I think anytime it's a Kansas City or an NWSPC, NWPSC. Anytime it's an NWPSC article, I pay attention. Anytime it's a Kansas City article, I pay attention. But other than that, I'm tired of seeing all these gastroschisis articles. I'm waiting for someone to give me something that is really meaningful.
I think anytime it's a Kansas City or an NWSPC, NWPSC. Anytime it's an NWPSC article, I pay attention. Anytime it's a Kansas City article, I pay attention. But other than that, I'm tired of seeing all these gastroschisis articles. I'm waiting for someone to give me something that is really meaningful.
I think anytime it's a Kansas City or an NWSPC, NWPSC. Anytime it's an NWPSC article, I pay attention. Anytime it's a Kansas City article, I pay attention. But other than that, I'm tired of seeing all these gastroschisis articles. I'm waiting for someone to give me something that is really meaningful.
I think anytime it's a Kansas City or an NWSPC, NWPSC. Anytime it's an NWPSC article, I pay attention. Anytime it's a Kansas City article, I pay attention. But other than that, I'm tired of seeing all these gastroschisis articles. I'm waiting for someone to give me something that is really meaningful.
I think anytime it's a Kansas City or an NWSPC, NWPSC. Anytime it's an NWPSC article, I pay attention. Anytime it's a Kansas City article, I pay attention. But other than that, I'm tired of seeing all these gastroschisis articles. I'm waiting for someone to give me something that is really meaningful.
I think it's clearly been a massive change in practice. It's one of the examples of a big change that we don't actually operate on those and they can be done at the bedside. And it also is an example of something that took a while to adopt. And now most people are doing it, I think.
Gastroschisis and sutureless abdominal wall closure
▶Ep 22 · 1:44
host_summaryIn 2004, Tony Sandler published the first manuscript about sutureless closures utilizing the natural umbilical properties to close the gastroschisis defect by itself.↗
▶Ep 22 · 1:44
quoteIn 2004, Tony Sandler published the first manuscript about suture disclosures to utilize the natural umbilical properties to closing that defect by itself.↗
▶Ep 22 · 2:45
quoteI didn't know about his article. I found out about it as a fellow when he taught us how to treat gastroschisis that way.↗
▶Ep 22 · 2:45
quoteI think it's clearly been a massive change in practice. It's one of the examples of a big change that we don't actually operate on those and they can be done at the bedside. And it also is an example of something that took a while to adopt. And now most people are doing it, I think.↗
▶Ep 22 · 3:26
quoteThere have been so many articles in the last few years that go back and forth. I mean, one said gastro suture list is better. One said definitely don't do suture list. So my question is now, I don't know. I almost don't read these articles anymore.↗
▶Ep 22 · 5:29
quoteI think anytime it's a Kansas City or an NWSPC, NWPSC. Anytime it's an NWPSC article, I pay attention. Anytime it's a Kansas City article, I pay attention. But other than that, I'm tired of seeing all these gastroschisis articles. I'm waiting for someone to give me something that is really meaningful.↗
▶Ep 22 · 6:01
host_summarySutureless closure patients had fewer surgical site and deep space infections compared to sutured closure patients.↗
▶Ep 22 · 6:01
host_summaryThe positive outcomes for sutureless repair were observed even when considering patients who required silo use.↗
▶Ep 22 · 6:01
host_summarySutureless closure patients had less ventilator use compared to sutured closure patients.↗
▶Ep 22 · 6:01
host_summaryThe Midwest Pediatric Surgery Consortium study was a retrospective cohort of infants born with gastroschisis between 2013 and 2016, with a total of 315 patients.↗
▶Ep 22 · 6:01
host_summaryThe study divided patients into sutured versus sutureless abdominal wall closures and required subgroup analysis because some babies received silos and some did not.↗
▶Ep 22 · 6:01
host_summaryPatients who underwent sutureless abdominal wall closure had no difference in days on TPN, time to goal feeds, time to initial feeds, or length of stay compared to sutured closure.↗
▶Ep 22 · 6:01
host_summarySutureless closure patients had less antibiotic use compared to sutured closure patients.↗
▶Ep 22 · 6:01
host_summarySutureless closure patients had fewer episodes of general anesthetics compared to sutured closure patients.↗
▶Ep 22 · 11:13
quoteYeah, I think in general, I, I, you're right. I don't know how the pendulum is going to swing, but we are finding more and more. There are things that we don't have to operate on.↗
▶Ep 22 · 11:22
host_summaryGastroschisis is an abdominal wall defect that used to necessitate a trip to the OR and is now more like a safe bedside procedure.↗
Intestinal rehabilitation: What is intestinal rehab? - Episode 1
▶Ep 23 · 2:24
host_summaryNew guidelines define intestinal failure as requiring parenteral support for at least 60 days due to inadequate intestinal function.↗
▶Ep 23 · 3:33
host_summaryIntestinal rehabilitation requires managing comorbidities including sepsis and liver disease that challenge infant growth.↗
▶Ep 23 · 8:41
host_summaryAccess and availability to intestinal rehabilitation programs is still very rare.↗
▶Ep 23 · 12:34
host_summaryOverall long-term survival in major intestinal rehabilitation programs is usually over 90%.↗
Intestinal Rehabilitation, Episode 1: What is intestinal rehabilitation?
▶Ep 24 · 2:24
host_summaryNew guidelines define intestinal failure as inadequate intestinal function requiring parenteral support for at least 60 days.↗
▶Ep 24 · 3:33
host_summaryIntestinal rehabilitation requires managing comorbidities including sepsis and liver disease that challenge infant growth.↗
▶Ep 24 · 12:34
host_summaryOverall survival in big intestinal rehabilitation programs is usually over 90% long-term.↗
Journal of Pediatric Surgery Article Review: January 2022 APSA Issue
▶Ep 26 · 3:58
host_summaryExternal federal research funding at Nationwide increased from $750,000 to $5.7 million, representing a 7.7-fold increase.↗
Quick Literature Updates Episode 6
▶Ep 30 · 2:50
host_summaryMiyata et al. used the Canadian Association of Pediatric Surgery Network to study pediatric patients with gastroschisis who underwent bedside reduction and closure.↗
▶Ep 30 · 2:50
host_summaryThere was no significant difference in the rate of successful primary closure between intubated and non-intubated neonates with gastroschisis.↗
host_summaryType 1 laryngeal cleft means the opening is above the vocal cords.↗
▶Ep 10 · 1:41
quoteEndoscopically or endoscopically unless there's a reason to do an open approach.↗
▶Ep 10 · 1:41
quoteYou want raw against raw. Mucosa is a nonstick surface. Get rid of the mucosa. You want a wide strip of raw against a wide strip of raw.↗
▶Ep 10 · 1:41
quoteFlexible bronchoscopy is not adequate for diagnosing a posterior laryngeal cleft.↗
▶Ep 10 · 1:41
quoteWe've been nagging Andy for years, Andy Inglis, to actually modify that classification.↗
▶Ep 10 · 1:41
host_summaryThe mass closure technique developed in Cincinnati uses the same concept as endoscopic tracheoesophageal fistula repair: you want raw against raw, with wide strips of raw tissue opposed after removing the non-stick mucosal surface.↗
▶Ep 10 · 1:41
host_summaryFlexible bronchoscopy is not adequate for diagnosing a posterior laryngeal cleft.↗
▶Ep 10 · 1:41
host_summaryThe Benjamin Inglis classification should be modified to include a type 4 long because type 4 could be proximal above the carina, at the carina, or go straight through the carina.↗
▶Ep 10 · 1:41
host_summaryType 3 laryngeal cleft means it extends down into the trachea.↗
▶Ep 10 · 1:41
host_summaryType 2 laryngeal cleft means it extends below the vocal cords.↗
The Colorectal Quiz Episode 11: Total Colonic Hirschsprung's Part 2
▶Ep 1 · 2:46
clinicalStudies showed no significant difference in skin excoriation between younger and older patients undergoing pull-through↗
▶Ep 1 · 6:26
clinicalOral sodium supplementation protocol: add 3 mEq/kg/day using recipe of 1 tablespoon salt plus 40 mL water (gives 2.5 mEq sodium per mL), continue 1-2 months then recheck urine sodium↗
▶Ep 1 · 9:38
clinicalGanglionated bowel can decompensate when there is slowing of stool in the Duhamel pouch↗
▶Ep 1 · 11:04
clinicalPatients with total colonic Hirschsprung disease are more susceptible to severe enterocolitis compared to traditional rectosigmoid Hirschsprung patients↗
▶Ep 1 · 11:16
clinicalFirst-line medical management is diet modification, which can be started before pull-through↗
Hirschsprung Disease in Brief
▶Ep 3 · 0:00
epidemiologicalThe first reports of Hirschsprung disease date back to the 17th century↗
▶Ep 3 · 0:00
epidemiologicalTreatment, workup, management, including operative surgical approach has changed dramatically since the 1940s↗
The Colorectal Quiz Episode 1: ARM - Low Bulbar Fistula
▶Ep 36 · 0:25
quoteI mean, just me mentioning this, I bet there's a case that popped up in your mind that was a real head scratcher that you've never seen before.↗
Colorectal Quiz Episode 2: When to redo a PSARP
▶Ep 37 · 0:00
opinionIf you don't get anorectoplasty perfect, you might not have the best outcomes, which separates it from other surgical procedures↗
▶Ep 37 · 0:00
quoteAnal rectoplasty. It's an incredibly particular procedure and as many of you know, if you don't get it perfect, you might not have the best outcomes.↗
▶Ep 37 · 0:50
opinionA lot of surgeons agree that oftentimes your first shot might be your only shot to give this patient a good outcome and the right anatomy↗
▶Ep 37 · 1:25
quoteHow many patients, Jason, have you seen on laxatives that comes with an anus in the wrong place? How many patients have you seen having had a cecostomy with perfect anatomy? That's the real frustrating one.↗
▶Ep 37 · 5:50
quoteI can tell you, the family doesn't really care how technically elegant is your analplasty. What they care about is whether that analplasty that you make is going to work.↗
▶Ep 37 · 5:50
opinionThe family doesn't really care how technically elegant is your anaplasty. What they care about is whether that anaplasty that you make is going to work↗
▶Ep 37 · 6:15
clinicalThe higher the malformation is, the worse the prognosis↗
▶Ep 37 · 6:30
clinicalSacrum ratio 0.7 or greater usually means normal or close to normal sphincters and good muscle tone and spine innervation↗
