Appendiceal location may affect the diagnosis and surgical management of acute appendicitis. However, pediatric-specific data remain limited. This study evaluated appendiceal location in Japanese children with acute appendicitis and examined its clinical implications.

In total, 105 pediatric patients who underwent laparoscopic or laparoscopic-assisted appendectomy between January 2015 and March 2024 were retrospectively reviewed. Appendiceal location was classified using a modified Wakeley classification based on intraoperative laparoscopic findings. Clinical presentation, ultrasonographic identification rate, and surgical outcomes were compared among groups.

The pelvic position was the most common appendiceal location (51.4%), followed by the retrocecal position (20.0%). Approximately 87.6% of patients underwent ultrasonography. The retrocecal group had a significantly lower identification rate than the other location groups (61.1% vs. 85.1%, p = 0.041). The retrocecal group had a significantly longer surgical duration than the pelvic group (median: 90 vs. 58 min, p = 0.010). The clinical presentation and postoperative complications did not differ significantly among the groups.

In this cohort of Japanese children with acute appendicitis, the pelvic position was the most common appendiceal location. The retrocecal position was associated with lower ultrasonographic identification rates and a longer surgical duration, indicating greater diagnostic and technical challenges.

To evaluate and compare short-term and two-year outcomes, particularly aspiration pneumonia-free survival, after fundoplication in pediatric patients with and without cerebral palsy (CP).

The study reviewed outcomes after fundoplication in pediatric patients performed between 2004 and 2025 at a university hospital in Thailand, focusing on aspiration pneumonia-free survival. Statistical analyses used log-rank test and Cox proportional hazards model.

During the study, 85 cases underwent surgery. Diagnoses included gastroesophageal reflux (84.7%) and hiatal hernia (10.9%). Forty-five cases (52.9%) had CP, with significantly higher rates of co-occurring epilepsy (OR 33.9) and recurrent pneumonia (OR 3.6). Post-procedure, first-year pneumonia episodes were similar (median 0 occurrence in the CP group and 0.5 occurrence in the non-CP, p = 0.473). The mean interval to first pneumonia was longer in CP (418 days) than in non-CP (209 days, p = 0.049). One-year overall survival was 69.6%. One-year pneumonia-free survival in CP (50.4%) did not differ from non-CP (51.5%, p = 0.29).

Despite a higher comorbidity burden and nutritional support needs, fundoplication outcomes in pediatric patients with CP were comparable to those without CP. These findings suggest fundoplication is an equally effective and safe surgical option for anti-reflux management in pediatric patients with CP.

This study aimed to evaluate the mid-term functional and cosmetic outcomes of perineal body–sparing trans-sphincteric anorectoplasty (TSARP) in patients with anal atresia and rectovestibular fistula.

Patients with anal atresia and rectovestibular fistula who underwent perineal body–sparing TSARP between 2018 and 2024 were retrospectively reviewed. All procedures were performed by a single pediatric surgeon. Demographic data, presence of colostomy, perioperative complications, postoperative first-feeding time, and functional outcomes were recorded. Functional outcomes in patients were assessed using the Krickenbeck classification.

Twenty-six patients underwent perineal body–sparing TSARP. One-stage repair was performed in 16 patients (61.5%), whereas 10 (38.5%) had a protective colostomy. The median age at operation was 40 days (range 2 days–7 months). Posterior vaginal wall injury occurred in two patients and was repaired uneventfully. Two patients developed wound infection that resolved with local wound care. The mean follow-up duration was 3.25 years. Among 18 patients older than 3 years old, voluntary bowel control was present in 15 patients (83.3%). Constipation occurred in seven patients, and no patient developed soiling.

Perineal body–sparing TSARP appears to be a safe and effective technique for rectovestibular fistula, providing low complication rates with satisfactory functional and cosmetic outcomes.

In giant omphalocele cases, small abdominal cavity leads to high intraabdominal pressure during closure, making repair challenging. This study aimed to evaluate our staged compressive dressing technique and its outcomes.

