Pediatric Surgical Unit

This proposal outlines the establishment of a comprehensive Kasai Portoenterostomy Program for infants diagnosed with biliary atresia. The objective is early diagnosis, timely surgical intervention, and structured postoperative follow-up to improve native liver survival and reduce the need for early liver transplantation.

Clinical Justification:

• Biliary atresia is a progressive obliterative cholangiopathy of infancy leading to cirrhosis and liver failure if untreated.

• Early Kasai portoenterostomy (ideally before 90 days of age) significantly improves bile drainage and long-term survival with native liver.

• Delay in diagnosis is the primary determinant of poor outcomes.

Clinical Pathway:

Early Identification: Direct hyperbilirubinemia screening in prolonged neonatal jaundice.

Diagnostic Workup: Liver function tests, abdominal ultrasound, HIDA scan, and intraoperative cholangiography for confirmation.

Operative Phase: Kasai portoenterostomy with excision of fibrotic biliary remnants and Roux-en-Y portoenterostomy reconstruction.

Post-Operative Care: Antibiotic prophylaxis, nutritional optimization, fat-soluble vitamin supplementation, and structured cholangitis monitoring.

Long-Term Follow-Up: Serial liver function monitoring, growth assessment, portal hypertension surveillance, and transplant referral pathway if needed.

Strategic and Financial Value:

• Establishes Al Nas Hospital as a regional referral center for neonatal hepatobiliary surgery.

• Improves institutional neonatal survival metrics.

• Enhances academic and research potential.

• Reduces long-term transplant burden through early intervention.

Key Performance Indicators (KPIs):

• Age at surgery (Target: < 60 days).

• Jaundice clearance rate (Total bilirubin < 2 mg/dL within 6 months).

• Cholangitis rate within first year.

• Native liver survival at 2 and 5 years.

• Time from referral to surgery.

Over the past two years, we have performed 15 cases with an overall success rate of 80%. Patients who did not demonstrate adequate clinical improvement following surgery were promptly referred to our liver transplantation team for further evaluation and advanced management.

This proposal establishes a comprehensive Intestinal Rehabilitation and Bowel Lengthening Program featuring the Serial Transverse Enteroplasty (STEP) procedure as its surgical cornerstone. The program targets pediatric Short Bowel Syndrome (SBS), aiming to achieve enteral autonomy, reduce dependence on Total Parenteral Nutrition (TPN), and prevent TPN-associated liver failure.

Clinical Background and Rationale:

• Short Bowel Syndrome commonly results from massive bowel resection secondary to necrotizing enterocolitis, intestinal atresia, or midgut volvulus.

• Chronic TPN dependence is associated with central line infections, sepsis, thrombosis, and progressive liver disease.

• The STEP procedure narrows and lengthens dilated bowel segments, improving motility and absorptive surface area.

Clinical Pathway:

• Pre-Operative (Intestinal Rehabilitation): Multidisciplinary optimization including nutritional management, growth monitoring, and serial contrast imaging to assess bowel length and dilation.

• Operative Phase: Serial Transverse Enteroplasty using sequential stapler applications from alternating sides of the mesentery to create a longer, narrower zigzag channel.

• Post-Operative Phase: Gradual reintroduction of enteral feeds with close monitoring, progressive TPN tapering, and structured outpatient rehabilitation follow-up.

Key Performance Indicators (KPIs):

• Enteral Autonomy Rate at 1 and 2 years post-STEP.

• Increase in percentage of daily caloric intake achieved enterally.

• Reduction in CLABSI incidence.

• Improvement in liver function tests and resolution of cholestasis.

• Reduction in total inpatient days related to TPN complications.

Over the past two years, we have performed more than five procedures with a clinical success rate ranging between 95% and 100%, consistent with internationally published benchmarks. Given the relative novelty of the technique and the limited number of cases encountered, this experience constitutes a valuable and distinctive contribution to the field.

This program provides definitive surgical management for pediatric patients with medically refractory colonic inertia through subtotal colectomy with ileorectal anastomosis. The aim is to reduce repeated hospital admissions and significantly improve patient's quality of life.

