Pediatric Surgery International最新文献

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.

Purpose: This study aimed to compare the efficacy and long-term outcomes of tunica albuginea plication and Heinecke-Mikulicz corporoplasty techniques in children.

Methods: A retrospective review was performed on 176 children who underwent corrective surgery for CPC with a curvature angle between 30° and 60° between 2014 and 2022. Patients were classified into three groups: degloving alone (Group 1, n = 85), tunica albuginea plication (Group 2, n = 72), and Heinecke-Mikulicz corporoplasty (Group 3, n = 19).

Results: The mean age at surgery was 7.6 ± 3.2 years (range: 4-11). Curvature was mainly ventral or ventrolateral (84.8%). Mean preoperative curvature angles were 36.2°, 37.4°, and 41.4° in Groups 1, 2, and 3, respectively. Adequate correction was achieved with degloving alone in 48.2% of patients. In those requiring additional correction, complete straightening was obtained in all cases (p < 0.001). During a mean follow-up of 26.7 ± 17.7 months, curvature recurrence occurred in 18.8%, 19.4%, and 21.1% of patients in Groups 1, 2, and 3, respectively. Late complications included palpable suture knots in two patients from Group 2 and four from Group 3.

Conclusions: Tunica albuginea plication is a safe, effective, and practical option for correcting penile curvature in children when degloving alone is insufficient.

Introduction: Postoperative outcomes in Hirschsprung disease (HSCR) may be extremely variable. Therefore, an appropriate follow up is mandatory due to the dynamic nature of patients' clinical history. We aim to provide a diagnostic-therapeutic algorithm for the multidisciplinary postoperative management of rectosigmoid HSCR patients and to characterize our study population based on patients' distribution within the algorithm.

Methods: We conducted a retrospective study including all patients with rectosigmoid HSCR treated at or referred after surgery to Umberto Bosio Center for Digestive Diseases between 2019 and 2023. Data concerning demographic and clinical features, diagnostic and therapeutic management as well as post-operative outcomes were collected. Three main functional groups were retrospectively defined (asymptomatic patients, patients with obstructive symptoms, patients with fecal incontinence/soiling). Diagnostic pathways and therapeutic strategies were analyzed for each group. The functional outcome after the rehabilitation programme was evaluated at the time of data collection.

Results: Eighty-six patients were included, 37% of whom referred from other centers. According to the first post-operative evaluation, patients were distributed as follows: 47.7% (41/86) were asymptomatic, 19.8% (17/86) had obstructive symptoms, and 32.5% (28/86) had fecal incontinence/soiling. Following the diagnostic and therapeutic measures, all patients that were initially classified as asymptomatic were still asymptomatic, patients with obstructive symptoms decreased of more than 75% (from 17 to 4) and among patients with fecal incontinence/soiling up to 68% (19/28) proved to be socially clean.

Conclusions: The algorithm proved to be effective for all patients even if operated elsewhere. Most patients with obstructive symptoms as well as those with fecal incontinence showed significant clinical improvement, confirming that a targeted treatment protocol can solve these conditions.

Purpose: Patients with an in-situ gastrostomy tube(G-tube) often require laparoscopic fundoplication (LF) for refractory gastro-oesophageal reflux disease. We evaluated the feasibility and outcomes of LF, identifying the need for gastrostomy detachment.

Method: All LF performed between 2014 and 2024 by a single surgeon in a tertiary paediatric centre were retrospectively analysed. Clinical data, operative technical aspects and outcomes were analysed.

Results: Of 170 LF,33 children had a G-tube. In 28 cases (85%, Group A), LF was completed without detaching the gastrostomy (median operating time 75 min). Five patients (15%, Group B) required detachment of the stoma due to severe scoliosis, giant hiatus hernia or short intra-abdominal oesophagus (median 100 min). There were no early postoperative complications in Group A, but five fundoplicationsfailed, requiring redo LF (twice in one patient). These six redo procedures were completed laparoscopically without detaching the gastrostomy. In Group B, one converted LF case required redo surgery for milk peritonitis secondary to dehiscence of the refashioned gastrostomy.

Conclusion: LF with an in-situ G-tube is safe and feasible with minimal risks. Patients with giant hiatus hernia, severe scoliosis or short intra-abdominal oesophagus are challenging, requiring tailored ports positioning to avoid detaching the pre-existing gastrostomy and its associated risks.

Background: Laparoscopic surgery is widely used for pediatric inguinal hernia repair, but evidence from resource-limited settings remains scarce. This study compared outcomes of open herniotomy (OH) and laparoscopic percutaneous extraperitoneal closure (LPEC) in a regional Thai hospital.

Methods: We conducted a retrospective review of children who underwent OH or LPEC between January 2018 and January 2024. A one-to-one propensity score-matched cohort was created based on age and sex. Outcomes included operative time, anesthetic time, and complications. Univariable and multivariable linear regression identified factors influencing operative and anesthetic time.