Eighteen giant omphalocele cases treated with staged compressive dressing/primary closure between 2014 and 2024 were retrospectively reviewed. All cases received compressive dressing every other day with wet sterile gauze and transparent adhesive surgical drapes from the first postnatal day until surgery to reduce intra-sac organs. Primary closure was performed after organ reduction.

Eighteen cases (Female/Male: 10/8) were included. Mean gestational age was 36.8 ± 1.7 weeks, birth weight 2988 ± 603 g. Major cardiac anomaly was present in 16.7% and liver herniation in 83.3%. Mean defect diameter was 6.0 ± 1.2 cm. Mean time to surgery was 6.4 ± 5.1 days. Primary repair was successfully performed in all cases (100%). Operation was delayed in patients with cardiac anomaly (13.0 ± 9.2 vs. 5.3 ± 3.4 days, p = 0.012). Seven patients (38.9%) had prolonged hospitalization (> 20 days). One patient with cardiac anomaly died postoperatively. Mean hospital stay was 22.2 ± 11.0 days .

In this single-center retrospective study, the staged compressive dressing technique appeared to be a feasible, simple, and potentially cost-effective method for giant omphalocele management. While we achieved primary closure in all cases without prosthetic materials, these findings require validation through larger multicenter studies and comparative trials before definitive conclusions can be drawn about superiority over alternative methods.

To evaluate current evidence on machine learning (ML) for the diagnosis of Hirschsprung disease (HSCR) and summarize its diagnostic performance and potential clinical utility.

PubMed, Web of Science, Cochrane Library, and Scopus were systematically searched (January 2016–November 2025) for studies applying ML to HSCR diagnosis. Study quality was assessed using QUADAS-2. Findings were narratively synthesized, with exploratory meta-analysis performed where feasible.

Eleven studies were included, with substantial heterogeneity in design, data modalities, and outcomes. Three barium enema–based studies were eligible for meta-analysis, showing pooled sensitivity of 0.857 (95% CI 0.738–0.936), specificity of 0.880 (95% CI 0.790–0.941), and an area under the curve of 0.927. In rectal biopsy–based studies, ML-assisted approaches appeared to reduce interpretation time, while evidence for improved diagnostic performance remains limited and heterogeneous.

ML may have potential value in supporting HSCR diagnosis, particularly when combined with imaging and clinical data. In histopathology, ML appears more likely to serve as an assistive tool to improve efficiency and potentially enhance diagnostic performance rather than replace expert interpretation. Further prospective multicenter studies are needed before routine clinical implementation.

Diaphragmatic eventration (DE) is an uncommon but clinically significant condition in children. Although diaphragmatic plication is widely performed in symptomatic patients, standardized criteria guiding surgical indication remain poorly defined. This review aimed to identify the clinical-radiological parameters most consistently used to select pediatric surgical candidates.

We performed a literature search for English-language studies (2000–2025) reporting pediatric DE cases. Studies limited to radiology, genetics, or unrelated diaphragmatic disorders were excluded. Extracted data included demographics, clinical presentation, surgical criteria, approach, and outcomes.

19 studies involving 893 surgically treated pediatric patients were included. Median age was 12 months (mean ± SD: 21.4 ± 28.7), with a male/female ratio of 1.68:1. Symptoms were reported in 18/19 studies (94.7%), with respiratory distress and pulmonary infection as most frequent ones (78.9% each), followed by GI symptoms (21%). Surgical criteria were described in 18/19 (94.7%): unspecified symptomatic patients (57.9%), respiratory distress (31.6%), recurrent infection (31.6%), ventilatory dependence (10.5%), and, in asymptomatic patients, progressive radiological elevation. Minimally-invasive approaches were reported in 52.3%. Postoperative mortality was 1.6% (14/893).

Respiratory compromise, ventilatory dependence, recurrent infections, progressive radiological elevation are the most reported indications. Evidence remains retrospective and heterogeneous, highlighting the need for standardized, evidence-based criteria.

Rectal atresia (RA) and rectal stenosis (RS) are rare anorectal malformations (ARM), comprising 1–2% of all cases. No consensus exists regarding optimal surgical technique. This study evaluated surgical approaches, complications, and long-term functional outcomes at a single referral center.

