How do intercostal nerve cryoablation and enhanced recovery after surgery, also known as ARIS protocols, affect pain management, opioid use, length of stay, and recovery in pectus excavatum patients undergoing the NES procedure?
The ERAS, or the Enhanced Recovery after Surgery Society, used a modified Delphi technique, which is a fancy way of saying that a multidisciplinary group of experts gathered together to reach more than a 70% consensus.
The ERAS, or the Enhanced Recovery after Surgery Society, used a modified Delphi technique, which is a fancy way of saying that a multidisciplinary group of experts gathered together to reach more than a 70% consensus.
The biggest barriers weren't the technology itself, they were the lack of standardized protocols, limited provider training, and uncertainty about how bowel ultrasound should guide treatment decisions.
The biggest barriers weren't the technology itself, they were the lack of standardized protocols, limited provider training, and uncertainty about how bowel ultrasound should guide treatment decisions.
So the message here is that curorino associated sacrococcygeal teratomas behave incredibly well oncologically, which means we may be able to rethink how aggressively we follow these kids long term.
Educational Outcomes in School-Aged Children With a History of Simple and Complex Gastroschisis are Poor Compared to Controls
▶Ep 42 · 0:00
quoteDo children born with gastroschisis perform worse in school compared to age-matched peers without the condition?↗
▶Ep 42 · 0:11
clinicalThis is a retrospective study using educational data from children born between 1991 and 2022↗
▶Ep 42 · 0:18
clinicalThe study compared 208 children with gastroschisis and over 2000 age-matched controls↗
▶Ep 42 · 0:18
clinicalResearchers used odds ratio and subgroup analysis to compare school performance using the Early Development Instrument or EDI and grade level assessments↗
▶Ep 42 · 0:33
quoteThey found that children with gastroschisis, even those with the simpler form, were significantly more likely to fail middle school assessments.↗
▶Ep 42 · 0:33
clinicalChildren with gastroschisis, even those with the simpler form, were significantly more likely to fail middle school assessments↗
▶Ep 42 · 0:41
opinionChildren with gastroschisis may face long-term learning challenges and could benefit from early educational support↗
Quick Literature Updates Episode 20
▶Ep 43 · 1:03
epidemiologicalThe meta-analysis included 709 patients from 15 research studies across multiple international centers↗
▶Ep 43 · 1:11
quoteThey wanted to know whether thoracoscopic repair has a higher recurrence rate and longer operating room time compared to open repair.↗
▶Ep 43 · 1:18
clinicalThoracoscopic repair has higher recurrence rates compared to open repair for congenital diaphragmatic hernia↗
▶Ep 43 · 1:18
clinicalThoracoscopic repair has longer operative times compared to open repair for congenital diaphragmatic hernia↗
▶Ep 43 · 1:25
clinicalThoracoscopic repair has a lower incidence of postoperative bowel obstruction compared to open repair↗
Quick Literature Updates Ep 22
▶Ep 44 · 1:03
clinicalThe Hirschsprung study was prospective and took place 2021 to 2023, including 33 patients under six months old who underwent endorectal pull-through surgeries↗
▶Ep 44 · 1:20
clinicalPrimary outcomes examined were anastomotic complications, enterocolitis, and constipation↗
▶Ep 44 · 1:27
clinicalThere was no significant difference in anastomotic complications between dilation and non-dilation groups↗
▶Ep 44 · 1:27
clinicalThe non-dilation group had less enterocolitis and less constipation compared to traditional dilation group↗
▶Ep 44 · 1:36
opinionChoosing not to do postoperative anal dilations may be a good alternative with benefits like lower constipation and enterocolitis↗
▶Ep 44 · 1:36
quoteThis means that choosing not to do postoperative anal dilations may be a good alternative with benefits like lower constipation and enterocolitis.↗
A multi-institutional comparison of management techniques for infants with giant omphalocele
▶Ep 45 · 0:00
quoteWhat's the best way to manage a giantombalocele?↗
▶Ep 45 · 0:07
clinicalFour treatment approaches were compared: paint-and-wait, operative silos, compression techniques, and Duoderm silo.↗
▶Ep 45 · 0:07
epidemiologicalThe study examined 117 infants with giant omphalocele.↗
▶Ep 45 · 0:19
clinicalBabies treated with Duoderm silo were most likely to have their abdomen closed in one surgery.↗
▶Ep 45 · 0:19
quoteBabies treated with the duoderm silo were most likely to have their abdomen closed in one surgery.↗
▶Ep 45 · 0:24
clinicalApproximately 80% of infants treated with Duoderm silo achieved single-stage abdominal closure.↗
clinicalApproximately 80% of infants treated with Duoderm silo achieved single-surgery abdominal closure↗
▶Ep 46 · 0:25
clinicalComplication rates were similar across all four management methods↗
▶Ep 46 · 0:25
clinicalSome babies treated with operative silos achieved closure sooner than other methods↗
▶Ep 46 · 0:32
clinicalAlmost half of infants required 6 months or more before complete abdominal closure could be achieved↗
▶Ep 46 · 0:38
opinionDuoderm silos may be particularly beneficial when the goal is single-stage abdominal closure↗
▶Ep 46 · 0:38
quoteThere's no one size fits all treatment, but Duoderm silos may be a really good option for certain babies, especially when the goal is closing the abdomen in one step.↗
▶Ep 46 · 0:38
opinionThere is no universal best treatment approach for giant omphalocele↗
Early Tricuspid Valve Surgery for Heart Failure in Congenital Heart Disease
▶Ep 3 · 0:00
quoteWhat if fixing a heart valve earlier could prevent heart failure and congenital heart disease?↗
▶Ep 3 · 0:08
clinicalIn adults with transposition of the great arteries, the right ventricle sometimes has to pump blood to the whole body.↗
▶Ep 3 · 0:08
clinicalThe right ventricle was not built to pump blood to the whole body.↗
▶Ep 3 · 0:16
clinicalOver time, many patients with transposition of the great arteries develop severe tricuspid regurgitation and worsening heart function.↗
▶Ep 3 · 0:25
clinicalPatients with moderate to severe tricuspid valve leakage but only mild to moderate ventricular dysfunction had better outcomes after surgery.↗
▶Ep 3 · 0:33
clinicalIf the right ventricle was already severely weak, tricuspid valve surgery did not make a difference in outcomes.↗
▶Ep 3 · 0:37
quoteBottom line, in patients with transposition of the great arteries, earlier valve surgery can improve their outcomes.↗
▶Ep 3 · 0:37
clinicalIn patients with transposition of the great arteries, earlier tricuspid valve surgery can improve outcomes.↗
Practice Patterns and Outcomes of Hemodialysis in Infants Undergoing Congenital Heart Surgery in th
▶Ep 4 · 0:00
quoteDoes it matter where a baby receives care after heart surgery?↗
▶Ep 4 · 0:07
epidemiological1% of infants can develop severe acute kidney injury and require dialysis after congenital heart surgery↗
▶Ep 4 · 0:14
epidemiologicalFor infants that needed hemodialysis after congenital heart surgery, one-year survival was 46%↗
▶Ep 4 · 0:14
epidemiologicalFor infants that did not need hemodialysis after congenital heart surgery, one-year survival was 94%↗
▶Ep 4 · 0:23
clinicalMost infants requiring dialysis after congenital heart surgery received continuous renal replacement therapy rather than intermittent dialysis↗
epidemiologicalHospitals that use dialysis more frequently had 3 times higher hospital survival for infants after congenital heart surgery↗
▶Ep 4 · 0:33
epidemiologicalHospitals that use dialysis more frequently had double the 1-year survival rate for infants after congenital heart surgery↗
▶Ep 4 · 0:39
epidemiologicalDialysis after infant heart surgery is rare↗
▶Ep 4 · 0:44
opinionOutcomes may improve when infants requiring dialysis after heart surgery are treated at a center with more experience in using dialysis↗
Practice Patterns and Outcomes of Hemodialysis in Infants Undergoing Congenital Heart Surgery in the
▶Ep 5 · 0:00
quoteDoes it matter where a baby receives care after heart surgery?↗
▶Ep 5 · 0:07
epidemiological1% of infants can develop severe acute kidney injury and require dialysis after congenital heart surgery↗
▶Ep 5 · 0:14
clinicalFor infants not needing hemodialysis after congenital heart surgery, one-year survival was 94%↗
▶Ep 5 · 0:14
clinicalFor infants needing hemodialysis after congenital heart surgery, one-year survival was 46%↗
▶Ep 5 · 0:23
clinicalMost infants requiring dialysis after congenital heart surgery received continuous renal replacement therapy rather than intermittent dialysis↗
clinicalHospitals that use dialysis more frequently had 3 times higher hospital survival for infants after congenital heart surgery↗
▶Ep 5 · 0:33
clinicalHospitals that use dialysis more frequently had double the 1-year survival rate for infants after congenital heart surgery↗
▶Ep 5 · 0:39
epidemiologicalDialysis after infant heart surgery is rare↗
▶Ep 5 · 0:44
opinionOutcomes may improve when infants requiring dialysis after heart surgery are treated at a center with more experience in using dialysis↗
Practice Patterns and Outcomes of Hemodialysis in Infants Undergoing Congenital Heart Surgery in the
▶Ep 6 · 0:00
quoteDoes it matter where a baby receives care after heart surgery?↗
▶Ep 6 · 0:07
epidemiological1% of infants can develop severe acute kidney injury and require dialysis after congenital heart surgery↗
▶Ep 6 · 0:14
clinicalFor infants not needing hemodialysis after congenital heart surgery, one-year survival was 94%↗
▶Ep 6 · 0:14
clinicalFor infants needing hemodialysis after congenital heart surgery, one-year survival was 46%↗
▶Ep 6 · 0:23
clinicalMost infants requiring dialysis after congenital heart surgery received continuous renal replacement therapy rather than intermittent dialysis↗
clinicalHospitals that use dialysis more frequently had double the 1-year survival rate for infants after congenital heart surgery↗
▶Ep 6 · 0:33
clinicalHospitals that use dialysis more frequently had 3 times higher hospital survival for infants after congenital heart surgery↗
▶Ep 6 · 0:39
epidemiologicalDialysis after infant heart surgery is rare↗
▶Ep 6 · 0:44
opinionOutcomes may improve when infants requiring dialysis after heart surgery are treated at a center with more experience in using dialysis↗
Practice Patterns and Outcomes of Hemodialysis in Infants Undergoing Congenital Heart Surgery...
