Cecilia Gigena
0 statements · 0 topics · summaries given as host listed separately
Abdominal Wall Defects
· guest expert
Aerodigestive / ENT
· guest expert
Biliary Atresia
· episode host
Choledochal Cyst / Biliary
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Colorectal / ARM & Hirschsprung
· guest expert
Congenital Lung Lesions (CPAM)
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Etiologies (Gastroschisis/NEC/Atresia/Volvulus)
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Fetal Surgery
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Inguinal Hernia
· episode host
Intestinal Failure
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Intestinal Rehab
· series host
Liver Tumors (Hepatoblastoma/HCC)
· episode host
Neuroblastoma
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Pancreatitis
· series host
Pectus Excavatum
· series host
Pediatric Robotic Surgery
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Peritoneal Dialysis Access
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Sarcoma (Ewing/Rhabdo)
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Short Bowel Syndrome
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Wilms Tumor
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Summaries Cecilia gave as host · 1045 summaries
Recaps of other experts' statements, not Cecilia's own clinical position.
Summaries Cecilia gave as host · Abdominal Wall Defects 30 summaries
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Quick Literature Updates Episode 6
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Cecilia Gigena summarizing a resource: Philips et al. conducted a retrospective study from 2015 to 2018 evaluating 117 patients from two trauma centers.
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Cecilia Gigena summarizing a resource: TEG may help identify hemorrhagic trauma patients who will benefit from cryoprecipitate or platelet transfusions.
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Cecilia Gigena summarizing a resource: Patients receiving massive transfusions had lower platelet counts.
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Cecilia Gigena summarizing a resource: Patients receiving massive transfusions had lower maximum amplitude values on TEG analysis.
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Cecilia Gigena summarizing a resource: Patients receiving massive transfusions had shortened alpha angles on TEG analysis.
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Quick Literature Updates Episode 11
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Cecilia Gigena summarizing a resource: Frazier et al. conducted a retrospective study from the Midwest Pediatric Surgery Consortium following 375 patients with gastroschisis who underwent closure between 2013 and 2016.
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Cecilia Gigena summarizing a resource: Spontaneous closure of periumbilical hernias after gastroschisis was seen in 38.8% of cases.
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Cecilia Gigena summarizing a resource: Only 16.4% of patients who underwent sutured gastroschisis closure had a persistent hernia.
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Cecilia Gigena summarizing a resource: Patients who underwent sutureless gastroschisis closures had 50% rates of persistent hernia.
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Cecilia Gigena summarizing a resource: Periumbilical hernia rate was significantly higher in patients who underwent primary closure versus those who needed silo placement.
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Cecilia Gigena summarizing a resource: The overall rate for periumbilical hernias after gastroschisis closure was 22.7%.
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Cecilia Gigena summarizing a resource: Only 31.8% of patients with periumbilical hernias after gastroschisis needed surgery.
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Cecilia Gigena summarizing a resource: Sutureless gastroschisis closures lead to more periumbilical hernias, but they can be managed as any other congenital umbilical hernia and have no additional risk.
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Quick Literature Updates Episode 16
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Cecilia Gigena summarizes what Dr. Alex Halpern said: The Phoenix study by Lie et al. was a retrospective single institution study from 2017 to 2021 comparing patients who underwent Nuss procedure with cryoanalgesia in the first quarter versus the fourth quarter of their experience.
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Cecilia Gigena summarizes what Dr. Alex Halpern said: The Phoenix study included 350 patients who underwent Nuss procedure with cryoanalgesia.
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Cecilia Gigena summarizes what Dr. Alex Halpern said: Patients in the last quarter of the Phoenix cryoablation experience required 74% less opioids than those in the first quarter.
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Cecilia Gigena summarizes what Dr. Alex Halpern said: Patients in the last quarter of the Phoenix cryoablation experience were discharged 1.3 days earlier than patients in the first quarter.
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Cecilia Gigena summarizes what Dr. Alex Halpern said: Experience plays a role in outcomes when using cryoanalgesia for Nuss procedures.
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Cecilia Gigena summarizes what Dr. Alex Halpern said: So it seems that experience really plays a role talking about cryoatissia.
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Quick Literature Updates Episode 20
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Cecilia Gigena summarizes what Dr. Alex Halpern said: Esposito 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).
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Cecilia Gigena summarizes what Dr. Alex Halpern said: Laparoscopic cholecystectomy with ICG had shorter surgery time compared to without ICG.
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Cecilia Gigena summarizes what Dr. Alex Halpern said: Laparoscopic cholecystectomy with ICG had no complications compared to 12% complication rate without ICG.
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Cecilia Gigena summarizes what Dr. Alex Halpern said: Laparoscopic cholecystectomy with ICG provided better visualization of the biliary tree compared to without ICG.
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Cecilia Gigena summarizes what Dr. Alex Halpern said: So it seems that laparoscopic cholecystectomy with ICG can be the new standard in our practice.
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Cecilia Gigena summarizes what Dr. Alex Halpern said: Laparoscopic cholecystectomy with ICG can be the new standard in pediatric surgery practice.
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Quick Literature Updates Ep 22
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Cecilia Gigena summarizing a resource: The Pefer et al. study is a retrospective study done in Texas using a state hospital database examining CDH outcomes by center volume.
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Cecilia Gigena summarizing a resource: The Pefer study identified 1,314 CDH patients: 728 from high volume centers, 9 from mid-volume centers, and 79 from low volume centers.
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Cecilia Gigena summarizing a resource: High volume centers had significantly lower mortality rates for CDH, even though they have significantly sicker patients.
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Cecilia Gigena summarizing a resource: High volume centers had significantly shorter length of stay for CDH patients.
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Cecilia Gigena summarizing a resource: High volume centers had better outcomes for patients with CDH.
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Summaries Cecilia gave as host · Acute Pancreatitis 2 summaries
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Update Course Rewind: Management of Acute Pancreatitis 2023
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Cecilia Gigena summarizing the discussion: Fluid resuscitation is key in pancreatitis management
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Cecilia Gigena summarizing the discussion: Patients should be reassessed at the 12 and 24 hour mark to avoid fluid overload
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Summaries Cecilia gave as host · Acute Recurrent Pancreatitis 12 summaries
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Update Course Rewind: Management of Recurrent Pancreatitis
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Cecilia Gigena summarizes what Dr. Juan Gurria said: If 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.
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Cecilia Gigena summarizes what Dr. Juan Gurria said: If 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.
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Cecilia Gigena summarizes what Dr. Juan Gurria said: Genetics 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.
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Cecilia Gigena summarizes what Dr. Juan Gurria said: Genetics 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.
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Cecilia Gigena summarizes what Dr. Juan Gurria said: Endoscopic treatment should be attempted first, but if it fails, transfer to a specialized center that performs TPIAT (total pancreatectomy with islet autotransplantation).
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Cecilia Gigena summarizes what Dr. Juan Gurria said: Endoscopic treatment should be attempted first, but if it fails, transfer to a specialized center that performs TPIAT (total pancreatectomy with islet autotransplantation).
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Cecilia Gigena summarizes what Dr. Juan Gurria said: For pancreatic imaging, start with ultrasound, then CT, and for better visualization of pancreatic anatomy, use MRCP with T2 sequences.
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Cecilia Gigena summarizes what Dr. Juan Gurria said: For pancreatic imaging, start with ultrasound, then CT, and for better visualization of pancreatic anatomy, use MRCP with T2 sequences.
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Cecilia Gigena summarizes what Dr. Juan Gurria said: Recurrent pancreatitis is a rare pathology that can lead to chronic pancreatitis and is associated with genetic mutations.
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Cecilia Gigena summarizes what Dr. Juan Gurria said: Recurrent pancreatitis is a rare pathology that can lead to chronic pancreatitis and is associated with genetic mutations.
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Cecilia Gigena summarizes what Dr. Juan Gurria said: If 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.
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Cecilia Gigena summarizes what Dr. Juan Gurria said: If 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.
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Summaries Cecilia gave as host · Aerodigestive / ENT 7 summaries
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Esophageal Surveillance Practices in Esophageal Atresia Patients
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Cecilia Gigena summarizing a resource: 139 pediatric surgeons responded to the survey
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Cecilia Gigena summarizing a resource: There is high agreement with current guidelines but weak adherence to them in esophageal atresia surveillance
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Cecilia Gigena summarizing a resource: Only 37% of respondents performed follow-up endoscopy regardless of symptoms
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Cecilia Gigena summarizing a resource: 80% of respondents agree or strongly agree that endoscopy should follow a set schedule
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Cecilia Gigena summarizing a resource: Only 37% of respondents reported that their esophageal atresia patients have pre-determined outpatient clinic follow-up schedule
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Cecilia Gigena summarizing a resource: 75% of respondents strongly agree or agree with current guidelines for esophageal atresia surveillance
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Cecilia Gigena summarizing a resource: The Eastern Pediatric Surgery Network in the US created a survey distributed among pediatric surgeons to understand current practices of esophageal surveillance in esophageal atresia patients
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Summaries Cecilia gave as host · ALL 2 summaries
Update Course Rewind: Management of Acute Pancreatitis 2023
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Cecilia Gigena summarizing the discussion: Fluid resuscitation is key in pancreatitis management
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Cecilia Gigena summarizing the discussion: Patients should be reassessed at the 12 and 24 hour mark to avoid fluid overload
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Summaries Cecilia gave as host · Anorectal Malformation 29 summaries
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Quick Literature Updates Episode 14
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Cecilia Gigena summarizes what Dr. Alex Halpern said: The Bokova et al. study is a multi-institutional one-year outcome study of anal sphincter reconstruction for patulous sphincter in 6 patients.
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Cecilia Gigena summarizes what Dr. Alex Halpern said: Of the 6 patients in the sphincter reconstruction study, 2 had Down syndrome and underwent redo pull-through with anal sphincter reconstruction.
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Cecilia Gigena summarizes what Dr. Alex Halpern said: Four patients in the sphincter reconstruction study received only anal sphincter reconstruction without redo pull-through.
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Cecilia Gigena summarizes what Dr. Alex Halpern said: The 4 patients who received only anal sphincter reconstruction achieved voluntary bowel movements with higher productivity and confidence.
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Cecilia Gigena summarizes what Dr. Alex Halpern said: Anal sphincter reconstruction appears to be an option for overstretched anal sphincters in patients with Hirschsprung disease after a pull-through.
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Transitional Care in Anorectal Malformation and Hirschsprung's Disease
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Cecilia Gigena summarizing a resource: Do you have a transitional care coordinator for colorectal patients in your hospital?
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Cecilia Gigena summarizing a resource: A systematic review was conducted in the UK to establish and categorize challenges and solutions related to transitional care in colorectal patients
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Cecilia Gigena summarizing a resource: The first challenge identified was patients' lack of understanding of their own pathology
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Cecilia Gigena summarizing a resource: The second challenge was the lack of education and awareness of adult surgeons about pediatric colorectal pathologies
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Cecilia Gigena summarizing a resource: The third challenge was the lack of an instructional transitional care program
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Cecilia Gigena summarizing a resource: The third proposed solution was to create a structured and coordinated transition program
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Cecilia Gigena summarizing a resource: The first proposed solution was to foster young adult patients' autonomy
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Cecilia Gigena summarizing a resource: The second proposed solution was to conduct joint pediatric adult transitional clinics
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Quick Literature Updates Episode 18
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Cecilia Gigena summarizes what Dr. Alex Halpern said: A retrospective cohort study of CPAM included 110 patients comparing outcomes based on timing of surgery relative to symptom onset.
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Cecilia Gigena summarizes what Dr. Alex Halpern said: Patients with CPAM who underwent surgery before becoming symptomatic had shorter operating times compared to those operated after symptom onset.
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Cecilia Gigena summarizes what Dr. Alex Halpern said: Patients with CPAM who underwent surgery before becoming symptomatic had shorter mechanical ventilation time after surgery compared to those operated after symptom onset.
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Cecilia Gigena summarizes what Dr. Alex Halpern said: Patients with CPAM who underwent surgery before becoming symptomatic had shorter length of stay compared to those operated after symptom onset.
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Cecilia Gigena summarizes what Dr. Alex Halpern said: In the CPAM study, there was no significant difference in conversion rates or post-operative complications between patients operated before versus after symptom onset.
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Cecilia Gigena summarizes what Dr. Alex Halpern said: The CPAM study findings suggest it is safer to operate these patients before they become symptomatic.
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Cecilia Gigena summarizes what Dr. Alex Halpern said: So it seems that it's safer to operate these patients before they become symptomatic.
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Quick Literature Updates Ep 23
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Cecilia Gigena summarizes what Dr. Alex Halpern said: A 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.
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Cecilia Gigena summarizes what Dr. Alex Halpern said: The systematic review included 234 studies and established 3 challenges and solutions.
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Cecilia Gigena summarizes what Dr. Alex Halpern said: The first challenge in transitional care for colorectal patients is the patients' lack of understanding of their own pathology.
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Cecilia Gigena summarizes what Dr. Alex Halpern said: The second challenge is the lack of education and awareness of adult surgeons about pediatric colorectal pathologies.
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Cecilia Gigena summarizes what Dr. Alex Halpern said: The third challenge is the lack of a structured transitional care program.
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Cecilia Gigena summarizes what Dr. Alex Halpern said: The first proposed solution is to foster young adult patients' autonomy.
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Cecilia Gigena summarizes what Dr. Alex Halpern said: The second proposed solution is to conduct joint pediatric-adult transitional clinics.
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Cecilia Gigena summarizes what Dr. Alex Halpern said: The third proposed solution is to create a structured and coordinated transition program.
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Summaries Cecilia gave as host · Appendicitis 14 summaries
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Quick Literature Updates Episode 11
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Cecilia Gigena summarizing a resource: Periumbilical hernia rate was significantly higher in patients who underwent primary closure versus those who needed silo placement.
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Cecilia Gigena summarizing a resource: Only 16.4% of patients who underwent sutured gastroschisis closure had a persistent hernia.
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Cecilia Gigena summarizing a resource: Spontaneous closure of periumbilical hernias after gastroschisis was seen in 38.8% of cases.
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Cecilia Gigena summarizing a resource: Only 31.8% of patients with periumbilical hernias after gastroschisis needed surgery.
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Cecilia Gigena summarizing a resource: Sutureless gastroschisis closures lead to more periumbilical hernias, but they can be managed as any other congenital umbilical hernia and have no additional risk.
Open
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Cecilia Gigena summarizing a resource: Patients who underwent sutureless gastroschisis closures had 50% rates of persistent hernia.
Open
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Cecilia Gigena summarizing a resource: Frazier et al. conducted a retrospective study from the Midwest Pediatric Surgery Consortium following 375 patients with gastroschisis who underwent closure between 2013 and 2016.
Open
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Cecilia Gigena summarizing a resource: The overall rate for periumbilical hernias after gastroschisis closure was 22.7%.
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Quick Literature Updates Ep 24
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Cecilia Gigena summarizes what Dr. Carlos Colunga said: The Rao study compared patients with suspected choledocholithiasis who underwent transcystic laparoscopic common bile duct exploration versus those who underwent ERCP first.
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Cecilia Gigena summarizes what Dr. Carlos Colunga said: The Rao et al. study is a multi-center retrospective study done in the US from 2018 to 2022.
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Cecilia Gigena summarizes what Dr. Carlos Colunga said: The Rao study included 252 patients total: 156 in the transcystic laparoscopic common bile duct exploration group and 96 in the ERCP-first group.
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Cecilia Gigena summarizes what Dr. Carlos Colunga said: Patients who underwent transcystic laparoscopic common bile duct exploration had lower length of stay compared to ERCP-first patients.
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Cecilia Gigena summarizes what Dr. Carlos Colunga said: Patients who underwent transcystic laparoscopic common bile duct exploration had significantly less complication rates compared to ERCP-first patients.
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Cecilia Gigena summarizes what Dr. Carlos Colunga said: Attempting a transcystic laparoscopic common bile duct exploration may benefit pediatric choledocholithiasis patients.
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Summaries Cecilia gave as host · Biliary Atresia 12 summaries
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Prof. Shilpa Sharma - Best of the Best in Pediatric Surgery 2024
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Cecilia Gigena summarizes what Dr. Shilpa Sharma said: The 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.
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Clinical Characteristics and Prognosis of Biliary Atresia with Low Serum Matrix Metalloproteinase-7 Levels
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Cecilia Gigena summarizing a resource: This 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.
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Cecilia Gigena summarizing a resource: The study was a retrospective cohort study conducted in China
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Cecilia Gigena summarizing a resource: They had 329 patients, and 40 of them had low MMP7.
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Cecilia Gigena summarizing a resource: 40 of the 329 patients had low MMP-7 levels
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Cecilia Gigena summarizing a resource: The study included 329 patients with biliary atresia
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Cecilia Gigena summarizing a resource: Patients with low MMP-7 had significantly lower 3-month jaundice clearance
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Cecilia Gigena summarizing a resource: And 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.
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Cecilia Gigena summarizing a resource: Patients with low MMP-7 had significantly lower 1-year native liver survival
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Cecilia Gigena summarizing a resource: Patients with low MMP-7 had significantly lower 6-month jaundice clearance
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Cecilia Gigena summarizing a resource: MMP-7 measurement may in the future help with treatment of biliary atresia patients
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Cecilia Gigena summarizing a resource: Measuring MMP-7 can help with prognosis in biliary atresia patients
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Summaries Cecilia gave as host · Cancer 9 summaries
Female Fertility Cryopreservation Outcomes in Childhood Cancer: A Systematic Review
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Cecilia Gigena summarizing a resource: Do you indicate cryopreservation in girls that are going to need chemotherapy?
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Cecilia Gigena summarizing a resource: The systematic review aimed to highlight outcomes of cryopreservation in pediatric female patients with cancer
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Cecilia Gigena summarizing a resource: The review included 12 studies with 612 patients total
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Cecilia Gigena summarizing a resource: 501 patients underwent ovarian tissue cryopreservation
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Cecilia Gigena summarizing a resource: Only 30 of the 501 patients received ovarian tissue transplantation
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Cecilia Gigena summarizing a resource: Of the 30 patients who received transplantation, 9 got pregnant
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Cecilia Gigena summarizing a resource: Only 6 of the 9 pregnancies resulted in live birth
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Cecilia Gigena summarizing a resource: More high quality studies are needed to understand cryopreservation better and improve its outcomes
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Cecilia Gigena summarizing a resource: So even though cryopreservation can be successful, we still need more high quality studies to understand it better and improve its outcomes.
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Summaries Cecilia gave as host · Choledochal Cyst / Biliary 12 summaries
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Quick Literature Updates Episode 15
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Cecilia Gigena summarizing a resource: The Hirschsprung-associated IBD study was a retrospective study gathering patients from 2000 to 2021 at 17 institutions.
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Cecilia Gigena summarizing a resource: The study gathered 55 Hirschsprung patients, and 50% had long segment disease.
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Cecilia Gigena summarizing a resource: it 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.
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Cecilia Gigena summarizing a resource: 68% of the Hirschsprung patients had Hirschsprung-associated enterocolitis.
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Cecilia Gigena summarizing a resource: 10% of the Hirschsprung patients had trisomy 21.
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Cecilia Gigena summarizing a resource: Long segment disease, Hirschsprung-associated enterocolitis, and trisomy 21 can be potential risk factors for IBD-like symptoms in Hirschsprung patients after pull through.
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Cecilia Gigena summarizing a resource: The 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.
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Cecilia Gigena summarizing a resource: The study gathered 262 patients with isolated solid organ injuries, grades 1 to 3.
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Cecilia Gigena summarizing a resource: 148 patients had solid organ injuries grades 1 or 2, and none of them required an acute intervention.
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Cecilia Gigena summarizing a resource: Of 114 patients with grade 3 solid organ injuries, only 3 patients required an acute intervention.
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Cecilia Gigena summarizing a resource: Isolated solid organ injuries after blunt abdominal trauma, grades 1 or 2, can be discharged from the ED.
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Cecilia Gigena summarizing a resource: So it seems that isolated solid organ injuries after a blunt abdominal trauma, grades 1 or 2 can be discharged from the ED.
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Summaries Cecilia gave as host · Choledocholithiasis 16 summaries
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Transcystic Laparoscopic Common Bile Duct Exploration for Pediatric Patients with Choledocholithiasis
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Cecilia Gigena summarizing a resource: This is a multi-center retrospective study done in the US from 2018 to 2022, and their aim was to compare patients with suspected.
