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November 2014

Transitional Care From Pediatric to Adult Surgery

Author Affiliations
  • 1Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
  • 2Division of Pediatric Surgery, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
  • 3currently with Department of Pediatric Surgery, Women and Children's Hospital of Buffalo, Buffalo, New York
JAMA Surg. 2014;149(11):1099-1100. doi:10.1001/jamasurg.2014.301

The field of pediatric surgery is principally involved in the surgical correction of congenital anomalies and the treatment of childhood cancers. From the time of Conrad Ramstedt in the early 1900s, who first operated on hypertrophic pyloric stenosis under uncertain anesthesia, to Robert Gross, who famously in 1938 was the first to operate on a patent ductus arteriosus while his surgeon-in-chief was away, to repair of esophageal atresias, anorectal malformations, and other congenital anomalies, surgeons operating on children have long attempted to convert nonsurvivable congenital and acquired anomalies into survivable ones. With time, and input from myriad collaborating specialists, we have succeeded. Isolated abdominal wall defects now carry a survival rate of greater than 95% and children born with esophageal atresia survive into adulthood at a rate higher than 90%. Although some pediatric solid organ malignancies continue to portend a poor outcome, patients with Wilms tumor and neuroblastoma, for example, now achieve overall 5-year survival rates of more than 90% and 70%, respectively. And it is precisely this success that has created a beautiful conundrum: who should take care of teenagers and young adults who have survived congenital anomalies and may require additional care but are physically and mentally adults?

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