Journal of Pediatric Surgery

Disparities in Engagement with an Artificial Intelligence-Based Chat Intervention Post-appendectomy

2026-06-11

Artificial intelligence (AI)-based text messaging, or “chat,” in post-appendectomy care has been shown to decrease preventable emergency department visits. As digital health grows, it is important to assess the impact of technology-based interventions across patients with diverse backgrounds and socioeconomic risk factors. The purpose of this study was to evaluate engagement with an AI-based texting platform for patients with risk factors related to social determinants of health (SDoH).

REGULATORY GENE ANALYSIS IN ENTERIC NEURAL CREST CELLS STRATIFIED BY GDNF ACTIVATION STATUS: AN INSIGHT INTO HIRSCHSPRUNG DISEASE PATHOPHYSIOLOGY.

2026-06-10

Incomplete migration of enteric neural crest cells (ENCCs) into the colon underlies the pathogenesis of Hirschsprung disease, resulting in aganglionosis and disordered intestinal motility. Although activation of the glial cell line-derived neurotrophic factor (GDNF) pathway has been implicated in neurosphere differentiation, specific regulatory genes governing ENCC differentiation and proliferation remain poorly characterized. This study seeks to elucidate regulatory genes and pathways involved in neural crest cell differentiation, furthering our understanding of GDNF’s role in enteric nervous system development.

Patient Reported Outcomes After Subtotal Colectomy in Pediatric Therapy-resistant Constipation: a combined retrospective and cross-sectional study

2026-06-08

Current literature on outcomes after subtotal colectomy for therapy-resistant constipation (TRC) in the pediatric population is scarce. We aimed to review clinical outcomes, postoperative complications and health-related quality of life (HRQoL) after subtotal colectomy in children with TRC.

Short Term Complications of Persistent Cloaca Reconstruction – A Single-Institution Review of 53 Cloacal Reconstructions

2026-06-07

To describe short-term complications following cloaca repair and evaluate their relationship with cloaca complexity.

Beyond the Pull-Through: A Multi-Institutional Study of Long-Term Surgical and Functional Outcomes in Total Colonic Hirschsprung Disease – A Pediatric Colorectal and Pelvic Learning Consortium (PCPLC) Study

2026-06-06

Total colonic Hirschsprung disease (TCHD), a severe Hirschsprung disease variant (∼5–10% of cases), is defined by aganglionosis of the entire colon. This study evaluates short-term surgical outcomes and long-term functional results in children with TCHD.

Association of Small Intestinal Atresia and Hirschsprung Disease in a Multi-institutional Colorectal Registry

2026-06-06

Unlike colonic atresia, concomitant jejuno-ileal atresia (JIA) and Hirschsprung disease (HSCR) is an under-recognized association. We used a multi-institutional patient registry to describe the incidence, clinical characteristics, management, and outcomes of patients with both conditions.

Impact of Trisomy 21 on post pull-through Enterocolitis and Bowel Function in children with Hirschsprung Disease: A PCPLC Analysis

2026-06-06

We evaluated whether Trisomy 21 (T21) affected bowel management use, ability to toilet train for stool, and rates of Hirschsprung-Associated Enterocolitis (HAEC) in children with Hirschsprung disease (HD). We hypothesized that T21 would be associated with increased rates of HAEC, bowel management program (BMP) use, and delayed toilet training for stool.

Trans-anastomotic Tube Feeding Following Repair of Congenital Duodenal Obstruction: A 15-Year Single-Centre Cohort Study

Aleksandra Nowak, Dr Dean Rex, Dr Sandeep Shetty, Dr Anay Kulkarni — 2026-06-05

To evaluate the association between trans-anastomotic tube (TAT) placement and feeding outcomes following surgical repair of congenital duodenal obstruction (CDO).

Predictors of residual fragments and hemorrhagic complications after pediatric mini-percutaneous nephrolithotomy: a retrospective cohort analysis of 371 renal units

2026-06-05

Pediatric renal stone surgery aims to achieve complete stone clearance with minimal perioperative morbidity. Mini-percutaneous nephrolithotomy (mini-PCNL) is widely used for larger stones, yet factors influencing postoperative residual fragments and bleeding risk in children are not fully clarified. This study evaluated outcomes after pediatric mini-PCNL and identified predictors of residual fragments and bleeding-related morbidity in a large single-center cohort.

Clinical outcome and long-term quality of life in patients treated for gastroschisis – Results from a national study

2026-06-05

Gastroschisis is the most common type of congenital abdominal wall defects. The survival rate is close to 100% in high-income countries, but knowledge on long-term outcomes is limited. Particularly, long-term quality of life (QoL) is scarcely reported. The aim of this study was to explore long-term clinical outcomes and to investigate patient-reported gastrointestinal and generic QoL in gastroschisis patients.

Does the need for early cutaneous vesicostomy correlate with poor urinary outcomes in girls with cloacal malformation?

2026-06-05

In the neonatal period, children with cloacal malformation may require bladder drainage with a vesicostomy. Little is known if vesicostomy creation in these patients affects long-term urinary outcomes, specifically volitional voiding rates and continence rates. Our objective was to determine whether the requirement of vesicostomy at birth is a predictor of worse urinary outcomes for patients with cloacal malformation.

Postoperative pain after low-pressure versus standard-pressure laparoscopic surgery in children. A randomized clinical trial.

2026-06-04

Children still suffer from substantial pain after laparoscopic surgery. It has been hypothesized that low-pressure pneumoperitoneum reduces postoperative pain after laparoscopic surgery. However, this has not yet been studied in school-aged children. Our objective was to determine whether low-pressure pneumoperitoneum (LPP) reduces postoperative abdominal pain compared to standard-pressure pneumoperitoneum (SPP) in children undergoing laparoscopic appendectomy for acute appendicitis.

Report of Pediatric Colorectal and Pelvic Reconstruction Conference

2026-06-04

The Pediatric Colorectal and Pelvic Learning Consortium (PCPLC) was established in 2016 as an international consortium of surgeons, scientists, and allied specialists with the primary goal of facilitating research to improve the care of patients with anorectal malformations (ARM), Hirschsprung disease (HD), intestinal dysmotility, fecal incontinence, and other colorectal and pelvic disorders. Surgical care and long-term follow up are required for these patient populations and are paramount to improving overall health, functional outcomes, and quality of life.

Shifting Pediatric Operative Experience in the Era of Fellowship Expansion: A National Analysis of Residents, Fellows, and the Match

2026-05-29

Pediatric surgery remains a highly competitive subspecialty. Prior work has shown declining operative experience for pediatric surgery fellows, but the broader impact of the increasing number of pediatric surgery fellowships on residents’ exposure to and interest in pediatric surgery has not been characterized at the national level during this time period.

A national analysis of social drivers of health and post-operative outcomes in previously healthy children.

2026-05-26

To better understand the relationships between social drivers of health (SDoH) and pediatric surgical outcomes, we examined neighborhood-based SDoH and surgical outcomes in a national cohort of children with low baseline surgical risk.

Letter to the Editor Comment on: Subclavian approach without ultrasound guidance is safe and effective for pediatric central venous access

2026-05-26

We read with interest the recent article by Mayon and colleagues describing a single-center cohort of 713 pediatric and adolescent/young adult oncology patients undergoing central venous access device (CVAD) placement [1]. The authors reported low immediate mechanical complication rates using a landmark-based subclavian approach without ultrasound (US) guidance, including pneumothorax (0.3%) and postoperative bleeding (0.7%), and concluded that this technique remains “safe and effective,” despite the 2011 recommendations from the American College of Surgeons supporting real-time US guidance.

Comparing Neighborhood Deprivation Metrics in Pediatric Trauma: Is There a Better Predictor?

2026-05-25

Neighborhood deprivation (ND) impacts pediatric trauma, the leading cause of mortality in children. The aim of this work was to compare the association of three common neighborhood deprivation metrics (NDMs) with pediatric trauma mechanisms and injury severity.

Letter to the Editor Comment on; Surgical Risk, Operative Time, and Anesthesia Time Associated With Combining Tracheostomy and Gastrostomy Tube Placement Under a Single Anesthetic

Abhishek Prasad, Bhuvan — 2026-05-17

We read with great interest the study by Cooke et al. [1], examining the combined tracheostomy and gastrostomy tube placement under a single anesthetic in infants.

Imposter syndrome: Reframing self-doubt in medicine

Holland Kaplan, C. Phifer Nicholson, Mary L. Brandt — 2026-05-09

Since it was first described in 1978, there have been over 15,000 publications in the academic and lay press on “imposter syndrome,” a form of distress commonly observed in high-achieving professionals. With the best of intentions, clinicians and researchers have approached this phenomenon with the same medical framework used to diagnose, prevent, and treat illness. In this paper, we review how the concept of the imposter syndrome evolved and argue that conceptualizing this phenomenon as a medical condition to be treated on an individual basis limits our understanding of the phenomenon and our ability to relieve the distress it causes.

Letter to the Editor comment on: Subclavian approach without ultrasound guidance is safe and effective for pediatric central venous access

Xinyue Zhang, Ruyuan Zhang — 2026-05-08

We read with great interest the recent article by Mayon et al. reporting that subclavian central venous access without ultrasound (US) guidance is “safe and effective” in children and adolescents and young adults [1]. The authors are to be commended for presenting a large, prospective cohort within a standardized perioperative protocol.

Letter to the Editor in Response to: Neurodevelopmental outcomes and long-term quality of life in esophageal atresia: A narrative review

Xiaoqian Zhang, Guobin Liu — 2026-05-05

We read with interest the narrative review by Doucet et al. [1], which helpfully shifts attention from survival after esophageal atresia repair to developmental and quality-of-life outcomes. In a field where long-term counseling often lags behind improvements in perioperative care, that emphasis is timely and clinically useful.

Letter to the Editor Comment on: Clinical characteristics and mortality prediction in neonatal gastric perforation: Insights from a regional multicenter retrospective cohort study

Jie Li, Yemin Cao — 2026-05-05

We read with interest the multicenter cohort by Fang et al., which assembles 83 neonatal gastric perforation cases across four hospitals and points to two correlates—distal gastrointestinal obstruction and a symptom-to-surgery interval ≥24 h—while also tempering a simplistic etiologic reading of muscular layer defects [1]. For a rare condition, that dataset is valuable.

Letter to the Editor Comment on: The physiological mirage: Why oxygen pulse overstates surgical success in pectus excavatum

2026-05-04

We read with interest the correspondence by de Paoli et al. regarding the interpretation of oxygen pulse (VO2/HR) after minimally invasive repair of pectus excavatum (MIRPE) [1]. While the authors raise relevant methodological concerns, describing postoperative changes as a “physiological mirage” risks oversimplifying a complex physiological response.

Letter to the Editor comment on: Progression of esophageal atresia associated Barrett's esophagus in adulthood – Is endoscopic surveillance worth it?

