More than 4 years ago, I (Pediatric surgeon - Dr.Kshama.Kulkarni-Wakankar) participated in a chat arranged by a MNC in Chennai. I was astonished to see a great response from parents and the enthusiasm to keep them updated about the surgical care for their children.
I was hoping a similar or even better awareness in Pune, being a IT Hub, but unfortunately, many people haven’t even heard of pediatric surgery, and to my surprise they aren’t even aware that someone like a Pediatric surgeon exists! I want to share with you my views in order to create more awareness in the society about the pediatric surgery and surgical problems in children, how to know these surgical issues and handle them without getting panicked.
Q. What is pediatric surgery and who is a pediatric surgeon?
I am sure u all know cardiac surgeon, plastic surgeon, Urosurgeon etc. A pediatric surgeon is also a super specialist like them. To become a pediatric surgeon, we first undergo a training(postgraduation) in general surgery (MS- Masters of surgery), which is a 3 years course after MBBS (5 half years after HSC)
After MS general surgery, we again have to give entrance exam, and then we choose super specialization subject, which can be urosurgery, neurosurgery, cardiac surgery, plastic surgery or Pediatric surgery.
This course is called M.Ch (Magistrate Chirurgiae), which is again a 3 years rigorous course where we are trained in performing operations in children, from newborn to 18 years of age(nowadays even we operate on fetuses within womb).
Q. Are operations in children safe?
Yes, of course, if carried out in safe hands – i.e by a Pediatric surgeon, who is trained in handling children and is updated with the physiology of children. They know exactly whether your child really needs surgery or can be treated without it, at what age is it better to do that surgery, and how to manage your child better.
Q. Why should we consult a Pediatric surgeon?
"A child is not a small adult"…. everything is different in a child and adult.
If your child is unwell, I am sure educated parents like you take him/her to a pediatrician and not a general practitioner (GP) or physician. Likewise if a surgical problem happens to your child, you as an educated parent should atleast have some knowledge which doctor to approach – that’s where a role of Pediatric surgeon starts.
Pediatrician is not a answer for every problem in your child. Many a times you might be misguided if your pediatrician is not updated with the surgical knowledge, and as they deal only with medical problems in children, so don’t expect them to be updated in surgery. (In your language, don’t expect a civil engineer to be updated in IT!!)
Q. When should a parent consult a pediatric surgeon?
We will start with very common surgical problems in children-
1.Any type of swelling /lump noticed anywhere on the body.
Eg: a. If you notice a swelling in groin region of both males/females of any age ,which appears on coughing or crying, and disappears again- it could be a INGUINAL HERNIA- Consult pediatric surgeon immediately.
b. Non-painful Scrotal swelling in your child- could be a HYDROCOELE- consult Pediatric surgeon
c. Acute painful scrotum in your son- could be a TORSION TESTIS- u can't waste time in such cases, needs immediate attention by only a Pediatric surgeon, or else your child will loose the testis!
d. Any redness, swelling, pus over body–could be an ABSCESS-needs surgical attention,rather than coming too late after your pediatrician has tried everything on your child.
e. Pain in abdomen-could be appendicitis, intestinal obstruction or just a constipation. All of these is dealt with by none other than a pediatric surgeon by his clinical judgment.
2. Any type of congenital problems in children- usually diagnosed either during pregnancy on sonography or later seen in newborn age. A pediatric surgeon starts counseling the, would be parents from pregnancy period onwards,so that the parents don’t panic after delivery, and are prepared both mentally and financially.
3. Any type of kidney and urinary tract related problems in your child.
Eg. a. Simple problem like the foreskin of your son is not going back/ some ballooning happening during urination at the tip of penis- could be PHIMOSIS- take opinion of Pediatric surgeon,if needed they will perform circumcision surgery.
b. Swelling of kidney (Hydronephrosis) noticed since antenatal period,and even at any age- could be some obstruction in the urinary tract- consult Pediatric surgeon,all urinary system anomalies in children are tackled by Pediatric surgeons.
c. Absent testis /testis not seen in scrotum of your son- needs attention before 3 months age,delay causes more harm.
d. Hypospadias- if the urinary opening is not at the tip of penis but proximal to it,surgery is best performed by a pediatric surgeon at 6 months age and best results are given.
