Pediatric Surgery International最新文献

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.

Background: Pediatric spinal injuries refers to a medical condition characterized by structural or functional impairment of the spinal cord in children, resulting from trauma, infections, or other etiological factors, which may lead to severe consequences such as paraplegia or quadriplegia.​ METHODS: Epidemiological data on subtypes of spinal injuries in children were sourced from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021, encompassing annual estimates from 1990 to 2021. We analyzed the disease burden and epidemiological trends of distinct spinal injuries subtypes in children. Using the nordpred model, we projected the global burden of pediatric spinal injuries through 2046.

Result: n 2021, the global incidence of pediatric spinal injury cases was 72,628 (55,829-94,283), including pediatric spinal cord lesion at neck level with 34,695 (25,206-49,063) incidence cases, and pediatric spinal cord lesion below neck level with 37,933 (27,349-51,354) incidence cases. The global ASIR of pediatric spinal injury cases was 3.60(2.70-4.83), including pediatric spinal cord lesion at neck level with an ASIR of 1.72(1.20-2.50), and pediatric spinal cord lesion below neck level with an ASIR of 1.88(1.30-2.71). The global prevalence of pediatric spinal injury cases was 593,486 (521,155-683,457) and the global ASPR of pediatric spinal injury cases was 28.65(24.88-33.18). The global Years Lived with Disability (YLDs) due to pediatric spinal injuries was 199,941 (139,710-265,960), and the global ASYR of pediatric spinal injury cases was 9.66(6.65-12.94). Based on Joinpoint Regression analysis, we found that from 1990 to 2021, the Average Annual Percent Change (AAPC) in the ASIR of Global Pediatric Spinal Injuries was - 1.4(-1.73 to -1.07)). The AAPC for the ASPR of Global Pediatric Spinal Injuries was - 1.32(-1.36 to -1.27). The AAPC for the ASYR of Global Pediatric Spinal Injuries was - 1.58(-1.62 to -1.52).Based on the Nordpred model, it is projected that by 2046, the global number of new pediatric spinal injuries cases would be 57,877 with an ASIR of 3.13. The global number of pediatric spinal injuries prevalent cases would be 472,447 with an ASPR of 24.69. The global YLDs from pediatric spinal injuries would be 153,221 with an ASYR of 8.01.

Conclusion: The global epidemiological curve of pediatric spinal injury incidence is trending downward, yet these injuries still impose severe YLDs and high prevalence worldwide.

Background: Chronic right lower quadrant (RLQ) abdominal pain in pediatric patients with a negative workup poses a diagnostic and therapeutic challenge. The role of laparoscopic appendectomy (LA) in this cohort remains controversial.

Methods: Patients ≤ 18 years old who underwent LA for chronic RLQ pain between 2010 and 2021 were reviewed across two academic centers. Clinical data, operative findings, and histopathological results were compared between those with resolved and persistent pain following appendectomy.

Results: 123 patients underwent LA for chronic RLQ pain. Patients were categorized based on resolution (n = 78) or persistence (n = 45) of their pain following LA. Neither median symptom duration (9.3 [IQR: 2.7-18.7] vs. 6.4 [2.9-18.6] months, p=0.75), presenting symptoms, nor incidence of prior abdominal surgery (14.1% vs. 17.8%, p = 0.58) differed between groups. There was a high incidence of psychiatric diagnoses in both groups (21.8% vs. 24.4%, p = 0.74). Histopathologic findings did not differ between responders and non-responders. Concomitant surgeries were performed in 14.1% of responders (6 planned cholecystectomies, 6 incidental pathologies) and 20.0% of non-responders (4 planned cholecystectomies, 7 incidental).

Conclusions: LA provided sustained pain relief for a large subset of pediatric patients with chronic RLQ pain, even though no objective findings could distinguish responders from non-responders. These findings underscore the need for additional research to optimize diagnostic and treatment strategies for these difficult patients.