2026-04-29

We commend Koivusalo et al. for highlighting surveillance endoscopy in esophageal atresia (EA) [1]. While their study of 71 adults with repaired type C EA identified increasing rate of Barrett's esophagus with age and zero cases of adenocarcinoma, their recommendation against surveillance before age 50 warrants caution. This conclusion, based on a small retrospective cohort and absence of adenocarcinoma, contrasts with reports of esophageal adenocarcinoma in EA patients as young as 20 years [2].

Physician guideline for pediatric palliative ECMO discontinuation

2026-04-29

Terminal discontinuation of pediatric extracorporeal membrane oxygenation (ECMO) can be one of the most challenging moments in critical care. Despite its significance, physician experience varies widely, and no standardized framework currently guides procedural, ethical, and family-centered aspects of palliative ECMO withdrawal.

Intraoperative ultrasound in nephron-sparing surgery for paediatric renal tumours: A single-centre cohort study

2026-04-27

Nephron-sparing surgery (NSS) for paediatric renal tumours seeks maximal parenchymal preservation. However, incomplete tumour excision often requires additional therapy impacting renal function. We evaluate the impact of intraoperative ultrasound on histological margins during NSS (US-NNS).

Surgical nodal staging in rhabdomyosarcoma of the bladder and/or prostate with or without nodal or metastatic spread. A report from the European Paediatric Soft-Tissue Sarcoma Study Group (EpSSG)

2026-04-27

Risk stratification of rhabdomyosarcoma (RMS) requires accurate staging, with histological nodal assessment being of critical importance for specific tumour sites. This report explores the value of surgical nodal staging in bladder-prostate rhabdomyosarcoma (BP-RMS).

Deep learning-based Wilms tumor segmentation to create 3D models for surgical planning: Implementation in the clinical workflow

2026-04-25

Creating 3D models based on pre-operative MRI of patients with a Wilms tumor (WT) can aid surgical planning. However, creating these models requires manual delineation (segmentation) of the MRI imaging. Deep learning can automate this, but most validations of these segmentation methods are retrospective. This article prospective evaluation of a WT segmentation method in a clinical workflow aimed at creating 3D models for surgical planning.

Artificial intelligence in rare pediatric solid tumor research and clinical care: A scoping review

2026-04-16

Clinical and research advances for children with solid tumors are limited by their rare nature. Artificial intelligence (AI) and machine learning (ML) hold potential for advancing diagnosis, risk stratification, and treatment in rare diseases where individual patients contribute high-dimensional data. This review characterizes current AI/ML applications in rare pediatric solid tumors.

Are purely cosmetic procedures appropriate for the management of pectus excavatum? A qualitative study of pediatric surgeons

2026-04-06

Pectus excavatum (PE) is the most common congenital chest wall deformity, characterized by posterior displacement of the sternum and costal cartilages leading to a concave anterior chest wall. While the Nuss procedure is the current gold standard for surgical management of PE, some children experience significant psychosocial distress related to the appearance of their chest but do not meet the standard Haller index threshold of 3.2 for surgical repair [1]. Others may meet criteria but are not interested in the invasiveness of the Nuss procedure.

Button battery ingestion clinical practice guidelines: An APSA Quality and Safety Committee appraisal

2026-03-31

Expeditious endoscopic retrieval of esophageal button batteries is crucial to minimize injury and associated complications [1,2]. As such, the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) have authored recommendations for their removal “immediately” and within 2 h of presentation, respectively [1,2]. Standardization of clinical management of button battery ingestion has been shown to decrease time to removal, reduce unnecessary imaging studies, and improve patient triage [3].

Malignant transformation of sacrococcygeal teratoma versus presacral teratoma in Currarino syndrome: Results of ‘The SCT-study’

2026-03-29

The risk of malignant transformation and recurrence of Sacrococcygeal Teratoma (SCT) is relatively high, while it is possibly lower in cases associated with Currarino Syndrome (CS). However, the existing literature gives contradictory results. We aimed to examine the risk of malignant transformation in a large cohort of SCT and CS patients.

Letter to the Editor comment on: Safety and feasibility of paediatric day case laparoscopic upper gastrointestinal surgery: Significance of nurse-led discharge

Jasmi Johnson, Dipti Shukla, Kamala Kant Parashar — 2026-03-27

Sabol et al. [1]. evaluated nurse-led discharge pathways for pediatric day-case laparoscopic upper GI surgery cholecystectomy, fundoplication, and Heller myotomy in a single-centre cohort. No 30-day readmissions, nearly half discharged early. For procedures that had defaulted to overnight admission, these outcomes support the need to re-evaluate the default duration.

Letter to the Editor: Pre- or intra-operative fecal diversion for children with a delayed diagnosis of Hirschsprung disease

2026-03-27

Children with Hirschsprung disease who present in a delayed fashion pose a clinical challenge for many pediatric surgeons. These children often present with massively dilated proximal bowel, increasing the technical difficulty of the pull-through operation, making the anastomosis more prone to leak [1]. Creation of a diverting stoma (either before or at the time of pull-through) is a strategy commonly used to mitigate this risk [2]. However, clear evidence to support this practice is lacking.

Letter to the Editor Comment on: The safety of conservative management of asymptomatic congenital pulmonary airway malformations (CPAMs) in children: A systematic review

Di Lian, Chenye Lin — 2026-03-25

We read with great interest the systematic review by Thorburn et al., which provides timely evidence supporting the safety of expectant management in asymptomatic CPAM patients [1]. We commend the authors for their rigorous methodology and valuable contribution to this ongoing debate. While the findings are reassuring, we wish to highlight a critical issue that warrants further discussion: the substantial heterogeneity in follow-up duration and protocols across included studies, and its implications for interpreting long-term safety.

Invited commentary on: Can indocyanine green fluorescence aid operative decision making in neuroblastic tumor surgery? Early experience from a single centre

2026-03-23

We read with great interest the report by Pachl et al. [1]. on the use of indocyanine green (ICG) near-infrared (NIR) fluorescence to support intraoperative decision-making during neuroblastic tumor biopsy and resection.

Letter to the Editor Comment on: Arnold Schwarzenegger or Danny DeVito? The Fate of Twins With Necrotizing Enterocolitis in the NICU

Kaan Sonmez, Cem Kaya, Ramazan Karabulut, Zafer Turkyilmaz — 2026-03-21

We read with great interest the article by Hellmann et al. titled “Arnold Schwarzenegger or Danny DeVito? The fate of twins with necrotizing enterocolitis in the NICU” [1]. In this comprehensive study, which is a major source in the literature, data from infants admitted to neonatal intensive care units between 2017 and 2023 were collected, and multiple pregnancies were identified in 8158 (3.2%) of 253,574 neonatal intensive care unit (NICU) infants. Although the probability of developing necrotizing enterocolitis (NEC) was found to be lower in multiple pregnancies compared to single births, if NEC develops in one infant in a set, the probability of the second sibling developing NEC was found to be higher than in the general NICU population (16.4% vs 2.6%, p < 0.01) [1].

Letter to the Editor Comment on: Development and validation of a predictive model for bile leakage after choledochal cyst excision in children: A multicenter retrospective cohort study

Xin Wang — 2026-03-20

I read with interest the recent multicenter study by Ding et al. [1], which develops and externally validates a nomogram for predicting postoperative bile leakage in children undergoing choledochal cyst excision. The rigorous methodology—combining LASSO regression, bootstrap internal validation, and an independent external cohort—offers a meaningful contribution to perioperative risk stratification in pediatric biliary surgery. Several points, however, merit further discussion.

Letter to the Editor Comment on: Vascular access in neonates and children: Techniques for the pediatric surgeon

Maurizio Pacilli, Mauro Pittiruti — 2026-03-20

We read with interest both the recent article “Vascular Access in Neonates and Children: Techniques for the Pediatric Surgeon” by Drucker et al., published on behalf of the American Pediatric Surgical Association (APSA) Surgical Critical Care Committee, and the accompanying invited commentary by Huntington and Paredes [1,2]. The authors provide a comprehensive technical overview that seeks to preserve surgical skills in "an era dominated by ultrasound-guided inserted vascular devices", such as peripherally inserted central catheters (PICC).

Letter to editor comments on: Antegrade continence enema treatment can lead to proximal colonic dilation while preserving motility in children with constipation

Haiyan Lei, Huan Li, Hongqiang Bian, Jun Yang — 2026-03-17

We read with interest the retrospective study by van der Zande and colleagues [1] evaluating colonic motility and anatomy in 70 children treated with antegrade continence enema (ACE). The authors report proximal colonic dysmotility in 6% and proximal dilation in 20% of patients with paired contrast enema (CE) data, with longer ACE duration as a contributing factor. This work addresses an important clinical question. However, we wish to raise three methodological considerations.

Why some children die more often in crashes—and what surgeons can do to change this

Shanquell M. Dixon, Keyonna M. Williams, Erin M. Garvey, Morgan K. Richards — 2026-03-17

“Child was not properly restrained.” Almost every pediatric surgeon has heard these words during a trauma activation, and we all have the same visceral reaction. Why? In 2023, 559 children in America died in a motor vehicle crash and 34% of them were unrestrained [1]. Despite the growth of the child passenger safety restraint industry, increased enforcement of traffic safety laws, and development of injury prevention programs focused on car seat safety there are still some children at an increased risk of death from motor vehicle crashes due to sociodemographic factors.

Letter to Editor Comment on: Outcomes following adoption and integration of robotic-assisted cholecystectomy for pediatric biliary tract disease: An eight-year, single-center experience

Fanchang Wang, Yuxin Ni, Xiaoming He — 2026-03-16

We read with interest the report by McRae et al. describing the largest single-center pediatric robotic-assisted cholecystectomy (RAC) experience to date [1]. The low complication rates across both RAC and laparoscopic cholecystectomy (LC) groups are reassuring. That said, several points deserve further consideration.

Letter to editor comment on: Angioembolization versus surgical repair in pediatric liver trauma: A propensity score–matched analysis of TQIP data

Hongyang Qiao, Hongxin Zhou, Feng Wang — 2026-03-16

We read with interest the study by Zhang et al. comparing angioembolization (AE) with surgical repair (SR) in pediatric liver trauma using the TQIP database [1]. This is the first national propensity score–matched analysis on this topic, and the findings make a persuasive case for broader consideration of AE in selected pediatric patients.

Letter to the editor comment on “A randomised study examining the utility of lauromacrogol foam sclerotherapy vs pingyangmycin in treatment of pediatric lymphatic malformations a single center report from China”

Vibhor Kumar Jain, Bindu Jain, Saurabh Agrawal — 2026-03-16

We read with great interest the randomized clinical study by Song et al. [1]. evaluating the efficacy and safety of ultrasound-guided lauromacrogol foam sclerotherapy compared with pingyangmycin for the treatment of pediatric lymphatic malformations. The authors should be commended for conducting a randomized trial addressing an important therapeutic question in the management of these challenging congenital vascular anomalies. Their findings suggest that lauromacrogol foam sclerotherapy provides comparable efficacy while reducing the number of treatment sessions and adverse events, which is particularly valuable in pediatric populations, where minimizing procedural burden and toxicity is essential.

