# Advances in Pediatric Surgery — GCMD Library living collection Updated: n/a · 5 episodes · 17 cited statements ## Episodes ### Innovative Techniques - [Profesor visitante Dr. Rodrigo Casals participa enseñando novedosa técnica quirúrgica](https://library.globalcastmd.com/watch/profesor-visitante-dr-rodrigo-casals-participa-ense-ando-novedosa-t-cnica-quir-rgica-14008) — article · [machine version](https://library.globalcastmd.com/watch/profesor-visitante-dr-rodrigo-casals-participa-ense-ando-novedosa-t-cnica-quir-rgica-14008.md) ### Fetal Surgery - [The fetal frontier: A review of current and emerging fetal therapies for genetic diseases](https://library.globalcastmd.com/watch/the-fetal-frontier-a-review-of-current-and-emerging-fetal-therapies-for-genetic-diseases-12057) — video · 0:44 · [machine version](https://library.globalcastmd.com/watch/the-fetal-frontier-a-review-of-current-and-emerging-fetal-therapies-for-genetic-diseases-12057.md) ### Literature Updates - [Journal of Pediatric Surgery Article Review: September 2021](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2021-4527) — podcast · 11:16 · [machine version](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2021-4527.md) - [Quick Literature Updates Episode 2](https://library.globalcastmd.com/watch/quick-literature-updates-episode-2-6509) — video · [machine version](https://library.globalcastmd.com/watch/quick-literature-updates-episode-2-6509.md) - [2025 Pediatric Surgery Update Course - Updates in Pediatric Surgery feat. non-JPS Journals](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-pediatric-surgery-feat-non-jps-journals-10897) — video · 22:32 · [machine version](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-pediatric-surgery-feat-non-jps-journals-10897.md) ## Chapters - [0:08](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2021-4527?t=8) Early feeding versus traditional feeding after neonatal intestinal anastomosis and Meckel diverticulum predictive score (Ep 3) - [6:53](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2021-4527?t=413) Perianal symptoms and Crohn disease incidence in children (Ep 3) - [0:00](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-pediatric-surgery-feat-non-jps-journals-10897?t=0) Introduction and Nonoperative Management of Appendicitis (Ep 5) - [4:07](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-pediatric-surgery-feat-non-jps-journals-10897?t=247) DVT Prophylaxis in Pediatric Trauma (Ep 5) - [9:28](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-pediatric-surgery-feat-non-jps-journals-10897?t=568) Neuroendocrine Tumors of the Appendix (Ep 5) - [16:52](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-pediatric-surgery-feat-non-jps-journals-10897?t=1012) Stoma versus Anastomosis in Necrotizing Enterocolitis (Ep 5) - [0:00](https://library.globalcastmd.com/watch/the-fetal-frontier-a-review-of-current-and-emerging-fetal-therapies-for-genetic-diseases-12057?t=0) Fetal Therapies for Genetic Diseases (Ep 2) ## Statements Every statement is attributed, typed, and timestamped; the link is the citation. - Although there is evidence that early feeding in adult patients after intestinal surgery is beneficial, the authors did not find any benefit in neonates. — Mick Kakaran (clinical) [Ep 3 · 2:37](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2021-4527?t=157) - Babies with blood in their stool causing a decrease in hemoglobin has always been a red flag sign for Meckel diverticulum. — Mick Kakaran (clinical) [Ep 3 · 3:06](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2021-4527?t=186) - A Cincinnati Children's study examined children aged 0-18 within a 15-mile radius who presented with perianal symptoms (abscess, fissure, fistula) to determine how often this represents Crohn disease. — Iris Lim Butel (clinical) [Ep 3 · 7:23](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2021-4527?t=443) - Overall, 3% of children presenting with perianal symptoms were diagnosed with Crohn disease. — Iris Lim Butel (epidemiological) [Ep 3 · 9:02](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2021-4527?t=542) - No children under age 1 with perianal abscess ended up having Crohn disease within the study period. — Iris Lim Butel (epidemiological) [Ep 3 · 9:02](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2021-4527?t=542) - Higher rates of Crohn disease were seen in older children, particularly over age 10, among those presenting with perianal symptoms. — Julian Goddard (epidemiological) [Ep 3 · 9:16](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2021-4527?t=556) - Many patients in the study had fissures, which are very