A clear, practical guide for parents facing the possibility of surgery for their child.
Short on Time? Read This First…
- Many children’s surgeries in Malaysia are still done using traditional open surgery by default.
- Minimally Invasive Surgery (MIS) — also called keyhole surgery — is a safer, gentler alternative for many conditions.
- MIS offers smaller scars, less pain, faster recovery, and shorter hospital stays.
- Parents are often not told about MIS because the hospital lacks equipment or the surgeon is not trained in it.
- MIS is suitable for conditions like appendicitis, hernias, undescended testes, atresias, and more — even in newborns.
- Costs are often similar or lower than open surgery when hospital stay and recovery time are factored in.
- Always ask if MIS is an option, and seek additional advice if you’re unsure.
- You can speak directly to Dr Nada, an experienced paediatric MIS surgeon, for a personalised review of your child’s case.
Being told your child needs surgery is one of the hardest moments any parent can face. It’s natural to feel fear, confusion, and urgency to act quickly. But what many parents aren’t told is that there may be more than one way to perform the surgery and some options are far gentler on your child than others.
This short guide was created to help you understand what most doctors don’t explain at the start: the difference between traditional open surgery and Minimally Invasive Surgery (MIS), also known as keyhole surgery.
It will also walk you through what to expect, what questions to ask, and how to make an informed decision before you agree to anything.
I’ve written this for you as a parent first—and as a surgeon second.
Let’s begin.
Dr. Nada Sudhakaran
Why Your Child Might Need Surgery
Surgery in children is more common than most parents expect. Some conditions are present at birth, while others develop as the child grows. In many cases, surgery provides a permanent solution — but the way the surgery is done can have a lasting impact on your child’s recovery, comfort, and long-term health.
Here are some of the most common reasons children may need surgery:
Inguinal Hernia
A bulge in the groin caused by a small opening in the abdominal wall, allowing the intestine to push through. It can look harmless but may become dangerous if the intestine gets trapped. Surgical repair is strongly advised to prevent complications.
YOUTUBE PLAYLIST: This list on Inguinal Hernias contains 14 short videos. Press the forward and backwards control to move between videos.
Appendicitis
An inflammation of the appendix that often presents with abdominal pain, vomiting, and fever. It is one of the most common childhood emergencies and usually requires surgical removal of the appendix.
Undescended Testicle (Cryptorchidism)
When one or both testicles fail to move into the scrotum before birth. Surgery is typically recommended after six months of age to prevent future fertility issues or testicular cancer risk.
Bowel Obstruction
A blockage in the intestines that can lead to vomiting, swelling, and severe pain. This may be due to twisting of the bowel, infection, or congenital issues — and often requires urgent surgical correction.
Atresias (Oesophageal, Duodenal, Jejunal, Colonic)
These are birth defects where part of the digestive tract is completely or partially closed, preventing food from passing through. Surgery is usually required within days of birth to restore proper function.
Choledochal Cyst
A rare condition where the bile ducts are abnormally enlarged. It can cause jaundice, abdominal pain, or infection, and increases the risk of liver complications if left untreated. Surgical removal of the cyst is the standard treatment.
Hirschsprung Disease
A condition where part of the bowel lacks the nerve cells needed to move waste through. This leads to chronic constipation and intestinal blockage. Surgery is required to remove the affected portion of the bowel.
Lung Malformation
A congenital condition where part of the lung develops abnormally, such as CPAM (Congenital Pulmonary Airway Malformation). Surgical removal is often advised in infancy or early childhood to prevent breathing difficulties or future infections.
In all of these cases, parents are often presented with only one option: traditional open surgery. But in many situations, there is another approach — one that is less invasive, less painful, and easier on your child’s body – Minimally Invasive Surgery (MIS) or also called keyhole surgery.
Let’s look at the difference between these two surgical methods, and why it matters.
Open Surgery vs Minimally Invasive Surgery – What’s the Difference?
When your child is recommended for surgery, the most common approach you’ll hear about is open surgery. This is the traditional method, where the surgeon makes a single, longer incision to access the area that needs treatment. It’s familiar to most hospitals and widely practiced.
But there is another option that many parents are not told about — Minimally Invasive Surgery (MIS), also known as keyhole surgery. This technique uses a tiny camera and specially designed instruments to perform the surgery through several small incisions, usually less than 1 cm in size.
