We were enrolling in this study. We had about 30 patients in each group when we tried the first cryotherapy. And when that patient went home on post-op day one, equipoise was lost. Once you see it, it's sort of a different game.
You literally just count down to the fourth rib and then freeze underneath it. It's two minutes per rib. We do four through seven. You're not supposed to go eight or below because you can get some abdominal wall paralysis.
These 4 patients got voluntary bowel movements with higher productivity and confidence, so it seems that we have an option for overstretched anal sphincters in patients with Hirschsprung disease after a pull-through.
They reviewed 6 articles and they found that patients operated before the discharge in the first hospitalization had lower odds of incarceration but had higher risk of respiratory complications in the post-op.
it seems that lung segment disease, Hirschprung associated enterocolitis, and trisomy 21 can be potential risk factors for IVD-like symptoms in Hirschprung patients after pull through
it seems that lung segment disease, Hirschprung associated enterocolitis, and trisomy 21 can be potential risk factors for IVD-like symptoms in Hirschprung patients after pull through
clinicalPatients with massive transfusions had lower maximum amplitude values on TEG analysis↗
▶Ep 30 · 3:33
clinicalPatients with massive transfusions had lower platelet counts↗
▶Ep 30 · 3:33
clinicalTEG may help identify hemorrhagic trauma patients who will benefit from cryoprecipitate or platelet transfusions↗
▶Ep 30 · 3:33
clinicalThe Philips study was a retrospective study from 2015 to 2018 evaluating 117 patients from two trauma centers↗
▶Ep 30 · 3:33
clinicalPatients with massive transfusions had shortened alpha angles on TEG analysis↗
Quick Literature Updates Episode 11
▶Ep 32 · 3:07
clinicalThe overall rate for periumbilical hernias after gastroschisis closure was 22.7%.↗
▶Ep 32 · 3:07
clinicalThe Midwest Pediatric Surgery Consortium study followed 375 patients with gastroschisis who underwent closure between 2013 and 2016.↗
▶Ep 32 · 3:07
clinicalPeriumbilical hernia rate was significantly higher in patients who underwent primary closure versus those who needed silo placement.↗
▶Ep 32 · 3:07
clinicalPatients who underwent sutureless closures had 50% rates of persistent hernia.↗
▶Ep 32 · 3:07
clinicalOnly 16.4% of patients who underwent sutured closure had a persistent hernia.↗
▶Ep 32 · 3:07
clinicalSpontaneous closure of periumbilical hernias after gastroschisis repair was seen in 38.8% of cases.↗
▶Ep 32 · 3:07
clinicalOnly 31.8% of periumbilical hernias after gastroschisis closure needed surgery.↗
▶Ep 32 · 3:07
opinionSutureless closures lead to more periumbilical hernias but they can be managed as any other congenital umbilical hernia and have no additional risk.↗
Quick Literature Updates Episode 20
▶Ep 43 · 3:10
epidemiologicalThe Italian study included 83 patients in the laparoscopic cholecystectomy without ICG group↗
▶Ep 43 · 3:10
epidemiologicalThe Italian study included 90 patients in the laparoscopic cholecystectomy with ICG group↗
▶Ep 43 · 3:23
clinicalThe ICG group had shorter surgery time compared to the non-ICG group↗
▶Ep 43 · 3:23
clinicalThe ICG group had no complications compared to 12% in the non-ICG group↗
▶Ep 43 · 3:23
clinicalThe ICG group had better visualization of the biliary tree compared to the non-ICG group↗
▶Ep 43 · 3:38
opinionLaparoscopic cholecystectomy with ICG can be the new standard in pediatric surgery practice↗
▶Ep 43 · 3:38
quoteSo it seems that laparoscopic cholecystectomy with ICG can be the new standard in our practice.↗
Quick Literature Updates Ep 22
▶Ep 44 · 3:16
clinicalThe CDH study was retrospective, done in Texas using a state hospital database↗
▶Ep 44 · 3:32
epidemiologicalThe CDH study identified 1,314 patients: 728 from high volume centers, 9 from mid-volume centers, and 79 from low volume centers↗
▶Ep 44 · 3:46
clinicalHigh volume centers had significantly lower mortality rates for CDH despite having significantly sicker patients↗
▶Ep 44 · 3:46
clinicalHigh volume centers had significantly shorter length of stay for CDH patients↗
▶Ep 44 · 4:00
opinionHigh volume centers had better outcomes for patients with CDH↗
▶Ep 44 · 4:00
quoteSo it seems that high volume centers had better outcomes for patients with CDH.↗
clinicalGross brain weight was significantly lower in IUGR patients with no treatment or just saline, and significantly higher in those treated with MSC↗
▶Ep 14 · 2:33
clinicalThe overall survival in the IUGR stem cell study was 75%↗
▶Ep 14 · 2:33
clinicalIn the IUGR study, subjects were divided into four groups: untreated, saline only, transamniotic stem cell therapy, and mesenchymal stem cells with a primer↗
▶Ep 14 · 2:33
clinicalThe aim of the stem cell study was to see if mesenchymal stem cell based transamniotic stem cell therapy can reduce the inflammation of the fetal brain in intrauterine growth restriction↗
Esophageal Surveillance Practices in Esophageal Atresia Patients
▶Ep 15 · 0:00
epidemiologicalThe Eastern Pediatric Surgery Network in the US created a survey distributed among pediatric surgeons to understand current practices of esophageal surveillance in esophageal atresia patients↗
▶Ep 15 · 0:00
quoteDo you have any surveillance guidance for esophageal atresia patients?↗
▶Ep 15 · 0:30
epidemiological139 pediatric surgeons responded to the survey↗
▶Ep 15 · 0:40
epidemiological75% of respondents strongly agree or agree with current esophageal atresia surveillance guidelines↗
▶Ep 15 · 0:50
epidemiologicalOnly 37% of respondents reported that their esophageal atresia patients have pre-determined outpatient clinic follow-up schedule↗
▶Ep 15 · 1:05
epidemiological80% of respondents agree or strongly agree that endoscopy should follow a set schedule↗
▶Ep 15 · 1:20
epidemiologicalOnly 37% of respondents perform follow-up endoscopy regardless of symptoms↗
▶Ep 15 · 1:35
opinionThere is high agreement with current esophageal atresia surveillance guidelines but weak adherence to them↗
▶Ep 15 · 1:35
quoteit seems that even though there's a high agreement with the current guidelines, there's a weak adherence to them↗
Clinical Characteristics and Prognosis of Biliary Atresia with Low Serum Matrix Metalloproteinase-7 Levels
▶Ep 21 · 0:11
epidemiologicalThe study was a retrospective cohort study conducted in China↗
▶Ep 21 · 0:11
quoteThis is a retrospective cohort study done in China that aimed to evaluate the characteristics and prognosis of patients with biliary atresia and low MMP 7.↗
▶Ep 21 · 0:21
epidemiologicalThe study included 329 patients with biliary atresia↗
▶Ep 21 · 0:21
quoteThey had 329 patients, and 40 of them had low MMP7.↗
▶Ep 21 · 0:21
epidemiological40 of the 329 patients had low MMP-7 levels↗
▶Ep 21 · 0:27
clinicalPatients with low MMP-7 had significantly lower 3-month jaundice clearance↗
▶Ep 21 · 0:27
clinicalPatients with low MMP-7 had significantly lower 6-month jaundice clearance↗
▶Ep 21 · 0:27
clinicalPatients with low MMP-7 had significantly lower 1-year native liver survival↗
▶Ep 21 · 0:27
quoteAnd what they found is that these patients had significantly lower 3 month and 6 month jaundice clearance and significantly lower 1 year native liver survival.↗
▶Ep 21 · 0:40
opinionMeasuring MMP-7 can help with prognosis in biliary atresia patients↗
▶Ep 21 · 0:40
opinionMMP-7 measurement may in the future help with treatment of biliary atresia patients↗
epidemiologicalThe Hirschsprung-associated IBD study was retrospective, gathering patients from 2000 to 2021 at 17 institutions↗
▶Ep 5 · 1:14
epidemiologicalThe study identified 55 Hirschsprung patients, with 50% having long segment disease↗
▶Ep 5 · 1:19
epidemiological10% of the Hirschsprung patients had trisomy 21↗
▶Ep 5 · 1:19
epidemiological68% of the Hirschsprung patients had Hirschsprung-associated enterocolitis↗
▶Ep 5 · 1:19
quoteit seems that lung segment disease, Hirschprung associated enterocolitis, and trisomy 21 can be potential risk factors for IVD-like symptoms in Hirschprung patients after pull through↗
▶Ep 5 · 1:19
clinicalLong segment disease, Hirschsprung-associated enterocolitis, and trisomy 21 are potential risk factors for IBD-like symptoms in Hirschsprung patients after pull through↗
▶Ep 5 · 3:09
