Background Long-gap esophageal atresia (LGEA) presents a significant surgical challenge due to the extensive gap precluding tension-free primary repair. Internal traction offers a potentially safer, esophagus-preserving alternative to external traction (Foker) techniques by avoiding prolonged sedation and ventilation. However, evidence is limited to small case series.Methods We searched several databases, such as PubMed, Embase, and Scopus, through October 4, 2025. Eight single-arm studies (122 patients) met inclusion criteria. Pooled proportions were calculated using random-effects models with Freeman-Tukey double arcsine transformation; heterogeneity was assessed via I² statistics.Results Internal traction achieved delayed primary anastomosis in 92% of patients (95% confidence interval (CI=80%–99%; I²=21.1%), with 90% achieving full oral feeding (95% CI=58%–100%). Esophageal replacement was rare (5%) and mortality low (5%). However, morbidity was substantial: gastroesophageal reflux occurred in 73% of patients, stricture requiring dilation in 46%, postoperative stenosis in 52%, and anastomotic leak in 28%. Complication rates directly attributable to internal traction were 28%, with fundoplication required in 22% of patients. Heterogeneity was moderate to substantial for several secondary outcomes.Conclusion Internal traction is a promising organ-preserving approach for LGEA, with high anastomotic success but substantial reflux- and stricture-related morbidity. Prospective, multicenter studies with standardized outcome definitions and comparator groups are needed to define its optimal role in LGEA management.PROSPERO registration number CRD420251161975.
Background Phimosis is an extremely common pediatric surgical condition. Given the convenience and accessibility brought by artificial intelligence, the readability, quality and accuracy evaluation on the information provided by large language models (LLM) is of utmost importance in providing comprehensive clinical care.Methods Six case questions relating to phimosis on its definition, diagnosis, treatment options and potential complications were inputted into each LLM-Chatbots (ChatGPT-3.5, Gemini-1.5 and Claude-3). All responses were reformatted, shuffled and recombined into three passages for single-blind scoring on accuracy by three pediatric surgeons with reference to European Association of Urology (EAU) pediatric urology guidelines. The responses were also assessed for readability using the Gunning-Fog score, Simple Measure of Gobbledygook (SMOG) index and Dale-Chall score and for quality using the DISCERN score.Results Comprehension of the information was considered difficult with a mean Gunning-Fog score, SMOG index score and Dale-Chall score of 14.2±2.6, 11.3±2.2 and 9.9±0.9, respectively. The mean summed DISCERN score was 39.6±2 out of 80. Claude-3-sonnet was considered of poor quality while others were fair. The mean accuracy score of the LLM-chatbots was 4.4±0.4 out of 5. The three LLMs performed similarly on readability and accuracy. The LLM-chatbots generally scored well in providing treatment options and their mechanisms, while lacking references and information regarding treatment benefits, risks of alternative treatments and impact on quality of life.Conclusions The three LLM-chatbots showed comparable and satisfactory accuracy in providing information on pediatric phimosis; however, their readability and overall quality were suboptimal. These limitations may affect parent counseling, shared decision-making and informed consent. LLM-generated information should, therefore, supplement, not replace, clinician guidance and reliable medical resources.Level of evidence III.
Objective To describe the clinical characteristics, treatment processes, and prognosis of primary neuroblastoma (NB) with concurrent pulmonary metastases.Methods Clinical data were collected retrospectively from 10 patients with primary NB and concurrent pulmonary metastases in our institution from March 2019 to October 2025. We collected and analyzed clinical and pathological features, imaging characteristics, and therapeutic responses.Results This cohort comprised seven boys and three girls, with a median age of 45.5 months (range 29–200 months). All patients were classified as stage M and high-risk group. N-myc proto-oncogene (MYCN) amplification was seen in four cases and gain in three cases. Heterogeneous responses to induction chemotherapy were observed. The primary tumor and bone marrow metastases showed favorable responses, whereas pulmonary metastases exhibited low sensitivity to chemotherapy. Nine patients died with a median survival of 17 months (range 5–64 months); one patient survived for 62 months. In the later stages of treatment, tumor progression or recurrence occurred in 9 patients, with bone (n=4), liver (n=4), lung (n=4), primary tumor site (n=3), distant lymph nodes (n=2), brain (n=2), and bone marrow (n=1) being the sites of first progression or recurrence.Conclusions Primary NB with pulmonary metastases is uncommon, frequently associated with MYCN amplification and multiple non-pulmonary metastases; prognosis is poor. Current clinical management predominantly involves systemic therapy, with limited local interventions for pulmonary metastases. Treatment responses vary across primary tumors and different metastatic sites.