Invited commentary on McRae, et al: Outcomes following adoption and integration of robotic-assisted cholecystectomy for pediatric biliary tract disease: An eight-year, single center experience. From adoption to integration: The maturation of pediatric robotic cholecystectomy

Katlyn G. McKay, Irving J. Zamora — 2026-03-12

Robotic surgery has become an increasingly important part of pediatric surgical practice over the last two decades. Early reports demonstrated that procedures such as fundoplication, cholecystectomy, and splenectomy could be performed safely using the robotic platform, and since then the technology has expanded into more complex abdominal and thoracic operations [1,2]. While adoption in pediatrics has been slower than in adult surgery, use continues to grow as surgeons recognize the advantages of improved visualization, instrument articulation, and surgeon ergonomics, particularly in technically demanding cases [2].

Congenital esophageal stenosis related to tracheobronchial remnant: Balloon dilatation versus resection and anastomosis - A systematic review

Miroslav Koychev, Oliver J. Muensterer — 2026-03-11

Congenital esophageal stenosis (CES) related to tracheobronchial remnant (TBR) is an extremely rare malformation, typically diagnosed in infants and young children. Endoscopic dilatation or resection and anastomosis are both accepted therapeutic options, but the superiority of one versus the other remains controversial.

The ethical dilemmas in the face of resource limitations for children needing surgery

2026-03-11

Children living in remote and Indigenous communities in Canada often face significant barriers to timely surgical care due to geographic isolation, limited local resources, and financial pressures within a publicly funded healthcare system. These challenges frequently create ethical dilemmas for clinicians and families, who must choose between delaying care for transfer to a tertiary center or proceeding locally with limited expertise. This paper explores three illustrative cases including emergent neonatal volvulus with no possibility of transfer, pyloric stenosis with family-declined transfer, and elective hernia repair with family-requested transfer.

Applicant assessment of a hybrid interview format for pediatric surgery fellowship

2026-03-10

The COVID-19 pandemic demanded organizations drastically shift methods of communication to maintain essential functions, prioritizing virtual over in-person interactions. Many changes have endured and redefined communication. The pediatric surgery fellowship recruitment and interview process was acutely interrupted by the pandemic, and what was previously a time for programs and applicants to meet in person to share commonalities and find best fits became technological glitches and awkward first meetings over videoconference.

Letter to the editor comment on: Generative AI and medical writing: Malfeasance or misdemeanour?

Hongnan Ye — 2026-03-09

Davenport and Tam's insights on artificial intelligence (AI) in medical writing are timely and valuable [1]. As a researcher and author, two questions have been occupying my thoughts.

Letter to the editor comment on: A novel subvacuum dressing to treat superficial second-degree burn wounds in children: A prospective, randomized, noninferiority, multicenter study

Ao Wang, Mengmeng Zhuang, Yong Sun — 2026-03-09

We read with great interest the article by Hu et al. published in the Journal of Pediatric Surgery [1], which compared the efficacy and safety of a novel sub-vacuum dressing with MepilexXT in treating superficial second-degree burns in children. We commend the authors for addressing the urgent clinical need for pediatric-friendly burn dressings in this multicenter study. However, we believe that accurately identifying the primary source of the noninferiority of the novel subvacuum dressing is crucial for optimizing pediatric burn care in the future.

Combined procedures in a single pediatric anesthesia episode

Rebecca Hong, Bishr Haydar — 2026-03-07

The practice of combining multiple procedures into a single anesthesia episode varies widely between children's hospitals [1]. This can result in improved access to care and convenience for the family, but with important downsides, both surgically and for the healthcare system. In this Perspectives article we will focus on combined procedures that involve multiple surgical subspecialties, as well as those that are combined with imaging in the radiology suite. We will discuss logistical considerations, putative benefits and downsides, including adverse events and complications.

Intraoperative fluorescence quantification of organ perfusion: Insights for future applications

2026-03-07

Indocyanine green (ICG) fluorescence imaging is increasingly used intraoperatively to assess tissue perfusion and guide surgical decision-making. While its qualitative use has been associated with improved outcomes, including reduced anastomotic leak rates, interpretation remains subjective and lacks standardization. Quantitative fluorescence analysis may improve reproducibility, precision, and broader clinical applicability.

Letter to the editor comment on: Opioid-sparing utility of subcutaneous analgesia systems in pediatric oncology patients following major tumor resection surgery: A matched case-control study

Neeraj Singh, Monika Srivastav — 2026-03-06

We read with great interest the matched case control analysis by Tham and colleagues evaluating subcutaneous analgesic systems (SAS) in pediatric oncology resections [1]. Focused matching by age and incision site and standardized conversion to oral morphine equivalent daily dose provide a clinically relevant framework for comparing postoperative opioid exposure. The topic is timely given the need for opioid minimization in vulnerable pediatric populations.

Letter to the editor comment on: Is 24 h enough? Evaluating prophylactic antibiotic duration after abdominal wall closure in neonatal gastroschisis

Riteshkumar Arya, Amruta Desai, Rajni Prakash — 2026-03-06

We read with interest the study by Zrinyi et al. [1]. examining whether discontinuation of prophylactic antibiotics within 24 h after abdominal wall closure increases the infection risk in neonates with gastroschisis managed with a silo. The authors are to be commended for directly addressing an important evidence gap underpinning the current American Pediatric Surgical Association (APSA) recommendations [2].

Feasibility and safety of laparoscopic versus open repair for rectobulbar fistula in anorectal malformations: A systematic review and meta-analysis

2026-03-06

Laparoscopic-assisted Anorectoplasty (LAARP) for male recto-bulbar fistula (RBF) remains debated, with early reports describing approach-specific complications. Prior meta-analyses pooled heterogeneous Anorectal malformation (ARM) subtypes, limiting conclusions for RBF. We conducted an RBF-specific systematic review and meta-analysis comparing LAARP with posterior sagittal anorectoplasty (PSARP).

Defining radiological progression in children who have ingested multiple magnets using a novel objective tool applied to abdominal radiographs

2026-03-05

The decision to operate on asymptomatic children who have ingested multiple magnetic objects is based on a subjective assessment of magnet progression via serial abdominal radiographs at non-standardised time-points. We aimed to develop an objective tool to identify non-progression on serial abdominal radiographs.

Letter to the editor comment on: Long-term follow-up in patients with anorectal malformation: MRI findings in relation to bowel function

Ahmad Shafi Antar, Asia Sharifi, Nuqba Mohinoor — 2026-03-03

We read with great interest the article by Huijgen et al., entitled "Long-term follow-up in patients with anorectal malformation: MRI findings in relation to bowel function" [1]. The authors should be congratulated on their comprehensive assessment of post-reconstruction pelvic anatomy and on highlighting the increasing role of MRI in the follow-up of adolescent ARM patients. Their study provides anatomical correlates as well as valuable insights for transitional care.

Pre-circumcision screening for genital anomalies: 6-year experience from Pakistan

2026-03-03

Pre-circumcision genital screening enables early detection of anomalies that contraindicate the procedure and require specialist management. In Pakistan, where most circumcisions are performed by untrained providers, such screening is rarely practiced. This study evaluated the effectiveness of training health workers (HWs) to identify genital anomalies through a structured Safe Circumcision Program (SCP).

Paediatric robotic surgery simulation: Results of a national survey and scoping review

2026-03-03

The present nationwide survey combined with a scoping review aimed to provide an overview of current paediatric robotic-assisted surgery (RAS) training practices in France, focusing on simulation tools and evaluation methods.

Letter to the Editor: preservation of the azygos vein in esophageal atresia repair: a comparative analysis of recent meta-analyses

Elif Yüksel, Tutku Soyer — 2026-03-02

Since the first description of primary repair for esophageal atresia (EA), the core surgical technique has remained largely unchanged; however, preservation of the azygos vein (AV) has increasingly been advocated as a preferred approach in recent years. The AV is a major vessel responsible for venous drainage of the esophagus and mediastinum, and a portion of the lymphatic flow also drains into this system. It has been proposed that preservation of the AV may reduce esophageal anastomotic edema and mediastinal inflammation by maintaining adequate venous outflow [1].

Letter to the editor comments on: Transanal irrigation in pediatric bowel dysfunction: A prospective study on clinical outcomes and quality of life

Ismael Elhalaby, Omar Koura, Mustafa Azizoglu, Essam Elhalaby — 2026-03-02

Di Mitri and colleagues' timely prospective study adds to the growing literature validating transanal irrigation (TAI) as a potent tool for achieving fecal continence in children with complex colorectal disorders [1]. The reported significant improvements in symptoms, medication burden, and quality of life are compelling. However, their data, viewed through the broader historical and comparative context, invite a deeper exploration of the fundamental dilemma facing pediatric colorectal specialists: the choice between retrograde (TAI) and antegrade (ACE) enema routes.

Letter to the editor comment on: Two-stage fowler-stephens orchidopexy in management of undescended testes: Is it time for a change?

Cyrine Saadi, Souha Laarif, Malak Boughdir, Youssef Hellal — 2026-03-02

We read with great interest the article “Two-Stage Fowler-Stephens Orchidopexy in Management of Undescended Testes: Is It Time for a Change?” and congratulate the authors for addressing this challenging issue in the management of high intra-abdominal testes through an important multicenter outcome.

Letter to the editor comment on: Long-term follow-up in patients with anorectal malformation: MRI findings in relation to bowel function

Huan Li, Jun Yang — 2026-03-02

We read with interest the report by Huijgen, et al., linking level-specific pelvic floor MRI anatomy with bowel function after anorectal malformation (ARM) repair. A particularly actionable finding was puborectalis muscle (PRM)-level lateralization of the pull-through—i.e., a “Y-shaped” PRM with the rectum coursing through one limb—observed only in complex ARMs [1].

Angioembolization versus surgical repair in pediatric liver trauma: A propensity score–matched analysis of TQIP data

2026-03-02

Liver trauma is a leading cause of pediatric mortality, yet consensus on optimal intervention in children remains unclear. Angioembolization (AE), widely adopted in adults, remains underutilized in children. We hypothesized that AE would be associated with lower in-hospital mortality than surgical repair (SR).

Long-term nephro-urological follow-up after Hellstrom-Chapman vascular hitch: A safe and effective procedure preserving renal perfusion

2026-03-02

Primary cause of extrinsic ureteropelvic junction obstruction is the crossing of accessory renal pole vessels. Vascular hitch (VH) is a safe and efficient procedure. The study aimed to analyze its long-term outcomes for renal perfusion and function.

