Surgical Clinics of North America RSS feed: Current Issue. For over 80 years, Surgical Clinics of North America has kept practitioners informed on the latest techniques from leading surgical centers worldwide. Each bimonthly issue is devoted to a single topic relevant to the busy surgeon, with articles written by experts in the field. Case studies and complete references are also included to give you the most thorough data you need to stay on top of your practice. http://www.surgical.theclinics.com/?rss=yesElsevier Inc.en © 2012 Published by Elsevier Inc. All rights reserved. Surgical Clinics of North America0039-6109923June 2012 © 2012 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.surgical.theclinics.com/article/PIIS0039610912000825/abstract?rss=yesContributors10.1016/S0039-6109(12)00082-5Surgical Clinics of North America 92, 3 (2012)2012-06-01Surgical Clinics of North America2012-06-01923S0039-6109(11)X0009-9iiivihttp://www.surgical.theclinics.com/article/PIIS0039610912000837/abstract?rss=yesContents10.1016/S0039-6109(12)00083-7Surgical Clinics of North America 92, 3 (2012)2012-06-01Surgical Clinics of North America2012-06-01923S0039-6109(11)X0009-9viixhttp://www.surgical.theclinics.com/article/PIIS0039610912000849/abstract?rss=yesForthcoming Issues10.1016/S0039-6109(12)00084-9Surgical Clinics of North America 92, 3 (2012)2012-06-01Surgical Clinics of North America2012-06-01923S0039-6109(11)X0009-9xixihttp://www.surgical.theclinics.com/article/PIIS0039610912000692/abstract?rss=yesThe last time we produced an issue of the Surgical Clinics of North America on the topic of surgical diseases of children was in 2006. In that issue I wrote about the problems of logistics in trying to care for children closer to their homes and the economic concerns that further complicate the delivery of care to these young people. Now six years later I find that the very same problems remain equally problematic. I am left wondering whether I am failing to recognize progress or whether we really aren't making headway.Pediatric SurgeryRonald F. Martin10.1016/j.suc.2012.03.019Surgical Clinics of North America 92, 3 (2012)2012-06-01Surgical Clinics of North America2012-06-01923S0039-6109(11)X0009-9xiiixvhttp://www.surgical.theclinics.com/article/PIIS0039610912000680/abstract?rss=yesWe feel privileged and honored to be guest editors of this edition of the Surgical Clinics of North America. It has been 6 years since the last pediatric surgery edition of Surgical Clinics of North America was published with Dr Mike Chen as guest editor. Given the new era of residency training with decreased work hours, increased postgraduate fellowships, and a redefined scope of general surgical practice, we have dedicated this issue to the graduating chief resident in general surgery. It has been said that to be an accomplished pediatric surgeon, one first must be an accomplished general surgeon. Each article is written with the intention of providing newly practicing general surgeons a synopsis of what they should be aware of regarding each of the pediatric conditions discussed. We realize that many of these conditions will not be part of the general surgeon's operative practice; however, it is anticipated that the general surgeon will likely come across or be referred to the disease entities discussed in this edition and thus will need to be prepared.Pediatric SurgeryKenneth S. Azarow, Robert A. Cusick10.1016/j.suc.2012.03.018Surgical Clinics of North America 92, 3 (2012)2012-04-19Surgical Clinics of North America2012-04-19923S0039-6109(11)X0009-9xviixixhttp://www.surgical.theclinics.com/article/PIIS0039610912000527/abstract?rss=yesSurgeons performing painful, invasive procedures in pediatric patients must be cognizant of both the potential short- and long-term detrimental effects of inadequate analgesia. This article reviews the available tools, sedation procedures, the management of intraoperative, postoperative, and postprocedural pain, and the issues surrounding neonatal addiction.Pain Management in the Pediatric Surgical PatientVance Y. Sohn, David Zenger, Scott R. Steele10.1016/j.suc.2012.03.002Surgical Clinics of North America 92, 3 (2012)2012-04-19Surgical Clinics of North America2012-04-19923S0039-6109(11)X0009-9471485http://www.surgical.theclinics.com/article/PIIS0039610912000679/abstract?rss=yesPediatric inguinal hernias are extremely common, and can usually be diagnosed by simple history taking and physical examination. Repair is elective, unless there is incarceration or strangulation. Hydroceles are also quite common, and in infancy many will resolve without