# Jejunal Atresia — GCMD Library living collection

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

Updated: n/a · 3 episodes · 125 cited statements

## Episodes
### Surgical Management
- [Laparoscopic Jejunal Atresia Repair - Technique](https://qa.library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-748) — video · 5:55 · [machine version](https://qa.library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-748.md)
- [Laparoscopic Jejunal Atresia Repair - Technique](https://qa.library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-751) — video · 5:55 · [machine version](https://qa.library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-751.md)

### In-Depth Reviews
- [Practical Approach: Intestinal Failure Innovations](https://qa.library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035) — video · 116:52 · [machine version](https://qa.library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035.md)

## Chapters
- [0:00](https://qa.library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-748?t=0) Case presentation and patient positioning (Ep 1)
- [1:30](https://qa.library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-748?t=90) Port placement and initial exploration (Ep 1)
- [3:00](https://qa.library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-748?t=180) Bowel examination and apple peel defect confirmation (Ep 1)
- [4:00](https://qa.library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-748?t=240) Resection of dilated proximal segment (Ep 1)
- [5:00](https://qa.library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-748?t=300) Anastomosis creation and procedure completion (Ep 1)
- [0:00](https://qa.library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-751?t=0) Case presentation and operative setup (Ep 2)
- [1:30](https://qa.library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-751?t=90) Initial exploration and identification of apple peel defect (Ep 2)
- [3:00](https://qa.library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-751?t=180) Resection of dilated proximal segment (Ep 2)
- [4:30](https://qa.library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-751?t=270) Anastomosis creation and closure (Ep 2)
- [5:40](https://qa.library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-751?t=340) Postoperative course and outcomes (Ep 2)
- [0:00](https://qa.library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=0) Surgical feeding access techniques and stoma management (Ep 3)
- [9:20](https://qa.library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=560) Gastrostomy tube indications and timing in intestinal failure (Ep 3)
- [22:46](https://qa.library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=1366) Dilated bowel management and lengthening procedure indications (Ep 3)
- [34:06](https://qa.library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=2046) Intestinal rehabilitation program structure and referral patterns (Ep 3)
- [46:16](https://qa.library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=2776) Feeding strategies: breast milk, formula selection, and concentration (Ep 3)
- [59:30](https://qa.library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=3570) Laboratory monitoring protocols and micronutrient surveillance (Ep 3)
- [72:00](https://qa.library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=4320) Bacterial overgrowth management: antibiotics versus prebiotics (Ep 3)
- [87:00](https://qa.library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=5220) Probiotic use and central line infection risk (Ep 3)
- [100:50](https://qa.library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=6050) Hypermotility management and anti-inflammatory strategies (Ep 3)
- [111:26](https://qa.library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=6686) Emerging therapeutics and future directions (Ep 3)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- "Jejunostomy chimney technique involves dividing bowel 2-3 cm distal to ligament of Treitz, bringing distal limb up as chimney over splenic flexure with side-to-end anastomosis, allowing Mickey button placement without luminal obstruction" (clinical) [Ep 3 · 3:00](https://qa.library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=180)
- "Placing balloon catheter directly in jejunal lumen creates obstruction; chimney technique avoids this by creating separate access limb" (clinical) [Ep 3 · 4:21](https://qa.library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=261)
- "Distal feeding can be provided through 3-4 French feeding tube placed in distal bowel and brought out as stent rather than matured mucous fistula, allowing easy refeeding without catheter access issues" (clinical) [Ep 3 · 0:57](https://qa.library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=57)
- "Refeeding distal bowel provides significant benefit for fluid/electrolyte absorption and allows bowel to dilate and mature, potentially decreasing technical problems at takedown" (clinical) [Ep 3 · 1:45](https://qa.library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=105)
