Alex Gibbons

13 statements · 5 topics · summaries given as host listed separately

Abdominal Wall Defects · guest expert Etiologies (Gastroschisis/NEC/Atresia/Volvulus) · guest expert Intestinal Rehab · guest expert

Featured statements

The chief limitation of thoracoscopic TEF repair is the technical demand, specifically the challenge of the anastomosis done in situ.
opinion · Esophageal Atresia
The retrospective data suggest no difference in leak rate or stricture rate between thoracoscopic and open TEF repair.
clinical · Esophageal Atresia

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Alex's statements about Appendicitis 1 statement

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Update Course Rewind: Perforated Appendicitis 2019

Quotation I think one of the issues is that no matter how good your data are, you can't beat a good rhyme. Open
Alex's statements about Appendicitis 1 statement

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Update Course Rewind: Perforated Appendicitis 2019

Quotation I think one of the issues is that no matter how good your data are, you can't beat a good rhyme. Open
Alex's statements about Esophageal Atresia 5 statements

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Thoracoscopic TEF Repair, Is It Really Better Than Open? Update Course 2018

Quotation I think the data would suggest a qualified yes. Open
Statement The retrospective data suggest no difference in leak rate or stricture rate between thoracoscopic and open TEF repair. Open
Statement There is potential benefit with thoracoscopic approach in time to extubation, time to first oral feeding, overall hospital length of stay, and musculoskeletal sequelae. Open
Statement The chief limitation of thoracoscopic TEF repair is the technical demand, specifically the challenge of the anastomosis done in situ. Open
Statement There remains a need for a powered randomized controlled trial comparing thoracoscopic and open TEF repair. Open
Alex's statements about Non-perforated Appendicitis 1 statement

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Update Course Rewind: Perforated Appendicitis 2019

Quotation I think one of the issues is that no matter how good your data are, you can't beat a good rhyme. Open
Alex's statements about Tracheoesophageal Fistula 5 statements

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Thoracoscopic TEF Repair, Is It Really Better Than Open? Update Course 2018

Quotation I think the data would suggest a qualified yes. Open
Statement The retrospective data suggest no difference in leak rate or stricture rate between thoracoscopic and open TEF repair. Open
Statement There is potential benefit with thoracoscopic approach in time to extubation, time to first oral feeding, overall hospital length of stay, and musculoskeletal sequelae. Open
Statement The chief limitation of thoracoscopic TEF repair is the technical demand, specifically the challenge of the anastomosis done in situ. Open
Statement There remains a need for a powered randomized controlled trial comparing thoracoscopic and open TEF repair. Open

Summaries Alex gave as host · 57 summaries

Recaps of other experts' statements, not Alex's own clinical position.

Summaries Alex gave as host · Abdominal Wall Defects 1 summary

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7th Annual Pediatric Surgery Update Course 2019 - FULL SHOW

Host summary Alex Gibbons summarizing the discussion: Restrictive transfusion protocols using a target hemoglobin of 7 instead of 8, 9, or 10 showed no difference in mortality Open
Summaries Alex gave as host · Esophageal Atresia 27 summaries

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Thoracoscopic TEF Repair, Is It Really Better Than Open? Update Course 2018

Host summary Alex Gibbons summarizing the discussion: The first successful open repair of tracheoesophageal fistula was performed in 1941 by Dr. Cameron Haight. Open
Host summary Alex Gibbons summarizes what Dr. Steven Rothenberg said: 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). Open
Host summary Alex Gibbons summarizes what Dr. Steven Rothenberg said: In Rothenberg's first decade of experience with 62 patients, he reported that thoracoscopic approach offered better visualization of the anatomy. Open
Host summary Alex Gibbons summarizes what Dr. Steven Rothenberg said: Rothenberg reported that performing the operation entirely in situ reduced manipulation of the trachea and therefore potentially reduced risk for tracheomalacia. Open
Host summary Alex Gibbons summarizes what Dr. Steven Rothenberg said: Rothenberg reported decreased tension on the esophageal anastomosis with thoracoscopic approach. Open
Host summary Alex Gibbons summarizes what Dr. Steven Rothenberg said: Rothenberg reported that smaller incisions would result in fewer musculoskeletal deformities such as scapular winging, chest wall asymmetry, and scoliosis. Open
Host summary Alex Gibbons summarizing the discussion: 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. Open
Host summary Alex Gibbons summarizing the discussion: The Tübingen study found slightly more associated anomalies in the minimally invasive group at about 40% compared to 31% in the open group. Open
Host summary Alex Gibbons summarizing the discussion: The Tübingen study found no statistically significant difference between groups in complication rate or time to postoperative extubation. Open
Host summary Alex Gibbons summarizing the discussion: 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. Open
Host summary Alex Gibbons summarizing the discussion: The Tübingen study found higher intraoperative PaCO2 in the MIS group, but postoperatively there was no statistically significant difference. Open
Host summary Alex Gibbons summarizing the discussion: 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. Open
Host summary Alex Gibbons summarizing the discussion: The Holcomb study found results equivalent to historical open controls in mortality rate and need for postoperative fundoplication. Open
Host summary Alex Gibbons summarizing the discussion: The Holcomb study found results compared favorably to historical controls in terms of leak and recurrence. Open
Host summary Alex Gibbons summarizing the discussion: The Japanese multi-center study of 7 hospitals with 58 patients found equivalence in mortality, leak rate, and recurrence between MIS and open approaches. Open
Host summary Alex Gibbons summarizing the discussion: The Japanese study found a higher stricture rate in the minimally invasive group at about 48% compared to 17% in the open group. Open
Host summary Alex Gibbons summarizing the discussion: 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. Open
Host summary Alex Gibbons summarizing the discussion: The Hanover study found patients were more satisfied with scarring in the MIS group based on Manchester scarring criteria. Open
Host summary Alex Gibbons summarizing the discussion: 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. Open
Host summary Alex Gibbons summarizing the discussion: The Hanover study found no difference in shoulder range of motion between MIS and open groups. Open
Host summary Alex Gibbons summarizing the discussion: 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. Open
Host summary Alex Gibbons summarizing the discussion: A 2016 meta-analysis of 8 articles with 452 patients (221 MIS, 231 open) found no difference in stricture rate or leak rate. Open
Host summary Alex Gibbons summarizing the discussion: The 2016 meta-analysis found operative time was about 20 minutes longer in the minimally invasive group. Open
Host summary Alex Gibbons summarizing the discussion: The 2016 meta-analysis found time to postoperative extubation and first postoperative feeding were about 2.5 days sooner in the MIS group. Open
Host summary Alex Gibbons summarizing the discussion: The 2016 meta-analysis found hospital length of stay was almost 11 days shorter in the MIS group. Open
Host summary Alex Gibbons summarizing the discussion: 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. Open
Host summary Alex Gibbons summarizing the discussion: 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. Open
Summaries Alex gave as host · Etiologies (Gastroschisis/NEC/Atresia/Volvulus) 1 summary