epidemiologicalThe solid organ injury study was retrospective and conducted in South Carolina↗
▶Ep 5 · 3:19
epidemiologicalThe study gathered 262 patients with isolated solid organ injuries, grades 1 to 3↗
▶Ep 5 · 3:26
clinical148 patients had solid organ injuries grades 1 or 2, and none required acute intervention↗
▶Ep 5 · 3:34
clinicalOf 114 patients with grade 3 solid organ injuries, only 3 required acute intervention↗
▶Ep 5 · 3:44
quoteit seems that isolated solid organ injuries after a blunt abdominal trauma, grades 1 or 2 can be discharged from the ED↗
▶Ep 5 · 3:44
clinicalIsolated solid organ injuries after blunt abdominal trauma, grades 1 or 2, can be discharged from the emergency department↗
Routine contrast enema prior to stoma reversal seems only required following treatment for necrotizing enterocolitis: An evaluation of the diagnostic accuracy of the contrast enema
▶Ep 137 · 0:00
clinicalContrast enema was able to detect 92% of strictures↗
▶Ep 137 · 0:00
quoteDo you always do a contrast enema prior to stoma reversal?↗
▶Ep 137 · 0:00
opinionContrast enema prior to stoma reversal appears useful primarily in patients who had necrotizing enterocolitis↗
▶Ep 137 · 0:00
epidemiological68% of all patients had a contrast enema prior to stoma reversal↗
▶Ep 137 · 0:00
clinical95% of strictures occurred in patients with necrotizing enterocolitis↗
▶Ep 137 · 0:00
epidemiological10% of patients developed strictures↗
▶Ep 137 · 0:00
epidemiological244 patients were included in the study↗
▶Ep 137 · 0:00
epidemiologicalThe study included patients under three years old who underwent stoma reversal↗
▶Ep 137 · 0:00
epidemiologicalThe study was retrospective and conducted in the Netherlands between 1998 and 2018↗
▶Ep 137 · 0:48
quoteSo it seems that contrast enema prior to stoma reversal is only useful if patients had NEC.↗
Quick Literature Updates Episode 7
▶Ep 138 · 2:43
epidemiologicalThe Olsen et al. systematic review analyzed 10 studies with 6,430 patients↗
▶Ep 138 · 3:00
clinicalThe definition of a high volume surgeon varies widely from 9 thyroidectomies per year to over 200 thyroidectomies with at least 30 being in pediatric patients↗
▶Ep 138 · 3:20
clinicalThyroidectomies performed by high volume surgeons show shorter length of stays↗
▶Ep 138 · 3:20
quoteit seems that for thyroid pathology, high volume surgeons does matter.↗
Journal of Pediatric Surgery Article Review: May 2023, CAPS Issue
▶Ep 144 · 1:33
clinicalThe Hirschsprung-associated IBD study was retrospective, looked at data from 2000 to 2021 at 17 institutions↗
▶Ep 144 · 2:05
clinicalEnterocolitis was reported in 68% of Hirschsprung patients after pull-through↗
▶Ep 144 · 2:05
clinical55 patients were included in the Hirschsprung study, 50% had long segment disease↗
▶Ep 144 · 2:17
clinicalThe most common presentation was colonic or small bowel inflammation resembling IBD↗
▶Ep 144 · 7:54
clinicalThe button battery study evaluated if implementation of a clinical algorithm shortened time from diagnosis to removal↗
▶Ep 144 · 8:09
clinicalThe algorithm was based on the national database algorithm and implemented in October 2019↗
▶Ep 144 · 8:45
clinicalTime from chest X-ray to button battery removal was shortened from 73 to 35 minutes after implementing the protocol↗
▶Ep 144 · 9:02
quoteBy instituting a protocol, not only may it improve outcomes, it actually cuts the time in half.↗
Meta-Analysis of Enhanced Recovery After Surgery Protocols for the Perioperative Management of Pediatric Colorectal Surgery
▶Ep 148 · 0:10
quoteThis is a meta-analysis that wanted to see the effects of the ERS protocol in pediatric colorectal surgery.↗
Quick Literature Updates Episode 14
▶Ep 149 · 3:48
epidemiologicalThe anal sphincter reconstruction study was a multi-institutional one-year outcome study↗
▶Ep 149 · 3:48
epidemiologicalSix patients underwent anal sphincter reconstruction for patulous sphincter after Hirschsprung pull-through↗
▶Ep 149 · 4:00
clinicalTwo patients underwent redo pull-through with anal sphincter reconstruction↗
▶Ep 149 · 4:00
clinicalFour patients received only anal sphincter reconstruction without redo pull-through↗
▶Ep 149 · 4:00
epidemiologicalTwo of the six patients had Down syndrome↗
▶Ep 149 · 4:12
quoteThese 4 patients got voluntary bowel movements with higher productivity and confidence, so it seems that we have an option for overstretched anal sphincters in patients with Hirschsprung disease after a pull-through.↗
▶Ep 149 · 4:12
clinicalThe four patients who received only sphincter reconstruction achieved voluntary bowel movements with higher productivity and confidence↗
▶Ep 149 · 4:12
clinicalAnal sphincter reconstruction is an option for overstretched anal sphincters in patients with Hirschsprung disease after pull-through↗
Meta-Analysis of Enhaced Recovery After Ssurgery Protocols for the Perioperative Management of Pediatric Colorectal Surgery
▶Ep 155 · 0:10
quoteThis is a meta-analysis done in China that wanted to analyze the effects and safety of ERES particle for colorectal surgery in pediatric patients.↗
▶Ep 155 · 0:10
epidemiologicalThe meta-analysis was conducted in China↗
▶Ep 155 · 0:22
epidemiologicalThe meta-analysis included studies with 1,298 patients↗
▶Ep 155 · 0:27
clinicalERAS protocols significantly reduced postoperative opioid use in pediatric colorectal surgery↗
clinicalERAS protocols shortened time to first enteral nutrition in pediatric colorectal surgery↗
▶Ep 155 · 0:34
clinicalERAS protocols shortened time to bowel function return in pediatric colorectal surgery↗
▶Ep 155 · 0:39
clinicalERAS protocols reduced hospital length of stay in pediatric colorectal surgery↗
▶Ep 155 · 0:39
clinicalERAS protocols reduced hospital costs in pediatric colorectal surgery↗
▶Ep 155 · 0:44
opinionERAS protocols are needed in pediatric colorectal surgery↗
▶Ep 155 · 0:44
quoteSo it seems that ERA's protocols are in need in colorectal pediatric surgery.↗
Quick Literature Updates Episode 15
▶Ep 156 · 0:59
epidemiologicalThe Hirschsprung-associated IBD study was retrospective, gathering patients from 2000 to 2021 at 17 institutions↗
▶Ep 156 · 1:14
epidemiologicalThe study identified 55 Hirschsprung patients, with 50% having long segment disease↗
▶Ep 156 · 1:19
clinicalLong segment disease, Hirschsprung-associated enterocolitis, and trisomy 21 are potential risk factors for IBD-like symptoms in Hirschsprung patients after pull through↗
▶Ep 156 · 1:19
epidemiological10% of the Hirschsprung patients had trisomy 21↗
▶Ep 156 · 1:19
epidemiological68% of the Hirschsprung patients had Hirschsprung-associated enterocolitis↗
▶Ep 156 · 1:19
quoteit seems that lung segment disease, Hirschprung associated enterocolitis, and trisomy 21 can be potential risk factors for IVD-like symptoms in Hirschprung patients after pull through↗
▶Ep 156 · 3:09
epidemiologicalThe solid organ injury study was retrospective and conducted in South Carolina↗
▶Ep 156 · 3:19
epidemiologicalThe study gathered 262 patients with isolated solid organ injuries, grades 1 to 3↗
▶Ep 156 · 3:26
clinical148 patients had solid organ injuries grades 1 or 2, and none required acute intervention↗
▶Ep 156 · 3:34
clinicalOf 114 patients with grade 3 solid organ injuries, only 3 required acute intervention↗
▶Ep 156 · 3:44
clinicalIsolated solid organ injuries after blunt abdominal trauma, grades 1 or 2, can be discharged from the emergency department↗
▶Ep 156 · 3:44
quoteit seems that isolated solid organ injuries after a blunt abdominal trauma, grades 1 or 2 can be discharged from the ED↗
Journal of Pediatric Surgery Article Review: September 2023
▶Ep 159 · 1:56
clinical47% of pectus arcuatum patients required X-ray or CT scan for diagnosis↗
▶Ep 159 · 3:07
clinicalPectus arcuatum treatment requires surgery that includes a sternotomy↗
▶Ep 159 · 7:41
clinicalERAS protocols significantly reduce postoperative opiate use in pediatric colorectal surgery↗
▶Ep 159 · 7:41
clinicalERAS protocols significantly reduce intraoperative fluids needed by pediatric colorectal surgery patients↗
▶Ep 159 · 7:55
clinicalTime to first oral intake was less in pediatric colorectal surgery patients with ERAS protocols↗
▶Ep 159 · 7:55
clinicalTime for complete nutrition was less in pediatric colorectal surgery patients with ERAS protocols↗
Transitional Care in Anorectal Malformation and Hirschsprung's Disease
▶Ep 161 · 0:00