- "When proximal and distal stomas are placed close together, takedown is less stressful on patient and surgeon than complete laparotomy to find and reconnect distant bowel segments" (opinion) [Ep 3 · 8:02](https://qa.library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=482)
- "Gastrostomy tubes in very small premature infants (700 grams) can be deferred by placing 3 French feeding tube coiled in stomach, then later dilating tract with wire and interventional radiology to place primary tube without second surgery" (clinical) [Ep 3 · 14:46](https://qa.library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=886)
- "Gastrostomy tube placement has costs including leakage issues if placed against costal margin in small infants; timing and location require careful consideration" (clinical) [Ep 3 · 20:41](https://qa.library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=1241)
- "Prolapsed gastrostomy tubes can cause significant formula loss during feeds; removing dysfunctional gastrostomy allows some children to thrive better" (clinical) [Ep 3 · 22:46](https://qa.library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=1366)
- "In 2-month-old with jejunal atresia unable to advance feeds beyond 20 mL/kg, if anastomosis appears patent at reoperation, would still revise it rather than leave it alone" (clinical) [Ep 3 · 24:16](https://qa.library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=1456)
- "At end of intestinal failure operation, must ensure no kinking, restriction, or potential problems remain - cannot tolerate leaving anything that 'could be a problem but is probably all right'" (clinical) [Ep 3 · 25:29](https://qa.library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=1529)
- "STEP procedure in first year of life, especially in infant who has not progressed with enteral feeds, is not beneficial unless specifically avoiding line infections and bacterial overgrowth" (clinical) [Ep 3 · 29:20](https://qa.library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=1760)
- "Dysmotile bowel does not become motile because you did a STEP procedure on it; if bowel hasn't been fed and isn't functioning, STEP won't make it work" (clinical) [Ep 3 · 29:32](https://qa.library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=1772)
- "The one thing that makes bowel adapt is feeding the bowel; procedures causing problems reinitiating feeds cause damage to patient" (clinical) [Ep 3 · 30:06](https://qa.library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=1806)
- "In patient with 50% estimated bowel length, expectation is they will come off parenteral nutrition; should not overtry to salvage bad bowel when good bowel exists" (clinical) [Ep 3 · 28:07](https://qa.library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=1687)
- "STEP registry paper showing procedures can be done safely in early neonatal period found only 3 patients came off parenteral nutrition, whereas natural data shows 80-90% of such patients off TPN at 12 months just by being fed" (epidemiological) [Ep 3 · 31:18](https://qa.library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=1878)
- "Kids who had early STEP procedures have often redilated, undergone second STEPs, and had mechanical obstructions very detrimental to feeding ability" (clinical) [Ep 3 · 31:43](https://qa.library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=1903)
- "Indication for lengthening procedure is complications from bacterial overgrowth (d-lactic acidosis) or ultra-short bowel with very dilated segment where tapering doesn't make sense - generally not decisions made at 2-3 months old but after first birthday" (clinical) [Ep 3 · 33:21](https://qa.library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=2001)
- "Expectation of going from 10 mL/kg enteral feeds to off TPN in 3 months after STEP is a fairy tale that doesn't exist" (opinion) [Ep 3 · 34:06](https://qa.library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=2046)
- "Surgical techniques for intestinal failure are not out of realm of any pediatric surgeon, but outcomes differ when done in isolation without multidisciplinary team consideration" (opinion) [Ep 3 · 34:46](https://qa.library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=2086)
- "Since maturing multidisciplinary program, transplant candidates declined by 75% and internal transplants almost non-existent" (epidemiological) [Ep 3 · 40:47](https://qa.library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=2447)
- "Patients should be referred to intestinal rehabilitation programs as soon as identified as needing comprehensive approach, not when complications exhausted local knowledge" (opinion) [Ep 3 · 44:23](https://qa.library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=2663)
- "Programs do far better with children who do not already have complications of their disease than patients who come already suffering from current management" (clinical) [Ep 3 · 44:34](https://qa.library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=2674)
- "In gastroschisis and surgical necrotizing enterocolitis, significant benefit to time to wean off parenteral nutrition based solely on breast milk (fortified or not) versus formula only" (clinical) [Ep 3 · 59:42](https://qa.library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=3582)
