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  • Print publication year: 2006
  • Online publication date: January 2010

20 - Abdominal surgery: general aspects

from Part IV - Abdomen

Summary

Introduction

The morbidity and mortality of abdominal surgery in infants and children continues to decline. This is partly due to overall socioeconomic progress and general improvements in health. Medical advances such as more effective antimicrobial therapy, better imaging techniques, progress in surgery and anesthesia, and improved nutritional care have also contributed. Other less obvious factors which may have contributed to improved long-term outcomes in children undergoing abdominal surgery include the development of specialist training programs and accreditation systems, and the regulation of operative procedures, equipment, and standards of care. However, medical advances have also generated new challenges: managing the problems of children with congenital and acquired conditions who would previously have died; greater societal expectations and demands; and iatrogenic complications.

This chapter has two main aims: first, to stress the importance of studying long-term outcomes in pediatric surgery and, second, to consider some of the general long-term issues of abdominal surgery in children.

Long-term outcomes

Mortality and postoperative morbidity are traditional and essential outcome measures in pediatric surgery but long-term results and quality of life issues – physical, psychological and social – are becoming increasingly important to parents, surgeons, and health economists.

Why are long-term outcomes important in pediatric surgery?

(i) To inform parents (and patients) about future health expectations.

(ii) To anticipate potential long-term complications that might be avoidable by monitoring and timely intervention, e.g., renal impairment secondary to neurogenic bladder in spinal dysraphism.

To guide current surgical practice, e.g., the long-term life-threatening consequences of choledochocystojejunostomy for congenital choledochal dilatation have caused it to be replaced by radical excision of the extrahepatic bile ducts and hepaticoenterostomy.

[…]

