The document provides tips for using a PowerPoint presentation. It recommends: 1. Freely downloading, editing, and modifying the slides and adding your name. 2. Not worrying about the number of slides, as half are blank except for the title. 3. First showing blank slides to ask students what they know, then showing slides with content. 4. Rerunning the show at the end to reinforce learning. 5. This process creates an active learning session that can be repeated and revised.

1. Tips on using my ppt.
1. You can freely download, edit, modify and put your
name etc.
2. Don’t be concerned about number of slides. Half the
slides are blanks except for the title.
3. First show the blank slides (eg. Aetiology ) > Ask
students what they already know about ethology of
today's topic. > Then show next slide which enumerates
aetiologies.
4. At the end rerun the show – show blank> ask questions >
show next slide.
5. This will be an ACTIVE LEARNING SESSION x
three revisions.
6. Good for self study also.
7. See notes for bibliography.

2. Pediatric Surgery

3. Pediatric Surgery
• Responsible for the treatment and
prevention of surgical conditions in fetus 28
weeks of gestation to adolescent at puberty
excluding cardiac and orthopedic lesions.

4. • Children are not little adults

5. Pediatric Surgery
• They differ in anatomy, physiology,,
pathology, pharmacology from adults
• You must understand these differences and
appreciate them to properly assess, plan,
and deliver surgical care.

6. Anatomy, Physiology

7. Anatomy, Physiology
Body Surface Area is more for weight.
– Head is large compared to the adult
• Often in newborns it exceeds the
circumference of the chest
– Arms and legs are shorted and
underdeveloped at birth
– Urinary bladder is intraperitoneal

8. Anatomy

9. Anatomy
• Musculoskeletal system
– Bone growth occurs at different rates
throughout the body
• This affects anatomical landmarks
– In the neonate, the imaginary line joining
the iliac crests occurs at S1
– Sacrum is not fused normally at birth
– At birth spinal column has only the
anterior curvature
– Cervical and lumbar curvature begin with
holding head up and walking

10. Anatomy, Physiology

11. Anatomy, Physiology
• Central Nervous System
– Higher function are underdeveloped.
– The brain at birth is 1/10 the body weight
– Only ¼ of the neuronal cells that exist in adults
are present in the newborn
– Neuronal development finishes as age 12
– Myelination is not complete until age 3
• Primitive reflexes (Moro, grasp) disappear with
myelination

12. Anatomy, Physiology
• Central Nervous System
– Autonomic nervous system is developed at
birth, though immature
– Parasympathetic system is intact and fully
functional
– Lower end of the cord is at L3 at birth
• Receeds to L1 by 1 year of age
– Dural sac shortens from S3 to S1 by 1 y/o

13. Anatomy, Physiology
• Cardiovascular System
– Many profound changes after birth
• SVR doubles after first breath
• Pulmonary vasculature dilates, decreasing
PVR
• Foramen ovale closes as left atrial pressure
becomes higher than right atrial pressure
• Flow reverses in the ductus arteriosis,
preventing flow between the pulmonary
artery and the aorta

14. Anatomy, Physiology
• Myocardium
– Stroke volume of an infant is relatively fixed
• “they live for (or better yet, by) heart rate”
• To increase CO, you must increase HR
• Myocardium is relatively stiff
• Increasing preload will not increase CO
• Cardiac reserve is limited
• Small changes in end diastolic volume yield large
changes in end diastolic pressure

15. Physiology
• Heart rate in infants is higher and decreases
gradually over the first 5 years of life to
near adult levels

16. Anatomy, Physiology
• Respiratory System
– Pediatric airway
• Obligate nose breathers because of the
close proximity of the epiglottis to the
soft palate
• Mouth breathing occurs only during
crying
• Obligate nose breathing is vital for
respiration during feeding.
• Respiration is mainly diaphragmatic.

17. Anatomy, Physiology
• Respiratory System
– Incompletely developed, new alveoli continue
to form up to 8 years of age.
– Reduced production of surfactant
– Small diameter airways are prone to get
blocked.
– Normal respiratory rate 40-60 breaths /minute
– Even Oxygen may lead to retrolental fibrosis.

18. Anatomy
• Burns: Estimate of body surface burnt.
• For adults Rule of 9
• For child Head is larger, LL is less
• At birth Head 20% LL 10%

19. Temperature control

20. Temperature control
• Large Body Surface Area.
• More prone to hypothermia.
• Large energy expenditure for maintaining
normal body temperature.
• Keep warm in ward and OT
• Give warmed iv fluids.

