Paediatric Surgery

Many millennia ago, gloves were devised for protection, first from the cold and then to protect the hands from injury. In time, they became associated with social class, wealth and as a sign of privilege. With status and prestige followed the glamour and commercialism of fashion. Surgeons had little interest in gloves until relatively recently unless they were dealing with foul and putrid wounds. The first serious use of gloves in surgery was to protect hands from the irritating effects of...

The aim of this study was to identify immune cells and inflammatory mediators associated with delayed wound healing in paediatric burn patients. Peripheral blood mononuclear cells (PBMCs) were isolated from 30 paediatric participants: 10 healthy age- and sex-matched controls, 10 burn patients whose wounds healed within 21 days (normal healing), and 10 patients with healing times exceeding 21 days (delayed healing). Flow cytometry was used to quantify immune cell subsets and intracellular...

CONCLUSION: Diapers are an accessible alternative to commercial stoma bags for patients with colostomies.

CONCLUSION: The study provides important insights into the current state of paediatric polytrauma management in the Italian healthcare system. The study emphasised the crucial need for standardisation, specialised training, and the development of evidence-based guidelines. The proposed national trauma registry will be instrumental in facilitating this process and improving the quality of care for paediatric polytrauma patients in Italy. Further research examining the effect of volume, training,...

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CONCLUSION: Paediatric surgery litigation in NHS England has increased over 19 years, driven predominantly by diagnostic and treatment delays rather than operative error. Improvement of time-critical diagnostic pathways, enhanced follow-up systems and targeted claims resolution strategies represent the most impactful approaches to reducing litigation burden in this specialty.

CONCLUSIONS: Despite longer operative times, LPM demonstrated significantly better postoperative recovery. With appropriate training and investment, LPM is a feasible and beneficial alternative to OPM in LMIC settings.

Oral contraceptives (OCs) can substantially modulate immune responses; however, their impact on vaccine immunogenicity remains poorly understood. This study investigated OC use patterns and their determinants among healthcare workers (HCWs), and the effects of OCs on humoral and T-cell-mediated immune responses following COVID-19 booster vaccination. From 29 September 2021 to 31 December 2023, 1061 female HCWs aged 18-50 years were enrolled in the CoVacSer study. OC users were compared to...

Background: Abdominal wall defects represent a significant spectrum of congenital anomalies, ranging from the more frequently encountered gastroschisis and omphalocele to the rare and intricate malformations such as limb-body wall complex, Pentalogy of Cantrell, and cloacal exstrophy. Understanding these conditions is crucial for improving patient outcomes. Materials and Methods: We conducted a comprehensive study presenting rare AWDs diagnosed at a tertiary referral center over two years. Our...

CONCLUSIONS: Models to predict DOSC identified in this review demonstrated moderate discrimination ability but there was significant heterogeneity between studies and reports of calibration were limited. This review serves as a valuable synthesis of current models to predict DOSC and should serve as a core reference for emerging studies in this field.

CONCLUSION: Macroscopic venous tumour thrombus identifies a high-risk subgroup, but complete resection remains achievable in selected patients and should not be equated with surgical futility.

CONCLUSIONS: This pragmatic preoperative anaemia-management pathway was feasible and produced a modest increase in Hb in children with IDA. These findings highlight the potential role of structured optimisation pathways and support further evaluation in resource-limited settings.

CONCLUSIONS: Hepatic pseudoaneurysms following trauma are uncommon. Their management in the pediatric population presents challenges regarding follow-up imaging, particularly the use of CT. Although the absence of standardized protocols complicates surveillance strategies, an individualized approach informed by patient-specific factors is essential. Contrast-enhanced ultrasound may optimize HPA detection while minimizing radiation exposure.

INTRODUCTION: Cancer recurrence is a pivotal outcome after treatment with curative intent for colon cancer patients, as it is related to worse survival, the subsequent need for further treatment and the associated use of healthcare resources. However, at present there is no consensus regarding the definition of locoregional recurrence of colon cancer. This contributes to variability in reporting outcomes and clinical management, limiting comparability across registries and clinical studies. This...

Ovarian torsion is a surgical emergency in which twisting of the ovarian vascular pedicle leads to ischaemia. Although an uncommon diagnosis in prepubescent girls, prompt recognition of this condition is essential in order to prevent ovarian necrosis, which can have long-term consequences in terms of fertility. Transabdominal ultrasound is the recommended imaging modality for diagnosing ovarian torsion; however, given the limited availability of paediatric-trained sonographers, patients may not...

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.

This case report details the rehabilitation of a male child in early teenage who developed complete left lower lobe collapse following surgical excision of a large mediastinal teratoma. The patient came with recurrent chest infections with severe bronchomalacia and other significant post-operative pulmonary complications. A comprehensive rehabilitation programme for 90 days was designed, with emphasis on integration of virtual reality (VR) exercises to promote lung expansion and improve overall...

