The Paediatric Surgical Unit has investigated the physiology, nutrition and metabolism of the surgical infants and children. This Unit has characterised their energy metabolism and substrate utilisation during parenteral nutrition and critical illness. It has elucidated the effects of parenteral nutrition on the immune system and bacterial translocation from the gut. Using an in vivo model of neonatal sepsis the Surgical Unit has characterised the biochemical pathways involved in liver derangement during sepsis and the strategies to prevent it. The Unit has contributed to the improvement in mortality and morbidity of neonates with necrotising enterocolitis by: 1) establishing in the laboratory an experimental model of the disease; 2) designing new minimally invasive surgical techniques and 3) co-ordinating a multicentre randomised controlled trial. In addition the Surgical Unit has recently acquired an isotope ratio mass spectrometer which is now being used for several innovative in vivo investigations in surgical infants and children.
The Unit has characterised the physiologic and metabolic response to operative trauma and minimally invasive surgery. To verify the experimental observations a “Clinical Trial Unit” has been established which co-ordinates randomised controlled trials locally, nationally and internationally.
Research in the Surgery Unit follows the following themes and includes the listed projects:
(i) Research into the pathogenesis and treatment of necrotizing enterocolitis (NEC)
We are investigating the pathogenesis of this devastating disease of newborns thereby trying to understand what leads to intestinal necrosis with the aim of developing new therapies. One potential therapy that we are now testing on patients is controlled moderate hypothermia. Surgical treatment for NEC varies widely between different centres and there is little consensus on the optimal surgical procedure. We have recently highlighted these differences in a survey of consultant surgeons, and are now undertaking an international multicentre randomised controlled trial to compare one of the most controversial methods of treatment, peritoneal drainage, with the more usual open surgery.
More details can be found at:
Talking to different surgeons around there world during this trial, we have noticed apparent marked differences in incidence and pattern of referral, and are currently designing an epidemiological
study to examine these differences in more detail.
(ii) Laparoscopic Surgery
- Laparoscopic, or keyhole, surgery, has only in the last few years become popular in paediatric surgery and for several operations, we do not currently know whether the perceived benefits of laparoscopy in children translate into benefits for the children operated. We have undertaken a randomised controlled trial comparing laparoscopic operation with the more traditional open operation for fundoplication, an operation to prevent gastro-oesophageal reflux which is a commonly performed procedure in children. Initial results suggested that although children operated by each procedure needed a similar amount of time before they were fully fed and were able to leave hospital, stomach function was better in children operated laparoscopically. We are therefore about to compare the long-term effectiveness of these operations in children, and also looking at stomach function in more detail.
- We are also currently comparing laparoscopic with open operation for two other types of operation performed in newborn infants: pyloromyotomy (Pi Trial), and hernia repair (MARCH Trial). Both of these studies are international randomised controlled trials.
- During laparoscopy, the abdomen of the patient is inflated with carbon dioxide to allow the surgeon enough room to work inside. However, some of this carbon dioxide can be absorbed and potentially have adverse effects so we have developed a novel method to measure the amount of carbon dioxide absorbed during an operation.
(iii) Nutrition of surgical infants and prevention of infections
Infants and children that need surgery frequently need intravenous nutrition and are at great risk from getting severe infections (sepsis), both by accidentally introducing bacteria with the intravenous feed, and because of the operation itself. We are interested in improving the nutrition of surgical infants and children to prevent this. One of the ways which we are trying to do this is using the amino acid glutamine, which is an important building block of protein in the body. As well as being an important constituent of body protein, glutamine is also a really good fuel for cells of the gut and the immune system so we think it is of benefit in preventing fighting infections. As well as this, glutamine is also useful for making one the body's anti-oxidants, glutathione. We are currently conducting several different studies looking at glutamine supplementation. In one of these, glutamine is being given around the time of surgery to see of it can help immune function and prevent infections. In another, it is being given to infants and children who already have infections to see if it can boost their immune system, their liver function and help them make more glutathione.
Page last modified on 17 mar 11 15:56