2025 Pediatric Surgery Update Course - Updates in Pediatric Surgery feat. non-JPS Journals

The APPY trial is an international multicenter study comparing appendectomy versus antibiotics for acute uncomplicated appendicitis in children, with 936 patients aged 5-16 years randomized across 11 hospitals

In the APPY trial, treatment failure was defined differently in each arm: in the antibiotic group as appendectomy needed within one year, and in the surgical group as negative appendectomy or any procedure under general anesthesia related to appendicitis within one year

At one year in the APPY trial, 31% of children in the antibiotic group failed treatment compared with 7% in the appendectomy group, with the 26.7% difference exceeding the pre-specified 20% non-inferiority margin

Children in the antibiotic group of the APPY trial returned to school earlier and needed almost no pain medication

The APPY trial had 10% of patients with incomplete data and consent refusal reasons were not collected

Some guidelines recommend against DVT prophylaxis in pediatric trauma, and in the study only 50% of doctors caring for these children gave DVT prophylaxis

A JAMA Surgery 2024 study prospectively evaluated 462 pediatric trauma patients with high risk for deep vein thrombosis across level one trauma centers, comparing outcomes based on whether prophylaxis was given and when it was initiated

No major bleeding event occurred in any patient who received anticoagulation in the DVT prophylaxis study

Patients who received DVT prophylaxis within 24 hours had a venous thromboembolism rate of 1.6%, while those who received it after 24 hours had a rate of 6.9%, nearly identical to the 5.3% in patients who never received prophylaxis

The DVT prophylaxis study had low adherence to VTE guidelines with almost half of patients never receiving prophylaxis and relatively low absolute numbers of VTE events restricting statistical power

The DVT prophylaxis study was powered to detect any adverse event and there was no adverse event whatsoever from prophylaxis

A Journal of American College of Surgeons 2025 study using the National Cancer Database between 2004 and 2022 identified 1339 patients under 18 years with appendiceal neuroendocrine tumors, comparing appendectomy versus right hemicolectomy

In the neuroendocrine tumor study, survival was excellent and equivalent between appendectomy and hemicolectomy groups: 99.9% at 5 years and 99.4% at 10 years without chemotherapy or additional treatment

No forced disease progression occurred in children treated with appendectomy alone, even when high-risk features like tumor larger than 2 centimeters, positive margins, or positive lymph nodes were present

The TOUCH trial was the first multicenter randomized control trial comparing stoma versus anastomosis in necrotizing enterocolitis, randomizing patients during laparotomy when both options were deemed feasible

The TOUCH trial found no difference in mortality or complications in general between stoma and anastomosis groups, but the stoma group had up to 19% of intestinal and stoma complications

In the TOUCH trial, the likelihood of being weaned from parenteral nutrition was much higher in the anastomosis group, and children were weaned 20 days earlier compared to the stoma group