Clinical Review Recent advances

Paediatric surgery

BMJ 1999; 318 doi: https://doi.org/10.1136/bmj.318.7199.1668 (Published 19 June 1999) Cite this as: BMJ 1999;318:1668
  1. Paul D Losty, senior lecturer. (Paul.Losty@rlchtr.nwest.nhs.uk)
  1. Department of Paediatric Surgery, Institute of Child Health, Alder Hey Children's Hospital, Liverpool L12 2AP
  • Accepted 8 January 1999

Introduction

Paediatric surgery—the surgical care of children from the fetus to adolescent—is a comparatively new surgical specialty, which began shortly after the second world war. 1 2 Pioneering work during the formative years of the specialty has enabled many lethal congenital malformations to be corrected. The surgical treatment of childhood disease has also progressed enormously. This review focuses on recent advances in paediatric surgery and its relation with scientific research, which is rapidly translating state of the art care from research to the patient.

Summary points

Exploring mechanisms to modulate abnormal fetal development pharmacologically may provide alternatives to fetal surgery and invasive fetal interventions

Progress in neonatal surgery has resulted in the survival of children with many types of congenital lethal malformations

Advances in paediatric gastroenterology include a greater understanding of biological mechanisms regulating normal and abnormal gut motility

New treatments are needed to induce biological regression of tumours and tumour maturation

Several laparoscopic techniques are now feasible, safe, and effective

Future developments include tissue engineering, antiangiogenic agents,scarless healing, in utero gene replacement, and treatments with growth factors

Methods

This article is based on a personal awareness of developments in paediatric surgery and relevant contributions from major paediatric surgical journals, review articles, and the proceedings from meetings of various international associations.

Fetal surgery and interventions

The close liaison between paediatric surgeons and colleagues in fetomaternal medicine enabled fetal defects to be diagnosed with ultrasonography and the clinical course and pathophysiology of many of these disorders to be observed (box).

Fetal malformations detected by antenatal ultrasonography

  • Spina bifida and hydrocephalus

  • Gastroschisis

  • Oesophageal atresia

  • Exomphalos

  • Cystic lung lesions

  • Renal tract disease

  • Congenital diaphragmatic hernia

  • Bladder exstrophy

  • Cardiac defects

  • Cloacal exstrophy

  • Duodenal atresia

The antenatal detection of a fetal structural abnormality often entails referral to a paediatric surgeon, who can counsel parents and discuss the likely outcomes for the fetus. For some structural abnormalities, such as the …

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