Pediatric gastrointestinal surgery
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quote from "Pediatric Surgery (Springer Surgery Atlas)" by Prem Puri, Michael E. Höllwarth - "When a baby is born with this malformation at our institution, we repair this malformation during the newborn period if the baby is otherwise healthy. If the baby is premature or has associated defects, it is always safer to open a protective colostomy or dilate the fistula until definitive repair can be performed. The surgeon must keep in mind that dehiscence and infection in patients with anorectal malformations not only represent a few more days in the hospital and an ugly scar but also represent the possibility of worsening the prognosis for bowel control."
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quote from "Pediatric Surgery (Springer Surgery Atlas)" by Prem Puri, Michael E. Höllwarth - "We prefer to operate on these babies to give the child an anal opening that is centered in the sphincter and appropriately sized, and to achieve a better cosmetic effect."
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Quotes from "Pediatric Surgery (Springer Surgery Atlas)" by Prem Puri, Michael E. Höllwarth - "Surgery is indicated only for selected patients with any one of three conditions: (1) when the absorptive surface area is definitely too small to allow enteral feeding; (2) when severe dysmotility in grossly dilated loops entails stagnation of chyme; and (3) when intestinal transit time is too fast to allow sufficient absorption of nutrients. In the first group of patients, intestinal transplantation is the mainstay of surgical therapy. In the second group, peristalsis can be improved by intestinal tapering or tapering and lengthening. In the third group, antiperistaltic segment…
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Quotes from "Pediatric Surgery (Springer Surgery Atlas)" by Prem Puri, Michael E. Höllwarth - "Resection of the jejunum is well tolerated owing to the enormous adaptive capacity of the ileum, the intact enterohepatic circulation of bile salts, and the preserved absorption of fat-soluble vitamins and vitamin B12. In contrast, if the entire ileum is lacking, absorption of nutrients is significantly more difficult because of the limited intestinal adaptation capacities of the jejunum. Nonabsorbed intestinal contents, including bile acids, spill over into the colon and may cause significant diarrhea. Furthermore, loss of the ileum leads to a reduction of the bile salt pool, m…
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Quote from "Pediatric Surgery (Springer Surgery Atlas)" by Prem Puri, Michael E. Höllwarth - "The term “short bowel” was defined by Rickham in 1967 as a small intestinal remnant of 75 cm or less in the newborn, which equals 30% of normal small bowel length in that age group. A more functional description, preferred by most authors, defines a “short bowel syndrome” (SBS) as a state of significant maldigestion and malabsorption due to an extensive loss of functional absorptive intestinal surface area."
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Quote from "Pediatric Surgery (Springer Surgery Atlas)" by Prem Puri, Michael E. Höllwarth - "These are usually found in the retrorectal space and do not communicate with the urinary tract. Cystic rectal duplications must be distinguished from cystic sacrococcygeal teratoma, tailgut cyst, and an anterior meningocele. When associated with an anorectal malformation and sacral anomalies, the cyst may be part of the Currarino syndrome. Rarely, a rectal duplication cyst presents as rectal prolapse in an infant.
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Quote from "Pediatric Surgery (Springer Surgery Atlas)" by Prem Puri, Michael E. Höllwarth - "Imaging is a critical aspect of preoperative preparation. The choice of imaging is dictated by the site of the duplication, clinical urgency, and the potential for associated anomalies. Isolated small bowel duplications often require no preoperative investigations other than abdominal sonography, a plain abdominal radiograph and routine blood tests. Occasionally, a technetium-99m pertechnetate radionuclide scan is helpful in detecting heterotopic gastric mucosa. In contrast, thoracoabdominal lesions demand detailed radiologic imaging of mediastinal, abdominal, and spinal componen…
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Quote from "Pediatric Surgery (Springer Surgery Atlas)" by Prem Puri, Michael E. Höllwarth - "The ischaemic insult also adversely influences the structure and subsequent function of the remaining bowel. Histological and histochemical abnormalities can be observed up to 20 cm cephalad from the end of the atretic proximal segment. The distal bowel is unused and potentially normal in function."
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Treatment of Anorectal malformation according to Talmud, 2000 years ago.
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