Rod Gerardo
0 statements · 0 topics · summaries given as host listed separately
Abdominal Wall Defects
· episode host
Aerodigestive / ENT
· guest expert
Biliary Atresia
· guest expert
Colorectal / ARM & Hirschsprung
· series host
Congenital Lung Lesions (CPAM)
· episode host
Etiologies (Gastroschisis/NEC/Atresia/Volvulus)
· series host
Fetal Surgery
· series host
Intestinal Failure
· series host
Intestinal Rehab
· series host
Motility / Pseudo-obstruction
· episode host
Pancreatic Tumors
· episode host
Sarcoma (Ewing/Rhabdo)
· episode host
Short Bowel Syndrome
· episode host
Wilms Tumor
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Summaries Rod gave as host · 666 summaries
Recaps of other experts' statements, not Rod's own clinical position.
Summaries Rod gave as host · Abdominal Wall Defects 26 summaries
Open the Abdominal Wall Defects collection →
Gastroschisis and sutureless abdominal wall closure
Host summary
Rod Gerardo summarizes what Dr. Jason Fraser said: In 2004, Tony Sandler published the first manuscript about sutureless closures utilizing the natural umbilical properties to close the gastroschisis defect by itself.
Open
Host summary
Rod Gerardo summarizes what Dr. Jason Fraser said: In 2004, Tony Sandler published the first manuscript about suture disclosures to utilize the natural umbilical properties to closing that defect by itself.
Open
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Rod Gerardo summarizes what Dr. Jason Fraser said: I didn't know about his article. I found out about it as a fellow when he taught us how to treat gastroschisis that way.
Open
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Rod Gerardo summarizes what Dr. Jason Fraser said: I think it's clearly been a massive change in practice. It's one of the examples of a big change that we don't actually operate on those and they can be done at the bedside. And it also is an example of something that took a while to adopt. And now most people are doing it, I think.
Open
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Rod Gerardo summarizes what Dr. Jason Fraser said: There have been so many articles in the last few years that go back and forth. I mean, one said gastro suture list is better. One said definitely don't do suture list. So my question is now, I don't know. I almost don't read these articles anymore.
Open
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Rod Gerardo summarizes what Dr. Jason Fraser said: I think anytime it's a Kansas City or an NWSPC, NWPSC. Anytime it's an NWPSC article, I pay attention. Anytime it's a Kansas City article, I pay attention. But other than that, I'm tired of seeing all these gastroschisis articles. I'm waiting for someone to give me something that is really meaningful.
Open
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Rod Gerardo summarizes what Dr. Jason Fraser said: Sutureless closure patients had fewer episodes of general anesthetics compared to sutured closure patients.
Open
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Rod Gerardo summarizes what Dr. Jason Fraser said: The positive outcomes for sutureless repair were observed even when considering patients who required silo use.
Open
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Rod Gerardo summarizes what Dr. Jason Fraser said: Sutureless closure patients had less ventilator use compared to sutured closure patients.
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Rod Gerardo summarizes what Dr. Jason Fraser said: The Midwest Pediatric Surgery Consortium study was a retrospective cohort of infants born with gastroschisis between 2013 and 2016, with a total of 315 patients.
Open
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Rod Gerardo summarizes what Dr. Jason Fraser said: The study divided patients into sutured versus sutureless abdominal wall closures and required subgroup analysis because some babies received silos and some did not.
Open
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Rod Gerardo summarizes what Dr. Jason Fraser said: Patients who underwent sutureless abdominal wall closure had no difference in days on TPN, time to goal feeds, time to initial feeds, or length of stay compared to sutured closure.
Open
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Rod Gerardo summarizes what Dr. Jason Fraser said: Sutureless closure patients had less antibiotic use compared to sutured closure patients.
Open
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Rod Gerardo summarizes what Dr. Jason Fraser said: Sutureless closure patients had fewer surgical site and deep space infections compared to sutured closure patients.
Open
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Rod Gerardo summarizes what Dr. Jason Fraser said: Yeah, I think in general, I, I, you're right. I don't know how the pendulum is going to swing, but we are finding more and more. There are things that we don't have to operate on.
Open
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Rod Gerardo summarizes what Dr. Jason Fraser said: Gastroschisis is an abdominal wall defect that used to necessitate a trip to the OR and is now more like a safe bedside procedure.
Open
Intestinal rehabilitation: What is intestinal rehab? - Episode 1
Host summary
Rod Gerardo summarizing the discussion: New guidelines define intestinal failure as requiring parenteral support for at least 60 days due to inadequate intestinal function.
Open
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Rod Gerardo summarizing the discussion: Intestinal rehabilitation requires managing comorbidities including sepsis and liver disease that challenge infant growth.
Open
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Rod Gerardo summarizing the discussion: Access and availability to intestinal rehabilitation programs is still very rare.
Open
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Rod Gerardo summarizing the discussion: Overall long-term survival in major intestinal rehabilitation programs is usually over 90%.
Open
Intestinal Rehabilitation, Episode 1: What is intestinal rehabilitation?
Host summary
Rod Gerardo summarizing the discussion: New guidelines define intestinal failure as inadequate intestinal function requiring parenteral support for at least 60 days.
Open
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Rod Gerardo summarizing the discussion: Intestinal rehabilitation requires managing comorbidities including sepsis and liver disease that challenge infant growth.
Open
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Rod Gerardo summarizing the discussion: Overall survival in big intestinal rehabilitation programs is usually over 90% long-term.
Open
Journal of Pediatric Surgery Article Review: January 2022 APSA Issue
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Rod Gerardo summarizing the discussion: External federal research funding at Nationwide increased from $750,000 to $5.7 million, representing a 7.7-fold increase.
Open
Quick Literature Updates Episode 6
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Rod Gerardo summarizing a resource: Miyata et al. used the Canadian Association of Pediatric Surgery Network to study pediatric patients with gastroschisis who underwent bedside reduction and closure.
Open
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Rod Gerardo summarizing a resource: There was no significant difference in the rate of successful primary closure between intubated and non-intubated neonates with gastroschisis.
Open
Summaries Rod gave as host · Aerodigestive / ENT 10 summaries
Open the Aerodigestive / ENT collection →
Laryngeal Clefts
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Rod Gerardo summarizing the discussion: The Benjamin Inglis classification should be modified to include a type 4 long because type 4 could be proximal above the carina, at the carina, or go straight through the carina.
Open
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Rod Gerardo summarizing the discussion: Type 1 laryngeal cleft means the opening is above the vocal cords.
Open
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Rod Gerardo summarizing the discussion: Flexible bronchoscopy is not adequate for diagnosing a posterior laryngeal cleft.
Open
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Rod Gerardo summarizing the discussion: The mass closure technique developed in Cincinnati uses the same concept as endoscopic tracheoesophageal fistula repair: you want raw against raw, with wide strips of raw tissue opposed after removing the non-stick mucosal surface.
Open
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Rod Gerardo summarizing the discussion: We've been nagging Andy for years, Andy Inglis, to actually modify that classification.
Open
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Rod Gerardo summarizing the discussion: Flexible bronchoscopy is not adequate for diagnosing a posterior laryngeal cleft.
Open
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Rod Gerardo summarizing the discussion: You want raw against raw. Mucosa is a nonstick surface. Get rid of the mucosa. You want a wide strip of raw against a wide strip of raw.
Open
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Rod Gerardo summarizing the discussion: Endoscopically or endoscopically unless there's a reason to do an open approach.
Open
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Rod Gerardo summarizing the discussion: Type 2 laryngeal cleft means it extends below the vocal cords.
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Rod Gerardo summarizing the discussion: Type 3 laryngeal cleft means it extends down into the trachea.
Open
Summaries Rod gave as host · Anorectal Malformation 13 summaries
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The Colorectal Quiz Episode 1: ARM - Low Bulbar Fistula
Host summary
Rod Gerardo summarizing the discussion: These patients can come with anatomic variances, really rare anomalies, their care can be complex, dynamic, multidisciplinary, and pose a lot of clinical challenges to your everyday pediatric surgeon.
Open
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Rod Gerardo summarizing the discussion: At those times, it might be nice to just step inside the mind of a pediatric colorectal surgeon who's been around the block.
Open
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Rod Gerardo summarizing the discussion: In low anorectal malformations, dissecting a small portion of the anterior rectal wall and carefully lifting it off the urinary tract will usually rule out a fistula.
Open
Colorectal Quiz Episode 13: Newborn ARM Part 2
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Rod Gerardo summarizing the discussion: Use Hagar dilators starting low and working up for accurate anal size measurement; do not use fingers because every surgeon has different size glove
Open
Host summary
Rod Gerardo summarizing the discussion: Don't use your fingers because every surgeon has a different size glove.
Open
Colorectal Quiz Episode 14: ARM Newborn Part 3
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Rod Gerardo summarizing the discussion: Posterior rectal wall only mobilization technique is only appropriate in situations where the dot of the fistula is in the sphincteric ellipse.
Open
Colorectal Quiz Episode 32: Anorectal Malformations And Cardiac Anomalies
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Rod Gerardo summarizing the discussion: whether you are watching us on YouTube, listening to us on Apple Podcasts, Spotify, Stitcher, or Amazon Music, really the best way to get the colorectal quiz is on the Stay Current Pediatric Surgery app
Open
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Rod Gerardo summarizing the discussion: When a baby in Georgia gets diagnosed with prenatal cardiac disease, the Sibley cardiology group gets called early and involved, including reviewing echocardiogram and meeting with high-risk OB.
Open
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Rod Gerardo summarizing the discussion: For hospitals that take care of many pediatric cardiac patients, an ostomy is probably the standard choice for ARM with really significant cardiac anomaly.
Open
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Rod Gerardo summarizing the discussion: Starting flow rate at 1 liter per minute for laparoscopy in babies is a cautious approach.
Open
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Rod Gerardo summarizing the discussion: I always start on the babies at a flow rate of one
Open
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Rod Gerardo summarizing the discussion: Dr. Tim Jackson's technique involves looking laparoscopically while passing a tube into the distal segment to perform irrigation under direct visualization.
Open
Colorectal Quiz: Episode 2
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Rod Gerardo summarizing the discussion: After anorectoplasty, your first shot might be your only shot to give the patient a good outcome
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Summaries Rod gave as host · Appendicitis 15 summaries
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Update Course Rewind: Perforated Appendicitis 2019
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Rod Gerardo summarizing the discussion: CT scan reviewers (6 surgeons including 2 fellows and 2 radiologists) were only 72% accurate in distinguishing perforated from non-perforated appendicitis when reviewing 200 CT scans
Open
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Rod Gerardo summarizing the discussion: We are terrible at telling whether or not an appendix is perforated or non-perforated on a CT scan.
Open
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Rod Gerardo summarizing the discussion: Among 62 attending surgeons (adult and pediatric, from university, community, and children's hospitals), agreement in defining intraoperative laparoscopic images as perforated or non-perforated appendicitis was 27%
Open
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Rod Gerardo summarizing the discussion: A standardized definition of perforated appendicitis as a hole in the appendix or a fecalith in the abdomen was implemented at one hospital
Open
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Rod Gerardo summarizing the discussion: At our hospital, uh, we identify a perforated appendicitis as a hole in the appendix or a fecal lith in the abdomen.
Open
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Rod Gerardo summarizing the discussion: Patients without a hole in the appendix or fecalith in the abdomen had an incidence of postoperative abscess less than 5%
Open
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Rod Gerardo summarizing the discussion: After implementing a standardized definition for perforated appendicitis, the non-perforation abscess rate decreased and the perforation abscess rate increased, suggesting previous misclassification
Open
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Rod Gerardo summarizing the discussion: In a randomized trial with 110 patients per arm, irrigation with minimum 500cc (average 850cc) showed no difference in postoperative abscess rate, length of stay, hospital cost, or operative time compared to no irrigation
Open
Journal Club: Appendicitis in 2021
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Rod Gerardo summarizing the discussion: Hey there, listeners, this is Rod Gerardo, research resident at Cincinnati Children's Hospital.
Open
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Rod Gerardo summarizing the discussion: The Shira score had an area under the curve of 0.84 and a failure rate of 3%, making it effective for ruling out appendicitis.
Open
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Rod Gerardo summarizing the discussion: A retrospective cohort study of 5000 patients identified four intraoperative findings that correlate with complicated postoperative course: visible hole, abscess, fecal material, and diffuse fibrinopurulent exudate outside the right iliac fossa or pelvis.
Open
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Rod Gerardo summarizing the discussion: The recent study differs from Saint Peter's study in that pus in the abdomen was found to be a predictor of abscess, whereas in Sean's study it was not.
Open
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Rod Gerardo summarizing the discussion: A 6% baseline infection rate for simple appendicitis seems too high.
Open
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Rod Gerardo summarizing the discussion: Nail on the head here, Jose, is that this is a, a very US centric problem that we need to come up with a way to decrease our opioid use. This has been one of the hardest things for me to adjust to out of all the things you brought up today because I, I really felt like these patients need opiates. And once I started converting to Tylenol and or Motrin, They're fine. And it, it totally surprised me, and patients really do not come back asking for opiates.
Open
Host summary
Rod Gerardo summarizing the discussion: Patients do well with Tylenol and/or Motrin after appendectomy and do not typically return asking for opiates.
Open
Summaries Rod gave as host · Appendicitis 15 summaries
Open the Appendicitis collection →
Update Course Rewind: Perforated Appendicitis 2019
Host summary
Rod Gerardo summarizing the discussion: CT scan reviewers (6 surgeons including 2 fellows and 2 radiologists) were only 72% accurate in distinguishing perforated from non-perforated appendicitis when reviewing 200 CT scans
Open
Host summary
Rod Gerardo summarizing the discussion: We are terrible at telling whether or not an appendix is perforated or non-perforated on a CT scan.
