Abstract Background One of the most frequent pediatric surgical procedures carried out globally is tonsillectomy. Even though tonsillectomy is one of the most popular otorhinolaryngology procedures, none of the routinely utilized techniques are now thought to be the best. Objective To evaluate the differences between surgical dissection, bipolar diathermy, and coblation for tonsillectomy in terms of postoperative discomfort, surgical blood loss, and the frequency of complications. Methods A meta-analysis and systematic review that complies with the guidelines set out by the Meta-analysis Of Observational Studies in Epidemiology (MOOSE) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statements. In order to find research that compares the methods of bipolar diathermy, cold dissection, and coblation, guidelines and an electronic search of the literature were carried out. Results According to this study, the least risk of main bleeding was associated with bipolar diathermy tonsillectomy, which was followed by coblation and cold dissection tonsillectomy; however, the differences were not statistically significant. The bipolar diathermy approach had the lowest risk, while the coblation technique had the highest secondary bleeding risk, followed by cold dissection. The difference did not achieve statistical significance. In terms of blood loss and operating time, coblation tonsillectomy was the most effective method; the difference between it and cold dissection was large, while the difference between it and bipolar diathermy was negligible. The majority of research demonstrated that the coblation approach was superior to cold dissection and bipolar diathermy in terms of postoperative pain, but we were unable to pool the data since the studies used various postoperative pain measurements. However, the majority of studies found no significant difference between bipolar diathermy and cold dissection. Conclusion Although the difference did not achieve statistical significance, the bipolar diathermy procedure for tonsillectomy was thought to be the superior technique overall in terms of main and secondary hemorrhage outcomes. When compared to the cold dissection approach, the coblation process for tonsillectomy was shown to be the optimum method for intraoperative blood loss; however, the difference between coblation and bipolar diathermy was not statistically significant. The coblation approach was also thought to be the best in terms of operating time, with a substantial difference when compared directly to cold therapy and a negligible difference when compared to bipolar diathermy. According to a comprehensive evaluation of 21 research studies, most studies comparing coblation with all other techniques reveal that it causes less postoperative discomfort than cold dissection and bipolar diathermy. Additionally, there was no discernible difference in postoperative discomfort across trials that examined cold dissection and bipolar diathermy.

Acute appendicitis and Familial Mediterranean Fever attacks are among the leading causes of acute abdominal pain in children and often present with overlapping clinical features. This study aimed to evaluate the diagnostic utility of the systemic immune-inflammation index in differentiating acute appendicitis from Familial Mediterranean Fever attacks and to assess whether combining this index with other hematological parameters improves diagnostic discrimination. A retrospective diagnostic accuracy study was conducted at a tertiary pediatric surgery center between January 2019 and December 2024. Pediatric patients aged 1 to 18 years with histopathologically confirmed acute appendicitis or clinically defined Familial Mediterranean Fever attacks were included. Demographic characteristics and complete blood count parameters were recorded. The systemic immune-inflammation index was calculated using neutrophil, platelet, and lymphocyte counts. The neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio were also calculated. Group comparisons were performed using nonparametric tests. Diagnostic performance was evaluated using receiver operating characteristic curve analysis, including a combined hematological model. A total of 90 patients were included, comprising 44 with acute appendicitis and 46 with Familial Mediterranean Fever attacks. Age and sex distributions were comparable between groups. Median systemic immune-inflammation index values were significantly higher in patients with acute appendicitis than in those with Familial Mediterranean Fever attacks. The neutrophil-to-lymphocyte ratio was also significantly higher in the acute appendicitis group, whereas the platelet-to-lymphocyte ratio did not differ significantly between groups. The combined hematological model demonstrated improved discriminative performance compared with the systemic immune-inflammation index alone. The systemic immune-inflammation index is significantly elevated in pediatric patients with acute appendicitis compared with those experiencing Familial Mediterranean Fever attacks and shows good diagnostic performance in this differential setting. The combined use of hematological indices may further enhance diagnostic discrimination and serve as a supportive tool in the evaluation of children presenting with acute abdominal pain.

