Quick Literature Updates Episode 14

Hello, pediatric surgery family. I'm M. Goddi, a research fellow from Cincinnati Children's Hospital Medical Center. And today, our team is going to deliver the articles that you should know about. We have three 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 VACTERL 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 Elena Enscisco. 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 VACTERL 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 anorectal malformations. They found that about 27% of the patients had a gynecologic anomaly, and about 46% of them had the VACTERL association, meaning that in addition to the anorectal malformation, they also had two of vertebral, cardiac, tracheoesophageal, renal, or limb anomaly. When comparing patients who had a VACTERL association to those who didn't, they found that having the VACTERL association was associated with more gynecologic anomalies. This was especially true when renal anomalies were found, and when patients had recto-vestibular or recto-perineal fistulas. So for females with anorectal malformations and VACTERL association, especially renal anomalies, we should look carefully for gynecologic anomalies. And our second paper of today, cost and outcomes of intercostal nerve cryoablation versus thoracic epidural following the Nuss procedure. By Peris Holquen at all, and this paper is summarized by Alex Halpern. He's one of our contributors here at Stacorn MD and a general surgery resident at George Washington University. Thoracic epidural and intercostal nerve cryoablation are two options for pain control in patients undergoing Nuss procedure for pectus excavatum. Now, what are the benefits of each? Dr. Tsi and his team from Penn State conducted a retrospective chart review looking at kids who underwent Nuss procedure between 2002 and 2020 and comparing the outcomes and cost 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 a 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 cryoablation 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 today, reconstructing the anal sphincter to reverse iatrogenic overstretching following a pull through for Hirschsprung's disease, one year outcomes by Bakueva at all. This one is summarized by Sicily Hina. She's a research fellow at Cincinnati Children's. This is a multi-institutional one-year outcome study where they did a reconstruction of the anal sphincter for pathless sphincter in six patients, then an assessment after a year. They had six patients, two of them had Down syndrome, and they did a redo pull through with an anal sphincter reconstruction, and the other four got only an anal sphincter reconstruction. These four 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 herchsprung 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 Stacorn MD on social media, give us a rating, and subscribe to YouTube channel. And don't forget to download the Stacorn app on the App Store or Play Store for tons of content.