How To Find The Right Paediatric Surgeon For Your Child in Malaysia
Finding the right paediatric surgeon for your child in Malaysia can be a daunting task. You want to make sure that you are putting your trust in the best possible care for your child.
With so many surgeons available, how do you know who is the right one for your child and family?
We’ve put together a few tips on what to look for when choosing a paediatric surgeon.
Two of the main things to look for are: 1) that the surgeon is a specialised paediatric (child) surgeon, rather than general adult surgeon, and 2) that they can perform keyhole (laparoscopic) surgery at a hospital that has the specialised equipment needed.
Find out why this is important below…
Before scheduling an appointment with any surgeon, take some time to research their qualifications and experience. Search on Google. Ask friends and family if they have any personal recommendations.
Once you have a shortlist of surgeons, schedule consultations and ask lots of questions!
The most important thing is that you feel comfortable with the surgeon and confident in their abilities.
If you have any concern, ask for a second opinion.
Your child’s surgeon should be accessible to answer questions, offer support and provide peace of mind that they are in good hands!
What’s the difference between a Paediatric (child) surgeon vs a general adult surgeon?
It is important to understand that babies and children are not just little adults. The anatomy, physiology and most importantly the psychology of a child are completely different vs an adult. Paediatric surgeons are specifically trained to deal with children.
So its is critical that you look for a paediatric (child) surgeon, rather than a general surgeon, to treat your child.
What’s the difference between keyhole (laparoscopic surgery) and traditional open surgery?
If you require surgical treatment for your child or baby, you typically have two surgical options: keyhole (laparoscopic) or traditional open surgery.
But what is the difference? And which leads to better outcomes?
| Factors | Keyhole Surgery | Open Surgery |
|---|---|---|
| Hospital Stay | Shorter: Patients can often be discharged sooner. | Longer: Patients may require a longer hospital stay for recovery. |
| Invasive Level | Less invasive: Uses small incisions, reducing trauma to the body. | More invasive: Requires larger incisions, causing more trauma to the body. |
| Recovery Time | Faster: Reduced postoperative pain and quicker recovery. | Slower: Increased postoperative pain and longer recovery time. |
| Scarring | Minimal: Smaller incisions lead to smaller scars. | Increased: Larger incisions result in more noticeable scars. |
| Infection Risk | Lower: Smaller incisions reduce the chance of infection. | Higher: Larger incisions increase the chance of infection. |
| Visibility & Precision | Excellent: 360 internal visibility, 4k 3D imagery allows for greater precision. | Limited: to the site of the incision, organs blocking view leads to higher chance of secondary damage. |
Paediatric laparoscopic surgery offers numerous benefits compared to open surgery, including being less invasive with smaller incisions, resulting in reduced trauma to the body.
This minimally invasive approach promotes faster recovery, less postoperative pain, and minimal scarring. The risk of infection is lower due to the smaller incisions, and patients generally experience shorter hospital stays.
Laparoscopic surgery is often favored for its improved patient outcomes and overall reduced impact on a child’s well-being during the surgical process.
However it does require higher levels of expertise and specialized equipment, which is why it is key to check whether your potential surgeon is trained in this technique and the hospital has the required equipment.
In the Klang Valley the hospitals that provide paediatric laparoscopic surgery are: Pantai Kuala Lumpur, Prince Court, Gleneagles, Tung Shin and Sentosa Klang.
How to find and research potential paediatric surgeons in Malaysia
With many hospitals and surgeons available in Malaysia it may be daunting to figure out how to start finding the right one for your child.
We cannot tell you exactly how to choose a paediatric surgeon, but we can give you some guidelines about what should be considered before making a decision.
The simple answer – do your research by going online with Google, Social media and of course, ask trusted family or friends.
Here is a simple 4-step process to get you started:
STEP 1: Educate yourself on the possible condition your child may be facing.
Start by going onto Google and searching for that condition, e.g “Appendicitis in Children Malaysia. Look at the results and start with the first 3-5 recommendations from Google.
Read up on the condition to better understand what it is, the causes, symptoms and ofcourse treatments available. This will help you be more confident when you eventually meet the surgeon.
Narrow the search into information related to your country or city to find localised information that may be more relevant for you , e.g “Appendicitis Children Malaysia
STEP 2: Now that you know more about the possible condition you are ready to identify the possible surgeons to visit.
Again start with Google and do a local search for paediatric surgeons in your area, e.g “Paediatric surgeon kuala lumpur”
Visit the pages shown by Google and based on your sense of comfort with what you find, create a short list of 2-3 surgeons you can contact.
STEP 3: Contact the surgeon or clinic in question and ask some initial questions to get a sense of how helpful the surgeon is.
Ideally, you want to find a surgeon that you can contact directly, rather than only through the hospital.
A caring surgeon will be able to answer a few basic questions (see below for example questions to ask) before you schedule an appointment with them.
This is not the time for an interrogation though! No professional surgeon will be able to diagnose your child without seeing them first. So, use these few questions just to gauge your comfort level with the availability and helpfulness of the surgeon.
STEP 4: Schedule an appointment with the surgeon.