Here’s how they compare:
Open Surgery
- Involves a larger incision, typically several centimetres long
- More trauma to the surrounding tissue
- Higher levels of post-operative pain
- Greater risk of wound infection
- Longer hospital stay and slower recovery
- More noticeable scarring
Minimally Invasive Surgery (MIS)
- Performed through 2–3 small incisions using a camera and fine instruments
- Less damage to muscle and tissue
- Less pain after surgery
- Lower risk of infection and faster wound healing
- Shorter hospital stay — often 1 to 2 days
- Smaller, less visible scars
Minimally Invasive Surgery is not suitable for every condition, but in many cases — including hernias, appendicitis, and even complex conditions like choledochal cysts — MIS can be just as effective, with better recovery and outcomes for your child.
The challenge is that many hospitals still default to open surgery, either because the equipment isn’t available or because not all surgeons are trained in paediatric MIS.
As a result, parents are often not informed that keyhole surgery may be an option — or are told that it is too risky or unnecessary. But with the right expertise and proper tools, MIS is a safe and effective technique that has been used in children and even newborns worldwide for decades.
In the next section, we’ll explore whether Minimally Invasive Surgery is safe for your child — and what every parent should know before making a decision.
Is Minimally Invasive Surgery Safe for Children?
It’s natural for parents to feel cautious when they hear the words “keyhole surgery” or “laparoscopic procedure.” The idea of operating through small incisions, with a camera and fine instruments, can sound unfamiliar and even risky.
But in reality, Minimally Invasive Surgery (MIS) is not only safe for children — it is often the preferred approach in many leading hospitals around the world.
MIS has been used safely in children, including newborns and infants, for over two decades. It is now a well-established method for many paediatric conditions, such as:
- Inguinal hernia
- Appendicitis
- Undescended testicles
- Bowel obstruction
- Choledochal cyst
- Atresias and other neonatal conditions
The key to safety lies in the surgeon’s experience and training. Performing MIS in children requires specialised instruments, careful control, and deep understanding of paediatric anatomy. This is why not all surgeons offer MIS — especially for newborns or complex cases.
In my own practice, I have been performing MIS in children for over 25 years. I’ve treated babies as small as 2 kilograms using keyhole surgery, and the results have consistently shown:
- Less pain after surgery
- Fewer complications
- Faster recovery and return to feeding
- Lower risk of wound infections
- Minimal scarring
Minimally Invasive Surgery is not about taking shortcuts. It is about using modern tools and refined techniques to reduce the impact of surgery on your child’s body — without compromising on results.
Still, MIS is not suitable for every child or every condition. Some situations may still require open surgery. A qualified paediatric surgeon will be able to assess this and explain the reasons clearly.
The important thing is that you should be made aware of all available options, not just the default one.
Next, we’ll look at why open surgery is still so commonly recommended – and what most parents are not told when they first receive a surgical recommendation.
What Doctors Often Don’t Tell You About MIS
When your child is referred for surgery, it’s understandable to trust the first recommendation you receive. Most parents assume that if a doctor suggests a particular surgical approach — especially open surgery — it must be the best or only option.
But the truth is more complex.
In many hospitals, open surgery is still the default approach, not because it’s always better, but because:
- The hospital may not have the equipment needed for Minimally Invasive Surgery.
- The surgeon may not be trained in MIS, especially for paediatric or neonatal cases.
- The condition may have been assessed quickly, without discussing all alternatives.
- The assumption is that parents will follow the recommendation without asking further questions.
This means that many parents are never informed that MIS is even an option, or they are told it is unnecessary, risky, or unavailable — even when that is not entirely accurate.
Some doctors may genuinely believe open surgery is sufficient. And in some situations, it is. But when MIS is an option, and especially when it offers a faster, less painful recovery for your child, you deserve to know about it.
It is your right to ask:
- Is open surgery the only option?
- Would my child be a candidate for Minimally Invasive Surgery?
- Are there surgeons who specialise in paediatric MIS?
- Can I get a second opinion?
These are not difficult questions. But asking them can make a very big difference.
In the next section, we’ll look at how the costs of surgery compare — and why MIS may not be as expensive as you might think.
How Much Does Paediatric Surgery Cost In Malaysia?
