I think anytime it's a Kansas City or an NWSPC, NWPSC. He got there eventually. 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. He got there eventually. 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. He got there eventually. 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.
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.
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
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 · 1:44
clinicalTony Sandler published the first manuscript about sutureless closures utilizing natural umbilical properties to close the gastroschisis defect by itself in 2004↗
▶Ep 22 · 2:09
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. He got there eventually. 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
clinicalSutureless closure patients had fewer surgical site and deep space infections than sutured closure patients↗
▶Ep 22 · 6:01
clinicalSutureless closure patients had fewer episodes of general anesthetics than sutured closure patients↗
▶Ep 22 · 6:01
clinicalSutureless closure patients had less ventilator use than sutured closure patients↗
▶Ep 22 · 6:01
clinicalSutureless closure patients had less antibiotic use than sutured closure patients↗
▶Ep 22 · 6:01
clinicalSutureless closure showed no difference in length of stay compared to sutured closure↗
▶Ep 22 · 6:01
clinicalSutureless closure showed no difference in time to initial feeds compared to sutured closure↗
▶Ep 22 · 6:01
clinicalSutureless closure showed no difference in time to goal feeds compared to sutured closure↗
▶Ep 22 · 6:01
clinicalSutureless closure showed no difference in days on TPN compared to sutured closure↗
▶Ep 22 · 6:01
clinicalPatients were divided into sutured versus sutureless abdominal wall closure groups with subgroup analysis for those who received silos↗
▶Ep 22 · 6:01
epidemiologicalThe study included a total of 315 patients↗
▶Ep 22 · 6:01
clinicalThe study was a retrospective cohort of infants born with gastroschisis between 2013 and 2016↗
▶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
opinionGastroschisis is now more like a safe bedside procedure rather than necessitating a trip to the OR↗
Intestinal rehabilitation: What is intestinal rehab? - Episode 1
▶Ep 23 · 2:24
guidelineNew guidelines define intestinal failure as requiring parental support for at least 60 days↗
▶Ep 23 · 8:41
epidemiologicalAccess and availability to an intestinal rehab program is still very rare↗
▶Ep 23 · 8:51
clinicalThere are three time points when families reach intestinal rehab programs: prenatal diagnosis, postnatal acquired problems, and later diagnosis after discharge↗
▶Ep 23 · 12:34
epidemiologicalSurvival overall in big intestinal rehab programs is usually over 90% long-term survival↗
Intestinal Rehabilitation, Episode 1: What is intestinal rehabilitation?
▶Ep 24 · 2:24
guidelineFor a patient to be defined as having intestinal failure, they must have inadequate intestinal function necessitating parenteral support for at least 60 days↗
▶Ep 24 · 3:33
quoteIt's like a dream team, but for pediatric guts↗
▶Ep 24 · 12:34
epidemiologicalThe survival overall in big intestinal rehabilitation programs is usually over 90% long-term survival↗
Journal of Pediatric Surgery Article Review: January 2022 APSA Issue
▶Ep 26 · 3:58
clinicalExternal federal funding increased from $750,000 to $5.7 million, a 7.7-fold increase, after implementing the academic RVU system↗
Update Course 2021: UPDATE COURSE 2020: REVIEW OF LAST YEAR'S IMPORTANT T OPICS
▶Ep 28 · 3:47
clinicalIntraoperative ICG can be used to determine biliary flow or identify a transaction↗
▶Ep 28 · 3:47
clinicalMMP7 could be used to distinguish biliary atresia from other cholestatic diseases↗
▶Ep 28 · 5:48
quoteUnfortunately, as you know, some of these children present at five weeks, and we have a limited time to get the best possible outcomes for them.↗
▶Ep 28 · 5:48
clinicalMMP7 testing is often a send-out test at non-freestanding children's hospitals↗
▶Ep 28 · 5:48
clinicalChildren with biliary atresia presenting at five weeks have limited time to achieve best outcomes↗
▶Ep 28 · 8:30
guidelineFor pediatric trauma patients, early blood therapy and massive transfusion protocol are where ATLS and literature are leading↗
▶Ep 28 · 8:30
clinicalThere is currently no great definition of what constitutes massive transfusion protocol in pediatric patients↗
▶Ep 28 · 8:30
clinicalBalanced resuscitation should be initiated when approaching 40 cc per kg blood transfusion↗
▶Ep 28 · 8:40
quoteI think currently we don't have a great definition of what an MTP is in pediatric patients. There's still a lot of debate about what constitutes that.↗
▶Ep 28 · 10:35
epidemiologicalHypertonic saline is the most common sclerotherapy choice at 46%, with phenol, ethyl alcohol, and dextrose in water at 10-16% each↗
