Journal of pediatric surgery最新文献

Introduction: Neonatal surgical conditions contribute significantly to under-five mortality, particularly in low- and middle-income countries (LMICs). However, comprehensive data on neonatal surgical mortality (NSM) and its determinants in East Africa remain scarce. This systematic review and meta-analysis aimed to estimate the pooled mortality rate among neonates with surgical conditions and identify key predictors of mortality in the region.

Methods: Following PRISMA guidelines, we searched PubMed, Scopus, EMBASE, and Google Scholar from inception to 30 June 2025. Observational studies from East Africa reporting mortality in neonates (0-28 days) with surgical conditions, regardless of operation status, were included. Data were extracted using a standardized form, and risk of bias was assessed using the Newcastle-Ottawa Scale. Random-effects meta-analysis was performed to estimate pooled mortality rates. Predictors of mortality were synthesized narratively and via meta-regression where possible.

Results: Twelve studies (n = 3451 neonates) from five East African countries were included. The pooled overall mortality rate was 25.7 % (95 % CI: 20.3-31.2 %; I² = 90.4 %, p < 0.001). Postoperative mortality was lower at 18 % ((95 % CI: 15-21 %); I² = 71 %, p < 0.001). Sepsis was the most consistent predictor of mortality (pooled AOR 1.70, 95 % CI: 1.20-2.40). Other predictors, such as postoperative hypothermia, prematurity, and outborn status, showed ranges across studies. Esophageal atresia and abdominal wall defects had the highest mortality risks.

Conclusion: Neonatal surgical mortality in East Africa is high, with nearly 1 in 4 neonates with surgical conditions dying. Disparities across countries may highlight systemic gaps in infrastructure, timely access, and perioperative care. Targeted interventions-such as sepsis prevention, thermoregulation protocols, and strengthened referral systems-are urgently needed to reduce mortality. Standardized regional registries and investment in neonatal surgical capacity are critical for equitable care.

The rise in global temperature changes environmental exposures and impacts health, especially for vulnerable populations such as children. The healthcare industry is responsible for a substantial proportion of national greenhouse gas emissions. Within hospitals, operating rooms generate large amounts of waste and use a lot of energy and resources that contribute to greenhouse gas emissions. While surgical care is necessarily resource intensive, strategies exist to mitigate this environmental impact. Surgeons and anesthesia practitioners have demonstrated a growing interesting in integrating ways to reduce environmental impact into their practice. This article summarizes the key discussion points from the recent American Academy of Pediatrics Section on Surgery session entitled Perioperative and Operative Stewardship. The highest impact areas to target in reducing environmental impact of surgical care include addressing single-use items, energy use, and anesthetic gases. Greening the operating room initiatives often align with principles of value-based care and are best addressed by a multidisciplinary team using quality improvement and implementation science principles. Surgeons and anesthesia practitioners are uniquely positioned to lead cost-conscious, high-value surgical care by collectively integrating and championing environmentally sustainable practices within their institutions.

Aim: The Turkish Esophageal Atresia Registry (TEAR) data were revisited using quality indicators (QIs) to evaluate quality care provided to patients with esophageal atresia (EA).

Methods: Among 36 centers registering data in the TEAR database, only those treating more than four patients per year were included. Based on predefined QIs, each center was assessed for structural, procedural and outcome indicators. Mean percentages were calculated for each QI. Centers with a lower-than-mean percentage for adverse outcomes were determined as 'meeting' that QI, while those with higher percentage were defined as 'not meeting' it.

Results: Fifteen centers and 525 patients were analyzed. MDTs existed in 80 % centers while 33 % had transition-to-adulthood programs. One center met the 91 % of all QIs, whereas, 2 centers met 82 % of them and 3 of them met 73 %. Two centers met only 36 % of all indicators. The most frequently met QIs were the presence of MDTs and low intraoperative complications (n = 12, 80 %) whereas anastomotic strictures were the least met (n = 6, 40 %). No correlation was found between the number of patients treated per centers and the number of QIs met (p > 0.05). The presence transition-to-adulthood facilities was associated with a significantly reduced rate of intraoperative complications compared with centers lacking such resources (p = 0.008).

Conclusions: QIs allow centers to gain insight into their EA care and compare their performance with that of other centers. Although the centers in TEAR met most of the QIs, certain measures-such as the rate of anastomotic stricture-should be improved at the national level.