▶Ep 7 · 0:00
quoteDoes it matter where a baby receives care after heart surgery?↗
▶Ep 7 · 0:07
epidemiological1% of infants develop severe acute kidney injury requiring dialysis after congenital heart surgery↗
▶Ep 7 · 0:14
epidemiologicalOne-year survival for infants not requiring hemodialysis after congenital heart surgery is 94%↗
▶Ep 7 · 0:14
epidemiologicalOne-year survival for infants requiring hemodialysis after congenital heart surgery is 46%↗
▶Ep 7 · 0:23
clinicalMost infants requiring dialysis after congenital heart surgery received continuous renal replacement therapy rather than intermittent dialysis↗
epidemiologicalHospitals that use dialysis more frequently had 3 times higher hospital survival for infants after congenital heart surgery↗
▶Ep 7 · 0:33
epidemiologicalHospitals that use dialysis more frequently had double the 1-year survival rate for infants after congenital heart surgery↗
▶Ep 7 · 0:39
epidemiologicalDialysis after infant heart surgery is rare↗
▶Ep 7 · 0:44
clinicalOutcomes for infants requiring dialysis after heart surgery may improve when treated at centers with more experience in using dialysis↗
Surgical and Catheter-Based Intervention in Pediatric Pulmonary Vein Stenosis
▶Ep 8 · 0:00
quoteCan you ever truly fix pulmonary vein stenosis?↗
▶Ep 8 · 0:06
clinicalPulmonary vein stenosis is a rare but serious condition where the veins from the lungs to the heart become narrowed↗
▶Ep 8 · 0:12
epidemiologicalA study from Cincinnati Children's examined 56 children comparing surgery versus catheter-based interventions for pulmonary vein stenosis↗
▶Ep 8 · 0:23
clinicalOver time, catheter-based treatments became the preferred first option for pulmonary vein stenosis↗
▶Ep 8 · 0:28
clinicalSurgery was reserved for complex cases involving multiple severely affected veins or other heart defects↗
▶Ep 8 · 0:34
clinicalRecurrence of pulmonary vein stenosis remained common regardless of the initial intervention type↗
▶Ep 8 · 0:34
epidemiological92% of children with pulmonary vein stenosis needed another intervention after initial treatment↗
▶Ep 8 · 0:34
epidemiologicalMost reinterventions for pulmonary vein stenosis occurred within the first year after initial treatment↗
▶Ep 8 · 0:45
quoteSo pulmonary vein stenosis isn't a one-time fix.↗
▶Ep 8 · 0:48
clinicalPulmonary vein stenosis requires ongoing surveillance, repeated interventions, and a long-term multidisciplinary approach↗
The use of postoperative calibrations in Hirschsprung disease
▶Ep 168 · 0:00
quoteFor patients with Hirschsprung disease who undergo endorectal pull-through surgeries, are daily postoperative anal dilations necessary and effective?↗
▶Ep 168 · 0:13
clinicalThe study was prospective and took place from 2021 to 2023↗
▶Ep 168 · 0:13
clinicalThe study included 33 patients under six months old who underwent endorectal pull-through surgeries↗
▶Ep 168 · 0:24
clinicalPatients were assigned to either a new non-dilation protocol group or a traditional dilation group↗
▶Ep 168 · 0:30
clinicalThe primary outcomes measured were anastomotic complications, enterocolitis, and constipation↗
▶Ep 168 · 0:37
clinicalThere was no significant difference in anastomotic complications between the two groups↗
▶Ep 168 · 0:37
clinicalThe non-dilation group had less constipation compared to the traditional dilation group↗
▶Ep 168 · 0:37
clinicalThe non-dilation group had less enterocolitis compared to the traditional dilation group↗
▶Ep 168 · 0:46
opinionChoosing not to do postoperative anal dilations may be a good alternative with benefits like lower constipation and enterocolitis↗
▶Ep 168 · 0:46
quoteThis means that choosing not to do postoperative anal dilations may be a good alternative with benefits like lower constipation and enterocolitis.↗
Quick Literature Updates Episode 17
▶Ep 172 · 3:25
clinicalThe Children's Hospital in Pakistan conducted a randomized control trial including 124 patients in 2021 to 2022 who needed stoma reversal↗
▶Ep 172 · 3:35
clinicalThe study aimed to compare surgical site infections and cosmetic outcomes of scars in patients receiving purse-string or linear skin closure techniques for stoma reversal↗
▶Ep 172 · 3:44
clinicalThe purse-string closure group had way fewer surgical site infections compared to the linear closure group↗
▶Ep 172 · 3:49
clinicalThe purse-string closure group had much better scar quality compared to the linear closure group↗
▶Ep 172 · 3:52
opinionWhen reversing a stoma, purse-string closure technique is the best way to do it↗
▶Ep 172 · 3:52
quoteSo when reversing a stoma, purse string closure technique is the best way to do it.↗
Finnish Pediatric Surgery Hub - From Centralization to Collective Learning and Sharing of Expertise
▶Ep 173 · 0:00
quoteDoes creating a collaborative initiative help with providing high quality pediatric surgical care?↗
▶Ep 173 · 0:10
clinicalThe Finnish Pediatric Surgery Hub was established in 2021 by pediatric surgeons from Finland's five neonatal surgery centers.↗
▶Ep 173 · 0:18
epidemiologicalThe most frequent diagnoses included anorectal malformations, esophageal atresia, and Hirschsprung disease.↗
▶Ep 173 · 0:18
epidemiologicalThe hub performed 34 elective and 6 urgent cases total.↗
▶Ep 173 · 0:28
clinicalThe hub held regular monthly virtual meetings to present new patients, discuss complex cases, and follow up on patients after surgery.↗
▶Ep 173 · 0:36
quoteTheir findings suggest that the Finnish Pediatric Surgery hub fosters an effective and safe place for sharing surgical expertise and learning.↗
▶Ep 173 · 0:36
opinionFindings suggest that the Finnish Pediatric Surgery hub fosters an effective and safe place for sharing surgical expertise and learning.↗
Quick Literature Updates Episode 18
▶Ep 174 · 1:10
quoteThe ERAS, or the Enhanced Recovery after Surgery Society, used a modified Delphi technique, which is a fancy way of saying that a multidisciplinary group of experts gathered together to reach more than a 70% consensus.↗
▶Ep 174 · 1:10
guidelineThe ERAS Society used a modified Delphi technique with a multidisciplinary group of experts to reach more than 70% consensus↗
▶Ep 174 · 1:34
guidelineThe ERAS Society agreed on 16 recommendations covering 11 topics including team communication, pre-surgery fasting, temperature control, and antibiotic use↗
▶Ep 174 · 1:43
guidelineThe ERAS Society did not have enough data to make recommendations about nasogastric tubes and central lines↗
Comparing Loop and Divided Colostomy for Anorectal Malformation: A Systematic Review and Meta-Analysis
▶Ep 176 · 0:01
quoteWhich colostomy is best in pediatric patients with anorectal malformation?↗
▶Ep 176 · 0:10
clinicalThe systematic review and meta-analysis compared clinical outcomes of loop colostomies versus divided colostomies in neonates with anorectal malformations↗
▶Ep 176 · 0:19
epidemiologicalThe review included 11 retrospective cohort studies↗
▶Ep 176 · 0:23
quoteThere were no significant differences between the two colostomy types in terms of complications such as stoma prolapse, urinary tract infections, and wound infections.↗
▶Ep 176 · 0:23
clinicalThere were no significant differences between the two colostomy types in terms of complications such as stoma prolapse, urinary tract infections, and wound infections↗
▶Ep 176 · 0:31
opinionBoth colostomies are good options for fecal diversion, with the choice depending on individual patient factors and surgical expertise↗
Morbidity of Rectal Prolapse Repair After Surgery for Anorectal Malformation
▶Ep 181 · 0:00
quoteWhat if the safest move for rectal prolapse after anorectal malformation surgery is not to repair it?↗
▶Ep 181 · 0:11
epidemiologicalA study examined 85 children treated for rectal prolapse after anorectal malformation surgery↗
▶Ep 181 · 0:16
epidemiologicalApproximately 30% of children had recurrence of prolapse requiring another repair↗
▶Ep 181 · 0:20
clinicalChildren without symptoms from prolapse at initial presentation were more likely to develop stricture later↗
▶Ep 181 · 0:26
quotesurgeons need to think twice before rushing into repair if the prolapse isn't causing big symptoms, because the treatment itself can carry risks↗
▶Ep 181 · 0:26
opinionSurgical repair of asymptomatic rectal prolapse may not be indicated because the treatment itself carries risks↗
Post Operative Anal Dilatations for the Prevention of Anal Strictures in Children With Anorectal Malformation: A Systematic Review
▶Ep 182 · 0:00
quoteAfter reconstructive surgery for anorectal malformations, dilatations are routine, but are they actually necessary?↗
▶Ep 182 · 0:11
clinicalRoutine anal dilatations after surgery for anorectal malformations have been standard since the 1980s↗
▶Ep 182 · 0:18
epidemiologicalStricture rates after anorectal malformation surgery range from 0 to almost 40%, even with the classic Pena protocol↗
▶Ep 182 · 0:25
clinicalAlternative methods like weekly dilatations or skipping dilatations altogether showed similar outcomes to standard protocols↗
▶Ep 182 · 0:32
opinionThere is insufficient high quality evidence proving that dilatations after anorectal malformation surgery are actually necessary↗
▶Ep 182 · 0:37
quoteBottom line, we might have been doing this for decades without really needing to, and we need more randomized trials to settle the debate.↗
▶Ep 182 · 0:37
opinionMore randomized trials are needed to determine whether post-operative anal dilatations are necessary↗
Quick Literature Updates Ep 22
▶Ep 184 · 1:03
clinicalThe Hirschsprung study was prospective and took place 2021 to 2023, including 33 patients under six months old who underwent endorectal pull-through surgeries↗
▶Ep 184 · 1:20
clinicalPrimary outcomes examined were anastomotic complications, enterocolitis, and constipation↗
▶Ep 184 · 1:27
clinicalThere was no significant difference in anastomotic complications between dilation and non-dilation groups↗
▶Ep 184 · 1:27
clinicalThe non-dilation group had less enterocolitis and less constipation compared to traditional dilation group↗
▶Ep 184 · 1:36
quoteThis means that choosing not to do postoperative anal dilations may be a good alternative with benefits like lower constipation and enterocolitis.↗
▶Ep 184 · 1:36
opinionChoosing not to do postoperative anal dilations may be a good alternative with benefits like lower constipation and enterocolitis↗
Quick Literature Updates Ep 23
▶Ep 185 · 1:02
guidelineAPSA published best practices for locum tenens surgeons, hospitals and agencies↗
▶Ep 185 · 1:12
guidelineAPSA guidelines stress the importance of patient safety and support for surgeons↗
▶Ep 185 · 1:17
opinionLocum tenens can help prevent burnout by offering flexible work options for a better work-life balance↗
▶Ep 185 · 1:23
guidelineHospitals should avoid relying solely on locum tenens pediatric surgeons without any full-time surgeons because this may cause patients to slip through handoffs↗
▶Ep 185 · 1:23
quoteHowever, hospitals should avoid relying solely on locum tenants pediatric surgeons without any full-time surgeons, because this may cause patients to slip through handoffs.↗
▶Ep 185 · 1:32
guidelineLocum tenens agencies should sponsor CME and conduct formal exit interviews↗
Sacrococcygeal Teratomas in Currarino Syndrome: A Multicenter Review of Tumor Characteristics, Surgical Outcomes, and Recurrence
▶Ep 186 · 0:00
quoteWhat if the sacrococcygeal teratomas that we worry most about are actually the least aggressive ones?↗
▶Ep 186 · 0:10
epidemiologicalA multicenter review examined over 200 sacrococcygeal teratoma cases comparing children with Currarino syndrome to those without it.↗
▶Ep 186 · 0:19
clinicalCurrarino patients were almost always diagnosed after birth.↗
▶Ep 186 · 0:19
clinicalTumors in Currarino patients are almost exclusively Altman type 4, buried deep in the pelvis.↗
▶Ep 186 · 0:27
clinicalEvery tumor in the Currarino group was a mature one with no immature or malignant components at all.↗
▶Ep 186 · 0:27
quoteEvery tumor in the curorinal group was a mature one. There were no immature or malignant components at all.↗
▶Ep 186 · 0:33
clinicalCurrarino-associated tumors were much smaller, around 3 centimeters instead of 8 centimeters.↗
▶Ep 186 · 0:36
clinicalRecurrence was almost nonexistent in Currarino cases and not significantly different from non-Currarino cases.↗
▶Ep 186 · 0:41
opinionCurrarino-associated sacrococcygeal teratomas behave incredibly well oncologically, suggesting potential for less aggressive long-term follow-up.↗
▶Ep 186 · 0:41
quoteSo the message here is that curorino associated sacrococcygeal teratomas behave incredibly well oncologically, which means we may be able to rethink how aggressively we follow these kids long term.↗
Quick Literature Updates Ep 26
▶Ep 188 · 1:07
quoteRecent literature has been supporting treating appendicitis with antibiotics rather than surgery.↗
▶Ep 188 · 1:07
opinionRecent literature has been supporting treating appendicitis with antibiotics rather than surgery↗
▶Ep 188 · 1:12
clinicalThe appendicitis study was a multi-center randomized trial conducted in Canada, the US, Finland, Sweden, and Singapore↗
▶Ep 188 · 1:24
clinicalOnly 7% in the appendectomy group required additional surgery within a year↗
▶Ep 188 · 1:24
clinical34% of children treated with antibiotics for appendicitis eventually required surgery within a year↗
▶Ep 188 · 1:32
clinicalThere were no deaths in either the antibiotic or surgery group for appendicitis treatment↗
▶Ep 188 · 1:32
clinicalChildren in the antibiotic group had a higher risk of mild to moderate adverse events compared to surgery group↗
▶Ep 188 · 1:39
clinicalAntibiotics were not as effective as surgery for treating non-perforated appendicitis in children and did not meet the threshold for non-inferiority↗
▶Ep 188 · 1:39
quoteThe key takeaway is that antibiotics were not as effective as surgery for treating non-perforated appendicitis in children, as it did not meet the threshold for non-inferiority.↗
guidelineThe ERAS Society used a modified Delphi technique with a multidisciplinary group of experts to reach more than 70% consensus↗
▶Ep 32 · 1:10
quoteThe ERAS, or the Enhanced Recovery after Surgery Society, used a modified Delphi technique, which is a fancy way of saying that a multidisciplinary group of experts gathered together to reach more than a 70% consensus.↗
▶Ep 32 · 1:34
guidelineThe ERAS Society agreed on 16 recommendations covering 11 topics including team communication, pre-surgery fasting, temperature control, and antibiotic use↗
▶Ep 32 · 1:43
guidelineThe ERAS Society did not have enough data to make recommendations about nasogastric tubes and central lines↗
STAT trial: stoma or intestinal anastomosis for necrotizing enterocolitis: a multicentre randomized controlled trial
▶Ep 65 · 0:00
quoteWhat's the best surgical approach for infants needing laparotomy, for necrotizing enterocolitis, anastomosis, or stoma formation?↗
▶Ep 65 · 0:13
clinicalThe STAT trial was a randomized controlled trial in 12 centers worldwide.↗
▶Ep 65 · 0:13
clinicalThe trial looked at newborns who underwent laparotomy for necrotizing enterocolitis requiring intestinal resection from 2010 to 2020.↗
▶Ep 65 · 0:26
clinicalPatients were randomized to two surgical approaches: either anastomosis or stoma formation.↗
▶Ep 65 · 0:31
clinicalInfants undergoing primary anastomosis had a significantly less duration of requiring parenteral nutrition compared to those with stoma formation.↗
▶Ep 65 · 0:31
clinicalThere was no difference in unplanned surgeries between primary anastomosis and stoma formation groups.↗
▶Ep 65 · 0:31
clinicalThere was no difference in mortality between primary anastomosis and stoma formation groups.↗
▶Ep 65 · 0:43
opinionPrimary anastomosis is superior for enhancing recovery from necrotizing enterocolitis in infants and does not increase adverse outcomes.↗
Educational Outcomes in School-Aged Children With a History of Simple and Complex Gastroschisis are Poor Compared to Controls
▶Ep 66 · 0:00
quoteDo children born with gastroschisis perform worse in school compared to age-matched peers without the condition?↗
▶Ep 66 · 0:11
clinicalThis is a retrospective study using educational data from children born between 1991 and 2022↗
▶Ep 66 · 0:18
clinicalResearchers used odds ratio and subgroup analysis to compare school performance using the Early Development Instrument or EDI and grade level assessments↗
▶Ep 66 · 0:18
clinicalThe study compared 208 children with gastroschisis and over 2000 age-matched controls↗
▶Ep 66 · 0:33
quoteThey found that children with gastroschisis, even those with the simpler form, were significantly more likely to fail middle school assessments.↗
▶Ep 66 · 0:33
clinicalChildren with gastroschisis, even those with the simpler form, were significantly more likely to fail middle school assessments↗
▶Ep 66 · 0:41
opinionChildren with gastroschisis may face long-term learning challenges and could benefit from early educational support↗
Quick Literature Updates Ep 22
▶Ep 68 · 1:03
clinicalThe Hirschsprung study was prospective and took place 2021 to 2023, including 33 patients under six months old who underwent endorectal pull-through surgeries↗
▶Ep 68 · 1:20
clinicalPrimary outcomes examined were anastomotic complications, enterocolitis, and constipation↗
▶Ep 68 · 1:27
clinicalThere was no significant difference in anastomotic complications between dilation and non-dilation groups↗
▶Ep 68 · 1:27
clinicalThe non-dilation group had less enterocolitis and less constipation compared to traditional dilation group↗
▶Ep 68 · 1:36
opinionChoosing not to do postoperative anal dilations may be a good alternative with benefits like lower constipation and enterocolitis↗
▶Ep 68 · 1:36
quoteThis means that choosing not to do postoperative anal dilations may be a good alternative with benefits like lower constipation and enterocolitis.↗
Quick Literature Updates Ep 27
▶Ep 69 · 1:04
clinicalThe Van Haal et al. study included 79 patients who had rigid tracheobronchoscopy done before and after esophageal atresia surgery↗
▶Ep 69 · 1:24
clinicalPre-operative tracheobronchoscopy for the presence of post-operative tracheomalacia had a sensitivity of 50% and a specificity of 67%↗
▶Ep 69 · 1:34
quoteThis shows that pre-op TBS, though routine, has limited predictive value for post-op tracheomalacia.↗
▶Ep 69 · 1:34
clinicalPre-operative tracheobronchoscopy has limited predictive value for post-operative tracheomalacia despite being routine↗
Availability, utilization, and barriers to bowel ultrasound for necrotizing enterocolitis...