Retrospective review of RA or RS patients treated between 2003 and 2020. Surgical technique, complications, and bowel function were analyzed. Fecal continence was assessed using Krickenbeck classification.

Eleven patients were included (7 RS, 4 RA), representing 1.2% of 900 ARM cases. Surgical techniques included posterior sagittal anorectoplasty (PSARP) in 4 (36.4%), transanal in 3 (27.3%), abdominoperineal pull-through in 2 (18.2%), and laparoscopic rectal web correction (LWC) in 2 (18.2%). Two patients required redo surgery. Ten of 11 patients were eligible for functional assessment; no true fecal incontinence was observed. Five (50%) required no bowel management; constipation was identified in five, including three with overflow soiling due to non-adherence. Median follow-up was 100.4 months (range 13–168).

Despite surgical complexity, most patients achieved satisfactory outcomes. The high incidence of constipation, particularly in RS, underscores the need for long-term follow-up and early intervention. The laparoscopic rectal web correction offers a reproducible, sphincter-preserving technique for effective correction of rectal webs.

This single-center study aimed to evaluate surgical management of congenital lung malformations (CLM) and its associated perioperative results and short- and long-term outcomes.

We analyzed data from patients who underwent surgical treatment for CLM. Data were collected within the framework of a structured, prospective longitudinal follow-up program. Length of hospital stay, age at surgery and drain days were analyzed as perioperative outcomes. Surgical approaches and complications were also described.

We included 80 surgically managed patients with CLM over a 25-year period. Eighty-two percent of patients who underwent resection were symptomatic, with respiratory insufficiency (45%) being the primary reason for intervention. Other symptoms were: reduced exercise tolerance, dyspnea and persistent coughing. Reoperation was needed in 2.5% of cases. Median age at intervention was 108 days (IQR 21–463 ) Surgical approaches included thoracotomy (60%), thoracoscopy (29%), embolization (4%) and other interventions (7%). Median length of postoperative hospitalization was 6 days. During their most recent follow-up visit, 21% of the cohort experienced pulmonary symptoms.

A minority of patients with CLM underwent surgical treatment, most of whom were symptomatic. Surgery had low rates of severe complications and a short postoperative stay. Our findings underscore the importance of a long-term management approach.

To evaluate outcomes of laparoscopic hiatal hernia repair with Nissen fundoplication in children, comparing infants (≤ 12 months) and older children (> 12 months).

Pediatric patients who underwent laparoscopic hiatal hernia repair with Nissen fundoplication between 2008 and 2025 were retrospectively reviewed. Patients were classified by age at surgery into ≤ 12 months and > 12 months. Outcomes included postoperative complications, recurrence, length of hospital stay, and follow-up.

Nineteen patients were included in this study (10 boys, 9 girls); of which 9 were ≤ 12 months and the remaining 10 were > 12 months. Age-stratified postoperative outcome comparisons were performed in 17 patients after exclusion of 2 patients (%10.5) with concomitant gastrostomy. Median age at repair was 20 months (IQR 5–58.5; 5 days–120 months) and median weight was 9.8 kg (IQR 5.1–17.5; 2.4–50.0 kg). Median length of stay was 4 days (IQR 3–5; 2–7 days), and median follow-up was 84 months (IQR 38.5–112; 4–205 months). Selective mesh reinforcement was used in 3 patients (15.8%) with wide hiatal defects and/or poor crural tissue quality. Postoperative complications occurred in 4 patients (21.1%). Recurrence occurred in 3 patients (15.8%) at 2, 4, and 9 months postoperatively. All underwent redo laparoscopic repair, and no further recurrence was observed during follow-up.

Laparoscopic hiatal hernia repair with Nissen fundoplication appeared feasible in selected pediatric patients, including infants ≤ 12 months. In this small single-center cohort, recurrences occurred within the first postoperative year and were managed with redo laparoscopy. These findings should be interpreted cautiously and require confirmation in larger multicenter studies.

To investigate the association between cholangitis and portal hypertension (PH) risk, and the efficacy of UDCA in native liver survivors after successful Kasai portoenterostomy (KPE).

