Clinical Utility of a Small Diameter Reload in Pediatric Appendectomies.

A population-based cohort examining factors affecting all-cause morbidity and cost after pediatric appendectomy: Does annual adult procedure volume matter?

Two for One? Safety and Efficacy of Concomitant Hernia Repair During Pediatric Appendectomy.

Posterior cranial vault distraction osteogenesis (PCVDO) is a well-established surgical technique for increasing intracranial volume and correcting cranial deformities in children with craniosynostosis. Despite its efficacy, PCVDO is associated with the risk for several perioperative complications. In this systematic review and proportional meta-analysis, the authors aimed to estimate the pooled prevalence of complications associated with PCVDO, including overall complications, infection, CSF leakage, device-related complications, premature device removal, and unplanned returns to the operating room. Additionally, they sought to identify sources of heterogeneity among the studies and evaluate the influence of key clinical and surgical moderators-such as patient age, syndromic status, distraction parameters, elevated intracranial pressure, hydrocephalus, Chiari malformation, syrinx, and prior surgical interventions-on complication rates. A systematic review and proportional meta-analysis were conducted, following the PRISMA guidelines. The MEDLINE/PubMed database was reviewed for English-language, peer-reviewed studies published between 2009 and 2025 that reported perioperative complications in pediatric patients (age < 18 years) with craniosynostosis who had undergone PCVDO and included at least 2 patients. Excluded publications were single case reports, editorials, technical notes, reviews, preclinical or animal studies, and studies not meeting these criteria. Data from the included studies were compiled into a comprehensive spreadsheet to facilitate qualitative and quantitative analyses. A quality assessment of all studies was conducted utilizing the Newcastle-Ottawa Scale. The primary outcome was the proportion of patients experiencing any complication. Secondary outcomes comprised rates of infection and wound-related events, CSF leakage, device-related complications, premature device removal, and unplanned returns to the operating room. Thirty-three studies were included in this analysis. The pooled overall complication rate was 26.3%. Infection and wound-related complications were most common (10.4%), followed by CSF leakage (6.7%) and device-related complications (6.0%). Premature device removal and return to the operating room occurred in 4.0% and 9.9% of patients, respectively. Meta-regression analysis revealed that younger age was significantly associated with an increased risk of CSF leakage and premature device removal. Shorter latency periods were associated with a higher risk of CSF leakage and return to the operating room. While PCVDO is effective in managing craniosynostosis, it is associated with a considerable risk of complications. Age and latency period are significant predictors of adverse outcomes. Innovations in device design and surgical protocols are warranted to optimize the safety and efficacy of the procedure.

Background: Appendicitis is a common surgical emergency in children, often requiring appendectomy. Traditional postoperative care focuses on nursing protocols for pain management and mobility. Recent evidence suggests that integrated care models combining nursing and rehabilitation services can enhance recovery outcomes. This study aims to investigate the effectiveness of such a model in pediatric appendectomy patients. Objective: To evaluate the impact of an integrated nursing and rehabilitation care model on recovery outcomes in children undergoing appendectomies. Methods: This study was conducted over one year with 42 pediatric appendectomy patients randomly assigned to either an integrated care group or a standard care group. The integrated care group received combined nursing and rehabilitation services, while the standard care group received traditional postoperative care. Immediate postoperative recovery was evaluated using pain scores, wound healing assessments, and mobility tests at 24, 48, and 72 hours post-surgery. Long-term functional outcomes, including return to school and physical activity levels, were assessed at 1, 3, and 6 months. Patient and family satisfaction were measured at discharge and follow-up intervals. Results: The integrated care group demonstrated significantly better outcomes: mean pain scores at 72 hours were 2.9 (SD = 0.3) compared to 3.8 (SD = 0.5) in the standard care group (p &lt; 0.01). Wound healing scores at 72 hours were 1.4 (SD = 0.4) versus 2.3 (SD = 0.4) (p &lt; 0.01). Mobility (TUG) scores improved from 9.0 (SD = 0.4) to 8.1 (SD = 0.4) (p &lt; 0.01). Physical activity scores were 3.4 (SD = 0.6) at 1 month, 4.0 (SD = 0.4) at 3 months, and 4.4 (SD = 0.5) at 6 months, compared to 3.0 (SD = 0.5), 3.2 (SD = 0.6), and 3.6 (SD = 0.4) in the standard care group, respectively (p &lt; 0.01). The integrated care group also had fewer days absent from school (mean 4.9, SD = 1.4 vs. 8.7, SD = 2.0) and higher patient satisfaction scores at all time points (p &lt; 0.01). Conclusion: The integrated nursing and rehabilitation care model significantly improved recovery outcomes for pediatric appendectomy patients, demonstrating better pain management, wound healing, mobility, and long-term functional recovery. These findings support the adoption of integrated care models to enhance postoperative recovery in pediatric surgical patients.