Abstract Background: Antibiotic prophylaxis in paediatric cardiac surgery is essential for preventing post-operative infections, which are particularly dangerous due to the patients’ compromised immune systems. These measures aim to reduce the risk of infections such as surgical site infections (SSIs) and mediastinitis, contributing to better patient outcomes. Studies in this area focus on evaluating current practices, adherence to guidelines and the impact of antibiotic prophylaxis on these patients. Aim: The aim of this study was to assess antibiotic prophylaxis prescribing practices in paediatric cardiac surgery, focussing on current practices, adherence to guidelines and clinical implications, for example, increased risk of infection, prolonged hospital stays or potentially affecting cardiac function. Methodology: A systematic review was conducted using PubMed, Web of Science, ScienceDirect, Google Scholar and Cochrane Library databases up to December 2023. Out of 650 articles, 42 studies met the inclusion criteria. The studies included cohort, cross-sectional, prospective, systematic reviews, retrospective and meta-analysis studies, with quality assessed using the Risk of Bias in Non-randomized Studies-of Interventions tool. Results: The review included 42 studies, highlighting the importance of administering prophylactic antibiotics, particularly vancomycin and cefazolin, in paediatric cardiac surgery. Limiting antibiotic duration to 24–48 h postoperatively did not increase infection risk when guidelines were followed. The appropriate use of prophylactic antibiotics significantly reduced the risk of SSIs and bloodstream infections. Conclusion: Prophylactic antibiotics play a key role in reducing post-operative infections in paediatric cardiac surgery. Adherence to guidelines, particularly short-term protocols, is essential for minimising resistance and optimising patient care. Future research should focus on refining these protocols and evaluating their clinical impact.

Implementation and Evaluation of a Protocol for the Management of Type C Tracheoesophageal Fistula.

The primary objective was to evaluate the incidence and risk factors for Meniscal Ramp Lesion (MRL), and secondarily, the rate of clinical failure, defined as the need for revision surgery for MRL at a minimum follow-up of 2 years. A retrospective analysis of prospectively collected data was conducted on patients operated in our department, a tertiary referral center for pediatric knee surgery. All patients under the age of 18 who underwent primary or revision anterior cruciate ligament reconstruction (ACLR) between January 1, 2015, and December 31, 2018, were considered. Patients with congenital absence of the anterior cruciate ligament (ACL) or with <2 years of follow-up were excluded. This study involved 2 overlapping patient cohorts. The first, the overall ACLR cohort, included all pediatric patients who underwent ACLR with or without associated MRL. The second, the MRL cohort, included patients diagnosed intraoperatively with an MRL during ACLR within the same study period. In the overall ACLR cohort, the primary analysis evaluated the incidence of MRL and compared patients with and without MRL to identify potential risk factors. In the MRL cohort, a secondary analysis assessed the rate of subsequent surgery involving the posterior segment of the medial meniscus. In the overall ACLR cohort (n=216), the incidence of MRL was 25.9% (56 ramp lesions identified among 216 procedures). Initial knee trauma sustained during contact sports was identified as a risk factor for the development of MRL. A total of 56 patients were diagnosed with an MRL intraoperatively, of whom 3 were lost to follow-up, leaving 53 patients in the MRL cohort. As a result, 53 patients were included in the secondary analysis. Mean follow-up time was 55.5±20.4 months (range: 24.0 to 107.0mo). Twelve patients (22.6%) were reoperated on the posterior segment of the medial meniscus, of which 5 patients (9.4%) had partial medial meniscectomy. MRL have a significant prevalence during ACLR in children and adolescent patients, and participation in pivot contact sport appears to be a significant risk factor of developing MRL in this specific population. The overall secondary surgery rate on the medial meniscus after MRL repair was 22.6% in this cohort. Level IV-retrospective case series.

A bstract Purpose: This study aims to identify the groups of surgeons most influential in the field of pediatric spinal deformity surgery and to assess their training experiences and contributions to the literature. This includes analyzing fellowship training positions, authorship in leading journals, and surgical caseloads during residency and fellowship. Materials and Methods: We gathered data on fellowship training in orthopedic spine surgery, pediatric orthopedic surgery, complex spine neurosurgery, and pediatric neurosurgery from various directories and matching programs. We screened journals Spine , Journal of Neurosurgery (JNS) , JNS Pediatrics , Journal of Bone and Joint Surgery (JBJS) , Spinal Deformity , and the Journal of Pediatric Orthopedics for articles related to pediatric spinal deformity surgery published between May 2019 and July 2021. We analyzed authorship lists for the authors’ training backgrounds. Additionally, we sought data on pediatric spinal deformity cases from insurance companies and large-scale healthcare data initiatives. Results: Orthopedic spine surgery fellowships offer the most positions with an 82.2% average fill rate, followed by pediatric orthopedic surgery fellowships with a 75.4% fill rate. Neurosurgical spine fellowships and pediatric neurosurgery fellowships had fewer positions and lower fill rates. Analysis of 4068 articles showed that pediatric orthopedic surgeons published the most on pediatric spinal deformity, with the journal Spine Deformity leading in relevant publications. Overall, orthopedic surgeons dominated the literature and fellowship positions. Conclusion: Orthopedic surgeons have the most fellowship opportunities and are the primary authors in the field of pediatric spinal deformity surgery. The study highlights the need for targeted fellowship training and institutional support to improve expertise in pediatric spinal deformity surgery. Embracing collaboration between orthopedic and neurosurgeons is essential to advance the field and ensure high-quality care for pediatric patients.

