# Esophageal Atresia — GCMD Library living collection

Everything in the library about esophageal atresia — built automatically from dossiers that name it.

Updated: n/a · 27 episodes · 541 cited statements

## Episodes
### Fundamentals
- [Esophageal Atresia & Tracheoesophageal Fistula (EA/TEF) Types Explained for Pediatric Surgery](https://qa.library.globalcastmd.com/watch/esophageal-atresia-tracheoesophageal-fistula-types-explained-for-pediatric-surgery-14001) — video · 2:11 · [machine version](https://qa.library.globalcastmd.com/watch/esophageal-atresia-tracheoesophageal-fistula-types-explained-for-pediatric-surgery-14001.md)

### Surgical Management
- [Thoracoscopic Repair of Tracheo-esophageal Fistula Tricks: Pediatric Surgery...](https://qa.library.globalcastmd.com/watch/thoracoscopic-repair-of-tracheo-esophageal-fistula-tricks-pediatric-surgery-424) — video · 19:14 · [machine version](https://qa.library.globalcastmd.com/watch/thoracoscopic-repair-of-tracheo-esophageal-fistula-tricks-pediatric-surgery-424.md)
- [Tracheoesophageal Fistula with Dr. Daniel von Allmen](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300) — podcast · 45:21 · [machine version](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300.md)
- [QUAD #1: Cervical Tracheopexy with Dr. Alessandro de Alarcon](https://qa.library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779) — video · 5:26 · [machine version](https://qa.library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779.md)
- [QUAD #2 Thoracoscopic Tracheopexy with Dr. Aaron Garrison](https://qa.library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919) — video · 7:36 · [machine version](https://qa.library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919.md)
- [QUAD #7 Anesthesia for Thoracoscopic Techniques with Dr. Nathaniel Tighe](https://qa.library.globalcastmd.com/watch/quad-7-anesthesia-for-thoracoscopic-techniques-with-dr-nathaniel-tighe-8115) — video · 7:35 · [machine version](https://qa.library.globalcastmd.com/watch/quad-7-anesthesia-for-thoracoscopic-techniques-with-dr-nathaniel-tighe-8115.md)
- [Dr. Marc Michalsky - Pediatric Robotic-Assisted Surgery – Developing a Programmatic Paradigm](https://qa.library.globalcastmd.com/watch/dr-marc-michalsky-pediatric-robotic-assisted-surgery-developing-a-programmatic-paradigm-11169) — video · 66:48 · [machine version](https://qa.library.globalcastmd.com/watch/dr-marc-michalsky-pediatric-robotic-assisted-surgery-developing-a-programmatic-paradigm-11169.md)

### Complications
- [Tricks - Indwelling Balloon Catheter For Refractory Esophageal Stenosis](https://qa.library.globalcastmd.com/watch/tricks-indwelling-balloon-catheter-for-refractory-esophageal-stenosis-640) — video · 23:57 · [machine version](https://qa.library.globalcastmd.com/watch/tricks-indwelling-balloon-catheter-for-refractory-esophageal-stenosis-640.md)
- [Aerodigestive & Esophageal Surgery - Difficult Tracheal Esophageal Fistula](https://qa.library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739) — video · 120:59 · [machine version](https://qa.library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739.md)
- [TEF Presentations (Extended): Aerodigestive & Esophageal Surgery](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037) — video · 108:11 · [machine version](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037.md)
- [Tracheobronchopexy to Avoid Tracheostomy in Esophageal Atresia Patients With Severe Life-Threatening Tracheobronchomalacia](https://qa.library.globalcastmd.com/watch/tracheobronchopexy-to-avoid-tracheostomy-in-esophageal-atresia-patients-with-severe-life-threatening-tracheobronchomalacia-10435) — video · 0:50 · [machine version](https://qa.library.globalcastmd.com/watch/tracheobronchopexy-to-avoid-tracheostomy-in-esophageal-atresia-patients-with-severe-life-threatening-tracheobronchomalacia-10435.md)

### Evidence & Research
- [Glycopyrrolate for Anastomtic Dehiscence in Esophageal Atresia](https://qa.library.globalcastmd.com/watch/glycopyrrolate-for-anastomtic-dehiscence-in-esophageal-atresia-328) — video · 2:20 · [machine version](https://qa.library.globalcastmd.com/watch/glycopyrrolate-for-anastomtic-dehiscence-in-esophageal-atresia-328.md)
- [Thoracoscopic TEF Repair, Is It Really Better Than Open? Update Course 2018](https://qa.library.globalcastmd.com/watch/thoracoscopic-tef-repair-is-it-really-better-than-open-update-course-2018-356) — video · 18:17 · [machine version](https://qa.library.globalcastmd.com/watch/thoracoscopic-tef-repair-is-it-really-better-than-open-update-course-2018-356.md)
- [Case Based Journal Review: Esophageal Atresia in 2022](https://qa.library.globalcastmd.com/watch/case-based-journal-review-esophageal-atresia-in-2022-5631) — podcast · 17:55 · [machine version](https://qa.library.globalcastmd.com/watch/case-based-journal-review-esophageal-atresia-in-2022-5631.md)
- [Journal of Pediatric Surgery Article Review: February 2023, BAPS issue](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-february-2023-baps-issue-6580) — podcast · 12:32 · [machine version](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-february-2023-baps-issue-6580.md)
- [Quick Literature Updates Episode 9](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-9-6770) — video · [machine version](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-9-6770.md)
- [Comparison of robotic versus thoracoscopic repair for congenital esophageal atresia](https://qa.library.globalcastmd.com/watch/comparison-of-robotic-versus-thoracoscopic-repair-for-congenital-esophageal-atresia-7940) — video · 0:56 · [machine version](https://qa.library.globalcastmd.com/watch/comparison-of-robotic-versus-thoracoscopic-repair-for-congenital-esophageal-atresia-7940.md)
- [Journal of Pediatric Surgery Article Review: October 2023](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-october-2023-8504) — podcast · 12:59 · [machine version](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-october-2023-8504.md)
- [Journal of Pediatric Surgery Article Review: Q1 (Jan-Mar) 2024](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754) — podcast · 13:34 · [machine version](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754.md)
- [Quick Literature Updates Episode 17](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-17-9803) — video · 4:28 · [machine version](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-17-9803.md)
- [Journal of Pediatric Surgery Article Review: 1st Quarter (Jan-Mar) 2025](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-1st-quarter-2025-10484) — podcast · 16:35 · [machine version](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-1st-quarter-2025-10484.md)
- [Journal of Pediatric Surgery Article Review: 2nd Quarter (Apr-Jun) 2025](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2025-10786) — podcast · 16:35 · [machine version](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2025-10786.md)
- [Quick Literature Updates Ep 27](https://qa.library.globalcastmd.com/watch/quick-literature-updates-ep-27-11580) — video · 4:20 · [machine version](https://qa.library.globalcastmd.com/watch/quick-literature-updates-ep-27-11580.md)

### In-Depth Reviews
- [Esophageal Atresia](https://qa.library.globalcastmd.com/watch/esophageal-atresia-627) — video · 39:30 · [machine version](https://qa.library.globalcastmd.com/watch/esophageal-atresia-627.md)
- [Finnish Pediatric Surgery Hub - From Centralization to Collective Learning and Sharing of Expertise](https://qa.library.globalcastmd.com/watch/finnish-pediatric-surgery-hub-from-centralization-to-collective-learning-and-sharing-of-expertise-9951) — video · 0:48 · [machine version](https://qa.library.globalcastmd.com/watch/finnish-pediatric-surgery-hub-from-centralization-to-collective-learning-and-sharing-of-expertise-9951.md)
- [QUAD #27 - Multidisciplinary - How Do Teams Enhance Outcomes by the CCHMC ADEC Team](https://qa.library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201) — video · 10:19 · [machine version](https://qa.library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201.md)

### Long-Term Care
- [Esophageal Surveillance Practices in Esophageal Atresia Patients](https://qa.library.globalcastmd.com/watch/esophageal-surveillance-practices-in-esophageal-atresia-patients-6844) — video · [machine version](https://qa.library.globalcastmd.com/watch/esophageal-surveillance-practices-in-esophageal-atresia-patients-6844.md)

## Chapters
- [0:00](https://qa.library.globalcastmd.com/watch/glycopyrrolate-for-anastomtic-dehiscence-in-esophageal-atresia-328?t=0) Study Design and Patient Population (Ep 1)
- [1:04](https://qa.library.globalcastmd.com/watch/glycopyrrolate-for-anastomtic-dehiscence-in-esophageal-atresia-328?t=64) Primary Outcomes and Study Quality (Ep 1)
- [1:43](https://qa.library.globalcastmd.com/watch/glycopyrrolate-for-anastomtic-dehiscence-in-esophageal-atresia-328?t=103) Clinical Implications (Ep 1)
- [0:00](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=0) Diagnostic Techniques for Finding TEF (Ep 7)
- [6:41](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=401) Endoscopic TEF Repair Technique and First Case (Ep 7)
- [19:16](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=1156) Recurrent TEF Case with Positive Pressure Testing (Ep 7)
- [28:29](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=1709) Slide Tracheoplasty for Complex TEF (Ep 7)
- [41:00](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=2460) Button Battery Injuries and Their Complications (Ep 7)
- [50:05](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=3005) Transtracheal Repair Approach for High TEF (Ep 7)
- [61:40](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=3700) Endoscopic Suturing and Alternative Techniques (Ep 7)
- [78:00](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=4680) Seven-Year-Old with Missed H-Type TEF (Ep 7)
- [89:33](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=5373) Hearing Aid Mold Foreign Body and Bronchoesophageal Fistula (Ep 7)
- [102:10](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=6130) Multiple Bronchoesophageal Fistulas Case (Ep 7)
- [104:24](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=6264) Laryngeal Cleft Missed on Flexible Bronchoscopy (Ep 7)
- [106:44](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=6404) Tracheal Pouch Marsupialization Technique (Ep 7)
- [0:00](https://qa.library.globalcastmd.com/watch/finnish-pediatric-surgery-hub-from-centralization-to-collective-learning-and-sharing-of-expertise-9951?t=0) Finnish Pediatric Surgery Hub Overview (Ep 20)
- [0:00](https://qa.library.globalcastmd.com/watch/comparison-of-robotic-versus-thoracoscopic-repair-for-congenital-esophageal-atresia-7940?t=0) Robotic vs Thoracoscopic Repair for Esophageal Atresia (Ep 15)
- [0:00](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-9-6770?t=0) Introduction and First Paper Setup (Ep 11)
- [1:10](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-9-6770?t=70) Transanastomotic Tubes and Patent Processus Vaginalis Studies (Ep 11)
- [2:13](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-9-6770?t=133) Biliary Atresia Transplant Timing (Ep 11)
- [4:14](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-9-6770?t=254) Social Risk Screening and Closing (Ep 11)
- [0:00](https://qa.library.globalcastmd.com/watch/esophageal-surveillance-practices-in-esophageal-atresia-patients-6844?t=0) Survey findings on esophageal atresia surveillance practices (Ep 12)
- [0:00](https://qa.library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=0) Introduction and Preoperative Workup (Ep 13)
- [1:14](https://qa.library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=74) Intraoperative Setup and Tools (Ep 13)
- [1:47](https://qa.library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=107) Surgical Technique and Approach (Ep 13)
- [3:24](https://qa.library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=204) Outcomes and Follow-up (Ep 13)
- [4:32](https://qa.library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=272) Summary and Conclusion (Ep 13)
- [0:00](https://qa.library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=0) Introduction and Evolution of Practice (Ep 14)
- [0:58](https://qa.library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=58) Rationale for Repair and Preoperative Imaging (Ep 14)
- [2:02](https://qa.library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=122) Bronchoscopy Classification and Minimally Invasive Advantages (Ep 14)
- [3:21](https://qa.library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=201) Patient Positioning and Aortopexy Technique (Ep 14)
- [4:28](https://qa.library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=268) Posterior Tracheopexy Technique (Ep 14)
- [6:07](https://qa.library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=367) Esophageal Management and Outcomes (Ep 14)
- [6:47](https://qa.library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=407) Summary and Conclusion (Ep 14)
- [0:00](https://qa.library.globalcastmd.com/watch/quad-7-anesthesia-for-thoracoscopic-techniques-with-dr-nathaniel-tighe-8115?t=0) Introduction and Conference Context (Ep 16)
- [0:53](https://qa.library.globalcastmd.com/watch/quad-7-anesthesia-for-thoracoscopic-techniques-with-dr-nathaniel-tighe-8115?t=53) Preoperative Assessment Considerations (Ep 16)
- [1:24](https://qa.library.globalcastmd.com/watch/quad-7-anesthesia-for-thoracoscopic-techniques-with-dr-nathaniel-tighe-8115?t=84) Intraoperative Goals and Techniques for Patient Immobility (Ep 16)
- [2:15](https://qa.library.globalcastmd.com/watch/quad-7-anesthesia-for-thoracoscopic-techniques-with-dr-nathaniel-tighe-8115?t=135) Intraoperative Neuromonitoring and Surgical Exposure via Insufflation (Ep 16)
- [3:10](https://qa.library.globalcastmd.com/watch/quad-7-anesthesia-for-thoracoscopic-techniques-with-dr-nathaniel-tighe-8115?t=190) Lung Isolation Techniques and Airway Anatomy (Ep 16)
- [5:34](https://qa.library.globalcastmd.com/watch/quad-7-anesthesia-for-thoracoscopic-techniques-with-dr-nathaniel-tighe-8115?t=334) Patient Selection and Special Populations (Ep 16)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- "The study was a prospective randomized control trial studying the effect of glycopyrolate on patients that had leak after esophageal atresia repair" — Todd Ponsky (host_summary) [Ep 1 · 0:08](https://qa.library.globalcastmd.com/watch/glycopyrrolate-for-anastomtic-dehiscence-in-esophageal-atresia-328?t=8)
- "There were 297 patients over a 10 year period that underwent esophageal atresia repair" — Todd Ponsky (host_summary) [Ep 1 · 0:08](https://qa.library.globalcastmd.com/watch/glycopyrrolate-for-anastomtic-dehiscence-in-esophageal-atresia-328?t=8)
- "Of the 297 patients, there were 42 leaks, approximately 14%" — Todd Ponsky (host_summary) [Ep 1 · 0:08](https://qa.library.globalcastmd.com/watch/glycopyrrolate-for-anastomtic-dehiscence-in-esophageal-atresia-328?t=8)
- "The 42 patients with leaks were prospectively randomized into two groups of 21 each, one receiving glycopyrrolate and the other receiving placebo (saline)" — Todd Ponsky (host_summary) [Ep 1 · 0:08](https://qa.library.globalcastmd.com/watch/glycopyrrolate-for-anastomtic-dehiscence-in-esophageal-atresia-328?t=8)
- "The observer was blinded to which treatment group the patient was in" — Todd Ponsky (host_summary) [Ep 1 · 0:08](https://qa.library.globalcastmd.com/watch/glycopyrrolate-for-anastomtic-dehiscence-in-esophageal-atresia-328?t=8)
- "Chest tube output was 124 mL in the glycopyrrolate treatment group compared to 370 mL in the placebo group" — Abdul Raoof Lamoshi (host_summary) [Ep 1 · 1:04](https://qa.library.globalcastmd.com/watch/glycopyrrolate-for-anastomtic-dehiscence-in-esophageal-atresia-328?t=64)
- "Leak resolution was accomplished in 76% of the glycopyrrolate treatment group compared to 29% of the placebo group" — Abdul Raoof Lamoshi (host_summary) [Ep 1 · 1:04](https://qa.library.globalcastmd.com/watch/glycopyrrolate-for-anastomtic-dehiscence-in-esophageal-atresia-328?t=64)
- "Oral feeding was achieved in 71% of the glycopyrrolate treatment group compared to only 14% of the placebo group" — Abdul Raoof Lamoshi (host_summary) [Ep 1 · 1:04](https://qa.library.globalcastmd.com/watch/glycopyrrolate-for-anastomtic-dehiscence-in-esophageal-atresia-328?t=64)
- "The study was a very well done randomized controlled trial with a very good sample size" — Abdul Raoof Lamoshi (opinion) [Ep 1 · 1:43](https://qa.library.globalcastmd.com/watch/glycopyrrolate-for-anastomtic-dehiscence-in-esophageal-atresia-328?t=103)
- "The results were both statistically and clinically significant" — Abdul Raoof Lamoshi (opinion) [Ep 1 · 1:43](https://qa.library.globalcastmd.com/watch/glycopyrrolate-for-anastomtic-dehiscence-in-esophageal-atresia-328?t=103)
- "Glycopyrrolate is a novel treatment that can have substantial effect on the complicated problem of anastomotic leak after esophageal atresia repair" — Todd Ponsky (opinion) [Ep 1 · 1:56](https://qa.library.globalcastmd.com/watch/glycopyrrolate-for-anastomtic-dehiscence-in-esophageal-atresia-328?t=116)
- "The bugbee cautery is useful and underutilized among general surgeons for treating recurrent tracheoesophageal fistulas." — Todd Ponsky (opinion) [Ep 7 · 0:04](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=4)
- "A 70-degree endoscope is a difficult tool to use but useful for tracking down hard-to-find tracheoesophageal fistulas." (clinical) [Ep 7 · 0:37](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=37)
- "Routine bronchoscopy is now standard practice for all type C esophageal atresia cases, though this represents a change from earlier training when it was not necessarily performed." — Dan (clinical) [Ep 7 · 1:13](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=73)
- "General surgeons may underappreciate tracheomalacia or laryngomalacia, making collaboration with ENT colleagues valuable for comprehensive airway assessment." — Todd Ponsky (opinion) [Ep 7 · 1:53](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=113)
- "Pediatric surgery fellows at this institution complete a one-month attachment with ENT to perform bronchoscopies as part of their training." (clinical) [Ep 7 · 2:22](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=142)
- "Dual scoping (simultaneous bronchoscopy and esophagoscopy) is enormously valuable for complicated TEF patients, providing different information and advantages in visualization." — Dan (clinical) [Ep 7 · 6:41](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=401)
- "During dual scoping, you can see the light from one scope through the epithelium, inject material that may come through subtle holes, or observe bubbles from air insufflation, making simultaneous visualization quite valuable." — Phil (clinical) [Ep 7 · 7:33](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=453)
- "For combined bronchoscopy and esophagoscopy in small children, a 2.8 mm flexible bronchoscope is typically used alongside an infant gastroscope (5.4 or 6 mm outer diameter)." — Phil (clinical) [Ep 7 · 8:19](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=499)
- "An infant gastroscope will fit retrograde through a 16 French gastrostomy tube." — Phil (clinical) [Ep 7 · 8:36](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=516)
- "The concept of endoscopic TEF repair is to demucosalize the tract because mucosa is a non-stick surface; you want raw against raw with a tiny bit of fibrin glue to seal it while it scars off." (clinical) [Ep 7 · 11:01](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=661)
- "When using fibrin glue for TEF repair, use a very small amount (about 0.1 ml) via a Duplo double-lumen catheter to avoid forming a foreign body." (clinical) [Ep 7 · 11:36](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=696)
- "Trichloroacetic acid (TCA) can be used for TEF demucosalization, but it is difficult to control precisely and leaves white tissue everywhere, whereas the bugbee provides more precise control." — Todd Ponsky (clinical) [Ep 7 · 12:21](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=741)
- "When using bugbee cautery for TEF repair, place something in the esophagus (such as an endotracheal tube) as a spacer to avoid burning the back of the esophageal wall." (clinical) [Ep 7 · 13:36](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=816)
- "A bugbee catheter will go down an EGD scope, allowing cauterization from the esophageal side if the tract angle is favorable." (clinical) [Ep 7 · 14:29](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=869)
- "A 3 French bugbee fits through a 2.8 mm flexible bronchoscope with a 1.2 mm suction channel, providing precise control of the tip." — Bob Wood (clinical) [Ep 7 · 15:10](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=910)
- "When passing a bugbee through a rigid scope, bending the end at a slight angle before insertion allows steering by rotation." (clinical) [Ep 7 · 15:32](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=932)
- "Endoscopic TEF repair often needs to be performed more than once; the average is approximately 2 procedures, with some requiring 1 and others 3-4 attempts." (clinical) [Ep 7 · 22:37](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=1357)
- "The success rate for endoscopic TEF closure is running about 80%, not 100%." (clinical) [Ep 7 · 24:18](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=1458)
- "After 3 or 4 failed endoscopic TEF repair attempts, it is typically time to give up and discuss alternative approaches." (clinical) [Ep 7 · 24:27](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=1467)
- "When cauterizing a TEF, you should particularly try to get the edges and sides because as they scar in, that will narrow the whole mouth, making re-intervention easier if needed." (clinical) [Ep 7 · 24:59](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=1499)
- "To reduce airway fire risk during bugbee cautery, insufflated oxygen should be kept at 30% or less." (clinical) [Ep 7 · 25:51](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=1551)
- "Patients can tolerate a minute or two of lower oxygen saturation during cautery procedures to maintain safe oxygen levels below 30%." — Bob Wood (clinical) [Ep 7 · 26:10](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=1570)
- "Radiance voice gel (used for vocal cord injection) can be injected into the wall beside a TEF to obliterate the potential space and hold raw surfaces together; it only lasts a few weeks." (clinical) [Ep 7 · 27:05](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=1625)
- "For TEF repair, all that matters is achieving raw-on-raw tissue contact for healing." — Todd Ponsky (clinical) [Ep 7 · 69:25](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=4165)
- "Thoracoscopic diaphragmatic hernia repairs may have a higher recurrence rate than open repairs, possibly because they do not cause enough raw-on-raw tissue contact." — Todd Ponsky (opinion) [Ep 7 · 69:33](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=4173)
- "Slide tracheoplasty is a useful technique for big complex TEF holes, using part of the trachea to repair the esophageal defect." (clinical) [Ep 7 · 30:55](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=1855)
- "Sternal periosteum is an excellent interposition graft material—it is like Kevlar, bulletproof, abundant, and very strong, though almost impossible to suture." (clinical) [Ep 7 · 34:02](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=2042)
- "Slide tracheoplasty appears to be a learning-curve, surgeon-dependent operation, unlike many operations where the surgeon does not matter long-term." (opinion) [Ep 7 · 57:09](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=3429)
- "Button batteries are extremely dangerous and can cause ongoing tissue damage that extends beyond what is visible and beyond the expected time frame." — Dan (clinical) [Ep 7 · 43:17](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=2597)
- "The institutional protocol for button battery ingestion is to remove them within 2 hours of identification, as it is considered a medical emergency." — Phil (guideline) [Ep 7 · 44:04](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=2644)
- "Dead button batteries still have about 2 volts and continue to cause damage." — Todd Ponsky (host_summary) [Ep 7 · 45:31](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=2731)
- "Button batteries can be distinguished from coins on AP X-ray by a visible rim, eliminating the need for a lateral view." — Todd Ponsky (host_summary) [Ep 7 · 45:37](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=2737)
- "The American Society of Pediatric Otolaryngology has a task force working to introduce legislation requiring skull-and-crossbones etching on all button batteries to distinguish them from coins on X-ray." (guideline) [Ep 7 · 44:22](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=2662)
- "In the series of approximately 12 slide tracheoplasties for TEF, there were two failures, both in button battery cases, and both patients were the only button battery cases in the series." (clinical) [Ep 7 · 41:00](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=2460)
- "For button battery ingestions, if there was a witnessed ingestion, the patient is asymptomatic, removal occurs within a couple of hours, and the mucosa looks good, the likelihood of doing well is high." — Phil (clinical) [Ep 7 · 46:02](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=2762)
- "Late deaths from aortoesophageal fistulas have occurred following unwitnessed button battery ingestions that were not terribly prolonged." — Phil (clinical) [Ep 7 · 46:18](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=2778)
- "For button battery cases, CT angiography to look at the aorta may provide as much information about risk of sudden death as endoscopic evaluation, though sensitivity data is lacking." — Phil (opinion) [Ep 7 · 47:10](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=2830)
- "The style of button battery matters for risk: large round flat 3-volt batteries are by far the most potentially damaging, while smaller fatter batteries pose less risk." (clinical) [Ep 7 · 48:01](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=2881)
- "The protocol is to remove button batteries from the stomach because if they do not leave and sit in one spot, they create considerable injury, especially in the distal stomach/antrum where scarring or stenosis can occur." — Phil (clinical) [Ep 7 · 49:22](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=2962)
- "For transtracheal TEF repair, a three-layer closure is performed: esophageal layer with knots in the esophageal lumen, interposition graft (typically sternal periosteum), and tracheal layer with knots in the tracheal lumen to reduce refistulization risk." (clinical) [Ep 7 · 54:11](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=3251)
- "Transtracheal repair is a relatively two-dimensional operation where the surgeon matters less than in three-dimensional operations like slide tracheoplasty." (opinion) [Ep 7 · 56:21](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=3381)
- "The primary complication of transtracheal TEF repair is refistulization, whereas slide tracheoplasty complications include dehiscence, which is a much bigger deal." (clinical) [Ep 7 · 56:03](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=3363)
