European Journal of Pediatric Surgery最新文献

Fenestrated laparoscopic-assisted internal ring-rrhaphy (FLAIR) is a refined percutaneous technique for pediatric inguinal hernia repair. Although its outcomes have been reported in boys, its application in girls, particularly in relation to round ligament management, remains underexplored. Whether to include or exclude the ligament during internal ring closure is still debated.This study evaluated the impact of round ligament management on surgical outcomes in girls undergoing FLAIR. A retrospective cohort of 69 hernias, operated on between July 2016 and December 2023, was reviewed. Patients were divided into two groups: those in whom the round ligament was included in the closure (Inclusion group) and those in whom it was deliberately spared (Exclusion group). Recurrence rates and postoperative complications were compared.All four recurrences (11%) occurred in the Inclusion group, while no recurrences were observed in the Exclusion group (p = 0.048). All recurrences occurred within 3 months postoperatively and were successfully reoperated using the exclusion technique, with no further recurrence during follow-up. No significant differences in other postoperative complications were identified between groups.FLAIR appears to be a safe and effective approach in girls, particularly when the round ligament is excluded from the closure. Exclusion was associated with zero recurrences and no increase in complications. These findings, observed over intermediate-term follow-up, suggest that sparing the round ligament may enhance repair integrity and potentially protect the ligament from entrapment, thereby preserving its anatomical function. Larger, multicenter studies with extended follow-up are needed to validate these results and guide pediatric hernia repair strategies.

We aimed to describe long-term outcome, treatment success, and complications of antegrade continence enema (ACE) procedures considering underlying etiologies and associated disorders.Overall, 180 patients undergoing ACE procedure at our institution during 1997-2019 were included in this retrospective study. Treatment success was defined as patient staying clean.The main underlying etiologies included spina bifida (n = 65, 36%), anorectal malformations (n = 58, 32%), Hirschsprung disease (n = 25, 14%), and functional constipation (n = 7, 4%). The most common complications were stomal leakage (n = 39, 22%), stenosis (n = 38, 21%), infection (n = 35, 19%), and granuloma/mucosal prolapse of the stoma (n = 34, 19%), and 29% (n = 52) of the patients reported functional problems. Overall, 48% of the patients (n = 87) experienced at least one ACE-related complication. At the latest follow-up, 61% of the patients were using ACE (n = 110), of whom 86% stayed clean (n = 95). Overall, ACE treatment was successful in 81% of patients (n = 144), defined as being clean with ACE in current use or after discontinuing ACE treatment as unnecessary. In total, 31% of the patients had stopped using ACE as unnecessary (n = 45). Spina bifida patients were least likely to discontinue ACE usage (n = 9, 14%), followed by anorectal malformation patients (n = 17, 29%), while 32% of Hirschsprung patients (n = 8) and 71% of constipation patients (n = 5) discontinued ACE as unnecessary.As previous studies have also shown, we demonstrated that ACE treatment can be successfully utilized in majority of children with impaired fecal control. Two-thirds of patients continued ACE treatment over 5 years of whom 86% patients were staying clean.

Flank bulge (FB) is a rare postoperative complication, most commonly following surgery with retroperitoneal access through flank incision. It is characterized by relaxation of anterolateral wall muscles with abnormal protrusion of the abdominal wall. The assumed pathomechanism is iatrogenic injury of the intercostal nerves T11/T12. During congenital diaphragmatic hernia (CDH) repair, dissection and sutures are necessary at this thoracic level. We aimed to assess the risk of FB in a consecutive series of patients after CDH repair.We retrospectively analyzed charts of all patients after CDH repair (2007-2024) with a follow-up of ≥3 months. FB was diagnosed during clinical follow-up examinations and defined as protrusion of abdominal wall with no sonographic evidence for hernia. Surgical variables and their association with FB were evaluated. For statistical analysis, Pearson's and Student's t-test were used. Multivariate logistic regression was performed to identify independent risk factors associated with FB development after CDH repair.Among 67 infants undergoing CDH repair with follow-up, 76% underwent open surgery and 48% required patch repair. Postoperative FB occurred in 11% of patients, exclusively following open repair with patch, and was significantly associated with rib sutures and higher birth weight. One-third of FB cases resolved spontaneously, while the remainder persisted, though without functional impairment.FB may be an underestimated complication after open CDH repair. Routine assessment of abdominal wall tone is recommended during follow-up after CDH repair. Larger studies are needed to clarify the clinical impact, patient-perceived level of disability, and long-term sequelae.

