Purpose The purpose of this study was to compare the perioperative course and long-term functional outcomes of children with early and late diagnosis of Hirschsprung ' s disease (HD). Methods This retrospective study included patients affected by HD who underwent pull-through between 1984 and 2015. Patients were classified into two groups: early diagnosis of HD (EDHD) before 1 year of age and late diagnosis of HD (LDHD) after 1 year. Functional outcomes at 3, 6, and 9 years after surgery were analyzed. Results One hundred and five patients, 83.8% with EDHD and 16.2% with LDHD. Abdominal distension and vomiting were the main presenting symptoms of EDHD, whereas chronic constipation was the primary symptom of LDHD. Preoperative intestinal obstruction occurred in 59.1% of EDHD versus 5.9% of LDHD (p < 0.0001). Diverting colostomy was performed in 31.8% of EDHD versus 5.9% in LDHD (p = 0.03). Anal strictures needing anal dilatation occurred in 30.7% of EDHD versus 5.9% in LDHD (p = 0.03). At 3 years of follow-up, there was a statistical difference in terms of constipation (10% in EDHD vs. 23.5% in LDHD; p = 0.04), but not in terms of soiling (30.7% vs. 29.4%; p = 0.65); 9 years after surgery, comparable results were shown in terms of both constipation and soiling. Conclusion Long-term functional outcome is generally comparable between patients with EDHD and LDHD.

ABSTRACT Congenital diaphragmatic hernia (CDH) is a rare disease that has been increasing in prevalence since the end of the 20th century. The recurrence rate of hernias is over 50%, increasing morbidity. Research is ongoing to identify a suitable solution to repair large defects because common prosthesis does not match the mechanical properties of the native tissue. This pilot study aims to evaluate a new non‐biodegradable thermoplastic polyurethane elastomer (TPU) bilayer patch. Its mechanical properties may be better suited to facilitate growth from childhood to adulthood. Its structure comprises a fibrous layer that promotes cell colonization and integration, and a smooth film layer that prevents cell adhesion. In vitro studies showed that both fibroblasts and myoblasts colonized the fibrous layers efficiently when they were optimized with an adhesive polydopamine (PDA) film and a collagen I (Coll I) coating. This facilitated early colonization, increased proliferation and cell spreading. New materials, whether functionalized or not, did not induce inflammation. Subsequent in vivo studies in rats showed significant cell integration in TPU patches without prosthetic debris. In contrast, phagocytosed prosthetic debris were detected in rats implanted with the reference material expanded polytetrafluoroethylene (e‐PTFE). These TPU patches appear as promising new implants for the treatment of diaphragmatic hernias.

Objectives: To evaluate the impact of undernutrition in school-aged children born with type III esophageal atresia (EA), and to determine its potential risk factors, including their respiratory history and status assessed by pulmonary function tests. Methods: Retrospective multicentre cohort study encompassing patients born between 2008 and 2013 with type III EA included in a national registry. Baseline data, surgical history and outcomes of patients with or without undernutrition (body mass index (BMI) z-score < -2 SD) at the age of 6-9 years were compared. Results: Of the 212 patients included in the study, 20 (9.4%) presented with undernutrition, with a mean BMI z-score of -2.5 +/- 0.4. At birth, 13 (65%) of them where preterm, twice as high as in the control group (34.9%, p = 0.013), but adjusted neonatal weights and associated malformations did not differ between groups. Surgical management of EA and other intestinal malformations, including gastrostomy and fundoplication, were comparable between groups, except for hernia/cryptorchidism occurrence (20% vs 5.2%, p = 0.03). On spirometry, 15 (75%) of these patients demonstrated restriction, as compared to 38% of normal weight patients (p=0.002), and 60% of them required pulmonary treatments (vs 32%, p=0.02). Multivariate analysis identified birth in a level 3 maternity (odds ratio OR=6.0), hernia/cryptorchidism surgery (OR=5.2), a restrictive syndrome (OR=3.3) and pulmonary crisis treatment use (OR=2.7) as risk factors for undernutrition. Conclusions: In contrast to intestinal and esophageal surgeries, the respiratory status appears to be significantly associated with nutritional outcomes in children born with type III EA. ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Protocols ### Funding Statement This study was funded by the University Hospital Centre of Angers (grant number 49RC19\_0185\_2), the non-profit sector associations "Institut de Recherche en Sante Respiratoire des Pays de la Loire (IRSR-PdL)" and the "Filiere des Maladies rares Abdomino-THOraciques (FIMATHO)". ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethics committee of the University Hospital Center of Angers gave ethical approvel for this work I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors

