Pediatric Surgical Services
Pediatric Surgeries We Perform
At Alaska Pediatric Surgery, we are able to perform a wide range of surgical procedures for the children of Alaska. Whether it is a scheduled routine surgery, an elective procedure, wound care, or a trauma surgery due to an injury, we can help!
A hernia is when tissue or bowel finds its way through gaps in the muscles of the abdomen or groin. A hernia can often be observed as a bump or a bulge under the skin where it exists. Hernias do not spontaneously resolve on their own and require surgical intervention to prevent damage to the intestine and allow for pain-free movement of the muscles affected. The major concern with any hernia is that the organs that pass through the wall may become incarcerated, or strangled.
Inguinal hernias are the most common hernias and the most common surgical problem of children. The inguinal ring is open in fetal life and closes around the time the baby is born. However, in some children, this ring does not close or does not close completely, which leaves space for bowel or an ovary to come through the inguinal ring into the groin. It usually appears as a bulge on the groin and can appear to get more prominent when the child strains or cries. To prevent injury and organ death to the parts that pass through the inguinal ring, it is important to have the hernia repaired as soon as possible.
Pediatric inguinal hernia repair surgery is generally quick and relatively not very invasive. The pediatric surgeon can usually move the herniated organs back into place and close the opening in the inguinal ring laparoscopically, through two or three tiny incisions or through a small (generally about an inch) incision. Find more information about inguinal hernia repair at Alaska Pediatric Surgery here.
Epigastric hernias are those that occur when tissue or organs protrude through the abdominal wall in the epigastric area (above the belly button and below the breastbone). Epigastric hernias may be present at birth and, for the most part, don’t cause many issues. They are usually small and only the lining of the abdomen breaks around the surrounding tissue. However, sometimes part of the stomach may push through, which can cause major problems. Epigastric hernias will not repair themselves and must be corrected surgically.
Pediatric epigastric hernia repair surgery is typically performed on an outpatient basis and is a quick procedure with very little risks. The pediatric surgical team will move herniated organs and close the opening in the abdominal wall laparoscopically. For more information about epigastric hernia repair surgery at Alaska Pediatric Surgery, read here.
Umbilical hernias are fairly common in children and may be present at birth. Umbilical hernias are a result of the abdominal wall not completely closing during the infant’s development and allows part of the intestine to come through. This is seen as a bulge at the belly button that may look bigger when the child strains or cries.
Approximately 90 percent of umbilical hernias close on their own by the time the child is five. Many times it will be recommended to wait until the child is five before surgical intervention. If, however, the hernia is large, painful, or causes incarceration (strangulation) of the intestines, it is considered a medical emergency that must be treated with hernia surgery as soon as possible. For more information about pediatric umbilical hernia repair at Alaska Pediatric Surgery, read here.
External Catheter and Port Placement and Removal
For children who require frequent intravenous infusions of medication, blood products, or nutrition, or require frequent blood sampling, a long-term intravenous catheter may be recommended. The benefit of a long-term catheter is that they reduce the number of needle sticks the child receives and reduces the risk of infection and vein damage when caustic medications such as chemotherapy or antibiotics are administered. There are two types of long-term central venous catheters, or central lines, that may be used: an external catheter (Broviac® or Hickamn®) or a totally implanted catheter, port, (Portacath® or Mediport®).
An external catheter leaves a tube that hangs out of the placement incision in the skin. An internal port is implanted under the skin and is accessed with a special needle as needed. Both types of central lines are placed by a pediatric surgeon in the operating room and can be removed in an outpatient procedure. To learn more about the Broviac placement procedure, read here.
Gastroschisis is a condition in which all or a part of the bowel or intestines develop outside of the baby’s body because the abdominal wall or the membranes that hold the intestines in don’t develop correctly. In some cases, other organs including the stomach and the liver, can also develop outside the baby’s body. It is generally identified during one of the ultrasounds prior to the birth of a baby. Surgery is required to repair this condition immediately.
Surgery to correct gastroschisis is often performed immediately following birth to reduce damage to the bowel or risk of infection. In some cases, the baby’s belly did not develop large enough to hold all of the organs and will require a series of procedures to protect the exposed bowel while creating space. If there is room, the pediatric surgeon will carefully place all of the organs where they should be and close the opening in the baby’s belly. Either version of the surgery may also require removal of damaged intestine. For information, read here.
Pectus Excavatum Correction
Pectus excavatum, also called a sunken chest, is a fairly common skeletal disorder in children. In some cases, it can be identified at birth, and in others, it is less obvious and worsens during puberty. Pectus excavatum is a condition where the upper ribs and the breastbone (sternum) grow inward instead of outward. In mild cases, this condition does not cause problems, but in most cases can cause problems tolerating exercise or deep breathing, can lead to recurrent respiratory infections or coughing and wheezing, heart murmurs or palpitation, or chronic fatigue. These issues are due to the restriction on the heart, lungs, and other organs.
Not all cases of pectus excavatum require surgical intervention. If your child does require surgical correction, your pediatric surgeon will evaluate your child and create a plan. If your child is young and the bones are still pliable, a single surgery can be successful. Depending on the severity of the depression and the age of the child, it will influence the procedural plan. At Alaska Pediatric Surgery, we will develop a surgical plan with you based on your child’s unique needs. For more information, read here.
For all of your child’s surgical needs, trust Alaska’s most experienced pediatric surgeon — Dr. Roaten and his team at Alaska Pediatric Surgery. To schedule your consult, contact our office today!
