I think some of us who are peat surgery trained were told initially that tracheomalacia is something that kids will grow out of and will get better and as data has shown recently that there's no long term consequences for soiling into the lungs and having chronic lung lung aspiration and over time that really is detrimental.
I think some of us who are peat surgery trained were told initially that tracheomalacia is something that kids will grow out of and will get better and as data has shown recently that there's no long term consequences for soiling into the lungs and having chronic lung lung aspiration and over time that really is detrimental.
I think some of us who are peat surgery trained were told initially that tracheomalacia is something that kids will grow out of and will get better and as data has shown recently that there's no long term consequences for soiling into the lungs and having chronic lung lung aspiration and over time that really is detrimental.
And I think the one take home point, if you can remember anything, is that if you have a patient who has had a battery removed and they present later with a bleed, that's an emergency that needs to be taken seriously and have a plan for.
It's so important to do a full thickness biopsy, and I like to cut a square, like a cube. And if we're looking at the sides of that cube, you want to make sure that the seromuscular side is the same as the mucosal side.
It's so important to do a full thickness biopsy, and I like to cut a square, like a cube. And if we're looking at the sides of that cube, you want to make sure that the seromuscular side is the same as the mucosal side.
QUAD #2 Thoracoscopic Tracheopexy with Dr. Aaron Garrison
▶Ep 17 · 0:58
quoteI think some of us who are peat surgery trained were told initially that tracheomalacia is something that kids will grow out of and will get better and as data has shown recently that there's no long term consequences for soiling into the lungs and having chronic lung lung aspiration and over time that really is detrimental.↗
▶Ep 17 · 0:58
opinionPediatric surgery trainees were initially told that tracheomalacia is something that kids will grow out of and will get better.↗
▶Ep 17 · 1:08
clinicalRecent data has shown that there are long term consequences for soiling into the lungs and having chronic lung aspiration, which over time is detrimental.↗
▶Ep 17 · 1:26
clinicalPreoperative dynamic reconstruction studies give a lot of information for determining which procedure is best for each patient.↗
▶Ep 17 · 1:31
clinicalDynamic expiratory films show what you need to see with the airway that inspiratory films alone do not reveal.↗
▶Ep 17 · 1:41
quoteYou really see what you need to see with the dynamic studies.↗
▶Ep 17 · 1:55
clinicalSurgeons always look for the thymus and make sure that there is enough tissue to remove to be able to bring the trachea up anteriorly.↗
▶Ep 17 · 2:17
opinionThe classification system for tracheomalacia is in evolution, and trying to describe what is mild or severe or moderate is a little bit challenging.↗
▶Ep 17 · 2:17
quoteOur classification system is in evolution, and trying to describe what is mild or severe or moderate is a little bit challenging.↗
▶Ep 17 · 2:34
quoteThe benefits of minimally invasive to me, the biggest one is that visualization and exposure.↗
▶Ep 17 · 2:34
opinionThe biggest benefit of minimally invasive approach is visualization and exposure.↗
▶Ep 17 · 2:39
opinionDisadvantages of minimally invasive approach include that it takes longer to learn and is more uncomfortable to learn.↗
▶Ep 17 · 2:42
opinionAnesthesia colleagues are sometimes hesitant to allow thoracoscopic cases to go on a little bit longer.↗
▶Ep 17 · 3:03
host_summaryA paper in Anesthesiology looked at open, thoracoscopic, and converted patients and found no difference in blood gases and metabolic derangements during surgery.↗
▶Ep 17 · 3:17
host_summaryThe same study found no difference when looking at blood pressure with acidosis and hypoxia between open and thoracoscopic approaches.↗
▶Ep 17 · 3:33
clinicalFor anterior mediastinal work, babies are positioned with the arm up and a bump underneath so that there is access to the axilla and anteriorly.↗
▶Ep 17 · 3:51
clinicalThe goal of aortopexy is to suspend the aorta.↗
▶Ep 17 · 3:54
clinicalThe first step in aortopexy is taking out the thymus, finding the innominate junction, and then identifying the arch of the aorta.↗
▶Ep 17 · 4:10
quoteIf you go up too high, then you're doing a pericardioexy and it isn't quite as successful or durable.↗
▶Ep 17 · 4:10
clinicalIf you go up too high during aortopexy, then you are doing a pericardiopexy and it is not quite as successful or durable.↗
▶Ep 17 · 4:45
clinicalThe goal of posterior tracheopexy is taking the anterior spinal ligament and fixing it to the posterior membranous trachea.↗
▶Ep 17 · 4:56
clinicalThe area of floppy membrane is distal to the dilated pouch usually.↗
▶Ep 17 · 5:09
clinicalSurgeons can make an indent on the posterior wall of the trachea, and pulmonologists can see it pop up on their bronchoscopy to help guide suture placement.↗
▶Ep 17 · 5:43
clinicalIt usually takes about 2 or 3 sutures for posterior tracheopexy, leaving enough space for the esophagus to come through.↗
▶Ep 17 · 5:48
opinionUsing the knot pusher and tension suture is helpful during tracheopexy.↗
▶Ep 17 · 5:58
quoteAnd this is the part that I think is honestly the, the hardest. Getting that suture to roll through the anterior spinal ligament is actually pretty, pretty challenging.↗
▶Ep 17 · 5:58
opinionGetting the suture to roll through the anterior spinal ligament is the hardest part and is pretty challenging.↗
▶Ep 17 · 6:20
clinicalThere are times when the esophagus is put to the left of the trachea, and times when it is put to the right of the trachea.↗
▶Ep 17 · 6:26
opinionDr. Garrison always worries a little bit about dysphagia when repositioning the esophagus, but it is not something he has seen a ton of.↗
▶Ep 17 · 6:26
quoteI always worry a little bit about dysphagia, but honestly, it's not something that I've, I've seen a ton of.↗
QUAD #4: Surgical Management of Button Battery & Caustic Ingestion with Dr. Aaron Garrison
▶Ep 18 · 1:06
quoteThere are 3 locations in the esophagus where things tend to get stuck, so the upper esophageal sphincter behind the aortic arch, and then at the lower esophageal sphincter.↗
▶Ep 18 · 1:06
clinicalThere are 3 locations in the esophagus where button batteries tend to get stuck: the upper esophageal sphincter, behind the aortic arch, and at the lower esophageal sphincter.↗
▶Ep 18 · 1:33
clinicalHigh-risk criteria include younger patients with smaller esophagus.↗
▶Ep 18 · 1:43
clinicalLonger duration that the battery has been in the esophagus is associated with worse outcomes.↗
▶Ep 18 · 1:52
clinicalIf a patient has had a battery removed and presents later with a bleed, that is an emergency that needs to be taken seriously and requires a plan.↗
▶Ep 18 · 1:52
quoteAnd I think the one take home point, if you can remember anything, is that if you have a patient who has had a battery removed and they present later with a bleed, that's an emergency that needs to be taken seriously and have a plan for.↗
▶Ep 18 · 2:22
epidemiologicalTwo of the fatalities in the Colorado series presented with the button batteries already in the stomach.↗
▶Ep 18 · 2:22
