Pediatric surgeons face substantial administrative workload. Large language models (LLMs) may streamline documentation, family communication, rapid reference, and education, but raise concerns about accuracy, bias, and privacy. This review summarizes practical, near-term uses with clinician oversight.Narrative review of LLMs in pediatric surgical workflows and scholarly writing. Sources included MEDLINE/PubMed, Scopus, Embase, Google Scholar, and policy documents (WHO, FDA, EU). Searches spanned January 2015 to August 2025, English only. Peer-reviewed and multicenter studies were prioritized; selected high-signal preprints were labeled. Data screening and extraction were performed by the author; findings were synthesized qualitatively.Across studies, LLMs reduced drafting time for discharge letters and operative note registries while maintaining clinician-rated quality; they improved readability of consent forms and postoperative instructions and supported patient education. For decision support, general models performed well on structured medical questions, with stronger results when grounded by retrieval. Common limits included coding performance, case-nuance/temporal reasoning, variable translation outside high-resource languages, and citation fabrication without curated sources. Privacy risks stemmed from logging, rare-string memorization, and poorly scoped tool connections. Recommended controls included a clinician-in-the-loop "review and release" workflow, privacy-preserving deployments, version pinning, and ongoing monitoring aligned with early-evaluation guidance.When outputs are grounded in structured EHR data or curated retrieval and briefly reviewed by clinicians, LLMs can responsibly reduce administrative burden and support communication and education. Early adoption should target high-volume, low-risk, auditable tasks. Future priorities must include multicenter pediatric datasets, transparent benchmarks (accuracy, calibration, equity, time saved), and prospective studies linked to safety outcomes.

Aim of the study Although is known that VR reduces presurgical anxiety, it has not been stratified by age to determine its effect. Nor has been applied before the day of surgery. This study has a novel age-stratified design offering VR months before surgery to address these unstudied issues. Methods Unicenter blinded clinical trial with parallel groups stratified by age (5-8 and 9-12 aged), including major outpatient surgery patients. VR video showing the course of surgery was offered months before surgery. Study had ethical committee approval. Main variable was modified Yale Preoperative Anxiety Scale (mYPAS) before entering operating room. Child Behavior Checklist (CBCL) measured basal anxiety and Posthospitalization Behavior Questionnaire (PHBQ) behaviour after one month. For comparison t Student or Kruskall-Wallis tests were used. Main results Of 72 patients, 6 met exclusion criteria and 5 withdrew consent. Of the remaining 61, 56 completed mYPAS. mYPAS decrease was significant for 5-8 aged (28.33 VIDEO vs. 35.83 non-VIDEO; p 0.042) (rank coefficient 0.45 (0.05- 0.72)). In the 9-12 aged (32.91 vs. 33.33; p 0.864), a tiny correlation r 0.04 (0.38-0.45) was found. 96.67% of CBCLs (n=58) scored normal. The 57 completed PHBQs had very low scores, both in non-VIDEO (0.00 (0.00-4.50)) and in VIDEO groups (0.00 (0.00-4.50)). No differences were found; neither globally (p>0.05), nor depending on age (5-8 aged p 0.508 / 9-12 aged, p 0.661). Conclusions VR may reduce preoperative anxiety in younger children (5 to 8 years), though its effect in the entire group was borderline. Larger multicenter studies are needed to confirm age and timing benefits.

Artificial intelligence (AI) is increasingly explored in pediatric surgical care, yet its translation into diagnostics and preoperative planning lags behind adult surgery. Unlike prior reviews, this study provides a comprehensive synthesis across four domains, diagnostics, preoperative planning, risk stratification, and surgical error prevention, highlighting recent advances and unmet challenges.A narrative review of PubMed/MEDLINE (2020-2025) identified peer-reviewed studies on AI in pediatric surgery. Eligible articles addressed one of the four domains and were assessed for methodology, clinical applicability, and relevance to pediatric surgical patients.Diagnostic imaging is the most advanced field, with deep learning models for fracture detection and bone age assessment achieving accuracies up to 95% and near-expert agreement, though external validation is scarce. Preoperative planning benefits from AI-driven segmentation, 3D reconstruction, and virtual reality, with reports of altered surgical strategy in up to 8% of oncology cases, but evidence of outcome benefit is limited. Risk models for appendicitis and congenital heart surgery often surpass clinical scores, yet fewer than 10% have undergone external validation. Tools for error prevention, such as intelligent checklists and workflow monitoring, remain at the proof-of-concept stage. Across domains, most studies are retrospective, single-center, and methodologically heterogeneous.AI demonstrates tangible potential to improve pediatric surgical diagnostics, planning, and safety. However, translation into clinical practice requires multicenter pediatric datasets, prospective validation, and transparent, interpretable models. By consolidating the most recent evidence across four domains, this review outlines both the opportunities and critical gaps that should be addressed for safe and effective adoption.

