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Ashcraft’s

Pediatric Surgery

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Ashcraft’sPediatric Surgery

5th edition

george Whitfield Holcomb iii, Md, MBaThe Katharine B. Richardson Professor of Pediatric SurgeryUniversity of Missouri–Kansas CitySurgeon-in-ChiefDirector, Center for Minimally Invasive SurgeryChildren’s Mercy HospitalKansas City, Missouri

J. Patrick Murphy, MdProfessor of SurgeryUniversity of Missouri–Kansas CitySection Chief, Urologic SurgeryChildren’s Mercy HospitalKansas City, Missouri

Associate Editordaniel J. Ostlie, MdAssociate Professor of SurgeryUniversity of Missouri–Kansas CityDirector, Surgical Critical CareChildren’s Mercy HospitalKansas City, Missouri


1600 John F. Kennedy Blvd.Ste 1800Philadelphia, PA 19103-2899

Notice

Knowledge and best practice in this field are constantly changing. As new research and experience broaden our knowledge, changes in practice, treatment, and drug therapy may become necessary or appropriate. Readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of practitioners, relying on their own experience and knowledge of the patient, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions. To the fullest extent of the law, neither the Publisher nor the Editors assume any liability for any injury and/or damage to persons or property arising out of or related to any use of the material contained in this book.

The Publisher

Ashcraft’s Pediatric Surgery ISBN:978-1-4160-6127-4

Copyright © 2010, 2005, 2000, 1993, 1980 by Saunders, an imprint of Elsevier Inc.

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Library of Congress Cataloging-in-Publication Data

Ashcraft’s pediatric surgery / [edited by] George Whitfield Holcomb III, J. Patrick Murphy ; associate editor, Daniel J. Ostlie. — 5th ed.p. ; cm.

Rev. ed. of: Pediatric surgery / [edited by] Keith W. Ashcraft, George Whitfield Holcomb III, J. Patrick Murphy. 4th ed. c2005.Includes bibliographical references and index.ISBN 978-1-4160-6127-4

1. Children—Surgery. I. Ashcraft, Keith W. II. Holcomb, George W. III. Murphy, J. Patrick. IV. Ostlie, Daniel J. V. Pediatric surgery. VI. Title: Pediatric surgery. [DNLM: 1. Surgical Procedures, Operative. 2. Child. 3. Infant. WO 925 A823 2009]RD137.P43 2009617.9’8—dc22 2009032713

Acquisitions Editor: Judith FletcherDevelopmental Editor: Arlene ChappellePublishing Services Manager: Tina RebaneProject Manager: Norm StellanderDesign Direction: Lou Forgione

Printed in the United States of America

Last digit is the print number: 9 8 7 6 5 4 3 2 1


DedicationDr. Tom Holder

Dr. Keith AshcraftMaster surgeons, teachers, mentors, and friends


vii

Stephanie P. acierno, Md, MPHSenior Pediatric Surgical FellowSeattle Children’s HospitalUniversity of Washington School of MedicineSeattle, Washington75: Head and Neck Sinuses and Masses

Pablo aguayo, MdInstructorSenior ResidentDepartment of SurgeryKansas University Medical CenterKansas City, Kansas31: Duodenal and Intestinal Atresia and Stenosis

craig t. albanese, Md, MBaProfessor of Surgery and PediatricsChief, Division of Pediatric SurgeryStanford University School of MedicineJohn A. and Cynthia Fry Gunn Director of Surgical

ServicesLucile Packard Children’s HospitalStanford, California22: Congenital Bronchopulmonary Malformations

d. adam algren, MdAssistant ProfessorDepartments of Emergency Medicine and PediatricsUniversity of Missouri–Kansas City School

of MedicineEmergency Medicine Physician and Medical

ToxicologistChildren’s Mercy HospitalKansas City, Missouri12: Bites

uri S. alon, MdProfessor of PediatricsUniversity of Missouri–Kansas City School

of MedicinePediatric NephrologistChildren’s Mercy HospitalKansas City, Missouri 4: Renal Impairment

Maria H. alonso, MdAssistant Professor of Surgery and PediatricsUniversity of Cincinnati College of MedicineSurgical Assistant Director, Liver TransplantationCincinnati Children’s Hospital Medical CenterCincinnati, Ohio45: Solid Organ and Intestinal Transplantation

richard J. andrassy, MdProfessor and ChairmanDepartment of SurgeryUniversity of Texas Medical School at HoustonChief, Section of Pediatric SurgeryUniversity of Texas M.D. Anderson Cancer CenterSurgeon-in-ChiefMemorial Hermann HospitalHouston, Texas72: Rhabdomyosarcoma

Walter S. andrews, MdProfessor of SurgeryUniversity of Missouri–Kansas City

School of MedicineChief, Transplant SurgeryChildren’s Mercy HospitalKansas City, Missouri69: Lesions of the Liver

Mara B. antonoff, MdSenior ResidentDepartment of SurgeryUniversity of Minnesota Medical SchoolMinneapolis, Minnesota1: Physiology of the Newborn

Jae-O Bae, MdPediatric Surgery FellowUniversity of Texas Southwestern Medical CenterDallas, Texas78: Endocrine Disorders and Tumors

Klaas M. a. Bax, Md, Phd, FrcS(ed)Professor of Pediatric SurgeryErasmus Medical SchoolUniversity of RotterdamHead, Department of Pediatric SurgerySophia Children’s Hospital Rotterdam, The Netherlands27: Esophageal Atresia and Tracheoesophageal

Malformations

robert e. Binda, Jr., MdAssociate Professor of Pediatric AnesthesiologyUniversity of Missouri–Kansas City School

of MedicineDirector, Pain ManagementChildren’s Mercy HospitalKansas City, Missouri3: Anesthetic Considerations

cOntriButOrS


CONTRIBUTORSviii

casey M. calkins, MdAssistant Professor of SurgeryMedical College of WisconsinPediatric General and Thoracic SurgeryChildren’s Hospital of WisconsinMilwaukee, Wisconsin38: Acquired Anorectal Disorders

Patrick c. cartwright, MdProfessor of SurgeryUniversity of Utah School of MedicineChief, Division of UrologyPrimary Children’s Medical CenterSalt Lake City, Utah57: Bladder and Urethra