Objectives To describe the demographic and clinical characteristics of neonates with congenital duodenal obstruction (CDO) and to describe postoperative outcomes of intraoperative trans-anastomotic feeding tube (TAT) placement.Methods We included a retrospective cohort of infants diagnosed (≤1 month of age) with CDO at the Royal Hospital, Oman, between January 2012 and December 2022. Descriptive statistics were used to summarize numerical and categorical data. A subgroup analysis compared outcomes between infants with TAT (Group 1) and without TAT (Group 2). Data were analyzed using independent sample t-test, Mann-Whitney U test, analysis of variance, and χ2 test as appropriate.Results Forty-two infants were included; 24 were born ≥38 weeks, 23 were female and 24 had birth weight ≥2.5 kg. Intrinsic CDO was the most common presentation (n=21). Cardiac anomalies were present in 19 infants, and syndromes in 18 infants, mainly trisomy 21 (n=11). In subgroup analysis, Group 1 (n=13) had a longer median hospital stay than Group 2 (n=18), but this failed to reach statistical significance (22 vs. 16 days, p=0.13). Rates of central line insertion (69.2% vs. 66.7%, p=0.88), parenteral nutrition (76.9% vs. 83.3%, p=0.65), duration of total parenteral nutrition (12.5 vs. 11 days, p=0.96), time to start enteral feeds (4 vs. 4 days, p=0.93) and time to full enteral feeds (10 vs. 12 days, p=0.32) were similar between groups. Overall complication rate was 19.4% (6/31), with no TAT-related complications.Conclusion Demographic and clinical characteristics were comparable with international findings. TAT insertion was safe but did not improve postoperative outcomes.
Background Pediatric pancreatic pseudocysts (PPCs) are uncommon complications of pancreatic injury or pancreatitis; evidence from resource-limited settings remains scarce. This study aimed to describe the etiology, clinical presentation, management, and short-term outcomes of pediatric PPCs across tertiary pediatric surgery centers in Sudan.Methods A multicenter retrospective cohort study was conducted across seven tertiary pediatric surgery centers in Sudan between March 2022 and February 2023. Patients younger than 18 years with radiologically confirmed PPCs were included. Demographic, clinical, radiological, management, and in-hospital outcome data were retrospectively extracted from medical records.Results Totally, 38 children were included; 27 were male, and 18 were aged 6–10 years. Trauma accounted for 28 cases, most commonly donkey-drawn water cart-related injuries (n=10) and handlebar injuries (n=7). Epigastric pain (n=33) and vomiting (n=31) were the most frequent presenting symptoms, with a median interval of approximately 8 weeks between the initial insult and presentation. Most PPCs measured 6–10 cm (n=24). Open cystogastrostomy (n=17) and ultrasound-guided percutaneous external drainage (n=13) were the predominant interventions; five patients were managed conservatively. Recurrence occurred in one patient, and two patients required reintervention. Two children with severe underlying comorbidities died during hospitalization; neither death was considered directly attributable to the PPC. Non-traumatic PPCs were associated with a significantly different distribution of hospital stay, with a greater proportion requiring prolonged hospitalization (p=0.008).Conclusions Pediatric PPCs in Sudan were predominantly trauma related and frequently required intervention. Management should be individualized according to clinical presentation, pseudocyst characteristics, and locally available expertise and resources.