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Cecilia Gigena summarizing a resource: The study aim was to compare patients with suspected choledocholithiasis who underwent transcystic laparoscopic common bile duct exploration versus those who underwent ERCP first
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Cecilia Gigena summarizing a resource: The study was a multi-center retrospective study conducted in the US from 2018 to 2022
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Cecilia Gigena summarizing a resource: 156 patients were in group one (transcystic laparoscopic common bile duct exploration)
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Cecilia Gigena summarizing a resource: Patients in group one (transcystic laparoscopic approach) had significantly less complication rates compared to group two
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Cecilia Gigena summarizing a resource: Patients in group one (transcystic laparoscopic approach) had lower length of stay compared to group two
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Cecilia Gigena summarizing a resource: Attempting a transcystic laparoscopic common bile duct exploration may benefit pediatric patients with choledocholithiasis
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Cecilia Gigena summarizing a resource: So it seems that attempting a transcystic laparoscopic common bile duct exploration may benefit our patients.
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Choledocholithiasis with Drs. David Vitale & Lucas Neff
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Cecilia Gigena summarizing the discussion: Choledocholithiasis stones may be made up of bile pigments or calcium and cholesterol salts.
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Cecilia Gigena summarizing the discussion: Patients with intermediate risk (abnormal liver biochemical tests or dilated common bile ducts) can undergo endoscopic ultrasound, MRCP, laparoscopic cholangiogram, or intraoperative ultrasound.
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Cecilia Gigena summarizing the discussion: Common bile duct diameter greater than 6 millimeters was most sensitive for predicting common bile duct stones in children, although without statistical significance.
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Cecilia Gigena summarizing the discussion: Randomized trials from 2013 show no significant difference in morbidity, mortality, retained stones, or failure rates between ERCP and laparoscopic common bile duct exploration.
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Cecilia Gigena summarizing the discussion: Most free-standing children's hospitals do not have ERCP capabilities.
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Cecilia Gigena summarizing the discussion: If the pancreatic duct is visualized during fluoroscopy, the procedure should be stopped due to higher risk for pancreatitis.
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Summaries Cecilia gave as host · Cholelithiasis 11 summaries
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Case-Based Journal Review: Cholelithiasis 2024
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Cecilia Gigena summarizes what Dr. Jose Campos said: In 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
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Cecilia Gigena summarizes what Dr. Jose Campos said: When cholecystectomy was delayed more than 6 weeks after gallstone pancreatitis, recurrence rate increased to 60%
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Cecilia Gigena summarizes what Dr. Jose Campos said: Patients who underwent early cholecystectomy did not have more biliary complications than delayed surgery patients
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Cecilia Gigena summarizes what Dr. Jose Campos said: In 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
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Cecilia Gigena summarizes what Dr. Jose Campos said: Patients 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
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Choledocholithiasis with Drs. David Vitale & Lucas Neff
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Cecilia Gigena summarizing the discussion: Choledocholithiasis stones may be made up of bile pigments or calcium and cholesterol salts.
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Cecilia Gigena summarizing the discussion: Patients with intermediate risk (abnormal liver biochemical tests or dilated common bile ducts) can undergo endoscopic ultrasound, MRCP, laparoscopic cholangiogram, or intraoperative ultrasound.
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Cecilia Gigena summarizing the discussion: Common bile duct diameter greater than 6 millimeters was most sensitive for predicting common bile duct stones in children, although without statistical significance.
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Cecilia Gigena summarizing the discussion: Randomized trials from 2013 show no significant difference in morbidity, mortality, retained stones, or failure rates between ERCP and laparoscopic common bile duct exploration.
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Cecilia Gigena summarizing the discussion: Most free-standing children's hospitals do not have ERCP capabilities.
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Cecilia Gigena summarizing the discussion: If the pancreatic duct is visualized during fluoroscopy, the procedure should be stopped due to higher risk for pancreatitis.
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Summaries Cecilia gave as host · Cholestasis 4 summaries
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Intestinal Rehabilitation, Episode 6: Cholestasis
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Cecilia Gigena summarizing the discussion: Advanced liver disease is defined as conjugated bilirubin above 5 or 6 mg/dL.
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Cecilia Gigena summarizing the discussion: Historically, 25-50% of intestinal failure patients died because of associated liver disease; now it is less than 2%.
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Cecilia Gigena summarizing the discussion: Risk factors for intestinal failure-associated liver disease include prematurity, lack of enteral feeding, sepsis, and TPN components.
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Cecilia Gigena summarizing the discussion: Prophylactic cholecystectomy is not recommended because the gallbladder helps with enterohepatic circulation and many patients will not need it.
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Summaries Cecilia gave as host · Chronic Pancreatitis 6 summaries
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Update Course Rewind: Management of Recurrent Pancreatitis
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Cecilia Gigena summarizes what Dr. Juan Gurria said: If 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.
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Cecilia Gigena summarizes what Dr. Juan Gurria said: Genetics 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.
Open
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Cecilia Gigena summarizes what Dr. Juan Gurria said: Endoscopic treatment should be attempted first, but if it fails, transfer to a specialized center that performs TPIAT (total pancreatectomy with islet autotransplantation).
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Cecilia Gigena summarizes what Dr. Juan Gurria said: For pancreatic imaging, start with ultrasound, then CT, and for better visualization of pancreatic anatomy, use MRCP with T2 sequences.
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Cecilia Gigena summarizes what Dr. Juan Gurria said: Recurrent pancreatitis is a rare pathology that can lead to chronic pancreatitis and is associated with genetic mutations.
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Cecilia Gigena summarizes what Dr. Juan Gurria said: If 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.
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Summaries Cecilia gave as host · Colorectal / ARM & Hirschsprung 102 summaries
Open the Colorectal / ARM & Hirschsprung collection →
Journal of Pediatric Surgery Article Review: February 2023, BAPS issue
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Cecilia Gigena summarizing the discussion: The Tanzania soap bathing study included 252 patients, with 114 receiving a preoperative bath with plain soap
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Cecilia Gigena summarizing the discussion: In the soap bathing group, 11.4% developed surgical site infections compared to 40.6% in the control group
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Cecilia Gigena summarizing the discussion: Preoperative soap bathing reduced the odds of surgical site infections by 80%
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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
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Cecilia Gigena summarizing a resource: Do you always do a contrast enema prior to stoma reversal?
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Cecilia Gigena summarizing a resource: A retrospective study was conducted in the Netherlands between 1998 and 2018 examining contrast enema use prior to stoma reversal.
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Cecilia Gigena summarizing a resource: The study included patients under three years old who underwent stoma reversal.
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Cecilia Gigena summarizing a resource: 95% of patients with strictures had necrotizing enterocolitis.
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Cecilia Gigena summarizing a resource: Only 68% of all patients had a contrast enema prior to stoma reversal.
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Cecilia Gigena summarizing a resource: Contrast enema was able to detect 92% of strictures.
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Cecilia Gigena summarizing a resource: Contrast enema prior to stoma reversal is only useful if patients had necrotizing enterocolitis.
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Cecilia Gigena summarizing a resource: So it seems that contrast enema prior to stoma reversal is only useful if patients had NEC.
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Quick Literature Updates Episode 7
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Cecilia Gigena summarizing a resource: Olsen et al. systematic review analyzed 10 studies with 6,430 patients examining surgeon volume and pediatric thyroid surgery outcomes.
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Cecilia Gigena summarizing a resource: Thyroidectomies performed by high volume surgeons show shorter length of stays.
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Cecilia Gigena summarizing a resource: The 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.
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Journal of Pediatric Surgery Article Review: May 2023, CAPS Issue
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Cecilia Gigena summarizing the discussion: The Hirschsprung-associated IBD study was a retrospective study from 2000 to 2021 at 17 institutions with 55 patients.
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Cecilia Gigena summarizing the discussion: Enterocolitis was reported in 68% of Hirschsprung patients after pull-through.
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Cecilia Gigena summarizing the discussion: 50% of Hirschsprung-associated IBD patients had long segment disease.
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Cecilia Gigena summarizing the discussion: The most common presentation for Hirschsprung-associated IBD was colonic or small bowel inflammation resembling IBD.
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Cecilia Gigena summarizing the discussion: The button battery study evaluated whether implementation of a clinical algorithm shortened time from diagnosis to removal of esophageal button battery.
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Cecilia Gigena summarizing the discussion: The algorithm was based on the national database algorithm and implemented in October 2019.
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Cecilia Gigena summarizing the discussion: After implementing the critical airway response team algorithm, time from chest X-ray to button battery removal was reduced from 73 minutes to 35 minutes.
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Meta-Analysis of Enhanced Recovery After Surgery Protocols for the Perioperative Management of Pediatric Colorectal Surgery
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Cecilia Gigena summarizing a resource: This is a meta-analysis that wanted to see the effects of the ERS protocol in pediatric colorectal surgery.
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Quick Literature Updates Episode 14
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Cecilia Gigena summarizes what Dr. Alex Halpern said: The Bokova et al. study is a multi-institutional one-year outcome study of anal sphincter reconstruction for patulous sphincter in 6 patients.
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Cecilia Gigena summarizes what Dr. Alex Halpern said: The Bokova et al. study is a multi-institutional one-year outcome study of anal sphincter reconstruction for patulous sphincter in 6 patients.
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Cecilia Gigena summarizes what Dr. Alex Halpern said: Of the 6 patients in the sphincter reconstruction study, 2 had Down syndrome and underwent redo pull-through with anal sphincter reconstruction.
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Cecilia Gigena summarizes what Dr. Alex Halpern said: Four patients in the sphincter reconstruction study received only anal sphincter reconstruction without redo pull-through.
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Cecilia Gigena summarizes what Dr. Alex Halpern said: Four patients in the sphincter reconstruction study received only anal sphincter reconstruction without redo pull-through.
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Cecilia Gigena summarizes what Dr. Alex Halpern said: Of the 6 patients in the sphincter reconstruction study, 2 had Down syndrome and underwent redo pull-through with anal sphincter reconstruction.
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Cecilia Gigena summarizes what Dr. Alex Halpern said: Anal sphincter reconstruction appears to be an option for overstretched anal sphincters in patients with Hirschsprung disease after a pull-through.
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Cecilia Gigena summarizes what Dr. Alex Halpern said: The 4 patients who received only anal sphincter reconstruction achieved voluntary bowel movements with higher productivity and confidence.
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Cecilia Gigena summarizes what Dr. Alex Halpern said: Anal sphincter reconstruction appears to be an option for overstretched anal sphincters in patients with Hirschsprung disease after a pull-through.
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Cecilia Gigena summarizes what Dr. Alex Halpern said: The 4 patients who received only anal sphincter reconstruction achieved voluntary bowel movements with higher productivity and confidence.
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Meta-Analysis of Enhaced Recovery After Ssurgery Protocols for the Perioperative Management of Pediatric Colorectal Surgery
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Cecilia Gigena summarizing a resource: This is a meta-analysis done in China that wanted to analyze the effects and safety of ERES particle for colorectal surgery in pediatric patients.
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Cecilia Gigena summarizing a resource: The meta-analysis included studies with 1,298 patients
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Cecilia Gigena summarizing a resource: ERAS protocols significantly reduced intraoperative fluid administration in pediatric colorectal surgery
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Cecilia Gigena summarizing a resource: ERAS protocols significantly reduced postoperative opioid use in pediatric colorectal surgery
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Cecilia Gigena summarizing a resource: ERAS protocols shortened time to first enteral nutrition in pediatric colorectal surgery
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Cecilia Gigena summarizing a resource: ERAS protocols shortened time to bowel function return in pediatric colorectal surgery
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Cecilia Gigena summarizing a resource: ERAS protocols reduced hospital length of stay in pediatric colorectal surgery
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Cecilia Gigena summarizing a resource: ERAS protocols reduced hospital costs in pediatric colorectal surgery
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Cecilia Gigena summarizing a resource: ERAS protocols are needed in pediatric colorectal surgery
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Cecilia Gigena summarizing a resource: So it seems that ERA's protocols are in need in colorectal pediatric surgery.
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Quick Literature Updates Episode 15
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Cecilia Gigena summarizing a resource: The Hirschsprung-associated IBD study was a retrospective study gathering patients from 2000 to 2021 at 17 institutions.
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Cecilia Gigena summarizing a resource: The study gathered 55 Hirschsprung patients, and 50% had long segment disease.
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Cecilia Gigena summarizing a resource: 10% of the Hirschsprung patients had trisomy 21.
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Cecilia Gigena summarizing a resource: 68% of the Hirschsprung patients had Hirschsprung-associated enterocolitis.
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Cecilia Gigena summarizing a resource: it 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.
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Cecilia Gigena summarizing a resource: Long segment disease, Hirschsprung-associated enterocolitis, and trisomy 21 can be potential risk factors for IBD-like symptoms in Hirschsprung patients after pull through.
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Cecilia Gigena summarizing a resource: The 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.
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Cecilia Gigena summarizing a resource: The study gathered 262 patients with isolated solid organ injuries, grades 1 to 3.
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Cecilia Gigena summarizing a resource: 148 patients had solid organ injuries grades 1 or 2, and none of them required an acute intervention.
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Cecilia Gigena summarizing a resource: Of 114 patients with grade 3 solid organ injuries, only 3 patients required an acute intervention.
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Cecilia Gigena summarizing a resource: Isolated solid organ injuries after blunt abdominal trauma, grades 1 or 2, can be discharged from the ED.
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Cecilia Gigena summarizing a resource: So it seems that isolated solid organ injuries after a blunt abdominal trauma, grades 1 or 2 can be discharged from the ED.
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Journal of Pediatric Surgery Article Review: September 2023
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Cecilia Gigena summarizing the discussion: In 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.
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Cecilia Gigena summarizing the discussion: ERAS protocols significantly reduce intraoperative fluids needed and postoperative opiate use in pediatric colorectal surgery.
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Cecilia Gigena summarizing the discussion: Time to first oral intake and time for complete nutrition was less in patients managed with ERAS protocols.
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Transitional Care in Anorectal Malformation and Hirschsprung's Disease
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Cecilia Gigena summarizing a resource: Do you have a transitional care coordinator for colorectal patients in your hospital?
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Cecilia Gigena summarizing a resource: A systematic review was conducted in the UK to establish and categorize challenges and solutions related to transitional care in colorectal patients
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Cecilia Gigena summarizing a resource: The first challenge identified was patients' lack of understanding of their own pathology
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Cecilia Gigena summarizing a resource: The second challenge was the lack of education and awareness of adult surgeons about pediatric colorectal pathologies
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Cecilia Gigena summarizing a resource: The third challenge was the lack of an instructional transitional care program
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Cecilia Gigena summarizing a resource: The third proposed solution was to create a structured and coordinated transition program
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Cecilia Gigena summarizing a resource: The first proposed solution was to foster young adult patients' autonomy
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Cecilia Gigena summarizing a resource: The second proposed solution was to conduct joint pediatric adult transitional clinics
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Quick Literature Updates Episode 17
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Cecilia Gigena summarizes what Dr. Alex Halpern said: The Zeng et al. study was a retrospective multi-center study done in China comparing robotic repair versus thoracoscopic repair for esophageal atresia.
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Cecilia Gigena summarizes what Dr. Alex Halpern said: Robotic surgery for esophageal atresia had longer operative time but shorter anastomotic time compared to thoracoscopic repair.
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Cecilia Gigena summarizes what Dr. Alex Halpern said: After propensity score matching, the study included 126 patients with 63 in each group (robotic vs thoracoscopic).
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Cecilia Gigena summarizes what Dr. Alex Halpern said: The robotic group had lower anastomotic strictures and lower readmissions within 2 years post-op compared to thoracoscopic repair.
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Cecilia Gigena summarizes what Dr. Alex Halpern said: So it seems that robotic surgery is a good answer for esophageal tissue repair.
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Cecilia Gigena summarizes what Dr. Alex Halpern said: Robotic surgery is a good answer for esophageal atresia repair.
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Quick Literature Updates Episode 18
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Cecilia Gigena summarizes what Dr. Alex Halpern said: A retrospective cohort study of CPAM included 110 patients comparing outcomes based on timing of surgery relative to symptom onset.
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Cecilia Gigena summarizes what Dr. Alex Halpern said: Patients with CPAM who underwent surgery before becoming symptomatic had shorter operating times compared to those operated after symptom onset.
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Cecilia Gigena summarizes what Dr. Alex Halpern said: Patients with CPAM who underwent surgery before becoming symptomatic had shorter length of stay compared to those operated after symptom onset.
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Cecilia Gigena summarizes what Dr. Alex Halpern said: Patients with CPAM who underwent surgery before becoming symptomatic had shorter mechanical ventilation time after surgery compared to those operated after symptom onset.
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Cecilia Gigena summarizes what Dr. Alex Halpern said: In the CPAM study, there was no significant difference in conversion rates or post-operative complications between patients operated before versus after symptom onset.
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Cecilia Gigena summarizes what Dr. Alex Halpern said: The CPAM study findings suggest it is safer to operate these patients before they become symptomatic.
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Cecilia Gigena summarizes what Dr. Alex Halpern said: So it seems that it's safer to operate these patients before they become symptomatic.
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Quick Literature Updates Ep 22
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Cecilia Gigena summarizing a resource: The Pefer et al. study is a retrospective study done in Texas using a state hospital database examining CDH outcomes by center volume.
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Cecilia Gigena summarizing a resource: The Pefer study identified 1,314 CDH patients: 728 from high volume centers, 9 from mid-volume centers, and 79 from low volume centers.
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Cecilia Gigena summarizing a resource: High volume centers had significantly shorter length of stay for CDH patients.
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Cecilia Gigena summarizing a resource: High volume centers had significantly lower mortality rates for CDH, even though they have significantly sicker patients.
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Cecilia Gigena summarizing a resource: High volume centers had better outcomes for patients with CDH.
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Quick Literature Updates Ep 23
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Cecilia Gigena summarizes what Dr. Alex Halpern said: A 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.
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Cecilia Gigena summarizes what Dr. Alex Halpern said: The systematic review included 234 studies and established 3 challenges and solutions.
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Cecilia Gigena summarizes what Dr. Alex Halpern said: The first challenge in transitional care for colorectal patients is the patients' lack of understanding of their own pathology.
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Cecilia Gigena summarizes what Dr. Alex Halpern said: The second challenge is the lack of education and awareness of adult surgeons about pediatric colorectal pathologies.
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Cecilia Gigena summarizes what Dr. Alex Halpern said: The third challenge is the lack of a structured transitional care program.
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Cecilia Gigena summarizes what Dr. Alex Halpern said: The second proposed solution is to conduct joint pediatric-adult transitional clinics.
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Host summary
Cecilia Gigena summarizes what Dr. Alex Halpern said: The first proposed solution is to foster young adult patients' autonomy.
Open
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Cecilia Gigena summarizes what Dr. Alex Halpern said: The third proposed solution is to create a structured and coordinated transition program.
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Quick Literature Updates Ep 26
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Cecilia Gigena summarizes what Dr. Alex Halpern said: The Schlapbach et al. study is a worldwide study with a Delphi consensus process that aimed to update the definitions of sepsis and septic shock
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Cecilia Gigena summarizes what Dr. Alex Halpern said: The Phoenix sepsis score includes variables in cardiovascular function, respiratory function, coagulation, and neurological function
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Cecilia Gigena summarizes what Dr. Alex Halpern said: The Phoenix sepsis score helped correlate the definition of sepsis with an actual mortality rate
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Cecilia Gigena summarizes what Dr. Alex Halpern said: Septic 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
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Cecilia Gigena summarizes what Dr. Alex Halpern said: The definition of sepsis is suspected infection plus 2 points in the Phoenix sepsis score
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Cecilia Gigena summarizes what Dr. Alex Halpern said: Sepsis has a mortality rate of 7.1%
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Cecilia Gigena summarizes what Dr. Alex Halpern said: Septic shock has a mortality rate of 10.8 to 33.5% according to the research settings
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Summaries Cecilia gave as host · Congenital Diaphragmatic Hernia 17 summaries
Open the Congenital Diaphragmatic Hernia collection →
Case-Based Journal Review: Congenital Diaphragmatic Hernia 2023
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Cecilia Gigena summarizes what Dr. Fernando Bullettin said: FETO (fetal endoscopic tracheal occlusion) increases general survival in moderate and severe CDH, with statistically significant benefit specifically in severe CDH cases, based on meta-analysis of 4 randomized controlled trials with 341 patients.
