Programs at Austin Pediatric Surgery

Learn more about our programs below.

Pectus Chest Wall Program

The surgeons of Austin Pediatric Surgery have helped to establish a multidisciplinary pectus excavatum and carinatum program at Dell Children’s Medical Center.  We continue to use our evidence-based outcomes and collaborate between the patient and family, surgeons, anesthesiologists, physical and occupational therapists, and nursing staff to strive for the best care of patients with chest wall deformities.

There are two main types of chest wall abnormalities – pectus excavatum, where the chest has a caved-in appearance, and pectus carinatum, where the chest protrudes outward.  Some patients have a combination of pectus excavatum and carinatum, and treatment options may be surgical or non-surgical.  Our team will work with you and your family to make the best plan for your condition.

Pectus Excavatum:

Pectus excavatum, or “funnel chest” occurs in 1 in 300-400 people.  It is more common in males than females. It is usually sporadic but may run in families. There is an increased prevalence of pectus excavatum in patients who have connective tissue disorders, suggesting that it is caused by abnormal development of the cartilage bridging the sternum and the ribs.  The condition may be present when the child is young, and most commonly becomes more prominent during the rapid growth of the pre-teen and teen years.

Many patients with pectus excavatum are asymptomatic.  But many others complain of shortness of breath, especially while exercising, or an inability to keep up physically with their peers. They may feel embarrassed or ashamed of their physical appearance, and this impaired body image can result in lower self-esteem and impaired quality of life.

Pectus excavatum often requires an operation to elevate the sternum, potentially improving heart and lung function, as well as improving the appearance of the chest.  The procedure is generally done via a minimally invasive approach, where two small incisions are made under the armpits and a curved metal bar is placed under the ribs and sternum.  The bar is generally left in place for two to three years.

At Austin Pediatric Surgery, we have taken the model of Enhanced Recovery After Surgery (ERAS) techniques that have improved surgical outcomes in other procedures and developed a pectus pathway to improve postoperative pain control, encourage early mobility, and decrease hospital length of stay.  This pathway optimizes care before, during, and after your surgery.  Advancement in surgical techniques and pain control at our institution have decreased the amount of time patients stay in the hospital after surgery and have improved comfort, even with less need for pain medications after discharge.

All families will start with a consultation with a pediatric surgeon. If the decision for surgery is made, we employ a joint evaluation with pain control specialists and physical therapists around the time of the operation.  We have a directed physical therapy program that begins before the procedure and continues after surgery.  Patients are generally out of bed the day of surgery and most can be comfortably discharged in the first few days after the operation.

Pectus Carinatum:

Pectus carinatum, or “pigeon chest” is a less common variant of a pectus anomaly.  As with excavatum, the condition generally becomes noticeable and more prominent during the pre-teen to teenage years.  Most patients with pectus carinatum are candidates for bracing to correct the defect, though occasionally surgery is indicated.  We will help you to determine and carry out the right plan for your condition.

Dr. Erich Grethel is a board certified pediatric surgeon who has a special interest in pectus deformities and leads the Pectus Chest Wall Program at APS. Please call our office at 512-708-1234 for an appointment or email ejgrethel@ascension.org with any questions.

Erich J. Grethel, MD, FACS, FAAP

Dr. Grethel lives in Austin, Texas with his wife and three children. He has been practicing pediatric surgery here since 2010. He is surgeon champion for the Dell pediatric NSQIP team and is involved in quality and outcome measures for pediatric surgery patients.

Pediatric Surgical Oncology

As pediatric surgeons, we treat a wide variety of tumors which can be found throughout the neck, chest and abdomen. These include:

  • Wilms’ Tumor
  • Neuroblastoma and other adrenal tumors
  • Pancreatic tumors
  • Hepatoblastoma and other liver tumors
  • Soft tissue sarcomas
  • Thyroid tumors

Please see our Oncology page to learn more about these tumors.

