Journal of Pediatric Surgery Open最新文献

{"title":"A single-center retrospective study of the surgery outcome of Megarectosigmoid (MRS) after anorectal malformation (ARM) repair","authors":"Zheng Le ,&nbsp;Shao Yifeng ,&nbsp;Ming Anxiao ,&nbsp;Luo Jianfeng ,&nbsp;Diao Mei ,&nbsp;Li Long","doi":"10.1016/j.yjpso.2026.100266","DOIUrl":"10.1016/j.yjpso.2026.100266","url":null,"abstract":"<div><h3>Background</h3><div>The Megarectosigmoid (MRS) after anorectal malformation (ARM) repair can have a negative impact on the pediatric quality of life. However, current treatments lack consensus due to variable efficacy.</div></div><div><h3>Objective</h3><div>To evaluate the long-term outcome of laparoscopic-assisted MRS resection (resection of the dilated sigmoid colon and rectum) with anal reconstruction (LAMR-AR) and provide the indications to surgical treatment for MRS.</div></div><div><h3>Methods</h3><div>A retrospective cohort analyzed 49 pediatric MRS patients, who all had underwent ARM repair before LAMR-AR. Clinical data included imaging and surgical parameters. Patients were stratified by anal morphology: normal anus group (NAG) vs abnormal anus group (AAG) (stenosis/ectopic anus). Functional outcomes were assessed via Rintala scores (R-score) and Krickenbeck criteria for soiling/constipation.</div></div><div><h3>Results</h3><div>This study enrolled a cohort of 49 pediatric patients (28 males, 21 females) with a median age of 2.75 years (interquartile range [IQR]: 1.42–3 years). Postoperatively, in normal anus group, constipation decreased from 92.9%(26/28 grade3:26) to 7.1%(2/28 grade2:1 grade3:1)(<em>p</em>&lt;0.01), while soiling increased from 3.6%(1/28 grade3:1) to 57.1%(16/28 grade1:9 grade2:7)(<em>p</em>&lt;0.01). As for the abnormal anus group, constipation decreased from 85.7%(18/21 grade3:18) to 23.8%(5/21 grade2:4 grade3:1)(<em>p</em>&lt;0.01) and soiling increased from 4.8%(1/21 grade3:1) to 71.4%(15/21 grade1:2 grade2:9 grade3:4)(<em>p</em>&lt;0.01).Cases in abnormal anus group showed higher complications after ARM repair rates (32.1% vs 14.3%, <em>p</em> <em>=</em> 0.04 abnormal anus group: wound infection/abscess (5), mucosal prolapse (6), recurrent urethral fistula (1), vaginal fistula (1), vestibular fistula (1), wound dehiscence (1) vs normal anus group: cutaneous fistula (1), urethral fistula (1), perianal abscess (1), mucosal prolapse (1)) and worse outcome in lower R-scores(NAG:17(15–19);AAG:14(11–16) <em>p</em> = 0.012).</div></div><div><h3>Conclusion</h3><div>LAMR-AR is more recommended for patients without anal abnormalities.</div></div>","PeriodicalId":100821,"journal":{"name":"Journal of Pediatric Surgery Open","volume":"14 ","pages":"Article 100266"},"PeriodicalIF":0.3,"publicationDate":"2026-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145986721","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":"Verrucous venous malformations in children: A case for surgical excision","authors":"Halah Hassan ,&nbsp;Hannah Triscott ,&nbsp;Professor Roy Kimble","doi":"10.1016/j.yjpso.2026.100265","DOIUrl":"10.1016/j.yjpso.2026.100265","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Verrucous venous malformations (VVMs) are rare congenital vascular anomalies characterized by ectatic venous channels in the dermis and subcutis, with overlying verrucous epidermal changes. Typically presenting in early childhood, they may cause pain, bleeding, infection, and psychosocial distress. Diagnosis and management are often difficult due to clinical and histopathologic overlap with other vascular lesions. Non-surgical therapies have been trialled with limited success, and surgical excision remains the primary treatment. However, the efficacy of surgery, particularly when combined with reconstructive techniques, has not been systematically compared to alternative modalities.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Materials and Methods&lt;/h3&gt;&lt;div&gt;Twenty-three paediatric patients (aged one month to 17 years) with congenital or early-onset vascular lesions suspected to be VVMs were evaluated at a tertiary vascular anomalies clinic between 2019 and 2025. Clinical presentation, imaging, histopathology, IHC, and NGS results of a 32-gene vascular anomaly panel were reviewed. All patients underwent biopsy or excision. Data were collected retrospectively from operative reports, pathology results, and follow-up documentation.