Pediatric Surgery International最新文献

Purpose: The present study explores the dynamics of cell death in Hirschsprung's disease (HSCR) and control (CO) groups under inflammatory stress conditions.

Methods: Using flow cytometry, we analyzed intestinal colonic organoid cultures derived from the ganglionic segment of the HSCR and CO groups. Our analysis focused on the quantification of RIPK1-independent and RIPK1-dependent apoptosis, as well as necroptosis in both viable and non-viable cells under acute and chronic inflammatory stress.

Results: Our findings indicate that HSCR cells are particularly vulnerable to inflammation during acute proinflammatory stress, as evidenced by an increase in dead cells (Zombie +). Under chronic conditions, adaptive changes are observed in both HSCR and CO groups, indicating survival mechanisms. These adaptations are uniquely altered in HSCR, suggesting an impaired response to chronic inflammation. HSCR cells show significantly decreased RIPK1-dependent apoptosis in acute scenarios compared to chronic ones, unlike the CO group, implying varied responses to different inflammatory stresses. In non-viable cells, considerable changes in RIPK1-dependent apoptosis under chronic conditions in HSCR indicate a heightened inflammatory response compared to CO.

Conclusion: This research provides insights into cell death regulation in HSCR under inflammatory stress by using patient-derived organoids, underscoring the complexity of its inflammatory response.

Purpose: Practice patterns of same-day discharge for pediatric laparoscopic appendectomy for non-perforated appendicitis are not well-analyzed. Our aim is to evaluate current practice patterns and outcomes of same-day discharge for these patients.

Methods: NSQIP-P retrospective registry identified patients (2017-2021) who underwent laparoscopic appendectomy for non-perforated appendicitis. Annual same-day discharge (SDD) rate was determined. SDD patients were compared to those discharged postoperative days 1-2 (non-SDD). Sub-group analysis was performed on ICD-10 code K35.30. Regression was performed.

Results: Overall, 67,214 patients were identified. The SDD rate increased from 33.3% (2017) to 52.5% (2021) with decreased 30-day readmissions between SDD and non-SDD (1.3% vs 2.1%, p < 0.001). Sub-group analysis identified 7,330 patients with SDD rates from 50.7% (2019) to 60.4% (2021) with decreased 30-day readmissions (1.3% vs 2.1%, p < 0.001) for SDD versus non-SDD. No increase in adverse events for SDD occurred in either analysis. Regression identified esophageal/gastric/intestinal diseases increased odds of early readmission or reoperation (OR 1.85, p = 0.042).

Conclusion: Same-day discharge after pediatric laparoscopic appendectomy for non-perforated acute appendicitis continues to increase in frequency without a significant increase in adverse outcomes. SDD rates are 20-30% lower than previously published single-center studies, indicating there is a likely a larger percentage of patients that could discharge same-day.

Level of evidence (i-v): Level III.

Purpose: Alimentary tract duplications (ATDs) are rare congenital lesions often associated with anomalies such as spinal, urinary and GI tract malformations. The purpose of this study was to report the experience of a single center with ATDs in children, focusing on the natural history, associated malformations, and their impact on patient management.

Methods: We performed a retrospective analysis over 14 years, collecting prenatal, clinical, surgical, and follow-up data. We focus on associated anomalies prenatal and postnatal management, and outcomes.

Results: Sixty-three patients with ATD (thirty-six females, twenty-seven males, aged 1 day to 14 years) were enrolled in this study. Prenatal diagnosis was made in 22 patients (35%), of whom 8 showed compression signs. Elective surgery was performed at a mean age of 1.5 years in prenatally diagnosed cases. The others presented symptoms at a mean age of 5.2 years (55.5%) or were detected incidentally (9.5%) at a mean age of 10.7 years. In four patients (6.3%), we identified multiple duplications, and ten cases (15.8%) were found with associated anomalies.

Conclusion: The wide spectrum of clinical appearance of ATDs and a comprehensive knowledge of human embryology might define surgical management, which should always be patient-tailored and respectful of the child's development.

Purpose: To evaluate the feasibility and outcomes of isolated laparoscopic extra-vesical ureteric reimplantation (I-LEVUR) for upper moiety ectopic ureter in patients with non-refluxing lower moiety ureter and avoid reimplanting normal lower moiety orifice.