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Cecilia Gigena summarizes what Dr. Fernando Bullettin said: Boston Children's Hospital retrospective cohort study found that on-ECMO repair demonstrated lower mortality rate, lower hazard ratio, and lower incidence of non-repair compared to post-ECMO repair.
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Cecilia Gigena summarizes what Dr. Fernando Bullettin said: In the Boston study's second analysis arm, early repair on ECMO was associated with lower mortality, lower hazard ratio, and lower incidence of non-repair compared to late repair on ECMO.
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Cecilia Gigena summarizes what Dr. Fernando Bullettin said: The lower recurrence rate with flap repair may be due to the flap's ability to grow over time with the child.
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Cecilia Gigena summarizes what Dr. Fernando Bullettin said: University of Colorado study (2019) of 52 patients found that muscle flap repair leads to lower recurrence rates compared to patch repair in CDH cases.
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Cecilia Gigena summarizes what Dr. Fernando Bullettin said: In the UK patch study, biological patches had adhesion rates between 7-35% while synthetic patches had adhesion rates between 4-29%.
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Cecilia Gigena summarizes what Dr. Fernando Bullettin said: UK systematic review and meta-analysis of 986 CDH patients (226 biological patches, 760 synthetic) found biological patches had a recurrence rate of 30.3% versus 16.7% for synthetic patches.
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Cecilia Gigena summarizes what Dr. Fernando Bullettin said: Synthetic patches were associated with chest wall deformities in 80% of cases in the UK meta-analysis.
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Cecilia Gigena summarizes what Dr. Fernando Bullettin said: The French study found that preventive fundoplication during patch repair does not decrease the need for future curative fundoplication and is associated with adverse GI outcomes.
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Cecilia Gigena summarizes what Dr. Fernando Bullettin said: French prospective cohort study (JPS 2022) of 762 CDH neonates found that 81 underwent fundoplication (either preventive or curative).
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Cecilia Gigena summarizes what Dr. Fernando Bullettin said: In the French fundoplication study, patients who received fundoplication had failure-to-thrive rates of 81% versus 51% in those who did not receive fundoplication.
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Quick Literature Updates Episode 20
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Cecilia Gigena summarizes what Dr. Alex Halpern said: Esposito 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).
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Cecilia Gigena summarizes what Dr. Alex Halpern said: Laparoscopic cholecystectomy with ICG provided better visualization of the biliary tree compared to without ICG.
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Cecilia Gigena summarizes what Dr. Alex Halpern said: Laparoscopic cholecystectomy with ICG had no complications compared to 12% complication rate without ICG.
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Cecilia Gigena summarizes what Dr. Alex Halpern said: Laparoscopic cholecystectomy with ICG had shorter surgery time compared to without ICG.
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Cecilia Gigena summarizes what Dr. Alex Halpern said: Laparoscopic cholecystectomy with ICG can be the new standard in pediatric surgery practice.
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Cecilia Gigena summarizes what Dr. Alex Halpern said: So it seems that laparoscopic cholecystectomy with ICG can be the new standard in our practice.
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Summaries Cecilia gave as host · Congenital Lung Lesions (CPAM) 25 summaries
Open the Congenital Lung Lesions (CPAM) collection →
Clinical Symptoms Affect Treatment and Prognosis in Pediatric Patients with Congenital Pulmonary Airway Malformation
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Cecilia Gigena summarizing a resource: Do you wait for symptoms to treat congenital pulmonary airway malformations?
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Cecilia Gigena summarizing a resource: The study was retrospective and aimed to investigate safety and efficacy of surgery in asymptomatic versus symptomatic CPAM patients
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Cecilia Gigena summarizing a resource: Patients who underwent surgery before becoming symptomatic had shorter mechanical ventilation after surgery
Open
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Cecilia Gigena summarizing a resource: Patients who underwent surgery before becoming symptomatic had shorter operating times
Open
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Cecilia Gigena summarizing a resource: Patients who underwent surgery before becoming symptomatic had shorter length of stay
Open
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Cecilia Gigena summarizing a resource: It appears safer to operate on CPAM patients before they become symptomatic
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Cecilia Gigena summarizing a resource: There was no significant difference in postoperative complications between asymptomatic and symptomatic groups
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Cecilia Gigena summarizing a resource: There was no significant difference in conversion rates between asymptomatic and symptomatic groups
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Host summary
Cecilia Gigena summarizing a resource: it seems that it's safer to operate these patients before they become symptomatic.
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Journal of Pediatric Surgery Article Review: October 2023
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Cecilia Gigena summarizing the discussion: Within 1,395 patients across 12 observational studies, 753 received acid suppression medication but this did not reduce the odds of having an esophageal stricture
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Cecilia Gigena summarizing the discussion: Within 1,395 patients across 12 observational studies, 753 received acid suppression medication but this did not reduce the odds of having an esophageal stricture
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Cecilia Gigena summarizing the discussion: Some randomized trials showed that doing something to the pleura does not actually reduce recurrences of spontaneous pneumothorax
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Cecilia Gigena summarizing the discussion: Some randomized trials showed that doing something to the pleura does not actually reduce recurrences of spontaneous pneumothorax
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Cecilia Gigena summarizing the discussion: For the asymptomatic contralateral side in children with spontaneous pneumothorax, do not do anything unless it develops symptoms
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Cecilia Gigena summarizing the discussion: For the asymptomatic contralateral side in children with spontaneous pneumothorax, do not do anything unless it develops symptoms
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Cecilia Gigena summarizing the discussion: The asymptomatic CPAM group had shorter operating times, shorter postoperative mechanical ventilation, shorter chest tube durations, and shorter hospital stays
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Cecilia Gigena summarizing the discussion: The asymptomatic CPAM group had shorter operating times, shorter postoperative mechanical ventilation, shorter chest tube durations, and shorter hospital stays
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Quick Literature Updates Episode 18
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Cecilia Gigena summarizes what Dr. Alex Halpern said: A retrospective cohort study of CPAM included 110 patients comparing outcomes based on timing of surgery relative to symptom onset.
Open
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Cecilia Gigena summarizes what Dr. Alex Halpern said: Patients with CPAM who underwent surgery before becoming symptomatic had shorter length of stay compared to those operated after symptom onset.
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Cecilia Gigena summarizes what Dr. Alex Halpern said: Patients with CPAM who underwent surgery before becoming symptomatic had shorter mechanical ventilation time after surgery compared to those operated after symptom onset.
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Host summary
Cecilia Gigena summarizes what Dr. Alex Halpern said: Patients with CPAM who underwent surgery before becoming symptomatic had shorter operating times compared to those operated after symptom onset.
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Cecilia Gigena summarizes what Dr. Alex Halpern said: In the CPAM study, there was no significant difference in conversion rates or post-operative complications between patients operated before versus after symptom onset.
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Host summary
Cecilia Gigena summarizes what Dr. Alex Halpern said: The CPAM study findings suggest it is safer to operate these patients before they become symptomatic.
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Host summary
Cecilia Gigena summarizes what Dr. Alex Halpern said: So it seems that it's safer to operate these patients before they become symptomatic.
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Summaries Cecilia gave as host · Congenital Pulmonary Airway Malformation 21 summaries
Open the Congenital Pulmonary Airway Malformation collection →
Clinical Symptoms Affect Treatment and Prognosis in Pediatric Patients with Congenital Pulmonary Airway Malformation
Host summary
Cecilia Gigena summarizing a resource: Do you wait for symptoms to treat congenital pulmonary airway malformations?
Open
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Cecilia Gigena summarizing a resource: The study was retrospective and aimed to investigate safety and efficacy of surgery in asymptomatic versus symptomatic CPAM patients
Open
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Cecilia Gigena summarizing a resource: Patients who underwent surgery before becoming symptomatic had shorter operating times
Open
Host summary
Cecilia Gigena summarizing a resource: Patients who underwent surgery before becoming symptomatic had shorter mechanical ventilation after surgery
Open
Host summary
Cecilia Gigena summarizing a resource: Patients who underwent surgery before becoming symptomatic had shorter length of stay
Open
Host summary
Cecilia Gigena summarizing a resource: It appears safer to operate on CPAM patients before they become symptomatic
Open
Host summary
Cecilia Gigena summarizing a resource: it seems that it's safer to operate these patients before they become symptomatic.
Open
Host summary
Cecilia Gigena summarizing a resource: There was no significant difference in conversion rates between asymptomatic and symptomatic groups
Open
Host summary
Cecilia Gigena summarizing a resource: There was no significant difference in postoperative complications between asymptomatic and symptomatic groups
Open
Journal of Pediatric Surgery Article Review: October 2023
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Cecilia Gigena summarizing the discussion: In a meta-analysis of 1,395 patients, 753 received acid suppression medication but it did not increase the odds of having an esophageal stricture
Open
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Cecilia Gigena summarizing the discussion: There was no evidence to associate prophylactic acid suppression with protection from stricture formation after esophageal atresia repair
Open
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Cecilia Gigena summarizing the discussion: For the asymptomatic contralateral side in children with pneumothorax, do not do anything unless it develops symptoms
Open
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Cecilia Gigena summarizing the discussion: In 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
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Quick Literature Updates Episode 18
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Cecilia Gigena summarizes what Dr. Alex Halpern said: Patients who underwent surgery before becoming symptomatic had shorter mechanical ventilation after surgery
Open
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Cecilia Gigena summarizes what Dr. Alex Halpern said: Patients who underwent surgery before becoming symptomatic had shorter operating times
Open
Host summary
Cecilia Gigena summarizes what Dr. Alex Halpern said: Patients who underwent surgery before becoming symptomatic had shorter length of stay
Open
Host summary
Cecilia Gigena summarizes what Dr. Alex Halpern said: The CPAM study included 110 patients
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Cecilia Gigena summarizes what Dr. Alex Halpern said: There was no significant difference in conversion or post-operative complications between symptomatic and asymptomatic CPAM patients undergoing surgery
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Cecilia Gigena summarizes what Dr. Alex Halpern said: So it seems that it's safer to operate these patients before they become symptomatic.
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Host summary
Cecilia Gigena summarizes what Dr. Alex Halpern said: It appears safer to operate on CPAM patients before they become symptomatic
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Summaries Cecilia gave as host · Esophageal Atresia 59 summaries
Open the Esophageal Atresia collection →
Journal of Pediatric Surgery Article Review: February 2023, BAPS issue
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Cecilia Gigena summarizing the discussion: The Tanzania soap bathing study included 252 patients, with 114 receiving a preoperative bath with plain soap
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Cecilia Gigena summarizing the discussion: In the soap bathing group, 11.4% developed surgical site infections compared to 40.6% in the control group
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Cecilia Gigena summarizing the discussion: Preoperative soap bathing reduced the odds of surgical site infections by 80%
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Esophageal Surveillance Practices in Esophageal Atresia Patients
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Cecilia Gigena summarizing a resource: Only 37% of respondents reported that their esophageal atresia patients have pre-determined outpatient clinic follow-up schedule
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Cecilia Gigena summarizing a resource: Only 37% of respondents performed follow-up endoscopy regardless of symptoms
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Cecilia Gigena summarizing a resource: 80% of respondents agree or strongly agree that endoscopy should follow a set schedule
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Cecilia Gigena summarizing a resource: 75% of respondents strongly agree or agree with current guidelines for esophageal atresia surveillance
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Cecilia Gigena summarizing a resource: 139 pediatric surgeons responded to the survey
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Cecilia Gigena summarizing a resource: The Eastern Pediatric Surgery Network in the US created a survey distributed among pediatric surgeons to understand current practices of esophageal surveillance in esophageal atresia patients
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Cecilia Gigena summarizing a resource: There is high agreement with current guidelines but weak adherence to them in esophageal atresia surveillance
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Comparison of robotic versus thoracoscopic repair for congenital esophageal atresia
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Cecilia Gigena summarizing a resource: The study is a retrospective multi-center study done in China
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Cecilia Gigena summarizing a resource: After propensity score matching, there were 126 patients total, 63 in each group
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Cecilia Gigena summarizing a resource: Robotic surgery had longer operative time compared to thoracoscopic repair
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Cecilia Gigena summarizing a resource: The robotic group had lower unplanned readmissions within 2 years post-op compared to thoracoscopic repair
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Cecilia Gigena summarizing a resource: The robotic group had lower anastomotic strictures compared to thoracoscopic repair
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Cecilia Gigena summarizing a resource: Robotic surgery had shorter anastomotic time compared to thoracoscopic repair
Open
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Cecilia Gigena summarizing a resource: So, it seems that robotic surgery is a good answer for esophageal tissue repair.
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Cecilia Gigena summarizing a resource: Robotic surgery appears to be a good option for esophageal atresia repair
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Journal of Pediatric Surgery Article Review: October 2023
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Cecilia Gigena summarizing the discussion: Within 1,395 patients across 12 observational studies, 753 received acid suppression medication but this did not reduce the odds of having an esophageal stricture
Open
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Cecilia Gigena summarizing the discussion: Some randomized trials showed that doing something to the pleura does not actually reduce recurrences of spontaneous pneumothorax
Open
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Cecilia Gigena summarizing the discussion: For the asymptomatic contralateral side in children with spontaneous pneumothorax, do not do anything unless it develops symptoms
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Cecilia Gigena summarizing the discussion: The asymptomatic CPAM group had shorter operating times, shorter postoperative mechanical ventilation, shorter chest tube durations, and shorter hospital stays
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Journal of Pediatric Surgery Article Review: Q1 (Jan-Mar) 2024
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Cecilia Gigena summarizing the discussion: The appendicitis study had 185 patients in the home antibiotic group and 121 patients in the no home antibiotic group.
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Cecilia Gigena summarizing the discussion: There was no significant difference in deep organ space infection requiring intervention between home antibiotic and no home antibiotic groups for complicated appendicitis.
Open
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Cecilia Gigena summarizing the discussion: There was no difference in length of stay between home antibiotic and no home antibiotic groups for complicated appendicitis.
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Cecilia Gigena summarizing the discussion: Type C esophageal atresia is the most common type and means esophageal atresia with a distal fistula; type A means pure esophageal atresia with no fistula to the trachea.
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Cecilia Gigena summarizing the discussion: The pectus study is a prospective cohort study from a single center in Phoenix aiming to quantify long-term hyperesthesia and neuropathic pain after minimally invasive repair of pectus excavatum with cryoablation.
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Cecilia Gigena summarizing the discussion: The pectus study selected patients under 21 years of age who presented for bar removal between November 2021 and May 2023.
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Cecilia Gigena summarizing the discussion: Testing for cold and soft touch and pinprick was performed just before bar removal.
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Cecilia Gigena summarizing the discussion: The pectus study enrolled 47 patients with a median bar dwell time of approximately 2.9 years.
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Cecilia Gigena summarizing the discussion: Patients had a median of 2 bars placed, and almost 81% were secured with pericostal sutures.
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Cecilia Gigena summarizing the discussion: Almost half of the pectus patients had some degree of hypoesthesia, with T5 being the most common dermatome affected.
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Cecilia Gigena summarizing the discussion: The area with hypoesthesia was less than 5% of the entire surface that was treated with cryo.
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Cecilia Gigena summarizing the discussion: Neuropathic symptoms were identified by only 13% of pectus patients, and none required treatment.
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Cecilia Gigena summarizing the discussion: In the long term after minimally invasive repair of pectus excavatum with cryo, many patients will experience some chest wall hypoesthesia limited to one or two dermatomes, and chronic symptomatic neuropathic pain is very rare.
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Cecilia Gigena summarizing the discussion: Pericostal sutures used to secure bars can damage nerves.
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Quick Literature Updates Episode 17
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Cecilia Gigena summarizes what Dr. Alex Halpern said: The Zeng et al. study was a retrospective multi-center study done in China comparing robotic repair versus thoracoscopic repair for esophageal atresia.
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Cecilia Gigena summarizes what Dr. Alex Halpern said: After propensity score matching, the study included 126 patients with 63 in each group (robotic vs thoracoscopic).
Open
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Cecilia Gigena summarizes what Dr. Alex Halpern said: Robotic surgery for esophageal atresia had longer operative time but shorter anastomotic time compared to thoracoscopic repair.
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Cecilia Gigena summarizes what Dr. Alex Halpern said: The robotic group had lower anastomotic strictures and lower readmissions within 2 years post-op compared to thoracoscopic repair.
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Cecilia Gigena summarizes what Dr. Alex Halpern said: So it seems that robotic surgery is a good answer for esophageal tissue repair.
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Host summary
Cecilia Gigena summarizes what Dr. Alex Halpern said: Robotic surgery is a good answer for esophageal atresia repair.
Open
Quick Literature Updates Ep 27
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Cecilia Gigena summarizes what Dr. Alex Halpern said: Huncheid et al. conducted a multi-center non-inferiority trial that compared preterm infants treated with expectant management versus early ibuprofen for patent ductus arteriosus.
Open
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Cecilia Gigena summarizes what Dr. Alex Halpern said: The trial included 273 infants: 136 treated with expectant management and 137 with early ibuprofen.
Open
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Cecilia Gigena summarizes what Dr. Alex Halpern said: In the expectant management group for PDA, there was 17.6% necrotizing enterocolitis, 33% bronchopulmonary dysplasia, and 14% death rates.
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Cecilia Gigena summarizes what Dr. Alex Halpern said: In the ibuprofen group for PDA, there was 15.4% necrotizing enterocolitis, 50% bronchopulmonary dysplasia, and 80% death rates.
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Cecilia Gigena summarizes what Dr. Alex Halpern said: Expectant management is not inferior to early ibuprofen in preterm patients with patent ductus arteriosus.
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Cecilia Gigena summarizes what Dr. Alex Halpern said: So it seems that expectant management is not inferiority that early ibuprofen in preterm patients with PDA.
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Update Course Rewind: Management of Esophageal Leaks 2022
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Cecilia Gigena summarizing the discussion: Every small or moderate leak that is contained can be managed by observation with no need for new intervention.
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Cecilia Gigena summarizing the discussion: New intervention for esophageal leaks is only considered when leaks create huge pneumothorax that are not well drained, or if the patient is unstable.
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Cecilia Gigena summarizing the discussion: Botulinum toxin can be used to block the secretion of saliva in patients with esophageal leaks.
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Cecilia Gigena summarizing the discussion: Glycopyrrolate is a medicine available in the US that blocks the secretion of saliva.
Open
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Cecilia Gigena summarizing the discussion: Retrograde endoscopy via gastrostomy tube is used when normal endoscopy cannot visualize the esophagus adequately due to stricture.
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Cecilia Gigena summarizing the discussion: Endoscopic vacuum closure (endo-bag) is constructed from an NG tube with a hose covered by a surgical sponge, which is covered by a perforated transparent adhesive.
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Cecilia Gigena summarizing the discussion: Endoscopic vacuum closure helps granulation tissue form by negative pressure, making the patient heal faster.
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Cecilia Gigena summarizing the discussion: Most esophageal leaks can be treated by observation or chest drain.
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Cecilia Gigena summarizing the discussion: If there is an external leak like in the neck or a fistula that is not healing well, an endovac can be a great solution.
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Cecilia Gigena summarizing the discussion: For some patients with deteriorated status or great leaks, a re-anastomosis can be attempted.
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Cecilia Gigena summarizing the discussion: After a leak, a stricture is more common, so patients have to be followed more thoroughly.
Open
Summaries Cecilia gave as host · Esophageal Atresia Masterclass 11 summaries
Open the Esophageal Atresia Masterclass collection →
Update Course Rewind: Management of Esophageal Leaks 2022
Host summary
Cecilia Gigena summarizing the discussion: Every small or moderate leak that is contained can be managed by observation with no need for new intervention.
Open
Host summary
Cecilia Gigena summarizing the discussion: New intervention for esophageal leaks is only considered when leaks create huge pneumothorax that are not well drained, or if the patient is unstable.
Open
Host summary
Cecilia Gigena summarizing the discussion: Botulinum toxin can be used to block the secretion of saliva in patients with esophageal leaks.
Open
Host summary
Cecilia Gigena summarizing the discussion: Glycopyrrolate is a medicine available in the US that blocks the secretion of saliva.
Open
Host summary
Cecilia Gigena summarizing the discussion: Retrograde endoscopy via gastrostomy tube is used when normal endoscopy cannot visualize the esophagus adequately due to stricture.
Open
Host summary
Cecilia Gigena summarizing the discussion: Endoscopic vacuum closure (endo-bag) is constructed from an NG tube with a hose covered by a surgical sponge, which is covered by a perforated transparent adhesive.
