# Neonatal Surgery — GCMD Library living collection

Updated: n/a · 5 episodes · 26 cited statements

## Episodes
### Necrotizing Enterocolitis
- [Surgical Decision-Making in Necrotizing Enterocolitis: Imaging, Timing, and Operative Strategies](https://library.globalcastmd.com/watch/surgical-decision-making-in-necrotizing-enterocolitis-imaging-timing-and-operati-16840) — podcast · 11:03 · [machine version](https://library.globalcastmd.com/watch/surgical-decision-making-in-necrotizing-enterocolitis-imaging-timing-and-operati-16840.md)
- [Literature review: tracheomalacia diagnosis, NEC strictures, and PDA management](https://library.globalcastmd.com/watch/literature-review-tracheomalacia-diagnosis-nec-strictures-and-pda-management-16860) — podcast · 4:19 · [machine version](https://library.globalcastmd.com/watch/literature-review-tracheomalacia-diagnosis-nec-strictures-and-pda-management-16860.md)

### Esophageal Anomalies
- [Transtracheal approach for recurrent tracheoesophageal fistula repair](https://library.globalcastmd.com/watch/transtracheal-approach-for-recurrent-tracheoesophageal-fistula-repair-16841) — podcast · 2:20 · [machine version](https://library.globalcastmd.com/watch/transtracheal-approach-for-recurrent-tracheoesophageal-fistula-repair-16841.md)

### Intestinal Atresia
- [Association of small intestinal atresia and Hirschsprung disease in a multi-institutional colorectal registry](https://library.globalcastmd.com/article/association-of-small-intestinal-atresia-and-hirschsprung-disease-in-a-multi-inst-16879) — article · [machine version](https://library.globalcastmd.com/article/association-of-small-intestinal-atresia-and-hirschsprung-disease-in-a-multi-inst-16879.md)

### Urachal Anomalies
- [Nonoperative management of symptomatic urachal anomalies](https://library.globalcastmd.com/article/nonoperative-management-of-symptomatic-urachal-anomalies-16885) — article · [machine version](https://library.globalcastmd.com/article/nonoperative-management-of-symptomatic-urachal-anomalies-16885.md)

## Chapters
- [0:00](https://library.globalcastmd.com/watch/surgical-decision-making-in-necrotizing-enterocolitis-imaging-timing-and-operati-16840?t=0) Introduction and Case Presentation: Diagnostic Challenges in NEC (Ep 1)
- [1:51](https://library.globalcastmd.com/watch/surgical-decision-making-in-necrotizing-enterocolitis-imaging-timing-and-operati-16840?t=111) Ultrasound vs X-ray: Improving Early Detection of Surgical NEC (Ep 1)
- [3:25](https://library.globalcastmd.com/watch/surgical-decision-making-in-necrotizing-enterocolitis-imaging-timing-and-operati-16840?t=205) Operative Decision-Making: Primary Anastomosis vs Stoma vs Clip-and-Drop (Ep 1)
- [7:23](https://library.globalcastmd.com/watch/surgical-decision-making-in-necrotizing-enterocolitis-imaging-timing-and-operati-16840?t=443) Postoperative Management: Mucous Fistula Refeeding (Ep 1)
- [8:30](https://library.globalcastmd.com/watch/surgical-decision-making-in-necrotizing-enterocolitis-imaging-timing-and-operati-16840?t=510) Stoma Closure Timing and Summary of Key Points (Ep 1)
- [0:01](https://library.globalcastmd.com/watch/transtracheal-approach-for-recurrent-tracheoesophageal-fistula-repair-16841?t=1) Introduction and clinical question (Ep 3)
- [0:34](https://library.globalcastmd.com/watch/transtracheal-approach-for-recurrent-tracheoesophageal-fistula-repair-16841?t=34) Case presentation and diagnostic findings (Ep 3)
- [1:17](https://library.globalcastmd.com/watch/transtracheal-approach-for-recurrent-tracheoesophageal-fistula-repair-16841?t=77) Transtracheal surgical approach and nerve protection (Ep 3)
- [2:01](https://library.globalcastmd.com/watch/transtracheal-approach-for-recurrent-tracheoesophageal-fistula-repair-16841?t=121) Summary and conclusion (Ep 3)
- [0:00](https://library.globalcastmd.com/watch/literature-review-tracheomalacia-diagnosis-nec-strictures-and-pda-management-16860?t=0) Preoperative Tracheobronchoscopy for Tracheomalacia in Esophageal Atresia (Ep 2)
