Paediatric Surgery

The thought of a child going through surgery is a matter of concern for every parent. However, it is a fact that most of children go through surgery better than adults.

Surgery in newborns – why?

Because, 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 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 a surgery will not only make them look better but also help them face the world with greater confidence.

Surgery in older children – why?

Because, some problems that babies are born with 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. 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 appendicitis and hernia.

Irrespective of the reason for surgery, gentleness and special care are always needed in the surgical treatment of children.

Can anomalies be detected antenatally?

Definitely. Approx 3-4% newborn babies have congenital malformations. Antenatal screening for detection of anomalies in the unborn child is being done at the AFCC (Advance Fetal Care Centre).  Congenital malformations can be anatomic, metabolic or genetic abnormalities. AFCC provides comprehensive care, in the form of a multidisciplinary approach to counsel the parents adequately and accurately, so that an appropriate decision can made during pregnancy. Kokilaben Dhirubhai Ambani Hospital being the tertiary care centre (with full time consultants) is geared to handle the toughest challenge with its impeccable patient care coupled with the state of the art infrastructure.

Circumcision: is it really necessary?

Phimosis is a common pediatric urological disorder. Existing scientific evidence demonstrates 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 childs 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 fibrosis with resultant narrowing of the prepuce and dysuria, which may require surgical correction.

We now have preputioplasty as an alternative surgical procedure to circumcision. Preputioplasty helps release of the narrowed preputial opening without sacrificing the prepuce itself.

Undesecended 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 mths to one year of age. However the boys who have a symptomatic hernia associated with a testicular descend are advised surgery at the earliest to avoid the potential risk of torsion or irreduciblity.

Is key-hole surgery (laparoscopy) safe in children?

Laparoscopy is safe in children provided it is performed by specially trained surgeons, nursing staff with well equipped infrastructure. Infact 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.

I am 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 is the answer to most of the cases.

However, one needs to rule out the possibility of Hirschsprung’s disease in a 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 pullthrough (scarless surgery). Endoanal pullthrough entails removal of the diseased (aganglionic) colon entirely by the anal route and thus the childs abdomen remains untouched.

Is it safe?

Surgery in children is fairly safe when:

• Done by specially trained surgeons and anaesthetists
• Performed in centres/hospitals that routinely perform such surgeries
• The nursing staff, the anaesthetist 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.

Is surgery really necessary for children?

Your doctor will have advised surgery in view of the symptoms or the potential complications which your child is likely to suffer from. Many of these operations may be necessary to help your child grow normally.

What is the ideal age for surgery in children?

Different conditions have a different recommended age 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.

Will it be very painful for the child?

Every effort is made to minimise the physiological trauma of surgery for the child and also reduce post operative pain.

Most operations will require the child to be asleep during surgery, so sedation or general anaesthesia will be needed. For most routine surgeries, the child will be free from pain a day or two after the operation.

Will my child need to be hungry for too long?

General aneathesia requires the child to fast for a few hours before and after anaesthesia. Expect 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.

Will we need to keep the child tied to the cot after the surgery?

It is very difficult to keep children in the bed if they do not have pain or discomfort. Therefore, for most operations, the paediatric 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.

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 hospitalisation. 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.

Who are paediatric surgeons?

Paediatric surgery is a super specialisation of general surgery. It involves specialised training 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.

How is paediatric surgery different from adult surgery?

Many of the operations performed by paediatric 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.

Paediatric 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 an expertise in this field.

Is it necessary to use aneasthesia during surgery?

Most surgeries in children require general anaesthesia 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 manoeuvres

With well-trained anaesthetists, newer drugs and the evolution of more advanced techniques in paediatric anaesthesia, children are able to tolerate anaesthesia almost as safely as adults.