Multicenter Analysis of Factors Associated With Delayed Analgesia and Response to Pain Medication in Pediatric Renal Colic Patients

Too much of a bad thing: Discharge opioid prescriptions in pediatric appendectomy patients

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

ObjectiveTo evaluate the clinical efficacy of a modified single-site two-port laparoscopic suspension technique combined with single-instrument knotting and absorbable clips in pediatric appendectomy, and to compare it with the single-site Hem-o-lok clip technique.MethodsThis retrospective study reviewed pediatric patients with acute appendicitis treated at our institution between January 2024 and March 2025. Patients who underwent one of the two single-site two-port laparoscopic techniques were included and classified according to the closure method used for the appendiceal stump and mesoappendix: absorbable clips combined with single-instrument knotting or Hem-o-lok clips. Perioperative outcomes, postoperative complications, ultrasonographic findings, and postoperative inflammatory markers were evaluated.ResultsA total of 133 pediatric patients were included, with 70 in the absorbable-clip group and 63 in the Hem-o-lok group. No significant differences were found between the two groups in abdominal drain placement, time to drain removal, intraoperative blood loss, time to first postoperative flatus, or postoperative hospital stay (P > 0.05). Operative time was significantly shorter in the Hem-o-lok group (P < 0.05). The incidences of subacute intestinal obstruction and postoperative abdominal pain were significantly higher in the Hem-o-lok group (P < 0.05), whereas incision infection, stump inflammation, and fecal leakage did not differ significantly between groups (P > 0.05). Ultrasonographic follow-up and postoperative inflammatory markers showed a stronger and more sustained inflammatory response in the Hem-o-lok group during follow-up. Two patients in the Hem-o-lok group required reoperation for clip removal because of refractory symptoms.ConclusionAlthough the modified single-site two-port laparoscopic suspension appendectomy combined with single-instrument knotting and absorbable clips required a slightly longer operative time than the Hem-o-lok clip technique, it was associated with fewer postoperative complications and a milder postoperative inflammatory response. These findings should be interpreted cautiously and confirmed in larger prospective studies with longer follow-up.

Factors affecting innovation in pediatric surgery: hospital type and appendectomies

179 How to approach oligometastatic disease – is there a role for surgery?

Pediatric appendectomy

Appendectomies are the most common abdominal emergency surgery in pediatric patients. Both pediatric and general surgeons are credentialed to perform this procedure, however pediatric surgeons are specialized in pediatrics. This study seeks to determine differences in pediatric appendectomy outcomes between general and pediatric surgeons. Pediatric patients undergoing appendectomies between 2015 and 2020 were identified in the National Surgical Quality Improvement Program-Pediatric (NSQIP-P) database. Multivariable logistic regression models examined association of surgeon specialty with readmission, postoperative complications, reoperation, non-home discharge destination, operative time, etc. Adjusted odds ratios (AOR) and 95% confidence intervals (CI) were calculated. Average ages of pediatric patients undergoing appendectomy by pediatric and general surgeons were 11.2 (n = 68,638) and 12.3 (n = 3,986) years, respectively (p < .001). General surgeons were not more likely to have adverse outcomes [AOR: 1.00 (0.99-1.01), p = 0.57], readmissions [AOR: 0.995 (0.98-1.00), p = 0.11], reoperations [AOR: 1.00 (0.99-1.00), p = 0.54], or non-home discharges [AOR: 0.99 (0.99-1.00), p = 0.94]. Similar outcomes arise in pediatric appendectomies performed by general surgery at a children's hospital or hospitals with a pediatric wing. Significant limitations to using the NSQIP-P database persist. Further research including hospitals contributing to both adult and pediatric databases can provide a clearer picture of post-surgical outcomes in appendectomies.

Using Consumer Wearable Devices to Profile Postoperative Complications After Pediatric Appendectomy

Appendectomy is the most frequent emergency abdominal operation in children, who regularly present with complicated acute appendicitis and thus need targeted antibiotic therapy. While in other fields antibiotic stewardship (ABS) is becoming increasingly well established, these principles are not consistently followed in pediatric surgery. With this study, we aimed to analyze the effects of the implementation of an ABS-compliant SOP on the postoperative care of patients. We compared the quality of antibiotic therapy before and after the implementation of standard operating procedure (SOP) for the peri-/postoperative antibiotic treatment of appendicitis in 2020. Pediatric patients who had undergone appendectomy were evaluated based on an algorithm presenting recommended antibiotic therapy of appendicitis, according to the current literature and good clinical practice. 165 patients were evaluated before and 209 patients after the implementation of SOP. The mean number of cases in which antibiotic therapy was given postoperatively was 10.5% lower (p-value 0.036) and the median quality-of-treatment score increased by 31.2% (p<0.0001) after the implementation of the SOP. The median length of antibiotic treatment in cases of advanced-stage appendicitis was 2.0 days shorter (p=0.062). The rate of oral antibiotic treatment after discharge decreased by 25.6% (p<0.0001). We observed no significant effects on the median length of hospital stay or the complication rate. The implementation of SOP based on the principles of ABS positively influenced the quality of treatment after pediatric appendectomy. The algorithm developed in this study may help pediatric surgeons to improve their antimicrobial assessment.

Don't forget the dose: Improving computed tomography dosing for pediatric appendicitis