If you're on a boat and you are sailing across the ocean on a beautiful, gorgeous, sunny day, and the water is flat, If you look under the ocean, it's flat. It's nice and calm. if you go on the ocean on a horrible day with terrible weather and the waves are crashing, and it's the outside of the, the, the surface of the water is dangerous, if you look under the ocean, it's still flat and calm.
What they tried to ascertain in this paper was, is there a difference in outcome in patients that were thought to have non-rhabdosarcoma that had a planned workup and excision versus those that had innocuous lesions that were not thought to be non-rhabdosarcoma were just denucleated or excised, and then they got the results back which showed non-rhabdosarcoma and went for a re.
a friend of mine wrote a review article on an esoteric topic in urology five years ago the old fashioned way they reviewed 30 articles and they worked two weeks on it they just did the same exercise with notebook lm and they put the same 30 articles in and of course it produced a very elegant outline in minutes
If I have a patient that comes in with an impacted stone, and their lipase is elevated, the next day their lipase goes up even more, they're, they're getting more and more jaundiced, they're getting worse, I would send them for ERCP because I don't know how good I am at retrieving impacted stones.
the most common thing that they mistake for a hernia when they say they see a groin bulge... I think it's often the testicle in a boy that's riding up into their groin and they see a bulge, but they don't at the same time evaluate if the testicle is there
When looking at the unplanned to the planned excision patients, so the first thing they looked at was residual tumor, and what was fascinating is they actually found that 45.7% of the patients that they did the re-excision on actually had residual tumor.
clinicalA study by Dr. Baird showed that patients with flap closure did better in every way than those with sutured fascial closure, including lower rates of umbilical hernia repair↗
▶Ep 6 · 18:10
clinicalSpring-loaded silos create outward pressure as you push down, making the defect larger over time↗
7th Annual Pediatric Surgery Update Course 2019 - FULL SHOW
▶Ep 16 · 0:58
quoteJust two days ago, I had a baby that I was operating on. And because you taught me this, the hemoglobin, they were going to transfuse up to a hematocrit of thoracin. No, I learned from the PDC. We don't have to do that anymore. Transfuse clinically.↗
▶Ep 16 · 2:56
quoteThis single teaching point made the whole update course worth it because he didn't realize this, and it totally changed his practice.↗
▶Ep 16 · 17:16
epidemiologicalParents surveyed for PCORI study said they would accept 50% success rate for non-operative appendicitis management↗
▶Ep 16 · 17:16
quoteI think the parents are more focused on the here and now. That is what's happening at that moment in the emergency room. Whereas we as their caregivers need to be thinking about what's best for the total life of the patient.↗
▶Ep 16 · 17:16
quoteI don't know if any surgeon would look at that and go 41 percent failure rate is a success.↗
▶Ep 16 · 17:16
epidemiologicalIn the APAC trial of adults, 41% of the non-operative appendicitis group underwent appendectomy at 5 years↗
QUAD #1: Cervical Tracheopexy with Dr. Alessandro de Alarcon
▶Ep 16 · 0:55
clinicalPreoperative testing includes dynamic CT imaging, pulmonary function tests, microlaryngoscopy and bronchoscopy, and flexible bronchoscopy↗
▶Ep 16 · 2:01
clinicalResidual or regrown large thymus can be removed during the cervical approach as it is in the way↗
▶Ep 16 · 2:19
clinicalIn the lateral approach, surgeons work on the side of the airway to find the esophagus↗
▶Ep 16 · 2:23
clinicalPediatric surgeons find the recurrent nerve for the ENT team to help prevent injury↗
▶Ep 16 · 2:43
clinicalThe esophagus is mobilized above the level where the team aims to pexy↗
▶Ep 16 · 2:49
clinicalMobilizing the esophagus above the pexy level makes it easier to place sutures exactly where needed↗
▶Ep 16 · 3:02
clinicalA pulmonologist assists with visualization inside the trachea using flexible endoscopy through the endotracheal tube while stitches are being placed↗
▶Ep 16 · 3:24
opinionThe combined approach is valuable for complicated cases or patients needing additional operations for symptom relief↗
▶Ep 16 · 4:32
opinionOtolaryngology involvement is important both in the procedure and during follow-up, and is easier when already built into the team↗
Biliary Atresia, Appendicitis, Intestinal Failure, and Anesthetic...
▶Ep 6 · 42:16
opinionRule of two suggested: defer elective operations until after age 2 and try not to have two anesthetics in one year↗
Biliary Atresia, Appendicitis, Intestinal Failure, and Anesthetic...
▶Ep 10 · 42:16
opinionRule of two suggested: defer elective operations until after age 2 and try not to have two anesthetics in one year↗
Biliary Atresia Part I
▶Ep 13 · 22:55
guidelineIPEG placed a moratorium on laparoscopic Kasai because of poor outcomes↗
▶Ep 13 · 23:44
guidelineLaparoscopic Kasai is only recommended for surgeons doing it in a prospective trial or who have demonstrated equivalent outcomes; it is not yet recommended for the masses↗
guidelineTraditional teaching advocates divided colostomy for anorectal malformations to prevent stool flow that could cause urinary tract infections↗
▶Ep 1 · 0:08
quotewe've all been taught over the years that when we do a colostomy for an anal rectal malformation, we should do a divided colostomy, and the main reason to do that is to prevent stool flowing down that could cause a urinary tract infection↗
▶Ep 1 · 0:27
clinicalMeta-analysis of multiple studies found no statistical difference in UTI incidence between divided colostomy and loop colostomy↗
▶Ep 1 · 0:39
clinicalSome individual studies showed a difference in UTI rates, but overall meta-analysis showed no statistical difference↗
▶Ep 1 · 0:51
clinicalLoop colostomies had a significantly higher stoma prolapse rate compared to divided colostomies↗
▶Ep 1 · 0:51
quotethe loop colostomies actually had a higher, significantly higher stoma prolapse rate↗
▶Ep 1 · 1:05
clinicalNo statistical difference was found between loop and divided colostomy for skin excoriation, stoma retraction, peristomal hernia, wound infection, and stoma stricture↗
▶Ep 1 · 1:22
quotethere we go, we've challenged dogma, and it seems like dogma necessarily at this point doesn't seem to hold true↗
Challenging Dogma: Does Colostomy Type Matter?