- "When repairing high H-type fistulas from a thoracic approach, there is a temptation to ligate the fistula on the esophageal side, which can leave a large tracheal pouch/diverticulum that causes problems if the patient needs a tracheostomy." (clinical) [Ep 7 · 64:18](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=3858)
- "Endoscopic suturing in the trachea is remarkably humbling and painful, and the hardest part is tying the knot." (opinion) [Ep 7 · 68:11](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=4091)
- "Nitinol clips could theoretically be used for endoscopic TEF repair, though they are permanent." — Dan (opinion) [Ep 7 · 68:33](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=4113)
- "Metal clips can be used with endoscopic sutures for laryngeal cleft repairs from the esophageal side to hold sutures; the patient swallows the clip when the PDS dissolves." (clinical) [Ep 7 · 69:01](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=4141)
- "Anal fistula plugs made of biologic material (surgesis) can be used for TEF repair by wrapping them with barbed VOC suture and inserting them into the fistula tract to promote scarring and collagen matrix formation." — Todd Ponsky (clinical) [Ep 7 · 97:24](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=5844)
- "Long skinny TEF tracts from proximal to distal are the ideal candidates for endoscopic repair, while short, fat, wide tracts do not tend to do well with endoscopic techniques." (clinical) [Ep 7 · 63:58](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=3838)
- "H-type fistulas are relatively short tracks straight from trachea to esophagus and do not do nearly as well with endoscopic repair compared to longer tracts." (clinical) [Ep 7 · 63:46](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=3826)
- "Positive pressure testing for TEF involves placing an endotracheal tube with cuff in the esophagus and applying 30 cm H2O pressure of air, then observing for air blowing out of the fistula; the stomach must be suctioned afterward." (clinical) [Ep 7 · 21:36](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=1296)
- "For proximal fistulas, intubation with a cuffed tube past the hole is preferred so the cuff holds the hole occluded during repair; this is not possible for fistulas on the carina." (clinical) [Ep 7 · 23:29](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=1409)
- "One of the problems with endoscopic TEF cauterization is not being aggressive enough; you need to destroy the mucosa, not just give it a fright." — Bob Wood (clinical) [Ep 7 · 17:42](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=1062)
- "With a flexible bronchoscope, you can insufflate through the suction channel and distend the lumen to get a better view and sweep the inside of the lumen during cauterization." — Bob Wood (clinical) [Ep 7 · 18:03](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=1083)
- "Laryngeal clefts are incredibly easy to miss and must be actively looked for and probed, not just visually inspected." (clinical) [Ep 7 · 20:10](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=1210)
- "A flexible bronchoscope is not a reliable tool for diagnosing laryngeal clefts; you cannot find them even when you know they are there 95% of the time due to limitations of flexible instrumentation." — Bob Wood (clinical) [Ep 7 · 103:43](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=6223)
- "For anything suspected in the posterior commissure, subglottic space, or cervical trachea, a rigid scope with probing is mandatory, not just visual inspection." — Bob Wood (clinical) [Ep 7 · 104:02](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=6242)
- "The retroflexed (upside-down) flexible bronchoscopy technique allows greater angulation at the scope tip in one direction than the opposite, making it useful for examining the posterior tracheal wall." — Bob Wood (clinical) [Ep 7 · 73:30](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=4410)
- "Insufflating with oxygen through the suction channel at about 2 L/min during bronchoscopy spreads tissue apart, does not hurt respirations, and gives a better view." — Bob Wood (clinical) [Ep 7 · 74:15](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=4455)
- "When advancing a flexible bronchoscope through the nose and glottis, it is very easy to miss pathology in the cervical trachea and subglottis; it is easier to see these areas while slowly withdrawing the scope than while advancing." — Bob Wood (clinical) [Ep 7 · 74:51](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=4491)
- "High tracheoesophageal fistulas are very difficult to find from the esophageal side because they are just below the esophageal inlet where a forward-viewing gastroscope does not deflect well enough to get an en face view." — Phil (clinical) [Ep 7 · 4:43](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=283)
- "Going retrograde up the esophagus provides easier maneuvering just below the esophageal inlet for finding high fistulas." — Phil (clinical) [Ep 7 · 5:17](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=317)
- "Bronchoesophageal fistulas can be very hard to find because there are so many subsegmental bronchi." (clinical) [Ep 7 · 5:36](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=336)
- "During dual scoping for bronchoesophageal fistula, you can shake hands across the fistula if you can track it down, and seeing the other operator's scope is usually a giveaway." (clinical) [Ep 7 · 5:50](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=350)
- "During dual scoping, you can see the light from the other scope through the epithelium, inject material that may come through a hole, or see bubbles from insufflation, making simultaneous scoping quite valuable." — Phil (clinical) [Ep 7 · 7:33](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=453)
- "Operators can turn off their light during dual scoping so the other person can see their light and determine if they are in the right region." (clinical) [Ep 7 · 7:58](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=478)
- "A 2.8 mm flexible bronchoscope is typically used for combined procedures, and the GI scope for small children is an infant scope (5.4 or 6 mm outer diameter)." — Phil (clinical) [Ep 7 · 8:19](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=499)
- "An infant gastroscope will fit retrograde through a 16 French gastrostomy tube, which is why 16 French G-tubes are preferred over 14 French." — Phil (clinical) [Ep 7 · 8:36](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=516)
- "A bronchoscope can be used retrograde in the esophagus because it fits through smaller openings." — Bob Wood (clinical) [Ep 7 · 8:57](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=537)
- "For patients with Down syndrome, swallow studies are difficult to interpret due to cooperation issues." (clinical) [Ep 7 · 71:25](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=4285)
- "If a patient is clinically aspirating with a history of TEF repair, maintain a high index of suspicion for recurrent fistula or laryngeal cleft even if initial studies are negative." (clinical) [Ep 7 · 71:44](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=4304)
- "After TEF repair, patients may have persistent bronchiectasis from years of aspiration, requiring months of care with vibrating vest and chest physiotherapy even after successful fistula closure." (clinical) [Ep 7 · 82:40](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=4960)
- "Tracheal pouches/diverticula can cause problems during tracheostomy tube changes because the tube may go into the pouch instead of the trachea, causing the patient to decompensate." (clinical) [Ep 7 · 104:45](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=6285)
- "Tracheal pouches can be marsupialized using a Storz ClickLine biopsy forceps (pediatric laparoscopic instrument) with suction and cautery at about 40 watts to divide the common party wall." (clinical) [Ep 7 · 105:12](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=6312)
- "Marsupializing tracheal pouches can make tracheomalacia worse symptomatically, though usually it does not and kids do well." — Bob Wood (clinical) [Ep 7 · 106:00](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=6360)
- "After marsupialization of tracheal pouches, what remains tends to scar to the sides and becomes almost invisible." (clinical) [Ep 7 · 106:29](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=6389)
- "Hearing aid molds are radiolucent and can be missed on chest X-ray." (clinical) [Ep 7 · 84:50](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=5090)
- "Airway stents can erode and create new fistulas into the esophagus." (clinical) [Ep 7 · 87:49](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=5269)
- "A Y-shaped stent placed in both bronchi and up the trachea with a trach tube into the stent can successfully bypass a bronchoesophageal fistula, allowing significant clinical improvement." (clinical) [Ep 7 · 88:07](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=5287)
- "Pectus excavatum can worsen tracheobronchomalacia, and sternotomy for other procedures can make the pectus worse." (clinical) [Ep 7 · 86:40](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=5200)
- "Placing a pectus bar can improve severe tracheobronchomalacia by pulling the chest wall forward." (clinical) [Ep 7 · 87:33](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=5253)
- "The Finnish Pediatric Surgery Hub was established in 2021 by pediatric surgeons from Finland's five neonatal surgery centers." — Lizzie Lee (clinical) [Ep 20 · 0:10](https://qa.library.globalcastmd.com/watch/finnish-pediatric-surgery-hub-from-centralization-to-collective-learning-and-sharing-of-expertise-9951?t=10)
- "The hub performed 34 elective and 6 urgent cases total." — Lizzie Lee (epidemiological) [Ep 20 · 0:18](https://qa.library.globalcastmd.com/watch/finnish-pediatric-surgery-hub-from-centralization-to-collective-learning-and-sharing-of-expertise-9951?t=18)
- "The most frequent diagnoses included anorectal malformations, esophageal atresia, and Hirschsprung disease." — Lizzie Lee (epidemiological) [Ep 20 · 0:18](https://qa.library.globalcastmd.com/watch/finnish-pediatric-surgery-hub-from-centralization-to-collective-learning-and-sharing-of-expertise-9951?t=18)
- "The hub held regular monthly virtual meetings to present new patients, discuss complex cases, and follow up on patients after surgery." — Lizzie Lee (clinical) [Ep 20 · 0:28](https://qa.library.globalcastmd.com/watch/finnish-pediatric-surgery-hub-from-centralization-to-collective-learning-and-sharing-of-expertise-9951?t=28)
- "Findings suggest that the Finnish Pediatric Surgery hub fosters an effective and safe place for sharing surgical expertise and learning." — Lizzie Lee (opinion) [Ep 20 · 0:36](https://qa.library.globalcastmd.com/watch/finnish-pediatric-surgery-hub-from-centralization-to-collective-learning-and-sharing-of-expertise-9951?t=36)
- "The study is a retrospective multi-center study done in China" — Cecilia Gigena (epidemiological) [Ep 15 · 0:10](https://qa.library.globalcastmd.com/watch/comparison-of-robotic-versus-thoracoscopic-repair-for-congenital-esophageal-atresia-7940?t=10)
- "After propensity score matching, there were 126 patients total, 63 in each group" — Cecilia Gigena (epidemiological) [Ep 15 · 0:21](https://qa.library.globalcastmd.com/watch/comparison-of-robotic-versus-thoracoscopic-repair-for-congenital-esophageal-atresia-7940?t=21)
- "Robotic surgery had longer operative time compared to thoracoscopic repair" — Cecilia Gigena (clinical) [Ep 15 · 0:28](https://qa.library.globalcastmd.com/watch/comparison-of-robotic-versus-thoracoscopic-repair-for-congenital-esophageal-atresia-7940?t=28)
- "Robotic surgery had shorter anastomotic time compared to thoracoscopic repair" — Cecilia Gigena (clinical) [Ep 15 · 0:28](https://qa.library.globalcastmd.com/watch/comparison-of-robotic-versus-thoracoscopic-repair-for-congenital-esophageal-atresia-7940?t=28)
- "The robotic group had lower anastomotic strictures compared to thoracoscopic repair" — Cecilia Gigena (clinical) [Ep 15 · 0:28](https://qa.library.globalcastmd.com/watch/comparison-of-robotic-versus-thoracoscopic-repair-for-congenital-esophageal-atresia-7940?t=28)
- "The robotic group had lower unplanned readmissions within 2 years post-op compared to thoracoscopic repair" — Cecilia Gigena (clinical) [Ep 15 · 0:28](https://qa.library.globalcastmd.com/watch/comparison-of-robotic-versus-thoracoscopic-repair-for-congenital-esophageal-atresia-7940?t=28)
- "Robotic surgery appears to be a good option for esophageal atresia repair" — Cecilia Gigena (opinion) [Ep 15 · 0:46](https://qa.library.globalcastmd.com/watch/comparison-of-robotic-versus-thoracoscopic-repair-for-congenital-esophageal-atresia-7940?t=46)
- "Patients with a transanastomotic tube had a 2.72 times higher risk of developing a stricture post-operatively after esophageal atresia with tracheoesophageal fistula repair" (clinical) [Ep 11 · 1:10](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-9-6770?t=70)
- "The Midwest Pediatric Surgery Consortium study examined every patient who had a laparoscopic pyloric myotomy to identify patent processus vaginalis and followed them annually" (clinical) [Ep 11 · 1:30](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-9-6770?t=90)
- "Of 526 patients enrolled in the PPV study, 283 had a patent processus vaginalis (bilateral, right, or left)" (epidemiological) [Ep 11 · 2:00](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-9-6770?t=120)
- "Of 208 patients with at least one year follow-up, only three underwent inguinal hernia repair, all within the first year" (clinical) [Ep 11 · 2:13](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-9-6770?t=133)
- "Most patent processus vaginalis do not turn into inguinal hernias based on four-year interim analysis data" (clinical) [Ep 11 · 2:35](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-9-6770?t=155)
- "Liver transplantation for biliary atresia can be performed as initial treatment (primary) or after failed Kasai hepatoportoenterostomy (salvage)" (clinical) [Ep 11 · 2:45](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-9-6770?t=165)
- "The current standard in the US for biliary atresia is Kasai first and liver transplant only if that fails" (guideline) [Ep 11 · 3:05](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-9-6770?t=185)
- "Children who had an early salvage liver transplant (before age one) and children who had a primary liver transplant had similar outcomes" (clinical) [Ep 11 · 3:30](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-9-6770?t=210)
- "Children who had a late salvage liver transplant had improved graft survival compared to other groups" (clinical) [Ep 11 · 3:45](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-9-6770?t=225)
- "Some children who undergo the Kasai procedure will never end up needing a liver transplant" (clinical) [Ep 11 · 4:00](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-9-6770?t=240)
- "Social risk screening in pediatrics involves screening for risk factors including food and housing insecurity, financial strain, and unsafe environments" (clinical) [Ep 11 · 4:30](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-9-6770?t=270)
- "There is low concordance between screening results showing who might need resources and who is actually asking for more resources" (epidemiological) [Ep 11 · 5:00](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-9-6770?t=300)
- "Families may feel uncomfortable with social risk screening and may think there might be downstream repercussions based on their answers" (opinion) [Ep 11 · 5:15](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-9-6770?t=315)
- "There may be racial biases in screening practices, with non-white patients potentially being asked social risk questions more often" (epidemiological) [Ep 11 · 5:28](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-9-6770?t=328)
- "Current social risk screening protocols may not be effective and may actually lead to more inequities" (opinion) [Ep 11 · 4:50](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-9-6770?t=290)
- "The Eastern Pediatric Surgery Network in the US created a survey distributed among pediatric surgeons to understand current practices of esophageal surveillance in esophageal atresia patients" — Cecilia Gigena (host_summary) [Ep 12 · 0:00](https://qa.library.globalcastmd.com/watch/esophageal-surveillance-practices-in-esophageal-atresia-patients-6844?t=0)
- "139 pediatric surgeons responded to the survey" — Cecilia Gigena (host_summary) [Ep 12 · 0:00](https://qa.library.globalcastmd.com/watch/esophageal-surveillance-practices-in-esophageal-atresia-patients-6844?t=0)
- "75% of respondents strongly agree or agree with current guidelines for esophageal atresia surveillance" — Cecilia Gigena (host_summary) [Ep 12 · 0:00](https://qa.library.globalcastmd.com/watch/esophageal-surveillance-practices-in-esophageal-atresia-patients-6844?t=0)
- "Only 37% of respondents reported that their esophageal atresia patients have pre-determined outpatient clinic follow-up schedule" — Cecilia Gigena (host_summary) [Ep 12 · 0:00](https://qa.library.globalcastmd.com/watch/esophageal-surveillance-practices-in-esophageal-atresia-patients-6844?t=0)
- "80% of respondents agree or strongly agree that endoscopy should follow a set schedule" — Cecilia Gigena (host_summary) [Ep 12 · 0:00](https://qa.library.globalcastmd.com/watch/esophageal-surveillance-practices-in-esophageal-atresia-patients-6844?t=0)
- "Only 37% of respondents performed follow-up endoscopy regardless of symptoms" — Cecilia Gigena (host_summary) [Ep 12 · 0:00](https://qa.library.globalcastmd.com/watch/esophageal-surveillance-practices-in-esophageal-atresia-patients-6844?t=0)
- "There is high agreement with current guidelines but weak adherence to them in esophageal atresia surveillance" — Cecilia Gigena (host_summary) [Ep 12 · 0:00](https://qa.library.globalcastmd.com/watch/esophageal-surveillance-practices-in-esophageal-atresia-patients-6844?t=0)
- "Cincinnati Children's typically uses a combined cervical and thoracic approach for esophageal atresia cases." — Alessandro de Alarcon (clinical) [Ep 13 · 0:49](https://qa.library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=49)
- "Preoperative testing includes dynamic CT imaging, pulmonary function tests, microlaryngoscopy and bronchoscopy, and flexible bronchoscopy." — Todd Ponsky (host_summary) [Ep 13 · 0:55](https://qa.library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=55)
- "Required intraoperative equipment includes a neck tray, MLB tray, and Maloney dilators or NG tubes." — Alessandro de Alarcon (clinical) [Ep 13 · 1:15](https://qa.library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=75)
- "Flexible bronchoscopy during the operation is key, and endotracheal tube placement must allow visualization during the procedure." — Alessandro de Alarcon (clinical) [Ep 13 · 1:21](https://qa.library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=81)
- "Nasotracheal intubation is often used with the cuff positioned high, sometimes almost at the glottis." — Alessandro de Alarcon (clinical) [Ep 13 · 1:29](https://qa.library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=89)
- "A NIM tube is preferred when possible to prevent injury to recurrent nerves or provide awareness when approaching them." — Alessandro de Alarcon (clinical) [Ep 13 · 1:39](https://qa.library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=99)
- "The surgical approach uses subplatysmal flaps and addresses anterior compression as needed." — Alessandro de Alarcon (clinical) [Ep 13 · 1:55](https://qa.library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=115)
- "The cervical approach can assist thoracoscopic procedures by removing residual or regrown large thymus tissue." — Todd Ponsky (host_summary) [Ep 13 · 2:01](https://qa.library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=121)
- "Aortopexy and innominate artery pexy can be added at the same time as the cervical procedure." — Alessandro de Alarcon (clinical) [Ep 13 · 2:09](https://qa.library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=129)
- "In the lateral approach, the surgical team works on the side of the airway to find the esophagus." — Todd Ponsky (host_summary) [Ep 13 · 2:19](https://qa.library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=139)
- "Pediatric surgeons identify the recurrent nerve for the ENT team to help prevent injury." — Todd Ponsky (host_summary) [Ep 13 · 2:23](https://qa.library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=143)
- "The Cincinnati team has learned not to be afraid of mobilizing the esophagus, which is important for the procedure." — Alessandro de Alarcon (opinion) [Ep 13 · 2:29](https://qa.library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=149)
- "The esophagus is mobilized above the level where the team aims to perform the pexy, making suture placement easier." — Todd Ponsky (host_summary) [Ep 13 · 2:43](https://qa.library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=163)
- "Stitches are sometimes placed in the trachea to pull it up and out of the way for visualization of the posterior aspect and spine." — Alessandro de Alarcon (clinical) [Ep 13 · 2:54](https://qa.library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=174)
- "A pulmonologist assists with flexible endoscopy through the endotracheal tube to visualize inside the trachea while stitches are placed." — Todd Ponsky (host_summary) [Ep 13 · 3:02](https://qa.library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=182)
- "The team uses 3-0 prolene sutures and places all stitches before securing them down." — Alessandro de Alarcon (clinical) [Ep 13 · 3:15](https://qa.library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=195)
- "Suture placement is performed under spontaneous ventilation conditions." — Alessandro de Alarcon (clinical) [Ep 13 · 3:15](https://qa.library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=195)
- "The combined approach is valuable for complicated cases or patients needing additional operations for symptom relief." — Todd Ponsky (host_summary) [Ep 13 · 3:24](https://qa.library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=204)
- "A patient who had prior thoracoscopic tracheopexy with dysphagia from torqued esophagus underwent the combined approach and became symptom-free." — Alessandro de Alarcon (clinical) [Ep 13 · 3:33](https://qa.library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=213)
- "Outcome measures include follow-up endoscopy, pulmonary function tests when patients are old enough, and imaging." — Alessandro de Alarcon (clinical) [Ep 13 · 4:00](https://qa.library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=240)
- "At 36 months follow-up, imaging may still show tracheomalacia, but patients can be symptomatically better." — Alessandro de Alarcon (clinical) [Ep 13 · 4:09](https://qa.library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=249)
- "The team is still learning what measures should define good versus bad outcomes." — Alessandro de Alarcon (opinion) [Ep 13 · 4:15](https://qa.library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=255)
- "Managing complications including swallowing dysfunction and vocal fold paralysis is part of postoperative care." — Alessandro de Alarcon (clinical) [Ep 13 · 4:26](https://qa.library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=266)
- "Otolaryngology involvement is important both during the procedure and in follow-up due to potential complications." — Todd Ponsky (host_summary) [Ep 13 · 4:32](https://qa.library.globalcastmd.com/watch/quad-1-cervical-tracheopexy-with-dr-alessandro-de-alarcon-7779?t=272)
- "Several years ago, the approach was that patients with tracheomalacia would undergo aortopexy." — Em Gootee (host_summary) [Ep 14 · 0:36](https://qa.library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=36)
- "In the last 4 to 5 years, it has become standard practice to determine which patients will respond best to tracheopexy versus aortopexy." — Em Gootee (host_summary) [Ep 14 · 0:43](https://qa.library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=43)
- "Pediatric surgery trainees were initially told that tracheomalacia is something that kids will grow out of and will get better." — Aaron Garrison (opinion) [Ep 14 · 0:58](https://qa.library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=58)
- "Recent data has shown that there are long term consequences for soiling into the lungs and having chronic lung aspiration, which over time is detrimental." — Aaron Garrison (clinical) [Ep 14 · 1:08](https://qa.library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=68)
- "Preoperative dynamic reconstruction studies give a lot of information for determining which procedure is best for each patient." — Aaron Garrison (clinical) [Ep 14 · 1:26](https://qa.library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=86)
- "Dynamic expiratory films show what you need to see with the airway that inspiratory films alone do not reveal." — Aaron Garrison (clinical) [Ep 14 · 1:31](https://qa.library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=91)
- "Part of the workup is making sure that there is space to anteriorly suspend the aorta so that the trachea diameter can actually be made larger." — Em Gootee (host_summary) [Ep 14 · 1:45](https://qa.library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=105)
- "Surgeons always look for the thymus and make sure that there is enough tissue to remove to be able to bring the trachea up anteriorly." — Aaron Garrison (clinical) [Ep 14 · 1:55](https://qa.library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=115)
- "Preoperative bronchoscopy gives the surgical team an idea of internal anatomy, which can assist in classifying the degree of tracheomalacia prior to surgical intervention." — Em Gootee (host_summary) [Ep 14 · 2:02](https://qa.library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=122)
- "The classification system for tracheomalacia is in evolution, and trying to describe what is mild or severe or moderate is a little bit challenging." — Aaron Garrison (opinion) [Ep 14 · 2:17](https://qa.library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=137)
- "The biggest benefit of minimally invasive approach is visualization and exposure." — Aaron Garrison (opinion) [Ep 14 · 2:34](https://qa.library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=154)
- "Disadvantages of minimally invasive approach include that it takes longer to learn and is more uncomfortable to learn." — Aaron Garrison (opinion) [Ep 14 · 2:39](https://qa.library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=159)
- "Anesthesia colleagues are sometimes hesitant to allow thoracoscopic cases to go on a little bit longer." — Aaron Garrison (opinion) [Ep 14 · 2:42](https://qa.library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=162)
- "A paper in Anesthesiology looked at open, thoracoscopic, and converted patients and found no difference in blood gases and metabolic derangements during surgery." — Aaron Garrison (host_summary) [Ep 14 · 3:03](https://qa.library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=183)
- "The same study found no difference when looking at blood pressure with acidosis and hypoxia between open and thoracoscopic approaches." — Aaron Garrison (host_summary) [Ep 14 · 3:17](https://qa.library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=197)
