Objective: The aim of the study was to investigate the effect of abdominal drainage at appendectomy for complicated appendicitis in children. Summary of Background Data: Although an abdominal drain placement at appendectomy is an option for reducing or preventing postoperative infectious complication, there is controversy regarding its effect for complicated appendicitis. Method: The study used the data on appendectomies for complicated appendicitis in children (≤15 years old) that were operated in 2015 and registered in the National Clinical Database, a nationwide surgical database in Japan. One-to-two propensity score matching was performed to compare postoperative outcomes between patients with and without drainage at appendectomy. Result: The study included 1762 pediatric appendectomies for complicated appendicitis, 458 of which underwent abdominal drainage at appendectomy. In the propensity-matched analysis, the drainage group showed a significant increase in wound dehiscence [drain (−) vs drain (+); 0.3% vs 2.4%, P = 0.001], and postoperative hospital stay (median: 7 days vs 9 days, P < 0.001). There were no significant differences in the incidence of any complications, organ space surgical site infection, re-admission, and reoperation. Subgroup analyses in perforated appendicitis and perforated appendicitis with abscess, and open and laparoscopic appendectomy all demonstrated that drain placement was not associated with a reduction in any complication or organ space surgical site infection. However, it was significantly associated with longer hospital stays. Conclusion: This study suggested that an abdominal drain placement at appendectomy for complicated appendicitis among children has no advantage and can be harmful for preventing postoperative complications.

Background: Diagnosing pediatric appendicitis by ultrasonography (US) is difficult because US requires significant training and skill. We evaluated whether artificial intelligence (AI) can augment US. Materials and Methods: Among 70 abdominal ultrasound videos containing 85–347 images each, 50 were used to train the AI neural network. Each video was categorized based on the detection percentage and percent accuracy: most (>50%), partial (10–50%), and none (<10%). Test 1 involved verification of appendix detection by AI using the remaining 20 videos. Test 2 involved the evaluation of the effect of AI utilization on pediatricians. Results: From 50 videos, 6914 images were used to train the AI network. In test 1, 3 pediatric surgeons judged 10 (50.0%), 4 (20.0%), and 6 (30.0%) videos as “most,” “partial,” and “none,” respectively, regarding the detection percentage; 7 (35.0%), 7 (35.0%), and 6 (30.0%) videos were judged, respectively, concerning the percent accuracy. Five (83.3%) of six test videos with a scan area depth of 8 cm were judged as “none” for both detection and accuracy. In test 2, six videos were also judged as “none” for both categories, showing a negative effect on the participants (5 pediatric residents and 5 pediatric intensive-emergency fellows), but the other categories showed little negative effect. Conclusions: Appendicitis in a shallow US scan area can be easily identified with AI support. Even with the detection of a partial appendicitis shadow, AI is still helpful. However, if AI does not detect appendicitis at all, examiners may be negatively affected.

Commercially available surgical-robot technology currently addresses many surgical scenarios for adult patients. This same technology cannot be used to the benefit of neonate patients given the considerably smaller workspace. Medically relevant procedures regarding neonate patients include minimally invasive surgery to repair congenital esophagus disorders, which entail the suturing of the fragile esophagus within the narrow neonate cavity. In this work, we explore the use of the SmartArm robotic system in a feasibility study using a neonate chest and esophagus model. We show that a medically inexperienced operator can perform two-throw knots inside the neonate chest model using the robotic system.

Aim: To clarify the characteristics of patients with rectal prolapse after laparoscopically assisted anorectoplasty (LAARP), estimate the causes, and evaluate its impact on postoperative bowel function. Methods: The medical records of patients who underwent LAARP for high- or intermediate-type anorectal malformation between 2000 and 2019 were retrospectively reviewed. Clinical data were compared between patients with (Group P) and without prolapse (normal, Group N). Fecal continence was evaluated using the clinical assessment score for fecal continence developed by the Japanese Study Group of Anorectal Anomalies. For patients who underwent pelvic magnetic resonance imaging (MRI) before LAARP, atrophy, or asymmetry of the anal sphincter and levator ani was evaluated by a radiologist. Results: Of the 49 patients, 29 (59%) had rectal prolapse after LAARP (Group P) and 20 did not (Group N). We found no significant difference in gender, type of malformations, incidence of associated spinal or lumbosacral anomalies, procedure time, and postoperative bowel function at ages 4, 8, 12, and 16 years. However, LAARP was performed significantly earlier in Group N (median [range], 180 [123–498] days) than in Group P (210 [141–570] days). In Group P, 18 patients (62%) developed prolapse before colostomy takedown. Eight of 26 patients who underwent surgical prolapse repair required redo procedures. Twenty-five patients who underwent preoperative pelvic MRI showed no significant relationship between the muscular abnormalities and the incidence of postoperative rectal prolapse. Conclusions: Although recurrence is common, performing LAARP at a younger age might prevent postoperative prolapse development.