▶Ep 74 · 0:00
quoteDo you routinely use bowel ultrasound to diagnose necrotizing enterocolitis?↗
▶Ep 74 · 0:08
clinicalBowel ultrasound is becoming an important tool for diagnosing necrotizing enterocolitis↗
▶Ep 74 · 0:19
epidemiologicalA national survey included more than 100 neonatologists, surgeons, and radiologists from 42 children's hospitals↗
▶Ep 74 · 0:26
epidemiologicalBowel ultrasound was available in 83% of level 4 NICUs↗
▶Ep 74 · 0:26
clinicalClinicians reported using bowel ultrasound inconsistently, most often only when X-rays were inconclusive↗
▶Ep 74 · 0:26
quoteWhile bowel ultrasound was available in 83% of level 4 NICUs, clinicians reported using it inconsistently, most often only when X-rays. Were inconclusive.↗
▶Ep 74 · 0:36
quoteThe biggest barriers weren't the technology itself, they were the lack of standardized protocols, limited provider training, and uncertainty about how bowel ultrasound should guide treatment decisions.↗
▶Ep 74 · 0:36
clinicalThe biggest barriers to bowel ultrasound adoption were lack of standardized protocols, limited provider training, and uncertainty about how bowel ultrasound should guide treatment decisions↗
▶Ep 74 · 0:46
opinionWider adoption of bowel ultrasound for NEC will depend on better evidence, standardized guidelines, and improved clinician training↗
Update Course Rewind 2025: Updates in NEC Management
▶Ep 75 · 2:06
clinicalFor every 10 babies with surgical NEC, an X-ray might only catch one or two in the early stages↗
▶Ep 75 · 2:15
clinicalA 2023 study in Pediatric Radiology suggests ultrasound can detect bowel wall thinning, perfusion abnormalities, and fluid collections that X-ray misses↗
▶Ep 75 · 5:00
clinicalIn the long run there is a benefit to primary anastomosis, though you might not see the benefit with immediate survival↗
▶Ep 75 · 5:18
clinicalThe clip-and-drop method involves removing necrotic segment, stapling ends, and returning in 24-48 hours to check gut hemodynamics before committing to stoma or anastomosis↗
▶Ep 75 · 6:55
clinicalIn the SAT trial, mortality was similar in both groups (anastomosis vs stoma)↗
▶Ep 75 · 6:56
clinicalBabies who received primary anastomosis got off parenteral nutrition significantly sooner than those with stoma↗
▶Ep 75 · 7:06
clinicalBabies with primary anastomosis were able to return to enteral feeds more quickly and had fewer intestinal complications than those with stoma↗
▶Ep 75 · 7:52
clinicalMucous fistula refeeding involves recycling upper stoma output into the lower bowel to keep it healthy↗
▶Ep 75 · 7:59
opinionMucous fistula refeeding is a practice many clinicians support, although formal evidence is still catching up↗
▶Ep 75 · 8:33
clinicalHistorically, surgeons waited months for stoma closure, but the tide is turning toward earlier intervention, sometimes when the patient is less than 8 weeks old↗
clinicalAPSA created a peer support program for pediatric surgeons in 2020↗
▶Ep 25 · 1:12
clinicalThe program's goal was to support surgeons after traumatic events↗
▶Ep 25 · 1:16
epidemiologicalThe most common referral reasons were toxic work environments and adverse events↗
▶Ep 25 · 1:20
epidemiological50 surgeons total agreed to receive training on how to be a supporter↗
▶Ep 25 · 1:25
epidemiologicalOver 80% of trained supporters were able to use peer support skills informally with colleagues, partners, and trainees↗
▶Ep 25 · 1:31
quoteThe peer support program shows that this type of support system can work really well to help surgeons heal from traumatic experiences and toxic work environments.↗
The fetal frontier: A review of current and emerging fetal therapies for genetic diseases
▶Ep 27 · 0:00
quoteWhat if we could treat genetic diseases before a baby is even born?↗
▶Ep 27 · 0:14
clinicalFaster prenatal diagnosis enables detection of many genetic conditions early↗
▶Ep 27 · 0:18
clinicalEnzyme replacement therapy can be delivered directly to the fetus↗
▶Ep 27 · 0:18
clinicalMedications can be given to the mother that cross the placenta↗
▶Ep 27 · 0:24
clinicalProtein therapy can be delivered to the fetus↗
clinicalThe fetus has a more permissive blood-brain barrier compared to postnatal life↗
▶Ep 27 · 0:27
quoteThe fetus actually has some advantages for treatment, a more tolerant immune system and a more permissive blood-brain barrier.↗
▶Ep 27 · 0:27
clinicalThe fetus has a more tolerant immune system compared to postnatal life↗
▶Ep 27 · 0:34
clinicalMost fetal therapies for genetic diseases are still experimental↗
▶Ep 27 · 0:38
quoteIntervene during fetal development to prevent lifelong disease.↗
▶Ep 27 · 0:38
clinicalFetal intervention aims to prevent lifelong disease by treating during fetal development↗
Utility of Fluorescence In Situ Hybridization as a Fetal Surgery Eligibility Criterion for....
▶Ep 28 · 0:00
quoteWhat if invasive genetic testing before fetal surgery might not actually change your decision?↗
▶Ep 28 · 0:09
clinicalMany centers require genetic testing to rule out chromosome abnormalities before fetal surgery, even when ultrasounds and blood tests already look reassuring↗
▶Ep 28 · 0:20
quoteAre we adding risk without adding information?↗
▶Ep 28 · 0:23
clinicalWhen imaging and cell-free DNA screening showed low risk for aneuploidy, the FISH test matched those results 100% of the time↗
▶Ep 28 · 0:23
epidemiologicalA study reviewed nearly 1000 pregnancies evaluated for fetal surgery↗
▶Ep 28 · 0:36
quoteIn other words, for low-risk pregnancies, fish didn't provide any new information that changed surgery candidacy.↗
▶Ep 28 · 0:36
clinicalFor low-risk pregnancies, FISH did not provide any new information that changed surgery candidacy↗
▶Ep 28 · 0:42
opinionIn carefully selected low-risk cases, non-invasive screening may be enough, potentially avoiding the FISH procedure↗
The Use of Laryngeal Mask Airway Versus Endotracheal Intubation in Pediatric Laparoscopic Inguinal Hernia Repair: A Randomized Controlled Trial
▶Ep 18 · 0:01
quoteWhen kids need laparoscopic surgery, do they really need a breathing tube, or could a less invasive airway work just as well?↗
▶Ep 18 · 0:11
clinicalIn laparoscopic surgery, the traditional airway approach is using endotracheal intubation↗
▶Ep 18 · 0:21
clinicalA randomized trial studied 50 kids having laparoscopic hernia repair comparing LMA to endotracheal intubation↗
▶Ep 18 · 0:26
clinicalThere was no difference in oxygen saturation between LMA and endotracheal intubation groups↗
▶Ep 18 · 0:26
clinicalThere was no difference in tidal carbon dioxide levels between LMA and endotracheal intubation groups↗
▶Ep 18 · 0:33
clinicalThere was only one desaturation event in the endotracheal intubation group↗
▶Ep 18 · 0:33
clinicalThere was only one desaturation event in the LMA group↗
▶Ep 18 · 0:37
quoteThe takeaway is that for certain laparoscopic surgeries in children, an LMA might be just as safe as a traditional endotracheal tube.↗
▶Ep 18 · 0:37
opinionFor certain laparoscopic surgeries in children, an LMA might be just as safe as a traditional endotracheal tube↗
Effect of a Pediatric Surgeon's Primarily Performed Technique on Inguinal Hernia Recurrence Rates: A Multicenter Retrospective Cohort Study
▶Ep 19 · 0:00
quoteDoes a surgeon's preferred technique actually affect hernia outcome? This study suggests that yes, it can.↗
▶Ep 19 · 0:09
epidemiologicalThe study examined pediatric inguinal hernia repairs across 21 children's hospitals↗
▶Ep 19 · 0:15
clinicalWhen surgeons who mostly do open repairs performed a laparoscopic repair, the hernia recurrence rate was 3.6%↗
▶Ep 19 · 0:15
quoteWhen surgeons who mostly do open repairs performed a laparoscopic repair, the hernia came back more often, 3.6% compared to 1.7% when laparoscopy was done by surgeons who use that approach.↗
▶Ep 19 · 0:15
clinicalWhen laparoscopy was done by surgeons who primarily use that approach, the recurrence rate was 1.7%↗
▶Ep 19 · 0:27
clinicalSurgeons who primarily do laparoscopic repairs had similar low recurrence rates whether they operated laparoscopically or open↗
▶Ep 19 · 0:35
quoteThis means that surgeons tend to get the best results with the technique they use most often.↗
▶Ep 19 · 0:35
opinionSurgeons tend to get the best results with the technique they use most often↗
▶Ep 19 · 0:39
opinionIf surgeons split their practice between open and laparoscopic hernia repairs, it's important to maintain strong skills in both so that outcomes can stay consistent↗
A Retrospective Nationwide Comparison of Laparoscopic vs Open Inguinal Hernia Repair in Children
▶Ep 20 · 0:00
quoteOpen or laparoscopic hernia repair, which is better for kids?↗
▶Ep 20 · 0:06
epidemiologicalThe study examined over 53,000 children who had inguinal hernia repair across the United States↗
▶Ep 20 · 0:13
epidemiologicalApproximately 16% of the children had laparoscopic surgery↗
clinicalFish oil-based parenteral nutrition was introduced in 2007↗
▶Ep 26 · 0:31
clinicalIntestinal failure associated liver disease was a factor that affected survival↗
▶Ep 26 · 0:31
clinicalIntroduction of fish oil-based parenteral nutrition improved survival↗
Advancements in Pediatric Intestinal Failure: Innovative Therapies and Improved Outcomes
▶Ep 28 · 1:24
clinicalChronic intestinal inflammation resembling Crohn's disease is now seen in intestinal failure patients, requiring management with inflammatory bowel disease therapies like biologics↗
▶Ep 28 · 3:19
epidemiologicalA 2012 Pediatric Intestinal Failure Consortium report showed 50% of intestinal failure patients achieved enteral autonomy, and 25% either passed away or had an intestinal transplant↗
▶Ep 28 · 3:51
epidemiologicalStudies from Canada, Michigan, and Spain show that a multidisciplinary intestinal rehab team improves survival↗
▶Ep 28 · 14:19
clinicalPatients with Type 3 short bowel syndrome have the best prognosis because they still have residual ileum↗
Impact of social determinants of health on outcomes in pediatric short bowel syndrome...