▶Ep 3 · 0:08
quotewe've all been taught over the years that when we do a colostomy for an anal rectal malformation, we should do a divided colostomy, and the main reason to do that is to prevent stool flowing down that could cause a urinary tract infection↗
▶Ep 3 · 0:08
guidelineTraditional teaching advocates divided colostomy for anorectal malformations to prevent stool flow that could cause urinary tract infections↗
▶Ep 3 · 0:27
clinicalMeta-analysis of multiple studies found no statistical difference in UTI incidence between divided colostomy and loop colostomy↗
▶Ep 3 · 0:39
clinicalSome individual studies showed a difference in UTI rates, but overall meta-analysis showed no statistical difference↗
▶Ep 3 · 0:51
clinicalLoop colostomies had a significantly higher stoma prolapse rate compared to divided colostomies↗
▶Ep 3 · 0:51
quotethe loop colostomies actually had a higher, significantly higher stoma prolapse rate↗
▶Ep 3 · 1:05
clinicalNo statistical difference was found between loop and divided colostomy for skin excoriation, stoma retraction, peristomal hernia, wound infection, and stoma stricture↗
▶Ep 3 · 1:22
quotethere we go, we've challenged dogma, and it seems like dogma necessarily at this point doesn't seem to hold true↗
Biliary Atresia, Appendicitis, Intestinal Failure, and Anesthetic...
▶Ep 76 · 42:16
opinionRule of two suggested: defer elective operations until after age 2 and try not to have two anesthetics in one year↗
Colorectal Quiz Episode 2: When to redo a PSARP
▶Ep 85 · 7:02
quoteWithout a stimulator in the office, what do you look for to immediately tell that the anoplasty was done too low?↗
The Colorectal Quiz Episode 3.5: Proximal Hirschsprung Disease
▶Ep 87 · 0:40
clinicalThe case involves a one-day-old full-term baby weighing 3.9 kilograms presenting with significant abdominal distension and bilious emesis↗
▶Ep 87 · 1:10
quoteIt's not your standard Hirschsprung's picture.↗
▶Ep 87 · 4:05
clinicalA baby with bilious emesis and non-classic abdominal x-ray could have had distal air and then had a volvulus, requiring urgent upper GI to rule out the dangerous thing before contrast enema↗
Colorectal Quiz: Episode 49 – Collaborating for Kids: Colorectal & Pelvic Solutions (with a Little Help from AI)
▶Ep 177 · 1:42
quoteWhat M and I are working on is how we can mass produce content to equilibrate knowledge around the world, and we know that the only way to do that is to use cutting edge technology, automation tools and AI.↗
▶Ep 177 · 2:16
clinicalNotebook LM is a free offering of Google that can create realistic-sounding podcasts between two people from uploaded content↗
▶Ep 177 · 2:31
quoteI would love to hear your thoughts, Mark, on your first experience with Notebook LM.↗
▶Ep 177 · 4:22
clinicalNotebook LM uses the same two voices (one man and one woman) for all generated podcasts↗
▶Ep 177 · 4:52
quoteDo I think this is the future of podcasting? I don't. I think the voices are great, but it's not customizable enough.↗
▶Ep 177 · 5:03
clinicalThe beta version of Notebook LM allows users to join the conversation and interact with the AI hosts↗
▶Ep 177 · 7:42
quoteThe AI revolution has happened, and each month, it's blowing up and replacing jobs.↗
▶Ep 177 · 7:58
quoteYou have to be looking at AI and using it in your workflow. If you're not, you'll get behind.↗
Colorectal Quiz: Episode 49 - Collaborating for Kids: Colorectal & Pelvic Solutions (with a Little Help from AI)
▶Ep 222 · 1:40
quotewhat em and i are working on is how we can mass produce content to equilibrate knowledge around the world and we know that the only way to do that is to use cutting edge technology automation tools and ai↗
▶Ep 222 · 2:10
quotethe future will be that you will just tell ai make me a 10 minute podcast on this so i can listen on the way to work and you can actually do that now↗
▶Ep 222 · 2:30
clinicalNotebookLM is a free offering from Google that can upload any content and create realistic-sounding podcasts between two people↗
▶Ep 222 · 4:20
quotethe problem is it is the same two voices it's the same man and woman↗
▶Ep 222 · 4:35
quotethere's actually an incredible video where they uploaded a document telling these two podcast hosts that they were ai and how they reacted they freaked out↗
▶Ep 222 · 5:10
quotedo i think this is the future of podcasting i don't i think the voices are great but it's not customizable enough↗
▶Ep 222 · 6:39
quotea friend of mine wrote a review article on an esoteric topic in urology five years ago the old fashioned way they reviewed 30 articles and they worked two weeks on it they just did the same exercise with notebook lm and they put the same 30 articles in and of course it produced a very elegant outline in minutes↗
▶Ep 222 · 6:39
clinicalA review article that took two weeks to produce five years ago can now be generated in minutes using NotebookLM with the same 30 source articles↗
▶Ep 222 · 7:10
clinicalNotebookLM can identify gaps in knowledge across multiple research articles and recognize when new articles fill those gaps↗
▶Ep 222 · 7:40
quotethe ai revolution has happened and each month it's blowing up and replacing jobs↗
▶Ep 222 · 7:55
quotethe key thing is to be like you're doing and everyone else you have to be looking at ai and using it in your workflow if you're not you'll get behind↗
Hirschsprung Disease Part 2
▶Ep 251 · 43:45
quoteIf you approach this in a methodical way and that every patient with a problematic pull through is evaluated with a sort of methodical approach and you start checking off these boxes, you will find a lot of solvable pathology out there.↗
quoteYou really have to take the diaper off to do a complete physical exam on a baby with neck.↗
Abdominal Wall Defects with Dr. Jacob Langer
▶Ep 10 · 14:19
clinicalA study by Dr. Baird showed that patients with flap closure did better in every way than those with sutured fascial closure, including lower rates of umbilical hernia repair↗
▶Ep 10 · 18:10
clinicalSpring-loaded silos create outward pressure as you push down, making the defect larger over time↗
7th Annual Pediatric Surgery Update Course 2019 - FULL SHOW
▶Ep 22 · 0:58
quoteJust two days ago, I had a baby that I was operating on. And because you taught me this, the hemoglobin, they were going to transfuse up to a hematocrit of thoracin. No, I learned from the PDC. We don't have to do that anymore. Transfuse clinically.↗
▶Ep 22 · 2:56
quoteThis single teaching point made the whole update course worth it because he didn't realize this, and it totally changed his practice.↗
▶Ep 22 · 17:16
epidemiologicalIn the APAC trial of adults, 41% of the non-operative appendicitis group underwent appendectomy at 5 years↗
▶Ep 22 · 17:16
epidemiologicalParents surveyed for PCORI study said they would accept 50% success rate for non-operative appendicitis management↗
▶Ep 22 · 17:16
quoteI don't know if any surgeon would look at that and go 41 percent failure rate is a success.↗
▶Ep 22 · 17:16
quoteI think the parents are more focused on the here and now. That is what's happening at that moment in the emergency room. Whereas we as their caregivers need to be thinking about what's best for the total life of the patient.↗
Biliary Atresia, Appendicitis, Intestinal Failure, and Anesthetic...
