Pediatric pancreatic pseudocysts are rare clinically and there is no consensus on an optimum treatment strategy for it. Here, we aim to evaluate the outcome and efficacy of percutaneous external drainage in treating pediatric pancreatic pseudocysts.

To investigate the risk factors of postoperative poor incision healing in children with congenital pectus excavatum who underwent thoracoscopic-assisted Nuss procedure.

Pancreatic trauma in the pediatric population is an uncommon but highly morbid injury. Its management remains controversial, with treatment strategies ranging from non-operative management (NOM) to upfront operative management (OM), primarily guided by the patient's hemodynamic stability and the integrity of the main pancreatic duct. This systematic review and meta-analysis aim to elucidate the comparative effectiveness and safety of NOM versus OM for pediatric pancreatic trauma.

The aim of the study was an assessment of whether the age of patients with WT could be measured as a risk factor and an analysis of the treatment of patients over 10 years old.

This prospective, randomized, double-blinded study aimed to compare the incidence of postoperative complications and perioperative analgesic efficacy between caudal and penile block in children undergoing primary hypospadias repair.

To provide a comprehensive resource for diagnosis and management of non-obstructive and obstructive Müllerian anomalies for pediatricians, pediatric surgeons, and gynecologists.

Ovarian torsion in the pediatric population is rare, however, delays in diagnosis and treatment can result in long term consequences including ischemia and necrosis of the affected ovary and/or fallopian tube. Clinical presentation is often vague and can be variable, thus a high index of suspicion is required for diagnosis. Pelvic ultrasound with color doppler can aid in diagnosis, however, a normal result does not exclude torsion and thus diagnosis is suspected based on patient history and clinical symptoms. Detorsion with ovarian conservation is the gold standard for both definitive diagnosis and treatment, even when the ovary appears necrotic. Following detorsion, long-term follow up demonstrates high rate of ovarian recovery and function highlighting the importance of ovarian preservation. Early recognition and prompt intervention are essential to optimize outcomes and preserve fertility in pediatric patients with ovarian torsion.

Malignant ovarian tumors are exceedingly rare in children. The overwhelming majority of ovarian masses in the pediatric population are benign. Distinguishing benign from malignant ovarian pathology can be challenging. Avoidance of oophorectomy for benign ovarian disease and potential fertility sparing surgery for ovarian malignancy are crucial preoperative risk stratification steps for the healthcare team. The presentation of malignant ovarian tumors in girls is often non-specific, and may include abdominal pain and distention, palpable abdominal or pelvic mass, hirsutism or virilization. When evaluating young girls presenting with ovarian masses, it is important to consider their clinical characteristics, as ovarian masses in young, pre-pubescent girls are more likely to be malignant. Imaging should include abdominal-pelvic US, and axial imaging (CT or MRI). Serum tumor markers are essential elements of the work up includingCA-125, β-hCG, AFP, estradiol, testosterone, inhibin, LDH, and FSH. Germline mutations and cancer predisposition syndromes are associated with malignant ovarian tumors. Malignant ovarian masses are categorized into epithelial and non-epithelial subtypes. Epithelial tumors are the most common type of ovarian tumor in adult women. Non-epithelial tumors are most frequent in children. Non-epithelial tumors include the germ cell tumors (most frequent malignant tumor in children), and sex-cord stromal cord tumors. The Fédération Internationale de Gynécologie et d'Obstétrique (FIGO) staging classification is used for staging epithelial tumors and sex-cord stromal tumors and the Children's Oncology Group (COG) staging is used for staging of germ cell tumors. The goal of treatment for all malignant ovarian tumors is complete resection and adjuvant platinum-based chemotherapy may be necessary for advanced stages. In the pediatric population, fertility sparing surgery should always be included in preoperative decision-making and family counseling.

Tubo-ovarian abscesses (TOA) in children and adolescents may be missed or delayed in diagnosis due to differences in the etiologies, presentation, and clinical evaluation compared to adult patients. Management of TOA should include intravenous (IV) broad-spectrum antibiotics for all patients; additional abscess drainage through image-guided techniques may be co-initiated with antibiotics as first line treatment for those with risk factors for treatment failure, or reserved as second-line treatment for those who do not improve with IV antibiotics. Surgical interventions impose a higher risk of complications and are generally reserved for clinically unstable patients or for those who fail both IV antibiotics and image-guided abscess drainage. Selection of management must balance complication risk of the TOA itself with iatrogenic complication risks. This article reviews TOA in the pediatric and adolescent population, highlighting the different etiologies in younger patients compared to adults, and reviewing current recommendations for evaluation and management.

With the decreasing mortality of pediatric cancer, issues of survivorship should be addressed at the beginning of therapy. It is known that some treatment protocols cause loss of fertility and hormone production and thus counseling should occur before treatment begins. Currently this is a top unmet need despite its recommendation from several pediatric oncologic and reproductive societies. All patients should be counseled on their risk of infertility related to gonadotoxic therapy and understand whether they are a candidate for a fertility preservation procedure. Both prepubertal and postpubertal girls can undergo ovarian tissue cryopreservation via unilateral oophorectomy, however only postpubertal patients can have ovarian hormone stimulation with egg retrieval. Autotransplantation of cryopreserved ovarian tissue is utilized when fertility or hormone function needs to be restored, while eggs can be thawed for future in-vitro fertilization. This review focuses on female fertility and hormone preservation counseling, options and surgical pearls, current state of research and fertility preservation outcomes, through a case-based format.

