I actually send people home with, for, for laparoscopic inguinal hernias. I'm not so sure if we're open yet, but lap, which is the majority of my practice, zero narcotics, zero six months. I have not written a script. I send them with ice and scheduled Motrin and Tylenol.
My name's Jason F Fisher. I'm a pediatric surgeon and director of the Colorectal Center at Cincinnati Children's, and I also happen to be. The lead of the subcommittee for Hirschprung's disease for the PCPLC or Pediatric Colorectal and Pelvic Learning Consortium.
My name's Jason F Fisher. I'm a pediatric surgeon and director of the Colorectal Center at Cincinnati Children's, and I also happen to be. The lead of the subcommittee for Hirschprung's disease for the PCPLC or Pediatric Colorectal and Pelvic Learning Consortium.
My name's Jason F Fisher. I'm a pediatric surgeon and director of the Colorectal Center at Cincinnati Children's, and I also happen to be. The lead of the subcommittee for Hirschprung's disease for the PCPLC or Pediatric Colorectal and Pelvic Learning Consortium.
My name's Jason F Fisher. I'm a pediatric surgeon and director of the Colorectal Center at Cincinnati Children's, and I also happen to be. The lead of the subcommittee for Hirschprung's disease for the PCPLC or Pediatric Colorectal and Pelvic Learning Consortium.
My name's Jason F Fisher. I'm a pediatric surgeon and director of the Colorectal Center at Cincinnati Children's, and I also happen to be. The lead of the subcommittee for Hirschprung's disease for the PCPLC or Pediatric Colorectal and Pelvic Learning Consortium.
Journal of Pediatric Surgery Article Review: 2nd Quarter (Apr-Jun) 2024
▶Ep 36 · 0:06
quoteHi everyone, I'm M. Goddy from Cincinnati Children's, and we are back with another episode of our Journal of Pediatric Surgery article review podcast.↗
▶Ep 36 · 1:05
quoteI'm a pediatric surgeon at Alberta Children's Hospital. I've also been the publication chair for the uh Pacific Association of Pediatric Surgeons.↗
▶Ep 36 · 1:25
host_summaryMMP-7 (matrix metalloproteinase 7) are proteolytic peptidases that break down peptide bonds for amino acids and are part of tissue remodeling processes, playing roles in tissue repair, arthritis, metastasis, and cirrhosis↗
▶Ep 36 · 1:43
host_summaryHigher levels of MMP-7 are associated with the diagnosis of biliary atresia↗
▶Ep 36 · 1:56
host_summaryIn a cohort of 329 biliary atresia cases from July 2020 to December 2022, 40 were classified as low MMP-7↗
▶Ep 36 · 2:11
quoteThis is a group that has an ability to access a very large number of patients in a very short period of time, which really puts them in a position where they can dive deeply into. To things that others couldn't even start thinking about↗
▶Ep 36 · 2:36
host_summaryLow levels of MMP-7 in biliary atresia patients are associated with low levels of preoperative GGT (gamma glutamyl transpeptidase) and direct bilirubin↗
▶Ep 36 · 3:02
host_summaryGGT (gamma glutamyl transpeptidase) is an enzyme found in high levels in liver, kidney, pancreas, heart, and brain, and blood GGT levels are used to detect diseases of the liver and bile ducts↗
▶Ep 36 · 3:19
host_summaryBiliary atresia has variable outcomes even within one center, with patients who anatomically look similar having dramatically different outcomes↗
▶Ep 36 · 4:09
host_summaryHaving lower MMP-7 levels within the cohort of biliary atresia patients is associated with worse prognosis↗
▶Ep 36 · 4:26
quoteAnd one of the things I love about this paper is that it just brings us down to some of those really basic questions about when we deal with these conditions, what actually underlies it? What are these processes? How do we target them?↗
▶Ep 36 · 4:41
host_summaryThe mechanism of why low MMP-7 levels in biliary atresia patients leads to worse prognosis is unknown↗
▶Ep 36 · 7:02
host_summaryIn a Canadian cohort of 411 infants with gastroschisis treated at CAPSNET centers from 2014 to 2022, 144 were excluded due to gestational age, birth weight, other congenital anomalies, or complicated gastroschisis, leaving 267 participants↗
▶Ep 36 · 7:43
host_summaryOf 267 uncomplicated gastroschisis patients, 78% received exclusive breast milk in the first 28 days of life and 22% received supplemental or exclusive formula↗
▶Ep 36 · 8:27
host_summaryThere were no significant differences between exclusive breast milk and formula groups in time to reach full enteral feeds, duration of parenteral nutrition, or length of stay in uncomplicated gastroschisis↗
▶Ep 36 · 8:53
host_summaryPatients with uncomplicated gastroschisis who received exclusive breast milk in the first 28 days were far more likely to transition to exclusive breastfeeding: 73% compared to 11% in those with formula exposure↗
▶Ep 36 · 12:46
host_summaryA systematic review on transition from pediatric to adult care for colorectal conditions included 8 studies with patient, parent, and clinician perspectives, focusing on patients aged 10-30 years with anorectal malformation or Hirschsprung disease↗
▶Ep 36 · 13:16
host_summaryThere is a group of colorectal patients discharged from care in late childhood around age 10 years, and another group that remains in pediatric care way beyond the normal age of transfer to adult care (around 25 years)↗
▶Ep 36 · 13:30
opinionThe life course progression of anorectal malformation and Hirschsprung disease is not well understood↗
Journal of Pediatric Surgery Article Review: 3rd Quarter (Jul-Sep) 2024
▶Ep 37 · 1:38
quoteMy name's Jason F Fisher. I'm a pediatric surgeon and director of the Colorectal Center at Cincinnati Children's, and I also happen to be. The lead of the subcommittee for Hirschprung's disease for the PCPLC or Pediatric Colorectal and Pelvic Learning Consortium.↗
▶Ep 37 · 3:20
host_summary85% of Hirschsprung disease patients in the study were diagnosed at less than 1 year of age↗
▶Ep 37 · 3:45
host_summaryKids with shorter segment Hirschsprung disease (rectosigmoid or small portion of aganglionic bowel) were more likely to be diagnosed at a later age↗
▶Ep 37 · 3:57
host_summaryChildren with long segment Hirschsprung disease typically presented at birth with classic symptoms such as failure to pass meconium↗
▶Ep 37 · 4:26
host_summaryApproximately one-third of neonates and 50% of infants, toddlers, and children had diverting ostomies performed prior to pull-through↗
▶Ep 37 · 5:01
host_summaryThere was no difference in overall rates of redo pull-throughs across age groups↗
▶Ep 37 · 5:07
host_summaryOlder children were more likely to need a redo pull-through due to an anastomotic leak↗
▶Ep 37 · 5:13
host_summaryHigher rates of diverting ostomy post pull-through were likely a treatment for a post pull-through leak or anastomotic leak↗
▶Ep 37 · 5:24
host_summaryThe only functional outcome that was different was nighttime soiling or incontinence in the older patient population↗
▶Ep 37 · 7:44
quoteI am a pediatric surgeon. Uh, in the division of pediatric Surgery with Presbyterian Healthcare Services in Albuquerque, New Mexico↗
▶Ep 37 · 8:09
host_summaryThe gastroschisis systematic review included 28 high quality manuscripts↗
▶Ep 37 · 8:15
host_summaryTwo randomized controlled trials on gastroschisis had been started but both ended prematurely and were underpowered↗
▶Ep 37 · 10:37
host_summarySkin organisms are most commonly identified in infections among infants with gastroschisis↗
▶Ep 37 · 10:44
host_summaryGastroschisis infants have a fairly high rate of wound infection↗
▶Ep 37 · 10:50
host_summarySilo closures have a higher rate of infection than other closure methods↗
▶Ep 37 · 10:50
host_summarySutureless closure has the lowest rate of infection in gastroschisis↗
▶Ep 37 · 10:57
host_summaryRecommendation is to provide antibiotic coverage for skin flora until the gastroschisis defect is closed and potentially for an additional 24 hours thereafter↗
▶Ep 37 · 12:22
host_summaryStable gastroschisis infants with sufficient abdominal capacity for sutureless closure tend to have the best outcomes↗
▶Ep 37 · 12:29
host_summaryMinimizing fluids and paralytics in gastroschisis infants improves their results↗
▶Ep 37 · 17:04
host_summary43% of pediatric surgeons preferred the Clavien-Madadi classification compared to 12% for the Clavien-Dindo classification↗
▶Ep 37 · 17:16
host_summaryAdvantages of the Clavien-Madadi classification were affirmed by nearly 82% of the surgeons↗
Umbilical Disorders with Dr. Rebeccah Brown
▶Ep 39 · 0:34
quoteTwo umbilical arteries and one umbilical vein surrounding by a gelatin-like extracellular matrix known as Worthin's jelly.↗
▶Ep 39 · 0:34
host_summaryThe umbilical cord contains two umbilical arteries and one umbilical vein surrounded by Wharton's jelly (a gelatin-like extracellular matrix).↗
▶Ep 39 · 0:50
quoteThey usually fall off 2 to 3 weeks, and the delay can be a manifestation of an immune deficiency.↗
▶Ep 39 · 0:50
host_summaryUmbilical cords usually fall off at 2 to 3 weeks after birth.↗
▶Ep 39 · 0:50
host_summaryDelayed umbilical cord separation can be a manifestation of an immune deficiency.↗
▶Ep 39 · 1:20
host_summaryMild omphalitis cases (inflammation of the belly button) may be treated with alcohol drying, ampicillin, or amoxicillin with follow-up every 24 hours.↗
▶Ep 39 · 1:40
host_summary16% of patients admitted with omphalitis develop necrotizing fasciitis.↗
▶Ep 39 · 1:40
quote16% of the patients admitted with onalittis develop necrotizing fasciitis.↗
▶Ep 39 · 1:46
host_summaryNecrotizing fasciitis from omphalitis presents with rapidly progressive umbilical edema, erythema, drainage, and has a high mortality rate.↗
▶Ep 39 · 2:27
host_summaryUmbilical hernias can be associated with trisomy 13, 18, and 21.↗
▶Ep 39 · 2:47
host_summaryDr. Brown mentioned that if the fascial opening in an umbilical hernia is larger than 1.5 centimeters, it may not close by itself.↗
▶Ep 39 · 2:55
host_summaryIn Walker's studies, 96% of very small umbilical hernias (less than 0.5 centimeters) closed by six years, but no hernia greater than 1.5 centimeters closed by six years of age.↗
▶Ep 39 · 4:54
host_summaryUnplanned emergency department returns within 30 days after umbilical hernia repair occurred at 2.5%, with rates twice as high for patients younger than 4 years old.↗
▶Ep 39 · 5:10
host_summaryAsymptomatic umbilical hernia repair should be delayed until greater than 4 years of age.↗
▶Ep 39 · 5:18
host_summaryIn Rangel's study of 167,000 patients at 68 pediatricians' offices, 4,486 had umbilical hernia diagnosis at a median age of 1.6 months, with spontaneous closure occurring in 89% by age 5.↗
▶Ep 39 · 5:53
host_summaryIn Rangel's study, closure rates for smaller hernias (≤1 cm) were nearly 90%, while for larger hernias they were around 80%.↗
▶Ep 39 · 6:12
host_summaryRangel's study concluded that umbilical hernia repair should be delayed until age 5 years given the high incidence of spontaneous closure.↗
▶Ep 39 · 6:56
host_summaryProboscoid hernia occurs when the skin above the hernia grows and pushes through the opening in the abdominal wall.↗
▶Ep 39 · 7:05
host_summaryIt is recommended to correct proboscoid hernias before school age to avoid psychological issues for the child.↗
▶Ep 39 · 8:00
host_summaryDr. Brown prefers to perform umbilicoplasty in umbilical hernia repairs, excising excess skin and using a 4-0 monocryl purse-string suture close to the skin surface to create a cosmetically appealing umbilicus.↗
▶Ep 39 · 8:55
host_summaryUmbilical granulomas are usually moist but commonly dry up and fall off spontaneously over time.↗
▶Ep 39 · 9:00
host_summaryUmbilical granulomas often respond to silver nitrate treatment.↗
Aerodigestive & Esophageal Surgery - The Unsalvageable Esophagus & Cases
▶Ep 3 · 16:30
quoteManubrial removing the manubrium is never as straightforward as it seems because your clavicles always get in the way.↗
▶Ep 3 · 16:30
quoteManubrial removing the manubrium is never as straightforward as it seems because your clavicles always get in the way.↗
▶Ep 3 · 16:38
clinicalManubrial resection for high esophageal strictures provides less exposure than expected because the clavicles limit the width of the resection corridor.↗
▶Ep 3 · 16:38
clinicalManubrial resection for high esophageal strictures provides less exposure than expected because the clavicles limit the width of the resection corridor.↗
▶Ep 3 · 19:36
quoteEsophageal stents are very much a double-edged sword. They can often cause as many problems as they fix.↗
▶Ep 3 · 19:36
quoteEsophageal stents are very much a double-edged sword. They can often cause as many problems as they fix.↗
▶Ep 3 · 33:28
clinicalKenalog (steroid) injection after stricture dilation is preferred over mitomycin. Mitomycin at high concentrations (up to 5 mg/mL) causes tissue necrosis and has not shown superior outcomes compared to steroids.↗
▶Ep 3 · 33:28
clinicalKenalog (steroid) injection after stricture dilation is preferred over mitomycin. Mitomycin at high concentrations (up to 5 mg/mL) causes tissue necrosis and has not shown superior outcomes compared to steroids.↗
▶Ep 3 · 36:29
clinicalFor recalcitrant esophageal strictures, weekly dilations (3–4 cycles) prevent fibroblasts from bridging and allow the stricture to scar open rather than closed.↗
▶Ep 3 · 36:29
clinicalFor recalcitrant esophageal strictures, weekly dilations (3–4 cycles) prevent fibroblasts from bridging and allow the stricture to scar open rather than closed.↗
▶Ep 3 · 45:47
clinicalFeeding via gastrojejunal tube with gastric drainage (GJ/G) is a temporizing measure to reduce reflux into the esophagus while managing a refractory stricture.↗
▶Ep 3 · 45:47
clinicalFeeding via gastrojejunal tube with gastric drainage (GJ/G) is a temporizing measure to reduce reflux into the esophagus while managing a refractory stricture.↗
▶Ep 3 · 47:43
quoteIf you've got mucosal disease, all you need to do is remove all the mucosa. You've got no disease.↗
▶Ep 3 · 47:43
quoteIf you've got mucosal disease, all you need to do is remove all the mucosa. You've got no disease.↗
▶Ep 3 · 48:18
clinicalEsophageal stents can compress the adjacent trachea, especially in children with tracheomalacia or when the esophagus lies directly posterior to the trachea. Always perform bronchoscopy after stent placement.↗
▶Ep 3 · 48:18
clinicalEsophageal stents can compress the adjacent trachea, especially in children with tracheomalacia or when the esophagus lies directly posterior to the trachea. Always perform bronchoscopy after stent placement.↗
▶Ep 3 · 48:20
quoteIf you put in an esophageal stent, have a quick look in the airway when you're done.↗
▶Ep 3 · 48:20
quoteIf you put in an esophageal stent, have a quick look in the airway when you're done.↗
▶Ep 3 · 50:13
quoteWe see it with um chronic oesophageal foreign bodies, um, classically the penny. And typically for a chronic one, they come in about 6 weeks later. And they come in with a diagnosis of asthma.↗
▶Ep 3 · 50:13
quoteWe see it with um chronic oesophageal foreign bodies, um, classically the penny. And typically for a chronic one, they come in about 6 weeks later. And they come in with a diagnosis of asthma.↗
▶Ep 3 · 50:20
clinicalChronic esophageal foreign bodies (e.g., coins lodged for weeks) can cause posterior tracheal bulge and present as refractory asthma or bronchiolitis, often diagnosed late because chest X-rays are not routinely obtained in asthma protocols.↗
▶Ep 3 · 50:20
clinicalChronic esophageal foreign bodies (e.g., coins lodged for weeks) can cause posterior tracheal bulge and present as refractory asthma or bronchiolitis, often diagnosed late because chest X-rays are not routinely obtained in asthma protocols.↗
