Pediatric Surgery International最新文献

Purpose: This multicenter study aims to describe the rate of postoperative infectious complications following minimally invasive repair of pectus excavatum (MIRPE) and explore the various approaches to treatment of these infections.

Methods: A retrospective review of patients ≤ 21 years of age who underwent MIRPE between 7/2022 and 10/2023 across 10 children's hospitals was conducted. Patient demographics, clinical characteristics, operative details, and postoperative outcomes were collected and analyzed.

Results: A total of 523 pediatric patients met inclusion criteria; 450 (86.5%) were males. Postoperative infection occurred in 17 patients (3.3%): 5 superficial surgical site infections (SSI) (29.4%) and 12 deep bar infections (70.6%). There were no significant differences in demographics, clinical characteristics, or operative details between patients with and without postoperative infection, except for race. The proportion of patients with one, two or three bars differed between those with and without superficial SSIs (p = 0.002). There was no significant difference in number of bars placed for patients with or without bar infection. All but one postoperative deep bar infection (91.7%) were managed with bar salvage.

Conclusions: The overall incidence of postoperative infectious complications after MIRPE is low. Most deep bar infections can be managed with antibiotics and washout, without need for bar replacement or early removal.

Extracellular vesicles (EVs) are released by most cells, including stem cells, into the extracellular environment and regulate cell function and tissue regeneration through cell-cell communication. The EVs derived from human placenta have a crucial role in regulating the maternal immune response for a successful pregnancy outcome. The purpose of the current study was to evaluate the effects of human villous trophoblasts (HVT)-derived EVs on structural intestinal adaptation, cell proliferation and apoptosis in a rat model of short bowel syndrome (SBS). HVT-EVs were isolated from cell media after 24 and 48 h of starvation (medium without serum) by subsequent centrifugation and ultracentrifugation (UC). HVT-EV protein content were screened by protein array. Male Sprague-Dawley rats were divided into four experimental groups: sham rats underwent bowel transection and re-anastomosis, sham-EV rats underwent bowel transection and re-anastomosis and were treated with HVT-EVs given intraperitoneally (IP) at a dose of 200ug/200ul once daily from postoperative day 3 through 14, SBS rats underwent a 75% small bowel resection and anastomosis, and SBS-EV rats underwent similar bowel resection and were likewise treated with HVT-EVs. Parameters of intestinal adaptation, enterocyte proliferation and enterocyte apoptosis were determined on postoperative day 15. Apoptosis/inflammatory-related protein levels were determined by ELISA (TNF-α) and immunohistochemistry (caspase-3). SBS rats demonstrated a significant increase in jejunal and ileal bowel (400%) and mucosal (250%) weight, jejunal (18%) and ileal (13%) villus height, ileal crypt depth (17%), cell proliferation rates in jejunum (45%) and ileum (54%) and concomitant increase in cell apoptosis in jejunum (400%) and ileum (500%) compared to sham animals. Treatment of SBS rats with HVT-EVs which contain proangiogenic proteins such as angiogenin and angiopoietin-1 resulted in additional increase in jejunal bowel weight (39%), ileal mucosal weight (25%), ileal villus height (23%) and jejunal crypt depth (14%) compared to SBS-nontreated animals. Enhanced adaptation in SBS-EVs rats was achieved by a mild increase in cell proliferation and a significant decrease in cell apoptosis rates (four-fold decrease in jejunum and ten-fold decrease in ileum) vs SBS-nontreated animals. Inhibited cell apoptosis in this group was accompanied by decrease in TNF-α and caspase-3 expression. In conclusion, in a rat model of SBS, parenteral HVT-EVs stimulate structural intestinal adaptation. Increased cell proliferation and decreased cell death via apoptosis (probably by the intrinsic pathway) appears to be responsible for the increased cell mass.

Purpose: Anorectal malformations exist across a spectrum of abnormalities involving the rectum, distal anus, genital and urinary tracts, and occur in approximately one in 5,000 live births. The purpose of this study was to investigate intersectional reporting, mental health co-morbidities, and psychosocial experiences of adults born with anorectal malformation.

Methods: A systematic quantitative literature review was utilized to collect and analyze data. Articles were required to discuss population demographics, mental health comorbidities, or psychosocial experiences associated with anorectal malformation in adulthood. A total of 94 articles were found suitable for review.

Results: Patient ethnicity, culture, sexuality, and spirituality were significantly underrepresented. Mental health co-morbidities such as anxiety and depression were discussed but rarely transitioned to intervention. Psychological challenges included psychosexual anxiety and limited professional knowledge. Sociological challenges included navigating health services and social settings. Literature prioritized continence outcomes that diminished psychosocial complexities.