BACKGROUND AND OBJECTIVE:This study aimed to explore the impact of positive or negative feedback on the performance of trainees in pediatric urology during simulation exercises in pediatric laparoscopy. METHODS:Twenty-five students enrolled in a national Pediatric Urology Laparoscopy Simulation participated in the study. They performed the Fundamentals of Laparoscopic Surgery (FLS) skills, specifically peg-transfer and intracorporeal knot-tying, in a randomized study design while receiving positive or negative feedback from an attending pediatric urologist. On the first day, all students performed FLS peg-transfer and intracorporeal knot-tying tasks on a pediatric laparoscopic simulator. On the second day, students were randomized to receive either positive or negative comments during the procedure. Task performances, measured by task time and errors, was compared between both groups. Statistical analysis was conducted using the Mann-Whitney U test. KEY FINDINGS AND LIMITATIONS:The difference in execution time between exercises with and without feedback was significantly greater in the group that received negative feedback compared to the group that received positive feedback (p = 0.003). Students who received positive feedback increased their time by a median of 2 s, whereas students who received negative comments increased their time by a median of 34 s. CONCLUSIONS AND CLINICAL IMPLICATIONS:Feedback should be delivered in a manner that is supportive, respectful, and improvement-focused rather than discouragement. Understanding these dynamics can guide the development of effective feedback strategies to optimize learning and enhance performance outcomes in training for minimally invasive surgery in pediatric urology.

Background: Minimally invasive surgery (MIS) for adrenal pathologies in children is still developing because of its low incidence in pediatric population and the discrepancy between the big volume of the masses and the reduced child's size especially in younger patients. In the literature, there are no guidelines about the use of laparoscopic andrenalectomy in children. The aim of this study is to evaluate the outcomes of MIS through a bicenter data analysis in order to propose a standardized protocol. Materials and Methods: Children who underwent minimally invasive adrenalectomy performed at two European Departments of Pediatric Surgery between 2000 and 2020 were included in this study. Data were collected and analyzed using X-square, Fisher tests, and multiple regression model. Results: Thirty-four patients (38 adrenal masses) were included. Mean age was 52 months (3-176). Median lesion diameter was 60 mm (40-125 mm). Histological examination revealed 24 neuroblastomas (NBs), 11 pheochromocytomas, 1 teratoma, 1 adrenal cyst, and 1 myelolipoma. Laterality was 52.6% left, 36.8% right, and 10.5% bilateral. Surgical access was transperitoneal in all patients. Mean operative time was 108 minutes for unilateral lesions and 270 minutes for bilateral ones. Mean hospital stay was 4.4 days. No major intraoperative complications were observed. 21.05% NBs were preemtively approached with a laparoscopic access and were converted to open surgery. Median follow-up was 88 months (24-264). Four patients affected by neuroblastoma reported metastatic dissemination and three died. Conclusions: Pediatric minimally invasive adrenalectomy is a safe and effective procedure, allowing surgeons to reduce the size of incision starting the dissection of the masses, and it has low rate of complication if we consider small masses. The only absolute contraindication is persistent image-defined risk factors for NBs. It should be considered as the first-line treatment for selected adrenal masses in centers with good experience in laparoscopy.

