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General pediatric surgery

23 Friday Dec 2011

Posted by medicalsurgeryindia in General pediatric surgery

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It is important that you be honest with your child. In a non-threatening way, being careful not to use words that will make the general peadiatric surgery sound scary. Let your child know what’s going to happen. Make your explanation age-sensitive. Don’t overwhelm a younger child with detailed (and scary) explanations. Remember to tell your child that you will be close to him throughout the entire hospital visit. Children often feel much less apprehensive when they know they’re not going to be left alone.

Division of General Surgery

The Division of General Surgery diagnoses and treats surgical conditions in infants, children, and adolescents. Typical diagnoses include inguinal hernias, umbilical hernias, pyloric stenosis, undescended testes, and appendicitis. Congenital and acquired lesions of the head and neck, chest, abdomen, gastrointestinal tract, and endocrine organs as well as skin lesions are frequently seen in our clinic.

The Division is staffed by physicians who are certified by the American Board of Surgery with special competence in pediatric surgery whose areas of expertise range from gastrointestinal diseases (i.e., gastroesophageal reflux, inflammatory bowel disease, and gallbladder disease) to tumors, newborn surgery (including the neonatal Extracorporeal Membrane Oxygenation Program [ECMO]), laparoscopy, and thoracoscopy. Fetal consultations and child abuse consultations are also provided through our general surgery service. Twenty-four-hour pediatric surgical care is available through duPonts Emergency Room.

Services Available:

  • Diagnosis of pediatric surgical conditions
  • Treatment of pediatric surgical conditions
  • Fetal consultations
  • Pediatric trauma evaluations
  • Twenty-four-hour surgical coverage

FAQs General Pediatric Surgery

How much should I tell my child beforehand about surgery?

It is important that you be honest with your child. In a non-threatening way, being careful not to use words that will make the surgery sound scary. Let your child know what’s going to happen. Make your explanation age-sensitive. Don’t overwhelm a younger child with detailed (and scary) explanations. Remember to tell your child that you will be close to him throughout the entire hospital visit. Children often feel much less apprehensive when they know they’re not going to be left alone.

Can my child have two different procedures done (by two doctors at the same time)?

Yes, it is possible for more than one procedure to be accomplished at the same time, as long as it is considered to be safe for the child. It is also possible for more than one surgeon to perform the procedures.

Do you perform any plastic surgery?

The pediatric surgeons always perform plastic surgical techniques to make certain that patients have the best cosmetic results possible, and do perform some plastic surgical procedures. They do not perform complex reconstructive surgery.

What is a hernia?

An inguinal hernia is an opening in the muscle of the groin in which a portion of the intestine (or ovary, in girls), can pass through. It may be large or small, and usually appears as a lump or swelling in the groin or scrotum in boys, or in the labia in girls. An umbilical hernia develops when the muscles in the abdomen (around the belly button) do not fully close before birth, and some intestine protrudes into the opening.

Will the operation and treatment for a hernia make my son sterile?

No. The operation is a perfectly safe operation and will not cause a male to become sterile. In fact, fixing a hernia prevents it from becoming stuck, which in turn prevents damage to the testicle.

How long will my child be in the hospital after surgery?

If your child is having an outpatient procedure, he or she will probably be in and out of the hospital in the same day. For inpatient procedures, the length of stay varies, depending on the procedure and your child’s rate of recovery. If your child has major abdominal or thoracic (chest) surgery, he will probably be in the hospital for five to seven days. If he follows the doctors’ and nurses’ postoperative instructions closely, he will most likely go home sooner. Length of stay often varies from child to child, so be sure to ask your surgeon about the timeline for your child’s visit.

How much pain will my child have after surgery?

Your child may experience soreness for one to two days after a common outpatient procedure such as a hernia operation. The doctor may give him a regional nerve block or caudal block during the procedure while he or she is asleep, and then prescribe pain medication for him to use after the surgery. Parents are often surprised at how quickly their children recover after an outpatient procedure. Keeping your child quiet and restful may become the real challenge!. For inpatient procedures, the surgeon and anesthesiologist will develop a pain treatment plan for your child together. They may give your child a patient-controlled analgesia pump or a postoperative epidural catheter. These therapies allow your child to determine exactly how much pain medication is used, and enables him to access that medication almost immediately.

When can my child resume full activity?

This depends primarily on the procedure being performed. Be aware that recovery timelines can vary from child to child. Your child’s doctor will be able to give you specific information about when your child can go back into action.

How soon after surgery may I see my child?

