European Journal of Pediatric Surgery最新文献

Thoracoscopic esophageal atresia (EA) repair is a demanding procedure. It provides long-term benefits for patients including better cosmesis and less musculoskeletal sequelae compared with open surgery. Besides technical challenges, there is concern that thoracoscopy increases treatment costs. However, surgical treatment of EA in Germany is not centralized with more than 90 pediatric surgical units offering treatment for 200 expected EA patients yearly. Our aim was to evaluate the rate of thoracoscopic EA repair regarding characteristics of treating hospitals, surgical approach and treatment costs in Germany.Insurance claims data (January 2020 to June 2024) from six health insurance companies representing about one-third (28.5 million) of the German population were analyzed. The database was queried for specific ICD-10-GM (International Statistical Classification of Diseases and Related Health Problems, 10th revision, German Modification) and OPS (Operationen- und Prozedurenschlüssel) coding. Characteristics of treating hospitals, length of hospital stay and medical treatment costs were assessed.A total of 149 reconstructive procedures for EA were analyzed. Eleven esophageal anastomoses were performed thoracoscopically (7%). All thoracoscopic procedures were performed in a specialized center. Mean length of hospital stay for open and thoracoscopic surgery was 76 versus 79 days, respectively (p > 0.05). Mean treatment costs were 142,741 € versus 150,238 €, respectively (p > 0.05).Thoracoscopic EA repair remains the exception in Germany. Thoracoscopy is exclusively performed in specialized hospitals. Length of hospital stay and treatment costs are comparable to open surgery, assumingly due to only uncomplicated patients without comorbidities being considered for thoracoscopy. We recommend surgical treatment in specialized centers to enable surgical advantages to all patients with EA.

Recent studies show that at least three-quarters of surgeons who perform minimally invasive surgery suffer from musculoskeletal pain and discomfort. This problem may compromise surgical performance, patient outcomes, and career longevity. Because of small patient dimensions, pediatric surgery is associated with a different set of ergonomic challenges than adult surgery.A 59-item questionnaire was sent to all practicing pediatric surgeons in Germany. It contained a general assessment of demographics, practice setting, operative volume, types of operations performed, and compensatory interventions, followed by the validated Nordic Questionnaires for the analysis of musculoskeletal symptoms (NMQ). Responses were collected and statistically evaluated to identify risk factors for musculoskeletal complications.A total of 152 pediatric surgeons participated in the survey. Among the participants, 21% were trainees, 58% attendings, and 21% chiefs of service. The median time in practice was 18 years (range: 0 to 38 years). Musculoskeletal pain was reported by 75%, and was most prevalent in the neck/cervical (80%), shoulder (56%), and lower back/lumbar region (71%). Footrests or steps were used by 88%, intraoperative breaks were employed by 49%, and 96% of respondents sometimes operated in a sitting position. The only significant factor for musculoskeletal pain was number of years in practice.Musculoskeletal pain among pediatric surgeons is common and increases with years in practice. Although many pediatric surgeons incorporate ergonomic measures in their daily activities, these are far from being implemented universally. More awareness and research on the prevention of long-term musculoskeletal sequelae in pediatric surgery is necessary.

Although it is known that virtual reality (VR) reduces presurgical anxiety, it has neither been stratified by age to determine its effect, nor has been applied before the day of surgery. This study has a novel age-stratified design offering VR months before surgery to address these unstudied issues.This was a unicentered, blinded clinical trial with parallel groups stratified by age (5-8 and 9-12 years), including major outpatient surgery patients. VR video showing the course of surgery was offered months before surgery. This study had ethical committee approval. The main variable was the modified Yale Preoperative Anxiety Scale (mYPAS) before entering the operating room. The Child Behavior Checklist (CBCL) measured basal anxiety and the Posthospitalization Behavior Questionnaire (PHBQ) measured behavior after 1 month. For comparison, Student's t-test or Kruskal-Wallis test was used.Of 72 patients, 6 met exclusion criteria and 5 withdrew consent. Of the remaining 61, 56 completed mYPAS. The mYPAS decrease was significant for children aged 5 to 8 years (28.33 VIDEO vs. 35.83 non-VIDEO; p = 0.042) (rank coefficient 0.45 [0.05-0.72]). In the children aged 9 to 12 years (32.91 vs. 33.33; p = 0.864), a tiny correlation (r = 0.04 [0.38-0.45]) was found. A total of 96.67% of CBCLs (n = 58) scored normal. The 57 completed PHBQs had very low scores, both in non-VIDEO (0.00 [0.00-4.50]) and in VIDEO groups (0.00 [0.00-4.50]). No differences were found; neither globally (p > 0.05), nor depending on age (5-8 years, p = 0.508/9-12 years, p = 0.661).VR may reduce preoperative anxiety in younger children (5 to 8 years), though its effect in the entire group was borderline. Larger multicenter studies are needed to confirm age and timing benefits.

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.

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.