Pediatric Surgery International最新文献

Background: The conventional management of long gap oesophageal atresia (LGOA) typically involves the insertion of a gastrostomy shortly after birth. This is our experience with laparoscopic gastrostomy tube (LGt) insertion in newborns diagnosed with LGOA.

Methods: A retrospective review of medical records for cases of LGOA that underwent laparoscopic-assisted Seldinger gastrostomy placement between 2019 and 2024. A 5 mm camera and 3 mm instruments were used to place transabdominal sutures to the stomach, which was then punctured with a needle and insufflated with 2 ml of air. A Seldinger wire and dilators were then used to insert a balloon gastrostomy tube. The sutures were tied extra-corporeally.

Results: Eight newborns with LGOA underwent LGt (median gestation 36.5 weeks, age 2 days, birth weight 2.2 kg. Seven neonates were fitted with a 12Fr gastrostomy tube, while one premature infant (33-week gestation, 1.4 kg) had an 8Fr Foley catheter. A contrast study was performed the following day to confirm the correct position of the feeding tube, and feeding was initiated after 24 h. There were no immediate complications or instances of tube displacement observed. Ultimately, all patients successfully underwent staged thoracoscopic repair of their LGOA using external traction sutures.

Conclusions: The insertion of LGt proved to be safe, in our series despite the tiny size of their stomachs. This minimally invasive approach offers several advantages, including excellent visualization, reduced liver retraction, and less manipulation of the stomach. Additionally, it may lead to fewer adhesions, which is an important factor to consider since many patients with LGOA will require fundoplication in the future.

Purpose: To describe the epidemiology and clinical presentation of children with pectus carinatum; and the outcome of their first hospital clinic appointment.

Methods: A single surgeon, retrospective cohort study of children presenting between 1998 and 2022. Demographic and clinical data were collected from the medical record.

Results: We present 430 children with pectus carinatum; 364 boys and 66 girls. Their asymmetry was identified at a median age of 11 years (range 0-16 years). Girls developed carinae earlier than boys (10 vs 14 years, p = 0.003), were more likely to present with pain (44% vs 26%, p = 0.041) and were more likely to have a family history of chest wall deformity (33% vs 20%, p = 0.070). The majority (342, 69%) had an asymmetrical, isolated carinatum. Isolated carinae were mainly right dominant (174, 57%), conversely, mixed carinatum/ excavatum were typically left side dominant (10/15 vs 2/15, p = 0.008).

Conclusion: The clinical presentation of carinatum is heterogenous with apparent differences between males and females. A detailed history and examination are required; if clinicians record, in detail, the clinical context and morphology of the carinatum, a comparison of phenotype and outcome would become feasible. Simply stating "Carinatum" is not enough.

Purpose: To evaluate the efficacy of injection sclerotherapy in the management of reducible rectal prolapse (RP) in children.

Methods: Children with reducible RP who underwent sclerotherapy with Kinurea-H^® (quinine dihydrochloride/urea) were retrospectively included, and divided into 2 groups, functional RP (FRP) or organic RP (ORP).

Results: Thirty-two patients were included, 18 FRP and 14 ORP (7 anorectal malformation (ARM), 2 anorexia nervosa, 1 Hirschsprung disease, 2 spinal dysraphism, 1 Ehlers-Danlos, 1 short bowel syndrome) with a median age of 4 years. After one injection, the success rate was higher in FRP (78%) than in ORP (21%) (p = 0.0009). After 2-4 injections, success rate was 94% in FRP and 93% in ORP, with a minimal mucosal resection of the fixed portion (less than 5 mm, limited to the ano-cutaneous junction) in 4/7 ARM. Repeated injections were performed at same site in all ORP without ARM, and in only 43% of ORP with ARM. Recurrence of reducible RP after the first injection at one site was associated with ORP (p = 0.03), particularly in ORP without ARM (p = 0.06).

Conclusion: Sclerotherapy for reducible RP is efficient after failure of conservative management in FRP and success rate after repeated injections is encouraging in ORP, particularly in ARM.

Purpose: This study aims to explore maternal and pregnancy-related risk factors for colonic atresia (CA) and assess the national total prevalence, mortality, and frequency of co-occurring anomalies of this rare malformation in 2004-2017.

Methods: This case-control study involved 36 cases with congenital CA identified from several Finnish registers. All cases were identified based on the ICD-9/ICD-10 codes and classified based on co-occurring anomalies. Five controls without gastrointestinal congenital malformations matched for residence and time of conception (± 1 year) were randomly selected for each case. Maternal risk factors were analyzed with data from the same registers.

