Pediatric surgery is a special field. Caring for kids from birth to adulthood and providing the family the support, education and comfort they need is an honor and privilege. After coming to Children's Hospital Los Angeles (CHLA) 20 years ago, I've been able to offer families care in the complex environment of CHLA or support them in one of the surrounding hospitals when the child's condition and needs can be met there. I also see patients at CHLA's Arcadia Outpatient Center. As a pediatric surgeon, my focus has become oncology caring for the most complex types of childhood tumors from around the globe, but I remain dedicated to my roots of neonatal and pediatric general surgical care- hernias, chest wall deformities (pectus excavatum and carinatum), lung abnormalities and of course newborn surgery. Here are a couple common problems your kids may face.
Chest Wall Deformities
Pigeon chest, or sunken chest, is the common term to describe the two common types of chest wall deformities. The medical terms are pectus excavatum (sunken) and pectus carinatum (pigeon). The treatment has evolved over time and now pectus ecavatum is treated most commonly with a bar introduced through a small incision on the side of the chest and out the other side to elevate the breast bone to a more normal position. This condition generally becomes more obvious in teenage years with a growth spurt, but following surgery an increased exercise tolerance and elevated self-esteem are the result. Most commonly this procedure gets done at time when the teens can take off time to allow for adequate recovery.
Pectus carinatum or a protruding breast bone (sternum) is now almost always treated with bracing so what was once a significant surgery now is much less invasive as CHLA has partnered with our brace maker to allow correction with a simple brace worn under a tee-shirt for a period of months to achieve a normal appearing chest.
Hernias and hydroceles
The common occurrence in kids of swelling in the groin or along the testicle in a boy can be one of two things -- a hernia- in which the intestine or sometimes the ovary in a girl pushes out into the groin or even down in to the scrotum. A hydrocele (hydro= water) is instead a condition in which the opening is small or tiny and only fluid can fill the area and cause an enlarged scrotum (this does not occur in females). A hernia should be repaired in a timely fashion to avoid the intestine, testicle or ovary getting stuck or injured. A hydrocele does not have that same risk, so this can be observed if not causing other issues for resolution until the age of two or so as many will resolve. The good news is these are outpatient procedures with little or no discomfort unlike the adult counterpart.
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