▶Ep 37 · 6:55
clinicalThe most common associated spinal anomaly is tethered cord, but the worst is myelomeningocele↗
▶Ep 37 · 6:55
clinicalPatients with myelomeningocele have much more trouble with continence↗
▶Ep 37 · 7:44
clinicalIt's amazingly common to have a mislocated anus↗
▶Ep 37 · 7:44
quoteIt's amazingly common to have a mislocated anus.↗
▶Ep 37 · 7:55
quoteI think a key pitfall is not do that. Mark the sphincters first, then open the PSARP because then you don't get confused at the end when you're trying to place the anoplasty in the correct location.↗
▶Ep 37 · 7:55
clinicalA key pitfall is opening the PSARP incision first; you should mark the sphincters first, then open the PSARP so you don't get confused when placing the anoplasty↗
▶Ep 37 · 10:40
clinicalIn higher malformations like bladder neck fistula in a boy, the sphincter complex isn't always where you think it's going to be; sometimes those sphincter complexes are more anterior than anticipated↗
Colorectal Quiz Episode 12: Newborn ARM Part 1
▶Ep 39 · 0:22
epidemiologicalAnorectal malformations occur in 1 in 5,000 live births↗
▶Ep 39 · 0:42
clinicalAnorectal malformations occur when the anus, rectum, and nerves do not develop properly during fetal growth↗
Colorectal Quiz Episode 13: Newborn ARM Part 2
▶Ep 40 · 2:54
clinicalSurgical indications for anorectal malformation include: locating the perineal fistula, determining if it is in the correct location, assessing if it is too big or too small, confirming it is within the sphincter, and evaluating the size of the perineal body↗
▶Ep 40 · 13:38
clinicalHagar dilators should be used to check anal size, starting low and working up for accurate measurement, rather than using fingers because every surgeon has a different size glove↗
Colorectal Quiz Episode 14: ARM Newborn Part 3
▶Ep 41 · 7:09
clinicalPosterior-only mobilization technique applies only when fistula dot is within the sphincteric ellipse↗
Colorectal Quiz Episode 32: Anorectal Malformations And Cardiac Anomalies
▶Ep 87 · 8:54
clinicalVCUG showed small diverticulum along right bladder base, otherwise normal↗
clinicalPSARP was performed approximately three months after cardiac repair↗
Colorectal Quiz Episode 32: Anorectal Malformations And Cardiac Anomalies
▶Ep 26 · 2:44
clinicalIn Georgia, when a baby gets diagnosed with prenatal cardiac disease, the cardiac group gets called early and gets involved, including reviewing echocardiograms and meeting with high-risk OB↗
▶Ep 26 · 6:13
clinicalFor patients with ARM and really significant cardiac anomaly, an ostomy is probably the standard choice↗
▶Ep 26 · 11:00
clinicalIf the baby has an umbilical line, consider Palmer's Point access rather than umbilical access, using a Hasson technique↗
clinicalDespite maneuvers, this baby continued to have hypercyanotic spells and required heart surgery sooner than the initially planned 6 months↗
▶Ep 26 · 12:10
clinicalEmergent tetralogy of Fallot repair was performed on day of life 5↗
Colorectal Quiz: Episode 2
▶Ep 90 · 0:00
opinionAnorectoplasty is an incredibly particular procedure where if you don't get it perfect, you might not have the best outcomes↗
▶Ep 90 · 0:20
opinionOftentimes your first shot might be your only shot to give this patient a good outcome↗
Colorectal Quiz: Episode 2
▶Ep 91 · 0:00
opinionAnorectoplasty is an incredibly particular procedure where if you don't get it perfect, you might not have the best outcomes↗
▶Ep 91 · 0:20
opinionOftentimes your first shot might be your only shot to give this patient a good outcome↗
The Colorectal Quiz: Episode 1
▶Ep 92 · 0:00
quotePediatric colorectal surgery. It just sounds really complex, right? These patients can come with anatomic variances, really rare anomalies. Their care can be complex, dynamic, multidisciplinary, and pose a lot of clinical challenges to your everyday pediatric surgeon.↗
▶Ep 92 · 6:01
clinicalFor cross-table lateral, the baby is positioned prone with a bump under the buttocks to make the buttock the highest point where air will rise↗
▶Ep 92 · 12:16
clinicalIn patients with low rectum, dissecting a little bit of the anterior wall and carefully lifting it off the urinary tract will usually rule out fistula↗
The Colorectal Quiz: Episode 1
▶Ep 93 · 0:00
quotePediatric colorectal surgery. It just sounds really complex, right? These patients can come with anatomic variances, really rare anomalies. Their care can be complex, dynamic, multidisciplinary, and pose a lot of clinical challenges to your everyday pediatric surgeon.↗
▶Ep 93 · 6:01
clinicalCross-table lateral can be obtained at bedside in neonatal unit by placing baby on bump under buttocks↗
▶Ep 93 · 6:01
clinicalFor cross-table lateral, baby is positioned prone with buttock at highest point where air will rise to↗
The Colorectal Quiz Episode 1: ARM - Low Bulbar Fistula
▶Ep 84 · 0:25
quoteI mean, just me mentioning this, I bet there's a case that popped up in your mind that was a real head scratcher that you've never seen before.↗
Colorectal Quiz Episode 2: When to redo a PSARP
▶Ep 85 · 0:00
quoteAnal rectoplasty. It's an incredibly particular procedure and as many of you know, if you don't get it perfect, you might not have the best outcomes.↗
▶Ep 85 · 0:00
opinionIf you don't get anorectoplasty perfect, you might not have the best outcomes, which separates it from other surgical procedures↗
▶Ep 85 · 0:50
opinionA lot of surgeons agree that oftentimes your first shot might be your only shot to give this patient a good outcome and the right anatomy↗
▶Ep 85 · 1:25
quoteHow many patients, Jason, have you seen on laxatives that comes with an anus in the wrong place? How many patients have you seen having had a cecostomy with perfect anatomy? That's the real frustrating one.↗
▶Ep 85 · 5:50
quoteI can tell you, the family doesn't really care how technically elegant is your analplasty. What they care about is whether that analplasty that you make is going to work.↗
▶Ep 85 · 5:50
opinionThe family doesn't really care how technically elegant is your anaplasty. What they care about is whether that anaplasty that you make is going to work↗
▶Ep 85 · 6:15
clinicalThe higher the malformation is, the worse the prognosis↗
▶Ep 85 · 6:30
clinicalSacrum ratio 0.7 or greater usually means normal or close to normal sphincters and good muscle tone and spine innervation↗
▶Ep 85 · 6:55
clinicalPatients with myelomeningocele have much more trouble with continence↗
▶Ep 85 · 6:55
clinicalThe most common associated spinal anomaly is tethered cord, but the worst is myelomeningocele↗
▶Ep 85 · 7:44
quoteIt's amazingly common to have a mislocated anus.↗
▶Ep 85 · 7:44
clinicalIt's amazingly common to have a mislocated anus↗
▶Ep 85 · 7:55
clinicalA key pitfall is opening the PSARP incision first; you should mark the sphincters first, then open the PSARP so you don't get confused when placing the anoplasty↗
▶Ep 85 · 7:55
quoteI think a key pitfall is not do that. Mark the sphincters first, then open the PSARP because then you don't get confused at the end when you're trying to place the anoplasty in the correct location.↗
▶Ep 85 · 10:40
clinicalIn higher malformations like bladder neck fistula in a boy, the sphincter complex isn't always where you think it's going to be; sometimes those sphincter complexes are more anterior than anticipated↗
The Colorectal Quiz Episode 3.5: Proximal Hirschsprung Disease
▶Ep 87 · 2:00
clinicalThe patient is 41 weeks gestation, just under 4 kilograms↗
▶Ep 87 · 2:30
clinicalIf the child is sick, resuscitation should be the first step before diagnostic workup↗
The Colorectal Quiz Episode 5: Proximal Hirschsprung Disease Surgical Technique
▶Ep 89 · 5:23
clinicalOn frozen section, you can rule out Hirschsprung disease but cannot rule it in↗
Update Course Rewind: 2020 Colorectal Part 1
▶Ep 90 · 5:32
clinicalEnterocolitis treatment must be individualized based on presentation spectrum, from mild white count elevation to gross distention with shock↗
▶Ep 90 · 8:47
guidelineThe diagnostic algorithm for post-pull-through obstruction includes rectal exam, contrast enema, rectal biopsy, and potentially botulinum toxin injection↗
▶Ep 90 · 9:01
guidelineMotility workup may be needed to determine if further colonic resection, bowel management, stoma, or ACE procedure is required↗
▶Ep 90 · 11:21
clinicalPseudo-incontinence from hypermotility can be managed with fiber intake adjustment, daily Imodium, and cholestyramine↗
The Colorectal Quiz Episode 10: Total Colonic Hirschsprung Disease Part 1
▶Ep 94 · 4:07
clinicalFailure to pass meconium in newborns is most commonly caused by Hirschsprung disease, meconium plug syndrome, meconium ileus, or anorectal malformation↗
▶Ep 94 · 6:33
clinicalIn total colonic Hirschsprung disease, contrast enema shows cylindrical, amorphous colon without the classic rectosigmoid narrowing seen in typical Hirschsprung disease↗
The Colorectal Quiz Episode 11: Total Colonic Hirschsprung's Part 2
▶Ep 95 · 2:46
clinicalStudies showed no significant difference in skin excoriation between younger and older patients undergoing pull-through↗
▶Ep 95 · 6:26
clinicalOral sodium supplementation protocol: add 3 mEq/kg/day using recipe of 1 tablespoon salt plus 40 mL water (gives 2.5 mEq sodium per mL), continue 1-2 months then recheck urine sodium↗
▶Ep 95 · 9:38
clinicalGanglionated bowel can decompensate when there is slowing of stool in the Duhamel pouch↗
▶Ep 95 · 11:04
clinicalPatients with total colonic Hirschsprung disease are more susceptible to severe enterocolitis compared to traditional rectosigmoid Hirschsprung patients↗
▶Ep 95 · 11:16
clinicalFirst-line medical management is diet modification, which can be started before pull-through↗
Colorectal Quiz Episode 12: Newborn ARM Part 1
▶Ep 97 · 0:22
epidemiologicalAnorectal malformations occur in 1 in 5,000 live births↗
▶Ep 97 · 0:42
clinicalAnorectal malformations occur when the anus, rectum, and nerves do not develop properly during fetal growth↗
Colorectal Quiz Episode 13: Newborn ARM Part 2
▶Ep 98 · 2:54
clinicalSurgical indications for anorectal malformation include: locating the perineal fistula, determining if it is in the correct location, assessing if it is too big or too small, confirming it is within the sphincter, and evaluating the size of the perineal body↗
▶Ep 98 · 13:38
clinicalHagar dilators should be used to check anal size, starting low and working up for accurate measurement, rather than using fingers because every surgeon has a different size glove↗