▶Ep 3 · 52:06
quoteThe aim is to probe it but not push so hard that you create a fistula. That's always embarrassing.↗
▶Ep 3 · 52:06
quoteThe aim is to probe it but not push so hard that you create a fistula. That's always embarrassing.↗
▶Ep 3 · 1:01:05
quoteA lot of kids have replaced esophaguuses and most of them don't aspirate, even if you've got a trashed cricoharyngeis.↗
▶Ep 3 · 1:01:05
quoteA lot of kids have replaced esophaguuses and most of them don't aspirate, even if you've got a trashed cricoharyngeis.↗
▶Ep 3 · 1:10:42
clinicalCovered esophageal stents can temporize anastomotic leaks and allow healing while maintaining luminal patency. Stent removal is typically planned after several weeks.↗
▶Ep 3 · 1:10:42
clinicalCovered esophageal stents can temporize anastomotic leaks and allow healing while maintaining luminal patency. Stent removal is typically planned after several weeks.↗
▶Ep 3 · 1:31:42
clinicalTracheal homografts (dead trachea implants) have been performed but are associated with difficult postoperative courses lasting several months.↗
▶Ep 3 · 1:31:42
clinicalTracheal homografts (dead trachea implants) have been performed but are associated with difficult postoperative courses lasting several months.↗
▶Ep 3 · 1:32:06
clinicalTissue-engineered tracheal homografts with pre-epithelialization are under development in multiple centers (London leading) but are not yet ready for routine clinical use.↗
▶Ep 3 · 1:32:06
clinicalTissue-engineered tracheal homografts with pre-epithelialization are under development in multiple centers (London leading) but are not yet ready for routine clinical use.↗
▶Ep 3 · 1:33:15
clinicalLong-term surveillance of bypassed esophagus includes periodic CT scans to rule out mucocele and endoscopic evaluation via the persistent TEF if needed.↗
▶Ep 3 · 1:33:15
clinicalLong-term surveillance of bypassed esophagus includes periodic CT scans to rule out mucocele and endoscopic evaluation via the persistent TEF if needed.↗
▶Ep 3 · 1:34:15
clinicalPosterior tracheopexy (pexing the trachea to the anterior spine) combined with bovine pericardial patch for tracheal defects is an alternative to esophageal bypass, but pericardial patches can fail and create large tracheal defects.↗
▶Ep 3 · 1:34:15
host_summaryPosterior tracheopexy (pexing the trachea to the anterior spine) combined with bovine pericardial patch for tracheal defects is an alternative to esophageal bypass, but pericardial patches can fail and create large tracheal defects.↗
▶Ep 3 · 1:39:43
opinionComplications are nearly inevitable in complex esophageal reconstruction. The goal is not to eliminate complications but to anticipate and manage them effectively through a multidisciplinary team approach.↗
▶Ep 3 · 1:39:43
quoteThis is a game where complications are almost inevitable. And it's not that you can eliminate them, you can minimize them, but then it's the team approach trying to work out how to manage them.↗
▶Ep 3 · 1:39:43
opinionComplications are nearly inevitable in complex esophageal reconstruction. The goal is not to eliminate complications but to anticipate and manage them effectively through a multidisciplinary team approach.↗
▶Ep 3 · 1:39:43
quoteThis is a game where complications are almost inevitable. And it's not that you can eliminate them, you can minimize them, but then it's the team approach trying to work out how to manage them.↗
QUAD #2 Thoracoscopic Tracheopexy with Dr. Aaron Garrison
▶Ep 17 · 0:36
host_summarySeveral years ago, the approach was that patients with tracheomalacia would undergo aortopexy.↗
▶Ep 17 · 0:43
host_summaryIn the last 4 to 5 years, it has become standard practice to determine which patients will respond best to tracheopexy versus aortopexy.↗
▶Ep 17 · 1:45
host_summaryPart of the workup is making sure that there is space to anteriorly suspend the aorta so that the trachea diameter can actually be made larger.↗
▶Ep 17 · 2:02
host_summaryPreoperative bronchoscopy gives the surgical team an idea of internal anatomy, which can assist in classifying the degree of tracheomalacia prior to surgical intervention.↗
▶Ep 17 · 3:23
host_summaryWhen using a thoracoscopic approach, correct positioning is the key to success.↗
▶Ep 17 · 3:27
host_summaryIt is best to use gravity to advantage as it aids in retracting the lungs and trachea placement.↗
▶Ep 17 · 4:01
host_summaryOpening the pericardium and finding the area at the pericardial-adventitial junction to suspend is the key point of aortopexy.↗
▶Ep 17 · 4:16
host_summaryPassing suture transternally is preferred with the aortopexy approach, though it can be technically difficult.↗
▶Ep 17 · 4:23
host_summaryFor tracheopexy, a posterior approach via semiprone position is preferred.↗
▶Ep 17 · 4:28
host_summaryCreating a pneumothorax by putting the Veress off the tip of the scapula helps collapse the lung for trocar placement.↗
▶Ep 17 · 4:38
host_summaryWhen operating posteriorly, triangulating your hands gives the best visualization and working space.↗
▶Ep 17 · 4:56
host_summaryWhen available, a multidisciplinary team which includes a pulmonologist can allow for internal visualization via bronchoscopy.↗
▶Ep 17 · 5:05
host_summaryBronchoscopic guidance technique is primarily used in non-esophageal atresia patients.↗
▶Ep 17 · 5:53
host_summaryIt is important to create enough tension in the suture to ensure that the pexy is secure.↗
▶Ep 17 · 6:07
host_summaryThe approach changes for patients without esophageal atresia or with an esophagus in continuity.↗
▶Ep 17 · 6:14
host_summaryFor patients with esophagus in continuity, the first step is to dissect around the esophagus using a vessel loop for retraction.↗
▶Ep 17 · 6:32
host_summaryUsing pre- and post-operative bronchoscopy allows the surgeon to see the improvement prior to case completion.↗
QUAD #4: Surgical Management of Button Battery & Caustic Ingestion with Dr. Aaron Garrison
▶Ep 18 · 0:41
host_summaryA 1992 study reviewed more than 2000 cases of button battery ingestion in children and found no deaths.↗
▶Ep 18 · 0:52
host_summaryRecent studies have found a sevenfold increase in fatalities following button battery ingestions.↗
▶Ep 18 · 0:59
host_summaryThe increase in fatalities is because of the change to a 20-volt lithium cell which causes coagulative necrosis.↗
▶Ep 18 · 1:14
host_summaryWhen a button battery sits in one of these positions, it causes transmural injury and will make a fistula between the esophagus and adjacent structures including trachea, blood vessels, or vocal cords.↗
▶Ep 18 · 1:39
host_summaryA larger battery over 20 millimeters or greater is riskier.↗
▶Ep 18 · 1:49
host_summaryA battery behind the aortic arch is more concerning.↗
▶Ep 18 · 2:05
host_summaryIn a Colorado study of 13 patients with high severity button battery injuries, 30% had esophageal perforation.↗
▶Ep 18 · 2:14
host_summaryIn the Colorado study, 23% of patients developed stricture.↗
▶Ep 18 · 2:16
host_summarySome patients in the Colorado study required G-tube placement and stayed in the hospital for nearly 2 weeks.↗
▶Ep 18 · 2:32
host_summarySentinel bleeds can be the first sign of aortoenteric fistulas.↗
▶Ep 18 · 2:50
host_summarySome aortoesophageal fistulas showed up over 2 weeks after the batteries were removed.↗
▶Ep 18 · 3:39
host_summaryImaging beforehand with a CTA to assess inflammation and proximity to the aorta is helpful.↗
▶Ep 18 · 3:59
host_summaryIf there is any bleeding or concern for sentinel bleed, have a plan with interventional radiology, cardiology, or anyone who can help in that situation.↗
▶Ep 18 · 4:10
host_summaryIn one case report with a pseudoaneurysm from the arch of the aorta, repair was done with a staged approach: sternotomy on bypass to fix the aorta with a graft, followed by flap repair of the esophagus.↗
▶Ep 18 · 6:10
host_summaryButton batteries are ingested more than 3500 times per year in the United States.↗
▶Ep 18 · 6:20
host_summaryCaustic ingestion is most common in young children between 1 and 3 years of age.↗
▶Ep 18 · 6:25
host_summaryMost caustic ingestions by children are accidental and the amounts ingested tend to be small.↗
▶Ep 18 · 6:43
host_summaryAcidic substances that are spit back up rather than swallowed can cause severe injury to the epiglottis.↗
▶Ep 18 · 7:20
host_summarySmaller children, bigger batteries, and longer ingestion time pose greater risk.↗
▶Ep 18 · 7:25
host_summaryDo not be reassured by a battery in the stomach, as injuries can progress even after battery removal.↗
▶Ep 18 · 7:31
host_summaryHaving an imaging plan to be proactive about finding transmural and worsening inflammation toward vessels is important.↗
▶Ep 18 · 7:39
host_summaryFor caustic ingestions, be patient; small perforations can heal and be managed conservatively.↗
▶Ep 18 · 7:43
host_summaryIf strictures develop after caustic ingestion, either dilation or surgery may be necessary.↗
QUAD #7 Anesthesia for Thoracoscopic Techniques with Dr. Nathaniel Tighe
▶Ep 20 · 1:05
host_summaryThe association between esophageal atresia and cardiac abnormalities is particularly relevant to anesthetic technique.↗
▶Ep 20 · 1:42
host_summaryThe most common technique for maintaining stillness is short-acting opioid infusions, which result in relatively little hemodynamic instability.↗
▶Ep 20 · 1:53
host_summaryVolatile anesthetics are especially useful when preservation of spontaneous ventilation is desired.↗
▶Ep 20 · 2:31
host_summaryInsufflation using pneumothorax created by trocar placement can facilitate surgical exposure by overcoming peak inspiratory pressures to allow lung collapse.↗
▶Ep 20 · 2:48
host_summaryInsufflation is useful for small kids with good lung compliance but not effective in kids with severe bronchopulmonary dysplasia or other compliance abnormalities.↗
▶Ep 20 · 4:19
host_summaryEndotracheal tube placement is technically easier than placement of other lung isolation devices.↗
▶Ep 20 · 4:39
quoteIn kids with a pig bronchus or similar situation, this really becomes very difficult.↗
▶Ep 20 · 4:48
host_summaryA tracheal bronchus (pig bronchus) is an anatomical variant where an accessory bronchus originates directly from the supracarinal trachea.↗
▶Ep 20 · 5:17
host_summaryIn larger kids (usually 8 years or above) with recurrent fistulas, double-lumen tubes can be used and are the easiest device for lung isolation because they allow independent ventilation of the two lungs.↗
▶Ep 20 · 5:38
host_summaryEarly conversations between anesthesiologists and surgeons about patient specifics are part of deciding the best modality for each individual patient.↗
▶Ep 20 · 6:07
host_summarySingle ventricle patients may be candidates for open repair or ECMO support to ensure good outcomes.↗
QUAD #5 Pharyngeal Scar Management with Dr. Doug von Allmen
▶Ep 21 · 0:42
host_summaryEtiologies of pharyngeal stenosis include caustic ingestion, iatrogenic injury, or multi-level upper airway surgery↗
▶Ep 21 · 1:05
host_summaryTreatment goals for pharyngeal stenosis patients are tiered: achieving adequate voice, breathing without tracheostomy, preventing aspiration, and swallowing without G-tube↗
▶Ep 21 · 2:59
host_summaryProlonged stenting of about 4 to 6 weeks is typical for pharyngeal stenosis management↗
▶Ep 21 · 4:10
host_summaryBalloon dilation typically works mostly in the post-cricoid area for smaller circumferential stenosis↗
▶Ep 21 · 4:24
host_summaryAdjuvant therapies including injectable steroids, mitomycin C, and 5-fluorouracil can be used to help delay formation of recalcitrant scar↗
▶Ep 21 · 5:48
host_summaryPharyngeal stenosis patients are at high risk for ongoing aspiration↗
▶Ep 21 · 5:53
host_summaryTracheostomy can be helpful for managing aspiration risk in pharyngeal stenosis patients↗
▶Ep 21 · 5:55
host_summarySwallowing outcomes can be difficult and poor in the long term for pharyngeal stenosis patients↗
QUAD #20: Endoscopic Repair of Minor Laryngeal Clefts with Dr. Catherine Hart
▶Ep 22 · 1:41
host_summaryThe goal of endoscopic cleft repair is to remove the interarytenoid mucosa to create two raw surfaces and then suture the edges together.↗
▶Ep 22 · 2:05
host_summaryIf suture bites are taken too deeply during cleft repair, edges will be inverted and the child will continue to have problems.↗
▶Ep 22 · 2:22
host_summaryInterarytenoid mucosa can be resected using laser or cold steel (knife), and the choice does not matter clinically.↗
▶Ep 22 · 2:42
host_summaryComplete demucosalization of the apex is essential; if incomplete, a hole will remain at the apex and the child will continue to aspirate.↗
▶Ep 22 · 3:01
host_summaryTypically 2 to 3 sutures are placed depending on the extent of the cleft.↗
▶Ep 22 · 3:01
host_summaryEpiglottic folds are released after suturing to create extra space.↗
▶Ep 22 · 4:31
host_summarySurgical closure of laryngeal clefts achieves improvement in symptoms in almost 80% of children and resolution in 70%.↗
▶Ep 22 · 4:36
host_summarySurgical closure has a slightly higher risk of complications compared to conservative management.↗
▶Ep 22 · 4:54
host_summaryA consensus guideline exists for diagnosing and managing laryngeal clefts in children and is a good resource, especially for those newer to practice.↗
QUAD #25: Medical Management of Minor Laryngeal Clefts with Dr. Greg Burg
▶Ep 24 · 0:54
host_summaryFlexible bronchoscopy is quite limited in evaluating a cleft unless it's a major cleft.↗
▶Ep 24 · 1:13
host_summaryA deep interarytenoid notch is considered a minor cleft by Dr. Burg's team.↗
▶Ep 24 · 1:44
host_summaryRespiratory culture showed predominantly upper airway flora and two Candida species in the mucopurulent bronchitis.↗
▶Ep 24 · 2:07
host_summaryClinical assessment includes evaluating frequency of coughing, sick visits, emergency room visits, and hospitalizations.↗
▶Ep 24 · 2:15
host_summaryBronchoscopic assessment looks for airway edema, visibility of tracheal rings, mucus plugging, and secretions.↗
▶Ep 24 · 3:18
host_summaryChest CT is the most important differential imaging study, used to look for chronic changes related to aspiration.↗
▶Ep 24 · 4:12
host_summaryG-tubes and NG-tubes are used as needed for nutritional intake.↗
▶Ep 24 · 4:57
host_summarySaline is used to thin out secretions.↗
▶Ep 24 · 4:57
host_summaryChronic macrolide therapy can be used as an anti-neutrophilic agent, derived from cystic fibrosis literature.↗
▶Ep 24 · 5:14
host_summaryFor patients with significant tracheomalacia, ipratropium may be used over albuterol.↗
Journal of Pediatric Surgery Article Review: 2nd Quarter (Apr-Jun) 2025
▶Ep 27 · 1:48
host_summaryA subset of children after esophageal atresia repair experience severe airway collapse, leaving them ventilator dependent or suffering repeated cyanotic spells↗
▶Ep 27 · 6:57
host_summaryA significant number of outreach services are located within 50 kilometers of a children's hospital, leaving vast regions without access to pediatric surgical care↗
▶Ep 27 · 12:38
host_summaryThe study examined 4,612 G-tube placements from 71 NSQIP-Pediatric hospitals in 2023↗
▶Ep 27 · 13:04
host_summaryUpper GI studies were obtained in 45% of first-time G-tube cases with substantial interhospital variability from 0 to 99%↗
▶Ep 27 · 13:45
host_summary14% of G-tube cases resulted in an ED visit within 0 to 30 days↗
▶Ep 27 · 13:45
host_summary5.2% of G-tube cases involved dislodgement within 0 to 30 days↗
Pediatric Colorectal Contraversies Part II: Pediatric Colorectal...
