Update Course Rewind: 2021 Top Ten Key Takeaways

In the Petcova et al. study published in Annals of Surgery 2020, children with uncomplicated appendicitis were randomized to medical management with antibiotics or surgery, with 5-year follow-up.

In the Petcova et al. appendicitis study, the surgery group had no complications, while 46% of patients in the non-surgical management group required appendectomy during follow-up.

Medical management of acute uncomplicated appendicitis may be safe but is associated with a high failure rate, with many children ultimately requiring laparoscopic appendectomy.

Metastectomy for osteosarcoma lung metastases improves survival and can make patients long-term survivors.

Approximately 10% of 1 millimeter lung nodules in osteosarcoma patients contain malignant disease.

The Children's Oncology Group is starting a study to determine whether thoracotomy or thoracoscopy is superior for resection of pulmonary metastases in osteosarcoma, with enrollment expected late 2021 or early 2022.

The Flourish device is a catheter-based device that places magnets in proximal and distal esophageal pouches to create a compression anastomosis by causing ischemia of tissue between the magnets, which then sloughs off.

Inclusion criteria for the Flourish device are: atretic gap less than 4 centimeters long, fistula repaired or absent, and G-tube able to accommodate an 18 French catheter.

The Flourish device is associated with a high stricture rate and known serious life-threatening complications, and should only be used by centers with capabilities to treat the many issues associated with esophageal atresia.

Indocyanine green (ICG) has become a topic of interest in the last few years for use in pediatric surgery, especially in minimally invasive procedures to improve visualization of structures.

For laparoscopic cholecystectomy, ICG must be administered intravenously 12 to 18 hours prior to surgery to allow time for accumulation in the extrahepatic ducts, or can be injected directly into the gallbladder during surgery.

ICG applications in pediatric surgery include laparoscopic cholecystectomies, varicocele repairs, partial nephrectomies, and tumor excisions.

For anorectal malformations with rectal-perineal or rectal-vestibular fistula, outcomes including complications are similar whether the procedure is done before or after 14 days of life.

A PCPLC consortium study comparing endorectal pull-through for Hirschsprung disease at less than 31 days versus greater than 31 days found that preoperative enterocolitis, postoperative enterocolitis, constipation, and incontinence were the same between both groups.

Delayed pull-through with irrigations is a safe alternative to an operation in the neonatal period for Hirschsprung disease.

Cryoanalgesia is probably effective at improving post-operative pain and decreasing length of stay for pectus patients, with length of stay reduced from 4 days to 1 day.

There are no long-term studies on the effects of cryoanalgesia for pectus repair.

The double rim sign or halo sign on X-ray indicates a child has swallowed a button battery rather than a coin.

The main goal of button battery ingestion treatment is to remove the battery within 2 hours of ingestion.

Sucralfate or honey can help reduce damage from button batteries on the child's esophagus as temporizing measures.

Children less than 1 year old should not receive honey due to risk of botulism and should instead receive 10 mL of sucralfate every 10 minutes for up to 3 doses for button battery ingestion.

Children over age 1 with button battery ingestion should receive honey 10 mL every 10 minutes for up to 6 doses.

New ATLS recommendations for pediatric trauma patients in hemorrhagic shock call for earlier transfusion: after 1 bolus of 20 cc per kilogram of crystalloid fluid, blood should be given.

Balanced transfusion protocol for pediatric hemorrhagic shock typically includes 10 to 20 mLs per kilogram of packed red blood cells, plus inclusion of FFP and platelets.

Earlier transfusion in pediatric trauma was associated with shorter median time to transfusion and a decrease in total fluid volume administered.

Whole blood in trauma patients requires less volume compared to component therapy.

Research shows that observation of spontaneous pneumothorax in adults is non-inferior to immediate intervention with tube thoracostomy.

The Midwest Pediatric Surgery Consortium study on spontaneous pneumothorax management with simple aspiration showed 48% success rate, but 44% of patients in the simple aspiration group recurred.

83% of patients who failed simple aspiration for spontaneous pneumothorax ultimately ended up with VATS or blebectomy.

Greenwood et al. showed that mortality amongst black newborns is 3 times that of white newborns.

When black newborns are treated by black physicians, their mortality is reduced by 58% compared to black newborns treated by white physicians.

Bias exists within medicine and can change outcomes; representation matters and can make a difference.