Pediatric Surgery International最新文献

Purpose: Congenital diaphragmatic herniae (CDH) may require patch closure in 50% of the cases. We assessed a biologic and composite mesh in a porcine CDH model.

Methods: Left sided thoracotomy was performed in 20 pigs. Approximately, 30% of the diaphragm was excised and the patch (Surgisis® or Parietex®) inserted to close this defect. The pigs were killed at 6 months and the diaphragm was harvested for biomechanical and histological assessment.

Results: The mean weight of the pigs at surgery and killing were 6.1 kg (4.2-8.4 kg) and 94.1 kg (80-131 kg), respectively. There were two recurrences and three eventrations, all with Surgisis®. There were less dense lung and abdominal adhesions in the Parietex group (P < 0.0001 and 0.025, respectively). The tensile strength of the Surgisis®, the Parietex® groups and controls were similar. There was significantly more muscle in-growth in the Parietex® patch over Surgisis® (p = 0.016).

Conclusion: Parietex® and Surgisis® patches at 6 months have a similar tensile strength to normal tissue. All recurrences and eventrations were in the Surgisis® group. Parietex® patches demonstrated more muscle in-growth into the patch compared to Surgisis®. This is the first study utilising Parietex® composite patch in the repair of large diaphragmatic defects in a porcine model.

Purpose: To assess parental stress in newborns undergoing surgical care.

Methods: A cross-sectional study was conducted in the Department of Pediatric Surgery at a tertiary center. The study included all parents of newborns requiring surgery, admitted between July 2023 and June 2024.

Results: The overall stress score among the study population was 3.3 ± 1. Approximately 90% of parents reported experiencing at least some level of stress (stress score ≥ 2), with the "parental role alteration" domain scoring the highest (3.9 ± 1.1). In the "surgical aspects" domain, 27% reported extreme stress and 22% reported high stress. Higher stress scores were found among parents of preterm infants (3.6 ± 0.9 vs. 3.1 ± 1.1, p = 0.04), infants with a birth order ≥ 2 (3.4 ± 1.1 vs. 3.1 ± 1, p = 0.04), and those from the Muslim community. Graduate parents (2.8 ± 0.9, p = 0.01) and parents of upper socioeconomic status (2.3 ± 0.7, p < 0.0001) were found to have lower stress scores.

Conclusion: Parental stress is significant among surgical newborns, especially in parents of preterm babies, babies with severe medical conditions, and those with lower education and socioeconomic status. "Parental role alteration" was the most stressful aspect, highlighting the need for targeted support.

Purpose: Neurodevelopmental disorders (ND) have been recognized as the most common and potentially most disabling outcome of congenital diaphragmatic hernia (CDH). Our aim was to evaluate the incidence of ND in patients with a history of CDH referred for ND assessment on the basis of clinically relevant symptoms rather than through a screening process.

Methods: The study was a nationwide, population-based prospective nested case-control study within a cohort of newborn children who survived the newborn period in Sweden during the observational period from 1st January 1982 until 31st December 2015.

Results: In the study period, 641 non-syndromic CDH survivors were identified, and 3080 control cases were selected. Significantly higher incidence of clinically relevant any ND (11.5% vs 5.6%,p < 0.001), ASD (3.9% vs 2.1%,p:0.011), and intellectual disorder (6.6% vs 0.7%,p < 0.001) were observed in CDH compared to controls. When compared with controls, those with CDH were found to have a 2.179 times higher risk to develop any ND (p < 0.001), 1.867 times higher risk for ASD (p = 0.008), and 10.63 times higher for intellectual disorder (p < 0.001).

Conclusion: CDH survivors have a higher risk of clinically relevant ND than the general population, independent of the effect of screening.

Purpose: Appendectomies are the most common abdominal emergency surgery in pediatric patients. Both pediatric and general surgeons are credentialed to perform this procedure, however pediatric surgeons are specialized in pediatrics. This study seeks to determine differences in pediatric appendectomy outcomes between general and pediatric surgeons.

Methods: Pediatric patients undergoing appendectomies between 2015 and 2020 were identified in the National Surgical Quality Improvement Program-Pediatric (NSQIP-P) database. Multivariable logistic regression models examined association of surgeon specialty with readmission, postoperative complications, reoperation, non-home discharge destination, operative time, etc. Adjusted odds ratios (AOR) and 95% confidence intervals (CI) were calculated.

