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अखिल भारतीय आयुर्विज्ञान संस्थान, नई दिल्ली
All India Institute Of Medical Sciences, New Delhi
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Paediatric Surgery

Introduction

The Department of Paediatric Surgery was created as an independent department in 1969 with Dr. P.Upadhayay as the first head of department. Thereafter the department was headed by Prof. M. Rohatgi (1987-1993) and then Prof. D.K.Mitra (1993-2004). Prof D.K.Gupta took over as Professor and Head of the Department in January 2005. Professor DK Gupta was nominated as the Vice Chancellor of the King George’s Medical University, Lucknow (UP) for 3 years from April 2011-2014 on lien from AIIMS. He has joined back after completion of tenure of three years.  During this time, Prof V Bhatnagar had served as Professor and Head of the Department. Dr Shilpa Sharma joined as Assistant Professor in 2012, increasing the faculty strength to six. Recently, four more faculty members Dr V Jain, Dr P Goel, Dr A Dhua and Dr D K Yadav, have joined the Department as Assistant Professors in 2014. 

The department has been on the forefront and is rated as one of the finest departments not only in the country but at the international level for its quality  patient care, teaching, training and research. The Department established a state of the art neonatal intensive care unit exclusively for the surgical newborns, for the first time in the country. The department has contributed significantly in promoting the development of pediatric surgery at the national and international level and is regularly represented in the national and international associations and various societies, projecting the current status and the contribution in the field of pediatric surgery from this major teaching institution.  

History of the Department 

It is a pleasant task to recall the history of the department and take pride in its achievements.  However as in everyday life, difficult moments did creep in and in overcoming these, we believe we have emerged stronger after each such episode.  

It was in 1968, that Dr.P.Upadhyaya, then Associate Professor of Surgery, returned after availing a WHO fellowship in Pediatric Surgery and took charge of the Pediatric Surgery unit within the department of General Surgery at AIIMS. 

It was on 29th March 1971, that the umbilical cord was finally severed and the Department of Pediatric Surgery came on its own with Dr.Upadhyaya as its first head.  It was a humble beginning with 24 beds earmarked within the surgical ward and two registrars - Dr.L.K.Sharma and Dr.R.K.Kashyap.  Dr.M.Rohatgi joined the department in May 1970 as Assistant Professor, the faculty strength of the department has gradually increased to six with the joining of Dr.D.K.Mitra (1976), Dr.D.K.Gupta (1985), Dr.V.Bhatnagar (1986), Dr.M.Bajpai (1988), Dr.S.Agarwala (1994) and Dr.M.Srinivas (1999). Dr Shilpa Sharma joined in 2012, increasing the faculty strength to six. Thereafter, four more new faculty members   Dr V Jain, Dr P Goel, Dr A Dhua and Dr D K Yadav, joined the Department as Assistant Professors in 2014, increasing the faculty strength to ten, in preparation for the new pediatric surgery centre that is currently under construction.  

Dr.P.Upadhyaya became the first professor in 1976 and was the head of the department till his retirement in 1987.  From this time onwards Dr. M.Rohatgi was the head till her untimely demise in January 1993 in a train accident. Prof. D.K.Mitra, took over as the Head of the Department in 1993 and superannuated in December 2004.  

The first M.Ch. trainee, Dr. S.Chooramani was selected in July 1972 and has been bestowed with the honorable Padamshree award in 2011. Since then 98 M.Ch. trainees and 1 PhD student have been groomed into holding responsible teaching positions in the country and abroad. Due to ever increasing clinical and research workload, the strength of the senior residents was increased from two to four in 1979, to six in 1982 and again to nine in 1994.  The six years' integrated M.Ch. course in Pediatric Surgery (after MBBS) was launched in the Department in July 1979 and it continues till date.  In addition the department also trains post-graduates in general surgery, pediatrics and neurosurgery for 2-12 weeks making them aware of the common pediatric surgical problems and their management.  The Department frequently receives postgraduate students in Pediatric surgery from different centers in the country for 4-12 weeks to obtain exposure in neonatal surgical techniques and post-operative care.  

Experimental work including animal experiments forms an integral part of the M.Ch. training, besides the routine clinical project. Original experimental work has been carried out in the field of splenic conservation, CSF shunts, embryo-toxic factors in congenital malformations, duplication cysts, metabolic responses to surgery, biliary atresia,  intersex disorders,  pediatric urological problems, intestinal atresia, esophageal atresia, to name  a few. The Department has two laparoscopic endotrainers. Many innovations made in the department are being utilized in day to day practice for the benefit of the patients.  