quoteDo you have a transitional care coordinator for colorectal patients in your hospital?↗
▶Ep 161 · 0:10
epidemiologicalA systematic review was conducted in the UK to establish and categorize challenges and solutions related to transitional care in colorectal patients↗
▶Ep 161 · 0:23
epidemiologicalThe systematic review included 234 studies↗
▶Ep 161 · 0:28
clinicalThe first challenge identified was patients' lack of understanding of their own pathology↗
▶Ep 161 · 0:34
clinicalThe second challenge was the lack of education and awareness of adult surgeons about pediatric colorectal pathologies↗
▶Ep 161 · 0:44
clinicalThe third challenge was the lack of an instructional transitional care program↗
▶Ep 161 · 0:46
guidelineThe first proposed solution was to foster young adult patients' autonomy↗
▶Ep 161 · 0:46
guidelineThe second proposed solution was to conduct joint pediatric adult transitional clinics↗
▶Ep 161 · 0:46
guidelineThe third proposed solution was to create a structured and coordinated transition program↗
Quick Literature Updates Episode 17
▶Ep 172 · 0:58
clinicalThe study by Zeng et al. is a retrospective multi-center study done in China comparing robotic repair versus thoracoscopic repair for esophageal atresia↗
▶Ep 172 · 1:07
clinicalAfter propensity score matching, the study included 126 patients with 63 in each group↗
▶Ep 172 · 1:15
clinicalRobotic surgery had longer operative time but shorter anastomotic time compared to thoracoscopic repair↗
▶Ep 172 · 1:22
clinicalThe robotic group had lower anastomotic strictures compared to thoracoscopic repair↗
▶Ep 172 · 1:28
clinicalThe robotic group had lower readmissions within 2 years post-op compared to thoracoscopic repair↗
▶Ep 172 · 1:32
quoteSo it seems that robotic surgery is a good answer for esophageal tissue repair.↗
▶Ep 172 · 1:32
opinionRobotic surgery is a good answer for esophageal atresia repair↗
Quick Literature Updates Episode 18
▶Ep 174 · 3:21
clinicalPatients who underwent surgery before becoming symptomatic had shorter mechanical ventilation after surgery↗
▶Ep 174 · 3:21
clinicalPatients who underwent surgery before becoming symptomatic had shorter length of stay↗
▶Ep 174 · 3:21
epidemiologicalThe CPAM study included 110 patients↗
▶Ep 174 · 3:21
clinicalPatients who underwent surgery before becoming symptomatic had shorter operating times↗
▶Ep 174 · 3:31
clinicalThere was no significant difference in conversion or post-operative complications between symptomatic and asymptomatic CPAM patients undergoing surgery↗
▶Ep 174 · 3:44
opinionIt appears safer to operate on CPAM patients before they become symptomatic↗
▶Ep 174 · 3:44
quoteSo it seems that it's safer to operate these patients before they become symptomatic.↗
Quick Literature Updates Ep 22
▶Ep 184 · 3:16
clinicalThe CDH study was retrospective, done in Texas using a state hospital database↗
▶Ep 184 · 3:32
epidemiologicalThe CDH study identified 1,314 patients: 728 from high volume centers, 9 from mid-volume centers, and 79 from low volume centers↗
▶Ep 184 · 3:46
clinicalHigh volume centers had significantly lower mortality rates for CDH despite having significantly sicker patients↗
▶Ep 184 · 3:46
clinicalHigh volume centers had significantly shorter length of stay for CDH patients↗
▶Ep 184 · 4:00
opinionHigh volume centers had better outcomes for patients with CDH↗
▶Ep 184 · 4:00
quoteSo it seems that high volume centers had better outcomes for patients with CDH.↗
Quick Literature Updates Ep 23
▶Ep 185 · 3:10
clinicalThe systematic review was done in the UK and aimed to establish and categorize challenges and solutions related to transitional care in colorectal patients↗
▶Ep 185 · 3:23
epidemiologicalThe systematic review included 234 studies↗
▶Ep 185 · 3:29
clinicalFirst challenge identified was patients' lack of understanding of their own pathology↗
▶Ep 185 · 3:34
clinicalSecond challenge was the lack of education and awareness of adult surgeons about pediatric colorectal pathologies↗
▶Ep 185 · 3:42
clinicalThird challenge was the lack of a structured transitional care program↗
▶Ep 185 · 3:46
guidelineThird proposed solution is to create a structured and coordinated transition program↗
▶Ep 185 · 3:46
guidelineSecond proposed solution is to conduct joint pediatric-adult transitional clinics↗
▶Ep 185 · 3:46
guidelineFirst proposed solution is to foster young adult patients' autonomy↗
Quick Literature Updates Ep 26
▶Ep 188 · 3:20
clinicalThe sepsis study was a worldwide study with a Delphi consensus process that aimed to update the definitions of sepsis and septic shock↗
▶Ep 188 · 3:29
clinicalThe Phoenix sepsis score includes variables in cardiovascular function, respiratory function, coagulation, and neurological function↗
▶Ep 188 · 3:42
clinicalThe Phoenix sepsis score correlates the definition with actual mortality rate↗
▶Ep 188 · 3:48
guidelineSepsis is defined as suspected infection plus 2 points in the Phoenix sepsis score↗
▶Ep 188 · 3:48
guidelineSeptic shock is defined as sepsis plus cardiovascular dysfunction seen when there is 1 point in the cardiovascular variable of the Phoenix sepsis score↗
▶Ep 188 · 4:06
epidemiologicalSeptic shock has a mortality rate of 10.8 to 33.5% according to the research settings↗
▶Ep 188 · 4:06
epidemiologicalSepsis has a mortality rate of 7.1%↗
clinicalThere was no significant difference in postoperative complications between asymptomatic and symptomatic groups↗
▶Ep 30 · 0:39
clinicalThere was no significant difference in conversion rates between asymptomatic and symptomatic groups↗
▶Ep 30 · 0:39
opinionIt appears safer to operate on CPAM patients before they become symptomatic↗
▶Ep 30 · 0:39
quoteit seems that it's safer to operate these patients before they become symptomatic.↗
Journal of Pediatric Surgery Article Review: October 2023
▶Ep 31 · 2:37
clinicalIn a meta-analysis of 1,395 patients, 753 received acid suppression medication but it did not increase the odds of having an esophageal stricture↗
▶Ep 31 · 2:57
clinicalThere was no evidence to associate prophylactic acid suppression with protection from stricture formation after esophageal atresia repair↗
▶Ep 31 · 7:40
guidelineFor the asymptomatic contralateral side in children with pneumothorax, do not do anything unless it develops symptoms↗
▶Ep 31 · 8:57
clinicalIn a study of 110 CPAM patients, the asymptomatic group had shorter operating times, shorter post-operative mechanical ventilation, shorter chest tube durations, and shorter hospital stays↗
Quick Literature Updates Episode 18
▶Ep 32 · 3:21
clinicalPatients who underwent surgery before becoming symptomatic had shorter operating times↗
▶Ep 32 · 3:21
epidemiologicalThe CPAM study included 110 patients↗
▶Ep 32 · 3:21
clinicalPatients who underwent surgery before becoming symptomatic had shorter length of stay↗
▶Ep 32 · 3:21
clinicalPatients who underwent surgery before becoming symptomatic had shorter mechanical ventilation after surgery↗
▶Ep 32 · 3:31
clinicalThere was no significant difference in conversion or post-operative complications between symptomatic and asymptomatic CPAM patients undergoing surgery↗
▶Ep 32 · 3:44
opinionIt appears safer to operate on CPAM patients before they become symptomatic↗
▶Ep 32 · 3:44
quoteSo it seems that it's safer to operate these patients before they become symptomatic.↗
Routine contrast enema prior to stoma reversal seems only required following treatment for necrotizing enterocolitis: An evaluation of the diagnostic accuracy of the contrast enema
▶Ep 47 · 0:00
opinionContrast enema prior to stoma reversal appears useful primarily in patients who had necrotizing enterocolitis↗
▶Ep 47 · 0:00
quoteDo you always do a contrast enema prior to stoma reversal?↗
▶Ep 47 · 0:00
epidemiological68% of all patients had a contrast enema prior to stoma reversal↗
▶Ep 47 · 0:00
epidemiologicalThe study was retrospective and conducted in the Netherlands between 1998 and 2018↗
▶Ep 47 · 0:00
clinical95% of strictures occurred in patients with necrotizing enterocolitis↗
▶Ep 47 · 0:00
epidemiological244 patients were included in the study↗
▶Ep 47 · 0:00
clinicalContrast enema was able to detect 92% of strictures↗
▶Ep 47 · 0:00
epidemiological10% of patients developed strictures↗
▶Ep 47 · 0:00
epidemiologicalThe study included patients under three years old who underwent stoma reversal↗
▶Ep 47 · 0:48
