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Pediatric Surgery—Current Hurdles and Future Perspectives

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Clinical Pediatrics".

Deadline for manuscript submissions: 27 June 2025 | Viewed by 5179

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Dr. Osnat Zmora

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Guest Editor

Department of Pediatric Surgery, Shamir Medical Center, Zerifin 70300, Israel
Interests: pediatric surgery; congenital anomalies; pediatric surgical oncology; trauma

Special Issue Information

Dear Colleagues,

The Journal of Clinical Medicine (JCM) is now introducing a special review series that will update our clinical and scientific community regarding the recent advances in pediatric surgery. We invite state-of-the-art reviews on current topical issues in pediatric surgery, including both clinical science and basic science. Pediatric surgery is a relatively new area of clinical medicine and surgery, with many unanswered questions regarding the natural history of disease, pathogenesis, and evidence-based therapies. Many of us worldwide are dedicating significant efforts to studying the large variety of medical conditions which pose challenges to the pediatric surgeon, and data have been gathered, with subsequent changes to traditional treatment options. Our understanding of the natural history of diseases that the pediatric patients and the pediatric surgeons are coping with is limited by the small numbers of patients with certain conditions and by the need for a very long follow-up. The long-term sequala of esophageal atresia, for example, and the need for follow-ups into adulthood have recently been recognized. Another example includes innovative surgical techniques to treat relatively common anorectal malformations, which challenge traditional techniques with fewer complications and excellent outcomes. Trauma paradigms have also been challenged, and using whole blood, as one example, is providing better survival outcomes for severely injured children. To address the important questions dealt within our daily clinical practices and to promote future research and improvements, we sincerely welcome your submissions to this Special Issue in the JCM. I hope that by reading this Special Issue, the readership of JCM will be able to advance the treatment of their patients and to further contribute to research.

Dr. Osnat Zmora
Guest Editor

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Keywords

congenital anomalies
esophageal atresia
anorectoal malformations
pediatric trauma
necrotizing enterocoloitis
pediatric oncology
Biliary atresia

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Published Papers (6 papers)

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Research

15 pages, 5488 KiB

Open AccessArticle

Delayed Surgical Management of Congenital Syndactyly Improves Range of Motion: A Long-Term Follow-Up

by Aba Lőrincz, Hermann Nudelman, Edina Ilona Kormos and Gergő Józsa

J. Clin. Med. 2025, 14(9), 3200; https://doi.org/10.3390/jcm14093200 - 5 May 2025

Viewed by 267

Abstract

Background: Syndactyly, the congenital fusion of digits, compromises hand function and esthetics. Although surgical separation is the standard treatment, the optimal timing of the intervention remains controversial. Methods: We prospectively analyzed 20 pediatric patients (86 operated fingers) undergoing syndactyly repair, comparing early (≤24 months) versus delayed (>24 months) surgery. Outcome measures included range of motion (ROM) at the metacarpophalangeal (MP), proximal interphalangeal (PIP), and distal interphalangeal (DIP) joints; complications (synostosis, nail deformities, finger length disparity, webbing); and patient-reported outcomes assessed by the Disabilities of the Arm, Shoulder, and Hand (DASH) and overall esthetic satisfaction scores. Results: The median age at surgery was 31 months (IQR25/75: 24.75–36.5), with a median follow-up of 72 months (IQR25/75: 42.0–86.25). Notably, digits III (28.24%) and IV (29.41%) were predominantly affected. Delayed surgery resulted in significantly improved MP ROM (90.98° ± 8.44° vs. 73.13° ± 22.37°, p = 0.004) and DIP ROM (76.28° ± 22.24° vs. 67.19° ± 22.78°, p = 0.028), with a non-significant trend toward better PIP ROM (93.00° ± 25.18° vs. 77.37° ± 30.29°, p = 0.075). Furthermore, the incidence of synostosis was markedly reduced in the delayed surgery group (6.0% vs. 38.9%, p = 0.001). Despite superior joint function associated with delayed intervention, early surgery patients reported higher satisfaction with cosmetic results (3.00 vs. 2.80, p = 0.028), while the DASH scores remained comparably low between groups (0.00 vs. 0.24, p = 0.141). Finger length disparities and webbing were minimal. Conclusions: Our study challenges the conventional advocacy for early syndactyly repair, by demonstrating that delaying surgery beyond 24 months significantly enhances joint mobility and reduces the synostosis rate. However, the higher satisfaction observed as a result of early intervention suggests that surgical timing should be individualized for affected fingers, joints, and severities to balance the functional and cosmetic outcomes. Further studies are needed to define the optimal surgical timing and techniques for pediatric syndactyly. Full article