▶Ep 26 · 42:16
opinionRule of two suggested: defer elective operations until after age 2 and try not to have two anesthetics in one year↗
Umbilical Cord Defects with Dr. Kenneth Azarow
▶Ep 29 · 4:54
guidelineAnesthesia data regarding operating before 2-3 years of age supports waiting for umbilical hernia repair↗
▶Ep 29 · 21:33
clinicalTriamcinolone (Kenalog) cream is more effective than silver nitrate for treating umbilical granulomas↗
▶Ep 29 · 29:22
epidemiologicalPHIS hospital data shows the mean age of umbilical hernia repair nationally is 4 years↗
Abdominal Wall Defects with Dr. Jacob Langer
▶Ep 30 · 18:10
clinicalSpring-loaded silos create outward pressure as you push down, causing the abdominal wall defect to become larger over time↗
Omphalocele and Gastroschisis With Dr. Foong-Yen Lim
▶Ep 37 · 3:15
epidemiologicalGastroschisis affects approximately one in every 2,200 live births↗
▶Ep 37 · 6:34
clinicalMajority of babies in the last four and a half years at Cincinnati Children's are being managed using a sutureless closure↗
Omphalocele & Gastroschisis
▶Ep 39 · 2:12
guidelineFetal growth is tracked monthly in these cases because there is concern for significant growth restriction↗
▶Ep 39 · 2:12
guidelineFor omphalocele, besides ultrasound, MRI and echocardiogram are routinely obtained because patients may have other associated anomalies↗
▶Ep 39 · 3:15
epidemiologicalGastroschisis affects approximately one in every 2200 live births↗
Stay Current Throwbacks Necrotizing Enterocolitis with Dr. Gail Besner
▶Ep 40 · 4:25
clinicalIndomethacin administration predisposes babies to both isolated ileal perforation and necrotizing enterocolitis↗
Update Course Rewind 2025: Updates in NEC Management
▶Ep 75 · 4:19
clinicalBabies are sick post-operatively whether you do anastomosis or not↗
▶Ep 75 · 4:28
clinicalBowel necrosis is a symptom or result of the illness, not the cause of the illness↗
▶Ep 75 · 4:28
quoteBowel is a symptom, is a result of the illness. It's not the cause of the illness. The disease still progresses, even that's the problem of going too early. You resect, it's still progressing.↗
▶Ep 75 · 4:34
clinicalThe disease still progresses even after resection, which is the problem of going too early↗
▶Ep 75 · 5:06
clinicalThe data shows primary anastomosis is better if the baby is well↗
▶Ep 75 · 5:06
quoteThe data shows it's better. If I feel like the baby is well, I would be convinced to do a primary anastomosis cause I do agree, doing a stoma, doing a silo clip and drop, maybe they won't do as well.↗
▶Ep 75 · 5:08
opinionDoing a stoma or clip-and-drop may result in babies not doing as well as primary anastomosis↗
▶Ep 75 · 5:31
opinionCurrent practice favors clip-and-drop with return at 24-48 hours rather than immediate stoma creation↗
▶Ep 75 · 5:31
quoteThe data shows that right now, I'm a clip and dropper. I would come back 24, 48 hours later, I would not do a stoma. Because I feel like I would have an answer in a couple of days.↗
▶Ep 75 · 5:45
clinicalDecision to proceed with anastomosis depends on hemodynamics including lactate correction, thrombocytopenia correction, and weaning off inotropes↗
clinicalThere is already shown benefit of repairing myelomeningocele in utero, and adding mesenchymal stromal cells provides even larger benefit in chance of ambulation↗
▶Ep 21 · 4:08
quoteSo, we already have shown a benefit of repairing these in utero, and now to take it a step further, if you impregnate it with mesenchymal stromal cells, you actually have even a larger benefit in the chance of ambulation.↗
▶Ep 21 · 6:38
quoteI think this paper highlights that this is what happens in an emerging field. You have disparities in what is happening.↗
▶Ep 21 · 6:38
opinionIn an emerging field like fetal surgery, there are disparities in what is happening at different centers↗
▶Ep 21 · 6:46
opinionThere is value in having some centers with dedicated teams focusing on fetal care even if they don't do interventions↗
quoteThis is our bread and butter. It's what we do. It's what sort of defines us, and we all are pretty confident about our hernia repairs.↗
▶Ep 1 · 2:43
quoteI think any type of hernia repair is probably fine. There's just different. I'm not going to state that one is substantially better than the other. It's that this is a new option.↗
▶Ep 1 · 4:52
quoteI am not as comfortable that my assessment of that silk glove sign is as good as others have said↗
▶Ep 1 · 5:18
quoteif it's a good story, I will go to, and I, and I feel fullness or asymmetry, I will go to laparoscopy↗
▶Ep 1 · 5:40
quotethe most common thing that they mistake for a hernia when they say they see a groin bulge... I think it's often the testicle in a boy that's riding up into their groin and they see a bulge, but they don't at the same time evaluate if the testicle is there↗
▶Ep 1 · 5:51
clinicalThe most common thing mistaken for a hernia is the testicle riding up into the groin↗
clinicalA patient had a patent processus identified incidentally years prior, then presented with groin pain and at laparoscopy the patent processus was gone↗
▶Ep 1 · 10:56
epidemiologicalWit Holcomb published in 1994 that contralateral patent processus presents in 30-40% of cases↗
▶Ep 1 · 11:05
clinicalThere is a 4 times greater risk of developing a hernia if a patent processus vaginalis is present↗
▶Ep 1 · 11:17
epidemiologicalThe risk of metachronous hernia is 3-11%↗
▶Ep 1 · 17:05
clinicalIn a rabbit model, grabbing the vas deferens once with pickups obliterates it↗
▶Ep 1 · 17:41
clinicalThe groin has a very high density of nerves, making it a problematic location for incisions↗
▶Ep 1 · 18:00
epidemiologicalA study by Zendejas in Journal of American College of Surgeons found 5% infertility rate after hernia repair, matching the general population↗
▶Ep 1 · 18:23
clinicalA study in Andrologia found markedly reduced semen quality in 8500 patients in fertility clinics who had prior hernia repairs, with morphology problems↗
▶Ep 1 · 19:20
quoteIf you're on a boat and you are sailing across the ocean on a beautiful, gorgeous, sunny day, and the water is flat, If you look under the ocean, it's flat. It's nice and calm. if you go on the ocean on a horrible day with terrible weather and the waves are crashing, and it's the outside of the, the, the surface of the water is dangerous, if you look under the ocean, it's still flat and calm.↗
▶Ep 1 · 20:41
