World Journal of Pediatric Surgery最新文献

Ambient artificial intelligence (AI) scribes offer promise for reducing documentation burden, yet their effects on surgical practice have not been well defined. We conducted a pilot study of an ambient AI scribe across 79 ambulatory providers (three surgeons) in a multihospital system from December 2024 to February 2025. Surgeon adoption of the AI scribe ranged from 58% to 90% of visits. We evaluated workload via pre- and post-intervention surveys (NASA-TLX mental demand and perceived rush), burnout rates, scheduling capacity, and Epic Signal metrics (note length, time per note) and compared billing data for high utilizers between August and October 2024 and the pilot period. Average "pajama time" did not change significantly (p=0.55). NASA-TLX mental demand decreased from 14 to 5 (p=0.08) and perceived rush from 15 to 5 (p=0.06). Burnout declined from 67% to 33%. Two surgeons reported the capacity to add three patients per clinic. The billing metric showed no significant changes. Undivided attention scores improved from 3.5 to 4.1 (p<0.0001). This preliminary data shows promise that ambient AI scribes in surgical clinics may reduce documentation burden and burnout, with potential gains in efficiency and throughput. Larger studies are warranted to further confirm these findings.

Background: Use of artificial intelligence (AI) in surgical practice is gaining attention globally, but the ethics of use in pediatric surgery within low-resource settings remains unexplored. This study assessed the experiences of Nigerian pediatric surgeons, their ethical concerns, perceived challenges, and training needs regarding integration of AI.

Methods: A cross-sectional questionnaire-based survey was conducted among consultant pediatric surgeons and senior residents in Nigeria using KoboToolbox. The survey explored demographics, AI use, ethical concerns, and regulatory preferences. Data were analyzed descriptively.

Results: Of 140 eligible participants, 88 responded with a response rate of 62.9%. Sixty-seven (76.1%) respondents were consultant pediatric surgeons. Most respondents (n=41, 46.6%) were aged between 40 and 49 years. The majority (n=71, 80.7%) were males . Only one-third (n=29, 33%) of the respondents reported having personally used AI in their pediatric surgical practice. Among those who had used AI, the most common area of application was research and literature review (n=27, 30.7%). The majority of participants expressed significant ethical concerns related to AI use in pediatric surgical care. Accountability in adverse outcomes (n=85, 96.6%), complexity of consent (n=84, 95.5%), and equity of access to AI (n=79, 89.8%) were among the ethical concerns. The majority (n=70, 79.5%) of participants reported that they were not confident in the adequacy of existing Nigerian laws to regulate AI use in healthcare. Over half (n=45, 51.1%) of participants chose the Medical and Dental Council of Nigeria as the body that should lead ethical regulation of AI in Nigeria.

Conclusions: The use of AI in pediatric surgery in Nigeria is uncommon and mostly academic. Key ethical concerns include accountability and consent requiring clear regulation and structured training programs.

Background: This study aimed to retrospectively compare postoperative recurrence rates between laparoscopic-assisted extraperitoneal closure and intracorporeal suturing for pediatric inguinal hernia (PIH) repair across multiple centers, and to investigate the clinical causes of recurrence to inform surgical practice.

Methods: This is a retrospective review of 5244 PIH repairs performed using single-port laparoscopic percutaneous extraperitoneal closure (SPLPEC) at the First Affiliated Hospital of Xiamen University and the Second Hospital of Hebei Medical University between January 2017 and December 2020. In addition, 6054 PIH repairs were performed using two-port laparoscopic intracorporeal suturing (TPLIS) at the Capital Center for Children's Health, Capital Medical University between January 2015 and December 2020. All patients were followed for 2 years with intraoperative findings at reoperation documented and causes of recurrence analyzed.

Results: There was recurrence in 30 SPLPEC cases (27 males, 3 females; mean interval to recurrence, 7.6 months). There was a recurrence in 35 TPLIS cases (31 males, 4 females; mean interval, 12.5 months). There was no statistically significant difference in recurrence rates (p=0.966). Laparoscopic re-exploration identified omitted or torn peritoneum (n=42), lipidosis in the abdominal wall (n=7), and loose knots (n=16) as the primary causes of recurrence. No further recurrences were seen in the SPLPEC group after reoperation. In the TPLIS group, 33 patients had favorable outcomes, 2 patients experienced a second recurrence.

