European Journal of Pediatric Surgery最新文献

Despite an awareness of the transformative potential of artificial intelligence (AI) in health care, its development in pediatric surgery seems slow. One major reason may be a lack of formal AI training. This study assesses the basic AI knowledge and the effectiveness of AI workshops (AI-WS).Four AI-WS were held at the International Academy of Pediatric Surgery 2024. Topics included AI principles, real-time algorithm training, and potential AI applications in pediatric surgery. Self-developed surveys consisting of eight pre-WS and nine post-WS questions were conducted, focusing on participants' AI competencies, usage, educational needs, barriers, and future perspectives.Out of 57 pediatric surgeons, 53 completed both surveys. None had formal AI training. Although 90% were familiar with AI in diagnostic imaging, most had only basic knowledge of AI technology. After the workshop, participants reported a significant increase in the general understanding of AI/machine learning (ML) (p < 0.001). 96% stated that they were better informed about AI/ML applications for clinical practice; 83% expressed interest in further AI training; 91% believed that AI will be more integrated into clinical practice; and over 80% anticipated that AI will improve patient outcomes.The AI-WS effectively enhanced pediatric surgeons' AI knowledge and their readiness to adopt AI technologies. Even though our study is limited by the relatively low sample size and a potential selection bias, our results still highlight the importance of targeted education in preparing health care professionals for AI integration. The long-term sustainability of knowledge gains, however, has to be examined in further studies.

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.

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.

The primary objectives were to know the prevalences of pulmonary hypoplasia (PH), persistent pulmonary hypertension of the newborn (PPHN), and mortality in newborn infants with giant omphalocele (GO). A secondary aim was to assess the prevalence of syndromes and other congenital anomalies (SCA) associated with GO.A systematic review according to PRISMA guidelines using MEDLINE/PubMed, Google Scholar, and Scopus platforms was performed. The search strategy combined indexed and in-process citations up to May 22, 2023.Out of 651 articles, 23 met the inclusion criteria, comprising 14 observational studies and 9 case reports. There was no uniformity in the criteria for diagnosing PH and PPHN among the studies. In the observational studies, the prevalence of PH varied between 18.5 and 54% (median: 26%); the prevalence of PPHN varied between 13 and 100% (median: 38.5%); and mortality varied between 4 and 50% (median 23.5%). SCA were reported in 58% of patients. In the case series, PH was present in 27.8% of the neonates, PPHN in 50%, and mortality occurred in 55.5%. About 55.5% had associated SCA. The association of SCA and preterm birth contributed significantly to increase the mortality rate.The reported prevalences of PH, PPHN, mortality, and SCA associated with GO are alarmingly high. Although the heterogeneity and limitations of the included studies prevent definitive prevalence estimates, the findings underscore the urgent need for standardized diagnostic criteria, better prenatal counseling, and management in highly specialized centers.

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.

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.

Background:  Necrotizing enterocolitis (NEC) is one of the main causes of acute abdomen in neonates. Surgical treatment entails important morbidity and mortality and conservative management, when possible, offers better outcomes. Post-NEC intestinal strictures are one of the main complications.

Methods: Retrospective analysis from June 2011 to November 2022 of post-NEC strictures (PNS) after conservative management of neonates diagnosed with NEC (modified Bell stage IIA or higher) at a tertiary neonatal surgery center.

Results:  Out of 219 NEC, 126 received initial conservative management (57.5%), 24 (19%) of which eventually underwent surgery for PNS. Average gestational age and weight at birth of our cohort were 31.3 ± 4.9 weeks and 1,694 ± 1,009 g.PNS diagnosis was made 38.4 ± 16.5 days after the NEC episode. 6/24 (25%) were asymptomatic and diagnosed by screening enema, 11 (46%) presented signs of intestinal obstruction before the enema could be performed and 7 (29%) after a normal previous protocol study.Median age at PNS surgery was 56 ± 17.9 days. A total of 2/3 strictures were found in cecum, ascendent, and transverse colon. Primary resection and anastomosis were performed in all cases. Feeds were restarted on postoperative day 4.3 ± 2.9. Two cases presented anastomotic complications (1 dehiscence and 1 stenosis), and no deaths were recorded.

Conclusions:  PNS is a frequent complication after conservative management. Deffered surgical treatment after the acute NEC episode is resolved allows for safer surgeries (since patients have reached hemodynamical stability and overcome septic shock), shorter resections, and favorable postoperative outcomes.

Introduction:  Pectus excavatum patients frequently experience psychosocial distress, yet the relationship with morphological features of the deformity remains unexplored. We hypothesize that certain morphological features analyzed by 3D optical surface imaging contribute more prominently to the distress experienced by pectus excavatum patients as they impact the visible severity of the deformity.

Materials and methods:  Consecutive pectus excavatum patients who received three-dimensional optical surface imaging between August 2019 and November 2022 were included. Logistic regression analysis assessed the association between morphological features and psychosocial distress in which the distress was scored as a binary variable, based on a self-reported assessment.

Results:  Among 215 patients, 55% reported psychosocial distress with multivariable analyses revealing greater depth and length of the deformity being significantly correlated with psychosocial distress. However, this prediction model demonstrated a moderate discriminative ability with an area under the receiver operating characteristic curve of 0.66 (95% confidence interval [CI], 0.59-0.73) for pectus depth and 0.58 (95% CI, 0.51-0.66) for pectus length.

Conclusions:  The morphological features of length and depth of the deformity are correlated with psychosocial distress. Nonetheless, these individual features are weak predictors due to their moderate discriminative ability. This underscores that other patient-related factors, such as personality traits, neuropsychological conditions, and other psychosocial influences, are likely to play a role in the occurrence of psychosocial distress. Future studies should investigate these variables alongside the incorporation of standardized instruments for measuring psychosocial distress to better understand and address the distress in this population.

Introduction:  This study aimed to evaluate the non-neoplastic renal parenchyma in Wilms tumor (WT) and investigate its impact on nephron-sparing surgery (NSS).

Materials and methods:  The non-neoplastic renal parenchyma of WT patients was prospectively collected for pathological examination. The histology of non-neoplastic renal parenchyma was assessed from two perspectives: nephrogenic rests (NRs) and nephrons.

Results:  A total of 46 non-neoplastic renal parenchyma specimens were collected from 42 WT patients. The surgeons assessed the median proportion of non-neoplastic renal parenchyma as 30%, whereas using ellipsoid volume, it was calculated to be 27%. The Youden index of surgeons' assessment peaked at a 15% proportion of non-neoplastic renal parenchyma. The bilateral WT (BWT) group and NSS group exhibited significant differences compared with the unilateral WT group and radical nephrectomy group, respectively, with the BWT group showing a tendency toward thickened basement membrane.

Conclusion:  The presence of NRs and endogenous nephron alternations should be given due attention in WT. The probability of abnormalities is low when the proportion of non-neoplastic renal parenchyma exceeds 15%, providing pathological support for expanding the adaptation of NSS.