I was a cryo skeptic. My biggest issues with it were the added time. The other is concerned about the neuralgia and the complications that I'd heard about. And I will tell you that it took me about four cases to realize, because most of our patients went home on day two or three. But it's not just when they go home. It's how they feel when they go home. And the cryo has been unbelievable. I mean, I feel bad that I waited so long.
I was a cryo skeptic. My biggest issues with it were the added time. The other is concerned about the neuralgia and the complications that I'd heard about. And I will tell you that it took me about four cases to realize, because most of our patients went home on day two or three. But it's not just when they go home. It's how they feel when they go home. And the cryo has been unbelievable. I mean, I feel bad that I waited so long.
I was a cryo skeptic. My biggest issues with it were the added time. The other is concerned about the neuralgia and the complications that I'd heard about. And I will tell you that it took me about four cases to realize, because most of our patients went home on day two or three. But it's not just when they go home. It's how they feel when they go home. And the cryo has been unbelievable. I mean, I feel bad that I waited so long.
I was a cryo skeptic. My biggest issues with it were the added time. The other is concerned about the neuralgia and the complications that I'd heard about. And I will tell you that it took me about four cases to realize, because most of our patients went home on day two or three. But it's not just when they go home. It's how they feel when they go home. And the cryo has been unbelievable. I mean, I feel bad that I waited so long.
These 4 patients got voluntary bowel movements with higher productivity and confidence, so it seems that we have an option for overstretched anal sphincters in patients with Hirschsprung disease after a pull-through.
They reviewed 6 articles and they found that patients operated before the discharge in the first hospitalization had lower odds of incarceration but had higher risk of respiratory complications in the post-op.
host_summaryTEG may help identify hemorrhagic trauma patients who will benefit from cryoprecipitate or platelet transfusions.↗
▶Ep 30 · 3:33
host_summaryPhilips et al. conducted a retrospective study from 2015 to 2018 evaluating 117 patients from two trauma centers.↗
▶Ep 30 · 3:33
host_summaryPatients receiving massive transfusions had shortened alpha angles on TEG analysis.↗
▶Ep 30 · 3:33
host_summaryPatients receiving massive transfusions had lower maximum amplitude values on TEG analysis.↗
▶Ep 30 · 3:33
host_summaryPatients receiving massive transfusions had lower platelet counts.↗
Quick Literature Updates Episode 11
▶Ep 32 · 3:07
host_summaryThe overall rate for periumbilical hernias after gastroschisis closure was 22.7%.↗
▶Ep 32 · 3:07
host_summaryPatients who underwent sutureless gastroschisis closures had 50% rates of persistent hernia.↗
▶Ep 32 · 3:07
host_summaryFrazier et al. conducted a retrospective study from the Midwest Pediatric Surgery Consortium following 375 patients with gastroschisis who underwent closure between 2013 and 2016.↗
▶Ep 32 · 3:07
host_summaryPeriumbilical hernia rate was significantly higher in patients who underwent primary closure versus those who needed silo placement.↗
▶Ep 32 · 3:07
host_summaryOnly 16.4% of patients who underwent sutured gastroschisis closure had a persistent hernia.↗
▶Ep 32 · 3:07
host_summarySpontaneous closure of periumbilical hernias after gastroschisis was seen in 38.8% of cases.↗
▶Ep 32 · 3:07
host_summaryOnly 31.8% of patients with periumbilical hernias after gastroschisis needed surgery.↗
▶Ep 32 · 3:07
host_summarySutureless gastroschisis closures lead to more periumbilical hernias, but they can be managed as any other congenital umbilical hernia and have no additional risk.↗
Quick Literature Updates Episode 20
▶Ep 43 · 3:01
epidemiologicalEsposito et al. retrospective comparison conducted in Italy included 83 patients who underwent laparoscopic cholecystectomy without ICG (group one) and 90 patients with ICG (group two).↗
▶Ep 43 · 3:01
host_summaryEsposito et al. retrospective comparison conducted in Italy included 83 patients who underwent laparoscopic cholecystectomy without ICG (group one) and 90 patients with ICG (group two).↗
▶Ep 43 · 3:23
clinicalLaparoscopic cholecystectomy with ICG provided better visualization of the biliary tree compared to without ICG.↗
▶Ep 43 · 3:23
host_summaryLaparoscopic cholecystectomy with ICG had no complications compared to 12% complication rate without ICG.↗
▶Ep 43 · 3:23
host_summaryLaparoscopic cholecystectomy with ICG had shorter surgery time compared to without ICG.↗
▶Ep 43 · 3:23
clinicalLaparoscopic cholecystectomy with ICG had shorter surgery time compared to without ICG.↗
▶Ep 43 · 3:23
clinicalLaparoscopic cholecystectomy with ICG had no complications compared to 12% complication rate without ICG.↗
▶Ep 43 · 3:23
host_summaryLaparoscopic cholecystectomy with ICG provided better visualization of the biliary tree compared to without ICG.↗
▶Ep 43 · 3:38
host_summaryLaparoscopic cholecystectomy with ICG can be the new standard in pediatric surgery practice.↗
▶Ep 43 · 3:38
quoteSo it seems that laparoscopic cholecystectomy with ICG can be the new standard in our practice.↗
▶Ep 43 · 3:38
quoteSo it seems that laparoscopic cholecystectomy with ICG can be the new standard in our practice.↗
▶Ep 43 · 3:38
opinionLaparoscopic cholecystectomy with ICG can be the new standard in pediatric surgery practice.↗
Quick Literature Updates Ep 22
▶Ep 44 · 3:16
host_summaryThe Pefer et al. study is a retrospective study done in Texas using a state hospital database examining CDH outcomes by center volume.↗
▶Ep 44 · 3:32
host_summaryThe Pefer study identified 1,314 CDH patients: 728 from high volume centers, 9 from mid-volume centers, and 79 from low volume centers.↗
▶Ep 44 · 3:46
host_summaryHigh volume centers had significantly lower mortality rates for CDH, even though they have significantly sicker patients.↗
▶Ep 44 · 3:46
host_summaryHigh volume centers had significantly shorter length of stay for CDH patients.↗
▶Ep 44 · 4:00
host_summaryHigh volume centers had better outcomes for patients with CDH.↗
Update Course Rewind: Management of Recurrent Pancreatitis
▶Ep 8 · 2:26
guidelineIf a patient has more than one episode of acute pancreatitis or a first severe episode, an MRCP and genetic panel should be performed to rule out genetic anomalies.↗
▶Ep 8 · 2:26
host_summaryIf a patient has more than one episode of acute pancreatitis or a first severe episode, an MRCP and genetic panel should be performed to rule out genetic anomalies.↗
▶Ep 8 · 3:37
host_summaryGenetics are very important before any resection procedure to avoid losing pancreatic cells in pathologies that will not benefit from resection and drainage but instead from islet cell transplant.↗
▶Ep 8 · 3:37
guidelineGenetics are very important before any resection procedure to avoid losing pancreatic cells in pathologies that will not benefit from resection and drainage but instead from islet cell transplant.↗
▶Ep 8 · 4:37
guidelineEndoscopic treatment should be attempted first, but if it fails, transfer to a specialized center that performs TPIAT (total pancreatectomy with islet autotransplantation).↗
▶Ep 8 · 4:37
host_summaryEndoscopic treatment should be attempted first, but if it fails, transfer to a specialized center that performs TPIAT (total pancreatectomy with islet autotransplantation).↗
▶Ep 8 · 5:11
host_summaryFor pancreatic imaging, start with ultrasound, then CT, and for better visualization of pancreatic anatomy, use MRCP with T2 sequences.↗
▶Ep 8 · 5:11
guidelineFor pancreatic imaging, start with ultrasound, then CT, and for better visualization of pancreatic anatomy, use MRCP with T2 sequences.↗
▶Ep 8 · 5:40
clinicalRecurrent pancreatitis is a rare pathology that can lead to chronic pancreatitis and is associated with genetic mutations.↗
▶Ep 8 · 5:40
host_summaryRecurrent pancreatitis is a rare pathology that can lead to chronic pancreatitis and is associated with genetic mutations.↗
▶Ep 8 · 5:50
host_summaryIf genetic mutations are confirmed, partial resection (e.g., Frey procedure) should be avoided to preserve pancreatic cells, and TPIAT should be considered sooner rather than later if endoscopic treatment fails.↗
▶Ep 8 · 5:50
guidelineIf genetic mutations are confirmed, partial resection (e.g., Frey procedure) should be avoided to preserve pancreatic cells, and TPIAT should be considered sooner rather than later if endoscopic treatment fails.↗
Esophageal Surveillance Practices in Esophageal Atresia Patients
▶Ep 15 · 0:00
host_summaryThere is high agreement with current guidelines but weak adherence to them in esophageal atresia surveillance↗
▶Ep 15 · 0:00
host_summaryThe 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↗
▶Ep 15 · 0:00
host_summary139 pediatric surgeons responded to the survey↗
▶Ep 15 · 0:00
host_summary75% of respondents strongly agree or agree with current guidelines for esophageal atresia surveillance↗
▶Ep 15 · 0:00
host_summaryOnly 37% of respondents reported that their esophageal atresia patients have pre-determined outpatient clinic follow-up schedule↗
▶Ep 15 · 0:00
host_summary80% of respondents agree or strongly agree that endoscopy should follow a set schedule↗
▶Ep 15 · 0:00
host_summaryOnly 37% of respondents performed follow-up endoscopy regardless of symptoms↗
host_summaryThe Bokova et al. study is a multi-institutional one-year outcome study of anal sphincter reconstruction for patulous sphincter in 6 patients.↗
▶Ep 48 · 4:00
host_summaryFour patients in the sphincter reconstruction study received only anal sphincter reconstruction without redo pull-through.↗
▶Ep 48 · 4:00
host_summaryOf the 6 patients in the sphincter reconstruction study, 2 had Down syndrome and underwent redo pull-through with anal sphincter reconstruction.↗
▶Ep 48 · 4:12
host_summaryAnal sphincter reconstruction appears to be an option for overstretched anal sphincters in patients with Hirschsprung disease after a pull-through.↗
▶Ep 48 · 4:12
host_summaryThe 4 patients who received only anal sphincter reconstruction achieved voluntary bowel movements with higher productivity and confidence.↗
Transitional Care in Anorectal Malformation and Hirschsprung's Disease
▶Ep 50 · 0:00
quoteDo you have a transitional care coordinator for colorectal patients in your hospital?↗
▶Ep 50 · 0:10
epidemiologicalA systematic review was conducted in the UK to establish and categorize challenges and solutions related to transitional care in colorectal patients↗
▶Ep 50 · 0:23
epidemiologicalThe systematic review included 234 studies↗
▶Ep 50 · 0:28
clinicalThe first challenge identified was patients' lack of understanding of their own pathology↗
▶Ep 50 · 0:34
clinicalThe second challenge was the lack of education and awareness of adult surgeons about pediatric colorectal pathologies↗
▶Ep 50 · 0:44
clinicalThe third challenge was the lack of an instructional transitional care program↗
▶Ep 50 · 0:46
guidelineThe third proposed solution was to create a structured and coordinated transition program↗
▶Ep 50 · 0:46
guidelineThe second proposed solution was to conduct joint pediatric adult transitional clinics↗
▶Ep 50 · 0:46
guidelineThe first proposed solution was to foster young adult patients' autonomy↗
Quick Literature Updates Episode 18
▶Ep 56 · 3:13
host_summaryA retrospective cohort study of CPAM included 110 patients comparing outcomes based on timing of surgery relative to symptom onset.↗
▶Ep 56 · 3:21
host_summaryPatients with CPAM who underwent surgery before becoming symptomatic had shorter length of stay compared to those operated after symptom onset.↗
▶Ep 56 · 3:21
host_summaryPatients with CPAM who underwent surgery before becoming symptomatic had shorter mechanical ventilation time after surgery compared to those operated after symptom onset.↗
▶Ep 56 · 3:21
host_summaryPatients with CPAM who underwent surgery before becoming symptomatic had shorter operating times compared to those operated after symptom onset.↗
▶Ep 56 · 3:31
host_summaryIn the CPAM study, there was no significant difference in conversion rates or post-operative complications between patients operated before versus after symptom onset.↗
▶Ep 56 · 3:44
host_summaryThe CPAM study findings suggest it is safer to operate these patients before they become symptomatic.↗
▶Ep 56 · 3:44
quoteSo it seems that it's safer to operate these patients before they become symptomatic.↗
Quick Literature Updates Ep 23
▶Ep 64 · 3:10
host_summaryA UK systematic review aimed to establish and categorize challenges and solutions related to transitional care in colorectal patients with anorectal malformations and Hirschsprung's disease.↗
▶Ep 64 · 3:23
host_summaryThe systematic review included 234 studies and established 3 challenges and solutions.↗
▶Ep 64 · 3:29
host_summaryThe first challenge in transitional care for colorectal patients is the patients' lack of understanding of their own pathology.↗
▶Ep 64 · 3:34
host_summaryThe second challenge is the lack of education and awareness of adult surgeons about pediatric colorectal pathologies.↗
▶Ep 64 · 3:42
host_summaryThe third challenge is the lack of a structured transitional care program.↗
▶Ep 64 · 3:46
host_summaryThe first proposed solution is to foster young adult patients' autonomy.↗
▶Ep 64 · 3:46
host_summaryThe second proposed solution is to conduct joint pediatric-adult transitional clinics.↗
▶Ep 64 · 3:46
host_summaryThe third proposed solution is to create a structured and coordinated transition program.↗
host_summaryOnly 31.8% of patients with periumbilical hernias after gastroschisis needed surgery.↗
▶Ep 10 · 3:07
host_summaryFrazier et al. conducted a retrospective study from the Midwest Pediatric Surgery Consortium following 375 patients with gastroschisis who underwent closure between 2013 and 2016.↗
▶Ep 10 · 3:07
host_summarySutureless gastroschisis closures lead to more periumbilical hernias, but they can be managed as any other congenital umbilical hernia and have no additional risk.↗
▶Ep 10 · 3:07
host_summarySpontaneous closure of periumbilical hernias after gastroschisis was seen in 38.8% of cases.↗
▶Ep 10 · 3:07
host_summaryOnly 16.4% of patients who underwent sutured gastroschisis closure had a persistent hernia.↗
▶Ep 10 · 3:07
host_summaryPatients who underwent sutureless gastroschisis closures had 50% rates of persistent hernia.↗
▶Ep 10 · 3:07
host_summaryPeriumbilical hernia rate was significantly higher in patients who underwent primary closure versus those who needed silo placement.↗
▶Ep 10 · 3:07
host_summaryThe overall rate for periumbilical hernias after gastroschisis closure was 22.7%.↗
Quick Literature Updates Ep 24
▶Ep 11 · 3:34
host_summaryThe Rao et al. study is a multi-center retrospective study done in the US from 2018 to 2022.↗
▶Ep 11 · 3:34
host_summaryThe Rao study compared patients with suspected choledocholithiasis who underwent transcystic laparoscopic common bile duct exploration versus those who underwent ERCP first.↗
▶Ep 11 · 3:53
host_summaryThe Rao study included 252 patients total: 156 in the transcystic laparoscopic common bile duct exploration group and 96 in the ERCP-first group.↗
▶Ep 11 · 4:02
host_summaryPatients who underwent transcystic laparoscopic common bile duct exploration had lower length of stay compared to ERCP-first patients.↗
▶Ep 11 · 4:02
host_summaryPatients who underwent transcystic laparoscopic common bile duct exploration had significantly less complication rates compared to ERCP-first patients.↗
▶Ep 11 · 4:16
host_summaryAttempting a transcystic laparoscopic common bile duct exploration may benefit pediatric choledocholithiasis patients.↗
Prof. Shilpa Sharma - Best of the Best in Pediatric Surgery 2024
▶Ep 17 · 5:08
clinicalThe team resected the left liver (segments 2 and 3) to leave enough liver to regenerate, particularly in patients presenting late after 80 days of life.↗
Clinical Characteristics and Prognosis of Biliary Atresia with Low Serum Matrix Metalloproteinase-7 Levels
▶Ep 21 · 0:11
epidemiologicalThe study was a retrospective cohort study conducted in China↗
▶Ep 21 · 0:11
quoteThis is a retrospective cohort study done in China that aimed to evaluate the characteristics and prognosis of patients with biliary atresia and low MMP 7.↗
▶Ep 21 · 0:21
quoteThey had 329 patients, and 40 of them had low MMP7.↗
▶Ep 21 · 0:21
epidemiologicalThe study included 329 patients with biliary atresia↗
▶Ep 21 · 0:21
epidemiological40 of the 329 patients had low MMP-7 levels↗
▶Ep 21 · 0:27
clinicalPatients with low MMP-7 had significantly lower 3-month jaundice clearance↗
▶Ep 21 · 0:27
clinicalPatients with low MMP-7 had significantly lower 6-month jaundice clearance↗
▶Ep 21 · 0:27
clinicalPatients with low MMP-7 had significantly lower 1-year native liver survival↗
▶Ep 21 · 0:27
quoteAnd what they found is that these patients had significantly lower 3 month and 6 month jaundice clearance and significantly lower 1 year native liver survival.↗
▶Ep 21 · 0:40
opinionMMP-7 measurement may in the future help with treatment of biliary atresia patients↗
▶Ep 21 · 0:40
opinionMeasuring MMP-7 can help with prognosis in biliary atresia patients↗
clinicalThe Hirschsprung-associated IBD study was a retrospective study gathering patients from 2000 to 2021 at 17 institutions.↗
▶Ep 5 · 0:59
host_summaryThe Hirschsprung-associated IBD study was a retrospective study gathering patients from 2000 to 2021 at 17 institutions.↗
▶Ep 5 · 1:14
host_summaryThe study gathered 55 Hirschsprung patients, and 50% had long segment disease.↗
▶Ep 5 · 1:14
epidemiologicalThe study gathered 55 Hirschsprung patients, and 50% had long segment disease.↗
▶Ep 5 · 1:19
epidemiological68% of the Hirschsprung patients had Hirschsprung-associated enterocolitis.↗
▶Ep 5 · 1:19
clinicalLong segment disease, Hirschsprung-associated enterocolitis, and trisomy 21 can be potential risk factors for IBD-like symptoms in Hirschsprung patients after pull through.↗
▶Ep 5 · 1:19
quoteit seems that lung segment disease, Hirschprung associated enterocolitis, and trisomy 21 can be potential risk factors for IVD-like symptoms in Hirschprung patients after pull through.↗
▶Ep 5 · 1:19
epidemiological10% of the Hirschsprung patients had trisomy 21.↗
▶Ep 5 · 1:19
quoteit seems that lung segment disease, Hirschprung associated enterocolitis, and trisomy 21 can be potential risk factors for IVD-like symptoms in Hirschprung patients after pull through.↗
▶Ep 5 · 1:19
host_summaryLong segment disease, Hirschsprung-associated enterocolitis, and trisomy 21 can be potential risk factors for IBD-like symptoms in Hirschsprung patients after pull through.↗
▶Ep 5 · 1:19
host_summary10% of the Hirschsprung patients had trisomy 21.↗
▶Ep 5 · 1:19
host_summary68% of the Hirschsprung patients had Hirschsprung-associated enterocolitis.↗
▶Ep 5 · 3:09
host_summaryThe solid organ injury study was a retrospective study done in South Carolina examining if isolated solid organ injuries after blunt abdominal trauma can be discharged from the ED.↗
▶Ep 5 · 3:09
clinicalThe solid organ injury study was a retrospective study done in South Carolina examining if isolated solid organ injuries after blunt abdominal trauma can be discharged from the ED.↗
▶Ep 5 · 3:19
epidemiologicalThe study gathered 262 patients with isolated solid organ injuries, grades 1 to 3.↗
▶Ep 5 · 3:19
host_summaryThe study gathered 262 patients with isolated solid organ injuries, grades 1 to 3.↗
▶Ep 5 · 3:26
host_summary148 patients had solid organ injuries grades 1 or 2, and none of them required an acute intervention.↗
▶Ep 5 · 3:26
clinical148 patients had solid organ injuries grades 1 or 2, and none of them required an acute intervention.↗
▶Ep 5 · 3:34
clinicalOf 114 patients with grade 3 solid organ injuries, only 3 patients required an acute intervention.↗
▶Ep 5 · 3:34
host_summaryOf 114 patients with grade 3 solid organ injuries, only 3 patients required an acute intervention.↗
▶Ep 5 · 3:44
host_summaryIsolated solid organ injuries after blunt abdominal trauma, grades 1 or 2, can be discharged from the ED.↗
▶Ep 5 · 3:44
quoteSo it seems that isolated solid organ injuries after a blunt abdominal trauma, grades 1 or 2 can be discharged from the ED.↗
▶Ep 5 · 3:44
quoteSo it seems that isolated solid organ injuries after a blunt abdominal trauma, grades 1 or 2 can be discharged from the ED.↗
▶Ep 5 · 3:44
clinicalIsolated solid organ injuries after blunt abdominal trauma, grades 1 or 2, can be discharged from the ED.↗
Transcystic Laparoscopic Common Bile Duct Exploration for Pediatric Patients with Choledocholithiasis
▶Ep 1 · 0:09
epidemiologicalThe study was a multi-center retrospective study conducted in the US from 2018 to 2022↗
▶Ep 1 · 0:09
epidemiologicalThe study aim was to compare patients with suspected choledocholithiasis who underwent transcystic laparoscopic common bile duct exploration versus those who underwent ERCP first↗
▶Ep 1 · 0:09
quoteThis is a multi-center retrospective study done in the US from 2018 to 2022, and their aim was to compare patients with suspected.↗
▶Ep 1 · 0:28
epidemiologicalThe study included 252 patients total↗
▶Ep 1 · 0:28
epidemiological156 patients were in group one (transcystic laparoscopic common bile duct exploration)↗
▶Ep 1 · 0:38
clinicalPatients in group one (transcystic laparoscopic approach) had significantly less complication rates compared to group two↗
▶Ep 1 · 0:38
epidemiological96 patients were in group two (ERCP first)↗
▶Ep 1 · 0:38
clinicalPatients in group one (transcystic laparoscopic approach) had lower length of stay compared to group two↗
▶Ep 1 · 0:52
opinionAttempting a transcystic laparoscopic common bile duct exploration may benefit pediatric patients with choledocholithiasis↗
▶Ep 1 · 0:52
quoteSo it seems that attempting a transcystic laparoscopic common bile duct exploration may benefit our patients.↗
Choledocholithiasis with Drs. David Vitale & Lucas Neff
▶Ep 2 · 0:43
host_summaryCholedocholithiasis stones may be made up of bile pigments or calcium and cholesterol salts.↗
▶Ep 2 · 2:11
host_summaryPatients with intermediate risk (abnormal liver biochemical tests or dilated common bile ducts) can undergo endoscopic ultrasound, MRCP, laparoscopic cholangiogram, or intraoperative ultrasound.↗
▶Ep 2 · 2:50
host_summaryCommon bile duct diameter greater than 6 millimeters was most sensitive for predicting common bile duct stones in children, although without statistical significance.↗
▶Ep 2 · 4:18
host_summaryRandomized trials from 2013 show no significant difference in morbidity, mortality, retained stones, or failure rates between ERCP and laparoscopic common bile duct exploration.↗
