sutures newsletter

PRODUCED BY AND FOR MEMBERS OF THE DEPARTMENT OF SURGERY October 2012 Issue | Archived Issues

Pediatric surgery has strong roots, future at Cedars-Sinai

Cedars-Sinai's pediatric surgeons have played key roles at the local, regional and national levels. It's been that way since Stephen Gans, MD, helped transform a fledgling group of child-caring surgeons into the American Pediatric Surgical Association and then developed the Journal of Pediatric Surgery.  

David W. Bliss, MD, FACS, FAAP,joined Cedars-Sinai as the director of the Division of Pediatric Surgery in early 2011.While clinical care will always be the group's focus, it also is now exploring ways to contribute to pediatric surgical science.

Hirschsprung’s disease model

Frykman 90pxPhilip Frykman, MD, PhD, (pictured left) associate director of Pediatric Surgery, is one of a select group of international physicians working on a basic science model of Hirschsprung’s disease (congenital megacolon) as well as a registry of patients with Hirschsprung’s enterocolitis.

Frykman’s work, which is funded by the National Institutes of Health, holds promise to identify new methods of treatment and discern risk factors for complications of the disease.

Evidence-based techniques

Bliss 90pxBliss (pictured right) brings an interest in using evidence-based techniques to define optimal care in Pediatric Surgery. His work includes studies of neonates with posterolateral diaphragmatic hernia, head-injured children and appendicitis.

In the past, hypercapnea was considered anathema in children with diaphragmatic hernia because of the perceived risk of recurrent, life-threatening pulmonary hypertension. Bliss’ work demonstrated that infants tolerate arterial CO2 concentrations above 120 torr and pH levels as low as 6.9 without clinically detectable complications.

He recently submitted for publication data demonstrating that only 7 percent of children undergoing a head CT for closed head injury will have findings on a subsequent scan that lead to a surgical intervention – thus suggesting that serial CT examinations are neither cost-effective nor clinically useful in these circumstances.

Since the advent of endoscopic surgical techniques, patients, families, referring physicians, and surgeons have rapidly accepted the "superiority" of these methods. While it seems intuitively obvious that these "minimally invasive" procedures should be less painful, have faster recoveries, shorter length of stays, and lower complication rates, the actual data to support these assertions has been in short supply.

Bliss recently completed the largest prospective, randomized, blinded trial of laparoscopic versus open appendectomy in children. While the findings are currently under peer review, the analysis suggests that the laparoscopic approach is faster and has fewer infectious complications but is no different than open operation with regard to pain medication requirements or length of stay.

To learn more about the clinical or research activities of the Division of Pediatric Surgery at Cedars-Sinai, please call the office at (310) 423-6235 or email Bliss at blissd@cshs.org.

Submitted by the Division of Pediatric Surgery in the Department of Surgery.