Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 18 appraisals
Scientific data
Appendix300: Surgical video and patient metadata of 330 laparoscopic appendectomy cases from five institutions
The limited availability of diverse and representative training data poses a critical barrier to the development of clinically relevant computational tools for intraoperative surgical decision support. Surgical procedures are not routinely recorded, and data annotation requires domain expertise, resulting in a scarcity of open-access surgical video datasets with high-quality annotations. Existing datasets are typically limited to single institutions and specific procedures, such as cholecystectomy, and rarely comprise patient-level metadata like demographic characteristics, disease history, or laboratory parameters. The Appendix300 dataset comprises 330 laparoscopic surgery recordings, including 325 full-length laparoscopic appendectomies and 5 control recordings from non-appendectomy procedures in pediatric and adult patients treated at five German centers. The dataset includes patient-level clinical metadata (demographics, medical history, clinical symptoms, preoperative laboratory parameters, and histopathologic findings, as well as standardized expert annotations of the laparoscopic grade of appendicitis). This dataset enables novel validation tasks for computer vision in laparoscopic surgery and facilitates simulation of decentralized learning approaches, overall enhancing the breadth and translational relevance of AI-based surgical video analysis.
14 June 2026
Read appraisal →Journal of the American College of Surgeons
Improving Trauma Triage Accuracy with Large Language Models: A Comparison to Human Expert Decisions
BACKGROUND: Accurate prehospital trauma triage and communication determine morbidity, mortality, and system efficiency. Advancements in large language models (LLMs) offer an opportunity to improve triage and yet to be implemented in prehospital trauma triage. STUDY DESIGN: This retrospective cohort study evaluates LLM performance in trauma triage and accuracy of prehospital tele-communication. Of 410 pediatric activations at a Level I center (January 2023 to May 2025, IRB no. 00009569), 133 activations with emergency medical service recordings, human-generated trauma pages, and injury severity scores were analyzed. Audio was transcribed with OpenAI Whisper. Structured "Essential Transcripts" were generated with named entity recognition. Entity ablation tested redaction of triage parameters on accuracy. In a prospective arm, trauma surgeons reviewed emergency medical service transcripts and triaged activations pre- and post-LLM exposure. Cribari criteria defined over and undertriage. McNemar's test and 95% CIs assessed paired differences in accuracy. RESULTS: The primary endpoint: LLM undertriage demonstrated modest improvement; 4.8% (3 to 8.2) vs 5.1% (3.1 to 9.3, p = 0.73, Bonferroni p = 1). For secondary endpoints, LLM triage outperformed human clinicians: 83.5% accuracy (80.6 to 90.6) vs 78.9% (73.9 to 82.6, p < 0.01, Bonferroni p < 0.01), with overtriage 58.6% (51.4 to 73.7) vs 71.8% (p < 0.05, Bonferroni p < 0.09). "Essential Transcripts" reduced transcript length by 80.8% (p < 0.001) while preserving accuracy (81.9%, 76.6 to 87.5, p < 0.001, Bonferroni p < 0.05). Entity ablation had marginal effect on triage. In prospective evaluation, human triage accuracy improved after LLM exposure (73.7% [69.8 to 77.2]) to 75.8% ([71.9 to 79.2], p = 0.04, Bonferroni p = 0.12), significantly improving the odds of a correct triage decision (odds ratio 2.57, 95% CI 1.39 to 6.83, p < 0.01). CONCLUSIONS: LLMs achieve triage accuracy comparable to trauma staff in retrospective review of pediatric trauma. Further validation is needed to assess clinical outcomes, generalizability, and user acceptance before widespread deployment.
14 June 2026
Read appraisal →Journal of the American College of Surgeons
What Is Included in Pediatric Enhanced Recovery After Surgery Protocols and How to Encourage Adoption: A Systematic Review of the Literature
The present systematic review is the first to describe and analyze the breadth of enhanced recovery after surgery (ERAS) elements across various pediatric surgery procedures. The aim of the article is to provide a compendium of ERAS elements that are used in pediatric protocols to identify both gaps and variation. In response to these findings, we then propose a methodology for addressing the gaps and variation we found and furthering the use of ERAS in pediatric surgery.
