Pediatric Surgery
Community Physicians

Redefining Standard of Care

The staff at Cincinnati Children’s believes that building collaborative relationships with primary care physicians helps achieve the best outcomes when treating patients.

In the Division of Pediatric General and Thoracic Surgery, we make strides to be an active member of the community. We want you and your patients to have confidence that we are here to answer questions you may have and deliver the highest quality of care to your patients.

Condition

Guidelines

Age Requirement

Masses (Cysts, Knots, Lesions)

Must be Subcutaneous

N/A

Hernias

Inguinal

Any may be considered

6 months – 21 years

Epigastric

Any may be considered

6 months – 21 years

Umbilical

Any may be considered

3 – 21 years

Keloids

Any may be considered

N/A

Lipomas

Must be less than 2 inches in size

N/A

Nevus/Moles

Any may be considered

Age 9 and under

Pilomatrixomas

Any may be considered

Age 9 and under

Testicular Hydrocele

Any may be considered

1 – 21 years

Circumcision

Any may be considered

N/A

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

How It Works

  1. Refer Patient by completing Request for Specialty Services and have your patient to call 513-636-4371, option #1 to speak with one of our surgery schedulers. 
  2. Our schedulers will verify your patient’s condition matches the Same Day Evaluation and Procedure's criteria and will work to schedule a time to come in for an official diagnosis and surgery.  
  3. This surgeon will verify the original diagnosis and make the assessment that surgery is or is not necessary during a physical exam. 
  4. After the surgeon meets with the family and patient, the patient will be triaged through surgery intake and taken back into surgery.    
  5. No later than the day after surgery, the surgeon will call the referring physician to provide an update on the surgery.  There is no clinic appointment necessary for the patient unless the parents have questions or concerns.  The day after surgery, an advance practice nurse will call the family to check-in.

Hernias: Exams and When to Refer

Condition: Inguinal Hernia

Clinical Findings

  • Bulge at groin that may extend into scrotum in boys or labia in girls that comes and goes, usually more prominent when straining, coughing, or standing
  • More common in premature infants and boy
  • Usually not painful unless incarcerated
  • Should be reducible unless incarcerated
  • Risk for incarcerated is inversely proportional to age
  • Diagnosis is clinical; should not need ultrasound 

When to Refer 

  • Whenever hernia is identified
  • If concerns exist for incarceration
  • Although surgical evaluation is recommended once hernia is identified, repair may be delayed in premature infants until they are > 60 weeks corrected gestational age to decrease anesthetic and surgical risks 
  • In non-premature infants, repair is performed as soon as it can be scheduled

Condition: Hydrocele

Clinical Findings

  • Fluid surrounding the testicle; may be bluish discolored; usually non-tender; usually non-reducible
  • May be non-communicating (no communication to peritoneal cavity) or communicating (communication with peritoneal cavity)
  • Non-communicating hydroceles should resolve over 6 months to 1 year; natural course is to gradually decrease in size as fluid is resorbed
  • Communicating hydroceles fluctuate in size and will not close spontaneously over time
  • Cord hydrocele (fluid along cord that extends up into groin) may be confused with incarcerated hernia but should not be painful

When to Refer 

  • Non-communicating hydroceles  - should close spontaneously over 6 months to 1 year; refer if not resolving over this time period
  • Communicating hydroceles are treated  like hernias—refer once identified
  • Refer if  unable to differentiate non-communicating from communicating hydrocele; cord hydrocele vs hernia; hernia vs hydrocele

Condition: Umbilical Hernia

Clinical Findings

  • Protrusion of omentum or intestines through fascial defect at umbilicus; may appear bluish discolored and make “gurgly” sounds; increases in size with straining; rarely causes pai
  • Rarely become incarcerated or strangulated
  • Umbilical hernias are only type of hernia that may close spontaneously over time
  • Size of fascial defect rather than degree of protuberance of umbilicus is the primary determining factor for whether or not the hernia will close spontaneously 
  • Most umbilical hernias with fascial defect <1.5 cm will close
  • Umbilical hernias with supraumbilical component are unlikely to close spontaneously

When to Refer

  • If no resolution of hernia by age 3-4 years
  • Occasionally in younger child 1-2 years of age with large fascial defect > 1.5 cm or large proboscoid hernia that is not decreasing in size
  • Umbilical hernias with supraumbilical component
  • If there is concern for incarceration

Undescended Testis: When to Refer to Surgery – Rebeccah Brown, MD

Undescended Testis is a condition in which the testicle has not dropped into the scrotum and cannot be manipulated into place, thus requiring surgical intervention. This condition occurs in roughly 3% of newborn males, though it is more frequent in premature male babies.  

When to Refer
Most testicles drop by 3-4 months of age.  If your patient is 6 months of age and the testicles have not yet descended and you are unable to palpate the testicle in the scrotum, refer to surgery. 

Surgery
It is best for the patient to have surgery before he is 1 year of age for fertility reasons.  This is an outpatient procedure that can be performed at our Base or Liberty campus. 

How to Refer
Healthcare providers or patients can call 513-636-4371, Option #1 or fax us at 513-636-7657.
Providers can also fill out our online form

Appendicitis Care at Liberty

Appendicitis is inflammation and infection of the appendix. There are three forms of appendicitis:

  • Non-perforated
  • Perforated, and
  • Perforated Appendicitis with Abscess

All three of these conditions require the appendix to be removed which requires an inpatient stay of anywhere between 1-2 days for non-perforated and 4-5 days for perforated. For you and your patient’s convenience, we offer appendectomies at both our Main Base and Liberty locations.

Our Liberty facility is fully equipped with 40 inpatient beds. The pediatric nursing team at our Liberty Campus is of the same high caliber as nursing teams at our Main Campus (Burnet Ave). The inpatient rooms are large, light-filled and close to the nursing station. 

Questions?

If you have any questions or would like to speak with one of our surgeons for a surgical consultation, please call 513-636-4371 between 8 am - 4:30 pm.

How to Contact Us 

Between the hours of 8 am - 4:30 pm, Monday thru Friday

If you have a patient who needs to be seen urgently please select the most applicable option for your patient:

  • Call 513-636-4371, option #1 to schedule a clinic appointment for the next day
  • Call 513-636-4371, option #3 to speak to a nurse

If the patient needs to be scheduled for clinic same day, a Cincinnati Children’s nurse can work with you and your patient to facilitate the appointment and accommodate them into an open clinic that day. Please note, the patient will need to be flexible with which provider they will see and at which location.

After 4:30 pm Monday - Friday, or weekends and holidays

If you have a patient who needs to be seen urgently, we recommend they be referred to the Cincinnati Children’s Burnet Emergency Department or the Liberty Campus Emergency Department.

Referrals

To Refer a Patient

Phone: 513-636-4371, Option #1
Fax: 513-636-7657
Please include all relevant medical records with the referral

To Speak with a Phone Triage Nurse

Phone: 513-636-4371. Option #5      
Email: Surgery_Nurse@cchmc.org
Our nurses are able to help with general questions such as clarification of discharge instructions, or other common questions.

Programs and Services

Mom and son smile together.
Utilizing the latest surgical techniques at the hands of experienced surgeons. Learn More

Meet Our Team

The Division of General and Thoracic Surgery is home to specialists with a wide variety of backgrounds and areas of focus.

Learn More