Seminars in Pediatric Surgery RSS feed: Current Issue. Seminars in Pediatric Surgery provides current state-of-the-art reviews of subjects of interest to those charged with the surgical care of young patients. Each quarterly issue addresses a single topic with articles written by the experts in the field. Guest editors, all noted authorities, prepare each issue. 2009 Topics , Volume 18, Issues 1-4 February Esophageal atresia Agostino Pierro, MD May Serious Complications in Pediatric Surgery-Recognition and Prevention Jean-Martin LaBerge, MD August The Impact of Bariatric Surgery on Childhood Obesity-Related Metabolic Disorders Marc P. Michalsky, MD and Steven Teich, MD November Gastrointestinal Motility Disorders Robert Carachi, MDhttp://www.sempedsurg.org/?rss=yesElsevier Inc.en © 2010 Published by Elsevier Inc. All rights reserved. Seminars in Pediatric Surgery1055-8586191February 2010 © 2010 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.sempedsurg.org/article/PIIS1055858609000845/abstract?rss=yesContents10.1053/S1055-8586(09)00084-5Seminars in Pediatric Surgery 19, 1 (2010)2010-02-01Seminars in Pediatric Surgery2010-02-01191S1055-8586(09)X0005-3iihttp://www.sempedsurg.org/article/PIIS1055858609000687/abstract?rss=yesThe understanding and management of pediatric intestinal failure is undergoing an exciting transformation. Recent innovations in medical and surgical therapy, coupled with the evolution of specialized multidisciplinary intestinal failure treatment centers, have been associated with significant improvements in patient survival. Although intestinal failure remains a major cause of pediatric morbidity and mortality, current research offers reason for continued optimism. This issue of the Seminars in Pediatric Surgery attempts to summarize recent progress in a logical manner, with contributions from groups that are leaders in the treatment and investigation of intestinal failure.PrefaceTom Jaksic10.1053/j.sempedsurg.2009.11.008Seminars in Pediatric Surgery 19, 1 (2010)2010-02-01Seminars in Pediatric Surgery2010-02-01191S1055-8586(09)X0005-312http://www.sempedsurg.org/article/PIIS1055858609000614/abstract?rss=yesPediatric short bowel syndrome (SBS) is most commonly caused by congenital or acquired conditions of the newborn. SBS is associated with an inability of the bowel to adequately absorb water and nutrients in sufficient quantities to meet caloric, fluid, and electrolyte demands, thus necessitating dependence on parenteral nutrition (PN). It is this dependence on PN, that is responsible for the majority of morbidity and mortality associated with SBS, including central venous catheter infections and PN-induced cholestatic liver dysfunction. There are very few estimates of SBS incidence and mortality in the literature. The epidemiology of SBS is reviewed and the limitations of the published literature are discussed.Short bowel syndrome: epidemiology and etiologyPaul W. Wales, Emily R. Christison-Lagay10.1053/j.sempedsurg.2009.11.001Seminars in Pediatric Surgery 19, 1 (2010)2010-02-01Seminars in Pediatric Surgery2010-02-01191S1055-8586(09)X0005-339http://www.sempedsurg.org/article/PIIS1055858609000626/abstract?rss=yesThe management of the child with intestinal failure is complex, and it is developing into a multispecialty field of its own led by expert teams of both transplant and nontransplant surgeons, gastroenterologists, and dieticians. Patients are at risk for medical, surgical, and nutritional complications that should be anticipated so that they can be prevented or managed appropriately. Catheter associated infections and intestinal failure associated liver diseases are important complications that impact the likelihood of bowel adaptation and long-term survival. The clinical assessment of a pediatric intestinal failure patient should include evaluation of the child within the context of recognized prognostic factors.Clinical assessment of the child with intestinal failureJason S. Soden10.1053/j.sempedsurg.2009.11.002Seminars in Pediatric Surgery 19, 1 (2010)2010-02-01Seminars in Pediatric Surgery2010-02-01191S1055-8586(09)X0005-31019http://www.sempedsurg.org/article/PIIS1055858609000638/abstract?rss=yesThe outcome for children with congenital enteropathies or massive surgical resections has improved significantly over the past two decades. Advances in understanding of the pathophysiology of intractable diarrhea and of the mutations causing many of the congenital enteropathies have enabled initiation of preventive measures for intractable diarrhea, and have enabled clinicians to provide focused treatment of