The present study compared the efficacy of laparoscopic partial splenectomy (LPS) and laparoscopic total splenectomy (LTS) in treating hereditary spherocytosis, evaluated the safety of anatomy-guided splenectomy using three-dimensional (3D) reconstruction planning, and determined the optimal residual splenic volume threshold. This study included 12 children with hereditary spherocytosis who required single-port laparoscopic splenectomy. Preoperative computed tomography (CT) imaging was used to evaluate the splenic anatomy, vascular topography, and spatial relationships with the pancreas to customize the surgical approach. The operation duration, intraoperative blood loss, and pre/postoperative hematological and immunological parameters were recorded for all patients. The data were statistically analyzed using SPSS (version 26.0). In two cases involving subtotal splenectomy, the residual splenic volume was quantified by 3D reconstruction. Patients were monitored postoperatively for hematological dynamics—particularly platelet counts—and adverse events. All laparoscopic splenectomies (total/partial) were successfully completed without intraoperative or postoperative complications. Compared with LTS, LPS resulted in a significantly slower trajectory of platelet counts (P < 0.001), whereas postoperative red blood cell (RBC) and hemoglobin levels showed no intergroup differences. Further assessments are needed to determine immunological outcomes. In the two subtotal splenectomy cases, 3D CT reconstruction precisely quantified residual splenic volumes at 3.38 and 6.43

OBJECTIVE:Laparoscopic orchiopexy has emerged as a viable alternative for the treatment of palpable undescended testis (UDT). This study aims to evaluate the feasibility and efficacy of needle-grasper hydrodissection-assisted laparoscopic orchiopexy (NHLO) in comparison to conventional laparoscopic orchiopexy (CLO) for palpable UDT. METHODS:A cohort of 96 patients diagnosed with palpable UDT, admitted between January 2020 and April 2024, was included in this study. Among these, 54 patients underwent NHLO, while 42 patients were treated with CLO. In the NHLO procedure, normal saline was injected into the retroperitoneal space to create a hydrodissection barrier, facilitating the separation and protection of the vas deferens and spermatic cord. The vas deferens and spermatic cord were meticulously dissected following the principles of integrity and minimal tissue trauma. Outcome measures included final testicular position, testicular volume growth, testicular atrophy, success rate, and postoperative complications. RESULTS:No significant differences were observed between the NHLO and CLO groups in terms of age, laterality, operative time (NHLO: 38-46 min; CLO: 39-48 min), or complication rates (NHLO: 1.9 %; CLO: 0.0 %). At follow-up, all patients in both groups exhibited palpable testes in satisfactory scrotal positions. Notably, no visible abdominal scarring was observed in the NHLO group, whereas there were two noticeable scars on the abdomen in CLO. CONCLUSION:Needle-grasper hydrodissection-assisted laparoscopic orchiopexy is a safe, effective, and minimally invasive technique that provides optimal protection of the vas deferens and spermatic cord while achieving excellent cosmetic outcomes.

This case report presents a laparoscopic surgery performed at The Second Hospital of Hebei Medical University for a patient with congenital duodenal diaphragm complicated by heterotopic pancreas (HP). The utilization of indocyanine green (ICG) molecular fluorescent imaging technology and the suspension traction method for duodenal obstruction points during the procedure demonstrates the potential for reducing operational complexity and enhancing surgical success rates. Postoperative feeding via a nasojejunal tube is shown to facilitate rapid restoration of enteral nutrition, mitigate postoperative complications, and decrease the duration of hospitalization.