21. Anatomy, Physiology

22. Anatomy, Physiology
• Renal System
– Full term infants have the same number of
nephrons as adults
– Glomeruli are much smaller than in adults
– GFR in the newborn is 30% that of the adult
– Tubular immaturity leads to a relative inability
to concentrate urine

23. Anatomy, Physiology
• Renal System
– Fluid turnover is 7 times greater than that of an
adult
– Altered fluid balance can have catastrophic
consequences
– Organ perfusion and metabolism count on
adequate hydration
– Infants and children are at a much higher risk
for developing dehydration

24. Anatomy, Physiology
• Hepatic System
– Neonatal liver is large
– Enzyme systems exist but have not been
sensitized or induced
– Neonates rely on limited supply of stored fats
– Gluconeogensis is deficient
– Plasma proteins are lower, greater levels of free
drug exist

25. Anatomy, Physiology
• GI System
– Gastroesophageal reflux is common until 5
months of age
• Due to inability to coordinate breathing and
swallowing until then
– Gastric pH is alkaline at delivery
– Gastric pH and volume are close to adult range
by 2nd day of life

26. Anatomy, Physiology
• Immunological status
– No own immunoglobins
– No antigenic experience
– Deficient complement factor
Thus he is a immunocompromised host

27. Fluid and Electrolyte
Requirement

28. Fluid and Electrolyte
Requirement
• Premature-150ml/kg/d
• Term 100ml/kg/d for 1st 10kg.
50ml/kg/d for 2nd 10kg
20ml/kg/d for > 20kg

29. Fluid and Electrolyte
Requirement
• Sodium 2-4 mEq/kg./d
• Chloride 2-4 mEq/kg./d
• Potassium 1-2mEq/kg./d
• Energy 124 kcal/kg./d at birth to 100
kcl/kg./d at 12 years.
Ideal iv fluid D5% with N/5Saline with 20 mEq/l
potassium

30. The Premature infant

31. The Premature infant
• Respiratory Surfactant def.> atelectasis
• Temperature regulation immature
• Apnoea, bradycardia
• Hepatic immaturity > hyperbilirubinemia
• Enteral nutrition

32. The Small for age infant

33. The Small for age infant
• Placental insufficiency/in utero infection
• Inadequate nutritional stores
• Physiological stress factors hypoglycemia,
polycythemia,pneumothorax,intracranial
hemorrhage,congenital infections and
congenital anomalies.

34. Pharmacologic considerations

35. Pharmacologic considerations
• Pharmacologic considerations
– Uptake
• Route of administration affects uptake
– IV – fastest
– Oral and rectal routes slowest
– Transdermal faster than adults, due to relatively thin skin
layers
– Pathological conditions of the liver and heart can
significantly effect uptake

36. – Distribution
• 55-70% of body weight is water in infants and
children
• Large ECF leads to large Vol. of distribution
– In adults, ECF accounts for 20% of body weight
– In children, ECF accounts for up to 40% of body weight
• The concentration and effects of water-soluble
agents are affected greatly by the larger Volume of
Distribution
Pharmacologic considerations

37. Pharmacologic considerations

38. Pharmacologic considerations
– Plasma protein binding
• Lower levels of serum albumin yield higher levels
of free drug
• Plasma protein levels are even lower in certain
disease states, like nephrotic syndrome or
malnutrition
• Endogenous molecules, like bilirubin, can be
displaced by protein bound drugs

39. Pediatric Surgery

40. Pediatric Surgery
• Pharmacologic considerations
– Metabolism
• Soundness and maturity of the liver affect
metabolism
• Glucuronidation is underdeveloped in neonates
• Maternal use of drugs may affect enzyme induction
• Medications, like phenobarbital, induce enzymes
rapidly

41. Pediatric Surgery
• Pharmacologic considerations
– Excretion
• Drugs dependent on renal excretion, like
Pancuronium and Digoxin, can be markedly affected
by immature kidney function

42. Pediatric Surgery
• Pharmacologic considerations
– ONLY body weight or BSA should be used to
calculate and determine correct pediatric drug
dosages
– Body weight is used in premature infants
– As always, titrate to effect

43. Pediatric Surgery
• Routes of administration
– Oral
• Sometimes it is difficult to gain cooperation
• Liquid forms have greater absorption
– Intramuscular
• Gluteus medius muscle over age 2
• Vastus lataralus under 2

44. Pediatric Surgery
• Routes of fluid administration
– Intravenous
– Intraosseous.

45. Pediatric Surgery
• Pharmacologic considerations
• Intravenous agents
– Typically pediatric patients require a larger kg
dose than adults

