Pediatric Surgery International最新文献

Purpose: This study evaluates the management and long-term outcomes of pediatric patients under 1 year of age with primary obstructive megaureters (POM) and vesicoureteral reflux (VUR), comparing primary ureteral reimplantation (PR) to a two-stage approach involving cutaneous ureterostomy (CU) followed by reimplantation.

Methods: A multi-institutional study was conducted between 1994 and 2024, including 28 pediatric patients under 12 months of age. Participants were divided into two groups: PR (n = 14) and CU (n = 14). Comprehensive preoperative assessments, including renal ultrasound, voiding cystourethrography, and radionuclide diuretic renal scans, were performed. Surgical indications were based on recurrent UTIs, impaired renal function, or progressive hydronephrosis.

Results: No significant difference in hydroureteronephrosis grade (SFU) was observed between the two groups (p < 0.05). In the PR group, two children required additional surgeries due to recurrent UTIs. Similarly, in the CU group, two children underwent subsequent ureteral reimplantation. The mean age at primary surgery was 6.9 months for the PR group, compared to 4 months for ureterostomy in the CU group (p < 0.05). The average operation time was 110.5 min for PR, vs. 64 min for CU (p < 0.05). Overall, more complications occurred in the group of children with CU until a definitive repair was performed.

Conclusions: Both primary ureteral reimplantation and the two-stage approach with cutaneous ureterostomy followed by reimplantation demonstrated effective outcomes in managing POM and VUR in infants. Given the findings, primary ureteral reimplantation may be considered a safe and effective approach in infants under 1 year with these conditions.

Objective: Analyze clinical characteristics and surgical outcomes of pediatric pilomatrixoma.

Methods: A retrospective analysis was performed on the clinical data of 332 pediatric patients diagnosed with pilomatrixoma, who were admitted to the Shanxi Provincial Children's Hospital between January 2017 and December 2024. This cohort included a total of 350 tumors, with 11 cases presenting with 2 tumors, 2 cases with 3 tumors, and 1 case with 4 tumors. The analysis encompassed various parameters, including sex, age, disease course, tumor site, maximum diameter, ultrasound characteristics, and treatment modalities.

Results: Patients aged 4 months-17 years (male:female = 1:1.26; 147 M:185F), peak incidence 0-2 years. Tumors primarily facial (71.4%, n = 250), then neck (10.3%), head (8.9%), limbs (8.3%), and torso (1.1%). The tumors adhere to the skin to varying degrees, but are mobile over the underlying base; 52.3% (n = 183) had overlying skin discoloration; 0.9% (n = 3) ulcerated. Ultrasound predominantly showed hypoechoic lesions (82.6%, n = 289); echogenicity positively correlated with disease course (P < 0.05). Tumor diameter ranged 0.3-3.6 cm; most enlarged progressively (3 stable). All underwent complete surgical excision with cosmetic closure and postoperative anti-scar therapy. No recurrences or hypertrophic scarring occurred during follow-up. Histopathology confirmed diagnosis (basophilic basaloid cells, shadow cells, calcification).

Conclusion: Pediatric pilomatrixoma shows slight female predominance, highest incidence under age 2, and favors the face. Hypoechoic ultrasound appearance is typical; size and echogenicity increase with longer duration. Early surgical intervention (within 6 months) minimizes incision length. Complete excision with cosmetic closure and anti-scar therapy achieves excellent aesthetic outcomes without recurrence.

Background: Hydatid disease is a zoonotic parasitic infection, endemic in many livestock-rearing regions, and remains a significant health concern. We report our experience managing childhood bilateral pulmonary hydatid cysts and discuss management strategies.

Methods: This was a retrospective analysis of data from the cohort of hydatid patients treated over a period of 5 years from January 2020 to December 2024. The care records were reviewed and data on clinical and radiological presentations were studied. The anesthesia and surgical management and intraoperative events were also recorded. The perioperative complications and hospital stay were studied, along with postoperative pharmacotherapy and recurrence. These patients were followed up for a minimum of 12 months.

Results: Out of 52 patients diagnosed with hydatid, 9 (aged 4-12 years, 66.7% male) were treated for bilateral hydatid lung. Cough was the commonest symptom, followed by fever and hemoptysis. The number of cysts ranged from one to three on either side. The cohort had low complication rates, with 88.9% avoiding major intraoperative spillage. Major intraoperative complications occurred in one patient, with one patient experiencing a mild postoperative air leak. Single-stage surgeries significantly reduced hospital stays (p = 0.049) and surgery duration per session (p = 0.013). Complication predictors, including liver involvement, cyst number, and diameter, were comparable. A follow-up between 12 and 60 months revealed recurrence in one patient on one side.

Conclusion: Surgery remains the definitive treatment for bilateral pulmonary hydatid cysts in children. Single-stage approaches are effective in reducing hospitalization times, while postoperative medical therapy ensures low recurrence rates. Conservative methods prioritizing parenchymal preservation should remain the cornerstone of surgical management.

