Pediatric Laparoscopy: Then and Now

Based in Valhalla, New York, renowned pediatric surgeon Dr. Gustavo Stringel is surgeon in chief of Maria Fareri Children’s Hospital. For over two decades, Dr. Gustavo Stringel has been at the forefront of the field of laparoscopic surgery for young patients.

Laparoscopic techniques are frequently used for a wide range of common pediatric procedures, typically with outcomes that are superior to those of more invasive open operations. Modern pediatric laparoscopic surgeries include appendectomies, various tumor and organ biopsies, and hernia exploration and repair, among many others.

Laparoscopic surgery wasn’t always available for children. In the early 1990s, laparoscopy was a fairly well-developed field in adult and gynecological medicine. The world of pediatric medicine, however, lagged behind for a couple of reasons. First, existing equipment was not ideally sized for children’s bodies. Secondly, a number of doctors resistant to pediatric laparoscopy suggested that the natural resilience of children to surgery made laparoscopy an unnecessary replacement for more traditional open surgery.

Fortunately, a few insightful pediatricians like Dr. Stringel identified the advantages of laparoscopy in the early 1990s, and worked hard toward establishing the necessary knowledge and expertise to safely operate laparoscopically on young patients. The less invasive nature of laparoscopy was found to be advantageous to children, as well, with quicker recovery times, fewer infections, and less postoperative pain. With the advent of smaller instruments better suited to children’s procedures, the results only improved.

Thanks to the persistence of those pioneering pediatric surgeons, today pediatric laparoscopic procedures are routine and produce positive outcomes for thousands of young patients every year.

Pylorlic Stenosis – What It Is, and How It’s Treated

Chief of pediatric surgery at Maria Fareri Children’s Hospital in Valhalla, New York, Dr. Gustavo Stringel is an accomplished surgeon with over 30 years of experience. Especially renowned for his innovation and skill in laparoscopic procedures, Dr. Gustavo Stringel also teaches medicine in his position as a professor of surgery and pediatrics at New York Medical College.

A relatively common infant ailment requiring surgery is pyloric stenosis, which consists of an irregularly large growth of muscle around the pylorus, the connection between the stomach to the small intestine. The result of this extra tissue is that food is restricted from passing through into the intestine. The condition is usually quickly identified, as it causes projectile vomiting. Pyloric stenosis most often occurs in infant males around a month old.

Fortunately, pyloric stenosis is easily corrected with surgery. The operation involves cutting the muscle tissue constricting the pylorus, which does not damage the stomach itself. This procedure can be done laparoscopically. In this case, the resulting tiny incisions not only leave practically no scarring later in life, but also greatly reduce the incidence of infection immediately following the surgery.

Is a Pediatric Endoscopy Necessary? by Gustavo Stringel

Dr. Gustavo Stringel, the Surgeon-in-Chief at Maria Fareri Children’s Hospital in Valhalla, New York, specializes in minimally invasive surgeries. Dr. Stringel has performed many pediatric endoscopies to diagnose and treat diseases of the digestive tract. Like many in his field, Dr. Gustavo Stringel must frequently explain to parents how he decides when an endoscopy is justified and when it is not.

The North American Society for Pediatric Gastroenterology and Nutrition (NASPGN) has issued a set of guidelines for pediatric endoscopies. These procedures require anesthesia and can be very expensive. Like all procedures, they carry risk. Therefore, the NASPGN recommends that doctors perform pediatric endoscopies only when they will provide diagnostic or therapeutic value to the patient.

For instance, these procedures, which involve inserting a small flexible tube with a light and a camera into a patient’s digestive tract, can locate the source of gastrointestinal bleeds and determine the source of poor weight gain and stooling issues. On the other hand, they should not be used in patients whose gastrointestinal issues are well controlled. For example, a patient with simple reflux who responds well to medication does not need an endoscopy. If a child has issues with constipation but laxatives resolve them, there is no need for this procedure. The NASPGN recommends that endoscopy be used only in cases in which it will increase quality of life and the potential benefits outweigh potential risks.

 

Dr. Gustavo Stringel Discusses the Hospital for Sick Children in Toronto

For nearly 130 years, the Hospital for Sick Children in Toronto has aided children in need of medical care. Affiliated with the University of Toronto, the Hospital for Sick Children is recognized across the globe as one of world’s best pediatric hospitals, due to its staff’s dedication, state-of-the-art equipment and laboratories, and innovative research programs.

