Update Course 2022 - TOP PUBLICATIONS IN NON- PED SURG JOURNALS - Jose Campos
With Dr. Jose Campos & Dr. Sean St. Peter & Dr. Mira Kotragal · hosted by Dr. Todd Ponsky · Live Event Content
Cued at 12:40 · stops at 13:25 · press play
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
The Chilean Society of Pediatric Surgery screens approximately 1,200 articles each month from non-pediatric surgical journals to identify the 3% relevant to pediatric surgery.
One participating hospital in the appendicitis antibiotic trial did not see a difference in abscess rates between the two antibiotic regimens in their cohort, while the overall study results were driven entirely by Phoenix Children's Hospital's experience.
NSQIP-P national data shows no difference in abscess rates between ceftriaxone-metronidazole and piperacillin-tazobactam across much larger patient numbers.
In the NEC trial, there was significant surgeon intention to treat, with most patients who received initial peritoneal drainage going to laparotomy shortly after drain placement.
Peritoneal drainage for NEC often serves as a temporizing measure to stabilize septic patients before laparotomy rather than as definitive therapy.
Peritoneal drainage started as a temporizing measure for NEC but morphed into a definitive management strategy in approximately 40-50% of surgeons' minds.
The original description of percutaneous endoscopic gastrostomy (PEG) was done by Todd Ponsky Sr.
The article by Todd Ponsky Sr. and Mike Goddard on PEG tube placement remains the most cited article in the history of the Journal of Pediatric Surgery, with approximately three times the citations of the number two article.
PEG tubes are difficult to change to button tubes, often requiring a second anesthetic with GI specialists to remove the PEG endoscopically before placing a button.
Sleeve gastrectomy is a very safe operation in adolescents with good long-term data showing resolution of comorbidities, especially in pre-diabetic and diabetic patients.
The Teen Labs Consortium has been conducting NIH-funded prospective trials on bariatric surgery in adolescents since 2007.
The average time pediatric patients spend in bariatric surgery programs before proceeding to surgery is approximately nine months.
A multi-institutional prospective randomized trial comparing piperacillin-tazobactam to ceftriaxone-metronidazole for perforated appendicitis was stopped at 75% enrollment when interim analysis favored the piperacillin-tazobactam group.
Intra-abdominal abscess formation was significantly lower in the piperacillin-tazobactam group with an odds ratio of 4.8.
The number needed to treat with piperacillin-tazobactam to prevent one intra-abdominal abscess was 5.7.
Necrotizing enterocolitis treated surgically is associated with high mortality rates and poor neurodevelopmental outcomes.
Two previous randomized controlled trials comparing surgical techniques for NEC both failed to enroll enough patients to answer the clinical question.
A 20-center randomized controlled trial by Marty Blakely comparing initial laparotomy versus peritoneal drainage for NEC randomized 310 premature newborns.
At 18 to 22 months of corrected age, the composite outcome of death and neurodevelopmental impairment was similar in both the laparotomy and peritoneal drainage groups in frequentist analysis.
Bayesian analysis of the NEC trial showed a high probability of laparotomy being superior to peritoneal drainage.
In the original papers by Ziggy Hein on peritoneal drainage for NEC, approximately one-third of patients died, one-third received laparotomy, and one-third were managed with drainage alone.
A systematic review examining gastrostomy insertion techniques reviewed 900 publications, with 58 being used for final recommendations.
Twelve studies directly compared outcomes between laparoscopic and percutaneous endoscopic gastrostomy, showing major complication rates were significantly less common with laparoscopic placement.
The number needed to treat to prevent one major complication from PEG (by using laparoscopic approach instead) is 24.
A database comparison of 3,000 patients with differentiated papillary thyroid cancer found no survival difference between total thyroidectomy and thyroid lobectomy.