CONCLUSION: Longitudinal data provided critical insights regarding representation of women in surgery in Pakistan.

A 12-year-old girl presented to the department of paediatric surgery of Mayo Hospital Lahore on March 31, 2021, with a large omphalocoele that healed as ventral hernia. Primary closure of the defect was done. This case highlights the importance of public awareness regarding congenital anomalies, early detection, and timely management to reduce childhood mortality and lifelong disability because delays in treatment may result in one of these disability and poor quality of life.

CONCLUSION: The Research Showcase provides a model for fostering regional academic communities in surgery through accessible, collaborative platforms. Its findings offer valuable insights for educators, academic surgeons, and policymakers addressing current challenges in surgical training. The reflections arising from the event contribute to the broader discourse in surgical education research and have important implications for the design of future curricula, assessment strategies, and...

Introduction Allgrove syndrome, also known as triple A (3A) syndrome, is a rare autosomal recessive disorder characterized by the association of achalasia, alacrima, adrenal insufficiency, and neurological manifestations. It is caused by the functional impairment of the nucleoporin ALADIN due to mutations in the AAAS gene. Data from African countries remain limited. We present the clinical profile, biochemical findings, management, and outcomes of 12 children with triple A syndrome who were...

CONCLUSIONS: Electroporation with cisplatin appears effective against neuroblastoma in vitro. Further work will investigate the efficacy of electroporation with cisplatin using clinical ECT devices.

CONCLUSION: Co-designed transition pathways offer a pragmatic opportunity to strengthen lifelong care for patients with ARMs in resource-constrained settings.

Urinary bladder agenesis is an extraordinarily rare congenital anomaly, often associated with complex genitourinary malformations and poses significant diagnostic challenges in infancy. We report an infant girl with progressive abdominal distension, continuous urinary dribbling and bilateral hydronephrosis, ultimately found to have bladder agenesis with bilateral pelviureteric junction obstruction, ectopic ureteric insertion into the vagina and malrotated kidneys. Multimodality imaging,...

CONCLUSION: Pathological fractures of the upper and lower extremities in children demonstrate distinct clinical characteristics. Lower-extremity fractures were more frequently associated with absent or low-energy trauma and showed a trend toward a higher proportion of malignant underlying lesions, whereas upper-extremity fractures predominantly resulted from falls on level surfaces. These location-specific differences suggest that fracture location may provide valuable diagnostic information and...

CONCLUSIONS: Malignant SMA-adjacent tissue involvement was identified in 7.6% of resectable pancreatic head tumours and was exclusive to PDAC. R-status appears to be the dominant determinant of survival. These findings should be considered hypothesis-generating and require validation in larger prospective cohorts.

CONCLUSION: While there are similarities in the broad aspects of how burns clinicians use laser to treat hypertrophic scars, there are several differences in practice. These variations highlight potential research directions to optimize patient outcomes from this treatment modality.

CONCLUSIONS: Management of paediatric FBI remains heterogeneous, with frequent deviations from recommended protocols and a notable rate of avoidable transfers and procedures. This study suggests that structured decision-support algorithms may help reduce avoidable transfers and improve guideline adherence in regional paediatric networks.

CONCLUSIONS: Among adults undergoing radical nephrectomy for high-complexity renal tumors, RARN confers a meaningful reduction in conversion to open surgery, intraoperative blood loss, transfusion requirement, and acute renal functional loss compared with LRN, at the cost of modestly longer operative time. Evidence quality is moderate for the primary outcome and low-to-moderate for secondary endpoints, reflecting a predominantly observational evidence base. A dedicated randomized controlled...

CONCLUSION: We report a significant increase in anti-TNF prevalence, with earlier deployment. Surgical resection rates have declined and plateaued; reflecting reduced CD surgery. Future research should focus on optimised anti-TNF and second-line biologic deployment to move beyond current levels of surgery.

CONCLUSION: ORALQUEST for assessing feeding difficulties in young children demonstrated good psychometric properties in children with and without somatic conditions. The investigation by ORALQUEST of four domains may help to determine the best management strategy.

CONCLUSIONS: This low-cost open inguinal herniotomy simulator demonstrated content validity, construct validity, and a high degree of functional task alignment.

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CONCLUSION(S): This blinded case series reveals a distinct spectrum of genital findings in ART-conceived neonates, with high hypospadias prevalence. Penile development appears primarily linked to parental fertility issues and preterm labor. Singleton pregnancy is likely a strong protective factor. These findings indicate underlying parental subfertility as the potential determinant of genital malformation risk, with ART procedures as a possible confounder.

CONCLUSION: Epigenetic regulation represents a critical dimension in hypospadias etiopathogenesis. DNA methylation alterations are linked to disrupted hormonal signaling, developmental pathways, and environmental exposures. Novel candidate genes and tissue-specific signatures offer potential biomarkers and therapeutic targets. These findings provide translational insights for early diagnosis, prevention strategies, and targeted interventions, warranting validation through larger multicentric...

