Paediatric (Ped) Surgery

Paediatric Surgery deals with surgical care for foetuses, infants and children to 18 years of age. A paediatric surgeon develops the best treatment plan for the patient, conducts preoperative examinations and preparations, and follows up on the patient's progress as part of the post-surgical care. They work closely with the patient's guardians and/or parents responsible for most of the care. They may provide instructions and counselling and even refer them to support groups or other professionals who can help manage the child's illness.

There are several areas of expertise in paediatric surgery. Prenatal surgery deals with foetuses or unborn children. Some conditions can be determined through ultrasounds and other examinations that can be performed on pregnant women. These tests are also often part of routine maternal and foetal care. A paediatric surgeon specialising in this field usually works closely with sonographers and radiologists. The other area of expertise is called neonatal surgery, which focuses on babies (both full-term or premature) who require surgical procedures- typically to correct a congenital abnormality that may prevent them from growing up normally or may be life-threatening. Meanwhile, paediatric oncosurgery is a subspecialty of paediatric surgery that includes managing cancer-related cases. Just like in adults, surgery is often the first line of treatment, particularly if there is a malignant tumour or mass that may not have spread to other nearby organs. Some paediatric surgeons specialise in trauma or injuries that result from accidents or violence. They often work with children who require emergency care and are suffering from trauma.

When do you need to see a paediatric surgeon?

You will need to see a paediatric surgeon when:

• Surgery becomes a part of pain management
• The child has congenital conditions that can be corrected only by surgery
• Surgery is required to improve the mobility of the child
• Corrective surgery is required due to the failure of the previous one
• The child develops complications like bleeding and infections after surgery
• There is a presence of tumours
• The child has been in a fatal accident, causing severe injuries that require surgery
• Any organ of the child is not functioning well and requires a transplant

What conditions do paediatric surgeons treat?

Paediatric surgeons have the expertise to treat a range of medical conditions. Some of them are:

• Surgery for cancer: Paediatric surgeons provide comprehensive care and treatment to children suffering from various cancers. These days, children are prone to develop cancer in their liver, lungs, and other body parts. Surgeries have been beneficial in removing tumours from children.
• Congenital disorders: Surgery is beneficial in treating congenital disabilities like an imperforate anus, gastroschisis, intestinal atresia, omphalocele, lung cysts, esophageal atresia, Hirschsprung's disease, etc.
• Pectus excavatum: Surgeries are performed to treat the condition of the sunken chest in children. It usually involves minimally invasive surgery with smaller incisions, scars, and a shorter recovery period.
• Vascular malformations: Children whose lymphatic vessels or blood vessels don't develop properly might require surgery.
• Appendectomy: The appendix is surgically removed when it is extremely infected and causes severe pain to the child.
• Bowed chest: A surgery is performed to correct the disappropriate growth of the ribs and breast bone of the child.
• Gallbladder surgery: The gallbladder can be harbouring stones, causing severe pain to the child. Hence, it is vital to get it removed surgically.
• Biliary Atresia: Here, the bile ducts are unable to empty properly. This condition is usually caused at the time of birth.
• Imperforate anus: Sometimes, children are born with incorrectly placed anus openings. This is corrected via surgery.
• Reproductive conditions: Sometimes, kids are born with reproductive conditions. These conditions can be corrected via surgery.
• Separating conjoined twins: Twins sometimes conjoin with each other in the womb. An extensive, well-planned surgery can be conducted to separate them without harming either of the twins. The risk involved in such surgeries is very high, and the paediatric surgeon usually has an army of other specialists by their side while performing this operation. It is a lengthy procedure and would be done step by step if most of the body parts of the twins were attached to each other.

Diagnosis

Paediatric surgeons may conduct several diagnostic tests before going ahead with the surgery. Some of them are:

• Pulse oximetry: This test helps measure oxygen levels in the blood to identify congenital heart diseases in infants.
• X-rays: X-ray is an imaging test that produces clear images of bones and other internal structures. 
• Angiogram: An angiogram is conducted to study the shape and size of the child's blood vessels.
• Ultrasound: This imaging test uses sound waves to create a picture of the internal organs of the patient.
• Blood tests: Blood tests can help gather information of general health, infections, organ function, genetic conditions and more.
• Urine tests: Urine tests are conducted to check for abnormalities in the bladder or urinary tract of the child.
• Biopsy: Doctors may conduct biopsies of your child for conditions like cancer, infection, inflammation, etc.
• Endoscopy: The doctor might order an endoscopy to detect acid reflux, ulcers, and infections. Children will be administered anaesthesia before performing an endoscopy. Symptoms like severe vomiting, nausea, and extreme abdominal pain might require an endoscopy.
• CT and MRI scan: These are imaging tests conducted to give the doctor a clear picture of the child's internal organs.
• Radioneucleide scans: To know the status of a child's kidneys and gather information about the relative function and presence or absence of scars.

Review

Reviewed by Dr. Anurag Krishna, Chairman - Paediatrics & Paediatric Surgery on 02-Feb-2023.