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Article ; Online: Letter to the Editor in Response to: Early Laparoscopic-Assisted Surgery is Associated with Decreased Post-Operative Inflammation and Intestinal Strictures in Infants with Necrotizing Enterocolitis.

Bethell, George S / Hall, Nigel J

2023 Volume 58, Issue 7, Page(s) 1403

MeSH term(s)	Infant, Newborn ; Infant ; Humans ; Enterocolitis, Necrotizing/complications ; Enterocolitis, Necrotizing/surgery ; Constriction, Pathologic/surgery ; Intestinal Obstruction/surgery ; Intestinal Obstruction/complications ; Infant, Newborn, Diseases/surgery ; Inflammation ; Laparoscopy
Language	English
Publishing date	2023-02-23
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	80165-3
ISSN	1531-5037 ; 0022-3468
ISSN (online)	1531-5037
ISSN	0022-3468
DOI	10.1016/j.jpedsurg.2023.02.046
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Article: Recent advances in our understanding of NEC diagnosis, prognosis and surgical approach.

Bethell, George S / Hall, Nigel J

Frontiers in pediatrics

2023 Volume 11, Page(s) 1229850

Abstract: Necrotising enterocolitis (NEC) remains a devasting condition that has seen limited improvement in outcomes in recent years. The incidence of the disease is increasing as more extremely premature infants survive. NEC is responsible for 1 in 10 neonatal ... ...

Abstract	Necrotising enterocolitis (NEC) remains a devasting condition that has seen limited improvement in outcomes in recent years. The incidence of the disease is increasing as more extremely premature infants survive. NEC is responsible for 1 in 10 neonatal deaths and up to 61% of survivors have significant neurodevelopmental delay. The aim of this review is to highlight recent advances in diagnosis, prognosis and surgical approach in this condition. Many recent studies have reported novel methods of diagnosis of NEC with the aim of earlier and more accurate identification. These include imaging and machine learning techniques. Prognostication of NEC is particularly important to allow earlier escalation of therapy. Around 25% of infants with NEC will require surgery and recent data has shown that time from disease onset to surgery is greater in infants whose indication for surgery is failed medical management, rather than pneumoperitoneum. This indication was also associated with worse outcomes compared to pneumoperitoneum. Ongoing research has highlighted several new methods of disease prognostication which includes differentiating surgical from medical NEC. Finally, recent randomised controlled trials in surgical technique are discussed along with the implications of these for practice. Further, high quality research utilising multi-centre collaborations and high fidelity data from electronic patient records is needed to address the issues discussed and ultimately improve outcomes in NEC.
Language	English
Publishing date	2023-07-31
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2711999-3
ISSN	2296-2360
ISSN	2296-2360
DOI	10.3389/fped.2023.1229850
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Article ; Online: Letter to the Editor in response to: Routine contrast enema prior to stoma reversal seems only required following treatment for necrotizing enterocolitis: An evaluation of the diagnostic accuracy of the contrast enema.

Bethell, George S / Hallows, Ruth

Journal of pediatric surgery

2022 Volume 58, Issue 2, Page(s) 357

MeSH term(s)	Infant, Newborn ; Humans ; Enterocolitis, Necrotizing/diagnosis ; Enterocolitis, Necrotizing/surgery ; Enema ; Surgical Stomas/adverse effects ; Contrast Media
Chemical Substances	Contrast Media
Language	English
Publishing date	2022-08-13
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	80165-3
ISSN	1531-5037 ; 0022-3468
ISSN (online)	1531-5037
ISSN	0022-3468
DOI	10.1016/j.jpedsurg.2022.08.009
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Zs.A 607: Show issues

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Article ; Online: Development Methodology, Availability, and Implementation of Core Outcome Sets in Pediatric Surgery.

Allin, Benjamin S R / Bethell, George S / Hall, Nigel J

European journal of pediatric surgery : official journal of Austrian Association of Pediatric Surgery ... [et al] = Zeitschrift fur Kinderchirurgie

2023 Volume 34, Issue 2, Page(s) 128–136

Abstract: Core outcome sets (COSs) provide a mechanism to guide researchers and clinicians when deciding which outcomes to report in research related to a specific clinical condition or intervention. The intention behind creating a COS for a specific condition is ... ...

