Resources and Education

Education

Appendicitis

Appendicitis is an infection of the appendix. The Appendix is a small pouch off the large intestine where the small intestine and large intestine connect.  When the appendix lumen is blocked, bacteria can grow and cause appendicitis. The blockage can be from different causes such as a recent illness, thick mucus, hard stool or tumor.

Symptoms

  • Pain usually starts around the umbilicus and moves to the right lower quadrant of the abdomen
  • Decrease/loss of appetite
  • Fever
  • Nausea and vomiting

Diagnosis

  • Ultrasound to evaluate the appendix
  • Blood test to check for infection count

Treatment

  • Surgical options
    – Laparoscopic appendectomy
    – Open appendectomy
  • Non-surgical options*
    – Antibiotics

Quality initiative

Radiation reduction by minimizing use of CT scan is one of the quality initiatives of the Department of Pediatric Surgery.

Recent studies on Appendicitis published by this division:

Burjonrappa SC, Nerkar H. Teaching single Incision Laparoscopic Appendectomy in Pediatric Patients to mid level Surgical Residents: An early experience.  JSLS 2012; 16(4):692-697

Ballehanina U, Burjonrappa SC. Laparoscopic Appendectomy in Children: A Comparative Analysis of Single Port Intra-corporeal Technique with Standard 3-Port Approach. Journal of Gastrointestinal & Digestive Surgery, 2014; 3:212

Burjonrappa SC, LaKam D. Pediatric Appendicitis: Timing and Risk assessment. American Surgeon. 2014; 80(5): 496-9

Burjonrappa SC. Does interval appendicectomy remain a suitable treatment option in the era of laparoscopy?  Global Journal of Surgery 2012, 3: 18

Pyloric Stenosis

Pyloric Stenosis is a muscular valve (pylorus) that is thickened and becomes large which blocks food from entering the small intestine. Pyloric Stenosis usually is diagnosed around three to five weeks of age.

Symptoms

  • Forceful/projectile vomiting of breast milk/formula contents
  • Dehydration
  • Weight loss

Diagnosis

  • Ultrasound to view the pylorus
  • Blood test to check for dehydration

Treatment

  • Laparoscopic Pyloromyotomy is a state of the art operation which avoids the horizontal upper abdominal scar that is used in conventional pyloromytomy.

Research on Pyloric Stenosis published by this Division:

Mueller C, Burjonrappa SC, Wiesenhauer C.  Complications of laparoscopic pyloromyotomy: Does size make a difference.  Journal of Laparoendoscopic & Advanced Surgical Techniques. June 1, 2008, 18(3): 561-566.

Cryptorchidism

Undescended testicle is a testicle that has not moved into the scrotum before birth. Cryptorchidism is the most common congenital abnormality of the genitourinary tract.  In most cases the undescended testicle will move to the proper position on its own. If testicle does not move down before 6 months, surgery can relocate the testicle into proper position.  This will decrease risk of future cancer and infertility.

Diagnosis

  • Physical exam for testes
  • Possible ultrasound or MRI

Treatment

  • Orchidopexy

Research on undescended testicles published by this division:

Burjonrappa SC, Barrieras D, Franc-Guimond J, Houle AM: Laparoscopic Orchidopexy: The easy way to go.  Journal of Pediatric Surgery November 2009, 44(11): 1762-1766 

Hernia

A hernia is weakness or defect that causes a protrusion or bulge of an organ or part of an organ through the body wall.

Symptoms

  • Abdominal pain
  • Nausea/vomiting
  • Change in bowel function

Diagnosis

  • Physical exam
  • Ultrasound
  • CT scan

Treatment

  • Hernia should be repaired when identified to prevent hernia incarceration or strangulation
  • Laparoscopic or open procedures
  • Most umbilical hernia can be safely observed and fixed only if persistent beyond 3 years

Post Procedural Care

Appendectomy

  • No school for 1 week
  • No shower for 48 hrs and no baths for 10 days
  • Scrub off dermabond (special glue) after 10 days in shower/bath
  • No physical education/gym or swimming for 1 month
  • No heavy lifting or straining
  • No travel until seen by surgeon at office
  • Tylenol 10-15 mg/kg/dose for pain control
  • Post operative follow up in 2 weeks – please call office at (516) 663-8488
  • In patient has a fever of > 100.4 F, erythema or drainage around incision; vomiting; severe abdominal pain, severe diarrhea please call surgical office (516) 663-8488

Circumcision

  • Regular bath after 24 hrs
  • Moist Tegaderm in bath after 24 hrs and remove dressing
  • Apply Bacitracin twice daily
  • No school for 1 week
  • No physical education/gym or swimming for 1 month
  • No travel until seen by surgeon at office
  • Tylenol 10-15 mg/kg/dose for pain control
  • Post operative follow up in 2-3 weeks – please call office at (516) 663-8488
  • In patient has a fever of > 100.4 F, erythema or drainage around incision; vomiting; severe abdominal pain, severe diarrhea please call surgical office (516) 663-8488

Hernia

  • No school for 2 days
  • No shower for 48 hrs and no baths for 10 days
  • Steri-strips will peel off in approximately 10 days.
  • No physical education/gym or swimming for 1 month
  • No heavy lifting or straining
  • No travel until seen by surgeon at office
  • Tylenol 10-15 mg/kg/dose for pain control
  • Post operative follow up in 2 weeks – please call office at (516) 663-8488
  • If patient has a fever of > 100.4 F, erythema or drainage around incision; vomiting, severe abdominal pain, severe diarrhea please call surgical office (516) 663-8488

Orchidopexy

  • No school for 2 days
  • No shower for 48 hrs and no baths for 10 days
  • Scrub off dermabond (special glue) after 10 days in shower/bath
  • No physical education/gym or swimming for 1 month
  • No heavy lifting or straining
  • No travel until seen by surgeon at office
  • Tylenol 10-15 mg/kg/dose for pain control
  • Post operative follow up in 2 weeks – please call office at (516) 663-8488
  • In patient has a fever of > 100.4 F, erythema or drainage around incision; vomiting, severe abdominal pain, severe diarrhea please call surgical office (516) 663-8488

Pilonidal Cyst

  • No physical education/gym or swimming until wound is completely healed
  • Sitz bath (warm bath with bath salts) 3-4 times daily. Sitz bath after each bowel movement
  • Strip (pulling) Jackson-Pratt drain daily
  • Record output from drain daily
  • Keep area dry and clean
  • Daily dressing change
  • Complete full course of antibiotic
  • No travel until seen by surgeon at office
  • Tylenol 10-15 mg/kg/dose for pain control
  • Post operative follow up in 2 weeks – please call office at (516) 663-8488
  • In patient has a fever of > 100.4 F, erythema or drainage around incision, vomiting, severe abdominal pain, severe diarrhea please call surgical office (516) 663-8488

*As part of clinical-trials