common in children and may have been managed as outpatients. — Iris Lim Butel (clinical) [Ep 3 · 9:41](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2021-4527?t=581) - Quite a few children with Crohn disease present with perirectal abscess rather than typical GI symptoms like abdominal pain and diarrhea. (clinical) [Ep 3 · 10:23](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2021-4527?t=623) - The Chilean Society of Pediatric Surgery Journal Hive team screens through 1200 articles each month using a method to select high-quality publications — Jose Campos (clinical) [Ep 5 · 0:48](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-pediatric-surgery-feat-non-jps-journals-10897?t=48) - The failure rate over 30% in nonoperative management of appendicitis is concerning, but nonoperative management is still safe with no adverse events in both groups (opinion) [Ep 5 · 6:37](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-pediatric-surgery-feat-non-jps-journals-10897?t=397) - In pediatric trauma, the cutoff of approximately 12 years or puberty is used as the breaking point for when to think about VTE prophylaxis — Katie Rossel (guideline) [Ep 5 · 11:04](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-pediatric-surgery-feat-non-jps-journals-10897?t=664) - VTE prophylaxis should be started as soon as the patient is stable unless there are contraindications like TBI, and conversations with neurosurgeons can often clarify when it is safe to start — Katie Rossel (clinical) [Ep 5 · 11:57](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-pediatric-surgery-feat-non-jps-journals-10897?t=717) - Only one in every 1000 appendectomy patients will have a tumor in the appendix, and not all are neuroendocrine tumors, meaning every surgeon will only treat a handful of these cases in their lifetime — Jose Campos (epidemiological) [Ep 5 · 13:37](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-pediatric-surgery-feat-non-jps-journals-10897?t=817) - Multiple retrospective studies and the large database study have shown that appendectomy alone is sufficient for appendiceal neuroendocrine tumors, and additional imaging is not needed because it does not change management (clinical) [Ep 5 · 17:18](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-pediatric-surgery-feat-non-jps-journals-10897?t=1038) - A review of 5000 children who had appendectomy at SickKids found about 30 had a carcinoid, only 10 underwent right hemicolectomy, and of these 10 maybe only half actually needed it (clinical) [Ep 5 · 17:44](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-pediatric-surgery-feat-non-jps-journals-10897?t=1064) - The biology of appendiceal neuroendocrine tumors is totally different in children compared to adults, and the behavior in pediatric patients and adolescents is entirely different than in adults, with margins not making a difference when doing appendectomy alone — Jose Campos (clinical) [Ep 5 · 18:51](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-pediatric-surgery-feat-non-jps-journals-10897?t=1131) - Previous studies on appendiceal neuroendocrine tumors drew the line at 15 years, but the database study compared up to 18 years, so conclusions are valid up to 18 years of age — Jose Campos (clinical) [Ep 5 · 19:35](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-pediatric-surgery-feat-non-jps-journals-10897?t=1175) ## Host summaries Recaps by a host of what the experts said — not the host's own clinical position. - Faster prenatal diagnosis enables detection of many genetic conditions early — Lizzie Lee summarizing a resource [Ep 2 · 0:14](https://library.globalcastmd.com/watch/the-fetal-frontier-a-review-of-current-and-emerging-fetal-therapies-for-genetic-diseases-12057?t=14) - Medications can be given to the mother that cross the placenta — Lizzie Lee summarizing a resource [Ep 2 · 0:18](https://library.globalcastmd.com/watch/the-fetal-frontier-a-review-of-current-and-emerging-fetal-therapies-for-genetic-diseases-12057?t=18) - Enzyme replacement therapy can be delivered directly to the fetus — Lizzie Lee summarizing a resource [Ep 2 · 0:18](https://library.globalcastmd.com/watch/the-fetal-frontier-a-review-of-current-and-emerging-fetal-therapies-for-genetic-diseases-12057?t=18) - Protein therapy can be delivered to the fetus — Lizzie Lee summarizing a resource [Ep 2 · 0:24](https://library.globalcastmd.com/watch/the-fetal-frontier-a-review-of-current-and-emerging-fetal-therapies-for-genetic-diseases-12057?t=24) - Stem cells can be delivered to the fetus — Lizzie Lee summarizing a resource [Ep 2 · 