quoteno matter how bad it is on the outside, it will still always be very easy on the inside↗
▶Ep 1 · 22:28
opinionWith laparoscopy, incarcerated hernias can be taken directly to OR without reduction attempts, as the repair is not harder when inflamed↗
▶Ep 1 · 24:51
clinicalThe most common cause of recurrence after open indirect hernia repair is development of a direct hernia↗
▶Ep 1 · 25:35
opinionIn open repair, pulling up the cord may take fibers of the floor and cause a direct hernia, especially in premature infants with very thin floors↗
▶Ep 1 · 27:39
clinicalRecent large studies from multiple countries show laparoscopic hernia repair recurrence rate of approximately 1% or less↗
▶Ep 1 · 41:48
opinionIn open hernia repair, the stitch likely dissolves (when using Vicryl) and the repair works because the cut sac ends scar together↗
▶Ep 1 · 42:14
clinicalMunther Haddad from Leeds published a series on open division of the sac without ligation with the same recurrence rate as traditional repair↗
▶Ep 1 · 42:27
opinionWhen ligating the sac, you create a new smaller hernia sac that still vaginates into the muscle↗
▶Ep 1 · 42:39
quotethe key to a good hernia repair is injury, not the stitch↗
▶Ep 1 · 44:16
clinicalIn rabbit model at 2 weeks, 75% of suture-alone repairs opened when suture was removed, but 87% of injury-plus-suture repairs stayed closed↗
▶Ep 1 · 44:33
clinicalIn rabbit model at 4 weeks, only 17% of suture-alone repairs stayed closed after suture removal, but 100% of injury-plus-suture repairs were reperitonealized↗
▶Ep 1 · 44:58
clinicalBraided non-absorbable sutures worked best in rabbit hernia repair model compared to dissolvable or monofilament↗
▶Ep 1 · 52:05
clinicalIn babies, single knot ligation is preferred over double ligation to reduce risk of suture granuloma due to thin subcutaneous tissue↗
▶Ep 1 · 1:03:40
clinicalCK Young in Hong Kong has done approximately 2000 laparoscopic hernia repairs with ligation alone (no injury) with very few recurrences↗
▶Ep 1 · 1:07:18
clinicalPostoperative hydroceles after laparoscopic hernia repair are extremely rare, with almost no cases requiring intervention↗
▶Ep 1 · 1:20:28
clinicalThe NIH study quoted 30% chronic pain rate after adult mesh hernia repair, though expert hernia surgeons claim their rates are lower↗
▶Ep 1 · 1:23:03
epidemiologicalThere is a bimodal distribution of hernias with peaks in infancy and older adulthood, with few adolescent cases↗
▶Ep 1 · 1:23:38
clinicalDirect hernias start developing around age 29, suggesting a change in floor integrity at that age↗
▶Ep 1 · 1:25:45
clinicalA retrospective two-center study (Kansas City and Rainbow) found 1.9% recurrence rate with open high ligation in adolescents↗
▶Ep 1 · 1:33:39
clinicalFelix Shear's ultrasound study showed no deficiency in testicular blood flow after laparoscopic hernia repair in babies↗
epidemiologicalPatent processus vaginalis confers 4 times greater risk than general population of developing hernia at some point in life↗
▶Ep 3 · 2:14
opinionHernia repair is not the type of conversation to have quickly in the waiting room with a family because if there were some injury, that was a rushed conversation about something they may never have a problem with their entire lives↗
▶Ep 3 · 2:59
clinicalAge 5 is used as cutoff to stop scoping the contralateral side or doing anything else for patent processus vaginalis↗
clinicalPatent processus vaginalis is the same from day of life one to end of life↗
▶Ep 3 · 5:54
clinicalHigh ligation is the appropriate repair for any age if it is a patent processus vaginalis↗
▶Ep 3 · 14:34
clinicalIn rabbit study, when injury was caused and repair done, it was much more durable - even if stitch was cut out after 12 weeks, closure remained intact↗
▶Ep 3 · 14:44
clinicalInjury really keeps things closed in hernia repair↗
▶Ep 3 · 17:18
clinicalWhen non-absorbable braided suture is used, the repair is better, at least in rabbits↗
▶Ep 3 · 27:58
clinicalOne-stage Fowler-Stevens is probably just as good as two-stage based on retrospective data and prospective pilot data↗
Best of the Best Gen Surg - Predictors of Low and High Opioid Tablet Consumption after Inguinal Hernia Repair – an ACHQC Opioid Reduction Task Force Analysis - Dr. Warren
▶Ep 13 · 6:13
quotethe reason I prescribe narcotics, and I sometimes prescribe more than I think the patient even needs, is I know that you can't call it in.↗
▶Ep 13 · 6:50
quoteI think we're causing the problem in the opposite way, that by having this restriction, we're over prescribing.↗
▶Ep 13 · 7:05
quoteIf you remove that restriction and allow us to call in controlled substances, I'll prescribe zero to three pills and say, well, we'll just call it in tomorrow if you need more.↗
▶Ep 13 · 10:35
quoteI think that the days of narcotics are going away. I've watched other specialties use drugs like gabapentin and Tylenol and get effective pain relief without narcotics.↗
▶Ep 13 · 10:40
clinicalOther specialties use drugs like gabapentin and Tylenol to achieve effective pain relief without narcotics↗
▶Ep 13 · 10:55
quoteI think we're learning a lot about alternative ways of managing pain. And we have to keep our eyes open on this. I think opioids are going by the wayside in the future.↗
Case-Based Journal Review: Inguinal Hernia 2025
▶Ep 17 · 1:17
clinicalPreterm infants with inguinal hernia have a very high rate of incarceration↗
▶Ep 17 · 1:17
quoteSo these babies have a very high rate of incarceration. So I tend to repair these before they leave the hospital.↗
▶Ep 17 · 4:47
quoteDid they mention if any of those had lost like dead bowel? Did they even talk about serious events, or is it just that they had to come back to have it pushed back in again?↗
▶Ep 17 · 4:56
clinicalOne patient had a bowel injury during repair↗
▶Ep 17 · 5:26
clinicalThere were more reintubations and more apnea in the early repair group↗
▶Ep 17 · 5:26
quoteIt seems like it's a well done study with pretty clear evidence that there were more. More reintubations, more apnea in the early repair, and the incidence of what we all fear was very low.↗
▶Ep 17 · 6:57
quoteBut what this paper does is it tells pediatric surgeons that sending them home is generally safe and maybe safer, and it is an option if in the past it was not an option for them.↗
▶Ep 17 · 13:42
