Paediatric Surgery

Healthcare-associated infections remain a major cause of morbidity and mortality in paediatric patients, particularly among those undergoing surgery or requiring intensive care. Distinguishing postoperative sterile inflammation from early sepsis is clinically challenging because conventional biomarkers such as C-reactive protein (CRP) and procalcitonin lack sufficient specificity. This narrative review aimed to analyse current evidence on pancreatic stone protein (PSP) as an emerging biomarker...

CONCLUSION: AL is an independent factor negatively influencing OS of colon cancer. These findings highlight the value of perioperative strategies reducing AL incidence.

CONCLUSIONS: Current evidence does not demonstrate significant differences in CSF serotonin or 5-HIAA levels in suicidal deaths. Methodological heterogeneity and limited data underscore the need for rigorously designed standardised post-mortem studies.

CONCLUSION: The overall incidence of metachronous cryptorchidism in patients with unilateral disease was 15%. A higher incidence was observed among patients with acquired cryptorchidism than among those with congenital cryptorchidism, although this difference did not reach statistical significance. These findings suggest that periodic follow-up until adolescence may be warranted in patients with unilateral cryptorchidism, particularly in those with acquired forms. Patients with congenital...

CONCLUSIONS: This review and consensus framework aims to bridge the gap between existing staging systems and modern radiological as well as surgical practice, standardize multidisciplinary communication, and optimize curative-intent treatment strategies in children with hepatoblastoma.

Malignant small round cell tumors are a heterogeneous group of aggressive neoplasms characterized by small, round cell morphology. The undifferentiated cells in these tumors exhibit a high nuclear-cytoplasmic ratio, and definitive histologic diagnosis via light microscopy can be extremely challenging. Diagnostic accuracy significantly improves with immunohistochemistry, molecular analyses, and cytogenetic studies, enhancing diagnosis and treatment, and ultimately leading to better survival...

CONCLUSIONS: Low-weight children with biliary atresia constituted a high-risk group, highlighting the necessity for early detection and management.

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Left cardiac sympathetic denervation (LCSD) via video-assisted thoracoscopy (VATS) is an effective therapy for drug-refractory malignant arrhythmias in congenital long QT syndromes and requires meticulous perioperative planning in children with automatic implantable cardioverter-defibrillators (AICDs). We describe what is likely the first paediatric VATS-LCSD performed in Pakistan. A boy in early childhood with Jervell and Lange-Nielsen syndrome, severe QT prolongation and recurrent ventricular...

CONCLUSIONS: Pediatric bezoars in this series were associated with psychiatric comorbidities and nutritional compromise. CT was reliable for diagnosis, and most cases required surgical management. No recurrence was observed during follow-up.

CONCLUSIONS: LM during KPE leads to increased intraoperative haemodynamic compromise requiring more intensive anaesthetic management and causes transient postoperative hepatic stress. LM does not appear to negatively affect LT and is associated with improved long-term native liver survival. These findings suggest potential benefits of LM during KPE, warranting further investigation in prospective studies.

CONCLUSION: In this cohort, TAT placement following CDO repair was not associated with earlier enteral feeding, improved postnatal growth, or reduced complications. These findings likely reflect the absence of an optimised nutritional strategy rather than an intrinsic limitation of TAT. A formal alongside nutritional protocol has been developed and is currently undergoing institutional approval prior to prospective evaluation at our centre.

The General Movement Assessment (GMA) according to Prechtl's method has the best predictive value for early detection of Cerebral Palsy (CP) in infants under 5 months of age. However, access to specialists in this assessment is scarce, particularly in lower and middle-income countries. The main objective was to determine the better accelerometric features for distinguishing spontaneous movements of infants with risk factors for CP (RF), and healthy controls (HC), under 9 weeks. We carried out a...

Ureterocele is a congenital dilatation of the distal ureter. Although typically diagnosed prenatally or incidentally, prolapsed ureterocele in a neonate is rare. We report a 13-day-old female infant referred for evaluation of a vulvar mass initially taken for hymeneal imperforation. Prenatal history was unremarkable. Physical examination revealed a reddish vulvar mass with whitish secretions. Pelvic ultrasound demonstrated a duplicated right renal system with a ureterocele, suggesting a...

CONCLUSIONS: Construct and content validity of the KT was demonstrated with significant differences in task performance times between surgical trainees and faculty, suggesting the ability to detect different skill levels. KT may provide a locally available solution for laparoscopic training in sub-Saharan Africa.

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BACKGROUND: Enteric infectious diseases claim more than 1 million lives annually and are among the top ten causes of death in children younger than 5 years. Remarkable global investment has been dedicated to enteric infectious disease prevention and control; however, the shifting global health landscape is testing the continuance of progress. To evaluate the current status and guide future interventions, we present the latest epidemiological estimates of enteric infectious diseases from the...

Currarino syndrome is a rare condition with an incidence of approximately 1 in 100,000. It is characterised by the triad of a sacral defect, a presacral mass and anal atresia or stenosis, and it is commonly associated with genetic mutations in the MNX1 gene.We report a case of an infant presenting with recurrent right gluteal abscess secondary to an infected sacrococcygeal teratoma, associated with anal stenosis. Extensive workup was performed to investigate for the source of her recurrent...

