European Journal of Pediatric Surgery最新文献

Objective: 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.

Methods: 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).

Results: 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%).

Conclusion: 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.

Objective: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Objective: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Objective: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Introduction: Treatment of pilonidal disease traditionally involves an operation under general anesthesia, which may have a period of postoperative disability and a significant recurrence rate. We report a novel treatment for pilonidal disease performed in-office using a pneumatic lidocaine injection device, requiring no pain medication or activity restrictions-supporting a non-operative standard of care.

Methods: Patients with gluteal crease pits at our Pilonidal Care Clinic were offered pit excision as standard care. Prospective data on demographics, pain scores (0-10), and outcomes were collected in REDCap. Under sterile conditions, patients received 1% buffered lidocaine via pneumatic injection. Laser follicle ablation was followed by punch excision (1.5 or 2 mm) of full-thickness pit epithelium. Sinus tracts were probed but not excised. Patients were asked to wash the area twice daily, maintain normal activities, and return in 6 to 8 weeks. Patients requiring nidus incision and drainage (I&D) were excluded.

Results: About 130 patients underwent this technique between February and June 2024; 100 were included in the analysis (5 excluded for concurrent I&D, 25 lost to follow-up). Mean age was 18.1 years; 50% were male. At subsequent follow-up, 60% patients healed all pits, resolving their condition, with 64% (144/224) of all pits healed. Patients with three or more pits were more likely to need an additional pit excision. Mean procedure pain score was 1.6/10 (SD 1.21); no patient used pain medication or experienced disability. Ultimately, 88% of patients healed all of their pits.

Conclusion: Pilonidal disease may be resolved non-operatively in a single outpatient clinic visit, without even a shot.

Purpose: Giant omphaloceles (GOs) pose significant surgical challenges. Two common strategies to close the defect include applying a topical epithelializing agent with delayed closure and the Schuster staged closure, which approximates the abdominal wall within 2 weeks of life. Although patient selection is critical for the Schuster staged closure, it remains unclear whether the rapid rise in intra-abdominal pressure increases abdominal hernia risk. We hypothesized that abdominal hernia rates differ between closure strategies.

Methods: We conducted a single-institution, retrospective cohort study comparing abdominal hernia rates in patients undergoing Schuster staged closure versus delayed closure between 2012 and 2022.

Results: Among 21 patients who met the inclusion criteria, 9 underwent the delayed closure, and 12 underwent the Schuster staged closure. Demographics were similar, but birth weight and prenatal lung volumes differed between groups, with greater values in the Schuster group. Abdominal hernias occurred more frequently after Schuster closure (n = 9, 75%) versus delayed closure (n = 2, 22%; p = 0.03) within 2 years. Bilateral inguinal hernias were most common.

Conclusion: Infants undergoing Schuster staged closure for GOs had a higher incidence of abdominal hernias than those with delayed closure. Given underlying physiologic differences between groups, these findings should be interpreted as hypothesis-generating rather than causal.

Background: In Hirschsprung disease (HD), the laparoscopic-assisted Yancey-Soave (LAYaSo) procedure retains an aganglionic muscular cuff, which may cause obstructive symptoms. The laparoscopic-assisted Swenson-like (LASwL) technique completely excises the aganglionic segment, potentially improving peristalsis. However, randomized evidence comparing these techniques with combined functional and quality-of-life outcomes is lacking.

Aim: This study aimed to compare surgical, functional, and quality-of-life outcomes between LASwL and LAYaSo pull-through procedures in a randomized controlled trial.

Methods: This prospective, single-center, randomized study included 110 children with HD at Al-Azhar University Hospitals (2020-2025). The inclusion criterion was biopsy-confirmed rectosigmoid HD. Exclusion criteria were ultrashort or total colonic aganglionosis, prior pull-through procedures, and major congenital anomalies. Patients were randomized to LASwL (n = 55) or LAYaSo (n = 55) using a computer-generated sequence and sequentially numbered, opaque, sealed envelopes (SNOSE). The primary outcome was the Rintala Bowel Function Score (BFS) at 2 years. Secondary outcomes included BFS at 1 year (exploratory), operative time, blood loss, hospital stay, Hirschsprung-associated enterocolitis (HAEC), and health-related quality of life (Pediatric Quality of Life Inventory [PedsQL] 4.0).

Results: All procedures were completed laparoscopically without conversion. Mean total operative time was shorter for LASwL (145.5 ± 36.8 vs. 160.3 ± 28.6 minutes, p = 0.081), with a significantly shorter transanal phase (p = 0.019). At the primary endpoint of 2 years, BFS was significantly higher in the LASwL group (18.20 ± 1.80 vs. 17.10 ± 2.30, p = 0.037). HAEC rates were 14.5% versus 20.0% (p = 0.61), all mild/moderate. At 2 years, total PedsQL scores were comparable (88.6 ± 7.5 vs. 86.2 ± 8.4, p = 0.12), though social functioning was numerically higher in LASwL (p = 0.055). Three LAYaSo patients required redo surgery for cuff-related stricture.

Conclusion: Both techniques are safe and effective. LASwL offers a modest but statistically significant advantage in bowel function at intermediate follow-up (1.1 points on the Rintala score) without a corresponding improvement in overall quality of life. LAYaSo was associated with a 5.5% risk of cuff-related stricture requiring reoperation. The limited clinical magnitude of the benefit supports individualized technique selection based on surgeon experience and patient factors. Single-center design and the need for longer follow-up are limitations of this study.

Background: The optimal treatment of pilonidal disease remains uncertain, with recurrence rates up to 30% after resection or sinusectomy. This retrospective single-center cohort study evaluates the recurrence rate after graduation from our Pilonidal Care Clinic's (PCC) Minimally Invasive Pilonidal Protocol (MIPP).

