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.
An inguinal hernia develops when an opening from the abdomen that extends into the groin does not close during fetal development.
- When a baby boy is developing in the wound the testicles start in his abdomen and then travel down into the scrotum. This tunnel usually closes. However, if the tunnel does not close the opening remains and bowel or an ovary can get trapped.
- Baby girls have the opening as well, it is called the processus vaginalis.
Inguinal hernias in children are common. They are more common in premature babies and males.
Inguinal hernias will not close on their own and require surgical repair. It is usually recommended that they are repaired shortly after they are identified to decrease the risk of bowel or ovaries getting stuck.
Find more information about inguinal hernia repair at Alaska Pediatric Surgery here.
Hernias in children are common. They’re caused by an abdominal wall defect that is present at birth. Epigastric hernias will not close on their own. Most often, the hernia is in the midline and can be seen when the patient strains to have a bowel movement, laughs or it can be when they lay down and relax. It can usually be felt as a bulge under the skin. Childhood hernias can be safely repaired using outpatient (same day) surgery. Best of all, most children recover quickly with only minor discomfort.
For more information about epigastric hernia repair surgery at Alaska Pediatric Surgery, read here.
Umbilical hernias in children are common. They are caused by an abdominal wall defect that is present at birth. It can usually be felt as a bulge under the skin where abdominal contents are poking out into the hernia sac. If an umbilical hernia has not closed by 3-5 years of age, it is unlikely that it is going to close on its own and surgical closure is usually recommended. Surgical closure may also be recommended earlier if the hernia is causing pain, if contents are getting stuck (incarcerated) or if the blood supply of the intestine is being cut off (strangulated).
As kids grow up and enter adulthood, risks of hernias, like incarceration, increase. Childhood hernias can be safely repaired using outpatient (same day) surgery. Best of all, most children recover quickly with only minor discomfort compared to older patients.
For more information about pediatric umbilical hernia repair at Alaska Pediatric Surgery, read here.
Thyroidectomy or Parathyroidectomy
The thyroid is responsible for vital bodily functions, including metabolism, breathing and heart rate, body temperature, and more. Conditions that impact the thyroid include Hashimoto’s thyroiditis, graves disease, hyper or hypo functioning, and cancer. Hyperthyroidism or thyroid cancer is both rare in children but may require surgical removal of part or all of the thyroid gland if they are identified. The procedure to remove the thyroid is called a thyroidectomy.
The parathyroid is comprised of four smaller glands located on the thyroid gland and controls the body’s calcium levels. Calcium levels directly impact heart, kidney, and nervous system functioning, among other roles. Hyperactivity or cancer of one or more of the parathyroid glands may require surgical intervention.
At Alaska Pediatric Surgery, we work closely with our partners at Alaska Pediatric Oncology to manage your child’s thyroid or parathyroid cancer.
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 problem that happens in newborns and is usually diagnosed prior to birth. It happens when the body structures that are supposed to hold the bowel (intestines) inside the abdomen (belly) do not form correctly. Normally, the body wall and a membrane enclose the bowel inside the abdomen. With gastroschisis, all or part of the bowel develops outside of the baby’s body instead. Other organs may be affected as well. There is no membrane covering to protect these organs. So, they’re more likely to become damaged or infected. Gastroschisis must be repaired with surgery very shortly after your baby is born.
For more information, read here.
Pectus Excavatum Correction
Pectus excavatum, also called a sunken chest, is a depression in the chest. The depression may be in the center of the chest or more pronounced on one side (asymmetrical). You may also hear the terms “cup,” “saucer-shaped,” “horns of steer,” or “elongated” used to describe this condition. A child can be born with pectus excavatum or develop their pectus excavatum during their pubertal growth spurt. The pectus excavatum may become more severe with growth spurts. The ribs may flare out as well.
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!
Appendicitis is a condition where the appendix is infected or inflamed. The appendix is a very small, narrow pouch attached to the intestine. Its purpose is not known. Food and stool can get trapped within this “pouch” and cause it to swell and become inflamed or infected. Occasionally other substances can obstruct this pouch and cause the same result. The appendix must be removed before it bursts or “perforates” and spreads the infection within the abdomen. An appendectomy is a relatively simple and safe procedure that can be performed laparoscopically.
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 failure of the anal opening to form correctly during fetal development. Children born with imperforate anus will not have an anal opening or may have what appears to be a small opening near where the anus should be. During a short time during embryo development, the ends of the gastrointestinal and genitourinary tracts share a common opening called a cloaca. Failure of these structures to separate completely leads to a variety of conditions known as anorectal malformations, which includes imperforate anus.
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 characterized by a protrusion of the sternum that occurs as a result of an abnormal and unequal growth of the costal cartilage connecting the ribs to the sternum. Rather than growing flat along the chest wall, the costal cartilages grow outward pushing the sternum forward, giving it a bird like appearance. Another name for pectus carinatum is ‘pigeon chest’. It is a cartilage problem not a bone problem. There can be asymmetry of the chest with one side more prominent than the other. Pectus carinatum is reported to occur less commonly than pectus excavatum.
The cause of pectus carinatum is not known. This deformity occurs in approximately 1 out of 1500 children, often runs in families, and is seen more commonly in males than females. The deformity presents later in childhood than pectus excavatum and becomes more severe as the child grows. Some children with pectus carinatum report that they have chest pain and shortness of breath or limited stamina with exercise. Some children can develop scoliosis. Some children develop self esteem issues related to the appearance. Other children have no symptoms.
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.
Pediatric Testicular Surgery
There are instances where pediatric testicular surgery may be necessary. The testicles are the male reproductive organs that produce testosterone and sperm. Alaska Pediatric Surgery provides two testicular surgery methods.
Pediatric Ovary/Ovarian Cyst Removal
The surgical removal of one or both of the ovaries is referred to as an Oophorectomy (oh-of-uh-REK-tuh-me.) The ovaries are the female reproductive organs that contain egg cells and regulate the menstrual cycle. Although this procedure can be done alone, it is often combined with hysterectomy. Removal of the ovaries as well as the fallopian tubes is referred to as a Salpingo-oophorectomy.
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