This study aims to compare the applied efficacy of barbed suture versus non-barbed suture, as well as various stitching techniques, for laparoscopic cholecystoduodenostomy (LCD) in rabbits (imitating infants) to determine the most viable suture option. LCD was performed in a total of 45 male New Zealand white rabbits. The rabbits were equally divided into three groups: the SFB group (single-layer full-thickness running suture using barbed sutures), the SSB group (simple seromuscular layer running suture using barbed sutures) and the PDS group (single-layer full-thickness running suture using PDS sutures). The incidence of anastomotic complications, and histopathological outcomes were evaluated and compared across the groups. The mean duration for LCD was 9.6 ± 1.2 min in the SFB group and 10.8 ± 1.5 min in SSB group, both significantly shorter than the 12.0 ± 0.9 min observed in the PDS group (P < 0.001). Three cases of bile leakage were found in SFB group. H&E staining clearly revealed two cases of ectopic mucosal tissues at the anastomotic muscular layer in the SFB group. The collagen fibers, transforming growth factor-beta1 (TGF-β1), α-smooth muscle actin (α-SMA) and interleukin 6 (IL-6) of anastomotic tissues at all examined time points post-surgery were generally higher in SFB group than in the other two groups, with some statistically significant differences. No significant differences were observed between the SSB group and PDS group. The findings demonstrate that for barbed sutures, full-thickness technique was inferior to PDS sutures due to a higher bile leakage rate, whereas the seromuscular technique achieved difficult to hepatic duct. As a result, barbed sutures are not recommended for use in infants.

Background This study aimed to retrospectively compare postoperative recurrence rates between laparoscopic-assisted extraperitoneal closure and intracorporeal suturing for pediatric inguinal hernia (PIH) repair across multiple centers, and to investigate the clinical causes of recurrence to inform surgical practice.Methods This is a retrospective review of 5244 PIH repairs performed using single-port laparoscopic percutaneous extraperitoneal closure (SPLPEC) at the First Affiliated Hospital of Xiamen University and the Second Hospital of Hebei Medical University between January 2017 and December 2020. In addition, 6054 PIH repairs were performed using two-port laparoscopic intracorporeal suturing (TPLIS) at the Capital Center for Children’s Health, Capital Medical University between January 2015 and December 2020. All patients were followed for 2 years with intraoperative findings at reoperation documented and causes of recurrence analyzed.Results There was recurrence in 30 SPLPEC cases (27 males, 3 females; mean interval to recurrence, 7.6 months). There was a recurrence in 35 TPLIS cases (31 males, 4 females; mean interval, 12.5 months). There was no statistically significant difference in recurrence rates (p=0.966). Laparoscopic re-exploration identified omitted or torn peritoneum (n=42), lipidosis in the abdominal wall (n=7), and loose knots (n=16) as the primary causes of recurrence. No further recurrences were seen in the SPLPEC group after reoperation. In the TPLIS group, 33 patients had favorable outcomes, 2 patients experienced a second recurrence.Conclusions The incidence of PIH in females may be higher than previously recognized. Both SPLPEC and TPLIS demonstrated low recurrence rates, particularly among females and the second operation proved to be an effective treatment option for recurrent cases. For SPLPEC in obese children, secure ligation of the hernia internal ring is essential to prevent recurrence. TPLIS requires extended follow-up to detect possible late recurrence.

Objective: To investigate the safety and feasibility of single-port-plus-one (SP + 1) thoracoscopic lobectomy in the treatment of congenital pulmonary airway malformation (CPAM) in infants. Methods: The clinical data of 35 infants who underwent SP + 1 thoracoscopic lobectomy from May 2017 to December 2023 were retrospectively analyzed. The median age was 7 months, and the median weight was 8 kg. Included: 4 cases of upper lobectomy, 3 cases of middle lobectomy, and 28 cases of lower lobectomy. Results: SP + 1 thoracoscopic lobectomy was successfully completed in all infants. One case developed a postoperative air leak. There were no deaths and no other postoperative complications such as pulmonary infection, bleeding, atelectasis, bronchopleural fistula, and chylothorax. Conclusion: SP + 1 thoracoscopic lobectomy for infants with CPAM is safe, feasible, and cosmetic with satisfactory perioperative results in our preliminary experience.

