Pediatric Surgery Digest

Preface
Synopsis
Acknowledgments to Previous Contributors
In Memory of the Following Contributors
List of Figure Sources
Contents
Contributors
Part I: Introduction
	1: Introduction
		1.1	 What Is Pediatric Surgery?
		1.2	 Pediatric Surgery Training Curriculum
		1.3	 Timing of Operations in Pediatric Surgical Patients
		1.4	 Preoperative Management
			1.4.1	 Medical History
			1.4.2	 Clinical Status
			1.4.3	 Laboratory Examinations
			1.4.4	 Additional Diagnostic Measures
			1.4.5	 Special Diagnostic Measures (as Indicated by the Suspected Diagnosis)
			1.4.6	 Contraindications for Elective Surgical Procedures
			1.4.7	 Emergency Measures
			1.4.8	 Transportation of High-Risk Pediatric Surgical Patients
		1.5	 The Newborn as a Pediatric Surgical Patient
			1.5.1	 Definition of the Newborn Period
			1.5.2	 Classification According to Birth Weight (Fig. 1.2)
			1.5.3	 Organ Function Changes After Birth
Part II: General Considerations
	2: Enteral/Parenetral Nutrition in Infants and Children
		2.1	 Nutrition of the Newborn
			2.1.1	 Definition
			2.1.2	 Energy Needed in the First Year of Life
			2.1.3	 Vitamin D Prophylaxis
			2.1.4	 Vitamin K Prophylaxis
			2.1.5	 Intolerant Feeding
			2.1.6	 Oral Nutrition in Cases of Diarrhea and Dysentery
			2.1.7	 Nasogastric or Nasojejunal Feeding
			2.1.8	 Enteral Nutrition Controlled by a Pump System
		2.2	 Vascular Access in Infants and Children
			2.2.1	 General Considerations
			2.2.2	 Insertion Techniques for Central Vein Lines
			2.2.3	 Peripheral Venous Access
			2.2.4	 Central Venous Access
			2.2.5	 Surgical Technique
			2.2.6	 Anesthetic Technique
			2.2.7	 Access in an Emergency
			2.2.8	 Central Line Catheter Types: Advantages and Disadvantages
			2.2.9	 Central Line Care
			2.2.10	 Complications
		2.3	 Parenteral Nutrition
			2.3.1	 Indications
			2.3.2	 Aim
			2.3.3	 Complications
			2.3.4	 Pharmaceutical Incompatibility
			2.3.5	 Basic Demand
			2.3.6	 Correction of Fluid Balance
			2.3.7	 Electrolyte Basic Demand
			2.3.8	 Selection of Marketable Infusion Solutions for Parenteral Nutrition
			2.3.9	 Parenteral Nutrition Plan
			2.3.10	 Infusion Plan
			2.3.11	 Laboratory Controls
		2.4	 Dehydration/Rehydration
			2.4.1	 Indications
			2.4.2	 Aim
			2.4.3	 Signs and Classification
			2.4.4	 Oral Rehydration
			2.4.5	 Oral Rehydration Solutions
			2.4.6	 Parenteral Rehydration
		2.5	 Antibiotics
	3: Emergencies/Resuscitation
		3.1	 Clinical Assessment of Children and Infants
		3.2	 Airway Management
			3.2.1	 Orotracheal Intubation
			3.2.2	 Cricothyroidotomy
		3.3	 Ventilation
		3.4	 Circulatory Resuscitation
		3.5	 Defibrillation
		3.6	 Shock
		3.7	 Hypoglycemia
		3.8	 Acid–base balance
	4: Blood/Blood Products Transfusion
		4.1	 Blood Transfusion
		4.2	 Platelet Transfusion
		4.3	 Fresh Frozen Plasma Transfusion
	5: Pain Management
		5.1	 Strategies for Pain Management
		5.2	 WHO Grades for Analgesia
		5.3	 Pain Medication Dosage
		5.4	 Quantitative Assessment of Pain in Children
	6: Wounds/Surgical Techniques
		6.1	 General Considerations
		6.2	 Wound Healing