Open
Host summary
Rod Gerardo summarizing the discussion: Among 62 attending surgeons (adult and pediatric, from university, community, and children's hospitals), agreement in defining intraoperative laparoscopic images as perforated or non-perforated appendicitis was 27%
Open
Host summary
Rod Gerardo summarizing the discussion: A standardized definition of perforated appendicitis as a hole in the appendix or a fecalith in the abdomen was implemented at one hospital
Open
Host summary
Rod Gerardo summarizing the discussion: At our hospital, uh, we identify a perforated appendicitis as a hole in the appendix or a fecal lith in the abdomen.
Open
Host summary
Rod Gerardo summarizing the discussion: Patients without a hole in the appendix or fecalith in the abdomen had an incidence of postoperative abscess less than 5%
Open
Host summary
Rod Gerardo summarizing the discussion: After implementing a standardized definition for perforated appendicitis, the non-perforation abscess rate decreased and the perforation abscess rate increased, suggesting previous misclassification
Open
Host summary
Rod Gerardo summarizing the discussion: In a randomized trial with 110 patients per arm, irrigation with minimum 500cc (average 850cc) showed no difference in postoperative abscess rate, length of stay, hospital cost, or operative time compared to no irrigation
Open
Journal Club: Appendicitis in 2021
Host summary
Rod Gerardo summarizing the discussion: Hey there, listeners, this is Rod Gerardo, research resident at Cincinnati Children's Hospital.
Open
Host summary
Rod Gerardo summarizing the discussion: The Shira score had an area under the curve of 0.84 and a failure rate of 3%, making it effective for ruling out appendicitis.
Open
Host summary
Rod Gerardo summarizing the discussion: A retrospective cohort study of 5000 patients identified four intraoperative findings that correlate with complicated postoperative course: visible hole, abscess, fecal material, and diffuse fibrinopurulent exudate outside the right iliac fossa or pelvis.
Open
Host summary
Rod Gerardo summarizing the discussion: The recent study differs from Saint Peter's study in that pus in the abdomen was found to be a predictor of abscess, whereas in Sean's study it was not.
Open
Host summary
Rod Gerardo summarizing the discussion: A 6% baseline infection rate for simple appendicitis seems too high.
Open
Host summary
Rod Gerardo summarizing the discussion: Patients do well with Tylenol and/or Motrin after appendectomy and do not typically return asking for opiates.
Open
Host summary
Rod Gerardo summarizing the discussion: Nail on the head here, Jose, is that this is a, a very US centric problem that we need to come up with a way to decrease our opioid use. This has been one of the hardest things for me to adjust to out of all the things you brought up today because I, I really felt like these patients need opiates. And once I started converting to Tylenol and or Motrin, They're fine. And it, it totally surprised me, and patients really do not come back asking for opiates.
Open
Summaries Rod gave as host · Aspiration 10 summaries
Open the Aspiration collection →
Laryngeal Clefts
Host summary
Rod Gerardo summarizing the discussion: Type 1 laryngeal cleft means the opening is above the vocal cords.
Open
Host summary
Rod Gerardo summarizing the discussion: Type 2 laryngeal cleft means it extends below the vocal cords.
Open
Host summary
Rod Gerardo summarizing the discussion: Type 3 laryngeal cleft means it extends down into the trachea.
Open
Host summary
Rod Gerardo summarizing the discussion: The Benjamin Inglis classification should be modified to include a type 4 long because type 4 could be proximal above the carina, at the carina, or go straight through the carina.
Open
Host summary
Rod Gerardo summarizing the discussion: We've been nagging Andy for years, Andy Inglis, to actually modify that classification.
Open
Host summary
Rod Gerardo summarizing the discussion: Flexible bronchoscopy is not adequate for diagnosing a posterior laryngeal cleft.
Open
Host summary
Rod Gerardo summarizing the discussion: The mass closure technique developed in Cincinnati uses the same concept as endoscopic tracheoesophageal fistula repair: you want raw against raw, with wide strips of raw tissue opposed after removing the non-stick mucosal surface.
Open
Host summary
Rod Gerardo summarizing the discussion: Endoscopically or endoscopically unless there's a reason to do an open approach.
Open
Host summary
Rod Gerardo summarizing the discussion: You want raw against raw. Mucosa is a nonstick surface. Get rid of the mucosa. You want a wide strip of raw against a wide strip of raw.
Open
Host summary
Rod Gerardo summarizing the discussion: Flexible bronchoscopy is not adequate for diagnosing a posterior laryngeal cleft.
Open
Summaries Rod gave as host · Colorectal / ARM & Hirschsprung 73 summaries
Open the Colorectal / ARM & Hirschsprung collection →
The Colorectal Quiz Episode 1: ARM - Low Bulbar Fistula
Host summary
Rod Gerardo summarizing the discussion: These patients can come with anatomic variances, really rare anomalies, their care can be complex, dynamic, multidisciplinary, and pose a lot of clinical challenges to your everyday pediatric surgeon.
Open
Host summary
Rod Gerardo summarizing the discussion: At those times, it might be nice to just step inside the mind of a pediatric colorectal surgeon who's been around the block.
Open
Host summary
Rod Gerardo summarizing the discussion: In low anorectal malformations, dissecting a small portion of the anterior rectal wall and carefully lifting it off the urinary tract will usually rule out a fistula.
Open
The Colorectal Quiz Episode 3.5: Proximal Hirschsprung Disease
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Rod Gerardo summarizing the discussion: If a child is sick with bilious emesis and distension, resuscitation should be the first step before diagnostic workup.
Open
The Colorectal Quiz Episode 4: Classic Hirschsprung disease - Surgical Technique
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Rod Gerardo summarizing the discussion: The reinforcement layer of sutures is critical for lining up the two pieces of bowel to achieve mucosa-to-mucosa edge approximation.
Open
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Rod Gerardo summarizing the discussion: The reinforcement layer of sutures is critical for lining up the two pieces of bowel to achieve mucosa-to-mucosa edge approximation.
Open
The Colorectal Quiz Episode 5: Proximal Hirschsprung Disease Surgical Technique
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Rod Gerardo summarizing the discussion: Frozen sections can rule out Hirschsprung disease but cannot definitively rule it in.
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Rod Gerardo summarizing the discussion: Frozen sections can rule out Hirschsprung disease but cannot definitively rule it in.
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Rod Gerardo summarizing the discussion: For proximal disease, the key question on biopsy is whether ganglion cells are present, not whether nerves are hypertrophic.
Open
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Rod Gerardo summarizing the discussion: For proximal disease, the key question on biopsy is whether ganglion cells are present, not whether nerves are hypertrophic.
Open
Update Course Rewind: 2020 Colorectal Part 1
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Rod Gerardo summarizing the discussion: Hirschsprung enterocolitis patients present across a spectrum from mild (slight white count elevation and concerning X-ray distention) to severe (gross distention with obvious shock), requiring different treatment approaches.
Open
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Rod Gerardo summarizing the discussion: Hirschsprung enterocolitis patients present across a spectrum from mild (slight white count elevation and concerning X-ray distention) to severe (gross distention with obvious shock), requiring different treatment approaches.
Open
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Rod Gerardo summarizing the discussion: The APSA algorithm for post-pull-through obstruction includes decision points starting with rectal exam and contrast enema, potentially moving to rectal biopsy, botulinum toxin injection, and ultimately motility workup that determines need for further colonic resection versus bowel management, stoma, or ACE.
Open
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Rod Gerardo summarizing the discussion: The APSA algorithm for post-pull-through obstruction includes decision points starting with rectal exam and contrast enema, potentially moving to rectal biopsy, botulinum toxin injection, and ultimately motility workup that determines need for further colonic resection versus bowel management, stoma, or ACE.
Open
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Rod Gerardo summarizing the discussion: The patient in Case 2 was diagnosed with pseudo-incontinence with hypermotility.
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Rod Gerardo summarizing the discussion: The patient in Case 2 was diagnosed with pseudo-incontinence with hypermotility.
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Rod Gerardo summarizing the discussion: Adjusting fiber intake, daily Imodium, and adding cholestyramine successfully managed the hypermotility patient, allowing return to school with other kids within about a year.
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Rod Gerardo summarizing the discussion: Adjusting fiber intake, daily Imodium, and adding cholestyramine successfully managed the hypermotility patient, allowing return to school with other kids within about a year.
Open
The Colorectal Quiz Episode 10: Total Colonic Hirschsprung Disease Part 1
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Rod Gerardo summarizing the discussion: Hey there listeners, it's Rod Gerardo and Amanda Jensen from Cincinnati Children's.
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Rod Gerardo summarizes what Dr. Jason Frischer said: That's Doctor Jason Fisher, pediatric colorectal surgeon at Cincinnati Children's Hospital.
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Rod Gerardo summarizing the discussion: Common causes of failure to pass meconium include Hirschsprung disease, meconium plug syndrome, meconium ileus, and anorectal malformation
Open
The Colorectal Quiz Episode 11: Total Colonic Hirschsprung's Part 2
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Rod Gerardo summarizing the discussion: Studies showed no significant difference in skin excoriation between younger and older patients after pull-through.
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Rod Gerardo summarizing the discussion: Oral sodium supplementation protocol: add 3 mEq/kg/day using a recipe of 1 tablespoon salt plus 40 mL water (yields 2.5 mEq sodium per mL), continue for 1-2 months, then recheck urine sodium.
Open
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Rod Gerardo summarizing the discussion: Serum sodium is usually normal even when total body sodium is depleted, which can be misleading.
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Rod Gerardo summarizing the discussion: Patients with total colonic Hirschsprung disease are more susceptible to severe enterocolitis compared to traditional rectosigmoid Hirschsprung patients.
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Rod Gerardo summarizing the discussion: First-line medical management is diet modification, which can be started before pull-through to monitor bowel movements.
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Rod Gerardo summarizing the discussion: Loperamide liquid form contains glucose and sugar which can cause hypermotility; crushing the pill and mixing with applesauce is an alternative.
Open
Colorectal Quiz Episode 13: Newborn ARM Part 2
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Rod Gerardo summarizing the discussion: Don't use your fingers because every surgeon has a different size glove.
Open
Host summary
Rod Gerardo summarizing the discussion: Don't use your fingers because every surgeon has a different size glove.
Open
Host summary
Rod Gerardo summarizing the discussion: Use Hagar dilators starting low and working up for accurate anal size measurement; do not use fingers because every surgeon has different size glove
Open
Host summary
Rod Gerardo summarizing the discussion: Use Hagar dilators starting low and working up for accurate anal size measurement; do not use fingers because every surgeon has different size glove
Open
Colorectal Quiz Episode 14: ARM Newborn Part 3
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Rod Gerardo summarizing the discussion: Posterior rectal wall only mobilization technique is only appropriate in situations where the dot of the fistula is in the sphincteric ellipse.
Open
Colorectal Collaboration: Neurogastroenterology/Motility Disorders
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Rod Gerardo summarizing the discussion: Sennosides or bisacodyl can be used to induce high-amplitude propagated contractions (HAPCs).
Open
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Rod Gerardo summarizing the discussion: When an HAPC occurs, the internal anal sphincter should relax (coloanal reflex) to allow stool evacuation.
Open
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Rod Gerardo summarizing the discussion: Fluoroscopy (C-arm) is used during manometry catheter placement to confirm exact positioning.
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Rod Gerardo summarizing the discussion: When an HAPC reaches the sigmoid or rectum, the internal anal sphincter relaxes to allow defecation.
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Rod Gerardo summarizing the discussion: Decisions about surgical intervention for segmental dysmotility are based not only on manometry but also on imaging (contrast enema), physical exam, and patient/family history.
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Rod Gerardo summarizing the discussion: Performing duodenal and colonic manometry in a patient with gastroparesis is valuable because it rules out more widespread dysmotility, which is especially important in patients with anorectal malformations.
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Hirschsprung Disease Workup
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Rod Gerardo summarizing the discussion: Even with suggestive manometry findings, a biopsy is still required before surgical intervention; no surgeon would operate on manometry alone.
Open
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Rod Gerardo summarizing the discussion: Even with suggestive manometry findings, a biopsy is still required before surgical intervention; no surgeon would operate on manometry alone.
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Rod Gerardo summarizing the discussion: nobody I know would operate on a manometry alone. So if there's a suggestive manometry, a biopsy will still be done.
Open
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Rod Gerardo summarizing the discussion: nobody I know would operate on a manometry alone. So if there's a suggestive manometry, a biopsy will still be done.
Open
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Rod Gerardo summarizing the discussion: Normal individuals without Hirschsprung disease have no ganglion cells in the very first (distal-most) part of the rectum.
Open
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Rod Gerardo summarizing the discussion: Normal individuals without Hirschsprung disease have no ganglion cells in the very first (distal-most) part of the rectum.
Open
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Rod Gerardo summarizing the discussion: In children over one year old, the suction biopsy tool cannot obtain adequate tissue depth because the tissue is thicker, necessitating surgical biopsy in the OR.
Open
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Rod Gerardo summarizing the discussion: In children over one year old, the suction biopsy tool cannot obtain adequate tissue depth because the tissue is thicker, necessitating surgical biopsy in the OR.
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Rod Gerardo summarizing the discussion: Surgical rectal biopsy in older children is a simple 20-minute procedure with same-day discharge.
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Rod Gerardo summarizing the discussion: Surgical rectal biopsy in older children is a simple 20-minute procedure with same-day discharge.