Results: Among 358 operations, 118 matched pairs (236 patients) were analyzed. Median operative time was longer for unilateral LPEC (30 vs. 25 min, p < 0.001) but shorter for bilateral cases (35 vs. 45 min, p = 0.027). Anesthetic time was longer in unilateral LPEC (70 vs. 55 min, p < 0.001) with no difference for bilateral repairs. Multivariable analysis showed LPEC added 4.3 min (95% CI: 0.8-7.9) to operative time after adjusting for confounders. Complication (OH 15.0% vs. LPEC 13.5%) and recurrence rates (1.2% vs. 1.1%) were similar. Metachronous contralateral inguinal hernia (MCIH) occurred only in OH (13.4%), whereas CPPV was detected in 38.6% of unilateral LPEC cases (NNT = 9).

Conclusion: LPEC is safe, prevents MCIH, and should be considered a first-line option when available.

Purpose: Decision-making for orchiectomy following testicular torsion often relies on subjective clinical evaluations. This study investigates the efficacy of machine learning (ML) models in objectively predicting post-torsion testicular viability, aiming to maintain a parenchymal ratio over 80% compared to the contralateral testicle, irrespective of initial appearance and surgical timing.

Methods: A prospective database from a single surgeon (2020-2024) covering all patients who underwent detorsion and subsequent bilateral orchidopexy was utilized. Follow-up ultrasounds were conducted at 6 to 12 months post-procedure. Variables included patient age (neonatal, prepubertal, post-pubertal), time from presentation to surgery, and history of torsion-detorsion events. Various ML models-logistic regression, k-nearest neighbors (k-NN), and decision trees-were assessed for precision and recall.

Results: The decision tree model demonstrated the highest accuracy at 90.5%, followed by the regression model at 82.7%, and the k-NN model at 81.4%. The area under the curve (AUC) for the regression model indicated adequate predictability for testicular viability. A crucial finding was the impact of the timing of surgical intervention; surgeries conducted within six hours showed a 100% viability rate (p = 0.001). The patient's age also significantly affected outcomes, with post-pubertal patients showing a highest viability rate of 57.1% (p = 0.041). Detailed performance metrics, such as precision, recall, and F1-scores for each model, further validate the predictive capacity of these ML models.

Conclusion: Preliminary results suggest that ML models are viable tools for predicting testicular viability post-torsion, significantly enhancing clinical decision-making by providing an objective basis for potentially preserving testicles. Further studies with larger datasets are necessary to confirm and refine these predictions.

Purpose: Trisomy 21 is associated with neonatal surgical disorders, such as duodenal atresia, Hirschsprung's disease, and anorectal malformation (ARM). Therefore, the purpose of this study was to compare postoperative complications in patients with vs. without trisomy 21 who underwent neonatal gastrointestinal surgery and to identify risk factors for postoperative complications after these surgeries in the Japanese population.

Methods: From the National Clinical Database-Pediatric, we selected patients with duodenal atresia/stenosis, Hirschsprung's disease, and ARM operated in the neonatal period from 2016 to 2020 and analyzed the risk factors for postoperative complications.

Results: Duodenal atresia/stenosis, Hirschsprung's disease, and ARM were diagnosed in 4052 patients, of which 2486 patients were operated on in the neonatal period. These patients comprised 801 with duodenal atresia/stenosis, 289 with Hirschsprung's disease, and 1446 with ARM. The numbers of patients with complicated trisomy 21 were 212 (26.5%), 16 (5.5%), and 102 (7.1%) for duodenal atresia/stenosis, Hirschsprung's disease, and ARM, respectively. Regarding duodenal atresia/stenosis, multivariable logistic regression analysis showed that trisomy 21 were risk factors for postoperative complications.

Conclusion: In this analysis of Japanese data, trisomy 21 was an independent risk factor for postoperative complications in patients with duodenal atresia/stenosis.

Purpose: Antibiotic resistance is a major public health concern. While surgical antibiotic prophylaxis (SAP) reduces surgical site infections (SSIs), inappropriate use may cause harm. This study evaluates the impact of SAP appropriateness and compares beta-lactam versus non-beta-lactam antibiotic use in pediatric surgery.

Methods: A retrospective cohort analysis was conducted using ACS NSQIP Pediatric data (2021-2023). Exclusions included preexisting infections, malignancy, immunodeficiencies, and emergent surgeries. SAP appropriateness was classified according to NSQIP guidelines. Logistic regression assessed association between SAP categories and postoperative infections, presented as odds ratios (ORs) and 95% confidence intervals (CIs).

Results: Of 189,111 patients, 87.5% received SAP, 10.2% were overtreated, and 3.9% undertreated. SSIs occurred in 1.9%. Compared to appropriate use, undertreatment was associated with higher odds of SSI (OR: 1.4; 95% CI: 1.2-1.7), sepsis (1.6; 1.1-2.2), C. difficile colitis (2.5; 1.2-5.5), and UTI (1.8; 1.2-2.5). Overtreatment was linked to lower odds of UTI (0.7; 0.5-0.8). Non-beta-lactam antibiotics had higher odds of pneumonia (1.4; 1.0-2.0; p = 0.047) compared to beta-lactam antibiotics.

Conclusion: Appropriate SAP is crucial in minimizing postoperative infections. These results underscore the importance of antibiotic selection among pediatric surgical patients.