Pediatric Surgeon — Prof. Dr. Hüseyin Özbey

What is pediatric surgery?

Pediatric surgery is a distinct specialty dealing with the diagnosis and surgical treatment of conditions in children, from the prenatal period through adolescence. A child is not a small adult: tissue characteristics, organ size, fluid balance and anaesthetic requirements all differ from those of adults. For this reason both the decision to operate and the surgical technique should be handled by a pediatric surgery specialist.

Prof. Dr. Hüseyin Özbey is a pediatric surgeon and pediatric urologist with more than 30 years of academic and clinical experience at the Department of Pediatric Surgery, Istanbul Faculty of Medicine. Since 2009 he has seen patients at his private practice in Bakırköy, Istanbul.

Which conditions does pediatric surgery cover?

The scope of pediatric surgery is broad. The main groups of conditions are:

Groin and genital region

• Inguinal hernia
• Hydrocele
• Undescended testis
• Circumcision
• Umbilical hernia

Head and neck

• Thyroglossal duct cyst
• Branchial cyst, sinus and remnants
• Lymphangioma (cystic hygroma)
• Haemangioma
• Torticollis

Neonatal surgery

• Oesophageal atresia
• Duodenal atresia
• Ileal–jejunal atresia
• Diaphragmatic hernia
• Omphalocele and gastroschisis
• Anorectal malformation
• Hirschsprung disease

Digestive system

• Appendicitis
• Pyloric stenosis
• Intussusception
• Meckel’s diverticulum
• Gastro-oesophageal reflux
• Corrosive oesophagitis
• Perianal fistula

Childhood tumours

• Neuroblastoma
• Wilms tumour
• Hepatoblastoma
• Teratoma
• Rhabdomyosarcoma

For kidney and urinary tract conditions, please see our Pediatric Urology page.

Common pediatric surgical procedures

Inguinal hernia

A common hernia in infants and children, presenting as a swelling in the groin. It occurs most often on the right side, and the risk is higher in boys and in premature babies. The first sign is groin swelling that becomes more obvious when the child cries.

Is surgery needed? Yes, and as early as possible. In a hernia that goes unnoticed for a long time, the small bowel in boys or the ovary in girls may become trapped, twist and be damaged. Restlessness, abdominal distension and vomiting may occur.

Hydrocele

Fluid from the abdominal cavity enters the sac formed by the peritoneum. It may be trapped around the testis (hydrocele) or move in and out of the abdomen so that its volume changes. A small hydrocele may be expected to resolve on its own within the first year. However, where the peritoneum remains open there is a risk that bowel may enter the same space; a hydrocele that is large for the child’s age and not resolving requires surgery.

Both inguinal hernia and hydrocele repairs are performed as day-case (out-patient) surgery; the patient is usually discharged 2–4 hours afterwards.

Undescended testis

The testis remains in the groin or abdomen instead of the scrotum. The testes descend towards the scrotum from the 30th week of pregnancy, which is why the condition is more common in premature babies.

Why does it matter? Within the scrotum the testes are kept 0.5–1 °C below body temperature, a condition required for normal cell development. Irreversible damage may develop from the 6th month in testes kept at body temperature. A proportion of testicular tumours has also been reported to arise from undescended testes.

When is it operated? Depending on its position and anatomical connections, it may be observed until the age of one, or surgery may be planned from the 6th month. Inguinal hernia frequently accompanies an undescended testis; when it occurs together with hypospadias, detailed investigation is required.

Circumcision

Partial removal of the foreskin so that the tip of the penis is exposed. A narrow opening at the tip of the foreskin can make urination and hygiene difficult, and recurrent infections may also cause problems in the upper urinary tract.

Best timing: before gender identity development is complete (within the first two years) and under general anaesthesia. The foreskin should not be removed completely; enough should be left to allow for penile growth and erection.

Important: Babies with suspected hypospadias must not be circumcised. The foreskin is a valuable source of tissue for the repair.

Appendicitis

Inflammation of the appendix, located where the small and large bowel meet. The main symptoms are abdominal pain, loss of appetite, nausea and vomiting, and fever. Treatment is surgical and should not be delayed once the diagnosis is made; the inflamed appendix must be removed before it perforates. The procedure is performed laparoscopically or by open surgery depending on the patient’s condition.

Torticollis

Shortening and tightening of the neck muscle (sternocleidomastoid) in the newborn. It is recognised by a mass within the muscle and by the baby constantly lying towards the same side; untreated, asymmetry of the head and face may develop. Passive stretching exercises help; surgical treatment is applied particularly where facial asymmetry is present.

Frequently asked questions

What is the difference between a pediatric surgeon and a general surgeon?

A pediatric surgeon has completed additional specialist training in surgical conditions from birth through adolescence. Because tissue structure, organ size, fluid balance and anaesthetic requirements differ from adults, both the decision to operate and the surgical technique differ as well.

At what age can my child have surgery?

The age depends on the condition. Inguinal hernia requires surgery as soon as it is diagnosed, while an undescended testis is usually operated between 6 months and 1 year, circumcision within the first two years, and hypospadias repair between 6 months and 2 years. A pediatric surgeon should advise on the right timing.

Can surgery be done as a day case?

Yes. Common procedures such as inguinal hernia, hydrocele and undescended testis repair can be performed as day-case (out-patient) surgery. Once preparation and tests are complete the operation is carried out the same day, and the patient is usually discharged after 2–4 hours.

Is general anaesthesia safe in children?

With an experienced pediatric anaesthetic team and appropriate age- and weight-based dosing, general anaesthesia is administered safely. Pre-operative assessment and investigations are an essential part of that safety.

How can I arrange an appointment in Istanbul?

Prof. Dr. Hüseyin Özbey sees patients at his private practice in Bakırköy, Istanbul. Address, telephone number and a contact form are available on our contact page.

Appointment and contact

If you think your child has a condition that may require surgery, you can reach us through our contact page, where you will find the clinic address in Bakırköy, Istanbul, the telephone number and a contact form.