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. 2012 Topics , Volume 21, Issues 1-4 February Childhood solid tumors Robert Shamberger May Challenges of Pediatric Surgical Practice in Africa Essam Elhalaby and Alastair Millar August Hepatobiliary and Pancreatic Disorders in Children Mark Davenport November Hirschsprung Disease and Related Disorders Daniel Teitelbaum http://www.sempedsurg.org/?rss=yesElsevier Inc.en © 2012 Published by Elsevier Inc. All rights reserved. Seminars in Pediatric Surgery1055-8586212May 2012 © 2012 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.sempedsurg.org/article/PIIS1055858612000145/abstract?rss=yesContents10.1053/S1055-8586(12)00014-5Seminars in Pediatric Surgery 21, 2 (2012)2012-05-01Seminars in Pediatric Surgery2012-05-01212S1055-8586(11)X0006-9iihttp://www.sempedsurg.org/article/PIIS1055858612000029/abstract?rss=yesAfrica is the world's second largest and second most populous continent, after Asia. It comprises an area of 30.2 million km (11.7 million square miles), including adjacent islands, and covers 6% of the Earth's total surface area and 20.4% of the total land area. With more than 1.0 billion people, nearly half children, in 65 territories (including 55 recognized states, following the recent independence of South Sudan), it accounts for approximately 15% of the world's human population. According to the World Health Organization 2006 report, Africa bears 24% of the burden of disease, with only 3% of health care workers, and uses less than 1% of the world health expenditure.PrefaceEssam A. Elhalaby, Alastair J.W. Millar10.1053/j.sempedsurg.2012.01.001Seminars in Pediatric Surgery 21, 2 (2012)2012-05-01Seminars in Pediatric Surgery2012-05-01212S1055-8586(11)X0006-9101102http://www.sempedsurg.org/article/PIIS1055858612000030/abstract?rss=yes The evolution and recognition of pediatric surgery as a specialty in Africa can be divided into 4 distinct phases, starting from early 1920s till the present. The pace of development has been quite variable in different parts of Africa. Despite all recent developments, the practice of pediatric surgery in Africa continues to face multiple challenges, including limited facilities, manpower shortages, the large number of sick children, disease patterns specific to the region, late presentation and advanced pathology, lack of pediatric surgeons outside the tertiary hospitals, and inadequate governmental support. Standardization of pediatric surgery training across the continent is advocated. Collaboration with well-established pediatric surgical training centers in Africa and other developed countries is necessary. The problems of delivery of pediatric surgical services need to be addressed urgently, if the African child is to have access to essential pediatric surgical services like his or her counterpart in the high-income parts of the world. Training and practice of pediatric surgery in Africa: past, present, and futureEssam A. Elhalaby, Francis A. Uba, Eric S. Borgstein, Heinz Rode, Alastair J.W. Millar10.1053/j.sempedsurg.2012.01.002Seminars in Pediatric Surgery 21, 2 (2012)2012-05-01Seminars in Pediatric Surgery2012-05-01212S1055-8586(11)X0006-9103110http://www.sempedsurg.org/article/PIIS1055858612000042/abstract?rss=yes Childhood trauma is one of the major health problems in the world. Although pediatric trauma is a global phenomenon in low- and middle-income countries, sub-Saharan countries are disproportionally affected. We reviewed the available literature relevant to pediatric trauma in Africa using the MEDLINE database, local libraries, and personal contacts. A critical review of all cited sources was performed with an emphasis on the progress made over the past decades as well as the ongoing challenges in the prevention and management of childhood trauma. After discussing the epidemiology and spectrum of pediatric trauma, we focus on the way forward to reduce the burden of childhood injuries and improve the management and outcome of injured children in Africa. Pediatric trauma care in Africa: the evolution and challengesLukman O. Abdur-Rahman, A.B. (Sebastian) van As, Heinz Rode10.1053/j.sempedsurg.2012.01.003Seminars in Pediatric Surgery 21, 2 (2012)2012-05-01Seminars in Pediatric Surgery2012-05-01212S1055-8586(11)X0006-9111115http://www.sempedsurg.org/article/PIIS1055858612000054/abstract?rss=yes Infections and their complications requiring surgical intervention are a frequent presentation in African children. Surgical site infection (SSI) is common with rates over 20%, even after clean procedures. The high rates of SSI are due in part to lack of infection control and surveillance policies in most hospitals in Africa. SSI is attended by complications, long hospital stay, and some mortality, but the economic consequences are unestimated. Typhoid fever and typhoid intestinal perforation are major problems with perforation rates of approximately 10%, which is higher in older children. The ideal surgical treatment is arguable, but simple closure and segmental resection are the present effective surgical options. Because of delayed presentation, complications after surgical treatment are high with a mortality approaching 41% in some parts of Africa. Nutrition for these patients remains a challenge. Acute appendicitis, although not as common in African children, often presents rather