{"title":"Congenital inguinal hernia, hydrocele and undescended testis","authors":"Nia Jones, Hetal N Patel","doi":"10.1016/j.mpsur.2025.05.002","DOIUrl":"10.1016/j.mpsur.2025.05.002","url":null,"abstract":"<div><div>Congenital (indirect) inguinal hernia, hydrocele and undescended testis (UDT) are common diagnoses in the paediatric patient. This article discusses the embryology and pathology of testicular descent and the patent processus vaginalis leading to congenital inguinal hernia and hydrocele. The presentation and managementin both the elective and acute setting is summarized as well as the operative steps of surgical repair.</div></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"43 8","pages":"Pages 530-534"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144738384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Nutrition in paediatric surgical patients","authors":"Oliver McCallion, Alex CH Lee","doi":"10.1016/j.mpsur.2025.06.005","DOIUrl":"10.1016/j.mpsur.2025.06.005","url":null,"abstract":"<div><div>Infancy and childhood are metabolically demanding periods of life that require adequate nutrition to enable growth, development, and activity. These demands are elevated during periods of illness and physiological stress, for example in the postoperative period, whilst various surgical pathologies can impede adequate enteral nutrition. In this article, we provide an overview of current practice in paediatric surgical nutrition and the practicalities of supplementing or replacing oral feeding by different routes.</div></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"43 8","pages":"Pages 492-497"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144738390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Intussusception","authors":"Sunit Davda, Hetal N Patel","doi":"10.1016/j.mpsur.2025.05.007","DOIUrl":"10.1016/j.mpsur.2025.05.007","url":null,"abstract":"<div><div>Intussusception is typically found in children between the ages of 3 months and 36 months, with careful resuscitation and electrolyte management required prior to any intervention. Typically, diagnosis is made with an abdominal ultrasound and a radiological procedure such as hydrostatic or pneumatic enema is the first line choice for management with good success rates. A second attempt at radiological reduction can be offered for a partial reduction or even non-reduction assuming the patient remains haemodynamically well with a non-acute abdomen. Surgical management, either minimally invasive or with a laparotomy, is performed when the clinical condition is unstable (i.e. in instances of perforation or peritonitis) or when a pathological lead point or repeated non-complete radiological reduction occurs. In the United Kingdom, patients are reviewed for approximately 24 hours to ensure resolution of symptoms without complication.</div></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"43 8","pages":"Pages 520-525"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144738394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Foreskin and penile problems in childhood","authors":"David Fawkner-Corbett, Ewan Brownlee","doi":"10.1016/j.mpsur.2025.05.008","DOIUrl":"10.1016/j.mpsur.2025.05.008","url":null,"abstract":"<div><div>Foreskin and penile conditions are a common presentation in paediatric surgical and urological practice, representing conditions ranging from normal developmental variations to pathological conditions requiring surgical intervention. A working knowledge of these will aid in planning management. Topics covered include: 1) physiological phimosis – a normal finding in young children that usually resolves spontaneously with age; 2) balanitis xerotica obliterans (BXO) – a progressive scarring condition requiring treatments including circumcision; 3) foreskin adhesions and smegma pearls – benign findings that do not require intervention; 4) paraphimosis – requiring emergent reduction or definitive treatment to prevent ischaemia; 5) hypospadias – representing a spectrum of severity and treatment strategies; 6) congenital megaprepuce and buried penis – which may have different causes and in certain cases surgical correction indicated for significant functional impairment. This article provides a structured approach to recognizing, differentiating, and managing common foreskin and penile conditions in childhood, emphasizing appropriate features for differentiation that will help indicate referral pathways, as well evidence-based treatment strategies for surgical trainees.</div></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"43 8","pages":"Pages 541-546"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144738385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Intravenous fluids in children and young people","authors":"Anthony Lander","doi":"10.1016/j.mpsur.2025.05.005","DOIUrl":"10.1016/j.mpsur.2025.05.005","url":null,"abstract":"<div><div>The enteral absorption of fluids, electrolytes, and nutrition is preferable to the intravenous route, but gastrointestinal pathology or fasting for surgery may limit or preclude it. We are concerned here with patients for whom enteral intake is negligible and for whom we need not yet worry about nutrition. In the premature neonate, intravenous nutrition should not be delayed as reserves are low. See NICE guidance NG29 entitled <em>Intravenous fluid therapy in children and young people in hospital,</em> as updated in June 2020. Hypotonic maintenance fluids, excessive volumes and failure to monitor and respond to electrolyte levels can lead to fluid overload, acute symptomatic hyponatraemic encephalopathy and death caused by too much water crossing the phospholipid cell membrane. However, more frequently, the fluid overload, compounded by the response to stress, leads to peripheral oedema involving the semi-permeable membrane of the capillary wall when the colligative solute is low albumin. We must not merge these phenomena or their mechanisms. This article aims to help the reader: (i) revise some basic science; (ii) use the terms <em>tonicity</em> and <em>osmolarity</em> safely; (iii) prescribe and monitor fluids; and (iv) manage common electrolyte derangements.