Once you have identified a potential surgeon it is time to schedule that first appointment.
When you see them with your child, always look for whether the surgeon focuses on your child and how he or she interacts with them. Ideally you want someone that seems caring and gives you a sense of trust.
You can then proceed to ask them some of the questions below to help you decide whether they are the right surgeon for your child.
Questions you can ask to evaluate if a paediatric surgeon is the right one for your child and you
We’ve put together a list of questions that you could ask a potential surgeon to help you better evaluate their qualifications, experience and general approach.
Ofcourse you don’t have to ask all of these, but the key is to not be shy to ask in advance until you are confident and re-assured that they are the best possible match for your child and yourself.
In the list below, Dr. Nada offers his own answers to those questions, so that you can get a general sense of what to expect as a good answer.
1. Do you treat all kinds of problems with surgery or are some problems treated with other procedures?
Dr. Nada: Most patients I see do not require surgery. Only about 10% of new patients I see will require surgery, the vast majority of these are for minor procedures.
2. Are there alternatives to the surgery, and if so, what are they?
Dr. Nada: Surgery may not be the only option and if it can be avoided or deferred then that’s the best choice. Some conditions in children can resolve with time so I provide a honest discussion about every child with their parents.
Some conditions such as chronic constipation are usually treated with medications alone and almost all do well.
3. What is the improvement expected from the surgery?
Dr. Nada: The decision to perform every surgery is made on the balance that the benefit of performing surgery for the child outweighs doing no surgery and the risks of performing surgery.
Therefore, the surgery should give significant improvement in the child’s condition.
4. What are your qualifications and how long have you been in surgical practice?
Dr. Nada: I graduated from University of Wales, UK in 1995. Subsequently I obtained the basic surgical qualification, MRCS from Glasgow in the year 2000. I completed 2 years of surgical research at Oxford University before starting the Paediatric Surgical training programme in London.
Following the fellowship programme, I was awarded the FRCS in Paediatric Surgery in 2009 and the Completion of Certified Training in Paediatric Surgery by the General Medical Council, UK and Placed on the National Specialist Register UK.
I also worked In Australia for a couple of years and Obtained the Fellow of the Australasian College of Surgeons in Paediatric Surgery (FRCS , Paediatric Surgery) and the Specialist Register there in Paediatric Surgery.
I am also on the specialist Register in Paediatric Surgery in Malaysia, making me the only one in the world with specialist registration in Paediatric Surgery in the UK, Australia and Malaysia.
I was an Associate Professor in Paediatric Surgery in University Malaya when I first returned from the UK where I was training paediatric surgeons, especially in the skills of Keyhole or minimally invasive surgery.
Altogether I have been a surgeon form 1997 and specifically in Paediatric Surgery form 1999.
I am now a trainer in the field of minimally invasive surgery (laparoscopic and thoracoscopic) in Malaysia and internationally.
5. How many times have you done this procedure?
Dr. Nada: With over 20 years of experience, I have a lot of experience with most paediatric surgical conditions. Being a trainer has allowed me to critically analyse every condition thoroughly both on the academic/ knowledge front but also performing surgery efficiently with minimal trauma, mostly by using keyhole surgery approach and to teach and transfer these skills to my trainees.
With every surgery I will offer the least traumatic procedure and this is mostly using keyhole surgery as the first choice surgical option.
6. What is your success rate?
Dr. Nada: My success rate is pretty good at over 99.9% for most procedures.
However, there is one condition called hypospadias where like me most surgeons throughout the world, I too have high complication rate, both minor or major. My success rate for this particular surgical procedure is about 85%.
7. What are the possible complications of the surgery?
Dr. Nada: The commonest complications are a bleeding or infection, often easily treated.
For Hypospadias surgery, there could be fistula (small leak) or stricture (narrowing of the opening).
Every type of surgery has its own specific complications other than the generic bleeding and infection.
For each surgery performed, thorough discussion takes place and consent for the procedure is obtained from parents before surgery happens.
8. What is the complication rate for performing this surgery on children of my child’s age and weight range?
Dr. Nada: As mentioned before the decision for surgery is made only if its necessary and done at the appropriate time.
Some conditions may require emergency surgery, even for a newborn, if the condition requires it. There are therefore a variety of conditions and severity of illnesses in children that I face, also their ages range from newborn or even premature babies up to someone of 18 years old. Obviously the more sick child have a higher risks when going for surgeries.
Anaesthesia these days are extremely safe even for the newborn babies. As mentioned before for 99% of the surgeries I do, the risks are minimal.
The very rare sick child or newborn baby may carry a higher risk for surgery and these risks will be discussed with their parents thoroughly before every surgery.
9. What happens if something goes wrong during surgery?
Dr. Nada: In my experience, it is rare for something untoward to happen during surgery.
Usually the problem is addressed in the acute situation and what happened during surgery is discussed with the child’s parents.
If I were to find something unusual during surgery and require further discussion and consent from parents, I would stop surgery, discuss with the child’s parents and then proceed with the decision of that discussion.
