Progress in Pediatric Surgery – serie

In 1968 the first contacts were arranged with the publishing house of Urban & Schwarzenberg concerning the establishment of a periodical to be produced in English with the aim of publishing important scientific work in pediatric surgery and related disciplines. I thought especially of certain excellent inaugural disser­ tations and theses. When Urban & Schwarzenberg promised to start such a series, I recruited Peter Rickham, then in Liverpool and now in Zurich, and Jean Prevot of Nancy as executive editors. We chose the title Progress in Pediatric Surgery - Fortschritte del' Kinderchirurgie - Acquisitions en Chirurgie Enfantile as the name of our new series. The first volume was published in 1970, followed by another 16 volumes during the next 14 years. At the suggestion of Michael Urban, we turned from the publication of long papers to theme-based volumes, which proved to be extraordinarily useful. Mr. Urban, the head of Urban & Schwarzenberg, told us in 1982 that his firm could no longer look after Progress in Pediatric Surgery. With the agreement of Mr. Urban, we had to look for another' publisher and found Springer-Verlag, who agreed to continue publishing Progress in Pediatric Surgery in the approved lay-out. We cordially thank Dietrich G6tze of Springer-Verlag for his helpful support. This volume (No. 18) is the first of Progress in Pediatric Surgery to appear under the guidance of Springer-Verlag. We want to express our thanks to Mr. Urban and Dr.

The comparison of established methods in surgery is necessary in order to evaluate the advantages or disadvantages of each. We have therefore tried to include discussions of all the problems which arise in the treat- ment of long-gap esophageal atresia. The long-term results of different types of colonic interposition, of different "stretching" procedures, and of simple staged surgery seemed especially worthy of discussion. It was also important to describe the role of complications caused by special pathology of the trachea in esophageal atresia and their management. Second, new problems continue to arise with regard to the prenatal diagnosis of malformations. These new aspects will continue to exert an influence on our surgical field. Malformations pose severe problems for parents, the growing fetus, and the doctors and are lasting burdens on our task. PETER WURNIG, Vienna Contents I. Long-gap Esophageal Atresia Current Surgical Strategies in Long-gap Esophageal Atresia with Regard to Endoscopy Anastomosis. D. BooB and J. Kotlarski. With 7 Figures ...1Long-gap Esophageal Atresia: Experience with Kato's Instru- mental Anastomosis, with Cervicothoracic Procedure and P- mary Anastomosis, and with Retrosternal Colonic Interposition. W. Ch. Hecker. With 6 Figures ...9 Esophagus Replacement by Free, Autologous Jejunal Mucosa Transplantation in Long-gap Esophageal Atresia. H. Halsband. With 10 Figures ...22 The Outcome of Colonic Replacement of the Esophagus in Ch- dren. A. Ahmed and L. Spitz. With 3 Figures ...37 Gastric Tube Esophagoplasty. K. D. Anderson. With 1 Figure 55 The Significance of Tracheal Stenosis in Esophageal Atresia.

At first sight it may appear strange that a volume of Progress in Pediatric Surgery should be devoted to the history of our specialty. One assumes that progress is concerned primarily with recent developments whilst history deals with matters of the past. However, in the past there has also been considerable progress in the development of our understand­ ing of paediatric surgical problems, otherwise we would not have pro­ gressed to our present achievements. The editors, therefore, do not apologize for compiling this volume but, on the contrary, feel that the publication of this volume is most timely. Modern paediatric surgery has now been practised for three genera­ tions. The handful of pioneers who were the founders of our specialty worked mainly before the last world war. A few dozen of the inter­ mediary generation started work immediately after the war, while the new generation who are now dominating our specialty must be counted in thousands. Two factors have radically altered paediatric surgery as practised by the intermediary and the present generation of surgeons.

With improvements in respirator therapy and intensive care, congenital malformations and various acquired pathologic deformities of the trachea or bronchi are more often observed than used to be the case. For a while it seemed that tracheostomy would be unnecessary, but it has since become quite clear that severe disturbance of the trachea would be the outcome owing to primary or secondary pathologic changes that had not been given adequate consideration previous. These changes can lead to urgent life-threatening episodes or definite mutilation for the rest of the child's life. Tracheal surgery thus repre­ sents a new and special challenge for the pediatric surgeon. A solution to these serious problems must be found and merits discussion. Further­ more, it seems worthwhile to review cases of surgical pulmonary dis­ eases, except for the already widely discussed problems ofempyemas or bronchiectasis. P. WURNIG, Vienna Contents Pathophysiology of Subglottic Tracheal Stenosis in Childhood. B.MINNIGERODE and H.G.RICHTER. With2Figures 1 Subglottic Stenosis in Newborns After Mechanical Ventilation. M.MARCOVICH, F.POLLAUF, and K.BURIAN. With 3 Figures ... 8 Treatment of Congenital Cricoid Stenosis. R.N. P. BERKOVITS, E.J. VAN DER SCHANS, and J. C. MOLENAAR. With 7 Figures . . .. 20 Surgical Correction of Laryngotracheal Stenoses in Children. E. HOF. With 6 Figures . . . . . . . . . . . . . . . . . . . . .. 29 Surgical Treatment of Congenital Laryngotracheo-oesophageal Cleft. R.N.P.BERKOVITS, N.M.A.BAX, and E.J. VAN DER SCHANS.

