Emory-Children's Center Division of Pediatric Surgery, in conjunction with Atlanta Pediatric Surgery
The Division of Pediatric Surgery, in conjunction with Atlanta Pediatric Surgery, Inc., provides comprehensive state of the art Pediatric Surgical care to infants, children, and adolescents throughout Georgia and the Southeast. Services provided include state of the art newborn surgery, ECMO, minimally invasive surgery (laparoscopic and thoracoscopic procedures), hernia surgery, trauma surgery, abdominal surgery, endoscopic surgery, pediatric surgical critical care, thoracic surgery, head and neck surgery, and many urologic procedures. Please explore our web site to find out more about the services offered.
The Division of Pediatric Surgery is part of Emory-Children's Center and the Department of Surgery at Emory University School of Medicine. We operate a private office on Clairmont Avenue off of I-85 where patients are seen Monday through Thursday. We primarily operate at the Egleston campus of Children's Healthcare of Atlanta where we provide around-the-clock coverage for pediatric surgical services. We occasionally perform procedures at Emory Crawford Long Hospital, Dekalb Medical Center, and the Scottish Rite campus of Children's Healthcare of Atlanta.
We are available 24 hours per day, 7 days per week at 404-982-9938. Click on a topic below to find out more.
Insurance Issues:
The group of general pediatric surgeons at Atlanta Pediatric Surgery and Emory-Children's Center are on virtually all insurance plans and HMO's. Your "provider book" for your plan may not have us listed, due to omissions or the timing of printing the books and plan updating. So, do not assume we are not covered in your plan just because we are not in your book! If you have any questions regarding your coverage, please call and speak to our staff. Providing as much information on your coverage as possible (cards, numbers, etc.) at the visit will help our staff limit any expenses to you that your company should be covering. Many companies may require "prior approval" for your visits; your pediatrician will be helpful with that. Please keep in mind that we serve the needs of children in the best way regardless of their insurance status, and certainly welcome all Medicaid patients and uninsured patients who need pediatric surgical care. Also, keep in mind that if your insurance carrier or HMO does not have a pediatric surgeon as a "provider", you have the right to request one. Also, all care done in an emergency situation is covered, regardless of the "provider" status of the surgeon caring for the child.
ECMO
Among the many services provided by the surgeons in this practice, surgical procedures to care for critical care issues such as Extracorporeal Membrane Oxygenation (ECMO) are noteworthy. The combined experience of our group reaches 34 years of ECMO related activities. Two of our group are Fellowship trained, having spent dedicated time in ECMO related research and patient care. This form of artificial organ support for children suffering from temporary, reversible lung failure or heart failure has been in use at Egleston for almost 9 full years. This temporary artificial organ support allows the lungs to be rested when injured and avoids the harmful effects of aggressive mechanical ventilation (Veno-Venous or VV bypass). It can also be used to provide cardiac support when the heart is stunned after cardiopulmonary bypass surgery (Veno-Arterial or VA bypass). This procedure can be used to treat patients with pulmonary insufficiency from surgical problems such as congenital diaphragmatic hernia or trauma, as well as several medical problems that are complicated by lung failure.
During the ECMO procedure, catheters are placed in large blood vessels and used to simultaneously drain blood from the body, oxygenate and warm it, and then return it to the heart through another cannula. The patient is heavily sedated during the ECMO course until the lungs have recovered and the cannulas are then removed through a second operative procedure. Historically, this procedure has been performed in an "open" fashion, through an incision in the neck or groin. More recently, we have begun using the "closed" or percutaneous method of placing the catheters into the vessels using a guidewire technique, thus decreasing the time to initiate supportive bypass in these critically ill patients, as well as minimizing the blood loss that occurs when such as procedure is done. ECMO has significantly reduced the mortality rate for acute respiratory failure and provides an important compliment to the critical care services at Egleston.
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Minimally Invasive Surgery
The Division of Pediatric Surgery of Emory University at Children's Healthcare of Atlanta at Egleston has one of the largest minimally invasive surgery programs country. We have over 28 years of combined experience with laparoscopic and thoracoscopic procedures.
Most minimally invasive procedures are performed with small telescopes and instruments placed through the abdominal wall (laparoscopy) or through the chest wall (thoracoscopy). Laparoscopic and thoracoscopic surgery is often mistakenly called laser surgery. Lasers are not usually used for most operations.
Laparoscopic procedures are performed by inflating the abdomen with carbon dioxide gas. A telescope and instruments are then placed into the abdomen to perform the operation. The operation is done through several (usually 3 to 5) punctures that are from 3-5 millimeters (~1/8-1/4 inches) in length. Occasionally a 10 or 12 millimeter (~1/2 inch) port is needed. Thoracoscopic procedures are performed in a similar manner through the chest wall.
