Pediatric Surgery International最新文献

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.

Purpose: Postoperative scarring remains a major concern for patients and parents following repair of congenital abdominal wall defects. This study evaluated perceptions of postoperative scars in children after omphalocele or gastroschisis repair, comparing self-assessments with parental evaluations. We hypothesized that parents perceive scarring more negatively than their children.

Methods: A single-center study was conducted among patients treated for omphalocele or gastroschisis at the Department of Pediatric Surgery, University Hospital Erlangen (2001-2011). Between July 2022 and March 2023, patients and their parents completed the Patient and Observer Scar Assessment Scale (POSAS) 2.0, Patient Scar Assessment Questionnaire (PSAQ), and Short Form-36 (SF-36). Exclusion criteria were death or psychomotor impairment precluding reliable self-assessment.

Results: Twenty-eight participants (61% gastroschisis, 39% omphalocele) were included. Parents rated scar appearance more negatively than their children (POSAS overall impression p = 0.040; appearance p = 0.002 in omphalocele). PSAQ revealed discrepancies regarding scar-related symptoms (p = 0.006) and satisfaction (p = 0.009 total; p = 0.038 omphalocele). Parents tended to underestimate children's physical complaints (p = 0.099). No differences were found between defect types. SF-36 indicated high overall quality of life (mean 79.9 ± 13.3).

Conclusion: Significant parent-child differences exist in scar perception. Parents emphasize cosmetic concerns, whereas children report physical symptoms. Larger studies are warranted to guide tailored postoperative support.

Objective: To compare the efficacy of Soave and Swenson procedures in the treatment of Hirschsprung disease (HSCR) through meta-analysis, and to provide evidence-based support for surgical choice.

Methods: A systematic search of Chinese and English databases was performed to identify clinical studies comparing the two procedures. Extracted outcomes included perioperative parameters, postoperative complications, and long-term bowel function. Data were analyzed using Review Manager 5.4.1 and Stata 17.0.

Results: Eleven retrospective cohort studies involving 972 children (506 Soave, 466 Swenson) were included. Compared with Soave, Swenson was associated with shorter operative time (MD: 26.39 min; 95% CI: 11.32-41.46; P < 0.001), reduced intraoperative blood loss (MD: 15.53 ml; 95% CI: 13.83-17.24; P < 0.001), and shorter postoperative hospital stay (MD: 1.50 days; 95% CI: 0.27-2.72; P = 0.02). No significant differences were found in early complications. Postoperative constipation was less frequent after Swenson (OR = 2.20; 95% CI: 1.04-4.64; P = 0.04), while no significant differences were observed for Hirschsprung-associated enterocolitis (HAEC), urinary retention, or other long-term outcomes.

Conclusion: The Soave and Swenson procedures each have their own characteristics. Swenson improves surgical efficiency and reduces constipation, while Soave, with its clearer anatomical planes, may lower the risk of pelvic nerve injury and remains widely applied. Surgical choice should be individualized, and prospective multicentre studies are needed to optimize long-term outcomes in HSCR.

Purpose: To describe characteristics of offspring born to mothers having an anorectal malformation (ARM).

Methods: This was a national population-based cohort study. The exposed group was the offspring of females with an ARM diagnosis (ICD-codes) in the Swedish National Patient Register 1964-2008. The unexposed group was the offspring of mothers without ARM. Five age-matched mothers without ARM were randomly identified for each mother with ARM by Statistics Sweden. Females with chromosomal aberrations were excluded prior to analysis. Outcomes of the mothers were retrieved from the National Patient Register (1964-2021) and Medical Birth Register (1973-2021). Outcomes of the offspring were based on data from Medical Birth Register. Using descriptive statistics, the children of mothers with an ARM were compared to children of mothers not having an ARM. The ethical review authorities approved the study.

Results: The mothers included 464 females with ARM and 2313 females without ARM. Of the 464 females with ARM, 132 (28.4%) gave birth to at least one child compared with 895 (38.7%) females without ARM (p < 0.001). The 132 first-born children of mothers with ARM were born at an 8-day younger median gestational age (272 days) when compared to children to mothers without ARM (280 days) (p < 0.001). The infants to mothers with ARM were more commonly small for gestational age (n = 10, 7.6%) than infants to mothers without ARM (n = 28, 3.1%) (p = 0.012). Initial results also showed that the first offspring to ARM mothers were statistically lighter and shorter than the offspring to mothers without ARM (p < 0.001), however, after adjusting for gestational age in a linear regression model, this was no longer the case (p = 0.398 and p = 0.255, respectively). Three first-born offspring in the group of mothers with an ARM, whereas no offspring from mothers without ARM had an ARM.

Conclusion: The first-born child of mothers with ARM are more commonly small for gestational age than the first-born of mothers without ARM. The offspring to mothers with ARM more commonly had an ARM.

Level of evidence iii: