Conditions and Treatments

Pediatric Surgery
The pediatric surgeons at Kalispell Regional Healthcare specialize in treating children from birth through adolescence. Below are some of the common conditions and surgical treatments we provide.

Anorectal Malformation
Appendicitis
Bowel Atresia
Branchial Cleft Anomaly
Breast Lump
Chest Wall Malformation
Choledochal Cyst
Congenital Diaphragmatic Hernia
Crohn's Disease
Dermoid Cyst
Failure to Thrive
Gallstone
Gastroesophageal Reflux
Gastroschisis
Hirschsprung's Disease
Hydrocele
Inflammatory Bowel Disease
Inguinal Hernia
Intestinal Malrotation and Volvulus
Intussusception
Lipoma
Malignant Tumor
Meconium Ileus
Necrotizing Enterocolitis
Omphalocele
Pectus Carinatum
Pectus Excavatum
Phimosis (Circumcision)
Pilomatrixoma/Pilomatricoma
Pilonidal Sinus
Pyloric Stenosis
Sacrococcygeal Teratoma
Skin Disorder
Spontaneous Pneumothorax
Testicular Torsion
Thyroglossal Duct Cyst
Ulcerative Colitis
Umbilical Hernia
Undescended Testicle
Vascular Access Surgery

Anorectal Malformation

What is an anorectal malformation?
An anorectal malformation is a rare birth defect. It is an abnormality of the rectum and anus. The anus may be narrow or covered by a membrane, or the rectum may not connect to the anus. This means the baby cannot have normal bowel movements. Sometimes anorectal malformation can be diagnosed before birth. More often it is found after birth during the doctor's initial examination of the newborn.

How is it treated?
Newborns with anorectal malformation need surgery in the first few days after birth. They will stay in the neonatal intensive care unit before surgery and during recovery. Some newborns will need only one procedure. Depending on the severity of the malformation, some babies may need a temporary ostomy (an artificial opening to divert the contents of the bowels into a bag).

Appendicitis

Boy with doctor What is appendicitis?
The appendix is a finger-shaped pouch attached to the large intestine. Appendicitis is an inflammation and infection of the appendix. It is most common between the ages of 10 and 30, but it can also affect younger children. Appendicitis causes pain in the lower right side of the belly, with or without vomiting or fever. The pain usually increases as the inflammation worsens. After two to three days, the infection can lead to perforated or ruptured appendicitis.

How is it treated?
Appendicitis can be treated with antibiotics or by removal of the inflamed appendix. In most cases your doctor will recommend surgical removal of the appendix. With very rare exceptions, this is done by minimally invasive surgery. If the appendix is ruptured, the patient will need antibiotics after the surgery and may need to stay in the hospital for a few days.

Bowel Atresia

What is bowel atresia?
Bowel atresia is a birth defect when a baby is born with a portion of the intestine undeveloped, narrowed or blocked. This means the baby cannot have normal bowel movements. Bowel atresia can sometimes be diagnosed before birth.

How is it treated?
Newborns with bowel atresia need surgery in the first few days after birth. They will stay in the neonatal intensive care unit before surgery and during recovery. The affected segment of the intestine will be removed or bypassed. When possible the surgeon will use a minimally invasive technique, although in some cases an open procedure (larger incision) may be necessary. Depending on the type of bowel atresia, some babies may need a temporary ostomy (an artificial opening to divert the contents of the bowels into a bag).

Branchial Cleft Anomaly

What is a branchial cleft anomaly?
A branchial cleft anomaly is a rare birth defect involving the neck. This may lead to cysts on either side of the neck, causing bulges, pain, drainage or infections. A branchial cleft anomaly is usually evident at birth or within the first few years of life.

How is it treated?
Acute infections are treated with antibiotics. Some branchial cleft anomalies may require surgical removal of the abnormal tissue or cyst.

Breast Lump

What is a breast lump?
Breast lumps are common among young women. Most lumps consist of benign (noncancerous) cysts or fibrous (dense soft tissue) masses. Breast cancer in teenagers is extremely rare. However, any growing or painful lump should be examined.

