BackgroundPreservation of ovarian function is a major objective in the surgical management of benign ovarian tumours in pediatric and adolescent patients. Robotic-assisted surgery may facilitate ovarian-sparing procedures by improving surgical precision and dissection capabilities. This study aimed to evaluate the feasibility and perioperative safety of robotic-assisted ovarian-sparing surgery and to compare outcomes with a pre-robotic cohort.MethodsA single-centre retrospective comparative cohort study was conducted at a tertiary pediatric referral centre. Consecutive patients aged ≤18 years undergoing surgery for radiologically suspected benign ovarian tumours between January 2023 and December 2025 were included. Patients were divided into a pre-robotic cohort (2023–2024) and a robotic cohort (2025). The primary outcome was the rate of ovarian-sparing surgery. Secondary outcomes included conversion to open surgery, operative time, length of hospital stay (LOS), postoperative complications, reoperation, and postoperative analgesic consumption.ResultsTwenty-four patients were included: 14 in the pre-robotic cohort and 10 in the robotic cohort. Baseline demographic characteristics were comparable between groups. Ovarian-sparing surgery was achieved in all robotic cases (100%) compared with 85.7% in the pre-robotic cohort. No conversions to open surgery occurred in the robotic group, whereas two conversions/oophorectomies occurred in the pre-robotic cohort. Operative time was longer in the robotic cohort (median 2:27:30 vs. 1:42:00; p=0.021), while LOS remained comparable. No intraoperative complications or surgical site infections were observed. One robotic patient required reoperation for trocar-site bleeding. Opioid rescue therapy was significantly less frequent in the robotic cohort (10% vs. 50%; p=0.048).ConclusionsRobotic-assisted ovarian-sparing surgery for benign ovarian tumours in pediatric and adolescent patients is feasible and safe. Robotic technology may facilitate fertility-preserving surgery by supporting precise tumour enucleation and consistent preservation of healthy ovarian tissue, particularly in technically demanding cases.

BACKGROUND:Foreign Body Ingestion (FBI) is a common reason for paediatric Emergency Department (ED) visits. Although most cases resolve spontaneously, a significant proportion requires urgent intervention. Adherence to standardised, evidence-based protocols is essential to prevent complications and ensure appropriate care. METHODS:This retrospective, single-centre study analysed all paediatric FBI cases over a four-year period. Demographic, clinical, and management data were retrieved and compared with international guidelines and recommendations from the Corpi Estranei mobile application, a digital decision-support tool derived from North American Society for Paediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) and European Society for Gastroenterology, Hepatology and Nutrition (ESPGHAN) protocols. RESULTS:A total of 475 confirmed cases were identified (59.6% males). Most patients were aged 2-5 years (50.3%), and blunt objects were the most frequently ingested items (82.5%). Most children were asymptomatic (72.6%), while 26% required hospitalisation. Among admitted patients, 64.7% underwent endoscopic or surgical intervention. Interhospital transfers significantly increased hospitalisation rates; however, 37% of transfers were potentially avoidable. Fifteen cases (3.2%) deviated from guideline-based management, mainly due to unnecessary or delayed procedures or omitted imaging, most of which involved transferred patients (p < 0.05). CONCLUSIONS:Management of paediatric FBI remains heterogeneous, with frequent deviations from recommended protocols and a notable rate of avoidable transfers and procedures. This study suggests that structured decision-support algorithms may help reduce avoidable transfers and improve guideline adherence in regional paediatric networks.