late with up to 50% of children presenting with perforation and other complications, and mortality is approximately 4% is some settings. Pyomyositis and necrotizing fasciitis are the more common serious soft-tissue infections, but early recognition and prompt treatment should minimize the occasional mortality. Though common in Africa, the exact impact of human immunodeficiency virus infection on the spectrum and severity of surgical infection in African children is not clear, but it may well worsen the course of infection in these patients. Surgical aspects of bacterial infection in African childrenEmmanuel A. Ameh, Francis A. Abantanga, Doreen Birabwa-Male10.1053/j.sempedsurg.2012.01.004Seminars in Pediatric Surgery 21, 2 (2012)2012-05-01Seminars in Pediatric Surgery2012-05-01212S1055-8586(11)X0006-9116124http://www.sempedsurg.org/article/PIIS1055858612000066/abstract?rss=yes Pediatric HIV (human immunodeficiency virus) is a pandemic predominantly in sub-Saharan Africa. Approximately 2.2 million children aged less than 15 years are infected with HIV, representing almost 95% of the total number of children globally infected with HIV. Therefore, increasing numbers of HIVi or -exposed but uninfected children can be expected to require a surgical procedure to assist in the diagnosis of an HIV/acquired immune deficiency syndrome–related complication, to address a life-threatening complication of the disease, or for routine surgery encountered in HIV-unexposed children. HIVi children may present with both conditions unique to HIV infection and surgical conditions routine in pediatric surgical practice. HIV exposure confers an increased risk of complications and mortality for all children after surgery, whether they are HIV infected or not. This risk of complications is higher in the HIVi group of patients. These findings seem to be independent of whether patients undergo an elective or emergency procedure, but the risk of an adverse outcome is higher for a major procedure. Surgical implications of HIV infection are comprehensively reviewed in this article. Surgical implications of human immunodeficiency virus infectionsJonty Karpelowsky, Alastair J.W. Millar10.1053/j.sempedsurg.2012.01.005Seminars in Pediatric Surgery 21, 2 (2012)2012-05-01Seminars in Pediatric Surgery2012-05-01212S1055-8586(11)X0006-9125135http://www.sempedsurg.org/article/PIIS1055858612000078/abstract?rss=yes The care of children with malignant solid tumors in sub-Saharan Africa is compromised by resource deficiencies that range from inadequate healthcare budgets and a paucity of appropriately trained personnel, to scarce laboratory facilities and inconsistent drug supplies. Patients face difficulties accessing healthcare, affording investigational and treatment protocols, and attending follow-up. Children routinely present with advanced local and metastatic disease and many children cannot be offered any effective treatment. Additionally, multiple comorbidities, including malaria, tuberculosis, and HIV when added to acute on chronic malnutrition, compound treatment-related toxicities. Survival rates are poor. Pediatric surgical oncology is not yet regarded as a health care priority by governments struggling to achieve their millennium goals. The patterns of childhood solid malignant tumors in Africa are discussed, and the difficulties encountered in their management are highlighted. Three pediatric surgeons from different regions of Africa reflect on their experiences and review the available literature. The overall incidence of pediatric solid malignant tumor is difficult to estimate in Africa because of lack of vital hospital statistics and national cancer registries in most of countries. The reported incidences vary between 5% and 15.5% of all malignant tumors. Throughout the continent, patterns of malignant disease vary with an obvious increase in the prevalence of Burkitt lymphoma (BL) and Kaposi sarcoma in response-increased prevalence of HIV disease. In northern Africa, the most common malignant tumor is leukemia, followed by brain tumors and nephroblastoma or neuroblastoma. In sub-Saharan countries, BL is the commonest tumor followed by nephroblastoma, non–Hodgkin lymphoma, and rhabdomyosarcoma. The overall 5-years survival varied between 5% (in Côte d'Ivoire before 2001) to 34% in Egypt and up to 70% in South Africa. In many reports, the survival rate of patients is not mentioned but is clearly very low in many sub-Saharan Africa countries (Sudan, Nigeria). Late presentation was observed for many tumors like nephroblastoma in Nigeria, 72% were stages III and IV or BL stages III and IV were observed in 40% and 30%, respectively. Africa bears a great burden of childhood cancer. Cancer is now curable in developed countries as survival rates approach 80%, but in Africa, >80% of children still die without access to adequate treatment. Sharpening the needlepoint of surgical expertise will, of itself, not compensate for the major infrastructural deficiencies, but must proceed in tandem with resource development and allow heath planners to realize that pediatric surgical oncology is a cost-effective service that can uplift regional services. Challenge of pediatric oncology in AfricaLarry G.P. Hadley, Bankole S. Rouma, Yasser Saad-Eldin10.1053/j.sempedsurg.2012.01.006Seminars in Pediatric Surgery 21, 2 (2012)2012-05-01Seminars in Pediatric Surgery2012-05-01212S1055-8586(11)X0006-9136141http://www.sempedsurg.org/article/PIIS1055858612000108/abstract?rss=yes Parasitic infestation is common in developing countries especially in Africa. Children are often more vulnerable to these infections. Many health problems result from these infestations, including malnutrition, iron-deficiency anemia, surgical morbidities, and even impaired cognitive function and educational achievement. Surgical intervention may be needed to treat serious complications caused by some of these parasites. Amoebic colitis and liver abscess caused by protozoan infections; intestinal obstruction, biliary infestation with cholangitis and liver abscess, and pancreatitis caused by Ascaris lumbricoides; biliary obstruction caused by Faschiola; hepatic and pulmonary hydatid cysts caused by Echinococcus granulosus and multilocularis are examples. Expenditure of medical care of affected children may cause a great burden on many African governments, which are already suffering from economic instability. The clinical presentation, investigation, and management of some parasitic infestations of surgical relevance in African children are discussed in this article. Parasitic infestations requiring surgical interventionsAfua A.J. Hesse, Abdellatif Nouri, Hussam S. Hassan, Amel A. Hashish10.1053/j.sempedsurg.2012.01.009Seminars in Pediatric Surgery 21, 2 (2012)2012-05-01Seminars in Pediatric Surgery2012-05-01212S1055-8586(11)X0006-9142150http://www.sempedsurg.org/article/PIIS105585861200008X/abstract?rss=yes The management of neonatal surgical problems continues to pose considerable challenges, particularly in low-resource settings. The burden of neonatal surgical diseases in Africa is not well documented. The characteristics of some neonatal surgical problems are highlighted. Late presentation coupled with poor understanding of the milieu interior of the neonates by incompetent health care providers and poorly equipped hospitals combine to give rise to the unacceptable high morbidity and mortality in most parts of Africa. Proper training of all staff involved in neonatal health care coupled with community awareness must be vigorously pursued by all stakeholders. Various governments throughout the continent of Africa, in conjunction with international donor agencies, must not only provide an adequate budget for health care services and improve infrastructures, but must also deliberately encourage and provide funding for neonatal surgical care and research across the continent. The well-established pediatric surgical training programs, particularly in North and South Africa, should hold the moral responsibility of training all possible numbers of young surgeons from other African countries that do not have any existing pediatric surgical training programs or those countries suffering from remarkable shortage of trained pediatric surgeons. Neonatal surgery in AfricaLohfa B. Chirdan, Petronilla J. Ngiloi, Essam A. Elhalaby10.1053/j.sempedsurg.2012.01.007Seminars in Pediatric Surgery 21, 2 (2012)2012-05-01Seminars in Pediatric Surgery2012-05-01212S1055-8586(11)X0006-9151159http://www.sempedsurg.org/article/PIIS1055858612000091/abstract?rss=yes The second largest and most populous continent, with an exploding pediatric population, Africa has an overwhelming burden on its very limited pediatric surgical services. In an international environment of progressively advancing endoscopic and robotic surgical techniques, the authors focus on the current role of endoscopic surgery on the continent and explore the potential reasons for its delayed acceptance and implementation. They proceed to document the spectrum of what is available and, using their “African experience,” expand on financially viable models of further rolling out these techniques, including discussion around suitable training models for surgeons and their teams. Pediatric minimally invasive surgery in Africa: limitations and current situationJerome Loveland, Alp Numanoglu, Sameh Abdel Hay10.1053/j.sempedsurg.2012.01.008Seminars in Pediatric Surgery 21, 2 (2012)2012-05-01Seminars in Pediatric Surgery2012-05-01212S1055-8586(11)X0006-9160163http://www.sempedsurg.org/article/PIIS105585861200011X/abstract?rss=yes Liver disease in children in the developing world is a frequent occurrence, which is generally inadequately managed because of lack of resources. However, increasingly, there has been a demand for liver transplantation, where primary medical or surgical therapies have failed. The expertise and infrastructure required for a successful outcome are no different from those in more developed countries; if anything, the challenges are greater. Lack of deceased donors because of cultural and religious factors has driven the use of living donors. Short-term survival has generally been good, but long-term outcomes have rarely been reported. In this article, we review the experience of 2 centers at opposite ends of the continent and share our experience of slightly different settings and show that success can be achieved even in resource-reduced environments. Liver transplantation in an African settingAlastair J.W. Millar, Alaa F. Hamza10.1053/j.sempedsurg.2012.01.010Seminars in Pediatric Surgery 21, 2 (2012)2012-05-01Seminars in Pediatric Surgery2012-05-01212S1055-8586(11)X0006-9164171