Pediatric surgery encompasses a broad spectrum of procedures, from the head to the feet, from neonates to 18 years or beyond. The conditions treated range from congenital to oncologic (cancer) to trauma.
At Children's Hospital of Greenville Health System (GHS), there is a growing team of surgeons who specialize in performing operations on children. There are pediatric general surgeons, orthopaedic surgeons, neurosurgeons and a urologist. Offering advanced pediatric surgery services in a child-friendly environment, the GHS Division of Pediatric Surgery draws patients from Greenville, Asheville, Columbia, and surrounding areas.
“Sending a child to a hospital that offers pediatric-oriented surgical care can make the procedure a more pleasant experience for the child and his or her family.”
John Chandler, M.D., FACS, FAAP
Dr. Chandler and the other pediatric surgeons of Children’s Hospital are very accustomed to working with children, as are the nurses, ancillary personnel and subspecialists. “That makes a difference,” he emphasized.
Although many people associate pediatrics with very young children, pediatric general surgeons at Children’s Hospital treat patients from birth to age 18. Patients range in size from premature babies to full-grown individuals. Sometimes the surgeons perform operations on adults who face congenital problems that don’t surface until adulthood. One example is malrotation of the intestines. Surgeons specializing in pediatrics are more likely to have experience with the operation required to treat this problem, and so adult patients with this condition may be referred to Pediatric Surgery.
A Minimally Invasive EmphasisChildren’s Hospital surgeons are dedicated to using the least invasive methods on their patients to minimize recovery time, pain and scarring. Surgical scarring is a particularly important issue in the care of adolescent patients, whose self-esteem is affected greatly by their outer appearance.
Children’s Hospital pediatric surgeon Michael Gauderer, M.D., FACS, FAAP, is a pioneer in minimally invasive surgery techniques. Nearly 25 years ago, he conceived and developed the percutaneous endoscopic gastrostomy (PEG) procedure that is now the standard for gastric access worldwide. More recently, he has published a technique for pyloromyotomy that is not only less invasive but also safer than some other traditional approaches. He also has fine-tuned an individualized approach to appendectomy to help ensure that patients receive the least-invasive option for appendix removal suitable for their circumstances.
Among other minimal access techniques, Dr. Gauderer has embraced the newest procedures for treating chest wall deformities. He has developed a significant practice in these operations, including minimally invasive repair of pectus excavatum. He can repair the child’s sunken chest area via two lateral chest incisions instead of a larger incision in the middle of the chest that would leave a much more noticeable scar.
Laparoscopic technology plays a big role in pediatric surgery just as it does in adult surgery. “The types of operations performed with a laparoscope are constantly expanding, and we’re right in line with state-of-the-art equipment,” Dr. Chandler said.
Surgical Oncology and NeurosurgeryAbout 5 percent of patients who present to Children’s Hospital for surgery have some form of cancer. The hospital’s pediatric general surgeons can remove tumors from just about any part of the body.
In October 2007, Children’s Hospital boosted its capability to treat children with brain tumors with the addition of Christopher Troup, M.D. To help support a growing caseload, fellowship-trained pediatric neuro-oncologist and hematologist- oncologist Nichole Bryant, M.D., and pediatric neurologist Addie Hunnicutt, M.D., have joined Children’s Hospital.
“We’re in the process of creating a pediatric neuroscience program unlike anything else in the Upstate,” Dr. Troup said.
A major focus is the establishment of a brain tumor clinic that will coordinate patients’ care so that they can see physicians, social workers and other health professionals in one office.
Children’s Hospital also is launching a spasticity clinic. “We have a tremendous population of children with cerebral palsy and spasticity in the Upstate,” Dr. Troup said. “The key people are here, but before now no one had organized a formal spasticity program.” Neurosurgeons, neurologists, a pediatric physiatrist and orthopaedic surgeons are expected to be involved with the spasticity program.
Children’s Hospital also looks forward to the next addition of a GHS craniofacial surgeon trained to treat both adults and children. “Surgeons have primarily been seeing patients for cleft lips and palates,” Dr. Troup said. “This new specialist will help us expand to see more of a complete range of craniofacial problems. It’s a great need that we’ll be glad to have filled.”