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Twenty-three patients (12 male, 11 female; mean age 6.6 years) were included in this series. Lesions were present at birth in all 23 children. Pain and ulceration were the most common symptoms reported, and most lesions demonstrated progressive enlargement. All were solitary and located on the limbs (&lt;em&gt;n&lt;/em&gt; = 19) or trunk (&lt;em&gt;n&lt;/em&gt; = 4), with a predilection for the lower limb. Imaging suggested low-flow vascular malformation in 14 patients. Twenty children underwent surgical excision. Excision techniques included elliptical excision, rhomboid flap reconstruction, and, in extensive lesions, staged excision with dermal regeneration templates, negative pressure wound therapy (NPWT) and split-thickness skin grafts (STSG). Adjunctive therapies were trialled in seven patients, including laser treatments such as Pulsed Dye Laser (PDL), Fractional Carbon Dioxide Laser (CO₂) and Neodymium-Doped Yttrium Aluminum Garnet Laser (Nd:YAG), microneedling, sclerotherapy, and topical sirolimus. Histopathology confirmed VVM in 19/21 children; immunohistochemistry showed GLUT1 positivity in 18/19 and D2–40 in 8/19. MAP3K3 mutations were identified in 8/20 patients and a KRIT1 variant in one. Postoperative recovery was uncomplicated in most lesions. No major complications or functional impairments were observed, and most patients achieved satisfactory aesthetic and functional outcomes. Quality-of-life assessment using the BBSIP demonstrated consistent functional and psychosocial benefit.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;VVMs present diagnostic and therapeutic challenges due to their overlap with other vascular anomalies and variable histopathologic and molecular features. Surgical excision","PeriodicalId":100821,"journal":{"name":"Journal of Pediatric Surgery Open","volume":"14 ","pages":"Article 100265"},"PeriodicalIF":0.3,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146039757","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":"Advances in surgical technique, functional outcomes, and postoperative care for pectus conditions","authors":"Madison C. Betcher,&nbsp;Daniel A. DeUgarte,&nbsp;Veronica F. Sullins,&nbsp;Howard C. Jen,&nbsp;Christine E. Dichter,&nbsp;Justin P. Wagner","doi":"10.1016/j.yjpso.2026.100261","DOIUrl":"10.1016/j.yjpso.2026.100261","url":null,"abstract":"<div><h3>Objective</h3><div>To summarize advances in the last decade of care for pectus deformities—primarily pectus excavatum (PE) and pectus carinatum (PC)—with attention to surgical technique, perioperative outcomes, functional and psychosocial effects, and emerging gaps in standardization.</div></div><div><h3>Methods</h3><div>Review of recent clinical studies, consensus statements, and large cohort analyses addressing indications, operative and non-operative management, outcomes, and postoperative protocols.</div></div><div><h3>Results</h3><div>Technique refinements to minimally invasive repair (e.g., multi-bar configurations, bridge fixation, shorter bars, and routine thoracoscopy) have reduced bar displacement and major complications while enabling more complete anterior chest wall remodeling. The modified Ravitch procedure remains an option for adults, complex anatomy, or recurrence, with comparable long-term satisfaction. Non-operative therapies—vacuum bell for selected children and orthotic bracing for PC—achieve good results when initiated early and used consistently. Cardiopulmonary diagnostics increasingly demonstrate postoperative improvements in cardiac output, indices of ventricular performance, and exercise capacity, with pulmonary function changes small or inconsistent. The psychosocial burden of disease is substantial, even in mild deformity, and improves after correction. Enhanced Recovery After Surgery pathways and intercostal nerve cryoablation shorten length of stay, lower opioid exposure, and support same-day discharge in selected programs. Despite progress, indications and preauthorization practices vary widely; reliance on “physiologic” criteria and extensive testing contributes to disparities in access.