Em Gootee

Summaries Em gave as host · Abdominal Wall Defects 120 summaries

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Update Course Rewind: 2022 Top Ten Key Takeaways

Host summary Em Gootee summarizing a resource: Infants with gastroschisis often require prolonged hospitalization for surgical repair and initiation and advancement of feeds. Open

Host summary Em Gootee summarizing a resource: Based on recently updated protocols from Cincinnati Children's Hospital and Children's Mercy Kansas City, feeds can be started immediately after sutureless abdominal closure for uncomplicated gastroschisis, beginning with 10-20 mL/kg/day and advancing by 20 mL/kg/day if tolerated. Open

Host summary Em Gootee summarizing a resource: Immediate feeding after gastroschisis closure has been shown to be associated with shorter length of stay and faster attainment of goal feeds. Open

Host summary Em Gootee summarizing a resource: it's safe to say that for babies with uncomplicated gastrochesis, it's safe to start feeding immediately after closure. And if they're tolerating for a few days and have even one bout of emesis, it's okay to continue with the feeding protocol. Open

Host summary Em Gootee summarizing a resource: For babies with uncomplicated gastroschisis tolerating feeds for a few days, it is okay to continue the feeding protocol even after one bout of emesis. Open

Host summary Em Gootee summarizing a resource: High resolution esophageal manometry, esophagography, and endoscopy can help determine the diagnosis of congenital esophageal stenosis. Open

Host summary Em Gootee summarizing a resource: Serial dilations may be used to manage congenital esophageal stenosis if there is no cartilage component suspected in the stenotic area. Open

Host summary Em Gootee summarizing a resource: Surgical resection for congenital esophageal stenosis can be reserved for patients where serial dilation is unsuccessful or there is concern for a cartilaginous component. Open

Host summary Em Gootee summarizing a resource: initial conservative management should be considered for patients with congenital esophageal stenosis, especially if a cartilagenous component is not suspected. Open

Host summary Em Gootee summarizing a resource: Initial conservative management should be considered for patients with congenital esophageal stenosis, especially if a cartilaginous component is not suspected. Open

Host summary Em Gootee summarizing a resource: Management of intussusception after enema reduction varies in practice, with historically recommended inpatient observation lacking evidence-based guidelines. Open

Host summary Em Gootee summarizing a resource: A systematic review and meta-analysis found that overall recurrence rates and recurrences within 24 and 48 hours were similar between inpatient and outpatient management groups after intussusception enema reduction. Open

Host summary Em Gootee summarizing a resource: There was no significant difference in the rate of return to the emergency department between inpatient and outpatient management after intussusception reduction, and both groups had similar rates of requiring operative intervention. Open

Host summary Em Gootee summarizing a resource: it's safe to say that outpatient management of intersusception after air enema reduction results in a shorter hospital stay with no difference in the rate of returns to the emergency department, recurrence, need for an operation, or mortality. Open

Host summary Em Gootee summarizing a resource: Outpatient management of intussusception after air enema reduction results in shorter hospital stay with no difference in rate of ED returns, recurrence, need for operation, or mortality. Open

Host summary Em Gootee summarizing a resource: There is no compelling evidence in pediatric or adult literature to support mechanical bowel preparation reducing surgical site infections in colorectal surgery. Open

Host summary Em Gootee summarizing a resource: Recent adult studies have shown no benefit from mechanical bowel preparation in reducing surgical site infections, with some studies showing an increase in wound infections. Open

Host summary Em Gootee summarizing a resource: Adult studies suggest a possible benefit of oral and IV antibiotics to reduce surgical site infections in colorectal surgery. Open

Host summary Em Gootee summarizing a resource: Recent retrospective studies have not shown the importance of oral antibiotics for pediatric colorectal operations. Open

Host summary Em Gootee summarizing a resource: we have seen no benefit of mechanical bowel preparations for reducing SSIs. However, case appropriate pre-operative IV antibiotics may reduce SSI incidents. Open

Host summary Em Gootee summarizing a resource: Case-appropriate preoperative IV antibiotics may reduce surgical site infection incidence in colorectal surgery. Open

Host summary Em Gootee summarizing a resource: Firearms are now the leading cause of death in all children and adolescents in the United States, overtaking motor vehicle crashes in 2019. Open

Host summary Em Gootee summarizing a resource: There are controversies about whether pediatric surgeons should be involved in firearm violence prevention efforts and advocacy across the country. Open

Host summary Em Gootee summarizing a resource: We believe as pediatric surgeons that we need to advocate with protecting children's health and well-being, no matter what the topic is. Open

Host summary Em Gootee summarizing a resource: As pediatric surgeons, we need to advocate for protecting children's health and well-being, no matter what the topic is. Open

Host summary Em Gootee summarizing a resource: Pediatric surgeons can play key roles for patients affected by firearms, including direct patient care and advocacy. Open

Host summary Em Gootee summarizing a resource: as pediatric surgeons, we can play key roles for patients affected by firearms, including direct patient care and advocacy. Open

Host summary Em Gootee summarizing a resource: Unwitnessed foreign body aspiration can be challenging to manage, and many items are not radiopaque so cannot be seen on plain x-ray. Open

Host summary Em Gootee summarizing a resource: The gold standard for airway evaluation has been rigid or flexible bronchoscopy, but there are risks of negative bronchoscopy with subsequent airway compromise. Open

Host summary Em Gootee summarizing a resource: CT bronchoscopy has been proposed as an adjunct in cases of children without obvious respiratory distress. Open

Host summary Em Gootee summarizing a resource: Low-dose non-contrast CT of the chest has high sensitivity and specificity for identification of airway foreign bodies. Open

Host summary Em Gootee summarizing a resource: CT can avoid the cost and resources of taking a child to the operating room for a non-therapeutic bronchoscopy procedure. Open

Host summary Em Gootee summarizing a resource: The largest study looking at initial laparotomy versus peritoneal drainage for necrotizing enterocolitis was conducted at 20 US centers and examined combined death or neurodevelopmental impairment at corrected age 18-22 months. Open

Host summary Em Gootee summarizing a resource: Death or neurodevelopmental impairment occurred in 69% of patients with preoperative diagnosis of NEC who underwent initial laparotomy versus 85% of those who underwent initial peritoneal drainage. Open