- [1:44](https://library.globalcastmd.com/watch/literature-review-tracheomalacia-diagnosis-nec-strictures-and-pda-management-16860?t=104) Intestinal Strictures After Conservative Management of Necrotizing Enterocolitis (Ep 2)
- [2:42](https://library.globalcastmd.com/watch/literature-review-tracheomalacia-diagnosis-nec-strictures-and-pda-management-16860?t=162) Expectant Management Versus Early Ibuprofen for Patent Ductus Arteriosus (Ep 2)
- [4:02](https://library.globalcastmd.com/watch/literature-review-tracheomalacia-diagnosis-nec-strictures-and-pda-management-16860?t=242) Closing Remarks (Ep 2)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- The seven-year-old patient had a history of TEF with prior repair and was presenting with chronic cough and food impaction. — Doug Van Altman (clinical) [Ep 3 · 0:34](https://library.globalcastmd.com/watch/transtracheal-approach-for-recurrent-tracheoesophageal-fistula-repair-16841?t=34)
- The patient was referred for esophageal diverticulum and airway evaluation was performed. — Doug Van Altman (clinical) [Ep 3 · 0:43](https://library.globalcastmd.com/watch/transtracheal-approach-for-recurrent-tracheoesophageal-fistula-repair-16841?t=43)
- Esophagoscopy showed the esophageal anastomosis with a ledge formation and dilated upper pouch. — Doug Van Altman (clinical) [Ep 3 · 0:53](https://library.globalcastmd.com/watch/transtracheal-approach-for-recurrent-tracheoesophageal-fistula-repair-16841?t=53)
- Bronchoscopy revealed granulation tissue along the back wall of the airway. — Doug Van Altman (clinical) [Ep 3 · 1:03](https://library.globalcastmd.com/watch/transtracheal-approach-for-recurrent-tracheoesophageal-fistula-repair-16841?t=63)
- Second fistulas or H-type fistulas can be very difficult to manage endoscopically. — Doug Van Altman (opinion) [Ep 3 · 1:06](https://library.globalcastmd.com/watch/transtracheal-approach-for-recurrent-tracheoesophageal-fistula-repair-16841?t=66)
- Esophagram demonstrated mismatch and out-pouching at the anastomosis site. — Doug Van Altman (clinical) [Ep 3 · 1:12](https://library.globalcastmd.com/watch/transtracheal-approach-for-recurrent-tracheoesophageal-fistula-repair-16841?t=72)
- The transtracheal technique involves performing a distal tracheotomy with ET tube placement, using bronchoscopy to localize the fistula level, then making a tracheotomy over the fistula site. — Doug Van Altman (clinical) [Ep 3 · 1:30](https://library.globalcastmd.com/watch/transtracheal-approach-for-recurrent-tracheoesophageal-fistula-repair-16841?t=90)
- The surgeon works through the tracheotomy to divide the layers of the esophagus. — Doug Van Altman (clinical) [Ep 3 · 1:41](https://library.globalcastmd.com/watch/transtracheal-approach-for-recurrent-tracheoesophageal-fistula-repair-16841?t=101)
- Recurrent laryngeal nerve injury is underreported. — Doug Van Altman (epidemiological) [Ep 3 · 1:49](https://library.globalcastmd.com/watch/transtracheal-approach-for-recurrent-tracheoesophageal-fistula-repair-16841?t=109)
- True recurrent laryngeal nerve paralysis leads to muscle atrophy over time, resulting in long-term voice problems and potential aspiration issues. — Doug Van Altman (clinical) [Ep 3 · 1:52](https://library.globalcastmd.com/watch/transtracheal-approach-for-recurrent-tracheoesophageal-fistula-repair-16841?t=112)
- Abdominal X-rays for NEC have sensitivity between 13 and 25% — Augusto Zani (clinical) [Ep 1 · 1:56](https://library.globalcastmd.com/watch/surgical-decision-making-in-necrotizing-enterocolitis-imaging-timing-and-operati-16840?t=116)
- High-risk ultrasound findings for bowel perforation include pneumoperitoneum, focal fluid collections, and complex fluid — Augusto Zani (clinical) [Ep 1 · 2:59](https://library.globalcastmd.com/watch/surgical-decision-making-in-necrotizing-enterocolitis-imaging-timing-and-operati-16840?t=179)
- Intermediate-risk ultrasound findings include increased bowel wall ecogenicity, absent perfusion, portal venous gas, and bowel thinning or thickening — Augusto Zani (clinical) [Ep 1 · 3:07](https://library.globalcastmd.com/watch/surgical-decision-making-in-necrotizing-enterocolitis-imaging-timing-and-operati-16840?t=187)