Dexamethasone as an Adjuvant to Erector Spinae Plane Block Is Associated With Improved Neuromonitoring Parameters and Analgesia in Pediatric Spine Surgery.

Objective: Infants and children undergoing cardiac surgery are one of the highest-risk groups for thrombosis and its sequelae. We sought to define the current rate of and risk factors for postoperative central venous catheter (CVC)-associated deep vein thrombosis (CA-DVT) using the Pediatric Cardiac Critical Care Consortium (PC4) dataset. Design: Retrospective review of PC4 database from February 2019 to February 2022. Patients: Children <18 years of age admitted for a surgical encounter who had a CVC placed. Results: Included were 33,491 patient encounters, of whom 37.6% (12,582/33,491) were infants (<12 months of age). The overall CA-DVT rate was 2.5% (844/33,491), which varied widely among centers (0-11%). Multivariable analysis showed increased risk of CA-DVT with increasing Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery (STAT) category (STAT 2 HR 1.8, CI [1.26-2.65]; STAT 3 HR 2.2, CI [1.56-3.39]; STAT 4 HR 2.1, CI [1.55-2.93]; STAT 5 HR 2.5, CI [1.69-3.82]), (P < .001 for all), low cardiac output syndrome (HR 1.5, CI [1.25-1.91]), P < .001, and postoperative arrhythmia (HR 1.23, CI [1.03-1.47]) P = .024). Patients with CA-DVT were less likely to have an internal jugular vein catheter or intracardiac line and more likely to have an umbilical venous catheter, femoral vein CVC, peripherally inserted CVC, and/or multiple CVCs. Conclusions: CA-DVT remains an important postoperative complication after pediatric cardiac surgery, with greatest risk of occurrence in the younger, smaller, more surgically complex by STAT category, and hemodynamically vulnerable patients. These risk factors must be considered when developing paradigms for CVC placement, thromboprophylaxis, and diagnosis/treatment of CA-DVT in the future.

Postoperative nausea and vomiting (PONV) remain a significant clinical challenge in pediatric squint surgeries, with potential serious complications. This randomized controlled trial aimed to evaluate the efficacy of preoperative ondansetron lozenges in preventing PONV among pediatric patients undergoing squint surgeries. Eighty pediatric patients (aged 4-15 years) undergoing squint surgeries were randomly assigned to two equal groups: Group S received 4 mg ondansetron lozenge for two hours preoperatively, while Group C served as the control. The ondansetron lozenge group demonstrated significantly lower PONV incidence (22.5% vs. 52.5%, P=0.006, with relative risk (RR) of 0.43 (95% CI 0.22:0.82), with reduced severity across 0-2-, 2-12-, and 12-24-hour intervals. Time to onset of emesis was prolonged (269.11±214.87 vs. 115.24±65.68, P=0.005), and the oculocardiac reflex incidence was reduced (12.5% vs. 37.5%, P=0.018). Parental satisfaction was significantly higher in the Ondansetron group (8.95±1.38 vs. 7.83±1.99, P=0.004). Preoperative ondansetron lozenges effectively reduce PONV incidence, severity, and complications in pediatric squint surgery, suggesting a promising prophylactic intervention.