Methods: Between 2013 and 2024, 12 patients (8 females, 4 males) with ectopic ureter associated with a duplex system underwent I-LEVUR. Preoperative assessment included ultrasonography, voiding cystourethrography (VCUG), and magnetic resonance urography (MRU)/retrograde pyelogram (RGP). The procedure involved laparoscopic extravesical approach dissecting only the ectopic ureter in lower most part, preserving vascularity, and performing an isolated reimplantation without manipulating lower moiety ureter.

Results: Twelve patients, with a median age of 2.8 years, underwent I-LEVUR. The mean operative time was 127.5 min. No intraoperative complications occurred. Postoperative follow-up (median: 78.5 months) showed no cases of ureteral obstruction or significant complications. Urinary continence improved in all patients. Two patients developed mild vesicoureteral reflux, managed conservatively, and one patient had minor urine leak which resolved spontaneously.

Conclusion: I-LEVUR is a viable and effective alternative to traditional en bloc reimplantation for upper moiety ectopic ureter. It preserves the normal ureteric orifice, reduces surgical trauma, and offers excellent outcomes in terms of renal function and urinary continence. Further studies with larger cohorts, control group of common sheath reimplantation, randomization, robust statistical validation and longer follow-up are recommended.

Purpose: The survival rate (SR) for neonates born with congenital diaphragmatic hernia (CDH) remains high. Our aim was to investigate the change in SR in children with CDH over the past decades.

Methods: The study was a nationwide, population-based prospective nested case-control study within a cohort of newborn children who was born in Sweden during the observational period from 1st January 1982 to 31st December 2015.

Results: In the study period, 4654 (99.6%) control children and 684 children with CDH (70.4%, p < 0.001) were with a survival of 2 years of age. Any patients who were born with CDH had a overall 5.8 times higher chance for not surviving 2 years of age than children without CDH. The SR improved significantly in CDH in the past 3 decades. Significantly higher number of patients were prematurely born in the CDH group than in the controls (23.3 vs 6.1%, p < 0.001). The SR of premature and non-premature born CDH patients has increased significantly over the past 3 decades.

Conclusion: The SR of CDH patients were significantly increased in the past 3 decades. The 2-year survival remains 5.8 times higher than those who were not born with CDH. These changes were mainly attributed to the improved SR of premature and non-premature born CDH patients.

Objective: To explore the comparative postoperative efficacy of partial splenectomy (PS) and total splenectomy (TS) in the treatment of children with hereditary spherocytosis (HS).

Methods: The relevant HS studies from databases were searched and screened, comparing the differences in hemoglobin concentration, reticulocyte percentage, bilirubin concentration before and after TS and PS surgery, and during the follow-up period, as well as the incidence of postoperative adverse events. Statistical analysis was performed using Review Manager 5.4.

Results: A total of 5 studies were included in this meta-analysis, with a cumulative enrollment of 312 children, 130 in the PS group and 182 in the TS group. The meta-analysis results showed that both PS and TS groups had statistically significant differences in postoperative hematological outcomes compared to before surgery, with TS showing better improvement than PS. In the postoperative follow-up, the changes in hematological outcomes between PS and TS were statistically significant for hemoglobin concentration: within 1 year [MD = 1.85, 95%CI(1.09,2.60)], 1-2 years [MD = 1.74, 95%CI(0.25,3.24)], not statistically significant for 4-6 years [MD = 1.28, 95%CI(-1.75,4.32)]; for reticulocyte percentage: within 1 year [MD = 2.23, 95%CI(0.80,3.66)] was statistically significant, not statistically significant for 4-6 years [MD = 1.77, 95%CI(-2.04,5.59)]; for serum bilirubin concentration: within 1 year [MD = 1.55, 95%CI(0.91,2.18)] was statistically significant, not statistically significant for 1-2 years [MD = 1.77, 95%CI(-2.04,5.99)]. In the incidence of postoperative adverse events, the incidence of cholelithiasis [MD = 1.77, 95%CI(-2.04,5.99)] showed a statistically significant difference between PS and TS, while there were no statistically significant differences in other included events, such as postoperative infection rate, secondary surgery rate, thrombosis rate, postoperative hemorrhage rate, and transfusion therapy rate.

