Pediatric surgery

Services offered

The Pediatric Surgeons perform a wide variety of surgical procedures in the following categories (lists are inclusive but not entirely exhaustive)

Trauma

The Pediatric Surgery service is consulted immediately for any pediatric trauma victim with serious and/or multiple injuries. The service will coordinate the trauma work-up, consult the appropriate subspecialty services, perform any necessary general surgical procedures, and coordinate care in the hospital. The service maintains a constant presence and therefore, an easily recognizable source of information for families and caretakers.

Tumors/Oncology

The Pediatric Surgery service is intimatbly involved with the management and performs surgery for surgical childhood malignancies. These include Wilms' tumor,

Head and Neck

The Pediatric Surgery service addresses a variety of conditions in the head and neck including branchial cleft anomalies and remnants, thyroglossal duct cysts, cystic hygroma / lymphangioma, abnormal/enlarged lymph nodes, neck masses, dermoid and sebaceous cysts, torticollis.

Lymph Node

The Pediatric Surgery service evaluates and surgically treats enlarged and infected lymph nodes when appropriate from a variety of conditions which include infections ( atypical mycobacteria, tuberculosis, staphylococcus, streptococcus, and a variety of other bacteria) , tumors (Hodgkin and non-Hodgkin lymphoma, metastases from other primary tumors), and idiopathic enlargement.

Endocrine

The Pediatric Surgery service evaluates and treats disorders of the thyroid gland, parathyroid glands, adrenal glands (adrenal tumors, hyperfunctioning and hypofunctioning gland, pheochromacytoma), pancreas (cysts and pseudocysts, hyperinsulinism, islet cell adenoma, tumors).

Breast

The Pediatric Surgery service evaluates and treats benign lesions of the breast in males (gynecomastia, breast enlargement, infection, congenital anomalies) and females (fibroadenoma, infection, inflammation, cysts, congenital anomalies). Endocrine evaluation is obtained when needed.

Neonatal Surgery

We, as pediatric surgeons, are expert in the surgical care of newborns. Management of neonatal surgical problems actually defines, in large part, the specialty of "pediatric surgery". It is what separates us from adult general surgeons who may operate on children but who do not have the expertise in treating newborn surgical problems. Not only is the actual surgical procedure important, but the pre-operative preparation and post­operative management is critical for a successful outcome. We work closely with our neonatology colleagues to optimize the management and outcome in our patients.

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

• Abdominal wall defects including gastroschisis, omphalocele, and Pentalogy of Cantrell

• Biliary atresia and choledochal cyst

• Cloacal exstrophy

• Conjoined twins

• Cystic adenomatoid malformation of the lung and other types of bronchogenic cysts

• Cystic hygroma and other neck masses

• Diaphragmatic hernia

• Duplication cysts and mesenteric cysts

• Esophageal atresia with or without TE fistula (TEF)

• Gastroesophageal reflux and hiatal hernia

• Hirschsprung"s disease (megacolon)

• Hydrometrocolpos and imperforate hymen

• Imperforate anus including persistent cloaca

• Inguinal hernias

• Intestinal obstruction including duodenal atresia, annular pancreas, malrotation, midgut volvulus, intestinal atresia, meconium ileus and meconium peritonitis

• Necrotizing enterocolitis

• Ovarian cysts

• Pyloric stenosis

• Ribcage and sternal deformities

• Teratoma (sacrococcygeal) and other tumors of the newborn

• Umbilical anomalies including hernia, patent urachus, patent omphalo-mesenteric duct

• 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.

Thoracic

The Pediatric Surgery service evaluates and treats a variety of congenital and acquired thoracic disorders. These include congenital diaphragmatic hernia, diaphragmatic eventration, mediastinal cysts and tumors, bronchogenic cysts, enlarged lymph nodes, pulmonary sequestration, cystic adenomatoid malformation (CAM), lobar emphysema, empyema, tracheal and bronchial malacia, pneumothorax, chylothorax, primary and the metastatic tumors of the lung, aberrant great vessels, vascular rings and slings, esophageal duplication cysts, esophageal atresia and tracheoesophageal fistula (TEF), Repair of esophageal atresia and tracheoesophageal fistula (TEF) by thoracotomy & post­operative barium swallow study showing good anastomotic patency congenital and acquired strictures of the esophagus, esophageal foreign bodies, esophageal rupture and perforation.

Open Thoracotomy ­Operative pictures of cystic adenomatoid malformation (CAM), lobar emphysema

Abdominal Wall

The Pediatric Surgery service evaluates and treats a variety of congenital abdominal wall defects including gastroschisis, omphalocele, and Prune Belly syndrome.

Hernias

The Pediatric Surgery service evaluates and treats a variety of hernias including inguinal, umbilical, epigastric, ventral etc.

Gastrointestinal

The Pediatric Surgery service evaluates and treats a wide variety of congenital and acquired gastrointestinal disorders. Conditions include pyloric stenosis, esophageal reflux, peptic ulcer, congenital duodenal obstruction (duodenal atresia, stenosis, web, annular pancreas), atresia and stenosis of small and large intestine, meconium ileus, Meckel diverticulum, intussusception, malrotation, intestinal obstruction from small bowel atresia intestinal obstruction from tumor or adhesions, short bowel syndrome, intestinal duplication, mesenteric and omental cysts, ascites, polypoid diseases of the intestinal tract, necrotizing enterocolitis (NEe), appendicitis, Hirschsprung"s disease, imperforate anus, and tumors of the abdomen and intestine, among others. A child with Down's syndrome & duodenal atresia-duodeno-duodenostomy done Laparoscopic techniques are used when appropriate.

Liver and Biliary Tract

The Pediatric Surgery service evaluates and treats conditions of the biliary tract including jaundice of the newborn, biliary atresia, choledochal cyst, diseases of the gallbladder (gallstones, cholecystitis), common bile duct obstruction, liver cysts and tumors, liver hemangioma, portal hypertension

Pancreas

The Pediatric Surgery service evaluates and treats conditions of the pancreas including cysts, pseudocysts, pancreatitis, neoplasms, hyperinsulinemia, islet cell adenoma.

Spleen

The Pediatric Surgery service evaluates and treats conditions of the spleen including splenomegaly and hypersplenism from a variety of hematologic disorders (sickle cell anemia, hereditary spherocytosis, Gaucher"s disease, idiopathic thrombocytopenic purpura (ITP), thrombotic thrombocytopenic purpura (TTP), thalessemias, autoimmune hemolytic anemias), cysts, tumors, and abscesses.

Genitourinary

The Pediatric Surgery service evaluates and treats undescended testicles, testicular torsion, labial fusion, clitoral hypertrophy, ambiguous genitalia, Prune Belly syndrome. The service regularly performs circumcision procedures as well.

Soft Tissue

The Pediatric Surgery service treats and evaluates congenital and acquired defects of the skin and soft tissue including cysts, nodules, pigmented lesions/nevi, hemangioma, lymphangioma/cystic hygroma.

Minimally Invasive Surgery(Laparoscopy, Thoracoscopy , Endoscopy}

The Pediatric Surgery regularly uses a variety of endoscopic techniques to evaluate and treat conditions of the chest (thoracoscopy), abdomen (Iaparoscopy) and urinary tract ( cystoscopy).