Difficult Decisions in Pediatric Surgery

Pediatric Surgery encompasses a multitude of specialty practice domains and thus requires detailed knowledge in a wide arena of topics. It is thus unique among surgical specialties for the breadth of knowledge that is required, emphasizing the potential utility of a volume on controversial topics in this specialty. Because of the challenges in performing clinical research in a pediatric population, the availability of high quality evidence is substantially less than that in other surgical specialties. This highlights the utility of having recognized experts opine on carefully selected well defined clinical questions.

The complexity of decision making in medicine, and in surgery in particular, is growing exponentially. As new technology is introduced, physicians from nonsurgical specialties offer alternative and competing therapies for what was once the exclusive province of the surgeon. In addition, there is increasing knowledge regarding the efficacy of traditional surgical therapies. How to select among these varied and complex approaches is becoming increasingly difficult. The Difficult Decisions in Surgery series was developed to address some of these challenges. To date, 10 volumes have been published, and they are finding enthusiastic audiences.

The volumes are multi-authored, containing brief chapters, each of which is devoted to one or two specific questions or decisions within that specialty that are difficult or controversial. The volumes are intended as a current and timely reference source for practicing surgeons, surgeons in training, and educators, and describe the recommended ideal approach, rather than customary care, in selected clinical situations. Recommendations are based on published evidence, and authors' personal approaches to these problems are also shared.

The chapters in each volume adhere to a specific format. This approach provides uniformity to thepresentations, making it possible to identify useful material at a glance:

· a brief general introduction

· identification of the specific characteristics relative to the question using PICO formatting

· a brief description of the literature search process

· a summary of available published evidence in tabular form

· a general discussion

· a recommendation using GRADE format

· illustrations (other than survival curves or similar graphs) are discouraged.

· use of uniform text formatting, volume size, volume length, and cover material enhances the brand recognition of the series.

· the editors for each volume are selected from among the faculty at The University of Chicago, an institution with high name recognition.

Each chapter is written by recognized experts in the field, lending credibility to the stated conclusions The use of standard formatting for posing questions in each chapter permits the reader to rapidly identify the issue at hand Use of a PICO table and recommendation boxes allows the reader to easily identify useful clinical guidelines

Auteur

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.

Contenu

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.