Pediatric Conditions That May Require Surgical Intervention
Appendicitis is a condition where the appendix is infected or inflamed. This can happen when normal functioning of the appendix is disrupted by the blockage of stool, a foreign body, or cancer. Appendicitis is a medical emergency that almost always requires immediate surgical intervention. Surgery will be performed to remove the inflamed appendix before it bursts or leaks infectious material into the abdomen. An appendectomy is a relatively simple and safe procedure that can be performed laparoscopically. The appendix is a very small appendage that we can live without and the surgery to remove it requires little recovery time.
When bile does not properly empty from the liver due to a congenital malformation, it is called biliary atresia. This rare disorder will appear within two to eight weeks of birth and will be confirmed through a liver biopsy, ultrasound, and nuclear medicine scan. These diagnostic tests will show the alternate path that the bile is taking out the liver. After biliary atresia has been diagnosed, your child’s pediatric surgeon will reconstruct the bile ducts and reattach them to the liver to restore their function and leave the liver.
There are many forms of cancer that can afflict children and that be treated or require surgical intervention. Hepatoblastoma is cancer of the liver that is treated by surgically removing the cancerous part of the liver. Neuroblastoma is a rare form of childhood cancer that typically begins near the adrenal glands, and is treated by surgically removing the cancerous cells. Other childhood cancers can be treated by surgically removing the cancerous tissue, always discuss treatment options with your oncologist and pediatric surgeon.
Esophageal Atresia and Tracheoesophageal Fistula
Esophageal atresia and tracheoesophageal fistula are terms that are used to describe abnormal pathways within the trachea or esophagus. These conditions are caused by the esophagus (food tube) or trachea (air tube) not forming properly during a baby’s intrauterine development. These conditions require surgical intervention to prevent food from entering the lungs. A pediatric surgeon will close each of the tubes and reconnect them to the correct organs not long after the baby is born.
The gallbladder is a very tiny pouch that sits just beneath the liver and is responsible for storing bile that is produced by the liver. An infection of this pouch can be either viral or some other cause, such as hypothyroidism. Gallstones, cholecystitis, cancer, and gallstone pancreatitis are common causes of gallbladder conditions that may require surgical intervention. Depending on the severity of the infection, it may require removing the gallbladder altogether.
Gastroesophageal reflux disease (GERD), more commonly referred to as acid reflux, is a condition in which food and stomach acid travel back up the esophagus, causing extreme discomfort and damaging the food pathways. To prevent worsening of the condition and cancers of the throat and esophagus, it can be treated by tightening the sphincter of the esophagus or placing a magnetic sphincter.
Gastroschisis is a congenital disorder where a baby’s intestines and/ or stomach protrude outside of their body. This condition will be identified on a routine prenatal ultrasound and monitored throughout the pregnancy. Once the baby is born, surgery will be performed by neonatal surgeons to correct the problem. To treat it, the intestines and/or stomach are placed back into the baby’s body, and the opening will be closed if it is possible.
This is one of the most common conditions that occur in children and the treatment is the most common surgical intervention performed on children. Surgery will put the herniated tissue back into the proper location and the opening in the muscle wall will be either closed or repaired.
Hirschsprung’s disease is a congenital condition that occurs when nerves do not form in certain parts of the large intestine. This prevents a child from being able to have a bowel movement. Treatment requires a pediatric surgeon to remove the section of the colon that is enlarged and non-functional.
Imperforate anus is a rare birth defect that is identified on initial assessment after birth. The condition is marked by the opening of the anus is missing or blocked. In some cases, the rectum may empty into a pouch that does not connect to the colon (exit) and in other cases, the rectum may open into other structures like the bladder or the vagina. This condition must be corrected quickly to avoid infection or other complications. With surgical intervention, normal bowel movements are possible.
Necrotizing enterocolitis is a condition that is most commonly found in premature or unwell newborn babies. It is a gastrointestinal disease that has been caused by some sort of infection or inflammation, which destroys a portion or all of the bowel, causing a portion of the intestine to die. Treatment requires surgical removal of the diseased area of the intestines.
Pectus carinatum is also known as “bowed chest” and is a congenital condition marked by an abnormal amount of growth between a baby’s breastbone and ribs. Treatment for this condition includes a chest brace that is used to push down directly on the child’s sternum. If that does not treat it, surgery may be required.
Pyloric stenosis is a condition where the opening between the stomach and small intestine is too narrow for it to function, blocking digested food from leaving the stomach. Treatment includes surgery to make the opening bigger, allowing food to pass through unimpeded.
There are a variety of reproductive disorders that may be present in children that require surgical intervention to correct. Some anomalies are apparent before or just after birth, while some may not present until later in life. A few conditions that are corrected by a team of skilled pediatric surgeons include bladder exstrophy, an external bladder; cloacal anomalies, the rectum, vagina, and urethra joining into one exit; and hypospadias/epispadias, the absence, mislocation, or obstructed urethra. Conditions that may require surgical intervention based on symptoms and severity of condition include vaginal agenesis, the absence of a uterus; obstructed hemivagina with ipsilateral renal agenesis, two independent uteri; and mixed gonadal dysgenesis, the presence of both or ambiguous sex organs, which may require removal of one or both of the gonads. If your child presents with any of these disorders, the team at Alaska Pediatric Surgery can discuss surgical treatment options with you.