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REFERENCES
Freeman, N. V. & Bulut, M.“High” anorectal anomalies treated by early “neonatal” operation. J Pediatr Surg 1986; 21:218–220.
Viner, R.Barriers and good practice in transition from paediatric to adult care. J. Roy. Soc. Med. 2001; 94 (Suppl.40):2–4.
Stringer, M. D. Long-term outcomes in newborn surgery. In Puri, P., ed. Newborn Surgery. 2nd edn., Arnold: London, 2003: 915–924.
Moss, R. L., Henry, M. C. W., Dimmitt, R. A.et al.The role of prospective randomized clinical trials in pediatric surgery: state of the art?J. Pediatr. Surg. 2001; 36:1182–1186.
Curry, J. I., Reeves, B., & Stringer, M. D.Randomized controlled trials in pediatric surgery: could we do better?J. Pediatr. Surg. 2003; 38:556–559.
Baraldini, V., Spitz, L., & Pierro, A.Evidence-based operations in paediatric surgery. Pediatr. Surg. Int. 1998; 13:331–335.
Gilbert, H. W., Thompson, M. H., & Armstrong, C. P.The presentation of malrotation of the intestine in adults. Ann. Roy. Coll. Surg. Engl. 1990; 72:239–242.
Hawley, P. R. & Ritchie, J. K. Hirschsprung's disease in adults. In Kamm, M. A. & Lennard-Jones, J. E., eds. Constipation. Petersfield: Wrightson Biomedical Publishing Ltd, 1994: 199–203.
Meurs, K. P., Robbins, S. T., Reed, V. L.et al.Congenital diaphrafgmatic hernia: long-term outcome in neonates treated with extracorporeal membrane oxygenation. J. Pediatr. 1993; 122:893–899.
Lumley, J. S. P.Creutzfeldt–Jakob Disease (CJD) in surgical practice. Ann. R. Coll. Surg. Engl. (Suppl.) 2004; 86:86–88.
Weiland, D. E., Bay, R. C., & Del Sordi, S.Choosing the best abdominal closure by meta-analysis. Am. J. Surg. 1998; 176:666–670.
Kiely, E. M. & Spitz, L.Layered versus mass closure of abdominal wounds in infants and children. Br. J. Surg. 1985; 72:739–740.
Horwitz, J. R., Chwals, W. J., Doski, J. J.et al.Pediatric wound infections. A prospective multicenter study. Ann. Surg. 1998; 227:553–558.
Brain, A. J. L. & Kiely, E. M.Use of a single layer extramucosal suture for intestinal anastomosis in children. Br. J. Surg. 1985; 72:483–484.
Spitz, L., Kiely, E., & Brereton, R. J.Esophageal atresia: five year experience with 148 cases. J. Pediatr. Surg. 1987; 22:103–108.
Steichen, F. M. & Ravitch, M. M. Staplers in gastrointestinal surgery. In Schwartz, S. I. & Ellis, H., Maingot's Abdominal Operations, 8th edn. Connecticut: Appleton-Century Crofts, 1985: 1537–1575.
Bayat, A., McGrouther, D. A., & Ferguson, M. W. J.Skin scarring. Br. Med. J. 2003; 326:88–92.
Partridge, J. & Rumsey, N.Skin scarring: new insights may make adjustment easier. Br. Med. J. 2003; 326:765 (letter).
Davies, B. W. & Stringer, M. D.Where are they now? The survivors of gastroschisis. Arch. Dis. Child. 1997; 77:158–160.
Tan, K. C. & Bianchi, A.Circumumbilical incision for pyloromyotomy. Br. J. Surg. 1986; 73:399.
Ragoowansi, R., Cornes, P. G., Moss, A. L., & Glees, J. P.Treatment of keloids by surgical excision and immediate postoperative single-fraction radiotherapy. Plast. Reconstr. Surg. 2003; 111:1853–1859.
Mustoe, T. A., Cooter, R. D., Gold, M. H.et al.International clinical recommendations on scar management. Plast. Reconstr. Surg. 2002; 110:560–571.
Adzick, N. S. & Lorenz, H. P.Cells, matrix, growth factors, and the surgeon. The biology of scarless fetal wound repair. Ann. Surg. 1994; 220:10–18.
Tsui, S. & Ellis, H.Healing of abdominal incisional hernia in infant rats. Br. J. Surg. 1991; 78:927–929.
Ellis, H., Bucknall, T. E., & Cox, P. J.Abdominal incisions and their closure. Curr. Probl. Surg. 1985; 22:28–30.