		6.3	 Common Types of Surgical Incisions
		6.4	 Skin Flaps
		6.5	 Skin Grafts
		6.6	 Surgical Sutures
	7: Minimally Invasive Surgery
		7.1	 Principles and General Considerations
		7.2	 Instrumentation
		7.3	 Indications
		7.4	 Ergonomics
		7.5	 Selected Minimal Invasive Techniques
			7.5.1	 Selected Thoracoscopic Techniques
				7.5.1.1	 Thoracoscopic Esophageal Atresia Repair
					7.5.1.1.1 Thoracoscopic Esophageal Atresia Repair (with TOF)
					7.5.1.1.2 Long Gap Esophageal Atresia Repair (E.G., Without TOF)
				7.5.1.2	 Thoracoscopic Lung Resections
					7.5.1.2.1 Surgical Procedures (Type of Lobectomies)
				7.5.1.3	 Thoracoscopic Diaphragmatic Hernia Repair
					7.5.1.3.1 Surgical Procedure
			7.5.2	 Selected Laparoscopic Techniques
				7.5.2.1	 Laparoscopic Splenectomy
				7.5.2.2	 Laparoscopic Duodenal Atresia Repair
				7.5.2.3	 Laparoscopic Nephrectomy
				7.5.2.4	 Laparoscopic Pyeloureteric Junction Obstruction Repair
				7.5.2.5	 Laparoscopic Vesicoureteric Re-implantation
	8: Imaging in Pediatric Surgery
		8.1	 General Considerations
		8.2	 Common Radiographic Images
		8.3	 Organ Topography in a CT
		8.4	 Nomograms for Organ Size
		8.5	 Conventional X-Rays
		8.6	 Ultrasonography
			8.6.1	 Focused Assessment with Sonography in Trauma (FAST)
			8.6.2	 Contrast-enhanced Ultrasonography (CEUS)
			8.6.3	 Documentation of Ultrasonography
		8.7	 Tomography
		8.8	 Magnetic Resonance Imaging (MRI) / Nuclear Magnetic Resonance Imaging (nMRI)
		8.9	 Scintigraphy/Nuclear Imaging
	9: Expert Witness Report
		9.1	 General Considerations
		9.2	 Examination of the Musculoskeletal Apparatus
		9.3	 Anthropometric Measures
	10: Special Situations
		10.1	 Polytrauma
			10.1.1	 Specific Considerations in Children
			10.1.2	 Polytrauma Protocol According to ATLS
			10.1.3	 ATLS Primary Survey
			10.1.4	 ATLS Secondary Survey
		10.2	 Child Maltreatment
		10.3	 Obesity in Children and Adolescents
Part III: Specific Diseases
	11: Birth Trauma
		11.1	 Bruising
		11.2	 Subconjunctival Hemorrhage
		11.3	 Birth Head Trauma
			11.3.1	 Scalp Injuries
		11.4	 Birth Skull Fractures
		11.5	 Birth Neurologic Injuries
			11.5.1	 Facial Paralysis
			11.5.2	 Brachial Palsy
			11.5.3	 Central Nervous System Injury
		11.6	 Birth Extremities Injuries
			11.6.1	 Clavicle Fracture
			11.6.2	 Fracture of Humerus
			11.6.3	 Femur Fracture
			11.6.4	 Congenital Torticollis
	12: Skull
		12.1	 Congenital Osteocutaneous Defect (Cutis Aplasia)
		12.2	 Encephalocele
		12.3	 Hydrocephalus
		12.4	 Craniosynostosis
		12.5	 Head and Brain Trauma
	13: Spinal Column
		13.1	 Spina Bifida/Meningocele/Myelomeningocele
		13.2	 Fetal Surgical Repair
		13.3	 Tethered Cord Syndrome
		13.4	 Chiari Malformation
	14: Face
		14.1	 Oral Cavity
			14.1.1	 Tongue Tie
			14.1.2	 Gum Lesions
			14.1.3	 Ranula
			14.1.4	 Macroglossia
			14.1.5	 Cleft Lip and Palate
		14.2	 Ears
			14.2.1	 Pre-auricular Defects
			14.2.2	 Prominent Ears
		14.3	 Nose
			14.3.1	 Choanal Atresia
		14.4	 Face
			14.4.1	 Dermoid Cysts
		14.5	 Facial Fractures
	15: Neck
		15.1	 Median and Lateral Neck Masses