epidemiologicalAlmost 25% of patients in the Colorado series died.↗
▶Ep 18 · 2:22
quoteAnd almost 25% of the patients in this series died, and what I thought was particularly sad is that 2 of the fatalities presented with the buttons already in the stomach.↗
▶Ep 18 · 2:41
clinicalAny small communication between the esophagus and the aorta can be potentially life-threatening.↗
▶Ep 18 · 2:55
quoteSo it is not something that always happens in the hospital, so I think having a high index of suspicion and a plan for what to do once the battery is removed is helpful.↗
▶Ep 18 · 2:55
clinicalAortoesophageal fistulas do not always happen in the hospital, so having a high index of suspicion and a plan for what to do once the battery is removed is helpful.↗
▶Ep 18 · 3:26
guidelineFor sick patients with esophageal foreign bodies and active bleeding or clinical instability, it is recommended to have GI surgery and CT surgery available for the procedure.↗
▶Ep 18 · 3:47
guidelineIf imaging shows injury close to the aorta, continue NPO and antibiotics and repeat MRI in 5 to 7 days to assess the trajectory of inflammation.↗
▶Ep 18 · 4:30
guidelineFor high-risk patients (less than 5 years old, larger battery size), endoscopic evaluation of the esophagus is recommended because the duration of battery presence higher up than the stomach is unknown.↗
▶Ep 18 · 4:43
clinicalThe need for ECMO or cardiopulmonary bypass depends on the location of the fistula and whether you can intubate past the injury enough to ventilate during the case.↗
▶Ep 18 · 4:59
clinicalIf the fistula is near the carina, complex airway reconstruction will be needed and adequate ventilation during the case will not be possible.↗
▶Ep 18 · 5:21
clinicalIn one case with a large tracheoesophageal fistula, the patient was placed on ECMO because they were unable to adequately ventilate.↗
▶Ep 18 · 5:45
clinicalIn the Cincinnati Children's case, an interposition graft was performed by removing a segment of trachea and using that trachea as the front wall of the esophagus.↗
▶Ep 18 · 6:31
quoteSometimes I think it's easy to get caught up in what the child drank and to forget that the kind of airway may take priority.↗
▶Ep 18 · 6:31
clinicalThe airway may take priority in caustic ingestion cases, and patients can present in extremis or with an allergic-reaction-like presentation.↗
▶Ep 18 · 6:56
clinicalFor esophageal perforation, the approach is to maintain the same exposure, debride to viable tissue, achieve layered closure with coverage, and if possible use a muscle flap for coverage.↗
▶Ep 18 · 7:09
clinicalIf the perforation is too big, drain it to allow for delayed repair.↗
clinicalSurgeons should wait for frozen section confirmation before taking mesentery during Hirschsprung pull-through.↗
▶Ep 1 · 11:13
clinicalMesenteric dissection should stay close to the bowel wall, not deep in the mesentery, as this plane tends to be less bloody.↗
▶Ep 1 · 15:03
clinicalFor standard rectosigmoid Hirschsprung cases, the patient can remain supine with legs wrapped and fastened to the ether screen, avoiding the need to flip prone.↗
▶Ep 1 · 16:30
clinicalTacking sutures on the serosa to the pelvic sidewall at 3 and 9 o'clock positions help anchor the anastomosis in place, though this does not constitute a true two-layer anastomosis.↗
The Colorectal Quiz Episode 4
▶Ep 2 · 7:09
quoteIt's so important to do a full thickness biopsy, and I like to cut a square, like a cube. And if we're looking at the sides of that cube, you want to make sure that the seromuscular side is the same as the mucosal side.↗
▶Ep 2 · 7:09
clinicalFull thickness biopsy must include seromuscular side same size as mucosal side, cut as a square cube↗
▶Ep 2 · 16:30
clinicalTacking sutures on serosa to sidewall at three and six o'clock positions anchor bowel in place↗
The Colorectal Quiz Episode 4
▶Ep 3 · 6:00
quotethe overstretching of the sphincters, which can be done if you do an extensive transanal amount of work, is really a morbidity that needs to be avoided↗
▶Ep 3 · 6:00
clinicalLaparoscopic approach allows deep pelvic dissection minimizing transanal work and avoiding sphincter overstretching↗
▶Ep 3 · 7:09
quoteIt's so important to do a full thickness biopsy, and I like to cut a square, like a cube. And if we're looking at the sides of that cube, you want to make sure that the seromuscular side is the same as the mucosal side↗
▶Ep 3 · 7:09
clinicalFull-thickness biopsy should be a cube with seromuscular side matching mucosal side dimensions↗
▶Ep 3 · 11:00
clinicalMesenteric dissection should stay close to bowel wall to minimize bleeding and avoid injury to nerves↗
▶Ep 3 · 16:06
clinicalFive-centimeter margin above biopsy site is safe for resection↗
▶Ep 3 · 16:30
clinicalLateral tacking sutures to pelvic sidewall at three and six o'clock positions anchor the pull-through↗
quoteHirschsprung disease is a congenital developmental anomaly of intestinal ganglion cell migration that results in a functional bowel obstruction.↗
▶Ep 73 · 0:07
quoteHirschsprung disease is a congenital developmental anomaly of intestinal ganglion cell migration that results in a functional bowel obstruction.↗
▶Ep 73 · 0:07
quoteAnd I'm Aaron Garrison. We're both pediatric surgeons at Cincinnati Children's.↗
▶Ep 73 · 0:07
clinicalHirschsprung disease is a congenital developmental anomaly of intestinal ganglion cell migration that results in a functional bowel obstruction.↗
▶Ep 73 · 0:07
clinicalHirschsprung disease is a congenital developmental anomaly of intestinal ganglion cell migration that results in a functional bowel obstruction.↗
▶Ep 73 · 0:07
quoteAnd I'm Aaron Garrison. We're both pediatric surgeons at Cincinnati Children's.↗
▶Ep 73 · 1:03
epidemiologicalOnly 1 to 2% of patients with trisomy 21 have Hirschsprung disease.↗
▶Ep 73 · 1:03
quoteSo Hirschsprung disease is actually relatively common in a busy children's hospital. It's got an incidence of about 1 in 5,000 children.↗
▶Ep 73 · 1:03
epidemiologicalHirschsprung disease has an incidence of about 1 in 5,000 children.↗
▶Ep 73 · 1:03
epidemiologicalAbout 10% of children with Hirschsprung disease will have a positive family history.↗
▶Ep 73 · 1:03
clinicalThere are predisposing genetic conditions such as the RET gene that can be associated with Hirschsprung disease.↗
▶Ep 73 · 1:03
quoteSo Hirschsprung disease is actually relatively common in a busy children's hospital. It's got an incidence of about 1 in 5,000 children.↗
▶Ep 73 · 1:03
epidemiologicalUp to 10% of children with Hirschsprung's disease will have trisomy 21.↗
▶Ep 73 · 1:03
epidemiologicalHirschsprung disease has an incidence of about 1 in 5,000 children.↗
▶Ep 73 · 1:03
epidemiologicalAbout 10% of children with Hirschsprung disease will have a positive family history.↗
▶Ep 73 · 1:03
clinicalThere are predisposing genetic conditions such as the RET gene that can be associated with Hirschsprung disease.↗
▶Ep 73 · 1:03
epidemiologicalUp to 10% of children with Hirschsprung's disease will have trisomy 21.↗
▶Ep 73 · 1:03
epidemiologicalOnly 1 to 2% of patients with trisomy 21 have Hirschsprung disease.↗
▶Ep 73 · 1:03
clinicalHirschsprung disease is associated with Waardenburg syndrome, congenital central hypoventilation (Ondine's curse), and some other syndromes.↗
▶Ep 73 · 1:03
clinicalHirschsprung disease is associated with Waardenburg syndrome, congenital central hypoventilation (Ondine's curse), and some other syndromes.↗
