An Analysis of a Congress Series: Distribution of Pediatric Surgery Topics in WOFAPS World Congresses and Their Changes Over Time

Technical Summary: Analysis of Pediatric Surgery Topics in WOFAPS World Congresses (2016–2025)

Problem Statement
Access to appropriate surgical treatment remains a critical global health disparity, with an estimated 5 billion people lacking access and 30% of global diseases requiring surgical solutions. This issue disproportionately affects low- and middle-income countries (LMICs), where access to surgical care is limited to only 3–8% of the population. Pediatric surgery faces unique challenges, including high mortality rates from untreated surgical conditions and the lifelong impact of disabilities resulting from delayed intervention. While the World Federation of Associations of Pediatric Surgeons (WOFAPS) serves as a primary platform for international cooperation and knowledge sharing, there is a need to systematically analyze the distribution of topics presented at its World Congresses to understand evolving priorities, training needs, and global surgical burdens. This study addresses the gap in bibliometric data regarding the specific thematic focus and temporal trends of pediatric surgery presentations over a decade.

Methodology
The study employed a bibliometric and trend analysis approach using presentation data from four WOFAPS World Congresses held in 2016, 2019, 2022, and 2025.

• Data Collection: Presentation data were extracted directly from congress programs and compiled into an Excel dataset.
• Classification: Topics were categorized under 65 distinct serial headings, ranging from specific congenital anomalies (e.g., anorectal malformations, Hirschsprung disease) to general procedures, trauma, oncology, and minimally invasive techniques. Cross-disciplinary presentations (ENT, neurosurgery, anesthesia) were classified under "Treatments, unclassified" where overlaps occurred.
• Statistical Analysis: The authors calculated total presentation counts per year, mean presentations per topic, and yearly percentage changes between consecutive congresses. Standard deviation was used to assess data variation. All calculations were performed manually and via Excel functions to ensure objective reflection of congress trends.

Key Contributions and Results
The analysis identified a total of 2,571 presentations across the four congresses. The distribution by year showed a fluctuating but generally increasing trend: 702 (2016), 450 (2019), 614 (2022), and 805 (2025). The 2019 decrease was noted, potentially influenced by external factors such as the global pandemic, though this was not directly measured.

Top Priority Topics:
The ten most frequent topics, representing the core focus of the congresses, were:

1. Trauma (all types): 157 presentations (highest volume).
2. General Hospital Procedures: 147 presentations (includes unclassified overlaps).
3. Small Bowel Obstructions: 112 presentations.
4. Appendicitis: 108 presentations.
5. Laparoscopy and Robotics: 105 presentations.
6. Anorectal Malformations: 105 presentations.
7. Kidney Diseases: 86 presentations.
8. Hirschsprung Disease: 79 presentations.
9. Hypospadias: 76 presentations.
10. Thoracic Surgery: 75 presentations.

Temporal Trends:

• Emergency and Common Conditions: Trauma, emergency conditions, and common surgical procedures (e.g., appendicitis, bowel obstructions) remained prominently represented, reflecting their high frequency and urgency.
• Minimally Invasive Surgery (MIS): Laparoscopy and robotics showed a fluctuating trend, with a sharp decline from 2016 to 2019 followed by a recovery, suggesting variable adoption or reporting cycles rather than a linear increase.
• Congenital Anomalies and Oncology: Topics such as anorectal malformations, Hirschsprung disease, and oncological conditions (e.g., Wilms tumor, neuroblastoma) maintained relatively stable interest, indicating their status as foundational pillars of pediatric surgery.
• Low-Frequency Topics: The lowest average annual presentations were observed for Ulcer (0.25), Septicemia (0.25), Surgery and Finance (0.50), Typhoid intestinal perforation (0.75), and Bariatrics (0.75).

Significance and Claims
The authors assert that this analysis provides a data-based framework for understanding the evolution of pediatric surgery. The findings highlight that WOFAPS congresses prioritize emergency conditions and common surgical problems, alongside minimally invasive techniques and congenital anomalies.

The paper claims these findings may assist in:

• Guiding future training priorities and identifying gaps in surgical education.
• Defining research directions and global surgical needs, particularly for LMICs where trauma and infectious complications are prevalent.
• Informing resource allocation and policy development to reduce global health inequalities.

The study concludes that WOFAPS congresses serve not only as platforms for knowledge sharing but as strategic tools that reflect the global evolution of the field. The authors emphasize the need for continuous evaluation of activity areas within the organization to support underdeveloped regions and improve surgical capacity. They advocate for increased international collaboration and quality improvement projects (such as NSQIP-Pediatric) to address the surgical burden in child health.

Limitations
The authors acknowledge several limitations: the analysis is restricted to four congresses and may not fully capture all global trends; missing data (empty cells) may affect total calculations; topic classification involves some subjectivity; and the 2025 data may be estimative. Furthermore, external factors influencing presentation numbers were not directly measured.