Background: Primary ovarian torsion (POT) affects a morphologically normal ovary without associated adnexal lesions and that carries a high recurrence risk. The role of oophoropexy in preventing POT recurrence remains unclear.

Objective: To evaluate the effectiveness of oophoropexy in reducing recurrence rates after the first episode of POT.

Methods: A systematic review and meta-analysis was conducted following PRISMA 2020 guidelines. Retrospective studies including girls <18 years undergoing surgery for POT were considered. The primary outcome was torsion recurrence. Study quality was assessed using the MINORS tool.

Results: Twelve studies (209 patients; mean age 7.8 ± 4.1 years) met inclusion criteria. Detorsion alone was performed in 168 patients (80.4 %) and detorsion + oophoropexy in 41 patients (19.6 %). Recurrence occurred in 17.3 % of patients after ovarian detorsion alone versus 4.9 % after detorsion + oophoropexy. Three comparative studies (106 patients) were included in the meta-analysis. Pooled analysis showed a trend toward reduction in recurrence for oophoropexy (OR 0.54, 95 % CI 0.17-1.72, p = 0.15, I² = 0 %). Ultrasonography demonstrated preserved ovarian vascularization and trophism in most patients.

Conclusions: POT carries a substantial risk of recurrence. Oophoropexy may reduce recurrence compared with detorsion alone without negatively affecting ovarian trophism, although statistical significance was not reached. At present, oophoropexy cannot yet be recommended as routine after a first episode of POT, but it appears to hold promise as a strategy to reduce recurrence.

Background: Congenital anomalies are structural abnormalities that occur during intrauterine life and are prenatally or postnatally identifiable. They are major contributors to neonatal and under-5 mortality. Childbirth is a pleasant phase of life for parents who birth healthy newborns. However, this would mean something different for parents who give birth to children with congenital anomalies. Even though these anomalies can be treated surgically, parents experience physical, psychological, and economic difficulties. Most of the literature on parental experiences originates from high-income countries, making their context less applicable to low and middle-income countries (LMICs) such as Ethiopia.

Purpose: This study aimed to explore the firsthand experiences of Ethiopian parents raising children with congenital anomalies.

Methods: A phenomenological study was conducted to explore the lived experiences of parents of children with congenital anomalies at two tertiary hospitals in South Ethiopia. Eighteen parents were purposively selected for the in-depth interviews. The interviews were audio recorded, transcribed, and translated. The rigor of the study was ensured by establishing its credibility, transferability, dependability, and conformability. Thematic analysis was performed using Open Code v4.03.

Results: Five overarching themes emerged. The themes include 'prior awareness, perception and discovery', 'parental emotional reaction', 'burden', 'support system', and 'impact of the anomaly'.

Conclusion: Parents of children with congenital anomalies face challenges in obtaining healthcare services and experience financial and hygiene-related burdens because of their children's condition. They experience emotional distress and social difficulties, while relying on their limited community and familial support.

Introduction: Laparoscopic common bile duct exploration (LCBDE) is underutilized in pediatric surgery despite its potential to reduce the need for endoscopic retrograde cholangiopancreatography (ERCP) and hospital length of stay. We aimed to characterize current LCBDE practice patterns among pediatric surgeons and identify barriers to broader adoption.

Methods and procedures: A 43-item survey assessing surgeon demographics, practice characteristics, LCBDE use, access to resources, and educational needs was distributed via REDCap to pediatric surgeons globally via the International Pediatric Endosurgery Group membership distribution list. Descriptive statistics were used to analyze responses.

Results: A total of 132 pediatric surgeons responded (13.3 % response rate). All respondents had completed fellowship training, and 100 % identified as pediatric surgeons. Only 34.4 % currently perform LCBDE, and 91.1 % of those perform fewer than 10 cases per year. The transcystic approach was used in 86.7 % of cases. Preferred techniques included choledochoscopy (45.5 %) and balloon sphincteroplasty (27.3 %). Major barriers included lack of supplies, unfamiliarity with techniques, and low perceived utility. Only 16.4 % knew reimbursement rates for LCBDE. 75.7 % recognized that ERCP is associated with longer length of stay.

Conclusions: Despite its clinical benefits, LCBDE remains uncommon in pediatric surgery due to logistical, educational, and perceptual barriers. Targeted training and standardization of supplies may help increase adoption.