14 June 2026
Read appraisal →Pediatric surgery international
Early vs. delayed feeding after pediatric gastrointestinal surgery: a systematic review and meta-analysis
BACKGROUND: The adoption of early feeding after pediatric gastrointestinal surgery remains inconsistent due to concerns regarding anastomotic safety. METHODS: A systematic review and meta-analysis of randomized controlled trials was conducted comparing early enteral feeding (initiation within 48 h) with delayed feeding in patients < 18 years undergoing intestinal anastomosis or stoma reversal. RESULTS: Eight trials comprising 704 patients (323 early feeding, 381 delayed) were included across neonatal and pediatric elective surgical populations. Early feeding significantly shortened hospital length of stay (mean difference - 3.53 days; 95% CI - 4.35 to - 2.71) and reduced time to full feeds (mean difference - 3.15 days; 95% CI - 3.89 to - 2.40). There was no significant difference in anastomotic leakage (log risk ratio - 0.36; 95% CI - 1.23 to 0.51; I²=0%) or postoperative vomiting (log risk ratio - 0.02; 95% CI - 0.41 to 0.38). Early feeding was also associated with fewer wound infections (log risk ratio - 0.85; 95% CI - 1.48 to - 0.22). CONCLUSIONS: Overall, early enteral feeding after pediatric gastrointestinal surgery appears safe and confers clinically meaningful benefits by accelerating nutritional recovery, reducing infectious complications, and shortening hospitalization, supporting its incorporation into pediatric postoperative care pathways.
13 June 2026
Read appraisal →European journal of pediatrics
Pediatric Trauma Score (PTS) combined with blood lactate measurement provides clinical treatment guidance and prognosis prediction for children with compound injuries: a prospective study
UNLABELLED: Compound injuries in children are the leading cause of death and disability, and early and accurate assessment is crucial to optimize treatment. This study aimed to explore the clinical value of Pediatric Trauma Score (PTS) combined with blood lactate measurement in the triage, treatment guidance and prognosis prediction of pediatric compound injuries. From January 2023 to December 2024, a randomized, single-blind controlled trial was conducted in the emergency department of Hebei Provincial Children's Hospital (the only tertiary pediatric medical center in Hebei Province), China. A total of 546 children with compound injuries who presented to the hospital were included and randomly divided into the intervention group (n = 273, managed by PTS combined with dynamic monitoring of blood lactate) and the control group (n = 273, managed by PTS only). The main outcomes were the timeliness of rescue (time to critical intervention) and the accuracy of prognosis prediction (predictive effectiveness of mortality and major complications). Secondary outcomes included emergency department length of stay, unplanned Intensive Care Unit (ICU) admission, and 30-day complication rate. The median time from admission to initiation of key interventions was significantly shorter in the intervention group compared with the control group (45 [interquartile range (IQR): 30-65] min vs. 68 [IQR: 45-95] min, P < 0.001). The area under the receiver operating characteristic (ROC) curve (AUC) of the combined indicator (PTS + initial lactate) to predict 30-day mortality was 0.936 (95% CI: 0.902-0.970), which was significantly higher than PTS alone (AUC: 0.812, P < 0.001) or initial lactate (AUC: 0.855, P = 0.002). The emergency department length of stay, unplanned ICU admission rate and 30-day complication rate of the intervention group were significantly lower than those of the control group (all P < 0.05). Dynamic monitoring showed that 6-h lactate clearance < 30% was a strong independent predictor of the occurrence of multiple organ dysfunction syndrome (MODS) (odds ratio (OR) = 5.42, 95% CI: 2.88-10.21,P < 0.001. CONCLUSION: The combined application of PTS and blood lactate integrates physiological status and metabolic information, which can significantly improve the accuracy of early triage of pediatric compound injuries, guide the implementation of rescue measures, and effectively predict prognosis through dynamic monitoring, providing a reliable basis for precise personalized management. WHAT IS KNOWN: • Compound injuries in children are the leading cause of death and disability, and early and accurate assessment is crucial to optimize treatment. WHAT IS NEW: • The combined application of the Pediatric Trauma Score (PTS) and blood lactate signifi cantly improves the accuracy of early triage and 30-day mortality prediction, shortens the time to critical intervention, and reduces unplanned ICU admission and 30-day complication rates in pediatric compound injuries. • Dynamic monitoring shows that 6-hour lactate clearance 30% is a strong independent predictor of multiple organ dysfunction syndrome (MODS).
