Paediatric surgery is one of the most vigorously growing fields in surgery. It came into existence as a distinct specialty in Hong Kong when Dr. Paul CK Yue established the first paediatric surgical unit at Queen Mary Hospital in 1967 and a neonatal surgical unit in 1968 .In the ensuing years, there was marked improvement in the survival rate of newborns with congenital surgical anomalies. In 1979 Professor Htut Saing succeeded Dr. Yue and a training programme was started. Subsequently, other paediatric surgical units were established in various hospitals. With the formation of the Board of Paediatric Surgery under the auspices of the College of Surgeons of Hong Kong in 1993, this specialty has now become well established. Currently, there are three paediatric surgical centres in Hong Kong providing service, training and research in various fields of paediatric surgery.
Paediatric surgeons operate on children whose age ranges from birth through to the teenage years. Children are not just small adults and the surgical problems are often quite different from those commonly seen by adult general surgeons. A wide spectrum of sub-specialties is within the realm of paediatric surgery. Indeed the management of surgical problems in children demands a multidisciplinary approach and a close collaboration with many other disciplines. This is reflected in the articles in the current issue of the Hong Kong Journal of Paediatrics with the main theme on paediatric surgery.
In this issue, there are seven original articles, one article on personal practice and two case reports covering major areas of paediatric surgery. The issue will certainly be of interest to surgeons, paediatricians, general practitioners, family physicians and other medical professionals related to child health.
In this edition, Dr. Nick Chao et al reported on the value of fundoplication in children with neurological impairment in relation to their respiratory function and nutrition. Dr. Michael Leung et al discussed on the incidence, diagnosis and management of occult spinal dysraphism in children with imperforate anus.
Cryptorchidism is the most common congenital anomaly involving the genitalia of baby boys and impalpable testis accounts for about 20 percent. Dr. Paula Tang et al described the use of laparoscopy in the management of this clinical problem. Urinary incontinence is a very distressing problem for children and their family. Dr. Jennifer Sihoe discussed the local prevalence, problems and management of non-neurogenic urinary incontinence from a surgeon's perspective.
Biliary atresia and choledochal cyst are common causes of surgical jaundice in children. Dr. KH Lee et al reported on their experience in the management of choledochal cyst from the open to laparoscopic approach. Most cases of biliary atresia will end up in liver failure requiring liver transplantation. However, there is a significant shortage of deceased donor grafts for paediatric patients. Dr. Patrick Chung et al reported on their experience of using split graft liver transplant to increase the number of deceased grafts.
Neuroblastoma is the most common adrenal tumour of infancy and early childhood. The management of advanced disease remains a challenge to clinicians. Dr. Ivy Chan et al reviewed their experience of managing neuroblastoma.
Henoch-Schönlein purpura is common in young children and may present with acute gastrointestinal and urological manifestations even before the onset of purpura and arthralgia. Dr. Nick Chao et al reviewed their experience in managing such manifestations.
The case reports are also very educational and informative. Dr. Genevieve Fung et al reported on a case of severe cytomegalovirus enteritis transmitted through breast milk in an immunocompetent infant following gastrointestinal surgery. Neonatal intestinal obstruction is a common problem encountered by clinicians looking after neonates. Dr. WK Kwok et al described a case of neonatal intestinal obstruction caused by intestinal Kaposiform haemangioendothelioma
Finally, I would like to thank all of the contributors who did a tremendous job in bringing this edition to fruition and also Professor Louis Low, Chief Editor, for giving us the opportunity to present our work in paediatric surgery.