Journal of pediatric surgery最新文献

{"title":"Resource utilization and surgical risk in pediatric pneumatosis intestinalis.","authors":"Shachi Srivatsa, Megan Read, Taha Akbar, Swapna Koppera, Melissa Hamrick, Joshua Gadelsayed, Jennifer H Aldrink, Kyle J Van Arendonk","doi":"10.1016/j.jpedsurg.2026.162923","DOIUrl":"10.1016/j.jpedsurg.2026.162923","url":null,"abstract":"<p><strong>Introduction: </strong>Pneumatosis intestinalis (PI) in children, excluding necrotizing enterocolitis (NEC), is typically managed non-operatively with bowel rest, antibiotics, and total parenteral nutrition (TPN). However, guidance is limited on estimating the risk of requiring surgery, complicating decisions about the duration of non-operative medical treatment. This study aimed to assess the management of non-NEC PI and identify factors associated with surgical intervention.</p><p><strong>Methods: </strong>A retrospective review was conducted of patients aged 6 months to 21 years diagnosed with PI from 2010 to 2023 at a free-standing children's hospital. Patients with NEC in the prior six months or abdominal surgery in the preceding three months were excluded.</p><p><strong>Results: </strong>102 patients (139 encounters) met inclusion criteria. Median age was 4.5 years; 29 % had genetic disorders, 22 % malignancies (17 on active treatment), and 13 % congenital heart disease. PI was identified via plain radiograph (71 %), CT (25 %), or both (4 %). In 16.5 % of cases, PI was an incidental finding. Antibiotics were used in 91 % of encounters and gastric decompression in 83 %. Surgery was required in 5 patients (3.6 %) due to radiologic progression (100 %), worsening pain/distention (100 %), fevers (60 %), and tachycardia (60 %). All surgical cases involved colonic PI and complex comorbidities. Four patients underwent bowel resection; two had colonic necrosis, and two had resections for underlying motility disorders.</p><p><strong>Conclusion: </strong>Surgery for non-NEC pediatric PI was rare and associated with colonic involvement, fever, tachycardia, and comorbidities. Most cases resolved with a brief course of medical management. Identifying high-risk features may help reduce unnecessary treatment in low-risk patients.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"162923"},"PeriodicalIF":2.5,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145952331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The application value of indocyanine green in assisting vascular identification during microsurgical varicocelectomy in children","authors":"Lei Zhang ,&nbsp;Yi Sun ,&nbsp;Xiangming Yan,&nbsp;Ting Zhang,&nbsp;Zheng Fang,&nbsp;Mingliu Huang,&nbsp;Xu Cao,&nbsp;Mingcui Fu,&nbsp;Hongliang Xia,&nbsp;Yun Zhou,&nbsp;Shu Dai","doi":"10.1016/j.jpedsurg.2025.162917","DOIUrl":"10.1016/j.jpedsurg.2025.162917","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the feasibility of indocyanine green (ICG) fluorescence imaging in microsurgical varicocelectomy (MVC).</div></div><div><h3>Methods</h3><div>A retrospective analysis was conducted on the clinical data of 46 pediatric patients with primary varicocele who underwent MVC at the Children's Hospital Affiliated to Soochow University between June 2022 and September 2024. Inclusion criteria encompassed a affected testicular volume at least 2 mL smaller than the contralateral side or a discrepancy exceeding 20 %, along with symptoms such as scrotal heaviness or pain. Guardians were thoroughly informed preoperatively about the role and potential adverse effects of ICG imaging, with intraoperative ICG utilization determined by parental preference. Patients were stratified into the microscopy-only group (control group A, n = 30) and the ICG-assisted group (group B, n = 16). Parameters recorded included arterial visualization time, venous visualization time, preoperative and postoperative testicular volumes, operative duration, postoperative hospital stay, and complications.</div></div><div><h3>Results</h3><div>A total of 46 pediatric patients (median age 12.0 years, interquartile range: 12.0–13.0 years) with primary varicocele were included, of whom 30 underwent conventional MVC (group A) and 16 received ICG-assisted MVC (group B). Baseline characteristics showed no significant intergroup differences (<em>P</em> &gt; 0.05). Operative duration in group B (42.12 ± 8.31 min) was significantly shorter than in group A (50.03 ± 12.63 min, <em>P</em> = 0.029). In group B, the mean time from ICG injection to spermatic cord arterial visualization was 23.62 ± 5.03 s, and to venous visualization was 40.62 ± 9.51 s. Postoperative affected testicular volumes were 5.94 ± 1.73 mL in group A and 6.56 ± 1.07 mL in group B (<em>P</em> = 0.138). No statistically significant differences were observed between groups in the 1-year postoperative growth rate of the affected testis (median: 0.17 vs. 0.20, <em>P</em> = 0.298) or testicular volume discrepancy (TVD). No complications occurred in group B postoperatively, whereas group A experienced one case of recurrence.