Number Of Pediatric Surgeons Research Articles

The investigation survey of inguinal hernia operation techniques preferred by pediatric surgeons in Turkey

In inguinal hernia, standard procedure has been considered open repair for a long time, the number of pediatric surgeons who prefer laparoscopic techniques is increasing day by day. In this study, it was aimed to determine how pediatric surgeons in our country approach patients with inguinal hernia and manage the treatment process. Controversial issues on inguinal hernia repair were identified and a questionnaire was prepared to reveal the current situation. The questionnaire was delivered to members of Turkish Association of Pediatric Surgery on the official website of the association. The survey was directed to 420 people, 92 people returned with the answers to the questionnaire. Thirty-six of the surgeons prefer the laparoscopic method for inguinal hernia repair. The reason for choosing open surgery was questioned, the most frequent answer was to be more experienced and to have more cumulative knowledge on open repair method. According to survey, the greatest advantage of laparoscopy was stated to be the better evaluation of the contralateral inguinal canal (n=16, %44.4). Twelve of surgeons who performed laparoscopic treatment in the selection of patients stated that gender is important and prefer laparoscopic surgery for female patients. Thirty percent (n = 11) of the participants stated that they prefer laparoscopy in patients between 3 months and 13 years old, while the rest prefer laparoscopy at all ages. In conclusion thirty nine percent of surgeons in Turkey prefer laparoscopic repair. Open repair is still preferred in our country. There is still no consensus on perfect method and patient selection yet.

Trends in robotic surgery utilization across tertiary children's hospitals in the United States.

A growing number of tertiary children's hospitals are utilizing robotic surgical technology. We sought to characterize national trends in pediatric surgical robotic case utilization and related drivers. Pediatric urology and pediatric surgery (abdominal and thoracic) procedures, performed from January 2010 to December 2019 across 19 U.S. tertiary care children's hospitals, were identified using the Pediatric Health Information System (PHIS). Trends in robot utilization were evaluated by surgical subspecialty, procedure type, and number of individual operating surgeons. Increases were noted in the overall numbers of pediatric surgery (1.3% per quarter, p = 0.005) and urology robotic procedures (2.0% per quarter, p < 0.001), as well as the numbers of pediatric surgeons (7.5% per year, p < 0.001) and pediatric urologists (7.8% per year, p < 0.001) operating robotically. Biliary system and spleen surgery were the most common robotic pediatric surgery procedures (45.5%) and had stable utilization over time (- 0.8% per quarter, 95% CI - 2.3-0.8). Robotic foregut surgery showed the most rapid growth in utilization (2.1% per quarter, 95% CI 0.7-3.6, p = 0.004) in pediatric surgery, while mediastinal/thoracic surgery demonstrated a decrease in utilization (- 4.6%, 95% CI - 7.9-1.2, p = 0.008). Renal pelvis/ureter surgery was the most common robotic urologic procedure (55.8%) and also demonstrated the fastest growth utilization (2.2% per quarter, 95% CI 1.5-2.9, p < 0.001) in urology. Utilization of robotic-assisted surgery in pediatric surgery and pediatric urology has increased both in case volume and the number of operating surgeons, with foregut and renal pelvis/ureter surgery responsible for the areas of greatest growth.

The start-up phase of a non-specialist paediatric surgical service by outreach focused on capacity building at the Consolata Hospital Ikonda, Makete District, Tanzania.