Congenital diaphragmatic hernia is a rare condition characterized by the development of a defect in the diaphragm during early embryogenesis. For the most severe cases, when the diaphragmatic defect is large, the gap is currently closed by a prosthetic patch made of e-PTFE (Gore-Tex) materials, which lack sufficient elasticity, causing early rupture of stitches and subsequent hernia recurrence. In this study, we introduce a novel thermoplastic polyurethane membrane designed to accommodate the child's growth. This film/fiber bilayer membrane, produced in a single continuous electrospinning process by varying the flow rate, exhibits a smooth surface to prevent adhesion of the tissues on the abdominal side and a rough surface to promote adhesion of the diaphragm muscle on the thoracic side. Mechanical properties of the membrane were evaluated under various deformation modes, including uniaxial tensile tests and equibiaxial tensile tests by the bubble inflation technique. We demonstrated the ability to tune the elastic modulus by adjusting the thickness of the film and fibers, achieving greater stretchability than specified for supporting child growth and respiration both in uniaxial and inflation tests. Moreover, in vitro biological tests showed that the membrane promotes cellular colonization without pro-inflammatory effect, making it a promising candidate to replace the currently used prosthesis.

OBJECTIVES:To identify the factors that result in a restrictive ventilatory impairment during childhood following type III esophageal atresia (EA) repair. STUDY DESIGN:A multicentre, retrospective, national cohort study was conducted on 503 patients who had undergone surgery for EA between 2008 and 2013. The results of pulmonary function tests (PFT) performed during childhood were used to compare patients with pure restrictive lung impairment to children with normal PFT. Subsequently, logistic regression was employed to ascertain potential risk factors for restrictive syndrome in type III EA. RESULTS:The cohort comprised 503 patients, of whom 216 (42.9 %) had interpretable PFT. Among them, 63.4 % exhibited normal results, 26.9 % pure restriction, 5.1 % pure obstruction, and 4.6 % a mixed pattern. Patient-associated factors that were associated with a restrictive impairment were birth weight, Caucasian ethnicity (odds ratio (OR) 4.3 [1.2-15.4]), and the presence of neonatal heart defects (OR = 5.8). [1.9-16.9]), tracheomalacia (OR = 4.1 [1.6-10.2]) and neonatal GERD (OR = 3.1 [1.3-7.4]). The sole healthcare-associated factor was the use of respiratory crisis treatment during childhood (OR = 4.8 [1.3-18.0]), whereas neither surgical factor nor postoperative parietal thoracic deformity was associated with restriction. CONCLUSION:In contrast to surgical approaches or chest wall abnormalities, neonatal EA-associated conditions appear to be associated with a restrictive pattern during childhood, but further prospective studies remain mandatory to validate these results.

Mastering paediatric laparoscopic surgery competency (PLSC) is technically challenging. The present study aimed to determine whether the inter-academic PLSC degree (IAD_PLSC) practical training program enables trainees to improve their skills. This retrospective study included trainees enrolled in the IAD_PLSC program in 2021 and 2022 which included two separate 12 h-sessions. Trainees practiced to perform intracorporeal laparoscopic knots (ILK) using 5- and 3-mm instruments on a pelvi-trainer simulator; Peg Transfer (PT) was used as a dexterity test; final marks added the adapted Objective Structured Assessment of Technical Skills (OSATS) score (out of 40) and time to complete ILK. ILK was considered a success in case the OSATS score > 27/40. A total of 43 trainees completed the IAD_PLSC program. N = 37 (86.0

Surgical management of ovarian masses in girls still challenging. The aim of the study is to report an 8-year experience in managing children with ovarian masses, and to demonstrate the advantages and the limitations of laparoscopy for such lesions. Data of girls aged less than 18 years operated because of an ovarian mass between January 2015 and February 2023 were retrospectively reviewed. Patients were divided into two groups: group A including children operated by laparoscopy, and Group B of patients who underwent open surgery. Eighty-eight children were enrolled. Laparoscopy was performed in 56 patients (63.6