▶Ep 2 · 8:59
host_summaryMost free-standing children's hospitals do not have ERCP capabilities.↗
▶Ep 2 · 12:24
host_summaryIf the pancreatic duct is visualized during fluoroscopy, the procedure should be stopped due to higher risk for pancreatitis.↗
host_summaryIn a multi-center study of 167 early cholecystectomy patients versus 79 delayed, early cholecystectomy had 2% recurrence of pancreatitis compared to 22% in delayed surgery↗
▶Ep 3 · 3:36
host_summaryWhen cholecystectomy was delayed more than 6 weeks after gallstone pancreatitis, recurrence rate increased to 60%↗
▶Ep 3 · 4:27
host_summaryPatients who underwent early cholecystectomy did not have more biliary complications than delayed surgery patients↗
▶Ep 3 · 11:27
host_summaryIn a multi-center study of 252 patients with choledocholithiasis, 156 underwent OR-first approach (laparoscopic cholecystectomy with intraoperative cholangiogram) and 96 underwent ERCP-first approach↗
▶Ep 3 · 11:41
host_summaryPatients who underwent intraoperative cholangiogram first had fewer complications and shorter length of stay than ERCP-first patients, and 86% needed only the surgery without subsequent ERCP↗
Choledocholithiasis with Drs. David Vitale & Lucas Neff
▶Ep 4 · 0:43
host_summaryCholedocholithiasis stones may be made up of bile pigments or calcium and cholesterol salts.↗
▶Ep 4 · 2:11
host_summaryPatients with intermediate risk (abnormal liver biochemical tests or dilated common bile ducts) can undergo endoscopic ultrasound, MRCP, laparoscopic cholangiogram, or intraoperative ultrasound.↗
▶Ep 4 · 2:50
host_summaryCommon bile duct diameter greater than 6 millimeters was most sensitive for predicting common bile duct stones in children, although without statistical significance.↗
▶Ep 4 · 4:18
host_summaryRandomized trials from 2013 show no significant difference in morbidity, mortality, retained stones, or failure rates between ERCP and laparoscopic common bile duct exploration.↗
▶Ep 4 · 8:59
host_summaryMost free-standing children's hospitals do not have ERCP capabilities.↗
▶Ep 4 · 12:24
host_summaryIf the pancreatic duct is visualized during fluoroscopy, the procedure should be stopped due to higher risk for pancreatitis.↗
host_summaryAdvanced liver disease is defined as conjugated bilirubin above 5 or 6 mg/dL.↗
▶Ep 4 · 2:36
host_summaryHistorically, 25-50% of intestinal failure patients died because of associated liver disease; now it is less than 2%.↗
▶Ep 4 · 3:19
host_summaryRisk factors for intestinal failure-associated liver disease include prematurity, lack of enteral feeding, sepsis, and TPN components.↗
▶Ep 4 · 12:24
host_summaryProphylactic cholecystectomy is not recommended because the gallbladder helps with enterohepatic circulation and many patients will not need it.↗
Update Course Rewind: Management of Recurrent Pancreatitis
▶Ep 6 · 2:26
guidelineIf a patient has more than one episode of acute pancreatitis or a first severe episode, an MRCP and genetic panel should be performed to rule out genetic anomalies.↗
▶Ep 6 · 2:26
host_summaryIf a patient has more than one episode of acute pancreatitis or a first severe episode, an MRCP and genetic panel should be performed to rule out genetic anomalies.↗
▶Ep 6 · 3:37
guidelineGenetics are very important before any resection procedure to avoid losing pancreatic cells in pathologies that will not benefit from resection and drainage but instead from islet cell transplant.↗
▶Ep 6 · 3:37
host_summaryGenetics are very important before any resection procedure to avoid losing pancreatic cells in pathologies that will not benefit from resection and drainage but instead from islet cell transplant.↗
▶Ep 6 · 4:37
host_summaryEndoscopic treatment should be attempted first, but if it fails, transfer to a specialized center that performs TPIAT (total pancreatectomy with islet autotransplantation).↗
▶Ep 6 · 4:37
guidelineEndoscopic treatment should be attempted first, but if it fails, transfer to a specialized center that performs TPIAT (total pancreatectomy with islet autotransplantation).↗
▶Ep 6 · 5:11
guidelineFor pancreatic imaging, start with ultrasound, then CT, and for better visualization of pancreatic anatomy, use MRCP with T2 sequences.↗
▶Ep 6 · 5:11
host_summaryFor pancreatic imaging, start with ultrasound, then CT, and for better visualization of pancreatic anatomy, use MRCP with T2 sequences.↗
▶Ep 6 · 5:40
host_summaryRecurrent pancreatitis is a rare pathology that can lead to chronic pancreatitis and is associated with genetic mutations.↗
▶Ep 6 · 5:40
clinicalRecurrent pancreatitis is a rare pathology that can lead to chronic pancreatitis and is associated with genetic mutations.↗
▶Ep 6 · 5:50
guidelineIf genetic mutations are confirmed, partial resection (e.g., Frey procedure) should be avoided to preserve pancreatic cells, and TPIAT should be considered sooner rather than later if endoscopic treatment fails.↗
▶Ep 6 · 5:50
host_summaryIf genetic mutations are confirmed, partial resection (e.g., Frey procedure) should be avoided to preserve pancreatic cells, and TPIAT should be considered sooner rather than later if endoscopic treatment fails.↗
Journal of Pediatric Surgery Article Review: February 2023, BAPS issue
▶Ep 135 · 9:23
host_summaryThe Tanzania soap bathing study included 252 patients, with 114 receiving a preoperative bath with plain soap↗
▶Ep 135 · 9:23
epidemiologicalThe Tanzania soap bathing study included 252 patients, with 114 receiving a preoperative bath with plain soap↗
▶Ep 135 · 9:26
epidemiologicalIn the soap bathing group, 11.4% developed surgical site infections compared to 40.6% in the control group↗
▶Ep 135 · 9:26
host_summaryIn the soap bathing group, 11.4% developed surgical site infections compared to 40.6% in the control group↗
▶Ep 135 · 9:43
host_summaryPreoperative soap bathing reduced the odds of surgical site infections by 80%↗
▶Ep 135 · 9:43
epidemiologicalPreoperative soap bathing reduced the odds of surgical site infections by 80%↗
Routine contrast enema prior to stoma reversal seems only required following treatment for necrotizing enterocolitis: An evaluation of the diagnostic accuracy of the contrast enema
▶Ep 137 · 0:00
quoteDo you always do a contrast enema prior to stoma reversal?↗
▶Ep 137 · 0:13
host_summaryA retrospective study was conducted in the Netherlands between 1998 and 2018 examining contrast enema use prior to stoma reversal.↗
▶Ep 137 · 0:24
host_summaryThe study included patients under three years old who underwent stoma reversal.↗
host_summary10% of patients developed strictures.↗
▶Ep 137 · 0:43
host_summary95% of patients with strictures had necrotizing enterocolitis.↗
▶Ep 137 · 0:47
host_summaryOnly 68% of all patients had a contrast enema prior to stoma reversal.↗
▶Ep 137 · 0:51
host_summaryContrast enema was able to detect 92% of strictures.↗
▶Ep 137 · 0:54
opinionContrast enema prior to stoma reversal is only useful if patients had necrotizing enterocolitis.↗
▶Ep 137 · 0:54
quoteSo it seems that contrast enema prior to stoma reversal is only useful if patients had NEC.↗
Quick Literature Updates Episode 7
▶Ep 138 · 2:43
host_summaryThyroidectomies performed by high volume surgeons show shorter length of stays.↗
▶Ep 138 · 2:43
host_summaryThe definition of a high volume surgeon varies widely, ranging from 9 thyroidectomies per year to over 200 thyroidectomies with at least 30 being in pediatric patients.↗
▶Ep 138 · 2:43
host_summaryOlsen et al. systematic review analyzed 10 studies with 6,430 patients examining surgeon volume and pediatric thyroid surgery outcomes.↗
Journal of Pediatric Surgery Article Review: May 2023, CAPS Issue
▶Ep 144 · 1:33
host_summaryThe Hirschsprung-associated IBD study was a retrospective study from 2000 to 2021 at 17 institutions with 55 patients.↗
▶Ep 144 · 1:33
clinicalThe Hirschsprung-associated IBD study was a retrospective study from 2000 to 2021 at 17 institutions with 55 patients.↗
▶Ep 144 · 2:05
host_summary50% of Hirschsprung-associated IBD patients had long segment disease.↗
▶Ep 144 · 2:05
epidemiologicalEnterocolitis was reported in 68% of Hirschsprung patients after pull-through.↗
▶Ep 144 · 2:05
epidemiological50% of Hirschsprung-associated IBD patients had long segment disease.↗
▶Ep 144 · 2:05
host_summaryEnterocolitis was reported in 68% of Hirschsprung patients after pull-through.↗
▶Ep 144 · 2:17
host_summaryThe most common presentation for Hirschsprung-associated IBD was colonic or small bowel inflammation resembling IBD.↗
▶Ep 144 · 2:17
clinicalThe most common presentation for Hirschsprung-associated IBD was colonic or small bowel inflammation resembling IBD.↗
▶Ep 144 · 7:54
host_summaryThe button battery study evaluated whether implementation of a clinical algorithm shortened time from diagnosis to removal of esophageal button battery.↗
▶Ep 144 · 7:54
clinicalThe button battery study evaluated whether implementation of a clinical algorithm shortened time from diagnosis to removal of esophageal button battery.↗
▶Ep 144 · 8:09
clinicalThe algorithm was based on the national database algorithm and implemented in October 2019.↗
▶Ep 144 · 8:09
host_summaryThe algorithm was based on the national database algorithm and implemented in October 2019.↗
▶Ep 144 · 8:45
clinicalAfter implementing the critical airway response team algorithm, time from chest X-ray to button battery removal was reduced from 73 minutes to 35 minutes.↗
▶Ep 144 · 8:45
host_summaryAfter implementing the critical airway response team algorithm, time from chest X-ray to button battery removal was reduced from 73 minutes to 35 minutes.↗
Meta-Analysis of Enhanced Recovery After Surgery Protocols for the Perioperative Management of Pediatric Colorectal Surgery
▶Ep 148 · 0:10
quoteThis is a meta-analysis that wanted to see the effects of the ERS protocol in pediatric colorectal surgery.↗
Quick Literature Updates Episode 14
▶Ep 149 · 3:48
host_summaryThe Bokova et al. study is a multi-institutional one-year outcome study of anal sphincter reconstruction for patulous sphincter in 6 patients.↗
▶Ep 149 · 3:48
epidemiologicalThe Bokova et al. study is a multi-institutional one-year outcome study of anal sphincter reconstruction for patulous sphincter in 6 patients.↗
▶Ep 149 · 4:00
host_summaryOf the 6 patients in the sphincter reconstruction study, 2 had Down syndrome and underwent redo pull-through with anal sphincter reconstruction.↗
▶Ep 149 · 4:00
clinicalOf the 6 patients in the sphincter reconstruction study, 2 had Down syndrome and underwent redo pull-through with anal sphincter reconstruction.↗
▶Ep 149 · 4:00
clinicalFour patients in the sphincter reconstruction study received only anal sphincter reconstruction without redo pull-through.↗
▶Ep 149 · 4:00
host_summaryFour patients in the sphincter reconstruction study received only anal sphincter reconstruction without redo pull-through.↗
▶Ep 149 · 4:12
opinionAnal sphincter reconstruction appears to be an option for overstretched anal sphincters in patients with Hirschsprung disease after a pull-through.↗
▶Ep 149 · 4:12
clinicalThe 4 patients who received only anal sphincter reconstruction achieved voluntary bowel movements with higher productivity and confidence.↗
▶Ep 149 · 4:12
host_summaryAnal sphincter reconstruction appears to be an option for overstretched anal sphincters in patients with Hirschsprung disease after a pull-through.↗
▶Ep 149 · 4:12
host_summaryThe 4 patients who received only anal sphincter reconstruction achieved voluntary bowel movements with higher productivity and confidence.↗
Meta-Analysis of Enhaced Recovery After Ssurgery Protocols for the Perioperative Management of Pediatric Colorectal Surgery
▶Ep 155 · 0:10
quoteThis is a meta-analysis done in China that wanted to analyze the effects and safety of ERES particle for colorectal surgery in pediatric patients.↗
▶Ep 155 · 0:10
epidemiologicalThe meta-analysis was conducted in China↗
▶Ep 155 · 0:22
epidemiologicalThe meta-analysis included studies with 1,298 patients↗
clinicalERAS protocols significantly reduced postoperative opioid use in pediatric colorectal surgery↗
▶Ep 155 · 0:34
clinicalERAS protocols shortened time to first enteral nutrition in pediatric colorectal surgery↗
▶Ep 155 · 0:34
clinicalERAS protocols shortened time to bowel function return in pediatric colorectal surgery↗
▶Ep 155 · 0:39
clinicalERAS protocols reduced hospital length of stay in pediatric colorectal surgery↗
▶Ep 155 · 0:39
clinicalERAS protocols reduced hospital costs in pediatric colorectal surgery↗
▶Ep 155 · 0:44
quoteSo it seems that ERA's protocols are in need in colorectal pediatric surgery.↗
▶Ep 155 · 0:44
opinionERAS protocols are needed in pediatric colorectal surgery↗
Quick Literature Updates Episode 15
▶Ep 156 · 0:59
clinicalThe Hirschsprung-associated IBD study was a retrospective study gathering patients from 2000 to 2021 at 17 institutions.↗
▶Ep 156 · 0:59
host_summaryThe Hirschsprung-associated IBD study was a retrospective study gathering patients from 2000 to 2021 at 17 institutions.↗
▶Ep 156 · 1:14
host_summaryThe study gathered 55 Hirschsprung patients, and 50% had long segment disease.↗
▶Ep 156 · 1:14
epidemiologicalThe study gathered 55 Hirschsprung patients, and 50% had long segment disease.↗
▶Ep 156 · 1:19
epidemiological10% of the Hirschsprung patients had trisomy 21.↗
▶Ep 156 · 1:19
epidemiological68% of the Hirschsprung patients had Hirschsprung-associated enterocolitis.↗
▶Ep 156 · 1:19
quoteit seems that lung segment disease, Hirschprung associated enterocolitis, and trisomy 21 can be potential risk factors for IVD-like symptoms in Hirschprung patients after pull through.↗
▶Ep 156 · 1:19
host_summary10% of the Hirschsprung patients had trisomy 21.↗
▶Ep 156 · 1:19
host_summary68% of the Hirschsprung patients had Hirschsprung-associated enterocolitis.↗
▶Ep 156 · 1:19
host_summaryLong segment disease, Hirschsprung-associated enterocolitis, and trisomy 21 can be potential risk factors for IBD-like symptoms in Hirschsprung patients after pull through.↗
▶Ep 156 · 1:19
quoteit seems that lung segment disease, Hirschprung associated enterocolitis, and trisomy 21 can be potential risk factors for IVD-like symptoms in Hirschprung patients after pull through.↗
▶Ep 156 · 1:19
clinicalLong segment disease, Hirschsprung-associated enterocolitis, and trisomy 21 can be potential risk factors for IBD-like symptoms in Hirschsprung patients after pull through.↗
▶Ep 156 · 3:09
host_summaryThe solid organ injury study was a retrospective study done in South Carolina examining if isolated solid organ injuries after blunt abdominal trauma can be discharged from the ED.↗
▶Ep 156 · 3:09
clinicalThe solid organ injury study was a retrospective study done in South Carolina examining if isolated solid organ injuries after blunt abdominal trauma can be discharged from the ED.↗
▶Ep 156 · 3:19
epidemiologicalThe study gathered 262 patients with isolated solid organ injuries, grades 1 to 3.↗
▶Ep 156 · 3:19
host_summaryThe study gathered 262 patients with isolated solid organ injuries, grades 1 to 3.↗
▶Ep 156 · 3:26
host_summary148 patients had solid organ injuries grades 1 or 2, and none of them required an acute intervention.↗
▶Ep 156 · 3:26
clinical148 patients had solid organ injuries grades 1 or 2, and none of them required an acute intervention.↗
▶Ep 156 · 3:34
clinicalOf 114 patients with grade 3 solid organ injuries, only 3 patients required an acute intervention.↗
▶Ep 156 · 3:34
host_summaryOf 114 patients with grade 3 solid organ injuries, only 3 patients required an acute intervention.↗
▶Ep 156 · 3:44
quoteSo it seems that isolated solid organ injuries after a blunt abdominal trauma, grades 1 or 2 can be discharged from the ED.↗
▶Ep 156 · 3:44
host_summaryIsolated solid organ injuries after blunt abdominal trauma, grades 1 or 2, can be discharged from the ED.↗
▶Ep 156 · 3:44
clinicalIsolated solid organ injuries after blunt abdominal trauma, grades 1 or 2, can be discharged from the ED.↗
▶Ep 156 · 3:44
quoteSo it seems that isolated solid organ injuries after a blunt abdominal trauma, grades 1 or 2 can be discharged from the ED.↗
Journal of Pediatric Surgery Article Review: September 2023
▶Ep 159 · 1:43
clinicalIn the pectus arcuatum study, 34 patients were reviewed with a mean age of 10 years, and 47% required X-ray or CT scan for diagnosis.↗
▶Ep 159 · 1:43
host_summaryIn the pectus arcuatum study, 34 patients were reviewed with a mean age of 10 years, and 47% required X-ray or CT scan for diagnosis.↗
▶Ep 159 · 7:41
clinicalERAS protocols significantly reduce intraoperative fluids needed and postoperative opiate use in pediatric colorectal surgery.↗
▶Ep 159 · 7:41
host_summaryERAS protocols significantly reduce intraoperative fluids needed and postoperative opiate use in pediatric colorectal surgery.↗
▶Ep 159 · 7:55
host_summaryTime to first oral intake and time for complete nutrition was less in patients managed with ERAS protocols.↗
▶Ep 159 · 7:55
clinicalTime to first oral intake and time for complete nutrition was less in patients managed with ERAS protocols.↗
Transitional Care in Anorectal Malformation and Hirschsprung's Disease
▶Ep 161 · 0:00
quoteDo you have a transitional care coordinator for colorectal patients in your hospital?↗
▶Ep 161 · 0:10
epidemiologicalA systematic review was conducted in the UK to establish and categorize challenges and solutions related to transitional care in colorectal patients↗
▶Ep 161 · 0:23
epidemiologicalThe systematic review included 234 studies↗
▶Ep 161 · 0:28
clinicalThe first challenge identified was patients' lack of understanding of their own pathology↗
▶Ep 161 · 0:34
clinicalThe second challenge was the lack of education and awareness of adult surgeons about pediatric colorectal pathologies↗
▶Ep 161 · 0:44
clinicalThe third challenge was the lack of an instructional transitional care program↗
▶Ep 161 · 0:46
guidelineThe third proposed solution was to create a structured and coordinated transition program↗
▶Ep 161 · 0:46
guidelineThe first proposed solution was to foster young adult patients' autonomy↗
▶Ep 161 · 0:46
guidelineThe second proposed solution was to conduct joint pediatric adult transitional clinics↗
Quick Literature Updates Episode 17
▶Ep 172 · 0:58
host_summaryThe Zeng et al. study was a retrospective multi-center study done in China comparing robotic repair versus thoracoscopic repair for esophageal atresia.↗
▶Ep 172 · 0:58
clinicalThe Zeng et al. study was a retrospective multi-center study done in China comparing robotic repair versus thoracoscopic repair for esophageal atresia.↗
▶Ep 172 · 1:07
host_summaryRobotic surgery for esophageal atresia had longer operative time but shorter anastomotic time compared to thoracoscopic repair.↗
▶Ep 172 · 1:07
clinicalRobotic surgery for esophageal atresia had longer operative time but shorter anastomotic time compared to thoracoscopic repair.↗
▶Ep 172 · 1:07
clinicalAfter propensity score matching, the study included 126 patients with 63 in each group (robotic vs thoracoscopic).↗
▶Ep 172 · 1:07
host_summaryAfter propensity score matching, the study included 126 patients with 63 in each group (robotic vs thoracoscopic).↗
▶Ep 172 · 1:22
clinicalThe robotic group had lower anastomotic strictures and lower readmissions within 2 years post-op compared to thoracoscopic repair.↗
▶Ep 172 · 1:22
host_summaryThe robotic group had lower anastomotic strictures and lower readmissions within 2 years post-op compared to thoracoscopic repair.↗
▶Ep 172 · 1:32
opinionRobotic surgery is a good answer for esophageal atresia repair.↗
▶Ep 172 · 1:32
quoteSo it seems that robotic surgery is a good answer for esophageal tissue repair.↗
▶Ep 172 · 1:32
opinionRobotic surgery is a good answer for esophageal atresia repair.↗
▶Ep 172 · 1:32
quoteSo it seems that robotic surgery is a good answer for esophageal tissue repair.↗
Quick Literature Updates Episode 18
▶Ep 174 · 3:13
epidemiologicalA retrospective cohort study of CPAM included 110 patients comparing outcomes based on timing of surgery relative to symptom onset.↗
▶Ep 174 · 3:21
clinicalPatients with CPAM who underwent surgery before becoming symptomatic had shorter operating times compared to those operated after symptom onset.↗
▶Ep 174 · 3:21
clinicalPatients with CPAM who underwent surgery before becoming symptomatic had shorter length of stay compared to those operated after symptom onset.↗
▶Ep 174 · 3:21
clinicalPatients with CPAM who underwent surgery before becoming symptomatic had shorter mechanical ventilation time after surgery compared to those operated after symptom onset.↗
▶Ep 174 · 3:31
clinicalIn the CPAM study, there was no significant difference in conversion rates or post-operative complications between patients operated before versus after symptom onset.↗
▶Ep 174 · 3:44
opinionThe CPAM study findings suggest it is safer to operate these patients before they become symptomatic.↗
▶Ep 174 · 3:44
quoteSo it seems that it's safer to operate these patients before they become symptomatic.↗
Quick Literature Updates Ep 22
▶Ep 184 · 3:16
host_summaryThe Pefer et al. study is a retrospective study done in Texas using a state hospital database examining CDH outcomes by center volume.↗
▶Ep 184 · 3:32
host_summaryThe Pefer study identified 1,314 CDH patients: 728 from high volume centers, 9 from mid-volume centers, and 79 from low volume centers.↗
▶Ep 184 · 3:46
host_summaryHigh volume centers had significantly lower mortality rates for CDH, even though they have significantly sicker patients.↗
▶Ep 184 · 3:46
host_summaryHigh volume centers had significantly shorter length of stay for CDH patients.↗
▶Ep 184 · 4:00
host_summaryHigh volume centers had better outcomes for patients with CDH.↗
Quick Literature Updates Ep 23
▶Ep 185 · 3:10
clinicalA UK systematic review aimed to establish and categorize challenges and solutions related to transitional care in colorectal patients with anorectal malformations and Hirschsprung's disease.↗
▶Ep 185 · 3:23
epidemiologicalThe systematic review included 234 studies and established 3 challenges and solutions.↗
▶Ep 185 · 3:29
clinicalThe first challenge in transitional care for colorectal patients is the patients' lack of understanding of their own pathology.↗
▶Ep 185 · 3:34
clinicalThe second challenge is the lack of education and awareness of adult surgeons about pediatric colorectal pathologies.↗
▶Ep 185 · 3:42
clinicalThe third challenge is the lack of a structured transitional care program.↗
▶Ep 185 · 3:46
guidelineThe first proposed solution is to foster young adult patients' autonomy.↗
▶Ep 185 · 3:46
guidelineThe second proposed solution is to conduct joint pediatric-adult transitional clinics.↗
▶Ep 185 · 3:46
guidelineThe third proposed solution is to create a structured and coordinated transition program.↗
Quick Literature Updates Ep 26
▶Ep 188 · 3:20