</div></div><div><h3>Conclusions</h3><div>Contemporary PE/PC care is safer, more effective, and more patient-centered, but remains heterogeneous. Field-wide, consensus-driven guidance that integrates anatomic severity, symptoms, psychosocial distress, and progression would improve equity of access, align payer policy with evidence, and standardize outcomes-oriented care.</div></div>","PeriodicalId":100821,"journal":{"name":"Journal of Pediatric Surgery Open","volume":"14 ","pages":"Article 100261"},"PeriodicalIF":0.3,"publicationDate":"2026-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146039758","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":"Management of obstructive peristomal complications in pediatric tracheostomy patients. A case series – Surgical decannulation","authors":"R. Sancho ,&nbsp;M. Díaz ,&nbsp;L. Solorio ,&nbsp;R. Quimbert ,&nbsp;N.N. Mata ,&nbsp;A.R. Barraza","doi":"10.1016/j.yjpso.2025.100259","DOIUrl":"10.1016/j.yjpso.2025.100259","url":null,"abstract":"<div><h3>Background</h3><div>Tracheal stenosis and suprastomal granuloma with collapse of the anterior tracheal wall are obstructive complications in pediatric tracheostomy patients. The objective of this study is to determine the safety and prognosis of surgical decannulation with simultaneous resection of the obstructive granuloma and tracheoplasty</div></div><div><h3>Methods</h3><div>A descriptive study between 2015 and 2024, seven children with obstructive complications associated with tracheostomy were included for surgical treatment with resection of suprastomal granuloma, stomoplasty and tracheoplasty simultaneously in surgical decannulation after failure of endoscopic treatment, surgical, endoscopic and prognostic characteristics are analyzed</div></div><div><h3>Results</h3><div>Seven, with bronchopulmonary dysplasia (n = 4) and prolonged intubation <em>n</em> = 3), all with obstructive suprastomal granulomas &gt; 95% of the airway with failure of endoscopic resection, all with dynamic peristomal obstruction &gt;75% and in 2 of them infrastomal tracheal stenosis Cotton III and IV, 5 were treated with granuloma resection, stomoplasty and anterior tracheoplasty achieving immediate extubation in 4 and one remained intubated for 24 h due to supraglottic edema, and in 2 granuloma resection, anterior malacia and infrastomal stenosis with end-to-end tracheal anastomosis were performed, all with successful decannulation</div></div><div><h3>Conclusions</h3><div>Surgical decannulation in the treatment of obstructive peristomal complications in children with tracheostomy is a safe option, with low morbidity and no recurrence with zero mortality when endoscopic treatment has failed</div></div><div><h3>Level of evidence</h3><div>IV</div></div>","PeriodicalId":100821,"journal":{"name":"Journal of Pediatric Surgery Open","volume":"14 ","pages":"Article 100259"},"PeriodicalIF":0.3,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146080590","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":"Editorial Board Page","authors":"","doi":"10.1016/S2949-7116(26)00003-1","DOIUrl":"10.1016/S2949-7116(26)00003-1","url":null,"abstract":"","PeriodicalId":100821,"journal":{"name":"Journal of Pediatric Surgery Open","volume":"13 ","pages":"Article 100263"},"PeriodicalIF":0.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145977007","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":"Incidence of intestinal volvulus in pediatric patients with intestinal malrotation: A single institution's experience","authors":"Takahiro Hosokawa ,&nbsp;Hiroshi Kawashima ,&nbsp;Tomoko Hara ,&nbsp;Yumiko Sato ,&nbsp;Yutaka Tanami ,&nbsp;Eiji Oguma","doi":"10.1016/j.yjpso.2025.100260","DOIUrl":"10.1016/j.yjpso.2025.100260","url":null,"abstract":"<div><h3>Purpose</h3><div>We investigated the future occurrence of intestinal volvulus in pediatric patients with intestinal malrotation, regardless of whether they are symptomatic or asymptomatic.