Open
Journal of Pediatric Surgery Article Review: October 2021
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Rod Gerardo summarizing the discussion: We might congratulate ourselves for having done a good job in perhaps saving the kid and identifying the problem, but perhaps not aware that we have a responsibility uh for the long-term health and uh we have to be advocates for the children.
Open
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Rod Gerardo summarizing the discussion: Complete metadata for medical education content includes title, description, summary, keywords, duration, content type, specialty area, target audience level, and language.
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Rod Gerardo summarizing the discussion: We currently do not have objective clinical markers, whether clinical features or novel biomarkers, to help make earlier surgical decisions in NEC.
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Rod Gerardo summarizing the discussion: It is obvious that we currently do not have the objective clinical markers, whether they are the uh clinical features or uh novel biomarkers to help us make an earlier decision.
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Rod Gerardo summarizing the discussion: The Italian study provides sufficient evidence to convince clinicians who are not doing routine spinal cord and spine assessment in anorectal malformation patients that they should be more serious with imaging.
Open
Intestinal rehabilitation: What is intestinal rehab? - Episode 1
Host summary
Rod Gerardo summarizing the discussion: New guidelines define intestinal failure as requiring parenteral support for at least 60 days due to inadequate intestinal function.
Open
Host summary
Rod Gerardo summarizing the discussion: Intestinal rehabilitation requires managing comorbidities including sepsis and liver disease that challenge infant growth.
Open
Host summary
Rod Gerardo summarizing the discussion: Access and availability to intestinal rehabilitation programs is still very rare.
Open
Host summary
Rod Gerardo summarizing the discussion: Overall long-term survival in major intestinal rehabilitation programs is usually over 90%.
Open
Intestinal Rehabilitation, Episode 1: What is intestinal rehabilitation?
Host summary
Rod Gerardo summarizing the discussion: New guidelines define intestinal failure as inadequate intestinal function requiring parenteral support for at least 60 days.
Open
Host summary
Rod Gerardo summarizing the discussion: Intestinal rehabilitation requires managing comorbidities including sepsis and liver disease that challenge infant growth.
Open
Host summary
Rod Gerardo summarizing the discussion: Overall survival in big intestinal rehabilitation programs is usually over 90% long-term.
Open
Quick Literature Updates Episode 7
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Rod Gerardo summarizing a resource: Patients with less than 50% of their colon had significantly less time on parenteral nutrition as long as they had their ileocecal valve.
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Rod Gerardo summarizing a resource: Peters et al. retrospectively reviewed 55 pediatric patients with small bowel syndrome to examine whether presence or absence of ileocecal valve and/or colon can predict enteral autonomy.
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Rod Gerardo summarizing a resource: Infants with an ileocecal valve had significantly shorter duration on parenteral nutrition.
Open
Colorectal Quiz Episode 32: Anorectal Malformations And Cardiac Anomalies
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Rod Gerardo summarizing the discussion: whether you are watching us on YouTube, listening to us on Apple Podcasts, Spotify, Stitcher, or Amazon Music, really the best way to get the colorectal quiz is on the Stay Current Pediatric Surgery app
Open
Host summary
Rod Gerardo summarizing the discussion: When a baby in Georgia gets diagnosed with prenatal cardiac disease, the Sibley cardiology group gets called early and involved, including reviewing echocardiogram and meeting with high-risk OB.
Open
Host summary
Rod Gerardo summarizing the discussion: For hospitals that take care of many pediatric cardiac patients, an ostomy is probably the standard choice for ARM with really significant cardiac anomaly.
Open
Host summary
Rod Gerardo summarizing the discussion: I always start on the babies at a flow rate of one
Open
Host summary
Rod Gerardo summarizing the discussion: Starting flow rate at 1 liter per minute for laparoscopy in babies is a cautious approach.
Open
Host summary
Rod Gerardo summarizing the discussion: Dr. Tim Jackson's technique involves looking laparoscopically while passing a tube into the distal segment to perform irrigation under direct visualization.
Open
Colorectal Quiz: Episode 2
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Rod Gerardo summarizing the discussion: After anorectoplasty, your first shot might be your only shot to give the patient a good outcome
Open
Summaries Rod gave as host · Congenital Diaphragmatic Hernia 21 summaries
Open the Congenital Diaphragmatic Hernia collection →
Fetoscopic Endoluminal Tracheal Occlusion (FETO)
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Rod Gerardo summarizes what Dr. Fung Lim said: He's the surgical director of the Fetal Care Center at Cincinnati Children's Hospital Medical Center.
Open
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Rod Gerardo summarizes what Dr. Fung Lim said: Ultrasound is usually the screening tool to find congenital diaphragmatic hernia in the fetus.
Open
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Rod Gerardo summarizes what Dr. Fung Lim said: MRI provides higher resolution imaging than ultrasound and yields information about the pulmonary status of the fetus in CDH.
Open
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Rod Gerardo summarizes what Dr. Fung Lim said: Fetuses with severe CDH (liver herniation and bilateral lung hypoplasia) are good candidates for FETO.
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Rod Gerardo summarizes what Dr. Fung Lim said: Because think about it, the fetal lung tissue is constantly creating this fluid. That escapes through the trachea normally, but if we occlude the trachea, then that fluid will continue to build up, the pressure will build up in that trachea, and for some reason, that seems to help the lungs develop.
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Rod Gerardo summarizes what Dr. Fung Lim said: Fetal lung tissue constantly creates fluid that normally escapes through the trachea; occluding the trachea causes fluid and pressure to build up, which helps the lungs develop.
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Rod Gerardo summarizes what Dr. Fung Lim said: The balloon is typically removed at about 34 weeks gestation.
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Journal of Pediatric Surgery Article Review: November 2021
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Rod Gerardo summarizing the discussion: A lung that was infected is going to be a more difficult lung to operate on
Open
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Rod Gerardo summarizing the discussion: A lung that was infected is gonna be a more difficult lung to operate on.
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Rod Gerardo summarizing the discussion: A lung that was infected is going to be a more difficult lung to operate on
Open
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Rod Gerardo summarizing the discussion: A lung that was infected is gonna be a more difficult lung to operate on.
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Rod Gerardo summarizing the discussion: The most common indication for partial splenectomy in the Indianapolis study was hereditary spherocytosis
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Rod Gerardo summarizing the discussion: The most common indication for partial splenectomy in the Indianapolis study was hereditary spherocytosis
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Neonatal Gastric Volvulus with Dr. Jason Frischer
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Rod Gerardo summarizing the discussion: Gastric volvulus is associated with eventration of the diaphragm about 25% of the time.
Open
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Rod Gerardo summarizing the discussion: Gastric volvulus is associated with congenital diaphragmatic hernia about 17% of the time.
Open
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Rod Gerardo summarizing the discussion: Acute gastric volvulus presentations are usually due to anatomic problems like congenital diaphragmatic hernia.
Open
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Rod Gerardo summarizing the discussion: Without ligamentous attachments, the stomach is kept in place only at two points: the GE junction and the pylorus, and rotations occur about these points.
Open
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Rod Gerardo summarizing the discussion: Gastric volvulus typically presents in children in the first year of life with non-bilious emesis, gastric distention, and issues passing an NG tube.
Open
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Rod Gerardo summarizing the discussion: A classic bird's beak appearance may be seen when contrast is swallowed or placed in a tube sitting in the esophagus in gastric volvulus.
Open
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Rod Gerardo summarizing the discussion: Gastropexy should be performed at at least one other location in addition to G-tube placement, fixing the stomach in multiple planes to reduce the chance of re-volvulization.
Open
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Rod Gerardo summarizing the discussion: Fundoplication is not required in pediatric gastric volvulus repair, unlike in some adult cases.
Open
Summaries Rod gave as host · Congenital Lung Lesions (CPAM) 19 summaries
Open the Congenital Lung Lesions (CPAM) collection →
Journal of Pediatric Surgery Article Review: November 2021
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Rod Gerardo summarizing the discussion: A lung that was infected is going to be a more difficult lung to operate on
Open
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Rod Gerardo summarizing the discussion: A lung that was infected is gonna be a more difficult lung to operate on.
Open
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Rod Gerardo summarizing the discussion: The most common indication for partial splenectomy in the Indianapolis study was hereditary spherocytosis
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Case Based Journal Review - CPAM in 2022
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Rod Gerardo summarizing the discussion: A 2017 prospective study in Archives of Disease in Childhood followed 119 prenatally diagnosed congenital cystic lung lesions for a median of 10 years
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Rod Gerardo summarizing the discussion: A 2017 prospective study in Archives of Disease in Childhood followed 119 prenatally diagnosed congenital cystic lung lesions for a median of 10 years
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Rod Gerardo summarizing the discussion: A 2021 Pediatrics study by the Midwest Pediatric Surgery Consortium retrospectively examined histology of 521 lung lesions resected across 11 children's hospitals
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Rod Gerardo summarizing the discussion: A 2021 Pediatrics study by the Midwest Pediatric Surgery Consortium retrospectively examined histology of 521 lung lesions resected across 11 children's hospitals
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Rod Gerardo summarizing the discussion: Of 177 children with postnatal diagnosis of CPAM, 15 (8.7%) were classified as having a malignant tumor
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Rod Gerardo summarizing the discussion: Of 177 children with postnatal diagnosis of CPAM, 15 (8.7%) were classified as having a malignant tumor
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Rod Gerardo summarizing the discussion: A 2021 Journal of Pediatric Surgery study examined whether previous infection matters for thoracoscopic surgery outcomes in congenital lung malformations
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Rod Gerardo summarizing the discussion: A 2021 Journal of Pediatric Surgery study examined whether previous infection matters for thoracoscopic surgery outcomes in congenital lung malformations
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Rod Gerardo summarizing the discussion: Patients without prior pulmonary infection had shorter operative time, fewer postoperative fevers, less need for postoperative antibiotics, but no significant difference in postoperative complications or conversion rates
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Rod Gerardo summarizing the discussion: Patients without prior pulmonary infection had shorter operative time, fewer postoperative fevers, less need for postoperative antibiotics, but no significant difference in postoperative complications or conversion rates
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Rod Gerardo summarizing the discussion: A 2018 Journal of Pediatric Surgery study examined optimal timing for elective resection of asymptomatic CPAM, dividing patients under 1 year into three groups: 1-3 months, 4-6 months, and 6-12 months
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Rod Gerardo summarizing the discussion: A 2018 Journal of Pediatric Surgery study examined optimal timing for elective resection of asymptomatic CPAM, dividing patients under 1 year into three groups: 1-3 months, 4-6 months, and 6-12 months
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Rod Gerardo summarizing the discussion: Operative time increased with each increase in age; at younger ages the tissue planes are easier to dissect
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Rod Gerardo summarizing the discussion: Operative time increased with each increase in age; at younger ages the tissue planes are easier to dissect
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Rod Gerardo summarizing the discussion: The 1-3 month group had the shortest operative time at 115 minutes compared to 163 minutes in the 6-12 month group
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Rod Gerardo summarizing the discussion: The 1-3 month group had the shortest operative time at 115 minutes compared to 163 minutes in the 6-12 month group
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Summaries Rod gave as host · Congenital Pulmonary Airway Malformation 8 summaries
Open the Congenital Pulmonary Airway Malformation collection →
Case Based Journal Review - CPAM in 2022
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Rod Gerardo summarizing the discussion: A 2017 prospective study in Archives of Disease in Childhood followed 119 prenatally diagnosed congenital cystic lung lesions for a median of 10 years
Open
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Rod Gerardo summarizing the discussion: A 2021 Pediatrics study by the Midwest Pediatric Surgery Consortium retrospectively examined histology of 521 lung lesions resected across 11 children's hospitals
Open
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Rod Gerardo summarizing the discussion: Of 177 children with postnatal diagnosis of CPAM, 15 (8.7%) were classified as having a malignant tumor
Open
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Rod Gerardo summarizing the discussion: A 2021 Journal of Pediatric Surgery study examined whether previous infection matters for thoracoscopic surgery outcomes in congenital lung malformations
Open
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Rod Gerardo summarizing the discussion: Patients without prior pulmonary infection had shorter operative time, fewer postoperative fevers, less need for postoperative antibiotics, but no significant difference in postoperative complications or conversion rates
Open
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Rod Gerardo summarizing the discussion: A 2018 Journal of Pediatric Surgery study examined optimal timing for elective resection of asymptomatic CPAM, dividing patients under 1 year into three groups: 1-3 months, 4-6 months, and 6-12 months
Open
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Rod Gerardo summarizing the discussion: Operative time increased with each increase in age; at younger ages the tissue planes are easier to dissect
Open
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Rod Gerardo summarizing the discussion: The 1-3 month group had the shortest operative time at 115 minutes compared to 163 minutes in the 6-12 month group
Open
Summaries Rod gave as host · Crohn's Disease 15 summaries
Open the Crohn's Disease collection →
Journal of Pediatric Surgery Article Review: September 2021
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Rod Gerardo summarizing the discussion: There was no significant difference between early and traditional feeding groups in length of stay, time to full feeds, postoperative complications, 30-day mortality, or 30-day readmissions
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Rod Gerardo summarizing the discussion: In the Chinese trial, the early feeding group started feeds at 2 days compared to 6 days in the traditional feeding group
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Rod Gerardo summarizing the discussion: In the early feeding group, patients did not have a decompressing nasogastric tube, suggesting nasogastric decompression is not needed after neonatal intestinal anastomosis
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Rod Gerardo summarizing the discussion: So the other take that Todd had, uh, that we, I don't think was directly addressed in the article. In the group that got early feeds, they also did not have a decompressing nasogastric tube. So, a summary point there is you don't need nasogastric decompression after an anastomosis. Forget the feeds. Like, that's huge, like to, to say that we don't need NG tubes anymore after an anastomosis is a big deal.
