Surgery

Finding out your child needs surgery can bring on a range of emotions, from anxiety to relief that they’re finally getting treated.

At Children’s Hospital & Medical Center, our pediatric surgeons and staff are dedicated to addressing your child’s medical issue and seeing them healthy on the other side of recovery.

Make An Appointment

Make An Appointment

Clinic Hours
Omaha: 8 a.m. – 5 p.m.
Lincoln: 9 a.m. – 4 p.m. Second and Fourth Wednesdays
Phone 402-955-7400 | Fax 402-955-7405

What Sets Children’s Apart?

We have the only board-certified pediatric surgeons in Nebraska:

  • Board certification requires staying up-to-date on the latest in surgical care. This means your child is receiving the most advanced care possible.
  • Combined, our surgeons bring about 50 years of experience and 30 years of training to the operating room. Since these experiences have been focused solely on treating children, they are experts at assessing the unique treatment needs of children and teenagers, since some treatments for adults aren’t appropriate for kids, and medical research done with adults may not apply to children.
  • Children’s is the region’s leader in developing and performing new, innovative pediatric minimally invasive surgical procedures. These procedures use tiny cuts, rather than large incisions. They produce minimal scarring, less pain, fewer complications, and a quicker recovery time.
  • All of our anesthesiologists are specially trained in meeting the needs of children. In addition to knowing the dose of anesthesia that’s safe for a child, they understand how to communicate with patients who are not yet able to describe pain or symptoms, and how to make children comfortable with the anesthesia process.

Surgeries We Perform

There are four specific types of surgery: bariatric, colorectal, thyroid and endocrine, and short gut/short bowel syndrome.

  • Bariatric Surgery

    Bariatric surgery a procedure that is performed on teenagers who have participated in our HEROES program (Healthy Eating with Resources, Options, and Everyday Strategies), and have not been able to lose weight despite diet and exercise changes.

    Bariatric surgery alters the digestive system by reducing the size of the stomach. This limits how much your teen can eat, and how many nutrients their body can absorb. It is a very effective procedure — the average teen loses about 90 pounds after surgery. They also see improvements in obesity-related conditions they may have had before surgery, such as diabetes or high blood pressure.

    Even though bariatric surgery is effective, it is not a cure by itself. Your teen will need to lead a healthy lifestyle by staying physically active and eating a nutritious diet.

    Learn more about the HEROES Program and bariatric surgery, including who is a candidate for the procedure.

  • Colorectal Surgery

    Colorectal surgery concerns the colon and the rectum. The colon is the longest part of the large intestine. It is a tube at the end of the digestive tract where the body makes and stores stool. When the colon is full, the stool is passed to the rectum — the end of the large intestine that is closest to the anus and holds stool until it is ready to leave the body.

    Some of the most common conditions we treat with colorectal surgery include:

    • Imperforate anus: The opening of the anus is either blocked or missing, making it impossible for your child to pass stool normally.
    • Hirschsprung’s disease: Nerves are missing from part of the bowel, causing poor muscle movement. This blocks the large intestine, making it difficult for your child to pass stool. As contents of the intestine build up behind the blockage, unable to pass, the abdomen and bowel swell.
    • Inflammatory bowel disease (IBD): This involves constant inflammation (swelling) of the digestive tract, which can cause diarrhea, abdominal pain, and occasional colorectal bleeding. There are two types of IBD:
      • Ulcerative colitis: This causes long-lasting swelling, irritation, and ulcers (sores) in the inner lining of the large intestine.
      • Crohn’s disease: This is very similar to ulcerative colitis, but it can affect any part of the digestive tract. It usually affects the part of the small intestine that’s closest to the large intestine.
    • Idiopathic constipation: Constipation is when your child has difficulty passing stool, or does not have enough bowel movements. Stool can be harder or larger than usual, making it painful to pass. Infants and toddlers have constipation if these symptoms last at least 1 month, and older children have constipation when the symptoms last at least 2 months. Constipation is considered idiopathic if there is no known cause.
  • Short Gut Syndrome/Short Bowel Surgery

    Children need fully-functioning intestines in order to absorb the nutrients they need for growth. Diseases, such as gastroschisis and necrotizing enterocolitis, can lead to short bowel syndrome (also called short gut syndrome), which is a condition where the small intestine has trouble absorbing nutrients.