Orthopaedic Surgery and Trauma CareChildren’s Hospital supports treatment of both chronic and acute orthopaedic problems. GHS pediatric orthopaedic surgeons treat basic and multiple fractures as well as perform corrective procedures for clubfoot, scoliosis and other congenital problems. The team also cares for patients with lower back pain and sports-related injuries, including those with symptoms of sports overuse.
“We treat any patient under age 18 who has an orthopaedic condition,” emphasized Michael Beckish, M.D., GHS director of Pediatric Orthopaedic Surgery. The team's surgical expertise and comprehensive pediatric orthopaedic surgery services draw patients from Greenville, Asheville, Columbia, and areas throughout the region.
The physicians see patients who present for emergency care at Children’s Hospital. These patients have their own entrance separate from the adult ER. On average, the pediatric orthopaedic division has 110 outpatient visits per week and 200 inpatient consultations annually. The surgeons perform approximately 300 pediatric orthopaedic operations a year. Children’s Hospital also works with the region’s only orthopaedic pediatric surgeons in private practice.
GHS pediatric orthopaedic surgeons work very closely with Children’s Hospital Infectious Disease physicians in the collaborative treatment of an increasing number of osteomyelitis cases.
“Our long-term plan is to grow and have two or three full-time pediatric orthopaedic surgeons on staff,” Dr. Beckish said. “It just takes time because there aren’t many specialists out there.”
Urologic SurgeryAnother specialty where physicians are lacking is pediatric urology. Children’s Hospital has been fortunate to have J. Lynn Teague, M.D., MHA, FAAP, on staff since last fall. In addition to providing care for kidney stones, hydronephrosis and bladder problems, Dr. Teague performs operations to treat genital abnormalities, such as hypospadias and undescended testis. He often must employ reconstructive techniques in the repair of children’s abnormal genitalia.
Dr. Teague sees growing demand for pediatric urology in the Upstate. In addition to his caseload at Children’s Hospital, he cares for patients at monthly clinics in Spartanburg and at Shriners Hospital for Children, Greenville Unit. At Shriners, he treats children with urinary incontinence and other urologic problems commonly associated with spinal cord defects, such as spina bifida.
Otolaryngology: Head and Neck Surgery
Pediatric ENT surgery consists of much more than inserting tubes into patients’ ears or removing tonsils. While most otolaryngology cases at Children’s Hospital focus on these procedures, ENT surgery specialists treat other conditions as well, said Robert O. Brown III, M.D., FACS, chair of the GHS Medical Staff’s Division of Otolaryngology–Head and Neck Surgery.
“Our doctors perform endoscopic sinus procedures on children, evaluate voice or vocal problems and recommend treatments, and help with airway obstruction problems,” Dr. Brown said. “We also remove benign and malignant tumors on the neck or face and perform operations for pediatric facial trauma.”
Dr. Brown is optimistic about some changes that promise to bring upstate pediatric patients even better care. One exciting new program for the hospital has been a partnership with John McElveen, M.D., who in 2007 started joining GHS monthly to perform cochlear implant procedures on children and adults. Within a year, more than half of the cochlear implant operations are expected to be performed on children.
Research and EducationThe faculty of Children's Hospital is known for its active role in research and trials, particularly in hematology and oncology. With the launch of the brain tumor clinic, there will be some brain tumor studies.
On the academic front, medical residents play an important role in providing surgical care at Children's Hospital. "The residents are really integrated into the practice," said Dr. Beckish. “They help with inpatient and outpatient evaluations, provide treatments and assist with surgical management. It’s a valuable part of their education and offers our patients even better care.”
Dr. Chandler concurred: “We offer an academic setting with high-quality physicians and some of the top people in the state. GHS is growing continuously, and the standard of care continues to improve.”
For more information about our pediatric surgery services, which draw patients from Greenville, Asheville, Columbia, and areas throughout the Southeast, or to refer a patient, call Children’s Hospital at (864) 455-8860.