While the Hospital for Sick Children treats a variety of illnesses, it specializes in several key areas such as attention-deficit/hyperactivity disorder, asthma, and juvenile diabetes. Additionally, it connects patients and their families with psychologists and social workers. Parents can remain in contact with their children, as each room contains a telephone, and computers are available free of charge.

People interested in learning more about this facility can log onto http://www.sickkids.ca. The site also contains links for individuals who want to donate money, toys, games, and other equipment to the institution.

About the Author:

A pediatric and laparoscopic surgeon, Dr. Gustavo Stringel trained at the Hospital for Sick Children. He also obtained experience in general surgery at the University of Toronto’s prestigious Gallie Program.

Appendectomies: Don’t Wait!

When the appendix becomes inflamed and infected, doctors perform an appendectomy to prevent a rupture and systemic infection. As a Pediatric Surgeon at Maria Fareri Children’s Hospital in Valhalla, New York, Dr. Gustavo Stringel frequently performs this type of surgery in children.

An untreated appendix can rupture quite quickly, which can be fatal. Dr. Gustavo Stringel cautions that appendicitis (inflammation of the appendix) is a medical emergency that requires immediate medical care. Parents should be alert for early signs of appendicitis in their children, including sharp pain around the belly button or in the right lower quadrant of the abdomen. Vomiting, dry heaves, loss of appetite, fever, and frequent painful urination may also be present.

Once doctors diagnose appendicitis, they move quickly. The child will be admitted to the hospital, and his or her physician will remove the appendix using a laparoscope or by open incision. The child will likely remain in the hospital for one to three days following the surgery, although laparoscopic removal often results in quicker recovery time than open surgery.

The Value of Experience for Surgeons versus the Value of Sleep, By Dr. Gustavo Stringel

In 2003, the Accreditation Council for Graduate Medical Education limited the number of hours resident surgeons could spend working to 80 per week. Before those limits were established, surgeons in training commonly worked more than 100 hours per week, which left many exhausted and, in some cases, caused fatigue-related mistakes that might otherwise have been avoided.

As new research shows, however, those 100-plus-hour weeks also allowed surgeons to complete 520 more surgical procedures per year of training than 80-hour weeks do. The new restrictions mean that surgeons are entering practice with less experience than they once had, and of course, this lack of experience can also lead to serious mistakes.

The debate over how to balance the need for extensive experience with the need for sleep and rest rages on in the medical field, but as long as the current restrictions remain, surgeons in training must maximize the benefits they can from the hours they are allowed to work.

About Dr. Gustavo Stringel:

A surgeon with more than 30 years of experience, Dr. Gustavo Stringel has studied the changes that surgeons’ training schedules have undergone in recent years. Dr. Stringel published an article on this issue, “Making the Most of the Hours We Have Left,” which he delivered as President of the Society of Laparoendoscopic Surgeons in 2010.

A Discussion about Laparoscopic Surgery

Dr. Gustavo Stringel is the Surgeon in Chief and Director of Pediatric Surgery and also Minimally Invasive Surgery (MIS) for the Maria Fareri Children’s Hospital at Westchester Medical Center in Valhalla, New York. In his position, Dr. Stringel fulfills a number of functions including hiring specialists in a variety of fields, treating patients, and managing the day-to-day operations. As head of MIS, Dr. Gustavo Stringel obtained several pieces of state-of-the-art technology, including da Vinci robotic surgical equipment, to assist practitioners engaged in laparoscopic surgery. Furthermore, he has engaged in research into laparoscopy in children and infants.

Laparoscopic Surgery oublic domain

Also known as minimally invasive surgery, laparoscopic surgery utilizes video cameras and tiny instruments to diagnose and treat certain conditions. Doctors start by making a small incision in the patient just large enough to insert the laparoscopy equipment and other instruments through the opening. The camera relays images to a monitor visible to the surgeons. These professionals can then mechanically control the other devices without needing to increase the size of the incision.

Laparoscopic techniques offer several benefits when compared to traditional forms of surgery, including smaller scars, quicker recovery time, shorter hospital stays, and less potential for complications.