General Paediatric Surgery

Paediatric General Surgery conditions & procedures

An inguinal hernia presents as a lump in the groin area. It is a protrusion of the abdominal contents through an abnormal opening into the groin. This abnormal opening is usually caused by the failure of closure of the passage which allows the developing testicle to descend from the abdomen into the scrotum. This is why it is more common in boys although it is also seen in girls (the passage way is still present - there is just no testicle to descend through it). The open passage way allows for a loop of intestine, or in girls sometimes the ovary, to bulge into the groin and may become stuck. Surgery is always required to repair a hernia. In young babies, this needs to be performed soon after it is diagnosed as the risk of getting stuck is highest in this age group.

After the operation please keep your dressing dry for 48 hours. The dressing can be removed after a week. The stitches dissolving stitches - all underneath the skin and don’t need to be removed. Return to normal activities in two weeks.

A hydrocele is a collection of fluid around a boy’s testicle. It is very common in baby boys and is due to a persistent opening of the passageway that allowed the developing testicle to descend from the abdomen into the scrotum. Usually the passageway will close and the hydrocoele will self-resolve by 2 years od age. If the hydrocoele has not significantly reduced in size, or resolved by this time; then it is reasonable to consider surgical repair as the chance of self-resolution becomes less.

After the operation please keep your dressing dry for 48 hours. The dressing can be removed after a week. The stitches dissolving stitches - all underneath the skin and don’t need to be removed. Return to normal activities in two weeks.

Umbilical herniae are very common in healthy babies and usually resolve by the age of two years. If they are not significantly smaller, or closed, by then, then a surgical repair is recommended.

After the operation keep the dressing dry for 48 hours. The dressing can be removed after a week. The stitches dissolving stitches - all underneath the skin and don’t need to be removed. Return to normal activities in two weeks.

An epigastric hernia is a swelling that is halfway between the umbilicus (belly button) and bottom of the rib cage. It is caused by a tiny opening in the muscle fibres deep to the skin. If it is causing pain or enlarging in size then it can be surgically closed.

After the operation please keep your dressing dry for 48 hours. The dressing can be removed after a week. The stitches dissolving stitches - all underneath the skin and don’t need to be removed. Return to normal activities in two weeks.

There are a number of conditions why a boy might have a testicle that is not in their scrotum. They may have an undescended testicle, a retractile testicle, or an ascending testicle.

Undescended testicle

In normal development, a baby boy’s testicle develops inside their abdomen but descends into their scrotum by birth. If at birth, the testicle is high, there is still a possibility that it may descend in the first three months. After this time, descent is unlikely and an operation called an orchidopexy is recommended to bring the testicle in the scrotum and fix it in place. This is to maximise the hormonal and fertility functions of the testicle and minimise the risk of malignant transformation later in life. In this scenario, the operation is ideally performed in the first year of life.

Retractile testicle

This is a very common condition where the one or both testicles may not be seen or felt in the scrotum - except when the boy is relaxed, in a warm room, or in a warm bath. This is because the cremaster muscle in the scrotum is very active in young boys and will contract to pull the testicle up into the body where it is a warmer temperature. An operation is not needed as long as the testicle can be gently milked into the scrotum and remains there for at least a short period of time (this can be tricky to do and is best done by a doctor). However, ongoing follow up is recommended to make sure it doesn’t become an ascending testis (explained below). If the testicle can’t be milked into the scrotum or feels very tight when doing so, then an orchidopexy is recommended.

Ascending testicle

This is a condition when the boy was born with his testes descended in his scrotum; however with growth the testicle has become high. It is too high to manipulate into his scrotum and so an orchidopexy will be required to ensure his testis continues to develop in the correct environment - the scrotum.

Postoperative instructions

There will be skin glue as the dressing on the scrotal incision and a waterproof dressing on the abdominal/ groin incision. Please keep both dry for 48 hours. Allow the skin glue on the scrotum to flake off by itself. The waterproof dressing on the abdomen can be removed after a week. The stitches are dissolving and don’t need to be removed.

There are a number of reasons why a boy might have a circumcision. The commonest medical reasons are recurrent infections of the foreskin called balanoposthisis; an underlying kidney abnormality which predisposes to recurrent urinary tract infections; or a scarring condition of the foreskin called balanitis xerotica obliterans.

After the operation, a small row of dissolving stitches will be visible if you look carefully. They will fall away themselves. Showers are fine to be resumed 48 hours after the operation. The dressing is an antiseptic ointment applied generously, several times a day. Please place a liner (such as a pantyliner) in your boy’s underwear and lather Vaseline onto the liner to prevent the head of the penis from catching on the underwear. Continue this for two weeks. Return to normal activities at two weeks.

The vast majority of skin lesions in children are benign. However your child’s GP or dermatologist may suggest surgical excision if they are causing complications such as infection, bleeding, or if they are growing or changing rapidly and so causing concern. Common skin lesions include naevi (moles) that are changing rapidly or have concerning features; pilomatrixomas which will continue to grow and may erode through the skin; dermoid cysts that will continue to grow and possibly become infected; or pyogenic granulomas that cause troublesome bleeding.

After the operation please keep your dressing dry for 48 hours. The dressing can be removed after a week. The stitches are dissolving stitches - all underneath the skin and don’t need to be removed. Return to normal activities will depend on the part of the body where the skin lesion was removed from. If it was removed from an area that undergoes a lot of movement such as near a joint then this may be two weeks. If it is from an area that has minimal movement such as over the eyebrow then return to normal activity will be likely be the day after surgery (other than water sports which is two weeks).

Ingrown toenails most commonly affect the big toe. A tiny spur of the edge of the nail presses against the skin causing it to break down and become infected. When conservative measures such as proper nail care and soaks are not effective, then surgery to remove the offending nail edge may be required.

After the operation please keep your legs elevated for 48 hours. Your dressings need to stay dry and intact for a few days until you return to Dr Ngu’s rooms for a change of dressing. After this, you will still require a simple protective dressing for two weeks and then you should be able to return to normal activities.

Perianal fistulas are very common in the first year of life and especially in boys more than girls. They are thought to arise from a blocked mucous gland in the lining of the anus. They can often be managed with antibiotics but if they are associated with an abscess then this may require surgical drainage. The fistula will often spontaneously resolve after a few months but if persisting then may require surgical excision. This leaves a raw surface which heals over 2 weeks. During this time, nappy cares are as per normal but with the addition of twice daily salt baths.