Communication skills are essential non-technical competencies in pediatric surgery, yet formal training programs remain limited and inconsistent. This perspective article examines the critical role of communication across pediatric surgical subspecialties and proposes frameworks for implementing structured communication training in residency programs. We performed a narrative review of published literature on communication skills in pediatric surgery and synthesized existing communication frameworks applicable to surgical training. Expert perspectives were gathered from an international group of pediatric surgeons representing diverse subspecialties including prenatal counseling, neonatal surgery, pediatric urology, and pediatric surgical oncology. We identify specific communication challenges unique to pediatric surgery, including prenatal counseling, neonatal intensive care discussions, sensitive urological conditions, and pediatric oncology. Existing frameworks such as SPIKES for delivering bad news and EMPATHY for non-verbal communication provide evidence-based tools adaptable to pediatric contexts. Current training approaches remain largely informal and mentor-dependent, with significant variability between programs. Pediatric surgery training programs should integrate structured communication curricula with defined learning objectives, simulation-based practice, and regular feedback mechanisms to prepare trainees for the unique communication demands of caring for children and their families.

Introduction Short Bowel Syndrome (SBS) is a complex paediatric condition and the primary pathophysiological cause of intestinal failure (IF), resulting from a significant reduction in the length of the small intestine. This reduction in absorptive surface area leads to nutrient malabsorption, impaired digestion, and other clinical complications. Case series This case series explores the clinical aspects of seven paediatric SBS subjects grouped according to IF classification associated with the variation in the intestinal microbiota composition. Blood and urine samples were collected twice a week during hospitalization to evaluate clinical parameters. Faecal samples collected before and after intestinal surgical intervention were analyzed for microbiota composition using a targeted metagenomics sequencing approach, focusing on the V3-V4 region of the 16S rRNA gene on the MiSeq (Illumina) platform. Results We observed specific variations in blood and urinary analytes according to the IF category as well as variations in the diversity and composition of the intestinal bacteria communities. Particularly, variations in the diversity were associated with specific changes in 15 bacterial ASVs abundances among the variables considered ( i.e. IF category, residual colon anatomy and specific clinical history (patient variable)). Conclusions This study provides valuable insights into the clinical history of paediatric cohorts with SBS, expanding the knowledge base for their clinical and nutritional management. Characterizing the intestinal microbiota in these patients plays a crucial role in identifying potential markers of dysbiosis which may provide important insights for developing targeted pharmacological therapies and personalized care for SBS patients. Monitoring specific microorganisms could enable timely pharmacological or clinical intervention, leading to personalized therapies ( e.g. , targeted antibiotic therapy). This case series highlights the complexity of SBS and the necessity of an integrated approach, in which microbiota composition can be leveraged to address dysbiosis, ultimately improving the quality of life of paediatric patients.

Background:Activating variants in GUCY2C increase cyclic GMP signaling in enterocytes, driving chloride rich luminal secretion and impaired sodium absorption. Affected neonates can present with prenatal bowel dilatation and severe postnatal fluid losses that mimic mechanical obstruction. Case report:We describe a term male infant with fetal ultrasound and MRI evidence of markedly dilated bowel loops and severe polyhydramnios. Fetal testing identified a de novo heterozygous GUCY2C missense variant (c.2732 A>G). After birth, profuse intestinal secretion combined with profound intestinal hypotonia led to acute functional obstruction and massive ileal dilatation, prompting urgent laparotomy and diverting ileostomy. No mechanical stenosis was found; the ileocecal valve and colon were patent. Histology showed eosinophilic enteritis with prominent ganglionitis and preserved ganglion cells. The infant required prolonged parenteral nutrition with gradual advancement of enteral feeds and fecal recycling through the distal mucous fistula to achieve enteral autonomy by 2 years of age. He is currently 3 years old. Conclusion:GUCY2C mediated secretory diarrhea may be complicated by severe dysmotility and inflammatory enteric neuropathy, requiring early decompression and prolonged intestinal rehabilitation before recovery.

