History of the Pan African Paediatric Surgery Association (PAPSA)
This article covers the history of the organisation post inception in 1994 to date. The near disbanding of the organisatio n due to political unrest and wars in Africa, to its success in the recent decade is highlighted in this manuscript. (Source: Pediatric Surgery International)
Source: Pediatric Surgery International - July 10, 2020 Category: Surgery Source Type: research

Evaluation of renal oxygenization in laparoscopic pediatric surgery by near infrared spectroscopy
ConclusionIAP with pneumoperitoneum may lead to renal hypoxia in children. Renal rSO2 returns to normal with desufflation. Renal NIRS monitorization might be needed in patients with renal parenchymal and vascular pathologies, solitary kidney, and multiorgan pathologies that may affect renal oxygenation. (Source: Pediatric Surgery International)
Source: Pediatric Surgery International - July 10, 2020 Category: Surgery Source Type: research

Efficacy and safety of adrenergic beta-antagonist combined with lasers in the treatment of infantile hemangiomas: a meta-analysis
AbstractTo investigate the efficacy and safety of combined therapy with adrenergic beta-antagonist and lasers in infantile hemangiomas (IH). A search of Pubmed, Cochrane, Embase, Wanfang Date, CNKI (China National Knowledge Infrastructure) and CBM (China Biology Medicine) databases was conducted to identify studies that examined response to combined therapy with adrenergic beta-antagonist and laser in IH patients. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) in random-effects or fixed-effects models were calculated with Review Manger 5.3. Efficacy of combined therapy with oral propranolol and lasers was sign...
Source: Pediatric Surgery International - July 9, 2020 Category: Surgery Source Type: research

Imaged-guided and muscle sparing laparoscopic anorectoplasty using real-time magnetic resonance imaging
We report the feasibility and utility of real-time MRI-assisted laparoscopic assisted anorectoplasty (RT MRI-LAARP). Needle guidance was performed with Siemens Espree 1.5 T MRI with T1 Flash RT Sequence. After needle placement, laparoscopic mobilization, fistula takedown and pull-through was performed using the needle to guide dilation to create a tract to pull-through the neo-rectum. Charts of patients who underwent RT MRI-LAARP were reviewed. Demographics, anatomy, number of needle passes, OR duration and complications are reported. There were five children that unde rwent RT MRI-LAARP; one was a redo secondary to a...
Source: Pediatric Surgery International - July 7, 2020 Category: Surgery Source Type: research

Thromboelastography-guided management of coagulopathy in neonates with congenital diaphragmatic hernia supported by extracorporeal membrane oxygenation
ConclusionInstitutional standardization of anti-coagulation management of CDH neonates on ECMO, including the use of goal-directed TEG monitoring may lead to improved blood product utilization and a decrease in bleeding complications in neonates with CDH supported by ECMO.Level of evidence/type of studyLevel III, Retrospective comparative study (Source: Pediatric Surgery International)
Source: Pediatric Surgery International - June 30, 2020 Category: Surgery Source Type: research

Assess, adapt and act: a paediatric surgery division ’s initial approach in a rapidly evolving pandemic
ConclusionChanges to delivery of surgical services and surgical training warrant a holistic approach and a constant re-evaluation of practices with emergence of new experiences and guidelines. (Source: Pediatric Surgery International)
Source: Pediatric Surgery International - June 27, 2020 Category: Surgery Source Type: research

Prevalence and distribution of occult fractures on skeletal surveys in children with suspected non-accidental trauma imaged or reviewed in a tertiary Dutch hospital
AbstractPurposeThe purpose of the study was to determine the rate of occult fractures (without clinical symptoms) per presenting clinical injury i.e., children presenting with a fracture, bruise, abusive head trauma and the types of fracture most likely to be found, in a series of infants and young children suspected of being victims of NAT.MethodsSkeletal surveys done between 2008 and 2018 of children (
Source: Pediatric Surgery International - June 26, 2020 Category: Surgery Source Type: research

