Pediatric Surgery

Pediatric surgery is the medical specialty concerned with the diagnosis, follow-up, and treatment of congenital or acquired surgical diseases in children from the neonatal period to adolescence. This department deals with many diseases such as inguinal hernia, undescended testicles, appendicitis, circumcision, congenital anomalies, intestinal obstructions, and some surgical problems of the urinary tract and genital area.

What is Pediatric Surgery?

Pediatric surgery is a department concerned with the diagnosis, follow-up, and treatment of surgical diseases in newborns, infants, children, and adolescents. This field encompasses a specialized surgical approach that considers children not just as miniature adults, but also their growth and development processes.

Surgical procedures in children have different dynamics compared to adult patients. This is because children's organs are still developing, their immune systems can vary with age, and disease symptoms may not always be as clear as in adults. Therefore, in evaluations within the scope of pediatric surgery, the child's age, weight, developmental milestones, current complaints, and general health status are considered together.

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What diseases does pediatric surgery treat?

Pediatric surgery deals with the diagnosis and treatment of surgical diseases related to the abdominal region, digestive system, inguinal region, urinary tract, genital area, rib cage, skin and soft tissues, and congenital anomalies. The most frequently evaluated diseases and conditions within this scope are as follows:

• Inguinal hernia: This occurs when abdominal tissues protrude through the inguinal canal and may require surgical evaluation in children.
• Hydrocele: A swelling caused by fluid accumulation around the testicle; depending on age and clinical condition, monitoring or surgical treatment may be necessary.
• Cord cyst: A cystic swelling caused by fluid accumulation in the inguinal canal or a structure extending to the testicle, and is evaluated by pediatric surgeons.
• Undescended testicles: In male children, this is a condition where the testicles fail to descend into the scrotum, and it is evaluated in terms of testicular development and future reproductive health.
• Acute scrotal and testicular torsion: These are emergencies that can present with sudden pain, swelling, or redness in the testicles and scrotum; testicular torsion may require prompt intervention.
• Umbilical hernia: This occurs when abdominal tissues protrude through an opening in the umbilical region; follow-up or treatment is planned according to the child's age, the size of the hernia, and the symptoms.
• Umbilical granuloma: A pinkish-red tissue growth that can form in the umbilical cord after it falls off in newborns, and is monitored with appropriate treatment.
• Appendicitis: This occurs as a result of inflammation of the appendix and is a common cause of acute abdominal pain in children.
• Appendicitis in children and laparoscopic treatment: In suitable children diagnosed with appendicitis, treatment can be planned using minimally invasive surgical techniques.
• Intestinal obstructions: Occur when intestinal contents cannot move; symptoms may include vomiting, abdominal distension, and inability to eat.
• Intestinal knotting: This occurs when a section of the intestine enters another segment of the intestine and may require urgent evaluation due to symptoms such as abdominal pain, vomiting, and bloody stools.
• Infantile pyloric stenosis: A condition in infants characterized by projectile vomiting due to narrowing of the gastric outlet, which may require surgical treatment.
• Hirschsprung's disease: It is a congenital disorder that can lead to difficulty defecating and intestinal obstruction due to a deficiency in the nerve cells that control bowel movements.
• Congenital digestive system anomalies: These include congenital structural problems affecting the esophagus, stomach, intestines, or anal region.
• Neonatal congenital diseases: This includes specific surgical conditions that occur in the neonatal period, such as intestinal obstructions, abdominal wall defects, and congenital organ anomalies.
• Anal region diseases: Conditions such as anal fissures, abscesses, fistulas, and congenital anal opening problems are evaluated by pediatric surgeons.
• Conditions related to bleeding from the anus: In children, bleeding from the anus can be caused by conditions such as anal fissures, rectal polyps, or bowel obstruction, and may require evaluation by a pediatric surgeon.
• Anal fissure: A crack that forms in the anal area; it can cause symptoms such as pain and bleeding during defecation.
• Rectal polyps: Benign tissue growths that can form in the last part of the large intestine and can cause rectal bleeding in children.
• Constipation and encopresis in children: Chronic constipation and fecal incontinence should be evaluated for underlying surgical or functional causes.
• Circumcision: A surgical procedure that can be performed on newborns and children; the child's general condition and genital structure are evaluated before the procedure.
• Circumcision-related problems: Adhesions, narrowing, healing problems, or deformities that may develop after circumcision are monitored by pediatric surgeons.
• Labial adhesion: In girls, this is a condition where the inner labia (lips) are fused together in the genital area. Treatment or monitoring is planned according to the severity of the symptoms.
• Pediatric urological conditions: Surgical conditions affecting the urinary tract and genital area, such as hypospadias and vesicoureteral reflux, can be considered within the scope of pediatric surgery.
• Hypospadias: In male children, this is a condition where the urethral opening is located in an abnormal position and may require surgical treatment.
• Vesicoureteral reflux: The backflow of urine from the bladder to the kidneys; it is evaluated in terms of recurrent urinary tract infections and kidney health.
• Ovarian cysts: Ovarian cysts, which can occur in girls, are monitored for size, symptoms, and risk of complications.
• Skin and soft tissue masses: Moles, cysts, lipomas, abscesses, or other soft tissue masses are evaluated for follow-up or surgical removal.
• Burns and traumatic injuries: This includes the treatment of burns, cuts, puncture wounds, or certain surgical conditions resulting from trauma in children.
• Foreign objects in the airway and digestive tract: Removal of foreign objects that have become lodged in a child's respiratory or digestive tract may require urgent evaluation.
• Chest wall deformities: Chest deformities such as pectus excavatum or pigeon chest are evaluated taking into account the child's development and respiratory function.
• Curvature of the neck disease: It, also known as torticollis, is a condition where the neck is tilted to one side and is evaluated according to the underlying cause.
• Hiatal hernia: This condition, which occurs when the stomach is positioned differently than its normal location, may be evaluated surgically depending on the child's symptoms.
• Gallbladder diseases: If gallstones or other diseases develop in the gallbladder, laparoscopic surgical treatment may be planned depending on the child's condition.
• Ureteropelvic stenosis: This is a narrowing of the passage between the kidney and the ureter, and when it affects urine flow, surgical treatment may be necessary.
• Urinary tract obstructions: Congenital or acquired strictures that impede urine flow in children are evaluated within the scope of pediatric urology.
• Varicocele: This is an enlargement of the testicular veins and may require monitoring or surgical treatment, especially during puberty, due to its potential impact on testicular development.
• Head and neck cysts: Congenital or acquired neck cysts, sinuses, and certain masses can be evaluated by pediatric surgeons.
• Lymph node and neck lesions: Masses, inflamed lymph nodes, or lesions in the neck area may require follow-up by pediatric surgery for diagnosis and treatment.
• Esophageal atresia: This is a congenital blockage of the esophagus and is one of the significant diseases requiring surgical treatment in the neonatal period.
• Intestinal atresias: This is a congenital blockage of the intestines and may require surgical intervention in the neonatal period.
• Anal atresia: This is a congenital closure of the anal opening and is evaluated within the scope of neonatal surgery.
• Diaphragmatic hernia: This occurs when abdominal organs pass into the chest cavity due to a congenital opening in the diaphragm and may require surgical treatment.