Surgery for symptomatic congenital pulmonary airway malformation (CPAM) is uncontroversial. However emergency surgery for neonates with CPAM presented as progressive respiratory distress still carries high risks. This article introduces a new strategy aimed at improving the safety and effectiveness of surgery. 4 neonates were diagnosed with CPAM with mediastinal shift by prenatal diagnosis and experienced progressive respiratory distress after birth. Insertion of a chest drain in the main cyst of the CPAM was performed as effective interim management to relieve respiratory distress, and delayed thoracoscopic lobectomy was performed after the stabilization. Thoracoscopic lobectomy was successfully performed in all 4 cases. The average operation time was 96.2 min, the mean blood loss volume was 10.0 ml, the postoperative recovery was uneventful, the postoperative ventilatory support time was 2.7 d and the time to postoperative discharge was 14.2 d. No death, pulmonary infection, bleeding, atelectasis, bronchopleural fistula, chylothorax or other postoperative complications occurred. During the follow-up of 6 months to 4 years, there was no respiratory morbidity. Delayed thoracoscopic lobectomy for symptomatic CPAM in neonates is safe and effective. Prior to surgery, it is essential to evaluate for possible associated malformations and to achieve preoperative stabilization by transthoracic drainage of the main cyst to relieve respiratory distress.

Variability in necrosis patterns and operative techniques in surgical necrotizing enterocolitis (NEC) necessitates a standardized classification system for consistent assessment and comparison. This study introduces a novel intraoperative reporting system for surgical NEC, focusing on reliability and reproducibility. Analyzing surgical NEC cases from January 2018 to June 2023 at two tertiary neonatal and pediatric surgery units, a new classification system incorporating anatomical details and intestinal involvement extent was developed. Its reproducibility was quantified using kappa coefficients (κ) for interobserver and intraobserver reliability, assessed by four specialists. Furthermore, following surgery, the occurrence of mortality and enteric autonomy were evaluated on the basis of surgical decision-making of the novel intraoperative classification system for surgical NEC. In total, 95 patients with surgical NEC were included in this analysis. The mean κ value of the intra-observer reliability was 0.889 (range, 0.790−0.941) for the new classification, indicating excellent agreement and the inter-observer reliability was 0.806 (range, 0.718−0.883), indicating substantial agreement. The introduced classification system for surgical NEC shows high reliability, deepening the understanding of NEC's intraoperative exploration aspects. It promises to indicate operative strategies, enhance prognosis prediction, and substantially facilitate scholarly communication in pediatric surgery. Importantly, it explores the potential for a standardized report and may represent a step forward in classifying surgical NEC, if pediatric surgeons are open to change.

Background: The first robotic surgery in children and adult happened in more or less that same time but the development in children subsequently lagged behind especially for complicated operations such as robotic- assisted hepaticojejunostomy for choledochal cyst (RHCC). In order to achieve a high standard for this operation, expert consensus was developed among Chinese experts with ample experience in RHCC. Methods: Thirty experts from twenty-six institutions experts participated in the consensus meeting. A Screening Committee was established to performed a comprehsenive literature review on RHCC. A few specific topics have been proposed based on the review but only topics which were agreed upon were discussed during the meeting using Delphi Rounds. Lastly, formulated recommendations were proposed by the Committee and finalized in the expert consensus meeting. Results: After initial screening and discussion, nine topics were selected for discusssion. Eight recommendation statements were formulated. All recommendations reached more than 80 % consensus among experts at the final Delphi Round. Conclusions: The consensus statementson RHCC in children were based on available international literatures and experience from Chinese experts. These statements helpto standardize the surgical techniques and prevent surgical complications during RHCC.

This retrospective analysis aimed to assess the feasibility and safety of endoscopic retrograde cholangiopancreatography (ERCP) in pediatric patients by examining ERCP-related adverse events (AEs) occurring over a decade at a single center. Pediatric patients under 18 years old who underwent ERCP at the Second Hospital of Hebei Medical University from 1/2013 to 11/2023 were included. ERCP-related AEs were defined according to ERCP-related adverse events: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Clinical data of patients experiencing ERCP-related AEs were obtained from electronic medical records for analysis. Over the past decade, a total of 76 pediatric patients underwent 113 ERCP procedures, including 26 patients who underwent repeat ERCP, totaling 63 procedures. There were 32 males and 44 females, with a median age of 13 years (range 3 years and 5 months–17 years and 9 months). Among all ERCP procedures, 14 (12.4