CONCLUSION: This national study provides a near-contemporaneous perspective on neonatal PM and adds to existing evidence of low rates. These data indicate the need to address the root causes of variation in PM completion to ensure equity in the care of families after a neonatal death.

Comprehensive genomic profiling of paediatric tumours has shown promise in guiding precision oncology approaches. However, the clinical utility of targeted sequencing panels in routine practice remains unclear. The results of such testing have not been reported in Southeast Asia. We implemented the AmpliSeq Childhood Cancer Panel for prospective molecular profiling of 130 paediatric patients with various solid tumours. The panel detects single nucleotide variants, gene fusions and...

CONCLUSION: This study showed a significant increase in UC admissions in Australia over the last decade. Medication changes were in line with global trends, and multi-disciplinary care remained inadequate despite national standards. This data provides evidence for planning and resourcing pIBD care nationally and worldwide.

BACKGROUND Stasis within the biliary limb of the Roux loop is rarely reported after successful Kasai portoenterostomy (KPE) for biliary atresia (BA). CASE REPORT This retrospective report describes 2 children (cases 1 and 2, aged 47 and 42 months) who underwent KPE for type 3 BA at 33 and 54 days of life, respectively, with postoperative jaundice clearance at 3 months (total bilirubin levels of 15 and 6 μmol/L, respectively). Both children experienced frequent episodes of cholangitis (5 episodes...

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CONCLUSION: Surgery and perioperative factors induce significant, early microbiome alterations, favouring facultative anaerobes over obligate anaerobes. Although selective digestive decontamination selectively modulates specific taxa, its overall impact on diversity appears less pronounced than surgery and ileostomy status. These findings underscore the need for studies linking perioperative microbiome trajectories to clinical endpoints and for evaluating microbiome-informed perioperative...

Necrotising enterocolitis (NEC) is a disorder characterised by intestinal ischaemia and inflammation. It predominantly impacts preterm and low birthweight infants and carries a high burden of mortality and both short and long-term morbidity for survivors. Postnatal factors such as abnormal bacterial colonisation of the gut (dysbiosis) and formula feeding are known to predispose to the development of NEC. The contribution of the antenatal period to the subsequent development of NEC is poorly...

CONCLUSION: Actigraphy-derived sleep estimates in one-month-old infants are strongly influenced by the choice of activity threshold and time-window duration. Comparing six configurations revealed clear trade-offs: shorter windows increased sensitivity to brief transitions, whereas longer windows reduced fragmentation artefacts and yielded more consolidated sleep periods. These findings underscore the need for standardized parameter settings in early-infancy actigraphy and provide a reproducible...

Epidural catheters are commonly used to provide effective postoperative analgesia and are usually removed without difficulty. We report a case of unexpected resistance during removal of an epidural catheter in an obese adolescent patient. After several unsuccessful manoeuvres, including positional changes and saline flushing, further blind traction was avoided to reduce the risk of catheter fracture or neurological injury. Imaging was done to identify the aetiology, which revealed looping of the...

CONCLUSION: KETOMED is expected to establish evidence supporting the implementation of low-cost preoperative ketonemia screening. The results have the potential to guide clinical practice regarding fasting management and clear fluid administration, ultimately aiming to reduce the incidence of ED and improve the quality and safety of paediatric anaesthetic recovery.

CONCLUSIONS: Partial neonatal intravenous nutritional support using locally available products was feasible and safe across study centers. This approach represents a pragmatic interim strategy in settings where neonatal PN is unavailable. Expanding access to neonatal PN remains essential to achieving Sustainable Development Goal 3.2 to end preventable neonatal deaths by 2030.

CONCLUSION: The study highlights the significant impact of this legislation on clinical practice for DSD in Germany. Our results show that the majority of patients with DSD assessed by the interdisciplinary committee had a diagnosis of CAH or hypospadias. The composition of the interdisciplinary committee is prescribed by law, but the approach to counselling may vary depending on the discussions within the DSD committee. Open questions include reimbursement and evaluation criteria.

CONCLUSION: Meatal stenosis following circumcision for LS is a common finding with an incidence of 12.8% in our study. 73.3% (11/15) of these patients required further surgical management with meatal dilatation and/or meatoplasty. Meatal dilatation was successful in 3/5 patients. Meatoplasty was successful in 6/6 patients. Steroid use was hard to assess due to large variation amongst prescribers. Formulation of a guideline for steroid use in LS patients would help provide consistent care to...

INTRODUCTION: Acute pain is an expected symptom for adolescents after outpatient surgery. In the USA, postoperative analgesic regimens frequently include prescription opioids. Increasing attention from clinicians, patients and other healthcare leaders has been directed toward non-opioid strategies, such as combining non-steroidal anti-inflammatory drugs (NSAIDs) plus acetaminophen, as potential first-line options for managing postoperative pain. However, the effectiveness and safety of home...