clinicalThe Schlapbach et al. study is a worldwide study with a Delphi consensus process that aimed to update the definitions of sepsis and septic shock↗
▶Ep 188 · 3:29
guidelineThe Phoenix sepsis score includes variables in cardiovascular function, respiratory function, coagulation, and neurological function↗
▶Ep 188 · 3:42
clinicalThe Phoenix sepsis score helped correlate the definition of sepsis with an actual mortality rate↗
▶Ep 188 · 3:48
guidelineSeptic shock is defined as sepsis plus cardiovascular dysfunction that is seen when there is 1 point in the cardiovascular variable of the Phoenix sepsis score↗
▶Ep 188 · 3:48
guidelineThe definition of sepsis is suspected infection plus 2 points in the Phoenix sepsis score↗
▶Ep 188 · 4:06
epidemiologicalSepsis has a mortality rate of 7.1%↗
▶Ep 188 · 4:06
epidemiologicalSeptic shock has a mortality rate of 10.8 to 33.5% according to the research settings↗
host_summaryEsposito et al. retrospective comparison conducted in Italy included 83 patients who underwent laparoscopic cholecystectomy without ICG (group one) and 90 patients with ICG (group two).↗
▶Ep 12 · 3:23
host_summaryLaparoscopic cholecystectomy with ICG had shorter surgery time compared to without ICG.↗
▶Ep 12 · 3:23
host_summaryLaparoscopic cholecystectomy with ICG provided better visualization of the biliary tree compared to without ICG.↗
▶Ep 12 · 3:23
host_summaryLaparoscopic cholecystectomy with ICG had no complications compared to 12% complication rate without ICG.↗
▶Ep 12 · 3:38
host_summaryLaparoscopic cholecystectomy with ICG can be the new standard in pediatric surgery practice.↗
▶Ep 12 · 3:38
quoteSo it seems that laparoscopic cholecystectomy with ICG can be the new standard in our practice.↗
clinicalPatients who underwent surgery before becoming symptomatic had shorter length of stay↗
▶Ep 30 · 0:39
clinicalThere was no significant difference in postoperative complications between asymptomatic and symptomatic groups↗
▶Ep 30 · 0:39
quoteit seems that it's safer to operate these patients before they become symptomatic.↗
▶Ep 30 · 0:39
opinionIt appears safer to operate on CPAM patients before they become symptomatic↗
▶Ep 30 · 0:39
clinicalThere was no significant difference in conversion rates between asymptomatic and symptomatic groups↗
Journal of Pediatric Surgery Article Review: October 2023
▶Ep 31 · 2:37
epidemiologicalWithin 1,395 patients across 12 observational studies, 753 received acid suppression medication but this did not reduce the odds of having an esophageal stricture↗
▶Ep 31 · 2:37
host_summaryWithin 1,395 patients across 12 observational studies, 753 received acid suppression medication but this did not reduce the odds of having an esophageal stricture↗
▶Ep 31 · 7:08
host_summarySome randomized trials showed that doing something to the pleura does not actually reduce recurrences of spontaneous pneumothorax↗
▶Ep 31 · 7:08
epidemiologicalSome randomized trials showed that doing something to the pleura does not actually reduce recurrences of spontaneous pneumothorax↗
▶Ep 31 · 7:40
guidelineFor the asymptomatic contralateral side in children with spontaneous pneumothorax, do not do anything unless it develops symptoms↗
▶Ep 31 · 7:40
host_summaryFor the asymptomatic contralateral side in children with spontaneous pneumothorax, do not do anything unless it develops symptoms↗
▶Ep 31 · 9:00
host_summaryThe asymptomatic CPAM group had shorter operating times, shorter postoperative mechanical ventilation, shorter chest tube durations, and shorter hospital stays↗
▶Ep 31 · 9:00
epidemiologicalThe asymptomatic CPAM group had shorter operating times, shorter postoperative mechanical ventilation, shorter chest tube durations, and shorter hospital stays↗
Quick Literature Updates Episode 18
▶Ep 32 · 3:13
host_summaryA retrospective cohort study of CPAM included 110 patients comparing outcomes based on timing of surgery relative to symptom onset.↗
▶Ep 32 · 3:13
epidemiologicalA retrospective cohort study of CPAM included 110 patients comparing outcomes based on timing of surgery relative to symptom onset.↗
▶Ep 32 · 3:21
host_summaryPatients with CPAM who underwent surgery before becoming symptomatic had shorter length of stay compared to those operated after symptom onset.↗
▶Ep 32 · 3:21
host_summaryPatients with CPAM who underwent surgery before becoming symptomatic had shorter operating times compared to those operated after symptom onset.↗
▶Ep 32 · 3:21
host_summaryPatients with CPAM who underwent surgery before becoming symptomatic had shorter mechanical ventilation time after surgery compared to those operated after symptom onset.↗
▶Ep 32 · 3:21
clinicalPatients with CPAM who underwent surgery before becoming symptomatic had shorter mechanical ventilation time after surgery compared to those operated after symptom onset.↗
▶Ep 32 · 3:21
clinicalPatients with CPAM who underwent surgery before becoming symptomatic had shorter operating times compared to those operated after symptom onset.↗
▶Ep 32 · 3:21
clinicalPatients with CPAM who underwent surgery before becoming symptomatic had shorter length of stay compared to those operated after symptom onset.↗
▶Ep 32 · 3:31
clinicalIn the CPAM study, there was no significant difference in conversion rates or post-operative complications between patients operated before versus after symptom onset.↗
▶Ep 32 · 3:31
host_summaryIn the CPAM study, there was no significant difference in conversion rates or post-operative complications between patients operated before versus after symptom onset.↗
▶Ep 32 · 3:44
quoteSo it seems that it's safer to operate these patients before they become symptomatic.↗
▶Ep 32 · 3:44
quoteSo it seems that it's safer to operate these patients before they become symptomatic.↗
▶Ep 32 · 3:44
host_summaryThe CPAM study findings suggest it is safer to operate these patients before they become symptomatic.↗
▶Ep 32 · 3:44
opinionThe CPAM study findings suggest it is safer to operate these patients before they become symptomatic.↗
clinicalPatients who underwent surgery before becoming symptomatic had shorter operating times↗
▶Ep 21 · 0:39
opinionIt appears safer to operate on CPAM patients before they become symptomatic↗
▶Ep 21 · 0:39
quoteit seems that it's safer to operate these patients before they become symptomatic.↗
▶Ep 21 · 0:39
clinicalThere was no significant difference in conversion rates between asymptomatic and symptomatic groups↗
▶Ep 21 · 0:39
clinicalThere was no significant difference in postoperative complications between asymptomatic and symptomatic groups↗
Journal of Pediatric Surgery Article Review: October 2023
▶Ep 7 · 2:37
clinicalIn a meta-analysis of 1,395 patients, 753 received acid suppression medication but it did not increase the odds of having an esophageal stricture↗
▶Ep 7 · 2:57
clinicalThere was no evidence to associate prophylactic acid suppression with protection from stricture formation after esophageal atresia repair↗
▶Ep 7 · 7:40
guidelineFor the asymptomatic contralateral side in children with pneumothorax, do not do anything unless it develops symptoms↗
▶Ep 7 · 8:57
clinicalIn a study of 110 CPAM patients, the asymptomatic group had shorter operating times, shorter post-operative mechanical ventilation, shorter chest tube durations, and shorter hospital stays↗
Quick Literature Updates Episode 18
▶Ep 9 · 3:21
clinicalPatients who underwent surgery before becoming symptomatic had shorter mechanical ventilation after surgery↗
▶Ep 9 · 3:21
clinicalPatients who underwent surgery before becoming symptomatic had shorter operating times↗
▶Ep 9 · 3:21
epidemiologicalThe CPAM study included 110 patients↗
▶Ep 9 · 3:21
clinicalPatients who underwent surgery before becoming symptomatic had shorter length of stay↗
▶Ep 9 · 3:31
clinicalThere was no significant difference in conversion or post-operative complications between symptomatic and asymptomatic CPAM patients undergoing surgery↗
▶Ep 9 · 3:44
opinionIt appears safer to operate on CPAM patients before they become symptomatic↗
▶Ep 9 · 3:44
quoteSo it seems that it's safer to operate these patients before they become symptomatic.↗
Journal of Pediatric Surgery Article Review: February 2023, BAPS issue
▶Ep 10 · 9:23
host_summaryThe Tanzania soap bathing study included 252 patients, with 114 receiving a preoperative bath with plain soap↗
▶Ep 10 · 9:26
host_summaryIn the soap bathing group, 11.4% developed surgical site infections compared to 40.6% in the control group↗
▶Ep 10 · 9:43
host_summaryPreoperative soap bathing reduced the odds of surgical site infections by 80%↗
Esophageal Surveillance Practices in Esophageal Atresia Patients
▶Ep 12 · 0:00
host_summary139 pediatric surgeons responded to the survey↗
▶Ep 12 · 0:00
host_summaryThe 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↗
▶Ep 12 · 0:00
host_summaryOnly 37% of respondents performed follow-up endoscopy regardless of symptoms↗
▶Ep 12 · 0:00
host_summaryThere is high agreement with current guidelines but weak adherence to them in esophageal atresia surveillance↗
▶Ep 12 · 0:00
host_summaryOnly 37% of respondents reported that their esophageal atresia patients have pre-determined outpatient clinic follow-up schedule↗
▶Ep 12 · 0:00
host_summary75% of respondents strongly agree or agree with current guidelines for esophageal atresia surveillance↗
▶Ep 12 · 0:00
host_summary80% of respondents agree or strongly agree that endoscopy should follow a set schedule↗
Comparison of robotic versus thoracoscopic repair for congenital esophageal atresia
▶Ep 15 · 0:10
epidemiologicalThe study is a retrospective multi-center study done in China↗
▶Ep 15 · 0:21
epidemiologicalAfter propensity score matching, there were 126 patients total, 63 in each group↗
▶Ep 15 · 0:28
clinicalThe robotic group had lower unplanned readmissions within 2 years post-op compared to thoracoscopic repair↗
▶Ep 15 · 0:28
clinicalRobotic surgery had longer operative time compared to thoracoscopic repair↗
▶Ep 15 · 0:28
clinicalThe robotic group had lower anastomotic strictures compared to thoracoscopic repair↗
▶Ep 15 · 0:28
clinicalRobotic surgery had shorter anastomotic time compared to thoracoscopic repair↗
▶Ep 15 · 0:46
opinionRobotic surgery appears to be a good option for esophageal atresia repair↗
▶Ep 15 · 0:46
quoteSo, it seems that robotic surgery is a good answer for esophageal tissue repair.↗
Journal of Pediatric Surgery Article Review: October 2023
▶Ep 17 · 2:37
host_summaryWithin 1,395 patients across 12 observational studies, 753 received acid suppression medication but this did not reduce the odds of having an esophageal stricture↗
▶Ep 17 · 7:08
host_summarySome randomized trials showed that doing something to the pleura does not actually reduce recurrences of spontaneous pneumothorax↗
▶Ep 17 · 7:40
host_summaryFor the asymptomatic contralateral side in children with spontaneous pneumothorax, do not do anything unless it develops symptoms↗
▶Ep 17 · 9:00
host_summaryThe asymptomatic CPAM group had shorter operating times, shorter postoperative mechanical ventilation, shorter chest tube durations, and shorter hospital stays↗
Journal of Pediatric Surgery Article Review: Q1 (Jan-Mar) 2024
▶Ep 18 · 2:45
host_summaryThe appendicitis study had 185 patients in the home antibiotic group and 121 patients in the no home antibiotic group.↗
▶Ep 18 · 2:55
host_summaryThere was no significant difference in deep organ space infection requiring intervention between home antibiotic and no home antibiotic groups for complicated appendicitis.↗
▶Ep 18 · 3:03
host_summaryThere was no difference in length of stay between home antibiotic and no home antibiotic groups for complicated appendicitis.↗
▶Ep 18 · 5:43
clinicalType 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.↗
▶Ep 18 · 8:47
host_summaryThe 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.↗
▶Ep 18 · 9:04
host_summaryThe pectus study selected patients under 21 years of age who presented for bar removal between November 2021 and May 2023.↗
▶Ep 18 · 9:15
host_summaryTesting for cold and soft touch and pinprick was performed just before bar removal.↗
▶Ep 18 · 9:25
host_summaryThe pectus study enrolled 47 patients with a median bar dwell time of approximately 2.9 years.↗
▶Ep 18 · 9:41
host_summaryPatients had a median of 2 bars placed, and almost 81% were secured with pericostal sutures.↗
▶Ep 18 · 9:51
host_summaryAlmost half of the pectus patients had some degree of hypoesthesia, with T5 being the most common dermatome affected.↗
▶Ep 18 · 10:00
host_summaryThe area with hypoesthesia was less than 5% of the entire surface that was treated with cryo.↗
▶Ep 18 · 10:18
host_summaryNeuropathic symptoms were identified by only 13% of pectus patients, and none required treatment.↗
▶Ep 18 · 10:26
host_summaryIn 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.↗
▶Ep 18 · 11:00
clinicalPericostal sutures used to secure bars can damage nerves.↗
Quick Literature Updates Episode 17
▶Ep 19 · 0:58
host_summaryThe Zeng et al. study was a retrospective multi-center study done in China comparing robotic repair versus thoracoscopic repair for esophageal atresia.↗
▶Ep 19 · 1:07
host_summaryRobotic surgery for esophageal atresia had longer operative time but shorter anastomotic time compared to thoracoscopic repair.↗
▶Ep 19 · 1:07
host_summaryAfter propensity score matching, the study included 126 patients with 63 in each group (robotic vs thoracoscopic).↗
▶Ep 19 · 1:22
host_summaryThe robotic group had lower anastomotic strictures and lower readmissions within 2 years post-op compared to thoracoscopic repair.↗
▶Ep 19 · 1:32
quoteSo it seems that robotic surgery is a good answer for esophageal tissue repair.↗
▶Ep 19 · 1:32
opinionRobotic surgery is a good answer for esophageal atresia repair.↗
Quick Literature Updates Ep 27
▶Ep 26 · 3:04
host_summaryHuncheid et al. conducted a multi-center non-inferiority trial that compared preterm infants treated with expectant management versus early ibuprofen for patent ductus arteriosus.↗
▶Ep 26 · 3:14
host_summaryThe trial included 273 infants: 136 treated with expectant management and 137 with early ibuprofen.↗
▶Ep 26 · 3:24
host_summaryIn the expectant management group for PDA, there was 17.6% necrotizing enterocolitis, 33% bronchopulmonary dysplasia, and 14% death rates.↗
▶Ep 26 · 3:36
host_summaryIn the ibuprofen group for PDA, there was 15.4% necrotizing enterocolitis, 50% bronchopulmonary dysplasia, and 80% death rates.↗
▶Ep 26 · 3:53
host_summaryExpectant management is not inferior to early ibuprofen in preterm patients with patent ductus arteriosus.↗
▶Ep 26 · 3:53
quoteSo it seems that expectant management is not inferiority that early ibuprofen in preterm patients with PDA.↗
Routine contrast enema prior to stoma reversal seems only required following treatment for necrotizing enterocolitis: An evaluation of the diagnostic accuracy of the contrast enema
▶Ep 47 · 0:00
quoteDo you always do a contrast enema prior to stoma reversal?↗
▶Ep 47 · 0:13
host_summaryA retrospective study was conducted in the Netherlands between 1998 and 2018 examining contrast enema use prior to stoma reversal.↗
▶Ep 47 · 0:24
host_summaryThe study included patients under three years old who underwent stoma reversal.↗
host_summary10% of patients developed strictures.↗
▶Ep 47 · 0:43
host_summary95% of patients with strictures had necrotizing enterocolitis.↗
▶Ep 47 · 0:47
host_summaryOnly 68% of all patients had a contrast enema prior to stoma reversal.↗
▶Ep 47 · 0:51
host_summaryContrast enema was able to detect 92% of strictures.↗
▶Ep 47 · 0:54
opinionContrast enema prior to stoma reversal is only useful if patients had necrotizing enterocolitis.↗
▶Ep 47 · 0:54
quoteSo it seems that contrast enema prior to stoma reversal is only useful if patients had NEC.↗
Quick Literature Updates Episode 6
▶Ep 49 · 3:33
host_summaryPatients receiving massive transfusions had lower platelet counts.↗
▶Ep 49 · 3:33
host_summaryPhilips et al. conducted a retrospective study from 2015 to 2018 evaluating 117 patients from two trauma centers.↗
▶Ep 49 · 3:33
host_summaryPatients receiving massive transfusions had shortened alpha angles on TEG analysis.↗
▶Ep 49 · 3:33
host_summaryPatients receiving massive transfusions had lower maximum amplitude values on TEG analysis.↗
▶Ep 49 · 3:33
host_summaryTEG may help identify hemorrhagic trauma patients who will benefit from cryoprecipitate or platelet transfusions.↗
Quick Literature Updates Episode 11
▶Ep 52 · 3:07
host_summaryPeriumbilical hernia rate was significantly higher in patients who underwent primary closure versus those who needed silo placement.↗
▶Ep 52 · 3:07
host_summaryFrazier et al. conducted a retrospective study from the Midwest Pediatric Surgery Consortium following 375 patients with gastroschisis who underwent closure between 2013 and 2016.↗
▶Ep 52 · 3:07
host_summarySutureless gastroschisis closures lead to more periumbilical hernias, but they can be managed as any other congenital umbilical hernia and have no additional risk.↗
▶Ep 52 · 3:07
host_summaryOnly 31.8% of patients with periumbilical hernias after gastroschisis needed surgery.↗
▶Ep 52 · 3:07
host_summarySpontaneous closure of periumbilical hernias after gastroschisis was seen in 38.8% of cases.↗
▶Ep 52 · 3:07
host_summaryOnly 16.4% of patients who underwent sutured gastroschisis closure had a persistent hernia.↗
▶Ep 52 · 3:07
host_summaryPatients who underwent sutureless gastroschisis closures had 50% rates of persistent hernia.↗
▶Ep 52 · 3:07
host_summaryThe overall rate for periumbilical hernias after gastroschisis closure was 22.7%.↗
Expectant Management or Early Ibuprofen for Patent Ductus Arteriosus
▶Ep 53 · 0:09
host_summaryA multi-center non-inferiority trial compared preterm infants treated with expectant management versus early ibuprofen for PDA↗
host_summary136 infants were treated with expectant management and 137 with early ibuprofen↗
▶Ep 53 · 0:31
host_summaryIn the expectant management group, the death rate was 14%↗
▶Ep 53 · 0:31
host_summaryIn the expectant management group, 33% developed bronchopulmonary dysplasia↗
▶Ep 53 · 0:31
host_summaryIn the expectant management group, 17.6% developed necrotizing enterocolitis↗
▶Ep 53 · 0:43
host_summaryIn the ibuprofen group, 15.4% developed necrotizing enterocolitis↗
▶Ep 53 · 0:43
host_summaryIn the ibuprofen group, 50% developed bronchopulmonary dysplasia↗
▶Ep 53 · 0:43
host_summaryIn the ibuprofen group, the death rate was 80%↗
▶Ep 53 · 1:01
host_summaryExpectant management is non-inferior to early ibuprofen in preterm patients with PDA↗
▶Ep 53 · 1:01
quoteSo it seems that expectant management is not inferiority that early ibuprofen in preterm patients with PDA.↗
Quick Literature Updates Ep 22
▶Ep 68 · 3:16
host_summaryThe Pefer et al. study is a retrospective study done in Texas using a state hospital database examining CDH outcomes by center volume.↗
▶Ep 68 · 3:32
host_summaryThe Pefer study identified 1,314 CDH patients: 728 from high volume centers, 9 from mid-volume centers, and 79 from low volume centers.↗
▶Ep 68 · 3:46
host_summaryHigh volume centers had significantly lower mortality rates for CDH, even though they have significantly sicker patients.↗
▶Ep 68 · 3:46
host_summaryHigh volume centers had significantly shorter length of stay for CDH patients.↗
▶Ep 68 · 4:00
host_summaryHigh volume centers had better outcomes for patients with CDH.↗
Quick Literature Updates Ep 27
▶Ep 69 · 3:04
host_summaryHuncheid et al. conducted a multi-center non-inferiority trial that compared preterm infants treated with expectant management versus early ibuprofen for patent ductus arteriosus.↗
▶Ep 69 · 3:14
host_summaryThe trial included 273 infants: 136 treated with expectant management and 137 with early ibuprofen.↗
▶Ep 69 · 3:24
host_summaryIn the expectant management group for PDA, there was 17.6% necrotizing enterocolitis, 33% bronchopulmonary dysplasia, and 14% death rates.↗
▶Ep 69 · 3:36
host_summaryIn the ibuprofen group for PDA, there was 15.4% necrotizing enterocolitis, 50% bronchopulmonary dysplasia, and 80% death rates.↗
▶Ep 69 · 3:53
host_summaryExpectant management is not inferior to early ibuprofen in preterm patients with patent ductus arteriosus.↗
▶Ep 69 · 3:53
quoteSo it seems that expectant management is not inferiority that early ibuprofen in preterm patients with PDA.↗
host_summaryThe IPSO systematic review and meta-analysis gathered 8 retrospective studies with 490 patients comparing image-guided core needle biopsy to surgical biopsy for neuroblastoma.↗
▶Ep 25 · 3:27
epidemiologicalThe IPSO systematic review and meta-analysis gathered 8 retrospective studies with 490 patients comparing image-guided core needle biopsy to surgical biopsy for neuroblastoma.↗
▶Ep 25 · 3:40
clinicalTissue adequacy and biological characterization of the biopsy was not significantly different between image-guided core needle biopsy and surgical biopsy groups for neuroblastoma.↗
▶Ep 25 · 3:40
host_summaryTissue adequacy and biological characterization of the biopsy was not significantly different between image-guided core needle biopsy and surgical biopsy groups for neuroblastoma.↗
▶Ep 25 · 3:54
clinicalIntraoperative transfusions and complications were higher in the surgical biopsy group compared to image-guided core needle biopsy for neuroblastoma.↗
▶Ep 25 · 3:54
host_summaryIntraoperative transfusions and complications were higher in the surgical biopsy group compared to image-guided core needle biopsy for neuroblastoma.↗
▶Ep 25 · 4:00
host_summaryImage-guided core needle biopsy is safe and effective for diagnosing neuroblastoma.↗
▶Ep 25 · 4:00
clinicalImage-guided core needle biopsy is safe and effective for diagnosing neuroblastoma.↗
host_summaryIn a multi-center study of 167 early cholecystectomy patients versus 79 delayed, early cholecystectomy had 2% recurrence of pancreatitis compared to 22% in delayed surgery↗
▶Ep 3 · 3:11
clinicalIn a multi-center study of 167 early cholecystectomy patients versus 79 delayed, early cholecystectomy had 2% recurrence of pancreatitis compared to 22% in delayed surgery↗
▶Ep 3 · 3:36
host_summaryWhen cholecystectomy was delayed more than 6 weeks after gallstone pancreatitis, recurrence rate increased to 60%↗
▶Ep 3 · 3:36
clinicalWhen cholecystectomy was delayed more than 6 weeks after gallstone pancreatitis, recurrence rate increased to 60%↗
▶Ep 3 · 4:27
clinicalPatients who underwent early cholecystectomy did not have more biliary complications than delayed surgery patients↗
▶Ep 3 · 4:27
host_summaryPatients who underwent early cholecystectomy did not have more biliary complications than delayed surgery patients↗
▶Ep 3 · 11:27
clinicalIn a multi-center study of 252 patients with choledocholithiasis, 156 underwent OR-first approach (laparoscopic cholecystectomy with intraoperative cholangiogram) and 96 underwent ERCP-first approach↗
▶Ep 3 · 11:27