</div></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"43 8","pages":"Pages 485-491"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144738389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Neck lumps and swellings in children","authors":"Emma Sidebotham","doi":"10.1016/j.mpsur.2025.05.003","DOIUrl":"10.1016/j.mpsur.2025.05.003","url":null,"abstract":"<div><div>Management of congenital and acquired neck lumps forms a large proportion of surgical interventions performed in childhood. Enlarged cervical lymph nodes are the commonest cervical swellings, and when related to infection these will often resolve spontaneously or with antibiotic treatment. They can, however, be the presentation of malignancy such as lymphoma, which requires biopsy for specific diagnosis to guide treatment. The commonest congenital malformations in the cervical region are thyroglossal duct cysts, which cause a midline cervical swelling that typically becomes apparent in the first few years of life. Remnants of the branchial arches, especially the second branchial arch, result in fistulae, sinuses and cysts. These lesions all require surgical excision to prevent infection of the lesions as well as for cosmesis. Up to 75% of lymphatic malformations occur in the cervical region. These are most commonly a cosmetic problem but can cause significant respiratory symptoms if large and involving the oropharyngeal region.</div></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"43 8","pages":"Pages 535-540"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144738387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Test yourself: MCQ and single best answer","authors":"Adrian Ben Cresswell","doi":"10.1016/j.mpsur.2025.06.006","DOIUrl":"10.1016/j.mpsur.2025.06.006","url":null,"abstract":"","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"43 8","pages":"Pages 547-548"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144738388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Appendicitis and non-specific abdominal pain","authors":"Shabnam Parkar","doi":"10.1016/j.mpsur.2025.07.001","DOIUrl":"10.1016/j.mpsur.2025.07.001","url":null,"abstract":"<div><div>Acute appendicitis is the most common surgical emergency in children and remains a core competency for all paediatric surgeons and junior trainees in surgical practice. Despite this, it can pose a diagnostic challenge in certain circumstances as well as challenges in management. It is essential to understand the basic pathophysiology of appendicitis and its differing presentations in different age groups as well as being aware of the appropriate clinical, laboratory-based and radiological investigations needed to formulate a coherent list of differential diagnoses and appropriate management plans. Acute appendicitis is best treated with appendicectomy, be it open or laparoscopic, and is different to the management of appendiceal mass. Although newer studies are also looking at the feasibility of conservative management in simple appendicitis as is increasingly being used in adult practice. This chapter aims to provide a practical and evidence-based guide tailored for surgeons caring for children with appendicitis.</div></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"43 8","pages":"Pages 498-502"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144738391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Surgical management of gastro-oesophageal reflux in children","authors":"Merrill McHoney","doi":"10.1016/j.mpsur.2025.05.006","DOIUrl":"10.1016/j.mpsur.2025.05.006","url":null,"abstract":"<div><div>Gastro-oesophageal reflux (GOR) in newborns does not necessarily represent a clinical disease, but rather a somewhat delayed physiological development that corrects with time. Gastro-oesophageal reflux disease (GORD) is defined as secondary symptoms and complications arising from gastro-oesophageal reflux. GORD requires aggressive medical management in an attempt to reverse complications and hopefully achieve long-term cure. Supportive or medical treatment is sufficient in mild cases, but GORD is best managed surgically when severe disease or complications are present. Investigations to support the diagnosis and assess the severity usually include: upper gastrointestinal endoscopy, pH study and upper gastrointestinal contrast study. A combined pH and impedance study may become the gold standard investigative tool with increased experience in children. Surgical procedures for GORD aims to augment or correct some of the mechanisms which prevent GOR. The Nissen fundoplication is the most frequently performed operation, but several other fundoplications are also used. Symptom control can be achieved with improvement in quality of life, but recurrence rates can be high in patients with neurological impairment or generalized bowel dysmotility.</div></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"43 8","pages":"Pages 503-509"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144738392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Abdominal and pelvic tumours in children: a review of diagnosis, management, and prognosis","authors":"V Rudolf von Rohr, M Pachl","doi":"10.1016/j.mpsur.2025.06.004","DOIUrl":"10.1016/j.mpsur.2025.06.004","url":null,"abstract":"<div><div>Abdominal tumours in children, though relatively uncommon, present significant challenges in terms of early detection, accurate diagnosis, and treatment. These tumours are a heterogeneous group of neoplasms that can arise from various organs, including the kidneys, liver, gonads and soft tissues, encompassing a range of benign and malignant conditions. The clinical presentation often overlaps with other more common paediatric conditions, making diagnosis difficult without a high index of suspicion. Unlike adult abdominal cancers, which are predominantly malignant, many paediatric abdominal tumours are benign or low-grade malignancies. However, the malignant tumours, if untreated or diagnosed late, can significantly impact survival. Early intervention and multimodal treatment strategies are crucial for improving survival rates and minimizing long-term complications. This review explores the most common types as neuroblastoma, Wilms tumour, rhabdomyosarcoma, lymphoma and ovarian cysts/germ cell tumours. An overview will be given of clinical features, diagnostic approaches, treatment options, and prognostic factors associated with abdominal tumours in children.</div></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"43 8","pages":"Pages 510-519"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144738393","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}