46. Pediatric Surgery
• Pharmacologic considerations
– Pediatric patients can be very sensitive to the
respiratory depressant effects of narcotics
– Careful titration is vital

47. Pediatric Anesthesia

48. Pediatric Anesthesia
• Mainly endotracheal controlled inhalational
anesthesia
• Spinal/ Epidural/Caudal with sedation
• No locoregional
– Difficult airway

49. Surgical Principles

50. Surgical Principles
• Transverse incisions
• Single layer anastomosis.
• Laparotomy closure by absorbable sutures.
• Scars are worse than adults.

51. Pediatric Surgical disorders

52. Pediatric Surgical disorders
• Congenital Malformations
• Trauma
• Malignancies
• Miscellaneous

53. Congenital Abnormality

54. Congenital Abnormality
• Defects in the abdominal wall (diaphragmatic
hernia, gastroschisis, omphalocele)
• Neurological system(brain, spinal cord, etc.)
• Cardiovascular and pulmonary abnormality
• Malformation of digestive system
• Malformation of urological and reproductive
system
• Limbs and vertebra abnormality

55. Congenital Posterolateral Diaphragmatic
Hernia (CDH)

56. Congenital Posterolateral Diaphragmatic
Hernia (CDH)
JOne of most severe conditions of
neonate
JDefect in diaphragm during early
fetal development
J left side most commonly affected
Jcontent of the hernia:
small bowel
colon
spleen
stomach
liver, kidney, tail of pancreatic

57. 【Embryology】

58. 【Embryology】
week8～9 ： division of coelomic cavity into the pleural
and peritoneal cavity by the diaphragm; a triangular area
in the posterolateral site was left open.
week10～12 ：herniation occur through this opening into
the pleural cavity at the return of midgut

59. 【pathophysiology】

60. 【pathophysiology】
1、Hypoplasia of the lung
Pulmonary weight (ipsilateral+contralateral)↓
Alveoli number↓
Hypertrophy of the media of pulmonary arteriole
Resistance of the vessels↑
2、Pulmonary hypertension
Abdominal viscera into the thoracic cavity → compression of the
lung, PaO2↓PaCO2↑→ acidosis, hypoxemia（PH<7.30）
→pulmonary vessels spasm →vessel resistance↑, right to left
shunting through patent ductus arteries and foramen
ovale↑→aggravate acidosis and hypoxemia in the body
circulation (fetal circulation syndrome)

61. diaphragmatic hernia

62. diaphragmatic hernia
Clinical manifestations：
1，Severe respiratory distress，cyanosis, vomit
2，Breath sounds: diminished on the side of hernia
3，Heart sounds: deviated to the contralateral
chest
4，Scaphoid abdomen

63. 【 diagnosis 】

64. 【 diagnosis 】
Prenatal diagnosis
ultrasound: abdominal organ visible in the
fetal chest

65. diagnosis after birth

66. diagnosis after birth
X-ray film:
•Typical air-filled stomach and
bowels in the chest, which
continues into the abdominal
cavity.
•Diaphram can not be seen at the
affected side.
•Absence or scarcity of intestine
in the abdominal cavity

67. Treatment

68. Treatment
• Before delivery: cortisone could induce the
maturation of pulmonary tissue
• Preoperative preparation:
（1）mechanical ventilation with pure oxygen
（2）nasogastric tube to decompress
stomach and intestine
（3）semi-supine and inclined to
the ipsilateral side， keep warm
（4） i.v. fuild, correction of acidosis
(5）surgical repair

69. Congenital Esophageal Atresia
Tracheoesophageal Fistula

70. Congenital Esophageal Atresia
Tracheoesophageal Fistula
 Incidence: 1/3000
 associated anomalies common
 Impediment of recanalization and
interruption of septation of trachea
and esophagus

71. Congenital esophageal atresia

72. Congenital esophageal atresia
Classification
Ⅰ6％， Ⅱ2％ ，Ⅲ85％， Ⅳ 1％ 。Ⅴ 6％

73. 【 clinical finding

74. 【 clinical findings】
1、drooling saliva, unable to swallow
2、cough and choke and may become cyanotic
after feeding
3、chemical and aspiration pneumonia
4、abdominal distention or scaphoid abdomen

75. 【 diagnosis 】

76. 【 diagnosis 】
1、prenatal diagnosis
2、nasogastric tube can
not reach stomach.
3、 X-ray film show the
coiling of the tube in the
upper mediastinum

77. Preoperative preparation

78. Preoperative preparation
 supine and elevated to 30～40º
 Catheter was put at the blind end of the
esophagus for continuous drainage
 oxygen inhalation, incubator
 i.v. fluid and broad-spectrum antibiotics
 surgical repair
4 Prognosis: 98%~100% survival rate for
the last decade (aboard), all of the 60+
cases survived since 2002 (our hospital) .

