Treating Unusual Cases

Bright-eyed and happy, little Aislinn Shedd doesn't look like a 3-month-old who had undergone historic surgery only a few days earlier to remove two extra stomachs. That's the beauty of laparoscopy, which reduces the pain and shortens the hospital stay for seriously ill children like her.

Aislinn's operation was one of nearly 1,800 that P. Cameron Mantor, M.D., and his colleagues Robert W. Letton, Jr, M.D., and Nikola K. Puffinbarger, M.D. and Alejandro Ruiz-Elizalde, MD, perform each year. One-fourth of them are laparoscopic/thorascopic procedures in which the surgeons use instruments that come in "baby sizes" as small as coffee stirrers.

Weeks before Aislinn was born, her mother's obstetrician was monitoring the fetus with an ultrasound scan when he noticed two unusual masses, the surgeon explained. "We said, ‘Let the baby get born, and we'll see what they are." Testing confirmed Aislinn had two duplicate stomachs that would have to be removed. A decision was made to put off surgery until she was several months old.

"All things being equal, it's better to do surgery on babies a few months after they're born," Dr. Tuggle said. "Sometimes you have to operate on babies immediately, but if they can eat, if they're not in trouble, and it doesn't look like cancer, you wait a little bit because bigger babies can tolerate surgery better than tiny newborn babies can."

Another unusual case involved inserting an esophageal stent in the throat of a 10-year-old who drank Drano® as a toddler. Years earlier, a Tulsa physician had built the child a new esophagus by using tissue from the boy's large intestine.

For the past year the child was operated on every month to remove scar tissue from the replacement esophagus and dilate it. Surely there was a better way of keeping the esophagus open.

A wire stent traditionally used for adult cancer patients hadn't been used on the boy because these stents would erode the esophagus over the child's lifetime. But a search for a better model turned up a soft, plastic insert new to the market. Although the stent - shaped much like a Chinese finger toy -- was made for adults, the smallest size fit this young patient.

Of course, this boy won't always be a child, a fact never far from the surgeon's mind. "When you operate on children, you have to remember that they're going to grow. So sometimes you can't do things the way you'd do with adults."

OU's pediatric surgeons do "a bit of everything" for their young patients except open heart, brain or orthopedic surgery. The variety may account for the popularity of the field despite a long residency requirement. The OU College of Medicine is one of only 36 medical schools in the country to offer the two years of pediatric residency training that follow five years of general surgery residency.