Surgeons are the masters of fluids because they need to be. They care for patients who cannot eat or drink for various reasons; for example, they have hemorrhaged, undergone surgery, or lost fluids from tubes, drains, or wounds. Surgeons are obligated to know how to care for these patients, who put their lives in their hands. This topic might appear simple only for those who do…
The inflammatory response occurs following invasion by foreign microbes with direct tissue injury or in response to systemic stress such as hypothermia or hypotension. Multiple cellular pathways function simultaneously in an attempt to limit further injury and spur healing. While localized inflammatory response can be beneficial, major bodily insult can result in a dysregulated, inappropriate inflammatory response. The outcome can be catastrophic. It has become evident…
“The intimacy between patient and surgeon is short-lived, but closer than between a son and his own father.” Aleksandr Solzhenitsyn, Cancer Ward The privilege of opening the body of another to manipulate, remove, repair, or implant is a profound endeavor for both the surgeon and patient. The medical team viscerally bears witness to parts of the body the patient never sees. The surgeon’s practice, a culmination…
Access the accompanying videos for this chapter online. Available on ExpertConsult.com . The treatment of pectus carinatum has evolved in the last two decades. Nowadays, the first line of treatment is a nonoperative remodeling of the chest by means of dynamic compression. This approach has increased the number of patients interested in receiving treatment for their chest deformity, and consultations for treatment of this condition have…
Access the accompanying videos for this chapter online. Available on ExpertConsult.com . Pectus excavatum is a depression of the anterior chest wall. It can be present at birth or may develop during childhood or early adolescence. The depression usually gets deeper as the child grows. During puberty, the deformity can worsen precipitously in as little as 6 months. Patients with a mild or moderate excavatum are…
Access the accompanying videos for this chapter online. Available on ExpertConsult.com . Both patent ductus arteriosus (PDA) and vascular rings often require surgical treatment. Persistent PDAs can lead to congestive heart failure, failure to thrive, and pulmonary hypertension as well as an increase in the risk for developing endocarditis. As such, intervention should be pursued when detected. Since surgical ligation of a PDA was first successfully…
Access the accompanying videos for this chapter online. Available on ExpertConsult.com . Aortopexy is indicated in young patients with life-threatening tracheal obstruction secondary to severe tracheomalacia. The tracheomalacia may be primary or secondary. The secondary form is often seen in combination with esophageal atresia (EA) and vascular rings. It has also been described in combination with congenital heart disease. Symptoms vary from mild and not requiring…
Access the accompanying videos for this chapter online. Available on ExpertConsult.com . Esophageal atresia (EA), with or without a tracheoesophageal fistula (TEF), is one of the more uncommon congenital anomalies, occurring in 1 in 5000 births. These newborns present shortly after birth because of an inability to pass an orogastric tube, respiratory distress, or an inability to tolerate feeding. The condition may be associated with other…
Access the accompanying videos for this chapter online. Available on ExpertConsult.com. Management of anterior and middle mediastinal masses in children often depends on obtaining tissue for diagnosis. Conversely, most posterior mediastinal masses require resection. Historically, several modalities have been available, including percutaneous fine-needle aspiration, mediastinoscopy, mediastinotomy, thoracotomy, and sternotomy. In recent years, the indications for thoracoscopy have expanded in adult and pediatric patients. Initial reports focused…
Access the accompanying videos for this chapter online. Available on ExpertConsult.com . Indications for Workup and Operation Thoracoscopy is now the preferred approach for the operative treatment of primary spontaneous pneumothorax (PSP) due to ease of operation and patient tolerance, with minimization of postoperative pain and good results. PSP is a pneumothorax that develops outside of an underlying preexisting pulmonary disease, such as malignancy or trauma,…
Access the accompanying videos for this chapter online. Available on ExpertConsult.com . Empyema thoracis is a collection of inflammatory fluid in the thoracic cavity. It usually arises as a complication of pneumonia, but it may also result from trauma, subdiaphragmatic infections, immunodeficient conditions, neoplastic processes, and other inflammatory states. Empyema formation annually occurs in 2% to 8% of children hospitalized for pneumonias. The progression of empyema…
This chapter discusses the minimally invasive repair of a Bochdalek (posterolateral) congenital diaphragmatic hernia (CDH) and an anterior Morgagni diaphragmatic hernia. Bochdalek Diaphragmatic Hernia Bochdalek hernias develop in early gestation and are located in the posterolateral aspect of the diaphragm. They are associated with pulmonary hypoplasia and pulmonary hypertension. These two factors conspire to create the major morbidity of respiratory failure associated with this fragile patient…
Access the accompanying videos for this chapter online. Available on ExpertConsult.com . Thoracoscopy was first described in the early 1900s, and by the mid-1990s, thoracoscopic lung biopsy had become accepted as a superior technique for obtaining tissue in cases of interstitial lung disease or malignancy. Thoracoscopy has also become the preferred approach in the treatment of most mediastinal masses in children. However, the thoracoscopic approach for…
Access the accompanying videos for this chapter online. Available on ExpertConsult.com . The need to obtain diagnostic lung tissue occurs often in infants and children. Disease processes such as interstitial lung disease (ILD), infectious lung disease, and metastatic lung lesions may require histologic examination for diagnosis and treatment. The ability to obtain these specimens thoracoscopically has greatly decreased the morbidity associated with open lung biopsy. Moreover,…
Although thoracoscopy was first described in the early 1900s, the minimally invasive approach to thoracic conditions has undergone an exponential increase in popularity and growth over the last two decades. In the 1970s and 1980s, the first significant experience with thoracoscopy in children was reported by Brad Rodgers. In these reports, equipment modified for pediatric patients was used to perform lung biopsies, evaluate various intrathoracic lesions,…
Vesicoureteral reflux (VUR) is one of the most common urological problems in infants and young children, resulting from an incompetent ureterovesical junction (UVJ) that allows abnormal retrograde flow of urine from the bladder to the upper urinary tract. Several studies have reported an incidence between 0.4% and 1.8%. VUR predisposes to urinary tract infections (UTIs) and can lead to potential problems including renal scarring, loss of…
Access the accompanying videos for this chapter online. Available on ExpertConsult.com . The use of laparoscopy in pediatric urology has evolved over the past 30 years. Beginning in the 1980s, with diagnostic laparoscopy for cryptorchidism, indications have expanded from straightforward laparoscopic procedures such as ligation of the spermatic vessels to extirpative procedures, with the first laparoscopic nephrectomy being reported in an adult patient in 1991. In…
Access the accompanying videos for this chapter online. Available on ExpertConsult.com . Robotic surgery is a well-established technology in all surgical specialties. An enormous variety of cases have been accomplished with robotic technology in general surgery, urology, gynecology, and otolaryngology. Pediatric surgery has lagged in the adoption of this technology, largely due to the high cost of the equipment and the limitations the larger instrumentation poses…
Access the accompanying videos for this chapter online. Available on ExpertConsult.com . Inguinal hernia repair is one of the most commonly performed operations in children. The open inguinal approach is an excellent method for repair but has the potential risk of injury to the spermatic cord and vas deferens, development of hematomas, wound infections, iatrogenic cryptorchidism, testicular atrophy, and recurrence. For many surgeons, laparoscopy has become…
Access the accompanying videos for this chapter online. Available on ExpertConsult.com . Approximately 8% of adolescents (12 to 19 years of age) in the United States suffer from severe obesity, with a significant proportion affected by obesity-associated comorbidities. Nonoperative strategies to treat obesity include lifestyle and behavioral modifications. However, these approaches rarely result in durable weight loss or resolution of comorbidities. Bariatric surgery, on the other…