# Journal of Pediatric Surgery Article Review: May 2019 — GCMD Library

Type: video · 9 min · posted 2026-06-25
Canonical: https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-may-2019-13361

## Chapters
- [0:03](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-may-2019-13361?t=3) Post-operative Follow-up Optimization and Telemedicine
- [3:26](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-may-2019-13361?t=206) Appendectomy Techniques: Intracorporeal vs Extracorporeal
- [6:07](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-may-2019-13361?t=367) Shock Index Pediatric Adjusted (SIPPA) in Trauma

## Statements
- "Guyan and Yonker from Alberta Children's Hospital studied optimizing post-operative follow-up by examining why patients show up, clinical relevance, and costs." — Ray (clinical) [0:27](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-may-2019-13361?t=27)
- "More complex cases were associated with higher likelihood of post-operative follow-up attendance." — Ray (clinical) [0:43](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-may-2019-13361?t=43)
- "Orchidopexy was one of the most common reasons why patients wanted to follow up post-operatively." — Ray (clinical) [0:49](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-may-2019-13361?t=49)
- "Follow-up visits were more clinically relevant if the patient had a more complex operation or something happened requiring earlier-than-expected follow-up." — Ray (clinical) [0:54](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-may-2019-13361?t=54)
- "D'Antonio and Lanning at Children's Hospital Richmond used iPads for telemedicine post-operative follow-up and found patients and families were happy with it." — Ray (clinical) [1:22](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-may-2019-13361?t=82)
- "There was no difference in diagnosis between telemedicine and in-person follow-up in the Richmond study's small cohort." — Ray (clinical) [1:29](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-may-2019-13361?t=89)
- "Telemedicine follow-up allows surgeons to fit more new patients into clinic and get more cases." — Gibbons (opinion) [1:47](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-may-2019-13361?t=107)
- "Telemedicine follow-up feasibility depends on patient population resources and education level." — Alex (opinion) [2:22](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-may-2019-13361?t=142)
- "Al Bahiri and Merritt from Western University in London, Ontario conducted a retrospective review of appendectomy techniques for simple appendicitis with over 200 patients in the intracorporeal 3-port group and about 70 in the extracorporeal group." — Gibbons (clinical) [4:00](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-may-2019-13361?t=240)
- "There was no difference in wound infection rates between intracorporeal and extracorporeal appendectomy methods." — Gibbons (clinical) [4:37](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-may-2019-13361?t=277)
- "Extracorporeal appendectomy was shorter than intracorporeal by about 17 minutes." — Gibbons (clinical) [4:46](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-may-2019-13361?t=286)
- "Extracorporeal appendectomy was cheaper than intracorporeal by about 30%." — Gibbons (clinical) [4:46](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-may-2019-13361?t=286)
- "In the Western University study, about 80% of intracorporeal appendectomies used a retrieval bag and 20% pulled the appendix out through the port." — Gibbons (clinical) [5:07](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-may-2019-13361?t=307)
- "Only one of four surgeons in the Western University study performed extracorporeal appendectomy; the other three did exclusively intracorporeal, which is a study limitation." — Gibbons (clinical) [5:19](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-may-2019-13361?t=319)
- "Children do excellent with both intracorporeal and extracorporeal appendectomy techniques, and outcomes are ultimately similar." — Alex (opinion) [5:35](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-may-2019-13361?t=335)
- "A study calculated shock index pediatric adjusted (SIPPA) using EMS pre-hospital information and tracked short and longer-term outcomes." — Alex (clinical) [7:14](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-may-2019-13361?t=434)
- "Pre-hospital SIPPA and the delta change between pre-hospital and ED SIPPA were statistically and clinically significant for predicting need for ICU, intubation, ventilation, and transfusions." — Alex (clinical) [7:35](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-may-2019-13361?t=455)
- "The SIPPA study was limited to patients with injury severity score (ISS) of 16 or greater." — Alex (clinical) [8:38](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-may-2019-13361?t=518)
- "At Todd Ponsky's hospital, a certain SIPPA number triggers immediate patient evaluation rather than using trauma score classification." — Todd Ponsky (clinical) [8:56](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-may-2019-13361?t=536)

