European Journal of Pediatric Surgery最新文献

{"title":"Effectiveness and Safety of Shortened Postoperative Antibiotic Regimens in Children with Perforated Appendicitis: A Systematic Review and Meta-Analysis.","authors":"Pia Löfgren, Elias Berge, Elisabeth M L de Wijkerslooth, Lennart Jivegård, Sofia Sjöström, Susanna M Wallerstedt","doi":"10.1055/a-2761-5649","DOIUrl":"10.1055/a-2761-5649","url":null,"abstract":"<p><strong>Background: </strong>Postoperative antibiotic treatment of varying length is routinely used in perforated appendicitis to reduce the risk of complications. In the pediatric population, outcomes of shortened antibiotic regimens have not been specifically reviewed.</p><p><strong>Methods: </strong>Medline, Embase, the Cochrane Library, and CINAHL were searched (October 2023): P, patients: Children with perforated appendicitis; I, intervention and C, comparison: Antibiotic regimen below (I) and above (C) a defined number of days; O, outcomes, focus: Patient risks and benefits. For the main outcome (intra-abdominal abscess), non-inferiority was assessed.</p><p><strong>Results: </strong>Three randomized controlled trials (RCTs; 215 children) and one non-randomized study (288 children) fulfilled the PICO criteria. Regarding intra-abdominal abscess, pooling data from two RCTs (<5 vs. 5 days of intravenous antibiotics; 16 (17%) vs. 15 [15%] events) resulted in a wide 95% confidence interval (risk difference: -8 to 12 percentage points) not meeting the predefined non-inferiority margin of 7.5. One RCT (2 vs. 5 days of intravenous antibiotics) provided data regarding readmissions (9 vs. 7 events) and complications to antibiotic treatment (8 vs. 9 events). Two RCTs (<5 vs. 5 days of intravenous antibiotics) reported significantly shorter length of stay in the intervention group.</p><p><strong>Conclusion: </strong>This systematic review shows neither non-inferiority nor an increased risk of intra-abdominal abscess with a shortened postoperative antibiotic regimen. There may be no difference regarding readmission rates and treatment-related complications. Shorter regimens probably offer the advantage of reduced hospital stay. Due to substantial uncertainties, further RCTs are needed to define the optimal duration of antibiotics in children.</p>","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":" ","pages":"210-216"},"PeriodicalIF":1.8,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13288424/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145829146","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":"Corrigendum: A Retrospective Assessment of Soft Tissue Interposition during Redo Surgery for Postoperative Hypospadias Repair-Related Complications.","authors":"Yuichiro Miyake, Shogo Seo, Junya Ishii, Masahiro Takeda, Yuta Yazaki, Takanori Ochi, Go Miyano, Hiroyuki Koga, Geoffrey J Lane, Atsuyuki Yamataka","doi":"10.1055/a-2839-1777","DOIUrl":"https://doi.org/10.1055/a-2839-1777","url":null,"abstract":"","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":"36 3","pages":"e2"},"PeriodicalIF":1.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147960603","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 Pediatric Surgeon's AI Toolbox: How Large Language Models Like ChatGPT Are Simplifying Practice and Expanding Global Access.","authors":"Carlos Andres Colunga Tinajero","doi":"10.1055/a-2722-3871","DOIUrl":"10.1055/a-2722-3871","url":null,"abstract":"<p><strong>Introduction: </strong>Pediatric surgeons face substantial administrative workload. Large language models (LLMs) may streamline documentation, family communication, rapid reference, and education, but raise concerns about accuracy, bias, and privacy. This review summarizes practical, near-term uses with clinician oversight.</p><p><strong>Materials and methods: </strong>Narrative review of LLMs in pediatric surgical workflows and scholarly writing. Sources included MEDLINE/PubMed, Scopus, Embase, Google Scholar, and policy documents (WHO, FDA, EU). Searches spanned January 2015 to August 2025, English only. Peer-reviewed and multicenter studies were prioritized; selected high-signal preprints were labeled. Data screening and extraction were performed by the author; findings were synthesized qualitatively.