Category: Common surgical procedures

Everyone is born with a small opening in the abdominal muscles where the umbilical cord connects. This usually closes up on its own. When it doesn’t, depending on whether it is causing problems, your child’s doctor may recommend umbilical hernia surgery (herniorraphy). Here is some information about the procedure and what to expect if your child needs it.

How is umbilical hernia surgery performed in children?

Usually, a small incision is made below the belly button, and the contents within the bulge are pushed back into the belly. The hernia hole is closed using stitches. The extra skin in the belly button from the hernia is usually stitched in place and allowed to scar in place there. In children, patches or mesh are not usually used.

What happens before surgery?

You will be instructed not to give your child any solid food for 8 hours before surgery and to stop clear liquids (liquids you can see through, not formula or milk) 2 hours before surgery (ask your doctor’s office for specific times).

Will my child have any pain?

Your child may have some pain where the incision was made. Some surgeons inject numbing medicine at that area to control pain. Acetaminophen (Tylenol) and ibuprofen are usually enough to control the pain from an umbilical hernia surgery. Rarely, your child’s surgeon may give you a prescription for stronger pain medicine to use.

How soon after surgery can I be with my child?

As soon as your child wakes up after surgery, someone from the recovery room will call you, and you will be able to be with your child again.​

When can my child go home after surgery?

Umbilical hernia surgery is usually done as an outpatient, which means that your child will likely be able to go home the same day as the surgery. Rarely, an overnight stay may be required for your child’s safety depending on how your child is doing after surgery or if your child has other medical issues.

How do I care for my child at home after umbilical hernia surgery?

Instructions for home will be different depending on the hospital, surgeon, age of your child, and the actual surgery. Usually, most children are able to eat regular food after surgery, return to school in 3-4 days after surgery, and return to sports in 2-4 weeks after surgery. Your child’s surgeon will give you instructions specific for your child.

When should I call the office?

• Bleeding or drainage from the incision
• Redness around the incision
• Swelling around the incision
• Fever above 101° F
• Vomiting
• Worsening pain
• Less peeing or fewer wet diapers than usual

You will receive specific instructions for follow up with the surgeon when your child goes home after surgery.

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Some children have medical conditions related to their thyroid. This is an H-shaped gland at the base of the neck that makes hormones (chemicals in your blood). Thyroid hormone helps control metabolism, which is how quick or slow the body works. It involves temperature, heart rate, breathing, energy, sleeping, growth, gut, and many other parts of your body.

Your doctor may decide your child’s thyroid problem could be helped with surgery.

What are some common reasons for thyroid surgery?

Your child may see a thyroid surgeon for conditions such as:

• a lump (mass) in your thyroid
• an over-active thyroid (Grave’s disease) that is not better with medicine
• a big thyroid (goiter)
• cancer of the thyroid
• genetic conditions with a high risk of cancer (Multiple Endocrine Neoplasia or MEN Syndromes. These are rare.)

What will the thyroid surgeon need to know?​​

Your surgeon will ask you about your child’s medical history, your family history, and perform a physical examination. Make sure to tell your surgeon if your child has:

• Any lumps or masses in the neck
• Previous thyroid problems or thyroid surgery
• ​Medications including vitamins and supplements
• Family history of thyroid problems
• Family history of calcium problems, belly or brain tumors
• If your child previously had cancer, chemotherapy (medicine for cancer), or radiation

What kind of tests need to be done to see if my child needs thyroid s​​urgery?

​Labs

The surgeon will get some blood tests to see how your child’s thyroid is working. Is it working too much or too little? These results will help your child’s surgeon decide what kind of radiology pictures to order.

Radiology

• Ultrasound. A thyroid ultrasound is a test that uses sound waves to look at the size and shape of the thyroid and things around the thyroid. This is the same kind of US used for pregnant women.
• Radioactive iodine uptake scan (RAIU). This test shows doctors how well your child’s thyroid absorbs iodine. They can see if one part of the thyroid takes up more iodine than the rest of the thyroid.

