Journal of pediatric surgery Article Review: April 2023, IPEG issue

The Titanic Index measures the percentage of sternum that lies under the anterior costal line

The study included 78 patients between 2020 and 2022, with 47% receiving two bars and 53% receiving more than two bars

A Titanic Index cutpoint of 66.5% predicted need for more than two implants with 93% sensitivity and 92% specificity

Severe outcomes in button battery ingestion were defined as deep mucosal erosion, perforation, mediastinitis, vascular or airway injury or fistula, and development of esophageal stricture

The Boston study included 143 patients under 21 years old from 2008 to 2021, with 24 having severe outcomes

Three predictive factors for severe button battery outcomes were: presence in esophagus at presentation, two centimeter or larger battery size, and presence of any symptoms

Time to removal was not a significant predictor of severe outcomes in the button battery series

The choledochal cyst study analyzed 577 patients aged 0-21 years from 2016 to 2018 in a national database

28% of choledochal cyst procedures were done laparoscopically and the rest were done open

Most open procedures for choledochal cysts were hepaticojejunostomy and most laparoscopic procedures were hepaticoduodenostomy

Patients receiving open operations had inferior outcomes including longer length of stay, higher cost, more TPN use, and more central line requirements

There was no significant difference in post-operative cholangitis or mortality between laparoscopic and open choledochal cyst resection

Laparoscopic biliary anastomosis for choledochal cysts has a learning curve and is not recommended for early career surgeons without assistance