Extraskeletal Ewing's sarcoma (EES) is a soft-tissue neoplasm which is extremely rare in neonates, especially over the head-and-neck region. Congenital extraskeletal Ewing's sarcoma is present at birth/early infancy. This often leads to misdiagnosis and there is a significant lack in specific treatment guidelines. Here, we present the case of congenital EES over forehead in a newborn which was successfully managed.

CONCLUSION: EBRT is a feasible adjuvant treatment option for selected pediatric DTC patients with locally aggressive disease - gross extrathyroidal extension or unresectable disease.

Glial choristomas are extremely rare and benign congenital tumors. Here, we present a case of glial choristoma of the tongue in an infant initially misdiagnosed with a hemangioma of the tongue, and its subsequent management, resulting in complete surgical excision. We also review the literature on this rare and obscure condition.

Combined vascular malformations in children often involve multiple structures, with lymphatic-venous malformations being the most common. These malformations tend to cause significant distortion and morbidity than other types, making their treatment a significant challenge for healthcare providers. This report focuses on managing a giant gluteal venolymphatic malformation in a 5-year-old with a neglected, ulcerated, and bleeding condition. We discuss surgical insights, multimodal management...

Concomitant anterior urethral valves and posterior urethral valves (AUV and PUV) are extremely rare congenital causes of bladder outlet obstruction in boys and can lead to significant renal damage if undiagnosed. A 10-month-old male, antenatally detected with bilateral hydroureteronephrosis, presented with dribbling and a weak urinary stream since birth. Micturating cystosurethrogram (MCU) showed a trabeculated bladder with left vesicoureteric reflux and a pseudodiverticulum inside the anterior...

CONCLUSION: The overall prognosis for newborn oropharyngeal tumor (OPT) is good. Early diagnosis, the establishment of good airway, complete excision of tumor and timely follow-up are the key factors for the survival of newborn. For congenital teratomas, oropharyngeal cavity is one of the rarest sites (2% of all teratomas).

CONCLUSION: MORE thereby optimizing prognostication, supporting evidence-based parental decision-making, and strengthening neonatal care delivery. Despite these benefits, its implementation was not uniform across healthcare settings, as attrition, limited availability of advanced diagnostic infrastructure, and sociocultural as well as economic constraints substantially influenced its feasibility and sustainability.

CONCLUSIONS: In HB, routine LN dissection may be unnecessary due to universally negative nodes. For HCC, the one-in-three positivity rate supports further evaluation of lymphadenectomy. Evidence remains limited for other tumors. Prospective multicenter studies using standardized protocols are needed to define the role of LN evaluation beyond HB.

Rectovestibular fistula is the most common presentation of female anorectal malformation. Its association with Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome and Colonic atresia is uncommon. We present the staged management of a case of a female neonate with MRKH syndrome with rectovestibular fistula and colonic atresia. This is probably the first such case ever to be documented in literature. An absent vaginal opening with rectovestibular fistula should raise suspicion of MRKH syndrome....

We report a rare and life-threatening case of pediatric gas gangrene caused by Clostridium septicum following an intramuscular injection. The child presented with severe pain and blisters over the left gluteal region. Rapid progression of surgical emphysema coupled with systemic toxicity necessitated immediate surgical debridement, intensive care, and broad-spectrum antibiotic therapy. The causative pathogen was C. septicum. Wound management was particularly challenging due to high exudate...

CONCLUSION: This meta-analysis provides strong evidence for a codominant inheritance pattern of the SRD5A2 V89L polymorphism with a stepwise increase in the risk of DSD per L allele. The results support the role of V89L as a genetic susceptibility factor in 46, XY DSD and isolated hypospadias. The findings have clinical implications for genetic counseling, early diagnosis, and potential therapeutic targeting.

CONCLUSIONS: This study significantly expands WT's genetic landscape by identifying 71 variants across 16 genes, including several genes with established roles in other cancers (MUC16, KRT18, FCGBP) that have not been previously implicated in WT, as well as genes with limited prior cancer associations. The identification of mutation hotspots and WT-specific gene associations provides new insights into WT development and potential therapeutic targets. These findings warrant further functional...

Superior mesenteric artery syndrome is a diagnosis of exclusion. We report a 17-year-old girl with SMA syndrome and the role of Cine magnetic resonance imaging in confirming the diagnosis and robotic surgery in successful management.

CONCLUSIONS: ARMA is a technically feasible, minimally invasive option for refractory GERD. While this initial case involved a high-risk, neurologically impaired child, the mechanism suggests broader applicability to other pediatric patients with medication-resistant GERD.

CONCLUSION: In comparison to the Duckett procedure, the M-Duckett procedure is associated with a lower rate of postoperative urethral stricture and a higher proportion of bell-shaped uroflow curves, without increasing the risk of other postoperative complications or leading to an undesirable penile appearance.