Common Cause For Surgery In Children
When it comes to medical procedures, surgery is often seen as a last resort. However, for some children, surgery may be necessary to address certain medical conditions or injuries. As a parent or caregiver, it’s important to understand the common reasons why children may require surgery and what to expect during the process.
In this blog, we will explore some of the most common causes for surgery in children and provide information to help you feel more informed and prepared.
A] Why Is Surgery In Newborns Necessary?
Some problems that babies are born with will not allow them to live if not tackled immediately. For e.g.: absent anus, incomplete development of the intestine, etc.
Some problems can even make them prone to infections that are life-threatening, while others will interfere with the normal development of the child. Some babies do not look normal. In these cases, performing pediatric surgeries will not only make them look better but also help them face the world with greater confidence.
B] Why Is Surgery In Older Children Necessary?
Because, some problems that babies are born with, such as hypospadias in child may show up later when children are growing up.
Some problems noticed at birth need to be treated immediately, these can be treated after children are a little older with the help of most common pediatric surgeries. There may be infections or other events that need surgical treatments. At times, children have diseases similar to adults, however, their diagnostic criteria and their management may be different from adults, like in cases of hernia or appendicitis.
Irrespective of the reason for surgery, gentleness and special care is always needed in the surgical treatment of children.
C] Can anomalies be detected antenatally?
Definitely. Approx 3-4% of newborn babies have congenital malformations. Antenatal screening for the detection of anomalies in the unborn child is being done at the AFCC (Advanced Fetal Care Centre). Congenital malformations can be anatomic, metabolic or genetic abnormalities and can be treated with common pediatric surgeries due to congenital conditions.
AFCC provides comprehensive care, in the form of a multidisciplinary approach to counsel the parents adequately and accurately, so that an appropriate decision can be made during pregnancy. Kokilaben Dhirubhai Ambani Hospital is a tertiary care center (with full-time consultants) that is geared to handle the toughest challenge with its impeccable patient care coupled with state-of-the-art infrastructure.
D] Circumcision: is it really necessary?
Phimosis is a common pediatric urological disorder. Existing scientific evidence demonstrates the potential medical benefits of newborn male circumcision; however, the present data are not sufficient to recommend routine neonatal circumcision.
In the initial years of a child’s life, squamous epithelium has no separation between the glans and the foreskin. As a result of this incomplete separation, the prepuce or foreskin may not be fully retractable until several years after birth. This is physiological phimosis and needs no treatment. However, there may be recurrent balanoposthitis resulting in fibrosis with resultant narrowing of the prepuce and dysuria, which may require surgical interventions in children.
We now have preputioplasty as an alternative surgical procedure to circumcision. Preputioplasty helps the release of the narrowed preputial opening without sacrificing the prepuce itself.
E] Undescended testis: when does one advise surgery?
Several clinical and histologic findings suggest the benefit of early therapy in improving fertility. In cryptorchid testes, the number of spermatogonia per tubule and the seminiferous diameter is higher in boys under the age of one year. Hence the present recommended age for surgery is between 8 months to one year of age. However, the boys who have a symptomatic hernia associated with a testicular descent are advised to undergo hernia surgery in children at the earliest to avoid the potential risk of torsion or irreducibility.
F] Is keyhole surgery (laparoscopy) safe in children?
Laparoscopy is safe in children provided it is performed by specially trained surgeons and nursing staff with well-equipped infrastructure. VATS (Video-Assisted Thoracoscopic Surgery) is now commonly used in the treatment of early thoracic empyema (post-pneumonia chest infection) to release the fibrinous peel encasing the lung parenchyma.
G] Should I be worried for my child with chronic constipation?
In today’s world, a lot of children present to us with dietary constipation. Proper diet and healthy eating habits are the answer to most cases.
However, one needs to rule out the possibility of Hirschsprung’s disease in the case of chronic constipation especially if the symptoms are present since birth. Traditional treatment options for a child included a multi-stage approach wherein the child is subjected to three surgeries and is left with a scarred abdomen.