Host summary Em Gootee summarizing a resource: The prospective randomized cohort study from the National Institute of Child Health and Human Development showed no difference in overall survival but did show improved long-term neurodevelopmental outcomes with initial laparotomy for NEC. Open

Host summary Em Gootee summarizing a resource: for infants with necrotizing enterocolitis, initial laparotomy may be associated with less neurodevelopmental impairment and improved outcomes for extremely low birth weight babies. Open

Host summary Em Gootee summarizing a resource: For infants with necrotizing enterocolitis, initial laparotomy may be associated with less neurodevelopmental impairment and improved outcomes for extremely low birth weight babies. Open

Host summary Em Gootee summarizing a resource: Racism and sexism that manifest as microaggressions are commonly experienced by members of minority groups. Open

Host summary Em Gootee summarizing a resource: Individuals from minoritized groups are often left weighing the potential benefits and risks of addressing microaggression comments. Open

Host summary Em Gootee summarizing a resource: Placing the burden to interrupt bias on our marginalized colleagues is unjust and such microaggressions can harm trainees's performance and sense of belonging. Open

Host summary Em Gootee summarizing a resource: Placing the burden to interrupt bias on marginalized colleagues is unjust, and microaggressions can harm trainees' performance and sense of belonging. Open

Host summary Em Gootee summarizing a resource: Bystanders can and should make an effort to become upstanders, which means bystanders who respond with action. Open

Host summary Em Gootee summarizing a resource: Bystanders can and should make an effort to become upstanders, which means bystanders who respond with action to interrupt microaggressions. Open

Host summary Em Gootee summarizing a resource: Blunt head trauma represents the majority of pediatric trauma admissions, but there is very little evidence on how to best manage isolated skull fractures. Open

Host summary Em Gootee summarizing a resource: A 10-year retrospective review of isolated traumatic skull fractures with normal neurologic exam findings showed that 77% of patients were admitted for observation, but none needed neurosurgical intervention or additional imaging during the index admission. Open

Host summary Em Gootee summarizing a resource: pediatric isolated skull fractures are low risk conditions with a low likelihood of complications. Therefore, these patients can be discharged safely from the emergency department without inpatient observation. Open

Host summary Em Gootee summarizing a resource: Pediatric isolated skull fractures are low risk conditions with a low likelihood of complications, and these patients can be discharged safely from the emergency department without inpatient observation. Open

Host summary Em Gootee summarizing a resource: The IMPACT trial was a multi-institutional prospective randomized trial comparing piperacillin-tazobactam monotherapy versus ceftriaxone-metronidazole combination therapy for perforated appendicitis in children, with 30-day post-operative intra-abdominal abscess rate as the primary outcome. Open

Host summary Em Gootee summarizing a resource: Patients taking piperacillin-tazobactam had lower incidence of intra-abdominal abscesses, lower usage of CT scans, and fewer ED revisits compared to combination therapy. Open

Host summary Em Gootee summarizing a resource: Piperacillin-tazobactam monotherapy did not have an increase in antibiotic usage or increase in antibiotic-related complications compared to combination therapy. Open

Host summary Em Gootee summarizing a resource: Monotherapy with piperacillin-tazobactam has been shown to be associated with decreased incidence of intra-abdominal abscesses after surgery for patients with perforated appendicitis. Open

Host summary Em Gootee summarizing a resource: monotherapy with piperacilin and tazobactam has been shown to be associated with decreased incidence of intra-abdominal abscesses after surgery for patients with perforated appendicitis. Open

Journal of Pediatric Surgery Article Review: 2nd Quarter (Apr-Jun) 2024

Host summary Em Gootee summarizing the discussion: Hi everyone, I'm M. Goddy from Cincinnati Children's, and we are back with another episode of our Journal of Pediatric Surgery article review podcast. Open

Host summary Em Gootee summarizing the discussion: I'm a pediatric surgeon at Alberta Children's Hospital. I've also been the publication chair for the uh Pacific Association of Pediatric Surgeons. Open

Host summary Em Gootee summarizing the discussion: MMP-7 (matrix metalloproteinase 7) are proteolytic peptidases that break down peptide bonds for amino acids and are part of tissue remodeling processes, playing roles in tissue repair, arthritis, metastasis, and cirrhosis Open

Host summary Em Gootee summarizing the discussion: Higher levels of MMP-7 are associated with the diagnosis of biliary atresia Open

Host summary Em Gootee summarizing the discussion: In a cohort of 329 biliary atresia cases from July 2020 to December 2022, 40 were classified as low MMP-7 Open

Host summary Em Gootee summarizing the discussion: This is a group that has an ability to access a very large number of patients in a very short period of time, which really puts them in a position where they can dive deeply into. To things that others couldn't even start thinking about Open

Host summary Em Gootee summarizing the discussion: Low levels of MMP-7 in biliary atresia patients are associated with low levels of preoperative GGT (gamma glutamyl transpeptidase) and direct bilirubin Open

Host summary Em Gootee summarizing the discussion: GGT (gamma glutamyl transpeptidase) is an enzyme found in high levels in liver, kidney, pancreas, heart, and brain, and blood GGT levels are used to detect diseases of the liver and bile ducts Open

Host summary Em Gootee summarizing the discussion: Biliary atresia has variable outcomes even within one center, with patients who anatomically look similar having dramatically different outcomes Open

Host summary Em Gootee summarizing the discussion: Having lower MMP-7 levels within the cohort of biliary atresia patients is associated with worse prognosis Open

Host summary Em Gootee summarizing the discussion: And one of the things I love about this paper is that it just brings us down to some of those really basic questions about when we deal with these conditions, what actually underlies it? What are these processes? How do we target them? Open

Host summary Em Gootee summarizing the discussion: The mechanism of why low MMP-7 levels in biliary atresia patients leads to worse prognosis is unknown Open

Host summary Em Gootee summarizing the discussion: In a Canadian cohort of 411 infants with gastroschisis treated at CAPSNET centers from 2014 to 2022, 144 were excluded due to gestational age, birth weight, other congenital anomalies, or complicated gastroschisis, leaving 267 participants Open

