Pediatric surgery is a surgical discipline that deals with the diagnosis and treatment of surgical and urological problems of children from birth to 16 years of age. It deals with the whole digestive and respiratory system, pediatric gynecology, chest, head and neck oncology, trauma and endocrine surgeries except the surgeries involving the heart. Pediatric surgery is a branch of medicine which employs technologies includes laparoscopic and thoracoscopic interventions as well as diagnostic and interventional endoscopic applications, anomalies known before birth or occurring after birth are also treated by pediatric surgery specialists. Unlike normal surgery, this department specializes in pediatrics; works with many departments such as neonatal unit, intensive care, oncology and traumatology. Physicians specializing in this field receive 6 years of specialization training on pediatric surgery after 6 years of medical school.
What is Pediatric Surgery?
Pediatric surgery is a branch of science that deals with the diagnosis and treatment of many different conditions that develop due to diseases and traumas acquired in childhood, as well as prenatal anomalies. Since people will live the results of the surgical intervention in childhood for a lifetime, extra care should be taken in order to not harm the patients development, taking into account their physiology and psychology health. Since the hormonal regulation has just begun in newborn patients, their metabolism is different from that of children and adults. Due to the fact that their immune systems are not yet developed, their resistance to infections is low. In child patients, unlike adults, cell division is achieved for physical and mental growth rather than reproductive purpose. Children and infants, are much more resistant to physical trauma, as the rapid cell division shortens the recovery period compared to adults and elderly patients.
Pediatric Surgical Diseases
In addition to inpatient and outpatient treatment of burns, pediatric surgery deals with many conditions such as traffic accidents, falls and similar traumas, abdominal and chest traumas caused by cutting and piercing tools, shaken baby syndrome. It also deals with the following diseases:
Digestive System: Esophageal strictures, corrosive esophagitis, diseases caused by drinking flammable and caustic substances, gastric strictures, obstruction and ulcer, gastroesophageal reflux, small intestine obstructions, presence of polyps, inflammatory bowel diseases, megacolon, Hirschsprung’s disease, many other diseases such as constipation, rectal tears and fistula formation, hemorrhoids, inguinal and umbilical hernias, liver cysts, abscesses and tumors, pancreatic cysts and tumors are among the childhood diseases that may require surgical intervention.
Respiratory System: Diseases that develop due to lung infection, trachea diseases, removal of foreign bodies that have lodged into the trachea and other bronchoscopic procedures, thoracic deformities known as barrel chest and pectus excavatum are respiratory diseases that are in the specialty of pediatric surgery.
Cancer Diseases in Childhood: Kidney, lung, liver, ovary, testis, lymph node and soft tissue tumors, as well as other tumors originating from nervous tissue, require multidisciplinary approach in pediatric surgery.
Surgical Treatment of Hormonal Diseases in Children: Deals with the diagnosis and treatment of thyroid gland, pancreas and adrenal gland diseases.
Head and Neck Surgery in Children: Congenital and acquired neck cysts and sinuses are specialty of pediatric surgery.
Neonatal Surgical Conditions
Diseases transmitted genetically during the development of the fetus, anomalies resulting from deformities, environmental factors, drugs used during pregnancy, and deformities and dysfunctions that occur as a result of late pregnancy may cause diseases requiring pediatric surgery in newborns. The incidence of these congenital anomalies in the society is between 3% and 5%. These diseases can be put under the following headings:
- Anorectal Malformations: These are the problems seen in the last part of the digestive system, the intestines, genital system, urinary tract and the last part of the large intestine known as the rectum. These are diseases that occur as a result of pathology of the rectum and anus, which must be separated from the urinary tract in the first 3 months of the baby's life in the uterus, not developing as they should requires surgery. Diagnosis is made by physical examination after birth, as well as ultrasound and direct radiography when deemed necessary. These diseases can be listed as stenosis of the anus, anterior anus, closed anus with a membrane, the rectum, defined as the last part of the large intestine, not joining with the anus, and the union of the rectum with the urinary tract, also known as fistula.
- Congenital Duodenal Obstructions: Most intestinal obstructions occur in the area known as the duodenum. Pathologies found in this region are mostly manifested as duodenal atresia. The diagnosis of duodenal atresia in which the only treatment option is surgical operation is made by radiological imaging. In this situation, which requires an emergency surgery, the closed parts are removed and the intestinal system works.
- Exstrophy Cloaca: In the 4th to 5th week of the baby's life in the womb, the end of the urinary, genital and digestive system is in a space called the cloaca. This space is divided into two in the 6th week of development and becomes two separate spaces, one at the front and one at the back. In people where division does not occur, the anterior wall of the abdomen does not close, known as cloaca exstrophy. Many structural defects such as closure of the anus, absence or shortness of the intestine, urinary system disorders may accompany.
- Exstrophy Vesica: This congenital anomaly, which is defined as the bladder being outside at birth, is seen 3 times more in boys than in girls. The inner part of the posterior wall, which does not have an anterior surface of the bladder, opens directly outward from the region known as the pubic region. Most patients also have an inguinal hernia. Usually, surgical treatment consists of more than one operation.
- Gastroschisis: Gastroschisis, one of the two most common congenital abdominal wall defects, is seen in approximately one in 2500 births. It is the external presence of the intestines and in some cases the stomach, rarely the urogenital structures located in the abdominal opening on the right side of the umbilical cord. The intestines are edematous and short.
- Omphalocele: Another of the abdominal wall defects, omphalocele occurs in approximately one in 5000 births. Internal organs such as the small intestines, colon, spleen and liver that should be located in the abdomen are located outside the anterior abdominal wall in a sac.
- IHPS: This condition, which is defined as infantile hypertrophic pyloric stenosis, manifests itself when the baby, who can feed normally for 2 to 4 weeks after birth, starts vomitting after feeding. The narrowing of the passageway from the stomach to the small intestine prevents the passage of food into the intestine. This disease, which is thought to be influenced by genetic and environmental factors, is more common in boys than girls. The pyloric muscle is measured and examined by abdominal ultrasound. When necessary, imaging is performed with barium radiography.
- Jejunoileal Atresia: It is a condition that occurs as a result of structurally inadequate formation of a part of the small intestines of the baby in the mother's womb due to vascular reasons. It is characterized by increasing swelling in the baby after birth, inability to defecate and vomiting. Diagnosis is made as a result of radiological imaging. The clogged area in the intestines is removed by intervention by the pediatric surgeon. Intestinal continuity is ensured by connecting healthy sections.
- CDH: Congenital diaphragmatic hernia is a type of hernia that occurs due to an opening in the diaphragm muscle. Often the intestines, rarely the liver and spleen can herniate. The only treatment option for CDH, which is a life-threatening condition, is surgery.
- Meconium ileus: Ileus, which is encountered in every 12 thousand births, is a type of obstruction in the intestines. It occurs when meconium, the baby's first stool, sticks to the intestine. The baby presents with symptoms such as abdominal distension and vomiting. By making an enema with urography, the meconium causing the obstruction is emptied and the intestines are completely opened. If the obstruction cannot be removed by this way, surgical operation is required.
- Esophageal Atresia: In esophageal atresia, which is defined as the congenital closure of the esophagus, a part of the esophagus is not formed. Often there is a connection with the trachea. In this situation where feeding is not possible, the only option is surgery.