quoteSo it seems that contrast enema prior to stoma reversal is only useful if patients had NEC.↗
Quick Literature Updates Episode 6
▶Ep 49 · 3:33
clinicalTEG may help identify hemorrhagic trauma patients who will benefit from cryoprecipitate or platelet transfusions↗
▶Ep 49 · 3:33
clinicalPatients with massive transfusions had lower maximum amplitude values on TEG analysis↗
▶Ep 49 · 3:33
clinicalPatients with massive transfusions had shortened alpha angles on TEG analysis↗
▶Ep 49 · 3:33
clinicalThe Philips study was a retrospective study from 2015 to 2018 evaluating 117 patients from two trauma centers↗
▶Ep 49 · 3:33
clinicalPatients with massive transfusions had lower platelet counts↗
Quick Literature Updates Episode 11
▶Ep 52 · 3:07
opinionSutureless closures lead to more periumbilical hernias but they can be managed as any other congenital umbilical hernia and have no additional risk.↗
▶Ep 52 · 3:07
clinicalOnly 16.4% of patients who underwent sutured closure had a persistent hernia.↗
▶Ep 52 · 3:07
clinicalPatients who underwent sutureless closures had 50% rates of persistent hernia.↗
▶Ep 52 · 3:07
clinicalSpontaneous closure of periumbilical hernias after gastroschisis repair was seen in 38.8% of cases.↗
▶Ep 52 · 3:07
clinicalThe Midwest Pediatric Surgery Consortium study followed 375 patients with gastroschisis who underwent closure between 2013 and 2016.↗
▶Ep 52 · 3:07
clinicalPeriumbilical hernia rate was significantly higher in patients who underwent primary closure versus those who needed silo placement.↗
▶Ep 52 · 3:07
clinicalThe overall rate for periumbilical hernias after gastroschisis closure was 22.7%.↗
▶Ep 52 · 3:07
clinicalOnly 31.8% of periumbilical hernias after gastroschisis closure needed surgery.↗
Expectant Management or Early Ibuprofen for Patent Ductus Arteriosus
▶Ep 53 · 0:09
clinicalThe study was a multi-center non-inferiority trial comparing preterm infants treated with expectant management versus early ibuprofen for PDA↗
epidemiological136 infants were treated with expectant management and 137 with early ibuprofen↗
▶Ep 53 · 0:31
clinicalIn the expectant management group, the death rate was 14%↗
▶Ep 53 · 0:31
clinicalIn the expectant management group, 33% developed bronchopulmonary dysplasia↗
▶Ep 53 · 0:31
clinicalIn the expectant management group, 17.6% developed necrotizing enterocolitis↗
▶Ep 53 · 0:43
clinicalIn the ibuprofen group, the death rate was 80%↗
▶Ep 53 · 0:43
clinicalIn the ibuprofen group, 15.4% developed necrotizing enterocolitis↗
▶Ep 53 · 0:43
clinicalIn the ibuprofen group, 50% developed bronchopulmonary dysplasia↗
▶Ep 53 · 1:01
clinicalExpectant management is not inferior to early ibuprofen in preterm patients with PDA↗
▶Ep 53 · 1:01
quoteSo it seems that expectant management is not inferiority that early ibuprofen in preterm patients with PDA.↗
Quick Literature Updates Ep 22
▶Ep 68 · 3:16
clinicalThe CDH study was retrospective, done in Texas using a state hospital database↗
▶Ep 68 · 3:32
epidemiologicalThe CDH study identified 1,314 patients: 728 from high volume centers, 9 from mid-volume centers, and 79 from low volume centers↗
▶Ep 68 · 3:46
clinicalHigh volume centers had significantly shorter length of stay for CDH patients↗
▶Ep 68 · 3:46
clinicalHigh volume centers had significantly lower mortality rates for CDH despite having significantly sicker patients↗
▶Ep 68 · 4:00
opinionHigh volume centers had better outcomes for patients with CDH↗
▶Ep 68 · 4:00
quoteSo it seems that high volume centers had better outcomes for patients with CDH.↗
Quick Literature Updates Ep 27
▶Ep 69 · 3:04
clinicalThe Huncheid et al. study was a multi-center non-inferiority trial comparing preterm infants treated with expectant management versus early ibuprofen for PDA↗
▶Ep 69 · 3:14
epidemiologicalThe PDA trial included 273 infants total, with 136 in expectant management and 137 in early ibuprofen groups↗
▶Ep 69 · 3:24
clinicalIn the expectant management group for PDA, 14% died↗
▶Ep 69 · 3:24
clinicalIn the expectant management group for PDA, 33% developed bronchopulmonary dysplasia↗
▶Ep 69 · 3:24
clinicalIn the expectant management group for PDA, 17.6% developed necrotizing enterocolitis↗
epidemiologicalThe IPSO meta-analysis gathered 8 retrospective studies with 490 patients↗
▶Ep 25 · 3:40
clinicalTissue adequacy and biological characterization of the biopsy was not significantly different between image-guided core needle biopsy and surgical biopsy groups↗
▶Ep 25 · 3:54
clinicalComplications were higher in the surgical biopsy group compared to image-guided core needle biopsy↗
▶Ep 25 · 3:54
clinicalIntraoperative transfusions were higher in the surgical biopsy group compared to image-guided core needle biopsy↗
▶Ep 25 · 4:00
quoteSo it seems that image-guided core needle biopsy is safe and effective for diagnosed neuroblastoma.↗
▶Ep 25 · 4:00
clinicalImage-guided core needle biopsy is safe and effective for diagnosing neuroblastoma↗
Delayed versus early repair of inguinal hernia in preterm infants
▶Ep 15 · 0:00
quoteWhen do you repair inguinal hernias in preterm babies?↗
▶Ep 15 · 0:10
clinicalThe systematic review and meta-analysis examined timing of inguinal hernia repair in preterm babies↗
▶Ep 15 · 0:21
quoteThey reviewed 6 articles and they found that patients operated before the discharge in the first hospitalization had lower odds of incarceration but had higher risk of respiratory complications in the post-op.↗
▶Ep 15 · 0:21
clinicalPatients operated before discharge in the first hospitalization had lower odds of incarceration↗
guidelineAdvanced liver disease is defined as conjugated bilirubin above 5 or 6 mg/dL↗
▶Ep 21 · 2:36
epidemiologicalHistorically 25-50% of intestinal failure patients died because of associated liver disease; now it is less than 2%↗
▶Ep 21 · 3:19
clinicalRisk factors for intestinal failure-associated liver disease include prematurity, lack of enteral feeding, sepsis, and TPN components↗
▶Ep 21 · 12:24
guidelineProphylactic cholecystectomy is not recommended because the gallbladder helps with enterohepatic circulation and many patients will not need it↗
Intestinal Rehabilitation, Episode 7: Refeeding in a neonatal patient
▶Ep 22 · 4:21
clinicalBreast milk has lower protein levels than desired and likely requires supplementation↗
▶Ep 22 · 7:00
clinicalChildren with sick intestines will not absorb all the calories provided↗
▶Ep 22 · 11:38
clinicalRefeeding the distal intestine stimulates the proximal portion to absorb more↗
Intestinal Rehabilitation Episode 8: Refeeding of an Older Patient
▶Ep 23 · 1:30
clinicalIn older children, normal feeding behavior is important for social aspects of life beyond nutrition↗
▶Ep 23 · 3:12
clinicalIncrease in sugars can create problems with absorption and changes in stool output↗
Routine contrast enema prior to stoma reversal seems only required following treatment for necrotizing enterocolitis: An evaluation of the diagnostic accuracy of the contrast enema
▶Ep 69 · 0:00
epidemiologicalThe study was retrospective and conducted in the Netherlands between 1998 and 2018↗
▶Ep 69 · 0:00
opinionContrast enema prior to stoma reversal appears useful primarily in patients who had necrotizing enterocolitis↗
▶Ep 69 · 0:00
quoteDo you always do a contrast enema prior to stoma reversal?↗
▶Ep 69 · 0:00
epidemiological68% of all patients had a contrast enema prior to stoma reversal↗
▶Ep 69 · 0:00
clinicalContrast enema was able to detect 92% of strictures↗
▶Ep 69 · 0:00
clinical95% of strictures occurred in patients with necrotizing enterocolitis↗
▶Ep 69 · 0:00
epidemiological10% of patients developed strictures↗
▶Ep 69 · 0:00
epidemiological244 patients were included in the study↗
▶Ep 69 · 0:00
epidemiologicalThe study included patients under three years old who underwent stoma reversal↗
▶Ep 69 · 0:48
quoteSo it seems that contrast enema prior to stoma reversal is only useful if patients had NEC.↗
Quick Literature Updates Episode 6
▶Ep 71 · 3:33
clinicalTEG may help identify hemorrhagic trauma patients who will benefit from cryoprecipitate or platelet transfusions↗
▶Ep 71 · 3:33
clinicalPatients with massive transfusions had shortened alpha angles on TEG analysis↗
▶Ep 71 · 3:33
clinicalPatients with massive transfusions had lower maximum amplitude values on TEG analysis↗
▶Ep 71 · 3:33
clinicalPatients with massive transfusions had lower platelet counts↗
