Quick Literature Updates Episode 9

Hello pediatric surgery family. I'm M. Tombash, a research fellow from Cincinnati Children's Hospital Medical Center. And along with StayCurrent, we are sharing knowledge to improve child health around the globe. Today, our team is going to deliver the articles that you should know about. We have four papers today. First two of them are from the Journal of Pediatric Surgery. And the last one is from Academic Pediatrics. We don't have much time, so let's start. Our first paper titled, "Effect of Transanastomotic Feeding Tubes on Anastomotic Strictures in Patients with Esophageal Atresia and Tracheoesophageal Fistula, the Quebec Experience" by Lo Russo at all. And this paper is summarized by Rod Gerardo. He was a research fellow at Cincinnati Children's Hospital, and now he's currently a general surgery resident at Wright State University. In this retrospective cohort study, the researchers looked at pediatric patients who received a transanastomotic tube for their repair of esophageal atresia with tracheoesophageal fistula and specifically the stricture rates. So what did they find? Those patients with a transanastomotic tube had a 2.72 times higher risk of developing a stricture post-operatively. So what do you do? Do you leave a tube or not? Leave a comment below. Awesome. Our second paper is "Natural History and Consequence of Patent Processus Vaginalis," an interm analysis from a multi-institutional prospective observational study by Frazier at all. This one is summarized by Cecilia Hena. She's a research fellow at Cincinnati Children's Hospital. This is a prospective study done by the Midwest Pediatric Surgery Consortium. They look every patient that had a laparoscopic pylon myotomy to see if they have a PPB, and then follow up them by a call every year. The idea is to reach the 18 years old age, but this is an interim analysis, so only four years have passed. And what did they find? From the 526 patients that were enrolled, 283 had a PPB, either bilateral, right, or left. Of all the patients, 208 had at least one year follow up. And what they found is that only three patients underwent an inguinal hernia repair, and all of them were within the first year of follow up. So, it seems that most of the PPBs don't turn into inguinal hernias. Great. Moving to the next one. Our third paper of the day, Primary versus salvage liver transplantation for biliary atresia, a retrospective cohort study by Yali at all. This paper is summarized by Alex Halpern. He's one of our contributors here at StayCurrent MD and a general surgery resident at George Washington University. Liver transplantation for biliary atresia can either be performed as initial treatment, called primary liver transplant, or can be performed after failed Kasai hepatoportoenterostomy, called salvage liver transplant. The current standard in the US is Kasai first and liver transplant only if that fails. But is this really what we should be doing? They looked at children with biliary atresia who underwent either a primary or salvage liver transplant, and they split these children into three groups. The first group had a primary liver transplant. The second group had an early salvage liver transplant before the age of one. And the third group had a late salvage liver transplant. They found that children who had an early salvage liver transplant and children who had a primary liver transplant had similar outcomes. They also found that children who had a late salvage liver transplant had improved graph survival. Now, why is this important? It's important because it shows that children who have a salvage liver transplant have similar, if not better outcomes in children who have a primary liver transplant. And backs up the current standard in the US of Kasai first and liver transplant only if needed, especially because some of these children that undergo the Kasai procedure will never end up needing a liver transplant. And here we are. The last paper of today is from Academic Pediatrics. Pediatric social risk screening, leveraging research to ensure equity by Colin at all. This final paper is summarized by Elena Cisco. She's a research fellow at Cincinnati Children's Hospital as well. In this article from March of 2022, the authors review current social risk screening of pediatric patients. Social risk screening means screening pediatric patients for risk factors for things like food and housing insecurity, financial strain, and unsafe environments. Often this is done by asking parents face-to-face or in using other devices like tablets. The authors discussed that the current screening protocols may not be effective and may actually lead to more inequities. First, there's low concordance between the screening results showing who might need resources and who is actually asking for more resources. Second, families may feel uncomfortable with the screening and may think there might be downstream repercussions based on their answers. And third, there may be racial biases in the screening practices. For example, non-white patients may be asked these questions more often. And these issues may lead to a misest between the opportunity for resource engagement and the actual resource engagement. So the authors have five suggestions for future work. One, use community needs assessments and other population level data to identify the community needs. Two, use community partnerships to ensure that the community needs are addressed. Three, conduct studies to determine if just offering resources universally is more effective than screening. Four, provide tiered levels of support. And five, get patient and family feedback and incorporate it. Check the link in the description below to read each paper. We hope you liked this episode. Please follow us on social media, give us a rating, and subscribe to our YouTube channel. And don't forget to download our StayCurrent app on App Store or Play Store for more content. Thank you for listening. Cincinnati Children's Hospital and StayCurrent are sharing knowledge to improve child health around the globe.