quoteThink about how many unnecessary times people are coming back to the hospital for a visit for social reasons. Leave it up to the parents. Some want to come. Let them come. But some don't, so you give them the choice.↗
▶Ep 17 · 16:42
quoteThe problem is 1 year is not enough. If you look at the study out of Mayo Clinic that Ben Zendejas wrote when he was a resident there. There was a contralateral hernia occurrence after a 50 year follow up.↗
▶Ep 17 · 16:43
clinicalA Mayo Clinic study by Ben Zendejas showed contralateral hernia occurrence after 50 year follow-up↗
▶Ep 17 · 16:59
quoteThe reason I would do it is not for the immediate year, it's for their lifetime, but it's an interesting paper.↗
2026 Laparoscopic Pediatric Hernia Repair
▶Ep 24 · 6:12
quoteI will never say that the way I am talking about today is the right way. It's one way of doing it.↗
▶Ep 24 · 11:16
epidemiologicalContralateral patent processus vaginalis is present 30-40% of the time in children with unilateral inguinal hernia↗
▶Ep 24 · 11:50
epidemiologicalRisk of metachronous hernia after unilateral repair is 3-11%↗
▶Ep 24 · 12:25
clinical50% of patent processus vaginalis may never become hernias↗
▶Ep 24 · 14:11
epidemiologicalRisk of incarceration is high in preemies but becomes negligible after 1 year of age, dropping to less than 1% per year↗
▶Ep 24 · 18:21
clinicalIn rabbit studies, grabbing the vas deferens in a preemie-sized vessel with one grab can obliterate and scar it↗
▶Ep 24 · 26:14
quoteThis slide is the reason I do lap hernias. Not any of the other stuff. This is why.↗
▶Ep 24 · 27:02
quoteNo matter how bad it is out here, it's always easy. Always easy. And that sounds like a very cocky thing to say, it's always easy. No, it is always easy.↗
▶Ep 24 · 27:22
quoteAnyone that says that incarcerated premie hernias are easy operations, they're lying to you.↗
▶Ep 24 · 28:15
quoteYou're taking one of the hardest operations. Believe it or not, we do TES, we do biliary retrission, we do all these things. I think an incarcerated, long-standing preemie hernia can be challenging, and by doing it lap, you're taking away that risk.↗
▶Ep 24 · 32:58
quoteI don't think you have to do any torture to the child of trying to reduce it. I would go straight to the operating room. With lap.↗
▶Ep 24 · 39:39
clinicalThe most common recurrence after indirect inguinal hernia repair is a direct hernia, not an indirect hernia↗
▶Ep 24 · 40:04
quoteYou're not putting the vase maybe, but you're definitely not putting the floor at risk if you do a lap.↗
▶Ep 24 · 40:21
quoteI feel pretty strongly that The premium open hernia repairs are causing floor injuries, and that's why they're getting fixed as adults.↗
▶Ep 24 · 43:00
clinicalRecurrence rate for laparoscopic PIRS technique is 0.9% in unilateral repairs and 0.3% in bilateral repairs in large series↗
▶Ep 24 · 56:06
quoteI've been doing this for 20 years, my whole career, I've been doing And I have had Maybe 2 hydroseals, and they both resolved.↗
▶Ep 24 · 1:06:54
clinicalIn rabbit studies, repairs with anterior peritoneal injury remained intact even after suture removal at 2 weeks with 36mmHg pressure, while suture-only repairs failed 75% of the time↗
▶Ep 24 · 1:09:00
clinicalIn rabbit studies, braided non-absorbable suture (silk) had only 10% failure rate after suture removal, compared to 75% for prolene and 80% for vicryl↗
▶Ep 24 · 1:22:23
clinicalStudies by Felix Shear showed no impediment to cord blood flow after laparoscopic hernia repair↗
▶Ep 24 · 1:29:11
quoteIt's not a muscle problem. The peritoneum is in the way, blocking the muscles from shuttering closed. There's no actual defect. It's just muscles that were sort of pushed out of the way.↗
▶Ep 24 · 1:36:11
quoteHow do we decide? Is, is it like, oh, well, they're 1 inch taller now. Now they're gonna get a like, What, is it their weight? What's the cutoff? Is it their height? Is it their age? So, I think it's very nebulous.↗
▶Ep 24 · 1:36:32
clinicalHigh ligation in adolescents aged 13-18 had 2% recurrence rate with only 0.9% confirmed recurrence at 2-year follow-up↗
▶Ep 24 · 1:37:33
epidemiologicalStatistical analysis shows direct hernias begin to predominate around age 40, though most hernias remain indirect even at that age↗
▶Ep 24 · 1:38:22
clinicalNorwegian study of laparoscopic high ligation in adults showed zero recurrences↗
▶Ep 24 · 1:50:56
quoteI think we do it better. I have to say that if it's, the reason I say that is I think they're putting mesh in people that don't need it.↗
▶Ep 24 · 1:58:27
clinicalVA cooperative study showed chronic pain after mesh hernia repair can be as high as 30%↗
quoteYou really have to take the diaper off to do a complete physical exam on a baby with neck.↗
Biliary Atresia, Appendicitis, Intestinal Failure, and Anesthetic...
▶Ep 14 · 42:16
opinionRule of two suggested: defer elective operations until after age 2 and try not to have two anesthetics in one year↗
Abdominal Wall Defects with Dr. Jacob Langer
▶Ep 17 · 14:19
clinicalA study by Dr. Baird showed that patients with flap closure did better in every way than those with sutured fascial closure, including lower rates of umbilical hernia repair↗
▶Ep 17 · 18:10
clinicalSpring-loaded silos create outward pressure as you push down, making the defect larger over time↗
7th Annual Pediatric Surgery Update Course 2019 - FULL SHOW
▶Ep 31 · 0:58
quoteJust two days ago, I had a baby that I was operating on. And because you taught me this, the hemoglobin, they were going to transfuse up to a hematocrit of thoracin. No, I learned from the PDC. We don't have to do that anymore. Transfuse clinically.↗
▶Ep 31 · 2:56
quoteThis single teaching point made the whole update course worth it because he didn't realize this, and it totally changed his practice.↗
▶Ep 31 · 17:16
quoteI think the parents are more focused on the here and now. That is what's happening at that moment in the emergency room. Whereas we as their caregivers need to be thinking about what's best for the total life of the patient.↗
▶Ep 31 · 17:16
epidemiologicalParents surveyed for PCORI study said they would accept 50% success rate for non-operative appendicitis management↗
▶Ep 31 · 17:16
epidemiologicalIn the APAC trial of adults, 41% of the non-operative appendicitis group underwent appendectomy at 5 years↗
▶Ep 31 · 17:16
quoteI don't know if any surgeon would look at that and go 41 percent failure rate is a success.↗
Biliary Atresia, Appendicitis, Intestinal Failure, and Anesthetic...
