Jacob Langer

102 statements · 4 topics

Abdominal Wall Defects · guest expert CICU / Post-op CHD Care · guest expert Colorectal / ARM & Hirschsprung · guest expert Etiologies (Gastroschisis/NEC/Atresia/Volvulus) · guest expert Intestinal Rehab · guest expert Single Ventricle / HLHS · guest expert

Featured statements

we have a lot of kids on chronic, uh, metronidazole. And when they, you know, they can be on it for three months and then you try taking them off and they start getting symptoms again. So, some of them need it for a long, long time
quote · Colorectal / ARM & Hirschsprung
Most of these cecal perforations from Hirschberg's disease are not total colonic disease. Most of them are shorter segment disease. It's like with a rectal cancer. The cecum gets more distended and pops
quote · Colorectal / ARM & Hirschsprung
I find that, that rectum gets so thickened trying to do it transanally, uh, you get into the wrong plane, you end up stretching the sphincters way more than you want to
quote · Enterocolitis
The three things. That came up as risk factors, trisomy 21, a history of enterocolitis following Coulter's surgery, and long segment disease.
quote · Hirschsprung disease
For recurrent enterocolitis, first rule out distal obstruction and residual aganglionosis with exam under anesthesia and biopsies
guideline · Enterocolitis
Two definitions exist for ultra-short segment Hirschsprung: (1) absence of recto-anal inhibitory reflex with normal ganglion cells on biopsy (internal sphincter achalasia, not true Hirschsprung), and (2) very short segment of aganglionosis
clinical · Hirschsprung disease

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Jacob's statements about Colorectal / ARM & Hirschsprung 34 statements

Open the Colorectal / ARM & Hirschsprung collection →

Hirschsprung Disease: Update Course 2013

Statement False positive contrast enemas showing transition zones can occur in newborns without Hirschsprung disease Open
Statement In Mana Proctor's series, 8% of cases with apparent short transition zone on imaging had pathologically higher transition zones (long transition zone concept) Open
Quotation you just have to get one patient who loses his endotracheal tube while you're doing that and it kind of sours you on that Open
Statement Manometry showing normal recto-anal inhibitory reflex rules out Hirschsprung disease in older children without need for biopsy Open
Statement Absence of recto-anal inhibitory reflex on manometry requires biopsy confirmation due to false positives Open
Quotation There are two definitions for ultra short segment Hirschmann's disease that people use, and these kinds of discussions get get foiled because one person's using one definition, another person's using another one Open
Statement Two definitions exist for ultra-short segment Hirschsprung: (1) absence of recto-anal inhibitory reflex with normal ganglion cells on biopsy (internal sphincter achalasia, not true Hirschsprung), and (2) very short segment of aganglionosis Open
Quotation it's hard for me to imagine how Doctor Pena could not believe in that. You know, why would there be a disease where there's a minimum of 5 centimeters of a ganglionosis? Why, you know, it's just he's, he's the big spectrum guy, right? There's a spectrum of disease, right? Open