(This article belongs to the Special Issue Pediatric Surgery—Current Hurdles and Future Perspectives)

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10 pages, 1146 KiB

Open AccessArticle

Outcomes of Tympanoplasty with an Autologous Two-Piece Perichondrium-Cartilage Graft in a Tertiary Care Setting

by Marie Reynders, Dylen Philips, Kelsey Van Den Houte, Lynn Van Der Sypt, Camille Levie and Ina Foulon

J. Clin. Med. 2025, 14(8), 2600; https://doi.org/10.3390/jcm14082600 - 10 Apr 2025

Viewed by 396

Abstract

Background/Objectives: This study evaluates the anatomical and functional outcomes of type 1 tympanoplasty using an autologous two-piece perichondrium-cartilage (CP) graft in pediatric and adult patients with tympanic membrane (TM) perforations. Methods: A retrospective review of 74 patients (59 children, 15 adults) undergoing type 1 tympanoplasty with CP by a single surgeon (IF) was conducted. Preoperative and postoperative audiological outcomes, perforation size, prognostic factors, and complications were analyzed. Success was defined as an intact TM and an air–bone gap (ABG) < 20 dBHL at 12 months postoperatively. Results: TM closure was achieved in 93.2% of patients, with 93.1% attaining an ABG < 20 dBHL. The combined success rate was 86.3%, with no significant differences between children and adults. Larger perforations (>50%) had significantly lower closure rates (55.6% vs. >97%, p < 0.002). Children who underwent prior adenoidectomy had significantly higher success rates (p = 0.04). Conclusions: Tympanoplasty with a CP graft provides high success rates in both children and adults. The procedure can be performed from age five, considering patient cooperation. In children, simultaneous adenoidectomy is recommended if significant adenoid hypertrophy is present to optimize outcomes. Larger perforations were associated with reduced success, while age had no significant impact. Full article

(This article belongs to the Special Issue Pediatric Surgery—Current Hurdles and Future Perspectives)

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18 pages, 16760 KiB

Open AccessArticle

Primary Lung Tumors in Children: Insights from a Single-Center Case Series

by Paola Borgia, Barbara Cafferata, Claudio Paratore, Lorenzo Anfigeno, Alessio Conte, Angelo Florio, Annalisa Gallizia, Marco Del Monte, Francesca Buffelli, Francesca Rizzo, Maria Beatrice Damasio, Pietro Salvati, Katia Perri, Alberto Garaventa, Teresa Battaglia, Virginia Livellara, Massimo Conte, Giovanni Arturo Rossi, Valerio Gaetano Vellone, Michele Torre, Carlo Castellani and Oliviero Sacco Show full author list Hide full author list