Colorectal Quiz Episode 14: ARM Newborn Part 3
▶Ep 99 · 7:09
clinicalPosterior-only mobilization technique applies only when fistula dot is within the sphincteric ellipse↗
host_summarySennosides or bisacodyl can be used to induce high-amplitude propagated contractions (HAPCs).↗
▶Ep 104 · 7:15
host_summaryWhen an HAPC occurs, the internal anal sphincter should relax (coloanal reflex) to allow stool evacuation.↗
▶Ep 104 · 8:06
host_summaryFluoroscopy (C-arm) is used during manometry catheter placement to confirm exact positioning.↗
▶Ep 104 · 8:51
host_summaryWhen an HAPC reaches the sigmoid or rectum, the internal anal sphincter relaxes to allow defecation.↗
▶Ep 104 · 9:51
host_summaryDecisions about surgical intervention for segmental dysmotility are based not only on manometry but also on imaging (contrast enema), physical exam, and patient/family history.↗
▶Ep 104 · 13:56
host_summaryPerforming duodenal and colonic manometry in a patient with gastroparesis is valuable because it rules out more widespread dysmotility, which is especially important in patients with anorectal malformations.↗
Hirschsprung Disease Workup
▶Ep 106 · 7:50
guidelineNobody would operate on manometry findings alone; if manometry is suggestive, a biopsy will still be done↗
▶Ep 106 · 7:55
quoteBut nobody I know would operate on a manometry alone.↗
▶Ep 106 · 8:10
guidelineThe gold standard for diagnosing Hirschsprung disease is biopsy↗
▶Ep 106 · 8:41
clinicalNormal individuals without Hirschsprung disease have no ganglion cells in the very first part of the rectum↗
▶Ep 106 · 9:30
clinicalIn older children after one year of age, tissue is thicker and suction biopsy cannot obtain adequate tissue depth to reach the level where ganglion cells would be present↗
▶Ep 106 · 9:55
clinicalSurgical biopsy in the operating room is a simple procedure taking about 20 minutes with same-day discharge↗
Journal of Pediatric Surgery Article Review: October 2021
▶Ep 110 · 2:50
quoteWe might congratulate ourselves for having done a good job in perhaps saving the kid and identifying the problem, but perhaps not aware that we have a responsibility uh for the long-term health and uh we have to be advocates for the children.↗
▶Ep 110 · 2:50
host_summaryComplete metadata for medical education content includes title, description, summary, keywords, duration, content type, specialty area, target audience level, and language.↗
▶Ep 110 · 8:32
host_summaryWe currently do not have objective clinical markers, whether clinical features or novel biomarkers, to help make earlier surgical decisions in NEC.↗
▶Ep 110 · 8:32
quoteIt is obvious that we currently do not have the objective clinical markers, whether they are the uh clinical features or uh novel biomarkers to help us make an earlier decision.↗
▶Ep 110 · 17:03
host_summaryThe Italian study provides sufficient evidence to convince clinicians who are not doing routine spinal cord and spine assessment in anorectal malformation patients that they should be more serious with imaging.↗
Intestinal rehabilitation: What is intestinal rehab? - Episode 1
▶Ep 112 · 2:24
host_summaryNew guidelines define intestinal failure as requiring parenteral support for at least 60 days due to inadequate intestinal function.↗
▶Ep 112 · 3:33
host_summaryIntestinal rehabilitation requires managing comorbidities including sepsis and liver disease that challenge infant growth.↗
▶Ep 112 · 8:41
host_summaryAccess and availability to intestinal rehabilitation programs is still very rare.↗
▶Ep 112 · 12:34
host_summaryOverall long-term survival in major intestinal rehabilitation programs is usually over 90%.↗
Intestinal Rehabilitation, Episode 1: What is intestinal rehabilitation?
▶Ep 113 · 2:24
host_summaryNew guidelines define intestinal failure as inadequate intestinal function requiring parenteral support for at least 60 days.↗
▶Ep 113 · 3:33
host_summaryIntestinal rehabilitation requires managing comorbidities including sepsis and liver disease that challenge infant growth.↗
▶Ep 113 · 12:34
host_summaryOverall survival in big intestinal rehabilitation programs is usually over 90% long-term.↗
Hirschsprung Disease in Brief
▶Ep 116 · 0:00
epidemiologicalThe first reports of Hirschsprung disease date back to the 17th century↗
▶Ep 116 · 0:00
epidemiologicalTreatment, workup, management, including operative surgical approach has changed dramatically since the 1940s↗
Quick Literature Updates Episode 7
▶Ep 138 · 1:35
host_summaryPeters et al. retrospectively reviewed 55 pediatric patients with small bowel syndrome to examine whether presence or absence of ileocecal valve and/or colon can predict enteral autonomy.↗
▶Ep 138 · 1:35
host_summaryInfants with an ileocecal valve had significantly shorter duration on parenteral nutrition.↗
▶Ep 138 · 1:35
host_summaryPatients with less than 50% of their colon had significantly less time on parenteral nutrition as long as they had their ileocecal valve.↗
Colorectal Quiz Episode 32: Anorectal Malformations And Cardiac Anomalies
▶Ep 231 · 8:54
clinicalVCUG showed small diverticulum along right bladder base, otherwise normal↗
clinicalPSARP was performed approximately three months after cardiac repair↗
Colorectal Quiz Episode 32: Anorectal Malformations And Cardiac Anomalies
▶Ep 232 · 2:44
clinicalIn Georgia, when a baby gets diagnosed with prenatal cardiac disease, the cardiac group gets called early and gets involved, including reviewing echocardiograms and meeting with high-risk OB↗
▶Ep 232 · 6:13
clinicalFor patients with ARM and really significant cardiac anomaly, an ostomy is probably the standard choice↗
▶Ep 232 · 11:00
clinicalIf the baby has an umbilical line, consider Palmer's Point access rather than umbilical access, using a Hasson technique↗
clinicalDespite maneuvers, this baby continued to have hypercyanotic spells and required heart surgery sooner than the initially planned 6 months↗
▶Ep 232 · 12:10
clinicalEmergent tetralogy of Fallot repair was performed on day of life 5↗
The Colorectal Quiz Episode 4
▶Ep 239 · 17:00
clinicalReinforcement layer is critical to line up mucosa edge to mucosa edge↗
Colorectal Quiz: Episode 2
▶Ep 240 · 0:00
opinionAnorectoplasty is an incredibly particular procedure where if you don't get it perfect, you might not have the best outcomes↗
▶Ep 240 · 0:20
opinionOftentimes your first shot might be your only shot to give this patient a good outcome↗
The Colorectal Quiz Episode 4
▶Ep 241 · 17:00
clinicalReinforcement layer is critical to align bowel edges for mucosa-to-mucosa anastomosis↗
Colorectal Quiz: Episode 2
▶Ep 242 · 0:00
opinionAnorectoplasty is an incredibly particular procedure where if you don't get it perfect, you might not have the best outcomes↗
▶Ep 242 · 0:20
opinionOftentimes your first shot might be your only shot to give this patient a good outcome↗
The Colorectal Quiz: Episode 1
▶Ep 243 · 0:00
quotePediatric colorectal surgery. It just sounds really complex, right? These patients can come with anatomic variances, really rare anomalies. Their care can be complex, dynamic, multidisciplinary, and pose a lot of clinical challenges to your everyday pediatric surgeon.↗
▶Ep 243 · 6:01
clinicalFor cross-table lateral, the baby is positioned prone with a bump under the buttocks to make the buttock the highest point where air will rise↗
▶Ep 243 · 12:16
clinicalIn patients with low rectum, dissecting a little bit of the anterior wall and carefully lifting it off the urinary tract will usually rule out fistula↗
The Colorectal Quiz: Episode 1
▶Ep 244 · 0:00
quotePediatric colorectal surgery. It just sounds really complex, right? These patients can come with anatomic variances, really rare anomalies. Their care can be complex, dynamic, multidisciplinary, and pose a lot of clinical challenges to your everyday pediatric surgeon.↗
▶Ep 244 · 6:01
clinicalCross-table lateral can be obtained at bedside in neonatal unit by placing baby on bump under buttocks↗
▶Ep 244 · 6:01
clinicalFor cross-table lateral, baby is positioned prone with buttock at highest point where air will rise to↗
quoteHe's the surgical director of the Fetal Care Center at Cincinnati Children's Hospital Medical Center.↗
▶Ep 6 · 1:40
clinicalUltrasound is usually the screening tool used to find congenital diaphragmatic hernia in the fetus↗
▶Ep 6 · 1:48
clinicalMRI provides higher resolution imaging than ultrasound for fetal CDH and can provide information about the pulmonary status of the fetus↗
▶Ep 6 · 2:35
clinicalFetuses with severe CDH are good candidates for FETO↗
▶Ep 6 · 3:48
clinicalFetal lung tissue constantly creates fluid that normally escapes through the trachea↗
▶Ep 6 · 3:52
clinicalWhen the trachea is occluded, fluid continues to build up and pressure builds in the trachea, which helps the lungs develop↗
▶Ep 6 · 4:18
clinicalBalloon removal is typically attempted at about 34 weeks gestation↗
Journal of Pediatric Surgery Article Review: November 2021
▶Ep 7 · 1:53
clinical60% of patients did not need a central line within a month after ECMO decannulation↗
▶Ep 7 · 6:09
quoteA lung that was infected is gonna be a more difficult lung to operate on.↗
▶Ep 7 · 6:09
clinicalA lung that was infected is going to be a more difficult lung to operate on↗
▶Ep 7 · 9:26
clinicalThe most common indication for partial splenectomy was hereditary spherocytosis↗
Neonatal Gastric Volvulus with Dr. Jason Frischer
▶Ep 8 · 1:18
host_summaryGastric volvulus is associated with congenital diaphragmatic hernia about 17% of the time.↗
▶Ep 8 · 1:18
host_summaryGastric volvulus is associated with eventration of the diaphragm about 25% of the time.↗
▶Ep 8 · 2:13
host_summaryAcute gastric volvulus presentations are usually due to anatomic problems like congenital diaphragmatic hernia.↗
▶Ep 8 · 3:27
host_summaryWithout ligamentous attachments, the stomach is kept in place only at two points: the GE junction and the pylorus, and rotations occur about these points.↗
▶Ep 8 · 4:58
host_summaryGastric volvulus typically presents in children in the first year of life with non-bilious emesis, gastric distention, and issues passing an NG tube.↗
▶Ep 8 · 5:41
host_summaryA classic bird's beak appearance may be seen when contrast is swallowed or placed in a tube sitting in the esophagus in gastric volvulus.↗
▶Ep 8 · 7:34
host_summaryGastropexy should be performed at at least one other location in addition to G-tube placement, fixing the stomach in multiple planes to reduce the chance of re-volvulization.↗
