European Journal of Pediatric Surgery最新文献

{"title":"Giant Omphalocele: Systematic Review of Pulmonary Complications and Implications for Neonatal Care.","authors":"Joana Peixoto, Joana Neto, Susana Pissarra, Inês Azevedo, Henrique Soares, Rita Amaral, Gustavo Rocha","doi":"10.1055/a-2649-0781","DOIUrl":"10.1055/a-2649-0781","url":null,"abstract":"<p><p>The primary objectives were to know the prevalences of pulmonary hypoplasia (PH), persistent pulmonary hypertension of the newborn (PPHN), and mortality in newborn infants with giant omphalocele (GO). A secondary aim was to assess the prevalence of syndromes and other congenital anomalies (SCA) associated with GO.A systematic review according to PRISMA guidelines using MEDLINE/PubMed, Google Scholar, and Scopus platforms was performed. The search strategy combined indexed and in-process citations up to May 22, 2023.Out of 651 articles, 23 met the inclusion criteria, comprising 14 observational studies and 9 case reports. There was no uniformity in the criteria for diagnosing PH and PPHN among the studies. In the observational studies, the prevalence of PH varied between 18.5 and 54% (median: 26%); the prevalence of PPHN varied between 13 and 100% (median: 38.5%); and mortality varied between 4 and 50% (median 23.5%). SCA were reported in 58% of patients. In the case series, PH was present in 27.8% of the neonates, PPHN in 50%, and mortality occurred in 55.5%. About 55.5% had associated SCA. The association of SCA and preterm birth contributed significantly to increase the mortality rate.The reported prevalences of PH, PPHN, mortality, and SCA associated with GO are alarmingly high. Although the heterogeneity and limitations of the included studies prevent definitive prevalence estimates, the findings underscore the urgent need for standardized diagnostic criteria, better prenatal counseling, and management in highly specialized centers.</p>","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":" ","pages":"150-156"},"PeriodicalIF":1.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661127","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":"Enhancing AI Readiness in Pediatric Surgery: Impact of a Targeted Workshop on Knowledge and Competencies.","authors":"Holger Till, Hesham Elsayed, Georg Singer, Beate Obermüller, Tristan Till, Richard Gnatzy, Sebastian Tschauner","doi":"10.1055/a-2650-6603","DOIUrl":"10.1055/a-2650-6603","url":null,"abstract":"<p><p>Despite an awareness of the transformative potential of artificial intelligence (AI) in health care, its development in pediatric surgery seems slow. One major reason may be a lack of formal AI training. This study assesses the basic AI knowledge and the effectiveness of AI workshops (AI-WS).Four AI-WS were held at the International Academy of Pediatric Surgery 2024. Topics included AI principles, real-time algorithm training, and potential AI applications in pediatric surgery. Self-developed surveys consisting of eight pre-WS and nine post-WS questions were conducted, focusing on participants' AI competencies, usage, educational needs, barriers, and future perspectives.Out of 57 pediatric surgeons, 53 completed both surveys. None had formal AI training. Although 90% were familiar with AI in diagnostic imaging, most had only basic knowledge of AI technology. After the workshop, participants reported a significant increase in the general understanding of AI/machine learning (ML) (<i>p</i> < 0.001). 96% stated that they were better informed about AI/ML applications for clinical practice; 83% expressed interest in further AI training; 91% believed that AI will be more integrated into clinical practice; and over 80% anticipated that AI will improve patient outcomes.The AI-WS effectively enhanced pediatric surgeons' AI knowledge and their readiness to adopt AI technologies. Even though our study is limited by the relatively low sample size and a potential selection bias, our results still highlight the importance of targeted education in preparing health care professionals for AI integration. The long-term sustainability of knowledge gains, however, has to be examined in further studies.</p>","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":" ","pages":"125-129"},"PeriodicalIF":1.