- "Breast milk is not just formula but really a therapy with components that are anti-inflammatory and promotile" (clinical) [Ep 3 · 60:19](https://qa.library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=3619)
- "Benefit to kids with spontaneous intestinal perforation is not seen with breast milk, suggesting specific anti-inflammatory and promotile components important for other conditions" (clinical) [Ep 3 · 60:20](https://qa.library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=3620)
- "Donor breast milk is less advantageous than maternal breast milk; usually taken from mothers 10-14 months postpartum before weaning, has lower caloric density and protein, and freezing may inactivate trophic factors" (clinical) [Ep 3 · 62:25](https://qa.library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=3745)
- "Express maternal breast milk is favorite approach; when patient predicted to do badly, go to elemental formulas as second line" (clinical) [Ep 3 · 63:19](https://qa.library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=3799)
- "Free amino acid formulas are relatively hyperosmolar at 20 kcal/oz (osmolarity around 350-360); going higher increases osmolarity, so tend to avoid high caloric density formulas in very young infants" (clinical) [Ep 3 · 64:20](https://qa.library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=3860)
- "In study by Joly et al in French adult cohort, hyperphagic adults with short bowel had 60% absorption coefficient with ad lib eating, 85% with continuous drip feeds, and 75% with half calories by mouth during day plus overnight drip feeds" (host_summary) [Ep 3 · 17:01](https://qa.library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=1021)
- "Continuous drip feeding improves absorptive index, but combining daytime oral intake with nighttime drip feeds may offer best of both approaches" (host_summary) [Ep 3 · 17:40](https://qa.library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=1060)
- "Prefer isotonic formulas (15-17 cal/oz) because digestion changes osmolarity in jejunum, and most bad kids don't have ileum so jejunum has no ability to absorb against concentration gradient" (clinical) [Ep 3 · 65:20](https://qa.library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=3920)
- "Kids without upper GI dysmotility handle volume much better than concentration, so keep concentration low and advance volume" (clinical) [Ep 3 · 65:55](https://qa.library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=3955)
- "Introduction of baby foods, meats, and vegetables remarkably helpful in adaptation process once kids get older" (clinical) [Ep 3 · 66:03](https://qa.library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=3963)
- "TPN panel includes renal panel, liver panel, calcium/phosphorus/magnesium; no longer follow prealbumin or RBP as money-saving strategy, follow albumin instead for chronic changes" (clinical) [Ep 3 · 70:04](https://qa.library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=4204)
- "Follow essential fatty acids monthly or every other month if on low lipid TPN; iron, ferritin, TIBC every 2-3 months; zinc, copper, ceruloplasmin every 3-6 months; selenium every 6 months" (clinical) [Ep 3 · 70:43](https://qa.library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=4243)
- "About 60% of patients weaned off TPN have deficiencies in one micronutrient or another" (epidemiological) [Ep 3 · 71:36](https://qa.library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=4296)
- "Follow B12 annually plus methylmalonic acid and homocysteine as more sensitive surrogate markers, since B12 can be synthesized by bacteria or falsely elevated with liver disease" (clinical) [Ep 3 · 72:03](https://qa.library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=4323)
- "Breast milk has non-nutrient oligosaccharides (2FL, 3FL) that are not nutrient source to humans but affect microflora and dysbiosis; 80% of secretor mothers make 2FL which is immunomodulatory" (clinical) [Ep 3 · 85:56](https://qa.library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=5156)
- "Dysbiosis in intestinal failure patients is profound and furthered by H2 blockers and antibiotics; how this affects adaptive process not well understood" (clinical) [Ep 3 · 86:24](https://qa.library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=5184)
- "Older patient recommends prebiotics more and antibiotics less; almost all patients with substantial resection and lost ileocecal valve have element of small bowel contamination with colonic flora" (opinion) [Ep 3 · 83:13](https://qa.library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=4993)
- "Want to encourage right flora (anaerobes) and discourage wrong flora (putrefactive bacteria like E. coli, Klebsiella); too many antibiotics kill bacteria you want present to break down starches into butyric acid" (clinical) [Ep 3 · 83:59](https://qa.library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=5039)