Statement For ultra-short segment with confirmed aganglionosis, pull-through is preferred over myectomy Open
Statement Most 16-year-olds with newly diagnosed Hirschsprung require diversion due to massive bowel dilation Open
Quotation I find that, that rectum gets so thickened trying to do it transanally, uh, you get into the wrong plane, you end up stretching the sphincters way more than you want to Open
Statement Laparoscopic Duhamel is preferred for older patients because thickened rectum makes transanal dissection difficult and causes excessive sphincter stretch Open
Statement Transitional epithelium (not normal rectal mucosa) should be seen on biopsy if specimen is truly from anal canal Open
Statement Most cecal perforations in Hirschsprung disease occur with shorter-segment disease (not total colonic), as cecum distends most and perforates like in rectal cancer Open
Statement For cecal perforation, close perforation and create loop ileostomy without frozen section of ileum, as total colonic disease is unlikely Open
Quotation Most of these cecal perforations from Hirschberg's disease are not total colonic disease. Most of them are shorter segment disease. It's like with a rectal cancer. The cecum gets more distended and pops Open
Statement In long-segment disease, delay pull-through 6-12 months until stoma output thickens to prevent severe perianal excoriation Open
Statement Pull-throughs using only cecum (very short colonic segment) have poor outcomes with stasis and enterocolitis; ileal Duhamel may be preferable Open
Statement If transition zone is at hepatic flexure (not just cecum), preserve the colon and perform Duhamel Open
Statement When bringing right colon down, flip it over rather than rotating; preserve marginal artery and let anatomy determine orientation Open
Statement Manometry is not reliably performed until age 5-6 years Open
Statement For 3-year-old with massive dilation, divert and attempt bowel decompression; resect dilated segment if it does not collapse after 6-8 months Open
Quotation I have had success in, uh, getting that distal bowel to, uh, shrink in size. With the stoma for 6 or 8 months Open
Statement Older children are less likely to have bowel shrinkage after diversion, but 3-year-olds may still respond Open
Quotation the older the kid, the less likely that it's going to shrink down in size. But, uh, at this age I think it will Open
Statement For recurrent enterocolitis, first rule out distal obstruction and residual aganglionosis with exam under anesthesia and biopsies Open
Statement Chronic oral metronidazole is used liberally for recurrent enterocolitis; some patients require it for months, and symptoms recur when discontinued Open
Quotation we have a lot of kids on chronic, uh, metronidazole. And when they, you know, they can be on it for three months and then you try taking them off and they start getting symptoms again. So, some of them need it for a long, long time Open
Statement Botox injection decreases number of hospitalizations for enterocolitis, though it does not work in all patients Open
Quotation we actually published a, uh, that Botox decreased the number of hospitalizations for enterocolitis in, in those children. It doesn't always work, though Open

