Indocyanine green (ICG)-guided near-infrared fluorescence has been recently adopted in pediatric surgery, although its use in the treatment of congenital hyperinsulinism has not been reported. We present a case of focal congenital hyperinsulinism in which ICG-navigation with ICG was used during surgical treatment. A 3-month-old infant was referred to our institution from a peripheral hospital for episodes of persistent hypoglycemia since birth, with no response to intravenous treatment with diazoxide, octreotide, or hydrochlorothiazide. An abdominal positron emission tomography-computed tomography scan showed a hypermetabolic nodule in the proximal portion of the body of the pancreas, compatible with focal congenital hyperinsulinism. A heterozygous mutation in the ABCC gene (Ala1516Glyfs*19) frameshift type inherited from the father was identified, which supported this diagnosis. Laparoscopy-assisted surgery was performed with ICG-guided near-infrared fluorescence, with intravenous injection of 16 mg ICG (2 mg/mg), which allowed localization of the focal lesion in the body of the pancreas. The lesion was resected with bipolar electrocautery and intraoperative histological study confirmed complete resection. Plasma glucose values normalized 6 hours after surgery and the patient was discharged 5 days later. In conclusion, the use of ICG in the treatment of congenital hyperinsulinism helps to identify hypermetabolic pancreatic nodules, decreasing the likelihood of incomplete resection.

Congenital infantile fibrosarcoma (CIF) is a rare tumor in children that occurs in the first years of life. It usually arises in the extremities but some cases affect the trunk, neck, abdomen, or retroperitoneum. Surgical resection has been traditionally the treatment of choice but the development of genomic analysis and targeted therapies has shed light on new therapeutic options.We present two patients with a congenital mass, one in the abdominal cavity (1-month-old) and the second in the left lower extremity respectively (2-months-old). In both cases, the clinical and radiological findings showed heterogeneous masses with rapidly progressive growth. MRI in the first patient exhibited an abdominal mass surrounding the aorta and inferior vena cava associated with a giant infrarenal aortic aneurysm. CT-guided biopsy was performed with pathological findings of fibrosarcoma and ETV6-NTRK3 gene fusion. The second patient underwent open biopsy also with histopathological diagnosis of fibrosarcoma and the same mutation in the TRK gene (NTRK3). Targeted therapy with a specific TRK inhibitor, larotrectinib, was started in both patients. Periodical controls were made by ultrasound or MRI, and after a few weeks of treatment, both children showed significant decrease in the mass. By the second and third months after starting the treatment, both tumors disappeared. The first patient is now 15-months-old and the second one is 8-months-old.Larotrectinib is a novel targeted therapy with excellent results in CIF but long-term outcomes are limited to establish it as a gold standard treatment.

Introduction: delayed abdominal closure following congenital diaphragmatic hernia (CDH) repair is required in patients with large defects in whom primary fascial closure would risk abdominal compartment syndrome. Several strategies have been described, but most require prolonged time to definitive closure. We present a novel technique based on a Gore-Tex^® abdominal patch with dynamic traction under intra-abdominal pressure monitoring. Methods: retrospective observational study of 41 neonates undergoing CDH repair at a tertiary referral center (2015–2023). Patients were divided into primary closure (n = 27) and delayed dynamic abdominal wall closure (DDAC) (n = 14) groups. Baseline characteristics, surgical outcomes, and mortality were compared between groups using Fisher’s exact test and the Wilcoxon rank-sum test. Results: patients requiring DDAC had more severe baseline disease, including lower O/E LHR (26.30 [21.40–31.00] vs. 42.00 [34.00–46.00], p < 0.001), higher rates of liver herniation (13/14 vs. 4/27, p < 0.001), more advanced defect type (p < 0.001) and greater need of ECMO (9/14 vs. 3/27, p < 0.001). Definitive fascial closure was achieved at a median of 6 days. In-hospital mortality after diaphragmatic repair was 19.5% (8/41), with 7 deaths occurring in the DDAC group. Mortality was strongly associated with the gradient of disease severity across prenatal and anatomical markers, although an independent contribution of the abdominal closure strategy cannot be excluded. Conclusions: DDAC achieves early definitive fascial closure and appears technically feasible in CDH patients unsuitable for primary closure. Higher mortality in this group was strongly associated with baseline disease severity, though its independent relationship with the closure technique remains to be established.

