Key Words: pediatric
surgery, Kerala, India
Pediatric surgeons of Kerala are very proud to have led the
development of superspeciality in any branch of medicine in
Kerala and also superspeciality of Pediatric surgery in whole
of India. Late Prof. Raman Nair returned in 1954 after
training under Dr. Everett Koop in US. Same year, in his
far-sighted vision for future development of the speciality,
he moved to SATH, Medical College, Trivandrum and started
Pediatric surgery as a speciality attached to Paediatrics
department; this was the beginning of Pediatric surgery in
India. He opted for Pediatric surgery as a full time job and
did not do any general surgery work in adults. He was the
first full time Pediatric surgeon of India; during the next
few years, 2 surgeons, one in Calcutta, Prof. UC Chakraboty
and Prof. D Anjaneyulu in Hyderabad started working as full
time Pediatric surgeons. In Mumbai, Delhi and Chennai,
Pediatric surgery developed much later and then all over the
country [1-4].
In UK, Sir Dennis Brown, an Australian surgeon became the
first full time Pediatric Surgeon in 1924. In US, W Ladd in
1927 and later R Gross were the 2 full time Pediatric
surgeons. In Asia, Japan was a lead country along with Kerala
to start Pediatric surgery as independent speciality in 50s.
Mario Kasai was the pioneer in this field [5].
Pediatric surgery department in Thiruvananthapuram developed
into a fully staffed department and by 1966, it was recognised
as one of the best departments in India. It was the first
department to obtain an infant ventilator and blood gas
analyser in 1970; in 1971, MCh course was started in
Pediatric surgery, first superspeciality course in Kerala
affiliated to Kerala university.
Prof. George Taliat started Pediatric surgery department in
Calicut in 1966 in the Medical College (then housed in Beach
hospital); Department had 40 beds allocated to it and obtained
2 operating rooms for its own use by 1970. In 1973 Prof KK
Varma took over as HOD of the department as Prof Taliat moved
to Trivandrum due to personal reasons. By 1979, department had
full staff with 1 Professor, 1 Associate Professor, 1
Assistant Professor and 3 lecturers. MCh course was
started in 1980. In 1970, first successful repair
of Congenital Diaphragmatic Hernia was carried out in a
newborn baby in Beach hospital; in 1979 first Esophageal
Atresia with fistula survived operative repair on day 3 after
birth and she is doing well at 34 years now. In 1979, a
tumor protocol for Wilm's Tumor, based partly on WTSG of US
was implemented and by 1990 the tumor-free survival rate had
reached more than 80% (much higher than any institution in
India at that time). Pediatric Urology clinic was started in
1979, with a research fund from ICMR. By 1988, Pediatric
Urology was established as one main area of research and
clinical work in addition to Congenital Megacolon, Imperforate
Anus and solid tumors; and residents and fellows from all over
India including those from Mumbai and Delhi were trained in
the department [6-13].
In 1970, in Kottayam Medical college, Pediatric surgery
department was started; soon, Alleppey (1978) and Trichur
(1986) had the speciality established. By 1986 all Government
Medical Colleges in Kerala had fully independent departments;
and by 1989, all Pediatric Surgery departments had a Professor
heading the department, first speciality to achieve the status
in Kerala and India.
In BMH, first Pediatric surgeon was Dr. MI Sreekumaran and
subsequently, Drs. KV Lakshmanan, KK Varma, VK Gopi, TP
Joseph, PR Babu and Satish Kumar worked in BMH; at present,
hospital has a full fledged Pediatric surgery department with
2 full time (Drs TP Joseph and KV Satish Kumar) and 2 visiting
consultants (Drs PR Babu and VK Gopi). Department caters to
children from age of day 1 to age 19 years and has an
excellent neonatal surgical care provided by Neonatal
ICU under Dr. N Rajesh. Excellent Anesthesia support is
provided by Dr. EK Ramadas and team, which has made it
possible to operate babies who weigh only 900 grams and who
have gone home well. Pediatric surgery department
carries out corrective surgery for most of the congenital
malformations; also it does manage Urology problems in babies
and children, so also Laparoscopic/Thoracoscopic
procedures such as Appendicectomy, Ovarian Cystectomy,
Cholecystectomy etc; poly trauma in children is managed by
Pediatric surgeons as well as solid tumors and acute abdomen
and other acute surgical lesions. Thanks to the vision of
Chairman Dr. KG Alexander, BMH can boast of the best Child and
Adolescent department in private sector in Kerala.
Future of Pediatric Surgery in BMH: We are yet to enter into
areas like EXIT (extra uterine intrapartum surgery), fetal
surgery and robotic surgery. These are some of the areas we
have to develop in the next decade to reach international
levels. Our main disadvantage is lack of medical insurance for
babies born with congenital anomalies; our aim is to get this
sorted out in the next few years.
References
1. Pathak IC. Pediatric Surgery in India; then and now. J
Indian Assoc Pediatr Surg. 2009; 14:2-5.
2. Chatterjee SK. Pediatric Surgery 40 years ago. J Indian
Assoc Pediatr Surg. 2007;12:190-191.
3. Mukopadhyay B. Pediatric Surgery in India and Journal of
Indian Association of Pediatric Surgeons. J Indian Assoc
Pediatr Surg. 2006;11:203.
4. Chowdhary SK. Random thoughts on Pediatric surgery. J
Indian Assoc Pediatr Surg. 2008;13:47-48.
5. Randolph JG, Younge DG. A brief history of Pediatric
surgery. Pediatric Surgery 6th Edn; vol 1; ed - JL Grossfield
et al; 2006; pp 3-10.
6. Joseph TP. Hirschsprung Disease. South Australian Clinics.
1974; 6:392.
7. Joseph TP et al. Vesical Diverticula in Children. Indian J
Surg. 1977; 39:209-212.
8. Joseph TP. Urinary Tract Infection in children. Kerala
Medical Journal. 1980; 21:3; 22:4.
9. Joseph TP et al. Solid Malignant tumors in childhood.
Indian J Pediatr. 1981; 18:365-368.
10. Joseph TP, Rex Thomas. Results of Childhood Maligancies -
An Indian Challenge. Surg J North India. 1985; 2:243-245.
11. Varma KK, Joseph TP. Alternate Algorithm for management of
Neonatal Hirschsprung disease. Pediatr Surg Int. 1994;
9:64-65.
12. Joseph TP et al. Incidence of Urological Anomalies in
children with Urinary Tract Infection. Pediatr Surg Int. 1996;
11:566-569.
13. Favourable outcome of Wilm's Tumor in Children - A
prospective study of 124 children. Proceedings of Indian
Association of Pediatric Surgeons' Annual Conference; Lucknow;
1995.