Journal of Pediatric Surgery Article Review: May 2023, CAPS Issue

Quotation The three things. That came up as risk factors, trisomy 21, a history of enterocolitis following Coulter's surgery, and long segment disease. Open
Statement Three risk factors for Hirschsprung-associated IBD are trisomy 21, a history of enterocolitis following pull-through surgery, and long segment disease. Open
Statement Hirschsprung's associated IBD is very poorly defined, presents in a number of different ways, and the reason why it happens is unknown. Open
Quotation This Hirschsprung's associated IBD is very poorly defined, and it presents in a number of different ways, and we have no idea why it happens. Open
Jacob's statements about Enterocolitis 30 statements

Open the Enterocolitis collection →

Hirschsprung Disease: Update Course 2013

Statement False positive contrast enemas showing transition zones can occur in newborns without Hirschsprung disease Open
Statement In Mana Proctor's series, 8% of cases with apparent short transition zone on imaging had pathologically higher transition zones (long transition zone concept) Open
Quotation you just have to get one patient who loses his endotracheal tube while you're doing that and it kind of sours you on that Open
Statement Manometry showing normal recto-anal inhibitory reflex rules out Hirschsprung disease in older children without need for biopsy Open
Statement Absence of recto-anal inhibitory reflex on manometry requires biopsy confirmation due to false positives Open
Statement Two definitions exist for ultra-short segment Hirschsprung: (1) absence of recto-anal inhibitory reflex with normal ganglion cells on biopsy (internal sphincter achalasia, not true Hirschsprung), and (2) very short segment of aganglionosis Open
Quotation There are two definitions for ultra short segment Hirschmann's disease that people use, and these kinds of discussions get get foiled because one person's using one definition, another person's using another one Open
Quotation it's hard for me to imagine how Doctor Pena could not believe in that. You know, why would there be a disease where there's a minimum of 5 centimeters of a ganglionosis? Why, you know, it's just he's, he's the big spectrum guy, right? There's a spectrum of disease, right? Open
Statement For ultra-short segment with confirmed aganglionosis, pull-through is preferred over myectomy Open
Statement Most 16-year-olds with newly diagnosed Hirschsprung require diversion due to massive bowel dilation Open
Statement Laparoscopic Duhamel is preferred for older patients because thickened rectum makes transanal dissection difficult and causes excessive sphincter stretch Open
Quotation I find that, that rectum gets so thickened trying to do it transanally, uh, you get into the wrong plane, you end up stretching the sphincters way more than you want to Open
Statement Transitional epithelium (not normal rectal mucosa) should be seen on biopsy if specimen is truly from anal canal Open
Statement Most cecal perforations in Hirschsprung disease occur with shorter-segment disease (not total colonic), as cecum distends most and perforates like in rectal cancer Open
Quotation Most of these cecal perforations from Hirschberg's disease are not total colonic disease. Most of them are shorter segment disease. It's like with a rectal cancer. The cecum gets more distended and pops Open
Statement For cecal perforation, close perforation and create loop ileostomy without frozen section of ileum, as total colonic disease is unlikely Open
Statement In long-segment disease, delay pull-through 6-12 months until stoma output thickens to prevent severe perianal excoriation Open
Statement Pull-throughs using only cecum (very short colonic segment) have poor outcomes with stasis and enterocolitis; ileal Duhamel may be preferable Open
Statement If transition zone is at hepatic flexure (not just cecum), preserve the colon and perform Duhamel Open
Statement When bringing right colon down, flip it over rather than rotating; preserve marginal artery and let anatomy determine orientation Open
Statement Manometry is not reliably performed until age 5-6 years Open
Statement For 3-year-old with massive dilation, divert and attempt bowel decompression; resect dilated segment if it does not collapse after 6-8 months Open
Quotation I have had success in, uh, getting that distal bowel to, uh, shrink in size. With the stoma for 6 or 8 months Open
Quotation the older the kid, the less likely that it's going to shrink down in size. But, uh, at this age I think it will Open
Statement Older children are less likely to have bowel shrinkage after diversion, but 3-year-olds may still respond Open
Statement For recurrent enterocolitis, first rule out distal obstruction and residual aganglionosis with exam under anesthesia and biopsies Open
Statement Chronic oral metronidazole is used liberally for recurrent enterocolitis; some patients require it for months, and symptoms recur when discontinued Open
Quotation we have a lot of kids on chronic, uh, metronidazole. And when they, you know, they can be on it for three months and then you try taking them off and they start getting symptoms again. So, some of them need it for a long, long time Open
Quotation we actually published a, uh, that Botox decreased the number of hospitalizations for enterocolitis in, in those children. It doesn't always work, though Open
Statement Botox injection decreases number of hospitalizations for enterocolitis, though it does not work in all patients Open
Jacob's statements about Hirschsprung disease 34 statements

