Mr John Bowen
Consultant Neonatal and Paediatric Surgeon
MB. ChB, FRCS (Paeds
Neonatal Surgery, Gastro-intestinal Surgery, especially inflammatory Bowel Disease; Flexible Endoscopy; Surgery to support nutrition
John Bowen FRCS (Paed) Consultant Neonatal and
NHS address Centre for Neonatal and Paediatric Surgery Ward79 RMCH
Manchester M13 0JH
Secretary Linda Greenhalgh 0161 701 5194
Email NHS: firstname.lastname@example.org
General professional background
I graduated from Leeds University in 1986. I undertook General
and Specialist surgical training in and around Manchester,
Liverpool and Melbourne, Australia. I became a Fellow of the
Royal College of surgeons of England in 1991, and obtained my
Specialty Fellowship in 1996. I was appointed Consultant Surgeon to
the Manchester Children's Hospitals in 1996, providing Specialist
Surgery for infants and children in Pendlebury, Booth Hall and St
Mary's Hospitals; and latterly in the new RMCH. I have extensive
experience of managing babies born with general neonatal
conditions, for example gastroschisis, complex oesopahgeal atresia,
Hirschsprung's disease, and the problems of prematurity.
In the older child, I am recognised as the local 'expert' on
surgical management of inflammatory bowel disease, and have a long
experience of managing the constipated child, which includes
diagnosing and treating late-presenting Hirschsprung's disease. I
frequently manage babies, infants and children who require
nutritional support, which might include performing gastrostomies
or fundoplications. Vascular access procedures are a major
component of the workload of a General Paediatric Surgeon; I may
perform over 50 per year. RMCH is a 'Major Trauma Centre'.
Teaching and Training
I am an Approved Educational Supervisor for specialist
Paediatric Surgical training. I am involved, in many capacities,
with the University of Manchester. I present at local and national
meetings on topics relevant to my practice. I sit on the Paediatric
Surgery Specialist Advisory Committee of the GMC.
I am a Fellow of the Royal College of Surgeons of England. I am
a member of the British Association of Paediatric Surgeons (BAPS),
and the British Society of Paediatric Gastro-Enterology, Hepatology
and Nutrition (BSPGHN).
As a Consultant of 20 years, I have contributed to numerous
hospital committees and working groups. These have included:
Improving services for Young people with Autistic Spectrum
Improving services for the non-communicating child, and the
child with medical complexity.
Major Trauma Centre working group.
Children's Intestinal Failure Service.
Improving arrangements for 'Transitional Care'.
Surgical Representative Clinical Audit Group.
Surgical Representative Hospital Mortality review group.
I have been the Speciality Lead Clinician for Paediatric
I have been the Clinical Director to the Ambulatory Services
I am trained to participate in high level clinical incident
Appraisal and CPD
My appraisals are up to date; I revalidated in January 2014. I
conduct appraisals for Consultant Colleagues. I have attended a
number of meetings over the last few years to update my Managerial
skills, including Day services workshops, leadership training and
problem analysis to deliver safer clinical systems; Leadership, and
Change Management training. I have training in preparing
I produce 6-10 Medico-legal reports each year. These have
included cases of personal injury, clinical negligence or criminal
injury. I have attended court as an expert witness. Please email me
at the above address for my T&Cs.
I hope you find this site helpful, both in understanding what
might happen if we decide your child needs an operation, and
deciding if I can help treat your child.
Why see a children's Specialist for your child's
My entire practice, within the NHS, is based at the new Royal
Manchester Children's Hospital. I am devoted to the care of
children from birth to their teenage years, who often suffer with a
wide range of medical problems, and who might require an operation
as part of their treatment. It is said that children are not
small adults. This is so very true. Their illnesses are different.
The language they use and understand is different, and changes as
they grow up. The operations they need can be different. I believe
I speak their language, and understand their changing hopes, and
fears, as they grow up.
I do not treat adults!