A multicenter, retrospective cross-sectional study was conducted at nine Chinese pediatric centers. Patient grouping was based on cumulative cholangitis episodes and UDCA regimens.

After a median follow-up of 56 months, the overall incidence of PH was 23.63% (198/838). Recurrent cholangitis (≥ 3 episodes) was an independent risk factor for PH (OR = 4.25, 95% CI 2.61–6.92, P < 0.001), associated with poorer liver function recovery, greater spleen thickness, and lower peak velocity of the main portal vein. Continuous UDCA therapy significantly attenuated the PH risk induced by recurrent cholangitis (RERI: − 7.66). Among this high-risk subgroup, low-dose UDCA (≤ 10 mg/kg/day) constituted an independent protective factor (OR = 0.17, 95%CI 0.04–0.67, P = 0.015) and showed superior efficacy in reducing total bilirubin. These benefits were evident in children under 48 months, but no clear advantage observed beyond this age.

Among native liver survivors with jaundice clearance, recurrent cholangitis (≥ 3 episodes) warrants long-term monitoring for PH. Continuous low-dose UDCA until 48 months is recommended for high-risk patients to improve outcomes.

The adoption of early feeding after pediatric gastrointestinal surgery remains inconsistent due to concerns regarding anastomotic safety.

A systematic review and meta-analysis of randomized controlled trials was conducted comparing early enteral feeding (initiation within 48 h) with delayed feeding in patients < 18 years undergoing intestinal anastomosis or stoma reversal.

Eight trials comprising 704 patients (323 early feeding, 381 delayed) were included across neonatal and pediatric elective surgical populations. Early feeding significantly shortened hospital length of stay (mean difference − 3.53 days; 95% CI − 4.35 to − 2.71) and reduced time to full feeds (mean difference − 3.15 days; 95% CI − 3.89 to − 2.40). There was no significant difference in anastomotic leakage (log risk ratio − 0.36; 95% CI − 1.23 to 0.51; I²=0%) or postoperative vomiting (log risk ratio − 0.02; 95% CI − 0.41 to 0.38). Early feeding was also associated with fewer wound infections (log risk ratio − 0.85; 95% CI − 1.48 to − 0.22).

Overall, early enteral feeding after pediatric gastrointestinal surgery appears safe and confers clinically meaningful benefits by accelerating nutritional recovery, reducing infectious complications, and shortening hospitalization, supporting its incorporation into pediatric postoperative care pathways.

Single center studies suggest utilization of fentanyl during extracorporeal membrane oxygenation (ECMO) may be associated with a higher risk of opioid withdrawal. This study evaluated fentanyl use during ECMO and subsequent methadone or buprenorphine treatment among pediatric ECMO survivors in a large multi-center cohort.

This retrospective study included children < 18y treated at 41 U.S. children’s hospitals in the Pediatric Health Information System between 2013 and 2023. Multivariable hierarchical regression was used to assess the relationship between fentanyl exposure on ECMO and likelihood of receiving methadone or buprenorphine after ECMO, adjusting for covariates including other opioid exposures.

Overall, 4,365 children were included (55.5% male; 47.9% neonatal). Median duration of ECMO was 5 (IQR: 3–8) days. Fentanyl exposure was categorized into quartiles:0–1 days, 2 days, 3–4 days, and ≥ 5 days. On multivariable regression, children in the 3–4 days quartile (OR 1.32; 95% CI: 1.05–1.65) and ≥ 5 days quartile (OR 2.21; 95% CI: 1.71–2.85) were more likely to receive methadone or buprenorphine after ECMO compared to those in the 0–1 days quartile. On bivariate comparison, children who received fentanyl during ECMO were found to have prolonged ventilator dependence, TPN use, and post-ECMO length of stay.

Patients receiving fentanyl while on ECMO had an increased risk of receiving methadone or buprenorphine treatment post-ECMO, suggesting a higher risk of opioid withdrawal in patients receiving fentanyl while on ECMO. Our findings underscore a need for expanded opioid stewardship initiatives to utilize alternative pain management and minimize fentanyl prescribing for children undergoing ECMO.

