Pediatric Surgery International最新文献

Objective: To evaluate the relationship between postoperative bowel dysfunction and pelvic floor muscle development in children with congenital megacolon.

Methods: Postoperative MRI data were collected from children with congenital megacolon who underwent surgery at the Department of General Surgery, Anhui Children's Hospital, between May 2007 and December 2024. MRI measurements included the position of the rectum, maximum thickness of the internal and external anal sphincters (EAS), levator ani, puborectalis, pubococcygeus, iliococcygeus, and ischiococcygeus muscles, upper rectal lumen width, and anorectal angle. Based on the 2016 Rome IV criteria for pediatric functional gastrointestinal disorders, children were classified as non-neurogenic fecal incontinence (NFI) group (Group A) or NFI group (Group B). Clinical data and MRI-derived muscle parameters were compared between groups.

Results: A total of 50 children were included, with 34 in Group A and 16 in Group B. Significant differences were observed in the thickness of the EAS and puborectalis muscle between the two groups (P < 0.05). Multivariate logistic regression revealed that greater EAS thickness (OR = 0.27, 95% CI: 0.08-0.90, P = 0.03) and puborectalis thickness (OR = 0.35, 95% CI: 0.13-0.84, P = 0.02) were independent protective factors against NFI, whereas long-segment congenital megacolon (OR = 7.72, 95% CI: 1.74-34.36, P = 0.007) was an independent risk factor.

Conclusion: Postoperative non-retentive fecal incontinence in children with congenital megacolon may be associated with the thickness of the EAS, puborectalis muscle, and megacolon type.

Purpose: Boys with genetic syndromes have an increased risk of undescended testes (UDT), but laparoscopic findings and outcomes after two-stage Fowler-Stephens orchiopexy (FS2) are rarely reported. This study aims to compare laparoscopic findings and results after FS2 between syndromic and non-syndromic boys.

Methods: A retrospective cohort study on boys with UDT who underwent laparoscopy between 2014 and 2024. Syndromic and non-syndromic patients were compared regarding age at surgery, bilaterality, type of UDT, and atrophy rate after FS2.

Results: In total, 190 boys with 298 testicles underwent laparoscopy. Of these, 42% were found to be intra-abdominal, 23% were vanishing testes and in 22% of cases, a testicular nubbin was found. Bilateral (p < 0.001) and intra-abdominal UDT (p < 0.01) were significantly more common in children with syndromes, whereas testicular nubbin was less common (p < 0.01). The median age at laparoscopy was higher in the group with syndromes. Atrophy occurred in 20% of all testicles undergoing FS2, with no significant difference in outcome between groups (p > 0,05).

Conclusion: Syndromic boys present with more severe UDT but achieve comparable outcomes after FS2. Early diagnosis and individualized management are essential to preserve testicular viability in this high-risk group.

Purpose: In 2017, the American Pediatric Surgical Association (APSA) published a systematic review that supported ovarian detorsion rather than oophorectomy for children with ovarian torsion. We evaluated our institutional ovarian salvage rate and outcomes following ovarian detorsion before and after publication of these APSA recommendations.

Methods: Electronic Medical Record data for patients who underwent operative intervention for adnexal torsion and between 01/01/2010 and 12/31/2023 at a single pediatric center were reviewed. Patients with antenatal torsion were excluded. Patient characteristics, operative findings, and postoperative outcomes were examined.

Results: A total of 238 patients were included. Mean age was 10.9 years (range 0.1-20.0). Mean time from presentation to OR was 9.5 h (SD 8.9). Ovarian detorsion was performed in 186 patients (78.2%). Oophorectomy was performed in 52 (21.8%); of these, 33 (63.5%) demonstrated evidence of necrosis and 14 (26.9%) were associated with a tumor. There were no intraoperative complications. There were no thromboembolic events following detorsion. Pregnancy data were available for 10 patients, with 7 live births.

Conclusion: Ovarian salvage is the preferred treatment for torsion. Our rates of ovarian salvage have improved over the past 10 years with no negative sequelae and no missed malignancies.

Purpose: The fertility potential of with 46,XY DSD individuals has remained poorly understood. This study aimed to assess testicular cytology and semen analysis findings in post-pubertal patients with 46,XY DSD.

Method: Following ethical approval, a cohort of post-pubertal (> 13 years) patients with 46,XY DSD assigned a male gender was evaluated through a personal interview, clinical examination, and hormonal assay. Prostatic and testicular volumes and echotexture were assessed. Semen analysis and testicular cytology were also performed.

Results: Of the 75 eligible patients, 17 responded. The mean age at the time of study was 17(± 3.33) years, with a follow-up of 160 (± 68.28) months. All patients reported comfort with male gender assignment. The median stretched penile length was 6 cm, and clinically assessed testicular volumes were within normal limits. However, prostate volumes were small, and prostate-specific antigen (PSA) levels were undetectable in one-third. Semen analysis revealed that 6 patients were unable to ejaculate, 4 had aspermia, 4 had oligospermia, and 3 had azoospermia. Testicular FNAC demonstrated normal spermatogenesis in only 6 patients. The median spermatogenic-to-Sertoli cell ratio was 0.84, markedly lower than the normal expected value. Notably, several patients with normal spermatogenesis on FNAC had abnormal semen analysis findings.

Conclusions: Despite overall comfort with male gender assignment and normal hormonal profiles, both semen analysis and testicular cytology revealed compromised fertility potential in post-pubertal patients with 46,XY DSD.

Purpose: Access to appropriate and clean toilet facilities is essential for children with Hirschsprung Disease (HD). This study aims to assess how parents of children with HD perceive school toilet facilities.