However, we now have the option of endoanal pull-through (scarless surgery). Endoanal pull-through entails the removal of the diseased (aganglionic) colon entirely by the anal route and thus the child’s abdomen remains untouched.
Expert Pediatric Urology Care
Experienced Care for Pediatric Urological Issues
H] Some common questions and apprehensions which come to mind
1. Is it safe?
Surgery in children is fairly safe when:
- Done by specially trained surgeons and anesthetists
- Performed in centers/hospitals that routinely perform such surgeries
- The nursing staff, the anesthetist and the doctors performing the surgery are properly trained
Even keyhole surgery in small children is safe with the proper precautions. In general, the safety of surgery in children can be compared to the safety level when driving on a highway. If the driver is experienced, and the vehicle is well-maintained, then the chances of an accident are minimal.
2. Is surgery really necessary for children?
Your doctor will have advised the surgery in view of the symptoms or the potential complications which your child is likely to suffer from. Many of these operations such as laparoscopic appendectomy surgery and appendectomy surgery in children may be necessary to help your child grow normally.
3. What is the ideal age for surgery in children?
Different conditions have different recommended ages for surgery. Certain conditions like a hernia may look minor, but can lead to complications. It is better to perform surgery as early as possible in such cases.
Other problems may not have any harmful effects in the near future. Such operations can be planned after the child has grown a bit, or at the convenience of the family members.
4. Will it be very painful for the child?
Every effort is made to minimize the physiological trauma of surgery for the child and also reduce postoperative pain.
Most operations will require the child to be asleep during surgery, so sedation or general anesthesia will be needed. For most routine surgeries, the child will be free from pain a day or two after the operation.
5. Will my child need to be hungry for too long?
General anesthesia requires the child to fast for a few hours before and after anesthesia. Except in those cases where the surgery has been a major one, your child may be fed a few hours after surgery but your doctor will give you instructions for the same.
6. Will we need to keep the child tied to the cot after the surgery?
It is very difficult to keep children in bed if they do not have pain or discomfort. Therefore, for most operations, the pediatric surgeon plans his/her surgery and post-operative plan so that the child can sit up and even move around the house as soon as possible.
7. How can we improve a child’s preparedness for surgery?
If you are stressed, your child will perceive this. We encourage you to be well informed about all aspects of hospitalization. This will help you to allay your anxiety and will also help your child to cope.
For older children who can understand, it is best to prepare them for surgery by explaining the need for surgery and that it is required for their good health. It is not advisable to lie and trick children into surgery.
8. Who are pediatric surgeons?
Pediatric surgery is a super specialization of general surgery. It involves specialized training in pediatric surgical procedures which is given after fully qualifying as a General (Adult) Surgeon. This course is similar in duration to the course for heart surgery or brain surgery or plastic surgery.
9. How is pediatric surgery different from adult surgery?
Many of the operations performed by pediatric surgeons involve the correction of defects that a child is born with. These surgeries often require a different approach as compared to operations performed on adults. Besides, tissue in children keeps growing and the surgical procedure needs to account for the same.
Pediatric surgeons are much more than just technicians. They know about all the aspects of the disease which they are treating, including how to handle a child.
Operating on children is a very delicate procedure and requires special care and gentleness on the part of the surgeon. It is necessary for a surgeon to exclusively perform such delicate surgeries on a regular basis in order to develop expertise in this field.
10. Is it necessary to use anesthesia during surgery?
Most common types of pediatric surgery in children require general anesthesia that:
- Helps keep the children calm and quiet
- Avoids leaving the child with any bad memories about the procedure
- Avoids sudden movements the child may make, allowing the surgeon to complete delicate surgical maneuvers
With well-trained anesthetists, newer drugs and the evolution of more advanced techniques in pediatric anesthesia, children are able to tolerate anesthesia almost as safely as adults.
