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Pediatric Surgery

Welcome

Nitsana Spigland, MD

Associate Professor of Clinical Surgery
Weill Cornell Medical College

Chief, Pediatric Surgery
Associate Attending Surgeon
NewYork-Presbyterian Hospital
Weill Cornell Medical Center

The pediatric surgical service promotes a team-based approach that involves consultations to parents and their families, interpretation of prenatal ultrasounds and MRIs, as well as post-natal care of newborns with complex congenital malformations. Our goal is to make the diagnosis of a potential congenital malformation before birth, and provide education to parents and their families about the fetal diagnosis. We provide careful guidance throughout the pregnancy and the birthing process and provide the best care to infants postnatally. Since the infants often have other associated congenital malformations, we work in conjunction with other nationally recognized leaders to provide a comprehensive multidisciplinary approach to the infant's care.

Our team offers expert pediatric surgical care by professionals who have expertise in addressing the needs of infants born with a variety of malformations. The team consists of expert surgeons, neonatologists, anesthesiologists and other subspecialists who are experienced in the special needs of infants born with these problems. We offer the most advanced surgical therapy including minimally invasive techniques to repair major abdominal and chest malformations. We perform the full spectrum of pediatric surgical procedures to address complications such as head and neck anomalies, thoracic malformations, abdominal malformations as well as tumors. Some of the common problems that we treat are listed below.

Congenital diaphragmatic hernia (CDH) occurs when the diaphragmatic components do not fuse properly allowing the abdominal organs like the stomach, spleen, liver and intestines to enter the chest cavity. The defect can occur on the right side or the left side, but more commonly on the left. Babies with CDH have small, underdeveloped lungs due to the presence of the abdominal organs in the chest. We offer a comprehensive plan of care for infants born with these anomalies including prenatal consultation with our neonatologists. Surgical approaches include an abdominal approach as well as a minimally invasive thoracoscopic approach for repair.

Congenital lung malformations are a family of structural abnormalities of the lung which arise from errors in the embryologic development of the lung. The categories of malformations include congenital cystic adenomatoid malformation (CCAM), pulmonary sequestration, bronchogenic cyst and congenital lobar emphysema. Many of these malformations are diagnosed on routine prenatal ultrasound and are fixed after birth. The type, extent, and location of the malformation dictate the amount of lung to be removed and the timing of the surgery. Both thoracotomy and thoracoscopic techniques are used to treat these malformations.

Esophageal atresia and tracheoesophageal fistula. Congenital esophageal atresia represents a failure of the esophagus to develop a continuous passage. Instead, most commonly it ends as a blind pouch and the distal end connects with the trachea. The presence is suspected in an infant with excessive salivation and is frequently accompanied by choking after birth. These are usually fixed shortly after birth by a thoracic approach whereby the fistula is divided and the two ends of the esophagus are connected to each other. These infants often learn to eat and swallow normally.

Intestinal atresia is a condition in which a portion of the intestine has not developed properly, such as duodenal atresia or jejunal atresia. The infant is often born with bilious vomiting and a blockage in the intestines. Operations are performed after birth to restore intestinal continuity.

Abdominal wall defects such as omphalocele and gastroschisis are the most common. An omphalocele is a birth defect in which the infant's intestine or other abdominal organs stick out of the umbilicus. In omphalocele the intestines are covered by a thin sac. Gastroschisis usually involves a protrusion of the intestine without a sac on the right side of the umbilical cord. These anomalies are usually repaired by a variety of techniques that involve progressive closure of the abdominal wall.