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Rod Gerardo summarizing the discussion: My argument is Why do we need to get a Mchel scan at all? Yeah, so here's how I would use that score. So for me, I would create an algorithm from this and say, OK, if the score is high, I would go straight to laparoscopy because even with a negative Mechel scan, I'm going to be thinking it's likely a Meckel's diverticulum.
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Rod Gerardo summarizing the discussion: Todd Ponsky suggests using the Meckel's score to go straight to laparoscopy in high-score patients, skipping the Meckel scan, because even with a negative scan he would still suspect Meckel's diverticulum
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Rod Gerardo summarizing the discussion: Under the age of 10, workup for Crohn's disease is not needed in children with perianal symptoms; over age 10, workup should be performed
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Rod Gerardo summarizing the discussion: So my conclusion from that is under the age of 10. You do not need to worry about doing a workup for Crohn's disease. And over the age of 10, you should.
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Intestinal rehabilitation: What is intestinal rehab? - Episode 1
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Rod Gerardo summarizing the discussion: New guidelines define intestinal failure as requiring parenteral support for at least 60 days due to inadequate intestinal function.
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Rod Gerardo summarizing the discussion: Intestinal rehabilitation requires managing comorbidities including sepsis and liver disease that challenge infant growth.
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Rod Gerardo summarizing the discussion: Access and availability to intestinal rehabilitation programs is still very rare.
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Rod Gerardo summarizing the discussion: Overall long-term survival in major intestinal rehabilitation programs is usually over 90%.
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Intestinal Rehabilitation, Episode 1: What is intestinal rehabilitation?
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Rod Gerardo summarizing the discussion: New guidelines define intestinal failure as inadequate intestinal function requiring parenteral support for at least 60 days.
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Rod Gerardo summarizing the discussion: Intestinal rehabilitation requires managing comorbidities including sepsis and liver disease that challenge infant growth.
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Rod Gerardo summarizing the discussion: Overall survival in big intestinal rehabilitation programs is usually over 90% long-term.
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Summaries Rod gave as host · Early Assessment and Management of Trauma 12 summaries
Open the Early Assessment and Management of Trauma collection →
ATLS 2021 Pediatric Surgery Update
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Rod Gerardo summarizes what Dr. Rich Falcone said: Trauma and trauma-related injuries are still the number one killer of pediatric patients.
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Rod Gerardo summarizes what Dr. Rich Falcone said: Trauma and trauma-related injuries are the number one killer of pediatric patients.
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Rod Gerardo summarizes what Dr. Rich Falcone said: That's not your definitive airway, that's a buy you time to get to the OR to do a formal tracheostomy.
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Rod Gerardo summarizes what Dr. Rich Falcone said: Cricothyroidotomy is not a definitive airway; it buys time to get to the OR for formal tracheostomy.
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Rod Gerardo summarizes what Dr. Rich Falcone said: Over 75% of pediatric trauma deaths are due to head injuries.
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Rod Gerardo summarizes what Dr. Rich Falcone said: Over 75% of pediatric trauma deaths are due to head injuries.
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Rod Gerardo summarizes what Dr. Rich Falcone said: A multi-institutional algorithm for blunt abdominal trauma uses criteria including abdominal pain, abdominal wall trauma/tenderness/distension, abnormal chest X-ray, AST greater than 200, and abnormal pancreatic enzymes.
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Rod Gerardo summarizes what Dr. Rich Falcone said: Validated algorithms exist to determine when head CT is not needed in pediatric trauma, with different criteria for children younger than 2 versus older than 2.
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Rod Gerardo summarizes what Dr. Rich Falcone said: For children younger than 2, head CT may not be needed if the child is not acting different per parents, has no skull fracture, and meets other criteria.
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Rod Gerardo summarizes what Dr. Rich Falcone said: For children older than 2, additional head CT decision criteria include history of vomiting and signs of basilar skull fracture.
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Rod Gerardo summarizes what Dr. Rich Falcone said: If all blunt abdominal trauma algorithm criteria are negative (approximately 35% of patients), the risk of intraabdominal injury is very low at 0.6%, with 0.0% requiring intervention.
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Rod Gerardo summarizes what Dr. Rich Falcone said: Having one positive criterion on the blunt abdominal trauma algorithm does not mandate CT but increases risk; multiple positive criteria further increase risk.
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Summaries Rod gave as host · Enterocolitis 4 summaries
Open the Enterocolitis collection →
Update Course Rewind: 2020 Colorectal Part 1
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Rod Gerardo summarizing the discussion: Hirschsprung enterocolitis patients present across a spectrum from mild (slight white count elevation and concerning X-ray distention) to severe (gross distention with obvious shock), requiring different treatment approaches.
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Rod Gerardo summarizing the discussion: The APSA algorithm for post-pull-through obstruction includes decision points starting with rectal exam and contrast enema, potentially moving to rectal biopsy, botulinum toxin injection, and ultimately motility workup that determines need for further colonic resection versus bowel management, stoma, or ACE.
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Rod Gerardo summarizing the discussion: The patient in Case 2 was diagnosed with pseudo-incontinence with hypermotility.
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Rod Gerardo summarizing the discussion: Adjusting fiber intake, daily Imodium, and adding cholestyramine successfully managed the hypermotility patient, allowing return to school with other kids within about a year.
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Summaries Rod gave as host · Esophageal Atresia 4 summaries
Open the Esophageal Atresia collection →
Journal of Pediatric Surgery Article Review: December 2021
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Rod Gerardo summarizing the discussion: ERAS protocols are relevant during COVID-19 pandemic for mobilizing hospital beds and reducing hospital stays.
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Journal of Pediatric Surgery Article Review: February 2022 BAPS Issue
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Rod Gerardo summarizing the discussion: Renal organoids could potentially be used as replacement therapy in pediatric renal transplant instead of formal kidney transplant.
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Journal of Pediatric Surgery Article Review: February 2022 - BAPS Issue
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Rod Gerardo summarizing the discussion: KidsOR has opened 50 operating rooms in 22 different countries.
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Rod Gerardo summarizing the discussion: KidsOR supports pediatric surgery residency programs run by CSECSA (College of East, Central and Southern Africa) and WACS (West African College of Surgeons), working closely with partners like Smile Train.
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Summaries Rod gave as host · Etiologies (Gastroschisis/NEC/Atresia/Volvulus) 41 summaries
Open the Etiologies (Gastroschisis/NEC/Atresia/Volvulus) collection →
Gastroschisis and sutureless abdominal wall closure
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Rod Gerardo summarizes what Dr. Jason Fraser said: In 2004, Tony Sandler published the first manuscript about sutureless closures utilizing the natural umbilical properties to close the gastroschisis defect by itself.
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Rod Gerardo summarizes what Dr. Jason Fraser said: In 2004, Tony Sandler published the first manuscript about suture disclosures to utilize the natural umbilical properties to closing that defect by itself.
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Rod Gerardo summarizes what Dr. Jason Fraser said: I didn't know about his article. I found out about it as a fellow when he taught us how to treat gastroschisis that way.
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Rod Gerardo summarizes what Dr. Jason Fraser said: I think it's clearly been a massive change in practice. It's one of the examples of a big change that we don't actually operate on those and they can be done at the bedside. And it also is an example of something that took a while to adopt. And now most people are doing it, I think.
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Rod Gerardo summarizes what Dr. Jason Fraser said: There have been so many articles in the last few years that go back and forth. I mean, one said gastro suture list is better. One said definitely don't do suture list. So my question is now, I don't know. I almost don't read these articles anymore.
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Rod Gerardo summarizes what Dr. Jason Fraser said: I think anytime it's a Kansas City or an NWSPC, NWPSC. Anytime it's an NWPSC article, I pay attention. Anytime it's a Kansas City article, I pay attention. But other than that, I'm tired of seeing all these gastroschisis articles. I'm waiting for someone to give me something that is really meaningful.
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Rod Gerardo summarizes what Dr. Jason Fraser said: The positive outcomes for sutureless repair were observed even when considering patients who required silo use.
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Rod Gerardo summarizes what Dr. Jason Fraser said: Sutureless closure patients had less antibiotic use compared to sutured closure patients.
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Rod Gerardo summarizes what Dr. Jason Fraser said: Sutureless closure patients had fewer surgical site and deep space infections compared to sutured closure patients.
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Rod Gerardo summarizes what Dr. Jason Fraser said: The Midwest Pediatric Surgery Consortium study was a retrospective cohort of infants born with gastroschisis between 2013 and 2016, with a total of 315 patients.
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Rod Gerardo summarizes what Dr. Jason Fraser said: Sutureless closure patients had fewer episodes of general anesthetics compared to sutured closure patients.
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Rod Gerardo summarizes what Dr. Jason Fraser said: Sutureless closure patients had less ventilator use compared to sutured closure patients.
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Rod Gerardo summarizes what Dr. Jason Fraser said: The study divided patients into sutured versus sutureless abdominal wall closures and required subgroup analysis because some babies received silos and some did not.
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Rod Gerardo summarizes what Dr. Jason Fraser said: Patients who underwent sutureless abdominal wall closure had no difference in days on TPN, time to goal feeds, time to initial feeds, or length of stay compared to sutured closure.
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Rod Gerardo summarizes what Dr. Jason Fraser said: Yeah, I think in general, I, I, you're right. I don't know how the pendulum is going to swing, but we are finding more and more. There are things that we don't have to operate on.
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Rod Gerardo summarizes what Dr. Jason Fraser said: Gastroschisis is an abdominal wall defect that used to necessitate a trip to the OR and is now more like a safe bedside procedure.
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Journal of Pediatric Surgery Article Review: October 2021
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Rod Gerardo summarizing the discussion: We might congratulate ourselves for having done a good job in perhaps saving the kid and identifying the problem, but perhaps not aware that we have a responsibility uh for the long-term health and uh we have to be advocates for the children.
Open
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Rod Gerardo summarizing the discussion: Complete metadata for medical education content includes title, description, summary, keywords, duration, content type, specialty area, target audience level, and language.
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Rod Gerardo summarizing the discussion: It is obvious that we currently do not have the objective clinical markers, whether they are the uh clinical features or uh novel biomarkers to help us make an earlier decision.
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Rod Gerardo summarizing the discussion: We currently do not have objective clinical markers, whether clinical features or novel biomarkers, to help make earlier surgical decisions in NEC.
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Rod Gerardo summarizing the discussion: The Italian study provides sufficient evidence to convince clinicians who are not doing routine spinal cord and spine assessment in anorectal malformation patients that they should be more serious with imaging.
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Intestinal rehabilitation: What is intestinal rehab? - Episode 1
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Rod Gerardo summarizing the discussion: New guidelines define intestinal failure as requiring parenteral support for at least 60 days due to inadequate intestinal function.
Open
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Rod Gerardo summarizing the discussion: Intestinal rehabilitation requires managing comorbidities including sepsis and liver disease that challenge infant growth.
Open
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Rod Gerardo summarizing the discussion: Access and availability to intestinal rehabilitation programs is still very rare.
Open
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Rod Gerardo summarizing the discussion: Overall long-term survival in major intestinal rehabilitation programs is usually over 90%.
Open
Intestinal Rehabilitation, Episode 1: What is intestinal rehabilitation?
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Rod Gerardo summarizing the discussion: New guidelines define intestinal failure as inadequate intestinal function requiring parenteral support for at least 60 days.
Open
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Rod Gerardo summarizing the discussion: Intestinal rehabilitation requires managing comorbidities including sepsis and liver disease that challenge infant growth.
Open
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Rod Gerardo summarizing the discussion: Overall survival in big intestinal rehabilitation programs is usually over 90% long-term.
Open
Journal of Pediatric Surgery Article Review: January 2022 APSA Issue
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Rod Gerardo summarizing the discussion: External federal research funding at Nationwide increased from $750,000 to $5.7 million, representing a 7.7-fold increase.
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Stay Current Throwbacks Necrotizing Enterocolitis with Dr. Gail Besner
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Rod Gerardo summarizes what Dr. Gail Besner said: The NEST trial results published in fall 2021 showed no overall difference in death or neurodevelopmental impairment between laparotomy and drainage groups.
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Rod Gerardo summarizes what Dr. Gail Besner said: In the NEST trial, neonates with a preoperative diagnosis of necrotizing enterocolitis (versus isolated intestinal perforation) had approximately 20% decrease in death rate with laparotomy compared to drainage.
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Neonatal Gastric Volvulus with Dr. Jason Frischer
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Rod Gerardo summarizing the discussion: Gastric volvulus is associated with congenital diaphragmatic hernia about 17% of the time.
Open
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Rod Gerardo summarizing the discussion: Gastric volvulus is associated with eventration of the diaphragm about 25% of the time.
Open
Host summary
Rod Gerardo summarizing the discussion: Acute gastric volvulus presentations are usually due to anatomic problems like congenital diaphragmatic hernia.
Open
Host summary
Rod Gerardo summarizing the discussion: Without ligamentous attachments, the stomach is kept in place only at two points: the GE junction and the pylorus, and rotations occur about these points.
Open
Host summary
Rod Gerardo summarizing the discussion: Gastric volvulus typically presents in children in the first year of life with non-bilious emesis, gastric distention, and issues passing an NG tube.
Open
Host summary
Rod Gerardo summarizing the discussion: A classic bird's beak appearance may be seen when contrast is swallowed or placed in a tube sitting in the esophagus in gastric volvulus.
Open
Host summary
Rod Gerardo summarizing the discussion: Gastropexy should be performed at at least one other location in addition to G-tube placement, fixing the stomach in multiple planes to reduce the chance of re-volvulization.
