General Paediatric SURGERY

Antenatal Counselling

Antenatal ultrasounds can detect a number of abnormal conditions in your foetus that may require surgery when your baby is born. Your obstetrician can advise you if it is appropriate to meet with one of our team at Sydney Children’s Surgery before the birth of your child.

You will want to get as much information as possible once you are aware that there is a possible problem with your baby. Dr Dilley and Dr Russell provide an antenatal counselling service whereby they can explain what to expect at the time of your child’s birth, and what is likely to happen afterwards.

Conditions that may be detected before your child’s birth include:

Abdominal wall defects such as gastroschisis or exomphalos
Blockages of the bowel such as duodenal atresia or small bowel atresia
Congenital diaphragmatic hernia
Cysts in the body such as cysts in the lung and chest, the abdomen or ovaries

Hydrocoeles

Hydrocoeles occur when fluid has pooled around the testicle, making it look and feel bigger. The size can change over the course of the day, bigger or smaller. Hydrocoeles can get better on their own. In some cases, surgical intervention is required. Hyrocoeles do not usually cause pain or discomfort.

After your consultation, you will have an understanding of what a hydocoele is and what to observe over time, and when/why surgery would be indicated.

Hypospadias Repair Surgery

Hypospadias is a relatively common condition affecting around one in 250 males in Australia. It presents with varying degrees of severity, and a number of different procedures have been described to correct it – for these reasons it can be difficult for parents to find information relevant to their child on the internet.

While most hypospadias repairs are intended to be successful at the first procedure, up to 15-25% of boys may require further a further procedure to achieve the desired outcome.

Most boys under 18 months of age are unaware that their penis is ‘different’ to other parts of their body, it is recommended therefore that correction be complete by then while they are relatively unaware.

Inguinal Hernia

An Inguinal hernia appears as a lump that may come and go in the child’s groin. Sometimes the lump can enter into the scrotum in boys or into the labium in girls. Inguinal hernias occur when there is an abnormal opening in the abdominal wall.

Inguinal hernias are common and may occur at any age in children. They rarely go away on their own. The younger the child, the more likely the hernia can become stuck or ‘irreducible’. The best management of an inguinal hernia is surgical repair.

Umbilical Hernia

An umbilical Hernia is an abnormal bulge that can be seen or felt at the umbilicus (belly button). These hernias are common in babies. Umbilical hernias occur when the small opening in the abdominal wall at the umbilicus has not closed. This closure may happen naturally and in some cases surgical intervention may be indicated.

Undescended Testes Procedure

Most testes are easy to see and feel after a boy is born. If a testis is not descended at birth, it will be in a normal position by around three months of age if it is going to come down spontaneously. If this has not happened, then surgery to bring it down is usually best carried out between six and twelve months of age.

It is not unusual for toddler males to have ‘difficult to locate’ testes. In most cases they turn out to be retractile (which is normal) and no operative intervention is needed.

It can be difficult to determine that the testis is retractile rather than undescended, and given the desirability of ensuring both testis are in the scrotum by a year of age, your family doctor may recommend review by a paediatric surgeon to ensure that everything is okay.

Less commonly the testis can be observed over a period of years to be sitting progressively higher in the scrotum (the acquired undescended testis or ascending testis), for boys in this situation surgery often occurs at around five or six years of age.

Correction of improperly positioned testes is usually a day surgical procedure. Less commonly, if the testis is within the abdomen, two procedures may be required to maximise the likelihood of a successful relocation.

Dr Russell and Dr Dilley can discuss with you the association of undescended testes and the issues of infertility and testicular cancer.

Testicular self-examination, recommended for all boys after puberty, is the main surveillance recommended.