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12965792/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144593011","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":"Evolving Surgical Practices in Esophageal Atresia: Insights from the EUPSA-ERNICA Survey a Decade After the 2014 Baseline Study.","authors":"Tutku Soyer, Federica Pederiva, Luca Pio, Olivia K C Spivack, Igor Sukhotnik, Fabian Doktor, Elke Zani-Ruttenstock, Ramon Gorter, Jens Dingemann, Carmen Mesas-Burgos, Rene Wijnen, Nigel Hall","doi":"10.1055/a-2793-1101","DOIUrl":"10.1055/a-2793-1101","url":null,"abstract":"<p><p>The European Paediatric Surgeons' Association (EUPSA) and the European Reference Network for Rare Inherited and Congenital Anomalies (ERNICA) conducted a survey to assess the current surgical management and care practices for esophageal atresia (EA) in order to assess changes over the past decade.An online survey consisting of 56 questions was administered to EUPSA members and ERNICA representatives between March and September 2025. The questionnaire covered seven domains: center structure, preoperative assessment, surgical management of esophageal atresia and tracheoesophageal fistula (EA-TEF) patients and long-gap EA, postoperative care, long-term follow-up, and the management of complications. Results were compared to practices reported in a previous EUPSA Network Office survey in 2013.There were a total of 202 respondents from 41 countries with 60% from European Union countries. Compared with previous surveys, the routine use of preoperative bronchoscopy and the use of trans-anastomotic tubes were found to be significantly more common (both <i>p</i> < 0.001). A marked increase in preference for thoracoscopic techniques for EA-TEF was observed (<i>p</i> < 0.001). The routine use of chest drains, elective paralysis, and contrast studies prior to feeding initiation also rose significantly over the decade (<i>p</i> ≤ 0.004). Yet for many areas of care, there remains variation between surgeons, and structured long-term follow-up arrangements are not universal.The findings demonstrate increased standardization and suggest increased adherence to recommendations in the management of EA-TEF. However, significant variation persists in long-term follow-up, transition-to-adult-care programs, and structured quality-of-life assessment, highlighting areas for future harmonization across European centers.</p>","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146042114","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 Enhances Diagnostic Accuracy of Contrast Enemas in Hirschsprung Disease Compared to Clinical Experts.","authors":"Paulina Vargova, Matej Varga, Beatriz Izquierdo-Hernández, Cristina Gutierrez-Alonso, Ainara Gonazlez-Esgueda, Maria Victoria Cobos-Hernández, Rafael Fernandez-Atuan, Yurema Gonzalez-Ruiz, Paolo Bragagnini-Rodriguez, María Del-Peral-Samaniego, Carolina Corona-Bellostas","doi":"10.1055/a-2646-2052","DOIUrl":"10.1055/a-2646-2052","url":null,"abstract":"<p><p>Contrast enema (CE) is widely used in the evaluation of suspected Hirschsprung disease (HD). Deep learning is a promising tool to standardize image assessment and support clinical decision-making. This study assesses the diagnostic performance of a deep neural network (DNN), with and without clinical data, and compares its interpretation with that of pediatric surgeons and radiologists.In this retrospective study, 1,471 CE images from patients <15 years were analyzed, with 218 images used for testing. A DNN, pediatric radiologists, and surgeons independently reviewed the testing set, with and without clinical data. Diagnostic performance was assessed using ROC and PR curves, and interobserver agreement was evaluated using Fleiss' kappa. Rectal biopsy served as the reference standard.The DNN achieved high diagnostic accuracy (area under the receiver operating characteristic curve [AUC-ROC] = 0.87) in CE interpretation, with improved performance when combining anteroposterior and lateral images (AUC-ROC = 0.92). Clinical data integration further enhanced model sensitivity and negative predictive value. The super-surgeon (majority voting of colorectal surgeons) outperformed most individual clinicians (sensitivity 81.8%, specificity 79.1%), while the super-radiologist (majority voting of radiologists) showed moderate accuracy. Interobserver analysis revealed strong agreement between the model and surgeons (Cohen's kappa = 0.73), and overall consistency among experts and the model (Fleiss' kappa = 0.62).Artificial intelligence-assisted CE interpretation achieved higher specificity and comparable sensitivity to that of the clinicians. Its consistent performance and substantial agreement with experts support its potential role in improving CE assessment in HD.</p>","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":" ","pages":"3-12"},"PeriodicalIF":1.