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EDITORIAL |
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| Year : 2015 | Volume
: 20
| Issue : 3 | Page : 103-104 |
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Surgical gastroenterology in children
Veereshwar Bhatnagar
Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi - 110029, India
| Date of Web Publication | 18-Jun-2015 |
Correspondence Address:
Veereshwar Bhatnagar
Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi - 110029
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0971-9261.159012
How to cite this article:
Bhatnagar V. Surgical gastroenterology in children. J Indian Assoc Pediatr Surg 2015;20:103-4 |
Gastrointestinal (including hepatobiliary and pancreatic) malformations, neoplasia, trauma, and diseases, which require surgical intervention constitute a major portion of a pediatric surgeon's clinical practice. In an undivided pediatric surgical set up (i.e. one in which the entire spectrum of pediatric surgery is being practiced), these procedures will account for almost the same percentage of work as pediatric urological procedures. A rough estimate would suggest 40 (GI): 40 (PU): 20 (others). Then why is it that pediatric gastrointestinal surgery has not emerged as a viable subspecialty and why is it that it does not enthuse pediatric surgeons in the same manner as pediatric urology does?
Pediatric Gastroenterology, as a recognized subspecialty of pediatrics, came about many decades ago. These physicians took upon themselves to focus on the diagnosis and medical management of gastrointestinal and hepatobiliary pancreatic problems. With the advent of endoscopes, the diagnostic armamentarium received a big boost and new techniques were developed by the pediatricians, which saw endoscopic procedures both for diagnosis and therapy. The pediatric gastroenterologist soon required dedicated pediatric surgeons to deal with problems, which could not be treated by medical measures alone. However, the reluctance of the majority of pediatric surgeons to narrow down their vast spectrum and variety of practice has not helped in developing a focused "pediatric gastrointestinal surgery" subspecialty in pediatric surgery.
The spectrum of work in pediatric surgical gastroenterology is phenomenal. Apart from the esophagus, which can be contested by the thoracic surgeons, the entire gastroenterological apparatus in the abdomen is in the domain of the pediatric surgeon. This includes the entire gut, the liver and gallbladder, spleen and pancreas; the terminal end of the gut, the anorectum, by itself can keep a pediatric surgeon professionally busy.
Hence, when I was requested to be a guest editor for this gastroenterologically focused issue of JIAPS, I made all efforts to select/generate articles, which could cover a wide spectrum. In some ways, we have succeeded. This issue has articles which deal with anorectal malformations, pouch colon (which is very much an Indian problem), duplications, Hirschsprung's disease, duodenal surgery, annular pancreas, biliary atresia, choledochal cyst, portal hypertension, and liver transplantation. Furthermore, gone are the days when simple descriptive papers would find a place in a journal of any standing or even interest the discerning reader. Preferences are always given to studies on aspects, which are not well-known, which solve controversies, answer research questions or are a manifestation of lateral thinking.
Despite standard treatment being available for a majority of disease processes, there are still gray areas in most aspects of clinical medicine. A classical example is biliary atresia. The standard treatment is the Kasai's procedure; yet it is a dilemma for the investigators, a challenge to the operating surgeon, a nightmare to the pediatric gastroenterologist during follow-up, a maze for those looking for prognostic factors and a never ending chain of supply for the liver transplant surgeon! Similarly, portal hypertension has had its ups and downs in the standardization of diagnosis and therapy. However, just when we started believing that medical management, pharmacological prophylaxis, and endoscopic procedures could reduce crowding in the pediatric surgical clinics, newer indications for surgical intervention, e.g. portal biliopathy, have emerged.
The vast spectrum of anorectal malformations, the technical nuances of surgery for Hirschsprung's disease, management of fecal incontinence, and the ever-expanding scope for newer instrumentation has changed the dimensions of the challenges thrown up by pediatric surgical gastroenterology.
Pediatric surgeons have to stop themselves from being enthralled by the lure of laparoscopy and now robotic surgery. In order to develop a subspecialty, the focus has to shift from the approach/technique/instrumentation to the region of interest. The nuances of operative surgery can be applied to the region of interest.
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