To compare the value of non-invasive liver fibrosis indicators, including serum matrix metalloproteinase-7 (MMP-7), APRI, collagen-related proteins [hyaluronic acid (HA), type IV collagen (IV-C), type III procollagen N-terminal peptide (PIIIP), laminin] and shear wave elastography (SWE), in assessing liver fibrosis for biliary atresia (BA).

A retrospective cohort study was conducted in BA infants from July 2020 to December 2023. Liver fibrosis was classified according to the Batts-Ludwig criteria.

A total of 471 BA infants were included. Serum MMP-7, HA, IV-C, PIIIP, laminin, and SWE all correlated with liver fibrosis, with correlation coefficients of 0.4, 0.28, 0.37, -0.15, 0.16, and 0.46 (all P < 0.01), respectively. For severe fibrosis, the AUROC was 0.675 (95% CI: 0.622–0.728) at a cutoff value of 58.98 ng/ml for MMP-7, 0.719 (95% CI: 0.664-0.775) at a cutoff value of 547.05 for IV-C, and 0.732 (95% CI: 0.667–0.796) at a cutoff value of 1.35 m/s for SWE. Among the combined models, IV-C + MMP-7 achieved the higher performance (AUROC 0.756, 95% CI 0.700–0.811).

Non-invasive serum markers and SWE all showed moderate value for fibrosis assessment in BA. SWE may be a promising and useful non-invasive tool, while selected serum biomarker combinations may provide complementary value for identifying severe fibrosis.

The optimal suturing technique for urethral tubularisation during tubularised incised plate (TIP) urethroplasty remains debated. This systematic review and meta-analysis compared perioperative and postoperative outcomes of interrupted versus continuous suturing techniques in paediatric hypospadias repair.

A systematic literature search was performed in PubMed, Cochrane Library, Embase, Scopus, and ClinicalTrials.gov from inception to December 2025 in accordance with PRISMA guidelines. Randomised controlled trials and observational studies comparing interrupted and continuous suturing during paediatric TIP urethroplasty were included. Outcomes assessed were urethrocutaneous fistula, surgical site infection, meatal stenosis, urethral stricture, glans dehiscence, overall complications, urinary stream outcomes, operative time, and reoperation rates. Risk of bias was evaluated using the Cochrane Risk of Bias 2.0 tool and the ROBINS-I. A random-effects meta-analysis supplemented by influence diagnostics and Hartung-Knapp adjustment for heterogeneous outcomes, were conducted using R version 4.5.2, with results expressed as odds ratios (ORs) or mean differences (MDs) and corresponding 95% confidence intervals (CIs).

Fifteen studies involving 2625 paediatric patients were included, with 800 undergoing interrupted suturing and 1,825 continuous suturing. No statistically significant differences were observed between techniques for urethrocutaneous fistula (OR 0.65, 95% CI 0.38–1.11), surgical site infection (OR 0.61, 95% CI 0.25–1.48), meatal stenosis (OR 0.98, 95% CI 0.54–1.80), urethral stricture (OR 1.08, 95% CI 0.29–3.97), overall complications (OR 0.75, 95% CI 0.48–1.17), or glans dehiscence (OR 0.77, 95% CI 0.36–1.63). Operating time showed no clinically meaningful difference operative time (MD 3.77 min, 95% CI − 3.69 to 11.24, Hartung–Knapp adjusted).

Continuous and interrupted suturing techniques during TIP urethroplasty demonstrate comparable complication rates and functional outcomes. These findings suggest that suturing technique may be selected based on surgeon preference and experience; however, large, well-designed multicentre randomised trials are required to further inform clinical practice.

Persistent cloaca (PC), the most severe subtype of congenital anorectal malformations (ARMs) in female infants with an incidence of 1/50,000 live births, has poorly understood etiology.

The study enrolled 12 Chinese PC patients (4 trio families, 8 unrelated individuals), performed whole exome sequencing (WES) via the CG Black Bird platform, extracted genomic DNA from peripheral blood and cryopreserved surgical specimens, annotated variants using databases (dbSNP, gnomAD) and tools (SIFT/PolyPhen2), assessed pathogenicity by 2015 ACMG/AMP Guidelines, and validated via Sanger sequencing. We generated Dnah2⁻/⁻ mice and silenced DNAH2 in human mesenchymal stem cells (hMSCs) to detect SHH pathway proteins.