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144546345","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":"Emergency Laparotomy in the Neonatal Intensive Care Unit: A Systematic Review of Indications and Outcomes.","authors":"Simran Sehdev, Benjamin O'Sullivan, Benjamin J Blaise, Geraint Lee, Andrew Selman, Iain Yardley","doi":"10.1055/a-2767-4700","DOIUrl":"10.1055/a-2767-4700","url":null,"abstract":"<p><p>Cotside laparotomy is often performed in critically ill neonates, but its indications over in-theatre laparotomy remain unclear. This is the first systematic review of published evidence, aiming to clarify the feasibility, safety, and indications for neonatal intensive care (NICU)-based laparotomy.A systematic review was conducted following PRISMA guidelines. Quantitative data on patient demographics and outcomes were extracted, and where possible, aggregated comparative analyses were performed. Qualitative thematic analysis was used to explore reported institutional experiences of cotside laparotomy.Eighteen studies were included, reporting data from 20 surgical sites across 10 countries, published from 1994 to 2024. Eight studies reported a comparator group of theatre-based laparotomies. In total, data on 418 cotside and 453 theatre laparotomies were included. Cotside cohorts had lower birthweight (approximately 1,305 g vs. 2,941 g, <i>p</i> = 0.016) and gestational age (approximately 29.5 vs. 34.3 weeks, <i>p</i> = 0.047). Postoperative adverse event rates were similar between neonates in each group (8.1%, 33/407 vs. 6.8%, 30/442; <i>χ</i> ² = 0.23, <i>p</i> = 0.63), as was in-hospital mortality (24.1%, 98/407 vs. 25.3%, 112/442; <i>χ</i> ² = 0.15, <i>p</i> = 0.70). Thematic analysis identified transfer-related events as a significant concern in babies operated in theatre, particularly endotracheal tube dislodgement and hypothermia, while cotside operating space constraints and disturbance to NICU activities were frequently cited issues. Decisions on surgical location were multifactorial and multidisciplinary, influenced by cardiorespiratory status and institutional factors. Formal institutional guidelines for cotside surgery were reported in only 33% (6/18) of studies.Emergency cotside laparotomy is safe and feasible. Despite consisting of a higher risk population, mortality and morbidity are comparable to theatre-based surgery. Avoiding the risks of transfer may confer additional benefit. Large-scale, prospective studies are needed to clarify the indications for cotside operating.</p>","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":" ","pages":"43-51"},"PeriodicalIF":1.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145716894","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":"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":"59-64"},"PeriodicalIF":1.4,"publicationDate":"2026-02-01","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":"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":"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":"29-35"},"PeriodicalIF":1.4,"publicationDate":"2026-02-01","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":"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":"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":"36-42"},"PeriodicalIF":1.4,"publicationDate":"2026-02-01","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":"Age-Stratified Impact of Early Virtual Reality Intervention on Preoperative Anxiety in Children: A Randomized Trial.","authors":"Gloria Chocarro Amatriain, Teresa M Cardenal Alonso-Allende, Olga Olivas Gallego, Iñigo Tuduri Limousin, Ruben I Garcia Fernandez, Arturo Galbarriatu Gutierrez, Luana Alvarez Martinez, Marcela P Valdivieso Castro, Carmen M Galvez Estevez, Maria I Rodriguez Tabares, Maria R Garcia Mate, Izaskun Grijalba Ipiñazar, Gorka Najarro Ajuria, Lara Medrano Mendez, Estibaliz Solorzano Rodriguez, Nagore Solaeche Prieto, Eduardo Ruiz Aja, Ana Muñiz Castellanos, Igone Chavarria Santiago, Jose L Blanco Bruned","doi":"10.1055/a-2753-9692","DOIUrl":"10.1055/a-2753-9692","url":null,"abstract":"<p><p>Although it is known that virtual reality (VR) reduces presurgical anxiety, it has neither been stratified by age to determine its effect, nor has been applied before the day of surgery. This study has a novel age-stratified design offering VR months before surgery to address these unstudied issues.This was a unicentered, blinded clinical trial with parallel groups stratified by age (5-8 and 9-12 years), including major outpatient surgery patients. VR video showing the