Pediatric Surgery

Kolan British Hospital Pediatric Unit performs polyclinic follow-up and treatment of all surgical problems related with digestive system, urinary tracts, chest cavity (excluding heart) All required interventions are planned considering metabolisms of the infant and child and their physiological and psychological development.

Frequently Observed Pediatric Surgery Diseases Necessitating Treatment

Digestive System Surgery Diseases

• Constipation and defecation related abnormalities; encopresis, nutrition disorders, anal fissure, fecal incontinence, fistula formation
• Esophageal strictures, diseases caused by drinking inflammable and caustic substances (Corrosive Esophagitis)
• Narrow stomach, occlusion and ulcer
• Gastroesophageal reflux disease (GER) and its complications
• Intestinal blockage, polypus, inflammatory intestinal diseases
• Appendicitis
• Megacolon induced by congenital developmental disorder of intestinal nerves (enlarged lower intestine) (Hirschsprung Disease)
• Inguinal hernia, exomphalos
• Hepatic cysts, abscesses and tumors
• Congenital absence of bile ducts, cystic enlargement and stone disease
• Pancreas cysts and tumors
• Spleen removal in splenic diseases and blood diseases
• Respiratory System Surgical Diseases
• Congenital hepatic diseases and cysts
• Treatment of abscess and empyema induced by hepatic infections
• Aspiration of foreign body into trachea and bronchoscopic interventions
• Thoracic cage deformities (pectus excavatum, pectus carinatum)
• Surgical Diseases Related with Urinary System and Genital Organs
• Kidney Cysts, tumors and stone disease
• Ureteropelvic junction obstructions (UPJ obstruction)
• Ureterovesical junction obstructions (UVJ obstruction)
• Ureteral enlargement, stones
• Vesicoureteral reflux (VUR) (Retrograde movement of urine from bladder to kidneys)
• Bladder infections, stone disease
• Abnormality of intestines protruding outside the abdomen due to absence of abdominal wall (Omphalocele and Gastroschisis)
• Urethra opening to underside of the penis in boys (hypospadias)
• Undescended testis, hydrocele, spermatic cordon cyst
• Infections such as epididymo-orchitis (testis inflammation), balanitis-posthitis (foreskin inflammation) and prostatitis
• Circumcision
• Ovarian cysts and torsion in girls
• Closed hymen (virginal membrane), labial adhesions
• Neonatal Surgical Diseases
• Esophageal Atresia: Congenital absence and developmental defects of alimentary canal, and its relationship with trachea
• Gastric-duodenal atresia: duodenal obstruction, atresia of small and large intestines
• Positioning of intestines in chest cavity due to the absence of diaphragm (Congenital Diaphragmatic Hernia)
• Congenital anal stenosis or absence (Anorectal malformations)
• Endoscopic Interventions
• Esophagoscopy, Gastroscopy, Duodenoscopy
• Colonoscopy, Rectoscopy, Anoscopy
• Cystoscopy, Ureteroscopy, Bronchoscopy
• Cancer Diseases and Their Treatment in Childhood
• Renal and suprarenal gland tumors
• Liver tumors
• Ovary, testis tumors
• Tumors in other organs
• Surgical Treatment of Hormonal Diseases
• Thyroid gland (goiter) diseases
• Pancreas diseases
• Head and Neck Surgery in Children
• Neck masses; reactive lymph nodes
• Congenital neck masses and sinuses

Heel Test

Screening tests are tests aiming to identify and treat diseases before they cause irrevocable damages. These diseases are frequently observed diseases that can be easily detected through simple tests. Tests used in screening alarm patients on a possible health problem. After that, tests needed to establish a final diagnosis of suspected disease should be conducted. Diseases that can be detected by prenatal triple test or amniocentesis are different from diseases screened on newborn. In many hospitals, in addition to metabolic disease screening, hearing and congenital hip dislocation screening tests are also conducted on newborn.

What is Metabolic Disease?

“Metabolism” is the process of degradation of nutrients and conversion thereof into constituents used in the body. Chemical substances called “enzymes” are needed to convert nutrients into amino acids, lipids and carbon hydrates. Metabolic diseases are seen in the case of deficiency or dysfunction of enzymes.

“Metabolism” is the process of degradation of nutrients and conversion thereof into constituents used in the body. Chemical substances called “enzymes” are needed to convert nutrients into amino acids, lipids and carbon hydrates. Metabolic diseases are seen in the case of deficiency or dysfunction of enzymes.

What Are Metabolic Diseases Screened in Newborns?

There are numerous metabolic diseases varying depending on each country, and even different regions of the same country. Hypothyroidism, Phenylketonuria, Galactosemia, Cystic Fibrosis, Homocystinuria, Biotinidase deficiency, Congenital Adrenal Hyperplasia, Sickle-Cell Anemia are some of the diseases screened on newborn.

By using Tandem Mass Spectrometry method developed in 1990s, about 20 – 25 metabolic diseases can be screened. These diseases include Amino acid metabolism disorders, organic acidemias and fatty acid oxidation disorders. In Turkey, neonatal screening is routinely applied by phenylketonuria test, frequently by Hypothyroidism test and by Tandem Mass in some centers.

Why Are Newborn Screening Tests Applied?

Early diagnosis gives many babies with congenital metabolic or hormonal disease the chance to lead a healthy life. Babies who look completely healthy at birth, however, diagnosed with a disease as a result of screening tests are given an appropriate dietary and/or drug treatment and protected against any probable future results such as mental retardation, convulsion and even death. It is estimated that a disease is detected in 1 in 1500 babies by newborn screening tests.

How to Apply Newborn Screening Test?

For neonatal metabolic diseases screening test, a few drops of blood are sampled from the heel and dripped on a special filter paper, sampled blood is dried in room temperature and transferred to relevant central laboratory. Since the test is conducted by using a blood sample from heels of newborns, it is also known as “Heel Test”.

When to Apply the Test?

To avoid false negative results, sampling should be made minimum 24 hours after starting to feed the baby with proteinaceous nutrients. Blood sampling is usually preferred in 48 to 72nd hours, which should not exceed 7 days. If sampling is required within the first 24 hours, test repetition should be recommended in 1- 2nd weeks.

Test must be conducted on 7th day in premature babies regardless of the treatment applied. Test repetition after a while is recommended in babies taking Antibiotics, Corticosteroids, Dopamine and babies with Iodine Contamination.

How to Learn Test Results?

If neonatal metabolic disease scanning results are positive, families are not informed thereon. If test results are suspicious, families are re-called and informed on next tests, and required tests for final diagnosis are initiated.