World Journal of Pediatric Surgery最新文献

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.

Normalization of serum bilirubin after Kasai portoenterostomy (KPE) is a prerequisite for long-term native liver (NL) survival. Following a successful KPE, fibrotic liver injury progresses variably, although a significant proportion of patients show decreasing histological liver fibrosis during follow-up. Eventually, the great majority of patients develop cirrhosis and clinical manifestations of portal hypertension (PH), while liver malignancies and pulmonary complications of PH occur infrequently. Accurate prediction of liver fibrosis remains challenging. Development of reliable noninvasive biomarkers of liver fibrosis would improve patient management and benefit performance of interventional trials. Although successful KPE modifies liver gene expression profile, molecular signature of active fibrogenesis and ductular reaction (DR) persists. Successful KPE reduces the abundance of activated myofibroblasts and macrophages, whereas cholangiocytes tend to increase. Progression of long-term fibrotic liver injury is tightly connected with DR, which is associated with serum bile acids. While serum bile acids are predictive of portal fibrosis and NL survival, there are ongoing randomized clinical trials evaluating the efficacy of bile acids lowering therapies on KPE outcomes. A better understanding of disease mechanisms underpinning progression of liver injury and clinical complications following successful KPE is needed for the development of novel adjuvant therapies, improvement of follow-up, and optimizing outcomes.

Background: Neonatal gastrointestinal surgical emergencies (NGSEs) require rapid decisions to prevent morbidity and mortality. This study assessed the potential use of ChatGPT in supporting clinical decision-making for NGSEs.

Methods: The challenging NGSE cases (ileal atresia, midgut volvulus, Hirschsprung disease, meconium ileus, and pseudo-obstruction) were converted into structured short-answer questions including histories and radiologic images. Questions covered differential diagnosis, diagnostic plan, management plan, final diagnosis, and surgical plan. Each case was scored out of 10 (maximum 50). Scenarios were presented to 10 general surgery (GS) residents, 10 GS attendings, and 10 pediatric surgery (PS) attendings. GPT-4o was tested with 10 iterations per case. Group scores were compared using appropriate statistical tests.

Results: A total of five cases were involved. GPT-4o achieved a mean score of 44.95 (89.9%), higher than GS residents (27.05, p<0.001) and GS attendings (28.35, p<0.001), but lower than PS attendings (47.70, p=0.021). Subgroup analysis showed GPT-4o matched PS attendings in management, final diagnosis, and surgical planning, but scored lower in differential diagnosis (87.8% vs. 92.8%, p=0.0479) and diagnostic plan (75.0% vs. 93.8%, p<0.001). Compared with GS residents and attendings, GPT-4o performed significantly better across all categories except diagnostic plan.

Conclusions: GPT-4o demonstrated performance comparable to PS attendings in key management domains, while clearly surpassing GS residents and attendings overall. These findings suggest that GPT-4o may have potential as a supplementary decision-support tool for NGSEs, although clinical use requires further validation in real-world settings.

This study aimed to evaluate the feasibility and efficacy of laparoscopic management in neonates diagnosed with congenital gastric muscular layer defects and gastric perforation. A retrospective analysis was conducted on four male neonates (median gestational age: 36.79 weeks; median birth weight: 2460 g) who underwent laparoscopic repair at Shanxi Provincial Children's Hospital between January 2022 and October 2024. All neonates presented with symptoms of vomiting, feeding intolerance, and abdominal distension, with preoperative imaging confirming pneumoperitoneum. Laparoscopic surgery was successfully completed in all cases without conversion to open surgery. The median operative time was 102 min, and no surgery-related complications such as anastomotic leakage or hemorrhage were observed. One neonate was transferred to the department of internal medicine due to postoperative feeding difficulties, failure, and persistent oxygen dependence. The median hospital stay was 27.5 days. At the 6-month postoperative follow-up, three neonates exhibited satisfactory growth and development, while one exhibited mild growth delay. Our findings indicate that laparoscopic repair offers significant advantages, including mitigated surgical trauma, quicker recovery, and lower incidence of intestinal adhesion. Provided that surgical indications are strictly assessed and the surgeon possesses proficient laparoscopic skills, it is feasible for specialized surgeons to manage this disease using laparoscopy.

Objective: To evaluate the clinical and oncological outcomes of transoral endoscopic thyroidectomy via the vestibular approach (TOETVA) in the management of pediatric patients with benign and malignant thyroid lesions in Vietnam.

Methods: A cross-sectional study was performed on pediatric patients (≤18 years old) who underwent TOETVA for thyroid cancer and benign thyroid nodules between August 2019 to September 2024.

Results: Of the 28 patients included in the study, 23 were female (82.1%), and 5 were male (17.9%) with a mean age of 15.86±2.45 years. Mean tumor size on ultrasound was 19.47±13.63 mm. TOETVA was completed successfully in all cases. Postoperative histopathological findings revealed benign lesions in 13 patients, differentiated thyroid carcinoma in 14 patients and non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) in one patient; central neck dissection (CND) was performed in 15 patients; nine of them had occult lymph node metastasis. Postoperative complications included transient hypoparathyroidism (3.6%) and vocal cord palsy (7.1%), all of which resolved. No permanent complications or recurrences were observed over a median follow-up of 26.5 months.