Michael g. caty, MdProfessor of Surgery and PediatricsChief, Division of Pediatric SurgeryState University of New York at BuffaloSurgeon-in-ChiefDepartment of Pediatric Surgical ServicesWomen and Children’s Hospital of BuffaloBuffalo, New York33: Meconium Disease

nicole M. chandler, MdStaff SurgeonPediatric General and Thoracic SurgeryAll Children’s Specialty PhysiciansSt. Petersburg, Florida26: The Esophagus

tyler L. christensen, MdChief Resident in UrologyDepartment of SurgeryWashington University School of MedicineBarnes Jewish HospitalSt. Louis Children’s HospitalSt. Louis, Missouri55: Ureteral Obstruction and Malformations

dai H. chung, MdProfessor and Vice-ChairDepartment of Pediatric SurgeryVanderbilt University School of MedicineNashville, Tennessee13: Burns

Paul M. colombani, Md, MBaProfessor of SurgeryJohns Hopkins UniversityChief, Division of Pediatric SurgeryJohns Hopkins HospitalBaltimore, Maryland26: The Esophagus

arthur cooper, Md, MSProfessor of SurgeryColumbia University College of Physicians

and SurgeonsDirector of Trauma and Pediatric Surgical ServicesHarlem Hospital CenterNew York, New York14: Early Assessment and Management of Trauma

douglas e. coplen, MdAssociate Professor of SurgeryWashington University School of MedicineDirector of Pediatric UrologySt. Louis Children’s HospitalSt. Louis, Missouri55: Ureteral Obstruction and Malformations

Hillary L. copp, MdAssistant ProfessorDepartment of UrologyUniversity of California, San FranciscoSan Francisco, California52: Undescended Testes and Testicular Tumors

andrew M. davidoff, MdAssociate ProfessorDepartment of Surgery and PediatricsUniversity of Tennessee School of MedicineChairman, Department of SurgerySt. Jude Children’s Research HospitalMemphis, Tennessee68: Neuroblastoma

romano t. deMarco, MdAssociate Professor of UrologyUniversity of Missouri–Kansas City School

of MedicineDirector, Urology Research Department of SurgeryChildren’s Mercy HospitalKansas City, Missouri62: Prune-Belly Syndrome

Jack S. elder, MdClinical Professor of UrologyCase Western Reserve University School of MedicineCleveland, OhioChief, Department of UrologyHenry Ford Health SystemAssociate DirectorVattikuti Urology InstituteDepartment of UrologyChildren’s Hospital of MichiganDetroit, Michigan58: Posterior Urethral Valves

Mauricio a. escobar, Jr., MdAttending SurgeonMary Bridge Children’s Hospital and Health CenterTacoma, Washington33: Meconium Disease


CONTRIBUTORS ix

Mary e. Fallat, MdProfessor of SurgeryDirector, Division of Pediatric SurgeryUniversity of LouisvilleChief of SurgeryKosair Children’s HospitalLouisville, Kentucky39: Intussusception

Steven J. Fishman, MdAssociate Professor of SurgeryHarvard Medical SchoolSenior Associate in SurgeryCo-Director, Vascular Anomalies CenterChildren’s Hospital BostonBoston, Massachusetts74: Vascular Anomalies

Jason S. Frischer, MdAssistant ProfessorDepartment of SurgeryUniversity of Cincinnati School of MedicineDivison of Pediatric General and Thoracic SurgeryCincinnati Children’s Hospital Medical CenterCincinnati, Ohio6: Extracorporeal Membrane Oxygenation

Samir gadepalli, MdClinical LecturerDepartment of Pediatric SurgeryPediatric SurgeryUniversity of MichiganC.S. Mott Children’s HospitalAnn Arbor, Michigan7: Mechanical Ventilation in Pediatric Surgical Disease

alan S. gamis, MdProfessor of PediatricsUniversity of Missouri–Kansas City School

of MedicineSection Chief, OncologyChildren’s Mercy HospitalKansas City, Missouri71: Lymphomas

Victor F. garcia, MdProfessor of SurgeryUniversity of Cincinnati College of MedicineDirector, Trauma ServicesAssociate Surgical DirectorComprehensive Weight Management CenterCincinnati Children’s Hospital Medical CenterCincinnati, Ohio79: Bariatric Surgical Procedures in Adolescence

carissa L. garey, MdSurgical Scholars ResidentDepartment of SurgeryChildren’s Mercy HospitalKansas City, Missouri41: Meckel’s Diverticulum

John M. gatti, MdAssociate Professor of Surgery and UrologyUniversity of Missouri–Kansas City School of MedicineDirector of Minimally Invasive UrologyChildren’s Mercy HospitalKansas City, Missouri53: The Acute Scrotum63: Disorders of Sexual Differentiation

Keith e. georgeson, MdJoseph M. Farley Professor of Surgery and Vice

ChairmanDepartment of Surgery, Division of PediatricsProgram Director, Pediatric Surgery FellowshipUniversity of Alabama School of Medicine

at BirminghamDirector, Pediatric Surgical Sciences and Division

of Pediatric SurgeryChildren’s Hospital of AlabamaBirmingham, Alabama35: Hirschprung’s Disease

Saif a. ghole, MdDepartment of SurgeryStanford University School of MedicineStanford University Hospital and ClinicsStanford, California22: Congenital Bronchopulmonary Malformations

george K. gittes, MdProfessor of SurgeryChief, Division of Pediatric SurgeryUniversity of Pittsburgh School of MedicineBenjamin R. Fisher Chair of Pediatric Surgery

and Surgeon-in-ChiefChildren’s Hospital of PittsburghPittsburgh, Pennsylvania46: Lesions of the Pancreas

richard W. grady, MdAssociate Professor of UrologyUniversity of Washington School of MedicineAttending and Fellowship Program DirectorSeattle Children’s HospitalSeattle, Washington59: Bladder and Cloacal Exstrophy

neil e. green, MdProfessor of Orthopaedic SurgeryVanderbilt School of MedicineDepartment of Orthopaedics and RehabilitationMonroe Carell Jr. Children’s Hospital at VanderbiltNashville, Tennessee18: Pediatric Orthopedic Trauma

clarence S. greene, Jr., MdAssociate Professor of NeurosurgeryUniversity of Missouri–Kansas City School of MedicineAttending NeurosurgeonChildren’s Mercy HospitalKansas City, Missouri19: Neurosurgical Conditions


CONTRIBUTORSx

Michael r. Harrison, MdDirector, Fetal Treatment CenterUniversity of California, San Francisco

Children’s HospitalSan Francisco, California10: Fetal Therapy

andré Hebra, MdProfessor of Surgery and PediatricsChief, Division of Pediatric SurgeryMedical University of South CarolinaSurgeon-in-ChiefThe Children’s HospitalCharleston, South Carolina21: Tracheal Obstruction and Repair

