When treating children, it is important to realise that they are not small adults. This means that every child must be treated according to their age and development and that the treatment concepts of adults cannot be applied.
Paediatric surgeons treat their patients from birth (sometimes even in the womb) until the end of puberty "from head to toe". This means that paediatric surgeons must have a complex knowledge of the entire child's organism. Furthermore, knowledge of growth, maturation and interaction of the various organ systems is a prerequisite for the treatment of complex congenital malformations and diseases during the growing years. Equally important is the special nature of working with children and adolescents. Here the demands on the practitioner are different from those for adults. Special attention and sensitivity in dealing with patients must be taken into account to ensure a good treatment outcome.
In order to ensure the best possible treatment for children, we have our own specialist for paediatric and adolescent surgery, which includes extensive further training.
In the following, we will give you an overview of the most common diagnoses that are treated in the paediatric surgery department at Ulm University Hospital, as well as special features of the treatment (equipment, techniques, developments).
The aim of minimally invasive surgery (MIS) is to perform operations with as little tissue damage as possible and with only small incisions. So-called "keyhole surgery" is possible in the abdomen, chest and through natural body openings. In recent years, there has been a massive development in the technique of MIS in children, so that newborn babies can also benefit from this surgical option.
Our clinic is equipped with the most modern devices and instruments to be able to perform such minimally invasive operations. A large proportion of the operations performed in our clinic are already minimally invasive.
These include congenital malformations or diseases in the chest and abdomen (e.g. liver/gall bladder, appendix, intestine), as well as operations for urological malformations and tumours.
If your child is due to have an operation, we will discuss the possibility of MIS with you during the consultation or in the emergency room.
Do you have any questions? Please write to us at sekr.kinderchirurgie@uniklinik-ulm.de.
This clinical picture occurs in approximately 1 newborn out of 3500 newborns. It affects the rectum and anus. According to studies, the development of these organs and structures is disturbed early in pregnancy (5th-7th week) when the malformations occur, i.e. sometimes even before the pregnancy is known. These malformations are rarely associated with other malformations.
The intestine normally ends in the middle of the sphincter muscle at the anus and forms a faecal reservoir in front of it, the rectum.
In the case of developmental disorders, this rectum cannot find its way downwards/outwards and ends in various other places, depending on gender.
In boys, the end of the undeveloped intestine (also known as a fistula) can occur in the bladder, urethra or even the perineum or testicles up to the shaft of the penis.
In girls, the vagina and uterus are adjacent to the bowel, so that this fistula (see above) can end directly in the vagina, but also in the perineum outside the sphincter.
The further down the fistula has travelled during the embryonic period, the easier it is to correct surgically. This usually takes place at the age of 3 months. Under anaesthesia before the operation, the muscles of the sphincter are tested with an electrostimulator to locate the centre. The fistula is then released while carefully protecting all structures and the rectum is pulled down into the centre of the muscle and sutured in place. The fistula itself is removed.
The children usually stay with us on the ward for 5-7 days.
If a fistula is further up in the abdomen, e.g. ends in the bladder, or if there is no fistula at all further up, i.e. a blind sac, then it is often necessary to operate from the abdomen. This can be done via laparoscopy. Occasionally, an artificial anus must first be created to establish the intestinal passage. Other malformations are clarified.
The further down the fistula has travelled during the embryonic period, the easier it is to correct surgically. This usually takes place at the age of 3 months. Under anaesthesia before the operation, the muscles of the sphincter are tested with an electrostimulator to locate the centre. The fistula is then released while carefully protecting all structures and the rectum is pulled down into the centre of the muscle and sutured in place. The fistula itself is removed.
The children usually stay with us on the ward for 5-7 days.
If a fistula is further up in the abdomen, e.g. ends in the bladder, or if there is no fistula at all further up, i.e. a blind sac, then it is often necessary to operate from the abdomen. This can be done via laparoscopy. Occasionally, an artificial anus must first be created to establish the intestinal passage. Other malformations are clarified.
With deep fistulas (next to the anus) and a well-developed sphincter muscle, the prognosis is often very good, so that no restrictions remain later. In the case of higher fistulas, such as urinary bladder fistulas in boys, the pelvic floor muscles, including the sphincter, may not be as well developed, which can unfortunately be associated with a poorer prognosis in terms of continence. In such cases, longer-term care may be necessary with the help of our cooperation partners gastroenterologists (paediatricians specialising in the stomach and intestines), physiotherapy, biofeedback therapy and, if necessary, psychological support. A diverse team ensures the best possible outcome for patients.
M. Hirschsprung's disease is a very rare disorder with a frequency of 1 in 5000 newborns. In the intestine of the embryo, the nerve cells develop from top to bottom. In Hirschsprung's disease, the "last meadow" is usually affected, so that the last nerve cells no longer reach the rectum (see Fig. 1). This can range from a very small section directly at the anus to - very rarely - involvement of the entire intestinal system. The affected bowel cannot relax the muscles and is therefore very tight. Here too - as with anal atresia - the disorder is thought to occur in early pregnancy (most likely between the 6th and 12th week of pregnancy).