▶Ep 29 · 0:00
quoteCan a child's zip code actually change their short bowel syndrome outcomes?↗
▶Ep 29 · 0:07
epidemiologicalThis was a retrospective cohort study of children with short bowel syndrome in an intestinal rehabilitation program, followed from 2006 to 2019.↗
▶Ep 29 · 0:16
epidemiologicalThe study asked whether social determinants of health predict outcomes like bloodstream infections, liver disease, and achieving enteral autonomy.↗
▶Ep 29 · 0:24
epidemiologicalSocial determinants of health do predict outcomes in pediatric short bowel syndrome.↗
▶Ep 29 · 0:27
epidemiologicalDistance from the hospital was associated with higher risks of serious complications in children with short bowel syndrome.↗
clinicalFish oil-based parenteral nutrition was introduced in 2007↗
▶Ep 93 · 0:31
clinicalIntroduction of fish oil-based parenteral nutrition improved survival↗
▶Ep 93 · 0:31
clinicalIntestinal failure associated liver disease was a factor that affected survival↗
STAT trial: stoma or intestinal anastomosis for necrotizing enterocolitis: a multicentre randomized controlled trial
▶Ep 96 · 0:00
quoteWhat's the best surgical approach for infants needing laparotomy, for necrotizing enterocolitis, anastomosis, or stoma formation?↗
▶Ep 96 · 0:13
clinicalThe trial looked at newborns who underwent laparotomy for necrotizing enterocolitis requiring intestinal resection from 2010 to 2020.↗
▶Ep 96 · 0:13
clinicalThe STAT trial was a randomized controlled trial in 12 centers worldwide.↗
▶Ep 96 · 0:26
clinicalPatients were randomized to two surgical approaches: either anastomosis or stoma formation.↗
▶Ep 96 · 0:31
clinicalThere was no difference in mortality between primary anastomosis and stoma formation groups.↗
▶Ep 96 · 0:31
clinicalInfants undergoing primary anastomosis had a significantly less duration of requiring parenteral nutrition compared to those with stoma formation.↗
▶Ep 96 · 0:31
clinicalThere was no difference in unplanned surgeries between primary anastomosis and stoma formation groups.↗
▶Ep 96 · 0:43
opinionPrimary anastomosis is superior for enhancing recovery from necrotizing enterocolitis in infants and does not increase adverse outcomes.↗
Educational Outcomes in School-Aged Children With a History of Simple and Complex Gastroschisis are Poor Compared to Controls
▶Ep 97 · 0:00
quoteDo children born with gastroschisis perform worse in school compared to age-matched peers without the condition?↗
▶Ep 97 · 0:11
clinicalThis is a retrospective study using educational data from children born between 1991 and 2022↗
▶Ep 97 · 0:18
clinicalThe study compared 208 children with gastroschisis and over 2000 age-matched controls↗
▶Ep 97 · 0:18
clinicalResearchers used odds ratio and subgroup analysis to compare school performance using the Early Development Instrument or EDI and grade level assessments↗
▶Ep 97 · 0:33
clinicalChildren with gastroschisis, even those with the simpler form, were significantly more likely to fail middle school assessments↗
▶Ep 97 · 0:33
quoteThey found that children with gastroschisis, even those with the simpler form, were significantly more likely to fail middle school assessments.↗
▶Ep 97 · 0:41
opinionChildren with gastroschisis may face long-term learning challenges and could benefit from early educational support↗
Quick Literature Updates Ep 22
▶Ep 99 · 1:03
clinicalThe Hirschsprung study was prospective and took place 2021 to 2023, including 33 patients under six months old who underwent endorectal pull-through surgeries↗
▶Ep 99 · 1:20
clinicalPrimary outcomes examined were anastomotic complications, enterocolitis, and constipation↗
▶Ep 99 · 1:27
clinicalThe non-dilation group had less enterocolitis and less constipation compared to traditional dilation group↗
▶Ep 99 · 1:27
clinicalThere was no significant difference in anastomotic complications between dilation and non-dilation groups↗
▶Ep 99 · 1:36
quoteThis means that choosing not to do postoperative anal dilations may be a good alternative with benefits like lower constipation and enterocolitis.↗
▶Ep 99 · 1:36
opinionChoosing not to do postoperative anal dilations may be a good alternative with benefits like lower constipation and enterocolitis↗
Quick Literature Updates Ep 27
▶Ep 100 · 1:04
clinicalThe Van Haal et al. study included 79 patients who had rigid tracheobronchoscopy done before and after esophageal atresia surgery↗
▶Ep 100 · 1:24
clinicalPre-operative tracheobronchoscopy for the presence of post-operative tracheomalacia had a sensitivity of 50% and a specificity of 67%↗
▶Ep 100 · 1:34
clinicalPre-operative tracheobronchoscopy has limited predictive value for post-operative tracheomalacia despite being routine↗
▶Ep 100 · 1:34
quoteThis shows that pre-op TBS, though routine, has limited predictive value for post-op tracheomalacia.↗
Availability, utilization, and barriers to bowel ultrasound for necrotizing enterocolitis...