Although VACTERL association is a recognized entity in patients with esophageal atresia (EA), its impact on surgical outcomes remains unclear. This study aimed to evaluate the influence of VACTERL association and chromosomal anomalies (VACTERL-CA) on the surgical outcomes of EA patients, offering novel insights into risk stratification.All patients enrolled in the European Pediatric Surgeons' Association (EUPSA) Esophageal Atresia Registry (EAR) between July 2014 and December 2017 were included. Patients were classified into two groups: those with VACTERL-CA and those without these anomalies (non-VACTERL). Groups were compared for demographics, associated malformations, surgical approach, complications, and outcomes.Among 372 patients, 22% ( = 82) were classified as VACTERL-CA. This group had significantly lower gestational age (35.9 weeks vs. 37.1 weeks,  = 0.004), birth weight (2,312 g vs. 2,663 g,  < 0.001), and APGAR scores at 5 and 10 minutes ( = 0.005). Surgical strategies, including rates of primary anastomosis (88% in both groups), did not differ. Anastomotic leak and stricture rates were similar; however, recurrent fistula was more common in VACTERL-CA (4.9% vs. 1.0%,  = 0.023). Overall mortality was higher in VACTERL-CA (14.6% vs. 5.2%,  = 0.003), largely due to associated anomalies such as cardiac or neurologic conditions, whereas EA-related mortality was more frequent in non-VACTERL (1% vs. 0%). Sepsis was also more frequent in VACTERL-CA (10.9% vs. 4.5%,  = 0.033). In multivariate analysis, low birth weight (adjusted odds ratios [aOR]: 0.95 per 100 g,  = 0.010) and cardiac malformations (aOR: 2.33,  = 0.002) were independently associated with VACTERL-CA.EA patients with VACTERL-CA represent a high-risk subgroup characterized by prematurity, major cardiac defects, and increased sepsis risk. These findings highlight the need for early cardiac screening, standardized infection-prevention bundles, and tailored multidisciplinary care to improve survival and reduce preventable complications.

Nuss procedure is the standard technique for pectus excavatum repair. Despite its minimally invasive nature, this procedure is associated with significant postoperative pain and high opioid consumption. Intercostal nerve cryoablation (INC) has emerged as an adjunct to multimodal analgesia (MMA) to improve pain control, reduce opioid use, and shorten length of stay (LOS). This systematic review aims to assess INC outcomes following the Nuss procedure in pediatric patients.A systematic search was conducted in PubMed, Web of Science, Scopus, and Cochrane Library databases through December 2024. Studies comparing INC with standard MMA, with or without thoracic epidural, in pediatric patients undergoing the Nuss procedure were included. The primary outcome was LOS, and the secondary outcomes were opioid consumption, postoperative pain, complications, operative time, and hospitalization costs. Risk of bias was determined using the National Institutes of Health assessment tool. Meta-analysis was performed using R software.Eleven studies met the inclusion criteria, comprising 922 patients (476 INC and 446 control). INC significantly reduced LOS (-2.2 days; 95% CI: -2.8 to -1.8) at the expense of increased operating room time (+23 minutes; 95% CI: 10-39). Qualitative analysis showed reduced opioid use and comparable pain scores and complication rates with INC, while its impact on costs was conflicting.INC reduces LOS and opioid use in pediatric patients undergoing the Nuss procedure without increasing complications. Further studies are needed to assess long-term safety and cost-effectiveness.