▶Ep 28 · 11:48
clinical3% sotradecol is used as an alternative sclerotherapy agent↗
▶Ep 28 · 11:56
clinicalD50 from the code cart is easier to acquire than 3% saline in some operating rooms↗
▶Ep 28 · 15:40
quoteI think getting patients out of the hospital sooner is a huge advantage as we get pushed for volumes. And it's a lot nicer for the patients to be at home.↗
▶Ep 28 · 16:14
clinicalERAS is a bundle of interventions to help patients get through the hospital faster with less pain and less narcotics↗
▶Ep 28 · 16:14
quoteEnhanced recovery after surgery. For those that don't know, it's actually, it's a bundle. Just like we have central line bundles to prevent infection, this is a bundle to help the patient get through the hospital faster with less pain, less narcotics, up and moving around.↗
▶Ep 28 · 16:14
clinicalERAS includes a carbohydrate drink two hours before surgery, changing from traditional NPO protocols↗
▶Ep 28 · 16:42
opinionERAS implementation requires anesthesiologist buy-in because it represents a big change from traditional practice↗
▶Ep 28 · 17:55
opinionERAS protocols are difficult to implement because they require the whole hospital to adopt a different culture and philosophy↗
▶Ep 28 · 19:09
clinicalSurgical pathways have led to decreased cost, antibiotic utilization, and decreased length of stay↗
▶Ep 28 · 19:09
clinicalSurgical pathways created for ERAS are used more by hospitalists and pediatric residents than any other pathways↗
▶Ep 28 · 19:42
opinionStarting with one component like decreasing opioid use intraoperatively and perioperatively can be an entry point for larger ERAS implementation↗
▶Ep 28 · 21:18
quoteI'll start with an energy source. You know, one of the sealing devices I think usually work pretty well. Remember, it's a low-pressure system. And then if you need to, then if that's not working, you can go to a clip, and you can even suture if you have to.↗
▶Ep 28 · 21:18
clinicalFor pulmonary vessel bleeding during thoracoscopic lobectomy, energy sources work well as initial hemostasis because it is a low-pressure system↗
▶Ep 28 · 21:38
clinicalMultiple hemostasis options including energy, clips, and sutures should be available for thoracoscopic vessel bleeding↗
Quick Literature Updates Episode 6
▶Ep 30 · 2:50
clinicalThere was no significant difference in the rate of successful primary closure between intubated and non-intubated neonates with gastroschisis↗
▶Ep 30 · 2:50
clinicalThe Miyata study used data from the Canadian Association of Pediatric Surgery Network for pediatric patients with gastroschisis who underwent bedside reduction and closure↗
quoteIs there anything that's beaten into our heads more during surgical training than the ABCs? I'm talking about airway, breathing, and circulation. And as you know, airway reigns supreme↗
▶Ep 10 · 1:41
clinicalType 1 laryngeal cleft means the opening is above the vocal cords↗
▶Ep 10 · 1:41
quoteFlexible bronchoscopy is not adequate for diagnosing a posterior laryngeal cleft↗
▶Ep 10 · 1:41
clinicalFlexible bronchoscopy is not adequate for diagnosing a posterior laryngeal cleft↗
▶Ep 10 · 1:41
clinicalType 4 cleft could be proximal above the carina, at the carina, or go straight through the carina↗
▶Ep 10 · 1:41
clinicalType 3 laryngeal cleft means it extends down into the trachea↗
▶Ep 10 · 1:41
clinicalType 2 laryngeal cleft means it extends below the vocal cords↗
▶Ep 10 · 3:43
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 · 3:43
clinicalThe endoscopic mass closure technique uses the concept of raw against raw surfaces, as mucosa is a nonstick surface↗
Quick Literature Updates Episode 8
▶Ep 14 · 1:31
clinical92% of patients who received Nuss bar repair were discharged on post-operative day one↗
▶Ep 14 · 1:31
clinicalIn the Nuss repair study, approximately 40 pediatric patients received a Nuss bar repair for pectus excavatum with perioperative ERAS pain protocol↗
▶Ep 14 · 1:31
quote92% of the patients were discharged on post-operative day one.↗
▶Ep 14 · 1:31
clinicalThere was a reduction in the total number of morphine equivalent doses that Nuss repair patients received without any difference in their pain scores at the time of discharge↗
Update Course 2021: UPDATE COURSE 2020: REVIEW OF LAST YEAR'S IMPORTANT T OPICS
▶Ep 11 · 3:47
clinicalIntraoperative ICG can be used to determine biliary flow or identify a transaction↗
▶Ep 11 · 3:47
clinicalMMP7 could be used to distinguish biliary atresia from other cholestatic diseases↗
▶Ep 11 · 5:48
quoteUnfortunately, as you know, some of these children present at five weeks, and we have a limited time to get the best possible outcomes for them.↗
▶Ep 11 · 5:48
clinicalMMP7 testing is often a send-out test at non-freestanding children's hospitals↗
▶Ep 11 · 5:48