Accurate localization and lateralization of language areas are essential in the preoperative evaluation of children with drug-resistant epilepsy (DRE) to minimize postoperative neurological deficits. Traditional invasive methods such as the Wada test and electrocortical stimulation remain gold standards but present significant limitations, especially in pediatric populations. Noninvasive techniques leveraging blood oxygen level-dependent (BOLD) signal fluctuations, such as functional magnetic resonance imaging (fMRI) and functional near-infrared spectroscopy (fNIRS), offer interesting and convenient alternatives, but clinical evidence is limited. This narrative review aims to synthesize current knowledge on noninvasive BOLD-based imaging techniques, specifically task-based and resting-state fMRI and fNIRS, for language mapping in children with epilepsy. A comprehensive literature search was conducted using PubMed, focusing on studies employing fMRI and fNIRS for language mapping in pediatric epilepsy and cross-referencing. Special consideration was given to higher-impact studies, frequently cited publications, and works by leading experts in the field. Task-based fMRI remains the clinical standard for language mapping but is frequently compromised by poor task compliance in children. Resting-state fMRI provides a task-free alternative with high sensitivity but often yields broader, bilateral networks that complicate precise lateralization. fNIRS offers a portable and child-friendly option with excellent tolerability but is limited by its spatial resolution and depth penetration. Further standardization of the various data-processing methods used for these modalities is required. BOLD-based noninvasive imaging techniques represent promising advancements in the preoperative evaluation of pediatric epilepsy surgery candidates. Future multicenter studies and the development of pediatric-specific tools are essential to establish standardized clinical use.

Communication skills are essential non-technical competencies in pediatric surgery, yet formal training programs remain limited and inconsistent. This perspective article examines the critical role of communication across pediatric surgical subspecialties and proposes frameworks for implementing structured communication training in residency programs. We performed a narrative review of published literature on communication skills in pediatric surgery and synthesized existing communication frameworks applicable to surgical training. Expert perspectives were gathered from an international group of pediatric surgeons representing diverse subspecialties including prenatal counseling, neonatal surgery, pediatric urology, and pediatric surgical oncology. We identify specific communication challenges unique to pediatric surgery, including prenatal counseling, neonatal intensive care discussions, sensitive urological conditions, and pediatric oncology. Existing frameworks such as SPIKES for delivering bad news and EMPATHY for non-verbal communication provide evidence-based tools adaptable to pediatric contexts. Current training approaches remain largely informal and mentor-dependent, with significant variability between programs. Pediatric surgery training programs should integrate structured communication curricula with defined learning objectives, simulation-based practice, and regular feedback mechanisms to prepare trainees for the unique communication demands of caring for children and their families.

Nurses as Safety Leaders in Pediatric Surgery

Background: Posterior Urethral Valve (PUV) is a congenital anomaly and the leading cause of chronic renal disease in boys. Several factors, such as age at presentation, high nadir serum creatinine, severe Vesicoureteric Reflux (VUR) recurrent UTIs, renal dysplasia, hypertension, albuminuria, growth failure, and primary therapy choice, are associated with poor longterm outcomes. However, studies on PUV in Bangladesh are limited. This study aimed to find out the factors affecting outcome of Posterior Urethral Valves (PUV) in children. Materials and methods: This prospective observational study was conducted at the Department of Pediatric Surgery, Chittagong Medical College Hospital (CMCH) Chattogram, Bangladesh, from April 2023 to September 2024. A total of 27 Children aged between 1 day to 12 years having posterior urethral valve were included. Age, type of valve, type of surgery, operating time, symptoms, presence of VUR, UTIs, Serum creatinine, anterior and posterior urethral ratio in micturating cystourethrogram were recorded and risk factors for adverse outcome and mortality were analysed. Results: The mean age of participants was 33.65±36.30 months, with 63% being children, 29.6% infants and 7.4% newborns. Type I posterior urethral valves were found in 88.9%, while 11.1% had Type III. Surgery types included valve fulguration (55.6%) and resection (44.4%) with a median operation duration of 22 minutes. Post-operative improvements were significant: dribbling of urine reduced from 85.2% to 20.8% (p &lt; 0.001) recurrent UTIs from 59.3% to 12.5% (p = 0.001), and VUR from 51.9% to 11.1% (p = 0.008). Serum creatinine decreased from 0.9 mg/dL to 0.5 mg/dL (p &lt; 0.001), and the posterior-to- anterior urethral ratio improved from 2.50 to 2.0 (p &lt; 0.001). Overall, 88.9% of patients showed improvement, though 11.1% (n=3) died, with no significant factors associated with mortality. There were no significant differences in outcomes between the two surgical approaches (p&gt;0.05). Conclusion: Surgical intervention in posterior urethral valves resulted in significant improvements in urinary symptoms and renal function, with no single factor linked to poor outcomes, highlighting the need for comprehensive management. JCMCTA 2025 ; 36 (2) : 13-18

Who's training tomorrow's pediatric surgeons? A global review of pediatric surgery postgraduate training programs in low- and middle-income countries.

