Daily Cosmetic Research Analysis
Across pediatric surgery, studies highlight strategies to improve cosmetic and clinical outcomes: percutaneous internal ring suturing (PIRS) for inguinal hernia shortened anesthesia time and reduced 1-year recurrence versus intra-corporeal purse-string laparoscopy; epidermal autografting enabled wider mesh ratios without delaying healing in pediatric burns; and a modified epispadias repair preserving the glans–frenular unit achieved favorable cosmetic results without ischemic glans loss.
Summary
Across pediatric surgery, studies highlight strategies to improve cosmetic and clinical outcomes: percutaneous internal ring suturing (PIRS) for inguinal hernia shortened anesthesia time and reduced 1-year recurrence versus intra-corporeal purse-string laparoscopy; epidermal autografting enabled wider mesh ratios without delaying healing in pediatric burns; and a modified epispadias repair preserving the glans–frenular unit achieved favorable cosmetic results without ischemic glans loss.
Research Themes
- Pediatric minimally invasive surgery and cosmetic outcomes
- Burn reconstruction with epidermal autografting
- Genitourinary reconstruction preserving vascular anatomy
Selected Articles
1. Pediatric Inguinal Hernia Repair with Laparoscopy (PIHRL)-trial: A multicenter study comparing extra-corporeal Percutaneous Internal Ring Suturing (PIRS) and intra-corporeal purse-string suture for inguinal hernia.
In this multicenter prospective non-randomized trial (n=177), PIRS significantly shortened anesthesia time and reduced 1-year recurrence compared with intra-corporeal purse-string laparoscopy. Safety was comparable, though the PIRS group required more re-interventions that were not statistically significant.
Impact: This study provides comparative prospective data supporting PIRS as an efficient minimally invasive option for pediatric inguinal hernia with potential cosmetic and quality-of-life benefits assessed by standardized tools.
Clinical Implications: PIRS may be preferred when aiming to minimize anesthesia exposure and recurrence risk at 1 year, with formal assessment of scar appearance and QoL. Confirmation in randomized trials with longer follow-up and standardized cosmetic endpoints is warranted.
Key Findings
- Total anesthesia time was shorter with PIRS (62.1 ± 24.6 min) than LIHR (84.7 ± 21.7 min), p=0.001.
- One-year recurrence was lower with PIRS (2%) versus LIHR (8%), p=0.038.
- One LIHR patient required readmission for subcutaneous hemorrhage; one PIRS patient had testicular atrophy; more re-interventions followed PIRS but were not statistically significant.
Methodological Strengths
- Prospective multicenter comparative design with predefined 1-year follow-up
- Objective endpoints including anesthesia time and recurrence; use of standardized scar and QoL questionnaires (POSAS, TAPQoL/TACQoL)
Limitations
- Non-randomized allocation with baseline age differences and potential confounding
- Imbalance in group sizes (PIRS n=126 vs LIHR n=51) and only 1-year follow-up
Future Directions: Randomized controlled trials with longer follow-up and core outcome sets including standardized cosmetic and patient-reported outcomes.
INTRODUCTION: Techniques for inguinal hernia repair (IHR) in children are continuously being improved. Open repair is increasingly giving way to laparoscopy, with two possible approaches for laparoscopy: extra-peritoneally (Percutaneous Internal Ring Suturing, PIRS) or intra-peritoneally (conventional laparoscopy with purse-string suture). The aim of this trial is to compare outcomes, e.g. recurrence and anesthesia times, of PIRS with intra-corporeal laparoscopy using a purse-string suture (LIHR). METHODS: Subjects were prospectively, non-randomly included in the multicenter 'Pediatric Inguinal Hernia Repair with Laparoscopy' (PIHRL)-trial, to undergo surgery with PIRS or LIHR. The choice of method was based on shared-decision making between parents and surgeon. Follow-up was conducted one year after surgery. Data concerning post-operative complications and anesthesia times were collected. Parents were asked to complete two questionnaires (POSAS and TAPQoL/TACQoL) to assess cosmetic results and quality of life one year postoperatively. RESULTS: 177 subjects were included (PIRS n = 126, LIHR n = 51). There was a baseline difference in age between the groups from the different centers (1.4 ± 2.8 and 1.5 ± 2.5 years for PIRS and LIHR respectively in the MUMC + vs. 3.6 ± 3.5 years for PIRS in UCHW, p = <0.001). Total anesthesia time was significantly shorter with PIRS (62.1 ± 24.6min vs. 84.7 ± 21.7min, p = 0.001). Net surgical time was also shorter; however, this difference was not significant. One readmittance within 30 days occurred in the LIHR group due to subcutaneous hemorrhage of the surgical site. This resolved spontaneously without the need for intervention. There was a significant difference in recurrence rate (PIRS n = 2 (2 %), LIHR n = 4 (8 %), p = 0.038). One patient in the PIRS group suffered from testicular atrophy (p = 0.523) and five re-interventions were necessary after PIRS due to wound complications (p = 0.984). DISCUSSION: PIRS is safe and effective for pediatric IHR, with shorter anesthesia times and a lower recurrence rate compared to LIHR at one-year follow-up. However, even though not significant, there were more re-interventions in the PIRS group necessary. Longer follow-up and a larger sample size are necessary to confirm these results.
