The sub specialty of surgery which involves surgery of fetuses, infants, children adolescents and young adults is known as pediatric surgery. The surgeons who deal with these surgeries are known as pediatric surgeons. It is to be noted that pediatricians cannot perform surgeries on adults and vice versa. Surgical problems solved by pediatric surgeons are quite different from those commonly seen by general surgeons. Special training is required by a pediatric surgeon. Common pediatric diseases that may require surgery include –
1. Separation of conjoined twins.
2. Chest wall deformities like pectus excavatum. In this condition, the sternum and rib cage grow abnormally which produces a caved-in or sunken appearance of the chest.
3. Abdominal wall defects such as omphalocele, gastroschisis, hernias etc.
4. Congenital malformations which are present since birth regardless of the cause. They may cause physical disability, intellectual disability or developmental disability.
5. Childhood tumors like neuroblastoma, wilms tumor, rhabdomyosarcoma, ATRT, liver tumors, teratomas etc.
There are two sub specialties of pediatric surgery –
1. Neonatology – Neonatology is a subspecialty of pediatrics that consists of the medical care of ill or premature newborns. Majority of the patients of neonatologists are newborn infants who require special medical care due to prematurity, low birth weight, sepsis, birth asphyxia, pulmonary hypoplasia etc.
2. Fetal surgery – This is a range of surgery that is used to treat birth defects in fetuses who are still in the pregnant uterus. In open fetal surgery, complete opening of the uterus is there. In minimally invasive fetoscopic surgery, small incisions are made and is guided by fetoscopy and sonography.
There are different types of pediatric surgeries which are performed. Some of the common ones are –
1. Kasai procedure – it is the preferred treatment for biliary atresia. Biliary atresia is a childhood condition which affects our liver. In this condition, one or more bile ducts are narrow or absent. Due to this, the green and brown liquid which is formed by the liver does not empty from the liver. In this procedure, surgeons first remove the damaged ducts outside of the liver. A small segment of the patient’s own intestine is used to replace the ducts at the spot where bile is expected to drain.
2. Appendectomy – it is a surgical method to get rid of appendicitis. If left untreated, it can rupture the appendix. The diagnosis of appendicitis is done with the help of an ultrasound study and occasionally a special X-ray called a CT scan. Laparoscopic appendectomy is increasingly being favored. In this type of procedure, there is lower wound infection rate, shorter length of stay and faster return to daily activities.
3. Gastroschisis repair – gastrochisis is a congenital condition in which a baby’s stomach protrudes out of the body due to an opening in the baby’s abdomen. The goal of this procedure is to place the organs back into the baby’s belly and fix the defect. Right after the birth, the intestine that is outside the belly is placed in a special bag and unhealthy parts are removed. The healthy edges are stitched together.
4. Posterior sagittal anorectoplasty (PSARP) – PSARP, also known as pull through procedure is a surgical technique used to correct a variety of anorectal and cloacal malformations. This surgery is needed when child’s ability to have a normal bowel movement is blocked. The exact type of PSARP procedure depends on if the defect is high or low.