Congenital Diaphragmatic Hernia
The contemporary pillars of congenital diaphragmatic hernia (CDH) management include prenatal diagnosis for multidisciplinary care coordination and counseling, medical optimization after birth, and elective (not emergent) operative repair after stabilization, allowing for improvement in pulmonary hypertension and maturation of lungs. Lung hypoplasia and pulmonary hypertension in infants with CDH represent a medical emergency, not one that necessitates immediate surgery. Many infants surviving CDH repair have significant morbidities that may persist into adulthood. Rare cases of previously occult CDH may present acutely in ...
Source: Surgical Clinics of North America - September 7, 2022 Category: Surgery Authors: Xiao-Yue Han, Leigh Taryn Selesner, Marilyn W. Butler Source Type: research
Esophageal Atresia and Tracheoesophageal Fistula
Esophageal atresia (EA) with tracheoesophageal fistula (TEF) is among the most common congenital anomalies requiring surgical intervention in infancy. General surgeons practicing in rural or austere environments may encounter emergency situations requiring their involvement. Respiratory emergencies can arise in the neonatal period; the recommended approaches are the ligation of the fistula through the chest or occlusion of the distal esophagus through the abdomen. As survivors of the condition reach late adulthood, general surgeons can anticipate encountering these patients. An understanding of risk factors, common symptom...
Source: Surgical Clinics of North America - September 7, 2022 Category: Surgery Authors: Ryan M. Walk Source Type: research
Pediatric Ingestions
Pediatric ingestions encompass a wide range of diseases, including foreign body ingestions, caustic ingestions, and aspiration. Specific topics of interest in the pediatric age group for adult general surgeons are button batteries and magnets, which have significant morbidity and mortality and require a high index of suspicion to provide timely care. Evaluation and management of these cases should be tailored to the offending agent and managed at an appropriate pediatric center. (Source: Surgical Clinics of North America)
Source: Surgical Clinics of North America - September 7, 2022 Category: Surgery Authors: Torbjorg Holtestaul, Jace Franko, Mauricio A. Escobar, Meade Barlow Source Type: research
Common Conditions II
Perforated appendicitis continues to be a significant cause of morbidity for children. In most centers, ultrasound has replaced computed tomography as the initial imaging modality for this condition. Controversies surrounding optimal medical and surgical management of appendicitis are discussed. Management of intussusception begins with clinical assessment and ultrasound, followed by image-guided air or saline reduction enema. When surgery is required, laparoscopy is typically utilized unless bowel resection is required. The differential diagnosis for pediatric gastrointestinal bleeding is broad but often made with age, hi...
Source: Surgical Clinics of North America - September 7, 2022 Category: Surgery Authors: Patrick N. Nguyen, Adam Petchers, Sarah Choksi, Mary J. Edwards Source Type: research
Malrotation
In this article, we aim to provide the general surgeon with a clinical blueprint to navigate disorders of gut rotation. We emphasize that bilious emesis in a newborn is malrotation with volvulus until proven otherwise. Although an upper GI series can establish the diagnosis, surgical intervention should not be delayed until the child is ill-appearing. Following detorsion, the key steps are to broaden the mesentery, fully Kocherize the duodenum, and mobilize the cecum. If nonviable bowel is encountered, the principles of damage control can be applied to children. Every effort should be made to preserve bowel length. (Source...
Source: Surgical Clinics of North America - September 7, 2022 Category: Surgery Authors: Woo S. Do, Craig W. Lillehei Source Type: research
Surgical Support of the Developmentally Delayed or Neurologically Impaired Child
Children with underlying neurologic conditions or developmental delay may have undergone prior surgical therapy to improve quality of life. These patients may present to the emergency room with complications associated with these procedures or present requiring emergent or urgent surgical management of a new diagnosis. An understanding of the anatomic variation and known long-term complications of these devices is important for any surgeon who may be called to care for these patients. The goal of this article was to provide recommendations that will assist the general surgeon in the surgical management of children with neu...
