Pediatric surgery is a collection of surgical procedures performed to treat a variety of diseases in children, ranging from abnormalities of internal organs to tumors. Many differences are found in surgical procedures in children and adults. Therefore, doctors who handle pediatric surgical procedures are different from general surgeons.
Pediatric surgery developed in the mid-20th century, more precisely around the 1950s, where there were still many death threats in infants caused by certain diseases, but treatment and treatment were not yet available. Pediatric surgery only focuses on implementing procedures for handling diseases in children. Doctors who specifically handle surgery on children are called pediatric surgery specialists (Sp. BA).
Indications for Child Surgery
Pediatric surgery is generally done to treat the conditions:
- Congenital heart disease. Abnormalities in the structure of the heart from birth that disrupt the function of the heart, and cause symptoms such as fatigue, irregular heartbeat, and chest pain.
- Patent ductus arteriosus (PDA). PDA is a condition where the ductus arteriosus is still open even though the baby has been born. Ductus arteriosus is a blood vessel that a baby needs as a respiratory system during the womb. These blood vessels normally close when the baby is born. However, if the ductus arteriosus is still open when the baby is born, it will cause complaints such as shortness of breath, rapid heartbeat, and fatigue.
- Intestinal atresia. Intestinal atresia is a congenital defect in which some parts of the intestine are narrowed or cut off. This condition causes interference with the baby's digestive system.
- Esophageal atresia. Birth defects where the esophagus does not develop as it should. This makes the baby difficult to swallow and shortness of breath.
- Tracheoesophageal fistula. Growth disorders of the esophagus (esophagus) and trachea. The esophagus and trachea are two separate channels. The esophagus is a tube (channel) to channel food consumed from the mouth to the stomach, while the trachea is the entrance of air into the lungs. When a child suffers from this condition, the esophagus is cut off and connects to the trachea. Connecting the esophagus to the trachea can certainly disrupt the function of the lungs and stomach.
- Diaphragmatic hernia. Abnormalities from birth where there are gaps in the diaphragm so that makes organs in the abdominal cavity, such as the intestine, sticking past the diaphragm and into the chest cavity. This condition causes shortness and rapid heart beat.
- Omphalocele. An abnormality in which the intestine or other organs of the body come out through a hole or gap in the navel. This condition can cause organs that come out of the navel to not get enough blood supply, so that its function is disrupted.
- Wilms tumor. Wilms tumor is a tumor that attacks the kidneys. This condition causes symptoms in the form of fever, constipation, and pain in the abdomen.
- Neuroblastoma. Cancer that develops from immature nerve cells. Symptoms that appear in the form of fever, weight loss, and loss of appetite.
- Pyloric stenosis. Pyloric stenosis is a disorder in which the pyloric muscles get bigger and thicker. The pyloric muscle is a muscle that functions to hold food in, until the stomach is ready for further digestion. Abnormalities in the pyloric muscles can cause obstacles in the process of digestion of food in the stomach.
- Intussusception. Parts of the intestine that are folded and infiltrate other parts of the intestine. This disrupts the distribution of food and fluids, blood supply, and can even cause swelling and pain.
- Midgut volvulus. An abnormality in which the intestines are twisted or bound due to a spinning error when the fetus develops in the womb. This condition can cause symptoms such as vomiting and pain in the abdomen.
Warning
Each surgical procedure in children has different conditions. Consult a doctor before the procedure is done.
Surgical procedures generally use anesthesia. In addition, some procedures also use antibiotics to avoid infection. If you have a history of allergies to anesthesia or antibiotics, consult your doctor so that treatment can be adjusted.
