|Year : 2013 | Volume
| Issue : 4 | Page : 131-132
Research in pediatric surgery: Indian scenario
Department of Pediatric Surgery, I.M.S, B.H.U, Varanasi, Uttar Pradesh, India
|Date of Web Publication||8-Nov-2013|
A N Gangopadhayay
Department of Pediatric Surgery, I.M.S, B.H.U, Varanasi, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Gangopadhayay A N. Research in pediatric surgery: Indian scenario. J Indian Assoc Pediatr Surg 2013;18:131-2
Pediatric surgery is a relatively new speciality that came into existence only after the Second World War. The various techniques of operation have been refined over the years. There has been ample research on the clinical side with established guidelines for the treatment.
Yet being a speciality dealing with developmental anomalies with a spectrum in each condition, one patient differing from the other, not much can be provided in terms of quality of life in some conditions like neurogenic bladder and neural tube defects.
There is a need for lot of research on basic sciences so as to justify the physiology of each anomaly and work toward its prevention.
The developing countries have a vast clinical load and are so engrossed in providing basic care that there is hardly any time for performing basic research.
Though ample research has been carried out in developed countries; application of their results in a different setting like developing countries may not be an appropriate thing to do.
The brunt of mortality in Pediatric Surgery today in India is newborn surgery and malignancy. With anaemia and malnutrition during pregnancy, the newborn babies have a poor reserve to tolerate Necrotizing Enterocolitis or any surgery pertaining to congenital anomalies. With the vast majority of tracheoesophageal fistula patients being less than 1.5 kg, there is very less to offer. It is difficult to compare results based on incidentally detected tumors or those during screening with advanced stage of malignancy at presentation.
There is a dire need for grass root level research on the basic needs for sustenance, the basic personal hygiene of caretakers and the improving the transport facilities of pediatric surgical patients to the tertiary care hospitals.
There is a need to conduct research on the level of awareness as it seems unrealistic and shocking to know about the level of awareness about medical and surgical conditions in the rural area. People have lived their lives without being operated for a congenital hernia.
The outpatient departments are full and the bed strength available is too little thus the priorities change in the desire to help the most number of patients in the minimum resource facilities.
There are also a lot of hurdles in performing research. Lack of facilities and infrastructure form the base of the pyramid. The reluctance of the Government and higher authorities to fund and provide manpower for research in the presence insufficiency to deal with the basic clinical cases is understandable.
The research methodologies need to be refined. The data need to be entered by trained personnel. The data need to be maintained in proper records. A stringent follow up needs to be maintained to be able to justify the implementation of a particular treatment.
Many questions thus remain unanswered. It is now the time to start dedicated multicentric trials and practice evidence-based medicine based on data from our own country, preferably at the grass root level.
Research in Pediatric Surgery can be conducted under the following headings:
- Laboratory Research
- Clinical Trial
- Technical innovation in Surgery
| Laboratory Research|| |
This is the most important aspect of research in Pediatric Surgery. Most of the Major Congenital Anomalies and Pediatric Malignancies need to be evaluated at cytogenetic level for its genesis. These types of fundamental research needs a cohesive interaction between Pediatric Surgeon, Basic Scientist and Technologist in order to achieve the desired goal. In this regards Medical Institutions in India can develop collaborative projects with Basic Scientist and technologist by picking up one subject from one Institution and published their data in our association journal. The Developed countries have already established this type of research (Stem cell research, Tissue Engineering etc.). Our Medical Institutions need to start such collaborative basic research along with research labs like ICMR, CCMV, DST etc. as we have tremendous clinical material for better research than developed countries. Our association can play a major role in allotting one particular disease for research to a particular institution where the disease is most prevalent based on database.
| Clinical Trials|| |
For the success of any research a methodical multicentric clinical trial is essential. Though lots of trials are being conducted in India in a sporadic manner, in order to avoid bias in their outcome they need to be monitored by a neutral body with stringent quality control. Again our association can play a great role in this regards. Any research gets it final recognition only after its final implementation of the community after conducting a proper multicentric clinical trial.
| Technical Innovation|| |
Lot of surgical technical innovation is being evolved in our country in the field of pediatric surgery. But quite a large number of them are not being published. These types of innovative research are cost effective and most suited in our scenario and hence need to be published at the earliest. Further feedback is equally important in these technical innovations from the other pediatric surgeons who are also adapting these techniques.
Earlier the most neglected part of pediatric clinical research was proper follow up. Now- a-days for better follow up of any clinical research and public awareness, mobile and internet are the most important tools. We should avail these facilities in an elaborate manner amongst ourselves and also with the patients.
In order to achieve excellence in research in the field of pediatric surgery a new stringent standard for monitoring and reporting is needed. I believe this can be most effectively performed through the use of a universal standardized guidelines evolved by our own experts.