Quick Literature Updates Episode 14

Hello pediatric surgery family, I'm E Gdy, a research fellow from Cincinnati Children's Hospital Medical Center, and today our team is gonna deliver the articles that you should know about. We have 3 papers today and all are from the Journal of Pediatric Surgery. We don't have much time, so let's start. Our first paper titled Does Presence of a Vectorral Anomaly Predict an Associated gynecologic anomaly in females with anorectal malformations? A Pediatric Colorectal and Pelvic Learning Consortium Study by Ahmad et al. This paper is summarized by Ellen and Cissko. She was a research fellow at Cincinnati Children's, and as of July she's back to being a general surgery resident at Mayo Clinic. Here, the authors wanted to know if a veal anomaly predicted an associated gynecologic anomaly in pediatric females with anorectal malformations. Using the database from the pediatric Colorectal and Pelvic Learning Consortium, they looked at 384 females with interectal malformations. They found that about 27% of the patients had a gynecologic anomaly, and about 46% of them had the veal association, meaning that in addition to the anorectal malformation, they also had two of a vertebral, cardiac, tracheoesophageal, renal, or limb anomaly. When comparing patients who had a veal association to those who didn't, they found that having the veal association was associated with more gynecologic anomalies. This was especially true when renal anomalies were found, and when patients had recto vestibular or rectal perineal fistulas. So for females with inner rectum malformations and veal association, especially renal anomalies, we should look carefully for gynecologic anomalies. And our second paper of the day, costs and outcomes of intercostal nerve cryoablation versus thoracic epidural following the Ns procedure by Perez Holguin et al. and this paper summarized by Alex Halpern. He's one of our contributors here at Steaker MD and a general surgery resident at George Washington University. Thoracic epidural and intercostal nerve coagulations are two options for pain control in patients undergoing a NUS procedure for pectus excavatum. Now, what are the benefits of each? Doctor Tsai and his team from Penn State conducted a retrospective chart review looking at kids who underwent a NUS procedure between 2002 and 2020 and comparing the outcomes and costs of intercostal nerve cryoablation and epidural. They found that the intercostal nerve cryoablation group. Had lower rates of PCA use, lower total morphine milligram equivalent requirement, and the shorter length of stay in the hospital. This group also had longer operative times and a higher total hospitalization cost than the thoracic epidural group. So it seems like both of these options have their pros and cons with the intercostal nerve carablation group having a decreased total opioid use and decreased length of stay in the hospital, but increased operating room times and increased total cost. Let's move to the last paper of the day, reconstructing the anal sphincters to reverse iatrogenic overstretching following a pull through for Hirschsprung disease, one year outcomes by Bokova et al. This one is summarized by Cecily Ghena. She's a research fellow at Cincinnati Children's. This is a multi-institutional 1-year outcome study, where they did a reconstruction of the anal sphincter for patella sphincter in 6 patients, then an assessment after 1 year. They had 6 patients, 2 of them had Down syndrome and they did a redo pull through with an anal sphincter reconstruction, and the other 4 got only an anal sphincter reconstruction. These 4 patients got voluntary bowel movements with higher productivity and confidence, so it seems that we have an option for overstretched anal sphincters in patients with Hirschsprung disease after a pull-through. And thank you for listening. Please check the link in the description below to read each paper. We hope you liked this episode. We hope you liked this episode. Please follow Stay Cern MD on social media, give us a rating, and subscribe to the YouTube channel. And don't forget to download the Stay Cern app on the App Store or Play Store for tons of content.