- "When using a thoracoscopic approach, correct positioning is the key to success." — Em Gootee (host_summary) [Ep 14 · 3:23](https://qa.library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=203)
- "It is best to use gravity to advantage as it aids in retracting the lungs and trachea placement." — Em Gootee (host_summary) [Ep 14 · 3:27](https://qa.library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=207)
- "For anterior mediastinal work, babies are positioned with the arm up and a bump underneath so that there is access to the axilla and anteriorly." — Aaron Garrison (clinical) [Ep 14 · 3:33](https://qa.library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=213)
- "The goal of aortopexy is to suspend the aorta." — Aaron Garrison (clinical) [Ep 14 · 3:51](https://qa.library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=231)
- "The first step in aortopexy is taking out the thymus, finding the innominate junction, and then identifying the arch of the aorta." — Aaron Garrison (clinical) [Ep 14 · 3:54](https://qa.library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=234)
- "Opening the pericardium and finding the area at the pericardial-adventitial junction to suspend is the key point of aortopexy." — Em Gootee (host_summary) [Ep 14 · 4:01](https://qa.library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=241)
- "If you go up too high during aortopexy, then you are doing a pericardiopexy and it is not quite as successful or durable." — Aaron Garrison (clinical) [Ep 14 · 4:10](https://qa.library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=250)
- "Passing suture transternally is preferred with the aortopexy approach, though it can be technically difficult." — Em Gootee (host_summary) [Ep 14 · 4:16](https://qa.library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=256)
- "For tracheopexy, a posterior approach via semiprone position is preferred." — Em Gootee (host_summary) [Ep 14 · 4:23](https://qa.library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=263)
- "Creating a pneumothorax by putting the Veress off the tip of the scapula helps collapse the lung for trocar placement." — Em Gootee (host_summary) [Ep 14 · 4:28](https://qa.library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=268)
- "When operating posteriorly, triangulating your hands gives the best visualization and working space." — Em Gootee (host_summary) [Ep 14 · 4:38](https://qa.library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=278)
- "The goal of posterior tracheopexy is taking the anterior spinal ligament and fixing it to the posterior membranous trachea." — Aaron Garrison (clinical) [Ep 14 · 4:45](https://qa.library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=285)
- "The area of floppy membrane is distal to the dilated pouch usually." — Aaron Garrison (clinical) [Ep 14 · 4:56](https://qa.library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=296)
- "When available, a multidisciplinary team which includes a pulmonologist can allow for internal visualization via bronchoscopy." — Em Gootee (host_summary) [Ep 14 · 4:56](https://qa.library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=296)
- "Bronchoscopic guidance technique is primarily used in non-esophageal atresia patients." — Em Gootee (host_summary) [Ep 14 · 5:05](https://qa.library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=305)
- "Surgeons can make an indent on the posterior wall of the trachea, and pulmonologists can see it pop up on their bronchoscopy to help guide suture placement." — Aaron Garrison (clinical) [Ep 14 · 5:09](https://qa.library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=309)
- "It usually takes about 2 or 3 sutures for posterior tracheopexy, leaving enough space for the esophagus to come through." — Aaron Garrison (clinical) [Ep 14 · 5:43](https://qa.library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=343)
- "Using the knot pusher and tension suture is helpful during tracheopexy." — Aaron Garrison (opinion) [Ep 14 · 5:48](https://qa.library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=348)
- "It is important to create enough tension in the suture to ensure that the pexy is secure." — Em Gootee (host_summary) [Ep 14 · 5:53](https://qa.library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=353)
- "Getting the suture to roll through the anterior spinal ligament is the hardest part and is pretty challenging." — Aaron Garrison (opinion) [Ep 14 · 5:58](https://qa.library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=358)
- "The approach changes for patients without esophageal atresia or with an esophagus in continuity." — Em Gootee (host_summary) [Ep 14 · 6:07](https://qa.library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=367)
- "For patients with esophagus in continuity, the first step is to dissect around the esophagus using a vessel loop for retraction." — Em Gootee (host_summary) [Ep 14 · 6:14](https://qa.library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=374)
- "There are times when the esophagus is put to the left of the trachea, and times when it is put to the right of the trachea." — Aaron Garrison (clinical) [Ep 14 · 6:20](https://qa.library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=380)
- "Dr. Garrison always worries a little bit about dysphagia when repositioning the esophagus, but it is not something he has seen a ton of." — Aaron Garrison (opinion) [Ep 14 · 6:26](https://qa.library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=386)
- "Using pre- and post-operative bronchoscopy allows the surgeon to see the improvement prior to case completion." — Em Gootee (host_summary) [Ep 14 · 6:32](https://qa.library.globalcastmd.com/watch/quad-2-thoracoscopic-tracheopexy-with-dr-aaron-garrison-7919?t=392)
- "Birth history and patient size are important preoperative considerations for esophageal atresia repair." — Nathan Tighe (clinical) [Ep 16 · 0:53](https://qa.library.globalcastmd.com/watch/quad-7-anesthesia-for-thoracoscopic-techniques-with-dr-nathaniel-tighe-8115?t=53)
- "Physiologic status from ventilation and cardiac standpoints is particularly important in preoperative assessment." — Nathan Tighe (clinical) [Ep 16 · 0:57](https://qa.library.globalcastmd.com/watch/quad-7-anesthesia-for-thoracoscopic-techniques-with-dr-nathaniel-tighe-8115?t=57)
- "The association between esophageal atresia and cardiac abnormalities is particularly relevant to anesthetic technique." — Em Gootee (host_summary) [Ep 16 · 1:05](https://qa.library.globalcastmd.com/watch/quad-7-anesthesia-for-thoracoscopic-techniques-with-dr-nathaniel-tighe-8115?t=65)
- "Preoperative visualization of the child's airway allows better decision-making and potentially less time under anesthesia." — Nathan Tighe (clinical) [Ep 16 · 1:13](https://qa.library.globalcastmd.com/watch/quad-7-anesthesia-for-thoracoscopic-techniques-with-dr-nathaniel-tighe-8115?t=73)
- "Akinesis (keeping children still) can be very challenging in small children, especially when intraoperative neuromonitoring is involved." — Nathan Tighe (clinical) [Ep 16 · 1:33](https://qa.library.globalcastmd.com/watch/quad-7-anesthesia-for-thoracoscopic-techniques-with-dr-nathaniel-tighe-8115?t=93)
- "The most common technique for maintaining stillness is short-acting opioid infusions, which result in relatively little hemodynamic instability." — Em Gootee (host_summary) [Ep 16 · 1:42](https://qa.library.globalcastmd.com/watch/quad-7-anesthesia-for-thoracoscopic-techniques-with-dr-nathaniel-tighe-8115?t=102)
- "Volatile anesthetics are especially useful when preservation of spontaneous ventilation is desired." — Em Gootee (host_summary) [Ep 16 · 1:53](https://qa.library.globalcastmd.com/watch/quad-7-anesthesia-for-thoracoscopic-techniques-with-dr-nathaniel-tighe-8115?t=113)
- "Intraoperative neuromonitoring precludes the use of neuromuscular blocking drugs like rocuronium and vecuronium." — Nathan Tighe (clinical) [Ep 16 · 2:25](https://qa.library.globalcastmd.com/watch/quad-7-anesthesia-for-thoracoscopic-techniques-with-dr-nathaniel-tighe-8115?t=145)
- "Insufflation using pneumothorax created by trocar placement can facilitate surgical exposure by overcoming peak inspiratory pressures to allow lung collapse." — Em Gootee (host_summary) [Ep 16 · 2:31](https://qa.library.globalcastmd.com/watch/quad-7-anesthesia-for-thoracoscopic-techniques-with-dr-nathaniel-tighe-8115?t=151)
- "Insufflation is useful for small kids with good lung compliance but not effective in kids with severe bronchopulmonary dysplasia or other compliance abnormalities." — Em Gootee (host_summary) [Ep 16 · 2:48](https://qa.library.globalcastmd.com/watch/quad-7-anesthesia-for-thoracoscopic-techniques-with-dr-nathaniel-tighe-8115?t=168)
- "Patients with compliance abnormalities often require higher peak inspiratory or mean airway pressures, resulting in the need for very high insufflation pressures." — Nathan Tighe (clinical) [Ep 16 · 3:00](https://qa.library.globalcastmd.com/watch/quad-7-anesthesia-for-thoracoscopic-techniques-with-dr-nathaniel-tighe-8115?t=180)
- "Lung isolation utility is restricted by patient size and airway anatomy and requires expertise and specialized equipment." — Nathan Tighe (clinical) [Ep 16 · 3:20](https://qa.library.globalcastmd.com/watch/quad-7-anesthesia-for-thoracoscopic-techniques-with-dr-nathaniel-tighe-8115?t=200)
- "Three dimensions are important for lung isolation: tracheal diameter (particularly AP diameter), bronchial diameters, and the length of the right main stem bronchus between carina and right upper lobe takeoff." — Nathan Tighe (clinical) [Ep 16 · 3:34](https://qa.library.globalcastmd.com/watch/quad-7-anesthesia-for-thoracoscopic-techniques-with-dr-nathaniel-tighe-8115?t=214)
- "Regular endotracheal tube is the most common device for lung isolation in neonates because it is relatively straightforward to mainstem into the left bronchus, which has a good landing zone for the balloon." — Nathan Tighe (clinical) [Ep 16 · 4:05](https://qa.library.globalcastmd.com/watch/quad-7-anesthesia-for-thoracoscopic-techniques-with-dr-nathaniel-tighe-8115?t=245)
- "Endotracheal tube placement is technically easier than placement of other lung isolation devices." — Em Gootee (host_summary) [Ep 16 · 4:19](https://qa.library.globalcastmd.com/watch/quad-7-anesthesia-for-thoracoscopic-techniques-with-dr-nathaniel-tighe-8115?t=259)
- "Bronchial blockers or Fogarty catheters require enough space between the carina and right upper lobe takeoff for balloon placement." — Nathan Tighe (clinical) [Ep 16 · 4:24](https://qa.library.globalcastmd.com/watch/quad-7-anesthesia-for-thoracoscopic-techniques-with-dr-nathaniel-tighe-8115?t=264)
- "In kids with a pig bronchus, bronchial blocker placement becomes very difficult and may require selective lobar blockade." — Nathan Tighe (clinical) [Ep 16 · 4:39](https://qa.library.globalcastmd.com/watch/quad-7-anesthesia-for-thoracoscopic-techniques-with-dr-nathaniel-tighe-8115?t=279)
- "A tracheal bronchus (pig bronchus) is an anatomical variant where an accessory bronchus originates directly from the supracarinal trachea." — Em Gootee (host_summary) [Ep 16 · 4:48](https://qa.library.globalcastmd.com/watch/quad-7-anesthesia-for-thoracoscopic-techniques-with-dr-nathaniel-tighe-8115?t=288)
- "Bronchial blockers can be helpful in kids with abnormal parenchyma when higher ventilatory pressures are needed but higher insufflation pressures should be avoided." — Nathan Tighe (clinical) [Ep 16 · 4:58](https://qa.library.globalcastmd.com/watch/quad-7-anesthesia-for-thoracoscopic-techniques-with-dr-nathaniel-tighe-8115?t=298)
- "In larger kids (usually 8 years or above) with recurrent fistulas, double-lumen tubes can be used and are the easiest device for lung isolation because they allow independent ventilation of the two lungs." — Em Gootee (host_summary) [Ep 16 · 5:17](https://qa.library.globalcastmd.com/watch/quad-7-anesthesia-for-thoracoscopic-techniques-with-dr-nathaniel-tighe-8115?t=317)
- "Early conversations between anesthesiologists and surgeons about patient specifics are part of deciding the best modality for each individual patient." — Em Gootee (host_summary) [Ep 16 · 5:38](https://qa.library.globalcastmd.com/watch/quad-7-anesthesia-for-thoracoscopic-techniques-with-dr-nathaniel-tighe-8115?t=338)
- "Unrepaired single ventricle patients are sensitive to changes in ventilation because they can have swings in circulation direction based on pulmonary vascular resistance." — Nathan Tighe (clinical) [Ep 16 · 5:55](https://qa.library.globalcastmd.com/watch/quad-7-anesthesia-for-thoracoscopic-techniques-with-dr-nathaniel-tighe-8115?t=355)
- "Single ventricle patients may be candidates for open repair or ECMO support to ensure good outcomes." — Em Gootee (host_summary) [Ep 16 · 6:07](https://qa.library.globalcastmd.com/watch/quad-7-anesthesia-for-thoracoscopic-techniques-with-dr-nathaniel-tighe-8115?t=367)
- "Insufflation causes changes in preload, and patients with passive pulmonary circulations are particularly sensitive to this insufflation." — Nathan Tighe (clinical) [Ep 16 · 6:18](https://qa.library.globalcastmd.com/watch/quad-7-anesthesia-for-thoracoscopic-techniques-with-dr-nathaniel-tighe-8115?t=378)
- "Esophageal atresia patients often have tracheobronchomalacia" — Lizzie Lee (host_summary) [Ep 22 · 0:13](https://qa.library.globalcastmd.com/watch/tracheobronchopexy-to-avoid-tracheostomy-in-esophageal-atresia-patients-with-severe-life-threatening-tracheobronchomalacia-10435?t=13)
- "Tracheobronchomalacia can cause serious breathing problems like blue spells in esophageal atresia patients" — Lizzie Lee (host_summary) [Ep 22 · 0:13](https://qa.library.globalcastmd.com/watch/tracheobronchopexy-to-avoid-tracheostomy-in-esophageal-atresia-patients-with-severe-life-threatening-tracheobronchomalacia-10435?t=13)
- "A retrospective observational study reviewed 80 esophageal atresia patients who underwent tracheobronchopexy at two hospitals between 2013 and 2021" — Lizzie Lee (host_summary) [Ep 22 · 0:23](https://qa.library.globalcastmd.com/watch/tracheobronchopexy-to-avoid-tracheostomy-in-esophageal-atresia-patients-with-severe-life-threatening-tracheobronchomalacia-10435?t=23)
- "94% of esophageal atresia patients who underwent tracheobronchopexy were able to avoid a tracheostomy" — Lizzie Lee (host_summary) [Ep 22 · 0:33](https://qa.library.globalcastmd.com/watch/tracheobronchopexy-to-avoid-tracheostomy-in-esophageal-atresia-patients-with-severe-life-threatening-tracheobronchomalacia-10435?t=33)
- "Tracheobronchopexy significantly reduced life-threatening breathing events in esophageal atresia patients" — Lizzie Lee (host_summary) [Ep 22 · 0:38](https://qa.library.globalcastmd.com/watch/tracheobronchopexy-to-avoid-tracheostomy-in-esophageal-atresia-patients-with-severe-life-threatening-tracheobronchomalacia-10435?t=38)
- "Tracheobronchopexy significantly reduced the need for positive pressure ventilation in esophageal atresia patients" — Lizzie Lee (host_summary) [Ep 22 · 0:38](https://qa.library.globalcastmd.com/watch/tracheobronchopexy-to-avoid-tracheostomy-in-esophageal-atresia-patients-with-severe-life-threatening-tracheobronchomalacia-10435?t=38)
- "Tracheobronchopexy significantly reduced ventilator dependence in esophageal atresia patients" — Lizzie Lee (host_summary) [Ep 22 · 0:38](https://qa.library.globalcastmd.com/watch/tracheobronchopexy-to-avoid-tracheostomy-in-esophageal-atresia-patients-with-severe-life-threatening-tracheobronchomalacia-10435?t=38)
- "Cincinnati Children's Hospital hosted the Quad Conference in October 2022, combining four conferences: International Organization for Esophageal Atresia, Aerodigestive Society Conference, Cincinnati Children's Airway Course, and Cincinnati Children's Pediatric Dysphagia Series." — Lizzie Lee (host_summary) [Ep 21 · 0:15](https://qa.library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=15)
- "Cincinnati Children's has one of the largest aerodigestive centers in the world." — Lizzie Lee (host_summary) [Ep 21 · 0:47](https://qa.library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=47)
- "The expert multidisciplinary team includes speech pathology, otolaryngology, gastroenterology, pulmonology, and pediatric general surgery." — Lizzie Lee (host_summary) [Ep 21 · 0:55](https://qa.library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=55)
- "The vision of the Aerodigestive and Esophageal Center is to improve efficiency and communication between team members and the family." — Claire Miller (clinical) [Ep 21 · 1:28](https://qa.library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=88)
- "The center provides coordinated multidisciplinary care to children with congenital or acquired complex digestive and airway disorders." — Lizzie Lee (host_summary) [Ep 21 · 1:37](https://qa.library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=97)
- "The clinical assessment is a poor predictor when there are airway protection issues." — Claire Miller (clinical) [Ep 21 · 2:44](https://qa.library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=164)
- "Video fluoroscopic swallowing study analyzes different phases of swallowing." — Lizzie Lee (host_summary) [Ep 21 · 2:52](https://qa.library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=172)
- "FEES (fiber optic endoscopic evaluation of swallowing study) allows visualization of pharyngeal and laryngeal structures and assessment of function, aspiration, and residual after each swallow." — Lizzie Lee (host_summary) [Ep 21 · 2:59](https://qa.library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=179)
- "High-resolution pharyngeal manometry allows objective assessment of the pressures of the swallow to understand what is underlying a swallowing dysfunction." — Claire Miller (clinical) [Ep 21 · 3:13](https://qa.library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=193)
- "ENT looks at swallowing study results and helps stratify the risk of proceeding with airway reconstruction and decannulation." — Lizzie Lee (host_summary) [Ep 21 · 3:48](https://qa.library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=228)
- "In aerodigestive patients, ENT performs esophageal and airway reconstruction, cleft repair, drool procedures, and manages vocal folds and mobility." — Lizzie Lee (host_summary) [Ep 21 · 3:54](https://qa.library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=234)
- "GERD pathophysiology includes an incompetent lower esophageal sphincter." — Lizzie Lee (host_summary) [Ep 21 · 4:19](https://qa.library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=259)
- "Patients with TEF have a lot of other things other than incompetent lower esophageal sphincters, including motility problems, hernias, and delayed emptying." — Scott Pentik (clinical) [Ep 21 · 4:31](https://qa.library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=271)
- "General signs and symptoms of GERD include regurgitation, vomiting, and heartburn." — Lizzie Lee (host_summary) [Ep 21 · 4:42](https://qa.library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=282)
- "Impedance is a tool used to measure reflux and distinguish between a swallow versus actual reflux." — Scott Pentik (clinical) [Ep 21 · 4:48](https://qa.library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=288)
- "Patients with eosinophilic esophagitis often have procedures performed on them even before their diagnosis." — Scott Pentik (clinical) [Ep 21 · 5:21](https://qa.library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=321)
- "Data shows an increase in airway surgery complications in patients who were later found to have eosinophilic esophagitis." — Lizzie Lee (host_summary) [Ep 21 · 5:28](https://qa.library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=328)
- "The center now performs endoscopy as part of workup prior to even considering surgery." — Scott Pentik (guideline) [Ep 21 · 5:35](https://qa.library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=335)
- "Anatomic issues in aerodigestive patients include strictures that need balloon dilations or stenting." — Lizzie Lee (host_summary) [Ep 21 · 5:40](https://qa.library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=340)
- "Kids will have Nissans and then have hernias later." — Scott Pentik (clinical) [Ep 21 · 5:49](https://qa.library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=349)
- "Motility issues after TEF repairs include narrowing of the esophagus and the esophagus not squeezing, leading to more reflux, more dysphagia, and impactions." — Scott Pentik (clinical) [Ep 21 · 5:58](https://qa.library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=358)
- "When 25 patients in the aerodigestive program were assessed, 76% of them had a feeding disorder." — Lizzie Lee (host_summary) [Ep 21 · 6:13](https://qa.library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=373)
- "Patients at risk for pulmonary insufficiency include preemies with chronic lung disease, patients with restrictive lung disease, congenital or acquired abnormalities, and heart disease like pulmonary hypertension." — Lizzie Lee (host_summary) [Ep 21 · 6:54](https://qa.library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=414)
- "Patients at risk for pulmonary insufficiency typically present with chronic symptoms including tachypnea, shortness of breath, retractions, non-apneic hypoxemia, and in older patients, exercise intolerance." — Sherry Torres Silva (clinical) [Ep 21 · 7:06](https://qa.library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=426)
- "Underlying pulmonary insufficiency should be suspected if patients have had complicated respiratory infections requiring positive pressure ventilation." — Lizzie Lee (host_summary) [Ep 21 · 7:20](https://qa.library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=440)
- "Patients at risk for chronic pulmonary aspiration include preemie babies, those with swallowing dysfunction, GI dysmotility, cardiothoracic esophageal and airway history, and syndromes including CHARGE syndrome, Mobius, Criducha, and trisomy." — Sherry Torres Silva (clinical) [Ep 21 · 7:32](https://qa.library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=452)
- "Risk factors for upper airway obstruction include airway abnormalities like mid-face hypoplasia, skeletal dysplasia, decreased muscle tone, and syndromes associated with airway obstruction." — Lizzie Lee (host_summary) [Ep 21 · 7:48](https://qa.library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=468)
- "Patients with airway obstruction, especially upper airway, will have symptoms with sleep and significant exertion or agitation, and noisy breathing might be one of the most significant symptoms reported." — Sherry Torres Silva (clinical) [Ep 21 · 8:02](https://qa.library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=482)
- "Risk factors for lower airway obstruction include acquired or congenital thoracic deformities and those who had thoracotomies done in the past." — Lizzie Lee (host_summary) [Ep 21 · 8:13](https://qa.library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=493)
- "Tracheomalacia is a very common comorbidity in patients with history of esophageal fistula or atresia." — Sherry Torres Silva (clinical) [Ep 21 · 8:22](https://qa.library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=502)
- "High-resolution CT is the gold standard for diagnosis because it is highly sensitive and detects early changes of the small airways, and 3D reconstructions can be performed." — Sherry Torres Silva (clinical) [Ep 21 · 8:36](https://qa.library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=516)
- "Flexible bronchoscopy is used starting in the nose and ending in the subsegmental bronchi, and bronchoalveolar lavage helps with identification of infections and markers of aspiration." — Sherry Torres Silva (clinical) [Ep 21 · 8:49](https://qa.library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=529)
- "Pulmonologists perform medical management of aspiration including control of sialorrhea, optimization of airway clearance, and use of anti-inflammatory medications for chronic aspiration or inflammation." — Sherry Torres Silva (clinical) [Ep 21 · 9:02](https://qa.library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=542)
- "For patients with ventilatory insufficiency, the pulmonologist determines if the child still needs ventilatory support and whether they are ready for decannulation." — Lizzie Lee (host_summary) [Ep 21 · 9:15](https://qa.library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=555)
- "The pulmonologist assesses how ready the patient is for weaning from the vent and whether they can start or advance feeding." — Lizzie Lee (host_summary) [Ep 21 · 9:26](https://qa.library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=566)
- "In the NICU, general surgeons obtain feeding access, manage anorectal malformations, and perform surgical procedures such as tracheopexies and lung resections." — Lizzie Lee (host_summary) [Ep 21 · 9:41](https://qa.library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=581)
- "A subset of children after esophageal atresia repair experience severe airway collapse, leaving them ventilator dependent or suffering repeated cyanotic spells" — Em Gootee (host_summary) [Ep 23 · 1:41](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-1st-quarter-2025-10484?t=101)
- "80 patients with severe airway collapse after esophageal atresia is a huge number; most pediatric surgeons won't see 10 such patients in their career, and many wouldn't see 5" — George W. Holcomb III (epidemiological) [Ep 23 · 2:17](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-1st-quarter-2025-10484?t=137)
- "90% of patients showed complete airway collapse on dynamic bronchoscopy" — George W. Holcomb III (host_summary) [Ep 23 · 2:34](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-1st-quarter-2025-10484?t=154)
- "Three-quarters of tracheobronchopexy procedures used a posterior approach" — George W. Holcomb III (host_summary) [Ep 23 · 2:40](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-1st-quarter-2025-10484?t=160)
- "Tracheobronchopexy was performed on thoracic trachea alone in over half the patients, but had to be extended onto the bronchi in 40%" — George W. Holcomb III (host_summary) [Ep 23 · 2:44](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-1st-quarter-2025-10484?t=164)
- "94% of patients avoided tracheostomy with a mortality rate of 5%, and the procedure significantly reduced pressure ventilation and ventilator dependence" — George W. Holcomb III (host_summary) [Ep 23 · 2:57](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-1st-quarter-2025-10484?t=177)
- "In experienced hands who have done numerous or hundreds of these procedures, tracheobronchopexy can have very good outcomes for patients with severe airway collapse symptoms" — George W. Holcomb III (opinion) [Ep 23 · 3:14](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-1st-quarter-2025-10484?t=194)
- "Canada is the second largest country in the world geographically, though population-wise smaller than California" — Eric Skarsgard (epidemiological) [Ep 23 · 5:28](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-1st-quarter-2025-10484?t=328)
- "The majority of Canada's population lives within 200 kilometers of the US border, but there are definitely lots of children in remote communities where it is not easy to access care" — Eric Skarsgard (epidemiological) [Ep 23 · 5:38](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-1st-quarter-2025-10484?t=338)