- "Use antibiotics selectively: for d-lactic acidosis, hyperammonemia, or older child no longer thriving on previously adequate caloric intake; if used, finite period 2-3 weeks, and abandon if no improved growth velocity" (clinical) [Ep 3 · 85:06](https://qa.library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=5106)
- "In recent data, probably 2/3 of bloodstream infections seen in patients on prophylactic Flagyl, because knocking out anaerobes facilitates aerobic overgrowth and presumably translocation" (clinical) [Ep 3 · 90:33](https://qa.library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=5433)
- "Metronidazole has limited spectrum, knocks off anaerobes, facilitates growth of aerobes - absolutely the wrong choice for bacterial overgrowth" (opinion) [Ep 3 · 91:56](https://qa.library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=5516)
- "If desperate for antibiotics, might use selective decontamination with non-absorbable aminoglycoside (Tobramycin) and Colistin" (clinical) [Ep 3 · 92:16](https://qa.library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=5536)
- "Rifaximin may have role but not well studied in bacterial overgrowth, appropriate dose unknown, and no stable suspension available" (clinical) [Ep 3 · 92:37](https://qa.library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=5557)
- "Use metronidazole to promote motility by decreasing overgrowth, improving mucosal quality, decreasing inflammation, and increasing tolerance and absorption - not to prevent bacterial infection" (clinical) [Ep 3 · 93:26](https://qa.library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=5606)
- "When culture most bacteria causing overgrowth, get anaerobes qualitatively, which is reason for metronidazole use" (clinical) [Ep 3 · 94:29](https://qa.library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=5669)
- "Lack of knowledge about microbiome in children with intestinal failure; tend to use antibiotics based on clinical findings - gram negatives or cholestasis suggests non-absorbable aminoglycoside; sudden distension with frothy diarrhea or lactic acidosis suggests Flagyl" (clinical) [Ep 3 · 95:24](https://qa.library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=5724)
- "Patients seem to advance well once on solid food, likely due to more physiological exposure to complex proteins and oligosaccharides, but can't identify single causative factor yet" (clinical) [Ep 3 · 96:45](https://qa.library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=5805)
- "Use antibiotics and not probiotics, only when forced to (d-lactic acidosis, stalling feeds with distension); metronidazole used because anaerobes are gas producers and cause lactic acidosis" (clinical) [Ep 3 · 97:56](https://qa.library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=5876)
- "Metronidazole doesn't work for everyone; with lactic acidosis, very specific antibiotics seem to work and must find best one; try not to cycle, use once and see how long before recurrence" (clinical) [Ep 3 · 98:47](https://qa.library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=5927)
- "Worry about probiotics getting in central lines through external contamination more than translocation; lactobacillus species extremely hard to clear, may require line removal" (clinical) [Ep 3 · 99:41](https://qa.library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=5981)
- "One case established blood infection with same genotype as lactobacillus given as probiotic, which turned program away from probiotics in all kids with central lines" (clinical) [Ep 3 · 100:06](https://qa.library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=6006)
- "First consideration with increased output is whether overfeeding and overtaxing gut, providing elements for osmotic diarrhea" (clinical) [Ep 3 · 101:17](https://qa.library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=6077)
- "Reanastomosing colon helps with output; when colon involved, anti-motility drugs like loperamide become helpful" (clinical) [Ep 3 · 101:51](https://qa.library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=6111)
- "Use soluble fibers to decrease high output; have tried octreotide but not found very useful and worry about chronic use with growth hormone suppression" (clinical) [Ep 3 · 102:20](https://qa.library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=6140)
- "For patients with lot of gastric output, might use proton pump inhibitor to decrease gastric secretions, but must balance with potential medication risks" (clinical) [Ep 3 · 103:12](https://qa.library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=6192)
- "Documented inflammation found on endoscopy in some kids; using anti-inflammatory agents (5-ASA products) seems to have impact, sometimes steroid-based enemas helpful depending on location" (clinical) [Ep 3 · 103:50](https://qa.library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=6230)
- "Anti-inflammatories really helpful in challenging Hirschsprung's patients with dysbiosis and high stool frequency not well managed with other interventions" (clinical) [Ep 3 · 104:29](https://qa.library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=6269)