</div></div><div><h3>Methods</h3><div>Among 148 pediatric patients with intestinal malrotation, categorization was based on the presence/absence of underlying conditions and the duodenal third portion. Patients with and without the occurrence of intestinal volvulus were compared. We evaluated the cumulative future occurrence of intestinal volvulus from a specified age to 15 years old. The incidence of intestinal malrotation-associated bowel necrosis/surgical complications was recorded.</div></div><div><h3>Results</h3><div>Seventy-nine of 107 Patients without underlying conditions and without the duodenal third portion, who are typically classified as having the typical type of intestinal malrotation, had intestinal volvulus, and those had significantly higher incidence of intestinal volvulus than that including all patients. The cumulative future occurrence of intestinal volvulus among patients without underlying disease and without duodenal third portion was 73.8 %, and remained at approximately 30 % across other age groups. Among all patients in the present study, including those with and without underlying disease and with typical or atypical malrotation, the incidence was highest at 0–1 years of age (56.1 %) and remained at approximately 20 % across other age groups. Intestinal necrosis/surgical complications occurred in 9.6 %/23.1 % of patients, respectively.</div></div><div><h3>Conclusions</h3><div>Intestinal volvulus occurs most frequently at 0–1 years of age and remains a risk in the future. These findings, along with considerations of underlying disease, duodenal anatomy, bowel necrosis risk, and surgical complications, provide useful information to assist pediatric surgeons in managing this patient cohort.</div></div>","PeriodicalId":100821,"journal":{"name":"Journal of Pediatric Surgery Open","volume":"13 ","pages":"Article 100260"},"PeriodicalIF":0.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145938714","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":"Development and validation of a perioperative pediatric cardiac risk calculator","authors":"Michael L. Daidone ,&nbsp;Ryan J. Salvatore ,&nbsp;Ryan Z. Gross ,&nbsp;Nicholas J. Dante ,&nbsp;Darya D. Dehkan ,&nbsp;Nicolas L. Carayannopoulos ,&nbsp;Sathyaprasad C. Burjonrappa","doi":"10.1016/j.yjpso.2025.100230","DOIUrl":"10.1016/j.yjpso.2025.100230","url":null,"abstract":"<div><h3>Background</h3><div>Numerous tools for cardiac risk stratification exist for the adult population. While each has its strengths, there remains a need for a calculator that reliably predicts the cardiac risk across all types of pediatric surgery. We aim to develop and validate a novel risk stratification tool predicting the probability of 30-day post-operative cardiac arrest in pediatric surgical patients.</div></div><div><h3>Methods</h3><div>Data from the 2020-2022 NSQIP Pediatric Database were analyzed. Forty nine risk factors were identified from the NSQIP database and used as potential predictors. Multicollinearity was evaluated by calculating the variance inflation factor for each predictor, and a reduced set of 21 variables was selected. Multiple models were created to assess the impact of different preoperative factors on the 30-day cardiac arrest risk using reduced and full variables. Calibration plots comparing the predicted probabilities with the actual outcomes across different probability bins were generated, and the Brier Score, C-Statistic, and H-L Values were calculated and used to compare the models’ performance. Validation was then performed using NSQIP Pediatric Data from 2018-2019, and sensitivity and specificity were calculated. From this data, an interactive application was created.</div></div><div><h3>Results</h3><div>Of all models developed and tested, the logistic regression model with reduced variables produced the best overall performance with a Brier score, C-statistic, and H-L value of 0.0021, 0.94, and 0.25, respectively. Upon validation, the sensitivity and specificity were 0.90 and 0.82, respectively.</div></div><div><h3>Conclusions</h3><div>The developed and validated novel risk calculator accurately predicts the risk of post-operative cardiac arrest in pediatric patients.</div></div>","PeriodicalId":100821,"journal":{"name":"Journal of Pediatric Surgery Open","volume":"13 ","pages":"Article 100230"},"PeriodicalIF":0.