BackgroundThe need for paediatric surgeons in Tanzania is largely unmet. Twelve in two main urban centres (0.06 for 100 000 population under 15 years of age) are far lower than the recommended workforce size. Complex conditions require a significant increase in the number of paediatric surgeons. In contrast, children with minor diseases, living in rural areas, could be managed even at the district level by trained general surgeons.AimThe aim of this study was to develop capacity for general paediatric surgical services in a district hospital by outreach with a focus on mentorship.MethodsCapacity building priorities for non-specialist paediatric surgery were identified and addressed using evidence-based guidelines. Local general surgeons were involved in supervised clinical decision-making and in all surgical procedures. The visiting team provided daily meetings, weekly lectures, and on-job training. Electronic copies of recent surgical textbooks were provided together with video-conferencing distant specialist consultations.ResultsA total of 715 children were handled by the visiting team during the 27-week period. Four hundred and fifty diseases were diagnosed amongst 406 children. Awareness of paediatric surgical needs, improved management of most common conditions like congenital hernias, undescended testis, hypospadias and anorectal malformations needing temporary colostomy occurred. Local general surgeons were assisted in treating 358 cases of general paediatric surgical conditions. Updated early management protocols were introduced for more complex diseases needing referral to specialist centres like solid tumours and neonatal abnormalities. The visiting team operated major paediatric surgical cases at the Consolata Hospital Ikonda.Lessons learntSurgical outreach and capacity building at the district hospital level could be a possible answer to the unmet paediatric surgical needs of children living in rural areas. Apprenticeship training for general surgeons may help to fill the gap provided that they are strongly motivated and supported on acquiring and implementing their paediatric surgical skills.Keywordsglobal health; paediatric surgery; humanitarian outreach.

Development of Pediatric Surgery department in resource-limiting country

Care of pediatric surgery patients demands a high level of commitment, expertise and logistic support as the child needs exclusive care from all aspects. At the same time, these services are neglected and not up to the mark, particularly in developing countries (1). It makes it compulsory to provide adequate and required infrastructure, equipment, trained staff and other logistics to take care of increasing burden of these patients. (1, 2)&#x0D; Pediatric surgery services are far lacking in Pakistan generally (1).As per American Pediatric Surgical Association, number of pediatric surgeons must be at least 1/100,000 population of 0-15 years (3). As per census of Pakistan done in 2017, the total population of 0-15 years was 43.4% of the total population (4). However, total pediatric surgeons working in Pakistan in 2019 were less than 200. The number of pediatric surgeons in Pakistan per 100,000 population is 0.26 (5), which is far less than the minimal required qualified consultants. Rawalpindi division is the fourth most populated city of Pakistan and has a population of 10.1 million as per census (6) and approximately 43.5 lacs are of the age 0-15 years.(4)&#x0D; Rawalpindi is a densely populated division of Punjab (6). Pediatric Surgery services are lacking in Pakistan generally, and in Northern Punjab especially. Enactment area of teaching hospitals of Rawalpindi includes a huge population of Northern areas of Punjab (including four districts of Rawalpindi), Khyber Pakhtunkhwa, Northern areas of Pakistan and Azad Jammu Kashmir. As only one public sector unit of pediatric surgery is available at federal level, so teaching hospitals of Rawalpindi have to provide care to a large population which reciprocates the burden exceeding the available resources. It results in provision of compromised care to the pediatric surgery patients.&#x0D; Developing pediatric surgery services at public sector hospitals is direly needed. Pediatric surgery department at Holy Family Hospital (HFH) started in July, 2016. Initially it started its services from a 4-bedded room and one day for Outpatient Department (OPD) patients. There was only one faculty member. However, later on, department progressed and soon teaching activities including rotation of post graduate residents (PGRs) was allowed. Afterwards in January 2018, this department got recognized for training of PGRs for FCPS program by the College of Physicians and Surgeons (CPSP) and Master of surgery program (MS) by University of Health Sciences (UHS), which populated the department.&#x0D; Currently pediatric surgery department, HFH is taking care of a huge number of patients presenting in OPD. It is providing its services in OPD for 3 days a week. The operation theatre services are being provided three days a week and 24/7 emergency cover for pediatric surgery cases is being provided. There are 4 faculty members now in pediatric surgery Department, HFH and 7 trainees of both FCPS and MS programs are being trained.&#x0D; Developing a pediatric surgery department at Rawalpindi Medical University (RMU) had been arduous. Pediatric surgery department cannot work alone, rather it is a team-based approach which needs exclusive support from pediatric medicine, anesthesia and intensive care units (ICU) staff (7, 8). Similar problems had been here as there was no trained staff for care of pediatric surgery patients, no faculty member from other units was there to join a newly developing department. However, luckily, pediatric surgery department found extensive support from the administration, general surgery, anesthesia and pediatric medicine departments which made it possible to develop a collaborative approach for these patients.&#x0D; Developing more and more departments is direly needed for provision of standardized and compassionate care to the patients regarding pediatric surgical services. It is need of the time to develop maternal and child health centres like Children hospitals so that multidisciplinary care may be available in a standardized fashion to children (1, 2). As the minimal invasive surgery services are developing globally, there is a need to develop these services at different centres of Pakistan. We suggest development of more centres and provision of logistic support to the newly developing departments in our country.

