Research in the Surgery Unit follows the themes below and includes the listed projects:
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 multi-centre randomised controlled trial to compare one form of treatment, peritoneal drainage, with the more usual open surgery. More details can be found at www.nettrial.net.
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.
Laparoscopic, or keyhole, surgery has only in the last few years become popular in paediatric surgery. For several operations, we do not currently know whether the theoretical benefits of laparoscopy in children translate into actual benefits.
We have undertaken a randomised controlled trial comparing the 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, and hernia repair. 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 so we have developed a novel method to measure the amount of carbon dioxide absorbed during an operation.
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 good fuel for cells of the gut and the immune system so we think it is of benefit in fighting infections. As well as this, glutamine is also useful for making one the body's anti-oxidants, glutathione.
We have several different projects 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.