Programs at Austin Pediatric Surgery

The surgeons of Austin Pediatric Surgery have helped to establish a multidisciplinary pectus excavatum and carinatum program at Dell Children’s Medical Center.  We continue to use our evidence-based outcomes and collaborate between the patient and family, surgeons, anesthesiologists, physical and occupational therapists, and nursing staff to strive for the best care of patients with chest wall deformities.

There are two main types of chest wall abnormalities – pectus excavatum, where the chest has a caved-in appearance, and pectus carinatum, where the chest protrudes outward.  Some patients have a combination of pectus excavatum and carinatum, and treatment options may be surgical or non-surgical.  Our team will work with you and your family to make the best plan for your condition.

Pectus Excavatum:

Pectus excavatum, or “funnel chest” occurs in 1 in 300-400 people.  It is more common in males than females. It is usually sporadic but may run in families. There is an increased prevalence of pectus excavatum in patients who have connective tissue disorders, suggesting that it is caused by abnormal development of the cartilage bridging the sternum and the ribs.  The condition may be present when the child is young, and most commonly becomes more prominent during the rapid growth of the pre-teen and teen years.

Many patients with pectus excavatum are asymptomatic.  But many others complain of shortness of breath, especially while exercising, or an inability to keep up physically with their peers. They may feel embarrassed or ashamed of their physical appearance, and this impaired body image can result in lower self-esteem and impaired quality of life.

Pectus excavatum often requires an operation to elevate the sternum, potentially improving heart and lung function, as well as improving the appearance of the chest.  The procedure is generally done via a minimally invasive approach, where two small incisions are made under the armpits and a curved metal bar is placed under the ribs and sternum.  The bar is generally left in place for two to three years.

At Austin Pediatric Surgery, we have taken the model of Enhanced Recovery After Surgery (ERAS) techniques that have improved surgical outcomes in other procedures and developed a pectus pathway to improve postoperative pain control, encourage early mobility, and decrease hospital length of stay.  This pathway optimizes care before, during, and after your surgery.  Advancement in surgical techniques and pain control at our institution have decreased the amount of time patients stay in the hospital after surgery and have improved comfort, even with less need for pain medications after discharge.

All families will start with a consultation with a pediatric surgeon. If the decision for surgery is made, we employ a joint evaluation with pain control specialists and physical therapists around the time of the operation.  We have a directed physical therapy program that begins before the procedure and continues after surgery.  Patients are generally out of bed the day of surgery and most can be comfortably discharged in the first few days after the operation.

Pectus Carinatum:

Pectus carinatum, or “pigeon chest” is a less common variant of a pectus anomaly.  As with excavatum, the condition generally becomes noticeable and more prominent during the pre-teen to teenage years.  Most patients with pectus carinatum are candidates for bracing to correct the defect, though occasionally surgery is indicated.  We will help you to determine and carry out the right plan for your condition.

Dr. Erich Grethel is a board certified pediatric surgeon who has a special interest in pectus deformities and leads the Pectus Chest Wall Program at APS. Please call our office at 512-708-1234 for an appointment or email ejgrethel@ascension.org with any questions.

As pediatric surgeons, we treat a wide variety of tumors which can be found throughout the neck, chest and abdomen. These include:

• Wilms’ Tumor
• Neuroblastoma and other adrenal tumors
• Pancreatic tumors
• Hepatoblastoma and other liver tumors
• Soft tissue sarcomas
• Thyroid tumors

Please see our Oncology page to learn more about these tumors.

As pediatric surgeons, we work in close collaboration with the medical oncologist, radiologist, radiation oncologist, and pathologist to ensure the optimal care for your child. We participate in a weekly Tumor Board conference to allow group discussions and coordination of patient care. The team of surgeons who specialize in surgical oncology at Austin Pediatric Surgeon is led by Mike Josephs and includes Jessica Naiditch, Ankur Rana, Erich Grethel and Jeffrey Horwitz.

Although thyroid disease is less common in children compared to adults, occasionally surgical issues arise. Most commonly this is for an overactive thyroid gland (hyperthyroidism) or a concerning thyroid nodule. Treating pediatric thyroid disease requires a multidisciplinary approach. As the lead surgeon of our Thyroid Surgery Program, Dr. Horwitz works closely with our partners in pediatric endocrinology, pediatric radiology and pediatric pathology. In addition, because recent studies have suggested that high volume thyroid surgeons (performing > 30 cases/year) have improved outcomes, Dr. Horwitz has partnered with Dr. Teresa Kroeker, one of the region’s leading adult thyroid surgeons. This collaboration between pediatric surgeons and a high-volume adult thyroid surgeon optimizes the care of children with surgical thyroid disease conferring the benefits of both a high volume thyroid surgeon and high volume pediatric surgical care.