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145938713","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":"Outcomes of selective case assignment for pediatric appendectomy in a teaching hospital: A seven-year analysis of resident training and surgical approach selection","authors":"Ming-Yu Hsieh ,&nbsp;Tzu-Ling Wang ,&nbsp;Pen-Hua Su ,&nbsp;Ming-Chih Chou","doi":"10.1016/j.yjpso.2025.100257","DOIUrl":"10.1016/j.yjpso.2025.100257","url":null,"abstract":"<div><h3>Background</h3><div>Appendectomy remains the gold standard treatment for appendicitis in pediatric patients. In teaching hospitals facing workforce constraints, the integration of laparoscopic techniques presents unique challenges in balancing optimal patient outcomes with surgical education. This study evaluates the clinical outcomes of a selective case assignment system that evolved to address these dual objectives in pediatric appendectomy.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study of 63 consecutive pediatric patients (≤18 years) who underwent appendectomy between January 2013 and December 2019 at a single tertiary teaching hospital. Complicated appendicitis was defined as perforated, gangrenous, or abscess-forming appendicitis based on operative findings and histopathology. Primary outcomes included length of hospital stay and complications. Case assignment patterns, surgeon experience levels, and temporal trends were analyzed to characterize institutional practices.</div></div><div><h3>Results</h3><div>Of 63 patients, 37 (58.7 %) underwent open appendectomy and 26 (41.3 %) laparoscopic appendectomy. No significant differences were observed in baseline characteristics. Case assignment patterns revealed systematic selection: attending surgeons performed 78.4 % of open procedures, predominantly for complicated cases (89.7 % of attending-performed open cases), while supervised chief residents performed 69.2 % of laparoscopic procedures with selective inclusion of complicated cases (61.1 %). Length of hospital stay was comparable (median 4 vs 3 days, <em>p</em> = 0.245). No major complications occurred in either group. Laparoscopic utilization increased from 20 % (2013) to 60 % (2019), <em>p</em> = 0.021 for trend.</div></div><div><h3>Conclusions</h3><div>Selective case assignment combined with structured supervision allowed safe integration of laparoscopic appendectomy into pediatric surgical training while maintaining acceptable clinical outcomes. These findings suggest that resident participation in minimally invasive pediatric emergency surgery is feasible when supported by appropriate case selection and oversight.</div></div>","PeriodicalId":100821,"journal":{"name":"Journal of Pediatric Surgery Open","volume":"13 ","pages":"Article 100257"},"PeriodicalIF":0.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145938712","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":"Assessment of hospital, surgeon, and geography-related factors associated with timely surgical care for undescended testes in a universal health care system","authors":"Hyunwoong Harry Chae ,&nbsp;Elaine J Redmond ,&nbsp;Alex Zheng ,&nbsp;Andrew MacNeily ,&nbsp;Kourosh Afshar ,&nbsp;Erik Skarsgard ,&nbsp;Jason M. Sutherland ,&nbsp;Soojin Kim","doi":"10.1016/j.yjpso.2025.100258","DOIUrl":"10.1016/j.yjpso.2025.100258","url":null,"abstract":"<div><h3>Introduction</h3><div>Canada’s healthcare system aims to provide equitable access to care. Guidelines recommend surgery for undescended testes (UDT) before 18 months of age. We evaluated time-appropriate access to surgery for UDT patients in Canada.</div></div><div><h3>Methods</h3><div>We conducted a secondary analysis of UDT patients who received surgery between 2010–2018. Multivariable logistic models identified factors associated with surgery within 18 months.