Surgical Overview

When preparing your child for surgery, there is a great deal to consider prior to the procedure. Listed in the directory below is some additional information regarding preparing your child, for which we have provided a brief overview.

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TYPES OF SURGERY

What is surgical diagnosis?

You and your child's physician will discuss surgery as a way to correct your child's health problem. This decision will be based on careful evaluation of your child's medical history and medical tests, such as blood tests, x-rays, MRI, CT scan, electrocardiogram or other laboratory work performed to determine the exact diagnosis.

What are the different types of surgery?

Surgery can be classified as major or minor, depending on the seriousness of the illness, the parts of the body affected, the complexity of the operation, and the expected recovery time.

Major Surgery -These are surgeries of the head, neck, chest, and abdomen. The recovery time can be lengthy and may involve a stay in intensive care or several days in the hospital. There is a higher risk of complications after such surgeries. In children, types of major surgery may include, but are not limited to, the following:

• removal of brain tumors
• correction of bone malformations of the skull and face
• repair of congenital heart disease, transplantation of organs, and repair of intestinal malformations
• correction of spinal abnormalities and treatment of injuries sustained from major blunt trauma
• correction of problems in fetal development of the lungs, intestines, diaphragm or anus

Minor Surgery - Some surgeries that children undergo are considered minor. The recovery time is short and children return to their usual activities rapidly. These surgeries are most often done as an outpatient, and children can return home the same day. Complications from these types of surgeries are rare. Examples of the most common types of minor surgeries may include, but are not limited to, the following:

• placement of ear tubes
• hernia repairs
• correction of bone fractures
• removal of skin lesions
• biopsy of growths

Elective Surgery -These are procedures you decide your child should undergo, which may be helpful, but are not necessarily essential. An example might be to have a birthmark removed, or to circumcise your male infant.

Required Surgery - These are procedures that need to be done to ensure the quality of your child's life in the future. An example might be having a spinal fusion to correct severe curvature of the spine. Required surgery, unlike emergency surgery, does not necessarily have to be done immediately and can allow you time to prepare your child for the experience.

Urgent or Emergency Surgery - This type of surgery is done in response to an urgent medical need, such as the correction of a life-threatening congenital heart malformation or the repair of injured internal organs after an automobile accident.

METHODS OF SURGERY

What are the different methods of surgery?

With technical advances today, surgery does not necessarily mean large incisions, as in the past. Depending on the type of surgery, there are several surgical methods that may be performed, including the following:

Open Surgery - An open surgery means cutting skin and tissues so the surgeon has a direct access to the structures or organs involved. Examples of open surgery include the removal of organs, such as the gallbladder or kidney.

Minimally Invasive Surgery - Minimally invasive surgery refers to any surgical technique that does not require a large incision. This allows the child to recuperate faster and with less pain. Not all conditions are treatable with minimally invasive surgery. Some minimally invasive surgical techniques include the following:

• laparoscopy - a procedure that uses a tube with a light and a camera lens at the end (laparoscope) to examine organs, check for abnormalities, or perform minimally invasive surgeries. Laparoscopy is a surgery which avoids making large incisions. Tissue samples may also be taken for examination and testing.
• endoscopy - a procedure that uses a small, flexible tube with a light and a camera lens at the end (endoscope) to examine the inside of the digestive tract. Tissue samples from inside the digestive tract may also be taken for examination and testing.
• arthroscopy - with the use of an endoscope, surgeons can look at the interior of a joint. This technique is most often used to inspect and surgically correct the inside of the knee joint.
• bronchoscopy - the examination of the bronchi (the main airways of the lungs) using a flexible tube (bronchoscope). Bronchoscopy helps to evaluate and diagnose lung problems, assess blockages, obtain samples of tissue and/or fluid, and/or help remove a foreign body.
• cystoscopy - examining the inside of the urethra and bladder cavity with a small, flexible tube with a light and a camera lens at the end (endoscope).
• gastroscopy - examining the lining of the stomach with a small, flexible tube with a light and a camera lens at the end (endoscope).
• laryngoscopy - inspecting the larynx (voice box) with a small, flexible tube with a light and a camera lens at the end (endoscope).
• sigmoidoscopy - examination of the rectum and sigmoid colon with a small, flexible tube with a light and a camera lens at the end (endoscope).
  

THE HOSPITAL SETTING

Where will my child have surgery?

Your child most likely has been referred by your pediatrician to a pediatric surgeon, or other specialist that has special training to care for infants, children, and adolescents. Surgery may be performed at a physician's office, a clinic, an outpatient surgery center, or the hospital, depending on the following:

• the reason for surgery
• whether the surgery is considered major or minor
• whether or not the surgery is an emergency
• your physician's preferences
• your preferences

Pediatric surgeons often work with a multidisciplinary team, including anesthesiologists, radiologists, nurses, and other medical professionals who are experienced in caring for children.

How long will my child stay in the hospital after minor surgery?

Many surgeries performed on children are done as an outpatient. With minor surgeries, your child will return to the outpatient surgery center after spending the required time in the recovery room. When your child is fully awake, able to drink some fluids, and meet all discharge criteria required by your child's surgeon, he/she will be discharged home. Some surgeries require that your child stay overnight to allow observation by the nursing staff.

How long will my child stay in the hospital after major surgery?

With a major surgical procedure, the time in the hospital is determined by the nature of the surgery and the health of your child. Some surgeries will require a stay in intensive care for close monitoring before your child is moved to a regular inpatient bed. On the pediatric unit, your child's recovery will continue to be monitored and immediate medical attention will be provided in case of complications. Your surgeon will be able to discuss your child's expected length of stay when you first meet during the preoperative visit. If your child has underlying medical conditions, his/her recovery time may be longer.