▶Ep 73 · 5:12
clinicalOlder children with Hirschsprung disease often have dilated colon and are not amenable to just doing a primary pull-through in many cases.↗
▶Ep 73 · 5:12
quoteSo the first thing I usually do is talk to the family and give them education about the disease, because most of them have never heard of it and they're not sure what to expect.↗
▶Ep 73 · 5:12
clinicalNICU babies diagnosed with Hirschsprung's disease are typically managed with irrigations, antibiotics if they show evidence of enterocolitis, and NPO or NG tubes if they're distended.↗
▶Ep 73 · 5:12
clinicalEnterocolitis is the life-threatening part of Hirschsprung's disease.↗
▶Ep 73 · 5:12
clinicalEnterocolitis is the life-threatening part of Hirschsprung's disease.↗
▶Ep 73 · 5:12
quoteSo the first thing I usually do is talk to the family and give them education about the disease, because most of them have never heard of it and they're not sure what to expect.↗
▶Ep 73 · 5:12
clinicalNICU babies diagnosed with Hirschsprung's disease are typically managed with irrigations, antibiotics if they show evidence of enterocolitis, and NPO or NG tubes if they're distended.↗
▶Ep 73 · 5:12
clinicalOlder children with Hirschsprung disease often have dilated colon and are not amenable to just doing a primary pull-through in many cases.↗
▶Ep 73 · 6:59
clinicalThe goal of surgery is to get past the aganglionic segment into the normally innervated bowel that does not have hypertrophic nerves, and to pull that segment of bowel down through and perform anastomosis above the dentate line.↗
▶Ep 73 · 6:59
clinicalThe contrast enema can be used as a roadmap for surgery, and most times it is accurate to where the level is, but not always.↗
▶Ep 73 · 6:59
clinicalThe goal of surgery is to get past the aganglionic segment into the normally innervated bowel that does not have hypertrophic nerves, and to pull that segment of bowel down through and perform anastomosis above the dentate line.↗
▶Ep 73 · 6:59
clinicalThe contrast enema can be used as a roadmap for surgery, and most times it is accurate to where the level is, but not always.↗
▶Ep 73 · 10:15
clinicalIn the Duhamel procedure, the anastomosis can leave a spur if it is not large enough, sometimes requiring revision.↗
▶Ep 73 · 10:15
clinicalIn the Duhamel procedure, you intentionally leave a portion of the aganglionic rectum behind and bring the normally ganglionated bowel posterior to that rectum, then make an anastomosis using a stapler to create a common panel.↗
▶Ep 73 · 10:15
opinionThe Duhamel procedure involves less dissection in the pelvis, so there may be less injury to pelvic structures.↗
▶Ep 73 · 10:15
clinicalIn the Duhamel procedure, the anastomosis can leave a spur if it is not large enough, sometimes requiring revision.↗
▶Ep 73 · 10:15
opinionAll three surgical techniques (Swenson, Suave, and Duhamel) are equally effective.↗
▶Ep 73 · 10:15
clinicalChildren who have the Duhamel procedure may have higher risks of constipation and stool withholding because they can have trouble evacuating the pouch.↗
▶Ep 73 · 10:15
clinicalIn the Duhamel procedure, you intentionally leave a portion of the aganglionic rectum behind and bring the normally ganglionated bowel posterior to that rectum, then make an anastomosis using a stapler to create a common panel.↗
▶Ep 73 · 10:15
opinionThe Duhamel procedure involves less dissection in the pelvis, so there may be less injury to pelvic structures.↗
▶Ep 73 · 10:15
clinicalChildren who have the Duhamel procedure may have higher risks of constipation and stool withholding because they can have trouble evacuating the pouch.↗
▶Ep 73 · 10:15
opinionAll three surgical techniques (Swenson, Suave, and Duhamel) are equally effective.↗
▶Ep 73 · 11:49
clinicalEarly complications after Hirschsprung surgery include diaper rash and excoriation that can need to be treated like a burn.↗
▶Ep 73 · 11:49
clinicalAnastomotic leaks are rare but usually show up in the first week after surgery with fever, abdominal distension, and possibly free air, often requiring another operation or proximal diversion.↗
▶Ep 73 · 11:49
clinicalEarly complications after Hirschsprung surgery include diaper rash and excoriation that can need to be treated like a burn.↗
▶Ep 73 · 11:49
clinicalAnastomotic leaks are rare but usually show up in the first week after surgery with fever, abdominal distension, and possibly free air, often requiring another operation or proximal diversion.↗
▶Ep 73 · 13:54
clinicalMost patients with rectosigmoid Hirschsprung disease should be continent by the time they enter kindergarten.↗
▶Ep 73 · 13:54
epidemiologicalAbout 80% of kids with Hirschsprung's disease are constipated and will need some kind of management.↗
▶Ep 73 · 13:54
epidemiologicalAbout 80% of kids with Hirschsprung's disease are constipated and will need some kind of management.↗
▶Ep 73 · 13:54
clinicalMost patients with rectosigmoid Hirschsprung disease should be continent by the time they enter kindergarten.↗
clinicalSurgeons should wait for frozen section confirmation before taking mesentery during Hirschsprung pull-through.↗
▶Ep 88 · 9:30
clinicalSurgeons should wait for frozen section confirmation before taking mesentery during Hirschsprung pull-through.↗
▶Ep 88 · 11:13
clinicalMesenteric dissection should stay close to the bowel wall, not deep in the mesentery, as this plane tends to be less bloody.↗
▶Ep 88 · 11:13
clinicalMesenteric dissection should stay close to the bowel wall, not deep in the mesentery, as this plane tends to be less bloody.↗
▶Ep 88 · 15:03
clinicalFor standard rectosigmoid Hirschsprung cases, the patient can remain supine with legs wrapped and fastened to the ether screen, avoiding the need to flip prone.↗
▶Ep 88 · 15:03
clinicalFor standard rectosigmoid Hirschsprung cases, the patient can remain supine with legs wrapped and fastened to the ether screen, avoiding the need to flip prone.↗
▶Ep 88 · 16:30
clinicalTacking sutures on the serosa to the pelvic sidewall at 3 and 9 o'clock positions help anchor the anastomosis in place, though this does not constitute a true two-layer anastomosis.↗
▶Ep 88 · 16:30
clinicalTacking sutures on the serosa to the pelvic sidewall at 3 and 9 o'clock positions help anchor the anastomosis in place, though this does not constitute a true two-layer anastomosis.↗
Hirschsprung Disease in Brief
▶Ep 116 · 0:48
quoteThe ganglion cells don't make it all the way down distally. The colon ends up not being able to contract.↗
▶Ep 116 · 0:48
clinicalIn Hirschsprung disease, the ganglion cells don't make it all the way down distally, and the colon ends up not being able to contract.↗
▶Ep 116 · 1:32
epidemiologicalHirschsprung disease has an incidence of about 1 in 5,000 children.↗
▶Ep 116 · 2:55
clinicalThe transition zone is from contracted rectum (where nerve cells are absent) to dilated rectum (where normal nerve cells are present).↗
▶Ep 116 · 2:55
quoteThe transition zone is from contracted rectum and all of a sudden it opens up into dilated rectum. That's the transition zone.↗
▶Ep 116 · 3:23
clinicalIn total colonic Hirschsprung's disease, a foreshortened or question mark colon can be seen on contrast enema.↗
▶Ep 116 · 3:23
clinicalIn Hirschsprung's disease, the rectum is usually less dilated than the proximal colon, making the rectosigmoid ratio less than 1.↗
▶Ep 116 · 3:23
clinicalInability to evacuate contrast is a finding suggestive of Hirschsprung disease.↗
