https://www.thieme-connect.com/products/ejournals/journal/10.1055/s-00024358

European Journal of Pediatric Surgery Reports, Bandipora (2026)

07/02/2026

🍼 Cotside in Critically Ill Neonates: Safe and Feasible?
performing emergency abdominal surgery directly in the NICU—is often done for our tiniest, sickest patients. But how does it compare to traditional theatre-based surgery?

A systematic review of 18 studies (418 cotside vs. 453 theatre laparotomies) sheds light:

✅ Mortality & adverse events were similar between cotside and theatre groups
✅ Cotside babies were smaller and more premature
✅ Risks of transfer—like tube dislodgement and hypothermia—highlight potential benefits of NICU-based surgery

⚠️ Challenges include limited space and disruption of Hashtag workflow
📊 Only 33% of studies reported formal guidelines for cotside surgery

Bottom line: Emergency cotside laparotomy is safe, feasible, and may reduce transfer-related risks, even in higher-risk neonates. More large-scale studies are needed to define clear indications.

Read the full article here: https://www.thieme-connect.com/products/ejournals/abstract/10.1055/a-2767-4700

European Paediatric Surgeons' Association
Iain Yardley Simran Sehdev Benjamin Blaise Geraint Lee Andrew Selman

03/02/2026

🧪 Urine dipstick in pediatric appendicitis—
Diagnosing in children remains challenging. In this prospective cohort of 311 children with suspected appendicitis:
🔹 62% were diagnosed with appendicitis
🔹 41% had complicated appendicitis
🔹 62% of children with appendicitis had abnormal urine results.

📌 While urine dipstick did not differentiate appendicitis vs no appendicitis, abnormal results were significantly associated with:
- Female s*x
- Retrocecal appendix position
- Complicated appendicitis

⚠️ Sensitivity and specificity for detecting complicated appendicitis were modest (AUC 0.62), but findings suggest urine dipstick may offer useful contextual information, not diagnostic certainty.

🩺 Take-home: Abnormal urine dipstick findings are common in pediatric appendicitis and may hint at severity or appendix position—interpret with caution, but don’t ignore them.

Read the whole article here: https://www.thieme-connect.com/products/ejournals/abstract/10.1055/a-2490-1156

31/01/2026

🔍🫁 Thoracoscopic (EA) Repair in Germany
Thoracoscopic EA repair offers clear long-term benefits 💎
…but how often is it actually used?
📊 Nationwide insurance claims analysis (2020–2024)

👶 149 EA reconstructions analyzed
🏥 Data from 6 insurance providers (~28.5 million people)

🔧 Surgical approach
🔹 Thoracoscopic repair: 7% (11 cases)
🔹 Open repair: 93%
🔹 ⭐ only in specialized centers

⏱️ Length of stay
📍 Open: 76 days
📍 Thoracoscopic: 79 days
❌ No significant difference

Treatment costs
💰 Open: 142,741 €
💰 Thoracoscopic: 150,238 €
❌ No significant difference

🚨 Thoracoscopic EA repair remains the exception

🏥 Centralization means access to expertise
⭐ Specialized centers may help extend benefits to more patients

🔗 https://www.thieme-connect.com/products/ejournals/abstract/10.1055/a-2676-2933

.wnmn

27/01/2026

What happens after a Kasai procedure may matter more than the Kasai itself.

For years, the conversation around biliary atresia has felt binary:
👉 Kasai first.
👉 Transplant later.

But what if there’s a meaningful middle ground?

Our recent review takes a systematic look at post-Kasai “salvage procedures” — interventions aimed not at replacing the liver, but at prolonging native liver survival (NLS) and optimizing transplant timing.

🔍 What was analyzed
• 15 studies | 794 patients
• Evidence levels IIc–IV
• Salvage strategies spanning infancy to adulthood

🛠️ Procedures reviewed
• Redo-Kasai for secondary bile flow failure
• Surgical & radiological interventions for bile lakes and recurrent cholangitis
• Shunt surgery & TIPS for portal hypertension

📌 Key takeaway
While transplantation remains inevitable for most patients, selected salvage procedures can buy meaningful time — particularly in patients with relatively stable liver function but specific, treatable complications.