Lilien, T., Salusky, I. B., Yap, H. K., Fonkalsrud, E. W., & Fine, R. N.Hernias: a frequent complication in children treated with continuous peritoneal dialysis. Am. J. Kidney. Dis. 1987; 10:356–360.
Waldhaussen, J. H.Incisional hernia in a 5-mm trocar site following pediatric laparoscopy. J. Laparoendosc. Surg. 1996; 6 Suppl 1:S89–S90.
Menzies, D.Postoperative adhesions: their treatment and relevance in clinical practice. Ann. Roy. Coll. Surg. Eng. 1993; 75:147–153.
Erdogan, E., Celayir, S., Eroglu, E., & Yilmaz, E.The relation between human leukocyte antigen (HLA) distribution and intestinal obstruction and adhesions in childhood: preliminary report. Pediatr. Surg. Int. 2000; 16:374–376.
Ellis, H., Morgan, B. J., Thompson, J. N.et al.Adhesion related hospital readmissions after abdominal and pelvic surgery: a retrospective cohort study. Lancet 1999; 353:1476–1480.
Ray, N. F., Larsen, J. W., Stillman, R. J., & Jacobs, R. J.Economic impact of hospitalizations for lower abdominal adhesiolysis in the United States in 1988. Surg. Gynecol. Obstet. 1993; 176:271–276.
Janik, J. S., Ein, S. H., Filler, R. M., Shandling, B., Simpson, J. S., Stephens, C. A.An assessment of the surgical treatment of adhesive small bowel obstruction in infants and children. J. Pediatr. Surg. 1981; 16:225–235.
Festen, C. T.Postoperative small bowel obstruction in infants and children. Ann. Surg. 1982; 196:580–583.
Grant, H. W., Parker, M. C., Wilson, M. S. et al. Population-based analysis of the risk of adhesions following abdominal surgery in children. Presented at British Association of Surgeons 51st Annual International Congress, Oxford, UK, July 2004.
Wilkins, B. M. & Spitz, L.Incidence of postoperative adhesion obstruction following neonatal laparotomy. Br. J. Surg. 1986; 73:762–764.
Vanamo, K., Rintala, R. J., Lindahl, H., & Louhimo, I.Long-term gastrointestinal morbidity in patients with congenital diaphragmatic defects. J. Pediatr. Surg. 1996; 31:551–554.
Devens, K.Recurrent intestinal obstruction in the neonatal period. Arch Dis. Child. 1963; 38:118–119.
Ritchey, M. L., Kelalis, P. P., Eltzioni, R., Breslow, N., Shochat, S., & Haase, G. M.Small bowel obstruction after nephrectomy for Wilms' tumor. Ann. Surg. 1993; 218:654–659.
Akgur, F. M., Tanyel, F. C., Buyukpamukcu, N., & Hicsonmez, A.Adhesive small bowel obstruction in children: the place and predictors of success for conservative treatment. J. Pediatr. Surg. 1991; 26:37–41.
Choudhry, M. S., Kader, M., & Grant, H. W. Retrospective study of incidence of adhesions following neonatal laparotomy. Presented at British Association of Surgeons 51st Annual International Congress, Oxford, UK, July 2004.
Andersson, R. E. B.Small bowel obstruction after appendicectomy. Br. J. Surg. 2001; 88:1387–1391.
Wilkins, B. M. & Spitz, L.Adhesion obstruction following Nissen fundoplication in children. Br. J. Surg. 1987; 74:777–779.
Mira-Navarro, J., Bayle-Bastos, F., Frieyro-Segui, M., Garramone, N., & Gambarini, A.Long-term follow-up of Nissen fundoplication. Eur. J. Pediatr. Surg. 1994; 4:7–10.
Morgan, R. A., Manning, P., & Coran, A. G.Experience with the straight endorectal pullthrough for the management of ulcerative colitis and familial polyposis in children and adults. Ann. Surg. 1987; 206:595–599.
Telander, R. L., Spencer, M., Perrault, J., Telander, D., & Zinsmeister, A. R.Long-term follow-up of the ileoanal anastomosis in children and young adults. Surgery 1990; 108:717–725.
Lund, D. P., Mitchell, J., Kharasch, V., Quigley, S., Kuehn, M., & Wilson, J. M.Congenital diaphragmatic hernia: the hidden morbidity. J. Pediatr. Surg. 1994; 29:258–264.
