European Journal of Pediatric Surgery最新文献

Acquired diaphragmatic hernia (ADH) is an uncommon yet relevant complication after pediatric liver transplantation (pLTx). True incidence and risk factors remain poorly defined, largely due to limited screening, heterogeneous imaging practices, and the absence of validated predictive models. This study aimed to determine the incidence, presentation, and risk factors for ADH and to compare surgical repair techniques and short-term outcomes of thoracoscopic versus open approaches.We performed a retrospective review of all children undergoing pLTx at our institution (2014 and 2024). Demographic and transplant-related data were analyzed in patients with and without ADH. Operative approach, postoperative recovery, and 6-month follow-up were assessed. Findings were placed into context by comparison with published series.Among 246 pediatric transplant recipients, 8 children developed ADH (3.3%). Two patients had bilateral defects; each side was repaired electively in separate, staged procedures. Counting each side as a distinct repair event yielded 10 ADH repair procedures for analysis. Children who developed ADH were significantly younger at transplantation (mean 9.7 months vs. 64.0 months, p = 0.002) and had lower body weight (7.8 kg vs. 20.7 kg, p = 0.004). Prior abdominal surgery was common (five-eighths). Seven patients received a left lateral segment graft (LLS); graft-to-recipient weight ratio was 3.8% versus 3.2% in non-ADH patients (p = 0.107). Most hernias were right-sided, with presentations ranging from respiratory symptoms to incidental imaging findings. Surgical repair was performed via laparotomy in six cases and thoracoscopy in four, with one conversion to thoracotomy. Short-term outcomes were favorable in both groups, with only one recurrence (after laparotomy) and no mortality during follow-up.ADH after pLTx occurred in a minority of recipients and was associated with younger age, low body weight, prior abdominal surgery, and LLS grafts. However, the specific contribution of these variables remains unclear. Persistent research gaps include the lack of standardized screening protocols, uncertainty regarding cumulative long-term risk, and the absence of predictive models to identify high-risk patients. Addressing these issues requires multicenter collaboration and prospective surveillance strategies. Thoracoscopic repair was feasible in selected patients and may be considered when suitable.

Although international guidelines address the management of esophageal atresia (EA), the optimal approach to gastroesophageal reflux disease (GERD) in this population remains controversial. This systematic review and meta-analysis aims to clarify the current management of GERD in children after EA repair, reporting the prevalence of GERD, indications, and effectiveness of medical and surgical therapies.A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. A literature search was performed in MEDLINE, Cochrane Database, and Web of Science. Studies involving patients under 18 years old with GERD following EA repair were included. Data were extracted on incidence, diagnostic approach, medical and surgical management, and outcomes.Out of 1,612 articles, 49 (5,613 patients) were included. Reporting diagnostic modality, pH-impedance was most frequently used. The pooled GERD incidence was 36.7% overall and 58.1% in type A/B EA. Postoperative anti-reflux medication was reported in 88% of patients; 53.8% of children receiving medical therapy subsequently required further procedures (anti-reflux surgery [ARS], feeding stoma, or total esophago-gastric dissociation). ARS was more common in type A/B than in type C/D cohorts. Resolution of symptoms after ARS was reported in 74.5% of patients. Complications following ARS occurred in 28.3%, with a 14.9% rate of redo fundoplication, and the highest incidence occurred in infants < 6 months. The data on timing and type of ARS were heterogeneous.GERD affected over one-third of EA patients, with higher prevalence in types A and B. Although proton pump inhibitor therapy is common, a large proportion required ARS, with higher complication rates in smaller children. These findings highlight the need for standardized diagnostic criteria and multicenter prospective registries with long-term follow-up to clarify optimal timing and technique.

