Pediatric Surgery International最新文献

Purpose: This study aimed to generate a hybrid colon lined with stratified esophageal squamous epithelium by replacing native colonic epithelium with esophageal organoids in mice.

Methods: Esophageal organoids were cultured from 8 to 10-week-old enhanced green fluorescent protein (EGFP) transgenic mice for 7-14 days before engraftment into syngeneic wild-type mice. A ~ 1.5 cm proximal colon segment was chemically de-epithelialized using ethylenediaminetetraacetic acid and flushed with phosphate buffered saline. The organoid suspension was then introduced into the lumen. Target tissues were collected on postoperative days 2, 11, 14, or 28 (n = 5, respectively) and analyzed by Hematoxylin-Eosin staining and immunofluorescence.

Results: Cultured esophageal organoids were lined by stratified epithelial structures with Cytokeratin (CK)14 + basal cells and CK13 + luminal cells, resembling native esophageal epithelium. Following transplantation, EGFP + cells that adhered to the luminal surface of the colon, first developed an immature multilayered epithelium and then formed a mature, differentiated epithelium by day 14. Immunofluorescence confirmed the presence of spatially organized CK14 and CK13 expression and the absence of the colon-specific marker CK20, indicating preservation of esophageal identity in the graft.

Conclusions: Engraftment of esophageal organoids into the de-epithelialized colon resulted in the successful reconstitution of esophageal epithelium, preserving their original phenotype.

Purpose: To assess how surgery and management protocols affect gut microbiota in postoperative biliary atresia (BA) patients by comparing survivors with native livers (NL) or transplanted livers (TL) with healthy non-surgical controls (CL).

Methods: Subjects were 62 post-portoenterostomy BA patients divided into 2 groups (NL and TL) and CL. All subjects were clinically stable with no dietary restrictions throughout the study period. Stool samples were compared for gut microbiota, organic acids, and fecal bile acids, while blood samples were compared for serum biochemistry and serum bile acids.

Results: Stool samples from CL (n = 30) were normal while NL (n = 31) and TL (n = 31) showed gut dysbiosis with significantly decreased total bacteria and reduced predominance of obligate anaerobes, and an abundance of Clostridioides difficile, Enterobacteriaceae, and Enterococcus. The latter two were more abundant in TL than NL. Biochemistry was normal in TL. In NL, elevated AST/ALT correlated with increased Clostridioides difficile, decreased Bacteroides fragilis group, and decreased Lactobacilli. Fecal secondary bile acids were lower and serum primary and secondary bile acids were higher in NL and TL compared with CL.

Conclusion: Gut dysbiosis was present in both NL and TL. Pathogenic florae were more abundant in TL despite TL biochemistry being normal.

Purpose: In a rat model of colocystoplasty, we aimed to characterize mitochondrial morphological and functional alterations in neobladder tissue, with a focus on the anastomotic bladder region where prolonged severe inflammation may occur.

Methods: Male Lewis rats (8-10 weeks old) underwent colocystoplasty, with neobladder tissues sampled within 5 mm of the anastomosis excluding the colon (A-part) or from the distal bladder (B-part) at 2 and 12 weeks. Sham-operated rats (bladder incision and closure) and intact controls were included (n = 5 each). Analyses included quantitative real-time polymerase chain reaction, hematoxylin and eosin staining, immunofluorescence, transmission electron microscopy, and MitoSOX assays to evaluate inflammation, mitochondrial morphology and function, and oxidative stress.

Results: Compared to the B-part, sham, and control, the A-part exhibited urothelial hyperplasia, marked inflammatory cell infiltration, and upregulated interleukin (IL)-1β and IL-6. Mitochondria in the A-part were swollen and contained inclusion bodies, accompanied by upregulated growth differentiation factor 15 and downregulated heat shock protein 60, indicating impaired viability. Superoxide production was increased, while mitochondrial transcription factor A and peroxisome proliferator-activated receptor gamma coactivator 1-α were less activated in the A-part.

