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Pediatric Surgery

Pediatric surgery for gastrointestinal and genital malformations

The purpose of this project is to develop, evaluate and implement novel bioimaging techniques for monitoring perfusion and oxygenation during pediatric surgery, with regard to congenital anorectal malformations, Hirschsprung’s disease and tumors, and to assess the correlation to postoperative complications in the skin and intestine. We hope to optimize existing surgical procedures and strengthen the surgical aftercare.

The pediatric surgery in Lund is one of two of Sweden's national centers for malformations in children's gastrointestinal tract and genitals. Every year, about 100 children undergo surgery with reconstruction of the rectum, pelvic floor and genitals due to malformations of the gastrointestinal tract such as anal atresia, Hirschsprung's disease, esophageal atresia, or urogenital malformations such as hypospadias, and congenital pelvic tumors such as sacrococcygeal teratoma. The children who undergo the operations are usually newborns or sometimes up to a few years old.

Pre-surgical image of dilated colon due to Hirshprungs disease. Photo.
Pre-surgical image of dilated colon due to Hirshprungs disease.

Although children often have significantly better healing than adults, wound complications occur with dehiscence and infections in about 20-30%, with a need for medication and antibiotics and extended hospital stays. In some of the gastrointestinal or urinary tract reconstructions, the wounds heal with stricture, and the child must then undergo dilatations or other treatments in anesthesia, which is stressful and causes suffering for both the child and the family. Understanding the mechanisms that lead to impaired wound healing and healing without stricture, could lead to safer surgeries and aftercare, reduce the child's suffering and also save families time and financial losses.

To date, there is no technology that enables the measurement of perfusion and oxygenation in the intestine during surgery. We have recently implemented laser speckle contrast imaging for perfusion monitoring in reconstructive surgery and we have also developed spectroscopic techniques that can measure oxygenation and tissue composition, e.g. hyperspectral imaging and diffuse reflectance spectroscopy.

The hypothesis is that high tissue tension during surgical reconstruction during infant surgery results in decreased blood perfusion, that may be associated with an increased risk of treatment-requiring postoperative complications with wound healing problems and stricture development, and that these can be avoided by perioperative monitoring.

Pediatric Surgery Team.Photo.
Pediatric Surgery Team. From the left: Kristine Hagelsteen (MD, PhD) post doc and senior consultant pediatric surgery, Pernilla Stenström (MD, PhD) associate professor and senior consultant pediatric surgery, Christina Graneli (MD,PhD) specialist pediatric surgery, Louise Tofft (MD, PhD) specialist pediatric surgery.

Selected references

Stenström P, Sheikh R, Granéli C, Vennström Berggren J. Perfusion monitoring using laser speckle contrast imaging during endorectal pull-through for Hirschsprung’s disease. Journal of Pediatric Surgery Case Reports. Volume 76, January 2022, 102142.

Tofft L Klasson S, Salö MHambraeus M, Arnbjörnsson E, Stenström P. Patient-reported physical and psychosocial significance of abdominal scarring in anorectal malformations, Journal Pediatric Surgery, 2021.

Stadil T, Koivusalo A, Svensson JF, Jönsson L, Lilja, H, Thorup J, Sæter T, Stenström P, Qvist N, Surgical treatment and major complications within the first year of life in newborns with long-gap esophageal atresia gross type A and B-a systematic review Journal of Pediatric Surgery. 2019 Nov 54:11:p 2242-2249

Stenström P, Salö M, Anderberg M, Arnbjörnsson, E, Congenital cardiac heart disease in children with esophageal atresia- impact on the development of anastomotic strictures. Gastroenterology and research and practice, 2018:2:1-5

Winberg H, Anderberg M, Arnbjörnsson E, Stenström P Urinary flow measurements in hypospadias correlated to surgical procedure and risk of development of urethra-cutaneous fistula, J Pediatric Urology 202o,16(3):