Conclusions: The incidence of PIH in females may be higher than previously recognized. Both SPLPEC and TPLIS demonstrated low recurrence rates, particularly among females and the second operation proved to be an effective treatment option for recurrent cases. For SPLPEC in obese children, secure ligation of the hernia internal ring is essential to prevent recurrence. TPLIS requires extended follow-up to detect possible late recurrence.

Background: Gestational age at birth is shaped by complex maternal and paternal factors prior to conception, yet few studies have integrated multidimensional clinical indicators from both parents to estimate their quantitative effects.

Methods: Using a large retrospective cohort with routinely collected preconception health data from both mothers and fathers, we applied a double machine learning (DML) framework combining Lasso, Random Forest and XGBoost regressors to estimate associations between parental biomarkers and gestational age at birth. Model interpretability was enhanced through Shapley Additive Explanations (SHAP) analysis, stratified interaction testing and estimation of individualized treatment effects (ITE).

Results: Elevated maternal fasting glucose, alanine aminotransferase, platelet count and anti-hepatitis B core seropositivity were consistently associated with shortened gestational age at birth across all DML models. For instance, a 10 mmol/L increase in fasting glucose corresponded to 2.8-4.9 days shorter gestation. Paternal Treponema pallidum seropositivity and increased monocyte proportion, defined as the fraction of monocytes within total circulating white blood cells, also demonstrated significant associations, with the former linked to gestational shortening and the latter to modest extension. Stratified and interaction analyses revealed that paternal immune markers modified the associations of maternal metabolic indicators with gestational age at birth. SHAP-based interpretation confirmed model consistency and ITE analysis indicated marked heterogeneity, particularly for fasting glucose.

Conclusions: This study demonstrates the utility of interpretable DML methods for quantifying the effects of multidimensional preconception health indicators from both parents on gestational age at birth. Our findings support integrating maternal and paternal screening into preconception risk assessments to enable early, targeted prevention of preterm birth. Given the established links between preterm birth and neonatal surgical conditions, early risk identification via parental screening may help inform perinatal care strategies and optimize resource allocation in pediatric surgery.

Introduction: The necessity for procedural sedation during hydrostatic reduction for ileocolic intussusception in children is being debated. This study aimed to compare outcomes of procedures with and without sedation, as well as parental preferences.

Methods: This retrospective study (2019-2021) reviewed the medical records of children treated for ileocolic intussusception at two hospitals-one that did not provide sedation (non-sedation, NS) and one that did (with-sedation, WS) during hydrostatic reduction. The primary outcomes encompassed success rate, perforation, and recurrence. Parental satisfaction was assessed using a 5-point Likert scale questionnaire.

Results: Data from 65 children were included: 42 in the NS group and 23 in the WS group. The hydrostatic reduction success rates were 79% (NS) and 74% (WS) (p=0.670). One colon perforation occurred in each group (p=0.661). Recurrence rates were 14.3% (NS) and 17.4% (WS) (p=0.740). The questionnaire response rates were 48% (NS) and 57% (WS). Of the NS parents, 75% (15/20) were (very) satisfied with the procedure, compared with 85% (11/13) of WS parents (p=0.196). Ten (50%) NS parents would have preferred sedation, while 46% (6/13) of WS parents would have preferred to be present during the procedure.

Conclusions: There were no significant differences in success rates, complications, or parental satisfaction between procedures performed with or without sedation during hydrostatic reduction. Effective pain management and a comforting approach are crucial for stress reduction. Shared decision-making with parents regarding the pros and cons of sedation is recommended.

Background: Necrotizing enterocolitis (NEC) is a gastrointestinal emergency in premature neonates. NEC is mediated by toll-like receptor-4 (TLR-4) and associated with lung injury. Previously, we showed that prenatal heparin-binding epidermal growth factor (HB-EGF) administration decreases the incidence of intestinal injury in a rat model of NEC. We tested the hypothesis that prenatally administered HB-EGF would decrease TLR-4 activation and lung injury in a murine model.

Methods: Pregnant mice were given HB-EGF (800 μg/kg/dose) via intraperitoneal injection prior to cesarean section. Pups were exposed to a NEC model and sacrificed on signs of NEC. We collected tissue, performed histological grading of NEC, evaluated alveolar morphometry, and counted TLR-4-expressing cells by immunohistochemistry, unbiased stereology, and quantified TLR-4 protein via ELISA.

