The length from the takeoff of the common channel to the urethra, so your to the, to the bladder neck is an important length, because what you don't want to do in a total urogen, the total urogenal mobilization is bring the bladder neck right down to the perineum. So I think if you, if that's done, then you're probably doomed to have that patient be incontinent of urine.
it's not just the Common channel length anymore. I think it's the common channel plus what is the length of the urethra, where does that take off from? And then also you may have a 1 to 3 centimeter common channel, but the rectal takeoff is way up on the back of the vagina, so that would then alter your approach.
if you actually manage the bladder appropriately, some of that excess volume is going to go down, and by allowing these bladders to cycle better with intermittent catheterization, we found that to be a better, uh, long term strategy than going in and surgically excising part of the bladder
I actually send people home with, for, for laparoscopic inguinal hernias. I'm not so sure if we're open yet, but lap, which is the majority of my practice, zero narcotics, zero six months. I have not written a script. I send them with ice and scheduled Motrin and Tylenol.
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.
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.
Journal of Pediatric Surgery Article Review: 2nd Quarter (Apr-Jun) 2024
▶Ep 36 · 0:06
quoteHi 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.↗
▶Ep 36 · 1:05
quoteI'm a pediatric surgeon at Alberta Children's Hospital. I've also been the publication chair for the uh Pacific Association of Pediatric Surgeons.↗
▶Ep 36 · 1:25
host_summaryMMP-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↗
▶Ep 36 · 1:43
host_summaryHigher levels of MMP-7 are associated with the diagnosis of biliary atresia↗
▶Ep 36 · 1:56
host_summaryIn a cohort of 329 biliary atresia cases from July 2020 to December 2022, 40 were classified as low MMP-7↗
▶Ep 36 · 2:11
quoteThis 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↗
▶Ep 36 · 2:36
host_summaryLow levels of MMP-7 in biliary atresia patients are associated with low levels of preoperative GGT (gamma glutamyl transpeptidase) and direct bilirubin↗
▶Ep 36 · 3:02
host_summaryGGT (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↗
▶Ep 36 · 3:19
host_summaryBiliary atresia has variable outcomes even within one center, with patients who anatomically look similar having dramatically different outcomes↗
▶Ep 36 · 4:09
host_summaryHaving lower MMP-7 levels within the cohort of biliary atresia patients is associated with worse prognosis↗
▶Ep 36 · 4:26
quoteAnd 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?↗
▶Ep 36 · 4:41
host_summaryThe mechanism of why low MMP-7 levels in biliary atresia patients leads to worse prognosis is unknown↗
▶Ep 36 · 7:02
host_summaryIn 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↗
▶Ep 36 · 7:43
host_summaryOf 267 uncomplicated gastroschisis patients, 78% received exclusive breast milk in the first 28 days of life and 22% received supplemental or exclusive formula↗
▶Ep 36 · 8:27
host_summaryThere 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↗
▶Ep 36 · 8:53
host_summaryPatients 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↗
▶Ep 36 · 12:46
host_summaryA 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↗
▶Ep 36 · 13:16
host_summaryThere 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)↗
▶Ep 36 · 13:30
opinionThe life course progression of anorectal malformation and Hirschsprung disease is not well understood↗
Journal of Pediatric Surgery Article Review: 3rd Quarter (Jul-Sep) 2024
▶Ep 37 · 0:06
quoteHi 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.↗
▶Ep 37 · 1:38
quoteMy 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.↗
▶Ep 37 · 1:56
clinicalThe PCPLC multi-institutional registry includes a number of institutions throughout the United States.↗
▶Ep 37 · 3:20
epidemiological85% of Hirschsprung patients were diagnosed at less than 1 year of age.↗
▶Ep 37 · 3:45
clinicalKids with shorter segment disease (rectosigmoid or very small portion of aganglionic bowel) were more likely to be diagnosed at a later age.↗
▶Ep 37 · 3:57
clinicalChildren with long segment Hirschsprung disease typically present at birth with classic symptoms such as failure to pass meconium.↗
▶Ep 37 · 4:26
clinicalApproximately one-third of neonates and 50% of infants, toddlers, and children had diverting ostomies performed prior to pull-through.↗
▶Ep 37 · 5:01
clinicalThere was no difference in overall rates of redo pull-throughs across age groups.↗
▶Ep 37 · 5:07
clinicalOlder children were more likely to need a redo pull-through due to an anastomotic leak.↗
▶Ep 37 · 5:13
opinionHigher rates of diverting ostomy post pull-through were suspected to be a treatment for post pull-through leak or anastomotic leak.↗
▶Ep 37 · 5:24
clinicalThe only outcome difference seen was nighttime soiling or incontinence in the older patient population.↗
▶Ep 37 · 7:44
quoteI am a pediatric surgeon. Uh, in the division of pediatric Surgery with Presbyterian Healthcare Services in Albuquerque, New Mexico↗
▶Ep 37 · 8:09
clinicalThe systematic review on gastroschisis included 28 high quality manuscripts.↗
▶Ep 37 · 8:15
clinicalTwo randomized controlled trials on gastroschisis had been started but both ended prematurely and were underpowered.↗
▶Ep 37 · 10:37
clinicalClinical practice suggests that skin organisms are most commonly identified in infections among infants with gastroschisis.↗
▶Ep 37 · 10:44
clinicalGastroschisis infants have a fairly high rate of wound infection.↗
▶Ep 37 · 10:50
clinicalSutureless closure has the lowest rate of infection for gastroschisis.↗
▶Ep 37 · 10:50
clinicalSilo closures have a higher rate of infection than other closure methods for gastroschisis.↗
▶Ep 37 · 10:57
guidelineThe 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.↗
▶Ep 37 · 12:22
clinicalStable gastroschisis infants with sufficient abdominal capacity for sutureless closure tend to have the best outcomes.↗
▶Ep 37 · 12:29
clinicalMinimizing fluids and paralytics in gastroschisis infants improves their results.↗
▶Ep 37 · 12:35
clinicalGastroschisis patients with sutureless closure have shorter length of stay and achieve feeding sooner.↗
▶Ep 37 · 15:11
clinicalThe Clavien-Madadi classification scale consists of several grades from 1 to 5 based on the type of therapy needed to correct the complication.↗
▶Ep 37 · 15:46
clinicalThe validation process circulated up to 20 case scenarios of unexpected events within the ERNICA Network (European Reference Network for inherited and congenital anomalies).↗
▶Ep 37 · 16:34
clinical59 surgeons from 12 European countries completed the Clavien-Madadi validation questionnaire.↗
▶Ep 37 · 17:04
clinicalNearly 82% of surgeons affirmed advantages of the Clavien-Madadi classification.↗
▶Ep 37 · 17:04
clinical43% of pediatric surgeons preferred the Clavien-Madadi classification compared to 12% for the Clavien-Dindo classification.↗
Umbilical Disorders with Dr. Rebeccah Brown
▶Ep 39 · 0:34
quoteTwo umbilical arteries and one umbilical vein surrounding by a gelatin-like extracellular matrix known as Worthin's jelly.↗
▶Ep 39 · 0:34
host_summaryThe umbilical cord contains two umbilical arteries and one umbilical vein surrounded by Wharton's jelly (a gelatin-like extracellular matrix).↗
▶Ep 39 · 0:50
host_summaryDelayed umbilical cord separation can be a manifestation of an immune deficiency.↗
▶Ep 39 · 0:50
quoteThey usually fall off 2 to 3 weeks, and the delay can be a manifestation of an immune deficiency.↗
▶Ep 39 · 0:50
host_summaryUmbilical cords usually fall off at 2 to 3 weeks after birth.↗
▶Ep 39 · 1:20
host_summaryMild omphalitis cases (inflammation of the belly button) may be treated with alcohol drying, ampicillin, or amoxicillin with follow-up every 24 hours.↗
▶Ep 39 · 1:40
quote16% of the patients admitted with onalittis develop necrotizing fasciitis.↗
▶Ep 39 · 1:40
host_summary16% of patients admitted with omphalitis develop necrotizing fasciitis.↗
▶Ep 39 · 1:46
host_summaryNecrotizing fasciitis from omphalitis presents with rapidly progressive umbilical edema, erythema, drainage, and has a high mortality rate.↗
▶Ep 39 · 2:27
host_summaryUmbilical hernias can be associated with trisomy 13, 18, and 21.↗
▶Ep 39 · 2:47
host_summaryDr. Brown mentioned that if the fascial opening in an umbilical hernia is larger than 1.5 centimeters, it may not close by itself.↗
▶Ep 39 · 2:55
host_summaryIn 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.↗
▶Ep 39 · 4:54
host_summaryUnplanned 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.↗
▶Ep 39 · 5:10
host_summaryAsymptomatic umbilical hernia repair should be delayed until greater than 4 years of age.↗
▶Ep 39 · 5:18
host_summaryIn 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.↗
▶Ep 39 · 5:53
host_summaryIn Rangel's study, closure rates for smaller hernias (≤1 cm) were nearly 90%, while for larger hernias they were around 80%.↗
▶Ep 39 · 6:12
host_summaryRangel's study concluded that umbilical hernia repair should be delayed until age 5 years given the high incidence of spontaneous closure.↗
▶Ep 39 · 6:56
host_summaryProboscoid hernia occurs when the skin above the hernia grows and pushes through the opening in the abdominal wall.↗
▶Ep 39 · 7:05
host_summaryIt is recommended to correct proboscoid hernias before school age to avoid psychological issues for the child.↗
▶Ep 39 · 8:00
host_summaryDr. 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.↗
▶Ep 39 · 8:55
host_summaryUmbilical granulomas are usually moist but commonly dry up and fall off spontaneously over time.↗
▶Ep 39 · 9:00
host_summaryUmbilical granulomas often respond to silver nitrate treatment.↗
Aerodigestive & Esophageal Surgery - The Unsalvageable Esophagus & Cases
▶Ep 3 · 16:30
quoteManubrial removing the manubrium is never as straightforward as it seems because your clavicles always get in the way.↗
▶Ep 3 · 16:30
quoteManubrial removing the manubrium is never as straightforward as it seems because your clavicles always get in the way.↗
▶Ep 3 · 16:38
clinicalManubrial resection for high esophageal strictures provides less exposure than expected because the clavicles limit the width of the resection corridor.↗
▶Ep 3 · 16:38
clinicalManubrial resection for high esophageal strictures provides less exposure than expected because the clavicles limit the width of the resection corridor.↗
▶Ep 3 · 19:36
quoteEsophageal stents are very much a double-edged sword. They can often cause as many problems as they fix.↗
▶Ep 3 · 19:36
quoteEsophageal stents are very much a double-edged sword. They can often cause as many problems as they fix.↗
▶Ep 3 · 33:28
clinicalKenalog (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.↗
▶Ep 3 · 33:28
clinicalKenalog (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.↗
▶Ep 3 · 36:29
clinicalFor recalcitrant esophageal strictures, weekly dilations (3–4 cycles) prevent fibroblasts from bridging and allow the stricture to scar open rather than closed.↗
▶Ep 3 · 36:29
clinicalFor recalcitrant esophageal strictures, weekly dilations (3–4 cycles) prevent fibroblasts from bridging and allow the stricture to scar open rather than closed.↗
▶Ep 3 · 45:47
clinicalFeeding via gastrojejunal tube with gastric drainage (GJ/G) is a temporizing measure to reduce reflux into the esophagus while managing a refractory stricture.↗
▶Ep 3 · 45:47
clinicalFeeding via gastrojejunal tube with gastric drainage (GJ/G) is a temporizing measure to reduce reflux into the esophagus while managing a refractory stricture.↗
▶Ep 3 · 47:43
quoteIf you've got mucosal disease, all you need to do is remove all the mucosa. You've got no disease.↗
▶Ep 3 · 47:43
quoteIf you've got mucosal disease, all you need to do is remove all the mucosa. You've got no disease.↗
▶Ep 3 · 48:18
clinicalEsophageal 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.↗
▶Ep 3 · 48:18
clinicalEsophageal 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.↗
▶Ep 3 · 48:20
quoteIf you put in an esophageal stent, have a quick look in the airway when you're done.↗
▶Ep 3 · 48:20
quoteIf you put in an esophageal stent, have a quick look in the airway when you're done.↗
▶Ep 3 · 50:13
quoteWe 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.↗
▶Ep 3 · 50:13
quoteWe 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.↗
▶Ep 3 · 50:20
clinicalChronic 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.↗
▶Ep 3 · 50:20
clinicalChronic 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.↗
▶Ep 3 · 52:06
quoteThe aim is to probe it but not push so hard that you create a fistula. That's always embarrassing.↗
▶Ep 3 · 52:06
quoteThe aim is to probe it but not push so hard that you create a fistula. That's always embarrassing.↗
▶Ep 3 · 1:01:05
quoteA lot of kids have replaced esophaguuses and most of them don't aspirate, even if you've got a trashed cricoharyngeis.↗
▶Ep 3 · 1:01:05
quoteA lot of kids have replaced esophaguuses and most of them don't aspirate, even if you've got a trashed cricoharyngeis.↗
▶Ep 3 · 1:10:42
clinicalCovered esophageal stents can temporize anastomotic leaks and allow healing while maintaining luminal patency. Stent removal is typically planned after several weeks.↗
▶Ep 3 · 1:10:42
clinicalCovered esophageal stents can temporize anastomotic leaks and allow healing while maintaining luminal patency. Stent removal is typically planned after several weeks.↗
▶Ep 3 · 1:31:42
clinicalTracheal homografts (dead trachea implants) have been performed but are associated with difficult postoperative courses lasting several months.↗
▶Ep 3 · 1:31:42
clinicalTracheal homografts (dead trachea implants) have been performed but are associated with difficult postoperative courses lasting several months.↗
▶Ep 3 · 1:32:06
clinicalTissue-engineered tracheal homografts with pre-epithelialization are under development in multiple centers (London leading) but are not yet ready for routine clinical use.↗
▶Ep 3 · 1:32:06
clinicalTissue-engineered tracheal homografts with pre-epithelialization are under development in multiple centers (London leading) but are not yet ready for routine clinical use.↗
▶Ep 3 · 1:33:15
clinicalLong-term surveillance of bypassed esophagus includes periodic CT scans to rule out mucocele and endoscopic evaluation via the persistent TEF if needed.↗
▶Ep 3 · 1:33:15
clinicalLong-term surveillance of bypassed esophagus includes periodic CT scans to rule out mucocele and endoscopic evaluation via the persistent TEF if needed.↗
▶Ep 3 · 1:34:15
clinicalPosterior 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.↗
▶Ep 3 · 1:34:15
host_summaryPosterior 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.↗
▶Ep 3 · 1:39:43
opinionComplications 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.↗
▶Ep 3 · 1:39:43
quoteThis 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.↗
▶Ep 3 · 1:39:43
quoteThis 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.↗
▶Ep 3 · 1:39:43
opinionComplications 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.↗
QUAD #2 Thoracoscopic Tracheopexy with Dr. Aaron Garrison
▶Ep 17 · 0:36
host_summarySeveral years ago, the approach was that patients with tracheomalacia would undergo aortopexy.↗
▶Ep 17 · 0:43
host_summaryIn the last 4 to 5 years, it has become standard practice to determine which patients will respond best to tracheopexy versus aortopexy.↗
▶Ep 17 · 1:45
host_summaryPart 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.↗
▶Ep 17 · 2:02
host_summaryPreoperative bronchoscopy gives the surgical team an idea of internal anatomy, which can assist in classifying the degree of tracheomalacia prior to surgical intervention.↗
▶Ep 17 · 3:23
host_summaryWhen using a thoracoscopic approach, correct positioning is the key to success.↗
▶Ep 17 · 3:27
host_summaryIt is best to use gravity to advantage as it aids in retracting the lungs and trachea placement.↗
▶Ep 17 · 4:01
host_summaryOpening the pericardium and finding the area at the pericardial-adventitial junction to suspend is the key point of aortopexy.↗
▶Ep 17 · 4:16
host_summaryPassing suture transternally is preferred with the aortopexy approach, though it can be technically difficult.↗
▶Ep 17 · 4:23
host_summaryFor tracheopexy, a posterior approach via semiprone position is preferred.↗
▶Ep 17 · 4:28
host_summaryCreating a pneumothorax by putting the Veress off the tip of the scapula helps collapse the lung for trocar placement.↗
▶Ep 17 · 4:38
host_summaryWhen operating posteriorly, triangulating your hands gives the best visualization and working space.↗
▶Ep 17 · 4:56
host_summaryWhen available, a multidisciplinary team which includes a pulmonologist can allow for internal visualization via bronchoscopy.↗
▶Ep 17 · 5:05
host_summaryBronchoscopic guidance technique is primarily used in non-esophageal atresia patients.↗
▶Ep 17 · 5:53
host_summaryIt is important to create enough tension in the suture to ensure that the pexy is secure.↗
▶Ep 17 · 6:07
host_summaryThe approach changes for patients without esophageal atresia or with an esophagus in continuity.↗
▶Ep 17 · 6:14
host_summaryFor patients with esophagus in continuity, the first step is to dissect around the esophagus using a vessel loop for retraction.↗
▶Ep 17 · 6:32
host_summaryUsing pre- and post-operative bronchoscopy allows the surgeon to see the improvement prior to case completion.↗
QUAD #4: Surgical Management of Button Battery & Caustic Ingestion with Dr. Aaron Garrison
▶Ep 18 · 0:41
host_summaryA 1992 study reviewed more than 2000 cases of button battery ingestion in children and found no deaths.↗
▶Ep 18 · 0:52
host_summaryRecent studies have found a sevenfold increase in fatalities following button battery ingestions.↗
▶Ep 18 · 0:59
host_summaryThe increase in fatalities is because of the change to a 20-volt lithium cell which causes coagulative necrosis.↗
▶Ep 18 · 1:14
host_summaryWhen 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.↗
▶Ep 18 · 1:39
host_summaryA larger battery over 20 millimeters or greater is riskier.↗
▶Ep 18 · 1:49
host_summaryA battery behind the aortic arch is more concerning.↗
▶Ep 18 · 2:05
host_summaryIn a Colorado study of 13 patients with high severity button battery injuries, 30% had esophageal perforation.↗
▶Ep 18 · 2:14
host_summaryIn the Colorado study, 23% of patients developed stricture.↗
▶Ep 18 · 2:16
host_summarySome patients in the Colorado study required G-tube placement and stayed in the hospital for nearly 2 weeks.↗
▶Ep 18 · 2:32
host_summarySentinel bleeds can be the first sign of aortoenteric fistulas.↗
▶Ep 18 · 2:50
host_summarySome aortoesophageal fistulas showed up over 2 weeks after the batteries were removed.↗
▶Ep 18 · 3:39
host_summaryImaging beforehand with a CTA to assess inflammation and proximity to the aorta is helpful.↗
▶Ep 18 · 3:59
host_summaryIf there is any bleeding or concern for sentinel bleed, have a plan with interventional radiology, cardiology, or anyone who can help in that situation.↗
▶Ep 18 · 4:10
host_summaryIn 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.↗
▶Ep 18 · 6:10
host_summaryButton batteries are ingested more than 3500 times per year in the United States.↗
▶Ep 18 · 6:20
host_summaryCaustic ingestion is most common in young children between 1 and 3 years of age.↗
▶Ep 18 · 6:25
host_summaryMost caustic ingestions by children are accidental and the amounts ingested tend to be small.↗
▶Ep 18 · 6:43
host_summaryAcidic substances that are spit back up rather than swallowed can cause severe injury to the epiglottis.↗
▶Ep 18 · 7:20
host_summarySmaller children, bigger batteries, and longer ingestion time pose greater risk.↗
▶Ep 18 · 7:25
host_summaryDo not be reassured by a battery in the stomach, as injuries can progress even after battery removal.↗
▶Ep 18 · 7:31
host_summaryHaving an imaging plan to be proactive about finding transmural and worsening inflammation toward vessels is important.↗
▶Ep 18 · 7:39
host_summaryFor caustic ingestions, be patient; small perforations can heal and be managed conservatively.↗
▶Ep 18 · 7:43
host_summaryIf strictures develop after caustic ingestion, either dilation or surgery may be necessary.↗
QUAD #7 Anesthesia for Thoracoscopic Techniques with Dr. Nathaniel Tighe
▶Ep 20 · 1:05
host_summaryThe association between esophageal atresia and cardiac abnormalities is particularly relevant to anesthetic technique.↗
▶Ep 20 · 1:42
host_summaryThe most common technique for maintaining stillness is short-acting opioid infusions, which result in relatively little hemodynamic instability.↗
▶Ep 20 · 1:53
host_summaryVolatile anesthetics are especially useful when preservation of spontaneous ventilation is desired.↗
▶Ep 20 · 2:31
host_summaryInsufflation using pneumothorax created by trocar placement can facilitate surgical exposure by overcoming peak inspiratory pressures to allow lung collapse.↗
▶Ep 20 · 2:48
host_summaryInsufflation is useful for small kids with good lung compliance but not effective in kids with severe bronchopulmonary dysplasia or other compliance abnormalities.↗
▶Ep 20 · 4:19
host_summaryEndotracheal tube placement is technically easier than placement of other lung isolation devices.↗
▶Ep 20 · 4:39
quoteIn kids with a pig bronchus or similar situation, this really becomes very difficult.↗
▶Ep 20 · 4:48
host_summaryA tracheal bronchus (pig bronchus) is an anatomical variant where an accessory bronchus originates directly from the supracarinal trachea.↗
▶Ep 20 · 5:17
host_summaryIn 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.↗
▶Ep 20 · 5:38
host_summaryEarly conversations between anesthesiologists and surgeons about patient specifics are part of deciding the best modality for each individual patient.↗
▶Ep 20 · 6:07
host_summarySingle ventricle patients may be candidates for open repair or ECMO support to ensure good outcomes.↗
QUAD #5 Pharyngeal Scar Management with Dr. Doug von Allmen
▶Ep 21 · 0:42
host_summaryEtiologies of pharyngeal stenosis include caustic ingestion, iatrogenic injury, or multi-level upper airway surgery↗
▶Ep 21 · 1:05
host_summaryTreatment goals for pharyngeal stenosis patients are tiered: achieving adequate voice, breathing without tracheostomy, preventing aspiration, and swallowing without G-tube↗
▶Ep 21 · 2:59
host_summaryProlonged stenting of about 4 to 6 weeks is typical for pharyngeal stenosis management↗
▶Ep 21 · 4:10
host_summaryBalloon dilation typically works mostly in the post-cricoid area for smaller circumferential stenosis↗
▶Ep 21 · 4:24
host_summaryAdjuvant therapies including injectable steroids, mitomycin C, and 5-fluorouracil can be used to help delay formation of recalcitrant scar↗
▶Ep 21 · 5:48
host_summaryPharyngeal stenosis patients are at high risk for ongoing aspiration↗
▶Ep 21 · 5:53
host_summaryTracheostomy can be helpful for managing aspiration risk in pharyngeal stenosis patients↗
▶Ep 21 · 5:55
host_summarySwallowing outcomes can be difficult and poor in the long term for pharyngeal stenosis patients↗
QUAD #20: Endoscopic Repair of Minor Laryngeal Clefts with Dr. Catherine Hart
▶Ep 22 · 1:41
host_summaryThe goal of endoscopic cleft repair is to remove the interarytenoid mucosa to create two raw surfaces and then suture the edges together.↗
▶Ep 22 · 2:05
host_summaryIf suture bites are taken too deeply during cleft repair, edges will be inverted and the child will continue to have problems.↗
▶Ep 22 · 2:22
host_summaryInterarytenoid mucosa can be resected using laser or cold steel (knife), and the choice does not matter clinically.↗
▶Ep 22 · 2:42
host_summaryComplete demucosalization of the apex is essential; if incomplete, a hole will remain at the apex and the child will continue to aspirate.↗
▶Ep 22 · 3:01
host_summaryEpiglottic folds are released after suturing to create extra space.↗
▶Ep 22 · 3:01
host_summaryTypically 2 to 3 sutures are placed depending on the extent of the cleft.↗
▶Ep 22 · 4:31
host_summarySurgical closure of laryngeal clefts achieves improvement in symptoms in almost 80% of children and resolution in 70%.↗
▶Ep 22 · 4:36
host_summarySurgical closure has a slightly higher risk of complications compared to conservative management.↗
▶Ep 22 · 4:54
host_summaryA consensus guideline exists for diagnosing and managing laryngeal clefts in children and is a good resource, especially for those newer to practice.↗
QUAD #25: Medical Management of Minor Laryngeal Clefts with Dr. Greg Burg
▶Ep 24 · 0:54
host_summaryFlexible bronchoscopy is quite limited in evaluating a cleft unless it's a major cleft.↗
▶Ep 24 · 1:13
host_summaryA deep interarytenoid notch is considered a minor cleft by Dr. Burg's team.↗
▶Ep 24 · 1:44
host_summaryRespiratory culture showed predominantly upper airway flora and two Candida species in the mucopurulent bronchitis.↗
▶Ep 24 · 2:07
host_summaryClinical assessment includes evaluating frequency of coughing, sick visits, emergency room visits, and hospitalizations.↗
▶Ep 24 · 2:15
host_summaryBronchoscopic assessment looks for airway edema, visibility of tracheal rings, mucus plugging, and secretions.↗
▶Ep 24 · 3:18
host_summaryChest CT is the most important differential imaging study, used to look for chronic changes related to aspiration.↗
▶Ep 24 · 4:12
host_summaryG-tubes and NG-tubes are used as needed for nutritional intake.↗
▶Ep 24 · 4:57
host_summarySaline is used to thin out secretions.↗
▶Ep 24 · 4:57
host_summaryChronic macrolide therapy can be used as an anti-neutrophilic agent, derived from cystic fibrosis literature.↗
▶Ep 24 · 5:14
host_summaryFor patients with significant tracheomalacia, ipratropium may be used over albuterol.↗
Journal of Pediatric Surgery Article Review: 2nd Quarter (Apr-Jun) 2025
▶Ep 27 · 1:48
host_summaryA subset of children after esophageal atresia repair experience severe airway collapse, leaving them ventilator dependent or suffering repeated cyanotic spells↗
▶Ep 27 · 6:57
host_summaryA significant number of outreach services are located within 50 kilometers of a children's hospital, leaving vast regions without access to pediatric surgical care↗
▶Ep 27 · 12:38
host_summaryThe study examined 4,612 G-tube placements from 71 NSQIP-Pediatric hospitals in 2023↗
▶Ep 27 · 13:04
host_summaryUpper GI studies were obtained in 45% of first-time G-tube cases with substantial interhospital variability from 0 to 99%↗
▶Ep 27 · 13:45
host_summary14% of G-tube cases resulted in an ED visit within 0 to 30 days↗
▶Ep 27 · 13:45
host_summary5.2% of G-tube cases involved dislodgement within 0 to 30 days↗
host_summaryThe 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.↗
▶Ep 2 · 1:20
host_summaryIn this neutropenic and thrombocytopenic patient, the approach taken was to start antibiotics and address the elevated liver function tests.↗
▶Ep 2 · 1:49
host_summaryGallstone 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.↗
▶Ep 2 · 3:11
host_summaryIn neutropenic and thrombocytopenic patients with cholecystitis and choledocholithiasis, initial conservative management with antibiotics can be effective, particularly when spontaneous stone passage occurs.↗
▶Ep 2 · 3:22
host_summaryFor gallstone pancreatitis, early ERCP is typically reserved for cases with persistent biliary obstruction or cholangitis, as many patients improve without intervention.↗
▶Ep 2 · 3:33
host_summaryThe 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.↗
Pediatric Colorectal Contraversies Part II: Pediatric Colorectal...