Background Megacystis–microcolon–intestinal hypoperistalsis syndrome (MMIHS) is a rare congenital visceral myopathy characterized by severe gastrointestinal dysmotility and bladder dysfunction, most commonly associated with ACTG2-mutations. Case report We report a preterm neonate with prenatally detected megacystis and a de novo heterozygous ACTG2 variant (c.593G>T; p.Gly198Val). Postnatally, the patient developed progressive abdominal distension and feeding intolerance. Imaging demonstrated dilated bowel loops and microcolon. Exploratory laparotomy on day 5 confirmed dilated ileum, microcolon, and massive megacystis without mechanical obstruction. Gastrostomy and ileostomy were performed. The patient required parenteral nutrition followed by gradual enteral feeding with stool recirculation. Clean intermittent catheterization and antibiotic prophylaxis were initiated. Conclusion MMIHS should be suspected in cases of fetal megacystis. Early genetic diagnosis and multidisciplinary management, including intestinal failure rehabilitation and urological care, are essential to improve outcomes.

BACKGROUND/OBJECTIVES:Ovarian malignancies in children and young women exhibit distinct clinical characteristics and may be managed by either paediatric surgeons or gynaecologists, depending on patient age and institutional protocols. This multicentre retrospective study aims to evaluate similarities and differences in the management and outcomes of ovarian malignancies treated by different surgical teams. DESIGN/METHODS:A multicentre retrospective review was conducted, including patients who underwent surgery for ovarian malignancies from 2013 to the present. Data were collected from two paediatric surgical departments and one adult gynaecological department. Patients were categorized into two groups according to the surgical team: Group A (paediatric surgeons) and Group B (gynaecologists). Clinical, diagnostic, surgical and oncological data were analysed. RESULTS:A total of 52 patients were included: 29 in Group A (median age 10 years, range 3-15) and 23 in Group B (median age 31 years, range 23-39). The most common tumour types were immature teratomas in Group A (45%) and borderline tumours in Group B (43.5%). Group A commonly underwent transabdominal ultrasound (87%) and MRI (31%), whereas Group B received transvaginal ultrasound (100%) and CT scans (78.2%). In Group A, 62% of girls underwent laparotomy, whereas 83.4% of women (Group B) underwent laparoscopy (p < 0.01). Oophorectomy was performed in 90% of cases across both groups. Patients in Group A presented more frequently with early-stage disease (93% vs. 30%, p < 0.05). During follow-up, relapse occurred in three paediatric and four adult patients, and two patients (one from each group) died due to disease progression. CONCLUSIONS:Despite variations in preoperative assessment and surgical approaches, postoperative oncological treatment and long-term outcomes, including disease-free and overall survival, were comparable between the groups. Integrating the strengths of both paediatric and gynaecological approaches may further optimize the management of ovarian malignancies in young patients.

Giant omphalocoeles, defined by a defect larger than 5 cm or significant liver herniation, present unique challenges due to viscero-abdominal disproportion. Traditional staged closure techniques aim to gradually reduce herniated organs but carry risks such as abdominal compartment syndrome and prolonged recovery. The use of an innovative vertical traction approach improves the compliance of the abdominal cavity through stretching of muscles and fascia and enables tension-free closure. We present the case of a female neonate with giant omphalocoele treated with this device.

Extra-axial ependymomas are rare tumours, and myxopapillary ependymoma (MPE) is the most common subtype in children, often misdiagnosed as other sacral lesions. MPEs are considered low-grade tumours, but relapse with distant metastasis is frequent. Therefore, therefore a proper diagnosis and subsequent follow-up are warranted. The current report presents a case of extra-axial MPE in a paediatric patient who presented with an indolent sacral mass and underwent surgical resection, along with a review of the literature. The aim was to highlight the importance of diagnostic suspicion in differential diagnosis of sacral soft-tissue masses