There are many different procedures that can be performed using minimally invasive techniques. These operations include appendectomy, bowel operations, fundoplication for gastroesophogeal reflux, pyloromyotomy, hernia, pectus excavatum repair, lung biopsy, lung resection and many other procedures. Surgery can be performed laparoscopically or thoracoscopically on children of all sizes. Most children who have minimally invasive operations will have much less pain and faster recovery than children who undergo similar procedures using traditional incisions.
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Thoraic (chest) Surgery
General pediatric surgeons are trained first in all aspects of general surgery for adults and children, then go on and train extra years in the specialty care of newborns, infants, and children. Part of that extra training is to gain expertise in the area of thoracic (chest) surgery. Board certified pediatric surgeons are trained in most all areas of thoracic surgery, including cardiac (heart) operations. But most, including our group, no longer do cardiac (heart) operations, but do perform all other types of thoracic surgery. That would include operations on the chest wall to correct congenital (birth) defects, "pectus" deformities, operations on the lungs, esophagus (swallowing tube), diaphragm (muscle for breathing), ribs, and blood vessels around the heart. Pediatric surgeons also care for children with traumatic (accidental) injuries to the chest. Some of the more common chest surgeries would include those for tumors of the chest, empyema (complications of pneumonias and other infections), pneumothorax (collapsed lung), and pectus excavatum (depression of the breastbone).
Unfortunately, many newborn babies are faced with thoracic surgical problems. These include hernias of the diaphragm, esophageal atresia (absence or a gap in the swallowing tube), tracheoesophageal fistula (an abnormal connection from the windpipe to the swallowing tube), lung cysts and sometimes tumors of the lung or other organs in the chest. Our group, all fully trained in neonatal (newborn) thoracic surgery, offers care for babies with these and other conditions. In addition to traditional surgery, we also treat many thoracic diseases or problems with endoscopic (telescope) techniques. This includes removing foreign bodies of the trachea and esophagus (objects like peanuts or coins that are "choked on" or swallowed by children) and removing infection or parts of lungs with thoracoscopy (telescopes placed through small holes in the chest). We are also now able to treat some chest wall deformities with these "minimally-invasive" surgery techniques to do the work that once required very major chest surgery, and now only requires placing internal braces through small incisions. These techniques have been useful in many areas to minimize the procedures necessary to treat certain illnesses. Our group is proud that we have the full range of expertise to offer all of these procedures, where appropriate, to the children of Georgia and southeast.
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Neonatal Surgery
We, as pediatric surgeons, are expert in the surgical care of newborns. Management of neonatal surgical problems actually defines, in large part, the specialty of "pediatric surgery". It is what separates us from adult general surgeons who may operate on children but who do not have the expertise in treating newborn surgical problems. Not only is the actual surgical procedure important, but the pre-operative preparation and post-operative management is critical for a successful outcome. We work closely with our neonatology colleagues to optimize the management and outcome in our patients.
Neonatal surgical conditions which are best managed by pediatric surgeons include (in alphabetical order):
- Abdominal wall defects including gastroschisis, omphalocele, and Pentalogy of Cantrell
- Biliary atresia and choledochal cyst
- Cloacal exstrophy
- Conjoined twins
- Cystic adenomatoid malformation of the lung and other types of bronchogenic cysts
- Cystic hygroma and other neck masses
- Diaphragmatic hernia
- Duplication cysts and mesenteric cysts
- Esophageal atresia with or without TE fistula (TEF)
- Gastroesophageal reflux and hiatal hernia
- Hirschsprung's disease (megacolon)
- Hydrometrocolpos and imperforate hymen
- Imperforate anus including persistent cloaca
- Inguinal hernias
- Intestinal obstruction including duodenal atresia, annular pancreas, malrotation, midgut volvulus, intestinal atresia, meconium ileus and meconium peritonitis
- Necrotizing enterocolitis
- Ovarian cysts
- Pyloric stenosis
- Ribcage and sternal deformities
- Teratoma (sacrococcygeal) and other tumors of the newborn
- Umbilical anomalies including hernia, patent urachus, patent omphalo-mesenteric duct
- Undescended testes
Many of these neonatal surgical problems are very rare, occurring in 1 in 5,000 to 1 in 25,000 live births. Pediatric surgeons have specialized training in treating these conditions, thus affording your baby the best possible outcome.
