Pediatric Surgery International最新文献

Background: Chronic right lower quadrant (RLQ) abdominal pain in pediatric patients with a negative workup poses a diagnostic and therapeutic challenge. The role of laparoscopic appendectomy (LA) in this cohort remains controversial.

Methods: Patients ≤ 18 years old who underwent LA for chronic RLQ pain between 2010 and 2021 were reviewed across two academic centers. Clinical data, operative findings, and histopathological results were compared between those with resolved and persistent pain following appendectomy.

Results: 123 patients underwent LA for chronic RLQ pain. Patients were categorized based on resolution (n = 78) or persistence (n = 45) of their pain following LA. Neither median symptom duration (9.3 [IQR: 2.7-18.7] vs. 6.4 [2.9-18.6] months, p=0.75), presenting symptoms, nor incidence of prior abdominal surgery (14.1% vs. 17.8%, p = 0.58) differed between groups. There was a high incidence of psychiatric diagnoses in both groups (21.8% vs. 24.4%, p = 0.74). Histopathologic findings did not differ between responders and non-responders. Concomitant surgeries were performed in 14.1% of responders (6 planned cholecystectomies, 6 incidental pathologies) and 20.0% of non-responders (4 planned cholecystectomies, 7 incidental).

Conclusions: LA provided sustained pain relief for a large subset of pediatric patients with chronic RLQ pain, even though no objective findings could distinguish responders from non-responders. These findings underscore the need for additional research to optimize diagnostic and treatment strategies for these difficult patients.

Objective: To evaluate the relationship between postoperative bowel dysfunction and pelvic floor muscle development in children with congenital megacolon.

Methods: Postoperative MRI data were collected from children with congenital megacolon who underwent surgery at the Department of General Surgery, Anhui Children's Hospital, between May 2007 and December 2024. MRI measurements included the position of the rectum, maximum thickness of the internal and external anal sphincters (EAS), levator ani, puborectalis, pubococcygeus, iliococcygeus, and ischiococcygeus muscles, upper rectal lumen width, and anorectal angle. Based on the 2016 Rome IV criteria for pediatric functional gastrointestinal disorders, children were classified as non-neurogenic fecal incontinence (NFI) group (Group A) or NFI group (Group B). Clinical data and MRI-derived muscle parameters were compared between groups.

Results: A total of 50 children were included, with 34 in Group A and 16 in Group B. Significant differences were observed in the thickness of the EAS and puborectalis muscle between the two groups (P < 0.05). Multivariate logistic regression revealed that greater EAS thickness (OR = 0.27, 95% CI: 0.08-0.90, P = 0.03) and puborectalis thickness (OR = 0.35, 95% CI: 0.13-0.84, P = 0.02) were independent protective factors against NFI, whereas long-segment congenital megacolon (OR = 7.72, 95% CI: 1.74-34.36, P = 0.007) was an independent risk factor.

Conclusion: Postoperative non-retentive fecal incontinence in children with congenital megacolon may be associated with the thickness of the EAS, puborectalis muscle, and megacolon type.

Purpose: Boys with genetic syndromes have an increased risk of undescended testes (UDT), but laparoscopic findings and outcomes after two-stage Fowler-Stephens orchiopexy (FS2) are rarely reported. This study aims to compare laparoscopic findings and results after FS2 between syndromic and non-syndromic boys.

Methods: A retrospective cohort study on boys with UDT who underwent laparoscopy between 2014 and 2024. Syndromic and non-syndromic patients were compared regarding age at surgery, bilaterality, type of UDT, and atrophy rate after FS2.

Results: In total, 190 boys with 298 testicles underwent laparoscopy. Of these, 42% were found to be intra-abdominal, 23% were vanishing testes and in 22% of cases, a testicular nubbin was found. Bilateral (p < 0.001) and intra-abdominal UDT (p < 0.01) were significantly more common in children with syndromes, whereas testicular nubbin was less common (p < 0.01). The median age at laparoscopy was higher in the group with syndromes. Atrophy occurred in 20% of all testicles undergoing FS2, with no significant difference in outcome between groups (p > 0,05).

Conclusion: Syndromic boys present with more severe UDT but achieve comparable outcomes after FS2. Early diagnosis and individualized management are essential to preserve testicular viability in this high-risk group.

Purpose: In 2017, the American Pediatric Surgical Association (APSA) published a systematic review that supported ovarian detorsion rather than oophorectomy for children with ovarian torsion. We evaluated our institutional ovarian salvage rate and outcomes following ovarian detorsion before and after publication of these APSA recommendations.

Methods: Electronic Medical Record data for patients who underwent operative intervention for adnexal torsion and between 01/01/2010 and 12/31/2023 at a single pediatric center were reviewed. Patients with antenatal torsion were excluded. Patient characteristics, operative findings, and postoperative outcomes were examined.

