SURGICAL TREATMENT OF CONGENITAL ANOMALIES

Amir Halilbašić, Fahrija Skokić, Nešad Hotić, Edin Husarić, Emir Rahmanović, Sanimir Suljendić

Abstract


More than half of all congenital deformities can be detected in utero. The initial surgical correction is of paramount importance for the achieve ment of good long-term results with low surgical morbidity and mortality. Congenital deformities are rare, and no controlled trials have been performed to determine their optimal treatment. In this article, we present the prenatal assessment, treatment, and results of selected types ofcongenital deformity. If a congenital anomaly is detected and its prognosis can be reliably inferred from a prenatal assessment, the child should be delivered at a specialized center (level 1 perinatal center). The associated survival rates are 60–80% after treatment for CDH and well over 90% after treatment for esophageal or small-bowel atresia. Despite improvements in surgical correction over the years, complications and comorbidities still affect 20–40% of the treated children. These are not limited to surgical complications in the narrow sense, such as recurrence, postoperative adhesions and obstruction, stenoses, strictures, and recurrent fistulae, but also include pulmonary problems (chronic lung disease, obstructive and restrictive pulmonary dysfunction), gastrointestinal problems (dysphagia, gastro-esophageal reflux, impaired intestinal motility), and failure to thrive. Moreover, the affected children can develop emotional and behavioral disturbances. Minimally invasive surgery in experienced hands yields results as good as those of conventional surgery, as long as proper selection criteria are observed.Congenital anomalies should be treated in recognized centers with highly experienced interdisciplinary teams. As no randomized trials of surgery for congenital anomalies are available, longitudinal studies and registries will be very important in the future.

 




DOI: 10.5457/ams.v45iSuppl. 1.377