AIM OF THE STUDY:Investigating the possible role of bioprosthesis in the treatment of primary chest wall Ewing sarcoma (pCWES) after major chest wall resection in the pediatric oncologic population and its role in addressing the significant controversies related to the ongoing growth process in this population. This study presents the insights from a pediatric referral center, aiming at evaluating the oncological and functional outcomes of children treated with bioprosthesis. METHODS:Data were collected retrospectively for all cases of pCWES managed at our facility over 5 years. All of the patients underwent the same surgical procedure for chest wall reconstruction, with positioning of a porcine biologic prosthesis covered by a latissimus dorsi muscle pedicled flap. A multidisciplinary evaluation was offered in all cases. Evaluated outcomes included morbidity, mortality, and subsequent functional and aesthetic results. RESULTS:Three patients were included: two males and one female. Median age at diagnosis was 13 years (range: 18 months to 19 years). One patient presented with lung metastases at diagnosis. All patients underwent a neoadjuvant chemotherapy regimen. Postoperative chemotherapy was restarted after a median of 47 postoperative days (range: 40-59). All of the patients are alive at the latest follow-up (mean follow-up time = 29 months), and the rate of local recurrence was 0. CONCLUSION:Our series includes the youngest patient documented in the literature to be treated with a biologic prosthesis without the use of rigid materials. This approach appears to be both safe and effective for pediatric patients with pCWES. A multidisciplinary approach remains essential.

BACKGROUND:The history of inguinal hernia repair has been marked by the description of several therapies over ages, each with its own approach to managing the hernial sac. An analysis of hernia sac transection (with or without high ligation) versus reduction (invagination) in adults who underwent Lichtenstein open tension-free inguinal hernia repair and in adult and pediatric patients who underwent suture repair has been the primary aim of this systematic review and meta-analysis. METHODS:The authors conducted a comprehensive review and meta-analysis. A comprehensive literature search yielded 15 publications, consisting of 12 randomized controlled trials (RCTs) including 1598 patients and 3 controlled clinical trials (CCTs) including 243 patients. In total, the included patients amounted to 1.841. RESULTS:Analysis of the data revealed a lower rate of recurrence in patients who had sac reduction (0.35% in randomized controlled trials and 0 in clinical trials) compared to patients who had sac excision and ligation (0.86% in randomized controlled trials and 0.93% in clinical trials). However, this difference was not statistically significant (RCTs: relative risk 2.94 [0.30, 29.24]-CCTs: relative risk 4.46 [0.18, 111.36]). CONCLUSION:The reduction of sacs does not result in a statistically significant decrease in recurrence compared to patients who underwent sac excision and subsequent ligation. This study has demonstrated that the various courses of treatment for the inguinal hernia sac have similar primary and secondary outcomes in both adult and pediatric patients.

Antenatally detected sacrococcygeal teratoma (SCT) is a potentially life-threatening condition. Its prenatal management remains a topic of debate due to its association with fetal and maternal complications. This review delves into various fetal approaches to SCT, elucidating the roles of different procedures. Overall, fetal treatments are proposed to highly selected patients, with severe complications of SCT who carry a dismal prognosis and a high-risk in utero death. No shared protocols for patient and/or procedure selection exist thus overall management of these patients is highly dependent on the team skills and facility resources. Despite the general feeling that a prenatal diagnosis of SCT involves a high mortality risk, this comprehensive review demonstrates that advancements in fetal SCT treatment positively affect both fetal and maternal outcomes.

Colostrum is a source of growth factors and nutrients aiding newborns in adaptation to extrauterine life. Its clinical use has been investigated as an immunological component to protect, especially preterm newborns, from early infectious complications. This article aims to investigate the current knowledge about the value of colostrum in enhancing mechanisms of intestinal adaptation in patients affected by Short Bowel Syndrome (SBS). A MEDLINE systematic search was conducted. Inclusion criteria were English language and post-operative colostrum administration in animals and humans undergoing bowel resection. From a total of 734, 10 full-text articles were included: 5 studies on animal models, 4 on humans affected by SBS, and 1 study on animal and paediatric populations. Intestinal adaptation was investigated through diverse clinical, morphological, and functional parameters. No clear benefits of colostrum were reported in both populations. Paucity of trials, limited study duration, and heterogeneous conditions led to poorly standardized results. Colostrum tolerability is an encouraging result, but the outcome of colostrum clinical use in short bowel has still to be determined. Further investigations are required to safely promote use of colostrum in nutritional programs. Standard parameters of intestinal adaptation would be required to evaluate the possible role of colostrum in the process.

