As a paediatric surgeon, a standard day may involve performing surgery for a tiny 1.5kg baby born at 25 weeks’ gestation to a laparoscopic appendectomy on a six-foot, 63kg teenager!Paediatric surgeons comprise about 2% of surgeons overall, making this a small emerging surgical specialty.Most specialised children’s surgery is performed in dedicated children’s hospitals or in paediatric surgical units within larger hospitals. Approximately 338 Paediatricsurgeons work in 29 centres of this kind in the UK, performing 11% of all operations on children. The remaining operations are performed mainly by surgeons from other specialties who have an interest in paediatric conditions.Within tertiary paediatrics, consultants may practice with an interest in paediatric orthopaedics, orthopaedic, cardiothoracic, plastic, oral and ophthalmic surgery as well as ENT and urology but they often come from adult surgical training routes, rather than paediatric surgery. As such placements in adult specialties are often beneficial to training.
There are some conditions innate to children, yet the routine workload is very broad as paediatric surgeons’ deal with surgical conditions across all ages. Paediatric surgeons often perform complex surgery on children with disabilities to improve their standard of living, often working in partnership with the adult specialists to treat uncommon childhood disorders such as thyroid and certain gastrointestinal conditions. Thus, paediatric surgeons aim to develop experience and skills across the breadth of surgery.
The types of surgery paediatric surgeonsperform are wide-ranging and include:
- Neonatal surgery – often for congenital abnormalities such as defects in the abdominal wall and diaphragmatic hernia. Routine antenatal ultrasound scanning means that our patientgroupsare getting younger and younger. For some conditions, such as gastroschisis and congenital diaphragmatic hernia, paediatric surgeons now provide antenatal counseling for parents in conjunction with obstetricians and specialists in fetal medicine. They plan the care of the mother and child from delivery to subsequent surgery.
- Paediatric gastrointestinal and hepatobiliary surgery – often working closely with gastroenterologists and adult hepatobiliary surgeons
- Urology – certain urological conditions, such as hypospadias, frequently present at birth or in young people.
- Oncology – childhood cancers are different from those developed by adults. Leukaemia remains the most significant in children.
- Thoracic - (oesophageal, lung and bronchial anomalies)
- Paediatric Emergency and Major Trauma– appendicectomy (lap/open), correction of torsion of the testis, pyloromyotomy for pyloric stenosis, malrotation.
- Minimally invasive (keyhole) and robotic assisted procedures
Paediatric surgery has a low level of emergency work so may be well suited to flexible working. There are few centres that specialise in paediatric surgery so training is limited in geographical location. If you are interested in both paediatric surgery and another specialty, it may be worth exploring training in the other specialty and specialising later in paediatric cases e.g. ENT. Competition ratio for applicants to ST3 in paediatric surgery posts was 4.06:1 in 2014, with 61 applications for 15 places nationally.
North West trainees experience paediatric surgery and paediatric urology at Royal Manchester Children’s Hospital as 6 month rotations as part of a Paediatric themed track. This includes 12 months of paediatric surgery over 2 rotations with 6 months of adult General Surgery.