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Paediatric surgery is the only medical speciality exclusively dedicated to diagnosis, treatment, and post-operative care for problems which occur during the life stage between the foetal period and adolescence and which need to be treated surgically. The surgical pathologies, physiology, doctor-patient relationship, and needs of the paediatric patient are very different from those of an adult. Due to the complexity of the pathologies treated and the special needs of the paediatric patient, this type of surgery is usually restricted to tertiary centres.
Thanks to the wide range of pathologies we treat, the paediatric surgeons here receive training on how to carry out procedures in almost all surgical areas. Working closely with obstetricians, the paediatric surgeons participate in detecting and treating pathologies that are diagnosed in utero, providing prenatal medical advice to families, and even carrying out surgeries on foetuses or during labour.
The specialists in paediatric surgery receive specific training on how to correct congenital abdominal, thoracic, and urological defects, some of which can potentially be fatal. We also provide care for patients who are multiple trauma victims and those who need surgical treatment for solid tumours. We are also the specialists who treat the urological and gynaecological problems that occur in this age range.
VHUH’s Paediatric Surgery Department is the reference centre in Catalonia for the surgical treatment of most problems in paediatric patients, and in some procedures, it is the reference centre for the entire country, covering all areas of paediatric surgery (from organ transplants to foetal surgery, and every sub-speciality in between).
In order to offer the best quality of care possible, the Department is organised into surgical sub-specialities: Neonatal Surgery, Oncological Surgery, Digestive Surgery, Thoracic Surgery, Hepatobiliopancreatic Surgery, and Urology. This innovative structure allows us to obtain a high level of specialisation and competence in each area of paediatric surgery. General surgery tasks (those corresponding to major outpatient surgery and emergency surgery) are shared among all members of the team.
Our Department was the first in the country to use foetal surgery techniques and it is part of a multidisciplinary foetal medicine programme. We are committed to performing highly complex surgery, such as oncological surgery and reconstructive urological surgery, also using minimally invasive surgery, even in newborns, and we are pioneers in foetal surgery. We also have a minimally invasive surgery simulation laboratory. Within these minimally invasive techniques, we have carried out robotic surgery since 2009; we were the first paediatric hospital in the country with a robotic surgery programme that was applied to every area of paediatric surgery.
We were also the first Paediatric Surgery Department in Spain to carry out a paediatric kidney transplant (1981) and paediatric liver transplant (1985), and we also did the first reduced-sized liver transplant (1987) and the first split liver transplant (1992). We continue to be directly involved with both transplant programmes, which have among the highest volumes of patients and the best results in the country.
In the year 2012, our Paediatric Surgery Department received the Certificate of Hospital Accreditation for Specialist Training in Paediatric Surgery, an acknowledgement from the European Board of Paediatric Surgeons that is backed by the UEMS, distinguishing it as a centre of excellence in training paediatric surgeons. We also actively participate in national and international programmes and have various RCSU (Department of Health Reference Centres, Services and Units) and ERN (European Reference Networks) accreditations.
For more than 20 years now, we have maintained several well-known lines of research in experimental paediatric surgery (and also more specifically, in foetal surgery) at the Vall d'Hebron Research Institute (VHIR). In 2015, we created the “Bioengineering, Cell Therapy and Surgery in Congenital Anomalies” group, which is currently carrying out research on the prenatal treatment of spina bifida and congenital diaphragmatic hernias. In addition, among other projects, we have carried out research projects on amniotic band syndrome, gastroschisis, oesophageal atresia, and cleft lip/palate.
As regards clinical research, our Department is constantly carrying out research activities and boasts numerous national and international publications. One noteworthy example is the first multi-centre randomised study on treating parapneumonic empyema. It compares video-assisted thoracoscopy to drainage and the use of fibrinolytics and was published in the journal Pediatrics in 2014. Another two examples are our intestinal lengthening techniques and the treatment of congenital portosystemic shunts (Abernathy malformation).
At the same time, we collaborate with other research teams, especially in the field of paediatric oncology, and we also participate in collaborative studies and international multi-centre studies.
The Paediatric Maxillofacial Surgery Unit is proud of its extensive experience in the treatment of complex cranioencephaly malformations. We should also highlight the treatment of paediatric maxilofacial tumours.
Our team is made up of paediatric surgeons who are a part of the Paediatric Surgery Department, and surgeons from the Oral and Maxillofacial Surgery Department.
One example of the work our team carries out is the application of nasoalveolar modelling (NAM) technique to treat children suffering from cleft lip and palate. This treatment is incorporated in the protocol of comprehensive treatment offered to such patients at our centre. This helps surgeons and improves the aesthetic and functional results of reconstructive surgery, as it reduces the severity of the deformity and can easily be carried out in the consultation in a way that is safe and pain-free.
The Paediatric Surgery Department at Vall d’Hebron University Hospital is a reference in Catalonia for the treatment of most paediatric surgical problems and in the rest of Spain for specific procedures. Our mission is to care for paediatric patients with surgical concerns.
Pediatric Surgery Training Itinerary
Paediatric Surgery is a discipline that covers a wide range of pathologies, from congenital, acquired, malformation, infectious and tumoral conditions, including thoracic, abdominal and genitourinary issues.
