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
- 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.
- 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.
- This surgeon will verify the original diagnosis and make the assessment that surgery is or is not necessary during a physical exam.
- After the surgeon meets with the family and patient, the patient will be triaged through surgery intake and taken back into surgery.
- 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.