As pediatric surgeons, we work in close collaboration with the medical oncologist, radiologist, radiation oncologist, and pathologist to ensure the optimal care for your child. We participate in a weekly Tumor Board conference to allow group discussions and coordination of patient care. The team of surgeons who specialize in surgical oncology at Austin Pediatric Surgeon is led by Mike Josephs and includes Jessica Naiditch, Ankur Rana, Erich Grethel and Jeffrey Horwitz.

Michael D. Josephs, MD, FACS

Dr. Josephs moved to Austin from the East Coast in 2002 to provide surgical care to the children of Central Texas. In addition to the state-of-the-art healthcare environment, he was drawn to the vast opportunities for outdoor activities in the hill country along with the many live music venues.

Jessica Ann Naiditch, MD, FACS, FAAP

Dr. Naiditch is a board certified pediatric surgeon with an interest in the surgical management of inflammatory bowel disease, trauma & oncology. She is the lead surgeon on the Austin Pediatric Surgery Inflammatory Bowel Disease Team and is the Trauma Medical Director at Dell Children’s Medical Center. She has published on topics including lung biopsy, […]

Ankur R. Rana, MD

Dr. Rana is a clinical pediatric surgeon with experience in all aspects of neonatal and pediatric surgery, with special clinical interest in pediatric oncology, thoracic surgery and complex gastrointestinal surgery including minimally invasive surgery. He is also the Educational Experience director.

Erich J. Grethel, MD, FACS, FAAP

Dr. Grethel lives in Austin, Texas with his wife and three children. He has been practicing pediatric surgery here since 2010. He is surgeon champion for the Dell pediatric NSQIP team and is involved in quality and outcome measures for pediatric surgery patients.

Jeffrey R. Horwitz, MD, FACS

Dr. Horwitz was born and raised in Houston. He has been living in Austin since 1999. His incredibly supportive family includes his wife Treva, daughter Aiden and two chihuahuas, Gracie and Bella.

Thyroid Surgery Program

Although thyroid disease is less common in children compared to adults, occasionally surgical issues arise. Most commonly this is for an overactive thyroid gland (hyperthyroidism) or a concerning thyroid nodule. Treating pediatric thyroid disease requires a multidisciplinary approach. As the lead surgeon of our Thyroid Surgery Program, Dr. Horwitz works closely with our partners in pediatric endocrinology, pediatric radiology and pediatric pathology. In addition, because recent studies have suggested that high volume thyroid surgeons (performing > 30 cases/year) have improved outcomes, Dr. Horwitz has partnered with Dr. Teresa Kroeker, one of the region’s leading adult thyroid surgeons. This collaboration between pediatric surgeons and a high-volume adult thyroid surgeon optimizes the care of children with surgical thyroid disease conferring the benefits of both a high volume thyroid surgeon and high volume pediatric surgical care.

Jeffrey R. Horwitz, MD, FACS

Dr. Horwitz was born and raised in Houston. He has been living in Austin since 1999. His incredibly supportive family includes his wife Treva, daughter Aiden and two chihuahuas, Gracie and Bella.

Liver Surgery

The doctors of Austin Pediatric Surgery are surgical specialists for infants, children and adolescents. We are committed to providing state of the art pediatric surgical care for the children of Central Texas. We provide the full spectrum of surgical care, including the surgical treatment of diseases of the liver, bile ducts and gallbladder. Our team strives to make the surgical experience of our patients and families as safe and pleasant as possible.

Tory A. Meyer, MD, FACS

Dr. Meyer has enjoyed the beauty of the Austin area since 2000 when he moved here with his wife and three children. In addition to a busy surgical practice, he has served as Surgery Dept. Chair and Chief of Staff and is the present Chairman of the Pediatric Leadership Board. Dr. Meyer is a Clinical […]

Inflammatory Bowel Disease

Inflammatory bowel disease (IBD) is an immune mediated inflammation of the intestines which can afflict pediatric patients. Although most IBD in children is treated with medicines, some children require surgical care for complex disease. The team at Austin Pediatric Surgery is committed to the care of children with IBD. We offer advanced treatments using minimally invasive techniques, such as laparoscopic ileocecectomy and colectomy with ileoanal pouch reconstruction. We work as a team with gastroenterologist to ensure you and your children receive the best multidisciplinary care we can provide.

