Overview of the Surgical Management of Acute and Chronic Pancreatitis in Children with Dr. Juan Gurria
With Dr. Juan Gurria · hosted by Dr. Todd Ponsky · Live Event Content
Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
Video
Update Course 2023 - Updates in Pancreatitis
32 min · Published Aug 2023
Video
Chronic Pancreatitis, Function Tests, & Pain Management: Pancreatic Disease
51 min · Published Sep 2016
Video
Acute and Acute Recurrent Pancreatitis: Pancreatic Disease
56 min · Published Sep 2016
Podcast
Acute Pancreatitis
45 min · Published Jul 2017
Video
Welcome and Introductions: Pancreatic Disease
Dr. Todd Ponsky · 6 min · Published Sep 2016
Podcast
Acute Pancreatitis
45 min · Published Jul 2017
Video
Update Course Rewind 2025: Robotics in Pediatric Surgery: Which indications benefit the most?
4 min · Published Jun 2026
Video
Total pancreatectomy with islet autotransplantation (TPIAT) - Cincinnati Children's Pancreas Care Center
CCHMC Pediatric Surgery · 10 min · Published Dec 2024
Video
Update Course Rewind: 2023 Top Ten Key Takeaways
16 min · Published Jun 2024
Video
Update Course Rewind: Management of Recurrent Pancreatitis
CCHMC Pediatric Surgery · 6 min · Published May 2024
Video
Update Course Rewind: Management of Chronic Pancreatitis 2023
8 min · Published Apr 2024
Video
Update Course Rewind: Management of Acute Pancreatitis 2023
6 min · Published Apr 2024
Video
Mental Health and Gun Safety in Pediatrics - Catherine Neyer - APP Conference 2026
48 min · Published May 2026
Video
Clinical & Research Update: Pediatric Liver Tumors - A Case-Based Discussion with Drs. Katherine Somers & Alex Bondoc
69 min · Published Apr 2026
Video
Beyond ChatGPT_ AI Tools You’re Not Using (But Should) - Vail, CO
Dr. Todd Ponsky · 97 min · Published Jan 2026
Video
Beyond ChatGPT: AI Tools You’re Not Using (But Should)
Dr. Todd Ponsky · 109 min · Published Oct 2025
Video
2025 Pediatric Surgery Update Course - Updates in Lap Chole and Cholecystitis Management
18 min · Published Aug 2025
Video
2025 Pediatric Surgery Update Course - Updates in Lap Chole and Cholecystitis Management
18 min · Published Aug 2025
What the experts said
Diagnosis of acute pancreatitis requires serum lipase ≥3× upper limit of normal plus imaging findings (ultrasound, MRCP, or CT)
85% of 1000+ pediatric pancreatitis patients at Cincinnati Children's have genetic mutations
PRSS1 mutation causes autoactivation of trypsinogen, leading to aggressive early-onset pancreatitis in children as young as 1–3 years
Medications causing pediatric pancreatitis include L-asparaginase, steroids, valproic acid, and furosemide
Hereditary pancreatitis markedly increases lifetime risk of pancreatic cancer
Most pediatric pancreatitis fluid collections are self-limited and do not require intervention
ERCP is essential for diagnosis and treatment of pediatric pancreatitis but carries ~10% risk of post-ERCP pancreatitis
Autoimmune pancreatitis can mimic chronic pancreatitis and should be ruled out before surgery; it responds to steroids
Early necrosectomy (before 4 weeks) increases mortality; wait for walled-off necrosis to mature
Transgastric endoscopic necrosectomy reduces major complications compared to open surgery
Asymptomatic pseudocysts, regardless of size, do not require intervention
Early enteral nutrition (as soon as tolerated) prevents bacterial translocation and reduces complications in acute pancreatitis
Lactated Ringer's solution is superior to normal saline for initial resuscitation in acute pancreatitis
~50% of pediatric patients with hereditary or anatomic pancreatitis develop chronic pancreatitis
Chronic pain in pediatric pancreatitis involves central sensitization and brain plasticity, requiring multidisciplinary pain management
Segmental pancreatic resections in genetic pancreatitis discard islet-cell mass and leave remaining pancreas vulnerable to ongoing disease
Pancreatic trauma in children (e.g., handlebar injury) can cause ductal strictures requiring distal pancreatectomy if endoscopic therapy fails
TPIAT is indicated for patients with refractory chronic pain, failed maximal medical/endoscopic therapy, and severe quality-of-life impairment
The primary goal of TPIAT is pain control and quality-of-life restoration, not diabetes prevention
Islet-cell yield is reduced by frequent pancreatitis attacks, obesity, and prior segmental resections
Spleen-sparing TPIAT is now performed in 80% of cases without compromising islet yield or glycemic outcomes
Portal vein thrombosis is a major complication of TPIAT; anticoagulation during surgery is mandatory
Pyloric botulinum toxin injection during TPIAT reduces gastroparesis and shortens length of stay
TPIAT patients are extubated in the operating room and maintained on insulin drip to rest islet cells during engraftment
Over 80% of TPIAT patients achieve sustained reduction in opioid use within 1–2 months
Younger age at TPIAT, higher islet yield, and absence of pre-op insulin use predict better glycemic outcomes
Insulin independence after TPIAT is ~70% overall and approaches 92% when ≥5000 islet equivalents/kg are transplanted
Families report dramatic quality-of-life improvements after TPIAT: children return to school, sports, and normal social activities
Cincinnati Children's evaluates >100 chronic pancreatitis patients per year but performs TPIAT in only 25–30, reflecting careful patient selection
Pseudocyst drainage should not be performed before 4 weeks; wall maturation is required to avoid spillage and infection