Wir berichten tiber 185 Kinder mit unterschiedlichen Erscheinungen, die her- kommlich als Riesenhamartom, Angiodysplasie, kongenitale Trophoedem, ort- licher Gigantismus (z. B. Macrodaktylie) usw. gekennzeichnet werden. Wir schla- gen vor, aIle diese Erscheinungen als eine Entitat zu verstehen: kongenitale Weich- teildysplasie (congenital soft-tissue dysplasia, CSTD. Nach jtingsten embryologischen und zellbiologischen Untersuchungen tritt die CSTD als Folge embryonaler oder fetaler biosynthetischer Zellfehlregulation auf. Das Konzept einer CSTD-Entitat fiihrt sowohl zu einem gemeinsamen Unter- suchungsprotokoll als auch zu einem gemeinsamen therapeutischen Vorgehen un- ter besonderer Berticksichtigung der "Stabilitat" und der Gutartigkeit des Zu- standes. Die Behandlung sollte auf die funktionelle Verbesserung beschrankt bleiben, anstatt die Korrektur kosmetischer Defekte zu versuchen. References 1. Andre JM (1973) Les dysplasies vasculaires systematisees, vol 1. L'expansion scientifique, Paris 2. Andre JM, Jacquier A, Picard L (1977) La neurofibromatose de Recklinghausen. Pathogenie - Conception actuelle. Ann Chir Thor Cardiovasc 16: 175-185 3.Andrews EJ, Ward BC, Altman NH (1979) Spontaneous animal models of human diseases, vols 1 and 2. Academic, New York 4. Azouz EM (1983) Hematuria, rectal-bleeding and pelvic phleboliths in children with Klippel- Trenaunay syndrome. Pediatr Radiol 13: 82-88 5. Barksy AJ (1967) Macrodactyly. J Bone Joint Surg 49A(7): 1255-1266 6. Berliner DL, Ruhmann AG (1966) Comparison of growth of fibroblasts under the influence of II-beta-hydroxy and ll-keto-corticosteroids. Endocrinology 78: 373 7. Chassaignac C (1959) Hypertrophie congenitale des 2 membres droits. Bull Soc Coo Paris 8.

The clinical application of anorectal manometry was pioneered by pediatric sur- geons. Swenson in 1949 reported that the aganglionic bowel of patients with Hirsch- sprung's disease did not show any propulsive movements. In 1967 Lawson and Nixon and Schnaufer et al. found that the rectosphincteric reflex, which is ob- served in both normal individuals and patients with chronic idiopathic constipa- tion, is absent in patients with Hirschsprung's disease, and suggested anorectal manometry to be useful for the differentiation of Hirschsprung's disease from chronic idiopathic constipation. Studies on the pathophysiology of constipation and incontinence problems have flourished in Japan; the Japanese Research Society for Anorectal Manometry in Childhood was founded in 1975 by Ikeda, Okamoto, Katsumata, and Kasai. The Society has contributed greatly to advances in the clinical application of anorectal manometry. Basic investigations on the function of the anorectum in both normal individuals and patients with constipation or incontinence problems have also been promoted by members of the Society. The technique of anorectal manometry has been refined and standardized.The criteria for manometric diag- nosis of Hirschsprung's disease have been established. And the correlation be- tween postoperative continence in patients with Hirschsprung's disease or ano- rectal malformation and manometric findings has been understood. In this section, works by members of the Society are presented.

In conventional partial resection of parenchymatous organs significant bleeding is one of the main problems, especially in neonates and infants. The patients rapidly lose considerable amounts of their small blood volume. Laser light leads to photo­ thermal effects in tissue and causes coagulation, drying up, carbonization and evaporization, depending on the temperature. The neodymium Y AG laser emits nonvisible light in the near infrared with a wavelength of l. 0611m. This wavelength implies a relatively deep penetration into the tissue. This laser system, properly a coagulation laser, achieves its cutting effect by its high power density [9]. Because of thermal radiation in all directions, both sides of the section plane are coagulated as a positive side effect. Thus, in parenchymatous organs a combination of resection and sealing of the cut vessels and ducts, up to a limited diameter, is obtained. Laser Instruments We use a neodymium-YAG laser mediLas 2 (MBB-Medizintechnik, D-8012 Ottobrunn, Federal Republic of Germany), wavelength l. 0611m, maximal power output around 110 W (Fig. 1). Normally we prefer to work without tissue contact, Fig. l. The Nd-YAG laser system mediLas 2 with maximal power output around 100 W The Neodymium Y AG Laser in Surgery of Parenchymatous Organs 25 Fig. 2. The focusing handpiece with focal distance of 50 mm 1cm Fig. 3.

The latest volume in a series for specialists in pediatric surgery.