Pediatric Surgical Care of Infants, Children and Adolescents

When parents, caregivers and children have to face upcoming surgical procedures, they often experience fear and anxiety which is daunting. We have a specialized team of child life advocates who help streamline care, as well as and provide guidance and reassurance for families and children who need upcoming surgeries and their parents and caregivers.

Through videos and tours, our patients, and families and caregivers can be guided and learn what to expect on the day of surgery. PThe parents, caregivers and patients are also comforted in that they are receiving care from the nation’'s leading surgeons as well as a team of other providers dedicated to maximizing the patient’'s experience and providing family- centered care.

Conditions We Surgically Treat

Head and Neck Surgery

●      Branchial cleft cyst: A branchial cleft cyst is a condition present at birth that develops in the neck. It is caused when fluid fills a space and causes a cyst in the neck or just below the jawbone. Treatment involves removal of the cyst.

●      Thyroglossal duct cyst: This is a mass or lump in the front part of the neck that is filled with fluid and extends to the back of the tongue and moves with swallowing. This can be treated by surgically removing the hyoid bone in the neck.

●      Cervical lymph nodes: Lymph glands in the neck may be enlarged. They sometimes need biopsy (removal for study) to rule out cancer or infection.

●      Neck abscess: Infants and children can develop a neck abscess just after a bacterial or viral infection. The infection can spread to the deep tissue spaces and may be treated with antibiotics. Occasionally these require surgical drainage.

●      Neck tumors: Most neck tumors in children are benign (noncancerous), such as neurofibromas. Occasionally cancerous tumors, such as lymphoma or neuroblastoma, may be found in the neck in children. These require surgical biopsy or resection (removal).

Breast Surgery for Children and Adolescents

●      Breast cyst: We treat adolescent patients with rare breast cysts. These generally do not require surgery, but may need aspiration.

●      Fibroadenoma: This is a common, noncancerous breast tumor that can occur in young girls and adolescents. These occasionally require surgical excision (removal).

●      Phylloides tumor: This type of breast tumor can be benign or malignant. It generally requires surgical resection (removal).

●      Gynecomastia: This condition is a hormonal imbalance that causes swollen breasts in boys. Although it usually resolves, severe cases may need surgery.

Chest Wall Conditions

●      Pectus excavatum: This is a condition in which the breastbone sinks into the chest. It typically worsens during the adolescent growth spurt. It is caused by a growth of the cartilage. Severe cases may require surgical correction. Our team often uses the Nuss procedure, a minimally invasive option for correcting severe pectus excavatum.

●      Pectus carinatum: This is a condition in which the child’'s breastbone protrudes outward. It occurs when the cartilage of the ribs grows more rapidly than the bones. Treatment involves bracing and physical therapy.

Thoracic Surgery in Infants, Children and Adolescents

●      Empyema: This is a a bacterial infection in the chest cavity often caused by pneumonia that may require drainage with a tube or a minimally invasive surgery called video-assisted thoracoscopic (VATS) drainage procedure.  

●      Pneumothorax: This condition occurs when air leaks between the lungs and the chest space. This often results in difficulty breathing and may be associated with blebs (small collections of air between the lung and the outer surface of the lung). When a bleb ruptures, air escapes causing a pneumothorax. This may require chest tube placement or surgical resection of the bleb.

●      Congenital lung lesions: These lesions (small growths) may be detected later in childhood. They are benign lung lesions, which may be cystic (fluid filled) or solid. They may enlarge and compress the lungs and other structures in the chest cavity or become infected. They generally require surgical resection to remove a portion of the lung that contains the lesion tissue.

●      Thoracic (lung) tumors and mMediastinal masses: The most common pediatric thoracic mass lesions include lymphoma, germ cell tumors, neurogenic cysts, foregut cysts, congenital pulmonary airway malformations, thoracic neuroblastoma, thymoma, seminomas, chest wall sarcoma and pleuropulmonary blastoma.The surgeon will often perform a biopsy or resection. Depending on the type of tumor, the patient may need multimodal adjuvant (medicinal) therapy.

Gastrointestinal, Abdominal, Abdominal Wall and Colorectal Surgery in Infants and Adolescents

Abdominal Wall Surgery:  

●      Inguinal hernia: An inguinal hernia is a bulge or a protrusion which can be seen and felt in the groin area near the scrotum or the labia. A hernia is present when an opening occurs in the abdominal wall through which a sac protrudes from the abdominal cavity through the abdominal wall. It is one of the most common procedures that we perform in children. It can be repaired through an open surgery or minimally invasive approach.

●      Umbilical hernia: This condition is a bulge or swelling in the belly button area. Many will go away on their own by the time the child reaches five years of age. For those that do not go away, surgery will be needed for repair.

