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Non-operative advances: What has happened in the last 50 years in paediatric surgery?


  • Andrew JA Holland,

    Corresponding author
    1. The Children's Hospital at Westmead Burns Research Institute, Burns Unit and Douglas Cohen Department of Paediatric Surgery, The University of Sydney, Sydney, New South Wales, Australia
    • Correspondence: Professor Andrew JA Holland, Douglas Cohen Department of Paediatric Surgery, The Children's Hospital at Westmead, Sydney Medical School, The University of Sydney, Locked Bag 4001, Westmead, NSW 2145, Australia. Fax: +61 2 9845 3346; email:

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  • Craig A McBride

    1. Centre for Children's Burns and Trauma Research, Queensland Children's Medical Research Institute, University of Queensland, Brisbane, Queensland, Australia
    2. Stuart Pegg Paediatric Burns Centre, Department of Paediatric Surgery, Royal Children's Hospital, Brisbane, Queensland, Australia
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  • Conflict of interest: None declared.


Paediatric surgeons remain paediatric clinicians who have the unique skill set to treat children with surgical problems that may require operative intervention. Many of the advances in paediatric surgical care have occurred outside the operating theatre and have involved significant input from medical, nursing and allied health colleagues. The establishment of neonatal intensive care units, especially those focusing on the care of surgical infants, has greatly enhanced the survival rates and long-term outcomes of those infants with major congenital anomalies requiring surgical repair. Educational initiatives such as the advanced trauma life support and emergency management of severe burns courses have facilitated improved understanding and clinical care. Paediatric surgeons have led with the non-operative management of solid organ injury following blunt abdominal trauma. Nano-crystalline burn wound dressings have enabled a reduced frequency of painful dressing changes in addition to effective antimicrobial efficacy and enhanced burn wound healing. Burns care has evolved so that many children may now be treated almost exclusively in an ambulatory care setting or as day case-only patients, with novel technologies allowing accurate prediction of burn would outcome and planning of elective operative intervention to achieve burn wound closure.