Definition and Overview
A paediatric pre-surgery consultation is an appointment with a surgeon to determine if surgical intervention is the best treatment option for a child who is suffering from certain medical conditions such as congenital heart failure and severe orthopaedic conditions, among others. During the consultation, the possible risks and benefits of the proposed surgical procedure will be discussed with the patient’s parents or legal guardians. The purpose is to guide them in making an informed decision about whether to pursue surgery.
Who Should Undergo and Expected Results
A paediatric pre-surgery consultation, which is the first visit to the surgeon, is crucial for patients who are being considered for surgery as part of their treatment. This is intended to help their family decide whether to go ahead with surgical treatment or explore other treatment options.
At the end of the consultation, the patient’s family should have received assistance in weighing the pros and cons of the surgical procedure, which could be open (traditional) or laparoscopic or minimally invasive surgery.
The patients and their families are under no obligation to go through any procedure after the consultation. They may choose to forego surgery or seek a second opinion from a different surgeon. However, if they decide to go ahead with a specific procedure, the consulting physician will proceed by scheduling a pre-surgical follow-up and actual surgery date.
In general, surgeons only recommend surgical intervention when its benefits far outweigh the potential risks. If there is any reason to doubt the safety of performing surgery on the patient, other treatment options, such as medications and therapies, will be explored.
How the Procedure Works
This type of consultation occurs at the office or clinic of a paediatric surgeon and usually takes an hour. It must be participated by at least one parent or legal guardian.
During the consultation, a patient registration and history form will be filled to acquaint the surgeon with the case. Questions regarding the patient’s current health, symptoms, other treatment options tried in the past and the results of these treatments, medications being used, and allergic reactions to medications and anesthetics will also be discussed. These details will help the doctor decide whether surgery is needed and, if so, what kind of surgery is most appropriate.
The surgeon will then discuss the following:
- Different surgical techniques that may benefit the patient
- Potential benefits and risks of each
- Costs involved in the surgery and billing policy
- The surgeon’s recommendation on the best type of surgery for the patient
If the patient is qualified for both traditional and modern surgical techniques, these too will be explained during the consultation.
Open surgery – Also known as traditional surgery, these procedures require large incisions to access the body part that needs treatment. This technique is typically associated with a lot of bleeding, higher risk of infections, and long recovery times.
Minimally invasive surgery – These refer to modern surgical techniques wherein only small cuts are used. A tube, a scope, and small surgical instruments are then inserted through these cuts, and the surgery is performed with guidance from a computer monitor that displays the images captured by the scope. These procedures are less risky, cause less bleeding, and do not require long recovery periods.
Patients are encouraged to ask questions that can help them make their decision. Some of the most frequently asked questions include:
- Who will perform the procedure?
- What are the surgeon’s qualifications and experience level?
- What kind of anesthesia will be used and who will administer it?
- Will the procedure cause scarring?
- How long would the patient be confined in the hospital?
- How long is the recovery period?
- How long will the child have to stay out of school?
One important factor that must be discussed during the consultation is if there is a history of allergic reactions to anesthesia in the family. If there seems to be a risk concerning the use of anesthesia, the patient’s family may also request for a consultation with an anesthesiologist.
Possible Risks and Complications
A paediatric pre-surgery consultation will help the child receive the best type of treatment that will be most beneficial for him. It can also protect patients from the risk of undergoing a procedure that is inappropriate or too risky for them.
This is because, aside from the common risks of infection and bleeding, surgery can also have other less obvious physical, psychological, and emotional effects on a young child. It can be taxing on the patient’s body, and can also be a difficult experience that they might find challenging to overcome. The pain during surgery and the recovery period can also be too much for a young child to handle.
Chung DH. Paediatric surgery. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 13.
Neumayer L, Vargo D. Principles of preoperative and operative surgery. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 11.