In April 1993 the department received a jolt when a fire consumed the department’s offices and laboratory destroying precious records and equipment.  What we see today is the department rebuilt after such a colossal loss. 

The pediatric surgical ward was trans-located to its present position on 5th floor (AB-5 wing) in the year 1969, and has now strength of 40 beds. The neonatal surgical intensive care unit (NSICU) was upgraded in 2000 to accommodate 8 neonates and in 2009 to accommodate 10 neonates and a separate feeding area for the mothers. The NSICU is equipped with state of the art life support systems for each newborn (ventilator, monitors, infusion pumps, humidifier, photo-therapy machine, blood gas analyzer and others).   

The department has been receiving support from the associate departments like anesthesiology, nuclear medicine, radiology, pathology, oncology and neonatology at odd hours. The department has also been extending the specialized services and running the afternoon clinics in the field of hydrocephalus, pediatric urology, oncology, intersex disorders and antenatal diagnosis and management. A follow-up clinic has also been started to manage the surgical newborns with antenatally detected malformations efficiently. 

Blood gas analyser and four channel recorder were installed in the ward way back in 1972, and now have been upgraded.  The Urodynamic machine serves both the clinical as well as the research purposes. Micro-analyser and multi-channel monitoring system have been added recently.  The ward now has a special care area equipped with the latest monitoring equipment, ventilators, intra-cranial pressure monitoring device, and facility for uroflometry and ano-rectal manometery.  Esophageal pH and manometry has also been recently added. The Department has also acquired a Doppler ultrasound machine to meet the requirements of the neonates and children with various types of disorders.   

In 1975, the first neonatal surgical ICU, in India, was established at the AIIMS.  This was initially located in separate cubicles at one end of the children’s surgical ward.  However its limitations were realized and in 1979 it was shifted to a separate area with its own air-conditioning, air filtration plant, and temperature and humidity control, with a capacity of 7 neonates and this was partially equipped under the Colombo plan by the British Government. Due to the ever increasing workload at this institute, the neonatal surgical ICU has now been expanded to accommodate ten newborns. It has been completely renovated and freshly equipped with state of art incubators, open infant care systems, portable incubators, neonatal ventilators, multi-function monitors, electronic weighing scale for the newborns, humidifiers, syringe pumps and slow suction machines.  

From its inception the department has tried to take care of all surgical needs of children.  The Upadhyaya shunt was the first of its kind in India, manufactured using an indigenously developed valve in the department.  The department has acquired fame and status as a center of excellence in the field of neonatal surgery, pediatric neurosurgery, thoracic surgery, plastic surgery, gastro-intestinal surgery, hepatobiliary surgery, urologic surgery, onco-surgery and endoscopic surgery. This is apparent from the number of admissions which were 443 in 1973, 1083 in 1983, 1641 in 1993, 2201 in 2004-05 and 1424 in 2010-2011 including ward and ICU. The number of operations performed per year has also shown a similar trend. Currently (2015), the Department operates around 2500 cases per year including 1600 major cases, 600 minor cases and 300 cases at CHC, Bhallabhgarh where the Department runs an Operation Theatre once a week.  However, the Department of Pediatric Surgery is only a part of this premier major institution and hence we face the limitation of the number of available beds and the operating time to us, forcing patients to be on the waiting list for months for routine and reconstructive surgery.

At the national level, the department of pediatric surgery at this institute has made significant contributions to the development of Pediatric Surgery. The first ever national gathering of the country’s Pediatric Surgeons took place in 1976 during the Ist WHO/NAMS sponsored National Seminar on Pediatric Surgery at AIIMS. The recommendations of the seminar formed the blue print for the evolution of pediatric surgery. A follow-up on this was made during the 2nd WHO/NAMS National Seminar on Pediatric Surgery in 1982 at AIIMS.  

