The 10th annual Pediatric Surgery Update Course was held as a webinar on August 30, 2022. We had a lot of lively discussion and engaging presentations on the latest updates in pediatric surgery. In this video we are reviewing the top ten key takeaways from the update course.
Hosts: Ellen Encisco, Brittany Levy & Todd Ponsky
00:00 Intro 00:31 #10: Gastroschisis feeding protocols
01:48 #9: Management of congenital esophageal stenosis
03:07 #8: Outpatient management of intussusception
04:49 #7: Mechanical bowel prep & surgical site infections
05:55 #6: Advocacy for preventing pediatric gunshot injuries
07:19 #5: Efficacy of CT of suspected airway foreign body aspiration
08:42 #4: Laparotomy vs peritoneal drainage for NEC
10:00 #3: Importance of explicit and implicit bias
11:18 #2: Can isolated skull fractures be safely discharged from ER?
12:46 #1: Antibiotic treatment for complicated appendicitis
Featured faculty: Beth Rymeski, DO, Cincinnati Children's Hospital Jason Fraser, MD, Children's Mercy Hospital Kansas City Steven L. Lee, MD, MBA, Seattle Children's Hospital Dan von Allmen, MD, Cincinnati Children's Hospital Ajay Kaul, MD, Cincinnati Children's Hospital Seref Kilic, MD, Cukurova University, Turkey Elizabeth Speck, Mott Children's Hospital Justin Huntington, MD, Akron Children's Hospital Mark Wulkan, MD, Akron Children's Hospital Paul Jeziorczak, MD, MPH, APSA PDC Marion Henry, MD, MPH, University of Chicago Peter Masiakos, MD, Massachusetts General Hospital Bindi Naik-Mathuria, MD, MPH, UTMB Health Richard Pearl, MD, University of Illinois at Chicago Charles Snyder, MD, APSA PDC Jose Campos, MD, Chilean Society for Pediatric Surgery Craig Lillehei, MD, APSA PDC
Type: video · posted 2023-06-23 Canonical: https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766 ## Chapters - [0:00](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=0) Introduction and Gastroschisis Feeding Protocols - [4:00](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=240) Congenital Esophageal Stenosis Management - [6:00](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=360) Outpatient Management of Intussusception - [9:00](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=540) Mechanical Bowel Preparation and SSI Prevention - [11:00](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=660) Pediatric Firearm Injury Prevention - [13:00](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=780) CT Evaluation for Airway Foreign Body - [15:00](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=900) Laparotomy vs Peritoneal Drainage for NEC - [17:00](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=1020) Addressing Implicit and Explicit Bias - [19:00](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=1140) Isolated Skull Fracture Management - [21:00](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=1260) Antibiotics for Perforated Appendicitis ## Statements - "Infants with gastroschisis often require prolonged hospitalization for surgical repair and then initiation and advancement of feeds" — Em Tombash (clinical) [1:00](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=60) - "For babies with uncomplicated gastroschisis, feeds can be started immediately after sutureless abdominal closure, beginning with 10 to 20 milliliters per kilogram per day with advancements of 20 milliliters per kilogram per day if tolerated" — Em Tombash (guideline) [2:30](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=150) - "Immediate feeding after gastroschisis closure has been shown to be associated with shorter length of stay and faster attainment of goal feeds" — Em Tombash (clinical) [3:00](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=180) - "For babies with uncomplicated gastroschisis tolerating feeds for a few days, it is okay to continue with the feeding protocol even after one bout of emesis" — Em Tombash (guideline) [3:30](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=210) - "High resolution esophageal manometry, esophagography, and endoscopy can help determine the diagnosis of congenital esophageal stenosis" — Em Tombash (clinical) [5:00](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=300) - "Serial dilatations may be used to manage congenital esophageal stenosis if there is no cartilage component suspected in the stenotic area" — Em Tombash (guideline) [5:30](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=330) - "Surgical resection for congenital esophageal stenosis can be reserved for patients where serial dilatations are unsuccessful or there is concern for cartilaginous component" — Em Tombash (guideline) [5:30](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=330) - "A systematic review and meta-analysis found that overall recurrence rates and recurrences within 24 and 48 hours of intussusception were similar between inpatient and outpatient management groups after enema reduction" — Em Tombash (epidemiological) [7:30](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=450) - "There was no significant difference in the rate of return to the emergency department between inpatient and outpatient management of intussusception after enema reduction" — Em Tombash (epidemiological) [8:00](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=480) - "Both inpatient and outpatient groups had similar rates of requiring operative intervention after intussusception reduction" — Em Tombash (epidemiological) [8:00](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=480) - "Outpatient management of intussusception after air enema reduction results in a shorter hospital stay with no difference in rate of returns to emergency department, recurrence, need for operation, or mortality" — Em Tombash (clinical) [8:30](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=510) - "There is no compelling evidence in pediatric or adult literature to support mechanical bowel preparation for reducing surgical site infections in colorectal surgery" — Em Tombash (epidemiological) [9:30](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=570) - "Recent adult studies have shown no benefit from mechanical bowel preparation in terms of reducing surgical site infections, and some studies showed an increase in wound infections" — Em Tombash (epidemiological) [10:00](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=600) - "Case appropriate pre-operative IV antibiotics may reduce surgical site infection incidents in colorectal operations" — Em Tombash (guideline) [10:30](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=630) - "Firearms are now the leading cause of death in all children and adolescents in the United States, overtaking motor vehicle crashes in 2019" — Em Tombash (epidemiological) [11:30](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=690) - "Low-dose non-contrast CT of the chest has high sensitivity and specificity for identification of airway foreign bodies" — Em Tombash (clinical) [14:00](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=840) - "CT bronchoscopy can avoid the cost and resources of taking a child to the operating room for a non-therapeutic bronchoscopy procedure" — Em Tombash (clinical) [14:30](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=870) - "Death or neurodevelopmental impairment occurred in 69% of patients with necrotizing enterocolitis who underwent initial laparotomy versus 85% of those who underwent initial peritoneal drainage" — Em Tombash (epidemiological) [16:00](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=960) - "A prospective randomized cohort study showed no difference in overall survival between laparotomy and peritoneal drainage for necrotizing enterocolitis, but did show improved long-term neurodevelopmental outcomes with laparotomy" — Em Tombash (epidemiological) [16:30](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=990) - "Racism and sexism that manifest as microaggressions are commonly experienced by members of minority groups in medical settings" — Em Tombash (opinion) [18:00](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=1080) - "Microaggressions can harm trainees's performance and sense of belonging" — Em Tombash (opinion) [18:30](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=1110) - "In a 10-year retrospective review of isolated traumatic skull fractures with normal neurologic exam findings, 77% of patients were admitted for observation but none needed neurosurgical intervention or additional imaging during the index admission" — Em Tombash (epidemiological) [20:00](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=1200) - "Pediatric isolated skull fractures are low risk conditions with a low likelihood of complications and can be discharged safely from the emergency department without inpatient observation" — Em Tombash (clinical) [20:30](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=1230) - "In the IMPACT trial, patients with perforated appendicitis taking piperacillin-tazobactam had lower incidence of intra-abdominal abscesses, lower usage of CT scans, and fewer ED revisits compared to ceftriaxone and metronidazole combination therapy" — Em Tombash (epidemiological) [22:00](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=1320) - "Piperacillin-tazobactam monotherapy did not have an increase in antibiotic usage or increase in antibiotic related complications compared to combination therapy" — Em Tombash (epidemiological) [22:30](https://library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=1350) --- Not medical advice · citation policy: https://library.globalcastmd.com/ai