operative intervention. Undescended testicles harbor an increased risk of infertility and malignancy, and require orchiopexy in early childhood.Pediatric Inguinal Hernias, Hydroceles, and Undescended TesticlesOliver B. Lao, Robert J. Fitzgibbons, Robert A. Cusick10.1016/j.suc.2012.03.017Surgical Clinics of North America 92, 3 (2012)2012-06-01Surgical Clinics of North America2012-06-01923S0039-6109(11)X0009-9487504http://www.surgical.theclinics.com/article/PIIS0039610912000618/abstract?rss=yesThree of the most common causes of surgical abdominal pain in pediatric patients include appendicitis, Meckel diverticulum, and intussusception. All 3 can present with right lower quadrant pain, and can lead to significant morbidity and even mortality. Although ultrasound is the preferred method of diagnosis with appendicitis and intussusception, considerable variety exists in the modalities needed in the diagnosis of Meckel diverticulum. This article discusses the pathways to diagnosis, the modes of treatment, and the continued areas of controversy.Diagnosis and Management of Pediatric Appendicitis, Intussusception, and Meckel DiverticulumVictoria K. Pepper, Amy B. Stanfill, Richard H. Pearl10.1016/j.suc.2012.03.011Surgical Clinics of North America 92, 3 (2012)2012-06-01Surgical Clinics of North America2012-06-01923S0039-6109(11)X0009-9505526http://www.surgical.theclinics.com/article/PIIS0039610912000564/abstract?rss=yesPyloric stenosis is a common pediatric surgical problem that requires a combination of both medical and surgical attention. This article reviews the classical elements necessary to care for the patient in a safe and effective manner. A well-tested management approach that can be applied to the general surgical environment is described. Perioperative management of the patient is discussed and the currently used techniques are reviewed. Current recommendations include the routine use of ultrasonography for diagnosis, attention to the preoperative correction of electrolytes, and the use of minimally invasive techniques for treatment.Pyloric Stenosis in Pediatric Surgery: An Evidence-Based ReviewSamir Pandya, Kurt Heiss10.1016/j.suc.2012.03.006Surgical Clinics of North America 92, 3 (2012)2012-04-23Surgical Clinics of North America2012-04-23923S0039-6109(11)X0009-9527539http://www.surgical.theclinics.com/article/PIIS003961091200059X/abstract?rss=yesThis article reviews the mechanisms responsible for gastroesophageal reflux disease (GERD), available techniques for diagnosis, and current medical management. In addition, it extensively discusses the surgical treatment of GERD, emphasizing the use of minimally invasive techniques.Pediatric Gastroesophageal Reflux DiseaseFelix C. Blanco, Katherine P. Davenport, Timothy D. Kane10.1016/j.suc.2012.03.009Surgical Clinics of North America 92, 3 (2012)2012-04-23Surgical Clinics of North America2012-04-23923S0039-6109(11)X0009-9541558http://www.surgical.theclinics.com/article/PIIS0039610912000576/abstract?rss=yesChildhood obesity is a tremendous burden for children, their families, and society. Obesity prevention remains the ultimate goal but rapid development and deployment of effective nonsurgical treatment options is not currently achievable given the complexity of this disease. Surgical options for adolescent obesity have been proven to be safe and effective and should be offered. The development of stratified protocols of increasing intensity should be individualized for patients based on their disease severity and risk factors. These protocols should be offered in multidisciplinary, cooperative clinical trials to critically evaluate and develop optimal treatment strategies for morbid obesity.Pediatric ObesityMark J. Holterman, Ai-Xuan Le Holterman, Allen F. Browne10.1016/j.suc.2012.03.007Surgical Clinics of North America 92, 3 (2012)2012-06-01Surgical Clinics of North America2012-06-01923S0039-6109(11)X0009-9559582http://www.surgical.theclinics.com/article/PIIS0039610912000655/abstract?rss=yesCongenital cervical anomalies are essential to consider in the clinical assessment of head and neck masses in children and adults. These lesions can present as palpable cystic masses, infected masses, draining sinuses, or fistulae. Thyroglossal duct cysts are most common, followed by branchial cleft anomalies and dermoid cysts. Other lesions reviewed include median ectopic thyroid, cervical teratomas, and midline cervical clefts. Appropriate diagnosis and management of these lesions requires a thorough understanding of their embryology and anatomy. Correct diagnosis, resolution of infectious issues before