Transgenic animal models of congenital diaphragmatic hernia: a comprehensive overview of candidate genes and signaling pathways
AbstractCongenital diaphragmatic hernia (CDH) is a relatively common and life-threatening birth defect, characterized by incomplete formation of the diaphragm. Because CDH herniation occurs at the same time as preacinar airway branching, normal lung development becomes severely disrupted, resulting almost invariably in pulmonary hypoplasia. Despite various research efforts over the past decades, the pathogenesis of CDH and associated lung hypoplasia remains poorly understood. With the advent of molecular techniques, transgenic animal models of CDH have generated a large number of candidate genes, thus providing a novel bas...
Source: Pediatric Surgery International - June 26, 2020 Category: Surgery Source Type: research

Barriers to the implementation of new guidelines among pediatric surgeons: online survey
ConclusionsPSUC and PSDC identified very different barriers to implementation of new guidelines. It is reassuring that accessibility to treatment is not the primary issue, though resistance to implementation is a resounding concern. Identifying the barriers will highlight areas that need to be addressed, and awareness may help resolve some of the barriers. (Source: Pediatric Surgery International)
Source: Pediatric Surgery International - June 25, 2020 Category: Surgery Source Type: research

Liver biopsy for hepatoblastoma: a single institution ’s experience
ConclusionPercutaneous liver biopsy is safe and effective for diagnosing hepatoblastoma, and its complication rate is very low. Collecting>3 pieces of tissue is preferred.Level of evidenceIII. (Source: Pediatric Surgery International)
Source: Pediatric Surgery International - June 25, 2020 Category: Surgery Source Type: research

Diagnostic performance and role of the contrast enema for low intestinal obstruction in neonates
ConclusionNeonatal CE demonstrates high specificities and low to moderate sensitivities across all diagnoses, with lowest performance in HD.Clinical trial registrationNone. (Source: Pediatric Surgery International)
Source: Pediatric Surgery International - June 23, 2020 Category: Surgery Source Type: research

Experience of diagnosis and treatment of traumatic bronchial rupture in children in a single clinical center
ConclusionBeing alert to bronchial rupture after trauma in children is helpful for diagnosis. Chest CT with three-dimensional reconstruction techniques and fiberoptic bronchoscopy are the most valuable diagnostic methods. The patients can show excellent results if the operation for a continuous valgus anastomosis of the posterior wall and interrupted end-to-end valgus anastomosis of the anterior wall on the ruptured side is performed in the early stage of traumatic bronchial rupture. (Source: Pediatric Surgery International)
Source: Pediatric Surgery International - June 22, 2020 Category: Surgery Source Type: research

Gastric tumors in children: single-center study with emphasis on treatment of repeated recurrence
ConclusionsGastric tumors are rare in children and represent a management challenge. Repeated recurrence of GISTs and myofibroblastic tumors remains frequent even after complete resection and may necessitate multiple surgeries, therefore patients require a lifelong follow-up. (Source: Pediatric Surgery International)
Source: Pediatric Surgery International - June 19, 2020 Category: Surgery Source Type: research

Reply to the letter to the editor concerning: “Normal anorectal musculatures and changes in anorectal malformation.”
(Source: Pediatric Surgery International)
Source: Pediatric Surgery International - June 17, 2020 Category: Surgery Source Type: research

Commentary to: Normal Anorectal Musculature and Changes in Anorectal Malformation by: Long Li. Xianghi Ren. Hui Xiao. Changlin Wang. Hang Xu. Anxiao and Ming. Zheng Li Pediatric Surgery International (2020) 36:103 –111 https://doi.org/10.1007/s00383-019-04583-1
(Source: Pediatric Surgery International)
Source: Pediatric Surgery International - June 15, 2020 Category: Surgery Source Type: research

Our experience on management of failed pediatric pyeloplasty
AbstractPurposeThe purpose of the study was to assess the outcomes of salvage procedures after failed pediatric pyeloplasty. Recurrent ureteropelvic junction obstruction treatment is a difficult course. The salvage surgery is more challenging in the pediatric population. We aimed to assess the outcomes of salvage procedures after failed pediatric pyeloplasty to determine the most efficient surgical intervention.Methods40 children with 41 renal units who have been treated for recurrent ureteropelvic junction obstruction after pyeloplasty were analyzed retrospectively. The outcomes of all initial and sequent interventions we...
Source: Pediatric Surgery International - June 15, 2020 Category: Surgery Source Type: research