One of the biggest concerns parents have — especially when considering private healthcare — is cost. At first glance, Minimally Invasive Surgery (MIS) can appear more expensive than open surgery. This is because MIS often involves:
- Specialised equipment
- A longer time in the operating theatre
- Highly trained surgical expertise
However, what many parents are not told is that the total cost of surgery is not just about the operation itself. You also have to consider the hospital stay, medication, nursing care, and recovery time.
| Condition | Surgery Cost RM000s | Hospital Stay Cost RM000s | Total Estimated Cost RM000s |
|---|---|---|---|
| Appendicitis | Open: 12–15k MIS: 14–18k | Open: 2–4k MIS: 1–2k | Open: 14–19k MIS: 15–20k |
| Inguinal Hernia | Open: 4–7k MIS: 5–8k | Open: NA MIS: NA | Open: 4–7k MIS: 5–8k |
| Neonatal Atresia | Open: 20–25k MIS: 23–28k | Open: 20–40k MIS: 10–20k | Open: 40–65k MIS: 33–48k |
| Choledochal Cyst | Open: 25–30k MIS: 28–33k | Open: 3–8k MIS: 1–3k | Open: 28–38k MIS: 29–36k |
| Hirschsprungs | Open: 20–23k MIS: 23–28k | Open: 3–5k MIS: 1–2k | Open: 23–28k MIS: 24–30k |
| Lung Malformation | Open: 20–23k MIS: 23–28k | Open: 3–5k MIS: 1–2k | Open: 23–28k MIS: 24–30k |
IMPORTANT: These are estimated private hospital costs in Malaysia. Actual costs will vary depending on the hospital, surgeon, room type, and complexity of the case.
Because MIS causes less trauma to the body, children usually:
- Stay fewer nights in hospital
- Experience less post-operative pain
- Recover faster, reducing the need for follow-up visits or complications
- Return to normal feeding, sleeping, and schooling routines more quickly
| Condition | Days in Hospital | MIS Benefits |
|---|---|---|
| Appendicitis | Open: 5–7 days MIS: 1–4 days | Shorter recovery (6 to 2 days), less pain, much smaller scars. Costs slightly higher (~6% more). |
| Inguinal Hernia | Day procedure (both) | Done as a day procedure, faster return to normal activities, less pain, much smaller scars. Costs slightly higher (~18% more) but able to check for developing hernia on the other side and to check uterus and ovaries in girls – avoiding need for fuuture surgeries. |
| Neonatal Atresia | Open: 5–10 days MIS: 2–5 days | Shorter recovery (7 to 3 days), less pain, much smaller scars. Costs lower (~23% less). |
| Choledochal Cyst | Open: 5–10 days MIS: 2–5 days | Shorter recovery (7 to 3 days), less pain, much smaller scars. Costs slightly lower (~2% less). |
| Hirschsprungs | Open: 5–8 days MIS: 2–4 days | Shorter recovery (6 to 3 days), less pain, much smaller scars. Costs slightly higher (~6% more). |
| Lung Malformation | Open: 5–8 days MIS: 2–4 days | Shorter recovery (6 to 3 days), less pain, much smaller scars. Costs slightly higher (~6% more). |
These benefits can significantly reduce the overall cost — and may even result in equal or lower total expenses compared to open surgery.
What matters is that you understand the full picture. While MIS may seem more expensive at the start, the shorter hospital stay, and faster recovery often mean the total cost is very similar — or sometimes even lower than open surgery.
In the next section, we’ll look at where in Malaysia you can access paediatric MIS, and how hospitals differ in terms of services and pricing.
Where Can You Get Paediatric MIS in Malaysia?
Minimally Invasive Surgery (MIS) is a highly specialised technique that requires not just the right equipment, but also specific training and experience — especially when performed on babies and young children.
In Malaysia, not all hospitals or surgeons offer paediatric MIS, and many parents are unaware that this option even exists until they actively seek it out.
So where should you start?
The availability of MIS depends on three main factors:
- The Hospital’s Equipment and Support Staff
MIS requires specialised instruments, operating theatres with high-definition camera systems, and trained surgical assistants and nurses who are familiar with laparoscopic procedures in children. Larger private hospitals are more likely to offer this setup, but not all do. - The Surgeon’s Training and Experience
Even if a hospital has the necessary tools, MIS must be performed by a surgeon who is specifically trained in paediatric laparoscopic techniques. This includes knowing how to operate safely in much smaller spaces, using fine instruments, and managing the unique needs of children, infants, and even newborns. - The Condition Being Treated
Some conditions are better suited to MIS than others. For example, hernias, appendicitis, and undescended testicles are commonly treated with MIS. More complex conditions like choledochal cysts or atresias can also be managed this way, but require advanced experience.
