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Emergency Surgery and Trauma Services in Children

St George’s Hospital is the tertiary paediatric surgical unit for Southwest London and is the regional major trauma centre (MTC). We have a paediatric intensive care unit (PICU) and a full range of tertiary acute specialties, namely cardiothoracic surgery, neurosurgery, interventional radiology all under one roof. This means that when a child is seriously unwell and needs an urgent operation, all the expertise required for the best possible outcome is available immediately in one place.

General Surgery of Childhood

General surgery is usually carried out in a daycase setting allowing children to be discharged from hospital on the same day after a minor procedure. Examples of conditions the team treats are “lumps and bumps”, hernias, hydroceles, phimoses (tight foreskins) and tongue ties. Where possible, we try and operate on these children at their local district general hospital saving them a journey to Tooting. We also provide this full range of operations at St George’s, mainly for our local population of Wandsworth.

Neonatal Surgery

We have a world famous fetal medicine unit (FMU) offering the full range of diagnostic and therapeutic antenatal interventions including ex utero intrapartum therapy (EXIT) procedure. We work closely with the team from fetal medicine to offer regular antenatal counselling sessions to expectant parents whose fetuses have possible or confirmed surgical problems.

St George’s is one of the busiest tertiary surgical neonatal centres. Our neonatal unit provides intensive care required even for the smallest babies. We treat many conditions including; anorectal anomalies, Hirschsprung’s disease, congenital diaphragmatic hernia, oesophageal atresia, bowel atresias, malrotation, necrotising enterocolitis, lung malformations and abdominal wall defects such as gastroschisis and exomphalos.

We are in the unique position in that our paediatric theatre is co-located with the neonatal unit next door, this allows us to provide safe surgical care for the sick, often very premature neonate. This is a team effort together with our neonatology colleagues and superb dedicated neonatal surgical nurse practitioner. There are approximately 630 admissions per year of which 100 require surgical consults and around 70 surgical procedures performed.

Oncology surgery

St George’s, working in partnership with the Royal Marsden Hospital, provides holistic care for children with cancer with our team of oncologists, radiologists, histopathologists, specialist nurses and paediatric surgeons. The paediatric oncology surgeons provide a state of the art surgical service for children with cancer and we have a world class reputation for the medical and surgical treatment of tumours such as neuroblastoma, Wilms tumour, sarcomas and lymphomas. We have a dedicated vascular access team which provides the service across both sites. Since 2018, we perform gonadal (ovary/testis) cryopreservation as part of the national programme offering the potential of long-term fertility for children with certain tumours who would otherwise become infertile. We are the first centre in the UK to offer paediatric hyperthermic intraperitoneal chemotherapy (HIPEC).

Gastrointestinal surgery

St George’s manages neonates and children with complex lower gastrointestinal (GI) problems such as anorectal anomalies and Hirschsprung’s disease. We are also the regional center for the surgical care of children with inflammatory bowel disease (IBD) such as Crohn’s disease and Ulcerative colitis. We have regular multidisciplinary team meetings with gastroenterologists, radiologists, dietetics, specialist nurses, histopathologists and adult colorectal surgeons. We run specialist anorectal clinics, joint clinics (with gastroenterology) and transition clinics to adult services for adolescent patients. We have formalised an upper GI bleeding pathway together with our adult endoscopy colleagues.

Thoracic surgery

St George’s Hospital is a centre of excellence for the care of children with chest disorders ranging from congenital lung lesions such as congenital pulmonary airway malformations (CPAMs) and sequestrations to severe chest infections such as empyema thoracis. We have expertise in both open and thoracoscopic approaches to these conditions. We also offer a specialist chest wall clinic for pectus deformities and have set up a bracing program in partnership with the orthotics department at Queen Mary’s, Roehampton.

Haematology surgery

We work closely with our paediatric haematology department for children who have clotting disorders, haemoglobinopathies (such as sickle cell anaemia or thalassaemia) or bone marrow failure. For the haematology children that need surgical input we help establish long term vascular access, or remove gallbladders (cholecystectomies) and spleens (splenectomies) as required.

Vascular anomalies

A multidisciplinary team of paediatric surgeons, plastic surgeons, dermatologists, geneticists and interventional radiologists, provide holistic care for children with rare conditions including haemangiomas, lymphangiomas and arterio – venous malformations.

Minimally invasive surgery (keyhole)

We have a twenty year experience of minimally invasive surgery (MIS) in children and a decade of neonatal MIS. We routinely perform hernia surgery, appendicectomy, pyloromyotomy, cholecystectomy, splenectomy, IBD surgery and fundoplication using MIS. We also do complex MIS for congenital diaphragmatic hernias, lung resections and tumour resections.

Antenatal Counselling

Many abnormalities are detected on routine ultrasound scanning of pregnant mothers, and some of these conditions will require surgical intervention after birth. Our paediatric surgeons provide a detailed antenatal counselling service for parents explaining the conditions, the likely outcomes and the surgical management, helping to reduce anxiety. The parents are therefore able to meet the team before their babies are born and gain a better understanding of the care their baby will receive. This also allows us to plan the optimal time and method of delivery.