Minimally Invasive Surgery

Types of Minimally Invasive Paediatric Surgery performed by Dr Florence Ngu

The commonest cause of gallstones in children a blood cell abnormality but now cholesterol stones are becoming more common. If they are causing symptoms such as pain, nausea, vomiting, jaundice, dark urine or pale stools; then a laparoscopic cholecystectomy is indicated to prevent complications such as cholecystitis, cholangitis or pancreatitis.

This operation is performed as a keyhole (laparoscopic) operation. There is usually a one to two night stay afterwards. After the operation, normal diet is permitted. The keyhole wounds are closed with dissolving stitches which are under the skin and don’t need to be removed. They will be covered with a waterproof dressing which stays in place for 1 week. Normal baths or showers are permitted after 48 hours. Return to daily activities at 1 week but sports at 3-4 weeks.

Gastro-oesophageal reflux is the reflux of stomach acid and stomach contents into the oesophagus. In children the symptoms can usually be managed by avoiding dietary triggers  or with medication that decreases the acid production by the stomach. However if the reflux is proving elusive to these measures, or causing damage to the oesophageal lining as confirmed on oesophageal biopsies obtained via endoscopy, then surgery to minimise reflux may be indicated.

This surgery wraps the top of the stomach around the base of the oesophagus to reinforce the sphincter muscles there which normally prevent reflux. It is performed laparoscopically (keyhole surgery). There is usually a 2-4 night stay in hospital afterwards. Initially a puree diet is recommended for two weeks and then a soft diet for the next two weeks. The anti-acid medication is weaned down.

There are a number of reasons a child may require a feeding gastrostomy. This is a port placed through the abdominal wall into the stomach that allows for feeding directly into the stomach. It is often more convenient than feeding via a nasogastric tube.

The feeding port is placed laparoscopically, via keyhole surgery. There is usually a one to two night stay after the operation primarily so the parents or caregivers can get used to using the feeding apparatus.

The usual formula that was previously given via the nasogastric tube is fed through the gastrostomy.  The keyhole wounds are closed with dissolving stitches which are under the skin and don’t need to be removed. They will be covered with a waterproof dressing which stays in place for 1 week. Normal baths or showers are permitted after 48 hours. Water activities such as hydrotherapy are permitted after two weeks.