World Journal of Pediatric Surgery最新文献

Background: The burden of perioperative complications following pediatric surgery in sub-Saharan Africa is high. Assessment of the patterns and determinants of such complications and their relationship to perioperative mortality are important in identifying indicators of poor outcomes. In this study, we aim to define predictors of perioperative mortality at a tertiary hospital in Nigeria.

Methods: This was a retrospective review of medical records between January 2014 and December 2023. We included patients aged 15 years and below, who had general pediatric, oncological or urological surgery under general anesthesia. Information extracted included biodata, diagnosis, American Society of Anesthesiology (ASA) classification of physical status, time of death after surgery, cause of death, and duration of surgery. Data were processed using univariate and multivariate statistical analysis.

Results: A total of 1621 patients were analyzed. The 30-day perioperative mortality rate was 2.96% (296 per 10 000 patients). Jejuno-ileal atresia, gastrochisis, and bladder exstrophy were associated with the highest mortality rates, well above 50%. Logistic regression identified neonatal age, ASA class greater than II, prolonged surgery, and repeated surgical procedures as significant predictors of mortality. Sepsis and intestinal or anastomotic failure were identified as the most common direct causes of death.

Conclusions: Neonatal age, ASA class greater than II and prolonged and repeated surgery are significant predictors of mortality in children's surgery in our practice. Efforts should be made to combat sepsis and provide physiologic support and intensive care provision to improve outcomes.

Background: Neonates and infants presenting for surgery experience not only pain but also heightened pain sensitivity due to immaturity of the nervous system, which may increase the risk of neurodevelopmental disorders. Improving awareness, assessment, and timely intervention of pediatric postoperative pain is critical.

Methods: Neonates and infants aged 0-12 months who underwent abdominal and/or sacroperineal surgeries between September 2022 and July 2023 were randomly assigned to a treatment group (oral paracetamol suspension, 0.1 mL/kg [10 mg/kg] administered every 6 hours for four doses after recovery from general anesthesia) or a control group (oral sterile water, 0.1 mL/kg). The primary outcome was postoperative pain intensity. Secondary outcomes included changes in liver and kidney function indices-aspartate aminotransferase (AST), alanine aminotransferase (ALT), blood urea nitrogen (BUN), and creatinine (Cr)-measured preoperatively and 48 hours postoperatively.

Results: A total of 220 neonates and infants were included. Postoperative pain scores were significantly lower in the treatment than in the control group at each time point at all assessed time points (1, 6, 12, 18, 24, 36, and 48 hours after recovery from general anesthesia, p<0.001). No significant differences were observed between groups in changes in AST, ALT, BUN, or Cr levels from baseline to 48 hours postoperatively.

Conclusions: Repeated oral administration of paracetamol after recovery from general anesthesia effectively reduces postoperative pain in neonates and infants without adversely affecting hepatic or renal function. This approach is safe and suitable for routine clinical use.

Trial registration number: NCT05564819.

Objective: This study aimed to compare multidimensional long-term outcomes between children who underwent colonic pedicled flap surgery versus gastric tube esophageal replacement in the mediastinum after caustic injuries.

Methods: This cross-sectional observational study was conducted in patients who were operated on during their childhood between 1989 and 2022. Patients completed a comprehensive assessment using Pediatric Quality of Life Inventory Gastrointestinal Symptoms Scale (PedsQL GI), KIDSCREEN-52 for psychosocial dimensions, the 36-Item Short Form Health Survey, the International Dysphagia Diet Standardization Initiative (IDDSI) scale and the 6-Minute Walk Test (6MWT).

Results: A total of 26 patients (aged 6-22 years with mean 14 years) were included. Among these, 17 had a colonic pedicled flap and 9 had a gastric tube. Mean operation-to-questionnaire interval was 8 years. No significant differences were observed between groups in PedsQL GI, SF-36 or 6MWT outcomes. Mean PedsQL GI scores indicated mild-to-moderate gastrointestinal symptoms, with lower score in trouble swallowing and heartburn and reflux. Significant psychosocial disparities emerged in KIDSCREEN-52 with higher scores in psychological well-being (p<0.05) for colonic patients. Dietary texture modifications were needed in 38% of patients (IDDSI levels 5 and 6), but these were equally distributed between groups.

Conclusion: Both colonic and gastric esophageal replacements provide satisfactory long-term outcomes and quality of life after pediatric caustic injury. Although gastrointestinal and functional results were comparable, psychosocial quality of life domains showed differences. Persistent dietary adaptations underline the necessity for tailored, multidisciplinary and culturally sensitive follow-up.

Background: Laparoscopic cholecystectomy (LC) is increasingly performed in pediatric patients. Bile duct injury remains one of its most serious complications. The critical view of safety (CVS) aims to reduce this risk, but its identification is subjective. Artificial intelligence (AI) has shown promise in adult surgery for CVS detection but it has not been applied in pediatrics. Remote implementation of AI could reduce subjectivity and improve access to advanced tools.

Methods: A prospective, observational, cross-sectional, single-blind study was conducted between May and August 2025. An AI algorithm trained with 346 validated adult LC cases was tested live in 50 pediatric patients. Surgeries were transmitted in real time via teleconferencing to a second center where the algorithm processed the surgical image and identified CVS structures. Two expert surgeons, blinded to the algorithm, assessed CVS presence independently.

