SERVICES PROVIDED

The department of Paediatric Surgery has a ward with a capacity of 50 beds – including an eight-bed intensive care unit and a dedicated operation theatre complex with an endoscopy room. The department deals with a wide spectrum of cases below the age of twelve years.

Both emergency and elective cases are seen; the referrals being from private practitioners, school health clinics, outpatient clinics, peripheral primary and secondary health care centres and from the Departments of Paediatrics and Neonatology. Regional patients form neighbouring states are also treated in the department.

The department provides emergency services daily with residents available on the floor round the clock. The department runs out patient clinics twice a week on Tuesday and Thursday at 1:30pm in OPD 11 on the ground floor Multistory Building. Every Thursday at 2.30 pm, a speciality multi-disciplinary Birth defect Clinic has been started , where couples with antenatal scan showing anomalies are jointly counseled.

The department runs two operation theatres five days a week. The total surgeries performed annually are about 2000; 800 of which are major operations. Routine upper G. I. Endoscopies, bronchoscopies and cystoscopies are done regularly.

Division of Paediatric Surgery covers a wide area of work namely :

1. General Paediatric Surgery
   This includes problems such as hernias, uro-genital lesions, lumps and bumps, head and neck lesions, haemangioma, lymphangioma, cystic hygroma and perianal conditions.
2. Neonatal Surgery
   Expectant mothers with babies with congenital anomalies are seen together with the obstetrician doing the ultrasound assessments and their management planned. Gastro-intestinal, abdominal wall defects, diaphragmatic hernias, lung cysts and malformations, teratomas (sacroccygeal, mediastinal, pharyngeal and cervical) and renal anomalies are among conditions diagnosed and managed.
3. Urology
   Paediatric urology makes up about 30% of the work of the division. Nephrectomies, nephro-ureterectomies and partial nephrectomies are carried out. Pyeloplasties, hypospadias repair, undescended testis, neurogenic bladder and vesico-ureteric reflux are common urologic conditions seen. A complete set of cystoscopes is available from newborn till adolescent age.
4. Hepato-biliary and Gastrointestinal Surgery
   Biliary atresia and choledochal cyst are common hepato-biliary conditions seen in the division. Liver tumours, though uncommon, are managed together with Paediatric oncologist. Pancreatic illnesses such as acute and chronic pancreatitis and pancreatic tumours are also treated. All small and large bowel atresias, obstructions and intussusceptions are managed. Upper GI endoscopy through flexible OGDscope with retrieval of foreign bodies, esophageal dilatation is also done.
5. Thoracic Surgery
   All extra cardiac thoracic lesions in the neonates are followed up from antenatal diagnosis to post-natal surgery by the division. The commonest of the conditions managed are empyema, lung cyst, cystic adenomatoid malformation of the lungs, pulmonary sequestration and congenital lobar emphysema. Intra thoracic tumours, lung bulae with recurrent pneumothorax, esophageal atresia and fistula are also dealt with.
6. Surgical Oncology
   Wilms’ tumour, neuroblastoma, hepatoblastoma, sacrococcygeal and other teratomas and mediastinal tumours are managed jointly with Medical Paediatric Oncology at Tata Memorial Hospital.
7. Minimally invasive surgeries
   Both diagnostic & therapeutic laparoscopies and thoracoscopies are performed regularly. In ther last 11 years, 1852 laparoscopic and thoracoscopic procedures have been conducted. The department has recently acquired 3 – D laparoscope, a first in MCGM Hospitals.
8. Birth Defect Clinic

Every Thursday at 2.30 pm a speciality Birth defect Clinic is conducted; where all children with any congenital anomaly, pregnant ladies with antenatal USG showing fetus with congenital anomalies, ladies with bad obstetric history and also couples with family history of birth defect are seen in the clinic. The specialists from respective speciality have a joint consultation, outline management plan and counsel the children alongwith their families in this clinic. More than 300 families have attended the clinic.The clinic is conducted every Thursday afternoon at 2.30 pm in the Board Room, Department of Paediatric Surgery, 3^rd Floor, Old building, Gynecology Wing, K.E.M. Hospital.

1. Sophisticated post-surgical ICU:

The special 8 bedded ICU provides much needed postoperative care to neonates, infants and children who need ventilation and/or ICU care. The department possesses a high frequency oscillatory ventilator system for ventilation of newborn children with congenital diaphragmatic hernia and pulmonary hypertension and adequate warmers and multipara monitors.

TRAINING FACILITIES

The department runs a superspecialty M. Ch. course in Paediatric Surgery for which post-MS or post-DNB General Surgery candidates are enrolled every year (recognized by Medical Council of India (MCI) and Maharashtra University Of Health sciences[MUHS]). The department undertakes teaching of undergraduate and postgraduate students. A specialised paediatric surgical and general nurses’ training is also undertaken.
The department has a well equipped library with all standard reference books, video cassettes, ebooks and slides. Journal Club is regularly conducted.
The department has an independent seminar hall and conducts regular clinical meetings, which are attended by surgeons from many hospitals in Mumbai.
Research work carried out by the department includes publication and analysis of rare case reports and other articles in international journals.
We have started fellowship in minimal access surgery in pediatric surgery, a 1-year course recognised by MUHS, for 2 candidates per year post M. Ch or DNB in pediatric surgery. Till date, 8 fellows have already been trained; 2 further are undergoing their fellowship.

MIS: 3286 total. Recently 4K laparoscopy system has been acquired also.
Add below it Laser as new point 8: Holmium Laser for laser treatment of posterior urethral valves, bladder and ureteric calculi, stricture urethra. More than 100 laser procedures done
Others, current activities. Diaphragmatic hernia-age from newborn to 13 years, including newborns on ventilators

Education: daily counselling of all ICU patients relatives, detailed counselling to admitted patients, detailed education about disease awith emphasis on treatment and follow up for all chronic conditions like posterior urethral valves, VUR, BOO, neurogenic bladder, anorectal malformations, esophageal atresia, diaphragmatic hernia, etc
Anjeze trust: weekly counsel patient regarding hygiene
Academic courses
MCh in pediatric surgery-3 year superspecialty course
Fellowship in Minimal Access in Pediatric Surgery-1 year MUHS recognised fellowship
Teaching schedule:
Weekly case presentation
Every  Saturday- grand round,
Monthly  journal club
Daily teaching in OT, in OPD and on ward rounds