2. Modified anatomical repair of epispadias (MARE)-with preservation of glans-frenular unit during urethral disassembly.
A seven-patient case series describes a modified epispadias repair that preserves the glans–frenular unit during urethral disassembly. Over a median 18-month follow-up, there were no ischemic glans losses, fistulae, or residual dorsal chordee, and cosmetic outcomes were satisfactory.
Impact: By preserving critical vascular connections, this technique may reduce risk of glans necrosis and improve cosmetic outcomes in epispadias repair, representing a meaningful surgical innovation.
Clinical Implications: For penile epispadias without incontinence, preserving the glans–frenular unit may minimize vascular complications and support better cosmetic reconstruction; comparative prospective studies are needed before broader adoption.
Key Findings
- Seven male patients (median age 18 months) with penile epispadias underwent MARE between 2000 and 2023.
- Mean operative time was 180 minutes (range 150–210) with no intraoperative or immediate postoperative complications and no ischemic glans loss.
- At a median follow-up of 18 months (12–36), there were no residual dorsal chordee or fistulae, and cosmetic outcomes were satisfactory.
Methodological Strengths
- Clear description of a reproducible surgical technique with anatomical rationale (vascular preservation)
- Follow-up up to 36 months with consistent reporting of functional and cosmetic outcomes
Limitations
- Small single-arm case series without a comparator group
- Limited sample size (n=7) limits generalizability and statistical inference
Future Directions: Prospective multicenter comparative studies evaluating complication rates, cosmesis (standardized scar scales), and functional outcomes versus conventional techniques.
BACKGROUND: In this video we report Modified Anatomical Repair of Epispadias (MARE)- where glans-frenular unit is preserved during urethral disassembly of Mitchell's technique. METHODS/TECHNIQUE: The epispadiac urethra and spongiosa were completely dissected off the corporal bodies; distally the urethra was dissected off, but the attachment at the frenulum and prepuce to hemi-glans was retained. The neourethra was tubularised using 7-0 Polydiaxone (PDS) over an 8Fr silastic catheter; neo-metaus was fashioned in a ventral position in the glans. The corporal bodies were approximated dorsally ventralising the repaired neourethra. Glansplasty was done after glans sculpting to prevent glans cleft. Skin cover was provided by rotation of ventral penile skin. RESULTS: Between 2000 and 2023, seven male epispadias patients; median age - 18 months (15-24 months) underwent MARE. All had penile epispadias without incontinence. Mean operative time was 180 min (150-210 min). There were no intraoperative/immediate post-operative complication or ischaemic glans loss. Median follow-up was 18 [12-36] months and there was no residual dorsal chordee/fistula. All had satisfactory cosmetic outcome. CONCLUSION: This pilot study reports satisfactory outcomes of MARE where glans-frenular unit is preserved during urethral disassembly. It minimises glans loss by preserving blood supply between hemi-glans via the frenulum/ventral foreskin.
3. Outcomes of Split-Thickness Skin Grafting With and Without Epidermal Autografting in Pediatric Burn Care.
In a retrospective pediatric cohort (n=47), combining epidermal autografting with split-thickness skin grafting enabled wider meshing ratios and reduced donor site size without prolonging healing, with no graft failures observed. The analysis was univariate and did not report detailed cosmetic scale outcomes.
Impact: Findings support an adjunctive technique that can spare donor skin in children without compromising healing, addressing a key constraint in pediatric burn reconstruction.
Clinical Implications: When donor skin is limited, adding epidermal autografting to STSG may allow higher mesh ratios and smaller donor sites without increasing graft failure or healing time; prospective studies should quantify scar quality and pain.
Key Findings
- Retrospective cohort of 47 pediatric burn patients (median age 6 years; median TBSA 7%).
- STSG plus epidermal autografting allowed wider meshing ratios and smaller donor sites.
- No increase in healing time and zero graft failures were reported with STSG+EA.
Methodological Strengths
- Direct comparative cohort focusing on practical reconstructive endpoints (mesh ratio, donor site, healing)
- Pediatric real-world population with diverse burn etiologies
Limitations
- Retrospective design with univariate analysis only and small sample size
- Cosmetic outcomes were not quantified with standardized scar scales in the abstract
Future Directions: Prospective controlled studies using standardized scar assessments (e.g., POSAS), pain metrics, and long-term functional outcomes to validate pediatric EA adjunct use.
BACKGROUND: Epidermal autografting (EA) creates a cell suspension from patient skin that is applied to burn wounds, often in conjunction with meshed split-thickness skin grafts (STSG). Application over STSG is thought to promote graft integration, decrease pain, and improve cosmetic appearance. This study compares outcomes of STSG+EA versus STSG alone in pediatric burn patients. METHODS: A retrospective cohort study was performed of pediatric burn patients (<16 years) who underwent STSG at a children's hospital (05/2021-05/2024). Demographics, injury characteristics, surgical details, and post-operative care were abstracted. Patients were categorized into STSG or STSG+EA. Univariate analysis was performed. RESULTS: In total, 47 patients were included (median age 6 years (IQR 2-10); 62% male). Burns were caused by hot liquid (47%), fire/explosion (30%), or hot surface contact (11%), with a median total body surface area of 7% (IQR 4-12). The median grafted area was 150cm CONCLUSION: STSG+EA provided opportunity for wider meshing ratios, decreasing the size of the donor site, without increasing healing time and with zero graft failures. LEVEL OF EVIDENCE: Level III.