●      Undescended testicle: This is a condition where the testicle has not moved into its proper position in the scrotal sac. Surgery is needed before 18 months of age to avoid problems with fertility and avoid the risk of testicular cancer. 

Abdominal Surgery

●      Appendicitis: This condition is an inflammation of the appendix, a finger-shaped pouch which projects from the colon. Prompt surgery is needed prior to the occurrence of perforation which results from a hole in the appendix that can leak infected contents into the body cavity. Surgery can be done through a minimally invasive approach with laparoscopy to remove the appendix.

●      Cholelithiasis and cholecystitis: The gallbladder is a small organ near the liver which stores bile. When stones develop in the gallbladder they can cause pain and inflammation. Surgery to remove the gallbladder (cholecystectomy) is done through a laparoscopic approach.

●      Conditions requiring splenectomy: A splenectomy is an operation to remove the spleen, which is an the organ on the left side of the body that which is an important part of the immune system and filters and stores blood. Surgery may be required if the spleen is injured, or the spleen may need to be removed for certain hematologic disorders (sickle cell disease, thalassemia and other blood conditions).

●      Intestinal obstruction: There are many causes of intestinal obstruction in children. One of the most common is due to adhesions from prior surgery. A laparoscopic procedure or laparotomy may be required to divide the adhesions and remove the blockage. Occasionally a segment of the intestine may need to be removed.

●      Malrotation and midgut volvulus: This condition is present at birth. The intestine becomes twisted, causing a blockage in the intestine or a condition, known as volvulus, where the intestine can twist upon itself and interfere with the blood supply of the intestine. This condition requires emergency surgery.

●      Meckel's diverticulum: This condition is caused by is a small pouch or diverticulum in the wall of the small intestine. It is the most common congenital condition of the gastrointestinal tract. It can contain cells from the stomach or the pancreas which can secrete acid and cause ulcers and bleeding. It can be attached to the belly button and the intestine can twist around it causing a blockage or it can become inflamed and perforate and lead to contamination of the abdominal cavity. Surgery is required to remove the Meckel's or a portion of the intestine that contains the ulcer.

●      Intestinal duplication: This condition is present at birth. It is a tube-like structure that can attach to any part of the intestine. An intestinal duplication has a similar lining as the gastrointestinal tract and shares the same blood supply. This condition can cause blockage, bleeding and perforation (holes in the organ walls). This condition may require emergency surgery.

●      Hirschsprung's disease: With this condition, a portion of the colon, the entire colon or the small intestine may lack nerve cells (ganglion cells). This can create a blockage of the intestine. Stool, intestinal contents and food do not move properly, which can cause constipation, abdominal distension (swelling outward) or an associated infection called Hirschsprung's enterocolitis infection. Surgical treatment generally involves a "pull through procedure," which removes the unhealthy intestine and connects the healthy intestine to the anus.

●      Intussusception: This is a condition where one segment of the intestine telescopes (slides into) into another, producing a blockage in the intestine. It is the most common cause of intestinal obstruction in children under three years of age. Treatment options include reducing the intussusception by barium enema or air enema (filling the rectum and bowel with water-soluble fluid or air). For some patients, surgery may be needed to treat the intussusception.

Colorectal Conditions

●      Crohn's disease: This belongs to a group of conditions, which are referred to as inflammatory bowel disease. It is a chronic inflammatory process most commonly affecting the end of the small bowel and the colon, but may affect any part of the gastrointestinal tract from the mouth to the anus. It can extend through one or more layers of the bowel. The condition may cause include bleeding, perforation (holes to form) and obstruction from narrowing of the intestine. Surgical treatment may benefit patients who have not experienced improvements with medical therapy or who develop complications associated with the disease.

●      Ulcerative colitis: This is a chronic inflammatory bowel disease that causes inflammation of the large intestine. It usually involves the innermost lining of the large intestine. The inflammation in the intestine is associated with abdominal pain, diarrhea and bloody stools. Complications of the disease include toxic megacolon, which results in severe dilation (widening) of the large intestine, bleeding , sepsis or perforation (small holes). Initial treatment is generally medical. Surgical treatment involves removal of the entire colon with construction of a pouch from the small intestine which is connected to the anus.

●      Perianal abscess: This condition occurs when pus (fluid) develops from an infection in the perianal area (in and around the anus). Treatment may include antibiotics, as well as surgical drainage to removedrain the pus.

●      Anorectal fistula: This is a connection between the anorectal canal and the perianal area skin. It creates an infected tunnel, which can drain pus. This can be treated by surgically removing part of the tunnel.

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