European Journal of Pediatric Surgery最新文献

Research indicates that the sexual support needs of patients with anorectal malformations (ARM) and Hirschsprung disease (HD) are often not addressed by patients, parents, and healthcare professionals (HPs) in their interactions. An international support website was developed to empower stakeholders, by addressing identified barriers. This study aimed to explore the empowerment potential of this disease-specific tool.Two online surveys were disseminated between May 1 and October 1, 2023; one for HPs and another for patients/parents. The surveys sought to assess and understand the website's expected empowerment effect. Empowerment was conceptualized using patient/professional empowerment models. Data were descriptively analyzed.A total of 12 patients (ARM, n = 11; HD, n = 1), 17 parents (ARM, n = 9; HD, n = 8), and 20 HPs responded to the survey. HPs largely expected the website to have a positive empowerment effect, by providing a sense of meaning, information, support, and opportunities to learn and grow. Less of an effect was expected for "freeing up resources." For patients and parents, an empowerment effect was also expected, by generating the knowledge, skills, attitudes, and self-awareness necessary to influence their own behavior and by providing a sense of meaning and coherence. Respondents experienced the website positively, yet one patient and one parent considered the website "fully complete." Inclusivity, cultural sensitivity, and accessibility were highlighted as focus points.To increase the website's empowerment potential, attention should be paid to inclusivity, cultural sensitivity, and accessibility, as well as its implementation within the (institutional) contexts where patients, parents, and HPs interact.

Inguinal hernias are common among preterm neonates in the neonatal intensive care unit (NICU), affecting up to 30% of all preterms. The timing of surgical repair remains controversial due to concerns about respiratory immaturity and the risk of hernia incarceration with delayed intervention. Previous meta-analyses were limited by methodological weaknesses, including heterogeneous populations and lack of randomized data. We aimed to provide an updated meta-analysis comparing outcomes associated with early versus late hernia repair in premature neonates based on more recent and rigorous evidence.A systematic review was conducted using PubMed, EMBASE, and Cochrane databases to identify studies comparing inguinal hernia repair (IHR) outcomes in preterm neonates during their initial NICU hospitalization (early repair) or after discharge (late repair). The review followed PRISMA guidelines, and statistical significance was defined as p < 0.05.Of 1,860 studies screened, 8 met inclusion criteria (one randomized controlled trial and seven retrospective cohort studies), encompassing 1,624 patients. Among them, 881 neonates (54.2%) underwent early herniorrhaphy. Mean gestational age ranged from 26 to 29 weeks in the early repair group and from 26 to 33 weeks in the late repair group. There was no significant difference in the odds of incarceration between groups (odds ratios [OR]: 1.16; 95% confidence interval [CI]: 0.76-1.79; p = 0.49; I ² = 16%). Early repair was associated with a significantly higher risk of respiratory complications (OR: 3.73; 95% CI: 2.02-6.9; p < 0.0001; I ² = 0%) and hernia recurrence (OR: 3.59; 95% CI: 1.22-10.5; p = 0.02; I ² = 0%). No significant differences were observed in wound infections, testicular complications, readmissions, mortality, procedure duration, or reoperation rates.Early IHR during initial NICU hospitalization in preterm neonates significantly increases the risk of respiratory complications and hernia recurrence without reducing the risk of incarceration or other major surgical complications. These findings suggest that delaying herniorrhaphy until after NICU discharge, when clinically feasible, may optimize outcomes and minimize perioperative risks for this vulnerable population.