Intestinal microecology is established from birth and is constantly changing until homeostasis is reached. Intestinal microbiota is involved in the immune inflammatory response of the intestine and regulates the intestinal barrier function. The imbalance of intestinal microecology is closely related to the occurrence and development of digestive system diseases. In some gastrointestinal diseases related to pediatric surgery, intestinal microbiota and its metabolites undergo a series of changes, which can provide a certain basis for the diagnosis of diseases. The continuous development of microecological agents and fecal microbiota transplantation technology has provided a new means for its clinical treatment. We review the relationship between pathogenesis, diagnosis and treatment of pediatric surgery-related gastrointestinal diseases and intestinal microecology, in order to provide new ideas and methods for clinical diagnosis, treatment and research. Level of evidence: : This is a review study, hence not applicable.

Surgical necrotizing enterocolitis (NEC) is a severe medical condition that, even after surgery, a portion of the survival infants may still have neurological sequelae. The objective of this study was to identify the risk factors associated with the development of permanent neurodevelopmental impairment (NDI) in neonates with surgical NEC. Between January 2016 and June 2022, a retrospective data collection was conducted on 98 individuals who experienced surgical NEC with gestational age ≥ 28 weeks. Among these patients, 27 patients were diagnosed with NDI, while the remaining 71 patients did not have NDI. Based on this division, the patients were categorized into the NDI group and the Non-NDI group. Demographics, comorbidities, and admission lab results were analyzed using univariate and logistic regression analyses. Of the 98 neonates following surgical NEC, 27(27.6

Purpose This paper explores the causes of paediatric inguinal hernia (PIH) recurrence after single-port laparoscopic percutaneous extraperitoneal closure (SPLPEC). Method From January 2015 to December 2020, the clinical data of 3480 children with PIHs who underwent SPLPEC were retrospectively reviewed, including 644 children who underwent SPLPEC with a homemade single-hook hernia needle from January 2015 to December 2016 and 2836 children who underwent the SPLPEC with a double-hook hernia needle and hydrodissection from January 2017 to December 2020. There were 39 recurrences (including communicating hydrocele) during the 2–5 years of follow-up. The findings of redo-laparoscopy were recorded and correlated with the revised video of the first operation to analyse the causes of recurrence. Result Thirty-three males and 6 females experienced recurrence, and 8 patients had a unilateral communicating hydrocele. The median time to recurrence was 7.1 months (0–38). There were 20 cases (3.11%) in the single-hook group and 19 cases (0.67%) in the double-hook group. Based on laparoscopic findings, recurrence most probably resulted from multiple factors, including uneven tension of the ligation (10 cases), missing part of the peritoneum (14 cases), loose ligation (8 cases), broken knot (5 cases), and knot reaction (2 cases). All children who underwent repeat SPLPEC were cured by double ligations or reinforcement with medial umbilical ligament. Conclusion The main cause of recurrence is improper ligation. Tension-free and complete PIH ligation are critical to the success of surgery, which requires avoiding the peritoneum skip area and the subcutaneous and muscular tissues. Redo-laparoscopic surgery was suitable for the treatment of recurrent inguinal hernia (RIH). For giant hernias, direct ligation of the internal ring incorporating the medial umbilical ligament (DIRIM) may be needed.

Total colonic aganglionosis (TCA), defined as aganglionosis extending from the anus up to the distal ileum, is a rare variant of Hirschsprung's disease. Surgery for TCA aims to remove the aganglionic colon and reconstruct the intestinal tract by bringing the normally innervated ileum down to the anus while preserving normal sphincter function. Laparoscopy with surgeries including laparoscopic-assisted Duhamel-like and Soave-like pull-through procedures have been progressively applied to the treatment of TCA over the past two decades and may become the dominant treatment for TCA in the future. Postoperative fecal continence, involving issues such as normal defecation, Hirschsprung-associated enterocolitis (HAEC), frequent stool and perianal erosion (perineal rash), soiling/fecal incontinence and constipation/obstructive symptoms, is very important to patients. These complications require nutritional support and comprehensive postoperative gastroenterological care and even require permanent ileostomy and redo pull-through. Some patients have previously seen a psychologist for frequent complaints of diarrhea and other physical symptoms. Patients with TCA postoperatively must be evaluated regularly by pediatric surgeons, enterostoma therapists, gastroenterologists, dieticians and psychologists to achieve a good nutritional status and psychological health.