A novel DNAH2 compound heterozygous variant (p.Ser312Thr, p.Arg573Cys, inherited from asymptomatic parents) was identified in one trio, both classified as Variants of Unknown Significance (VUS). Dnah2⁻/⁻ mice showed vaginal atresia and features consistent with ciliary dysfunction; DNAH2 silencing in hMSCs reduced Smo (53.1%), Gli2 (66.4%).

The first report of the DNAH2 compound heterozygous variant in Chinese PC patients suggests DNAH2 should be considered a candidate susceptibility gene for PC (limited by small sample, conflicting evidence, model flaws), providing a preliminary basis for cilia-associated gene research in PC.

The aim of this study was to evaluate the effects of meteorological variables on the development of complicated appendicitis in pediatric patients with acute appendicitis in Turkey and to determine whether these associations differ across NUTS (Nomenclature of Territorial Units for Statistics) regions.

This multicenter retrospective study included 4361 pediatric patients who underwent surgery for acute appendicitis in different NUTS regions of Turkey between 2023 and 2024. Patients were classified as uncomplicated (71.4%) or complicated (28.6%) appendicitis. Meteorological data, including temperature, humidity, atmospheric pressure, precipitation, and wind speed corresponding to the patients’ operation dates, were obtained from the Turkish State Meteorological Service database. Statistical analyses included descriptive statistics, chi-square test, point-biserial correlation, ROC analysis, and univariable logistic regression. Statistical significance was set at p < 0.05.

No significant nationwide association was observed between meteorological variables and the development of complicated appendicitis (p > 0.05). However, regional analyses demonstrated significant differences. In the Aegean region, increases in temperature, atmospheric pressure, and wind speed were associated with 2.3%, 1.7%, and 35.1% reductions in the risk of complicated appendicitis, respectively. In contrast, increases in atmospheric pressure and wind speed were associated with an increased complication risk in the Western Anatolia and Western Black Sea regions. In the Eastern Black Sea region, atmospheric pressure, and in Southeastern Anatolia, humidity and precipitation showed positive associations with complicated appendicitis risk.

Although meteorological variables were not associated with complicated appendicitis at the nationwide level, regional analyses revealed significant associations. These findings suggest that regional meteorological conditions may influence the risk of complicated appendicitis in children.

Although pediatric thoracic injuries constitute only a small proportion of all childhood injuries, the risk of morbidity and mortality is increased due to the anatomical and physiological characteristics of children. Early diagnosis and timely referral to appropriate centers are critically important, particularly in hospitals with limited advanced imaging, thoracic surgery, and intensive care facilities. This study aims to comprehensively evaluate the interhospital transfer characteristics of pediatric patients with thoracic trauma in Turkey.

The patients’ age, gender, nationality, referring–receiving province and region, referral time, distance, and ICD-10 codes were retrospectively evaluated.

A total of 313 patients were examined (78% male; mean age, 11.2 ± 5.8 years). The most common diagnosis was pneumothorax (27.2%). The vast majority of transfers were by road (98.1%), within the province (82.7%), outside working hours (78%), and on weekdays (70.9%). A significant proportion of air transfers were performed during working hours (p = 0.023). No significant relationship was found between diagnoses and either the transfer route or the transfer time. The distance was significantly longer for out-of-province transfers (p < 0.001). Although significance was detected between the transferring and receiving regions and the direction of transfer, it disappeared in subgroup analyses.

Regulating the criteria for the use of air ambulance services is crucial for strengthening national trauma systems, regionalizing pediatric trauma management, and increasing timely access to advanced trauma centers.

Ovarian torsion is a surgical emergency that can threaten ovarian viability and future fertility. Long-term functional recovery and predictors of postoperative atrophy remain incompletely defined in children.

To evaluate long-term follicular development and ovarian atrophy after pediatric ovarian torsion and to assess the influence of torsion severity and surgical approach.