The children are usually symptomatic early on with an absence of faeces within the first 2 days after birth. They often only defecate on enemas and are constipated. What is feared is the development of a so-called megacolon, where the large intestine widens extremely before the narrow part (see Fig. 2). Intestinal germs can then pass through the very vulnerable colon wall into the bloodstream and into the open abdominal cavity, which can lead to severe peritonitis as well as blood poisoning (septicaemia).
In order to detect Hirschsprung's disease, an enema with contrast medium under fluoroscopy can often be used to see a change in calibre from a narrow to a wide colon. In addition, the pressure can be measured with a thin catheter in the baby's bottom (rectomanometry), which also shows whether the bowel can relax.
With a tissue sample from the rectum (rectal biopsy), which is taken under a short general anaesthetic, the nerve cells in the intestinal wall can be examined in detail. The child is then hospitalised for one night to rule out secondary bleeding.
If Hirschsprung's disease is suspected, bowel movements are regulated using laxatives and enemas until surgery is performed. During the operation, the affected part is removed, if possible only from the anus, but sometimes the bowel has to be dissected from higher up using laparoscopy. A so-called frozen section with microscopic examination by a pathologist during the operation is used to determine whether the removed part is sufficient.
The children usually remain hospitalised for approx. 1 week after the operation. Afterwards, the children are seen in our gastrointestinal consultation more frequently at the beginning, later annually. Occasionally constipation still occurs, but this can usually be treated well with laxatives.
In tumour surgery, we distinguish between benign and malignant tumours. In the latter case in particular, the diagnosis of a malignant tumour is a major challenge for the affected children and their families. Thanks to the latest research and the development of new therapy concepts, there is a high cure rate for these diseases, especially in children. Surgical therapy is an important part of the interdisciplinary therapy concept.
One speciality of our paediatric surgery clinic is the treatment of benign and malignant tumours of various organs. These include tumours of the kidneys, adrenal glands, liver, genitals, lungs, pancreas, thyroid gland and congenital tumours.
The aim is always to operate as organ-preserving as possible. This means that, as far as possible, only the tumour is removed while preserving the structure and function of the operated organ. This leads to a faster recovery with a shorter hospital stay and fewer restrictions in normal life, as well as less impact on the growth and development of the children.
Together with our paediatric oncology colleagues, we will work with you to develop the best treatment concept for your child.
Our clinic is also actively involved in tumour research in cooperation with centres in Germany and abroad.
Plastic surgery in children has nothing to do with "cosmetic surgery". It involves improving, correcting or restoring external changes or functional limitations in the case of congenital malformations.
The plastic surgery procedures we frequently perform on children include
Haemangiomas (blood sponges), vascular malformations, nevus cell nevus (birthmarks), malformations of the hands and feet such as fused fingers (syndactyly) or supernumerary fingers/toes (hexadactyly), auricle plastic surgery for protruding ears.
We specialise in the treatment of thermal injuries (burns/scalds) in children. We treat children with thermal injuries up to an extent of 10% KOF. Small superficial burns or scalds can often be treated on an outpatient basis. For more extensive burns or more extensive therapy, inpatient treatment is required. Conservative and surgical therapies according to the latest treatment standards, including skin transplantation, are available. Consistent aftercare is also provided with all options for conservative and surgical scar treatment.
We use state-of-the-art, non-invasive technology for the diagnosis and treatment of thermal injuries.
The PeriCam PSI system is an imaging system based on special laser technology. It measures and records the superficial blood flow in large areas particularly quickly. It is primarily used in our department to assess burn and scald wounds.
Vascular surgery includes the detection, treatment and aftercare of malformations and diseases of the vascular system as well as surgical interventions on vessels. In contrast to adults, children do not have degenerative vascular diseases, which means that other operations are the focus of vascular surgery. In addition to additional vascular reconstructions during major surgical interventions, these include above all the insertion of central venous catheters (Hickman or port catheters, dialysis catheters). These catheters are part of a wide range of therapies, both in paediatric oncology and in paediatric haematology or immunology. We work closely with our colleagues at the Department of Paediatrics and Adolescent Medicine. Do you have any questions? Please write to us at sekr.kinderchirurgie@uniklinik-ulm.de.
Robotic surgery is a new development in minimally invasive surgery, whereby the operation is performed using robot-assisted endoscopy of the abdominal or thoracic cavity. This technique was developed in the 1980s and 1990s and is now used in around 4,300 clinics worldwide, including Ulm University Hospital.
In addition to smaller skin incisions, less blood loss and faster wound healing, the main advantages are the more precise visualisation of finer structures thanks to the up to 10-fold magnification of the 3D camera system and more precise dissection due to a larger radius of movement in the surgical area.
As part of the development of the paediatric surgery section, robot-assisted operations on the pancreas and colon have been performed since 2021. Depending on the development of the technology, further procedures are to follow in the future for use on smaller children
Do you have any questions? Please write to us at sekr.kinderchirurgie@uniklinik-ulm.de.