The parents are 100% the difference. So, you need the parents’ consent and that can be tricky if parents disagree. You only need one parent to consent for an operation that has parental responsibility, so it’s on the birth certificate of the child. But, you can get problems with parents disagreeing about whether they need an operation or not. That’s one of the first steps – the consent process.
Children are smaller, which is one fundamental thing. That doesn’t mean you have to do things differently, so you can still do a keyhole operation down to about a two year old – is the youngest I’ve seen someone do a keyhole operation on. But under five, it’s much more risky, and much more complicated. So, in a general hospital that doesn’t have paediatric surgeons, or children’s surgeons, will normally do appendix operations on children who are five or above.
In under fives, they’ll normally go to a specialist paediatric surgery unit because they’re better able to deal with the complications of operating on a really small child, and their anaesthetists will be able to cope with very small children. You have to be really careful going into their abdomen because they have much less fat, so everything is very close together, and you don’t have very much space. So, you have to be very careful when you’re putting in your first port around the belly button. So, when you’re first accessing the abdomen, you’re doing it without being able to see what’s underneath -so you have to go very carefully, and there’s different manoeuvres that you can do. You can sort of pick up their abdominal wall, in order to very carefully go in so that you don’t damage the other structures around it.
Children have bigger bladders as well, in comparison to the size of their abdomen. So, we always tell people for an appendix operation to go for a wee beforehand, so the bladder is out of the way. But children, you can’t rely on them to do that. Sometimes you have to put a catheter tube in their bladder just before the operation, to make sure that their bladder is out of the way. If you have a bladder injury in a child, it’s obviously quite significant and they’ll have to go to a specialist unit. So, you have to be really careful where you put your ports, where you put your instruments.
It can make it easier, so there’s less fat and stuff inside the abdomen, so it’s easier to see things. But, you’ve also got to be really careful because any complications are much more severe for a child. So damage to a child’s bowel is extremely serious. Often, if they’re very, very small, we mainly do it on the height and weight – so if they’re very small for a child, then we will do it as an open operation, rather than a keyhole – because an open operation is much easier, and with a child can go right over the appendix, as there’s not other stuff in the way and you can do it much simpler. So, if they’re really small and very young, we will do it as a planned open operation, rather than starting with a keyhole. But, it’s mainly about there not being as much stuff in the way – so you just have to be very careful.
Adults can be tricky as well. So, you can get really thin, small adults, and you can get really big adults, and getting into the tummy of someone who’s over 100 kilograms, who’s really big – is a different type of challenge. So those are the main differences.