Austin Pediatric Surgery has a team of surgeons that are focused on taking care of children with hepatobiliary problems, or problems with the liver, gallbladder or bile ducts. Bile ducts drain fluids and digestive enzymes from your liver to your intestine. This drainage is important both for your ability to absorb nutrients from your intestine and also for the health of your liver. Our team takes care of children with a wide variety of hepatobiliary problems. The two most significant biliary problems that can occur in children are biliary atresia and choledochal cyst. Both of these problems prevent the normal drainage of bile through these ducts but are treatable with surgery.

Biliary atresia is a progressive obliteration of the bile ducts from inflammation. The exact cause of biliary atresia is not known but it may be related to an immune response to an infection or in some cases the ducts may have never properly formed. Since bile from the liver can’t go through these ducts, it backs up in the liver and causes scarring and damage to the liver. Biliary atresia is usually first noticed by either a yellow color in the skin (jaundice) or a decrease of color of the stool (clay or white colored stools). If treated early, some infants with biliary atresia can be cured with a Kasai Procedure. Many others, however, despite having a Kasai operation, ultimately go on to have liver failure and will require a liver transplant.

Choledochal cysts are dilated or swollen areas of the bile ducts that prevent normal flow of bile through the duct. Patients are born with this cyst. Patients with a choledochal cyst may develop symptoms as an infant or as a teenager or any time in between. These symptoms usually include becoming jaundiced (yellow color of the skin or eyes) or having right upper abdominal pain and abnormalities in their liver enzymes. If a choledochal cyst is not removed, these patients have a higher incidence of developing cancers of the bile ducts later in life.

The pediatric surgeons at Austin Pediatric Surgery lead a multidisciplinary team which includes surgeons, gastroenterologists, and radiologists who take care of children with these disorders and make sure they get the best care possible for these conditions. Our team works to bring the most recent data and advanced techniques to the care of children with these problems.

Our hepatobiliary team is led by Dr. Tory Meyer and includes Dr. Michael Josephs, Dr. Julie Sanchez, Dr. Jeff Zweiner, and Dr. Jeb Baker.

Inflammatory bowel disease (IBD) is an immune mediated inflammation of the intestines which can afflict pediatric patients. Although most IBD in children is treated with medicines, some children require surgical care for complex disease. The team at Austin Pediatric Surgery is committed to the care of children with IBD. We offer advanced treatments using minimally invasive techniques, such as laparoscopic ileocecectomy and colectomy with ileoanal pouch reconstruction. We work as a team with gastroenterologist to ensure you and your children receive the best multidisciplinary care we can provide.

Dr. Jessica Naiditch is a board certified pediatric surgeon who has a special interest in IBD and leads the surgical IBD team at APS. Please call our office at 512-708-1234 for an appointment or email janaiditch@ascension.org with any questions.

Our bowel management program is for children with constipation and/or fecal incontinence. We work with children and families to achieve a goal of predictable bowel movements to improve quality of life. This program is designed to avoid bowel accidents and diaper dependence which can lead to remaining clean and improved self-esteem. We offer daily feedback via email or a phone call to achieve the individualized goals discussed at initial meeting.

Fecal incontinence can be a result of congenital conditions, constipation, or issues with muscle weakness or injury. Symptoms of this can be mild leakage of stool when passing gas to no control of bowel movements with daily accidents. Some congenital conditions our program will be successful for are:

• Imperforate anus/anorectal malformation
• Hirschsprung Disease
• idiopathic constipation
• fecal incontinence
• cloaca exstrophy
• spina bifida

What to expect

Your family will meet with the team to review the past medical and surgical history and type of bowel control issues your child is experiencing. After a physical exam and radiographic imaging, an individualized program will be created to achieve the goals of bowel control discussed for your child. This can be achieved with dietary changes, medications such as laxatives, and/or enemas. We understand the importance of daily communication, dedication, and teamwork between our medical providers and families to achieve success.

Please call our office at 512-708-1234 for an appointment in our bowel management clinic or email arrana@ascension.org with any questions.

 

The news that your unborn baby may have a congenital defect can be frightening and overwhelming for a family. Our team of experts are available for you and your unborn child. As experienced pediatric surgeons, we collaborate with maternal-fetal medicine experts, pediatric anesthesiologist and neonatologist with one goal in mind: to deliver and provide the best care for your baby.

At Austin Pediatric Surgery, we offer highly specialized surgical care to treat a range of complex congenital anomalies including:

• Congenital Diaphragmatic Hernia
• Gastroschisis/Omphaloceles
• Esophageal Atresia
• Tracheal Esophageal Fistula
• Pulmonary anomalies
• Intestinal anomalies
• Ovarian anomalies
• ECMO and EXIT procedures

APS is committed to providing the highest quality of care from prenatal diagnosis to long term follow-up.  We are readily available for consultation and look forward to meeting with you.

Dr. Julie Sanchez is a board certified pediatric surgeon who has a special interest in congenital anomalies and leads the Congenital Consultation Program.  Please call our office at (512) 708-1234 for an appointment or email Dr. Sanchez at jsanchez@ascension.org.