▶Ep 35 · 42:16
opinionRule of two suggested: defer elective operations until after age 2 and try not to have two anesthetics in one year↗
Umbilical Cord Defects with Dr. Kenneth Azarow
▶Ep 38 · 4:54
guidelineAnesthesia data regarding operating before 2-3 years of age supports waiting for umbilical hernia repair↗
▶Ep 38 · 21:33
clinicalTriamcinolone (Kenalog) cream is more effective than silver nitrate for treating umbilical granulomas↗
▶Ep 38 · 29:22
epidemiologicalPHIS hospital data shows the mean age of umbilical hernia repair nationally is 4 years↗
Abdominal Wall Defects with Dr. Jacob Langer
▶Ep 39 · 18:10
clinicalSpring-loaded silos create outward pressure as you push down, causing the abdominal wall defect to become larger over time↗
Omphalocele and Gastroschisis With Dr. Foong-Yen Lim
▶Ep 50 · 3:15
epidemiologicalGastroschisis affects approximately one in every 2,200 live births↗
▶Ep 50 · 6:34
clinicalMajority of babies in the last four and a half years at Cincinnati Children's are being managed using a sutureless closure↗
Omphalocele & Gastroschisis
▶Ep 54 · 2:12
guidelineFor omphalocele, besides ultrasound, MRI and echocardiogram are routinely obtained because patients may have other associated anomalies↗
▶Ep 54 · 2:12
guidelineFetal growth is tracked monthly in these cases because there is concern for significant growth restriction↗
▶Ep 54 · 3:15
epidemiologicalGastroschisis affects approximately one in every 2200 live births↗
Stay Current Throwbacks Necrotizing Enterocolitis with Dr. Gail Besner
▶Ep 55 · 4:25
clinicalIndomethacin administration predisposes babies to both isolated ileal perforation and necrotizing enterocolitis↗
Update Course Rewind 2025: Updates in NEC Management
▶Ep 107 · 4:19
clinicalBabies are sick post-operatively whether you do anastomosis or not↗
▶Ep 107 · 4:28
clinicalBowel necrosis is a symptom or result of the illness, not the cause of the illness↗
▶Ep 107 · 4:28
quoteBowel is a symptom, is a result of the illness. It's not the cause of the illness. The disease still progresses, even that's the problem of going too early. You resect, it's still progressing.↗
▶Ep 107 · 4:34
clinicalThe disease still progresses even after resection, which is the problem of going too early↗
▶Ep 107 · 5:06
quoteThe data shows it's better. If I feel like the baby is well, I would be convinced to do a primary anastomosis cause I do agree, doing a stoma, doing a silo clip and drop, maybe they won't do as well.↗
▶Ep 107 · 5:06
clinicalThe data shows primary anastomosis is better if the baby is well↗
▶Ep 107 · 5:08
opinionDoing a stoma or clip-and-drop may result in babies not doing as well as primary anastomosis↗
▶Ep 107 · 5:31
quoteThe data shows that right now, I'm a clip and dropper. I would come back 24, 48 hours later, I would not do a stoma. Because I feel like I would have an answer in a couple of days.↗
▶Ep 107 · 5:31
opinionCurrent practice favors clip-and-drop with return at 24-48 hours rather than immediate stoma creation↗
▶Ep 107 · 5:45
clinicalDecision to proceed with anastomosis depends on hemodynamics including lactate correction, thrombocytopenia correction, and weaning off inotropes↗
clinicalEven with no stones remaining, 2% baseline recurrence rate of pancreatitis exists from initial insult↗
▶Ep 18 · 3:44
quoteSo 2% of the time in patients, even if they have no stones, they will get recurrent pancreatitis from their initial insult, whereas 60% if you wait 6 weeks. That is. So provocative. That is so clear cut that nobody should be debating this anymore.↗
▶Ep 18 · 5:01
clinicalIn gallstone pancreatitis, pain and elevated enzymes typically occur as the stone is passing, often resolving overnight↗
▶Ep 18 · 5:36
clinicalIf laboratory values normalize after gallstone pancreatitis, ERCP is not indicated; intraoperative cholangiogram is sufficient to check for retained stones↗
▶Ep 18 · 8:58
quoteIf I have a patient that comes in with an impacted stone, and their lipase is elevated, the next day their lipase goes up even more, they're, they're getting more and more jaundiced, they're getting worse, I would send them for ERCP because I don't know how good I am at retrieving impacted stones.↗
▶Ep 18 · 8:58
opinionFor patients with impacted CBD stone, worsening lipase, and increasing jaundice, ERCP is preferred because surgeon skill at retrieving impacted stones may be limited↗
▶Ep 18 · 9:17
clinicalStones identified on ultrasound (non-impacted) are more amenable to intraoperative laparoscopic removal↗
▶Ep 18 · 9:26
quoteSo I think I would do an intraoperative angiogram, but I do need to get better at learning all these new techniques of stone removal.↗
▶Ep 18 · 13:07
quoteSo here's an example of where I am old and washed up. The answer to this should be yes. I just don't have as much experience as my younger colleagues.↗
▶Ep 18 · 15:06
quoteI am skeptical of papers that claim that something is now the new standard just because it's become their new standard. It doesn't. Necessarily mean that it's recommended as the standard of care.↗
▶Ep 18 · 15:26
clinicalIntravenous ICG administration eliminates need for instrumentation of the biliary tree, which is a significant advantage↗
▶Ep 18 · 15:56
quoteI think we should be learning about ICG. I mean this is provocative for me to say, Todd, come on, get with it. Like this is something you should probably learn.↗
Stay Current Journal Club: Episode 1 - Ventricular Dysfunction in CDH and...