course of surgery was offered months before surgery. This study had ethical committee approval. The main variable was the modified Yale Preoperative Anxiety Scale (mYPAS) before entering the operating room. The Child Behavior Checklist (CBCL) measured basal anxiety and the Posthospitalization Behavior Questionnaire (PHBQ) measured behavior after 1 month. For comparison, Student's <i>t</i>-test or Kruskal-Wallis test was used.Of 72 patients, 6 met exclusion criteria and 5 withdrew consent. Of the remaining 61, 56 completed mYPAS. The mYPAS decrease was significant for children aged 5 to 8 years (28.33 VIDEO vs. 35.83 non-VIDEO; <i>p</i> = 0.042) (rank coefficient 0.45 [0.05-0.72]). In the children aged 9 to 12 years (32.91 vs. 33.33; <i>p</i> = 0.864), a tiny correlation (<i>r</i> = 0.04 [0.38-0.45]) was found. A total of 96.67% of CBCLs (<i>n</i> = 58) scored normal. The 57 completed PHBQs had very low scores, both in non-VIDEO (0.00 [0.00-4.50]) and in VIDEO groups (0.00 [0.00-4.50]). No differences were found; neither globally (<i>p</i> > 0.05), nor depending on age (5-8 years, <i>p</i> = 0.508/9-12 years, <i>p</i> = 0.661).VR may reduce preoperative anxiety in younger children (5 to 8 years), though its effect in the entire group was borderline. Larger multicenter studies are needed to confirm age and timing benefits.</p>","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":" ","pages":"13-22"},"PeriodicalIF":1.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145643392","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":"Acquired Diaphragmatic Hernia Following Pediatric Liver Transplantation: Incidence, Risk Factors, and Surgical Outcomes.","authors":"Nathalie Pauer, Nicolas Richter, Ulrich Baumann, Norman Junge, Caroline Fortmann, Mikal Obed, Jens Dingemann, Rim Kiblawi","doi":"10.1055/a-2767-7420","DOIUrl":"10.1055/a-2767-7420","url":null,"abstract":"<p><p>Acquired diaphragmatic hernia (ADH) is an uncommon yet relevant complication after pediatric liver transplantation (pLTx). True incidence and risk factors remain poorly defined, largely due to limited screening, heterogeneous imaging practices, and the absence of validated predictive models. This study aimed to determine the incidence, presentation, and risk factors for ADH and to compare surgical repair techniques and short-term outcomes of thoracoscopic versus open approaches.We performed a retrospective review of all children undergoing pLTx at our institution (2014 and 2024). Demographic and transplant-related data were analyzed in patients with and without ADH. Operative approach, postoperative recovery, and 6-month follow-up were assessed. Findings were placed into context by comparison with published series.Among 246 pediatric transplant recipients, 8 children developed ADH (3.3%). Two patients had bilateral defects; each side was repaired electively in separate, staged procedures. Counting each side as a distinct repair event yielded 10 ADH repair procedures for analysis. Children who developed ADH were significantly younger at transplantation (mean 9.7 months vs. 64.0 months, <i>p</i> = 0.002) and had lower body weight (7.8 kg vs. 20.7 kg, <i>p</i> = 0.004). Prior abdominal surgery was common (five-eighths). Seven patients received a left lateral segment graft (LLS); graft-to-recipient weight ratio was 3.8% versus 3.2% in non-ADH patients (<i>p</i> = 0.107). Most hernias were right-sided, with presentations ranging from respiratory symptoms to incidental imaging findings. Surgical repair was performed via laparotomy in six cases and thoracoscopy in four, with one conversion to thoracotomy. Short-term outcomes were favorable in both groups, with only one recurrence (after laparotomy) and no mortality during follow-up.ADH after pLTx occurred in a minority of recipients and was associated with younger age, low body weight, prior abdominal surgery, and LLS grafts. However, the specific contribution of these variables remains unclear. Persistent research gaps include the lack of standardized screening protocols, uncertainty regarding cumulative long-term risk, and the absence of predictive models to identify high-risk patients. Addressing these issues requires multicenter collaboration and prospective surveillance strategies. Thoracoscopic repair was feasible in selected patients and may be considered when suitable.</p>","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":" ","pages":"52-58"},"PeriodicalIF":1.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145776659","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}