</p><p><strong>Results: </strong>Across studies, LLMs reduced drafting time for discharge letters and operative note registries while maintaining clinician-rated quality; they improved readability of consent forms and postoperative instructions and supported patient education. For decision support, general models performed well on structured medical questions, with stronger results when grounded by retrieval. Common limits included coding performance, case-nuance/temporal reasoning, variable translation outside high-resource languages, and citation fabrication without curated sources. Privacy risks stemmed from logging, rare-string memorization, and poorly scoped tool connections. Recommended controls included a clinician-in-the-loop \"review and release\" workflow, privacy-preserving deployments, version pinning, and ongoing monitoring aligned with early-evaluation guidance.</p><p><strong>Conclusion: </strong>When outputs are grounded in structured EHR data or curated retrieval and briefly reviewed by clinicians, LLMs can responsibly reduce administrative burden and support communication and education. Early adoption should target high-volume, low-risk, auditable tasks. Future priorities must include multicenter pediatric datasets, transparent benchmarks (accuracy, calibration, equity, time saved), and prospective studies linked to safety outcomes.</p>","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":" ","pages":"190-196"},"PeriodicalIF":1.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145294499","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":"Lateral Release in Neonatal Congenital Diaphragmatic Hernia Is Associated with Faster Recovery Compared to Abdominal Wall Patch Repair: A Preliminary Prospective Cohort Study.","authors":"Kaja Riebesell, Julia Elrod, Patrick Thees, Richard Martel, Christoph Mohr, Christel Weiss, Thomas Schaible, Carolin Riemer, Nina Dietze, Michael Boettcher, Michaela Klinke","doi":"10.1055/a-2709-5368","DOIUrl":"10.1055/a-2709-5368","url":null,"abstract":"<p><strong>Background: </strong>Open repair of congenital diaphragmatic hernia (CDH) in neonates often requires surgical reconstruction of the abdominal wall. Lateral release (LR) of the abdominal wall fascia, a novel technique avoiding prosthetic patches, offers potential advantages. However, data comparing its outcomes to traditional patch repair are limited.</p><p><strong>Materials and methods: </strong>A preliminary prospective cohort study was conducted at the University Medical Center Mannheim from 2021 to 2024, including neonates undergoing CDH surgery with abdominal wall reconstruction via direct closure, LR, or patch repair based on intraoperative surgeon decision. Perioperative, postoperative, and short-term outcome data were analyzed during our standardized follow-up protocols and compared between groups.</p><p><strong>Results: </strong>Among 77 eligible neonates, 11 underwent patch repair and 10 received LR. Baseline characteristics between groups were comparable. The median follow-up was 391 days in the patch group and 215 days in the LR group (<i>p</i> = 0.1971). The LR group had significantly shorter median intubation duration, neonatal intensive care unit stay, and overall length of stay compared with the patch group (32.0 days vs. 43.0 days, <i>p</i> = 0.0445; 33.5 days vs. 66.0 days, <i>p</i> = 0.0309; 68.0 days vs. 97.0 days, <i>p</i> = 0.0435). There were no significant differences in recurrence rates, short-term complications, or motor developmental outcomes.</p><p><strong>Conclusion: </strong>LR appears to be associated with shorter hospital stays and faster recovery, without an increase in perioperative or long-term complications. While these findings suggest potential benefits of LR, they must be interpreted with caution due to the limited sample size. Further randomized, multicenter studies with larger cohorts, including long-term assessment of complications, are needed to confirm its efficacy and refine clinical guidelines.</p>","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":" ","pages":"221-228"},"PeriodicalIF":1.