What's New in Pediatric Surgery 2020 - FULL SHOW

In the Midwest Pediatric Surgery Consortium prospective trial of spontaneous pneumothorax, 83% of patients who failed initial aspiration (pneumothorax recurred within 6 hours) eventually required VATS procedure.

Patients with spontaneous pneumothorax who were sent home after successful aspiration had a 44% recurrence rate with no episodes of tension pneumothorax.

In a 12-center UK retrospective review, the recurrence rate of benign ovarian tumors (mature and immature teratomas and serous cystadenomas) in children was 8%.

The UK study authors recommend every 6-month ultrasounds for benign ovarian tumor follow-up but do not conclude on duration of surveillance.

After uncomplicated appendectomy, 84% of patients require no opioids on post-operative day 1, 95% by post-op day 2, and 100% by post-op day 3.

In the Riley Hospital RCT comparing pyloric stenosis feeding strategies, a relaxed ad-lib feeding protocol decreased time to goal feeds and overall length of stay without significant differences in post-operative vomiting or readmissions compared to incremental scheduled feeds.

Pyloric stenosis patients with serum chloride less than 100 on admission took significantly longer to reach their feeding goal.

In a multi-state retrospective cohort study, umbilical hernia repair before age 4 had double the recurrence rate and double the readmission rate compared to repair at age 4 or later.

Nationwide Children's Hospital reduced stoma takedown wound infection rate from 21% to 8% by implementing a perioperative bundle, then further reduced it to 2% by changing antibiotics from cefoxitin to Unasyn.

In a prospective multicenter study published in Journal of Crohn's and Colitis, appendectomy in patients with refractory ulcerative colitis resulted in sustained symptomatic improvement in 30%, pathologic improvement in 50%, and complete endoscopic remission in 17%.

Dr. Levitt identified changing gloves and changing instruments when doing fascial and skin closures as the bundle element that probably made the biggest difference in reducing stoma takedown infections.

A 1960s study of African-American children in the United States found that very large umbilical hernia defects had a lower chance of spontaneous closure.

The reason for switching to Unasyn for stoma takedown was that infections after stoma closure were predominantly enterococcus, and Unasyn provides better enterococcus coverage than cefoxitin.

In a retrospective study of 24 patients with penile necrosis after circumcision, five predictive factors were identified: monopolar cautery use, post-circumcision infection, compartment syndrome, local anesthetic agent use, and methemoglobinemia.

The Gips procedure for pilonidal disease involves coring out pits with a trephine or punch biopsy, extracting granulation tissue and hair with a mosquito, curettage with a smaller trephine, flushing with saline then hydrogen peroxide, leaving punch openings unpacked and unsutured with no drains, and takes 3-5 minutes.

In a 133-patient series using chest CT for suspected airway foreign body, CT excluded foreign body in 30% of patients who would have otherwise undergone bronchoscopy.

When chest CT showed findings of airway foreign body, bronchoscopy confirmed the findings 94% of the time, compared to only 61% positive yield when bronchoscopy was performed based on clinical suspicion alone.

Modern pediatric chest CT delivers 1 to 10 millisieverts of radiation, equivalent to living on Earth for 1 year, with chest CTs often in the 1-3 millisievert range.

For intussusception that reaches the cecum on contrast enema but cannot be fully reduced, a second enema attempt has a 50-64% success rate in stable patients without peritoneal signs.

The ATOMAC multi-center prospective data showed that pediatric trauma patients do better with earlier blood administration: only one 20 cc/kg bolus of saline should be given, and if the patient does not respond, blood should be given rather than a second crystalloid bolus.

In pediatric trauma, the magic number for operative intervention is 40 cc/kg of blood or 4 units: patients transfused with this amount probably cannot be managed non-operatively and should go to the operating room.

For stable pediatric solid organ injury patients who never required blood transfusion, they can be discharged home the next day if hemoglobin remains stable.

Kansas City data on 622 central line placements showed that obtaining chest X-rays only for symptomatic patients (rather than routine post-procedure imaging) resulted in no critically ill patients, with only one patient requiring intervention.

In an RCT of glycopyrrolate for anastomotic leak after esophageal atresia repair, the treatment group had chest tube output of 124 mL versus 370 mL in placebo, leak resolution in 76% versus 29%, and oral feeding achieved in 71% versus 14%.

In the Riley Hospital study of operating room headgear, cloth skull caps had the lowest permeability and lowest particle/microbial shedding on the surgical field, while disposable bouffant caps had the highest shedding.