What diagnostic methods are used in the Pediatric Surgery Department?

In the Pediatric Surgery Department, the diagnostic process is planned by evaluating the child's age, complaints, physical examination findings, and possible causes of the disease together. While some surgical diseases in children manifest with clear symptoms, in some cases laboratory tests and imaging methods are used to clarify the diagnosis. These methods include:

• Blood tests: Provide information about infection, inflammation, fluid and electrolyte balance, and overall health; can be particularly helpful in cases of appendicitis and acute abdominal pain.
• Urine test: Used to evaluate urinary tract infections, bleeding, reflux, or other urinary tract problems.
• Stool test: Helps to investigate constipation, blood in the stool, intestinal infections, or other digestive system problems.
• Ultrasonography: A non-radiation imaging method frequently used to evaluate diseases of the abdomen, groin, testicles, ovaries, gallbladder, kidneys, and soft tissues.
• Plain radiography: Can be used to evaluate intestinal obstruction, foreign bodies, certain bone and soft tissue problems, and surgical conditions in the abdominal or chest area.
• Computed tomography (CT) scan: This may be preferred for abdominal diseases, traumas, tumors, or emergency surgical situations requiring more detailed imaging.
• Magnetic resonance imaging (MRI): Can be used for detailed evaluation of soft tissues, intra-abdominal masses, the pelvic region, and some congenital anomalies.
• Contrast imaging techniques: These help evaluate conditions such as narrowing, blockage, and leakage in the esophagus, stomach, intestines, or urinary tract.
• Endoscopic evaluation: This can be used to visualize the internal structure of the digestive system and, in some cases, to perform both diagnosis and treatment in the same procedure.
• Cystoscopy: This procedure allows for the examination of the bladder and urinary tract using a camera; it can be used to evaluate urinary tract strictures and some urological problems.
• Biopsy: In cases of suspicious masses, lesions, or tissue changes, a small tissue sample is taken for pathological examination to clarify the diagnosis.
• Pathological examination: Tissue samples are evaluated in a laboratory to determine whether the disease is benign, inflammatory, or of a different nature.
• Urodynamic evaluation: This is a specialized diagnostic method that can be used in children to examine bladder and urinary function.
• Nuclear medicine examinations: These can be performed in patients where deemed necessary to evaluate kidney function, urinary tract obstructions, or the functioning of certain organs.