▶Ep 6 · 0:34
quoteI prefer primary repair around, uh, 75 or 7 days. It means I wait until 5th or 7th day, and I perform primary repair.↗
▶Ep 6 · 0:34
host_summaryFor vestibular fistula, Professor Liam prefers primary repair around day 5-7 of life↗
▶Ep 6 · 8:38
epidemiologicalAbout 30-40% of anorectal stenosis or rectal atresia cases will have a presacral mass↗
▶Ep 6 · 8:45
clinicalMRI is the best way to show a presacral mass↗
▶Ep 6 · 8:57
clinicalFor anorectal stenosis repair, open posteriorly only to preserve anterior dentate line and avoid anterior rectal dissection↗
▶Ep 6 · 14:37
quoteLoop colostomy is never completely diverting no matter how much people believe their loops are diverting.↗
▶Ep 6 · 14:37
clinicalLoop colostomy is never completely diverting no matter how much surgeons believe it is↗
▶Ep 6 · 15:05
clinicalSpillage across loop colostomy causes urinary tract infections in patients with fistulas↗
▶Ep 6 · 15:42
clinicalCleaning out distal colon at colostomy creation takes about 20-30 minutes and is very important↗
▶Ep 6 · 21:07
clinicalDistal sigmoid colostomy makes laparoscopic operation more difficult and may require opening to take down mucous fistula↗
▶Ep 6 · 28:14
clinicalBest tube for hydrocolpos drainage is curled pigtail tube because hydrocolpos recedes into pelvis over months; straight tube will fall out↗
Prenatal Imaging and Counseling: Cloaca and Complex ARMs 2015
▶Ep 18 · 5:17
host_summaryCloaca management has become a collaborative team effort involving pediatric surgery, urology, and gynecology, plus ancillary services (fetal medicine, neonatology, nephrology, GI, radiology, behavioral medicine, social work, nursing).↗
▶Ep 18 · 31:00
clinicalFalse-positive prenatal diagnoses of ARM occur, causing parental alarm when the baby is born without any issues.↗
Update Course Rewind: Perineal Body Sparing PSARP 2023
▶Ep 52 · 1:17
host_summaryOne study has 6 patients and the other has 4 patients.↗
▶Ep 52 · 1:20
host_summaryThe techniques are similar but slightly different.↗
▶Ep 52 · 2:29
host_summaryPerineal body-sparing techniques can reduce postoperative infection risks in patients undergoing dilations.↗
Colorectal Quiz: Episode 49 – Collaborating for Kids: Colorectal & Pelvic Solutions (with a Little Help from AI)
▶Ep 63 · 5:56
quoteWhen you upload anything to the Notebook LM, you kind of create your own expert just from the provided document.↗
▶Ep 63 · 5:56
host_summaryWhen content is uploaded to Notebook LM, it creates an expert based only on the provided documents, not external sources↗
Journal of Pediatric Surgery Article Review: 2nd Quarter (Apr-Jun) 2024
▶Ep 23 · 0:06
quoteHi everyone, I'm M. Goddy from Cincinnati Children's, and we are back with another episode of our Journal of Pediatric Surgery article review podcast.↗
▶Ep 23 · 1:05
quoteI'm a pediatric surgeon at Alberta Children's Hospital. I've also been the publication chair for the uh Pacific Association of Pediatric Surgeons.↗
▶Ep 23 · 1:25
host_summaryMMP-7 (matrix metalloproteinase 7) are proteolytic peptidases that break down peptide bonds for amino acids and are part of tissue remodeling processes, playing roles in tissue repair, arthritis, metastasis, and cirrhosis↗
▶Ep 23 · 1:43
host_summaryHigher levels of MMP-7 are associated with the diagnosis of biliary atresia↗
▶Ep 23 · 1:56
host_summaryIn a cohort of 329 biliary atresia cases from July 2020 to December 2022, 40 were classified as low MMP-7↗
▶Ep 23 · 2:11
quoteThis is a group that has an ability to access a very large number of patients in a very short period of time, which really puts them in a position where they can dive deeply into. To things that others couldn't even start thinking about↗
▶Ep 23 · 2:36
host_summaryLow levels of MMP-7 in biliary atresia patients are associated with low levels of preoperative GGT (gamma glutamyl transpeptidase) and direct bilirubin↗
▶Ep 23 · 3:02
host_summaryGGT (gamma glutamyl transpeptidase) is an enzyme found in high levels in liver, kidney, pancreas, heart, and brain, and blood GGT levels are used to detect diseases of the liver and bile ducts↗
▶Ep 23 · 3:19
host_summaryBiliary atresia has variable outcomes even within one center, with patients who anatomically look similar having dramatically different outcomes↗
▶Ep 23 · 4:09
host_summaryHaving lower MMP-7 levels within the cohort of biliary atresia patients is associated with worse prognosis↗
▶Ep 23 · 4:26
quoteAnd one of the things I love about this paper is that it just brings us down to some of those really basic questions about when we deal with these conditions, what actually underlies it? What are these processes? How do we target them?↗
▶Ep 23 · 4:41
host_summaryThe mechanism of why low MMP-7 levels in biliary atresia patients leads to worse prognosis is unknown↗
▶Ep 23 · 7:02
host_summaryIn a Canadian cohort of 411 infants with gastroschisis treated at CAPSNET centers from 2014 to 2022, 144 were excluded due to gestational age, birth weight, other congenital anomalies, or complicated gastroschisis, leaving 267 participants↗
▶Ep 23 · 7:43
host_summaryOf 267 uncomplicated gastroschisis patients, 78% received exclusive breast milk in the first 28 days of life and 22% received supplemental or exclusive formula↗
▶Ep 23 · 8:27
host_summaryThere were no significant differences between exclusive breast milk and formula groups in time to reach full enteral feeds, duration of parenteral nutrition, or length of stay in uncomplicated gastroschisis↗
▶Ep 23 · 8:53
host_summaryPatients with uncomplicated gastroschisis who received exclusive breast milk in the first 28 days were far more likely to transition to exclusive breastfeeding: 73% compared to 11% in those with formula exposure↗
▶Ep 23 · 12:46
host_summaryA systematic review on transition from pediatric to adult care for colorectal conditions included 8 studies with patient, parent, and clinician perspectives, focusing on patients aged 10-30 years with anorectal malformation or Hirschsprung disease↗
▶Ep 23 · 13:16
host_summaryThere is a group of colorectal patients discharged from care in late childhood around age 10 years, and another group that remains in pediatric care way beyond the normal age of transfer to adult care (around 25 years)↗
▶Ep 23 · 13:30
opinionThe life course progression of anorectal malformation and Hirschsprung disease is not well understood↗
Update Course Rewind: Pediatric Biliary Stones - Surgery First Mindset 2024
▶Ep 4 · 0:52
host_summaryStone disease is increasing along with obesity in pediatric patients around the world, not just in the United States↗
▶Ep 4 · 1:25
host_summaryThere are two main approaches for CBD stones requiring cholecystectomy: ERCP first followed by laparoscopic cholecystectomy, or surgery-first with IOC to identify and potentially remove stones during the same surgery↗
▶Ep 4 · 2:11
host_summaryA surgery-first pathway reduces resource utilization, including MRCP↗
▶Ep 4 · 3:02
host_summaryERCP adds potential morbidity, with a pancreatitis rate of 10% even when performed well↗
▶Ep 4 · 3:16
host_summaryIf a surgeon cannot perform a cholangiogram, then ERCP is necessary if available↗
▶Ep 4 · 3:44
host_summaryIf you know how to put in a central line and understand Seldinger technique, you can perform intraoperative stone removal↗
▶Ep 4 · 3:44
quoteif you know how to put in a central line and you understand the principles Singer technique, then you can do this.↗
▶Ep 4 · 3:50
host_summaryWith a surgery-first mindset, stone clearance rate reflected by negative IOC was 86%↗
▶Ep 4 · 4:01
host_summaryWith simple adjuncts like advancing the catheter into the CBD or reaming the sphincter, success rate rises to the 90s↗
▶Ep 4 · 4:11
quoteThat's the dirty little secret is like, let's do something that, that I think is accessible to everybody.↗
▶Ep 4 · 4:17
host_summaryFor the 15% of unsuccessful cases, the plan is to clip the cystic duct, close, and have ERCP performed within the next day or two, or same-day in the OR if an endoscopist is available↗
▶Ep 4 · 4:56
host_summaryAn endo-loop may be used instead of a clip when ERCP is planned, to facilitate subsequent endoscopic access↗
▶Ep 4 · 5:06
host_summaryThe learning curve for intraoperative stone removal is manageable: the first few times are difficult, but after a few cases it becomes easier and even enjoyable↗
▶Ep 4 · 5:15
host_summaryThe biggest key to success is having all necessary equipment in one place, because OR staff will not know what to get on the fly↗
▶Ep 4 · 5:26
host_summarySuccess depends on IOC findings: a CBD chock full of 3-4 impacted stones is typically not amenable to surgery-first approach↗
▶Ep 4 · 6:03
host_summaryWhen flushing an impacted stone, there is a risk of inadvertently injecting contrast into the pancreatic duct, which can increase the risk of pancreatitis↗
▶Ep 4 · 6:15
quoteI think as soon as you start seeing that pancreatic duct light up, that is a signal to slow down on your flush, be careful because you can cause pancreatitis.↗
▶Ep 4 · 6:15
host_summaryIf the pancreatic duct lights up during flushing, that is a signal to slow down and be careful to avoid causing pancreatitis↗
▶Ep 4 · 6:33
host_summaryA study demonstrated 86% success rate for surgery-first, while the ERCP group had a 10% complication rate including cholangitis, bleeding, pancreatitis, and hemophilia↗
Update Course Rewind: Pediatric Biliary Stones - Surgery First Mindset 2024
▶Ep 4 · 0:52
host_summaryStone disease is increasing along with obesity in pediatric patients around the world, not just in the United States↗
▶Ep 4 · 1:25
host_summaryThere are two main approaches for CBD stones requiring cholecystectomy: ERCP first followed by laparoscopic cholecystectomy, or surgery-first with IOC to identify and potentially remove stones during the same surgery↗
▶Ep 4 · 2:11
host_summaryA surgery-first pathway reduces resource utilization, including MRCP↗
▶Ep 4 · 3:02
host_summaryERCP adds potential morbidity, with a pancreatitis rate of 10% even when performed well↗
▶Ep 4 · 3:16
host_summaryIf a surgeon cannot perform a cholangiogram, then ERCP is necessary if available↗
▶Ep 4 · 3:44
host_summaryIf you know how to put in a central line and understand Seldinger technique, you can perform intraoperative stone removal↗
▶Ep 4 · 3:44
quoteif you know how to put in a central line and you understand the principles Singer technique, then you can do this.↗
▶Ep 4 · 3:50
host_summaryWith a surgery-first mindset, stone clearance rate reflected by negative IOC was 86%↗
▶Ep 4 · 4:01
host_summaryWith simple adjuncts like advancing the catheter into the CBD or reaming the sphincter, success rate rises to the 90s↗
▶Ep 4 · 4:11
quoteThat's the dirty little secret is like, let's do something that, that I think is accessible to everybody.↗
▶Ep 4 · 4:17
host_summaryFor the 15% of unsuccessful cases, the plan is to clip the cystic duct, close, and have ERCP performed within the next day or two, or same-day in the OR if an endoscopist is available↗
▶Ep 4 · 4:56
host_summaryAn endo-loop may be used instead of a clip when ERCP is planned, to facilitate subsequent endoscopic access↗
▶Ep 4 · 5:06
host_summaryThe learning curve for intraoperative stone removal is manageable: the first few times are difficult, but after a few cases it becomes easier and even enjoyable↗
▶Ep 4 · 5:15
host_summaryThe biggest key to success is having all necessary equipment in one place, because OR staff will not know what to get on the fly↗
▶Ep 4 · 5:26
host_summarySuccess depends on IOC findings: a CBD chock full of 3-4 impacted stones is typically not amenable to surgery-first approach↗
▶Ep 4 · 6:03
host_summaryWhen flushing an impacted stone, there is a risk of inadvertently injecting contrast into the pancreatic duct, which can increase the risk of pancreatitis↗
▶Ep 4 · 6:15
quoteI think as soon as you start seeing that pancreatic duct light up, that is a signal to slow down on your flush, be careful because you can cause pancreatitis.↗
▶Ep 4 · 6:15
host_summaryIf the pancreatic duct lights up during flushing, that is a signal to slow down and be careful to avoid causing pancreatitis↗
▶Ep 4 · 6:33
host_summaryA study demonstrated 86% success rate for surgery-first, while the ERCP group had a 10% complication rate including cholangitis, bleeding, pancreatitis, and hemophilia↗
Prenatal Imaging and Counseling: Cloaca and Complex ARMs 2015
▶Ep 6 · 5:17
clinicalCloaca management has become a collaborative team effort involving pediatric surgery, urology, and gynecology, plus ancillary services (fetal medicine, neonatology, nephrology, GI, radiology, behavioral medicine, social work, nursing).↗
▶Ep 6 · 31:00
clinicalFalse-positive prenatal diagnoses of ARM occur, causing parental alarm when the baby is born without any issues.↗
Pediatric Colorectal Contraversies Part II: Pediatric Colorectal...
▶Ep 6 · 0:34
quoteI prefer primary repair around, uh, 75 or 7 days. It means I wait until 5th or 7th day, and I perform primary repair.↗
▶Ep 6 · 0:34
clinicalFor vestibular fistula, Professor Liam prefers primary repair around day 5-7 of life↗
▶Ep 6 · 0:34
host_summaryFor vestibular fistula, Professor Liam prefers primary repair around day 5-7 of life↗
▶Ep 6 · 0:34
quoteI prefer primary repair around, uh, 75 or 7 days. It means I wait until 5th or 7th day, and I perform primary repair.↗
▶Ep 6 · 8:38
epidemiologicalAbout 30-40% of anorectal stenosis or rectal atresia cases will have a presacral mass↗
▶Ep 6 · 8:38
epidemiologicalAbout 30-40% of anorectal stenosis or rectal atresia cases will have a presacral mass↗
▶Ep 6 · 8:45
clinicalMRI is the best way to show a presacral mass↗
▶Ep 6 · 8:45
clinicalMRI is the best way to show a presacral mass↗
▶Ep 6 · 8:57
clinicalFor anorectal stenosis repair, open posteriorly only to preserve anterior dentate line and avoid anterior rectal dissection↗
▶Ep 6 · 8:57
clinicalFor anorectal stenosis repair, open posteriorly only to preserve anterior dentate line and avoid anterior rectal dissection↗
▶Ep 6 · 14:37
clinicalLoop colostomy is never completely diverting no matter how much surgeons believe it is↗
▶Ep 6 · 14:37
quoteLoop colostomy is never completely diverting no matter how much people believe their loops are diverting.↗
▶Ep 6 · 14:37
clinicalLoop colostomy is never completely diverting no matter how much surgeons believe it is↗
▶Ep 6 · 14:37
quoteLoop colostomy is never completely diverting no matter how much people believe their loops are diverting.↗
▶Ep 6 · 15:05
clinicalSpillage across loop colostomy causes urinary tract infections in patients with fistulas↗
▶Ep 6 · 15:05
clinicalSpillage across loop colostomy causes urinary tract infections in patients with fistulas↗
▶Ep 6 · 15:42
clinicalCleaning out distal colon at colostomy creation takes about 20-30 minutes and is very important↗
▶Ep 6 · 15:42
clinicalCleaning out distal colon at colostomy creation takes about 20-30 minutes and is very important↗
▶Ep 6 · 21:07
clinicalDistal sigmoid colostomy makes laparoscopic operation more difficult and may require opening to take down mucous fistula↗
▶Ep 6 · 21:07
clinicalDistal sigmoid colostomy makes laparoscopic operation more difficult and may require opening to take down mucous fistula↗
▶Ep 6 · 28:14
clinicalBest tube for hydrocolpos drainage is curled pigtail tube because hydrocolpos recedes into pelvis over months; straight tube will fall out↗
▶Ep 6 · 28:14
clinicalBest tube for hydrocolpos drainage is curled pigtail tube because hydrocolpos recedes into pelvis over months; straight tube will fall out↗
Prenatal Imaging and Counseling: Cloaca and Complex ARMs 2015
▶Ep 38 · 5:17
clinicalCloaca management has become a collaborative team effort involving pediatric surgery, urology, and gynecology, plus ancillary services (fetal medicine, neonatology, nephrology, GI, radiology, behavioral medicine, social work, nursing).↗
▶Ep 38 · 5:17
host_summaryCloaca management has become a collaborative team effort involving pediatric surgery, urology, and gynecology, plus ancillary services (fetal medicine, neonatology, nephrology, GI, radiology, behavioral medicine, social work, nursing).↗
▶Ep 38 · 31:00
clinicalFalse-positive prenatal diagnoses of ARM occur, causing parental alarm when the baby is born without any issues.↗
▶Ep 38 · 31:00
clinicalFalse-positive prenatal diagnoses of ARM occur, causing parental alarm when the baby is born without any issues.↗
Update Course Rewind: Perineal Body Sparing PSARP 2023
▶Ep 154 · 1:17
host_summaryOne study has 6 patients and the other has 4 patients.↗
▶Ep 154 · 1:20
host_summaryThe techniques are similar but slightly different.↗
▶Ep 154 · 2:29
host_summaryPerineal body-sparing techniques can reduce postoperative infection risks in patients undergoing dilations.↗
Journal of Pediatric Surgery Article Review: September 2023
▶Ep 159 · 5:17
host_summaryDuration of ECMO support was shorter in the early CDH repair group↗
▶Ep 159 · 5:17
host_summarySurvival was not statistically different between early and delayed CDH repair groups on ECMO↗
▶Ep 159 · 9:32
host_summaryPhysician suicide is characterized by tragically high rates of suicide among doctors compared to the general population↗
▶Ep 159 · 10:17
host_summaryHigh levels of stress, emotional and physical burnout, demanding work schedules, and pressure to maintain successful careers contribute to physician suicide↗
▶Ep 159 · 10:33
host_summaryStigma associated with mental health issues within the medical profession discourages physicians from seeking help, leading to untreated depression, anxiety, and other mental health disorders↗
Journal of Pediatric Surgery Article Review: 2nd Quarter (Apr-Jun) 2024
▶Ep 164 · 0:06
quoteHi everyone, I'm M. Goddy from Cincinnati Children's, and we are back with another episode of our Journal of Pediatric Surgery article review podcast.↗
▶Ep 164 · 1:05
quoteI'm a pediatric surgeon at Alberta Children's Hospital. I've also been the publication chair for the uh Pacific Association of Pediatric Surgeons.↗
▶Ep 164 · 1:25