</div></div><div><h3>Conclusion</h3><div>ICG fluorescence imaging facilitates precise and rapid identification of spermatic cord arteries, yielding definitive benefits in arterial preservation and operative time reduction. Additionally, venous visualization enables detection of potential missed ligations. This modality holds promising potential in the management of pediatric varicocele.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"61 4","pages":"Article 162917"},"PeriodicalIF":2.5,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145952414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Standardized surgical approach to gastrostomy tube placement: A quality improvement initiative at a multi-hospital Children's health care system","authors":"Alexa G. Turpin ,&nbsp;Sage A. Vincent ,&nbsp;Arezoo Zomorrodi ,&nbsp;Collin Miller ,&nbsp;Ana Burleson ,&nbsp;Heather Ammirata ,&nbsp;Tanae Christopher ,&nbsp;Arianna Phillips ,&nbsp;Teerin Meckmongkol ,&nbsp;Loren Berman","doi":"10.1016/j.jpedsurg.2025.162912","DOIUrl":"10.1016/j.jpedsurg.2025.162912","url":null,"abstract":"<div><h3>Background</h3><div>Children who require gastrostomy tube (G-tube) placement often have multiple medical comorbidities and are typically high-utilizers of the healthcare system. Multiple interventions have been studied to understand how to streamline the process of gastrostomy tube insertion and reduce hospital length of stay (LOS).</div></div><div><h3>Local problem</h3><div>Within our multi-hospital children's healthcare system, the pre-operative workup for gastrostomy tube insertion was variable between providers and between hospitals. Also, the timeframe for which enteral tube feeds were started was inconsistent and without standardization. We hypothesized that standardization would lead to reduced hospital length of stay, and we aimed to decrease postop LOS for patients undergoing G-tube placement by 25 %.</div></div><div><h3>Interventions</h3><div>We created a clinical pathway for all children undergoing gastrostomy tube insertion within our healthcare system. The pathway included utilization of a pre-operative checklist, which included: (1) establishing a medical home for the patient, (2) identifying a durable medical equipment company to supply equipment and formula, (3) consultation with nutrition to establish feeding goals, (4) consultation with speech-language pathologist, as indicated, (5) educating families about the surgical procedure and enteral feeding expectations, (6) consultation with social work to identify psychosocial barriers and assess family readiness, (7) ensuring the patient is able to tolerate bolus feeds via a nasogastric tube. The post-operative portion of the pathway included initiating enteral feeds 4 h post-operatively.</div></div><div><h3>Results</h3><div>After one year, pathway utilization across our enterprise was 71 %. Enteral tube feeds beginning within the appropriate timeframe increased from a baseline of 4 %–40.1 %. Length of stay for patients undergoing outpatient G-tube decreased from 2.1 to 1.4 days, but there has not been a decrease in LOS for inpatient G-tube placement. There was no increase in returns to system despite reductions in LOS.</div></div><div><h3>Conclusions</h3><div>Introduction of a standardized pathway for G-tube placement, which includes a pre-operative checklist and initiation of early enteral feeds, led to a decrease in hospital length of stay without increasing readmissions.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"61 4","pages":"Article 162912"},"PeriodicalIF":2.5,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145944510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of pediatric trauma: Non-operative approach for grade V splenic injuries","authors":"Aryan Rafieezadeh,&nbsp;Kartik Prabhakaran,&nbsp;Christa Grant,&nbsp;Dylan Stewart,&nbsp;Jordan Kirsch,&nbsp;Ilya Shnaydman,&nbsp;Anna Jose,&nbsp;Bardiya Zangbar","doi":"10.1016/j.jpedsurg.2026.162918","DOIUrl":"10.1016/j.jpedsurg.2026.162918","url":null,"abstract":"<div><h3>Background</h3><div>In pediatric patients with grade V blunt splenic injuries, the optimal management strategy remains controversial, but more studies are supporting the non-operative management of these injuries. This study aims to elucidate the differences in clinical outcomes between operative intervention and non-operative management.</div></div><div><h3>Study design</h3><div>We reviewed 5 years of TQIP (2017–2021) data for pediatric patients (age&lt; 18 years) with isolated grade V blunt splenic injuries. Patients with death on arrival, withdrawal of care, and transfers were excluded. We compared mortality and hospital complications between patients undergoing operative management (OM) and non-operative management (NOM).