European Journal of Pediatric Surgery最新文献

{"title":"In-Office Pit Excision for Pilonidal Disease Using Needle-Free Local Anesthesia: A Minimally Invasive, Non-Operative Treatment Approach.","authors":"Ashley Stoeckel, Kathleen Renzi, Gheed Murtadi, Madelyn McArthur, Tayana Jean Pierre, Rachael Cohen, David P Mooney","doi":"10.1055/a-2773-3657","DOIUrl":"10.1055/a-2773-3657","url":null,"abstract":"<p><strong>Introduction: </strong>Treatment of pilonidal disease traditionally involves an operation under general anesthesia, which may have a period of postoperative disability and a significant recurrence rate. We report a novel treatment for pilonidal disease performed in-office using a pneumatic lidocaine injection device, requiring no pain medication or activity restrictions-supporting a non-operative standard of care.</p><p><strong>Methods: </strong>Patients with gluteal crease pits at our Pilonidal Care Clinic were offered pit excision as standard care. Prospective data on demographics, pain scores (0-10), and outcomes were collected in REDCap. Under sterile conditions, patients received 1% buffered lidocaine via pneumatic injection. Laser follicle ablation was followed by punch excision (1.5 or 2 mm) of full-thickness pit epithelium. Sinus tracts were probed but not excised. Patients were asked to wash the area twice daily, maintain normal activities, and return in 6 to 8 weeks. Patients requiring nidus incision and drainage (I&D) were excluded.</p><p><strong>Results: </strong>About 130 patients underwent this technique between February and June 2024; 100 were included in the analysis (5 excluded for concurrent I&D, 25 lost to follow-up). Mean age was 18.1 years; 50% were male. At subsequent follow-up, 60% patients healed all pits, resolving their condition, with 64% (144/224) of all pits healed. Patients with three or more pits were more likely to need an additional pit excision. Mean procedure pain score was 1.6/10 (SD 1.21); no patient used pain medication or experienced disability. Ultimately, 88% of patients healed all of their pits.</p><p><strong>Conclusion: </strong>Pilonidal disease may be resolved non-operatively in a single outpatient clinic visit, without even a shot.</p>","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":" ","pages":"351-355"},"PeriodicalIF":1.8,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145859697","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":"Post-Closure Abdominal Hernias in Infants with Giant Omphaloceles: Schuster Staged Repair versus Delayed Closure.","authors":"Jingdian Huang, Caitlin Eason, Sarkis C Derderian","doi":"10.1055/a-2819-1651","DOIUrl":"10.1055/a-2819-1651","url":null,"abstract":"<p><strong>Purpose: </strong>Giant omphaloceles (GOs) pose significant surgical challenges. Two common strategies to close the defect include applying a topical epithelializing agent with delayed closure and the Schuster staged closure, which approximates the abdominal wall within 2 weeks of life. Although patient selection is critical for the Schuster staged closure, it remains unclear whether the rapid rise in intra-abdominal pressure increases abdominal hernia risk. We hypothesized that abdominal hernia rates differ between closure strategies.</p><p><strong>Methods: </strong>We conducted a single-institution, retrospective cohort study comparing abdominal hernia rates in patients undergoing Schuster staged closure versus delayed closure between 2012 and 2022.</p><p><strong>Results: </strong>Among 21 patients who met the inclusion criteria, 9 underwent the delayed closure, and 12 underwent the Schuster staged closure. Demographics were similar, but birth weight and prenatal lung volumes differed between groups, with greater values in the Schuster group. Abdominal hernias occurred more frequently after Schuster closure (<i>n</i> = 9, 75%) versus delayed closure (<i>n</i> = 2, 22%; <i>p</i> = 0.03) within 2 years. Bilateral inguinal hernias were most common.</p><p><strong>Conclusion: </strong>Infants undergoing Schuster staged closure for GOs had a higher incidence of abdominal hernias than those with delayed closure. Given underlying physiologic differences between groups, these findings should be interpreted as hypothesis-generating rather than causal.</p>","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":" ","pages":"300-304"},"PeriodicalIF":1.8,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147286102","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":"Anorectal Malformation with Rectoperineal Fistula in Females Treated with a Posterior Rectal Advancement Anoplasty: Report of Early Outcomes.","authors":"Thomas Xu, Julia A Ryan, Filipa Jalles, Arianne M Maya, Christina Feng, Richard J Wood, Andrea Badillo, Marc A Levitt","doi":"10.1055/a-2770-2641","DOIUrl":"10.1055/a-2770-2641","url":null,"abstract":"<p><strong>Objective: </strong>The posterior rectal advancement anoplasty (PRAA) is a novel approach for females with rectoperineal fistulas in which the distal fistula tract lies within the anterior limit of the anal sphincter complex. PRAA eliminates the risk of vaginal injury and perineal body dehiscence while allowing for an appropriately sized and centered anal opening. This study aims to examine the complications and outcomes following PRAA.</p><p><strong>Methods: </strong>A retrospective, single-institution study was performed of female patients with an anorectal malformation with a rectoperineal fistula between January 2020 and December 2023. PRAA was performed when the rectoperineal fistula was located within the anterior extent of the anal sphincteric ellipse. We assessed time to first feeding, length of stay, and early stooling patterns and complications.