These studies can help decide what kind of surgery is needed. Sometimes other types of radiology studies are also needed, and your child’s surgeon will talk to you about what those would be.​

Biopsy

• Fine needle aspiration. If your child has a lump in their thyroid, the surgeon may recommend a biopsy called a fine needle aspiration. This is a procedure done in the radiology room with or without sedation (relaxing medicine). A small needle is used to pull out some thyroid cells, which are checked under a microscope by a pathologist (a doctor who specialized in looking at cells). Risks of problems from having this biopsy are small but may include mild discomfort, bleeding or a need for repeat biopsy.

What should I expect the day of surgery?

If you and your child’s surgeon decide that surgery is the best treatment, your child will be scheduled for surgery to remove a part or all of your child’s thyroid. Your child will be given general anesthesia, which means they will be fully asleep for the entire surgery.

An incision is made on the front of your child’s neck in a crease in the skin. Part (lobectomy) or all (total thyroidectomy) of the thyroid is removed. Your child’s surgeon will take care to protect the tissue around the thyroid especially the parathyroid glands (calcium glands) and nerves near the thyroid. The incision is then closed with stitches and dressed with glue or medical tape.

Risks​​ and possible complications of thyroid surgery include:BleedingInfectionDamage to things near the thyroid like the nerve to the voice box (recurrent laryngeal nerve) or the calcium glands (parathyroid gland)Low to very low calcium requiring medication – this can be for a few days, weeks, months, or years Risk of lump coming back (recurring) ​​

What should I expect after surgery?

Recovery Room

As soon as your child wakes up after surgery, someone from the recovery room will call and take you to be with your child again. It may take a while for the anesthesia to wear off. Once awake, your child can eat and drink. Nausea after surgery is common. Depending on the extent of surgery, your child may stay in the recovery room for a couple of hours or your child’s surgeon may want to monitor your child overnight in the hospital.

Your child may have some pain at the incision. Sometimes surgeons inject numbing medicine under the skin to help control pain. Your child will also be given pain medicine.

Your child may have a sore throat from the breathing tube used for anesthesia during the surgery. That should be mild and go away in a day or two.

​How do I care for my child at home?

• Know how to care of your child’s wound.
  • Help your child avoid picking, scratching or pulling at the incision.
  • No swimming until the skin has healed.
  • Discuss with your child’s surgeon when your child can bath normally (usually within a day or two)
• Understand any activity restrictions after surgery.
  • After anesthesia, your child may feel sleepy or dizzy for a few hours. Limit their activity on the day of surgery. Do not let them drive, bike, or operate motorized vehicles (ATVs, golf carts, boats, scooters, etc.) The next day, your child can resume normal activities as tolerated.
  • No contact sports allowed right after surgery. Your child should avoid being punched or kicked in their incision so the incision will heal well.
  • Your child can return to work/school in about 2-7 days – it is up to your child’s surgeon.
• Give medicines as ​directed.
  • Pain medicine. Usually acetaminophen not more often than every 4 hours for a day or two
  • Calcium medicine. If the calcium in your child’s blood is low, the surgeon may want your child to take calcium to keep that level normal.
  • Thyroid hormone. If your child’s entire thyroid is removed, your child will need to take thyroid hormone every day. This is very important for their body’s energy and metabolism. Make sure they take the medicine as directed. Your child should never decide on their own to stop taking medicines.
• Make any needed follow-up appointments.
  • Follow up with your child’s surgeon as directed, usually in 1-4 weeks. Your child may need some blood work at that visit to check the amount of thyroid hormone and/or calcium in their blood.
  • Your child’s surgeon may also refer your child to an endocrinologist (thyroid medical doctor) to follow the thyroid hormone level for a longer time.
• Know how to reduce the appearance of scars.
  • You may use sunblock over your child’s incision after the wound has healed (talk to your child’s surgeon). Do not put sunblock on before the wound heals – it may hurt or turn red and get irritated. After the skin is healed, sunscreen will help prevent the wound from leaving a darker scar. Keep using sunscreen on the wound for the first year after surgery, especially when the scar is exposed to a lot of sun.
  • After your child’s wound has healed, gently massaging the scar may help fade its appearance.​
  • You may also consider using over-the-counter ​silicone gel or tape to help fade the scars. Once the wound has healed, apply twice a day for 3 months. ​

When should I​ call the surgeon’s office?