Stringer, M. D., Pablot, S. M., & Brereton, R. J.Paediatric intussusception. Br. J. Surg. 1992; 79:867–876.
Meagher, A. P., Moller, C., & Hoffmann, D. C.Non-operative treatment of small bowel obstruction following appendicectomy or operation on the ovary or tube. Br. J. Surg. 1993; 80:1310–1311.
Shieh, C.-S., Chuang, J.-H., & Huang, S.-C.Adhesive small-bowel obstruction in children. Pediatr. Surg. Int. 1995; 10:339–341.
Monk, B. J., Berman, M. L., & Montz, F. J.Adhesions after extensive gynecologic surgery: clinical significance, etiology, and prevention. Am. J. Obstet. Gynecol. 1994; 170:1396–1403.
Zee, D. C. & Bax, N. M.Management of adhesive bowel obstruction in children is changed by laparoscopy. Surg. Endosc. 1999; 13:925–927.
El Ghoneimi, A., Valla, J. S., Limonne, B.et al.Laparoscopic appendectomy in children: report of 1,379 cases. J. Pediatr. Surg. 1994; 29:786–789.
Moore, R. G., Kavoussi, L. R., Bloom, D. A.et al.Postoperative adhesion formation after urological laparoscopy in the pediatric population. J. Urol. 1995; 153:792–795.
Torre, M., Favre, A., Pini Prato, A., Brizzolara, A., & Martucciello, G.Histologic study of peritoneal adhesions in children and in a rat model. Pediatr. Surg. Int. 2002; 18:673–676.
Watson, A., Vandekerckhove, P., & Lilford, R.Liquid and fluid agents for preventing adhesions after surgery for subfertility. Cochrane Database Syst. Rev. 2000;(3):CD001298.
Reijnen, M. M., Bleichrodt, R. P., & Goor, H.Pathophysiology of intra-abdominal adhesion and abscess formation, and the effect of hyaluronan. Br. J. Surg. 2003; 90:533–541.
Becker, J. M., Dayton, M. T., Fazio, V. W.et al.Prevention of postoperative abdominal adhesions by a sodium hyaluronate-based bioresorbable membrane: a prospective, randomized, double-blind multicenter study. J. Am. Coll. Surg. 1996; 183:297–306.
Inoue, M., Uchida, K., Miki, C., & Kusunoki, M.Efficacy of Seprafilm® for reducing reoperative risk in pediatic surgical patients undergoing abdominal surgery. J. Pediatr. Surg. 2005; 40:1301–1306.
Beck, D. E., Cohen, Z., Fleshman, J. W.et al.A prospective, randomized, multicenter, controlled study of the safety of Seprafilm adhesion barrier in abdominopelvic surgery of the intestine. Dis. Colon. Rectum. 2003; 46:1310–1319.
Holland-Cunz, S., Boelter, A. V., & Waag, K. L.Protective fibrin-sealed plication of the small bowel in recurrent laparotomy. Pediatr. Surg. Int. 2003; 19:540–543.
Springall, R. G. & Spitz, L.The prevention of post-operative adhesions using a gastrointestinal prokinetic agent. J. Pediatr. Surg. 1989; 24:530–533.
Steinbrook, R. A.An opioid antagonist for postoperative ileus. N. Engl. J. Med. 2001; 345:988–989.
Grosfeld, J. L., Cooney, D. R., & Csicsko, J. F.Gastrointestinal tube stent plication in infants and children. Arch. surg. 1975; 110:594–599.
Stringer, M. D. & Puntis, J. W. L.Short bowel syndrome. Arch. Dis. Child. 1995; 73:170–173.
Valman, H. B. & Roberts, P. D.Vitamin B12 absorption after resection of ileum in childhood. Arch. Dis. Child. 1974; 49:932–935.
Parashar, K., Booth, I. W., Corkery, J. J., Gornall, P., & Buick, R. G.The long-term sequelae of ileocolic anastomosis in childhood: a retrospective survey. Br. J. Surg. 1990; 77:645–646.
Ooi, B. C., Barnes, G. L., & Tauro, G. P.Normalization of vitamin B12 absorption after ileal resection in children. J. Pediatr. Child Health 1992; 28:168–171.
Touloukian, R. J. & Gertner, J. M.Vitamin D deficiency rickets as a late complication of the short gut syndrome during infancy. J. Pediatr. Surg. 1981; 16:230–236.
Preece, M. A. & Valman, H. B.Vitamin D status after resection of ileum in childhood. Arch. Dis. Child. 1975; 50:283–285.