Background: Same-day discharge after laparoscopic appendectomy for uncomplicated appendicitis has been proposed as a strategy to reduce hospital costs without compromising safety, but evidence in pediatric patients remains limited. Methods: We conducted a retrospective study of pediatric patients undergoing laparoscopic appendectomy for uncomplicated appendicitis, comparing same-day and next-day discharge. Baseline differences were addressed using 1:2 propensity score matching. Costs were analyzed using linear regression with cluster-robust standard errors, and inverse probability of treatment weighting was used as a sensitivity analysis. Results: Among 102 patients (37 same-day discharge and 65 delayed discharge), 28 same-day discharge patients were matched to 36 delayed-discharge controls. Same-day discharge was associated with a mean reduction in total cost of €319.9 (95% CI: −€413.6 to −€226.2; p < 0.0001), mainly explained by lower admission-related costs, with no significant difference in outpatient consultation costs. Sensitivity analysis using inverse probability weighting in the full cohort showed a similar estimate (−€311.7; 95% CI: −€421.1 to −€202.3; p < 0.0001). Complications were rare and similar in both groups (1/28 vs. 1/36), which limited formal comparison of complication risk. Conclusions: Same-day discharge after laparoscopic appendectomy for uncomplicated appendicitis was associated with lower healthcare costs, largely due to reduced admission-related costs, with no apparent signal of increased complications.

Objective: To determine whether the observed-to-expected lung-to-head ratio (O/E LHR) independently predicts the need for delayed abdominal wall closure (DAC) in isolated left-sided congenital diaphragmatic hernia (CDH), and to establish an optimal cut-off value. Design: Retrospective, single-centre cohort study. Setting: Tertiary referral centre, Hospital Universitario La Paz, Madrid, Spain, January 2015 to May 2026. Patients: 45 neonates with isolated left-sided CDH; 28 underwent primary abdominal closure and 17 required DAC. Interventions: None (observational study). Main outcome measures: Need for DAC; discriminative capacity of O/E LHR for DAC and its optimal cut-off; O/E LHR–DAC association adjusted for liver herniation. Results: DAC was associated with lower gestational age at birth (37.00 [34.00–38.00] vs 39.00 [38.00–39.00] weeks), lower birth weight (2,690 [2,290–3,210] vs 3,120 [2,968– 3,285] g), higher rates of liver herniation (13/17 vs 1/28), greater ECMO requirement (9/17 [52.9%] vs 3/28 [10.7%]), and higher in-hospital mortality (35.3% vs 3.6%) than primary closure. O/E LHR showed excellent discriminative ability for DAC (AUC 0.939, 95% CI 0.877 to 1.000), with an optimal cut-off of 34.1% (sensitivity 82.4%, specificity 82.1%, positive predictive value 73.7%, negative predictive value 88.5%). O/E LHR remained independently associated with DAC after adjustment for liver herniation (adjusted OR 0.82 per one-point increase, 95% CI 0.67 to 0.94). Conclusions: O/E LHR was independently associated with the risk of DAC beyond the effect of liver herniation. These preliminary findings suggest a role for O/E LHR in prenatal risk stratification for DAC, pending external validation in larger, multicentre cohorts. What’s already known about this topic?: O/E LHR is an established prenatal predictor of survival and pulmonary morbidity in isolated CDH. Delayed abdominal closure has been linked to lower LHR, liver herniation, and higher ECMO use and mortality, but without adjusting for confounders or using O/E LHR. What does this study add?: O/E LHR independently predicts DAC risk beyond liver herniation, with excellent discriminative ability (AUC 0.939) and a proposed cut-off of 34.1%, extending its prognostic role to this surgical outcome. Data availability statement: The data that support the findings of this study are available from the corresponding author upon reasonable request. Note: This study is based on a cohort that partially overlaps with our previously published report on delayed dynamic abdominal wall closure using a Gore-Tex patch ¹ , which addressed surgical technique and outcomes. The present study addresses the distinct question of prenatal predictors of the need for delayed closure. This overlap is disclosed in accordance with ICMJE recommendations.