We’re back with fourteenth episode of "Quick Literature Updates" the podcast series that delivers the latest updates in pediatric surgery literature in a quick and digestible format. In each episode, we review articles covering the most interesting and relevant topics in the field.
These articles are either chosen by JPS editors or APSA Articles of Interest. We present these reviews as short news pieces with a summarization of key points.
Whether you're a trainee, attending, or an advanced medical professional, tune in to our podcast for a dose of medical knowledge in every episode. Stay up to date on the latest trends and advancements in pediatric surgery with "Quick Literature Updates".
Host: Em Gootee
Ahmad H, Wood RJ, Avansino JR, Calkins CM, Dickie BH, Durham MM, Frischer J, Fuller M, Ralls M, Reeder RW, Rentea RM, Rollins MD, Saadai P, Oelschlager AEA, Breech LL, Hewitt GD, Kluivers K, van Leeuwen KD, McCracken KA. Does presence of a VACTERL anomaly predict an associated gynecologic anomaly in females with anorectal malformations?: A Pediatric Colorectal and Pelvic Learning Consortium Study. J Pediatr Surg. 2023 Mar;58(3):471-477. doi: 10.1016/j.jpedsurg.2022.06.006. Epub 2022 Jun 23. PMID: 35879143.
https://www.jpedsurg.org/article/S0022-3468(22)00396-7/fulltext
Perez Holguin RA, DeAngelo N, Sinha A, Shen C, Tsai AY. Cost and outcomes of intercostal nerve cryoablation versus thoracic epidural following the Nuss procedure. J Pediatr Surg. 2023 Apr;58(4):608-612. doi: 10.1016/j.jpedsurg.2022.12.011. Epub 2022 Dec 22. PMID: 36646539.
https://www.jpedsurg.org/article/S0022-3468(22)00784-9/fulltext
Bokova E, McKenna E, Krois W, Reck CA, Al-Shamaileh T, Jacobs SE, Tiusaba L, Russell TL, Darbari A, Feng C, Badillo AT, Levitt MA. Reconstructing the anal sphincters to reverse iatrogenic overstretching following a pull-through for Hirschsprung disease. One-year outcomes. J Pediatr Surg. 2023 Mar;58(3):484-489. doi: 10.1016/j.jpedsurg.2022.10.052. Epub 2022 Nov 7. PMID: 36470689.
https://www.jpedsurg.org/article/S0022-3468(22)00718-7/fulltext
Type: video · 4 min · posted 2023-12-11 Canonical: https://library.globalcastmd.com/watch/quick-literature-updates-episode-14-7776 ## Chapters - [0:09](https://library.globalcastmd.com/watch/quick-literature-updates-episode-14-7776?t=9) Introduction and First Paper Overview - [0:54](https://library.globalcastmd.com/watch/quick-literature-updates-episode-14-7776?t=54) VACTERL and Gynecologic Anomalies Study - [2:08](https://library.globalcastmd.com/watch/quick-literature-updates-episode-14-7776?t=128) Nuss Procedure Pain Control Comparison - [3:31](https://library.globalcastmd.com/watch/quick-literature-updates-episode-14-7776?t=211) Anal Sphincter Reconstruction Outcomes - [4:29](https://library.globalcastmd.com/watch/quick-literature-updates-episode-14-7776?t=269) Closing ## Statements - "384 females with anorectal malformations were studied from the Pediatric Colorectal and Pelvic Learning Consortium database" — Ellen Encisco (epidemiological) [1:13](https://library.globalcastmd.com/watch/quick-literature-updates-episode-14-7776?t=73) - "About 27% of patients with anorectal malformations had a gynecologic anomaly" — Ellen Encisco (epidemiological) [1:22](https://library.globalcastmd.com/watch/quick-literature-updates-episode-14-7776?t=82) - "About 46% of females with anorectal malformations had VACTERL association (anorectal malformation plus two of: vertebral, cardiac, tracheoesophageal, renal, or limb anomaly)" — Ellen Encisco (epidemiological) [1:22](https://library.globalcastmd.com/watch/quick-literature-updates-episode-14-7776?t=82) - "Having VACTERL association was associated with more gynecologic anomalies compared to those without VACTERL" — Ellen Encisco (clinical) [1:39](https://library.globalcastmd.com/watch/quick-literature-updates-episode-14-7776?t=99) - "The association between VACTERL and gynecologic anomalies was especially true when renal anomalies were found" — Ellen Encisco (clinical) [1:49](https://library.globalcastmd.com/watch/quick-literature-updates-episode-14-7776?t=109) - "The association between VACTERL and gynecologic anomalies was especially true when patients had recto vestibular or rectal perineal fistulas" — Ellen Encisco (clinical) [1:49](https://library.globalcastmd.com/watch/quick-literature-updates-episode-14-7776?t=109) - "For females with anorectal malformations and VACTERL association, especially renal anomalies, clinicians should look carefully for gynecologic anomalies" — Ellen Encisco (guideline) [1:57](https://library.globalcastmd.com/watch/quick-literature-updates-episode-14-7776?t=117) - "Thoracic epidural and intercostal nerve cryoablation are two options for pain control in patients undergoing Nuss procedure for pectus excavatum" — Alex Halpern (clinical) [2:30](https://library.globalcastmd.com/watch/quick-literature-updates-episode-14-7776?t=150) - "The study was a retrospective chart review of kids who underwent Nuss procedure between 2002 and 2020" — Alex Halpern (epidemiological) [2:42](https://library.globalcastmd.com/watch/quick-literature-updates-episode-14-7776?t=162) - "The intercostal nerve cryoablation group had lower rates of PCA use compared to thoracic epidural" — Alex Halpern (clinical) [2:56](https://library.globalcastmd.com/watch/quick-literature-updates-episode-14-7776?t=176) - "The intercostal nerve cryoablation group had lower total morphine milligram equivalent requirement compared to thoracic epidural" — Alex Halpern (clinical) [2:56](https://library.globalcastmd.com/watch/quick-literature-updates-episode-14-7776?t=176) - "The intercostal nerve cryoablation group had shorter length of stay in the hospital compared to thoracic epidural" — Alex Halpern (clinical) [2:56](https://library.globalcastmd.com/watch/quick-literature-updates-episode-14-7776?t=176) - "The intercostal nerve cryoablation group had longer operative times compared to thoracic epidural" — Alex Halpern (clinical) [3:07](https://library.globalcastmd.com/watch/quick-literature-updates-episode-14-7776?t=187) - "The intercostal nerve cryoablation group had higher total hospitalization cost compared to thoracic epidural" — Alex Halpern (clinical) [3:07](https://library.globalcastmd.com/watch/quick-literature-updates-episode-14-7776?t=187) - "The anal sphincter reconstruction study was a multi-institutional one-year outcome study" — Cecilia Gigena (epidemiological) [3:48](https://library.globalcastmd.com/watch/quick-literature-updates-episode-14-7776?t=228) - "Six patients underwent anal sphincter reconstruction for patulous sphincter after Hirschsprung pull-through" — Cecilia Gigena (epidemiological) [3:48](https://library.globalcastmd.com/watch/quick-literature-updates-episode-14-7776?t=228) - "Two of the six patients had Down syndrome" — Cecilia Gigena (epidemiological) [4:00](https://library.globalcastmd.com/watch/quick-literature-updates-episode-14-7776?t=240) - "Two patients underwent redo pull-through with anal sphincter reconstruction" — Cecilia Gigena (clinical) [4:00](https://library.globalcastmd.com/watch/quick-literature-updates-episode-14-7776?t=240) - "Four patients received only anal sphincter reconstruction without redo pull-through" — Cecilia Gigena (clinical) [4:00](https://library.globalcastmd.com/watch/quick-literature-updates-episode-14-7776?t=240) - "The four patients who received only sphincter reconstruction achieved voluntary bowel movements with higher productivity and confidence" — Cecilia Gigena (clinical) [4:12](https://library.globalcastmd.com/watch/quick-literature-updates-episode-14-7776?t=252) - "Anal sphincter reconstruction is an option for overstretched anal sphincters in patients with Hirschsprung disease after pull-through" — Cecilia Gigena (clinical) [4:12](https://library.globalcastmd.com/watch/quick-literature-updates-episode-14-7776?t=252) ## Transcript 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. --- Not medical advice · citation policy: https://library.globalcastmd.com/ai