{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T15:40:37Z","timestamp":1789486837674,"version":"build-2803163510"},"reference-count":10,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T00:00:00Z","timestamp":1785801600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T00:00:00Z","timestamp":1785801600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>In low\u2010 and middle\u2010income countries (LMIC), pediatric surgical care remains concentrated in urban tertiary centers, resulting in delayed access for rural populations. To address this inequity, we established an academic pediatric surgery department within a secondary\u2010level regional hospital in Zaghouan, Tunisia, serving a broad underserved catchment area. Operating without dedicated pediatric infrastructure or pediatric anesthesiology services, we implemented a \u201cservice without walls\u201d model by embedding pediatric surgery within an existing adult surgical department. Adult wards and perioperative systems were adapted through close collaboration with anesthesia teams, and a strict triage system was implemented to ensure safe case selection. Since its establishment, the department has demonstrated a significant increase in activity, with an 84% rise in annual surgical volume (361 procedures in 2025) and a tripling of inpatient admissions. The service now manages a wide spectrum of pediatric surgical conditions locally, including emergencies and selected complex cases, while high\u2010risk neonates are stabilized and referred. No perioperative mortality occurred, and postoperative morbidity was limited to 3% consisting of minor wound\u2010related complications. Our experience demonstrates that establishing a regional surgical hub does not require waiting for flawless infrastructure. By embedding pediatric surgery within existing adult surgical infrastructure, implementing collaborative perioperative protocols, and using triage\u2010based risk management, safe pediatric surgical care can be successfully decentralized in resource\u2010constrained settings. This model provides a scalable framework for improving access to pediatric surgical care in similar LMIC settings.<\/jats:p>","DOI":"10.1002\/wjs.70514","type":"journal-article","created":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T11:28:54Z","timestamp":1785842934000},"page":"2699-2703","source":"Crossref","is-referenced-by-count":0,"title":["From Barriers to Solutions: Establishing an Academic Pediatric Surgical Hub in an Underserved Region of Tunisia"],"prefix":"10.1002","volume":"50","author":[{"given":"Saida","family":"Hidouri","sequence":"first","affiliation":[{"name":"Department of Pediatric Surgery Zaghouan Hospital  Zaghouan Tunisia"},{"name":"Faculty of Medicine of Monastir University of Monastir  Monastir Tunisia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2518-3555","authenticated-orcid":false,"given":"Saida","family":"Sakhri","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology Salah Azaiez Institute  Tunis Tunisia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yosra","family":"Elmansouri","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery Zaghouan Hospital  Zaghouan Tunisia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Najla","family":"Feriani","sequence":"additional","affiliation":[{"name":"Department of Adult Surgery Zaghouan Hospital  Zaghouan Tunisia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabrine Ben","family":"Ammar","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery Zaghouan Hospital  Zaghouan Tunisia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,4]]},"reference":[{"key":"e_1_2_14_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(15)60160\u2010X"},{"key":"e_1_2_14_3_1","volume-title":"Essential Surgery","author":"World Bank","year":"2015"},{"key":"e_1_2_14_4_1","doi-asserted-by":"publisher","DOI":"10.2471\/blt.15.159293"},{"key":"e_1_2_14_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.11044"},{"key":"e_1_2_14_6_1","volume-title":"Strat\u00e9gie Alternative de d\u00e9veloppement de la Tunisie","author":"Ben Jelili R.","year":"2024"},{"key":"e_1_2_14_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/hpm.3632"},{"key":"e_1_2_14_8_1","volume-title":"Carte Sanitaire de la Tunisie 2020\u20132021","author":"Minist\u00e8re de la Sant\u00e9 (Tunisie)","year":"2021"},{"key":"e_1_2_14_9_1","doi-asserted-by":"publisher","DOI":"10.1136\/wjps\u20102025\u2010001084"},{"key":"e_1_2_14_10_1","doi-asserted-by":"publisher","DOI":"10.3389\/fped.2023.1189676"},{"key":"e_1_2_14_11_1","doi-asserted-by":"publisher","DOI":"10.1055\/s\u20100037\u20101604399"}],"container-title":["World Journal of Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/wjs.70514","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/wjs.70514","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/wjs.70514","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T13:23:55Z","timestamp":1789478635000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/wjs.70514"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,4]]},"references-count":10,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1002\/wjs.70514"],"URL":"https:\/\/doi.org\/10.1002\/wjs.70514","archive":["Portico"],"relation":{},"ISSN":["0364-2313","1432-2323"],"issn-type":[{"value":"0364-2313","type":"print"},{"value":"1432-2323","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,4]]}}}