General Info for Children’s Surgery

Preoperatively

The Spire Southampton Hospital continues to expand its facilities for the treatment of children and is a first class centre for Paediatric Orthopaedics and Paediatric surgery and Medicine generally. A new bed area has been built and access to HDU and ICU are available if required. There are specialised expert ward nursing staff as well as pain specialists, Advanced nurse practitioners and play specialists to ensure your child has the best available care at all times.

  • Your child will be seen in a pre-assessment clinic by one or more members of the specialist children’s nursing team. They will ask questions about medical history and previous surgery.
  • For some bigger operations blood tests may be required prior to surgery.
  • Your child will be admitted on the day of surgery and seen by a children’s nurse from the ward. Mr Uglow will see you and mark your child with a marker pen to indicate the site of surgery. You will be asked to sign a consent form. The consultant anaesthetist will also visit and check that your child is fit for the operation.
  • Special anaesthetic cream will be applied to several sites (back of hands and front of elbows) and covered with a sticky dressing. This is to numb the skin to allow later insertion of a plastic cannula in the anaesthetic room.
  • Sometimes medical problems are identified at the pre-assessment visit or by the anaesthetist before the operation. On occasion it may be necessary to postpone the operation in order to further investigate or treat a problem. Rest assured that this only happens when the risks from having an anaesthetic are considered to be significantly increased.
  • Patients may be fit in the preassessment clinic but develop a cold prior to admission. Coughs and colds can pose a significant risk if an anaesthetic is given and so the operation may need to be postponed. Please be reassured that if the operation is postponed then this is for your child’s benefit and safety.

Operation

  • You will be escorted from the ward with your child to the operating theatre by a nurse. If your son or daughter is able to walk then this is the preferred method of transfer. If unable they will be taken in a chair or on a trolley.
  • When arriving at the theatre suite you will be checked in first and then taken to the anaesthetic room. Here various monitors will be attached and usually some oxygen is given to breathe from a mask. A small plastic cannula will be placed in your child’s arm. Your child will be anaesthetised according to the method discussed with you by the anaesthetist beforehand.
  • It is not practical to keep a constant commentary on the progress during surgery but if notable delays occur every attempt will be made to inform you.
  • After the operation you will be taken to the recovery room to be with your child as soon as it is safe to do so. They will have monitoring of vital signs (pulse and blood pressure mainly) until it is safe for you to transfer back to the ward.

Complications

  • Complications can occur during any type of surgery. Infection occurs in less than 1% of planned orthopaedic operations. If this occurs to you, it may involve the skin in which case there may be an increase in pain and a delay in wound healing. Antibiotics will need to be given but it would be very unusual to need any further surgery.
  • Infection can rarely affect the deep tissues and bones. If this occurs then antibiotics will be needed and further surgery to clean out the infected area may be performed. The risks of infection are increased in patients suffering from diabetes, concurrent infection or any form of immunocompromisation.
  • Bleeding can occur into the tissues or joint after an operation. During the operation blood vessels are identified and sealed off with an electric current (diathermy) or tied with a suture. Occasionally they may bleed afterwards and form a haematoma. Mostly if this happens no action is required and the blood will reabsorb over a few weeks. If the tissues are tense or the joint deemed to be very tight then the haematoma may need to be evacuated which would mean returning to the operating theatre. If this were to occur it would happen within 48 hrs of the operation.
  • Nerve injuries can occur. There are many small nerves which supply sensation to the skin and these can be cut or stretched at the operation. Large nerves are identified where possible and protected. Sometimes the nerves fail to work properly after being handled and this can lead to numbness or tingling in the skin. The majority of times that this happens the symptoms will be temporary but permanent changes can sometimes occur. It would be very unusual for persistent pain to occur following nerve trauma but it can happen.

Postoperatively

  • Depending on the operation to be performed the wounds will be dressed using gauze and a wool and crepe bandage or an adhesive dressing. If a plaster cast is to be used as part of the procedure you will have been advised about this prior to the operation and will therefore expect one to be in place.
  • Mr Uglow will see you and your child after the operation at some stage during the day before you are discharged or on the morning after surgery to ensure that all is well and advise on any specific management details. An outpatient appointment will be made by Mrs Carol Barstow which will usually be in the first or second postoperative week depending on the operation performed.
  • If any problems occur before this first visit then you should phone the Spire Southampton Hospital and ask for ward 2 (direct dial: 023 8076 4371) or Carol Barstow (direct dial: 023 8076 4304).