The lost art of the splenorrhaphy

BackgroundIn the case of the hemodynamically unstable child, splenorrhaphy is preferred to splenectomy to avert postsplenectomy sepsis. However, successful splenorrhaphy requires familiarity with the procedure. We sought to determine how many splenectomies or splenorrhaphies for trauma the average pediatric surgeon can be expected to perform during their career. MethodsThe Pediatric Health Information System (PHIS) Database was queried for patients ≤18years coded with an International Classification of Diseases 9th Edition diagnosis code of a splenic injury from 2004 to 2013. Age, gender, grade of splenic injury, and operations performed were extracted. Numbers of pediatric surgeons per hospital were obtained. Results9567 children were identified. 2.1% underwent a splenectomy and 0.8% underwent a splenorrhaphy. The average surgeon performed 0.6 (SD=0.6) splenectomies and 0.2 (SD=0.4) splenorrhaphies for trauma. If these rates remain constant over time, the average surgeon would perform 1.8 (SD =1.7) splenectomies and 0.6 (SD =1.1) splenorrhaphies for trauma over a 30-year surgical career. ConclusionNonoperative management is associated with a host of benefits, but has resulted in a decrease in the experience level of the pediatric surgeons expected to perform an emergency splenectomy or splenorrhaphy when the unusual occasion arises.

Neonatal surgical care: a review of the burden, progress and challenges in sub-Saharan Africa

The outcome of neonatal surgery has significantly improved over the decades in high-income countries. In sub-Saharan Africa (SSA), however, it has lagged behind. This is a review of the current state of neonatal surgery in SSA. The conditions requiring surgery in the newborn are largely congenital but the rate of emergency surgery is high, reaching 40% of all neonatal surgery in some settings. Most operations are for intestinal obstruction, commonly owing to anorectal malformations and intestinal atresia, as well as abdominal wall defects. Many of the patients are delivered outside a hospital facility and often present or are referred late and are very ill at time of presentation. The morbidity following surgery is high, particularly from surgical site infections and respiratory problems. Mortality is high, sometimes reaching 45%, but has decreased in recent times. Because of a lack of trained paediatric anaesthetists, anaesthesia is often problematic and surgery is sometimes undertaken using a local anaesthetic. Further care, including bowel management and orthopaedic and neurological rehabilitation, are sub-optimal owing to a lack of appropriately trained personnel and financial constraints. While the number of paediatric surgeons has increased, there are still few anaesthetists. In order to significantly improve the outcome for neonates with surgical problems in SSA, paediatric surgery, anaesthesia, neonatology and neonatal nursing capacity need to be scaled up and fast-tracked. To make neonatal surgery safer in these settings, neonatal intensive care facilities need to be provided and improved.