Limitations of adult post-hepatectomy liver failure criteria in pediatric liver tumor surgery: A single-center retrospective study

2026-03-02

Post-hepatectomy liver failure (PHLF) is a major concern after extensive liver resection. Adult volumetric rules (20/30/40 rules) and International Study Group of Liver Surgery (ISGLS) definitions are often applied to children, but their relevance is unclear. We evaluated PHLF incidence and course in a pediatric surgical series, with attention to salvage liver transplantation (SLTx).

Definitive surgery for Hirschsprung Disease between 3 and 12 months achieves best outcomes: A systematic review with meta-analysis

2026-03-02

Optimal age for definitive pull-through in Hirschsprung disease (HD) is debated. Both early and delayed interventions may influence short- and long-term outcomes, but current guidelines do not provide a clear recommendation.

Robotic surgery for pancreatic disorders in children: Insights from two centers

XiaoLi Chen, Yong Zhan, QingJiang Chen, ZhiGang Gao — 2026-02-26

This study aimed to present our experience in applying robotic-assisted surgery for managing pancreatic disorders in children.

Antegrade continence enema treatment can lead to proximal colonic dilation while preserving motility in children with constipation

2026-02-26

The aim of this study was to evaluate colonic motility and anatomy in children treated with antegrade continence enema (ACE), utilizing colonic manometry (CM) and contrast enema (CE) studies.

A randomized control trial for assessing virtual reality for perioperative anxiolysis and postoperative pain modulation in adolescents undergoing MIRPE

2026-02-26

Pectus deformities, including pectus excavatum, are associated with psychosocial burden and in severe cases impaired cardiorespiratory function. Minimally invasive repair of pectus excavatum (MIRPE) is the standard corrective surgery; however, the postoperative pain can be significant. Patients’ perioperative anxiety can be severe as they are cognitively aware of the awaiting surgical challenges but often lack effective coping strategies. Virtual reality (VR) is a non-invasive, non-pharmacological modality that has shown promise in reducing anxiety and modulate pain in the pediatric population.

Standardized prospective multidisciplinary follow-up of patients with surgical congenital malformations: A model for continuous data driven improvement of health care

2026-02-26

Congenital malformations requiring surgery are rare conditions, and despite decreasing mortality, these conditions are associated with substantial morbidity. Although research on outcomes of these patients is mostly focused on short term somatic outcomes, emerging evidence suggests morbidity in other aspects of functioning, such as neurodevelopmental impairment and impaired psychosocial functioning. Therefore, prospective multidisciplinary follow-up is important. Moreover, standardizing follow-up creates the opportunity to use data collected in follow-up for routine outcome monitoring aimed at healthcare evaluation and improvement of patient outcome, and for scientific research.

Laparoscopic versus open ileal Pouch-Anal anastomosis in paediatric patients: A systematic review and meta-analysis

2026-02-25

Restorative Proctocolectomy (RP) with Ileal Pouch-Anal Anastomosis (IPAA) represents the gold-standard surgical treatment for patients requiring total colonic and rectal removal due to ulcerative colitis, familial adenomatous polyposis, and other colonic pathologies. The laparoscopic approach (L-IPAA) has been increasingly utilized in pediatric and young adult populations to enhance recovery and reduce morbidity; however, its benefits over open surgery (O-IPAA) remain uncertain. This meta-analysis aimed to compare outcomes between L-IPAA and O-IPAA, focusing on complications, operative time, and length of hospital stay (LOS).

Inverted V–I MeatoGlanuloplasty (IV-IMG): Twenty years’ experience with a new technique for distal hypospadias repair

2026-02-25

No Urethroplasty Techniques (NUTs) are technically simple, low-morbidity alternatives to urethroplasty for the correction of distal hypospadias. Along with functional outcomes, cosmetic results have become increasingly relevant in recent years. Despite the high number of techniques, some drawbacks remain in achieving these goals. The aim of this paper is to describe the Inverted V–I MeatoGlanuloplasty technique, developed at our center for the treatment of distal hypospadias and to evaluate its outcomes.

Letter to the Editor Comment on: Preservation of the azygos vein versus ligation of the azygos vein during surgical repair of esophageal atresia-tracheoesophageal fistula-a systematic review and meta-analysis

Divya Mishra, Syed Moiz Ahmed, Shantanu Shubham — 2026-02-24

We read with interest the systematic review and meta-analysis by Shahid et al. [1]. comparing preservation versus ligation of the azygos vein during primary repair of esophageal atresia with tracheoesophageal fistula. The authors synthesized an important body of literature addressing a long-standing technical debate in pediatric surgery, and their effort to pool randomized and non-randomized evidence is commendable.

Survival in children with hepatoblastoma and pulmonary metastatic disease at diagnosis based on extent of metastases and need for surgical clearance

2026-02-23

This study analyzed the effect of pulmonary metastatic burden at diagnosis and response to chemotherapy on disease-free and overall survival in patients with hepatoblastoma (HB), hypothesizing that long-term survival can be achieved in the setting of extensive pulmonary metastatic disease requiring metastasectomy.

Skip segment Hirschsprung Disease: Unicentric experience with four cases and systematic literature review

2026-02-22

Skip lesion aganglionosis is characterized by intestinal aganglionosis interrupted by portions of normally ganglionated bowel that is located in between segments of aganglionosis. Even though this is a well-known entity, only scattered cases have been reported so far. The aim of this manuscript is to present our series of patients and perform a systematic literature review, to offer a critical overview of possible management.

Bedside surgery in neonates: Reaffirming the importance of contextual interpretation

Fabiola Cassaro, Pietro Impellizzeri, Carmelo Romeo, Salvatore Arena — 2026-02-20

We thank Pio et al. [1] for their thoughtful and constructive perspective on our recent meta-analysis comparing bedside and conventional surgery in critically ill neonates [2]. We welcome their clinical interpretation and their highlighting of key considerations that closely align with the cautions we raised in our original report. We agree that mortality differences must always be interpreted within the appropriate clinical context.

Revisiting the mini open thoracoscopically-assisted anterior (MOTA) approach for thoracic and thoracolumbar spine exposure in adolescent idiopathic scoliosis: A single institution experience

George Youssef, Olgerta Mucollari, Jeanne Wu, Baron Lonner, Sergei Dolgopolov — 2026-02-20

Surgical correction of adolescent idiopathic scoliosis (AIS) has traditionally relied on posterior spinal fusion (PSF). However anterior vertebral body tethering (VBT) has offered a motion-preserving alternative that maintains spinal flexibility. This study describes our institutions’ mini-open thoracoscopically assisted anterior (MOTA) approach and outcomes for anterior spinal VBT exposure.

Building an “Abdomen-First” multidisciplinary system for pediatric polytrauma with major abdominal injuries: A decade of surgical evolution and outcomes

2026-02-20

The management of pediatric abdominal-dominant polytrauma, where life-threatening abdominal injuries coexist with other system injuries, lacks a standardized, surgery-led decision-making framework. This study aimed to evaluate the evolution and impact of a structured “Abdomen-First” Multidisciplinary Trauma Protocol (AF-MTP) developed at a high-volume pediatric trauma center.

Validation of an anorectal malformation trainer - Can a high-fidelity model simulate real life?

2026-02-19

The reconstruction of anorectal malformations (ARMs) is a technical but reproducible operation. The average number of ARM repairs performed by U.S. pediatric surgery trainees is 15 with recertifying pediatric surgeons performing an average of only 2 ARM repairs annually. The aim of this study was to investigate the validity of a surgical simulator that replicates the steps of repair.

Clinical relevance of postoperative biomarkers in pediatric endourology: Is procalcitonin telling the truth?

2026-02-19

Although acute phase reactants (APRs) are widely used in the postoperative period in various procedures, no clear recommendations exist for their clinical use in pediatric stone disease. We aimed to evaluate the clinical utility of APRs to diagnose UTI and urosepsis in pediatric endourological postoperative courses.

Outcomes following adoption and integration of robotic-assisted cholecystectomy for pediatric biliary tract disease: An eight-year, single-center experience

2026-02-18

The incidence of pediatric gallstone disease continues to rise, largely driven by increasing obesity rates. Laparoscopic cholecystectomy (LC) has been the standard surgical approach, with robotic-assisted cholecystectomy (RAC) utilized less frequently. This study aimed to evaluate the implementation of RAC and its outcomes compared to LC at a single institution.

Opioid-sparing utility of subcutaneous analgesia systems in pediatric oncology patients following major tumor resection surgery: A matched case–control study

2026-02-18

For pediatric oncology patients undergoing major tumor surgery, subcutaneous analgesic systems (SAS) have been suggested as a potential pain-relief alternative to epidural analgesia. Studies randomizing the two modalities have not demonstrated benefit of SAS but suffer from inherent bias due to frequent contraindications to epidural analgesia in this population. We sought to quantify the incremental analgesic benefit of SAS versus standard intravenous analgesia following major pediatric oncology surgeries, adjusting for potentially confounding factors.

Preliminary application and efficacy evaluation of the modified Lich-Gregoir technique in the management of primary obstructive megaureter

2026-02-18

To evaluate the clinical efficacy and safety of a modified Lich-Gregoir technique for treating primary obstructive megaureter (POM) in children.

Multicenter analysis of time interval to intussusception reduction: Success and complication rates

2026-02-16

Recent evidence shows that a 6–8 h interval between diagnosis and reduction of ileocolic intussusception does not negatively impact clinical outcomes. The goal of this study is to investigate the safe interval between diagnosis and non-operative reduction attempt for ileocolic intussusception.

Letter to the Editor comment on: The Space Child Neonatal Trainer (SCNT), a novel 3D-Printed Simulator for Neonatal Laparoscopy

Hinpetch Daungsupawong, Viroj Wiwanitkit — 2026-02-14

The publication on “The Space Child Neonatal Trainer (SCNT), a Novel 3D-Printed Simulator for Neonatal Laparoscopy [1]” is interesting. Although this study shows great creativity in creating a low-cost, real-world patient-based model for training newborn endoscopic surgery, it is important to take into account certain conceptual and methodological limitations. First first, the SCNT model might not accurately represent the physical differences of babies in the actual population because it was created using CT images of just one baby.

CITED2 deficiency drives pulmonary hypoplasia via miR-200b and inflammatory pathways

2026-02-12

CITED2 is a transcriptional co-activator with widespread roles in development. We recently found that the nitrofen rat model of congenital diaphragmatic hernia (CDH) showed CITED2 dysregulation at a late stage of abnormal lung development, but the role of CITED2 in lung development remains unexplored. Here, we study potential pathways of CITED2 in multiple models of lung hypoplasia.

Understanding barriers and facilitators to pediatric surgical access for rural patients: A qualitative study

2026-02-10

This study explored the experiences and perspectives of the barriers and facilitators to pediatric surgical care for families accessing care from rural communities.