Clinical Rationale: Colonic inertia causes severe chronic constipation and recurrent fecal impaction. Properly selected patients benefit from subtotal colectomy while preserving rectal continence.

Clinical Pathway:

• Pre-Operative: Confirmation via transit study and anorectal manometry; failure of optimal medical therapy.

• Operative: Laparoscopic or open subtotal colectomy with primary ileorectal anastomosis.

• Post-Operative: ERAS protocol, electrolyte monitoring, structured dietary progression.

Strategic and Financial Value:

• Reduction in recurrent emergency admissions.

• Conversion of chronic admissions to planned elective procedures.

• Establishment as regional referral center for motility disorders.

Key Performance Indicators:

• Resolution of constipation without daily enemas.

• Anastomotic leak rate.

• Surgical site infection rate.

• Reduction in hospital readmissions.

Over the past two years, we have performed more than 50 procedures, achieving a clinical success rate ranging from 80% to 95%, in alignment with internationally reported outcomes and established standards of care.

This program establishes a dual emergency and elective pathway for pediatric intestinal malrotation managed via GMC operation. The objective is rapid response to acute volvulus and standardized care for elective cases.

Clinical Justification:

• Midgut volvulus is a time-sensitive emergency that may result in massive bowel necrosis and short bowel syndrome if not treated promptly.

• Standardized rapid protocols reduce morbidity and mortality.

• Clinical Pathway

• Emergency Pathway: Immediate triage, STAT Upper GI contrast, rapid transfer to OR for GMC operation.

• Elective Pathway: Planned admission and GMC operation where appropriate.

Strategic and Financial Value

• Prevention of catastrophic short bowel syndrome.

• Strengthened emergency response capability.

• Improved institutional accreditation profile.

Key Performance Indicators

• Diagnosis-to-incision time.

• Bowel salvage rate.

• Mortality rate.

Over the past two years, we have undertaken more than 10 highly specialized procedures, achieving clinical success rates ranging from 80% to 95%, in accordance with leading international standards. The relative rarity and technical complexity of these cases underscore the advanced expertise and multidisciplinary proficiency of our team.

Our program occupies a distinctive position in this field, particularly with the involvement of Professor Kareem Abu-Elmagd, a pioneer in the development of the procedure that carries his name. His leadership and innovative contributions have positioned our center among a select number of institutions worldwide with specialized experience in performing this technique.

The Pancreatic Surgery Clinical Program provides advanced surgical care for patients with pancreatic and periampullary diseases, with particular expertise in the management of complex pancreatic tumors requiring pancreaticoduodenectomy (Whipple procedure). The program is dedicated to delivering safe, effective, and individualized surgical treatment through a multidisciplinary approach that integrates surgical expertise, perioperative optimization, and comprehensive postoperative care.

Patient management is guided through a collaborative multidisciplinary framework involving pancreatic surgeons, gastroenterologists, radiologists, pathologists, oncologists, anesthesiologists, and intensive care specialists. This coordinated model ensures accurate evaluation, careful patient selection, optimal surgical planning, and continuity of care throughout the treatment pathway.

The surgical expertise includes:

·        Pancreaticoduodenectomy (Whipple procedure) for pancreatic head and periampullary lesions

·        Distal pancreatectomy for lesions involving the pancreatic body and tail

·        Surgical management of complex pancreatic cystic and solid neoplasms

·        Reconstruction and perioperative care for patients requiring major pancreatic resection

A special emphasis is placed on the Whipple procedure, which represents one of the most technically demanding operations in gastrointestinal surgery and requires a high level of surgical precision, perioperative coordination, and postoperative monitoring. During 2025, our program successfully performed 9 Whipple operations, achieving zero mortality and a 100% success rate, reflecting the safety, expertise, and high standard of care delivered by our team.

We also apply enhanced recovery principles and meticulous postoperative follow-up to reduce complications, support recovery, and optimize overall outcomes. The results of our pancreatic surgery program demonstrate the strength of our multidisciplinary model and our commitment to excellence in complex pancreatic surgical care.