Temporal geomapping of pediatric surgeons in the United States

Several studies have addressed the issue of manpower needs in pediatric surgery. The number of training programs has multiplied dramatically over the past decade. The distribution of surgeons is more significant than the absolute change in numbers--are major metropolitan areas seeing a more dramatic increase than less populated areas? To evaluate the geographic and demographic changes associated with this increase, we used choropleth and geomapping techniques to evaluate the change in number and distribution of American Pediatric Surgical Association (APSA) members (and by proxy, pediatric surgeons) in the United States over the past decade. Data regarding membership were obtained from APSA. In 1996, management companies changed, and accurate data for initial year of membership were only available after 1996. Online sources (www.services.alphaworks.ibm.com/manyeyes/home and www.mapresso.com) were used for data analysis. There was a 175% increase in the number of APSA members over the past decade. The geographic distribution parallels the state population to some extent but is uneven. The number of APSA members by state over time is displayed in color density maps. Predictions of prior manpower studies were generally accurate. The number of pediatric surgeons in the United States has rapidly increased in the past decade, with no sign of diminution in this trend. Increases in the number of surgeons correlates with state population, indicating a tendency for surgeons to reside in more densely populated areas, as expected. Areas with a disproportionately high or low number of surgeons can be identified via choropleth mapping.

Antireflux Surgery: New Era's, New Results

INTRODUCTION In the past, surgical treatment for gastroesophageal reflux disease has known its ups and downs. Substantial morbidity in Nissen fundoplication made many pediatricians and also some pediatric surgeons reluctant to propose surgery in GERD.When alternative techniques with less complications, but with the same effect, became available, a number of pediatric surgeons became less restrained to offer surgery as a means of therapy for GERD (1). The advent of in particular protonpump inhibitors (PPIs) has revolutionized the approach to acid-related disorders, reducing the indications for surgery again (2). However, putting children on lifelong PPIs is a dilemma for both doctor and parents. The safety of long-term administration of acid blocking medication needs to be considered in relation to potential consequences of prolonged acid suppression, such as hypergastrinemia, proliferation of gastric flora, enterochromaffin-like cell hyperplasia theoretically leading to gastric cancer (3), and nosocomial infections. As almost half of the pediatric population with GERD is mentally handicapped, nosocomial infections are a non-neglectable thread. When the laparoscopic surgical approach to GERD was introduced in pediatric surgery in the nineties of the last century, it became apparent that this approach was beneficial for the pediatric patient (4). In particular the group of mentally handicapped children, which in the past had always been a complication prone population in regard to postoperative morbidity, duration of hospitalization, and cure of GERD, seemed to benefit from the laparoscopic approach and showed no increase in postoperative morbidity, had a reduced hospital stay and showed an equal cure of GERD as did children in the not-mentally handicapped group (5). In a group of 149 children, operated between 1993 and 2002 laparoscopically according to Thal for GERD, 49% was mentally handicapped. Follow-up ranged from 6 months to 9 years (median 4.5y). Nineteen children died. All but one were not related with the antireflux procedure. Immediate relief of symptoms occurred in 120 children (80,5%). In 29 children the results were less than optimal. Eight patients underwent a laparoscopic redo-procedure (5,4%). However, none of the children with a follow-up of more than five years showed any symptoms anymore. It was concluded from this study that the laparoscopic Thal fundoplication was a safe procedure and that results in the long run were favorable, irrespective of the nature of the cause, i.e. mental retardation (5). Close examination of the subgroup that did not do well directly after the operation, showed that in particular children with motility disorders of the esophagus or gastroduodenal motility disorder continued to have problems. It is therefore of great importance to identify these children during preoperative work-up for GERD. Alternative therapeutic strategies for these patient groups are warranted.

A state-wide survey of index pediatric surgical conditions

A statewide survey of pediatric surgery was sponsored by the Connecticut Society of American Board Surgeons to determine the general surgeons attitudes about performing routine and complex pediatric surgery, the absolute volume of index pediatric surgical conditions in the state, and the proportion treated by pediatric and nonpediatric surgeons. The incidence of index conditions studied was very similar to those previously reported. Approximately one half of all index cases were treated by nonpediatric surgeons, indicating that the number of pediatric surgeons could be increased, and possibly doubled, if all index procedures were performed by pediatric surgeons. Two-thirds of responding surgeons recognized the need for a regional neonatal surgical center. Regional or statewise surveys of index surgical conditions are recommended to determine regional manpower needs.