Gynaecological concerns in cloaca anomaly: A 20-year single-centre experience

A. Mahfouz, J. Almaary, F. Alrabodh, F. AlModhen — 2026-02-10

Persistent cloaca is a rare form of anorectal malformation, and the literature on long-term gynecological outcomes is limited. We present our experience with cloacal malformations, focusing on gynecological concerns and outcomes in adolescent patients. We also describe our standard assessment and follow-up protocol during puberty and evaluate the concurrence of renal and Müllerian anomalies.

Surgeons and medical illustrators: A symbiotic relationship

Francois I. Luks — 2026-02-10

Medical illustration has played a crucial role through the history of modern medicine. When, with the advent of asepsis and anesthesia, complex surgery became possible, surgeons needed illustrators to describe their exploits, and hand-drawn figures were far clearer than early photographs. Today's high-definition image capture is often still not as useful as medical illustrations: rather than faithfully representing reality, medical illustration aims to inform and teach - to be didactic. It does not even have to be high art: we "all" draw in our daily practice, and we can all hone our visual communication skills.

Minimally invasive care for pectus carinatum

Fawaz Aljohar, Eleanor Ferris, Sela Grays, Robert Baird — 2026-02-10

Pectus Carinatum (PC) is a chest wall difference characterised by protrusion of the anterior chest wall and is commonly treated by Dynamic Compression Bracing (DCB). Whereas bracing programs are traditionally characterized by direct physician and health ally involvement at regular follow-up appointments, we hypothesize that PC can be successfully treated without in-person clinical care.

Pediatric quality of life post esophageal atresia repair: A systematic review and meta-analysis

2026-02-10

Provide a quantitative overview on pediatric quality of life (QoL) and its dimensions after esophageal atresia (EA) and/or tracheoesophageal fistula (TEF) repair.

Gender equity in pediatric surgical care in Central and South Asia: A systematic review and meta-analysis

2026-02-09

We assessed gender based access to pediatric surgical care in Central and South Asia (CSA) by reviewing published clinical studies.

The power of pretend: Caregiver perspectives on sham feeding for infants with long-gap esophageal atresia

2026-02-08

Neonates with long-gap esophageal atresia (LGEA) experience oral aversion and prolonged feeding difficulties, even after surgical repair. Sham feeding—providing non-nutritive oral experiences—may support feeding skill development and caregiver bonding prior to anastomosis. This study explores the clinical and psychosocial impact of sham feeding in this population.

Invited commentary on: Vascular access in neonates and children: Techniques for the pediatric surgeon

Justin T. Huntington, Anghela Z. Paredes — 2026-02-06

We welcome this technical overview of vascular access in neonates and children that highlights a core skill-set in pediatric surgery. Drucker and colleagues present a timely APSA Committee review addressing the increasingly relevant challenges of vascular access in pediatric surgical practice during the era of routine peripherally inserted central catheter (PICC) placement [1]. The gradual erosion of surgeon familiarity with complex vascular access techniques has led to a knowledge gap. As reliance on specialized vascular access teams has expanded, pediatric surgeons are often consulted only after conventional options have failed, making proficiency with alternative approaches essential.

Prevalence of contrast extravasation and embolization in blunt liver and spleen injuries at a single pediatric trauma center

2026-02-06

In 2019, the APSA guidelines for the management of solid organ injuries in children recommended limiting embolization to patients with evidence of ongoing hemorrhage. We sought to identify patients who presented to our institution with contrast extravasation (CE) on initial imaging, determine the proportion who required embolization, and describe their associated outcomes.

Is 24 hours enough? Evaluating prophylactic antibiotic duration after abdominal wall closure in neonatal gastroschisis

Anna Zrinyi, Anna Shawyer, Richard Keijzer, Suyin A. Lum Min — 2026-02-05

While the current American Pediatric Surgical Association (APSA) recommendation is to discontinue prophylactic antibiotics 24 h after abdominal wall closure in otherwise healthy gastroschisis patients managed with a silo, the evidence supporting this recommendation is limited. We aimed to determine if at our center the odds of infection in cases who received prophylactic antibiotics only up to 24 h after closure was greater than cases who received longer courses of antibiotics.

Maternal risk factors associated with complex gastroschisis: Cannabis exposure and recurrent urinary tract infections may be modifiable targets

Olugbenga Awolaran, Kaitlyn MacGregor, Suyin A. Lum Min, Richard Keijzer — 2026-02-04

Maternal risk factors associated with gastroschisis occurrence have been identified, but predisposing factors to the complex variant are unknown. This study aimed to identify factors associated with complex gastroschisis by comparing the maternal risk factor profiles of simple and complex gastroschisis pregnancies.

Assessing language bias in pediatric surgical systematic reviews: A meta-epidemiological study

Dunya Moghul, Elena Guadagno, Shreenik Kundu, Dan Poenaru, Robert Baird — 2026-02-04

Linguistic bias limits insight from non-English regions and potentially skews conclusions toward Western contexts. We evaluated the extent and impact of language-based exclusions in systematic reviews (SRs) within pediatric surgery, assessing how such limitations threaten the comprehensiveness and generalizability of evidence syntheses.

A call for personalized transition of care in congenital surgical anomalies: A population-based cohort study on healthcare utilization from birth to adulthood

2026-02-04

Many children with congenital surgical anomalies (CSA) face complex, lifelong healthcare challenges. We aimed to evaluate long-term healthcare utilization patterns to guide effective transition-of-care strategies.

Invited commentary re: “Malignant transformation of sacrococcygeal teratoma (SCT) versus presacral teratoma in Currarino syndrome (CS): Results of ‘The SCT-study,’”

Peter F. Ehrlich, Robin T. Petroze — 2026-02-04

Physician-scientists studying childhood diseases face unique and challenging problems. For example, although around 50 million adults undergo surgery each year, only about 450,000 children do—a stark difference that makes pediatric cases almost a statistical “rounding error” compared to adults [1,2]. Childhood cancers account for just 1 % of all new cancer diagnoses, making pediatric research particularly difficult [3,4]. Significant advances have been made thanks to large consortiums such as the International Society of Pediatric Oncology (SIOP), the Children's Oncology Group (COG), and the Pediatric Surgical Oncology Research Collaborative (PSORC) [5].

Who's training tomorrow's pediatric surgeons? A global review of pediatric surgery postgraduate training programs in low- and middle-income countries

2026-02-03

Low- and Middle-Income Countries (LMICs) have significantly younger populations than High-Income Countries, with a high burden of morbidity and mortality due to operable conditions. However, access to pediatric surgical care and trained specialists remains limited. Mapping existing pediatric surgery training programs in LMICs may guide trainees seeking education and inform global surgery efforts to build capacity.

Applications of artificial intelligence in pediatric surgical pathology: A systematic review

Eve Wang, Sarah Wu, Mohsen Amoei, Elena Guadagno, Karl Grenier, Dan Poenaru — 2026-02-03

Artificial Intelligence (AI) techniques can transform and enhance diagnosis and treatment response predictions in pediatric surgical pathology. AI offers the potential to reduce the workload of pathologists by automating routine and labor-intensive tasks. In this systematic review, we investigate current applications of computational pathology in pediatric surgical conditions.

Long-term follow-up after choledochal cyst excision in children

2026-02-02

Choledochal cyst (CC) excision is indicated to avoid complications. There is no consensus on postoperative follow-up investigations, duration, or timing. At our institution, patients are followed for 5 years after CC excision with ultrasound and liver laboratory tests. We aimed to evaluate both the post-operative outcomes after pediatric CC excision, focusing on long-term complications, and the adherence to our postoperative follow-up protocol.

The safety of conservative management of asymptomatic congenital pulmonary airway malformations (CPAMs) in children: A systematic review

2026-02-02

The optimal management of infants born with asymptomatic congenital pulmonary airway malformations (CPAMs) remains controversial. However, emerging evidence increasingly supports a conservative non-operative approach for these patients. We aimed to evaluate this evidence with the hope of clarifying optimal management for these patients.

Hepatic CMV-IE expression and distribution further defines the aetiological and prognostic subtypes of biliary atresia

2026-02-02

Cytomegalovirus (CMV) is involved in the pathogenesis and progression of biliary atresia (BA). The immediate-early (IE) protein, the earliest and abundantly expressed viral protein following CMV infection, serves as an indicator of active viral replication when upregulated. This study aimed to investigate the expression and distribution of CMV-IE in liver tissues of BA and to evaluate their impact on postoperative prognosis following Kasai portoenterostomy (KPE).

Letter to the Letter Comment on: Role of oophoropexy in pediatric primary ovarian torsion without adnexal lesions: A systematic review and meta-analysis

Ahmad Shafi Antar — 2026-02-01

We enthusiastically read the recent systematic review and meta-analysis by Mandarano et al. evaluating the role of oophoropexy in pediatric primary ovarian torsion [1]. The authors should be commended for addressing an important and clinically controversial topic in pediatric surgery, where evidence remains limited and practice patterns are highly variable. By synthesizing available retrospective data using a PRISMA-based approach, the study provides a valuable overview of recurrence patterns following ovarian detorsion and contributes meaningfully to discussions on fertility-preserving surgical strategies.

Vascular access in neonates and children: Techniques for the pediatric surgeon

2026-01-29

Vascular access in infants and small children can be challenging, particularly when standard techniques are unavailable or unsuitable. In this manuscript, we describe alternative approaches for establishing vascular access in pediatric patients, especially those with conditions that contraindicate conventional access methods. These techniques were used routinely before the widespread adoption of peripherally inserted central catheters (PICC) lines. While a surgeon certainly is capable of placing a PICC line, these procedures are generally performed by non-physicians as part of a vascular access team.

Print, plan, perform: Evaluating the clinical impact of anatomical modelling in the surgical treatment of pediatric thoracic and abdominal tumours

2026-01-29

Pediatric thoracic and abdominal tumours present unique challenges due to complex anatomic relationships. Patient-specific anatomical models can enhance surgical planning and conduct. Our objective was to evaluate the clinical impact of anatomical models in the perioperative management of patients with thoracic and abdominal tumours.

The impact of pediatric surgery global travel fellowships: A study by the Canadian Association of Paediatric Surgeons Global Partnership Committee

2026-01-29

Pediatric surgical societies in high-income countries (HICs) have historically offered travel fellowships to surgeons from low- and middle-income countries (LMICs) to attend annual meetings. The value and return on investment of these programs have recently been questioned. We surveyed the experiences and outcomes of these fellows.

Short-chain fructooligosaccharides protect against intestinal injury in NEC by restoring AKT/GSK-3β signaling

2026-01-29

Necrotizing enterocolitis (NEC) is a severe gastrointestinal disease affecting preterm neonates, characterized by intestinal inflammation, epithelial injury, and microbial dysbiosis. Prebiotics such as short-chain fructooligosaccharides (scFOS) have been proposed as nutritional interventions to support intestinal health, but their protective mechanisms in NEC remain incompletely understood.