▶Ep 71 · 3:33
clinicalThe Philips study was a retrospective study from 2015 to 2018 evaluating 117 patients from two trauma centers↗
Quick Literature Updates Episode 7
▶Ep 72 · 2:43
epidemiologicalThe Olsen et al. systematic review analyzed 10 studies with 6,430 patients↗
▶Ep 72 · 3:00
clinicalThe definition of a high volume surgeon varies widely from 9 thyroidectomies per year to over 200 thyroidectomies with at least 30 being in pediatric patients↗
▶Ep 72 · 3:20
quoteit seems that for thyroid pathology, high volume surgeons does matter.↗
▶Ep 72 · 3:20
clinicalThyroidectomies performed by high volume surgeons show shorter length of stays↗
Intestinal Rehabilitation, Episode 6: Cholestasis
▶Ep 73 · 1:48
guidelineAdvanced liver disease is defined as conjugated bilirubin above 5 or 6 mg/dL↗
▶Ep 73 · 2:36
epidemiologicalHistorically 25-50% of intestinal failure patients died because of associated liver disease; now it is less than 2%↗
▶Ep 73 · 3:19
clinicalRisk factors for intestinal failure-associated liver disease include prematurity, lack of enteral feeding, sepsis, and TPN components↗
▶Ep 73 · 12:24
guidelineProphylactic cholecystectomy is not recommended because the gallbladder helps with enterohepatic circulation and many patients will not need it↗
Quick Literature Updates Episode 11
▶Ep 76 · 3:07
clinicalOnly 31.8% of periumbilical hernias after gastroschisis closure needed surgery.↗
▶Ep 76 · 3:07
clinicalOnly 16.4% of patients who underwent sutured closure had a persistent hernia.↗
▶Ep 76 · 3:07
clinicalPeriumbilical hernia rate was significantly higher in patients who underwent primary closure versus those who needed silo placement.↗
▶Ep 76 · 3:07
clinicalPatients who underwent sutureless closures had 50% rates of persistent hernia.↗
▶Ep 76 · 3:07
clinicalThe overall rate for periumbilical hernias after gastroschisis closure was 22.7%.↗
▶Ep 76 · 3:07
clinicalThe Midwest Pediatric Surgery Consortium study followed 375 patients with gastroschisis who underwent closure between 2013 and 2016.↗
▶Ep 76 · 3:07
opinionSutureless closures lead to more periumbilical hernias but they can be managed as any other congenital umbilical hernia and have no additional risk.↗
▶Ep 76 · 3:07
clinicalSpontaneous closure of periumbilical hernias after gastroschisis repair was seen in 38.8% of cases.↗
Disruption of enterohepatic Circulation of Bile acids ameliorates small bowel resection associated hepatic injury
▶Ep 77 · 0:00
quoteDid you know that the disruption of the enterohepatic circulation of bilasses is beneficial for the liver?↗
▶Ep 77 · 0:00
clinicalDisruption of the enterohepatic circulation of bile acids is beneficial for the liver↗
▶Ep 77 · 0:13
clinicalThe study was conducted at Saint Louis Children's Hospital↗
▶Ep 77 · 0:13
clinicalThe study aim was to elucidate the driving force behind hepatic injury↗
▶Ep 77 · 0:13
quoteThis is a basic science study done in Saint Louis Children's Hospital, and their aim was to elucidate the driving force behind the hepatic injury.↗
▶Ep 77 · 0:22
clinicalThree groups of mice were studied: sham, 50% with proximal or duodenal resection, and 50% with distal resection or resection of the ileocecal valve↗
▶Ep 77 · 0:34
clinicalTissue samples were taken at the second and 10th postoperative weeks↗
▶Ep 77 · 0:41
clinicalMice with distal resection show more hydrophilic bile acid profile↗
▶Ep 77 · 0:41
clinicalIleal resection could lead to less hepatic injury↗
▶Ep 77 · 0:41
clinicalMice with distal resection show less hepatic oxidative stress↗
Expectant Management or Early Ibuprofen for Patent Ductus Arteriosus
▶Ep 78 · 0:09
clinicalThe study was a multi-center non-inferiority trial comparing preterm infants treated with expectant management versus early ibuprofen for PDA↗
epidemiological136 infants were treated with expectant management and 137 with early ibuprofen↗
▶Ep 78 · 0:31
clinicalIn the expectant management group, 33% developed bronchopulmonary dysplasia↗
▶Ep 78 · 0:31
clinicalIn the expectant management group, 17.6% developed necrotizing enterocolitis↗
▶Ep 78 · 0:31
clinicalIn the expectant management group, the death rate was 14%↗
▶Ep 78 · 0:43
clinicalIn the ibuprofen group, 50% developed bronchopulmonary dysplasia↗
▶Ep 78 · 0:43
clinicalIn the ibuprofen group, 15.4% developed necrotizing enterocolitis↗
▶Ep 78 · 0:43
clinicalIn the ibuprofen group, the death rate was 80%↗
▶Ep 78 · 1:01
quoteSo it seems that expectant management is not inferiority that early ibuprofen in preterm patients with PDA.↗
▶Ep 78 · 1:01
clinicalExpectant management is not inferior to early ibuprofen in preterm patients with PDA↗
Intestinal Rehabilitation, Episode 7: Refeeding in a neonatal patient
▶Ep 79 · 4:21
clinicalBreast milk has lower protein levels than desired and likely requires supplementation↗
▶Ep 79 · 7:00
clinicalChildren with sick intestines will not absorb all the calories provided↗
▶Ep 79 · 11:38
clinicalRefeeding the distal intestine stimulates the proximal portion to absorb more↗
Intestinal Rehabilitation Episode 8: Refeeding of an Older Patient
▶Ep 80 · 1:30
clinicalIn older children, normal feeding behavior is important for social aspects of life beyond nutrition↗
▶Ep 80 · 3:12
clinicalIncrease in sugars can create problems with absorption and changes in stool output↗
Quick Literature Updates Ep 22
▶Ep 99 · 3:16
clinicalThe CDH study was retrospective, done in Texas using a state hospital database↗
▶Ep 99 · 3:32
epidemiologicalThe CDH study identified 1,314 patients: 728 from high volume centers, 9 from mid-volume centers, and 79 from low volume centers↗
▶Ep 99 · 3:46
clinicalHigh volume centers had significantly lower mortality rates for CDH despite having significantly sicker patients↗
▶Ep 99 · 3:46
clinicalHigh volume centers had significantly shorter length of stay for CDH patients↗
▶Ep 99 · 4:00
opinionHigh volume centers had better outcomes for patients with CDH↗
▶Ep 99 · 4:00
quoteSo it seems that high volume centers had better outcomes for patients with CDH.↗
Quick Literature Updates Ep 27
▶Ep 100 · 3:04
clinicalThe Huncheid et al. study was a multi-center non-inferiority trial comparing preterm infants treated with expectant management versus early ibuprofen for PDA↗
▶Ep 100 · 3:14
epidemiologicalThe PDA trial included 273 infants total, with 136 in expectant management and 137 in early ibuprofen groups↗
▶Ep 100 · 3:24
clinicalIn the expectant management group for PDA, 33% developed bronchopulmonary dysplasia↗
▶Ep 100 · 3:24
clinicalIn the expectant management group for PDA, 14% died↗
▶Ep 100 · 3:24
clinicalIn the expectant management group for PDA, 17.6% developed necrotizing enterocolitis↗
▶Ep 100 · 3:36
clinicalIn the ibuprofen group for PDA, 50% developed bronchopulmonary dysplasia↗
▶Ep 100 · 3:36
clinicalIn the ibuprofen group for PDA, 15.4% developed necrotizing enterocolitis↗
Aggressive Pursuit of No Evidence of Disease Status in Hepatoblastoma Improves Survival
▶Ep 9 · 0:00
quoteDo you pursue no evidence of disease status in hepatoblastoma?↗
▶Ep 9 · 0:00
clinicalThe study was a retrospective observational study conducted at Cincinnati Children's Hospital from 2005 to 2021↗
▶Ep 9 · 0:20
clinicalThe study aim was to examine the effect of aggressive pursuit of no evidence of disease status on overall survival and event free status↗
▶Ep 9 · 0:35
epidemiologicalThe study included 50 patients with hepatoblastoma↗
▶Ep 9 · 0:42
clinical41 patients were rendered to no evidence of disease status↗
▶Ep 9 · 0:48
clinicalOverall survival and event free status were significantly improved in both high risk and non-high risk patients who achieved no evidence of disease status↗
▶Ep 9 · 0:58
quoteit seems that pursuing no evidence of disease status is better for overall survival in hepatoblastoma patients↗
▶Ep 9 · 0:58
opinionPursuing no evidence of disease status is better for overall survival in hepatoblastoma patients↗
Journal of Pediatric Article Review: June 2023, AAP Issue
▶Ep 10 · 2:39
clinicalPatients with distal resection in short bowel syndrome had a protective effect on liver injuries↗
Image-guided core-needle or surgical biopsy for neuroblastoma diagnosis in children
▶Ep 13 · 0:09
clinicalThe review analyzed the accuracy and safety of image-guided core needle biopsy for neuroblastoma↗
▶Ep 13 · 0:09
clinicalThe systematic review and meta-analysis was conducted by IPSO↗
