12 Chapter 1 1. A short history of abdominal surgery in young children Since the “father of pediatric surgery” doctor Ladd (1888-1967) (known for the Ladd’s procedure as a treatment for malrotation) was the first to devote his career to the surgical care of children, medicine focusing on young patients did not stop evolving. Many advancements have been made in surgical treatment as well as perioperative care for pediatric patients, especially for those born prematurely.[3] Important innovations in critical care of neonates, such as incubators, surfactant and parenteral nutrition, have resulted in a steadily increase of neonatal survival.[4-6] These innovations go hand in hand with targeted child health strategies undertaken globally by the United Nations in their Millennium Development Goals but also the interventions taken on a national level by individual countries. These actions combined have resulted in cutting in half global mortality of children aged under five years.[6] Whilst this increase in survival has simultaneously went in tandem with an increase in treatment of all surgical diseases in young children, this surge in numbers is even more profound in patients treated for congenital diseases.[4] This could be expected following an increase in the survival of premature born babies since premature birth is associated with a four-fold increased risk of having a congenital anomaly.[7] Due to these developments pediatric- and neonatal surgery now make up a significant proportion of the total surgical care in high-income countries. At the moment 6% of all children undergo an operation before the age of five years in the United States of America.[8] Whilst in Europe, a pediatric surgeon performs 202 surgeries on average per year, of which 11 procedures are on neonates.[9] Although currently surgical supply is meeting demands in high-income countries, an estimated 4.8 billion people in general do not have access to surgical care mainly in low- and middle-income countries.[1, 2] A large proportion is related to care for pediatric patients which is why the World Health Association (WHO) stated pediatric surgery in general and specifically surgery for congenital diseases as an important resolution of pediatric morbidity globally.[10] Multiple studies and programs aim to detect and address this lack of surgical care which suggests that the global number of surgeries in children will only increase in the upcoming years. 2. Complications following abdominal surgery in young children A next step in improving surgical care for children would be to detect and reduce complications of surgery. Though surgical interventions in young children are now common, there is sparse data on these complications of surgery. This is especially true in patients treated for congenital diseases, as there is limited access to databases containing large cohorts necessary for these evaluations due to the rare nature of these diseases.
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