What treatments are offered in the Pediatric Surgery Department?

Treatments in the Pediatric Surgery Department are planned using different methods depending on whether the disease requires surgical intervention. While regular monitoring may be sufficient for some diseases, in other cases open surgery, closed surgery, or endoscopic procedures may be applied.

Minimally invasive surgery

This includes surgical procedures performed through small incisions or with the aid of a camera, such as laparoscopic, thoracoscopic, endoscopic, and cystoscopic approaches. The goal is to provide a more comfortable recovery process for suitable patients.

Hernia surgery

This includes surgical treatment of inguinal hernias, umbilical hernias, hydroceles, spermatic cord cysts, and some types of congenital hernias. The treatment plan is determined according to the child's age, the type of hernia, and the severity of the symptoms.

Intra-abdominal surgeries

Surgical treatment includes appendicitis, intestinal obstructions, gallbladder diseases, pyloric stenosis, and some intra-abdominal masses. Open or laparoscopic methods may be used when necessary.

Digestive system surgery

This encompasses the treatment of congenital or acquired diseases of the esophagus, stomach, intestines, and anal region. Esophageal atresia, intestinal atresia, Hirschsprung's disease, anal atresia, and reflux surgery can be considered under this heading.

Pediatric urology surgeries

This includes the treatment of surgical conditions related to the urinary tract and genital area, such as hypospadias, vesicoureteral reflux, ureteropelvic stenosis, urinary tract obstructions, and varicocele. Treatment is planned according to the child's age, the severity of the disease, and kidney and testicular development.

Testis and scrotum surgeries

This includes the treatment of undescended testicles, testicular torsion, acute scrotum, hydrocele, and scrotal emergencies. Rapid assessment is particularly important in cases of sudden onset of pain and swelling.

Neonatal surgery

Neonatal care encompasses the treatment of congenital anomalies, intestinal obstructions, esophageal and anal opening problems, and diaphragmatic hernias. The treatment plan is determined by considering the baby's overall condition and organ development.

Head and neck surgery

This includes the surgical treatment of congenital or acquired neck cysts, sinuses, lymph node enlargements, and certain lesions in the neck region. The diagnosis and treatment plan are determined according to the location, size, and cause of the mass.

Skin and soft tissue surgery

Treatment includes cysts, abscesses, moles, lipomas, soft tissue masses, and some superficial lesions. Surgical removal, drainage, or pathological examination may be planned as needed.

Tumor surgery

Surgical diagnosis and treatment encompass the surgical diagnosis and treatment of various benign or malignant masses located in the abdominal cavity, chest cavity, or soft tissue. The treatment plan is determined based on the location, size, and pathological characteristics of the mass.

Trauma and burn treatments

This includes the treatment of cuts, puncture wounds, burns, and trauma-related conditions requiring surgical intervention. Depending on the severity of the child's injury, a dressing, repair, or surgical procedure may be planned.

Treatments for anal and defecation problems

This includes the treatment of anal fissures, rectal polyps, constipation, encopresis, and certain diseases that cause rectal bleeding. Treatment may be planned as observation, medication, endoscopic procedure, or surgical intervention, depending on the underlying cause.

Circumcision and genital procedures

This includes circumcision in newborns and children, as well as the treatment of adhesions, strictures, or healing problems that may develop after circumcision. Genital problems such as labial adhesions, which can occur in girls, can also be evaluated within this scope.