Results: Total prevalence of CA was 0.45/10,000, birth prevalence was 0.37/10,000 and live birth prevalence was 0.36/10,000. The overall prevalence trend did not change (p = 0.11) during the study period. There were 15 (41.7%) isolated cases, 3 (8.3%) were associated with known syndromes and 18 (50.0%) had multiple congenital anomalies. Together there were 19.4% (n = 7) terminations or neonatal mortalities. An association was observed with maternal diabetes and CA (p = 0.03).

Conclusion: The prevalence of CA in Finland is low with no significant change over the study period. Despite the high frequency of associated anomalies, the overall survival of CA is very high, 97%.

Objective: To explore the therapeutic efficacy and technical characteristics of pneumovesical Cohen ureteral reimplantation (PCUR) versus laparoscopic dismembered Lich-Gregoir ureteral reimplantation (LLGR) in the treatment of primary obstructive megaureter (POM) in Paediatric Patients.

Methods: A retrospective analysis was performed on 94 paediatric patients with unilateral POM who were admitted to the Department of Paediatric Surgery, The First Affiliated Hospital of Zhengzhou University between October 2017 and October 2023. Based on the surgical approach, patients were allocated into two groups: 51 cases underwent PCUR, constituting the PCUR group; the remaining 43 cases underwent LLGR, forming the LLGR group. Preoperative baseline characteristics, intraoperative metrics, and postoperative outcomes were compared between the cohorts. The study specifically evaluated the changes in the renal pelvis anteroposterior diameter (APD), the maximum distal ureteral diameter (MDUD), and differential renal function (DRF) on the affected side, comparing preoperative and postoperative values.

Results: No significant differences were observed in preoperative baseline characteristics between the PCUR and LLGR groups. Compared to the PCUR group, the LLGR group was associated with a significantly shorter operative time (Z=-1.473, P = 0.015) and a reduced duration of postoperative haematuria (Z = -4.843, P < 0.001). Preoperative and postoperative measurements of the affected-side APD, MDUD, DRF and RCT were comparable between the two groups, with no statistically significant differences identified. However, intragroup analysis demonstrated a significant postoperative improvement in all three parameters (APD, MDUD, DRF and RCT) within both surgical cohorts. Furthermore, the magnitude of improvement, defined as the delta (Δ) values for APD (ΔAPD; t = -0.310, P = 0.758), MDUD (ΔMDUD; t = -0.418, P = 0.678), DRF (ΔDRF; t = -1.526, P = 0.129), and RCT(△RC; t = -0.431, P = 0.668), did not differ significantly between the groups.

Conclusion: Both PCUR and LLGR are safe and effective in treating paediatric POM. Compared with PCUR, LLGR offers advantages including shorter operative time, reduced duration of postoperative haematuria, broader age range applicability, more spacious surgical field, lower technical difficulty in ureteral tailoring, and no compromise to subsequent endoscopic interventions.

Purpose: Congenital inguinal hernia is a common condition treated by Pediatric Surgeons. Despite laparoscopy being the preferred method for many, there is still debate on its efficacy compared to the open technique. We compared our outcomes of laparoscopic percutaneous internal ring suturing with peritoneal thermal injury to open repairs.

Methods: Retrospective, cohort study from 2014 to 2023 at Dayton Children's Hospital of children aged 17 years or less who had an inguinal hernia repair by a Pediatric Surgeon via either of the two techniques. Demographics, operative technique, complications, hernia recurrence or metachronous contralateral hernia development, and follow-up length were collected.

Results: 1,141 children were included, of which 61.5% (n = 702) had an open repair and 38.5% (n = 439) had a laparoscopic repair. Demographics were similar, except infants comprised a greater proportion of the laparoscopic group (45.1% vs. 36.2%, p = 0.002). There were more bilateral repairs in the laparoscopic group (p < 0.001). Post-operative complications were similar. The recurrence rate was 2.5% with laparoscopic repairs and 1.1% with open repairs (p = 0.079).

Conclusions: The rate of hernia recurrence and other post-operative outcomes were similar for the two techniques, providing further evidence for the continued use of our laparoscopic technique.

Background: Biliary atresia (BA) is a progressive neonatal cholestatic liver disease that requires timely diagnosis and intervention. Differentiating BA from other causes of neonatal cholestasis remains a significant clinical challenge.