▶Ep 5 · 0:34
host_summaryFor vestibular fistula, Professor Liam prefers primary repair around day 5-7 of life↗
▶Ep 5 · 0:34
quoteI prefer primary repair around, uh, 75 or 7 days. It means I wait until 5th or 7th day, and I perform primary repair.↗
▶Ep 5 · 8:38
epidemiologicalAbout 30-40% of anorectal stenosis or rectal atresia cases will have a presacral mass↗
▶Ep 5 · 8:45
clinicalMRI is the best way to show a presacral mass↗
▶Ep 5 · 8:57
clinicalFor anorectal stenosis repair, open posteriorly only to preserve anterior dentate line and avoid anterior rectal dissection↗
▶Ep 5 · 14:37
quoteLoop colostomy is never completely diverting no matter how much people believe their loops are diverting.↗
▶Ep 5 · 14:37
clinicalLoop colostomy is never completely diverting no matter how much surgeons believe it is↗
▶Ep 5 · 15:05
clinicalSpillage across loop colostomy causes urinary tract infections in patients with fistulas↗
▶Ep 5 · 15:42
clinicalCleaning out distal colon at colostomy creation takes about 20-30 minutes and is very important↗
▶Ep 5 · 21:07
clinicalDistal sigmoid colostomy makes laparoscopic operation more difficult and may require opening to take down mucous fistula↗
▶Ep 5 · 28:14
clinicalBest tube for hydrocolpos drainage is curled pigtail tube because hydrocolpos recedes into pelvis over months; straight tube will fall out↗
Prenatal Imaging and Counseling: Cloaca and Complex ARMs 2015
▶Ep 18 · 5:17
host_summaryCloaca 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).↗
▶Ep 18 · 31:00
clinicalFalse-positive prenatal diagnoses of ARM occur, causing parental alarm when the baby is born without any issues.↗
Update Course Rewind: Perineal Body Sparing PSARP 2023
▶Ep 48 · 1:17
host_summaryOne study has 6 patients and the other has 4 patients.↗
▶Ep 48 · 1:17
epidemiologicalOne study has 6 patients and the other has 4 patients.↗
▶Ep 48 · 1:20
clinicalThe techniques are similar but slightly different.↗
▶Ep 48 · 1:20
host_summaryThe techniques are similar but slightly different.↗
▶Ep 48 · 2:12
host_summaryPerineal body sparing techniques can reduce post-operative infection risks in patients undergoing dilations.↗
▶Ep 48 · 2:12
clinicalPerineal body sparing techniques can reduce post-operative infection risks in patients undergoing dilations.↗
Colorectal Quiz: Episode 49 – Collaborating for Kids: Colorectal & Pelvic Solutions (with a Little Help from AI)
▶Ep 59 · 5:50
clinicalWhen documents are uploaded to Notebook LM, the AI creates an expert based solely on the provided content, not external sources.↗
The Colorectal Quiz: Episode 1
▶Ep 87 · 0:00
quotePediatric 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.↗
▶Ep 87 · 6:01
host_summaryFor 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↗
▶Ep 87 · 12:16
host_summaryIn 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↗
The Colorectal Quiz: Episode 1
▶Ep 88 · 0:00
quotePediatric 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.↗
▶Ep 88 · 6:01
host_summaryFor cross-table lateral imaging, the baby is positioned prone with buttocks at the highest point where air will rise to, and can be done at bedside in the neonatal unit with a bump under the buttocks↗
▶Ep 88 · 12:16
host_summaryIn patients with low rectum, dissecting a bit of the anterior rectal wall and carefully lifting it off the urinary tract will usually rule out fistula↗
epidemiologicalBiliary atresia is the number one reason for pediatric liver transplant↗
▶Ep 12 · 0:12
epidemiologicalBiliary atresia is the most common cause of end-stage liver failure in the pediatric patient population↗
▶Ep 12 · 0:12
host_summaryBiliary atresia is the number one reason for pediatric liver transplant↗
▶Ep 12 · 0:12
host_summaryBiliary atresia is the most common cause of end-stage liver failure in the pediatric patient population↗
Heat 1 Winner: Dariusz Patkowski, MD, PhD - Best of the Best in Pediatric Surgery 2024
▶Ep 18 · 0:04
host_summaryDr. Shilpa Sharma presented on exploring alternative pathways of stem cell perforation for hepatic regeneration by partial liver resection in extrahepatic biliary atresia↗
▶Ep 18 · 0:04
clinicalDr. Shilpa Sharma presented on exploring alternative pathways of stem cell perforation for hepatic regeneration by partial liver resection in extrahepatic biliary atresia↗
▶Ep 18 · 0:20
clinicalDr. Toshio Haromaz presented analysis of potential risk factors for defecation problems and their bowel management based on long-term bowel function in patients with persistent cloaca↗
▶Ep 18 · 0:20
host_summaryDr. Toshio Haromaz presented analysis of potential risk factors for defecation problems and their bowel management based on long-term bowel function in patients with persistent cloaca↗
▶Ep 18 · 1:25
clinicalDr. Dariusz Patkowski won Heat 1 of the competition↗
▶Ep 18 · 1:25
clinicalDr. Dariusz Patkowski won Heat 1 of the competition↗
Journal of Pediatric Surgery Article Review: 2nd Quarter (Apr-Jun) 2024
▶Ep 23 · 0:06
quoteHi 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.↗
▶Ep 23 · 1:05
quoteI'm a pediatric surgeon at Alberta Children's Hospital. I've also been the publication chair for the uh Pacific Association of Pediatric Surgeons.↗
▶Ep 23 · 1:25
host_summaryMMP-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↗
▶Ep 23 · 1:43
host_summaryHigher levels of MMP-7 are associated with the diagnosis of biliary atresia↗
▶Ep 23 · 1:56
host_summaryIn a cohort of 329 biliary atresia cases from July 2020 to December 2022, 40 were classified as low MMP-7↗
▶Ep 23 · 2:11
quoteThis 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↗
▶Ep 23 · 2:36
host_summaryLow levels of MMP-7 in biliary atresia patients are associated with low levels of preoperative GGT (gamma glutamyl transpeptidase) and direct bilirubin↗
▶Ep 23 · 3:02
host_summaryGGT (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↗
▶Ep 23 · 3:19
host_summaryBiliary atresia has variable outcomes even within one center, with patients who anatomically look similar having dramatically different outcomes↗
▶Ep 23 · 4:09
host_summaryHaving lower MMP-7 levels within the cohort of biliary atresia patients is associated with worse prognosis↗
▶Ep 23 · 4:26
quoteAnd 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?↗
▶Ep 23 · 4:41
host_summaryThe mechanism of why low MMP-7 levels in biliary atresia patients leads to worse prognosis is unknown↗
▶Ep 23 · 7:02
host_summaryIn 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↗
▶Ep 23 · 7:43
host_summaryOf 267 uncomplicated gastroschisis patients, 78% received exclusive breast milk in the first 28 days of life and 22% received supplemental or exclusive formula↗
▶Ep 23 · 8:27
host_summaryThere 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↗
▶Ep 23 · 8:53
host_summaryPatients 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↗
▶Ep 23 · 12:46
host_summaryA 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↗
▶Ep 23 · 13:16
host_summaryThere 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)↗
▶Ep 23 · 13:30
opinionThe life course progression of anorectal malformation and Hirschsprung disease is not well understood↗
epidemiologicalStone disease is increasing along with obesity in pediatric patients around the world, not just in the United States.↗
▶Ep 4 · 1:25
clinicalThere are two main approaches for patients with stones in the common bile duct who need gallbladder removal: ERCP first to remove ductal stones followed by laparoscopic cholecystectomy, or laparoscopic cholecystectomy with intraoperative cholangiogram to identify and potentially remove stones during the same surgery.↗
▶Ep 4 · 2:11
clinicalA surgery-first pathway reduces resource utilization, including MRCP, according to recently published work.↗
▶Ep 4 · 2:25
clinicalA paper from the Journal of American College of Surgeons defined a very specific and predictive score for cholelithiasis.↗
▶Ep 4 · 3:02
clinicalERCP adds potential morbidity to a procedure, and even with good technique, pancreatitis occurs 10% of the time.↗
clinicalIf the surgeon cannot do a cholangiogram, then ERCP is needed if someone can do it.↗
▶Ep 4 · 3:44
opinionIf you know how to put in a central line and understand the principles of Seldinger technique, then you can do intraoperative stone removal.↗
▶Ep 4 · 3:44
quoteSure, and I think if you know how to put in a central line and you understand the principles Singer technique, then you can do this.↗
▶Ep 4 · 3:50
clinicalIn a paper published in JPS, stone clearance rate reflected by a negative intraoperative cholangiogram was 86% with a surgery-first mindset.↗
▶Ep 4 · 4:01
clinicalWith minor additional techniques like advancing the catheter into the common bile duct or reaming the sphincter, the success rate was in the 90s.↗
▶Ep 4 · 4:10
quoteSo it doesn't take much. That's the dirty little secret is like, let's do something that, that I think is accessible to everybody.↗
▶Ep 4 · 4:38
clinicalAt Cincinnati Children's, when surgeons cannot clear the duct, they call from the OR and an ERCP can be performed quickly in most cases.↗
▶Ep 4 · 4:47
clinicalAt institutions without access to immediate ERCP, surgeons can place a clip or endo loop, close up, and perform ERCP within the next day or two.↗
▶Ep 4 · 5:15
clinicalAccording to Doctor Huntington, the biggest key to success is having all the necessary equipment in one place, because no one in the OR is going to know what to get on the fly.↗
▶Ep 4 · 5:26
clinicalA common bile duct with 3 or 4 impacted stones is typically not suitable for surgery-first approach.↗
▶Ep 4 · 6:03
clinicalDoctor Vitale cautions that when flushing, if a stone is impacted, there is a risk of inadvertently injecting contrast into the pancreatic duct, which can increase the risk of pancreatitis.↗
▶Ep 4 · 6:15
clinicalWhen the pancreatic duct lights up during flushing, that is a signal to slow down because you can cause pancreatitis by flushing contrast into the pancreatic duct with a stone present.↗
▶Ep 4 · 6:33
clinicalA study demonstrated an 86% success rate for surgery-first, but the ERCP group had a 10% complication rate, including cholangitis, bleeding, pancreatitis, and hemophilia.↗
host_summaryA Western Pediatric Surgery Research Consortium machine learning algorithm based on 1600 patients from 10 centers (2016-2019) can predict common bile duct stones using nine clinical factors, with 20% of patients having CBD stones↗
▶Ep 3 · 7:33
host_summaryThe previous algorithm for predicting CBD stones was based on 300-400 patients, compared to 1600 in the new algorithm↗
▶Ep 3 · 13:34
host_summaryIn a study of 173 laparoscopic cholecystectomies over 10 years (2013-2023), 83 used standard technique and 90 used ICG fluorescence↗
▶Ep 3 · 13:54
host_summaryThe ICG study showed perioperative complication rate of 12% in standard technique versus 0% with ICG, with significantly shorter operative times and better biliary visualization in the ICG group↗
Update Course Rewind: Pediatric Biliary Stones - Surgery First Mindset 2024
host_summaryStone disease is increasing along with obesity in pediatric patients around the world, not just in the United States.↗
▶Ep 5 · 1:25
host_summaryThere are two main approaches for patients with stones in the common bile duct who need gallbladder removal: ERCP first to remove ductal stones followed by laparoscopic cholecystectomy, or laparoscopic cholecystectomy with intraoperative cholangiogram to identify and potentially remove stones during the same surgery.↗
▶Ep 5 · 2:11
host_summaryA surgery-first pathway reduces resource utilization, including MRCP, according to recently published work.↗
▶Ep 5 · 2:25
host_summaryA paper from the Journal of American College of Surgeons defined a very specific and predictive score for cholelithiasis.↗
▶Ep 5 · 3:02
host_summaryERCP adds potential morbidity to a procedure, and even with good technique, pancreatitis occurs 10% of the time.↗
host_summaryIf the surgeon cannot do a cholangiogram, then ERCP is needed if someone can do it.↗
▶Ep 5 · 3:44
host_summaryIf you know how to put in a central line and understand the principles of Seldinger technique, then you can do intraoperative stone removal.↗
▶Ep 5 · 3:44
quoteSure, and I think if you know how to put in a central line and you understand the principles Singer technique, then you can do this.↗
▶Ep 5 · 3:50
host_summaryIn a paper published in JPS, stone clearance rate reflected by a negative intraoperative cholangiogram was 86% with a surgery-first mindset.↗
▶Ep 5 · 4:01
host_summaryWith minor additional techniques like advancing the catheter into the common bile duct or reaming the sphincter, the success rate was in the 90s.↗
▶Ep 5 · 4:10
quoteSo it doesn't take much. That's the dirty little secret is like, let's do something that, that I think is accessible to everybody.↗
▶Ep 5 · 4:38
host_summaryAt Cincinnati Children's, when surgeons cannot clear the duct, they call from the OR and an ERCP can be performed quickly in most cases.↗
▶Ep 5 · 4:47
host_summaryAt institutions without access to immediate ERCP, surgeons can place a clip or endo loop, close up, and perform ERCP within the next day or two.↗
▶Ep 5 · 5:15
host_summaryAccording to Doctor Huntington, the biggest key to success is having all the necessary equipment in one place, because no one in the OR is going to know what to get on the fly.↗
▶Ep 5 · 5:26
host_summaryA common bile duct with 3 or 4 impacted stones is typically not suitable for surgery-first approach.↗
▶Ep 5 · 6:03
host_summaryDoctor Vitale cautions that when flushing, if a stone is impacted, there is a risk of inadvertently injecting contrast into the pancreatic duct, which can increase the risk of pancreatitis.↗
▶Ep 5 · 6:15
host_summaryWhen the pancreatic duct lights up during flushing, that is a signal to slow down because you can cause pancreatitis by flushing contrast into the pancreatic duct with a stone present.↗
▶Ep 5 · 6:33
host_summaryA study demonstrated an 86% success rate for surgery-first, but the ERCP group had a 10% complication rate, including cholangitis, bleeding, pancreatitis, and hemophilia.↗
Chronic Pancreatitis - Pancreatic Pathologies by Cincinnati Children's Pancreas Care Center
▶Ep 7 · 0:54
host_summaryOngoing damage in chronic pancreatitis affects acinar cells, ductal cells, and islet cells which are responsible for producing insulin.↗
▶Ep 7 · 1:25
host_summaryWhen islet cells which produce insulin are damaged by chronic pancreatitis, it can lead to endocrine issues such as diabetes.↗
▶Ep 7 · 1:33
host_summaryChronic pancreatitis is a progressive inflammatory disorder that results in irreversible loss of pancreatic function.↗
▶Ep 7 · 1:48
host_summaryDiagnosis of chronic pancreatitis involves identifying calcifications, ductal obstruction, or dilation combined with one of three criteria: pain consistent with pancreatic origin, exocrine dysfunction, or endocrine dysfunction.↗
▶Ep 7 · 2:33
host_summaryIn adults, CT with IV contrast often includes multiple phases (non-contrast, arterial, and portal venous), but this is avoided in children because it markedly increases radiation dose without providing much additional diagnostic information.↗
▶Ep 7 · 3:02
host_summaryAccording to Dr. Trout, arterial phase imaging is reserved for specific questions about arterial pseudoaneurysms or when characterizing potential masses.↗
▶Ep 7 · 3:25
host_summaryAt initial characterization of a patient with acute recurrent or chronic pancreatitis, IV contrast can be useful to understand vascular complications or fluid collections, but in many cases MRI exams can be done without IV contrast.↗
▶Ep 7 · 3:56
host_summaryCincinnati Children's has an in-house 10-gene pancreatitis risk panel to screen for genetic links to pancreatitis.↗
▶Ep 7 · 5:33
host_summaryFor pancreatic enzyme replacement, cystic fibrosis guidelines are followed for dosing, and enzymes are reserved only for cases with documented exocrine pancreatic insufficiency.↗
▶Ep 7 · 5:55
host_summaryEndoscopic therapy for chronic pancreatitis relies on two methods: endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP).↗
▶Ep 7 · 6:22
host_summaryPain management in chronic pancreatitis follows a stepwise ladder approach, starting with opiate-sparing medications and reserving opiates for severe pain cases.↗
▶Ep 7 · 6:25
host_summaryOpiate-sparing chronic pain medications include neuropathic medications like amitriptyline and gabapentin, usually prescribed in partnership with a pain specialist as part of multidisciplinary management.↗
▶Ep 7 · 7:10
host_summaryAt Cincinnati Children's, cognitive behavioral therapy (CBT) is incorporated in multidisciplinary pain management and has been shown in other chronic conditions to be helpful in managing pain.↗
quoteI think it's important to remember that, you know, sometimes when we have had our interventional radiologists drain, um, hydrocoals for us, they potentially go through the uterus or potentially come very close to the cervix↗
▶Ep 2 · 8:57
clinicalInterventional radiology drainage of hydrocolpos may traverse the uterus or come close to the cervix, potentially compromising future fertility↗
▶Ep 2 · 20:55
clinicalCommon channel length alone is insufficient for surgical planning; urethral length, urethral takeoff location, and rectal fistula position also determine approach↗
▶Ep 2 · 21:20
quoteit's not just the Common channel length anymore. I think it's the common channel plus what is the length of the urethra, where does that take off from? And then also you may have a 1 to 3 centimeter common channel, but the rectal takeoff is way up on the back of the vagina, so that would then alter your approach.↗
▶Ep 2 · 22:00
clinicalFor very short common channels (less than 1 cm), the urethra can be left in place with acceptable female hypospadias, mobilizing only vagina and rectum↗
▶Ep 2 · 23:00
clinicalSufficient female hypospadias must be accepted to allow catheterization if needed, with the meatus identifiable by patient or physician↗
▶Ep 2 · 23:00
quoteI think you have to accept enough that the patient can catheterize if needed, so the patient has to be able, or the doctor has to be able to identify the meatus. In case catheterization is needed.↗
▶Ep 2 · 34:30
quoteThe length from the takeoff of the common channel to the urethra, so your to the, to the bladder neck is an important length, because what you don't want to do in a total urogen, the total urogenal mobilization is bring the bladder neck right down to the perineum. So I think if you, if that's done, then you're probably doomed to have that patient be incontinent of urine.↗
▶Ep 2 · 34:52
clinicalTotal urogenital mobilization requires sufficient urethral length (at least 1-2 cm) to avoid bringing the bladder neck to the perineum, which would cause urinary incontinence↗
▶Ep 2 · 34:52
quoteyou want, I think at least 1 to 2 centimeters↗
Prenatal Imaging and Counseling: Cloaca and Complex ARMs 2015
▶Ep 9 · 5:17
host_summaryCloaca 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).↗
▶Ep 9 · 31:00
clinicalFalse-positive prenatal diagnoses of ARM occur, causing parental alarm when the baby is born without any issues.↗
Pediatric Colorectal Contraversies Part II: Pediatric Colorectal...
