Purpose: Pediatric surgery in Korea has historically been undervalued under the national fee system. Since 2021, the government has progressively expanded surgical add-on reimbursement for pediatric surgeries, yet their real-world impact remains unclear. Methods: We retrospectively analyzed pediatric surgeries (<19 years) performed at 4 tertiary institutions from 2020 to 2025. Surgeries were divided into 4 periods based on major policy changes. Variables included the number of surgeries, claimed surgical fees, patient age and weight, and eligibility for add-on reimbursement. Trends over time and variations among hospitals were examined. Results: A total of 1,959 surgeries were analyzed. Surgical volume did not significantly change across periods (P = 0.342).In contrast, total claimed surgical fees increased 1.66-fold in Period 2, 3.26-fold in Period 3, and 3.42-fold in Period 4 compared with Period 1. The proportion of surgeries eligible for add-on reimbursement rose to 76.6% in Period 4. The average claimed fee per case increased from 973,446 Korean won in Period 1 to 3,463,428 in Period 4. Patients <1,500g demonstrated the largest increase (471%). Across hospitals, the magnitude of claimed fee increases varied, but all institutions showed substantial growth in claimed surgical fees. Conclusion Stepwise expansion of pediatric surgical add-on reimbursement substantially increased claimed surgical fees across institutions without inflating surgical volume. These reforms improved financial reimbursement and may support future improvements in workforce sustainability, training, and care equity. Continuous policy monitoring will be essential to ensure long-term effectiveness and fiscal balance.

Purpose: To report the findings of a perception survey on intestinal malrotation conducted by the Korean Association of Pediatric Surgeons (KAPS) in 2021. Methods: The perceptions on intestinal malrotation regarding clinical decision making of the KAPS members were collected through web-based survey. Results: A total of 22 surgeons were answered for this study. The results were presented and discussed at the 37th annual meeting of KAPS, which was held in Seoul on June 18, 2021. Conclusion This study provides the clinical decisions of the KAPS members on the intestinal malrotation. The study is expected to be an important reference for improving pediatric surgeons’ understanding and treatment of intestinal malrotation.

Purpose: Biliary atresia (BA) is a rare but progressive cholangiopathy and the leading cause of pediatric liver transplantation worldwide. The Korean Association of Pediatric Surgeons (KAPS) has conducted three national surveys (2001, 2011, and 2023) to assess long-term trends in the diagnosis, treatment, and outcomes of BA. This study provides a comparative analysis of the 2nd and 3rd national surveys, with reference to selected findings from the 1st survey. Methods: This study included 453 patients from the 3rd national survey (2011–2021) and 435 patients from the 2nd survey (2001–2010), all of whom underwent Kasai portoenterostomy. Data were collected via electronic case report forms from pediatric surgical centers nationwide. Comparisons were made regarding demographics, clinical features, diagnostic patterns, operative details, follow-up outcomes, and survival. Kaplan–Meier analysis was used to evaluate long-term survival. Results: The mean number of BA patients per year remained stable between surveys (43.5 in the 2nd, 41.18 in the 3rd), though centralization of care increased, with 61.5% of cases managed by two major institutions in the 3rd survey. The median age at surgery decreased, and the use of preoperative imaging (especially magnetic resonance cholangiopancreatography) increased. The 10-year native liver survival rate declined from 59.8% to 53.7%, while overall 10-year survival improved slightly (92.9% to 93.2%). Postoperative complications, such as cholangitis and liver failure, persisted but were better categorized. The 3rd survey also reported improved mortality (4.9%) and reduced follow-up loss (11.5%) compared to the 2nd survey. Conclusion While overall survival after Kasai operation has remained high and even improved, native liver survival has slightly declined. The findings reflect earlier diagnosis, more consistent diagnostic imaging, and increasing centralization of care. These trends underscore the importance of long-term nationwide data collection in guiding future strategies for BA management in Korea.

Purpose: This study aims to investigate and compare the incidence, demographic characteristics, clinical manifestations, preoperative diagnostic methods, anatomical classifications, associated anomalies, operative treatments, and postoperative outcomes of patients with intestinal atresia treated by the members of the Korean Association of Pediatric Surgeons (KAPS) through three nationwide surveys. Methods: KAPS conducted 3 national surveys in 1998, 2010, and 2024 to examine the patients diagnosed with intestinal atresia. In preparation for the survey, we developed a customized case registration form to obtain data on patient sex, birth weight, gestational age, clinical manifestations, preoperative diagnostic methods, anatomical types, associated anomalies, operative treatments, and postoperative outcomes. Authorized KAPS members completed the case registration form. Results: The first, second, and third national surveys included 218, 222, and 236 individuals diagnosed with intestinal atresia, respectively. The male-to-female ratios were 1.5:1, 1.1:1, and 1.1:1, respectively. The first, second, and third national surveys revealed that 34.3%, 43.3%, and 53.4% of patients were born before 37 weeks of gestation, respectively. Additionally, 28.7%, 32.0%, and 40.7% of patients had a birth weight under 2,500 g. In the third national survey, duodenoduodenostomy was the most common procedure, performed in 70 out of 82 patients diagnosed with duodenal atresia. Resection and anastomosis were the main surgical procedures conducted in 47 out of 54 cases of jejunal atresia and 74 out of 92 cases of ileal atresia. The mortality rates in the first, second, and third national surveys were 13.8%, 3.6%, and 1.3% respectively, with the lowest rate observed in the third national survey. Conclusion These national surveys offer valuable insights into the current state of intestinal atresia, including specific surgical interventions and postoperative outcomes in South Korea. For pediatric surgeons aiming to enhance their understanding of intestinal atresia and its treatment options, these surveys could be an indispensable resource and guide.