host_summaryIn a multi-center study of 252 patients with choledocholithiasis, 156 underwent OR-first approach (laparoscopic cholecystectomy with intraoperative cholangiogram) and 96 underwent ERCP-first approach↗
▶Ep 3 · 11:41
clinicalPatients who underwent intraoperative cholangiogram first had fewer complications and shorter length of stay than ERCP-first patients, and 86% needed only the surgery without subsequent ERCP↗
▶Ep 3 · 11:41
host_summaryPatients who underwent intraoperative cholangiogram first had fewer complications and shorter length of stay than ERCP-first patients, and 86% needed only the surgery without subsequent ERCP↗
host_summaryPatients receiving massive transfusions had lower maximum amplitude values on TEG analysis.↗
▶Ep 7 · 3:33
host_summaryPatients receiving massive transfusions had lower platelet counts.↗
▶Ep 7 · 3:33
host_summaryTEG may help identify hemorrhagic trauma patients who will benefit from cryoprecipitate or platelet transfusions.↗
▶Ep 7 · 3:33
host_summaryPatients receiving massive transfusions had shortened alpha angles on TEG analysis.↗
▶Ep 7 · 3:33
host_summaryPhilips et al. conducted a retrospective study from 2015 to 2018 evaluating 117 patients from two trauma centers.↗
Quick Literature Updates Episode 11
▶Ep 20 · 3:07
host_summaryOnly 31.8% of patients with periumbilical hernias after gastroschisis needed surgery.↗
▶Ep 20 · 3:07
host_summaryFrazier et al. conducted a retrospective study from the Midwest Pediatric Surgery Consortium following 375 patients with gastroschisis who underwent closure between 2013 and 2016.↗
▶Ep 20 · 3:07
host_summaryThe overall rate for periumbilical hernias after gastroschisis closure was 22.7%.↗
▶Ep 20 · 3:07
host_summaryPeriumbilical hernia rate was significantly higher in patients who underwent primary closure versus those who needed silo placement.↗
▶Ep 20 · 3:07
host_summaryPatients who underwent sutureless gastroschisis closures had 50% rates of persistent hernia.↗
▶Ep 20 · 3:07
host_summaryOnly 16.4% of patients who underwent sutured gastroschisis closure had a persistent hernia.↗
▶Ep 20 · 3:07
host_summarySpontaneous closure of periumbilical hernias after gastroschisis was seen in 38.8% of cases.↗
▶Ep 20 · 3:07
host_summarySutureless gastroschisis closures lead to more periumbilical hernias, but they can be managed as any other congenital umbilical hernia and have no additional risk.↗
Quick Literature Updates Ep 22
▶Ep 27 · 3:16
host_summaryThe Pefer et al. study is a retrospective study done in Texas using a state hospital database examining CDH outcomes by center volume.↗
▶Ep 27 · 3:32
host_summaryThe Pefer study identified 1,314 CDH patients: 728 from high volume centers, 9 from mid-volume centers, and 79 from low volume centers.↗
▶Ep 27 · 3:46
host_summaryHigh volume centers had significantly lower mortality rates for CDH, even though they have significantly sicker patients.↗
▶Ep 27 · 3:46
host_summaryHigh volume centers had significantly shorter length of stay for CDH patients.↗
▶Ep 27 · 4:00
host_summaryHigh volume centers had better outcomes for patients with CDH.↗
epidemiologicalEsposito et al. retrospective comparison conducted in Italy included 83 patients who underwent laparoscopic cholecystectomy without ICG (group one) and 90 patients with ICG (group two).↗
▶Ep 6 · 3:23
clinicalLaparoscopic cholecystectomy with ICG provided better visualization of the biliary tree compared to without ICG.↗
▶Ep 6 · 3:23
clinicalLaparoscopic cholecystectomy with ICG had no complications compared to 12% complication rate without ICG.↗
▶Ep 6 · 3:23
clinicalLaparoscopic cholecystectomy with ICG had shorter surgery time compared to without ICG.↗
▶Ep 6 · 3:38
quoteSo it seems that laparoscopic cholecystectomy with ICG can be the new standard in our practice.↗
▶Ep 6 · 3:38
opinionLaparoscopic cholecystectomy with ICG can be the new standard in pediatric surgery practice.↗
Aggressive Pursuit of No Evidence of Disease Status in Hepatoblastoma Improves Survival
▶Ep 7 · 0:00
clinicalThe study was a retrospective observational study conducted at Cincinnati Children's Hospital from 2005 to 2021↗
▶Ep 7 · 0:00
quoteDo you pursue no evidence of disease status in hepatoblastoma?↗
▶Ep 7 · 0:20
clinicalThe study aim was to examine the effect of aggressive pursuit of no evidence of disease status on overall survival and event free status↗
▶Ep 7 · 0:35
epidemiologicalThe study included 50 patients with hepatoblastoma↗
▶Ep 7 · 0:42
clinical41 patients were rendered to no evidence of disease status↗
▶Ep 7 · 0:48
clinicalOverall survival and event free status were significantly improved in both high risk and non-high risk patients who achieved no evidence of disease status↗
▶Ep 7 · 0:58
quoteit seems that pursuing no evidence of disease status is better for overall survival in hepatoblastoma patients↗
▶Ep 7 · 0:58
opinionPursuing no evidence of disease status is better for overall survival in hepatoblastoma patients↗
Journal of Pediatric Surgery Article Review: February 2023, BAPS issue
▶Ep 55 · 9:23
host_summaryThe Tanzania soap bathing study included 252 patients, with 114 receiving a preoperative bath with plain soap↗
▶Ep 55 · 9:23
epidemiologicalThe Tanzania soap bathing study included 252 patients, with 114 receiving a preoperative bath with plain soap↗
▶Ep 55 · 9:26
epidemiologicalIn the soap bathing group, 11.4% developed surgical site infections compared to 40.6% in the control group↗
▶Ep 55 · 9:26
host_summaryIn the soap bathing group, 11.4% developed surgical site infections compared to 40.6% in the control group↗
▶Ep 55 · 9:43
host_summaryPreoperative soap bathing reduced the odds of surgical site infections by 80%↗
▶Ep 55 · 9:43
epidemiologicalPreoperative soap bathing reduced the odds of surgical site infections by 80%↗
Quick Literature Updates Episode 7
▶Ep 58 · 2:43
host_summaryThe definition of a high volume surgeon varies widely, ranging from 9 thyroidectomies per year to over 200 thyroidectomies with at least 30 being in pediatric patients.↗
▶Ep 58 · 2:43
host_summaryOlsen et al. systematic review analyzed 10 studies with 6,430 patients examining surgeon volume and pediatric thyroid surgery outcomes.↗
▶Ep 58 · 2:43
host_summaryThyroidectomies performed by high volume surgeons show shorter length of stays.↗
Journal of Pediatric Surgery Article Review: May 2023, CAPS Issue
▶Ep 60 · 1:33
clinicalThe Hirschsprung-associated IBD study was a retrospective study from 2000 to 2021 at 17 institutions with 55 patients.↗
▶Ep 60 · 2:05
epidemiologicalEnterocolitis was reported in 68% of Hirschsprung patients after pull-through.↗
▶Ep 60 · 2:05
epidemiological50% of Hirschsprung-associated IBD patients had long segment disease.↗
▶Ep 60 · 2:17
clinicalThe most common presentation for Hirschsprung-associated IBD was colonic or small bowel inflammation resembling IBD.↗
▶Ep 60 · 7:54
clinicalThe button battery study evaluated whether implementation of a clinical algorithm shortened time from diagnosis to removal of esophageal button battery.↗
▶Ep 60 · 8:09
clinicalThe algorithm was based on the national database algorithm and implemented in October 2019.↗
▶Ep 60 · 8:45
clinicalAfter implementing the critical airway response team algorithm, time from chest X-ray to button battery removal was reduced from 73 minutes to 35 minutes.↗
Quick Literature Updates Episode 15
▶Ep 66 · 0:59
host_summaryThe Hirschsprung-associated IBD study was a retrospective study gathering patients from 2000 to 2021 at 17 institutions.↗
▶Ep 66 · 0:59
clinicalThe Hirschsprung-associated IBD study was a retrospective study gathering patients from 2000 to 2021 at 17 institutions.↗
▶Ep 66 · 1:14
epidemiologicalThe study gathered 55 Hirschsprung patients, and 50% had long segment disease.↗
▶Ep 66 · 1:14
host_summaryThe study gathered 55 Hirschsprung patients, and 50% had long segment disease.↗
▶Ep 66 · 1:19
host_summary68% of the Hirschsprung patients had Hirschsprung-associated enterocolitis.↗
▶Ep 66 · 1:19
host_summary10% of the Hirschsprung patients had trisomy 21.↗
▶Ep 66 · 1:19
epidemiological10% of the Hirschsprung patients had trisomy 21.↗
▶Ep 66 · 1:19
quoteit seems that lung segment disease, Hirschprung associated enterocolitis, and trisomy 21 can be potential risk factors for IVD-like symptoms in Hirschprung patients after pull through.↗
▶Ep 66 · 1:19
clinicalLong segment disease, Hirschsprung-associated enterocolitis, and trisomy 21 can be potential risk factors for IBD-like symptoms in Hirschsprung patients after pull through.↗
▶Ep 66 · 1:19
host_summaryLong segment disease, Hirschsprung-associated enterocolitis, and trisomy 21 can be potential risk factors for IBD-like symptoms in Hirschsprung patients after pull through.↗
▶Ep 66 · 1:19
epidemiological68% of the Hirschsprung patients had Hirschsprung-associated enterocolitis.↗
▶Ep 66 · 1:19
quoteit seems that lung segment disease, Hirschprung associated enterocolitis, and trisomy 21 can be potential risk factors for IVD-like symptoms in Hirschprung patients after pull through.↗
▶Ep 66 · 3:09
host_summaryThe solid organ injury study was a retrospective study done in South Carolina examining if isolated solid organ injuries after blunt abdominal trauma can be discharged from the ED.↗
▶Ep 66 · 3:09
clinicalThe solid organ injury study was a retrospective study done in South Carolina examining if isolated solid organ injuries after blunt abdominal trauma can be discharged from the ED.↗
▶Ep 66 · 3:19
epidemiologicalThe study gathered 262 patients with isolated solid organ injuries, grades 1 to 3.↗
▶Ep 66 · 3:19
host_summaryThe study gathered 262 patients with isolated solid organ injuries, grades 1 to 3.↗
▶Ep 66 · 3:26
host_summary148 patients had solid organ injuries grades 1 or 2, and none of them required an acute intervention.↗
▶Ep 66 · 3:26
clinical148 patients had solid organ injuries grades 1 or 2, and none of them required an acute intervention.↗
▶Ep 66 · 3:34
clinicalOf 114 patients with grade 3 solid organ injuries, only 3 patients required an acute intervention.↗
▶Ep 66 · 3:34
host_summaryOf 114 patients with grade 3 solid organ injuries, only 3 patients required an acute intervention.↗
▶Ep 66 · 3:44
clinicalIsolated solid organ injuries after blunt abdominal trauma, grades 1 or 2, can be discharged from the ED.↗
▶Ep 66 · 3:44
quoteSo it seems that isolated solid organ injuries after a blunt abdominal trauma, grades 1 or 2 can be discharged from the ED.↗
▶Ep 66 · 3:44
host_summaryIsolated solid organ injuries after blunt abdominal trauma, grades 1 or 2, can be discharged from the ED.↗
▶Ep 66 · 3:44
quoteSo it seems that isolated solid organ injuries after a blunt abdominal trauma, grades 1 or 2 can be discharged from the ED.↗
Transitional Care in Anorectal Malformation and Hirschsprung's Disease
▶Ep 68 · 0:00
quoteDo you have a transitional care coordinator for colorectal patients in your hospital?↗
▶Ep 68 · 0:10
epidemiologicalA systematic review was conducted in the UK to establish and categorize challenges and solutions related to transitional care in colorectal patients↗
▶Ep 68 · 0:23
epidemiologicalThe systematic review included 234 studies↗
▶Ep 68 · 0:28
clinicalThe first challenge identified was patients' lack of understanding of their own pathology↗
▶Ep 68 · 0:34
clinicalThe second challenge was the lack of education and awareness of adult surgeons about pediatric colorectal pathologies↗
▶Ep 68 · 0:44
clinicalThe third challenge was the lack of an instructional transitional care program↗
▶Ep 68 · 0:46
guidelineThe third proposed solution was to create a structured and coordinated transition program↗
▶Ep 68 · 0:46
guidelineThe first proposed solution was to foster young adult patients' autonomy↗
▶Ep 68 · 0:46
guidelineThe second proposed solution was to conduct joint pediatric adult transitional clinics↗
Quick Literature Updates Episode 17
▶Ep 75 · 0:58
clinicalThe Zeng et al. study was a retrospective multi-center study done in China comparing robotic repair versus thoracoscopic repair for esophageal atresia.↗
▶Ep 75 · 0:58
host_summaryThe Zeng et al. study was a retrospective multi-center study done in China comparing robotic repair versus thoracoscopic repair for esophageal atresia.↗
▶Ep 75 · 1:07
clinicalRobotic surgery for esophageal atresia had longer operative time but shorter anastomotic time compared to thoracoscopic repair.↗
▶Ep 75 · 1:07
host_summaryAfter propensity score matching, the study included 126 patients with 63 in each group (robotic vs thoracoscopic).↗
▶Ep 75 · 1:07
clinicalAfter propensity score matching, the study included 126 patients with 63 in each group (robotic vs thoracoscopic).↗
▶Ep 75 · 1:07
host_summaryRobotic surgery for esophageal atresia had longer operative time but shorter anastomotic time compared to thoracoscopic repair.↗
▶Ep 75 · 1:22
host_summaryThe robotic group had lower anastomotic strictures and lower readmissions within 2 years post-op compared to thoracoscopic repair.↗
▶Ep 75 · 1:22
clinicalThe robotic group had lower anastomotic strictures and lower readmissions within 2 years post-op compared to thoracoscopic repair.↗
▶Ep 75 · 1:32
opinionRobotic surgery is a good answer for esophageal atresia repair.↗
▶Ep 75 · 1:32
opinionRobotic surgery is a good answer for esophageal atresia repair.↗
▶Ep 75 · 1:32
quoteSo it seems that robotic surgery is a good answer for esophageal tissue repair.↗
▶Ep 75 · 1:32
quoteSo it seems that robotic surgery is a good answer for esophageal tissue repair.↗
Quick Literature Updates Ep 22
▶Ep 79 · 3:16
host_summaryThe Pefer et al. study is a retrospective study done in Texas using a state hospital database examining CDH outcomes by center volume.↗
▶Ep 79 · 3:32
host_summaryThe Pefer study identified 1,314 CDH patients: 728 from high volume centers, 9 from mid-volume centers, and 79 from low volume centers.↗
▶Ep 79 · 3:46
host_summaryHigh volume centers had significantly shorter length of stay for CDH patients.↗
▶Ep 79 · 3:46
host_summaryHigh volume centers had significantly lower mortality rates for CDH, even though they have significantly sicker patients.↗
▶Ep 79 · 4:00
host_summaryHigh volume centers had better outcomes for patients with CDH.↗
Quick Literature Updates Ep 23
▶Ep 80 · 3:10
clinicalA UK systematic review aimed to establish and categorize challenges and solutions related to transitional care in colorectal patients with anorectal malformations and Hirschsprung's disease.↗
▶Ep 80 · 3:23
epidemiologicalThe systematic review included 234 studies and established 3 challenges and solutions.↗
▶Ep 80 · 3:29
clinicalThe first challenge in transitional care for colorectal patients is the patients' lack of understanding of their own pathology.↗
▶Ep 80 · 3:34
clinicalThe second challenge is the lack of education and awareness of adult surgeons about pediatric colorectal pathologies.↗
▶Ep 80 · 3:42
clinicalThe third challenge is the lack of a structured transitional care program.↗
▶Ep 80 · 3:46
guidelineThe second proposed solution is to conduct joint pediatric-adult transitional clinics.↗
▶Ep 80 · 3:46
guidelineThe third proposed solution is to create a structured and coordinated transition program.↗
▶Ep 80 · 3:46
guidelineThe first proposed solution is to foster young adult patients' autonomy.↗
Journal of Pediatric Surgery Article Review: May 2023, CAPS Issue
▶Ep 2 · 1:33
clinicalThe Hirschsprung-associated IBD study was a retrospective study from 2000 to 2021 at 17 institutions with 55 patients.↗
▶Ep 2 · 2:05
epidemiological50% of Hirschsprung-associated IBD patients had long segment disease.↗
▶Ep 2 · 2:05
epidemiologicalEnterocolitis was reported in 68% of Hirschsprung patients after pull-through.↗
▶Ep 2 · 2:17
clinicalThe most common presentation for Hirschsprung-associated IBD was colonic or small bowel inflammation resembling IBD.↗
▶Ep 2 · 7:54
clinicalThe button battery study evaluated whether implementation of a clinical algorithm shortened time from diagnosis to removal of esophageal button battery.↗
▶Ep 2 · 8:09
clinicalThe algorithm was based on the national database algorithm and implemented in October 2019.↗
▶Ep 2 · 8:45
clinicalAfter implementing the critical airway response team algorithm, time from chest X-ray to button battery removal was reduced from 73 minutes to 35 minutes.↗
Quick Literature Updates Episode 15
▶Ep 3 · 0:59
host_summaryThe Hirschsprung-associated IBD study was a retrospective study gathering patients from 2000 to 2021 at 17 institutions.↗
▶Ep 3 · 0:59
clinicalThe Hirschsprung-associated IBD study was a retrospective study gathering patients from 2000 to 2021 at 17 institutions.↗
▶Ep 3 · 1:14
epidemiologicalThe study gathered 55 Hirschsprung patients, and 50% had long segment disease.↗
▶Ep 3 · 1:14
host_summaryThe study gathered 55 Hirschsprung patients, and 50% had long segment disease.↗
▶Ep 3 · 1:19
host_summary68% of the Hirschsprung patients had Hirschsprung-associated enterocolitis.↗
▶Ep 3 · 1:19
host_summaryLong segment disease, Hirschsprung-associated enterocolitis, and trisomy 21 can be potential risk factors for IBD-like symptoms in Hirschsprung patients after pull through.↗
▶Ep 3 · 1:19
quoteit seems that lung segment disease, Hirschprung associated enterocolitis, and trisomy 21 can be potential risk factors for IVD-like symptoms in Hirschprung patients after pull through.↗
▶Ep 3 · 1:19
quoteit seems that lung segment disease, Hirschprung associated enterocolitis, and trisomy 21 can be potential risk factors for IVD-like symptoms in Hirschprung patients after pull through.↗
▶Ep 3 · 1:19
host_summary10% of the Hirschsprung patients had trisomy 21.↗
▶Ep 3 · 1:19
epidemiological10% of the Hirschsprung patients had trisomy 21.↗
▶Ep 3 · 1:19
clinicalLong segment disease, Hirschsprung-associated enterocolitis, and trisomy 21 can be potential risk factors for IBD-like symptoms in Hirschsprung patients after pull through.↗
▶Ep 3 · 1:19
epidemiological68% of the Hirschsprung patients had Hirschsprung-associated enterocolitis.↗
▶Ep 3 · 3:09
host_summaryThe solid organ injury study was a retrospective study done in South Carolina examining if isolated solid organ injuries after blunt abdominal trauma can be discharged from the ED.↗
▶Ep 3 · 3:09
clinicalThe solid organ injury study was a retrospective study done in South Carolina examining if isolated solid organ injuries after blunt abdominal trauma can be discharged from the ED.↗
▶Ep 3 · 3:19
host_summaryThe study gathered 262 patients with isolated solid organ injuries, grades 1 to 3.↗
▶Ep 3 · 3:19
epidemiologicalThe study gathered 262 patients with isolated solid organ injuries, grades 1 to 3.↗
▶Ep 3 · 3:26
clinical148 patients had solid organ injuries grades 1 or 2, and none of them required an acute intervention.↗
▶Ep 3 · 3:26
host_summary148 patients had solid organ injuries grades 1 or 2, and none of them required an acute intervention.↗
▶Ep 3 · 3:34
host_summaryOf 114 patients with grade 3 solid organ injuries, only 3 patients required an acute intervention.↗
▶Ep 3 · 3:34
clinicalOf 114 patients with grade 3 solid organ injuries, only 3 patients required an acute intervention.↗
▶Ep 3 · 3:44
host_summaryIsolated solid organ injuries after blunt abdominal trauma, grades 1 or 2, can be discharged from the ED.↗
▶Ep 3 · 3:44
clinicalIsolated solid organ injuries after blunt abdominal trauma, grades 1 or 2, can be discharged from the ED.↗
▶Ep 3 · 3:44
quoteSo it seems that isolated solid organ injuries after a blunt abdominal trauma, grades 1 or 2 can be discharged from the ED.↗
▶Ep 3 · 3:44
quoteSo it seems that isolated solid organ injuries after a blunt abdominal trauma, grades 1 or 2 can be discharged from the ED.↗
Delayed versus early repair of inguinal hernia in preterm infants
▶Ep 15 · 0:00
quoteWhen do you repair inguinal hernias in preterm babies?↗
▶Ep 15 · 0:10
host_summaryA systematic review and meta-analysis examined the optimal timing for operating inguinal hernias in preterm babies.↗
▶Ep 15 · 0:21
host_summaryPreterm patients operated before discharge in the first hospitalization had lower odds of incarceration.↗
▶Ep 15 · 0:21
host_summaryThe systematic review included 6 articles.↗
▶Ep 15 · 0:21
quoteThey reviewed 6 articles and they found that patients operated before the discharge in the first hospitalization had lower odds of incarceration but had higher risk of respiratory complications in the post-op.↗
▶Ep 15 · 0:21
host_summaryPreterm patients operated before discharge in the first hospitalization had higher risk of respiratory complications in the post-op.↗
host_summaryAdvanced liver disease is defined as conjugated bilirubin above 5 or 6 mg/dL.↗
▶Ep 21 · 2:36
host_summaryHistorically, 25-50% of intestinal failure patients died because of associated liver disease; now it is less than 2%.↗
▶Ep 21 · 3:19
host_summaryRisk factors for intestinal failure-associated liver disease include prematurity, lack of enteral feeding, sepsis, and TPN components.↗
▶Ep 21 · 12:24
host_summaryProphylactic cholecystectomy is not recommended because the gallbladder helps with enterohepatic circulation and many patients will not need it.↗
Intestinal Rehabilitation, Episode 7: Refeeding in a neonatal patient
▶Ep 22 · 4:21
host_summaryBreast milk has lower protein levels than desired and likely requires supplementation.↗
Intestinal Rehabilitation Episode 8: Refeeding of an Older Patient
▶Ep 23 · 1:30
host_summaryIn older children, normal feeding behavior is important in many social aspects of life, not just nutrition.↗
Routine contrast enema prior to stoma reversal seems only required following treatment for necrotizing enterocolitis: An evaluation of the diagnostic accuracy of the contrast enema
▶Ep 69 · 0:00
quoteDo you always do a contrast enema prior to stoma reversal?↗
▶Ep 69 · 0:13
host_summaryA retrospective study was conducted in the Netherlands between 1998 and 2018 examining contrast enema use prior to stoma reversal.↗
▶Ep 69 · 0:24
host_summaryThe study included patients under three years old who underwent stoma reversal.↗
host_summary10% of patients developed strictures.↗
▶Ep 69 · 0:43
host_summary95% of patients with strictures had necrotizing enterocolitis.↗
▶Ep 69 · 0:47
host_summaryOnly 68% of all patients had a contrast enema prior to stoma reversal.↗
▶Ep 69 · 0:51
host_summaryContrast enema was able to detect 92% of strictures.↗
▶Ep 69 · 0:54
opinionContrast enema prior to stoma reversal is only useful if patients had necrotizing enterocolitis.↗
▶Ep 69 · 0:54
quoteSo it seems that contrast enema prior to stoma reversal is only useful if patients had NEC.↗
Quick Literature Updates Episode 6
▶Ep 71 · 3:33
host_summaryPatients receiving massive transfusions had shortened alpha angles on TEG analysis.↗
▶Ep 71 · 3:33
host_summaryPatients receiving massive transfusions had lower platelet counts.↗
▶Ep 71 · 3:33
host_summaryTEG may help identify hemorrhagic trauma patients who will benefit from cryoprecipitate or platelet transfusions.↗