Substance use and mental health disorders in pediatric firearm trauma

2026-01-29

Firearm injuries are prevalent among children in the United States and induce significant psychological distress. This study aims to identify clinical predictors for developing mental health disorders (MHD) and substance use disorders (SUD) after firearm injury within the pediatric population.

Seasonal and feeding variations in the development of pyloric stenosis: A retrospective case-control study

2026-01-29

To examine the association between pyloric stenosis development and seasonal variation or feeding practices.

Large language models for electronic health records in pediatric and surgical care: A systematic review

2026-01-29

Large language models (LLMs) are promising tools in healthcare, particularly for accessing unstructured, text-based electronic health record (EHR) data. This systematic review evaluates the applications of LLMs in the EHR for pediatric and surgical care, model performance compared to traditional methods, and proposed clinical potential to improve healthcare processes, patient outcomes, and overall quality of care.

Enteral feeding practices among infants with gastroschisis in Canada: A national cohort study

2026-01-28

To describe enteral feeding practices and clinical outcomes among infants with gastroschisis at neonatal intensive care units (NICUs) in Canada.

Ultrasound guided percutaneous central venous access using a head-up display – A feasibility study

Anne-Sophie Holler, Luise Marie Böhm, Oliver J. Muensterer — 2026-01-28

Ultrasound guidance for percutaneous central venous access (CVA) insertion has become standard of care. Due to the design of ultrasound devices, the screen is usually positioned in an unergonomic location. In this study, we evaluated the use of a head-up display (HUD) to project the ultrasound image above the eye of the surgeon, overcoming the above limitations.

Pediatric quality of life post congenital diaphragmatic hernia repair: A systematic review and meta-analysis

2026-01-28

Provide a quantitative summary of parent- and child-reported quality of life (QoL) outcomes in children with congenital diaphragmatic hernia (CDH).

What to do after it’s swallowed? Management strategies after superabsorbent polymer bead ingestion: A scoping review

2026-01-28

To conduct a scoping review of the medical literature on the evaluation, management, and consequences of superabsorbent polymer (SAP) bead ingestion in children.

Molding mastery: Validation of a 3D-Printed simulator for pediatric inguinal hernia repair

2026-01-28

Pediatric inguinal hernia repair (PIHR) is a common procedure performed using either open or laparoscopic techniques. Both approaches require detailed anatomical knowledge and specialized training. To address these training needs, we developed a low-cost, 3D-printed Pediatric Open and Laparoscopic Integrated Simulator for Inguinal Hernia Repair (POLISHeR). This study aimed to validate POLISHeR as a simulation tool for essential PIHR skills.

Locally developed low-cost simulator for manual reduction of pediatric inguinal hernia in Rwanda

2026-01-28

Manual reduction of incarcerated inguinal hernias is a fundamental skill to decrease morbidity from bowel strangulation. It is essential in low-income countries, where surgical care may not be available at the initial receiving facility. We created a low-cost, reproducible simulator using materials available in Rwanda. The simulator teaches learners to identify and reduce incarcerated bowel, stabilizing the bowel with two hands to guide it into the inguinal canal. We implemented it in the context of a structured training course on initial management of pediatric surgical conditions for Rwandan general practitioners at rural hospitals.

Letter to the Editor regarding: Hospital variation in postoperative mortality among preterm infants

Kaiyuan Zhang, Fuyou Guo — 2026-01-23

We read with interest the article by Mehl et al. reporting hospital-level variation in postoperative mortality among preterm infants treated at U.S. pediatric centers. In a large national cohort with risk- and reliability-adjusted analyses, the authors show substantial variation in mortality, most pronounced at lower gestational ages [1].

Traditional misconceptions in hypospadias surgery – Letter to the editor regarding “Two-stage repair for primary hypospadias: Functional and cosmetic outcomes in 145 cases with a follow-up period of over five years”

Hüseyin Özbey — 2026-01-22

In this article, the authors analyze urinary and sexual functions, postoperative complications, and cosmetic results in patients who have undergone two-stage primary hypospadias repair [1]. The misconception of relying on tradition is widespread in medicine, can be taught by the experts, and if one is not careful, can be very convincing. This also leads to the acceptance of complications, and there is no other surgical specialty that accepts postoperative complications as readily as hypospadias surgery.

Letter to the editor regarding: Pediatric complicated appendicitis: Results of a standardized antibiotic protocol in a tertiary center

Yan Lu, Yingzhe Zhang — 2026-01-14

We have read with great interest the paper, “Pediatric Complicated Appendicitis: Results of a Standardized Antibiotic Protocol in a Tertiary Center”by Estelle Studer et al. [1]. By comparing the first-line regimen of Ceftriaxone/Metronidazole (CM) with the alternative regimen of switching to Piperacillin/Tazobactam (PT) after CM treatment failure, they found that patients with preoperative CRP >150 mg/L and intraoperative intra-abdominal abscess might benefit from shorter hospital stays if PT was chosen as the first-line therapy.

Generative AI and medical writing: Malfeasance or misdemeanour?

Mark Davenport, Paul KH. Tam — 2025-12-30

2022 was that pivotal year, and with that, the floodgates opened, allowing the ingress of tools designed to widen the access of non-specialist writers and improve the quality of the finished product. No one should now be deterred from medical writing with their hands guided by ChatGPT© (others are very much available). Can this really be a bad thing?

Landscape of caregiver decisional regret

2025-12-30

Decisions around both invasive and non-invasive medical treatments can be wrought with uncertainty. The need for caregiver consent in pediatric cases can introduce additional complexities to the decision-making process. Patients and families may experience decisional conflict, characterized by feelings of uncertainty prior to undergoing care, while deciding on a treatment plan [1]. Patients and families may subsequently experience decisional regret, which refers to a negative emotional response after one undergoes treatment or intervention [2].

Surgeon annual volume impacts recurrence rates of pediatric inguinal hernia repairs: A multi-institutional study

2025-12-29

This study aimed to investigate effect of surgeon annual case volume on pediatric inguinal hernia recurrence rates.

Letter to the editor regarding “Characteristics of pelvic anatomy predict need for vaginal replacement during initial reconstruction of cloacal malformations”

Ismael Elhalaby, Rebecca M. Rentea — 2025-12-24

We read with great interest the recent article by Evans et al., “Characteristics of pelvic anatomy predict need for vaginal replacement during initial reconstruction of cloacal malformations.” [1]. The authors are to be commended for their work, providing the largest cohort to date and robust statistical validation that common channel (CC) length ≥3.5 cm and vaginal hypoplasia are powerful independent predictors of vaginal replacement (VR).

Letter to the editor regarding “ Pediatric Inguinal Hernia Repair with Laparoscopy (PIHRL)-trial: A multicenter study comparing extra-corporeal Percutaneous Internal Ring Suture (PIRS) and intracorporeal purse-string suture for inguinal hernia”: The significance of fragility index

Mustafa Azizoglu, Mehmet Saban Korkmaz, Ahmet Bas — 2025-12-11

We read with great interest the article by Eurlings et al., " Pediatric Inguinal Hernia Repair with Laparoscopy (PIHRL)-trial: A multicenter study comparing extra-corporeal Percutaneous Internal Ring Suture (PIRS) and intracorporeal purse-string suture for inguinal hernia” and find it to be a commendable and valuable contribution to the pediatric surgical literature [1]. As the first multicenter, prospective study comparing extra-corporeal PIRS with intra-corporeal LIHR, it provides much-needed data on a common procedure.

Invited commentary on: Surgeon annual volume impacts recurrence rates of pediatric inguinal hernia repairs: A multi-institutional study

Oliver J. Muensterer — 2025-12-11

The manuscript by authors Heller et al. [1] addresses the important question whether outcome after pediatric inguinal hernia repair is dependent on case volume. The authors analyzed a retrospective database of 21 medical centers collected over a 2 year period and including a total of over 8,500 cases operated by 207 surgeons. Surgeon volume was categorized in quartiles, defining those in the highest quartile as high volume surgeons, stratified by operative approach. High volume was thus defined as >18 operations per year for open, and >14 operations per year for laparoscopic technique.

Indicators of potential disability among pediatric firearm injury survivors

2025-12-11

Pediatric firearm injury represents an increasing national crisis. While many injuries are fatal, a greater proportion of children survive, often facing significant long-term disabilities. This study aims to characterize the outcomes of pediatric firearm injury and identify predictors of persisting symptoms.

Pilonidal disease: Toward a severity-stratified, value-based approach

Anam N. Ehsan, Claire Abrajano, Bill Chiu — 2025-12-07

Pilonidal disease affects up to 100 per 100,000 adolescents and young adults, with incidence rising worldwide. Its impact extends far beyond the operating room. During formative years, patients face disruptions in education, employment, and social life that are disproportionate to what is often labeled a “minor” surgical problem. Despite this burden, care remains fragmented and guided more by surgeon preference and local practice than by standardized, evidence-based frameworks [1].

Letter to the editor regarding “Artificial womb technologies-innovation at the edge of viability: Ethical considerations”

Nicholas Colgrove — 2025-11-29

Jennifer Paul et al. claim that artificial womb technology (or “AWT”) aims “to extend fetal development ex utero” by “replicating the intrauterine environment” outside of the maternal body [1]. The legal and moral status of subjects within AWs has been debated, though Paul et al.’s presentation of these issues is inaccurate. They claim, for example, that subjects within AWs “occupy a legal gray zone, with unclear entitlement to care, protection, or representation.” [1] Under United States law, this is false.

Beyond hyponatremia: The crucial role of hypernatremia and hypokalemia in pediatric intussusception surgical outcomes

2025-11-24

While hyponatremia is a recognized marker of disease severity in certain pediatric gastrointestinal conditions, the prognostic value of serum potassium and a comprehensive assessment of electrolyte imbalances in intussusception outcomes remain limited. We aimed to quantify the association between dysnatremia and dyskalemia at presentation and major surgical complications in children with intussusception.

Extracorporeal membrane oxygenation (ECMO) in neonates with severe uropathies: A single-center experience

2025-11-21

Extracorporeal membrane oxygenation (ECMO) is an advanced extracorporeal life support rarely used in neonates with severe uropathies. This study describes our experience with ECMO support in five neonates presenting with life-threatening respiratory failure associated with congenital uropathy.

Reply to Letter to the Editor concerning the article “Minimal invasive duodenal atresia repair – does surgical technique of anastomosis matter? A systematic review”

Tobias Jhala — 2025-11-19

We appreciate the reviewer's detailed evaluation of our study and the opportunity to clarify both our methodological rationale and the additional analyses performed in response.

A multi-institutional comparison of management techniques for infants with giant omphalocele

2025-11-17

Giant omphaloceles (GO) are uncommon with no consensus on treatment strategy. Placement of a DuoDerm® silo (DDS) is a novel management technique. We sought to identify optimal approach by comparing outcomes of patients who underwent DDS placement, paint and wait (P&W), operative silo placement (OSP), or alternative compression techniques (ACT).