79. Hypertrophic Pyloric Stenosis
【pathophsiology】

80. Hypertrophic Pyloric Stenosis
【pathophsiology
】
1、olive shaped mass：
length 2～3.5cm，
thickness 0.4～0.6cm，
pale in color with
consistency of cartilage
2、Muscular hypertrophy of
all the layers of the
pylorus , most significant
in the circular layer,
causing the stenosis

81. Hypertrophic Pyloric Stenosis
【symptoms】

82. Hypertrophic Pyloric Stenosis
【symptoms】
1、 projectile vomiting: onset:2-3 weeks after birth and
progressive with time; vomitus: non-bilious milk and milk
curds
2、 jaundice ：deficiency in liver enzyme and compression
of the biliary tract
3、 overall condition: dehydration, weight lose, hypo-
chloride metabolic alkalosis, oliguria
4、abdominal examination: distention of epigastrium,
visible gastric waves, presence of a palpable pyloric
tumor (unique physical sign)

83. 【Diagnosis】

84. 【Diagnosis】
1、typical vomiting and mass in the epigastrium
2、ultrsound: muscular thickness≥0.4cm，
SD=thickness×2/diameter≥50％
3、GI for cases with difficulty in diagnosis：
①distention of the stomach
②strong gastric waves
③elongated and narrow
pyloric channel
④delay in stomach emptying

85. 【Treatment】

86. 【Treatment】
Surgery ———— pyloromyotomy

87. Intestinal Obstruction
in the Neonate

88. 【 Etiology 】

89. 【 Etiology 】
1、Malrotation of midgut around the axis of superior
mesenteric artery
2、Intestinal recanalization anomaly
3、Compromise of intestinal blood supply
4、Arrest of the migration of neuroblast derived from
neural crest of epiderm
5、Viscosity of meconium : cystic fibrosis
6、Maternal factors: infection, diabetes, pharmaceuticals

90. 【 Pathophysiology】

91. 【 Pathophysiology】
1、Loss of fluid from emesis: dehydration,
electrolyte disturbance, acid-base imbalance
2、Aspiration and abdominal distention:
chemical and bacterial pneumonia, apnea
3、Dissemination of enterobacterium: ischemia,
necrosis, perforation and sepsis

92. 【Clinical manifestation】

93. 【Clinical manifestation】
Characters of neonate ileus:
Bilious vomiting
Abdominal distention
Failure to pass meconium
General condition：drowsy、hypomyotonia、
tachypnea

94. 【Neonatal Peritonitis】

95. 【Neonatal Peritonitis】
1、abdominal distention, abdominal wall
erythema
2、tenderness manifested as crying, flexing
legs,grimace
3、guarding reflex not obvious

96. 4、abdominocentesis as shifting dullness unobvious
5、diminished gurgling sound：enteroparalysis
6、abdominal mass：necrotizing intestinal loop、
calcification、infection
General condition：
drowsiness, dyspnea
hypomyotonia,oliguria

97. Common causes of neonate intestinal
obstruction

98. Common causes of neonate intestinal
obstruction
Mechanic obstruction
Extrinsic ： Intrinsic：
•intestinal atresia meconium peritonitis
and stenosis 40％
•annular pancreas milk curds obstrution
•Malrotation 10～15% meconium plug
•intestinal duplication
• meconium peritonitis（adhesion）
•internal hernia, incarcerated external hernia
•intussuception

99. Functional obstruction

100. Functional obstruction
Hirschsprung’s disease 25～30％
Necrotizaing enterocolitis
Left microcolon syndrome
Infection
Metabolic

101. Intestinal Atresia
and Stenosis

102. 【Clinical findings】

103. 【Clinical findings】
1、vomiting
onset: from first time of feeding
to a few days after birth
vomitus: bilious or feculent
2、abdominal distention
high: confined to epigastrium
low: full abdomen distention
3、failure to pass meconium:
normally meconium was passed within the first 24hrs
of life and cleared in 2-3 days.
4、General condition