		15.2	 Congenital Malformations
			15.2.1	 Thyroglossal Cysts and Fistulas
			15.2.2	 Branchial Arch/Cleft Remnants
			15.2.3	 Congenital Torticollis/Sternomastoid Tumor
		15.3	 Cervical Lymphadenitis
		15.4	 Thyroid Enlargement
		15.5	 Hyperparathyroidism
	16: Thorax
		16.1	 General Considerations
		16.2	 Principles of Thoracic Surgery
			16.2.1	 Thoracotomy
			16.2.2	 Bronchus Closure
			16.2.3	 Large Vessel Closure (Pulmonary Arteries and Veins)
			16.2.4	 Lobe/Segmental Resection
		16.3	 Video Assited Thoracic Surgery (VATS)
		16.4	 Tracheostomy
		16.5	 Chest Wall
			16.5.1	 Gynecomastia
			16.5.2	 Mastitis
			16.5.3	 Breast Tumors
			16.5.4	 Pectus Excavatum
			16.5.5	 Pectus Carinatum
			16.5.6	 Sternal Cleft
		16.6	 Pleura and Pleural Cavity
			16.6.1	 Pneumothorax
			16.6.2	 Empyema
			16.6.3	 Hemothorax
			16.6.4	 Chylothorax
		16.7	 Laryngotracheal Lesions
			16.7.1	 Laryngomalacia
			16.7.2	 Laryngotracheal (Subglottic) Stenosis
			16.7.3	 Benign Laryngeal Tumors
				16.7.3.1	 Papilloma
				16.7.3.2	 Subglottic Hemangioma
			16.7.4	 Tracheomalacia
		16.8	 Lung
			16.8.1	 Foreign Body Aspiration
			16.8.2	 Shock Lung (Acute Respiratory Distress Syndrome)
			16.8.3	 Lung Contusion
			16.8.4	 Lung Abscess
			16.8.5	 Pneumatocele
			16.8.6	 Chronic Atelectasis (Middle Lobe Syndrome)
			16.8.7	 Bronchiectasis
			16.8.8	 Bronchogenic Cysts
			16.8.9	 Pulmonary Cysts
			16.8.10	 Congenital Pulmonary Airway Malformation (CPAM) or Cystic Adenomatoid Malformation (CCAM)
			16.8.11	 Congenital Lobar Emphysema
			16.8.12	 Bronchopulmonary Sequestration
			16.8.13	 Pulmonary Arteriovenous Aneurysm
		16.9	 Mediastinum
			16.9.1	 Patent Ductus Arteriosus
			16.9.2	 Mediastinitis
	17: Diaphragm
		17.1	 Congenital Diaphragmatic Hernia (CDH)
			17.1.1	 Postnatal Procedure
			17.1.2	 Fetoscopic Approach (FETENDO)
			17.1.3	 Extracorporeal Membrane Oxygenation
		17.2	 Diaphragmatic Eventration
		17.3	 Gastroesophageal Reflux/Paraesophageal Hernia
		17.4	 Traumatic Diaphragm Rupture
	18: Esophagus
		18.1	 Esophageal Stenosis
		18.2	 Corrosive Esophagitis
		18.3	 Achalasia
		18.4	 Esophageal Atresia (EA)
			18.4.1	 Long Gap
		18.5	 Esophagotracheal H-Fistula
		18.6	 Esophageal Dilatation
		18.7	 Esophageal Varices
		Reference
	19: Abdominal Wall
		19.1	 Umbilical Hernia
		19.2	 Supraumbilical Hernia
		19.3	 Omphaloenteric Duct
		19.4	 Urachal Cysts/Urachal Fistulas
		19.5	 Inguinal Hernia
		19.6	 Femoral Hernia
		19.7	 Other Types of Hernias
		19.8	 Hydrocele
		19.9	 Omphalocele (Exomphalos)
		19.10	 Laparoschisis (Gastroschisis)
	20: Abdomen
		20.1	 Principles of Surgery
		20.2	 Organ Anatomy
		20.3	 Age Related Anatomical Particularities
		20.4	 Abdominal Incisions
		20.5	 Common Bowel Surgical Techniques
		20.6	 Types of Ostomies
		20.7	 Special Bowel Surgical Techniques
	21: Stomach and Duodenum
		21.1	 Infantile Hypertrophic Pyloric Stenosis
		21.2	 Gastrostomy
		21.3	 Duodenal Atresia and Stenosis
	22: Intestinal Congenital Malformations
		22.1	 Jejunoileal/Colonic Atresia
		22.2	 Malrotation/Ladd’s Bands
		22.3	 Intestinal Volvulus