- "Successfully managed some Hirschsprung's patients (8-9 years old, stooling 12 times daily, not responding to antibiotic cycling or prebiotics/formulas) with long-term anti-inflammatories and 5-ASA with remarkable success" (clinical) [Ep 3 · 104:49](https://qa.library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=6289)
- "Avoid cholestyramine as much as possible; doses effective in firming stool usually bind nutrients, fat-soluble vitamins, and fats; slight risk for hyperchloremic acidosis and cholestyramine bezos" (clinical) [Ep 3 · 105:42](https://qa.library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=6342)
- "Encountered patients on almost homeopathic cholestyramine doses whose parents/physicians believed stools looked better, but not sure stool volume actually declined" (clinical) [Ep 3 · 106:30](https://qa.library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=6390)
- "Ursodiol in child with very short gut can contribute to diarrhea due to osmotic component with no real benefit preventing cholestasis" (clinical) [Ep 3 · 107:10](https://qa.library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=6430)
- "Pancreatic enzymes not physiologic in humans until 5-7 months of age; worry about enzymes in dysmotile bowel areas especially with stomas - have seen strictures/stoma problems related to enzymes sitting in stenotic areas" (clinical) [Ep 3 · 108:12](https://qa.library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=6492)
- "Only pancreatic enzyme present in adult quantities in young infants are proteases; amylases don't appear until 6-12 months, lipase doesn't reach adult levels until end of first year" (clinical) [Ep 3 · 109:23](https://qa.library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=6563)
- "Short gut patients have high trypsinogen levels because they don't have enough enterokinase, but formal pancreatic stimulation shows proteases do appear" (clinical) [Ep 3 · 109:52](https://qa.library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=6592)
- "Problem with pancreatic enzymes in short gut is they go through before releasing" (clinical) [Ep 3 · 110:47](https://qa.library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=6647)
- "No upper number for acceptable stoma output that is hard and fast; have many patients with 40-50 cc/kg stoma output who continue feeding based on electrolyte profile" (clinical) [Ep 3 · 111:14](https://qa.library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=6674)
- "Don't want patients acidotic (CO2 dropping to teens despite maximizing acetate) - that's the limit, not volume; electrolytes and acidosis drive decision, not volume" (clinical) [Ep 3 · 111:29](https://qa.library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=6689)
- "Knee-jerk reactions to volume of output (unless otherwise sick with acidosis/abnormal electrolytes) should not be made; using nurse-callable number for output leads to variable feeding over longer time, very detrimental to weaning program" (opinion) [Ep 3 · 111:45](https://qa.library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=6705)
- "Stoma output or stool output more relevant in guiding fluid and electrolyte replacement than making decisions about stopping or decreasing feeds" (clinical) [Ep 3 · 112:36](https://qa.library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=6756)
- "Patients receiving GLP-2 analog therapies have dramatically decreased stomal output with benefit in fluid and electrolytes, though whether this gives sustainable benefit and whether use in kids is indicated not yet determined" (clinical) [Ep 3 · 113:12](https://qa.library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=6792)
- "Adult GLP-2 analog studies suggest it is beneficial: can reduce fecal output in 60-70% of patients allowing 20% TPN reduction, and in extension study 20% of patients totally emancipated from TPN" (host_summary) [Ep 3 · 113:45](https://qa.library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=6825)
- "Some patients do fine on GLP-2 analog while on it but regress when they come off, so jury still out" (clinical) [Ep 3 · 114:35](https://qa.library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=6875)
- "Studies waiting until children have late intestinal failure not likely to give needed insight; multi-institutional trials following patients in areas where they can be monitored will provide better outcomes and insight for next 5-10 years" (opinion) [Ep 3 · 114:53](https://qa.library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=6893)
- "Major advancements made in intestinal failure field in last 5-6 years not fully recognized; trajectory suggests remarkably different treatment paradigm in very short time" (opinion) [Ep 3 · 115:31](https://qa.library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=6931)
- "When patients on long-term TPN, must monitor not just growth (weight and length) but micronutrient status - impacts neurodevelopmental/cognitive outcome and bone health" (clinical) [Ep 3 · 116:10](https://qa.library.globalcastmd.com/watch/practical-approach-intestinal-failure-innovations-1035?t=6970)