As a Specialist Paediatric General Surgeon, the range of
problems I treat tend to be those problems that are not treated by
my colleagues in other Specialities, for instance ENT, or
Neuro-surgery or Orthopaedic Surgery etc. If you are not sure if I
can help, please feel free to email me your enquiry and I will do
my best to advise you.
I would be very happy to see you with your child in my Out-patient
clinic at RMCH, held on Tuesdays. You can ask your GP to contact me
I would also be happy to offer you and your child private
consultation at Spire Hospital, Manchester, in Whalley Range, or
the Spire, Hale, clinic. Please email me at the above address for
details of making an appointment; I will require a letter of
referral from your GP if I have not already seen you at RMCH.
What do I treat?
For general advice see "Your child's treatment/FAQ" below
Common General Surgical problems of
Groin Hernia or hydrocele
Probably the most common operation that I perform is an
operation to repair an inguinal, or groin, hernia, and hydrocele,
which are technically the same procedure. Hernias are very
common in boys, especially when they are born prematurely; although
less common in girls, it is not a surprise if I see young girls
with a hernia too. I always recommend a small operation to fix a
hernia, and if your child is over a year of age I would recommend
an operation if your child has a hydrocele too; sometimes a
hydrocele will get better on its own in younger babies. Your child
will usually have their operation as a 'day case' and under general
anaesthetic. Complications are unusual after this operation.
Your child will be away from you for about 45 minutes
Umbilical, or tummy-button, hernia
Many babies develop a swelling behind the tummy button, or
umbilicus, that protrudes when they cry. In the first few weeks
after the swelling first appears, it can enlarge very rapidly, and
this may really worry you. Many have got better by 3 or 4 years of
Umbilical hernias very rarely cause pain and I almost never see a
child with a tummy button hernia that is causing emergency
If we do agree that an operation is appropriate, I would plan to
admit your child as a 'day case' and I carry it out under General
Your child will be away from you for about 45 minutes.
Complications are unusual after this operation.
Circumcision (removing the foreskin)
I usually circumcise boys because they have developed
complications that might cause problems as they grow up. These
complications are usually due to chronic infection, and include
recurrent infections, a painful, bleeding foreskin or scarring that
means I cannot pull the foreskin back when I examine your
child. The foreskin is naturally tight in babies and young
boys, this is not a reason to have your son circumcised.
Sometimes I am asked to carry out a circumcision on a boy because
of cultural or religious beliefs. In this case the foreskin is
healthy, but the operation is the same otherwise. I would prefer
not to do this operation until your son is out of nappies as there
is a higher chance of complications when your son is a little
Your son will have his operation as a 'day case' under general
Your son will be away from you for about 45 minutes.
Sometimes, despite the most thorough technique, a few boys will
develop a small bleed from the cut skin a few hours after the
operation. If we cannot get this stop on the ward, it may be
necessary for me to go back to the operating theatre with your son
to put another stitch into the wound.
Undescended testicles and other testicular
Often, what your Doctor thinks might be an undescended testicle is
actually a 'retractile' testicle. This does not require an
operation, and I will talk to you about this in clinic. In some
cases, your son will have a true non-descended or undescended
testicle. This would require an operation for a number of reasons,
we will talk about this at length in clinic; the operation would be
carried out as a day-case admission, and your son will be away from
from you for about an hour.
There are a number of other, usually minor, problems that boys
will complain of related to their testicles. I may need to organise
scans to help understand the problem, and some of these problems
may need an operation to sort them out. We will discuss this in
detail when we meet, and as the investigations proceed.
Lumps and Bumps
Children develop lumps and bumps under the skin, all over their
bodies. The more common places for lumps to appear are in the
skin itself neck armpit groin breast arms and legs.
Do not worry, this will almost certainly NOT be cancer, which is
incredibly rare in children. I will thoroughly examine the lump and
since most are quite distinctive, I am able to tell what the
problem is very quickly. Sometimes I might organize a scan to help
understand the nature of the lump better. A lot of lumps can be
very easily removed, and not only does this get rid of the
'problem', but means we can send it to the lab to be examined under
the microscope.These operations always need to be carried out
thoroughly, as some of these lumps can grow back if not completely
removed.Most of these operations will only take about 45 minutes to
This is a very common symptom in children and can be a cause of
immense anxiety; when the pains are frequent or severe some
children will miss a lot of school.In at least half of the children
I see in clinic with recurring abdominal pains, no diagnosis is
ever found and the symptoms eventually get better. I would say your
child has suffered from 'non-specific abdominal pain'.