Background: Pediatric short bowel syndrome (SBS) is a severe cause of intestinal failure, often requiring prolonged parenteral nutrition (PN) and exposing children to sepsis and intestinal failure–associated liver disease (IFALD). In 2018, our institution established a multidisciplinary Pediatric Intestinal Rehabilitation Program (IRP) to optimize medical, nutritional, and surgical care. Methods: We performed a retrospective cohort study of children with anatomic SBS managed within our IRP (Meyer Children’s Hospital, Florence) between 2018 and 2024. SBS was defined as PN dependence for > 60 consecutive days. Data included demographics, SBS etiology and anatomy, major interventions (including autologous bowel lengthening: SILT/LILT/STEP), central line infections, IFALD, survival, enteral autonomy (complete PN discontinuation with adequate growth), and PN volume trends. Results: Forty-nine patients met inclusion criteria; 21 underwent bowel lengthening at our center. In this surgical subgroup, survival was 100% at last follow-up and no patient required intestinal transplantation. Seven of 21 children (33.3%) achieved enteral autonomy during follow-up. PN requirements decreased over time across techniques, with an overall PN volume reduction of 42.3% at 48 months (p < 0.05). SILT and LILT were associated with significant post-operative increases in bowel length and decreases in bowel diameter, whereas STEP showed non-significant length gains. Conclusions: Early outcomes from a newly established IRP show excellent survival, meaningful PN reduction, and no need for transplant in a high-risk pediatric SBS population, supporting the effectiveness and scalability of structured multidisciplinary intestinal rehabilitation.

IntroductionAppendicitis is the most frequent non-traumatic surgical emergency in children. While laparoscopic surgery is standard, postoperative recovery often involves pain, delayed bowel function, and reduced mobility. Osteopathic manipulative treatment (OMT) may improve recovery by addressing fascial restrictions and visceral dysfunction. This pilot study investigates OMT's effect on postoperative pain and hospital length of stay in pediatric patients undergoing appendectomy.MethodsThis non-randomized, time-controlled clinical trial was conducted at Meyer Pediatric Hospital (Florence, Italy) with 43 patients aged 5–17 undergoing laparoscopic appendectomy. Participants were divided by appendicitis type (complicated/uncomplicated) and treatment group (OMT vs. control). The OMT group received two standardized sessions within 48 h post-surgery. Primary outcomes included postoperative pain (assessed via Numeric Rating Scale) and hospital stay. Secondary outcomes included bowel function, mobilization, and nausea/vomiting. Data were analyzed using multivariate statistics and t-tests, with p < 0.05 as the significance threshold.ResultsThe OMT group showed a shorter mean hospital stay (4.6 vs. 7 days) and significantly greater reductions in abdominal and shoulder pain compared to controls. In uncomplicated appendicitis, pain reduction reached 3/10 vs. 1.7/10 in controls; in complicated cases, 3.6/10 vs. 1.8/10. Shoulder pain relief was also more pronounced in the OMT groups. Improvements in bowel function, mobilization, and nausea were observed in both groups, with no statistically significant differences.ConclusionsThis pilot study provides preliminary evidence that OMT may enhance postoperative recovery in pediatric appendectomy by reducing pain and potentially shortening hospital stays. Although not statistically significant due to the small sample size, the clinical relevance of these findings supports further investigation through larger, randomized trials.