▶Ep 116 · 4:47
clinicalSuction rectal biopsy is painless and commonly done at the bedside in neonates.↗
▶Ep 116 · 4:47
clinicalIn anorectal manometry for Hirschsprung disease, there is a lack of the recto-anal inhibitory reflex (RAIR).↗
▶Ep 116 · 4:47
clinicalThe recto-anal inhibitory reflex may be absent in other conditions besides Hirschsprung disease, and some children have a false positive test.↗
▶Ep 116 · 6:07
opinionChildren with Hirschsprung disease will need this condition managed for life, but the expectation is that they will live a normal life with close management and care.↗
▶Ep 116 · 6:37
guidelineNPO babies diagnosed with Hirschsprung disease are typically managed with irrigations, antibiotics if they show evidence of enterocolitis, and NPO or NG tubes if they're distended.↗
▶Ep 116 · 7:03
clinicalOlder children with Hirschsprung disease are not amenable to just doing a primary pull through in many cases because the colon has become dilated.↗
▶Ep 116 · 7:03
guidelineOlder children with Hirschsprung disease will start on an enema program, and some may need diversion more proximally to give the colon time to decompress.↗
▶Ep 116 · 8:48
clinicalAnastomotic leak is a rare but possible early complication after Hirschsprung surgery.↗
▶Ep 116 · 8:48
clinicalEarly postoperative complications include diaper rash and excoriation that can often need to be treated like a burn.↗
▶Ep 116 · 8:48
opinionHirschsprung's associated enterocolitis is the main early complication everyone needs to be aware of.↗
▶Ep 116 · 10:09
epidemiologicalAbout 80% of kids with Hirschsprung's disease are constipated and will need some kind of management.↗
▶Ep 116 · 10:09
opinionAssuming the operation has been done well and there are no transition zone or strictures, most patients with Hirschsprung disease are expected to do very well and be in kindergarten socially confident.↗
The Colorectal Quiz Episode 4
▶Ep 239 · 7:09
quoteIt's so important to do a full thickness biopsy, and I like to cut a square, like a cube. And if we're looking at the sides of that cube, you want to make sure that the seromuscular side is the same as the mucosal side.↗
▶Ep 239 · 7:09
clinicalFull thickness biopsy must include seromuscular side same size as mucosal side, cut as a square cube↗
▶Ep 239 · 16:30
clinicalTacking sutures on serosa to sidewall at three and six o'clock positions anchor bowel in place↗
The Colorectal Quiz Episode 4
▶Ep 241 · 6:00
clinicalLaparoscopic approach allows deep pelvic dissection minimizing transanal work and avoiding sphincter overstretching↗
▶Ep 241 · 6:00
quotethe overstretching of the sphincters, which can be done if you do an extensive transanal amount of work, is really a morbidity that needs to be avoided↗
▶Ep 241 · 7:09
quoteIt's so important to do a full thickness biopsy, and I like to cut a square, like a cube. And if we're looking at the sides of that cube, you want to make sure that the seromuscular side is the same as the mucosal side↗
▶Ep 241 · 7:09
clinicalFull-thickness biopsy should be a cube with seromuscular side matching mucosal side dimensions↗
▶Ep 241 · 11:00
clinicalMesenteric dissection should stay close to bowel wall to minimize bleeding and avoid injury to nerves↗
▶Ep 241 · 16:06
clinicalFive-centimeter margin above biopsy site is safe for resection↗
▶Ep 241 · 16:30
clinicalLateral tacking sutures to pelvic sidewall at three and six o'clock positions anchor the pull-through↗
clinicalHirschsprung disease is a congenital developmental anomaly of intestinal ganglion cell migration that results in a functional bowel obstruction.↗
▶Ep 2 · 0:07
quoteHirschsprung disease is a congenital developmental anomaly of intestinal ganglion cell migration that results in a functional bowel obstruction.↗
▶Ep 2 · 0:07
quoteAnd I'm Aaron Garrison. We're both pediatric surgeons at Cincinnati Children's.↗
▶Ep 2 · 0:07
quoteHirschsprung disease is a congenital developmental anomaly of intestinal ganglion cell migration that results in a functional bowel obstruction.↗
▶Ep 2 · 0:07
quoteAnd I'm Aaron Garrison. We're both pediatric surgeons at Cincinnati Children's.↗
▶Ep 2 · 0:07
clinicalHirschsprung disease is a congenital developmental anomaly of intestinal ganglion cell migration that results in a functional bowel obstruction.↗
▶Ep 2 · 1:03
clinicalHirschsprung disease is associated with Waardenburg syndrome, congenital central hypoventilation (Ondine's curse), and some other syndromes.↗
▶Ep 2 · 1:03
epidemiologicalUp to 10% of children with Hirschsprung's disease will have trisomy 21.↗
▶Ep 2 · 1:03
clinicalThere are predisposing genetic conditions such as the RET gene that can be associated with Hirschsprung disease.↗
▶Ep 2 · 1:03
epidemiologicalAbout 10% of children with Hirschsprung disease will have a positive family history.↗
▶Ep 2 · 1:03
epidemiologicalHirschsprung disease has an incidence of about 1 in 5,000 children.↗
▶Ep 2 · 1:03
epidemiologicalOnly 1 to 2% of patients with trisomy 21 have Hirschsprung disease.↗
▶Ep 2 · 1:03
epidemiologicalOnly 1 to 2% of patients with trisomy 21 have Hirschsprung disease.↗
▶Ep 2 · 1:03
epidemiologicalHirschsprung disease has an incidence of about 1 in 5,000 children.↗
▶Ep 2 · 1:03
quoteSo Hirschsprung disease is actually relatively common in a busy children's hospital. It's got an incidence of about 1 in 5,000 children.↗
▶Ep 2 · 1:03
epidemiologicalAbout 10% of children with Hirschsprung disease will have a positive family history.↗
▶Ep 2 · 1:03
clinicalThere are predisposing genetic conditions such as the RET gene that can be associated with Hirschsprung disease.↗
▶Ep 2 · 1:03
epidemiologicalUp to 10% of children with Hirschsprung's disease will have trisomy 21.↗
▶Ep 2 · 1:03
clinicalHirschsprung disease is associated with Waardenburg syndrome, congenital central hypoventilation (Ondine's curse), and some other syndromes.↗
▶Ep 2 · 1:03
quoteSo Hirschsprung disease is actually relatively common in a busy children's hospital. It's got an incidence of about 1 in 5,000 children.↗
▶Ep 2 · 5:12
clinicalEnterocolitis is the life-threatening part of Hirschsprung's disease.↗
▶Ep 2 · 5:12
quoteSo the first thing I usually do is talk to the family and give them education about the disease, because most of them have never heard of it and they're not sure what to expect.↗
▶Ep 2 · 5:12
quoteSo the first thing I usually do is talk to the family and give them education about the disease, because most of them have never heard of it and they're not sure what to expect.↗
▶Ep 2 · 5:12
clinicalNICU babies diagnosed with Hirschsprung's disease are typically managed with irrigations, antibiotics if they show evidence of enterocolitis, and NPO or NG tubes if they're distended.↗
▶Ep 2 · 5:12
clinicalOlder children with Hirschsprung disease often have dilated colon and are not amenable to just doing a primary pull-through in many cases.↗
▶Ep 2 · 5:12
clinicalNICU babies diagnosed with Hirschsprung's disease are typically managed with irrigations, antibiotics if they show evidence of enterocolitis, and NPO or NG tubes if they're distended.↗
▶Ep 2 · 5:12
clinicalEnterocolitis is the life-threatening part of Hirschsprung's disease.↗
▶Ep 2 · 5:12
clinicalOlder children with Hirschsprung disease often have dilated colon and are not amenable to just doing a primary pull-through in many cases.↗
▶Ep 2 · 6:59