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145152036","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":"AI in Robotic-assisted Pediatric Surgery: Current Applications and Future Directions.","authors":"Ciro Esposito, Claudia Di Mento, Fulvia Del Conte, Francesco Tedesco, Roberta Guglielmini, Giovanni Esposito, Maria Escolino","doi":"10.1055/a-2722-3348","DOIUrl":"10.1055/a-2722-3348","url":null,"abstract":"<p><strong>Background: </strong>Artificial intelligence (AI) is increasingly integrated into surgical practice, offering enhanced decision-making, precision, and workflow efficiency. In pediatric surgery, the convergence of AI and robotic-assisted platforms represents a promising frontier, addressing the unique anatomical, physiological, and technical challenges of operating on children. Aim of this review is to provide an overview of the current state of art of AI use in pediatric robotic-assisted surgery (RAS), outlining the available evidence, potential benefits, existing limitations, and prospective developments.</p><p><strong>Materials and methods: </strong>A literature-based search of PubMed and Scopus was performed to identify articles covering any aspect of AI application in pediatric RAS. Selection criteria included English language, pediatric patients (under 18 years of age), and AI application to pediatric RAS. Additionally, studies reporting AI applications in adult RAS or for surgical training, which were not primarily focused on pediatric surgery but presented potential translational applicability to pediatric RAS, were considered.</p><p><strong>Results: </strong>A total of 746 papers published until July 2025 were collected. A total of 15 full-text articles were assessed for eligibility, meeting the inclusion criteria. The other studies were excluded because they did not address pediatric surgery, did not involve robotic-assisted procedures, or did not include applications of AI.</p><p><strong>Conclusion: </strong>Although RAS is well established in pediatric practice, the direct application of AI remains limited, with AI-like features such as machine vision and augmented reality serving mainly as supportive tools rather than autonomous decision-making systems. Nevertheless, emerging AI-like technologies and ongoing research hold promising potential for future applications in pediatric robotic surgery.</p>","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":" ","pages":"184-189"},"PeriodicalIF":1.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145294416","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":"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":"168-173"},"PeriodicalIF":1.8,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13305571/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of Corkscrew-Tipped Telescopic Nail in the Management of Osteogenesis Imperfecta in Pediatric Patients.","authors":"Safak Sayar, Celil Alemdar, Ramazan Atic, Sebahattin Demir, Abdulkadir Aydin, Eyyup Serdar Yalvac","doi":"10.1055/a-2877-4810","DOIUrl":"https://doi.org/10.1055/a-2877-4810","url":null,"abstract":"<p><strong>Background: </strong>Telescopic intramedullary nailing is a cornerstone in the surgical management of pediatric osteogenesis imperfecta (OI), providing fracture prevention and deformity correction while accommodating bone growth. Nevertheless, implant-related complications remain a challenge affecting long-term outcomes.</p><p><strong>Methods: </strong>This retrospective single-center study evaluated 13 pediatric patients with OI who underwent femoral fixation using corkscrew-tipped telescopic nails (CTTN) between 2014 and 2021. Demographic characteristics, Sillence classification, surgical indications, radiological outcomes, rod migration, complication, and revision rates were analyzed. Implant survival was assessed using Kaplan-Meier analysis.</p><p><strong>Results: </strong>The study consisted of 7 female (53.8%) and 6 male (46.2%) patients, with a mean age of 9.2 ± 3.8 years. Most patients were classified as Sillence type IB (84.6%), with one patient each classified as Type IA and Type III. Rod migration occurred in three patients (23.0%) without distal joint penetration. Limited telescoping was observed in two femurs (15.2%). The revision rate was 23.0%, and the overall complication rate was 38.4%. Mean rod survival was 4.8 years (95% confidence interval [CI], 3.9-5.7).</p><p><strong>Conclusion: </strong>CTTNs appear to be a feasible option for femoral fixation in pediatric patients with OI, avoiding joint arthrotomy and demonstrating acceptable complication and revision rates. However, lateral rod migration remains a notable limitation, indicating that adjunct stabilization techniques may be required.