Department of Pediatric Surgery, Charles University, 2nd Medical Faculty,

Thoracic surgery

Author: Jiří Šnajdauf

Chest wall deformities:
• Pectus excavatum - (funnel chest), most common chest wall deformity, Surgical repair - without metallic strut - modif. Welch, with metallic strut - modif. Holcomb, complications, Minimally invasive Repair of Pectus Excavatum - Nuss technique
• Pectus carinatum - (pigeon brest) - protrusion deformity
• Poland´s syndrom - Absence of the pectoralis major and minor muscles and syndactyly
• Sternal defects
Esophageal Atresia; CCAM; Oncological pulmonary diseases; Mediastinal Masses; Anterior and superior mediastinum.

Perioperative analgesia in children

Author: Vladimír Mixa, MUDr. Jiří Náhlovský

Perioperative analgesia in children; Postoperative pain management is a crucial task for all doctors treating children in a postoperative setting; Aims:
- to eliminate postoperative pain
- to minimize perioperative stress
- to prevent forming of negative memory imprints
Patophysiology of paediatric perioperative pain;
Drug absorption is decreased in neonates because of
Drug distribution in influenced by
Drug elimination is influenced by
Analgetics overview; Opioids I.; Opioids II.; Non-opioids I.

Onconsurgery in children

Author: Michal Rygl

Onconsurgery in children:
• Embryonal tumors
• Neuroblastoma
• Nephroblastoma
• Hepatoblastoma
• Pulmoblastoma, pankreatoblastoma, lipoblastoma
• Sarcoma

Intrabdominal Mass
• Hepatomegaly, Hydrops, Liver cyst, Liver tumor, Choledochal cyst
• Infiltration– appendix, Crohn; Abscess – appendix, Crohn
• Splenomegaly, Bezoar, Splenic cyst
• Gas, Stoool, Intestinal tumor, Abscess

Neonatal surgery

Author: Michal Rygl

Neonatal surgery Congenital diseases
•Atresia GIT, biliary atresia, Malrotation, Diaphragmatic hernias, Abdominal wall defects, Lung anomaly

Acquired diseases
•Perinatal trauma, Hernias, Testicular torsion, Ileus, Perforation and inflammation of GIT, NEC, Tumors

Surgery of congenital malformations - complex treatment; Survival in isolated malformation in Motol Hospital; Congenital diaphragmatic hernia – posterolateral, Bochdalek - Czech pathologist Professor Bochdalek in1848.

Hepatobiliary surgery

Author: Jiří Šnajdauf

Hepatobiliary surgery; Liver tumors in children; Benign liver tumors; Hemangiomas: 1. Cavernous hemangiomas 2. Hemangioendotheliomas
•Cardiac failure - digoxin, diuretics
•Corticosteroids or alpha2A-interferon induce regresion in some cases
•Localized - resection
•Bilobar - hepatic artery ligation or embolization
•Rare - transplantation
Focal nodular hyperplasia - FNH; Adenoma; Non-Parasitic Cysts; Congenital liver cyst – located partially extrahepatic in porta hepatis; Malignant liver tumors; Hepatoblastoma; Staging by SIOP of malignant liver tumors; Hepatoblastoma - Histopathology

Anorectal malformations

Author: Richard Škába

Anorectal malformations; Anorectal malformations; Congenital defects of anus and rectum;
Failure of cloaca´s development; Classification Anorectal malformations - Male, Female; ARM - embryology, genetics, Incidence, diagnosis, Magnetic Resonance Imaging, Treatment; Standard surgical technique of definitive ARM repair; PSARP - minimal, classical - perineal, perineal + abdominal; Postoperative complications in 156 patients.

Acute abdominal conditions

Author: Jan Trachta

Inflammatory; Bowel obstruction; Trauma; Peritoneal and thoracic cavity with foetal circulation; Gastrointestinal; Genitourinary; Gynaecolologic; Neurogenic; Vascular; Systemic disease; Mimicking intraabdominal pathology; Bowel obstruction - Mechanic, Neurogenic, Vascular; Ladd syndrome – malrotation of the midgut with Ladd´s bands; The difference between hernia in a child and an adult.

Abdominal trauma

Author: Jan Trachta

Abdominal trauma
Blunt trauma 85% mortality 9%
Penetrating trauma 15% mortality 6%
Shock = Inadequate tissue perfusion
Shock - clinical features
Management of abdominal trauma
Treatment of shock:
•oxygen support - 100% O2
•cannulation of peripheral vein 2x
•fluid replacement - crystalloid solution
•transport to ICU
ICU management
ICU monitoring
Fluid resuscitation - hemodynamic stability

Neonatal perioperative care - Clinical cases

Author: Alena Kokešová, Ph.D., MUDr. Jiří Náhlovský

NICU clinical cases
Case no. 1: Patient after omphalocele repair - contrast study for CVC placement
Case no. 2: Patient after AOE repair – primary anastomosis – X-ray control on 2nd postoperative day for ventilatory deterioration following extubation
Case no. 3: Boy 2-mo. old, meconium plug syndrome with spontaneous resolution, discharged home, healthy until…
Case no. 4: Dyspnea after delivery. Transferred to NICU, where X-rayed.
Case no. 5: 3-d. old infant, treated for suspected infection from day 2, bloody stools, spinal tap performed, on day 3 for abdominal distention X-ray study

Neonatal perioperative care

Author: Alena Kokešová, MUDr. Jiří Náhlovský

Podklady pro výukový seminář "Neonatal perioperative care".



-minimalize stress factors
-optimalize operation
-avoid complications
-improve postoperative adaptation