25 May 2026
Read appraisal →European journal of pediatrics
Development and validation of an explainable machine learning model for predicting surgical intervention in pediatric intestinal obstruction
Pediatric intestinal obstruction, a critical acute abdomen condition, carries a risk of intestinal necrosis. Decisions for urgent surgery lack standardized criteria. This study aimed to develop an explainable machine learning (ML) model to predict surgical indication, reducing diagnostic variability. A retrospective study included 642 children from our center (split into training/internal validation sets) and 137 from two external centers. Surgical indication was defined based on the presence of one or more of the following: evidence of peritonitis on physical examination, radiographic signs of strangulation, or failure of conservative management for > 24 h; in cases of diagnostic uncertainty, consensus among three senior physicians was used as the adjudication standard. We built models using 35 easily obtainable features across eleven algorithms and evaluated performance via AUC and other metrics. SHapley Additive exPlanations (SHAP) provided model interpretability, and an optimal probability threshold was established for clinical stratification. At the optimal threshold determined by maximizing the Youden index, the model achieved a sensitivity of 89% and a specificity of 99% in the internal validation set. The random forest model demonstrated the highest discriminative performance. A streamlined, interpretable model using the eight most important features (including vital sign dynamics and clinical markers) showed no evidence of overfitting based on the close agreement between training and validation performance metrics. It achieved AUCs of 0.988 (internal validation) and 0.981 (external validation). The model has been translated into a convenient clinical tool.Conclusion: Our explainable ML model demonstrates strong discriminative performance in predicting the need for surgery in pediatric intestinal obstruction and is strongly associated with intestinal necrosis. By mitigating the "black-box" concern through SHAP, it offers transparent, interpretable decision support to clinicians.
20 May 2026
Read appraisal →World journal of urology
Supine mini-PCNL using pneumatic lithotripsy for pediatric renal stones: safety and efficacy in low-income countries
BACKGROUND: Mini-percutaneous nephrolithotomy (mini-PCNL) is an effective surgical technique for pediatric renal stones. However, data comparing different lithotripsy modalities in this population are limited. PURPOSE: To compare the efficacy, safety, and acute renal parenchymal impact of pneumatic lithotripsy versus Holmium: YAG (Ho: YAG) laser dusting during supine mini-percutaneous nephrolithotomy (mini-PCNL) in pediatric patients. PATIENTS AND METHODS: A double-masked, randomized clinical trial was conducted between March 2023 and October 2024. A total of 104 pediatric patients (ages 3-10 years) with solitary renal stones (10-25 mm) were randomized into two groups: Group 1 (n = 53) underwent mini-PCNL using a pneumatic lithotripter, and Group 2 (n = 51) underwent mini-PCNL using Ho: YAG laser dusting. Primary outcomes included operative time, stone-free rate (SFR), complications (Clavien-Dindo), and biochemical markers of renal injury, including Kidney Injury Molecule-1 (KIM-1) and albumin/creatinine (A/C) ratio. RESULTS: Pneumatic lithotripsy demonstrated significantly shorter mean operative times (59.5 vs. 67.6 min, p = 0.007) and lithotripsy times (p < 0.001) compared to the laser group. The stone-free rates were comparable between the pneumatic and laser groups (92.45% vs. 94.1%, p > 0.05). Group 1 (pneumatic) had a significantly shorter hospital stay (2.2 vs. 2.6 days, p = 0.004). While both groups showed postoperative elevations in injury markers, the laser group exhibited significantly higher and more sustained levels of urinary KIM-1 and A/C ratios, as well as higher postoperative RBC counts in nephrostomy samples (p < 0.05). No major complications or perforations occurred in either group. CONCLUSIONS: Pneumatic lithotripsy is a highly effective and safe alternative to laser lithotripsy for pediatric mini-PCNL. It offers comparable operative efficiency, reduced hospital stays, and potentially lower acute tubular injury as evidenced by lower KIM-1 levels. Given its lower cost and comparable stone-free rates, pneumatic lithotripsy is a favorable option for managing pediatric renal stones in resource-conscious settings.