</div></div><div><h3>Results</h3><div>The total study population consisted of 527 patients. 183 patients (34.7 %) underwent OM. There were no significant differences between the two groups in terms of mortality (0.5 % in OM and 0 in NOM, p = 0.347). Patients in the OM group had higher rates of unplanned intubation (1.6 % vs. 0, p = 0.041). OM group had significantly higher volume of blood transfusion within the first 24 h compared to NOM (202.29 ± 49.69 ml vs. 19.44 ± 50.46 ml, p &lt; 0.001) and had longer hospital (6.03 ± 3.47 vs. 4.46 ± 2.52 days, p &lt; 0.001) and ICU (3.33 ± 2.65 vs. 2.85 ± 1.64 days, p = 0.026) length of stay (LOS). Rates of home discharge was significantly different in both groups (98.6 % in NOM and 89.6 % in OM) and 6.5 % of OM group were discharged to short-term general hospitals or in-patient rehabilitation centers (p &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>We found fewer complications and hospital LOS and higher rates of routine home discharge in NOM of isolated grade V blunt splenic injuries in pediatric patients.</div></div><div><h3>Level of evidence</h3><div>Level III retrospective study.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"61 4","pages":"Article 162918"},"PeriodicalIF":2.5,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145949064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Congenital perineal and perianal lipoma with and without anorectal malformation. A case series of eleven patients and updated literature review","authors":"S. Langer ,&nbsp;J.M. Patsch ,&nbsp;A. Scharrer ,&nbsp;J. Ludwiczek ,&nbsp;M. Metzelder ,&nbsp;W. Krois","doi":"10.1016/j.jpedsurg.2025.162914","DOIUrl":"10.1016/j.jpedsurg.2025.162914","url":null,"abstract":"<div><h3>Introduction</h3><div>Perineal and perianal lipomas with and without anorectal malformations (ARM) are rare.</div></div><div><h3>Methods</h3><div>This retrospective study evaluated records from patients with congenital perianal and perineal fatty-tissue growths with and without anorectal abnormalities in two tertiary centres. To contextualize the findings, an updated review of the literature spanning 2019 to 2023 was conducted.</div></div><div><h3>Results</h3><div>Eleven patients (m:f = 4:7) from two tertiary care centres were included over eight years; five (m:f = 2:3) had concomitant ARM. Other malformations included heterotaxy syndrome and urogenital malformations. Preoperative MRI was essential for diagnosis and surgical planning. Complete excision was performed in all cases (0–12 months of age) with only one minor wound infection and no recurrence of the lipoma. A posterior sagittal anorectoplasty was performed in cases of concurrent anorectal malformation. Malignancy was ruled out histopathologically in all cases. Postoperative bowel control seems to correlate with the severity of concurrent anorectal or spinal malformation: There was no postoperative fecal incontinence in patients without anorectal malformation.</div></div><div><h3>Conclusion</h3><div>Perineal and perianal lipomas are rare congenital anomalies that can occur in isolation or in combination with ARM. Preoperative imaging, particularly high-resolution pelvic MRI, is essential for accurate diagnosis and optimal surgical planning. Surgical excision is both safe and curative, even when performed alongside corrective procedures for ARM. Perineal or perianal lipomas do not influence postoperative functional outcome; postoperative continence is primarily determined by the severity of associated anomalies, such as ARM or spinal malformations. The familial cases in our series suggest a potential genetic component, highlighting the need for further research into the underlying embryological and genetic mechanisms.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"61 3","pages":"Article 162914"},"PeriodicalIF":2.5,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145944454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of the Outcomes of Mini-Percutaneous Nephrolithotomy for Kidney Stones in Galdakao Modified Position Between Preschoolers and Schoolchildren: A Single-Centre Study","authors":"Valeria Testa ,&nbsp;Morgane Père ,&nbsp;Hortense Alliot ,&nbsp;Coralie Defert ,&nbsp;Karim Braik ,&nbsp;Sarah Amar ,&nbsp;Anais Victor ,&nbsp;Marc Barras ,&nbsp;Xavier Delforge ,&nbsp;Melodie Juricic ,&nbsp;Samy Hafez ,&nbsp;Marc-David Leclair ,&nbsp;Thomas Loubersac","doi":"10.1016/j.jpedsurg.2025.162913","DOIUrl":"10.1016/j.jpedsurg.2025.162913","url":null,"abstract":"<div><h3>Purpose</h3><div>Percutaneous nephrolithotomy (PCNL) is the recommended treatment for renal stones larger than 20 mm or 10 mm for lower calyx stones. Treating children aged 6 years or younger appears to be more complex. This study compares the success rate and the complications of mini-PCNL (&lt;12F) for complex renal stones in Galdakao-modified supine Valdivia (GMSV) position between children under 6 years old (Group A) and those aged 6 years and older (Group B).