▶Ep 21 · 8:48
quoteI think it's interesting. I can't tell if left ventricular dysfunction is a marker or an actual cause of higher mortality.↗
▶Ep 21 · 8:57
quoteSo I don't know how it's supposed to play into my practice. Does this mean, and you alluded to this, does this mean I lean more towards repairing on ECMO. Does this mean to early on ECMO, early off ECMO?↗
▶Ep 21 · 10:36
quoteSo I don't know how many pediatric surgeons subscribe to this journal, but my guess is most don't, which means most will never see this article.↗
▶Ep 21 · 10:45
quoteAnd so, this points out, uh, the problem of how we get information now. And that's why I'm glad you brought this to our attention in forums like this, because otherwise, uh, we're gonna miss these articles.↗
▶Ep 21 · 14:57
clinicalKansas City has published quite a bit about cryotherapy and shown good results↗
Update Course Rewind: Pectus Excavatum 2021
▶Ep 25 · 6:02
clinicalMultimodal pain therapy should include preoperative counseling, gabapentin pre and postoperatively, methadone, clonidine, bowel regimen medications, and anti-emetics↗
▶Ep 25 · 6:19
clinicalWith multimodal pain regimen at Nebraska, length of stay is under 2 days and patients are off opioids by 1 week↗
▶Ep 25 · 7:40
clinicalComputational modeling shows shorter flat bars have more pressure on the sternum and are therefore more stable than traditional U-shaped bars↗
Update Course Rewind: Pectus Excavatum 2021
▶Ep 26 · 6:02
clinicalMultimodal pain therapy components include preoperative counseling, gabapentin pre and postoperatively, methadone, clonidine, bowel regimen medications, and anti-emetics↗
▶Ep 26 · 6:19
clinicalWith multimodal pain regimen at Nebraska, length of stay is under 2 days and patients are off opioids by 1 week↗
▶Ep 26 · 7:40
clinicalComputational modeling shows shorter flat bars have more pressure on the sternum and are therefore more stable than traditional U-shaped bars↗
Update Course Rewind: Pectus Excavatum 2021
▶Ep 56 · 0:31
clinicalA 16-year-old male with shortness of breath on exertion, no comorbidities, and pectus index of 5.5 was planned for chest wall reconstruction↗
▶Ep 56 · 1:02
clinicalA randomized trial of 110 patients comparing epidural and PCA showed epidurals did not provide adequate pain control↗
▶Ep 56 · 1:56
clinicalCryoanalgesia uses cold temperatures to cause a conduction block that interrupts pain impulses to the brain↗
▶Ep 56 · 2:09
clinicalCryoanalgesia technique involves freezing ribs four through seven for two minutes per rib; ribs eight and below should not be treated due to risk of abdominal wall paralysis↗
▶Ep 56 · 2:43
clinicalCryoanalgesia dramatically reduced median morphine equivalents compared to previous pain management approaches↗
▶Ep 56 · 3:14
guidelineMedical devices and techniques are not required to undergo clinical trials before market introduction, unlike medications↗
▶Ep 56 · 4:30
clinicalErector spinae catheters reduced opioid requirements both in-hospital and post-discharge, achieving two-day hospital stays↗
▶Ep 56 · 5:34
clinicalMultimodal pain control includes Tylenol, NSAIDs, precedex for gentle wake-up, dexamethasone for nausea, ketamine to avoid opioids, child life specialists, mindfulness resources, and physical therapy↗
▶Ep 56 · 6:26
clinicalBar flippage typically occurs early due to bars sitting in incorrect intercostal space, poor positioning, inadequate wrapping, or insufficient securing↗
▶Ep 56 · 6:26
quoteI do think that bar flippage is completely a surgical issue.↗
▶Ep 56 · 6:26
opinionBar flippage is completely a surgical technique issue, not related to the securing method↗
▶Ep 56 · 8:01
clinicalSternal elevation in deep, stiff pectus cases allows less tissue damage and better repair↗
▶Ep 56 · 8:01
clinicalSternal elevator is used in approximately 10% of cases, primarily in younger patients where thoracoscopy provides adequate visualization↗
▶Ep 56 · 8:01
clinicalSternal elevator enables consistent entry and exit at the same intercostal space↗
▶Ep 56 · 9:20
clinicalPassing the bar from left to right avoids pointing the introducer directly at the ventricle↗
▶Ep 56 · 9:20
quoteAs long as you have the sub-sternal space well dissected and everything's clear, then it probably doesn't make a whole lot of difference.↗
▶Ep 56 · 9:20
opinionBar passage direction is surgeon preference and does not make significant difference if sub-sternal space is well dissected and clear↗
▶Ep 56 · 9:20
quoteI go from the left chest to the right chest because if you go from the right chest to the left chest, you're coming down and whatever you're passing across is pointing right at the ventricle.↗
quoteWhat they tried to ascertain in this paper was, is there a difference in outcome in patients that were thought to have non-rhabdosarcoma that had a planned workup and excision versus those that had innocuous lesions that were not thought to be non-rhabdosarcoma were just denucleated or excised, and then they got the results back which showed non-rhabdosarcoma and went for a re.↗
▶Ep 1 · 0:49
clinical40 patients were referred after having an innocuous lesion removed that came back as non-rhabdomyosarcoma↗
▶Ep 1 · 1:00
clinical5 of the 40 referred patients were deemed impossible to re-excise based on location or other reasons↗
▶Ep 1 · 1:00
clinical35 patients underwent re-excision after unplanned primary excision↗
▶Ep 1 · 1:10
clinical44 patients had planned excision at the study hospital after workup with MRI or incisional biopsy or core biopsy↗
▶Ep 1 · 1:33
clinical23 of the 44 planned excision patients received neoadjuvant therapy↗
▶Ep 1 · 1:38
clinical21 patients had workup followed by planned wide local excision without neoadjuvant therapy↗
▶Ep 1 · 1:56
clinical45.7% of patients who underwent re-excision had residual tumor↗
▶Ep 1 · 1:56
quoteWhen looking at the unplanned to the planned excision patients, so the first thing they looked at was residual tumor, and what was fascinating is they actually found that 45.7% of the patients that they did the re-excision on actually had residual tumor.↗
▶Ep 1 · 2:13
clinicalThere was no difference in disease relapse between planned and unplanned excision groups↗
▶Ep 1 · 2:21
clinicalThere was no difference in 5-year overall survival between planned and unplanned excision groups↗
▶Ep 1 · 2:26
clinicalThere was no difference in local control rates or local recurrence between planned and unplanned excision groups↗
▶Ep 1 · 2:26
clinicalThere was no difference in disease-free survival between planned and unplanned excision groups↗
▶Ep 1 · 2:56