Host summary Em Gootee summarizing the discussion: Of 267 uncomplicated gastroschisis patients, 78% received exclusive breast milk in the first 28 days of life and 22% received supplemental or exclusive formula Open

Host summary Em Gootee summarizing the discussion: There were no significant differences between exclusive breast milk and formula groups in time to reach full enteral feeds, duration of parenteral nutrition, or length of stay in uncomplicated gastroschisis Open

Host summary Em Gootee summarizing the discussion: Patients with uncomplicated gastroschisis who received exclusive breast milk in the first 28 days were far more likely to transition to exclusive breastfeeding: 73% compared to 11% in those with formula exposure Open

Host summary Em Gootee summarizing the discussion: A systematic review on transition from pediatric to adult care for colorectal conditions included 8 studies with patient, parent, and clinician perspectives, focusing on patients aged 10-30 years with anorectal malformation or Hirschsprung disease Open

Host summary Em Gootee summarizing the discussion: There is a group of colorectal patients discharged from care in late childhood around age 10 years, and another group that remains in pediatric care way beyond the normal age of transfer to adult care (around 25 years) Open

Host summary Em Gootee summarizing the discussion: The life course progression of anorectal malformation and Hirschsprung disease is not well understood Open

Journal of Pediatric Surgery Article Review: 3rd Quarter (Jul-Sep) 2024

Host summary Em Gootee summarizing the discussion: Hi everyone, I'm M. Goddy from Cincinnati Children's, and we are back with another episode of our Journal of Pediatric Surgery article review podcast. Open

Host summary Em Gootee summarizing the discussion: My name's Jason F Fisher. I'm a pediatric surgeon and director of the Colorectal Center at Cincinnati Children's, and I also happen to be. The lead of the subcommittee for Hirschprung's disease for the PCPLC or Pediatric Colorectal and Pelvic Learning Consortium. Open

Host summary Em Gootee summarizing the discussion: The PCPLC multi-institutional registry includes a number of institutions throughout the United States. Open

Host summary Em Gootee summarizing the discussion: 85% of Hirschsprung patients were diagnosed at less than 1 year of age. Open

Host summary Em Gootee summarizing the discussion: Kids with shorter segment disease (rectosigmoid or very small portion of aganglionic bowel) were more likely to be diagnosed at a later age. Open

Host summary Em Gootee summarizing the discussion: Children with long segment Hirschsprung disease typically present at birth with classic symptoms such as failure to pass meconium. Open

Host summary Em Gootee summarizing the discussion: Approximately one-third of neonates and 50% of infants, toddlers, and children had diverting ostomies performed prior to pull-through. Open

Host summary Em Gootee summarizing the discussion: There was no difference in overall rates of redo pull-throughs across age groups. Open

Host summary Em Gootee summarizing the discussion: Older children were more likely to need a redo pull-through due to an anastomotic leak. Open

Host summary Em Gootee summarizing the discussion: Higher rates of diverting ostomy post pull-through were suspected to be a treatment for post pull-through leak or anastomotic leak. Open

Host summary Em Gootee summarizing the discussion: The only outcome difference seen was nighttime soiling or incontinence in the older patient population. Open

Host summary Em Gootee summarizing the discussion: I am a pediatric surgeon. Uh, in the division of pediatric Surgery with Presbyterian Healthcare Services in Albuquerque, New Mexico Open

Host summary Em Gootee summarizing the discussion: The systematic review on gastroschisis included 28 high quality manuscripts. Open

Host summary Em Gootee summarizing the discussion: Two randomized controlled trials on gastroschisis had been started but both ended prematurely and were underpowered. Open

Host summary Em Gootee summarizing the discussion: Clinical practice suggests that skin organisms are most commonly identified in infections among infants with gastroschisis. Open

Host summary Em Gootee summarizing the discussion: Gastroschisis infants have a fairly high rate of wound infection. Open

Host summary Em Gootee summarizing the discussion: Sutureless closure has the lowest rate of infection for gastroschisis. Open

Host summary Em Gootee summarizing the discussion: Silo closures have a higher rate of infection than other closure methods for gastroschisis. Open

Host summary Em Gootee summarizing the discussion: The recommendation for gastroschisis is to provide antibiotic coverage for skin flora until the defect is closed and potentially for an additional 24 hours thereafter if the infant is clinically stable. Open

Host summary Em Gootee summarizing the discussion: Stable gastroschisis infants with sufficient abdominal capacity for sutureless closure tend to have the best outcomes. Open

Host summary Em Gootee summarizing the discussion: Minimizing fluids and paralytics in gastroschisis infants improves their results. Open

Host summary Em Gootee summarizing the discussion: Gastroschisis patients with sutureless closure have shorter length of stay and achieve feeding sooner. Open

Host summary Em Gootee summarizing the discussion: The Clavien-Madadi classification scale consists of several grades from 1 to 5 based on the type of therapy needed to correct the complication. Open

Host summary Em Gootee summarizing the discussion: The validation process circulated up to 20 case scenarios of unexpected events within the ERNICA Network (European Reference Network for inherited and congenital anomalies). Open

Host summary Em Gootee summarizing the discussion: 59 surgeons from 12 European countries completed the Clavien-Madadi validation questionnaire. Open

Host summary Em Gootee summarizing the discussion: 43% of pediatric surgeons preferred the Clavien-Madadi classification compared to 12% for the Clavien-Dindo classification. Open

Host summary Em Gootee summarizing the discussion: Nearly 82% of surgeons affirmed advantages of the Clavien-Madadi classification. Open

Umbilical Disorders with Dr. Rebeccah Brown

Host summary Em Gootee summarizes what Dr. Rebecca Brown said: Two umbilical arteries and one umbilical vein surrounding by a gelatin-like extracellular matrix known as Worthin's jelly. Open

Host summary Em Gootee summarizes what Dr. Rebecca Brown said: The umbilical cord contains two umbilical arteries and one umbilical vein surrounded by Wharton's jelly (a gelatin-like extracellular matrix). Open

Host summary Em Gootee summarizes what Dr. Rebecca Brown said: Umbilical cords usually fall off at 2 to 3 weeks after birth. Open

Host summary Em Gootee summarizes what Dr. Rebecca Brown said: They usually fall off 2 to 3 weeks, and the delay can be a manifestation of an immune deficiency. Open