- In NEC, the diseased bowel is a symptom or result of the illness, not the cause of the illness — Todd Ponsky (opinion) [Ep 1 · 4:28](https://library.globalcastmd.com/watch/surgical-decision-making-in-necrotizing-enterocolitis-imaging-timing-and-operati-16840?t=268)
- The disease process in NEC still progresses even after resection, which is the problem of operating too early — Todd Ponsky (clinical) [Ep 1 · 4:34](https://library.globalcastmd.com/watch/surgical-decision-making-in-necrotizing-enterocolitis-imaging-timing-and-operati-16840?t=274)
- In stable babies with a limited segment of necrotic bowel (approximately 10 cm), resection with primary anastomosis may not result in poor outcomes — Augusto Zani (opinion) [Ep 1 · 4:47](https://library.globalcastmd.com/watch/surgical-decision-making-in-necrotizing-enterocolitis-imaging-timing-and-operati-16840?t=287)
- Data shows primary anastomosis is better than stoma or clip-and-drop in well babies — Todd Ponsky (clinical) [Ep 1 · 5:06](https://library.globalcastmd.com/watch/surgical-decision-making-in-necrotizing-enterocolitis-imaging-timing-and-operati-16840?t=306)
- Decision to proceed with anastomosis after clip-and-drop depends on hemodynamic markers: correcting lactic acid, correcting thrombocytopenia, and weaning off inotropes — Juan Gurria (clinical) [Ep 1 · 5:45](https://library.globalcastmd.com/watch/surgical-decision-making-in-necrotizing-enterocolitis-imaging-timing-and-operati-16840?t=345)
- The SAT trial was a randomized controlled trial with final eligibility determined by surgeon's judgment during laparotomy — Simon Eaton (clinical) [Ep 1 · 6:19](https://library.globalcastmd.com/watch/surgical-decision-making-in-necrotizing-enterocolitis-imaging-timing-and-operati-16840?t=379)
- In the SAT trial, randomization occurred intraoperatively after the surgeon determined the baby was hemodynamically stable — Augusto Zani (clinical) [Ep 1 · 6:34](https://library.globalcastmd.com/watch/surgical-decision-making-in-necrotizing-enterocolitis-imaging-timing-and-operati-16840?t=394)
- A systematic review and meta-analysis by Bonnie Jasani from Toronto Sick Kids examined mucous fistula refeeding, but the evidence isn't strong so far — Simon Eaton (clinical) [Ep 1 · 8:10](https://library.globalcastmd.com/watch/surgical-decision-making-in-necrotizing-enterocolitis-imaging-timing-and-operati-16840?t=490)
- A randomized controlled trial of mucous fistula refeeding timed to full enteral feeds is currently ongoing — Simon Eaton (clinical) [Ep 1 · 8:21](https://library.globalcastmd.com/watch/surgical-decision-making-in-necrotizing-enterocolitis-imaging-timing-and-operati-16840?t=501)
- A recent paper in Journal of Surgical Research shows that early stoma closure (before 8 weeks) appears to be safe — Simon Eaton (clinical) [Ep 1 · 8:41](https://library.globalcastmd.com/watch/surgical-decision-making-in-necrotizing-enterocolitis-imaging-timing-and-operati-16840?t=521)
- The early stoma closure study is very underpowered, and in the less-than-8-weeks group, 2 infants had repeat episodes of NEC — Simon Eaton (clinical) [Ep 1 · 8:54](https://library.globalcastmd.com/watch/surgical-decision-making-in-necrotizing-enterocolitis-imaging-timing-and-operati-16840?t=534)
- The Toskin mixed-method study is an ongoing preparation for a randomized trial in the UK examining timing of stoma closure — Simon Eaton (clinical) [Ep 1 · 9:07](https://library.globalcastmd.com/watch/surgical-decision-making-in-necrotizing-enterocolitis-imaging-timing-and-operati-16840?t=547)
- Surgeons need to be prepared to have some negative laparotomies when operating based on clinical suspicion and ultrasound findings without free air on X-ray — Augusto Zani (opinion) [Ep 1 · 9:45](https://library.globalcastmd.com/watch/surgical-decision-making-in-necrotizing-enterocolitis-imaging-timing-and-operati-16840?t=585)

## Host summaries
Recaps by a host of what the experts said — not the host's own clinical position.