Open
Host summary
Cecilia Gigena summarizing the discussion: Endoscopic vacuum closure helps granulation tissue form by negative pressure, making the patient heal faster.
Open
Host summary
Cecilia Gigena summarizing the discussion: Most esophageal leaks can be treated by observation or chest drain.
Open
Host summary
Cecilia Gigena summarizing the discussion: If there is an external leak like in the neck or a fistula that is not healing well, an endovac can be a great solution.
Open
Host summary
Cecilia Gigena summarizing the discussion: For some patients with deteriorated status or great leaks, a re-anastomosis can be attempted.
Open
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Cecilia Gigena summarizing the discussion: After a leak, a stricture is more common, so patients have to be followed more thoroughly.
Open
Summaries Cecilia gave as host · Etiologies (Gastroschisis/NEC/Atresia/Volvulus) 51 summaries
Open the Etiologies (Gastroschisis/NEC/Atresia/Volvulus) collection →
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
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Cecilia Gigena summarizing a resource: Do you always do a contrast enema prior to stoma reversal?
Open
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Cecilia Gigena summarizing a resource: A retrospective study was conducted in the Netherlands between 1998 and 2018 examining contrast enema use prior to stoma reversal.
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Cecilia Gigena summarizing a resource: The study included patients under three years old who underwent stoma reversal.
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Cecilia Gigena summarizing a resource: 95% of patients with strictures had necrotizing enterocolitis.
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Cecilia Gigena summarizing a resource: Only 68% of all patients had a contrast enema prior to stoma reversal.
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Cecilia Gigena summarizing a resource: Contrast enema was able to detect 92% of strictures.
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Cecilia Gigena summarizing a resource: Contrast enema prior to stoma reversal is only useful if patients had necrotizing enterocolitis.
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Cecilia Gigena summarizing a resource: So it seems that contrast enema prior to stoma reversal is only useful if patients had NEC.
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Quick Literature Updates Episode 6
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Cecilia Gigena summarizing a resource: Patients receiving massive transfusions had lower platelet counts.
Open
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Cecilia Gigena summarizing a resource: Patients receiving massive transfusions had lower maximum amplitude values on TEG analysis.
Open
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Cecilia Gigena summarizing a resource: Philips et al. conducted a retrospective study from 2015 to 2018 evaluating 117 patients from two trauma centers.
Open
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Cecilia Gigena summarizing a resource: Patients receiving massive transfusions had shortened alpha angles on TEG analysis.
Open
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Cecilia Gigena summarizing a resource: TEG may help identify hemorrhagic trauma patients who will benefit from cryoprecipitate or platelet transfusions.
Open
Quick Literature Updates Episode 11
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Cecilia Gigena summarizing a resource: Patients who underwent sutureless gastroschisis closures had 50% rates of persistent hernia.
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Cecilia Gigena summarizing a resource: The overall rate for periumbilical hernias after gastroschisis closure was 22.7%.
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Cecilia Gigena summarizing a resource: Periumbilical hernia rate was significantly higher in patients who underwent primary closure versus those who needed silo placement.
Open
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Cecilia Gigena summarizing a resource: Frazier et al. conducted a retrospective study from the Midwest Pediatric Surgery Consortium following 375 patients with gastroschisis who underwent closure between 2013 and 2016.
Open
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Cecilia Gigena summarizing a resource: Sutureless gastroschisis closures lead to more periumbilical hernias, but they can be managed as any other congenital umbilical hernia and have no additional risk.
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Cecilia Gigena summarizing a resource: Only 16.4% of patients who underwent sutured gastroschisis closure had a persistent hernia.
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Cecilia Gigena summarizing a resource: Only 31.8% of patients with periumbilical hernias after gastroschisis needed surgery.
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Cecilia Gigena summarizing a resource: Spontaneous closure of periumbilical hernias after gastroschisis was seen in 38.8% of cases.
Open
Expectant Management or Early Ibuprofen for Patent Ductus Arteriosus
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Cecilia Gigena summarizing a resource: A multi-center non-inferiority trial compared preterm infants treated with expectant management versus early ibuprofen for PDA
Open
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Cecilia Gigena summarizing a resource: 136 infants were treated with expectant management and 137 with early ibuprofen
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Cecilia Gigena summarizing a resource: In the expectant management group, 17.6% developed necrotizing enterocolitis
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Cecilia Gigena summarizing a resource: In the expectant management group, 33% developed bronchopulmonary dysplasia
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Cecilia Gigena summarizing a resource: In the expectant management group, the death rate was 14%
Open
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Cecilia Gigena summarizing a resource: In the ibuprofen group, 50% developed bronchopulmonary dysplasia
Open
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Cecilia Gigena summarizing a resource: In the ibuprofen group, 15.4% developed necrotizing enterocolitis
Open
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Cecilia Gigena summarizing a resource: In the ibuprofen group, the death rate was 80%
Open
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Cecilia Gigena summarizing a resource: Expectant management is non-inferior to early ibuprofen in preterm patients with PDA
Open
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Cecilia Gigena summarizing a resource: So it seems that expectant management is not inferiority that early ibuprofen in preterm patients with PDA.
Open
Quick Literature Updates Episode 16
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Cecilia Gigena summarizes what Dr. Alex Halpern said: The Phoenix study by Lie et al. was a retrospective single institution study from 2017 to 2021 comparing patients who underwent Nuss procedure with cryoanalgesia in the first quarter versus the fourth quarter of their experience.
Open
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Cecilia Gigena summarizes what Dr. Alex Halpern said: The Phoenix study included 350 patients who underwent Nuss procedure with cryoanalgesia.
Open
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Cecilia Gigena summarizes what Dr. Alex Halpern said: Patients in the last quarter of the Phoenix cryoablation experience were discharged 1.3 days earlier than patients in the first quarter.
Open
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Cecilia Gigena summarizes what Dr. Alex Halpern said: Patients in the last quarter of the Phoenix cryoablation experience required 74% less opioids than those in the first quarter.
Open
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Cecilia Gigena summarizes what Dr. Alex Halpern said: So it seems that experience really plays a role talking about cryoatissia.
Open
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Cecilia Gigena summarizes what Dr. Alex Halpern said: Experience plays a role in outcomes when using cryoanalgesia for Nuss procedures.
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Quick Literature Updates Ep 22
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Cecilia Gigena summarizing a resource: The Pefer et al. study is a retrospective study done in Texas using a state hospital database examining CDH outcomes by center volume.
Open
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Cecilia Gigena summarizing a resource: The Pefer study identified 1,314 CDH patients: 728 from high volume centers, 9 from mid-volume centers, and 79 from low volume centers.
Open
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Cecilia Gigena summarizing a resource: High volume centers had significantly shorter length of stay for CDH patients.
Open
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Cecilia Gigena summarizing a resource: High volume centers had significantly lower mortality rates for CDH, even though they have significantly sicker patients.
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Cecilia Gigena summarizing a resource: High volume centers had better outcomes for patients with CDH.
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Quick Literature Updates Ep 27
Host summary
Cecilia Gigena summarizes what Dr. Alex Halpern said: Huncheid et al. conducted a multi-center non-inferiority trial that compared preterm infants treated with expectant management versus early ibuprofen for patent ductus arteriosus.
Open
Host summary
Cecilia Gigena summarizes what Dr. Alex Halpern said: The trial included 273 infants: 136 treated with expectant management and 137 with early ibuprofen.
Open
Host summary
Cecilia Gigena summarizes what Dr. Alex Halpern said: In the expectant management group for PDA, there was 17.6% necrotizing enterocolitis, 33% bronchopulmonary dysplasia, and 14% death rates.
Open
Host summary
Cecilia Gigena summarizes what Dr. Alex Halpern said: In the ibuprofen group for PDA, there was 15.4% necrotizing enterocolitis, 50% bronchopulmonary dysplasia, and 80% death rates.
Open
Host summary
Cecilia Gigena summarizes what Dr. Alex Halpern said: So it seems that expectant management is not inferiority that early ibuprofen in preterm patients with PDA.
Open
Host summary
Cecilia Gigena summarizes what Dr. Alex Halpern said: Expectant management is not inferior to early ibuprofen in preterm patients with patent ductus arteriosus.
Open
Summaries Cecilia gave as host · Fetal Surgery 4 summaries
Open the Fetal Surgery collection →
Quick Literature Updates Ep 19
Host summary
Cecilia Gigena summarizes what Dr. Carlos Colunga said: The IPSO systematic review and meta-analysis gathered 8 retrospective studies with 490 patients comparing image-guided core needle biopsy to surgical biopsy for neuroblastoma.
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Cecilia Gigena summarizes what Dr. Carlos Colunga said: Tissue adequacy and biological characterization of the biopsy was not significantly different between image-guided core needle biopsy and surgical biopsy groups for neuroblastoma.
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Cecilia Gigena summarizes what Dr. Carlos Colunga said: Intraoperative transfusions and complications were higher in the surgical biopsy group compared to image-guided core needle biopsy for neuroblastoma.
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Cecilia Gigena summarizes what Dr. Carlos Colunga said: Image-guided core needle biopsy is safe and effective for diagnosing neuroblastoma.
Open
Summaries Cecilia gave as host · Gallstone Pancreatitis 10 summaries
Open the Gallstone Pancreatitis collection →
Case-Based Journal Review: Cholelithiasis 2024
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Cecilia Gigena summarizes what Dr. Jose Campos said: In 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
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Host summary
Cecilia Gigena summarizes what Dr. Jose Campos said: In 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
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Cecilia Gigena summarizes what Dr. Jose Campos said: When cholecystectomy was delayed more than 6 weeks after gallstone pancreatitis, recurrence rate increased to 60%
Open
Host summary
Cecilia Gigena summarizes what Dr. Jose Campos said: When cholecystectomy was delayed more than 6 weeks after gallstone pancreatitis, recurrence rate increased to 60%
Open
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Cecilia Gigena summarizes what Dr. Jose Campos said: Patients who underwent early cholecystectomy did not have more biliary complications than delayed surgery patients
Open
Host summary
Cecilia Gigena summarizes what Dr. Jose Campos said: Patients who underwent early cholecystectomy did not have more biliary complications than delayed surgery patients
Open
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Cecilia Gigena summarizes what Dr. Jose Campos said: In 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
Open
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Cecilia Gigena summarizes what Dr. Jose Campos said: In 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
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Cecilia Gigena summarizes what Dr. Jose Campos said: Patients 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
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Host summary
Cecilia Gigena summarizes what Dr. Jose Campos said: Patients 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
Open
Summaries Cecilia gave as host · Gastroesophageal Reflux Disease 9 summaries
Open the Gastroesophageal Reflux Disease collection →
Case-Based Journal Review: G-Tube & Fundoplication for GERD 2023
Host summary
Cecilia Gigena summarizing the discussion: According to 2018 NASPGHAN/ESPGHAN guidelines, no complementary study (barium imaging, ultrasonography, endoscopy, biomarkers, manometry, scintigraphy) is sufficient to diagnose gastroesophageal reflux disease requiring fundoplication
Open
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Cecilia Gigena summarizing the discussion: Even with best settings and resources, there is no good laboratory test or radiological test to determine need for fundoplication in GERD
Open
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Cecilia Gigena summarizing the discussion: According to 2013 JAMA Pediatrics study of over 4000 infants from 42 US children's hospitals, infants with neurological impairment who underwent fundoplication at time of gastrostomy placement did not have reduced rate of reflux-related hospitalization during first year compared to gastrostomy alone
Open
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Cecilia Gigena summarizing the discussion: The 2013 JAMA Pediatrics fundoplication study used propensity score matching to create two comparable groups of 1,027 infants each (gastrostomy alone vs gastrostomy with fundoplication)
Open
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Cecilia Gigena summarizing the discussion: According to June 2022 Pediatrics systematic review of 58 publications comparing gastrostomy techniques, complication rates significantly favored laparoscopic approach (1.2%) over PEG (5.4%)
Open
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Cecilia Gigena summarizing the discussion: The 2022 Pediatrics systematic review comparing PEG versus laparoscopy included 12 studies with more than 2000 patients
Open
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Cecilia Gigena summarizing the discussion: The 1.2% vs 5.4% complication rate comparison in the 2022 systematic review included only major complications requiring reoperation (colonic perforation, colocutaneous fistula), not minor complications like leaks, dislodgements, or granulomas
Open
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Cecilia Gigena summarizing the discussion: According to randomized prospective study from Mott Children's Hospital comparing bolus versus continuous feeding post-gastrostomy, patients receiving bolus feeding had more leakage and more feeding modifications but achieved total feeds in the same timeframe
Open
Host summary
Cecilia Gigena summarizing the discussion: There is no significant difference in patient outcomes between bolus and continuous feeding regimens after gastrostomy placement
Open
Summaries Cecilia gave as host · Gastroschisis 24 summaries
Open the Gastroschisis collection →
Quick Literature Updates Episode 6
Host summary
Cecilia Gigena summarizing a resource: TEG may help identify hemorrhagic trauma patients who will benefit from cryoprecipitate or platelet transfusions.
Open
Host summary
Cecilia Gigena summarizing a resource: Patients receiving massive transfusions had lower maximum amplitude values on TEG analysis.
Open
Host summary
Cecilia Gigena summarizing a resource: Patients receiving massive transfusions had lower platelet counts.
Open
Host summary
Cecilia Gigena summarizing a resource: Philips et al. conducted a retrospective study from 2015 to 2018 evaluating 117 patients from two trauma centers.
Open
Host summary
Cecilia Gigena summarizing a resource: Patients receiving massive transfusions had shortened alpha angles on TEG analysis.
Open
Quick Literature Updates Episode 11
Host summary
Cecilia Gigena summarizing a resource: The overall rate for periumbilical hernias after gastroschisis closure was 22.7%.
Open
Host summary
Cecilia Gigena summarizing a resource: Sutureless gastroschisis closures lead to more periumbilical hernias, but they can be managed as any other congenital umbilical hernia and have no additional risk.
Open
Host summary
Cecilia Gigena summarizing a resource: Only 31.8% of patients with periumbilical hernias after gastroschisis needed surgery.
Open
Host summary
Cecilia Gigena summarizing a resource: Spontaneous closure of periumbilical hernias after gastroschisis was seen in 38.8% of cases.
Open
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Cecilia Gigena summarizing a resource: Only 16.4% of patients who underwent sutured gastroschisis closure had a persistent hernia.
Open
Host summary
Cecilia Gigena summarizing a resource: Periumbilical hernia rate was significantly higher in patients who underwent primary closure versus those who needed silo placement.
Open
Host summary
Cecilia Gigena summarizing a resource: Frazier et al. conducted a retrospective study from the Midwest Pediatric Surgery Consortium following 375 patients with gastroschisis who underwent closure between 2013 and 2016.
Open
Host summary
Cecilia Gigena summarizing a resource: Patients who underwent sutureless gastroschisis closures had 50% rates of persistent hernia.
Open
Quick Literature Updates Episode 16
Host summary
Cecilia Gigena summarizes what Dr. Alex Halpern said: The Phoenix study by Lie et al. was a retrospective single institution study from 2017 to 2021 comparing patients who underwent Nuss procedure with cryoanalgesia in the first quarter versus the fourth quarter of their experience.
Open
Host summary
Cecilia Gigena summarizes what Dr. Alex Halpern said: The Phoenix study included 350 patients who underwent Nuss procedure with cryoanalgesia.
Open
Host summary
Cecilia Gigena summarizes what Dr. Alex Halpern said: Patients in the last quarter of the Phoenix cryoablation experience were discharged 1.3 days earlier than patients in the first quarter.
Open
Host summary
Cecilia Gigena summarizes what Dr. Alex Halpern said: Patients in the last quarter of the Phoenix cryoablation experience required 74% less opioids than those in the first quarter.
Open
Host summary
Cecilia Gigena summarizes what Dr. Alex Halpern said: So it seems that experience really plays a role talking about cryoatissia.
Open
Host summary
Cecilia Gigena summarizes what Dr. Alex Halpern said: Experience plays a role in outcomes when using cryoanalgesia for Nuss procedures.
Open
Quick Literature Updates Ep 22
Host summary
Cecilia Gigena summarizing a resource: The Pefer et al. study is a retrospective study done in Texas using a state hospital database examining CDH outcomes by center volume.
Open
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Cecilia Gigena summarizing a resource: The Pefer study identified 1,314 CDH patients: 728 from high volume centers, 9 from mid-volume centers, and 79 from low volume centers.
Open
Host summary
Cecilia Gigena summarizing a resource: High volume centers had significantly shorter length of stay for CDH patients.
Open
Host summary
Cecilia Gigena summarizing a resource: High volume centers had significantly lower mortality rates for CDH, even though they have significantly sicker patients.
Open
Host summary
Cecilia Gigena summarizing a resource: High volume centers had better outcomes for patients with CDH.
Open
Summaries Cecilia gave as host · Giant Omphalocele 6 summaries
Open the Giant Omphalocele collection →
Quick Literature Updates Episode 20
Host summary
Cecilia Gigena summarizes what Dr. Alex Halpern said: Esposito 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).
Open
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Cecilia Gigena summarizes what Dr. Alex Halpern said: Laparoscopic cholecystectomy with ICG had shorter surgery time compared to without ICG.
Open
Host summary
Cecilia Gigena summarizes what Dr. Alex Halpern said: Laparoscopic cholecystectomy with ICG had no complications compared to 12% complication rate without ICG.
Open
Host summary
Cecilia Gigena summarizes what Dr. Alex Halpern said: Laparoscopic cholecystectomy with ICG provided better visualization of the biliary tree compared to without ICG.
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Cecilia Gigena summarizes what Dr. Alex Halpern said: Laparoscopic cholecystectomy with ICG can be the new standard in pediatric surgery practice.
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Host summary
Cecilia Gigena summarizes what Dr. Alex Halpern said: So it seems that laparoscopic cholecystectomy with ICG can be the new standard in our practice.
Open
Summaries Cecilia gave as host · Hepatoblastoma 8 summaries
Open the Hepatoblastoma collection →
Aggressive Pursuit of No Evidence of Disease Status in Hepatoblastoma Improves Survival
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Cecilia Gigena summarizing a resource: Do you pursue no evidence of disease status in hepatoblastoma?
Open
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Cecilia Gigena summarizing a resource: The study was a retrospective observational study conducted at Cincinnati Children's Hospital from 2005 to 2021
Open
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Cecilia Gigena summarizing a resource: The study aim was to examine the effect of aggressive pursuit of no evidence of disease status on overall survival and event free status
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Cecilia Gigena summarizing a resource: The study included 50 patients with hepatoblastoma
Open
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Cecilia Gigena summarizing a resource: 41 patients were rendered to no evidence of disease status
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Cecilia Gigena summarizing a resource: Overall survival and event free status were significantly improved in both high risk and non-high risk patients who achieved no evidence of disease status
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Cecilia Gigena summarizing a resource: it seems that pursuing no evidence of disease status is better for overall survival in hepatoblastoma patients
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Cecilia Gigena summarizing a resource: Pursuing no evidence of disease status is better for overall survival in hepatoblastoma patients
Open
Summaries Cecilia gave as host · Hirschsprung disease 53 summaries
Open the Hirschsprung disease collection →
Journal of Pediatric Surgery Article Review: February 2023, BAPS issue
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Cecilia Gigena summarizing the discussion: The Tanzania soap bathing study included 252 patients, with 114 receiving a preoperative bath with plain soap
Open
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Cecilia Gigena summarizing the discussion: In the soap bathing group, 11.4% developed surgical site infections compared to 40.6% in the control group
Open
Host summary
Cecilia Gigena summarizing the discussion: Preoperative soap bathing reduced the odds of surgical site infections by 80%
Open
Quick Literature Updates Episode 7
Host summary
Cecilia Gigena summarizing a resource: Thyroidectomies performed by high volume surgeons show shorter length of stays.
Open
Host summary
Cecilia Gigena summarizing a resource: Olsen et al. systematic review analyzed 10 studies with 6,430 patients examining surgeon volume and pediatric thyroid surgery outcomes.
Open
Host summary
Cecilia Gigena summarizing a resource: The 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.
Open
Journal of Pediatric Surgery Article Review: May 2023, CAPS Issue
Host summary
Cecilia Gigena summarizing the discussion: The Hirschsprung-associated IBD study was a retrospective study from 2000 to 2021 at 17 institutions with 55 patients.