To compare the efficacy of hybrid transumbilical and anal laparoscopic pull-through (HTALP) and totally transanal laparoscopic assisted pull-through (TTLAP) for the treatment of common type Hirschsprung’s Disease (HD). A retrospective investigation was performed on the clinical data of children with common type Hirschsprung’s disease who underwent either HTALP or TTLAP between 2010 and 2020. A comparative analysis was conducted between the two groups in terms of general patient information, operative time, postoperative defecation recovery interval, bowel control, and postoperative anorectal manometry. A total of 74 cases were included in this study, comprising 53 cases of HTALP and 21 cases of TTLAP. The operative time for HTALP was 99.1 ± 18.7 min, while for TTLAP it was 137.6 ± 35.9 min, showing a statistically significant difference between the two groups (P < 0.001). The blood loss for HTALP was 16.7 ± 12.98 ml, compared to 25.20 ± 9.98 ml for TTLAP, demonstrating a statistically significant difference (P = 0.009). The postoperative bowel recovery interval for HTALP was 1.5 ± 0.35 days, whereas for TTLAP it was 3.3 ± 0.50 days, indicating a statistically significant difference between the two groups (P < 0.001). The postoperative hospital stay for HTALP was 5.3 ± 1.1 days, whereas for TTLAP it was 7.5 ± 0.8 days, showing a statistically significant difference between the two groups (P < 0.001). At 1 month and 3 months postoperatively, the resting anal pressure was significantly lower in the HTALP group compared to TTALP. At 3 months postoperatively, the length of the anal high-pressure zone in the HTALP group was significantly lower than that in the TTLAP group. The HTALP procedure for the radical surgery of HD has favorable surgical outcomes and a relatively low rate of perioperative complications. It is safe and reliable, and can further shorten the operative time and reduce intraoperative blood loss. It causes less damage to the anal sphincter muscles, thereby promoting rapid recovery.

Introduction: Hirschsprung disease (HD) is a birth defect in which some of the intestinal nerve cells (ganglion cells) do not form completely. Improvements in laparoscopic skills among pediatric surgeons, along with technological advancements, have led to the widespread use of the natural orifice transluminal endoscopic surgery (NOTES) technique; however, reports on long-term outcomes and high-quality follow-up data on anorectal manometry in patients treated with this approach are scarce. Aim: We aimed to compare the short-term and long-term efficacy of 2 surgical approaches to the treatment of common-type HD: total transanal laparoscopic pull-through (TTLP, which falls under the category of NOTES), and pure transanal endorectal pull-through (PTEP; not classified as NOTES) in order to provide a reference for clinical strategy selection. Materials and methods: We retrospectively evaluated clinical data and follow-up results of 60 children with common-type HD who underwent TTLP or PTEP. The patients were divided into 2 equal-size groups according to the treatment method. Perioperative parameters were recorded, and regular follow-up was conducted by designated staff for over 10 years. The frequency and type of postoperative short- and long-term complications, pre- and postoperative anorectal manometry data, and daily bowel movement frequencies were recorded. The postoperative defecation function and quality of life scores were assessed and compared. Results: The mean (SD) age of patients undergoing surgery was 16.75 (12.82) months in the TTLP group and 18.92 (11.55) months in the PTEP group. The incidence of perioperative and long-term complications did not differ between the groups. One month postsurgery, the TTLP group showed lower values of anorectal manometry indicators, as compared with the PTEP group. At 1 to 10 years postsurgery, except for lower anal resting pressure values in the TTLP patients, there was no significant difference in the anorectal manometry indicators between the groups. Both early and late postoperative defecation frequencies were similar between the 2 types of surgeries. Within the first 6 months postsurgery, the defecation function scores were higher in the TTLP group than in the PTEP group; however, after 1 year, there were no significant differences in these scores between the groups. The quality of life scores of the 2 groups showed no difference in the first 1 to 2 years of the surgery. However, the mean quality of life scores evaluated from 2 to 10 years postsurgery were higher in the TTLP group than in the PTEP group. Conclusions: TTLP for common-type HD not only contributes to early postoperative recovery, but also enhances the long-term quality of life, as compared with PTEP.