Host summary Em Gootee summarizes what Dr. Rebecca Brown said: Delayed umbilical cord separation can be a manifestation of an immune deficiency. Open

Host summary Em Gootee summarizes what Dr. Rebecca Brown said: Mild omphalitis cases (inflammation of the belly button) may be treated with alcohol drying, ampicillin, or amoxicillin with follow-up every 24 hours. Open

Host summary Em Gootee summarizes what Dr. Rebecca Brown said: 16% of patients admitted with omphalitis develop necrotizing fasciitis. Open

Host summary Em Gootee summarizes what Dr. Rebecca Brown said: 16% of the patients admitted with onalittis develop necrotizing fasciitis. Open

Host summary Em Gootee summarizes what Dr. Rebecca Brown said: Necrotizing fasciitis from omphalitis presents with rapidly progressive umbilical edema, erythema, drainage, and has a high mortality rate. Open

Host summary Em Gootee summarizes what Dr. Rebecca Brown said: Umbilical hernias can be associated with trisomy 13, 18, and 21. Open

Host summary Em Gootee summarizes what Dr. Rebecca Brown said: Dr. Brown mentioned that if the fascial opening in an umbilical hernia is larger than 1.5 centimeters, it may not close by itself. Open

Host summary Em Gootee summarizes what Dr. Rebecca Brown said: In Walker's studies, 96% of very small umbilical hernias (less than 0.5 centimeters) closed by six years, but no hernia greater than 1.5 centimeters closed by six years of age. Open

Host summary Em Gootee summarizes what Dr. Rebecca Brown said: Unplanned emergency department returns within 30 days after umbilical hernia repair occurred at 2.5%, with rates twice as high for patients younger than 4 years old. Open

Host summary Em Gootee summarizes what Dr. Rebecca Brown said: Asymptomatic umbilical hernia repair should be delayed until greater than 4 years of age. Open

Host summary Em Gootee summarizes what Dr. Rebecca Brown said: In Rangel's study of 167,000 patients at 68 pediatricians' offices, 4,486 had umbilical hernia diagnosis at a median age of 1.6 months, with spontaneous closure occurring in 89% by age 5. Open

Host summary Em Gootee summarizes what Dr. Rebecca Brown said: In Rangel's study, closure rates for smaller hernias (≤1 cm) were nearly 90%, while for larger hernias they were around 80%. Open

Host summary Em Gootee summarizes what Dr. Rebecca Brown said: Rangel's study concluded that umbilical hernia repair should be delayed until age 5 years given the high incidence of spontaneous closure. Open

Host summary Em Gootee summarizes what Dr. Rebecca Brown said: Proboscoid hernia occurs when the skin above the hernia grows and pushes through the opening in the abdominal wall. Open

Host summary Em Gootee summarizes what Dr. Rebecca Brown said: It is recommended to correct proboscoid hernias before school age to avoid psychological issues for the child. Open

Host summary Em Gootee summarizes what Dr. Rebecca Brown said: Dr. Brown prefers to perform umbilicoplasty in umbilical hernia repairs, excising excess skin and using a 4-0 monocryl purse-string suture close to the skin surface to create a cosmetically appealing umbilicus. Open

Host summary Em Gootee summarizes what Dr. Rebecca Brown said: Umbilical granulomas are usually moist but commonly dry up and fall off spontaneously over time. Open

Host summary Em Gootee summarizes what Dr. Rebecca Brown said: Umbilical granulomas often respond to silver nitrate treatment. Open

Summaries Em gave as host · Aerodigestive / ENT 125 summaries

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Aerodigestive & Esophageal Surgery - The Unsalvageable Esophagus & Cases

Host summary Em Gootee summarizing the discussion: Manubrial removing the manubrium is never as straightforward as it seems because your clavicles always get in the way. Open

Host summary Em Gootee summarizing the discussion: Manubrial resection for high esophageal strictures provides less exposure than expected because the clavicles limit the width of the resection corridor. Open

Host summary Em Gootee summarizing the discussion: Esophageal stents are very much a double-edged sword. They can often cause as many problems as they fix. Open

Host summary Em Gootee summarizing the discussion: Kenalog (steroid) injection after stricture dilation is preferred over mitomycin. Mitomycin at high concentrations (up to 5 mg/mL) causes tissue necrosis and has not shown superior outcomes compared to steroids. Open

Host summary Em Gootee summarizing the discussion: For recalcitrant esophageal strictures, weekly dilations (3–4 cycles) prevent fibroblasts from bridging and allow the stricture to scar open rather than closed. Open

Host summary Em Gootee summarizing the discussion: Feeding via gastrojejunal tube with gastric drainage (GJ/G) is a temporizing measure to reduce reflux into the esophagus while managing a refractory stricture. Open

Host summary Em Gootee summarizing the discussion: If you've got mucosal disease, all you need to do is remove all the mucosa. You've got no disease. Open

Host summary Em Gootee summarizing the discussion: Esophageal stents can compress the adjacent trachea, especially in children with tracheomalacia or when the esophagus lies directly posterior to the trachea. Always perform bronchoscopy after stent placement. Open

Host summary Em Gootee summarizing the discussion: If you put in an esophageal stent, have a quick look in the airway when you're done. Open

Host summary Em Gootee summarizing the discussion: We see it with um chronic oesophageal foreign bodies, um, classically the penny. And typically for a chronic one, they come in about 6 weeks later. And they come in with a diagnosis of asthma. Open

Host summary Em Gootee summarizing the discussion: Chronic esophageal foreign bodies (e.g., coins lodged for weeks) can cause posterior tracheal bulge and present as refractory asthma or bronchiolitis, often diagnosed late because chest X-rays are not routinely obtained in asthma protocols. Open

Host summary Em Gootee summarizing the discussion: The aim is to probe it but not push so hard that you create a fistula. That's always embarrassing. Open

Host summary Em Gootee summarizing the discussion: A lot of kids have replaced esophaguuses and most of them don't aspirate, even if you've got a trashed cricoharyngeis. Open

Host summary Em Gootee summarizing the discussion: Covered esophageal stents can temporize anastomotic leaks and allow healing while maintaining luminal patency. Stent removal is typically planned after several weeks. Open