Small bowel volvulus is a clinical condition that causes intestinal ischemia-reperfusion (I/R) injury, leading to severe tissue damage and high mortality rates. Polydatin, a natural stilbenoid polyphenol, has demonstrated anti-inflammatory and antioxidant properties. This study aimed to evaluate the protective effects of polydatin on I/R injury using an experimental small bowel volvulus model.A total of 24 healthy female Wistar albino rats were divided into four groups: Sham (Group 1), Polydatin (Group 2), I/R (Group 3), and Treatment (Group 4). In Group 1, no I/R procedure was applied, and intraperitoneal saline was administered. Group 2 received 20 mg/kg intraperitoneal polydatin without I/R. In Group 3, a 5-cm segment of the small intestine was twisted 360 degrees clockwise, leading to 2 hours of ischemia and 2 hours of reperfusion. Group 4 received 20 mg/kg intraperitoneal polydatin before reperfusion. Blood and intestinal tissue samples were collected for biochemical and histopathological analysis.Serum total antioxidant status (TAS) levels were significantly higher in the treatment group compared with the I/R group (p = 0.004). Serum total oxidant status (TOS) levels were significantly elevated in the I/R group compared with all other groups (p < 0.001) but were significantly reduced in the treatment group (p < 0.001). Tissue oxidative stress index (OSI) values were significantly lower in the treatment group compared with the I/R group (p = 0.004). Although serum OSI levels and tissue TAS and TOS values showed a favorable trend, they were not statistically significant. Histopathological evaluations revealed a marked reduction in tissue damage in the treatment group compared with the I/R group.Polydatin exerts protective effects against I/R injury in an experimental small bowel volvulus model by reducing oxidative stress and histopathological damage. These findings highlight its therapeutic potential and warrant further clinical research.

Ex vivo fluorescence confocal microscopy (FCM) is an emerging technology that enables real-time, high-resolution digital imaging of freshly excised tissues without requiring standard histological preparation. This study aims to evaluate the diagnostic performance of FCM compared with conventional histology in a pediatric population with suspected oncological pathology.A total of 18 tissue samples from pediatric patients with suspected oncological lesions were analyzed using FCM. The results were compared with the definitive diagnoses obtained via conventional histology, serving as the gold standard. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated to assess the diagnostic accuracy. Cohen's kappa coefficient (Κ), 95% confidence interval (95% CI), and p-value were computed to evaluate the interobserver agreement and the concordance between FCM and histology.FCM correctly identified 10 positive cases (true positives) and 7 negative cases (true negatives), with 1 false positive and no false negatives. Interobserver agreement was perfect, with a Cohen's kappa coefficient of 1.00 (95% CI: 0.81-1.00, p < 0.001). Sensitivity was 100% (95% CI: 72.2-100%), specificity 87.5% (95% CI: 52.9-97.8%), PPV 90.9% (95% CI: 62.3-98.4%), and NPV 100% (95% CI: 64.6-100%). The Cohen's kappa coefficient was 0.89, indicating excellent agreement between FCM and histology (95% CI: 0.67-1.10, p < 0.001). FCM provided rapid diagnostic results, significantly reducing turnaround time compared with conventional methods.FCM demonstrates exceptional diagnostic accuracy, with excellent sensitivity and specificity in evaluating pediatric specimens. Its ability to deliver reliable intraoperative results highlights its potential as a valuable adjunct to conventional histopathology in pediatric surgery. Larger studies are warranted to confirm these findings and establish their role in clinical practice.

Metabolic and bariatric surgery is an established treatment for severe obesity. Laparoscopic adjustable gastric banding (LAGB) was once considered a promising option for adolescents. However, long-term data in this population are lacking. We aimed to evaluate the long-term effectiveness of LAGB in adolescents extending beyond 3 years postoperatively.Adolescents with severe obesity were randomly assigned to the intervention group (LAGB and multidisciplinary lifestyle intervention [MLI]) or the control group (MLI), with annual follow-ups for 3 years. We conducted a follow-up analysis of this cohort after 8.6 years (range: 5.0-12.5).A total of 59 patients were randomized (29 LAGB + MLI and 30 MLI only). Early differences in weight loss were observed during the first 2 years, but no significant difference persisted after 8.7 years (mean difference body mass index: 1.8 kg/m², 95% CI: -3.2, 6.8). The band removal rate was high (52%).After nearly 9 years, LAGB resulted in minimal weight loss and had a high removal rate in adolescents with severe obesity. Our study was limited by loss to follow-up, self-reported weights, and crossover. Nonetheless, these findings confirm the lack of efficacy that has led to the global decline in LAGB procedures and underscore the shift toward more effective surgical procedures.

