What's New in Pediatric Surgery

¹ Pediatric Surgery, Yale University School of Medicine, New Haven, Connecticut

Advances in the pathophysiology, diagnosis, and treatment of congenital malformations, trauma, tumors, and innovations in organ transplantation form the cornerstones of progress in pediatric surgery during the past year. Significant new contributions presented at the past year's meeting of pediatric surgical organizations, including the 56th Annual Meeting of the Surgical Section of the American Academy of Pediatrics, are summarized, and selected references from the pediatric and surgical literature are presented.

PRENATAL DIAGNOSIS/FETAL SURGERY

In the area of fetal surgery, Manning et al¹ summarized the experience with 74 cases of catheter decompression for fetal hydronephrosis and hydrocephalus reported to the International Fetal Surgery Register. The center reported an overall survival rate of 41% for urinary obstruction with a procedure-related death rate of 4.6%. The results of ventriculoamniotic shunt procedure for obstructive hydrocephalus were even less encouraging with a procedure-related mortality of 10%; moreover, more than 50% of survivors had serious neurologic handicaps. Sauer et al² studied the relative importance of an abdominal mass and oligohydramnios causing pulmonary hypoplasia in fetal rabbits. Animals having bladder outlet obstruction developed severe pulmonary hypoplasia, whereas other subjects having a synthetic mass inserted into the abdomen of a size equal to that of the obstructed bladder showed minimal signs of pulmonary hypoplasia. Results of the study suggest that prenatal catheter decompression be limited to the fetus with oligohydramnios.

The wisdom of planning the mode of delivery for babies with major congenital malformations referred to a maternal high-risk unit for evaluation remains controversial.