As a parent, it’s important to:
- Ask whether the recommended hospital offers paediatric MIS
- Confirm whether the surgeon is trained in MIS specifically for children
- Understand if MIS is suitable for your child’s specific diagnosis
If you’re unsure, don’t hesitate to ask for a referral or seek a second opinion. You have the right to explore all available options before making a decision — and in many cases, that decision can significantly improve your child’s recovery, comfort, and long-term outcome.
In the next section, we’ll show you how to choose the right surgeon — and the questions every parent should ask before surgery.
How to Choose the Right Paediatric Surgeon for Your Child
When your child needs surgery, choosing the right surgeon is one of the most important decisions you will make. For many parents, this decision happens quickly, often with little information or guidance.
Below are key qualities to look for and questions you can ask to ensure you are making the most informed choice.
What to Look For
- Specialisation in Paediatric Surgery
Children have different needs compared to adults. Their anatomy, physiology, and healing processes require a surgeon trained specifically in treating children. - Experience with Minimally Invasive Surgery (MIS)
Not all surgeons are trained in MIS. Look for someone who regularly performs keyhole surgery in children and who has experience with infants and complex cases if necessary. - Access to Proper Facilities
Even the most experienced surgeon needs the right environment. Choose a hospital that is equipped with paediatric MIS tools and a surgical team trained to support these procedures. - Clear and Honest Communication
A good surgeon should be able to explain your child’s condition, the recommended treatment, and any available options in simple, straightforward language. You should never feel rushed, uncertain, or pressured. - Availability for Follow-Up Care
Surgery is just one part of the process. Make sure the surgeon is available to provide follow-up care, answer questions, and support your child’s recovery.
Questions to Ask
- Is this surgery necessary right now, or can we monitor the condition for a while?
- Could my child be a candidate for Minimally Invasive Surgery?
- How many similar procedures have you performed in children?
- What are the risks and benefits of MIS in this case?
- How long will my child take to recover, and what will that involve?
- What are the total expected costs, including surgery, hospital stay, and follow-up?
- If we want a second opinion, what is the best way to get one?
Asking these questions is not being difficult. It is being thorough. You are your child’s voice and advocate, and you have every right to understand all the options before moving forward.
In the next section, we will help you prepare for surgery with a practical overview of what to expect — before, during, and after the procedure.
What to Expect Before, During, and After Paediatric Surgery
Preparing for your child’s surgery can feel overwhelming, especially if it is your first time navigating a hospital or surgical process. Understanding what to expect at each stage can help reduce anxiety and give you the confidence to support your child through their recovery.
Before Surgery
Once a surgical date is confirmed, the hospital will usually schedule a pre-operative assessment. This may include:
- A physical examination
- Blood tests or imaging (if needed)
- A review of your child’s medical history
- A discussion about anaesthesia and fasting instructions
You will be given specific instructions, including when your child should stop eating or drinking before surgery. Younger children may require extra emotional support or reassurance — bring a favourite toy or comfort item to help them feel at ease.
If you have not yet received clear information about the surgical approach — whether it is open or minimally invasive — this is your opportunity to ask. Make sure you fully understand the type of procedure being planned and why.
During Surgery
Most paediatric surgeries are performed under general anaesthesia, which means your child will be fully asleep and will not feel pain during the procedure.
The duration of the surgery depends on the condition being treated. Some procedures, like hernia repairs, are relatively quick. Others, such as bowel corrections or cyst removals, may take longer.
You will wait in a designated area and will be notified as soon as the procedure is complete. The surgeon will speak with you immediately after to explain how the operation went and what the next steps are.
After Surgery
After surgery, your child will be moved to a recovery area where nurses will monitor them closely as they wake from anaesthesia. Once stable, they will be transferred to a ward for observation.
Recovery will depend on the type of surgery and whether it was performed as open or minimally invasive:
Minimally Invasive Surgery (MIS):
- Shorter hospital stay (often 1 to 2 days)
- Less pain
- Faster return to feeding, walking, and normal activity
- Smaller incisions and reduced risk of wound infection
Open Surgery:
- Longer hospital stay (typically 3 to 5 days)
- Larger wound to manage
- Greater need for pain relief
- Longer time before returning to school or daily routines
Before discharge, the healthcare team will explain how to care for the wound, monitor for signs of infection, manage pain, and schedule follow-up visits.