Open
Host summary
Cecilia Gigena summarizing the discussion: 50% of Hirschsprung-associated IBD patients had long segment disease.
Open
Host summary
Cecilia Gigena summarizing the discussion: Enterocolitis was reported in 68% of Hirschsprung patients after pull-through.
Open
Host summary
Cecilia Gigena summarizing the discussion: The most common presentation for Hirschsprung-associated IBD was colonic or small bowel inflammation resembling IBD.
Open
Host summary
Cecilia Gigena summarizing the discussion: The button battery study evaluated whether implementation of a clinical algorithm shortened time from diagnosis to removal of esophageal button battery.
Open
Host summary
Cecilia Gigena summarizing the discussion: The algorithm was based on the national database algorithm and implemented in October 2019.
Open
Host summary
Cecilia Gigena summarizing the discussion: After implementing the critical airway response team algorithm, time from chest X-ray to button battery removal was reduced from 73 minutes to 35 minutes.
Open
Quick Literature Updates Episode 15
Host summary
Cecilia Gigena summarizing a resource: The Hirschsprung-associated IBD study was a retrospective study gathering patients from 2000 to 2021 at 17 institutions.
Open
Host summary
Cecilia Gigena summarizing a resource: The study gathered 55 Hirschsprung patients, and 50% had long segment disease.
Open
Host summary
Cecilia Gigena summarizing a resource: 10% of the Hirschsprung patients had trisomy 21.
Open
Host summary
Cecilia Gigena summarizing a resource: it 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.
Open
Host summary
Cecilia Gigena summarizing a resource: 68% of the Hirschsprung patients had Hirschsprung-associated enterocolitis.
Open
Host summary
Cecilia Gigena summarizing a resource: Long segment disease, Hirschsprung-associated enterocolitis, and trisomy 21 can be potential risk factors for IBD-like symptoms in Hirschsprung patients after pull through.
Open
Host summary
Cecilia Gigena summarizing a resource: The 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.
Open
Host summary
Cecilia Gigena summarizing a resource: The study gathered 262 patients with isolated solid organ injuries, grades 1 to 3.
Open
Host summary
Cecilia Gigena summarizing a resource: 148 patients had solid organ injuries grades 1 or 2, and none of them required an acute intervention.
Open
Host summary
Cecilia Gigena summarizing a resource: Of 114 patients with grade 3 solid organ injuries, only 3 patients required an acute intervention.
Open
Host summary
Cecilia Gigena summarizing a resource: So it seems that isolated solid organ injuries after a blunt abdominal trauma, grades 1 or 2 can be discharged from the ED.
Open
Host summary
Cecilia Gigena summarizing a resource: Isolated solid organ injuries after blunt abdominal trauma, grades 1 or 2, can be discharged from the ED.
Open
Transitional Care in Anorectal Malformation and Hirschsprung's Disease
Host summary
Cecilia Gigena summarizing a resource: Do you have a transitional care coordinator for colorectal patients in your hospital?
Open
Host summary
Cecilia Gigena summarizing a resource: A systematic review was conducted in the UK to establish and categorize challenges and solutions related to transitional care in colorectal patients
Open
Host summary
Cecilia Gigena summarizing a resource: The first challenge identified was patients' lack of understanding of their own pathology
Open
Host summary
Cecilia Gigena summarizing a resource: The second challenge was the lack of education and awareness of adult surgeons about pediatric colorectal pathologies
Open
Host summary
Cecilia Gigena summarizing a resource: The third challenge was the lack of an instructional transitional care program
Open
Host summary
Cecilia Gigena summarizing a resource: The third proposed solution was to create a structured and coordinated transition program
Open
Host summary
Cecilia Gigena summarizing a resource: The first proposed solution was to foster young adult patients' autonomy
Open
Host summary
Cecilia Gigena summarizing a resource: The second proposed solution was to conduct joint pediatric adult transitional clinics
Open
Quick Literature Updates Episode 17
Host summary
Cecilia Gigena summarizes what Dr. Alex Halpern said: The Zeng et al. study was a retrospective multi-center study done in China comparing robotic repair versus thoracoscopic repair for esophageal atresia.
Open
Host summary
Cecilia Gigena summarizes what Dr. Alex Halpern said: Robotic surgery for esophageal atresia had longer operative time but shorter anastomotic time compared to thoracoscopic repair.
Open
Host summary
Cecilia Gigena summarizes what Dr. Alex Halpern said: After propensity score matching, the study included 126 patients with 63 in each group (robotic vs thoracoscopic).
Open
Host summary
Cecilia Gigena summarizes what Dr. Alex Halpern said: The robotic group had lower anastomotic strictures and lower readmissions within 2 years post-op compared to thoracoscopic repair.
Open
Host summary
Cecilia Gigena summarizes what Dr. Alex Halpern said: Robotic surgery is a good answer for esophageal atresia repair.
Open
Host summary
Cecilia Gigena summarizes what Dr. Alex Halpern said: So it seems that robotic surgery is a good answer for esophageal tissue repair.
Open
Quick Literature Updates Ep 22
Host summary
Cecilia Gigena summarizing a resource: The Pefer et al. study is a retrospective study done in Texas using a state hospital database examining CDH outcomes by center volume.
Open
Host summary
Cecilia Gigena summarizing a resource: The Pefer study identified 1,314 CDH patients: 728 from high volume centers, 9 from mid-volume centers, and 79 from low volume centers.
Open
Host summary
Cecilia Gigena summarizing a resource: High volume centers had significantly shorter length of stay for CDH patients.
Open
Host summary
Cecilia Gigena summarizing a resource: High volume centers had significantly lower mortality rates for CDH, even though they have significantly sicker patients.
Open
Host summary
Cecilia Gigena summarizing a resource: High volume centers had better outcomes for patients with CDH.
Open
Quick Literature Updates Ep 23
Host summary
Cecilia Gigena summarizes what Dr. Alex Halpern said: A 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.
Open
Host summary
Cecilia Gigena summarizes what Dr. Alex Halpern said: The systematic review included 234 studies and established 3 challenges and solutions.
Open
Host summary
Cecilia Gigena summarizes what Dr. Alex Halpern said: The first challenge in transitional care for colorectal patients is the patients' lack of understanding of their own pathology.
Open
Host summary
Cecilia Gigena summarizes what Dr. Alex Halpern said: The second challenge is the lack of education and awareness of adult surgeons about pediatric colorectal pathologies.
Open
Host summary
Cecilia Gigena summarizes what Dr. Alex Halpern said: The third challenge is the lack of a structured transitional care program.
Open
Host summary
Cecilia Gigena summarizes what Dr. Alex Halpern said: The third proposed solution is to create a structured and coordinated transition program.
Open
Host summary
Cecilia Gigena summarizes what Dr. Alex Halpern said: The first proposed solution is to foster young adult patients' autonomy.
Open
Host summary
Cecilia Gigena summarizes what Dr. Alex Halpern said: The second proposed solution is to conduct joint pediatric-adult transitional clinics.
Open
Summaries Cecilia gave as host · Inflammatory Bowel Disease 19 summaries
Open the Inflammatory Bowel Disease collection →
Journal of Pediatric Surgery Article Review: May 2023, CAPS Issue
Host summary
Cecilia Gigena summarizing the discussion: The Hirschsprung-associated IBD study was a retrospective study from 2000 to 2021 at 17 institutions with 55 patients.
Open
Host summary
Cecilia Gigena summarizing the discussion: 50% of Hirschsprung-associated IBD patients had long segment disease.
Open
Host summary
Cecilia Gigena summarizing the discussion: Enterocolitis was reported in 68% of Hirschsprung patients after pull-through.
Open
Host summary
Cecilia Gigena summarizing the discussion: The most common presentation for Hirschsprung-associated IBD was colonic or small bowel inflammation resembling IBD.
Open
Host summary
Cecilia Gigena summarizing the discussion: The button battery study evaluated whether implementation of a clinical algorithm shortened time from diagnosis to removal of esophageal button battery.
Open
Host summary
Cecilia Gigena summarizing the discussion: The algorithm was based on the national database algorithm and implemented in October 2019.
Open
Host summary
Cecilia Gigena summarizing the discussion: After implementing the critical airway response team algorithm, time from chest X-ray to button battery removal was reduced from 73 minutes to 35 minutes.
Open
Quick Literature Updates Episode 15
Host summary
Cecilia Gigena summarizing a resource: The Hirschsprung-associated IBD study was a retrospective study gathering patients from 2000 to 2021 at 17 institutions.
Open
Host summary
Cecilia Gigena summarizing a resource: The study gathered 55 Hirschsprung patients, and 50% had long segment disease.
Open
Host summary
Cecilia Gigena summarizing a resource: 10% of the Hirschsprung patients had trisomy 21.
Open
Host summary
Cecilia Gigena summarizing a resource: Long segment disease, Hirschsprung-associated enterocolitis, and trisomy 21 can be potential risk factors for IBD-like symptoms in Hirschsprung patients after pull through.
Open
Host summary
Cecilia Gigena summarizing a resource: it 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.
Open
Host summary
Cecilia Gigena summarizing a resource: 68% of the Hirschsprung patients had Hirschsprung-associated enterocolitis.
Open
Host summary
Cecilia Gigena summarizing a resource: The 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.
Open
Host summary
Cecilia Gigena summarizing a resource: The study gathered 262 patients with isolated solid organ injuries, grades 1 to 3.
Open
Host summary
Cecilia Gigena summarizing a resource: 148 patients had solid organ injuries grades 1 or 2, and none of them required an acute intervention.
Open
Host summary
Cecilia Gigena summarizing a resource: Of 114 patients with grade 3 solid organ injuries, only 3 patients required an acute intervention.
Open
Host summary
Cecilia Gigena summarizing a resource: So it seems that isolated solid organ injuries after a blunt abdominal trauma, grades 1 or 2 can be discharged from the ED.
Open
Host summary
Cecilia Gigena summarizing a resource: Isolated solid organ injuries after blunt abdominal trauma, grades 1 or 2, can be discharged from the ED.
Open
Summaries Cecilia gave as host · Inguinal Hernia 6 summaries
Open the Inguinal Hernia collection →
Delayed versus early repair of inguinal hernia in preterm infants
Host summary
Cecilia Gigena summarizing a resource: When do you repair inguinal hernias in preterm babies?
Open
Host summary
Cecilia Gigena summarizing a resource: A systematic review and meta-analysis examined the optimal timing for operating inguinal hernias in preterm babies.
Open
Host summary
Cecilia Gigena summarizing a resource: Preterm patients operated before discharge in the first hospitalization had higher risk of respiratory complications in the post-op.
Open
Host summary
Cecilia Gigena summarizing a resource: Preterm patients operated before discharge in the first hospitalization had lower odds of incarceration.
Open
Host summary
Cecilia Gigena summarizing a resource: 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.
Open
Summaries Cecilia gave as host · Intestinal Failure 6 summaries
Open the Intestinal Failure collection →
Intestinal Rehabilitation, Episode 6: Cholestasis
Host summary
Cecilia Gigena summarizing the discussion: Advanced liver disease is defined as conjugated bilirubin above 5 or 6 mg/dL.
Open
Host summary
Cecilia Gigena summarizing the discussion: Historically, 25-50% of intestinal failure patients died because of associated liver disease; now it is less than 2%.
Open
Host summary
Cecilia Gigena summarizing the discussion: Risk factors for intestinal failure-associated liver disease include prematurity, lack of enteral feeding, sepsis, and TPN components.
Open
Host summary
Cecilia Gigena summarizing the discussion: Prophylactic cholecystectomy is not recommended because the gallbladder helps with enterohepatic circulation and many patients will not need it.
Open
Intestinal Rehabilitation, Episode 7: Refeeding in a neonatal patient
Host summary
Cecilia Gigena summarizing the discussion: Breast milk has lower protein levels than desired and likely requires supplementation.
Open
Intestinal Rehabilitation Episode 8: Refeeding of an Older Patient
Host summary
Cecilia Gigena summarizing the discussion: In older children, normal feeding behavior is important in many social aspects of life, not just nutrition.
Open
Summaries Cecilia gave as host · Intestinal Rehab 69 summaries
Open the Intestinal Rehab collection →
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
Host summary
Cecilia Gigena summarizing a resource: Do you always do a contrast enema prior to stoma reversal?
Open
Host summary
Cecilia Gigena summarizing a resource: A retrospective study was conducted in the Netherlands between 1998 and 2018 examining contrast enema use prior to stoma reversal.
Open
Host summary
Cecilia Gigena summarizing a resource: The study included patients under three years old who underwent stoma reversal.
Open
Host summary
Cecilia Gigena summarizing a resource: 95% of patients with strictures had necrotizing enterocolitis.
Open
Host summary
Cecilia Gigena summarizing a resource: Only 68% of all patients had a contrast enema prior to stoma reversal.
Open
Host summary
Cecilia Gigena summarizing a resource: Contrast enema was able to detect 92% of strictures.
Open
Host summary
Cecilia Gigena summarizing a resource: So it seems that contrast enema prior to stoma reversal is only useful if patients had NEC.
Open
Host summary
Cecilia Gigena summarizing a resource: Contrast enema prior to stoma reversal is only useful if patients had necrotizing enterocolitis.
Open
Quick Literature Updates Episode 6
Host summary
Cecilia Gigena summarizing a resource: Patients receiving massive transfusions had shortened alpha angles on TEG analysis.
Open
Host summary
Cecilia Gigena summarizing a resource: Patients receiving massive transfusions had lower maximum amplitude values on TEG analysis.
Open
Host summary
Cecilia Gigena summarizing a resource: Philips et al. conducted a retrospective study from 2015 to 2018 evaluating 117 patients from two trauma centers.
Open
Host summary
Cecilia Gigena summarizing a resource: TEG may help identify hemorrhagic trauma patients who will benefit from cryoprecipitate or platelet transfusions.
Open
Host summary
Cecilia Gigena summarizing a resource: Patients receiving massive transfusions had lower platelet counts.
Open
Quick Literature Updates Episode 7
Host summary
Cecilia Gigena summarizing a resource: Thyroidectomies performed by high volume surgeons show shorter length of stays.
Open
Host summary
Cecilia Gigena summarizing a resource: Olsen et al. systematic review analyzed 10 studies with 6,430 patients examining surgeon volume and pediatric thyroid surgery outcomes.
Open
Host summary
Cecilia Gigena summarizing a resource: The 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.
Open
Intestinal Rehabilitation, Episode 6: Cholestasis
Host summary
Cecilia Gigena summarizing the discussion: Advanced liver disease is defined as conjugated bilirubin above 5 or 6 mg/dL.
Open
Host summary
Cecilia Gigena summarizing the discussion: Historically, 25-50% of intestinal failure patients died because of associated liver disease; now it is less than 2%.
Open
Host summary
Cecilia Gigena summarizing the discussion: Risk factors for intestinal failure-associated liver disease include prematurity, lack of enteral feeding, sepsis, and TPN components.
Open
Host summary
Cecilia Gigena summarizing the discussion: Prophylactic cholecystectomy is not recommended because the gallbladder helps with enterohepatic circulation and many patients will not need it.
Open
Quick Literature Updates Episode 11
Host summary
Cecilia Gigena summarizing a resource: Only 16.4% of patients who underwent sutured gastroschisis closure had a persistent hernia.
Open
Host summary
Cecilia Gigena summarizing a resource: Frazier et al. conducted a retrospective study from the Midwest Pediatric Surgery Consortium following 375 patients with gastroschisis who underwent closure between 2013 and 2016.
Open
Host summary
Cecilia Gigena summarizing a resource: Periumbilical hernia rate was significantly higher in patients who underwent primary closure versus those who needed silo placement.
Open
Host summary
Cecilia Gigena summarizing a resource: Patients who underwent sutureless gastroschisis closures had 50% rates of persistent hernia.
Open
Host summary
Cecilia Gigena summarizing a resource: The overall rate for periumbilical hernias after gastroschisis closure was 22.7%.
Open
Host summary
Cecilia Gigena summarizing a resource: Sutureless gastroschisis closures lead to more periumbilical hernias, but they can be managed as any other congenital umbilical hernia and have no additional risk.
Open
Host summary
Cecilia Gigena summarizing a resource: Only 31.8% of patients with periumbilical hernias after gastroschisis needed surgery.
Open
Host summary
Cecilia Gigena summarizing a resource: Spontaneous closure of periumbilical hernias after gastroschisis was seen in 38.8% of cases.
Open
Disruption of enterohepatic Circulation of Bile acids ameliorates small bowel resection associated hepatic injury
Host summary
Cecilia Gigena summarizing a resource: Did you know that the disruption of the enterohepatic circulation of bilasses is beneficial for the liver?
Open
Host summary
Cecilia Gigena summarizing a resource: Disruption of the enterohepatic circulation of bile acids is beneficial for the liver
Open
Host summary
Cecilia Gigena summarizing a resource: The study was conducted at Saint Louis Children's Hospital and aimed to elucidate the driving force behind hepatic injury following bowel resection
Open
Host summary
Cecilia Gigena summarizing a resource: The study used three groups of mice: sham, 50% with proximal or duodenal resection, and 50% with distal resection or resection of the ileocecal valve
Open
Host summary
Cecilia Gigena summarizing a resource: Tissue samples were taken at the second and tenth post-operative weeks
Open
Host summary
Cecilia Gigena summarizing a resource: Mice with distal resection showed less hepatic oxidative stress compared to proximal resection
Open
Host summary
Cecilia Gigena summarizing a resource: They 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.
Open
Host summary
Cecilia Gigena summarizing a resource: Ileal resection could lead to less hepatic injury
Open
Host summary
Cecilia Gigena summarizing a resource: Mice with distal resection showed a more hydrophilic bile acid profile compared to proximal resection
Open
Expectant Management or Early Ibuprofen for Patent Ductus Arteriosus
Host summary
Cecilia Gigena summarizing a resource: A multi-center non-inferiority trial compared preterm infants treated with expectant management versus early ibuprofen for PDA
Open
Host summary
Cecilia Gigena summarizing a resource: 136 infants were treated with expectant management and 137 with early ibuprofen
Open
Host summary
Cecilia Gigena summarizing a resource: In the expectant management group, 33% developed bronchopulmonary dysplasia
Open
Host summary
Cecilia Gigena summarizing a resource: In the expectant management group, the death rate was 14%
Open
Host summary
Cecilia Gigena summarizing a resource: In the expectant management group, 17.6% developed necrotizing enterocolitis
Open
Host summary
Cecilia Gigena summarizing a resource: In the ibuprofen group, 50% developed bronchopulmonary dysplasia
Open
Host summary
Cecilia Gigena summarizing a resource: In the ibuprofen group, 15.4% developed necrotizing enterocolitis
Open
Host summary
Cecilia Gigena summarizing a resource: In the ibuprofen group, the death rate was 80%
Open
Host summary
Cecilia Gigena summarizing a resource: So it seems that expectant management is not inferiority that early ibuprofen in preterm patients with PDA.
Open
Host summary
Cecilia Gigena summarizing a resource: Expectant management is non-inferior to early ibuprofen in preterm patients with PDA
Open
Intestinal Rehabilitation, Episode 7: Refeeding in a neonatal patient
Host summary
Cecilia Gigena summarizing the discussion: Breast milk has lower protein levels than desired and likely requires supplementation.
Open
Intestinal Rehabilitation Episode 8: Refeeding of an Older Patient
Host summary
Cecilia Gigena summarizing the discussion: In older children, normal feeding behavior is important in many social aspects of life, not just nutrition.
Open
Quick Literature Updates Episode 16
Host summary
Cecilia Gigena summarizes what Dr. Alex Halpern said: The Phoenix study by Lie et al. was a retrospective single institution study from 2017 to 2021 comparing patients who underwent Nuss procedure with cryoanalgesia in the first quarter versus the fourth quarter of their experience.
Open
Host summary
Cecilia Gigena summarizes what Dr. Alex Halpern said: The Phoenix study included 350 patients who underwent Nuss procedure with cryoanalgesia.
Open
Host summary
Cecilia Gigena summarizes what Dr. Alex Halpern said: Patients in the last quarter of the Phoenix cryoablation experience were discharged 1.3 days earlier than patients in the first quarter.
Open
Host summary
Cecilia Gigena summarizes what Dr. Alex Halpern said: Patients in the last quarter of the Phoenix cryoablation experience required 74% less opioids than those in the first quarter.
Open
Host summary
Cecilia Gigena summarizes what Dr. Alex Halpern said: So it seems that experience really plays a role talking about cryoatissia.
