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    javeriaj@stanford.edu
    University - Scholar Department: Surgery Position: Postdoctoral Scholar

All Publications

  • Single-Stage Surgical Management Versus Conventional Two-Stage Management for Pediatric Choledocholithiasis: A Systematic Review and Meta-Analysis. Journal of pediatric surgery Nasim, M. T., Nasim, M. T., Rao, A. G., Javed, J., Athavan, S., Tahan, D., Fatimi, A. S., Thobani, H., Ehsan, A. N., Iqbal, B., Islam, S., Tirrell, T. F., Khan, F. A. 2026: 163412

    Abstract

    The prevalence of pediatric choledocholithiasis is rising, yet the optimal management strategy remains uncertain. Pediatric practice has traditionally favored a two-stage strategy of endoscopic retrograde cholangiopancreatography (ERCP) for ductal clearance followed by interval laparoscopic cholecystectomy. Single-stage management, combining laparoscopic cholecystectomy with either laparoscopic common bile duct exploration (LC-LCBDE) or intraoperative ERCP (LC-ERCP), offers a potential alternative. This meta-analysis aimed to compare the safety and efficacy of single-stage versus two-stage management in children.A PRISMA-compliant systematic review was registered with PROSPERO (CRD420251169007). PubMed, Embase, and Scopus were searched from inception through October 13, 2025. Primary outcomes were postoperative complication rate and length of hospital stay (LOS). Random-effects meta-analysis was performed.Eight retrospective cohort studies comprising 562 pediatric patients (single-stage: 278, conventional: 284) met inclusion criteria. Compared to conventional two-stage management, LC-LCBDE was associated with significantly fewer complications (OR: 0.21, [95% CI: 0.08, 0.60]), reduced pancreatitis (OR:0.27, [95% CI: 0.09, 0.88]), and a shorter LOS (MD: -1.46 days, [95% CI: -2.35, -0.56]), but a greater need for additional procedures (OR: 5.86, [95% CI: 1.05, 32.7]). LC-ERCP was associated with a significantly shorter anesthesia duration (MD: -25.5 minutes, [95% CI: -49.0, -2.0]) but otherwise did not differ significantly from conventional management. Readmission rates did not differ between groups.Single-stage management, particularly transcystic LC-LCBDE combined with cholecystectomy, represents a viable alternative associated with fewer complications and shorter length of stay. Treatment decisions should be guided by multidisciplinary evaluation and institutional expertise to ensure safe, definitive stone clearance.

    View details for DOI 10.1016/j.jpedsurg.2026.163412

    View details for PubMedID 42637088

  • Optimizing Resource Utilization in Low- and Middle-Income Country NICUs: A Clinical Audit of Surgical Infection Screening Practices at a High-Volume NICU in Pakistan. Pakistan journal of medical sciences Thobani, H., Durrani, R., Khan, M. O., Javed, J., Sajjad, S., Iftikhar, Z., Soomro, M. A., Qazi, S., Khan, F. A., Islam, S. 2026; 42 (411AASC): S21-S27

    Abstract

    Post operative sepsis in neonates is a serious problem that may be challenging to diagnose. It is standard practice at our Neonatal Intensive Care Unit (NICU) in Pakistan to perform routine Blood Cultures (BLCS) and C-Reactive Protein (CRP) to screen for post-operative sepsis. We aimed to review this practice to investigate its effectiveness at screening for post-operative sepsis.All neonates admitted to the NICU post-operatively at our center from 2017-2022 were included. Relevant clinical and demographic data were collected. The sensitivity of BLCS was calculated for each post-operative day (POD) and an ROC curve was constructed for overall CRP values to quantify their screening value.A total of 109 post-operative neonates were included (median gestational age 37 weeks, birth weight 2.4kg). Thirteen (12.6%) developed sepsis. Only two patients had pathological microbe growth on POD 0 or 1, both having growth preoperatively. BLCS sensitivity increased significantly after POD 2. CRP performed poorly at discriminating post-operative sepsis (AUROC=0.55).Routine BLCS performed immediately after surgery did not predict the onset of post-operative sepsis. CRP performed poorly at discriminating post-operative sepsis, likely due to physiologic inflammation in post-operative neonates. Unnecessary screening tests represent a significant financial burden in LMICs, with little clear clinical benefit.

    View details for DOI 10.12669/pjms.42.(11AASC).15734

    View details for PubMedID 42136778

    View details for PubMedCentralID PMC13169989