▶Ep 6 · 0:34
quoteI prefer primary repair around, uh, 75 or 7 days. It means I wait until 5th or 7th day, and I perform primary repair.↗
▶Ep 6 · 0:34
quoteI prefer primary repair around, uh, 75 or 7 days. It means I wait until 5th or 7th day, and I perform primary repair.↗
▶Ep 6 · 0:34
host_summaryFor vestibular fistula, Professor Liam prefers primary repair around day 5-7 of life↗
▶Ep 6 · 0:34
clinicalFor vestibular fistula, Professor Liam prefers primary repair around day 5-7 of life↗
▶Ep 6 · 8:38
epidemiologicalAbout 30-40% of anorectal stenosis or rectal atresia cases will have a presacral mass↗
▶Ep 6 · 8:38
epidemiologicalAbout 30-40% of anorectal stenosis or rectal atresia cases will have a presacral mass↗
▶Ep 6 · 8:45
clinicalMRI is the best way to show a presacral mass↗
▶Ep 6 · 8:45
clinicalMRI is the best way to show a presacral mass↗
▶Ep 6 · 8:57
clinicalFor anorectal stenosis repair, open posteriorly only to preserve anterior dentate line and avoid anterior rectal dissection↗
▶Ep 6 · 8:57
clinicalFor anorectal stenosis repair, open posteriorly only to preserve anterior dentate line and avoid anterior rectal dissection↗
▶Ep 6 · 14:37
quoteLoop colostomy is never completely diverting no matter how much people believe their loops are diverting.↗
▶Ep 6 · 14:37
clinicalLoop colostomy is never completely diverting no matter how much surgeons believe it is↗
▶Ep 6 · 14:37
quoteLoop colostomy is never completely diverting no matter how much people believe their loops are diverting.↗
▶Ep 6 · 14:37
clinicalLoop colostomy is never completely diverting no matter how much surgeons believe it is↗
▶Ep 6 · 15:05
clinicalSpillage across loop colostomy causes urinary tract infections in patients with fistulas↗
▶Ep 6 · 15:05
clinicalSpillage across loop colostomy causes urinary tract infections in patients with fistulas↗
▶Ep 6 · 15:42
clinicalCleaning out distal colon at colostomy creation takes about 20-30 minutes and is very important↗
▶Ep 6 · 15:42
clinicalCleaning out distal colon at colostomy creation takes about 20-30 minutes and is very important↗
▶Ep 6 · 21:07
clinicalDistal sigmoid colostomy makes laparoscopic operation more difficult and may require opening to take down mucous fistula↗
▶Ep 6 · 21:07
clinicalDistal sigmoid colostomy makes laparoscopic operation more difficult and may require opening to take down mucous fistula↗
▶Ep 6 · 28:14
clinicalBest tube for hydrocolpos drainage is curled pigtail tube because hydrocolpos recedes into pelvis over months; straight tube will fall out↗
▶Ep 6 · 28:14
clinicalBest tube for hydrocolpos drainage is curled pigtail tube because hydrocolpos recedes into pelvis over months; straight tube will fall out↗
Prenatal Imaging and Counseling: Cloaca and Complex ARMs 2015
▶Ep 38 · 5:17
clinicalCloaca 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).↗
▶Ep 38 · 5:17
host_summaryCloaca 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).↗
▶Ep 38 · 31:00
clinicalFalse-positive prenatal diagnoses of ARM occur, causing parental alarm when the baby is born without any issues.↗
▶Ep 38 · 31:00
clinicalFalse-positive prenatal diagnoses of ARM occur, causing parental alarm when the baby is born without any issues.↗
The Colorectal Quiz Episode 11: Total Colonic Hirschsprung's Part 2
▶Ep 95 · 3:59
clinicalPectin or Imodium can be used to thicken high-output ileostomy stools.↗
▶Ep 95 · 3:59
host_summaryPectin or Imodium can be used to thicken high-output ileostomy stools.↗
▶Ep 95 · 7:03
host_summarySodium is the most abundant electrolyte in extracellular space, acquired through dietary intake, and absorbed actively in the ileum but passively in the jejunum.↗
▶Ep 95 · 7:03
clinicalSodium is the most abundant electrolyte in extracellular space, acquired through dietary intake, and absorbed actively in the ileum but passively in the jejunum.↗
▶Ep 95 · 14:17
opinionThe role of Botox in total colonic Hirschsprung disease is vital.↗
▶Ep 95 · 14:17
host_summaryThe role of Botox in total colonic Hirschsprung disease is vital.↗
Journal of Pediatric Surgery Article Review: May 2022, CAPS Issue
▶Ep 125 · 11:32
host_summaryIn the Miami bicycle injury study of 77 cases over eight years, only one patient was wearing a helmet.↗
▶Ep 125 · 11:32
epidemiologicalIn the Miami bicycle injury study of 77 cases over eight years, only one patient was wearing a helmet.↗
▶Ep 125 · 13:02
host_summaryThe majority of bicycle injuries were happening in low income neighborhoods.↗
▶Ep 125 · 13:02
epidemiologicalThe majority of bicycle injuries were happening in low income neighborhoods.↗
▶Ep 125 · 13:10
epidemiologicalBicycle injuries were happening at high speed areas, like interstate on-ramps and off-ramps.↗
▶Ep 125 · 13:10
host_summaryBicycle injuries were happening at high speed areas, like interstate on-ramps and off-ramps.↗
▶Ep 125 · 13:13
epidemiologicalAbout half of the bicycle injuries happened within 1 mile from home.↗
▶Ep 125 · 13:13
host_summaryAbout half of the bicycle injuries happened within 1 mile from home.↗
▶Ep 125 · 13:51
opinionFree helmet programs going through a pediatrician's office are useful but need to be sustained.↗
▶Ep 125 · 13:51
host_summaryFree helmet programs going through a pediatrician's office are useful but need to be sustained.↗
▶Ep 125 · 13:58
opinionCities that have been successful with helmet programs have implemented multidisciplinary approaches including free helmet programs, changing laws, and public education, sustained over several years.↗
▶Ep 125 · 13:58
host_summaryCities that have been successful with helmet programs have implemented multidisciplinary approaches including free helmet programs, changing laws, and public education, sustained over several years.↗
Update Course Rewind: Perineal Body Sparing PSARP 2023
▶Ep 154 · 1:17
host_summaryOne study has 6 patients and the other has 4 patients.↗
▶Ep 154 · 1:17
epidemiologicalOne study has 6 patients and the other has 4 patients.↗
▶Ep 154 · 1:20
clinicalThe techniques are similar but slightly different.↗
▶Ep 154 · 1:20
host_summaryThe techniques are similar but slightly different.↗
▶Ep 154 · 2:12
host_summaryPerineal body sparing techniques can reduce post-operative infection risks in patients undergoing dilations.↗
▶Ep 154 · 2:12
clinicalPerineal body sparing techniques can reduce post-operative infection risks in patients undergoing dilations.↗
Quick Literature Updates Episode 15
▶Ep 156 · 0:09
quoteHello pediatric surgery family, I'm E Gdy, a research fellow from Cincinnati Children's Hospital Medical Center.↗
▶Ep 156 · 0:09
quoteHello pediatric surgery family, I'm E Gdy, a research fellow from Cincinnati Children's Hospital Medical Center.↗
Journal of Pediatric Surgery Article Review: September 2023
▶Ep 159 · 4:24
host_summaryThe Boston CDH study reviewed 146 infants who underwent CDH repair while on ECMO support from 1995 to 2021.↗
▶Ep 159 · 4:24
clinicalThe Boston CDH study reviewed 146 infants who underwent CDH repair while on ECMO support from 1995 to 2021.↗
▶Ep 159 · 5:17
clinicalDuration of ECMO support was shorter in the early CDH repair group.↗
▶Ep 159 · 5:17
clinicalSurvival was not statistically different between early and delayed CDH repair groups.↗
▶Ep 159 · 5:17
host_summarySurvival was not statistically different between early and delayed CDH repair groups.↗
▶Ep 159 · 5:17
host_summaryDuration of ECMO support was shorter in the early CDH repair group.↗
▶Ep 159 · 5:56
host_summaryThe Boston center historically preferred early CDH repair for patients on ECMO, so patients who had delayed repair may have had clinical differences.↗
▶Ep 159 · 5:56
clinicalThe Boston center historically preferred early CDH repair for patients on ECMO, so patients who had delayed repair may have had clinical differences.↗
▶Ep 159 · 9:16
epidemiologicalPhysician suicide rates are tragically high among doctors compared to the general population.↗
▶Ep 159 · 9:16
host_summaryPhysician suicide rates are tragically high among doctors compared to the general population.↗
▶Ep 159 · 10:11
host_summaryFactors contributing to physician suicide include high levels of stress, emotional and physical burnout, demanding work schedules, and pressure to maintain a successful career.↗
▶Ep 159 · 10:11
clinicalFactors contributing to physician suicide include high levels of stress, emotional and physical burnout, demanding work schedules, and pressure to maintain a successful career.↗
▶Ep 159 · 10:33
clinicalStigma associated with mental health issues within the medical profession discourages physicians from seeking help, leading to untreated depression, anxiety, and other mental health disorders.↗
▶Ep 159 · 10:33
host_summaryStigma associated with mental health issues within the medical profession discourages physicians from seeking help, leading to untreated depression, anxiety, and other mental health disorders.↗
Journal of Pediatric Surgery Article Review: 2nd Quarter (Apr-Jun) 2024
▶Ep 164 · 0:06
quoteHi 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.↗
▶Ep 164 · 1:05
quoteI'm a pediatric surgeon at Alberta Children's Hospital. I've also been the publication chair for the uh Pacific Association of Pediatric Surgeons.↗
▶Ep 164 · 1:25
host_summaryMMP-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↗
▶Ep 164 · 1:43
host_summaryHigher levels of MMP-7 are associated with the diagnosis of biliary atresia↗
▶Ep 164 · 1:56
host_summaryIn a cohort of 329 biliary atresia cases from July 2020 to December 2022, 40 were classified as low MMP-7↗
▶Ep 164 · 2:11
quoteThis 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↗
▶Ep 164 · 2:36
host_summaryLow levels of MMP-7 in biliary atresia patients are associated with low levels of preoperative GGT (gamma glutamyl transpeptidase) and direct bilirubin↗
▶Ep 164 · 3:02
host_summaryGGT (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↗
▶Ep 164 · 3:19
host_summaryBiliary atresia has variable outcomes even within one center, with patients who anatomically look similar having dramatically different outcomes↗
▶Ep 164 · 4:09
host_summaryHaving lower MMP-7 levels within the cohort of biliary atresia patients is associated with worse prognosis↗
▶Ep 164 · 4:26
quoteAnd 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?↗
▶Ep 164 · 4:41
host_summaryThe mechanism of why low MMP-7 levels in biliary atresia patients leads to worse prognosis is unknown↗
▶Ep 164 · 7:02
host_summaryIn 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↗
▶Ep 164 · 7:43
host_summaryOf 267 uncomplicated gastroschisis patients, 78% received exclusive breast milk in the first 28 days of life and 22% received supplemental or exclusive formula↗
▶Ep 164 · 8:27
host_summaryThere 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↗
▶Ep 164 · 8:53
host_summaryPatients 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↗
▶Ep 164 · 12:46
host_summaryA 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↗
▶Ep 164 · 13:16
host_summaryThere 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)↗
▶Ep 164 · 13:30
opinionThe life course progression of anorectal malformation and Hirschsprung disease is not well understood↗
Journal of Pediatric Surgery Article Review: 3rd Quarter (Jul-Sep) 2024
▶Ep 167 · 0:06
quoteHi 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.↗
▶Ep 167 · 1:38
quoteMy 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.↗
▶Ep 167 · 1:56
clinicalThe PCPLC multi-institutional registry includes a number of institutions throughout the United States.↗
▶Ep 167 · 3:20
epidemiological85% of Hirschsprung patients were diagnosed at less than 1 year of age.↗
▶Ep 167 · 3:45
clinicalKids with shorter segment disease (rectosigmoid or very small portion of aganglionic bowel) were more likely to be diagnosed at a later age.↗
▶Ep 167 · 3:57
clinicalChildren with long segment Hirschsprung disease typically present at birth with classic symptoms such as failure to pass meconium.↗
▶Ep 167 · 4:26
clinicalApproximately one-third of neonates and 50% of infants, toddlers, and children had diverting ostomies performed prior to pull-through.↗
▶Ep 167 · 5:01
clinicalThere was no difference in overall rates of redo pull-throughs across age groups.↗
▶Ep 167 · 5:07
clinicalOlder children were more likely to need a redo pull-through due to an anastomotic leak.↗
▶Ep 167 · 5:13
opinionHigher rates of diverting ostomy post pull-through were suspected to be a treatment for post pull-through leak or anastomotic leak.↗
▶Ep 167 · 5:24
clinicalThe only outcome difference seen was nighttime soiling or incontinence in the older patient population.↗
▶Ep 167 · 7:44
quoteI am a pediatric surgeon. Uh, in the division of pediatric Surgery with Presbyterian Healthcare Services in Albuquerque, New Mexico↗
▶Ep 167 · 8:09
clinicalThe systematic review on gastroschisis included 28 high quality manuscripts.↗
▶Ep 167 · 8:15
clinicalTwo randomized controlled trials on gastroschisis had been started but both ended prematurely and were underpowered.↗
▶Ep 167 · 10:37
clinicalClinical practice suggests that skin organisms are most commonly identified in infections among infants with gastroschisis.↗
▶Ep 167 · 10:44
clinicalGastroschisis infants have a fairly high rate of wound infection.↗
▶Ep 167 · 10:50
clinicalSilo closures have a higher rate of infection than other closure methods for gastroschisis.↗
▶Ep 167 · 10:50
clinicalSutureless closure has the lowest rate of infection for gastroschisis.↗
▶Ep 167 · 10:57
guidelineThe 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.↗
▶Ep 167 · 12:22
clinicalStable gastroschisis infants with sufficient abdominal capacity for sutureless closure tend to have the best outcomes.↗
▶Ep 167 · 12:29
clinicalMinimizing fluids and paralytics in gastroschisis infants improves their results.↗
▶Ep 167 · 12:35
clinicalGastroschisis patients with sutureless closure have shorter length of stay and achieve feeding sooner.↗
▶Ep 167 · 15:11
clinicalThe Clavien-Madadi classification scale consists of several grades from 1 to 5 based on the type of therapy needed to correct the complication.↗
▶Ep 167 · 15:46
clinicalThe validation process circulated up to 20 case scenarios of unexpected events within the ERNICA Network (European Reference Network for inherited and congenital anomalies).↗
▶Ep 167 · 16:34
clinical59 surgeons from 12 European countries completed the Clavien-Madadi validation questionnaire.↗
▶Ep 167 · 17:04
clinical43% of pediatric surgeons preferred the Clavien-Madadi classification compared to 12% for the Clavien-Dindo classification.↗
▶Ep 167 · 17:04
clinicalNearly 82% of surgeons affirmed advantages of the Clavien-Madadi classification.↗
Colorectal Quiz: Episode 49 – Collaborating for Kids: Colorectal & Pelvic Solutions (with a Little Help from AI)
▶Ep 177 · 5:50
clinicalWhen documents are uploaded to Notebook LM, the AI creates an expert based solely on the provided content, not external sources.↗
▶Ep 177 · 5:50
clinicalWhen documents are uploaded to Notebook LM, the AI creates an expert based solely on the provided content, not external sources.↗
The Colorectal Quiz: Episode 1
▶Ep 243 · 0:00
quotePediatric 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.↗
▶Ep 243 · 0:00
quotePediatric 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.↗
▶Ep 243 · 6:01
clinicalFor 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↗
▶Ep 243 · 6:01
host_summaryFor 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↗
▶Ep 243 · 12:16
host_summaryIn 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↗
▶Ep 243 · 12:16
clinicalIn 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↗
The Colorectal Quiz: Episode 1
▶Ep 244 · 0:00
quotePediatric 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.↗
▶Ep 244 · 0:00
quotePediatric 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.↗
▶Ep 244 · 6:01
host_summaryFor cross-table lateral imaging, the baby is positioned prone with buttocks at the highest point where air will rise to, and can be done at bedside in the neonatal unit with a bump under the buttocks↗
▶Ep 244 · 6:01
clinicalFor cross-table lateral imaging, the baby is positioned prone with buttocks at the highest point where air will rise to, and can be done at bedside in the neonatal unit with a bump under the buttocks↗
▶Ep 244 · 12:16
clinicalIn patients with low rectum, dissecting a bit of the anterior rectal wall and carefully lifting it off the urinary tract will usually rule out fistula↗
▶Ep 244 · 12:16
host_summaryIn patients with low rectum, dissecting a bit of the anterior rectal wall and carefully lifting it off the urinary tract will usually rule out fistula↗
Journal of Pediatric Surgery Article Review: October 2023
▶Ep 31 · 3:14
epidemiologicalThere was no significant difference in secondary outcomes (gastroesophageal reflux disease, anastomotic leak, esophagitis) between infants receiving prophylactic acid suppression and those who did not↗
▶Ep 31 · 3:14
host_summaryThere was no significant difference in secondary outcomes (gastroesophageal reflux disease, anastomotic leak, esophagitis) between infants receiving prophylactic acid suppression and those who did not↗
▶Ep 31 · 3:51
host_summaryPotential risks of long-term acid suppression therapy include dysbiosis, necrotizing enterocolitis, and increased neonatal infection rates, particularly relevant in preterm and low birth weight infants↗
▶Ep 31 · 3:51
clinicalPotential risks of long-term acid suppression therapy include dysbiosis, necrotizing enterocolitis, and increased neonatal infection rates, particularly relevant in preterm and low birth weight infants↗
▶Ep 31 · 9:20
epidemiologicalFactors associated with symptomatic CPAM lesions include age older than 4 years, postnatal diagnosis, and maximum cyst diameter greater than 39.9 millimeters↗
▶Ep 31 · 9:20
host_summaryFactors associated with symptomatic CPAM lesions include age older than 4 years, postnatal diagnosis, and maximum cyst diameter greater than 39.9 millimeters↗
▶Ep 31 · 9:50
epidemiologicalThe CPAM study did not enroll patients who accepted conservative treatment compared to asymptomatic patients↗
▶Ep 31 · 9:50
host_summaryThe CPAM study did not enroll patients who accepted conservative treatment compared to asymptomatic patients↗
▶Ep 31 · 10:00
epidemiologicalThe CPAM study sample size was insufficient and all patients were from a single center↗
▶Ep 31 · 10:00
host_summaryThe CPAM study sample size was insufficient and all patients were from a single center↗
Journal of Pediatric Surgery Article Review: October 2023
▶Ep 7 · 3:14
host_summaryNo significant differences were found in secondary outcomes including gastroesophageal reflux disease, anastomotic leak, and esophagitis between infants receiving prophylactic acid suppression and those who did not↗
▶Ep 7 · 3:51
host_summaryPotential risks of long-term acid suppression therapy include dysbiosis, necrotizing enterocolitis, and increased neonatal infection rates, particularly relevant in preterm and low birth weight infants↗
▶Ep 7 · 9:20
host_summaryFactors associated with symptomatic CPAM lesions include age older than 4 years, postnatal diagnosis, and maximum cyst diameter bigger than 39.9 millimeters↗
▶Ep 7 · 9:50
host_summaryThe CPAM study did not enroll patients who accepted conservative treatment↗
▶Ep 7 · 10:00
host_summaryThe CPAM study had insufficient sample size and was from a single center↗
Aerodigestive & Esophageal Surgery - The Unsalvageable Esophagus & Cases
▶Ep 1 · 16:30
quoteManubrial removing the manubrium is never as straightforward as it seems because your clavicles always get in the way.↗
▶Ep 1 · 16:30
quoteManubrial removing the manubrium is never as straightforward as it seems because your clavicles always get in the way.↗
▶Ep 1 · 16:38
clinicalManubrial resection for high esophageal strictures provides less exposure than expected because the clavicles limit the width of the resection corridor.↗
▶Ep 1 · 16:38
clinicalManubrial resection for high esophageal strictures provides less exposure than expected because the clavicles limit the width of the resection corridor.↗
▶Ep 1 · 19:36
quoteEsophageal stents are very much a double-edged sword. They can often cause as many problems as they fix.↗
▶Ep 1 · 19:36
quoteEsophageal stents are very much a double-edged sword. They can often cause as many problems as they fix.↗
▶Ep 1 · 33:28
clinicalKenalog (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.↗
▶Ep 1 · 33:28
clinicalKenalog (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.↗
▶Ep 1 · 36:29
clinicalFor recalcitrant esophageal strictures, weekly dilations (3–4 cycles) prevent fibroblasts from bridging and allow the stricture to scar open rather than closed.↗
▶Ep 1 · 36:29
clinicalFor recalcitrant esophageal strictures, weekly dilations (3–4 cycles) prevent fibroblasts from bridging and allow the stricture to scar open rather than closed.↗
▶Ep 1 · 45:47
clinicalFeeding via gastrojejunal tube with gastric drainage (GJ/G) is a temporizing measure to reduce reflux into the esophagus while managing a refractory stricture.↗
▶Ep 1 · 45:47
clinicalFeeding via gastrojejunal tube with gastric drainage (GJ/G) is a temporizing measure to reduce reflux into the esophagus while managing a refractory stricture.↗
▶Ep 1 · 47:43
quoteIf you've got mucosal disease, all you need to do is remove all the mucosa. You've got no disease.↗
▶Ep 1 · 47:43
quoteIf you've got mucosal disease, all you need to do is remove all the mucosa. You've got no disease.↗
▶Ep 1 · 48:18
clinicalEsophageal 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.↗
▶Ep 1 · 48:18
clinicalEsophageal 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.↗
▶Ep 1 · 48:20
quoteIf you put in an esophageal stent, have a quick look in the airway when you're done.↗
▶Ep 1 · 48:20
quoteIf you put in an esophageal stent, have a quick look in the airway when you're done.↗
▶Ep 1 · 50:13
quoteWe 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.↗
▶Ep 1 · 50:13
quoteWe 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.↗
▶Ep 1 · 50:20
clinicalChronic 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.↗