- Recurrent tracheoesophageal fistulas can develop years after initial repair. — Jill Knepprath summarizes what Dr. Doug Van Altman said [Ep 3 · 0:08](https://library.globalcastmd.com/watch/transtracheal-approach-for-recurrent-tracheoesophageal-fistula-repair-16841?t=8)
- Esophageal dilations were performed without improvement. — Jill Knepprath summarizes what Dr. Doug Van Altman said [Ep 3 · 0:48](https://library.globalcastmd.com/watch/transtracheal-approach-for-recurrent-tracheoesophageal-fistula-repair-16841?t=48)
- The recurrent laryngeal nerve is at risk of damage during repair of recurrent TEFs. — Jill Knepprath summarizes what Dr. Doug Van Altman said [Ep 3 · 1:17](https://library.globalcastmd.com/watch/transtracheal-approach-for-recurrent-tracheoesophageal-fistula-repair-16841?t=77)
- A transtracheal approach provides better surgical exposure and reduces risk to the recurrent laryngeal nerve. — Jill Knepprath summarizes what Dr. Doug Van Altman said [Ep 3 · 1:25](https://library.globalcastmd.com/watch/transtracheal-approach-for-recurrent-tracheoesophageal-fistula-repair-16841?t=85)
- The transtracheal approach minimizes injury to the recurrent laryngeal nerve. — Jill Knepprath summarizes what Dr. Doug Van Altman said [Ep 3 · 1:46](https://library.globalcastmd.com/watch/transtracheal-approach-for-recurrent-tracheoesophageal-fistula-repair-16841?t=106)
- A 2023 study in Pediatric Radiology suggests ultrasound can detect bowel wall thinning, perfusion abnormalities, and fluid collections that X-ray misses — Lizzy Lee summarizing the discussion [Ep 1 · 2:15](https://library.globalcastmd.com/watch/surgical-decision-making-in-necrotizing-enterocolitis-imaging-timing-and-operati-16840?t=135)
- The long-term benefit of primary anastomosis may not be seen in immediate survival outcomes — Lizzy Lee summarizing the discussion [Ep 1 · 5:00](https://library.globalcastmd.com/watch/surgical-decision-making-in-necrotizing-enterocolitis-imaging-timing-and-operati-16840?t=300)
- The clip-and-drop method involves removing necrotic bowel segment, stapling the ends, and returning in 24-48 hours to assess bowel hemodynamics before committing to stoma or anastomosis — Lizzy Lee summarizing the discussion [Ep 1 · 5:18](https://library.globalcastmd.com/watch/surgical-decision-making-in-necrotizing-enterocolitis-imaging-timing-and-operati-16840?t=318)
- In the SAT trial, mortality was similar between primary anastomosis and stoma groups — Lizzy Lee summarizing the discussion [Ep 1 · 6:55](https://library.globalcastmd.com/watch/surgical-decision-making-in-necrotizing-enterocolitis-imaging-timing-and-operati-16840?t=415)
- Babies who received primary anastomosis in the SAT trial got off parenteral nutrition significantly sooner than those with stoma — Lizzy Lee summarizing the discussion [Ep 1 · 6:56](https://library.globalcastmd.com/watch/surgical-decision-making-in-necrotizing-enterocolitis-imaging-timing-and-operati-16840?t=416)
- Babies with primary anastomosis were able to return to enteral feeding more quickly and had fewer intestinal complications than those with stoma — Lizzy Lee summarizing the discussion [Ep 1 · 7:06](https://library.globalcastmd.com/watch/surgical-decision-making-in-necrotizing-enterocolitis-imaging-timing-and-operati-16840?t=426)
- Van Haal et al. conducted a retrospective cohort study in the Netherlands that included 79 patients who had rigid tracheobronchoscopy done before and after esophageal atresia surgery. — Lizzy Lee summarizes what Dr. Alex Halpern said [Ep 2 · 1:04](https://library.globalcastmd.com/watch/literature-review-tracheomalacia-diagnosis-nec-strictures-and-pda-management-16860?t=64)