18 May 2026
Read appraisal →PloS one
Effects of nebulized dexmedetomidine for premedication on the parameters of oxidative and inflammatory stress in children undergoing tonsillotomy and adenoidectomy: A pilot randomized controlled trial
BACKGROUND: This prospective randomized clinical pilot study aimed to evaluate the effect of inhaled Dexmedetomidine in premedication in children after tonsillectomy with adenoidectomy on oxidative and inflammatory stress and the drugs impact on clinical parameters such as perioperative sedation, hemodynamics, respiratory function, postoperative delirium, analgesia, opioid consumption and frequency of complications. METHODS: Children aged 4-13 years with an indication for tonsillotomy with adenoidectomy were randomized into two groups: (D) - Dexmedetomidine treated group and (N) - control, non-treated group. Ramsey's sedation score, Bispectral index (BIS), and vital signs (heart rate, respiratory rate, noninvasive blood pressure and hemoglobin oxygen saturation) were monitored perioperatively in at defined time points. After 15 minutes of extubation, the postoperative delirium score (PEAD) and pain score (VAS) were noticed. Pain scores were monitored for up to 12 postoperative hours every three hours on the ward. Venous blood samples were taken before intervention and after surgery to evaluate redox homeostasis (levels of malondialdehyde - MDA, nitrogen monoxide, glutathione and sulfhydryl groups and the activity of superoxide dismutase and catalase) and inflammatory parameters (blood count, neutrophile/lymphocyte ratio, C-reactive protein and Interleukin 6). Perioperative complications in the induction phase, intraoperative and postoperative period, as well as the consumption of opioids, were noted. RESULTS: 16 patients in the D and 15 in the N groups participated in the study. There was no difference in age, sex, body weight and duration of surgery between the two groups. The obtained results of oxidative stress and inflammatory response markers showed that there was a statistically significant difference in the MDA level between compared groups (postoperative MDA 88.93 ± 1.19 vs. 95.05 ± 1.58, ΔMDA 0.014), with no difference observed in other investigated oxidative and inflammatory stress in plasma samples. Patients in both groups were hemodynamically and respiratory stable. Still, patients in the treated (D) group achieved the desired level of sedation compared to the control evaluated by the Ramsey sedation score (p < 0.001). The BIS values were statistically significantly different between the D and N groups 30 minutes after inhalation (86.6 ± 11.6 vs. 98.1 ± 1.2, P < 0.001), but showed no differences during and after the procedure. The two groups had a significant difference in pain control upon awakening and one hour after the operation, respectively (pain on awakening p = 0.024; pain during the first hour of stay in the ward p = 0.039). The consumption of intraoperative opioids was slightly lower in the D group than in the N group (D vs. N group: fentanyl in µg/kg mean 3.67 ± 0.78 vs. 3.94 ± 1.12, p = 0.445, i.e., alfentanil in µg/kg mean 2.02 ± 1.85 vs. 2.30 ± 2.08, p = 0.691). Also, there were no differences in observed perioperative complications between groups. CONCLUSION: Inhaled Dexmedetomidine at a dose of 2 µg/kg in premedication reduces oxidative stress. However, the statistical significance of this drugs effect on the level of markers of antioxidant defense and inflammation has not been proven in children operated on for tonsillar hypertrophy. This dose regimen and route of application of Dexmedetomidine significantly affect the degree of perioperative sedation and BIS values, provides perioperative hemodynamic and respiratory stability, significant immediate postoperative analgesia, and reduces the consumption of analgesics with minimal complications, which makes it useful for shorter surgical interventions.
14 May 2026
Read appraisal →Hernia : the journal of hernias and abdominal wall surgery
Open versus laparoscopic repair in pediatric incarcerated inguinal hernia: a systematic review and meta-analysis
PURPOSE: The optimal surgical approach for pediatric incarcerated inguinal hernia remains controversial. This study aimed to systematically compare the clinical outcomes of laparoscopic repair (LH) and open repair (OH) in children with incarcerated inguinal hernia through a systematic review and meta-analysis. METHODS: A comprehensive literature search was conducted in PubMed, Embase, Web of Science, and the Cochrane Library from database inception to March 2026. Comparative studies evaluating LH versus OH in pediatric incarcerated inguinal hernia were included. Primary outcomes included operative time, intraoperative blood loss, and length of hospital stay. Secondary outcomes included intraoperative injury, wound infection, testicular atrophy, and recurrence. Pooled mean differences (MD) and odds ratios (OR) with 95% confidence intervals (CI) were calculated using Review Manager 5.4. RESULTS: Nine studies involving 584 pediatric patients were included in the meta-analysis. Compared with OH, LH was associated with significantly shorter operative time and reduced intraoperative blood loss. The length of hospital stay was also significantly shorter in the LH group. In addition, LH showed a significantly lower risk of intraoperative injury and recurrence. No statistically significant differences were observed between the two groups in terms of wound infection or testicular atrophy. CONCLUSIONS: Laparoscopic repair appears to be a safe and effective alternative to open repair for pediatric incarcerated inguinal hernia. Further high-quality prospective studies are warranted to confirm these findings.
