Preface

*Pediatric Surgery, Flowcharts and Clinical Algorithms* is for readers interested in pediatric surgery. It provides updated information about some common topics together with suggested algorithms to assist the clinical management of different disease presentations.

The section on fetal surgery includes a chapter by Dr. Ahmed Abdelghaffar Helal that covers the most common anomalies encountered in fetal screening and possible fetal interventions as well as their success rates and the possible risks to the fetus and the mother.

The section on gastrointestinal disorders includes three chapters. "Gastrointestinal Surgical Disorders in Neonates" by Dr. Rita Verma covers the common gastrointestinal disorders in pediatric surgery, suggested diagnostic approaches, and updated management protocols together with prognosis.

"Oesophageal Atresia: Drowning a Child in His/Her Own Saliva" by Dr. Samuel Osei-Nketiah, and Dr. William Appeadu-Mensahm is a comprehensive review of esophageal atresia starting with a detailed description of the embryology, anatomy and physiology of the esophagus, and ending with antenatal and post-natal diagnosis and resuscitative management.

The chapter also describes different classifications systems and prognostic indicators as well as the surgical strategy for long-gap esophageal atresia, including early and late postoperative complications.

"Meconium Ileus" by Dr. Omogiade Ernest Udefiagbon covers the salient features of meconium ileus including an interesting algorithm to assist in decision making whether using operative or non-operative management.

The hepatobiliary section includes a chapter on "Choledochus Cysts" by Dr. Hasan Özkan Gezer that covers the history and etiology of these malformations and the different classification systems used over time. It discusses investigatory workup as well as the different management options for the different types of cysts, including open and laparoscopic approaches with discussion of the possible postoperative complications.

The section on abdominal wall defects includes a chapter on "Gastroschisis" by Dr. Alaa Obeida and Dr. Aly Shalaby. It covers the important aspects of gastroschisis including etiology and antenatal detection with special emphasis on gastroschisis in low- to middle-income countries. The chapter includes an important section on intraoperative decision making in some of the difficult comorbidities.

The section on minimally invasive surgery includes a chapter about "Single-Port Laparoscopic Surgery" by Dr. Enaam Raboei, which is about the tips and tricks of single-incision laparoscopic surgery, clearly showing the advantages and

**II**

**Section 5**

Minimally Invasive Surgery **137**

**Chapter 7 139**

*by Enaam Raboei, Ameen Alsaggaf, Yazeed Owiwi, Syed Salahuddin,* 

Single-Incision Pediatric Endosurgery (SIPES)

*Alaa Ghallab and Mazen Zidan*

disadvantages of the technique, and some practical examples and personal experience for its application in common pediatric surgical procedures.

The chapter authors have made a great effort to bring the most updated information about these conditions to the pediatric surgeon to facilitate decision making and achieve best results and prognosis.

> **Sameh Shehata** Alexandria University, Alexandria, Egypt

> > **1**

Section 1

Fetal Surgery

Section 1 Fetal Surgery

**3**

**Chapter 1**

**Abstract**

fetal procedures

**1. Introduction**

**2. Key points**

Principles of Fetal Surgery

Fetal therapy (in utero therapy) is a type of special therapy which aims to prevent or correct congenital anomalies in fetus, and prevents their severe consequences on later fetal development. It includes the use of in utero human fetal stem cell transplantation, fetal gene therapy and gene-editing technology as a new treatment for fetal genetic disorders. It started with open fetal surgery and then significantly advancing with innovations, toward minimally invasive fetal procedures, which are undoubtedly the future of fetal surgery, with the goal of providing the best possible fetal outcome, while minimizing the morbidity and mortality to the mother. The goal of fetal treatments is to decrease both fetal and maternal risks and prevent premature rupture of membranes. Fetal ultrasound and MRI are crucial for successful fetal interventions. Moreover, multidisciplinary fetal teams, including fetal surgeon, ultrasonographer, perinatologist, and anesthesiologist, are essential for optimum care to both mother and fetus. Finally, any new modality of fetal therapy must be thoroughly evaluated in animal models before clinical practice. In this chapter, we discuss the basic principles of fetal surgery, milestones of fetal surgery, specific fetal anomalies that are amenable for fetal surgery, successful fetal

**Keywords:** fetal therapy, in utero therapy, fetal team, minimally invasive

procedures used to treat them, and the future of the field.

prevent premature rupture of membranes.

success of fetal procedures.

Fetal surgery or in utero therapy tries to prevents or corrects multiple congenital anomalies in the fetus to prevent their severe consequences on later fetal development. It started with open fetal surgery then innovations toward minimally invasive procedures have occurred. In this chapter, we discuss the basic principles of fetal surgery, the general history of its development, important specific conditions and

• The goal of fetal treatments is to decrease both fetal and maternal risk and

• Real-time ultrasound and fetal MRI is crucial to the implementation and

*Ahmed Abdelghaffar Helal*

surgery criteria and future of fetal surgery.
