Paediatric surgeryBMJ 1999; 318 doi: https://doi.org/10.1136/bmj.318.7199.1668 (Published 19 June 1999) Cite this as: BMJ 1999;318:1668
- Paul D Losty, senior lecturer. (Paul.Losty@rlchtr.nwest.nhs.uk)
- Department of Paediatric Surgery, Institute of Child Health, Alder Hey Children's Hospital, Liverpool L12 2AP
- Accepted 8 January 1999
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.
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
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
Cystic lung lesions
Renal tract disease
Congenital diaphragmatic hernia
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 …