▶Ep 1 · 50:20
clinicalChronic 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.↗
▶Ep 1 · 52:06
quoteThe aim is to probe it but not push so hard that you create a fistula. That's always embarrassing.↗
▶Ep 1 · 52:06
quoteThe aim is to probe it but not push so hard that you create a fistula. That's always embarrassing.↗
▶Ep 1 · 1:01:05
quoteA lot of kids have replaced esophaguuses and most of them don't aspirate, even if you've got a trashed cricoharyngeis.↗
▶Ep 1 · 1:01:05
quoteA lot of kids have replaced esophaguuses and most of them don't aspirate, even if you've got a trashed cricoharyngeis.↗
▶Ep 1 · 1:10:42
clinicalCovered esophageal stents can temporize anastomotic leaks and allow healing while maintaining luminal patency. Stent removal is typically planned after several weeks.↗
▶Ep 1 · 1:10:42
clinicalCovered esophageal stents can temporize anastomotic leaks and allow healing while maintaining luminal patency. Stent removal is typically planned after several weeks.↗
▶Ep 1 · 1:31:42
clinicalTracheal homografts (dead trachea implants) have been performed but are associated with difficult postoperative courses lasting several months.↗
▶Ep 1 · 1:31:42
clinicalTracheal homografts (dead trachea implants) have been performed but are associated with difficult postoperative courses lasting several months.↗
▶Ep 1 · 1:32:06
clinicalTissue-engineered tracheal homografts with pre-epithelialization are under development in multiple centers (London leading) but are not yet ready for routine clinical use.↗
▶Ep 1 · 1:32:06
clinicalTissue-engineered tracheal homografts with pre-epithelialization are under development in multiple centers (London leading) but are not yet ready for routine clinical use.↗
▶Ep 1 · 1:33:15
clinicalLong-term surveillance of bypassed esophagus includes periodic CT scans to rule out mucocele and endoscopic evaluation via the persistent TEF if needed.↗
▶Ep 1 · 1:33:15
clinicalLong-term surveillance of bypassed esophagus includes periodic CT scans to rule out mucocele and endoscopic evaluation via the persistent TEF if needed.↗
▶Ep 1 · 1:34:15
clinicalPosterior 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.↗
▶Ep 1 · 1:34:15
host_summaryPosterior 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.↗
▶Ep 1 · 1:39:43
quoteThis 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.↗
▶Ep 1 · 1:39:43
opinionComplications 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.↗
▶Ep 1 · 1:39:43
opinionComplications 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.↗
▶Ep 1 · 1:39:43
quoteThis 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.↗
Case Based Journal Review: Esophageal Atresia in 2022
▶Ep 9 · 7:54
host_summaryPatients with transanastomotic tubes started feeding on day 2 versus day 10 for those without tubes, but early feeding did not lead to less TPN—duration was 9 days in both groups↗
▶Ep 9 · 12:20
host_summaryIn a meta-analysis of about 500 newborns, there was no significant difference in leak occurrence, pneumothorax, or mortality based on whether a chest drain was placed↗
▶Ep 9 · 12:31
host_summaryThe group that received a chest drain had a significantly higher chance of returning to the operating room↗
QUAD #2 Thoracoscopic Tracheopexy with Dr. Aaron Garrison
▶Ep 14 · 0:36
host_summarySeveral years ago, the approach was that patients with tracheomalacia would undergo aortopexy.↗
▶Ep 14 · 0:43
host_summaryIn the last 4 to 5 years, it has become standard practice to determine which patients will respond best to tracheopexy versus aortopexy.↗
▶Ep 14 · 1:45
host_summaryPart 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.↗
▶Ep 14 · 2:02
host_summaryPreoperative bronchoscopy gives the surgical team an idea of internal anatomy, which can assist in classifying the degree of tracheomalacia prior to surgical intervention.↗
▶Ep 14 · 3:23
host_summaryWhen using a thoracoscopic approach, correct positioning is the key to success.↗
▶Ep 14 · 3:27
host_summaryIt is best to use gravity to advantage as it aids in retracting the lungs and trachea placement.↗
▶Ep 14 · 4:01
host_summaryOpening the pericardium and finding the area at the pericardial-adventitial junction to suspend is the key point of aortopexy.↗
▶Ep 14 · 4:16
host_summaryPassing suture transternally is preferred with the aortopexy approach, though it can be technically difficult.↗
▶Ep 14 · 4:23
host_summaryFor tracheopexy, a posterior approach via semiprone position is preferred.↗
▶Ep 14 · 4:28
host_summaryCreating a pneumothorax by putting the Veress off the tip of the scapula helps collapse the lung for trocar placement.↗
▶Ep 14 · 4:38
host_summaryWhen operating posteriorly, triangulating your hands gives the best visualization and working space.↗
▶Ep 14 · 4:56
host_summaryWhen available, a multidisciplinary team which includes a pulmonologist can allow for internal visualization via bronchoscopy.↗
▶Ep 14 · 5:05
host_summaryBronchoscopic guidance technique is primarily used in non-esophageal atresia patients.↗
▶Ep 14 · 5:53
host_summaryIt is important to create enough tension in the suture to ensure that the pexy is secure.↗
▶Ep 14 · 6:07
host_summaryThe approach changes for patients without esophageal atresia or with an esophagus in continuity.↗
▶Ep 14 · 6:14
host_summaryFor patients with esophagus in continuity, the first step is to dissect around the esophagus using a vessel loop for retraction.↗
▶Ep 14 · 6:32
host_summaryUsing pre- and post-operative bronchoscopy allows the surgeon to see the improvement prior to case completion.↗
QUAD #7 Anesthesia for Thoracoscopic Techniques with Dr. Nathaniel Tighe
▶Ep 16 · 1:05
host_summaryThe association between esophageal atresia and cardiac abnormalities is particularly relevant to anesthetic technique.↗
▶Ep 16 · 1:42
host_summaryThe most common technique for maintaining stillness is short-acting opioid infusions, which result in relatively little hemodynamic instability.↗
▶Ep 16 · 1:53
host_summaryVolatile anesthetics are especially useful when preservation of spontaneous ventilation is desired.↗
▶Ep 16 · 2:31
host_summaryInsufflation using pneumothorax created by trocar placement can facilitate surgical exposure by overcoming peak inspiratory pressures to allow lung collapse.↗
▶Ep 16 · 2:48
host_summaryInsufflation is useful for small kids with good lung compliance but not effective in kids with severe bronchopulmonary dysplasia or other compliance abnormalities.↗
▶Ep 16 · 4:19
host_summaryEndotracheal tube placement is technically easier than placement of other lung isolation devices.↗
▶Ep 16 · 4:39
quoteIn kids with a pig bronchus or similar situation, this really becomes very difficult.↗
▶Ep 16 · 4:48
host_summaryA tracheal bronchus (pig bronchus) is an anatomical variant where an accessory bronchus originates directly from the supracarinal trachea.↗
▶Ep 16 · 5:17
host_summaryIn 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.↗
▶Ep 16 · 5:38
host_summaryEarly conversations between anesthesiologists and surgeons about patient specifics are part of deciding the best modality for each individual patient.↗
▶Ep 16 · 6:07
host_summarySingle ventricle patients may be candidates for open repair or ECMO support to ensure good outcomes.↗
Journal of Pediatric Surgery Article Review: October 2023
▶Ep 17 · 3:14
host_summaryThere was no significant difference in secondary outcomes (gastroesophageal reflux disease, anastomotic leak, esophagitis) between infants receiving prophylactic acid suppression and those who did not↗
▶Ep 17 · 3:51
host_summaryPotential risks of long-term acid suppression therapy include dysbiosis, necrotizing enterocolitis, and increased neonatal infection rates, particularly relevant in preterm and low birth weight infants↗
▶Ep 17 · 9:20
host_summaryFactors associated with symptomatic CPAM lesions include age older than 4 years, postnatal diagnosis, and maximum cyst diameter greater than 39.9 millimeters↗
▶Ep 17 · 9:50
host_summaryThe CPAM study did not enroll patients who accepted conservative treatment compared to asymptomatic patients↗
▶Ep 17 · 10:00
host_summaryThe CPAM study sample size was insufficient and all patients were from a single center↗
Journal of Pediatric Surgery Article Review: Q1 (Jan-Mar) 2024
▶Ep 18 · 5:13
host_summaryThe esophageal atresia study had 215 patients, 13% had complex esophageal atresia, and of those 25 patients survived the repair.↗
▶Ep 18 · 5:28
host_summaryOf the 25 complex esophageal atresia survivors, 14 patients were type A and 11 patients were type C.↗
▶Ep 18 · 6:03
host_summaryOf the 25 complex esophageal atresia patients, 18 had delayed primary anastomosis and 7 had esophageal replacement.↗
▶Ep 18 · 6:13
host_summaryOnly 4 patients with esophageal atresia were potentially treatable by traction.↗
▶Ep 18 · 6:13
host_summaryTwo of the esophageal replacements were salvage procedures following a failed traction.↗
▶Ep 18 · 6:57
host_summaryIn cases where traction techniques had not been attempted, the native esophagus was retained in 80% of cases.↗
▶Ep 18 · 7:02
host_summaryThe median time to esophageal continuity in the Newcastle series was 77 days.↗
▶Ep 18 · 7:12
host_summaryManagement of complex esophageal atresia without lengthening procedure can result in a similar rate of retention of the native esophagus but with significantly less morbidity.↗
Journal of Pediatric Surgery Article Review: 1st Quarter (Jan-Mar) 2025
▶Ep 23 · 1:41
host_summaryA subset of children after esophageal atresia repair experience severe airway collapse, leaving them ventilator dependent or suffering repeated cyanotic spells↗
▶Ep 23 · 6:57
host_summaryA significant number of outreach services are located within 50 kilometers of a children's hospital, leaving vast regions without access to pediatric surgical care↗
▶Ep 23 · 12:38
host_summaryThe study examined 4,612 G-tube placements from 71 NSQIP-Pediatric hospitals in 2023↗
▶Ep 23 · 13:04
host_summaryUpper GI studies were obtained in 45% of first-time G-tube cases with substantial interhospital variability from 0 to 99%↗
▶Ep 23 · 13:45
host_summary14% of G-tube cases resulted in an ED visit within 0 to 30 days↗
▶Ep 23 · 13:45
host_summary5.2% of G-tube cases involved dislodgement within 0 to 30 days↗
Journal of Pediatric Surgery Article Review: 2nd Quarter (Apr-Jun) 2025
▶Ep 24 · 1:48
host_summaryA subset of children after esophageal atresia repair experience severe airway collapse, leaving them ventilator dependent or suffering repeated cyanotic spells↗
▶Ep 24 · 6:57
host_summaryA significant number of outreach services are located within 50 kilometers of a children's hospital, leaving vast regions without access to pediatric surgical care↗
▶Ep 24 · 12:38
host_summaryThe study examined 4,612 G-tube placements from 71 NSQIP-Pediatric hospitals in 2023↗
▶Ep 24 · 13:04
host_summaryUpper GI studies were obtained in 45% of first-time G-tube cases with substantial interhospital variability from 0 to 99%↗
▶Ep 24 · 13:45
host_summary14% of G-tube cases resulted in an ED visit within 0 to 30 days↗
▶Ep 24 · 13:45
host_summary5.2% of G-tube cases involved dislodgement within 0 to 30 days↗
Journal of Pediatric Surgery Article Review: 2nd Quarter (Apr-Jun) 2024
▶Ep 56 · 0:06
quoteHi 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.↗
▶Ep 56 · 1:05
quoteI'm a pediatric surgeon at Alberta Children's Hospital. I've also been the publication chair for the uh Pacific Association of Pediatric Surgeons.↗
▶Ep 56 · 1:25
host_summaryMMP-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↗
▶Ep 56 · 1:43
host_summaryHigher levels of MMP-7 are associated with the diagnosis of biliary atresia↗
▶Ep 56 · 1:56
host_summaryIn a cohort of 329 biliary atresia cases from July 2020 to December 2022, 40 were classified as low MMP-7↗
▶Ep 56 · 2:11
quoteThis 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↗
▶Ep 56 · 2:36
host_summaryLow levels of MMP-7 in biliary atresia patients are associated with low levels of preoperative GGT (gamma glutamyl transpeptidase) and direct bilirubin↗
▶Ep 56 · 3:02
host_summaryGGT (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↗
▶Ep 56 · 3:19
host_summaryBiliary atresia has variable outcomes even within one center, with patients who anatomically look similar having dramatically different outcomes↗
▶Ep 56 · 4:09
host_summaryHaving lower MMP-7 levels within the cohort of biliary atresia patients is associated with worse prognosis↗
▶Ep 56 · 4:26
quoteAnd 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?↗
▶Ep 56 · 4:41
host_summaryThe mechanism of why low MMP-7 levels in biliary atresia patients leads to worse prognosis is unknown↗
▶Ep 56 · 7:02
host_summaryIn 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↗
▶Ep 56 · 7:43
host_summaryOf 267 uncomplicated gastroschisis patients, 78% received exclusive breast milk in the first 28 days of life and 22% received supplemental or exclusive formula↗
▶Ep 56 · 8:27
host_summaryThere 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↗
▶Ep 56 · 8:53
host_summaryPatients 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↗
▶Ep 56 · 12:46
host_summaryA 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↗
▶Ep 56 · 13:16
host_summaryThere 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)↗
▶Ep 56 · 13:30
opinionThe life course progression of anorectal malformation and Hirschsprung disease is not well understood↗
Journal of Pediatric Surgery Article Review: 3rd Quarter (Jul-Sep) 2024
▶Ep 57 · 0:06
quoteHi 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.↗
▶Ep 57 · 1:38
quoteMy 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.↗
▶Ep 57 · 1:56
clinicalThe PCPLC multi-institutional registry includes a number of institutions throughout the United States.↗
▶Ep 57 · 3:20
epidemiological85% of Hirschsprung patients were diagnosed at less than 1 year of age.↗
▶Ep 57 · 3:45
clinicalKids with shorter segment disease (rectosigmoid or very small portion of aganglionic bowel) were more likely to be diagnosed at a later age.↗
▶Ep 57 · 3:57
clinicalChildren with long segment Hirschsprung disease typically present at birth with classic symptoms such as failure to pass meconium.↗
▶Ep 57 · 4:26
clinicalApproximately one-third of neonates and 50% of infants, toddlers, and children had diverting ostomies performed prior to pull-through.↗
▶Ep 57 · 5:01
clinicalThere was no difference in overall rates of redo pull-throughs across age groups.↗
▶Ep 57 · 5:07
clinicalOlder children were more likely to need a redo pull-through due to an anastomotic leak.↗
▶Ep 57 · 5:13
opinionHigher rates of diverting ostomy post pull-through were suspected to be a treatment for post pull-through leak or anastomotic leak.↗
▶Ep 57 · 5:24
clinicalThe only outcome difference seen was nighttime soiling or incontinence in the older patient population.↗
▶Ep 57 · 7:44
quoteI am a pediatric surgeon. Uh, in the division of pediatric Surgery with Presbyterian Healthcare Services in Albuquerque, New Mexico↗
▶Ep 57 · 8:09
clinicalThe systematic review on gastroschisis included 28 high quality manuscripts.↗
▶Ep 57 · 8:15
clinicalTwo randomized controlled trials on gastroschisis had been started but both ended prematurely and were underpowered.↗
▶Ep 57 · 10:37
clinicalClinical practice suggests that skin organisms are most commonly identified in infections among infants with gastroschisis.↗
▶Ep 57 · 10:44
clinicalGastroschisis infants have a fairly high rate of wound infection.↗
▶Ep 57 · 10:50
clinicalSilo closures have a higher rate of infection than other closure methods for gastroschisis.↗
▶Ep 57 · 10:50
clinicalSutureless closure has the lowest rate of infection for gastroschisis.↗
▶Ep 57 · 10:57
guidelineThe 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.↗
▶Ep 57 · 12:22
clinicalStable gastroschisis infants with sufficient abdominal capacity for sutureless closure tend to have the best outcomes.↗
▶Ep 57 · 12:29
clinicalMinimizing fluids and paralytics in gastroschisis infants improves their results.↗
▶Ep 57 · 12:35
clinicalGastroschisis patients with sutureless closure have shorter length of stay and achieve feeding sooner.↗
▶Ep 57 · 15:11
clinicalThe Clavien-Madadi classification scale consists of several grades from 1 to 5 based on the type of therapy needed to correct the complication.↗
▶Ep 57 · 15:46
clinicalThe validation process circulated up to 20 case scenarios of unexpected events within the ERNICA Network (European Reference Network for inherited and congenital anomalies).↗
▶Ep 57 · 16:34
clinical59 surgeons from 12 European countries completed the Clavien-Madadi validation questionnaire.↗
▶Ep 57 · 17:04
clinicalNearly 82% of surgeons affirmed advantages of the Clavien-Madadi classification.↗
▶Ep 57 · 17:04
clinical43% of pediatric surgeons preferred the Clavien-Madadi classification compared to 12% for the Clavien-Dindo classification.↗
Umbilical Disorders with Dr. Rebeccah Brown
▶Ep 59 · 0:34
host_summaryThe umbilical cord contains two umbilical arteries and one umbilical vein surrounded by Wharton's jelly (a gelatin-like extracellular matrix).↗
▶Ep 59 · 0:34
quoteTwo umbilical arteries and one umbilical vein surrounding by a gelatin-like extracellular matrix known as Worthin's jelly.↗
▶Ep 59 · 0:50
host_summaryUmbilical cords usually fall off at 2 to 3 weeks after birth.↗
▶Ep 59 · 0:50
quoteThey usually fall off 2 to 3 weeks, and the delay can be a manifestation of an immune deficiency.↗
▶Ep 59 · 0:50
host_summaryDelayed umbilical cord separation can be a manifestation of an immune deficiency.↗
▶Ep 59 · 1:20
host_summaryMild omphalitis cases (inflammation of the belly button) may be treated with alcohol drying, ampicillin, or amoxicillin with follow-up every 24 hours.↗
▶Ep 59 · 1:40
host_summary16% of patients admitted with omphalitis develop necrotizing fasciitis.↗
▶Ep 59 · 1:40
quote16% of the patients admitted with onalittis develop necrotizing fasciitis.↗
▶Ep 59 · 1:46
host_summaryNecrotizing fasciitis from omphalitis presents with rapidly progressive umbilical edema, erythema, drainage, and has a high mortality rate.↗
▶Ep 59 · 2:27
host_summaryUmbilical hernias can be associated with trisomy 13, 18, and 21.↗
▶Ep 59 · 2:47
host_summaryDr. Brown mentioned that if the fascial opening in an umbilical hernia is larger than 1.5 centimeters, it may not close by itself.↗
▶Ep 59 · 2:55
host_summaryIn 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.↗
▶Ep 59 · 4:54
host_summaryUnplanned 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.↗
▶Ep 59 · 5:10
host_summaryAsymptomatic umbilical hernia repair should be delayed until greater than 4 years of age.↗
▶Ep 59 · 5:18
host_summaryIn 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.↗
▶Ep 59 · 5:53
host_summaryIn Rangel's study, closure rates for smaller hernias (≤1 cm) were nearly 90%, while for larger hernias they were around 80%.↗
▶Ep 59 · 6:12
host_summaryRangel's study concluded that umbilical hernia repair should be delayed until age 5 years given the high incidence of spontaneous closure.↗
▶Ep 59 · 6:56
host_summaryProboscoid hernia occurs when the skin above the hernia grows and pushes through the opening in the abdominal wall.↗
▶Ep 59 · 7:05
host_summaryIt is recommended to correct proboscoid hernias before school age to avoid psychological issues for the child.↗
▶Ep 59 · 8:00
host_summaryDr. 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.↗
▶Ep 59 · 8:55
host_summaryUmbilical granulomas are usually moist but commonly dry up and fall off spontaneously over time.↗
▶Ep 59 · 9:00
host_summaryUmbilical granulomas often respond to silver nitrate treatment.↗
Journal of Pediatric Surgery Article Review: 1st Quarter (Jan-Mar) 2025
▶Ep 67 · 1:41
host_summaryA subset of children after esophageal atresia repair experience severe airway collapse, leaving them ventilator dependent or suffering repeated cyanotic spells↗
▶Ep 67 · 6:57
host_summaryA significant number of outreach services are located within 50 kilometers of a children's hospital, leaving vast regions without access to pediatric surgical care↗
▶Ep 67 · 12:38
host_summaryThe study examined 4,612 G-tube placements from 71 NSQIP-Pediatric hospitals in 2023↗
▶Ep 67 · 13:04
host_summaryUpper GI studies were obtained in 45% of first-time G-tube cases with substantial interhospital variability from 0 to 99%↗
▶Ep 67 · 13:45
host_summary14% of G-tube cases resulted in an ED visit within 0 to 30 days↗
▶Ep 67 · 13:45
host_summary5.2% of G-tube cases involved dislodgement within 0 to 30 days↗
host_summaryA Western Pediatric Surgery Research Consortium machine learning algorithm based on 1600 patients from 10 centers (2016-2019) can predict common bile duct stones using nine clinical factors, with 20% of patients having CBD stones↗
▶Ep 3 · 6:26
clinicalA Western Pediatric Surgery Research Consortium machine learning algorithm based on 1600 patients from 10 centers (2016-2019) can predict common bile duct stones using nine clinical factors, with 20% of patients having CBD stones↗
▶Ep 3 · 7:33
clinicalThe previous algorithm for predicting CBD stones was based on 300-400 patients, compared to 1600 in the new algorithm↗
▶Ep 3 · 7:33
host_summaryThe previous algorithm for predicting CBD stones was based on 300-400 patients, compared to 1600 in the new algorithm↗
▶Ep 3 · 13:34
clinicalIn a study of 173 laparoscopic cholecystectomies over 10 years (2013-2023), 83 used standard technique and 90 used ICG fluorescence↗
▶Ep 3 · 13:34
host_summaryIn a study of 173 laparoscopic cholecystectomies over 10 years (2013-2023), 83 used standard technique and 90 used ICG fluorescence↗
▶Ep 3 · 13:54
host_summaryThe ICG study showed perioperative complication rate of 12% in standard technique versus 0% with ICG, with significantly shorter operative times and better biliary visualization in the ICG group↗
▶Ep 3 · 13:54
clinicalThe ICG study showed perioperative complication rate of 12% in standard technique versus 0% with ICG, with significantly shorter operative times and better biliary visualization in the ICG group↗
Esophageal Disconnect for Severe GERD in Neurologically-Impaired Children:...