clinicalThe contrast enema can be used as a roadmap for surgery, and most times it is accurate to where the level is, but not always.↗
▶Ep 2 · 6:59
clinicalThe contrast enema can be used as a roadmap for surgery, and most times it is accurate to where the level is, but not always.↗
▶Ep 2 · 6:59
clinicalThe goal of surgery is to get past the aganglionic segment into the normally innervated bowel that does not have hypertrophic nerves, and to pull that segment of bowel down through and perform anastomosis above the dentate line.↗
▶Ep 2 · 6:59
clinicalThe goal of surgery is to get past the aganglionic segment into the normally innervated bowel that does not have hypertrophic nerves, and to pull that segment of bowel down through and perform anastomosis above the dentate line.↗
▶Ep 2 · 10:15
opinionThe Duhamel procedure involves less dissection in the pelvis, so there may be less injury to pelvic structures.↗
▶Ep 2 · 10:15
clinicalIn the Duhamel procedure, you intentionally leave a portion of the aganglionic rectum behind and bring the normally ganglionated bowel posterior to that rectum, then make an anastomosis using a stapler to create a common panel.↗
▶Ep 2 · 10:15
clinicalChildren who have the Duhamel procedure may have higher risks of constipation and stool withholding because they can have trouble evacuating the pouch.↗
▶Ep 2 · 10:15
clinicalIn the Duhamel procedure, the anastomosis can leave a spur if it is not large enough, sometimes requiring revision.↗
▶Ep 2 · 10:15
opinionAll three surgical techniques (Swenson, Suave, and Duhamel) are equally effective.↗
▶Ep 2 · 10:15
opinionThe Duhamel procedure involves less dissection in the pelvis, so there may be less injury to pelvic structures.↗
▶Ep 2 · 10:15
clinicalIn the Duhamel procedure, the anastomosis can leave a spur if it is not large enough, sometimes requiring revision.↗
▶Ep 2 · 10:15
opinionAll three surgical techniques (Swenson, Suave, and Duhamel) are equally effective.↗
▶Ep 2 · 10:15
clinicalIn the Duhamel procedure, you intentionally leave a portion of the aganglionic rectum behind and bring the normally ganglionated bowel posterior to that rectum, then make an anastomosis using a stapler to create a common panel.↗
▶Ep 2 · 10:15
clinicalChildren who have the Duhamel procedure may have higher risks of constipation and stool withholding because they can have trouble evacuating the pouch.↗
▶Ep 2 · 11:49
clinicalAnastomotic leaks are rare but usually show up in the first week after surgery with fever, abdominal distension, and possibly free air, often requiring another operation or proximal diversion.↗
▶Ep 2 · 11:49
clinicalEarly complications after Hirschsprung surgery include diaper rash and excoriation that can need to be treated like a burn.↗
▶Ep 2 · 11:49
clinicalEarly complications after Hirschsprung surgery include diaper rash and excoriation that can need to be treated like a burn.↗
▶Ep 2 · 11:49
clinicalAnastomotic leaks are rare but usually show up in the first week after surgery with fever, abdominal distension, and possibly free air, often requiring another operation or proximal diversion.↗
▶Ep 2 · 13:54
clinicalMost patients with rectosigmoid Hirschsprung disease should be continent by the time they enter kindergarten.↗
▶Ep 2 · 13:54
epidemiologicalAbout 80% of kids with Hirschsprung's disease are constipated and will need some kind of management.↗
▶Ep 2 · 13:54
epidemiologicalAbout 80% of kids with Hirschsprung's disease are constipated and will need some kind of management.↗
▶Ep 2 · 13:54
clinicalMost patients with rectosigmoid Hirschsprung disease should be continent by the time they enter kindergarten.↗
Hirschsprung Disease in Brief
▶Ep 2 · 0:48
clinicalIn Hirschsprung disease, the ganglion cells don't make it all the way down distally, and the colon ends up not being able to contract.↗
▶Ep 2 · 0:48
quoteThe ganglion cells don't make it all the way down distally. The colon ends up not being able to contract.↗
▶Ep 2 · 1:32
epidemiologicalHirschsprung disease has an incidence of about 1 in 5,000 children.↗
▶Ep 2 · 2:55
quoteThe transition zone is from contracted rectum and all of a sudden it opens up into dilated rectum. That's the transition zone.↗
▶Ep 2 · 2:55
clinicalThe transition zone is from contracted rectum (where nerve cells are absent) to dilated rectum (where normal nerve cells are present).↗
▶Ep 2 · 3:23
clinicalIn total colonic Hirschsprung's disease, a foreshortened or question mark colon can be seen on contrast enema.↗
▶Ep 2 · 3:23
clinicalIn Hirschsprung's disease, the rectum is usually less dilated than the proximal colon, making the rectosigmoid ratio less than 1.↗
▶Ep 2 · 3:23
clinicalInability to evacuate contrast is a finding suggestive of Hirschsprung disease.↗
▶Ep 2 · 4:47
clinicalThe recto-anal inhibitory reflex may be absent in other conditions besides Hirschsprung disease, and some children have a false positive test.↗
▶Ep 2 · 4:47
clinicalIn anorectal manometry for Hirschsprung disease, there is a lack of the recto-anal inhibitory reflex (RAIR).↗
▶Ep 2 · 4:47
clinicalSuction rectal biopsy is painless and commonly done at the bedside in neonates.↗
▶Ep 2 · 6:07
opinionChildren with Hirschsprung disease will need this condition managed for life, but the expectation is that they will live a normal life with close management and care.↗
▶Ep 2 · 6:37
guidelineNPO babies diagnosed with Hirschsprung disease are typically managed with irrigations, antibiotics if they show evidence of enterocolitis, and NPO or NG tubes if they're distended.↗
▶Ep 2 · 7:03
guidelineOlder children with Hirschsprung disease will start on an enema program, and some may need diversion more proximally to give the colon time to decompress.↗
▶Ep 2 · 7:03
clinicalOlder children with Hirschsprung disease are not amenable to just doing a primary pull through in many cases because the colon has become dilated.↗
▶Ep 2 · 8:48
clinicalAnastomotic leak is a rare but possible early complication after Hirschsprung surgery.↗
▶Ep 2 · 8:48
clinicalEarly postoperative complications include diaper rash and excoriation that can often need to be treated like a burn.↗
▶Ep 2 · 8:48
opinionHirschsprung's associated enterocolitis is the main early complication everyone needs to be aware of.↗
▶Ep 2 · 10:09
epidemiologicalAbout 80% of kids with Hirschsprung's disease are constipated and will need some kind of management.↗
▶Ep 2 · 10:09
opinionAssuming the operation has been done well and there are no transition zone or strictures, most patients with Hirschsprung disease are expected to do very well and be in kindergarten socially confident.↗
quoteAnd I'm Aaron Garrison. We're both pediatric surgeons at Cincinnati Children's.↗
▶Ep 10 · 0:07
clinicalHirschsprung disease is a congenital developmental anomaly of intestinal ganglion cell migration that results in a functional bowel obstruction.↗
▶Ep 10 · 0:07
quoteHirschsprung disease is a congenital developmental anomaly of intestinal ganglion cell migration that results in a functional bowel obstruction.↗
▶Ep 10 · 1:03
epidemiologicalAbout 10% of children with Hirschsprung disease will have a positive family history.↗
▶Ep 10 · 1:03
quoteSo Hirschsprung disease is actually relatively common in a busy children's hospital. It's got an incidence of about 1 in 5,000 children.↗
▶Ep 10 · 1:03
epidemiologicalUp to 10% of children with Hirschsprung's disease will have trisomy 21.↗
▶Ep 10 · 1:03
epidemiologicalHirschsprung disease has an incidence of about 1 in 5,000 children.↗
