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Pediatric surgery is a demanding specialty that requires not only technical expertise but also exceptional clinical judgment and adaptability. Pediatric surgeons frequently encounter rare congenital anomalies and unusual surgical problems, often requiring them to make difficult decisions with limited precedent. Even well-recognized congenital conditions can present in atypical ways, necessitating a patient-centered approach that may deviate from routine practice. This places a premium on a surgeon’s ability to apply broad surgical principles to novel and complex situations, tailoring interventions to each child’s unique anatomy and pathology. Compounding this challenge is the rapidly evolving literature in pediatric surgery, where new techniques, evolving guidelines, and emerging technologies continually reshape best practices. Thoughtful interpretation of the literature is essential, particularly when the optimal approach to a problem remains unclear or controversial. Pediatric surgeons must not only stay abreast of these developments but also critically analyze and synthesize data to make sound, evidence-based decisions in the face of uncertainty.
The Difficult Decisions in Surgery series was developed to address many of these challenges faced by surgeons. To date, 10 volumes have been published, receiving enthusiastic engagement from the surgical community. These multi-authored volumes consist of concise chapters, each focused on a specific difficult or controversial decision within a surgical specialty. This series is particularly well-suited for pediatric surgeons, as it provides insight into difficult decisions faced within the field.
The volumes serve as a timely reference for practicing surgeons, trainees, and educators, emphasizing the ideal approach to selected clinical situations rather than merely reflecting customary care. Recommendations are grounded in published evidence, while also incorporating expert opinions and personal experiences, helping surgeons navigate complex, evolving literature and apply general surgical principles to novel pediatric challenges.
The chapters in each volume adhere to a specific format. This approach provides uniformity to the presentations, making it possible to identify useful material at a glance:
Pages i-viii
Front Matter
Pages 1-1
Evidence Based Medicine and Decision-Making in Pediatric Surgery
Pages 3-13
Pages 15-22
Pediatric Acute Appendicitis as a Model for Shared Decision-Making
Pages 23-37
Front Matter
Pages 39-39
Non-operative Management of Blunt Solid Organ Injuries in Pediatric Trauma
Pages 41-48
Optimal Management of Children with Concern for Possible Traumatic Brain Injury
Pages 49-65
Pages 67-76
Where Should Children Be Treated After Sustaining a Traumatic Injury?
Pages 77-84
Which Surgeons Should Care for Traumatically Injured Children in Rural Areas?
Pages 85-93
Pages 95-106
Choice of Injury Severity Scoring System in the Evaluation of Pediatric Trauma Patients
Pages 107-117
Pages 119-126
Meaningful Survival After Neonatal ECMO: A Systematic Review of Long-Term Outcomes
Pages 127-139
Front Matter
Pages 141-141
Wilms Tumor—NWTSG/COG Versus SIOP Approach Now and in the Future
Pages 143-154
Rhabdomyosarcoma—Biopsy Approach
Pages 155-163
Which Pediatric Breast Lesions Are Best Managed by Pediatric Surgeons?
Pages 165-174
Pages 175-188
Front Matter
Pages 189-189
What Is the Optimal Timing of Congenital Diaphragmatic Hernia Repair in a Neonate Requiring ECMO?
Pages 191-201
Pectus Excavatum—Evidence-Based Indications for Surgical Correction
Pages 203-213
What Is the Best Approach to Evaluation and Treatment of Children with Diaphragmatic Eventration?
Pages 215-229
Spontaneous Pneumothorax: Watchful Waiting or Surgical Intervention?
Pages 231-243
Pleural Empyema—VATS Versus Pleural Drainage and Fibrinolysis
Pages 245-254
Front Matter
Pages 255-255
Management of Long-Gap Esophageal Atresia
Pages 257-277
Pages 279-291
Esophageal Replacement in Children: Optimal Approach
Pages 293-302
Pages 303-311
Front Matter
Pages 313-313
Pages 315-324
Appendicitis: Medical Management of Early Appendicitis
Pages 325-332
Pages 333-339
Do Consensus-Based Care Pathways Improve Patient Outcomes in the Management of Gastroschisis?
Pages 341-357
Necrotizing Enterocolitis: Indications to Operate
Pages 359-373
What Is the Optimal Interval Between Ostomy Formation and Ostomy Takedown in a Newborn After NEC?
Pages 375-387
Intussusception Management: Can We Do Better?
Pages 389-394
Ladd’s Procedure in an Asymptomatic Child with Congenital Heart Disease and Heterotaxy
Pages 395-404
Front Matter
Pages 405-405
Pages 407-428
Pages 429-439
Anorectal Malformations- Who Should Perform the Repair?
Pages 441-455
Pull-through in the Setting of Cloacal Exstrophy
Pages 457-464
Undescended Testes: Timing of Orchidopexy
Pages 465-488
Front Matter
Pages 489-489
Management of Anorectal Malformations and Hirschsprung’s Disease in Resource Challenged Settings?
Pages 491-505
Pages 507-513
Ethical Dilemmas in Global Pediatric Surgery
Pages 515-531
Front Matter
Pages 533-533
Selection of the Next Generation of Pediatric Surgery Trainees: Best Practices and Best Outcomes
Pages 535-546
Pages 547-558
Is It Ethically Permissible to Prioritize Pediatric Patients for Scarce Surgical Resources?
Pages 559-567
Changing Postoperative Opioid Prescribing Practices
Pages 569-584
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