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ABSTRACT: Like many innovations in surgery, implementing enhanced recovery after surgery (ERAS) programs in pediatric surgery has lagged behind its adult counterpart. Our institutions have recently made a concerted effort to introduce and implement ERAS widely throughout the Department of Pediatric Surgery, which includes 10 surgical specialties. Our strategy revolved around the early inclusion of all stakeholders, significant educational efforts, and creating a roadmap for development and implementation of ERAS programs. It culminated in the first Canadian pediatric ERAS conference, which was held in Montreal on April 28, 2023, and served as a launching pad for instituting an ERAS culture in our hospital. Throughout the process, we identified specific themes that helped emphasize the rationale for pediatric ERAS programs and kept stakeholders engaged in the efforts. In this paper, we share these strategies and themes, believing they can aid other pediatric institutions seeking to initiate an ERAS culture.Level of evidence: V

Calcifying fibrous tumor is a rare benign tumor that occurs in multiple locations, and originates from the subcutaneous and deep soft tissues. There are some reported adult cases of multiple or disseminated calcifying fibrous tumors of the pleura. We are reporting the first case of multiple calcifying fibrous tumors of the pleura in a 15 year old girl presenting with cyclical chest pain, with possible hormonal influence.

Perineal hernias can occur primarily or secondary to a pelvic operation. Among primary perineal hernias, the congenital type is very rare, with less than 10 cases reported in the literature. This is a case report of a healthy female child presenting with a congenital posterior perineal hernia who underwent successful delayed operative repair using a perineal approach. Level of evidence: Level V – case report. Keywords: Perineal hernia, Pelvic hernia, Congenital, Rare hernia, Rectal hernia

Background: Anecdotal evidence and a handful of literature reports suggest that the outcome for infants born with gastroschisis in many African countries is poor when compared to Western nations. We wished to evaluate current management strategies and outcomes in African and Western units that treat infants with gastroschisis. Patients and Methods: We conducted a retrospective review of case-notes for infants with gastroschisis who presented to a hospital between 1 January 2004 and 31 December 2007. There were five participating centres, divided for analysis into an African cohort (three centres) and a Western cohort (two centres). Results: Fewer infants presented to a hospital with gastroschisis in the African cohort when compared to the Western cohort, particularly when the size of catchment area of each hospital was taken into account. The physiological state of the infant on presentation and management strategy varied widely between centres. Primary closure, preformed silo and surgical silo with delayed closure were all utilised in the African cohort. Use of the preformed silo and delayed abdominal wall closure was the strategy of choice in the Western cohort. The 30-day mortality was 23% and 1% respectively. This primary outcome measure varied considerably in the African cohort but was the same in the two Western units. Conclusions: Gastroschisis in the African cohort was characterised by fewer infants presenting to a hospital and a more variable outcome when compared to the Western cohort. A detailed epidemiological study to determine the incidence of gastroschisis in African countries may provide valuable information. In addition, interventions such as prompt resuscitation, safe neonatal transfer, the use of the preformed silo and parenteral nutrition could improve outcomes in infants with gastroschisis.