Development of Paediatric Surgery during the Last Twenty Years

Overview

The authors submit a study on the development of paediatric surgery during the last twenty years at the Clinicof Paediatric Surgery Charles University Prague, Second Medical Faculty Motol. They draw attention to theadvances in paediatric surgery which pertain to new surgical techniques, the introduction of new diagnosticmethods and advances in anaesthesia, circumsurgical care which had a marked influence on reduction of themortality and quality of life of the operated children. During the follow up period the hospitalization period incommon and serious operations declined markedly. In the area of neonatal surgery there was a significant drop ofthe percentage of deaths of operated patients from 25% in 1980 to 3% in 1999. A significant factor is the team ofneonatologists and paediatricians which became part of the team of the surgical department.In 1992 the method of replacement of the oesophagus by the whole stomach in oesophageal atresia wasintroduced. During a 10-year period the oesophagus was replaced by thismethod in 14 children, all patients survive.During the period from 1985 - 1993 the mortality rate of neonates with congenital diaphragmatic hernia was 60%,during the period from 1994 - 2002 10%. In thoracic surgery the thoracoscopic method was introduced, mainlyfor the diagnostic sampling of malignant mediastinal tumours. The diagnosis of gastrooesophageal reflux waselaborated and indication criteria for its surgical solution were defined. In abdominal surgery new surgicalprocedures were introduced in surgery of abnormal biliary pathways and in surgery of the liver. During the lastten years all resections of the liver in children were implemented in the authors’ department. Up to 1990 only 11%children with hepatoblastoma survived, during the period between 1991 - 2000 the survival is 85%. A significantadvance was achieved in the sphere of coloproctology. When dealing with anorectal malformations the techniqueof a posterior sagittal approach (PSARP) was introduced and a new technique for dealing with cloacal malformations.In the Motol Faculty Hospital a Paediatric Traumatological Centre was established which specializes inproblems of multiple trauma, injuries of the liver, pancreas, lungs, bone injuries, neurosurgery and maxillarysurgery.

Key words:
paediatric surgery, advances, development