Abstract	Core outcome sets (COSs) provide a mechanism to guide researchers and clinicians when deciding which outcomes to report in research related to a specific clinical condition or intervention. The intention behind creating a COS for a specific condition is to improve the reporting of important and meaningful outcomes, thus enhancing the relevance of research. Additionally, a COS helps facilitate comparison of outcomes between different clinical studies and reduces research waste. In this paper, we discuss the availability of COSs in the field of pediatric general surgery. We provide an overview of the methodologies used to develop a COS, including common pitfalls, and finally, we discuss COS uptake and implementation. An understanding of all these aspects is important for researchers considering developing a new COS and for those reading research where a COS has been developed or used within a study. Failure to adequately appreciate the nuances of COS development, in particular, risks fundamental flaws that may jeopardize COS validity and subsequently hinder COS uptake and implementation.
MeSH term(s)	Child ; Humans ; Research Design ; Delphi Technique ; Consensus ; Specialties, Surgical ; Outcome Assessment, Health Care ; Treatment Outcome
Language	English
Publishing date	2023-10-23
Publishing country	United States
Document type	Journal Article
ZDB-ID	1065043-x
ISSN	1439-359X ; 0939-7248 ; 0939-6764 ; 0930-7249
ISSN (online)	1439-359X
ISSN	0939-7248 ; 0939-6764 ; 0930-7249
DOI	10.1055/a-2196-1887
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Zs.A 3140: Show issues

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Article ; Online: Factors associated with outcomes in congenital duodenal obstruction: population-based study.

Bethell, George S / Long, Anna-May / Knight, Marian / Hall, Nigel J

The British journal of surgery

2023 Volume 110, Issue 9, Page(s) 1053–1056

MeSH term(s)	Humans ; Duodenal Obstruction/surgery ; Duodenal Obstruction/congenital ; Intestines ; Retrospective Studies ; Research
Language	English
Publishing date	2023-03-03
Publishing country	England
Document type	Journal Article
ZDB-ID	2985-3
ISSN	1365-2168 ; 0263-1202 ; 0007-1323 ; 1355-7688
ISSN (online)	1365-2168
ISSN	0263-1202 ; 0007-1323 ; 1355-7688
DOI	10.1093/bjs/znad040
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Article ; Online: Outcomes 1 year after non-operative management of uncomplicated appendicitis in children: Children with AppendicitiS during the CoronAvirus panDEmic (CASCADE) study.

Bethell, George S / Rees, Clare M / Sutcliffe, Jonathan / Hall, Nigel J

BJS open

2023 Volume 7, Issue 3

Abstract: Background: A major shift in treatment of appendicitis occurred early in the SARS-CoV-2 pandemic with non-operative management used commonly outside research protocols and in units with limited previous experience. This study aims to compare real-world ... ...

Abstract	Background: A major shift in treatment of appendicitis occurred early in the SARS-CoV-2 pandemic with non-operative management used commonly outside research protocols and in units with limited previous experience. This study aims to compare real-world outcomes of surgery versus non-operative management of uncomplicated appendicitis in children with 1-year follow-up. Method: A prospective multicentre observational study of children treated for uncomplicated appendicitis at 74 hospitals in the UK and Ireland from 1 April to 31 July 2020 was performed. Propensity-score matched analysis was conducted using age, sex, C-reactive protein at diagnosis and duration of symptoms as covariates. Primary outcomes were success of non-operative management defined as achieving 1-year follow-up without undergoing appendicectomy due to recurrent appendicitis or ongoing symptoms, and occurrence of any predefined complication (intra-abdominal collection, wound infection, bowel obstruction or reintervention). Results: Of 1464 children with presumed uncomplicated appendicitis, 1027 (70.2 per cent) underwent surgery and 437 (29.9 per cent) underwent non-operative management. Ninety-four children (21.5 per cent) treated by initial non-operative management required appendicectomy during the index hospital admission while recurrent appendicitis after discharge occurred in 25 (10.4 per cent) children within 1 year. The overall success rate of non-operative management at 1 year was 63.1 per cent (95 per cent c.i. 58.0 to 68.3 per cent). For propensity-score matched analyses, 688 children undergoing surgery and 307 undergoing non-operative management were included. Any predefined complication occurred in 50 (7.3 per cent) children undergoing surgery and in four (1.3 per cent) children undergoing non-operative management (OR 5.9 (95 per cent c.i. 2.1 to 16.6)) in the propensity-score matched cohort. There was no mortality or stoma formation. Conclusion: Non-operative management is a safe and valid alternative to appendicectomy in children with uncomplicated appendicitis.
MeSH term(s)	Child ; Humans ; Anti-Bacterial Agents/therapeutic use ; Appendicitis/surgery ; Appendicitis/complications ; COVID-19 ; Pandemics ; Prospective Studies ; SARS-CoV-2 ; Treatment Outcome ; Male ; Female
Chemical Substances	Anti-Bacterial Agents
Language	English
Publishing date	2023-06-02
Publishing country	England
Document type	Journal Article ; Multicenter Study ; Observational Study
ISSN	2474-9842
ISSN (online)	2474-9842
DOI	10.1093/bjsopen/zrad055
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Article: Development Methodology, Availability, and Implementation of Core Outcome Sets in Pediatric Surgery

Allin, Benjamin S.R. / Bethell, George S. / Hall, Nigel J.