- Pre-operative tracheobronchoscopy for the presence of post-operative tracheomalacia had a sensitivity of 50% and a specificity of 67%. — Lizzy Lee summarizes what Dr. Alex Halpern said [Ep 2 · 1:24](https://library.globalcastmd.com/watch/literature-review-tracheomalacia-diagnosis-nec-strictures-and-pda-management-16860?t=84)
- Pre-operative tracheobronchoscopy, though routine, has limited predictive value for post-operative tracheomalacia in esophageal atresia patients. — Lizzy Lee summarizes what Dr. Alex Halpern said [Ep 2 · 1:34](https://library.globalcastmd.com/watch/literature-review-tracheomalacia-diagnosis-nec-strictures-and-pda-management-16860?t=94)
- Mina et al. performed a retrospective review of all patients who underwent conservative management of modified Bell stage 2A or greater necrotizing enterocolitis at a single institution from 2011 to 2022. — Alex Halpern summarizing a resource [Ep 2 · 2:05](https://library.globalcastmd.com/watch/literature-review-tracheomalacia-diagnosis-nec-strictures-and-pda-management-16860?t=125)
- 126 patients underwent conservative management of necrotizing enterocolitis, and 24 of those patients eventually underwent surgery for a post-NEC stricture. — Alex Halpern summarizing a resource [Ep 2 · 2:20](https://library.globalcastmd.com/watch/literature-review-tracheomalacia-diagnosis-nec-strictures-and-pda-management-16860?t=140)
- Primary resection and anastomosis was performed in all cases of post-NEC stricture requiring surgery. — Alex Halpern summarizing a resource [Ep 2 · 2:29](https://library.globalcastmd.com/watch/literature-review-tracheomalacia-diagnosis-nec-strictures-and-pda-management-16860?t=149)
- Post-NEC strictures are a common occurrence after conservative management of necrotizing enterocolitis. — Alex Halpern summarizing a resource [Ep 2 · 2:33](https://library.globalcastmd.com/watch/literature-review-tracheomalacia-diagnosis-nec-strictures-and-pda-management-16860?t=153)
- Hunhide et al. conducted a multi-center non-inferiority trial that compared pre-term infants treated with expectant management versus early ibuprofen for patent ductus arteriosus. — Cecilia Gigena summarizes what Dr. Alex Halpern said [Ep 2 · 3:00](https://library.globalcastmd.com/watch/literature-review-tracheomalacia-diagnosis-nec-strictures-and-pda-management-16860?t=180)
- The trial included 273 infants: 136 treated with expectant management and 137 with early ibuprofen. — Cecilia Gigena summarizes what Dr. Alex Halpern said [Ep 2 · 3:13](https://library.globalcastmd.com/watch/literature-review-tracheomalacia-diagnosis-nec-strictures-and-pda-management-16860?t=193)
- In the expectant management group for PDA, there were 17.6% necrotizing enterocolitis, 33% bronchopulmonary dysplasia, and 14% death rates. — Cecilia Gigena summarizes what Dr. Alex Halpern said [Ep 2 · 3:22](https://library.globalcastmd.com/watch/literature-review-tracheomalacia-diagnosis-nec-strictures-and-pda-management-16860?t=202)
- In the ibuprofen group for PDA, there were 15.4% necrotizing enterocolitis, 50% bronchopulmonary dysplasia, and 18% death rates. — Cecilia Gigena summarizes what Dr. Alex Halpern said [Ep 2 · 3:22](https://library.globalcastmd.com/watch/literature-review-tracheomalacia-diagnosis-nec-strictures-and-pda-management-16860?t=202)
- Expectant management is non-inferior to early ibuprofen in preterm patients with patent ductus arteriosus. — Cecilia Gigena summarizes what Dr. Alex Halpern said [Ep 2 · 3:52](https://library.globalcastmd.com/watch/literature-review-tracheomalacia-diagnosis-nec-strictures-and-pda-management-16860?t=232)

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