OLEG TIMOSHCHENKO, pediatric surgeon, Children’s City Clinical Hospital. N.F. Filatov, Center for outpatient surgery
Today, out-patient surgery deals with problems that do not require hospitalization of young patients: we are talking about a lot of manipulations and surgical interventions – therapeutic and necessary for making a diagnosis. Moreover, with the rational organization of such assistance, more and more different tasks can be solved, thereby avoiding the need to go to the hospital. Our 25-year experience in the development of outpatient surgery at Filatovskaya Hospital has led to the creation of a special center with a daytime surgical hospital in which many types of surgical interventions can be performed, including operations of moderate complexity.
Most of our patients, about 70%, are children from 1 year to 5 years.
It is very important that such a center is part of a multidisciplinary hospital. After all, for any, even a small operation and manipulation, the use of different methods of anesthesia, situations may arise that require observation of the child already in a hospital setting and the attention of surgeons of various specialties.
This must be remembered when you are going to go to the one-day hospital, working autonomously or in the conditions of the district clinic.
Parents are free to choose the institution where the baby will be observed. And if specialists of a non-district clinic take care of him, information about his state of health and the results of a medical examination should be transferred to the institution where the main medical card of the small one is located – now it is called “History of a child’s development”.
This document is legally binding, and based on the information contained in it, all decisions (including expert ones) concerning the health of the baby are made.
All surgeries in our center are performed in a single-day hospital. Children come here from the Consultative and Diagnostic Department, where patients are identified for out-patient treatment for outpatient treatment (and not only for the operating room) and for those who need help in a hospital setting.
Then the center includes treatment departments for benign vascular neoplasms (hemangiomas, angiofibromas, and so on), ambulatory orthopedics (here they are engaged in therapy for congenital hip dislocation, clubfoot, torticollis, disorders of the formation of children’s feet) – their specialists use techniques that do not require intervention. If it is necessary, the hospital of one day will be engaged in it.
We accept children from 1 year old – this is a global practice. The fact is that 98% of surgical interventions are done under general anesthesia.
And children under the age of 1 need a longer observation of the anesthesiologist, and this situation goes beyond the scope of outpatient surgery.
Young patients up to 4 years most often go to the hospital for one day for the treatment of inguinal and umbilical hernia, dropsy, cysts of the membranes of the testicle and spermatic cord, phimosis, undescended testicle.
Modern surgical treatment is based on the principle of minimizing the surgical wound. And that means reducing its marks on the surface as much as possible. Techniques have been developed, thanks to which, firstly, after the operation, the child does not hurt anything, and secondly, complications and exacerbations of past problems are almost completely excluded.
This is achieved by a very small skin incision (no longer than 1 cm long), the most gentle treatment of tissues and the use of the most modern suture material. In the past 14 years, we have completely abandoned the unpleasant procedure of stitching, because we practice intradermal cosmetic suture made with absorbable materials. Add to this a noticeable reduction in the time of surgery and general anesthesia.
And finally, another task is to ensure that the traces of the operation are, to the extent possible, cosmetic. As a result, parents can hardly detect the result of the surgeon’s work on the child’s body.
For anesthesia, we use only inhalation (mask) anesthesia, it will be the most benign of all possible, and supplement it with other methods when a local anesthetic is applied to the skin or injected at special points in the area of the wound.
- A few hours spent in the hospital with the mother, the kids tolerate better than multi-day hospital stay, sometimes without parents.
- The list of examinations before the visit to the hospital is reduced.
- The risk of hospital infections is reduced to a minimum.
- The condition of the child at all stages of treatment is observed by one specialist.
- Here are taken “sparing” (doctors say – minimally invasive) intervention.
To begin with, it is very important to determine which particular treatment a small patient needs: is it necessary to have surgery, will it be outpatient, or will he need help in the conditions of the planned surgery department of the hospital. This is the task of the first stage – the primary technique, which should be conducted by surgeons of various specialties.
And then the doctor needs to establish close contact with the child. Then a detailed conversation with the parents follows, so that they can be convinced: they are an experienced specialist who is fully responsible for the success of the treatment.
That is why it is so important that the same doctor oversees the child at all its stages.
Children spend in the hospital for 1 day no more than 3.5 hours: from preoperative examination to discharge. The possibilities of our center allow us to conduct a full course of treatment, from establishing the correct diagnosis to complete recovery, including the operation itself.
On the 7th day after the intervention, the child will have a second visit to the center, during which the parents receive recommendations for the future. Or he may need to come back again for further observation and / or a new stage of treatment.
ALEXEY GERASKIN, Head of the Department of Pediatric Surgery, Russian State Medical University. N.I. Pirogov, MD, Professor
The first pediatric surgical hospitals of the same day (CSFD) appeared in the USA in the mid 60s of the last century. The first such institution in the USSR was our department, which was organized in January 1985 on the initiative of the Department of Pediatric Surgery of the Russian State Medical University.
Since the beginning of the 90s, the hospital of one day became a member of the Center for Ambulatory Surgery.
Now our center operates according to modern standards adopted for this type of medical care throughout the world. This means that we can also replace the inpatient hospital by conducting the necessary treatment in half a day, and supplement it by monitoring the condition and completing the medical care of the children already operated on in the hospital.
The first visit to the doctor will take place when the baby is 1 month old. Next – in 1 year.
The surgeon deals with the problems of malformations of babies whose treatment requires surgery. He establishes the diagnosis and determines what kind of treatment the baby needs: planned or emergency.
A surgeon should be contacted, for example, in the following cases: you notice that your baby has a bulge in the navel or groin area; the child has an ingrown nail; in boys, one half of the scrotum is larger than the other, or it is empty; if the child is seriously injured; his stomach hurts badly; redness and swelling appeared on the skin; he cannot move the handle or the foot.
Before you go to kindergarten, the baby will have to undergo a small examination. In addition to the surgeon, he will be examined: a pediatrician, a neurologist, an orthopedist, an ophthalmologist, and also a dermatologist, a speech therapist, and in kindergarten a teacher or psychologist.
The level of training of doctors and the equipment of our Center for Outpatient Surgery give us the opportunity to treat the whole range of surgical problems, from quite common hernias, dropsy, hemangiomas, disorders in the formation of children’s feet, to the uroandrological disorders recently issued as a separate medical specialty (in fact – the risk of malfunction in the reproductive systems in children). And this means that our little patients, regardless of their problems, will not be redirected somewhere else and will receive the full range of treatment, starting with the diagnosis and ending with full recovery.
In addition, I emphasize, we have the principle of “one-handed” – the opposite of the situation when a child is observed and treated by a string of doctors.
Faced with the problem of choosing an institution for consultation or surgical treatment, parents need to remember that the surgical departments of district polyclinics do not always have the capacity to provide expert assistance, and contacting specialists from large clinics will avoid many problems. Small Muscovites here are accepted free of charge, residents of other cities need to get a referral to the city health committee, and there is a contract system for citizens of other countries.