host_summaryMMP-7 (matrix metalloproteinase 7) are proteolytic peptidases that break down peptide bonds for amino acids and are part of tissue remodeling processes, playing roles in tissue repair, arthritis, metastasis, and cirrhosis↗
▶Ep 164 · 1:43
host_summaryHigher levels of MMP-7 are associated with the diagnosis of biliary atresia↗
▶Ep 164 · 1:56
host_summaryIn a cohort of 329 biliary atresia cases from July 2020 to December 2022, 40 were classified as low MMP-7↗
▶Ep 164 · 2:11
quoteThis is a group that has an ability to access a very large number of patients in a very short period of time, which really puts them in a position where they can dive deeply into. To things that others couldn't even start thinking about↗
▶Ep 164 · 2:36
host_summaryLow levels of MMP-7 in biliary atresia patients are associated with low levels of preoperative GGT (gamma glutamyl transpeptidase) and direct bilirubin↗
▶Ep 164 · 3:02
host_summaryGGT (gamma glutamyl transpeptidase) is an enzyme found in high levels in liver, kidney, pancreas, heart, and brain, and blood GGT levels are used to detect diseases of the liver and bile ducts↗
▶Ep 164 · 3:19
host_summaryBiliary atresia has variable outcomes even within one center, with patients who anatomically look similar having dramatically different outcomes↗
▶Ep 164 · 4:09
host_summaryHaving lower MMP-7 levels within the cohort of biliary atresia patients is associated with worse prognosis↗
▶Ep 164 · 4:26
quoteAnd one of the things I love about this paper is that it just brings us down to some of those really basic questions about when we deal with these conditions, what actually underlies it? What are these processes? How do we target them?↗
▶Ep 164 · 4:41
host_summaryThe mechanism of why low MMP-7 levels in biliary atresia patients leads to worse prognosis is unknown↗
▶Ep 164 · 7:02
host_summaryIn a Canadian cohort of 411 infants with gastroschisis treated at CAPSNET centers from 2014 to 2022, 144 were excluded due to gestational age, birth weight, other congenital anomalies, or complicated gastroschisis, leaving 267 participants↗
▶Ep 164 · 7:43
host_summaryOf 267 uncomplicated gastroschisis patients, 78% received exclusive breast milk in the first 28 days of life and 22% received supplemental or exclusive formula↗
▶Ep 164 · 8:27
host_summaryThere were no significant differences between exclusive breast milk and formula groups in time to reach full enteral feeds, duration of parenteral nutrition, or length of stay in uncomplicated gastroschisis↗
▶Ep 164 · 8:53
host_summaryPatients with uncomplicated gastroschisis who received exclusive breast milk in the first 28 days were far more likely to transition to exclusive breastfeeding: 73% compared to 11% in those with formula exposure↗
▶Ep 164 · 12:46
host_summaryA systematic review on transition from pediatric to adult care for colorectal conditions included 8 studies with patient, parent, and clinician perspectives, focusing on patients aged 10-30 years with anorectal malformation or Hirschsprung disease↗
▶Ep 164 · 13:16
host_summaryThere is a group of colorectal patients discharged from care in late childhood around age 10 years, and another group that remains in pediatric care way beyond the normal age of transfer to adult care (around 25 years)↗
▶Ep 164 · 13:30
opinionThe life course progression of anorectal malformation and Hirschsprung disease is not well understood↗
Journal of Pediatric Surgery Article Review: 3rd Quarter (Jul-Sep) 2024
▶Ep 167 · 1:38
quoteMy name's Jason F Fisher. I'm a pediatric surgeon and director of the Colorectal Center at Cincinnati Children's, and I also happen to be. The lead of the subcommittee for Hirschprung's disease for the PCPLC or Pediatric Colorectal and Pelvic Learning Consortium.↗
▶Ep 167 · 3:20
host_summary85% of Hirschsprung disease patients in the study were diagnosed at less than 1 year of age↗
▶Ep 167 · 3:45
host_summaryKids with shorter segment Hirschsprung disease (rectosigmoid or small portion of aganglionic bowel) were more likely to be diagnosed at a later age↗
▶Ep 167 · 3:57
host_summaryChildren with long segment Hirschsprung disease typically presented at birth with classic symptoms such as failure to pass meconium↗
▶Ep 167 · 4:26
host_summaryApproximately one-third of neonates and 50% of infants, toddlers, and children had diverting ostomies performed prior to pull-through↗
▶Ep 167 · 5:01
host_summaryThere was no difference in overall rates of redo pull-throughs across age groups↗
▶Ep 167 · 5:07
host_summaryOlder children were more likely to need a redo pull-through due to an anastomotic leak↗
▶Ep 167 · 5:13
host_summaryHigher rates of diverting ostomy post pull-through were likely a treatment for a post pull-through leak or anastomotic leak↗
▶Ep 167 · 5:24
host_summaryThe only functional outcome that was different was nighttime soiling or incontinence in the older patient population↗
▶Ep 167 · 7:44
quoteI am a pediatric surgeon. Uh, in the division of pediatric Surgery with Presbyterian Healthcare Services in Albuquerque, New Mexico↗
▶Ep 167 · 8:09
host_summaryThe gastroschisis systematic review included 28 high quality manuscripts↗
▶Ep 167 · 8:15
host_summaryTwo randomized controlled trials on gastroschisis had been started but both ended prematurely and were underpowered↗
▶Ep 167 · 10:37
host_summarySkin organisms are most commonly identified in infections among infants with gastroschisis↗
▶Ep 167 · 10:44
host_summaryGastroschisis infants have a fairly high rate of wound infection↗
▶Ep 167 · 10:50
host_summarySilo closures have a higher rate of infection than other closure methods↗
▶Ep 167 · 10:50
host_summarySutureless closure has the lowest rate of infection in gastroschisis↗
▶Ep 167 · 10:57
host_summaryRecommendation is to provide antibiotic coverage for skin flora until the gastroschisis defect is closed and potentially for an additional 24 hours thereafter↗
▶Ep 167 · 12:22
host_summaryStable gastroschisis infants with sufficient abdominal capacity for sutureless closure tend to have the best outcomes↗
▶Ep 167 · 12:29
host_summaryMinimizing fluids and paralytics in gastroschisis infants improves their results↗
▶Ep 167 · 17:04
host_summary43% of pediatric surgeons preferred the Clavien-Madadi classification compared to 12% for the Clavien-Dindo classification↗
▶Ep 167 · 17:16
host_summaryAdvantages of the Clavien-Madadi classification were affirmed by nearly 82% of the surgeons↗
Colorectal Quiz: Episode 49 – Collaborating for Kids: Colorectal & Pelvic Solutions (with a Little Help from AI)
▶Ep 177 · 5:56
quoteWhen you upload anything to the Notebook LM, you kind of create your own expert just from the provided document.↗
▶Ep 177 · 5:56
host_summaryWhen content is uploaded to Notebook LM, it creates an expert based only on the provided documents, not external sources↗
Journal of Pediatric Surgery Article Review: October 2023
▶Ep 31 · 3:14
host_summaryNo significant differences were found in secondary outcomes including gastroesophageal reflux disease, anastomotic leak, and esophagitis between infants receiving prophylactic acid suppression and those who did not↗
▶Ep 31 · 3:51
host_summaryPotential risks of long-term acid suppression therapy include dysbiosis, necrotizing enterocolitis, and increased neonatal infection rates, particularly relevant in preterm and low birth weight infants↗
▶Ep 31 · 9:20
host_summaryFactors associated with symptomatic CPAM lesions include age older than 4 years, postnatal diagnosis, and maximum cyst diameter bigger than 39.9 millimeters↗
▶Ep 31 · 9:50
host_summaryThe CPAM study did not enroll patients who accepted conservative treatment↗
▶Ep 31 · 10:00
host_summaryThe CPAM study had insufficient sample size and was from a single center↗
Journal of Pediatric Surgery Article Review: October 2023
▶Ep 7 · 3:14
host_summaryNo significant differences were found in secondary outcomes including gastroesophageal reflux disease, anastomotic leak, and esophagitis between infants receiving prophylactic acid suppression and those who did not↗
▶Ep 7 · 3:51
host_summaryPotential risks of long-term acid suppression therapy include dysbiosis, necrotizing enterocolitis, and increased neonatal infection rates, particularly relevant in preterm and low birth weight infants↗
▶Ep 7 · 9:20
host_summaryFactors associated with symptomatic CPAM lesions include age older than 4 years, postnatal diagnosis, and maximum cyst diameter bigger than 39.9 millimeters↗
▶Ep 7 · 9:50
host_summaryThe CPAM study did not enroll patients who accepted conservative treatment↗
▶Ep 7 · 10:00
host_summaryThe CPAM study had insufficient sample size and was from a single center↗
Aerodigestive & Esophageal Surgery - The Unsalvageable Esophagus & Cases
▶Ep 1 · 16:30
quoteManubrial removing the manubrium is never as straightforward as it seems because your clavicles always get in the way.↗
▶Ep 1 · 16:30
quoteManubrial removing the manubrium is never as straightforward as it seems because your clavicles always get in the way.↗
▶Ep 1 · 16:38
clinicalManubrial resection for high esophageal strictures provides less exposure than expected because the clavicles limit the width of the resection corridor.↗
▶Ep 1 · 16:38
clinicalManubrial resection for high esophageal strictures provides less exposure than expected because the clavicles limit the width of the resection corridor.↗
▶Ep 1 · 19:36
quoteEsophageal stents are very much a double-edged sword. They can often cause as many problems as they fix.↗
▶Ep 1 · 19:36
quoteEsophageal stents are very much a double-edged sword. They can often cause as many problems as they fix.↗
▶Ep 1 · 33:28
clinicalKenalog (steroid) injection after stricture dilation is preferred over mitomycin. Mitomycin at high concentrations (up to 5 mg/mL) causes tissue necrosis and has not shown superior outcomes compared to steroids.↗
▶Ep 1 · 33:28
clinicalKenalog (steroid) injection after stricture dilation is preferred over mitomycin. Mitomycin at high concentrations (up to 5 mg/mL) causes tissue necrosis and has not shown superior outcomes compared to steroids.↗
▶Ep 1 · 36:29
clinicalFor recalcitrant esophageal strictures, weekly dilations (3–4 cycles) prevent fibroblasts from bridging and allow the stricture to scar open rather than closed.↗
▶Ep 1 · 36:29
clinicalFor recalcitrant esophageal strictures, weekly dilations (3–4 cycles) prevent fibroblasts from bridging and allow the stricture to scar open rather than closed.↗
▶Ep 1 · 45:47
clinicalFeeding via gastrojejunal tube with gastric drainage (GJ/G) is a temporizing measure to reduce reflux into the esophagus while managing a refractory stricture.↗
▶Ep 1 · 45:47
clinicalFeeding via gastrojejunal tube with gastric drainage (GJ/G) is a temporizing measure to reduce reflux into the esophagus while managing a refractory stricture.↗
▶Ep 1 · 47:43
quoteIf you've got mucosal disease, all you need to do is remove all the mucosa. You've got no disease.↗
▶Ep 1 · 47:43
quoteIf you've got mucosal disease, all you need to do is remove all the mucosa. You've got no disease.↗
▶Ep 1 · 48:18
clinicalEsophageal stents can compress the adjacent trachea, especially in children with tracheomalacia or when the esophagus lies directly posterior to the trachea. Always perform bronchoscopy after stent placement.↗
▶Ep 1 · 48:18
clinicalEsophageal stents can compress the adjacent trachea, especially in children with tracheomalacia or when the esophagus lies directly posterior to the trachea. Always perform bronchoscopy after stent placement.↗
▶Ep 1 · 48:20
quoteIf you put in an esophageal stent, have a quick look in the airway when you're done.↗
▶Ep 1 · 48:20
quoteIf you put in an esophageal stent, have a quick look in the airway when you're done.↗
▶Ep 1 · 50:13
quoteWe see it with um chronic oesophageal foreign bodies, um, classically the penny. And typically for a chronic one, they come in about 6 weeks later. And they come in with a diagnosis of asthma.↗
▶Ep 1 · 50:13
quoteWe see it with um chronic oesophageal foreign bodies, um, classically the penny. And typically for a chronic one, they come in about 6 weeks later. And they come in with a diagnosis of asthma.↗
▶Ep 1 · 50:20
clinicalChronic esophageal foreign bodies (e.g., coins lodged for weeks) can cause posterior tracheal bulge and present as refractory asthma or bronchiolitis, often diagnosed late because chest X-rays are not routinely obtained in asthma protocols.↗
▶Ep 1 · 50:20
clinicalChronic esophageal foreign bodies (e.g., coins lodged for weeks) can cause posterior tracheal bulge and present as refractory asthma or bronchiolitis, often diagnosed late because chest X-rays are not routinely obtained in asthma protocols.↗
▶Ep 1 · 52:06
quoteThe aim is to probe it but not push so hard that you create a fistula. That's always embarrassing.↗
▶Ep 1 · 52:06
quoteThe aim is to probe it but not push so hard that you create a fistula. That's always embarrassing.↗
▶Ep 1 · 1:01:05
quoteA lot of kids have replaced esophaguuses and most of them don't aspirate, even if you've got a trashed cricoharyngeis.↗
▶Ep 1 · 1:01:05
quoteA lot of kids have replaced esophaguuses and most of them don't aspirate, even if you've got a trashed cricoharyngeis.↗
▶Ep 1 · 1:10:42
clinicalCovered esophageal stents can temporize anastomotic leaks and allow healing while maintaining luminal patency. Stent removal is typically planned after several weeks.↗
▶Ep 1 · 1:10:42
clinicalCovered esophageal stents can temporize anastomotic leaks and allow healing while maintaining luminal patency. Stent removal is typically planned after several weeks.↗
▶Ep 1 · 1:31:42
clinicalTracheal homografts (dead trachea implants) have been performed but are associated with difficult postoperative courses lasting several months.↗
▶Ep 1 · 1:31:42
clinicalTracheal homografts (dead trachea implants) have been performed but are associated with difficult postoperative courses lasting several months.↗
▶Ep 1 · 1:32:06
clinicalTissue-engineered tracheal homografts with pre-epithelialization are under development in multiple centers (London leading) but are not yet ready for routine clinical use.↗
▶Ep 1 · 1:32:06
clinicalTissue-engineered tracheal homografts with pre-epithelialization are under development in multiple centers (London leading) but are not yet ready for routine clinical use.↗
▶Ep 1 · 1:33:15
clinicalLong-term surveillance of bypassed esophagus includes periodic CT scans to rule out mucocele and endoscopic evaluation via the persistent TEF if needed.↗
▶Ep 1 · 1:33:15
clinicalLong-term surveillance of bypassed esophagus includes periodic CT scans to rule out mucocele and endoscopic evaluation via the persistent TEF if needed.↗
▶Ep 1 · 1:34:15
clinicalPosterior tracheopexy (pexing the trachea to the anterior spine) combined with bovine pericardial patch for tracheal defects is an alternative to esophageal bypass, but pericardial patches can fail and create large tracheal defects.↗
▶Ep 1 · 1:34:15
host_summaryPosterior tracheopexy (pexing the trachea to the anterior spine) combined with bovine pericardial patch for tracheal defects is an alternative to esophageal bypass, but pericardial patches can fail and create large tracheal defects.↗
▶Ep 1 · 1:39:43
opinionComplications are nearly inevitable in complex esophageal reconstruction. The goal is not to eliminate complications but to anticipate and manage them effectively through a multidisciplinary team approach.↗
▶Ep 1 · 1:39:43
quoteThis is a game where complications are almost inevitable. And it's not that you can eliminate them, you can minimize them, but then it's the team approach trying to work out how to manage them.↗
▶Ep 1 · 1:39:43
opinionComplications are nearly inevitable in complex esophageal reconstruction. The goal is not to eliminate complications but to anticipate and manage them effectively through a multidisciplinary team approach.↗
▶Ep 1 · 1:39:43
quoteThis is a game where complications are almost inevitable. And it's not that you can eliminate them, you can minimize them, but then it's the team approach trying to work out how to manage them.↗
QUAD #2 Thoracoscopic Tracheopexy with Dr. Aaron Garrison
▶Ep 8 · 0:36
host_summarySeveral years ago, the approach was that patients with tracheomalacia would undergo aortopexy.↗
▶Ep 8 · 0:43
host_summaryIn the last 4 to 5 years, it has become standard practice to determine which patients will respond best to tracheopexy versus aortopexy.↗
▶Ep 8 · 1:45
host_summaryPart of the workup is making sure that there is space to anteriorly suspend the aorta so that the trachea diameter can actually be made larger.↗
▶Ep 8 · 2:02
host_summaryPreoperative bronchoscopy gives the surgical team an idea of internal anatomy, which can assist in classifying the degree of tracheomalacia prior to surgical intervention.↗
▶Ep 8 · 3:23
host_summaryWhen using a thoracoscopic approach, correct positioning is the key to success.↗
▶Ep 8 · 3:27
host_summaryIt is best to use gravity to advantage as it aids in retracting the lungs and trachea placement.↗
▶Ep 8 · 4:01
host_summaryOpening the pericardium and finding the area at the pericardial-adventitial junction to suspend is the key point of aortopexy.↗
▶Ep 8 · 4:16
host_summaryPassing suture transternally is preferred with the aortopexy approach, though it can be technically difficult.↗
▶Ep 8 · 4:23
host_summaryFor tracheopexy, a posterior approach via semiprone position is preferred.↗
▶Ep 8 · 4:28
host_summaryCreating a pneumothorax by putting the Veress off the tip of the scapula helps collapse the lung for trocar placement.↗
▶Ep 8 · 4:38
host_summaryWhen operating posteriorly, triangulating your hands gives the best visualization and working space.↗
▶Ep 8 · 4:56
host_summaryWhen available, a multidisciplinary team which includes a pulmonologist can allow for internal visualization via bronchoscopy.↗
▶Ep 8 · 5:05
host_summaryBronchoscopic guidance technique is primarily used in non-esophageal atresia patients.↗
▶Ep 8 · 5:53
host_summaryIt is important to create enough tension in the suture to ensure that the pexy is secure.↗