</p><p><strong>Results: </strong>Twelve patients underwent PRAA at a median age of 171 days with a median follow-up of 5 months. None were previously diverted with an ostomy. There was no incidence of vaginal injury, wound dehiscence, rectal prolapse, or anal stricture. All were able to resume feeds immediately and were discharged home on postoperative day 1. On follow-up, all patients were stooling spontaneously, and nine (75%) were utilizing daily laxatives.</p><p><strong>Conclusion: </strong>The PRAA, specifically in female patients with rectoperineal fistula within the anterior limit of the sphincters, eliminates the risk of vaginal injury and perineal body dehiscence. This technique decreases the risk of rectal prolapse and anal stricture and allows patients to return to their regular diet and home quickly, after only 1 postoperative day. It can be done without the need for a colostomy. Longer-term data are needed to continue to explore functional outcomes.</p>","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":" ","pages":"217-220"},"PeriodicalIF":1.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145764439","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":"10.1055/a-2708-2852","url":null,"abstract":"<p><strong>Objective: </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-CA and those without these anomalies (non-VACTERL). Groups were compared for demographics, associated malformations, surgical approach, complications, and outcomes.</p><p><strong>Results: </strong>Among 372 patients, 22% (<i>n</i> = 82) were classified as VACTERL-CA. This group had significantly lower gestational age (35.9 weeks vs. 37.1 weeks, <i>p</i> = 0.004), birth weight (2,312 g vs. 2,663 g, <i>p</i> < 0.001), and APGAR scores at 5 and 10 minutes (<i>p</i> = 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%, <i>p</i> = 0.023). Overall mortality was higher in VACTERL-CA (14.6% vs. 5.2%, <i>p</i> = 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%, <i>p</i> = 0.033). In multivariate analysis, low birth weight (adjusted odds ratios [aOR]: 0.95 per 100 g, <i>p</i> = 0.010) and cardiac malformations (aOR: 2.33, <i>p</i> = 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":"229-236"},"PeriodicalIF":1.4,"publicationDate":"2026-06-01","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":"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><strong>Background: </strong>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.</p><p><strong>Patients and methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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":"237-250"},"PeriodicalIF":1.4,"publicationDate":"2026-06-01","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":"Artificial Intelligence in Pediatric Surgery: From Diagnostics and Preoperative Planning to Risk Stratification: A Comprehensive Review of Current Applications.","authors":"Richard Gnatzy, Xiaoyan Feng, Daniel Graefe, Oliver J Deffaa, Martin Lacher","doi":"10.1055/a-2743-4868","DOIUrl":"10.1055/a-2743-4868","url":null,"abstract":"<p><strong>Objective: </strong>Artificial intelligence (AI) is increasingly explored in pediatric surgical care, yet its translation into diagnostics and preoperative planning lags behind adult surgery. Unlike prior reviews, this study provides a comprehensive synthesis across four domains, diagnostics, preoperative planning, risk stratification, and surgical error prevention, highlighting recent advances and unmet challenges.</p><p><strong>Methods: </strong>A narrative review of PubMed/MEDLINE (2020-2025) identified peer-reviewed studies on AI in pediatric surgery. Eligible articles addressed one of the four domains and were assessed for methodology, clinical applicability, and relevance to pediatric surgical patients.</p><p><strong>Results: </strong>Diagnostic imaging is the most advanced field, with deep learning models for fracture detection and bone age assessment achieving accuracies up to 95% and near-expert agreement, though external validation is scarce. Preoperative planning benefits from AI-driven segmentation, 3D reconstruction, and virtual reality, with reports of altered surgical strategy in up to 8% of oncology cases, but evidence of outcome benefit is limited. Risk models for appendicitis and congenital heart surgery often surpass clinical scores, yet fewer than 10% have undergone external validation. Tools for error prevention, such as intelligent checklists and workflow monitoring, remain at the proof-of-concept stage. Across domains, most studies are retrospective, single-center, and methodologically heterogeneous.</p><p><strong>Conclusion: </strong>AI demonstrates tangible potential to improve pediatric surgical diagnostics, planning, and safety. However, translation into clinical practice requires multicenter pediatric datasets, prospective validation, and transparent, interpretable models. By consolidating the most recent evidence across four domains, this review outlines both the opportunities and critical gaps that should be addressed for safe and effective adoption.</p>","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":" ","pages":"174-183"},"PeriodicalIF":1.