    If your child has short bowel syndrome, they may need a serial transverse enteroplasty (STEP). STEP is a procedure to lengthen the small bowel, allowing more room to absorb nutrients.

  • Thyroid And Endocrine Surgery

    The endocrine system is a network of eight glands that make hormones. Hormones travel through the bloodstream to the tissues and organs that are responsible for telling body parts how to form and function. These hormones control growth, development, reproduction, sexual function, mood, and metabolism (how the body converts food and drink to energy). If your child’s body makes too much or too little of a hormone, they may have an endocrine disorder.

    Our surgeons can perform surgery for several different endocrine diseases, but the vast majority of our patients have problems with their thyroids — the gland in the neck that produces the hormone that controls metabolism. This hormone helps the body use energy to keep the heart, muscles, brains, and other organs functioning correctly.

    The thyroid problems we most commonly treat surgically include:

    • Hyperthyroidism: The thyroid makes too much of the thyroid hormone. This can cause mood swings, fatigue, irritability, hand tremors, rapid heartbeat, frequent bowel movements, diarrhea, weight loss, difficulty sleeping, and a neck that appears swollen.
    • Hypothyroidism: The thyroid does not make enough thyroid hormone to meet the body’s needs. This can cause fatigue, weight gain, joint and muscle pain, puffy face, constipation, dry skin, depression, and slow heart rate.
    • Thyroid cancer: Cancerous cells grow on the thyroid. Your child may have a lump or swelling in their neck.
    • Thyroid nodules: A group of cells form a lump on the thyroid. The majority are non-cancerous. Nodules are often symptomless, but your child may notice some pain in their ears, jaw, or neck. These nodules may need to be removed if they are causing symptoms or the physician thinks they might be cancerous.

    In addition to thyroid problems, we also perform surgery for multiple endocrine neoplasia (MEN) syndromes. These are rare disorders in which either cancerous or noncancerous tumors — masses of cells that lump together — develop on several endocrine glands. MEN can also occur if several endocrine glands grow excessively without forming any tumors. Depending on the glands involved and the types of tumors, MEN can be classified as Type 1, Type 2A, or Type 2B.

    The procedures we perform most often include:

    • Fine needle aspiration (FNA) biopsy: We use a very thin needle attached to a syringe to take a sample of tissue from your child’s thyroid. The sample is the examined under a microscope to look for signs of cancer.
    • Thyroidectomy: We remove the entire thyroid (total thyroidectomy) or part of the thyroid (partial thyroidectomy). This may be recommended if your child has thyroid cancer or a noncancerous tumor that is causing symptoms. After a total thyroidectomy, your child will probably need to take thyroid hormone replacement pills for the rest of their life.
    • Parathyroidectomy: The parathyroid glands are just below the thyroid, and they help control calcium levels in the blood. Your child may need one or more of these glands removed if they are causing hyperparathyroidism — producing too much parathyroid hormone, causing symptoms such as bone pain, nausea, or kidney stones.
    • Neck dissection: This procedure involves removing lymph nodes — small structures filled with immune cells that fight infection by destroying germs in lymph fluid. Your child may need neck dissection if they have cancer that has spread to the lymph nodes.
    • Adrenalectomy: The adrenal glands are located on top of the kidneys, and produce steroid hormones (e.g., cortisol), hormones that can be changed into testosterone, adrenaline, and noradrenaline. Your child may need one or both adrenal glands removed if there is a lump that is cancerous, looks like it could be cancerous, or is causing harmful side effects (e.g., high blood pressure).
  • Total Parenteral Nutrition (IV Feeding, Tube Feeding)

    We often work with patients who need total parenteral nutrition — feeding through an IV. Nutrients are delivered directly into your child’s vein, rather than having to go through the digestive system.