How is it treated?
An ultrasound is used to examine the mass, and a doctor will determine whether surgical removal or a biopsy is necessary.

Chest Wall Malformation

What is a chest wall malformation?
In most cases, a chest wall malformation is a benign (noncancerous) variant of a normal chest and has no impact on lung or heart function.

Chest wall deformities are common birth defects occurring in about 1 of 300 to 500 children in the United States. Most of them are benign (noncancerous) variants of a normal chest shape and have no impact on lung or heart function. There are two forms of chest wall deformities: pectus excavatum (“funnel chest”) and pectus carinatum (“pigeon chest”).

At KRH we offer unique expertise in an exceptional setting for chest wall deformity treatment in Montana. We follow standardized treatment protocols and collaborate with high volume centers to assure consistent quality and outcomes. For more information, see our Chest Wall Deformity Clinic page.

Choledochal Cyst

Teen boy with doctor What is a choledochal cyst?
A choledochal cyst is a very rare birth defect involving the bile duct. Bile is produced in the liver and flows through small channels called bile ducts into the small bowel. Cysts can develop at different points along these bile ducts, obstructing the bile flow and causing pain and jaundice. There is long-term risk for development of cancer in the wall of the cysts if not treated.

How is it treated?
Choledochal cysts must be surgically removed, often using minimally invasive techniques or robotic surgery. The surgeon creates a new connection to the bowel. The patient will need to stay in the hospital for a few days.

Congenital Diaphragmatic Hernia

What is congenital diaphragmatic hernia?
Congenital diaphragmatic hernia is a birth defect of the diaphragm. The diaphragm is a flat muscle dividing the belly from the chest. Babies born with congenital diaphragmatic hernia have a hole in the diaphragm, allowing the bowels and abdominal organs to slip into the chest. This happens early in a baby's development and compromises the development of the lungs.

How is it treated?
Babies who are born with diaphragmatic hernia need surgery to repair the defect in the diaphragm. In most cases this is done in the first week of life after the newborn is treated in the neonatal intensive care unit. Depending on the condition of the patient and the size of the defect, this is achieved with minimally invasive surgery. Babies with severe diaphragmatic hernia or babies suffering from other conditions may need a machine to temporarily take over the work of the lungs and sometimes also the heart.

Crohn's Disease

What is Crohn’s disease?
Crohn’s disease is a type of inflammatory bowel disease that may affect any part of the gastrointestinal tract (intestines). In North America it affects 2-4 in 1,000 people and can begin in the teenage years. The cause of Crohn’s disease is not completely known. People with Crohn’s disease may experience a wide range of symptoms such as abdominal pain, diarrhea, or blood or mucus in the stool.

How is it treated?
Surgery is not always required. A primary care provider or gastroenterologist can treat the disease with medication. Some patients may need surgery in the course of the disease if a portion of the bowel does not heal, is perforated or becomes narrow.

Dermoid Cyst

What is a dermoid cyst?
Dermoid cysts are benign (noncancerous) lumps that can be felt under the skin. Dermoid cysts can be found anywhere. The most common locations are the forehead, eyelids or scalp. These bumps are usually present at birth and grow slowly. Untreated, they can get infected or push on adjacent structures like the eyes.

How is it treated?
A dermoid cyst can be diagnosed by clinical exam. An ultrasound may be used to differentiate it from other skin lumps. Surgical removal treats the condition.

Failure to Thrive

What is failure to thrive?
"Failure to thrive" means a child is not gaining weight. There are multiple reasons for this condition.

How is it treated?
If the reason is inability to eat, a small feeding tube can be inserted through the skin of the belly into the stomach. This is a surgical procedure done with the aid of endoscopy (insertion of a tiny camera through the mouth into the stomach) or laparoscopy (insertion of a camera through the belly button into the abdomen).

