All about paediatric upper gastrointestinal (GI) surgery

Written in association with: Mr Ashok Ram
Published: | Updated: 14/10/2024
Edited by: Conor Lynch

Paediatric upper gastrointestinal (GI) surgery refers to surgical interventions in children that address conditions affecting the upper part of the digestive tract, including the oesophagus, stomach, and the first portion of the small intestine. These surgeries are often necessary to treat a range of congenital and acquired conditions that can significantly impact a child's digestion, nutrition, and overall well-being.

 

Some of the most common conditions requiring upper GI surgery in children include gastroesophageal reflux disease (GERD), oesophageal atresia, pyloric stenosis, and achalasia.

GERD

Gastroesophageal reflux disease (GERD) is one of the more frequently seen conditions in paediatric patients. While mild reflux is common in infants, severe cases may require surgical correction, particularly if they result in complications like failure to thrive, recurrent lung infections, or oesophagitis. A procedure called fundoplication is often performed to strengthen the lower oesophageal sphincter, preventing the backward flow of stomach contents into the oesophagus.

 

Oesophageal atresia

Oesophageal atresia, a congenital condition in which the oesophagus does not properly connect to the stomach, often requires early surgical intervention. Babies born with this condition are typically unable to swallow and may develop life-threatening complications without timely surgery. Surgeons will repair the oesophagus to allow normal feeding and digestion.

 

Pyloric stenosis

Pyloric stenosis, a condition that affects newborns, involves the thickening of the muscles in the pylorus, the lower part of the stomach. This condition causes severe vomiting and can lead to dehydration and weight loss. A surgical procedure called pyloromyotomy is performed to split the muscle, allowing food to pass from the stomach into the intestine.

 

Achalasia

Finally, achalasia, a rare condition where the muscles of the oesophagus fail to move food toward the stomach, may also require surgical correction. Treatments for achalasia include balloon dilation or a surgical procedure known as Heller myotomy to help the oesophagus function more effectively.

 

Paediatric upper GI surgery is complex but can significantly improve a child’s quality of life. With early diagnosis and intervention, many children go on to lead healthy, normal lives. Parents should work closely with their paediatric surgeon to understand the condition and the best treatment options for their child. 

By Mr Ashok Ram
Paediatric surgery

Mr Ashok Ram is an experienced consultant paediatric and neonatal surgeon who practises at the Norfolk and Norwich University Hospital. He trained in major paediatric surgical centres across the UK and obtained his CCT in paediatric surgery after which he joined the Paediatric Surgical Department in Norwich.

His practice is the general surgery of childhood and he sub-specialises in neonatal surgery, thoracic surgery and upper gastrointestinal surgery. He is also a staunch educationist and holds the positions of honorary associate professor at the Norwich Medical School of the University of East Anglia, regional training director, director of advanced paediatric life support, faculty for the European paediatric advanced life support courses and surgical skills courses (basic surgical skills, laparoscopic skills, pre-hospital and emergency resuscitative thoracotomy, specialty skills for emergency and trauma) from the Royal College of Surgeons of England.

He is an executive member of the Education Committee of the European Society of Paediatric Endoscopic Surgeons. He conceptualised, founded, directs, and teaches on the SPRINT (International Paediatric Surgical Training Programme), a virtual forum which holds seminars and postgraduate exam preparation sessions attended by paediatric surgeons and trainees worldwide. He has presented his work at numerous national and international meetings and conferences and authored multiple chapters in various paediatric surgical textbooks and journals.

He received the Gold Medal from the European Board of Paediatric Surgery as a candidate to which he has now joined as an Examiner. He has also won multiple awards nominated by patients and students alike.

Many paediatric and neonatal surgical conditions are best seen and managed in the NHS setting where he is a full-time consultant. The following are some of the conditions that may be suitable for consultation and management in his private clinic and settings: abdominal conditions, abdominal pain, acid reflux, chest deformities (pectus carinatum and excavatum), congenital malformations, constipation, gastrointestinal conditions, groin conditions, head lesions, hydrocele, inguinal hernia, laparoscopy, nail diseases, neck lesions and swellings, neonatal surgery, perianal conditions, phimosis and circumcision, thoracic conditions, tongue tie, umbilical hernia, undescended testicle, and upper GI endoscopy. 

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