▶Ep 8 · 6:07
host_summaryThe approach changes for patients without esophageal atresia or with an esophagus in continuity.↗
▶Ep 8 · 6:14
host_summaryFor patients with esophagus in continuity, the first step is to dissect around the esophagus using a vessel loop for retraction.↗
▶Ep 8 · 6:32
host_summaryUsing pre- and post-operative bronchoscopy allows the surgeon to see the improvement prior to case completion.↗
QUAD #7 Anesthesia for Thoracoscopic Techniques with Dr. Nathaniel Tighe
▶Ep 10 · 1:05
host_summaryThe association between esophageal atresia and cardiac abnormalities is particularly relevant to anesthetic technique.↗
▶Ep 10 · 1:42
host_summaryThe most common technique for maintaining stillness is short-acting opioid infusions, which result in relatively little hemodynamic instability.↗
▶Ep 10 · 1:53
host_summaryVolatile anesthetics are especially useful when preservation of spontaneous ventilation is desired.↗
▶Ep 10 · 2:31
host_summaryInsufflation using pneumothorax created by trocar placement can facilitate surgical exposure by overcoming peak inspiratory pressures to allow lung collapse.↗
▶Ep 10 · 2:48
host_summaryInsufflation is useful for small kids with good lung compliance but not effective in kids with severe bronchopulmonary dysplasia or other compliance abnormalities.↗
▶Ep 10 · 4:19
host_summaryEndotracheal tube placement is technically easier than placement of other lung isolation devices.↗
▶Ep 10 · 4:39
quoteIn kids with a pig bronchus or similar situation, this really becomes very difficult.↗
▶Ep 10 · 4:48
host_summaryA tracheal bronchus (pig bronchus) is an anatomical variant where an accessory bronchus originates directly from the supracarinal trachea.↗
▶Ep 10 · 5:17
host_summaryIn larger kids (usually 8 years or above) with recurrent fistulas, double-lumen tubes can be used and are the easiest device for lung isolation because they allow independent ventilation of the two lungs.↗
▶Ep 10 · 5:38
host_summaryEarly conversations between anesthesiologists and surgeons about patient specifics are part of deciding the best modality for each individual patient.↗
▶Ep 10 · 6:07
host_summarySingle ventricle patients may be candidates for open repair or ECMO support to ensure good outcomes.↗
Journal of Pediatric Surgery Article Review: October 2023
▶Ep 11 · 3:14
host_summaryNo significant differences were found in secondary outcomes including gastroesophageal reflux disease, anastomotic leak, and esophagitis between infants receiving prophylactic acid suppression and those who did not↗
▶Ep 11 · 3:51
host_summaryPotential risks of long-term acid suppression therapy include dysbiosis, necrotizing enterocolitis, and increased neonatal infection rates, particularly relevant in preterm and low birth weight infants↗
▶Ep 11 · 9:20
host_summaryFactors associated with symptomatic CPAM lesions include age older than 4 years, postnatal diagnosis, and maximum cyst diameter bigger than 39.9 millimeters↗
▶Ep 11 · 9:50
host_summaryThe CPAM study did not enroll patients who accepted conservative treatment↗
▶Ep 11 · 10:00
host_summaryThe CPAM study had insufficient sample size and was from a single center↗
Journal of Pediatric Surgery Article Review: 1st Quarter (Jan-Mar) 2025
▶Ep 17 · 1:41
host_summaryA subset of children after esophageal atresia repair experience severe airway collapse, leaving them ventilator dependent or suffering repeated cyanotic spells↗
▶Ep 17 · 6:57
host_summaryA significant number of outreach services are located within 50 kilometers of a children's hospital, leaving vast regions without access to pediatric surgical care↗
▶Ep 17 · 12:38
host_summaryThe study examined 4,612 G-tube placements from 71 NSQIP-Pediatric hospitals in 2023↗
▶Ep 17 · 13:04
host_summaryUpper GI studies were obtained in 45% of first-time G-tube cases with substantial interhospital variability from 0 to 99%↗
▶Ep 17 · 13:45
host_summary5.2% of G-tube cases involved dislodgement within 0 to 30 days↗
▶Ep 17 · 13:45
host_summary14% of G-tube cases resulted in an ED visit within 0 to 30 days↗
Journal of Pediatric Surgery Article Review: 2nd Quarter (Apr-Jun) 2025
▶Ep 18 · 1:48
host_summaryA subset of children after esophageal atresia repair experience severe airway collapse, leaving them ventilator dependent or suffering repeated cyanotic spells↗
▶Ep 18 · 6:57
host_summaryA significant number of outreach services are located within 50 kilometers of a children's hospital, leaving vast regions without access to pediatric surgical care↗
▶Ep 18 · 12:38
host_summaryThe study examined 4,612 G-tube placements from 71 NSQIP-Pediatric hospitals in 2023↗
▶Ep 18 · 13:04
host_summaryUpper GI studies were obtained in 45% of first-time G-tube cases with substantial interhospital variability from 0 to 99%↗
▶Ep 18 · 13:45
host_summary5.2% of G-tube cases involved dislodgement within 0 to 30 days↗
▶Ep 18 · 13:45
host_summary14% of G-tube cases resulted in an ED visit within 0 to 30 days↗
Journal of Pediatric Surgery Article Review: 2nd Quarter (Apr-Jun) 2024
▶Ep 56 · 0:06
quoteHi everyone, I'm M. Goddy from Cincinnati Children's, and we are back with another episode of our Journal of Pediatric Surgery article review podcast.↗
▶Ep 56 · 1:05
quoteI'm a pediatric surgeon at Alberta Children's Hospital. I've also been the publication chair for the uh Pacific Association of Pediatric Surgeons.↗
▶Ep 56 · 1:25
host_summaryMMP-7 (matrix metalloproteinase 7) are proteolytic peptidases that break down peptide bonds for amino acids and are part of tissue remodeling processes, playing roles in tissue repair, arthritis, metastasis, and cirrhosis↗
▶Ep 56 · 1:43
host_summaryHigher levels of MMP-7 are associated with the diagnosis of biliary atresia↗
▶Ep 56 · 1:56
host_summaryIn a cohort of 329 biliary atresia cases from July 2020 to December 2022, 40 were classified as low MMP-7↗
▶Ep 56 · 2:11
quoteThis is a group that has an ability to access a very large number of patients in a very short period of time, which really puts them in a position where they can dive deeply into. To things that others couldn't even start thinking about↗
▶Ep 56 · 2:36
host_summaryLow levels of MMP-7 in biliary atresia patients are associated with low levels of preoperative GGT (gamma glutamyl transpeptidase) and direct bilirubin↗
▶Ep 56 · 3:02
host_summaryGGT (gamma glutamyl transpeptidase) is an enzyme found in high levels in liver, kidney, pancreas, heart, and brain, and blood GGT levels are used to detect diseases of the liver and bile ducts↗
▶Ep 56 · 3:19
host_summaryBiliary atresia has variable outcomes even within one center, with patients who anatomically look similar having dramatically different outcomes↗
▶Ep 56 · 4:09
host_summaryHaving lower MMP-7 levels within the cohort of biliary atresia patients is associated with worse prognosis↗
▶Ep 56 · 4:26
quoteAnd one of the things I love about this paper is that it just brings us down to some of those really basic questions about when we deal with these conditions, what actually underlies it? What are these processes? How do we target them?↗
▶Ep 56 · 4:41
host_summaryThe mechanism of why low MMP-7 levels in biliary atresia patients leads to worse prognosis is unknown↗
▶Ep 56 · 7:02
host_summaryIn a Canadian cohort of 411 infants with gastroschisis treated at CAPSNET centers from 2014 to 2022, 144 were excluded due to gestational age, birth weight, other congenital anomalies, or complicated gastroschisis, leaving 267 participants↗
▶Ep 56 · 7:43
host_summaryOf 267 uncomplicated gastroschisis patients, 78% received exclusive breast milk in the first 28 days of life and 22% received supplemental or exclusive formula↗
▶Ep 56 · 8:27
host_summaryThere were no significant differences between exclusive breast milk and formula groups in time to reach full enteral feeds, duration of parenteral nutrition, or length of stay in uncomplicated gastroschisis↗
▶Ep 56 · 8:53
host_summaryPatients with uncomplicated gastroschisis who received exclusive breast milk in the first 28 days were far more likely to transition to exclusive breastfeeding: 73% compared to 11% in those with formula exposure↗
▶Ep 56 · 12:46
host_summaryA systematic review on transition from pediatric to adult care for colorectal conditions included 8 studies with patient, parent, and clinician perspectives, focusing on patients aged 10-30 years with anorectal malformation or Hirschsprung disease↗
▶Ep 56 · 13:16
host_summaryThere is a group of colorectal patients discharged from care in late childhood around age 10 years, and another group that remains in pediatric care way beyond the normal age of transfer to adult care (around 25 years)↗
▶Ep 56 · 13:30
opinionThe life course progression of anorectal malformation and Hirschsprung disease is not well understood↗
Journal of Pediatric Surgery Article Review: 3rd Quarter (Jul-Sep) 2024
▶Ep 57 · 1:38
quoteMy name's Jason F Fisher. I'm a pediatric surgeon and director of the Colorectal Center at Cincinnati Children's, and I also happen to be. The lead of the subcommittee for Hirschprung's disease for the PCPLC or Pediatric Colorectal and Pelvic Learning Consortium.↗
▶Ep 57 · 3:20
host_summary85% of Hirschsprung disease patients in the study were diagnosed at less than 1 year of age↗
▶Ep 57 · 3:45
host_summaryKids with shorter segment Hirschsprung disease (rectosigmoid or small portion of aganglionic bowel) were more likely to be diagnosed at a later age↗
▶Ep 57 · 3:57
host_summaryChildren with long segment Hirschsprung disease typically presented at birth with classic symptoms such as failure to pass meconium↗
▶Ep 57 · 4:26
host_summaryApproximately one-third of neonates and 50% of infants, toddlers, and children had diverting ostomies performed prior to pull-through↗
▶Ep 57 · 5:01
host_summaryThere was no difference in overall rates of redo pull-throughs across age groups↗
▶Ep 57 · 5:07
host_summaryOlder children were more likely to need a redo pull-through due to an anastomotic leak↗
▶Ep 57 · 5:13
host_summaryHigher rates of diverting ostomy post pull-through were likely a treatment for a post pull-through leak or anastomotic leak↗
▶Ep 57 · 5:24
host_summaryThe only functional outcome that was different was nighttime soiling or incontinence in the older patient population↗
▶Ep 57 · 7:44
quoteI am a pediatric surgeon. Uh, in the division of pediatric Surgery with Presbyterian Healthcare Services in Albuquerque, New Mexico↗
▶Ep 57 · 8:09
host_summaryThe gastroschisis systematic review included 28 high quality manuscripts↗
▶Ep 57 · 8:15
host_summaryTwo randomized controlled trials on gastroschisis had been started but both ended prematurely and were underpowered↗
▶Ep 57 · 10:37
host_summarySkin organisms are most commonly identified in infections among infants with gastroschisis↗
▶Ep 57 · 10:44
host_summaryGastroschisis infants have a fairly high rate of wound infection↗
▶Ep 57 · 10:50
host_summarySilo closures have a higher rate of infection than other closure methods↗
▶Ep 57 · 10:50
host_summarySutureless closure has the lowest rate of infection in gastroschisis↗
▶Ep 57 · 10:57
host_summaryRecommendation is to provide antibiotic coverage for skin flora until the gastroschisis defect is closed and potentially for an additional 24 hours thereafter↗
▶Ep 57 · 12:22
host_summaryStable gastroschisis infants with sufficient abdominal capacity for sutureless closure tend to have the best outcomes↗
▶Ep 57 · 12:29
host_summaryMinimizing fluids and paralytics in gastroschisis infants improves their results↗
▶Ep 57 · 17:04
host_summary43% of pediatric surgeons preferred the Clavien-Madadi classification compared to 12% for the Clavien-Dindo classification↗
▶Ep 57 · 17:16
host_summaryAdvantages of the Clavien-Madadi classification were affirmed by nearly 82% of the surgeons↗
Umbilical Disorders with Dr. Rebeccah Brown
▶Ep 59 · 0:34
host_summaryThe umbilical cord contains two umbilical arteries and one umbilical vein surrounded by Wharton's jelly (a gelatin-like extracellular matrix).↗
▶Ep 59 · 0:34
quoteTwo umbilical arteries and one umbilical vein surrounding by a gelatin-like extracellular matrix known as Worthin's jelly.↗
▶Ep 59 · 0:50
quoteThey usually fall off 2 to 3 weeks, and the delay can be a manifestation of an immune deficiency.↗
▶Ep 59 · 0:50
host_summaryDelayed umbilical cord separation can be a manifestation of an immune deficiency.↗
▶Ep 59 · 0:50
host_summaryUmbilical cords usually fall off at 2 to 3 weeks after birth.↗
▶Ep 59 · 1:20
host_summaryMild omphalitis cases (inflammation of the belly button) may be treated with alcohol drying, ampicillin, or amoxicillin with follow-up every 24 hours.↗
▶Ep 59 · 1:40
host_summary16% of patients admitted with omphalitis develop necrotizing fasciitis.↗
▶Ep 59 · 1:40
quote16% of the patients admitted with onalittis develop necrotizing fasciitis.↗
▶Ep 59 · 1:46
host_summaryNecrotizing fasciitis from omphalitis presents with rapidly progressive umbilical edema, erythema, drainage, and has a high mortality rate.↗
▶Ep 59 · 2:27
host_summaryUmbilical hernias can be associated with trisomy 13, 18, and 21.↗
▶Ep 59 · 2:47
host_summaryDr. Brown mentioned that if the fascial opening in an umbilical hernia is larger than 1.5 centimeters, it may not close by itself.↗
▶Ep 59 · 2:55
host_summaryIn Walker's studies, 96% of very small umbilical hernias (less than 0.5 centimeters) closed by six years, but no hernia greater than 1.5 centimeters closed by six years of age.↗
▶Ep 59 · 4:54
host_summaryUnplanned emergency department returns within 30 days after umbilical hernia repair occurred at 2.5%, with rates twice as high for patients younger than 4 years old.↗
▶Ep 59 · 5:10
host_summaryAsymptomatic umbilical hernia repair should be delayed until greater than 4 years of age.↗
▶Ep 59 · 5:18
host_summaryIn Rangel's study of 167,000 patients at 68 pediatricians' offices, 4,486 had umbilical hernia diagnosis at a median age of 1.6 months, with spontaneous closure occurring in 89% by age 5.↗
▶Ep 59 · 5:53
host_summaryIn Rangel's study, closure rates for smaller hernias (≤1 cm) were nearly 90%, while for larger hernias they were around 80%.↗
▶Ep 59 · 6:12
host_summaryRangel's study concluded that umbilical hernia repair should be delayed until age 5 years given the high incidence of spontaneous closure.↗
▶Ep 59 · 6:56
host_summaryProboscoid hernia occurs when the skin above the hernia grows and pushes through the opening in the abdominal wall.↗
▶Ep 59 · 7:05
host_summaryIt is recommended to correct proboscoid hernias before school age to avoid psychological issues for the child.↗
▶Ep 59 · 8:00
host_summaryDr. Brown prefers to perform umbilicoplasty in umbilical hernia repairs, excising excess skin and using a 4-0 monocryl purse-string suture close to the skin surface to create a cosmetically appealing umbilicus.↗
▶Ep 59 · 8:55
host_summaryUmbilical granulomas are usually moist but commonly dry up and fall off spontaneously over time.↗
▶Ep 59 · 9:00
host_summaryUmbilical granulomas often respond to silver nitrate treatment.↗
Journal of Pediatric Surgery Article Review: 1st Quarter (Jan-Mar) 2025
▶Ep 67 · 1:41
host_summaryA subset of children after esophageal atresia repair experience severe airway collapse, leaving them ventilator dependent or suffering repeated cyanotic spells↗
▶Ep 67 · 6:57
host_summaryA significant number of outreach services are located within 50 kilometers of a children's hospital, leaving vast regions without access to pediatric surgical care↗
▶Ep 67 · 12:38
host_summaryThe study examined 4,612 G-tube placements from 71 NSQIP-Pediatric hospitals in 2023↗
▶Ep 67 · 13:04
host_summaryUpper GI studies were obtained in 45% of first-time G-tube cases with substantial interhospital variability from 0 to 99%↗
▶Ep 67 · 13:45
host_summary14% of G-tube cases resulted in an ED visit within 0 to 30 days↗
▶Ep 67 · 13:45
host_summary5.2% of G-tube cases involved dislodgement within 0 to 30 days↗
Journal of Pediatric Surgery Article Review: 2nd Quarter (Apr-Jun) 2024
▶Ep 23 · 0:06
quoteHi everyone, I'm M. Goddy from Cincinnati Children's, and we are back with another episode of our Journal of Pediatric Surgery article review podcast.↗
▶Ep 23 · 1:05
quoteI'm a pediatric surgeon at Alberta Children's Hospital. I've also been the publication chair for the uh Pacific Association of Pediatric Surgeons.↗
▶Ep 23 · 1:25
host_summaryMMP-7 (matrix metalloproteinase 7) are proteolytic peptidases that break down peptide bonds for amino acids and are part of tissue remodeling processes, playing roles in tissue repair, arthritis, metastasis, and cirrhosis↗
▶Ep 23 · 1:43
host_summaryHigher levels of MMP-7 are associated with the diagnosis of biliary atresia↗
▶Ep 23 · 1:56
host_summaryIn a cohort of 329 biliary atresia cases from July 2020 to December 2022, 40 were classified as low MMP-7↗
▶Ep 23 · 2:11
quoteThis is a group that has an ability to access a very large number of patients in a very short period of time, which really puts them in a position where they can dive deeply into. To things that others couldn't even start thinking about↗
▶Ep 23 · 2:36
host_summaryLow levels of MMP-7 in biliary atresia patients are associated with low levels of preoperative GGT (gamma glutamyl transpeptidase) and direct bilirubin↗
▶Ep 23 · 3:02
host_summaryGGT (gamma glutamyl transpeptidase) is an enzyme found in high levels in liver, kidney, pancreas, heart, and brain, and blood GGT levels are used to detect diseases of the liver and bile ducts↗
▶Ep 23 · 3:19
host_summaryBiliary atresia has variable outcomes even within one center, with patients who anatomically look similar having dramatically different outcomes↗
▶Ep 23 · 4:09
host_summaryHaving lower MMP-7 levels within the cohort of biliary atresia patients is associated with worse prognosis↗
▶Ep 23 · 4:26
quoteAnd one of the things I love about this paper is that it just brings us down to some of those really basic questions about when we deal with these conditions, what actually underlies it? What are these processes? How do we target them?↗