- "Outreach services were present in only 7 out of 10 provinces, and only 8 out of 18 children's hospitals (44%) provided outreach services" — Preet Bir (epidemiological) [Ep 23 · 6:43](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-1st-quarter-2025-10484?t=403)
- "A significant number of outreach services are located within 50 kilometers of a children's hospital, leaving vast regions without access to pediatric surgical care" — Em Gootee (host_summary) [Ep 23 · 6:57](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-1st-quarter-2025-10484?t=417)
- "In most places in Canada, no one would transfer a 16 or 17 year old with appendicitis to a children's hospital for surgery; physiologically and every other way they're an adult and do not need the expertise of a pediatric surgeon" — Eric Skarsgard (clinical) [Ep 23 · 7:36](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-1st-quarter-2025-10484?t=456)
- "It's a misconception that the Canadian healthcare system ensures timely care; it actually doesn't, and children wait for surgery beyond their wait time target" — Eric Skarsgard (clinical) [Ep 23 · 8:01](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-1st-quarter-2025-10484?t=481)
- "Newfoundland and Labrador has the best outreach setup with only two pediatric surgeons who have established outreach clinics all over the province, serving as a model to others" — Eric Skarsgard (clinical) [Ep 23 · 8:16](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-1st-quarter-2025-10484?t=496)
- "The population of Newfoundland and Labrador is really rural and spread out, and weather-wise it can be impossible sometimes to access care or financially devastating" — Eric Skarsgard (epidemiological) [Ep 23 · 8:31](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-1st-quarter-2025-10484?t=511)
- "There are measurable costs of living remote to accessible high-quality care in terms of time required to be seen and actual clinical outcomes" — Eric Skarsgard (clinical) [Ep 23 · 9:01](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-1st-quarter-2025-10484?t=541)
- "In the NSQIP database, 5% of all pediatric procedures were G-tube, which is a pretty sizable percent" — Sean Kunisaki (epidemiological) [Ep 23 · 11:56](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-1st-quarter-2025-10484?t=716)
- "The study examined 4,612 G-tube placements from 71 NSQIP-Pediatric hospitals in 2023" — Em Gootee (host_summary) [Ep 23 · 12:38](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-1st-quarter-2025-10484?t=758)
- "77% of G-tube cases were first-time G-tubes as opposed to redos" (epidemiological) [Ep 23 · 12:46](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-1st-quarter-2025-10484?t=766)
- "Upper GI studies were obtained in 45% of first-time G-tube cases with substantial interhospital variability from 0 to 99%" — Em Gootee (host_summary) [Ep 23 · 13:04](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-1st-quarter-2025-10484?t=784)
- "The heterogeneity in use of preoperative upper GIs was extremely broad with no real reason, indicating a potential teaching moment" — Sean Kunisaki (opinion) [Ep 23 · 13:20](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-1st-quarter-2025-10484?t=800)
- "14% of G-tube cases resulted in an ED visit within 0 to 30 days" — Em Gootee (host_summary) [Ep 23 · 13:45](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-1st-quarter-2025-10484?t=825)
- "5.2% of G-tube cases involved dislodgement within 0 to 30 days" — Em Gootee (host_summary) [Ep 23 · 13:45](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-1st-quarter-2025-10484?t=825)
- "An additional 5.5% of G-tubes were dislodged in the 31 to 60 day period" (clinical) [Ep 23 · 13:55](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-1st-quarter-2025-10484?t=835)
- "Dislodgement rates are higher than rates of readmissions or IR interventions, making dislodgements a great QI target" (opinion) [Ep 23 · 13:55](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-1st-quarter-2025-10484?t=835)
- "If you can get dislodgements down, ED visits go down; when dislodgements happen early, patients are told to come back to the ED" (clinical) [Ep 23 · 14:15](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-1st-quarter-2025-10484?t=855)
- "A subset of children after esophageal atresia repair experience severe airway collapse, leaving them ventilator dependent or suffering repeated cyanotic spells" — Em Gootee (host_summary) [Ep 24 · 1:48](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2025-10786?t=108)
- "The tracheobronchopexy series included 80 patients, which is a huge number - most pediatric surgeons won't see 10 of these patients in their career, and many wouldn't see 5" — George W. Holcomb III (epidemiological) [Ep 24 · 2:17](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2025-10786?t=137)
- "90% of patients on dynamic bronchoscopy showed complete airway collapse" — George W. Holcomb III (host_summary) [Ep 24 · 2:34](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2025-10786?t=154)
- "Three-quarters of tracheobronchopexy procedures used a posterior approach" — George W. Holcomb III (host_summary) [Ep 24 · 2:40](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2025-10786?t=160)
- "Tracheobronchopexy was performed on thoracic trachea alone in over half the patients, but had to be extended onto the bronchi in 40%" — George W. Holcomb III (host_summary) [Ep 24 · 2:44](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2025-10786?t=164)
- "94% of tracheobronchopexy patients avoided tracheostomy with a mortality rate of 5%" — George W. Holcomb III (host_summary) [Ep 24 · 2:57](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2025-10786?t=177)
- "Tracheobronchopexy significantly reduced pressure ventilation and ventilator dependence" — George W. Holcomb III (host_summary) [Ep 24 · 2:57](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2025-10786?t=177)
- "In experienced hands who have done numerous or hundreds of these type procedures, tracheobronchopexy can have very good outcomes for patients with severe airway collapse symptoms" — George W. Holcomb III (opinion) [Ep 24 · 3:14](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2025-10786?t=194)
- "Canada is the 2nd largest country in the world geographically, though population-wise smaller than California" — Eric Skarsgard (epidemiological) [Ep 24 · 5:28](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2025-10786?t=328)
- "The majority of Canada's population lives within 200 kilometers of the US border, but there are definitely lots of children in remote communities where it is not easy to access care" — Eric Skarsgard (epidemiological) [Ep 24 · 5:38](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2025-10786?t=338)
- "Outreach services were present in only 7 out of 10 provinces, and only 8 out of 18 children's hospitals (44%) provided outreach services" — Preet Bir (epidemiological) [Ep 24 · 6:43](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2025-10786?t=403)
- "A significant number of outreach services are located within 50 kilometers of a children's hospital, leaving vast regions without access to pediatric surgical care" — Em Gootee (host_summary) [Ep 24 · 6:57](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2025-10786?t=417)
- "In most places in Canada, no one would ever transfer a 16 or 17 year old with appendicitis to a children's hospital for surgery - physiologically and every other way they're an adult and clearly do not need the expertise of a pediatric surgeon" — Eric Skarsgard (opinion) [Ep 24 · 7:36](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2025-10786?t=456)
- "Access to surgical care for children in Canada has been in need of improvement for decades" — Eric Skarsgard (opinion) [Ep 24 · 7:51](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2025-10786?t=471)
- "It's a misconception that the Canadian healthcare system ensures timely care - it actually doesn't, and children wait for surgery beyond their wait time target" — Eric Skarsgard (clinical) [Ep 24 · 8:01](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2025-10786?t=481)
- "Newfoundland and Labrador has the best outreach setup with only two pediatric surgeons who have established outreach clinics all over the province, serving as a model for others" — Eric Skarsgard (opinion) [Ep 24 · 8:16](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2025-10786?t=496)
- "The population of Newfoundland and Labrador is really rural and spread out, and geographically and weather-wise it can be impossible sometimes to access care or financially devastating" — Eric Skarsgard (epidemiological) [Ep 24 · 8:31](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2025-10786?t=511)
- "There are measurable costs in terms of time required to be seen and actual clinical outcomes for patients living remote from accessible high quality care" — Eric Skarsgard (clinical) [Ep 24 · 9:01](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2025-10786?t=541)
- "In the NSQIP database, 5% of all pediatric procedures were G-tube, which is a pretty sizable percent" — Sean Kunisaki (epidemiological) [Ep 24 · 11:56](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2025-10786?t=716)
- "The study examined 4,612 G-tube placements from 71 NSQIP-Pediatric hospitals in 2023" — Em Gootee (host_summary) [Ep 24 · 12:38](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2025-10786?t=758)
- "77% of G-tube cases were first-time G-tubes as opposed to redos" (epidemiological) [Ep 24 · 12:46](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2025-10786?t=766)
- "Upper GI studies were obtained in 45% of first-time G-tube cases with substantial interhospital variability from 0 to 99%" — Em Gootee (host_summary) [Ep 24 · 13:04](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2025-10786?t=784)
- "The heterogeneity in use of preoperative upper GIs was extremely broad with no real reason for it, indicating a potential teaching moment" — Sean Kunisaki (opinion) [Ep 24 · 13:23](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2025-10786?t=803)
- "14% of G-tube cases resulted in an ED visit within 0 to 30 days" — Em Gootee (host_summary) [Ep 24 · 13:45](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2025-10786?t=825)
- "5.2% of G-tube cases involved dislodgement within 0 to 30 days" — Em Gootee (host_summary) [Ep 24 · 13:45](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2025-10786?t=825)
- "An additional 5.5% of G-tubes were dislodged in the 31 to 60 day period" (epidemiological) [Ep 24 · 13:55](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2025-10786?t=835)
- "Dislodgement rates are higher than rates of readmissions or IR interventions, making them a great QI target" (opinion) [Ep 24 · 13:55](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2025-10786?t=835)
- "If you can get dislodgements down, ED visits go down - when dislodgements happen early, patients are told to come back to the ED" (clinical) [Ep 24 · 14:15](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-2nd-quarter-2025-10786?t=855)
- "Van Haal et al. conducted a retrospective cohort study in the Netherlands that included 79 patients who had rigid tracheobronchoscopy done before and after esophageal atresia surgery." — Lizzie Lee (host_summary) [Ep 26 · 1:04](https://qa.library.globalcastmd.com/watch/quick-literature-updates-ep-27-11580?t=64)
- "Preoperative tracheobronchoscopy for the presence of post-operative tracheomalacia had a sensitivity of 50% and a specificity of 67%." — Lizzie Lee (host_summary) [Ep 26 · 1:24](https://qa.library.globalcastmd.com/watch/quick-literature-updates-ep-27-11580?t=84)
- "Preoperative tracheobronchoscopy, though routine, has limited predictive value for post-operative tracheomalacia in esophageal atresia patients." — Lizzie Lee (host_summary) [Ep 26 · 1:34](https://qa.library.globalcastmd.com/watch/quick-literature-updates-ep-27-11580?t=94)
- "Mina et al. performed a retrospective review of all patients who underwent conservative management of modified Bell stage 2A or greater necrotizing enterocolitis at a single institution from 2011 to 2022." — Alex Halpern (host_summary) [Ep 26 · 2:05](https://qa.library.globalcastmd.com/watch/quick-literature-updates-ep-27-11580?t=125)
- "126 patients underwent conservative management of necrotizing enterocolitis, and 24 of those patients eventually underwent surgery for a post-NEC stricture." — Alex Halpern (host_summary) [Ep 26 · 2:20](https://qa.library.globalcastmd.com/watch/quick-literature-updates-ep-27-11580?t=140)
- "Primary resection and anastomosis was performed in all cases of post-NEC stricture requiring surgery." — Alex Halpern (host_summary) [Ep 26 · 2:29](https://qa.library.globalcastmd.com/watch/quick-literature-updates-ep-27-11580?t=149)
- "Post-NEC strictures are a common occurrence after conservative management of necrotizing enterocolitis." — Alex Halpern (host_summary) [Ep 26 · 2:33](https://qa.library.globalcastmd.com/watch/quick-literature-updates-ep-27-11580?t=153)
- "Huncheid et al. conducted a multi-center non-inferiority trial that compared preterm infants treated with expectant management versus early ibuprofen for patent ductus arteriosus." — Cecilia Gigena (host_summary) [Ep 26 · 3:04](https://qa.library.globalcastmd.com/watch/quick-literature-updates-ep-27-11580?t=184)
- "The trial included 273 infants: 136 treated with expectant management and 137 with early ibuprofen." — Cecilia Gigena (host_summary) [Ep 26 · 3:14](https://qa.library.globalcastmd.com/watch/quick-literature-updates-ep-27-11580?t=194)
- "In the expectant management group for PDA, there was 17.6% necrotizing enterocolitis, 33% bronchopulmonary dysplasia, and 14% death rates." — Cecilia Gigena (host_summary) [Ep 26 · 3:24](https://qa.library.globalcastmd.com/watch/quick-literature-updates-ep-27-11580?t=204)
- "In the ibuprofen group for PDA, there was 15.4% necrotizing enterocolitis, 50% bronchopulmonary dysplasia, and 80% death rates." — Cecilia Gigena (host_summary) [Ep 26 · 3:36](https://qa.library.globalcastmd.com/watch/quick-literature-updates-ep-27-11580?t=216)
- "Expectant management is not inferior to early ibuprofen in preterm patients with patent ductus arteriosus." — Cecilia Gigena (host_summary) [Ep 26 · 3:53](https://qa.library.globalcastmd.com/watch/quick-literature-updates-ep-27-11580?t=233)
- "Most children who aspirate have a functional or neurological problem (cerebral palsy, CHARGE syndrome); some have anatomical problems (TEF, laryngeal cleft, pharyngeal scar, esophageal stenosis)." — Michael Rutter (clinical) [Ep 6 · 4:39](https://qa.library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=279)
- "Lipid-laden macrophages are non-specific markers of aspiration; their recovery depends on the lipid content of aspirated material, the amount aspirated, and time since aspiration." — Bob Wood (clinical) [Ep 6 · 8:05](https://qa.library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=485)
- "Multi-channel intraluminal impedance testing detects reflux but does not diagnose aspiration; it tells you whether something is delivered from the stomach to the esophagus, not what happens after." — Phil Putnam (clinical) [Ep 6 · 9:38](https://qa.library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=578)
- "If a patient is aspirating from above (oropharyngeal or esophageal source), an anti-reflux procedure does not help and may make them worse." — Daniel von Allmen (clinical) [Ep 6 · 9:58](https://qa.library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=598)
- "A 3-French bugbee cautery is a smooth, excellent probe for identifying subtle tracheoesophageal fistulas." — Michael Rutter (clinical) [Ep 6 · 12:10](https://qa.library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=730)
- "A 70-degree endoscope is a difficult tool to use but can visualize TEFs that are otherwise hard to see with standard forward-viewing scopes." — Michael Rutter (clinical) [Ep 6 · 13:21](https://qa.library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=801)
- "Routine bronchoscopy is now standard practice for all type C TEF repairs at Cincinnati Children's, often done in collaboration with ENT colleagues." — Daniel von Allmen (clinical) [Ep 6 · 14:02](https://qa.library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=842)
- "Pediatric surgery fellows at Cincinnati Children's complete a one-month attachment with ENT to perform bronchoscopies and gain airway expertise." — Michael Rutter (clinical) [Ep 6 · 14:51](https://qa.library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=891)
- "Dual scoping (simultaneous bronchoscopy and esophagoscopy) allows scopes to 'shake hands' across a fistula, light transillumination through tissue, and injection of saline or air to reveal subtle openings." — Daniel von Allmen (clinical) [Ep 6 · 19:37](https://qa.library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=1177)
- "A 2.8 mm flexible bronchoscope and a 5.4–6 mm infant gastroscope are the typical scopes used for combined airway-esophageal examination in small children." — Phil Putnam (clinical) [Ep 6 · 21:02](https://qa.library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=1262)
- "Endoscopic TEF closure requires demucosalization of the tract (mucosa is a non-stick surface); the goal is raw-against-raw apposition with minimal fibrin glue (0.1 mL) to seal the tract while scarring occurs." — Michael Rutter (clinical) [Ep 6 · 23:41](https://qa.library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=1421)
- "Endoscopic TEF repair success rate is approximately 80%, typically requiring 2 attempts; after 3–4 failed attempts, open repair should be considered." — Michael Rutter (clinical) [Ep 6 · 37:01](https://qa.library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=2221)
- "Positive-pressure air insufflation (30 cm H₂O) via an endotracheal tube in the esophagus can reveal a TEF by causing air to bubble out of the tracheal opening." — Michael Rutter (clinical) [Ep 6 · 34:20](https://qa.library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=2060)
- "Injection of an inert material (e.g., Radiesse voice gel) into the walls adjacent to a TEF tract can obliterate the potential space and promote raw-on-raw apposition; the material is absorbed over a few weeks." — Michael Rutter (clinical) [Ep 6 · 39:48](https://qa.library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=2388)
- "Slide tracheoplasty for TEF involves transecting the trachea above and below the fistula, beveling the edges, turning in the tracheal wings to repair the esophagus, interposing sternal periosteum, and reconnecting the trachea; it is a three-layer repair." — Michael Rutter (clinical) [Ep 6 · 45:48](https://qa.library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=2748)
- "Sternal periosteum is an excellent interposition graft material: it is abundant, in the surgical field, and extremely strong ('like Kevlar'), though difficult to suture." — Michael Rutter (clinical) [Ep 6 · 46:52](https://qa.library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=2812)
- "Button batteries can cause ongoing tissue injury for weeks after ingestion, even if 'dead' (they retain ~2 volts); institutional protocol mandates removal within 2 hours of identification." — Michael Rutter (guideline) [Ep 6 · 53:37](https://qa.library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=3217)
- "Button battery injuries in the esophagus can progress to aortoesophageal fistula; CT angiography and close follow-up for 6 weeks post-removal are recommended, especially if the battery was at the aortoesophageal junction." — Phil Putnam (guideline) [Ep 6 · 59:02](https://qa.library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=3542)
- "Two slide tracheoplasty repairs for button battery TEF both dehisced (one at 10 days, one at 3 months); both were successfully revised. This may be more than coincidence, suggesting button battery injuries pose unique challenges." — Michael Rutter (clinical) [Ep 6 · 54:02](https://qa.library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=3242)
- "Transtracheal TEF repair is a two-dimensional operation with lower complication risk than slide tracheoplasty; the primary complication is re-fistulization, whereas slide tracheoplasty dehiscence is a more serious event." — Michael Rutter (opinion) [Ep 6 · 69:04](https://qa.library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=4144)
- "Transtracheal repair technique: anterior tracheotomy, identify the fistula from within the trachea, separate tracheal and esophageal layers, three-layer closure (esophageal mucosa with knots in lumen, sternal periosteum, tracheal wall with knots in lumen)." — Michael Rutter (clinical) [Ep 6 · 64:43](https://qa.library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=3883)
- "In patients with retroesophageal subclavian artery, the right recurrent laryngeal nerve is non-recurrent and at higher risk during neck dissection; awareness is critical during transtracheal or slide tracheoplasty approaches." — Michael Rutter (clinical) [Ep 6 · 94:43](https://qa.library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=5683)
- "Flexible bronchoscopy cannot reliably diagnose laryngeal clefts; rigid microlaryngoscopy with active probing is mandatory when posterior glottic pathology is suspected." — Bob Wood (clinical) [Ep 6 · 116:27](https://qa.library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=6987)
- "When examining the cervical trachea and subglottis with a flexible bronchoscope, it is easier to see pathology while slowly withdrawing the scope than while advancing it, due to the need to flex and extend the tip to navigate the glottis." — Bob Wood (clinical) [Ep 6 · 87:43](https://qa.library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=5263)
- "Insufflation with oxygen at 2 L/min through the suction channel of a flexible bronchoscope spreads tissue apart, improves visualization, and does not impair respirations." — Bob Wood (clinical) [Ep 6 · 86:58](https://qa.library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=5218)
- "The degree of angulation at the tip of a flexible bronchoscope is much greater in one direction (retroflexion) than the other; rotating the scope 180° (Sabode maneuver) can reveal posterior tracheal pathology more easily." — Bob Wood (clinical) [Ep 6 · 86:30](https://qa.library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=5190)
- "Endoscopic closure of bronchoesophageal fistulas is feasible but challenging; proximity to large vessels (e.g., pulmonary artery branches) may preclude safe cautery and necessitate surgical resection." — Michael Rutter (clinical) [Ep 6 · 107:43](https://qa.library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=6463)
- "In a patient with multiple bronchoesophageal fistulas and chronic bronchiectasis, lobectomy with resection of the esophageal pseudo-diverticulum can be performed safely; the esophagus can be primarily closed if not strictured." — Daniel von Allmen (clinical) [Ep 6 · 112:36](https://qa.library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=6756)
- "A Y-shaped airway stent from both bronchi into the trachea, with the tracheostomy tube sitting within the stent, can effectively bypass a bronchoesophageal fistula and allow clinical stability when further repair is not feasible." — Michael Rutter (clinical) [Ep 6 · 100:56](https://qa.library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=6056)
- "Tracheal pouches (diverticula) can be marsupialized endoscopically using a Storz ClickLine laparoscopic biopsy forceps with cautery at 40 watts; the technique is quick, well-tolerated, and eliminates the risk of tracheostomy tube misplacement." — Michael Rutter (clinical) [Ep 6 · 118:01](https://qa.library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=7081)
- "When cauterizing in the airway with a bugbee, oxygen concentration should be kept below 30% to minimize fire risk; brief periods of lower oxygen saturation are tolerable." — Michael Rutter (clinical) [Ep 6 · 38:35](https://qa.library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=2315)
- "A 3-French bugbee cautery fits through the 1.2 mm suction channel of a 2.8 mm flexible bronchoscope, allowing precise control and steering of the cautery tip." — Bob Wood (clinical) [Ep 6 · 27:54](https://qa.library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=1674)
- "Trichloroacetic acid (TCA) can be used to demucosalize TEF tracts, but control is less precise than with bugbee cautery; TCA is applied on a pledget and can cause unintended burns if it contacts tissue during insertion." — Todd Ponsky (clinical) [Ep 6 · 25:08](https://qa.library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=1508)
- "Anal fistula plugs (biologic, cone-shaped, made of Surgisis) can theoretically be used to occlude distal airway fistulas; they are wrapped with barbed suture and inserted into the tract to promote collagen matrix formation and scarring." — Todd Ponsky (clinical) [Ep 6 · 110:04](https://qa.library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=6604)
- "Slide tracheoplasty appears to be a learning-curve, surgeon-dependent operation; revision cases have been necessary as experience was gained." — Michael Rutter (opinion) [Ep 6 · 69:59](https://qa.library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=4199)
- "After 7 years of aspiration through a TEF, a child may have significant bronchiectasis; repair of the fistula does not immediately resolve lower airway disease, and ongoing chest physiotherapy and airway clearance are required." — Michael Rutter (clinical) [Ep 6 · 95:23](https://qa.library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=5723)
- "Hearing aid molds are radiolucent and can be missed on chest X-ray; high clinical suspicion is required when a foreign body ingestion is reported but not visualized." — Michael Rutter (clinical) [Ep 6 · 97:35](https://qa.library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=5855)
- "Pectus excavatum can worsen tracheobronchomalacia; placement of a pectus bar can improve airway support and reduce the need for stenting or tracheostomy." — Michael Rutter (clinical) [Ep 6 · 99:49](https://qa.library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=5989)
- "Airway stents can erode into the esophagus, creating secondary fistulas; long-term stent management requires vigilance and may necessitate alternative strategies (e.g., Y-stent with tracheostomy tube within the stent)." — Michael Rutter (clinical) [Ep 6 · 100:32](https://qa.library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=6032)
- "When repairing a high TEF from a thoracic approach, ligation of the fistula on the esophageal side can leave a large tracheal pouch; if the patient has tracheomalacia and requires a tracheostomy, the tube may enter the pouch, causing life-threatening obstruction." — Michael Rutter (clinical) [Ep 6 · 77:21](https://qa.library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=4641)
- "The azygous vein drains the bronchi, trachea, and esophagus, and its division may lead to impaired function postoperatively and impaired clearance of mucus and debris from the tracheobronchial tree" — Jose Campos (host_summary) [Ep 9 · 3:25](https://qa.library.globalcastmd.com/watch/case-based-journal-review-esophageal-atresia-in-2022-5631?t=205)
- "In a meta-analysis of almost 700 neonates, preserving the azygous vein resulted in significantly lower postoperative pneumonitis compared to division" — Ellen Encisco (host_summary) [Ep 9 · 3:02](https://qa.library.globalcastmd.com/watch/case-based-journal-review-esophageal-atresia-in-2022-5631?t=182)
