Pediatric Surgery International最新文献

Purpose: To evaluate outcomes of thoracoscopic staged internal traction combined with a waiting period in long-gap esophageal atresia (LGEA) at a single center.

Methods: Retrospective analysis of perinatal characteristics, surgical interventions, postoperative complications, and long-term outcomes in LGEA patients undergoing delayed thoracoscopic staged repair between 2018 and 2024.

Results: Among141 esophageal atresia repairs, 15 patients had LGEA (13 Gross type A, 2 type B). All patients underwent gastrostomy placement. The first thoracoscopic stage occurred at a median age 2.4 months (1.1-3.7). Internal traction was applied in 13/15 (86%), two required gastric interposition (GI) for an extreme long gap diagnosed at initial thoracoscopy. Traction patients underwent a median of 2 tractions (1-3). Delayed anastomosis was achieved in 10/13 (77%) within a median 11.5 days (6-43) from first thoracoscopy. In three, anastomosis remained unfeasible after traction due to a persistent long gap, necessitating GI. Complications included one recurrent fistula, one leak, and five strictures requiring a median 1.5 dilatations (1-7). At a median 50-month follow-up (12-91), all delayed-anastomosis patients and 60% of GI patients tolerated full oral feeds.

Conclusion: A delayed thoracoscopic staged internal traction enabled safe anastomosis with a low complication rate; however, one-third of patients required GI.

Purpose: Emergency neonatal laparotomy can be undertaken on the intensive care unit (ICU) or in the operating theatre. The evidence-base establishing indications, benefits or disadvantages is limited. We conducted a multidisciplinary survey of UK neonatal surgical centres to describe current practice.

Methods: A 16-item online survey was developed, and responses sought from one anaesthetist, one neonatologist and one surgeon at each of the 25 neonatal surgery centres in the UK. Quantitative responses were analysed with descriptive statistics (IBM SPSS Statistics v30). Free-text responses were subjected to qualitative thematic analysis.

Results: 23 anaesthetists, 23 neonatologists, and 23 paediatric surgeons responded (69/75; 92%). At least one response was received from every centre. Cotside laparotomy is carried out in 22 (88%) of centres. 44 (64%) respondents preferred operating in theatre although a significant minority favoured cotside surgery (13 (19%)). Only 5 (20%) centres reported having formal indications for cotside laparotomy. Centres with established pathways performed a significantly higher proportion of cotside laparotomies compared to centres without established guidelines (p < 0.001). Factors influencing decision to operate at the cotside were patient-specific: cardiovascular instability (86%), ventilator dependence (70%) and low birthweight (42%). 46 (67%) respondents recalled complications associated with theatre-based operating including hypothermia (41%), airway complications (15%) and cardiovascular instability (10%). Respondents perceived bedside surgery to be constrained by limited space (62%), disturbance to NICU families and staff (56%) and lack of neonatal surgical instruments (49%).

Conclusion: This study establishes the first UK dataset on location of neonatal laparotomy, revealing marked variation in practice based on institutional preference, signalling need for national guideline development.

Objective: The aim of this study was to evaluate the differences in physical examination and radiologic findings of patients with proximal hypospadias in terms of Disorders of Sex Development (DSD) groups.

Materials and methods: The ages, physical examination and radiological findings and diagnoses of the cases aged 0-18 years who were admitted to our hospital due to proximal hypospadias between 2005 and 2022 and whose male gender was determined because of their evaluation for DSD were evaluated.

Results: The study population included 43 patients with a median age of 4 months (1 day-14 years): 19 presented with penoscrotal, 13 with scrotal, and 11 with perineal hypospadias. All cases exhibited severe ventral chordee, with micropenis observed in most patients. 46,XY DSD represented most cases, followed by sex chromosome DSD, 46,XX DSD, and other karyotype anomalies. Most patients in the DSD group had undescended testes and/or micropenis. Penoscrotal hypospadias was seen only in the 46,XY DSD group and no uterine remnants were seen in this group.

Conclusion: Patients with proximal hypospadias accompanied by undescended testis and/or micropenis should be evaluated in detail before any surgical intervention. We believe that especially in cases with scrotal and perineal hypospadias should be investigated for possible uterine remnants.

Purpose: The development of effective medical expulsive therapy (MET) following extracorporeal shock wave lithotripsy (ESWL) for pediatric urolithiasis is crucial for enhancing stone fragment clearance. This study aimed to evaluate the efficacy and safety of alpha-1 adrenergic blockers (tamsulosin and silodosin) in children after ESWL.