Children often bounce back more quickly than expected, especially with gentle encouragement and support at home.
In the final section, we will look at how you can get a second opinion — and why it can be one of the most important decisions you make.
Need More Clarity? Speak to a Specialist First
Being told your child needs surgery can be overwhelming. It is a decision that affects your child’s comfort, recovery, and long-term wellbeing. As a parent, it is perfectly reasonable to want greater clarity before moving forward.
In many cases, surgery is presented quickly — sometimes as the only option, and often without full explanation of alternative approaches such as Minimally Invasive Surgery (MIS). But taking a little time to explore all options and speak to a specialist can make a big difference.
Why Consider an Additional Review?
Seeking a specialist review is not about challenging anyone’s medical advice. It is about making sure that the plan in place is the best one for your child.
You may want to speak to a surgeon who is experienced in both open and minimally invasive techniques, so you can:
- Understand whether MIS is a suitable option for your child
- Ask questions that were not fully answered in your first consultation
- Confirm whether surgery is urgent, or whether it can be scheduled with more flexibility
- Discuss recovery timelines, costs, and what to expect after surgery
- Feel more confident in the choice you are making for your child
This is not a confrontation. It is a responsible step that many parents take to better understand their child’s care.
What Dr Nada Offers
Dr. Nada Sudhakaran is a Consultant Paediatric Surgeon with over 25 years of experience. He has performed more than 5,000 surgeries in children, including complex and neonatal cases. He specialises in Minimally Invasive Surgery and is one of the few surgeons in Malaysia offering this technique even for infants and newborns.
Dr Nada offers private online consultations for parents who would like a personalised review of their child’s condition and the available treatment options. This is a safe, respectful space to ask questions and explore whether MIS might be appropriate in your child’s case.
You are not committing to surgery — only choosing to understand more before making a decision.
How to Book
You can request an online consultation with Dr Nada by visiting www.drnadachildsurgeon.com. The clinic will guide you through the simple steps to prepare your child’s information, including any scans, reports, or surgical notes.
If you have concerns, questions, or just want to explore your options before proceeding with surgery, this is your opportunity to do so with an experienced and caring specialist.
About Dr. Nada Sudhakaran
Dr Nada Sudhakaran is a Consultant Paediatric Surgeon based in Kuala Lumpur and Petaling Jaya, Malaysia. He has over 25 years of experience treating surgical conditions in children — from newborns to teenagers — and has performed more than 5,000 MIS surgeries (10,000+ overall) across Asia, Europe, and Australia.
He is one of the few surgeons in Malaysia who specialises in Minimally Invasive Surgery (MIS) for children. This includes laparoscopic (keyhole) procedures for conditions such as hernias, appendicitis, undescended testicles, bowel obstruction, choledochal cysts, and various types of atresias. Dr Nada also performs thoracoscopic surgery for chest-related conditions, a highly specialised area within paediatric MIS.
Dr Nada is also a well-established trainer in paediatric MIS, regularly invited to teach at conferences, surgical workshops, and training schools across Malaysia, Taiwan and the region. His focus on surgical precision, safety, and innovation has made him a sought-after mentor among younger surgeons looking to develop their skills in advanced MIS techniques.
Areas of Special Focus
- Minimally Invasive Surgery in newborns, infants, and children
- Laparoscopic procedures for abdominal conditions
- Thoracoscopic (keyhole chest) surgery
- Neonatal surgery for complex birth defects
- Reoperative surgery for recurrent or failed procedures
Where He Practices
Dr Nada is available for in-person consultations and surgery at:
- Pantai Hospital Kuala Lumpur
- Assunta Hospital, Petaling Jaya
He also offers online consultations for parents across Malaysia and the region who are seeking clarity, advice, or a review of their child’s surgical options.
Why Parents Choose Dr Nada
- Longstanding commitment to paediatric care
- Honest, clear communication with families
- Specialised focus on less invasive, child-friendly techniques
- Personal attention before, during, and after surgery
- Deep experience with newborn and infant cases
To learn more or request a consultation, visit:
Thank you for taking the time to read this guide. The more informed you are, the more empowered you will feel — and that’s exactly what your child needs from you right now.
You are not alone. The right questions can lead to better answers — and better outcomes.
Dr Nada Sudhakaran