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145643441","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":"Intercostal Nerve Cryoablation for Postoperative Pain Control After the Nuss Procedure in Children: A Systematic Review and Meta-Analysis.","authors":"Diogo Marques, Rafael Vieira, Ana Fragoso, Tiago Tuna","doi":"10.1055/a-2708-2796","DOIUrl":"10.1055/a-2708-2796","url":null,"abstract":"<p><strong>Introduction: </strong>Nuss procedure is the standard technique for pectus excavatum repair. Despite its minimally invasive nature, this procedure is associated with significant postoperative pain and high opioid consumption. Intercostal nerve cryoablation (INC) has emerged as an adjunct to multimodal analgesia (MMA) to improve pain control, reduce opioid use, and shorten length of stay (LOS). This systematic review aims to assess INC outcomes following the Nuss procedure in pediatric patients.</p><p><strong>Materials and methods: </strong>A systematic search was conducted in PubMed, Web of Science, Scopus, and Cochrane Library databases through December 2024. Studies comparing INC with standard MMA, with or without thoracic epidural, in pediatric patients undergoing the Nuss procedure were included. The primary outcome was LOS, and the secondary outcomes were opioid consumption, postoperative pain, complications, operative time, and hospitalization costs. Risk of bias was determined using the National Institutes of Health assessment tool. Meta-analysis was performed using R software.</p><p><strong>Results: </strong>Eleven studies met the inclusion criteria, comprising 922 patients (476 INC and 446 control). INC significantly reduced LOS (-2.2 days; 95% CI: -2.8 to -1.8) at the expense of increased operating room time (+23 minutes; 95% CI: 10-39). Qualitative analysis showed reduced opioid use and comparable pain scores and complication rates with INC, while its impact on costs was conflicting.</p><p><strong>Conclusion: </strong>INC reduces LOS and opioid use in pediatric patients undergoing the Nuss procedure without increasing complications. Further studies are needed to assess long-term safety and cost-effectiveness.</p>","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":" ","pages":"198-209"},"PeriodicalIF":1.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145139607","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":"Pediatric Empyema in the Post-Pandemic Period: Evaluating Changing Trends in Microbiology, Investigations, Fibrinolysis, and Surgical Outcomes.","authors":"Kevin Xi Cao, Eleftheria Xilas, Imogen Seago, Mahmoud Abdelbary, Wajid Jawaid, Adil Aslam","doi":"10.1055/a-2766-6940","DOIUrl":"10.1055/a-2766-6940","url":null,"abstract":"<p><strong>Introduction: </strong>We present a retrospective analysis of our experience managing pediatric empyema, focusing on clinical, microbiological, radiological aspects, surgical and fibrinolytic outcomes over an 8-year period, encompassing the 2022-2023 United Kingdom invasive group A <i>Streptococcus</i> (iGAS) surge. This observational study aimed to test the hypothesis that the post-pandemic period has revealed a new pattern of microbes, disease patterns, and treatment effectiveness.</p><p><strong>Materials and methods: </strong>Case notes of children (<16 years) with thoracic empyema who had an intercostal drain between 2014 and 2023 were reviewed for demographic, imaging, microbiological, and operative findings. Periods were categorized as pre-pandemic (2015-2020), pandemic (2020-2021), and post-pandemic (2022-2023).</p><p><strong>Results: </strong>From 86 cases, median ages fell from 9.9 years (pre-pandemic), 6.2 years (pandemic), to 4.4 years (post-pandemic). Pleural culture detected organisms in 27% while 16S PCR increased the yield to 90.7%. <i>Streptococcus pyogenes</i> (43.4%) and <i>Streptococcus pneumoniae</i> (30.2%) predominated. Viral coinfection was associated with necrosis (45% vs. 24% without coinfection). Intrapleural fibrinolysis effectiveness fell from 81% pre-pandemic to 60% post-pandemic, with a concomitant rise in need for further surgery from 19% to 48%. Alongside these changes, the length of stay increased from 8 to 11 days (pre- vs. post-pandemic). There were no empyema-related deaths at our center over this study period.</p><p><strong>Conclusion: </strong>Post-pandemic empyema was characterized by younger age, a higher proportion of <i>S. pyogenes</i>, and increased intrapleural fibrinolytics failure and surgery. These data support earlier surgical consultation for younger patients or those with viral coinfections, prospective evaluation of dual-agent fibrinolysis in children, and integration of 16S PCR into pleural workflows. Ongoing surveillance of empyema epidemiology is needed to optimize future management.</p>","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":" ","pages":"251-258"},"PeriodicalIF":1.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145716872","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":"Artificial Intelligence in Pediatric Surgery-From Vision to Clinical Reality.","authors":"Holger Till, Richard Gnatzy","doi":"10.1055/a-2702-2003","DOIUrl":"10.1055/a-2702-2003","url":null,"abstract":"","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":" ","pages":"167"},"PeriodicalIF":1.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145745737","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":"Comment on \"The Pediatric Surgeon's AI Toolbox: How Large Language Models Like ChatGPT Are Simplifying Practice and Expanding Global Access\".","authors":"Hinpetch Daungsupawong, Viroj Wiwanitkit","doi":"10.1055/a-2794-6130","DOIUrl":"10.1055/a-2794-6130","url":null,"abstract":"","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":" ","pages":"197"},"PeriodicalIF":1.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146114982","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}