European Journal of Pediatric Surgery最新文献

The European Paediatric Surgeons' Association (EUPSA) and the European Reference Network for Rare Inherited and Congenital Anomalies (ERNICA) conducted a survey to assess the current surgical management and care practices for esophageal atresia (EA) in order to assess changes over the past decade.An online survey consisting of 56 questions was administered to EUPSA members and ERNICA representatives between March and September 2025. The questionnaire covered seven domains: center structure, preoperative assessment, surgical management of esophageal atresia and tracheoesophageal fistula (EA-TEF) patients and long-gap EA, postoperative care, long-term follow-up, and the management of complications. Results were compared to practices reported in a previous EUPSA Network Office survey in 2013.There were a total of 202 respondents from 41 countries with 60% from European Union countries. Compared with previous surveys, the routine use of preoperative bronchoscopy and the use of trans-anastomotic tubes were found to be significantly more common (both p < 0.001). A marked increase in preference for thoracoscopic techniques for EA-TEF was observed (p < 0.001). The routine use of chest drains, elective paralysis, and contrast studies prior to feeding initiation also rose significantly over the decade (p ≤ 0.004). Yet for many areas of care, there remains variation between surgeons, and structured long-term follow-up arrangements are not universal.The findings demonstrate increased standardization and suggest increased adherence to recommendations in the management of EA-TEF. However, significant variation persists in long-term follow-up, transition-to-adult-care programs, and structured quality-of-life assessment, highlighting areas for future harmonization across European centers.

Artificial intelligence (AI) is increasingly recognized as a transformative force in healthcare. In the field of rare diseases, AI can enhance diagnostic accuracy and facilitate knowledge-sharing across borders. To effectively contribute to the development and use of AI-based medical support systems, clinicians must provide specialized AI competencies. This survey assesses the AI readiness, educational needs, and perceptions of members within the European Reference Network for Rare Inherited and Congenital Anomalies (ERNICA).A structured online survey consisting of 22 questions was distributed to 389 ERNICA members, collecting data on demographics, AI awareness, current use, educational needs, concerns, and future expectations.A total of 89 members responded (23%), representing a multidisciplinary group with varying experience. Most respondents (94%) reported no formal AI training yet, and rated their AI knowledge as basic (66%) or intermediate (26%). About 48% of the participants stated using AI applications already. Key educational needs included online courses and webinars. Major concerns focused on the reliability and accuracy of AI tools (80%) and ethical implications (71%). At the same time, 55% expect ERNICA to take a leading role in AI education in the diagnosis and management of rare gastrointestinal diseases.This survey among ERNICA members revealed a definite gap of AI understanding and training. Addressing these issues requires tailored educational initiatives focused on practical AI applications, ethical considerations, and interpretability. By adopting a proactive role in AI capacity-building, ERNICA could contribute to responsible and effective integration of AI into rare disease care.

Contrast enema (CE) is widely used in the evaluation of suspected Hirschsprung disease (HD). Deep learning is a promising tool to standardize image assessment and support clinical decision-making. This study assesses the diagnostic performance of a deep neural network (DNN), with and without clinical data, and compares its interpretation with that of pediatric surgeons and radiologists.In this retrospective study, 1,471 CE images from patients <15 years were analyzed, with 218 images used for testing. A DNN, pediatric radiologists, and surgeons independently reviewed the testing set, with and without clinical data. Diagnostic performance was assessed using ROC and PR curves, and interobserver agreement was evaluated using Fleiss' kappa. Rectal biopsy served as the reference standard.The DNN achieved high diagnostic accuracy (area under the receiver operating characteristic curve [AUC-ROC] = 0.87) in CE interpretation, with improved performance when combining anteroposterior and lateral images (AUC-ROC = 0.92). Clinical data integration further enhanced model sensitivity and negative predictive value. The super-surgeon (majority voting of colorectal surgeons) outperformed most individual clinicians (sensitivity 81.8%, specificity 79.1%), while the super-radiologist (majority voting of radiologists) showed moderate accuracy. Interobserver analysis revealed strong agreement between the model and surgeons (Cohen's kappa = 0.73), and overall consistency among experts and the model (Fleiss' kappa = 0.62).Artificial intelligence-assisted CE interpretation achieved higher specificity and comparable sensitivity to that of the clinicians. Its consistent performance and substantial agreement with experts support its potential role in improving CE assessment in HD.