		22.4	 Duplications of the Gastrointestinal Tract
		22.5	 Stoma Complications
		22.6	 Short Bowel Syndrome
	23: Intestinal Diseases
		23.1	 Meconium Ileus
		23.2	 Necrotizing Enterocolitis
		23.3	 Meckel’s Diverticulum
		23.4	 Intussusception
		23.5	 Appendicitis
		23.6	 Complicated Appendicitis: Plastron and Abscess
	24: Anorectal Diseases
		24.1	 Bowel Washout
		24.2	 Chronic Constipation
		24.3	 Anorectal Manometry
		24.4	 Rectal/Colonic Biopsy
		24.5	 Hirschsprung’s Disease
		24.6	 Allied Hirschsprung’s Disease
		24.7	 Anorectal Malformations
		24.8	 Anal Fissures
		24.9	 Anal Fistulas
		24.10	 Rectal Prolapse
		24.11	 Colonoscopy
		24.12	 Large Bowel Polyps
	25: Inflammatory Bowel Diseases
		25.1	 Ulcerative Colitis
		25.2	 Crohn’s Disease
	26: Blunt Abdominal Trauma
	27: Liver and Pancreas
		27.1	 Congenital Hyperinsulinism (CHI)
		27.2	 Congenital Biliary Atresia (BA)
		27.3	 Choledochal Cyst
		27.4	 Cholelithiasis
		27.5	 Parasitic Liver Cysts
		27.6	 Non-parasitic Liver Cysts
			27.6.1 Simple Biliary Cyst
			27.6.2 Ciliated Hepatic Foregut Cysts
		27.7	 Benign Liver Tumors
		27.8	 Pediatric Liver Transplantation (LT)
	28: Pediatric Surgical Oncology
		28.1	 Pediatric Tumor Patient
		28.2	 Congenital Vascular Malformations
			28.2.1	 Hemangiomas
			28.2.2	 Vascular Malformations
		28.3	 Lymphatic Malformations
		28.4	 Lymphomas
		28.5	 Neuroblastoma
		28.6	 Sacrococcygeal Teratoma (SGCT)
		28.7	 Lung Tumors
		28.8	 Mediastinal Tumors
		28.9	 Malignant Liver Tumors
			28.9.1	 Hepatoblastoma (HB)
			28.9.2	 Hepatocarcinoma (HCC)
			28.9.3	 Fibrolamellar Carcinoma (FLC)
			28.9.4	 Hepatic Sarcomas
			28.9.5	 Secondary Liver Tumors
			28.9.6	 Partial Hepatectomies; General Principles
		28.10	 Nephroblastoma
		28.11	 Ovarian Tumors
		28.12	 Testicular Tumors
		28.13	 Soft Tissue Sarcomas (STS)
		28.14	 Rhabdomyosarcoma
		28.15	 Ewing’s Sarcoma (ES)
		28.16	 Osteosarcoma
	29: Urologenital Tract
		29.1	 General Considerations
		29.2	 Pathophysiology
		29.3	 Congenital Anomalies of the Urinary Tract
			29.3.1	 Common Problems in Pediatric Urology
		29.4	 Organ Anatomy
		29.5	 Bladder Innervation (Fig. 29.3)
		29.6	 Vascular Anatomy
			29.6.1	 Urinary Tract
			29.6.2	 Male Genital System
			29.6.3	 Female Genital System
		29.7	 Development of the Genital Organs in Puberty
	30: Penis
		30.1	 Phimosis/Paraphimosis
			30.1.1	 Circumcision
		30.2	 Hypospadias
			30.2.1	 Meatotomy
			30.2.2	 Chordee Correction
			30.2.3	 Dorsal Plication
			30.2.4	 Double Y Glanuloplasty (DYG)
			30.2.5	 Meatal Advancement
			30.2.6	 Meatal Advancement and Glanuloplasty Incorporated (MAGPI)
			30.2.7	 The Slit-Like Adjusted Mathieu Repair (SLAM)
			30.2.8	 Tubularized Incised Plate Urethroplasty (TIP Urethroplasty)
			30.2.9	 Lateral-Based Onlay Flap (LABO)
			30.2.10	 Transverse Preputial Island Flap (Duckett Operation)
			30.2.11	 Onlay Island Flap
			30.2.12	 Bilateral Based Flap (BILAB) for Perineal Hypospadias
			30.2.13	 Perineal Hypospadias
			30.2.14	 Neourethra from Buccal Mucosa/Non-Hairy Skin
		30.3	 Buried Penis (BP)
		30.4	 Peno-scrotal Transposition