Bracka verses Byar ’s two-stage repair in proximal hypospadias associated with severe chordee: a randomized comparative study
This study was conducted from January 2013 to February 2018 in a tertiary care centre. Patients of hypospadias with severe chordee who required urethral plate transection were included in the study. Patients were randomly divided into two groups by simple randomization method. Bracka staged repair was done in Group A and Byar ’s staged repair in Group B. Postoperatively complications including graft loss, flap necrosis, fistula formation, meatal stenosis, stricture, diverticula formation, residual chordee were noted in both the groups and compared.p value of  
Source: Pediatric Surgery International - June 13, 2020 Category: Surgery Source Type: research

How well do image-defined risk factors (IDRFs) predict surgical outcomes and survival in patients with neuroblastoma? A systematic review and meta-analysis
ConclusionIDRF-positive neuroblastoma patients have a higher risk of incomplete surgical resection, surgical complications, and 5-year mortality and/or relapse. Our results affirm that IDRFs remain a useful prognostic tool for neuroblastoma patients both for short and long-term outcomes.Level of evidenceII. (Source: Pediatric Surgery International)
Source: Pediatric Surgery International - June 12, 2020 Category: Surgery Source Type: research

The role of preoperative instructions in parents ’ understanding of preoperative fasting for outpatient pediatric urology procedures
AbstractPurposeTo assess the impact of modifications in preoperative instructions on parental understanding of preoperative fasting guidelines.MethodsA prospective postoperative parental survey was conducted to assess parental understanding of preoperative fasting requirements in patients undergoing surgery before and after institution of instructions that included visual aids. Data regarding demographics, procedure type, and time to surgery from preoperative visit were also captured. Survey data were compared between pre- and post-intervention groups using Chi-squared tests for categorical variables and Wilcoxon rank sum ...
Source: Pediatric Surgery International - June 10, 2020 Category: Surgery Source Type: research

Short- and long-term outcome of surgery for chronic pancreatitis in children: a single surgeon experience
ConclusionsSurgery is safe with fairly acceptable perioperative complications and good long-term pain control. (Source: Pediatric Surgery International)
Source: Pediatric Surgery International - June 8, 2020 Category: Surgery Source Type: research

Trapdoor anterior thoracotomy for cervicothoracic and apical thoracic neuroblastoma in children
ConclusionGross total resection of cervicothoracic and apical thoracic neuroblastoma can be accomplished by TAT with minimal morbidity. (Source: Pediatric Surgery International)
Source: Pediatric Surgery International - June 8, 2020 Category: Surgery Source Type: research

Downregulation of miR-140-5p affects the pathogenesis of HSCR by targeting EGR2
ConclusionsmiR-140-5p may influence the pathogenesis of HSCR by targeting EGR2. (Source: Pediatric Surgery International)
Source: Pediatric Surgery International - June 7, 2020 Category: Surgery Source Type: research

Resection margin histology may predict intermediate-term outcomes in children with rectosigmoid Hirschsprung disease
Conclusion1 –2 year follow-up may be insufficient to determine if resection margin histology correlates with outcomes. Patient-reported quality of life surveys, although limited in number, suggest that neurotransmitter imbalance at the resection margin may predict poor outcomes in HSCR patients. This study s upports the concept that the ganglionated portion of the remaining colon post-surgery may not sustain normal bowel function. (Source: Pediatric Surgery International)
Source: Pediatric Surgery International - June 6, 2020 Category: Surgery Source Type: research