▶Ep 71 · 3:33
host_summaryPatients receiving massive transfusions had lower maximum amplitude values on TEG analysis.↗
▶Ep 71 · 3:33
host_summaryPhilips et al. conducted a retrospective study from 2015 to 2018 evaluating 117 patients from two trauma centers.↗
Quick Literature Updates Episode 7
▶Ep 72 · 2:43
host_summaryThyroidectomies performed by high volume surgeons show shorter length of stays.↗
▶Ep 72 · 2:43
host_summaryOlsen et al. systematic review analyzed 10 studies with 6,430 patients examining surgeon volume and pediatric thyroid surgery outcomes.↗
▶Ep 72 · 2:43
host_summaryThe definition of a high volume surgeon varies widely, ranging from 9 thyroidectomies per year to over 200 thyroidectomies with at least 30 being in pediatric patients.↗
Intestinal Rehabilitation, Episode 6: Cholestasis
▶Ep 73 · 1:48
host_summaryAdvanced liver disease is defined as conjugated bilirubin above 5 or 6 mg/dL.↗
▶Ep 73 · 2:36
host_summaryHistorically, 25-50% of intestinal failure patients died because of associated liver disease; now it is less than 2%.↗
▶Ep 73 · 3:19
host_summaryRisk factors for intestinal failure-associated liver disease include prematurity, lack of enteral feeding, sepsis, and TPN components.↗
▶Ep 73 · 12:24
host_summaryProphylactic cholecystectomy is not recommended because the gallbladder helps with enterohepatic circulation and many patients will not need it.↗
Quick Literature Updates Episode 11
▶Ep 76 · 3:07
host_summaryPatients who underwent sutureless gastroschisis closures had 50% rates of persistent hernia.↗
▶Ep 76 · 3:07
host_summaryOnly 16.4% of patients who underwent sutured gastroschisis closure had a persistent hernia.↗
▶Ep 76 · 3:07
host_summarySpontaneous closure of periumbilical hernias after gastroschisis was seen in 38.8% of cases.↗
▶Ep 76 · 3:07
host_summaryOnly 31.8% of patients with periumbilical hernias after gastroschisis needed surgery.↗
▶Ep 76 · 3:07
host_summaryPeriumbilical hernia rate was significantly higher in patients who underwent primary closure versus those who needed silo placement.↗
▶Ep 76 · 3:07
host_summaryThe overall rate for periumbilical hernias after gastroschisis closure was 22.7%.↗
▶Ep 76 · 3:07
host_summaryFrazier et al. conducted a retrospective study from the Midwest Pediatric Surgery Consortium following 375 patients with gastroschisis who underwent closure between 2013 and 2016.↗
▶Ep 76 · 3:07
host_summarySutureless gastroschisis closures lead to more periumbilical hernias, but they can be managed as any other congenital umbilical hernia and have no additional risk.↗
Disruption of enterohepatic Circulation of Bile acids ameliorates small bowel resection associated hepatic injury
▶Ep 77 · 0:00
quoteDid you know that the disruption of the enterohepatic circulation of bilasses is beneficial for the liver?↗
▶Ep 77 · 0:00
host_summaryDisruption of the enterohepatic circulation of bile acids is beneficial for the liver↗
▶Ep 77 · 0:13
host_summaryThe study was conducted at Saint Louis Children's Hospital and aimed to elucidate the driving force behind hepatic injury following bowel resection↗
▶Ep 77 · 0:22
host_summaryThe study used three groups of mice: sham, 50% with proximal or duodenal resection, and 50% with distal resection or resection of the ileocecal valve↗
▶Ep 77 · 0:34
host_summaryTissue samples were taken at the second and tenth post-operative weeks↗
▶Ep 77 · 0:41
host_summaryMice with distal resection showed less hepatic oxidative stress compared to proximal resection↗
▶Ep 77 · 0:41
quoteThey find that mice with distal resection show less hepatic oxidative stress and more hydrophilic bile acid profile, meaning that the ilisal resection could lead to less hepatic injury.↗
▶Ep 77 · 0:41
host_summaryIleal resection could lead to less hepatic injury↗
▶Ep 77 · 0:41
host_summaryMice with distal resection showed a more hydrophilic bile acid profile compared to proximal resection↗
Expectant Management or Early Ibuprofen for Patent Ductus Arteriosus
▶Ep 78 · 0:09
host_summaryA multi-center non-inferiority trial compared preterm infants treated with expectant management versus early ibuprofen for PDA↗
host_summary136 infants were treated with expectant management and 137 with early ibuprofen↗
▶Ep 78 · 0:31
host_summaryIn the expectant management group, the death rate was 14%↗
▶Ep 78 · 0:31
host_summaryIn the expectant management group, 33% developed bronchopulmonary dysplasia↗
▶Ep 78 · 0:31
host_summaryIn the expectant management group, 17.6% developed necrotizing enterocolitis↗
▶Ep 78 · 0:43
host_summaryIn the ibuprofen group, 50% developed bronchopulmonary dysplasia↗
▶Ep 78 · 0:43
host_summaryIn the ibuprofen group, 15.4% developed necrotizing enterocolitis↗
▶Ep 78 · 0:43
host_summaryIn the ibuprofen group, the death rate was 80%↗
▶Ep 78 · 1:01
host_summaryExpectant management is non-inferior to early ibuprofen in preterm patients with PDA↗
▶Ep 78 · 1:01
quoteSo it seems that expectant management is not inferiority that early ibuprofen in preterm patients with PDA.↗
Intestinal Rehabilitation, Episode 7: Refeeding in a neonatal patient
▶Ep 79 · 4:21
host_summaryBreast milk has lower protein levels than desired and likely requires supplementation.↗
Intestinal Rehabilitation Episode 8: Refeeding of an Older Patient
▶Ep 80 · 1:30
host_summaryIn older children, normal feeding behavior is important in many social aspects of life, not just nutrition.↗
Quick Literature Updates Ep 22
▶Ep 99 · 3:16
host_summaryThe Pefer et al. study is a retrospective study done in Texas using a state hospital database examining CDH outcomes by center volume.↗
▶Ep 99 · 3:32
host_summaryThe Pefer study identified 1,314 CDH patients: 728 from high volume centers, 9 from mid-volume centers, and 79 from low volume centers.↗
▶Ep 99 · 3:46
host_summaryHigh volume centers had significantly shorter length of stay for CDH patients.↗
▶Ep 99 · 3:46
host_summaryHigh volume centers had significantly lower mortality rates for CDH, even though they have significantly sicker patients.↗
▶Ep 99 · 4:00
host_summaryHigh volume centers had better outcomes for patients with CDH.↗
Quick Literature Updates Ep 27
▶Ep 100 · 3:04
host_summaryHuncheid et al. conducted a multi-center non-inferiority trial that compared preterm infants treated with expectant management versus early ibuprofen for patent ductus arteriosus.↗
▶Ep 100 · 3:14
host_summaryThe trial included 273 infants: 136 treated with expectant management and 137 with early ibuprofen.↗
▶Ep 100 · 3:24
host_summaryIn the expectant management group for PDA, there was 17.6% necrotizing enterocolitis, 33% bronchopulmonary dysplasia, and 14% death rates.↗
▶Ep 100 · 3:36
host_summaryIn the ibuprofen group for PDA, there was 15.4% necrotizing enterocolitis, 50% bronchopulmonary dysplasia, and 80% death rates.↗
▶Ep 100 · 3:53
host_summaryExpectant management is not inferior to early ibuprofen in preterm patients with patent ductus arteriosus.↗
▶Ep 100 · 3:53
quoteSo it seems that expectant management is not inferiority that early ibuprofen in preterm patients with PDA.↗
Clinical Characteristics and Prognosis of Biliary Atresia with Low Serum Matrix Metalloproteinase-7 Levels
▶Ep 3 · 0:11
quoteThis is a retrospective cohort study done in China that aimed to evaluate the characteristics and prognosis of patients with biliary atresia and low MMP 7.↗
▶Ep 3 · 0:11
epidemiologicalThe study was a retrospective cohort study conducted in China↗
▶Ep 3 · 0:21
epidemiological40 of the 329 patients had low MMP-7 levels↗
▶Ep 3 · 0:21
epidemiologicalThe study included 329 patients with biliary atresia↗
▶Ep 3 · 0:21
quoteThey had 329 patients, and 40 of them had low MMP7.↗
▶Ep 3 · 0:27
quoteAnd what they found is that these patients had significantly lower 3 month and 6 month jaundice clearance and significantly lower 1 year native liver survival.↗
▶Ep 3 · 0:27
clinicalPatients with low MMP-7 had significantly lower 1-year native liver survival↗
▶Ep 3 · 0:27
clinicalPatients with low MMP-7 had significantly lower 6-month jaundice clearance↗
▶Ep 3 · 0:27
clinicalPatients with low MMP-7 had significantly lower 3-month jaundice clearance↗
▶Ep 3 · 0:40
opinionMMP-7 measurement may in the future help with treatment of biliary atresia patients↗
▶Ep 3 · 0:40
opinionMeasuring MMP-7 can help with prognosis in biliary atresia patients↗
Aggressive Pursuit of No Evidence of Disease Status in Hepatoblastoma Improves Survival
▶Ep 9 · 0:00
quoteDo you pursue no evidence of disease status in hepatoblastoma?↗
▶Ep 9 · 0:00
clinicalThe study was a retrospective observational study conducted at Cincinnati Children's Hospital from 2005 to 2021↗
▶Ep 9 · 0:20
clinicalThe study aim was to examine the effect of aggressive pursuit of no evidence of disease status on overall survival and event free status↗
▶Ep 9 · 0:35
epidemiologicalThe study included 50 patients with hepatoblastoma↗
▶Ep 9 · 0:42
clinical41 patients were rendered to no evidence of disease status↗
▶Ep 9 · 0:48
clinicalOverall survival and event free status were significantly improved in both high risk and non-high risk patients who achieved no evidence of disease status↗
▶Ep 9 · 0:58
opinionPursuing no evidence of disease status is better for overall survival in hepatoblastoma patients↗
▶Ep 9 · 0:58
quoteit seems that pursuing no evidence of disease status is better for overall survival in hepatoblastoma patients↗
Routine contrast enema prior to stoma reversal seems only required following treatment for necrotizing enterocolitis: An evaluation of the diagnostic accuracy of the contrast enema
▶Ep 12 · 0:00
quoteDo you always do a contrast enema prior to stoma reversal?↗
▶Ep 12 · 0:13
host_summaryA retrospective study was conducted in the Netherlands between 1998 and 2018 examining contrast enema use prior to stoma reversal.↗
▶Ep 12 · 0:24
host_summaryThe study included patients under three years old who underwent stoma reversal.↗
Image-guided core-needle or surgical biopsy for neuroblastoma diagnosis in children
▶Ep 13 · 0:09
clinicalThe systematic review and meta-analysis was conducted by IPSO↗
▶Ep 13 · 0:09
clinicalThe review analyzed the accuracy and safety of image-guided core needle biopsy for neuroblastoma↗
▶Ep 13 · 0:23
clinicalIntraoperative transfusions were higher in the surgical biopsy group compared to image-guided core needle biopsy↗
▶Ep 13 · 0:23
clinicalTissue adequacy was not significantly different between image-guided core needle biopsy and surgical biopsy groups↗
▶Ep 13 · 0:23
clinicalBiological characterization of the biopsy was not significantly different between image-guided core needle biopsy and surgical biopsy groups↗
▶Ep 13 · 0:23
epidemiologicalThe review included 8 retrospective studies with 490 patients↗
▶Ep 13 · 0:23
clinicalComplications were higher in the surgical biopsy group compared to image-guided core needle biopsy↗
▶Ep 13 · 0:43
opinionImage-guided core needle biopsy is safe and effective for diagnosing neuroblastoma↗
▶Ep 13 · 0:43
quoteSo it seems that image-guided core needle biopsy is safe and effective for diagnosed neuroblastoma.↗
Quick Literature Updates Ep 19
▶Ep 21 · 3:27
host_summaryThe IPSO systematic review and meta-analysis gathered 8 retrospective studies with 490 patients comparing image-guided core needle biopsy to surgical biopsy for neuroblastoma.↗
▶Ep 21 · 3:27
epidemiologicalThe IPSO systematic review and meta-analysis gathered 8 retrospective studies with 490 patients comparing image-guided core needle biopsy to surgical biopsy for neuroblastoma.↗
▶Ep 21 · 3:40
clinicalTissue adequacy and biological characterization of the biopsy was not significantly different between image-guided core needle biopsy and surgical biopsy groups for neuroblastoma.↗
▶Ep 21 · 3:40
host_summaryTissue adequacy and biological characterization of the biopsy was not significantly different between image-guided core needle biopsy and surgical biopsy groups for neuroblastoma.↗
▶Ep 21 · 3:54
host_summaryIntraoperative transfusions and complications were higher in the surgical biopsy group compared to image-guided core needle biopsy for neuroblastoma.↗
▶Ep 21 · 3:54
clinicalIntraoperative transfusions and complications were higher in the surgical biopsy group compared to image-guided core needle biopsy for neuroblastoma.↗
▶Ep 21 · 4:00
clinicalImage-guided core needle biopsy is safe and effective for diagnosing neuroblastoma.↗
▶Ep 21 · 4:00
host_summaryImage-guided core needle biopsy is safe and effective for diagnosing neuroblastoma.↗
Update Course Rewind: Management of Acute Pancreatitis 2023
▶Ep 14 · 5:55
clinicalFluid resuscitation is key in pancreatitis management↗
▶Ep 14 · 5:57
clinicalPatients should be reassessed at the 12 and 24 hour mark to avoid fluid overload↗
Transcystic Laparoscopic Common Bile Duct Exploration for Pediatric Patients with Choledocholithiasis
▶Ep 16 · 0:09
epidemiologicalThe study aim was to compare patients with suspected choledocholithiasis who underwent transcystic laparoscopic common bile duct exploration versus those who underwent ERCP first↗
▶Ep 16 · 0:09
quoteThis is a multi-center retrospective study done in the US from 2018 to 2022, and their aim was to compare patients with suspected.↗
▶Ep 16 · 0:09
epidemiologicalThe study was a multi-center retrospective study conducted in the US from 2018 to 2022↗
▶Ep 16 · 0:28
epidemiologicalThe study included 252 patients total↗
▶Ep 16 · 0:28
epidemiological156 patients were in group one (transcystic laparoscopic common bile duct exploration)↗
▶Ep 16 · 0:38
clinicalPatients in group one (transcystic laparoscopic approach) had significantly less complication rates compared to group two↗
▶Ep 16 · 0:38
clinicalPatients in group one (transcystic laparoscopic approach) had lower length of stay compared to group two↗
▶Ep 16 · 0:38
epidemiological96 patients were in group two (ERCP first)↗
▶Ep 16 · 0:52
opinionAttempting a transcystic laparoscopic common bile duct exploration may benefit pediatric patients with choledocholithiasis↗
▶Ep 16 · 0:52
quoteSo it seems that attempting a transcystic laparoscopic common bile duct exploration may benefit our patients.↗
Update Course Rewind: Management of Recurrent Pancreatitis
▶Ep 17 · 2:26
guidelineIf a patient has more than one episode of acute pancreatitis or a first severe episode, an MRCP and genetic panel should be performed to rule out genetic anomalies.↗
▶Ep 17 · 2:26
host_summaryIf a patient has more than one episode of acute pancreatitis or a first severe episode, an MRCP and genetic panel should be performed to rule out genetic anomalies.↗
▶Ep 17 · 3:37
guidelineGenetics are very important before any resection procedure to avoid losing pancreatic cells in pathologies that will not benefit from resection and drainage but instead from islet cell transplant.↗
▶Ep 17 · 3:37
host_summaryGenetics are very important before any resection procedure to avoid losing pancreatic cells in pathologies that will not benefit from resection and drainage but instead from islet cell transplant.↗
▶Ep 17 · 4:37
host_summaryEndoscopic treatment should be attempted first, but if it fails, transfer to a specialized center that performs TPIAT (total pancreatectomy with islet autotransplantation).↗
▶Ep 17 · 4:37
guidelineEndoscopic treatment should be attempted first, but if it fails, transfer to a specialized center that performs TPIAT (total pancreatectomy with islet autotransplantation).↗
▶Ep 17 · 5:11
guidelineFor pancreatic imaging, start with ultrasound, then CT, and for better visualization of pancreatic anatomy, use MRCP with T2 sequences.↗
▶Ep 17 · 5:11
host_summaryFor pancreatic imaging, start with ultrasound, then CT, and for better visualization of pancreatic anatomy, use MRCP with T2 sequences.↗
▶Ep 17 · 5:40
host_summaryRecurrent pancreatitis is a rare pathology that can lead to chronic pancreatitis and is associated with genetic mutations.↗
▶Ep 17 · 5:40
clinicalRecurrent pancreatitis is a rare pathology that can lead to chronic pancreatitis and is associated with genetic mutations.↗
▶Ep 17 · 5:50
host_summaryIf genetic mutations are confirmed, partial resection (e.g., Frey procedure) should be avoided to preserve pancreatic cells, and TPIAT should be considered sooner rather than later if endoscopic treatment fails.↗
▶Ep 17 · 5:50
guidelineIf genetic mutations are confirmed, partial resection (e.g., Frey procedure) should be avoided to preserve pancreatic cells, and TPIAT should be considered sooner rather than later if endoscopic treatment fails.↗
Case-Based Journal Review: Cholelithiasis 2024
▶Ep 18 · 3:11
clinicalIn a multi-center study of 167 early cholecystectomy patients versus 79 delayed, early cholecystectomy had 2% recurrence of pancreatitis compared to 22% in delayed surgery↗
▶Ep 18 · 3:11
host_summaryIn a multi-center study of 167 early cholecystectomy patients versus 79 delayed, early cholecystectomy had 2% recurrence of pancreatitis compared to 22% in delayed surgery↗
▶Ep 18 · 3:36
host_summaryWhen cholecystectomy was delayed more than 6 weeks after gallstone pancreatitis, recurrence rate increased to 60%↗
▶Ep 18 · 3:36
clinicalWhen cholecystectomy was delayed more than 6 weeks after gallstone pancreatitis, recurrence rate increased to 60%↗
▶Ep 18 · 4:27
clinicalPatients who underwent early cholecystectomy did not have more biliary complications than delayed surgery patients↗
▶Ep 18 · 4:27
host_summaryPatients who underwent early cholecystectomy did not have more biliary complications than delayed surgery patients↗
▶Ep 18 · 11:27
clinicalIn a multi-center study of 252 patients with choledocholithiasis, 156 underwent OR-first approach (laparoscopic cholecystectomy with intraoperative cholangiogram) and 96 underwent ERCP-first approach↗
▶Ep 18 · 11:27
host_summaryIn a multi-center study of 252 patients with choledocholithiasis, 156 underwent OR-first approach (laparoscopic cholecystectomy with intraoperative cholangiogram) and 96 underwent ERCP-first approach↗
▶Ep 18 · 11:41
host_summaryPatients who underwent intraoperative cholangiogram first had fewer complications and shorter length of stay than ERCP-first patients, and 86% needed only the surgery without subsequent ERCP↗
▶Ep 18 · 11:41
clinicalPatients who underwent intraoperative cholangiogram first had fewer complications and shorter length of stay than ERCP-first patients, and 86% needed only the surgery without subsequent ERCP↗
clinicalCryoanalgesia uses cold temperatures to cause a conduction block that interrupts pain impulses to the brain.↗
▶Ep 25 · 1:57
host_summaryCryoanalgesia uses cold temperatures to cause a conduction block that interrupts pain impulses to the brain.↗
▶Ep 25 · 3:36
host_summaryFor medications, the FDA requires clinical trials with long-term clinical results before approval, but this is not required for medical devices and techniques like cryoanalgesia.↗
▶Ep 25 · 3:36
guidelineFor medications, the FDA requires clinical trials with long-term clinical results before approval, but this is not required for medical devices and techniques like cryoanalgesia.↗
▶Ep 25 · 9:41
quoteI've always done right to left. Um, I never even thought about doing left to right, I must admit.↗
▶Ep 25 · 9:41
clinicalDr. Slater has always performed the Nuss procedure right to left and had not previously considered left to right.↗
▶Ep 25 · 9:41
host_summaryDr. Slater has always performed the Nuss procedure right to left and had not previously considered left to right.↗
▶Ep 25 · 9:41
quoteI've always done right to left. Um, I never even thought about doing left to right, I must admit.↗
Update Course Rewind: Pectus Excavatum 2021
▶Ep 26 · 1:57
host_summaryCryoanalgesia uses cold temperatures to cause a conduction block, interrupting pain impulses to the brain.↗
▶Ep 26 · 1:57
clinicalCryoanalgesia uses cold temperatures to cause a conduction block, interrupting pain impulses to the brain.↗
▶Ep 26 · 3:36
guidelineThe FDA requires clinical trials with long-term results for medications before approval, but not for medical devices and techniques.↗
▶Ep 26 · 3:36
host_summaryThe FDA requires clinical trials with long-term results for medications before approval, but not for medical devices and techniques.↗
▶Ep 26 · 9:41
quoteI've always done right to left. Um, I never even thought about doing left to right, I must admit.↗
▶Ep 26 · 9:41
quoteI've always done right to left. Um, I never even thought about doing left to right, I must admit.↗
Cryoablation in 350 Nuss procedures
▶Ep 33 · 0:10
clinicalThe study was a retrospective single institution study conducted in Phoenix from 2017 to 2021↗
▶Ep 33 · 0:16
clinicalThe study compared patients who underwent Nuss procedure with cryoanalgesia in the first quarter of institutional experience versus the fourth quarter↗
▶Ep 33 · 0:29
epidemiological350 patients underwent Nuss procedure with cryoanalgesia in the study period↗
▶Ep 33 · 0:34
clinicalPatients in the last quarter required 74% less opioids compared to the first quarter↗
▶Ep 33 · 0:34
clinicalPatients in the last quarter were discharged 1.3 days earlier than patients in the first quarter↗
▶Ep 33 · 0:46
opinionExperience plays a role in cryoanalgesia outcomes for Nuss procedures↗
▶Ep 33 · 0:46
quoteSo it seems that experience really plays a role talking about cryoathesia.↗
Initial Outcomes Using Cryoablation in Surgical Management of Slipping Rib Syndrome
▶Ep 35 · 0:00
quoteDo you use cryo for resecting cartilage in the slipping ribs syndrome?↗
▶Ep 35 · 0:11
clinicalThe study was a retrospective review conducted in Phoenix between 2018 and 2022↗
▶Ep 35 · 0:16
clinicalThe study compared length of stay and opiate use in patients undergoing cartilaginous rib excision with and without cryo↗
▶Ep 35 · 0:27
epidemiological22 patients underwent resection with cryo↗
▶Ep 35 · 0:27
epidemiological8 patients underwent a NAS procedure plus cartilaginous resection with cryoalgesia↗
▶Ep 35 · 0:27
epidemiological68 patients underwent resection without cryo↗
▶Ep 35 · 0:27
epidemiologicalThe study included 98 patients total↗
▶Ep 35 · 0:43
clinicalPatients who underwent resection with cryo stayed one day less than patients without cryo, though this difference was not statistically significant↗
▶Ep 35 · 0:43
clinicalPatients who underwent resection with cryo had significantly less opiate use↗
Quick Literature Updates Episode 13
▶Ep 37 · 3:16
host_summaryIn a Boston Children's Hospital study of 143 button battery ingestion patients from 2008 to 2021, 24 had severe outcomes.↗
▶Ep 37 · 3:37
host_summaryLocation of the button battery in the esophagus is an independent predictor for severe outcomes in button battery ingestion.↗
▶Ep 37 · 3:45
host_summaryA button battery larger than 2 centimeters is an independent predictor for severe outcomes in button battery ingestion.↗
▶Ep 37 · 3:49