Results: Average ages of pediatric patients undergoing appendectomy by pediatric and general surgeons were 11.2 (n = 68,638) and 12.3 (n = 3,986) years, respectively (p < .001). General surgeons were not more likely to have adverse outcomes [AOR: 1.00 (0.99-1.01), p = 0.57], readmissions [AOR: 0.995 (0.98-1.00), p = 0.11], reoperations [AOR: 1.00 (0.99-1.00), p = 0.54], or non-home discharges [AOR: 0.99 (0.99-1.00), p = 0.94].

Conclusions: Similar outcomes arise in pediatric appendectomies performed by general surgery at a children's hospital or hospitals with a pediatric wing. Significant limitations to using the NSQIP-P database persist. Further research including hospitals contributing to both adult and pediatric databases can provide a clearer picture of post-surgical outcomes in appendectomies.

Purpose: Anorectal malformations (ARMs) are rare congenital anomalies causing altered anatomy and frequent hospitalizations. Parental awareness and clear communication are crucial in family-centered care. This study assesses the impact of patient-held ARM Medical Alert Cards on healthcare providers and caregivers.

Methods: Caregivers of children with ARMs, including cloacal anomalies, received Medical Alert Cards with (1) contact details; (2) disease-related information; and (3) patient-specific data. A survey evaluated these cards' effectiveness in enhancing ARM awareness among healthcare professionals and caregivers.

Results: Among 33 respondents, 29 (88%) found the cards helpful in increasing ARM awareness. Both caregivers and providers found the content coherent, with a median readability score of 9 (IQR 8-10). The card layout was well-received by 30 out of 32 respondents (94%), and all noted the clarity of the contact details, facilitating patient referrals to specialized care. Most caregivers (13 out of 14, 93%) expressed willingness to use these cards in medical settings. Suggestions for improvement included adding more patient-specific information, enhancing readability, and providing visual anatomy diagram.

Conclusion: Medical Alert Cards for patients with ARMs can enhance understanding of ARMs among caregivers and healthcare providers, serving as a vital tool in patient-centered management strategies tailored to individual needs.

Objectives: This study aims to measure the diagnostic accuracy and reliability of US and CT in diagnosing complicated appendicitis among pediatric patients and to find the performance of the imaging modalities in detecting complication signs.

Methods: a systematic review and meta-analysis were done on 15 eligible studies from the Medline Database concerning pediatric appendicitis and its complications. Studies either provided an overall estimate of sensitivity and specificity of the imaging modality or addressed signs of complicated appendicitis The reference standard employed was either surgical findings or histopathology reports.

Results: The review included assessments of 4,497 pediatric patients, with 285 undergoing CT and 4,212 undergoing US imaging. CT demonstrated sensitivities of 62% and 68.4%, and specificities of 81% and 92.4%. US showed sensitivities of 33.9% to 51.5% and specificities ranging from 68.8% to 95%. The ultrasound's ability to detect appendiceal wall diameter > 5 mm showed the highest sensitivity (99.4%), while the conglomerate sign indicated the highest specificity (99.9%).

Conclusion: The findings suggest that both US and CT exhibit higher specificity than sensitivity in diagnosing complicated appendicitis in pediatric patients. Given its favorable specificity, non-invasiveness, and lack of radiation exposure, US should be the first-line imaging modality in suspected cases of pediatric appendicitis. CT, offering robust specificity, should be reserved for ambiguous cases where US results are inconclusive. These insights underscore the critical role of precise imaging modalities in enhancing diagnostic accuracy, reducing unnecessary surgeries, and improving clinical outcomes in pediatric appendicitis management.

Purpose: The purpose of this study was to understand the provision and distribution of esophageal atresia (EA) follow-up (FU) and transition services across European Reference Network for rare Inherited and Congenital Anomalies (ERNICA) member and affiliate centers.

Methods: A REDCap questionnaire was sent to clinical leads of 18 ERNICA members and 14 affiliate centers.

Results: 29 of 32 centers responded (91%), the majority of which were highly specialized. Two-thirds had a dedicated EA clinic with a specialist multi-disciplinary team (MDT), offered to selected/complex patients only in 40% of centers. ERNICA centers were more likely to offer an MDT FU clinic than affiliates, with lack of resources most cited as a barrier to uptake (67%). Delivery of routine investigations was heterogeneous, particularly provision of three endoscopies over the course of FU (24%). Only 55% had a dedicated transition pathway, more prevalent in ERNICA centers (81% vs. 30%; p < 0.01). Self-reported awareness of ERNICA and European Society for Pediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) guidance for FU and transition was poor (28%).

