Pediatric surgery and pediatric surgical oncology
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Pediatric surgery and pediatric surgical oncology Jin-Zhe Zhang Beijing, China
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Clinical experience 232
espite major advances in pediatric surgery, skills at the operating table should not be neglected. Surgical technique requirements differ in children of different ages, and many techniques are special in pediatric surgery. The following is a brief account of my experience showing the peculiarities of surgery in children (more illustrative in newborns) and suggestions for up-grading pediatric surgical techniques.
Peculiarities in pediatric surgery
The abdominal cavity of a baby is relatively small, while the tumor is much bigger. A large enough transverse incision should be made and then all intestines are placed out of the abdomen, making the abdominal cavity nearly empty to expose the tumor fully as much as possible. In severely distended intestine of a newborn (The intestinal wall looks like a transparent plastic film), its seromuscular coat may burst into bivalves suddenly following even a negligible injury, leaving an isolated bare mucosal tube bulged out from the broken intestine coat, which will naturally lose its viability (Fig. 1). In order to avoid peritoneal contamination due to puncture leakage, a fine needle connected to a suction can be used. Complete decompression should be achieved until the intestinal wall recovers its normal thickness and color. Sometimes, a little bit antibiotics may be injected before pulling the needle, and additional fine suture is rarely necessary. At the critical moment when a rapid closure of the abdomen requires for resuscitation, the wound should be closed in a few minutes. Commonly, the patient's
Author Affiliations: Department of Pediatric Surgery, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China (Zhang JZ) Corresponding Author: Jin-Zhe Zhang, MD, Honorary Fellow of the Royal College of Surgeons (HonFRCS), Member of Chinese Academy of Engineering (MCAE), Professor and Senior Consultant of Pediatric Surgery, Beijing Children's Hospital, Beijing 100045, China (Email: jinzhezhang@ sina.com) doi:10.1007/s12519-009-0045-y ©2009, World J Pediatr. All rights reserved.
World J Pediatr, Vol 5 No 3 . August 15, 2009 . www.wjpch.com
condition is very poor and anesthesia is inadequate. It is wise to leave all the intestines outside the abdomen undisturbed. Running suture from one end of the wound is used to close most parts of abdominal wound until a small opening (about 2-3 stitches untied) is left behind. Then the outside intestine is sent in its natural sequence into the deep part of the abdominal cavity, and finally the rest stitches are tied (Fig. 2). The largest chest wound is in the 6th intercostal space (ICS, cut-in directly without rib resection) of neonates for tumors of all locations in the thoracic cavity (Fig. 3A). Subcutaneous binding of the upper and lower marginal ribs of the wound by 4 heavy stitches to close the wound tightly air-proved (Fig. 3B). No drainage is preferred because the chest wall is too thin to keep the draina
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