▶Ep 106 · 0:00
quoteDo you routinely use bowel ultrasound to diagnose necrotizing enterocolitis?↗
▶Ep 106 · 0:08
clinicalBowel ultrasound is becoming an important tool for diagnosing necrotizing enterocolitis↗
▶Ep 106 · 0:19
epidemiologicalA national survey included more than 100 neonatologists, surgeons, and radiologists from 42 children's hospitals↗
▶Ep 106 · 0:26
quoteWhile bowel ultrasound was available in 83% of level 4 NICUs, clinicians reported using it inconsistently, most often only when X-rays. Were inconclusive.↗
▶Ep 106 · 0:26
epidemiologicalBowel ultrasound was available in 83% of level 4 NICUs↗
▶Ep 106 · 0:26
clinicalClinicians reported using bowel ultrasound inconsistently, most often only when X-rays were inconclusive↗
▶Ep 106 · 0:36
quoteThe biggest barriers weren't the technology itself, they were the lack of standardized protocols, limited provider training, and uncertainty about how bowel ultrasound should guide treatment decisions.↗
▶Ep 106 · 0:36
clinicalThe biggest barriers to bowel ultrasound adoption were lack of standardized protocols, limited provider training, and uncertainty about how bowel ultrasound should guide treatment decisions↗
▶Ep 106 · 0:46
opinionWider adoption of bowel ultrasound for NEC will depend on better evidence, standardized guidelines, and improved clinician training↗
Update Course Rewind 2025: Updates in NEC Management
▶Ep 107 · 2:06
clinicalFor every 10 babies with surgical NEC, an X-ray might only catch one or two in the early stages↗
▶Ep 107 · 2:15
clinicalA 2023 study in Pediatric Radiology suggests ultrasound can detect bowel wall thinning, perfusion abnormalities, and fluid collections that X-ray misses↗
▶Ep 107 · 5:00
clinicalIn the long run there is a benefit to primary anastomosis, though you might not see the benefit with immediate survival↗
▶Ep 107 · 5:18
clinicalThe clip-and-drop method involves removing necrotic segment, stapling ends, and returning in 24-48 hours to check gut hemodynamics before committing to stoma or anastomosis↗
▶Ep 107 · 6:55
clinicalIn the SAT trial, mortality was similar in both groups (anastomosis vs stoma)↗
▶Ep 107 · 6:56
clinicalBabies who received primary anastomosis got off parenteral nutrition significantly sooner than those with stoma↗
▶Ep 107 · 7:06
clinicalBabies with primary anastomosis were able to return to enteral feeds more quickly and had fewer intestinal complications than those with stoma↗
▶Ep 107 · 7:52
clinicalMucous fistula refeeding involves recycling upper stoma output into the lower bowel to keep it healthy↗
▶Ep 107 · 7:59
opinionMucous fistula refeeding is a practice many clinicians support, although formal evidence is still catching up↗
▶Ep 107 · 8:33
clinicalHistorically, surgeons waited months for stoma closure, but the tide is turning toward earlier intervention, sometimes when the patient is less than 8 weeks old↗
Advancements in Pediatric Intestinal Failure: Innovative Therapies and Improved Outcomes
▶Ep 108 · 1:24
clinicalChronic intestinal inflammation resembling Crohn's disease is now seen in intestinal failure patients, requiring management with inflammatory bowel disease therapies like biologics↗
▶Ep 108 · 3:19
epidemiologicalA 2012 Pediatric Intestinal Failure Consortium report showed 50% of intestinal failure patients achieved enteral autonomy, and 25% either passed away or had an intestinal transplant↗
▶Ep 108 · 3:51
epidemiologicalStudies from Canada, Michigan, and Spain show that a multidisciplinary intestinal rehab team improves survival↗
▶Ep 108 · 14:19
clinicalPatients with Type 3 short bowel syndrome have the best prognosis because they still have residual ileum↗
Impact of social determinants of health on outcomes in pediatric short bowel syndrome...
▶Ep 109 · 0:00
quoteCan a child's zip code actually change their short bowel syndrome outcomes?↗
▶Ep 109 · 0:07
epidemiologicalThis was a retrospective cohort study of children with short bowel syndrome in an intestinal rehabilitation program, followed from 2006 to 2019.↗
▶Ep 109 · 0:16
epidemiologicalThe study asked whether social determinants of health predict outcomes like bloodstream infections, liver disease, and achieving enteral autonomy.↗
▶Ep 109 · 0:24
epidemiologicalSocial determinants of health do predict outcomes in pediatric short bowel syndrome.↗
clinicalAPSA created a peer support program for pediatric surgeons in 2020↗
▶Ep 21 · 1:12
clinicalThe program's goal was to support surgeons after traumatic events↗
▶Ep 21 · 1:16
epidemiologicalThe most common referral reasons were toxic work environments and adverse events↗
▶Ep 21 · 1:20
epidemiological50 surgeons total agreed to receive training on how to be a supporter↗
▶Ep 21 · 1:25
epidemiologicalOver 80% of trained supporters were able to use peer support skills informally with colleagues, partners, and trainees↗
▶Ep 21 · 1:31
quoteThe peer support program shows that this type of support system can work really well to help surgeons heal from traumatic experiences and toxic work environments.↗
Pectus Bar Dislocation: Comparison Between Three Different Stabilization Techniques Adopted in a Single Centre
▶Ep 45 · 0:13
epidemiologicalThe study was an observational perspective study conducted in Italy from 2013 to 2022.↗
▶Ep 45 · 0:13
epidemiologicalThe study included 468 patients around 15 years old.↗
▶Ep 45 · 0:23
epidemiologicalSurgeons placed 733 bars total across the patient cohort.↗
▶Ep 45 · 0:31
clinicalBar dislocation is defined as when a bar rotates more than 30 degrees out of place.↗
▶Ep 45 · 0:31
quoteDislocation is when a bar rotates more than 30 degrees out of place.↗
▶Ep 45 · 0:43
clinicalNone of the patients with bridge fixation had dislocated bars.↗
▶Ep 45 · 0:43
quoteNone of the patients with bridge fixation had dislocated bars compared to those who underwent the single bar technique.↗
Update Course Rewind: Cryoanalgesia in Pectus Cases 2024
▶Ep 46 · 0:57
clinicalCryoanalgesia is a minimally invasive procedure to repair pectus excavatum or alleviate pain during surgery on the chest wall that temporarily blocks nerve conduction along peripheral nerve pathways by freezing the affected nerve↗
▶Ep 46 · 1:30
clinicalThe freeze point is in the posterior axillary line, 4 centimeters from the vertebral column↗
▶Ep 46 · 1:36
clinicalWith the original cryoprobe, it's a 2-minute freeze cycle↗
▶Ep 46 · 2:02
clinicalSubpleural injection with 0.25% marcaine with epinephrine works immediately, as opposed to the 8 to 10 hour delay with the cryo nerve block↗
▶Ep 46 · 2:13
clinicalSubpleural injection takes only 15 seconds per interspace↗
▶Ep 46 · 2:26
epidemiological50% of the update course audience has never used cryoanalgesia↗
▶Ep 46 · 2:33
epidemiologicalAbout 40% of the update course responders answered that cost is the main reason they don't use cryoanalgesia↗
▶Ep 46 · 2:55
clinicalDoing T3 to T8 bilaterally with the new probe saves almost 30 minutes↗
▶Ep 46 · 3:10
clinicalThe new probe shaft only reaches room temperature so it can touch the lung↗
▶Ep 46 · 3:48
clinicalThe Chicago study did not measure pain scores or compare the 1 minute freeze cycle directly to 2-minute freeze cycles↗
▶Ep 46 · 4:13
clinicalThere is a risk of pneumothorax from the lung tearing after inadvertent adhesion to the cryoprobe↗
▶Ep 46 · 4:19
clinicalThe double lumen endotracheal tube helps minimize pneumothorax risk by deflating the lung and maximizing working space so that the cryoprobe does not touch the lung↗
▶Ep 46 · 4:39
clinicalA major advantage of the double lumen tube over the single lumen tube is that it helps prevent the nerve block from being done too far anteriorly, which will make the nerve block ineffective↗
▶Ep 46 · 5:13
clinicalDoctor Sung Kim did a cadaver study at UCSF showing that 18% of the lateral cutaneous branch nerves are posterior to the mid axillary line↗
▶Ep 46 · 6:17
clinicalDoctor Defiori has done the dual freeze point technique in 20 patients anecdotally↗
▶Ep 46 · 6:32
clinicalIn the UCSF study with 2 freeze points per interspace on 22 patients, the length of stay decreased from 2 days to 1 day↗
▶Ep 46 · 6:42
clinical9 out of the 22 patients in the UCSF dual freeze point study reported pain scores of 0↗
▶Ep 46 · 7:00
clinicalCryoanalgesia controls pain and decreases hospital length stay with few short-term complications↗
Six Years of Quality Improvement in Pectus Excavatum Repair: Implementation of Intercostal Nerve Cryoablation and ERAS Protocols for Patients Undergoing Nuss Procedure
▶Ep 47 · 0:00
quoteHow do intercostal nerve cryoablation and enhanced recovery after surgery, also known as ARIS protocols, affect pain management, opioid use, length of stay, and recovery in pectus excavatum patients undergoing the NES procedure?↗
▶Ep 47 · 0:19
epidemiologicalThe study was a retrospective cohort study that looked at 62 patients from 2017 to 2023↗
▶Ep 47 · 0:25
clinicalIntercostal nerve cryoablation slightly increased early postoperative pain in pectus excavatum patients undergoing the Nuss procedure↗
▶Ep 47 · 0:25
clinicalIntercostal nerve cryoablation significantly reduced hospital stays in pectus excavatum patients undergoing the Nuss procedure↗
▶Ep 47 · 0:25
clinicalIntercostal nerve cryoablation significantly reduced opioid use in pectus excavatum patients undergoing the Nuss procedure↗
▶Ep 47 · 0:25
clinicalIntercostal nerve cryoablation slightly increased surgery time in pectus excavatum patients undergoing the Nuss procedure↗
▶Ep 47 · 0:36
clinicalAdding ERAS protocols to cryoablation further reduced early pain scores in pectus excavatum patients undergoing the Nuss procedure↗