▶Ep 8 · 7:47
host_summaryFundoplication is not required in pediatric gastric volvulus repair, unlike in some adult cases.↗
The Colorectal Quiz Episode 1: ARM - Low Bulbar Fistula
▶Ep 6 · 0:25
quoteI mean, just me mentioning this, I bet there's a case that popped up in your mind that was a real head scratcher that you've never seen before.↗
The Colorectal Quiz: Episode 1
▶Ep 12 · 0:00
quotePediatric colorectal surgery. It just sounds really complex, right? These patients can come with anatomic variances, really rare anomalies. Their care can be complex, dynamic, multidisciplinary, and pose a lot of clinical challenges to your everyday pediatric surgeon.↗
▶Ep 12 · 6:01
clinicalFor cross-table lateral, the baby is positioned prone with a bump under the buttocks to make the buttock the highest point where air will rise↗
▶Ep 12 · 12:16
clinicalIn patients with low rectum, dissecting a little bit of the anterior wall and carefully lifting it off the urinary tract will usually rule out fistula↗
The Colorectal Quiz: Episode 1
▶Ep 13 · 0:00
quotePediatric colorectal surgery. It just sounds really complex, right? These patients can come with anatomic variances, really rare anomalies. Their care can be complex, dynamic, multidisciplinary, and pose a lot of clinical challenges to your everyday pediatric surgeon.↗
▶Ep 13 · 6:01
clinicalFor cross-table lateral, baby is positioned prone with buttock at highest point where air will rise to↗
▶Ep 13 · 6:01
clinicalCross-table lateral can be obtained at bedside in neonatal unit by placing baby on bump under buttocks↗
Gastroschisis and sutureless abdominal wall closure
▶Ep 31 · 1:44
host_summaryIn 2004, Tony Sandler published the first manuscript about sutureless closures utilizing the natural umbilical properties to close the gastroschisis defect by itself.↗
▶Ep 31 · 1:44
quoteIn 2004, Tony Sandler published the first manuscript about suture disclosures to utilize the natural umbilical properties to closing that defect by itself.↗
▶Ep 31 · 2:45
quoteI didn't know about his article. I found out about it as a fellow when he taught us how to treat gastroschisis that way.↗
▶Ep 31 · 2:45
quoteI think it's clearly been a massive change in practice. It's one of the examples of a big change that we don't actually operate on those and they can be done at the bedside. And it also is an example of something that took a while to adopt. And now most people are doing it, I think.↗
▶Ep 31 · 3:26
quoteThere have been so many articles in the last few years that go back and forth. I mean, one said gastro suture list is better. One said definitely don't do suture list. So my question is now, I don't know. I almost don't read these articles anymore.↗
▶Ep 31 · 5:29
quoteI think anytime it's a Kansas City or an NWSPC, NWPSC. Anytime it's an NWPSC article, I pay attention. Anytime it's a Kansas City article, I pay attention. But other than that, I'm tired of seeing all these gastroschisis articles. I'm waiting for someone to give me something that is really meaningful.↗
▶Ep 31 · 6:01
host_summaryThe Midwest Pediatric Surgery Consortium study was a retrospective cohort of infants born with gastroschisis between 2013 and 2016, with a total of 315 patients.↗
▶Ep 31 · 6:01
host_summarySutureless closure patients had less antibiotic use compared to sutured closure patients.↗
▶Ep 31 · 6:01
host_summarySutureless closure patients had less ventilator use compared to sutured closure patients.↗
▶Ep 31 · 6:01
host_summaryThe positive outcomes for sutureless repair were observed even when considering patients who required silo use.↗
▶Ep 31 · 6:01
host_summaryPatients who underwent sutureless abdominal wall closure had no difference in days on TPN, time to goal feeds, time to initial feeds, or length of stay compared to sutured closure.↗
▶Ep 31 · 6:01
host_summarySutureless closure patients had fewer surgical site and deep space infections compared to sutured closure patients.↗
▶Ep 31 · 6:01
host_summaryThe study divided patients into sutured versus sutureless abdominal wall closures and required subgroup analysis because some babies received silos and some did not.↗
▶Ep 31 · 6:01
host_summarySutureless closure patients had fewer episodes of general anesthetics compared to sutured closure patients.↗
▶Ep 31 · 11:13
quoteYeah, I think in general, I, I, you're right. I don't know how the pendulum is going to swing, but we are finding more and more. There are things that we don't have to operate on.↗
▶Ep 31 · 11:22
host_summaryGastroschisis is an abdominal wall defect that used to necessitate a trip to the OR and is now more like a safe bedside procedure.↗
Journal of Pediatric Surgery Article Review: October 2021
▶Ep 33 · 2:50
host_summaryComplete metadata for medical education content includes title, description, summary, keywords, duration, content type, specialty area, target audience level, and language.↗
▶Ep 33 · 2:50
quoteWe might congratulate ourselves for having done a good job in perhaps saving the kid and identifying the problem, but perhaps not aware that we have a responsibility uh for the long-term health and uh we have to be advocates for the children.↗
▶Ep 33 · 8:32
quoteIt is obvious that we currently do not have the objective clinical markers, whether they are the uh clinical features or uh novel biomarkers to help us make an earlier decision.↗
▶Ep 33 · 8:32
host_summaryWe currently do not have objective clinical markers, whether clinical features or novel biomarkers, to help make earlier surgical decisions in NEC.↗
▶Ep 33 · 17:03
host_summaryThe Italian study provides sufficient evidence to convince clinicians who are not doing routine spinal cord and spine assessment in anorectal malformation patients that they should be more serious with imaging.↗
Intestinal rehabilitation: What is intestinal rehab? - Episode 1
▶Ep 34 · 2:24
host_summaryNew guidelines define intestinal failure as requiring parenteral support for at least 60 days due to inadequate intestinal function.↗
▶Ep 34 · 3:33
host_summaryIntestinal rehabilitation requires managing comorbidities including sepsis and liver disease that challenge infant growth.↗
▶Ep 34 · 8:41
host_summaryAccess and availability to intestinal rehabilitation programs is still very rare.↗
▶Ep 34 · 12:34
host_summaryOverall long-term survival in major intestinal rehabilitation programs is usually over 90%.↗
Intestinal Rehabilitation, Episode 1: What is intestinal rehabilitation?
▶Ep 35 · 2:24
host_summaryNew guidelines define intestinal failure as inadequate intestinal function requiring parenteral support for at least 60 days.↗
▶Ep 35 · 3:33
host_summaryIntestinal rehabilitation requires managing comorbidities including sepsis and liver disease that challenge infant growth.↗
▶Ep 35 · 12:34
host_summaryOverall survival in big intestinal rehabilitation programs is usually over 90% long-term.↗
Journal of Pediatric Surgery Article Review: January 2022 APSA Issue
▶Ep 38 · 3:58
host_summaryExternal federal research funding at Nationwide increased from $750,000 to $5.7 million, representing a 7.7-fold increase.↗
Stay Current Throwbacks Necrotizing Enterocolitis with Dr. Gail Besner
▶Ep 40 · 46:18
clinicalNEST trial results published in fall 2021 showed no overall difference in death or neurodevelopmental impairment between laparotomy and drainage groups↗
▶Ep 40 · 46:50
clinicalIn the NEST trial, neonates diagnosed with NEC (versus isolated perforation) had approximately 20% decrease in death rate with laparotomy compared to drainage↗
Neonatal Gastric Volvulus with Dr. Jason Frischer
▶Ep 43 · 1:18
host_summaryGastric volvulus is associated with eventration of the diaphragm about 25% of the time.↗
▶Ep 43 · 1:18
host_summaryGastric volvulus is associated with congenital diaphragmatic hernia about 17% of the time.↗
▶Ep 43 · 2:13
host_summaryAcute gastric volvulus presentations are usually due to anatomic problems like congenital diaphragmatic hernia.↗
▶Ep 43 · 3:27
host_summaryWithout ligamentous attachments, the stomach is kept in place only at two points: the GE junction and the pylorus, and rotations occur about these points.↗
▶Ep 43 · 4:58
host_summaryGastric volvulus typically presents in children in the first year of life with non-bilious emesis, gastric distention, and issues passing an NG tube.↗
▶Ep 43 · 5:41
host_summaryA classic bird's beak appearance may be seen when contrast is swallowed or placed in a tube sitting in the esophagus in gastric volvulus.↗
▶Ep 43 · 7:34
host_summaryGastropexy should be performed at at least one other location in addition to G-tube placement, fixing the stomach in multiple planes to reduce the chance of re-volvulization.↗
▶Ep 43 · 7:47
host_summaryFundoplication is not required in pediatric gastric volvulus repair, unlike in some adult cases.↗
Quick Literature Updates Episode 6
▶Ep 49 · 2:50
host_summaryThere was no significant difference in the rate of successful primary closure between intubated and non-intubated neonates with gastroschisis.↗
▶Ep 49 · 2:50
host_summaryMiyata et al. used the Canadian Association of Pediatric Surgery Network to study pediatric patients with gastroschisis who underwent bedside reduction and closure.↗
quoteHe's the surgical director of the Fetal Care Center at Cincinnati Children's Hospital Medical Center.↗
▶Ep 15 · 1:40
clinicalUltrasound is usually the screening tool used to find congenital diaphragmatic hernia in the fetus↗
▶Ep 15 · 1:48
clinicalMRI provides higher resolution imaging than ultrasound for fetal CDH and can provide information about the pulmonary status of the fetus↗
▶Ep 15 · 2:35
clinicalFetuses with severe CDH are good candidates for FETO↗
▶Ep 15 · 3:48
clinicalFetal lung tissue constantly creates fluid that normally escapes through the trachea↗
▶Ep 15 · 3:52
clinicalWhen the trachea is occluded, fluid continues to build up and pressure builds in the trachea, which helps the lungs develop↗
▶Ep 15 · 4:18
clinicalBalloon removal is typically attempted at about 34 weeks gestation↗
Fetoscopic Repair of Myelomeningocele (MMC)
▶Ep 16 · 0:42
epidemiologicalNeural tube defects are the most common congenital central nervous system anomaly↗
▶Ep 16 · 1:20
epidemiologicalMyelomeningocele or spina bifida is the most common neural tube defect↗
▶Ep 16 · 1:25
clinicalIn myelomeningocele, the patient is born with a cleft in the vertebral column and a defect in the skin so the meninges and spinal cord are exposed↗
▶Ep 16 · 1:33