▶Ep 10 · 1:03
clinicalHirschsprung disease is associated with Waardenburg syndrome, congenital central hypoventilation (Ondine's curse), and some other syndromes.↗
▶Ep 10 · 1:03
epidemiologicalOnly 1 to 2% of patients with trisomy 21 have Hirschsprung disease.↗
▶Ep 10 · 1:03
clinicalThere are predisposing genetic conditions such as the RET gene that can be associated with Hirschsprung disease.↗
▶Ep 10 · 5:12
clinicalEnterocolitis is the life-threatening part of Hirschsprung's disease.↗
▶Ep 10 · 5:12
clinicalOlder children with Hirschsprung disease often have dilated colon and are not amenable to just doing a primary pull-through in many cases.↗
▶Ep 10 · 5:12
quoteSo the first thing I usually do is talk to the family and give them education about the disease, because most of them have never heard of it and they're not sure what to expect.↗
▶Ep 10 · 5:12
clinicalNICU babies diagnosed with Hirschsprung's disease are typically managed with irrigations, antibiotics if they show evidence of enterocolitis, and NPO or NG tubes if they're distended.↗
▶Ep 10 · 6:59
clinicalThe goal of surgery is to get past the aganglionic segment into the normally innervated bowel that does not have hypertrophic nerves, and to pull that segment of bowel down through and perform anastomosis above the dentate line.↗
▶Ep 10 · 6:59
clinicalThe contrast enema can be used as a roadmap for surgery, and most times it is accurate to where the level is, but not always.↗
▶Ep 10 · 10:15
clinicalChildren who have the Duhamel procedure may have higher risks of constipation and stool withholding because they can have trouble evacuating the pouch.↗
▶Ep 10 · 10:15
opinionAll three surgical techniques (Swenson, Suave, and Duhamel) are equally effective.↗
▶Ep 10 · 10:15
clinicalIn the Duhamel procedure, the anastomosis can leave a spur if it is not large enough, sometimes requiring revision.↗
▶Ep 10 · 10:15
opinionThe Duhamel procedure involves less dissection in the pelvis, so there may be less injury to pelvic structures.↗
▶Ep 10 · 10:15
clinicalIn the Duhamel procedure, you intentionally leave a portion of the aganglionic rectum behind and bring the normally ganglionated bowel posterior to that rectum, then make an anastomosis using a stapler to create a common panel.↗
▶Ep 10 · 11:49
clinicalAnastomotic leaks are rare but usually show up in the first week after surgery with fever, abdominal distension, and possibly free air, often requiring another operation or proximal diversion.↗
▶Ep 10 · 11:49
clinicalEarly complications after Hirschsprung surgery include diaper rash and excoriation that can need to be treated like a burn.↗
▶Ep 10 · 13:54
clinicalMost patients with rectosigmoid Hirschsprung disease should be continent by the time they enter kindergarten.↗
▶Ep 10 · 13:54
epidemiologicalAbout 80% of kids with Hirschsprung's disease are constipated and will need some kind of management.↗
QUAD #2 Thoracoscopic Tracheopexy with Dr. Aaron Garrison
▶Ep 7 · 0:58
opinionPediatric surgery trainees were initially told that tracheomalacia is something that kids will grow out of and will get better.↗
▶Ep 7 · 0:58
quoteI think some of us who are peat surgery trained were told initially that tracheomalacia is something that kids will grow out of and will get better and as data has shown recently that there's no long term consequences for soiling into the lungs and having chronic lung lung aspiration and over time that really is detrimental.↗
▶Ep 7 · 1:08
clinicalRecent data has shown that there are long term consequences for soiling into the lungs and having chronic lung aspiration, which over time is detrimental.↗
▶Ep 7 · 1:26
clinicalPreoperative dynamic reconstruction studies give a lot of information for determining which procedure is best for each patient.↗
▶Ep 7 · 1:31
clinicalDynamic expiratory films show what you need to see with the airway that inspiratory films alone do not reveal.↗
▶Ep 7 · 1:41
quoteYou really see what you need to see with the dynamic studies.↗
▶Ep 7 · 1:55
clinicalSurgeons always look for the thymus and make sure that there is enough tissue to remove to be able to bring the trachea up anteriorly.↗
▶Ep 7 · 2:17
quoteOur classification system is in evolution, and trying to describe what is mild or severe or moderate is a little bit challenging.↗
▶Ep 7 · 2:17
opinionThe classification system for tracheomalacia is in evolution, and trying to describe what is mild or severe or moderate is a little bit challenging.↗
▶Ep 7 · 2:34
opinionThe biggest benefit of minimally invasive approach is visualization and exposure.↗
▶Ep 7 · 2:34
quoteThe benefits of minimally invasive to me, the biggest one is that visualization and exposure.↗
▶Ep 7 · 2:39
opinionDisadvantages of minimally invasive approach include that it takes longer to learn and is more uncomfortable to learn.↗
▶Ep 7 · 2:42
opinionAnesthesia colleagues are sometimes hesitant to allow thoracoscopic cases to go on a little bit longer.↗
▶Ep 7 · 3:03
host_summaryA paper in Anesthesiology looked at open, thoracoscopic, and converted patients and found no difference in blood gases and metabolic derangements during surgery.↗
▶Ep 7 · 3:17
host_summaryThe same study found no difference when looking at blood pressure with acidosis and hypoxia between open and thoracoscopic approaches.↗
▶Ep 7 · 3:33
clinicalFor anterior mediastinal work, babies are positioned with the arm up and a bump underneath so that there is access to the axilla and anteriorly.↗
▶Ep 7 · 3:51
clinicalThe goal of aortopexy is to suspend the aorta.↗
▶Ep 7 · 3:54
clinicalThe first step in aortopexy is taking out the thymus, finding the innominate junction, and then identifying the arch of the aorta.↗
▶Ep 7 · 4:10
quoteIf you go up too high, then you're doing a pericardioexy and it isn't quite as successful or durable.↗
▶Ep 7 · 4:10
clinicalIf you go up too high during aortopexy, then you are doing a pericardiopexy and it is not quite as successful or durable.↗
▶Ep 7 · 4:45
clinicalThe goal of posterior tracheopexy is taking the anterior spinal ligament and fixing it to the posterior membranous trachea.↗
▶Ep 7 · 4:56
clinicalThe area of floppy membrane is distal to the dilated pouch usually.↗
▶Ep 7 · 5:09
clinicalSurgeons can make an indent on the posterior wall of the trachea, and pulmonologists can see it pop up on their bronchoscopy to help guide suture placement.↗
▶Ep 7 · 5:43
clinicalIt usually takes about 2 or 3 sutures for posterior tracheopexy, leaving enough space for the esophagus to come through.↗
▶Ep 7 · 5:48
opinionUsing the knot pusher and tension suture is helpful during tracheopexy.↗
▶Ep 7 · 5:58
opinionGetting the suture to roll through the anterior spinal ligament is the hardest part and is pretty challenging.↗
▶Ep 7 · 5:58
quoteAnd this is the part that I think is honestly the, the hardest. Getting that suture to roll through the anterior spinal ligament is actually pretty, pretty challenging.↗
▶Ep 7 · 6:20
clinicalThere are times when the esophagus is put to the left of the trachea, and times when it is put to the right of the trachea.↗
▶Ep 7 · 6:26
quoteI always worry a little bit about dysphagia, but honestly, it's not something that I've, I've seen a ton of.↗
▶Ep 7 · 6:26
opinionDr. Garrison always worries a little bit about dysphagia when repositioning the esophagus, but it is not something he has seen a ton of.↗
