Transplantation

This chapter begins with an introduction to transplant surgery with its intriguing history and development as a specialty. The general principles of biological rejection are covered on a background of immunology and immunosuppression. Clinical transplants in children are detailed with the first and most well-established being renal transplantation . The causes of end-stage renal failure are listed with further details of preparation, the operation itself, and potential complications. Cardiac transplantation is fully discussed, including indications, contraindications, the role of mechanical support, surgery for the donor and the recipient, complications, and postoperative management. Liver transplantation is covered in detail, including listing for a transplant, choice of a suitable donor, the surgical procedure, and outcomes and complications. Finally, intestinal transplantation is covered with discussion on indications, potential complications, and outcomes.

Trauma

This chapter covers trauma and the mechanisms of injury (blunt, penetrating, and burns or scalds), grading of injury severity, and initial management. The incidence, clinical features, and management of thoracic and abdominal trauma, including specific organ injury, and blast injuries are all described. The concepts of damage control resuscitation (DCR) and damage control surgery (DCS); organ injury scaling (OIS), blunt and penetrating trauma, compression injury to the chest; pneumothorax; liver injury; splenic injury: and intestinal injury are detailed. The role of contrast-enhanced ultrasound (CEUS) and endoscopic retrograde cholangiopancreatography (ERCP) is emphasized in liver and splenic injury. Blast injuries affecting children are also reviewed.

Urology

This chapter covers urological issues in the paediatric patient. This includes not only common conditions such as phimosis and paraphimosis, undescended testes, the acute scrotum, and varicocele. The spectrum of hypospadias is reviewed with a number of modern surgical operations described in detail. Other major urological conditions such as renal anomalies, urinary tract stones and obstruction, and vesico-ureteric reflux are reviewed with an algorithmic approach to diagnosis and management. There is an in-depth review and clear management guidelines offered for rarer urological conditions such as prune belly syndrome, posterior urethral valves, bladder exstrophy, and disorders of sexual development.

General considerations

This chapter covers the general considerations in safely and effectively performing paediatric surgery. It starts with the ethical and legal requirements, including withdrawal of treatment, treating children in the Jehovah’s Witness faith, and safeguarding. It then outlines evidence-based medicine, including meta-analysis, statistics, and reporting trials. Transport of the sick child, anaesthesia, analgesia, intensive care, sepsis, and the use of antibiotics in children are all covered. Day-case surgery, from its history to indications, pre- and postoperative care, and proper documentation, is described. Pre-assessment, care of the neurologically impaired child, basics of vascular access and radiology, and nutrition in the surgical patient are all covered.

Introduction

Paediatric surgery is the surgical care of children from fetus to adolescent. It is a comparatively new surgical specialty, only formally recognized after the Second World War. This chapter provides a history and overview of the specialty, including the associations related to paediatric surgery, and biographies of famous surgeons who contributed to the field throughout their careers. The main organization in the United Kingdom is the British Association of Paediatric Surgeons (BAPS) founded in 1953 with Sir Denis Browne as the first president. Though based in London, it now has many international contacts and, through its conferences and symposia inside and outside the United Kingdom, is a leading educational provider in the specialty.

Associated specialties

This chapter covers other specialties that can overlap with paediatric surgery. It covers, therefore, gynaecology, cleft lip and palate surgery, otorhinolaryngology, orthopaedics, cardiology, neurosurgery, and vascular malformations. Among the specific subjects within are labial adhesions and ovarian cysts; choanal atresia, dermoid cysts, obstructive sleep apnoea, tonsillitis, laryngomalacia, airway foreign bodies and tracheostomy; the ‘limping child’, developmental dysplasia of the hip and slipped capital femoral epiphysis; cardiac failure and arrhythmias in children, and endocarditis; ventricular shunts, hydrocephalus, traumatic brain injury, brain tumours and abscesses; and finally haemangiomas and vascular tumours. The sections are written by specialists in the field with the non-specialist in mind.

Common operations

This chapter describes and illustrates key common operations in the paediatric patient. These include circumcision, the drainage of soft tissue abscesses, common nerve injuries, open and laparoscopic inguinal hernia repair, orchidopexy and scrotal exploration, laparotomy, minimally invasive access, pyloromyotomy, laparoscopic fundoplication, appendicectomy, intestinal anastomosis and stomas, and thoracotomy and thoracoscopy. The aim was to include a structured approach to guide the junior trainee in their performance—given that all operations no matter how complex they appear initially are simply a series of steps which when taken together lead to a logical whole. Though obviously not common, the principles behind robotic surgery are described.

Children’s surgery

This chapter covers the clinical features, decision making, aetiology, pathophysiology, and management of a broad range of surgical conditions that may occur in children and require operative intervention. First, the relevant symptoms are described including vomiting, dysphagia, vomiting, bleeding, the ingestion of foreign bodies, constipation, and jaundice. Then the surgical pathology itself is considered in detail with individual sections on head and neck lesions, thyroid disease, tumours, oesophageal disorders, appendicitis, inflammatory bowel disease, choledochal malformations, intussusception, short bowel syndrome, rectal prolapse, abdominal wall hernias, and bariatric surgery among others. Where appropriate, the details of the surgical operations are described.

Neonatal medicine

Paediatric surgeons are key members of a multidisciplinary team where neonates are concerned and pre- and postoperative care needs to be optimal to achieve the best outcome. This chapter provides a background for medical care of the surgical neonate and begins with infant statistics, including definitions in the field, current UK birth trends, and live birth and mortality rates. The assessment, diagnosis, and treatment of newborn respiratory distress and neonatal ventilation (including indications for extracorporeal membrane oxygenation (ECMO)) are covered. The range of infant formula milks and nutritional requirements are described. Use and indications for antibiotics are given with a standardized dosage chart designed specifically for neonates is tabulated.

Tropical and overseas surgery

This chapter looks at a new aspect of paediatric surgery: that of global paediatric surgery and the provision of surgical services in constrained settings, with a focus on populations that are ordinarily neglected and vulnerable. It outlines challenges that give rise to disparities in outcome, such as lack of human resources, infrastructure, and equipment, as well as potential solutions. We have included individual sections from areas falling under the umbrella term global paediatric surgery to highlight variation and contrast different needs and requirements. So, specifics of paediatric surgery in regions, such as West Africa, East Africa, South Africa, and India are highlighted.