Gallstone

What is a gallstone?
A gallstone is a bile stone that can form in the gallbladder. Common causes of gallstones include obesity and poor nutrition. Gallstones can cause infection, pain in the right upper half of the belly, jaundice (yellow skin and eyes), nausea and vomiting. These symptoms can be triggered by eating fatty foods.

How is it treated?
Diagnosis is made with an exam, a blood test and ultrasound. Your doctor will prescribe antibiotics or recommend gallbladder removal. In most cases gallbladder removal (cholecystectomy) is done by minimally invasive surgery.

Gastroesophageal Reflux

What is gastroesophageal reflux?
Gastroesophageal reflux is the backflow of the stomach's contents into the esophagus. This is normal to a certain degree in babies, less so in children and adults. Most babies have gastroesphageal reflux, in the form of spitting up after feeding. Most babies outgrow this normal condition. In extreme cases, the stomach's acidic contents can rise into the mouth, where they can get into the windpipe and cause inflammation or infection. Symptoms of reflux are heartburn and lung problems such as pneumonia, with subsequent failure to thrive. In the long term, gastroesophageal reflux can harm the esophagus and even lead to cancer.

How is it treated?
If a baby develops symptoms such as increased throwing up or pain, a pediatrician will first treat the reflux with medication and might change the baby's formula. For babies or children with intractable reflux and vomiting, a surgical treatment can prevent the stomach contents from refluxing into the esophagus. This surgery is called fundoplication and is usually performed using minimally invasive techniques.

Gastroschisis

What is gastroschisis?
Gastroschisis is a birth defect of the belly wall that affects approximately 1,800 babies a year in the U.S. It happens when a baby is born with a hole adjacent to the belly button through which the intestines protrude. This condition can be diagnosed before birth with ultrasound. In most cases it is an isolated condition without any related issues.

How is it treated?
Gastroschisis is treated shortly after birth. In minor cases, the intestines can be returned to the abdomen without an operation. In severe cases, the intestines are temporarily wrapped in a bag, and the hole is closed in a second procedure a few days later. Babies are treated in the neonatal intensive care unit during recovery.

Hirschsprung's Disease

What is Hirschsprung's disease?
Hirschsprung's is a birth defect of the large bowel. A segment of the intestine does not develop normally. It occurs in approximately 1 in 5,000 babies. Babies with this condition cannot have normal bowel movements and are at risk for potentially life-threatening infections.

How is it treated?
Hirschsprung's is treated as soon as it is diagnosed. If a baby is diagnosed with Hirschsprung's, temporary treatment with enemas followed by surgery might be recommended. Depending on the severity of the condition, some babies may need a temporary ostomy (an artificial opening to divert the contents of the bowels into a bag). Others may need just one operation to remove the affected bowel segment.

Hydrocele

What is a hydrocele?
A hydrocele is an accumulation of fluid around a testicle, which can cause swelling on one or both sides of the scrotum. A hydrocele may be the result of an infection or trauma (such as a sports injury). These types of hydrocele resolve on their own. In babies or toddlers, a hydrocele may occur when there is a small opening between the abdomen and scrotum, allowing fluid to flow from the belly into the scrotum. This is called a communicating hydrocele.

How is it treated?
A communicating hydrocele needs surgical treatment. The opening that allows fluid to flow from the belly into the scrotum can also act as tunnel for the intestines to slip into the scrotum, which is called inguinal hernia. A communicating hydrocele can be repaired with minimally invasive surgery or a small incision in the groin. Patients can go home the same day of surgery.

Inflammatory Bowel Disease

Preparing for surgery What is inflammatory bowel disease?
The term “inflammatory bowel disease” covers a group of different diseases characterized by inflammation of the bowels. Causes are not entirely known, but a hereditary component is likely. The autoimmune system plays a crucial role in the development of these conditions, which can cause stomach pain and disruption to bowel movements.

See ulcerative colitis and Crohn’s disease.