- "There was no significant difference in anastomotic leak rate or stricture rate between azygous vein preservation and division" — Ellen Encisco (host_summary) [Ep 9 · 3:11](https://qa.library.globalcastmd.com/watch/case-based-journal-review-esophageal-atresia-in-2022-5631?t=191)
- "The endpoint of chest infection in the azygous vein meta-analysis was not clearly defined across studies—some used 'chest infection,' some 'pneumonitis,' some 'pneumonia'—making it a non-homogeneous endpoint" — Jose Campos (clinical) [Ep 9 · 4:45](https://qa.library.globalcastmd.com/watch/case-based-journal-review-esophageal-atresia-in-2022-5631?t=285)
- "In the Quebec study of 244 patients, the overall anastomotic stricture rate at one year was 30%" — Ellen Encisco (host_summary) [Ep 9 · 6:43](https://qa.library.globalcastmd.com/watch/case-based-journal-review-esophageal-atresia-in-2022-5631?t=403)
- "36% of patients with transanastomotic tubes developed strictures compared to 19% without tubes, a difference that remained significant after multivariable analysis" — Ellen Encisco (host_summary) [Ep 9 · 6:50](https://qa.library.globalcastmd.com/watch/case-based-journal-review-esophageal-atresia-in-2022-5631?t=410)
- "Patients with transanastomotic tubes had 2.72 times higher odds of developing a stricture compared to those without" — Ellen Encisco (host_summary) [Ep 9 · 7:06](https://qa.library.globalcastmd.com/watch/case-based-journal-review-esophageal-atresia-in-2022-5631?t=426)
- "The Quebec study adjusted for gestational age, leak, length of gap, and tension, and still found almost 3 times higher stricture rates with transanastomotic tubes" — Jose Campos (host_summary) [Ep 9 · 7:32](https://qa.library.globalcastmd.com/watch/case-based-journal-review-esophageal-atresia-in-2022-5631?t=452)
- "Patients with transanastomotic tubes started feeding on day 2 versus day 10 for those without tubes, but early feeding did not lead to less TPN—duration was 9 days in both groups" — Em Gootee (host_summary) [Ep 9 · 7:54](https://qa.library.globalcastmd.com/watch/case-based-journal-review-esophageal-atresia-in-2022-5631?t=474)
- "Congenital esophageal stenosis is associated with esophageal atresia in 7% to 10% of cases and most are diagnosed really late, sometimes after the anastomosis fails" — Jose Campos (epidemiological) [Ep 9 · 9:44](https://qa.library.globalcastmd.com/watch/case-based-journal-review-esophageal-atresia-in-2022-5631?t=584)
- "Passing a tube through the anastomosis to check for resistance can help identify distal esophageal stenosis intraoperatively" — Jose Campos (clinical) [Ep 9 · 9:58](https://qa.library.globalcastmd.com/watch/case-based-journal-review-esophageal-atresia-in-2022-5631?t=598)
- "In a meta-analysis of about 500 newborns, there was no significant difference in leak occurrence, pneumothorax, or mortality based on whether a chest drain was placed" — Em Gootee (host_summary) [Ep 9 · 12:20](https://qa.library.globalcastmd.com/watch/case-based-journal-review-esophageal-atresia-in-2022-5631?t=740)
- "The group that received a chest drain had a significantly higher chance of returning to the operating room" — Em Gootee (host_summary) [Ep 9 · 12:31](https://qa.library.globalcastmd.com/watch/case-based-journal-review-esophageal-atresia-in-2022-5631?t=751)
- "If a leak occurs, it doesn't always drain through the chest tube" — Todd Ponsky (clinical) [Ep 9 · 11:23](https://qa.library.globalcastmd.com/watch/case-based-journal-review-esophageal-atresia-in-2022-5631?t=683)
- "A chest tube may injure, suck on, or increase the chance of disruption of the anastomosis" — Todd Ponsky (opinion) [Ep 9 · 11:30](https://qa.library.globalcastmd.com/watch/case-based-journal-review-esophageal-atresia-in-2022-5631?t=690)
- "Chest tubes are painful for patients" — Todd Ponsky (clinical) [Ep 9 · 11:39](https://qa.library.globalcastmd.com/watch/case-based-journal-review-esophageal-atresia-in-2022-5631?t=699)
- "Giving acid suppression to neonates increases the risk of necrotizing enterocolitis according to neonatologists' concerns" — Todd Ponsky (host_summary) [Ep 9 · 13:41](https://qa.library.globalcastmd.com/watch/case-based-journal-review-esophageal-atresia-in-2022-5631?t=821)
- "Giving PPIs to neonates can increase pneumonia in different populations, but the risk is very minimal" — Jose Campos (clinical) [Ep 9 · 14:24](https://qa.library.globalcastmd.com/watch/case-based-journal-review-esophageal-atresia-in-2022-5631?t=864)
- "In the Midwest Pediatric Surgery Consortium study, antibiotics for more than 24 hours and acid suppression showed no difference in strictures or leaks" — Ellen Encisco (host_summary) [Ep 9 · 14:54](https://qa.library.globalcastmd.com/watch/case-based-journal-review-esophageal-atresia-in-2022-5631?t=894)
- "Not giving antibiotics postoperatively helps detect complications early rather than having antibiotics cover a complication" — Jose Campos (clinical) [Ep 9 · 14:10](https://qa.library.globalcastmd.com/watch/case-based-journal-review-esophageal-atresia-in-2022-5631?t=850)
- "In Poland, thoracoscopic esophageal atresia repair has been performed exclusively since 2005" — Ellen Encisco (host_summary) [Ep 10 · 1:38](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-february-2023-baps-issue-6580?t=98)
- "The first thoracoscopic esophageal atresia procedure took almost 4 hours, but with experience it became a 1-hour procedure" — Ellen Encisco (host_summary) [Ep 10 · 1:54](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-february-2023-baps-issue-6580?t=114)
- "Dr. Patkowski's team has had no conversions from thoracoscopic to open approach since beginning the technique" — Ellen Encisco (host_summary) [Ep 10 · 1:59](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-february-2023-baps-issue-6580?t=119)
- "All esophageal atresia cases in Dr. Patkowski's center have been managed by one team using only the thoracoscopic approach since the beginning" — Ellen Encisco (host_summary) [Ep 10 · 2:06](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-february-2023-baps-issue-6580?t=126)
- "Centralizing care for esophageal atresia patients is important even if transportation costs are higher, because complication costs are much higher" — Ellen Encisco (host_summary) [Ep 10 · 2:58](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-february-2023-baps-issue-6580?t=178)
- "Dr. Patkowski's center handles 15 to 20 esophageal atresia cases per year, which provides sufficient volume for good experience" — Ellen Encisco (host_summary) [Ep 10 · 3:06](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-february-2023-baps-issue-6580?t=186)
- "The Centre in Rocklaw has become the referral center for esophageal atresia and long gap esophageal atresia cases from the whole of Poland" — Mark Davenport (clinical) [Ep 10 · 3:38](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-february-2023-baps-issue-6580?t=218)
- "Centers of excellence for esophageal atresia are showing better outcomes" — Todd Ponsky (clinical) [Ep 10 · 4:13](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-february-2023-baps-issue-6580?t=253)
- "Centralization of esophageal atresia care would be difficult to implement in the United States healthcare system" — Todd Ponsky (opinion) [Ep 10 · 4:26](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-february-2023-baps-issue-6580?t=266)
- "In the Sheffield study, 47% of Hirschsprung disease patients needed a stoma before primary pull-through" — Govind Murti (epidemiological) [Ep 10 · 5:35](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-february-2023-baps-issue-6580?t=335)
- "In the stoma cohort, 38 patients had ileostomies and the remaining had colostomies" — Ellen Encisco (host_summary) [Ep 10 · 5:41](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-february-2023-baps-issue-6580?t=341)
- "The most common indication for initial stoma in Hirschsprung disease was washout failure, accounting for nearly 40% of cases" — Ellen Encisco (host_summary) [Ep 10 · 5:46](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-february-2023-baps-issue-6580?t=346)
- "Of 20 patients who needed post-pull-through stoma formation, 7 occurred within 30 days and 13 occurred after 30 days" — Govind Murti (epidemiological) [Ep 10 · 6:19](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-february-2023-baps-issue-6580?t=379)
- "Most post-pull-through stomas after 30 days were needed because of constipation or soiling" — Govind Murti (clinical) [Ep 10 · 6:28](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-february-2023-baps-issue-6580?t=388)
- "The Sheffield study represents real life surgical reporting and reflects overall management of Hirschsprung's disease within the UK" — Mark Davenport (opinion) [Ep 10 · 6:35](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-february-2023-baps-issue-6580?t=395)
- "The Sheffield Hirschsprung management sequence does not reflect typical practice in the United States" — Beth Rymeski (opinion) [Ep 10 · 7:09](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-february-2023-baps-issue-6580?t=429)
- "In US practice, most Hirschsprung patients undergo either neonatal pull-through or are sent home on irrigations for pull-through in the first couple of months of life" — Beth Rymeski (clinical) [Ep 10 · 7:20](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-february-2023-baps-issue-6580?t=440)
- "In US practice, pre-pull-through diversion is only done for delayed presentation with perforation or complicated cardiac babies" — Beth Rymeski (clinical) [Ep 10 · 7:39](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-february-2023-baps-issue-6580?t=459)
- "Sheffield primarily performs Duhamel pull-throughs while Cincinnati primarily performs Swenson procedures for Hirschsprung disease" — Ellen Encisco (host_summary) [Ep 10 · 8:10](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-february-2023-baps-issue-6580?t=490)
- "The Tanzania soap bathing study included 252 patients, with 114 receiving a preoperative bath with plain soap" — Cecilia Gigena (host_summary) [Ep 10 · 9:23](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-february-2023-baps-issue-6580?t=563)
- "In the soap bathing group, 11.4% developed surgical site infections compared to 40.6% in the control group" — Cecilia Gigena (host_summary) [Ep 10 · 9:26](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-february-2023-baps-issue-6580?t=566)
- "Preoperative soap bathing reduced the odds of surgical site infections by 80%" — Cecilia Gigena (host_summary) [Ep 10 · 9:43](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-february-2023-baps-issue-6580?t=583)
- "Length of stay in the soap bathing intervention group was 12 days compared to 22 days in the non-intervention group" — Mark Davenport (host_summary) [Ep 10 · 9:53](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-february-2023-baps-issue-6580?t=593)
- "The Tanzania study used trained carers to direct the method of cleansing, concentrating on areas known to harbor commensal and pathogenic bacteria" — Mark Davenport (clinical) [Ep 10 · 9:04](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-february-2023-baps-issue-6580?t=544)
- "Before implementing preoperative bathing in Tanzania, almost every pediatric surgery patient developed a wound infection" — Beth Rymeski (clinical) [Ep 10 · 10:41](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-february-2023-baps-issue-6580?t=641)
- "After implementing preoperative baths in Tanzania, wound infection rates dropped to nearly zero" — Beth Rymeski (clinical) [Ep 10 · 10:56](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-february-2023-baps-issue-6580?t=656)
- "The Tanzania soap bathing trial was well designed, analyzed in substantial detail, and has implications for low to middle income countries where surgical site infections are a major problem" — Mark Davenport (opinion) [Ep 10 · 11:04](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-february-2023-baps-issue-6580?t=664)
- "Acid suppression medicines, particularly proton pump inhibitors (PPIs), have potential harms" — Tom Wiley (clinical) [Ep 17 · 2:03](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-october-2023-8504?t=123)
- "There are no randomized controlled trials on prophylactic acid suppression after esophageal atresia repair" — Madina Chakraborty (epidemiological) [Ep 17 · 2:30](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-october-2023-8504?t=150)
- "Within 1,395 patients across 12 observational studies, 753 received acid suppression medication but this did not reduce the odds of having an esophageal stricture" — Cecilia Gigena (host_summary) [Ep 17 · 2:37](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-october-2023-8504?t=157)
- "There was no significant difference in secondary outcomes (gastroesophageal reflux disease, anastomotic leak, esophagitis) between infants receiving prophylactic acid suppression and those who did not" — Em Gootee (host_summary) [Ep 17 · 3:14](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-october-2023-8504?t=194)
- "There is currently no evidence that anti-acid medication reduces the risk of stricture, and there was a tendency toward higher incidence of strictures with treatment" — Pablo Laje (clinical) [Ep 17 · 3:33](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-october-2023-8504?t=213)
- "Potential risks of long-term acid suppression therapy include dysbiosis, necrotizing enterocolitis, and increased neonatal infection rates, particularly relevant in preterm and low birth weight infants" — Em Gootee (host_summary) [Ep 17 · 3:51](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-october-2023-8504?t=231)
- "A large prospective study demonstrated that even children with sizable pneumothorax can be safely observed" — Elizabeth Speck (clinical) [Ep 17 · 5:43](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-october-2023-8504?t=343)
- "Not every patient with pneumothorax has an active leak; aspiration followed by repeat imaging a few hours later can identify patients who can go home if there is no recurrence" — Pablo Laje (clinical) [Ep 17 · 6:04](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-october-2023-8504?t=364)
- "Cross-sectional imaging should not be performed on children with spontaneous pneumothorax to help make clinical decisions; the data support this conclusion" — Elizabeth Speck (guideline) [Ep 17 · 6:22](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-october-2023-8504?t=382)
- "If patients reaccumulate air after initial management, they have an ongoing air leak and warrant an operation" — Elizabeth Speck (clinical) [Ep 17 · 6:42](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-october-2023-8504?t=402)
- "The data support doing some pleural-based management rather than just staple lobectomy alone for spontaneous pneumothorax" — Elizabeth Speck (clinical) [Ep 17 · 6:51](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-october-2023-8504?t=411)
- "Studies are not available to demonstrate that one pleural-based procedure is better than another" — Elizabeth Speck (epidemiological) [Ep 17 · 7:28](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-october-2023-8504?t=448)
- "Some randomized trials showed that doing something to the pleura does not actually reduce recurrences of spontaneous pneumothorax" — Cecilia Gigena (host_summary) [Ep 17 · 7:08](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-october-2023-8504?t=428)
- "For the asymptomatic contralateral side in children with spontaneous pneumothorax, do not do anything unless it develops symptoms" — Cecilia Gigena (host_summary) [Ep 17 · 7:40](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-october-2023-8504?t=460)
- "For recurrent pneumothorax, whatever procedure was done before, do something more aggressive" — Elizabeth Speck (opinion) [Ep 17 · 7:52](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-october-2023-8504?t=472)
- "The CPAM study reviewed 110 patients operated over about 5 years, comparing perioperative outcomes between symptomatic and asymptomatic patients" — Pablo Laje (epidemiological) [Ep 17 · 8:44](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-october-2023-8504?t=524)
- "The asymptomatic CPAM group had shorter operating times, shorter postoperative mechanical ventilation, shorter chest tube durations, and shorter hospital stays" — Cecilia Gigena (host_summary) [Ep 17 · 9:00](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-october-2023-8504?t=540)
- "Factors associated with symptomatic CPAM lesions include age older than 4 years, postnatal diagnosis, and maximum cyst diameter greater than 39.9 millimeters" — Em Gootee (host_summary) [Ep 17 · 9:20](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-october-2023-8504?t=560)
- "The CPAM study did not enroll patients who accepted conservative treatment compared to asymptomatic patients" — Em Gootee (host_summary) [Ep 17 · 9:50](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-october-2023-8504?t=590)
- "The CPAM study sample size was insufficient and all patients were from a single center" — Em Gootee (host_summary) [Ep 17 · 10:00](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-october-2023-8504?t=600)
- "The CPAM study did not explain why operations were performed in asymptomatic patients, some of whom were several years old (5 to 120 months)" — Pablo Laje (opinion) [Ep 17 · 10:09](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-october-2023-8504?t=609)
- "The CPAM study excluded patients who underwent thoracotomy, including only thoracoscopic resections" — Pablo Laje (epidemiological) [Ep 17 · 10:31](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-october-2023-8504?t=631)
- "The appendicitis study compared two cohorts defined by time frame before and after near uniform implementation of stopping antibiotics at discharge." — Scott Short (clinical) [Ep 18 · 2:07](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754?t=127)
- "The appendicitis study looked at deep space organ infections, length of stay, readmissions, and use of CT scans as outcomes." — Romeo Ignacio (host_summary) [Ep 18 · 2:33](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754?t=153)
- "The appendicitis study had 185 patients in the home antibiotic group and 121 patients in the no home antibiotic group." — Cecilia Gigena (host_summary) [Ep 18 · 2:45](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754?t=165)
- "There was no significant difference in deep organ space infection requiring intervention between home antibiotic and no home antibiotic groups for complicated appendicitis." — Cecilia Gigena (host_summary) [Ep 18 · 2:55](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754?t=175)
- "There was no difference in length of stay between home antibiotic and no home antibiotic groups for complicated appendicitis." — Cecilia Gigena (host_summary) [Ep 18 · 3:03](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754?t=183)
- "Secondary outcomes including C. diff infections, superficial site infections, length of stay, post-operative CT imaging, and readmission showed no difference between antibiotic groups." — Romeo Ignacio (host_summary) [Ep 18 · 3:06](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754?t=186)
- "The appendicitis study challenges the tradition of giving antibiotics and possibly too much antibiotics after discharge." — Romeo Ignacio (opinion) [Ep 18 · 3:17](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754?t=197)
- "The next step for the appendicitis study is to roll it out to the Western Pediatric Surgery Research Consortium to study it on a broader scale." — Scott Short (clinical) [Ep 18 · 3:55](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754?t=235)
- "The esophageal atresia study is a 25 year experience describing 220 consecutive infants with esophageal atresia in Newcastle." — Mark Davenport (host_summary) [Ep 18 · 4:44](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754?t=284)
- "The esophageal atresia study had 215 patients, 13% had complex esophageal atresia, and of those 25 patients survived the repair." — Em Gootee (host_summary) [Ep 18 · 5:13](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754?t=313)
- "Of the 25 complex esophageal atresia survivors, 14 patients were type A and 11 patients were type C." — Em Gootee (host_summary) [Ep 18 · 5:28](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754?t=328)
- "Type C esophageal atresia is the most common type and means esophageal atresia with a distal fistula; type A means pure esophageal atresia with no fistula to the trachea." — Cecilia Gigena (clinical) [Ep 18 · 5:43](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754?t=343)
- "Of the 25 complex esophageal atresia patients, 18 had delayed primary anastomosis and 7 had esophageal replacement." — Em Gootee (host_summary) [Ep 18 · 6:03](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754?t=363)
- "Two of the esophageal replacements were salvage procedures following a failed traction." — Em Gootee (host_summary) [Ep 18 · 6:13](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754?t=373)
- "Only 4 patients with esophageal atresia were potentially treatable by traction." — Em Gootee (host_summary) [Ep 18 · 6:13](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754?t=373)
- "The esophagus has a great intrinsic blood supply and can be mobilized right down to the diaphragm and right up to the thoracic inlet and will stay alive." — Bruce Jaffray (clinical) [Ep 18 · 6:28](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754?t=388)
- "Many cases being put forward for lengthening are because surgeons get cold feet about attempting a primary anastomosis." — Bruce Jaffray (opinion) [Ep 18 · 6:46](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754?t=406)
- "In cases where traction techniques had not been attempted, the native esophagus was retained in 80% of cases." — Em Gootee (host_summary) [Ep 18 · 6:57](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754?t=417)
- "The median time to esophageal continuity in the Newcastle series was 77 days." — Em Gootee (host_summary) [Ep 18 · 7:02](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754?t=422)
- "Management of complex esophageal atresia without lengthening procedure can result in a similar rate of retention of the native esophagus but with significantly less morbidity." — Em Gootee (host_summary) [Ep 18 · 7:12](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754?t=432)
- "The Newcastle series is a pushback series which extols relatively conventional open surgery and begs the question as to what role lengthening procedures have in those with long gaps." — Mark Davenport (opinion) [Ep 18 · 7:32](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754?t=452)
- "Unless an experienced surgeon says after maximum mobilization they genuinely can't get the esophagus together, esophageal lengthening is not required." — Bruce Jaffray (opinion) [Ep 18 · 7:56](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754?t=476)
- "If esophaguses were being anastomosed with excess tension and repairs were failing, there would be a very high incidence of esophageal replacement, which is not seen in the Newcastle series." — Bruce Jaffray (clinical) [Ep 18 · 8:09](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754?t=489)
- "The pectus study is a prospective cohort study from a single center in Phoenix aiming to quantify long-term hyperesthesia and neuropathic pain after minimally invasive repair of pectus excavatum with cryoablation." — Cecilia Gigena (host_summary) [Ep 18 · 8:47](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754?t=527)
- "The pectus study selected patients under 21 years of age who presented for bar removal between November 2021 and May 2023." — Cecilia Gigena (host_summary) [Ep 18 · 9:04](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754?t=544)
- "Testing for cold and soft touch and pinprick was performed just before bar removal." — Cecilia Gigena (host_summary) [Ep 18 · 9:15](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754?t=555)
- "The pectus study enrolled 47 patients with a median bar dwell time of approximately 2.9 years." — Cecilia Gigena (host_summary) [Ep 18 · 9:25](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754?t=565)
- "Patients had a median of 2 bars placed, and almost 81% were secured with pericostal sutures." — Cecilia Gigena (host_summary) [Ep 18 · 9:41](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754?t=581)
- "Almost half of the pectus patients had some degree of hypoesthesia, with T5 being the most common dermatome affected." — Cecilia Gigena (host_summary) [Ep 18 · 9:51](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754?t=591)
- "The area with hypoesthesia was less than 5% of the entire surface that was treated with cryo." — Cecilia Gigena (host_summary) [Ep 18 · 10:00](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754?t=600)
- "Neuropathic symptoms were identified by only 13% of pectus patients, and none required treatment." — Cecilia Gigena (host_summary) [Ep 18 · 10:18](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754?t=618)
- "In the long term after minimally invasive repair of pectus excavatum with cryo, many patients will experience some chest wall hypoesthesia limited to one or two dermatomes, and chronic symptomatic neuropathic pain is very rare." — Cecilia Gigena (host_summary) [Ep 18 · 10:26](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754?t=626)
- "Pericostal sutures used to secure bars can damage nerves." — Cecilia Gigena (clinical) [Ep 18 · 11:00](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754?t=660)
- "The Zeng et al. study was a retrospective multi-center study done in China comparing robotic repair versus thoracoscopic repair for esophageal atresia." — Cecilia Gigena (host_summary) [Ep 19 · 0:58](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-17-9803?t=58)
- "After propensity score matching, the study included 126 patients with 63 in each group (robotic vs thoracoscopic)." — Cecilia Gigena (host_summary) [Ep 19 · 1:07](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-17-9803?t=67)
- "Robotic surgery for esophageal atresia had longer operative time but shorter anastomotic time compared to thoracoscopic repair." — Cecilia Gigena (host_summary) [Ep 19 · 1:07](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-17-9803?t=67)
- "The robotic group had lower anastomotic strictures and lower readmissions within 2 years post-op compared to thoracoscopic repair." — Cecilia Gigena (host_summary) [Ep 19 · 1:22](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-17-9803?t=82)
- "Robotic surgery is a good answer for esophageal atresia repair." — Cecilia Gigena (opinion) [Ep 19 · 1:32](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-17-9803?t=92)
- "The Pediatric Colorectal and Pelvic Learning Consortium conducted a multi-center retrospective review from 2017 to 2023 examining delayed diagnosis of Hirschsprung disease." — Alex Halpern (host_summary) [Ep 19 · 2:05](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-17-9803?t=125)
- "The Hirschsprung study included 679 patients from 14 different sites." — Alex Halpern (host_summary) [Ep 19 · 2:16](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-17-9803?t=136)
- "Increased age at diagnosis of Hirschsprung disease was associated with a greater likelihood of undergoing fecal diversion after initial pull-through procedure." — Alex Halpern (host_summary) [Ep 19 · 2:22](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-17-9803?t=142)