guidelineThe study authors concluded that patients should have a higher index of suspicion and should be worked up more thoroughly↗
▶Ep 1 · 3:10
quoteI'm thinking about all the patients that weren't mentioned here that had an excision or a nucleation of a benign looking lesion that wasn't non rhabdosarcoma.↗
▶Ep 1 · 3:26
opinionSince there is no outcome difference, it may be acceptable with low index of suspicion to excise the lesion and do re-excision if it comes back as non-rhabdomyosarcoma↗
▶Ep 1 · 3:26
quoteI think that since there's no outcome difference, it seems to me that it's probably OK with a low index of suspicion to excise the lesion and if it comes back as non-rhabdosarcoma, then do a re-excision.↗
▶Ep 1 · 3:39
clinicalRe-excision sometimes has high morbidity because you have to take a lot more tissue↗
Urology Part I
▶Ep 9 · 0:00
quotebetter to skip a tag than to hallucinate a specialty↗
Update Course Rewind: Thoracotomy vs VATS for Lung Metastases
▶Ep 18 · 8:56
clinicalThe Children's Oncology Group is starting a study to answer the question of thoracotomy versus VATS, with enrollment starting towards the end of this year or early next year↗
Case-Based Journal Review: Inguinal Hernia 2025
▶Ep 28 · 1:17
clinicalPreterm infants with inguinal hernia have a very high rate of incarceration↗
▶Ep 28 · 1:17
quoteSo these babies have a very high rate of incarceration. So I tend to repair these before they leave the hospital.↗
▶Ep 28 · 4:47
quoteDid they mention if any of those had lost like dead bowel? Did they even talk about serious events, or is it just that they had to come back to have it pushed back in again?↗
▶Ep 28 · 4:56
clinicalOne patient had a bowel injury during repair↗
▶Ep 28 · 5:26
quoteIt seems like it's a well done study with pretty clear evidence that there were more. More reintubations, more apnea in the early repair, and the incidence of what we all fear was very low.↗
▶Ep 28 · 5:26
clinicalThere were more reintubations and more apnea in the early repair group↗
▶Ep 28 · 6:57
quoteBut what this paper does is it tells pediatric surgeons that sending them home is generally safe and maybe safer, and it is an option if in the past it was not an option for them.↗
▶Ep 28 · 13:42
quoteThink about how many unnecessary times people are coming back to the hospital for a visit for social reasons. Leave it up to the parents. Some want to come. Let them come. But some don't, so you give them the choice.↗
▶Ep 28 · 16:42
quoteThe problem is 1 year is not enough. If you look at the study out of Mayo Clinic that Ben Zendejas wrote when he was a resident there. There was a contralateral hernia occurrence after a 50 year follow up.↗
▶Ep 28 · 16:43
clinicalA Mayo Clinic study by Ben Zendejas showed contralateral hernia occurrence after 50 year follow-up↗
▶Ep 28 · 16:59
quoteThe reason I would do it is not for the immediate year, it's for their lifetime, but it's an interesting paper.↗
quoteThis is really cool for me. I've never heard of a posterior tracheopexy.↗
Posterior Tracheopexy For Severe Tracheomalacia
▶Ep 2 · 2:01
quoteThis is really cool for me. I've never heard of a posterior tracheopexy.↗
Esophagogastric Dissociation for GERD in Severe Neurodisability
▶Ep 3 · 0:14
clinicalEsophagogastric dissociation was historically thought of as a last resort operation when Nissen fundoplication won't work↗
▶Ep 3 · 0:14
quoteThe dissociation was thought of historically as sort of the last resort operation, the big operation when a Nissan won't work, where we dissociate the esophagus from the stomach.↗
▶Ep 3 · 0:24
clinicalEsophagogastric dissociation is being suggested as an upfront primary operation for a small subset of patients with severe neurologic impairment↗
▶Ep 3 · 2:12
opinionA multi-center study will probably be needed to really understand the difference between the procedures↗
▶Ep 3 · 2:15
clinicalThe study did not look at complication rates such as leaks and strictures↗
▶Ep 3 · 2:18
quoteAbout leaks and strictures, which are really the concern of why most of us don't do this big operation.↗
▶Ep 3 · 2:18
opinionLeaks and strictures are the main concern for why most surgeons don't do esophagogastric dissociation↗
Abdominal Wall Defects with Dr. Jacob Langer
▶Ep 22 · 14:19
clinicalA study by Dr. Baird showed that patients with flap closure did better in every way than those with sutured fascial closure, including lower rates of umbilical hernia repair↗
▶Ep 22 · 18:10
clinicalSpring-loaded silos create outward pressure as you push down, making the defect larger over time↗
Esophagogastric Dissociation for GERD in Severe Neurodisability
▶Ep 23 · 0:14
quoteThe dissociation was thought of historically as sort of the last resort operation, the big operation when a Nissan won't work, where we dissociate the esophagus from the stomach.↗
▶Ep 23 · 0:14
clinicalEsophagogastric dissociation was historically thought of as a last resort operation when a Nissen won't work↗
▶Ep 23 · 0:24
clinicalEsophagogastric dissociation is being suggested as an upfront primary operation for a small subset of patients who have severe neurologic impairment↗
▶Ep 23 · 2:12
opinionA multi-center study will probably be needed to really understand the difference between these procedures↗
▶Ep 23 · 2:16
clinicalThe study did not adequately look at complication rates such as leaks and strictures↗
▶Ep 23 · 2:18
opinionLeaks and strictures are the main concern of why most surgeons don't do esophagogastric dissociation↗
Abdominal Wall Defects with Dr. Jacob Langer
▶Ep 34 · 18:10
clinicalSpring-loaded silos create outward pressure as you push down, causing the abdominal wall defect to become larger over time↗
quoteI love how you stated that right off the bat. So we're going to start and end with that, that if anything to take away, it's the movement towards ovarian preservation.↗
clinicalThere is already shown benefit of repairing myelomeningocele in utero, and adding mesenchymal stromal cells provides even larger benefit in chance of ambulation↗
▶Ep 12 · 4:08
quoteSo, we already have shown a benefit of repairing these in utero, and now to take it a step further, if you impregnate it with mesenchymal stromal cells, you actually have even a larger benefit in the chance of ambulation.↗
▶Ep 12 · 6:38
quoteI think this paper highlights that this is what happens in an emerging field. You have disparities in what is happening.↗
▶Ep 12 · 6:38
opinionIn an emerging field like fetal surgery, there are disparities in what is happening at different centers↗
▶Ep 12 · 6:46
opinionThere is value in having some centers with dedicated teams focusing on fetal care even if they don't do interventions↗
