Latest Pediatric Surgery research

Top 10 this week

Week of 1 November 2026

1. 1

   Telemedicine Consultation for Pediatric Trauma in Community ED Visits and Parent Experience of Care: A Stepped-Wedge Cluster-Randomized Clinical Trial

   JAMA network open · Q1 journal · RCT · Evidence level 1 (High) · 1 October 2026

   In a randomized trial across 10 community emergency departments, telemedicine consultations with pediatric trauma specialists did not significantly change parents' overall care ratings or distress, or how often children were transferred. Parents rated discharge and transfer experiences more favorably with telemedicine, but that was a subscale finding; whether better transition communication translates into meaningful benefits remains unknown.

2. 2

   Exploring Outcomes for Infants with Surgical Necrotising Enterocolitis: A Systematic Review of Surgical Interventions and Patient Characteristics Associated with Mortality

   Journal of pediatric surgery · Q1 journal · SR/MA of RCTs · Evidence level 1 (High) · 26 October 2026

   Across 29 studies of infants operated on for necrotising enterocolitis or intestinal perforation, pooled results linked peritoneal drainage with higher mortality than laparotomy. The comparison is uncertain because studies varied widely and sicker infants may have been more likely to receive drainage; the review found no clear timing effect, while lower gestational age and birthweight consistently predicted poorer outcomes.

3. 3

   Comparison of Surgical Approaches for Hirschsprung's Disease: A Network Meta-Analysis

   Journal of pediatric surgery · Q1 journal · SR of cohorts · Evidence level 2 (Moderate) · 28 October 2026

   A network meta-analysis of 28 studies and 1,911 patients found robotic surgery had the lowest blood loss, transanal Swenson had the shortest operating time, and laparoscopic Swenson ranked best for length of stay. Postoperative enterocolitis, constipation, and incontinence did not differ significantly, suggesting technique choice chiefly affects perioperative efficiency; direct comparisons and longer-term evidence remain important.

4. 4

   Association Between Methemoglobin Levels and Necrotizing Enterocolitis in Preterm Infants: A Retrospective Cohort Study

   Children (Basel, Switzerland) · Q2 journal · Prospective cohort · Evidence level 2 (Moderate) · 30 September 2026

   In a single-center study of 291 preterm infants, each doubling of methemoglobin was associated with higher odds of necrotizing enterocolitis after adjustment for sex and gestational age. But the test distinguished infants with and without NEC poorly, did not separate disease stages, and was not significantly linked to death after adjustment; it is not ready for diagnosis or prediction.

5. 5

   Digital stool color screening for biliary atresia-Comparing a deep learning approach to the analogue stool color card

   Journal of pediatric gastroenterology and nutrition · Q1 journal · Case-control · Evidence level 3 (Low) · 29 October 2026

   Biliary atresia screening could support earlier Kasai pathway diagnosis

6. 6

   Derivation of a clinical-radiological scoring system to predict foreign body aspiration in children

   World journal of clinical pediatrics · Q1 journal · Cohort · Evidence level 3 (Low) · 9 December 2026

   In a retrospective review of 274 bronchoscopies, a score combining seven clinical and chest X-ray findings predicted foreign-body aspiration with 83% sensitivity and 63% specificity at a cutoff of 7. Aspiration probability ranged from 24% for scores of 6 or less to 85% for scores of 10 or higher. The score needs validation before it can guide bronchoscopy decisions.

7. 7

   Long-term outcomes and direct surgical cost of robot-assisted versus laparoscopic pyeloplasty in children

   Journal of pediatric urology · Q2 journal · Cohort · Evidence level 3 (Low) · 23 October 2026

   In 54 operated kidneys followed for a median of 9.3 years, robot-assisted surgery cost $3,209 more per case than laparoscopy, with no statistically detected advantage in success, imaging response or parent-reported quality of life. Robot-assisted cases had longer operations and stays and more mild complications. Because this was a small retrospective study, it cannot establish equivalence; the cost-benefit balance may depend on local robotic use and expertise.