Host summary Em Gootee summarizing the discussion: Tracheal homografts (dead trachea implants) have been performed but are associated with difficult postoperative courses lasting several months. Open

Host summary Em Gootee summarizing the discussion: Tissue-engineered tracheal homografts with pre-epithelialization are under development in multiple centers (London leading) but are not yet ready for routine clinical use. Open

Host summary Em Gootee summarizing the discussion: Long-term surveillance of bypassed esophagus includes periodic CT scans to rule out mucocele and endoscopic evaluation via the persistent TEF if needed. Open

Host summary Em Gootee summarizing the discussion: Posterior tracheopexy (pexing the trachea to the anterior spine) combined with bovine pericardial patch for tracheal defects is an alternative to esophageal bypass, but pericardial patches can fail and create large tracheal defects. Open

Host summary Em Gootee summarizing the discussion: Complications are nearly inevitable in complex esophageal reconstruction. The goal is not to eliminate complications but to anticipate and manage them effectively through a multidisciplinary team approach. Open

Host summary Em Gootee summarizing the discussion: This is a game where complications are almost inevitable. And it's not that you can eliminate them, you can minimize them, but then it's the team approach trying to work out how to manage them. Open

Host summary Em Gootee summarizing the discussion: Complications are nearly inevitable in complex esophageal reconstruction. The goal is not to eliminate complications but to anticipate and manage them effectively through a multidisciplinary team approach. Open

Host summary Em Gootee summarizing the discussion: This is a game where complications are almost inevitable. And it's not that you can eliminate them, you can minimize them, but then it's the team approach trying to work out how to manage them. Open

Quick Literature Updates Episode 8

Host summary Em Gootee summarizing a resource: Hello, pediatric surgery family. I'm M Tombash, a research fellow from Cincinnati Children's Hospital Medical Center. Open

QUAD #2 Thoracoscopic Tracheopexy with Dr. Aaron Garrison

Host summary Em Gootee summarizes what Dr. Aaron Garrison said: Several years ago, the approach was that patients with tracheomalacia would undergo aortopexy. Open

Host summary Em Gootee summarizes what Dr. Aaron Garrison said: In the last 4 to 5 years, it has become standard practice to determine which patients will respond best to tracheopexy versus aortopexy. Open

Host summary Em Gootee summarizes what Dr. Aaron Garrison said: Part of the workup is making sure that there is space to anteriorly suspend the aorta so that the trachea diameter can actually be made larger. Open

Host summary Em Gootee summarizes what Dr. Aaron Garrison said: Preoperative bronchoscopy gives the surgical team an idea of internal anatomy, which can assist in classifying the degree of tracheomalacia prior to surgical intervention. Open

Host summary Em Gootee summarizes what Dr. Aaron Garrison said: When using a thoracoscopic approach, correct positioning is the key to success. Open

Host summary Em Gootee summarizes what Dr. Aaron Garrison said: It is best to use gravity to advantage as it aids in retracting the lungs and trachea placement. Open

Host summary Em Gootee summarizes what Dr. Aaron Garrison said: Opening the pericardium and finding the area at the pericardial-adventitial junction to suspend is the key point of aortopexy. Open

Host summary Em Gootee summarizes what Dr. Aaron Garrison said: Passing suture transternally is preferred with the aortopexy approach, though it can be technically difficult. Open

Host summary Em Gootee summarizes what Dr. Aaron Garrison said: For tracheopexy, a posterior approach via semiprone position is preferred. Open

Host summary Em Gootee summarizes what Dr. Aaron Garrison said: Creating a pneumothorax by putting the Veress off the tip of the scapula helps collapse the lung for trocar placement. Open

Host summary Em Gootee summarizes what Dr. Aaron Garrison said: When operating posteriorly, triangulating your hands gives the best visualization and working space. Open

Host summary Em Gootee summarizes what Dr. Aaron Garrison said: When available, a multidisciplinary team which includes a pulmonologist can allow for internal visualization via bronchoscopy. Open

Host summary Em Gootee summarizes what Dr. Aaron Garrison said: Bronchoscopic guidance technique is primarily used in non-esophageal atresia patients. Open

Host summary Em Gootee summarizes what Dr. Aaron Garrison said: It is important to create enough tension in the suture to ensure that the pexy is secure. Open

Host summary Em Gootee summarizes what Dr. Aaron Garrison said: The approach changes for patients without esophageal atresia or with an esophagus in continuity. Open

Host summary Em Gootee summarizes what Dr. Aaron Garrison said: For patients with esophagus in continuity, the first step is to dissect around the esophagus using a vessel loop for retraction. Open

Host summary Em Gootee summarizes what Dr. Aaron Garrison said: Using pre- and post-operative bronchoscopy allows the surgeon to see the improvement prior to case completion. Open

QUAD #4: Surgical Management of Button Battery & Caustic Ingestion with Dr. Aaron Garrison

Host summary Em Gootee summarizes what Dr. Aaron Garrison said: A 1992 study reviewed more than 2000 cases of button battery ingestion in children and found no deaths. Open

Host summary Em Gootee summarizes what Dr. Aaron Garrison said: Recent studies have found a sevenfold increase in fatalities following button battery ingestions. Open

Host summary Em Gootee summarizes what Dr. Aaron Garrison said: The increase in fatalities is because of the change to a 20-volt lithium cell which causes coagulative necrosis. Open

Host summary Em Gootee summarizes what Dr. Aaron Garrison said: When a button battery sits in one of these positions, it causes transmural injury and will make a fistula between the esophagus and adjacent structures including trachea, blood vessels, or vocal cords. Open

Host summary Em Gootee summarizes what Dr. Aaron Garrison said: A larger battery over 20 millimeters or greater is riskier. Open

Host summary Em Gootee summarizes what Dr. Aaron Garrison said: A battery behind the aortic arch is more concerning. Open

Host summary Em Gootee summarizes what Dr. Aaron Garrison said: In a Colorado study of 13 patients with high severity button battery injuries, 30% had esophageal perforation. Open

Host summary Em Gootee summarizes what Dr. Aaron Garrison said: In the Colorado study, 23% of patients developed stricture. Open

