Pediatric Surgery International最新文献

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.

Introduction: The management of duplex renal systems remains controversial. Depending on patient characteristics, conservative management, minimally invasive techniques, or open surgery may be considered, each offering distinct advantages and limitations. In this study, we aimed to present the outcomes of upper-pole heminephrectomy for poorly functioning moieties in duplex systems while preserving the lower urinary tract.

Materials and methods: All patients underwent routine clinical evaluation, including medical history, physical examination, biochemical tests, and radiological imaging. Surgical intervention was indicated in symptomatic patients or based on shared decision-making after counseling the parents. Thirty-six patients who underwent upper-pole heminephrectomy between 2014 and 2024 were retrospectively analyzed with respect to demographic characteristics, preoperative and perioperative findings, and postoperative follow-up. Postoperative outcomes were classified as short-term and long-term. Patients who required reoperation were compared with those who did not.

Results: The cohort consisted of 28 female and 8 male children with a mean age of 36.1 ± 39.5 months at the time of surgery. In the short term, only one patient required reoperation due to suspected urinary leakage. Over a mean postoperative follow-up of 29.83 ± 31.50 months, eight patients underwent additional procedures: two stump excisions, five endoscopic interventions, and one open anti-reflux surgery. All six patients who required anti-reflux intervention were female and had high-grade vesicoureteral reflux (VUR) prior to heminephrectomy. Younger age at surgery and preoperative VUR were identified as significant risk factors for reoperation.

Conclusions: Upper-pole heminephrectomy prevented the need for open bladder surgery in 97% of patients during follow-up. However, parents of female patients and those with high-grade VUR should be counseled regarding the increased risk of secondary procedures related to postoperative VUR and febrile urinary tract infections. The likelihood of additional surgery during follow-up appears to be primarily driven by the preoperative VUR status.

This study investigated the protective effects of naringin, a flavanone glycoside with established antioxidant, anti-inflammatory, and anti-apoptotic properties, against testicular ischemia/reperfusion (I/R) injury in a mouse torsion/detorsion model. Forty adult male mice underwent a 720° torsion for two hours, followed by detorsion. Five groups (n = 8) received naringin (50, 100, or 200 mg/kg) administered intraperitoneally 30 min prior to detorsion: sham, T/D, and three T/D + naringin groups. After 30 days, sperm quality (concentration, motility, kinematics), oxidative stress markers, histological alterations, apoptotic markers (Bcl-2, Bax, caspase-3), hormonal profiles, and fertility outcomes were evaluated. The T/D group exhibited deteriorated sperm quality, reduced antioxidant levels (TAC, SOD, GPx), decreased hormones (testosterone, FSH, LH), elevated MDA and apoptotic markers, and impaired fertility. Notably, FSH levels decreased after T/D - in contrast to the typical increase in chronic damage models - possibly due to acute-phase pituitary suppression in this short-term mouse model. Naringin (particularly 100 and 200 mg/kg) dose-dependently improved sperm parameters, antioxidant status, testicular histology, hormonal levels, and fertility. The 50 mg/kg dose showed limited efficacy. Naringin inhibited apoptosis by upregulating Bcl-2 and downregulating Bax and caspase-3. These results indicate that intraperitoneal naringin, especially at 100-200 mg/kg, exerts significant protective effects against testicular I/R injury and may warrant further investigation as a potential adjunctive therapy in the clinical management of testicular torsion.

Purpose: The aim of this study was to compare the clinical efficacy, diagnostic concordance, and recurrence rates of open high ligation versus laparoscopic percutaneous internal ring suturing (PIRS) in adolescent inguinal hernia repair.

Methods: A retrospective review was conducted of 87 adolescent patients who underwent inguinal hernia repair via open high ligation (n = 44) or laparoscopic PIRS (n = 43) between 2012 and 2024 at a single tertiary care center. Demographic data, postoperative complications, recurrence, diagnostic concordance (kappa), and follow-up duration were analyzed.

Results: The median age in both groups was 12 years (range 10-17). Intraoperative diagnostic laparoscopy was performed in 44 patients in the open surgery group to evaluate the contralateral inguinal region, and contralateral hernia was detected and repaired simultaneously in one patient. Diagnostic concordance was perfect in the open group (κ = 0.945) and near-perfect in the PIRS group (κ = 0.885), both statistically significant (p < 0.001). No recurrences were observed in the open group, whereas recurrence occurred in one patient in the laparoscopic group (p = 0.99). The mean follow-up duration was 103.8 months (range 11-150) and 31.7 months (range 4-137) in the open and laparoscopic group, respectively.

Conclusion: Laparoscopic PIRS repair in adolescents demonstrated outcomes comparable to open high ligation in terms of recurrence and complication rates.

Objective: Advances in pediatric healthcare have improved survival rates of congenital urogenital conditions, emphasizing the need for effective transition programs from pediatric to adult care. However, transition challenges often lead to suboptimal outcomes. This study evaluated a structured urologic transitional care program's impact on transition readiness and healthcare resource utilization in a single-payer healthcare system.

Methods: A retrospective comparative study included 106 patients aged 12-21 with congenital urogenital conditions. The intervention group (n = 53) participated in a urologic transitional care program, while the control group (n = 53) received standard care. Transition readiness was assessed using the Good2Go questionnaire, evaluating self-advocacy, knowledge, self-care, and social support. Healthcare resource utilization was measured through emergency room (ER) visits, admissions, and complications.

Results: At baseline, transition readiness scores showed no significant differences between groups, although higher ER-to-admission ratios were observed in the intervention group. Post-intervention, the intervention group demonstrated significant improvements in knowledge readiness (mean difference: +12.78, p = 0.005) and reductions in ER visits (mean difference: - 0.64, p = 0.022) and admissions (mean difference: - 0.28, p = 0.007) compared to controls. Difference-in-differences analysis confirmed significant improvements in knowledge readiness in the intervention group, although reductions in all ER metrics were inconclusive.

Conclusions: The urologic transitional care program effectively enhanced knowledge readiness and possibly reduced ER visits among adolescents with congenital urogenital conditions. These findings underscore the importance of structured interventions to support successful transitions. Additional strategies are needed to address other readiness domains, healthcare resource utilization and the sustainability of long-term benefits.

Clinical trials registry: This study was not registered in a clinical trials registry as it is a retrospective observational study. IRB study approval granted by UAB # 300012178; SickKids REB # 1000079219.

Objectives: Transanal irrigation (TAI) is an emerging minimally invasive therapy for children with severe bowel dysfunction, including fecal incontinence and refractory constipation. The aim of this study was to evaluate the impact of TAI on bowel habits, medication use, quality of life, and caregiver burden in a pediatric population.

Methods: A prospective observational study was conducted on 20 pediatric patients with fecal incontinence. A structured questionnaire assessing bowel function and quality of life was administered at baseline and after 60 days of TAI. Outcomes were compared using Fisher's exact and Wilcoxon signed-rank tests.

Results: Significant improvements were observed in bowel care time (p < 0.01), frequency of soiling (p < 0.01), fecal incontinence episodes (p < 0.01), and dependence on laxatives or enemas (p < 0.01). Social participation and emotional well-being also improved. Most patients reported better autonomy and reduced discomfort related to bowel management.

Conclusions: TAI is an effective strategy to improve continence, reduce the burden of bowel care, and enhance quality of life in children with refractory bowel dysfunction.