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CONCLUSION: Among the nine case, we observed spontaneous regression in six of nine patients. Temporal evolution of lesion volume proved more informative for clinical decision-making than initial imaging characteristics. The adrenocortical carcinoma case illustrates that radiological trend alone does not always determine management, and that clinical context-including genetic predisposition-must guide decisions. Although our small cohort precludes generalizable conclusions, this institutional...

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CONCLUSIONS: Contrast enema showed moderate to high diagnostic accuracy for Hirschsprung disease in this biopsy-constrained setting and may be useful as a triage tool within a limited diagnostic pathway. However, its false negative rate indicates that it should not be used as a standalone rule-out test when histological confirmation is available.

INTRODUCTION: Craniosynostosis, the premature fusion of calvarial bones, requires surgical intervention within a critical time-period. Early referral potentiates the application of less invasive treatments. Previous studies from the United States have demonstrated that socioeconomically disadvantaged groups experience delayed referrals, older age at surgery and require more complex interventions. This study investigated the relationship between socioeconomic status and management for...

CONCLUSION: In PWS, LSG produces clinically relevant early weight loss with partial maintenance at 5 years, but markedly attenuated long-term benefit compared with non-syndromic peers. Nevertheless, when interpreted against the progressive worsening of obesity and cardiometabolic comorbidities observed with lifestyle intervention alone, LSG appears to modify disease trajectory in PWS.

CONCLUSION: Single-use fURS is an effective and safe alternative for the treatment of urological lithiasis in children. It has good results in terms of safety, recovery time, and stone removal, even in coral-shaped or lower calyx stones. These preliminary results suggest that single-use fURS may support an expansion of current ESPU indications, though larger prospective studies are needed to confirm these findings.

CONCLUSION: Midline lumbosacral cutaneous lesions, particularly when multiple or associated with high-risk markers such as lipomas or dermal sinuses, have a significant association with occult spinal dysraphism.

CONCLUSIONS: Non-inferiority of a non-operative treatment strategy for acute simple appendicitis in children could not be proven significantly. Most of the 95% CI was within the 5% non-inferiority margin, however, with a probability of 90.7% that a non-operative treatment strategy resulted in an increase in complications of ≤5%. Absolute risk difference in the proportion of participants with complications was marginal. Surgery was avoided in about 70% of participants in the non-operative...

Inflammatory myofibroblastic tumour (IMT) is an uncommon and enigmatic neoplasm that can imitate a range of other medical conditions, frequently making it difficult to reach an accurate diagnosis. It primarily affects children, though there is a shortage of documented cases in the medical literature. The lungs are the most common location for this tumour to develop and intra-abdominal lesions are rare. Tumours arising from the small intestine and mesentery are exceptionally uncommon. This report...

CONCLUSIONS: Most patients in this study were children aged 0-5 years, highlighting the need for targeted prevention through improved education and stronger, more obvious and clearer warnings on steam inhalation, along with vigilant supervision to reduce these preventable injuries. It is also possible changes could be made in the information given to all parents of a newborn baby in the "Blue Book" in NSW, with mention of this specific mechanism of injury. The upper limbs, particularly the...

INTRODUCTION: Congenital malformations (CMs) are the leading cause of infant mortality. Still, the aetiology remains unknown in 70% of cases. The most accepted hypothesis is that hereditary and environmental elements concur in altering embryo-fetal development. Recently, the role of the environment has been emphasised.Women are exposed to several xenobiotics during pregnancy. This review aims to study the available literature on the exposure of pregnant women to pesticides through drinking water...

CONCLUSION: The study highlights the high prevalence of MRSA in pus and soft tissue infections, with nearly half being PVL-positive. High resistance rates were observed for other antibiotics, particularly ciprofloxacin, erythromycin, and levofloxacin. CA-MRSA infections had a higher PVL positivity rate.

CONCLUSION: While simple drainage of PPE should not be attempted, thoracoscopic decortication and fibrinolysis seem equally effective. There was a shorter treatment duration with thoracoscopic decortication and no increase in complications, so the authors recommend it should be employed promptly when fibrinolysis is contraindicated, as in necrotizing pneumonia.

CONCLUSION: This systematic review highlights the lack of reporting and subgroup analysis in the published literature regarding long-term outcomes of ACE use in children with ARM. These patients differ from those with chronic idiopathic constipation, neurogenic bowel or Hirschsprung disease and, therefore, require an independent assessment of the utility of the ACE. We urge authors to consider children with ARM as a separate group when reporting outcomes of ACE use in future studies.

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CONCLUSION: The outcomes for neonates with surgical NEC in Ireland in our study are favourable compared to the published literature. Our outcomes may be better than published data as they may not reflect a subgroup of patients with NEC in Ireland that never made it to our tertiary institutions for surgical assessment.

CONCLUSIONS: Across Europe, centres broadly endorse risk-adapted care but diverge at key decision nodes-extent of surgery, formal risk framework, and RAIT in low-risk disease-reflecting guidance plurality and organizational context. Leveraging existing infrastructures offers pragmatic avenues to reduce unwarranted variation while generating paediatric-specific evidence to refine recommendations.