Dr Vijay Kundal

When your child needs medical attention, you want him or her to have the very best care available with the pediatrician. Similarly, when your child needs an operation, you want to consult a surgeon who is qualified and experienced in operating on children. Surgeons who specialize in general surgery often provide surgical care for children, and they perform many operations on children. But with the development and availability of superspeciality services at the door steps, another kind of surgeon-the Pediatric surgeon-is trained to provide comprehensive surgical care for children. Paediatric surgeons operate on children whose development ranges from the newborn stage through the teenage years.

Today is Paediatric Surgery Day

Role of Paediatric surgeon in treating the child
Pediatric surgeons are primarily concerned with the diagnosis, preoperative, operative, and postoperative management of all the surgical diseases in children. Some medical conditions in newborn babies are not compatible with a good quality of life unless these problems are corrected surgically. These clinical conditions must be diagnosed early by neonatologists, paediatricians. Pediatric surgeons cooperate with all of the specialists involved in a child’s medical care to know whether surgery is the best treatment option for the child.
Scope of Paediatric surgery
Paediatric surgeons utilize their expertise in providing surgical care for all problems or conditions affecting children that require surgical intervention. They participate in transplantation operations, and like most surgeons today, they use laparoscopic techniques for some operations. They also have particular expertise in the following areasof responsibility:
Neonatal- Paediatric surgeons have specialized knowledge in the surgical repair of birth defects, some of which may be life threatening to premature and full-term infants. Important ones include spinal cord defects, anorectal defects, intestinal atresias, genito-urinary birth defects, hydrocephalus.
Fetal Surgery- Paediatric surgeons, in association with radiologists, use ultrasound and other technologies during the fetal stage of a child’s development to detect any congenitial abnormalities. They can then plan corrective surgery and educate and get to know parents before their baby is born. Prenatal diagnosis may lead to fetal surgery, which is a new forefront in the subspecialty of pediatric surgery.
Trauma- As trauma is the number one killer of children in India, paediatric surgeons are routinely faced with critical care situations involving severe traumatic injuries sustained by children that may or may not require surgical intervention. Many pediatric surgeons are involved in accident prevention programs in their communities that are aimed at decreasing traumatic injuries in children.
Paediatric Oncology-Paediatric surgeons are involved in the diagnosis and surgical care of children with malignant tumors seen exclusively in children like kidney cancer(Wilms tumor), Neuroblastoma, hepatoblastoma(liver tumor), soft tissue cancers, teratomas.
Paediatric surgeons training and certification in India
Paediatric surgeons must have graduated from Institutes of National Importance or National Medical Commision recognised medical institutions and must have completed five and half years of MBBS degree. Then, they must have completed three years of full-time training course of masters degree in general surgery from a recognised institute. This is followed by approved further three year Mch training program in paediatric surgery(post doctoral course). Following completion of their three-year study in the subspecialty of pediatric surgery, they must pass a written examination to ensure that their surgical knowledge is of the highest level and an oral exam to determine their ability to manage a variety of surgical problems in infants and children. After these requirements have been fulfilled, surgeons are granted a special certificate in the subspecialty of paediatric surgery.
What difference can a Paediatric surgeon make
Children are not little adults. The pathophysiology of their complicated congenital defects requires very special surgical management. As per the Kyoto Declaration of WOFAPS in 2002, all the newborns, infants, and children deserve to be treated only by experienced and qualified medical personnel. Paediatric surgeons are specialized persons who are trained and are oriented toward working with children and understanding their special needs. Paediatric surgeons are specially trained to do surgery on very small babies (even weighing less than 1.5kg) and can deal with small anatomical structures delicately. In addition, they work with various specialists who are also oriented toward children and toward providing high-quality, safe, and emotionally supportive care for their patients.
When a Paediatric surgeon performs an operation, it is the culmination of an orderly and detailed process involving Paediatricians, physicians, and other medical specialists who work together to treat the whole child. For pediatric surgeons, one of the most satisfying and fulfilling aspects of their profession is that the majority of their patients will live long into the 21st century. Most of the specialities of medical science quote 5- 10 year survival rate for there patients, but the Paediatric surgeon have there patients who have survival rate of 60-70 years. Pediatric surgeons are able to save whole lifetimes, and have the opportunity to follow their patients through a productive young life into adulthood.
(The author is Additional Professor Paediatric Surgery AIIMS, Jammu)

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