Pediatric Surgery

1. General Information

Pediatric Surgery is a surgical speciality dealing with prevention, diagnosis and treatment of both birth defects and acquired diseases requiring surgical intervention in a life time period which begins from gestation and extends to adulthood. These disorders particularly involve respiratory, digestive and urinary/reproductive systems and result from accidents, tumors, infectious / inflammatory processes, etc. Some diseases in pediatric surgery can be managed without the need for surgery, but most of them require open or closed (endoscopic) surgical intervention. These operations are usually performed under “elective” conditions after a certain period of investigation and preparation. However, sometimes patients undergo surgery under “emergency” conditions to save life or to protect the organs and tissues.

Pediatric surgery is also a surgical branch familiar with “multi-disciplinary” concept especially for some complex cases. In other words, it has close relationship and cooperation with other related specialties. Therefore, a dynamic communication with other medical disciplines including especially pediatrics (neonatalogy, nephrology, gastroenterology, oncology, etc), anesthesiology, radiology, nuclear medicine and pathology should be considered.

Pediatric surgeon, in all of the above situations, behaves as the most suitable for the child’s health on the basis of the training received, his experiences and facilities of the center (staff, nurse, equipment, etc.). In doing so, respect the rights of the child to behave is one of his/her most important features. Major diseases that the pediatric surgeons interested can be summarized in two main groups as congenital or acquired diseases.

2. Congenital Diseases

These occur during pregnancy and originate from head and neck, chest, abdomen and genitourinary tract. The main diseases in this group are listed below.

  • Lung disorders (lobar emphysema, pulmonary sequestration, etc.)
  • Esophageal atresia
  • Diaphragmatic hernia
  • Intestinal atresia
  • Omphalocele/Gastroschisis
  • Umbilical hernia
  • Anal Atresia/Anorectal malformations
  • Biliary atresia
  • Prenatal hydronephrosis
  • Posterior urethral valves
  • Hypospadias/epispadias
  • Undescended testis (cryptorchidism)
  • Disorder of sex development
  • Cysts and tumors
  • Hemangiomas/lymphangiomas

3. Acquired Diseases

These diseases are absent at the time of birth but occur in the ongoing process towards adulthood, depending on environmental factors or subsequent developmental disorders, and can be classified as several subgroups. Head and neck, chest, abdomen and genitoyrinary tract are the most common sites involved.

  • Accidents: Trauma related with all organ or tissues of respiratory, digestive and urinary/reproductive systems (lung, stomach, intestines, liver, spleen, pancreas, kidney, bladder, urinary tract, etc.) are included in this subgroup. In addition, aspiration of foreign bodies into airways or entering them into digestive tract through ingestion may be matter of surgical evaluation.
  • Tumors: Benign or malign masses originating from respiratory, digestive and urinary/reproductive systems, organs or tissues (lung, stomach, intestines, liver, spleen, pancreas, kidney, bladder, urinary tract, etc.) are included in this subgroup. Some of those may be congenital in origin.
  • Infectious (inflammatory) conditions: Infections/ inflammations of organs or tissues pertaining to respiratory, digestive and excretory/reproductive systems (lung, stomach, intestines, liver, spleen, pancreas, kidney, bladder, urinary tract, etc.) are included in this subgroup. Most common ones are lung membrane infection (empyema), infection of the appendix (appendicitis), gallbladder infection (cholecystitis), infection of pancreas (pancreatitis), and infections of the skin (abscess, cellulitis, etc.).
  • Other (Developmental) disorders: Lymphadenopathies and absscesses in the neck, soft tissue tumors and thyroid nodules are the disorders necessitating pediatric surgical evaluation. In addition, groin (inguinal) hernia which is the most common operation in pediatric surgery accumulation of fluid around testis (hydrocele) and spermatic cord (hydrocele of the spermatic cord) also may develop after birth.