▶Ep 2 · 1:34
quotethe definition of insanity is, uh, continued. You're trying to redo the same applying the same solution to the same problem and expecting a different outcome.↗
Journal of Pediatric Surgery Article Review: 2nd Quarter (Apr-Jun) 2024
▶Ep 22 · 0:06
quoteHi 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.↗
▶Ep 22 · 1:05
quoteI'm a pediatric surgeon at Alberta Children's Hospital. I've also been the publication chair for the uh Pacific Association of Pediatric Surgeons.↗
▶Ep 22 · 1:25
host_summaryMMP-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↗
▶Ep 22 · 1:43
host_summaryHigher levels of MMP-7 are associated with the diagnosis of biliary atresia↗
▶Ep 22 · 1:56
host_summaryIn a cohort of 329 biliary atresia cases from July 2020 to December 2022, 40 were classified as low MMP-7↗
▶Ep 22 · 2:11
quoteThis 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↗
▶Ep 22 · 2:36
host_summaryLow levels of MMP-7 in biliary atresia patients are associated with low levels of preoperative GGT (gamma glutamyl transpeptidase) and direct bilirubin↗
▶Ep 22 · 3:02
host_summaryGGT (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↗
▶Ep 22 · 3:19
host_summaryBiliary atresia has variable outcomes even within one center, with patients who anatomically look similar having dramatically different outcomes↗
▶Ep 22 · 4:09
host_summaryHaving lower MMP-7 levels within the cohort of biliary atresia patients is associated with worse prognosis↗
▶Ep 22 · 4:26
quoteAnd 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?↗
▶Ep 22 · 4:41
host_summaryThe mechanism of why low MMP-7 levels in biliary atresia patients leads to worse prognosis is unknown↗
▶Ep 22 · 7:02
host_summaryIn 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↗
▶Ep 22 · 7:43
host_summaryOf 267 uncomplicated gastroschisis patients, 78% received exclusive breast milk in the first 28 days of life and 22% received supplemental or exclusive formula↗
▶Ep 22 · 8:27
host_summaryThere 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↗
▶Ep 22 · 8:53
host_summaryPatients 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↗
▶Ep 22 · 12:46
host_summaryA 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↗
▶Ep 22 · 13:16
host_summaryThere 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)↗
▶Ep 22 · 13:30
opinionThe life course progression of anorectal malformation and Hirschsprung disease is not well understood↗
Journal of Pediatric Surgery Article Review: 3rd Quarter (Jul-Sep) 2024
▶Ep 23 · 0:06
quoteHi 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.↗
▶Ep 23 · 1:38
quoteMy 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.↗
▶Ep 23 · 1:56
clinicalThe PCPLC multi-institutional registry includes a number of institutions throughout the United States.↗
▶Ep 23 · 3:20
epidemiological85% of Hirschsprung patients were diagnosed at less than 1 year of age.↗
▶Ep 23 · 3:45
clinicalKids with shorter segment disease (rectosigmoid or very small portion of aganglionic bowel) were more likely to be diagnosed at a later age.↗
▶Ep 23 · 3:57
clinicalChildren with long segment Hirschsprung disease typically present at birth with classic symptoms such as failure to pass meconium.↗
▶Ep 23 · 4:26
clinicalApproximately one-third of neonates and 50% of infants, toddlers, and children had diverting ostomies performed prior to pull-through.↗
▶Ep 23 · 5:01
clinicalThere was no difference in overall rates of redo pull-throughs across age groups.↗
▶Ep 23 · 5:07
clinicalOlder children were more likely to need a redo pull-through due to an anastomotic leak.↗
▶Ep 23 · 5:13
opinionHigher rates of diverting ostomy post pull-through were suspected to be a treatment for post pull-through leak or anastomotic leak.↗
▶Ep 23 · 5:24
clinicalThe only outcome difference seen was nighttime soiling or incontinence in the older patient population.↗
▶Ep 23 · 7:44
quoteI am a pediatric surgeon. Uh, in the division of pediatric Surgery with Presbyterian Healthcare Services in Albuquerque, New Mexico↗
▶Ep 23 · 8:09
clinicalThe systematic review on gastroschisis included 28 high quality manuscripts.↗
▶Ep 23 · 8:15
clinicalTwo randomized controlled trials on gastroschisis had been started but both ended prematurely and were underpowered.↗
▶Ep 23 · 10:37
clinicalClinical practice suggests that skin organisms are most commonly identified in infections among infants with gastroschisis.↗
▶Ep 23 · 10:44
clinicalGastroschisis infants have a fairly high rate of wound infection.↗
▶Ep 23 · 10:50
clinicalSilo closures have a higher rate of infection than other closure methods for gastroschisis.↗
▶Ep 23 · 10:50
clinicalSutureless closure has the lowest rate of infection for gastroschisis.↗
▶Ep 23 · 10:57
guidelineThe 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.↗
▶Ep 23 · 12:22
clinicalStable gastroschisis infants with sufficient abdominal capacity for sutureless closure tend to have the best outcomes.↗
▶Ep 23 · 12:29
clinicalMinimizing fluids and paralytics in gastroschisis infants improves their results.↗
▶Ep 23 · 12:35
clinicalGastroschisis patients with sutureless closure have shorter length of stay and achieve feeding sooner.↗
▶Ep 23 · 15:11
clinicalThe Clavien-Madadi classification scale consists of several grades from 1 to 5 based on the type of therapy needed to correct the complication.↗
▶Ep 23 · 15:46
clinicalThe validation process circulated up to 20 case scenarios of unexpected events within the ERNICA Network (European Reference Network for inherited and congenital anomalies).↗
▶Ep 23 · 16:34
clinical59 surgeons from 12 European countries completed the Clavien-Madadi validation questionnaire.↗
▶Ep 23 · 17:04
clinical43% of pediatric surgeons preferred the Clavien-Madadi classification compared to 12% for the Clavien-Dindo classification.↗
▶Ep 23 · 17:04
clinicalNearly 82% of surgeons affirmed advantages of the Clavien-Madadi classification.↗
Journal of Pediatric Surgery Article Review: May 2022, CAPS Issue
▶Ep 53 · 11:32
epidemiologicalIn the Miami bicycle injury study of 77 cases over eight years, only one patient was wearing a helmet.↗
▶Ep 53 · 13:02
epidemiologicalThe majority of bicycle injuries were happening in low income neighborhoods.↗
▶Ep 53 · 13:10
epidemiologicalBicycle injuries were happening at high speed areas, like interstate on-ramps and off-ramps.↗
▶Ep 53 · 13:13
epidemiologicalAbout half of the bicycle injuries happened within 1 mile from home.↗
▶Ep 53 · 13:51
opinionFree helmet programs going through a pediatrician's office are useful but need to be sustained.↗
▶Ep 53 · 13:58
opinionCities that have been successful with helmet programs have implemented multidisciplinary approaches including free helmet programs, changing laws, and public education, sustained over several years.↗
Quick Literature Updates Episode 15
▶Ep 66 · 0:09
quoteHello pediatric surgery family, I'm E Gdy, a research fellow from Cincinnati Children's Hospital Medical Center.↗
▶Ep 66 · 0:09
quoteHello pediatric surgery family, I'm E Gdy, a research fellow from Cincinnati Children's Hospital Medical Center.↗
Journal of Pediatric Surgery Article Review: 2nd Quarter (Apr-Jun) 2024
▶Ep 71 · 0:06
quoteHi 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.↗
▶Ep 71 · 1:05
quoteI'm a pediatric surgeon at Alberta Children's Hospital. I've also been the publication chair for the uh Pacific Association of Pediatric Surgeons.↗
▶Ep 71 · 1:25
host_summaryMMP-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↗
▶Ep 71 · 1:43
host_summaryHigher levels of MMP-7 are associated with the diagnosis of biliary atresia↗
▶Ep 71 · 1:56
host_summaryIn a cohort of 329 biliary atresia cases from July 2020 to December 2022, 40 were classified as low MMP-7↗
▶Ep 71 · 2:11
quoteThis 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↗
▶Ep 71 · 2:36
host_summaryLow levels of MMP-7 in biliary atresia patients are associated with low levels of preoperative GGT (gamma glutamyl transpeptidase) and direct bilirubin↗
▶Ep 71 · 3:02
host_summaryGGT (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↗
▶Ep 71 · 3:19
host_summaryBiliary atresia has variable outcomes even within one center, with patients who anatomically look similar having dramatically different outcomes↗
▶Ep 71 · 4:09
host_summaryHaving lower MMP-7 levels within the cohort of biliary atresia patients is associated with worse prognosis↗
▶Ep 71 · 4:26
quoteAnd 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?↗
▶Ep 71 · 4:41
host_summaryThe mechanism of why low MMP-7 levels in biliary atresia patients leads to worse prognosis is unknown↗
▶Ep 71 · 7:02
host_summaryIn 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↗
▶Ep 71 · 7:43
host_summaryOf 267 uncomplicated gastroschisis patients, 78% received exclusive breast milk in the first 28 days of life and 22% received supplemental or exclusive formula↗
▶Ep 71 · 8:27
host_summaryThere 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↗
▶Ep 71 · 8:53
host_summaryPatients 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↗
▶Ep 71 · 12:46
host_summaryA 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↗
▶Ep 71 · 13:16
host_summaryThere 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)↗
▶Ep 71 · 13:30
opinionThe life course progression of anorectal malformation and Hirschsprung disease is not well understood↗
Journal of Pediatric Surgery Article Review: 3rd Quarter (Jul-Sep) 2024
▶Ep 73 · 0:06
quoteHi 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.↗
▶Ep 73 · 1:38
quoteMy 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.↗
▶Ep 73 · 1:56
clinicalThe PCPLC multi-institutional registry includes a number of institutions throughout the United States.↗
▶Ep 73 · 3:20
epidemiological85% of Hirschsprung patients were diagnosed at less than 1 year of age.↗
▶Ep 73 · 3:45
clinicalKids with shorter segment disease (rectosigmoid or very small portion of aganglionic bowel) were more likely to be diagnosed at a later age.↗
▶Ep 73 · 3:57
clinicalChildren with long segment Hirschsprung disease typically present at birth with classic symptoms such as failure to pass meconium.↗
▶Ep 73 · 4:26
clinicalApproximately one-third of neonates and 50% of infants, toddlers, and children had diverting ostomies performed prior to pull-through.↗
▶Ep 73 · 5:01
clinicalThere was no difference in overall rates of redo pull-throughs across age groups.↗
▶Ep 73 · 5:07
clinicalOlder children were more likely to need a redo pull-through due to an anastomotic leak.↗
▶Ep 73 · 5:13
opinionHigher rates of diverting ostomy post pull-through were suspected to be a treatment for post pull-through leak or anastomotic leak.↗
▶Ep 73 · 5:24
clinicalThe only outcome difference seen was nighttime soiling or incontinence in the older patient population.↗
▶Ep 73 · 7:44
quoteI am a pediatric surgeon. Uh, in the division of pediatric Surgery with Presbyterian Healthcare Services in Albuquerque, New Mexico↗
▶Ep 73 · 8:09
clinicalThe systematic review on gastroschisis included 28 high quality manuscripts.↗
▶Ep 73 · 8:15
clinicalTwo randomized controlled trials on gastroschisis had been started but both ended prematurely and were underpowered.↗
▶Ep 73 · 10:37
clinicalClinical practice suggests that skin organisms are most commonly identified in infections among infants with gastroschisis.↗
▶Ep 73 · 10:44
clinicalGastroschisis infants have a fairly high rate of wound infection.↗
▶Ep 73 · 10:50
clinicalSutureless closure has the lowest rate of infection for gastroschisis.↗
▶Ep 73 · 10:50
clinicalSilo closures have a higher rate of infection than other closure methods for gastroschisis.↗
▶Ep 73 · 10:57
guidelineThe 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.↗
▶Ep 73 · 12:22
clinicalStable gastroschisis infants with sufficient abdominal capacity for sutureless closure tend to have the best outcomes.↗
▶Ep 73 · 12:29
clinicalMinimizing fluids and paralytics in gastroschisis infants improves their results.↗
▶Ep 73 · 12:35
clinicalGastroschisis patients with sutureless closure have shorter length of stay and achieve feeding sooner.↗
▶Ep 73 · 15:11
clinicalThe Clavien-Madadi classification scale consists of several grades from 1 to 5 based on the type of therapy needed to correct the complication.↗
▶Ep 73 · 15:46
clinicalThe validation process circulated up to 20 case scenarios of unexpected events within the ERNICA Network (European Reference Network for inherited and congenital anomalies).↗
▶Ep 73 · 16:34
clinical59 surgeons from 12 European countries completed the Clavien-Madadi validation questionnaire.↗
▶Ep 73 · 17:04
clinical43% of pediatric surgeons preferred the Clavien-Madadi classification compared to 12% for the Clavien-Dindo classification.↗
▶Ep 73 · 17:04
clinicalNearly 82% of surgeons affirmed advantages of the Clavien-Madadi classification.↗
Colorectal Quiz: Episode 49 – Collaborating for Kids: Colorectal & Pelvic Solutions (with a Little Help from AI)
▶Ep 77 · 5:50
clinicalWhen documents are uploaded to Notebook LM, the AI creates an expert based solely on the provided content, not external sources.↗
▶Ep 77 · 5:50
clinicalWhen documents are uploaded to Notebook LM, the AI creates an expert based solely on the provided content, not external sources.↗
Best of the Best Gen Surg - Predictors of Low and High Opioid Tablet Consumption after Inguinal Hernia Repair – an ACHQC Opioid Reduction Task Force Analysis - Dr. Warren
▶Ep 13 · 7:50
clinicalAlmost every state has reversed legislation to allow prescribing limited opioids without hand-off through EMRs↗
▶Ep 13 · 8:40
host_summaryThe rate of refill calls for inguinal hernias following these guidelines is 4%↗
▶Ep 13 · 9:00
host_summaryThe number one predictor of how many opioid tablets a patient takes is how many they are prescribed↗
▶Ep 13 · 9:00
quotethe number one predictor of how many opioid tablets a patient takes is how many they are prescribed.↗
▶Ep 13 · 9:20
clinicalA surgeon previously discharged every inguinal hernia patient with 50 oxycodones at $3 prescription cost plus $23 FedEx for refills↗
▶Ep 13 · 10:00
clinicalFor laparoscopic inguinal hernias, a surgeon has discharged patients with zero narcotics for six months, using ice and scheduled Motrin and Tylenol, with only one refill request↗
▶Ep 13 · 10:00
quoteI actually send people home with, for, for laparoscopic inguinal hernias. I'm not so sure if we're open yet, but lap, which is the majority of my practice, zero narcotics, zero six months. I have not written a script. I send them with ice and scheduled Motrin and Tylenol.↗
Case-Based Journal Review: Inguinal Hernia 2025
▶Ep 17 · 3:36
host_summaryIn the JAMA trial of 308 preterm infants, 44 patients (28%) in the early repair group had at least one serious adverse event versus 27 patients (18%) in the late repair group↗
▶Ep 17 · 4:07
host_summaryRecurrence rate after inguinal hernia repair in the trial was less than 1%↗
▶Ep 17 · 4:07
host_summaryIncarceration rate in the late repair group was around 4%↗
▶Ep 17 · 7:12
host_summaryThe JAMA trial was terminated early, had low recruitment rate, and ended up with less statistical power than initially calculated↗
▶Ep 17 · 10:54
host_summaryIn the Dutch one-stop surgery study of 91 patients (54 one-stop, 37 usual care), all but one of the one-stop surgery patients were discharged home on the day of surgery↗
▶Ep 17 · 10:59
host_summaryPost-operative complication and recurrence rates did not differ between one-stop surgery and usual care patients in the Dutch study↗
▶Ep 17 · 11:05
host_summaryGeneral satisfaction and inclusion of family were higher after one-stop surgery experience↗
▶Ep 17 · 15:34
host_summaryIn the multi-institutional patent processus vaginalis study, 246 eligible infants under 4 months with PPV found at pyloromyotomy were enrolled at 8 children's hospitals, with 85% responding to at least one annual follow-up↗
▶Ep 17 · 15:49
host_summaryOf the 246 infants with patent processus vaginalis, two had inguinal hernia repair for symptomatic hernia, one had orchiopexy and incidental inguinal hernia repair, for a total of 3 hernia repairs↗
▶Ep 17 · 16:13
host_summaryThe presence of patent processus vaginalis at the time of pyloromyotomy was common, but the need for hernia repair was around 1% in the first year of follow-up↗
Journal of Pediatric Surgery Article Review: 2nd Quarter (Apr-Jun) 2024
▶Ep 85 · 0:06
quoteHi 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.↗
▶Ep 85 · 1:05
quoteI'm a pediatric surgeon at Alberta Children's Hospital. I've also been the publication chair for the uh Pacific Association of Pediatric Surgeons.↗
▶Ep 85 · 1:25
host_summaryMMP-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↗
▶Ep 85 · 1:43
host_summaryHigher levels of MMP-7 are associated with the diagnosis of biliary atresia↗
▶Ep 85 · 1:56
host_summaryIn a cohort of 329 biliary atresia cases from July 2020 to December 2022, 40 were classified as low MMP-7↗
▶Ep 85 · 2:11
quoteThis 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↗
▶Ep 85 · 2:36
host_summaryLow levels of MMP-7 in biliary atresia patients are associated with low levels of preoperative GGT (gamma glutamyl transpeptidase) and direct bilirubin↗
▶Ep 85 · 3:02
host_summaryGGT (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↗
▶Ep 85 · 3:19
host_summaryBiliary atresia has variable outcomes even within one center, with patients who anatomically look similar having dramatically different outcomes↗
▶Ep 85 · 4:09
host_summaryHaving lower MMP-7 levels within the cohort of biliary atresia patients is associated with worse prognosis↗
▶Ep 85 · 4:26
quoteAnd 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?↗
▶Ep 85 · 4:41
host_summaryThe mechanism of why low MMP-7 levels in biliary atresia patients leads to worse prognosis is unknown↗
▶Ep 85 · 7:02
host_summaryIn 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↗
▶Ep 85 · 7:43
host_summaryOf 267 uncomplicated gastroschisis patients, 78% received exclusive breast milk in the first 28 days of life and 22% received supplemental or exclusive formula↗
▶Ep 85 · 8:27
host_summaryThere 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↗
▶Ep 85 · 8:53
host_summaryPatients 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↗
▶Ep 85 · 12:46
host_summaryA 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↗
▶Ep 85 · 13:16
host_summaryThere 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)↗
▶Ep 85 · 13:30
opinionThe life course progression of anorectal malformation and Hirschsprung disease is not well understood↗
Journal of Pediatric Surgery Article Review: 3rd Quarter (Jul-Sep) 2024
▶Ep 86 · 0:06
quoteHi 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.↗
▶Ep 86 · 0:06
quoteHi 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.↗
▶Ep 86 · 1:38
quoteMy 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.↗
▶Ep 86 · 1:38
quoteMy 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.↗
▶Ep 86 · 1:56
clinicalThe PCPLC multi-institutional registry includes a number of institutions throughout the United States.↗
▶Ep 86 · 1:56
host_summaryThe PCPLC multi-institutional registry includes a number of institutions throughout the United States.↗
▶Ep 86 · 3:20
host_summary85% of Hirschsprung patients were diagnosed at less than 1 year of age.↗
▶Ep 86 · 3:20
epidemiological85% of Hirschsprung patients were diagnosed at less than 1 year of age.↗
▶Ep 86 · 3:45
clinicalKids with shorter segment disease (rectosigmoid or very small portion of aganglionic bowel) were more likely to be diagnosed at a later age.↗
▶Ep 86 · 3:45
host_summaryKids with shorter segment disease (rectosigmoid or very small portion of aganglionic bowel) were more likely to be diagnosed at a later age.↗
▶Ep 86 · 3:57
host_summaryChildren with long segment Hirschsprung disease typically present at birth with classic symptoms such as failure to pass meconium.↗
▶Ep 86 · 3:57
clinicalChildren with long segment Hirschsprung disease typically present at birth with classic symptoms such as failure to pass meconium.↗
▶Ep 86 · 4:26
clinicalApproximately one-third of neonates and 50% of infants, toddlers, and children had diverting ostomies performed prior to pull-through.↗
▶Ep 86 · 4:26
host_summaryApproximately one-third of neonates and 50% of infants, toddlers, and children had diverting ostomies performed prior to pull-through.↗
▶Ep 86 · 5:01
host_summaryThere was no difference in overall rates of redo pull-throughs across age groups.↗
▶Ep 86 · 5:01
clinicalThere was no difference in overall rates of redo pull-throughs across age groups.↗
▶Ep 86 · 5:07
clinicalOlder children were more likely to need a redo pull-through due to an anastomotic leak.↗
▶Ep 86 · 5:07
host_summaryOlder children were more likely to need a redo pull-through due to an anastomotic leak.↗
▶Ep 86 · 5:13
host_summaryHigher rates of diverting ostomy post pull-through were suspected to be a treatment for post pull-through leak or anastomotic leak.↗
▶Ep 86 · 5:13
opinionHigher rates of diverting ostomy post pull-through were suspected to be a treatment for post pull-through leak or anastomotic leak.↗