Marion c. W. Henry, Md, MPHAttending Pediatric SurgeonSection of Pediatric SurgeryYale University School of MedicineNew Haven, Connecticut34: Necrotizing Enterocolitis

david n. Herndon, MdProfessor and Jesse H. Jones Distinguished Chair

in SurgeryDepartments of Surgery and PediatricsUniversity of Texas Medical BranchChief of Staff, Department of SurgeryShriners Hospital for Children at GalvestonGalveston, Texas13: Burns

Barry a. Hicks, MdProfessor of Surgery and PediatricsDivision of Pediatric SurgeryUniversity of Texas Southwestern Medical Center at

DallasChildren’s Medical Center–DallasDallas, Texas16: Abdominal and Renal Trauma

Shinjiro Hirose, MdPediatric SurgeonFetal Treatment CenterUniversity of California, San Francisco

Children’s HospitalSan Francisco, California10: Fetal Therapy

ronald B. Hirschl, MdArnold G. Coran ProfessorDepartment of Pediatric SurgeryUniversity of Michigan Health SystemSection Head and Surgeon-in-ChiefC.S. Mott Children’s HospitalAnn Arbor, Michigan7: Mechanical Ventilation in Pediatric Surgical Disease

george W. Holcomb iii, Md, MBaThe Katharine B. Richardson Endowed Professor

of Pediatric SurgeryUniversity of Missouri–Kansas City School

of MedicineSurgeon-in-ChiefDirector, Center for Minimally Invasive SurgeryChildren’s Mercy HospitalKansas City, Missouri29: Gastroesophageal Reflux40: Alimentary Tract Duplications50: Laparoscopy

gregory W. Hornig, MdClinical Assistant Professor of NeurosurgeryUniversity of Missouri–Kansas City School

of MedicineChief, Section of NeurosurgeryChildren’s Mercy HospitalKansas City, Missouri19: Neurosurgical Conditions

romeo c. ignacio, Jr., MdPediatric Surgery FellowDivision of Pediatric SurgeryUniversity of LouisvilleKosair Children’s HospitalLouisville, Kentucky39: Intussusception

thomas H. inge, Md, PhdAssociate Professor Department of Pediatrics and SurgeryUniversity of Cincinnati College of MedicineDirector, Surgical Weight Loss Program

for TeensCincinnati Children’s Hospital Medical CenterCincinnati, Ohio79: Bariatric Surgical Procedures in Adolescence

tom Jaksic, Md, PhdW. Hardy Hendren Professor of SurgeryHarvard Medical SchoolVice Chairman of Pediatric SurgeryChildren’s Hospital BostonBoston, Massachusetts2: Nutritional Support of the Pediatric Patient

yoshifumi Kato, Md, PhdAssociate ProfessorPediatric General and Urogenital SurgeryJuntendo University School of MedicineTokyo, Japan44: Biliary Tract Disorders and Portal Hypertension

Scott J. Keckler, MdSurgical Scholars ResidentDepartment of SurgeryChildren’s Mercy HospitalKansas City, Missouri40: Alimentary Tract Duplications


CONTRIBUTORS xi

cassandra Kelleher, MdPediatric Surgery FellowHospital for Sick ChildrenToronto, Ontario, Canada48: Congenital Abdominal Wall Defects

robert e. Kelly, Jr., MdProfessor of Clinical Surgery and PediatricsEastern Virginia Medical SchoolChief, Department of SurgeryChildren’s Hospital of The King’s DaughtersNorfolk, Virginia20: Congenital Chest Wall Deformities

curtis S. Koontz, MdAssistant Professor of SurgeryUniversity of Tennessee–ChattanoogaChattanooga, Tennessee30: Lesions of the Stomach

thomas M. Krummel, MdEmile Holman Professor and ChairDepartment of SurgeryStanford University School of MedicineSusan B. Ford Surgeon-in-ChiefLucile Packard Children’s HospitalStanford, California9: Surgical Infectious Disease

arlet g. Kurkchubasche, MdKurkchubasche, Md, MdAssociate Professor of Surgery and PediatricsBrown University Medical SchoolMedical SchoolHasbro Children’s HospitalProvidence, Rhode Island73: Nevus and Melanoma

Jean-Martin Laberge, Md, FrcSc, FacSProfessor of SurgeryMcGill UniversitySenior Pediatric SurgeonMontreal Children’s HospitalMontreal, Quebec, Canada70: Teratomas, Dermoids, and Other Soft Tissue Tumors

Kevin P. Lally, Md, MSA. G. McNeese Chair and ProfessorDepartment of Pediatric SurgeryUniversity of Texas Medical School at HoustonSurgeon-in-ChiefChildren’s Memorial Hermann HospitalHouston, Texas24: Congenital Diaphragmatic Hernia and Eventration

Jacob c. Langer, MdProfessor of SurgeryUniversity of TorontoChief, Pediatric General and Thoracic SurgeryHospital for Sick ChildrenToronto, Ontario, Canada48: Congenital Abdominal Wall Defects

Joseph L. Lelli, Jr., Md, MBaAssistant ProfessorWayne State Medical SchoolChief of Pediatric General and Thoracic SurgeryChildren’s Hospital of MichiganDetroit, Michigan11: Foreign Bodies

Marc a. Levitt, MdAssociate ProfessorDepartment of SurgeryUniversity of CincinnatiAssociate Director, Colorectal CenterCincinnati Children’s Hospital Medical CenterCincinnati, Ohio36: Imperforate Anus and Cloacal Malformations37: Fecal Incontinence and Constipation

Karen B. Lewing, MdAssistant Professor of PediatricsUniversity of Missouri–Kansas City School

of MedicineFellowship Program DirectorDivision of Hematology/OncologyChildren’s Mercy HospitalKansas City, Missouri71: Lymphomas

charles M. Leys, MdAssistant Professor of SurgeryIndiana University School of MedicineStaff SurgeonRiley Hospital for ChildrenIndianapolis, Indiana53: The Acute Scrotum

danny c. Little, MdAssistant Professor of SurgeryTexas A&M University Health Center–College

of MedicineChief of Pediatric SurgeryChildren’s Hospital at Scott & WhiteTemple, Texas32: Malrotation

Jennifer a. Lowry, MdAssistant Professor, Department of PediatricsUniversity of Missouri–Kansas City School

of MedicineMedical Toxicologist and Clinical PharmacologistChildren’s Mercy HospitalKansas City, Missouri12: Bites

Marcus M. Malek, MdSurgical Research FellowChildren’s Hospital of PittsburghPittsburgh, Pennsylvania46: Lesions of the Pancreas