Focal forms of congenital hyperinsulinism (FoCHI) are rare pediatric conditions managed using established metabolic and surgical protocols. To date, the use of a robotic approach for this surgery in children has not been described. We present our initial experience with robotic pancreatectomy, compared with the open approach, for the management of FoCHI.We conducted a retrospective, single-center study involving 25 children who underwent pancreatectomy for CHI between 2011 and 2024. Collected data included patient demographics, surgical details, complications, and post-operative outcomes. The Da Vinci Xi robotic system was used for all robotic procedures.Ten patients underwent robotic pancreatectomy, and 10 underwent open surgery; five children treated laparoscopically were excluded. There were no significant differences between the robotic and open groups in median weight at surgery (7.7 kg vs. 7.3 kg, p = 0.7), median age (7 months vs. 5.9 months, p = 0.48), median operative time (298 minutes vs. 285 minutes, p = 0.5), length of stay (14 days vs. 14.5 days, p = 0.26), or time to postoperative feeding resumption (4 days vs. 4.5 days, p = 0.68). Intraoperatively, 80% of lesions were visible on the pancreatic surface. Two cases of incomplete resection occurred in each group; after multidisciplinary review, both patients in the robotic group required a second procedure. No intraoperative bleeding or conversions were reported. The overall cure rate was 90% in the robotic group and 80% in the open surgery group.This preliminary study suggests that robotic pancreatectomy for congenital hyperinsulinism may be both safe and feasible. The robotic approach provides enhanced visualization of small vessels, enabling limited dissection and safe resection. Given the sample size, further studies are required to confirm these findings.

To report our institutional experience with a portal venous pressure (PVP)-guided surgical strategy for congenital portosystemic shunts (CPSs) and introduce a novel bedside ligation technique for staged shunt closure.We retrospectively reviewed 20 children who underwent surgical CPS closure between 2013 and 2023. The surgical approach was determined by intraoperative PVP during temporary shunt occlusion. One-stage ligation was performed when PVP remained < 25 mm Hg, whereas shunts with PVP ≥ 25 mm Hg were banded for staged closure using either bedside ligation or endovascular completion.Fourteen patients (70%) underwent one-stage closure (median PVP: 22.0 mm Hg, interquartile range [IQR]: 18.0-22.5), and six (30%) required two-stage closure (median PVP: 28.0 mm Hg, IQR: 25.8-29.5). Among the latter, five achieved complete shunt occlusion through the bedside technique, avoiding reoperation or readmission. The primary composite outcome-radiologic closure, fasting blood ammonia normalization, and absence of severe complications-was achieved in all 20 patients (100%) at 1-year follow-up. Significant intrahepatic portal vein (IPV) remodeling was observed, with median left and right IPV diameters increasing from 1.4 and 1.6 to 4.8 and 5.0 mm, respectively (both p < 0.0001). The overall complication rate was 15% (3/20), all Clavien-Dindo Grades I to II.In children with CPSs unsuitable for endovascular closure, a PVP-guided surgical strategy appears safe and effective. For those requiring two-stage closure due to elevated PVP, bedside ligation after Endoloop banding provides a feasible, less invasive alternative to reoperation. However, larger studies are needed to confirm its safety and efficacy.

