Survey on surgical treatment of neonatal necrotizing enterocolitis in China 2022

Objective The aim of this study was to identify the state of surgical treatment of neonatal necrotizing enterocolitis(NEC)in China.Methods A total of 246 delegates(88.0%senior surgeons)completed a survey sent by the Neonatal Surgery Group of the Pediatric Surgery Branch of the Chinese Medical Association in 2022.Five centers were eliminated due to lack of experience.Results Generally,38.2% of surgeons work in centers where more than 20 cases of surgical NEC are treated per year.A total of 81.3% of surgeons reported the use of ultrasonography;the most used biomarkers were white blood cell count(95.9%),C-reactive protein(93.8%),and procalcitonin(76.3%).Most surgeons(80.9%)used a combination of two(67.2%)antibiotics or single(29.5%)antibiotic for a treatment period of 7-14 days,and most used antibiotics were carbapenems(73.9%),penicillin and cephalosporins(56.0%).Patients are issued the fasting order for 5-7 days by nearly half surgeons(49.8%)for conservative treatment.70.1% of surgeons deemed that the most difficult decision was to evaluate the optimal timing of surgery.Most surgeons(76.3%)performed diagnostic aspiration of peritoneal fluid.Laparoscopy was performed for the diagnosis and/or treatment of NEC by 40.2% of surgeons.A total of 53.5% of surgeons reported being able to identify localized intestinal necrosis preoperatively.Surgeons relied the most on pneumoperitoneum(94.2%)and failure of conservative treatment(88.8%)to evaluate the surgical indications.At laparotomy,surgical treatments vary according to NEC severity.Infants are fasted for 5–7 days by 55.2% of surgeons postoperatively.Most surgeons(91.7%)followed up with patients with NEC after discharge for up to 5 years(53.8%).Conclusions The most difficult aspect of surgical NEC is evaluating the timing of surgery,and surgeons in the children’s specialized hospitals are experienced.The treatment of NEC totalis is controversial,and the indications for laparoscopy need to be further clarified.More multicenter prospective studies are needed to develop surgical guidelines in the future.

Umbilical cord sparing technique of umbilicoplasty in infants with giant omphalocele

Omphalocele is a congenital defect of the abdominal wall characterized by the absence of abdominal muscles,fascia,and skin.1 According to the size of the abdominal wall defect and bulge,it can be divided into small or giant omphalocele.2 Surgery to repair omphalocele includes excision of the amniotic sac,individual ligation of the umbilical vessels at the level of the peritoneum,fascial closure,and reconstruction of the skin with a circumferential subcuticular purse-string suture.34 However,this technique cannot reconstruct a well-formed umbilical cord,which flattens out or disappears.This study aims to introduce an umbilical cord-sparing method to reconstruct the umbilical cord of children with giant omphalocele,thereby improving the appearance of the umbilical cord.

Digestive perianastomotic ulcerations after intestinal resection in children

Digestive perianastomotic ulceration(DPAU)is a rare complication after intestinal resection and anastomosis occurring at or near the anastomosis site.The purpose of this review is to summarize the characteristics of DPAU,including the etiology,diagnosis and differential diagnosis,clinical manifestations,treatment,and future research.All recent literature on DPAU was searched in PubMed,Embase,and Cochrane and then reviewed.The clinical manifestations of DPAU are mainly gastrointestinal symptoms such as bloody stool and chronic anemia.The diagnosis of DPAU is difficult.Specific diseases,such as Crohn’s disease,must be ruled out before a diagnosis can be made.In addition,there are no clear treatment guidelines due to the high degree of heterogeneity in response to drugs and surgery.It is recommended to adjust medication in time and combine various treatment methods.In addition,the mechanism that causes DPAU is not well understood;however,several possible mechanisms have been proposed,such as scar tissue ischemia and underlying diseases.Moreover,there is a high risk of relapses,and a long-term follow-up is necessary.Numerous issues remain to be solved in this area;therefore,more randomized controlled trials and studies should be carried out to further understand this disease.

Prevention and control strategies for emergency,limited-term,and elective operations in pediatric surgery during the epidemic period of COVID-19

The outbreak of coronavirus disease 2019(COVID-19)caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)has spread to more than 100 countries.Children approved to be susceptible to SARS-CoV-2 infection.Preventing and controlling the epidemic while ensuring orderly flows of pediatric surgery clinical work has proven to be a big challenge for both patients and clinicians during the epidemic.Based on the transmission characteristics of SARS-CoV-2 and the requirements for prevention and control of COVID-19,the authors proposed some concrete measures and practical strategies of managing emergency,limited-term,and elective pediatric surgeries during the epidemic period.

Application and prospects of robotic surgery in children: a scoping review

As an innovative minimally invasive surgical technology, robot-assisted surgery (RAS) has greatly improved the accuracy and safety of surgery through the advantages of three-dimensional magnification, tremor filtering, precision and flexibility, and has been carried out by an increasing number of surgeries. In recent years, robots have been gradually applied to children, bringing new ideas and challenges to pediatric surgeons. This review will describe the advantages and limitations of robotic surgery in children, summarize its application in pediatric surgery, and provide an outlook. It is believed that clinicians should actively carry out RAS under the premise of rigorously ensuring surgical indications and strive to improve the efficacy of surgical treatment for children.

Expression and possible role of Smad3 in postnecrotizing enterocolitis stricture

Objective To investigate the expression of Smad3(mothers against decapentaplegic homolog 3)protein in postnecrotizing enterocolitis stricture and its possible mechanism of action.Methods We used immunohistochemistry to detect the expression characteristics of Smad3 and nuclear factor kappa B(NF-κB)proteins in human postnecrotizing enterocolitis stricture.We cultured IEC-6(crypt epithelial cells of rat small intestine)in vitro and inhibited the expression of Smad3 using siRNA technique.Quantitative PCR,western blotting,and ELISA were used to detect the changes in transforming growth factor-β1(TGF-β1),NF-κB,tumor necrosis factor-α(TNF-α),vascular endothelial growth factor(VEGF),and zonula occludens-1(ZO-1)messenger RNA(mRNA)and protein expressions in IEC-6 cells.CCK8 kit and Transwell cellular migration were used to detect cell proliferation and migration.Changes in epithelial-mesenchymal transition(EMT)markers(E-cadherin and vimentin)in IEC-6 cells were detected by immunofluorescence technique.Results The results showed that Smad3 protein and NF-κB protein were overexpressed in narrow intestinal tissues and that Smad3 protein expression was positively correlated with NF-κB protein expression.After inhibiting the expression of Smad3 in IEC-6 cells,the mRNA expressions of NF-κB,TGF-β1,ZO-1,and VEGF decreased,whereas the mRNA expression of TNF-αdid not significantly change.TGF-β1,NF-κB,and TNF-αprotein expressions in IEC-6 cells decreased,whereas ZO-1 and intracellular VEGF protein expressions increased.IEC-6 cell proliferation and migration capacity decreased.There was no significant change in protein expression levels of EMT markers E-cadherin and vimentin and also extracellular VEGF protein expression.Conclusions We suspect that the high expression of Smad3 protein in postnecrotizing enterocolitis stricture may promote the occurrence and development of secondary intestinal stenosis.The mechanism may be related to the regulation of TGF-β1,NF-κB,TNF-α,ZO-1,and VEGF mRNA and protein expression.This may also be related to the ability of Smad3 to promote epithelial cell proliferation and migration.