Pediatric Surgery Literature Updates: Lymphatic Malformations, G-Tube Complications, and Cryptorchidism Timing

Texas Children's Hospital researchers performed a systematic review focusing on 200 articles published from 1990 to 2021 on pediatric lymphatic malformations.

Sclerotherapy had a success rate of over 90% for macrocystic lymphatic malformations.

Sirolimus is helpful for extensive lymphatic malformations that are refractory to surgery and/or sclerotherapy.

Sirolimus is used as an initial treatment for extensive lymphatic malformations that compromise the airway.

Small asymptomatic lymphatic malformation lesions can be observed.

Large symptomatic lymphatic malformation lesions need to be divided into macrocystic, microcystic, or mixed lesions for treatment planning.

For localized lymphatic malformations, surgery or sclerotherapy is effective.

G-tube placement made up 5.3% of all cases submitted to NSQIP pediatric in 2023.

Upper GI studies were obtained in 45% of G-tube cases with significant inter-hospital variability.

In the first 30 days postoperatively after G-tube placement, 14% of patients went to the ED.

In the first 30 days postoperatively after G-tube placement, 5.2% of patients experienced G-tube dislodgement.

There is high postoperative G-tube related morbidity as well as high variability in preoperative upper GI use, which can both serve as targets for future quality improvement projects.

The Swedish cryptorchidism study included 22 patients with spontaneous descent, 37 with surgery at 9 months, and 48 with surgery at 3 years of age.

Testicular volume at puberty was significantly higher in patients with spontaneous descent of undescended testes versus those who had surgery at 9 months.

Testicular volume at puberty was significantly higher in patients who had orchiopexy at 9 months versus those who had surgery at 3 years of age.

Earlier orchiopexy is better for testicular volume outcomes as long as patients are given enough time for spontaneous descent.