Paediatric (Children’s) Surgery

There are a number of common surgical conditions that affect children. Mr Higman has many years experience in treating these and will be able to discuss them in detail during your consultation.

Inguinal or Groin Hernia

Inguinal hernias in children appear as a lump in the groin which is usually soft and disappears when the child is lying down and relaxed. They are commoner in boys but occur in girls also, and may be present at birth or appear later in childhood.

Inguinal hernias should be treated surgically because of the rare but important risk of bowel getting stuck in the hernia. A stuck or strangulated hernia would produce a hard painful lump in the groin, and is a surgical emergency.

Hernia repair is a simple day-case procedure under a general anaesthetic. Mr Higman  uses dissolvable stitches under the skin and a special nerve block to prevent any discomfort when your child wakes up. He or she is able to drink as soon as fully awake, and most children are able to go home after a few hours.

Circumcision

 In normal baby boys, the foreskin is usually attached to the head of the penis at birth, and retracts gradually as a natural process, although this make take several years to occur fully. Some children can get repeated soreness or infection or the foreskin; this can cause scarring and prevents the foreskin retracting naturally. In these cases, it may be necessary to perform a circumcision.

Circumcision is performed as a day-case procedure under a general anaesthetic. Surgeons use dissolvable stitches and a special nerve block is used to prevent any discomfort when your child wakes up. He is able to drink as soon as he is fully awake, and most children are able to go home after a few hours.

At home it is advisable to keep the wound as dry as possible for 48 hours. Children can take Calpol for any discomfort, and parents are also given some anaesthetic jelly to apply to the operation site as required.

Older children are usually back at school in 2 days, and back at games lessons in under 2 weeks.

Absent Testicle

 In most boys, both testicles are in their normal position in the scrotal sac at birth. If it is discovered that one or both of the testicles cannot be felt, it is possible that they have failed to come down normally and may be either stuck in the groin, or still up in the abdomen where they first developed.

Whatever the reason, if both testicles cannot be detected in their normal position, then this should be investigated promptly by a general paediatric surgeon.

At consultation, the surgeon will perform a careful examination of your child. Many boys have a very muscular cord above the testicle which may pull it up into the groin from time to time; this is a normal response and nothing further needs to be done. If the testicle cannot be felt, then an ultrasound scan may be requested to try and locate the testicle in the groin. A testicle that is caught up in the groin will require a small day-case operation to bring it down into a normal position; the details of this can be discussed with your surgeon. A testicle that is high up in the abdomen will require more specialist intervention, and the details of this can be discussed with your surgeon.

Hydrocoele (Fluid around the testicle)

It is very common for boys to be born with a small amount of fluid around the testicle. This is not dangerous in any way and most of the time this disappears over a few weeks or months.

 If there is a large amount of fluid around the testicle that persists for many months, then this is because there is a persistent track from the abdomen (down which the testicle descended originally) and some fluid from the abdomen is able to pass down the track to surround the testicle. This is called a hydrocoele.

 Most small hydrocoeles do not need any treatment. However, if they are large or persist beyond 2-3 years of age, then they can be treated surgically. This is performed as a small day-case procedure under general anaesthetic, where the open track is tied off in the groin through a small incision. Your surgeon will be able to give you full details of this procedure at consultation.

Ingrowing Toenail

Ingrowing toenail usually occurs in teenage children and in the big toenail only. It can cause painful swelling on the edge of the nail, requiring repeated dressing and courses of antibiotics.

The most effective treatment is a small day case operation performed under general anaesthetic called wedge excision. The operation removes the affected edge of the toenail, which then heals with daily dressing over a period of 2-3 weeks. The child wakes up from the operation pain-free because of a nerve block performed earlier, and there are no stitches to be removed. This procedure is 95% successful in treating ingrowing toenail.