You may see your child when the medical team determines that he is in a stable condition in the recovery room or the Post-Anesthesia Care Unit (PACU). You can usually see your child approximately 30 to 45 minutes after surgery, which is when they are usually just becoming aware of where they are.

What sort of dietary restrictions will my child need to follow before and after the surgery?

The medical staff will give you detailed instructions outlining what your child will and will not be able to eat before and after the surgery. The factors vary greatly depending on local factors.

When can my child return to school?

The length of time your child will need to wait before returning to school will vary depending on the type of surgery and your child’s response to it. Your child’s discharge instructions will usually note the date your child may return to school.

When can my child take a bath?

For most operations, children may bathe after 48 hours. For tonsil removal and ear tube insertion procedures, it is important that your child does not allow any water to enter his ears. Some ear tube and tonsil patients may shower after 24 hours, although some are encouraged to wait until their return visits.

Will my child vomit after the operation?

Vomiting is a possible side effect of anesthesia, but does not happen frequently. All of the anesthesiologists at Nemours are pediatric anesthesiologists, and therefore are trained to make the anesthesia experience as comfortable as possible for your child. Their child-centered expertise, coupled with the use of new anesthetic agents and anti-nausea medications, will greatly reduce your child’s risk of vomiting after surgery.

For more information please visit www.medsurgeindia.com  or email us at info@medsurgeindia.com dushyant.magu@medsurgeindia.com  you can also follow us at LinkedIn: http://www.linkedin.com/profile/edit?trk=hb_tab_pro_top  Follow us on Twitter: http://twitter.com/#!/MedSurgeIndia

 

To get free no obligation quote kindly contact us at :

UK : +44-2033185974

USA/Canada(Toll Free): +1-855-773-3245

Germany: +49-89120895003

India: +91-9654742998

Skype: dushyantmagu

BB PIN: 24E4EC5B

 

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Neonatal Surgery

23 Friday Dec 2011

Posted by medicalsurgeryindia in Neonatal Surgery

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Neonatal surgery refers to operations on children in the first month of life, almost always on an emergency or urgent basis. Many of these conditions are interesting and myriad, ranging from common in-born anomalies (cardio-vascular and gastro-intestinal) to fortunately rarer lethal conditions. All neonatal surgeries are undertaken by the senior staff in cooperation with the Specialist Neonatal Medical and Paediatric Anaesthesiology staff.

Neonatal surgical conditions which are best managed by pediatric surgeons include (in alphabetical order):

1. Abdominal wall defects including gastroschisis, omphalocele, and Pentalogy of Cantrell
2. Biliary atresia and choledochal cyst
3. Cloacal exstrophy
4. Conjoined twins
5. Cystic adenomatoid malformation of the lung and other types of bronchogenic cysts
6. Cystic hygroma and other neck masses
7. Diaphragmatic hernia
8. Duplication cysts and mesenteric cysts
9. Esophageal atresia with or without TE fistula (TEF)
10. Gastroesophageal reflux and hiatal hernia
11. Hirschsprung’s disease (megacolon)
12. Hydrometrocolpos and imperforate hymen
13. Imperforate anus including persistent cloaca
14. Inguinal hernias
15. Intestinal obstruction including duodenal atresia, annular pancreas, malrotation, midgut volvulus, intestinal atresia, meconium ileus and meconium peritonitis
16. Necrotizing enterocolitis
17. Ovarian cysts
18. Pyloric stenosis
19. Ribcage and sternal deformities
20. Teratoma (sacrococcygeal) and other tumors of the newborn
21. Umbilical anomalies including hernia, patent urachus, patent omphalo-mesenteric duct
22. Undescended testes

Many of these neonatal surgical problems are very rare, occurring in 1 in 5,000 to 1 in 25,000 live births. Pediatric surgeons have specialized training in treating these conditions, thus affording your baby the best possible outcome.

Neonatal Cardiothoracic Surgery

The goal of surgery in the neonatal period is complete repair of the heart defect whenever possible. Examples of some congenital defects that complete repair is offered for include:

  • Transposition of the Great Arteries

    In the normal heart, the right side of the heart pumps ‘blue’ blood (un-oxygenated) from the body to the lungs through the pulmonary artery (main artery to the lungs), while the left heart pumps “red” blood (oxygenated) from the lungs to the body through the aorta (main artery to the body).In the normal heart, the right side of the heart pumps ‘blue’ blood (un-oxygenated) from the body to the lungs through the pulmonary artery (main artery to the lungs), while the left heart pumps “red” blood (oxygenated) from the lungs to the body through the aorta (main artery to the body).
    In this defect, the position of the main vessels to the lungs and body is reversed so that the aorta arises from the right side of the heart and the pulmonary artery form the left side of the heart. The consequences of this reversal are severe, since blood which has gone to the lungs to pick up oxygen is not pumped to the body as it should be, but instead returns to the lungs. The only way blood with oxygen can reach the body is by passing through a hole between the upper collecting chambers and mixing with the “blue” blood.The surgeons perform an arterial switch procedure for this anomaly, which connects the aorta to the left ventricle and connects the pulmonary artery to the right ventricle.