When using drugs, the doctor will advise patients to avoid using drugs that contain aspirin. Also, tell your doctor if you are using supplements or herbal products, such as:
- Ginseng
- Garlic
- Ginkgo biloba
So is the case with blood-thinning drugs that can increase the risk of bleeding. Usually the doctor will ask the patient to stop using the drug, at least 1 week before surgery. Tell your doctor if you are using blood-thinning drugs, such as:
- Apixaban
- Aspirin
- Warfarin
- Heparin
- Rivaroxaban
- Dabigatran
Preparations for Pediatric Surgery
Initially, the doctor will begin by conducting a question and answer session. Parents of patients or patients themselves will be asked to describe complaints, history of the disease they have, and drugs that are being consumed. Some procedures also have provisions or require special measures, such as urine tests on Wilms tumor surgery.
Each pediatric surgical technique has different preparations. But generally, the doctor will do an examination first. The examination is carried out to find out other diseases that may be suffered or any existing allergies.
The doctor's examination can be in the form of imaging methods such as MRI and CT scan, or even in the form of a blood test. The results of the inspection will be used to support the smooth procedures to be carried out. Because pediatric surgery generally uses total anesthesia, the doctor will ask the patient to fast for 6 hours before anesthesia is given and the procedure begins.
Pediatric Surgery Procedure
In the initial stages, the patient will be taken to the operating room. The doctor will put on special clothes that have been provided to the patient. Furthermore, the patient will be positioned at the operating site, whether in a sitting, supine, or stomach position, depending on the surgical procedure to be performed.
Then the doctor will provide anesthesia, can be a local, regional, or general anesthesia (general anesthesia), so that patients do not feel pain due to the incision during the procedure. When the patient begins to fall unconscious, the doctor will install a breathing tube through the patient's mouth. Before the surgery is done, the area of the skin to be dissected is cleaned first with a special antiseptic fluid. This is done so that patients avoid infection.
After the area of the skin to be removed has been cleansed, the procedure is continued by making an incision. The number and size of the incisions and their locations vary depending on the conditions being overcome. For example in a hernia treatment procedure, the incision is only about 1-2 cm.
There are also several procedures that use tools in their implementation. As with surgery to treat a hernia, a laparoscope is used to help the doctor see the condition of the organ while simplifying the operation process.
After Pediatric Surgery
Generally, after a surgical procedure on a child is performed, the doctor will recommend that the patient stay in the hospital for several days until his condition is restored and allows him to go home. This is intended to facilitate doctors in conducting post-operative surveillance.
In some procedures, the breathing tube is fixed to the patient. The hose will be removed when the patient's condition has recovered and can move normally.
Side effects of the procedure can occur in each patient. Different procedures, also different side effects that can occur. In some cases, the surgical incision will cause pain, redness, or swelling. This is considered normal and can last for several days after surgery. If the pain on the incision is very disturbing, the doctor can prescribe painkillers.
The patient's parents can also perform independent care on the incision, so that the wound does not become infected and heal faster. Some treatments that can be done include:
- Avoid incision in the water, at least 24 hours after surgery. However, it would be better if it was consulted with a doctor.
- Clean the skin around the incision with a soft, sterile cloth.
- Avoid cleaning the skin around the incision with antibacterial soap, alcohol, iodine, or peroxide. The use of this material can slow down the recovery time of the incision.
- Avoid activities or movements that can pull or squeeze the skin around the incision.
Patients are allowed to go home when their condition is good enough. The length of the procedure and recovery will vary depending on the actions taken and the conditions being handled.
Risks of Pediatric Surgery
The risk for each procedure is different. However, because pediatric surgical procedures generally require an incision, some of the risks that can occur are:
- The incision area is painful
- The incision and surrounding skin are swollen
- The skin color in the area around the incision is red
In addition, many pediatric surgical procedures also use anesthesia. The use of anesthesia can cause complaints in the form of:
- Nausea
- Dry mouth
- Sore throat
- Sleepy
- Hoarseness
- Gag
In some procedures, antibiotics are given to the patient to minimize the occurrence of infection. However, antibiotics themselves can cause side effects, such as:
- Diarrhea
- Gag
- Stomach ache
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