clinicalThe patient may be left with neural defects based on the level of the spinal cord where the lesion is↗
▶Ep 16 · 2:51
clinicalFetal anesthesia is induced via an intragluteal injection↗
▶Ep 16 · 3:08
clinicalThe sack is opened and dissection is performed circumferentially around it↗
▶Ep 16 · 5:14
clinicalIf able, the baby is delivered vaginally at term↗
Treatment for Long Gap Esophageal Atresia: Esophageal Elongation and Replacement
▶Ep 18 · 1:08
clinicalIn the Foker technique, surgeons tie sutures to both esophageal ends, externalize them through the chest wall, and progressively tighten them with spacers until the ends approximate↗
▶Ep 18 · 2:10
clinicalThe van der Zee technique uses the same traction concept as Foker but is performed thoracoscopically with all tension maintained inside the thorax↗
▶Ep 18 · 2:10
opinionThe Kimura technique is not used often anymore↗
▶Ep 18 · 2:10
clinicalThe Kimura technique creates a spit fistula that is progressively moved down the chest wall to stretch the proximal pouch toward the distal pouch↗
▶Ep 18 · 4:12
guidelineThe surgical dictum states that every effort should be made to conserve the native esophagus as no other conduit can replace its function satisfactorily↗
▶Ep 18 · 4:12
quoteWe were all taught the dictum that every effort should be made to conserve the native esophagus as no other conduit can replace its function in transporting food from the oral cavity to the stomach satisfactorily.↗
▶Ep 18 · 5:08
clinicalPyloroplasty is performed during colonic interposition to help with gastric emptying↗
▶Ep 18 · 5:08
clinicalThe choice of colon segment for interposition is based on blood supply and required diameter↗
▶Ep 18 · 5:08
clinicalIn colonic interposition, the colon is passed behind the stomach while maintaining blood supply↗
▶Ep 18 · 9:56
opinionThe short interval between traction initiation and anastomosis (less than five days in some cases) raises questions about whether the mechanism is growth or stretch↗
Journal of Pediatric Surgery Article Review: January 2022 APSA Issue
▶Ep 19 · 3:58
host_summaryExternal federal research funding at Nationwide increased from $750,000 to $5.7 million, representing a 7.7-fold increase.↗
Journal of Pediatric Surgery Article Highlights: April 2022
▶Ep 21 · 4:31
quoteI am not smart enough to select an article like this, and I'm absolutely astounded by it.↗
▶Ep 21 · 4:58
clinicalThe fetal surgery survey was of non-trainee surgeons within the American Pediatric Surgical Association to gauge practice patterns in fetal surgery across the country↗
Gastroschisis and sutureless abdominal wall closure
▶Ep 15 · 1:44
quoteIn 2004, Tony Sandler published the first manuscript about suture disclosures to utilize the natural umbilical properties to closing that defect by itself.↗
▶Ep 15 · 1:44
host_summaryIn 2004, Tony Sandler published the first manuscript about sutureless closures utilizing the natural umbilical properties to close the gastroschisis defect by itself.↗
▶Ep 15 · 2:45
quoteI think it's clearly been a massive change in practice. It's one of the examples of a big change that we don't actually operate on those and they can be done at the bedside. And it also is an example of something that took a while to adopt. And now most people are doing it, I think.↗
▶Ep 15 · 2:45
quoteI didn't know about his article. I found out about it as a fellow when he taught us how to treat gastroschisis that way.↗
▶Ep 15 · 3:26
quoteThere have been so many articles in the last few years that go back and forth. I mean, one said gastro suture list is better. One said definitely don't do suture list. So my question is now, I don't know. I almost don't read these articles anymore.↗
▶Ep 15 · 5:29
quoteI think anytime it's a Kansas City or an NWSPC, NWPSC. Anytime it's an NWPSC article, I pay attention. Anytime it's a Kansas City article, I pay attention. But other than that, I'm tired of seeing all these gastroschisis articles. I'm waiting for someone to give me something that is really meaningful.↗
▶Ep 15 · 6:01
host_summaryPatients who underwent sutureless abdominal wall closure had no difference in days on TPN, time to goal feeds, time to initial feeds, or length of stay compared to sutured closure.↗
▶Ep 15 · 6:01
host_summaryThe positive outcomes for sutureless repair were observed even when considering patients who required silo use.↗
▶Ep 15 · 6:01
host_summarySutureless closure patients had less ventilator use compared to sutured closure patients.↗
▶Ep 15 · 6:01
host_summarySutureless closure patients had fewer episodes of general anesthetics compared to sutured closure patients.↗
▶Ep 15 · 6:01
host_summarySutureless closure patients had fewer surgical site and deep space infections compared to sutured closure patients.↗
▶Ep 15 · 6:01
host_summarySutureless closure patients had less antibiotic use compared to sutured closure patients.↗
▶Ep 15 · 6:01
host_summaryThe study divided patients into sutured versus sutureless abdominal wall closures and required subgroup analysis because some babies received silos and some did not.↗
▶Ep 15 · 6:01
host_summaryThe Midwest Pediatric Surgery Consortium study was a retrospective cohort of infants born with gastroschisis between 2013 and 2016, with a total of 315 patients.↗
▶Ep 15 · 11:13
quoteYeah, I think in general, I, I, you're right. I don't know how the pendulum is going to swing, but we are finding more and more. There are things that we don't have to operate on.↗
▶Ep 15 · 11:22
host_summaryGastroschisis is an abdominal wall defect that used to necessitate a trip to the OR and is now more like a safe bedside procedure.↗
Journal of Pediatric Surgery Article Review: January 2022 APSA Issue
▶Ep 17 · 3:58
host_summaryExternal federal research funding at Nationwide increased from $750,000 to $5.7 million, representing a 7.7-fold increase.↗
Intestinal Rehabilitation, Episode 3: Enteral Autonomy, Part 1
▶Ep 4 · 10:34
clinicalA full-term baby is born with approximately 160 centimeters of small bowel↗
▶Ep 4 · 12:58
clinicalBacterial colonization of the intestines is part of the adaptive response↗
Quick Literature Updates Episode 6
▶Ep 7 · 2:50
host_summaryThere was no significant difference in the rate of successful primary closure between intubated and non-intubated neonates with gastroschisis.↗
▶Ep 7 · 2:50
host_summaryMiyata et al. used the Canadian Association of Pediatric Surgery Network to study pediatric patients with gastroschisis who underwent bedside reduction and closure.↗
The Colorectal Quiz Episode 3.5: Proximal Hirschsprung Disease
▶Ep 35 · 2:00
clinicalThe patient is 41 weeks gestation, just under 4 kilograms↗
▶Ep 35 · 2:30
clinicalIf the child is sick, resuscitation should be the first step before diagnostic workup↗
The Colorectal Quiz Episode 5: Proximal Hirschsprung Disease Surgical Technique
▶Ep 37 · 5:23
clinicalOn frozen section, you can rule out Hirschsprung disease but cannot rule it in↗
Update Course Rewind: 2020 Colorectal Part 1
▶Ep 38 · 5:32
clinicalEnterocolitis treatment must be individualized based on presentation spectrum, from mild white count elevation to gross distention with shock↗
▶Ep 38 · 8:47
guidelineThe diagnostic algorithm for post-pull-through obstruction includes rectal exam, contrast enema, rectal biopsy, and potentially botulinum toxin injection↗
▶Ep 38 · 9:01
guidelineMotility workup may be needed to determine if further colonic resection, bowel management, stoma, or ACE procedure is required↗
▶Ep 38 · 11:21
clinicalPseudo-incontinence from hypermotility can be managed with fiber intake adjustment, daily Imodium, and cholestyramine↗
The Colorectal Quiz Episode 10: Total Colonic Hirschsprung Disease Part 1
▶Ep 42 · 4:07
clinicalFailure to pass meconium in newborns is most commonly caused by Hirschsprung disease, meconium plug syndrome, meconium ileus, or anorectal malformation↗
▶Ep 42 · 6:33
clinicalIn total colonic Hirschsprung disease, contrast enema shows cylindrical, amorphous colon without the classic rectosigmoid narrowing seen in typical Hirschsprung disease↗
Hirschsprung Disease Workup
▶Ep 43 · 7:50
guidelineNobody would operate on manometry findings alone; if manometry is suggestive, a biopsy will still be done↗
▶Ep 43 · 7:55
quoteBut nobody I know would operate on a manometry alone.↗
▶Ep 43 · 8:10
guidelineThe gold standard for diagnosing Hirschsprung disease is biopsy↗
▶Ep 43 · 8:41
clinicalNormal individuals without Hirschsprung disease have no ganglion cells in the very first part of the rectum↗
▶Ep 43 · 9:30
clinicalIn older children after one year of age, tissue is thicker and suction biopsy cannot obtain adequate tissue depth to reach the level where ganglion cells would be present↗
▶Ep 43 · 9:55
clinicalSurgical biopsy in the operating room is a simple procedure taking about 20 minutes with same-day discharge↗
Journal of Pediatric Surgery Article Review: January 2022 APSA Issue
▶Ep 50 · 3:58
host_summaryExternal federal research funding at Nationwide increased from $750,000 to $5.7 million, representing a 7.7-fold increase.↗
Quick Literature Updates Episode 7
▶Ep 58 · 1:35
host_summaryPatients with less than 50% of their colon had significantly less time on parenteral nutrition as long as they had their ileocecal valve.↗
▶Ep 58 · 1:35
host_summaryPeters et al. retrospectively reviewed 55 pediatric patients with small bowel syndrome to examine whether presence or absence of ileocecal valve and/or colon can predict enteral autonomy.↗
▶Ep 58 · 1:35
host_summaryInfants with an ileocecal valve had significantly shorter duration on parenteral nutrition.↗
The Colorectal Quiz Episode 4
▶Ep 94 · 17:00
clinicalReinforcement layer is critical to line up mucosa edge to mucosa edge↗
The Colorectal Quiz Episode 4
▶Ep 95 · 17:00
clinicalReinforcement layer is critical to align bowel edges for mucosa-to-mucosa anastomosis↗
Intestinal rehabilitation: What is intestinal rehab? - Episode 1
▶Ep 8 · 2:24
host_summaryNew guidelines define intestinal failure as requiring parenteral support for at least 60 days due to inadequate intestinal function.↗
▶Ep 8 · 3:33
host_summaryIntestinal rehabilitation requires managing comorbidities including sepsis and liver disease that challenge infant growth.↗
▶Ep 8 · 8:41
host_summaryAccess and availability to intestinal rehabilitation programs is still very rare.↗
▶Ep 8 · 12:34
host_summaryOverall long-term survival in major intestinal rehabilitation programs is usually over 90%.↗
Intestinal Rehabilitation, Episode 1: What is intestinal rehabilitation?