    Total parenteral nutrition begins with surgery in the Short Gut Syndrome/Short Bowel Surgery Clinic. We will insert a catheter (thin tube) into the vein in your child’s chest area. Once it is in place, we take a chest x-ray to make sure we have the correct placement.

    After the procedure, we mix a total parenteral nutrition solution and put it into your child’s IV. Since the area has to remain sterile, in order to prevent infection, we change the outside tubing that leads from the solution bag to the catheter every day, and change the dressings that cover the catheter every other day.
    Your child’s total parenteral nutrition care doesn’t end with surgery to implant the catheter. Our surgeons work alongside social workers, nutritionists, therapists, and other physicians to monitor your child’s health.

  • Other Conditions We Treat

    Neonatal (newborn) conditions, including:

    • Congenital diaphragmatic hernia
    • Duodenal atresia
    • Intestinal atresias
    • Malrotation
    • Lung malformations

    Genitourinary (genital and urinary) conditions, including:

    • Circumcisions
    • Testicular torsion
    • Undescended testicle
    • Inguinal hernia
    • Ovarian cysts and tumors
    • Ovarian torsion

    General and thoracic conditions, including:

    • Congenital lung masses
    • Bronchogenic cysts
    • Congenital cystic adenomatoid malformation
    • Pectus excavatum
    • Pectus carinatum
    • Pulmonary sequestration
    • Lymphangiomas

    We also perform the Ex Utero Intrapartum Treatment Procedure (EXIT procedure).

    Head and neck conditions, including:

    • Branchial cleft remnants
    • Thyroglossal duct cysts
    • Teratomas
    • Cystic hygromas

Outpatient Surgeries

Your child may need inpatient surgery, which requires staying overnight at the hospital. But for some smaller procedures, they may be able to have outpatient surgery, meaning they can go home the same day.

Our Outpatient Surgery Center is the only one in the region staffed by pediatric surgeons, pediatric board-certified anesthesiologists and bachelor’s-prepared pediatric nurses. In addition to general surgery procedures, we also perform many dental, dermatology, ear, nose, and throat, ophthalmology, and urology surgeries on an outpatient basis.

Looking for information about other types of surgery offered at Children’s? In addition to general and thoracic surgery, Children’s also provides surgical services in these specialties:

How To Prepare For Your Child’s Surgery

As the surgery day approaches, explain to your child why they are having surgery in simple, non-threatening words. Let your child know that the surgery is a way to help them feel better. Use simple, honest explanations to tell your child what will happen, and listen to all of their questions or concerns.

For example, avoid phrases such as, “you will be put to sleep,” as they may confuse that with what happened to the family pet. Instead, use phrases such as, “the doctor will give you medicine to help you fall asleep, so you won’t feel anything.”

The following will help you prepare for common concerns and fears your child may have before surgery:

Age When To Prepare Your Child Common Concerns, Stresses, Or Fears
Birth – 1 year There is no set time frame for children this young. Remember that children take cues from parents. The more calm and relaxed you are, the more relaxed your child also will be.
  • Separation from parents
  • Having many different caregivers
  • Seeing strange sights, sounds, and smells
1-2 years 1 to 2 days before surgery
  • Being left alone
  • Being in contact with unfamiliar people
  • Painful procedures
  • Medical equipment that looks and sounds scary
3-5 years 3 to 5 days before surgery to give your child time to ask questions. Be patient with your child. It is normal for children to require more attention during this time.
  • Thinks that they’re in the hospital because they’re in trouble or being punished
  • Fear of having a part of the body damaged
  • Fear of needles, shots, pain, or waking up during surgery
6-11 years A few days to two weeks before surgery. After talking to your child about the surgery, have them repeat back what you have told them to see if they understand what is going to happen. This will give you the opportunity to clear up any misunderstandings.
  • Thinks that they’re in the hospital because they’re in trouble or being punished
  • Having a part of the body destroyed or injured
  • Fear of needles, shots, pain, or loss of control
  • Not waking up after surgery
12+ years As early as possible. Your child will want to be involved in decision making and planning for surgery. They may not want to admit if they don’t understand something, so make sure that they are comfortable asking questions and that they fully understand what’s happening.
  • Loss of control
  • Lack of privacy
  • Having a part of her body damaged or changed in appearance
  • Fear of surgery and related risks

We want your family to be comfortable and prepared. If you or your child have any concerns, you are always welcome to reach out to the surgeon or a child life specialist.