clinicalChildren with biliary atresia presenting at five weeks have limited time to achieve best outcomes↗
▶Ep 11 · 8:30
clinicalBalanced resuscitation should be initiated when approaching 40 cc per kg blood transfusion↗
▶Ep 11 · 8:30
guidelineFor pediatric trauma patients, early blood therapy and massive transfusion protocol are where ATLS and literature are leading↗
▶Ep 11 · 8:30
clinicalThere is currently no great definition of what constitutes massive transfusion protocol in pediatric patients↗
▶Ep 11 · 8:40
quoteI think currently we don't have a great definition of what an MTP is in pediatric patients. There's still a lot of debate about what constitutes that.↗
▶Ep 11 · 10:35
epidemiologicalHypertonic saline is the most common sclerotherapy choice at 46%, with phenol, ethyl alcohol, and dextrose in water at 10-16% each↗
▶Ep 11 · 11:48
clinical3% sotradecol is used as an alternative sclerotherapy agent↗
▶Ep 11 · 11:56
clinicalD50 from the code cart is easier to acquire than 3% saline in some operating rooms↗
▶Ep 11 · 15:40
quoteI think getting patients out of the hospital sooner is a huge advantage as we get pushed for volumes. And it's a lot nicer for the patients to be at home.↗
▶Ep 11 · 16:14
quoteEnhanced recovery after surgery. For those that don't know, it's actually, it's a bundle. Just like we have central line bundles to prevent infection, this is a bundle to help the patient get through the hospital faster with less pain, less narcotics, up and moving around.↗
▶Ep 11 · 16:14
clinicalERAS includes a carbohydrate drink two hours before surgery, changing from traditional NPO protocols↗
▶Ep 11 · 16:14
clinicalERAS is a bundle of interventions to help patients get through the hospital faster with less pain and less narcotics↗
▶Ep 11 · 16:42
opinionERAS implementation requires anesthesiologist buy-in because it represents a big change from traditional practice↗
▶Ep 11 · 17:55
opinionERAS protocols are difficult to implement because they require the whole hospital to adopt a different culture and philosophy↗
▶Ep 11 · 19:09
clinicalSurgical pathways created for ERAS are used more by hospitalists and pediatric residents than any other pathways↗
▶Ep 11 · 19:09
clinicalSurgical pathways have led to decreased cost, antibiotic utilization, and decreased length of stay↗
▶Ep 11 · 19:42
opinionStarting with one component like decreasing opioid use intraoperatively and perioperatively can be an entry point for larger ERAS implementation↗
▶Ep 11 · 21:18
clinicalFor pulmonary vessel bleeding during thoracoscopic lobectomy, energy sources work well as initial hemostasis because it is a low-pressure system↗
▶Ep 11 · 21:18
quoteI'll start with an energy source. You know, one of the sealing devices I think usually work pretty well. Remember, it's a low-pressure system. And then if you need to, then if that's not working, you can go to a clip, and you can even suture if you have to.↗
▶Ep 11 · 21:38
clinicalMultiple hemostasis options including energy, clips, and sutures should be available for thoracoscopic vessel bleeding↗
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
clinicalThe most common associated spinal anomaly is tethered cord, but the worst is myelomeningocele↗
▶Ep 85 · 6:55
clinicalPatients with myelomeningocele have much more trouble with continence↗
▶Ep 85 · 7:44
clinicalIt's amazingly common to have a mislocated anus↗
▶Ep 85 · 7:44
quoteIt's amazingly common to have a mislocated anus.↗
▶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 · 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 · 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↗
clinicalSennosides or bisacodyl can be used to induce high-amplitude propagated contractions.↗
▶Ep 104 · 7:15
clinicalWhen an HAPC occurs, the internal anal sphincter should relax (choloanal reflex) to allow stool evacuation.↗
▶Ep 104 · 14:03
opinionDuodenal and colonic manometry can rule out more widespread dysmotility, which is invaluable information in a patient with an anorectal malformation.↗
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 · 8:32
clinicalThere are currently no objective clinical markers or novel biomarkers to help make earlier surgical decisions in NEC↗
Intestinal rehabilitation: What is intestinal rehab? - Episode 1
▶Ep 112 · 2:24
guidelineNew guidelines define intestinal failure as requiring parental support for at least 60 days↗
▶Ep 112 · 8:41
epidemiologicalAccess and availability to an intestinal rehab program is still very rare↗
▶Ep 112 · 8:51
clinicalThere are three time points when families reach intestinal rehab programs: prenatal diagnosis, postnatal acquired problems, and later diagnosis after discharge↗
▶Ep 112 · 12:34
epidemiologicalSurvival overall in big intestinal rehab programs is usually over 90% long-term survival↗
Intestinal Rehabilitation, Episode 1: What is intestinal rehabilitation?
