PAEDIATRIC SURGERY IN GERMANY

Paediatric surgery in Germany is a byword for the highest standard of surgical care for children.

Paediatric surgery is a distinct discipline that covers the whole range of surgical procedures in children — from premature babies to adolescents. Children are not small adults: their diseases present differently (congenital malformations and rare conditions, for example), they express their feelings and respond to pain differently, they have particular needs (warmth, for example), and they require an age-appropriate environment and a therapy adapted to their age and weight. Treating children calls for specially trained doctors and nurses.

All of this is offered by the paediatric surgery centres that work with msp group germany.

Here, treatment is provided for premature and newborn babies and for children and adolescents with congenital malformations, tumours of infancy, specific diseases of the various growth phases, and disorders or deformities of the chest, lungs, abdominal cavity and urinary tract, including those following accidents.

The teams at paediatric surgery hospitals in Germany have particular expertise in treating congenital malformations in premature and newborn babies — for example, children with congenital diaphragmatic hernia or with lung malformations such as congenital bronchopulmonary sequestration (pulmonary sequestration, sequestered lung lobe), congenital cystic adenomatoid malformation of the lung (CCAM, congenital cystic lung disease), congenital lobar emphysema, and abdominal wall defects (gastroschisis and omphalocele).

Minimally invasive paediatric surgery in Germany

Minimally invasive surgical techniques, the so-called «keyhole» approach («keyhole surgery»), are used wherever this is possible and appropriate. The paediatric surgeons at University Hospital Bonn, for example, specialise in the minimally invasive correction of congenital pectus excavatum (funnel chest) using the Nuss technique (the Nuss procedure). This technique considerably reduces the risk of intraoperative and postoperative complications and shortens the time needed for the patient to recover fully. Unlike in many countries, where such cases are still treated with open operations involving complete division of the ribs, German surgeons offer a minimally traumatic procedure.
With this technique, a surgical instrument is introduced into the chest through a mini-access (two small incisions 4 cm long). An implant (a titanium bar) is then carefully positioned horizontally beneath the ribs, so as not to damage the vessels or the heart, and fixed with special clips; it straightens the anterior chest wall, that is, brings it into its anatomically correct position. Occasionally, if the child is very tall and the sternum has an unusual shape, two implants are placed instead of the usual one. An operation of this kind requires specific equipment and skills, as well as a sufficient number of procedures already performed using the technique.

Laparoscopic appendicectomy in children, laparoscopic search for an undescended testis in testicular ectopia and cryptorchidism, laparoscopic removal of the gallbladder in children, surgery for varicocele in children and diagnostic laparoscopy, including for tumours, are all part of the routine use of laparoscopy.

Paediatric surgery in Germany: close interdisciplinary cooperation

All paediatric surgery hospitals in Germany work closely with paediatric oncology centres certified by the German Cancer Society (DKG). Every case of childhood cancer is discussed at an interdisciplinary tumour board made up of paediatric oncologists, paediatric surgeons, paediatric radiologists, pathologists and radiation oncologists. Cancer in children is treated in strict accordance with the protocols of the Society for Paediatric Oncology and Haematology (GPOH). Every paediatric oncology centre in Germany has its own focus. Since Germany's training centre for the treatment of intracranial and extracranial germ cell tumours is located in Bonn, for instance, children with such tumours (for example, tumours of the coccyx) are most often treated there.

Working together with colleagues from paediatric nephrology, paediatric radiology, prenatal medicine, fetal surgery and neonatology, the surgeons operate on children with urological problems such as LUTO (lower urinary tract obstruction), vesicoureteral reflux (VUR), urinary tract disorders and malformations of the kidneys. Individual treatment concepts are drawn up at a joint paediatric urology and nephrology board.

The paediatric surgery hospitals also include colleagues who have completed special training and hold certification in paediatric gynaecology.

The aim of paediatric surgery hospitals is to provide optimal, age-appropriate treatment and care for their young patients while taking the parents' wishes into account.

Interdisciplinary cooperation between paediatric surgeons and adult surgeons, paediatricians, paediatric anaesthetists, paediatric radiologists, prenatal specialists, fetal surgeons, obstetricians and gynaecologists, paediatric cardiac surgeons, paediatric orthopaedic surgeons, trauma surgeons, paediatric neurosurgeons, plastic surgeons, maxillofacial surgeons and others is a great advantage for young patients: everything is on site, and everything is there for your child!

How are children's operations performed in Germany?

As already mentioned, paediatric surgery in Germany is notable for the wide use of minimally invasive techniques. Operations in children, including emergency procedures, are most often performed laparoscopically or thoracoscopically, which guarantees minimal incisions (1–2 cm) and little tissue damage. These technologies make it possible to reduce pain and the length of recovery considerably.

Paediatric intensive care rooms and units are fitted with state-of-the-art equipment. Round-the-clock monitoring systems are installed, and experienced medical staff watch over the condition of the young patients at all times. Should it deteriorate, paediatricians or neonatologists provide the necessary care immediately.

In German hospitals, underage children may stay in the room together with their mother, father or grandmother.
Most elective operations are carried out as day-case surgery, with the child and the parents spending no more than 6-12 hours in the room at the surgical hospital. A complete preoperative work-up can be carried out at the hospital within a single day.