104. 【 Diagnosis 】

105. 【 Diagnosis 】
1、prenatal ultrasound
2、Clinical findings:
bilious vomiting 24-48hrs after birth
abdominal distention
failure to pass meconium
3、X-ray：
duodenal atresia－－Double bubble sign
jejunal atresia－－triple bubble sign
low intestinal atresia－－multiple air-fluid level

106. 【 Treatment 】

107. 【 Treatment 】
The only option is surgery：
intestinal septum excision
Intestine resection and anastomosis

108. Congenital
Malrotation of Intestine

109. 【Definition】

110. 【Definition】
Malrotation is the term used to define the group of
congenital anomalies resulting from aberrant intestinal
rotation and fixation
【Embryology】
Week 6~8: Herniation of midgut into the umbilical
cord with a 180 degree of counterclockwise rotation
along the axis of superior mesenteric artery
Week 10: Return to the abdominal cavity with a
final 90 degree of rotation to complete the 270-degree
counterclockwise rotation

111. 【 Pathology 】

112. 【 Pathology 】
Nonrotation and Incomplete rotation: abnormal
positioning of the proximal small bowel and the cecum
Duodenum compressed by abnormal peritoneal
band(Ladd’s band): high incomplete extrinsic obstruction
Midgut volvulus: torsion of the narrow mesenteric pedicle
produces an acute closed-loop intestinal obstruction and
vascular insufficiency.
Proximal jejunum fused to the ascending colon by
anomalous peritoneal attachments

113. Malrotation

114. Malrotation
 Pathology：
Compression of duodenum
Kinked and foreshortened proximal jejunum by
peritoneal band
Midgut volvulus

115. 【Clinical manifestations】

116. 【Clinical manifestations】
Emesis：bilious, intermittent，occur at 3-5 days after
birth or asymptomatic
Abdominal distention: confined in epigastrium, diffuse to
the full abdomen in bowel necrosis
Stool: normal meconium, bloody stool suggests volvulus
and necrosis
Newborn: normal meconium，intermittent vomiting after
3-5 days of birth，no abdominal distention, hard stool
Children and infant：asymptomatic since birth,
intermittent onset or sudden onset of volvulus

117. Clinical manifestations

118. Clinical manifestations
 Symptoms of volvulus: bloody vomitus
and stool, abdominal tenderness

119. 【X-ray film】

120. 【X-ray film】
1、Plain X-ray film:
double-bubble sign
2、barium enema: cecum
in the upper or left
abdomen
3、GI： incomplete
duodenal obstruction;
ligament of Treitz not to
the left of the midline;
abnormal position of the
proximal jejunal loops to
the right of the midline

121. Treatment

122. Treatment
Principles：
Asymptomatic malrotation
most recommend surgical treatment
some believe operation only necessary in young children
High intestinal obstruction
operated on promptly, but not necessarily emergently
Volulus with sign of bowel necrosis
immediate operation

123. Treatment
Ladds operation
• All volvulus is clockwise so the small bowel must
be rotated in a counterclockwise fashion
• Expose duodenum by division of the Ladd’s bands
• Dissection additional peritoneal bands to convert
the mesenteric pedicle to a wide plane
• Alignment of small bowel to the right and colon to
the left of the abdominal cavity

124. Hirschsprung’s Disea
Anatomy

125. Hirschsprung’s Disea
Anatomy
1、distended segment: proxiaml
colon enlarged with muscular
hypertrophy
2、stenosis segment：distal colon
spasm
3、transitional segment：between
distal and proximal segments

126. Histology

127. Histology
1、lack of ganglion cell in the neural plexus of
the affected segment of intestine
2、hypertrophied nerve trunk stain positive
for acetylcholinesterase
3、Disarray of adrenergic fibers

128. 【Pathophysiology】

129. 【Pathophysiology】
Arrest of cranial to caudal migration of neuroblasts
derived from neural crest precursors along the
intestinal tract with vagal nerve fiber at 6-12 weeks of
gestation, which results in aganglionosis of the distal
bowel.
1、spasm of affected segment
no normal peristalsis
2、internal sphincter spasm
no normal defecation reflex
3、proximal bowel distended with histologic evidence
of muscular hypertrophy

130. 【clinical findings】

131. 【clinical findings】
Neonate：
1、emesis：bilious or feculent
2、abdominal distention
3、delayed passage of meconium
4、rectal examination：tightness of internal
sphincter,rectal emptiness，withdraw brings out meconium
and gas
5、after bowel irrigation, temporary subsiding of the
symptoms
Children and infant：
1、History of neonate constipation
2、Malnutrition , anemia
3、Chronic abdominal distention