J. Clin. Med. 2025, 14(7), 2173; https://doi.org/10.3390/jcm14072173 - 22 Mar 2025

Viewed by 596

Abstract

Background: Primary lung tumors in pediatric patients are rare, predominantly malignant, and present diagnostic challenges due to symptom overlap with more common conditions such as inflammatory processes or asthma. Evidence-based approaches for managing these rare neoplasms in childhood are scarce. This retrospective study reports the experience of a pediatric referral center in diagnosing and treating these tumors. Methods: Pediatric primary lung tumors treated at Giannina Gaslini Children’s Hospital between January 2016 and January 2024 were included. Data on clinical presentation, histopathology, imaging, treatment approaches, and outcomes were systematically collected and analyzed. Results: Nine patients (six males and three females) were identified, with a mean age (±SD) at diagnosis of 8.81 ± 5 years. The most common clinical manifestation was recurrent pneumonia (four patients), followed by persistent cough and wheezing (three patients). The average duration of symptoms before diagnosis was 12.8 months ± 12.2 months. Histopathological diagnoses were typical carcinoid tumors (n = 2), atypical carcinoid tumors (n = 2), inflammatory myofibroblastic tumors (n = 2), congenital peribronchial myofibroblastic tumor (n = 1), myoepithelial carcinoma (n = 1), and pleuropulmonary blastoma (n = 1). Radical surgery resulted in complete response for seven patients, with a median follow-up of 52 months (IQR 39 months). The myoepithelial carcinoma was treated with multimodal therapy, relapsed after 17 months, and adjuvant chemotherapy is currently ongoing. Neoadjuvant chemotherapy for the pleuropulmonary blastoma is currently ongoing. Conclusions: Primary lung tumors in children, though rare, may have favorable outcomes when appropriately managed. Nonspecific clinical presentations often contribute to diagnostic delays. This study highlights the critical need of thorough evaluation in cases of persistent, therapy-resistant aspecific respiratory symptoms. Early diagnosis, coupled with complete surgical resection, significantly improves prognosis. Full article

(This article belongs to the Special Issue Pediatric Surgery—Current Hurdles and Future Perspectives)

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9 pages, 216 KiB

Open AccessArticle

Is There a Pediatric Role for the General Thoracic Surgeon in a General Hospital? A 22-Year Single-Center Experience

by Francesco Petrella, Sara Degiovanni, Federico Raveglia, Andrea Cara, Enrico Mario Cassina, Francesca Graziano, Lidia Libretti, Emanuele Pirondini, Sara Vaquer, Antonio Tuoro, Giuseppe Foti, Alessandra Moretto, Alessandro Cattoni, Andrea Biondi and Adriana Balduzzi

J. Clin. Med. 2024, 13(23), 7231; https://doi.org/10.3390/jcm13237231 - 28 Nov 2024

Viewed by 626

Abstract

Background: Although general thoracic surgery is usually focused on adult patients, there are some settings of pediatric diseases which can benefit from thoracic surgical procedures. In this study, we retrospectively reviewed the contribution of general thoracic surgeons to pediatric patients in a high-volume hospital. Methods: From September 2002 to August 2024, 8897 consecutive patients were operated on; among them, 202 patients (2.2%) were younger than 18. Age, sex, operatory setting, side, indications, procedures, procedure duration, and perioperative mortality were collected for each patient. Results: Among the 202 patients younger than 18, 27 (13.3%) were 0–6 yo; 13 (6.4%) were 6–12 yo; 162 (80.1%) were 12–18 yo. In the first group, metapneumonic pleural effusion was the most frequent indication (44.4%) and chest drain the most frequent procedure (51.8%). No perioperative mortality was reported. In the second group, metapneumonic pleural effusion was the most frequent indication (30.7%) and chest drain the most frequent procedure (46.1%). No perioperative mortality was reported. In the third group, pneumothorax was the most frequent indication (41.3%) and bullectomy the most frequent procedure; (41.3%); one intraoperative death (0.4%) was reported in a case of major trauma. Conclusions: A general thoracic surgeon can effectively contribute to the surgical care of pediatric patients; in younger patients (<12 yo) urgent procedures related to infections are the most commonly performed; on the other hand, in patients aged between 12 and 18, elective procedures are more commonly performed, these being sympathectomy for hyperhidrosis and bullectomy for pneumothorax the most frequent. Full article

(This article belongs to the Special Issue Pediatric Surgery—Current Hurdles and Future Perspectives)