▶Ep 113 · 2:24
guidelineFor a patient to be defined as having intestinal failure, they must have inadequate intestinal function necessitating parenteral support for at least 60 days↗
▶Ep 113 · 3:33
quoteIt's like a dream team, but for pediatric guts↗
▶Ep 113 · 12:34
epidemiologicalThe survival overall in big intestinal rehabilitation programs is usually over 90% long-term survival↗
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
clinicalThe Peters et al. study examined 55 pediatric patients with short bowel syndrome↗
▶Ep 138 · 1:50
clinicalInfants with an ileocecal valve had significantly shorter duration on parenteral nutrition↗
▶Ep 138 · 2:05
clinicalPatients with less than 50% of their colon had significantly less time on parenteral nutrition as long as they had their ileocecal valve↗
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
clinicalFor cross-table lateral, baby is positioned prone with buttock at highest point where air will rise to↗
▶Ep 244 · 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
clinicalTony Sandler published the first manuscript about sutureless closures utilizing natural umbilical properties to close the gastroschisis defect by itself in 2004↗
▶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 · 2:09
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. He got there eventually. 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
clinicalSutureless closure patients had less ventilator use than sutured closure patients↗
▶Ep 31 · 6:01
clinicalSutureless closure showed no difference in length of stay compared to sutured closure↗
▶Ep 31 · 6:01
clinicalSutureless closure showed no difference in time to initial feeds compared to sutured closure↗
▶Ep 31 · 6:01
clinicalSutureless closure showed no difference in time to goal feeds compared to sutured closure↗
▶Ep 31 · 6:01
clinicalSutureless closure showed no difference in days on TPN compared to sutured closure↗
▶Ep 31 · 6:01
clinicalPatients were divided into sutured versus sutureless abdominal wall closure groups with subgroup analysis for those who received silos↗
▶Ep 31 · 6:01
epidemiologicalThe study included a total of 315 patients↗
▶Ep 31 · 6:01
clinicalThe study was a retrospective cohort of infants born with gastroschisis between 2013 and 2016↗
▶Ep 31 · 6:01
clinicalSutureless closure patients had fewer surgical site and deep space infections than sutured closure patients↗
▶Ep 31 · 6:01
clinicalSutureless closure patients had fewer episodes of general anesthetics than sutured closure patients↗
▶Ep 31 · 6:01
clinicalSutureless closure patients had less antibiotic use than 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
opinionGastroschisis is now more like a safe bedside procedure rather than necessitating a trip to the OR↗
Journal of Pediatric Surgery Article Review: October 2021
▶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
clinicalThere are currently no objective clinical markers or novel biomarkers to help make earlier surgical decisions in NEC↗
Intestinal rehabilitation: What is intestinal rehab? - Episode 1
▶Ep 34 · 2:24
guidelineNew guidelines define intestinal failure as requiring parental support for at least 60 days↗
▶Ep 34 · 8:41
epidemiologicalAccess and availability to an intestinal rehab program is still very rare↗
▶Ep 34 · 8:51
clinicalThere are three time points when families reach intestinal rehab programs: prenatal diagnosis, postnatal acquired problems, and later diagnosis after discharge↗
▶Ep 34 · 12:34
epidemiologicalSurvival overall in big intestinal rehab programs is usually over 90% long-term survival↗
Intestinal Rehabilitation, Episode 1: What is intestinal rehabilitation?
▶Ep 35 · 2:24
guidelineFor a patient to be defined as having intestinal failure, they must have inadequate intestinal function necessitating parenteral support for at least 60 days↗
▶Ep 35 · 3:33
quoteIt's like a dream team, but for pediatric guts↗
▶Ep 35 · 12:34
epidemiologicalThe survival overall in big intestinal rehabilitation programs is usually over 90% long-term survival↗
Intestinal Rehabilitation, Episode 2: Overwhelming intestinal damage, Part 1
▶Ep 36 · 2:20
clinicalThe conversation with the family and understanding of the family's wishes is important to figure out if the baby is salvageable or not salvageable↗
Journal of Pediatric Surgery Article Review: January 2022 APSA Issue
▶Ep 38 · 3:58
clinicalExternal federal funding increased from $750,000 to $5.7 million, a 7.7-fold increase, after implementing the academic RVU system↗
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↗
Update Course 2021: UPDATE COURSE 2020: REVIEW OF LAST YEAR'S IMPORTANT T OPICS
▶Ep 42 · 3:47
clinicalMMP7 could be used to distinguish biliary atresia from other cholestatic diseases↗
▶Ep 42 · 3:47
clinicalIntraoperative ICG can be used to determine biliary flow or identify a transaction↗
▶Ep 42 · 5:48
quoteUnfortunately, as you know, some of these children present at five weeks, and we have a limited time to get the best possible outcomes for them.↗
▶Ep 42 · 5:48
clinicalMMP7 testing is often a send-out test at non-freestanding children's hospitals↗
▶Ep 42 · 5:48
clinicalChildren with biliary atresia presenting at five weeks have limited time to achieve best outcomes↗
▶Ep 42 · 8:30
clinicalThere is currently no great definition of what constitutes massive transfusion protocol in pediatric patients↗
▶Ep 42 · 8:30
clinicalBalanced resuscitation should be initiated when approaching 40 cc per kg blood transfusion↗
▶Ep 42 · 8:30
guidelineFor pediatric trauma patients, early blood therapy and massive transfusion protocol are where ATLS and literature are leading↗
▶Ep 42 · 8:40
quoteI think currently we don't have a great definition of what an MTP is in pediatric patients. There's still a lot of debate about what constitutes that.↗
▶Ep 42 · 10:35