132. 【Diagnosis】

133. 【Diagnosis】
Barium enema
Demonstration of a spasmodic distal
intestinal segment with dilated proximal
bowel
Failure to evacuate barium from
colon within 24hours
simplicity of the method
accuracy in neonate 80％
not suitable for short segment type

134. Anorectal Manometry

135. Anorectal Manometry
•Aid diagnosis through identification of the rectoanal
inhibitory reflex which is absent in the vast majority of
children with Hirschsprung’s disease
•Drawbacks: false-positive in older children due to
masking of the relaxation response by contraction of the
external sphincter

136. Rectal biopsy (Definitive diagnosis )

137. Rectal biopsy (Definitive diagnosis )
Suction biopsy
 Biopsy taken at 1-2cm above the dentate line
 looking for the presence or absence of ganglion cells and
hypertrophied nerve trunks
 simplicity, accuracy, absence of complications
 False-negative (age, mucosal edema, tissue quality,
experience )

138. Histologic staining of mucosa

139. Histologic staining of mucosa
Increased AChE content in the nerve fibers of the
lamina propria and muscularis mucosae
Full-thickness Rectal Biopsy
Complexity and complications, possible effect on future definitive
surgery

140. 【Complications】

141. 【Complications】
1、Enterocolitis
Most frequently encountered and life-
threatening:
from constipation to diarrhea
peritonitis and sepsis
fever and abdominal distention
digital exam：massive amount of odorant stool
2、Perforation：
Cecum peforation
Bowel necrosis and perforation

142. 【Treatment】

143. 【Treatment】
1、Colon irrigations:
isotonic fluid
one to two times a day
＃Do not use tape water
2、Colostomy：
3、Surgical options
Swenson
Duhamal
Rehbein
Soave Neonatal surgery
Laparoscope's
Transanal pullthrough

144. Anorectal Malformations
(ARMs)

145. Anorectal Malformations
(ARMs)
 One of the most frequently encountered
digestive tract abnormality
 Frequency is slightly higher in males
compared with females
 Associated anomaly: urogenital,another gastrointestinal
anomaly, cardiovascular, vertebra
 Arrest of the caudal descent of the urorectal septum
toward the cloacal membrane during the fourth week and
ending by the eighth week of gestation.

146. ARM classification

147. ARM classification
Wingspread classification :
according to the relative position of retal
end to the elevater ani：
high:above elevater ani
intermediate:within elevater ani
low:pass through elevater ani
Further classification according to the fistula

148. PC line: pubococcygeal line
I line: ischial line

149. ARM treatment
Aim：Rebuilt an anus with well functioning
anal sphincte
 High and intermediate imperforated anus
– colostomy at birth
– definitive surgery at 6-12months of age
 Low imperforated anus
– Trans- perineal anoplasty after birth
– For female with fistula，Dilatation of fistula,
anoplasty at 6-8 months

150. Hydronephrosis
(Ureteropelvic junction obstruction)

151. symptoms
•abdominal mass
• haematuria
•abdominal pain
•urinary tract infection
• others
Diagnosis
• sonograph
• IVP
• isotope renograph
• others：CT、MRU

152. Surgical Principles

153. Surgical Principles
• Always consider pyleoplasty , be very prudent to
do nephrectomy
• For bilateral hydronephrosis, pyleoplasty for both
sides could be carried out at the same operation
due to a high success rate nowadays
• Index for nephrectomy:
– Complete loss of function,
– parenchymal thickness <3mm
– sever cases of renal abscess

154. Fetal Surgical Procedures

155. Fetal Surgical Procedures
Focus is on defects which can
be accurately identified
antenatally and which cause
progressive and permanent
damage to the fetus if not
corrected.

156. Fetal Surgery

157. Fetal Surgery
• Open procedures are investigational -
performed only at a few centers
• Most data on open fetal surgery comes
from UCSF and CHOP, where the
majority of these procedures have
been performed
• Some less invasive procedures are
more commonly performed

158. Examples of malformations that may
benefit from in utero surgical
correction

159. Examples of malformations that may
benefit from in utero surgical
correction
• Bladder outlet obstruction (posterior urethral
valves)
• Diaphragmatic hernia
• Cystic Adenomatoid Malformation (CAM)
• Sacrococcygeal Teratoma
• Tracheal atresia/stenosis
• Neural tube defects

160. Get this ppt in mobile
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PowerPoint from play
store.
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3. Open Google lens.
4. Scan qr code from
next slide.

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