host_summaryHaving symptoms at presentation is an independent predictor for severe outcomes in button battery ingestion.↗
Impact of Cryoanalgesia Use During Minimally Invasive Pectus Excavatum Repair on Hospital Days and Total Hospital Costs Among Pediatric Patients
▶Ep 38 · 0:00
quoteDo you use cryoalgesia for the NAS procedure in pectus excavatum repair?↗
▶Ep 38 · 0:11
epidemiologicalThe study was a retrospective review conducted in Texas↗
▶Ep 38 · 0:11
epidemiologicalThe study aimed to evaluate hospital cost and length of stay for patients undergoing minimally invasive repair of pectus excavatum plus cryoanalgesia↗
▶Ep 38 · 0:26
epidemiologicalThe study included 44 patients total, with 29 undergoing cryoanalgesia↗
▶Ep 38 · 0:26
clinicalPatients who underwent cryoanalgesia had significantly lower complication rates compared to those without cryoanalgesia↗
▶Ep 38 · 0:26
clinicalPatients who underwent cryoanalgesia had significantly less length of stay compared to those without cryoanalgesia↗
▶Ep 38 · 0:39
clinicalPatients who underwent cryoanalgesia had lower hospital costs than those without cryoanalgesia, though this difference was not statistically significant↗
▶Ep 38 · 0:48
opinionCryoanalgesia helps with pain management in pectus excavatum repair↗
▶Ep 38 · 0:48
quoteSo it seems that cryo not only helps with pain management, but also can help with hospital cost.↗
▶Ep 38 · 0:48
opinionCryoanalgesia can help with hospital cost reduction in pectus excavatum repair↗
Pectus Arcuatum a Pectus Unlike any Other
▶Ep 40 · 0:00
quoteHave you ever treated a pectussarquatum like a pectus carinatum?↗
▶Ep 40 · 0:11
epidemiologicalThe study is a multi-center retrospective study conducted in France describing pectus arcuatum↗
▶Ep 40 · 0:20
clinical47% of patients needed chest x-ray or CT scan to confirm the diagnosis of pectus arcuatum↗
▶Ep 40 · 0:20
epidemiologicalThe study included 34 patients with pectus arcuatum↗
▶Ep 40 · 0:29
clinicalNoonan syndrome is an associated malformation seen with pectus arcuatum↗
▶Ep 40 · 0:29
clinicalThe best treatment for pectus arcuatum was surgical correction that included a sternotomy↗
▶Ep 40 · 0:29
clinicalScoliosis is an associated malformation seen with pectus arcuatum↗
▶Ep 40 · 0:29
epidemiological35% of pectus arcuatum patients were associated with a malformation↗
▶Ep 40 · 0:41
clinicalPectus arcuatum should not be confused with pectus carinatum as they are different conditions↗
▶Ep 40 · 0:43
quoteDo not confusefectus or quatum with thefectus carinatum.↗
Journal of Pediatric Surgery Article Review: July 2023, PAPS Issue
▶Ep 41 · 1:39
host_summaryThe cryoanalgesia study compared patients from 2011 to 2021, with 29 patients receiving cryoanalgesia and 15 not receiving it.↗
▶Ep 41 · 1:39
clinicalThe cryoanalgesia study compared patients from 2011 to 2021, with 29 patients receiving cryoanalgesia and 15 not receiving it.↗
▶Ep 41 · 1:48
host_summaryPatients who received cryoanalgesia had shorter hospital stays: 3.0 days versus 5.4 days for those without cryoanalgesia.↗
▶Ep 41 · 1:48
clinicalPatients who received cryoanalgesia had shorter hospital stays: 3.0 days versus 5.4 days for those without cryoanalgesia.↗
▶Ep 41 · 2:00
clinicalHospital costs were slightly lower (less than $1000 difference) in patients who received cryoanalgesia despite the expensive equipment.↗
▶Ep 41 · 2:00
host_summaryHospital costs were slightly lower (less than $1000 difference) in patients who received cryoanalgesia despite the expensive equipment.↗
▶Ep 41 · 6:51
host_summaryThe pilonidal disease cohort included 21 patients with skin types 1-2, 156 with skin types 3-4, and 21 with skin types 5-6, with approximately 151 having dark colored hair.↗
▶Ep 41 · 6:51
clinicalThe pilonidal disease cohort included 21 patients with skin types 1-2, 156 with skin types 3-4, and 21 with skin types 5-6, with approximately 151 having dark colored hair.↗
▶Ep 41 · 7:34
host_summaryTo reach 75% hair reduction requires a mean of 4.8 to 6.8 laser ablation sessions depending on skin and hair characteristics.↗
▶Ep 41 · 7:34
clinicalTo reach 75% hair reduction requires a mean of 4.8 to 6.8 laser ablation sessions depending on skin and hair characteristics.↗
▶Ep 41 · 7:47
host_summaryThe overall recurrence rate for pilonidal disease after laser hair reduction was 6%.↗
▶Ep 41 · 7:47
clinicalDark hair and skin types 5-6 were associated with higher recurrence rates in pilonidal disease after laser hair reduction.↗
▶Ep 41 · 7:47
host_summaryDark hair and skin types 5-6 were associated with higher recurrence rates in pilonidal disease after laser hair reduction.↗
▶Ep 41 · 7:47
clinicalThe overall recurrence rate for pilonidal disease after laser hair reduction was 6%.↗
Journal of Pediatric Surgery Article Review: September 2023
▶Ep 42 · 1:43
host_summaryIn the pectus arcuatum study, 34 patients were reviewed with a mean age of 10 years, and 47% required X-ray or CT scan for diagnosis.↗
▶Ep 42 · 1:43
clinicalIn the pectus arcuatum study, 34 patients were reviewed with a mean age of 10 years, and 47% required X-ray or CT scan for diagnosis.↗
▶Ep 42 · 7:41
clinicalERAS protocols significantly reduce intraoperative fluids needed and postoperative opiate use in pediatric colorectal surgery.↗
▶Ep 42 · 7:41
host_summaryERAS protocols significantly reduce intraoperative fluids needed and postoperative opiate use in pediatric colorectal surgery.↗
▶Ep 42 · 7:55
host_summaryTime to first oral intake and time for complete nutrition was less in patients managed with ERAS protocols.↗
▶Ep 42 · 7:55
clinicalTime to first oral intake and time for complete nutrition was less in patients managed with ERAS protocols.↗
Journal of Pediatric Surgery Article Review: Q1 (Jan-Mar) 2024
▶Ep 44 · 2:45
clinicalThe appendicitis study had 185 patients in the home antibiotic group and 121 patients in the no home antibiotic group.↗
▶Ep 44 · 2:45
host_summaryThe appendicitis study had 185 patients in the home antibiotic group and 121 patients in the no home antibiotic group.↗
▶Ep 44 · 2:55
clinicalThere was no significant difference in deep organ space infection requiring intervention between home antibiotic and no home antibiotic groups for complicated appendicitis.↗
▶Ep 44 · 2:55
host_summaryThere was no significant difference in deep organ space infection requiring intervention between home antibiotic and no home antibiotic groups for complicated appendicitis.↗
▶Ep 44 · 3:03
host_summaryThere was no difference in length of stay between home antibiotic and no home antibiotic groups for complicated appendicitis.↗
▶Ep 44 · 3:03
clinicalThere was no difference in length of stay between home antibiotic and no home antibiotic groups for complicated appendicitis.↗
▶Ep 44 · 5:43
clinicalType 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.↗
▶Ep 44 · 5:43
clinicalType 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.↗
▶Ep 44 · 8:47
host_summaryThe 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.↗
▶Ep 44 · 8:47
clinicalThe 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.↗
▶Ep 44 · 9:04
clinicalThe pectus study selected patients under 21 years of age who presented for bar removal between November 2021 and May 2023.↗
▶Ep 44 · 9:04
host_summaryThe pectus study selected patients under 21 years of age who presented for bar removal between November 2021 and May 2023.↗
▶Ep 44 · 9:15
clinicalTesting for cold and soft touch and pinprick was performed just before bar removal.↗
▶Ep 44 · 9:15
host_summaryTesting for cold and soft touch and pinprick was performed just before bar removal.↗
▶Ep 44 · 9:25
clinicalThe pectus study enrolled 47 patients with a median bar dwell time of approximately 2.9 years.↗
▶Ep 44 · 9:25
host_summaryThe pectus study enrolled 47 patients with a median bar dwell time of approximately 2.9 years.↗
▶Ep 44 · 9:41
clinicalPatients had a median of 2 bars placed, and almost 81% were secured with pericostal sutures.↗
▶Ep 44 · 9:41
host_summaryPatients had a median of 2 bars placed, and almost 81% were secured with pericostal sutures.↗
▶Ep 44 · 9:51
host_summaryAlmost half of the pectus patients had some degree of hypoesthesia, with T5 being the most common dermatome affected.↗
▶Ep 44 · 9:51
clinicalAlmost half of the pectus patients had some degree of hypoesthesia, with T5 being the most common dermatome affected.↗
▶Ep 44 · 10:00
clinicalThe area with hypoesthesia was less than 5% of the entire surface that was treated with cryo.↗
▶Ep 44 · 10:00
host_summaryThe area with hypoesthesia was less than 5% of the entire surface that was treated with cryo.↗
▶Ep 44 · 10:18
clinicalNeuropathic symptoms were identified by only 13% of pectus patients, and none required treatment.↗
▶Ep 44 · 10:18
host_summaryNeuropathic symptoms were identified by only 13% of pectus patients, and none required treatment.↗
▶Ep 44 · 10:26
host_summaryIn 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.↗
▶Ep 44 · 10:26
clinicalIn 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.↗
▶Ep 44 · 11:00
clinicalPericostal sutures used to secure bars can damage nerves.↗
▶Ep 44 · 11:00
clinicalPericostal sutures used to secure bars can damage nerves.↗
Quick Literature Updates Ep 24
▶Ep 54 · 3:34
epidemiologicalThe Rao et al. study is a multi-center retrospective study done in the US from 2018 to 2022.↗
▶Ep 54 · 3:34
epidemiologicalThe Rao study compared patients with suspected choledocholithiasis who underwent transcystic laparoscopic common bile duct exploration versus those who underwent ERCP first.↗
▶Ep 54 · 3:53
epidemiologicalThe Rao study included 252 patients total: 156 in the transcystic laparoscopic common bile duct exploration group and 96 in the ERCP-first group.↗
▶Ep 54 · 4:02
clinicalPatients who underwent transcystic laparoscopic common bile duct exploration had significantly less complication rates compared to ERCP-first patients.↗
▶Ep 54 · 4:02
clinicalPatients who underwent transcystic laparoscopic common bile duct exploration had lower length of stay compared to ERCP-first patients.↗
▶Ep 54 · 4:16
opinionAttempting a transcystic laparoscopic common bile duct exploration may benefit pediatric choledocholithiasis patients.↗
Update Course Rewind: Pectus Excavatum 2021
▶Ep 56 · 1:21
quoteWe were enrolling in this study. We had about 30 patients in each group when we tried the first cryotherapy. And when that patient went home on post-op day one, equipoise was lost. Once you see it, it's sort of a different game.↗
▶Ep 56 · 1:21
clinicalAfter implementing cryoanalgesia, the first patient went home on post-operative day one, leading Dr. St. Peter to discontinue enrollment in the epidural/PCA comparison trial↗
▶Ep 56 · 1:21
host_summaryAfter implementing cryoanalgesia, the first patient went home on post-operative day one, leading Dr. St. Peter to discontinue enrollment in the epidural/PCA comparison trial↗
▶Ep 56 · 1:21
quoteWe were enrolling in this study. We had about 30 patients in each group when we tried the first cryotherapy. And when that patient went home on post-op day one, equipoise was lost. Once you see it, it's sort of a different game.↗
▶Ep 56 · 2:33
host_summaryWith cryoanalgesia, length of stay decreased from four days (baseline) to one day↗
▶Ep 56 · 2:33
clinicalWith cryoanalgesia, length of stay decreased from four days (baseline) to one day↗
▶Ep 56 · 2:33
quoteWhat we saw there is the length of stay where we just couldn't get below four days. All of a sudden became one.↗
▶Ep 56 · 2:33
quoteWhat we saw there is the length of stay where we just couldn't get below four days. All of a sudden became one.↗
▶Ep 56 · 2:52
quoteI agree with Sean. It works. I mean, it is great. One day. Yeah, no. So what I'm concerned about is that there are no long-term studies. But I believe we just don't know. We don't have the long-term data.↗
▶Ep 56 · 2:52
opinionDr. Garcia expressed concern that there are no long-term studies of cryoanalgesia and potential for chronic neuropathic pain↗
▶Ep 56 · 2:52
quoteI agree with Sean. It works. I mean, it is great. One day. Yeah, no. So what I'm concerned about is that there are no long-term studies. But I believe we just don't know. We don't have the long-term data.↗
▶Ep 56 · 2:52
host_summaryDr. Garcia expressed concern that there are no long-term studies of cryoanalgesia and potential for chronic neuropathic pain↗
▶Ep 56 · 3:50
host_summaryDr. Garcia's hospital uses erector spinae catheters placed by the pain team with ultrasound guidance, positioned juxtaposed to but not in the vertebral space↗
▶Ep 56 · 3:50
clinicalDr. Garcia's hospital uses erector spinae catheters placed by the pain team with ultrasound guidance, positioned juxtaposed to but not in the vertebral space↗
▶Ep 56 · 4:08
clinicalWith erector spinae catheters, hospital stay is two days, catheters remain in place for five days total (three days at home on automated pump), and families remove catheters at home on day five↗
▶Ep 56 · 4:08
host_summaryWith erector spinae catheters, hospital stay is two days, catheters remain in place for five days total (three days at home on automated pump), and families remove catheters at home on day five↗
▶Ep 56 · 4:52
quoteI was a cryo skeptic. My biggest issues with it were the added time. The other is concerned about the neuralgia and the complications that I'd heard about. And I will tell you that it took me about four cases to realize, because most of our patients went home on day two or three. But it's not just when they go home. It's how they feel when they go home. And the cryo has been unbelievable. I mean, I feel bad that I waited so long.↗
▶Ep 56 · 4:52
host_summaryDr. Rothenberg initially had concerns about cryoanalgesia including added operative time and risk of neuralgia, but after four cases observed that patients not only went home earlier but felt significantly better at discharge↗
▶Ep 56 · 4:52
opinionDr. Rothenberg initially had concerns about cryoanalgesia including added operative time and risk of neuralgia, but after four cases observed that patients not only went home earlier but felt significantly better at discharge↗
▶Ep 56 · 4:52
quoteI was a cryo skeptic. My biggest issues with it were the added time. The other is concerned about the neuralgia and the complications that I'd heard about. And I will tell you that it took me about four cases to realize, because most of our patients went home on day two or three. But it's not just when they go home. It's how they feel when they go home. And the cryo has been unbelievable. I mean, I feel bad that I waited so long.↗
▶Ep 56 · 5:34
clinicalDr. Ponsky's multimodal regimen includes preoperative counseling, gabapentin pre and postoperatively, methadone, clonidine, bowel regimen medications, and antiemetics↗
▶Ep 56 · 5:34
host_summaryDr. Ponsky's multimodal regimen includes preoperative counseling, gabapentin pre and postoperatively, methadone, clonidine, bowel regimen medications, and antiemetics↗
▶Ep 56 · 6:15
host_summaryAt Nebraska where Dr. Rayner practices, length of stay is under two days and patients are off opioids by one week using multimodal pain control↗
▶Ep 56 · 6:15
clinicalAt Nebraska where Dr. Rayner practices, length of stay is under two days and patients are off opioids by one week using multimodal pain control↗
▶Ep 56 · 7:35
clinicalComputational modeling by physics-minded surgeons showed that shorter flat bars create more pressure on the sternum compared to traditional U-shaped bars, potentially increasing stability↗
▶Ep 56 · 7:35
host_summaryComputational modeling by physics-minded surgeons showed that shorter flat bars create more pressure on the sternum compared to traditional U-shaped bars, potentially increasing stability↗
▶Ep 56 · 8:58
host_summaryTechniques to avoid cardiac injury during introducer passage include thoracoscopy, sternal elevator, vacuum bell in the operating room, and sub-xiphoid incision↗
▶Ep 56 · 8:58
quoteThoracoscopy or sternal elevator or vacuum bell in the operating room or sub-xiphoid incision, the idea is to not injure the heart. So whatever technique helps you do that, I think is the technique you ought to use.↗
▶Ep 56 · 8:58
quoteThoracoscopy or sternal elevator or vacuum bell in the operating room or sub-xiphoid incision, the idea is to not injure the heart. So whatever technique helps you do that, I think is the technique you ought to use.↗
▶Ep 56 · 8:58
clinicalTechniques to avoid cardiac injury during introducer passage include thoracoscopy, sternal elevator, vacuum bell in the operating room, and sub-xiphoid incision↗
Update Course Rewind: Pectus Excavatum 2021
▶Ep 57 · 1:21
quoteOnce you see it, it's sort of a different game.↗
▶Ep 57 · 1:21
quoteOnce you see it, it's sort of a different game.↗
▶Ep 57 · 2:07
host_summaryThe cryoanalgesia technique involves two minutes of freezing per rib, applied to ribs four through seven; ribs eight and below should not be treated due to risk of abdominal wall paralysis.↗
▶Ep 57 · 2:07
clinicalThe cryoanalgesia technique involves two minutes of freezing per rib, applied to ribs four through seven; ribs eight and below should not be treated due to risk of abdominal wall paralysis.↗
▶Ep 57 · 2:43
host_summaryCryoanalgesia dramatically reduced median morphine equivalents compared to epidural/PCA approaches.↗
▶Ep 57 · 2:43
clinicalCryoanalgesia dramatically reduced median morphine equivalents compared to epidural/PCA approaches.↗
▶Ep 57 · 3:14
guidelineMedical devices and implants are not required to undergo clinical trials before market introduction, unlike medications which require FDA clinical trials with long-term results.↗
▶Ep 57 · 3:14
guidelineMedical devices and implants are not required to undergo clinical trials before market introduction, unlike medications which require FDA clinical trials with long-term results.↗
▶Ep 57 · 4:08
clinicalWith erector spinae catheters, hospital stay is two days, catheters remain in place for five days on an automated pump, and families remove the catheters at home on the third day.↗
▶Ep 57 · 4:08
clinicalErector spinae catheters are placed by the pain team with ultrasound guidance in a position juxtaposed to but not within the vertebral space.↗
▶Ep 57 · 4:08
host_summaryErector spinae catheters are placed by the pain team with ultrasound guidance in a position juxtaposed to but not within the vertebral space.↗
▶Ep 57 · 4:08
host_summaryWith erector spinae catheters, hospital stay is two days, catheters remain in place for five days on an automated pump, and families remove the catheters at home on the third day.↗
▶Ep 57 · 4:30
quoteIt's not just when they go home. It's how they feel when they go home. And the cryo has been unbelievable. I mean, I feel bad that I waited so long.↗
▶Ep 57 · 4:30
quoteI accept Vic's concerns and criticisms. And I agree, perhaps, you know, that we do need to have a registry for this. But it has totally changed the management of these patients.↗
▶Ep 57 · 4:30
quoteIt's not just when they go home. It's how they feel when they go home. And the cryo has been unbelievable. I mean, I feel bad that I waited so long.↗
▶Ep 57 · 4:30
host_summaryCryoanalgesia changed not just discharge timing but how patients feel at discharge, with a qualitatively different recovery experience.↗
▶Ep 57 · 4:30
quoteI accept Vic's concerns and criticisms. And I agree, perhaps, you know, that we do need to have a registry for this. But it has totally changed the management of these patients.↗
▶Ep 57 · 4:30
opinionCryoanalgesia changed not just discharge timing but how patients feel at discharge, with a qualitatively different recovery experience.↗
▶Ep 57 · 5:34
clinicalMultimodal pain therapy components include Tylenol, NSAIDs, precedex for gentle wake-up, dexamethasone for post-anesthetic nausea, ketamine when used by experienced practitioners, and support from child life specialists and physical therapists.↗
▶Ep 57 · 5:34
host_summaryMultimodal pain therapy components include Tylenol, NSAIDs, precedex for gentle wake-up, dexamethasone for post-anesthetic nausea, ketamine when used by experienced practitioners, and support from child life specialists and physical therapists.↗
▶Ep 57 · 6:26
host_summaryBar flippage typically occurs early and results from the bar sitting in an incorrect intercostal space, poor positioning, inadequate wrapping, or insufficient securing; proper initial bar positioning is more important than securing technique.↗
▶Ep 57 · 6:26
opinionBar flippage typically occurs early and results from the bar sitting in an incorrect intercostal space, poor positioning, inadequate wrapping, or insufficient securing; proper initial bar positioning is more important than securing technique.↗
▶Ep 57 · 8:01
clinicalSome centers use sternal elevator in every pectus case to eliminate guesswork and ensure consistent entry and exit at the same intercostal space.↗
▶Ep 57 · 8:01
clinicalSternal elevator use varies by case complexity; one center uses it in approximately 10% of cases (younger patients with adequate thoracoscopic visualization), while it is particularly valuable in deep, stiff pectus cases to reduce tissue damage.↗
▶Ep 57 · 8:01
quoteI think one of the things that Steve mentioned is being able to go in and out at the same inner space, I think is important.↗
▶Ep 57 · 8:01
host_summarySternal elevator use varies by case complexity; one center uses it in approximately 10% of cases (younger patients with adequate thoracoscopic visualization), while it is particularly valuable in deep, stiff pectus cases to reduce tissue damage.↗
▶Ep 57 · 8:01
host_summarySome centers use sternal elevator in every pectus case to eliminate guesswork and ensure consistent entry and exit at the same intercostal space.↗
▶Ep 57 · 8:01
quoteI think one of the things that Steve mentioned is being able to go in and out at the same inner space, I think is important.↗
▶Ep 57 · 9:20
host_summaryIntroducer passage direction (left-to-right versus right-to-left) is likely surgeon preference and does not make significant difference when the substernal space is well dissected and visualization is clear.↗
▶Ep 57 · 9:20
host_summaryPassing the introducer from left chest to right chest is preferred by some surgeons because right-to-left passage directs the instrument toward the ventricle during the crossing maneuver.↗
▶Ep 57 · 9:20
opinionPassing the introducer from left chest to right chest is preferred by some surgeons because right-to-left passage directs the instrument toward the ventricle during the crossing maneuver.↗
▶Ep 57 · 9:20
opinionIntroducer passage direction (left-to-right versus right-to-left) is likely surgeon preference and does not make significant difference when the substernal space is well dissected and visualization is clear.↗
Update Course Rewind: Pectus Excavatum 2021
▶Ep 58 · 1:02
quoteWe of course struggled with postoperative pain management as everybody did. And we had completed a randomized trial, 110 patients, to epidural and PCA. And in that study, the epidurals didn't really drop off.↗