Introduction: Antenatal detection of structural fetal anomalies is rising with advancements in prenatal imaging, necessitating robust frameworks for risk stratification and counseling. Traditional binary approaches often fail to encompass the multifactorial decision-making process involved. To address this gap, the MORE classification system-encompassing Management (M), Outcome (O), Risk (R), and Expectation (E)-was developed to guide structured antenatal counseling.

Methods: This prospective study evaluated the inter-rater reliability and construct validity of the MORE classification when applied independently by three senior pediatric surgeons to 55 antenatally diagnosed fetal anomalies. Ratings were performed using the M, O, and R components, with E excluded from statistical analysis due to its subjectivity. Intraclass correlation coefficients (ICC), Fleiss' kappa, Cronbach's alpha, and Spearman's correlation were computed.

Results: The study cohort had a median gestational age of 19 weeks, with 42% primigravidas. Isolated anomalies were predominant (80%), and 16.4% had suspected chromosomal associations. Internal consistency was acceptable to good (Cronbach's α: 0.757-0.812), and construct validity was high (Spearman's ρ overall = 0.812). ICCs indicated fair-to-moderate inter-rater agreement (0.398-0.584). Fleiss' kappa showed variable agreement: slight for Management (κ = 0.163), fair for Outcome (κ = 0.293), and moderate for Rsk (κ = 0.409). Test-retest reliability was excellent across all domains.

Conclusion: The MORE classification demonstrated good reliability and strong validity in antenatal counseling when used by experienced pediatric surgeons. While the Outcome domain showed highest consistency, the Management and Risk domains warrant refinement for broader adoption. The classification provides a pragmatic, structured framework for multidisciplinary decision-making and can aid in standardizing antenatal counseling practices, especially in resource-limited settings.

Background: The Bowel Function Score (BFS) questionnaire is the most widely utilized tool for assessing bowel function in patients with Hirschsprung disease (HD) or anorectal malformation (ARM). However, the questionnaire has not undergone a formal validation process. This study aimed to compare self-administered responses with those obtained during clinical consultations to determine whether patients can reliably report their bowel function when completing the questionnaire independently.

Methods: "Patients with HD or ARM and/or with their parents, completed the BFS questionnaire prior to their outpatient clinic visit. During consultations, the questionnaires were reviewed, with any missing or unclear responses addressed and adjustments recorded. The agreement between self-administered and interview-obtained BFS scores was assessed using the intraclass correlation coefficient (ICC)."

Results: A total of 103 questionnaires with 721 answered questions were evaluated. The agreement between self-administered and interview-based BFS scores was found to be nearly perfect (ICC) 0.96. The question recording frequency of defecation, was the only item that did not demonstrate perfect agreement.

Conclusion: This study supports the use of the self-administered BFS questionnaire as a reliable tool for assessing bowel function in HD and ARM patients in both clinical practice and research.

Purpose: Symptomatic Meckel's diverticulum (MD) has various clinical presentations and can be easily misdiagnosed. This multicenter study examines the clinical characteristics, management, and outcomes of patients across five academic pediatric surgery centers in Bosnia & Herzegovina and Serbia.

Methods: We retrospectively included all pediatric patients (< 18 years) who were surgically and histopathologically confirmed to have symptomatic MD between 2011 and 2020. Demographics, clinical and radiological features, surgical treatment approaches, histopathologic findings, and outcomes were collected and analyzed.

Results: Among 151 patients (80.1% male), the median age was 6.7 years (IQR 1.5-10.8). Presentations included intestinal obstruction (38.4%), GI bleeding (37.8%), and peritonitis (23.8%); 63.6% had multiple symptoms. A technetium-99 m scan was positive in 80.7% of bleeding cases. Laparotomy was performed in 72.2%, laparoscopy in 23.2%, and conversion in 4.6%. Partial small bowel resection was required in 80.8%, versus diverticulectomy in 19.2% (p < 0.001). Ectopic mucosa was found in 55.6% (gastric 48.3%, pancreatic 2.6%, both 4.6%; p = 0.05), significantly more common in males (p < 0.001). Postoperative complications occurred in 3.2%, with no mortality.

Conclusions: Symptomatic MD displays highly variable clinical presentations. It is often underdiagnosed preoperatively, particularly without GI bleeding, emphasizing the need for high clinical suspicion and tailored surgical approaches.

Purpose: To evaluate the relationship between nutritional status and surgical outcomes in patients with esophageal atresia (EA) from the Turkish Esophageal Atresia Registry (TEAR).

Methods: Between 2015 and 2024, 713 patients with the complete data of neonatal period and first year of life were included. According to FENTON, growth charts and patients were grouped as small for gestational age (SGA, < 10 percentiles), medium SGA (percentiles = 10-20), appropriate for gestational age (AGA, percentiles = 20-90) and large for gestational age (LGA, percentiles > 90) at birth. The z scores for height-for-weight were reevaluated at 6th and 12th months of age.