0:24](https://library.globalcastmd.com/watch/the-fetal-frontier-a-review-of-current-and-emerging-fetal-therapies-for-genetic-diseases-12057?t=24) - The fetus has a more tolerant immune system compared to postnatal life — Lizzie Lee summarizing a resource [Ep 2 · 0:27](https://library.globalcastmd.com/watch/the-fetal-frontier-a-review-of-current-and-emerging-fetal-therapies-for-genetic-diseases-12057?t=27) - The fetus has a more permissive blood-brain barrier compared to postnatal life — Lizzie Lee summarizing a resource [Ep 2 · 0:27](https://library.globalcastmd.com/watch/the-fetal-frontier-a-review-of-current-and-emerging-fetal-therapies-for-genetic-diseases-12057?t=27) - Most fetal therapies for genetic diseases are still experimental — Lizzie Lee summarizing a resource [Ep 2 · 0:34](https://library.globalcastmd.com/watch/the-fetal-frontier-a-review-of-current-and-emerging-fetal-therapies-for-genetic-diseases-12057?t=34) - Fetal intervention aims to prevent lifelong disease by treating during fetal development — Lizzie Lee summarizing a resource [Ep 2 · 0:38](https://library.globalcastmd.com/watch/the-fetal-frontier-a-review-of-current-and-emerging-fetal-therapies-for-genetic-diseases-12057?t=38) - A Chinese randomized multi-center trial of 156 neonates who underwent surgery for gastrointestinal malformation with intestinal anastomosis compared early internal feeding versus traditional nasogastric decompression. — Rod Gerardo summarizing the discussion [Ep 3 · 0:44](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2021-4527?t=44) - The early feeding group started feeds at 2 days compared to 6 days in the traditional feeding group. — Rod Gerardo summarizing the discussion [Ep 3 · 0:44](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2021-4527?t=44) - There was no significant difference between early and traditional feeding groups in length of stay, time to full feeds, postoperative complications, 30-day mortality, or 30-day readmissions. — Rod Gerardo summarizing the discussion [Ep 3 · 0:44](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2021-4527?t=44) - In the early feeding group, patients did not have a decompressing nasogastric tube, suggesting nasogastric decompression is not needed after neonatal intestinal anastomosis. — Rod Gerardo summarizing the discussion [Ep 3 · 3:06](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2021-4527?t=186) - A Utah study examined patients under age 18 who presented with hematochezia to identify which factors predict Meckel diverticulum and created a risk score. — Rod Gerardo summarizing the discussion [Ep 3 · 3:06](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2021-4527?t=186) - The Meckel score could help clinicians skip the Meckel scan and go straight to laparoscopy in high-score patients, even with a negative scan. — Rod Gerardo summarizing the discussion [Ep 3 · 3:06](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2021-4527?t=186) - Under age 10, clinicians do not need to worry about doing a workup for Crohn disease in children with perianal symptoms; over age 10, they should. — Rod Gerardo summarizing the discussion [Ep 3 · 10:06](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2021-4527?t=606) - The APPY trial is an international multicenter study comparing appendectomy versus antibiotics for acute uncomplicated appendicitis in children, with 936 patients aged 5-16 years randomized across 11 hospitals — Jose Campos summarizing the discussion [Ep 5 · 4:33](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-pediatric-surgery-feat-non-jps-journals-10897?t=273) - In the APPY trial, treatment failure was defined differently in each arm: in the antibiotic group as appendectomy needed within one year, and in the surgical group as negative appendectomy or any procedure under general anesthesia related to appendicitis within one year — Jose Campos summarizing the discussion [Ep 5 · 4:33](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-pediatric-surgery-feat-non-jps-journals-10897?t=273) - At one year in the APPY trial, 31% of children in the antibiotic group failed treatment compared with 7% in the appendectomy group, with the 26.7% difference exceeding the pre-specified 20% non-inferiority margin — Jose Campos summarizing the discussion [Ep 5 · 4:33](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-pediatric-surgery-feat-non-jps-journals-10897?t=273) - Children in the antibiotic group of the APPY trial returned to school earlier and needed almost no pain medication — Jose Campos summarizing the discussion [Ep 5 · 6:10](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-pediatric-surgery-feat-non-jps-journals-10897?t=370) - The APPY trial had 10% of