European Journal of Pediatric Surgery

2023 Volume 34, Issue 02, Page(s) 128–136

Abstract	Core outcome sets (COSs) provide a mechanism to guide researchers and clinicians when deciding which outcomes to report in research related to a specific clinical condition or intervention. The intention behind creating a COS for a specific condition is to improve the reporting of important and meaningful outcomes, thus enhancing the relevance of research. Additionally, a COS helps facilitate comparison of outcomes between different clinical studies and reduces research waste. In this paper, we discuss the availability of COSs in the field of pediatric general surgery. We provide an overview of the methodologies used to develop a COS, including common pitfalls, and finally, we discuss COS uptake and implementation. An understanding of all these aspects is important for researchers considering developing a new COS and for those reading research where a COS has been developed or used within a study. Failure to adequately appreciate the nuances of COS development, in particular, risks fundamental flaws that may jeopardize COS validity and subsequently hinder COS uptake and implementation.
Keywords	core outcome set ; pediatric surgery ; outcomes ; evidence
Language	English
Publishing date	2023-10-23
Publisher	Georg Thieme Verlag KG
Publishing place	Stuttgart ; New York
Document type	Article
ZDB-ID	1065043-x
ISSN	1439-359X ; 0939-7248 ; 0939-6764 ; 0930-7249
ISSN (online)	1439-359X
ISSN	0939-7248 ; 0939-6764 ; 0930-7249
DOI	10.1055/a-2196-1887
Database	Thieme publisher's database

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Zs.A 3140: Show issues

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Article ; Online: Surgical necrotizing enterocolitis: Association between surgical indication, timing, and outcomes.

Bethell, George S / Knight, Marian / Hall, Nigel J

Journal of pediatric surgery

2021 Volume 56, Issue 10, Page(s) 1785–1790

Abstract: Background/purpose: Despite improvements in neonatal care the outcomes of Necrotizing Enterocolitis (NEC) remain unchanged over previous decades. The study aims to explore whether different indications for surgical intervention in NEC are associated ... ...

Abstract	Background/purpose: Despite improvements in neonatal care the outcomes of Necrotizing Enterocolitis (NEC) remain unchanged over previous decades. The study aims to explore whether different indications for surgical intervention in NEC are associated with timing of surgery and outcomes. Methods: Population-based, prospective, observational study of all 27 paediatric surgical centres in the United Kingdom and Ireland identified using the British Association of Paediatric Surgeons Congenital Anomalies Surveillance System from 1st February 2013 to 28th February 2014. Infants were included if they had NEC and underwent first surgical intervention within 7 days of diagnosis. Primary outcomes were death, parenteral nutrition requirement or a composite outcome of death or PN requirement at 28 days post surgery. Results: There were 133 infants meeting inclusion criteria. Indications for surgery were bowel perforation (n = 67), suspected necrotic bowel without bowel perforation and not deemed to have failed medical management (n = 20), those who had failed medical management (n = 42) and a palpable mass without any other indication (n = 4). Failed medical treatment as an indication for surgery was associated with an increased time to surgery of 30.28 (95% CI 13.46-47.10) hours from those whose indication was perforation and was also the strongest predictor of PN requirement or death at 28 days post-surgery (OR 4.54 [1.59-13.0]). Conclusions: Failed medical treatment as an indication for surgery for NEC is associated with poor outcome. Earlier intervention in these infants represents a potential opportunity to improve outcomes in this population.
MeSH term(s)	Enterocolitis, Necrotizing/epidemiology ; Enterocolitis, Necrotizing/surgery ; Humans ; Infant, Newborn ; Infant, Newborn, Diseases ; Intestinal Perforation/epidemiology ; Intestinal Perforation/etiology ; Intestinal Perforation/surgery ; Parenteral Nutrition ; Prospective Studies
Language	English
Publishing date	2021-05-02
Publishing country	United States
Document type	Journal Article ; Observational Study
ZDB-ID	80165-3
ISSN	1531-5037 ; 0022-3468
ISSN (online)	1531-5037
ISSN	0022-3468
DOI	10.1016/j.jpedsurg.2021.04.028
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Zs.A 607: Show issues

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Article ; Online: Impact of the COVID-19 pandemic on management and outcomes of children with appendicitis: The Children with AppendicitiS during the CoronAvirus panDEmic (CASCADE) study.