Source: Surgical Clinics of North America - September 7, 2022 Category: Surgery Authors: Robert L. Ricca, Edward Penn Source Type: research
Meconium Ileus, Distal Intestinal Obstruction Syndrome, and Other Gastrointestinal Pathology in the Cystic Fibrosis Patient
This article describes the presentation, diagnosis, and management of these conditions in patients with cystic fibrosis, from birth to adulthood. (Source: Surgical Clinics of North America)
Source: Surgical Clinics of North America - September 7, 2022 Category: Surgery Authors: Joseph Tobias, Mckinna Tillotson, Lauren Maloney, Elizabeth Fialkowski Source Type: research
Retroperitoneal Sarcomas
This article provides a summary of recent updates to the management of RPS. (Source: Surgical Clinics of North America)
Source: Surgical Clinics of North America - August 1, 2022 Category: Surgery Authors: Michael K. Turgeon, Kenneth Cardona Source Type: research
Gastrointestinal Stromal Tumors and the General Surgeon
Gastrointestinal stromal tumors (GISTs) are rare malignancies of the gastrointestinal tract but are the most common sarcoma. This review covers aspects of the care of patients with GIST relevant to surgeons. In particular, management of sub-2 cm GISTs, the utility of neoadjuvant and adjuvant therapy for primary GISTs, and indications for surgery in the setting of metastatic disease are discussed. (Source: Surgical Clinics of North America)
Source: Surgical Clinics of North America - August 1, 2022 Category: Surgery Authors: Ilaria Caturegli, Chandrajit P. Raut Source Type: research
Lipoma and Its Doppelganger
This article reviews the epidemiology, clinical history, diagnostic workup, management, natural history, and surveillance of benign lipomas and atypical lipomatous tumors/well-differentiated liposarcomas. Although it is important that aggressive, potentially malignant atypical lipomatous tumors and liposarcomas be managed in a multidisciplinary, preferably high-volume setting, it is equally as important for the nonspecialist general surgeon to be familiar with lipoma and its doppelganger —the well-differentiated liposarcoma. (Source: Surgical Clinics of North America)
Source: Surgical Clinics of North America - August 1, 2022 Category: Surgery Authors: Elliott J. Yee, Camille L. Stewart, Michael R. Clay, Martin M. McCarter Source Type: research
Benign Neurogenic Tumors
Neurogenic tumors arise from cells of the nervous system. These tumors can be found anywhere along the distribution of the sympathetic and parasympathetic nervous system and are categorized based on cell of origin: ganglion cell, paraganglion cell, and nerve sheath cells. Ganglion cell-derived tumors include neuroblastomas, ganglioneuroblastomas, and ganglioneuromas. Paraganglion cell-derived tumors include paragangliomas and pheochromocytomas. Nerve sheath cell-derived tumors include schwannomas (neurilemmomas), neurofibromas, and neurofibromatosis. Most of these are benign; however, they can cause local compressive sympt...
Source: Surgical Clinics of North America - August 1, 2022 Category: Surgery Authors: Jeffrey M. Farma, Andrea S. Porpiglia, Elaine T. Vo Source Type: research
Sarcoma Pulmonary Metastatic Disease
Tumors of soft tissue origin are not common but are increasing in incidence. Given the rare and heterogeneous nature of the disease, deciding on an effective treatment approach to the patient can be challenging. Approximately 20-50% of patients with sarcoma will develop metastases to the lung via hematogenous spread. Despite improvements in systemic therapy options for patients with metastatic disease to the lung, surgical resection of metastases is often the preferred option in patients who are safe surgical candidates. Clearance of metastatic disease with surgical resection has been proven to be cost-effective and can im...
Source: Surgical Clinics of North America - August 1, 2022 Category: Surgery Authors: Mark Hennon Source Type: research
Dermatofibrosarcoma Protuberans: What Is This?
Dermatofibrosarcoma protuberans (DFSP) is a rare, locally aggressive dermal-based sarcoma. Metastatic potential is extremely low, primarily in the setting of fibrosarcomatous transformation. DFSP is characterized by a t(17;22) (q22;q13) translocation that results in active PDGFB signaling. Surgical resection with negative margins (typically including the underlying fascia) is the potentially curative treatment. Delayed wound closure should be considered for cases requiring extensive resection or tissue rearrangement. Tyrosine kinase inhibitors, such as imatinib, have shown response rates of 50% to 60% in patients with loca...
Source: Surgical Clinics of North America - August 1, 2022 Category: Surgery Authors: Gerardo A. Vitiello, Ann Y. Lee, Russell S. Berman Source Type: research
The Evolving Management of Desmoid Fibromatosis
Desmoid fibromatosis is a rare disease caused by genetic alterations that activate β-catenin. The tumors were previously treated with aggressive surgeries but do not metastasize and may regress spontaneously. For these reasons, in the absence of symptoms and when growth would not induce significant complications, active observation is considered first-line therapy. When intervent ion is required, surgery can be considered based on anatomy and risk of postoperative recurrence, but increasingly nonoperative therapies such as liposomal doxorubicin or sorafenib are prescribed. Cryoablation, chemoembolization, and high-intensi...
Source: Surgical Clinics of North America - August 1, 2022 Category: Surgery Authors: Katherine Prendergast, Sara Kryeziu, Aimee M. Crago Source Type: research
Sarcoma
It has been said that medicine is an unusual industry in that its goal is to make itself obsolete. That may be the case in some circumstances, but I would say that it not likely to happen any time soon. In some areas of medicine, we may be closer to reducing the need for our services, while in other areas we are certainly generating increased demand for services. Also, given that health care as economic entity writ large represents approximately one-fifth of the US gross domestic product, there are substantial forces at play that must assure that any downward pressure on the need for medical care will be incremental at bes...
Source: Surgical Clinics of North America - August 1, 2022 Category: Surgery Authors: Ronald F. Martin Tags: Foreword Source Type: research