Open
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Rod Gerardo summarizing the discussion: Fundoplication is not required in pediatric gastric volvulus repair, unlike in some adult cases.
Open
Quick Literature Updates Episode 6
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Rod Gerardo summarizing a resource: There was no significant difference in the rate of successful primary closure between intubated and non-intubated neonates with gastroschisis.
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Rod Gerardo summarizing a resource: Miyata et al. used the Canadian Association of Pediatric Surgery Network to study pediatric patients with gastroschisis who underwent bedside reduction and closure.
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Summaries Rod gave as host · Extracorporeal Membrane Oxygenation 3 summaries
Open the Extracorporeal Membrane Oxygenation collection →
Update Course Rewind: ECMO 2018
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Rod Gerardo summarizes what Dr. Ron Herschel said: The Avalon double-lumen catheter is the preferred VV ECMO access across the country and world
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Rod Gerardo summarizes what Dr. Ron Herschel said: When using femoral artery cannulation for VA ECMO, prophylactic posterior tibial artery cannulation should be performed without waiting for ischemia to develop
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Rod Gerardo summarizes what Dr. Ron Herschel said: For double-lumen VV ECMO catheter placement, it is acceptable to use the operating room, and fluoroscopy and echo should be used when possible
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Summaries Rod gave as host · Fetal Surgery 45 summaries
Open the Fetal Surgery collection →
Fetoscopic Endoluminal Tracheal Occlusion (FETO)
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Rod Gerardo summarizes what Dr. Fung Lim said: He's the surgical director of the Fetal Care Center at Cincinnati Children's Hospital Medical Center.
Open
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Rod Gerardo summarizes what Dr. Fung Lim said: Ultrasound is usually the screening tool to find congenital diaphragmatic hernia in the fetus.
Open
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Rod Gerardo summarizes what Dr. Fung Lim said: MRI provides higher resolution imaging than ultrasound and yields information about the pulmonary status of the fetus in CDH.
Open
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Rod Gerardo summarizes what Dr. Fung Lim said: Fetuses with severe CDH (liver herniation and bilateral lung hypoplasia) are good candidates for FETO.
Open
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Rod Gerardo summarizes what Dr. Fung Lim said: Fetal lung tissue constantly creates fluid that normally escapes through the trachea; occluding the trachea causes fluid and pressure to build up, which helps the lungs develop.
Open
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Rod Gerardo summarizes what Dr. Fung Lim said: Because think about it, the fetal lung tissue is constantly creating this fluid. That escapes through the trachea normally, but if we occlude the trachea, then that fluid will continue to build up, the pressure will build up in that trachea, and for some reason, that seems to help the lungs develop.
Open
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Rod Gerardo summarizes what Dr. Fung Lim said: The balloon is typically removed at about 34 weeks gestation.
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Fetoscopic Repair of Myelomeningocele (MMC)
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Rod Gerardo summarizes what Dr. Fung Lim said: Neural tube defects are the most common congenital central nervous system anomaly.
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Rod Gerardo summarizes what Dr. Fung Lim said: Neural tube defects are the most common congenital central nervous system anomaly.
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Rod Gerardo summarizes what Dr. Fung Lim said: He's the director of the Fetal Care Center at Cincinnati Children's Hospital Medical Center.
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Rod Gerardo summarizes what Dr. Fung Lim said: He's the director of the Fetal Care Center at Cincinnati Children's Hospital Medical Center.
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Rod Gerardo summarizes what Dr. Fung Lim said: Myelomeningocele or spina bifida is the most common neural tube defect.
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Rod Gerardo summarizes what Dr. Fung Lim said: Myelomeningocele or spina bifida is the most common neural tube defect.
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Rod Gerardo summarizes what Dr. Fung Lim said: In myelomeningocele, the patient is born with a cleft in the vertebral column and a defect in the skin, so the meninges and the spinal cord are exposed.
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Rod Gerardo summarizes what Dr. Fung Lim said: In myelomeningocele, the patient is born with a cleft in the vertebral column and a defect in the skin, so the meninges and the spinal cord are exposed.
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Rod Gerardo summarizes what Dr. Fung Lim said: The patient may be left with neural defects based on the level of the spinal cord where the lesion is.
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Rod Gerardo summarizes what Dr. Fung Lim said: The patient may be left with neural defects based on the level of the spinal cord where the lesion is.
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Rod Gerardo summarizes what Dr. Fung Lim said: Under ultrasound guidance, the first port is placed.
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Rod Gerardo summarizes what Dr. Fung Lim said: Under ultrasound guidance, the first port is placed.
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Rod Gerardo summarizes what Dr. Fung Lim said: Anesthesia is induced on the baby via an intragluteal injection.
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Rod Gerardo summarizes what Dr. Fung Lim said: Anesthesia is induced on the baby via an intragluteal injection.
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Rod Gerardo summarizes what Dr. Fung Lim said: The first step is to open the sac, then dissect around the sac circumferentially.
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Rod Gerardo summarizes what Dr. Fung Lim said: The first step is to open the sac, then dissect around the sac circumferentially.
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Rod Gerardo summarizes what Dr. Fung Lim said: The placode is the open area of exposed neural tissue.
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Rod Gerardo summarizes what Dr. Fung Lim said: The placode is the open area of exposed neural tissue.
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Rod Gerardo summarizes what Dr. Fung Lim said: A skin flap is created to loosen up the skin, which will help form a watertight closure of the spinal defect.
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Rod Gerardo summarizes what Dr. Fung Lim said: A skin flap is created to loosen up the skin, which will help form a watertight closure of the spinal defect.
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Rod Gerardo summarizes what Dr. Fung Lim said: The mother and the fetus are monitored postoperatively, and if able, the baby is delivered vaginally at term.
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Rod Gerardo summarizes what Dr. Fung Lim said: The mother and the fetus are monitored postoperatively, and if able, the baby is delivered vaginally at term.
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Treatment for Long Gap Esophageal Atresia: Esophageal Elongation and Replacement
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Rod Gerardo summarizes what Dr. Daniel von Allmen said: In the Foker technique, the surgeon ties sutures to either end of the esophagus through an open incision, brings them out through the chest wall, ties them together in a knot, and places spacers underneath periodically (about every day) until the ends come together for primary anastomosis.
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Rod Gerardo summarizes what Dr. Daniel von Allmen said: In the Foker technique, the surgeon ties sutures to either end of the esophagus through an open incision, brings them out through the chest wall, ties them together in a knot, and places spacers underneath periodically (about every day) until the ends come together for primary anastomosis.
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Rod Gerardo summarizes what Dr. Daniel von Allmen said: The van der Zee technique uses the same concept as Foker but is done thoracoscopically with no external sutures, so all tension is inside the thorax.
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Rod Gerardo summarizes what Dr. Daniel von Allmen said: The van der Zee technique uses the same concept as Foker but is done thoracoscopically with no external sutures, so all tension is inside the thorax.
Open
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Rod Gerardo summarizes what Dr. Daniel von Allmen said: The Kimura technique involves creating a spit fistula and periodically moving it down the chest wall over time to stretch the proximal pouch closer to the distal pouch, but is not used all that often anymore.
Open
Host summary
Rod Gerardo summarizes what Dr. Daniel von Allmen said: The Kimura technique involves creating a spit fistula and periodically moving it down the chest wall over time to stretch the proximal pouch closer to the distal pouch, but is not used all that often anymore.
Open
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Rod Gerardo summarizes what Dr. Daniel von Allmen said: We were all taught the dictum that every effort should be made to conserve the native esophagus as no other conduit can replace its function in transporting food from the oral cavity to the stomach satisfactorily.
Open
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Rod Gerardo summarizes what Dr. Daniel von Allmen said: We were all taught the dictum that every effort should be made to conserve the native esophagus as no other conduit can replace its function in transporting food from the oral cavity to the stomach satisfactorily.
Open
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Rod Gerardo summarizes what Dr. Daniel von Allmen said: In colonic interposition, the piece of colon chosen is based on the blood supply and the diameter needed.
Open
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Rod Gerardo summarizes what Dr. Daniel von Allmen said: In colonic interposition, a pyloroplasty is performed to help with gastric emptying.
Open
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Rod Gerardo summarizes what Dr. Daniel von Allmen said: In colonic interposition, a pyloroplasty is performed to help with gastric emptying.
Open
Host summary
Rod Gerardo summarizes what Dr. Daniel von Allmen said: In colonic interposition, the piece of colon chosen is based on the blood supply and the diameter needed.
Open
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Rod Gerardo summarizes what Dr. Daniel von Allmen said: The short interval between time of traction and anastomosis (less than five days) raises the question of whether the mechanism is stretching or growth, which will impact results and likely reflects on complications.
Open
Host summary
Rod Gerardo summarizes what Dr. Daniel von Allmen said: The short interval between time of traction and anastomosis (less than five days) raises the question of whether the mechanism is stretching or growth, which will impact results and likely reflects on complications.
Open
Journal of Pediatric Surgery Article Review: January 2022 APSA Issue
Host summary
Rod Gerardo summarizing the discussion: External federal research funding at Nationwide increased from $750,000 to $5.7 million, representing a 7.7-fold increase.
Open
Journal of Pediatric Surgery Article Highlights: April 2022
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Rod Gerardo summarizing the discussion: The third article is titled 'Current Status of Sub-specialization in Pediatric Surgery, a Focus on fetal Surgery' and surveys practice patterns in fetal surgery across the country.
Open
Summaries Rod gave as host · Gastroschisis 21 summaries
Open the Gastroschisis collection →
Gastroschisis and sutureless abdominal wall closure
Host summary
Rod Gerardo summarizes what Dr. Jason Fraser said: In 2004, Tony Sandler published the first manuscript about suture disclosures to utilize the natural umbilical properties to closing that defect by itself.
Open
Host summary
Rod Gerardo summarizes what Dr. Jason Fraser said: In 2004, Tony Sandler published the first manuscript about sutureless closures utilizing the natural umbilical properties to close the gastroschisis defect by itself.
Open
Host summary
Rod Gerardo summarizes what Dr. Jason Fraser said: I didn't know about his article. I found out about it as a fellow when he taught us how to treat gastroschisis that way.
Open
Host summary
Rod Gerardo summarizes what Dr. Jason Fraser said: I think it's clearly been a massive change in practice. It's one of the examples of a big change that we don't actually operate on those and they can be done at the bedside. And it also is an example of something that took a while to adopt. And now most people are doing it, I think.
Open
Host summary
Rod Gerardo summarizes what Dr. Jason Fraser said: There have been so many articles in the last few years that go back and forth. I mean, one said gastro suture list is better. One said definitely don't do suture list. So my question is now, I don't know. I almost don't read these articles anymore.
Open
Host summary
Rod Gerardo summarizes what Dr. Jason Fraser said: I think anytime it's a Kansas City or an NWSPC, NWPSC. Anytime it's an NWPSC article, I pay attention. Anytime it's a Kansas City article, I pay attention. But other than that, I'm tired of seeing all these gastroschisis articles. I'm waiting for someone to give me something that is really meaningful.
Open
Host summary
Rod Gerardo summarizes what Dr. Jason Fraser said: Sutureless closure patients had fewer episodes of general anesthetics compared to sutured closure patients.
Open
Host summary
Rod Gerardo summarizes what Dr. Jason Fraser said: The positive outcomes for sutureless repair were observed even when considering patients who required silo use.
Open
Host summary
Rod Gerardo summarizes what Dr. Jason Fraser said: Sutureless closure patients had less ventilator use compared to sutured closure patients.
Open
Host summary
Rod Gerardo summarizes what Dr. Jason Fraser said: Sutureless closure patients had fewer surgical site and deep space infections compared to sutured closure patients.
Open
Host summary
Rod Gerardo summarizes what Dr. Jason Fraser said: Sutureless closure patients had less antibiotic use compared to sutured closure patients.
Open
Host summary
Rod Gerardo summarizes what Dr. Jason Fraser said: Patients who underwent sutureless abdominal wall closure had no difference in days on TPN, time to goal feeds, time to initial feeds, or length of stay compared to sutured closure.
Open
Host summary
Rod Gerardo summarizes what Dr. Jason Fraser said: The study divided patients into sutured versus sutureless abdominal wall closures and required subgroup analysis because some babies received silos and some did not.
Open
Host summary
Rod Gerardo summarizes what Dr. Jason Fraser said: The Midwest Pediatric Surgery Consortium study was a retrospective cohort of infants born with gastroschisis between 2013 and 2016, with a total of 315 patients.
Open
Host summary
Rod Gerardo summarizes what Dr. Jason Fraser said: Yeah, I think in general, I, I, you're right. I don't know how the pendulum is going to swing, but we are finding more and more. There are things that we don't have to operate on.
Open
Host summary
Rod Gerardo summarizes what Dr. Jason Fraser said: Gastroschisis is an abdominal wall defect that used to necessitate a trip to the OR and is now more like a safe bedside procedure.
Open
Journal of Pediatric Surgery Article Review: January 2022 APSA Issue
Host summary
Rod Gerardo summarizing the discussion: External federal research funding at Nationwide increased from $750,000 to $5.7 million, representing a 7.7-fold increase.
Open
Intestinal Rehabilitation, Episode 3: Enteral Autonomy, Part 1
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Rod Gerardo summarizing the discussion: A full-term baby is born with approximately 160 centimeters of small bowel
Open
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Rod Gerardo summarizing the discussion: Bacterial colonization of the intestines is part of the adaptive response
Open
Quick Literature Updates Episode 6
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Rod Gerardo summarizing a resource: There was no significant difference in the rate of successful primary closure between intubated and non-intubated neonates with gastroschisis.