▶Ep 9 · 2:24
host_summaryNew guidelines define intestinal failure as inadequate intestinal function requiring parenteral support for at least 60 days.↗
▶Ep 9 · 3:33
host_summaryIntestinal rehabilitation requires managing comorbidities including sepsis and liver disease that challenge infant growth.↗
▶Ep 9 · 12:34
host_summaryOverall survival in big intestinal rehabilitation programs is usually over 90% long-term.↗
Intestinal Rehabilitation, Episode 3: Enteral Autonomy, Part 1
▶Ep 12 · 10:34
clinicalA full-term baby is born with approximately 160 centimeters of small bowel↗
▶Ep 12 · 12:58
clinicalBacterial colonization of the intestines is part of the adaptive response↗
Pediatric Vascular Access in Brief: Preoperative, Operative, and Postoperative Considerations
▶Ep 15 · 0:13
host_summaryIn the United States, approximately 5 million central venous catheter lines are placed annually, with several thousand in pediatric surgical patients.↗
▶Ep 15 · 1:00
host_summaryCentral venous catheters are non-tunneled, typically for temporary hospital use, and can have 1 to 3 lumens.↗
▶Ep 15 · 1:25
host_summaryBroviac catheters are tunneled lines with cuffs, used for months to years for chemotherapy, parenteral nutrition, or frequent blood transfusions, and can have 1 or 2 lumens.↗
▶Ep 15 · 4:43
host_summaryFor very small neonates, many surgeons prefer a cut-down approach over percutaneous access.↗
▶Ep 15 · 9:21
host_summaryLong-term complications include thrombosis, catheter displacement, kinking, and eventual line degradation over extended periods.↗
Gastroschisis and sutureless abdominal wall closure
▶Ep 40 · 1:44
quoteIn 2004, Tony Sandler published the first manuscript about suture disclosures to utilize the natural umbilical properties to closing that defect by itself.↗
▶Ep 40 · 1:44
host_summaryIn 2004, Tony Sandler published the first manuscript about sutureless closures utilizing the natural umbilical properties to close the gastroschisis defect by itself.↗
▶Ep 40 · 2:45
quoteI didn't know about his article. I found out about it as a fellow when he taught us how to treat gastroschisis that way.↗
▶Ep 40 · 2:45
quoteI think it's clearly been a massive change in practice. It's one of the examples of a big change that we don't actually operate on those and they can be done at the bedside. And it also is an example of something that took a while to adopt. And now most people are doing it, I think.↗
▶Ep 40 · 3:26
quoteThere have been so many articles in the last few years that go back and forth. I mean, one said gastro suture list is better. One said definitely don't do suture list. So my question is now, I don't know. I almost don't read these articles anymore.↗
▶Ep 40 · 5:29
quoteI think anytime it's a Kansas City or an NWSPC, NWPSC. Anytime it's an NWPSC article, I pay attention. Anytime it's a Kansas City article, I pay attention. But other than that, I'm tired of seeing all these gastroschisis articles. I'm waiting for someone to give me something that is really meaningful.↗
▶Ep 40 · 6:01
host_summaryThe study divided patients into sutured versus sutureless abdominal wall closures and required subgroup analysis because some babies received silos and some did not.↗
▶Ep 40 · 6:01
host_summaryPatients who underwent sutureless abdominal wall closure had no difference in days on TPN, time to goal feeds, time to initial feeds, or length of stay compared to sutured closure.↗
▶Ep 40 · 6:01
host_summarySutureless closure patients had less antibiotic use compared to sutured closure patients.↗
▶Ep 40 · 6:01
host_summarySutureless closure patients had less ventilator use compared to sutured closure patients.↗
▶Ep 40 · 6:01
host_summarySutureless closure patients had fewer episodes of general anesthetics compared to sutured closure patients.↗
▶Ep 40 · 6:01
host_summarySutureless closure patients had fewer surgical site and deep space infections compared to sutured closure patients.↗
▶Ep 40 · 6:01
host_summaryThe Midwest Pediatric Surgery Consortium study was a retrospective cohort of infants born with gastroschisis between 2013 and 2016, with a total of 315 patients.↗
▶Ep 40 · 6:01
host_summaryThe positive outcomes for sutureless repair were observed even when considering patients who required silo use.↗
▶Ep 40 · 11:13
quoteYeah, I think in general, I, I, you're right. I don't know how the pendulum is going to swing, but we are finding more and more. There are things that we don't have to operate on.↗
▶Ep 40 · 11:22
host_summaryGastroschisis is an abdominal wall defect that used to necessitate a trip to the OR and is now more like a safe bedside procedure.↗
host_summarySennosides or bisacodyl can be used to induce high-amplitude propagated contractions (HAPCs).↗
▶Ep 44 · 7:15
host_summaryWhen an HAPC occurs, the internal anal sphincter should relax (coloanal reflex) to allow stool evacuation.↗
▶Ep 44 · 8:06
host_summaryFluoroscopy (C-arm) is used during manometry catheter placement to confirm exact positioning.↗
▶Ep 44 · 8:51
host_summaryWhen an HAPC reaches the sigmoid or rectum, the internal anal sphincter relaxes to allow defecation.↗
▶Ep 44 · 9:51
host_summaryDecisions about surgical intervention for segmental dysmotility are based not only on manometry but also on imaging (contrast enema), physical exam, and patient/family history.↗
▶Ep 44 · 13:56
host_summaryPerforming duodenal and colonic manometry in a patient with gastroparesis is valuable because it rules out more widespread dysmotility, which is especially important in patients with anorectal malformations.↗
Journal of Pediatric Surgery Article Review: October 2021
▶Ep 45 · 2:50
quoteWe might congratulate ourselves for having done a good job in perhaps saving the kid and identifying the problem, but perhaps not aware that we have a responsibility uh for the long-term health and uh we have to be advocates for the children.↗
▶Ep 45 · 2:50
host_summaryComplete metadata for medical education content includes title, description, summary, keywords, duration, content type, specialty area, target audience level, and language.↗
▶Ep 45 · 8:32
quoteIt is obvious that we currently do not have the objective clinical markers, whether they are the uh clinical features or uh novel biomarkers to help us make an earlier decision.↗
▶Ep 45 · 8:32
host_summaryWe currently do not have objective clinical markers, whether clinical features or novel biomarkers, to help make earlier surgical decisions in NEC.↗
▶Ep 45 · 17:03
host_summaryThe Italian study provides sufficient evidence to convince clinicians who are not doing routine spinal cord and spine assessment in anorectal malformation patients that they should be more serious with imaging.↗
Intestinal rehabilitation: What is intestinal rehab? - Episode 1
▶Ep 46 · 2:24
host_summaryNew guidelines define intestinal failure as requiring parenteral support for at least 60 days due to inadequate intestinal function.↗
▶Ep 46 · 3:33
host_summaryIntestinal rehabilitation requires managing comorbidities including sepsis and liver disease that challenge infant growth.↗
▶Ep 46 · 8:41
host_summaryAccess and availability to intestinal rehabilitation programs is still very rare.↗
▶Ep 46 · 12:34
host_summaryOverall long-term survival in major intestinal rehabilitation programs is usually over 90%.↗
Intestinal Rehabilitation, Episode 1: What is intestinal rehabilitation?
▶Ep 47 · 2:24
host_summaryNew guidelines define intestinal failure as inadequate intestinal function requiring parenteral support for at least 60 days.↗
▶Ep 47 · 3:33
host_summaryIntestinal rehabilitation requires managing comorbidities including sepsis and liver disease that challenge infant growth.↗
▶Ep 47 · 12:34
host_summaryOverall survival in big intestinal rehabilitation programs is usually over 90% long-term.↗
Journal of Pediatric Surgery Article Review: January 2022 APSA Issue
▶Ep 51 · 3:58
host_summaryExternal federal research funding at Nationwide increased from $750,000 to $5.7 million, representing a 7.7-fold increase.↗
Intestinal Rehabilitation, Episode 3: Enteral Autonomy, Part 1
▶Ep 52 · 10:34
clinicalA full-term baby is born with approximately 160 centimeters of small bowel↗
▶Ep 52 · 12:58
clinicalBacterial colonization of the intestines is part of the adaptive response↗
Stay Current Throwbacks Necrotizing Enterocolitis with Dr. Gail Besner
▶Ep 55 · 46:18
clinicalNEST trial results published in fall 2021 showed no overall difference in death or neurodevelopmental impairment between laparotomy and drainage groups↗
▶Ep 55 · 46:50
clinicalIn the NEST trial, neonates diagnosed with NEC (versus isolated perforation) had approximately 20% decrease in death rate with laparotomy compared to drainage↗
Neonatal Gastric Volvulus with Dr. Jason Frischer
▶Ep 59 · 1:18
host_summaryGastric volvulus is associated with eventration of the diaphragm about 25% of the time.↗
▶Ep 59 · 1:18
host_summaryGastric volvulus is associated with congenital diaphragmatic hernia about 17% of the time.↗
▶Ep 59 · 2:13
host_summaryAcute gastric volvulus presentations are usually due to anatomic problems like congenital diaphragmatic hernia.↗
▶Ep 59 · 3:27
host_summaryWithout ligamentous attachments, the stomach is kept in place only at two points: the GE junction and the pylorus, and rotations occur about these points.↗
▶Ep 59 · 4:58
host_summaryGastric volvulus typically presents in children in the first year of life with non-bilious emesis, gastric distention, and issues passing an NG tube.↗
▶Ep 59 · 5:41
host_summaryA classic bird's beak appearance may be seen when contrast is swallowed or placed in a tube sitting in the esophagus in gastric volvulus.↗
▶Ep 59 · 7:34
host_summaryGastropexy should be performed at at least one other location in addition to G-tube placement, fixing the stomach in multiple planes to reduce the chance of re-volvulization.↗
▶Ep 59 · 7:47
host_summaryFundoplication is not required in pediatric gastric volvulus repair, unlike in some adult cases.↗
Pediatric Vascular Access in Brief: Preoperative, Operative, and Postoperative Considerations
▶Ep 63 · 0:13
host_summaryIn the United States, approximately 5 million central venous catheter lines are placed annually, with several thousand in pediatric surgical patients.↗
▶Ep 63 · 1:00
host_summaryCentral venous catheters are non-tunneled, typically for temporary hospital use, and can have 1 to 3 lumens.↗
▶Ep 63 · 1:25
host_summaryBroviac catheters are tunneled lines with cuffs, used for months to years for chemotherapy, parenteral nutrition, or frequent blood transfusions, and can have 1 or 2 lumens.↗
▶Ep 63 · 4:43
host_summaryFor very small neonates, many surgeons prefer a cut-down approach over percutaneous access.↗
▶Ep 63 · 9:21
host_summaryLong-term complications include thrombosis, catheter displacement, kinking, and eventual line degradation over extended periods.↗