▶Ep 86 · 5:24
clinicalThe only outcome difference seen was nighttime soiling or incontinence in the older patient population.↗
▶Ep 86 · 5:24
host_summaryThe only outcome difference seen was nighttime soiling or incontinence in the older patient population.↗
▶Ep 86 · 7:44
quoteI am a pediatric surgeon. Uh, in the division of pediatric Surgery with Presbyterian Healthcare Services in Albuquerque, New Mexico↗
▶Ep 86 · 7:44
quoteI am a pediatric surgeon. Uh, in the division of pediatric Surgery with Presbyterian Healthcare Services in Albuquerque, New Mexico↗
▶Ep 86 · 8:09
clinicalThe systematic review on gastroschisis included 28 high quality manuscripts.↗
▶Ep 86 · 8:09
host_summaryThe systematic review on gastroschisis included 28 high quality manuscripts.↗
▶Ep 86 · 8:15
host_summaryTwo randomized controlled trials on gastroschisis had been started but both ended prematurely and were underpowered.↗
▶Ep 86 · 8:15
clinicalTwo randomized controlled trials on gastroschisis had been started but both ended prematurely and were underpowered.↗
▶Ep 86 · 10:37
clinicalClinical practice suggests that skin organisms are most commonly identified in infections among infants with gastroschisis.↗
▶Ep 86 · 10:37
host_summaryClinical practice suggests that skin organisms are most commonly identified in infections among infants with gastroschisis.↗
▶Ep 86 · 10:44
host_summaryGastroschisis infants have a fairly high rate of wound infection.↗
▶Ep 86 · 10:44
clinicalGastroschisis infants have a fairly high rate of wound infection.↗
▶Ep 86 · 10:50
clinicalSutureless closure has the lowest rate of infection for gastroschisis.↗
▶Ep 86 · 10:50
clinicalSilo closures have a higher rate of infection than other closure methods for gastroschisis.↗
▶Ep 86 · 10:50
host_summarySilo closures have a higher rate of infection than other closure methods for gastroschisis.↗
▶Ep 86 · 10:50
host_summarySutureless closure has the lowest rate of infection for gastroschisis.↗
▶Ep 86 · 10:57
host_summaryThe 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.↗
▶Ep 86 · 10:57
guidelineThe 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.↗
▶Ep 86 · 12:22
clinicalStable gastroschisis infants with sufficient abdominal capacity for sutureless closure tend to have the best outcomes.↗
▶Ep 86 · 12:22
host_summaryStable gastroschisis infants with sufficient abdominal capacity for sutureless closure tend to have the best outcomes.↗
▶Ep 86 · 12:29
host_summaryMinimizing fluids and paralytics in gastroschisis infants improves their results.↗
▶Ep 86 · 12:29
clinicalMinimizing fluids and paralytics in gastroschisis infants improves their results.↗
▶Ep 86 · 12:35
host_summaryGastroschisis patients with sutureless closure have shorter length of stay and achieve feeding sooner.↗
▶Ep 86 · 12:35
clinicalGastroschisis patients with sutureless closure have shorter length of stay and achieve feeding sooner.↗
▶Ep 86 · 15:11
host_summaryThe Clavien-Madadi classification scale consists of several grades from 1 to 5 based on the type of therapy needed to correct the complication.↗
▶Ep 86 · 15:11
clinicalThe Clavien-Madadi classification scale consists of several grades from 1 to 5 based on the type of therapy needed to correct the complication.↗
▶Ep 86 · 15:46
clinicalThe validation process circulated up to 20 case scenarios of unexpected events within the ERNICA Network (European Reference Network for inherited and congenital anomalies).↗
▶Ep 86 · 15:46
host_summaryThe validation process circulated up to 20 case scenarios of unexpected events within the ERNICA Network (European Reference Network for inherited and congenital anomalies).↗
▶Ep 86 · 16:34
host_summary59 surgeons from 12 European countries completed the Clavien-Madadi validation questionnaire.↗
▶Ep 86 · 16:34
clinical59 surgeons from 12 European countries completed the Clavien-Madadi validation questionnaire.↗
▶Ep 86 · 17:04
clinical43% of pediatric surgeons preferred the Clavien-Madadi classification compared to 12% for the Clavien-Dindo classification.↗
▶Ep 86 · 17:04
clinicalNearly 82% of surgeons affirmed advantages of the Clavien-Madadi classification.↗
▶Ep 86 · 17:04
host_summaryNearly 82% of surgeons affirmed advantages of the Clavien-Madadi classification.↗
▶Ep 86 · 17:04
host_summary43% of pediatric surgeons preferred the Clavien-Madadi classification compared to 12% for the Clavien-Dindo classification.↗
Umbilical Disorders with Dr. Rebeccah Brown
▶Ep 89 · 0:34
host_summaryThe umbilical cord contains two umbilical arteries and one umbilical vein surrounded by Wharton's jelly (a gelatin-like extracellular matrix).↗
▶Ep 89 · 0:34
quoteTwo umbilical arteries and one umbilical vein surrounding by a gelatin-like extracellular matrix known as Worthin's jelly.↗
▶Ep 89 · 0:50
quoteThey usually fall off 2 to 3 weeks, and the delay can be a manifestation of an immune deficiency.↗
▶Ep 89 · 0:50
host_summaryUmbilical cords usually fall off at 2 to 3 weeks after birth.↗
▶Ep 89 · 0:50
host_summaryDelayed umbilical cord separation can be a manifestation of an immune deficiency.↗
▶Ep 89 · 1:20
host_summaryMild omphalitis cases (inflammation of the belly button) may be treated with alcohol drying, ampicillin, or amoxicillin with follow-up every 24 hours.↗
▶Ep 89 · 1:40
quote16% of the patients admitted with onalittis develop necrotizing fasciitis.↗
▶Ep 89 · 1:40
host_summary16% of patients admitted with omphalitis develop necrotizing fasciitis.↗
▶Ep 89 · 1:46
host_summaryNecrotizing fasciitis from omphalitis presents with rapidly progressive umbilical edema, erythema, drainage, and has a high mortality rate.↗
▶Ep 89 · 2:27
host_summaryUmbilical hernias can be associated with trisomy 13, 18, and 21.↗
▶Ep 89 · 2:47
host_summaryDr. Brown mentioned that if the fascial opening in an umbilical hernia is larger than 1.5 centimeters, it may not close by itself.↗
▶Ep 89 · 2:55
host_summaryIn 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.↗
▶Ep 89 · 4:54
host_summaryUnplanned 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.↗
▶Ep 89 · 5:10
host_summaryAsymptomatic umbilical hernia repair should be delayed until greater than 4 years of age.↗
▶Ep 89 · 5:18
host_summaryIn 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.↗
▶Ep 89 · 5:53
host_summaryIn Rangel's study, closure rates for smaller hernias (≤1 cm) were nearly 90%, while for larger hernias they were around 80%.↗
▶Ep 89 · 6:12
host_summaryRangel's study concluded that umbilical hernia repair should be delayed until age 5 years given the high incidence of spontaneous closure.↗
▶Ep 89 · 6:56
host_summaryProboscoid hernia occurs when the skin above the hernia grows and pushes through the opening in the abdominal wall.↗
▶Ep 89 · 7:05
host_summaryIt is recommended to correct proboscoid hernias before school age to avoid psychological issues for the child.↗
▶Ep 89 · 8:00
host_summaryDr. 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.↗
▶Ep 89 · 8:55
host_summaryUmbilical granulomas are usually moist but commonly dry up and fall off spontaneously over time.↗
▶Ep 89 · 9:00
host_summaryUmbilical granulomas often respond to silver nitrate treatment.↗
Journal of Pediatric Surgery Article Review: 1st Quarter (Jan-Mar) 2025
▶Ep 98 · 1:41
host_summaryA subset of children after esophageal atresia repair experience severe airway collapse, leaving them ventilator dependent or suffering repeated cyanotic spells↗
▶Ep 98 · 6:57
host_summaryA significant number of outreach services are located within 50 kilometers of a children's hospital, leaving vast regions without access to pediatric surgical care↗
▶Ep 98 · 12:38
host_summaryThe study examined 4,612 G-tube placements from 71 NSQIP-Pediatric hospitals in 2023↗
▶Ep 98 · 13:04
host_summaryUpper GI studies were obtained in 45% of first-time G-tube cases with substantial interhospital variability from 0 to 99%↗
▶Ep 98 · 13:45
host_summary14% of G-tube cases resulted in an ED visit within 0 to 30 days↗
▶Ep 98 · 13:45
host_summary5.2% of G-tube cases involved dislodgement within 0 to 30 days↗
QUAD #20: Endoscopic Repair of Minor Laryngeal Clefts with Dr. Catherine Hart
▶Ep 2 · 1:41
host_summaryThe goal of endoscopic cleft repair is to remove the interarytenoid mucosa to create two raw surfaces and then suture the edges together.↗
▶Ep 2 · 2:05
host_summaryIf suture bites are taken too deeply during cleft repair, edges will be inverted and the child will continue to have problems.↗
▶Ep 2 · 2:22
host_summaryInterarytenoid mucosa can be resected using laser or cold steel (knife), and the choice does not matter clinically.↗
▶Ep 2 · 2:42
host_summaryComplete demucosalization of the apex is essential; if incomplete, a hole will remain at the apex and the child will continue to aspirate.↗
▶Ep 2 · 3:01
host_summaryEpiglottic folds are released after suturing to create extra space.↗
▶Ep 2 · 3:01
host_summaryTypically 2 to 3 sutures are placed depending on the extent of the cleft.↗
▶Ep 2 · 4:31
host_summarySurgical closure of laryngeal clefts achieves improvement in symptoms in almost 80% of children and resolution in 70%.↗
▶Ep 2 · 4:36
host_summarySurgical closure has a slightly higher risk of complications compared to conservative management.↗
▶Ep 2 · 4:54
host_summaryA consensus guideline exists for diagnosing and managing laryngeal clefts in children and is a good resource, especially for those newer to practice.↗
QUAD #25: Medical Management of Minor Laryngeal Clefts with Dr. Greg Burg
▶Ep 3 · 0:54
host_summaryFlexible bronchoscopy is quite limited in evaluating a cleft unless it's a major cleft.↗
▶Ep 3 · 1:13
host_summaryA deep interarytenoid notch is considered a minor cleft by Dr. Burg's team.↗
▶Ep 3 · 1:44
host_summaryRespiratory culture showed predominantly upper airway flora and two Candida species in the mucopurulent bronchitis.↗
▶Ep 3 · 2:07
host_summaryClinical assessment includes evaluating frequency of coughing, sick visits, emergency room visits, and hospitalizations.↗
▶Ep 3 · 2:15
host_summaryBronchoscopic assessment looks for airway edema, visibility of tracheal rings, mucus plugging, and secretions.↗
▶Ep 3 · 3:18
host_summaryChest CT is the most important differential imaging study, used to look for chronic changes related to aspiration.↗
▶Ep 3 · 4:12
host_summaryG-tubes and NG-tubes are used as needed for nutritional intake.↗
▶Ep 3 · 4:57
host_summaryChronic macrolide therapy can be used as an anti-neutrophilic agent, derived from cystic fibrosis literature.↗
▶Ep 3 · 4:57
host_summarySaline is used to thin out secretions.↗
▶Ep 3 · 5:14
host_summaryFor patients with significant tracheomalacia, ipratropium may be used over albuterol.↗
Aerodigestive & Esophageal Surgery - The Unsalvageable Esophagus & Cases
▶Ep 1 · 16:30
quoteManubrial removing the manubrium is never as straightforward as it seems because your clavicles always get in the way.↗
▶Ep 1 · 16:38
clinicalManubrial resection for high esophageal strictures provides less exposure than expected because the clavicles limit the width of the resection corridor.↗
▶Ep 1 · 19:36
quoteEsophageal stents are very much a double-edged sword. They can often cause as many problems as they fix.↗
▶Ep 1 · 33:28
clinicalKenalog (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.↗
▶Ep 1 · 36:29
clinicalFor recalcitrant esophageal strictures, weekly dilations (3–4 cycles) prevent fibroblasts from bridging and allow the stricture to scar open rather than closed.↗
▶Ep 1 · 45:47
clinicalFeeding via gastrojejunal tube with gastric drainage (GJ/G) is a temporizing measure to reduce reflux into the esophagus while managing a refractory stricture.↗
▶Ep 1 · 47:43
quoteIf you've got mucosal disease, all you need to do is remove all the mucosa. You've got no disease.↗
▶Ep 1 · 48:18
clinicalEsophageal 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.↗
▶Ep 1 · 48:20
quoteIf you put in an esophageal stent, have a quick look in the airway when you're done.↗
▶Ep 1 · 50:13
quoteWe 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.↗
▶Ep 1 · 50:20
clinicalChronic 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.↗
▶Ep 1 · 52:06
quoteThe aim is to probe it but not push so hard that you create a fistula. That's always embarrassing.↗
▶Ep 1 · 1:01:05
quoteA lot of kids have replaced esophaguuses and most of them don't aspirate, even if you've got a trashed cricoharyngeis.↗
▶Ep 1 · 1:10:42
clinicalCovered esophageal stents can temporize anastomotic leaks and allow healing while maintaining luminal patency. Stent removal is typically planned after several weeks.↗
▶Ep 1 · 1:31:42
clinicalTracheal homografts (dead trachea implants) have been performed but are associated with difficult postoperative courses lasting several months.↗
▶Ep 1 · 1:32:06
clinicalTissue-engineered tracheal homografts with pre-epithelialization are under development in multiple centers (London leading) but are not yet ready for routine clinical use.↗
▶Ep 1 · 1:33:15
clinicalLong-term surveillance of bypassed esophagus includes periodic CT scans to rule out mucocele and endoscopic evaluation via the persistent TEF if needed.↗
▶Ep 1 · 1:34:15
host_summaryPosterior 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.↗
▶Ep 1 · 1:39:43
quoteThis 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.↗
▶Ep 1 · 1:39:43
opinionComplications 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.↗
clinicalThe Curie score is used to assess the extent of metastasis in neuroblastoma patients based on MIBG scans, with the body divided into 10 regions each scored 0-3, for a maximum score of 30.↗
▶Ep 17 · 3:03
host_summaryThe Curie score is used to assess the extent of metastasis in neuroblastoma patients based on MIBG scans, with the body divided into 10 regions each scored 0-3, for a maximum score of 30.↗
▶Ep 17 · 4:04
host_summaryThe International Neuroblastoma Staging System (INSS) takes into account the results of surgery to remove the tumor and cannot help doctors determine a stage before any treatment has started.↗
▶Ep 17 · 4:04
guidelineThe International Neuroblastoma Staging System (INSS) takes into account the results of surgery to remove the tumor and cannot help doctors determine a stage before any treatment has started.↗
▶Ep 17 · 4:26
guidelineThe International Neuroblastoma Risk Group (INRG) is a preoperative staging system designed to assess how difficult patients may be to resect and allow comparison of patients preoperatively.↗
▶Ep 17 · 4:26
host_summaryThe International Neuroblastoma Risk Group (INRG) is a preoperative staging system designed to assess how difficult patients may be to resect and allow comparison of patients preoperatively.↗
▶Ep 17 · 5:44
host_summaryNMYC amplification status, ploidy, and 11Q aberrations are factors considered for neuroblastoma staging.↗
▶Ep 17 · 5:44
clinicalNMYC amplification status, ploidy, and 11Q aberrations are factors considered for neuroblastoma staging.↗
▶Ep 17 · 6:11
clinicalFor low stage neuroblastoma with good survival rates, the goal is to reduce therapy and avoid late effects, as 2/3 of cancer patients will have some long-term morbidity from chemotherapy.↗
▶Ep 17 · 6:11
host_summaryFor low stage neuroblastoma with good survival rates, the goal is to reduce therapy and avoid late effects, as 2/3 of cancer patients will have some long-term morbidity from chemotherapy.↗
▶Ep 17 · 7:29
host_summaryNeuroblastoma resections differ from other tumors because the tumor is divided into tiny pieces during removal.↗
▶Ep 17 · 7:29
clinicalNeuroblastoma resections differ from other tumors because the tumor is divided into tiny pieces during removal.↗
▶Ep 17 · 7:38
quoteThe biggest thing to do with neuroblastoma is stay on the vessels.↗
▶Ep 17 · 7:38
quoteThe biggest thing to do with neuroblastoma is stay on the vessels.↗
▶Ep 17 · 7:42
quoteSo find yourself a normal vessel and work from normal to abnormal.↗
▶Ep 17 · 7:42
quoteSo find yourself a normal vessel and work from normal to abnormal.↗
▶Ep 17 · 11:01
quoteSo basically your goal is to get as much of the tumor as you can without causing harm.↗
▶Ep 17 · 11:01
quoteSo basically your goal is to get as much of the tumor as you can without causing harm.↗
▶Ep 17 · 12:21
host_summaryA Children's Oncology Group study of 87 patients less than 6 months of age with small adrenal masses and no metastatic disease showed 97% four-year event-free survival with observation.↗
▶Ep 17 · 12:21
epidemiologicalA Children's Oncology Group study of 87 patients less than 6 months of age with small adrenal masses and no metastatic disease showed 97% four-year event-free survival with observation.↗
Update Course Rewind: Highlighting Collaboration from Surgery & Interventional Radiology in the OR 2024
▶Ep 20 · 0:13
guidelineThe 12th annual update course in pediatric surgery was held in August 2024 and introduced a new classification system: green circle for established practice, blue square for promising newer practice, and black diamond for early adopter practice only.↗
▶Ep 20 · 0:13
host_summaryThe 12th annual update course in pediatric surgery was held in August 2024 and introduced a new classification system: green circle for established practice, blue square for promising newer practice, and black diamond for early adopter practice only.↗
▶Ep 20 · 0:56
host_summaryInformation from this session on image-guided surgery collaboration classifies as a blue square for promising newer practice.↗
▶Ep 20 · 0:56
guidelineInformation from this session on image-guided surgery collaboration classifies as a blue square for promising newer practice.↗
▶Ep 20 · 1:15
clinicalImage-guided surgery uses real-time imaging (CT, MRI, ultrasound, or fluoroscopy) to help surgeons navigate during procedures with greater precision, improving accuracy and safety.↗
▶Ep 20 · 1:15
host_summaryImage-guided surgery uses real-time imaging (CT, MRI, ultrasound, or fluoroscopy) to help surgeons navigate during procedures with greater precision, improving accuracy and safety.↗
▶Ep 20 · 1:50
host_summaryA hybrid operating room integrates advanced imaging technology and traditional surgical setup, eliminating the need to transport patients between radiology and surgical areas, which enhances efficiency, reduces complications, and improves patient outcomes.↗
▶Ep 20 · 1:50
clinicalA hybrid operating room integrates advanced imaging technology and traditional surgical setup, eliminating the need to transport patients between radiology and surgical areas, which enhances efficiency, reduces complications, and improves patient outcomes.↗
▶Ep 20 · 2:59
clinicalCone beam CT provides excellent visualization of bony structures, making it valuable for maxillofacial, ENT, spine, and orthopedic surgeries.↗
▶Ep 20 · 2:59
host_summaryCone beam CT provides excellent visualization of bony structures, making it valuable for maxillofacial, ENT, spine, and orthopedic surgeries.↗
▶Ep 20 · 3:35
host_summaryInterventional radiologists at Cincinnati Children's help train pediatric surgery fellows including guidance for vascular access.↗
▶Ep 20 · 3:35
clinicalInterventional radiologists at Cincinnati Children's help train pediatric surgery fellows including guidance for vascular access.↗
▶Ep 20 · 9:03
host_summaryIn a hydrocephalic sheep model demonstration, MRI imaging was used to create a holographic overlay of anatomy, and by aligning key reference points (fiducials), the hologram matches perfectly with actual anatomy, allowing virtual slicing through the holographic image to view dilated ventricles for precise drain placement.↗
▶Ep 20 · 9:03
clinicalIn a hydrocephalic sheep model demonstration, MRI imaging was used to create a holographic overlay of anatomy, and by aligning key reference points (fiducials), the hologram matches perfectly with actual anatomy, allowing virtual slicing through the holographic image to view dilated ventricles for precise drain placement.↗
clinicalA Western Pediatric Surgery Research Consortium machine learning algorithm based on 1600 patients from 10 centers (2016-2019) can predict common bile duct stones using nine clinical factors, with 20% of patients having CBD stones↗
▶Ep 18 · 6:26
host_summaryA Western Pediatric Surgery Research Consortium machine learning algorithm based on 1600 patients from 10 centers (2016-2019) can predict common bile duct stones using nine clinical factors, with 20% of patients having CBD stones↗
▶Ep 18 · 7:33
host_summaryThe previous algorithm for predicting CBD stones was based on 300-400 patients, compared to 1600 in the new algorithm↗
▶Ep 18 · 7:33
clinicalThe previous algorithm for predicting CBD stones was based on 300-400 patients, compared to 1600 in the new algorithm↗
▶Ep 18 · 13:34
host_summaryIn a study of 173 laparoscopic cholecystectomies over 10 years (2013-2023), 83 used standard technique and 90 used ICG fluorescence↗
▶Ep 18 · 13:34
clinicalIn a study of 173 laparoscopic cholecystectomies over 10 years (2013-2023), 83 used standard technique and 90 used ICG fluorescence↗
▶Ep 18 · 13:54