Open
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Rod Gerardo summarizing a resource: Miyata et al. used the Canadian Association of Pediatric Surgery Network to study pediatric patients with gastroschisis who underwent bedside reduction and closure.
Open
Summaries Rod gave as host · Hemorrhagic Shock 15 summaries
Open the Hemorrhagic Shock collection →
ATLS 2021 Pediatric Surgery Update
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Rod Gerardo summarizes what Dr. Rich Falcone said: Trauma and trauma-related injuries are still the number one killer of pediatric patients.
Open
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Rod Gerardo summarizes what Dr. Rich Falcone said: Trauma and trauma-related injuries are the number one killer of pediatric patients.
Open
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Rod Gerardo summarizes what Dr. Rich Falcone said: Cricothyroidotomy is not a definitive airway; it buys time to get to the OR for formal tracheostomy.
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Rod Gerardo summarizes what Dr. Rich Falcone said: That's not your definitive airway, that's a buy you time to get to the OR to do a formal tracheostomy.
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Rod Gerardo summarizes what Dr. Rich Falcone said: Over 75% of pediatric trauma deaths are due to head injuries.
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Rod Gerardo summarizes what Dr. Rich Falcone said: Over 75% of pediatric trauma deaths are due to head injuries.
Open
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Rod Gerardo summarizes what Dr. Rich Falcone said: For children younger than 2, head CT may not be needed if the child is not acting different per parents, has no skull fracture, and meets other criteria.
Open
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Rod Gerardo summarizes what Dr. Rich Falcone said: Having one positive criterion on the blunt abdominal trauma algorithm does not mandate CT but increases risk; multiple positive criteria further increase risk.
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Rod Gerardo summarizes what Dr. Rich Falcone said: If all blunt abdominal trauma algorithm criteria are negative (approximately 35% of patients), the risk of intraabdominal injury is very low at 0.6%, with 0.0% requiring intervention.
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Rod Gerardo summarizes what Dr. Rich Falcone said: A multi-institutional algorithm for blunt abdominal trauma uses criteria including abdominal pain, abdominal wall trauma/tenderness/distension, abnormal chest X-ray, AST greater than 200, and abnormal pancreatic enzymes.
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Rod Gerardo summarizes what Dr. Rich Falcone said: For children older than 2, additional head CT decision criteria include history of vomiting and signs of basilar skull fracture.
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Rod Gerardo summarizes what Dr. Rich Falcone said: Validated algorithms exist to determine when head CT is not needed in pediatric trauma, with different criteria for children younger than 2 versus older than 2.
Open
ATLS 2021 Pediatric Surgery Update
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Rod Gerardo summarizes what Dr. Rich Falcone said: Trauma and trauma-related injuries are the number one killer of pediatric patients.
Open
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Rod Gerardo summarizes what Dr. Rich Falcone said: There are validated clinical decision rules for determining when head CT is not necessary in pediatric trauma, with different criteria for children under 2 versus over 2 years old.
Open
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Rod Gerardo summarizes what Dr. Rich Falcone said: In the low-risk abdominal trauma group identified by the algorithm, 0.0% required intervention for intraabdominal injury.
Open
Summaries Rod gave as host · Hepatoblastoma 7 summaries
Open the Hepatoblastoma collection →
Image Guided Surgery Video Series, Episode 2 - Lung Nodule Localization &...
Host summary
Rod Gerardo summarizing the discussion: More recently, localization has been done with microembolization coils in combination with Copan's wire as backup in case the wire becomes inadvertently pulled out during thoracoscopic resection.
Open
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Rod Gerardo summarizing the discussion: Cone beam CT performs a 360 degree scan of a designated 3D volume, giving cross-sectional images that account for the z-axis and provide 3D spatial information.
Open
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Rod Gerardo summarizing the discussion: To ensure reproducible respiratory effort, patients are fully paralyzed and tubes disconnected from ventilator so the patient exhales naturally to a natural stopping point, which is more reproducible than using CPAP.
Open
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Rod Gerardo summarizing the discussion: To ensure the same respiratory effort, we ask our anesthesia colleagues to fully paralyze the patient and then disconnect the tubes from the ventilator. This way the patient can just exhale naturally and and stop at a very natural stopping point.
Open
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Rod Gerardo summarizing the discussion: Using no positive pressure (natural exhalation) is thought to reduce the chance of pneumothorax.
Open
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Rod Gerardo summarizing the discussion: If multiple lesions are in the same lobe, thoracic surgeons can resect them all together; if in different lobes with concern for different etiology, typically the biggest lesion is targeted.
Open
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Rod Gerardo summarizing the discussion: The display monitor shows live X-ray with graphics superimposed and the pre-op CT for comparison during needle advancement.
Open
Summaries Rod gave as host · Hirschsprung disease 34 summaries
Open the Hirschsprung disease collection →
The Colorectal Quiz Episode 3.5: Proximal Hirschsprung Disease
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Rod Gerardo summarizing the discussion: If a child is sick with bilious emesis and distension, resuscitation should be the first step before diagnostic workup.
Open
The Colorectal Quiz Episode 4: Classic Hirschsprung disease - Surgical Technique
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Rod Gerardo summarizing the discussion: The reinforcement layer of sutures is critical for lining up the two pieces of bowel to achieve mucosa-to-mucosa edge approximation.
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Rod Gerardo summarizing the discussion: The reinforcement layer of sutures is critical for lining up the two pieces of bowel to achieve mucosa-to-mucosa edge approximation.
Open
The Colorectal Quiz Episode 5: Proximal Hirschsprung Disease Surgical Technique
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Rod Gerardo summarizing the discussion: Frozen sections can rule out Hirschsprung disease but cannot definitively rule it in.
Open
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Rod Gerardo summarizing the discussion: Frozen sections can rule out Hirschsprung disease but cannot definitively rule it in.
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Rod Gerardo summarizing the discussion: For proximal disease, the key question on biopsy is whether ganglion cells are present, not whether nerves are hypertrophic.
Open
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Rod Gerardo summarizing the discussion: For proximal disease, the key question on biopsy is whether ganglion cells are present, not whether nerves are hypertrophic.
Open
Update Course Rewind: 2020 Colorectal Part 1
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Rod Gerardo summarizing the discussion: Hirschsprung enterocolitis patients present across a spectrum from mild (slight white count elevation and concerning X-ray distention) to severe (gross distention with obvious shock), requiring different treatment approaches.
Open
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Rod Gerardo summarizing the discussion: Hirschsprung enterocolitis patients present across a spectrum from mild (slight white count elevation and concerning X-ray distention) to severe (gross distention with obvious shock), requiring different treatment approaches.
Open
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Rod Gerardo summarizing the discussion: The APSA algorithm for post-pull-through obstruction includes decision points starting with rectal exam and contrast enema, potentially moving to rectal biopsy, botulinum toxin injection, and ultimately motility workup that determines need for further colonic resection versus bowel management, stoma, or ACE.
Open
Host summary
Rod Gerardo summarizing the discussion: The APSA algorithm for post-pull-through obstruction includes decision points starting with rectal exam and contrast enema, potentially moving to rectal biopsy, botulinum toxin injection, and ultimately motility workup that determines need for further colonic resection versus bowel management, stoma, or ACE.
Open
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Rod Gerardo summarizing the discussion: The patient in Case 2 was diagnosed with pseudo-incontinence with hypermotility.
Open
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Rod Gerardo summarizing the discussion: The patient in Case 2 was diagnosed with pseudo-incontinence with hypermotility.
Open
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Rod Gerardo summarizing the discussion: Adjusting fiber intake, daily Imodium, and adding cholestyramine successfully managed the hypermotility patient, allowing return to school with other kids within about a year.
Open
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Rod Gerardo summarizing the discussion: Adjusting fiber intake, daily Imodium, and adding cholestyramine successfully managed the hypermotility patient, allowing return to school with other kids within about a year.
Open
The Colorectal Quiz Episode 10: Total Colonic Hirschsprung Disease Part 1
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Rod Gerardo summarizing the discussion: Hey there listeners, it's Rod Gerardo and Amanda Jensen from Cincinnati Children's.
Open
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Rod Gerardo summarizes what Dr. Jason Frischer said: That's Doctor Jason Fisher, pediatric colorectal surgeon at Cincinnati Children's Hospital.
Open
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Rod Gerardo summarizing the discussion: Common causes of failure to pass meconium include Hirschsprung disease, meconium plug syndrome, meconium ileus, and anorectal malformation
Open
Hirschsprung Disease Workup
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Rod Gerardo summarizing the discussion: Even with suggestive manometry findings, a biopsy is still required before surgical intervention; no surgeon would operate on manometry alone.
Open
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Rod Gerardo summarizing the discussion: Even with suggestive manometry findings, a biopsy is still required before surgical intervention; no surgeon would operate on manometry alone.
Open
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Rod Gerardo summarizing the discussion: nobody I know would operate on a manometry alone. So if there's a suggestive manometry, a biopsy will still be done.
Open
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Rod Gerardo summarizing the discussion: nobody I know would operate on a manometry alone. So if there's a suggestive manometry, a biopsy will still be done.
Open
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Rod Gerardo summarizing the discussion: Normal individuals without Hirschsprung disease have no ganglion cells in the very first (distal-most) part of the rectum.
Open
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Rod Gerardo summarizing the discussion: Normal individuals without Hirschsprung disease have no ganglion cells in the very first (distal-most) part of the rectum.
Open
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Rod Gerardo summarizing the discussion: In children over one year old, the suction biopsy tool cannot obtain adequate tissue depth because the tissue is thicker, necessitating surgical biopsy in the OR.
Open
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Rod Gerardo summarizing the discussion: In children over one year old, the suction biopsy tool cannot obtain adequate tissue depth because the tissue is thicker, necessitating surgical biopsy in the OR.
Open
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Rod Gerardo summarizing the discussion: Surgical rectal biopsy in older children is a simple 20-minute procedure with same-day discharge.
Open
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Rod Gerardo summarizing the discussion: Surgical rectal biopsy in older children is a simple 20-minute procedure with same-day discharge.
Open
Journal of Pediatric Surgery Article Review: January 2022 APSA Issue
Host summary
Rod Gerardo summarizing the discussion: External federal research funding at Nationwide increased from $750,000 to $5.7 million, representing a 7.7-fold increase.
Open
Quick Literature Updates Episode 7
Host summary
Rod Gerardo summarizing a resource: Patients with less than 50% of their colon had significantly less time on parenteral nutrition as long as they had their ileocecal valve.
Open
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Rod Gerardo summarizing a resource: Infants with an ileocecal valve had significantly shorter duration on parenteral nutrition.
Open
Host summary
Rod Gerardo summarizing a resource: Peters et al. retrospectively reviewed 55 pediatric patients with small bowel syndrome to examine whether presence or absence of ileocecal valve and/or colon can predict enteral autonomy.
Open
Summaries Rod gave as host · Intestinal Failure 12 summaries
Open the Intestinal Failure collection →
Intestinal rehabilitation: What is intestinal rehab? - Episode 1
Host summary
Rod Gerardo summarizing the discussion: New guidelines define intestinal failure as requiring parenteral support for at least 60 days due to inadequate intestinal function.
Open
Host summary
Rod Gerardo summarizing the discussion: Intestinal rehabilitation requires managing comorbidities including sepsis and liver disease that challenge infant growth.
Open
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Rod Gerardo summarizing the discussion: Access and availability to intestinal rehabilitation programs is still very rare.
Open
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Rod Gerardo summarizing the discussion: Overall long-term survival in major intestinal rehabilitation programs is usually over 90%.
Open
Intestinal Rehabilitation, Episode 1: What is intestinal rehabilitation?
Host summary
Rod Gerardo summarizing the discussion: New guidelines define intestinal failure as inadequate intestinal function requiring parenteral support for at least 60 days.
Open
Host summary
Rod Gerardo summarizing the discussion: Intestinal rehabilitation requires managing comorbidities including sepsis and liver disease that challenge infant growth.
Open
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Rod Gerardo summarizing the discussion: Overall survival in big intestinal rehabilitation programs is usually over 90% long-term.
Open
Pediatric Vascular Access in Brief: Preoperative, Operative, and Postoperative Considerations
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Rod Gerardo summarizing the discussion: In the United States, approximately 5 million central venous catheter lines are placed annually, with several thousand in pediatric surgical patients.
Open
Host summary
Rod Gerardo summarizing the discussion: Central venous catheters are non-tunneled, typically for temporary hospital use, and can have 1 to 3 lumens.
Open
Host summary
Rod Gerardo summarizing the discussion: Broviac catheters are tunneled lines with cuffs, used for months to years for chemotherapy, parenteral nutrition, or frequent blood transfusions, and can have 1 or 2 lumens.
Open
Host summary
Rod Gerardo summarizing the discussion: For very small neonates, many surgeons prefer a cut-down approach over percutaneous access.
Open
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Rod Gerardo summarizing the discussion: Long-term complications include thrombosis, catheter displacement, kinking, and eventual line degradation over extended periods.
Open
Summaries Rod gave as host · Intestinal Rehab 57 summaries
Open the Intestinal Rehab collection →
Gastroschisis and sutureless abdominal wall closure
Host summary
Rod Gerardo summarizes what Dr. Jason Fraser said: In 2004, Tony Sandler published the first manuscript about sutureless closures utilizing the natural umbilical properties to close the gastroschisis defect by itself.
Open
Host summary
Rod Gerardo summarizes what Dr. Jason Fraser said: In 2004, Tony Sandler published the first manuscript about suture disclosures to utilize the natural umbilical properties to closing that defect by itself.
