Dr Muhammad Eyad Ba'Ath
General Surgery of Childhood
Inguinal Hernias
Most common type of hernias in children. Usually presents with an intermittent bulge in the groin. Can happen on both sides in about 10% of cases. Treatment is surgical, which can be done by both laparoscopic (keyhole) or open traditional method. Both methods are acceptable with comparable recurrence rates, but laparoscopy has few added benefits which makes it Dr Ba’Ath preferred method. The main benefits are smaller scars, ability to address umbilical and other side hernia without added incisions, and the clarity of visualization of important structures. The timing of the surgery should be within weeks from diagnosis, mostly regardless of the child’s age. Pain in the hernia, or the hernia being persistently stuck out, might indicate incarceration which necessitates immediate surgical review and treatment. In the pictures below you will see samples of scars of laparoscopic inguinal hernia repair done by Dr Ba’Ath.
Umbilical Hernias
A very common pathology in children’ particularly in those of African ancestry. Usually presents with a bulge in the belly button that increases and decreases in size intermittently and can be quite dramatic. Treatment is surgical and is rather straight forward but usually recommended only after 2 years of age. The cosmetic outcome is expected to be excellent. An example of what an umbilical hernia should look like is shown in the in the picture.
Midline (epigastric) Hernias
A bulge in the abdomen in the area above the belly button. Can be painful. Will need elective surgery and has no chance of spontaneous resolution. It can also be multiple and will increase in size slowly over time. An example of what such a hernia should look like is shown in the pictures.
Hydrocele
A collection of fluid around the testis. Usually presents as a swollen scrotum and mostly on one side. Has two main types: communicating and non-communicating. Most hydroceles in children are of the first type. A very common problem especially in early childhood. Fortunately, when diagnosed early in life (under two years), has an excellent chance of resolving spontaneously without any treatment. Can rarely be painful or evolve into a hernia. After 2 years of age usually elective, day case surgery is recommended with excellent results and minimal risks.
Male Circumcision
The oldest and the most commonly performed surgical procedure. About one third of the world’s males are circumcised, mostly for religious or cultural preferences. In this procedure, part of the foreskin is removed. While clearly not essential, it does have proven health benefits. Circumcised boys are much less likely to acquire urinary tract infection by up to 90%. Circumcised men are much less likely to have a sexually transmitted disease (STDs), in the case of HIV by up to 70% in a single unprotected encounter. Some of the benefits of reducing the spread of STDs is clearly transferred to the female side of the society. Studies in countries with similar cultural mix and differences in the rates of male circumcision shows that females are a lot less likely to have cancer of the cervix, which is related to HPV infection. Also, circumcised men are much less likely to have cancer of the penis, which happens in the elderly.
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Circumcision is still a surgical procedure and carries small risks which are very minimal in expert hands. It is preferably done in the first three months of life as the procedure is simple, can be done under local anesthesia, and the aftercare is easy. Sometimes this is not possible due to anatomical or logistical reasons. Later, it usually requires general anesthesia.
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Reasons not to do circumcision early include deformities of the penis such as a twist or a curvature or abnormal skin attachments or buried penis or hypospadias. In such circumstances, circumcision is better deferred to a later date when it can be done under general anesthesia and all such abnormalities corrected. This is usually done after 6-9 months of age.
There are many surgical techniques and devices to perform circumcision, but the ones mostly applied by Dr Ba’Ath are Plastibell (the ring) for the neonatal period, or free hand circumcision later in life. Both give excellent outcomes when applied correctly and should leave no suture marks on the penis. Many people call sutureless circumcision “laser”, which is a misnomer.
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Two common problems seen after early circumcision are glanular adhesions and apparent buried penis. Both are transient problems that resolve spontaneously. Dr Ba’Ath made two education videos about these common problems that can be accessed on his YouTube channel on these links:
Buried penis after circumcision
Glanular adhesions after circumcision
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Circumcision has little-known long-term effects. The removal of the foreskin can potentially reduce sensation in the penis, but this does not seem to lead to impotence or erectile dysfunction. There is some evidence that circumcised men take slightly longer to climax during intercourse but most participants in medical studies thought about this as an advantage.
Appendicitis
The most common pediatric surgical emergency. Symptoms are acute, worsening abdominal pain, fever, and vomiting, amongst others. With prompt and appropriate treatment, it should have minimal morbidity. Dr Ba’Ath does it using Single Incision Laparoscopic Surgery (SILS), also known as “scarless surgery. In the picture shown you can see an example of the wound in a child who had this surgery by Dr Ba’Ath. You may find more details about Dr Ba’Ath scarless surgery in this page on the same website.
Neonatal Surgery
Dr Ba’Ath is trained to deal with a wide variety of neonatal conditions, including congenital malformations amongst others. He utilizes minimally invasive techniques whenever possible. Most of these conditions are cared for in a neonatal unit setup where there will be a team of specialists in multiple disciplines caring for the child.
Bowel Obstruction
Another common pediatric surgical emergency. Symptoms are worsening abdominal pain, distension, vomiting especially green or brown, and constipation. It is essential that appropriate specialist care is sought early. Reasons and treatment are variable but there is a high chance of needing surgical treatment, usually with excellent results.