Conclusion: These findings demonstrate that colocystoplasty induces persistent oxidative stress and mitochondrial dysfunction at the anastomotic site, associated with chronic inflammation.

Background: The antenatal diagnosis of hypospadias has implications for parental counselling, decision-making and organizing postnatal management. Recent imaging advancements have enabled antenatal detection of hypospadias with significant implications for parental psychology and clinical management. However, there is considerable variability in the application of the diagnostic techniques and their reliability or diagnostic accuracy.

Objective: To assess the diagnostic accuracy of prenatal imaging modalities in the antenatal detection of hypospadias using a Bayesian statistical framework and to identify key imaging features that enhance prenatal diagnosis.

Materials and methods: Comprehensive searches across PubMed, Scopus and Google Scholar identified primary research on antenatal hypospadias diagnosis, which was subject to systematic review as per PRISMA guidelines. A Bayesian model employing non-informative priors (Beta (1,1)) was used to calculate pooled sensitivity and specificity, along with corresponding 95% credible intervals, enabling the probabilistic quantification of diagnostic uncertainty.

Results: The review included 34 studies published between 1989 and 2023, representing 280 pregnant females with 282 foetuses. Bayesian analysis revealed high sensitivity (0.87; 95% CrI: 0.80-0.92) and moderate specificity (0.46; 95% CrI: 0.34-0.58), translating into reliable detection of cases, though with a higher risk of false positives. While 2D sonography served as the universal screening tool (100%), supplementary techniques included 3D sonography (32.3%), color Doppler (32.3%) and magnetic resonance imaging (8.8%). Diagnosis occurred at a mean gestational age of 26.3 ± 5.5 weeks (range 20-39 weeks). Key imaging features identified were ventral curvature (n = 62), a shortened penile shaft (n = 52), a blunt penile tip (n = 60), Meizner's tulip sign (n = 51) and a bifid scrotum (n = 20). The tulip sign, bifid scrotum and cranially-directed phallus were exclusively associated with proximal variants.

Conclusions: While 2D-ultrasonography remains the primary investigative modality, antenatal detection of hypospadias may be improved through the integration of 3D ultrasound, Doppler and MRI, particularly in complex cases. Confirmatory postnatal evaluation is crucial to address the moderate specificity and risk of false-positive results. However, there is a need to address the disparities in access to advanced imaging and technical expertise in prenatal diagnosis.

Aims: This study aimed to implement and evaluate an enhanced recovery after surgery pathway for pediatric patients undergoing the Nuss procedure.

Methods: The enhanced recovery after surgery pathway was implemented in 2024, and this protocol included preoperative education and counseling, a perioperative multimodal pain management protocol, a perioperative staged rehabilitation exercise program, and predischarge education. Data were collected prospectively for patients in the ERAS pathway and retrospectively for previous patients. Length of stay (LOS) and activity of daily living (the Barthel Index) were the main outcomes of this study, and the pain scores and time to first ambulation postoperatively were the secondary outcomes.

Results: A total of 86 patients were included in this study, with 43 patients in each group. There was no significant difference in age, sex, or the Haller index between the two groups. The average LOS decreased from 7.74 days to 6.84 days with ERAS. Patients in the ERAS group had improved Barthel indices, particularly on the day of discharge, and significantly lower pain scores from POD0 to POD3. The time to first ambulation was also shorter in the ERAS group.

Conclusion: An enhanced recovery after surgery procedure implemented for the Nuss procedure can reduce the length of stay and early pain score. Alterations in the pathway may lead to the achievement of the desired goals of better self-care ability in daily living.

Clinical trial number: Not applicable.

Objective: To evaluate early outcomes of infants with gastroschisis managed at a UK tertiary centre over 16 years, focusing on associations between maternal factors, closure techniques, and postoperative outcomes.

Methods: A retrospective cohort study included 126 live-born infants with intra-operatively confirmed gastroschisis (June 2008-June 2024). Data on maternal demographics, perinatal factors, surgical management, and outcomes were collected. Multivariable logistic regression adjusted for gestational age, birth weight, gastroschisis complexity, and maternal smoking.