Method: A cross-sectional survey was spread among parents of children aged 4-13 years with HD. The questionnaire addressed the frequency of toilet use and reasons for positive or negative experiences, with open- and closed-ended questions, for quantitatively and qualitatively analyses, respectively.

Results: Forty-four parents completed the questionnaire. The median age of the children was 7 years (IQR 5.3-10.8). Five (11.4%) children never used the school toilet, 16 (36.6%) used it for urination only, and 23 (52.3%) used it for urination and defecation. Positive parental experiences (29, 65.9%) were associated with the possibility for the child to clean themselves at school, while negative experiences (15, 38.6%) were linked to the absence of child-specific toilet rules. Qualitative analysis revealed six influencing themes; assistance, possibilities, school rules, medical nature, toilet facilities, and information.

Conclusion: Toilet avoidance for defecation remains common among children with HD. Improvements in toilet facilities, support, and individualized toilet policies may enhance well-being in this population.

Purpose: To evaluate whether hemoglobin P₅₀, automatically calculated from routine blood gas analyses, can serve as a practical early biomarker for necrotizing enterocolitis (NEC) in preterm infants.

Methods: We retrospectively analyzed 117 preterm infants born at < 32 weeks' gestation who were admitted to a tertiary NICU between 2022 and 2024. Hemoglobin P₅₀ and serum lactate values were obtained from arterial blood gases on postnatal days 1-3. NEC was defined according to modified Bell's criteria (stage ≥ II). Discriminative performance was assessed using receiver operating characteristic (ROC) analysis, with a prespecified P₅₀ threshold of 21.0 mmHg.

Results: NEC developed in 27 infants (23%). Mean day-2 P₅₀ was significantly higher in the NEC group compared with controls (22.5 ± 6.8 vs. 18.9 ± 3.6 mmHg; p = 0.03). Day-2 P₅₀ predicted NEC with moderate accuracy (AUC 0.70, 95% CI 0.56-0.83), outperforming lactate (AUC 0.52, 95% CI 0.38-0.67). At the 21.0 mmHg cutoff, sensitivity was 67%, specificity 72%, positive predictive value 41.8%, and negative predictive value 87.9%.

Conclusion: Day-2 hemoglobin P₅₀ was elevated in infants who subsequently developed NEC. These preliminary findings indicate that P₅₀ may be a feasible, cost-effective biomarker for early NEC risk stratification; however, larger prospective studies are required to validate its predictive utility.

Purpose: Perineal morphometric alterations and functional outcomes in patients with hypospadias remain a subject of ongoing debate. This study aimed to evaluate the changes in anogenital distance (AGD)/anal position index (API) values and their intestinal functional impacts in relation to the severity of hypospadias in children.

Method: Fifty-one children who underwent hypospadias surgery (2014-2024) and 19 controls presenting for circumcision (June-September 2024) were assessed. Patients were classified as distal hypospadias (n = 31) or proximal hypospadias (n = 20). Posterior scrotal raphe-anus center (AGD), posterior scrotal raphe-coccyx distance, and API were measured. Constipation was evaluated using Rome IV criteria. Percentile values ​​were calculated.

Results: Patient ages (years): 7.42 ± 1.67/11.51 ± 2.79/8.8 ± 2.37 for control/distal/proximal hypospadias groups. Proximal hypospadias showed significantly lower AGD (33.39 ± 8.11 mm) and API (0.35 ± 0.07) compared to distal hypospadias (54.79 ± 15.65 mm; 0.53 ± 0.07) and controls (55.54 ± 15.57 mm; 0.59 ± 0.08) (p = 0.042), (p < 0.001). Constipation was strongly associated with proximal hypospadias (p < 0.001). AGD distribution varied significantly across percentiles (p < 0.001), whereas API distribution did not significantly (p = 0.587).

Conclusion: Changes in perineal morphometric parameters and their functional outcomes exhibit clinically meaningful distinctions in pediatric patients with proximal hypospadias. Furthermore, it is suggested that these perineal morphometric measurements should be taken into account in predicting and monitoring constipation status during postoperative follow-up in children with hypospadias.

Background: Mechanical bowel preparation (MBP) has traditionally been routine before pediatric intestinal surgery, based on the belief that it reduces the risk of infection. In adults, benefits are only observed when MBP is combined with oral antibiotics; however, evidence in pediatrics remains limited and inconsistent.

Methods: We conducted a systematic review and meta-analysis (PROSPERO CRD420251133552) following PRISMA 2020 and Cochrane guidelines, searching databases up to August 2025. Eligible studies included Randomized controlled trials and comparative observational cohorts comparing MBP with no MBP in elective Pediatric intestinal surgery. The primary outcome was surgical site infection (SSI); secondary outcomes included anastomotic leak (AL), intra-abdominal abscess (IAA), ileus, bowel obstruction, and length of stay (LOS). Random-effects models produced pooled estimates, and certainty was assessed using the GRADE approach.

Results: Seventeen studies involving 3,036 children were included. MBP showed no reduction in SSI, AL, or IAA, with moderate certainty for SSI and low certainty for AL/IAA due to rare events. MBP was associated with longer LOS and possible non-significant increases in ileus and obstruction.

Conclusion: Current evidence suggests that MBP offers no significant benefits in pediatric elective intestinal surgery and may even delay recovery. Within the framework of ERAS protocols, routine use of MBP appears unnecessary. However, MBP might still be required for specific functional or reconstructive indications. Further high-quality multicentre trials are essential before any definitive conclusions can be drawn regarding its discontinuation.