Pediatric surgery
Encyclopedia
Pediatric surgery or paediatric surgery (BE
) is a subspecialty of surgery
involving the surgery of fetuses, infants, children, adolescents, and young adults. Many pediatric surgeons practice at children's hospital
s.
Pediatric surgery arose when medical doctors recognized that children, especially infants and newborns have different medical and surgical needs compared to that of an adult. This reason for this discovery is because children have lower immunity to viruses compared to that of the adults, so children are more likely to easily catch a sickness. Also, children need overall smaller tools when getting surgery so it was specialized at children's hospitals. Children also react differently to certain treatments and they tend to need extra care, so pediatric surgery was created especially for the children so that they could be treated faster and they would have more care.
Pediatric surgery arose in the middle of the 20th century as the surgical care of birth defects required novel techniques and methods and became more commonly based at children's hospitals. One of the sites of this innovation was Children's Hospital of Philadelphia
. Beginning in the 1940s under the surgical leadership of C. Everett Koop
, newer techniques for endotracheal anesthesia
of infants allowed surgical repair of previously untreatable birth defects. By the late 1970s, the infant death rate from several major congenital malformation syndrome
s had been reduced to near zero.
Subspecialties of pediatric surgery itself include: neonatal
surgery and fetal surgery
.
Other areas of surgery also have pediatric specialties of their own that require further training during the residencies and in a fellowship: pediatric cardiothoracic (surgery on the child's heart and/or lungs, including heart and/or lung transplantation), pediatric nephrological surgery (surgery on the child's kidneys and ureters, including renal, or kidney, transplantation), pediatric neurosurgery (surgery on the child's brain, central nervous system, spinal cord, and peripheral nerves), pediatric urological surgery (surgery on the child's urinary bladder and other structures below the kidney necessary for urination), pediatric emergency surgery, surgery involving fetuses or embryos (overlapping with obstetric/gynecological surgery, neonatology, and maternal-fetal medicine), surgery involving adolescents or young adults, pediatric hepatological (liver) and gastrointestinal (stomach and intestines) surgery (including liver and intestinal transplantation in children), pediatric orthopedic surgery (muscle and bone surgery in children), pediatric plastic and reconstructive surgery (such as for burns, or for congenital defects like cleft palate not involving the major organs), and pediatric oncological (childhood cancer) surgery.
Common pediatric diseases that may require pediatric surgery include
British English
British English, or English , is the broad term used to distinguish the forms of the English language used in the United Kingdom from forms used elsewhere...
) is a subspecialty of surgery
Surgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...
involving the surgery of fetuses, infants, children, adolescents, and young adults. Many pediatric surgeons practice at children's hospital
Children's hospital
A children's hospital is a hospital which offers its services exclusively to children . The number of children's hospitals proliferated in the 20th century, as pediatric medical and surgical specialties separated from internal medicine and adult surgical specialties...
s.
Pediatric surgery arose when medical doctors recognized that children, especially infants and newborns have different medical and surgical needs compared to that of an adult. This reason for this discovery is because children have lower immunity to viruses compared to that of the adults, so children are more likely to easily catch a sickness. Also, children need overall smaller tools when getting surgery so it was specialized at children's hospitals. Children also react differently to certain treatments and they tend to need extra care, so pediatric surgery was created especially for the children so that they could be treated faster and they would have more care.
Pediatric surgery arose in the middle of the 20th century as the surgical care of birth defects required novel techniques and methods and became more commonly based at children's hospitals. One of the sites of this innovation was Children's Hospital of Philadelphia
Children's Hospital of Philadelphia
The Children's Hospital of Philadelphia is one of the largest and oldest children's hospitals in the world. CHOP has been ranked as the best children's hospital in the United States by U.S. News & World Report and Parents Magazine in recent years. As of 2008, it was ranked #1 in the nation for...
. Beginning in the 1940s under the surgical leadership of C. Everett Koop
C. Everett Koop
Charles Everett Koop, MD is an American pediatric surgeon and public health administrator. He was a vice admiral in the Public Health Service Commissioned Corps, and served as thirteenth Surgeon General of the United States under President Ronald Reagan from 1982 to 1989.-Early years:Koop was born...
, newer techniques for endotracheal anesthesia
Anesthesia
Anesthesia, or anaesthesia , traditionally meant the condition of having sensation blocked or temporarily taken away...
of infants allowed surgical repair of previously untreatable birth defects. By the late 1970s, the infant death rate from several major congenital malformation syndrome
Syndrome
In medicine and psychology, a syndrome is the association of several clinically recognizable features, signs , symptoms , phenomena or characteristics that often occur together, so that the presence of one or more features alerts the physician to the possible presence of the others...
s had been reduced to near zero.
Subspecialties of pediatric surgery itself include: neonatal
Neonatology
Neonatology is a subspecialty of pediatrics that consists of the medical care of newborn infants, especially the ill or premature newborn infant. It is a hospital-based specialty, and is usually practiced in neonatal intensive care units...
surgery and fetal surgery
Fetal surgery
Fetal surgery is any of a broad range of surgical techniques that are used to treat birth defects in fetuses who are still in the pregnant uterus.* Open fetal surgery involves completely opening the uterus to operate on the fetus....
.