patients with incomplete data and consent refusal reasons were not collected — Jose Campos summarizing the discussion [Ep 5 · 6:10](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-pediatric-surgery-feat-non-jps-journals-10897?t=370) - Some guidelines recommend against DVT prophylaxis in pediatric trauma, and in the study only 50% of doctors caring for these children gave DVT prophylaxis — Jose Campos summarizing the discussion [Ep 5 · 7:25](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-pediatric-surgery-feat-non-jps-journals-10897?t=445) - A JAMA Surgery 2024 study prospectively evaluated 462 pediatric trauma patients with high risk for deep vein thrombosis across level one trauma centers, comparing outcomes based on whether prophylaxis was given and when it was initiated — Johan Karameez summarizing the discussion [Ep 5 · 9:28](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-pediatric-surgery-feat-non-jps-journals-10897?t=568) - No major bleeding event occurred in any patient who received anticoagulation in the DVT prophylaxis study — Johan Karameez summarizing the discussion [Ep 5 · 9:28](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-pediatric-surgery-feat-non-jps-journals-10897?t=568) - Patients who received DVT prophylaxis within 24 hours had a venous thromboembolism rate of 1.6%, while those who received it after 24 hours had a rate of 6.9%, nearly identical to the 5.3% in patients who never received prophylaxis — Johan Karameez summarizing the discussion [Ep 5 · 9:28](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-pediatric-surgery-feat-non-jps-journals-10897?t=568) - The DVT prophylaxis study had low adherence to VTE guidelines with almost half of patients never receiving prophylaxis and relatively low absolute numbers of VTE events restricting statistical power — Johan Karameez summarizing the discussion [Ep 5 · 10:36](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-pediatric-surgery-feat-non-jps-journals-10897?t=636) - The DVT prophylaxis study was powered to detect any adverse event and there was no adverse event whatsoever from prophylaxis — Jose Campos summarizing the discussion [Ep 5 · 13:06](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-pediatric-surgery-feat-non-jps-journals-10897?t=786) - A Journal of American College of Surgeons 2025 study using the National Cancer Database between 2004 and 2022 identified 1339 patients under 18 years with appendiceal neuroendocrine tumors, comparing appendectomy versus right hemicolectomy — Jose Campos summarizing the discussion [Ep 5 · 15:12](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-pediatric-surgery-feat-non-jps-journals-10897?t=912) - In the neuroendocrine tumor study, survival was excellent and equivalent between appendectomy and hemicolectomy groups: 99.9% at 5 years and 99.4% at 10 years without chemotherapy or additional treatment — Jose Campos summarizing the discussion [Ep 5 · 15:12](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-pediatric-surgery-feat-non-jps-journals-10897?t=912) - No forced disease progression occurred in children treated with appendectomy alone, even when high-risk features like tumor larger than 2 centimeters, positive margins, or positive lymph nodes were present — Jose Campos summarizing the discussion [Ep 5 · 15:12](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-pediatric-surgery-feat-non-jps-journals-10897?t=912) - The TOUCH trial was the first multicenter randomized control trial comparing stoma versus anastomosis in necrotizing enterocolitis, randomizing patients during laparotomy when both options were deemed feasible — Jose Campos summarizing the discussion [Ep 5 · 20:31](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-pediatric-surgery-feat-non-jps-journals-10897?t=1231) - The TOUCH trial found no difference in mortality or complications in general between stoma and anastomosis groups, but the stoma group had up to 19% of intestinal and stoma complications — Jose Campos summarizing the discussion [Ep 5 · 21:30](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-pediatric-surgery-feat-non-jps-journals-10897?t=1290) - In the TOUCH trial, the likelihood of being weaned from parenteral nutrition was much higher in the anastomosis group, and children were weaned 20 days earlier compared to the stoma group — Jose Campos summarizing the discussion [Ep 5 · 21:30](https://library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-pediatric-surgery-feat-non-jps-journals-10897?t=1290) --- Educational content from recorded physician discussions — not medical advice. 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