Purpose: This study provides insights into the prevalence at birth, clinical characteristics, and outcomes of gastroschisis and omphalocele in Korea over the past decade, addressing the lack of localized data despite advanced healthcare capabilities. Methods: The study retrospectively analyzed data from 20 pediatric surgical centers in Korea from January 2012 to December 2021, including 269 patients diagnosed with gastroschisis or omphalocele. Data variables included gender, gestational age, birth weight, associated anomalies, type of defect, surgical interventions, and outcomes. Results: The study covered 269 patients, with 80 gastroschisis and 189 omphalocele cases. Gastroschisis prevalence at birth remained stable at 2.15 per 100,000 live births, while omphalocele increased to 5.08 per 100,000. Both conditions had similar gender ratios (0.95). Gastroschisis patients had lower birth weights (2,463.90±505.50 g) and smaller head circumferences (31.97±1.86 cm) compared to omphalocele patients (2,757.65±761.24 g, 32.78±2.64 cm). Omphalocele cases had more associated anomalies, especially cardiovascular issues. Prenatal diagnosis rates were high: 93.7% for gastroschisis and 86.4% for omphalocele. About 96.3% of gastroschisis and 84.1% of omphalocele patients were born in their treatment hospitals. Gastroschisis patients underwent surgery sooner (average 3.5 days) and started feeding later (16.5 days) than omphalocele patients (average 56.5 days to surgery, 6.6 days to start feeding). Hospital stays and follow-up durations were similar, averaging around 782.6 days for gastroschisis and 800.3 days for omphalocele patients. Survival rates were 89.7% for gastroschisis and 87.1% for omphalocele. Conclusion The study highlights the need for early diagnosis, centralized care, and specialized surgical approaches to optimize outcomes for gastroschisis and omphalocele patients in Korea. Enhanced prenatal screening and surgical protocols are recommended to improve these patients' prognosis.

Iliopsoas abscess (IPA) rarely occurs in newborns and infants. Symptom triad, including fever, inguinal swelling or discoloration, and limited lower limb movement, is observed in most cases. Herein, we report a case of unusual IPA in an 82-day-old boy who presented with fever as the only symptom. To our best knowledge, there have been no reports of infant IPA presenting without localizing signs. This report highlights the importance of a high degree of suspicion for timely diagnosis of infant IPA when an infant presents only with fever.

PURPOSE: To analyze clinical outcomes of sentinel lymph node (SLN) biopsy in lower extremity melanoma with dual-basin drainage on lymphoscintigraphy.METHODS: We retrospectively analyzed patients with lower extremity melanoma who underwent lymphoscintigraphy and SLN biopsy in a single center between 2006 and 2015. Gamma probe was used to detect SLNs. For dual-basin drainage, we regarded a basin that showed a two-fold greater radioactivity value than the others as a ‘dominant’ basin. SLN biopsy was performed only for the dominant basin. If two basins showed similar radioactivity, biopsy was conducted for both.RESULTS: One hundred and seven patients underwent preoperative lymphoscintigraphy, and 29 dual (popliteal, inguinal) drainages were found. Of the 29 melanomas with dual drainage, seven showed similar radioactivity on both basins, 22 showed inguinal as the dominant basin and no melanoma had a dominant popliteal basin. Among the seven patients who underwent dual-basin biopsy, six had negative results, all of which experienced no recurrence during follow-up. Among the 22 patients who underwent biopsy of the dominant inguinal basin, 19 had negative results. During the follow-up, these patients showed six recurrences, but none of them experienced popliteal recurrence. All three patients who had tumor-positive inguinal node experienced recurrence in the popliteal basin as well as at other sites.CONCLUSION: For melanomas showing dual-basin drainage on lymphoscintigraphy, performing SLN biopsy only on the dominant (inguinal) basin is reliable when the dominant basin shows negative results. However, considering the recurrence pattern of our data, a tumor-positive dominant basin should prompts an SLN biopsy of the other basin.
Biopsy ; Drainage ; Follow-Up Studies ; Humans ; Lower Extremity ; Lymph Nodes ; Lymphoscintigraphy ; Melanoma ; Radioactivity ; Recurrence ; Retrospective Studies ; Sentinel Lymph Node Biopsy