8. 8

   Evaluation and Management of Adolescent Breast Masses: A Systematic Review From the American Pediatric Surgical Association Outcomes and Evidence-Based Practice Committee

   The Journal of surgical research · Q1 journal · SR of cohorts · Evidence level 2 (Moderate) · 30 October 2026

   Only 11 studies met review criteria, and they offer limited guidance on when to biopsy or how often to monitor breast masses in adolescents. Ultrasound was the main imaging test, while adult BI-RADS categories may not reliably assess cancer risk in this low-risk population. Better evidence is needed to define surveillance and risk assessment.

9. 9

   Essential fatty acid status and cognition in children with chronic intestinal failure

   Journal of pediatric gastroenterology and nutrition · Q1 journal · Prospective cohort · Evidence level 2 (Moderate) · 26 October 2026

   In this small study, 5 of 17 children receiving home parenteral nutrition met criteria for essential fatty acid deficiency. Those children scored lower in working memory and cognitive processing than peers without deficiency, but the cross-sectional study cannot show that deficiency caused the differences. Larger prospective studies are needed to confirm the link and guide screening and lipid provision.

10. 10

    Factors Associated with Complications in Pediatric Foreign Body Ingestion: A Retrospective Cohort Study of 754 Children

    Children (Basel, Switzerland) · Q2 journal · Prospective cohort · Evidence level 2 (Moderate) · 12 October 2026

    Complications occurred in 29 of 754 children (3.8%), including nine with major complications. In adjusted analysis, throat or esophageal location was linked to about 13-fold higher odds of complications; vomiting and sharp objects were also associated with higher odds. These findings could help identify children needing closer evaluation, but require prospective validation before guiding clinical decisions.

Paper of the day, last two weeks

• Outcomes of laparoscopic versus open appendectomy in children with complex appendicitis without appendiceal mass and/or abscess: a subgroup analysis from a multicentre prospective cohort study (CAPP study)

  Surgical endoscopy · Q1 journal · Prospective cohort · Evidence level 2 (Moderate) · 6 November 2026

  In a prospective study of 989 children with complex appendicitis without an abscess or mass, complications within three months occurred in 14.4% after laparoscopic surgery and 15.2% after open surgery, with no significant difference. Other measured outcomes were similar, while open surgery cost less; however, only 46 children had open surgery, limiting the comparison.

• Managing Small Intestinal Bacterial Overgrowth in Pediatric Short Bowel Syndrome: A Consensus Statement

  JAMA network open · Q1 journal · Guideline · Evidence level 1 (High) · 2 November 2026

  An international expert panel agreed on 21 recommendations for diagnosing and managing bacterial overgrowth in children with short bowel syndrome, including metronidazole as the preferred first antibiotic and cycling antibiotics for selected patients with recurrent, responsive infections. The guidance aims to reduce practice variation, but it is expert consensus built on limited pediatric evidence, not proof that the recommendations improve outcomes.

• Delayed appendectomy as part of a nonoperative treatment strategy does not increase postoperative complications in children with simple appendicitis-A secondary analysis from a randomized controlled trial (Antibiotics Versus Primary Appendectomy in Children trial)

  Surgery · Q1 journal · RCT · Evidence level 1 (High) · 9 October 2026

  In children with simple appendicitis, complications occurred in 4 of 46 who had delayed surgery after initial nonoperative treatment, compared with 11 of 143 who had surgery first. The secondary analysis found no significant difference in complication rates or severity, but the small delayed-surgery group leaves uncertainty about how closely outcomes compare.

• A Single Daily Dose of Metronidazole is Non-Inferior to Three Daily Doses in Children With Perforated Appendicitis: A Real-World Randomized Trial

  World journal of surgery · Q1 journal · RCT · Evidence level 1 (High) · 2 November 2026

  In a randomized trial of 201 children who had open surgery, once-daily metronidazole with gentamicin was non-inferior to three daily doses for infection outcomes and treatment success; no severe antibiotic-related adverse events were recorded. The simpler regimen lowered metronidazole costs by an average of $1.71 per child, but the trial did not establish whether results apply beyond this setting.