▶Ep 47 · 0:36
clinicalAdding ERAS protocols to cryoablation further reduced opioid needs in pectus excavatum patients undergoing the Nuss procedure↗
▶Ep 47 · 0:40
opinionCombining cryoablation and ERAS protocols leads to better outcomes and pain management in pectus excavatum patients undergoing the Nuss procedure↗
▶Ep 47 · 0:40
quoteThese findings suggest that combining cryoablation and ARR protocols leads to better outcomes and pain management.↗
Cardiopulmonary Impact of the Minimally Invasive Repair of Pectus Excavatum in Pediatric Patients: A Prospective Pilot Study
▶Ep 49 · 0:00
quoteDoes minimally invasive repair of pectus excavatum improve heart and lung function during exercise in pediatric patients?↗
clinicalStudy included patients under 18 who had cardiopulmonary exercise testing before minimally invasive repair of pectus excavatum and then after removal of their pectus bar↗
▶Ep 49 · 0:24
clinicalO2 pulse is a measure of how much oxygen the heart pumps per beat↗
▶Ep 49 · 0:24
clinicalImproved O2 pulse suggests better heart function after the repair↗
clinicalResults showed a significant improvement in O2 pulse after the repair↗
▶Ep 49 · 0:37
opinionThe improvement may reflect relief of cardiac compression that was present preoperatively due to pectus excavatum↗
▶Ep 49 · 0:43
quoteThe main takeaway is that minimally invasive repair of pectus excavatum does appear to improve heart performance during exercise.↗
▶Ep 49 · 0:43
clinicalMinimally invasive repair of pectus excavatum does appear to improve heart performance during exercise↗
Update Course Rewind: Part 1 Non-Pectus Uses of Cryoanalgesia 2024
▶Ep 52 · 0:25
quoteThis year we introduced a new approach to classify practice changing ideas at our update course.↗
▶Ep 52 · 0:30
quotePresentations now fall into three categories green circles for established practices, blue squares for promising newer practices, and black diamonds for early adopter practices only.↗
▶Ep 52 · 1:02
clinicalCryoanalgesia temporarily blocks nerve conduction along peripheral nerve pathways by freezing the affected nerve↗
▶Ep 52 · 1:25
clinicalWhen fibrous outer neural structures remain intact, axons can regenerate in 4 to 6 weeks↗
▶Ep 52 · 1:39
epidemiologicalVery few people do intercostal nerve cryoablation for pain control during thoracotomy, based on poll results from combined live and virtual audience↗
▶Ep 52 · 1:57
clinicalCryoanalgesia can help with pain control all through the recovery period↗
▶Ep 52 · 1:57
clinicalEpidurals usually only give pain relief for a few days↗
▶Ep 52 · 2:23
clinicalAt T10 level or lower, you can start to get pseudohernias on the abdominal wall from affecting the motor branches↗
▶Ep 52 · 2:44
clinicalA cardiac probe is used for ablations in smaller children↗
▶Ep 52 · 2:58
clinicalThe newest probe has shaft insulation that only gets to room temperature, eliminating skin freeze risk because only the probe tip gets cold↗
▶Ep 52 · 3:21
clinicalKids were sent home without any narcotic prescriptions↗
▶Ep 52 · 3:24
clinicalYou don't have to wait for a regional team when using cryoanalgesia↗
▶Ep 52 · 3:40
epidemiologicalThe cryoablation group used dramatically fewer oral morphine equivalents during hospital stay compared to the regional nerve block group↗
Update Course Rewind: Part 2 Non-Pectus Uses of Cryoanalgesia 2024
▶Ep 53 · 0:56
clinicalCryoablation is not limited to just thoracotomy or thoracoscopy↗
▶Ep 53 · 1:00
clinicalThere are novel ways to use cryotherapy in a percutaneous approach↗
▶Ep 53 · 1:21
clinicalSlipping rib syndrome is a condition with cartilaginous union at the end of the ribs, for floating ribs in particular, but also for false ribs↗
▶Ep 53 · 1:58
epidemiologicalSlipping rib syndrome is more common in teenage girls than boys↗
▶Ep 53 · 2:01
clinicalPatients with slipping rib syndrome really won't have a visceral type tenderness↗
▶Ep 53 · 2:01
clinicalPatients with slipping rib syndrome often present with somatic tenderness of the abdominal wall that can be elicited by asking them to flex or crunch their abdominal muscles↗
▶Ep 53 · 2:25
clinicalIf patients get pain relief from the intercostal block with ropivacaine and dexamethasone, the next step is to refer them to interventional radiology for ultrasound guided cryotherapy↗
▶Ep 53 · 3:13
clinicalOutcomes from using cryoablation for slipping rib syndrome included shorter length of stay in the hospital↗
▶Ep 53 · 3:13
clinicalOutcomes from using cryoablation for slipping rib syndrome included reduced pain scores↗
▶Ep 53 · 3:13
clinicalOutcomes from using cryoablation for slipping rib syndrome included reduced narcotic use↗
▶Ep 53 · 3:19
clinicalPatients were able to resume normal activities much earlier after cryoablation for slipping rib syndrome↗
Quick Literature Updates Ep 24
▶Ep 54 · 1:03
epidemiologicalStudy conducted in Italy from 2013 to 2022 on 468 patients around 15 years old with pectus excavatum↗
▶Ep 54 · 1:13
epidemiologicalSurgeons placed 733 bars total across the patient cohort↗
▶Ep 54 · 1:21
clinicalBar dislocation is defined as rotation more than 30 degrees out of place↗
▶Ep 54 · 1:28
quoteBridge fixation was significantly more stable than single bar fixation.↗
▶Ep 54 · 1:28
clinicalBridge fixation was significantly more stable than single bar fixation↗
▶Ep 54 · 1:33
clinicalNone of the patients with bridge fixation had dislocated bars compared to those who underwent the single bar technique↗
▶Ep 54 · 1:33
quoteNone of the patients with bridge fixation had dislocated bars compared to those who underwent the single bar technique.↗
▶Ep 54 · 1:39
clinicalBridge fixation is the best technique for preventing bar dislocation in pectus excavatum patients↗
Practice Patterns and Outcomes of Hemodialysis in Infants Undergoing Congenital Heart Surgery in th
▶Ep 9 · 0:00
quoteDoes it matter where a baby receives care after heart surgery?↗
▶Ep 9 · 0:07
epidemiological1% of infants can develop severe acute kidney injury and require dialysis after congenital heart surgery↗
▶Ep 9 · 0:14
epidemiologicalFor infants that needed hemodialysis after congenital heart surgery, one-year survival was 46%↗
▶Ep 9 · 0:14
epidemiologicalFor infants that did not need hemodialysis after congenital heart surgery, one-year survival was 94%↗
▶Ep 9 · 0:23
clinicalMost infants requiring dialysis after congenital heart surgery received continuous renal replacement therapy rather than intermittent dialysis↗
epidemiologicalHospitals that use dialysis more frequently had double the 1-year survival rate for infants after congenital heart surgery↗
▶Ep 9 · 0:33
epidemiologicalHospitals that use dialysis more frequently had 3 times higher hospital survival for infants after congenital heart surgery↗
▶Ep 9 · 0:39
epidemiologicalDialysis after infant heart surgery is rare↗
▶Ep 9 · 0:44
opinionOutcomes may improve when infants requiring dialysis after heart surgery are treated at a center with more experience in using dialysis↗
Practice Patterns and Outcomes of Hemodialysis in Infants Undergoing Congenital Heart Surgery in the
▶Ep 10 · 0:00
quoteDoes it matter where a baby receives care after heart surgery?↗
▶Ep 10 · 0:07
epidemiological1% of infants can develop severe acute kidney injury and require dialysis after congenital heart surgery↗
▶Ep 10 · 0:14
clinicalFor infants needing hemodialysis after congenital heart surgery, one-year survival was 46%↗
▶Ep 10 · 0:14
clinicalFor infants not needing hemodialysis after congenital heart surgery, one-year survival was 94%↗
▶Ep 10 · 0:23
clinicalMost infants requiring dialysis after congenital heart surgery received continuous renal replacement therapy rather than intermittent dialysis↗
clinicalHospitals that use dialysis more frequently had 3 times higher hospital survival for infants after congenital heart surgery↗
▶Ep 10 · 0:33
clinicalHospitals that use dialysis more frequently had double the 1-year survival rate for infants after congenital heart surgery↗
▶Ep 10 · 0:39
epidemiologicalDialysis after infant heart surgery is rare↗
▶Ep 10 · 0:44
opinionOutcomes may improve when infants requiring dialysis after heart surgery are treated at a center with more experience in using dialysis↗
Practice Patterns and Outcomes of Hemodialysis in Infants Undergoing Congenital Heart Surgery in the
▶Ep 11 · 0:00
quoteDoes it matter where a baby receives care after heart surgery?↗
▶Ep 11 · 0:07
epidemiological1% of infants can develop severe acute kidney injury and require dialysis after congenital heart surgery↗
▶Ep 11 · 0:14
clinicalFor infants not needing hemodialysis after congenital heart surgery, one-year survival was 94%↗
▶Ep 11 · 0:14
clinicalFor infants needing hemodialysis after congenital heart surgery, one-year survival was 46%↗
▶Ep 11 · 0:23
clinicalMost infants requiring dialysis after congenital heart surgery received continuous renal replacement therapy rather than intermittent dialysis↗
clinicalHospitals that use dialysis more frequently had double the 1-year survival rate for infants after congenital heart surgery↗
▶Ep 11 · 0:33
clinicalHospitals that use dialysis more frequently had 3 times higher hospital survival for infants after congenital heart surgery↗
▶Ep 11 · 0:39
epidemiologicalDialysis after infant heart surgery is rare↗
▶Ep 11 · 0:44
opinionOutcomes may improve when infants requiring dialysis after heart surgery are treated at a center with more experience in using dialysis↗
Practice Patterns and Outcomes of Hemodialysis in Infants Undergoing Congenital Heart Surgery...