Background:Endoscopic injection (EI) is a safe treatment for vesico-ureteral reflux (VUR) in children, but recurrences are not insignificant. This study aims to show if multiple EI is still the best first line management even if in case of recurrences. Methods:All patients affected by primary VUR, treated with at least one EI and with at least 5 years follow up were included. All general data were analyzed. Recurrence rate after one, two and three EIs were calculated. Results:One hundred and sixty-one patients (total number =210) were healed after 1 injection, 28 after 2 and 4 after 3 with a global success rate of 91.90%. Recurrence rate is higher in patients older than 3 years old and with IV and V reflux grade. Even if 67.7% of recurrent VUR after one injection was symptomatic, diagnosis of recurrences after multiple EI was mainly radiological. Only 8% of the patients underwent EI need an anti-reflux surgery. Conclusions:Thanks to its low costs and the acceptable recurrence rate, Deflux EI should be proposed as the first therapeutic approach for children affected by VUR, especially in those with low and moderate grades of VUR. Multiple injections could be contraindicated only in older children thank 1 year with high-grade VUR (IV symptomatic and V grade).

Abstract Background Minimally invasive surgery for adrenal pathologies in children is still developing because of the low incidence of adrenal masses in pediatric population and the discrepancy between the size of the mass and the child’s one. In Literature there are no any guidelines about the use of laparoscopic andrenalectomy in children. The aim of this study is to evaluate the outcomes of minimally invasive surgery through a bi-center data analysis in order to propose a standardized protocol. Materials and methods Children who underwent minimally invasive adrenalectomy between 2000 and 2020 performed by two expert Pediatric surgeons at two European departments of Pediatric Surgery were included in this study. Data were collected and analyzed using X-square, Fisher tests, multiple regression model. Results 34 patients (38 adrenal masse)s were included. Mean age was 52 months 3–176]. Median lesion diameter was 60 mm [40-125mm]. Histological examination revealed 24 neuroblastomas, 11 pheochromocytomas, 1 teratoma, 1 adrenal cyst and 1 Myelolipoma. Laterality was 52.6% left, 36.8% right and 10.5% bilateral. Surgical access was trans-peritoneal in all patients. Mean operative time was 108 min for unilateral lesions and 270 min for bilateral ones. Mean hospital stay was 4.4 days. No major intra operative complications were observed. 21.05% neuroblastomas were preventively approached with a laparoscopic access and were converted to open surgery. Median follow-up was 88 months [24–264]. 4 patients affected by neuroblastoma reported metastatic dissemination and 3 died. Conclusions Pediatric minimally invasive adrenalectomy was a safe and effective procedure, it allows surgeons to reduce the size of laparotomies starting the dissection of the masses and it has low rate of complication if we consider small masses. The only absolute contraindication is persistent IDRF for neuroblastomas. It should be considered the first-line treatment for selected adrenal masses in centers with good experience in laparoscopy.

Even if vesicoureteral reflux is a common condition in children, there are no guidelines about the best therapeutic approach. This study aims to compare the results of endoscopic injection and ureteral reimplantation in children with grade III, IV and V VUR. A multicenter retrospective study included children with grade III, IV and V VUR treated from 2003 to 2018 at three Departments of Pediatric Surgery. Patients were divided into Group A (endoscopic injections) and Group B (anti-reflux surgery), B1 (open, OUR), B2 (laparoscopic, LUR) and B3 (robot-assisted laparoscopic RALUR). Follow-up was at least 5 years. 400 patients were included, 232 (58

In 2007, polydopamine (PDA) films were shown to be formed spontaneously on the surface of all known classes of materials by simply dipping those substrates in an aerated dopamine solution at pH = 8.5 in the presence of Tris(hydroxymethyl) amino methane buffer. This universal deposition method has raised a burst of interest in surface science, owing not only to the universality of this water based one pot deposition method but also to the ease of secondary modifications. Since then, PDA films and particles are shown to have applications in energy conversion, water remediation systems, and last but not least in bioscience. The deposition of PDA films from aerated dopamine solutions is however a slow and inefficient process at ambient temperature with most of the formed material being lost as a precipitate. This incited to explore the possibility to get PDA and related films based on other catecholamines, using other oxidants than dissolved oxygen and other deposition methods. Those alternatives to get PDA and related films are reviewed and compared in this paper. It will appear that many more investigations are required to get better insights in the relationships between the preparation method of PDA and the properties of the obtained coatings.