Open repair of congenital diaphragmatic hernia (CDH) in neonates often requires surgical reconstruction of the abdominal wall. Lateral release (LR) of the abdominal wall fascia, a novel technique avoiding prosthetic patches, offers potential advantages. However, data comparing its outcomes to traditional patch repair are limited.A preliminary prospective cohort study was conducted at the University Medical Center Mannheim from 2021 to 2024, including neonates undergoing CDH surgery with abdominal wall reconstruction via direct closure, LR, or patch repair based on intraoperative surgeon decision. Perioperative, postoperative, and short-term outcome data were analyzed during our standardized follow-up protocols and compared between groups.Among 77 eligible neonates, 11 underwent patch repair and 10 received LR. Baseline characteristics between groups were comparable. The median follow-up was 391 days in the patch group and 215 days in the LR group ( = 0.1971). The LR group had significantly shorter median intubation duration, neonatal intensive care unit stay, and overall length of stay compared with the patch group (32.0 days vs. 43.0 days,  = 0.0445; 33.5 days vs. 66.0 days,  = 0.0309; 68.0 days vs. 97.0 days,  = 0.0435). There were no significant differences in recurrence rates, short-term complications, or motor developmental outcomes.LR appears to be associated with shorter hospital stays and faster recovery, without an increase in perioperative or long-term complications. While these findings suggest potential benefits of LR, they must be interpreted with caution due to the limited sample size. Further randomized, multicenter studies with larger cohorts, including long-term assessment of complications, are needed to confirm its efficacy and refine clinical guidelines.

Artificial intelligence (AI) is increasingly integrated into surgical practice, offering enhanced decision-making, precision, and workflow efficiency. In pediatric surgery, the convergence of AI and robotic-assisted platforms represents a promising frontier, addressing the unique anatomical, physiological, and technical challenges of operating on children. Aim of this review is to provide an overview of the current state of art of AI use in pediatric robotic-assisted surgery (RAS), outlining the available evidence, potential benefits, existing limitations, and prospective developments.A literature-based search of PubMed and Scopus was performed to identify articles covering any aspect of AI application in pediatric RAS. Selection criteria included English language, pediatric patients (under 18 years of age), and AI application to pediatric RAS. Additionally, studies reporting AI applications in adult RAS or for surgical training, which were not primarily focused on pediatric surgery but presented potential translational applicability to pediatric RAS, were considered.A total of 746 papers published until July 2025 were collected. A total of 15 full-text articles were assessed for eligibility, meeting the inclusion criteria. The other studies were excluded because they did not address pediatric surgery, did not involve robotic-assisted procedures, or did not include applications of AI.Although RAS is well established in pediatric practice, the direct application of AI remains limited, with AI-like features such as machine vision and augmented reality serving mainly as supportive tools rather than autonomous decision-making systems. Nevertheless, emerging AI-like technologies and ongoing research hold promising potential for future applications in pediatric robotic surgery.

The European Pediatric Surgeons' Association (EUPSA) Network Office regularly endorses surveys that address controversial topics in pediatric surgery. However, the scientific impact of these within the medical literature remains unclear. To address this gap, we conducted a bibliometric analysis of all published EUPSA-endorsed surveys.Surveys endorsed by the EUPSA Network Office were reviewed for topic, journal, participation, bibliometric indicators (total number of citations and citations per article and year), and citing countries. Simple linear regression was used to determine citation time trends.Between 2013 and 2024, at least one survey was published each year (  = 0.26;  = 0.1). Most commonly, surveys were published in the European Journal of Pediatric Surgery ( = 15), and the most common survey topics included general pediatric ( = 7), thoracic ( = 4), and colorectal ( = 3) surgery. The average number of participants per survey was 167 ± 53, with 75% (range: 54-89%) European responses. The most cited surveys addressed esophageal atresia, necrotizing enterocolitis, and Hirschsprung's Disease. The median number of citations per survey was 11 (range: 1-160), with a median of 6 citations per year (range: 0-26). The total number of citations from all EUPSA Network Office-endorsed surveys increased over time (  = 0.75;  = 0.0006), and the average citation per article and year was consistent (  = 0.09;  = 0.34). Citations originated from 63 countries, mostly from the United States ( = 75), Germany ( = 64), and China ( = 44).Despite inherent limitations of survey-based research, the growing bibliometric impact of EUPSA Network Office-endorsed surveys highlights their scientific merit as an important tool for exploring current pediatric surgical practices, which will inform future multi-institutional studies.