definitive therapy, and complete surgical excision are imperative in the prevention of recurrence.Congenital Cervical Cysts, Sinuses, and Fistulae in Pediatric SurgeryCabrini A. LaRiviere, John H.T. Waldhausen10.1016/j.suc.2012.03.015Surgical Clinics of North America 92, 3 (2012)2012-06-01Surgical Clinics of North America2012-06-01923S0039-6109(11)X0009-9583597http://www.surgical.theclinics.com/article/PIIS0039610912000552/abstract?rss=yesOvarian pathology in children is common and the pathology can be quite diverse. The most common benign ovarian tumor in childhood is a teratoma. In this article, we discuss the origin of these germ cell tumors followed by a complete discussion of ovarian pathology.Teratomas and Ovarian Lesions in ChildrenAnne-Marie E. Amies Oelschlager, Robert Sawin10.1016/j.suc.2012.03.005Surgical Clinics of North America 92, 3 (2012)2012-06-01Surgical Clinics of North America2012-06-01923S0039-6109(11)X0009-9599613http://www.surgical.theclinics.com/article/PIIS0039610912000631/abstract?rss=yesThis article addresses basic anatomic considerations of the chest and describes common conditions of the lungs, pleura, and mediastinum that affect children.Pediatric Chest I: Developmental and Physiologic Conditions for the SurgeonChristopher Guidry, Eugene D. McGahren10.1016/j.suc.2012.03.013Surgical Clinics of North America 92, 3 (2012)2012-06-01Surgical Clinics of North America2012-06-01923S0039-6109(11)X0009-9615643http://www.surgical.theclinics.com/article/PIIS0039610912000643/abstract?rss=yesThoracic tumors are rare in children, and metastatic or malignant conditions must be excluded during the diagnostic evaluation. The majority of primary pulmonary neoplasms in children are malignant; this article primarily addresses benign tumors. Surgical resection is the standard treatment for benign thoracic tumors in children. Thoracotomy is a traditional approach, but the thoracoscopic technique for diagnosis and treatment of thoracic tumors is well established. The term benign tumors can be a misnomer in that although their histology is not malignant, these tumors can be locally aggressive with significant associated morbidity and potential for mortality.Pediatric Chest II: Benign Tumors and CystsRobin Petroze, Eugene D. McGahren10.1016/j.suc.2012.03.014Surgical Clinics of North America 92, 3 (2012)2012-04-27Surgical Clinics of North America2012-04-27923S0039-6109(11)X0009-9645658http://www.surgical.theclinics.com/article/PIIS0039610912000539/abstract?rss=yesInfants affected with congenital diaphragmatic hernias (CDH) suffer from some degree of respiratory insufficiency arising from a combination of pulmonary hypoplasia and pulmonary hypertension. Respiratory care strategies to optimize blood gasses lead to significant barotrauma, increased morbidity, and overuse of extracorporeal membrane oxygenation (ECMO). Newer permissive hypercapnia/spontaneous ventilation protocols geared to accept moderate hypercapnia at lower peak airway pressures have led to improved outcomes. High-frequency oscillatory ventilation can be used in infants who continue to have persistent respiratory distress despite conventional ventilation. ECMO can be used successfully as a resuscitative strategy to minimize further barotrauma in carefully selected patients.Congenital Diaphragmatic Hernia and Protective Ventilation Strategies in Pediatric SurgeryAlejandro Garcia, Charles J.H. Stolar10.1016/j.suc.2012.03.003Surgical Clinics of North America 92, 3 (2012)2012-04-27Surgical Clinics of North America2012-04-27923S0039-6109(11)X0009-9659668http://www.surgical.theclinics.com/article/PIIS0039610912000515/abstract?rss=yesChest wall deformities can be divided into 2 main categories, congenital and acquired. Congenital chest wall deformities may present any time between birth and early adolescence. Acquired chest wall deformities typically follow prior chest surgery or a posterolateral diaphragmatic hernia repair (Bochdalek). The most common chest wall deformities are congenital pectus excavatum (88%) and pectus carinatum (5%). This article addresses the etiology, pathophysiology, clinical evaluation, diagnosis, and management of these deformities.Chest Wall Deformities in Pediatric SurgeryRobert J. Obermeyer, Michael J. Goretsky10.1016/j.suc.2012.03.001Surgical Clinics of North America 92, 3 (2012)2012-04-19Surgical Clinics of North America2012-04-19923S0039-6109(11)X0009-9669684http://www.surgical.theclinics.com/article/PIIS0039610912000588/abstract?rss=yesNewborn intestinal obstructions are a common reason for admission to neonatal ICUs. The incidence is estimated to