Difficult Decisions in Pediatric Surgery
Description
Pediatric surgery is a demanding specialty that requires not only technical expertise but also exceptional clinical judgment and adaptability. Pediatric surgeons frequently encounter rare congenital anomalies and unusual surgical problems, often requiring them to make difficult decisions with limited precedent. Even well-recognized congenital conditions can present in atypical ways, necessitating a patient-centered approach that may deviate from routine practice. This places a premium on a surgeon's ability to apply broad surgical principles to novel and complex situations, tailoring interventions to each child's unique anatomy and pathology. Compounding this challenge is the rapidly evolving literature in pediatric surgery, where new techniques, evolving guidelines, and emerging technologies continually reshape best practices. Thoughtful interpretation of the literature is essential, particularly when the optimal approach to a problem remains unclear or controversial. Pediatric surgeons must not only stay abreast of these developments but also critically analyze and synthesize data to make sound, evidence-based decisions in the face of uncertainty.
The Difficult Decisions in Surgery series was developed to address many of these challenges faced by surgeons. To date, 10 volumes have been published, receiving enthusiastic engagement from the surgical community. These multi-authored volumes consist of concise chapters, each focused on a specific difficult or controversial decision within a surgical specialty. This series is particularly well-suited for pediatric surgeons, as it provides insight into difficult decisions faced within the field.
The volumes serve as a timely reference for practicing surgeons, trainees, and educators, emphasizing the ideal approach to selected clinical situations rather than merely reflecting customary care. Recommendations are grounded in published evidence, while also incorporating expert opinions and personal experiences, helping surgeons navigate complex, evolving literature and apply general surgical principles to novel pediatric challenges.
The chapters in each volume adhere to a specific format. This approach provides uniformity to the presentations, making it possible to identify useful material at a glance:
- a brief general introduction and description of the Difficult Decision laid out using PICO formatting·
- a brief description of the literature search process.
- a summary of available published evidence and discussion of the findings.
- the author's personal view of the data and approach to the problem and why they do (or don't do) things found in the presented literature.
- the chapter authors were selected from experts around the world.
- the editors for this volume were selected from among internationally renown faculty at The University of Chicago and The Johns Hopkins University.
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Persons
Marion C. W. Henry is a nationally renowned pediatric surgeon and a leader in medical and surgical education and faculty development. She is a passionate advocate and activist for children and she is working towards comprehensive, multidisciplinary approaches to fighting the epidemics of gun violence and healthcare disparities. She serves on several national committees working on these critical issues.
Mark B. Slidell is an internationally recognized pediatric surgeon with expertise in advanced minimally invasive surgery, pediatric trauma and pediatric hepatobiliary surgery. He is a renowned health services researcher focused on improving health systems and patient outcomes for children. He is the recipient of numerous teaching awards, and he serves as a mentor for students, residents and fellows in surgery.
Content
I. Decision-making and Implementation Science.- Evidence Based Medicine and Decision Making in Pediatric Surgery.- Implementation science - Best methods for significant, sustainable change, and optimal metrics to evaluate progress in pediatric surgery?.- Pediatric Acute Appendicitis as a Model for Shared Decision-Making.- II. Trauma and Critical Care.- Non-operative Management of Blunt Solid Organ Injuries in Pediatric Trauma.- Optimal management of children with concern for possible traumatic brain injury.- Utility of Hemicraniectomy for Medically Refractory Elevated Intracranial Pressure Following Pediatric Traumatic Brain Injury.- Where Should Children be Treated After Sustaining a Traumatic Injury?.- Which surgeons should care for traumatically injured children in rural areas?.- What scoring system should we use to evaluate for hemorrhage-related interventions in pediatric trauma patients?.- Choice of Injury Severity Scoring System in the Evaluation of Pediatric Trauma Patients.- Utilization of ECMO as a Bridge to Decision in Neonatal and Pediatric Patients with an Uncertain Diagnosis.- Meaningful Survival After Neonatal ECMO: A Systematic Review of Long-Term.- III. Pediatric Oncology.- Wilms tumor - NWTSG/COG versus SIOP approach now and in the future.- Rhabdomyosarcoma - Biopsy approach.- Which pediatric breast lesions are best managed by pediatric surgeons?.- Pediatric HIPEC.- IV. Thoracic.- What is the optimal timing of congenital diaphragmatic hernia repair in a neonate requiring ECMO?.- Pectus excavatum - Evidence based indications for surgical correction.- What is the best approach to evaluation and treatment of children with diaphragmatic eventration?.- Spontaneous pneumothorax: Watchful Waiting or Surgical Intervention?.- Pleural empyema - VATS vs chest tube and tPA.- V. Foregut.- Management of Long-gap Esophageal atresia.- What is the best approach to medical and surgical management of GERD after esophageal atresia repair.- Esophageal replacement in Children- Optimal approach.- Thoracoscopic Repair of Esophageal Atresia/Tracheoesophageal Fistula: Selection Criteria and Learning Curve.- VI. Abdomen and Hepatobiliary.- Kasai vs Primary Liver Transplantation: Optimizing the Surgical Approach for Patients Diagnosed with Biliary Atresia.- Appendicitis - Medical management of early appendicitis.- Appendicitis - Indications for interval appendectomy after medical management of uncomplicated or complicated appendicitis with appendix mass?.- Do consensus-based care pathways improve patient outcomes in the management of gastroschisis?.- Necrotizing Enterocolitis - Indications to operate.- What is the optimal interval between ostomy formation and ostomy takedown in a newborn after NEC?.- Intussusception Management: Can We Do Better?.- Ladd's Procedure in an Asymptomatic Child with Congenital Heart Disease and Heterotaxy.- VII. Colorectal and Genitourinary.- IBD - Staging operations for children undergoing total colectomy for ulcerative coliits - Do they all need a 3-stage approach?.- IBD - Decision-making in the management of the ileal pouch, pouchitis, and pouch dysfunction.- Anorectal Malformations- Who should perform the repair?.- Pull-through in the Setting of Cloacal Exstrophy.- Undescended testes: Timing of Orchidopexy.- VIII. Pediatric Surgery in Resource-Constrained Settings.- Management of anorectal malformations and Hirschsprung's disease in resource challenged settings.- Diagnosis and management of Wilms Tumors in Resource-Constrained Settings: Evidence and outcomes based approach to Care.- Ethical Dilemmas in Global Pediatric Surgery.- IX. Special Areas.- Selection of the Next Generation of Pediatric Surgery Trainees: Best Practices and Best Outcomes.- Ethical Considerations in the Surgical Care of Children: Balancing the Interests of the Child, the Family, and the Surgeon.- Is it ethically permissible to prioritize pediatric patients for scarce surgical resources?.- Changing Postoperative Opioid Prescribing Practices.