ACUTE EMERGENCY CONDITIONS AND MANAGEMENT

Appendicitis in children – Laparoscopic appendicectomy

Intussusception- initially enema reduction (air/saline/barium), failing this, proceed with laparoscopic reduction

Painful scrotum (torsion of testis, epididimo- orchitis) – assessment and possibly explorative surgery

Hypertrophic pyloric stenosis – laparoscopic pyloromyotomy

Abscesses – usually will require drainage of pus and possibly antibiotics

Trauma injuries / burns – mostly non-operative, but rarely may require surgery Careful assessment and observation in hospital is crucial.

Malrotation and volvulus of bowel – urgent surgery

Bowel obstruction – can sometimes be treated without surgery, failing that may require surgery however this can be done laparoscopically

Meckels diverticulum – surgical excision if presents with symptoms

Bleeding from intestine (heamatemesis, vomiting blood or Per rectal bleeding) – often requires endoscopy

Acute foreskin problems- trauma or paraphimosis (stuck foreskin)

Infections – urinary tracts, penis (balanitis, due to tight foreskin or phimosis)
Lumps on necks (thyroglossal cysts, branchial cysts)
Cold abscesses
Intra abdominal infections – abscess, liver abscess, splenic cysts
All may require antibiotics and/or drainage of pus

Foreign bodies in oesophagus or upper airway (eg button batteries, coins) – will often require endoscopic removal

Acute abdominal pain – mesenteric adenitis, constipation, inflammatory bowel disease (Crohns disease or Ulcerative colitis), the vast majority will not require surgery following assessment

Lumps in the abdomen, eg: bile ducts abnormality –choleduochal malformations; abnormalities of the bowel or the blood supply of the bowel, Meckels diverticulum, bowel duplication or mesenteric cysts. Most of these presents with symptoms hence surgical removal is the most probable course of action.

NEONATAL SURGERY

Oesophageal (esophageal) atresia (+/- tracheo- esophageal fistula)– surgery soon after birth
Neonatal atresia – requires surgery at birth: most can be treated by laparoscopic surgery

Duodenal atresia
Biliary atresia
Jejunal atresia
Ileal atresia
Colonic atresia
Necrotizing enterocolitis (especially in premature or low birth weight newborns)

Antenatal scans showing echogenic bowel or bowel dilatation – assess and treat appropriately. Antenatally detected cysts in chest or abdomen may require procedures on the foetus prior to the baby being born.

Gastroschisis – closure of abdominal wall

Exomphalos (omphalocoele) – single stage closure or conservative management with delayed closure of abdominal wall

Hirschprungs disease – single stage transanal pull through (mostly), otherwise dependent on the length of effected bowel

Anorectal malformation (imperforate anus) – laparoscopic repair/ PSARP

Tongue ties may require division if this is a cause for poor feeding in the baby

Inguinal hernia – laparoscopic repair

Tumours in neonates – sacrococcygeal teratoma or neurobalstoma

Semi-elective surgery
Inguinal hernia – laparoscopic surgery soon after diagnosis is made
Umbilical hernia – repair when old enough and if the hernia does not disappear in the preschool age.
Hydrocele- laparoscopic/ open surgery
Undescended testicle – need for orchidopexy or fixing of testis into scrotum at about 6 months of life to improve its function

Lumps anywhere on the body, groin and head and neck areas – assess for cause, may need excision and/ or repair surgery, eg. dermoid cysts, superficial skin cysts

SEMI-ELECTIVE SURGERY

Inguinal hernia – laparoscopic surgery soon after diagnosis is made
Umbilical hernia – repair when old enough and if the hernia does not disappear in the preschool age.
Hydrocele- laparoscopic/ open surgery
Undescended testicle – need for orchidopexy or fixing of testis into scrotum at about 6 months of life to improve its function

Lumps anywhere on the body, groin and head and neck areas – assess for cause, may need excision and/ or repair surgery, eg. dermoid cysts, superficial skin cysts

PAEDIATRIC THORACIC CONDITIONS AND TREATMENTS

Lung infection (pneumonia) causing collection of fluid or pus in the chest (parapneumonic effusion and empyema) may require Video assisted Thoracoscopic surgery to clear the pus and inflammatory tissues

Congenital lung anomaly:

CCAM (congenital cystic adenomatoid malformation)
Congenital Emphysema
Bronchogenic cysts
Pulmonary sequestration
These abnormalities will most likely require surgery to remove the effected part of lung to enable the “good lung” to expand and to grow, this is performed by the keyhole, thoracoscopic, technique.

Hyperhydrosis or sweaty palms – if there is failure of simple measures to control the excessive sweating, and if causes much distress, a quick thoracoscopic surgery is all that is required to completely cure this condition

Oesophageal abnormalities such as strictures, duplication etc., need to be assessed and appropriate management undertaken. This may involve surgery.

Chest wall deformity (pectus excervatum, pectus carinatum), these conditions will need thorough assessment and rarely will require surgery

Gastro oesophageal reflux disease (GORD or GERD)- failure of medical management of the reflux or if there was recurrent chest infection or if there were blue or life threatening episodes, a laparoscopic fundoplication is required.

Gastrostomy placement for feeding problems, this can be laparoscopic or endoscopic, and conversion to a button gastrostomy later.

CHILDHOOD TUMOURS

Surgery for insertion of long term chemotherapy lines (chemoports or hickman lines)

Biopsy of tumour for diagnosis – this may be laparoscopic (in abdomen) or thoracoscopic (in chest)

Removal of tumours – The common types present in children are Wilms (kidney), neuroblastoma (adrenal), testicular or ovarian tumours

PAEDIATRIC UROLOGY CONDITIONS AND MANAGEMENT

Posterior Urethral Valves – Can be diagnosed antenatally. This may need antenatal intervention. When born, the baby boy will require endoscopic surgery to release the obstruction

Vesico-ureteric reflux – The child will need assessment and depending on the severity may need surgical procedure often by endoscopic procedure. (Deflux injection)

Pelvi-ureteric junction obstruction – If severe and causing functional problems, the child probably will require a laparoscopic pyeloplasty

Hypospadias – Surgery is required to correct the bend (chordee), abnormally positioned opening and the hooded foreskin. Circumcision should be avoided prior to repair surgery as the foreskin would be used for the reconstructive surgery.

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