Pediatric surgical conditions and key insights for their care

Undescended Testis

• • Any undescended testis can spontaneously descend to the scrotum until six months.
  • If not descended, surgery is suggested between 6 months to 1.5 years.
  • For undescended testis, surgery is done either in a “Single stage” or a “2- staged procedure” 6 months apart.
  • Depending on the location of the testis, the decision regarding “Single stage”, or “2-staged” surgery is made during surgery.
  • The earlier the surgery, the better the chances of maintaining the fertility of the testis.

Inguinal hernia

• • All inguinal hernias require surgery- there is no such thing as conservative management for inguinal hernia.
  • The aim is to operate as early as possible to prevent complications like irreducibility and obstruction.

Umbilical hernia

• • Umbilical hernias can usually be managed conservatively until at least two years of age, as there is a chance of spontaneous defect closure.
  • If the defect is more than 2 cm in size and does not resolve by age two, surgical repair is performed.

Hydrocoele

• • A hydrocele can resolve spontaneously by 1.5 years of age. If not resolved by then, it requires surgical repair.
  • “Traumatic hydrocele” is nothing but a congenital hydrocele swelling that has been noticed after the injury.
  • There is no chance of any damage to the testis by compression from the hydrocele, even if the swelling is increasing in size (the stretching of the lax scrotal skin dissipates the pressure from the increasing swelling).

Phimosis

• • More than 50% of new born boys have physiological phimosis, which can resolve spontaneously by two years of age.
  • Surgery is indicated if the patient has symptoms like dysuria, ballooning of prepuce, or urinary tract infections.
  • Prepucioplasty is a foreskin-saving surgery that can be done to treat phimosis in young boys in the early stage of phimosis.

Cholelithiasis

• • The incidence of gallbladder stones in children is increasing, presumably due to an increase in junk food diets among children in recent years.
  • Cholecystectomy is recommended for patients having symptoms like recurrent upper abdominal pain and dyspepsia, along with ultrasound findings of multiple gall bladder stones or a single large stone.
  • In some select patients, treatment with medications (to dissolve the stones) can be tried. If the stone does not dissolve, the patient is advised surgery.
  • In any case, in patients with gallstones with symptoms lasting for more than one year, cholecystectomy should be done to prevent long-term chances of carcinoma of the bladder.