clinicalThe ICG study showed perioperative complication rate of 12% in standard technique versus 0% with ICG, with significantly shorter operative times and better biliary visualization in the ICG group↗
▶Ep 18 · 13:54
host_summaryThe ICG study showed perioperative complication rate of 12% in standard technique versus 0% with ICG, with significantly shorter operative times and better biliary visualization in the ICG group↗
Chronic Pancreatitis - Pancreatic Pathologies by Cincinnati Children's Pancreas Care Center
▶Ep 20 · 0:54
host_summaryOngoing damage in chronic pancreatitis affects acinar cells, ductal cells, and islet cells which are responsible for producing insulin.↗
▶Ep 20 · 0:54
host_summaryOngoing damage in chronic pancreatitis affects acinar cells, ductal cells, and islet cells which are responsible for producing insulin.↗
▶Ep 20 · 1:25
host_summaryWhen islet cells which produce insulin are damaged by chronic pancreatitis, it can lead to endocrine issues such as diabetes.↗
▶Ep 20 · 1:25
host_summaryWhen islet cells which produce insulin are damaged by chronic pancreatitis, it can lead to endocrine issues such as diabetes.↗
▶Ep 20 · 1:33
host_summaryChronic pancreatitis is a progressive inflammatory disorder that results in irreversible loss of pancreatic function.↗
▶Ep 20 · 1:33
host_summaryChronic pancreatitis is a progressive inflammatory disorder that results in irreversible loss of pancreatic function.↗
▶Ep 20 · 1:48
host_summaryDiagnosis of chronic pancreatitis involves identifying calcifications, ductal obstruction, or dilation combined with one of three criteria: pain consistent with pancreatic origin, exocrine dysfunction, or endocrine dysfunction.↗
▶Ep 20 · 1:48
host_summaryDiagnosis of chronic pancreatitis involves identifying calcifications, ductal obstruction, or dilation combined with one of three criteria: pain consistent with pancreatic origin, exocrine dysfunction, or endocrine dysfunction.↗
▶Ep 20 · 2:33
host_summaryIn adults, CT with IV contrast often includes multiple phases (non-contrast, arterial, and portal venous), but this is avoided in children because it markedly increases radiation dose without providing much additional diagnostic information.↗
▶Ep 20 · 2:33
host_summaryIn adults, CT with IV contrast often includes multiple phases (non-contrast, arterial, and portal venous), but this is avoided in children because it markedly increases radiation dose without providing much additional diagnostic information.↗
▶Ep 20 · 3:02
host_summaryAccording to Dr. Trout, arterial phase imaging is reserved for specific questions about arterial pseudoaneurysms or when characterizing potential masses.↗
▶Ep 20 · 3:02
host_summaryAccording to Dr. Trout, arterial phase imaging is reserved for specific questions about arterial pseudoaneurysms or when characterizing potential masses.↗
▶Ep 20 · 3:25
host_summaryAt initial characterization of a patient with acute recurrent or chronic pancreatitis, IV contrast can be useful to understand vascular complications or fluid collections, but in many cases MRI exams can be done without IV contrast.↗
▶Ep 20 · 3:25
host_summaryAt initial characterization of a patient with acute recurrent or chronic pancreatitis, IV contrast can be useful to understand vascular complications or fluid collections, but in many cases MRI exams can be done without IV contrast.↗
▶Ep 20 · 3:56
host_summaryCincinnati Children's has an in-house 10-gene pancreatitis risk panel to screen for genetic links to pancreatitis.↗
▶Ep 20 · 3:56
host_summaryCincinnati Children's has an in-house 10-gene pancreatitis risk panel to screen for genetic links to pancreatitis.↗
▶Ep 20 · 5:33
host_summaryFor pancreatic enzyme replacement, cystic fibrosis guidelines are followed for dosing, and enzymes are reserved only for cases with documented exocrine pancreatic insufficiency.↗
▶Ep 20 · 5:33
host_summaryFor pancreatic enzyme replacement, cystic fibrosis guidelines are followed for dosing, and enzymes are reserved only for cases with documented exocrine pancreatic insufficiency.↗
▶Ep 20 · 5:55
host_summaryEndoscopic therapy for chronic pancreatitis relies on two methods: endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP).↗
▶Ep 20 · 5:55
host_summaryEndoscopic therapy for chronic pancreatitis relies on two methods: endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP).↗
▶Ep 20 · 6:22
host_summaryPain management in chronic pancreatitis follows a stepwise ladder approach, starting with opiate-sparing medications and reserving opiates for severe pain cases.↗
▶Ep 20 · 6:22
host_summaryPain management in chronic pancreatitis follows a stepwise ladder approach, starting with opiate-sparing medications and reserving opiates for severe pain cases.↗
▶Ep 20 · 6:25
host_summaryOpiate-sparing chronic pain medications include neuropathic medications like amitriptyline and gabapentin, usually prescribed in partnership with a pain specialist as part of multidisciplinary management.↗
▶Ep 20 · 6:25
host_summaryOpiate-sparing chronic pain medications include neuropathic medications like amitriptyline and gabapentin, usually prescribed in partnership with a pain specialist as part of multidisciplinary management.↗
▶Ep 20 · 7:10
host_summaryAt Cincinnati Children's, cognitive behavioral therapy (CBT) is incorporated in multidisciplinary pain management and has been shown in other chronic conditions to be helpful in managing pain.↗
▶Ep 20 · 7:10
host_summaryAt Cincinnati Children's, cognitive behavioral therapy (CBT) is incorporated in multidisciplinary pain management and has been shown in other chronic conditions to be helpful in managing pain.↗
Update Course Rewind: Pediatric Biliary Stones - Surgery First Mindset 2024
host_summaryStone disease is increasing along with obesity in pediatric patients around the world, not just in the United States.↗
▶Ep 23 · 0:52
epidemiologicalStone disease is increasing along with obesity in pediatric patients around the world, not just in the United States.↗
▶Ep 23 · 1:25
clinicalThere are two main approaches for patients with stones in the common bile duct who need gallbladder removal: ERCP first to remove ductal stones followed by laparoscopic cholecystectomy, or laparoscopic cholecystectomy with intraoperative cholangiogram to identify and potentially remove stones during the same surgery.↗
▶Ep 23 · 1:25
host_summaryThere are two main approaches for patients with stones in the common bile duct who need gallbladder removal: ERCP first to remove ductal stones followed by laparoscopic cholecystectomy, or laparoscopic cholecystectomy with intraoperative cholangiogram to identify and potentially remove stones during the same surgery.↗
▶Ep 23 · 2:11
clinicalA surgery-first pathway reduces resource utilization, including MRCP, according to recently published work.↗
▶Ep 23 · 2:11
host_summaryA surgery-first pathway reduces resource utilization, including MRCP, according to recently published work.↗
▶Ep 23 · 2:25
clinicalA paper from the Journal of American College of Surgeons defined a very specific and predictive score for cholelithiasis.↗
▶Ep 23 · 2:25
host_summaryA paper from the Journal of American College of Surgeons defined a very specific and predictive score for cholelithiasis.↗
host_summaryIf the surgeon cannot do a cholangiogram, then ERCP is needed if someone can do it.↗
▶Ep 23 · 3:16
clinicalIf the surgeon cannot do a cholangiogram, then ERCP is needed if someone can do it.↗
▶Ep 23 · 3:44
host_summaryIf you know how to put in a central line and understand the principles of Seldinger technique, then you can do intraoperative stone removal.↗
▶Ep 23 · 3:44
opinionIf you know how to put in a central line and understand the principles of Seldinger technique, then you can do intraoperative stone removal.↗
▶Ep 23 · 3:44
quoteSure, and I think if you know how to put in a central line and you understand the principles Singer technique, then you can do this.↗
▶Ep 23 · 3:44
quoteSure, and I think if you know how to put in a central line and you understand the principles Singer technique, then you can do this.↗
▶Ep 23 · 3:50
host_summaryIn a paper published in JPS, stone clearance rate reflected by a negative intraoperative cholangiogram was 86% with a surgery-first mindset.↗
▶Ep 23 · 3:50
clinicalIn a paper published in JPS, stone clearance rate reflected by a negative intraoperative cholangiogram was 86% with a surgery-first mindset.↗
▶Ep 23 · 4:01
clinicalWith minor additional techniques like advancing the catheter into the common bile duct or reaming the sphincter, the success rate was in the 90s.↗
▶Ep 23 · 4:01
host_summaryWith minor additional techniques like advancing the catheter into the common bile duct or reaming the sphincter, the success rate was in the 90s.↗
▶Ep 23 · 4:10
quoteSo it doesn't take much. That's the dirty little secret is like, let's do something that, that I think is accessible to everybody.↗
▶Ep 23 · 4:10
quoteSo it doesn't take much. That's the dirty little secret is like, let's do something that, that I think is accessible to everybody.↗
▶Ep 23 · 4:38
clinicalAt Cincinnati Children's, when surgeons cannot clear the duct, they call from the OR and an ERCP can be performed quickly in most cases.↗
▶Ep 23 · 4:38
host_summaryAt Cincinnati Children's, when surgeons cannot clear the duct, they call from the OR and an ERCP can be performed quickly in most cases.↗
▶Ep 23 · 4:47
host_summaryAt institutions without access to immediate ERCP, surgeons can place a clip or endo loop, close up, and perform ERCP within the next day or two.↗
▶Ep 23 · 4:47
clinicalAt institutions without access to immediate ERCP, surgeons can place a clip or endo loop, close up, and perform ERCP within the next day or two.↗
▶Ep 23 · 5:15
host_summaryAccording to Doctor Huntington, the biggest key to success is having all the necessary equipment in one place, because no one in the OR is going to know what to get on the fly.↗
▶Ep 23 · 5:15
clinicalAccording to Doctor Huntington, the biggest key to success is having all the necessary equipment in one place, because no one in the OR is going to know what to get on the fly.↗
▶Ep 23 · 5:26
clinicalA common bile duct with 3 or 4 impacted stones is typically not suitable for surgery-first approach.↗
▶Ep 23 · 5:26
host_summaryA common bile duct with 3 or 4 impacted stones is typically not suitable for surgery-first approach.↗
▶Ep 23 · 6:03
host_summaryDoctor Vitale cautions that when flushing, if a stone is impacted, there is a risk of inadvertently injecting contrast into the pancreatic duct, which can increase the risk of pancreatitis.↗
▶Ep 23 · 6:03
clinicalDoctor Vitale cautions that when flushing, if a stone is impacted, there is a risk of inadvertently injecting contrast into the pancreatic duct, which can increase the risk of pancreatitis.↗
▶Ep 23 · 6:15
host_summaryWhen the pancreatic duct lights up during flushing, that is a signal to slow down because you can cause pancreatitis by flushing contrast into the pancreatic duct with a stone present.↗
▶Ep 23 · 6:15
clinicalWhen the pancreatic duct lights up during flushing, that is a signal to slow down because you can cause pancreatitis by flushing contrast into the pancreatic duct with a stone present.↗
▶Ep 23 · 6:33
clinicalA study demonstrated an 86% success rate for surgery-first, but the ERCP group had a 10% complication rate, including cholangitis, bleeding, pancreatitis, and hemophilia.↗
▶Ep 23 · 6:33
host_summaryA study demonstrated an 86% success rate for surgery-first, but the ERCP group had a 10% complication rate, including cholangitis, bleeding, pancreatitis, and hemophilia.↗
host_summaryThe 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.↗
▶Ep 24 · 0:56
clinicalThe 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.↗
▶Ep 24 · 1:20
clinicalIn this neutropenic and thrombocytopenic patient, the approach taken was to start antibiotics and address the elevated liver function tests.↗
▶Ep 24 · 1:20
host_summaryIn this neutropenic and thrombocytopenic patient, the approach taken was to start antibiotics and address the elevated liver function tests.↗
▶Ep 24 · 1:49
host_summaryGallstone 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.↗
▶Ep 24 · 1:49
clinicalGallstone 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.↗
▶Ep 24 · 3:11
host_summaryIn neutropenic and thrombocytopenic patients with cholecystitis and choledocholithiasis, initial conservative management with antibiotics can be effective, particularly when spontaneous stone passage occurs.↗
▶Ep 24 · 3:11
clinicalIn neutropenic and thrombocytopenic patients with cholecystitis and choledocholithiasis, initial conservative management with antibiotics can be effective, particularly when spontaneous stone passage occurs.↗
▶Ep 24 · 3:22
guidelineFor gallstone pancreatitis, early ERCP is typically reserved for cases with persistent biliary obstruction or cholangitis, as many patients improve without intervention.↗
▶Ep 24 · 3:22
host_summaryFor gallstone pancreatitis, early ERCP is typically reserved for cases with persistent biliary obstruction or cholangitis, as many patients improve without intervention.↗
▶Ep 24 · 3:33
host_summaryThe 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.↗
▶Ep 24 · 3:33
guidelineThe 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.↗
host_summaryIn the JAMA trial of 308 preterm infants, 44 patients (28%) in the early repair group had at least one serious adverse event versus 27 patients (18%) in the late repair group↗
▶Ep 4 · 4:07
host_summaryIncarceration rate in the late repair group was around 4%↗
▶Ep 4 · 4:07
host_summaryRecurrence rate after inguinal hernia repair in the trial was less than 1%↗
▶Ep 4 · 7:12
host_summaryThe JAMA trial was terminated early, had low recruitment rate, and ended up with less statistical power than initially calculated↗
▶Ep 4 · 10:54
host_summaryIn the Dutch one-stop surgery study of 91 patients (54 one-stop, 37 usual care), all but one of the one-stop surgery patients were discharged home on the day of surgery↗
▶Ep 4 · 10:59
host_summaryPost-operative complication and recurrence rates did not differ between one-stop surgery and usual care patients in the Dutch study↗
▶Ep 4 · 11:05
host_summaryGeneral satisfaction and inclusion of family were higher after one-stop surgery experience↗
▶Ep 4 · 15:34
host_summaryIn the multi-institutional patent processus vaginalis study, 246 eligible infants under 4 months with PPV found at pyloromyotomy were enrolled at 8 children's hospitals, with 85% responding to at least one annual follow-up↗
▶Ep 4 · 15:49
host_summaryOf the 246 infants with patent processus vaginalis, two had inguinal hernia repair for symptomatic hernia, one had orchiopexy and incidental inguinal hernia repair, for a total of 3 hernia repairs↗
▶Ep 4 · 16:13
host_summaryThe presence of patent processus vaginalis at the time of pyloromyotomy was common, but the need for hernia repair was around 1% in the first year of follow-up↗
Journal of Pediatric Surgery Article Review: September 2023
▶Ep 13 · 4:24
host_summaryThe Boston CDH study reviewed 146 infants who underwent CDH repair while on ECMO support from 1995 to 2021.↗
▶Ep 13 · 4:24
clinicalThe Boston CDH study reviewed 146 infants who underwent CDH repair while on ECMO support from 1995 to 2021.↗
▶Ep 13 · 5:17
clinicalSurvival was not statistically different between early and delayed CDH repair groups.↗
▶Ep 13 · 5:17
host_summarySurvival was not statistically different between early and delayed CDH repair groups.↗
▶Ep 13 · 5:17
host_summaryDuration of ECMO support was shorter in the early CDH repair group.↗
▶Ep 13 · 5:17
clinicalDuration of ECMO support was shorter in the early CDH repair group.↗
▶Ep 13 · 5:56
host_summaryThe Boston center historically preferred early CDH repair for patients on ECMO, so patients who had delayed repair may have had clinical differences.↗
▶Ep 13 · 5:56
clinicalThe Boston center historically preferred early CDH repair for patients on ECMO, so patients who had delayed repair may have had clinical differences.↗
▶Ep 13 · 9:16
host_summaryPhysician suicide rates are tragically high among doctors compared to the general population.↗
▶Ep 13 · 9:16
epidemiologicalPhysician suicide rates are tragically high among doctors compared to the general population.↗
▶Ep 13 · 10:11
host_summaryFactors contributing to physician suicide include high levels of stress, emotional and physical burnout, demanding work schedules, and pressure to maintain a successful career.↗
▶Ep 13 · 10:11
clinicalFactors contributing to physician suicide include high levels of stress, emotional and physical burnout, demanding work schedules, and pressure to maintain a successful career.↗
▶Ep 13 · 10:33
clinicalStigma associated with mental health issues within the medical profession discourages physicians from seeking help, leading to untreated depression, anxiety, and other mental health disorders.↗
▶Ep 13 · 10:33
host_summaryStigma associated with mental health issues within the medical profession discourages physicians from seeking help, leading to untreated depression, anxiety, and other mental health disorders.↗
quoteHello pediatric surgery family, I'm E Gdy, a research fellow from Cincinnati Children's Hospital Medical Center.↗
Journal of Pediatric Surgery Article Review: July 2023, PAPS Issue
▶Ep 41 · 0:25
quotePABPS is Pacific Association of Pediatric Surgeons.↗
▶Ep 41 · 0:25
quotePABPS is Pacific Association of Pediatric Surgeons.↗
▶Ep 41 · 3:55
host_summaryOf the 130 procedures, 59 were lobectomies (group 1), 19 were diagnostic wedge resections (group 2), and 52 were excisional wedge resections (group 3).↗
▶Ep 41 · 3:55
clinicalOf the 130 procedures, 59 were lobectomies (group 1), 19 were diagnostic wedge resections (group 2), and 52 were excisional wedge resections (group 3).↗
▶Ep 41 · 4:30
clinicalIn diagnostic wedge resection patients (group 2), nearly 90% had no air leak and median chest tube duration was 1 day.↗
▶Ep 41 · 4:30
host_summaryIn diagnostic wedge resection patients (group 2), nearly 90% had no air leak and median chest tube duration was 1 day.↗
▶Ep 41 · 4:39
host_summaryIn excisional wedge resection patients (group 3), 80% had no air leak and median chest tube duration was 1 day.↗
▶Ep 41 · 4:39
clinicalIn excisional wedge resection patients (group 3), 80% had no air leak and median chest tube duration was 1 day.↗
Journal of Pediatric Surgery Article Review: September 2023
▶Ep 42 · 4:24
clinicalThe Boston CDH study reviewed 146 infants who underwent CDH repair while on ECMO support from 1995 to 2021.↗
▶Ep 42 · 4:24
host_summaryThe Boston CDH study reviewed 146 infants who underwent CDH repair while on ECMO support from 1995 to 2021.↗
▶Ep 42 · 5:17
clinicalDuration of ECMO support was shorter in the early CDH repair group.↗
▶Ep 42 · 5:17
host_summaryDuration of ECMO support was shorter in the early CDH repair group.↗
▶Ep 42 · 5:17
host_summarySurvival was not statistically different between early and delayed CDH repair groups.↗
▶Ep 42 · 5:17
clinicalSurvival was not statistically different between early and delayed CDH repair groups.↗
▶Ep 42 · 5:56
clinicalThe Boston center historically preferred early CDH repair for patients on ECMO, so patients who had delayed repair may have had clinical differences.↗
▶Ep 42 · 5:56
host_summaryThe Boston center historically preferred early CDH repair for patients on ECMO, so patients who had delayed repair may have had clinical differences.↗
▶Ep 42 · 9:16
host_summaryPhysician suicide rates are tragically high among doctors compared to the general population.↗
▶Ep 42 · 9:16
epidemiologicalPhysician suicide rates are tragically high among doctors compared to the general population.↗
▶Ep 42 · 10:11
host_summaryFactors contributing to physician suicide include high levels of stress, emotional and physical burnout, demanding work schedules, and pressure to maintain a successful career.↗
▶Ep 42 · 10:11
clinicalFactors contributing to physician suicide include high levels of stress, emotional and physical burnout, demanding work schedules, and pressure to maintain a successful career.↗
▶Ep 42 · 10:33
clinicalStigma associated with mental health issues within the medical profession discourages physicians from seeking help, leading to untreated depression, anxiety, and other mental health disorders.↗
▶Ep 42 · 10:33
host_summaryStigma associated with mental health issues within the medical profession discourages physicians from seeking help, leading to untreated depression, anxiety, and other mental health disorders.↗
Journal of Pediatric Surgery Article Review: Q1 (Jan-Mar) 2024
▶Ep 44 · 5:13
clinicalThe esophageal atresia study had 215 patients, 13% had complex esophageal atresia, and of those 25 patients survived the repair.↗
▶Ep 44 · 5:13
host_summaryThe esophageal atresia study had 215 patients, 13% had complex esophageal atresia, and of those 25 patients survived the repair.↗
▶Ep 44 · 5:28
clinicalOf the 25 complex esophageal atresia survivors, 14 patients were type A and 11 patients were type C.↗