💡 Bottom line
Post-Kasai management should not be passive.
Decision-making must be multidisciplinary, individualized, and dynamic — balancing complications, liver function, quality of life, and transplant timing.

📄 Madadi-Sanjani O, et al.
Optimizing Post-Kasai Management in Biliary Atresia: Balancing Native Liver Survival and Transplant Timing.
Eur J Pediatr Surg. 2025;35(4):261-268.

27/01/2026

What happens after Kasai matters more than we admit.

This review systematically explores post-Kasai “salvage procedures” in biliary atresia—interventions aimed at prolonging native liver survival (NLS) rather than moving straight to transplantation.

🔍 What’s inside the paper:
• 15 studies | 794 patients
• Evidence levels IIc–IV
• Salvage strategies across infancy to adulthood

🛠️ Procedures reviewed:
• Redo-Kasai for secondary bile flow failure
• Surgical & radiological interventions for bile lakes and recurrent cholangitis
• Shunt surgery & TIPS for portal hypertension

📌 Key message:
While transplantation remains inevitable for most patients, selected salvage procedures can buy meaningful time—especially in patients with stable liver function but specific complications.

💡 Decision-making must be multidisciplinary, individualized, and dynamic.

20/01/2026

“It’s not just the chest wall.”

Caption:
Pectus excavatum is often measured in millimeters —
but experienced in emotions.

In a cohort of 215 patients, over 55% reported psychosocial distress.

🔍 Using 3D optical surface imaging, we found:
• Greater depth and longer deformities were associated with higher distress
• Yet, morphology alone had only moderate predictive power

📉 AUC values ranged from 0.58–0.66, reminding us that:
👉 visible severity ≠ lived experience

🧠 Psychosocial distress is shaped by more than anatomy —
personality, neuropsychological factors, and social context matter.

📖 Published in European Journal of Pediatric Surgery
Janssen N, et al. Beyond the Chest Wall: Examining the Relationship between Morphological Features and Psychosocial Distress in Pectus Excavatum Patients. Eur J Pediatr Surg. 2025 Jun;35(3):247-254. https://www.thieme-connect.com/products/ejournals/abstract/10.1055/a-2507-8195

18/01/2026

🫁 Intrauterine thoracoamniotic shunting for CPAM – what happens after birth?

This study reports postnatal outcomes after Somatex™ placement for suspected ( ).

🔹 12 patients, multicenter experience
🔹 All patients underwent early surgery (muscle-sparing thoracotomy), ages 1–42 days
🔹 11/12 survivors at median follow-up of 19 months

📌 Take-home message:
While Somatex™ shunts may offer technical prenatal advantages, postnatal complications are frequent, with a high risk of pneumothorax and a strong likelihood of early surgical intervention. Neonatologists and pediatric surgeons should be prepared.

Read the whole article here: https://www.thieme-connect.de/products/ejournals/abstract/10.1055/a-2631-4152

12/01/2026

🚨 What if one intraoperative decision could cut opioid use by more than HALF after the Nuss procedure?

A new observational study in European Journal of Pediatric Surgery (2025) puts intercostal nerve cryoablation (INC) in the spotlight—and the results are hard to ignore 👇

🔹 Shorter hospital stays
Patients receiving INC went home faster (2.9 days) compared with thoracic epidurals (4.7 days) and PCA (3.7 days).

🔹 Dramatically lower opioid exposure
INC patients used 50 MME, versus 117 MME with epidurals and 172 MME with PCA.

🔹 Pain control without the opioid burden
Pain scores were comparable to epidurals—but opioid consumption was significantly lower than all other strategies.

🔹 Higher upfront cost ≠ higher total cost
Despite increased initial expense, INC did not lead to the highest total hospital charges, suggesting real-world cost-effectiveness.