Conducting multicenter randomized controlled trials (RCTs) in pediatric surgery for rare congenital anomalies presents unique challenges, including low patient recruitment, complex regulatory landscapes, and variability in care standards. This paper reflects on the experiences and lessons learned from the MUC-FIRE and STEPS-EA trials, supported by the European Reference Network for Rare Inherited and Congenital Anomalies (ERNICA), to provide guidance for future studies.A retrospective review was conducted on the design and execution of these trials, focusing on team composition, endpoint selection, patient recruitment strategies, regulatory compliance, and adaptive methodologies. Insights were derived from study protocols, monitoring reports, and the authors' experiences.Key factors contributing to trial success included multidisciplinary collaboration, leveraging existing research networks, and defining clear, measurable endpoints. Challenges such as recruitment delays, regulatory hurdles, and variations in care were mitigated through flexible protocols, proactive amendments, and stakeholder engagement. The COVID-19 pandemic amplified these difficulties, necessitating innovative strategies and extended timelines.The MUC-FIRE and STEPS-EA trials underscore the critical importance of international collaboration, adaptive strategies, and patient-centered approaches in overcoming the complexities of multicenter RCTs. Lessons from these experiences can inform the design and implementation of future trials, ultimately enhancing evidence generation and improving outcomes for children with rare congenital anomalies.

Rectoperineal fistula (RPF) and rectovestibular fistula (RVF) are the most common forms of low anorectal malformations (ARMs) in girls, and lead to difficult stooling, thus demanding early surgical correction. This study's aim was to assess early outcomes associated with one-step ventral and dorsal proctoplasty in RPF/RVF.All female infants who consecutively underwent one-step proctoplasty for RPF/RVF at our institution (2012-2022) were retrospectively included. Reviewed data included: age at procedure, congenital anomalies, fistula location, preoperative symptoms, intraoperative findings, operative time, postoperative complications, and bowel functional outcome. Success of the technique, defined as spontaneous bowel movement at last follow-up without anal dilation, was assessed. Secondary outcomes included resolution of preoperative symptoms, and Krickenbeck score and fecal continence in girls older than 3 years at last follow-up. No preoperative bowel preparation was necessary.None of the 77 included girls (median age at surgery: 3.2 months (2.3-7.3)) had prior colostomy. In every case, intraoperative findings included: ventral defect of the external anal sphincter, and abnormal attachment of the bulbospongiosus muscles to the fistula and posterior ledge, thus justifying both ventral and dorsal reconstructions. The median operative time was 34 min (27-38), and the median hospital stay was 2 days (2-3). Limited ventral skin dehiscence was the most common postoperative complication (31%), with limited effect on clinical outcome (one secondary anal stricture). No child required secondary colostomy or revision anoplasty. One child underwent secondary pull-through due to persistent megarectum. Preoperative symptoms resolved in 98% of cases. After a median follow-up of 27.6 months (9.8-48.3), all girls had spontaneous bowel movement and 21% had grade-2 constipation. The technique was successful in 97% of cases (two anal strictures treated with dilations).RPF/RVF in female share abnormal anatomical characteristics. One-step ventral and dorsal proctoplasty allows precise anatomical correction of low ARM in girls.

The use of indocyanine green (ICG) fluorescence in neonatal procedures is limited to specific pathologies, with variability in its application, highlighting the need to expand its indications and standardize administration protocols. We present our experience and review of the literature.Prospective assessment (2019-2023) of ICG-navigated neonatal surgeries. Administration routes included intravenous, endoluminal, and intracatheter. ICG dosages were variable according to the indication. The results were prospectively registered, focusing on its ability to achieve the desired goal. A systematic literature review identifying neonatal cases where ICG fluorescence was used for surgical assistance was conducted according to the PRISMA guidelines.ICG was used in 23 procedures. The average weight was 3.5 kg (SD = 1.4). Surgical procedures were: esophageal atresia repair (eight), intestinal anastomosis (five), Kasai portoenterostomy (five), H-type tracheoesophageal fistula closure (one), diaphragmatic plication (one), omphalocele repair (one) and resection of choledochal cyst (one), lymphatic malformation (one), and pyloric duplication (one). 52.2% were minimally invasive. ICG was useful in 21/23 (91.3%) procedures and was unsuccessful in two cases due to technical difficulties. There were no complications following the ICG injection. Eight studies reporting on 23 neonatal patients were selected for the review. The primary applications of ICG included angiography, cholangiography, lymphography, and visualization of the digestive tract.To date, this is the largest reported series of ICG-navigated neonatal surgeries. ICG proved to be safe and feasible in this population, allowing the identification of anatomical structures, facilitating decision-making, and minimizing the risk of complications. It is versatile for various procedures and approaches.