Conclusion: Despite the existence of European follow-up and transition guidelines, their delivery is not uniform and may be limited by lack of awareness of the guidelines and a lack of resources.

Purpose: Limited data exists evaluating same-day discharge for pediatric Nuss procedure; most being single-center studies. Our analysis, using the NSQIP-P registry, aimed to assess if same-day discharge for the Nuss procedure influenced post-operative outcomes.

Methods: The NSQIP-P database (2017-2022) identified patients who underwent the Nuss procedure. Patients discharged same-day postoperatively (SDD) were compared to those discharged 1-7 days postoperatively (non-SDD).

Results: Of 5486 patients identified, 91 (1.7%) were SDD. From 2018 to 2022, the annual SDD rate increased from 0.8% to 2.7%. There was no significant difference between SDD and non-SDD groups for 30-day readmission (1.1% vs 3.5%, p = 0.376), reoperation (0% vs 1.5%, p = 0.643), or other outcomes. Twenty-six patients required readmission or reoperation within 3-days; only one underwent SDD. The most common readmission was for pain (n = 4) and reoperation for chest-tube placement (n = 10). Asthma (OR 1.66, 95% CI 1.03-2.67, p = 0.038), and increased operative time (per 10 min increment: OR 1.060, 95% CI 1.034-1.086, p < 0.001) each increased risk of readmission or reoperation.

Conclusion: Same-day discharge for the Nuss procedure, although infrequent, has increased without significant differences in complications in the 91 patients who were discharged same-day in this analysis. Same-day discharge for Nuss procedure is reasonable for non-asthmatic patients with a satisfactory postoperative x-ray and meeting other goal-based discharge criteria, including adequate pain control.

Level of evidence (i-v): Level III.

The aim of this study was to investigate the utility of ureteral diameter ratio (UDR) as a tool to prognosticate and manage vesicoureteral reflux (VUR). Four scientific databases (PubMed, EMBASE, Web of Science, and Scopus) were systematically searched. Inclusion criteria were all studies in which UDR was used in prognostication and/or management of VUR. An independent assessment of the methodological quality was performed by two authors using the Newcastle Ottawa Quality scale. The statistical analysis was performed using a random-effects model. Thirteen studies (all retrospective) were included in this review. Pooling the data demonstrated a significantly lower UDR in the spontaneous resolution vs. persistence of VUR group (p = 0.001). Also, the pooled data showed significantly higher values of UDR in the breakthrough UTI group (p < 0.00001), those requiring operative intervention (p = 0.03), and those with persistence of VUR after endoscopic treatment (p < 0.0001). The estimated heterogeneity for two outcomes, i.e., spontaneous resolution and requirement of operative intervention in VUR were substantial and statistically significant. All except one of the included studies were of good methodological quality. However, further studies are required to identify the cut-off values for these respective outcomes.

Background: The obesity epidemic has led to an increased number of adolescents requiring metabolic and bariatric surgery (MBS), but there is paucity of data on the impact of implementing all aspects of Enhanced Recovery After Surgery (ERAS) protocols to improve outcomes in this population.

Methods: We implemented a comprehensive ERAS pathway for adolescents undergoing laparoscopic sleeve gastrectomy (LSG). Key elements included pre-operative fasting with carbohydrate loading in the morning of surgery, comprehensive anti-emetic and analgesic regimens including intra-operative lidocaine infusion (initiated before formal ERAS launch), regional anesthesia, and early goal-directed ambulation. We tracked opioid utilization, rescue anti-emetic use, time to oral intake, and hospital length of stay (HLOS) as outcome measures, and post-operative pain and returns to the system as balancing measures.

Results: Eighty-six patients (52 patients pre-ERAS and 34 patients post-ERAS) underwent LSG with no differences in demographics. The post-ERAS group had earlier time to oral intake (3.0 vs. 5.5 h, p = 0.003), used less rescue anti-emetics, (8.0 vs. 16.0 mg, p < 0.001), and had shorter HLOS (33 vs. 54 h, p < 0.001) but no difference in opioid use (0.370 vs. 0.435 MME/kg, p = 0.17), post-operative pain scores or return to the system.

Conclusions: Our novel use of bariatric-specific ERAS protocol with intra-operative lidocaine infusion accelerates the time to goal-directed oral intake and decreases HLOS without increasing the rate of returns to the system. This study highlights the feasibility and effectiveness of adapting adult ERAS protocols to the pediatric MBS population.

Level of evidence: Level III.