Link: Santana L, Abels M, Driggers J, Carvalho N. Intercostal Nerve Cryoablation as an Effective Pain Management Strategy in the Nuss Procedure: Reducing Opioid Use and Hospital Stay. Eur J Pediatr Surg. 2025 Jun;35(3):240-246.
https://www.thieme-connect.com/products/ejournals/abstract/10.1055/a-2490-1091

💡 Takeaway:
In an era focused on enhanced recovery and opioid stewardship, intercostal nerve cryoablation may represent a meaningful shift in perioperative pain management for the Nuss procedure.

📌 Larger randomized trials are still needed—but this data makes a compelling case to rethink our default analgesic strategies.

11/01/2026

🔁 Redo surgery after hypospadias repair: what really makes the difference?
Posturethroplasty complications remain common — affecting 15–55% of patients — and redo surgery is often technically challenging due to scarring and poor tissue quality.
📊 In this single-surgeon retrospective study (n=217 between 2003–2019), soft tissue interposition using
🔹 Scrotal fat or
🔹 Tunica vaginalis flap
was evaluated during redo urethroplasty for complex complications (stenosis, diverticulum, dehiscence, persistent curvature).
💡 Key outcomes:
Successful reinforcement of the neourethra in all cases.
No recurrent complications over a mean 5.6-year follow-up.
Excellent cosmetic and functional outcomes, including standing urination
Safe tissue harvest, even in heavily scarred surgical fields
🧠 Take-home message:
Unlike dartos fascia alone, soft tissue interposition actively improves tissue thickness and perfusion, offering a powerful strategy for difficult redo hypospadias surgery.
.eu

15/12/2025

What if “success” in chest wall surgery is subjective?

Our new study in European Journal of Pediatric Surgery shows that evaluating pectus carinatum outcomes is far less objective than we think:

• Surgeons disagree with each other
• Peers disagree with surgeons
• Even individuals don’t always agree with themselves
• Scars matter more to patients than to surgeons
• Age and treatment duration? No clear impact on results
• Ravitch looks worse pre-op — but delivers better aesthetics

Conclusion:
If outcomes depend on who’s looking… we need better tools.

👉 3D surface scanning could help bring objectivity into decision-making and treatment endpoints.

📄 van Braak H, de Beer SA, Zwaveling S, Oomen MWN, van Heurn LWE, de Jong JR. Evaluating Inter- and Intraobserver Agreement on Pectus Carinatum Severity and Treatment Outcomes: A Comparison of Subjective and Objective Assessment Methods. Eur J Pediatr Surg. 2025 Jun;35(3):232-239.

13/12/2025

🔍 Rare case | Pediatric Surgery | Robotic Innovation

Superior mesenteric artery (SMA) syndrome is an uncommon cause of proximal in children.
This French team reports a rare, acute, idiopathic SMA syndrome in a 14.5-year-old girl, initially managed conservatively but ultimately requiring surgery after persistent symptoms.

🤖 A robotic-assisted duodenojejunostomy, preserving the fourth portion of the duodenum, led to:
✔️ Immediate symptom relief
✔️ Discharge on postoperative day 4
✔️ Uneventful long-term follow-up at 7 years

Read the whole article here: https://www.thieme-connect.com/products/ejournals/abstract/10.1055/a-2662-2517

An excellent example of how minimally invasive and robotic approaches can safely expand into rare pediatric pathologies with durable outcomes. 👏

08/12/2025

NEC isn’t over when the acute phase ends.

Our new paper in European Journal of Pediatric Surgery shows that 19% of conservatively treated NEC survivors develop intestinal strictures — often silently and weeks later.

In our cohort:
• Median diagnosis ~38 days after NEC
• 25% were completely asymptomatic
• Most strictures were colonic
• Deferred surgery = safer resections + excellent outcomes
• No mortality

Take-home message:
Conservative NEC management saves lives — but surveillance saves intestines.

Mena R, Guillén G, Lopez-Fernandez S, Martos Rodríguez M, Ruiz CW, Montaner-Ramon A, López M, Molino JA. Conservative Management of Necrotizing Enterocolitis in Newborns: Incidence and Management of Intestinal Strictures. Eur J Pediatr Surg. 2025 Jun;35(3):224-231.
https://www.thieme-connect.com/products/ejournals/abstract/10.1055/a-2426-9723

European Journal of Pediatric Surgery Reports

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