Open
Host summary
Rod Gerardo summarizes what Dr. Jason Fraser said: I didn't know about his article. I found out about it as a fellow when he taught us how to treat gastroschisis that way.
Open
Host summary
Rod Gerardo summarizes what Dr. Jason Fraser said: I think it's clearly been a massive change in practice. It's one of the examples of a big change that we don't actually operate on those and they can be done at the bedside. And it also is an example of something that took a while to adopt. And now most people are doing it, I think.
Open
Host summary
Rod Gerardo summarizes what Dr. Jason Fraser said: There have been so many articles in the last few years that go back and forth. I mean, one said gastro suture list is better. One said definitely don't do suture list. So my question is now, I don't know. I almost don't read these articles anymore.
Open
Host summary
Rod Gerardo summarizes what Dr. Jason Fraser said: I think anytime it's a Kansas City or an NWSPC, NWPSC. Anytime it's an NWPSC article, I pay attention. Anytime it's a Kansas City article, I pay attention. But other than that, I'm tired of seeing all these gastroschisis articles. I'm waiting for someone to give me something that is really meaningful.
Open
Host summary
Rod Gerardo summarizes what Dr. Jason Fraser said: Sutureless closure patients had fewer episodes of general anesthetics compared to sutured closure patients.
Open
Host summary
Rod Gerardo summarizes what Dr. Jason Fraser said: Sutureless closure patients had less ventilator use compared to sutured closure patients.
Open
Host summary
Rod Gerardo summarizes what Dr. Jason Fraser said: The study divided patients into sutured versus sutureless abdominal wall closures and required subgroup analysis because some babies received silos and some did not.
Open
Host summary
Rod Gerardo summarizes what Dr. Jason Fraser said: Patients who underwent sutureless abdominal wall closure had no difference in days on TPN, time to goal feeds, time to initial feeds, or length of stay compared to sutured closure.
Open
Host summary
Rod Gerardo summarizes what Dr. Jason Fraser said: Sutureless closure patients had less antibiotic use compared to sutured closure patients.
Open
Host summary
Rod Gerardo summarizes what Dr. Jason Fraser said: The positive outcomes for sutureless repair were observed even when considering patients who required silo use.
Open
Host summary
Rod Gerardo summarizes what Dr. Jason Fraser said: Sutureless closure patients had fewer surgical site and deep space infections compared to sutured closure patients.
Open
Host summary
Rod Gerardo summarizes what Dr. Jason Fraser said: The Midwest Pediatric Surgery Consortium study was a retrospective cohort of infants born with gastroschisis between 2013 and 2016, with a total of 315 patients.
Open
Host summary
Rod Gerardo summarizes what Dr. Jason Fraser said: Yeah, I think in general, I, I, you're right. I don't know how the pendulum is going to swing, but we are finding more and more. There are things that we don't have to operate on.
Open
Host summary
Rod Gerardo summarizes what Dr. Jason Fraser said: Gastroschisis is an abdominal wall defect that used to necessitate a trip to the OR and is now more like a safe bedside procedure.
Open
Colorectal Collaboration: Neurogastroenterology/Motility Disorders
Host summary
Rod Gerardo summarizing the discussion: Sennosides or bisacodyl can be used to induce high-amplitude propagated contractions (HAPCs).
Open
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Rod Gerardo summarizing the discussion: When an HAPC occurs, the internal anal sphincter should relax (coloanal reflex) to allow stool evacuation.
Open
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Rod Gerardo summarizing the discussion: Fluoroscopy (C-arm) is used during manometry catheter placement to confirm exact positioning.
Open
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Rod Gerardo summarizing the discussion: When an HAPC reaches the sigmoid or rectum, the internal anal sphincter relaxes to allow defecation.
Open
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Rod Gerardo summarizing the discussion: Decisions about surgical intervention for segmental dysmotility are based not only on manometry but also on imaging (contrast enema), physical exam, and patient/family history.
Open
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Rod Gerardo summarizing the discussion: Performing duodenal and colonic manometry in a patient with gastroparesis is valuable because it rules out more widespread dysmotility, which is especially important in patients with anorectal malformations.
Open
Journal of Pediatric Surgery Article Review: October 2021
Host summary
Rod Gerardo summarizing the discussion: We might congratulate ourselves for having done a good job in perhaps saving the kid and identifying the problem, but perhaps not aware that we have a responsibility uh for the long-term health and uh we have to be advocates for the children.
Open
Host summary
Rod Gerardo summarizing the discussion: Complete metadata for medical education content includes title, description, summary, keywords, duration, content type, specialty area, target audience level, and language.
Open
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Rod Gerardo summarizing the discussion: It is obvious that we currently do not have the objective clinical markers, whether they are the uh clinical features or uh novel biomarkers to help us make an earlier decision.
Open
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Rod Gerardo summarizing the discussion: We currently do not have objective clinical markers, whether clinical features or novel biomarkers, to help make earlier surgical decisions in NEC.
Open
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Rod Gerardo summarizing the discussion: The Italian study provides sufficient evidence to convince clinicians who are not doing routine spinal cord and spine assessment in anorectal malformation patients that they should be more serious with imaging.
Open
Intestinal rehabilitation: What is intestinal rehab? - Episode 1
Host summary
Rod Gerardo summarizing the discussion: New guidelines define intestinal failure as requiring parenteral support for at least 60 days due to inadequate intestinal function.
Open
Host summary
Rod Gerardo summarizing the discussion: Intestinal rehabilitation requires managing comorbidities including sepsis and liver disease that challenge infant growth.
Open
Host summary
Rod Gerardo summarizing the discussion: Access and availability to intestinal rehabilitation programs is still very rare.
Open
Host summary
Rod Gerardo summarizing the discussion: Overall long-term survival in major intestinal rehabilitation programs is usually over 90%.
Open
Intestinal Rehabilitation, Episode 1: What is intestinal rehabilitation?
Host summary
Rod Gerardo summarizing the discussion: New guidelines define intestinal failure as inadequate intestinal function requiring parenteral support for at least 60 days.
Open
Host summary
Rod Gerardo summarizing the discussion: Intestinal rehabilitation requires managing comorbidities including sepsis and liver disease that challenge infant growth.
Open
Host summary
Rod Gerardo summarizing the discussion: Overall survival in big intestinal rehabilitation programs is usually over 90% long-term.
Open
Journal of Pediatric Surgery Article Review: January 2022 APSA Issue
Host summary
Rod Gerardo summarizing the discussion: External federal research funding at Nationwide increased from $750,000 to $5.7 million, representing a 7.7-fold increase.
Open
Stay Current Throwbacks Necrotizing Enterocolitis with Dr. Gail Besner
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Rod Gerardo summarizes what Dr. Gail Besner said: The NEST trial results published in fall 2021 showed no overall difference in death or neurodevelopmental impairment between laparotomy and drainage groups.
Open
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Rod Gerardo summarizes what Dr. Gail Besner said: The NEST trial results published in fall 2021 showed no overall difference in death or neurodevelopmental impairment between laparotomy and drainage groups.
Open
Host summary
Rod Gerardo summarizes what Dr. Gail Besner said: In the NEST trial, neonates with a preoperative diagnosis of necrotizing enterocolitis (versus isolated intestinal perforation) had approximately 20% decrease in death rate with laparotomy compared to drainage.
Open
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Rod Gerardo summarizes what Dr. Gail Besner said: In the NEST trial, neonates with a preoperative diagnosis of necrotizing enterocolitis (versus isolated intestinal perforation) had approximately 20% decrease in death rate with laparotomy compared to drainage.
Open
Neonatal Gastric Volvulus with Dr. Jason Frischer
Host summary
Rod Gerardo summarizing the discussion: Gastric volvulus is associated with eventration of the diaphragm about 25% of the time.
Open
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Rod Gerardo summarizing the discussion: Gastric volvulus is associated with congenital diaphragmatic hernia about 17% of the time.
Open
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Rod Gerardo summarizing the discussion: Acute gastric volvulus presentations are usually due to anatomic problems like congenital diaphragmatic hernia.
Open
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Rod Gerardo summarizing the discussion: Without ligamentous attachments, the stomach is kept in place only at two points: the GE junction and the pylorus, and rotations occur about these points.
Open
Host summary
Rod Gerardo summarizing the discussion: Gastric volvulus typically presents in children in the first year of life with non-bilious emesis, gastric distention, and issues passing an NG tube.
Open
Host summary
Rod Gerardo summarizing the discussion: A classic bird's beak appearance may be seen when contrast is swallowed or placed in a tube sitting in the esophagus in gastric volvulus.
Open
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Rod Gerardo summarizing the discussion: Gastropexy should be performed at at least one other location in addition to G-tube placement, fixing the stomach in multiple planes to reduce the chance of re-volvulization.
Open
Host summary
Rod Gerardo summarizing the discussion: Fundoplication is not required in pediatric gastric volvulus repair, unlike in some adult cases.
Open
Pediatric Vascular Access in Brief: Preoperative, Operative, and Postoperative Considerations
Host summary
Rod Gerardo summarizing the discussion: In the United States, approximately 5 million central venous catheter lines are placed annually, with several thousand in pediatric surgical patients.
Open
Host summary
Rod Gerardo summarizing the discussion: Central venous catheters are non-tunneled, typically for temporary hospital use, and can have 1 to 3 lumens.
Open
Host summary
Rod Gerardo summarizing the discussion: Broviac catheters are tunneled lines with cuffs, used for months to years for chemotherapy, parenteral nutrition, or frequent blood transfusions, and can have 1 or 2 lumens.
Open
Host summary
Rod Gerardo summarizing the discussion: For very small neonates, many surgeons prefer a cut-down approach over percutaneous access.
Open
Host summary
Rod Gerardo summarizing the discussion: Long-term complications include thrombosis, catheter displacement, kinking, and eventual line degradation over extended periods.
Open
Quick Literature Updates Episode 6
Host summary
Rod Gerardo summarizing a resource: Miyata et al. used the Canadian Association of Pediatric Surgery Network to study pediatric patients with gastroschisis who underwent bedside reduction and closure.
Open
Host summary
Rod Gerardo summarizing a resource: There was no significant difference in the rate of successful primary closure between intubated and non-intubated neonates with gastroschisis.
Open
Quick Literature Updates Episode 7
Host summary
Rod Gerardo summarizing a resource: Patients with less than 50% of their colon had significantly less time on parenteral nutrition as long as they had their ileocecal valve.
Open
Host summary
Rod Gerardo summarizing a resource: Infants with an ileocecal valve had significantly shorter duration on parenteral nutrition.
Open
Host summary
Rod Gerardo summarizing a resource: Peters et al. retrospectively reviewed 55 pediatric patients with small bowel syndrome to examine whether presence or absence of ileocecal valve and/or colon can predict enteral autonomy.
Open
Summaries Rod gave as host · Intussusception 11 summaries
Open the Intussusception collection →
Case-Based Journal Review- Intussusception in 2022
Host summary
Rod Gerardo summarizing a resource: Point-of-care ultrasound for intussusception diagnosis achieved 95% sensitivity and 99% specificity in a 2019 American Journal of Emergency Medicine study.
Open
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Rod Gerardo summarizing a resource: Ultrasound-guided hydrostatic reduction had 95.8% success rate versus 93.1% for fluoroscopy-guided air reduction in a 2021 World Journal of Emergency Surgery study from China.
Open
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Rod Gerardo summarizing a resource: Obstructive bowel gas pattern on radiograph is associated with decreased air enema success and increased need for surgical bowel resection in a 2020 Pediatric Radiology study.
Open
Host summary
Rod Gerardo summarizing a resource: A 2018 Journal of Pediatric Surgery prediction model using clinical and sonographic data (free fluid, extension beyond splenic flexure, altered Doppler) identified 80% of failed saline enema reductions before the procedure.
Open
Host summary
Rod Gerardo summarizing a resource: S-ketamine sedation versus morphine analgesia showed non-significant differences in success rate (90% vs 70%) and recurrence (10% vs 15%) with no perforations in either group.
Open
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Rod Gerardo summarizing a resource: A 2019 JPS systematic review and meta-analysis of 10 studies found no significant difference in ED returns, recurrence, need for operation, or mortality between inpatient and outpatient management after successful air enema reduction.
Open
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Rod Gerardo summarizing a resource: A 2020 Journal of Pediatric Surgery database study of 8,289 patients found 3.7% readmission and recurrence rate after intussusception reduction.
Open
Journal of Pediatric Surgery Article Review: The Disruption Score
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Rod Gerardo summarizing the discussion: Neuroblastoma research tends to be developmental in nature because it involves surgical oncology
Open
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Rod Gerardo summarizing the discussion: The study stopped examining articles around 2014, introducing a time lag limitation
Open
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Rod Gerardo summarizing the discussion: There is no current method to identify an important paper immediately upon release; the disruption score measures whether a paper changes the field over time, not whether it goes viral
Open
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Rod Gerardo summarizing the discussion: This is an equation that's for, does it change the game.
Open
Summaries Rod gave as host · Laryngeal Cleft 10 summaries
Open the Laryngeal Cleft collection →
Laryngeal Clefts
Host summary
Rod Gerardo summarizing the discussion: You want raw against raw. Mucosa is a nonstick surface. Get rid of the mucosa. You want a wide strip of raw against a wide strip of raw.
Open
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Rod Gerardo summarizing the discussion: The Benjamin Inglis classification should be modified to include a type 4 long because type 4 could be proximal above the carina, at the carina, or go straight through the carina.
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Rod Gerardo summarizing the discussion: Type 1 laryngeal cleft means the opening is above the vocal cords.
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Rod Gerardo summarizing the discussion: Type 2 laryngeal cleft means it extends below the vocal cords.