After you and your child have described the symptoms and I have
asked a lot of questions, I will examine your child thoroughly. I
won't do an intimate internal examination of your child in clinic.
To help understand your child's problem, I might organise a number
of tests including blood tests, XRays and scans and possibly an
examination under a full general anaesthetic. I will of course
explain everything as we go along.
Non Specific Abdominal Pain/Irritable Bowel
This is generally a diagnosis I use if I can find nothing abnormal
to account for your child's symptoms.
This is very common in children of all ages and is often
associated with painful bowel movements (poo-ing), that only occur
every few days. There is often blood on the poo, or the toilet
paper when your child wipes their bottom. I can sometimes see a
small abnormality outside the back passage that helps me explain
I usually recommend generous doses of laxatives to make the poo
soft and comfortable to poo out. I may advise that you give your
child these medicines for many months, which will cause no
It can be difficult to tell you why your child suffers from
constipation but it almost always gets better within a few months
of getting the treatment right.
This is an emergency condition that causes severe abdominal pain.
The nature of the pain is very often not at all typical, and varies
a lot between different children.Your child may be vomiting, and
won't feel hungry. When I examine your child, I may find exquiste
tenderness in the lower right hand corner of their
tummy. Sometimes it can be difficult to diagnose acute
appendicitis, and blood tests and scans might be helpful. Even
then, a diagnosis might be difficult, and I will then re-examine
your child every few hours to watch for changing features.
If your child has acute appendicitis, he or she will need an
urgent operation to make them better. This does not need to be done
in the middle of the night, and we would spend a few hours
correcting any dehydration your child might be suffering. It is
good to start antibiotics before theatre too. We will spend as much
time as is necessary to explain what we intend to do, and to help
you understand your child's illness.
You should expect your child to be in hospital for a least 48
hours after their operation.
Gall-stones, ulcers and indigestion
These are rare problems in children. To help make a diagnosis, I
might organise blood tests, Xrays and scans; sometimes I will
recommend an endoscopy (examination of the bowel with a flexible
An operation is sometimes necessary; I will explain all of my
findings to you, as well as my recommendations, as we go along.
Endoscopy- Gastroscopy and colonoscopy
A lot of the children that I look after will require an endoscopy
at some time. Examination of the gullet (oesophagus) and stomach is
called gastroscopy, and examination of the large intestine (colon)
is called colonoscopy. Both are carried out under general
To make sure I can get good and clear views of the large
intestine, which is normally full of poo, I will send you some
medicine to take the night before your child's examination. This is
a very strong laxative and will give your child diarrhoea. I will
make sure the instructions you need to understand this treatment
come with the medicine. The next day, when I examine your child,
there will be no poo to block my views.
Vomiting is a very common problem in childhood. Babies will
often vomit frequently in the first few months of life
(possetting). the vast majority of babies do grow out of this
within 6 months or so.
There are many causes of vomiting. To help understand why your
child is vomiting, I will ask a lot of questions, and examine your
child. I may organise some blood tests, XRays and scans; endoscopy
(examination with a flexible camera) may also help me.
Once I have made a diagnosis, I will discuss treatment options
with you. Some of the problems I see are better looked after by a
Paediatrician, or a Specialist Paediatric Gastro-enterologist
(bowel specialist) and I will help you decide who I should refer
you child to.
Some of the problems that make your child vomit can be treated
with medicines, and sometimes I might recommend an operation. I
will discuss this with you at length.
This is a relatively common problem in babies. It is caused by a
thickening of the muscle that regulates how quickly your child's
stomach empties into the rest of the intestine. This thickening
causes a blockage, meaning the stomach cannot empty, and your child
therefore vomits his or her feeds back.