14 May 2026
Read appraisal →JMIR medical informatics
Natural Language Processing for Automated Classification of Cleft and Craniofacial Procedures From Operative Notes: Model Development and Feasibility Study
BACKGROUND: The accurate classification of operative notes is essential for surgical outcomes research; however, CPT code classification is notoriously nonspecific for many procedures. In such situations, the operative note (or "dictation") must be reviewed manually, a process that is labor-intensive and unsustainable. Natural language processing demonstrates tremendous potential for improving the efficiency and accuracy of procedure classification from unstructured operative notes. To date, it remains unexplored whether natural language processing can reliably differentiate between complex, multicomponent procedures, such as those involved in the care of cleft lip or palate and craniofacial anomalies. OBJECTIVE: This study aims to develop and evaluate a machine learning framework for the automated classification of operative notes for cleft and craniofacial procedures. METHODS: This single-institution, retrospective observational study used operative notes from patients undergoing cleft and craniofacial procedures at a single academic medical center from 2016 to 2024. Each note in the database had been manually classified previously. Notes were preprocessed and vectorized using term frequency-inverse document frequency. A One-vs-Rest classification framework with random forest as the base classifier was developed to categorize procedures at 3 levels: primary procedure type (cleft lip repair, alveolar bone grafting, cleft palate repair, velopharyngeal insufficiency correction, rhinoplasty, and other), procedural subtype (primary vs revision), and specific surgical technique used (eg, Fisher, Mulliken, or rotation-advancement technique for cleft lip repair). Each hierarchical level was developed and evaluated using cross-validation. To improve procedural subtype classification for classes with few samples, synthetic notes were added to the dataset. Area under the receiver operating characteristic curve (AUC), an area under the precision-recall curve, micro- and macro-averaged F1-scores, and Hamming loss were used to assess model performance. RESULTS: The dataset comprised 630 operative notes from 311 pediatric patients undergoing cleft and craniofacial procedures between 2016 and 2024, with a mean age of 3.75 (range 0-19) years. The primary classification model achieved strong performance in distinguishing procedure types with an AUC of 0.93 (SD 0.04), area under the precision-recall curve of 0.84 (SD 0.05), micro-averaged F1-score of 0.88 (SD 0.02), a macro-averaged F1-score of 0.84 (SD 0.03), and a Hamming loss of 0.04 (SD 0.01). Secondary classifiers achieved AUC scores of 1.0 (SD 0.00) for cleft lip revision classification but failed to discriminate between alveolar bone grafting primary and revision procedures (AUC 0.49, SD 0.02). Tertiary classifiers for surgical technique identification showed AUC scores of 0.88 (SD 0.03), 0.89 (SD 0.03), and 0.89 (SD 0.09) for cleft lip, cleft palate, and velopharyngeal insufficiency repair techniques, respectively. CONCLUSIONS: This pilot study demonstrates that machine learning approaches can automate the classification of pediatric craniofacial operative notes across multiple levels of procedural detail. The implementation of such systems could significantly reduce the administrative burden related to surgical research, operations, and quality improvement.
13 May 2026
Read appraisal →Pediatric surgery international
Selective non-operative management of post-appendectomy abscesses in children: a comprehensive systematic review and pairwise meta-analysis
Post-appendectomy intra-abdominal abscess remains a common complication following pediatric appendicitis. Although drainage has traditionally been considered standard treatment, increasing evidence suggests selected patients may be successfully managed with antibiotics alone. A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines and registered in PROSPERO (CRD420251075191). PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched through June 20, 2025. Eligible studies included pediatric patients (0-18 years) with post-appendectomy abscess managed with antibiotic vs. invasive drainage. The primary outcome was failure of first-line treatment requiring escalation. Secondary outcomes included recurrence and length of hospital stay. Ten observational studies involving 363 pediatric patients were included (152 drainage, 211 conservative). Treatment success was 80.9% with drainage and 89.1% with antibiotics. Pooled analysis demonstrated no statistically significant difference in treatment success (RR 1.00; 95% CI 0.95-1.05) or recurrence (RR 0.99; 95% CI 0.57-1.74). Drainage was associated with longer hospital stays (MD 3.40 days; 95% CI 0.65-6.14; p = 0.02). Subgroup analyses demonstrated consistent findings. All included studies demonstrated a serious risk of bias due to confounding by indication. An antibiotics-first approach appears viable for clinically stable pediatric patients, achieving comparable outcomes with shorter hospitalization.