We retrospectively reviewed records of patients aged 0–18 years treated for ovarian torsion at our center between August, 2019 and August, 2022. Data included age group, laterality, symptom timing, torsion degree, operative technique, pathology, postoperative ultrasound follicular presence, and atrophy. Statistical tests were performed using IBM SPSS Statistics v25. A ROC analysis was used to explore rotation thresholds associated with atrophy. Statistical significance was defined as p < 0.05.

Forty-three patients were included; torsion was more frequent on the right ovary. Detorsion alone was performed in 17 patients, detorsion plus oophoropexy in 16, oophorectomy in 2, and salpingo-oophorectomy in 8. Among patients with postoperative ultrasound follow-up, follicular development was observed in 90% of those undergoing oophoropexy, with no significant difference compared with those without oophoropexy (p = 0.46). Atrophy was more frequent in torsions with 720 or more twisted ovaries (p = 0.01). ROC analysis suggested 900 degrees as a clinically relevant cut-off for increased atrophy risk.

In this single-center cohort, ovarian-sparing surgery achieved high follicular recovery. Torsion rotation severity was strongly associated with postoperative atrophy, with higher risk beyond approximately 900 degrees. Oophoropexy did not adversely affect follicular development, while its protective effect against atrophy remains uncertain.

Patients with anorectal malformation (ARM) and associated sacral agenesis (SA) are at increased risk of long-term bowel and bladder dysfunction, but outcome data to guide early counselling and follow-up remain limited. We aimed to evaluate bowel and bladder outcomes in patients with concurrent ARM and SA, with a focus on transanal irrigation (TAI) and clean intermittent catheterization (CIC) use.

In this retrospective single-center cohort study, all patients with ARM and SA born between January 2000 and January 2024 were included. SA was diagnosed radiologically and classified using Pang’s classification. The primary outcome was TAI and/or CIC use. Secondary outcomes included fecal incontinence (≥ 4 years), urinary incontinence (≥ 5 years), and neurogenic bladder.

In total, 41 patients were included, with a median age at follow-up of 11.2 years. Of 33 patients ≥ 4 years, 22 (66.7%) used TAI during follow-up, primarily for fecal incontinence. Fecal incontinence was present in 26.3% of current TAI users versus 71.4% of non-users (p = .015). CIC was initiated in 18 of 41 patients (43.9%), mostly due to urodynamically confirmed neurogenic bladder. TAI and CIC use were associated with ARM complexity, but not with radiological SA severity.

Patients with concurrent ARM and SA represent a high-risk group for long-term bowel and bladder dysfunction, and many require structured bowel and/or bladder management. These findings support anticipatory counselling and multidisciplinary follow-up.

Lichen sclerosus et atrophicus (LS), often known as Balanitis Xerotica Obliterans, is a common indication for paediatric circumcision. LS is associated with scarring of the foreskin and glans, with meatal stenosis a possible complication. This study aimed to assess the incidence of meatal stenosis among patients undergoing circumcision for LS and assess the risk factors and management of meatal stenosis.

A retrospective case note review was undertaken of all patients under the age of 16 in NHS Grampian undergoing circumcision for LS from 2017 to 2022. Demographics, intervention and outcome data was collected.

131 male patients, with a median age of 9-years-old, underwent circumcision for LS over a 5-year period. Histology was sent for 122 patients of which 117(95.9%) was positive for LS. 15/117 (12.8%) patients were diagnosed clinically with meatal stenosis post-operatively. 9/117(7.7%) patients underwent uroflow studies. 4 patients were managed conservatively after normal uroflows. 11 patients (9.4%) required surgical intervention. 5 patients underwent meatal dilatation. However, 2 patients required further meatoplasty after initial dilatation. 6 patients underwent primary meatoplasty. 42(35.9%) patients were prescribed topical steroids pre-operatively and 21(17.9%) post-operatively. Fischer’s exact test and a Pearson Chi square indicated a significant link between post-operative steroid use and meatal stenosis. However, this is likely due to prescribers favouring steroid use in patients with significant LS of the glans associated with meatal stenosis.

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