- "Increasing age at diagnosis of Hirschsprung disease was associated with an increased risk of constipation or incontinence requiring intervention postoperatively." — Alex Halpern (host_summary) [Ep 19 · 2:32](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-17-9803?t=152)
- "The Hirschsprung study did not find an association between age at diagnosis and 30-day complication rate after initial pull-through." — Alex Halpern (host_summary) [Ep 19 · 2:42](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-17-9803?t=162)
- "The Hirschsprung study did not find an association between age at diagnosis and need for pull-through revision." — Alex Halpern (host_summary) [Ep 19 · 2:42](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-17-9803?t=162)
- "Delayed diagnosis of Hirschsprung disease does affect certain outcomes in these patients." — Alex Halpern (opinion) [Ep 19 · 2:51](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-17-9803?t=171)
- "The Children's Hospital in Pakistan conducted a randomized control trial including 124 patients in 2021 to 2022 who needed stoma reversal." — Lizzie Lee (host_summary) [Ep 19 · 3:25](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-17-9803?t=205)
- "The Pakistani stoma reversal trial aimed to compare surgical site infections and cosmetic outcomes of scars in patients receiving purse-string or linear skin closure techniques." — Lizzie Lee (host_summary) [Ep 19 · 3:35](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-17-9803?t=215)
- "The purse-string closure group had way fewer surgical site infections compared to the linear closure group for stoma reversal." — Lizzie Lee (host_summary) [Ep 19 · 3:44](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-17-9803?t=224)
- "The purse-string closure group had much better scar quality compared to the linear closure group for stoma reversal." — Lizzie Lee (host_summary) [Ep 19 · 3:44](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-17-9803?t=224)
- "When reversing a stoma, purse-string closure technique is the best way to do it." — Lizzie Lee (opinion) [Ep 19 · 3:52](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-17-9803?t=232)
- "The green telepresence system from Stanford Research Institute was originally designed as an open surgical platform, not for minimally invasive surgery." — Marc Michalsky (clinical) [Ep 25 · 7:56](https://qa.library.globalcastmd.com/watch/dr-marc-michalsky-pediatric-robotic-assisted-surgery-developing-a-programmatic-paradigm-11169?t=476)
- "Colonel Rick Satava had an 'aha moment' after seeing Jacques Marescaux's laparoscopic cholecystectomy video, leading him to propose marrying robotic and laparoscopic technologies." — Marc Michalsky (clinical) [Ep 25 · 8:34](https://qa.library.globalcastmd.com/watch/dr-marc-michalsky-pediatric-robotic-assisted-surgery-developing-a-programmatic-paradigm-11169?t=514)
- "Computer Motion's 5mm instruments were sunsetted by Intuitive after acquisition, creating a persistent gap for pediatric applications." — Marc Michalsky (clinical) [Ep 25 · 13:09](https://qa.library.globalcastmd.com/watch/dr-marc-michalsky-pediatric-robotic-assisted-surgery-developing-a-programmatic-paradigm-11169?t=789)
- "The transition from da Vinci SI to XI was transformational, creating much more flexible range of motion." — Marc Michalsky (clinical) [Ep 25 · 12:20](https://qa.library.globalcastmd.com/watch/dr-marc-michalsky-pediatric-robotic-assisted-surgery-developing-a-programmatic-paradigm-11169?t=740)
- "One large children's hospital acquired a robot without planning; it sat unused for 18 months costing $25,000/month in maintenance." — Marc Michalsky (clinical) [Ep 25 · 22:12](https://qa.library.globalcastmd.com/watch/dr-marc-michalsky-pediatric-robotic-assisted-surgery-developing-a-programmatic-paradigm-11169?t=1332)
- "Nationwide formed a steering committee with pediatric surgery, urology, anesthesia, nursing, and periop administration to develop integrated multidisciplinary program." — Marc Michalsky (clinical) [Ep 25 · 23:14](https://qa.library.globalcastmd.com/watch/dr-marc-michalsky-pediatric-robotic-assisted-surgery-developing-a-programmatic-paradigm-11169?t=1394)
- "Robotic cases garner a higher facility charge (level 5, ~$4000 per 15 minutes) versus laparoscopic cases (level 3, ~$2200 per 15 minutes)." — Marc Michalsky (clinical) [Ep 25 · 60:27](https://qa.library.globalcastmd.com/watch/dr-marc-michalsky-pediatric-robotic-assisted-surgery-developing-a-programmatic-paradigm-11169?t=3627)
- "Nationwide has seen no insurance denials for robotic pre-certification and no patient reports of astronomical bills or surcharges attributed to robot use." — Marc Michalsky (clinical) [Ep 25 · 61:21](https://qa.library.globalcastmd.com/watch/dr-marc-michalsky-pediatric-robotic-assisted-surgery-developing-a-programmatic-paradigm-11169?t=3681)
- "Maintenance of certification requires at least 10 robotic cases over a 2-year credentialing cycle plus mandatory quarterly digital simulation." — Marc Michalsky (guideline) [Ep 25 · 30:19](https://qa.library.globalcastmd.com/watch/dr-marc-michalsky-pediatric-robotic-assisted-surgery-developing-a-programmatic-paradigm-11169?t=1819)
- "Block time overlay system assigns automated robot availability on top of surgeons' existing block time, with 14-day release mechanism if unused." — Marc Michalsky (clinical) [Ep 25 · 32:20](https://qa.library.globalcastmd.com/watch/dr-marc-michalsky-pediatric-robotic-assisted-surgery-developing-a-programmatic-paradigm-11169?t=1940)
- "Using longer 'bariatric' instruments spreads out the robot above the patient and reduces likelihood of external arm collisions, even in smaller children." — Marc Michalsky (clinical) [Ep 25 · 34:36](https://qa.library.globalcastmd.com/watch/dr-marc-michalsky-pediatric-robotic-assisted-surgery-developing-a-programmatic-paradigm-11169?t=2076)
- "In Nationwide's experience of ~1000 patients, 12% of robotic cases were performed on patients less than 15kg, primarily driven by urology." — Marc Michalsky (epidemiological) [Ep 25 · 35:29](https://qa.library.globalcastmd.com/watch/dr-marc-michalsky-pediatric-robotic-assisted-surgery-developing-a-programmatic-paradigm-11169?t=2129)
- "No difference in operating time, 30-day complications, or readmissions for sleeve gastrectomy above versus below BMI 50." — Marc Michalsky (clinical) [Ep 25 · 36:43](https://qa.library.globalcastmd.com/watch/dr-marc-michalsky-pediatric-robotic-assisted-surgery-developing-a-programmatic-paradigm-11169?t=2203)
- "Learning curve for robotic sleeve gastrectomy decreased from 132 minutes with SI to 36 minutes with XI; speaker has performed cases in 21 minutes." — Marc Michalsky (clinical) [Ep 25 · 41:44](https://qa.library.globalcastmd.com/watch/dr-marc-michalsky-pediatric-robotic-assisted-surgery-developing-a-programmatic-paradigm-11169?t=2504)
- "Robotic sleeve gastrectomy initially took 30 minutes longer than laparoscopic but patients were discharged earlier." — Marc Michalsky (clinical) [Ep 25 · 41:07](https://qa.library.globalcastmd.com/watch/dr-marc-michalsky-pediatric-robotic-assisted-surgery-developing-a-programmatic-paradigm-11169?t=2467)
- "No difference in time or complications for robotic acute cholecystitis versus elective cholecystectomy." — Marc Michalsky (clinical) [Ep 25 · 43:51](https://qa.library.globalcastmd.com/watch/dr-marc-michalsky-pediatric-robotic-assisted-surgery-developing-a-programmatic-paradigm-11169?t=2631)
- "Robotic surgery experience has made the speaker a better laparoscopic surgeon, particularly for intracorporeal knot tying." — Marc Michalsky (opinion) [Ep 25 · 44:29](https://qa.library.globalcastmd.com/watch/dr-marc-michalsky-pediatric-robotic-assisted-surgery-developing-a-programmatic-paradigm-11169?t=2669)
- "Intuitive has 4 pediatric surgeons working for it, including James Wall, all with Stanford/Palo Alto connections." — Marc Michalsky (clinical) [Ep 25 · 58:25](https://qa.library.globalcastmd.com/watch/dr-marc-michalsky-pediatric-robotic-assisted-surgery-developing-a-programmatic-paradigm-11169?t=3505)
- "Intuitive is working with FDA to reconfigure clearance from specific case indications to categories, which will include pediatrics." — Marc Michalsky (clinical) [Ep 25 · 58:25](https://qa.library.globalcastmd.com/watch/dr-marc-michalsky-pediatric-robotic-assisted-surgery-developing-a-programmatic-paradigm-11169?t=3505)
- "Carl Storz platform has 5mm instrumentation and strong interest in pediatric applications." — Marc Michalsky (clinical) [Ep 25 · 59:07](https://qa.library.globalcastmd.com/watch/dr-marc-michalsky-pediatric-robotic-assisted-surgery-developing-a-programmatic-paradigm-11169?t=3547)
- "Intuitive will not build a pediatric-specific robot as it would require ~$1 billion investment without adequate ROI." — Marc Michalsky (opinion) [Ep 25 · 59:17](https://qa.library.globalcastmd.com/watch/dr-marc-michalsky-pediatric-robotic-assisted-surgery-developing-a-programmatic-paradigm-11169?t=3557)
- "Fellow credentialing requires 10 bedside assists and 20 console cases as primary surgeon, plus skills/drills and certificate completion." — Marc Michalsky (guideline) [Ep 25 · 62:42](https://qa.library.globalcastmd.com/watch/dr-marc-michalsky-pediatric-robotic-assisted-surgery-developing-a-programmatic-paradigm-11169?t=3762)
- "Hopkins performed a robotic cholecystectomy in a pig cadaver model with effectively no human input earlier this summer." — Marc Michalsky (clinical) [Ep 25 · 55:30](https://qa.library.globalcastmd.com/watch/dr-marc-michalsky-pediatric-robotic-assisted-surgery-developing-a-programmatic-paradigm-11169?t=3330)
- "J&J has partnership with Google for metadata power to develop digital overlay systems incorporating axial imaging into robotic view." — Marc Michalsky (clinical) [Ep 25 · 64:45](https://qa.library.globalcastmd.com/watch/dr-marc-michalsky-pediatric-robotic-assisted-surgery-developing-a-programmatic-paradigm-11169?t=3885)
- "Dr. Clatworthy was the first pediatric surgeon in Ohio, trained by Dr. Gross at Boston Children's, and became first surgeon-in-chief at Columbus Children's Hospital." — Marc Michalsky (host_summary) [Ep 25 · 4:32](https://qa.library.globalcastmd.com/watch/dr-marc-michalsky-pediatric-robotic-assisted-surgery-developing-a-programmatic-paradigm-11169?t=272)
- "Teen-LABS data at 10 years shows effectively no difference in outcomes between Roux-en-Y gastric bypass and sleeve gastrectomy." — Marc Michalsky (host_summary) [Ep 25 · 39:10](https://qa.library.globalcastmd.com/watch/dr-marc-michalsky-pediatric-robotic-assisted-surgery-developing-a-programmatic-paradigm-11169?t=2350)
- "EA/TEF is a basic concept in pediatric surgery." — Jill Knepprath (opinion) [Ep 27 · 0:05](https://qa.library.globalcastmd.com/watch/esophageal-atresia-tracheoesophageal-fistula-types-explained-for-pediatric-surgery-14001?t=5)
- "In normal anatomy, the esophagus goes straight down to the stomach with no atresia or interruptions, and the trachea goes straight down to the lungs with no connections between the two." — Jill Knepprath (clinical) [Ep 27 · 0:10](https://qa.library.globalcastmd.com/watch/esophageal-atresia-tracheoesophageal-fistula-types-explained-for-pediatric-surgery-14001?t=10)
- "Type A EA/TEF consists of esophageal atresia proximally and distally in the esophagus, preventing solids and liquids from reaching the stomach, with no connection between esophagus and trachea." — Jill Knepprath (clinical) [Ep 27 · 0:29](https://qa.library.globalcastmd.com/watch/esophageal-atresia-tracheoesophageal-fistula-types-explained-for-pediatric-surgery-14001?t=29)
- "Type B EA/TEF has distal esophageal atresia and a proximal fistula, allowing solids and liquids to enter the trachea while the stomach remains empty." — Jill Knepprath (clinical) [Ep 27 · 0:45](https://qa.library.globalcastmd.com/watch/esophageal-atresia-tracheoesophageal-fistula-types-explained-for-pediatric-surgery-14001?t=45)
- "Type C EA/TEF is the most common type." — Jill Knepprath (epidemiological) [Ep 27 · 1:08](https://qa.library.globalcastmd.com/watch/esophageal-atresia-tracheoesophageal-fistula-types-explained-for-pediatric-surgery-14001?t=68)
- "Type C EA/TEF has proximal esophageal atresia and a distal fistula, allowing air to reach both lungs and stomach while solids and liquids cannot reach the stomach." — Jill Knepprath (clinical) [Ep 27 · 1:13](https://qa.library.globalcastmd.com/watch/esophageal-atresia-tracheoesophageal-fistula-types-explained-for-pediatric-surgery-14001?t=73)
- "Type D EA/TEF has both a distal fistula and a proximal fistula, allowing solids and liquids into the trachea and air into both lungs and stomach." — Jill Knepprath (clinical) [Ep 27 · 1:28](https://qa.library.globalcastmd.com/watch/esophageal-atresia-tracheoesophageal-fistula-types-explained-for-pediatric-surgery-14001?t=88)
- "Type E EA/TEF has no atresia but does have a tracheoesophageal fistula, which is often pretty high." — Jill Knepprath (clinical) [Ep 27 · 1:43](https://qa.library.globalcastmd.com/watch/esophageal-atresia-tracheoesophageal-fistula-types-explained-for-pediatric-surgery-14001?t=103)
- "Type E EA/TEF is also known as H-type because of its anatomical appearance." — Jill Knepprath (clinical) [Ep 27 · 1:52](https://qa.library.globalcastmd.com/watch/esophageal-atresia-tracheoesophageal-fistula-types-explained-for-pediatric-surgery-14001?t=112)
- "Type E (H-type) EA/TEF has the best results and is usually the easiest to fix." — Jill Knepprath (clinical) [Ep 27 · 1:56](https://qa.library.globalcastmd.com/watch/esophageal-atresia-tracheoesophageal-fistula-types-explained-for-pediatric-surgery-14001?t=116)
- "Children with Type E (H-type) EA/TEF may present with symptoms later because they are still able to get solids and liquids down to the stomach and air to the lungs." — Jill Knepprath (clinical) [Ep 27 · 2:01](https://qa.library.globalcastmd.com/watch/esophageal-atresia-tracheoesophageal-fistula-types-explained-for-pediatric-surgery-14001?t=121)
- "TEF is a defining procedure of pediatric surgery with challenges including long gap atresia, recurrent fistulas, and strictures" (host_summary) [Ep 8 · 0:00](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=0)
- "Cincinnati Children's has a multidisciplinary aerodigestive center including ENT airway surgeons, GI, pulmonary, general surgeons, nurse practitioners, geneticists, and dietitians" — Daniel von Allmen (clinical) [Ep 8 · 2:01](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=121)
- "The aerodigestive center typically receives more complicated patients referred from outside through either esophageal or airway arms" — Daniel von Allmen (clinical) [Ep 8 · 2:46](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=166)
- "Physical examination should assess for scaphoid versus full or distended abdomen and respiratory distress" — Daniel von Allmen (clinical) [Ep 8 · 3:55](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=235)
- "The surgeon should personally attempt to pass the NG tube rather than relying on nursing reports, as tubes reported as not passing sometimes pass easily" — Daniel von Allmen (clinical) [Ep 8 · 4:20](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=260)
- "Injecting air into the NG tube and obtaining a plain film helps visualize proximal pouch distention and assess distal GI gas pattern" — Daniel von Allmen (clinical) [Ep 8 · 4:55](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=295)
- "Lack of visible distended proximal pouch raises concern for either incorrect diagnosis or presence of proximal fistula allowing pouch decompression" — Daniel von Allmen (clinical) [Ep 8 · 5:01](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=301)
- "Contrast studies can be performed if there is high suspicion of unusual anatomy, as long as the radiologist knows the esophagus may be obstructed" — Daniel von Allmen (clinical) [Ep 8 · 5:42](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=342)
- "Echocardiogram is the most important preoperative study to assess cardiac anatomy and rule out right-sided aortic arch" — Daniel von Allmen (clinical) [Ep 8 · 6:25](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=385)
- "Renal ultrasound and spine evaluation for tethered cord are needed but are elective and not necessary before addressing esophageal atresia" — Daniel von Allmen (clinical) [Ep 8 · 6:54](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=414)
- "Conventional wisdom is to perform left thoracotomy for right-sided aortic arch" — Daniel von Allmen (guideline) [Ep 8 · 7:27](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=447)
- "Left thoracotomy for right-sided arch is somewhat more difficult with the heart more in the way and harder proximal pouch mobilization" — Daniel von Allmen (clinical) [Ep 8 · 7:51](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=471)
- "It is possible to complete the repair from the right side if right-sided arch is discovered intraoperatively, though some reports suggest higher incidence of swallowing problems" — Daniel von Allmen (clinical) [Ep 8 · 8:20](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=500)
- "In a stable larger baby not intubated, it is reasonable to wait until all resources are available in the middle of the day, even waiting 1-2 days" — Daniel von Allmen (clinical) [Ep 8 · 9:31](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=571)
- "Should not wait a long time before repair due to risk of colonizing GI tract and soiling lungs" — Daniel von Allmen (clinical) [Ep 8 · 9:56](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=596)
- "Oscillator ventilation does not make a significant difference in managing large fistulas with abdominal distention" — Daniel von Allmen (opinion) [Ep 8 · 10:15](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=615)
- "Large fistula with distention tends to be a bigger problem in more premature infants with significant lung disease, where poor lung compliance drives air into GI tract" — Daniel von Allmen (clinical) [Ep 8 · 10:15](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=615)
- "Treating with surfactant and improving lung compliance helps as much as changing ventilator type" — Daniel von Allmen (clinical) [Ep 8 · 10:56](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=656)
- "Risk of waiting too long to make a decision in worsening distention can lead to emergency situation where child cannot be ventilated" — Daniel von Allmen (clinical) [Ep 8 · 11:21](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=681)
- "For reasonably stable but worsening distention, would take child urgently to OR for right thoracotomy and fistula ligation" — Daniel von Allmen (clinical) [Ep 8 · 12:00](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=720)
- "Bronchoscopic Fogarty balloon placement sounds good but is difficult unless expertise and equipment are immediately available" — Daniel von Allmen (opinion) [Ep 8 · 12:00](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=720)
- "G-tube decompression may paradoxically worsen ventilation by making stomach lower resistance, allowing more air to go there instead of lungs" — Daniel von Allmen (clinical) [Ep 8 · 12:00](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=720)
- "Laparotomy with vessel loop around esophagogastric junction at hiatus with gentle traction (Rommel tourniquet technique) can temporize severe cases, leaving in place for several days before definitive repair" — Daniel von Allmen (clinical) [Ep 8 · 12:50](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=770)
- "For associated duodenal atresia in stable child, would potentially fix duodenal atresia first to avoid fixing esophagus upstream from obstruction" — Daniel von Allmen (clinical) [Ep 8 · 13:36](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=816)
- "Both duodenal and esophageal atresia could potentially be fixed at same time if child is old enough and stable enough" — Daniel von Allmen (clinical) [Ep 8 · 14:05](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=845)
- "Von Allmen changed practice to always perform intraoperative bronchoscopy after exposure to Cincinnati's complex patient population" — Daniel von Allmen (clinical) [Ep 8 · 14:35](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=875)
- "Bronchoscopy documents fistula location, assesses for proximal fistula, and most importantly rules out laryngeal cleft which is easily missed" — Daniel von Allmen (clinical) [Ep 8 · 14:35](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=875)
- "Many referred patients with multiple thoracotomies never had bronchoscopy and actually have laryngeal cleft" — Daniel von Allmen (clinical) [Ep 8 · 14:35](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=875)
- "Second fistula occurs in approximately 1% of cases and can be very difficult to diagnose" — Daniel von Allmen (epidemiological) [Ep 8 · 15:35](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=935)
- "High fistulas can range from trifurcation of carina (suggesting difficulty getting ends together) to very high fistulas potentially approachable through neck" — Daniel von Allmen (clinical) [Ep 8 · 15:52](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=952)
- "Bronchoscopy allows guidance of ET tube placement by anesthesiologist based on fistula location" — Daniel von Allmen (clinical) [Ep 8 · 16:35](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=995)
- "For fistula at carina (trifurcation), ET tube should be placed higher as it cannot pass the fistula; for high fistula, tube should be placed distal to fistula but not into the fistula itself" — Daniel von Allmen (clinical) [Ep 8 · 16:35](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=995)
- "Extrapleural approach offers advantage of potentially limiting soilage of pleural space if there is postoperative leak" — Daniel von Allmen (clinical) [Ep 8 · 17:19](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=1039)
- "Dividing azygos has no morbidity, gives better access, and frequently guides to the fistula" — Daniel von Allmen (clinical) [Ep 8 · 17:41](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=1061)
- "Open azygos division is done by ligation and division; thoracoscopically can use energy devices or clips" — Daniel von Allmen (clinical) [Ep 8 · 17:59](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=1079)
- "Hook cautery can safely divide vessels if done slowly going up and down to ensure coagulation, learned from robotic Nissen experience dividing short gastrics" — Daniel von Allmen (clinical) [Ep 8 · 18:51](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=1131)
- "3mm surgical sealer is ideal device for this size patient and vessel" — Daniel von Allmen (opinion) [Ep 8 · 18:51](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=1131)
- "Spreading heel of right angle on ribs nicely shows extrapleural plane when going through intercostal muscles" — Daniel von Allmen (clinical) [Ep 8 · 19:35](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=1175)
- "Important to mobilize pleura up around apex of lung to have access for proximal pouch mobilization" — Daniel von Allmen (clinical) [Ep 8 · 19:35](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=1175)
- "After azygos division, identify distal esophagus and control with vessel loop, then dissect proximally to identify fistula site" — Daniel von Allmen (clinical) [Ep 8 · 19:35](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=1175)
- "Muscle-sparing thoracotomy can make exposure more difficult; has not seen significant morbidity from standard posterolateral thoracotomy" — Daniel von Allmen (opinion) [Ep 8 · 20:28](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=1228)
- "Standard teaching has been not to mobilize distal esophagus, but can actually mobilize it significantly especially laterally all the way to diaphragm" — Daniel von Allmen (clinical) [Ep 8 · 21:10](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=1270)
- "Must be careful with medial mobilization of distal esophagus due to blood supply concerns" — Daniel von Allmen (clinical) [Ep 8 · 21:10](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=1270)
- "Extensive proximal pouch mobilization gives the most length to get ends together" — Daniel von Allmen (clinical) [Ep 8 · 21:10](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=1270)
- "Thoracoscopic approach advantage is clearer visualization for proximal pouch mobilization" — Daniel von Allmen (opinion) [Ep 8 · 21:10](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=1270)
- "Proximal pouch dissection is similar to separating rectum and vagina - making two planes out of one without great natural separation" — Todd Ponsky (clinical) [Ep 8 · 22:03](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=1323)
- "Risk of entering trachea during proximal dissection; must be very careful using blade cautery with light buzz and mostly blunt dissection with flat end of blade" — Daniel von Allmen (clinical) [Ep 8 · 22:20](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=1340)
- "Better to be in esophagus than trachea during high chest dissection; esophagus is thickened from obstruction" — Daniel von Allmen (clinical) [Ep 8 · 22:20](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=1340)
- "For significant tracheal defect, could perform sleeve resection as trachea is incredibly mobile, then place pericardium or autologous tissue between trachea and esophageal repair" — Daniel von Allmen (clinical) [Ep 8 · 23:01](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=1381)
- "Personal preference is 5-0 PDS - absorbable monofilament suture; not a fan of silk" — Daniel von Allmen (opinion) [Ep 8 · 23:59](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=1439)
- "Not a fan of myotomies as they potentially create even more dysfunctional esophageal segment; motility is already clearly abnormal in esophageal atresia" — Daniel von Allmen (opinion) [Ep 8 · 24:42](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=1482)
- "For cases too tight for primary repair, would ligate ends, tack both on tension to prevertebral fascia, close, let patient grow for couple weeks, then return to put together" — Daniel von Allmen (clinical) [Ep 8 · 24:42](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=1482)
- "Traction or pressure is very strong stimulus to growth throughout cardiovascular system and lungs" — Daniel von Allmen (clinical) [Ep 8 · 25:38](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=1538)
- "For thoracoscopic approach, can place traction sutures in proximal and distal ends brought out through crossed trocar sites with tension, allowing return within a week for anastomosis" — Daniel von Allmen (clinical) [Ep 8 · 26:10](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=1570)
- "Would not do classic Foker technique with prolonged paralysis and sequential suture tensioning" — Daniel von Allmen (opinion) [Ep 8 · 26:10](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=1570)
- "Rusty Jennings and Foker published series in JPS showing 98% success getting ends together in primary atresia versus only 67% in secondary approaches after previous surgeries" — Daniel von Allmen (epidemiological) [Ep 8 · 27:38](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=1658)
- "Foker technique requires patients intubated and paralyzed spending weeks in ICU, which is probably worth it if you get good result" — Daniel von Allmen (clinical) [Ep 8 · 27:38](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=1658)
- "For thoracoscopic procedure, rotate patient past 90 degrees to allow gravity to move lungs out of way" — Daniel von Allmen (clinical) [Ep 8 · 29:18](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=1758)