</p>","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148058430","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":"Recurrent Tracheoesophageal Fistula: A Systematic Review and Meta-Analysis on Surgical and Endotracheal Treatment.","authors":"Julia E Hut, Marit J B van Stigt, Abdulqader Alitani, Ellen M B P Reuling, Robert J Stokroos, Stefaan H A J Tytgat, Johannes W Verweij, Arnold J N Bittermann, Maud Y A Lindeboom","doi":"10.1055/a-2868-4226","DOIUrl":"10.1055/a-2868-4226","url":null,"abstract":"<p><strong>Background: </strong>Recurrent tracheoesophageal fistula (rTEF) is a complication of esophageal atresia, with treatment posing a significant challenge. Surgical treatment (ST) can be performed through thoracotomy, thoracoscopy, or via endotracheal treatment (ET) with de-epithelialization and/or sealants. The optimal treatment option for rTEF, however, remains unclear.</p><p><strong>Aim: </strong>This study systematically reviewed the outcomes of ST and ET for rTEF to determine which treatment approach yields the best outcome.</p><p><strong>Methods: </strong>The study was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Embase, and the Cochrane Library were comprehensively searched for studies published from 2000 to December 2024. Two reviewers independently screened and analyzed the relevant studies. Success and complication rates were pooled using a random-effects model for the meta-analysis. For additional outcomes, descriptive statistics were used.</p><p><strong>Results: </strong>Twenty-seven studies (15 case series, 12 cohort studies), including 540 patients with rTEF, were eligible for inclusion in the systematic review. Meta-analysis showed a pooled success rate after the first procedure of 92.4% (95% CI: 87.8-95.4%) for ST and 27.7% (95% CI: 18.3-39.6%) for ET. After revisional procedures, the success rates increased to 97.7% (95% CI: 92.7-99.3%) for ST and 72.6% (95% CI: 59.5-82.6%) for ET. The mean number of procedures ranged from 1.0 to 1.2 for ST and from 1.3 to 3.8 for ET. The pooled complication rate for ST was 31.0% (95% CI: 5.7-77.1%). The pooled complication rate for ET was 2.1% (95% CI: 0.01-24.1%). The most reported complications for ST included anastomotic strictures and leakage, while postoperative respiratory tract infections were the primary complications for ET.</p><p><strong>Conclusion: </strong>These findings demonstrate that although ST is highly effective and efficient, it is also associated with a high risk of severe complications. In contrast, ET demonstrates a lower success rate, but complications occur less frequently and are less severe. Despite the lower success rate, the minimally invasive techniques and reduced complication risk of endotracheal repair may support its consideration as a first-line treatment option.</p><p><strong>Type of study: </strong>Systematic review and meta-analysis.</p>","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846635","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 Mobilization and Intraoperative Internal Traction-A Novel Approach for Treatment of Long-gap Type C Esophageal Atresia with Distal Carinal Fistula.","authors":"Ludovica Magni, Chiara Barbera, Tobias G H Teunissen, Demi K Focke, Julia E Hut, Lucas F Townsend, Sarah K Rushforth, Arnold J N Bittermann, Johannes W Verweij, Maud Y A Lindeboom, Ellen M B P Reuling, Stefaan H A J Tytgat","doi":"10.1055/a-2844-1481","DOIUrl":"10.1055/a-2844-1481","url":null,"abstract":"<p><strong>Introduction: </strong>Long-gap esophageal atresia (LGEA) is challenging due to the substantial distance between the proximal and distal esophageal pouches. Traditionally, it includes Gross types A and B, while inclusion of long-gap type C cases remains debated. In type C esophageal atresia (EA), the distal tracheoesophageal fistula (TEF) varies in location; when situated at the carina, the effective pouch distance may be markedly increased, making it one of the most complex anatomical subtypes.</p><p><strong>Introduction: </strong>We hypothesized that early primary anastomosis in type C with carinal fistula (TEFC) is feasible using thoracoscopic mobilization and intraoperative internal traction, and aimed to compare outcomes with type C cases where the TEF is higher on the tracheal wall (TEFT).