Inguinal Hernia

What is inguinal hernia?
Inguinal hernia is a condition in which the bowel or other belly content bulges through the belly wall into the groin. In children, most inguinal hernias are caused by the intestines slipping through a narrow channel in the belly wall from the inside out – into the scrotum in boys or the labia in girls. Symptoms range from a nonpainful groin lump to stabbing pain. Approximately 1 percent of all babies are born with this channel, leading to an inguinal hernia. Premature babies are much more likely to develop this condition.

How is it treated?
Inguinal hernias do not heal but need surgical closure to prevent damage to the intestines. An inguinal hernia can be diagnosed by physical exam. Sometimes an ultrasound helps to differentiate it from other lumps in the groin. The treatment can be performed by a small incision in the groin or by minimally invasive surgery. These techniques do not require an overnight stay. Only premature babies may need to be observed overnight after anesthesia.

Intestinal Malrotation and Volvulus

What is intestinal malrotation and volvulus?
Intestinal malrotation is a birth defect that affects approximately 1 in 400 newborns. Normally the bowels are oriented and attached within the belly in an organized fashion, preventing them from twisting. In babies with malrotation, bowel loops are prone to twist. This is called volvulus. The risk for volvulus is highest in the first year of life. Symptoms of volvulus are belly pain and green (bilious) vomiting. Therefore, bilious vomiting in babies is an alarming symptom that requires immediate attention.
 
How is it treated?
Intestinal malrotation in older children without symptoms does not require surgical treatment. In children with symptoms such as pain, nausea or vomiting, the doctor may recommend a surgical procedure to fixate the bowel loops in a position that prevents them from twisting.

Intussusception

What is intussusception?
Intussusception is a condition in which part of the intestine slides into an adjacent portion of the intestine. It happens mostly in children younger than 3 years old. This condition can block the intestine and can also cut off the blood supply. Symptoms include intermittent cramping and bloody or mucousy bowel movements. Mostly the cause of intussusception is unknown, but inflamed lymph nodes around the intestines are believed to play a role in the development of this condition.

How is it treated?
Intussusception is diagnosed using ultrasound. Most children can be treated without surgery; an X-ray procedure is used to push the intestines back into position. In some cases the telescoped bowel is so stuck that it requires surgery.

Lipoma

What is a lipoma?
A lipoma is a benign (noncancerous) lump of fat cells that can grow anywhere on the body under the skin. These cells appear as soft round bumps on the skin that grow very slowly. Lipomas do not cause pain or other symptoms and are only treated for cosmetic reasons or if they push on adjacent organs.

How is it treated?
An ultrasound is used to confirm a suspected lipoma. Treatment is done by surgical removal.

Malignant Tumor

What is a malignant tumor?
Malignant tumors are cancer masses. Solid malignant tumors in children, while very rare, can occur in organs such as the kidneys, liver or soft tissues.

How is it treated?
Sometimes a biopsy or surgical removal of the entire tumor is necessary.

Meconium Ileus

What is meconium ileus?
Meconium is fetal stool, which is gooey and black. Newborns excrete this meconium with the first few bowel movements. Meconium ileus is a condition where thickened meconium causes a blockage of the intestines.

How is it treated?
Many babies born with meconium ileus can be treated with medication. They will undergo tests to rule out other medical conditions, such as cystic fibrosis. Rarely, babies with meconium ileus need surgery to remove part of the intestine.

Necrotizing Enterocolitis

What is necrotizing enterocolitis?
Necrotizing enterocolitis (NEC) is a serious intestinal illness in babies. It occurs most frequently in premature babies with very low weight. The cause for this is not entirely understood, but maturity of the baby, type and timing of feeding seem to play a role in its development. This condition causes a severe inflammation of parts of the intestine that can lead to permanent damage and perforation of the bowel.

How is it treated?
As soon as necrotizing enterocolitis is suspected, the baby is treated with antibiotics and bowel rest. A small tube is inserted through the nose into the stomach to suck out all fluids, and the baby is not allowed to eat until fully recovered. Often this treatment is sufficient. If the condition progresses, surgery might be necessary to remove the affected intestine. Some babies may need a temporary ostomy (an artificial opening to divert the contents of the bowels into a bag).