Host summary Em Gootee summarizes what Dr. Aaron Garrison said: Some patients in the Colorado study required G-tube placement and stayed in the hospital for nearly 2 weeks. Open

Host summary Em Gootee summarizes what Dr. Aaron Garrison said: Sentinel bleeds can be the first sign of aortoenteric fistulas. Open

Host summary Em Gootee summarizes what Dr. Aaron Garrison said: Some aortoesophageal fistulas showed up over 2 weeks after the batteries were removed. Open

Host summary Em Gootee summarizes what Dr. Aaron Garrison said: Imaging beforehand with a CTA to assess inflammation and proximity to the aorta is helpful. Open

Host summary Em Gootee summarizes what Dr. Aaron Garrison said: If there is any bleeding or concern for sentinel bleed, have a plan with interventional radiology, cardiology, or anyone who can help in that situation. Open

Host summary Em Gootee summarizes what Dr. Aaron Garrison said: In one case report with a pseudoaneurysm from the arch of the aorta, repair was done with a staged approach: sternotomy on bypass to fix the aorta with a graft, followed by flap repair of the esophagus. Open

Host summary Em Gootee summarizes what Dr. Aaron Garrison said: Button batteries are ingested more than 3500 times per year in the United States. Open

Host summary Em Gootee summarizes what Dr. Aaron Garrison said: Caustic ingestion is most common in young children between 1 and 3 years of age. Open

Host summary Em Gootee summarizes what Dr. Aaron Garrison said: Most caustic ingestions by children are accidental and the amounts ingested tend to be small. Open

Host summary Em Gootee summarizes what Dr. Aaron Garrison said: Acidic substances that are spit back up rather than swallowed can cause severe injury to the epiglottis. Open

Host summary Em Gootee summarizes what Dr. Aaron Garrison said: Smaller children, bigger batteries, and longer ingestion time pose greater risk. Open

Host summary Em Gootee summarizes what Dr. Aaron Garrison said: Do not be reassured by a battery in the stomach, as injuries can progress even after battery removal. Open

Host summary Em Gootee summarizes what Dr. Aaron Garrison said: Having an imaging plan to be proactive about finding transmural and worsening inflammation toward vessels is important. Open

Host summary Em Gootee summarizes what Dr. Aaron Garrison said: For caustic ingestions, be patient; small perforations can heal and be managed conservatively. Open

Host summary Em Gootee summarizes what Dr. Aaron Garrison said: If strictures develop after caustic ingestion, either dilation or surgery may be necessary. Open

QUAD #7 Anesthesia for Thoracoscopic Techniques with Dr. Nathaniel Tighe

Host summary Em Gootee summarizes what Dr. Nathan Tighe said: The association between esophageal atresia and cardiac abnormalities is particularly relevant to anesthetic technique. Open

Host summary Em Gootee summarizes what Dr. Nathan Tighe said: The most common technique for maintaining stillness is short-acting opioid infusions, which result in relatively little hemodynamic instability. Open

Host summary Em Gootee summarizes what Dr. Nathan Tighe said: Volatile anesthetics are especially useful when preservation of spontaneous ventilation is desired. Open

Host summary Em Gootee summarizes what Dr. Nathan Tighe said: Insufflation using pneumothorax created by trocar placement can facilitate surgical exposure by overcoming peak inspiratory pressures to allow lung collapse. Open

Host summary Em Gootee summarizes what Dr. Nathan Tighe said: Insufflation is useful for small kids with good lung compliance but not effective in kids with severe bronchopulmonary dysplasia or other compliance abnormalities. Open

Host summary Em Gootee summarizes what Dr. Nathan Tighe said: Endotracheal tube placement is technically easier than placement of other lung isolation devices. Open

Host summary Em Gootee summarizes what Dr. Nathan Tighe said: In kids with a pig bronchus or similar situation, this really becomes very difficult. Open

Host summary Em Gootee summarizes what Dr. Nathan Tighe said: A tracheal bronchus (pig bronchus) is an anatomical variant where an accessory bronchus originates directly from the supracarinal trachea. Open

Host summary Em Gootee summarizes what Dr. Nathan Tighe said: In larger kids (usually 8 years or above) with recurrent fistulas, double-lumen tubes can be used and are the easiest device for lung isolation because they allow independent ventilation of the two lungs. Open

Host summary Em Gootee summarizes what Dr. Nathan Tighe said: Early conversations between anesthesiologists and surgeons about patient specifics are part of deciding the best modality for each individual patient. Open

Host summary Em Gootee summarizes what Dr. Nathan Tighe said: Single ventricle patients may be candidates for open repair or ECMO support to ensure good outcomes. Open

QUAD #5 Pharyngeal Scar Management with Dr. Doug von Allmen

Host summary Em Gootee summarizes what Dr. Douglas von Allmen said: Etiologies of pharyngeal stenosis include caustic ingestion, iatrogenic injury, or multi-level upper airway surgery Open

Host summary Em Gootee summarizes what Dr. Douglas von Allmen said: Treatment goals for pharyngeal stenosis patients are tiered: achieving adequate voice, breathing without tracheostomy, preventing aspiration, and swallowing without G-tube Open

Host summary Em Gootee summarizes what Dr. Douglas von Allmen said: Prolonged stenting of about 4 to 6 weeks is typical for pharyngeal stenosis management Open

Host summary Em Gootee summarizes what Dr. Douglas von Allmen said: Balloon dilation typically works mostly in the post-cricoid area for smaller circumferential stenosis Open

Host summary Em Gootee summarizes what Dr. Douglas von Allmen said: Adjuvant therapies including injectable steroids, mitomycin C, and 5-fluorouracil can be used to help delay formation of recalcitrant scar Open

Host summary Em Gootee summarizes what Dr. Douglas von Allmen said: Pharyngeal stenosis patients are at high risk for ongoing aspiration Open

Host summary Em Gootee summarizes what Dr. Douglas von Allmen said: Tracheostomy can be helpful for managing aspiration risk in pharyngeal stenosis patients Open

Host summary Em Gootee summarizes what Dr. Douglas von Allmen said: Swallowing outcomes can be difficult and poor in the long term for pharyngeal stenosis patients Open