Conclusion: Splenectomy is a beneficial surgical strategy for children with moderate-to-severe HS, reducing; early hematological outcomes of TS are more robust than PS in the follow-up period, and there is no difference between the two in the later period; for postoperative adverse events, the incidence of cholelithiasis in children after PS is higher than after TS, and there is a risk of requiring a second surgery for total splenectomy due to hemolytic recurrences.

Purpose: Tracheomalacia (TM) is commonly associated with esophageal atresia (EA) and compression by the brachiocephalic artery is a factor for TM. Previous research has focused on the lateral-to-anteroposterior tracheal diameter ratio (LAR). This study aimed to assess the LAR and postoperative outcomes of EA patients.

Methods: Patients undergoing thoracoscopic repair for EA between March 2020 and October 2023 were enrolled. Posterior tracheopexy (PT) was performed during thoracoscopic repair of EA on patients with bronchoscopy-confirmed TM; clinical courses and LAR were retrospectively analyzed.

Results: Overall, 18 patients were enrolled; 14 patients underwent PT. Their median preoperative and postoperative LARs were 2.26 and 1.50, respectively; this difference was statistically significant. Four patients without TM did not undergo PT and their median LAR was 1.59. Median LAR for patients without PT was lower than that of preoperative patients with PT and no statistical differences were observed from that of postoperative patients with PT. The patients whose LAR improved with PT did not require further surgical intervention for TM. One patient who had a postoperative LAR of 2.25 required external tracheal stenting.

Conclusion: LAR is a useful index for determining the severity of TM associated with EA. LAR can reflects the efficacy of PT.

Purpose: This study aimed to investigate the effectiveness of dipeptidyl peptidase IV inhibitors (DPP4-I) against liver damage, especially fibrosis and lipid accumulation, in a rat intestinal failure-associated liver disease (IFALD) model.

Methods: SD rats were divided into two groups: the Control (n = 7; normal saline + IFALD model) and DPP4-I (n = 7; DPP4-I + IFALD model; short bowel syndrome (SBS) + total parenteral nutrition) groups. All rats were euthanized 21 days postoperatively to obtain tissue samples. Liver fibrosis was evaluated by Sirius Red and α-SMA staining. Liver damage was assessed using the steatosis, activity, and fibrosis score. Inflammation cytokines were examined by ELISA.

Results: The survival rate was comparatively different, being 87.5% in the DPP4-I group and 70.0% in the Control group. Two rats of the Control group showed progressive liver fibrosis in the periportal area with fibrous streaks. Further, the mean area percentage of α-SMA immune-positive cells was significantly lower in the DPP4-I group than in the Control group. TGF-β levels were significantly lower in the DPP4-I group than in the Control group.

Conclusion: DPP4-I administration reduced liver fibrosis in IFALD, possibly by inhibiting DPP4-I-induced adipogenesis and suppressing TGF-β. These results may contribute to elucidating the mechanism of IFALD.

Purpose: The STAT trial is a multicenter randomized controlled trial in 12 centers worldwide aiming to determine the most effective operation for neonates with necrotizing enterocolitis (NEC) requiring intestinal resection: stoma formation (ST) or primary anastomosis (PA).

Methods: Infants having a primary laparotomy for NEC were randomized intraoperatively to PA or ST if the operating surgeon thought that both were viable treatment options for that patient. The primary outcome (duration of parenteral nutrition [PN]) was evaluated by Cox regression.

Results: Eighty patients were recruited from 2010 to 2019. Infants undergoing anastomosis finished PN significantly earlier than patients undergoing stoma (hazard ratio PA vs. ST 2.38, 95% CI 1.36-4.12 p = 0.004). There was no difference in mortality between the two groups (PA 4/35 vs. ST 8/38 p = 0.35) or in the rate of complications requiring further unplanned operations (p = n.s.). Multiple intestinal complications were more frequent in the stoma group compared to the anastomosis group (ST 12/26 vs. PA 5/31, p = 0.02, Fisher's Exact test).

Conclusion: At laparotomy for NEC, when there is no disease distal to resected intestine, primary anastomosis should be performed as it enhances the recovery from NEC, reduces the risk of multiple intestinal complications and does not increase adverse outcomes.