Other areas of surgery also have pediatric specialties of their own that require further training during the residencies and in a fellowship: pediatric cardiothoracic (surgery on the child's heart and/or lungs, including heart and/or lung transplantation), pediatric nephrological surgery (surgery on the child's kidneys and ureters, including renal, or kidney, transplantation), pediatric neurosurgery (surgery on the child's brain, central nervous system, spinal cord, and peripheral nerves), pediatric urological surgery (surgery on the child's urinary bladder and other structures below the kidney necessary for urination), pediatric emergency surgery, surgery involving fetuses or embryos (overlapping with obstetric/gynecological surgery, neonatology, and maternal-fetal medicine), surgery involving adolescents or young adults, pediatric hepatological (liver) and gastrointestinal (stomach and intestines) surgery (including liver and intestinal transplantation in children), pediatric orthopedic surgery (muscle and bone surgery in children), pediatric plastic and reconstructive surgery (such as for burns, or for congenital defects like cleft palate not involving the major organs), and pediatric oncological (childhood cancer) surgery.
Common pediatric diseases that may require pediatric surgery include
- congenital malformationsCongenital disorderA congenital disorder, or congenital disease, is a condition existing at birth and often before birth, or that develops during the first month of life , regardless of causation...
: lymphangiomaLymphangiomaLymphangiomas are malformations of the lymphatic system, which is the network of vessels responsible for returning to the venous system excess fluid from tissues. These malformations can occur at any age and may involve any part of the body, but 90% occur in children less than 2 years of age and...
, cleft lip and palate, esophageal atresiaEsophageal atresiaEsophageal atresia is a congenital medical condition which affects the alimentary tract. It causes the esophagus to end in a blind-ended pouch rather than connecting normally to the stomach. It comprises a variety of congenital anatomic defects that are caused by an abnormal embryological...
and tracheoesophageal fistulaTracheoesophageal fistulaA tracheoesophageal fistula is an abnormal connection between the esophagus and the trachea...
, hypertrophic pyloric stenosis, intestinal atresiaAtresiaAtresia is a condition in which a body orifice or passage in the body is abnormally closed or absent.Examples of atresia include:* Imperforate anus - malformation of the opening between the rectum and anus....
, necrotizing enterocolitisNecrotizing enterocolitisNecrotizing enterocolitis is a medical condition primarily seen in premature infants, where portions of the bowel undergo necrosis .-Signs and symptoms:...
, meconium plugs, Hirschsprung's diseaseHirschsprung's diseaseHirschsprung's disease , or congenital aganglionic megacolon is a serious medical problem where the enteric nervous system is missing from the end of the bowel. The enteric nervous system is a complex network of neurons and glia that controls most aspects of intestinal function...
, imperforate anusImperforate anusAn imperforate anus or anal atresia is a birth defect in which the rectum is malformed. Its cause is unknown.-Features:There are several forms of imperforate anus:* A low lesion, in which the colon remains close to the skin...
, undescended testesCryptorchidismCryptorchidism is the absence of one or both testes from the scrotum. It is the most common birth defect regarding male genitalia. In unique cases, cryptorchidism can develop later in life, often as late as young adulthood. About 3% of full-term and 30% of premature infant boys are born with at...
,... - abdominal wall defects: omphaloceleOmphaloceleAn omphalocele is a type of abdominal wall defect in which the intestines, liver, and occasionally other organs remain outside of the abdomen in a sac because of a defect in the development of the muscles of the abdominal wall.-Presentation:The sac, which is formed from an outpouching of...
, gastroschisisGastroschisisGastroschisis represents a congenital defect characterized by a defect in the anterior abdominal wall through which the abdominal contents freely protrude. There is no overlying sac and the size of the defect is usually less than 4 cm...
, herniaHerniaA hernia is the protrusion of an organ or the fascia of an organ through the wall of the cavity that normally contains it. A hiatal hernia occurs when the stomach protrudes into the mediastinum through the esophageal opening in the diaphragm....
s,... - chestChestThe chest is a part of the anatomy of humans and various other animals. It is sometimes referred to as the thorax or the bosom.-Chest anatomy - Humans and other hominids:...
wall deformities: pectus excavatumPectus excavatumPectus excavatum is the most common congenital deformity of the anterior wall of the chest, in which several ribs and the sternum grow abnormally. This produces a caved-in or sunken appearance of the chest... - childhood tumors: like neuroblastomaNeuroblastomaNeuroblastoma is the most common extracranial solid cancer in childhood and the most common cancer in infancy, with an annual incidence of about 650 cases per year in the US , and 100 cases per year in the UK . Close to 50 percent of neuroblastoma cases occur in children younger than two years old...
, Wilms' tumorWilms' tumorWilms' tumor or nephroblastoma is cancer of the kidneys that typically occurs in children, rarely in adults.Its common name is an eponym, referring to Dr. Max Wilms, the German surgeon who first described this kind of tumor....
, rhabdomyosarcomaRhabdomyosarcomaA rhabdomyosarcoma is a type of cancer, specifically a sarcoma , in which the cancer cells are thought to arise from skeletal muscle progenitors. It can also be found attached to muscle tissue, wrapped around intestines, or in any anatomic location...
, ATRT, liver tumorLiver cancerLiver tumors or hepatic tumors are tumors or growths on or in the liver . Several distinct types of tumors can develop in the liver because the liver is made up of various cell types. These growths can be benign or malignant...
s, teratomaTeratomaA teratoma is an encapsulated tumor with tissue or organ components resembling normal derivatives of all three germ layers. There are rare occasions when not all three germ layers are identifiable...
s,... - Separation of conjoined twinsConjoined twinsConjoined twins are identical twins whose bodies are joined in utero. A rare phenomenon, the occurrence is estimated to range from 1 in 50,000 births to 1 in 100,000 births, with a somewhat higher incidence in Southwest Asia and Africa. Approximately half are stillborn, and a smaller fraction of...