Results: Mean alveolar area was significantly different between HB-EGF and control groups compared with NEC only (HB-EGF>NEC; p<0.0001; control>NEC; p=0.0008). Alveolar wall area was significantly decreased in HB-EGF and control groups versus NEC group (p<0.0001). TLR-4-expressing cells were greater in the NEC group versus HB-EGF and control groups (p=0.002). TLR-4 protein was increased in pups exposed to the NEC protocol compared with control (p=0.005 for NEC only; p=0.0004 for HB-EGF treated). There was no difference in TLR-4 protein between HB-EGF and NEC groups.

Conclusions: Our results suggest that prenatal HB-EGF administration preserves lung morphometry and decreases TLR-4 in a murine model of NEC. Possibly, the administration of HB-EGF prenatally to pregnant mothers at risk of delivering a premature infant susceptible to NEC may prevent lung injury.

Objective: The aim of this study was to present clinical and radiological outcomes of surgical treatment for proximal femur unicameral bone cysts (UBCs) in children.

Methods: Pediatric patients recruited from our institution between 2015 and 2024 with proximal femur UBC were analyzed retrospectively. Patients were divided into two groups according to whether internal fixation was used. Demographics, cyst activity, cyst area, healing time of pathological fractures and cysts, clinical and radiological outcomes, time to activity and complications were analyzed.

Results: Thirty-seven pediatric patients were included in this study. There were 18 patients in the non-internal fixation group and 19 patients in the internal fixation. There was no significant difference between these two groups in terms of age, duration of follow-up, fracture at diagnosis, cyst activity or healing time of pathological fractures and cysts. Cyst area in the internal fixation group was 1609±1131 mm², which was significantly greater than that in the group without internal fixation (936±597 mm², p<0.05). There was no significant difference in clinical or radiological outcomes between the two groups. Patients who were treated with internal fixation were able to return to activity significantly sooner than those who were not (5.9 months vs. 7.7 months; p<0.05). There was no significant difference in complications between the two groups (p=1.000).

Conclusions: Surgical treatment of proximal femoral UBCs in children remains a challenge. The use of internal fixation is beneficial for accelerating the healing process and reducing the time to activity.

Background: Robot-assisted surgery is becoming increasingly used in pediatric oncology. The present study aimed to evaluate the feasibility and safety of robotic liver resection (RLR) for hepatic focal nodular hyperplasia (FNH) in children and compare surgical outcomes between RLR and open liver resection (OLR).

Methods: Pediatric patients with liver FNH undergoing lesion resection between January 2020 and June 2024 were included in the study. Patient demographics, operative details, postoperative outcomes, and follow-up were recorded and analyzed.

Results: A total of 20 patients were included in this study. Twelve patients underwent RLR and eight underwent OLR. In the RLR group, the median age was 93.1 months (range, 28-134 months) with a median weight of 32.4 kg (range, 9.7-80 kg). The median maximum tumor diameter at operation was 62.6 mm (range, 49-80 mm) and the median tumor volume was 94.3 mL (range, 35-254.1 mL). Operative time was 168.5 min (range, 116-245 min), intraoperative blood loss was 23.3 mL (range, 5-50 mL) and the length of postoperative hospital stay was 5.7 days (range, 4-11 days). There was a significant difference (p<0.05) between the RLR and OLR groups for: age (93.1 months vs. 137.6 months), maximum tumor diameter (62.6 mm vs. 98 mm), tumor volume (94.3 mL vs. 496.2 mL), operative time (168.5 min vs. 281.4 min), blood loss (23.3 mL vs. 288.7 mL), and length of postoperative hospital stay (5.7 days vs. 9.5 days). There was a borderline significant association between surgical approach (RLR/OLR) and fluctuation in the magnitude of Alanine aminotransferase (ALT) (odds ratio=0.004, 95% confidence interval: 0.000 to 1.096, p=0.05).

Conclusions: Our initial experience suggested that RLR for hepatic FNH in children was both feasible and safe. Tumors in the RLR group were significantly smaller than the OLR group: it proved possible to excise tumors larger than 250 mL in volume.