Open
Host summary
Cecilia Gigena summarizes what Dr. Alex Halpern said: Experience plays a role in outcomes when using cryoanalgesia for Nuss procedures.
Open
Quick Literature Updates Ep 22
Host summary
Cecilia Gigena summarizing a resource: The Pefer et al. study is a retrospective study done in Texas using a state hospital database examining CDH outcomes by center volume.
Open
Host summary
Cecilia Gigena summarizing a resource: The Pefer study identified 1,314 CDH patients: 728 from high volume centers, 9 from mid-volume centers, and 79 from low volume centers.
Open
Host summary
Cecilia Gigena summarizing a resource: High volume centers had significantly lower mortality rates for CDH, even though they have significantly sicker patients.
Open
Host summary
Cecilia Gigena summarizing a resource: High volume centers had significantly shorter length of stay for CDH patients.
Open
Host summary
Cecilia Gigena summarizing a resource: High volume centers had better outcomes for patients with CDH.
Open
Quick Literature Updates Ep 27
Host summary
Cecilia Gigena summarizes what Dr. Alex Halpern said: Huncheid et al. conducted a multi-center non-inferiority trial that compared preterm infants treated with expectant management versus early ibuprofen for patent ductus arteriosus.
Open
Host summary
Cecilia Gigena summarizes what Dr. Alex Halpern said: The trial included 273 infants: 136 treated with expectant management and 137 with early ibuprofen.
Open
Host summary
Cecilia Gigena summarizes what Dr. Alex Halpern said: In the expectant management group for PDA, there was 17.6% necrotizing enterocolitis, 33% bronchopulmonary dysplasia, and 14% death rates.
Open
Host summary
Cecilia Gigena summarizes what Dr. Alex Halpern said: In the ibuprofen group for PDA, there was 15.4% necrotizing enterocolitis, 50% bronchopulmonary dysplasia, and 80% death rates.
Open
Host summary
Cecilia Gigena summarizes what Dr. Alex Halpern said: Expectant management is not inferior to early ibuprofen in preterm patients with patent ductus arteriosus.
Open
Host summary
Cecilia Gigena summarizes what Dr. Alex Halpern said: So it seems that expectant management is not inferiority that early ibuprofen in preterm patients with PDA.
Open
Summaries Cecilia gave as host · Lectures, Courses and Honors 3 summaries
Open the Lectures, Courses and Honors collection →
Update Course Rewind: Pectus Excavatum 2021
Host summary
Cecilia Gigena summarizing the discussion: Cryoanalgesia uses cold temperatures to cause a conduction block, interrupting pain impulses to the brain.
Open
Host summary
Cecilia Gigena summarizing the discussion: The FDA requires clinical trials with long-term results for medications before approval, but not for medical devices and techniques.
Open
Host summary
Cecilia Gigena summarizing the discussion: I've always done right to left. Um, I never even thought about doing left to right, I must admit.
Open
Summaries Cecilia gave as host · Liver Tumors (Hepatoblastoma/HCC) 8 summaries
Open the Liver Tumors (Hepatoblastoma/HCC) collection →
Aggressive Pursuit of No Evidence of Disease Status in Hepatoblastoma Improves Survival
Host summary
Cecilia Gigena summarizing a resource: The study was a retrospective observational study conducted at Cincinnati Children's Hospital from 2005 to 2021
Open
Host summary
Cecilia Gigena summarizing a resource: Do you pursue no evidence of disease status in hepatoblastoma?
Open
Host summary
Cecilia Gigena summarizing a resource: The study aim was to examine the effect of aggressive pursuit of no evidence of disease status on overall survival and event free status
Open
Host summary
Cecilia Gigena summarizing a resource: The study included 50 patients with hepatoblastoma
Open
Host summary
Cecilia Gigena summarizing a resource: 41 patients were rendered to no evidence of disease status
Open
Host summary
Cecilia Gigena summarizing a resource: Overall survival and event free status were significantly improved in both high risk and non-high risk patients who achieved no evidence of disease status
Open
Host summary
Cecilia Gigena summarizing a resource: it seems that pursuing no evidence of disease status is better for overall survival in hepatoblastoma patients
Open
Host summary
Cecilia Gigena summarizing a resource: Pursuing no evidence of disease status is better for overall survival in hepatoblastoma patients
Open
Summaries Cecilia gave as host · Long-gap Esophageal Atresia 14 summaries
Open the Long-gap Esophageal Atresia collection →
Journal of Pediatric Surgery Article Review: February 2023, BAPS issue
Host summary
Cecilia Gigena summarizing the discussion: The Tanzania soap bathing study included 252 patients, with 114 receiving a preoperative bath with plain soap
Open
Host summary
Cecilia Gigena summarizing the discussion: In the soap bathing group, 11.4% developed surgical site infections compared to 40.6% in the control group
Open
Host summary
Cecilia Gigena summarizing the discussion: Preoperative soap bathing reduced the odds of surgical site infections by 80%
Open
Update Course Rewind: Management of Esophageal Leaks 2022
Host summary
Cecilia Gigena summarizing the discussion: Every small or moderate leak that is contained can be managed by observation with no need for new intervention.
Open
Host summary
Cecilia Gigena summarizing the discussion: New intervention for esophageal leaks is only considered when leaks create huge pneumothorax that are not well drained, or if the patient is unstable.
Open
Host summary
Cecilia Gigena summarizing the discussion: Botulinum toxin can be used to block the secretion of saliva in patients with esophageal leaks.
Open
Host summary
Cecilia Gigena summarizing the discussion: Glycopyrrolate is a medicine available in the US that blocks the secretion of saliva.
Open
Host summary
Cecilia Gigena summarizing the discussion: Retrograde endoscopy via gastrostomy tube is used when normal endoscopy cannot visualize the esophagus adequately due to stricture.
Open
Host summary
Cecilia Gigena summarizing the discussion: Endoscopic vacuum closure (endo-bag) is constructed from an NG tube with a hose covered by a surgical sponge, which is covered by a perforated transparent adhesive.
Open
Host summary
Cecilia Gigena summarizing the discussion: Endoscopic vacuum closure helps granulation tissue form by negative pressure, making the patient heal faster.
Open
Host summary
Cecilia Gigena summarizing the discussion: Most esophageal leaks can be treated by observation or chest drain.
Open
Host summary
Cecilia Gigena summarizing the discussion: If there is an external leak like in the neck or a fistula that is not healing well, an endovac can be a great solution.
Open
Host summary
Cecilia Gigena summarizing the discussion: For some patients with deteriorated status or great leaks, a re-anastomosis can be attempted.
Open
Host summary
Cecilia Gigena summarizing the discussion: After a leak, a stricture is more common, so patients have to be followed more thoroughly.
Open
Summaries Cecilia gave as host · Midgut Volvulus 1 summary
Open the Midgut Volvulus collection →
Intestinal Rehabilitation Episode 8: Refeeding of an Older Patient
Host summary
Cecilia Gigena summarizing the discussion: In older children, normal feeding behavior is important in many social aspects of life, not just nutrition.
Open
Summaries Cecilia gave as host · Necrotizing Enterocolitis 21 summaries
Open the Necrotizing Enterocolitis collection →
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
Host summary
Cecilia Gigena summarizing a resource: Do you always do a contrast enema prior to stoma reversal?
Open
Host summary
Cecilia Gigena summarizing a resource: A retrospective study was conducted in the Netherlands between 1998 and 2018 examining contrast enema use prior to stoma reversal.
Open
Host summary
Cecilia Gigena summarizing a resource: The study included patients under three years old who underwent stoma reversal.
Open
Host summary
Cecilia Gigena summarizing a resource: 95% of patients with strictures had necrotizing enterocolitis.
Open
Host summary
Cecilia Gigena summarizing a resource: Only 68% of all patients had a contrast enema prior to stoma reversal.
Open
Host summary
Cecilia Gigena summarizing a resource: Contrast enema was able to detect 92% of strictures.
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Cecilia Gigena summarizing a resource: Contrast enema prior to stoma reversal is only useful if patients had necrotizing enterocolitis.
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Cecilia Gigena summarizing a resource: So it seems that contrast enema prior to stoma reversal is only useful if patients had NEC.
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Expectant Management or Early Ibuprofen for Patent Ductus Arteriosus
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Cecilia Gigena summarizing a resource: A multi-center non-inferiority trial compared preterm infants treated with expectant management versus early ibuprofen for PDA
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Cecilia Gigena summarizing a resource: 136 infants were treated with expectant management and 137 with early ibuprofen
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Cecilia Gigena summarizing a resource: In the expectant management group, 17.6% developed necrotizing enterocolitis
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Cecilia Gigena summarizing a resource: In the expectant management group, 33% developed bronchopulmonary dysplasia
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Cecilia Gigena summarizing a resource: In the expectant management group, the death rate was 14%
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Cecilia Gigena summarizing a resource: In the ibuprofen group, the death rate was 80%
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Cecilia Gigena summarizing a resource: In the ibuprofen group, 50% developed bronchopulmonary dysplasia
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Cecilia Gigena summarizing a resource: In the ibuprofen group, 15.4% developed necrotizing enterocolitis
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Cecilia Gigena summarizing a resource: Expectant management is non-inferior to early ibuprofen in preterm patients with PDA
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Cecilia Gigena summarizing a resource: So it seems that expectant management is not inferiority that early ibuprofen in preterm patients with PDA.
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Summaries Cecilia gave as host · Neonatal & Pediatric Minimally Invasive Surgery 11 summaries
Open the Neonatal & Pediatric Minimally Invasive Surgery collection →
Update Course Rewind: Management of Esophageal Leaks 2022
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Cecilia Gigena summarizing the discussion: Every small or moderate leak that is contained can be managed by observation with no need for new intervention.
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Cecilia Gigena summarizing the discussion: New intervention for esophageal leaks is only considered when leaks create huge pneumothorax that are not well drained, or if the patient is unstable.
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Cecilia Gigena summarizing the discussion: Botulinum toxin can be used to block the secretion of saliva in patients with esophageal leaks.
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Cecilia Gigena summarizing the discussion: Glycopyrrolate is a medicine available in the US that blocks the secretion of saliva.
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Cecilia Gigena summarizing the discussion: Retrograde endoscopy via gastrostomy tube is used when normal endoscopy cannot visualize the esophagus adequately due to stricture.
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Cecilia Gigena summarizing the discussion: Endoscopic vacuum closure (endo-bag) is constructed from an NG tube with a hose covered by a surgical sponge, which is covered by a perforated transparent adhesive.
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Cecilia Gigena summarizing the discussion: Endoscopic vacuum closure helps granulation tissue form by negative pressure, making the patient heal faster.
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Cecilia Gigena summarizing the discussion: Most esophageal leaks can be treated by observation or chest drain.
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Cecilia Gigena summarizing the discussion: If there is an external leak like in the neck or a fistula that is not healing well, an endovac can be a great solution.
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Cecilia Gigena summarizing the discussion: For some patients with deteriorated status or great leaks, a re-anastomosis can be attempted.
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Cecilia Gigena summarizing the discussion: After a leak, a stricture is more common, so patients have to be followed more thoroughly.
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Summaries Cecilia gave as host · Neuroblastoma 13 summaries
Open the Neuroblastoma collection →
Image-guided core-needle or surgical biopsy for neuroblastoma diagnosis in children
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Cecilia Gigena summarizing a resource: The review analyzed the accuracy and safety of image-guided core needle biopsy for neuroblastoma
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Cecilia Gigena summarizing a resource: The systematic review and meta-analysis was conducted by IPSO
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Cecilia Gigena summarizing a resource: Biological characterization of the biopsy was not significantly different between image-guided core needle biopsy and surgical biopsy groups
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Cecilia Gigena summarizing a resource: The review included 8 retrospective studies with 490 patients
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Cecilia Gigena summarizing a resource: Complications were higher in the surgical biopsy group compared to image-guided core needle biopsy
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Cecilia Gigena summarizing a resource: Intraoperative transfusions were higher in the surgical biopsy group compared to image-guided core needle biopsy
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Cecilia Gigena summarizing a resource: Tissue adequacy was not significantly different between image-guided core needle biopsy and surgical biopsy groups
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Cecilia Gigena summarizing a resource: So it seems that image-guided core needle biopsy is safe and effective for diagnosed neuroblastoma.
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Cecilia Gigena summarizing a resource: Image-guided core needle biopsy is safe and effective for diagnosing neuroblastoma
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Quick Literature Updates Ep 19
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Cecilia Gigena summarizes what Dr. Carlos Colunga said: The IPSO systematic review and meta-analysis gathered 8 retrospective studies with 490 patients comparing image-guided core needle biopsy to surgical biopsy for neuroblastoma.
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Cecilia Gigena summarizes what Dr. Carlos Colunga said: Tissue adequacy and biological characterization of the biopsy was not significantly different between image-guided core needle biopsy and surgical biopsy groups for neuroblastoma.
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Cecilia Gigena summarizes what Dr. Carlos Colunga said: Intraoperative transfusions and complications were higher in the surgical biopsy group compared to image-guided core needle biopsy for neuroblastoma.
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Cecilia Gigena summarizes what Dr. Carlos Colunga said: Image-guided core needle biopsy is safe and effective for diagnosing neuroblastoma.
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Summaries Cecilia gave as host · Non-perforated Appendicitis 7 summaries
Open the Non-perforated Appendicitis collection →
Quick Literature Updates Ep 26
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Cecilia Gigena summarizes what Dr. Alex Halpern said: The Schlapbach et al. study is a worldwide study with a Delphi consensus process that aimed to update the definitions of sepsis and septic shock
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Cecilia Gigena summarizes what Dr. Alex Halpern said: The Phoenix sepsis score includes variables in cardiovascular function, respiratory function, coagulation, and neurological function
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Cecilia Gigena summarizes what Dr. Alex Halpern said: The Phoenix sepsis score helped correlate the definition of sepsis with an actual mortality rate
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Cecilia Gigena summarizes what Dr. Alex Halpern said: The definition of sepsis is suspected infection plus 2 points in the Phoenix sepsis score
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Cecilia Gigena summarizes what Dr. Alex Halpern said: Septic 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
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Cecilia Gigena summarizes what Dr. Alex Halpern said: Sepsis has a mortality rate of 7.1%
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Cecilia Gigena summarizes what Dr. Alex Halpern said: Septic shock has a mortality rate of 10.8 to 33.5% according to the research settings
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Summaries Cecilia gave as host · Pancreatitis 34 summaries
Open the Pancreatitis collection →
Update Course Rewind: Management of Acute Pancreatitis 2023
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Cecilia Gigena summarizing the discussion: Fluid resuscitation is key in pancreatitis management
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Cecilia Gigena summarizing the discussion: Patients should be reassessed at the 12 and 24 hour mark to avoid fluid overload
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Transcystic Laparoscopic Common Bile Duct Exploration for Pediatric Patients with Choledocholithiasis
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Cecilia Gigena summarizing a resource: This is a multi-center retrospective study done in the US from 2018 to 2022, and their aim was to compare patients with suspected.
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Cecilia Gigena summarizing a resource: The study aim was to compare patients with suspected choledocholithiasis who underwent transcystic laparoscopic common bile duct exploration versus those who underwent ERCP first
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Cecilia Gigena summarizing a resource: The study was a multi-center retrospective study conducted in the US from 2018 to 2022
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Cecilia Gigena summarizing a resource: 156 patients were in group one (transcystic laparoscopic common bile duct exploration)
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Cecilia Gigena summarizing a resource: Patients in group one (transcystic laparoscopic approach) had significantly less complication rates compared to group two
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Cecilia Gigena summarizing a resource: Patients in group one (transcystic laparoscopic approach) had lower length of stay compared to group two
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Cecilia Gigena summarizing a resource: Attempting a transcystic laparoscopic common bile duct exploration may benefit pediatric patients with choledocholithiasis
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Cecilia Gigena summarizing a resource: So it seems that attempting a transcystic laparoscopic common bile duct exploration may benefit our patients.
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Update Course Rewind: Management of Recurrent Pancreatitis
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Cecilia Gigena summarizes what Dr. Juan Gurria said: If 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.
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Cecilia Gigena summarizes what Dr. Juan Gurria said: If 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.
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Cecilia Gigena summarizes what Dr. Juan Gurria said: Genetics 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.
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Cecilia Gigena summarizes what Dr. Juan Gurria said: Genetics 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.
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Cecilia Gigena summarizes what Dr. Juan Gurria said: Endoscopic treatment should be attempted first, but if it fails, transfer to a specialized center that performs TPIAT (total pancreatectomy with islet autotransplantation).
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Cecilia Gigena summarizes what Dr. Juan Gurria said: Endoscopic treatment should be attempted first, but if it fails, transfer to a specialized center that performs TPIAT (total pancreatectomy with islet autotransplantation).
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Cecilia Gigena summarizes what Dr. Juan Gurria said: For pancreatic imaging, start with ultrasound, then CT, and for better visualization of pancreatic anatomy, use MRCP with T2 sequences.
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Cecilia Gigena summarizes what Dr. Juan Gurria said: For pancreatic imaging, start with ultrasound, then CT, and for better visualization of pancreatic anatomy, use MRCP with T2 sequences.
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Cecilia Gigena summarizes what Dr. Juan Gurria said: Recurrent pancreatitis is a rare pathology that can lead to chronic pancreatitis and is associated with genetic mutations.
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Cecilia Gigena summarizes what Dr. Juan Gurria said: Recurrent pancreatitis is a rare pathology that can lead to chronic pancreatitis and is associated with genetic mutations.
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Cecilia Gigena summarizes what Dr. Juan Gurria said: If 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.
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Cecilia Gigena summarizes what Dr. Juan Gurria said: If 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.
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Case-Based Journal Review: Cholelithiasis 2024
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Cecilia Gigena summarizes what Dr. Jose Campos said: In 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
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Cecilia Gigena summarizes what Dr. Jose Campos said: In 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
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Cecilia Gigena summarizes what Dr. Jose Campos said: When cholecystectomy was delayed more than 6 weeks after gallstone pancreatitis, recurrence rate increased to 60%
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Cecilia Gigena summarizes what Dr. Jose Campos said: When cholecystectomy was delayed more than 6 weeks after gallstone pancreatitis, recurrence rate increased to 60%
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Cecilia Gigena summarizes what Dr. Jose Campos said: Patients who underwent early cholecystectomy did not have more biliary complications than delayed surgery patients
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Cecilia Gigena summarizes what Dr. Jose Campos said: Patients who underwent early cholecystectomy did not have more biliary complications than delayed surgery patients
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Cecilia Gigena summarizes what Dr. Jose Campos said: In 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
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Cecilia Gigena summarizes what Dr. Jose Campos said: In 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
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Cecilia Gigena summarizes what Dr. Jose Campos said: Patients 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
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Cecilia Gigena summarizes what Dr. Jose Campos said: Patients 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
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Summaries Cecilia gave as host · Pectus Carinatum 13 summaries
Open the Pectus Carinatum collection →
Pectus Arcuatum a Pectus Unlike any Other
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Cecilia Gigena summarizing a resource: Have you ever treated a pectussarquatum like a pectus carinatum?
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Cecilia Gigena summarizing a resource: The study is a multi-center retrospective study conducted in France describing pectus arcuatum
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Cecilia Gigena summarizing a resource: The study included 34 patients with pectus arcuatum
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Cecilia Gigena summarizing a resource: 47% of patients needed chest x-ray or CT scan to confirm the diagnosis of pectus arcuatum
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Cecilia Gigena summarizing a resource: 35% of pectus arcuatum patients were associated with a malformation
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Cecilia Gigena summarizing a resource: Noonan syndrome is an associated malformation seen with pectus arcuatum
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Cecilia Gigena summarizing a resource: Scoliosis is an associated malformation seen with pectus arcuatum
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Cecilia Gigena summarizing a resource: The best treatment for pectus arcuatum was surgical correction that included a sternotomy
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Cecilia Gigena summarizing a resource: Pectus arcuatum should not be confused with pectus carinatum as they are different conditions
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Cecilia Gigena summarizing a resource: Do not confusefectus or quatum with thefectus carinatum.
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Journal of Pediatric Surgery Article Review: September 2023
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Cecilia Gigena summarizing the discussion: In 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.
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Cecilia Gigena summarizing the discussion: ERAS protocols significantly reduce intraoperative fluids needed and postoperative opiate use in pediatric colorectal surgery.
