Pediatric Surgery: Treatment, Effects & Risks

Pediatric surgery is a branch of surgery that transfers knowledge to be used on babies, children and adolescents. In part, pediatric surgery uses its own procedures and its own instruments; whenever possible, surgical procedures are performed as closely as possible to adult procedures.

What is pediatric surgery?

Pediatric surgery is primarily concerned with the diagnosis, surgical and conservative treatment, and follow-up care of surgically relevant pediatric conditions, treating people from infancy through adolescence. Pediatric surgery is very close to pediatrics. It is mainly concerned with the diagnosis, surgical and conservative treatment and aftercare of surgically relevant childhood diseases and treats people from infancy to adolescence. The treatment of pediatric surgery includes malformations, tumors, (accidental) injuries as well as the treatment of the unborn child in the prenatal phase. Pediatric surgeons treat the human being in a time window of his life, in which he partly still “functions” very differently than an adult human being. Pediatric surgery therefore requires far more in-depth knowledge of the organ system than adult surgery, since the specialist must know not only the organ structure itself but also the growth phase and conditions of the body part he or she is treating. Pediatric surgeons also deal with the interaction of different organs, their different healing and the consequences of surgical interventions on natural growth in childhood. Because urological problems are even more common in children than in adults, such as foreskin stenosis, urology plays a greater role in pediatric surgery than in a surgeon’s day-to-day work with adult patients. In addition, pediatric surgeons not only operate on their young patients, but also deal directly with babies, children and adolescents during diagnosis, preoperative and postoperative care, and therefore must also take into account a psychological component, since people of this age process interventions and diagnoses quite differently than adults.

Treatments and therapies

The most common cases in pediatric surgery are injuries and maldevelopments. Common injuries that can be treated with pediatric surgery include concussion and broken bones, and sports accidents also become relatively common beginning in kindergarten and elementary school. The pediatric surgeon is also called in to clarify symptoms typical of childhood, such as abdominal pain, since appendicitis can often be a trigger for the symptom in childhood. While young girls are less frequently referred to pediatric surgery for urological treatment, testicular displacements or treatment of a narrowed foreskin in boys are also still relatively common in pediatric surgery. At this point, the treatment spectrum crosses over into the urologic realm. Beyond these common cases, pediatric surgeons are involved in almost any condition that warrants a visit or stay in the hospital in infancy, childhood or adolescence. In rare cases, the pediatric surgeon is present during birth for immediate follow-up care of the newborn, or operates on an unborn child while still in the womb if it is too early to bring him or her into the world. Until the individual completes growth, he or she is considered a pediatric surgery case for diagnoses, surgical treatment, pre- and post-operative care, and may be followed by various other specialists as needed. Because pediatric surgery, unlike adult surgery, is often consulted earlier in the diagnosis process and takes on a larger share of treatment and follow-up, it requires such extensive expertise. A case of childhood cancer, for example, is treated by the oncologist with medication and by the pediatric surgeon with surgery as soon as the need arises. However, he or she is there from the moment the decision is made to proceed or not to proceed with a surgical procedure and has knowledge of the history of the disease in order to make an informed decision.

Diagnosis and examination methods

In many cases, pediatric surgery uses the same diagnostic and investigative procedures as adult surgery. To determine inflammatory and internal diseases, the first step is to take blood samples and tissue samples; in some cases, tissue must be removed surgically.The presence of marker substances can be used to identify whether inflammation is present at all, for example, and whether the pediatric surgeon needs to investigate further in this direction. Appendicitis, for example, is diagnosed by a combination of blood testing for inflammatory substances and an ultrasound image – this is enough to prompt surgical removal of the appendix. Less invasive are X-rays, CT scans, or MRIs, as well as follow-up ultrasounds. These imaging procedures are authoritative for confirming suspected diagnoses of internal diseases. Furthermore, anamnesis as well as simple palpation and the questioning of pain types and frequency are part of pediatric surgery – this sounds simple, but actually requires intuition on the part of the pediatric surgeon, since often not only the child alone can be questioned. Observation by the parents is also important, and the child’s statements are sometimes difficult to interpret the younger he or she is and the less able he or she is to express himself or herself due to his or her age. Abdominal pain in a very young child can mean anything from nausea with vomiting (typical of poisoning) to pulling in the lower right abdomen (warning sign of appendicitis). In all diagnostic procedures in pediatric surgery, it is important to remember that babies and young children in particular do not yet understand that these examinations are for their own good. It is therefore incumbent upon the pediatric surgeon to examine them as gently as possible and with as much vigor as necessary. In adolescence, pediatric surgical examinations already become easier because adolescents can understand what is being done to them right now and what it is for.