Results: Antenatal ultrasound identified 98% of cases. Median gestational age was 37 weeks; mean birth weight was 2.4 kg. Sutureless closure was used in 41% of cases and showed a trend toward earlier feeding and shorter hospital stay, though differences were not statistically significant. However, sutureless closure was associated with higher rates of sepsis (73% vs. 41%, p = 0.005) and hernia formation (42% vs. 22%, p = 0.01). Maternal smoking independently increased neonatal sepsis risk (adjusted OR 2.1, 95% CI 1.1-4.0). Overall survival was 96.8%, with all deaths occurring in complex cases.

Conclusion: While sutureless closure may offer perioperative advantages, it is associated with increased postoperative morbidity. Maternal smoking is a modifiable risk factor for neonatal sepsis. Individualised surgical approaches and targeted maternal interventions are recommended.

Purpose: Most children with acute appendicitis are treated with laparoscopic appendectomy followed by antibiotics if the appendix is found to be perforated. There is variation in the type of post-operative antibiotics used for these patients.

Methods: We conducted systematic searches of Medline, Embase, and Cochrane for comparative studies of children with perforated appendicitis treated with post-operative piperacillin/tazobactam versus ceftriaxone and metronidazole.

Results: We identified four studies consisting of 25,730 children with perforated appendicitis treated with laparoscopic appendectomy followed by post-operative piperacillin/tazobactam (n = 9,950) or ceftriaxone and metronidazole (n = 15,780). One study was a randomized controlled trial (RCT) and three were multicenter observational studies. Meta-analysis suggested no differences between piperacillin/tazobactam and ceftriaxone and metronidazole in terms of deep/organ-space surgical site infection (risk ratio [RR] = 0.97, 95% confidence interval [CI] 0.57-1.65), post-operative imaging (RR = 0.99, 95% CI 0.71-1.37), return to the emergency department (RR = 0.82, 95% CI 0.50-1.37), and readmission to hospital (RR = 0.85, 95% CI 0.45-1.62). Heterogeneity between studies was substantial (I² 73-83%). The RCT was limited by possible ascertainment bias, while the three observational studies may have been affected by baseline differences between treatment groups.

Conclusion: This systematic review suggests that there is ongoing uncertainty regarding the optimal post-operative antibiotics for children with perforated appendicitis.

Clinical trial registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD42023421492 .

Introduction: Falls from windows are a source of significant morbidity and mortality among pediatric trauma patients. Public health initiatives to prevent these injuries are crucial, but to appropriately deploy these initiatives, understanding where to target these interventions is critical. The purpose of this study was to identify geographic locations of these injuries to develop targeted injury prevention strategies.

Methods: This study conducted a retrospective analysis of all window fall injuries that presented to Utah's only Level 1 Pediatric Trauma Center from 2015 to 2024. A geographic analysis was performed using ArcGIS mapping software, and linear and logistic regression models were employed to examine the relationships between patient characteristics and Area Deprivation Index (ADI) values.

Results: A total of 223 window fall injuries were identified over the 9-year study period. The median age at presentation was 3.8 [2.8-5.2] years. Most patients were male (58%) and lived in single-family homes (58%). The median injury severity score was 9 [2-14], and 37% of patients had an Abbreviated Injury Scale (AIS) score of greater than 3, indicating a significant injury, for the head and neck region. There was no relationship between state or national ADI and injury severity score, length of stay, Glasgow coma scale, or intensive care unit admission. Younger patients were more likely to live in a more disadvantaged neighborhood based on state ADI (p = 0.03), but not based on national ADI (p = 0.06).

Conclusions: The geographic distribution and patient injury characteristics of window fall injuries from the state of Utah over a 9-year period were not correlated with state or national ADI, contrary to what has been seen in other locations. From these data, key communities where these injuries have been most common have been identified and will be the focus of targeted prevention strategies moving forward.