Conclusions: The intersectionality, mental health concerns, and psychosocial experiences of adults born with anorectal malformation remain largely unknown. Allied health professionals such as social workers can improve ongoing support provision, with interventions that enhance psychosocial functioning and emotional wellbeing.

Background/aim: Anatomical classifications of posterior urethral valves (PUV) have limited prognostic utility. We evaluated a Renal & Bladder Status (RBS) grading system, based on early post-treatment renal function and bladder morphology, in predicting long-term outcomes.

Methods: A retrospective review of 254 boys treated for PUV between 2003 and 2023 was performed. RBS-0 included non-classical/ suspected valves; RBS-1 classical PUV with preserved renal/bladder function (nadir creatinine <1 mg/dl and bladder contour normal); RBS-2 impaired but recoverable renal/bladder function (nadir creatinine <1 mg/dl and bladder contour improves) after fulguration; and RBS-3 persistent dysfunction (nadir creatinine >1 mg/dl or bladder contour abnormal/ persistent VUR) despite treatment. Primary outcome was progression to end-stage renal disease (ESRD); secondary outcome was valve bladder (VB). Kaplan-Meier survival and Cox proportional hazards models assessed predictors of ESRD.

Results: ESRD occurred in 0% of RBS-0, 6.3% of RBS-1, 12.2% of RBS-2, and 51.7% of RBS-3 (p < 0.001). VB developed in 0%, 4.7%, 8.8%, and 41.3% respectively (p < 0.001). At 10 years, ESRD-free survival was 95% (RBS-0), 85% (RBS-1), 65% (RBS-2), and 35% (RBS-3) (log-rank p < 0.001). On multivariable Cox analysis, RBS-2 (HR 3.1, 95% CI 1.4-6.8), RBS-3 (HR 6.7, 95% CI 3.2-14.0), nadir creatinine > 1 mg/dL (HR 2.5, 95% CI 1.5-4.2), and high-grade VUR (HR 1.9, 95% CI 1.1-3.4) independently predicted ESRD, while age at presentation was not significant.

Conclusion: RBS grading, incorporating early renal and bladder recovery after treatment, provides prognostic information and enables early risk stratification in PUV. Larger prospective multi-center studies are warranted to validate RBS grading.

Purpose: To investigate associated anomalies and the postoperative defecation function in female patients with low-type anorectal malformations (ARMs), focusing on comparing anovestibular fistula (AVF) with other subtypes.

Methods: Patient data were collected between 1984 and 2021. Eighty-seven female patients with low-type ARMs were enrolled after excluding one undetermined case. Associated anomalies, operative procedures, and the long-term defecation function were analyzed and compared between the AVF and non-AVF groups.

Results: AVF was the most common subtype (52.9%), followed by anocutaneous fistula (21.8%), covered anal stenosis (11.5%), anovulvar fistula (10.3%), and covered anal complete (3.4%). Upper urinary tract anomalies and VACTERL association were significantly more frequent in AVF (17.4% and 13.0%) than in non-AVF. Specific associations were identified: trisomy 21 with covered anal complete (100%), perineal groove with anocutaneous fistula (10.5%), and MRKH syndrome with AVF (2.2%). Chronologically, non-AVF low-type ARMs achieved "excellent" evacuation scores at 6 years, whereas AVF patients typically achieved this by 9 years. Individual defecation parameters reached full scores by 7 years in all subtypes except AVF, where constipation persisted beyond 11 years.

Conclusion: The postoperative defecation function in female patients with low-type ARMs demonstrates differential improvement patterns, with AVF requiring extended management until at least 9 years.

Purpose: Oesophageal substitution following atresia repair, caustic damage or cancer of the oesophagus can be challenging. We and others are working on engineering oesophageal tissue using a combination of decellularised oesophagi and cell injection. So far this has been achieved using highly operator-dependent techniques. This study aimed to establish a reproducible method for cell delivery into scaffolds.

Methods: To improve consistency, a stereotaxic robotic platform was adapted to deliver a suspension of porcine gelatin and cells in a 1:1 ratio. The scaffold was mounted on a 3D-printed rod linked to a stepper motor, enabling automated 36° rotation for circumferential coverage. Two circumferential rows, each rotated 36°, with 3 - 2 points at 3-mm intervals, ensured even seeding. Injection depth was calibrated to target the inner layer.

Results: Cells injected robotically remained viable, with no significant difference from manual injection. Post-injection analyses confirmed cell viability and distribution within the scaffold.

Conclusion: Automated robotic injection provides a reliable, reproducible alternative to manual methods, reducing operator bias.