Be sure to call the surgeon if your child has:

• A lot of swelling or bleeding from the incision
• Redness or drainage from incision. This could be a sign of an infection.
• Fever greater than 101.5 (38.5 degrees Celsius). This could be another sign of an infection.
• Numbness or tingling around lips or fingertips. This could be a sign of low calcium.​

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Cholecystectomy is a type of surgery to remove the gallbladder​, a small, hollow organ that stores digestive fluids. It is one of the most common surgeries among U.S. adults.  A growing number of children also have the procedure.​

Conditions it tr​​eats

• Gallstones causing blocked digestive fluids and swelling in the gallbladder (cholelithiasis)
• Gallbladder that isn’t working well (biliary dyskinesia)

How is gallbladder surgery perfor​​​med in children?

Laparoscopic surgery. Gallbladder surgery is usually done using a video camera and small incisions. There are usually between 2 and 4 incisions, each less than 1 cm in length. The stones and the gallbladder are removed in this surgery.

Cholangiogram. This may be performed as part of the operation if the surgeon feels it is necessary. It is done by putting dye into the bile ducts and taking x-rays of those ducts to see if there are stones stuck in them.

Open surgery. Sometimes there is too much infection around the gallbladder and it is not safe to do the surgery laparoscopically. If this happens, your surgeon may need to do the surgery with one bigger incision.

What happens before s​urger​​y?

Doctors will want to make sure your child is as healthy as possible before surgery. If there is infection in the gallbladder, your child may be given antibiotics before surgery. For children with sickle cell anemia, blood transfusions may be needed before surgery to prevent a sickle cell crisis.

Patients are usually asked to take a shower or bath the night before surgery. Your child will also need to stop eating or drinking for at least a few hours before surgery.

When can my ch​​ild go home after surgery?

If your child has laparoscopic surgery, they likely can go home the same day as the surgery, or the next. If a bigger incision and open surgery is needed, your child may need to stay in the hospital up to 5-7 days.

How do I care for my child at home after gallbladder​​​ surgery?

Taking care of the wound. Wounds should be kept clean and dry for 2 days. Most of the time, the stitches used in kids dissolve on their own and do not require removal. Your surgeon will give advice about how to care for the wounds.

Limit activity while healing. Your child should avoid intense activity and avoid heavy lifting for 2 weeks after a laparoscopic surgery, and 4-6 weeks after open surgery.

Diet. Most children can eat a normal diet after surgery. Sometimes, eating lots fatty foods may cause nausea, bloating, cramping and watery stools. These problems will likely go away in a few months as the body adjusts to not having a gallbladder.

Medicines your child may need to take. For a few days after surgery, Tylenol or ibuprofen may be used for pain. Sometimes, your doctor will give you a stronger pain medication to help with pain for the first few days after surgery. It is common for children to have constipation after surgery (trouble passing a stool). If this happens, your child may need to take medicine to make their stool soft.

Problems to watch for during recovery. Call your doctor if your child’s pain gets worse, has a fever, vomiting, yellowing of the eyes or skin or if the wounds are red or draining fluid.

What are possible complications with gal​​lbladde​r surgery?​

• Bleeding
• Infection​
• Injury to the ducts draining the liver
• Injury to the blood vessels of the liver
• Leakage of bile from the ducts

These complications are rare, happening in less than 1% of surgeries. Your surgeon can discuss these with you.

When will my child need to see the doctor again?