▶Ep 13 · 0:23
clinicalTissue adequacy was not significantly different between image-guided core needle biopsy and surgical biopsy groups↗
▶Ep 13 · 0:23
clinicalIntraoperative transfusions were higher in the surgical biopsy group compared to image-guided core needle biopsy↗
▶Ep 13 · 0:23
clinicalComplications were higher in the surgical biopsy group compared to image-guided core needle biopsy↗
▶Ep 13 · 0:23
epidemiologicalThe review included 8 retrospective studies with 490 patients↗
▶Ep 13 · 0:23
clinicalBiological characterization of the biopsy was not significantly different between image-guided core needle biopsy and surgical biopsy groups↗
▶Ep 13 · 0:43
quoteSo it seems that image-guided core needle biopsy is safe and effective for diagnosed neuroblastoma.↗
▶Ep 13 · 0:43
opinionImage-guided core needle biopsy is safe and effective for diagnosing neuroblastoma↗
Quick Literature Updates Ep 19
▶Ep 21 · 3:40
clinicalTissue adequacy and biological characterization of the biopsy was not significantly different between image-guided core needle biopsy and surgical biopsy groups↗
▶Ep 21 · 3:40
epidemiologicalThe IPSO meta-analysis gathered 8 retrospective studies with 490 patients↗
▶Ep 21 · 3:54
clinicalIntraoperative transfusions were higher in the surgical biopsy group compared to image-guided core needle biopsy↗
▶Ep 21 · 3:54
clinicalComplications were higher in the surgical biopsy group compared to image-guided core needle biopsy↗
▶Ep 21 · 4:00
clinicalImage-guided core needle biopsy is safe and effective for diagnosing neuroblastoma↗
▶Ep 21 · 4:00
quoteSo it seems that image-guided core needle biopsy is safe and effective for diagnosed neuroblastoma.↗
Transcystic Laparoscopic Common Bile Duct Exploration for Pediatric Patients with Choledocholithiasis
▶Ep 16 · 0:09
epidemiologicalThe study was a multi-center retrospective study conducted in the US from 2018 to 2022↗
▶Ep 16 · 0:09
quoteThis is a multi-center retrospective study done in the US from 2018 to 2022, and their aim was to compare patients with suspected.↗
▶Ep 16 · 0:09
epidemiologicalThe study aim was to compare patients with suspected choledocholithiasis who underwent transcystic laparoscopic common bile duct exploration versus those who underwent ERCP first↗
▶Ep 16 · 0:28
epidemiological156 patients were in group one (transcystic laparoscopic common bile duct exploration)↗
▶Ep 16 · 0:28
epidemiologicalThe study included 252 patients total↗
▶Ep 16 · 0:38
clinicalPatients in group one (transcystic laparoscopic approach) had lower length of stay compared to group two↗
▶Ep 16 · 0:38
epidemiological96 patients were in group two (ERCP first)↗
▶Ep 16 · 0:38
clinicalPatients in group one (transcystic laparoscopic approach) had significantly less complication rates compared to group two↗
▶Ep 16 · 0:52
opinionAttempting a transcystic laparoscopic common bile duct exploration may benefit pediatric patients with choledocholithiasis↗
▶Ep 16 · 0:52
quoteSo it seems that attempting a transcystic laparoscopic common bile duct exploration may benefit our patients.↗
Update Course Rewind: Management of Recurrent Pancreatitis
▶Ep 17 · 2:26
guidelinePatients with more than 1 episode of acute pancreatitis or a first severe episode should undergo MRCP and genetic panel testing↗
▶Ep 17 · 3:37
guidelineGenetic testing is essential before any resection procedure to avoid losing pancreatic cells in pathologies that will not benefit from resection and drainage↗
▶Ep 17 · 4:37
guidelineEndoscopic treatment should be attempted first, but if it fails, transfer to a specialized center that performs TPIAT↗
▶Ep 17 · 5:11
guidelineImaging approach starts with ultrasound, then CT, and MRCP with T2 sequences for better pancreatic anatomy visualization↗
▶Ep 17 · 5:40
epidemiologicalRecurrent pancreatitis is a rare pathology that can lead to chronic pancreatitis and is associated with genetic mutations↗
▶Ep 17 · 5:50
guidelineIf genetic mutations are confirmed, partial pancreatic resection (Frey procedure) should be avoided to prevent loss of pancreatic cells↗
▶Ep 17 · 6:01
guidelineIf endoscopic approach fails, TPIAT should be considered sooner rather than later↗
Case-Based Journal Review: Cholelithiasis 2024
▶Ep 18 · 3:11
clinicalIn multi-center study of 246 patients (167 early, 79 delayed cholecystectomy), early cholecystectomy during index admission had 2% pancreatitis recurrence vs. 22% in delayed approach↗
▶Ep 18 · 3:36
clinicalWhen cholecystectomy was delayed more than 6 weeks, pancreatitis recurrence rate increased to 60%↗
▶Ep 18 · 4:27
clinicalEarly cholecystectomy did not result in increased biliary complications compared to delayed approach↗
▶Ep 18 · 11:27
clinicalIn multi-center study of 252 patients (156 OR-first, 96 ERCP-first), OR-first approach with intraoperative cholangiogram had fewer complications and shorter length of stay↗
▶Ep 18 · 11:41
clinical86% of patients in OR-first group required only the initial surgery without subsequent ERCP↗
clinicalThe study was a retrospective single institution study conducted in Phoenix from 2017 to 2021↗
▶Ep 33 · 0:16
clinicalThe study compared patients who underwent Nuss procedure with cryoanalgesia in the first quarter of institutional experience versus the fourth quarter↗
▶Ep 33 · 0:29
epidemiological350 patients underwent Nuss procedure with cryoanalgesia in the study period↗
▶Ep 33 · 0:34
clinicalPatients in the last quarter were discharged 1.3 days earlier than patients in the first quarter↗
▶Ep 33 · 0:34
clinicalPatients in the last quarter required 74% less opioids compared to the first quarter↗
▶Ep 33 · 0:46
quoteSo it seems that experience really plays a role talking about cryoathesia.↗
▶Ep 33 · 0:46
opinionExperience plays a role in cryoanalgesia outcomes for Nuss procedures↗
Initial Outcomes Using Cryoablation in Surgical Management of Slipping Rib Syndrome
▶Ep 35 · 0:00
quoteDo you use cryo for resecting cartilage in the slipping ribs syndrome?↗
▶Ep 35 · 0:11
clinicalThe study was a retrospective review conducted in Phoenix between 2018 and 2022↗
▶Ep 35 · 0:16
clinicalThe study compared length of stay and opiate use in patients undergoing cartilaginous rib excision with and without cryo↗
▶Ep 35 · 0:27
epidemiological8 patients underwent a NAS procedure plus cartilaginous resection with cryoalgesia↗
▶Ep 35 · 0:27
epidemiologicalThe study included 98 patients total↗
▶Ep 35 · 0:27
epidemiological68 patients underwent resection without cryo↗
▶Ep 35 · 0:27
epidemiological22 patients underwent resection with cryo↗
▶Ep 35 · 0:43
clinicalPatients who underwent resection with cryo had significantly less opiate use↗
▶Ep 35 · 0:43
clinicalPatients who underwent resection with cryo stayed one day less than patients without cryo, though this difference was not statistically significant↗
Quick Literature Updates Episode 13
▶Ep 37 · 3:16
epidemiologicalThe button battery study was a retrospective study done at Boston Children's Hospital from 2008 to 2021↗
▶Ep 37 · 3:30
epidemiologicalThe button battery study analyzed 143 patients, of whom 24 had severe outcomes↗
▶Ep 37 · 3:37
clinicalLocation of the button battery in the esophagus is an independent predictor for severe outcomes↗
▶Ep 37 · 3:45
clinicalA button battery larger than 2 centimeters is an independent predictor for severe outcomes↗
▶Ep 37 · 3:49
clinicalHaving symptoms at presentation is an independent predictor for severe outcomes in button battery ingestion↗
Impact of Cryoanalgesia Use During Minimally Invasive Pectus Excavatum Repair on Hospital Days and Total Hospital Costs Among Pediatric Patients
▶Ep 38 · 0:00
quoteDo you use cryoalgesia for the NAS procedure in pectus excavatum repair?↗
▶Ep 38 · 0:11
epidemiologicalThe study aimed to evaluate hospital cost and length of stay for patients undergoing minimally invasive repair of pectus excavatum plus cryoanalgesia↗
▶Ep 38 · 0:11
epidemiologicalThe study was a retrospective review conducted in Texas↗
▶Ep 38 · 0:26
epidemiologicalThe study included 44 patients total, with 29 undergoing cryoanalgesia↗
▶Ep 38 · 0:26
clinicalPatients who underwent cryoanalgesia had significantly less length of stay compared to those without cryoanalgesia↗
▶Ep 38 · 0:26
clinicalPatients who underwent cryoanalgesia had significantly lower complication rates compared to those without cryoanalgesia↗
▶Ep 38 · 0:39