Artificial intelligence (AI) and machine learning (ML) models rapidly transform health care with applications ranging from diagnostic image interpretation, predictive modeling, personalized treatment planning, real-time intraoperative guidance, and outcome prediction. However, their implementation in general pediatric surgery remains limited due to the rarity and complexity of pediatric surgical conditions, small and heterogeneous datasets, and a lack of formal AI training and competencies among pediatric surgeons.This narrative review explores the current landscape of AI and ML applications in general pediatric surgery, focusing on five key conditions: appendicitis, necrotizing enterocolitis, Hirschsprung's disease, congenital diaphragmatic hernia, and biliary atresia. For each, we summarize recent developments, including the use of AI in image analysis, diagnostic support, prediction of disease severity and outcome, postoperative monitoring, and histopathological evaluation. We also highlight novel tools such as explainable AI models, natural language processing, and wearable technologies.Recent findings demonstrate promising diagnostic and prognostic capabilities across multiple conditions. However, most AI/ML models still require external validation and standardization. The review underscores the importance of collaborative, multicenter research based on joint datasets as well as targeted AI education for pediatric surgeons to fully explore the benefits of these technologies in clinical practice.AI and ML offer significant potential to improve pediatric surgical care, but broader implementation will require multicenter collaboration, a robust dataset, and targeted AI education for pediatric surgeons.

The European Pediatric Surgeons' Association (EUPSA) Network Office regularly endorses surveys that address controversial topics in pediatric surgery. However, the scientific impact of these within the medical literature remains unclear. To address this gap, we conducted a bibliometric analysis of all published EUPSA-endorsed surveys.Surveys endorsed by the EUPSA Network Office were reviewed for topic, journal, participation, bibliometric indicators (total number of citations and citations per article and year), and citing countries. Simple linear regression was used to determine citation time trends.Between 2013 and 2024, at least one survey was published each year (R ² = 0.26; p = 0.1). Most commonly, surveys were published in the European Journal of Pediatric Surgery (n = 15), and the most common survey topics included general pediatric (n = 7), thoracic (n = 4), and colorectal (n = 3) surgery. The average number of participants per survey was 167 ± 53, with 75% (range: 54-89%) European responses. The most cited surveys addressed esophageal atresia, necrotizing enterocolitis, and Hirschsprung's Disease. The median number of citations per survey was 11 (range: 1-160), with a median of 6 citations per year (range: 0-26). The total number of citations from all EUPSA Network Office-endorsed surveys increased over time (R ² = 0.75; p = 0.0006), and the average citation per article and year was consistent (R ² = 0.09; p = 0.34). Citations originated from 63 countries, mostly from the United States (n = 75), Germany (n = 64), and China (n = 44).Despite inherent limitations of survey-based research, the growing bibliometric impact of EUPSA Network Office-endorsed surveys highlights their scientific merit as an important tool for exploring current pediatric surgical practices, which will inform future multi-institutional studies.

There is a lack of background regarding knowledge about the involvement of pediatric surgeons (PSs) in scientific activities. We aimed to investigate scientific activity among PSs worldwide.An anonymous online questionnaire in English collected demographic data, time spent on research, participation in scientific conferences, publications, and funding for conference attendance. Co-authors distributed it through national and international pediatric surgery societies and groups to reach their members.A total of 526 PSs responded (57% female). About 55% of those surveyed reside in Europe. Most worked in university hospitals (61%), 9% at a university faculty, and 0.8% in a research facility. Only 23% were engaged in research, with similar rates for females (21%) and males (26%) (NS).Additional time out of working hours was required for research, particularly among female PSs. Full compensation for research was reported by 10% of females and 29% of males (p < 0.02). Around 73% had attended at least one local, regional, national, or international scientific conference (75% of females vs. 70% of males, NS), while 84% had no funding for at least one event (87% of females vs. 80% of males, NS). Scientific paper was presented by 69% at some conference. At least one scientific paper was published by 20% (17% of females vs. 23% of males, NS).Research involvement among PSs is limited, with unpaid work and funding gaps, particularly among women. Potential solutions include improving research training, structured mentorship (especially for women), institutional support for protected research time, and equitable access to funding opportunities.

