecting pediatric urethral strictures following tubularized incised plate (TIP) and non-TIP urethroplasty.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.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 (Q_max) exhibited a higher area under the curve (AUC) than the average urinary flow rate (Q_ave) in both the TIP and non-TIP groups. The Q_max in the non-TIP group demonstrated a higher AUC than in the TIP group (non-TIP: AUC = 0.94, cutoff = 6.65 ml/s, sensitivity = 100%, specificity = 81.0%; TIP: AUC = 0.80, cutoff = 5.75 ml/s, sensitivity = 100%, specificity = 58.1%). A significant quadratic correlation was found between Q_max and urethral calibration (non-TIP: <i>C</i> ² = 14.72 * Q_max, <i>R</i> ² = 0.96; TIP: <i>C</i> ² = 14.76 * Q_max, <i>R</i> ² = 0.88). The Q_max nomogram interval ≤ -3 standard deviation was a significant predictor for non-TIP urethral strictures (kappa = 0.70).Uroflowmetry, particularly Q_max, shows promise as a noninvasive screening tool for detecting urethral strictures after hypospadias repair. It has 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":"309-315"},"PeriodicalIF":1.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12245517/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk Factors for 30-day Mortality in Patients with Surgically Treated Necrotizing Enterocolitis: A Multicenter Retrospective Cohort Study.","authors":"Adinda G H Pijpers, Ceren Imren, Otis C van Varsseveld, Laurens D Eeftinck Schattenkerk, Claudia M G Keyzer-Dekker, Jan B F Hulscher, Elisabeth M W Kooi, Chris H P van den Akker, Joost van Schuppen, H Rob Taal, Jos W R Twisk, Joep P M Derikx, Marijn J Vermeulen","doi":"10.1055/a-2536-4757","DOIUrl":"10.1055/a-2536-4757","url":null,"abstract":"<p><p>Necrotizing enterocolitis (NEC) is a leading cause of death in very preterm born infants. The most severe variant is NEC totalis (NEC-T), where necrosis of the small intestines is so extensive that curative care is often withdrawn. Mortality and NEC-T are difficult to predict before surgery, complicating counseling and decision-making. This study's aim was to identify preoperative risk factors for overall 30-day mortality and NEC-T in preterm born infants with surgical NEC.This multicenter retrospective cohort study included preterm born infants (<35 weeks) surgically treated for NEC between 2008 and 2022. NEC-T was defined as necrosis of the majority of small intestine, leading to a surgical open-close procedure without curative treatment. Preoperative risk factors for 30-day postoperative mortality, NEC-T, and mortality without NEC-T were assessed using multivariable logistic regression analyses.Among the 401 patients included, the 30-day mortality rate was 34.2% (137/401), of which 18.7% (75/401) involved NEC-T. Significant risk factors for mortality were male sex (odds ratio [OR]: 2.53; 95% confidence interval [CI]: 1.54-4.16), lower birthweight (OR: 0.91; 95% CI: 0.86-0.96/100 g), portal venous gas (PVG) on abdominal radiograph (OR: 1.89; 95% CI: 1.11-3.20), need for cardiovascular support between NEC diagnosis and surgery (OR: 3.26; 95% CI: 2.02-5.24), and shorter time between diagnosis and surgery (OR: 0.74; 95% CI: 0.65-0.84). Similar risk factors were found for NEC-T. In patients without NEC-T, the need for cardiovascular support (OR: 2.33; 95% CI: 1.33-4.09) and time between diagnosis and surgery (OR: 0.77; 95% CI: 0.64-0.91) were significant.Male sex, lower birthweight, PVG, cardiovascular support, and a short interval between NEC diagnosis and surgery are preoperative risk factors for 30-day mortality and NEC-T. Preoperative cardiovascular support and a shorter time interval between diagnosis and surgery are also risk factors for mortality without NEC-T.II.</p>","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":" ","pages":"332-340"},"PeriodicalIF":1.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12245516/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143675069","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":"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":"10.1055/a-2536-4328","url":null,"abstract":"<p><p>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 of PFPT and outcomes following PFPT.We performed a single-institution, retrospective chart review of patients with HD referred to PFPT between 2020 and 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; symptoms were also compared. A <i>p</i>-value of 0.05 was considered significant.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 the 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%, <i>p</i> = 0.02) and required formal support systems (28.2% vs. 3.3%, <i>p</i> = 0.02). In patients seeing PFPT, incontinence significantly improved (81.1% before vs. 40.5% after, <i>p</i> = 0.001).Although 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":"295-301"},"PeriodicalIF":1.5,"publicationDate":"2025-08-01","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":"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":"261-268"},"PeriodicalIF":1.5,"publicationDate":"2025-08-01","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}