CONTRIBUTORSxii

thao t. Marquez, MdSenior ResidentDepartment of SurgeryUniversity of Minnesota Medical SchoolMinneapolis, Minnesota1: Physiology of the Newborn

nilesh M. Mehta, Md, dcHInstructor in AnesthesiaHarvard Medical SchoolDivision of Critical Care MedicineChildren’s Hospital BostonBoston, Massachusetts2: Nutritional Support of the Pediatric Patient

gregory a. Mencio, MdProfessor and ChiefPediatric OrthopaedicsVanderbilt University School of MedicineMonroe Carell Jr. Children’s Hospital at VanderbiltNashville, Tennessee18: Pediatric Orthopedic Trauma

Marc P. Michalsky, MdAssistant Professor of Clinical SurgeryOhio University College of MedicinePrincipal InvestigatorCenter for Clinical and Translational ResearchNationwide Children’s HospitalColumbus, Ohio23: Acquired Lesions of the Lung and Pleura

eugene a. Minevich, MdAssociate Professor of SurgeryUniversity of Cincinnati College of MedicineCincinnati Children’s Hospital Medical CenterCincinnati, Ohio56: Urinary Tract Infection and Vesicoureteral Reflux

Michael e. Mitchell, MdProfessor of UrologyMedical College of WisconsinChief of Pediatric UrologyChildren’s Hospital of WisconsinMilwaukee, Wisconsin59: Bladder and Cloacal Exstrophy

go Miyano, MdDepartment of Pediatric General and Urogenital

SurgeryJuntendo University HospitalTokyo, Japan79: Bariatric Surgical Procedures in Adolescence

takeshi Miyano, Md, PhdEmeritus ProfessorPediatric General and Urogenital SurgeryJuntendo University School of MedicineTokyo, Japan44: Biliary Tract Disorders and Portal Hypertension

christopher r. Moir, MdProfessor of SurgeryMayo ClinicRochester, Minnesota42: Inflammatory Bowel Disease and Intestinal Cancer

r. Lawrence Moss, Md, FacSRobert Pritzker Professor and ChiefPediatric Surgery Yale University School of MedicineSurgeon-in-ChiefYale New Haven Children’s HospitalNew Haven, Connecticut34: Necrotizing Enterocolitis

J. Patrick Murphy, MdProfessor of Surgery and UrologyUniversity of Missouri–Kansas City School of MedicineSection Chief, Urologic SurgeryChildren’s Mercy HospitalKansas City, Missouri60: Hypospadias

don K. nakayama, Md, MBaMilford B. Hatcher Professor and ChairDepartment of SurgeryMercer University School of MedicineProgram Director, Residency in SurgeryMedical Center of Central GeorgiaMacon, Georgia77: Breast Diseases

Jaimie d. nathan, Md, MSAssistant Professor of Surgery and PediatricsUniversity of Cincinnati College of MedicineCincinnati Children’s Hospital Medical CenterCincinnati, Ohio45: Solid Organ and Intestinal TransplantationTransplantation

Kathleen a. neville, Md, MSAssistant Professor of PediatricsDivisions of Pediatric Hematology/Oncology and

Pediatric Pharmacology and Medical ToxicologyChildren’s Mercy HospitalKansas City, Missouri5: Coagulopathies and Sickle Cell Disease

donald nuss, MB, chB, FrcS(c), FacSProfessor of Surgery and PediatricsEastern Virginia Medical SchoolPediatric SurgeonChildren’s Hospital of The King’s DaughtersNorfolk, Virginia20: Congenital Chest Wall Deformities

Keith t. Oldham, MdProfessor and ChiefDivision of Pediatric SurgeryMedical College of WisconsinMarie Z. Uihlein Chair and Surgeon-in-ChiefChildren’s Hospital of WisconsinMilwaukee, Wisconsin38: Acquired Anorectal Disorders


CONTRIBUTORS xiii

James a. O’neill, Jr., MdJ. C. Foshee Distinguished ProfessorChairman Emeritus, Section of Surgical SciencesDepartment of Pediatric SurgeryVanderbilt University School of MedicineMonroe Carell Jr. Children’s Hospital at VanderbiltNashville, Tennessee65: Renovascular Hypertension

daniel J. Ostlie, MdAssociate Professor of SurgeryUniversity of Missouri–Kansas City School

of MedicineDirector, Surgical Critical CareChildren’s Mercy HospitalKansas City, Missouri29: Gastroesophageal Reflux31: Duodenal and Intestinal Atresia and Stenosis

H. Biemann Othersen, Jr., Md, BSMProfessor of Surgery and PediatricsEmeritus Head, Division of Pediatric SurgeryMedical University of South CarolinaCharleston, South Carolina21: Tracheal Obstruction and Repair

alberto Peña, MdProfessor, Department of SurgeryUniversity of CincinnatiDirector, Colorectal CenterCincinnati Children’s Hospital Medical CenterCincinnati, Ohio36: Imperforate Anus and Cloacal Malformations37: Fecal Incontinence and Constipation

Kathy M. Perryman, Md, FaaPAssociate Professor of Pediatric AnesthesiologyUniversity of Missouri–Kansas City School

of MedicineChildren’s Mercy HospitalKansas City, Missouri3: Anesthetic Considerations

craig a. Peters, MdJohn E. Cole Professor of UrologyUniversity of Virginia School of MedicineChief, Division of Pediatric UrologyUniversity of Virginia Children’s HospitalCharlottesville, Virginia64: Urologic Laparoscopy

devin P. Puapong, MdChief Resident in Pediatric SurgeryUniversity of Oklahoma Health Sciences CenterChildren’s HospitalOklahoma City, Oklahoma15: Thoracic Trauma

Pramod S. Puligandla, Md, FrcSc, FacSAssociate Professor of Surgery and PediatricsMcGill UniversityPediatric Surgery Training Program DirectorMontreal Children’s HospitalMontreal, Quebec, Canada70: Teratomas, Dermoids, and Other Soft Tissue Tumors

Stephen c. raynor, MdChief of Pediatric SurgeryChildren’s Hospital & Medical CenterOmaha, Nebraska61: Circumcision

Frederick J. rescorla, MdLafayette L. Page Professor and DirectorSection of Pediatric SurgeryIndiana University School of MedicineSurgeon-in-ChiefRiley Hospital for ChildrenIndianapolis, Indiana47: Splenic Conditions

Bradley M. rodgers, MdProfessor of Surgery and PediatricsUniversity of Virginia Health Sciences CenterChief of Pediatric SurgeryUniversity of Virginia Children’s HospitalCharlottesville, Virginia23: Acquired Lesions of the Lung and Pleura

Michael t. rohmiller, MdOrthopedic Spine SurgeonCincinnati Spine InstituteCincinnati, Ohio 18: Pediatric Orthopedic Trauma