quoteHirschsprung disease is a congenital developmental anomaly of intestinal ganglion cell migration that results in a functional bowel obstruction.↗
▶Ep 29 · 0:07
quoteAnd I'm Aaron Garrison. We're both pediatric surgeons at Cincinnati Children's.↗
▶Ep 29 · 0:07
clinicalHirschsprung disease is a congenital developmental anomaly of intestinal ganglion cell migration that results in a functional bowel obstruction.↗
▶Ep 29 · 0:07
quoteAnd I'm Aaron Garrison. We're both pediatric surgeons at Cincinnati Children's.↗
▶Ep 29 · 0:07
quoteHirschsprung disease is a congenital developmental anomaly of intestinal ganglion cell migration that results in a functional bowel obstruction.↗
▶Ep 29 · 0:07
clinicalHirschsprung disease is a congenital developmental anomaly of intestinal ganglion cell migration that results in a functional bowel obstruction.↗
▶Ep 29 · 1:03
epidemiologicalUp to 10% of children with Hirschsprung's disease will have trisomy 21.↗
▶Ep 29 · 1:03
epidemiologicalHirschsprung disease has an incidence of about 1 in 5,000 children.↗
▶Ep 29 · 1:03
clinicalHirschsprung disease is associated with Waardenburg syndrome, congenital central hypoventilation (Ondine's curse), and some other syndromes.↗
▶Ep 29 · 1:03
epidemiologicalOnly 1 to 2% of patients with trisomy 21 have Hirschsprung disease.↗
▶Ep 29 · 1:03
epidemiologicalUp to 10% of children with Hirschsprung's disease will have trisomy 21.↗
▶Ep 29 · 1:03
clinicalThere are predisposing genetic conditions such as the RET gene that can be associated with Hirschsprung disease.↗
▶Ep 29 · 1:03
clinicalHirschsprung disease is associated with Waardenburg syndrome, congenital central hypoventilation (Ondine's curse), and some other syndromes.↗
▶Ep 29 · 1:03
epidemiologicalOnly 1 to 2% of patients with trisomy 21 have Hirschsprung disease.↗
▶Ep 29 · 1:03
epidemiologicalAbout 10% of children with Hirschsprung disease will have a positive family history.↗
▶Ep 29 · 1:03
clinicalThere are predisposing genetic conditions such as the RET gene that can be associated with Hirschsprung disease.↗
▶Ep 29 · 1:03
epidemiologicalAbout 10% of children with Hirschsprung disease will have a positive family history.↗
▶Ep 29 · 1:03
epidemiologicalHirschsprung disease has an incidence of about 1 in 5,000 children.↗
▶Ep 29 · 1:03
quoteSo Hirschsprung disease is actually relatively common in a busy children's hospital. It's got an incidence of about 1 in 5,000 children.↗
▶Ep 29 · 1:03
quoteSo Hirschsprung disease is actually relatively common in a busy children's hospital. It's got an incidence of about 1 in 5,000 children.↗
▶Ep 29 · 5:12
quoteSo the first thing I usually do is talk to the family and give them education about the disease, because most of them have never heard of it and they're not sure what to expect.↗
▶Ep 29 · 5:12
clinicalEnterocolitis is the life-threatening part of Hirschsprung's disease.↗
▶Ep 29 · 5:12
clinicalOlder children with Hirschsprung disease often have dilated colon and are not amenable to just doing a primary pull-through in many cases.↗
▶Ep 29 · 5:12
clinicalNICU babies diagnosed with Hirschsprung's disease are typically managed with irrigations, antibiotics if they show evidence of enterocolitis, and NPO or NG tubes if they're distended.↗
▶Ep 29 · 5:12
clinicalEnterocolitis is the life-threatening part of Hirschsprung's disease.↗
▶Ep 29 · 5:12
clinicalNICU babies diagnosed with Hirschsprung's disease are typically managed with irrigations, antibiotics if they show evidence of enterocolitis, and NPO or NG tubes if they're distended.↗
▶Ep 29 · 5:12
quoteSo the first thing I usually do is talk to the family and give them education about the disease, because most of them have never heard of it and they're not sure what to expect.↗
▶Ep 29 · 5:12
clinicalOlder children with Hirschsprung disease often have dilated colon and are not amenable to just doing a primary pull-through in many cases.↗
▶Ep 29 · 6:59
clinicalThe contrast enema can be used as a roadmap for surgery, and most times it is accurate to where the level is, but not always.↗
▶Ep 29 · 6:59
clinicalThe goal of surgery is to get past the aganglionic segment into the normally innervated bowel that does not have hypertrophic nerves, and to pull that segment of bowel down through and perform anastomosis above the dentate line.↗
▶Ep 29 · 6:59
clinicalThe contrast enema can be used as a roadmap for surgery, and most times it is accurate to where the level is, but not always.↗
▶Ep 29 · 6:59
clinicalThe goal of surgery is to get past the aganglionic segment into the normally innervated bowel that does not have hypertrophic nerves, and to pull that segment of bowel down through and perform anastomosis above the dentate line.↗
▶Ep 29 · 10:15
clinicalIn the Duhamel procedure, you intentionally leave a portion of the aganglionic rectum behind and bring the normally ganglionated bowel posterior to that rectum, then make an anastomosis using a stapler to create a common panel.↗
▶Ep 29 · 10:15
opinionThe Duhamel procedure involves less dissection in the pelvis, so there may be less injury to pelvic structures.↗
▶Ep 29 · 10:15
clinicalIn the Duhamel procedure, the anastomosis can leave a spur if it is not large enough, sometimes requiring revision.↗
▶Ep 29 · 10:15
opinionAll three surgical techniques (Swenson, Suave, and Duhamel) are equally effective.↗
▶Ep 29 · 10:15
clinicalChildren who have the Duhamel procedure may have higher risks of constipation and stool withholding because they can have trouble evacuating the pouch.↗
▶Ep 29 · 10:15
clinicalIn the Duhamel procedure, you intentionally leave a portion of the aganglionic rectum behind and bring the normally ganglionated bowel posterior to that rectum, then make an anastomosis using a stapler to create a common panel.↗
▶Ep 29 · 10:15
clinicalChildren who have the Duhamel procedure may have higher risks of constipation and stool withholding because they can have trouble evacuating the pouch.↗
▶Ep 29 · 10:15
clinicalIn the Duhamel procedure, the anastomosis can leave a spur if it is not large enough, sometimes requiring revision.↗
▶Ep 29 · 10:15
opinionAll three surgical techniques (Swenson, Suave, and Duhamel) are equally effective.↗
▶Ep 29 · 10:15
opinionThe Duhamel procedure involves less dissection in the pelvis, so there may be less injury to pelvic structures.↗
▶Ep 29 · 11:49
clinicalEarly complications after Hirschsprung surgery include diaper rash and excoriation that can need to be treated like a burn.↗
▶Ep 29 · 11:49
clinicalAnastomotic leaks are rare but usually show up in the first week after surgery with fever, abdominal distension, and possibly free air, often requiring another operation or proximal diversion.↗
▶Ep 29 · 11:49
clinicalEarly complications after Hirschsprung surgery include diaper rash and excoriation that can need to be treated like a burn.↗
▶Ep 29 · 11:49
clinicalAnastomotic leaks are rare but usually show up in the first week after surgery with fever, abdominal distension, and possibly free air, often requiring another operation or proximal diversion.↗
▶Ep 29 · 13:54
clinicalMost patients with rectosigmoid Hirschsprung disease should be continent by the time they enter kindergarten.↗
▶Ep 29 · 13:54
epidemiologicalAbout 80% of kids with Hirschsprung's disease are constipated and will need some kind of management.↗
▶Ep 29 · 13:54
clinicalMost patients with rectosigmoid Hirschsprung disease should be continent by the time they enter kindergarten.↗
▶Ep 29 · 13:54