</p><p><strong>Materials and methods: </strong>We analyzed 134 EA patients treated thoracoscopically at the Wilhelmina Children's Hospital in Utrecht between 2012 and 2024, including 25 TEFC and 109 TEFT patients. TEF location was determined by perioperative tracheobronchoscopy, and the surgical approach was tailored accordingly. TEFC patients underwent thoracoscopic esophageal mobilization with intraoperative internal traction, while TEFT patients received conventional primary thoracoscopic anastomosis. Primary outcomes were early successful anastomosis, preservation of the native esophagus, and anastomotic leakage. Secondary outcomes included postoperative morbidity and clinical results during childhood.</p><p><strong>Results: </strong>All patients underwent successful thoracoscopic repair shortly after birth, without requiring esophageal replacement. In the TEFC group, single-stage anastomosis was achieved in 23 patients; two required temporary external traction followed by delayed repair. TEFC patients showed higher rates of anastomotic leakage (40% vs. 20.2%), recurrent stenosis (24% vs. 10.1%), and need for anti-reflux surgery (26.1% vs. 11.3%). Early feeding difficulties affected weight gain in both groups, with 10 to 20% underweight at 6 to 12 months and no significant group difference. By 5.5 years, growth improved markedly, with no TEFC patients and 8.6% of TEFT patients remaining underweight.</p><p><strong>Conclusion: </strong>Although TEFC represents a more complex subgroup with higher complication rates, early thoracoscopic anastomosis with preservation of the native esophagus is achievable in these long-gap type C patients. Routine tracheobronchoscopy may support accurate classification and optimized surgical planning.</p>","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147629328","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":"Esophagus Bioengineering.","authors":"Marta Gazzaneo, Soichi Shibuya, Natalie Durkin, Simon Eaton, Marco Pellegrini, Paolo De Coppi","doi":"10.1055/a-2839-5608","DOIUrl":"10.1055/a-2839-5608","url":null,"abstract":"<p><strong>Abstract: </strong>Tissue engineering represents a promising and innovative strategy for the treatment of complex congenital and acquired esophageal disorders, particularly in patients for whom conventional therapies have failed or current options for organ replacement remain inadequate. Current approaches have explored the use of synthetic and biological scaffolds, cell-based therapies, or combinations of both to promote tissue regeneration and restoration of function. Increasing evidence suggests that, in order to achieve a functional esophagus, hybrid strategies incorporating exogenous cell delivery may further enhance regenerative outcomes while simultaneously modulating inflammatory responses.</p><p><strong>Abstract: </strong>Importantly, the feasibility and effectiveness of esophageal tissue engineering are strongly influenced by the extent and depth of the defect. Encouraging results achieved in partial-thickness defects and patch repair models have supported early clinical translation. Reconstruction of full-thickness circumferential esophageal defects, as required in long-gap esophageal atresia, remains a challenge, primarily due to luminal stenosis, anastomotic leakage, and incomplete regeneration of organized muscular and neuromuscular structures. Recently, the first preclinical demonstration of secondary peristalsis and stent independence in a circumferential, cell-seeded esophageal graft in a growing large-animal model has provided important proof of concept, though translation to longer grafts and clinical application remains to be established. Further preclinical and translational research is required to develop safe, reproducible, and standardized strategies for circumferential esophageal replacement, supported by transparent and comprehensive reporting of experimental outcomes.</p><p><strong>Abstract: </strong>Consequently, further preclinical and translational research is required to develop safe, reproducible, and standardized strategies for circumferential esophageal replacement. Such efforts must be supported by transparent and comprehensive reporting of experimental outcomes to facilitate meaningful comparison and clinical translation. In this review, we summarize current esophageal tissue engineering strategies relevant to esophageal atresia, critically evaluate the available evidence, and discuss future directions in the field.</p>","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147610314","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}