Introduction: Congenital pouch colon (CPC) is a rare intestinal anomaly usually associated with an anorectal malformation (ARM). Because of its low incidence, there are no guidelines on the correct treatment. We report the step-by-step management and challenging surgery of a newborn with CPC and cloaca to ensure the patient's best quality of life possible. Case presentation: We describe a case of type II CPC associated with a complex cloaca with a retrovesical didelphus uterus in a 1530g preterm syndromic female. A preoperative cystoscopy identified a urogenital sinus with an anterior bladder and a posterior vagina. The abdominal exploration done on day 1 showed a dilated CPC with the cecum ending in a large structure extending toward the bladder, and a proximal diverting ileostomy was created. Eight months later, the CPC was mobilized, and the common wall of the bladder and the pouch colon was excised. The 8-cm colonic pouch was tabularized by a triangle resection resulting in a colonic tube used to create a colostomy. Because of the syndromic nature of the patient, the consensus has been not to proceed with the urogenital reconstruction and the ileo-anal pull-through. Conclusion: CPC malformations should be suspected in the case of a single perineal orifice. There is no consensus about the best surgical approach to CPC. The operative reconstruction must be tailored to each patient in order to ensure the best possible quality of life.

Introduction: Congenital volvulus without a prenatal diagnosis of malrotation is an extremely rare cause of acute intestinal obstruction in the foetal and neonatal period with a high morbidity and mortality. The aim of this report is to describe prenatal imaging, pregnancy characteristics and clinical outcomes to identify a gold standard management approach for neonates affected by congenital volvulus through our experience with this case as well as a review of the literature. Case presentation: We describe an intrauterine case of volvulus without malrotation suspected by prenatal ultrasound at 28 weeks' gestation, with enlarged hyperechogenic loops without peristalsis in a 715g preterm boy born at 29 weeks' gestation. The discrepancy between the minimal clinical manifestations and the severity of intestinal pathology is highlighted. At explorative laparotomy following delivery, a congenital mesenteric defect was identified through which small bowel had herniated and volvulised, causing prenatal bowel dilatation and necrosis. The necrotic bowel was resected, and both an ileostomy and jejunostomy were created within 30 hours of birth. However, severe post-operative complications were encountered, which ultimately led to the newborn's death. Conclusion: Foetal volvulus is a rare condition with high rates of preterm birth and perinatal mortality. A high index of suspicion is required in cases of bowel dilatation, intestinal duplication or malrotation. Strict foetal follow up with serial ultrasound assessment and planned cesarean delivery are recommended. Multidisciplinary care is essential. Time of delivery and surgical intervention should be standardised to reduce the risk of neonatal mortality.

Bioinspired adhesives have been increasingly developed, especially towards a biomedical application. Therefore, in this study, dopamine (DA) was oxidized into polydopamine (PDA) in a gelatin mixture via titration with NaIO4 as a strong oxidant to easily obtain an adhesive antioxidant and self-healing PDA–gelatin hydrogel. Rheology experiments show a stiffness in the order of kPa and a thermal resistance above 50 °C, much above the gel–sol transition temperature of pristine gelatin. After heating at 55 °C, the gel is self-healing. In addition, just after formulation, it shows strong peeling-rate-dependent adhesion to steel with a tensile work per unit area (W) of up to 100 ± 39 J/m2, which is 2.5 times higher than that of the same gel without PDA at a peeling rate of 1000 µm/s. The increase in W between peeling rates of 10 and 1000 µm/s was studied and interpreted in terms of the gels’ viscoelasticity. Moreover, this hydrogel offers significant antioxidant activity (measured by DPPH scavenging) that lasts with storage for at least over 15 days, this being then prolonged for 2 additional days, which seems particularly relevant considering the importance of reactive oxygen species (ROS) in wound healing. To summarize, PDA–gelatin gel is a promising strong and antioxidant adhesive.