clinicalPatients who underwent cryoanalgesia had lower hospital costs than those without cryoanalgesia, though this difference was not statistically significant↗
▶Ep 38 · 0:48
opinionCryoanalgesia can help with hospital cost reduction in pectus excavatum repair↗
▶Ep 38 · 0:48
opinionCryoanalgesia helps with pain management in pectus excavatum repair↗
▶Ep 38 · 0:48
quoteSo it seems that cryo not only helps with pain management, but also can help with hospital cost.↗
Pectus Arcuatum a Pectus Unlike any Other
▶Ep 40 · 0:00
quoteHave you ever treated a pectussarquatum like a pectus carinatum?↗
▶Ep 40 · 0:11
epidemiologicalThe study is a multi-center retrospective study conducted in France describing pectus arcuatum↗
▶Ep 40 · 0:20
epidemiologicalThe study included 34 patients with pectus arcuatum↗
▶Ep 40 · 0:20
clinical47% of patients needed chest x-ray or CT scan to confirm the diagnosis of pectus arcuatum↗
▶Ep 40 · 0:29
clinicalScoliosis is an associated malformation seen with pectus arcuatum↗
▶Ep 40 · 0:29
epidemiological35% of pectus arcuatum patients were associated with a malformation↗
▶Ep 40 · 0:29
clinicalNoonan syndrome is an associated malformation seen with pectus arcuatum↗
▶Ep 40 · 0:29
clinicalThe best treatment for pectus arcuatum was surgical correction that included a sternotomy↗
▶Ep 40 · 0:41
clinicalPectus arcuatum should not be confused with pectus carinatum as they are different conditions↗
▶Ep 40 · 0:43
quoteDo not confusefectus or quatum with thefectus carinatum.↗
Journal of Pediatric Surgery Article Review: July 2023, PAPS Issue
▶Ep 41 · 1:48
clinicalPatients with cryoanalgesia had 3.0 days hospital stay versus 5.4 days without↗
Journal of Pediatric Surgery Article Review: September 2023
▶Ep 42 · 1:56
clinical47% of pectus arcuatum patients required X-ray or CT scan for diagnosis↗
▶Ep 42 · 3:07
clinicalPectus arcuatum treatment requires surgery that includes a sternotomy↗
▶Ep 42 · 7:41
clinicalERAS protocols significantly reduce intraoperative fluids needed by pediatric colorectal surgery patients↗
▶Ep 42 · 7:41
clinicalERAS protocols significantly reduce postoperative opiate use in pediatric colorectal surgery↗
▶Ep 42 · 7:55
clinicalTime for complete nutrition was less in pediatric colorectal surgery patients with ERAS protocols↗
▶Ep 42 · 7:55
clinicalTime to first oral intake was less in pediatric colorectal surgery patients with ERAS protocols↗
Journal of Pediatric Surgery Article Review: Q1 (Jan-Mar) 2024
▶Ep 44 · 2:45
clinical185 patients were in the home antibiotic group and 121 patients in the no home antibiotic group↗
▶Ep 44 · 2:55
clinicalThere was no significant difference in deep organ space infection requiring intervention between groups↗
▶Ep 44 · 3:03
clinicalThere was no difference in length of stay between antibiotic groups↗
▶Ep 44 · 5:43
clinicalType C esophageal atresia is the most common type and means esophageal atresia with a distal fistula↗
▶Ep 44 · 5:50
clinicalType A means pure esophageal atresia with no fistula to the trachea↗
▶Ep 44 · 9:25
clinicalThe pectus study enrolled 47 patients with median bar dwell time of approximately 2.9 years↗
▶Ep 44 · 9:41
clinicalPatients had a median of 2 bars placed, with almost 81% secured with pericostal sutures↗
▶Ep 44 · 9:51
clinicalAbout half of the patients had some degree of hypoesthesia↗
▶Ep 44 · 9:56
clinicalT5 was the most common dermatome with hypoesthesia↗
▶Ep 44 · 10:00
clinicalThe area with hypoesthesia was less than 5% of the entire surface treated with cryo↗
▶Ep 44 · 10:18
clinicalNeuropathic symptoms were identified by only 13% of patients and none required treatment↗
▶Ep 44 · 10:26
clinicalLong-term chest wall hypoesthesia after minimally invasive pectus repair with cryo is limited to one or two dermatomes and chronic symptomatic neuropathic pain is very rare↗
Quick Literature Updates Ep 24
▶Ep 54 · 3:34
epidemiologicalMulti-center retrospective study conducted in the US from 2018 to 2022 on pediatric choledocholithiasis↗
▶Ep 54 · 3:34
clinicalStudy compared transcystic laparoscopic common bile duct exploration versus ERCP-first approach↗
▶Ep 54 · 3:53
epidemiologicalStudy included 252 patients total: 156 in transcystic laparoscopic CBD exploration group and 96 in ERCP-first group↗
▶Ep 54 · 4:02
clinicalPatients in transcystic laparoscopic CBD exploration group had lower length of stay↗
▶Ep 54 · 4:02
clinicalPatients in transcystic laparoscopic CBD exploration group had significantly lower complication rates↗
▶Ep 54 · 4:16
opinionAttempting transcystic laparoscopic common bile duct exploration may benefit pediatric patients with choledocholithiasis↗
Update Course Rewind: Pectus Excavatum 2021
▶Ep 56 · 1:21
quoteOnce you see it, it's sort of a different game.↗
▶Ep 56 · 1:21
clinicalAfter implementing cryoanalgesia, a patient went home on post-operative day one, ending equipoise in the trial↗
▶Ep 56 · 2:33
clinicalCryoanalgesia reduced hospital length of stay from four days to one day↗
▶Ep 56 · 2:33
quoteWhat we saw there is the length of stay where we just couldn't get below four days. All of a sudden became one.↗
▶Ep 56 · 2:52
opinionThere are no long-term studies on cryoanalgesia outcomes, raising concerns about potential chronic neuropathic pain↗
▶Ep 56 · 2:52
quoteI agree with Sean. It works. I mean, it is great. One day. Yeah, no. So what I'm concerned about is that there are no long-term studies. But I believe we just don't know. We don't have the long-term data.↗
▶Ep 56 · 3:50
clinicalErector spinae catheters are placed by the pain team with ultrasound guidance, stay in for five days, and allow hospital discharge at two days with family removal of catheters on day three↗
▶Ep 56 · 4:52
quoteIt's not just when they go home. It's how they feel when they go home. And the cryo has been unbelievable. I mean, I feel bad that I waited so long.↗
opinionCryoanalgesia changed not just discharge timing but how patients feel at discharge↗
▶Ep 56 · 6:15
clinicalA multimodal pain regimen achieved hospital length of stay under two days with patients off opioids by one week↗
▶Ep 56 · 6:15
clinicalBest multimodal treatments are preoperative counseling, gabapentin pre and postoperatively, methadone, clonidine, bowel regimen medications, and antiemetics↗
▶Ep 56 · 7:35
clinicalComputational modeling shows shorter flat bars create more pressure on the sternum compared to traditional U-shaped bars, making them more stable↗
▶Ep 56 · 8:58
quoteWhatever technique helps you do that, I think is the technique you ought to use.↗
▶Ep 56 · 8:58
clinicalThoracoscopy, sternal elevator, vacuum bell, and sub-xiphoid incision are all techniques aimed at preventing cardiac injury↗
▶Ep 56 · 9:20
quoteI never even thought about doing left to right, I must admit. So I'm also learning something new and think that's a really fascinating idea.↗
Update Course Rewind: Pectus Excavatum 2021
▶Ep 57 · 1:21
quoteWe were enrolling in this study. We had about 30 patients in each group when we tried the first cryotherapy. And when that patient went home on post-op day one, equipoise was lost. Once you see it, it's sort of a different game.↗
▶Ep 57 · 1:21
clinicalAfter implementing cryoanalgesia, a patient went home on postoperative day one, leading to loss of equipoise in the trial comparing cryotherapy to epidural/PCA↗
▶Ep 57 · 2:07
quoteYou literally just count down to the fourth rib and then freeze underneath it. It's two minutes per rib. We do four through seven. You're not supposed to go eight or below because you can get some abdominal wall paralysis.↗
▶Ep 57 · 2:07
clinicalCryoanalgesia should not be applied to rib 8 or below because it can cause abdominal wall paralysis↗
▶Ep 57 · 2:07
clinicalCryoanalgesia technique involves freezing underneath ribs 4 through 7 for two minutes per rib↗
▶Ep 57 · 2:43
clinicalCryoanalgesia dramatically reduced median morphine equivalents compared to previous pain control methods↗
▶Ep 57 · 3:14
guidelineMedical devices and implants are not required to undergo clinical trials before introduction to market, unlike drugs↗
▶Ep 57 · 3:14
quoteUnlike drugs, medical devices and implants are not, are not required to undergo clinical trials before they're introduced into the market.↗
▶Ep 57 · 3:35
guidelineFDA requires clinical trials with long-term results before approving medications for use↗
▶Ep 57 · 3:50