Methods: A prospective randomized comparative study was conducted involving 200 patients (aged 2-18 years) who underwent ESWL. Participants were allocated to a study group (n = 50, receiving α1-blockers: tamsulosin 0.2 mg/day for ages 2-5, silodosin 4 mg/day for ages > 5) or a control group (n = 150, receiving standard therapy). Primary endpoints were stone-free rate (SFR) and stone expulsion time. Secondary endpoints included pain dynamics (visual analog scale, VAS), analgesic requirements, and adverse events. Statistical analysis was performed using StatTech v.4.8.3.

Results: The odds of being stone-free were 2.11 times higher with α1-blocker therapy (OR = 2.11; 95% CI: 1.02-4.37). The median expulsion time was reduced from 7 [5-9] days in the control group to 5 [4-7] days in the study group (p = 0.010). ROC analysis identified a 6-day threshold for stone passage (sensitivity 63.6%, specificity 72.1%, AUC = 0.627; p = 0.010). Pain intensity was significantly lower in the study group on postoperative day 1 (3 [0-4] vs. 6 [5-8] points, p < 0.001), with reduced analgesic requirements (1 [0-2] vs. 2 [1-4] doses/day, p = 0.003). Adverse events were mild and infrequent (5 cases of nasal congestion, 2 of nausea).

Conclusion: Adjunctive therapy with α1-blockers after ESWL in children with urolithiasis improves treatment efficacy, shortens stone expulsion time, reduces pain, and demonstrates a favorable safety profile. An optimal timeframe for efficacy assessment is 6 days post-ESWL.

Purpose: After decades of increase, gastroschisis prevalence in the United States has recently declined. We aim to use birth certificate data to explore trends in maternal age and smoking as possible contributors, and to examine national racial and ethnic patterns in gastroschisis prevalence.

Methods: A retrospective cross sectional database review was performed on three national datasets: American College of Surgeons National Surgical Quality Improvement Program- Pediatric® (ACS NSQIP-P®), Healthcare Cost and Utilization Project National Inpatient Sample (HCUP-NIS), and Center for Disease Control and Prevention Wide-ranging ONline Data for Epidemiologic Research (CDC WONDER) for racial and ethnic trends in gastroschisis from 2016-2023. Maternal age and tobacco use were extracted from CDC WONDER.

Results: Gastroschisis prevalence significantly declined among infants born to mothers aged 15-29. Maternal tobacco use also declined in both affected and unaffected births, with a significant drop in the population attributable risk from smoking. The proportion of White (but not Black or Asian/Pacific Islander) infants with gastroschisis declined in ACS NSQIP-P®. HCUP-NIS and CDC WONDER demonstrated constant racial proportions but an overall decline in cases. Both ACS NSQIP-P® and CDC WONDER showed an increasing proportion of Hispanic infants with gastroschisis as non-Hispanic cases decreased. CDC WONDER demonstrated disparate changes in prevalence by race and decreasing (though not equally) prevalence in Hispanic and non-Hispanic ethnicities.

Conclusion: Shifting maternal age demographics and declining maternal tobacco use are likely two reasons for the recent gastroschisis prevalence decline. The decline varies by race and ethnicity, suggesting multifactorial influences on disease prevalence.

Purpose: Biliary atresia (BA) is a progressive fibro-inflammatory cholangiopathy and the leading cause of neonatal cholestasis and pediatric liver transplantation. Mesenchymal stem cell (MSC)-derived secretome has emerged as promising acellular alternative to cell therapy. This study evaluated the potential of hypoxia-conditioned umbilical cord MSC (HU-UCMSC) secretome in rat model of biliary fibrosis induced by bile duct ligation (BDL).

Methods: Twenty-four male Sprague-Dawley rats were randomized into six groups: Sham, BDL, BDL + vehicle, and BDL treated with HU-UCMSC secretome at doses of 100, 200, and 400 μL. Serum biochemical markers and hepatic gene expression were analyzed using photometry and RT-qPCR. Histopathology and fibrosis fraction area were evaluated by Sirius Red staining.

Results: HU-UCMSC secretome produced dose-dependent hepatoprotection, significantly reducing SGOT, SGPT, and total bilirubin levels compared with untreated BDL rats. Histologically, collagen deposition and fibrosis fraction area were markedly reduced. Gene expression analysis showed significant downregulation of PDGF, α-SMA, and TNF-α, with context-dependent modulation of TGF-β and VEGF.

Conclusion: Hypoxia-conditioned UC-MSC secretome improved hepatic function and mitigated fibrosis in the BDL model through suppression of profibrotic and inflammatory mediators. These findings support HU-UCMSC secretome as a safe, cell-free therapeutic candidate for biliary atresia and related pediatric cholestatic liver diseases.