Surgery for child: Anesthesia or not?

Question

Two months ago my 9 year old daughter had surgery to remove a pyogenic granuloma from her lip. It came back and the doctor tried freezing it and also tried topical ointments, all to no avail. Now our only option is to cut it out and stitch the lip, which may cause scarring. :( Anyway, I had to pay A LOT of money out of my pocket for the first surgery since the plastic surgeon does not pre-authorize for insurance. I am STILL waiting for reimbursement from my insurance company. The doctor has not charged me for any of the work since then, and he wants to do the next procedure in the office, so he can complete it free of charge ( if we go to the surgery center, we'll have to pay the same amount we paid the first time). But, the dr. cannot put my daughter under in the office, and she's very afraid to have the surgery done while she's awake. I, too, would prefer that the dr. do the 45 minute procedure at the surgery center...I think he'd do a more careful job if she's under anesthesia. If she's awake, she will be fussing and stressing the whole time.

What should I do? Have the dr. do the surgery in the office so it won't cost me any money? Or elect to have him do the procedure at the surgery center, which will cost me almost $1000 but make my daughter much more comfortable? What would you do?

Anyway, shouldn't the doctor do this surgery free of charge since the first surgery failed to correct the problem? (Well, I guess that's another issue altogether!)

Answer 1

No, he shouldn't do the surgery for no charge. If you think about it, your daughter grew it back. Her body is the culprit. You don't say if you will have a hard time paying for the surgery. If money is an issue, have the doctor perform the operation in his office. Your daughter's lip will be numb and she won't feel a thing. At 9, she will be able to hold still especially if she knows how important it is. Good luck

Answer 2

I actually think that it would be worth it for your daughter's sake to go ahead and have her sedated for the procedure.  It's one thing to do a procedure on an adult, where you can talk things out and work through the anxiety.  It's a whole different ballgame when you are dealing with a child who has been traumatized enough already.  If she were mine, I'd bite the bullet and spring for the sedated procedure.  As far as the doctor doing it free because the first surgery failed, no he's not responsible.  One of the reasons for a pyogenic granuloma is rapid capillary growth in an area of previous trauma, and they are also sometimes associated with hemangiomas.  Hemangiomas are clusters of mis-grown capillaries, veins and sometimes small arteries, and are the result of genetics.  Your daughter probably has this predisposition and the first surgery did actually remove the first lesion.  It also unfortunately may have stimulated a new one to grow in the area.  It's really hard to gauge what the skin will do in healing, plastic surgeon or not.  Healing is also genetically influenced.  I imagine he was trying to be conservative with the first procedure, to spare her a nasty scar.  Sometimes you can get away with that, sometimes you can't.  Hindsight is always 20/20, after all.  And you would prefer to not make a bigger scar on the lipline than you have to.  All this aside, while I would like to think the doctor would do as good a job whether she was awake or not, it's hard to work on a child you know is upset, and you know you are upsetting even more.  It's not so much you don't try to do a good job, as it is you push to get things done as quickly as you can to limit the trauma you are doing to them.  So yes, having her asleep would take that pressure off him as well as her.  Then he can really concentrate of doing what needs to be done, and what he can to limit the scar as much as he can.  It will also make matters easier on you afterwards, since she won't be so upset you won't have the challenge of keeping her calm before, during or afterwards.  Good luck to you both dear, and hopefully this time it will solve the entire problem.  

Answer 3

So sad you have to pay at all, but I think you should see that the child gets it done painlessly to prevent any problems during the surgery or mental trauma. Then I would try to get the original fee reimbursed (see a solicitor).    

Answer 4

I think I would get another opinion on what to do from a dermatologist than a regular Doctor. If my daughter may end up with a scar on her lip, I would be particular who did the work, and would not have anything like that done in an office. She is worth more than that. They can give your daughter an IV Sedative instead of penathol, and that will cause her not to jerk while the procedure is being done, because that may make things worse for her. You can make the charges in payments, so go for the gold. I wish for you and your daughter the very best and hope things go perfect with the procedure. Good luck.

Answer 5

Definitely put her under anesthesia it seems like it will be safer and less traumatizing for her.  

Answer 6

In performing procedures on children under 14, especially those which affect structures inside the vermilion border (the lips) I would opt for anesthesia.  Where there is a reasonable expectation of scarring, movement by the patient due to  anxiety (which would be normal for any pre-adolescent) would result in a less desirable result.  If this was a procedure on a body part other than the sensitive structures of the face, where scarring is probable, I might choose office sedation.  But if it were my child I would find the money to pay for the best result.

Answer 7

I am not sure what I would do. I try to advoid anesthesia as much as possible when it comes to my children.

   If you can't really afford the $1000, then your next step would be asking about having your daughter premedicated for the office surgery. There are several things a doctor can give them to make them relax and not care what is going on around them.