Pelvic pain is a common concern among adolescent females, with gynecologic etiologies ranging from dysmenorrhea, most often due to endometriosis, to obstructive anomalies and adnexal masses. Evaluation requires a detailed history, including menstrual and pain characteristics, functional impact, and relevant family history, as well as a focused physical exam tailored to the adolescent's developmental stage and comfort. Pelvic ultrasonography is often the initial imaging modality, with additional imaging and laboratory testing as adjuncts. Endometriosis, the leading cause of secondary dysmenorrhea, frequently presents with debilitating pain and may require diagnostic laparoscopy if pain persists despite medical therapy. Given the variation in practice patterns and the involvement of multiple specialties, coordinated, evidence-based care is essential. This review outlines the evaluation and surgical management of gynecologic pelvic pain in the pediatric and adolescent population, with a focus on endometriosis.

The umbrella term disorders of sexual development (DSD) encompasses a broad spectrum of congenital conditions with atypical chromosomal, gonadal or anatomic sex development. These conditions include mosaic chromosomal disorders, gonadal disorders of development, disorders of androgen synthesis, action or excess, and anatomical disorders, such as cloacal anomalies or mullerian structural errors. The incidence of DSD is estimated to be around 1% of all live births. DSD patients can also be considered to have congenital conditions affecting reproductive development (CCARD) and an important element of their care as the age is taking regular inventory of their anatomy so decisions regarding medical, surgical and psychological options can be made. There are many specialties that are asked to help these families, including pediatricians, endocrinologists, urologists, pediatrics surgeons and, as they age, pediatric/adolescent gynecologists and adult gynecologists. Keeping the message consistent is difficult across such a wide spectrum of specialists. Tools that can offer a review of the function of the body and, in particular, the specific anatomy unique to these diagnoses, is essential. We present a review of common DSD or CCARD conditions and propose education delivered at typical milestones to help empower decision making.

The fallopian tube develops from the paramesonephric (Mullerian duct) and connects the uterus to the ovary. There are many mild tubal anomalies. While many tubal pathologies are benign and asymptomatic, some may have significant clinical implications if left unidentified or inadequately treated. Clinicians should maintain a broad differential diagnosis when evaluating pediatric and adolescent patients with vague abdominopelvic symptoms. A thorough history and abdominal examination should be performed and may help delineate adnexal etiologies of pain or discomfort. In sexually active adolescents, testing for common sexually transmitted infections such as C. trachomatis and N. gonorrhoeae is recommended, though clinicians should be mindful that a negative infectious workup does not exclude the possibility of an inflammatory fallopian tube pathology. Imaging modalities, such as transabdominal ultrasound and MRI, can be valuable for assessing tubal abnormalities and guiding surgical planning, particularly in premenarchal or never sexually active patients for whom transvaginal ultrasound may be inappropriate. When surgical intervention is indicated, laparoscopy can often provide a safe and effective means of definitive diagnosis and treatment.

Adnexal lesions including ovarian, paraovarian, paratubal, and benign or malignant tumors are the most common reason for gynecologic surgery during childhood. Adnexal lesions can occur at any age and may be secondary to hormonal influences. Presentation of a benign or malignant adnexal lesion is non-specific but is usually asymptomatic and progression slow making early diagnosis challenging. Developing a comprehensive differential diagnosis involves obtaining a thorough history and physical exam and often requires the use of imaging and consideration of a panel of tumor markers. In most cases, management includes observation or ovarian sparing surgery optimizing pubertal development and future fertility. Oophorectomy for benign adnexal lesions is rarely indicated.

Abnormal uterine bleeding is common during adolescence and can have significant impact on health and development. The causes are wide leading to diagnostic complexity. This review starts with definitions to help identify abnormal uterine bleeding patterns. A well-established classification system is presented that can be used to organize the evaluation. Underlying causes are discussed with a focus on specific bleeding patterns and appropriate treatment options.

This study evaluates the safety and efficacy of single-port versus multi-port laparoscopic surgery in pediatric inguinal hernia repair through a systematic review and meta-analysis.

With the continuous advancement of surgical instruments and techniques, laparoscopic minimally invasive surgery (LMIS) has become a standard practice in many pediatric medical centers. LMIS offers significant benefits over traditional open surgery, including reduced perioperative complications and enhanced postoperative recovery. In comparison to laparoscopic surgery, the robotic system is equipped with magnified 3D image, superior visualization, dexterity and tremor filter, enabling more precise operative actions, stable control, and clearer exposure of surgical field, facilitating the handling of deep anatomical structures and protecting critical blood vessels and nerves. Robotic surgery represents the pinnacle of precision in minimally invasive techniques and is gaining popularity among surgeons for complex reconstructive procedures.

Pediatric choledocholithiasis is a rare but increasingly recognized disease process that is predominantly managed with either an "endoscopy-first" or "surgery-first" approach. In the endoscopy-first approach, a preoperative endoscopic retrograde cholangiopancreatography is performed with subsequent cholecystectomy. In contrast, the surgery-first approach is a single-stage procedure that includes a laparoscopic cholecystectomy and intraoperative cholangiogram, followed by a laparoscopic common bile duct exploration when indicated. Recent studies have highlighted the potential advantages of the SF approach. However, no standardized treatment algorithm exists, and institutional capabilities and practicing patterns heavily influence management decisions. This point-counterpoint review explores both approaches, analyzing their effects on clinical outcomes and healthcare resources. Continued research and a multidisciplinary approach are needed to develop consensus-driven treatment algorithms.

Physician advocacy continues to be controversial. The concept of social medicine is long-standing, though its optimal, even permissible, contemporary application remains dubious. Physicians may be motivated to become active advocates but ought to appreciate ethical concerns regarding the impact of their actions, both on patients and the larger healthcare landscape. This manuscript explores the ethical implications of physician advocacy.