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"The Current Landscape of Paediatric Surgery in India: Challenges and Opportunities"

The Evolving Landscape of Paediatric Surgery in India: A Look at Progress and Potential



Paediatric surgery in India is undergoing a period of significant transformation. With a growing young population and increasing access to healthcare facilities, the demand for skilled paediatric surgeons and advanced surgical techniques is on the rise. This blog post dives into the current landscape of paediatric surgery in India, exploring its strengths, challenges, and exciting future prospects.


A Growing Need and Expanding Expertise:


India has one of the largest child populations globally, with an estimated 311 million children under the age of 15 (Census of India, 2011). This vast population presents a significant need for paediatric surgical care, encompassing conditions like congenital malformations, appendicitis, hernias, and urological issues. There is an increasing neonatal and paediatric surgical burden due to a rising population, advances in infertility and perinatal care, increased survival of neonates with congenital anomalies and diminishing mortality due to infectious diseases— all typical of a developing country.

The good news is that the number of qualified paediatric surgeons in India is steadily increasing. According to the Indian Association of Pediatric Surgeons (IAPS), there are currently over 1,600 paediatric surgeons practicing across the country. This growth is fueled by dedicated training programs and a growing emphasis on paediatric surgical subspecialties like neonatal surgery, urology, and oncology.


Technological Advancements and Minimally Invasive Techniques:


The landscape of paediatric surgery in India is also being shaped by the adoption of cutting-edge technologies. Minimally invasive surgery (MIS) techniques like laparoscopy and robotic surgery are gaining traction, offering several advantages:

  • Reduced Scarring: Smaller incisions translate to faster healing and improved cosmetic outcomes for children.

  • Shorter Hospital Stays: MIS procedures often lead to quicker patient discharge and recovery times, minimizing disruption to a child's life.

  • Improved Precision: Advanced laparoscopic and robotic platforms offer surgeons enhanced visualization and dexterity, enabling greater precision during complex procedures.

Data suggests a rise in MIS procedures in paediatric surgery: A 2020 study published in the Journal of Pediatric Surgery reported that laparoscopic surgery was the preferred approach for a variety of paediatric procedures in Indian hospitals, with success rates comparable to those reported in developed countries.


Challenges and Opportunities:


Source: The Times Of India. Pune Edition, December 29, 2022

Despite the progress, there are still challenges to address:

  • Unequal Distribution of Resources: Access to specialized paediatric surgical care remains concentrated in urban areas. Expanding access to rural communities requires infrastructure development and training initiatives for healthcare professionals.

  • Awareness and Early Diagnosis: Raising awareness among parents and caregivers about the signs and symptoms of paediatric surgical conditions can lead to earlier diagnosis and better treatment outcomes.

  • Paediatric Surgery is not viewed as a viable superspeciality career choice by many surgeons still: Paediatric surgical training in India is at a critical juncture with few students opting for the postdoctoral (Magister Chirurgiae [MCh]/Diplomate of the National Board of Examinations [DNB]) courses. In 2018–2019, the media headline ‘Surgical super-specialty courses fail to attract doctors in the current times’ summed it all! The Medical Council of India (MCI) noted that 189/2029 seats for superspecialty surgical courses were vacant after the national eligibility-cum-entrance test (NEET), the vast majority of these being from 4 superspecialities: CVTS, Paediatric Surgery, Neurosurgery and Plastic Surgery.

The Future of Paediatric Surgery in India:


The future of paediatric surgery in India is brimming with potential. Here are some exciting possibilities on the horizon:

  • Telemedicine: Telemedicine consultations could improve access to specialist advice for paediatric surgeons in remote areas.

  • Advanced Robotics: The adoption of newer, more versatile robotic platforms specifically designed for paediatric surgery could lead to even greater precision and minimally invasive procedures.

  • Focus on Innovation: Indian researchers and surgeons can play a significant role in developing innovative solutions and techniques tailored to address the specific needs of the country's paediatric population.


The current status of pediatric surgery in the country appears to be heartening. There has been a visible change in the infrastructure of our intensive care units in the major pediatric surgery centers of the country and also in big corporate hospitals. Neonatal surgery admissions, which 25 years ago usedto be about 10% of our emergency surgical admissions,has gone up to nearly 50 percent now. Besides improvement in the intensive care units, there has been a dramatic change in the practice of pediatric surgery during the last decade. This has been the result of newer diagnostic tools, newer imaging techniques, use of interventional radiology, development of ambulatory day care surgery, and change of surgical management.


Conclusion:


Great advances may follow in the field of paediatric surgery in the future; however the basic principles of surgery would continue to guide us in the care of children. As Willis Potts – one of the pioneers of pediatric surgery, highlighting these very principles in his book “Surgeon and the Child” published in 1959 –dedicating it to the infant who had the terrible misfortune of being born with a serious congenital deformity said

If this infant 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 landscape of paediatric surgery in India is evolving rapidly. With a growing pool of skilled surgeons, the adoption of advanced technologies, and a focus on improving accessibility, the future looks bright for children requiring surgical intervention. Continued investment in infrastructure, training, and research will ensure that even the most vulnerable young patients have access to the best possible care.




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