Our involvement in patient care spans from before birth (foetus, prenatal period) through to late adolescence.
To provide the highest quality, our service is structured into different subspecialities:
This innovative structure allows us to achieve a high level of super-specialisation and expertise in a specific area of modern paediatric surgery, which further benefits our paediatric patients and ensures a higher quality of care.
Our Paediatric Surgery department was the first in Spain to introduce a Foetal Surgery Programme, forming part of the multidisciplinary Foetal Medicine programme.
Similarly, we were the first hospital in Spain to perform paediatric transplants, kidney transplants from 1981 and liver transplants from 1985, including being the first to carry out a reduced liver transplant in 1987 and the first ‘split’ liver transplant in 1992. Our Hospital and our Department remain directly involved in the liver and kidney transplant programmes, which are among the highest volume and best-performing in the country.
We are committed to high-complexity surgery, introducing increasingly minimally invasive techniques to various paediatric-age groups, including neonatal surgery, and even venturing into foetal surgery. Among these minimally invasive techniques, we incorporate robotic surgery. Starting in 2009, we were the first paediatric hospital in the country to develop a robotic surgery programme.
Our department is currently accredited by various national and international benchmarking programmes: CSUR (Centres, Services and Units of Reference of the Ministry of Health) for Neuroblastomas, Childhood Sarcomas, Paediatric Liver Transplant, Paediatric Kidney Transplant, Bladder Exstrophy and Epispadias.
We are also ‘Full-Members’ of various ERN (European Reference Networks) such as ERNICA and EUROGEN, as well as Paediatric Oncology and Erythropathies.
In 2012, we received the Certificate of Hospital Accreditation for Specialist Training in Paediatric Surgery from the European Board of Paediatric Surgeons, with the endorsement of the UEMS, as a centre of excellence for the training of paediatric surgeons and in 2023, we were again re-accredited as a Centre for Training in Paediatric Surgery.
Our programme allows residents to gain comprehensive training in all areas of paediatric surgery, which, unlike programmes at other centres, encompasses everything from organ transplants to foetal surgery, including neonatal, oncological, thoracic, digestive and urological surgeries. Training emphasises the most advanced minimally invasive techniques, including robotic surgery. Our simulation laboratory for minimally invasive surgery enables our residents to train in an appropriate and safe environment.
During the first semester, residents undergo adult general and thoracic surgery training. Subsequently, they join our department, rotating through the various subspecialities according to their training programme. During on-call shifts (4-5 per month), the resident is accompanied by a senior doctor who is physically present. During continuous care, paediatric surgical emergencies are covered, and they participate in the paediatric polytrauma care programme. During these shifts, we encourage the resident’s autonomy in surgical decision-making and their proficiency executing the various surgical techniques performed. Furthermore, residents are integrated into paediatric transplant programmes (liver and kidney).
The training pathway for residents in our centre ensures learning across all paediatric surgical subspecialities, encompassing everything from outpatient surgeries to highly complex surgeries such as intricate oncological surgeries, complex anorectal malformations and solid organ transplants. Additionally, there is a six-month period where optional rotations can be undertaken, where the resident can choose from options available in our centre including: paediatric plastic surgery, paediatric cardiovascular surgery, paediatric neurosurgery, paediatric anaesthesia, paediatric maxillofacial surgery.
Continued training sessions are held between members of the department and external specialists:
During the final year of training, a rotation to international centres of excellence is encouraged. Throughout the residency, clinical and laboratory research is promoted, encouraging the presentation of papers at national and international conferences and publications.
Furthermore, training courses deemed necessary for the speciality are provided during the residency:
Throughout rotations in various units, the relevant team provides information on courses and subspecialist conferences that are more appropriate to attend and/or submit papers. There are also specific courses which, depending on the resident’s interest, can be optional or mandatory.
In the field of research, residents are encouraged to participate in the department’s active research initiatives and new research that may or may not be related to these research lines and which may result in the pursuit of a doctoral thesis.
Currently, at the Vall d’ Hebron Research Institute (VHIR) we maintain several established paediatric research lines in experimental surgery, specifically focusing on foetal surgery. In 2015 we created the Bioengineering group, Cellular Therapies and Surgery in Congenital Malformations, which is currently researching prenatal treatment of spina bifida and congenital diaphragmatic hernia. Moreover, among other projects, we have conducted research on amniotic band syndrome, gastroschisis, oesophageal atresia and bladder augmentations. These translational research programmes have enabled patients to benefit from them, notably the FETO techniques (foetal tracheal occlusion in the serious congenital diaphragmatic hernia) and the prenatal repair of the myelomeningocele, initially by open surgery and since 2015 via fetoscopic methods.
Regarding clinical research, the first multicentre randomised controlled trial on the treatment of parapneumonic empyema stands out, comparing video-assisted thoracoscopy to drainage and use of fibrinolytics, subsequently published in the journal Pediatrics. Additionally, there are numerous clinical research lines across all units, with publications in national and international journals.
At the same time, we collaborate with other research teams, particularly in the field of paediatric oncology, as well as in collaborative studies and international multicentre studies. Experimental research groups:
Paediatric Maxillofacial Surgery, Children's Hospital and Woman's Hospital
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