epidemiologicalHypertonic saline is the most common sclerotherapy choice at 46%, with phenol, ethyl alcohol, and dextrose in water at 10-16% each↗
▶Ep 42 · 11:48
clinical3% sotradecol is used as an alternative sclerotherapy agent↗
▶Ep 42 · 11:56
clinicalD50 from the code cart is easier to acquire than 3% saline in some operating rooms↗
▶Ep 42 · 15:40
quoteI think getting patients out of the hospital sooner is a huge advantage as we get pushed for volumes. And it's a lot nicer for the patients to be at home.↗
▶Ep 42 · 16:14
clinicalERAS includes a carbohydrate drink two hours before surgery, changing from traditional NPO protocols↗
▶Ep 42 · 16:14
quoteEnhanced recovery after surgery. For those that don't know, it's actually, it's a bundle. Just like we have central line bundles to prevent infection, this is a bundle to help the patient get through the hospital faster with less pain, less narcotics, up and moving around.↗
▶Ep 42 · 16:14
clinicalERAS is a bundle of interventions to help patients get through the hospital faster with less pain and less narcotics↗
▶Ep 42 · 16:42
opinionERAS implementation requires anesthesiologist buy-in because it represents a big change from traditional practice↗
▶Ep 42 · 17:55
opinionERAS protocols are difficult to implement because they require the whole hospital to adopt a different culture and philosophy↗
▶Ep 42 · 19:09
clinicalSurgical pathways created for ERAS are used more by hospitalists and pediatric residents than any other pathways↗
▶Ep 42 · 19:09
clinicalSurgical pathways have led to decreased cost, antibiotic utilization, and decreased length of stay↗
▶Ep 42 · 19:42
opinionStarting with one component like decreasing opioid use intraoperatively and perioperatively can be an entry point for larger ERAS implementation↗
▶Ep 42 · 21:18
clinicalFor pulmonary vessel bleeding during thoracoscopic lobectomy, energy sources work well as initial hemostasis because it is a low-pressure system↗
▶Ep 42 · 21:18
quoteI'll start with an energy source. You know, one of the sealing devices I think usually work pretty well. Remember, it's a low-pressure system. And then if you need to, then if that's not working, you can go to a clip, and you can even suture if you have to.↗
▶Ep 42 · 21:38
clinicalMultiple hemostasis options including energy, clips, and sutures should be available for thoracoscopic vessel bleeding↗
Neonatal Gastric Volvulus with Dr. Jason Frischer
▶Ep 43 · 1:18
epidemiologicalGastric volvulus is associated with eventration of the diaphragm about 25% of the time↗
▶Ep 43 · 1:18
epidemiologicalGastric volvulus is associated with CDH about 17% of the time↗
▶Ep 43 · 2:13
clinicalAcute gastric volvulus is usually due to anatomic problems like CDH↗
▶Ep 43 · 3:27
clinicalWithout ligamentous attachments, the stomach is only fixed at two points: the GE junction and the pylorus↗
▶Ep 43 · 4:58
clinicalTypical presentation includes non-bilious emesis, gastric distention, and possible history of CDH↗
▶Ep 43 · 5:10
clinicalPlain films may show significant gastric distention in gastric volvulus↗
▶Ep 43 · 5:10
clinicalPatients with gastric volvulus typically have issues with NG tube passage↗
▶Ep 43 · 5:21
clinicalContrast study is the next diagnostic step after plain films↗
▶Ep 43 · 5:49
clinicalA classic bird's beak appearance may be seen when contrast is in the esophagus or at the GE junction↗
▶Ep 43 · 6:08
clinicalIn mesenteroaxial volvulus, the duodenum may fill above or superior to the GE junction↗
▶Ep 43 · 7:34
clinicalGastropexy should be performed at at least one additional location beyond the G-tube site↗
▶Ep 43 · 7:37
clinicalThe goal of multiple gastropexy sites is to fix the stomach in multiple planes to reduce recurrence risk↗
▶Ep 43 · 7:47
clinicalFundoplication is not required in pediatric gastric volvulus repair, unlike in adult practice↗
▶Ep 43 · 8:53
clinicalPatients may have latent onset with volvulus present longer than clinically apparent↗
▶Ep 43 · 9:49
clinicalFull set of labs should be sent during resuscitation↗
Quick Literature Updates Episode 6
▶Ep 49 · 2:50
clinicalThe Miyata study used data from the Canadian Association of Pediatric Surgery Network for pediatric patients with gastroschisis who underwent bedside reduction and closure↗
▶Ep 49 · 2:50
clinicalThere was no significant difference in the rate of successful primary closure between intubated and non-intubated neonates with gastroschisis↗
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 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 · 2:10
opinionThe Kimura technique is not used often anymore↗
▶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 · 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 · 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 · 5:08
clinicalIn colonic interposition, the colon is passed behind the stomach while maintaining blood supply↗
▶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 · 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
clinicalExternal federal funding increased from $750,000 to $5.7 million, a 7.7-fold increase, after implementing the academic RVU system↗
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↗
Intestinal rehabilitation: What is intestinal rehab? - Episode 1
▶Ep 8 · 2:24
guidelineNew guidelines define intestinal failure as requiring parental support for at least 60 days↗
▶Ep 8 · 8:41
epidemiologicalAccess and availability to an intestinal rehab program is still very rare↗
▶Ep 8 · 8:51
clinicalThere are three time points when families reach intestinal rehab programs: prenatal diagnosis, postnatal acquired problems, and later diagnosis after discharge↗
▶Ep 8 · 12:34
epidemiologicalSurvival overall in big intestinal rehab programs is usually over 90% long-term survival↗
Intestinal Rehabilitation, Episode 1: What is intestinal rehabilitation?