4. Any accidents, burns, cuts,injuries to your child.
Eg- a. Children have a habit of putting everything in mouth, sometimes this goes into their windpipe, and they get choking episode,this is very dangerous. Emergency removal of such foreign body from bronchus is very essential,or else they can lose their life...and this is done by a pediatric surgeon only.
b. Falls during play, with cuts on face or body are very common. If you want a cosmetic and less ugly looking scar, go to the pediatric surgeon, they put absorbable sutures, from within, which don’t need removal, and don’t leave a scar.
c. Any accidents- injuries to chest, abdomen etc in children. Always handled by a pediatric surgeon, they know exactly whether your child needs surgery or can be managed by observation alone.
Burns in children- again a pediatric surgeon manages them, not a physician (pediatrician),so ask for the best for your child.
If you choose a wrong doctor and your child will undergo unnecessary xrays, CT scans and blood tests, and finally a pediatric surgeon will be called, after your child has lost the crucial time.So wake up parents!
5. Any cancers in children
Pediatric surgeon performs surgery for cancer in children- kidney cancer/liver/ neuroblastomas etc. So in short,any surgical problem in children,from head to toe,is managed by a pediatric surgeon.
Q. Will the child take more time to recover after surgery than adults?
Not at all, rather children start playing immediately after the operations. It’s always better to get them operated at the age which the pediatric surgeon suggests that’s the best time during which healing is better and risk is less. And with safe anesthesia these days, and also pediatric anesthetists available, it’s better to subject them to operation at appropriate age, rather than delaying and causing more complications.
Q. Will you give full body anesthesia to my child or only to the part?
This is a very common question asked by parents, and when I say full body(general anesthesia), they look quite worried. See, nowadays anesthesia has become very safe, in children, it’s better to give general anesthesia, and safer, rather we can’t perform many surgeries unless the child is anesthetized. Imagine performing operation in a crying, howling and moving child, its more dangerous.
So don’t worry, the pediatric surgeon knows better what your child needs!
Q.How many stitches after operation?
Again, a very common question asked, and the most funny to answer. We don’t count the sutures during surgery and it’s of least importance, the number of sutures doesn’t matter.
Nowadays, most of the times, we use only absorbable stitches in children, which are from within, no need to remove, and it will be a single suture form one end to other.
Many surgeons publish it as SUTURE LESS and the layman runs behind such advertisements!
Q. Will you do a keyhole surgery (laparoscopic) or you will take a cut?
With advances in medical field,we too are doing laparoscopic surgery in children. But mind you, even in laparoscopic surgery, we take cuts to put the ports for instruments, and then suture them back. People have a misconception that there won’t be any stitches after laparoscopic surgery. Laparoscopic surgery is good for cases like Appendectomy, gallbladder removal, absent testis, and some intestinal surgeries in children.
Some cases in children are better done and more cosmetic by open technique,so laparoscopy is not the answer for all cases. So believe what your pediatric surgeon suggests, and have faith in him/her. They can better judge your child’s problem than you, they are trained for that! I am sure; you still must be having many more queries, which I will be happy to answer on an individual problem basis.
Parents- it’s time for you to keep yourself updated, don’t go by everything that is given on internet on medical subjects (its half knowledge,and that’s more dangerous).
Nowadays we get many parents, who enter the consulting room with a list of queries, and more than that a list of articles read from internet and they feel they know more than their doctor!
Mind it, we as super specialists wouldn’t have spent 13-14 years studying a subject and understanding it, and still not having answers for some questions, which Google would have taught in half hour!
So believe and have faith in your doctor, and choose the best for your child.
MBBS,M.S(Gen.surg), DNB(Gen.surg),MRCS (England),M.Ch(Gold medalist)
Consultant Neonatal and Pediatric surgeon/pediatric urologist/laparoscopic surgeon
NOBLE HOSPITAL, HADAPSAR, PUNE- opd-wed/fri
DEENANATH MANGESHKAR HOSPITAL, PUNE-opd-mon/thurs
INAMDAR MULTISPECIALITY HOSPITAL, FATIMANAGAR, PUNE (by appt)
SAHYADRI HOSPITAL, HADAPSAR AND KALYANINAGAR (by appt)
MAI MANGESHKAR HOSPITAL, WARJE-opd-mon/thurs
COLUMBIA ASIA HOSPITAL, KHARADI, PUNE- opd-wed/ fri ( by appt)
JEHANGIR HOSPITAL, PUNE(by appt)
ADITYA BIRLA HOSPITAL, PUNE (by appt)
SURYA HOSPITAL(UPCOMING PROJECT), WAKAD,PUNE