Omphalocele

Meeting the surgeon What is omphalocele?
Babies with omphalocele are born with a hole in the belly button through which a part of the intestines protrude. This condition can be diagnosed before birth with ultrasound and is often associated with other malformations, such as anomalies of the heart or kidneys. Omphalocele can be confused with gastroschisis.

How is it treated?
The treatment of omphalocele is similar to that of gastroschisis. Testing may be necessary to rule out other malformations. In minor cases, the intestines can be returned to the abdomen without an operation. In severe cases, the intestines are temporarily wrapped in a bag, and the hole is closed in a second procedure a few days later. Babies are treated in the neonatal intensive care unit during recovery.

Pectus Carinatum

What is pectus carinatum (“pigeon chest”)
Pectus carinatum, also called pigeon chest, is a deformity of the breastbone and rib cartilages that causes the chest to stick out. It is less common than pectus excavatum. This condition can be present at birth. In most cases it becomes more evident and more pronounced in the early teenage years. The cause for pectus carinatum is not known. Some children with this protruding chest have pain, shortness of breath or exercise intolerance. In many cases it does not cause any symptoms. Pectus carinatum can have a negative psychological impact on children and teenagers. Some patients experience embarrassment and lack of self-esteem leading to social isolation and withdrawal from school and athletic involvement.

How is pectus carinatum treated?
In patients without symptoms, treatment is optional. We may recommend tests to examine the anatomy and function of the lungs and heart. Pectus carinatum can be treated surgically or nonsurgically. Surgical correction involves a procedure under general anesthesia. It requires an incision in the mid-chest to remove abnormal ribs and reshape the sternum. A hospital stay of approximately one week is necessary. Bracing is a good alternative to surgery for many patients. It requires a long-term commitment as most patients have to wear a metal brace for one to two years. The brace consists of a metal belt and cushioned compression zone. It should be worn as much as possible to apply constant pressure on the protruding chest wall to remold it. The brace can be removed for bathing, showering and sports.

Pectus Excavatum

What is pectus excavatum (“funnel chest”)?
Pectus excavatum, also called funnel chest, is the most common chest wall deformity. It is three times more common in boys than girls. The chest appears sunken or caved in, caused by an inward growth of the breastbone and portions of the ribs. The cause for this deformity is not completely understood. Like pectus carinatum, this condition can be present at birth but becomes more pronounced during the pubertal growth spurt. Possible symptoms include chest pain, exercise intolerance or shortness of breath. Many teenagers with a sunken chest suffer from psychological symptoms that manifest with feelings of embarrassment and social anxiety.

How is pectus excavatum treated?
After a thorough exam, we may recommend tests to examine the anatomy and function of the lungs and heart. In asymptomatic patients with normal heart and lung function, the repair is optional. The repair of pectus excavatum can be achieved with a minimally invasive approach or an operation involving an incision on the chest. In many cases, the minimally invasive techniques can be applied. This involves temporary placement of a metal bar in the chest (Nuss bar), which immediately corrects the sunken chest. The bar needs to be removed in another surgery after approximately three years. An alternative to this technique is an open corrective chest wall repair with a larger incision in the middle of the chest. This procedure involves resection of abnormal ribs and repositioning of the sternum. Both surgical techniques require a five- to seven-day hospital stay.

Phimosis

What is phimosis?
Phimosis is a narrowing of the foreskin that prevents the foreskin from being retracted over the tip (glans) of the penis. At birth, all babies have phimosis and the foreskin is fused to the glans. The foreskin should not be forcefully retracted. In the first few years of life, the foreskin loosens up, allowing retraction and cleaning. Phimosis after the age of 3 can be caused by recurrent infections or scar tissue as a consequence of traumatic attempts to retract a narrow foreskin too early.

How is it treated?
Phimosis can be successfully treated with steroid cream. However, this treatment takes weeks. An alternative is circumcision (permanent removal of the foreskin). Circumcision is a painful procedure and is performed in older babies and children in the operating room under general anesthesia. Circumcision shortly after birth under local anesthesia is still a common procedure but is not necessary for all boys. Discuss potential benefits and risks with your doctor.