Ward, H. C., Leake, J., Milla, P. J., & Spitz, L.Brown bowel syndrome: a late complication of intestinal atresia. J. Pediatr. Surg. 1992; 27:1593–1595.
Nightingale, J. M. D., Lennard-Jones, J. E., Gertner, D. J., Wood, S. R., & Bartram, C. I.Colonic preservation reduces need for parenteral therapy, increases incidence of renal stones but does not change high prevalence of gall stones in patients with short bowel. Gut 1992; 33:1493–1497.
Valman, H. B., Oberholzer, V. G., & Palmer, T.Hyperoxaluria after resection of ileum in childhood. Arch. Dis. Child. 1974; 49:171–173.
Bohane, T. D., Haka-Ikse, K., Biggar, W. D., Hamilton, J. R., & Gall, D. G.A clinical study of young infants after small intestinal resection. J. Pediatr. 1979; 94:552–558.
Parashar, K., Kyawhla, S., Booth, I. W., Buick, R. G., & Corkery, J. J.Ileocolic ulceration: a long-term complication following ileocolic anastomosis. J. Pediatr. Surg. 1988; 23:226–228.
Couper, R. T., Durie, P. R., Stafford, S. E.et al.Late gastrointestinal bleeding and protein loss after distal small-bowel resection in infancy. J. Pediatr. Gastroenterol. Nutr. 1989; 9:454–460.
Hamilton, A. H., Beck, J. M., Wilson, G. M., Heggarty, H. J., & Puntis, J. W. L.Severe anaemia and ilecolic anastomotic ulceration. Arch. Dis. Child. 1992; 67:1385–1386.
Paterson, C. A., Langer, J. C., Cameron, G. S., Issenman, R. M., & Marcaccio, M. J.Late anastomotic ulceration after ileocolic resection in childhood. Can. J. Surg. 1993; 36:162–164.
Arnbjornsson, E. & Larsson, L. T.Ulceration in an ileocolic anastomosis treated with ranitidin. J. Pediatr. Surg. 1999; 34:1532–1533.
Ceylan, H., Puntis, J. W. L., Abbott, C., & Stringer, M. D.Recurrent peri-anastomotic ileo/jejuno-colic ulceration. J. Pediatr. Gastroenterol. Nutr. 2000; 30:450–452.
Valman, H. B.Intelligence after malnutrition caused by neonatal resection of ileum. Lancet 1974; 1:425–427.
Tejani, A., Dobias, B., Nangia, B. S., & Mahadevan, R.Growth, health, and development after neonatal gut surgery: a long-term follow-up. Pediatrics 1978; 61:685–693.
Davies, B. W., Abel, G., Puntis, J. W. L.et al.Limited ileal resection in infancy; the long-term consequences. J. Pediatr. Surg. 1999; 34:583–587.
Nour, S., Beck, J. M., & Stringer, M. D.Colostomy complications in infants and children. Ann. R. Coll. Surg. Engl. 1996; 78:526–530.
Malone, P. S., Ransley, P. G., & Kiely, E. M.Preliminary report: the antegrade continence enema. Lancet 1990; 336:1217–1218.
Bower, T. B., Pringle, K. C., & Soper, R. T.Sodium deficit causing decreased weight gain and metabolic acidosis in infants with ileostomy. J. Pediatr. Surg. 1988; 23:567–572.
Shellito, P. C.Complications of abdominal stoma surgery. Dis. Colon. Rectum. 1998; 41:1562–1572.
Carlstedt, A., Fasth, S., Hulten, L., Nordgren, S., & Palselius, I.Long-term ileostomy complications in patients with ulcerative colitis and Crohn's disease. Int. J. Colorectal Dis. 1987; 2:22–25.
Ecker, K. W., Schmid, T., Xu, H. S., & Feifel, G.Improved stabilization of conventional (Brooke) ileostomies with the stapler technique. World J. Surg. 1992; 16:525–529.
Londono-Schimmer, E. E., Leong, A. P., & Phillips, R. K.Life table analysis of stomal complications following colostomy. Dis. Colon Rectum 1994; 37:916–920.
Husmann, D. A., McLorie, G. A., Churchill, B. M., & Ein, S. H.Management of the hindgut in cloacal exstrophy: terminal ileostomy versus colostomy. J. Pediatr. Surg. 1988; 23:1107–1113.
Giunchi, F., Balbi, B., Giulianini, G., & Cacciaguerra, G.Cholelithiasis and urolithiasis in ileostomy patients. Ital. J. Surg. Sci. 1989; 19:37–40.