13 May 2026
Read appraisal →Pediatric surgery international
Development of a machine learning-based prognostic prediction model and a web-based tool for pediatric hepatoblastoma: a Surveillance, Epidemiology, and End Results (SEER) database study
BACKGROUND: Prognostic evaluation of pediatric hepatoblastoma (HB) remains challenging due to the low accuracy of traditional risk stratification models. This study aims to leverage the U.S. Surveillance, Epidemiology, and End Results (SEER) database to develop and compare several machine learning-based survival models and create an online prediction tool for individualized survival probability estimation in children with HB. METHODS: A total of 614 pediatric HB patients diagnosed from 2000 to 2021 in the SEER database were identified and randomly split (7:3 ratio) into a training set (n = 429) and an internal hold-out validation cohort (n = 185). This split was selected to retain sufficient data for model development while preserving an adequate validation cohort for performance assessment. Least Absolute Shrinkage and Selection Operator (LASSO) regression analysis was used for feature selection, and three prognostic prediction models (Cox regression, random survival forest (RSF), and a deep learning-based survival (DeepSurv) neural network) were developed using the training data. Model performance was evaluated by Harrell's concordance index (C-index), time-dependent area under the receiver operating characteristic (ROC) curve (AUC) at 1, 3, and 5 years, and decision curve analysis (DCA). We also used SHapley Additive exPlanations (SHAP) analysis to interpret the RSF model. Based on RSF-derived risk scores, patients were classified into high-, intermediate-, and low-risk groups for survival analysis. Ultimately, a web-based tool was developed to enable real-time prediction of 1-, 3-, and 5-year survival probabilities using individual patient characteristics. RESULTS: In the validation cohort, the RSF model achieved the highest C-index (0.745), outperforming the DeepSurv (0.720) and Cox regression models (0.709). The RSF also yielded favorable 1-year, 3-year, and 5-year AUC values, and DCA indicated a greater net benefit across clinically relevant threshold probabilities. SHAP analysis highlighted distant-stage disease, surgical treatment status, and tumor extent as key factors influencing survival predictions. Kaplan-Meier curves stratified by the RSF risk groups showed significantly different survival outcomes among high-, intermediate-, and low-risk patients (log-rank P < 0.001 for all comparisons). The finalized online tool allows users to input patient characteristics and obtain estimated 1-year, 3-year, and 5-year survival probabilities, which may assist individualized prognostic assessment as an adjunctive reference. CONCLUSION: The RSF-based prognostic model showed favorable predictive performance compared with the Cox and DeepSurv models in this retrospective SEER-based cohort of pediatric HB. With interpretable model outputs and an accessible web-based interface, the model may serve as an adjunctive tool for individualized risk assessment. However, external validation and prospective evaluation are required before routine clinical implementation.
13 May 2026
Read appraisal →Pediatric surgery international
Total versus partial fundoplication in children with gastroesophageal reflux disease: a systematic review and comparative meta-analysis of 2633 patients highlighting the trade-off between reflux control and postoperative dysphagia
INTRODUCTION: Gastroesophageal reflux disease (GERD) is a common condition in children requiring surgical intervention when medical therapy fails. Nissen (total) and Toupet (partial) fundoplications are the most frequently performed antireflux procedures; however, their comparative effectiveness and safety in the pediatric population remain uncertain. METHODS: A systematic literature search was conducted in PubMed, Embase, and Cochrane CENTRAL from database inception to 2025. Eligible studies included randomized controlled trials and observational studies comparing total and partial fundoplication in patients younger than 18 years with GERD. Pooled risk ratios (RR) with 95% confidence intervals (CI) were calculated using random-effects models in R software. RESULTS: Eighteen studies including 2,633 children were analyzed. Total fundoplication was associated with a significantly higher risk of postoperative dysphagia compared with partial fundoplication (RR 1.69; 95% CI 1.07-2.68; p = 0.024; I²=12%; n = 1,154), corresponding to an absolute risk increase of 5.7% and a number needed to harm (NNH) of 17. No significant difference was observed in reflux recurrence (RR 0.72; 95% CI 0.21-2.42; p = 0.59; I²=71% n = 834), although event rates were numerically lower after total fundoplication (6.8% vs. 13.7%), corresponding to an absolute risk reduction of 6.9% (NNT = 15). Intraoperative complications (RR 1.11; p = 0.84), postoperative complications (RR 1.49; p = 0.12), reoperation rates (RR 0.95; p = 0.88), and mortality (RR 1.09; p = 0.74) were comparable between procedures. CONCLUSIONS: Total and partial fundoplication demonstrate similar effectiveness for reflux control and overall safety in pediatric GERD. However, total fundoplication is associated with a higher risk of postoperative dysphagia, suggesting that partial fundoplication may offer functional advantages in selected patients.