This study aimed to evaluate the impact of surgical antimicrobial prophylaxis (SAP) on testicular torsion surgery (TTS) postoperative outcomes using data from the National Surgical Quality Improvement Program Pediatric (NSQIP-P). Across multiple studies, NSQIP-P has proven increased sensitivity in recording postoperative complications compared with similar databases.The 2021-2023 NSQIP-P participant user and SAP files were queried for all TTSs. Patients with unrecorded SAP administration data (n = 2,725) were excluded. Postoperative events were then compared between subjects who did or did not receive SAP. Primary outcomes included rates of surgical site infection (SSI), 30-day readmission, and 30-day reoperation. SPSS statistical software was used to perform comparative statistical analyses between groups.A total of 614 patients were included in the study and divided into Group 1 (+SAP, n = 322) and Group 2 (-SAP, n = 292). In the +SAP group, there was no observation of SSI, but one case resulted in 30-day readmission and reoperation. Another 30-day readmission and 30-day reoperation were noted, as well. In the -SAP, there was one observation of a deep incisional SSI who was readmitted. There were no 30-day reoperations in this group. There was no statistical significance in outcomes between the two groups.To date, this is the first study assessing the impact of SAP in torsion-reduction surgeries using the NSQIP-P database. There is a low frequency of postoperative complications with this procedure. Our study suggests limited utility of SAP with this surgery despite continued use.

Pectus carinatum (PC) is a common chest wall deformity, but there is currently a lack of predictive models and tools for forecasting deformity improvement with compressive orthotic bracing (COB) therapy. This study aimed to identify key factors influencing treatment outcomes, and to develop and integrate a predictive efficacy scoring tool with a clinical decision pathway to provide evidence-based treatment recommendations for pediatric PC patients.In this retrospective study, 182 pediatric PC patients evaluated and followed using three-dimensional scanning were enrolled. A multiple linear regression model was developed to create and validate a predictive efficacy scoring tool, which subsequently informed the establishment of a treatment decision pathway.The predictive model identified smaller initial external thoracic width (p < 0.001, β = - 0.644), older age at treatment initiation (p = 0.04, β = 0.271), good compliance (p = 0.008, β = 0.188), and favorable chest wall morphology (p = 0.033, β = 0.152) as independent predictors of deformity improvement. The model was optimized into a predictive efficacy scoring tool (Score = Expected %dEHI + 4.761). Comparison between the good response (score > 0) and poor response (score ≤ 0) groups confirmed the tool's excellent discriminative ability (8.348 vs. 15.320, p < 0.001).Treatment recommendations were derived by integrating the scoring tool with the decision pathway: children with score > 0 are strongly recommended to continue bracing; those with score ≤ 0 due to poor compliance should receive intensified supervision, while those with score ≤ 0 due to other factors should be counseled on possible surgery; children under 4 years require personalized recommendations integrating the score, symptoms, and parental preferences. However, as a single-center retrospective study without a control group and with subjective compliance assessment, future prospective multicenter studies are required to validate the model's generalizability.

Objective: To evaluate whether preservation of the azygos vein influences postoperative outcomes in infants undergoing repair of esophageal atresia with tracheoesophageal fistula (EA-TEF).

Materials and methods: A systematic review and meta-analysis were conducted using six major databases, identifying all relevant studies published up to January 2025. Seven studies met inclusion criteria, including five randomized controlled trials and two retrospective analyses. Outcomes assessed were anastomotic leaks, esophageal strictures, chest infections, and mortality.

Results: Across studies, azygos vein preservation was generally associated with fewer postoperative complications compared with ligation. Preservation of the Azygos vein appeared to reduce the risk of anastomotic leak, chest infection, and mortality, while also showing a trend toward fewer strictures. However, the strength of evidence was limited by study heterogeneity, small sample sizes, and variation in surgical techniques.

Conclusion: This systematic review and meta-analysis suggest that preserving the azygos vein may be beneficial in reducing major postoperative complications. Nevertheless, because most included studies were small and of mixed quality, these findings should be interpreted with caution. Larger, high-quality randomized trials are needed to confirm whether Azygos vein preservation directly improves clinical outcomes.