OPERATIVE SURGERY

OPERATIVE SURGERY

Preoperative fasting should be limited ( Summary box 17.2 ). Surgery requires meticulous and gentle tissue handling, strict haemostasis, fine sutures and magnification. Tissues should minimised. The intestine can be anastomosed with single-layer interrupted or continuous extramucosal sutures. Wounds are closed with absorbable sutures in layers or a mass closure. Establishing a layer of fat between skin and muscle in the malnourished or thin child prevents the skin from adhering to muscle. Toothed forceps may be used when closing the skin, but the skin must not be punctured; epidermal tunnels can form, trapping skin debris and creating a comedo-like blackhead. Clean skin incisions are closed with absorbable subcuticular sutures or skin glue, avoiding staples. Minimally invasive approaches can be used at all ages with appropriate instruments, flow rates and pressures. Postoperatively , children recover swiftly with adequate analgesia. Summary box 17.2 Fasting instructions /uni25CF /uni25CF /uni25CF

1 hour for clear /f_l uids 4 hours for breast milk 6 hours for solids

OPERATIVE SURGERY

Preoperative fasting should be limited ( Summary box 17.2 ). Surgery requires meticulous and gentle tissue handling, strict haemostasis, fine sutures and magnification. Tissues should minimised. The intestine can be anastomosed with single-layer interrupted or continuous extramucosal sutures. Wounds are closed with absorbable sutures in layers or a mass closure. Establishing a layer of fat between skin and muscle in the malnourished or thin child prevents the skin from adhering to muscle. Toothed forceps may be used when closing the skin, but the skin must not be punctured; epidermal tunnels can form, trapping skin debris and creating a comedo-like blackhead. Clean skin incisions are closed with absorbable subcuticular sutures or skin glue, avoiding staples. Minimally invasive approaches can be used at all ages with appropriate instruments, flow rates and pressures. Postoperatively , children recover swiftly with adequate analgesia. Summary box 17.2 Fasting instructions /uni25CF /uni25CF /uni25CF

1 hour for clear /f_l uids 4 hours for breast milk 6 hours for solids

OPERATIVE SURGERY

Preoperative fasting should be limited ( Summary box 17.2 ). Surgery requires meticulous and gentle tissue handling, strict haemostasis, fine sutures and magnification. Tissues should minimised. The intestine can be anastomosed with single-layer interrupted or continuous extramucosal sutures. Wounds are closed with absorbable sutures in layers or a mass closure. Establishing a layer of fat between skin and muscle in the malnourished or thin child prevents the skin from adhering to muscle. Toothed forceps may be used when closing the skin, but the skin must not be punctured; epidermal tunnels can form, trapping skin debris and creating a comedo-like blackhead. Clean skin incisions are closed with absorbable subcuticular sutures or skin glue, avoiding staples. Minimally invasive approaches can be used at all ages with appropriate instruments, flow rates and pressures. Postoperatively , children recover swiftly with adequate analgesia. Summary box 17.2 Fasting instructions /uni25CF /uni25CF /uni25CF

1 hour for clear /f_l uids 4 hours for breast milk 6 hours for solids