Pediatric Surgery International最新文献

Background: Early identification of high-risk surgical neonates is essential in resource-limited settings. Risk stratification tools such as the Score for Neonatal Acute Physiology with Perinatal Extension II (SNAPPE II) are widely used in neonatal intensive care units but have not been validated in surgical neonatal populations in sub-Saharan Africa. This study evaluated outcomes and the prognostic utility of SNAPPE II in surgical neonates.

Methods: A 5-year retrospective cohort study was conducted including neonates admitted under general paediatric surgery to the neonatal intensive care unit at Nelson Mandela Children's Hospital. SNAPPE II scores were calculated within 12 h of admission. Associations between SNAPPE II and mortality were assessed using relative risk, odds ratios, and receiver operating characteristic (ROC) analysis.

Results: 380 neonates were analysed. Overall mortality was 22.6%, with sepsis accounting for 65.1% deaths. SNAPPE II demonstrated strong prognostic performance: scores > 20 were associated with markedly increased mortality (relative risk 9.2, odds ratio 43.7), and no neonates survived with scores ≥ 40. ROC analysis showed excellent discrimination (AUC 0.88), with an optimal cut-off of 25.

Conclusion: SNAPPE II reliably predicts mortality in surgical neonates and supports early triage, rational resource allocation, and informed family counselling in resource-limited neonatal surgical units.

Background: Pilonidal Sinus Disease (PSD) is an acquired inflammatory condition with no standard treatment. We evaluated our initial experience with Pediatric Endoscopic Pilonidal Sinus Treatment (PEPSiT).

Methods: We retrospectively reviewed all PEPSiT cases from May 2021-January 2025. Data collected included demographics, presentation, comorbidities, BMI, surgical time, anesthesia, hospital stay, complications, healing, recurrence, and follow-up (median, range).

Results: Thirty-two patients (18 males) underwent PEPSiT, median age 15 years (11-18), BMI 26.6 kg/m² (16.7-51.6). None had prior surgery for PSD. Three had comorbidities (two with type 1 diabetes, one with Hemophilia B). Median operative time was 39 min (19-58). All were day surgery procedures; 28 under sedation/local and 4 under general anesthesia. Median healing was 3 months (1-24). Complications included one granuloma (treated with silver nitrate) and one hematoma. All resumed normal activities the next day. Median follow-up was 9 months (1-52). Three recurrences were successfully treated with redo-PEPSiT.

Conclusion: Our outcomes suggest that PEPSiT is a safe, effective option for PSD. However, larger prospective studies are needed.

Purpose: Rectal dilatation is common in anorectal malformations (ARMs), predisposing patients to postoperative defecation dysfunction. However, studies of diagnostic criteria and risk factors are lacking.

Methods: This retrospective study enrolled 100 male patients with intermediate/high-type ARMs who underwent high-pressure distal colostogram (HPC) prior to anoplasty. The recto-sacral index (RSI), defined as the maximum diameter of the rectal pouch divided by the height of the second sacral vertebra, was developed and measured. Patients were categorized based on intraoperative and pathological findings of rectal dilatation. Demographic and fistula-related factors were compared between groups. Receiver operating characteristic (ROC) curve analysis was used to determine the optimal RSI cutoff for diagnosing rectal dilatation.

Results: The incidence of rectal dilatation and the recto-sacral index (RSI) varied significantly according to ARMs type (P = 0.001 and P < 0.001, respectively), being highest in rectovesical and rectoprostatic (high-type) fistulas. A higher RSI was also associated with the absence of meconium per urethra (P = 0.029) and longer fistula length (P = 0.039). The RSI was significantly larger in the dilatation group (2.54 ± 0.09) than in the non-dilatation group (1.89 ± 0.05, P < 0.001). ROC analysis identified an RSI cutoff of > 2.34 for diagnosing rectal dilatation, with an area under the curve of 0.841 (95% CI: 0.762-0.921, P < 0.001).

Conclusion: Rectovesical/prostatic fistulas, longer fistula, and no history of meconium per urethra may be predictive risk factors for rectal dilatation in male patients with ARMs. The RSI > 2.34 serves as a reliable and objective imaging-based criterion for preoperative identification of rectal dilatation.