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7th Annual Pediatric Surgery Update Course 2019 - FULL SHOW

Host summary Alex Gibbons summarizing the discussion: Restrictive transfusion protocols using a target hemoglobin of 7 instead of 8, 9, or 10 showed no difference in mortality Open
Summaries Alex gave as host · Intestinal Rehab 1 summary

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7th Annual Pediatric Surgery Update Course 2019 - FULL SHOW

Host summary Alex Gibbons summarizing the discussion: Restrictive transfusion protocols using a target hemoglobin of 7 instead of 8, 9, or 10 showed no difference in mortality Open
Summaries Alex gave as host · Tracheoesophageal Fistula 27 summaries

Open the Tracheoesophageal Fistula collection →

Thoracoscopic TEF Repair, Is It Really Better Than Open? Update Course 2018

Host summary Alex Gibbons summarizing the discussion: The first successful open repair of tracheoesophageal fistula was performed in 1941 by Dr. Cameron Haight. Open
Host summary Alex Gibbons summarizes what Dr. Steven Rothenberg said: 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). Open
Host summary Alex Gibbons summarizes what Dr. Steven Rothenberg said: In Rothenberg's first decade of experience with 62 patients, he reported that thoracoscopic approach offered better visualization of the anatomy. Open
Host summary Alex Gibbons summarizes what Dr. Steven Rothenberg said: Rothenberg reported that performing the operation entirely in situ reduced manipulation of the trachea and therefore potentially reduced risk for tracheomalacia. Open
Host summary Alex Gibbons summarizes what Dr. Steven Rothenberg said: Rothenberg reported decreased tension on the esophageal anastomosis with thoracoscopic approach. Open
Host summary Alex Gibbons summarizes what Dr. Steven Rothenberg said: Rothenberg reported that smaller incisions would result in fewer musculoskeletal deformities such as scapular winging, chest wall asymmetry, and scoliosis. Open
Host summary Alex Gibbons summarizing the discussion: 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. Open
Host summary Alex Gibbons summarizing the discussion: The Tübingen study found slightly more associated anomalies in the minimally invasive group at about 40% compared to 31% in the open group. Open
Host summary Alex Gibbons summarizing the discussion: The Tübingen study found no statistically significant difference between groups in complication rate or time to postoperative extubation. Open
Host summary Alex Gibbons summarizing the discussion: 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. Open
Host summary Alex Gibbons summarizing the discussion: The Tübingen study found higher intraoperative PaCO2 in the MIS group, but postoperatively there was no statistically significant difference. Open
Host summary Alex Gibbons summarizing the discussion: 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. Open
Host summary Alex Gibbons summarizing the discussion: The Holcomb study found results equivalent to historical open controls in mortality rate and need for postoperative fundoplication. Open
Host summary Alex Gibbons summarizing the discussion: The Holcomb study found results compared favorably to historical controls in terms of leak and recurrence. Open
Host summary Alex Gibbons summarizing the discussion: The Japanese multi-center study of 7 hospitals with 58 patients found equivalence in mortality, leak rate, and recurrence between MIS and open approaches. Open
Host summary Alex Gibbons summarizing the discussion: The Japanese study found a higher stricture rate in the minimally invasive group at about 48% compared to 17% in the open group. Open
Host summary Alex Gibbons summarizing the discussion: 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. Open
Host summary Alex Gibbons summarizing the discussion: The Hanover study found patients were more satisfied with scarring in the MIS group based on Manchester scarring criteria. Open
Host summary Alex Gibbons summarizing the discussion: 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. Open
Host summary Alex Gibbons summarizing the discussion: The Hanover study found no difference in shoulder range of motion between MIS and open groups. Open
Host summary Alex Gibbons summarizing the discussion: 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. Open
Host summary Alex Gibbons summarizing the discussion: A 2016 meta-analysis of 8 articles with 452 patients (221 MIS, 231 open) found no difference in stricture rate or leak rate. Open
Host summary Alex Gibbons summarizing the discussion: The 2016 meta-analysis found operative time was about 20 minutes longer in the minimally invasive group. Open
Host summary Alex Gibbons summarizing the discussion: The 2016 meta-analysis found time to postoperative extubation and first postoperative feeding were about 2.5 days sooner in the MIS group. Open
Host summary Alex Gibbons summarizing the discussion: The 2016 meta-analysis found hospital length of stay was almost 11 days shorter in the MIS group. Open
Host summary Alex Gibbons summarizing the discussion: 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. Open
Host summary Alex Gibbons summarizing the discussion: 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. Open