- "Standard port placement: camera in center, posterior port inferiorly, anterior port superiorly" — Daniel von Allmen (clinical) [Ep 8 · 29:18](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=1758)
- "Uses 3mm instruments for thoracoscopic TEF repair" — Daniel von Allmen (clinical) [Ep 8 · 29:52](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=1792)
- "Important to do same quality operation thoracoscopically as would do open" — Daniel von Allmen (opinion) [Ep 8 · 30:10](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=1810)
- "Sewing the anastomosis is one of the challenges with thoracoscopic TEF repair and requires most experience with minimally invasive techniques" — Daniel von Allmen (clinical) [Ep 8 · 30:10](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=1810)
- "Would use clips for dividing fistula thoracoscopically, less worried about them falling off esophagus than blood vessel" — Daniel von Allmen (opinion) [Ep 8 · 30:10](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=1810)
- "Thoracoscopic visualization is very helpful for mobilizing proximal pouch" — Daniel von Allmen (opinion) [Ep 8 · 30:10](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=1810)
- "Simulation courses for TEF repair will be great advantage for trainees as these cases are not done often enough to get practice" — Daniel von Allmen (opinion) [Ep 8 · 30:10](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=1810)
- "Marcelo Martinez Ferro's 'spaghetti trick' - grabbing and twirling tip of proximal pouch shows the dissection plane nicely" — Todd Ponsky (clinical) [Ep 8 · 31:21](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=1881)
- "Atlanta group uses stay stitch between two ends brought out of chest to hold anastomosis up for subsequent stitches, similar to duodenal atresia technique" — Daniel von Allmen (host_summary) [Ep 8 · 31:37](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=1897)
- "Vicryl ties down nice and tight but cannot use knot pusher for first stitch under tension as it will tear through esophagus; need monofilament for extracorporeal knots" — Todd Ponsky (clinical) [Ep 8 · 32:10](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=1930)
- "Braided suture is safe for all intracorporeal technique" — Todd Ponsky (clinical) [Ep 8 · 32:10](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=1930)
- "After clipping fistula, do not divide it completely until ready to place first stitch so distal esophagus doesn't drop toward diaphragm" — Todd Ponsky (clinical) [Ep 8 · 32:45](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=1965)
- "Hanging stitch helps let go of some tension as first couple stitches are placed, providing some degree of approximation before throwing down first stitches" — Avi Schlager (clinical) [Ep 8 · 33:21](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=2001)
- "Must be able to see and incorporate mucosa on every stitch; hanging stitch helps visualize lumen of both proximal and distal ends" — Todd Ponsky (clinical) [Ep 8 · 33:54](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=2034)
- "Thoracoscopic ventilation management depends more on anesthesiologist than ventilator type; need anesthesiologist comfortable with procedure who pays attention during operation" — Daniel von Allmen (clinical) [Ep 8 · 34:30](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=2070)
- "Can position ET tube after bronchoscopy to selectively ventilate left lung" — Todd Ponsky (clinical) [Ep 8 · 34:48](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=2088)
- "Little CO2 insufflation with some time will collapse lung as long as anesthesiologist isn't fighting with positive pressure" — Daniel von Allmen (clinical) [Ep 8 · 35:20](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=2120)
- "Anesthesiologists can get scared seeing initial shunting but things settle down if they wait" — Daniel von Allmen (clinical) [Ep 8 · 35:20](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=2120)
- "Concern about reintubation exists, but equally concerned that positive pressure puts pressure on tracheal repair" — Daniel von Allmen (clinical) [Ep 8 · 36:05](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=2165)
- "Prefer spontaneous breathing with negative pressure in trachea rather than positive pressure" — Daniel von Allmen (opinion) [Ep 8 · 36:05](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=2165)
- "If patient had good lung function preoperatively and operation went smoothly, advocate extubating as soon as possible, even conceivably in operating room" — Daniel von Allmen (clinical) [Ep 8 · 36:05](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=2165)
- "Gets contrast study at 5-7 days before pulling chest drain, timing depends on avoiding weekends" — Daniel von Allmen (clinical) [Ep 8 · 36:35](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=2195)
- "Uses small TLS drain rather than formal chest tube, especially for open extrapleural approach" — Daniel von Allmen (clinical) [Ep 8 · 36:35](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=2195)
- "Does not use transanastomotic tube based on Midwest Pediatric Surgical Consortium study showing much higher stricture and leak rate with transanastomotic tubes" — Daniel von Allmen (clinical) [Ep 8 · 37:20](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=2240)
- "Midwest consortium study was presented at APSA and should be published in JPS soon" — Daniel von Allmen (clinical) [Ep 8 · 37:37](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=2257)
- "Unless incredibly tight stricture risking complete obstruction, would wait several weeks before first dilation" — Daniel von Allmen (clinical) [Ep 8 · 37:55](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=2275)
- "Always appears to be narrowing at anastomosis because proximal pouch is dilated; as long as patent with free contrast flow distally, would hold off on dilation" — Daniel von Allmen (clinical) [Ep 8 · 37:55](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=2275)
- "Fairly aggressive with dilations: dilate, wait 1-2 weeks, restudy, potentially dilate again" — Daniel von Allmen (clinical) [Ep 8 · 38:23](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=2303)
- "Huge spectrum from very tight strictures requiring many dilations to kids fine after one dilation" — Daniel von Allmen (clinical) [Ep 8 · 38:23](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=2303)
- "If case goes well and post-op study looks great, does not get routine follow-up esophagrams; studies based on clinical symptoms suggesting stricture" — Daniel von Allmen (clinical) [Ep 8 · 38:23](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=2303)
- "Balloon or radial dilation is less traumatic for tissue than bougie dilators" — Daniel von Allmen (clinical) [Ep 8 · 39:19](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=2359)
- "Dilations done with GI colleagues in aerodigestive center for bigger kids or with interventional radiologists" — Daniel von Allmen (clinical) [Ep 8 · 39:19](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=2359)
- "For small leak with child not sick, would absolutely wait and do nothing, leaving drain in; vast majority close" — Daniel von Allmen (clinical) [Ep 8 · 39:51](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=2391)
- "Leak increases risk of postoperative stricture" — Todd Ponsky (clinical) [Ep 8 · 40:04](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=2404)
- "Would only go to OR for leak if child getting sicker, wide open leak, or large uncontrollable pneumothorax" — Daniel von Allmen (clinical) [Ep 8 · 40:09](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=2409)
- "Even reasonably significant leaks will heal, then can deal with stricture postoperatively" — Daniel von Allmen (clinical) [Ep 8 · 40:09](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=2409)
- "Usually waits one week between esophagrams for leak; if child continues to do well, restudies" — Daniel von Allmen (clinical) [Ep 8 · 40:34](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=2434)
- "Sometimes little outpouching where leak happened makes it unclear if still leaking; if nothing from tube and nothing goes further, leak probably healed and would remove tube" — Daniel von Allmen (clinical) [Ep 8 · 40:34](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=2434)
- "Pediatric surgeons don't do fantastic job of long-term follow-up with TEF patients" — Todd Ponsky (opinion) [Ep 8 · 41:09](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=2469)
- "International esophageal atresia meeting occurs every 2 years and is multidisciplinary including patients" — Daniel von Allmen (clinical) [Ep 8 · 41:19](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=2479)
- "Patients in their 20s-40s at international meeting discuss long-term issues; surgeons tend to follow until eating well or age 18 then never see them again" — Daniel von Allmen (clinical) [Ep 8 · 41:19](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=2479)
- "Have a lot to learn about long-term complications; personally follows patients for at least couple years which is probably not long enough" — Daniel von Allmen (opinion) [Ep 8 · 41:19](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=2479)
- "Biggest challenges in long-term follow-up are reflux and recurrent strictures" — Daniel von Allmen (clinical) [Ep 8 · 42:15](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=2535)
- "More concerning are patients with ongoing reflux due to unknown long-term impact on Barrett's esophagus and potential malignant change" — Daniel von Allmen (clinical) [Ep 8 · 42:15](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=2535)
- "If patient has stricture dilated 2-3 times, next move would be to address reflux" — Daniel von Allmen (clinical) [Ep 8 · 42:45](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=2565)
- "Most patients left on anti-reflux medications when discharged from hospital" — Daniel von Allmen (clinical) [Ep 8 · 42:45](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=2565)
- "Virtually all patients have some degree of gastroesophageal reflux" — Daniel von Allmen (clinical) [Ep 8 · 42:45](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=2565)
- "Very aggressive about fundoplication for strictures not responsive to dilations (dilates easily then restrictures)" — Daniel von Allmen (clinical) [Ep 8 · 42:45](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=2565)
- "Does Nissen fundoplication in patients with poor esophageal motility but makes them loose and short, using 2 or at most 3 stitches" — Daniel von Allmen (clinical) [Ep 8 · 43:26](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=2606)
- "For pure esophageal atresia, approach is G-tube placement with calibration of gap length using distal catheter pushed up and NG tube in proximal pouch" — Daniel von Allmen (clinical) [Ep 8 · 43:26](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=2606)
- "Would wait 4-6 weeks to see how close ends come together, then attempt primary repair once within 2 vertebral bodies" — Daniel von Allmen (clinical) [Ep 8 · 43:26](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=2606)
- "The first successful open repair of tracheoesophageal fistula was performed in 1941 by Dr. Cameron Haight." — Alex Gibbons (host_summary) [Ep 2 · 1:24](https://qa.library.globalcastmd.com/watch/thoracoscopic-tef-repair-is-it-really-better-than-open-update-course-2018-356?t=84)
- "In the year 2000, Dr. Steven Rothenberg performed the first successful repair of a tracheoesophageal fistula with a minimally invasive approach (esophageal atresia had been the year before)." — Alex Gibbons (host_summary) [Ep 2 · 1:46](https://qa.library.globalcastmd.com/watch/thoracoscopic-tef-repair-is-it-really-better-than-open-update-course-2018-356?t=106)
- "In Rothenberg's first decade of experience with 62 patients, he reported that thoracoscopic approach offered better visualization of the anatomy." — Alex Gibbons (host_summary) [Ep 2 · 2:10](https://qa.library.globalcastmd.com/watch/thoracoscopic-tef-repair-is-it-really-better-than-open-update-course-2018-356?t=130)
- "Rothenberg reported that performing the operation entirely in situ reduced manipulation of the trachea and therefore potentially reduced risk for tracheomalacia." — Alex Gibbons (host_summary) [Ep 2 · 2:40](https://qa.library.globalcastmd.com/watch/thoracoscopic-tef-repair-is-it-really-better-than-open-update-course-2018-356?t=160)
- "Rothenberg reported decreased tension on the esophageal anastomosis with thoracoscopic approach." — Alex Gibbons (host_summary) [Ep 2 · 3:00](https://qa.library.globalcastmd.com/watch/thoracoscopic-tef-repair-is-it-really-better-than-open-update-course-2018-356?t=180)
- "Rothenberg reported that smaller incisions would result in fewer musculoskeletal deformities such as scapular winging, chest wall asymmetry, and scoliosis." — Alex Gibbons (host_summary) [Ep 2 · 3:10](https://qa.library.globalcastmd.com/watch/thoracoscopic-tef-repair-is-it-really-better-than-open-update-course-2018-356?t=190)
- "The Tübingen Germany single-center study found the minimally invasive group was slightly larger at about 2,700g compared to 2,100g in the open group." — Alex Gibbons (host_summary) [Ep 2 · 4:00](https://qa.library.globalcastmd.com/watch/thoracoscopic-tef-repair-is-it-really-better-than-open-update-course-2018-356?t=240)
- "The Tübingen study found slightly more associated anomalies in the minimally invasive group at about 40% compared to 31% in the open group." — Alex Gibbons (host_summary) [Ep 2 · 4:30](https://qa.library.globalcastmd.com/watch/thoracoscopic-tef-repair-is-it-really-better-than-open-update-course-2018-356?t=270)
- "The Tübingen study found no statistically significant difference between groups in complication rate or time to postoperative extubation." — Alex Gibbons (host_summary) [Ep 2 · 5:00](https://qa.library.globalcastmd.com/watch/thoracoscopic-tef-repair-is-it-really-better-than-open-update-course-2018-356?t=300)
- "The Tübingen study found operative time was slightly longer at about half an hour longer in the minimally invasive group than in the open group." — Alex Gibbons (host_summary) [Ep 2 · 5:15](https://qa.library.globalcastmd.com/watch/thoracoscopic-tef-repair-is-it-really-better-than-open-update-course-2018-356?t=315)
- "The Tübingen study found higher intraoperative PaCO2 in the MIS group, but postoperatively there was no statistically significant difference." — Alex Gibbons (host_summary) [Ep 2 · 5:30](https://qa.library.globalcastmd.com/watch/thoracoscopic-tef-repair-is-it-really-better-than-open-update-course-2018-356?t=330)
- "The Holcomb multi-center study included 6 hospitals (Stanford California, Kansas City Missouri, Denver Colorado, Buenos Aires Argentina, Utrecht Netherlands, and Hong Kong China) with 104 total patients." — Alex Gibbons (host_summary) [Ep 2 · 5:50](https://qa.library.globalcastmd.com/watch/thoracoscopic-tef-repair-is-it-really-better-than-open-update-course-2018-356?t=350)
- "The Holcomb study found results equivalent to historical open controls in mortality rate and need for postoperative fundoplication." — Alex Gibbons (host_summary) [Ep 2 · 6:30](https://qa.library.globalcastmd.com/watch/thoracoscopic-tef-repair-is-it-really-better-than-open-update-course-2018-356?t=390)
- "The Holcomb study found results compared favorably to historical controls in terms of leak and recurrence." — Alex Gibbons (host_summary) [Ep 2 · 6:45](https://qa.library.globalcastmd.com/watch/thoracoscopic-tef-repair-is-it-really-better-than-open-update-course-2018-356?t=405)
- "The Japanese multi-center study of 7 hospitals with 58 patients found equivalence in mortality, leak rate, and recurrence between MIS and open approaches." — Alex Gibbons (host_summary) [Ep 2 · 7:30](https://qa.library.globalcastmd.com/watch/thoracoscopic-tef-repair-is-it-really-better-than-open-update-course-2018-356?t=450)
- "The Japanese study found a higher stricture rate in the minimally invasive group at about 48% compared to 17% in the open group." — Alex Gibbons (host_summary) [Ep 2 · 7:50](https://qa.library.globalcastmd.com/watch/thoracoscopic-tef-repair-is-it-really-better-than-open-update-course-2018-356?t=470)
- "The Hanover Germany study of patients who had minimally invasive or open thoracic procedures for benign conditions found improved rate of mild scoliosis in MIS group: over 50% in thoracotomy group compared to less than 10% in minimally invasive group." — Alex Gibbons (host_summary) [Ep 2 · 9:00](https://qa.library.globalcastmd.com/watch/thoracoscopic-tef-repair-is-it-really-better-than-open-update-course-2018-356?t=540)
- "The Hanover study found patients were more satisfied with scarring in the MIS group based on Manchester scarring criteria." — Alex Gibbons (host_summary) [Ep 2 · 9:30](https://qa.library.globalcastmd.com/watch/thoracoscopic-tef-repair-is-it-really-better-than-open-update-course-2018-356?t=570)
- "The Hanover study found chest wall asymmetry was improved in the minimally invasive group, specifically in chest wall diameter and distance of nipple to xiphoid." — Alex Gibbons (host_summary) [Ep 2 · 9:40](https://qa.library.globalcastmd.com/watch/thoracoscopic-tef-repair-is-it-really-better-than-open-update-course-2018-356?t=580)
- "The Hanover study found no difference in shoulder range of motion between MIS and open groups." — Alex Gibbons (host_summary) [Ep 2 · 9:55](https://qa.library.globalcastmd.com/watch/thoracoscopic-tef-repair-is-it-really-better-than-open-update-course-2018-356?t=595)
- "A 2012 meta-analysis of 4 articles representing 166 patients (69 MIS, 97 open) found no statistically significant difference in stricture rate, leak rate, operative time, or time to postoperative extubation." — Alex Gibbons (host_summary) [Ep 2 · 10:10](https://qa.library.globalcastmd.com/watch/thoracoscopic-tef-repair-is-it-really-better-than-open-update-course-2018-356?t=610)
- "A 2016 meta-analysis of 8 articles with 452 patients (221 MIS, 231 open) found no difference in stricture rate or leak rate." — Alex Gibbons (host_summary) [Ep 2 · 10:35](https://qa.library.globalcastmd.com/watch/thoracoscopic-tef-repair-is-it-really-better-than-open-update-course-2018-356?t=635)
- "The 2016 meta-analysis found operative time was about 20 minutes longer in the minimally invasive group." — Alex Gibbons (host_summary) [Ep 2 · 10:50](https://qa.library.globalcastmd.com/watch/thoracoscopic-tef-repair-is-it-really-better-than-open-update-course-2018-356?t=650)
- "The 2016 meta-analysis found time to postoperative extubation and first postoperative feeding were about 2.5 days sooner in the MIS group." — Alex Gibbons (host_summary) [Ep 2 · 11:00](https://qa.library.globalcastmd.com/watch/thoracoscopic-tef-repair-is-it-really-better-than-open-update-course-2018-356?t=660)
- "The 2016 meta-analysis found hospital length of stay was almost 11 days shorter in the MIS group." — Alex Gibbons (host_summary) [Ep 2 · 11:15](https://qa.library.globalcastmd.com/watch/thoracoscopic-tef-repair-is-it-really-better-than-open-update-course-2018-356?t=675)
- "A pilot randomized controlled trial at Children's Hospital London with 10 patients (randomized to MIS or open) found no difference in intraoperative PaCO2, pH, time in OR, peak inspiratory pressure, or length of ICU stay." — Alex Gibbons (host_summary) [Ep 2 · 11:30](https://qa.library.globalcastmd.com/watch/thoracoscopic-tef-repair-is-it-really-better-than-open-update-course-2018-356?t=690)
- "The London pilot RCT found 1 stricture in the open group compared to 3 strictures in the thoracoscopic group, and 1 leak in the thoracoscopic group compared to none in the open group." — Alex Gibbons (host_summary) [Ep 2 · 12:00](https://qa.library.globalcastmd.com/watch/thoracoscopic-tef-repair-is-it-really-better-than-open-update-course-2018-356?t=720)
- "The retrospective data suggest no difference in leak rate or stricture rate between thoracoscopic and open TEF repair." — Alex Gibbons (clinical) [Ep 2 · 12:30](https://qa.library.globalcastmd.com/watch/thoracoscopic-tef-repair-is-it-really-better-than-open-update-course-2018-356?t=750)
- "There is potential benefit with thoracoscopic approach in time to extubation, time to first oral feeding, overall hospital length of stay, and musculoskeletal sequelae." — Alex Gibbons (opinion) [Ep 2 · 12:45](https://qa.library.globalcastmd.com/watch/thoracoscopic-tef-repair-is-it-really-better-than-open-update-course-2018-356?t=765)
- "The chief limitation of thoracoscopic TEF repair is the technical demand, specifically the challenge of the anastomosis done in situ." — Alex Gibbons (opinion) [Ep 2 · 13:00](https://qa.library.globalcastmd.com/watch/thoracoscopic-tef-repair-is-it-really-better-than-open-update-course-2018-356?t=780)
- "There remains a need for a powered randomized controlled trial comparing thoracoscopic and open TEF repair." — Alex Gibbons (opinion) [Ep 2 · 13:15](https://qa.library.globalcastmd.com/watch/thoracoscopic-tef-repair-is-it-really-better-than-open-update-course-2018-356?t=795)
- "The primary reason for doing thoracoscopic TEF repair is eliminating the thoracotomy and its associated morbidity." — Steven Rothenberg (opinion) [Ep 2 · 12:40](https://qa.library.globalcastmd.com/watch/thoracoscopic-tef-repair-is-it-really-better-than-open-update-course-2018-356?t=760)
- "No matter what kind of thoracotomy is performed, there is morbidity associated with having a thoracotomy as an infant." — Steven Rothenberg (opinion) [Ep 2 · 12:55](https://qa.library.globalcastmd.com/watch/thoracoscopic-tef-repair-is-it-really-better-than-open-update-course-2018-356?t=775)
- "A recent study from the Midwest Consortium of approximately 10 hospitals showed less than 15% of TEF cases were done thoracoscopically in major US training centers." — Steven Rothenberg (host_summary) [Ep 2 · 14:30](https://qa.library.globalcastmd.com/watch/thoracoscopic-tef-repair-is-it-really-better-than-open-update-course-2018-356?t=870)
- "In US training programs, fellows who are not as experienced as staff are being trained to do the TEF operation, making them perhaps the least experienced person in the operating room." (opinion) [Ep 2 · 15:30](https://qa.library.globalcastmd.com/watch/thoracoscopic-tef-repair-is-it-really-better-than-open-update-course-2018-356?t=930)
- "In the multi-center report from 13-14 years ago, the surgeons were very experienced in MIS, which contributed to the good results (3 recurrences in 104 patients)." (opinion) [Ep 2 · 16:10](https://qa.library.globalcastmd.com/watch/thoracoscopic-tef-repair-is-it-really-better-than-open-update-course-2018-356?t=970)
- "Thoracoscopic TEF repair requires surgeons who are skilled in MIS to perform it and pass that skill on to trainees." — Steven Rothenberg (opinion) [Ep 2 · 16:33](https://qa.library.globalcastmd.com/watch/thoracoscopic-tef-repair-is-it-really-better-than-open-update-course-2018-356?t=993)
- "Rothenberg reports he has never had to resect a diverticulum after thoracoscopic TEF repair, whereas he has had to resect a number of diverticulums that were all done open." — Steven Rothenberg (clinical) [Ep 2 · 17:50](https://qa.library.globalcastmd.com/watch/thoracoscopic-tef-repair-is-it-really-better-than-open-update-course-2018-356?t=1070)
- "Thoracoscopically, the fistula is seen coming in directly at 90 degrees perpendicular, which is not seen when the operation is done open." — Steven Rothenberg (clinical) [Ep 2 · 18:10](https://qa.library.globalcastmd.com/watch/thoracoscopic-tef-repair-is-it-really-better-than-open-update-course-2018-356?t=1090)
- "Less than half of esophageal atresia cases are detected antenatally, typically by small stomach and polyhydramnios." (epidemiological) [Ep 4 · 1:00](https://qa.library.globalcastmd.com/watch/esophageal-atresia-627?t=60)
- "Echocardiography is performed preoperatively to rule out congenital heart defects and determine aortic arch sidedness (right vs. left)." (clinical) [Ep 4 · 2:12](https://qa.library.globalcastmd.com/watch/esophageal-atresia-627?t=132)
- "VACTERL workup (renal ultrasound, vertebral X-rays, anorectal exam) can be completed electively after initial repair." (clinical) [Ep 4 · 2:31](https://qa.library.globalcastmd.com/watch/esophageal-atresia-627?t=151)
- "Right-sided aortic arch does not necessarily require left thoracotomy; multiple surgeons report successful repairs from the right side despite right arch." (clinical) [Ep 4 · 9:00](https://qa.library.globalcastmd.com/watch/esophageal-atresia-627?t=540)
- "Echocardiography may misidentify aortic arch sidedness; one surgeon encountered a double arch after echo reported right arch." (clinical) [Ep 4 · 10:00](https://qa.library.globalcastmd.com/watch/esophageal-atresia-627?t=600)
- "Preoperative bronchoscopy can identify double fistulas and predict gap length: fistula at mid-trachea suggests shorter gap, fistula at carina suggests longer gap." (clinical) [Ep 4 · 13:00](https://qa.library.globalcastmd.com/watch/esophageal-atresia-627?t=780)
- "For thoracoscopic repair, bronchoscopy helps the surgeon understand fistula location and anticipate gap distance." (clinical) [Ep 4 · 14:00](https://qa.library.globalcastmd.com/watch/esophageal-atresia-627?t=840)
- "Standard open approach uses right posterolateral thoracotomy, extrapleural dissection to vertebral bodies, with azygos vein as landmark for fistula location." (clinical) [Ep 4 · 17:00](https://qa.library.globalcastmd.com/watch/esophageal-atresia-627?t=1020)
- "For uncomplicated EA, tissue interposition between trachea and esophagus is not routinely used because adequate tissue is difficult to find." (clinical) [Ep 4 · 17:30](https://qa.library.globalcastmd.com/watch/esophageal-atresia-627?t=1050)
- "Chest tube is placed in extrapleural space on water seal (not suction) and removed after postoperative contrast study confirms no leak." (clinical) [Ep 4 · 18:00](https://qa.library.globalcastmd.com/watch/esophageal-atresia-627?t=1080)
- "Retrospective study of ~100 patients found no difference in complications between Vicryl and silk suture for EA repair." (clinical) [Ep 4 · 21:00](https://qa.library.globalcastmd.com/watch/esophageal-atresia-627?t=1260)
- "For thoracoscopic repair using knot-pusher technique, PDS must be used for the first stitch to avoid sawing through tissue; Vicryl can be used for intracorporeal ties." (clinical) [Ep 4 · 21:30](https://qa.library.globalcastmd.com/watch/esophageal-atresia-627?t=1290)
- "Approximately 75% of EA/TEF patients are candidates for thoracoscopic repair; complicated congenital heart disease may preclude thoracoscopic approach due to longer operative time." (clinical) [Ep 4 · 23:00](https://qa.library.globalcastmd.com/watch/esophageal-atresia-627?t=1380)
- "If the two esophageal ends cannot be approximated thoracoscopically, conversion to open is appropriate—surgeons get one good chance at primary repair." (opinion) [Ep 4 · 23:30](https://qa.library.globalcastmd.com/watch/esophageal-atresia-627?t=1410)
- "Early thoracoscopic series (2008-2010) showed lower stricture rates with thoracoscopic vs. open repair, but more recent data show equivalent stricture rates." (host_summary) [Ep 4 · 25:00](https://qa.library.globalcastmd.com/watch/esophageal-atresia-627?t=1500)
- "Babies under 2 kg are more difficult for thoracoscopic repair due to limited space for lung retraction and intracorporeal suturing." (clinical) [Ep 4 · 26:00](https://qa.library.globalcastmd.com/watch/esophageal-atresia-627?t=1560)