▶Ep 58 · 1:02
clinicalDr. St. Peter's hospital completed a randomized trial of 110 patients comparing epidural and PCA for pectus pain control, and epidurals did not show superior results.↗
▶Ep 58 · 1:02
quoteWe of course struggled with postoperative pain management as everybody did. And we had completed a randomized trial, 110 patients, to epidural and PCA. And in that study, the epidurals didn't really drop off.↗
▶Ep 58 · 1:02
host_summaryDr. St. Peter's hospital completed a randomized trial of 110 patients comparing epidural and PCA for pectus pain control, and epidurals did not show superior results.↗
▶Ep 58 · 1:21
quoteWe were enrolling in this study. We had about 30 patients in each group when we tried the first cryotherapy. And when that patient went home on post-op day one, equipoise was lost. Once you see it, it's sort of a different game.↗
▶Ep 58 · 1:21
host_summaryAfter trying cryoanalgesia with the first patient who went home on post-op day one, Dr. St. Peter's team lost equipoise and stopped enrolling patients in the epidural/PCA comparison study.↗
▶Ep 58 · 1:21
clinicalAfter trying cryoanalgesia with the first patient who went home on post-op day one, Dr. St. Peter's team lost equipoise and stopped enrolling patients in the epidural/PCA comparison study.↗
▶Ep 58 · 1:21
quoteWe were enrolling in this study. We had about 30 patients in each group when we tried the first cryotherapy. And when that patient went home on post-op day one, equipoise was lost. Once you see it, it's sort of a different game.↗
▶Ep 58 · 1:56
clinicalCryoanalgesia uses cold temperatures to cause a conduction block that interrupts pain impulses to the brain.↗
▶Ep 58 · 1:56
host_summaryCryoanalgesia uses cold temperatures to cause a conduction block that interrupts pain impulses to the brain.↗
▶Ep 58 · 2:09
quoteWe currently put the camera on the top and the probe through the bottom. But you can see how they're separated. One's an inner space above. That just keeps them out of each other's way. And you literally just count down to the fourth rib and then freeze underneath it. It's two minutes per rib. We do four through seven. You're not supposed to go eight or below because you can get some abdominal wall paralysis.↗
▶Ep 58 · 2:09
host_summaryThe cryoanalgesia technique involves freezing underneath ribs four through seven for two minutes per rib; ribs eight and below should not be treated due to risk of abdominal wall paralysis.↗
▶Ep 58 · 2:09
clinicalThe cryoanalgesia technique involves freezing underneath ribs four through seven for two minutes per rib; ribs eight and below should not be treated due to risk of abdominal wall paralysis.↗
▶Ep 58 · 2:09
quoteWe currently put the camera on the top and the probe through the bottom. But you can see how they're separated. One's an inner space above. That just keeps them out of each other's way. And you literally just count down to the fourth rib and then freeze underneath it. It's two minutes per rib. We do four through seven. You're not supposed to go eight or below because you can get some abdominal wall paralysis.↗
▶Ep 58 · 2:33
clinicalAfter implementing cryoanalgesia, Dr. St. Peter's length of stay decreased from four days (which they could not get below previously) to one day.↗
▶Ep 58 · 2:33
quoteWhat we saw there is the length of stay where we just couldn't get below four days. All of a sudden became one.↗
▶Ep 58 · 2:33
host_summaryAfter implementing cryoanalgesia, Dr. St. Peter's length of stay decreased from four days (which they could not get below previously) to one day.↗
▶Ep 58 · 2:33
quoteWhat we saw there is the length of stay where we just couldn't get below four days. All of a sudden became one.↗
▶Ep 58 · 2:43
host_summaryCryoanalgesia dramatically reduced median morphine equivalents compared to previous pain control methods at Dr. St. Peter's hospital.↗
▶Ep 58 · 2:43
clinicalCryoanalgesia dramatically reduced median morphine equivalents compared to previous pain control methods at Dr. St. Peter's hospital.↗
▶Ep 58 · 2:52
opinionDr. Garcia acknowledges cryoanalgesia works but is concerned about lack of long-term studies and unknown potential for chronic neuropathic pain.↗
▶Ep 58 · 2:52
quoteI agree with Sean. It works. I mean, it is great. One day. Yeah, no. So what I'm concerned about is that there are no long-term studies. But I believe we just don't know. We don't have the long-term data.↗
▶Ep 58 · 2:52
host_summaryDr. Garcia acknowledges cryoanalgesia works but is concerned about lack of long-term studies and unknown potential for chronic neuropathic pain.↗
▶Ep 58 · 2:52
quoteI agree with Sean. It works. I mean, it is great. One day. Yeah, no. So what I'm concerned about is that there are no long-term studies. But I believe we just don't know. We don't have the long-term data.↗
▶Ep 58 · 3:14
host_summaryMedical devices and techniques are not required to undergo clinical trials before introduction to market, unlike medications which require FDA clinical trials with long-term results.↗
▶Ep 58 · 3:14
guidelineMedical devices and techniques are not required to undergo clinical trials before introduction to market, unlike medications which require FDA clinical trials with long-term results.↗
▶Ep 58 · 3:50
quoteAbout 100 patients. Looking to Sean's point, as far as, and this was a comparison between epidurals as well as, not perivertebral, but erector spinae catheter.↗
▶Ep 58 · 3:50
clinicalDr. Garcia's hospital uses erector spinae catheters placed by the pain team with ultrasound guidance, which stay in for five days with hospital stay of two days and catheter removal by family on day three at home.↗
▶Ep 58 · 3:50
quoteAbout 100 patients. Looking to Sean's point, as far as, and this was a comparison between epidurals as well as, not perivertebral, but erector spinae catheter.↗
▶Ep 58 · 3:50
host_summaryDr. Garcia's hospital uses erector spinae catheters placed by the pain team with ultrasound guidance, which stay in for five days with hospital stay of two days and catheter removal by family on day three at home.↗
▶Ep 58 · 4:08
quoteErectospinae catheters, they are placed by the pain team with ultrasound guidance. They're not in the vertebral space, but they are juxtaposed to it. Those catheters stay in for five days. The hospital stays two days. Third day, while they're outside, the catheters are pulled out by the family. It is on a pump. It's automated.↗
▶Ep 58 · 4:08
quoteErectospinae catheters, they are placed by the pain team with ultrasound guidance. They're not in the vertebral space, but they are juxtaposed to it. Those catheters stay in for five days. The hospital stays two days. Third day, while they're outside, the catheters are pulled out by the family. It is on a pump. It's automated.↗
▶Ep 58 · 4:30
quoteOur hospital stays are two days. We've been able to reduce the opioid requirements, not only in the hospital, but also outside of the hospital. So, I'm, from the perspective, at least with our experience, that we do have an alternative. Is it going to be one day? No. But is it certainly much less than the four or five days that we saw with epidurals? Absolutely, yes.↗
▶Ep 58 · 4:30
clinicalDr. Garcia's hospital achieved two-day hospital stays and reduced opioid requirements both in-hospital and post-discharge using erector spinae catheters.↗
▶Ep 58 · 4:30
quoteOur hospital stays are two days. We've been able to reduce the opioid requirements, not only in the hospital, but also outside of the hospital. So, I'm, from the perspective, at least with our experience, that we do have an alternative. Is it going to be one day? No. But is it certainly much less than the four or five days that we saw with epidurals? Absolutely, yes.↗
▶Ep 58 · 4:30
host_summaryDr. Garcia's hospital achieved two-day hospital stays and reduced opioid requirements both in-hospital and post-discharge using erector spinae catheters.↗
▶Ep 58 · 4:55
quoteI was a cryo skeptic. My biggest issues with it were the added time. The other is concerned about the neuralgia and the complications that I'd heard about. And I will tell you that it took me about four cases to realize, because most of our patients went home on day two or three. But it's not just when they go home. It's how they feel when they go home. And the cryo has been unbelievable. I mean, I feel bad that I waited so long.↗
▶Ep 58 · 4:55
host_summaryDr. Rothenberg was initially a cryo skeptic due to concerns about added time and neuralgia complications, but after four cases realized the benefit was not just early discharge but how patients feel at discharge.↗
▶Ep 58 · 4:55
quoteI was a cryo skeptic. My biggest issues with it were the added time. The other is concerned about the neuralgia and the complications that I'd heard about. And I will tell you that it took me about four cases to realize, because most of our patients went home on day two or three. But it's not just when they go home. It's how they feel when they go home. And the cryo has been unbelievable. I mean, I feel bad that I waited so long.↗
▶Ep 58 · 4:55
opinionDr. Rothenberg was initially a cryo skeptic due to concerns about added time and neuralgia complications, but after four cases realized the benefit was not just early discharge but how patients feel at discharge.↗
▶Ep 58 · 5:40
clinicalDr. Wagner recommends multimodal pain control including Tylenol, NSAIDs, precedex for gentle wake-up, dexamethasone for post-anesthetic nausea, ketamine to avoid opioids, and support from child life specialists and physical therapists.↗
▶Ep 58 · 5:40
quoteI accept Vic's concerns and criticisms. And I agree, perhaps, you know, that we do need to have a registry for this. But it has totally changed the management of these patients.↗
▶Ep 58 · 5:40
host_summaryDr. Wagner recommends multimodal pain control including Tylenol, NSAIDs, precedex for gentle wake-up, dexamethasone for post-anesthetic nausea, ketamine to avoid opioids, and support from child life specialists and physical therapists.↗
▶Ep 58 · 5:40
quoteI accept Vic's concerns and criticisms. And I agree, perhaps, you know, that we do need to have a registry for this. But it has totally changed the management of these patients.↗
▶Ep 58 · 6:10
host_summaryDr. Ponsky's multimodal therapy regimen includes preoperative counseling, gabapentin pre and postoperatively, methadone, clonidine, bowel regimen medications, and antiemetics.↗
▶Ep 58 · 6:10
clinicalDr. Ponsky's multimodal therapy regimen includes preoperative counseling, gabapentin pre and postoperatively, methadone, clonidine, bowel regimen medications, and antiemetics.↗
▶Ep 58 · 6:20
clinicalAt the Nebraska program where Dr. Rayner trained, length of stay is under two days and patients are off opioids by one week using multimodal pain control.↗
▶Ep 58 · 6:20
host_summaryAt the Nebraska program where Dr. Rayner trained, length of stay is under two days and patients are off opioids by one week using multimodal pain control.↗
▶Ep 58 · 6:35
clinicalBar flipping typically occurs early and is due to surgical factors: bar sitting in wrong intercostal space, bad positioning, insufficient wrapping, or inadequate securing.↗
▶Ep 58 · 6:35
host_summaryBar flipping typically occurs early and is due to surgical factors: bar sitting in wrong intercostal space, bad positioning, insufficient wrapping, or inadequate securing.↗
▶Ep 58 · 7:30
clinicalComputational modeling by physics-minded surgeons showed that shorter flat bars create more pressure on the sternum compared to traditional U-shaped bars, making them more stable.↗
▶Ep 58 · 7:30
host_summaryComputational modeling by physics-minded surgeons showed that shorter flat bars create more pressure on the sternum compared to traditional U-shaped bars, making them more stable.↗
▶Ep 58 · 8:20
host_summaryDr. Wolkine uses sternal elevator in about 10% of cases at Akron Children's, primarily in younger patients where thoracoscopy provides adequate visualization.↗
▶Ep 58 · 8:20
clinicalDr. Wolkine uses sternal elevator in about 10% of cases at Akron Children's, primarily in younger patients where thoracoscopy provides adequate visualization.↗
▶Ep 58 · 8:40
clinicalSternal elevation in deep stiff pectus cases allows less tissue damage and better repair.↗
▶Ep 58 · 8:40
host_summarySternal elevation in deep stiff pectus cases allows less tissue damage and better repair.↗
▶Ep 58 · 8:55
host_summaryDr. St. Peter uses sternal elevator in every case because it eliminates guesswork and allows consistent entry and exit at the same intercostal space.↗
▶Ep 58 · 8:55
clinicalDr. St. Peter uses sternal elevator in every case because it eliminates guesswork and allows consistent entry and exit at the same intercostal space.↗
▶Ep 58 · 9:25
clinicalTechniques including thoracoscopy, sternal elevator, vacuum bell in the operating room, and sub-xiphoid incision all serve the same purpose: avoiding cardiac injury during introducer passage.↗
▶Ep 58 · 9:25
host_summaryTechniques including thoracoscopy, sternal elevator, vacuum bell in the operating room, and sub-xiphoid incision all serve the same purpose: avoiding cardiac injury during introducer passage.↗
▶Ep 58 · 9:50
host_summaryDr. Holcomb passes the bar from left chest to right chest because passing right to left directs the instrument toward the ventricle.↗
▶Ep 58 · 9:50
clinicalDr. Holcomb passes the bar from left chest to right chest because passing right to left directs the instrument toward the ventricle.↗
▶Ep 58 · 10:05
opinionDr. Slater has always performed the procedure right to left and had not considered left to right direction.↗
▶Ep 58 · 10:05
host_summaryDr. Slater has always performed the procedure right to left and had not considered left to right direction.↗
▶Ep 58 · 10:15
host_summaryBar passage direction (left-to-right versus right-to-left) is surgeon preference and probably does not make significant difference as long as the sub-sternal space is well dissected and visualization is clear.↗
▶Ep 58 · 10:15
opinionBar passage direction (left-to-right versus right-to-left) is surgeon preference and probably does not make significant difference as long as the sub-sternal space is well dissected and visualization is clear.↗
epidemiologicalOnly 30 of the 501 patients received ovarian tissue transplantation↗
▶Ep 22 · 0:36
clinicalOf the 30 patients who received transplantation, 9 got pregnant↗
▶Ep 22 · 0:40
clinicalOnly 6 of the 9 pregnancies resulted in live birth↗
▶Ep 22 · 0:43
quoteSo even though cryopreservation can be successful, we still need more high quality studies to understand it better and improve its outcomes.↗
▶Ep 22 · 0:43
opinionMore high quality studies are needed to understand cryopreservation better and improve its outcomes↗
Choledocholithiasis with Drs. David Vitale & Lucas Neff
▶Ep 26 · 0:43
host_summaryCholedocholithiasis stones may be made up of bile pigments or calcium and cholesterol salts.↗
▶Ep 26 · 0:43
clinicalCholedocholithiasis stones may be made up of bile pigments or calcium and cholesterol salts.↗
▶Ep 26 · 2:11
guidelinePatients with intermediate risk (abnormal liver biochemical tests or dilated common bile ducts) can undergo endoscopic ultrasound, MRCP, laparoscopic cholangiogram, or intraoperative ultrasound.↗
▶Ep 26 · 2:11
host_summaryPatients with intermediate risk (abnormal liver biochemical tests or dilated common bile ducts) can undergo endoscopic ultrasound, MRCP, laparoscopic cholangiogram, or intraoperative ultrasound.↗
▶Ep 26 · 2:50
host_summaryCommon bile duct diameter greater than 6 millimeters was most sensitive for predicting common bile duct stones in children, although without statistical significance.↗
▶Ep 26 · 2:50
clinicalCommon bile duct diameter greater than 6 millimeters was most sensitive for predicting common bile duct stones in children, although without statistical significance.↗
▶Ep 26 · 4:18
clinicalRandomized trials from 2013 show no significant difference in morbidity, mortality, retained stones, or failure rates between ERCP and laparoscopic common bile duct exploration.↗
▶Ep 26 · 4:18
host_summaryRandomized trials from 2013 show no significant difference in morbidity, mortality, retained stones, or failure rates between ERCP and laparoscopic common bile duct exploration.↗
▶Ep 26 · 8:59
host_summaryMost free-standing children's hospitals do not have ERCP capabilities.↗
▶Ep 26 · 8:59
epidemiologicalMost free-standing children's hospitals do not have ERCP capabilities.↗
▶Ep 26 · 12:24
clinicalIf the pancreatic duct is visualized during fluoroscopy, the procedure should be stopped due to higher risk for pancreatitis.↗
▶Ep 26 · 12:24
host_summaryIf the pancreatic duct is visualized during fluoroscopy, the procedure should be stopped due to higher risk for pancreatitis.↗
host_summaryThe definition of a high volume surgeon varies widely, ranging from 9 thyroidectomies per year to over 200 thyroidectomies with at least 30 being in pediatric patients.↗
▶Ep 6 · 2:43
host_summaryOlsen et al. systematic review analyzed 10 studies with 6,430 patients examining surgeon volume and pediatric thyroid surgery outcomes.↗
▶Ep 6 · 2:43
host_summaryThyroidectomies performed by high volume surgeons show shorter length of stays.↗
Disruption of enterohepatic Circulation of Bile acids ameliorates small bowel resection associated hepatic injury
▶Ep 7 · 0:00
host_summaryDisruption of the enterohepatic circulation of bile acids is beneficial for the liver↗
▶Ep 7 · 0:00
quoteDid you know that the disruption of the enterohepatic circulation of bilasses is beneficial for the liver?↗
▶Ep 7 · 0:13
host_summaryThe study was conducted at Saint Louis Children's Hospital and aimed to elucidate the driving force behind hepatic injury following bowel resection↗
▶Ep 7 · 0:22
host_summaryThe study used three groups of mice: sham, 50% with proximal or duodenal resection, and 50% with distal resection or resection of the ileocecal valve↗
▶Ep 7 · 0:34
host_summaryTissue samples were taken at the second and tenth post-operative weeks↗
▶Ep 7 · 0:41
quoteThey find that mice with distal resection show less hepatic oxidative stress and more hydrophilic bile acid profile, meaning that the ilisal resection could lead to less hepatic injury.↗
▶Ep 7 · 0:41
host_summaryMice with distal resection showed less hepatic oxidative stress compared to proximal resection↗
▶Ep 7 · 0:41
host_summaryMice with distal resection showed a more hydrophilic bile acid profile compared to proximal resection↗
▶Ep 7 · 0:41
host_summaryIleal resection could lead to less hepatic injury↗
clinicalCryoanalgesia uses cold temperatures to cause a conduction block that interrupts pain impulses to the brain.↗
▶Ep 1 · 3:36
guidelineFor medications, the FDA requires clinical trials with long-term clinical results before approval, but this is not required for medical devices and techniques like cryoanalgesia.↗
▶Ep 1 · 9:41
clinicalDr. Slater has always performed the Nuss procedure right to left and had not previously considered left to right.↗
▶Ep 1 · 9:41
quoteI've always done right to left. Um, I never even thought about doing left to right, I must admit.↗
Update Course Rewind: Pectus Excavatum 2021
▶Ep 2 · 1:57
host_summaryCryoanalgesia uses cold temperatures to cause a conduction block, interrupting pain impulses to the brain.↗
▶Ep 2 · 1:57
clinicalCryoanalgesia uses cold temperatures to cause a conduction block, interrupting pain impulses to the brain.↗
▶Ep 2 · 3:36
guidelineThe FDA requires clinical trials with long-term results for medications before approval, but not for medical devices and techniques.↗
▶Ep 2 · 3:36
host_summaryThe FDA requires clinical trials with long-term results for medications before approval, but not for medical devices and techniques.↗
▶Ep 2 · 9:41
quoteI've always done right to left. Um, I never even thought about doing left to right, I must admit.↗
▶Ep 2 · 9:41
quoteI've always done right to left. Um, I never even thought about doing left to right, I must admit.↗
Update Course Rewind: Pectus Excavatum 2021
▶Ep 3 · 1:21
clinicalAfter implementing cryoanalgesia, the first patient went home on post-operative day one, leading Dr. St. Peter to discontinue enrollment in the epidural/PCA comparison trial↗
▶Ep 3 · 1:21
quoteWe were enrolling in this study. We had about 30 patients in each group when we tried the first cryotherapy. And when that patient went home on post-op day one, equipoise was lost. Once you see it, it's sort of a different game.↗
▶Ep 3 · 2:33
quoteWhat we saw there is the length of stay where we just couldn't get below four days. All of a sudden became one.↗
▶Ep 3 · 2:33
clinicalWith cryoanalgesia, length of stay decreased from four days (baseline) to one day↗
▶Ep 3 · 2:52
quoteI agree with Sean. It works. I mean, it is great. One day. Yeah, no. So what I'm concerned about is that there are no long-term studies. But I believe we just don't know. We don't have the long-term data.↗
▶Ep 3 · 2:52
opinionDr. Garcia expressed concern that there are no long-term studies of cryoanalgesia and potential for chronic neuropathic pain↗
▶Ep 3 · 3:50
clinicalDr. Garcia's hospital uses erector spinae catheters placed by the pain team with ultrasound guidance, positioned juxtaposed to but not in the vertebral space↗
▶Ep 3 · 4:08
clinicalWith erector spinae catheters, hospital stay is two days, catheters remain in place for five days total (three days at home on automated pump), and families remove catheters at home on day five↗
▶Ep 3 · 4:52
quoteI was a cryo skeptic. My biggest issues with it were the added time. The other is concerned about the neuralgia and the complications that I'd heard about. And I will tell you that it took me about four cases to realize, because most of our patients went home on day two or three. But it's not just when they go home. It's how they feel when they go home. And the cryo has been unbelievable. I mean, I feel bad that I waited so long.↗
▶Ep 3 · 4:52
opinionDr. Rothenberg initially had concerns about cryoanalgesia including added operative time and risk of neuralgia, but after four cases observed that patients not only went home earlier but felt significantly better at discharge↗
▶Ep 3 · 5:34
clinicalDr. Ponsky's multimodal regimen includes preoperative counseling, gabapentin pre and postoperatively, methadone, clonidine, bowel regimen medications, and antiemetics↗
▶Ep 3 · 6:15
clinicalAt Nebraska where Dr. Rayner practices, length of stay is under two days and patients are off opioids by one week using multimodal pain control↗
▶Ep 3 · 7:35
clinicalComputational modeling by physics-minded surgeons showed that shorter flat bars create more pressure on the sternum compared to traditional U-shaped bars, potentially increasing stability↗
▶Ep 3 · 8:58
