Top Themes From The Stay Current App

Yeah, so here's the deal. Uh, last year's fellows, you guys probably all heard their names, um Alex Kassar, Ray Hnky and Alexander Gibbons. Uh, they're back in residency, uh, and uh weren't able to come for this course physically, so they made a video. Now, this is a cool video they made. For those of you who've downloaded the app, the Stay Current app, who also helps to support this event, Stay Current, um, is sponsored by um Cincinnati and Kansas City. So thank you both for for making that happen. This app, um, um is viewed by uh 6,000 people, 6,000 pediatric surgeons, and we went through and looked at the most popular content shared. So what is it that people care about? So they go through and they review in the last year, what were the most pop and it's a random array of things, you'll see. It's pretty interesting. So let's roll the tape. As many of you know, the Stay Current team in partnership with Cincinnati Children's, Children's Mercy, Kansas City, and the Journal of Pediatric Surgery released Stay Current Pediatric Surgery in February of 2019. Since that time, our users have shared over 450 pieces of content, approximately 1400 times. Today, we're going to highlight the top items our users felt were worth sharing. Feel free to scan the QR codes to find each item in the Stay Current app. Starting us off at number nine is anorectal malformation. First in this category was the lap assisted pull through technique video for imperferate anus by Dr. Stephen Rothenberg. Next was the article effectiveness of digital anal dilation in preventing anal strictures after anorectal malformation repair published in JPS. Authors found that digital anal dilation is safe if the digits are appropriately sized and if the families follow a strict protocol of dilations. At number eight, the topic is congenital diaphragmatic hernia. One of the highlights of the app is its international user base. And this doesn't refer only to the people who are sharing the content, but those who created it as well. This video was created by Dr. Marcelo Martinez Ferro and Dr. Carolina Millan, both from Argentina and highlights techniques that they find helpful for the laparoscopic treatment of congenital diaphragmatic hernia. Some of the highlights from the video include utilizing a needle to decompress bowel that's in the way laparoscopically. Creating a pneumothorax in order to allow easier retraction of the hernia sac. And utilizing a laparoscopic detectable magnet in order to have greater maneuverability of the hernia sac. At number seven, the topic was esophageal atresia. Here, we highlighted an A review on the management of long gap esophageal atresia, focus on the diagnosis, management and follow up of these patients. We also highlighted a technical video from Dr. Sri Ramiel where he highlights thoscopic repair of esophageal atresia with distal tracheoesophageal fistula. In summary, the evidence supporting best practices for long gap esophageal atresia is currently low quality. Further research is needed. However, we should ensure patients receive appropriate long-term follow-up. Watch Dr. Emil's video for technical pearls for thoscopic repair. Coming in at number six was gastroesophageal reflux disease or GERD. Dr. Witt Holkham and Dr. Rachel Rosen, a pediatric gastroenterologist at Boston Children's, joined our fearless leader, Dr. Todd Ponsky to debate the appropriate management of patients with suspected GERD. The big takeaway here is that workup, diagnosis, and treatment of these patients is complex. And for those surgeons out there striving to perform the perfect Nissan, the latest and greatest recommendation involves minimal dissection at the GE junction, but also be sure you're still performing your wrap above the left gastric artery. Check out the audio chapter for some great discussion. At number five, the topic is pyloric stenosis. Guidelines are one of the most commonly shared pieces of content on our app and that makes sense because guidelines allow us to have a protocolized treatment for problems that we see frequently in pediatric surgery. This first guideline, referring to pyloric stenosis, was put together by Dr. Amir Kogel from Cincinnati Children's Hospital and it refers to both pre and postoperative treatment of patients with pyloric stenosis. In terms of the preoperative component, this is based off of an article by Dalton at all that highlighted how to properly resuscitate patients based only off of their lab values coming in in order to minimize future lab draws. In terms of the postoperative treatment, the highlight for this protocol is in terms of the feeding and is based off of multiple randomized control trials that have shown that adlib feeds are superior or equivalent to uh protocolized feeds. At number four, the topic was perioperative management. Here, we highlighted guidelines on postoperative apnea monitoring for infants, an infographic on fasting and NPO guidelines before surgery, and the guideline on preoperative and perioperative antibiotic prophylaxis dosing. In summary, all infants less than 50 weeks post-conceptual age at the time of surgery need some level of observation for apnea monitoring. NPO guidelines include clears up to two hours preop and breast milk up to four hours preop, and we tend to be too restrictive with these. And pre-op antibiotic prophylaxis must be administered within 60 minutes before incision and redoses needed for the duration of the operation. Generally, antibiotics are not needed after surgery unless the case determines otherwise. Coming in at number three and also the number one search topic on the app overall is Hirschsprung's disease. The article, the extent of the transition zone in Hirschsprung's disease caught many people's eye. So much so that Dr. Bazan Garwu of our idea team created a metabite. Next is another technique video from Dr. Stephen Rothenberg, but this time he's demonstrating the lap assisted pull through for Hirschsprung's disease. Finally, we have the evidence-based Cincinnati Children's video guideline for suspected Hirschsprung's associated enterocolitis. Your highlights here are that the transition zone can vary widely depending on the extent of disease with numbers as high as 22 centimeters for total colonic Hirschsprung's disease. Coyle at all recommend resecting greater than 5 cm proximately to the normal biopsy to avoid transition zone pull through. If you're wondering what that pull through might look like with a lap assisted approach, check out Dr. Rothenberg's video. And finally, remember in suspected Hirschsprung's associated enterocolitis, management includes prompt evaluation of the patient, rectal irrigations with lifesaving salt water, NPO, IV fluids, antibiotics and continuous monitoring. At number two, the topic is intussusception. We had two pieces of content that were widely shared for this. The first one was a guideline, again by Dr. Amir Kogel from Cincinnati Children's Hospital. And this guideline highlighted when patients should go to the operating room, specifically if they haveal signs or if they fail reduction after three attempts. And when patients can be safely discharged after reduction. One of the articles in which that protocol was based was the other piece of content that was widely shared and this was a video review highlighting article that showed that patients can be safely discharged home after four hours of observation after a successful reduction. Therefore, the highlights for interception would be that patients can have the air enema repeated every hour up to three times as long as there are no signs of peritonitis before operative aspiration and that patients who are asymptomatic for four hours after a successful reduction can be discharged from the emergency department. And lastly, the number one topic for content shared was blunt trauma. Here, we highlighted an infographic based on our ABS systematic review for blunt solid organ injuries in children. We also highlighted a podcast by PTS or the Pediatric Trauma Society that expands this guidelines to include renal and pancreas injuries. In summary, we should primarily consider non-operative management in hemodynamically stable patients. We should also consider angioembolization for ongoing or delayed bleeding, high grade injuries and early hemodynamic compromise before proceeding to the operating room. And that's the top shared content from State Current Pediatric Surgery for the year. Be sure to check out the app for this great content and more.