Cotside laparotomy is often performed in critically ill neonates, but its indications over in-theatre laparotomy remain unclear. This is the first systematic review of published evidence, aiming to clarify the feasibility, safety, and indications for neonatal intensive care (NICU)-based laparotomy.A systematic review was conducted following PRISMA guidelines. Quantitative data on patient demographics and outcomes were extracted, and where possible, aggregated comparative analyses were performed. Qualitative thematic analysis was used to explore reported institutional experiences of cotside laparotomy.Eighteen studies were included, reporting data from 20 surgical sites across 10 countries, published from 1994 to 2024. Eight studies reported a comparator group of theatre-based laparotomies. In total, data on 418 cotside and 453 theatre laparotomies were included. Cotside cohorts had lower birthweight (approximately 1,305 g vs. 2,941 g, p = 0.016) and gestational age (approximately 29.5 vs. 34.3 weeks, p = 0.047). Postoperative adverse event rates were similar between neonates in each group (8.1%, 33/407 vs. 6.8%, 30/442; χ ² = 0.23, p = 0.63), as was in-hospital mortality (24.1%, 98/407 vs. 25.3%, 112/442; χ ² = 0.15, p = 0.70). Thematic analysis identified transfer-related events as a significant concern in babies operated in theatre, particularly endotracheal tube dislodgement and hypothermia, while cotside operating space constraints and disturbance to NICU activities were frequently cited issues. Decisions on surgical location were multifactorial and multidisciplinary, influenced by cardiorespiratory status and institutional factors. Formal institutional guidelines for cotside surgery were reported in only 33% (6/18) of studies.Emergency cotside laparotomy is safe and feasible. Despite consisting of a higher risk population, mortality and morbidity are comparable to theatre-based surgery. Avoiding the risks of transfer may confer additional benefit. Large-scale, prospective studies are needed to clarify the indications for cotside operating.

The aim of this study is to explore the protective effects and mechanisms of Eupatilin, a peroxisome proliferator-activated receptor α (PPARα) agonist, on cholestatic liver disease induced by common bile duct ligation (BDL) in mice.We selected Balb/c mice (both male and female) aged 6 to 8 weeks for the common BDL procedure (ethical approval number: MUST-FDCT-20241114001). The groups include the BDL group and the BDL+ Eupatilin group, with three mice in each group. Once the mice developed jaundice postsurgery (5 days), they were treated with Eupatilin via gavage at a dosage of 20 mg/kg daily for a period of 8 days. On day 13, ocular blood was collected, and liver tissues were extracted for histopathological examination with H&E staining, Sirius Red staining, and subsequent RNA sequencing. Statistical differences among the parameters were evaluated using a t-test.Eupatilin reduces the liver weight/body weight ratio by 41% and ameliorates liver necrosis and fibrosis in Balb/c mice. It could decrease alanine transaminase ( p = 0.0498), aspartate aminotransferase (p = 0.0077), while maintaining ALB (Albumin) and γ-GT (gamma-glutamyl transferase) within normal ranges. RNA sequencing analysis revealed that antioxidant genes (acetaldehyde dehydrogenase 2 [Aldh2] and superoxide dismutase 1 [Sod1]) might be the targets of Eupatilin action.We found that Eupatilin can upregulate antioxidant genes (Aldh2; p = 0.0107) and Sod1 (p = 0.0208) of Balb/c mice, thereby ameliorating BDL damage in mice with cholestatic liver disease.