In this report we present a new anatomical stratification for vaginal obstruction (hydrocolpos) based on MRI findings while referring the level of obstruction to a fixed bony landmark (the pubic symphysis). This new approach can overcome the limitations of current classifications, which are prone to approximation errors during measurement and fail to account for variations in body mass across different age groups.Data of cases diagnosed with vaginal obstruction were retrospectively analyzed. Cases of cloaca with vaginal obstruction were excluded. MRI confirmed the diagnosis and enabled classification of the level of vaginal obstruction relative to the pubic symphysis in the mid-sagittal plane as low, intermediate, or high-opposite the lower, mid, or upper end of the pubic symphysis, respectively.A total of 13 girls presented with vaginal obstruction during the period 2010 through 2024. Their age ranged between 1 month and 14 years (mean: 54 months; median: 18 months). Three cases presented in the neonatal period with antenatal diagnosis of hydrocolpos, while six cases were referred later during infancy/childhood from other centers. Another group of adolescent girls (four cases) presented with a clinical picture of cryptomenorrhea. The cause of vaginal obstruction was imperforate hymen in one, vaginal atresia in six, persistent urogenital sinus (five cases), and one case of obstructed hemi-vagina. In this series, six cases (46%) had features related to genetic syndromes (Bardet Biedl/ McKusick-Kaufman spectrum). Chronic parenchymatous renal disease was present in three cases among other syndromic features of Bardet Biedl syndrome, in addition to another case with obstructed left hemi-vagina that had absent left kidney (Herlyn-Werner-Wunderlich syndrome). Surgical techniques included simple excision of distal obstructing membrane (four cases), abdominal assisted vaginoplasty (two cases), vaginal pull-through (four cases), simple introitoplasty (one case), urogenital sinus mobilization (one case), and division of longitudinal vaginal septum for a case of obstructed hemi-vagina. Vaginal stenosis or retraction occurred in three cases with intermediate to high-level obstruction-two following abdominal assisted vaginoplasty and one after vaginal pull-through.MRI-based stratification of vaginal obstruction using the pubic symphysis as a reference provides a practical and reproducible approach for surgical planning.This is a case series (level IV evidence).

Congenital pulmonary airway malformation (CPAM) is a rare fetal lung anomaly characterized by cystic lesions that can impede lung development. While smaller lesions may remain asymptomatic and are managed postnatally, larger lesions can cause severe complications such as mediastinal shift and hydrops fetalis. Fetal surgery may be indicated in these cases. This study analyzed whether fetal surgical intervention affects outcomes of subsequent postnatal surgery in CPAM patients.A retrospective single-center cohort study was conducted on pediatric patients treated for CPAM between January 2010 and August 2024. Patients were divided into two groups: those with prenatal surgical intervention and those treated with postnatal surgery only. Propensity score matching based on gestational age, gender, birth weight, and lesion volume ratio yielded 23 matched patients: 14 in the fetal surgery group and 9 in the control group. Baseline characteristics, type of fetal intervention, intraoperative, and long-term postoperative outcomes were assessed. Multivariable regression was performed to account for confounding variables.Among 179 identified patients, 23 were included after propensity score matching: 14 in the fetal surgery group and 9 in the standard postnatal surgery group. Baseline characteristics were balanced, except for significantly higher disease severity in the fetal surgery group (hydrops 69% vs. 0%, p < 0.001; mediastinal shift 93% vs. 33%, p = 0.001). Alcohol ablation was the most common fetal intervention; however, various other prenatal procedures were also performed, with most patients undergoing multiple interventions. Tendencies but no significant differences were found in primary outcomes, including mortality (15% vs. 0%, p = 0.26) and recurrence (29% vs. 0%, p = 0.18). Secondary outcomes such as ventilation duration and intensive care stay were longer in the fetal surgery group, but not statistically significant.Despite higher baseline disease severity, patients who underwent fetal intervention showed postnatal outcomes comparable to those with less severe CPAM. Fetal surgery did not appear to adversely affect surgical recovery. These findings should be interpreted with caution but may support the selective use of prenatal intervention in high-risk cases and underscore the need for further research to refine both prenatal strategies and postnatal care.

This study aimed to assess if the position of the duodenal-jejunal junction in the anteroposterior view can reliably diagnose malrotation and if atypical position of the duodenal-jejunal junction (medial to the left pedicle to midline) is associated with a low risk of narrow mesenteric root.Children diagnosed with intestinal rotational abnormalities (2007-2023) through upper gastrointestinal fluoroscopy (UGI) studies who underwent surgery were reviewed independently by two pediatric radiologists. Key observations included the duodenal-jejunal junction location in the anteroposterior view, duodenal position in the lateral view, jejunal loop position, and colon anatomy.Radiologists independently reviewed the UGI studies and disagreements between radiologists were resolved by consensus readings. Chi-square tests were used to compare the anatomical variables and the presence of surgically confirmed narrow mesenteric roots.Of the examined 79 children (mean age, 2 years), 60 (75.9%) underwent Ladd's procedure after confirming a narrow mesenteric root.According to the consensus, 77.1% of children with atypical duodenal-jejunal junction in the anteroposterior view had narrow mesenteric roots, and one had midgut volvulus. The likelihood of missing a surgically confirmed narrow mesenteric root was significantly lower (p = 0.0167) when considering the position of the duodenum in the lateral view, along with the jejunal loops and colonic position (0/3), compared with relying solely on duodenal-jejunal junction position in the anteroposterior view (29/37).The anteroposterior view alone is insufficient for diagnosing malrotation. Reviewing the lateral view of the duodenum, and when necessary, the colonic anatomy, reduces the risk of missing cases with surgically confirmed narrow mesenteric roots.