▶Ep 9 · 2:24
guidelineFor a patient to be defined as having intestinal failure, they must have inadequate intestinal function necessitating parenteral support for at least 60 days↗
▶Ep 9 · 3:33
quoteIt's like a dream team, but for pediatric guts↗
▶Ep 9 · 12:34
epidemiologicalThe survival overall in big intestinal rehabilitation programs is usually over 90% long-term survival↗
Intestinal Rehabilitation, Episode 2: Overwhelming intestinal damage, Part 1
▶Ep 10 · 2:20
clinicalThe conversation with the family and understanding of the family's wishes is important to figure out if the baby is salvageable or not salvageable↗
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↗
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
clinicalTony Sandler published the first manuscript about sutureless closures utilizing natural umbilical properties to close the gastroschisis defect by itself in 2004↗
▶Ep 40 · 2:09
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. He got there eventually. 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
clinicalPatients were divided into sutured versus sutureless abdominal wall closure groups with subgroup analysis for those who received silos↗
▶Ep 40 · 6:01
clinicalSutureless closure showed no difference in time to goal feeds compared to sutured closure↗
▶Ep 40 · 6:01
clinicalSutureless closure showed no difference in days on TPN compared to sutured closure↗
▶Ep 40 · 6:01
epidemiologicalThe study included a total of 315 patients↗
▶Ep 40 · 6:01
clinicalThe study was a retrospective cohort of infants born with gastroschisis between 2013 and 2016↗
▶Ep 40 · 6:01
clinicalSutureless closure patients had less ventilator use than sutured closure patients↗
▶Ep 40 · 6:01
clinicalSutureless closure patients had fewer episodes of general anesthetics than sutured closure patients↗
▶Ep 40 · 6:01
clinicalSutureless closure patients had fewer surgical site and deep space infections than sutured closure patients↗
▶Ep 40 · 6:01
clinicalSutureless closure patients had less antibiotic use than sutured closure patients↗
▶Ep 40 · 6:01
clinicalSutureless closure showed no difference in length of stay compared to sutured closure↗
▶Ep 40 · 6:01
clinicalSutureless closure showed no difference in time to initial feeds compared to sutured closure↗
▶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
opinionGastroschisis is now more like a safe bedside procedure rather than necessitating a trip to the OR↗
clinicalSennosides or bisacodyl can be used to induce high-amplitude propagated contractions.↗
▶Ep 44 · 7:15
clinicalWhen an HAPC occurs, the internal anal sphincter should relax (choloanal reflex) to allow stool evacuation.↗
▶Ep 44 · 14:03
opinionDuodenal and colonic manometry can rule out more widespread dysmotility, which is invaluable information in a patient with an anorectal malformation.↗
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 · 8:32
clinicalThere are currently no objective clinical markers or novel biomarkers to help make earlier surgical decisions in NEC↗
Intestinal rehabilitation: What is intestinal rehab? - Episode 1
▶Ep 46 · 2:24
guidelineNew guidelines define intestinal failure as requiring parental support for at least 60 days↗
▶Ep 46 · 8:41
epidemiologicalAccess and availability to an intestinal rehab program is still very rare↗
▶Ep 46 · 8:51
clinicalThere are three time points when families reach intestinal rehab programs: prenatal diagnosis, postnatal acquired problems, and later diagnosis after discharge↗
▶Ep 46 · 12:34
epidemiologicalSurvival overall in big intestinal rehab programs is usually over 90% long-term survival↗
Intestinal Rehabilitation, Episode 1: What is intestinal rehabilitation?
