Journal of Pediatric Surgery Article Review: 3rd Quarter (Jul-Sep) 2024
With Dr. Colin Martin & Dr. Casey Culkins & Dr. Mark Slidell & Dr. Whitt Holcomb · hosted by Dr. M. Gootee · StayCurrentMD
Cued at 9:03 · stops at 9:48 · press play
Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
Podcast
Journal of Pediatric Surgery Article Review: January 2022 APSA Issue
13 min · Published Feb 2022
Video
Does Delayed Diagnosis of Hirschsprung Disease Impact Post-operative and Functional Outcomes? A Multi-Center Review From the Pediatric Colorectal and Pelvic Learning Consortium
1 min · Published Oct 2024
Video
CAPS - Educational Outcomes in School Age Children with a History of Hirschsprung’s Disease - Michael Cowap
Published May 2022
Podcast
Hirschsprung Disease Audience Q&A with Dr. Marc Levitt
12 min · Published Apr 2017
Podcast
Journal of Pediatric Surgery Article Review: 2nd Quarter (Apr-Jun) 2024
17 min · Published Sep 2024
Video
Quick Literature Updates Ep 22
4 min · Published Oct 2025
Only a few other public items share this expert — go deeper there →
Video
Pediatric Surgical Oncology Research Collaborative (PSORC): Studying Rare Pediatric Tumors
56 s · Published May 2026
Video
Update Course Rewind 2025: Hirschsprung + ARM: Rare but Real
1 min · Published May 2026
Video
Update Course Rewind 2025: Hirschsprung + ARM: Rare but Real
1 min · Published May 2026
Video
Pooling Patients to Study Rare Pediatric Tumors: An Introduction to PSORC
56 s · Published May 2026
Video
The fetal frontier: A review of current and emerging fetal therapies for genetic diseases
44 s · Published May 2026
Video
Indocyanine green assists with sentinel lymph node mapping in pediatric and adolescent patients
1 min · Published May 2026
What the experts said
The study included 679 patients diagnosed with Hirschsprung's disease.
Delayed diagnosis of Hirschsprung's disease does not impact postoperative outcomes nor the need for revision surgery of the pull-through, but is associated with increased need for fecal diversion after pull through.
There is significant practice variation regarding the optimal timing of delivery for infants with gastroschisis.
Currently there's no evidence to suggest that earlier delivery prior to 37 weeks is justified for gastroschisis.
Planned delivery before 37 weeks gestational age for gastroschisis is probably not beneficial and may in fact be harmful.
Early delivery of gastroschisis may promote complications of prematurity.
Delivery of infants with gastroschisis after 37 weeks post-conception seems to be preferable.
Once the gastroschisis defect is closed, antibiotics can be safely stopped unless there's some other reason to continue.
Sutureless repair for gastroschisis is safe and effective and associated with a clear decrease in the need for mechanical ventilation.
The literature on gastroschisis suffers from a lack of level 1 randomized controlled trials or high level comparative studies.
There was no pediatric surgery-specific classification system for complications prior to the Clavien-Madadi system.
The Clavien-Dindo classification was validated in the adult world but used in pediatric surgery despite not being validated for that population.
The benefits of the Clavien-Dindo classification reported from adult surgical literature were not transferrable into pediatric surgery.
An unexpected event includes any event with a subsequent deviation from the planned pre-intra and post-operative course of children.
The Clavien-Madadi classification showed improved agreement rates of respondents at 85% versus 76% for the Clavien-Dindo classification.
The Clavien-Madadi classification was less frequently considered inaccurate for rating in the pediatric population compared to the Clavien-Dindo classification.
The PCPLC multi-institutional registry includes a number of institutions throughout the United States.
85% of Hirschsprung patients were diagnosed at less than 1 year of age.
Kids with shorter segment disease (rectosigmoid or very small portion of aganglionic bowel) were more likely to be diagnosed at a later age.
Children with long segment Hirschsprung disease typically present at birth with classic symptoms such as failure to pass meconium.
Approximately one-third of neonates and 50% of infants, toddlers, and children had diverting ostomies performed prior to pull-through.
There was no difference in overall rates of redo pull-throughs across age groups.
Older children were more likely to need a redo pull-through due to an anastomotic leak.
Higher rates of diverting ostomy post pull-through were suspected to be a treatment for post pull-through leak or anastomotic leak.
The only outcome difference seen was nighttime soiling or incontinence in the older patient population.
The systematic review on gastroschisis included 28 high quality manuscripts.
Two randomized controlled trials on gastroschisis had been started but both ended prematurely and were underpowered.
Clinical practice suggests that skin organisms are most commonly identified in infections among infants with gastroschisis.
Gastroschisis infants have a fairly high rate of wound infection.
Silo closures have a higher rate of infection than other closure methods for gastroschisis.
Sutureless closure has the lowest rate of infection for gastroschisis.
The recommendation for gastroschisis is to provide antibiotic coverage for skin flora until the defect is closed and potentially for an additional 24 hours thereafter if the infant is clinically stable.
Stable gastroschisis infants with sufficient abdominal capacity for sutureless closure tend to have the best outcomes.
Minimizing fluids and paralytics in gastroschisis infants improves their results.
Gastroschisis patients with sutureless closure have shorter length of stay and achieve feeding sooner.
The Clavien-Madadi classification scale consists of several grades from 1 to 5 based on the type of therapy needed to correct the complication.
The validation process circulated up to 20 case scenarios of unexpected events within the ERNICA Network (European Reference Network for inherited and congenital anomalies).
59 surgeons from 12 European countries completed the Clavien-Madadi validation questionnaire.
43% of pediatric surgeons preferred the Clavien-Madadi classification compared to 12% for the Clavien-Dindo classification.
Nearly 82% of surgeons affirmed advantages of the Clavien-Madadi classification.