Pediatric Surgery International最新文献

Purpose: Pediatric negative pressure wound therapy (NPWT) is widely used, but etiology- and age-informed real-world benchmarks are limited. We compared treatment burden and closure trajectories across pediatric wound categories.

Methods: Retrospective single-center cohort of children (< 18 years) treated with NPWT for open wounds (2020-2025). Wounds were categorized as surgical (G1), acute (G2), chronic (G3), and burns (G4). NPWT was performed in accordance with an age-adapted institutional protocol in continuous mode; dressing changes were usually performed every 72 h.

Results: 106 patients (median age 144 months, IQR 60-180) were included: G1 42, G2 22, G3 31, G4 11. Age distribution differed by group (p < 0.001), and instillation use varied (p = 0.014). Duration was longest in G3 (median 13 [8,-24] days) and shortest in G4 (median 6 [5,-9] days), while G1 and G2 were similar. Median cycle counts were similar across groups. Re-debridement was least frequent in G1. Definitive outcomes differed by etiology: primary closure predominated in G1, secondary healing in G3, and spontaneous closure in G4; grafting occurred mainly in burns, and flap reconstruction was rare.

Conclusions: NPWT was feasible across heterogeneous pediatric wounds when used with a standardized, age-adapted approach. Etiology-specific differences in burden and outcomes inform expectations and support prospective multicenter evaluation.

Purpose: Adequate lymph node sampling is essential for accurate staging and treatment planning in Wilms tumour. Both SIOP and COG protocols recommend sampling more than six lymph nodes. However, median retrieval rates remain low in both open and minimally invasive approaches. This study aimed to assess the feasibility, safety, and efficacy of intraoperative indocyanine green (ICG) fluorescence imaging for sentinel lymph node (SLN) identification in paediatric renal tumours and to contribute to the standardization of dosage and timing protocols.

Methods: A two-centre prospective study (2023-2025) was conducted in Wrocław and Gdańsk involving 20 paediatric patients undergoing nephron-sparing surgery (n = 14) or nephrectomy (n = 6) for renal tumours with ambiguous lymphatic drainage. ICG (0.2 ml of a 5 mg/ml solution) was injected into four sites of healthy renal parenchyma, 1-2 cm from the tumour margin, after kidney exposure and before vascular pedicle preparation. Near-infrared (NIR) imaging (Stryker) was used to visualise lymphatic drainage and sentinel nodes.

Results: Twenty children were included (median age 3 years, IQR 1.75-5.00). The median number of lymph nodes retrieved was 4 (IQR 3-6), with a median of 3 fluorescent nodes (IQR 1.5-4.5). Sentinel lymph node visualisation was successful in six cases (one benign renal cyst and five nephroblastomas) and failed in chromophobe carcinoma and renal cell carcinoma. No ICG-related adverse events were observed. The number of lymph nodes retrieved did not differ significantly between nephron-sparing surgery and nephrectomy; however, a higher number of fluorescent nodes was observed in the nephron-sparing group (median 3.5 vs. 1.0; p = 0.0757). Compared with historical controls, the ICG-guided cohort demonstrated a significantly higher lymph node yield (median 4.0 vs. 3.0; p = 0.00468). Operative time was significantly longer in the ICG group (median 130.5 min [IQR 114.5-145.0] vs. 109.5 min [IQR 91.0-112.5]; p = 0.00513), likely reflecting the initial learning curve associated with adoption of the technique.

Conclusion: ICG fluorescence imaging is a promising adjunct for SLN mapping in paediatric renal tumours. Standardisation of injection protocols is required to improve reproducibility. The technique is safe, feasible, and may improve staging accuracy while reducing the need for repeat surgeries.

Objective: To evaluate quality of life in pediatric patients with Müllerian anomalies who underwent surgical intervention between 2018 and 2023.

Methods: A retrospective descriptive case series was conducted including patients younger than 18 years who underwent surgical correction for Müllerian anomalies between 2018 and 2023. Quality of life was assessed using the validated Spanish version of the Pediatric Quality of Life Inventory (PedsQL 4.0^®) through telephone follow-up at least six months after surgery.

Results: The most frequent anomalies were longitudinal vaginal septum and uterus didelphys (42.8%), while OHVIRA syndrome was least common (2.9%). Renal agenesis occurred in 28.6% of patients, predominantly right-sided (80%), and anorectal malformations (ARM) were associated in 57.1%. All underwent vaginoscopy and surgery, most commonly vaginal septum resection (40%). The PedsQL was applied by phone to all patients, with a mean follow-up of 48 months. Mean quality-of-life scores were good and comparable between parent-proxy and self-reports in the 13-18-year (73.34 vs. 77.51) and 8-12-year (68.75 vs. 72.82) groups. The highest scores were in the 2-4-year (80.43) and 5-7-year (79.71) groups. Emotional functioning consistently scored lowest, while physical and social functioning were highest. Currently, 25.7% of patients have initiated sexual activity, and two have had children-one by vaginal delivery and one by cesarean.

Conclusions: Pediatric patients with Müllerian anomalies demonstrated good postoperative quality of life, highlighting the positive impact of timely surgical management on physical, social, and reproductive outcomes.

Purpose: Pediatric cholecystitis and cholelithiasis management is heterogeneous. We surveyed European centers to map current practices, training exposure, and outcomes of pediatric biliary cholecystectomy.

Methods: A 24-item cross-sectional international survey was developed by the European Union of Medical Specialists (UEMS) Section of Paediatric Surgery and distributed to centers in 31 UEMS member states. Items covered institutional resources, indications and timing, surgical approach and adjuncts (ERCP, ICG), training exposure, and center-level outcomes; results are reported as n (%), median (IQR). Outcomes were reported at the center level and were self-reported by participating institutions.

Results: Thirty-two centers from 23/31 states responded (74.2%). Pediatric surgeons were primary operators in 84% (shared with adult surgeons in 16%); ERCP access was 66%. Trainee operator share was 22.5% (IQR 5-50) and simulator access 56%. ICG cholangiography was routine in 12.5% and selective in 31%. Acute calculous cholecystitis: 6% always index-admission and 59.4% interval (29-41 days) cholecystectomy; post-ERCP choledocholithiasis: 16% always index-admission cholecystectomy. In 2023, 185 cases were reported: 98.9% laparoscopic with 1.6% conversion; median age 14 years (IQR 12.25-15), operative time 90 min (IQR 60-110), length of stay 2 days (IQR 1-2); 10 complications (5.4%).

Conclusion: Substantial heterogeneity persists in both care pathways and training exposure; most centers lack formal pediatric-specific guidelines, and trainee-led operating remains limited, supporting the need for evidence-based protocols and structured training pathways.