Objective: To evaluate the relationship between postoperative bowel dysfunction and pelvic floor muscle development in children with congenital megacolon.

Methods: Postoperative MRI data were collected from children with congenital megacolon who underwent surgery at the Department of General Surgery, Anhui Children's Hospital, between May 2007 and December 2024. MRI measurements included the position of the rectum, maximum thickness of the internal and external anal sphincters (EAS), levator ani, puborectalis, pubococcygeus, iliococcygeus, and ischiococcygeus muscles, upper rectal lumen width, and anorectal angle. Based on the 2016 Rome IV criteria for pediatric functional gastrointestinal disorders, children were classified as non-neurogenic fecal incontinence (NFI) group (Group A) or NFI group (Group B). Clinical data and MRI-derived muscle parameters were compared between groups.

Results: A total of 50 children were included, with 34 in Group A and 16 in Group B. Significant differences were observed in the thickness of the EAS and puborectalis muscle between the two groups (P < 0.05). Multivariate logistic regression revealed that greater EAS thickness (OR = 0.27, 95% CI: 0.08-0.90, P = 0.03) and puborectalis thickness (OR = 0.35, 95% CI: 0.13-0.84, P = 0.02) were independent protective factors against NFI, whereas long-segment congenital megacolon (OR = 7.72, 95% CI: 1.74-34.36, P = 0.007) was an independent risk factor.

Conclusion: Postoperative non-retentive fecal incontinence in children with congenital megacolon may be associated with the thickness of the EAS, puborectalis muscle, and megacolon type.

Purpose: Boys with genetic syndromes have an increased risk of undescended testes (UDT), but laparoscopic findings and outcomes after two-stage Fowler-Stephens orchiopexy (FS2) are rarely reported. This study aims to compare laparoscopic findings and results after FS2 between syndromic and non-syndromic boys.

Methods: A retrospective cohort study on boys with UDT who underwent laparoscopy between 2014 and 2024. Syndromic and non-syndromic patients were compared regarding age at surgery, bilaterality, type of UDT, and atrophy rate after FS2.

Results: In total, 190 boys with 298 testicles underwent laparoscopy. Of these, 42% were found to be intra-abdominal, 23% were vanishing testes and in 22% of cases, a testicular nubbin was found. Bilateral (p < 0.001) and intra-abdominal UDT (p < 0.01) were significantly more common in children with syndromes, whereas testicular nubbin was less common (p < 0.01). The median age at laparoscopy was higher in the group with syndromes. Atrophy occurred in 20% of all testicles undergoing FS2, with no significant difference in outcome between groups (p > 0,05).

Conclusion: Syndromic boys present with more severe UDT but achieve comparable outcomes after FS2. Early diagnosis and individualized management are essential to preserve testicular viability in this high-risk group.

Purpose: In 2017, the American Pediatric Surgical Association (APSA) published a systematic review that supported ovarian detorsion rather than oophorectomy for children with ovarian torsion. We evaluated our institutional ovarian salvage rate and outcomes following ovarian detorsion before and after publication of these APSA recommendations.

Methods: Electronic Medical Record data for patients who underwent operative intervention for adnexal torsion and between 01/01/2010 and 12/31/2023 at a single pediatric center were reviewed. Patients with antenatal torsion were excluded. Patient characteristics, operative findings, and postoperative outcomes were examined.

Results: A total of 238 patients were included. Mean age was 10.9 years (range 0.1-20.0). Mean time from presentation to OR was 9.5 h (SD 8.9). Ovarian detorsion was performed in 186 patients (78.2%). Oophorectomy was performed in 52 (21.8%); of these, 33 (63.5%) demonstrated evidence of necrosis and 14 (26.9%) were associated with a tumor. There were no intraoperative complications. There were no thromboembolic events following detorsion. Pregnancy data were available for 10 patients, with 7 live births.

Conclusion: Ovarian salvage is the preferred treatment for torsion. Our rates of ovarian salvage have improved over the past 10 years with no negative sequelae and no missed malignancies.