Bethell, George S / Gosling, Tom / Rees, Clare M / Sutcliffe, Jonathan / Hall, Nigel J

Journal of pediatric surgery

2022 Volume 57, Issue 10, Page(s) 380–385

Abstract: Aim: To report the impact of the SARS-CoV-2 pandemic on management and outcomes of paediatric appendicitis in the UK and Ireland.: Methods: Prospective, multicentre observational cohort study at general surgical and specialist paediatric surgical ... ...

Abstract	Aim: To report the impact of the SARS-CoV-2 pandemic on management and outcomes of paediatric appendicitis in the UK and Ireland. Methods: Prospective, multicentre observational cohort study at general surgical and specialist paediatric surgical centres in the United Kingdom and Ireland from 1st April to 31st July 2020. Primary outcome was treatment strategy used for acute appendicitis. Results: This study includes 2002 children treated for acute appendicitis of a median age of 10 (range 1-15) years and 605 children from a similar data set pre pandemic from 2017. In the pandemic cohort 560/2002(28%) were initially treated non operatively of whom 125/560(22%) proceeded to appendicectomy within initial hospital admission. Non operative treatment wasn't used in the pre pandemic cohort. Diagnostic imaging use was greater during the pandemic compared to pre pandemic (54vs31%; p < 0.00001) but overall use of laparoscopy was similar during both time periods (62.4vs66.6%). Hospital readmission rate was lower (8.7vs13.9%; p = 0.0002) during the pandemic than pre pandemic and Re-intervention rate was similar (2.9vs2.6%;p = 0.42). In cases treated operatively negative appendicectomy rate was lower during the pandemic than pre pandemic (4.4vs15.4%; p =0.0001), and during the pandemic was amongst the lowest ever reported in the UK. Conclusion: COVID-19 has had a significant impact on the management of children with appendicitis in the UK and Ireland. The rate of imaging and the use of non operative management increased, whilst the negative appendicectomy rate reduced. Overall, patient outcomes have not been adversely impacted by change in management during the pandemic. Conclusion: Level I. Type of study: Prognosis study.
MeSH term(s)	Adolescent ; Appendectomy/methods ; Appendicitis/epidemiology ; Appendicitis/surgery ; COVID-19/epidemiology ; Child ; Child, Preschool ; Humans ; Infant ; Pandemics ; Prospective Studies ; SARS-CoV-2
Language	English
Publishing date	2022-04-02
Publishing country	United States
Document type	Journal Article ; Observational Study
ZDB-ID	80165-3
ISSN	1531-5037 ; 0022-3468
ISSN (online)	1531-5037
ISSN	0022-3468
DOI	10.1016/j.jpedsurg.2022.03.029
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Zs.A 607: Show issues

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Article ; Online: One-year Outcomes of Congenital Duodenal Obstruction: A Population-based Study.

Bethell, George S / Long, Anna-May / Knight, Marian / Hall, Nigel J

Journal of pediatric gastroenterology and nutrition

2020 Volume 72, Issue 2, Page(s) 239–243

Abstract: Objectives: Congenital duodenal obstruction (CDO) occurs in 1.2 per 10,000 live births and is frequently associated with other anomalies, most commonly cardiac. The aim of this study was to report important outcomes to 1 year following surgical repair.!# ...

Abstract	Objectives: Congenital duodenal obstruction (CDO) occurs in 1.2 per 10,000 live births and is frequently associated with other anomalies, most commonly cardiac. The aim of this study was to report important outcomes to 1 year following surgical repair. Methods: This was a prospective population-based study using the British Association of Paediatric Surgeons Congenital Anomaly Surveillance System. Cases were identified at specialist pediatric surgical centres in the United Kingdom during a 12-month period starting in March 2016. Outcomes were recorded at 1 year following surgical repair. Results: There were 100 infants with possible follow-up at 1 year and follow-up was achieved in 80 of these (80%) of whom 76 were alive at 1 year. The remainder had been discharged home, although one remained on parenteral nutrition. Five (6.1%) infants underwent repeat surgery for reasons related to CDO and overall 23 (23%) experienced at least 1 central venous catheter-related complication within 1 year. Overall mortality either before repair or within 1 year following surgical repair was 8.4% (95% CI 2.5%-14.4%), no deaths were related to CDO. Conclusions: One year outcomes for CDO are generally very good with poor outcomes typically related to comorbidities. These data are useful for national benchmarking and parental counselling.
MeSH term(s)	Child ; Duodenal Obstruction/epidemiology ; Duodenal Obstruction/etiology ; Duodenal Obstruction/surgery ; Humans ; Infant ; Parenteral Nutrition, Total ; Prospective Studies ; Reoperation ; United Kingdom/epidemiology
Language	English
Publishing date	2020-08-20
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	603201-1
ISSN	1536-4801 ; 0277-2116
ISSN (online)	1536-4801
ISSN	0277-2116
DOI	10.1097/MPG.0000000000002921
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