10 May 2026
Read appraisal →Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery
Surgical management of anterior sacral meningoceles: a case series and systematic review
PURPOSE: Anterior sacral meningoceles (ASMs) are rare forms of spinal dysraphism caused by anterior herniation of meninges through a sacral defect. Surgical management is the treatment of choice, yet the optimal approach remains debated. This study compares outcomes of three main surgical approaches-anterior transabdominal, posterior transsacral, posterior sagittal (PSARP-type)-focusing on the efficacy and safety of the PSARP-type. METHODS: A retrospective single-center analysis was conducted on eight patients treated for ASM between 2008 and 2025. Demographic, clinical, radiological, functional data were reviewed. Outcomes included recurrence, reoperation, sac size reduction, bladder function; complications were categorized as early or late. A systematic literature review was performed according to PRISMA guidelines. RESULTS: Eight patients (6 females, 2 males; mean age 19.4 years) underwent surgery (five anterior Pfannenstiel incision, two posterior sagittal, one posterior transsacral). All were symptomatic, 87.5% had associated malformations. Sac reduction was achieved in 87.5% of cases, with no new neurological deficits. Complications were mild and self-limiting, including transient urinary retention and cerebrospinal fluid fistula managed with lumboperitoneal shunt. The literature review (49 studies, 68 patients) confirmed female predominance (81%), association with Marfan and Currarino syndromes (35%), preference for posterior approaches (70%), which showed lower morbidity and recurrence rates. One postoperative death (1.4%) was reported. CONCLUSIONS: Posterior approaches-particularly the PSARP-type-provide safe, effective, and functionally favorable alternatives to anterior surgery for ASM, offering optimal exposure, precise dural closure, superior cosmetic outcomes with minimal morbidity. The anterior route should be reserved for large or high-lying lesions. Further multicenter studies with longer follow-up are warranted.
17 Apr 2026
Read appraisal →Journal of the American College of Surgeons
Effect of Adhesion Barrier Use During Ladd Procedure for Intestinal Malrotation on Postoperative Midgut Volvulus and Postoperative Small-Bowel Obstruction: A Retrospective Cohort Study Using a National Inpatient Database
BACKGROUND: Postoperative midgut volvulus is a life-threatening complication after the Ladd procedure. An adhesion barrier to prevent postoperative small-bowel obstruction could increase postoperative midgut volvulus incidence due to reduced adhesions. We aimed to examine the effect of adhesion barrier use during Ladd procedures on postoperative midgut volvulus and postoperative small-bowel obstruction. STUDY DESIGN: We retrospectively identified patients younger than 18 years who underwent the Ladd procedure between July 2010 and March 2021, using a Japanese nationwide inpatient database. We used propensity score overlap-weighting analyses to compare reoperation for midgut volvulus, rehospitalization, and operation for small-bowel obstruction, mortality, total rehospitalization length, and total rehospitalization cost within 1 year after the Ladd procedure between patients in whom adhesion barrier was used (barrier group) and patients in whom it was not used (nonbarrier group). RESULTS: Of the 1,159 eligible patients, adhesion barrier was used in 314 and not used in 845 patients. The proportion of reoperations for midgut volvulus did not differ between the barrier and nonbarrier groups (3.5% vs 2.7%; risk difference 0.8%, 95% CI -1.9 to 3.5). The proportion of rehospitalization due to small-bowel obstruction was lower in the barrier group than in the nonbarrier group (2.6% vs 6.3%; risk difference -3.6%, 95% CI -6.6 to -0.8). No significant differences were observed in operation for small-bowel obstruction, mortality, and total length and cost of rehospitalization. CONCLUSIONS: The use of adhesion barrier during the Ladd procedure can prevent rehospitalization due to postoperative small-bowel obstruction without increasing the incidence of postoperative midgut volvulus.