Results: A total of 238 patients were included. Mean age was 10.9 years (range 0.1-20.0). Mean time from presentation to OR was 9.5 h (SD 8.9). Ovarian detorsion was performed in 186 patients (78.2%). Oophorectomy was performed in 52 (21.8%); of these, 33 (63.5%) demonstrated evidence of necrosis and 14 (26.9%) were associated with a tumor. There were no intraoperative complications. There were no thromboembolic events following detorsion. Pregnancy data were available for 10 patients, with 7 live births.

Conclusion: Ovarian salvage is the preferred treatment for torsion. Our rates of ovarian salvage have improved over the past 10 years with no negative sequelae and no missed malignancies.

Purpose: The fertility potential of with 46,XY DSD individuals has remained poorly understood. This study aimed to assess testicular cytology and semen analysis findings in post-pubertal patients with 46,XY DSD.

Method: Following ethical approval, a cohort of post-pubertal (> 13 years) patients with 46,XY DSD assigned a male gender was evaluated through a personal interview, clinical examination, and hormonal assay. Prostatic and testicular volumes and echotexture were assessed. Semen analysis and testicular cytology were also performed.

Results: Of the 75 eligible patients, 17 responded. The mean age at the time of study was 17(± 3.33) years, with a follow-up of 160 (± 68.28) months. All patients reported comfort with male gender assignment. The median stretched penile length was 6 cm, and clinically assessed testicular volumes were within normal limits. However, prostate volumes were small, and prostate-specific antigen (PSA) levels were undetectable in one-third. Semen analysis revealed that 6 patients were unable to ejaculate, 4 had aspermia, 4 had oligospermia, and 3 had azoospermia. Testicular FNAC demonstrated normal spermatogenesis in only 6 patients. The median spermatogenic-to-Sertoli cell ratio was 0.84, markedly lower than the normal expected value. Notably, several patients with normal spermatogenesis on FNAC had abnormal semen analysis findings.

Conclusions: Despite overall comfort with male gender assignment and normal hormonal profiles, both semen analysis and testicular cytology revealed compromised fertility potential in post-pubertal patients with 46,XY DSD.

Purpose: Access to appropriate and clean toilet facilities is essential for children with Hirschsprung Disease (HD). This study aims to assess how parents of children with HD perceive school toilet facilities.

Method: A cross-sectional survey was spread among parents of children aged 4-13 years with HD. The questionnaire addressed the frequency of toilet use and reasons for positive or negative experiences, with open- and closed-ended questions, for quantitatively and qualitatively analyses, respectively.

Results: Forty-four parents completed the questionnaire. The median age of the children was 7 years (IQR 5.3-10.8). Five (11.4%) children never used the school toilet, 16 (36.6%) used it for urination only, and 23 (52.3%) used it for urination and defecation. Positive parental experiences (29, 65.9%) were associated with the possibility for the child to clean themselves at school, while negative experiences (15, 38.6%) were linked to the absence of child-specific toilet rules. Qualitative analysis revealed six influencing themes; assistance, possibilities, school rules, medical nature, toilet facilities, and information.

Conclusion: Toilet avoidance for defecation remains common among children with HD. Improvements in toilet facilities, support, and individualized toilet policies may enhance well-being in this population.

Purpose: To evaluate whether hemoglobin P₅₀, automatically calculated from routine blood gas analyses, can serve as a practical early biomarker for necrotizing enterocolitis (NEC) in preterm infants.

Methods: We retrospectively analyzed 117 preterm infants born at < 32 weeks' gestation who were admitted to a tertiary NICU between 2022 and 2024. Hemoglobin P₅₀ and serum lactate values were obtained from arterial blood gases on postnatal days 1-3. NEC was defined according to modified Bell's criteria (stage ≥ II). Discriminative performance was assessed using receiver operating characteristic (ROC) analysis, with a prespecified P₅₀ threshold of 21.0 mmHg.

Results: NEC developed in 27 infants (23%). Mean day-2 P₅₀ was significantly higher in the NEC group compared with controls (22.5 ± 6.8 vs. 18.9 ± 3.6 mmHg; p = 0.03). Day-2 P₅₀ predicted NEC with moderate accuracy (AUC 0.70, 95% CI 0.56-0.83), outperforming lactate (AUC 0.52, 95% CI 0.38-0.67). At the 21.0 mmHg cutoff, sensitivity was 67%, specificity 72%, positive predictive value 41.8%, and negative predictive value 87.9%.

Conclusion: Day-2 hemoglobin P₅₀ was elevated in infants who subsequently developed NEC. These preliminary findings indicate that P₅₀ may be a feasible, cost-effective biomarker for early NEC risk stratification; however, larger prospective studies are required to validate its predictive utility.