Sivula, A.Long-term results of continent ileostomy. Int. J. Colorectal Dis. 1986; 1:40–43.
Ein, S. H.A ten-year experience with the pediatric Kock pouch. J. Pediatr. Surg. 1987; 22:764–766.
Lask, B., Jenkins, J., Nabarro, L., & Booth, I.Psychosocial sequelae of stoma surgery for inflammatory bowel disease in childhood. Gut. 1987; 28:1257–1260.
O'Brien, B. K.Coming of age with an ostomy. Am. J. Nursing 1999; 99:71–74.
Stringer, M. D., Spitz, L., Abel, R.et al.Management of alimentary tract duplication in children. Br. J. Surg. 1995; 82:74–78.
Orr, M. M. & Edwards, A. J.Neoplastic change in duplications of the alimentary tract. Br. J. Surg. 1975; 62:269–274.
Coit, D. G. & Mies, C.Adenocarcinoma arising within a gastric duplication cyst. J. Surg. Oncol. 1992; 50:274–277.
Gibson, T. C., Edwards, J. M., & Shafiq, S.Carcinoma arising in a rectal duplication cyst. Br. J. Surg. 1986; 73:377.
LaQuaglia, M. P., Feins, N., Eraklis, A., & Hendren, W. H.Rectal duplications. J. Pediatr. Surg. 1990; 25:980–984.
Stringer, M. D.Adenocarcinoma within a rectal duplication. Ann. Roy. Coll. Surg. Engl. 1999; 81:436.
Yamaguchi, M.Congenital choledochal cyst. Analysis of 1,433 patients in the Japanese literature. Am. J. Surg. 1980; 140:653–657.
Bismuth, H. & Krissat, J.Choledochal cystic malignancies. Ann. Oncol. 1999; 10 Suppl. 4:S94–S98.
Voyles, C. R., Smadja, C., Shands, W. C., & Blumgart, L. H.Carcinoma in choledochal cysts: age related incidence. Arch. Surg. 1983; 118:986–988.
Iwai, N., Deguchi, E., Yanagihara, J.et al.Cancer arising in a choledochal cyst in a 12-year-old girl. J. Pediatr. Surg. 1990; 12:1261–1263.
Axon, A. T. R.Cancer surveillance in ulcerative colitis – a time for reappraisal. Gut 1994; 35:587–589.
Woodhouse, C. R. J. Urinary diversion. In Woodhouse, C. R. J., ed. Long-term Paediatric Urology. Blackwell Scientific Publications, Oxford, 1991: 80–96.
Appelqvist, P. & Salmo, M.Lye corrosion carcinoma of the esophagus. Cancer 1980; 45:2655–2658.
Kurtz, R. J., Heimann, T. M., Beck, A. R., & Holt, J.Mesenteric and retroperitoneal cysts. Ann. Surg. 1986; 203:109–112.
Hassall, E., Dimmick, J. E., & Magee, J. F.Adenocarcinoma in childhood Barrett's esophagus: case documentation and the need for surveillance in children. Am. J. Gastroenterol. 1993; 88:282–288.
Adzick, N. S., Fisher, J. H., Winter, H. S., Sandler, R. H., & Hendren, W. H.Esophageal adenocarcinoma 20 years after esophageal atresia repair. J. Pediatr. Surg. 1989; 24:741–744.
Pultrum, B. B., Bijleveld, C. M., Langen, Z. J., & Plukker, J. T.Development of an adenocarcinoma of the esophagus 22 years after primary repair of a congenital atresia. J. Pediatr. Surg. 2005; 40:E1–E4.
Parsonnet, J., Harris, R. A., Hack, H. M., & Owens, D. K.Modelling cost-effectiveness of Helicobacter pylori screening to prevent gastric cancer: a mandate for clinical trials. Lancet 1996; 348:150–154.
Stringer, M. D., Ramani, P., Yeung, C. K., Capps, S. N. J., Kiely, E. M., & Spitz, L.Abdominal inflammatory myofibroblastic tumours (inflammatory pseudotumours) in children. Br. J. Surg. 1992; 79:1357–1360.
Clark, S. K., Neale, K. F., Landgrebe, J. C., & Phillips, R. K.Desmoid tumours complicating familial adenomatous polyposis. Br. J. Surg. 1999; 86:1185–1189.
Ellis, H.Medicolegal consequences of postoperative intra-abdominal adhesions. J. Roy. Soc. Med. 2001; 94:331–332.
McClelland, B. & Contreras, M.Appropriateness and safety of blood transfusion. Br. Med. J. 2005; 330:104–105.
Metkus, A. P., Esserman, L., Sola, A., Harrison, M. R., & Adzick, N. S.Cost per anomaly: what does a diaphragmatic hernia cost?J. Pediatr. Surg. 1995; 30:226–230.