Helping Heal Hawaii’s Keiki
Interviewed by Melissa Moniz
Wednesday - March 18, 2009
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Dr. Sid Johnson
Pediatric Surgeon at Kapiolani Medical Center for Women & Children
Interviewed by Melissa Moniz
Do you have a sub-specialty?
After my general surgical training I did subspecialty training in pediatric surgery, pediatric critical care and bioethics. My pediatric subspecialty training was all done at Children’s Hospital Boston. The easiest way to sum up my specialty is to say that I do general, thoracic and minimally invasive surgery on children and babies - everything but the brain, bones and open-heart.
About how many surgeries do you perform a week here at Kapiolani?
On a busy week, I’ll do 20 to 22 operations. On a lighter week, I’ll do 10 to 14. I’m very busy now because we’re in the process of recruiting more pediatric surgeons.
Can you talk about some of the more common surgical procedures you perform?
Easily the most common operation I do is an infant hernia repair. The more interesting surgeries I do are complex but less common. They include operations on preterm infants, repairs of complex birth defects and the removal of pediatric tumors. Examples include abdominal wall defects, lung malformations or cancer in babies. The complex reconstructions are what make my job rewarding.
Are baby hernias congenital?
Yes. Actually, most hernias are congenital. It’s just that sometimes people don’t know they have a hernia until they strain hard enough and find it.
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Why is it important to operate on a baby with a hernia? Is it life-threatening?
A hernia is rarely a life-threatening problem. We fix hernias because they are uncomfortable, they generally won’t go away on their own and they do pose a low but clear risk. On occasion, an incarcerated hernia can become a life-threatening problem. Since we can’t really predict when and if a hernia will incarcerate, we fix them. Sometimes we make exceptions for the elderly because if you’ve had a hernia for years and it hasn’t caused a problem, the compounded risk is fairly low. Because a baby may have another 100 years ahead of him and we can’t predict which hernias will incarcerate, we recommend repairing them all. It’s a pretty low-risk, low-complication operation.
Besides the obvious size difference in children and adults, what are the other differences in operating on a child versus an adult?
The diseases we see in children are often different from those seen in adults. As such, they require special treatment. The intestinal problems that I see tend to be congenital anomalies or the consequence of prematurity. The cancers that I see are childhood cancers, which are completely different from adult cancers. The whole chemotherapy and surgical approach is quite different from adult cancer. The nuts and bolts of operating are essentially the same, except a pediatric surgeon has to do everything on a smaller scale and, in a baby, things are more fragile. One of my areas of emphasis is minimally invasive pediatric surgery. Minimally invasive surgery in a baby requires many different techniques and completely different instruments - all downsized for a baby.
Of the problems you see, which are preventable in the womb stage? Or are most genetic?
Very few are preventable that we know of. Probably the biggest bang for the buck for prevention is folate during the first trimester of pregnancy. There are many congenital anomalies that are either genetic or we don’t know why they happen or how to prevent them. One of the main things I try to explain to parents is that most malformations are not their fault. For a new mom, anything wrong with the baby is always tough because she thinks it’s something she ate or did during pregnancy. Most of the time we don’t know why these things happen.
Should parents opt to see a pediatric surgeon versus a general surgeon when looking for care for their child?
The easy answer is yes. The longer answer is, it depends on the problem. Sometimes I’ll see an 18-year-old for a problem that could easily be managed by a general surgeon. That said, there are certain problems that even in young adults are only treated by pediatric surgeons. An example is a problem called pectus excavatum or “funnel chest.” Many of my patients are older teenagers because the corrective procedure is simply not done by general surgeons. They aren’t trained to do the surgery (the chest concavity forms from birth so the repair falls to the pediatric surgeons). Another example is a hernia repair. In general, when kids are 14 and under, then it’s probably advantageous to see a pediatric surgeon.
As far as recovery time, do children tend to recover faster than adults?
They seem to recover a lot faster, and seem to also manage their pain a lot better. I say this specifically about babies and young children. Teenagers tend to have a lot more pain. In many cases, the surgeries are done slightly differently, which puts less stress on the body - at Kapiolani we put a special emphasis on pediatric minimally invasive surgery.
Do you perform surgeries on fetuses?
I participated in fetal surgeries when I trained in Boston. Some fetal interventions are done here on Oahu, but the need and indications for fetal surgery is relatively rare. Nationally there is a trend to refer those few patients to a few select centers. That way, a few centers get good at treating rare problems. There are very few times when surgery on the fetus is actually beneficial. Over the past couple of decades, we have learned that some fetal surgery exposes the mother to undue risk with little benefit to the fetus. When we do have a case that actually may benefit from a fetal surgery, we can refer those patients to Boston, Philadelphia or San Francisco.
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