immune-mediated congenital diarrheal illnesses. Children with surgical short bowel syndrome also face an improved outcome because of improvements in the composition of parenteral nutrition (TPN) and in enteral alimentation strategies. It is now recognized that, through adaptation, small intestinal surface area and absorptive function may improve over time to facilitate emancipation from parenteral nutrition. Beyond provision of enteral nutrition, ancillary therapies such as judicious use of acid suppression, antibiotics, prokinetic agents, and soluble fiber seem to accelerate the rate of adaptation in young children. In the future, trophic hormones such as epidermal growth factor (EGF) or glucagon-like peptide 2 (GLP-2) may become routine members of the therapeutic armamentarium for surgical short bowel syndrome, thus further improving outcomes.Medical management of pediatric intestinal failureSamuel A. Kocoshis10.1053/j.sempedsurg.2009.11.003Seminars in Pediatric Surgery 19, 1 (2010)2010-02-01Seminars in Pediatric Surgery2010-02-01191S1055-8586(09)X0005-32026http://www.sempedsurg.org/article/PIIS105585860900064X/abstract?rss=yesChildren with intestinal failure (IF) suffer from insufficient intestinal length or function, making them dependent on parenteral nutrition (PN) for growth and survival. PN and its components are associated with many complications ranging from simple electrolyte abnormalities to life-threatening PN-associated liver disease, which is also called intestinal failure-associated liver disease (IFALD). From a nutrition perspective, the ultimate goal is to provide adequate caloric requirements and make the transition from PN to full enteral nutrition (EN) successful. Upon review of the literature, we have summarized the most effective and innovative PN and EN therapies for this patient population. Antibiotic-coated catheters and antibiotic or ethanol locks can be implemented, as they appear effective in reducing catheter-related infection and thus further reduce the risk of IFALD. Lipid emulsions should be given judiciously. The use of an omega-3 fatty acid-based formulation should be considered in patients who develop IFALD. Trophic feeding is important for intestinal adaptation, and EN should be initiated early to help wean patients from PN. Long-term management of children with IF continues to be an emerging field. We have entered uncharted territory as more children survive complications of IF and IFALD. Careful monitoring and individualized management to ensure maintenance of growth while avoiding complications are the keys to successful patient outcomes.Innovative parenteral and enteral nutrition therapy for intestinal failureHau D. Le, Erica M. Fallon, Vincent E. de Meijer, Alpin D. Malkan, Mark Puder, Kathleen M. Gura10.1053/j.sempedsurg.2009.11.004Seminars in Pediatric Surgery 19, 1 (2010)2010-02-01Seminars in Pediatric Surgery2010-02-01191S1055-8586(09)X0005-32734http://www.sempedsurg.org/article/PIIS1055858609000705/abstract?rss=yesThe structural and functional changes during intestinal adaptation are necessary to compensate for the sudden loss of digestive and absorptive capacity after massive intestinal resection. When the adaptive response is inadequate, short bowel syndrome (SBS) ensues and patients are left with the requirement for parenteral nutrition and its associated morbidities. Several hormones have been studied as potential enhancers of the adaptation process. The effects of growth hormone, insulin-like growth factor-1, epidermal growth factor, and glucagon-like peptide 2 on adaptation have been studied extensively in animal models. In addition, growth hormone and glucagon-like peptide 2 have shown promise for the treatment of SBS in clinical trials in human beings. Several lesser studied hormones, including leptin, corticosteroids, thyroxine, testosterone, and estradiol, are also discussed.Growth factors: possible roles for clinical management of the short bowel syndromeMark E. McMellen, Derek Wakeman, Shannon W. Longshore, Lucas A. McDuffie, Brad W. Warner10.1053/j.sempedsurg.2009.11.010Seminars in Pediatric Surgery 19, 1 (2010)2010-02-01Seminars in Pediatric Surgery2010-02-01191S1055-8586(09)X0005-33543http://www.sempedsurg.org/article/PIIS1055858609000651/abstract?rss=yesThe treatment of patients with short bowel syndrome is hampered by a lack of treatment and measurement methods. This article reviews our evolving understanding of the role of glucagon-like peptide 2 (GLP-2) in controlling the adaptive process. The ability of the remnant intestine to produce GLP-2 appears to be predictive of the