Operation Learn

If your child is between ages 3 and 8, our Operation Learn program can help you, your child, and your family learn about what will happen during surgery. You will watch a video that walks you through the surgery process and receive a tour of the surgical services area.

We also offer medical play with child life specialists, which is the opportunity to learn more about surgery through playing. Play is a one way that your child can cope with fear and anxiety, as well as feel a sense of control and self-expression. It allows them to learn about what will be happening to them in a non-threatening or scary environment.

The program is free to any family whose child is preparing for surgery at Children’s. Programs are held weekly on Tuesday evenings. Individual preparation sessions are available by appointment. Call 402-955-5309 to register or learn more.

The Night Before Surgery

The night before surgery, select comfortable clothes for your child to wear. Your child may wear his or her pajamas to the hospital. If your child has surgery on the abdomen, legs, buttocks, etc., please dress him or her in loose fitting clothes such as elastic waist shorts, jogging pants or pajama bottoms.

Please give your child a bath, since it may be a few days before he or she can bathe again. Also have your child remove all non-permanent dental wear, contact lenses, nail polish, body piercings, and any hair accessories with metal.

Packing For The Hospital

Pack a diaper bag or backpack with a few of your child’s favorite comfort items, such as a blanket, stuffed animal, pacifier and an empty sippy cup or bottle. Older children may bring a headset, MP3 player, and hand-held video games.

Please also bring:

  • Registration information (provided by the hospital prior to surgery)
  • Your driver’s license
  • Your child’s Social Security card
  • Paperwork, including orders, lab results, X-rays, medical history, and notes from your child’s annual physical (obtained from your child’s pediatrician)
  • Your child’s insurance card
  • Guardianship papers (if you are not the parent)
  • Current medication list with names of medications, doses, and times medications are given

Pre-Surgery Instructions

A nurse will call you a couple of days prior to your child’s surgery to provide preoperative instructions. The nurse will discuss what your child can eat or drink the day before surgery and medical information such as your child’s current list of medications and doses. If the pre-op nurse does not call you, please contact the pre-op nurses’ office at 402-955-4749 between 6 a.m. and 3 p.m. on the weekday prior to your child’s surgery.

If your child develops a cold, fever, rash, diarrhea, vomiting, or other signs of infection anytime before surgery, please call 402-955-4777 to notify the surgical staff. The surgeon may want to reschedule the surgery for a later date after the infection has passed.

What To Do On The Day Of Surgery

When you arrive at the hospital, you will go to our Children’s Ambulatory Recovery and Express Services Unit (CARES). This is where we do pre-surgery check-ins, and where you will wait while your child is in surgery.

Only two adults may accompany your child in the outpatient surgery. No siblings will be allowed into the unit. Before the procedure, you will visit with your child’s anesthesiologist, surgeon, and CARES nurse to discuss any questions or concerns.

A member of our Child Life staff will be on hand to make sure your child feels supported and understands what is happening. They will also provide activities for your child while waiting for the surgery.

About Anesthesia

Many of our procedures require general anesthesia — medications that put your child into a deep sleep so they cannot feel pain during surgery or remember anything once the anesthesia takes effect.

The thought of anesthesia can be scary for both you and your child, but it is typically very safe. There is always a member of our anesthesiology team in the operating room to monitor blood pressure, pulse, and breathing.

After surgery, your child may experience some pain or nausea. However, we can provide medication to help with these effects. We also have at least one nurse present in a recovery room right after the procedure to help with symptoms and make sure that your child does not have any complications as the anesthesia wears off.

