Pediatric surgery, particularities in the treatment of congenital malformations: A literature review

Abstract

Introduction: Congenital malformations are a major cause of infant morbidity and mortality and often require early surgical intervention and longitudinal follow-up. The pediatric surgical management of these conditions requires specific considerations regarding prenatal diagnosis, perinatal preparation, choice of surgical timing, techniques (minimally invasive versus conventional), neonatal support, and rehabilitation, all of which influence functional and neurodevelopmental outcomes. Objective: A bibliografic review was conducted to synthesize evidence on the technical, temporal, and multidisciplinary particularities in the surgical treatment of congenital malformations in pediatrics, with an emphasis on perioperative outcomes, short-and long-term morbidity, and practical recommendations for referral services. Methods: This is a descriptive and analytical literature review based on national and international publications available in the Scientific Electronic Library Online (SciELO), Latin American and Caribbean Health Sciences Literature (LILACS), United States National Library of Medicine (PubMed), and Oxford Research Encyclopedia databases. Studies published between 2010 and 2022 were included. Results: The literature indicates that about one-third of children with congenital anomalies require surgery in early childhood, many requiring multiple procedures before the age of 5, which reinforces the need for centralization and multidisciplinary planning. Prenatal detection allows for delivery planning and preparation of the neonatal team, reducing therapeutic delays and initial complications; in selected cases, fetal surgery improves prognosis but requires a referral structure and rigorous selection. Minimally invasive techniques in neonatology and infants have shown advantages in terms of pain, scarring, and length of hospital stay, but require technical skill, adequate equipment, and specific anesthetic protocols; for some malformations, conversion and recurrence rates vary between approaches, requiring careful case selection. Perioperative management, including nutritional optimization, pain control, hemodynamic monitoring, and early rehabilitation intervention, directly impacts growth and neurodevelopmental outcomes. Integrated care systems (prenatal, perinatal, surgical, and rehabilitative) and experienced centers demonstrate fewer complications and better functional outcomes. Conclusion: Therefore, the surgical treatment of congenital malformations in pediatrics requires a multidisciplinary approach, centralization in centers with expertise, standardized perioperative protocols, and careful selection between open, minimally invasive techniques, or, when indicated, fetal intervention. Investments in prenatal diagnosis, training in neonatal MIS, referral networks, and longitudinal follow-up are essential to optimize survival, reduce morbidity, and improve neurofunctional outcomes.