▶Ep 23 · 4:41
host_summaryThe mechanism of why low MMP-7 levels in biliary atresia patients leads to worse prognosis is unknown↗
▶Ep 23 · 7:02
host_summaryIn a Canadian cohort of 411 infants with gastroschisis treated at CAPSNET centers from 2014 to 2022, 144 were excluded due to gestational age, birth weight, other congenital anomalies, or complicated gastroschisis, leaving 267 participants↗
▶Ep 23 · 7:43
host_summaryOf 267 uncomplicated gastroschisis patients, 78% received exclusive breast milk in the first 28 days of life and 22% received supplemental or exclusive formula↗
▶Ep 23 · 8:27
host_summaryThere were no significant differences between exclusive breast milk and formula groups in time to reach full enteral feeds, duration of parenteral nutrition, or length of stay in uncomplicated gastroschisis↗
▶Ep 23 · 8:53
host_summaryPatients with uncomplicated gastroschisis who received exclusive breast milk in the first 28 days were far more likely to transition to exclusive breastfeeding: 73% compared to 11% in those with formula exposure↗
▶Ep 23 · 12:46
host_summaryA systematic review on transition from pediatric to adult care for colorectal conditions included 8 studies with patient, parent, and clinician perspectives, focusing on patients aged 10-30 years with anorectal malformation or Hirschsprung disease↗
▶Ep 23 · 13:16
host_summaryThere is a group of colorectal patients discharged from care in late childhood around age 10 years, and another group that remains in pediatric care way beyond the normal age of transfer to adult care (around 25 years)↗
▶Ep 23 · 13:30
opinionThe life course progression of anorectal malformation and Hirschsprung disease is not well understood↗
Journal of Pediatric Surgery Article Review: 3rd Quarter (Jul-Sep) 2024
▶Ep 24 · 1:38
quoteMy name's Jason F Fisher. I'm a pediatric surgeon and director of the Colorectal Center at Cincinnati Children's, and I also happen to be. The lead of the subcommittee for Hirschprung's disease for the PCPLC or Pediatric Colorectal and Pelvic Learning Consortium.↗
▶Ep 24 · 3:20
host_summary85% of Hirschsprung disease patients in the study were diagnosed at less than 1 year of age↗
▶Ep 24 · 3:45
host_summaryKids with shorter segment Hirschsprung disease (rectosigmoid or small portion of aganglionic bowel) were more likely to be diagnosed at a later age↗
▶Ep 24 · 3:57
host_summaryChildren with long segment Hirschsprung disease typically presented at birth with classic symptoms such as failure to pass meconium↗
▶Ep 24 · 4:26
host_summaryApproximately one-third of neonates and 50% of infants, toddlers, and children had diverting ostomies performed prior to pull-through↗
▶Ep 24 · 5:01
host_summaryThere was no difference in overall rates of redo pull-throughs across age groups↗
▶Ep 24 · 5:07
host_summaryOlder children were more likely to need a redo pull-through due to an anastomotic leak↗
▶Ep 24 · 5:13
host_summaryHigher rates of diverting ostomy post pull-through were likely a treatment for a post pull-through leak or anastomotic leak↗
▶Ep 24 · 5:24
host_summaryThe only functional outcome that was different was nighttime soiling or incontinence in the older patient population↗
▶Ep 24 · 7:44
quoteI am a pediatric surgeon. Uh, in the division of pediatric Surgery with Presbyterian Healthcare Services in Albuquerque, New Mexico↗
▶Ep 24 · 8:09
host_summaryThe gastroschisis systematic review included 28 high quality manuscripts↗
▶Ep 24 · 8:15
host_summaryTwo randomized controlled trials on gastroschisis had been started but both ended prematurely and were underpowered↗
▶Ep 24 · 10:37
host_summarySkin organisms are most commonly identified in infections among infants with gastroschisis↗
▶Ep 24 · 10:44
host_summaryGastroschisis infants have a fairly high rate of wound infection↗
▶Ep 24 · 10:50
host_summarySilo closures have a higher rate of infection than other closure methods↗
▶Ep 24 · 10:50
host_summarySutureless closure has the lowest rate of infection in gastroschisis↗
▶Ep 24 · 10:57
host_summaryRecommendation is to provide antibiotic coverage for skin flora until the gastroschisis defect is closed and potentially for an additional 24 hours thereafter↗
▶Ep 24 · 12:22
host_summaryStable gastroschisis infants with sufficient abdominal capacity for sutureless closure tend to have the best outcomes↗
▶Ep 24 · 12:29
host_summaryMinimizing fluids and paralytics in gastroschisis infants improves their results↗
▶Ep 24 · 17:04
host_summary43% of pediatric surgeons preferred the Clavien-Madadi classification compared to 12% for the Clavien-Dindo classification↗
▶Ep 24 · 17:16
host_summaryAdvantages of the Clavien-Madadi classification were affirmed by nearly 82% of the surgeons↗
Journal of Pediatric Surgery Article Review: 2nd Quarter (Apr-Jun) 2024
▶Ep 71 · 0:06
quoteHi everyone, I'm M. Goddy from Cincinnati Children's, and we are back with another episode of our Journal of Pediatric Surgery article review podcast.↗
▶Ep 71 · 1:05
quoteI'm a pediatric surgeon at Alberta Children's Hospital. I've also been the publication chair for the uh Pacific Association of Pediatric Surgeons.↗
▶Ep 71 · 1:25
host_summaryMMP-7 (matrix metalloproteinase 7) are proteolytic peptidases that break down peptide bonds for amino acids and are part of tissue remodeling processes, playing roles in tissue repair, arthritis, metastasis, and cirrhosis↗
▶Ep 71 · 1:43
host_summaryHigher levels of MMP-7 are associated with the diagnosis of biliary atresia↗
▶Ep 71 · 1:56
host_summaryIn a cohort of 329 biliary atresia cases from July 2020 to December 2022, 40 were classified as low MMP-7↗
▶Ep 71 · 2:11
quoteThis is a group that has an ability to access a very large number of patients in a very short period of time, which really puts them in a position where they can dive deeply into. To things that others couldn't even start thinking about↗
▶Ep 71 · 2:36
host_summaryLow levels of MMP-7 in biliary atresia patients are associated with low levels of preoperative GGT (gamma glutamyl transpeptidase) and direct bilirubin↗
▶Ep 71 · 3:02
host_summaryGGT (gamma glutamyl transpeptidase) is an enzyme found in high levels in liver, kidney, pancreas, heart, and brain, and blood GGT levels are used to detect diseases of the liver and bile ducts↗
▶Ep 71 · 3:19
host_summaryBiliary atresia has variable outcomes even within one center, with patients who anatomically look similar having dramatically different outcomes↗
▶Ep 71 · 4:09
host_summaryHaving lower MMP-7 levels within the cohort of biliary atresia patients is associated with worse prognosis↗
▶Ep 71 · 4:26
quoteAnd one of the things I love about this paper is that it just brings us down to some of those really basic questions about when we deal with these conditions, what actually underlies it? What are these processes? How do we target them?↗
▶Ep 71 · 4:41
host_summaryThe mechanism of why low MMP-7 levels in biliary atresia patients leads to worse prognosis is unknown↗
▶Ep 71 · 7:02
host_summaryIn a Canadian cohort of 411 infants with gastroschisis treated at CAPSNET centers from 2014 to 2022, 144 were excluded due to gestational age, birth weight, other congenital anomalies, or complicated gastroschisis, leaving 267 participants↗
▶Ep 71 · 7:43
host_summaryOf 267 uncomplicated gastroschisis patients, 78% received exclusive breast milk in the first 28 days of life and 22% received supplemental or exclusive formula↗
▶Ep 71 · 8:27
host_summaryThere were no significant differences between exclusive breast milk and formula groups in time to reach full enteral feeds, duration of parenteral nutrition, or length of stay in uncomplicated gastroschisis↗
▶Ep 71 · 8:53
host_summaryPatients with uncomplicated gastroschisis who received exclusive breast milk in the first 28 days were far more likely to transition to exclusive breastfeeding: 73% compared to 11% in those with formula exposure↗
▶Ep 71 · 12:46
host_summaryA systematic review on transition from pediatric to adult care for colorectal conditions included 8 studies with patient, parent, and clinician perspectives, focusing on patients aged 10-30 years with anorectal malformation or Hirschsprung disease↗
▶Ep 71 · 13:16
host_summaryThere is a group of colorectal patients discharged from care in late childhood around age 10 years, and another group that remains in pediatric care way beyond the normal age of transfer to adult care (around 25 years)↗
▶Ep 71 · 13:30
opinionThe life course progression of anorectal malformation and Hirschsprung disease is not well understood↗
Journal of Pediatric Surgery Article Review: 3rd Quarter (Jul-Sep) 2024
▶Ep 73 · 1:38
quoteMy name's Jason F Fisher. I'm a pediatric surgeon and director of the Colorectal Center at Cincinnati Children's, and I also happen to be. The lead of the subcommittee for Hirschprung's disease for the PCPLC or Pediatric Colorectal and Pelvic Learning Consortium.↗
▶Ep 73 · 3:20
host_summary85% of Hirschsprung disease patients in the study were diagnosed at less than 1 year of age↗
▶Ep 73 · 3:45
host_summaryKids with shorter segment Hirschsprung disease (rectosigmoid or small portion of aganglionic bowel) were more likely to be diagnosed at a later age↗
▶Ep 73 · 3:57
host_summaryChildren with long segment Hirschsprung disease typically presented at birth with classic symptoms such as failure to pass meconium↗
▶Ep 73 · 4:26
host_summaryApproximately one-third of neonates and 50% of infants, toddlers, and children had diverting ostomies performed prior to pull-through↗
▶Ep 73 · 5:01
host_summaryThere was no difference in overall rates of redo pull-throughs across age groups↗
▶Ep 73 · 5:07
host_summaryOlder children were more likely to need a redo pull-through due to an anastomotic leak↗
▶Ep 73 · 5:13
host_summaryHigher rates of diverting ostomy post pull-through were likely a treatment for a post pull-through leak or anastomotic leak↗
▶Ep 73 · 5:24
host_summaryThe only functional outcome that was different was nighttime soiling or incontinence in the older patient population↗
▶Ep 73 · 7:44
quoteI am a pediatric surgeon. Uh, in the division of pediatric Surgery with Presbyterian Healthcare Services in Albuquerque, New Mexico↗
▶Ep 73 · 8:09
host_summaryThe gastroschisis systematic review included 28 high quality manuscripts↗
▶Ep 73 · 8:15
host_summaryTwo randomized controlled trials on gastroschisis had been started but both ended prematurely and were underpowered↗
▶Ep 73 · 10:37
host_summarySkin organisms are most commonly identified in infections among infants with gastroschisis↗
▶Ep 73 · 10:44
host_summaryGastroschisis infants have a fairly high rate of wound infection↗
▶Ep 73 · 10:50
host_summarySutureless closure has the lowest rate of infection in gastroschisis↗
▶Ep 73 · 10:50
host_summarySilo closures have a higher rate of infection than other closure methods↗
▶Ep 73 · 10:57
host_summaryRecommendation is to provide antibiotic coverage for skin flora until the gastroschisis defect is closed and potentially for an additional 24 hours thereafter↗
▶Ep 73 · 12:22
host_summaryStable gastroschisis infants with sufficient abdominal capacity for sutureless closure tend to have the best outcomes↗
▶Ep 73 · 12:29
host_summaryMinimizing fluids and paralytics in gastroschisis infants improves their results↗
▶Ep 73 · 17:04
host_summary43% of pediatric surgeons preferred the Clavien-Madadi classification compared to 12% for the Clavien-Dindo classification↗
▶Ep 73 · 17:16
host_summaryAdvantages of the Clavien-Madadi classification were affirmed by nearly 82% of the surgeons↗
Colorectal Quiz: Episode 49 – Collaborating for Kids: Colorectal & Pelvic Solutions (with a Little Help from AI)
▶Ep 77 · 5:56
quoteWhen you upload anything to the Notebook LM, you kind of create your own expert just from the provided document.↗
▶Ep 77 · 5:56
host_summaryWhen content is uploaded to Notebook LM, it creates an expert based only on the provided documents, not external sources↗
Best of the Best Gen Surg - Predictors of Low and High Opioid Tablet Consumption after Inguinal Hernia Repair – an ACHQC Opioid Reduction Task Force Analysis - Dr. Warren
▶Ep 13 · 7:50
clinicalAlmost every state has reversed legislation to allow prescribing limited opioids without hand-off through EMRs↗
▶Ep 13 · 8:40
host_summaryThe rate of refill calls for inguinal hernias following these guidelines is 4%↗
▶Ep 13 · 9:00
quotethe number one predictor of how many opioid tablets a patient takes is how many they are prescribed.↗
▶Ep 13 · 9:00
host_summaryThe number one predictor of how many opioid tablets a patient takes is how many they are prescribed↗
▶Ep 13 · 9:20
clinicalA surgeon previously discharged every inguinal hernia patient with 50 oxycodones at $3 prescription cost plus $23 FedEx for refills↗
▶Ep 13 · 10:00
quoteI actually send people home with, for, for laparoscopic inguinal hernias. I'm not so sure if we're open yet, but lap, which is the majority of my practice, zero narcotics, zero six months. I have not written a script. I send them with ice and scheduled Motrin and Tylenol.↗
▶Ep 13 · 10:00
clinicalFor laparoscopic inguinal hernias, a surgeon has discharged patients with zero narcotics for six months, using ice and scheduled Motrin and Tylenol, with only one refill request↗
Case-Based Journal Review: Inguinal Hernia 2025
▶Ep 17 · 3:36
host_summaryIn the JAMA trial of 308 preterm infants, 44 patients (28%) in the early repair group had at least one serious adverse event versus 27 patients (18%) in the late repair group↗
▶Ep 17 · 4:07
host_summaryRecurrence rate after inguinal hernia repair in the trial was less than 1%↗
▶Ep 17 · 4:07
host_summaryIncarceration rate in the late repair group was around 4%↗
▶Ep 17 · 7:12
host_summaryThe JAMA trial was terminated early, had low recruitment rate, and ended up with less statistical power than initially calculated↗
▶Ep 17 · 10:54
host_summaryIn the Dutch one-stop surgery study of 91 patients (54 one-stop, 37 usual care), all but one of the one-stop surgery patients were discharged home on the day of surgery↗
▶Ep 17 · 10:59
host_summaryPost-operative complication and recurrence rates did not differ between one-stop surgery and usual care patients in the Dutch study↗
▶Ep 17 · 11:05
host_summaryGeneral satisfaction and inclusion of family were higher after one-stop surgery experience↗
▶Ep 17 · 15:34
host_summaryIn the multi-institutional patent processus vaginalis study, 246 eligible infants under 4 months with PPV found at pyloromyotomy were enrolled at 8 children's hospitals, with 85% responding to at least one annual follow-up↗
▶Ep 17 · 15:49
host_summaryOf the 246 infants with patent processus vaginalis, two had inguinal hernia repair for symptomatic hernia, one had orchiopexy and incidental inguinal hernia repair, for a total of 3 hernia repairs↗
▶Ep 17 · 16:13
host_summaryThe presence of patent processus vaginalis at the time of pyloromyotomy was common, but the need for hernia repair was around 1% in the first year of follow-up↗
Journal of Pediatric Surgery Article Review: 2nd Quarter (Apr-Jun) 2024
▶Ep 85 · 0:06
quoteHi everyone, I'm M. Goddy from Cincinnati Children's, and we are back with another episode of our Journal of Pediatric Surgery article review podcast.↗
▶Ep 85 · 1:05
quoteI'm a pediatric surgeon at Alberta Children's Hospital. I've also been the publication chair for the uh Pacific Association of Pediatric Surgeons.↗
▶Ep 85 · 1:25
host_summaryMMP-7 (matrix metalloproteinase 7) are proteolytic peptidases that break down peptide bonds for amino acids and are part of tissue remodeling processes, playing roles in tissue repair, arthritis, metastasis, and cirrhosis↗
▶Ep 85 · 1:43
host_summaryHigher levels of MMP-7 are associated with the diagnosis of biliary atresia↗
▶Ep 85 · 1:56
host_summaryIn a cohort of 329 biliary atresia cases from July 2020 to December 2022, 40 were classified as low MMP-7↗
▶Ep 85 · 2:11
quoteThis is a group that has an ability to access a very large number of patients in a very short period of time, which really puts them in a position where they can dive deeply into. To things that others couldn't even start thinking about↗
▶Ep 85 · 2:36
host_summaryLow levels of MMP-7 in biliary atresia patients are associated with low levels of preoperative GGT (gamma glutamyl transpeptidase) and direct bilirubin↗
▶Ep 85 · 3:02
host_summaryGGT (gamma glutamyl transpeptidase) is an enzyme found in high levels in liver, kidney, pancreas, heart, and brain, and blood GGT levels are used to detect diseases of the liver and bile ducts↗
▶Ep 85 · 3:19
host_summaryBiliary atresia has variable outcomes even within one center, with patients who anatomically look similar having dramatically different outcomes↗
▶Ep 85 · 4:09
host_summaryHaving lower MMP-7 levels within the cohort of biliary atresia patients is associated with worse prognosis↗
▶Ep 85 · 4:26
quoteAnd one of the things I love about this paper is that it just brings us down to some of those really basic questions about when we deal with these conditions, what actually underlies it? What are these processes? How do we target them?↗
▶Ep 85 · 4:41
host_summaryThe mechanism of why low MMP-7 levels in biliary atresia patients leads to worse prognosis is unknown↗
▶Ep 85 · 7:02
host_summaryIn a Canadian cohort of 411 infants with gastroschisis treated at CAPSNET centers from 2014 to 2022, 144 were excluded due to gestational age, birth weight, other congenital anomalies, or complicated gastroschisis, leaving 267 participants↗
▶Ep 85 · 7:43
host_summaryOf 267 uncomplicated gastroschisis patients, 78% received exclusive breast milk in the first 28 days of life and 22% received supplemental or exclusive formula↗
▶Ep 85 · 8:27
host_summaryThere were no significant differences between exclusive breast milk and formula groups in time to reach full enteral feeds, duration of parenteral nutrition, or length of stay in uncomplicated gastroschisis↗
▶Ep 85 · 8:53
host_summaryPatients with uncomplicated gastroschisis who received exclusive breast milk in the first 28 days were far more likely to transition to exclusive breastfeeding: 73% compared to 11% in those with formula exposure↗
