Neonate undergoes peri-umbilical surgery to repair bowel
Posted on 5 December 2019
It is well accepted that minimal invasive surgery is considered to be superior to open surgery, especially when it comes to decreased post-operative pain, quicker post-operative recovery, shorter hospital stay and better cosmetic outcome. According to Prof. Daniel Sidler, “In neonates and infants, a peri-umbilical incision seems to offer similar benefits without the added costs of laparoscopic surgery.”
This was the case recently when Prof. Daniel Sidler, paediatric surgeon based at Mediclinic Louis Leipoldt, performed peri-umbilical surgery on a neonate with jejunal atresia, where the blood supplying artery to the bowel was damaged during the pregnancy, leading to the affected piece of bowel dying off and leaving a gap in the continuity of the bowel. A periumbilical incision was made, and the small bowel, with the atresia/ defect, was brought out through the incision. Both ends were trimmed back and anastomosed so as to establish continuity.
“Following a 20 week scan during pregnancy, we knew there was something wrong with our son’s belly. We were told that tests could only be done once he was born. Two days after his birth, he got sick and tests were done. The doctors then indicated that he needed surgery,” says Mr Karelse, father to the young patient.
For surgeons working with smaller patients such as neonates and small infants, a peri-umbilical incision allows easy access to intra-abdominal surgical pathology, and offers improved post-operative recovery, with a shortened hospital stay, decreased pain and improved cosmesis (scar less surgery).
According to Prof. Sidler, “Advanced laparoscopic surgery made us comfortable with small incisions and with time we realised that some of the surgery could be done without using expensive equipment. Over time we realised that we can shorten surgical time by omitting the laparoscopic part and just performing the entire procedure via a peri-umbilical incision and having the same outcome.”
Since then, this surgery has proven to have very good results. It is important to consider that successful neonatal surgery depends on a multidisciplinary approach: the maternal fetal medicine team together with the ultrasonographer make the diagnosis, the obstetrician delivers the baby safely and the neonatology team takes care of the baby, preparing it for surgery and thereafter. The antenatal ultrasound was performed and diagnosed by Heidi Nolan, the neonatologist was Dr Paul Keating, the anaesthetist was Prof. Andrew Levine and the paediatric surgeon was Prof. Daniel Sidler. “Having early diagnosis helps to plan a complex procedure such as this one, involving super specialists,” says Prof. Sidler.
“We thought it would take weeks to months for him to recover, but after a week we saw the improvement in his health and his recovery was quicker than we thought – thanks to Prof. Sidler and the other assistant doctors in the ICU theatre,” Mr Karelse explains.
For patients such as this, the birth of their child has already been traumatic, often as a result of a premature birth or admission to NICU. “When considering prematurity and the various issues that are associated with such, one wants to try to provide the best, least traumatic care for the infant and family who are facing such unfortunate start,” he explains, “Thus the decision to be minimally invasive and proceed with a peri-umbilical incision.” He strongly believes it offers less pain, quicker recovery to feed, shorter hospitalisation and improved cosmesis. It might also improve the bonding in that the mother/parents might be less scared to hold and handle the baby, contrary to an infant with a large wound.
When it comes to expertise and the ability to intervene at a key moment in time, Prof. Sidler explains his motivation, “There is a very rewarding element of resilience and ‘bounce back’ and gratitude in children and it is very satisfying to know that a surgical intervention can improve a life time ahead. I enjoy the interaction with children and their parents as well as with other team members and medical role players. It is always a team approach.”
“It feels like a miracle was performed during that period in time on our baby, and we are just happy that the problem our baby had could be resolved. We are so grateful that Prof. Sidler was available to assist our boy. Having to see our son in the ICU on a daily basis with all the pipes wasn’t easy but we always got the reassurance from the doctors that he was recovering well,” the Karelse parents conclude.