Aortopexy is the most common surgical intervention for pediatric tracheomalacia (TM). The thoracoscopic approach, despite being reported by a few authors, remains controversial due to the different reported techniques and outcomes.We report a retrospective review of our preliminary experience with thoracoscopic aortopexy from 2023 to date. Patients' demographic data and symptoms were collected: age and weight at surgery, comorbidities, presence of brief resolved unexplained event (BRUE), dyspnea, chest infections, and barking cough. The study describes our surgical technique and its evolution. We analyzed the clinical outcome and endoscopic improvement, success and complication rate, operative time, and length of stay. We then compared our findings with the results of open and thoracoscopic aortopexy reported in the current literature.A total of 12 thoracoscopic aortopexies were performed on 10 patients (including two redo). The mean age and weight at operation were 3.2 years (range: 4 months-6 years) and 13.6 kg (range: 3.5-23), respectively. Two patients presented with BRUE, one with dyspnea, in the other cases the indications were recurrent pneumonia (more than six per year or three in 6 months). All patients underwent preoperative flexible bronchoscopy for the diagnosis of TM. The average estimated tracheal collapse was 86% (range: 70-95%). One intraoperative bleeding caused a conversion to open surgery, but no other complications occurred. All patients were extubated on the same day. Two cases required a redo due to suture tearing, and one of them required an additional posterior tracheopexy for persistent symptoms. The remaining patients had significant improvement on follow-up: success rate is 75%. Both patients requiring redo underwent aortopexy without pledgeted sutures or innominate artery (IA) suspension: these steps are associated with a success rate of 88.9% (p = 0.0182). Our refined technique now includes total thymectomy, pericardiotomy, pledgeted horizontal mattress sutures on the aorta, and the IA after full mobilization of the innominate vein.Thoracoscopic aortopexy appears to be a feasible and effective option for pediatric TM, particularly when replicating open surgical principles. Further research is needed to optimize the technique and improve the clinical results.

Cryoanalgesia (CA) has shown promise in managing postoperative pain in patients undergoing the Nuss procedure for pectus excavatum, but has a delayed onset. Adjunctive regional anesthesia, such as nerve blocks (NBs), may enhance early analgesia. Our meta-analysis aims to evaluate the comparative efficacy of combining CA with NB (CNB) versus CA alone.A literature search was conducted focusing on studies that compared CNB and CA alone for postoperative pain management following the Nuss procedure. RevMan 8.13.0 was used to calculate effect estimates reported as mean differences (MDs), with 95% confidence intervals (CIs).Three observational studies comprising a total of 161 patients were included. Of these, 71 patients (44.1%) received the combined treatment of CNB. CNB was associated with significantly shorter hospital stays (MD -0.51 days; 95% CI -0.80 to -0.21; p < 0.05; I ² = 0%), reduced postoperative opioid consumption (MD -0.74 OME/kg; 95% CI -1.16 to -0.32; p < 0.05; I ² = 35%), and lower postoperative pain scores on postoperative day (POD) 3 (MD -1.03 points; 95% CI -1.76 to -0.30; p < 0.05; I ² = 0%). No significant differences were observed in operative duration or postoperative pain scores on POD 0, 1, and 2.CNB may be associated with improved postoperative outcomes compared with CA alone in patients undergoing the Nuss procedure. However, given the small sample size and the observational nature of the included studies, further high-quality randomized controlled trials are needed to validate these findings and inform clinical practice.

