It is natural for parents and relatives to be anxious if a child in the family needs surgery. Often, multiple opinions are sought and the more the opinions, the more is the confusion.
Avoiding surgery is the primary concern of most parents and especially grand parents who get very emotional for putting a small baby through surgery.
However it is important to get the right kind of advise for such a problem and look at it objectively, looking at the long term outcome for the child. Any damage in early childhood maybe permanent and irreparable beyond a certain limit.
The parents and relatives must try to understand the disease/problem and what damage it can do if left untreated or if the treatment is delayed. Such advise must be sought from a qualified surgeon who specialises in operating only on children. The ‘paediatric surgeon’ would then weigh the risks and benefits of surgery and look at long term benefits which must last decades not years.
Paediatric surgeons are now available in many cities but only a few suburbs of even a big city like Mumbai have a Paediatric Surgeon. They treat a variety of problems in children from food pipe blockage, to malformed lungs, intestines, kidneys, liver, genitalia to antenatally diagnosed conditions, tumours, emergencies etc.
Today, a few paediatric surgeons have started offering Laparoscopic and Robotic surgery for children. Although not new, these technologies have completely changed the outlook for children who need surgery. Recovery times are much faster, and long term impact of surgery is favourable for the child.
Diseases and treatments
The following are the common problems/diseases treated by paediatric surgeons. The list is not exhaustive and if there is a doubt, it is best to consult a paediatric surgeon before making a decision.
Common diseases and treatments
Robotic and Laparoscopic Surgery is now commonly performed for Oesophageal (food pipe), Lung, Kidney, & Intestinal problems, even in newborn babies. Most surgeries involve removing the diseased or malformed organ or a part of it, minimising damage to surrounding structures. Visualisation is done by magnification and 3D vision both of which help with delicate organ surgery in children and newborn babies. Then reconstruction is done by stitching together remaining parts using very fine threads 0.07 – 0.1 mm thin. The instrumentation for children is finer and more specialised.
Dr. Kant Shah has trained in ORSI, Belgium, Oxford John Radcliffe hospital, UK and CEMAST, Mumbai for Robotic and Laparoscopic surgery. He has been performing laparoscopic surgery since 2006 and performs most of the surgeries in babies this way. He believes it has made tremendous difference in the quality of life for children.
Acute Appendicitis in children is now routinely treated by Laparoscopy even if there is perforation or pus formation
Hernia and Hydrocoele are very common in children. Hernia needs urgent treatment and hydrocele surgery could be done after one year of age.
Undescended testis are also common in children and many will need surgery at 6 months of age by open or laparoscopic method
Hypospadias is a defect in the formation of urethra and can be rectified by surgery. Complex defects will need more than one stage of surgery.
Hydronephrosis of the Kidney is very commonly found in antenatal scans. Such babies will need ultrasound scans in the first week of life and need to be seen by a Paediatric Surgeon. Many such problems will resolve spontaneously but it is important to diagnose significant problems which can damage the kidneys permanently.
Urine infections and Vesicle-Ureteric reflux are uncommon in children but often can be treated with antibiotics only. However children need investigations such as micturating cystourethrogram (MCU) and nuclear scans such as DMSA or EC or DTPA to diagnose birth defects. Vesicle-ureteric reflux (VUR) is a birth defect which can spontaneously resolve if of a lower grade. High grade VUR often (>50%) needs surgical correction to prevent recurrent infections and damage to the kidneys. Pneumovesicoscopic ureteric reimplantation is telescopic surgery to correct such damaged ureters.
Organ-wise diseases and treatments
Lung and Chest lesions like Lobar Emphysema, Airway Malformations, Cysts, & Diaphragmatic Hernia are rare problems in newborn babies and sometimes diagnosed antenatally. Any breathing difficulty or rapid breathing in a young infant must be thoroughly investigated. Occasionally a foreign body may be inhaled unnoticed by parents, and must be immediately removed
Oesophagus / food pipe problems like Atresia, Tracheo-Oesophageal Fistula, Foreign body, Achalasia Cardia are must be corrected immediately upon diagnosis as the oesophagus is vulnerable to long term damage. Oesophageal replacement may be required for children with long strictures or atresia and can be done by robotic or laparoscopic assistance.
Kidney problems like Hydronephrosis, Pelvi-ureteric junction obstruction are common and amenable to laparoscopic and robotic surgery. Posterior urethral valves cause damage to both kidneys and the bladder and hence must be treated by delicate instrumentation designed for children only. Nocturnal Urinary Incontinence is common until the age of six to seven years and may not need treatment. Children with day-time incontinence or nocturnal incontinence beyond seven years need investigations such as Ultrasound, Uroflowmetry, Urodynamics etc. to determine the cause. Robotic Bladder Augmentation and Bladder Neck Repair (BNR) are done for children who have a permanently damaged bladder.
Intestinal problems may be seen in newborn babies such as Atresia, constipation due to Hirschsprung’s disease (HD) or Anorectal Malformation, Malrotation etc. Older children may have rectal bleeding due to Intussusception or Meckel’s diverticulum. All such problems need urgent surgical correction which can often be done by laparoscopy or robotic surgery.
Genital problems such as hypospadias, undescended testis, epispadias, etc, often need surgery which may be electively done at 6-12 months of age
Skin lesions like haemangioma, vascular malformations, need to be differentiated. Oral medications can successfully treat infantile haemangiomas anywhere on the body. Vascular malformations can cause significant disfiguration and hence need prompt investigation to know exact extent. Treatment may involve a combination of injection sclerotherapy, oral medications, surgery or laser treatment.
Tumours like Wilm’s tumour, Hepatoblastoma, Neuroblastoma, Teratoma etc. are rare but need to be promptly seen by a paediatric surgeon. The surgeon would do more scans to determine if the tumour can be immediately removed or chemotherapy may be required to make it smaller before surgery. Specialist Paediatric Oncosurgeons and Oncologists are now available for children and only such trained doctors must diagnose and treat children with tumours.
Dr. Kant Shah is trained Paediatric Oncosurgeon, and part of Daffodil Paediatric Haematology-Oncology group which is attached to NH SRCC CHildren’s hospital, Jaslok hospital, Saifee hospital, Nanavati Hospital etc.
Liver, Gall bladder and Pancreas diseases are complex but rare problems in children. Obstructive Jaundice due to Biliary Atresia, Choledochal cyst, Pancreatitis and Pseudocyst, Splenic cyst all need complicated surgery with life-long implications. The surgery is very delicate as the liver and biliary ducts of children are tiny and any repair must be done with long term outcomes in mind. Nowadays laparoscopic and robotic surgery has transformed the lives of children with such complex malformations.
Dr. Kant Shah is trained in Paediatric Hepatobiliary surgery at prestigious hospitals in UK and India. He performs many such procedures in children every year, including newborn babies. Since the past 4 years, robotic and laparoscopic surgery is now commonly used for such conditions by him.
Hospitals visited by Dr. Kant Shah
- Borivali Healthcare, Borivali
- Nanavati Max Super Specialty hospital, Vile Parle
- Saifee hospital, Charni road
- Jaslok hospital, Peddar road
- NH SRCC children’s hospital, Haji Ali
- Apollo Hospital, Belapur