Neo-Natal Surgery

I'HIS paper is based on1 experience-often bitter experience-and makes no pretence at summarizing the literature, which makes the whole problem sound far too easy. As we all know, textbook cases occur only in textbooks. Nor shall I quote the incidence of various conditions per one thousand live births. To know that something happens once in every two thousand babies is no help in deciding whether any given infant is number 2,000, or number 1,999. There are various ways of classifying the neo-natal lesions requiring surgery, which, incidentally, should aim only at being lifesaving, surgery of election being very limited in amount. Thus, the scope of neo-natal surgery may be classified A-According to Cautse The rest (not of immediate urgency). C-'lhose in1 which the diagnosis is: Manifest (imposing no strain on the diagnostician), e.g., exomphalos. In doubt (extremely worrying, since delay or unnecessary operation are almost equally hazardous). I shall deal first with exomphalos and omphalocele, which appear in all these groups. They differ only in-severity, the first term being applied to cases in which almost the whole abdominal contents are enclosed only by a thin transparent membrane, while the second term covers suclh lesser abnormalities as the presence of a single loop of bowel containied in a small sac intimately connected with the umbilical cord. The cord theni has the appearance of being unduly vascular, and may be ligatured with more than usual firmness on that account. Ihese children need urgent operationi on account of the risk of peritoniitis, which is inevitable if the sac ruptures, wvhile the minor degrees of omplhalocele carry the additional risk of strangulation at the neck of the sac if atny more bowel forces its way out as the child becomes more active. Operation should be undertaken in a matter of minutes rather than hours and no special pre-operative treatment is required.