• Surgical Faculties
• Paediatric General Surgery
• Surgery in Premature and Newborn Babies
• Paediatric Urology and Cystoscopic Surgery
• Genital Reconstructive Surgery
• Thoracoscopy and Chest Surgery
• Laproscopy and Surgery of the Gastrointestinal System
• Bronchoscopy
• Paediatric Orthopaedic Surgery
• Paediatric Neurosurgery
• Day Care Hypospadias Surgery
• Paediatric Endo-Urology

• Liver, Biliary system and Pancreatic illnesses in children are on the rise, primarily because of changes in the lifestyle, activity and diet in children which has seen a rapid shift in the last decade.
• Surgery of the Liver Biliary & the Pancreatic System is one of the most challenging surgeries amongst children and can range from reconstructive surgeries for congenital defects of the Biliary system like Choledochal Cyst to a complex Liver resection due to Tumors or cancers and Pancreatic Bypass for Chronic Pancreatitis.
• Traditionally and even till this day majority of the centres in India and abroad do these surgeries in an open manner which entails a large inverted V shaped incision on the abdomen of the child.
• Leaving the trauma of the scar aside, the big incision itself leads to prolonged pain and delayed recovery in the child. A typical recovery from an open surgery can take up to 3 weeks.
• At the Department of Pediatric Surgery at Kokilaben Dhirubhai Ambani Hospital we do these surgeries through Minimal Access Technique.
• Popularly called as key-hole surgery, we are currently the only centre in India who are offering the entire range of Liver, Biliary & Pancreatic System Surgeries to be done in children.
• Minimally Invasive Liver, Biliary & Pancreatic System Surgery can be performed either Laparoscopically or with the help of the Robot.
• Robot Assisted Liver Surgery is the latest and the most cutting edge technique available at only a handful of centres around the world. The entire surgery is performed through tiny 5 mm incisions on the abdomen of the child. Such small incisions do not entail any damage to the muscle and consequently leads to minimal pain after surgery. Lack of major pain leads to early mobilisation of the child after surgery and also faster recovery and reduced hospital stay.
• So if your child is suffering from a Liver, Biliary or a Pancreatic System disease, do get an opinion from us for a Laparoscopic or a Robotic Surgery for the same.
• In Fact, Kokilaben Dhirubhai Ambani Hospital is the only Centre for Pediatric Robotic Surgery in Western India and also the only Centre in India to have done a Robotic Liver Resection in Children.

Hypospadias as a clinical entity and as a surgical problem has beguiled the surgeons and the patients since time immemorial. Traditionally Hypospadias surgery has had poor success rates and over the years it has been accepted that the treatment of Hypospadias should be done by a Surgeon Specializing in Hypospadias Surgery, namely a Hypospadiologist. Even now the surgery for Hypospadias in India involves a minimum of 7-10 days of Hospital stay even in the best of centres.

At Kokilaben under the able hands of Dr. Gursev Sandlas we have developed a new technique of Catheterless Hypospadias surgery. The technique is unique in that no stent or catheter is placed in the Patient after surgery which ensures painless faster recovery. Typically a hypospadias patient goes home the same day or the next day. It has been possible because of changes in the technique of traditional hypospadias repair thus optimizing the surgical repair and ensuring successful repairs everytime. Our complication rate of 1% is amongst the lowest in the World.

So if your child has been advised a Hypospadias Surgery, do drop in for a Second opinion. Our specialized Hypospadias Clinic will ensure a wonderful experience and a faster uncomplicated recovery for your child.

Though uncommon in the past, kidney and bladder stones in children have shown an exponential increase in incidence in the past decade. This could be attributed to changing life styles as well as dietary patterns to a large extent. Traditionally due to lack of equipment and expertise most of the kids were offered an open surgical procedure for the removal of these stones.

At the Dept of Paediatric Urology at Kokilaben Ambani Hospital under the able guidance of Dr. Gursev Sandlas, we offer state of the Art solutions for Stones in the form of Paediatric Endo-Urology.

Endo-Urology basically involves use of sophisticated telescopes that are introduced through the natural orifices of the urinary tract for removal of stones. This technique ensures no external cuts on the body which translates to faster and pain free recovery for the child. Typically it is a day care procedure with a majority of children going home the same day having been relieved of their stone problem in the best possible way.

If your child has been diagnosed with kidney or bladder stones and surgery has been recommended, it's advisable to consult a pediatric surgeon in Indore. The Department of Pediatric Urology at Kokilaben Ambani Hospital offers advanced non-surgical solutions for such conditions.

• Antenatal Counselling for Foetal Malformations
• Spina Bifida Clinic
• Nocturnal Enuresis Treatment
• Treatment for Incontinence

• State-of-the-art Intensive Care Units
• Transport facilities to the hospital
• Experienced anaesthetists
• Child-friendly, stress-free environment