I can usually diagnose the problem by feeling for the lump of
muscle in your child's tummy, although I will sometimes organise an
ultra-sound scan.It is always necessary to treat pyloric stenosis
with a small operation. This will be carried out after we have
corrected your child's dehydration with an intra-venous drip. The
operation is never carried out as an emergency.
Inflammatory bowel disease
Crohn's disease and Ulcerative Colitis (UC) do occur in children,
although these conditions are not as common as in adults. I
recommend that your child is looked after by one of my Specialist
Paediatric Gastro-enterolgy colleagues, although I work very
closely with them if your child might require an operation as part
of their treatment. There are many operations I might recommend,
from removing diseased bowel, to operations to help your child take
enough nutrition to fight their illness. We will meet to discuss
this as frequently as is necessary to make the right decision,
often with your child's Consultant Paediatric Gastro-enterologist
This is an essential part of preparing your child for an operation;
in fact unless we are treating a child as an absolute emergency, we
cannot carry an operation without your permission. This involves
you and I signing a form, and if your child is old enough, s/he can
sign it too. We only sign this form when we have spoken about my
recommended operation, and you feel you have enough information to
allow me and my team to do that operation.Signing a consent form
does not commit you to letting us operate, you can always change
your mind, and ask more questions before finally allowing us to
proceed.I will usually ask yo to sign the consent form in the
clinic, giving you time to go away, and think about what I have
said, and talk things over with people important to you. I will
give you a copy of the form we have signed together, but I keep the
'master copy' and you do not have to bring your copy back with you
when we do your child's operation.On the day of surgery, I will go
through everything again, and give you chance to ask anymore
questions. I will then re-sign the form to confirm we are 'good to
Your child's treatment /FAQ
"A silly question is the one you did not ask!!".
I know families can find coming to hospital quite upsetting, and
so forget all of the things they wanted to ask. Therefore, I
suggest that you write down everything that you want to ask BEFORE
you come to see me, either in clinic, or on the ward.
Please never leave a consultation with me feeling confused- always
*Does every child I see need an operation?
NO! Just because I am a Surgeon does not mean that all children I
am referred need an operation! For some conditions an operation
might be part of the treatment, but part of my job is helping
understand when an operation is NOT necessary. Quite a lot of my
work is carried out in the Out-patient clinic only.
*Where do I have out-patient clinics?
All of my NHS out-patient work is carried out at RMCH; my clinics
happen on Tuesdays *If my child needs an operation, where will it
happen? Most NHS treatments are carried out at RMCH If I am
treating your child privately, I will advise you where it is most
appropriate for you child to have his/her operation; most children
are very safely treated at the Spire Hospital, Manchester. However,
if your child is very young, or has complex medical problems, I
will organise an admission to RMCH.
*Will the nurses looking after my child be Registered
Children's Nurses (RSCN)?
Yes, always at RMCH However, if your child is over 13 years of age
in the Spire Hospital, care may be shared between an RSCN and Adult
trained nurse. This will not affect the quality of care your child
*Will my Child's Anaesthetist be a Paediatric
Yes always; I work with a Team of skilled Consultant Paediatric
Anaesthetists who are experienced in anaesthesia for babies and
children. I make sure that your child's anaesthetist has expertise
appropriate to your child's needs.
*What if my child needs an Xray?
If your child needs Xray or scan I refer to Consultant Paediatric
Radiologists based with me at RMCH; most children I see do not need
*Or blood tests?
My Nurses in Out-patient or on the wards will take your child's
blood although most children I see do not need blood tests
*Do we need Private Healthcare insurance for private
Not at all. More and more people without insurance
are choosing to pay for Out-patient consultation or even surgical
treatment ('self pay').
If you are insured I will give you details of your child's
condition and treatment to make authorisation for treatment with
your insurance company as smooth as possible.
Coming to hospital.