▶Ep 44 · 5:28
host_summaryOf the 25 complex esophageal atresia survivors, 14 patients were type A and 11 patients were type C.↗
▶Ep 44 · 6:03
clinicalOf the 25 complex esophageal atresia patients, 18 had delayed primary anastomosis and 7 had esophageal replacement.↗
▶Ep 44 · 6:03
host_summaryOf the 25 complex esophageal atresia patients, 18 had delayed primary anastomosis and 7 had esophageal replacement.↗
▶Ep 44 · 6:13
clinicalOnly 4 patients with esophageal atresia were potentially treatable by traction.↗
▶Ep 44 · 6:13
host_summaryOnly 4 patients with esophageal atresia were potentially treatable by traction.↗
▶Ep 44 · 6:13
host_summaryTwo of the esophageal replacements were salvage procedures following a failed traction.↗
▶Ep 44 · 6:13
clinicalTwo of the esophageal replacements were salvage procedures following a failed traction.↗
▶Ep 44 · 6:57
clinicalIn cases where traction techniques had not been attempted, the native esophagus was retained in 80% of cases.↗
▶Ep 44 · 6:57
host_summaryIn cases where traction techniques had not been attempted, the native esophagus was retained in 80% of cases.↗
▶Ep 44 · 7:02
clinicalThe median time to esophageal continuity in the Newcastle series was 77 days.↗
▶Ep 44 · 7:02
host_summaryThe median time to esophageal continuity in the Newcastle series was 77 days.↗
▶Ep 44 · 7:12
host_summaryManagement of complex esophageal atresia without lengthening procedure can result in a similar rate of retention of the native esophagus but with significantly less morbidity.↗
▶Ep 44 · 7:12
clinicalManagement of complex esophageal atresia without lengthening procedure can result in a similar rate of retention of the native esophagus but with significantly less morbidity.↗
Journal of Pediatric Surgery Article Review: 1st Quarter (Jan-Mar) 2025
▶Ep 50 · 1:41
host_summaryA subset of children after esophageal atresia repair experience severe airway collapse, leaving them ventilator dependent or suffering repeated cyanotic spells↗
▶Ep 50 · 6:57
host_summaryA significant number of outreach services are located within 50 kilometers of a children's hospital, leaving vast regions without access to pediatric surgical care↗
▶Ep 50 · 12:38
host_summaryThe study examined 4,612 G-tube placements from 71 NSQIP-Pediatric hospitals in 2023↗
▶Ep 50 · 13:04
host_summaryUpper GI studies were obtained in 45% of first-time G-tube cases with substantial interhospital variability from 0 to 99%↗
▶Ep 50 · 13:45
host_summary5.2% of G-tube cases involved dislodgement within 0 to 30 days↗
▶Ep 50 · 13:45
host_summary14% of G-tube cases resulted in an ED visit within 0 to 30 days↗
guidelineIn Minnesota, the requirement for gym class is 1 year out of 4 years of high school, with only half of that year being gym and the other half being health↗
Heat 1 Winner: Dariusz Patkowski, MD, PhD - Best of the Best in Pediatric Surgery 2024
▶Ep 4 · 0:04
host_summaryDr. Shilpa Sharma presented on exploring alternative pathways of stem cell perforation for hepatic regeneration by partial liver resection in extrahepatic biliary atresia↗
▶Ep 4 · 0:04
clinicalDr. Shilpa Sharma presented on exploring alternative pathways of stem cell perforation for hepatic regeneration by partial liver resection in extrahepatic biliary atresia↗
▶Ep 4 · 0:20
clinicalDr. Toshio Haromaz presented analysis of potential risk factors for defecation problems and their bowel management based on long-term bowel function in patients with persistent cloaca↗
▶Ep 4 · 0:20
host_summaryDr. Toshio Haromaz presented analysis of potential risk factors for defecation problems and their bowel management based on long-term bowel function in patients with persistent cloaca↗
▶Ep 4 · 1:25
clinicalDr. Dariusz Patkowski won Heat 1 of the competition↗
▶Ep 4 · 1:25
clinicalDr. Dariusz Patkowski won Heat 1 of the competition↗
Heat 1 Winner: Dariusz Patkowski, MD, PhD - Best of the Best in Pediatric Surgery 2024
▶Ep 1 · 0:04
host_summaryDr. Shilpa Sharma presented on exploring alternative pathways of stem cell perforation for hepatic regeneration by partial liver resection in extrahepatic biliary atresia↗
▶Ep 1 · 0:20
host_summaryDr. Toshio Haromaz presented analysis of potential risk factors for defecation problems and their bowel management based on long-term bowel function in patients with persistent cloaca↗
▶Ep 1 · 1:25
clinicalDr. Dariusz Patkowski won Heat 1 of the competition↗
quoteif you actually manage the bladder appropriately, some of that excess volume is going to go down, and by allowing these bladders to cycle better with intermittent catheterization, we found that to be a better, uh, long term strategy than going in and surgically excising part of the bladder↗
▶Ep 1 · 13:12
clinicalReduction cystoplasty was historically performed for large atonic PUV bladders, but appropriate bladder management with intermittent catheterization allows excess volume to decrease and bladder cycling to improve, making surgery less necessary.↗
quoteReflux is really common in the first year of life.↗
▶Ep 3 · 2:19
quoteDon't forget the bilious vomiting should be considered as an emergency in an infant.↗
▶Ep 3 · 3:24
host_summaryA 2017 Journal of Pediatric Surgery study of 584 patients found African American infants with pyloric stenosis presented with higher bicarbonate and lower chloride levels.↗
▶Ep 3 · 4:25
host_summaryResearchers have identified a molecular diagnostic marker and can trace specific genetic changes indicating risk for pyloric stenosis.↗
▶Ep 3 · 7:04
host_summaryRecommended fluid resuscitation: isotonic saline bolus followed by maintenance IV fluids (D5 half-normal saline with 20 mEq/L potassium chloride).↗
▶Ep 3 · 8:12
host_summaryA 2023 Journal of Pediatric Surgery study suggests antibiotic prophylaxis may be unnecessary for pyloromyotomy and may carry unnecessary long-term side effects.↗
▶Ep 3 · 14:30
host_summaryA flexible feeding protocol (reducing volume if baby vomits 6 times but continuing smaller feeds and increasing as tolerated) decreases length of hospital stay.↗
Case Based Journal Review: Esophageal Atresia in 2022
▶Ep 17 · 7:54
host_summaryPatients with transanastomotic tubes started feeding on day 2 versus day 10 for those without tubes, but early feeding did not lead to less TPN—duration was 9 days in both groups↗
▶Ep 17 · 7:54
epidemiologicalPatients with transanastomotic tubes started feeding on day 2 versus day 10 for those without tubes, but early feeding did not lead to less TPN—duration was 9 days in both groups↗
▶Ep 17 · 12:20
epidemiologicalIn a meta-analysis of about 500 newborns, there was no significant difference in leak occurrence, pneumothorax, or mortality based on whether a chest drain was placed↗
▶Ep 17 · 12:20
host_summaryIn a meta-analysis of about 500 newborns, there was no significant difference in leak occurrence, pneumothorax, or mortality based on whether a chest drain was placed↗
▶Ep 17 · 12:31
host_summaryThe group that received a chest drain had a significantly higher chance of returning to the operating room↗
▶Ep 17 · 12:31
epidemiologicalThe group that received a chest drain had a significantly higher chance of returning to the operating room↗
Pyloric Stenosis with Dr. Alex Bondoc
▶Ep 24 · 1:42
quoteReflux is really common in the first year of life.↗
▶Ep 24 · 1:42
quoteReflux is really common in the first year of life.↗
▶Ep 24 · 2:19
quoteDon't forget the bilious vomiting should be considered as an emergency in an infant.↗
▶Ep 24 · 2:19
quoteDon't forget the bilious vomiting should be considered as an emergency in an infant.↗
▶Ep 24 · 3:24
epidemiologicalA 2017 Journal of Pediatric Surgery study of 584 patients found African American infants with pyloric stenosis presented with higher bicarbonate and lower chloride levels.↗
▶Ep 24 · 3:24
host_summaryA 2017 Journal of Pediatric Surgery study of 584 patients found African American infants with pyloric stenosis presented with higher bicarbonate and lower chloride levels.↗
▶Ep 24 · 4:25
host_summaryResearchers have identified a molecular diagnostic marker and can trace specific genetic changes indicating risk for pyloric stenosis.↗
▶Ep 24 · 4:25
clinicalResearchers have identified a molecular diagnostic marker and can trace specific genetic changes indicating risk for pyloric stenosis.↗
▶Ep 24 · 7:04
guidelineRecommended fluid resuscitation: isotonic saline bolus followed by maintenance IV fluids (D5 half-normal saline with 20 mEq/L potassium chloride).↗
▶Ep 24 · 7:04
host_summaryRecommended fluid resuscitation: isotonic saline bolus followed by maintenance IV fluids (D5 half-normal saline with 20 mEq/L potassium chloride).↗
▶Ep 24 · 8:12
host_summaryA 2023 Journal of Pediatric Surgery study suggests antibiotic prophylaxis may be unnecessary for pyloromyotomy and may carry unnecessary long-term side effects.↗
▶Ep 24 · 8:12
clinicalA 2023 Journal of Pediatric Surgery study suggests antibiotic prophylaxis may be unnecessary for pyloromyotomy and may carry unnecessary long-term side effects.↗
▶Ep 24 · 14:30
host_summaryA flexible feeding protocol (reducing volume if baby vomits 6 times but continuing smaller feeds and increasing as tolerated) decreases length of hospital stay.↗
▶Ep 24 · 14:30
clinicalA flexible feeding protocol (reducing volume if baby vomits 6 times but continuing smaller feeds and increasing as tolerated) decreases length of hospital stay.↗
Case-Based Journal Review: Inguinal Hernia 2025
▶Ep 28 · 3:36
host_summaryIn the JAMA trial of 308 preterm infants, 44 patients (28%) in the early repair group had at least one serious adverse event versus 27 patients (18%) in the late repair group↗
▶Ep 28 · 4:07
host_summaryRecurrence rate after inguinal hernia repair in the trial was less than 1%↗
▶Ep 28 · 4:07
host_summaryIncarceration rate in the late repair group was around 4%↗
▶Ep 28 · 7:12
host_summaryThe JAMA trial was terminated early, had low recruitment rate, and ended up with less statistical power than initially calculated↗
▶Ep 28 · 10:54
host_summaryIn the Dutch one-stop surgery study of 91 patients (54 one-stop, 37 usual care), all but one of the one-stop surgery patients were discharged home on the day of surgery↗
▶Ep 28 · 10:59
host_summaryPost-operative complication and recurrence rates did not differ between one-stop surgery and usual care patients in the Dutch study↗
▶Ep 28 · 11:05
host_summaryGeneral satisfaction and inclusion of family were higher after one-stop surgery experience↗
▶Ep 28 · 15:34
host_summaryIn the multi-institutional patent processus vaginalis study, 246 eligible infants under 4 months with PPV found at pyloromyotomy were enrolled at 8 children's hospitals, with 85% responding to at least one annual follow-up↗
▶Ep 28 · 15:49
host_summaryOf the 246 infants with patent processus vaginalis, two had inguinal hernia repair for symptomatic hernia, one had orchiopexy and incidental inguinal hernia repair, for a total of 3 hernia repairs↗
▶Ep 28 · 16:13
host_summaryThe presence of patent processus vaginalis at the time of pyloromyotomy was common, but the need for hernia repair was around 1% in the first year of follow-up↗
Update Course Rewind: Highlighting Collaboration from Surgery & Interventional Radiology in the OR 2024
▶Ep 12 · 0:13
guidelineThe 12th annual update course in pediatric surgery was held in August 2024 and introduced a new classification system: green circle for established practice, blue square for promising newer practice, and black diamond for early adopter practice only.↗
▶Ep 12 · 0:56
guidelineInformation from this session on image-guided surgery collaboration classifies as a blue square for promising newer practice.↗
▶Ep 12 · 1:15
clinicalImage-guided surgery uses real-time imaging (CT, MRI, ultrasound, or fluoroscopy) to help surgeons navigate during procedures with greater precision, improving accuracy and safety.↗
▶Ep 12 · 1:50
clinicalA hybrid operating room integrates advanced imaging technology and traditional surgical setup, eliminating the need to transport patients between radiology and surgical areas, which enhances efficiency, reduces complications, and improves patient outcomes.↗
▶Ep 12 · 2:59
clinicalCone beam CT provides excellent visualization of bony structures, making it valuable for maxillofacial, ENT, spine, and orthopedic surgeries.↗
▶Ep 12 · 3:35
clinicalInterventional radiologists at Cincinnati Children's help train pediatric surgery fellows including guidance for vascular access.↗
▶Ep 12 · 9:03
clinicalIn a hydrocephalic sheep model demonstration, MRI imaging was used to create a holographic overlay of anatomy, and by aligning key reference points (fiducials), the hologram matches perfectly with actual anatomy, allowing virtual slicing through the holographic image to view dilated ventricles for precise drain placement.↗
Aerodigestive & Esophageal Surgery - The Unsalvageable Esophagus & Cases
▶Ep 1 · 16:30
quoteManubrial removing the manubrium is never as straightforward as it seems because your clavicles always get in the way.↗
▶Ep 1 · 16:30
quoteManubrial removing the manubrium is never as straightforward as it seems because your clavicles always get in the way.↗
▶Ep 1 · 16:38
clinicalManubrial resection for high esophageal strictures provides less exposure than expected because the clavicles limit the width of the resection corridor.↗
▶Ep 1 · 16:38
clinicalManubrial resection for high esophageal strictures provides less exposure than expected because the clavicles limit the width of the resection corridor.↗
▶Ep 1 · 19:36
quoteEsophageal stents are very much a double-edged sword. They can often cause as many problems as they fix.↗
▶Ep 1 · 19:36
quoteEsophageal stents are very much a double-edged sword. They can often cause as many problems as they fix.↗
▶Ep 1 · 33:28
clinicalKenalog (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.↗
▶Ep 1 · 33:28
clinicalKenalog (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.↗
▶Ep 1 · 36:29
clinicalFor recalcitrant esophageal strictures, weekly dilations (3–4 cycles) prevent fibroblasts from bridging and allow the stricture to scar open rather than closed.↗
▶Ep 1 · 36:29
clinicalFor recalcitrant esophageal strictures, weekly dilations (3–4 cycles) prevent fibroblasts from bridging and allow the stricture to scar open rather than closed.↗
▶Ep 1 · 45:47
clinicalFeeding via gastrojejunal tube with gastric drainage (GJ/G) is a temporizing measure to reduce reflux into the esophagus while managing a refractory stricture.↗
▶Ep 1 · 45:47
clinicalFeeding via gastrojejunal tube with gastric drainage (GJ/G) is a temporizing measure to reduce reflux into the esophagus while managing a refractory stricture.↗
▶Ep 1 · 47:43
quoteIf you've got mucosal disease, all you need to do is remove all the mucosa. You've got no disease.↗
▶Ep 1 · 47:43
quoteIf you've got mucosal disease, all you need to do is remove all the mucosa. You've got no disease.↗
▶Ep 1 · 48:18
clinicalEsophageal 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.↗
▶Ep 1 · 48:18
clinicalEsophageal 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.↗
▶Ep 1 · 48:20
quoteIf you put in an esophageal stent, have a quick look in the airway when you're done.↗
▶Ep 1 · 48:20
quoteIf you put in an esophageal stent, have a quick look in the airway when you're done.↗
▶Ep 1 · 50:13
quoteWe 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.↗
▶Ep 1 · 50:13
quoteWe 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.↗
▶Ep 1 · 50:20
clinicalChronic 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.↗
▶Ep 1 · 50:20
clinicalChronic 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.↗
▶Ep 1 · 52:06
quoteThe aim is to probe it but not push so hard that you create a fistula. That's always embarrassing.↗
▶Ep 1 · 52:06
quoteThe aim is to probe it but not push so hard that you create a fistula. That's always embarrassing.↗
▶Ep 1 · 1:01:05
quoteA lot of kids have replaced esophaguuses and most of them don't aspirate, even if you've got a trashed cricoharyngeis.↗
▶Ep 1 · 1:01:05
quoteA lot of kids have replaced esophaguuses and most of them don't aspirate, even if you've got a trashed cricoharyngeis.↗
▶Ep 1 · 1:10:42
clinicalCovered esophageal stents can temporize anastomotic leaks and allow healing while maintaining luminal patency. Stent removal is typically planned after several weeks.↗
▶Ep 1 · 1:10:42
clinicalCovered esophageal stents can temporize anastomotic leaks and allow healing while maintaining luminal patency. Stent removal is typically planned after several weeks.↗
▶Ep 1 · 1:31:42
clinicalTracheal homografts (dead trachea implants) have been performed but are associated with difficult postoperative courses lasting several months.↗
▶Ep 1 · 1:31:42
clinicalTracheal homografts (dead trachea implants) have been performed but are associated with difficult postoperative courses lasting several months.↗
▶Ep 1 · 1:32:06
clinicalTissue-engineered tracheal homografts with pre-epithelialization are under development in multiple centers (London leading) but are not yet ready for routine clinical use.↗
▶Ep 1 · 1:32:06
clinicalTissue-engineered tracheal homografts with pre-epithelialization are under development in multiple centers (London leading) but are not yet ready for routine clinical use.↗
▶Ep 1 · 1:33:15
clinicalLong-term surveillance of bypassed esophagus includes periodic CT scans to rule out mucocele and endoscopic evaluation via the persistent TEF if needed.↗
▶Ep 1 · 1:33:15
clinicalLong-term surveillance of bypassed esophagus includes periodic CT scans to rule out mucocele and endoscopic evaluation via the persistent TEF if needed.↗
▶Ep 1 · 1:34:15
host_summaryPosterior 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.↗
▶Ep 1 · 1:34:15
clinicalPosterior 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.↗
▶Ep 1 · 1:39:43
opinionComplications 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.↗
▶Ep 1 · 1:39:43
quoteThis 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.↗
▶Ep 1 · 1:39:43
quoteThis 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.↗
▶Ep 1 · 1:39:43
opinionComplications 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.↗
Case Based Journal Review: Esophageal Atresia in 2022
▶Ep 8 · 7:54
host_summaryPatients with transanastomotic tubes started feeding on day 2 versus day 10 for those without tubes, but early feeding did not lead to less TPN—duration was 9 days in both groups↗
▶Ep 8 · 12:20
host_summaryIn a meta-analysis of about 500 newborns, there was no significant difference in leak occurrence, pneumothorax, or mortality based on whether a chest drain was placed↗
▶Ep 8 · 12:31
host_summaryThe group that received a chest drain had a significantly higher chance of returning to the operating room↗
QUAD #2 Thoracoscopic Tracheopexy with Dr. Aaron Garrison
▶Ep 4 · 0:36
host_summarySeveral years ago, the approach was that patients with tracheomalacia would undergo aortopexy.↗
▶Ep 4 · 0:43
host_summaryIn the last 4 to 5 years, it has become standard practice to determine which patients will respond best to tracheopexy versus aortopexy.↗
▶Ep 4 · 1:45
host_summaryPart 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.↗
▶Ep 4 · 2:02
host_summaryPreoperative bronchoscopy gives the surgical team an idea of internal anatomy, which can assist in classifying the degree of tracheomalacia prior to surgical intervention.↗
▶Ep 4 · 3:23
host_summaryWhen using a thoracoscopic approach, correct positioning is the key to success.↗
▶Ep 4 · 3:27
host_summaryIt is best to use gravity to advantage as it aids in retracting the lungs and trachea placement.↗
▶Ep 4 · 4:01
host_summaryOpening the pericardium and finding the area at the pericardial-adventitial junction to suspend is the key point of aortopexy.↗
▶Ep 4 · 4:16
host_summaryPassing suture transternally is preferred with the aortopexy approach, though it can be technically difficult.↗
▶Ep 4 · 4:23
host_summaryFor tracheopexy, a posterior approach via semiprone position is preferred.↗
▶Ep 4 · 4:28
host_summaryCreating a pneumothorax by putting the Veress off the tip of the scapula helps collapse the lung for trocar placement.↗
▶Ep 4 · 4:38
host_summaryWhen operating posteriorly, triangulating your hands gives the best visualization and working space.↗
▶Ep 4 · 4:56
host_summaryWhen available, a multidisciplinary team which includes a pulmonologist can allow for internal visualization via bronchoscopy.↗
▶Ep 4 · 5:05
host_summaryBronchoscopic guidance technique is primarily used in non-esophageal atresia patients.↗
▶Ep 4 · 5:53
host_summaryIt is important to create enough tension in the suture to ensure that the pexy is secure.↗
▶Ep 4 · 6:07
host_summaryThe approach changes for patients without esophageal atresia or with an esophagus in continuity.↗
▶Ep 4 · 6:14
host_summaryFor patients with esophagus in continuity, the first step is to dissect around the esophagus using a vessel loop for retraction.↗
▶Ep 4 · 6:32
host_summaryUsing pre- and post-operative bronchoscopy allows the surgeon to see the improvement prior to case completion.↗