adaptive process; exogenous GLP-2 may be a therapy to augment adaptation. Strategies for monitoring patients, including conventional means, such as anthropomorphic measurements, plasma levels of specific nutrients, and vitamins and radiological contrast studies are reviewed. Investigational methods, such as nutrient balance studies, plasma citrulline levels, and the absorption of inert sugars (3-0 methyl glucose, mannitol, and lactulose) are discussed with the evidence to support their use.The assessment, and glucagon-like peptide-2 modulation, of intestinal absorption and functionDavid L. Sigalet, Viona Lam, Dana Boctor10.1053/j.sempedsurg.2009.11.005Seminars in Pediatric Surgery 19, 1 (2010)2010-02-01Seminars in Pediatric Surgery2010-02-01191S1055-8586(09)X0005-34449http://www.sempedsurg.org/article/PIIS1055858609000663/abstract?rss=yesGastrointestinal motility disorders in their most severe forms may directly lead to intestinal failure. Abnormal motor function may also contribute to the overall gut dysfunction of children who have other underlying gastrointestinal diseases, such as Hirschsprung disease or gastroschisis. Understanding the extent and the severity of the dysmotile segments has direct therapeutic and prognostic implications. Our ability to study gastrointestinal motility has greatly improved in the past few years, with the development of less-invasive diagnostic tests. Optimal treatment of children with intestinal motility disorders relies on a multidisciplinary approach, which focuses on optimizing nutrition, improving gastrointestinal motility, and reducing psychosocial disability. Patient education is important to avoid aggravations of symptoms caused by dietary indiscretions.Diagnosis and management of intestinal motility disordersCarlo Di Lorenzo, Nader N. Youssef10.1053/j.sempedsurg.2009.11.006Seminars in Pediatric Surgery 19, 1 (2010)2010-02-01Seminars in Pediatric Surgery2010-02-01191S1055-8586(09)X0005-35058http://www.sempedsurg.org/article/PIIS1055858609000675/abstract?rss=yesMultidisciplinary management of intestinal failure has progressed over the last 30 years, facilitating the transition to enteral autonomy in many pediatric patients. However, there remains a select group of patients who reach a plateau in advancement of their enteral nutrition. Numerous surgical options have been pursued to attempt to slow intestinal transit, taper dilated bowel, and promote intestinal adaptation. The purpose of this chapter is to review the current literature on autologous intestinal reconstruction surgery, including a brief historical perspective, descriptions of procedures, and reported surgical outcomes.Autologous intestinal reconstruction surgeryBrian A. Jones, Melissa A. Hull, Margaret M. McGuire, Heung Bae Kim10.1053/j.sempedsurg.2009.11.007Seminars in Pediatric Surgery 19, 1 (2010)2010-02-01Seminars in Pediatric Surgery2010-02-01191S1055-8586(09)X0005-35967http://www.sempedsurg.org/article/PIIS1055858609000699/abstract?rss=yesThe multivisceral liver-intestine-pancreas-stomach allograft was first described by Starzl nearly 50 years ago. Since then, over 1000 children have received small bowel transplantation (SBTx), alone or with the liver and other organs, for refractory short gut syndrome (SGS) because of a variety of congenital conditions. In 2001, SBTx was approved as definitive therapy for SGS by Medicare. Currently, 1- and 5-year graft survival routinely exceeds 90% and 80%, respectively. The expected outcomes also include freedom from parenteral nutrition, normalization of growth parameters, and quality of life. However, recurrent rejection, complications of high-dose immunosuppression, or chronic rejection, which is more likely to occur after SBTx without a liver graft, account for differences between early and late survival. Future efforts aimed at overcoming such challenges include preventing SBTx through early referral to comprehensive SGS management programs and understanding why the liver protects the small bowel allograft from rejection. Finally, inflammatory mechanisms, which predispose the highly immunogenic small bowel allograft to a protracted risk of resistant rejection must be elucidated, in order to ensure durable success.Pediatric small bowel transplantationNavdeep Nayyar, George Mazariegos, Sarangarajan Ranganathan, Kyle Soltys, Geoffrey Bond, Ronald Jaffe, Qing Sun, Anita Nucci, Beverly Kosmach, Robert Squires, Kareem Abu-Elmagd, Rakesh Sindhi10.1053/j.sempedsurg.2009.11.009Seminars in Pediatric Surgery 19, 1 (2010)2010-02-01Seminars in Pediatric Surgery2010-02-01191S1055-8586(09)X0005-36877