epidemiologicalAbout 80% of kids with Hirschsprung's disease are constipated and will need some kind of management.↗
clinicalSurgeons should wait for frozen section confirmation before taking mesentery during Hirschsprung pull-through.↗
▶Ep 36 · 9:30
clinicalSurgeons should wait for frozen section confirmation before taking mesentery during Hirschsprung pull-through.↗
▶Ep 36 · 11:13
clinicalMesenteric dissection should stay close to the bowel wall, not deep in the mesentery, as this plane tends to be less bloody.↗
▶Ep 36 · 11:13
clinicalMesenteric dissection should stay close to the bowel wall, not deep in the mesentery, as this plane tends to be less bloody.↗
▶Ep 36 · 15:03
clinicalFor standard rectosigmoid Hirschsprung cases, the patient can remain supine with legs wrapped and fastened to the ether screen, avoiding the need to flip prone.↗
▶Ep 36 · 15:03
clinicalFor standard rectosigmoid Hirschsprung cases, the patient can remain supine with legs wrapped and fastened to the ether screen, avoiding the need to flip prone.↗
▶Ep 36 · 16:30
clinicalTacking sutures on the serosa to the pelvic sidewall at 3 and 9 o'clock positions help anchor the anastomosis in place, though this does not constitute a true two-layer anastomosis.↗
▶Ep 36 · 16:30
clinicalTacking sutures on the serosa to the pelvic sidewall at 3 and 9 o'clock positions help anchor the anastomosis in place, though this does not constitute a true two-layer anastomosis.↗
The Colorectal Quiz Episode 4
▶Ep 94 · 7:09
quoteIt's so important to do a full thickness biopsy, and I like to cut a square, like a cube. And if we're looking at the sides of that cube, you want to make sure that the seromuscular side is the same as the mucosal side.↗
▶Ep 94 · 7:09
clinicalFull thickness biopsy must include seromuscular side same size as mucosal side, cut as a square cube↗
▶Ep 94 · 16:30
clinicalTacking sutures on serosa to sidewall at three and six o'clock positions anchor bowel in place↗
The Colorectal Quiz Episode 4
▶Ep 95 · 6:00
quotethe overstretching of the sphincters, which can be done if you do an extensive transanal amount of work, is really a morbidity that needs to be avoided↗
▶Ep 95 · 6:00
clinicalLaparoscopic approach allows deep pelvic dissection minimizing transanal work and avoiding sphincter overstretching↗
▶Ep 95 · 7:09
quoteIt's so important to do a full thickness biopsy, and I like to cut a square, like a cube. And if we're looking at the sides of that cube, you want to make sure that the seromuscular side is the same as the mucosal side↗
▶Ep 95 · 7:09
clinicalFull-thickness biopsy should be a cube with seromuscular side matching mucosal side dimensions↗
▶Ep 95 · 11:00
clinicalMesenteric dissection should stay close to bowel wall to minimize bleeding and avoid injury to nerves↗
▶Ep 95 · 16:06
clinicalFive-centimeter margin above biopsy site is safe for resection↗
▶Ep 95 · 16:30
clinicalLateral tacking sutures to pelvic sidewall at three and six o'clock positions anchor the pull-through↗
QUAD #2 Thoracoscopic Tracheopexy with Dr. Aaron Garrison
▶Ep 4 · 0:58
opinionPediatric surgery trainees were initially told that tracheomalacia is something that kids will grow out of and will get better.↗
▶Ep 4 · 0:58
quoteI think some of us who are peat surgery trained were told initially that tracheomalacia is something that kids will grow out of and will get better and as data has shown recently that there's no long term consequences for soiling into the lungs and having chronic lung lung aspiration and over time that really is detrimental.↗
▶Ep 4 · 1:08
clinicalRecent data has shown that there are long term consequences for soiling into the lungs and having chronic lung aspiration, which over time is detrimental.↗
▶Ep 4 · 1:26
clinicalPreoperative dynamic reconstruction studies give a lot of information for determining which procedure is best for each patient.↗
▶Ep 4 · 1:31
clinicalDynamic expiratory films show what you need to see with the airway that inspiratory films alone do not reveal.↗
▶Ep 4 · 1:41
quoteYou really see what you need to see with the dynamic studies.↗
▶Ep 4 · 1:55
clinicalSurgeons always look for the thymus and make sure that there is enough tissue to remove to be able to bring the trachea up anteriorly.↗
▶Ep 4 · 2:17
opinionThe classification system for tracheomalacia is in evolution, and trying to describe what is mild or severe or moderate is a little bit challenging.↗
▶Ep 4 · 2:17
quoteOur classification system is in evolution, and trying to describe what is mild or severe or moderate is a little bit challenging.↗
▶Ep 4 · 2:34
quoteThe benefits of minimally invasive to me, the biggest one is that visualization and exposure.↗
▶Ep 4 · 2:34
opinionThe biggest benefit of minimally invasive approach is visualization and exposure.↗
▶Ep 4 · 2:39
opinionDisadvantages of minimally invasive approach include that it takes longer to learn and is more uncomfortable to learn.↗
▶Ep 4 · 2:42
opinionAnesthesia colleagues are sometimes hesitant to allow thoracoscopic cases to go on a little bit longer.↗
▶Ep 4 · 3:03
host_summaryA paper in Anesthesiology looked at open, thoracoscopic, and converted patients and found no difference in blood gases and metabolic derangements during surgery.↗
▶Ep 4 · 3:17
host_summaryThe same study found no difference when looking at blood pressure with acidosis and hypoxia between open and thoracoscopic approaches.↗
▶Ep 4 · 3:33
clinicalFor anterior mediastinal work, babies are positioned with the arm up and a bump underneath so that there is access to the axilla and anteriorly.↗
▶Ep 4 · 3:51
clinicalThe goal of aortopexy is to suspend the aorta.↗
▶Ep 4 · 3:54
clinicalThe first step in aortopexy is taking out the thymus, finding the innominate junction, and then identifying the arch of the aorta.↗
▶Ep 4 · 4:10
clinicalIf you go up too high during aortopexy, then you are doing a pericardiopexy and it is not quite as successful or durable.↗
▶Ep 4 · 4:10
quoteIf you go up too high, then you're doing a pericardioexy and it isn't quite as successful or durable.↗
▶Ep 4 · 4:45
clinicalThe goal of posterior tracheopexy is taking the anterior spinal ligament and fixing it to the posterior membranous trachea.↗
▶Ep 4 · 4:56
clinicalThe area of floppy membrane is distal to the dilated pouch usually.↗
▶Ep 4 · 5:09
clinicalSurgeons can make an indent on the posterior wall of the trachea, and pulmonologists can see it pop up on their bronchoscopy to help guide suture placement.↗
▶Ep 4 · 5:43
clinicalIt usually takes about 2 or 3 sutures for posterior tracheopexy, leaving enough space for the esophagus to come through.↗
▶Ep 4 · 5:48
opinionUsing the knot pusher and tension suture is helpful during tracheopexy.↗
▶Ep 4 · 5:58
opinionGetting the suture to roll through the anterior spinal ligament is the hardest part and is pretty challenging.↗
▶Ep 4 · 5:58
quoteAnd this is the part that I think is honestly the, the hardest. Getting that suture to roll through the anterior spinal ligament is actually pretty, pretty challenging.↗
▶Ep 4 · 6:20
clinicalThere are times when the esophagus is put to the left of the trachea, and times when it is put to the right of the trachea.↗
▶Ep 4 · 6:26
opinionDr. Garrison always worries a little bit about dysphagia when repositioning the esophagus, but it is not something he has seen a ton of.↗
▶Ep 4 · 6:26
quoteI always worry a little bit about dysphagia, but honestly, it's not something that I've, I've seen a ton of.↗