Quick Literature Updates Episode 6
▶Ep 71 · 2:50
host_summaryThere was no significant difference in the rate of successful primary closure between intubated and non-intubated neonates with gastroschisis.↗
▶Ep 71 · 2:50
host_summaryMiyata et al. used the Canadian Association of Pediatric Surgery Network to study pediatric patients with gastroschisis who underwent bedside reduction and closure.↗
Quick Literature Updates Episode 7
▶Ep 72 · 1:35
host_summaryPeters et al. retrospectively reviewed 55 pediatric patients with small bowel syndrome to examine whether presence or absence of ileocecal valve and/or colon can predict enteral autonomy.↗
▶Ep 72 · 1:35
host_summaryPatients with less than 50% of their colon had significantly less time on parenteral nutrition as long as they had their ileocecal valve.↗
▶Ep 72 · 1:35
host_summaryInfants with an ileocecal valve had significantly shorter duration on parenteral nutrition.↗
quoteWe've been nagging Andy for years, Andy Inglis, to actually modify that classification.↗
▶Ep 1 · 1:41
quoteEndoscopically or endoscopically unless there's a reason to do an open approach.↗
▶Ep 1 · 1:41
host_summaryThe mass closure technique developed in Cincinnati uses the same concept as endoscopic tracheoesophageal fistula repair: you want raw against raw, with wide strips of raw tissue opposed after removing the non-stick mucosal surface.↗
▶Ep 1 · 1:41
host_summaryFlexible bronchoscopy is not adequate for diagnosing a posterior laryngeal cleft.↗
▶Ep 1 · 1:41
host_summaryThe Benjamin Inglis classification should be modified to include a type 4 long because type 4 could be proximal above the carina, at the carina, or go straight through the carina.↗
▶Ep 1 · 1:41
host_summaryType 3 laryngeal cleft means it extends down into the trachea.↗
▶Ep 1 · 1:41
host_summaryType 2 laryngeal cleft means it extends below the vocal cords.↗
▶Ep 1 · 1:41
host_summaryType 1 laryngeal cleft means the opening is above the vocal cords.↗
▶Ep 1 · 1:41
quoteYou want raw against raw. Mucosa is a nonstick surface. Get rid of the mucosa. You want a wide strip of raw against a wide strip of raw.↗
▶Ep 1 · 1:41
quoteFlexible bronchoscopy is not adequate for diagnosing a posterior laryngeal cleft.↗
host_summarySennosides or bisacodyl can be used to induce high-amplitude propagated contractions (HAPCs).↗
▶Ep 4 · 7:15
host_summaryWhen an HAPC occurs, the internal anal sphincter should relax (coloanal reflex) to allow stool evacuation.↗
▶Ep 4 · 8:06
host_summaryFluoroscopy (C-arm) is used during manometry catheter placement to confirm exact positioning.↗
▶Ep 4 · 8:51
host_summaryWhen an HAPC reaches the sigmoid or rectum, the internal anal sphincter relaxes to allow defecation.↗
▶Ep 4 · 9:51
host_summaryDecisions about surgical intervention for segmental dysmotility are based not only on manometry but also on imaging (contrast enema), physical exam, and patient/family history.↗
▶Ep 4 · 13:56
host_summaryPerforming duodenal and colonic manometry in a patient with gastroparesis is valuable because it rules out more widespread dysmotility, which is especially important in patients with anorectal malformations.↗
Intestinal rehabilitation: What is intestinal rehab? - Episode 1
▶Ep 5 · 2:24
host_summaryNew guidelines define intestinal failure as requiring parenteral support for at least 60 days due to inadequate intestinal function.↗
▶Ep 5 · 3:33
host_summaryIntestinal rehabilitation requires managing comorbidities including sepsis and liver disease that challenge infant growth.↗
▶Ep 5 · 8:41
host_summaryAccess and availability to intestinal rehabilitation programs is still very rare.↗
▶Ep 5 · 12:34
host_summaryOverall long-term survival in major intestinal rehabilitation programs is usually over 90%.↗
Intestinal Rehabilitation, Episode 1: What is intestinal rehabilitation?
▶Ep 6 · 2:24
host_summaryNew guidelines define intestinal failure as inadequate intestinal function requiring parenteral support for at least 60 days.↗
▶Ep 6 · 3:33
host_summaryIntestinal rehabilitation requires managing comorbidities including sepsis and liver disease that challenge infant growth.↗
▶Ep 6 · 12:34
host_summaryOverall survival in big intestinal rehabilitation programs is usually over 90% long-term.↗
epidemiologicalNeural tube defects are the most common congenital central nervous system anomaly↗
▶Ep 3 · 1:20
epidemiologicalMyelomeningocele or spina bifida is the most common neural tube defect↗
▶Ep 3 · 1:25
clinicalIn myelomeningocele, the patient is born with a cleft in the vertebral column and a defect in the skin so the meninges and spinal cord are exposed↗
▶Ep 3 · 1:33
clinicalThe patient may be left with neural defects based on the level of the spinal cord where the lesion is↗
▶Ep 3 · 2:51
clinicalFetal anesthesia is induced via an intragluteal injection↗
▶Ep 3 · 3:08
clinicalThe sack is opened and dissection is performed circumferentially around it↗
▶Ep 3 · 5:14
clinicalIf able, the baby is delivered vaginally at term↗
Journal of Pediatric Surgery Article Review: January 2022 APSA Issue
▶Ep 4 · 3:58
host_summaryExternal federal research funding at Nationwide increased from $750,000 to $5.7 million, representing a 7.7-fold increase.↗
Journal of Pediatric Surgery Article Highlights: April 2022
▶Ep 5 · 4:31
quoteI am not smart enough to select an article like this, and I'm absolutely astounded by it.↗
▶Ep 5 · 4:58
clinicalThe fetal surgery survey was of non-trainee surgeons within the American Pediatric Surgical Association to gauge practice patterns in fetal surgery across the country↗
Journal of Pediatric Surgery Article Review: October 2021
▶Ep 5 · 2:50
quoteWe might congratulate ourselves for having done a good job in perhaps saving the kid and identifying the problem, but perhaps not aware that we have a responsibility uh for the long-term health and uh we have to be advocates for the children.↗
▶Ep 5 · 2:50
host_summaryComplete metadata for medical education content includes title, description, summary, keywords, duration, content type, specialty area, target audience level, and language.↗
▶Ep 5 · 8:32
quoteIt is obvious that we currently do not have the objective clinical markers, whether they are the uh clinical features or uh novel biomarkers to help us make an earlier decision.↗
▶Ep 5 · 8:32
host_summaryWe currently do not have objective clinical markers, whether clinical features or novel biomarkers, to help make earlier surgical decisions in NEC.↗
▶Ep 5 · 17:03
host_summaryThe Italian study provides sufficient evidence to convince clinicians who are not doing routine spinal cord and spine assessment in anorectal malformation patients that they should be more serious with imaging.↗
Intestinal Rehabilitation, Episode 3: Enteral Autonomy, Part 1
▶Ep 7 · 10:34
clinicalA full-term baby is born with approximately 160 centimeters of small bowel↗
▶Ep 7 · 12:58
clinicalBacterial colonization of the intestines is part of the adaptive response↗
Stay Current Throwbacks Necrotizing Enterocolitis with Dr. Gail Besner
▶Ep 8 · 46:18
clinicalNEST trial results published in fall 2021 showed no overall difference in death or neurodevelopmental impairment between laparotomy and drainage groups↗
▶Ep 8 · 46:50
clinicalIn the NEST trial, neonates diagnosed with NEC (versus isolated perforation) had approximately 20% decrease in death rate with laparotomy compared to drainage↗
clinicalSurgical indications for anorectal malformation include: locating the perineal fistula, determining if it is in the correct location, assessing if it is too big or too small, confirming it is within the sphincter, and evaluating the size of the perineal body↗
▶Ep 9 · 13:38
clinicalHagar dilators should be used to check anal size, starting low and working up for accurate measurement, rather than using fingers because every surgeon has a different size glove↗
opinionIf you don't get anorectoplasty perfect, you might not have the best outcomes, which separates it from other surgical procedures↗
▶Ep 1 · 0:00
quoteAnal rectoplasty. It's an incredibly particular procedure and as many of you know, if you don't get it perfect, you might not have the best outcomes.↗
▶Ep 1 · 0:50
opinionA lot of surgeons agree that oftentimes your first shot might be your only shot to give this patient a good outcome and the right anatomy↗
▶Ep 1 · 1:25
quoteHow many patients, Jason, have you seen on laxatives that comes with an anus in the wrong place? How many patients have you seen having had a cecostomy with perfect anatomy? That's the real frustrating one.↗
▶Ep 1 · 5:50
opinionThe family doesn't really care how technically elegant is your anaplasty. What they care about is whether that anaplasty that you make is going to work↗
▶Ep 1 · 5:50
quoteI can tell you, the family doesn't really care how technically elegant is your analplasty. What they care about is whether that analplasty that you make is going to work.↗
▶Ep 1 · 6:15
clinicalThe higher the malformation is, the worse the prognosis↗
▶Ep 1 · 6:30
clinicalSacrum ratio 0.7 or greater usually means normal or close to normal sphincters and good muscle tone and spine innervation↗
▶Ep 1 · 6:55
clinicalPatients with myelomeningocele have much more trouble with continence↗
▶Ep 1 · 6:55
clinicalThe most common associated spinal anomaly is tethered cord, but the worst is myelomeningocele↗
▶Ep 1 · 7:44
clinicalIt's amazingly common to have a mislocated anus↗
▶Ep 1 · 7:44
quoteIt's amazingly common to have a mislocated anus.↗
▶Ep 1 · 7:55
quoteI think a key pitfall is not do that. Mark the sphincters first, then open the PSARP because then you don't get confused at the end when you're trying to place the anoplasty in the correct location.↗
▶Ep 1 · 7:55
clinicalA key pitfall is opening the PSARP incision first; you should mark the sphincters first, then open the PSARP so you don't get confused when placing the anoplasty↗
▶Ep 1 · 10:40
clinicalIn higher malformations like bladder neck fistula in a boy, the sphincter complex isn't always where you think it's going to be; sometimes those sphincter complexes are more anterior than anticipated↗
Colorectal Quiz: Episode 2
▶Ep 5 · 0:00
opinionAnorectoplasty is an incredibly particular procedure where if you don't get it perfect, you might not have the best outcomes↗
▶Ep 5 · 0:20
opinionOftentimes your first shot might be your only shot to give this patient a good outcome↗
Case-Based Journal Review- Intussusception in 2022
▶Ep 14 · 2:12
clinicalPoint-of-care ultrasound for intussusception diagnosis has approximately 95% sensitivity and 99% specificity↗
▶Ep 14 · 5:50
clinicalUltrasound-guided hydrostatic reduction has a 95.8% success rate versus 93.1% for fluoroscopy-guided air reduction↗
▶Ep 14 · 7:58