Recent studies show that at least three-quarters of surgeons who perform minimally invasive surgery suffer from musculoskeletal pain and discomfort. This problem may compromise surgical performance, patient outcomes, and career longevity. Because of small patient dimensions, pediatric surgery is associated with a different set of ergonomic challenges than adult surgery.A 59-item questionnaire was sent to all practicing pediatric surgeons in Germany. It contained a general assessment of demographics, practice setting, operative volume, types of operations performed, and compensatory interventions, followed by the validated Nordic Questionnaires for the analysis of musculoskeletal symptoms (NMQ). Responses were collected and statistically evaluated to identify risk factors for musculoskeletal complications.A total of 152 pediatric surgeons participated in the survey. Among the participants, 21% were trainees, 58% attendings, and 21% chiefs of service. The median time in practice was 18 years (range: 0 to 38 years). Musculoskeletal pain was reported by 75%, and was most prevalent in the neck/cervical (80%), shoulder (56%), and lower back/lumbar region (71%). Footrests or steps were used by 88%, intraoperative breaks were employed by 49%, and 96% of respondents sometimes operated in a sitting position. The only significant factor for musculoskeletal pain was number of years in practice.Musculoskeletal pain among pediatric surgeons is common and increases with years in practice. Although many pediatric surgeons incorporate ergonomic measures in their daily activities, these are far from being implemented universally. More awareness and research on the prevention of long-term musculoskeletal sequelae in pediatric surgery is necessary.

The optimal approach for repairing severe hypospadias remains debated. In our institution, the single-stage double-face preputial island flap (DFPIF) has been employed to reduce the number of procedures and costs. Given the resource-limited context, an evidence-based comparison of repair techniques was warranted to inform cost-effective surgical decision-making.A prospective randomized study was conducted on 36 patients with proximal hypospadias and chordee >30 degrees, treated between 2022 and 2025. Patients were randomly allocated to Group A (DFPIF) or Group B (Byars' flap) using a computer-generated block randomization with allocation concealment. All surgeries were performed by the same team. Patients were followed for 12 months. Groups were compared regarding complications, functional, and cosmetic outcomes. Functional outcomes were assessed using parent-reported urinary stream and erection, with objective chordee assessment under anesthesia. Cosmetic results were evaluated using the Hypospadias Objective Scoring Evaluation (HOSE) score and a 10-point parental satisfaction scale. Outcomes were assessed by a blinded team member who was not involved in the operative procedures. Data were analyzed by a blinded analyst.Thirty-six patients were included, with 18 patients in each group. There was no statistically significant difference in complications, except for partial wound dehiscence, which was higher in group A ( = 0.041). Functional and cosmetic outcomes, as well as parental satisfaction, did not differ significantly.While both techniques achieved acceptable early outcomes, the double-face flap group showed higher rates of partial wound dehiscence. Further studies with larger samples and longer follow-up are required to determine long-term efficacy and safety.

Artificial intelligence (AI) is increasingly integrated into pediatric healthcare, offering opportunities to improve diagnostic accuracy and clinical decision-making. However, the complexity and opacity of many AI models raise concerns about trust, transparency, and safety, especially in vulnerable pediatric populations. Explainable AI (XAI) aims to make AI-driven decisions more interpretable and accountable. This review outlines the role of XAI in pediatric surgery, emphasizing challenges related to bias, the importance of ethical frameworks, and the need for standardized benchmarks. Addressing these aspects is essential to developing fair, safe, and effective AI applications for children. Finally, we provide recommendations for future research and implementation to guide the development of robust and ethically sound XAI solutions.

Artificial intelligence (AI) and machine learning (ML) models rapidly transform health care with applications ranging from diagnostic image interpretation, predictive modeling, personalized treatment planning, real-time intraoperative guidance, and outcome prediction. However, their implementation in general pediatric surgery remains limited due to the rarity and complexity of pediatric surgical conditions, small and heterogeneous datasets, and a lack of formal AI training and competencies among pediatric surgeons.This narrative review explores the current landscape of AI and ML applications in general pediatric surgery, focusing on five key conditions: appendicitis, necrotizing enterocolitis, Hirschsprung's disease, congenital diaphragmatic hernia, and biliary atresia. For each, we summarize recent developments, including the use of AI in image analysis, diagnostic support, prediction of disease severity and outcome, postoperative monitoring, and histopathological evaluation. We also highlight novel tools such as explainable AI models, natural language processing, and wearable technologies.Recent findings demonstrate promising diagnostic and prognostic capabilities across multiple conditions. However, most AI/ML models still require external validation and standardization. The review underscores the importance of collaborative, multicenter research based on joint datasets as well as targeted AI education for pediatric surgeons to fully explore the benefits of these technologies in clinical practice.AI and ML offer significant potential to improve pediatric surgical care, but broader implementation will require multicenter collaboration, a robust dataset, and targeted AI education for pediatric surgeons.