QUAD #20: Endoscopic Repair of Minor Laryngeal Clefts with Dr. Catherine Hart

Host summary Em Gootee summarizes what Dr. Katherine Hart said: The goal of endoscopic cleft repair is to remove the interarytenoid mucosa to create two raw surfaces and then suture the edges together. Open

Host summary Em Gootee summarizes what Dr. Katherine Hart said: If suture bites are taken too deeply during cleft repair, edges will be inverted and the child will continue to have problems. Open

Host summary Em Gootee summarizes what Dr. Katherine Hart said: Interarytenoid mucosa can be resected using laser or cold steel (knife), and the choice does not matter clinically. Open

Host summary Em Gootee summarizes what Dr. Katherine Hart said: Complete demucosalization of the apex is essential; if incomplete, a hole will remain at the apex and the child will continue to aspirate. Open

Host summary Em Gootee summarizes what Dr. Katherine Hart said: Epiglottic folds are released after suturing to create extra space. Open

Host summary Em Gootee summarizes what Dr. Katherine Hart said: Typically 2 to 3 sutures are placed depending on the extent of the cleft. Open

Host summary Em Gootee summarizes what Dr. Katherine Hart said: Surgical closure of laryngeal clefts achieves improvement in symptoms in almost 80% of children and resolution in 70%. Open

Host summary Em Gootee summarizes what Dr. Katherine Hart said: Surgical closure has a slightly higher risk of complications compared to conservative management. Open

Host summary Em Gootee summarizes what Dr. Katherine Hart said: A consensus guideline exists for diagnosing and managing laryngeal clefts in children and is a good resource, especially for those newer to practice. Open

QUAD #25: Medical Management of Minor Laryngeal Clefts with Dr. Greg Burg

Host summary Em Gootee summarizes what Dr. Greg Burg said: Flexible bronchoscopy is quite limited in evaluating a cleft unless it's a major cleft. Open

Host summary Em Gootee summarizes what Dr. Greg Burg said: A deep interarytenoid notch is considered a minor cleft by Dr. Burg's team. Open

Host summary Em Gootee summarizes what Dr. Greg Burg said: Respiratory culture showed predominantly upper airway flora and two Candida species in the mucopurulent bronchitis. Open

Host summary Em Gootee summarizes what Dr. Greg Burg said: Clinical assessment includes evaluating frequency of coughing, sick visits, emergency room visits, and hospitalizations. Open

Host summary Em Gootee summarizes what Dr. Greg Burg said: Bronchoscopic assessment looks for airway edema, visibility of tracheal rings, mucus plugging, and secretions. Open

Host summary Em Gootee summarizes what Dr. Greg Burg said: Chest CT is the most important differential imaging study, used to look for chronic changes related to aspiration. Open

Host summary Em Gootee summarizes what Dr. Greg Burg said: G-tubes and NG-tubes are used as needed for nutritional intake. Open

Host summary Em Gootee summarizes what Dr. Greg Burg said: Saline is used to thin out secretions. Open

Host summary Em Gootee summarizes what Dr. Greg Burg said: Chronic macrolide therapy can be used as an anti-neutrophilic agent, derived from cystic fibrosis literature. Open

Host summary Em Gootee summarizes what Dr. Greg Burg said: For patients with significant tracheomalacia, ipratropium may be used over albuterol. Open

Journal of Pediatric Surgery Article Review: 2nd Quarter (Apr-Jun) 2025

Host summary Em Gootee summarizing the discussion: A subset of children after esophageal atresia repair experience severe airway collapse, leaving them ventilator dependent or suffering repeated cyanotic spells Open

Host summary Em Gootee summarizing the discussion: A significant number of outreach services are located within 50 kilometers of a children's hospital, leaving vast regions without access to pediatric surgical care Open

Host summary Em Gootee summarizing the discussion: The study examined 4,612 G-tube placements from 71 NSQIP-Pediatric hospitals in 2023 Open

Host summary Em Gootee summarizing the discussion: Upper GI studies were obtained in 45% of first-time G-tube cases with substantial interhospital variability from 0 to 99% Open

Host summary Em Gootee summarizing the discussion: 14% of G-tube cases resulted in an ED visit within 0 to 30 days Open

Host summary Em Gootee summarizing the discussion: 5.2% of G-tube cases involved dislodgement within 0 to 30 days Open

Summaries Em gave as host · ALL 11 summaries

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Update Course Rewind: Pediatric Biliary Stones - Preventing Gallstone Pancreatitis 2024

Host summary Em Gootee summarizing the discussion: Hello pediatric surgery family. Open

Host summary Em Gootee summarizing the discussion: The patient is a 16-year-old currently undergoing treatment for acute lymphoblastic leukemia (ALL) who presents with right upper quadrant pain, neutropenia, markedly elevated liver function tests, and ultrasound findings consistent with acute cholecystitis and choledocholithiasis. Open

Host summary Em Gootee summarizing the discussion: In this neutropenic and thrombocytopenic patient, the approach taken was to start antibiotics and address the elevated liver function tests. Open

Host summary Em Gootee summarizing the discussion: Gallstone pancreatitis is inflammation of the pancreas triggered by a gallstone obstructing the bile duct, which can also impede pancreatic drainage, preventing pancreatic enzymes from reaching the small intestine and leading them to accumulate and damage the pancreas. Open

Host summary Em Gootee summarizing the discussion: In neutropenic and thrombocytopenic patients with cholecystitis and choledocholithiasis, initial conservative management with antibiotics can be effective, particularly when spontaneous stone passage occurs. Open

Host summary Em Gootee summarizing the discussion: For gallstone pancreatitis, early ERCP is typically reserved for cases with persistent biliary obstruction or cholangitis, as many patients improve without intervention. Open

Host summary Em Gootee summarizing the discussion: The timing of cholecystectomy in gallstone pancreatitis should be based on clinical improvement rather than complete biochemical normalization, with intraoperative cholangiogram and ERCP coordinated as needed. Open

Update Course Rewind: Pediatric Biliary Stones - Preventing Gallstone Pancreatitis 2024

Host summary Em Gootee summarizing the discussion: The 12th annual update course in pediatric surgery introduced a new classification system with three categories: Green Circle for established practice, Blue Square for promising newer practice, and Black Diamond for early adopter practice only. Open

Host summary Em Gootee summarizing the discussion: In neutropenic and thrombocytopenic patients with cholecystitis and choledocholithiasis, initial conservative management with antibiotics can be effective, particularly when spontaneous stone passage occurs. Open

Host summary Em Gootee summarizing the discussion: For gallstone pancreatitis, early ERCP is typically reserved for cases with persistent biliary obstruction or cholangitis, as many patients improve without intervention. Open

Host summary Em Gootee summarizing the discussion: The timing of cholecystectomy in gallstone pancreatitis should be based on clinical improvement rather than complete biochemical normalization, with intraoperative cholangiogram and ERCP coordinated as needed. Open

Summaries Em gave as host · Anorectal Malformation 27 summaries

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Pediatric Colorectal Contraversies Part II: Pediatric Colorectal...

