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Paedratic Surgery

Department of Pediatric Surgery of Kanti Children’s Hospital: Past, Present & Future!

Pediatric surgery is an evolving branch of surgical subspecialty and is conceived as the surgical companion to Pediatric Medicine. With increasing use of fetal antenatal screening and diagnostic tests, there is a changing pattern of neonatal malformations requiring surgery. In Nepal, there is increasing trend of antenatal diagnosis in women with regular antenatal check up; still large number of neonatal problems is diagnosed late causing late intervention and increased morbidity and mortality. So far we are unable to think about fetal surgery.

The Department of Pediatric surgery of Kanti Children’s Kanti children’s hospital was established in 1975 A.D with the foundation laid by Dr. K.B. Rajbhandari and Dr. N. B. Thapa. We can understand it must have been possible with the meticulous plan, hard work, lot of struggles and challenges. We should be really indebt to them and really appreciate and thank them for their sincere effort to establish it.

This is the one and only governmental children’s Hospital in Nepal with tertiary level pediatric surgical center having Surgical Intensive Care Unit and the only national referral pediatric surgical center having well developed pediatric burn unit.

The department of pediatric surgery of Kanti shares the most brunt of whole Nepalese pediatric surgical problems despite addition of few other private children hospitals and other general hospitals who also provide pediatric surgical services.

As far as the developments of pediatric surgical services are concerned, we have moved ahead in terms of updated technical quality of work and in terms of updating the facilities. We have modern operating rooms, nice surgical intensive care unit, post operative wards and well maintained surgical ward. Our work load is enormous and to be honest, beyond our capacities to deal the real pediatric surgical problems of whole Pediatric population with the existing manpower.

At present we have two consultants – Dr. R. P. Chaudhary and Dr. M.S. Pun, two registrars – Dr. Anupama Thapa (Basnet) and Dr. Bijay Thapa, two pediatric surgeons – Dr Puskar Pokhrel and Dr Ramana Rajkarnikar and other medical officers. It’s good that youngsters have joined us which has definitely strengthened our department and our surgical output has also increased enormously.

We feel proud to mention that we have started dedicated pediatric laparoscopic surgical services this year. We still feel proud to have Surgical Intensive Care Unit (SICU), so far the only one of its kinds in Nepal where we can take care of most complicated neonatal and pediatric surgical cases.

We also have the Pediatric burn center, the only and possibly the largest of it’s kind of the country. With the start of burn project with the help of IHLFS, we have really improved in burn care services. We have regular visit of overseas faculties for further improvement.

Facilities available at surgical unit:

  • General neonatal & Pediatric Surgery.
  • Emergency neonatal and Pediatric surgical services.
  • Pediatric Laparoscopic Surgery.
  • Pediatric Urology.
  • Indoor Services.
  • PediatricBurn center.
  • Out Patient Services.

Indoor services available:

  • Surgical Intensive Care Unit (SICU)  – 04 beds with one incubator.
  • Post operative Ward                          – 06 beds
  • Surgical ward including paying ward – 30 beds.
  • Burn ward with post operative ward  – 22 beds.
  • Observation ward
  • Cabins

We annually perform more than 2500 operations ranging from complicated to minor which is probably really a large number for a single center worldwide. We get referral cases from all corners of Nepal and we perform all sorts of general neonatal and pediatric surgical operations including the pediatric burn surgeries. We feel proud to receive all sorts of complicated surgical cases referred from east to west and south to north. In recent years, we have noticed a major change for the shift to more complicated surgical cases being dealt more frequently than the past, possibly because of early referral by pediatrician colleagues and also may be because of public awareness.

As far as the spectrum of surgical diseases are concerned, we deal almost all sorts of congenital anomalies like anorectal malformations, various types of intestinal atresia including esophageal atresia, Hirschsprung’s disease, Urogenital anomalies, Onco-surgeries, burn related surgeries and various rare surgeries with  the newer techniques. We have started performing Snodgraft TIP Urethroplasty for  proximal penile hypospadias, Laparoscopic assisted transanal pull through and Endorectal pull through for Hirschsprung’s disease, single stage anorectal surgeries for intermediate type of anorectal malformations without colostomy and primary skin grafting for burn cases.

Our Pediatric burn center is really a dedicated center and provides burn injuries of various kinds and the results are commendable. It’s because of sincere and hard work of our burn staffs despite without any dedicated plastic surgeon and less attention from the concerned authority.

Even though our results are up to the international standard; we are still focusing more on qualitative improvement. This department is actively involved in academic activities also. We have regularly posting of residents of Master of General Surgery in our department during their residency program and so are foreign elective students.

We are hopeful of further qualitative improvement in minimal invasive surgery for neonatal and pediatric major surgical problems and in endourology after procurement of updated equipments and may be fetal surgery also in future.

We would like to have your kind attention towards our constraints, limitations and recommendations for further improvement.

Constraints and limitations:

  • Less attention to Pediatric surgical department in regular hospital affairs.
  • Less man powers particularly of consultants leading to long waiting list for regular major operations.
  • Lack of Histopathology division and Frozen section facility.
  • Lack of updated equipments and trainings.
  • Lack of work culture and encouragement.

 Our recommendations:

  • Encouragement and Promotion of Pediatric surgeons of governmental services.
  • Development of other pediatric surgical center in other parts of the country.
  • More attention towards pediatric surgical facilities from hospital authority as it is only center of the country & as we make more money for the hospital fund.
  • Updated equipments / subspecialties training opportunities for surgical faculties.
  • Procurement of more updated surgical instruments for pediatric minimal invasive surgeries.
  • Development of Pediatric surgical subspecialties in near future to move with pace.

 We are still optimistic that our department will get more attention from our hospital authority, health policy makers and the ministry of health and population taking in to the account of one and only national governmental referral pediatric surgical center to provide basic as well as advanced pediatric surgical services for existing and future pediatric population of new Nepal .We appreciate your cooperation and do expect more in future too for our better performance.

 Looking forward to work together and to provide qualitative and quantitative pediatric surgical services.