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.
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.