clinicalObstructive gas pattern on radiograph is associated with decreased success of air enema and increased need for bowel resection↗
▶Ep 14 · 8:50
clinicalA prediction model using clinical and sonographic data can identify 80% of failed ultrasound-guided saline enema reductions before the procedure↗
▶Ep 14 · 9:06
clinicalFree fluid and extension beyond the splenic angle are sonographic predictors of failed reduction↗
▶Ep 14 · 9:06
clinicalAltered Doppler signal is a predictor of failed enema reduction↗
▶Ep 14 · 11:27
clinicalRecurrence rates were 10% for ketamine and 15% for morphine, not statistically significant↗
▶Ep 14 · 11:27
clinicalKetamine sedation had 90% success rate versus 70% for morphine analgesia during hydrostatic reduction, but difference was not statistically significant↗
▶Ep 14 · 13:23
clinicalSystematic review found no significant difference in emergency department returns, recurrence, need for operation, or mortality between inpatient and outpatient management after successful air enema reduction↗
▶Ep 14 · 15:31
epidemiologicalNationwide database study of 8,289 patients found 3.7% readmission and recurrence rate after intussusception reduction↗
Case Based Journal Review - CPAM in 2022
▶Ep 15 · 2:43
clinicalOf the conservatively managed patients who were followed up, none became symptomatic↗
▶Ep 15 · 4:36
quoteOut of the 344 prenatally diagnosed lesions, actually, none of them had malignant pathology when they were resected.↗
▶Ep 15 · 4:36
clinicalOut of 344 prenatally diagnosed lesions, none had malignant pathology when resected↗
▶Ep 15 · 7:50
clinicalThere was no significant difference in conversion rate from thoracoscopic to open between groups with and without prior infection↗
▶Ep 15 · 10:08
clinicalThere were no differences in major complications, conversion rates, or readmissions between age groups↗
Commercial Audio Only (1080p)
▶Ep 36 · 0:00
clinicalThe speaker is Rod Gerardo from Cincinnati Children's↗
▶Ep 36 · 0:00
quoteHi, it's Rod Gerardo from Cincinnati Children's, and we have some brand new content for you.↗
▶Ep 36 · 0:06
quoteNo, it's not like our YouTube videos or our podcast where we get deep in the weeds with pediatric surgery.↗
▶Ep 36 · 0:10
opinionThe new content format differs from existing YouTube videos and podcasts that go deep in the weeds with pediatric surgery↗
▶Ep 36 · 0:20
quoteI and Dr. Jeff Ponsky are going to interview our friends from around the globe, residents, fellows, attendings.↗
▶Ep 36 · 0:20
clinicalDr. Jeff Ponsky will co-conduct interviews with Rod Gerardo↗
▶Ep 36 · 0:24
clinicalInterview subjects will include residents, fellows, and attendings from around the globe↗
▶Ep 36 · 0:28
clinicalTopics will cover resident wellness, general surgery concepts, and new technologies↗
▶Ep 36 · 0:32
clinicalEpisodes will be available on the Stay Current Pediatric Surgery app and social media channels↗
Intestinal rehabilitation: What is intestinal rehab? - Episode 1
▶Ep 3 · 2:24
host_summaryNew guidelines define intestinal failure as requiring parenteral support for at least 60 days due to inadequate intestinal function.↗
▶Ep 3 · 3:33
host_summaryIntestinal rehabilitation requires managing comorbidities including sepsis and liver disease that challenge infant growth.↗
▶Ep 3 · 8:41
host_summaryAccess and availability to intestinal rehabilitation programs is still very rare.↗
▶Ep 3 · 12:34
host_summaryOverall long-term survival in major intestinal rehabilitation programs is usually over 90%.↗
Intestinal Rehabilitation, Episode 1: What is intestinal rehabilitation?
▶Ep 4 · 2:24
host_summaryNew guidelines define intestinal failure as inadequate intestinal function requiring parenteral support for at least 60 days.↗
▶Ep 4 · 3:33
host_summaryIntestinal rehabilitation requires managing comorbidities including sepsis and liver disease that challenge infant growth.↗
▶Ep 4 · 12:34
host_summaryOverall survival in big intestinal rehabilitation programs is usually over 90% long-term.↗
Quick Literature Updates Episode 7
▶Ep 6 · 1:35
host_summaryPatients with less than 50% of their colon had significantly less time on parenteral nutrition as long as they had their ileocecal valve.↗
▶Ep 6 · 1:35
host_summaryInfants with an ileocecal valve had significantly shorter duration on parenteral nutrition.↗
▶Ep 6 · 1:35
host_summaryPeters et al. retrospectively reviewed 55 pediatric patients with small bowel syndrome to examine whether presence or absence of ileocecal valve and/or colon can predict enteral autonomy.↗
The Colorectal Quiz Episode 10: Total Colonic Hirschsprung Disease Part 1
▶Ep 1 · 4:07
clinicalFailure to pass meconium in newborns is most commonly caused by Hirschsprung disease, meconium plug syndrome, meconium ileus, or anorectal malformation↗
▶Ep 1 · 6:33
clinicalIn total colonic Hirschsprung disease, contrast enema shows cylindrical, amorphous colon without the classic rectosigmoid narrowing seen in typical Hirschsprung disease↗
The Colorectal Quiz Episode 11: Total Colonic Hirschsprung's Part 2
▶Ep 2 · 2:46
clinicalStudies showed no significant difference in skin excoriation between younger and older patients undergoing pull-through↗
▶Ep 2 · 6:26
clinicalOral sodium supplementation protocol: add 3 mEq/kg/day using recipe of 1 tablespoon salt plus 40 mL water (gives 2.5 mEq sodium per mL), continue 1-2 months then recheck urine sodium↗
▶Ep 2 · 9:38
clinicalGanglionated bowel can decompensate when there is slowing of stool in the Duhamel pouch↗
▶Ep 2 · 11:04
clinicalPatients with total colonic Hirschsprung disease are more susceptible to severe enterocolitis compared to traditional rectosigmoid Hirschsprung patients↗
▶Ep 2 · 11:16
clinicalFirst-line medical management is diet modification, which can be started before pull-through↗
Treatment for Long Gap Esophageal Atresia: Esophageal Elongation and Replacement
▶Ep 2 · 1:08
clinicalIn the Foker technique, surgeons tie sutures to both esophageal ends, externalize them through the chest wall, and progressively tighten them with spacers until the ends approximate↗
▶Ep 2 · 2:10
opinionThe Kimura technique is not used often anymore↗
▶Ep 2 · 2:10
clinicalThe van der Zee technique uses the same traction concept as Foker but is performed thoracoscopically with all tension maintained inside the thorax↗
▶Ep 2 · 2:10
clinicalThe Kimura technique creates a spit fistula that is progressively moved down the chest wall to stretch the proximal pouch toward the distal pouch↗
▶Ep 2 · 4:12
guidelineThe surgical dictum states that every effort should be made to conserve the native esophagus as no other conduit can replace its function satisfactorily↗
▶Ep 2 · 4:12
quoteWe were all taught the dictum that every effort should be made to conserve the native esophagus as no other conduit can replace its function in transporting food from the oral cavity to the stomach satisfactorily.↗
▶Ep 2 · 5:08
clinicalThe choice of colon segment for interposition is based on blood supply and required diameter↗
▶Ep 2 · 5:08
clinicalPyloroplasty is performed during colonic interposition to help with gastric emptying↗
▶Ep 2 · 5:08
clinicalIn colonic interposition, the colon is passed behind the stomach while maintaining blood supply↗
▶Ep 2 · 9:56
opinionThe short interval between traction initiation and anastomosis (less than five days in some cases) raises questions about whether the mechanism is growth or stretch↗
Gastroschisis and sutureless abdominal wall closure
▶Ep 3 · 1:44
quoteIn 2004, Tony Sandler published the first manuscript about suture disclosures to utilize the natural umbilical properties to closing that defect by itself.↗
▶Ep 3 · 1:44
host_summaryIn 2004, Tony Sandler published the first manuscript about sutureless closures utilizing the natural umbilical properties to close the gastroschisis defect by itself.↗
▶Ep 3 · 2:45
quoteI think it's clearly been a massive change in practice. It's one of the examples of a big change that we don't actually operate on those and they can be done at the bedside. And it also is an example of something that took a while to adopt. And now most people are doing it, I think.↗
▶Ep 3 · 2:45
quoteI didn't know about his article. I found out about it as a fellow when he taught us how to treat gastroschisis that way.↗
▶Ep 3 · 3:26
quoteThere have been so many articles in the last few years that go back and forth. I mean, one said gastro suture list is better. One said definitely don't do suture list. So my question is now, I don't know. I almost don't read these articles anymore.↗
▶Ep 3 · 5:29
quoteI think anytime it's a Kansas City or an NWSPC, NWPSC. Anytime it's an NWPSC article, I pay attention. Anytime it's a Kansas City article, I pay attention. But other than that, I'm tired of seeing all these gastroschisis articles. I'm waiting for someone to give me something that is really meaningful.↗
▶Ep 3 · 6:01
host_summaryThe positive outcomes for sutureless repair were observed even when considering patients who required silo use.↗
▶Ep 3 · 6:01
host_summaryThe Midwest Pediatric Surgery Consortium study was a retrospective cohort of infants born with gastroschisis between 2013 and 2016, with a total of 315 patients.↗
▶Ep 3 · 6:01
host_summarySutureless closure patients had less ventilator use compared to sutured closure patients.↗
▶Ep 3 · 6:01
host_summarySutureless closure patients had less antibiotic use compared to sutured closure patients.↗
▶Ep 3 · 6:01
host_summarySutureless closure patients had fewer surgical site and deep space infections compared to sutured closure patients.↗
▶Ep 3 · 6:01
host_summaryPatients who underwent sutureless abdominal wall closure had no difference in days on TPN, time to goal feeds, time to initial feeds, or length of stay compared to sutured closure.↗
▶Ep 3 · 6:01
host_summarySutureless closure patients had fewer episodes of general anesthetics compared to sutured closure patients.↗
▶Ep 3 · 6:01
host_summaryThe study divided patients into sutured versus sutureless abdominal wall closures and required subgroup analysis because some babies received silos and some did not.↗
▶Ep 3 · 11:13
quoteYeah, I think in general, I, I, you're right. I don't know how the pendulum is going to swing, but we are finding more and more. There are things that we don't have to operate on.↗
▶Ep 3 · 11:22
host_summaryGastroschisis is an abdominal wall defect that used to necessitate a trip to the OR and is now more like a safe bedside procedure.↗
Journal of Pediatric Surgery Article Highlights: April 2022
▶Ep 12 · 4:31
quoteI am not smart enough to select an article like this, and I'm absolutely astounded by it.↗
▶Ep 12 · 4:58
clinicalThe fetal surgery survey was of non-trainee surgeons within the American Pediatric Surgical Association to gauge practice patterns in fetal surgery across the country↗