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Prenatal Visits
We encourage and are very happy to meet with expectant parents to discuss surgical problems which have been diagnosed in their infant prenatally. Almost all pregnant women now get an ultrasound as part of their prenatal management. Occasionally these demonstrate anomalies which will require surgical repair after the baby is born. In very rare instances, intrauterine surgery may be needed. We, as specialists in neonatal surgery, can thoroughly explain surgical conditions to the expectant parents. We will discuss with the parent:
- How the condition occurred
- How it is affecting the development of the baby
- What other problems might be associated with this condition
- The options for the mode and place of delivery (C-section versus vaginal delivery)
- How the baby will be treated immediately after delivery
- How the baby will be transported to the Children's hospital for surgery
- What we will do at the time of surgery
- Potential complications of the surgical procedure
- The short- and long-term prognosis for their baby
The prenatal visit also gives parents a chance to meet the surgeon who will be taking care of their baby. Many surgical conditions in babies require emergency surgery. Mothers often must remain in the referring hospital while their baby is transferred to Children's for surgical care. By meeting with us ahead of time, the mother knows who will be operating on her baby. The mother will have already had a chance to ask her questions and will already have a working knowledge about what will happen to her baby; this brings mothers a certain sense of relief during this most stressful time.
Surgical conditions which are frequently diagnosed in-utero and for which a prenatal visit with a pediatric surgeon is appropriate include:
- Gastroschisis
- Omphalocele
- Diaphragmatic hernia
- Cystic hygroma
- Esophageal atresia
- Cystic adenomatoid malformation of the lung
- Intestinal obstruction
- Ascites
- Tumors
- Teratomas
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Oncology (Tumor surgery)
Board certified general pediatric surgeons are trained in the area of tumor, cancer, or "oncology" surgery. This is different than in the field of adult general surgery, where specialist within that field do only oncology surgery. General pediatric surgeons are trained to care for all aspects of tumor surgery in infants, children, and teenagers. The only exception to this is when the tumor involves a specific area of the body requiring other expertise. This would be limited to bone tumors, which require the expertise of orthopedic surgeons, and brain tumors, which require the expertise of neurosurgeons. The general pediatric surgeon may be helpful in many different aspects of care for children with tumors. This may be from the initial evaluation and ordering of tests or x-rays for a child with a "lump" or "mass" anywhere in the body, to actually performing the surgery to remove the tumor. The general pediatric surgeon works closely with the pediatric medical oncologist (pediatric tumor specialist) in assessing the stage of a tumor (or how far it has spread), in planning the appropriate therapy (chemotherapy or radiation), and the proper timing of surgery. Therefore, the pediatric surgeons and pediatric oncologists meet weekly ("Tumor Board") to plan proper treatments for children with tumors.
In addition to planning treatments and performing surgery to remove tumors, general surgeons also perform biopsies of suspicious "lumps", lymph nodes (glands), or "masses" as an initial step in making the diagnosis of a tumor or reassuring the family and pediatrician that a lump is not a cancer. The general pediatric surgeon also performs surgery on children with tumors and leukemias to place "central venous lines", or "ports", devices implanted under the skin to be able to give chemotherapy to children in a less painful and more effective way.
Examples of who a general pediatric surgeon would be asked to see for evaluation would include a child with:
- abdominal mass (lump or swelling in the belly)
- a mass seen on the chest or seen on chest x-ray
- a lump or swollen gland in the neck, axilla (armpit), groin or elsewhere
- a swollen testicle
- a thyroid nodule
Examples of tumors that a general pediatric surgeon would be asked to remove or biopsy (remove a small piece for evaluation or diagnosis) would include:
- tumors in the neck (thyroid gland tumors, lymphoma, sarcoma, benign tumors like hygroma, etc.)
- tumors in the chest (nodules in the lung, tumors of the thymus/thymoma, mediastinal tumors or lymphomas, neuroblastoma)
- tumors of the chest wall (sarcoma of the ribs or muscles)
- liver tumors (hepatoblastoma, hepatocellular carcinoma, hemangioma, hemangioendothelioma, mesenchymal hamartoma)
- other abdominal tumors (neuroblastoma, rhabdomyosarcoma, lymphoma, tumors of the intestinal tract)
- kidney tumors (Wilm's tumor, renal cell carcinoma, etc.)
- tumors of the testicle (germ cell tumor, seminoma, etc.)
- endocrine tumors (glands that make hormones: thyroid tumors, parathyroid adenomas, thymomas, adrenal gland tumors-pheochromocytoma, etc)
- tumors of the newborn (sacrococcygeal teratoma, hemangioma, hygroma, etc.)
- tumors of the ovary, vagina, or breast (teratoma, rhabdomyosarcoma, fibroadenoma, etc.)
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