</div></div><div><h3>Methods</h3><div>We retrospectively analysed patients who underwent mini-PCNL at our centre between 2018 and 2024 for renal stones larger than 2 cm or lower calyx stones exceeding 10 mm using the GMSV position. Preoperative, perioperative, and postoperative data were assessed. The primary outcome was the stone-free rate (SFR) at three months, defined as no residual fragments larger than 4 mm on imaging.</div></div><div><h3>Results</h3><div>A total of 36 procedures were performed on 28 patients. The groups differed significantly only in weight, and the median cumulative stone size was similar (p = 0.99). The SFR after one procedure was 79 % in Group A and 65 % in Group B (p = 0.46). The SFR after one or more procedures reached 86 % and 88 %, respectively, p = 0.99. The average procedure duration, the hospital stays, and the mean follow-up were comparable. Four major complications (Clavien grade ≥3) occurred, two in each group.</div></div><div><h3>Conclusions</h3><div>Mini-PCNL in the GMSV position is effective for treating renal stones in children, regardless of age.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"61 3","pages":"Article 162913"},"PeriodicalIF":2.5,"publicationDate":"2026-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145917919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When the bough breaks: Children's healthcare insurance and pediatric surgery.","authors":"Kenneth W Gow","doi":"10.1016/j.jpedsurg.2025.162916","DOIUrl":"10.1016/j.jpedsurg.2025.162916","url":null,"abstract":"","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"162916"},"PeriodicalIF":2.5,"publicationDate":"2026-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145917851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of pediatric housing status and racial profile on outcomes after traumatic injury","authors":"Nicholas J. Larson ,&nbsp;Rachael Rivard ,&nbsp;Blaise Boyle ,&nbsp;Ella Chrenka ,&nbsp;David J. Dries ,&nbsp;Benoit Blondeau ,&nbsp;Barbara A. Gaines ,&nbsp;Frederick B. Rogers","doi":"10.1016/j.jpedsurg.2025.162915","DOIUrl":"10.1016/j.jpedsurg.2025.162915","url":null,"abstract":"<div><h3>Background</h3><div>It is well documented that houseless patients tend to have worse medical outcomes; however, the interaction between housing status and traumatic injury, particularly in pediatric patients, is not well-understood. In this study we sought to identify if houseless patients have greater morbidity and mortality after trauma utilizing the years 2022–2023 of the Trauma Quality Improvement Program (TQIP) database.</div></div><div><h3>Methods</h3><div>We conducted a case-control study utilizing years 2022–2023 of the TQIP database, matching pediatric houseless patients in a 1:3 proportion to housed patients by admission year, age, sex, and ISS. Multinomial logistic regression modeled the relationship between housing status and discharge disposition, and structured generalized linear mixed models assessed differences in length of stay and likelihood of any hospital complication.</div></div><div><h3>Results</h3><div>453 houseless patients were compared to 1359 controls. Significantly more houseless patients died (5.7 %) compared to controls (3.7 %). On multivariable analysis, houseless patients had over double the likelihood of death compared to discharge home (aOR 2.19), 58 % greater odds of transfer for additional care (aOR 1.58), with no significant difference in complications or resource utilization (LOS, ICU LOS, ventilator days). Identifying as a person of color doubled the odds of mortality (aOR 2.01) and increased odds of hospital complications by 76 % (aOR 1.76).</div></div><div><h3>Conclusions</h3><div>Caring for pediatric houseless patients presents a difficult balance between treating physical injuries while addressing social issues. Addressing the increased odds of mortality after trauma among the houseless children described in this report begins with funding social programs dedicated to preventing houselessness in the community.</div></div><div><h3>Study Type</h3><div>Prognostic and Epidemiological; Level IV.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"61 3","pages":"Article 162915"},"PeriodicalIF":2.5,"publicationDate":"2026-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145906236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of clinical efficacy of surgical progressive treatment for corrosive esophageal stricture in children","authors":"Yuzhong Yang,&nbsp;Yong Chen,&nbsp;Lina Cai,&nbsp;Jirong Qi,&nbsp;Zhiqi Wang,&nbsp;Xuming Mo","doi":"10.1016/j.jpedsurg.2025.162891","DOIUrl":"10.1016/j.jpedsurg.2025.162891","url":null,"abstract":"<div><h3>Objective</h3><div>To explore the clinical efficacy of surgical progressive individualized treatment for corrosive esophageal stricture in children.