	31: Testicles
		31.1	 Cryptorchidism
		31.2	 Testicular Torsion
		31.3	 Testicular Appendages Torsion
		31.4	 Varicocele
	32: External Female Genitalia
		32.1	 Labial Synechiae (Labial Adhesion)
		32.2	 Imperforate Hymen
		32.3	 Cyst of Nuck
	33: Ambiguous Genitalia
		33.1	 Female Gender
		33.2	 Male Gender
		33.3	 Gonadal Dysgenesis
		33.4	 Ovotesticular DSD (Previously Known as True Hermaphroditism)
	34: Ovarian Cysts
	35: Kidney and Bladder
		35.1	 Urinary Tract Infections
		35.2	 Vesicoureteral Reflux (VUR)
		35.3	 Ureterovesical Junction Obstruction/Megaureter
		35.4	 Ureteric Duplication
		35.5	 Ureteropelvic Junction (UPJ) Obstruction/Hydronephrosis
		35.6	 Cutaneous Ureterostomy
		35.7	 Posterior Urethral Valves (PUV)
		35.8	 Bladder Exstrophy
		35.9	 Bladder Augmentation
		35.10	 Mitrofanoff Procedure
		35.11	 Renal Malformations
		35.12	 Nephrolithiasis
		35.13	 Urinary Incontinence
		35.14	 Bladder Injuries
		35.15	 Urethral Injuries
		35.16	 Renal Injuries
	36: Renal Insufficiency
		36.1	 Tenckhoff Catheter Implantation
		36.2	 Arteriovenous Fistula (AV)
	37: Skin and Soft Tissues
		37.1	 Pigmented Nevi
		37.2	 Dermoid Cysts
		37.3	 Lymphadenitis
		37.4	 Burns
			37.4.1	 Initial Treatment of Burns
			37.4.2	 Treatment of Severe Burns
	38: Osteoarticular System
		38.1	 Ganglions/Baker’s Cyst
		38.2	 Developmental Dysplasia of the Hip (DDH)
		38.3	 Osteomyelitis
	39: Hand Surgery
		39.1	 Malformations of the Hand
			39.1.1	 Polydactyly
			39.1.2	 Syndactyly
		39.2	 Hand Trauma
			39.2.1	 Fingertip Injuries
			39.2.2	 Lacerations
			39.2.3	 Surgical Principles For Hand Surgery
			39.2.4	 Hand Fractures
				39.2.4.1	 Wrist Fractures
				39.2.4.2	 Metacarpal Fractures
				39.2.4.3	 Finger Fractures
			39.2.4.4	 Finger Sprains
		39.3	 Other Conditions of the Pediatric Hand
			39.3.1	 Trigger Thumb
			39.3.2	 Ganglion Cyst
	40: Skeletal System
		40.1	 General Considerations
		40.2	 Classification
		40.3	 Skeleton Standard and Special X-Rays
		40.4	 Development of Ossification Centers
		40.5	 Plaster Immobilization
		40.6	 Therapy Principles
		40.7	 Spinal Injuries
		40.8	 Sling-Shot Injury of the Cervical Spine
		40.9	 Pectoral Girdle and Clavicle
		40.10	 Humeral Fractures
		40.11	 Elbow Joint Region Fractures
		40.12	 Forearm Fractures
		40.13	 Wrist and Hand Fractures
		40.14	 Pelvic Ring Fractures
		40.15	 Lower Limb Fractures
		40.16	 Distal Femur and Proximal Tibia Fractures
		40.17	 Patella Fractures and Dislocations
		40.18	 Tibial Shaft Fractures
		40.19	 Distal Tibia and Ankle Joint Fractures
			40.19.1 Bi- and Tri-plane Fractures: “Fractures of Tillaux”
		40.20	 Foot Fractures
Part IV: Appendices
	41: Embryology
		41.1	 Embryological Organ Development
		41.2	 Fetal Circulation
		41.3	 Development of the Intestine
		41.4	 Development of the Female Genitourinary System
		41.5	 Gonad Descent
		41.6	 Newborn Icterus
		41.7	 Segmental Innervation
	42: Vaccination
		42.1	 Vaccines
	43: Fever Types
	44: Catheter Size
	45: Notifiable Infectious Diseases
	46: Commonly Used Pharmaceuticals
	47: Reference Values
	48: Syndromes
Index