Results: Among 713 patients, 56% were boys. 23.7% of patients were SGA. There was no difference among groups for demographic features, outcomes, and mortality (p > 0.05). Patients with SGA had a higher rate of karyotype anomalies (23.1%, p < 0.05). At the 6th month, 20% of patients had improved nutritional status, 46.2% unchanged, and 33.5% worsened. At the 12th month, it was 31.6%, 50.2%, and 18.3%, respectively. 32.8% of the SGA patients had severe malnutrition at the 6th month, while this rate decreased to 10.2% at the end of the first year of life. Patients with worsened nutritional status had a significantly higher rate of mortality (10.2%) than patients with unchanged and improved nutritional status (3.7%, 2%, respectively, p < 0.05). There was no statistical difference between nutritional status and surgical outcomes at the 6th and 12th months (p > 0.05).

Conclusions: The incidence of SGA was significantly higher in EA patients with karyotype anomalies. While 20% of patients improved nutritional status at the 6th month, only one-third of patients improved nutritional status at the end of the first year. Closer follow-up is needed in patients with EA to avoid malnutrition, which can lead to poor growth, developmental delay, and impaired immune function.

Purpose: There are limited data to show how sex impacts the early clinical course of patients with Hirschsprung disease (HSCR). This study aimed to explore potential sex related disparities in the preoperative, surgical, and early postoperative course of HSCR patients.

Methods: This retrospective study analyzed data of HSCR patients who underwent pull-through surgery at pediatric surgery centers in Sweden from July 1st, 2013, to June 30th, 2023. Male and female patients were compared regarding diagnostics, surgical treatment, unplanned procedures under general anesthesia or readmissions within 90 days after pull-through, and complications (Clavien-Madadi grade ≥ 3) up to 30 days after pull-through.

Results: A total of 197 patients were included from four treating centers (158 males, 39 females). Females had a higher prevalence of familial disease (28.2% vs. 8.2%; p < 0.01) and RET gene mutations (15.4% vs. 2.5%; p = 0.02). No differences were observed in age at biopsy, need for re-biopsy, preoperative stoma rates, or age at diagnosis. Time from diagnosis to pull-through was longer in females (median 48.5 vs. 28 days; p = 0.02), but age at pull-through did not differ. No significant differences were found in postoperative hospital stay, severe complications within 30 days, nor unplanned procedures, HAEC, or readmissions within 90 days.

Conclusion: The early clinical course of HSCR patients does not appear to be sex dependent. Although females had a longer interval from diagnosis to pull-through, their age at pull-through was comparable to males. As expected, a higher proportion of females reported familial disease and had a verified RET-mutation.

Level of evidence: Level III.

Purpose: This study aimed to evaluate the ability of the hinotori™ system to mitigate technical and ergonomic challenges in pediatric laparoscopy by comparing usability, suturing precision, and stress responses with that of conventional laparoscopy in a simulated infant abdomen.

Methods: Ten pediatric surgeons with limited robotic experience performed peg transfer and suturing in a 1,400-mL box model simulating a 6-month-old abdomen, using robotic-assisted (Robo) and laparoscopic (Lap) approaches in a crossover design. Performance was assessed using the Fundamentals of Laparoscopic Surgery (FLS) score and the A-Lap Mini platform, which evaluates suturing accuracy across five domains. Physiological stress (heart rate and salivary amylase levels) and subjective fatigue (Chalder Fatigue Scale and visual analog scale) were recorded.

Results: Peg-transfer FLS scores were comparable between Robo and Lap (497.5 vs 531), with progressive improvement across Robo trials. Robotic suturing demonstrated greater air-leak resistance, smaller wound openings, and fewer internal collisions. Stress and fatigue indices did not differ significantly, although trends favored Robo.

Conclusion: Pediatric surgeons with minimal robotic experience achieved higher suturing precision using hinotori™, suggesting intuitive usability and potential safety-related benefits in training. Owing to the small sample size, absence of resident-level validation, and lack of formal performance-stress correlation, confirmation in larger cohorts is warranted.

Purpose: Necrotizing enterocolitis (NEC) is a severely life-threatening gastrointestinal emergency in newborns, especially when surgical intervention is needed. The ideal time for resuming oral feeding after surgery is still unclear, leading to variations in practice and prolonged parenteral nutrition. This study aims to develop and validate a scoring system to determine the best time to reintroduce oral feeding in neonates following surgical NEC.

Methods: A multicenter retrospective study was conducted from 2016 to 2024, including 500 neonates with surgical NEC (Bell's Stage III-IV). Patients were divided into early (5 days), intermediate (8-14 days), and delayed (≥ 15 days) feeding groups. A predictive score was constructed on 100 patients using eight preoperative, intraoperative, and postoperative variables. Validation was performed on an independent cohort of 400 patients.

Results: The scoring system demonstrated strong predictive accuracy (AUC = 0.967). Variables such as localized pneumatosis, absence of portal venous gas, higher platelet count, no second-look laparotomy, and early normalization of nasogastric aspirates and lab parameters were significantly associated with early feeding tolerance (p < 0.05). Validation confirmed reproducibility across cohorts without NEC recurrence or feeding-related complications.

Conclusion: We present a validated, clinically practical scoring system to guide early oral intake initiation after NEC surgery. It enables stratified decision-making, reduces reliance on parenteral nutrition, and enhances postoperative recovery.