Biliary atresia in twins: a systematic review and meta-analysis
ConclusionBA was found in nearly half of twin subjects with an even gender split. Isolated BA was the largest group, in which the number of monozygotic twins was similar with dizygotic twins, so the onset of the disease may not associate with the zygosity of twins. Most of twin sets had discordant disease presentation, especially monozygotic twins therein, emphasizing the role of epigenetic factor in the pathogenesis of BA. Future studies should take genetic testing among any twin sets in BA, especially the disease-associated mutations, thus be useful to investigate the etiology of disease. (Source: Pediatric Surgery International)
Source: Pediatric Surgery International - June 5, 2020 Category: Surgery Source Type: research

Correction to: 14 Years ’ experience of esophageal replacement surgeries
The quality of the images published in the original version was not satisfactory. The better version images are provided below. (Source: Pediatric Surgery International)
Source: Pediatric Surgery International - June 3, 2020 Category: Surgery Source Type: research

Significant practice variability exists in the prevention of venous thromboembolism in injured children: results from a joint survey of the Pediatric Trauma Society and the Trauma Center Association of America
ConclusionCurrently no consensus regarding the prevention of VTE in pediatric trauma exists. Prospective application of PTS/EAST guidelines has been limited, likely due to poor quality of evidence and a reliance on post-injury metrics. Results of this survey suggest that further investigation is needed to more clearly define the risk of VTE in children, evaluate, and prospectively validate alternative scoring systems for VTE prevention in injured children.Level of evidenceN/A —Survey. (Source: Pediatric Surgery International)
Source: Pediatric Surgery International - June 2, 2020 Category: Surgery Source Type: research

Treatment of megarectum in anorectal malformation with emphasis on preventive aspects: 17  years experience
ConclusionEX did not confer benefit in the functional outcome but carried a high risk of complications, often needing ACE or stoma. By adhering to strategies discussed, we reduced the incidence of megarectum and have avoided EX since 2013. (Source: Pediatric Surgery International)
Source: Pediatric Surgery International - June 1, 2020 Category: Surgery Source Type: research

Pediatric endoscopic procedures during the COVID-19 pandemic: an Italian center experience
(Source: Pediatric Surgery International)
Source: Pediatric Surgery International - May 30, 2020 Category: Surgery Source Type: research

Endoscopic removal of tracheobronchial foreign bodies: results on a series of 51 pediatric patients
ConclusionFOB can be used not only as a diagnostic procedure, but also as the first method for the removal of airway FBs. The Dormia basket is a useful tool, especially to remove peripherally located FBs. (Source: Pediatric Surgery International)
Source: Pediatric Surgery International - May 28, 2020 Category: Surgery Source Type: research

Bladder bowel dysfunction in children with Down ’s syndrome
ConclusionThis study reviews the largest cohort of patients with BBD in DS. It is common with serious consequences requiring operative intervention. Usual interventions are unreliable due to poor compliance. Early identification and management protect the renal tract. Regular screening for urogenital anomalies in DS is currently not performed. We recommend a thorough history of bladder function in DS patients to identify these cases early. (Source: Pediatric Surgery International)
Source: Pediatric Surgery International - May 26, 2020 Category: Surgery Source Type: research

Scoliosis after thoracotomy repair of esophageal atresia: a systematic review
In conclusion, the reported prevalence of scoliosis varies widely but on average affects about one in eight children after open repair of EA/TEF. Most cases are mild and do not require intervention. It is currently uncertain whether secondary scoliosis is preventable by using meticulous thoracotomy techniques or thoracoscopic repair.Level of evidence IV. (Source: Pediatric Surgery International)
Source: Pediatric Surgery International - May 25, 2020 Category: Surgery Source Type: research

Therapeutic potential of mature adipocyte-derived dedifferentiated fat cells for inflammatory bowel disease
ConclusionDFAT cells possess immunoregulatory potential and the cell transplantation promoted recovery from colon damage and improved clinical symptoms in the IBD model. DFAT cells could play an important role in the treatment of IBD. (Source: Pediatric Surgery International)
Source: Pediatric Surgery International - May 24, 2020 Category: Surgery Source Type: research