Methods: We conducted a retrospective review of a single center's prospectively collected demographic and treatment data for patients with pilonidal disease who completed the MIPP between January 2021 and December 2024. Follow-up appointments were scheduled every 6 to 8 weeks, continuing until disease resolution and completion of laser ablation sessions. The analysis focused on patients who graduated. Patients still receiving care at study completion and those lost to follow-up were excluded. Recurrence was defined as any PCC visit after graduation with pilonidal disease on examination. Graduated patients who had not returned to the PCC were contacted via text message and queried about new symptoms since graduation.

Results: Of the initial 884 patients, 8 patients presented for a second opinion only, 353 were lost to follow-up, and 226 were still receiving care, leaving the study group of 297 patients who completed the protocol and graduated. They graduated after an average of 6.4 PCC visits, two pit-picking procedures, and 5.3 laser epilations. The average disease duration before treatment was 11.4 months. The mean treatment duration was 12.3 months (standard deviation: 8), with a median of 10 months (interquartile range: 6-17). The follow-up period for these patients ranged from 4 to 55 months. Of the 297 graduates, 17 patients (5.7%) returned to the PCC with recurrence concerns; however, only 12 (4.0%) showed physical evidence of recurrence: 8 of them (66.7%) had new pits and 4 (33.3%) had both pits and a nidus. The other 5 showed no signs of pilonidal disease on examination. Recurrence occurred on average 16.3 months after graduating, and 9 of 12 patients with a recurrence were successfully regraduated; 3 were lost to follow-up. Among the 280 patients who did not revisit the clinic, 72 (25.7%) replied to the text survey: 68 (94.4%) of respondents remained disease-free, whereas 4 (5.6%) reported recurrence, 2 of whom sought medical care.

Conclusion: Completion of the MIPP at this center is associated with a 4.0% recurrence rate within 16 months, with most recurrences mild and again resolved with minimally invasive care.

Introduction: Anorectal malformations (ARMs) represent the most common form of congenital gastrointestinal malformations. ARMs range from mild anal stenosis to complex abnormalities involving the rectum, genitals, and urinary tract. The aim of this study is to investigate prevalence, mortality, and associated anomalies of ARMs in the Finnish population. This study offers comprehensive updated population-based estimates on stillbirths and terminations of pregnancy due to fetal anomalies (TOPFA).

Materials and methods: The data were obtained on all live births, TOPFA, and stillbirths from registers maintained by the Finnish Institute for Health and Welfare and Statistics Finland. All individuals diagnosed with ARM between January 1, 2004 and December 31, 2017, were included in the study.

Results: This population-based study identified 646 ARM cases, including 545 (84.4%) live births, 8 (1.2%) stillbirths, and 93 (14.4%) TOPFA. The total prevalence for ARM in Finland was 8.00 per 10,000 births, without significant variation in prevalence between 2004 and 2017. Neonatal mortality was 4.6% (n = 25), and infant mortality was 6.0% (n = 33). Neonatal and infant mortality were both associated with very low birth weight (p = 0.0001), prematurity (p = 0.0001), congenital heart defects (p = 0.02 and p < 0.001), and VACTERL (vertebral, anal, cardiac, tracheoesophageal, renal, limb; p = 0.0002 and p < 0.001, respectively). Postnatal survival rate for isolated ARM was 100%. Most commonly associated anomalies were urinary tract, heart, and limb malformations.

Conclusion: The overall prevalence of ARMs has remained stable in the Finnish population. Neonatal and infant mortality remains a significant concern, particularly among patients with severe associated anomalies, highlighting the importance of systematic screening for co-occurring malformations.

Introduction: The management of meconium ileus (MI) has yet to reach a unified consensus among pediatric surgeons, particularly regarding diagnostics and variants, conservative treatment strategies, surgical approaches, and clinical outcomes. This topic was therefore selected for the 2024 Consensus Session of the Annual Congress European Paediatric Surgeons' Association (EUPSA).

Methods: A structured literature review was conducted across Cochrane, Medline, and EMBASE databases up to April 2024. Nine pediatric surgeons appointed by the European Paediatric Surgeons' Association (EUPSA) Consensus Committee reviewed the evidence and developed topic-specific recommendations relating to (1) diagnostics and variants, (2) Gastrografin® (Bracco Diagnostics Inc, Monroe Township, NJ) application and outcomes, and (3) surgery-related outcomes. Findings were presented at the 2024 EUPSA Annual Congress, with consensus statements formulated through iterative discussion and refinement, incorporating feedback from congress participants.

Results: The consensus addresses antenatal and postnatal diagnosis, differentiation between simple and complex MI, conservative management using contrast enemas, surgical strategies, and short- and long-term outcomes, particularly in relation to cystic fibrosis (CF). Key recommendations include the use of contrast enema as the primary diagnostic modality and first-line treatment in uncomplicated cases, with surgical intervention indicated for complicated MI or failed conservative management. Enterostomy remains a widely used surgical approach, with technique guided by intraoperative findings and patient factors. Recommendations regarding stoma reversal emphasize the role of multidisciplinary assessment and preoperative evaluation including CF workup and confirmation of distal bowel patency.

Conclusion: A peer-reviewed consensus statement on the diagnosis and management of MI has been developed, informed by current evidence and expert practice. This statement provides pragmatic guidance in the diagnosis and management of MI, including the role of contrast enema in uncomplicated cases and surgical intervention for complicated disease. It is recognized by the EUPSA as a valuable resource to support pediatric surgeons in clinical decision-making for this pathology.