Paediatric Surgery and Urology treatments
We carry out general surgical procedures for conditions common in childhood including hernia, hydrocele (a build up of fluid in a body cavity), orchidopexy (undescended testes), circumcision and appendicitis.
For newborn babies we also carry out surgery for:
- Gastroschisis - a defect of the abdominal wall that causes babies to be born with their intestines outside the body
- Oesophageal atresia - a defect that means the upper part of the oesophagus doesn't connect with the lower oesophagus and stomach
- Tracheoesophageal atresia - an abnormal connection between the esophagus (the tube that leads from the throat to the stomach) and the trachea (the tube that leads from the throat to the lungs)
- Congenital diaphragmatic hernia (CDH)
- Exomphalos - a weakness in a baby's abdominal wall that allows the abdominal contents to protrude
- Intestinal atresias - blockages in the intestine
- Malrotation and volvulus - malrotation occurs when the bowel forms in the wrong place. Volvulus is a complication of this that occurs when the bowel twists and the blood supply through it is cut off
- Anorectal malformations
- Hirschsprung’s disease - a disorder of the bowel that can lead to severe constipation
- Pyloric stenosis - a narrowing of the opening between the stomach and the intestine that can cause projectile vomiting in babies
Further information on these conditions and support for families can be found on these external links:
Our Urology department provides a number of general and specialist urology services. General paediatric urology provided by all of our consultants includes the management of childhood conditions such as groin hernias, undescended testes, hypospadias (a common condition where the penis opening can appear in the wrong place). They also provide investigation and management of hydronephrosis (a condition where the kidneys become stretched due to a build up of urine).
Our consultant surgeons Mr Liam McCarthy, Mr Andrew Robb and Mr Karan Parashar provide specialist care to children with complex bladder problems. This can include video urodynamics (a test that measures pressure inside the bladder), bladder augmentation (a procedure to enlarge the bladder) and formation of Mitrofanoff channels (a procedure that allows the bladder to drain via a tube through the abdomen). Underlying conditions include posterior urethral valves (an obstructing membrane in the urethra) and spina bifida (a condition where the spine does not develop properly in the womb).
Care of children with urinary tract stones is undertaken by Mr Harish Chandran and Mr Robb. They use lithotripsy (ultrasound) to break up stones and also laparoscopic (keyhole) or endoscopic (minimally invasive) surgery to remove the stones. The decision on which type of management a child needs is taken depending on the size and location of the stone(s), along with the underlying cause of stone formation. This is a service which is provided jointly with our nephrology colleagues.
We have a large renal transplant service within the hospital and perform between 12 and 20 kidney transplants per year. This service is provided via a multi-disciplinary approach including paediatric urology (Mr McCarthy and Mr Robb), the liver transplant team (Mr Khalid Sharif and Miss Evelyn Ong), paediatric nephrology and adult renal transplant services from the Queen Elizabeth Hospital, Birmingham.
Disorders of sexual development are also managed within our team. This service is provided by a multi-disciplinary team including paediatric urology, paediatric endocrinology, genetics, clinical psychology and adolescent gynaecology. The surgical support is provided by Mr Chandran and Mr McCarthy.
All of our urologists will care for children with congenital conditions of the kidney and ureter. Occasionally this involves a need for surgery and all surgeons in the department perform laparoscopic (keyhole) surgery in addition to open procedures. Mr Chandran is the lead consultant for the laparoscopic approach. He is a pioneer in the UK for using keyhole surgery in the treatment of children’s urological conditions, in particular nephrectomy (removal of a kidney), heminephrectomy (partial removal of a kidney) and pyeloplasty (an operation to remove a blockage in a ureter that is causing pressure in the kidney).
Minimally invasive (keyhole) surgery
Minimally invasive surgery - also known as keyhole surgery - is a major part of our work in the department of Paediatric Surgery and Urology. We have a state-of-the-art laparoscopic operating theatre with complete integration of cameras, high definition screens, lights and recording facilities. All of the consultant surgeons are highly-trained in the use of these cutting-edge techniques and several are part of national and international training programs to educate other surgeons. Many recognised keyhole operations were pioneered by our consultants at the Children’s Hospital.
Keyhole surgery can offer major benefits including smaller scars, less post-operative pain, quicker recovery, shorter stays in hospital and better long-term cosmetic results. Not all operations, however, are best treated with keyhole surgery. All of our consultant surgeons are fully trained in both keyhole and open surgical techniques and will know which approach will be most beneficial to a child. They will discuss this with families in detail prior to the operation.
Oncology (cancer) surgery in children
Management of cancer in children is very much a team approach involving oncologists, surgeons, radiologists, pathologists, radiation oncologists and specialist nurses. The surgical oncology unit has three surgeons, Mr Suren Arul, Mr Ingo Jester and Mr Max Pachl. Surgery is mainly done on tumours arising from the chest, abdomen, pelvis and neck. This is one of the biggest units in the country covering approximately 10% of the UK population. Common children’s tumours that require surgery include Wilms' tumours (a type of kidney cancer), neuroblastoma (a cancer that forms in nerve tissue), rhabdomyosarcoma (a cancer that usually begins in muscles attached to bones) as well as many less common tumour types. In addition to the resections we are involved in taking biopsies (taking a small section of the tumour for analysis to make a diagnosis) and inserting semi-permanent central lines to allow the patients to have their chemotherapy. Fighting cancer involves jumping many hurdles, only one of which is the surgery, however, this is a big day for the child and their parents. Read ‘A day in the life of an oncology surgeon’.
The thoracic surgical team has three consultants with a special interest in this surgery – Mr Parikh, Mr Singh and Mr Soccorso. They run a specialist clinic for thoracic surgical conditions (congenital lung lesions and the chest wall deformities pectus excavatum and pectus carinatum). They have pioneered the role of minimally invasive surgery in thoracic surgery in children in the UK.
Lower gastrointestinal, inflammatory bowel disease and non-transplant intestinal failure surgery
In older children, we work closely with our colleagues in Gastroenterology to facilitate surgical management of inflammatory bowel disease. This is mainly carried out by minimal access surgery in order to minimise the cosmetic and scar tissue complications of this type of surgery.
In addition, both Mr Jester and Mr Lander carry out surgery for intestinal failure. This involves the lengthening of the remaining intestine using specialist surgical techniques. We have a recognised intestinal failure service and surgery is carried out following meetings between all the relevant specialists. In addition to patients from the West Midlands, we accept referrals from other children’s hospitals in the UK.