Objectives The aim of this study was to compare the performances of residents and ChatGPT in answering validated questions and assess paediatric surgery residents’ acceptance, perceptions and readiness to integrate artificial intelligence (AI) into clinical practice.Methods We conducted a cross-sectional study using randomly selected questions and clinical cases on paediatric surgery topics. We examined residents’ acceptance of AI before and after comparing their results to ChatGPT’s results using the Unified Theory of Acceptance and Use of Technology 2 (UTAUT2) model. Data analysis was performed using Jamovi V.2.4.12.0.Results 30 residents participated. ChatGPT-4.0’s median score was 13.75, while ChatGPT-3.5’s was 8.75. The median score among residents was 8.13. Differences appeared statistically significant. ChatGPT outperformed residents specifically in definition questions (ChatGPT-4.0 vs residents, p<0.0001; ChatGPT-3.5 vs residents, p=0.03). In the UTAUT2 Questionnaire, respondents expressed a more positive evaluation of ChatGPT with higher mean values for each construct and lower fear of technology after learning about test scores.Discussion ChatGPT performed better than residents in knowledge-based questions and simple clinical cases. The accuracy of ChatGPT declined when confronted with more complex questions. The UTAUT questionnaire results showed that learning about the potential of ChatGPT could lead to a shift in perception, resulting in a more positive attitude towards AI.Conclusion Our study reveals residents’ positive receptivity towards AI, especially after being confronted with its efficacy. These results highlight the importance of integrating AI-related topics into medical curricula and residency to help future physicians and surgeons better understand the advantages and limitations of AI.

Introduction:The liver hanging maneuver (HM) is a well-established technique in hepatic surgery, primarily employed to optimize exposure and simplify parenchymal transection during liver resections. While its efficacy and safety have been extensively documented in adult populations, reports on its application in pediatric surgery are limited. This may be related to peculiarities of the liver anatomy and texture in children and to some specific issues of pediatric liver tumors, especially hepatoblastoma (HB). Methods:This study reviews the technical adaptations, feasibility, and outcomes of the HM in children, focusing on its role in both routine liver resections and complex cases, such as the separation of conjoined twins. Data of patients treated with and without HM at our center were retrospectively analyzed and a review of recent literature on this topic was performed. Results:A total of 16 pediatric patients (7 females) underwent HM during hepatic resections with a median age at surgery of 16 months (IQR: 8-22.5). No complications or mortality related to surgery were observed. Discussion:Results demonstrate that with appropriate modifications, the HM is a safe and effective technique in children, offering advantages in minimizing bleeding while improving surgical efficiency.

In pediatric thoracic surgery, reported predictors for increased risk are symptoms and active/previous infections (RAP). We investigated the adverse events related to Video-Assisted Thoracic Surgery (VATS) in pediatric patients when considering RAP predictors. A retrospective analysis of pediatric VATS major lung resections in 2008-2021 was conducted at three institutions. We employed the pediatric surgical risk calculator to define patients’ preoperative predicted risk (PredR). Postoperative complications were classified according to the Thoracic Morbidity & Mortality (TM&M) system. The observed TM&M rate (ObsR) and the PredR were compared. A subgroup analysis by RAP predictors was conducted. 37 patients (54% female) were included. Mean age and weight were 5.8 years and 22.8 kg. 56.7% had respiratory symptoms, 38.9% active infection and 59.5% history of infections (RAP subpopulations). VATS procedures were lobectomy (n=32), segmentectomy (n=3), bilobectomy (n=1) and pneumonectomy (n=1). The conversion rate was 5.4%. The mean PredR was of 4.43% (±1.8) and the overall ObsR was 45.94% with a median severity of II (I-III). This difference was significant and a higher PredR was not associated with complications development. PredR does not show association among the RAP vs non-RAP group. ObsR showed positive association with RAP, even if it reached statistical significance only for “respiratory symptoms” risk factor. ObsR reflected the number of bronchiectasis patients in our series (n=9), aligning with the hypothesis of “earlier and safer surgery”. The risk calculator underestimates VATS morbidity. Multicentre studies will clarify the correlation between inflammation and surgical adverse events.