</div></div><div><h3>Results</h3><div>Among 19,209 UDT cases, 5186 (27.0%) had surgery within 18 months- 5051/17,947 (28.1%) orchidopexies and 135/1262 (10.7%) orchiectomies. Higher odds of timely orchidopexy were observed at teaching children’s (OR 1.52, CI 1.29–1.79, <em>p</em> &lt; 0.001) and teaching non-children’s hospitals (OR 2.21, CI 1.87–2.61, <em>p</em> &lt; 0.001) versus community hospitals. Hospitals with higher UDT volume (2nd–4th quartiles versus 1st quartile hospitals; &gt;46 cases/year) were more likely to perform surgery within 18 months for both procedures (all OR&gt;1, <em>p</em> &lt; 0.05). Pediatric (OR 1.67, CI 1.53–1.84, <em>p</em> &lt; 0.001) and general surgeons (OR 1.89, CI 1.58–2.26, <em>p</em> &lt; 0.001) were more likely than pediatric urologists to operate within 18 months for orchidopexy, while only pediatric surgeons were more likely for to do so for orchiectomy (OR 1.95, CI 1.00–3.79, <em>p</em> = 0.05). Odds of surgery within 18 months declined over time for orchidopexies (OR 0.99, CI 0.97–1.00, <em>p</em> = 0.039) and orchiectomies (OR 0.88, CI 0.81–0.95, <em>p</em> = 0.001).</div></div><div><h3>Conclusion</h3><div>Fewer than 30% of UDT surgeries in Canada occurred within 18 months. High-volume and teaching hospitals, and pediatric/general surgeons, were more likely to operate within 18 months. Odds of operation within 18 months declined in recent years. Systemic factors may delay care for UDT patients in Canada.</div></div>","PeriodicalId":100821,"journal":{"name":"Journal of Pediatric Surgery Open","volume":"14 ","pages":"Article 100258"},"PeriodicalIF":0.3,"publicationDate":"2025-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145986720","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":"Satisfactory treatment of pediatric constipation: It is time for sennosides","authors":"Celeste Carolina Patiño Gonzalez ,&nbsp;Agostina Fontaine ,&nbsp;Marcos Federico Leyba","doi":"10.1016/j.yjpso.2025.100256","DOIUrl":"10.1016/j.yjpso.2025.100256","url":null,"abstract":"<div><h3>IntroductionA</h3><div>Constipation is a condition affecting children with an estimated prevalence of 9.5–14 %, without gender differences. Its diagnosis is clinical. In some cases, fecal impaction in the rectum produces encopresis or fecal pseudo-incontinence, generating a negative bio-psycho-social impact. While osmotic laxatives like polyethylene glycol (PEG) are the first line of treatment, there are cases refractory to PEG. Stimulant laxatives, such as sennosides, increase colonic motility. The objective of this study is to describe our experience using sennosides for the treatment of constipation in pediatric patients.</div></div><div><h3>Materials and Methods</h3><div>A retrospective review was conducted on patients treated with sennosides between August 2023 and July 2024. Inclusion criteria: patients aged 1–14 years with idiopathic constipation (Rome IV) or post-surgical constipation (anorectal malformation, Hirschsprung disease). Patients with true fecal incontinence were excluded. A Bowel Management Program was applied with initial disimpaction using enemas followed by daily sennosides (15 mg). Doses were titrated based on response. Therapeutic success (good response) was defined as daily bowel movements, no soiling, and an abdominal radiograph showing no rectal fecal impaction.</div></div><div><h3>Results</h3><div>Twenty-four patients were treated (median age 66 months; 58 % male). Diagnoses included idiopathic constipation (63 %), anorectal malformation (25 %), and Hirschsprung disease (13 %). Seventy-one percent had a history of poor response to PEG. Successful disimpaction with enemas was achieved in 100 % of required cases. Sennoside doses ranged from 7.5 mg to 45 mg. Clinical response was satisfactory in 96 % of patients. Radiological control showed a clean rectum in 58 % and minimal stool in 42 %. Adverse events included one case of perianal dermatitis and one case of blistering (moderate), both resolving with conservative management.</div></div><div><h3>Conclusion</h3><div>Treatment with sennosides is feasible and effective for pediatric patients with constipation refractory to other pharmacological treatments, achieving high therapeutic satisfaction.</div></div>","PeriodicalId":100821,"journal":{"name":"Journal of Pediatric Surgery Open","volume":"13 ","pages":"Article 100256"},"PeriodicalIF":0.3,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145799736","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}