Steven S. rothenberg, MdClinical Professor of SurgeryColumbia University College of Physicians

and SurgeonsNew York, New YorkChief of Pediatric SurgeryThe Rocky Mountain Hospital for ChildrenDenver, Colorado28: Thoracoscopy in Infants and Children

Frederick c. ryckman, MdProfessor of Surgery and PediatricsUniversity of Cincinnati College of MedicineVice-President, System Capacity and Perioperative

OperationsCincinnati Children’s Hospital Medical CenterCincinnati, Ohio45: Solid Organ and Intestinal Transplantation


CONTRIBUTORSxiv

Shawn d. St. Peter, MdAssistant Professor of SurgeryUniversity of Missouri–Kansas City School

of MedicineDirector, Center for Prospective Clinical TrialsChildren’s Mercy HospitalKansas City, Missouri43: Appendicitis80: Evidence-Based Medicine

daniel a. Saltzman, Md, PhdAssociate Professor of Surgery and PediatricsDr. A.S. Leonard Endowed Chair in Pediatric Surgery Chief, Division of Pediatric SurgeryUniversity of Minnesota Medical SchoolSurgeon-in-ChiefUniversity of Minnesota Amplatz Children‘s HospitalMinneapolis, Minnesota1: Physiology of the Newborn

adam J. Schow, MdAssistant Professor of Pediatric AnesthesiologyUniversity of Missouri–Kansas City School

of MedicineMedical DirectorSame Day Surgery and Post Anesthesia Care UnitChildren’s Mercy HospitalKansas City, Missouri3: Anesthetic Considerations

Kurt P. Schropp, MdAssociate Professor of SurgeryProgram Director, General Surgery ResidencyKansas University School of MedicineKansas City, Kansas41: Meckel’s Diverticulum

Shinil K. Shah, dOSenior ResidentDepartment of SurgeryUniversity of Texas Medical School at HoustonHouston, Texas72: Rhabdomyosarcoma

robert c. Shamberger, MdRobert E. Gross Professor of SurgeryHarvard Medical SchoolChief of SurgeryChildren’s Hospital BostonBoston, Massachusetts67: Renal Tumors

ellen Shapiro, MdProfessor of UrologyNew York University School of MedicineDirector of Pediatric UrologyNYU Langone Medical CenterNew York, New York58: Posterior Urethral Valves

Kenneth Shaw, Md, FrcSeAssistant Professor of SurgeryMcGill UniversityStaff Pediatric SurgeonMontreal Children’s HospitalMontreal, Quebec, Canada70: Teratomas, Dermoids, and Other Soft Tissue Tumors

curtis a. Sheldon, MdAssistant Professor of SurgeryUniversity of Cincinnati College of MedicineDirector, Pediatric UrologyCincinnati Children’s Hospital Medical CenterCincinnati, Ohio56: Urinary Tract Infection and Vesicoureteral Reflux

Stephen J. Shochat, MdDepartment of SurgerySt. Jude Children’s Research HospitalMemphis, Tennessee66: Principles of Adjuvant Therapy in Childhood Cancer

Linda d. Shortliffe, MdProfessor and Department ChairDepartment of UrologyStanford University School of MedicinePediatric Urology Service ChiefDepartment of UrologyStanford University Medical CenterStanford, California52: Undescended Testes and Testicular Tumors

Michael a. Skinner, MdEdwin Ide Smith, M.D. Professor of Pediatric SurgeryUniversity of Texas-Southwestern Medical CenterChildren’s Medical Center–DallasDallas, Texas78: Endocrine Disorders and Tumors

Bethany J. Slater, MdSenior ResidentDepartment of SurgeryStanford University Medical CenterStanford, California9: Surgical Infectious Disease

Samuel d. Smith, MdProfessor of SurgeryUniversity of Arkansas for Medical Sciences College

of MedicineChief of Pediatric SurgeryArkansas Children’s HospitalLittle Rock, Arkansas32: Malrotation

c. Jason Smithers, MdInstructor in SurgeryHarvard Medical SchoolAssistant in SurgeryChildren’s Hospital BostonBoston, Massachusetts74: Vascular Anomalies


CONTRIBUTORS xv

Brent W. Snow, Md, FacS, FaaPProfessor of SurgeryUniversity of Utah School of MedicineChief, Division of Pediatric UrologyPrimary Children’s Medical CenterSalt Lake City, Utah57: Bladder and Urethra

charles L. Snyder, MdProfessor of SurgeryUniversity of Missouri–Kansas City School

of MedicineDirector of Clinical ResearchChildren’s Mercy HospitalKansas City, Missouri51: Inguinal Hernias and Hydroceles

Howard M. Snyder iii, MdProfessor of UrologyDepartment of SurgeryUniversity of Pennsylvania School of MedicineDirector of Surgical Teaching, Division of Pediatric

UrologyChildren’s Hospital of PhiladelphiaPhiladelphia, Pennsylvania54: Developmental and Positional Anomalies of the Kidneys

charles J. H. Stolar, MdProfessor of Surgery and PediatricsColumbia University College of Physicians

and SurgeonsSurgeon-in-ChiefDepartment of Pediatric SurgeryMorgan Stanley Children’s Hospital of New York–

PresbyterianColumbia University Medical CenterNew York, New York6: Extracorporeal Membrane Oxygenation

Julie L. Strickland, Md, MPHAssociate ProfessorDepartment of Obstetrics and GynecologyUniversity of Missouri–Kansas City School

of MedicineSection Chief, Gynecological SurgeryChildren’s Mercy HospitalKansas City, Missouri76: Pediatric and Adolescent Gynecology

Steven Stylianos, MdClinical Professor of Surgery and PediatricsFlorida International University College of MedicineVoluntary Associate Professor of SurgeryUniversity of Miami Miller School of MedicineChief, Department of Pediatric SurgeryMedical Director, Pediatric Training ProgramMiami Children’s HospitalMiami, Florida16: Abdominal and Renal Trauma

Karl g. Sylvester, MdAssociate Professor of Surgery and PediatricsStanford University School of MedicineAttending SurgeonLucile Packard Children’s HospitalStanford, California22: Congenital Bronchopulmonary Malformations

greg M. tiao, MdAssociate Professor of Surgery and PediatricsUniversity of Cincinnati College of MedicineDirector, Liver/Intestine Transplant ProgramCincinnati Children’s Hospital Medical CenterCincinnati, Ohio45: Solid Organ and Intestinal Transplantation