Results: A total of 50 patients (38 females and 12 males were classified as middle childhood to early adolescence) were included. The mean body mass index was 29.3±5.8. CVS was detected fully in 37 cases. In 13 cases, one or more elements were absent. Agreement between the algorithm and surgeons assessments was 100%. No postoperative complications were reported.

Conclusion: Remote AI-assisted CVS detection in pediatric LC is feasible, safe and consistent with expert evaluation.

Ependymomas are rare central nervous system tumors, with posterior fossa group A (PFA) ependymomas representing an aggressive pediatric subtype. While cerebrospinal fluid dissemination is well recognized, hematogenous spread and extracranial metastasis remain exceedingly rare and poorly understood. A 7-year-old child presented with symptoms of increased intracranial pressure and was found to have a mass in the fourth ventricle. Histopathology confirmed an ependymoma with features of the PFA subtype, including high marker of proliferation Kiel 67 index, glial fibrillar acidic protein and epithelial membrane antigen positivity, loss of trimethylation of lysine 27 on histone H3 and chromosome 1q gain (three copies). The patient underwent subtotal resection followed by craniospinal radiotherapy, local boost and six cycles of adjuvant chemotherapy with cisplatin, temozolomide and bevacizumab. Subsequently, progressive respiratory symptoms led to the discovery of pleural effusion and mediastinal metastases. Thoracoscopic biopsy confirmed metastatic ependymoma with immunophenotypic concordance to the primary tumor. Management included systemic chemotherapy, surgical resection and localized thoracic radiotherapy. This case reveals the rare occurrence of extracranial metastasis in pediatric PFA ependymoma and emphasizes the challenges of incomplete resection and atypical dissemination. A focused review of 14 pediatric PFA ependymoma cases highlights the importance of molecular profiling, close surveillance and recognition of non-traditional metastatic pathways in high-risk disease.

Biliary atresia (BA) is a progressive cholangiopathy of infancy and the leading cause of pediatric liver transplantation. Despite surgical intervention with the Kasai portoenterostomy, long-term outcomes remain poor, with many patients progressing to cirrhosis. Emerging evidence implicates the gut microbiota-a dynamic ecosystem crucial to immune development and liver homeostasis-in BA pathogenesis and clinical progression. This review synthesizes current literature on gut microbiota composition in BA before and after the Kasai procedure, highlighting consistent patterns of dysbiosis, including pathobiont expansion and depletion of beneficial microbes such as Bifidobacterium. The review explores associations between microbial profiles and clinical outcomes-highlighting potential mechanisms involving bile acid metabolism, microbial translocation, and immune modulation. Further understanding of gut-liver-microbiota interactions in BA may inform microbiome-targeted therapies to improve native liver survival.

Neuroblastoma constitutes the most common extracranial solid tumor encountered in children under 5 years of age. The clinical course is highly variable, ranging from spontaneous tumor regression in very young infants to a highly aggressive disease in older children. 5-year survival of > 90% in low and intermediate-risk disease compares to < 60% in those with high-risk neuroblastoma despite recent genetic and clinical advances. Treatment strategies vary significantly in intensity depending on the aggressiveness of disease with surgery playing a pivotal role in the management. A solid understanding of different risk groups, individualized management, and outcomes is important for pediatric surgeons to achieve best outcomes, and provide highest quality advice at the multidisciplinary tumor board meeting. This article offers a narrative update on the diagnosis and management of neuroblastoma in childhood and highlights some of the key controversies in the surgical management of the disease.

Objective: To describe phenotype, perioperative events, and early morbidity among infants with esophageal atresia with or without tracheoesophageal fistula (EA/TEF), and to evaluate how gap length relates to postoperative and follow-up outcomes.

Methods: A retrospective single-center cohort study was conducted in a tertiary neonatal and pediatric surgery service, Riyadh, Saudi Arabia. All infants with EA/TEF managed between January 1, 2016 and December 31, 2024. Clinical data include early clinical anastomotic leak (≤14 days), recurrent fistula, anastomotic stricture and time-to-event outcomes including hospital length of stay, time to full oral feeding, duration of postoperative ventilation and duration of parenteral nutrition. Follow-up outcomes included respiratory morbidity and feeding support requirements.

Results: Sixty-seven infants were included; gross type C was most frequent (73.1%). Gap length was assessable in 63 non-H-type cases, with 31.7% classified as long-gap EA. Survival to discharge was 86% after excluding three trisomy 18 infants managed palliatively. Primary repair was achieved in 67.2% overall but in only 10% of long-gap infants, among whom staged repair or gastric pull-up predominated. Early anastomotic leak occurred in 26.9%, recurrent fistula in 14.9% and anastomotic stricture in 32.8%. In multivariable logistic regression, long-gap EA was the only independent predictor of stricture (adjusted odds ratio (OR) 4.44; 95% confidence interval (CI) 1.27 to 15.55; p=0.020). Recovery was substantially longer for long-gap infants: median hospital stay 186 vs. 53 days (p<0.001) and time to full oral feeding 209 vs. 29 days (p<0.001). At follow-up (n=55), 34.5% required gastrostomy, 20% had feeding aversion, 36.4% experienced recurrent respiratory infections, and 10.9% had tracheomalacia.

Conclusions: Gap length was the principal determinant of anastomotic stricture and prolonged recovery after EA/TEF repair. These data provide a baseline for ongoing quality improvement and support early referral of long-gap cases to specialized multidisciplinary centers with structured follow-up programs.