Conclusions: TOETVA appears feasible for the treatment of thyroid nodules in children. However, larger prospective studies are needed to confirm these findings.

Background: Management of pediatric intestinal obstruction remains clinically challenging, particularly regarding the selection between surgical and conservative approaches. This study aimed to develop artificial intelligence (AI) models to support treatment decision-making.

Methods: A retrospective analysis was conducted on clinical data from pediatric intestinal obstruction patients. The dataset was split via stratified sampling (70% training/ 30% test), preserving outcome distribution. Predictive models incorporating clinical indicators were developed using machine learning, with evaluation metrics including accuracy, F1-score, Kappa value, positive predictive value (PPV), negative predictive value (NPV), precision-recall curves, calibration plots and decision curve analysis (DCA).

Results: Among 765 pediatric patients, 425 responded to conservative treatment while 340 required surgery. The Random Forest model demonstrated optimal performance in the test cohort (area under the curve: 0.953; sensitivity: 0.879; specificity: 0.901; accuracy: 0.892; F1-score: 0.878; Kappa value: 0.780; PPV: 0.878; NPV: 0.905). Calibration, precision-recall, and DCAs indicated favorable clinical applicability.

Conclusion: Machine learning integration with clinical indicators shows potential as a decision-support tool for selecting surgical or conservative treatment in pediatric intestinal obstruction.

Application of artificial intelligence (AI) within electronic health record (EHR) systems is influencing clinical care, research, education, and quality improvement in pediatric surgical practice. In clinical settings, these technologies organize and structure patient information, enable predictive analytics, and support decision-making tools that enhance awareness and facilitate interventions.Longitudinal datasets in EHR create opportunities for data-driven research ranging from modeling and outcome prediction to clinical trial recruitment. Educational applications of AI-enabled EHR extend to healthcare professionals, trainees, patients, and caregivers. For professionals, case-based learning and simulation resources strengthen decision-making skills and clinical judgment. For patients and caregivers, personalized guidance and accessible health records foster understanding of disease, encourage active participation in care, and improve adherence to management plans. Quality improvement initiatives benefit from AI-assisted audit systems, automated tracking of outcomes, and identification of workflow inefficiencies. These benefits are accompanied by challenges, including the risk of overreliance on automated alerts, limited representativeness of training data, lack of external validation, workflow misalignment, and concerns about privacy and transparency. Addressing these issues through rigorous validation, inclusive datasets, user-focused design, and informatics education will be essential to ensure that AI-enabled EHR systems enhance rather than replace clinician expertise, while promoting safe, equitable, and patient-centered care.

Objective: The aim of this study was to determine the prevalence, outcomes and risk factors for intraoperative desaturation in neonates undergoing non-cardiac surgery.

Methods: This retrospective study included neonates who underwent non-cardiac surgery between April 2020 and October 2022. Patients were classified as normal or reduced oxygenation based on a review of their medical records and whether they experienced intraoperative desaturation. The incidence of intraoperative desaturation, as well as postoperative outcomes and other characteristics, was recorded.

Results: A total of 1005 neonates were included, of whom 118 (11.74%) experienced intraoperative desaturation. Intraoperative desaturation was significantly associated with increased postoperative mortality (16.95% vs. 4.62%, p<0.001) and postoperative outcomes including pulmonary complications, acidosis, anemia, thrombocytopenia, unplanned surgery and intubation along with prolonged hospital and intensive care unit stay (all p<0.05). After conducting both univariate and multivariate analyses, 10 preoperative and surgical factors were identified to be significantly associated with intraoperative desaturation. These included six preoperative disease and treatment factors (pneumonia, pulmonary arterial hypertension, anemia, acidosis, pulmonary surfactant treatment and oxygen therapy), two surgical factors (duration of surgery and thoracic surgery) along with the American Society of Anesthesiologists physical status and low weight.

Conclusions: The incidence of intraoperative desaturation among neonatal patients is relatively high, and it may be associated with a multitude of serious adverse complications. Several perioperative factors are significantly associated with the occurrence of intraoperative desaturation.

Following Kasai portoenterostomy for biliary atresia (BA), long-term survival in children is associated with chronic liver cirrhosis leading to hepatopulmonary syndrome (HPS) and portopulmonary hypertension (PoPH). This further causes a diverse array of respiratory and circulatory symptoms. The incidence of these complications in children with BA is higher than that seen in other chronic liver diseases. With a faster progression, BA is life-threatening in some severe cases. Moreover, HPS and PoPH may coexist in the same child. Enhancing our understanding of HPS/PoPH, making an early diagnosis, rational selection of medication, and appropriate timing of liver transplantation underscore the need for multidisciplinary collaboration.