## Transcript
Hey guys, so the Canadian Association of Pediatric Surgery JPS issue just came out. What were your thoughts? Ray, what did you like? So I had a question for you, Todd. What do you and your partners do for post-op follow-up? We used to absolutely see every patient in the office, and lately we've been doing phone follow-up, and a lot of the patients really like that. So one study that I found interesting was from Guyan and Yonker from Alberta Children's Hospital looking at optimizing post-op follow-up. So they were looking at why are people actually showing up in their post-op visit, what makes it clinically relevant, and how much is it costing. So they found basically the more complex cases, patients were more likely to follow up. Interestingly enough, an orchidopexy was actually one of the most common reasons why people wanted to follow up. And then if the surgeon said you should follow up, they found that it's more clinically relevant if you had a more complex operation or something happened and you had to show up earlier than you normally expected, and it cost a lot of money, not surprising to any of us. So they basically said we need to optimize. Our follow up with our patients, do we actually need to be following up? But there's another study in this issue that addressed actually following up post-op using telemedicine. D'Antonio and Lanning out of the Children's Hospital at Richmond gave their patients these iPads essentially that they could. Follow up with instead of coming in in real life they found that patients and families are happy with it and there is no difference in diagnosis in their small group that they looked at. So what do you guys think about following up via telemedicine? From a surgeon's standpoint, I think it's fantastic. It saves you some time in the, in your clinic visit. You can fit more um new patients in and get more cases. From a parent's perspective, I might have been a little bit apprehensive at first cause just are wondering if there's anything that might be missed. But I think if the surgeon had told me ahead of time, hey, this is how we kind of do it routinely now, feel free to call or come in if there's any concerns at all. I think that would kind of reassure me and make me more comfortable with it. Mhm. Alex, Uh, I think it's a good option to have. Uh, I think you always have to look at the population and see if your patient population is gonna be OK. I think. In, in children's in the hospitals that I worked at, we have populations that have very limited resources, where this would either not be possible or just the education uh around it might not make it a feasible, uh, technology, but it definitely allows us to do that with the bulk of patients, so that then we have some room in our clinics to take care of the rest. I think it'll still be, it'll, it'll be interesting to see the dynamic in their home too, right? Because you get to, you get an insight into their living situation rather than taking them out of that and putting them in clinics. So I feel like it might actually give us a, a better insight into the family dynamic and the family situation as a whole. Great study. This was good. Thanks, Ray. Gibbons, what did you find? So, uh, let me also start off with a question for you. What's your favorite way to do an appendectomy? Uh, well, I do it laparoscopically, but usually I start off through a single incision and extra corporealize the appendix. Uh, it is fun, uh, but it is only 11 scar, potentially less pain. Well, the study I looked at was kind of given some more reasons why, uh, extra corporalizing the appendix be uh, a beneficial thing. So it was, uh, coming out of Western University in London, Ontario, uh, Doctor Al Bahiri and Doctor Merritt, and basically, they just did a retrospective review of all their patients who they did an appendectomy for for simple appendicitis. They had a little bit more than 200 patients, uh, in the total intracorporeal 3 port group and about 70 patients in the extracorporeal group, and that was either single port, two ports, or in rare instances, 3 ports. And they were just wanted to look at seeing, uh, which way, uh, they wanted to look at some of the different outcomes for it in terms of, uh, surgical site infections, cost, and time of the operation. They found no difference in terms of the wound infection rate. There's a concern that if you pull an appendix up through the belly button, you might get some more wound infections there, but they didn't see that. And then they found that it was, uh, shorter when you were doing the extrapoal method by about 17 minutes, and it was also cheaper by about 30%. So can I ask you a quick question for the intracorporeal, uh, appendectomies, did they, uh, use like, um, do they just like straight up pull it out through the trochar, or did they discuss how they removed the appendix? For the intracorporeal one, about, uh, I think 80%, uh, use the retrieval bag and the other 20% pulled it out through the port. And for this that's certainly one of the 4 surgeons, um, actually did it extracorporeal. The other 3 all did it exclusively incorporeal. So that's definitely a, a limitation of the study, yeah. Alex, thoughts? I like them both. I think kids do excellent with uh both, and I do think it, it ends up being a little bit what the surgeon's comfortable with. Ultimately, the outcomes sort of are going to look similar. Like, there, I know there's studies that prove like one's better, one's, one's worse, but I think ultimately what, what surgeons are more comfortable doing is what's gonna be the best for their patients right now with the options we have. I agree. So, do you take tramadol, Todd? Yes, What information do you get, like, about the patient when they call you down for a trauma? It depends um which hospital. So, uh, a lot of times it just says their age, their vital signs, and the mechanism of injury and how long until they get here. 12 or 3? If it's a 1 trauma, I run into the hospital. If it's a level 2, I honestly Don't do much with it except for wait to hear what happens when they come in. OK. So this article is about using shock index. Have you heard about it, used it before? Yes, yes. We we use it once they're in the hospital. I've never done it pre-hospital. So this is, this is the cool thing about this article. They use the shock index pediatric adjusted. There's papers, there's already papers out there that say like it's better because, you know, kids' vital signs are different, depending on their age group, whatever. So this study. Calculated SIPPAs with the EMS information they had and tracked outcomes for patients like short and longer term outcomes using pre-hospital SIPPA and then the change between pre-hospital SIPPA and ED SIPPA. So it's two values that they took, the pre-hospital one and then the sort of trail they took on on that, and that delta change was another factor they evaluated and it's statistically significant and clinically significant for need for ICU, need for intubation, ventilation, and transfusions, and all these things. But I think, like, at a systems level, just having this perspective and knowing that this kid might need X or Y, just out of one score. Uh, it's something that we should be looking at because you think, so do you think we should be adding that then to like the page that goes out like SIA score, vitals? I think if we had a number that like now we know is tracked to other issues and factors, I think we can definitely do something with it. Did this study account for ISS also because I know like in the original CIA was they did have pretty strong correlations with ISS above 25. Uh, the study was limited to patients with ISS greater than, uh, well, 16 or greater. So I think, I think it's a great study. I think that the score is clearly emerging as an important number to follow. I think the point is we don't exactly know how to use the number yet. Uh, at our hospital, it means that a certain number, we actually have to go in to see the patient immediately, uh, rather than using the trauma score. The classification. Uh, so I think it's a great study to talk about because I think we're going to find out more and more and realize more and more how we should be using this, this score. I think that was great. These were good reviews. It sounds like this is a good issue of JPS. I'm looking forward to reading those articles. Thanks for reviewing those.

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Not medical advice · citation policy: https://library.globalcastmd.com/ai