Congenital pulmonary airway malformation (CPAM) is a rare fetal lung anomaly characterized by cystic lesions that can impede lung development. While smaller lesions may remain asymptomatic and are managed postnatally, larger lesions can cause severe complications such as mediastinal shift and hydrops fetalis. Fetal surgery may be indicated in these cases. This study analyzed whether fetal surgical intervention affects outcomes of subsequent postnatal surgery in CPAM patients.A retrospective single-center cohort study was conducted on pediatric patients treated for CPAM between January 2010 and August 2024. Patients were divided into two groups: those with prenatal surgical intervention and those treated with postnatal surgery only. Propensity score matching based on gestational age, gender, birth weight, and lesion volume ratio yielded 23 matched patients: 14 in the fetal surgery group and 9 in the control group. Baseline characteristics, type of fetal intervention, intraoperative, and long-term postoperative outcomes were assessed. Multivariable regression was performed to account for confounding variables.Among 179 identified patients, 23 were included after propensity score matching: 14 in the fetal surgery group and 9 in the standard postnatal surgery group. Baseline characteristics were balanced, except for significantly higher disease severity in the fetal surgery group (hydrops 69% vs. 0%,  < 0.001; mediastinal shift 93% vs. 33%,  = 0.001). Alcohol ablation was the most common fetal intervention; however, various other prenatal procedures were also performed, with most patients undergoing multiple interventions. Tendencies but no significant differences were found in primary outcomes, including mortality (15% vs. 0%,  = 0.26) and recurrence (29% vs. 0%,  = 0.18). Secondary outcomes such as ventilation duration and intensive care stay were longer in the fetal surgery group, but not statistically significant.Despite higher baseline disease severity, patients who underwent fetal intervention showed postnatal outcomes comparable to those with less severe CPAM. Fetal surgery did not appear to adversely affect surgical recovery. These findings should be interpreted with caution but may support the selective use of prenatal intervention in high-risk cases and underscore the need for further research to refine both prenatal strategies and postnatal care.

Ex vivo fluorescence confocal microscopy (FCM) is an emerging technology that enables real-time, high-resolution digital imaging of freshly excised tissues without requiring standard histological preparation. This study aims to evaluate the diagnostic performance of FCM compared with conventional histology in a pediatric population with suspected oncological pathology.A total of 18 tissue samples from pediatric patients with suspected oncological lesions were analyzed using FCM. The results were compared with the definitive diagnoses obtained via conventional histology, serving as the gold standard. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated to assess the diagnostic accuracy. Cohen's kappa coefficient (Κ), 95% confidence interval (95% CI), and -value were computed to evaluate the interobserver agreement and the concordance between FCM and histology.FCM correctly identified 10 positive cases (true positives) and 7 negative cases (true negatives), with 1 false positive and no false negatives. Interobserver agreement was perfect, with a Cohen's kappa coefficient of 1.00 (95% CI: 0.81-1.00,  < 0.001). Sensitivity was 100% (95% CI: 72.2-100%), specificity 87.5% (95% CI: 52.9-97.8%), PPV 90.9% (95% CI: 62.3-98.4%), and NPV 100% (95% CI: 64.6-100%). The Cohen's kappa coefficient was 0.89, indicating excellent agreement between FCM and histology (95% CI: 0.67-1.10,  < 0.001). FCM provided rapid diagnostic results, significantly reducing turnaround time compared with conventional methods.FCM demonstrates exceptional diagnostic accuracy, with excellent sensitivity and specificity in evaluating pediatric specimens. Its ability to deliver reliable intraoperative results highlights its potential as a valuable adjunct to conventional histopathology in pediatric surgery. Larger studies are warranted to confirm these findings and establish their role in clinical practice.

 In this report we present a new anatomical stratification for vaginal obstruction (hydrocolpos) based on MRI findings while referring the level of obstruction to a fixed bony landmark (the pubic symphysis). This new approach can overcome the limitations of current classifications, which are prone to approximation errors during measurement and fail to account for variations in body mass across different age groups.