本研究旨在探讨缩短禁食水时间以及术前补液和营养支持对学龄前儿童腹腔镜疝修补术后免疫功能的影响。

Objective:To explore the hepatic expression of platelet-derived growth factor-BB (PDGF-BB), Snail 1 and epithelial-mesenchymal transition (EMT) in children of biliary atresia (BA) and examine the relationship among three parameters.Methods:From January 2018 to December 2019, there were BA ( n=25), choledochal cysts (CCC, n=15) and liver tumors (NL, n=10). After collecting biopsy tissues, immunohistochemistry and real-time fluorescent quantitative polymerase chain reaction (PCR) were employed for detecting the expression of PDGF-BB, Snail 1, E-cadherin and N-cadherin and analyzing their correlations. Results:mRNA and protein expressions of PDGF-BB, Snail 1 and N-cadherin were significantly higher in liver of BA group than those of CCC/NL group ( P<0.05); mRNA and protein expressions of E-cadherin were significantly lower than that of CCC/NL group ( P<0.05). PDGF-BB was correlated positively with Snail 1 mRNA and protein expressions ( r=0.772, P<0.05; r=0.780, P<0.05); PDGF-BB was correlated positively with N-cadherin mRNA and protein expressions ( r=0.835, P<0.05; r=0.702, P<0.05); PDGF-BB and E-cadherin mRNA and protein expressions were correlated negatively ( r=-0.756, P<0.05; r=-0.696, P<0.05); Snail 1 and N-cadherin mRNA and protein expression were correlated positively ( r=0.723, P<0.05; r=0.702, P<0.05); Snail 1 was correlated negatively with E-cadherin mRNA and protein expressions ( r=-0.720, P<0.05; r=-0.636, P<0.05). Conclusion:In BA children, PDGF-BB may promote EMT through enhancing the transcription activity of transcription factor Snail 1.Thus it may provide new theoretical rationales for diagnosing and treating BA children.

Objectives To explore the association of Children's Dietary Inflammatory Index (C-DII) scores with inflammation and markers of inflammatory factors in children and adolescents. Methods Data on dietary nutrient intake, markers of inflammation (ferritin, alkaline phosphatase, C-reactive protein (CRP), absolute neutrophil cell count and lymphocyte count) and oxidative stress (serum bilirubin, albumin, and iron) were available for participants aged 6–19 years (n = 1281). Each participant's C-DII score was calculated based on a 24-h diet and recall. Generalized linear models were applied to examine associations between C-DII and markers of inflammation and oxidative stress, while adjusting for covariates. Restricted cubic splines were used to explore the dose-response association of C-DII scores with indicators of inflammatory oxidative stress. Akaike's Information Criterionwas applied to compare the performance of linear and non-linear models. Results After adjusting for potential confounders, quantile regression results showed that when comparing C-DII quartile 4 (most pro-inflammatory) and quartile 1 (most anti-inflammatory), lymphocytes, ferritin, CRP were statistically significant differences in serum bilirubin, albumin and serum iron (P < 0.05). The C-DII score showed a non-linear relationship with inflammatory oxidative stress indicators. Overweight/obese children and adolescents who ate a high pro-inflammatory diet were more likely to have higher levels of inflammatory cytokines (P = 0.002). Conclusions The dietary inflammatory index in children is associated with markers of chronic inflammation and oxidative stress. A pro-inflammatory diet resulted in increased serum concentrations of these markers, implying that early dietary interventions have implications for reducing chronic inflammation and oxidative stress in children and adolescents.