17 Apr 2026
Read appraisal →Pediatric surgery international
Anorectal malformation in adulthood: a systematic review of biological, psychological, and sociological outcomes and experiences
PURPOSE: Anorectal malformations are congenital anomalies involving the rectum, anus, genital, and urinary tracts, and occur in approximately one in 5000 live births. A lack of transition from pediatric to adult health services means little is known about how this condition is experienced in adulthood. The purpose of this review was to discover biopsychosocial challenges and supports experienced by adults living with anorectal malformation. MATERIALS AND METHODS: A systematic quantitative literature review was the preferred method to collect and analyze data. Articles included in the review were sorted into purpose-built datasets, with data coded into biopsychosocial themes and patterns. RESULTS: The most frequently reported biological challenge was surgical intervention; the most frequently reported support was positively framed continence management. The most common psychological challenges were psychosexual concerns such as sexual anxiety, and the most common supports were interventions focused on improving self-perception. The most reported sociological challenge was navigating complex health systems, and the most reported support was forming meaningful relationships. CONCLUSION: Biopsychosocial outcomes experienced by adults born with anorectal malformation remain largely unknown. Social work and psychology can provide therapeutic interventions that enhance emotional wellbeing, psychosocial functioning, and patient-led care.
17 Apr 2026
Read appraisal →European journal of pediatrics
Efficacy of physiotherapeutic interventions in the management of functional constipation in pediatric and adolescent populations: a systematic review and meta-analysis
UNLABELLED: To evaluate the efficacy of physiotherapeutic interventions in the management of functional constipation (FC) in pediatric and adolescent populations, and to analyze the methodological quality of the available evidence. A systematic review of randomized controlled trials (RCTs) published in PubMed, Cochrane Library, Embase, and Web of Science was conducted (February-March 2025). Studies including participants aged 18 years diagnosed with FC, treated with pelvic floor physiotherapy versus conventional medical treatment, were included. Methodological quality was assessed using the PEDro scale (Physiotherapy Evidence Database). Seven clinical trials were included in the meta-analysis with sample sizes ranging from 45 to 400 participants (total n = 775). The interventions covered pelvic floor exercises, biofeedback, telerehabilitation, visceral mobilization, and electrostimulation. The majority showed improvements in painful defecation, fecal consistency, and quality of life, with less consistent results in defecatory frequency (MD = 1.00; 95% CI: 0.35 to 1.65). However, the marked heterogeneity in protocols (type, intensity, duration), variability in assessment instruments, and frequent co-intervention with polyethylene glycol (PEG) hinder comparison between studies and limit external validity. Follow-ups shorter than 12 months and the absence of blinding of participants and therapists constitute additional risks of bias. CONCLUSIONS: Pelvic floor physiotherapy appears to be a promising adjuvant intervention in the treatment of pediatric FC, with positive effects on symptoms and quality of life. Nevertheless, multicenter trials with standardized protocols, large samples, and prolonged follow-up are required to confirm its efficacy and long-term sustainability. WHAT IS KNOWN: •Despite the clinical use of physiotherapy, there was no quantitative synthesis integrating its efficacy against standard medical treatment, nor had its specific effect size on defecatory pain and quality of life been established in the pediatric population. WHAT IS NEW: •This meta-analysis confi rms that pelvic fl oor physiotherapy is an eff ective adjuvant with a large effect size, demonstrating consistent improvements in reducing painful defecation and enhancing the biopsychosocial dimensions of quality of life.
12 Apr 2026
Read appraisal →European journal of pediatric surgery : official journal of Austrian Association of Pediatric Surgery ... [et al] = Zeitschrift fur Kinderchirurgie
Latest Developments in Artificial Intelligence and Machine Learning Models in General Pediatric Surgery
Artificial intelligence (AI) and machine learning (ML) models rapidly transform health care with applications ranging from diagnostic image interpretation, predictive modeling, personalized treatment planning, real-time intraoperative guidance, and outcome prediction. However, their implementation in general pediatric surgery remains limited due to the rarity and complexity of pediatric surgical conditions, small and heterogeneous datasets, and a lack of formal AI training and competencies among pediatric surgeons.This narrative review explores the current landscape of AI and ML applications in general pediatric surgery, focusing on five key conditions: appendicitis, necrotizing enterocolitis, Hirschsprung's disease, congenital diaphragmatic hernia, and biliary atresia. For each, we summarize recent developments, including the use of AI in image analysis, diagnostic support, prediction of disease severity and outcome, postoperative monitoring, and histopathological evaluation. We also highlight novel tools such as explainable AI models, natural language processing, and wearable technologies.Recent findings demonstrate promising diagnostic and prognostic capabilities across multiple conditions. However, most AI/ML models still require external validation and standardization. The review underscores the importance of collaborative, multicenter research based on joint datasets as well as targeted AI education for pediatric surgeons to fully explore the benefits of these technologies in clinical practice.AI and ML offer significant potential to improve pediatric surgical care, but broader implementation will require multicenter collaboration, a robust dataset, and targeted AI education for pediatric surgeons.
4 Apr 2026
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