Children who have had gallbladder surgery will need to see the surgeon 2-3 weeks after surgery to make sure they are healing well. They should also continue to see their pediatrician regularly.

What is the long-term outlook after surgery?

The long-term result is excellent after surgery. Rarely, some people may feel bloated or have loose stools after eating fatty foods after their gallbladders are removed. This is usually temporary. See your pediatric surgeon if your child experiences these symptoms.

An appendectomy is surgery to remove the appendix, a small, pouch-like organ attached to the colon. Your child may need an appendectomy if the appendix becomes infected. An infection of the appendix is called appendicitis.

How is an appendectomy be performed?

Your doctor will discuss the surgery type with you. Surgery to remove the appendix can be done with a single incision on the abdomen. Surgery can also be done with small incisions using a camera and small surgical instruments (this is called laparoscopic surgery). Either type of surgery (open or laparoscopic) could be used to remove the appendix. These days, many surgeons use laparoscopic surgery to remove the appendix because the incisions are smaller and your child will have less pain.

First, your child will be prepared for surgery. They will receive fluids in their IV and antibiotics to treat the infection of the appendix. Fluids and antibiotics are important to make sure your child is ready before surgery.

Your child will not be allowed to eat or drink anything for many hours before surgery. They cannot have any water, ice, chewing gum or anything else to eat or drink. This is because the stomach needs to be completely empty when they go to sleep with anesthesia.

How long will my child be in the hospital?

If your child’s appendix did not burst (not ruptured), then the infection was mild. It may be possible that your child goes home very soon after surgery. Your child may not need any more antibiotics or other medicines. Your child will be able to drink and eat.

If your child’s appendix did burst (ruptured), then the infection is more serious. Your child will be kept in the hospital for recovery. During recovery, your child will be given more antibiotics through their IV. They will be given liquids then solid food to eat when they feel better. They may be in the hospital for days after surgery. Once they have recovered, have no more fevers and are able to eat, your doctor will tell you when they can go home.

What do I need to do for my child when they go home?

Your child will be encouraged to walk around as soon as possible after surgery. They may have a normal diet after surgery.

• Activities my child can do. Your child should avoid heavy lifting or strenuous activity for 1-2 weeks after surgery. They can return to school once they are not needing medicines for pain and have energy.

• Taking care of the wound. The bandages should be kept on the incision for a few days after surgery. The bandages should also be dry and clean. The stitches used on the inside during surgery are usually the type that do not need removal. Your doctor will give you specific instructions.
• Medicines my child may need to take. Your child may need mild pain medicine like acetaminophen or ibuprofen. They should be taken as described on the bottle if needed for pain. If your doctor gives your child stronger medicines for pain, there will be specific instructions for how it should be given. Some children will need antibiotics too and your doctor will give them if necessary.

When should I call the doctor?

You should call your child’s doctor if your child develops a fever, pain in the belly, vomiting, diarrhea or if the wounds look red or drains fluid. Sometimes children can have problems related to surgery for the appendix, which your doctor can check for and treat. Any problems typically happen soon after surgery. Examples include a wound infection, abscess, or bowel blockage.

• Wound infection. This is when an infection forms at one of the surgery incisions. The incision will appear red, be painful to your child, and possibly drain pus or liquid. This may need treatment with antibiotics or drainage. You should call your child’s doctor if you see redness or drainage at one of the surgical incisions.
• Abscess. An abscess is a pus pocket that can sometimes form inside the abdomen. An appendix that had burst is a more serious infection and more likely to cause an abscess. If your child develops fevers, new belly pain or vomiting, you should call their doctor. Your child’s doctor may order tests to determine if there is an abscess after surgery to remove the appendix. If an abscess is found, your child may need more antibiotics or drainage of the pus.

A​re there lasting effects from appendectomy?

After surgery to remove the appendix, your child will return to normal. The appendix is not a vital organ, so your child will continue to grow up and be healthy without an appendix.