▶Ep 12 · 0:00
quoteDoes it matter where a baby receives care after heart surgery?↗
▶Ep 12 · 0:07
epidemiological1% of infants develop severe acute kidney injury requiring dialysis after congenital heart surgery↗
▶Ep 12 · 0:14
epidemiologicalOne-year survival for infants requiring hemodialysis after congenital heart surgery is 46%↗
▶Ep 12 · 0:14
epidemiologicalOne-year survival for infants not requiring hemodialysis after congenital heart surgery is 94%↗
▶Ep 12 · 0:23
clinicalMost infants requiring dialysis after congenital heart surgery received continuous renal replacement therapy rather than intermittent dialysis↗
clinicalIntroduction of fish oil-based parenteral nutrition improved survival↗
▶Ep 8 · 0:31
clinicalFish oil-based parenteral nutrition was introduced in 2007↗
▶Ep 8 · 0:31
clinicalIntestinal failure associated liver disease was a factor that affected survival↗
Impact of social determinants of health on outcomes in pediatric short bowel syndrome...
▶Ep 10 · 0:00
quoteCan a child's zip code actually change their short bowel syndrome outcomes?↗
▶Ep 10 · 0:07
epidemiologicalThis was a retrospective cohort study of children with short bowel syndrome in an intestinal rehabilitation program, followed from 2006 to 2019.↗
▶Ep 10 · 0:16
epidemiologicalThe study asked whether social determinants of health predict outcomes like bloodstream infections, liver disease, and achieving enteral autonomy.↗
▶Ep 10 · 0:24
epidemiologicalSocial determinants of health do predict outcomes in pediatric short bowel syndrome.↗
▶Ep 10 · 0:27
epidemiologicalDistance from the hospital was associated with higher risks of serious complications in children with short bowel syndrome.↗
Outcomes of Fontan Patients Undergoing Combined Heart - Liver Transplantation in Pediatric Hospitals Across the U.S.
▶Ep 35 · 0:00
quoteWhat happens when kids who underwent Fontan procedure don't just need a new heart, but a new liver as well.↗
▶Ep 35 · 0:11
epidemiologicalLiver disease is becoming a rising issue in Fontan patients↗
▶Ep 35 · 0:11
epidemiologicalMore Fontan patients are surviving into adolescence and adulthood↗
▶Ep 35 · 0:11
epidemiologicalCombined heart-liver transplantation is happening more often in Fontan patients↗
▶Ep 35 · 0:21
clinicalThe study examined children and young adults undergoing combined heart-liver transplant at hospitals across the US in the last few years↗
▶Ep 35 · 0:28
clinicalMany of the patients in the study had hypoplastic left heart syndrome↗
▶Ep 35 · 0:36
clinicalAbout 85% of patients survived at 1 year after combined heart-liver transplant↗
▶Ep 35 · 0:36
clinicalLong-term outcomes after combined heart-liver transplant were excellent↗
▶Ep 35 · 0:41
clinicalThree-year survival after combined heart-liver transplant was basically identical to patients who received heart transplant alone↗
▶Ep 35 · 0:48
epidemiologicalCombined heart-liver transplant is increasingly common for Fontan patients with advanced liver disease↗
▶Ep 35 · 0:48
quoteThe big takeaway, combined heart liver transplant is effective and increasingly common for Fontan patients with advanced liver disease.↗
▶Ep 35 · 0:48
clinicalCombined heart-liver transplant is effective for Fontan patients with advanced liver disease↗
Surgical and Catheter-Based Intervention in Pediatric Pulmonary Vein Stenosis
▶Ep 37 · 0:00
quoteCan you ever truly fix pulmonary vein stenosis?↗
▶Ep 37 · 0:06
clinicalPulmonary vein stenosis is a rare but serious condition where the veins from the lungs to the heart become narrowed↗
▶Ep 37 · 0:12
epidemiologicalA study from Cincinnati Children's examined 56 children comparing surgery versus catheter-based interventions for pulmonary vein stenosis↗
▶Ep 37 · 0:23
clinicalOver time, catheter-based treatments became the preferred first option for pulmonary vein stenosis↗
▶Ep 37 · 0:28
clinicalSurgery was reserved for complex cases involving multiple severely affected veins or other heart defects↗
▶Ep 37 · 0:34
epidemiological92% of children with pulmonary vein stenosis needed another intervention after initial treatment↗
▶Ep 37 · 0:34
epidemiologicalMost reinterventions for pulmonary vein stenosis occurred within the first year after initial treatment↗
▶Ep 37 · 0:34
clinicalRecurrence of pulmonary vein stenosis remained common regardless of the initial intervention type↗
▶Ep 37 · 0:45
quoteSo pulmonary vein stenosis isn't a one-time fix.↗
▶Ep 37 · 0:48
clinicalPulmonary vein stenosis requires ongoing surveillance, repeated interventions, and a long-term multidisciplinary approach↗
clinicalK-wire drill used to drill through remaining ribs instead of packaged screws↗
▶Ep 13 · 3:11
clinicalProline sutures used to secure the implant↗
▶Ep 13 · 3:29
clinicalPermacol is a porcine dermal collagen matrix surgical implant↗
▶Ep 13 · 4:12
clinicalFurther chest wall reconstruction excised entire sternum, costochondrocartilages, and anterior ribs, replaced with cement mesh↗
▶Ep 13 · 4:42
clinicalBoth seroma patients were treated with IR drainage↗
▶Ep 13 · 4:45
clinicalOne case of minor scoliosis on follow-up being followed by spinal team, has not needed intervention so far↗
▶Ep 13 · 5:17
opinionBioengineering of tissue replacement and 3D printing may be the way of the future in chest wall reconstructions↗
Appendectomy vs Right Hemicolectomy for Pediatric Neuroendocrine Tumor of the Appendix
▶Ep 14 · 0:00
quoteWhat if I told you kids with appendix tumors might not need the big surgery that doctors have been doing for decades?↗
▶Ep 14 · 0:06
clinicalThe speaker is affiliated with Cincinnati Children's Hospital↗
▶Ep 14 · 0:10
clinicalTraditionally, children with neuroendocrine appendix tumors have been treated the same way as adults with right hemicolectomy↗
▶Ep 14 · 0:10
quoteTraditionally, kids with neuroendocrine appendix tumors have been treated the same way as adults with a right hemicolectomy.↗
▶Ep 14 · 0:19
epidemiologicalA new national study examined over 1,300 children with neuroendocrine appendix tumors↗
▶Ep 14 · 0:24
quoteEven when the tumors were larger or had positive margins, survival rates were almost perfect, like 99%, whether they just had an appendectomy or the bigger colectomy surgery.↗
▶Ep 14 · 0:24
clinicalSurvival rates were approximately 99% whether patients had appendectomy or right hemicolectomy, even with larger tumors or positive margins↗
▶Ep 14 · 0:35
quoteSo the big takeaway, for kids, appendectomy alone is not only enough, it's safe, effective, and avoids putting them through a much bigger operation for no added benefit.↗
▶Ep 14 · 0:35
opinionFor pediatric patients, appendectomy alone is safe and effective for neuroendocrine tumors of the appendix↗
▶Ep 14 · 0:35
opinionAppendectomy avoids putting pediatric patients through a much bigger operation with no added survival benefit compared to right hemicolectomy↗
Update Course Rewind: Updates in Wilms Management 2024
▶Ep 15 · 0:00
quoteSurgery first or chemo first? Would you risk changing the order for Wilm's tumor patients if it could change the outcome?↗
▶Ep 15 · 1:54
clinicalLoss of heterozygosity is the loss of genetic diversity in tumor cells↗
▶Ep 15 · 1:58
clinicalIn Wilms tumor, loss of heterozygosity can indicate more aggressive disease↗
▶Ep 15 · 2:02
clinicalGain of 1Q refers to an extra copy of a section of chromosome 1, which is linked to worse outcomes in some cancers↗
▶Ep 15 · 3:15
guidelineAccording to Children's Oncology Group updates, adverse biologic factors are associated with worse prognosis in stage 2 patients↗
▶Ep 15 · 3:15
guidelineAdverse biologic factors are not associated with worse prognosis in stage 1 favorable histology Wilms tumor patients↗
▶Ep 15 · 3:37
guidelineThe North American Children's Oncology Group approach often involves immediate surgery↗
▶Ep 15 · 3:37
guidelineThe European Society of Pediatric Oncology approach typically starts with chemotherapy before surgery↗
▶Ep 15 · 3:49
clinicalGenetic markers like loss of heterozygosity at specific chromosomes can indicate a higher risk of cancer recurrence↗
▶Ep 15 · 3:49
clinicalGenetic markers guide decisions about adding chemotherapy treatments↗
Quick Literature Updates Ep 21
▶Ep 16 · 1:02
clinicalPediatric trauma patients are at high risk for developing venous thromboembolism↗
▶Ep 16 · 1:02
quotePediatric trauma patients are at high risk for developing blood clots, also known as VTE or venous thromboembolism.↗
▶Ep 16 · 1:09
epidemiologicalThe cohort study included patients younger than 18 years old from eight pediatric trauma centers between 2019 and 2022↗
▶Ep 16 · 1:18
epidemiologicalAmong 460 high-risk patients, more than half received chemical VTE prophylaxis↗
▶Ep 16 · 1:25
clinicalDelaying blood thinners beyond 24 hours of hospital arrival increases the risk of blood clots↗
▶Ep 16 · 1:32
clinicalVTE prophylaxis is safe and effective for pediatric trauma patients when started within 24 hours of admission↗
▶Ep 16 · 1:32
quoteThis study shows that VTE prophylaxis is safe and effective for pediatric trauma patients and needs to be started within 24 hours of admission to the hospital.↗