- "In US training programs, fellows typically perform 4-8 EA repairs during fellowship, raising questions about adequate thoracoscopic training volume." (epidemiological) [Ep 4 · 27:00](https://qa.library.globalcastmd.com/watch/esophageal-atresia-627?t=1620)
- "Average US attending surgeon performs 1-2 TEF repairs per year, making advanced thoracoscopic technique acquisition challenging." (host_summary) [Ep 4 · 27:30](https://qa.library.globalcastmd.com/watch/esophageal-atresia-627?t=1650)
- "For thoracoscopic repair, ports should be spaced widely and staggered, with patient positioned more prone than lateral since esophagus is posterior mediastinal." (clinical) [Ep 4 · 29:00](https://qa.library.globalcastmd.com/watch/esophageal-atresia-627?t=1740)
- "High-frequency oscillatory ventilation in the OR keeps the lung collapsed during thoracoscopic repair; disadvantage is the baby shaking, but hypercarbia is avoided." (clinical) [Ep 4 · 30:00](https://qa.library.globalcastmd.com/watch/esophageal-atresia-627?t=1800)
- "Low-cost training models for EA repair are available and should be used at society meetings (IPEG, APSA) to address low case volume." (host_summary) [Ep 4 · 31:00](https://qa.library.globalcastmd.com/watch/esophageal-atresia-627?t=1860)
- "Marcello reports doing all EA repairs thoracoscopically for over 10 years after performing ~150 open repairs, finding the approach natural and comfortable." (host_summary) [Ep 4 · 31:30](https://qa.library.globalcastmd.com/watch/esophageal-atresia-627?t=1890)
- "Wet clips are a fast and reliable method for dividing the TEF during thoracoscopic repair." (host_summary) [Ep 4 · 32:00](https://qa.library.globalcastmd.com/watch/esophageal-atresia-627?t=1920)
- "Yama's technique: divide only 3/4 of the fistula initially, leaving partial attachment as traction to facilitate anastomosis, then complete division." (host_summary) [Ep 4 · 33:00](https://qa.library.globalcastmd.com/watch/esophageal-atresia-627?t=1980)
- "C1 or TF needles (5-0 PDS) are preferred for thoracoscopic EA repair due to appropriate curve and ability to pass through 5-6mm trocars without tip damage." (clinical) [Ep 4 · 34:00](https://qa.library.globalcastmd.com/watch/esophageal-atresia-627?t=2040)
- "Starting the anastomosis at the lateral (far) corner is most common; some start with a middle back-row stitch tied intracorporeally." (clinical) [Ep 4 · 34:30](https://qa.library.globalcastmd.com/watch/esophageal-atresia-627?t=2070)
- "Passing a transanastomotic feeding tube after back-row sutures provides volume to help guide the needle through the anterior wall." (host_summary) [Ep 4 · 35:00](https://qa.library.globalcastmd.com/watch/esophageal-atresia-627?t=2100)
- "The first anastomotic stitch does not need to be tied tight; subsequent stitches are tightened once approximation is confirmed." (clinical) [Ep 4 · 35:30](https://qa.library.globalcastmd.com/watch/esophageal-atresia-627?t=2130)
- "Exteriorizing the first stitch through the chest wall with a hemostat can help bring the gap closer before placing subsequent sutures." (clinical) [Ep 4 · 36:00](https://qa.library.globalcastmd.com/watch/esophageal-atresia-627?t=2160)
- "Minimal dissection of the distal esophagus preserves blood supply and reduces trauma, even in long-gap cases." (host_summary) [Ep 4 · 36:30](https://qa.library.globalcastmd.com/watch/esophageal-atresia-627?t=2190)
- "For long-gap atresia (pure EA with gasless abdomen), G-tube placement allows gap assessment; if gap is ≤2 vertebral bodies, primary repair is attempted." (clinical) [Ep 4 · 37:30](https://qa.library.globalcastmd.com/watch/esophageal-atresia-627?t=2250)
- "Interventional radiology can pass a wire and catheter up the distal esophagus via G-tube to define the gastroesophageal junction and measure gap accurately." (clinical) [Ep 4 · 38:00](https://qa.library.globalcastmd.com/watch/esophageal-atresia-627?t=2280)
- "Cervical esophagostomy commits the patient to esophageal replacement; most surgeons avoid it and attempt delayed primary anastomosis." (opinion) [Ep 4 · 38:30](https://qa.library.globalcastmd.com/watch/esophageal-atresia-627?t=2310)
- "For long-gap EA, waiting up to 3 months with G-tube feeds (advancing to bolus feeds to encourage distal esophageal growth) is reasonable before declaring the gap irreparable." (clinical) [Ep 4 · 39:00](https://qa.library.globalcastmd.com/watch/esophageal-atresia-627?t=2340)
- "Routine bougienage of the proximal pouch does not reliably promote esophageal growth; growth occurs spontaneously over time." (opinion) [Ep 4 · 39:00](https://qa.library.globalcastmd.com/watch/esophageal-atresia-627?t=2340)
- "For thoracoscopic TEF repair, spk_0 assesses the gap between proximal and distal esophagus preoperatively using bronchoscopy (to identify the fistula orifice) followed by X-ray with the bronchoscope in place and a gastric tube, measuring the gap in vertebral body units." — Yama (clinical) [Ep 3 · 0:00](https://qa.library.globalcastmd.com/watch/thoracoscopic-repair-of-tracheo-esophageal-fistula-tricks-pediatric-surgery-424?t=0)
- "In the presented case, the gap between proximal and distal esophagus was approximately one vertebral body." — Yama (clinical) [Ep 3 · 2:12](https://qa.library.globalcastmd.com/watch/thoracoscopic-repair-of-tracheo-esophageal-fistula-tricks-pediatric-surgery-424?t=132)
- "The majority of surgeons divide the distal esophagus completely during TEF repair, but spk_0 leaves one quarter of the fistula uncut." — Yama (clinical) [Ep 3 · 2:31](https://qa.library.globalcastmd.com/watch/thoracoscopic-repair-of-tracheo-esophageal-fistula-tricks-pediatric-surgery-424?t=151)
- "If the distal esophagus is divided completely, it can retract cranially and anastomosis becomes more difficult." — Yama (clinical) [Ep 3 · 3:00](https://qa.library.globalcastmd.com/watch/thoracoscopic-repair-of-tracheo-esophageal-fistula-tricks-pediatric-surgery-424?t=180)
- "Leaving one quarter of the fistula uncut provides fixation of the distal esophagus and makes it easier to grasp the mucosa during anastomosis." — Yama (clinical) [Ep 3 · 3:20](https://qa.library.globalcastmd.com/watch/thoracoscopic-repair-of-tracheo-esophageal-fistula-tricks-pediatric-surgery-424?t=200)
- "spk_0 does not cut all of the tip of the proximal esophagus; he leaves one-quarter to one-fifth of the cap of the proximal esophagus to grab with forceps, avoiding grasping the anastomotic site." — Yama (clinical) [Ep 3 · 3:50](https://qa.library.globalcastmd.com/watch/thoracoscopic-repair-of-tracheo-esophageal-fistula-tricks-pediatric-surgery-424?t=230)
- "If there is a 1-3 vertebral body gap, the assistant can pull the proximal esophagus caudally using the uncut cap." — Yama (clinical) [Ep 3 · 4:20](https://qa.library.globalcastmd.com/watch/thoracoscopic-repair-of-tracheo-esophageal-fistula-tricks-pediatric-surgery-424?t=260)
- "spk_0 places the first anastomotic stitch in the middle of the posterior wall, not at the edge, finding this easier especially with his technique." — Yama (clinical) [Ep 3 · 4:47](https://qa.library.globalcastmd.com/watch/thoracoscopic-repair-of-tracheo-esophageal-fistula-tricks-pediatric-surgery-424?t=287)
- "spk_0 uses 6-0 or 5-0 PDS suture for the anastomosis." — Yama (clinical) [Ep 3 · 7:30](https://qa.library.globalcastmd.com/watch/thoracoscopic-repair-of-tracheo-esophageal-fistula-tricks-pediatric-surgery-424?t=450)
- "The mucosa of both proximal and distal esophagus must be included in the anastomotic stitches; otherwise the patient will have postoperative stenosis." — Yama (clinical) [Ep 3 · 7:40](https://qa.library.globalcastmd.com/watch/thoracoscopic-repair-of-tracheo-esophageal-fistula-tricks-pediatric-surgery-424?t=460)
- "spk_0 divides the tracheoesophageal fistula completely after placing one or two anastomotic stitches." — Yama (clinical) [Ep 3 · 8:40](https://qa.library.globalcastmd.com/watch/thoracoscopic-repair-of-tracheo-esophageal-fistula-tricks-pediatric-surgery-424?t=520)
- "spk_0 divides the uncut cap of the proximal esophagus after placing 2-3 anastomotic stitches." — Yama (clinical) [Ep 3 · 9:00](https://qa.library.globalcastmd.com/watch/thoracoscopic-repair-of-tracheo-esophageal-fistula-tricks-pediatric-surgery-424?t=540)
- "spk_0 does not touch the site of the anastomosis in the proximal and distal esophagus during his technique." — Yama (clinical) [Ep 3 · 9:20](https://qa.library.globalcastmd.com/watch/thoracoscopic-repair-of-tracheo-esophageal-fistula-tricks-pediatric-surgery-424?t=560)
- "spk_1 tried spk_0's technique after seeing the video in September and found it worked well, though he was uncertain how much he needed the traction provided by the uncut tissue." (opinion) [Ep 3 · 9:45](https://qa.library.globalcastmd.com/watch/thoracoscopic-repair-of-tracheo-esophageal-fistula-tricks-pediatric-surgery-424?t=585)
- "spk_1 suggests there is no downside to leaving the last bit of fistula uncut initially; if the stitch sets up perfectly, it can be taken, and if not, it can be cut and the anastomosis completed." (opinion) [Ep 3 · 10:40](https://qa.library.globalcastmd.com/watch/thoracoscopic-repair-of-tracheo-esophageal-fistula-tricks-pediatric-surgery-424?t=640)
- "David Vanderzee (spk_2) thinks leaving the fistula partially connected to the trachea initially might be helpful, but his group does not do it." — David Vanderzee (opinion) [Ep 3 · 11:13](https://qa.library.globalcastmd.com/watch/thoracoscopic-repair-of-tracheo-esophageal-fistula-tricks-pediatric-surgery-424?t=673)
- "David Vanderzee's group uses a transfixing suture to close the fistula to ensure it does not come off, and never uses clips because they tend to hook behind the anastomotic suture." — David Vanderzee (clinical) [Ep 3 · 11:30](https://qa.library.globalcastmd.com/watch/thoracoscopic-repair-of-tracheo-esophageal-fistula-tricks-pediatric-surgery-424?t=690)
- "For type C esophageal atresia with considerable length, David Vanderzee's group puts in two sutures, makes them into sliding knots, and slowly brings the esophageal ends together, dividing tension between the two ends." — David Vanderzee (clinical) [Ep 3 · 11:55](https://qa.library.globalcastmd.com/watch/thoracoscopic-repair-of-tracheo-esophageal-fistula-tricks-pediatric-surgery-424?t=715)
- "David Vanderzee's group finalizes the posterior anastomosis before putting through a tube and closing the anterior wall." — David Vanderzee (clinical) [Ep 3 · 12:25](https://qa.library.globalcastmd.com/watch/thoracoscopic-repair-of-tracheo-esophageal-fistula-tricks-pediatric-surgery-424?t=745)
- "Mark Wolkan presented a technique from Atlanta in which a stitch is placed through the chest wall, through the proximal esophageal end, through the distal end, and back out through the chest wall, and held up during anastomosis." (host_summary) [Ep 3 · 13:50](https://qa.library.globalcastmd.com/watch/thoracoscopic-repair-of-tracheo-esophageal-fistula-tricks-pediatric-surgery-424?t=830)
- "Jeff Blair (spk_3) speculates that in the next decade, mechanical devices may be used to grab and seal the lower esophageal pouch via the upper pouch, possibly with thoracoscopic or imaging facilitation." — Jeff Blair (opinion) [Ep 3 · 15:06](https://qa.library.globalcastmd.com/watch/thoracoscopic-repair-of-tracheo-esophageal-fistula-tricks-pediatric-surgery-424?t=906)
- "Suet (spk_4) found it much easier to identify the fistula laparoscopically (likely meant thoracoscopically) and to appreciate how much esophagus to leave on the tracheal side." — Suet (opinion) [Ep 3 · 15:40](https://qa.library.globalcastmd.com/watch/thoracoscopic-repair-of-tracheo-esophageal-fistula-tricks-pediatric-surgery-424?t=940)
- "Suet found dissecting the upper segment of the esophagus difficult, particularly in handling the esophagus without damaging the wall needed for anastomosis." — Suet (opinion) [Ep 3 · 16:10](https://qa.library.globalcastmd.com/watch/thoracoscopic-repair-of-tracheo-esophageal-fistula-tricks-pediatric-surgery-424?t=970)
- "Sharif (spk_5), who started doing thoracoscopic TEF a year ago and has done three cases, finds the dissection and fistula division phase easy but the anastomotic phase difficult." — Sharif (opinion) [Ep 3 · 16:34](https://qa.library.globalcastmd.com/watch/thoracoscopic-repair-of-tracheo-esophageal-fistula-tricks-pediatric-surgery-424?t=994)
- "Steve Rothenberg uses clips routinely for TEF repair." — Sharif (host_summary) [Ep 3 · 17:10](https://qa.library.globalcastmd.com/watch/thoracoscopic-repair-of-tracheo-esophageal-fistula-tricks-pediatric-surgery-424?t=1030)
- "There have been several instances where clips seem to erode or be implicated in TEF recurrences." — Sharif (host_summary) [Ep 3 · 17:25](https://qa.library.globalcastmd.com/watch/thoracoscopic-repair-of-tracheo-esophageal-fistula-tricks-pediatric-surgery-424?t=1045)
- "spk_1 has had a clip erode into the esophagus in his experience." (clinical) [Ep 3 · 17:40](https://qa.library.globalcastmd.com/watch/thoracoscopic-repair-of-tracheo-esophageal-fistula-tricks-pediatric-surgery-424?t=1060)
- "Steve Rothenberg, who has the largest experience with thoracoscopic TEF, has never had a clip erode." (host_summary) [Ep 3 · 17:55](https://qa.library.globalcastmd.com/watch/thoracoscopic-repair-of-tracheo-esophageal-fistula-tricks-pediatric-surgery-424?t=1075)
- "spk_1 uses metal clips for fistula closure." (clinical) [Ep 3 · 18:10](https://qa.library.globalcastmd.com/watch/thoracoscopic-repair-of-tracheo-esophageal-fistula-tricks-pediatric-surgery-424?t=1090)
- "spk_1 has tried Weck Hema-lock clips 2-3 times but finds the clip applier too large, reducing visualization compared to the metal clip applier." (opinion) [Ep 3 · 18:20](https://qa.library.globalcastmd.com/watch/thoracoscopic-repair-of-tracheo-esophageal-fistula-tricks-pediatric-surgery-424?t=1100)
- "Weck Hema-lock clips are not easy to remove if their position is unsatisfactory." (clinical) [Ep 3 · 18:40](https://qa.library.globalcastmd.com/watch/thoracoscopic-repair-of-tracheo-esophageal-fistula-tricks-pediatric-surgery-424?t=1120)
- "spk_0 believes that if the fistula is clipped very tightly, it will erode the muscle of the esophagus, but if the clip is applied just to oppose (not crush), it does not cause erosion." — Yama (opinion) [Ep 3 · 18:50](https://qa.library.globalcastmd.com/watch/thoracoscopic-repair-of-tracheo-esophageal-fistula-tricks-pediatric-surgery-424?t=1130)
- "Tight clipping may crush the esophageal muscle, erode it, and cause recurrence of the fistula." — Yama (opinion) [Ep 3 · 18:50](https://qa.library.globalcastmd.com/watch/thoracoscopic-repair-of-tracheo-esophageal-fistula-tricks-pediatric-surgery-424?t=1130)
- "Esophageal stenosis after atresia repair or reflux esophagitis can be managed with balloon dilatation, but persistent stenosis has increasing recurrence rates requiring repeated dilatation." — David (clinical) [Ep 5 · 0:03](https://qa.library.globalcastmd.com/watch/tricks-indwelling-balloon-catheter-for-refractory-esophageal-stenosis-640?t=3)
- "The technique was first tried approximately 10 years ago, involving transnasal insertion of dilatation balloons under direct esophagoscopic vision, placement at the stenosis site, and intermittent inflation three times daily for 10 seconds followed by desufflation." — David (clinical) [Ep 5 · 1:30](https://qa.library.globalcastmd.com/watch/tricks-indwelling-balloon-catheter-for-refractory-esophageal-stenosis-640?t=90)
- "The rationale is that the esophagus will heal at least to the diameter of the balloon (e.g., 10 millimeters for a 10mm balloon), which is usually sufficient." — David (clinical) [Ep 5 · 3:00](https://qa.library.globalcastmd.com/watch/tricks-indwelling-balloon-catheter-for-refractory-esophageal-stenosis-640?t=180)
- "Compared to stents, balloons have very little dislodgement because the balloon is fixed to the catheter exiting through the nose." — David (clinical) [Ep 5 · 3:30](https://qa.library.globalcastmd.com/watch/tricks-indwelling-balloon-catheter-for-refractory-esophageal-stenosis-640?t=210)
- "Children can drink or eat solid foods alongside the indwelling balloon." — David (clinical) [Ep 5 · 4:00](https://qa.library.globalcastmd.com/watch/tricks-indwelling-balloon-catheter-for-refractory-esophageal-stenosis-640?t=240)
- "Olympus endotherapy balloons were initially used, but when unavailable, Boston Scientific Ultrasin vascular stent balloons were substituted successfully." — David (clinical) [Ep 5 · 4:40](https://qa.library.globalcastmd.com/watch/tricks-indwelling-balloon-catheter-for-refractory-esophageal-stenosis-640?t=280)
- "Balloons are available in different sizes and lengths, allowing selection based on patient age and desired diameter; for extensive burns, two balloons can be used simultaneously (e.g., 8cm and 4cm balloons)." — David (clinical) [Ep 5 · 5:20](https://qa.library.globalcastmd.com/watch/tricks-indwelling-balloon-catheter-for-refractory-esophageal-stenosis-640?t=320)
- "The patient series included 5 long-gap atresia cases with stenosis, 2 type C atresia cases, 7 caustic burns, 3 stenoses of unknown cause, and 2 persistent reflux cases despite anti-reflux surgery." — David (epidemiological) [Ep 5 · 6:40](https://qa.library.globalcastmd.com/watch/tricks-indwelling-balloon-catheter-for-refractory-esophageal-stenosis-640?t=400)
- "Caustic burn and unknown-cause stenosis patients required prolonged dilatation periods, but the technique reduced the number of required endoscopies to approximately once every 4 weeks." — David (clinical) [Ep 5 · 7:30](https://qa.library.globalcastmd.com/watch/tricks-indwelling-balloon-catheter-for-refractory-esophageal-stenosis-640?t=450)
- "Complications included restenosis in 6 children after balloon removal at 4-6 weeks, managed by reinsertion for another 4-6 weeks; occasional dislodgement when children manipulated the catheter; balloon leakage requiring replacement; and one case of sputum retention leading to removal." — David (clinical) [Ep 5 · 8:10](https://qa.library.globalcastmd.com/watch/tricks-indwelling-balloon-catheter-for-refractory-esophageal-stenosis-640?t=490)
- "There was no mortality and no patient required surgical intervention (reanastomosis, esophagoscopy, or esophageal replacement)." — David (clinical) [Ep 5 · 9:20](https://qa.library.globalcastmd.com/watch/tricks-indwelling-balloon-catheter-for-refractory-esophageal-stenosis-640?t=560)
- "In a 16-year-old with a 10cm lye burn stenosis, two balloons (8cm lower, 4cm upper) were used simultaneously, achieving complete healing in approximately 3 months with the patient able to eat solids within 2-3 weeks." — David (clinical) [Ep 5 · 10:20](https://qa.library.globalcastmd.com/watch/tricks-indwelling-balloon-catheter-for-refractory-esophageal-stenosis-640?t=620)
- "The technique can be taught to parents for home use, is safe, and obviates the need for reanastomosis, esophagoscopy, or esophageal replacement." — David (opinion) [Ep 5 · 11:40](https://qa.library.globalcastmd.com/watch/tricks-indwelling-balloon-catheter-for-refractory-esophageal-stenosis-640?t=700)
- "The principle of frequent dilatation promoting healing in the open position is analogous to historical practice of passing Maloney bougies multiple times daily at the bedside." — Jack (clinical) [Ep 5 · 7:49](https://qa.library.globalcastmd.com/watch/tricks-indwelling-balloon-catheter-for-refractory-esophageal-stenosis-640?t=469)
- "The balloon technique differs from bougie dilatation in that after initial dilatation under anesthesia, subsequent inflations only maintain patency and are not painful." — David (clinical) [Ep 5 · 9:03](https://qa.library.globalcastmd.com/watch/tricks-indwelling-balloon-catheter-for-refractory-esophageal-stenosis-640?t=543)
- "A small child who swallowed a battery lodged in the upper sphincter was successfully managed with a 4cm 10mm balloon using gradual inflation (5cc warning inflation followed by full inflation) to allow the child to swallow, with no complications." — David (clinical) [Ep 5 · 9:40](https://qa.library.globalcastmd.com/watch/tricks-indwelling-balloon-catheter-for-refractory-esophageal-stenosis-640?t=580)
- "The catheters are stiffer than standard nasogastric or silastic tubes; the tip must be bent for nasal introduction, or a guide wire can be used to facilitate replacement without anesthesia." — David (clinical) [Ep 5 · 10:40](https://qa.library.globalcastmd.com/watch/tricks-indwelling-balloon-catheter-for-refractory-esophageal-stenosis-640?t=640)
- "In small children, the catheter may need to be forcefully bent into a hook shape at the nasal exit point and fixed with Duoderm and plaster; nasal wing distortion can be prevented by tying the catheter to the opposite side with umbilical tie material." — David (clinical) [Ep 5 · 11:20](https://qa.library.globalcastmd.com/watch/tricks-indwelling-balloon-catheter-for-refractory-esophageal-stenosis-640?t=680)
- "Initial dilatation typically involves 1-3 sessions before recognizing persistence; at that point, the balloon is left indwelling for 2 weeks initially (if severe inflammation) or 4-week stretches for burns, with endoscopic reassessment and possible replacement." — David (clinical) [Ep 5 · 10:55](https://qa.library.globalcastmd.com/watch/tricks-indwelling-balloon-catheter-for-refractory-esophageal-stenosis-640?t=655)
- "The dual-lumen catheters allow tube feeding through the catheter while the balloon is indwelling." — David (clinical) [Ep 5 · 11:43](https://qa.library.globalcastmd.com/watch/tricks-indwelling-balloon-catheter-for-refractory-esophageal-stenosis-640?t=703)
- "In the two reflux stricture cases, both experienced restenosis; one retarded child with mid-esophageal stenosis and pH study showing no reflux (pH=1) after anti-reflux surgery was ultimately treated with swallowed transanal steroid gels, leading to resolution and remaining symptom-free approximately 2 years later." — David (clinical) [Ep 5 · 12:02](https://qa.library.globalcastmd.com/watch/tricks-indwelling-balloon-catheter-for-refractory-esophageal-stenosis-640?t=722)
- "Caustic burn cases required indwelling periods of 3-6 months to ensure complete healing before catheter removal." — David (clinical) [Ep 5 · 13:10](https://qa.library.globalcastmd.com/watch/tricks-indwelling-balloon-catheter-for-refractory-esophageal-stenosis-640?t=790)
- "The inflation protocol uses a 20cc syringe with air only (no fluids to prevent balloon adhesion); initial 5cc inflation alerts the child to swallow, followed by full inflation to 15-20cc, then immediate complete desufflation with vacuum, performed three times daily." — David (clinical) [Ep 5 · 14:32](https://qa.library.globalcastmd.com/watch/tricks-indwelling-balloon-catheter-for-refractory-esophageal-stenosis-640?t=872)
- "First endoscopic reassessment occurs at 2 weeks; if progress is satisfactory, intervals can be extended to 4 weeks until complete healing is observed, at which point the catheter is removed and the child monitored for symptoms without routine contrast studies or endoscopy unless complaints arise." — David (clinical) [Ep 5 · 15:30](https://qa.library.globalcastmd.com/watch/tricks-indwelling-balloon-catheter-for-refractory-esophageal-stenosis-640?t=930)
- "Two patients in the series experienced recurrent stricture after initial successful treatment and catheter removal, requiring an additional 4-6 week period of balloon dilatation." — David (clinical) [Ep 5 · 16:26](https://qa.library.globalcastmd.com/watch/tricks-indwelling-balloon-catheter-for-refractory-esophageal-stenosis-640?t=986)
- "Balloon position is marked by two metal spots on the catheter visible on radiography; position can be confirmed with contrast swallow or, under anesthesia, by endoscopic visualization with placement approximately 1cm above the stenosis for a 4cm balloon, followed by fixation at the nose before deflation." — David (clinical) [Ep 5 · 17:08](https://qa.library.globalcastmd.com/watch/tricks-indwelling-balloon-catheter-for-refractory-esophageal-stenosis-640?t=1028)
- "Dislodged balloons can be replaced under fluoroscopy without anesthesia." — David (clinical) [Ep 5 · 18:16](https://qa.library.globalcastmd.com/watch/tricks-indwelling-balloon-catheter-for-refractory-esophageal-stenosis-640?t=1096)
- "Topical mitomycin application for recurrent esophageal strictures usually requires a few treatments and has maintained patency in patients with dozens of prior dilatations." (clinical) [Ep 5 · 18:23](https://qa.library.globalcastmd.com/watch/tricks-indwelling-balloon-catheter-for-refractory-esophageal-stenosis-640?t=1103)
- "Mitomycin is applied topically, not injected, for esophageal strictures." (clinical) [Ep 5 · 19:06](https://qa.library.globalcastmd.com/watch/tricks-indwelling-balloon-catheter-for-refractory-esophageal-stenosis-640?t=1146)
- "A recent article in the Journal of Gastrointestinal Surgery reviews fully covered metal expandable stents for both leaks and strictures, showing outstanding results with average indwelling periods of 4-5 weeks, though migration can occur and sometimes requires one stent inside another." — JP (host_summary) [Ep 5 · 19:58](https://qa.library.globalcastmd.com/watch/tricks-indwelling-balloon-catheter-for-refractory-esophageal-stenosis-640?t=1198)
- "Fully covered metal stents do not require transnasal placement and may be more comfortable than balloons." — JP (opinion) [Ep 5 · 21:00](https://qa.library.globalcastmd.com/watch/tricks-indwelling-balloon-catheter-for-refractory-esophageal-stenosis-640?t=1260)
- "Injection of steroids into the esophageal wall has been useful for recalcitrant or recurrent strictures." — JP (clinical) [Ep 5 · 21:20](https://qa.library.globalcastmd.com/watch/tricks-indwelling-balloon-catheter-for-refractory-esophageal-stenosis-640?t=1280)
- "Metal expandable stents have caused catastrophic complications in pediatrics, including erosion through the esophagus into an aberrant innominate artery causing fatal exsanguination; multiple pediatric surgeons have had similar unreported disasters." (clinical) [Ep 5 · 21:04](https://qa.library.globalcastmd.com/watch/tricks-indwelling-balloon-catheter-for-refractory-esophageal-stenosis-640?t=1264)
- "In small children with atresia, metal stents must be very carefully size-matched to the esophagus to prevent erosion; nitinol is unforgiving and will erode if not the right size." (clinical) [Ep 5 · 21:51](https://qa.library.globalcastmd.com/watch/tricks-indwelling-balloon-catheter-for-refractory-esophageal-stenosis-640?t=1311)
- "Biodegradable stents are available in Europe and the UK with limited data but represent the future; they dissolve after 4-6 weeks." (clinical) [Ep 5 · 22:13](https://qa.library.globalcastmd.com/watch/tricks-indwelling-balloon-catheter-for-refractory-esophageal-stenosis-640?t=1333)
- "Newer fully covered metal stents can be removed by pulling a central string to collapse them; nitinol stents should be pre-treated with cold water through the lumen to cause shrinkage before string-pulling and removal." — JP (clinical) [Ep 5 · 22:23](https://qa.library.globalcastmd.com/watch/tricks-indwelling-balloon-catheter-for-refractory-esophageal-stenosis-640?t=1343)
- "Patients with indwelling balloon catheters can tolerate semi-solid food." (clinical) [Ep 5 · 22:49](https://qa.library.globalcastmd.com/watch/tricks-indwelling-balloon-catheter-for-refractory-esophageal-stenosis-640?t=1369)

## Changelog
- Sep 15: 6 items added automatically
- Sep 13: 1 item added automatically
- Sep 12: 2 items added automatically
- Sep 9: 1 item no longer name esophageal atresia
- Sep 8: 1 item no longer name esophageal atresia
- Sep 7: 6 items added automatically
- Sep 7: 14 items added automatically

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