Patient reported outcomes measures (PROMS) are important endpoints to measure patient health status in the perioperative setting. However, there are no good tools to measure PROMS in the pediatric surgical population. Patients 7 to 17 years old undergoing surgery were included and followed up for 1 day after surgery (POD1). At POD1 the patients were asked to rate their overall postoperative recovery using a 100-mm visual analog scale (VAS). The primary outcome was the pediatric QoR-15 score on postoperative day 1 (POD1). 150 patients completed the study. The mean (SD) pediatric QoR-15F scores were 132.1 (14.1) and 111.0 (27.0), preoperatively and on POD1, respectively. Convergent validity confirmed with Pearson (r) correlation between the postoperative pediatric QoR-15F and the patient-rated global recovery assessment was 0.72 (95% confidence interval [0.63–0.79]; p < 10–16). Concerning reliability, internal consistency of the pediatric QoR-15 assessed by Cronbach’s alpha was 0.90. The test–retest concordance correlation coefficient was 0.92; 95% CI [0.83–0.96]. Split-half alpha was 0.74. The pictorial pediatric version of the QoR-15F showed good validity, reliability, responsiveness, acceptability and feasibility. This PROMS should be considered for clinical care and research in the perioperative pediatric patient setting. Trial Registration: NCT04453410 on clinicaltrials.gov.

Objectives: To assess the efficacy of thoracoscopy and the outcome for children with thoracic neurogenic tumors. Methods: We performed a retrospective review of 15 European centers between 2000 and 2020 with patients who underwent thoracoscopy for a neurogenic mediastinal tumor. We assessed preoperative data, complications, and outcomes. Results were expressed with the median and range values. Results: We identified 119 patients with a median age of 4 years old (3 months–17 years). The diameter was 5.7 cm (1.1–15). INRG stage was L1 n = 46, L2 n = 56, MS n = 5, M n = 12. Of 69 patients with image-defined risk factors (IDRF), 29 had only (T9–T12) locations. Twenty-three out of 34 patients with preoperative chemotherapy had an 18 mm (7–24) decrease in diameter. Seven out of 31 patients lost their IDRF after chemotherapy. Fourteen had a conversion to thoracotomy. The length of the hospital stay was 4 days (0–46). The main complications included chylothorax (n = 7) and pneumothorax (n = 5). Long-term complications included Horner’s syndrome (n = 5), back pain, and scoliosis (n = 5). Pathology was 53 neuroblastomas, 36 ganglioneuromas, and 30 ganglioneuroblastomas. Fourteen had a postoperative residue. With a median follow-up of 21 months (4–195), 9 patients had a recurrence, and 5 died of disease. Relapses were associated with tumor biology, histology, and the need for chemotherapy (p = 0.034, <0.001, and 0.015, respectively). Residues were associated with preoperative IDRF (excluding T9–T12 only) and the need for preoperative chemotherapy (p = 0.04 and 0.020). Conclusion: Our results show that thoracoscopy is safe, with good outcomes for thoracic neurogenic tumors in selected cases. Surgical outcomes are related to the IDRFs, whereas oncologic outcomes are related to tumor histology and biology.

Although central venous catheter (CVC)-related thrombosis (CRT) is a severe complication of home parenteral nutrition (HPN), the amount and quality of data in the diagnosis and management of CRT remain low. We aimed to describe current practices regarding CVC management in French adult and pediatric HPN centers, with a focus on CVC obstruction and CRT. Current practices regarding CVC management in patients on HPN were collected by an online-based cross-sectional survey sent to expert physicians of French HPN centers. We compared these practices to published guidelines and searched for differences between pediatric and adult HPN centers’ practices. Finally, we examined the heterogeneity of practices in both pediatric and adult HPN centers. The survey was completed by 34 centers, including 21 pediatric and 13 adult centers. We found a considerable heterogeneity, especially in the responses of pediatric centers. On some points, the centers’ responses differed from the current guidelines. We also found significant differences between practices in adult and pediatric centers. We conclude that the management of CVC and CRT in patients on HPN is a serious and complex situation for which there is significant heterogeneity between HPN centers. These findings highlight the need for more well-designed clinical trials in this field.