▶Ep 47 · 2:24
guidelineFor a patient to be defined as having intestinal failure, they must have inadequate intestinal function necessitating parenteral support for at least 60 days↗
▶Ep 47 · 3:33
quoteIt's like a dream team, but for pediatric guts↗
▶Ep 47 · 12:34
epidemiologicalThe survival overall in big intestinal rehabilitation programs is usually over 90% long-term survival↗
Intestinal Rehabilitation, Episode 2: Overwhelming intestinal damage, Part 1
▶Ep 48 · 2:20
clinicalThe conversation with the family and understanding of the family's wishes is important to figure out if the baby is salvageable or not salvageable↗
Journal of Pediatric Surgery Article Review: January 2022 APSA Issue
▶Ep 51 · 3:58
clinicalExternal federal funding increased from $750,000 to $5.7 million, a 7.7-fold increase, after implementing the academic RVU system↗
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↗
Update Course 2021: UPDATE COURSE 2020: REVIEW OF LAST YEAR'S IMPORTANT T OPICS
▶Ep 57 · 3:47
clinicalIntraoperative ICG can be used to determine biliary flow or identify a transaction↗
▶Ep 57 · 3:47
clinicalMMP7 could be used to distinguish biliary atresia from other cholestatic diseases↗
▶Ep 57 · 5:48
clinicalMMP7 testing is often a send-out test at non-freestanding children's hospitals↗
▶Ep 57 · 5:48
quoteUnfortunately, as you know, some of these children present at five weeks, and we have a limited time to get the best possible outcomes for them.↗
▶Ep 57 · 5:48
clinicalChildren with biliary atresia presenting at five weeks have limited time to achieve best outcomes↗
▶Ep 57 · 8:30
clinicalThere is currently no great definition of what constitutes massive transfusion protocol in pediatric patients↗
▶Ep 57 · 8:30
guidelineFor pediatric trauma patients, early blood therapy and massive transfusion protocol are where ATLS and literature are leading↗
▶Ep 57 · 8:30
clinicalBalanced resuscitation should be initiated when approaching 40 cc per kg blood transfusion↗
▶Ep 57 · 8:40
quoteI think currently we don't have a great definition of what an MTP is in pediatric patients. There's still a lot of debate about what constitutes that.↗
▶Ep 57 · 10:35
epidemiologicalHypertonic saline is the most common sclerotherapy choice at 46%, with phenol, ethyl alcohol, and dextrose in water at 10-16% each↗
▶Ep 57 · 11:48
clinical3% sotradecol is used as an alternative sclerotherapy agent↗
▶Ep 57 · 11:56
clinicalD50 from the code cart is easier to acquire than 3% saline in some operating rooms↗
▶Ep 57 · 15:40
quoteI think getting patients out of the hospital sooner is a huge advantage as we get pushed for volumes. And it's a lot nicer for the patients to be at home.↗
▶Ep 57 · 16:14
quoteEnhanced recovery after surgery. For those that don't know, it's actually, it's a bundle. Just like we have central line bundles to prevent infection, this is a bundle to help the patient get through the hospital faster with less pain, less narcotics, up and moving around.↗
▶Ep 57 · 16:14
clinicalERAS is a bundle of interventions to help patients get through the hospital faster with less pain and less narcotics↗
▶Ep 57 · 16:14
clinicalERAS includes a carbohydrate drink two hours before surgery, changing from traditional NPO protocols↗
▶Ep 57 · 16:42
opinionERAS implementation requires anesthesiologist buy-in because it represents a big change from traditional practice↗
▶Ep 57 · 17:55
opinionERAS protocols are difficult to implement because they require the whole hospital to adopt a different culture and philosophy↗
▶Ep 57 · 19:09
clinicalSurgical pathways have led to decreased cost, antibiotic utilization, and decreased length of stay↗
▶Ep 57 · 19:09
clinicalSurgical pathways created for ERAS are used more by hospitalists and pediatric residents than any other pathways↗
▶Ep 57 · 19:42
opinionStarting with one component like decreasing opioid use intraoperatively and perioperatively can be an entry point for larger ERAS implementation↗
▶Ep 57 · 21:18
clinicalFor pulmonary vessel bleeding during thoracoscopic lobectomy, energy sources work well as initial hemostasis because it is a low-pressure system↗
▶Ep 57 · 21:18
quoteI'll start with an energy source. You know, one of the sealing devices I think usually work pretty well. Remember, it's a low-pressure system. And then if you need to, then if that's not working, you can go to a clip, and you can even suture if you have to.↗
▶Ep 57 · 21:38
clinicalMultiple hemostasis options including energy, clips, and sutures should be available for thoracoscopic vessel bleeding↗
Neonatal Gastric Volvulus with Dr. Jason Frischer
▶Ep 59 · 1:18
epidemiologicalGastric volvulus is associated with CDH about 17% of the time↗
▶Ep 59 · 1:18
epidemiologicalGastric volvulus is associated with eventration of the diaphragm about 25% of the time↗
▶Ep 59 · 2:13
clinicalAcute gastric volvulus is usually due to anatomic problems like CDH↗
▶Ep 59 · 3:27
clinicalWithout ligamentous attachments, the stomach is only fixed at two points: the GE junction and the pylorus↗
▶Ep 59 · 4:58
clinicalTypical presentation includes non-bilious emesis, gastric distention, and possible history of CDH↗
▶Ep 59 · 5:10
clinicalPlain films may show significant gastric distention in gastric volvulus↗
▶Ep 59 · 5:10
clinicalPatients with gastric volvulus typically have issues with NG tube passage↗
▶Ep 59 · 5:21
clinicalContrast study is the next diagnostic step after plain films↗
▶Ep 59 · 5:49
