Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
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Surgeons need to be prepared to have some negative laparotomies when operating based on clinical suspicion and ultrasound findings without free air on X-ray — Augusto Zani, Surgical Decision-Making in Necrotizing Enterocolitis: Imaging, Timing, and Operative Strategies · 9:45
Surgical Decision-Making in Necrotizing Enterocolitis: Imaging, Timing, and Operative Strategies
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Narrated by Lizzy Lee, PA-C & Maggie Koenig, FNP-BC, this podcast, a rewind from the 2025 Pediatric Surgery Update Course, delves into crucial updates in Necrotizing Enterocolitis (NEC) management. Leading pediatric surgeons Drs. Augusto Za
podcast11:03 · Nov 2026
Literature review: tracheomalacia diagnosis, NEC strictures, and PDA management
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We’re back with 27th episode of "Quick Literature Updates" the podcast series that delivers the latest updates in pediatric surgery literature in a quick and digestible format. In each episode, we review articles covering the most interesti
podcast4:19 · Nov 2026
Second fistulas or H-type fistulas can be very difficult to manage endoscopically. — Doug Van Altman, Transtracheal approach for recurrent tracheoesophageal fistula repair · 1:06
Transtracheal approach for recurrent tracheoesophageal fistula repair
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This video, featuring experts from Cincinnati Children's, discusses the challenging management of recurrent tracheoesophageal fistula (TEF) years after initial repair. Dr. Douglas von Allmen presents a clinical scenario and highlights the r
podcast2:20 · Nov 2026
Association of small intestinal atresia and Hirschsprung disease in a multi-institutional colorectal registry
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Purpose: Unlike colonic atresia, concomitant jejuno-ileal atresia (JIA) and Hirschsprung disease (HSCR) is an under-recognized association. We used a multi-institutional patient registry to describe the incidence, clinical characteristics,
article · Nov 2026
Nonoperative management of symptomatic urachal anomalies
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Introduction: Symptomatic urachal anomalies are rare disorders that consist of urachal remnants or fistulas with or without an associated cyst. Traditionally, when a urachal anomaly was recognized, operative excision was performed. There ha
article · Nov 2026
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Transtracheal approach for recurrent tracheoesophageal fistula repair
Recurrent tracheoesophageal fistulas can develop years after initial repair.
Host summaryJill Knepprath summarizes what Dr. Doug Van Altman said — not the host's own clinical position0:08 ↗
The seven-year-old patient had a history of TEF with prior repair and was presenting with chronic cough and food impaction.
clinicalDoug Van Altman0:34 ↗
The patient was referred for esophageal diverticulum and airway evaluation was performed.
clinicalDoug Van Altman0:43 ↗
Esophageal dilations were performed without improvement.
Host summaryJill Knepprath summarizes what Dr. Doug Van Altman said — not the host's own clinical position0:48 ↗
Esophagoscopy showed the esophageal anastomosis with a ledge formation and dilated upper pouch.
clinicalDoug Van Altman0:53 ↗
Bronchoscopy revealed granulation tissue along the back wall of the airway.
clinicalDoug Van Altman1:03 ↗
Second fistulas or H-type fistulas can be very difficult to manage endoscopically.
opinionDoug Van Altman1:06 ↗
Esophagram demonstrated mismatch and out-pouching at the anastomosis site.
clinicalDoug Van Altman1:12 ↗
The recurrent laryngeal nerve is at risk of damage during repair of recurrent TEFs.
Host summaryJill Knepprath summarizes what Dr. Doug Van Altman said — not the host's own clinical position1:17 ↗
A transtracheal approach provides better surgical exposure and reduces risk to the recurrent laryngeal nerve.
Host summaryJill Knepprath summarizes what Dr. Doug Van Altman said — not the host's own clinical position1:25 ↗
The transtracheal technique involves performing a distal tracheotomy with ET tube placement, using bronchoscopy to localize the fistula level, then making a tracheotomy over the fistula site.
clinicalDoug Van Altman1:30 ↗
The surgeon works through the tracheotomy to divide the layers of the esophagus.
clinicalDoug Van Altman1:41 ↗
The transtracheal approach minimizes injury to the recurrent laryngeal nerve.
Host summaryJill Knepprath summarizes what Dr. Doug Van Altman said — not the host's own clinical position1:46 ↗
Recurrent laryngeal nerve injury is underreported.
epidemiologicalDoug Van Altman1:49 ↗
True recurrent laryngeal nerve paralysis leads to muscle atrophy over time, resulting in long-term voice problems and potential aspiration issues.
clinicalDoug Van Altman1:52 ↗
Surgical Decision-Making in Necrotizing Enterocolitis: Imaging, Timing, and Operative Strategies
Abdominal X-rays for NEC have sensitivity between 13 and 25%
clinicalAugusto Zani1:56 ↗
A 2023 study in Pediatric Radiology suggests ultrasound can detect bowel wall thinning, perfusion abnormalities, and fluid collections that X-ray misses
Host summaryLizzy Lee summarizing the discussion — not the host's own clinical position2:15 ↗
High-risk ultrasound findings for bowel perforation include pneumoperitoneum, focal fluid collections, and complex fluid
clinicalAugusto Zani2:59 ↗
Intermediate-risk ultrasound findings include increased bowel wall ecogenicity, absent perfusion, portal venous gas, and bowel thinning or thickening
clinicalAugusto Zani3:07 ↗
In NEC, the diseased bowel is a symptom or result of the illness, not the cause of the illness
opinionTodd Ponsky4:28 ↗
The disease process in NEC still progresses even after resection, which is the problem of operating too early
clinicalTodd Ponsky4:34 ↗
In stable babies with a limited segment of necrotic bowel (approximately 10 cm), resection with primary anastomosis may not result in poor outcomes
opinionAugusto Zani4:47 ↗
The long-term benefit of primary anastomosis may not be seen in immediate survival outcomes
Host summaryLizzy Lee summarizing the discussion — not the host's own clinical position5:00 ↗
Data shows primary anastomosis is better than stoma or clip-and-drop in well babies
clinicalTodd Ponsky5:06 ↗
The clip-and-drop method involves removing necrotic bowel segment, stapling the ends, and returning in 24-48 hours to assess bowel hemodynamics before committing to stoma or anastomosis
Host summaryLizzy Lee summarizing the discussion — not the host's own clinical position5:18 ↗
Decision to proceed with anastomosis after clip-and-drop depends on hemodynamic markers: correcting lactic acid, correcting thrombocytopenia, and weaning off inotropes
clinicalJuan Gurria5:45 ↗
The SAT trial was a randomized controlled trial with final eligibility determined by surgeon's judgment during laparotomy
clinicalSimon Eaton6:19 ↗
In the SAT trial, randomization occurred intraoperatively after the surgeon determined the baby was hemodynamically stable
clinicalAugusto Zani6:34 ↗
In the SAT trial, mortality was similar between primary anastomosis and stoma groups
Host summaryLizzy Lee summarizing the discussion — not the host's own clinical position6:55 ↗
Babies who received primary anastomosis in the SAT trial got off parenteral nutrition significantly sooner than those with stoma
Host summaryLizzy Lee summarizing the discussion — not the host's own clinical position6:56 ↗
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