Response to “Enteral access in pediatric cardiac patients: A survey of pediatric surgeons at the top 50 cardiac hospitals”

Yasmine Houas, Nada Sghairoun, Said Jlidi — 2025-11-12

We read with great interest the article by McKay et al., “Enteral access in pediatric cardiac patients: A survey of pediatric surgeons at the top 50 cardiac hospitals.” By McKay et al. [1]. The study offers valuable insight into the management of enteral access in children with congenital heart disease and highlights important variations in surgical practice among leading centers.

Enhancing parental well-being in ARM: Integrating psychoeducation Into surgical practice

Rikas Saputra, Yenni Lidyawati — 2025-11-12

The recent study by [1] represents an important advancement in understanding the psychological burden faced by parents of children with anorectal malformations (ARM). By applying the Common-Sense Model of Illness Self-Regulation, the authors provide a theoretically grounded explanation for how illness representation and coping strategies shape depressive symptoms among caregivers. The identification of threat-focused perceptions as a key contributor to distress is a valuable contribution to pediatric surgical psychology.

Reply to letter to the editor by Rattanapitoon S, et al., regarding “Effects of virtual reality distraction on pain, stress, and heart rate during pediatric ingrown toenail surgery: A randomized controlled trial”

2025-11-11

We appreciate the interest shown by Rattanapitoon, et al. [1], Wahyudin, et al. [2], and Siregar, et al. [3] in our recent article [4], and we welcome the opportunity to clarify and further discuss the issues the authors raised in their letters.

Letter to the editor regarding “Antecedents of mental health in parents of individuals born with ARM: The association between illness representations, negative and positive coping, and depressive symptoms”

Mohamad Saripudin — 2025-11-05

The article by Magnavacca et al. [1], “Antecedents of Mental Health in Parents of Individuals Born with ARM: The Association Between Illness Representations, Negative and Positive Coping, and Depressive Symptoms,” deserves high appreciation for its significant contribution to understanding the psychological mechanisms influencing the mental health of parents of children with congenital conditions, particularly anorectal malformations (ARM). By applying the Common-Sense Model of Illness Self-Regulation (CSM), this study offers a comprehensive examination of how illness representations—especially perceptions of threat and control—interact with coping strategies in predicting depressive symptoms among parents.

Letter to the editor regarding “Charges associated with preventable trauma transfers after application of pediatric brain injury guidelines (kBIG)”

2025-11-03

We would like to commend the insightful article "Charges associated with Preventable Trauma Transfers after Application of Pediatric Brain Injury Guidelines (kBIG)" by Kahan et al., [1] which offers a robust analysis of the potential cost savings and healthcare efficiencies achieved through the application of kBIG guidelines in pediatric traumatic brain injury (TBI) care. The study's findings underscore the significant economic burden of preventable transfers, as well as the role of kBIG in reducing unnecessary costs.

Letter to the editor regarding “Laparoscopic-assisted resection with adjunct sclerotherapy for abdominal lymphatic malformations: Long-term outcomes from a large cohort study”

Emir Q. Haxhija, Paolo Gasparella — 2025-11-01

We read with great interest the article entitled “Laparoscopic-Assisted Resection with Adjunct Sclerotherapy for Abdominal Lymphatic Malformations: Long-term Outcomes from a Large Cohort Study” by Tran et al. [1]. This work represents one of the largest single-center series (83 patients over five years) addressing the rare entity of intraabdominal lymphatic malformations (LMs). The authors report an impressive success rate for surgical treatment and excellent long-term disease-free outcomes.

Letter to the Editor regarding “Effects of vertical reality distraction on pain, stress, and heart rate during ingrown toenail surgery”

2025-10-28

The recent trial by Felnhofer et al. raises important questions about the role of virtual reality (VR) in pediatric surgery [1]. Their results show that not all VR approaches are equally effective, and unguided VR may even increase pain perception. This suggests VR should be understood as more than a distraction.

Letter to the Editor: The-unit of-analysis error in meta-analysis: Why univariable tests cannot substitute for robust methodological synthesis

Javier Arredondo Montero — 2025-10-23

Meta-analytic modelling has long been a source of debate and continuous refinement, precisely because it must account for multiple interrelated factors: between-study heterogeneity, study weighting, confidence interval computation, and estimator choice, among others. Each of these components is designed to converge on a single goal—producing a robust, reproducible, and clinically meaningful inference from disparate studies. By contrast, univariate statistical tests are indispensable tools in clinical research, yet their scope is fundamentally different: they assess isolated comparisons, not aggregate effect estimates across heterogeneous datasets.

Letter to the Editor Comment on: Operating without direct supervision during pediatric surgery fellowship: When, how, and why

2025-10-23

We read with great appreciation the article “Operating Without Direct Supervision During Pediatric Surgery Fellowship: When, How, and Why” by Gollin et al. [1], which provides valuable insight into the current state of operative autonomy in pediatric surgery training. Their finding that only 7 of 44 programs had formal criteria for unsupervised operations and none required explicit parental consent for “teaching assistant” (TA) cases underscores a critical governance and ethical gap within competency-based surgical education.

Exploring the power of virtual reality in reducing pain and stress in pediatric surgery

2025-10-23

We would like to commend the authors of the study “Effects of virtual reality distraction on pain, stress, and heart rate during pediatric ingrown toenail surgery: A randomized controlled trial” for their significant contribution to the growing body of research on non-pharmacological interventions for pediatric pain management [1]. This study provides valuable insights into the efficacy of immersive Virtual Reality (VR) as a distraction technique in pediatric surgery, with particular focus on pain, stress, and physiological responses (heart rate).

Methodological considerations in the study of quality of life after slide tracheoplasty for congenital tracheal stenosis

2025-10-23

We read with great interest the article “Quality of Life and its Clinical Determinants After Slide Tracheoplasty for Congenital Tracheal Stenosis” by Nakatani and colleagues [1]. The study provides valuable insight into the long-term outcomes of pediatric patients undergoing slide tracheoplasty, particularly regarding quality of life (QOL) and voice function. However, we would like to raise several methodological and interpretative considerations.

Letter to the editor: Challenges and opportunities of early plasma administration in Pediatric Severe Traumatic Brain Injury: A response to Furman et al.'s study

Wiwi Winarti, Aldian Yusuf, Dita Rosyalita, Laelaturramadani — 2025-10-21

I am writing in response to the article titled “Impact of Early Plasma Resuscitation in Pediatric Severe Traumatic Brain Injury” by [1], published in the Journal of Pediatric Surgery. The authors' examination of the safety of early plasma administration for children with severe traumatic brain injury (TBI) provides valuable insight into an area of pediatric trauma care. However, I would like to address certain points in the study, particularly its design limitations and the need for further research to clarify the potential clinical implications.

Strengthening inclusive disaster preparedness for medically complex children: Advancing equity and integrated response systems

2025-10-21

We read with great interest the article [1]“Bridging the Gap: Disaster Preparedness for Medically Complex Pediatric Patients.” The authors offer a timely and compelling exploration of an underrepresented dimension in pediatric emergency care. Their emphasis on multidisciplinary coordination, caregiver engagement, and health equity reflects a crucial awareness of post-pandemic realities where disaster vulnerability has become more stratified. This contribution deserves appreciation for highlighting system-level disparities affecting children with complex medical needs.

Integrating acceptance and commitment therapy to enhance wellbeing in adults born with congenital diaphragmatic hernia

Dony Darma Sagita, Roby Maiva Putra, Freddi Sarman — 2025-10-21

Im Apreciated with the result study by Pulvirenti et al. (2025) provides an important contribution to understanding the long-term quality of life of survivors of congenital diaphragmatic hernia (CDH). The finding that most adult patients achieved good social participation, yet experienced significant fatigue and internalizing problems, suggests the need for psychological interventions focused on long-term adaptation [1]. In this context, Acceptance and Commitment Therapy (ACT) may be a relevant psychotherapeutic approach.

Environment matters: Understanding the social and built environment's role in pediatric surgical outcomes

R.A. Dodi Sukma, Sri Wahyuni, Ramtia Darma Putri, Erfan Ramadhani — 2025-10-18

I would like to commend the authors for their thorough and insightful systematic review, which offers a comprehensive examination of the impact of neighborhood and built environment factors on pediatric perioperative care. This review highlights a crucial area of research by analyzing the influence of social determinants of health (SDOH) on pediatric surgical outcomes [1]. The findings, particularly those related to the Area Deprivation Index (ADI) and Child Opportunity Index (COI), underscore the significant role that socio-economic and environmental factors play in shaping health outcomes for pediatric surgical patients.

Unveiling the hidden danger: A comprehensive analysis of pediatric aortic trauma and its mortality risk

Robertus Heru Setyo Suhartono — 2025-10-18

I am writing to share my reflections on the article "Pediatric Aortic Trauma: National Database Analysis of Trauma Outcomes in Pediatric Population", published in the Journal of Pediatric Surgery [1]. The study offers significant insights into the rare yet highly fatal nature of pediatric aortic injuries, drawing from a comprehensive dataset covering 955 pediatric trauma cases. The authors provide a thorough analysis of demographic characteristics, injury mechanisms, treatment modalities, and mortality outcomes, contributing immensely to the field of pediatric trauma care.

Comment on “The effect of age and symptom duration on the accuracy of twist score for testicular torsion in boys”

Jianjie Ju, Ming Chen, Jingjing Chen, Limei Yang — 2025-10-18

We read with great interest the recent paper by Eswaravaka and colleagues assessing how age and symptom duration influence the diagnostic accuracy of the Testicular Workup for Ischaemia and Suspected Torsion (TWIST) score in boys with acute scrotal pain [1]. Their work adds meaningful evidence that these factors do not significantly affect diagnostic performance, supporting TWIST as a rapid and reliable bedside tool for early triage in suspected testicular torsion.

Enhancing pediatric surgery outcomes: Integrating solution-focused brief counseling and cognitive behavioral therapy Into Virtual Reality interventions

2025-10-14

We would like to express our appreciation for the insightful article “Exploring the Effectiveness of Virtual Reality in Pain and Stress Management in Pediatric Surgery” by Guan et al. [1], which provides a thorough investigation into the role of Virtual Reality (VR) in reducing pain and stress during pediatric surgery. The study's examination of focused VR and exploratory VR presents valuable insights into how these VR approaches can be tailored for specific therapeutic outcomes. However, we believe that integrating additional therapeutic techniques could further enhance the effectiveness of VR interventions in pediatric surgery.

Lichen Sclerosus: A black hole in current knowledge and management

2025-10-13

We read with interest the study by Neville et al. [1], “Clinical and Histological Predictors of Disease Severity in Boys with Lichen Sclerosus”. The authors describe an intraoperative clinical grading system for lichen sclerosus (LS) and assess its correlation with histopathology and one-year outcomes. The finding that neither clinical appearance nor histological severity predicted the need for reintervention highlights the difficulty of anticipating LS progression based only on morphology.