clinicalTechniques to avoid cardiac injury during introducer passage include thoracoscopy, sternal elevator, vacuum bell in the operating room, and sub-xiphoid incision↗
▶Ep 3 · 8:58
quoteThoracoscopy or sternal elevator or vacuum bell in the operating room or sub-xiphoid incision, the idea is to not injure the heart. So whatever technique helps you do that, I think is the technique you ought to use.↗
Update Course Rewind: Pectus Excavatum 2021
▶Ep 4 · 1:21
quoteOnce you see it, it's sort of a different game.↗
▶Ep 4 · 2:07
clinicalThe cryoanalgesia technique involves two minutes of freezing per rib, applied to ribs four through seven; ribs eight and below should not be treated due to risk of abdominal wall paralysis.↗
▶Ep 4 · 2:43
clinicalCryoanalgesia dramatically reduced median morphine equivalents compared to epidural/PCA approaches.↗
▶Ep 4 · 3:14
guidelineMedical devices and implants are not required to undergo clinical trials before market introduction, unlike medications which require FDA clinical trials with long-term results.↗
▶Ep 4 · 4:08
clinicalErector spinae catheters are placed by the pain team with ultrasound guidance in a position juxtaposed to but not within the vertebral space.↗
▶Ep 4 · 4:08
clinicalWith erector spinae catheters, hospital stay is two days, catheters remain in place for five days on an automated pump, and families remove the catheters at home on the third day.↗
▶Ep 4 · 4:30
quoteIt's not just when they go home. It's how they feel when they go home. And the cryo has been unbelievable. I mean, I feel bad that I waited so long.↗
▶Ep 4 · 4:30
quoteI accept Vic's concerns and criticisms. And I agree, perhaps, you know, that we do need to have a registry for this. But it has totally changed the management of these patients.↗
▶Ep 4 · 4:30
opinionCryoanalgesia changed not just discharge timing but how patients feel at discharge, with a qualitatively different recovery experience.↗
▶Ep 4 · 5:34
clinicalMultimodal pain therapy components include Tylenol, NSAIDs, precedex for gentle wake-up, dexamethasone for post-anesthetic nausea, ketamine when used by experienced practitioners, and support from child life specialists and physical therapists.↗
▶Ep 4 · 6:26
opinionBar flippage typically occurs early and results from the bar sitting in an incorrect intercostal space, poor positioning, inadequate wrapping, or insufficient securing; proper initial bar positioning is more important than securing technique.↗
▶Ep 4 · 8:01
clinicalSternal elevator use varies by case complexity; one center uses it in approximately 10% of cases (younger patients with adequate thoracoscopic visualization), while it is particularly valuable in deep, stiff pectus cases to reduce tissue damage.↗
▶Ep 4 · 8:01
clinicalSome centers use sternal elevator in every pectus case to eliminate guesswork and ensure consistent entry and exit at the same intercostal space.↗
▶Ep 4 · 8:01
quoteI think one of the things that Steve mentioned is being able to go in and out at the same inner space, I think is important.↗
▶Ep 4 · 9:20
opinionPassing the introducer from left chest to right chest is preferred by some surgeons because right-to-left passage directs the instrument toward the ventricle during the crossing maneuver.↗
▶Ep 4 · 9:20
opinionIntroducer passage direction (left-to-right versus right-to-left) is likely surgeon preference and does not make significant difference when the substernal space is well dissected and visualization is clear.↗
Update Course Rewind: Pectus Excavatum 2021
▶Ep 5 · 1:02
quoteWe of course struggled with postoperative pain management as everybody did. And we had completed a randomized trial, 110 patients, to epidural and PCA. And in that study, the epidurals didn't really drop off.↗
▶Ep 5 · 1:02
host_summaryDr. St. Peter's hospital completed a randomized trial of 110 patients comparing epidural and PCA for pectus pain control, and epidurals did not show superior results.↗
▶Ep 5 · 1:02
quoteWe of course struggled with postoperative pain management as everybody did. And we had completed a randomized trial, 110 patients, to epidural and PCA. And in that study, the epidurals didn't really drop off.↗
▶Ep 5 · 1:02
clinicalDr. St. Peter's hospital completed a randomized trial of 110 patients comparing epidural and PCA for pectus pain control, and epidurals did not show superior results.↗
▶Ep 5 · 1:21
clinicalAfter trying cryoanalgesia with the first patient who went home on post-op day one, Dr. St. Peter's team lost equipoise and stopped enrolling patients in the epidural/PCA comparison study.↗
▶Ep 5 · 1:21
quoteWe were enrolling in this study. We had about 30 patients in each group when we tried the first cryotherapy. And when that patient went home on post-op day one, equipoise was lost. Once you see it, it's sort of a different game.↗
▶Ep 5 · 1:21
host_summaryAfter trying cryoanalgesia with the first patient who went home on post-op day one, Dr. St. Peter's team lost equipoise and stopped enrolling patients in the epidural/PCA comparison study.↗
▶Ep 5 · 1:21
quoteWe were enrolling in this study. We had about 30 patients in each group when we tried the first cryotherapy. And when that patient went home on post-op day one, equipoise was lost. Once you see it, it's sort of a different game.↗
▶Ep 5 · 1:56
host_summaryCryoanalgesia uses cold temperatures to cause a conduction block that interrupts pain impulses to the brain.↗
▶Ep 5 · 1:56
clinicalCryoanalgesia uses cold temperatures to cause a conduction block that interrupts pain impulses to the brain.↗
▶Ep 5 · 2:09
quoteWe currently put the camera on the top and the probe through the bottom. But you can see how they're separated. One's an inner space above. That just keeps them out of each other's way. And you literally just count down to the fourth rib and then freeze underneath it. It's two minutes per rib. We do four through seven. You're not supposed to go eight or below because you can get some abdominal wall paralysis.↗
▶Ep 5 · 2:09
clinicalThe cryoanalgesia technique involves freezing underneath ribs four through seven for two minutes per rib; ribs eight and below should not be treated due to risk of abdominal wall paralysis.↗
▶Ep 5 · 2:09
quoteWe currently put the camera on the top and the probe through the bottom. But you can see how they're separated. One's an inner space above. That just keeps them out of each other's way. And you literally just count down to the fourth rib and then freeze underneath it. It's two minutes per rib. We do four through seven. You're not supposed to go eight or below because you can get some abdominal wall paralysis.↗
▶Ep 5 · 2:09
host_summaryThe cryoanalgesia technique involves freezing underneath ribs four through seven for two minutes per rib; ribs eight and below should not be treated due to risk of abdominal wall paralysis.↗
▶Ep 5 · 2:33
host_summaryAfter implementing cryoanalgesia, Dr. St. Peter's length of stay decreased from four days (which they could not get below previously) to one day.↗
▶Ep 5 · 2:33
quoteWhat we saw there is the length of stay where we just couldn't get below four days. All of a sudden became one.↗
▶Ep 5 · 2:33
clinicalAfter implementing cryoanalgesia, Dr. St. Peter's length of stay decreased from four days (which they could not get below previously) to one day.↗
▶Ep 5 · 2:33
quoteWhat we saw there is the length of stay where we just couldn't get below four days. All of a sudden became one.↗
▶Ep 5 · 2:43
clinicalCryoanalgesia dramatically reduced median morphine equivalents compared to previous pain control methods at Dr. St. Peter's hospital.↗
▶Ep 5 · 2:43
host_summaryCryoanalgesia dramatically reduced median morphine equivalents compared to previous pain control methods at Dr. St. Peter's hospital.↗
▶Ep 5 · 2:52
quoteI agree with Sean. It works. I mean, it is great. One day. Yeah, no. So what I'm concerned about is that there are no long-term studies. But I believe we just don't know. We don't have the long-term data.↗
▶Ep 5 · 2:52
host_summaryDr. Garcia acknowledges cryoanalgesia works but is concerned about lack of long-term studies and unknown potential for chronic neuropathic pain.↗
▶Ep 5 · 2:52
opinionDr. Garcia acknowledges cryoanalgesia works but is concerned about lack of long-term studies and unknown potential for chronic neuropathic pain.↗
▶Ep 5 · 2:52
quoteI agree with Sean. It works. I mean, it is great. One day. Yeah, no. So what I'm concerned about is that there are no long-term studies. But I believe we just don't know. We don't have the long-term data.↗
▶Ep 5 · 3:14
guidelineMedical devices and techniques are not required to undergo clinical trials before introduction to market, unlike medications which require FDA clinical trials with long-term results.↗
▶Ep 5 · 3:14
host_summaryMedical devices and techniques are not required to undergo clinical trials before introduction to market, unlike medications which require FDA clinical trials with long-term results.↗
▶Ep 5 · 3:50
quoteAbout 100 patients. Looking to Sean's point, as far as, and this was a comparison between epidurals as well as, not perivertebral, but erector spinae catheter.↗
▶Ep 5 · 3:50
host_summaryDr. Garcia's hospital uses erector spinae catheters placed by the pain team with ultrasound guidance, which stay in for five days with hospital stay of two days and catheter removal by family on day three at home.↗
▶Ep 5 · 3:50
quoteAbout 100 patients. Looking to Sean's point, as far as, and this was a comparison between epidurals as well as, not perivertebral, but erector spinae catheter.↗
▶Ep 5 · 3:50
clinicalDr. Garcia's hospital uses erector spinae catheters placed by the pain team with ultrasound guidance, which stay in for five days with hospital stay of two days and catheter removal by family on day three at home.↗
▶Ep 5 · 4:08
quoteErectospinae catheters, they are placed by the pain team with ultrasound guidance. They're not in the vertebral space, but they are juxtaposed to it. Those catheters stay in for five days. The hospital stays two days. Third day, while they're outside, the catheters are pulled out by the family. It is on a pump. It's automated.↗
▶Ep 5 · 4:08
quoteErectospinae catheters, they are placed by the pain team with ultrasound guidance. They're not in the vertebral space, but they are juxtaposed to it. Those catheters stay in for five days. The hospital stays two days. Third day, while they're outside, the catheters are pulled out by the family. It is on a pump. It's automated.↗
▶Ep 5 · 4:30
quoteOur hospital stays are two days. We've been able to reduce the opioid requirements, not only in the hospital, but also outside of the hospital. So, I'm, from the perspective, at least with our experience, that we do have an alternative. Is it going to be one day? No. But is it certainly much less than the four or five days that we saw with epidurals? Absolutely, yes.↗
▶Ep 5 · 4:30
host_summaryDr. Garcia's hospital achieved two-day hospital stays and reduced opioid requirements both in-hospital and post-discharge using erector spinae catheters.↗
▶Ep 5 · 4:30
quoteOur hospital stays are two days. We've been able to reduce the opioid requirements, not only in the hospital, but also outside of the hospital. So, I'm, from the perspective, at least with our experience, that we do have an alternative. Is it going to be one day? No. But is it certainly much less than the four or five days that we saw with epidurals? Absolutely, yes.↗
▶Ep 5 · 4:30
clinicalDr. Garcia's hospital achieved two-day hospital stays and reduced opioid requirements both in-hospital and post-discharge using erector spinae catheters.↗
▶Ep 5 · 4:55
quoteI was a cryo skeptic. My biggest issues with it were the added time. The other is concerned about the neuralgia and the complications that I'd heard about. And I will tell you that it took me about four cases to realize, because most of our patients went home on day two or three. But it's not just when they go home. It's how they feel when they go home. And the cryo has been unbelievable. I mean, I feel bad that I waited so long.↗
▶Ep 5 · 4:55
opinionDr. Rothenberg was initially a cryo skeptic due to concerns about added time and neuralgia complications, but after four cases realized the benefit was not just early discharge but how patients feel at discharge.↗
▶Ep 5 · 4:55
quoteI was a cryo skeptic. My biggest issues with it were the added time. The other is concerned about the neuralgia and the complications that I'd heard about. And I will tell you that it took me about four cases to realize, because most of our patients went home on day two or three. But it's not just when they go home. It's how they feel when they go home. And the cryo has been unbelievable. I mean, I feel bad that I waited so long.↗
▶Ep 5 · 4:55
host_summaryDr. Rothenberg was initially a cryo skeptic due to concerns about added time and neuralgia complications, but after four cases realized the benefit was not just early discharge but how patients feel at discharge.↗
▶Ep 5 · 5:40
quoteI accept Vic's concerns and criticisms. And I agree, perhaps, you know, that we do need to have a registry for this. But it has totally changed the management of these patients.↗
▶Ep 5 · 5:40
host_summaryDr. Wagner recommends multimodal pain control including Tylenol, NSAIDs, precedex for gentle wake-up, dexamethasone for post-anesthetic nausea, ketamine to avoid opioids, and support from child life specialists and physical therapists.↗
▶Ep 5 · 5:40
clinicalDr. Wagner recommends multimodal pain control including Tylenol, NSAIDs, precedex for gentle wake-up, dexamethasone for post-anesthetic nausea, ketamine to avoid opioids, and support from child life specialists and physical therapists.↗
▶Ep 5 · 5:40
quoteI accept Vic's concerns and criticisms. And I agree, perhaps, you know, that we do need to have a registry for this. But it has totally changed the management of these patients.↗
▶Ep 5 · 6:10
clinicalDr. Ponsky's multimodal therapy regimen includes preoperative counseling, gabapentin pre and postoperatively, methadone, clonidine, bowel regimen medications, and antiemetics.↗
▶Ep 5 · 6:10
host_summaryDr. Ponsky's multimodal therapy regimen includes preoperative counseling, gabapentin pre and postoperatively, methadone, clonidine, bowel regimen medications, and antiemetics.↗
▶Ep 5 · 6:20
host_summaryAt the Nebraska program where Dr. Rayner trained, length of stay is under two days and patients are off opioids by one week using multimodal pain control.↗
▶Ep 5 · 6:20
clinicalAt the Nebraska program where Dr. Rayner trained, length of stay is under two days and patients are off opioids by one week using multimodal pain control.↗
▶Ep 5 · 6:35
clinicalBar flipping typically occurs early and is due to surgical factors: bar sitting in wrong intercostal space, bad positioning, insufficient wrapping, or inadequate securing.↗
▶Ep 5 · 6:35
host_summaryBar flipping typically occurs early and is due to surgical factors: bar sitting in wrong intercostal space, bad positioning, insufficient wrapping, or inadequate securing.↗
▶Ep 5 · 7:30
host_summaryComputational modeling by physics-minded surgeons showed that shorter flat bars create more pressure on the sternum compared to traditional U-shaped bars, making them more stable.↗
▶Ep 5 · 7:30
clinicalComputational modeling by physics-minded surgeons showed that shorter flat bars create more pressure on the sternum compared to traditional U-shaped bars, making them more stable.↗
▶Ep 5 · 8:20
clinicalDr. Wolkine uses sternal elevator in about 10% of cases at Akron Children's, primarily in younger patients where thoracoscopy provides adequate visualization.↗
▶Ep 5 · 8:20
host_summaryDr. Wolkine uses sternal elevator in about 10% of cases at Akron Children's, primarily in younger patients where thoracoscopy provides adequate visualization.↗
▶Ep 5 · 8:40
host_summarySternal elevation in deep stiff pectus cases allows less tissue damage and better repair.↗
▶Ep 5 · 8:40
clinicalSternal elevation in deep stiff pectus cases allows less tissue damage and better repair.↗
▶Ep 5 · 8:55
clinicalDr. St. Peter uses sternal elevator in every case because it eliminates guesswork and allows consistent entry and exit at the same intercostal space.↗
▶Ep 5 · 8:55
host_summaryDr. St. Peter uses sternal elevator in every case because it eliminates guesswork and allows consistent entry and exit at the same intercostal space.↗
▶Ep 5 · 9:25
host_summaryTechniques including thoracoscopy, sternal elevator, vacuum bell in the operating room, and sub-xiphoid incision all serve the same purpose: avoiding cardiac injury during introducer passage.↗
▶Ep 5 · 9:25
clinicalTechniques including thoracoscopy, sternal elevator, vacuum bell in the operating room, and sub-xiphoid incision all serve the same purpose: avoiding cardiac injury during introducer passage.↗
▶Ep 5 · 9:50
clinicalDr. Holcomb passes the bar from left chest to right chest because passing right to left directs the instrument toward the ventricle.↗
▶Ep 5 · 9:50
host_summaryDr. Holcomb passes the bar from left chest to right chest because passing right to left directs the instrument toward the ventricle.↗
▶Ep 5 · 10:05
host_summaryDr. Slater has always performed the procedure right to left and had not considered left to right direction.↗
▶Ep 5 · 10:05
opinionDr. Slater has always performed the procedure right to left and had not considered left to right direction.↗
▶Ep 5 · 10:15
opinionBar passage direction (left-to-right versus right-to-left) is surgeon preference and probably does not make significant difference as long as the sub-sternal space is well dissected and visualization is clear.↗
▶Ep 5 · 10:15
host_summaryBar passage direction (left-to-right versus right-to-left) is surgeon preference and probably does not make significant difference as long as the sub-sternal space is well dissected and visualization is clear.↗
host_summaryThe IPSO systematic review and meta-analysis gathered 8 retrospective studies with 490 patients comparing image-guided core needle biopsy to surgical biopsy for neuroblastoma.↗
▶Ep 6 · 3:27
epidemiologicalThe IPSO systematic review and meta-analysis gathered 8 retrospective studies with 490 patients comparing image-guided core needle biopsy to surgical biopsy for neuroblastoma.↗
▶Ep 6 · 3:40
clinicalTissue adequacy and biological characterization of the biopsy was not significantly different between image-guided core needle biopsy and surgical biopsy groups for neuroblastoma.↗
▶Ep 6 · 3:40
host_summaryTissue adequacy and biological characterization of the biopsy was not significantly different between image-guided core needle biopsy and surgical biopsy groups for neuroblastoma.↗
▶Ep 6 · 3:54
host_summaryIntraoperative transfusions and complications were higher in the surgical biopsy group compared to image-guided core needle biopsy for neuroblastoma.↗
▶Ep 6 · 3:54
clinicalIntraoperative transfusions and complications were higher in the surgical biopsy group compared to image-guided core needle biopsy for neuroblastoma.↗
▶Ep 6 · 4:00
clinicalImage-guided core needle biopsy is safe and effective for diagnosing neuroblastoma.↗
▶Ep 6 · 4:00
host_summaryImage-guided core needle biopsy is safe and effective for diagnosing neuroblastoma.↗
Quick Literature Updates Ep 27
▶Ep 7 · 3:04
host_summaryHuncheid et al. conducted a multi-center non-inferiority trial that compared preterm infants treated with expectant management versus early ibuprofen for patent ductus arteriosus.↗
▶Ep 7 · 3:14
host_summaryThe trial included 273 infants: 136 treated with expectant management and 137 with early ibuprofen.↗
▶Ep 7 · 3:24
host_summaryIn the expectant management group for PDA, there was 17.6% necrotizing enterocolitis, 33% bronchopulmonary dysplasia, and 14% death rates.↗
▶Ep 7 · 3:36
host_summaryIn the ibuprofen group for PDA, there was 15.4% necrotizing enterocolitis, 50% bronchopulmonary dysplasia, and 80% death rates.↗
▶Ep 7 · 3:53
host_summaryExpectant management is not inferior to early ibuprofen in preterm patients with patent ductus arteriosus.↗
▶Ep 7 · 3:53
quoteSo it seems that expectant management is not inferiority that early ibuprofen in preterm patients with PDA.↗
epidemiologicalThe anal sphincter reconstruction study was a multi-institutional one-year outcome study↗
▶Ep 9 · 3:48
epidemiologicalSix patients underwent anal sphincter reconstruction for patulous sphincter after Hirschsprung pull-through↗
▶Ep 9 · 4:00
clinicalTwo patients underwent redo pull-through with anal sphincter reconstruction↗
▶Ep 9 · 4:00
epidemiologicalTwo of the six patients had Down syndrome↗
▶Ep 9 · 4:00
clinicalFour patients received only anal sphincter reconstruction without redo pull-through↗
▶Ep 9 · 4:12
quoteThese 4 patients got voluntary bowel movements with higher productivity and confidence, so it seems that we have an option for overstretched anal sphincters in patients with Hirschsprung disease after a pull-through.↗
▶Ep 9 · 4:12
clinicalThe four patients who received only sphincter reconstruction achieved voluntary bowel movements with higher productivity and confidence↗
▶Ep 9 · 4:12
clinicalAnal sphincter reconstruction is an option for overstretched anal sphincters in patients with Hirschsprung disease after pull-through↗
clinicalThere were no significant differences in hypertension rates between nephron-sparing surgery and radical nephrectomy↗
▶Ep 13 · 0:27
clinicalThere were no significant differences in renal dysfunction rates between nephron-sparing surgery and radical nephrectomy↗
Quick Literature Updates Ep 21
▶Ep 16 · 3:09
epidemiologicalThe Lee et al. systematic review and meta-analysis from Chongqing, China evaluated efficacy and long-term renal function after nephron-sparing surgery in patients with unilateral Wilms tumor.↗
▶Ep 16 · 3:09
host_summaryThe Lee et al. systematic review and meta-analysis from Chongqing, China evaluated efficacy and long-term renal function after nephron-sparing surgery in patients with unilateral Wilms tumor.↗
▶Ep 16 · 3:23
host_summaryThe meta-analysis gathered 26 studies on nephron-sparing surgery for unilateral Wilms tumor.↗
▶Ep 16 · 3:23
epidemiologicalThe meta-analysis gathered 26 studies on nephron-sparing surgery for unilateral Wilms tumor.↗
▶Ep 16 · 3:25
clinicalNephron-sparing surgery increased glomerular filtration rate after surgery for unilateral Wilms tumor.↗
▶Ep 16 · 3:25
host_summaryNephron-sparing surgery increased glomerular filtration rate after surgery for unilateral Wilms tumor.↗
▶Ep 16 · 3:25
clinicalNephron-sparing surgery showed no significant differences in overall survival, recurrences, hypertension, or renal dysfunction compared to radical nephrectomy for unilateral Wilms tumor.↗
▶Ep 16 · 3:25
host_summaryNephron-sparing surgery showed no significant differences in overall survival, recurrences, hypertension, or renal dysfunction compared to radical nephrectomy for unilateral Wilms tumor.↗