Host summary Em Gootee summarizing the discussion: For vestibular fistula, Professor Liam prefers primary repair around day 5-7 of life Open

Host summary Em Gootee summarizing the discussion: I prefer primary repair around, uh, 75 or 7 days. It means I wait until 5th or 7th day, and I perform primary repair. Open

Host summary Em Gootee summarizing the discussion: About 30-40% of anorectal stenosis or rectal atresia cases will have a presacral mass Open

Host summary Em Gootee summarizing the discussion: MRI is the best way to show a presacral mass Open

Host summary Em Gootee summarizing the discussion: For anorectal stenosis repair, open posteriorly only to preserve anterior dentate line and avoid anterior rectal dissection Open

Host summary Em Gootee summarizing the discussion: Loop colostomy is never completely diverting no matter how much people believe their loops are diverting. Open

Host summary Em Gootee summarizing the discussion: Loop colostomy is never completely diverting no matter how much surgeons believe it is Open

Host summary Em Gootee summarizing the discussion: Spillage across loop colostomy causes urinary tract infections in patients with fistulas Open

Host summary Em Gootee summarizing the discussion: Cleaning out distal colon at colostomy creation takes about 20-30 minutes and is very important Open

Host summary Em Gootee summarizing the discussion: Distal sigmoid colostomy makes laparoscopic operation more difficult and may require opening to take down mucous fistula Open

Host summary Em Gootee summarizing the discussion: Best tube for hydrocolpos drainage is curled pigtail tube because hydrocolpos recedes into pelvis over months; straight tube will fall out Open

Prenatal Imaging and Counseling: Cloaca and Complex ARMs 2015

Host summary Em Gootee summarizing the discussion: Cloaca management has become a collaborative team effort involving pediatric surgery, urology, and gynecology, plus ancillary services (fetal medicine, neonatology, nephrology, GI, radiology, behavioral medicine, social work, nursing). Open

Host summary Em Gootee summarizing the discussion: False-positive prenatal diagnoses of ARM occur, causing parental alarm when the baby is born without any issues. Open

Update Course Rewind: Perineal Body Sparing PSARP 2023

Host summary Em Gootee summarizing the discussion: One study has 6 patients and the other has 4 patients. Open

Host summary Em Gootee summarizing the discussion: The techniques are similar but slightly different. Open

Host summary Em Gootee summarizing the discussion: Perineal body sparing techniques can reduce post-operative infection risks in patients undergoing dilations. Open

Colorectal Quiz: Episode 49 – Collaborating for Kids: Colorectal & Pelvic Solutions (with a Little Help from AI)

Host summary Em Gootee summarizing the discussion: When documents are uploaded to Notebook LM, the AI creates an expert based solely on the provided content, not external sources. Open

Colorectal Quiz: Episode 49 – Collaborating for Kids: Colorectal & Pelvic Care (with Help from AI)

Host summary Em Gootee summarizing the discussion: When you upload anything to the Notebook LM, you kind of create your own expert just from the provided document. It's not like any other chatbots or chat GPT go look around what's out there with the anorectal malformations and pulling information from that. Open

Host summary Em Gootee summarizing the discussion: When documents are uploaded to Notebook LM, it creates an expert based solely on the provided document without searching external sources Open

Colorectal Quiz Episode 1 - Low Bulbar Fistua

Host summary Em Gootee summarizing the discussion: I mean just me mentioning this, I bet there's a case that popped up in your mind that was a real head scratcher that you'd never seen before. Open

Host summary Em Gootee summarizing the discussion: In low rectal malformations, dissecting a small portion of the anterior rectal wall and lifting it off the urinary tract will usually rule out fistula. Open

The Colorectal Quiz: Episode 1

Host summary Em Gootee summarizing the discussion: Pediatric colorectal surgery. It just sounds really complex, right? These patients can come with anatomic variances, really rare anomalies. Their care can be complex, dynamic, multidisciplinary, and pose a lot of clinical challenges to your everyday pediatric surgeon. Open

Host summary Em Gootee summarizing the discussion: For cross-table lateral, baby is positioned prone with buttocks at highest point where air will rise, can be done at bedside with bump under buttocks Open

Host summary Em Gootee summarizing the discussion: In patients with low rectum, inspecting anterior rectal wall by dissecting a little bit and carefully lifting it off the urinary tract will usually rule out fistula Open

Summaries Em gave as host · Anorectal Malformations & Cloacal Reconstruction 2 summaries

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Colorectal Quiz Episode 1 - Low Bulbar Fistua

Host summary Em Gootee summarizing the discussion: I mean just me mentioning this, I bet there's a case that popped up in your mind that was a real head scratcher that you'd never seen before. Open

Host summary Em Gootee summarizing the discussion: In low rectal malformations, dissecting a small portion of the anterior rectal wall and lifting it off the urinary tract will usually rule out fistula. Open

Summaries Em gave as host · Anorectal Malformations & Cloacal Reconstruction 2 summaries

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Colorectal Quiz Episode 1 - Low Bulbar Fistua

Host summary Em Gootee summarizing the discussion: I mean just me mentioning this, I bet there's a case that popped up in your mind that was a real head scratcher that you'd never seen before. Open

Host summary Em Gootee summarizing the discussion: In low rectal malformations, dissecting a small portion of the anterior rectal wall and lifting it off the urinary tract will usually rule out fistula. Open

Summaries Em gave as host · Aspiration 17 summaries

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