Kelly S. tieves, dO, MSAssistant ProfessorDepartment of PediatricsUniversity of Missouri–Kansas City School

of MedicinePediatric Intensivist, AnesthesiologyChildren’s Mercy HospitalKansas City, Missouri17: Pediatric Head Trauma

Juan a. tovar, Md, PhdProfessor of Pediatric SurgeryAutonomous University of MadridChief, Department of Pediatric SurgeryUniversity Hospital of La PazMadrid, Spain25: Mediastinal Tumors

thomas F. tracy, Jr., Md, MSProfessor of Surgery and PediatricsVice Chairman, Department of SurgeryBrown University Medical School Medical SchoolPediatric Surgeon-in-ChiefHasbro Children’s HospitalProvidence, Rhode Island73: Nevus and Melanoma

KuoJen tsao, MdAssistant Professor of SurgeryDepartment of Pediatric SurgeryUniversity of Texas Medical School at HoustonChildren’s Memorial Hermann HospitalHouston, Texas24: Congenital Diaphragmatic Hernia and Eventration

david W. tuggle, MdProfessor and Vice-Chairman, Department of SurgeryChief, Section of Pediatric SurgeryPaula Milburn Miller/Children’s Medical Research

Chair in Pediatric SurgeryUniversity of Oklahoma Health Sciences CenterChildren’s HospitalOklahoma City, Oklahoma15: Thoracic Trauma


CONTRIBUTORSxvi

ravindra K. Vegunta, Md, MBBSAssociate Professor of Surgery and PediatricsUniversity of Illinois College of Medicine at PeoriaDirector, Pediatric Minimally Invasive SurgeryChildren’s Hospital of Illinois Pediatric Surgical

CenterPeoria, Illinois8: Vascular Access

daniel von allmen, MdProfessor of SurgeryUniversity of Cincinnati College of MedicineDirector, Division of General and Thoracic SurgeryCincinnati Children’s Hospital Medical CenterCincinnati, Ohio66: Principles of Adjuvant Therapy in Childhood Cancer

John H. t. Waldhausen, MdProfessor of SurgeryUniversity of Washington School of MedicineDivision Chief, Pediatric General and Thoracic SurgerySeattle Children’s HospitalSeattle, Washington75: Head and Neck Sinuses and Masses

Peter a. Walker, MdSenior ResidentDepartment of SurgeryUniversity of Texas Medical School at HoustonHouston, Texas72: Rhabdomyosarcoma

M. chad Wallis, MdClinical Assistant ProfessorDepartment of SurgeryUniversity of Utah School of MedicinePrimary Children’s Medical CenterSalt Lake City, Utah57: Bladder and Urethra

Bradley a. Warady, MdProfessor and Associate ChairmanDepartment of PediatricsUniversity of Missouri–Kansas City School

of MedicineSection Chief, NephrologyDirector of Dialysis and TransplantationChildren’s Mercy HospitalKansas City, Missouri4: Renal Impairment

gary S. Wasserman, dOProfessorDepartment of PediatricsUniversity of Missouri–Kansas City School

of MedicineChief, Section of Medical ToxicologyChildren’s Mercy HospitalKansas City, Missouri12: Bites

thomas r. Weber, MdProfessor of Surgery and PediatricsUniversity of Illinois College of MedicineDirector, Pediatric SurgeryAdvocate Hope Children’s HospitalChicago, Illinois49: Umbilical and Other Abdominal Wall Hernias

Brian M. Wicklund, Md, cM, MPHAssociate Professor of PediatricsUniversity of Missouri–Kansas City School

of MedicineDirector, Hemophilia Treatment CenterChildren’s Mercy HospitalKansas City, Missouri5: Coagulopathies and Sickle Cell Disease

gerald M. Woods, MdProfessor of PediatricsUniversity of Missouri–Kansas City School

of MedicineChief, Division of Hematology/OncologyChildren’s Mercy HospitalKansas City, Missouri5: Coagulopathies and Sickle Cell Disease

Hsi-yang Wu, MdAssociate ProfessorDepartment of UrologyStanford University School of MedicinePediatric UrologistLucile Packard Children’s HospitalStanford, California54: Developmental and Positional Anomalies of the Kidneys

Mark L. Wulkan, MdAssistant Professor of Surgery and PediatricsEmory University School of MedicineDirector, Minimally Invasive SurgeryChildren’s Healthcare of Atlanta at EglestonAtlanta, Georgia30: Lesions of the Stomach

atsuyuki yamataka, Md, PhdProfessor and HeadPediatric General and Urogenital SurgeryJuntendo University School of MedicineTokyo, Japan44: Biliary Tract Disorders and Portal Hypertension


xvii

This is the fifth edition of Pediatric Surgery, but the first edition without the insights and efforts of either Dr. Tom Holder or Dr. Keith Ashcraft. In 1980, these two master surgeons had the foresight to develop a reference text focusing on infants and children with surgical conditions. The current editors would like to dedicate this fifth edition to our founding editors, Drs. Tom Holder and Keith Ashcraft.

Drs. Holder and Aschraft wanted to create a single-volume pediatric surgical work that was broad in scope and had some detail about each condition; how-ever, they did not intend for this work to be encyclo-pedic. As they stated in their first Preface, “An effort has been made to provide sufficient information con-cerning physiology, embryology, and anatomy so that the reader may gain a thorough understanding of the patient, the disease process, its symptoms, diagnosis, and treatment. Authors were selected because they are acknowledged authorities in the area of their con-tribution.”

This concept of a single-volume text has persisted over the subsequent editions. The current editors have tried to maintain this book in the style originally con-ceived by Drs. Holder and Ashcraft. Although most of the chapters in this edition have the same title as those in the first edition, the information and knowl-edge in the field of pediatric surgery have dramatically evolved. More than half the illustrations in this fifth edition are new. Management of urologic conditions remains an important part of this book because many pediatric surgeons around the world also perform uro-logic operations in children. An effort has been made to use experts from all over the world to write the chapters, as this book is read worldwide by surgeons, pediatricians, residents, and medical students.