clinicalA classic bird's beak appearance may be seen when contrast is in the esophagus or at the GE junction↗
▶Ep 59 · 6:08
clinicalIn mesenteroaxial volvulus, the duodenum may fill above or superior to the GE junction↗
▶Ep 59 · 7:34
clinicalGastropexy should be performed at at least one additional location beyond the G-tube site↗
▶Ep 59 · 7:37
clinicalThe goal of multiple gastropexy sites is to fix the stomach in multiple planes to reduce recurrence risk↗
▶Ep 59 · 7:47
clinicalFundoplication is not required in pediatric gastric volvulus repair, unlike in adult practice↗
▶Ep 59 · 8:53
clinicalPatients may have latent onset with volvulus present longer than clinically apparent↗
▶Ep 59 · 9:49
clinicalFull set of labs should be sent during resuscitation↗
Quick Literature Updates Episode 6
▶Ep 71 · 2:50
clinicalThere was no significant difference in the rate of successful primary closure between intubated and non-intubated neonates with gastroschisis↗
▶Ep 71 · 2:50
clinicalThe Miyata study used data from the Canadian Association of Pediatric Surgery Network for pediatric patients with gastroschisis who underwent bedside reduction and closure↗
Quick Literature Updates Episode 7
▶Ep 72 · 1:35
clinicalThe Peters et al. study examined 55 pediatric patients with short bowel syndrome↗
▶Ep 72 · 1:50
clinicalInfants with an ileocecal valve had significantly shorter duration on parenteral nutrition↗
▶Ep 72 · 2:05
clinicalPatients with less than 50% of their colon had significantly less time on parenteral nutrition as long as they had their ileocecal valve↗
clinicalSennosides or bisacodyl can be used to induce high-amplitude propagated contractions.↗
▶Ep 4 · 7:15
clinicalWhen an HAPC occurs, the internal anal sphincter should relax (choloanal reflex) to allow stool evacuation.↗
▶Ep 4 · 14:03
opinionDuodenal and colonic manometry can rule out more widespread dysmotility, which is invaluable information in a patient with an anorectal malformation.↗
Intestinal rehabilitation: What is intestinal rehab? - Episode 1
▶Ep 5 · 2:24
guidelineNew guidelines define intestinal failure as requiring parental support for at least 60 days↗
▶Ep 5 · 8:41
epidemiologicalAccess and availability to an intestinal rehab program is still very rare↗
▶Ep 5 · 8:51
clinicalThere are three time points when families reach intestinal rehab programs: prenatal diagnosis, postnatal acquired problems, and later diagnosis after discharge↗
▶Ep 5 · 12:34
epidemiologicalSurvival overall in big intestinal rehab programs is usually over 90% long-term survival↗
Intestinal Rehabilitation, Episode 1: What is intestinal rehabilitation?
▶Ep 6 · 2:24
guidelineFor a patient to be defined as having intestinal failure, they must have inadequate intestinal function necessitating parenteral support for at least 60 days↗
▶Ep 6 · 3:33
quoteIt's like a dream team, but for pediatric guts↗
▶Ep 6 · 12:34
epidemiologicalThe survival overall in big intestinal rehabilitation programs is usually over 90% long-term survival↗
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
clinicalAltered Doppler signal is a predictor of failed enema reduction↗
▶Ep 14 · 9:06
clinicalFree fluid and extension beyond the splenic angle are sonographic predictors of failed 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
clinicalOut of 344 prenatally diagnosed lesions, none had malignant pathology when resected↗
▶Ep 15 · 4:36
quoteOut of the 344 prenatally diagnosed lesions, actually, none of them had malignant pathology when they were 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
quoteHi, it's Rod Gerardo from Cincinnati Children's, and we have some brand new content for you.↗
▶Ep 36 · 0:00
clinicalThe speaker is Rod Gerardo from Cincinnati Children's↗
▶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
clinicalDr. Jeff Ponsky will co-conduct interviews with Rod Gerardo↗
▶Ep 36 · 0:20
quoteI and Dr. Jeff Ponsky are going to interview our friends from around the globe, residents, fellows, attendings.↗
▶Ep 36 · 0:24
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
guidelineNew guidelines define intestinal failure as requiring parental support for at least 60 days↗
▶Ep 3 · 8:41
epidemiologicalAccess and availability to an intestinal rehab program is still very rare↗
▶Ep 3 · 8:51
clinicalThere are three time points when families reach intestinal rehab programs: prenatal diagnosis, postnatal acquired problems, and later diagnosis after discharge↗
▶Ep 3 · 12:34
epidemiologicalSurvival overall in big intestinal rehab programs is usually over 90% long-term survival↗
Intestinal Rehabilitation, Episode 1: What is intestinal rehabilitation?
▶Ep 4 · 2:24
guidelineFor a patient to be defined as having intestinal failure, they must have inadequate intestinal function necessitating parenteral support for at least 60 days↗
▶Ep 4 · 3:33
quoteIt's like a dream team, but for pediatric guts↗
▶Ep 4 · 12:34
epidemiologicalThe survival overall in big intestinal rehabilitation programs is usually over 90% long-term survival↗
Quick Literature Updates Episode 7
▶Ep 6 · 1:35
clinicalThe Peters et al. study examined 55 pediatric patients with short bowel syndrome↗
▶Ep 6 · 1:50
clinicalInfants with an ileocecal valve had significantly shorter duration on parenteral nutrition↗
▶Ep 6 · 2:05
clinicalPatients with less than 50% of their colon had significantly less time on parenteral nutrition as long as they had their ileocecal valve↗
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↗