Open the Hirschsprung disease collection →

Hirschsprung Disease: Update Course 2013

Statement False positive contrast enemas showing transition zones can occur in newborns without Hirschsprung disease Open
Statement In Mana Proctor's series, 8% of cases with apparent short transition zone on imaging had pathologically higher transition zones (long transition zone concept) Open
Quotation you just have to get one patient who loses his endotracheal tube while you're doing that and it kind of sours you on that Open
Statement Manometry showing normal recto-anal inhibitory reflex rules out Hirschsprung disease in older children without need for biopsy Open
Statement Absence of recto-anal inhibitory reflex on manometry requires biopsy confirmation due to false positives Open
Quotation There are two definitions for ultra short segment Hirschmann's disease that people use, and these kinds of discussions get get foiled because one person's using one definition, another person's using another one Open
Statement Two definitions exist for ultra-short segment Hirschsprung: (1) absence of recto-anal inhibitory reflex with normal ganglion cells on biopsy (internal sphincter achalasia, not true Hirschsprung), and (2) very short segment of aganglionosis Open
Quotation it's hard for me to imagine how Doctor Pena could not believe in that. You know, why would there be a disease where there's a minimum of 5 centimeters of a ganglionosis? Why, you know, it's just he's, he's the big spectrum guy, right? There's a spectrum of disease, right? Open
Statement For ultra-short segment with confirmed aganglionosis, pull-through is preferred over myectomy Open
Statement Most 16-year-olds with newly diagnosed Hirschsprung require diversion due to massive bowel dilation Open
Quotation I find that, that rectum gets so thickened trying to do it transanally, uh, you get into the wrong plane, you end up stretching the sphincters way more than you want to Open
Statement Laparoscopic Duhamel is preferred for older patients because thickened rectum makes transanal dissection difficult and causes excessive sphincter stretch Open
Statement Transitional epithelium (not normal rectal mucosa) should be seen on biopsy if specimen is truly from anal canal Open
Statement Most cecal perforations in Hirschsprung disease occur with shorter-segment disease (not total colonic), as cecum distends most and perforates like in rectal cancer Open
Statement For cecal perforation, close perforation and create loop ileostomy without frozen section of ileum, as total colonic disease is unlikely Open
Quotation Most of these cecal perforations from Hirschberg's disease are not total colonic disease. Most of them are shorter segment disease. It's like with a rectal cancer. The cecum gets more distended and pops Open
Statement In long-segment disease, delay pull-through 6-12 months until stoma output thickens to prevent severe perianal excoriation Open
Statement Pull-throughs using only cecum (very short colonic segment) have poor outcomes with stasis and enterocolitis; ileal Duhamel may be preferable Open
Statement If transition zone is at hepatic flexure (not just cecum), preserve the colon and perform Duhamel Open
Statement When bringing right colon down, flip it over rather than rotating; preserve marginal artery and let anatomy determine orientation Open
Statement Manometry is not reliably performed until age 5-6 years Open
Statement For 3-year-old with massive dilation, divert and attempt bowel decompression; resect dilated segment if it does not collapse after 6-8 months Open
Quotation I have had success in, uh, getting that distal bowel to, uh, shrink in size. With the stoma for 6 or 8 months Open
Quotation the older the kid, the less likely that it's going to shrink down in size. But, uh, at this age I think it will Open
Statement Older children are less likely to have bowel shrinkage after diversion, but 3-year-olds may still respond Open
Statement For recurrent enterocolitis, first rule out distal obstruction and residual aganglionosis with exam under anesthesia and biopsies Open
Statement Chronic oral metronidazole is used liberally for recurrent enterocolitis; some patients require it for months, and symptoms recur when discontinued Open
Quotation we have a lot of kids on chronic, uh, metronidazole. And when they, you know, they can be on it for three months and then you try taking them off and they start getting symptoms again. So, some of them need it for a long, long time Open
Quotation we actually published a, uh, that Botox decreased the number of hospitalizations for enterocolitis in, in those children. It doesn't always work, though Open
Statement Botox injection decreases number of hospitalizations for enterocolitis, though it does not work in all patients Open

Journal of Pediatric Surgery Article Review: May 2023, CAPS Issue

Statement Three risk factors for Hirschsprung-associated IBD are trisomy 21, a history of enterocolitis following pull-through surgery, and long segment disease. Open
Quotation The three things. That came up as risk factors, trisomy 21, a history of enterocolitis following Coulter's surgery, and long segment disease. Open
Quotation This Hirschsprung's associated IBD is very poorly defined, and it presents in a number of different ways, and we have no idea why it happens. Open
Statement Hirschsprung's associated IBD is very poorly defined, presents in a number of different ways, and the reason why it happens is unknown. Open
Jacob's statements about Inflammatory Bowel Disease 4 statements

Open the Inflammatory Bowel Disease collection →

Journal of Pediatric Surgery Article Review: May 2023, CAPS Issue

Quotation The three things. That came up as risk factors, trisomy 21, a history of enterocolitis following Coulter's surgery, and long segment disease. Open
Statement Three risk factors for Hirschsprung-associated IBD are trisomy 21, a history of enterocolitis following pull-through surgery, and long segment disease. Open
Statement Hirschsprung's associated IBD is very poorly defined, presents in a number of different ways, and the reason why it happens is unknown. Open
Quotation This Hirschsprung's associated IBD is very poorly defined, and it presents in a number of different ways, and we have no idea why it happens. Open