Investigation into multi-centre diagnosis and treatment strategies of biliary atresia in mainland China
ConclusionMainland China has a large number of patients with biliary atresia. Diagnostic and surgical methods vary from centre to centre and are related to its caseload. In most centres, KPE is supplemented with glucocorticoids, antibiotics, and choleretic agents without a standard regimen. (Source: Pediatric Surgery International)
Source: Pediatric Surgery International - May 22, 2020 Category: Surgery Source Type: research

Laparoscopic diverticulectomy or laparoscopic-assisted resection of symptomatic Meckel diverticulum in children? A systematic review
Conclusions are limited by the number of patients and variable follow up. Short, wide MD with a height:base ratio of 
Source: Pediatric Surgery International - May 20, 2020 Category: Surgery Source Type: research

Intracellular localization of beta-catenin expression plays a possible prognostic role on the outcome of hepatoblastoma patients
ConclusionAlthough the numbers are limited in our series, the intracellular localization of BC expression has been found to be a promising determining factor for hepatoblastoma prognosis. With larger patient series, more reliable results can be achieved. (Source: Pediatric Surgery International)
Source: Pediatric Surgery International - May 20, 2020 Category: Surgery Source Type: research

Does physiotherapy applied in conjunction with compression brace treatment in patients with pectus carinatum have efficacy? A preliminary randomized-controlled study
In this study, we aimed to examine the effect of a physiotherapy protocol applied as adjunct to compression brace treatment in patients with PC.MethodsThe study included 30 male patients between 11 and 18  years of age. Patients were randomly assigned into two groups: a brace treatment only group (Group 1) and a brace and physiotherapy group (Group 2). Patient demographics and disease-related properties, protrusion measurements, postural evaluations, deformity perceptions, life quality, and treatmen t satisfaction were evaluated.ResultsAlthough both groups showed improvements based on external chest measurements relat...
Source: Pediatric Surgery International - May 18, 2020 Category: Surgery Source Type: research

The treatment of congenital pyriform sinus fistula: a single-center experience
ConclusionsHypothermia plasma cauterization with suspension laryngoscopy alongside 3D imaging is both minimally invasive and repeatable with neglectable complications, which has the potential to serve as the first-line treatment for CPSF in the future. (Source: Pediatric Surgery International)
Source: Pediatric Surgery International - May 18, 2020 Category: Surgery Source Type: research

Short-term surgical trips: local collaboration and its effects on complications and patient satisfaction
ConclusionFacilitating visiting and local surgeons performing cases together increases the expertise of local providers, strengthens infrastructure, and establishes clear follow-up. Despite complications, patients and families continued to recommend care to family and friends by the relief organization and were happy with support from local providers. Engaging local providers is the gold-standard for short-term trips. (Source: Pediatric Surgery International)
Source: Pediatric Surgery International - May 16, 2020 Category: Surgery Source Type: research

Response to letter to the editor
(Source: Pediatric Surgery International)
Source: Pediatric Surgery International - May 15, 2020 Category: Surgery Source Type: research

Assessment of neurogenic bowel symptoms with the bowel dysfunction score in children with spina bifida: a prospective case –control study
AbstractAimTo compare the quality of life (QoL) in children with spina bifida with a control group of their peers using a validated questionnaire, the Neurogenic Bowel Dysfunction Score (NBDS).MethodsThe NBDS questionnaire was prospectively distributed to children attending a multi-disciplinary Spina Bifida clinic and healthy controls attending pediatric urology clinics. A score (out of 41) was assigned to each child based on their responses to the validated questionnaire. A lower score indicates better bowel function-related quality of life. SPSS software (v.25) was used for all statistical analysis.ResultsThere were 98 r...
Source: Pediatric Surgery International - May 13, 2020 Category: Surgery Source Type: research

Management of perinatal testicular torsion: experience of two tertiary centers
ConclusionAlthough ipsilateral testicular salvage rates are low, urgent bilateral exploration in a multidisciplinary center seems reasonable to give a chance to the ipsilateral testis and to avoid the rare but catastrophic bilateral torsion, after discussing with the family. (Source: Pediatric Surgery International)
Source: Pediatric Surgery International - May 13, 2020 Category: Surgery Source Type: research