To evaluate two established soft tissue interposition techniques used during redo surgery for selected posturethroplasty complications of hypospadias surgery.Patients with complications who had interposition of scrotal fat, tunica vaginalis fascia, or external spermatic fascia identified from all hypospadias patients presenting to a single institute treated by a single surgeon between 2003 and 2019 (n = 217) were reviewed retrospectively. Urethrocutaneous fistula repair and minor cosmetic corrections were excluded.Eight cases had 10 complications: residual penile curvature > 30 degrees (n = 5), urethral diverticulum > 15 mm (n = 3), urethral dehiscence (n = 1), and urethral stricture (n = 1). All were Japanese. Hypospadias was perineal/penoscrotal (n = 7) or midshaft (n = 1). Initial procedures performed in infancy were single-stage urethroplasty (n = 4) or multistage urethroplasty (n = 4). Ages at first soft tissue interposition during redo single-stage urethroplasty (n = 1) or multistage urethroplasty (n = 7; two-stage: n = 4, three-stage: n = 3) ranged from 4.2 to 46.5 years old. All had their neourethras covered and four also had their scarred urethral plates reinforced laterally. There have been no complications during a mean of 5.6-year follow-up after the last procedure (range: 3.4-8.3 years) and all expressed satisfaction with cosmetic and functional outcomes including standing urination. Tissues for interposition were harvested easily without injuring surrounding structures such as the vas deferens or testicular vessels, even though previous surgery had caused extensive adhesions and structural disruption.Unlike reinforcement with tunica dartos fascia, soft tissue interposition specifically boosts tissue thickness and perfusion at the operative site during redo surgery for technically challenging posturethroplasty complications.

Intrauterine thoracoamniotic shunting in fetuses with congenital pulmonary airway malformation (CPAM) was first described using Cook™ or Rocket™ shunts. With the availability of the Somatex™ intrauterine shunt, a new device with the supposed advantages of less invasive placement and less frequent dislocations, pediatric surgeons and neonatologists are increasingly confronted with a new cohort of patients. Data on postnatal findings and the impact on surgical management are scarce.We conducted a multicenter retrospective study of all children born after prenatal treatment with a Somatex™ thoracoamniotic shunt for suspected CPAM. We analyzed the clinical and respiratory conditions of the children at birth as well as shunt locations, removal procedures, and timing of surgery.Twelve patients were included. 8/12 patients presented postnatally with pneumothorax, necessitating in all cases the placement of a chest tube. In 6/12 patients, the removal of the Somatex™ shunt had to be done surgically, bedside removal was possible in 5 patients. One patient was born without the shunt due to intrauterine dislocation. All patients were operated on using a muscle-sparing thoracotomy, at ages ranging from 1 to 42 days; only one could be discharged before surgery. One patient underwent emergency surgery. With a median follow-up of 19 months, 11/12 patients survived.Despite the small number of patients and the retrospective aspect of this study, our observations showed that intrauterine treatment of CPAM with the Somatex™ shunt is frequently associated with postnatal complications. Neonatologists and pediatric surgeons must be aware of the high rate of pneumothorax and the presumable necessity of early surgical intervention.

Artificial intelligence (AI) is increasingly explored in pediatric surgical care, yet its translation into diagnostics and preoperative planning lags behind adult surgery. Unlike prior reviews, this study provides a comprehensive synthesis across four domains, diagnostics, preoperative planning, risk stratification, and surgical error prevention, highlighting recent advances and unmet challenges.A narrative review of PubMed/MEDLINE (2020-2025) identified peer-reviewed studies on AI in pediatric surgery. Eligible articles addressed one of the four domains and were assessed for methodology, clinical applicability, and relevance to pediatric surgical patients.Diagnostic imaging is the most advanced field, with deep learning models for fracture detection and bone age assessment achieving accuracies up to 95% and near-expert agreement, though external validation is scarce. Preoperative planning benefits from AI-driven segmentation, 3D reconstruction, and virtual reality, with reports of altered surgical strategy in up to 8% of oncology cases, but evidence of outcome benefit is limited. Risk models for appendicitis and congenital heart surgery often surpass clinical scores, yet fewer than 10% have undergone external validation. Tools for error prevention, such as intelligent checklists and workflow monitoring, remain at the proof-of-concept stage. Across domains, most studies are retrospective, single-center, and methodologically heterogeneous.AI demonstrates tangible potential to improve pediatric surgical diagnostics, planning, and safety. However, translation into clinical practice requires multicenter pediatric datasets, prospective validation, and transparent, interpretable models. By consolidating the most recent evidence across four domains, this review outlines both the opportunities and critical gaps that should be addressed for safe and effective adoption.