Pediatric Surgery International最新文献

Objectives: Minimally Invasive Repair of Pectus Excavatum (MIRPE) is the most popular technique to repair pectus excavatum in young patients. One or more metallic bars are inserted and maintained for at least 2-3 years. Only a few reports on possible metal release in these patients have been published. The study aimed to search for an increase in blood metal levels in patients after MIRPE and to investigate if surgical details (number of bars and stabilizers) were correlated with metal release.

Methods: We have prospectively studied blood levels of chromium, nickel, molybdenum and manganese before bar implant in a group of patients undergoing MIRPE between 2017 and 2019 and, in the same patients, at the moment of bar removals between 2020 and 2022. All our patients had the same stainless-steel bar. Blood samples were analysed using inductively coupled plasma mass spectrometry.

Main results: We included a total of 53 (10 females) patients. Median age at MIRPE was 15.4 years. After a median bar maintenance time of 3.1 years, we observed significantly higher mean levels of chromium (2.43 vs. 0.52 µg/L) and molybdenum (1.87 vs. 0.35 µg/L; p < 0.05). Nickel (4.24 vs. 80.80 µg/L) and manganese (12.69 vs. 19.81 µg/L) were also higher, although not statistically significant. No differences were found regarding the number of bars, stabilizers implanted or gender. No patients had clinical symptoms of metallosis.

Conclusions: We demonstrated that metal blood levels increase in patients with retrosternal bars after MIRPE. Clinical implications of our finding are still unknown.

Background: First branchial cleft anomalies are uncommon paediatric congenital lesions that may present as persistent pre-auricular or post-auricular sinuses and can involve the parotid region and facial nerve. We present a single-centre 10-year experience describing presentation, imaging, management and outcomes.

Methods: Retrospective review of a prospectively collected local dataset of paediatric patients with first branchial arch cleft cysts/tracts who underwent evaluation and surgery at a tertiary paediatric centre. Data elements included age at presentation, presenting symptoms, imaging modality, surgical treatment, postoperative complications, facial nerve dysfunction, fistula course, recurrence and follow-up.

Results: Eleven patients were included (mean age 5.55 years, median 4 years). The commonest presentation was a persistent sinus with purulent discharge (9/11). Laterality was predominantly left-sided (8/11). MRI was the most used imaging modality (8/11). Postoperative wound infection occurred in 3/11 patients (27%); marginal mandibular branch weakness was recorded in 2/11 (both documented as transient/resolved). One patient had documented recurrence. The fistula/tract most commonly tracked from level II to the ear canal (9/11).

Conclusion: In this paediatric series, first branchial arch cleft anomalies most commonly presented as persistent left-sided sinuses with purulent discharge. MRI was commonly used for preoperative assessment. Surgical excision was associated with wound infection in a minority and transient marginal mandibular weakness in several cases. Larger multi-centre series with systematic prospective follow-up are needed.

Purpose: Minimally invasive pectus excavatum repair (MIRPE) using the Nuss procedure is associated with significant postoperative pain. Intercostal nerve cryoablation (INC), used alone or with adjuncts like intercostal nerve blocks (INB) have improved pain control. This retrospective study aimed to compare the impact of INC with INB on overall postoperative medication exposure.

Methods: Patients aged ≤ 20 years who underwent MIRPE with bilateral INC and INB (INC-INB) from 2021 - March 2023 were compared to historical controls with bilateral paravertebral blocks (PVB) from 2018 to 2020. Demographics, operative details, and outcomes were compared using Chi-square and Kruskal-Wallis tests.

Results: Of 164 patients, 90 (55%) underwent repair with INC-INB, and 74 (45%) with PVB. Age, Haller index, and second bar usage were comparable between groups. While median (IQR) operative time was longer for patients with INC-INB [110 (102, 122) vs. 69 (60, 82) minutes, p < .001], total operating room time was equivalent [185 (169, 199) vs. 194 (174, 209) minutes, p = .09]. Compared to PVB, INC-INB was associated with lower opioid consumption [0 (0, 0.2) vs. 1.6 (0.7, 3.0) OME/kg, p < .001], fewer total postoperative medications [6 (4, 7) vs. 12 (11, 13), p < .001], and shorter length of stay [30 (28, 34) vs. 59 (55, 77) hours, p < .001].

Conclusion: INC-INB reduces overall postoperative medication exposure and length of stay compared to percutaneous PVB for pain control in children undergoing MIRPE.

Level of evidence: III.

Purpose: To describe institutional approaches to prophylactic appendectomy during Ladd's procedure in Japan, including rationales and prespecified exceptions.

Methods: We conducted a cross-sectional questionnaire survey through the Japanese Society of Pediatric Surgeons Under-45 Working Group. Member institutions reported their usual institutional approach in a standardized index scenario of emergency Ladd's procedure for midgut volvulus in a stable term neonate without intestinal necrosis or perforation. Responses were analyzed descriptively.

Results: Forty-six of 50 invited institutions responded; 45 with a unified institutional approach were analyzed. In the index scenario, 22 institutions (48.9%) reported routinely performing prophylactic appendectomy and 23 (51.1%) reported not performing it. Performance institutions most commonly cited avoidance of future diagnostic confusion (72.7%) and prevention of future appendicitis (68.2%), whereas non-performance institutions emphasized confidence in contemporary imaging (60.9%) and avoidance of unnecessary procedures or complications (47.8%). Among performance institutions, omission was mainly reported in the presence of intestinal necrosis, perforation, or very or extremely low birthweight; deviations from non-performance were rare.

Conclusion: Japanese institutions show highly standardized yet divergent approaches to prophylactic appendectomy during Ladd's procedure. These findings clarify how diagnostic, operative, and future reconstructive considerations are balanced and provide a practical framework for protocol review and outcome-focused studies.

Purpose: Communication skills are essential non-technical competencies in pediatric surgery, yet formal training programs remain limited and inconsistent. This perspective article examines the critical role of communication across pediatric surgical subspecialties and proposes frameworks for implementing structured communication training in residency programs.

Methods: We performed a narrative review of published literature on communication skills in pediatric surgery and synthesized existing communication frameworks applicable to surgical training. Expert perspectives were gathered from an international group of pediatric surgeons representing diverse subspecialties including prenatal counseling, neonatal surgery, pediatric urology, and pediatric surgical oncology.

Results: We identify specific communication challenges unique to pediatric surgery, including prenatal counseling, neonatal intensive care discussions, sensitive urological conditions, and pediatric oncology. Existing frameworks such as SPIKES for delivering bad news and EMPATHY for non-verbal communication provide evidence-based tools adaptable to pediatric contexts. Current training approaches remain largely informal and mentor-dependent, with significant variability between programs.

Conclusion: Pediatric surgery training programs should integrate structured communication curricula with defined learning objectives, simulation-based practice, and regular feedback mechanisms to prepare trainees for the unique communication demands of caring for children and their families.