Many, if not most, operations are now performed using a minimally invasive approach. Thus, operative technique is emphasized more in this edition than in previous ones. Prenatal diagnosis is an entity now com-monly encountered by pediatric surgeons. In addition, so much more about genetic predisposition to certain conditions and cancers is known now versus 30 years ago. Finally, in this fifth edition, a chapter on “Evi-dence Based Medicine” has made its way into a pedi-atric surgical textbook for the first time. As previously emphasized, a concerted effort has been made to keep this book to a single volume. However, as there is so much more information that is important and known

about pediatric surgical conditions than was available in 1980, we also need to allow for that growth. In an effort to limit the book to a single volume, references have been placed online on the associated Expert Con-sult website (www.expertconsult.com), rather than at the end of each chapter in the book itself. While some readers do not look at the references, those who do will find that they are easily accessible and linked to PubMed for easy access to abstracts and full text. By saving nearly 200 pages of text, we have helped to maintain the cost of the book. Also, the amount of paper needed was significantly reduced. In addi-tion, the full text and color figures are also available on Expert Consult. Purchasers receive a PIN code and password with each copy of the book, making this edition the first pediatric surgery text that is available online. We hope our readers enjoy and appreciate this feature as we believe that a definite advantage of this book will be its portability. Whether in the office, the operating room, at home, or out of town, Pediatric Sur-gery, fifth edition, will be available online through a personal password.

In the fourth edition, videos were available on a DVD that accompanied the book. Since a companion book (Atlas of Laparoscopy and Thoracoscopy, Holcomb GW III, Georgeson KE, Rothenberg SS, editors) was recently published by Elsevier, access to videos from this atlas will also be available on Expert Consult to pur-chasers of this fifth edition.

The editors would like to thank all of the authors for their extraordinary efforts and time spent in writ-ing their chapters. In addition, three of our colleagues (Kathy Smith, Linda Jankowski, and Barbara Juarez) have provided extraordinary technical support for this book. This book would not have been possible without their help. In addition, we would also like to thank the administration and leadership at The Children’s Mercy Hospital for their continued full support for this book for the past 30 years. Finally, the editors would also like to thank our colleagues at Elsevier for their time-less attention to detail and support throughout the process of editing and publishing this textbook. This book was truly a team effort by a great many people. We hope you will enjoy this fifth edition and find it helpful in treating your patients.

GeorGe W. Holcomb III, mD, mbA

J. PAtrIck murPHy, mD

PreFace


xix

SectiOn 1 � generaL

Chapter 1 PHYSIOLOGYOFTHENEWBORN, 3MaraAntonoff,MD • ThaoMarquez,MD •DanielSaltzman,MD,PhD

Chapter 2 NUTRITIONAL SUPPORTNUTRITIONALSUPPORTOFTHEPEDIATRICPATIENT, 19NileshMehta,MD,DCH • TomJaksic,MD,PhD

Chapter 3 ANESTHETICCONSIDERATIONS, 32KathyM.Perryman,MD • AdamJ.Schow,MD •RobertE.Binda,Jr.,MD

Chapter 4 RENALIMPAIRMENT, 49UriS.Alon,MD • BradleyA.Warady,MD

Chapter 5 COAGULOPATHIESANDSICKLECELLDISEASE, 61KathleenA.Neville,MD,MS • BrianM.Wicklund,MD,CM,MPH • GeraldM.Woods,MD

Chapter 6 EXTRACORPOREALMEMBRANEOXYGENATION, 74JasonS.Frischer,MD • CharlesJ.H.Stolar,MD

Chapter 7 MECHANICALVENTILATIONINPEDIATRICSURGICALDISEASE, 87SamirGadepalli,MD • RonaldB.Hirschl,MD

Chapter 8 VASCULARACCESS, 110RavindraK.Vegunta,MD,MBBS

Chapter 9 SURGICALINFECTIOUSDISEASE, 117, 117BethanyJ.Slater,MD • ThomasM.Krummel,MD

Chapter 10 FETALTHERAPY, 125ShinjiroHirose,MD • MichaelR.Harrison,MD

SectiOn 2 � trauMa

Chapter 11 FOREIGNBODIES, 135JosephL.Lelli,Jr.,MD

Chapter 12 BITES, 144GaryS.Wasserman,DO • JenniferLowry,MD • D.AdamAlgren,MD

Chapter 13 BURNS, 154DaiH.Chung,MD • DavidN.Herndon,MD

Chapter 14 EARLYASSESSMENTANDMANAGEMENTOFTRAUMA, 167ArthurCooper,MD,MS

Chapter 15 THORACICTRAUMA, 182DevinP.Puapong,MD • DavidW.Tuggle,MD

Chapter 16 ABDOMINALANDRENALTRAUMA, 190StevenStylianos,MD•BarryA.Hicks,MD

Chapter 17 PEDIATRICHEADTRAUMA, 209KellyTieves,DO

Chapter 18 PEDIATRICORTHOPEDICTRAUMA, 221GregoryA.Mencio,MD • MichaelT.Rohmiller,MD • NeilE.Green,MD

Chapter 19 NEUROSURGICALCONDITIONS, 235GregoryW.Hornig,MD • ClarenceGreene,Jr.,MD

SectiOn 3 � tHOracic

Chapter 20 CONGENITALCHESTWALLDEFORMITIES, 249DonaldNuss,MB,ChB • RobertE.Kelly,Jr.,MD

Chapter 21 TRACHEALOBSTRUCTIONANDREPAIR, 266H.BiemannOthersen,Jr.,MD • AndréHebra,MD

Chapter 22 CONGENITALBRONCHOPULMONARYMALFORMATIONS, 279KarlG.Sylvester,MD • SaifGhole,MD • CraigT.Albanese,MD

Chapter 23 ACQUIREDLESIONSOFTHELUNGANDPLEURA, 290BradleyM.Rodgers,MD • MarcP.Michalsky,MD

Chapter 24 CONGENITALDIAPHRAGMATICHERNIAANDEVENTRATION, 304KuoJenTsao,MD • KevinP.Lally,MD

Chapter 25 MEDIASTINALTUMORS, 322JuanA.Tovar,MD,PhD

Chapter 26 THEESOPHAGUS, 330NicoleChandler,MD • PaulM.Colombani,MD

taBLe OF cOntentS


xx

Chapter 27 ESOPHAGEALATRESIAANDTRACHEOESOPHAGEALMALFORMATIONS, 345KlaasBax,MD,PhD

Chapter 28 THORACOSCOPYININFANTSANDCHILDREN, 362StevenS.Rothenberg,MD

SectiOn 4 � aBdOMen

Chapter 29 GASTROESOPHAGEALREFLUX, 379DanielJ.Ostlie,MD • GeorgeW.HolcombIII,MD,MBA

Chapter 30 LESIONSOFTHESTOMACH, 391CurtS.Koontz,MD • MarkWulkan,MD

Chapter 31 DUODENALANDINTESTINALATRESIAANDSTENOSIS, 400PabloAguayo,MD • DanielJ.Ostlie,MD

Chapter 32 MALROTATION, 416DannyC.Little,MD • SamuelD.Smith,MD

Chapter 33 MECONIUMDISEASE, 425MichaelG.Caty,MD • MauricioA.Escobar,MD

Chapter 34 NECROTIZINGENTEROCOLITIS, 439MarionC.W.Henry,MD,MPH • R.LawrenceMoss,MD