Coming to hospital can be distressing for everyone. How many
parents would not swap places with their child when they see their
child so vulnerable? I will do my best to ease all your anxieties
by explaining as much as I can in a way that you all understand. If
your child is very anxious, or has specific fears that will make
their treatment very difficult, we are very fortunate to be able to
get support from my Play Leaders, based at RMCH. If your child has
an illness on the Autistic spectrum, please let me know before
you attend hospital or Out-patients so that we can be in touch
and devise a pathway of care individualised for you child.
*What about after my child's operation?
Most children I treat are admitted as 'day cases" that is, you
will be admitted and discharged the same day
Please make sure you have plenty of Calpol or paracetamol at home-
most operations I do mean that you child will be sore for up to 1
day after discharge from hospital. Generally I use dressings
that will fall off after about 10 days. I sometimes will ask a
District Nurse to pop in, or that you go to your GP, for a dressing
change after a few days. I will discuss this with you after the
operation. I generally do not advise you bath your child for
24 hours after the operation. After that I am happy to recommend a
daily bath or shower.
Most children are ready for school 48 hours after their operation.
We can discuss this in clinic before your admission. I do recommend
older children avoid PE or sport at school for a week or two after
surgery; in fact most children will find their comfortable level of
activity as they recover, and I do not discourage you from letting
your child do what they want.
*Will you send me some information to prepare for my
child's admission to hospital?
Yes; our pre-admission team will confirm your child's admission a
few days before the planned day. Please make sure you let us know
that you are coming in; sometimes, when a family have not confirmed
with us that they will be bringing their child for an operation, we
offer the space to another child which can then cause upset to
everyone if the first family arrive! We will also send you the
important instructions about how to prepare your child for their
operation- please read the carefully!
If your child is having a colonoscopy I will have sent you some
'Bowel prep'. You give these strong laxatives the night before your
child's examination, and are meant to clear all of the poo from
your child's large intestine so that I can get good views all the
way around. Without the bowel prep, all I will be able to see could
be last night's supper!
It is essential that your child has nothing to eat or drink for 6
hours before the intended operation time; s/he can have a glass of
water no less than 2 hours before this time. I am very happy
for your child to come to the operating theatre in his/her own
clothes or PJs. Your child should wear a hospital gown if I am
carrying out a colonoscopy.
Please do bring a favourite teddy or toy, but please don't bring
many items as things get lost
*What happens when we arrive at the
One of my Nursing staff will introduce you to the ward. My
Nurses will ask some questions about your child to make sure we are
prepared for the operation
You may be asked to choose a meal for after the operation
Your Anaesthetist will meet you and discuss the anaesthetic
Please ask all the questions you feel necessary
I will also be there to go through the operation again; I will go
through the consent form with you again, and ask to to sign it if
we did not do this in clinic already. Please do not sign this until
you completely understand what I am planning (see above
I will give the chance for older children to sign the consent form
too; although this is not a legal requirement, it does let your
child tell us they understand what is happening to them
*Tell me what happens around the time of the
You will able to accompany your child to the anaesthetic room.
This can be quite upsetting for some parents Once your child has
been 'put to sleep', my nurses will accompany you back to the ward
You will usually be apart from your child for less than an hourOnce
your child is awake in the recovery room, you will be able to go
over and fetch him/her back to the ward, with one of our
nurses. I usually advise you to give your child some food, or
a feed, when s/he is back on the ward
Your child will be sleepy for couple of hours after the
Children often don't have a wee before they go home.
*What happens in the post-op period?
I hope to discharge your child within 2 or 3 hours after they come
back to the ward from theatre after a 'day-case' operation
I will come and visit you on the ward as soon as I can after the
operation to let you know how things went, and discuss
dressings, discharge, school, pain relief etc
A review in clinic (Follow-up) is sometimes necessary a few weeks
after surgery. I will organise this before you leave hospital if I
can. I will always write to your GP so that s/he knows what I
have done, and if I want them to help with your child's post-op
care. After some operations I will ask a District Nurse to pop in,
or that you see your GP practice nurse.
My Nurses on the ward will also give you contact details before
you go home in case you need to ring them
Getting in touch.
At RMCH, Linda is my PA, on 0161 701 5194
Email - email@example.com