10. What is the possible outcome if the surgery fails to correct my child’s condition?
Dr. Nada: It is essential to pick your surgeon carefully. For your child, do look for a Paediatric surgeon (not an adult general surgeon) who is experienced in the field.
You will have an idea of your surgeons experience and often a gut feeling from your rapport with your surgeon. For any situation, especially in children, surgery is best done once and done well so there are no problems with your child for the rest of his or her life.
A skilled paediatric surgeon should be able to make good progress with your child’s condition, so do avoid adult surgeons for even common conditions such as appendicectomies or hernias where the risk of complications in the wrong hands are greater.
If the surgery fails then reassessment is made to decide if a repeat surgery is required.
11. If something goes wrong, can you fix it again later if I need another operation?
Dr. Nada: When we assess the outcomes of surgery, we like to see that function is as normal as we can get it after surgery and secondly the appearance should be great too.
If something does not turn out as expected, there may be non surgical remedies that can prevent issues with function or appearance. However in rare cases there may be a need for surgical repair.
12. How long will my child be in the hospital?
Dr. Nada: Most paediatric surgical conditions are conducted as a day procedure. However, in babies under 3 months of age, we need to monitor them overnight after surgery, for the same surgery.
For complex surgeries which are done by the keyhole method children on average stay 2 days in hospital post-surgery but for some specific surgeries such as anorectal malformation reconstruction, the child usually stays in for 5 days post-surgery.
13. What will it cost, and do you accept my insurance?
Dr. Nada: If the condition is not congenital (found at birth) then most insurance companies in Malaysia would cover the cost for example surgery for appendicitis. However, some employers’ insurance would cover surgical costs for congenital conditions as well.
There are some insurances that when taken before your child is born may cover for a number of surgical conditions if found in the child when born.
The costs of surgery vary depending on if it’s a complex surgery requiring many days in hospital or even ICU stays (eg: surgery to lung) which may come to RM25 to 50 thousand or for most day surgery procedures costs about RM5000.
Even these costs can further be reduced to as low as RM2500 (under general anesthesia) at some selected hospitals where I visit too.
14. What is the cost of surgery in comparison to other clinics or hospitals?
Dr. Nada: In my experience, the total cost of surgery varies according to the hospital and the type of surgery.
In general, the larger hospitals in the Klang Valley are the most expensive compared to the smaller hospitals in the same area or even outside Klang Valley. Though the difference between the cost of surgery at the various big hospitals in the Klang Valley is almost identical.
However, as I perform most surgeries by the keyhole (laparoscopic or thoracoscopic) method, the overall cost of surgery maybe 5 to 10% higher.
This is clearly the better option for surgery in terms of trauma, pain, recovery, and scar appearance for your child compared to the old-fashioned larger cuts (see video below).
This day and age, to be offered open surgery when there is a better keyhole method is akin to being sold a Nokia 3110 phone today when there are the most advanced smartphones available.
The cost difference in these 2 methods is usually compensated by the days in hospitals and hospital costs since the open procedure will need more days in the hospital.
15. How much pain will the operation cause my child? Can you explain how to control this pain?
Dr. Nada: With the keyhole method the pain should be minimal.
For complex and long surgeries, your child may be on some stronger pain killers given by the intravenous method, for 1 to 2 days post operatively.
Though most kids following keyhole surgery are up and about the next day with simple analgesia they take orally.
16. Who is going to monitor my child while they are in the hospital for signs of pain or complications from the anaesthesia?
Dr. Nada: Usually, the staff nurses do regular assessment post operatively for pain and for general observation on your child following surgery.
Parents have a buzzer to press to request for assessment or for additional pain relief if your child require more analgesia if the planned analgesia was not sufficient.
The general observation will monitor the child’s temperature, heart rate, blood pressure and oxygen saturation, which will indicate if rarely, the child has any issues with the anaesthesia.
17. How often will my child need to see you for follow-up visits, and how long will these visits last?
Dr. Nada: For most surgery which is done as a day procedure, only one or 2 follow-up appointments are required one week and maybe 3 months afterward. The duration of these appointments is anything from 5 to 10minutes.
Following more complex surgery, the first appointment is again usually after 1 week after discharge. Subsequent follow up are done every 2 to 3 months up to a year or until your child has no issues.
18. Will our family be able to contact you when we have questions about what is happening with our child in the hospital?
Dr. Nada: Yes, of course. I am always available if there are any issues with my patients.
19. Can you give me a list of satisfied patients that I can contact as a reference?
Dr. Nada: Most parents like to keep their child’s hospital admission private.
However, when there is a complex procedure that is required for a child which may need long term care, eg anorectal malformation or Hirschsprungs disease, if requested, I may introduce the new parent to an experienced parents if they agree to be contacted.
This will allow the new parent to get a better understanding of what to expect.
Conclusion
If you are considering surgery for your child, the most important decision you will make is who to choose as your paediatric surgeon.
It is crucial to find a doctor who has experience in the specific procedure you need and who makes you feel comfortable and confident in their abilities.
Don’t be afraid to ask questions or get second opinions until you are sure that you have found the best possible surgeon for your child. By taking the time to choose the right paediatric surgeon, you can ensure that your child receives the best care possible.