clinicalA comparison study of approximately 100 patients examined epidurals versus erector spinae catheters for pectus excavatum pain control↗
▶Ep 57 · 4:08
clinicalErector spinae catheters are placed by the pain team with ultrasound guidance and are juxtaposed to but not in the vertebral space↗
▶Ep 57 · 4:08
clinicalErector spinae catheters stay in place for five days on an automated pump, with families removing them on day three while patients are at home↗
▶Ep 57 · 5:34
clinicalMultimodal pain control for pectus excavatum includes Tylenol, NSAIDs, precedex for gentle wake up, dexamethasone for post-anesthetic nausea, ketamine to avoid opioids, child life specialists, mindfulness resources, and physical therapists↗
▶Ep 57 · 6:26
quoteI do think that bar flippage is completely a surgical issue.↗
▶Ep 57 · 6:26
clinicalWhen bars flip, they typically flip early due to sitting in a funky intercostal space, sitting in a bad spot, insufficient bar wrapping, or inadequate securing↗
▶Ep 57 · 6:26
opinionBar flipping is completely a surgical technique issue, not related to the securing method↗
▶Ep 57 · 8:01
clinicalSternal elevation in really deep stiff pectus cases allows less tissue damage and better repair↗
▶Ep 57 · 8:01
clinicalOne center uses sternal elevator in every case to eliminate guesswork and enable consistent access to the same intercostal space↗
▶Ep 57 · 8:01
clinicalOne center uses sternal elevator in about 10% of cases, primarily in younger patients where thoracoscopy provides adequate visualization↗
▶Ep 57 · 9:20
clinicalPassing the bar from right chest to left chest means the introducer is pointing directly at the ventricle↗
▶Ep 57 · 9:20
quoteI go from the left chest to the right chest because if you go from the right chest to the left chest, you're coming down and whatever you're passing across is pointing right at the ventricle.↗
▶Ep 57 · 9:20
opinionBar passage direction (left-to-right versus right-to-left) probably does not make a significant difference as long as the sub-sternal space is well dissected and everything is clear↗
Update Course Rewind: Pectus Excavatum 2021
▶Ep 58 · 1:02
quoteWe of course struggled with postoperative pain management as everybody did. And we had completed a randomized trial, 110 patients, to epidural and PCA. And in that study, the epidurals didn't really drop off.↗
▶Ep 58 · 1:02
clinicalA randomized trial of 110 patients comparing epidural and PCA for pectus excavatum pain control showed that epidurals did not provide superior pain relief↗
▶Ep 58 · 1:56
clinicalCryoanalgesia uses cold temperatures to cause a conduction block that interrupts pain impulses to the brain↗
▶Ep 58 · 2:09
clinicalCryoanalgesia should not be performed on rib eight or below because it can cause abdominal wall paralysis↗
▶Ep 58 · 2:09
clinicalThe cryoanalgesia technique involves freezing underneath ribs four through seven for two minutes per rib↗
▶Ep 58 · 2:25
quoteYou're not supposed to go eight or below because you can get some abdominal wall paralysis.↗
▶Ep 58 · 2:43
clinicalCryoanalgesia dramatically reduced median morphine equivalents compared to previous pain control methods↗
▶Ep 58 · 3:14
guidelineMedical devices and techniques are not required to undergo clinical trials before introduction to market, unlike medications↗
▶Ep 58 · 3:14
quoteYou know, unlike drugs, medical devices and implants are not, are not required to undergo clinical trials before they're introduced into the market.↗
▶Ep 58 · 4:30
quoteOur hospital stays are two days. We've been able to reduce the opioid requirements, not only in the hospital, but also outside of the hospital.↗
▶Ep 58 · 4:30
clinicalErector spinae catheters reduced opioid requirements both in the hospital and outside of the hospital↗
▶Ep 58 · 4:30
clinicalWith erector spinae catheters, hospital stay is two days, which is much less than the four or five days seen with epidurals↗
▶Ep 58 · 5:40
clinicalFor multimodal pain therapy, the best treatments are preoperative counseling, gabapentin both pre and postoperatively, methadone, clonidine, bowel regimen medications and antiemetics↗
▶Ep 58 · 6:00
quoteSo for multimodal therapy, the best treatments are preoperative counseling, gabapentin both pre and postoperatively, and then methadone, clonidine, bowel regimen medications and antiemetics.↗
▶Ep 58 · 6:20
clinicalWith multimodal pain control at one institution, length of stay is under two days and patients are off opioids by one week↗
▶Ep 58 · 7:00
clinicalComputational modeling showed that shorter flat bars have more pressure on the sternum compared to traditionally U-shaped bars, making them more stable↗
▶Ep 58 · 7:40
clinicalSternal elevator is used in about 10% of cases at one institution↗
▶Ep 58 · 8:00
clinicalIn younger patients with average anatomy, thoracoscopy provides adequate visualization without needing a sternal elevator↗
▶Ep 58 · 8:20
clinicalIn really deep stiff pectus cases, sternal elevation allows less tissue damage and a better repair↗
▶Ep 58 · 8:40
clinicalOne surgeon uses the sternal elevator in every case to eliminate guesswork and enable passage in and out at the same intercostal space↗
▶Ep 58 · 9:00
clinicalThoracoscopy, sternal elevator, vacuum bell in the operating room, or subxiphoid incision all serve the purpose of avoiding cardiac injury↗
epidemiologicalOnly 30 of the 501 patients received ovarian tissue transplantation↗
▶Ep 22 · 0:36
clinicalOf the 30 patients who received transplantation, 9 got pregnant↗
▶Ep 22 · 0:40
clinicalOnly 6 of the 9 pregnancies resulted in live birth↗
▶Ep 22 · 0:43
opinionMore high quality studies are needed to understand cryopreservation better and improve its outcomes↗
▶Ep 22 · 0:43
quoteSo even though cryopreservation can be successful, we still need more high quality studies to understand it better and improve its outcomes.↗
Choledocholithiasis with Drs. David Vitale & Lucas Neff
▶Ep 26 · 2:11
guidelinePatients with intermediate risk (abnormal liver biochemical tests or dilated common bile ducts) can undergo endoscopic ultrasound, MRCP, laparoscopic cholangiogram, or intraoperative ultrasound↗
▶Ep 26 · 2:50
clinicalCommon bile duct diameter greater than 6 millimeters was most sensitive for predicting common bile duct stones in children, although without statistical significance↗
▶Ep 26 · 4:18
clinicalRandomized trials from 2013 show no significant difference in morbidity, mortality, retained stones, or failure rates between ERCP and laparoscopic common bile duct exploration↗
▶Ep 26 · 9:12
epidemiologicalMost free-standing children's hospitals do not have ERCP capabilities↗
▶Ep 26 · 12:24
clinicalIf the pancreatic duct is seen on fluoroscopy during the procedure, stop because that has a higher risk for pancreatitis↗
epidemiologicalThe Olsen et al. systematic review analyzed 10 studies with 6,430 patients↗
▶Ep 6 · 3:00
clinicalThe definition of a high volume surgeon varies widely from 9 thyroidectomies per year to over 200 thyroidectomies with at least 30 being in pediatric patients↗
▶Ep 6 · 3:20
quoteit seems that for thyroid pathology, high volume surgeons does matter.↗
▶Ep 6 · 3:20
clinicalThyroidectomies performed by high volume surgeons show shorter length of stays↗
Disruption of enterohepatic Circulation of Bile acids ameliorates small bowel resection associated hepatic injury
▶Ep 7 · 0:00
clinicalDisruption of the enterohepatic circulation of bile acids is beneficial for the liver↗
▶Ep 7 · 0:00
quoteDid you know that the disruption of the enterohepatic circulation of bilasses is beneficial for the liver?↗
▶Ep 7 · 0:13
clinicalThe study aim was to elucidate the driving force behind hepatic injury↗
▶Ep 7 · 0:13
quoteThis is a basic science study done in Saint Louis Children's Hospital, and their aim was to elucidate the driving force behind the hepatic injury.↗
▶Ep 7 · 0:13
clinicalThe study was conducted at Saint Louis Children's Hospital↗
▶Ep 7 · 0:22
clinicalThree groups of mice were studied: sham, 50% with proximal or duodenal resection, and 50% with distal resection or resection of the ileocecal valve↗
▶Ep 7 · 0:34
clinicalTissue samples were taken at the second and 10th postoperative weeks↗
▶Ep 7 · 0:41
clinicalIleal resection could lead to less hepatic injury↗
▶Ep 7 · 0:41
clinicalMice with distal resection show less hepatic oxidative stress↗
▶Ep 7 · 0:41
clinicalMice with distal resection show more hydrophilic bile acid profile↗