17 pages, 2400 KiB

Open AccessArticle

Maximizing Survival in Pediatric Congenital Cardiac Surgery Using Machine Learning, Explainability, and Simulation Techniques

by David Mauricio, Jorge Cárdenas-Grandez, Giuliana Vanessa Uribe Godoy, Mirko Jerber Rodríguez Mallma, Nelson Maculan and Pedro Mascaro

J. Clin. Med. 2024, 13(22), 6872; https://doi.org/10.3390/jcm13226872 - 15 Nov 2024

Viewed by 1178

Abstract

Background: Pediatric and congenital heart surgery (PCHS) is highly risky. Complications associated with this surgical procedure are mainly caused by the severity of the disease or the unnecessary, late, or premature execution of the procedure, which can be fatal. In this context, prognostic models are crucial to reduce the uncertainty of the decision to perform surgery; however, these models alone are insufficient to maximize the probability of success or to reverse a future scenario of patient death. Method: A new approach is proposed to reverse the prognosis of death in PCHS through the use of (1) machine learning (ML) models to predict the outcome of surgery; (2) an explainability technique (ET) to determine the impact of main risk factors; and (3) a simulation method to design health scenarios that potentially reverse a negative prognosis. Results: Accuracy levels of 96% in the prediction of mortality and survival were achieved using a dataset of 565 patients undergoing PCHS and assessing 10 risk factors. Three case studies confirmed that the ET known as LIME provides explanations that are consistent with the observed results, and the simulation of one real case managed to reverse the initial prognosis of death to one of survival. Conclusions: An innovative method that integrates ML models, ETs, and Simulation has been developed to reverse the prognosis of death in patients undergoing PCHS. The experimental results validate the relevance of this approach in medical decision-making, demonstrating its ability to reverse negative prognoses and provide a solid basis for more informed and personalized medical decisions. Full article

(This article belongs to the Special Issue Pediatric Surgery—Current Hurdles and Future Perspectives)

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10 pages, 1962 KiB

Open AccessArticle

Infectious Diseases-Approved Virtual Reality Goggles for Common Procedures in Pediatric Surgical Patients

by Yarden Gilboa Pras, Atara Indursky, Shai Gilboa Pras, Ortal Schaffer, Eleonora Niazov and Osnat Zmora

J. Clin. Med. 2024, 13(18), 5572; https://doi.org/10.3390/jcm13185572 - 20 Sep 2024

Viewed by 1209

Abstract

Background/Objective: Virtual reality (VR) technology has been reported as effective in mitigating fear, anxiety, and pain in children undergoing various medical procedures. Our aim was to test the effectiveness of non-sponge-coated mobile phone-operated VR goggles approved by infectious diseases (ID) control in pediatric surgical patients. Methods: A prospective randomized trial in which pre-procedural and post-procedural heart rate, fear, and anxiety, and post-procedural pain were measured in pediatric surgical patients assigned to receive standard care versus standard care and VR goggles. The patients underwent line insertions, peripheral venipunctures for blood draws, drain removals, and wound care. Results: The control group and the intention-to-treat group were each randomly assigned twenty-four patients. Since eight patients who received VR goggles removed them prior to completion of the procedure, the study group included sixteen patients. In the study group, heart rate, fear, and anxiety scores were significantly lower after the procedure as compared to prior to the procedure. In the control group, these parameters were similar before and after the procedure. Post-procedural decrease in fear and anxiety was significant when comparing VR to control. However, despite better post-procedural physiological and emotional scores in the VR group as compared to control, the differences were not statistically significant. Pre-procedural anxiety was significantly higher in the study group. Conclusions: ID-approved VR goggles can reduce fear and anxiety associated with procedures commonly performed in pedicatric surgical patients. However, since increased baseline anxiety might be associated with VR, a higher benefit might be achieved if goggles were worn only by children who express a clear desire to use them. Full article

(This article belongs to the Special Issue Pediatric Surgery—Current Hurdles and Future Perspectives)

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