  • Coarctation of the Aorta
    Coarctation of the aorta is defined as a narrowing of the upper thoracic aorta. To repair this defect, the aorta is clamped on either side of the narrowing, the segment of narrowing is removed, and the two ends of the aorta are sewn together.Coarctation of the aorta is defined as a narrowing of the upper thoracic aorta. To repair this defect, the aorta is clamped on either side of the narrowing, the segment of narrowing is removed, and the two ends of the aorta are sewn together (end to end anastomosis). The two ends of the segment may also be joined using a graft

  • Total Anomalous Pulmonary Venous Return
    In the normal heart, pulmonary veins carry oxygenated blood from the lungs to the left side of the heart (left atrium), which pumps the oxygenated blood to the body. In a heart with TAPVR, the pulmonary veins connect to the right atrium, where the oxygenated blood mixed with the un-oxygenated blood through a hole in between the left and right atria.In the normal heart, pulmonary veins carry oxygenated blood from the lungs to the left side of the heart (left atrium), which pumps the oxygenated blood to the body. In a heart with TAPVR, the pulmonary veins connect to the right atrium, where the oxygenated blood mixed with the un-oxygenated blood through a hole in between the left and right atria. The mixed blood does not provide enough oxygen for the entire body.
     The surgical repair of anomalous pulmonary veins involves the redirection of the abnormal veins to the left atrium, usually by connecting them directly to the back wall of the atrium.
  • Truncus Arteriosus

    In the normal heart there are two main vessels leaving the pumping chambers: the aorta, which carries blood to the body from the left side; and the pulmonary artery, which carries blood to the lungs from the right heart. In the defect known as Truncus, the two main vessels are fused into one large channel into which both pumping chambers empty.

Other Neonatal Surgery

Children born with single ventricle offer complex challenges, such as hypoplastic left heart syndrome. Other types of neonatal surgery include valve disorders and other complex disorders.

  • Hypoplastic Left Heart Syndrome
    HLHS is a severe congenital heart defect in which the left side of the heart does not develop during pregnancy. This means the left ventricle (the pumping chamber that sends blood to the body) and the aorta (the main artery that carries the blood to the body) and the mitral and aortic valves are very small and cannot support life. 
    HLHS is a severe congenital heart defect in which the left side of the heart does not develop during pregnancy. This means the left ventricle (the pumping chamber that sends blood to the body) and the aorta (the main artery that carries the blood to the body) and the mitral and aortic valves are very small and cannot support life. Surgical repair requires three stages to enable the single working chamber to do the work of two ventricles. The first stage, the Norwood I procedure is typically performed within the first 2 weeks of life. The second stage, the bi-directional Glenn, is typically performed before the infant is 6 months old. At two to three years old, the third, and final stage – the Fontan operation is completed.Rarely, the staged approach cannot be performed on an HLHS heart, and a Heart Transplant is performed.
  • Ebstein’s Anomaly
    In a normal heart, the tricuspid valve controls blood blow from the right atrium to the right ventricle. When a person has Ebstein’s anomaly, the leaflets of the tricuspid valve are not formed correctly, and the valve is located lower than normal.
    In a normal heart, the tricuspid valve controls blood blow from the right atrium to the right ventricle. When a person has Ebstein’s anomaly, the leaflets of the tricuspid valve are not formed correctly, and the valve is located lower than normal.The leaflets do not control the blood flow properly, resulting in a right ventricle that is too small, and a right atrium that is too large. There are varying degrees of severity of Ebstein’s anomaly, and there is usually an atrial septal defect.

    For more information please visit www.medsurgeindia.com  or email us at info@medsurgeindia.com dushyant.magu@medsurgeindia.com  you can also follow us at LinkedIn: http://www.linkedin.com/profile/edit?trk=hb_tab_pro_top  Follow us on Twitter: http://twitter.com/#!/MedSurgeIndia

    To get free no obligation quote kindly contact us at :

    UK : +44-2033185974

    USA/Canada(Toll Free): +1-855-773-3245

    Germany: +49-89120895003

    India: +91-9654742998

    Skype: dushyantmagu

    BB PIN: 24E4EC5B

     

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