be approximately 1 in 2000 live births. There are 4 cardinal signs of intestinal obstruction in newborns: (1) maternal polyhydramnios, (2) bilious emesis, (3) failure to pass meconium in the first day of life, and (4) abdominal distention. The presentation may vary from subtle and easily overlooked findings on physical examination to massive abdominal distention with respiratory distress and cardiovascular collapse. A careful history and physical examination often identify the diagnosis. Concomitant resuscitation (volume, gastric decompression, and ventilatory support) may be necessary.Neonatal Bowel ObstructionDavid Juang, Charles L. Snyder10.1016/j.suc.2012.03.008Surgical Clinics of North America 92, 3 (2012)2012-04-19Surgical Clinics of North America2012-04-19923S0039-6109(11)X0009-9685711http://www.surgical.theclinics.com/article/PIIS0039610912000606/abstract?rss=yesThe embryology, epidemiology, associated anomalies, prenatal course and the neonatal and surgical care of newborns with gastroschisis and omphalocele are reviewed. For gastroschisis temporary intestinal coverage is often done before a more definitive operative closure that may be immediate or delayed. Outcomes in gastroschisis are determined by associated bowel injury. For omphalocele small defects are closed primarily while large defects are treated topically to allow initial skin coverage before a later definitive closure. Outcomes for omphalocele are determined mainly by the presence of associated anomalies.Congenital Abdominal Wall Defects and Reconstruction in Pediatric Surgery: Gastroschisis and OmphaloceleDaniel J. Ledbetter10.1016/j.suc.2012.03.010Surgical Clinics of North America 92, 3 (2012)2012-04-19Surgical Clinics of North America2012-04-19923S0039-6109(11)X0009-9713727http://www.surgical.theclinics.com/article/PIIS003961091200062X/abstract?rss=yesEmerging developments in the care of intestinal failure (IF) patients have drastically improved their overall prognosis, with recently reported survival rates over 90%. IF patients remain an extremely complex population who benefit from specialized, multidisciplinary care. Advances in the provision of parenteral and enteral nutrition, progress in the management of IF-associated liver disease with parenteral fish oil and catheter-associated blood stream infection with ethanol lock therapy, and the availability of novel surgical interventions, such as the serial transverse enteroplasty procedure, have made this a dynamic health care field with the promise of ongoing improvements in outcomes for these patients.Pediatric Intestinal Failure and Vascular AccessBiren P. Modi, Tom Jaksic10.1016/j.suc.2012.03.012Surgical Clinics of North America 92, 3 (2012)2012-06-01Surgical Clinics of North America2012-06-01923S0039-6109(11)X0009-9729743http://www.surgical.theclinics.com/article/PIIS0039610912000540/abstract?rss=yesCommon pediatric malignancies are reviewed: neuroblastoma, Wilms tumor, hepatoblastoma, rhabdomyosarcoma, and sacrococcygeal teratoma. Elements of presentation, diagnosis, staging, treatment, and longterm prognosis are discussed, with particular attention to surgical management.Pediatric Malignancies: Neuroblastoma, Wilm's Tumor, Hepatoblastoma, Rhabdomyosarcoma, and Sacroccygeal TeratomaKatherine P. Davenport, Felix C. Blanco, Anthony D. Sandler10.1016/j.suc.2012.03.004Surgical Clinics of North America 92, 3 (2012)2012-04-27Surgical Clinics of North America2012-04-27923S0039-6109(11)X0009-9745767http://www.surgical.theclinics.com/article/PIIS0039610912000667/abstract?rss=yesVascular tumors consist of lesions secondary to endothelial hyperplasia, incorporating both hemangiomas and less common pediatric vascular tumors. Vascular malformations arise by dysmorphogenesis and exhibit normal endothelial cell turnover. Some anomalies may incorporate multiple areas of the vascular tree. Use of this division has provided a clinically useful method of diagnosis and prognosis, as well as a guide to therapy. It is hoped that with continued investigation into the biology and pathogenesis of these lesions, a more comprehensive molecular classification will soon be developed.Vascular Anomalies in PediatricsR. Dawn Fevurly, Steven J. Fishman10.1016/j.suc.2012.03.016Surgical Clinics of North America 92, 3 (2012)2012-04-27Surgical Clinics of North America2012-04-27923S0039-6109(11)X0009-9769800http://www.surgical.theclinics.com/article/PIIS0039610912000850/abstract?rss=yesIndex10.1016/S0039-6109(12)00085-0Surgical Clinics of North America 92, 3 (2012)2012-06-01Surgical Clinics of North America2012-06-01923S0039-6109(11)X0009-9801821