Frequently Asked Questions About Anesthesia

Q: Does my child have to have an IV?

A: Most often, yes. It is usually placed after your child is asleep. It may be necessary to start the IV prior to going to sleep for your child’s safety. Your anesthesiologist will discuss this with you before surgery.

Q: Can I be present while my child goes to sleep?

A: This is not possible due to a variety of reasons related to hospital policy, safety concerns, and logistical considerations.

Q: Will someone be present to monitor my child continuously?

Absolutely! At least one member of our anesthesia care team is always present at the head of the table throughout the surgery. A minimum of one-to-one nursing care is provided in a recovery room.

Q: How long will it be until the effects of the anesthesia wear off?

A: The effects of the anesthetic agents may last up to 24 hours. Use of narcotic pain medicines may cause sleepiness during the surgical recovery.

Okay, What About After Surgery?

Recovery

Once surgery is completed, your child will be transferred to a recovery room, where they will be provided one-on-one nursing care. As soon as your child is awake, they will be transferred to your outpatient surgery room to continue recovery in your company.

Your child will remain in outpatient surgery until they are fully recovered and able to drink clear liquids without problems, like vomiting. This may take several hours. During this time frame, your child may have mild discomfort, a sore throat, or a cough.

If your child needs to spend the night after surgery, you’ll be taken to an inpatient hospital room after a recovery room.

We strongly encourage you to spend the night with your child to comfort them. There are sleeping accommodations for one parent in your child’s room. Additional accommodations for your family are available through the Carolyn Scott Rainbow House if you are coming to us from more than 60 miles outside of Omaha.

Your surgeon will inform you when your child will be able to leave the hospital. Before you go home, your CARES nurse will discuss and provide you with written instructions on how to care for your child at home. Your child may also be prescribed medication to relieve pain and prevent infections. A CARES nurse will call you the day after surgery to follow up on how your child is doing.

Post-Surgical And Follow-up Care

Post-surgical care is just as important as the surgery itself. That’s why our surgeons work right alongside social workers, nutritionists, therapists, and other physicians to monitor your child’s health after surgery.

After surgery, your child will need to follow up in our clinic for long-term care. They will work with multiple specialists, including a surgeon, gastroenterologist (physician who treats the digestive system), and nutritionist.

The amount of follow-up meetings needed, as well as how long your child will need to do follow-ups, will depend on their personal needs, such as how much nutrients their intestine is absorbing.

Parenteral Nutrition-Associated Liver Disease (PNALD)

One of our biggest concerns is parenteral nutrition-associated liver disease (PNALD) — liver disease caused by long-term use of soy-based lipid products in total parenteral nutrition or feeding through an intravenous (IV) tube. We recommend giving your child alternative lipid nutrients, such as Smof (combination of soy and fish oil) and Omegaven (fish oil).

These alternative nutrients can lower the risk of liver damage, but there is a challenge — Omegaven has not been officially approved by the Federal Drug Administration (FDA). This can make it difficult for you to understand how to use it correctly. Our experts make Children’s the premier resource in the region for learning how to use Omegaven, and understanding its benefits.

Our Specialists

What To Do Next

For Patients

If you have questions about pre-operation instructions, please call the pre-op nurse’s office at 402-955-4749. For information about admitting and hospital access, call 402-955-5410.

Our Children’s Ambulatory Recovery and Express Services Unit (CARES) unit can be reached at 402-955-4777.

Before Surgery

If your child develops a cold, fever, rash, diarrhea, vomiting, or other signs of infection anytime before surgery, please call 402-955-4777 to notify the surgical staff. The surgeon may want to reschedule the surgery for a later date after the infection has passed.

For Referring Providers

The Physicians’ Priority Line is your 24-hour link to pediatric specialists at Children’s for referrals, emergency and urgent consults, physician-to-physician consults, admissions, and transport services. Call 855-850-KIDS (5437).

Learn more about referring patients.

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