The aim of this study is to explore the protective effects and mechanisms of Eupatilin, a peroxisome proliferator-activated receptor α (PPARα) agonist, on cholestatic liver disease induced by common bile duct ligation (BDL) in mice.We selected Balb/c mice (both male and female) aged 6 to 8 weeks for the common BDL procedure (ethical approval number: MUST-FDCT-20241114001). The groups include the BDL group and the BDL+ Eupatilin group, with three mice in each group. Once the mice developed jaundice postsurgery (5 days), they were treated with Eupatilin via gavage at a dosage of 20 mg/kg daily for a period of 8 days. On day 13, ocular blood was collected, and liver tissues were extracted for histopathological examination with H&E staining, Sirius Red staining, and subsequent RNA sequencing. Statistical differences among the parameters were evaluated using a -test.Eupatilin reduces the liver weight/body weight ratio by 41% and ameliorates liver necrosis and fibrosis in Balb/c mice. It could decrease alanine transaminase (  = 0.0498), aspartate aminotransferase ( = 0.0077), while maintaining ALB (Albumin) and γ-GT (gamma-glutamyl transferase) within normal ranges. RNA sequencing analysis revealed that antioxidant genes (acetaldehyde dehydrogenase 2 [] and superoxide dismutase 1 []) might be the targets of Eupatilin action.We found that Eupatilin can upregulate antioxidant genes (;  = 0.0107) and ( = 0.0208) of Balb/c mice, thereby ameliorating BDL damage in mice with cholestatic liver disease.

Thoracoscopic esophageal atresia (EA) repair is a demanding procedure. It provides long-term benefits for patients including better cosmesis and less musculoskeletal sequelae compared with open surgery. Besides technical challenges, there is concern that thoracoscopy increases treatment costs. However, surgical treatment of EA in Germany is not centralized with more than 90 pediatric surgical units offering treatment for 200 expected EA patients yearly. Our aim was to evaluate the rate of thoracoscopic EA repair regarding characteristics of treating hospitals, surgical approach and treatment costs in Germany.Insurance claims data (January 2020 to June 2024) from six health insurance companies representing about one-third (28.5 million) of the German population were analyzed. The database was queried for specific ICD-10-GM (International Statistical Classification of Diseases and Related Health Problems, 10th revision, German Modification) and OPS (Operationen- und Prozedurenschlüssel) coding. Characteristics of treating hospitals, length of hospital stay and medical treatment costs were assessed.A total of 149 reconstructive procedures for EA were analyzed. Eleven esophageal anastomoses were performed thoracoscopically (7%). All thoracoscopic procedures were performed in a specialized center. Mean length of hospital stay for open and thoracoscopic surgery was 76 versus 79 days, respectively ( > 0.05). Mean treatment costs were 142,741 € versus 150,238 €, respectively ( > 0.05).Thoracoscopic EA repair remains the exception in Germany. Thoracoscopy is exclusively performed in specialized hospitals. Length of hospital stay and treatment costs are comparable to open surgery, assumingly due to only uncomplicated patients without comorbidities being considered for thoracoscopy. We recommend surgical treatment in specialized centers to enable surgical advantages to all patients with EA.

Small bowel volvulus is a clinical condition that causes intestinal ischemia-reperfusion (I/R) injury, leading to severe tissue damage and high mortality rates. Polydatin, a natural stilbenoid polyphenol, has demonstrated anti-inflammatory and antioxidant properties. This study aimed to evaluate the protective effects of polydatin on I/R injury using an experimental small bowel volvulus model.A total of 24 healthy female Wistar albino rats were divided into four groups: Sham (Group 1), Polydatin (Group 2), I/R (Group 3), and Treatment (Group 4). In Group 1, no I/R procedure was applied, and intraperitoneal saline was administered. Group 2 received 20 mg/kg intraperitoneal polydatin without I/R. In Group 3, a 5-cm segment of the small intestine was twisted 360 degrees clockwise, leading to 2 hours of ischemia and 2 hours of reperfusion. Group 4 received 20 mg/kg intraperitoneal polydatin before reperfusion. Blood and intestinal tissue samples were collected for biochemical and histopathological analysis.Serum total antioxidant status (TAS) levels were significantly higher in the treatment group compared with the I/R group ( = 0.004). Serum total oxidant status (TOS) levels were significantly elevated in the I/R group compared with all other groups ( < 0.001) but were significantly reduced in the treatment group ( < 0.001). Tissue oxidative stress index (OSI) values were significantly lower in the treatment group compared with the I/R group ( = 0.004). Although serum OSI levels and tissue TAS and TOS values showed a favorable trend, they were not statistically significant. Histopathological evaluations revealed a marked reduction in tissue damage in the treatment group compared with the I/R group.Polydatin exerts protective effects against I/R injury in an experimental small bowel volvulus model by reducing oxidative stress and histopathological damage. These findings highlight its therapeutic potential and warrant further clinical research.

