Some Common Diseases in Pediatric Surgery:

Undescended Testes

Inguinal hernia (groin hernia, hernia) in children does not occur as a result of strain as in adults. While babies develop in the womb, a glove-like protrusion from the membrane lining the abdomen extends out of the inguinal canal. In one in 50 boys and one in 250 girls, this bulge remains open after birth, causing swelling in the groin area. If the relationship between this residue and the inside of the abdomen is narrow, the intra-abdominal fluid gradually descends and forms a fluid-filled swelling. This situation causes diseases called hydrocele or cord cyst. If the relationship between the relevant residue and the inside of the abdomen is wide, or if the narrow passage widens over time, the intestines in the abdomen enter this sac and cause inguinal hernia.

Since the cause of inguinal hernia in children is a residue, there is no possibility of spontaneous recovery. Remnants in the form of cord cysts or hydroceles eventually turn into inguinal hernia. The main principle in the treatment of all diseases is to remove the relevant residue and close its relationship with the inside of the abdomen. In inguinal hernias, surgery is performed as soon as possible to prevent the development of an emergency problem called hernia strangulation. If the cord is due to cyst and the baby is a newborn, it is expected to be 3 months old.

In hydroceles, if there is no associated inguinal hernia, it can be waited until 1 year of age. All of the aforementioned surgeries are performed without the child being hospitalized, but by being sent home a few hours after the surgery. If your child has a swelling in the groin, consult your doctor as you may have a related disease. If your child has pain and vomiting, and the swelling in the groin is hard and does not disappear with pressure, consult a physician immediately. Unfortunately, inguinal hernias can cause immediate problems due to strangulation when they are first noticed…

Undescended Testes
Boys’ testicles (ovaries) are normally located in the scrotum (bag). When the testicles that form in the abdomen while the fetus is developing in the mother’s womb, pass through the inguinal canal and descend to the scrotum, fail to descend into the scrotum, it is called undescended testicle.

If you cannot see both of your son’s testicles in his scottum, check again after a warm bath. The phenomenon most confused with undescended testicle is the condition of retraltile testicle (better known as shy testicle in Turkish), where the testicles are pulled into the inguinal canal due to a muscle in the groin. This is not a disease and will heal on its own as the child grows up. Shy testicles often manifest themselves by descending into the scrotum in warm environments.

If the testicles do not descend into the scrotum even in a hot environment, it would be appropriate to consult your physician. One of the feared consequences of undescended testicles is the loss of the ability of the testicles to produce sperm, that is, infertility. Although infertility does not occur suddenly, its rate gradually increases in untreated testicles after the age of two. For this reason, surgery is currently recommended when the child is 12-18 months old.

If your doctor cannot find the testicle in the inguinal canal, laparoscopy can determine whether there is a testicle in the abdomen. ?Surgery without a knife? In laparoscopy, known as laparoscopy, a small device is inserted into the abdomen and the testicles are examined.

All of the aforementioned surgeries are performed without the child being hospitalized, but by being sent home a few hours after the surgery.

UMBLICAL HERNIA (Umbilical hernia)
The fetus in the mother’s womb survives through the veins that come out of the navel and extend to the mother. There is an opening in the abdominal wall so that these vessels in the umbilical cord, which falls off after birth, can pass through. In many newborn babies, intra-abdominal organs come out through this opening, creating a swelling in the navel. This condition is called umbilical hernia. Babies with umbilical hernia do not need any treatment within the first two years of life. Even if the swelling on the outside of the hernia grows over time, it will most likely heal on its own as the abdominal wall develops. Methods such as sticking a coin to the navel or tying an umbilical cord should not be used as they do not increase the likelihood of recovery. If a child who is two years old still has an umbilical hernia, a doctor should be consulted.

HYPOSPADIAS (Sunnah of the Prophet)
It is a disease of the penis, the male sexual organ. Lack of foreskin; The opening for urination is opened further back rather than in its normal position. The most frightening aspect of this condition, also called circumcision of the Prophet, is that some children also have a curvature in the penis.

If you see any deformity in your child’s penis, consult a physician. Even if only the foreskin appears to be missing, do not complete your child’s circumcision without consulting a specialist. Although different surgeries are performed today depending on the type of hypospadias, the majority of these surgeries can be performed when the baby is six months old. Since ages 3-6 are not psychologically suitable for hypospadias surgeries, it is beneficial to have the repair done at a young age and to prevent the child from remembering the genital disease when he/she focuses on his/her genitals.

The tip of the penis skin is referred to as the prepuce in medical language. The process of removing this skin and exposing the tip of the penis is called circumcision. Circumcision is performed for religious and medical reasons. In Islam and Judaism, circumcision is performed on boys who do not have bleeding diathesis (patients with blood clotting disorders). There is a medical need for circumcision in boys whose prepuce tip is narrow, who have recurrent urinary tract infections, and who develop infections at the tip of the penis.

The appropriate age for circumcision is debated. Jewish circumcision for religious purposes is performed when the baby is 1 week old. In Islam, there is no specific religious time specified. For health reasons, circumcision should be avoided between the ages of 3 and 6, when the child psychologically returns to his genitals. Circumcision can be performed before or after these ages, which cause serious psychological injury to the child.

Based on the principle of separating a part from the body, circumcision, which is a surgical procedure, is most appropriate to be performed in hospitals that provide operating room conditions.