Atypical rectoscrotal and rectoperineal fistula in male anorectal malformations: a case series of non-detaching strategies for preventing urethral injury
We present here three male ARM patients with an atypical fistula which did not have connection with the urinary tract, but ran near the fistula. Case 1 has a low-type ARM with a rectoscrotal fistula running deep and partly involved in the corpus spongiosum. Anorectoplasty was performed through an anterior sagittal incision and the anterior wall of the fistula was laid open leaving the posterior wall undetached. Case 2 was diagnosed with an intermediate-type ARM with a long rectoscrotal fistula running near and parallel the urethra. Posterior sagittal anorectoplasty (PSARP) was performed leaving the fistula untouched. Case ...
Source: Pediatric Surgery International - May 12, 2020 Category: Surgery Source Type: research

Comment on A serious complication of liver hydatid cysts in children: cystobiliary fistulas
(Source: Pediatric Surgery International)
Source: Pediatric Surgery International - May 12, 2020 Category: Surgery Source Type: research

Letter to the Editor concerning: “Nonoperative treatment for nonperforated appendicitis in children: a systematic review and meta-analysis”
(Source: Pediatric Surgery International)
Source: Pediatric Surgery International - May 11, 2020 Category: Surgery Source Type: research

Ethics of randomized trials in pediatric surgery
This article reviews the ethic al aspects unique to pediatric surgical RCTs and prospective comparative studies.Level of evidence: Level 3. (Source: Pediatric Surgery International)
Source: Pediatric Surgery International - May 11, 2020 Category: Surgery Source Type: research

Letter  to the Editor concerning: ‟Follow-up outcomes of pediatric patients who underwent surgical resection for lipoblastomas or lipoblastomatosis: a single-institution experience with a systematic review and meta-analysis”
(Source: Pediatric Surgery International)
Source: Pediatric Surgery International - May 8, 2020 Category: Surgery Source Type: research

The value of prophylactic chest tubes in tracheoesophageal fistula repair
AbstractPurposeIntraoperative chest tubes (IOCTs) can be placed during esophageal atresia/tracheoesophageal fistula (EA/TEF) repair to control pneumothoraces and detect esophageal leaks, potentially preventing the need for postoperative chest tubes (POCTs). However, data are lacking regarding IOCTs ’ effect. We hypothesized that IOCT placement would not reduce the risk of POCT placement and would increase hospital length of stay (LOS).MethodsThis was a single-center case-control study of type C EA/TEF patients repaired at a tertiary referral center between 2006 and 2017. Postoperative complications of patients who re...
Source: Pediatric Surgery International - May 6, 2020 Category: Surgery Source Type: research

Biliary atresia in twins ’population: a retrospective multicenter study in mainland China
ConclusionsDiscordance for BA in 19 pairs of twins supported that BA may be related to genetic phenotype or penetrance. The difference in genetic background between MZ and DZ affects the susceptibility of the host to virus infection. High acceptance of KP (84.2%) in our study implied a high motivation for treatment for twins with BA. Delays of KP (78  days) in affected twin may be related to the postnatal gradual onset and the late diagnosis. (Source: Pediatric Surgery International)
Source: Pediatric Surgery International - May 4, 2020 Category: Surgery Source Type: research

Risk factors for pneumothorax associated with isolated congenital diaphragmatic hernia: results of a Japanese multicenter study
ConclusionsThe cumulative survival rate was significantly lower in isolated CDH patients with pneumothorax than in those without pneumothorax. A higher MAP was a risk factor for pneumothorax in CDH patients. (Source: Pediatric Surgery International)
Source: Pediatric Surgery International - April 28, 2020 Category: Surgery Source Type: research

A clinical review of ovarian tumors in children and adolescents
ConclusionPreoperative imaging findings and the serum tumor marker values enabled us to make an accurate preoperative diagnosis. Patients with intermittent abdominal primary symptoms were more likely to have ovarian torsion than those without such symptoms, and leukocytosis may indicate irreversible ischemic changes in the affected ovary. (Source: Pediatric Surgery International)
Source: Pediatric Surgery International - April 28, 2020 Category: Surgery Source Type: research