Fenestrated laparoscopic-assisted internal ring-rrhaphy (FLAIR) is a refined percutaneous technique for pediatric inguinal hernia repair. Although its outcomes have been reported in boys, its application in girls, particularly in relation to round ligament management, remains underexplored. Whether to include or exclude the ligament during internal ring closure is still debated.This study evaluated the impact of round ligament management on surgical outcomes in girls undergoing FLAIR. A retrospective cohort of 69 hernias, operated on between July 2016 and December 2023, was reviewed. Patients were divided into two groups: those in whom the round ligament was included in the closure (Inclusion group) and those in whom it was deliberately spared (Exclusion group). Recurrence rates and postoperative complications were compared.All four recurrences (11%) occurred in the Inclusion group, while no recurrences were observed in the Exclusion group ( = 0.048). All recurrences occurred within 3 months postoperatively and were successfully reoperated using the exclusion technique, with no further recurrence during follow-up. No significant differences in other postoperative complications were identified between groups.FLAIR appears to be a safe and effective approach in girls, particularly when the round ligament is excluded from the closure. Exclusion was associated with zero recurrences and no increase in complications. These findings, observed over intermediate-term follow-up, suggest that sparing the round ligament may enhance repair integrity and potentially protect the ligament from entrapment, thereby preserving its anatomical function. Larger, multicenter studies with extended follow-up are needed to validate these results and guide pediatric hernia repair strategies.

Flank bulge (FB) is a rare postoperative complication, most commonly following surgery with retroperitoneal access through flank incision. It is characterized by relaxation of anterolateral wall muscles with abnormal protrusion of the abdominal wall. The assumed pathomechanism is iatrogenic injury of the intercostal nerves T11/T12. During congenital diaphragmatic hernia (CDH) repair, dissection and sutures are necessary at this thoracic level. We aimed to assess the risk of FB in a consecutive series of patients after CDH repair.We retrospectively analyzed charts of all patients after CDH repair (2007-2024) with a follow-up of ≥3 months. FB was diagnosed during clinical follow-up examinations and defined as protrusion of abdominal wall with no sonographic evidence for hernia. Surgical variables and their association with FB were evaluated. For statistical analysis, Pearson's and Student's t-test were used. Multivariate logistic regression was performed to identify independent risk factors associated with FB development after CDH repair.Among 67 infants undergoing CDH repair with follow-up, 76% underwent open surgery and 48% required patch repair. Postoperative FB occurred in 11% of patients, exclusively following open repair with patch, and was significantly associated with rib sutures and higher birth weight. One-third of FB cases resolved spontaneously, while the remainder persisted, though without functional impairment.FB may be an underestimated complication after open CDH repair. Routine assessment of abdominal wall tone is recommended during follow-up after CDH repair. Larger studies are needed to clarify the clinical impact, patient-perceived level of disability, and long-term sequelae.

The primary objectives were to know the prevalences of pulmonary hypoplasia (PH), persistent pulmonary hypertension of the newborn (PPHN), and mortality in newborn infants with giant omphalocele (GO). A secondary aim was to assess the prevalence of syndromes and other congenital anomalies (SCA) associated with GO.A systematic review according to PRISMA guidelines using MEDLINE/PubMed, Google Scholar, and Scopus platforms was performed. The search strategy combined indexed and in-process citations up to May 22, 2023.Out of 651 articles, 23 met the inclusion criteria, comprising 14 observational studies and 9 case reports. There was no uniformity in the criteria for diagnosing PH and PPHN among the studies. In the observational studies, the prevalence of PH varied between 18.5 and 54% (median: 26%); the prevalence of PPHN varied between 13 and 100% (median: 38.5%); and mortality varied between 4 and 50% (median 23.5%). SCA were reported in 58% of patients. In the case series, PH was present in 27.8% of the neonates, PPHN in 50%, and mortality occurred in 55.5%. About 55.5% had associated SCA. The association of SCA and preterm birth contributed significantly to increase the mortality rate.The reported prevalences of PH, PPHN, mortality, and SCA associated with GO are alarmingly high. Although the heterogeneity and limitations of the included studies prevent definitive prevalence estimates, the findings underscore the urgent need for standardized diagnostic criteria, better prenatal counseling, and management in highly specialized centers.