- "A newborn with prenatal diagnosis of bowel obstruction was found to have jejunal atresia on upper GI study" (clinical) [Ep 1 · 0:00](https://qa.library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-748?t=0)
- "The surgeon stands at the baby's feet with the cameraman on the baby's right and the scrub tech on the patient's left for this procedure" (clinical) [Ep 1 · 0:30](https://qa.library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-748?t=30)
- "A 3-port technique was used with a 4 mm 30-degree scope for visualization and two 3 mm ports for dissection" (clinical) [Ep 1 · 0:50](https://qa.library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-748?t=50)
- "The left mid-quadrant port was later changed to a 5 mm port for the stapler" (clinical) [Ep 1 · 1:10](https://qa.library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-748?t=70)
- "The Veress needle is inserted below the umbilicus to avoid injury to the umbilical vessels and prevent CO2 embolism" (clinical) [Ep 1 · 1:20](https://qa.library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-748?t=80)
- "There was a complete gap between the proximal jejunum and the distal bowel, with visualization of appendix and cecum suggesting an apple peel defect" (clinical) [Ep 1 · 2:00](https://qa.library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-748?t=120)
- "The bowel was run from proximal to distal to ensure there were no other areas of obstruction or kinking" (clinical) [Ep 1 · 2:30](https://qa.library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-748?t=150)
- "Running the bowel distally confirmed an apple peel defect, as the bowel could be seen twisting around the mesentery" (clinical) [Ep 1 · 2:50](https://qa.library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-748?t=170)
- "Because there was no evidence of a kink or significant obstruction, the mesentery was not further manipulated" (clinical) [Ep 1 · 3:10](https://qa.library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-748?t=190)
- "A decision was made to remove the proximal dilated segment in the hopes of improving bowel motility following surgery, because it was relatively short and significantly dilated" (clinical) [Ep 1 · 3:40](https://qa.library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-748?t=220)
- "The mesentery is taken down using a 3 mm bipolar vessel sealer, with vessels clamped, sealed, and then teased off the mesenteric border of the bowel" (clinical) [Ep 1 · 4:10](https://qa.library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-748?t=250)
- "The dissection was carried back almost to the ligament of Treitz and encompassed approximately 10 cm length of bowel" (clinical) [Ep 1 · 4:30](https://qa.library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-748?t=270)
- "A 5 mm endoscopic stapler was used to divide the bowel, laying down 4 rows of staples and dividing between them" (clinical) [Ep 1 · 4:50](https://qa.library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-748?t=290)
- "Two applications of the stapler were required because the bowel was so dilated, with a diameter of almost 4 cm" (clinical) [Ep 1 · 5:10](https://qa.library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-748?t=310)
- "The distal jejunal segment was anastomosed to the proximal dilated segment in an end-to-side fashion" (clinical) [Ep 1 · 5:30](https://qa.library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-748?t=330)
- "An enterotomy was made in the proximal dilated bowel using a 3 mm hook cautery and then decompressed with a 3 mm sucker" (clinical) [Ep 1 · 5:45](https://qa.library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-748?t=345)
- "A similar enterotomy was made in the distal jejunal segment and slightly dilated to allow access of the stapler" (clinical) [Ep 1 · 6:00](https://qa.library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-748?t=360)
- "The anastomosis was approximately 2.5 cm in length" (clinical) [Ep 1 · 6:15](https://qa.library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-748?t=375)
- "The resultant enterotomy was closed with a running absorbable suture" (clinical) [Ep 1 · 6:25](https://qa.library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-748?t=385)
- "Previous to having the stapler, an end-to-end anastomosis would have been performed with multiple interrupted or running sutures" (clinical) [Ep 1 · 6:35](https://qa.library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-748?t=395)
- "After completion of the enterotomy, there was no evidence of significant mesenteric defect or any gap in the anatomy" (clinical) [Ep 1 · 6:50](https://qa.library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-748?t=410)
- "The procedure took 80 minutes and was tolerated well by the infant" (clinical) [Ep 1 · 7:05](https://qa.library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-748?t=425)
- "The patient had diminishing NG aspirates over the next week" (clinical) [Ep 1 · 7:20](https://qa.library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-748?t=440)
- "An upper GI obtained one week postoperatively showed a widely patent anastomosis" (clinical) [Ep 1 · 5:55](https://qa.library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-748?t=355)