▶Ep 85 · 12:46
host_summaryA systematic review on transition from pediatric to adult care for colorectal conditions included 8 studies with patient, parent, and clinician perspectives, focusing on patients aged 10-30 years with anorectal malformation or Hirschsprung disease↗
▶Ep 85 · 13:16
host_summaryThere is a group of colorectal patients discharged from care in late childhood around age 10 years, and another group that remains in pediatric care way beyond the normal age of transfer to adult care (around 25 years)↗
▶Ep 85 · 13:30
opinionThe life course progression of anorectal malformation and Hirschsprung disease is not well understood↗
Journal of Pediatric Surgery Article Review: 3rd Quarter (Jul-Sep) 2024
▶Ep 86 · 1:38
quoteMy name's Jason F Fisher. I'm a pediatric surgeon and director of the Colorectal Center at Cincinnati Children's, and I also happen to be. The lead of the subcommittee for Hirschprung's disease for the PCPLC or Pediatric Colorectal and Pelvic Learning Consortium.↗
▶Ep 86 · 3:20
host_summary85% of Hirschsprung disease patients in the study were diagnosed at less than 1 year of age↗
▶Ep 86 · 3:45
host_summaryKids with shorter segment Hirschsprung disease (rectosigmoid or small portion of aganglionic bowel) were more likely to be diagnosed at a later age↗
▶Ep 86 · 3:57
host_summaryChildren with long segment Hirschsprung disease typically presented at birth with classic symptoms such as failure to pass meconium↗
▶Ep 86 · 4:26
host_summaryApproximately one-third of neonates and 50% of infants, toddlers, and children had diverting ostomies performed prior to pull-through↗
▶Ep 86 · 5:01
host_summaryThere was no difference in overall rates of redo pull-throughs across age groups↗
▶Ep 86 · 5:07
host_summaryOlder children were more likely to need a redo pull-through due to an anastomotic leak↗
▶Ep 86 · 5:13
host_summaryHigher rates of diverting ostomy post pull-through were likely a treatment for a post pull-through leak or anastomotic leak↗
▶Ep 86 · 5:24
host_summaryThe only functional outcome that was different was nighttime soiling or incontinence in the older patient population↗
▶Ep 86 · 7:44
quoteI am a pediatric surgeon. Uh, in the division of pediatric Surgery with Presbyterian Healthcare Services in Albuquerque, New Mexico↗
▶Ep 86 · 8:09
host_summaryThe gastroschisis systematic review included 28 high quality manuscripts↗
▶Ep 86 · 8:15
host_summaryTwo randomized controlled trials on gastroschisis had been started but both ended prematurely and were underpowered↗
▶Ep 86 · 10:37
host_summarySkin organisms are most commonly identified in infections among infants with gastroschisis↗
▶Ep 86 · 10:44
host_summaryGastroschisis infants have a fairly high rate of wound infection↗
▶Ep 86 · 10:50
host_summarySilo closures have a higher rate of infection than other closure methods↗
▶Ep 86 · 10:50
host_summarySutureless closure has the lowest rate of infection in gastroschisis↗
▶Ep 86 · 10:57
host_summaryRecommendation is to provide antibiotic coverage for skin flora until the gastroschisis defect is closed and potentially for an additional 24 hours thereafter↗
▶Ep 86 · 12:22
host_summaryStable gastroschisis infants with sufficient abdominal capacity for sutureless closure tend to have the best outcomes↗
▶Ep 86 · 12:29
host_summaryMinimizing fluids and paralytics in gastroschisis infants improves their results↗
▶Ep 86 · 17:04
host_summary43% of pediatric surgeons preferred the Clavien-Madadi classification compared to 12% for the Clavien-Dindo classification↗
▶Ep 86 · 17:16
host_summaryAdvantages of the Clavien-Madadi classification were affirmed by nearly 82% of the surgeons↗
Umbilical Disorders with Dr. Rebeccah Brown
▶Ep 89 · 0:34
host_summaryThe umbilical cord contains two umbilical arteries and one umbilical vein surrounded by Wharton's jelly (a gelatin-like extracellular matrix).↗
▶Ep 89 · 0:34
quoteTwo umbilical arteries and one umbilical vein surrounding by a gelatin-like extracellular matrix known as Worthin's jelly.↗
▶Ep 89 · 0:50
quoteThey usually fall off 2 to 3 weeks, and the delay can be a manifestation of an immune deficiency.↗
▶Ep 89 · 0:50
host_summaryUmbilical cords usually fall off at 2 to 3 weeks after birth.↗
▶Ep 89 · 0:50
host_summaryDelayed umbilical cord separation can be a manifestation of an immune deficiency.↗
▶Ep 89 · 1:20
host_summaryMild omphalitis cases (inflammation of the belly button) may be treated with alcohol drying, ampicillin, or amoxicillin with follow-up every 24 hours.↗
▶Ep 89 · 1:40
host_summary16% of patients admitted with omphalitis develop necrotizing fasciitis.↗
▶Ep 89 · 1:40
quote16% of the patients admitted with onalittis develop necrotizing fasciitis.↗
▶Ep 89 · 1:46
host_summaryNecrotizing fasciitis from omphalitis presents with rapidly progressive umbilical edema, erythema, drainage, and has a high mortality rate.↗
▶Ep 89 · 2:27
host_summaryUmbilical hernias can be associated with trisomy 13, 18, and 21.↗
▶Ep 89 · 2:47
host_summaryDr. Brown mentioned that if the fascial opening in an umbilical hernia is larger than 1.5 centimeters, it may not close by itself.↗
▶Ep 89 · 2:55
host_summaryIn Walker's studies, 96% of very small umbilical hernias (less than 0.5 centimeters) closed by six years, but no hernia greater than 1.5 centimeters closed by six years of age.↗
▶Ep 89 · 4:54
host_summaryUnplanned emergency department returns within 30 days after umbilical hernia repair occurred at 2.5%, with rates twice as high for patients younger than 4 years old.↗
▶Ep 89 · 5:10
host_summaryAsymptomatic umbilical hernia repair should be delayed until greater than 4 years of age.↗
▶Ep 89 · 5:18
host_summaryIn Rangel's study of 167,000 patients at 68 pediatricians' offices, 4,486 had umbilical hernia diagnosis at a median age of 1.6 months, with spontaneous closure occurring in 89% by age 5.↗
▶Ep 89 · 5:53
host_summaryIn Rangel's study, closure rates for smaller hernias (≤1 cm) were nearly 90%, while for larger hernias they were around 80%.↗
▶Ep 89 · 6:12
host_summaryRangel's study concluded that umbilical hernia repair should be delayed until age 5 years given the high incidence of spontaneous closure.↗
▶Ep 89 · 6:56
host_summaryProboscoid hernia occurs when the skin above the hernia grows and pushes through the opening in the abdominal wall.↗
▶Ep 89 · 7:05
host_summaryIt is recommended to correct proboscoid hernias before school age to avoid psychological issues for the child.↗
▶Ep 89 · 8:00
host_summaryDr. Brown prefers to perform umbilicoplasty in umbilical hernia repairs, excising excess skin and using a 4-0 monocryl purse-string suture close to the skin surface to create a cosmetically appealing umbilicus.↗
▶Ep 89 · 8:55
host_summaryUmbilical granulomas are usually moist but commonly dry up and fall off spontaneously over time.↗
▶Ep 89 · 9:00
host_summaryUmbilical granulomas often respond to silver nitrate treatment.↗
Journal of Pediatric Surgery Article Review: 1st Quarter (Jan-Mar) 2025
▶Ep 98 · 1:41
host_summaryA subset of children after esophageal atresia repair experience severe airway collapse, leaving them ventilator dependent or suffering repeated cyanotic spells↗
▶Ep 98 · 6:57
host_summaryA significant number of outreach services are located within 50 kilometers of a children's hospital, leaving vast regions without access to pediatric surgical care↗
▶Ep 98 · 12:38
host_summaryThe study examined 4,612 G-tube placements from 71 NSQIP-Pediatric hospitals in 2023↗
▶Ep 98 · 13:04
host_summaryUpper GI studies were obtained in 45% of first-time G-tube cases with substantial interhospital variability from 0 to 99%↗
▶Ep 98 · 13:45
host_summary14% of G-tube cases resulted in an ED visit within 0 to 30 days↗
▶Ep 98 · 13:45
host_summary5.2% of G-tube cases involved dislodgement within 0 to 30 days↗
QUAD #20: Endoscopic Repair of Minor Laryngeal Clefts with Dr. Catherine Hart
▶Ep 2 · 1:41
host_summaryThe goal of endoscopic cleft repair is to remove the interarytenoid mucosa to create two raw surfaces and then suture the edges together.↗
▶Ep 2 · 2:05
host_summaryIf suture bites are taken too deeply during cleft repair, edges will be inverted and the child will continue to have problems.↗
▶Ep 2 · 2:22
host_summaryInterarytenoid mucosa can be resected using laser or cold steel (knife), and the choice does not matter clinically.↗
▶Ep 2 · 2:42
host_summaryComplete demucosalization of the apex is essential; if incomplete, a hole will remain at the apex and the child will continue to aspirate.↗
▶Ep 2 · 3:01
host_summaryTypically 2 to 3 sutures are placed depending on the extent of the cleft.↗
▶Ep 2 · 3:01
host_summaryEpiglottic folds are released after suturing to create extra space.↗
▶Ep 2 · 4:31
host_summarySurgical closure of laryngeal clefts achieves improvement in symptoms in almost 80% of children and resolution in 70%.↗
▶Ep 2 · 4:36
host_summarySurgical closure has a slightly higher risk of complications compared to conservative management.↗
▶Ep 2 · 4:54
host_summaryA consensus guideline exists for diagnosing and managing laryngeal clefts in children and is a good resource, especially for those newer to practice.↗
QUAD #25: Medical Management of Minor Laryngeal Clefts with Dr. Greg Burg
▶Ep 3 · 0:54
host_summaryFlexible bronchoscopy is quite limited in evaluating a cleft unless it's a major cleft.↗
▶Ep 3 · 1:13
host_summaryA deep interarytenoid notch is considered a minor cleft by Dr. Burg's team.↗
▶Ep 3 · 1:44
host_summaryRespiratory culture showed predominantly upper airway flora and two Candida species in the mucopurulent bronchitis.↗
▶Ep 3 · 2:07
host_summaryClinical assessment includes evaluating frequency of coughing, sick visits, emergency room visits, and hospitalizations.↗
▶Ep 3 · 2:15
host_summaryBronchoscopic assessment looks for airway edema, visibility of tracheal rings, mucus plugging, and secretions.↗
▶Ep 3 · 3:18
host_summaryChest CT is the most important differential imaging study, used to look for chronic changes related to aspiration.↗
▶Ep 3 · 4:12
host_summaryG-tubes and NG-tubes are used as needed for nutritional intake.↗
▶Ep 3 · 4:57
host_summaryChronic macrolide therapy can be used as an anti-neutrophilic agent, derived from cystic fibrosis literature.↗
▶Ep 3 · 4:57
host_summarySaline is used to thin out secretions.↗
▶Ep 3 · 5:14
host_summaryFor patients with significant tracheomalacia, ipratropium may be used over albuterol.↗
host_summaryNeuroblastoma cells often make catecholamines like epinephrine and norepinephrine↗
▶Ep 17 · 3:03
host_summaryThe Curie score is specifically used to assess the extent of metastasis in neuroblastoma patients based on MIBG scans, with the body divided into 10 regions each scored 0 to 3, producing a maximum score of 30↗
▶Ep 17 · 4:08
host_summaryThe INSS takes into account the results of surgery to remove the tumor and cannot help doctors determine a stage before any treatment has started↗
▶Ep 17 · 4:26
host_summaryINRG is a preoperative staging system designed to allow thinking about how difficult patients may be to resect and how to compare patients preoperatively↗
▶Ep 17 · 6:11
host_summaryFor many cancer patients, 2/3 of them will have some long term morbidity from their chemo↗
▶Ep 17 · 7:29
host_summaryWith neuroblastoma resections, we divide them into tiny, tiny pieces while we're taking them out↗
▶Ep 17 · 7:38
host_summaryThe biggest thing to do with neuroblastoma is stay on the vessels - find yourself a normal vessel and work from normal to abnormal↗
▶Ep 17 · 7:38
quoteThe biggest thing to do with neuroblastoma is stay on the vessels.↗
▶Ep 17 · 9:13
host_summaryWhen corneal biopsies are performed by experienced practitioners who ensure to obtain multiple cores, the adequacy of these biopsies significantly improves↗
▶Ep 17 · 10:44
host_summaryFor neuroblastoma, unlike most tumors that we resect, we would like to get as much of it we can, but we would expect that we're not possibly getting every single ounce of tumor↗
▶Ep 17 · 11:01
quoteYour goal is to get as much of the tumor as you can without causing harm.↗
▶Ep 17 · 11:01
host_summaryYour goal is to get as much of the tumor as you can without causing harm↗
▶Ep 17 · 12:21
host_summaryIn the COG study of 87 patients less than 6 months of age with a small adrenal mass, the 4 year event free survival for patients with neuroblastoma was 97%↗
Update Course Rewind: Highlighting Collaboration from Surgery & Interventional Radiology in the OR 2024
▶Ep 20 · 0:13
host_summaryThe 12th annual update course in pediatric surgery was held in August 2024↗
▶Ep 20 · 0:56
host_summaryImage-guided surgery session classifies as blue square for promising newer practice↗
▶Ep 20 · 1:15
host_summaryImage-guided surgery uses real-time imaging including CT, MRI, ultrasound, or fluoroscopy to provide detailed views of internal structures↗
▶Ep 20 · 1:39
host_summarySurgeons may not know what is possible with image guidance so they don't know what to ask for↗
▶Ep 20 · 2:59
host_summaryCone beam CT provides excellent visualization of bony structures making it valuable for maxillofacial, ENT, spine, and orthopedic surgeries↗
▶Ep 20 · 3:36
host_summaryInterventional radiologists at Cincinnati Children's help train pediatric surgery fellows including guidance for vascular access↗
Update Course Rewind: Pediatric Biliary Stones - Surgery First Mindset 2024
▶Ep 23 · 0:52
host_summaryStone disease is increasing along with obesity in pediatric patients around the world, not just in the United States↗
▶Ep 23 · 1:25
host_summaryThere are two main approaches for CBD stones requiring cholecystectomy: ERCP first followed by laparoscopic cholecystectomy, or surgery-first with IOC to identify and potentially remove stones during the same surgery↗
▶Ep 23 · 2:11
host_summaryA surgery-first pathway reduces resource utilization, including MRCP↗
▶Ep 23 · 3:02
host_summaryERCP adds potential morbidity, with a pancreatitis rate of 10% even when performed well↗
▶Ep 23 · 3:16
host_summaryIf a surgeon cannot perform a cholangiogram, then ERCP is necessary if available↗
▶Ep 23 · 3:44
quoteif you know how to put in a central line and you understand the principles Singer technique, then you can do this.↗
▶Ep 23 · 3:44
host_summaryIf you know how to put in a central line and understand Seldinger technique, you can perform intraoperative stone removal↗
▶Ep 23 · 3:50
host_summaryWith a surgery-first mindset, stone clearance rate reflected by negative IOC was 86%↗
▶Ep 23 · 4:01
host_summaryWith simple adjuncts like advancing the catheter into the CBD or reaming the sphincter, success rate rises to the 90s↗
▶Ep 23 · 4:11
quoteThat's the dirty little secret is like, let's do something that, that I think is accessible to everybody.↗
▶Ep 23 · 4:17
host_summaryFor the 15% of unsuccessful cases, the plan is to clip the cystic duct, close, and have ERCP performed within the next day or two, or same-day in the OR if an endoscopist is available↗
▶Ep 23 · 4:56
host_summaryAn endo-loop may be used instead of a clip when ERCP is planned, to facilitate subsequent endoscopic access↗
▶Ep 23 · 5:06
host_summaryThe learning curve for intraoperative stone removal is manageable: the first few times are difficult, but after a few cases it becomes easier and even enjoyable↗
▶Ep 23 · 5:15
host_summaryThe biggest key to success is having all necessary equipment in one place, because OR staff will not know what to get on the fly↗
▶Ep 23 · 5:26
host_summarySuccess depends on IOC findings: a CBD chock full of 3-4 impacted stones is typically not amenable to surgery-first approach↗
▶Ep 23 · 6:03
host_summaryWhen flushing an impacted stone, there is a risk of inadvertently injecting contrast into the pancreatic duct, which can increase the risk of pancreatitis↗
▶Ep 23 · 6:15
quoteI think as soon as you start seeing that pancreatic duct light up, that is a signal to slow down on your flush, be careful because you can cause pancreatitis.↗
▶Ep 23 · 6:15
host_summaryIf the pancreatic duct lights up during flushing, that is a signal to slow down and be careful to avoid causing pancreatitis↗
▶Ep 23 · 6:33
host_summaryA study demonstrated 86% success rate for surgery-first, while the ERCP group had a 10% complication rate including cholangitis, bleeding, pancreatitis, and hemophilia↗
host_summaryPatient is neutropenic with markedly elevated liver function tests and ultrasound findings consistent with acute cholecystitis and choledocholithiasis↗
▶Ep 24 · 1:20
host_summaryOver 50% of audience opted to start antibiotics and address elevated liver function tests↗
▶Ep 24 · 1:49
host_summaryGallstone pancreatitis is inflammation of the pancreas triggered by a gallstone obstructing the bile duct, which can also impede pancreatic drainage↗
▶Ep 24 · 1:57
host_summaryBlockage prevents pancreatic enzymes from reaching the small intestine, leading them to accumulate and damage the pancreas↗
host_summaryIn the JAMA trial of 308 preterm infants, 44 patients (28%) in the early repair group had at least one serious adverse event versus 27 patients (18%) in the late repair group↗
▶Ep 4 · 4:07
host_summaryRecurrence rate after inguinal hernia repair in the trial was less than 1%↗
▶Ep 4 · 4:07
host_summaryIncarceration rate in the late repair group was around 4%↗
▶Ep 4 · 7:12
host_summaryThe JAMA trial was terminated early, had low recruitment rate, and ended up with less statistical power than initially calculated↗
▶Ep 4 · 10:54
host_summaryIn the Dutch one-stop surgery study of 91 patients (54 one-stop, 37 usual care), all but one of the one-stop surgery patients were discharged home on the day of surgery↗
▶Ep 4 · 10:59
host_summaryPost-operative complication and recurrence rates did not differ between one-stop surgery and usual care patients in the Dutch study↗
▶Ep 4 · 11:05
host_summaryGeneral satisfaction and inclusion of family were higher after one-stop surgery experience↗
▶Ep 4 · 15:34