Workshops, Seminars, Symposia 

The department hosted the first International Workshop on Neonatal Surgery in 1980. Since then, the department has been holding various workshops, symposia, conferences and other teaching courses each year.  Over 50 such conferences have already been organized by the department in the field of pediatric thoracic surgery, pancreatic and hepatobiliary surgery, vascular malformations,  esophageal surgery, pediatric urology and intersex disorders, inviting  each time distinguished faculty members from India and abroad. The department also hosted workshops and seminars for the training of nurses in neonatal intensive care, knot tying, staplers, suture practicum and neonatal resuscitation. International Workshop on Hypospadias and Intersex Disorders in 1999, International Workshop on Neonatal Surgery in the year 2000 and recently the International Workshop on Neurogenic bladder and the Hypospadias in 2001 have been very well attended by delegates not only from various parts of India but overseas also. All these have proved to be very educative and informative. The 3rd World Congress on Pediatric Esophagus including Prevention and Treatment of Caustic Esophageal Burns & Live Operative Workshop on Esophageal Surgery (February 1-3, 2002) organized by the Department is another feather in its cap in the field of education. The Biennial Asian Association of Pediatric Surgeons was organized in August 2006 and had about 660 delegates from 80 countries.  The   3rd World Congress of Pediatric Surgery along with the 36th Annual National Conference of Indian Association of Pediatric Surgeons, 21-24 October, 2010 was organized by the department as a landmark congress in the speciality including delegates from 93 countries. This was associated with 3 major workshops, the Pre congress course on Minimally Invasive surgery, 21 October 2010, Pre congress course on Anorectal Malformations, 21 October 2010 and Live Operative Workshop on Hypospadias and DSD, 25-26 October 2010. 

This was shortly followed by the Symposium on Pediatric Uro oncology in association with the Indian Society of Pediatric Urology, from December 3-4, 2010. An International workshop cum Symposium on Pediatric Urology and Annual Conference of Delhi Chapter of IAPS and Pediatric Urology Chapter of IAPS was organized from 29-31 August, 2013. A Public Awareness Program on Hernia in Children was organized on 7th September 2013 AIIMS, New Delhi.

The Department regularly holds meetings of the of the Delhi chapter of IAPS, New Delhi, Past and present members of the Department have received many prestigious awards and honors. The faculty members have served not only the National Association with flying colors but have also been nominated uncontested to the  Asian Association and the World federation of Association of Pediatric Surgeons.  The faculty members are constantly updating their knowledge by participating in the national and the international conferences. They have also visited centers of excellence in Pediatric Surgery the world over through various fellowships and scholarships.  

Objectives of the Department 

1.      To offer the best possible care to the surgical neonate and child

2.      To train the students and nurses in the field of Pediatric Surgery

3.      To establish guidelines on how a particular problem should be solved in the Indian setting

4.      To carry out research in the specialty under ethical and scientific guidelines

5.      To serve as a role model for ideal pediatric surgical practice 

The Department of Pediatric Surgery at AIIMS offers State-of-the-art patient care, not only in General Pediatric Surgery, but also in the field of Neonatal surgery, Pediatric Urology including Disorders of Sexual Differentiation, Thoracic surgery, Oncology, Gastrointestinal Surgery, Laparoscopy, Endoscopy ( Bronchoscopy, Esophagoscopy and  Cystoscopy) and Neurosurgery in children up to 14 years of age. 

 The Department has several follow-up clinics including antenatal counseling for congenital malformations and follow-up of the cases till they reach adolescence and even after adulthood in some selected cases where meticulous surgery is required. The Department has daily outpatient services and follow up clinics in the mornings  and afternoons. 

Currently (Jan 2015), there are nineteen trainees (3-year MCh students and 6-yr MCh) including 13 senior and 6 junior residents in the Department. Apart from these, there are regular student on rotations from General Surgery, Neonatology and Neurosurgery to learn the basics of the speciality. There is a stringent academic training program with regular morning classes from 8-9 am daily before the routine clinical work starts.

Many alumni of the Department are presently holding key faculty positions (Principal of the Medical College, Heads of the Departments in India and Consultant Pediatric surgeons) in various pediatric surgical centers in India and abroad and making us proud. 

The Department has made remarkable strides in the past and continues to work hard for excellence in patient care, clinical and experimental research, and post-doctoral teaching and training the residents. We remain committed to continue this tradition to the best of our ability and dedication, and hopefully prove up to the expectations of the public at large.   

Willis Potts - one of the pioneers of pediatric surgery in North America, highlighting these very principles from the preface of his book "Surgeon and the Child" published in 1959 - dedicating it to the new born baby who has the great misfortune of being born with a serious deformity saying that "if this baby could speak, it would beg imploringly of the Surgeon, please exercise the greatest gentleness with my miniature tissues and try to correct the deformity at the first operation. Give me blood and the proper amount of fluid and electrolytes; and plenty of oxygen to the anesthesia and I will show that I can tolerate terrific amount of surgery. You will be surprised at the speed of my recovery and I shall be always grateful to you." 

The pediatric surgical patient requires tender care with delicate skills and diligent follow up as the newborn, baby or toddler grows through adolescence into a mature adult. As pediatric surgeons we learn from the little kids daily and are grateful to them for giving us the opportunity to serve them.

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