</div></div><div><h3>Methods</h3><div>A retrospective analysis was conducted on the medical records of 52 children with corrosive esophageal stricture who were treated and followed up regularly in the Department of Cardiothoracic Surgery, Children's Hospital Affiliated to Nanjing Medical University from January 2017 to December 2024, including 30 males and 22 females, with an age of (4.20 ± 0.81) years and a weight of (12.20 ± 1.35) kg. There were 18 cases of acid substance ingestion, 31 cases of alkaline substance ingestion, and 3 cases of button battery ingestion. Sequential treatment methods including gastroscopic balloon dilation under direct vision, balloon dilation combined with submucosal injection of Mitomycin C into the esophagus, esophageal stent placement, and esophageal reconstruction were applied for the treatment of corrosive esophageal stricture in children. Postoperatively, the degree of esophageal stricture was observed via esophagography and gastroscopy, and the clinical efficacy of the surgical progressive treatment was evaluated in combination with the children's dysphagia grade. The t-test or chi-square test was used for difference comparison.</div></div><div><h3>Results</h3><div>All 52 children were discharged successfully. All children underwent balloon dilation treatment, among which 22 cases treated with simple gastroscopic balloon dilation under direct vision achieved good results; 30 cases received balloon dilation combined with submucosal injection of Mitomycin C into the esophagus, of which 16 cases achieved good results and 14 cases underwent esophageal stent placement; 14 cases underwent esophageal stent placement, of which 9 cases achieved good results and 5 cases underwent surgical treatment with good results.</div></div><div><h3>Conclusion</h3><div>The progressive individualized methods of gastroscopic balloon dilation under direct vision, balloon dilation combined with submucosal injection of Mitomycin C into the esophagus, esophageal stent placement, and esophageal reconstruction have definite clinical effects in the treatment of corrosive esophageal stricture in children, with simple methods that are easy to operate and promote.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"61 4","pages":"Article 162891"},"PeriodicalIF":2.5,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145900807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Open versus minimally invasive surgery for pediatric choledochal cyst in a propensity score matched cohort","authors":"Paulo Castro ,&nbsp;Anna M. Lin ,&nbsp;Lindsey Asti ,&nbsp;Loren Berman ,&nbsp;Matthew Boelig","doi":"10.1016/j.jpedsurg.2025.162524","DOIUrl":"10.1016/j.jpedsurg.2025.162524","url":null,"abstract":"<div><h3>Background</h3><div>This study aims to evaluate 30-day outcomes for children undergoing open versus minimally invasive surgery (MIS) for choledochal cysts using a propensity score matched cohort created from a national database.</div></div><div><h3>Methods</h3><div>Children undergoing surgery for choledochal cyst from 2013 to 2023 were identified using the National Surgical Quality Improvement Program-Pediatric (NSQIP-P) database. A propensity score match was performed. Outcomes were compared between operative approaches using an intention-to-treat analysis. Pearson’s chi-square, Fisher’s exact, and Mann–Whitney’s U tests were used as appropriate. A Cochran–Armitage test was used to assess operative trends.</div></div><div><h3>Results</h3><div>A total of 773 children who underwent surgery for choledochal cyst were identified. Pre-match, children undergoing open surgery were more likely to be younger, smaller in weight, have Roux-en-Y hepaticojejunostomy performed, have a history of gastrointestinal disease, and have higher American Society of Anesthesiology (ASA) class. Post-match, the groups were similar and included 247 cases per group. The MIS approach was associated with a longer median operative time (311 min vs. 261 mins, <em>p</em> &lt; 0.001) and more surgical site infections (SSI) (6.5 % vs. 1.6 %, <em>p</em> = 0.006). There were no differences in composite morbidity, postoperative length of stay, and readmission or reoperation at 30 days. MIS utilization increased over the study period (<em>p</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>MIS utilization has steadily increased within the NSQIP-P cohort. The MIS approach takes longer to perform and may be associated with a higher rate of SSIs. We observed no significant differences in overall morbidity, postoperative length of stay, readmission, or reoperation. Multicenter prospective trials would be useful to further compare these two approaches.</div></div><div><h3>Type of study</h3><div>Retrospective comparative study.</div></div><div><h3>Level of Evidence</h3><div>Level III.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"61 1","pages":"Article 162524"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144847110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}