European Journal of Pediatric Surgery最新文献

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.

Pediatric surgeons face substantial administrative workload. Large language models (LLMs) may streamline documentation, family communication, rapid reference, and education, but raise concerns about accuracy, bias, and privacy. This review summarizes practical, near-term uses with clinician oversight.Narrative review of LLMs in pediatric surgical workflows and scholarly writing. Sources included MEDLINE/PubMed, Scopus, Embase, Google Scholar, and policy documents (WHO, FDA, EU). Searches spanned January 2015 to August 2025, English only. Peer-reviewed and multicenter studies were prioritized; selected high-signal preprints were labeled. Data screening and extraction were performed by the author; findings were synthesized qualitatively.Across studies, LLMs reduced drafting time for discharge letters and operative note registries while maintaining clinician-rated quality; they improved readability of consent forms and postoperative instructions and supported patient education. For decision support, general models performed well on structured medical questions, with stronger results when grounded by retrieval. Common limits included coding performance, case-nuance/temporal reasoning, variable translation outside high-resource languages, and citation fabrication without curated sources. Privacy risks stemmed from logging, rare-string memorization, and poorly scoped tool connections. Recommended controls included a clinician-in-the-loop "review and release" workflow, privacy-preserving deployments, version pinning, and ongoing monitoring aligned with early-evaluation guidance.When outputs are grounded in structured EHR data or curated retrieval and briefly reviewed by clinicians, LLMs can responsibly reduce administrative burden and support communication and education. Early adoption should target high-volume, low-risk, auditable tasks. Future priorities must include multicenter pediatric datasets, transparent benchmarks (accuracy, calibration, equity, time saved), and prospective studies linked to safety outcomes.

Artificial intelligence (AI) is increasingly integrated into surgical practice, offering enhanced decision-making, precision, and workflow efficiency. In pediatric surgery, the convergence of AI and robotic-assisted platforms represents a promising frontier, addressing the unique anatomical, physiological, and technical challenges of operating on children. Aim of this review is to provide an overview of the current state of art of AI use in pediatric robotic-assisted surgery (RAS), outlining the available evidence, potential benefits, existing limitations, and prospective developments.A literature-based search of PubMed and Scopus was performed to identify articles covering any aspect of AI application in pediatric RAS. Selection criteria included English language, pediatric patients (under 18 years of age), and AI application to pediatric RAS. Additionally, studies reporting AI applications in adult RAS or for surgical training, which were not primarily focused on pediatric surgery but presented potential translational applicability to pediatric RAS, were considered.A total of 746 papers published until July 2025 were collected. A total of 15 full-text articles were assessed for eligibility, meeting the inclusion criteria. The other studies were excluded because they did not address pediatric surgery, did not involve robotic-assisted procedures, or did not include applications of AI.Although RAS is well established in pediatric practice, the direct application of AI remains limited, with AI-like features such as machine vision and augmented reality serving mainly as supportive tools rather than autonomous decision-making systems. Nevertheless, emerging AI-like technologies and ongoing research hold promising potential for future applications in pediatric robotic surgery.

Although VACTERL association is a recognized entity in patients with esophageal atresia (EA), its impact on surgical outcomes remains unclear. This study aimed to evaluate the influence of VACTERL association and chromosomal anomalies (VACTERL-CA) on the surgical outcomes of EA patients, offering novel insights into risk stratification.All patients enrolled in the European Pediatric Surgeons' Association (EUPSA) Esophageal Atresia Registry (EAR) between July 2014 and December 2017 were included. Patients were classified into two groups: those with VACTERL-CA and those without these anomalies (non-VACTERL). Groups were compared for demographics, associated malformations, surgical approach, complications, and outcomes.Among 372 patients, 22% (n = 82) were classified as VACTERL-CA. This group had significantly lower gestational age (35.9 weeks vs. 37.1 weeks, p = 0.004), birth weight (2,312 g vs. 2,663 g, p < 0.001), and APGAR scores at 5 and 10 minutes (p = 0.005). Surgical strategies, including rates of primary anastomosis (88% in both groups), did not differ. Anastomotic leak and stricture rates were similar; however, recurrent fistula was more common in VACTERL-CA (4.9% vs. 1.0%, p = 0.023). Overall mortality was higher in VACTERL-CA (14.6% vs. 5.2%, p = 0.003), largely due to associated anomalies such as cardiac or neurologic conditions, whereas EA-related mortality was more frequent in non-VACTERL (1% vs. 0%). Sepsis was also more frequent in VACTERL-CA (10.9% vs. 4.5%, p = 0.033). In multivariate analysis, low birth weight (adjusted odds ratios [aOR]: 0.95 per 100 g, p = 0.010) and cardiac malformations (aOR: 2.33, p = 0.002) were independently associated with VACTERL-CA.EA patients with VACTERL-CA represent a high-risk subgroup characterized by prematurity, major cardiac defects, and increased sepsis risk. These findings highlight the need for early cardiac screening, standardized infection-prevention bundles, and tailored multidisciplinary care to improve survival and reduce preventable complications.