Chapter 35 HIRSCHSPRUNG’SDISEASE, 456KeithE.Georgeson,MD

Chapter 36 IMPERFORATEANUSANDCLOACALMALFORMATIONS, 468MarcA.Levitt,MD • AlbertoPeña,MD

Chapter 37 FECALINCONTINENCEANDCONSTIPATION, 491MarcA.Levitt,MD • AlbertoPeña,MD

Chapter 38 ACQUIREDANORECTALDISORDERS, 502CaseyM.Calkins,MD • KeithT.Oldham,MD

Chapter 39 INTUSSUSCEPTION, 508RomeoC.Ignacio,Jr.,MD • MaryE.Fallat,MD

Chapter 40 ALIMENTARYTRACTDUPLICATIONS, 517ScottJ.Keckler,MD • GeorgeW.HolcombIII,MD,MBA

Chapter 41 MECKEL’SDIVERTICULUM, 526KurtP.Schropp,MD • CarissaL.Garey,MD

Chapter 42 INFLAMMATORYBOWELDISEASEANDINTESTINALCANCER, 532ChristopherR.Moir,MD

Chapter 43 APPENDICITIS, 549ShawnD.St.Peter,MD

Chapter 44 BILIARYTRACTDISORDERSANDPORTALHYPERTENSION, 557AtsuyukiYamataka,MD,PhD • YoshifumiKato,MD,PhD • TakeshiMiyano,MD,PhD

Chapter 45 SOLIDORGANANDINTESTINALTRANSPLANTATION, 578FrederickC.Ryckman,MD • MariaH.Alonso,MD • JaimieD.Nathan,MD • GregTiao,MD

Chapter 46 LESIONSOFTHEPANCREAS, 605MarcusM.Malek,MD • GeorgeK.Gittes,MD

Chapter 47 SPLENICCONDITIONS, 616FrederickJ.Rescorla,MD

Chapter 48 CONGENITALABDOMINALWALLDEFECTS, 625CassandraKelleher,MD • JacobC.Langer,MD

Chapter 49 UMBILICALANDOTHERABDOMINALWALLHERNIAS, 637ThomasR.Weber,MD

Chapter 50 LAPAROSCOPY, 641GeorgeW.HolcombIII,MD,MBA

SectiOn 5 � inguinaL regiOn and ScrOtuM

Chapter 51 INGUINALHERNIASANDHYDROCELES, 669CharlesL.Snyder,MD

Chapter 52 UNDESCENDEDTESTESANDTESTICULARTUMORS, 676HillaryL.Copp,MD • LindaD.Shortliffe,MD

Chapter 53 THEACUTESCROTUM, 687CharlesM.Leys,MD,MSCI • JohnM.Gatti,MD

SectiOn 6 � urOLOgy

Chapter 54 DEVELOPMENTALANDPOSITIONALANOMALIESOFTHEKIDNEYS, 695Hsi-YangWu,MD • HowardM.SnyderIII,MD

TABLEOFCONTENTS


xxi

Chapter 55 URETERALOBSTRUCTIONANDMALFORMATIONS, 703TylerChristensen,MD • DouglasE.Coplen,MD

Chapter 56 URINARYTRACTINFECTIONANDVESICOURETERALREFLUX, 716EugeneMinevich,MD • CurtisA.Sheldon,MD

Chapter 57 BLADDERANDURETHRA, 731PatrickC.Cartwright,MD • BrentW.Snow,MD • M.ChadWallis,MD

Chapter 58 POSTERIORURETHRALVALVES, 744JackS.Elder,MD • EllenShapiro,MD

Chapter 59 BLADDERANDCLOACALEXSTROPHY, 755MichaelMitchell,MD • RichardGrady,MD

Chapter 60 HYPOSPADIAS, 775J.PatrickMurphy,MD

Chapter 61 CIRCUMCISION, 791StephenC.Raynor,MD

Chapter 62 PRUNE-BELLYSYNDROME, 796RomanoT.DeMarco,MD

Chapter 63 DISORDERSOFSEXUALDIFFERENTIATION, 805JohnM.Gatti,MD

Chapter 64 UROLOGICLAPAROSCOPY, 817CraigA.Peters,MD

Chapter 65 RENOVASCULARHYPERTENSION, 829JamesA.O’Neill,Jr.,MD

SectiOn 7 � neOPLaSMS

Chapter 66 PRINCIPLESOFADJUVANTTHERAPYINCHILDHOODCANCER, 837DanielvonAllmen,MD • StephenShochat,MD

Chapter 67 RENALTUMORS, 853RobertC.Shamberger,MD

Chapter 68 NEUROBLASTOMA, 872AndrewM.Davidoff,MD

Chapter 69 LESIONSOFTHELIVER, 895WalterS.Andrews,MD

Chapter 70 TERATOMAS,DERMOIDS,ANDOTHERSOFTTISSUETUMORS, 915Jean-MartinLaberge,MD • PramodS.Puligandla,MD • KennethShaw,MD

Chapter 71 LYMPHOMAS, 936KarenB.Lewing,MD • AlanS.Gamis,MD,MPH

Chapter 72 RHABDOMYOSARCOMA, 954ShinilK.Shah,DO • PeterA.Walker,MD •RichardJ.Andrassy,MD

SectiOn 8 � SKin and SOFt tiSSue diSeaSeS

Chapter 73 NEVUSANDMELANOMA, 967ArletKurkchubasche,MD•ThomasF.Tracy,Jr.,MD

Chapter 74 VASCULARANOMALIES, 982C.JasonSmithers,MD • StevenJ.Fishman,MD

Chapter 75 HEADANDNECKSINUSESANDMASSES, 997StephanieAcierno,MD,MPH • JohnH.T.Waldhausen,MD

SectiOn 9 � SPeciaL tOPicS

Chapter 76 PEDIATRICANDADOLESCENTGYNECOLOGY, 1015JulieStrickland,MD

Chapter 77 BREASTDISEASES, 1028DonK.Nakayama,MD,MBA

Chapter 78 ENDOCRINEDISORDERSANDTUMORS, 1037Jae-OBae,MD • MichaelA.Skinner,MD

Chapter 79 BARIATRICSURGICALPROCEDURESINADOLESCENCE, 1055GoMiyano,MD • VictorF.Garcia,MD •ThomasH.Inge,MD,PhD

Chapter 80 EVIDENCE-BASEDMEDICINE, 1065ShawnD.St.Peter,MD

Index, 1071

TABLEOFCONTENTS


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