Journal of Pediatric Surgery Article Review: November 2021
With Dr. Pablo Lache & Dr. Frederick Scola & Dr. Nellie Hafezy · hosted by Dr. Ellen Cisco & Dr. Rod Gerardo & Dr. Todd Ponsky · StayCurrentMD
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Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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What the experts said
Todd Ponsky has worked at 5 children's hospitals and has had to place a central line at ECMO decannulation only twice, never having to reinsert a line afterwards
If you just need access, then just use a PICC line rather than a central line
Leaving a central line at ECMO decannulation may be reasonable in older patients because they'll need hemodialysis more often
The main reason to operate on congenital lung malformations early is not only that it's easier, but you have a much less chance of having an infection beforehand, so it's clean, pristine virgin plains
Todd Ponsky was trained to operate on congenital lung malformations at 6 to 8 months of age, but now operates at 3 months
At CHOP, the median age for elective lobectomy for asymptomatic congenital lung lesions is about 8 weeks, with follow-up CT scan around 4 weeks and surgery around 8-10 weeks
Patients in the partial splenectomy study were divided into two groups: those who underwent partial splenectomy without subsequent re-operation and those who subsequently underwent total splenectomy
The 30% completion rate after partial splenectomy is on the higher end of what's been recorded in the literature so far
Partial splenectomies are not undergoing completions until years after the initial index procedure
Partial splenectomy has not gained universal acceptance among pediatric surgeons, and at CHOP it is very uncommon to do a partial splenectomy
If you feel comfortable doing a partial splenectomy, it works 70% of the time (avoiding completion splenectomy)
40% of patients ultimately required a central venous line within 30 days after ECMO decannulation in the University of Michigan study
In neonates (babies less than 28 days), the primary reason for needing a central line after ECMO decannulation was access, with many being CDH babies
In older children or babies, the primary reason for needing a line after ECMO decannulation was hemodialysis
In the Paris study comparing congenital lung malformation resections, there were about 30 patients with prior infections and 60 without prior infections
Every parameter examined (time of operation, needed transfusions, need for re-operations, more conversions, operative time) was worse in the group that had previous infections before lung malformation surgery
There were no differences in complications between the infection and no-infection groups in the lung malformation study
A lung that was infected is going to be a more difficult lung to operate on
The Indianapolis partial splenectomy study reviewed cases over 17 years from 2002 to 2019
The most common indication for partial splenectomy in the Indianapolis study was hereditary spherocytosis
About 29% of patients required completion splenectomy after partial splenectomy