Methods: In this study, we retrospectively analyzed the clinical and biochemical data of 243 cholestatic neonates, comprising 61 with BA and 182 with non-BA. We utilized five supervised machine learning algorithms-logistic regression (LRM), decision tree (DET), multilayer perceptron (MLP), support vector machine (SVC), and random forest (RF)-to construct diagnostic models for BA. The performance of each model was evaluated based on its accuracy, sensitivity, specificity, and area under the receiver operating characteristic curve (AUC). We then developed an online diagnostic tool based on the best-performing model.

Results: The BA and non-BA groups showed significant differences across multiple biochemical markers. All five models demonstrated good diagnostic performance, with the random forest (RF) model achieving the best results (AUC = 0.93, sensitivity = 88.5%, specificity = 85.2%). The combination of multiple biochemical parameters substantially improved diagnostic accuracy compared to using single indicators. The web-based tool provides an intuitive and user-friendly interface to support early BA screening in clinical practice.

Conclusion: Machine learning-based models, particularly the RF model, show great potential for the early diagnosis of BA in cholestatic neonates. The implementation of a dedicated online platform may facilitate timely identification and assist clinicians in decision-making.

Objective: Remote ischemic conditioning (RIC) potentially is an innovative therapeutic strategy for preterm infants with necrotizing enterocolitis (NEC). RIC appears safe in human premature neonates with NEC, as demonstrated by no adverse effects or complications due to RIC in our previous trial. The aim of the current study is to further assess the safety of RIC during its extended application in preterm infants with NEC.

Methods: A single center phase I non-randomized trial was conducted. Preterm (< 36 weeks gestational age at birth) infants with confirmed NEC were recruited and received RIC intervention. RIC consisted of four cycles of limb ischemia (5-min via cuff inflation) followed by reperfusion (5-min via cuff deflation), repeated on two consecutive days post enrollment. Demographic and clinical data were collected at enrollment. The primary endpoint of this study was safety defined as perfusion returning to baseline within 5 min after cuff deflation. Secondary endpoints included cutaneous injury and pain (measured by PIPP scores).

Results: A total of 6 neonates were recruited. All neonates were preterm with a birth weight ranging from 450 to 3150 g. NEC was diagnosed between 7 and 30 days and weight at RIC ranged from 780 to 3040 g. Two (33.3%) patients had medical NEC. Four (66.7%) patients underwent RIC postoperatively. RIC was completed in all neonates. Arterial flow and limb perfusion returned to baseline within 5 min in all patients. All patients had a normal grasp reflex both before and after RIC. No new-onset skin lesions were observed. There was no significant difference in PIPP score before and after RIC.

Conclusions: RIC intervention with 5-min ischemia-reperfusion cycles is safe. RIC is also safe when extended to extremely preterm neonates with confirmed medical or surgical NEC.

Background: Congenital duodenal obstruction (DO) is an anomaly which requires surgery shortly after birth. However, its long-term gastrointestinal (GI) sequelae remain unknown. Therefore, this study aimed to determine the long-term GI patient-reported outcome measurements (PROMs) using the Pediatric Quality of Life Inventory™ (PedsQL™) GI-Module in patients with DO compared to healthy controls. Secondly, we evaluated the PROMs comparing patients with DO with and without trisomy 21.

Methods: We performed a cross-sectional cohort study (September-December 2023). The PedsQL™ GI-Module questionnaire was sent to all patients who underwent DO surgery between 1999 and 2022. Data were compared with a published healthy control group (n = 513). Bonferroni correction was used to adjust for multiple tests.

Results: In total, 33/89 patients completed the PedsQL™ GI-Module questionnaire. The majority of the patients were female (N = 19/33) with a mean age of 13.3 years (SD ± 6.6). Trisomy 21 was diagnosed in seven patients. The DO group had a similar mean total score compared to healthy controls (84.5 ± 11.5 vs. 88.6 ± 12.9,p = 0.075). The mean score for constipation (77.2 ± 22.0 vs. 86.9 ± 17.6,p = 0.002) was significantly lower compared to the healthy controls, indicating a worse outcome, whilst all other domains were similar. Four patients used laxatives. Patients with DO and trisomy 21 had similar scores compared to patients with DO without trisomy 21.

Conclusion: The results showed similar long-term GI PROMs in patients who underwent DO surgery compared to healthy controls. Patients with DO experienced constipation more frequently, emphasizing the need for attention during follow-up and education of (parents) of patients. Additionally, children with DO and trisomy 21 showed similar PROMs to those without trisomy 21.

Level of evidence: II.