Common Surgical Conditions In Children And Important Things To Remember Regarding Them

Did you know that some conditions in children are best treated with surgery? While surgery may sound scary, many pediatric procedures are routine and can help your child grow up healthy and strong. This guide will explore some common surgical conditions in children, including undescended testicles, hernias, and more. We’ll also provide important information for parents, such as when surgery may be necessary and what to expect. With knowledge on your side, you can feel empowered to make informed decisions about your child’s health.

1. Undescended testes

Undescended testes, also known as cryptorchidism, are conditions in which one or both testes fail to descend into the scrotum before birth. Normally, testes form in the abdomen and descend into the scrotum before birth. This descent is necessary for appropriate testicular growth and function. When one or both testes fail to descend, it can lead to complications if not treated.

1. Any undescended testis can descend to the scrotum spontaneously till 6 months of age
2. If not descended, surgery is indicated between 6 months to 1.5 years 
3. A non-palpable undescended testes is not visible on ultrasound should be subjected to “Examination under anesthesia”. If still not palpable, “Diagnostic laparoscopy sos Orchiopexy” is warranted
4. For undescended testis, surgery might be done either in “Single stage” or a “2- staged procedure (Stephen-Fowler)” 6 months apart
5. Decision regarding “Single stage” or “2-staged” surgery is taken intra-operatively, depending upon the location of the testis
6. Earlier the surgery, the better the chances of maintaining fertility of the testis

 

Causes The exact cause of Cryptorchidism is not known. It can be attributed to factors that may disrupt hormones, physical changes, and nerve functions involved in the development of testes such as:

• Genetics
• Maternal health
• Environmental factors

Parents of children with undescended testes should consult with a pediatrician or pediatric urologist for proper examination and treatment.

2. Inguinal hernia

Inguinal hernias in children are relatively common and occur when a portion of the intestine protrudes through a weak spot in the abdominal muscles, usually near the groin.

1. All inguinal hernias require surgery- there is no such thing as conservative management for inguinal hernia
2. The aim is to operate as early as possible to prevent complications like irreducibility and obstruction

Causes: Inguinal hernias in children are often caused by a weakening in the abdominal wall that exists from birth. During fetal development, the inguinal canal, which allows the testicles to descend into the scrotum in males, may not seal properly, creating a weak region that might allow a hernia to form.

3. Umbilical hernia

It occurs when there’s a weakness in the abdominal wall muscles around the belly button (umbilicus), allowing the abdominal contents to protrude through. It’s relatively common in infants and typically manifests as a bulge or swelling around the belly button area. Here’s some key information:

1. Umbilical hernias can be managed conservatively till at least 2 years of age as there is a chance of spontaneous closure of defect
2. If not resolved till 2 years of age and if the defect size is more than 2 cm, surgical repair is done

4. Hydrocoele

Hydrocele in children is a condition where there is a collection of fluid in the scrotum, the sac that holds the testicles. It’s quite common and usually harmless, especially in newborns and infants. Here’s some more information:

1. A hydrocele can resolve spontaneously by 1.5 years of age. If not resolved by then, it requires surgical repair
2. Traumatic hydrocele” is nothing but a congenital hydrocele swelling which has been noticed after the injury
3. There is no chance of any damage to the testis by compression from the hydrocele, even if the swelling is increasing in size (the pressure from the increasing swelling is dissipated by the stretching of the lax scrotal skin)

 

Must Read: Top home care tips post hypospadias surgery

 

5. Phimosis

Phimosis in children is a condition in which the penis’ foreskin is too tight to pull back over the penis’ head (glans). It is extremely common in newborns and young males, and it normally resolves itself as they get older. In certain circumstances, however, it may persist and need medical intervention.

1. More than 50% new born boys have physiological phimosis which can resolve spontaneously by 2 years of age
2. Surgery is indicated if patient has symptoms like dysuria, ballooning of prepuce or urinary tract infections
3. Prepucioplasty is a foreskin-saving surgery that can be done to treat phimosis in young boys in early stage of phimosis

6. Cholelithiasis

Cholelithiasis, commonly known as gallstones, is typically associated with adults, but it can also occur in children, albeit less frequently. 

1. Incidence of gall bladder stones without concomitant haemolytic disease is increasing
2. If patient has symptoms like recurrent upper abdominal pain and dyspepsia along with ultrasound findings of multiple gall bladder stones or single stone more than 5mm in size, cholecystectomy is advised
3. If ultrasound of abdomen shows a single gall stone less than 5mm in size, a trial of ursodeoxycholic acid for 3 months can be given. If the stone does not dissolve, patient is advised surgery
4. In any case, in patients with gall stones with symptoms lasting for more than 1 year, cholecystectomy should be done, to prevent long-term chances of carcinoma of gall bladder 

 

Dr. Apoorva Kulkarni is a renowned Pediatric Surgeon and Pediatric Urologist practicing in Thane, Bandra, and Chembur. With extensive experience in the field, Dr. Kulkarni specializes in the surgical management of common conditions affecting children, including undescended testes, inguinal hernias, umbilical hernias, hydroceles, phimosis, and cholelithiasis.

Parents can trust Dr. Apoorva Kulkarni for expert pediatric surgical and urological care to ensure the health and well-being of their children. Schedule an appointment today for expert advice and specialized care.