Letter to the Editor Comment on: Early postoperative fever in pediatric oncology patients undergoing solid tumor resection

Asma Jabloun, Aida Daib, Youssef Hellal — 2025-10-10

We read with great interest the recent study “Early postoperative fever in pediatric oncology patients undergoing solid tumor resection” by Lundstedt J et al. [1]. The authors conclude that postoperative fever following solid tumor resection in pediatric oncology patients is a frequent but usually non-infectious event, and that routine, extensive diagnostic workups are rarely necessary. Their dataset is indeed one of the largest cohorts in this underexplored field, However, we would like to raise a few important points for consideration before extrapolating these findings into clinical practice.

Response to “Perinatal prognostic factors of recurrence or functional sequelae in neonatal sacrococcygeal teratoma, and implications for prenatal counselling: A multicenter retrospective study”

Yasmine Houas, Said Jlidi — 2025-10-10

We read with great interest the article entitled “Perinatal prognostic factors of recurrence or functional sequelae in neonatal sacrococcygeal teratoma, and implications for prenatal counselling: A multicenter retrospective study.”by Vinit et al. [1]. This excellent work provides valuable insights into the medium- and long-term prognosis of patients with sacrococcygeal teratoma and offers useful guidance for prenatal counselling.

Pediatric genitourinary trauma in combat zones: Insights and lessons from military healthcare

2025-10-09

I am writing to share my thoughts on the article "Combat-related Genitourinary Trauma in Pediatric Patients: Data from the Department of Defense Trauma Registry," by Kronstedt et al., [1]. This study provides invaluable insight into the prevalence, mechanisms, and outcomes of genitourinary (GU) trauma among pediatric casualties in recent conflicts in Afghanistan and Iraq. The data and conclusions presented highlight the pressing need for more targeted training for healthcare personnel deploying to combat zones, especially regarding pediatric GU trauma.

Endovascular stenting in pediatric trauma: A critical analysis of long-term outcomes and follow-up gaps

Mifta Rizka, Rizky Andana Pohan, Santy Andrianie — 2025-10-08

We are writing in response to the article “Stent it and Forget it? Not in Kids: Endovascular Treatment of Traumatic Arterial Injuries in Adolescents” by Sutyak et al., published in Journal of Pediatric Surgery [1]. The study presents a valuable investigation into the use of endovascular stenting as a treatment for traumatic arterial injuries in pediatric patients. While the study offers important insights into the feasibility of stenting for children and adolescents, there are several areas of critical analysis that merit attention.

Response to “Outcome of esophageal atresia: What choice of suture material?”

Yasmine Houas, Said Jlidi — 2025-10-08

We read with great interest the article entitled “Outcome of esophageal atresia: What choice of suture material?” by Martz et al. [1]. The authors present an important study comparing postoperative complications of esophageal atresia repair according to the type of suture material used. This subject is particularly relevant, as the choice of suture remains a key technical consideration in pediatric surgery, with potential implications for anastomotic healing and long-term outcomes.

Letter to the Editor Comment on: Transumbilical laparoscopic-assisted appendectomy without pneumoperitoneum in children: Feasibility and outcomes from a single centre

Asma Jabloun, Fatma Trabelsi, Youssef Hellal — 2025-10-08

We read with interest the article Editor “Transumbilical laparoscopic-assisted appendectomy without pneumoperitoneum in children: Feasibility and outcomes from a single center” by Yamaoka et al. The authors report a high completion rate and acceptable complication profile, suggesting that this technique may represent a safe alternative to conventional laparoscopic appendectomy However, we would like to highlight several points that merit further discussion.

Response to “Is there a role for ERCP in the management of gallstone pancreatitis in children? A western pediatric surgery research consortium study” by Patwarthan et al

Yasmine Houas, Said Jlidi — 2025-10-08

We read with great interest “Is there a role for ERCP in the management of gallstone pancreatitis in children? A western pediatric surgery research consortium study” by Patwarthan et al. [1]. The authors should be commended for presenting the largest pediatric series to date addressing the role of endoscopic retrograde cholangiopancreatography (ERCP) in acute pancreatitis. However, several important aspects deserve further clarification.First, the precise indications for ERCP were not explicitly defined in their report.

Phased return-to-work policies and global digital mentorship: Transforming gender equality in pediatric surgery

Syariful, Herul Wahyudin, Maria Oktasari, Hayu Stevani, Ken Heryani Sulis — 2025-10-08

We would like to express our appreciation for the insightful article “The Gender Gap in Pediatric Surgery: Barriers, Disparities, and the Way Forward” by Luz et al. [1], which offers a comprehensive analysis of the persistent gender disparities in pediatric surgery. The study highlights critical issues such as the “leaky pipeline,” sexual discrimination, and the disproportionate impact of caregiving responsibilities on women's career progression. While these findings are crucial, we believe that innovative, evidence-based solutions are necessary to address these barriers and drive sustainable change within the field.

Response to “Exercise-induced ectopy and its relationship to fitness, cardiac function, and markers of severity in youth with pectus excavatum”

Yasmine Houas, Said Jlidi — 2025-10-08

We read with great interest the article entitled “Exercise-induced ectopy and its relationship to fitness, cardiac function, and markers of severity in youth with pectus excavatum” by Piczer et al. [1]. The authors provide an important contribution by demonstrating that patients with pectus excavatum exhibit a higher incidence of ventricular ectopy, and that this finding is more common in individuals with greater markers of chest wall structural abnormality. This observation adds to our understanding of the potential cardiovascular implications of pectus excavatum beyond its well-recognized cosmetic and psychosocial impact.

Letter to the editor: Odds ratio versus risk ratios: Rejuvenating an important debate and an opportunity to learn

2025-10-07

We read with great interest the letter by Dr. Montero [1], which provides thoughtful comments on our recent systematic review and meta-analysis comparing bedside versus conventional operating room surgery in critically ill neonates [2]. We appreciate his careful reading and engagement with our work. At the same time, we wish to clarify several methodological points and address certain criticisms that, in our view, merit further discussion.

Congenital diaphragmatic hernia: Exclusion criteria for repair or ECMO?

2025-10-07

Mortality in congenital diaphragmatic hernia (CDH) approximates 30 %. Both severe lung hypoplasia and other anomalies contribute to demise regardless of repair and/or extracorporeal membrane oxygenation (ECMO). We report clinical and physiological parameters for CDH infants not offered repair or ECMO (NoR/ECMO).

Postnatal outcomes of in utero repair of simple gastroschisis in an ovine model

2025-10-04

Gastroschisis is a congenital abdominal wall defect resulting in fetal bowel evisceration, causing significant postnatal morbidity, including prolonged bowel dysmotility and increased susceptibility to life-threatening infections. This study aims to optimize an ovine model of gastroschisis by evaluating defect size to improve fetal survival and assess the impact of in utero repair (IUR) on postnatal outcomes.

Erratum to “Best Practices for Vessel Management in Pediatric Extracorporeal Membrane Oxygenation Cannulation, Decannulation, and Follow-up: A Narrative Review” [J Pediatr Surg 60 (2025) 161961]

Katherine M. McDermott, Mohammed Moursi, Sandra Tomita, David H. Rothstein — 2025-07-05

The publisher regrets that the following footnote was inadvertently omitted from the original article:

Leveraging Multicenter Databases to Improve Care in Pediatric Vascular Surgery

2025-07-02

Pediatric vascular surgical problems are rare and variable in presentation, thus making them challenging to characterize and treat. The diversity of patient conditions and size combined with variability in pediatric vascular surgical training leads to an ad hoc approach to these patients. With few published guidelines as well as a lack of robust research to support evidence-based assertions, pediatric vascular practices have been largely driven by anecdotal evidence and limited retrospective single-institution reviews.

Vascular Surgery in Children

David H. Rothstein, John V. White, Regan F. Williams, Dawn M. Coleman — 2025-06-02

What comprises vascular disease in children? Who is best suited to care for them? And where should this care be provided? These are the questions that spurred the creation 3 years ago of a joint national taskforce between the American Pediatric Surgical Association (APSA) and the Society for Vascular Surgery (SVS). The authors of this Viewpoint (D.H.R. and R.F.W., pediatric surgeons; J.V.W. and D.M.C., adult vascular surgeons) have had the privilege of working jointly and with a dedicated group of colleagues in both disciplines to define the scope of vascular diseases, congenital and acquired, and propose pathways for improvement in the collaborative efforts that are required to render best care in often complex cases.

Blunt Brachial Arterial Injury in Pediatric Patients

2025-06-02

Blunt brachial arterial injury (BBAI) is the most common vascular injury in pediatric patients. BBAI can lead to a spectrum of clinical signs and symptoms in the affected extremity, depending on the degree of occlusion and the robustness of the collateral circulation. The proper treatment ranges from expectant and conservative medical management to surgical revascularization. Although the management depends on the degree of ischemia, there is still controversy about the treatment algorithm for a pink pulseless hand following BBAI.

Principles and Practice in Pediatric Vascular Trauma: Part 2: Fundamental Vascular Principles, Pediatric Nuance, and Follow-up Strategies

2024-07-29

As of 2020, penetrating injuries became the leading cause of death among children and adolescents ages 1–19 in the United States. For those patients who survive and receive advanced medical care, vascular injuries are a significant cause of morbidity and trigger notable trauma team angst. Moreover, penetrating injuries can lead to life-threatening hemorrhage and/or limb-threatening ischemia if not addressed promptly. Vascular injury management demands timely and unique expertise, particularly for pediatric patients.

Principles and Practice in Pediatric Vascular Trauma: Part 1: Scope of Problem, Team Structure, Multidisciplinary Dynamics, and Solutions

2024-07-26

As of 2020, penetrating injuries became the leading cause of death among children and adolescents ages 1–19 in the United States. For the patients who initially survive and receive advanced medical care, vascular injuries are a significant cause of morbidity and additionally trigger notable trauma team angst. Moreover, penetrating injuries can lead to life-threatening hemorrhage and/or limb-threatening ischemia if not addressed promptly. Vascular injury management demands timely and unique expertise, particularly for pediatric patients.

WITHDRAWN: Open versus Robot-assisted Laparoscopic Ureteral Reimplantation: Hospital Charges Analysis and Outcomes at a Single Institution

2020-01-16

This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause.

Identification of risk factors for postoperative recurrent Hirschsprung associated enterocolitis

Qi Dong, Guoxin Li, Jingqing Dong — 2018-08-07

This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause.The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal

WITHDRAWN: Outcomes of laparoscopic inguinal herniorrhaphy in female pediatric patients, particularly those with ovarian hernias

Sung Ryul Lee — 2017-08-22

This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause.

2026-06