The Space Child Neonatal Trainer (SCNT), a Novel 3D-Printed Simulator for Neonatal Laparoscopy.

Women remain underrepresented in surgery, with dropouts occurring at every stage of training, and women representing under 20% of consultant surgeons. This study explored the relationship between sex, applications for national selection for Higher Specialty Training (ST3), and receipt of an offer. This retrospective longitudinal cohort study used data from the UK Medical Education Database. The study population included 1,960 doctors eligible to progress to higher training between 2014 and 2019. The primary outcomes of interest were application for and offer of an ST3 post. Logistic regression analysis was conducted after adjusting for confounders using a directed acyclic graph. Within the cohort, paediatrics and ear, nose and throat (ENT) had the highest proportion of female applicants (50%), followed by plastic and reconstructive surgery, general surgery (including vascular surgery applicants), urology, and trauma and orthopaedics, with the lowest (22%). Significant (p<0.01) associations were identified between being female and applying for ST3 general, paediatric, and plastic surgery, while applications to orthopaedics favoured men. No association was found between sex and ENT or urology applications. For ST3 offers, significant sex associations favouring women were identified for general surgery and urology. No associations were observed for the other specialties or the cohort as a whole. Differences exist in the proportion of women applying for ST3 across surgical specialties, with women more likely to obtain a post in general and urological surgery. Recognising these disparities and promoting efforts to cultivate a more diverse and inclusive workforce remains critical.

The diagnostic evaluation, antibiotic treatment, and type and timing of surgical intervention for pediatric patients with complicated pneumonia is not standardized and may lead to increased length of stay, more radiation exposure, and higher cost. A multidisciplinary team at our institution developed a clinical practice algorithm for pediatric complicated pneumonia to align and optimize care. The aim of this study was to examine the effectiveness of this algorithm in improving overall patient care while minimizing changes in physician workload. A clinical practice algorithm for pediatric complicated pneumonia was created and implemented at our institution in February 2018 based on expert opinion and literature review, providing guidance on options for imaging, antibiotics, and interventions based on clinical characteristics. Retrospective data were collected for 31 months before and after implementation excluding a six-month transition period. Forty patients were identified (pre-protocol implementation=25, post-protocol implementation=15). There were no differences in age, race/ethnicity, and size of pleural effusion between groups. Following protocol implementation, the time to pediatric surgery consult, number of consulting services, ICU admission, number and types of radiologic studies, and readmission rates remained unchanged. Protocol implementation was associated with a significant decrease in the need for repeat procedures (32% vs. 0%, p=0.02). There was a trend toward decreased length of stay (10.0 vs. 9.0 days, p=0.31). Implementation of our institutional protocol did not increase utilized services and was associated with a decrease in the need for additional procedures after treatment failure. Larger prospective studies may help optimize the approach to complicated pneumonia.

Pediatric Breast Pathologies: 5-Year Experience and Proposal for a Risk-Based Management Algorithm.

A BSTRACT Background: Hepatoblastoma (HB) is the most common malignant liver tumor in children under 3 years of age. Surgical resection, combined with neoadjuvant chemotherapy, is essential for optimal outcomes. We present a 10-year institutional experience focusing on technical tips for liver resection in children with HB. Materials and Methods: A retrospective review of pediatric HB patients who underwent liver resection at a tertiary care Children’s hospital from January 2014 to June 2024 was conducted. All patients received preoperative PLADO (cisplatin + doxorubicin) chemotherapy per SIOPEL guidelines. Surgical resection type, outcomes, recurrence, and survival data were analyzed. Technical considerations for standard and complex hepatectomies were described. Results: Out of 26 children with HB (mean age 15 months), 19 (73%) underwent liver resection. Right hepatectomy was the most common (42%), followed by left hepatectomy and segmentectomies. No patient developed postoperative liver failure. Two patients (10.5%) experienced recurrence; one was salvaged successfully. The disease-free survival rate was 89.5%, and overall survival at 3 and 5 years was 81.8%. Surgical margins were negative in all patients. Technical tips adopted to improve visualization, minimize blood loss, avoid bile duct injury, and vascular inflow and outflow control are detailed. Conclusion: Liver resection with adjuvant chemotherapy (PLADO and SIOPEL) results in favorable outcome in children with HB. Understanding the anatomical nuances and meticulous surgical technique improves outcomes and minimizes complications.

Assessing Language Bias in Pediatric Surgical Systematic Reviews: A Meta-epidemiological Study.