Patients have access to:

• emergency and elective paediatric surgery;
• experienced paediatric anaesthetists and intensivists, and dedicated equipment;
• minimally invasive technologies and the gentlest possible operations;
• precise diagnostics: a diagnosis in the shortest possible time;
• a comfortable inpatient unit where parents can stay with their children;
• admission of international patients for emergency and elective treatment.

Areas of specialisation of paediatric surgery hospitals and centres

General paediatric surgery

• surgery for hernia of the linea alba (epigastric hernia);
  
• surgery for inguinal hernia;
  
• surgery for umbilical hernia;
  
• removal of a pilonidal (coccygeal) cyst;
  
• puncture of a cephalohaematoma in newborns;
  
• removal of neck fistulas in children;
  
• removal of neck cysts in children;
  
• removal of warts, naevi, lipomas, atheromas and fibromas;
  
• removal of papillomas and condylomas;
  
• removal of molluscum contagiosum..

Thoracic surgery

• pectus excavatum and pectus carinatum;
• pleural effusion and pleural empyema;
• congenital lung malformations (pulmonary sequestration, emphysema);
• bronchogenic cysts;
• tumours of the chest organs.

Malformations of the gastrointestinal tract

• anorectal malformations (ARM);
• congenital malformations of the abdominal wall and abdominal cavity (gastroschisis and omphalocele);
• oesophageal malformations in newborns (oesophageal atresia, oesophageal cleft, achalasia of the oesophagus);
• anal atresia;
  
• atresia of the bile ducts;
  
• biliary atresia (Kasai procedure);
• diaphragmatic hernia;
  
• duodenal obstruction;
  
• «prune belly» syndrome;
• gastroschisis;
  
• intestinal duplication;
  
• jejunoileal atresia and large bowel obstruction;
• short bowel syndrome (SBS);
• Hirschsprung's disease (congenital megacolon);
• malabsorption syndromes;
  
• small intestinal bacterial overgrowth;
  
• carbohydrate intolerance;
  
• coeliac disease;
  
• intestinal lymphangiectasia;
  
• chronic inflammatory bowel disease (ulcerative colitis, Crohn's disease);
• tropical sprue;
  
• Whipple's disease.
  

Vascular malformations in children

• haemangiomas;
• arteriovenous malformations (malformations of the blood vessels);
• lymphangiomas (rare anomalies of the lymphatic vessels).

Congenital diaphragmatic hernia (CDH)

• surgical treatment of CDH after the child is born;
• fetal (intrauterine) minimally invasive surgery for CDH;
• interdisciplinary care in the intensive care unit;
• use of extracorporeal membrane oxygenation (ECMO);
• high chances of survival without loss of quality of life.

Emergency and elective urological operations for the following conditions

• adrenogenital syndrome / congenital adrenal hyperplasia (CAH);
• bladder exstrophy and the full spectrum of malformations of the lower abdominal wall;
• impaired bladder emptying as a consequence of an underlying neurological;
• disorder (e.g. myelomeningocele, spina bifida / spinal dysraphism);
• vesicoureteral reflux / vesicorenal reflux / vesicoureteric reflux;
• urinary tract infections;
• cryptorchidism (undescended testis);
• inguinal hernia;
• hydrocele (hydrocele of the testis);
• hypospadias;
• urinary incontinence in childhood (enuresis);
• stricture of the pelviureteric junction;
• phimosis;
• cloacal anomalies (urogenital sinus);
• transabdominal pyeloplasty using the Hynes–Anderson technique;
• acute scrotum syndrome
• hydronephrosis.

Surgical correction of hand and foot anomalies

• polydactyly (preaxial polydactyly, central polydactyly, postaxial polydactyly);
• syndactyly.

Polydactyly and syndactyly are treated surgically. The treatment of absent or hypoplastic limbs consists mainly of prosthetics, which is most appropriate when the lower limbs are missing and when the upper limbs are completely or almost completely absent.

Paediatric plastic surgery, burn surgery and hand surgery

• correction of congenital defects (craniofacial defects, cleft lip, cleft palate);
• functional rhinoplasty; 
• aesthetic rhinoplasty (from the age of 7);
  
• reconstruction after injuries and malignant lesions, correction of congenital anomalies of the face, head and neck;
• correction of craniofacial congenital defects and of defects following trauma and injuries to the head and face;
• microsurgical reconstruction of the facial nerves;
• otoplasty (from the age of 7);
  
• correction of breast asymmetry;
• reconstructive surgery after cancer, trauma and injuries in the head and neck region;
• haemangiomas;
• chemical and thermal burns and correction of post-burn scars;
• scar correction;
• tumours of the skin and subcutaneous fat;
• gynaecomastia;
• pilonidal sinus;
• poly-/syndactyly;
• liposuction (from the age of 16 and with the consent of both parents);
• surgical repair of congenital defects of the external genitalia.

Paediatric ENT surgery

• removal of adenoids in children (adenoidectomy);
• removal of tonsils in children (the palatine tonsils);
• septoplasty for a deviated nasal septum;
• vasotomy of the inferior turbinates;
• operations on the maxillary sinuses in children;
• puncture for sinusitis in children;
• removal of nasal cysts in children;
• removal of nasal polyps in children;
• reduction of the nasal bones in children;
• removal of foreign bodies from the throat;
• insertion of grommets (tympanostomy tubes).