host_summaryIn the multi-institutional patent processus vaginalis study, 246 eligible infants under 4 months with PPV found at pyloromyotomy were enrolled at 8 children's hospitals, with 85% responding to at least one annual follow-up↗
▶Ep 4 · 15:49
host_summaryOf the 246 infants with patent processus vaginalis, two had inguinal hernia repair for symptomatic hernia, one had orchiopexy and incidental inguinal hernia repair, for a total of 3 hernia repairs↗
▶Ep 4 · 16:13
host_summaryThe presence of patent processus vaginalis at the time of pyloromyotomy was common, but the need for hernia repair was around 1% in the first year of follow-up↗
Journal of Pediatric Surgery Article Review: September 2023
▶Ep 13 · 5:17
host_summaryDuration of ECMO support was shorter in the early CDH repair group↗
▶Ep 13 · 5:17
host_summarySurvival was not statistically different between early and delayed CDH repair groups on ECMO↗
▶Ep 13 · 9:32
host_summaryPhysician suicide is characterized by tragically high rates of suicide among doctors compared to the general population↗
▶Ep 13 · 10:17
host_summaryHigh levels of stress, emotional and physical burnout, demanding work schedules, and pressure to maintain successful careers contribute to physician suicide↗
▶Ep 13 · 10:33
host_summaryStigma associated with mental health issues within the medical profession discourages physicians from seeking help, leading to untreated depression, anxiety, and other mental health disorders↗
quoteHello pediatric surgery family, I'm E Gdy, a research fellow from Cincinnati Children's Hospital Medical Center.↗
Journal of Pediatric Surgery Article Review: September 2023
▶Ep 42 · 5:17
host_summaryDuration of ECMO support was shorter in the early CDH repair group↗
▶Ep 42 · 5:17
host_summarySurvival was not statistically different between early and delayed CDH repair groups on ECMO↗
▶Ep 42 · 9:32
host_summaryPhysician suicide is characterized by tragically high rates of suicide among doctors compared to the general population↗
▶Ep 42 · 10:17
host_summaryHigh levels of stress, emotional and physical burnout, demanding work schedules, and pressure to maintain successful careers contribute to physician suicide↗
▶Ep 42 · 10:33
host_summaryStigma associated with mental health issues within the medical profession discourages physicians from seeking help, leading to untreated depression, anxiety, and other mental health disorders↗
Journal of Pediatric Surgery Article Review: 1st Quarter (Jan-Mar) 2025
▶Ep 50 · 1:41
host_summaryA subset of children after esophageal atresia repair experience severe airway collapse, leaving them ventilator dependent or suffering repeated cyanotic spells↗
▶Ep 50 · 6:57
host_summaryA significant number of outreach services are located within 50 kilometers of a children's hospital, leaving vast regions without access to pediatric surgical care↗
▶Ep 50 · 12:38
host_summaryThe study examined 4,612 G-tube placements from 71 NSQIP-Pediatric hospitals in 2023↗
▶Ep 50 · 13:04
host_summaryUpper GI studies were obtained in 45% of first-time G-tube cases with substantial interhospital variability from 0 to 99%↗
▶Ep 50 · 13:45
host_summary14% of G-tube cases resulted in an ED visit within 0 to 30 days↗
▶Ep 50 · 13:45
host_summary5.2% of G-tube cases involved dislodgement within 0 to 30 days↗
host_summaryPyloric stenosis occurs when the pyloric muscle becomes thickened or hypertrophied, creating a narrower passage between stomach and small intestine that blocks food passage.↗
▶Ep 24 · 0:40
host_summaryThe classic symptom of pyloric stenosis is projectile vomiting after feeding followed by signs of hunger, which can lead to severe dehydration and weight loss.↗
▶Ep 24 · 2:19
host_summaryBilious vomiting should be considered an emergency in an infant.↗
▶Ep 24 · 2:19
quoteDon't forget the bilious vomiting should be considered as an emergency in an infant.↗
▶Ep 24 · 2:56
host_summaryPyloric stenosis usually affects babies between 2 and 8 weeks of age but can occur anytime from birth to 6 months.↗
▶Ep 24 · 3:24
host_summaryA 2017 Journal of Pediatric Surgery study of 584 patients found African American infants with pyloric stenosis presented with higher bicarbonate and lower chloride levels.↗
▶Ep 24 · 4:25
host_summaryResearchers have identified specific genetic changes that may indicate risk for pyloric stenosis as a molecular diagnostic marker.↗
▶Ep 24 · 5:22
host_summaryLaboratory findings typically include hyperbilirubinemia, hypochloremia, and elevated bicarbonate levels.↗
▶Ep 24 · 5:46
host_summaryElevated bicarbonate is excreted in urine, which obligates sodium loss to maintain electroneutrality; water loss follows sodium excretion, making the patient more hemodynamically unstable.↗
▶Ep 24 · 7:04
host_summaryRecommended fluid resuscitation is a bolus of isotonic saline followed by maintenance IV fluids of D5 half-normal saline with 20 milliequivalents per liter of potassium chloride added.↗
▶Ep 24 · 7:53
host_summaryPyloromyotomy is a 45-minute curative operation that can be done safely and quickly.↗
▶Ep 24 · 8:12
host_summaryAccording to a 2023 Journal of Pediatric Surgery study, antibiotic prophylaxis may be unnecessary for pyloromyotomy and may carry unnecessary long-term side effects.↗
▶Ep 24 · 12:52
host_summaryRisks of pyloromyotomy include incomplete myotomy, mucosal perforation, aspiration, and wound infection.↗
▶Ep 24 · 14:30
host_summaryA flexible feeding protocol that reduces formula volume if a baby vomits 6 times but continues smaller feeds and increases as tolerated allows greater flexibility and decreases length of hospital stay.↗
Case-Based Journal Review: Inguinal Hernia 2025
▶Ep 28 · 3:36
host_summaryIn the JAMA trial of 308 preterm infants, 44 patients (28%) in the early repair group had at least one serious adverse event versus 27 patients (18%) in the late repair group↗
▶Ep 28 · 4:07
host_summaryIncarceration rate in the late repair group was around 4%↗
▶Ep 28 · 4:07
host_summaryRecurrence rate after inguinal hernia repair in the trial was less than 1%↗
▶Ep 28 · 7:12
host_summaryThe JAMA trial was terminated early, had low recruitment rate, and ended up with less statistical power than initially calculated↗
▶Ep 28 · 10:54
host_summaryIn the Dutch one-stop surgery study of 91 patients (54 one-stop, 37 usual care), all but one of the one-stop surgery patients were discharged home on the day of surgery↗
▶Ep 28 · 10:59
host_summaryPost-operative complication and recurrence rates did not differ between one-stop surgery and usual care patients in the Dutch study↗
▶Ep 28 · 11:05
host_summaryGeneral satisfaction and inclusion of family were higher after one-stop surgery experience↗
▶Ep 28 · 15:34
host_summaryIn the multi-institutional patent processus vaginalis study, 246 eligible infants under 4 months with PPV found at pyloromyotomy were enrolled at 8 children's hospitals, with 85% responding to at least one annual follow-up↗
▶Ep 28 · 15:49
host_summaryOf the 246 infants with patent processus vaginalis, two had inguinal hernia repair for symptomatic hernia, one had orchiopexy and incidental inguinal hernia repair, for a total of 3 hernia repairs↗
▶Ep 28 · 16:13
host_summaryThe presence of patent processus vaginalis at the time of pyloromyotomy was common, but the need for hernia repair was around 1% in the first year of follow-up↗
Update Course Rewind: Highlighting Collaboration from Surgery & Interventional Radiology in the OR 2024
▶Ep 12 · 0:13
host_summaryThe 12th annual update course in pediatric surgery was held in August 2024↗
▶Ep 12 · 0:56
host_summaryImage-guided surgery session classifies as blue square for promising newer practice↗
▶Ep 12 · 1:15
host_summaryImage-guided surgery uses real-time imaging including CT, MRI, ultrasound, or fluoroscopy to provide detailed views of internal structures↗
▶Ep 12 · 1:39
host_summarySurgeons may not know what is possible with image guidance so they don't know what to ask for↗
▶Ep 12 · 2:59
host_summaryCone beam CT provides excellent visualization of bony structures making it valuable for maxillofacial, ENT, spine, and orthopedic surgeries↗
▶Ep 12 · 3:36
host_summaryInterventional radiologists at Cincinnati Children's help train pediatric surgery fellows including guidance for vascular access↗
Aerodigestive & Esophageal Surgery - The Unsalvageable Esophagus & Cases
▶Ep 1 · 16:30
quoteManubrial removing the manubrium is never as straightforward as it seems because your clavicles always get in the way.↗
▶Ep 1 · 16:30
quoteManubrial removing the manubrium is never as straightforward as it seems because your clavicles always get in the way.↗
▶Ep 1 · 16:38
clinicalManubrial resection for high esophageal strictures provides less exposure than expected because the clavicles limit the width of the resection corridor.↗
▶Ep 1 · 16:38
clinicalManubrial resection for high esophageal strictures provides less exposure than expected because the clavicles limit the width of the resection corridor.↗
▶Ep 1 · 19:36
quoteEsophageal stents are very much a double-edged sword. They can often cause as many problems as they fix.↗
▶Ep 1 · 19:36
quoteEsophageal stents are very much a double-edged sword. They can often cause as many problems as they fix.↗
▶Ep 1 · 33:28
clinicalKenalog (steroid) injection after stricture dilation is preferred over mitomycin. Mitomycin at high concentrations (up to 5 mg/mL) causes tissue necrosis and has not shown superior outcomes compared to steroids.↗
▶Ep 1 · 33:28
clinicalKenalog (steroid) injection after stricture dilation is preferred over mitomycin. Mitomycin at high concentrations (up to 5 mg/mL) causes tissue necrosis and has not shown superior outcomes compared to steroids.↗
▶Ep 1 · 36:29
clinicalFor recalcitrant esophageal strictures, weekly dilations (3–4 cycles) prevent fibroblasts from bridging and allow the stricture to scar open rather than closed.↗
▶Ep 1 · 36:29
clinicalFor recalcitrant esophageal strictures, weekly dilations (3–4 cycles) prevent fibroblasts from bridging and allow the stricture to scar open rather than closed.↗
▶Ep 1 · 45:47
clinicalFeeding via gastrojejunal tube with gastric drainage (GJ/G) is a temporizing measure to reduce reflux into the esophagus while managing a refractory stricture.↗
▶Ep 1 · 45:47
clinicalFeeding via gastrojejunal tube with gastric drainage (GJ/G) is a temporizing measure to reduce reflux into the esophagus while managing a refractory stricture.↗
▶Ep 1 · 47:43
quoteIf you've got mucosal disease, all you need to do is remove all the mucosa. You've got no disease.↗
▶Ep 1 · 47:43
quoteIf you've got mucosal disease, all you need to do is remove all the mucosa. You've got no disease.↗
▶Ep 1 · 48:18
clinicalEsophageal stents can compress the adjacent trachea, especially in children with tracheomalacia or when the esophagus lies directly posterior to the trachea. Always perform bronchoscopy after stent placement.↗
▶Ep 1 · 48:18
clinicalEsophageal stents can compress the adjacent trachea, especially in children with tracheomalacia or when the esophagus lies directly posterior to the trachea. Always perform bronchoscopy after stent placement.↗
▶Ep 1 · 48:20
quoteIf you put in an esophageal stent, have a quick look in the airway when you're done.↗
▶Ep 1 · 48:20
quoteIf you put in an esophageal stent, have a quick look in the airway when you're done.↗
▶Ep 1 · 50:13
quoteWe see it with um chronic oesophageal foreign bodies, um, classically the penny. And typically for a chronic one, they come in about 6 weeks later. And they come in with a diagnosis of asthma.↗
▶Ep 1 · 50:13
quoteWe see it with um chronic oesophageal foreign bodies, um, classically the penny. And typically for a chronic one, they come in about 6 weeks later. And they come in with a diagnosis of asthma.↗
▶Ep 1 · 50:20
clinicalChronic esophageal foreign bodies (e.g., coins lodged for weeks) can cause posterior tracheal bulge and present as refractory asthma or bronchiolitis, often diagnosed late because chest X-rays are not routinely obtained in asthma protocols.↗
▶Ep 1 · 50:20
clinicalChronic esophageal foreign bodies (e.g., coins lodged for weeks) can cause posterior tracheal bulge and present as refractory asthma or bronchiolitis, often diagnosed late because chest X-rays are not routinely obtained in asthma protocols.↗
▶Ep 1 · 52:06
quoteThe aim is to probe it but not push so hard that you create a fistula. That's always embarrassing.↗
▶Ep 1 · 52:06
quoteThe aim is to probe it but not push so hard that you create a fistula. That's always embarrassing.↗
▶Ep 1 · 1:01:05
quoteA lot of kids have replaced esophaguuses and most of them don't aspirate, even if you've got a trashed cricoharyngeis.↗
▶Ep 1 · 1:01:05
quoteA lot of kids have replaced esophaguuses and most of them don't aspirate, even if you've got a trashed cricoharyngeis.↗
▶Ep 1 · 1:10:42
clinicalCovered esophageal stents can temporize anastomotic leaks and allow healing while maintaining luminal patency. Stent removal is typically planned after several weeks.↗
▶Ep 1 · 1:10:42
clinicalCovered esophageal stents can temporize anastomotic leaks and allow healing while maintaining luminal patency. Stent removal is typically planned after several weeks.↗
▶Ep 1 · 1:31:42
clinicalTracheal homografts (dead trachea implants) have been performed but are associated with difficult postoperative courses lasting several months.↗
▶Ep 1 · 1:31:42
clinicalTracheal homografts (dead trachea implants) have been performed but are associated with difficult postoperative courses lasting several months.↗
▶Ep 1 · 1:32:06
clinicalTissue-engineered tracheal homografts with pre-epithelialization are under development in multiple centers (London leading) but are not yet ready for routine clinical use.↗
▶Ep 1 · 1:32:06
clinicalTissue-engineered tracheal homografts with pre-epithelialization are under development in multiple centers (London leading) but are not yet ready for routine clinical use.↗
▶Ep 1 · 1:33:15
clinicalLong-term surveillance of bypassed esophagus includes periodic CT scans to rule out mucocele and endoscopic evaluation via the persistent TEF if needed.↗
▶Ep 1 · 1:33:15
clinicalLong-term surveillance of bypassed esophagus includes periodic CT scans to rule out mucocele and endoscopic evaluation via the persistent TEF if needed.↗
▶Ep 1 · 1:34:15
host_summaryPosterior tracheopexy (pexing the trachea to the anterior spine) combined with bovine pericardial patch for tracheal defects is an alternative to esophageal bypass, but pericardial patches can fail and create large tracheal defects.↗
▶Ep 1 · 1:34:15
clinicalPosterior tracheopexy (pexing the trachea to the anterior spine) combined with bovine pericardial patch for tracheal defects is an alternative to esophageal bypass, but pericardial patches can fail and create large tracheal defects.↗
▶Ep 1 · 1:39:43
quoteThis is a game where complications are almost inevitable. And it's not that you can eliminate them, you can minimize them, but then it's the team approach trying to work out how to manage them.↗
▶Ep 1 · 1:39:43
opinionComplications are nearly inevitable in complex esophageal reconstruction. The goal is not to eliminate complications but to anticipate and manage them effectively through a multidisciplinary team approach.↗
▶Ep 1 · 1:39:43
quoteThis is a game where complications are almost inevitable. And it's not that you can eliminate them, you can minimize them, but then it's the team approach trying to work out how to manage them.↗
▶Ep 1 · 1:39:43
opinionComplications are nearly inevitable in complex esophageal reconstruction. The goal is not to eliminate complications but to anticipate and manage them effectively through a multidisciplinary team approach.↗
QUAD #2 Thoracoscopic Tracheopexy with Dr. Aaron Garrison
▶Ep 4 · 0:36
host_summarySeveral years ago, the approach was that patients with tracheomalacia would undergo aortopexy.↗
▶Ep 4 · 0:43
host_summaryIn the last 4 to 5 years, it has become standard practice to determine which patients will respond best to tracheopexy versus aortopexy.↗
▶Ep 4 · 1:45
host_summaryPart of the workup is making sure that there is space to anteriorly suspend the aorta so that the trachea diameter can actually be made larger.↗
▶Ep 4 · 2:02
host_summaryPreoperative bronchoscopy gives the surgical team an idea of internal anatomy, which can assist in classifying the degree of tracheomalacia prior to surgical intervention.↗
▶Ep 4 · 3:23
host_summaryWhen using a thoracoscopic approach, correct positioning is the key to success.↗
▶Ep 4 · 3:27
host_summaryIt is best to use gravity to advantage as it aids in retracting the lungs and trachea placement.↗
▶Ep 4 · 4:01
host_summaryOpening the pericardium and finding the area at the pericardial-adventitial junction to suspend is the key point of aortopexy.↗
▶Ep 4 · 4:16
host_summaryPassing suture transternally is preferred with the aortopexy approach, though it can be technically difficult.↗
▶Ep 4 · 4:23
host_summaryFor tracheopexy, a posterior approach via semiprone position is preferred.↗
▶Ep 4 · 4:28
host_summaryCreating a pneumothorax by putting the Veress off the tip of the scapula helps collapse the lung for trocar placement.↗
▶Ep 4 · 4:38
host_summaryWhen operating posteriorly, triangulating your hands gives the best visualization and working space.↗
▶Ep 4 · 4:56
host_summaryWhen available, a multidisciplinary team which includes a pulmonologist can allow for internal visualization via bronchoscopy.↗
▶Ep 4 · 5:05
host_summaryBronchoscopic guidance technique is primarily used in non-esophageal atresia patients.↗
▶Ep 4 · 5:53
host_summaryIt is important to create enough tension in the suture to ensure that the pexy is secure.↗
▶Ep 4 · 6:07
host_summaryThe approach changes for patients without esophageal atresia or with an esophagus in continuity.↗
▶Ep 4 · 6:14
host_summaryFor patients with esophagus in continuity, the first step is to dissect around the esophagus using a vessel loop for retraction.↗
▶Ep 4 · 6:32
host_summaryUsing pre- and post-operative bronchoscopy allows the surgeon to see the improvement prior to case completion.↗