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Cecilia Gigena summarizing the discussion: Time to first oral intake and time for complete nutrition was less in patients managed with ERAS protocols.
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Summaries Cecilia gave as host · Pectus Excavatum 120 summaries
Open the Pectus Excavatum collection →
Update Course Rewind: Pectus Excavatum 2021
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Cecilia Gigena summarizing the discussion: Cryoanalgesia uses cold temperatures to cause a conduction block that interrupts pain impulses to the brain.
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Cecilia Gigena summarizing the discussion: Cryoanalgesia uses cold temperatures to cause a conduction block that interrupts pain impulses to the brain.
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Cecilia Gigena summarizing the discussion: For 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.
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Cecilia Gigena summarizing the discussion: For 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.
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Cecilia Gigena summarizing the discussion: Dr. Slater has always performed the Nuss procedure right to left and had not previously considered left to right.
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Cecilia Gigena summarizing the discussion: Dr. Slater has always performed the Nuss procedure right to left and had not previously considered left to right.
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Cecilia Gigena summarizing the discussion: I've always done right to left. Um, I never even thought about doing left to right, I must admit.
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Cecilia Gigena summarizing the discussion: I've always done right to left. Um, I never even thought about doing left to right, I must admit.
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Update Course Rewind: Pectus Excavatum 2021
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Cecilia Gigena summarizing the discussion: Cryoanalgesia uses cold temperatures to cause a conduction block, interrupting pain impulses to the brain.
Open
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Cecilia Gigena summarizing the discussion: Cryoanalgesia uses cold temperatures to cause a conduction block, interrupting pain impulses to the brain.
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Cecilia Gigena summarizing the discussion: The FDA requires clinical trials with long-term results for medications before approval, but not for medical devices and techniques.
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Cecilia Gigena summarizing the discussion: The FDA requires clinical trials with long-term results for medications before approval, but not for medical devices and techniques.
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Cecilia Gigena summarizing the discussion: I've always done right to left. Um, I never even thought about doing left to right, I must admit.
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Cecilia Gigena summarizing the discussion: I've always done right to left. Um, I never even thought about doing left to right, I must admit.
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Cryoablation in 350 Nuss procedures
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Cecilia Gigena summarizing a resource: The study was a retrospective single institution study conducted in Phoenix from 2017 to 2021
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Cecilia Gigena summarizing a resource: The study compared patients who underwent Nuss procedure with cryoanalgesia in the first quarter of institutional experience versus the fourth quarter
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Cecilia Gigena summarizing a resource: 350 patients underwent Nuss procedure with cryoanalgesia in the study period
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Cecilia Gigena summarizing a resource: Patients in the last quarter required 74% less opioids compared to the first quarter
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Cecilia Gigena summarizing a resource: Patients in the last quarter were discharged 1.3 days earlier than patients in the first quarter
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Cecilia Gigena summarizing a resource: So it seems that experience really plays a role talking about cryoathesia.
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Cecilia Gigena summarizing a resource: Experience plays a role in cryoanalgesia outcomes for Nuss procedures
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Initial Outcomes Using Cryoablation in Surgical Management of Slipping Rib Syndrome
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Cecilia Gigena summarizing a resource: Do you use cryo for resecting cartilage in the slipping ribs syndrome?
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Cecilia Gigena summarizing a resource: The study was a retrospective review conducted in Phoenix between 2018 and 2022
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Cecilia Gigena summarizing a resource: The study compared length of stay and opiate use in patients undergoing cartilaginous rib excision with and without cryo
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Cecilia Gigena summarizing a resource: 8 patients underwent a NAS procedure plus cartilaginous resection with cryoalgesia
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Cecilia Gigena summarizing a resource: 68 patients underwent resection without cryo
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Cecilia Gigena summarizing a resource: Patients who underwent resection with cryo stayed one day less than patients without cryo, though this difference was not statistically significant
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Cecilia Gigena summarizing a resource: Patients who underwent resection with cryo had significantly less opiate use
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Quick Literature Updates Episode 13
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Cecilia Gigena summarizes what Dr. Alex Halpern said: In a Boston Children's Hospital study of 143 button battery ingestion patients from 2008 to 2021, 24 had severe outcomes.
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Cecilia Gigena summarizes what Dr. Alex Halpern said: Location of the button battery in the esophagus is an independent predictor for severe outcomes in button battery ingestion.
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Cecilia Gigena summarizes what Dr. Alex Halpern said: A button battery larger than 2 centimeters is an independent predictor for severe outcomes in button battery ingestion.
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Cecilia Gigena summarizes what Dr. Alex Halpern said: Having symptoms at presentation is an independent predictor for severe outcomes in button battery ingestion.
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Impact of Cryoanalgesia Use During Minimally Invasive Pectus Excavatum Repair on Hospital Days and Total Hospital Costs Among Pediatric Patients
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Cecilia Gigena summarizing a resource: Do you use cryoalgesia for the NAS procedure in pectus excavatum repair?
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Cecilia Gigena summarizing a resource: The study aimed to evaluate hospital cost and length of stay for patients undergoing minimally invasive repair of pectus excavatum plus cryoanalgesia
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Cecilia Gigena summarizing a resource: The study was a retrospective review conducted in Texas
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Cecilia Gigena summarizing a resource: Patients who underwent cryoanalgesia had significantly lower complication rates compared to those without cryoanalgesia
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Cecilia Gigena summarizing a resource: The study included 44 patients total, with 29 undergoing cryoanalgesia
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Cecilia Gigena summarizing a resource: Patients who underwent cryoanalgesia had significantly less length of stay compared to those without cryoanalgesia
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Cecilia Gigena summarizing a resource: Patients who underwent cryoanalgesia had lower hospital costs than those without cryoanalgesia, though this difference was not statistically significant
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Cecilia Gigena summarizing a resource: Cryoanalgesia helps with pain management in pectus excavatum repair
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Cecilia Gigena summarizing a resource: Cryoanalgesia can help with hospital cost reduction in pectus excavatum repair
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Cecilia Gigena summarizing a resource: So it seems that cryo not only helps with pain management, but also can help with hospital cost.
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Pectus Arcuatum a Pectus Unlike any Other
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Cecilia Gigena summarizing a resource: Have you ever treated a pectussarquatum like a pectus carinatum?
Open
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Cecilia Gigena summarizing a resource: The study is a multi-center retrospective study conducted in France describing pectus arcuatum
Open
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Cecilia Gigena summarizing a resource: 47% of patients needed chest x-ray or CT scan to confirm the diagnosis of pectus arcuatum
Open
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Cecilia Gigena summarizing a resource: The study included 34 patients with pectus arcuatum
Open
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Cecilia Gigena summarizing a resource: The best treatment for pectus arcuatum was surgical correction that included a sternotomy
Open
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Cecilia Gigena summarizing a resource: 35% of pectus arcuatum patients were associated with a malformation
Open
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Cecilia Gigena summarizing a resource: Noonan syndrome is an associated malformation seen with pectus arcuatum
Open
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Cecilia Gigena summarizing a resource: Scoliosis is an associated malformation seen with pectus arcuatum
Open
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Cecilia Gigena summarizing a resource: Pectus arcuatum should not be confused with pectus carinatum as they are different conditions
Open
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Cecilia Gigena summarizing a resource: Do not confusefectus or quatum with thefectus carinatum.
Open
Journal of Pediatric Surgery Article Review: July 2023, PAPS Issue
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Cecilia Gigena summarizing the discussion: The cryoanalgesia study compared patients from 2011 to 2021, with 29 patients receiving cryoanalgesia and 15 not receiving it.
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Cecilia Gigena summarizing the discussion: The cryoanalgesia study compared patients from 2011 to 2021, with 29 patients receiving cryoanalgesia and 15 not receiving it.
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Cecilia Gigena summarizing the discussion: Patients who received cryoanalgesia had shorter hospital stays: 3.0 days versus 5.4 days for those without cryoanalgesia.
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Cecilia Gigena summarizing the discussion: Patients who received cryoanalgesia had shorter hospital stays: 3.0 days versus 5.4 days for those without cryoanalgesia.
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Cecilia Gigena summarizing the discussion: Hospital costs were slightly lower (less than $1000 difference) in patients who received cryoanalgesia despite the expensive equipment.
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Cecilia Gigena summarizing the discussion: Hospital costs were slightly lower (less than $1000 difference) in patients who received cryoanalgesia despite the expensive equipment.
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Cecilia Gigena summarizing the discussion: The 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.
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Cecilia Gigena summarizing the discussion: The 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.
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Cecilia Gigena summarizing the discussion: To reach 75% hair reduction requires a mean of 4.8 to 6.8 laser ablation sessions depending on skin and hair characteristics.
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Cecilia Gigena summarizing the discussion: To reach 75% hair reduction requires a mean of 4.8 to 6.8 laser ablation sessions depending on skin and hair characteristics.
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Cecilia Gigena summarizing the discussion: The overall recurrence rate for pilonidal disease after laser hair reduction was 6%.
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Cecilia Gigena summarizing the discussion: Dark hair and skin types 5-6 were associated with higher recurrence rates in pilonidal disease after laser hair reduction.
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Cecilia Gigena summarizing the discussion: The overall recurrence rate for pilonidal disease after laser hair reduction was 6%.
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Cecilia Gigena summarizing the discussion: Dark hair and skin types 5-6 were associated with higher recurrence rates in pilonidal disease after laser hair reduction.
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Journal of Pediatric Surgery Article Review: September 2023
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Cecilia Gigena summarizing the discussion: In 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.
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Cecilia Gigena summarizing the discussion: ERAS protocols significantly reduce intraoperative fluids needed and postoperative opiate use in pediatric colorectal surgery.
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Cecilia Gigena summarizing the discussion: Time to first oral intake and time for complete nutrition was less in patients managed with ERAS protocols.
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Journal of Pediatric Surgery Article Review: Q1 (Jan-Mar) 2024
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Cecilia Gigena summarizing the discussion: The appendicitis study had 185 patients in the home antibiotic group and 121 patients in the no home antibiotic group.
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Cecilia Gigena summarizing the discussion: The appendicitis study had 185 patients in the home antibiotic group and 121 patients in the no home antibiotic group.
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Cecilia Gigena summarizing the discussion: There was no significant difference in deep organ space infection requiring intervention between home antibiotic and no home antibiotic groups for complicated appendicitis.
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Cecilia Gigena summarizing the discussion: There was no significant difference in deep organ space infection requiring intervention between home antibiotic and no home antibiotic groups for complicated appendicitis.
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Cecilia Gigena summarizing the discussion: There was no difference in length of stay between home antibiotic and no home antibiotic groups for complicated appendicitis.
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Cecilia Gigena summarizing the discussion: There was no difference in length of stay between home antibiotic and no home antibiotic groups for complicated appendicitis.
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Cecilia Gigena summarizing the discussion: Type C esophageal atresia is the most common type and means esophageal atresia with a distal fistula; type A means pure esophageal atresia with no fistula to the trachea.
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Cecilia Gigena summarizing the discussion: Type C esophageal atresia is the most common type and means esophageal atresia with a distal fistula; type A means pure esophageal atresia with no fistula to the trachea.
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Cecilia Gigena summarizing the discussion: The pectus study is a prospective cohort study from a single center in Phoenix aiming to quantify long-term hyperesthesia and neuropathic pain after minimally invasive repair of pectus excavatum with cryoablation.
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Cecilia Gigena summarizing the discussion: The pectus study is a prospective cohort study from a single center in Phoenix aiming to quantify long-term hyperesthesia and neuropathic pain after minimally invasive repair of pectus excavatum with cryoablation.
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Cecilia Gigena summarizing the discussion: The pectus study selected patients under 21 years of age who presented for bar removal between November 2021 and May 2023.
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Cecilia Gigena summarizing the discussion: The pectus study selected patients under 21 years of age who presented for bar removal between November 2021 and May 2023.
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Cecilia Gigena summarizing the discussion: Testing for cold and soft touch and pinprick was performed just before bar removal.
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Cecilia Gigena summarizing the discussion: Testing for cold and soft touch and pinprick was performed just before bar removal.
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Cecilia Gigena summarizing the discussion: The pectus study enrolled 47 patients with a median bar dwell time of approximately 2.9 years.
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Cecilia Gigena summarizing the discussion: The pectus study enrolled 47 patients with a median bar dwell time of approximately 2.9 years.
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Cecilia Gigena summarizing the discussion: Patients had a median of 2 bars placed, and almost 81% were secured with pericostal sutures.
Open
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Cecilia Gigena summarizing the discussion: Patients had a median of 2 bars placed, and almost 81% were secured with pericostal sutures.
Open
Host summary
Cecilia Gigena summarizing the discussion: Almost half of the pectus patients had some degree of hypoesthesia, with T5 being the most common dermatome affected.
Open
Host summary
Cecilia Gigena summarizing the discussion: Almost half of the pectus patients had some degree of hypoesthesia, with T5 being the most common dermatome affected.
Open
Host summary
Cecilia Gigena summarizing the discussion: The area with hypoesthesia was less than 5% of the entire surface that was treated with cryo.
Open
Host summary
Cecilia Gigena summarizing the discussion: The area with hypoesthesia was less than 5% of the entire surface that was treated with cryo.
Open
Host summary
Cecilia Gigena summarizing the discussion: Neuropathic symptoms were identified by only 13% of pectus patients, and none required treatment.
Open
Host summary
Cecilia Gigena summarizing the discussion: Neuropathic symptoms were identified by only 13% of pectus patients, and none required treatment.
Open
Host summary
Cecilia Gigena summarizing the discussion: In the long term after minimally invasive repair of pectus excavatum with cryo, many patients will experience some chest wall hypoesthesia limited to one or two dermatomes, and chronic symptomatic neuropathic pain is very rare.
Open
Host summary
Cecilia Gigena summarizing the discussion: In the long term after minimally invasive repair of pectus excavatum with cryo, many patients will experience some chest wall hypoesthesia limited to one or two dermatomes, and chronic symptomatic neuropathic pain is very rare.
Open
Host summary
Cecilia Gigena summarizing the discussion: Pericostal sutures used to secure bars can damage nerves.
Open
Host summary
Cecilia Gigena summarizing the discussion: Pericostal sutures used to secure bars can damage nerves.
Open
Quick Literature Updates Ep 24
Host summary
Cecilia Gigena summarizes what Dr. Carlos Colunga said: The Rao et al. study is a multi-center retrospective study done in the US from 2018 to 2022.
Open
Host summary
Cecilia Gigena summarizes what Dr. Carlos Colunga said: The Rao study compared patients with suspected choledocholithiasis who underwent transcystic laparoscopic common bile duct exploration versus those who underwent ERCP first.
Open
Host summary
Cecilia Gigena summarizes what Dr. Carlos Colunga said: The Rao study included 252 patients total: 156 in the transcystic laparoscopic common bile duct exploration group and 96 in the ERCP-first group.
Open
Host summary
Cecilia Gigena summarizes what Dr. Carlos Colunga said: Patients who underwent transcystic laparoscopic common bile duct exploration had lower length of stay compared to ERCP-first patients.
Open
Host summary
Cecilia Gigena summarizes what Dr. Carlos Colunga said: Patients who underwent transcystic laparoscopic common bile duct exploration had significantly less complication rates compared to ERCP-first patients.
Open
Host summary
Cecilia Gigena summarizes what Dr. Carlos Colunga said: Attempting a transcystic laparoscopic common bile duct exploration may benefit pediatric choledocholithiasis patients.
Open
Update Course Rewind: Pectus Excavatum 2021
Host summary
Cecilia Gigena summarizing a resource: After 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
Open
Host summary
Cecilia Gigena summarizing a resource: We 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.
Open
Host summary
Cecilia Gigena summarizing a resource: With cryoanalgesia, length of stay decreased from four days (baseline) to one day
Open
Host summary
Cecilia Gigena summarizing a resource: What we saw there is the length of stay where we just couldn't get below four days. All of a sudden became one.
Open
Host summary
Cecilia Gigena summarizing a resource: I 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.
Open
Host summary
Cecilia Gigena summarizing a resource: Dr. Garcia expressed concern that there are no long-term studies of cryoanalgesia and potential for chronic neuropathic pain
Open
Host summary
Cecilia Gigena summarizing a resource: Dr. Garcia's hospital uses erector spinae catheters placed by the pain team with ultrasound guidance, positioned juxtaposed to but not in the vertebral space
Open
Host summary
Cecilia Gigena summarizing a resource: With 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
Open
Host summary
Cecilia Gigena summarizing a resource: Dr. 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
Open
Host summary
Cecilia Gigena summarizing a resource: 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.
Open
Host summary
Cecilia Gigena summarizing a resource: Dr. Ponsky's multimodal regimen includes preoperative counseling, gabapentin pre and postoperatively, methadone, clonidine, bowel regimen medications, and antiemetics
Open
Host summary
Cecilia Gigena summarizing a resource: At Nebraska where Dr. Rayner practices, length of stay is under two days and patients are off opioids by one week using multimodal pain control
Open
Host summary
Cecilia Gigena summarizing a resource: Computational 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
Open
Host summary
Cecilia Gigena summarizing a resource: Techniques to avoid cardiac injury during introducer passage include thoracoscopy, sternal elevator, vacuum bell in the operating room, and sub-xiphoid incision
Open
Host summary
Cecilia Gigena summarizing a resource: Thoracoscopy 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.
Open
Summaries Cecilia gave as host · Pediatric Robotic Surgery 8 summaries
Open the Pediatric Robotic Surgery collection →
Comparison of robotic versus thoracoscopic repair for congenital esophageal atresia
Host summary
Cecilia Gigena summarizing a resource: The study is a retrospective multi-center study done in China
Open
Host summary
Cecilia Gigena summarizing a resource: After propensity score matching, there were 126 patients total, 63 in each group
Open
Host summary
Cecilia Gigena summarizing a resource: The robotic group had lower anastomotic strictures compared to thoracoscopic repair
Open
Host summary
Cecilia Gigena summarizing a resource: Robotic surgery had shorter anastomotic time compared to thoracoscopic repair
Open
Host summary
Cecilia Gigena summarizing a resource: Robotic surgery had longer operative time compared to thoracoscopic repair
Open
Host summary
Cecilia Gigena summarizing a resource: The robotic group had lower unplanned readmissions within 2 years post-op compared to thoracoscopic repair
Open
Host summary
Cecilia Gigena summarizing a resource: So, it seems that robotic surgery is a good answer for esophageal tissue repair.
Open
Host summary
Cecilia Gigena summarizing a resource: Robotic surgery appears to be a good option for esophageal atresia repair
Open
Summaries Cecilia gave as host · Peritoneal Dialysis Access 4 summaries
Open the Peritoneal Dialysis Access collection →
Quick Literature Updates Episode 13
Host summary
Cecilia Gigena summarizes what Dr. Alex Halpern said: In a Boston Children's Hospital study of 143 button battery ingestion patients from 2008 to 2021, 24 had severe outcomes.
Open
Host summary
Cecilia Gigena summarizes what Dr. Alex Halpern said: Location of the button battery in the esophagus is an independent predictor for severe outcomes in button battery ingestion.
Open
Host summary
Cecilia Gigena summarizes what Dr. Alex Halpern said: A button battery larger than 2 centimeters is an independent predictor for severe outcomes in button battery ingestion.
Open
Host summary
Cecilia Gigena summarizes what Dr. Alex Halpern said: Having symptoms at presentation is an independent predictor for severe outcomes in button battery ingestion.
Open
Summaries Cecilia gave as host · Pilonidal Disease 7 summaries
Open the Pilonidal Disease collection →
Journal of Pediatric Surgery Article Review: July 2023, PAPS Issue
Host summary
Cecilia Gigena summarizing the discussion: The cryoanalgesia study compared patients from 2011 to 2021, with 29 patients receiving cryoanalgesia and 15 not receiving it.
Open
Host summary
Cecilia Gigena summarizing the discussion: Patients who received cryoanalgesia had shorter hospital stays: 3.0 days versus 5.4 days for those without cryoanalgesia.
Open
Host summary
Cecilia Gigena summarizing the discussion: Hospital costs were slightly lower (less than $1000 difference) in patients who received cryoanalgesia despite the expensive equipment.
Open
Host summary
Cecilia Gigena summarizing the discussion: The 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.
Open
Host summary
Cecilia Gigena summarizing the discussion: To reach 75% hair reduction requires a mean of 4.8 to 6.8 laser ablation sessions depending on skin and hair characteristics.
