Paediatric surgery carried out by general surgeons: A rural New Zealand experience

Background: There are increasing moves towards centralization in paediatric surgery. With only four paediatric tertiary centres in New Zealand, many general surgeons still routinely carry out paediatric surgery. We present an audit of paediatric surgical patients admitted to our general surgical unit. Methods: Data were prospectively recorded using a standardized pro forma on all children aged 15 years and below, who presented to general surgery between 11 December 2005 and 11 December 2006. Results: There were 209 admissions (194 children); the median age was 8 years (range 6 weeks to 15 years) with 153 (73%) acutes. Male : female ratio was 3:2 and 37 children (18%) were less than 2 years of age. Procedures (n = 119) comprised appendicectomy (35), inguinal herniotomy (30), skin procedures (29), endoscopy (10), testicular (10) and others (5). The commonest acute and elective operations were appendicectomy and inguinal herniotomy, respectively, with 51% of all operations carried out acutely. There were 10 tertiary hospital transfers (5%) for burns (4), pyloric stenosis (3), intussusception (1), neonatal inguinal hernia (1) and pyoderma gangrenosum (1). Median age of transfers was 11 months (range 6 weeks to 14 years). Complications were wound infection (1), postoperative ileus (2) and infarcted ovary (1). Conclusion: A large number of children presented to our surgical department. Approximately half required surgery and half of the operations were acute. There is still a significant need for general paediatric surgery in the provinces and hence close collaboration with specialist paediatric surgeons.