Pilomatrixoma/Pilomatricoma

What is pilomatrixoma?
Pilomatrixoma (also known as pilomatricoma or calcifying epithelioma of Malherbe) is a benign (noncancerous) skin lump that is derived from a hair root. Pilomatrixomas can appear all over the body. They present as slowly growing hard nodules under the skin. Long-term, these nodules can grow to a significant size and cause infections.

How is it treated?
The treatment for pilomatrixoma is surgical excision on an outpatient basis, with the patient returning home the same day.

Pilonidal Sinus

What is pilonidal sinus?
Pilonidal sinus, or pilonidal cyst, is a small skin pouch overlying the tailbone. It can be found early in life and has a tendency to get infected in adolescence or early adulthood. An infected pilonidal cyst can develop into a very painful abscess. Uninfected cysts generally have no symptoms. Infection results in drainage, swelling and pain.

How is it treated?
Depending on the state of infection and the size of the sinus, the doctor may recommend antibiotic therapy or surgical excision. Pilonidal cysts can heal spontaneously by scarring down after an infection. If surgery is needed, it can be done as an outpatient.

Pyloric Stenosis

What is pyloric stenosis?
Pyloric stenosis is a narrowing of the pyloric muscle (pylorus). The pylorus is a muscular valve at the end of the stomach that controls stomach juices moving into the intestines. The cause for pyloric stenosis is unknown. This condition mostly affects babies in their first 2 months of life and presents as forceful vomiting of milk or formula after feedings. If not treated early, pyloric stenosis can lead to dangerous dehydration.

How is it treated?
After the baby is treated with intravenous fluids, an operation is necessary. The thickened pylorus is cut to allow the stomach to empty into the intestine. This operation can be done with minimally invasive techniques, barely leaving visible scars. Babies recover very quickly from this procedure and are usually discharged from the hospital the next day.

Sacrococcygeal Teratoma

What is sacrococcygeal teratoma?
Sacrococcygeal teratoma is a rare tumor of the tailbone in newborns. It is usually diagnosed before birth. Some sacrococcygeal teratomas are aggressive (invading other tissues) while the majority are benign (noncancerous). Depending on the size and type, sacrococcygeal teratomas can affect bowel movements, bladder function and the nerves that are responsible for the movement of both legs.

How is it treated?
Most babies with sacrococcygeal teratoma need surgery early in life. The tailbone mass is removed, preserving surrounding structures as much as possible. The type of the tumor will determine the need for further treatment such as chemotherapy.

Skin Disorder

What is a skin disorder?
There are a variety of skin disorders that either cause symptoms or represent a long-term risk for infection, pain, bleeding or the development of cancer. A primary care physician might refer a patient to a dermatologist for a detailed examination.

How is it treated?
Many skin disorders can be treated with creams or oral medication. Most lesions that need to be surgically removed can be excised under local or general anesthesia on an outpatient basis.

Spontaneous Pneumothorax

Pediatric surgeons What is spontaneous pneumothorax?
A pneumothorax occurs when air accumulates between the lungs and the chest wall. This causes a collapse of the lungs, which is experienced as shortness of breath and chest pain. A primary spontaneous pneumothorax occurs in the absence of a known lung disease and most frequently affects slender adolescents. A weak area in the lungs that spontaneously “pops” is believed to cause this condition. A continuously increasing pneumothorax can cause a life-threatening collapse of the lungs and compromise the heart.

How is it treated?
A significant or growing pneumothorax needs decompression. A fine rubber tube is inserted through a small cut in the chest to suction out the accumulated air, allowing the lung to re-expand. This tube may need to stay in place for a few days, until the hole in the lung has sealed. In recurring cases, or when the hole does not heal on its own, a minimally invasive surgery is necessary to remove the weak or perforated portion of the lung.