• Cholecystectomy at the index admission decreases 60-day readmission rates in pediatric gallstone pancreatitis

  Surgical endoscopy · Q1 journal · Unclassified · Evidence level 5 (Expert Opinion) · 30 October 2026

  In a nationwide database study of 13,517 children, readmission within 60 days was 4.4% after gallbladder removal during the initial admission, versus 24.8% with no intervention. ERCP was also associated with fewer readmissions when surgery was not performed, but the observational findings cannot prove that either procedure caused the reduction.

• Effect of antibiotic prophylaxis on surgical site infection after elective laparoscopic cholecystectomy in low-risk pediatric patients

  Journal of pediatric surgery · Q1 journal · Unclassified · Evidence level 5 (Expert Opinion) · 29 October 2026

  In 5,004 adolescents undergoing elective laparoscopic gallbladder removal, surgical infections were similarly rare with and without preventive antibiotics: 0.3% versus 0.4%. Antibiotic use was associated with about $2,109 in additional charges per patient, with no difference in readmissions or interventions; the database study supports current guidance against routine use in this low-risk group.

• Noninferiority of Implementing a Telephone Follow-Up Based Pathway After Uncomplicated Pediatric Appendectomy: A Retrospective Cohort Study

  Journal of pediatric surgery · Q1 journal · Retrospective cohort · Evidence level 3 (Low) · 29 October 2026

  In this single-center study, related 30-day emergency visits occurred in 3.4% of children after the telephone pathway was introduced, versus 4.3% before; the difference met the prespecified standard for noninferiority. Telephone follow-up rose to 65.7%, and overall follow-up completion improved, but the retrospective design and single-center setting limit how widely the results can be applied.

• Early echocardiographic hemodynamic phenotypes and clinical outcomes in congenital diaphragmatic hernia

  European journal of pediatrics · Q1 journal · Retrospective cohort · Evidence level 3 (Low) · 28 October 2026

  In this 66-infant cohort, ECMO or death occurred in 65% of infants with left-ventricle-involved pulmonary hypertension, versus 27% with right-ventricle-predominant pulmonary hypertension and none with no or mild pulmonary hypertension. Greater phenotype severity remained associated with poor outcomes after accounting for prenatal lung size, but the left- versus right-ventricle comparison was no longer significant after adjustment, so added prognostic value needs validation.

• Recurrence following congenital diaphragmatic hernia repair: a twelve-year single-center review

  Journal of pediatric surgery · Q1 journal · Retrospective cohort · Evidence level 3 (Low) · 26 October 2026

  In this 489-patient review, recurrence occurred in 7% overall: 3.5% after primary repair, 11.2% after patch repair and 5.4% after muscle flap repair. The patch and muscle flap rates did not differ significantly, but muscle flap patients had shorter follow-up, limiting comparison; longer observation is needed to clarify whether recurrence risks truly differ.

• Evidence-based clinical practice guidelines for pediatric hepatoblastoma: a systematic review and expert recommendations from Korea

  Clinical and experimental pediatrics · Q1 journal · Guideline · Evidence level 1 (High) · 23 October 2026

  Korea's first evidence-based pediatric hepatoblastoma guideline recommends cisplatin without doxorubicin for standard-risk disease, citing equivalent survival with fewer adverse effects. It also supports upfront surgery for carefully selected children and lung surgery for residual metastases after chemotherapy. Because this rare cancer limits the available evidence, international collaboration and prospective data remain important for future updates.

• Are Contrast Studies Reliable for Ruling Out Post-Necrotizing Enterocolitis Strictures? A Systematic Review and Meta-Analysis

  Journal of pediatric surgery · Q1 journal · SR of cohorts · Evidence level 4 (Very Low) · 23 October 2026

  Across five studies, contrast studies had 93% sensitivity and 94% specificity for detecting strictures after necrotizing enterocolitis, but missed about 7% of cases. Only one procedure-related perforation was reported, yet these tests did not consistently guide surgical decisions. Their accuracy supports a screening role, but not use as the sole way to rule out disease.