Thoracoscopic esophageal atresia (EA) repair is a demanding procedure. It provides long-term benefits for patients including better cosmesis and less musculoskeletal sequelae compared with open surgery. Besides technical challenges, there is concern that thoracoscopy increases treatment costs. However, surgical treatment of EA in Germany is not centralized with more than 90 pediatric surgical units offering treatment for 200 expected EA patients yearly. Our aim was to evaluate the rate of thoracoscopic EA repair regarding characteristics of treating hospitals, surgical approach and treatment costs in Germany.Insurance claims data (January 2020 to June 2024) from six health insurance companies representing about one-third (28.5 million) of the German population were analyzed. The database was queried for specific ICD-10-GM (International Statistical Classification of Diseases and Related Health Problems, 10th revision, German Modification) and OPS (Operationen- und Prozedurenschlüssel) coding. Characteristics of treating hospitals, length of hospital stay and medical treatment costs were assessed.A total of 149 reconstructive procedures for EA were analyzed. Eleven esophageal anastomoses were performed thoracoscopically (7%). All thoracoscopic procedures were performed in a specialized center. Mean length of hospital stay for open and thoracoscopic surgery was 76 versus 79 days, respectively (p > 0.05). Mean treatment costs were 142,741 € versus 150,238 €, respectively (p > 0.05).Thoracoscopic EA repair remains the exception in Germany. Thoracoscopy is exclusively performed in specialized hospitals. Length of hospital stay and treatment costs are comparable to open surgery, assumingly due to only uncomplicated patients without comorbidities being considered for thoracoscopy. We recommend surgical treatment in specialized centers to enable surgical advantages to all patients with EA.

Recent studies show that at least three-quarters of surgeons who perform minimally invasive surgery suffer from musculoskeletal pain and discomfort. This problem may compromise surgical performance, patient outcomes, and career longevity. Because of small patient dimensions, pediatric surgery is associated with a different set of ergonomic challenges than adult surgery.A 59-item questionnaire was sent to all practicing pediatric surgeons in Germany. It contained a general assessment of demographics, practice setting, operative volume, types of operations performed, and compensatory interventions, followed by the validated Nordic Questionnaires for the analysis of musculoskeletal symptoms (NMQ). Responses were collected and statistically evaluated to identify risk factors for musculoskeletal complications.A total of 152 pediatric surgeons participated in the survey. Among the participants, 21% were trainees, 58% attendings, and 21% chiefs of service. The median time in practice was 18 years (range: 0 to 38 years). Musculoskeletal pain was reported by 75%, and was most prevalent in the neck/cervical (80%), shoulder (56%), and lower back/lumbar region (71%). Footrests or steps were used by 88%, intraoperative breaks were employed by 49%, and 96% of respondents sometimes operated in a sitting position. The only significant factor for musculoskeletal pain was number of years in practice.Musculoskeletal pain among pediatric surgeons is common and increases with years in practice. Although many pediatric surgeons incorporate ergonomic measures in their daily activities, these are far from being implemented universally. More awareness and research on the prevention of long-term musculoskeletal sequelae in pediatric surgery is necessary.

Although it is known that virtual reality (VR) reduces presurgical anxiety, it has neither been stratified by age to determine its effect, nor has been applied before the day of surgery. This study has a novel age-stratified design offering VR months before surgery to address these unstudied issues.This was a unicentered, blinded clinical trial with parallel groups stratified by age (5-8 and 9-12 years), including major outpatient surgery patients. VR video showing the course of surgery was offered months before surgery. This study had ethical committee approval. The main variable was the modified Yale Preoperative Anxiety Scale (mYPAS) before entering the operating room. The Child Behavior Checklist (CBCL) measured basal anxiety and the Posthospitalization Behavior Questionnaire (PHBQ) measured behavior after 1 month. For comparison, Student's t-test or Kruskal-Wallis test was used.Of 72 patients, 6 met exclusion criteria and 5 withdrew consent. Of the remaining 61, 56 completed mYPAS. The mYPAS decrease was significant for children aged 5 to 8 years (28.33 VIDEO vs. 35.83 non-VIDEO; p = 0.042) (rank coefficient 0.45 [0.05-0.72]). In the children aged 9 to 12 years (32.91 vs. 33.33; p = 0.864), a tiny correlation (r = 0.04 [0.38-0.45]) was found. A total of 96.67% of CBCLs (n = 58) scored normal. The 57 completed PHBQs had very low scores, both in non-VIDEO (0.00 [0.00-4.50]) and in VIDEO groups (0.00 [0.00-4.50]). No differences were found; neither globally (p > 0.05), nor depending on age (5-8 years, p = 0.508/9-12 years, p = 0.661).VR may reduce preoperative anxiety in younger children (5 to 8 years), though its effect in the entire group was borderline. Larger multicenter studies are needed to confirm age and timing benefits.