Testicular Torsion

What is testicular torsion?
Testicular torsion occurs when a testicle twists, cutting off its blood supply. This causes sudden severe pain and swelling. Testicular torsion can occur at any age and requires emergency surgery. If not treated immediately, testicular torsion can cause severe damage to the testicle. In most cases a thorough physical exam and ultrasound confirm the diagnosis.

How is it treated?
Patients with testicular torsion need immediate surgery. A small cut in the groin or scrotum is necessary to expose the affected testicle in order to examine and untwist it. If the testicle is severely damaged it must be removed. Then both testicles are fixated to the scrotum to prevent a recurrent torsion.

Thyroglossal Duct Cyst

What is a thyroglossal duct cyst?
A thyroglossal duct cyst is a rare birth defect that can be present at birth or, more frequently, becomes apparent in the first years of life. It is an irregular neck lump made up of leftover tissues from the development of the thyroid gland. Thyroglossal duct cysts are benign but carry a significant risk for infections.

How is it treated?
The diagnosis can be made by examination and ultrasound. A small neck incision is necessary to surgically remove the cyst and duct. In most cases this is possible with same-day surgery.

Ulcerative Colitis

What is ulcerative colitis?
Ulcerative colitis is an inflammatory bowel disease affecting the large bowel (colon). The causes for ulcerative colitis are unknown. It may cause abdominal pain, diarrhea and other symptoms that vary from person to person. These symptoms range from mild to severe. Ulcerative colitis affects approximately 700,000 people in the U.S. Untreated, ulcerative colitis poses a long-term risk for the development of colon cancer.

How is it treated?
Surgery is not always necessary. Patients can be treated with oral or intravenous medication. Regular colonoscopies provide information about the progression of the disease and the potential need for removal of the large bowel and reconstructive surgery to reconnect the bowels. If needed, this surgery can be done with minimally invasive techniques. After surgery some patients may need a temporary ostomy (an artificial opening to divert the contents of the bowels into a bag).

Umbilical Hernia

What is an umbilical hernia?
An umbilical hernia is a defect of the belly wall at the umbilicus, causing the skin of the umbilicus to stick out (outie belly button). Many babies are born with umbilical hernias. Umbilical hernias usually close on their own in the first years of life. There is a small long-term risk for a piece of the intestines to get stuck in the hernia, causing pain and the potential for injury to the stuck intestine.

How is it treated?
Children with persistent outies should be checked for umbilical hernia. After age 3 or 4, surgical closure of the hernia is recommended to prevent future damage to the intestines. This can be done as same-day surgery and requires only a very small cut.

Undescended Testicle

What is an undescended testicle?
During fetal development, a boy's testicles develop in the belly and descend into the scrotum before birth. Sometimes this process is not complete at birth and the baby has an empty scrotum on one or both sides. This is called an undescended testicle. The doctor will examine the baby to feel for the testicle. It can take a few months after birth for a testicle to descend into the scrotum. Testicles that do not sit in the scrotum carry long-term risk for decreased function and testicular cancer in adulthood.

How is it treated?
If a testicle has not reached the scrotum in the first 6 to 12 months of life, surgery will be necessary to bring the testicle into the scrotum. This procedure is called orchiopexy or orchidopexy. Sometimes an ultrasound or other imaging exam will be necessary prior to surgery. Depending on the location of the testicle, this operation requires a small cut in the groin or the use of minimally invasive surgery.

Vascular Access Surgery

What is vascular access surgery?
Some patients require frequent blood draws or intravenous medication. In order to avoid repeated needle sticks, the doctor may recommend placement of a temporary vascular access device such as a Broviac catheter or mediport. A Broviac catheter is a fine rubber tube that is inserted through the skin into a large blood vessel. The outside end is accessible for administering medication or taking blood samples. A mediport is a similar device that is implanted under the skin with attached tubing entering a blood vessel. Mediports need to be accessed with a needle through the skin. The overlying skin will get less sensitive over time and can be numbed with a cream prior to access.

How is it done?
Broviac catheters and mediports are placed under sterile conditions in the operating room under general anesthesia. This can be done as outpatient surgery, without a hospital stay.