Dr. Jessica Naiditch is a board certified pediatric surgeon who has a special interest in IBD and leads the surgical IBD team at APS. Please call our office at 512-708-1234 for an appointment or email janaiditch@ascension.org with any questions.

Jessica Ann Naiditch, MD, FACS, FAAP

Dr. Naiditch is a board certified pediatric surgeon with an interest in the surgical management of inflammatory bowel disease, trauma & oncology. She is the lead surgeon on the Austin Pediatric Surgery Inflammatory Bowel Disease Team and is the Trauma Medical Director at Dell Children’s Medical Center. She has published on topics including lung biopsy, […]

Pediatric Bowel Management

Our bowel management program is for children with constipation and/or fecal incontinence. We work with children and families to achieve a goal of predictable bowel movements to improve quality of life. This program is designed to avoid bowel accidents and diaper dependence which can lead to remaining clean and improved self-esteem. We offer daily feedback via email or a phone call to achieve the individualized goals discussed at initial meeting.

Fecal incontinence can be a result of congenital conditions, constipation, or issues with muscle weakness or injury. Symptoms of this can be mild leakage of stool when passing gas to no control of bowel movements with daily accidents. Some congenital conditions our program will be successful for are:

  • Imperforate anus/anorectal malformation
  • Hirschsprung Disease
  • idiopathic constipation
  • fecal incontinence
  • cloaca exstrophy
  • spina bifida

What to expect

Your family will meet with the team to review the past medical and surgical history and type of bowel control issues your child is experiencing. After a physical exam and radiographic imaging, an individualized program will be created to achieve the goals of bowel control discussed for your child. This can be achieved with dietary changes, medications such as laxatives, and/or enemas. We understand the importance of daily communication, dedication, and teamwork between our medical providers and families to achieve success.

Please call our office at 512-708-1234 for an appointment in our bowel management clinic or email arrana@ascension.org with any questions.

 

Ankur R. Rana, MD

Dr. Rana is a clinical pediatric surgeon with experience in all aspects of neonatal and pediatric surgery, with special clinical interest in pediatric oncology, thoracic surgery and complex gastrointestinal surgery including minimally invasive surgery. He is also the Educational Experience director.

Congenital Consultation

The news that your unborn baby may have a congenital defect can be frightening and overwhelming for a family. Our team of experts are available for you and your unborn child. As experienced pediatric surgeons, we collaborate with maternal-fetal medicine experts, pediatric anesthesiologist and neonatologist with one goal in mind: to deliver and provide the best care for your baby.

At Austin Pediatric Surgery, we offer highly specialized surgical care to treat a range of complex congenital anomalies including:

  • Congenital Diaphragmatic Hernia
  • Gastroschisis/Omphaloceles
  • Esophageal Atresia
  • Tracheal Esophageal Fistula
  • Pulmonary anomalies
  • Intestinal anomalies
  • Ovarian anomalies
  • ECMO and EXIT procedures

APS is committed to providing the highest quality of care from prenatal diagnosis to long term follow-up.  We are readily available for consultation and look forward to meeting with you.

Dr. Julie Sanchez is a board certified pediatric surgeon who has a special interest in congenital anomalies and leads the Congenital Consultation Program.  Please call our office at (512) 708-1234 for an appointment or email Dr. Sanchez at jsanchez@ascension.org.

Julie I. Sanchez, MD, FACS

Dr. Sanchez and her family have lived in Austin since 2001. In addition to a successful surgical practice, she is a co-founder of Abilitee Adaptive Wear, an online clothing company for children and adults with special needs. She also has a passion for education, global health and injury prevention.