This article is based on the Hugh Greenwood Lecture delivered at the 2026 Congress of the British Association of Paediatric Surgeons. Childhood injury remains one of the leading causes of death and disability worldwide, disproportionately affecting children in low- and middle-income countries despite the availability of effective prevention strategies. This paper argues that paediatric surgeons have an important role that extends beyond the operating theatre and presents a practical roadmap for reducing childhood injury based on the public health approach to injury prevention. Seven interdependent pillars are proposed: surveillance, risk factor identification, intervention development, implementation, trauma system strengthening, evaluation and advocacy. Together, these provide a framework for translating evidence into sustained reductions in childhood injury through contextually appropriate prevention, stronger trauma systems and leadership from the paediatric surgical community. EVIDENCE LEVEL: Level V.

Since the first laparoscopic splenectomy in 1991, splenic surgery has evolved steadily toward minimally invasive techniques, which now represent the gold standard for most indications. In children, the principal indications remain hemolytic disorders, mainly sickle cell disease and hereditary spherocytosis, for which the optimal timing of surgery and the choice between partial and total splenectomy continue to be debated. Two laparoscopic approach, anterior and posterior, are described, each dictating a specific patient position, dissection sequence, and trocar placement. Teaching the procedure is facilitated by dividing it into defined operative steps, distinguishing "fast steps," which are technically straightforward and reproducible, from "slow steps," which demand caution and should be taught only once the trainee is proficient. Adhering to a fixed sequence helps prevent complications. The two principal postoperative complications, acute chest syndrome and post-splenectomy infection, are reviewed. Shorter operative times and inadequate mobilization of the pancreatic tail appear associated with acute chest syndrome. Contemporary French national data confirm that a substantial proportion of splenectomy, roughly one-fifth of total and nearly one-third of partial procedure, are still performed open, underscoring that open surgery remains indispensable for emergency hemostasis, malignancy, massive splenomegaly, and conversion of a minimally invasive operation. Yet training now focuses almost exclusively on minimally invasive techniques, while robotic platforms raise the further question of whether robotic splenectomy should be taught to trainees who have never performed an open procedure. Modern pediatric surgical training must therefore remain comprehensive and structured, preserving fundamental open skills alongside laparoscopic and robotic proficiency.

The aim of this study was to compare outcomes of neonates born at 22-24 weeks of gestational age (GA) to those born at 25-26 weeks GA after emergent surgeries to determine the association between GA and post-operative mortality and morbidity.