Purpose: Collective evidence from single-centre studies suggests an increasing incidence of pilonidal sinus disease in the last decades, but population-based data is scarce. Methods: We analysed administrative case–based principal diagnoses of pilonidal sinus disease and its surgical therapy between 2005 and 2017 in inpatients. Changes were addressed via linear regression. Results: The mean rate of inpatient episodes of pilonidal sinus disease per 100,000 men increased from 43 in 2005 to 56 in 2017. In females, the mean rate of inpatient episodes per 100,000 women rose from 14 in 2005 to 18 in 2017. In the whole population, for every case per 100,000 females, there were 3.1 cases per 100,000 males, but the numbers were highly variable between the age groups. There was considerable regional variation within Germany. Rates of inpatient episodes of pilonidal sinus disease were increasing in almost all age groups and both sexes by almost a third. Surgery was dominated by excision of pilonidal sinus without reconstructive procedures, such as flaps, whose share was around 13% of all procedures, despite recommendations of the national guidelines to prefer flap procedures. Conclusion: Rates of inpatient episodes of pilonidal sinus disease in Germany rose across almost all age groups and both sexes with relevant regional variation. The underlying causative factors are unknown. Thus, patient-centred research is necessary to explore them. This should also take cases into account that are solely treated office-based in order to obtain a full-spectrum view of pilonidal sinus disease incidence rates.

AFP is still the most important serologic marker for the hepatoblastoma as the most common liver tumor in children. An AFP negative hepatoblastoma is rare. We present the first documented case of an infant with an AFP negative and cystic liver lesion later diagnosed as a fetal hepatoblastoma.

Background/purpose: Circumcisions are among the most frequent operations in children. Health service data on circumcision in the United States has documented an increase in neonatal circumcisions since 2012. We investigated whether a similar effect could be found in Germany, which does not endorse neonatal circumcision.Methods: We analysed German routine administrative data for operations conducted on the preputium in order to analyse the frequency, age distribution, and time-trends in hospital-based procedures on a nationwide basis.Results: There were 9418 [95% confidence interval (CI) 8860–10,029] procedures per year, of which 4977 (95% CI 4676–5337) were circumcisions. Age distributions were highly different between both circumcisions (van der Waerden’s χ² = 58.744,df = 4,P < 0.0001) and preputium-preserving operations (van der Waerden’s χ² = 58.481,df = 4,P < 0.0001). Circumcisions were more frequent in the first 5 years of life and above 15 years of age, whereas preputium-preserving procedures were preferred in the age groups between 5 and 14 years of age. The number of circumcisions and preputium-preserving operations decreased in absolute and relative numbers.Conclusions: The increasing trend towards neonatal circumcision observed in the United States is absent in Germany. The majority of patients were operated after the first year of life and absolute and relative numbers of hospital-based procedures were decreasing. Other factors such as increasing use of steroids for the preferred non-operative treatment of phimosis may play a role. As operations in outpatients and office-based procedures were not covered, additional research is necessary to obtain a detailed picture of circumcision and its surgical alternatives in Germany.Level of evidence: III.

Background: Anorectal malformations comprise a broad spectrum of disease. We developed a percutaneous anorectoplasty (PARP) technique as a minimal-invasive option for repair of amenable types of lesions. Methods: Patients who underwent PARP at five institutions from 2008 through 2021 were retrospectively analyzed. Demographic information, details of the operative procedure, and perioperative complications and outcomes were collected. Results: A total of 10 patients underwent the PARP procedure during the study interval. Patients either had low perineal malformations or no appreciable fistula. Most procedures were guided by ultrasound, fluoroscopy, or endoscopy. Median age at PARP was 3 days (range 1 to 311) days; eight patients were male. Only one intraoperative complication occurred, prompting conversion to posterior sagittal anorectoplasty. Functional outcomes in most children were highly satisfactory in terms of continence and functionality. Conclusions: The PARP technique is an excellent minimal-invasive alternative for boys born with perineal fistulae, as well as patients of both sexes without fistulae. The optimal type of guidance (ultrasound, fluoroscopy, or endoscopy) depends on the anatomy of the lesion and the presence of a colostomy at the time of repair.

Background: In recent years, digital chest tube drainage systems have been introduced. Limited studies address their benefits and risks in pediatric patients, particularly neonates. This study compares a three‐chamber chest drainage system with a digital system using a high‐fidelity 3D‐printed model.Methods: We conducted direct measurements and 3D‐printed model tests with both systems at different suction pressures (−1 to −20 cmH₂O) to assess the actual pressures. The effects of siphon and automatic flushes in the digital system were also studied.Results: At −20 and −10 cmH₂O, significant differences were found between the digital and analog systems in direct and model measurements. The analog system became unreliable below −10 cmH₂O. For the digital system, most measurements remained within the set pressures, with outliers up to −30 cmH₂O due to regular flushing.Conclusion: This experimental study evaluates the suitability of digital drainage systems for the pediatric and neonatal populations. Our model demonstrated reliable simulation of thoracic conditions, making it a useful tool for pre‐clinical testing where patient testing may be limited. Both systems yielded satisfactory results at −20 and −10 cmH₂O, but the digital system showed greater flexibility, maintaining pressures as low as −5 cmH₂O. The analog system was consistent but less adaptable, which may limit its use in dynamic situations. The digital system's ability to simulate more flexible scenarios offers potential clinical advantages, though further investigation is needed to assess its impact on neonatal safety. The increase in suction during flushing may pose a risk for neonatal patients.

Introduction: Testicular cancer is the most common cancer in young men. Studies show that general awareness among the risk group is low, and anticipatory guidance is of paramount importance for early detection. We queried pediatricians and pediatric surgeons on their perceived role and their interaction with patients regarding education on this issue. Materials and Methods: A survey was sent to pediatricians and pediatric surgeons in Germany to assess the extent of genitourinary examinations, health education about testicular cancer, and instructions for testicular self-examination during well-child visits and clinic contacts. Statistics were processed using R software (Version 4.5.1). Results: Data from 150 participating pediatricians and 21 pediatric surgeons were analyzed. Genitourinary examinations were performed routinely by the majority of participants, especially those in solo or group practices (p < 0.05). In particular, physicians who provide health education about testicular cancer perform testicular examinations significantly more often than those who do not provide such education (p < 0.05). Four percent of the participants offered a special consultation for male adolescents to provide information about male sexual diseases. There was a significant correlation between the length of experience of physicians and the level of health education (p < 0.01). Discussion: Although the majority of participants perform regular genitourinary examinations, only a minority provide special health education about testicular cancer or provide instructions for testicular self-examination. Most participating pediatricians and pediatric surgeons asked for more support regarding testicular cancer screening and health education.