- "The resected specimen measured 10 cm" (clinical) [Ep 1 · 5:55](https://qa.library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-748?t=355)
- "Newborn had prenatal diagnosis of bowel obstruction and was found to have jejunal atresia on upper GI study" (clinical) [Ep 2 · 0:00](https://qa.library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-751?t=0)
- "Surgeon stands at baby's feet with cameraman on baby's right and scrub tech on patient's left" (clinical) [Ep 2 · 0:30](https://qa.library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-751?t=30)
- "3-port technique used with 4mm 30-degree scope for visualization and two 3mm ports for dissection" (clinical) [Ep 2 · 0:50](https://qa.library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-751?t=50)
- "Left mid quadrant port was later changed to 5mm for the stapler" (clinical) [Ep 2 · 1:10](https://qa.library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-751?t=70)
- "Veress needle is inserted below the umbilicus to avoid injury to umbilical vessels and prevent CO2 embolism" (clinical) [Ep 2 · 1:20](https://qa.library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-751?t=80)
- "Complete gap identified between proximal jejunum and distal bowel" (clinical) [Ep 2 · 2:00](https://qa.library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-751?t=120)
- "Visualization of appendix and cecum suggests apple peel defect" (clinical) [Ep 2 · 2:20](https://qa.library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-751?t=140)
- "Bowel twisting around mesentery confirmed apple peel defect" (clinical) [Ep 2 · 2:40](https://qa.library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-751?t=160)
- "Because there was no evidence of kink or significant obstruction, mesentery was not further manipulated" (clinical) [Ep 2 · 3:00](https://qa.library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-751?t=180)
- "Decision made to remove proximal dilated segment to improve bowel motility following surgery because it was relatively short and significantly dilated" (clinical) [Ep 2 · 3:20](https://qa.library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-751?t=200)
- "3mm bipolar vessel sealer used to take down mesentery by clamping, sealing, and teasing vessels off mesenteric border of bowel" (clinical) [Ep 2 · 3:50](https://qa.library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-751?t=230)
- "Dissection carried back almost to ligament of Treitz and encompassed approximately 10 cm length of bowel" (clinical) [Ep 2 · 4:10](https://qa.library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-751?t=250)
- "5mm endoscopic stapler lays down 4 rows of staples and divides between them" (clinical) [Ep 2 · 4:30](https://qa.library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-751?t=270)
- "Two applications of stapler required because bowel was so dilated with diameter almost 4 cm" (clinical) [Ep 2 · 4:45](https://qa.library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-751?t=285)
- "Distal jejunal segment anastomosed to proximal dilated segment in end-to-side fashion" (clinical) [Ep 2 · 5:00](https://qa.library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-751?t=300)
- "Enterotomy made in proximal dilated bowel using 3mm hook cautery and decompressed with 3mm sucker" (clinical) [Ep 2 · 5:15](https://qa.library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-751?t=315)
- "Distal jejunal segment enterotomy slightly dilated to allow access of stapler" (clinical) [Ep 2 · 5:30](https://qa.library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-751?t=330)
- "End-to-side anastomosis approximately 2.5 cm in length performed without difficulty" (clinical) [Ep 2 · 5:40](https://qa.library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-751?t=340)
- "Resultant enterotomy closed with running bioabsorbable suture" (clinical) [Ep 2 · 5:55](https://qa.library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-751?t=355)
- "Previous to having stapler, would have performed end-to-end anastomosis with multiple interrupted or running sutures" (clinical) [Ep 2 · 6:05](https://qa.library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-751?t=365)
- "No evidence of significant mesenteric defect or gap in anatomy after enterotomy completion" (clinical) [Ep 2 · 6:20](https://qa.library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-751?t=380)
- "Procedure took 80 minutes and was tolerated well by infant" (clinical) [Ep 2 · 6:35](https://qa.library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-751?t=395)
- "Patient had diminishing NG aspirates over next week" (clinical) [Ep 2 · 6:50](https://qa.library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-751?t=410)
- "Upper GI obtained one week postoperatively showed widely patent anastomosis" (clinical) [Ep 2 · 7:00](https://qa.library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-751?t=420)
- "Resected specimen measured 10 cm" (clinical) [Ep 2 · 7:15](https://qa.library.globalcastmd.com/watch/laparoscopic-jejunal-atresia-repair-technique-751?t=435)

## Changelog
- Sep 15: 3 items added automatically

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