Open
Host summary
Cecilia Gigena summarizing the discussion: The overall recurrence rate for pilonidal disease after laser hair reduction was 6%.
Open
Host summary
Cecilia Gigena summarizing the discussion: Dark hair and skin types 5-6 were associated with higher recurrence rates in pilonidal disease after laser hair reduction.
Open
Summaries Cecilia gave as host · Primary Spontaneous Pneumothorax 10 summaries
Open the Primary Spontaneous Pneumothorax collection →
Journal of Pediatric Surgery Article REview: August Issue 2023
Host summary
Cecilia Gigena summarizing the discussion: IV PCA does not appear necessary in Nuss procedures with cryoablation and can be eliminated fairly early in a surgeon's experience.
Open
Host summary
Cecilia Gigena summarizing the discussion: Reduced opioid use and shorter length of stay in Nuss procedures was primarily related to discontinuing use of IV PCA during the study period, based on observation that patients weren't using the IV PCA.
Open
Host summary
Cecilia Gigena summarizing the discussion: The learning curve for cryoablation in Nuss procedures is not about surgical technique but about pain protocols, with earlier differences due to comfort level with discontinuing PCA and switching to oral pain medication rather than poor cryoablation technique.
Open
Host summary
Cecilia Gigena summarizing the discussion: Cryoablation implementation requires a protocol or regimen including pain team involvement preoperatively and postoperatively, with adjuncts such as gabapentin, rather than cryoablation alone.
Open
Host summary
Cecilia Gigena summarizing the discussion: I certainly think that cryoablation in and of itself may not lead to the same results as if you were to implement cryoablation within a, almost like a protocol or a regimen.
Open
Host summary
Cecilia Gigena summarizing the discussion: Patients going to VATS immediately after failed aspiration had median length of stay of 3.1 days, compared to 6 days median length of stay for patients in the Midwest Pediatric Surgery Consortium.
Open
Host summary
Cecilia Gigena summarizing the discussion: Phoenix Children's slipping rib syndrome study included 98 patients: 68 had rib resection without cryoablation (receiving other blocks like rectus spinae, paravertebral, or intercostal), 22 had extrathoracic cryoablation plus other nerve blocks, and 8 had slipping ribs resected as part of Nuss procedure.
Open
Host summary
Cecilia Gigena summarizing the discussion: Patients who underwent rib excision with cryoablation used significantly less opioids in hospital compared to rib excision without cryoablation, with median length of stay of 1 day versus 2 days.
Open
Host summary
Cecilia Gigena summarizing the discussion: 91% of cryoablation patients had cryoablation of T9 and T10 intercostal nerves with no documented abdominal wall laxity at immediate follow-up of 16 days.
Open
Host summary
Cecilia Gigena summarizing the discussion: Patients with very low pectus deformities may have more discomfort in the lower costal margin area because it extends beyond the T7 and T8 field where most cryoablation is performed.
Open
Summaries Cecilia gave as host · Sarcoma (Ewing/Rhabdo) 21 summaries
Open the Sarcoma (Ewing/Rhabdo) collection →
Female Fertility Cryopreservation Outcomes in Childhood Cancer: A Systematic Review
Host summary
Cecilia Gigena summarizing a resource: Do you indicate cryopreservation in girls that are going to need chemotherapy?
Open
Host summary
Cecilia Gigena summarizing a resource: The systematic review aimed to highlight outcomes of cryopreservation in pediatric female patients with cancer
Open
Host summary
Cecilia Gigena summarizing a resource: The review included 12 studies with 612 patients total
Open
Host summary
Cecilia Gigena summarizing a resource: 501 patients underwent ovarian tissue cryopreservation
Open
Host summary
Cecilia Gigena summarizing a resource: Only 30 of the 501 patients received ovarian tissue transplantation
Open
Host summary
Cecilia Gigena summarizing a resource: Of the 30 patients who received transplantation, 9 got pregnant
Open
Host summary
Cecilia Gigena summarizing a resource: Only 6 of the 9 pregnancies resulted in live birth
Open
Host summary
Cecilia Gigena summarizing a resource: More high quality studies are needed to understand cryopreservation better and improve its outcomes
Open
Host summary
Cecilia Gigena summarizing a resource: So even though cryopreservation can be successful, we still need more high quality studies to understand it better and improve its outcomes.
Open
Choledocholithiasis with Drs. David Vitale & Lucas Neff
Host summary
Cecilia Gigena summarizing the discussion: Choledocholithiasis stones may be made up of bile pigments or calcium and cholesterol salts.
Open
Host summary
Cecilia Gigena summarizing the discussion: Choledocholithiasis stones may be made up of bile pigments or calcium and cholesterol salts.
Open
Host summary
Cecilia Gigena summarizing the discussion: Patients with intermediate risk (abnormal liver biochemical tests or dilated common bile ducts) can undergo endoscopic ultrasound, MRCP, laparoscopic cholangiogram, or intraoperative ultrasound.
Open
Host summary
Cecilia Gigena summarizing the discussion: Patients with intermediate risk (abnormal liver biochemical tests or dilated common bile ducts) can undergo endoscopic ultrasound, MRCP, laparoscopic cholangiogram, or intraoperative ultrasound.
Open
Host summary
Cecilia Gigena summarizing the discussion: Common bile duct diameter greater than 6 millimeters was most sensitive for predicting common bile duct stones in children, although without statistical significance.
Open
Host summary
Cecilia Gigena summarizing the discussion: Common bile duct diameter greater than 6 millimeters was most sensitive for predicting common bile duct stones in children, although without statistical significance.
Open
Host summary
Cecilia Gigena summarizing the discussion: Randomized trials from 2013 show no significant difference in morbidity, mortality, retained stones, or failure rates between ERCP and laparoscopic common bile duct exploration.
Open
Host summary
Cecilia Gigena summarizing the discussion: Randomized trials from 2013 show no significant difference in morbidity, mortality, retained stones, or failure rates between ERCP and laparoscopic common bile duct exploration.
Open
Host summary
Cecilia Gigena summarizing the discussion: Most free-standing children's hospitals do not have ERCP capabilities.
Open
Host summary
Cecilia Gigena summarizing the discussion: Most free-standing children's hospitals do not have ERCP capabilities.
Open
Host summary
Cecilia Gigena summarizing the discussion: If the pancreatic duct is visualized during fluoroscopy, the procedure should be stopped due to higher risk for pancreatitis.
Open
Host summary
Cecilia Gigena summarizing the discussion: If the pancreatic duct is visualized during fluoroscopy, the procedure should be stopped due to higher risk for pancreatitis.
Open
Summaries Cecilia gave as host · Short Bowel Syndrome 12 summaries
Open the Short Bowel Syndrome collection →
Quick Literature Updates Episode 7
Host summary
Cecilia Gigena summarizing a resource: The 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.
Open
Host summary
Cecilia Gigena summarizing a resource: Olsen et al. systematic review analyzed 10 studies with 6,430 patients examining surgeon volume and pediatric thyroid surgery outcomes.
Open
Host summary
Cecilia Gigena summarizing a resource: Thyroidectomies performed by high volume surgeons show shorter length of stays.
Open
Disruption of enterohepatic Circulation of Bile acids ameliorates small bowel resection associated hepatic injury
Host summary
Cecilia Gigena summarizing a resource: Did you know that the disruption of the enterohepatic circulation of bilasses is beneficial for the liver?
Open
Host summary
Cecilia Gigena summarizing a resource: Disruption of the enterohepatic circulation of bile acids is beneficial for the liver
Open
Host summary
Cecilia Gigena summarizing a resource: The study was conducted at Saint Louis Children's Hospital and aimed to elucidate the driving force behind hepatic injury following bowel resection
Open
Host summary
Cecilia Gigena summarizing a resource: The study used three groups of mice: sham, 50% with proximal or duodenal resection, and 50% with distal resection or resection of the ileocecal valve
Open
Host summary
Cecilia Gigena summarizing a resource: Tissue samples were taken at the second and tenth post-operative weeks
Open
Host summary
Cecilia Gigena summarizing a resource: They 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.
Open
Host summary
Cecilia Gigena summarizing a resource: Ileal resection could lead to less hepatic injury
Open
Host summary
Cecilia Gigena summarizing a resource: Mice with distal resection showed a more hydrophilic bile acid profile compared to proximal resection
Open
Host summary
Cecilia Gigena summarizing a resource: Mice with distal resection showed less hepatic oxidative stress compared to proximal resection
Open
Summaries Cecilia gave as host · Shortness of Breath On Exertion 22 summaries
Open the Shortness of Breath On Exertion collection →
Update Course Rewind: Pectus Excavatum 2021
Host summary
Cecilia Gigena summarizing the discussion: Cryoanalgesia uses cold temperatures to cause a conduction block that interrupts pain impulses to the brain.
Open
Host summary
Cecilia Gigena summarizing the discussion: For 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.
Open
Host summary
Cecilia Gigena summarizing the discussion: I've always done right to left. Um, I never even thought about doing left to right, I must admit.
Open
Host summary
Cecilia Gigena summarizing the discussion: Dr. Slater has always performed the Nuss procedure right to left and had not previously considered left to right.
Open
Update Course Rewind: Pectus Excavatum 2021
Host summary
Cecilia Gigena summarizing the discussion: Cryoanalgesia uses cold temperatures to cause a conduction block, interrupting pain impulses to the brain.
Open
Host summary
Cecilia Gigena summarizing the discussion: The FDA requires clinical trials with long-term results for medications before approval, but not for medical devices and techniques.
Open
Host summary
Cecilia Gigena summarizing the discussion: I've always done right to left. Um, I never even thought about doing left to right, I must admit.
Open
Update Course Rewind: Pectus Excavatum 2021
Host summary
Cecilia Gigena summarizing a resource: After 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
Open
Host summary
Cecilia Gigena summarizing a resource: We 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.
Open
Host summary
Cecilia Gigena summarizing a resource: What we saw there is the length of stay where we just couldn't get below four days. All of a sudden became one.
Open
Host summary
Cecilia Gigena summarizing a resource: With cryoanalgesia, length of stay decreased from four days (baseline) to one day
Open
Host summary
Cecilia Gigena summarizing a resource: I 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.
Open
Host summary
Cecilia Gigena summarizing a resource: Dr. Garcia expressed concern that there are no long-term studies of cryoanalgesia and potential for chronic neuropathic pain
Open
Host summary
Cecilia Gigena summarizing a resource: Dr. Garcia's hospital uses erector spinae catheters placed by the pain team with ultrasound guidance, positioned juxtaposed to but not in the vertebral space
Open
Host summary
Cecilia Gigena summarizing a resource: With 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
Open
Host summary
Cecilia Gigena summarizing a resource: Dr. 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
Open
Host summary
Cecilia Gigena summarizing a resource: 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.
Open
Host summary
Cecilia Gigena summarizing a resource: Dr. Ponsky's multimodal regimen includes preoperative counseling, gabapentin pre and postoperatively, methadone, clonidine, bowel regimen medications, and antiemetics
Open
Host summary
Cecilia Gigena summarizing a resource: At Nebraska where Dr. Rayner practices, length of stay is under two days and patients are off opioids by one week using multimodal pain control
Open
Host summary
Cecilia Gigena summarizing a resource: Computational 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
Open
Host summary
Cecilia Gigena summarizing a resource: Thoracoscopy 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.
Open
Host summary
Cecilia Gigena summarizing a resource: Techniques to avoid cardiac injury during introducer passage include thoracoscopy, sternal elevator, vacuum bell in the operating room, and sub-xiphoid incision
Open
Summaries Cecilia gave as host · Slipping Rib Syndrome 19 summaries
Open the Slipping Rib Syndrome collection →
Initial Outcomes Using Cryoablation in Surgical Management of Slipping Rib Syndrome
Host summary
Cecilia Gigena summarizing a resource: Do you use cryo for resecting cartilage in the slipping ribs syndrome?
Open
Host summary
Cecilia Gigena summarizing a resource: The study was a retrospective review conducted in Phoenix between 2018 and 2022
Open
Host summary
Cecilia Gigena summarizing a resource: The study compared length of stay and opiate use in patients undergoing cartilaginous rib excision with and without cryo
Open
Host summary
Cecilia Gigena summarizing a resource: 68 patients underwent resection without cryo
Open
Host summary
Cecilia Gigena summarizing a resource: 8 patients underwent a NAS procedure plus cartilaginous resection with cryoalgesia
Open
Host summary
Cecilia Gigena summarizing a resource: Patients who underwent resection with cryo stayed one day less than patients without cryo, though this difference was not statistically significant
Open
Host summary
Cecilia Gigena summarizing a resource: Patients who underwent resection with cryo had significantly less opiate use
Open
Journal of Pediatric Surgery Article REview: August Issue 2023
Host summary
Cecilia Gigena summarizing the discussion: Reduced opioid use and shorter length of stay in Nuss procedures was primarily related to discontinuing use of IV PCA during the study period, based on observation that patients weren't using the IV PCA.
Open
Host summary
Cecilia Gigena summarizing the discussion: IV PCA does not appear necessary in Nuss procedures with cryoablation and can be eliminated fairly early in a surgeon's experience.
Open
Host summary
Cecilia Gigena summarizing the discussion: The learning curve for cryoablation in Nuss procedures is not about surgical technique but about pain protocols, with earlier differences due to comfort level with discontinuing PCA and switching to oral pain medication rather than poor cryoablation technique.
Open
Host summary
Cecilia Gigena summarizing the discussion: I certainly think that cryoablation in and of itself may not lead to the same results as if you were to implement cryoablation within a, almost like a protocol or a regimen.
Open
Host summary
Cecilia Gigena summarizing the discussion: Cryoablation implementation requires a protocol or regimen including pain team involvement preoperatively and postoperatively, with adjuncts such as gabapentin, rather than cryoablation alone.
Open
Host summary
Cecilia Gigena summarizing the discussion: Patients going to VATS immediately after failed aspiration had median length of stay of 3.1 days, compared to 6 days median length of stay for patients in the Midwest Pediatric Surgery Consortium.
Open
Host summary
Cecilia Gigena summarizing the discussion: Phoenix Children's slipping rib syndrome study included 98 patients: 68 had rib resection without cryoablation (receiving other blocks like rectus spinae, paravertebral, or intercostal), 22 had extrathoracic cryoablation plus other nerve blocks, and 8 had slipping ribs resected as part of Nuss procedure.
Open
Host summary
Cecilia Gigena summarizing the discussion: 91% of cryoablation patients had cryoablation of T9 and T10 intercostal nerves with no documented abdominal wall laxity at immediate follow-up of 16 days.
Open
Host summary
Cecilia Gigena summarizing the discussion: Patients who underwent rib excision with cryoablation used significantly less opioids in hospital compared to rib excision without cryoablation, with median length of stay of 1 day versus 2 days.
Open
Host summary
Cecilia Gigena summarizing the discussion: Patients with very low pectus deformities may have more discomfort in the lower costal margin area because it extends beyond the T7 and T8 field where most cryoablation is performed.
Open
Summaries Cecilia gave as host · Tracheomalacia 10 summaries
Open the Tracheomalacia collection →
Quick Literature Updates Ep 19
Host summary
Cecilia Gigena summarizes what Dr. Carlos Colunga said: The IPSO systematic review and meta-analysis gathered 8 retrospective studies with 490 patients comparing image-guided core needle biopsy to surgical biopsy for neuroblastoma.
Open
Host summary
Cecilia Gigena summarizes what Dr. Carlos Colunga said: Tissue adequacy and biological characterization of the biopsy was not significantly different between image-guided core needle biopsy and surgical biopsy groups for neuroblastoma.
Open
Host summary
Cecilia Gigena summarizes what Dr. Carlos Colunga said: Intraoperative transfusions and complications were higher in the surgical biopsy group compared to image-guided core needle biopsy for neuroblastoma.
Open
Host summary
Cecilia Gigena summarizes what Dr. Carlos Colunga said: Image-guided core needle biopsy is safe and effective for diagnosing neuroblastoma.
Open
Quick Literature Updates Ep 27
Host summary
Cecilia Gigena summarizes what Dr. Alex Halpern said: Huncheid et al. conducted a multi-center non-inferiority trial that compared preterm infants treated with expectant management versus early ibuprofen for patent ductus arteriosus.
Open
Host summary
Cecilia Gigena summarizes what Dr. Alex Halpern said: The trial included 273 infants: 136 treated with expectant management and 137 with early ibuprofen.
Open
Host summary
Cecilia Gigena summarizes what Dr. Alex Halpern said: In the expectant management group for PDA, there was 17.6% necrotizing enterocolitis, 33% bronchopulmonary dysplasia, and 14% death rates.
Open
Host summary
Cecilia Gigena summarizes what Dr. Alex Halpern said: In the ibuprofen group for PDA, there was 15.4% necrotizing enterocolitis, 50% bronchopulmonary dysplasia, and 80% death rates.
Open
Host summary
Cecilia Gigena summarizes what Dr. Alex Halpern said: So it seems that expectant management is not inferiority that early ibuprofen in preterm patients with PDA.
Open
Host summary
Cecilia Gigena summarizes what Dr. Alex Halpern said: Expectant management is not inferior to early ibuprofen in preterm patients with patent ductus arteriosus.
Open
Summaries Cecilia gave as host · Trisomy 21 8 summaries
Open the Trisomy 21 collection →
Quick Literature Updates Episode 14
Host summary
Cecilia Gigena summarizes what Dr. Alex Halpern said: The anal sphincter reconstruction study was a multi-institutional one-year outcome study
Open
Host summary
Cecilia Gigena summarizes what Dr. Alex Halpern said: Six patients underwent anal sphincter reconstruction for patulous sphincter after Hirschsprung pull-through
Open
Host summary
Cecilia Gigena summarizes what Dr. Alex Halpern said: Four patients received only anal sphincter reconstruction without redo pull-through
Open
Host summary
Cecilia Gigena summarizes what Dr. Alex Halpern said: Two of the six patients had Down syndrome
Open
Host summary
Cecilia Gigena summarizes what Dr. Alex Halpern said: Two patients underwent redo pull-through with anal sphincter reconstruction
Open
Host summary
Cecilia Gigena summarizes what Dr. Alex Halpern said: 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.
Open
Host summary
Cecilia Gigena summarizes what Dr. Alex Halpern said: Anal sphincter reconstruction is an option for overstretched anal sphincters in patients with Hirschsprung disease after pull-through
Open
Host summary
Cecilia Gigena summarizes what Dr. Alex Halpern said: The four patients who received only sphincter reconstruction achieved voluntary bowel movements with higher productivity and confidence
Open
Summaries Cecilia gave as host · Wilms Tumor 13 summaries
Open the Wilms Tumor collection →
Efficacy and late kidney effects of nephron-sparing surgery in the management of unilateral Wilms tumor
Host summary
Cecilia Gigena summarizing a resource: Do you do nephrine sparing surgery or radical nephrectomy when you're treating a unilateral wounds tumor?
Open
Host summary
Cecilia Gigena summarizing a resource: The study aimed to evaluate efficacy and long-term renal function after nephron-sparing surgery in patients with unilateral Wilms tumor
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Cecilia Gigena summarizing a resource: The systematic review and meta-analysis was conducted in Chongqing, China
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Cecilia Gigena summarizing a resource: There were no significant differences in overall survival between nephron-sparing surgery and radical nephrectomy
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Cecilia Gigena summarizing a resource: There were no significant differences in hypertension rates between nephron-sparing surgery and radical nephrectomy
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Cecilia Gigena summarizing a resource: There were no significant differences in recurrence rates between nephron-sparing surgery and radical nephrectomy
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Cecilia Gigena summarizing a resource: Nephron-sparing surgery increased glomerular filtration rate after surgery
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Cecilia Gigena summarizing a resource: There were no significant differences in renal dysfunction rates between nephron-sparing surgery and radical nephrectomy
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Quick Literature Updates Ep 21
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Cecilia Gigena summarizes what Dr. Alex Halpern said: The 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.
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Cecilia Gigena summarizes what Dr. Alex Halpern said: The meta-analysis gathered 26 studies on nephron-sparing surgery for unilateral Wilms tumor.
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Cecilia Gigena summarizes what Dr. Alex Halpern said: Nephron-sparing surgery showed no significant differences in overall survival, recurrences, hypertension, or renal dysfunction compared to radical nephrectomy for unilateral Wilms tumor.
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Cecilia Gigena summarizes what Dr. Alex Halpern said: Nephron-sparing surgery increased glomerular filtration rate after surgery for unilateral Wilms tumor.
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