Raising the Bar in Pediatric Surgical Care

At Lehigh Valley Reilly Children’s Hospital, the division of pediatric surgical specialties has the area’s most board-certified Pediatric General and Thoracic surgeons. These surgeons specialize in diagnosing and treating surgical conditions in neonates, children, teenagers and young adults.

Dedicated to minimally-invasive techniques, these surgeons focus on the abdominal and chest areas. They perform procedures to address congenital malformations, injuries and diseases, ensuring careful, age-appropriate care.

As the Division Chief of Pediatric Surgical Specialties for the past 10 years, Marybeth Browne, MD, has built a children’s surgical program dedicated to following national best practices and the highest of quality care and patient safety standards.  

“When a child needs surgical care, parents seek a surgeon who is skilled, compassionate, trustworthy and attentive to their child’s needs” she says. “As experienced surgeons and also parents, my partners and I are dedicated to providing expert care to the children of this region for common problems like a hernia, skin lesions and appendicitis to complex and congenital conditions of the chest and abdomen.”

In addition to being the only children’s hospital in eastern Pennsylvania that participates in the American College of Surgeons’ (ACS) National Surgical Quality Improvement Program, the Children’s Surgery Program is preparing to apply for designation through the ACS Children’s Surgery Verification™ Program – a step reflecting the network’s tremendous commitment to the highest standards of surgical care for the pediatric population.

Minimally invasive hernia repairs

Abdominal wall hernias and hydroceles are common conditions in infants and children, often requiring surgical repair. The pediatric general and thoracic surgeons at Lehigh Valley Reilly Children’s Hospital specialize in minimally invasive repair techniques for inguinal hernias and hydroceles. This can allow for smaller incisions and quicker operating and recovery times.

“Childhood hernias are different than adult abdominal wall hernias; it’s not a muscle weakness but rather a congenital abdominal wall opening or hole. These holes may cause discomfort or can be asymptomatic,” Dr. Browne explains. “Incarceration or strangulation is rare in children and so most hernias are repaired electively. But, since incarceration can be more common in infants, we try to repair inguinal hernias in babies soon after diagnosis or before a baby goes home from the NICU to prevent these complications.” 

Umbilical hernias in children are often noticed during infancy. Unlike inguinal hernias, which may need prompt attention, umbilical hernias can close spontaneously within the first few years of life and are usually not repaired until after the age of four or five.

“It’s all about reducing the burden of surgery for their families while achieving the best outcomes for their children,” Dr. Browne explains. “We want children to go home soon and thrive in their recovery.”

Chest wall deformities

Lehigh Valley Reilly Children’s Hospital also excels in treating chest wall deformities, such as pectus excavatum (sunken chest) and pectus carinatum (protruding chest), through its dedicated Chest Wall Program. These conditions, although rare, can affect both physical health and self-esteem.

“We typically see a mid-to-late teenager who is unhappy with the appearance of their chest and/or is suffering from the physiologic consequences of cardiac compression by the sternum (breastbone),” explains Sarah Sapienza, MD, Chief of Pediatric Trauma, who directs the program and stresses the importance of early referrals. “Seeing a pediatric surgeon before puberty helps families understand what to expect and allows us to discuss the timing of surgical and nonsurgical options.”

Surgical repair of pectus excavatum, for example, typically occurs after teen growth has stopped; however, some younger children with symptomatic cardiac compression benefit from an earlier repair.

“The reward for the patient and the surgical team is the relief of symptoms almost immediately,” Dr. Sapienza says.

For severe cases of pectus excavatum, the team does a minimally invasive Nuss procedure, which uses customized metal bars to reshape the chest. Innovations like intraoperative cryoablation minimize postoperative pain, reduce the need for narcotics and allow for faster recovery. In addition, the team is incorporating enhanced recovery-after-surgery concepts into their treatment pathway to promote a shorter hospital stay and focus on factors that delay postoperative recovery.

Pilonidal disease

Anytime a doctor or clinician notices that there is disease in the intergluteal cleft, they should refer the child to Lehigh Valley Reilly Children’s Hospital’s Pilonidal Care Program.

Led by pediatric general surgeon Daniel Relles, MD, the program includes care for pilonidal abscess, cysts, sinuses and pits, which can present along a spectrum of acuity: asymptomatic pits in the cleft, mild pain or discomfort, chronic drainage or a chronic wound, or abscess.

“When we see patients, many of them do not need surgery and can manage their condition with aggressive hygiene of the cleft and hair removal, but an abscess is often painful and will be seen in the office or the emergency department,” he explains.

For those who need surgery, the team uses a minimally invasive approach called trephination. A circular knife punches a hole anywhere from 3 to 6 millimeters in diameter to remove any pits and clean and flush the area underneath – which can be the size of a grape up to the size of a lemon.

“The benefit of this approach is that there aren’t many restrictions after and it isn’t very painful after the operation,” Dr. Relles says. “Our patients are told to take Tylenol or Motrin after the procedure for pain; many are back running track or playing competitive sports three days after the procedure.”