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Rod Gerardo summarizing the discussion: Flexible bronchoscopy is not adequate for diagnosing a posterior laryngeal cleft.
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Rod Gerardo summarizing the discussion: The mass closure technique developed in Cincinnati uses the same concept as endoscopic tracheoesophageal fistula repair: you want raw against raw, with wide strips of raw tissue opposed after removing the non-stick mucosal surface.
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Rod Gerardo summarizing the discussion: Endoscopically or endoscopically unless there's a reason to do an open approach.
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Rod Gerardo summarizing the discussion: We've been nagging Andy for years, Andy Inglis, to actually modify that classification.
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Rod Gerardo summarizing the discussion: Flexible bronchoscopy is not adequate for diagnosing a posterior laryngeal cleft.
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Rod Gerardo summarizing the discussion: Type 3 laryngeal cleft means it extends down into the trachea.
Open
Summaries Rod gave as host · Long-gap Esophageal Atresia 10 summaries
Open the Long-gap Esophageal Atresia collection →
Treatment for Long Gap Esophageal Atresia: Esophageal Elongation and Replacement
Host summary
Rod Gerardo summarizes what Dr. Daniel von Allmen said: In the Foker technique, the surgeon ties sutures to either end of the esophagus through an open incision, brings them out through the chest wall, ties them together in a knot, and places spacers underneath periodically (about every day) until the ends come together for primary anastomosis.
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Rod Gerardo summarizes what Dr. Daniel von Allmen said: The van der Zee technique uses the same concept as Foker but is done thoracoscopically with no external sutures, so all tension is inside the thorax.
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Rod Gerardo summarizes what Dr. Daniel von Allmen said: The Kimura technique involves creating a spit fistula and periodically moving it down the chest wall over time to stretch the proximal pouch closer to the distal pouch, but is not used all that often anymore.
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Rod Gerardo summarizes what Dr. Daniel von Allmen said: We were all taught the dictum that every effort should be made to conserve the native esophagus as no other conduit can replace its function in transporting food from the oral cavity to the stomach satisfactorily.
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Rod Gerardo summarizes what Dr. Daniel von Allmen said: In colonic interposition, the piece of colon chosen is based on the blood supply and the diameter needed.
Open
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Rod Gerardo summarizes what Dr. Daniel von Allmen said: In colonic interposition, a pyloroplasty is performed to help with gastric emptying.
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Rod Gerardo summarizes what Dr. Daniel von Allmen said: The short interval between time of traction and anastomosis (less than five days) raises the question of whether the mechanism is stretching or growth, which will impact results and likely reflects on complications.
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Journal of Pediatric Surgery Article Review: February 2022 BAPS Issue
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Rod Gerardo summarizing the discussion: Renal organoids could potentially be used as replacement therapy in pediatric renal transplant instead of formal kidney transplant.
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Journal of Pediatric Surgery Article Review: February 2022 - BAPS Issue
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Rod Gerardo summarizing the discussion: KidsOR has opened 50 operating rooms in 22 different countries.
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Rod Gerardo summarizing the discussion: KidsOR supports pediatric surgery residency programs run by CSECSA (College of East, Central and Southern Africa) and WACS (West African College of Surgeons), working closely with partners like Smile Train.
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Summaries Rod gave as host · Malrotation 1 summary
Open the Malrotation collection →
The Colorectal Quiz Episode 3.5: Proximal Hirschsprung Disease
Host summary
Rod Gerardo summarizing the discussion: If a child is sick with bilious emesis and distension, resuscitation should be the first step before diagnostic workup.
Open
Summaries Rod gave as host · Meckel's Diverticulum 8 summaries
Open the Meckel's Diverticulum collection →
Journal of Pediatric Surgery Article Review: September 2021
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Rod Gerardo summarizing the discussion: There was no significant difference between early and traditional feeding groups in length of stay, time to full feeds, postoperative complications, 30-day mortality, or 30-day readmissions
Open
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Rod Gerardo summarizing the discussion: In the Chinese trial, the early feeding group started feeds at 2 days compared to 6 days in the traditional feeding group
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Rod Gerardo summarizing the discussion: In the early feeding group, patients did not have a decompressing nasogastric tube, suggesting nasogastric decompression is not needed after neonatal intestinal anastomosis
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Rod Gerardo summarizing the discussion: So the other take that Todd had, uh, that we, I don't think was directly addressed in the article. In the group that got early feeds, they also did not have a decompressing nasogastric tube. So, a summary point there is you don't need nasogastric decompression after an anastomosis. Forget the feeds. Like, that's huge, like to, to say that we don't need NG tubes anymore after an anastomosis is a big deal.
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Rod Gerardo summarizing the discussion: My argument is Why do we need to get a Mchel scan at all? Yeah, so here's how I would use that score. So for me, I would create an algorithm from this and say, OK, if the score is high, I would go straight to laparoscopy because even with a negative Mechel scan, I'm going to be thinking it's likely a Meckel's diverticulum.
Open
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Rod Gerardo summarizing the discussion: Todd Ponsky suggests using the Meckel's score to go straight to laparoscopy in high-score patients, skipping the Meckel scan, because even with a negative scan he would still suspect Meckel's diverticulum
Open
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Rod Gerardo summarizing the discussion: Under the age of 10, workup for Crohn's disease is not needed in children with perianal symptoms; over age 10, workup should be performed
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Rod Gerardo summarizing the discussion: So my conclusion from that is under the age of 10. You do not need to worry about doing a workup for Crohn's disease. And over the age of 10, you should.
Open
Summaries Rod gave as host · Motility / Pseudo-obstruction 13 summaries
Open the Motility / Pseudo-obstruction collection →
Colorectal Collaboration: Neurogastroenterology/Motility Disorders
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Rod Gerardo summarizing the discussion: Sennosides or bisacodyl can be used to induce high-amplitude propagated contractions (HAPCs).
Open
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Rod Gerardo summarizing the discussion: When an HAPC occurs, the internal anal sphincter should relax (coloanal reflex) to allow stool evacuation.
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Rod Gerardo summarizing the discussion: Fluoroscopy (C-arm) is used during manometry catheter placement to confirm exact positioning.
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Rod Gerardo summarizing the discussion: When an HAPC reaches the sigmoid or rectum, the internal anal sphincter relaxes to allow defecation.
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Rod Gerardo summarizing the discussion: Decisions about surgical intervention for segmental dysmotility are based not only on manometry but also on imaging (contrast enema), physical exam, and patient/family history.
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Rod Gerardo summarizing the discussion: Performing duodenal and colonic manometry in a patient with gastroparesis is valuable because it rules out more widespread dysmotility, which is especially important in patients with anorectal malformations.
Open
Intestinal rehabilitation: What is intestinal rehab? - Episode 1
Host summary
Rod Gerardo summarizing the discussion: New guidelines define intestinal failure as requiring parenteral support for at least 60 days due to inadequate intestinal function.
Open
Host summary
Rod Gerardo summarizing the discussion: Intestinal rehabilitation requires managing comorbidities including sepsis and liver disease that challenge infant growth.
Open
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Rod Gerardo summarizing the discussion: Access and availability to intestinal rehabilitation programs is still very rare.
Open
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Rod Gerardo summarizing the discussion: Overall long-term survival in major intestinal rehabilitation programs is usually over 90%.
Open
Intestinal Rehabilitation, Episode 1: What is intestinal rehabilitation?
Host summary
Rod Gerardo summarizing the discussion: New guidelines define intestinal failure as inadequate intestinal function requiring parenteral support for at least 60 days.
Open
Host summary
Rod Gerardo summarizing the discussion: Intestinal rehabilitation requires managing comorbidities including sepsis and liver disease that challenge infant growth.
Open
Host summary
Rod Gerardo summarizing the discussion: Overall survival in big intestinal rehabilitation programs is usually over 90% long-term.
Open
Summaries Rod gave as host · Myelomeningocele 13 summaries
Open the Myelomeningocele collection →
Fetoscopic Repair of Myelomeningocele (MMC)
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Rod Gerardo summarizes what Dr. Fung Lim said: Neural tube defects are the most common congenital central nervous system anomaly.
Open
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Rod Gerardo summarizes what Dr. Fung Lim said: He's the director of the Fetal Care Center at Cincinnati Children's Hospital Medical Center.
Open
Host summary
Rod Gerardo summarizes what Dr. Fung Lim said: Myelomeningocele or spina bifida is the most common neural tube defect.
Open
Host summary
Rod Gerardo summarizes what Dr. Fung Lim said: In myelomeningocele, the patient is born with a cleft in the vertebral column and a defect in the skin, so the meninges and the spinal cord are exposed.
Open
Host summary
Rod Gerardo summarizes what Dr. Fung Lim said: The patient may be left with neural defects based on the level of the spinal cord where the lesion is.
Open
Host summary
Rod Gerardo summarizes what Dr. Fung Lim said: Under ultrasound guidance, the first port is placed.
Open
Host summary
Rod Gerardo summarizes what Dr. Fung Lim said: Anesthesia is induced on the baby via an intragluteal injection.
Open
Host summary
Rod Gerardo summarizes what Dr. Fung Lim said: The first step is to open the sac, then dissect around the sac circumferentially.
Open
Host summary
Rod Gerardo summarizes what Dr. Fung Lim said: The placode is the open area of exposed neural tissue.
Open
Host summary
Rod Gerardo summarizes what Dr. Fung Lim said: A skin flap is created to loosen up the skin, which will help form a watertight closure of the spinal defect.
Open
Host summary
Rod Gerardo summarizes what Dr. Fung Lim said: The mother and the fetus are monitored postoperatively, and if able, the baby is delivered vaginally at term.
Open
Journal of Pediatric Surgery Article Review: January 2022 APSA Issue
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Rod Gerardo summarizing the discussion: External federal research funding at Nationwide increased from $750,000 to $5.7 million, representing a 7.7-fold increase.
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Journal of Pediatric Surgery Article Highlights: April 2022
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Rod Gerardo summarizing the discussion: The third article is titled 'Current Status of Sub-specialization in Pediatric Surgery, a Focus on fetal Surgery' and surveys practice patterns in fetal surgery across the country.
Open
Summaries Rod gave as host · Necrotizing Enterocolitis 7 summaries
Open the Necrotizing Enterocolitis collection →
Journal of Pediatric Surgery Article Review: October 2021
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Rod Gerardo summarizing the discussion: We might congratulate ourselves for having done a good job in perhaps saving the kid and identifying the problem, but perhaps not aware that we have a responsibility uh for the long-term health and uh we have to be advocates for the children.
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Rod Gerardo summarizing the discussion: Complete metadata for medical education content includes title, description, summary, keywords, duration, content type, specialty area, target audience level, and language.
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Rod Gerardo summarizing the discussion: It is obvious that we currently do not have the objective clinical markers, whether they are the uh clinical features or uh novel biomarkers to help us make an earlier decision.
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Rod Gerardo summarizing the discussion: We currently do not have objective clinical markers, whether clinical features or novel biomarkers, to help make earlier surgical decisions in NEC.
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Rod Gerardo summarizing the discussion: The Italian study provides sufficient evidence to convince clinicians who are not doing routine spinal cord and spine assessment in anorectal malformation patients that they should be more serious with imaging.
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Stay Current Throwbacks Necrotizing Enterocolitis with Dr. Gail Besner
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Rod Gerardo summarizes what Dr. Gail Besner said: The NEST trial results published in fall 2021 showed no overall difference in death or neurodevelopmental impairment between laparotomy and drainage groups.
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Rod Gerardo summarizes what Dr. Gail Besner said: In the NEST trial, neonates with a preoperative diagnosis of necrotizing enterocolitis (versus isolated intestinal perforation) had approximately 20% decrease in death rate with laparotomy compared to drainage.
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Summaries Rod gave as host · Non-perforated Appendicitis 8 summaries
Open the Non-perforated Appendicitis collection →
Update Course Rewind: Perforated Appendicitis 2019
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Rod Gerardo summarizing the discussion: CT scan reviewers (6 surgeons including 2 fellows and 2 radiologists) were only 72% accurate in distinguishing perforated from non-perforated appendicitis when reviewing 200 CT scans
Open
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Rod Gerardo summarizing the discussion: We are terrible at telling whether or not an appendix is perforated or non-perforated on a CT scan.
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Rod Gerardo summarizing the discussion: Among 62 attending surgeons (adult and pediatric, from university, community, and children's hospitals), agreement in defining intraoperative laparoscopic images as perforated or non-perforated appendicitis was 27%
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Rod Gerardo summarizing the discussion: A standardized definition of perforated appendicitis as a hole in the appendix or a fecalith in the abdomen was implemented at one hospital
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Rod Gerardo summarizing the discussion: At our hospital, uh, we identify a perforated appendicitis as a hole in the appendix or a fecal lith in the abdomen.
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Rod Gerardo summarizing the discussion: Patients without a hole in the appendix or fecalith in the abdomen had an incidence of postoperative abscess less than 5%
Open
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Rod Gerardo summarizing the discussion: After implementing a standardized definition for perforated appendicitis, the non-perforation abscess rate decreased and the perforation abscess rate increased, suggesting previous misclassification
Open
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Rod Gerardo summarizing the discussion: In a randomized trial with 110 patients per arm, irrigation with minimum 500cc (average 850cc) showed no difference in postoperative abscess rate, length of stay, hospital cost, or operative time compared to no irrigation
Open
Summaries Rod gave as host · Osteosarcoma 3 summaries
Open the Osteosarcoma collection →
Update Course Rewind: Thoracotomy vs VATS for Lung Metastases
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Rod Gerardo summarizing the discussion: About 20% of osteosarcoma patients already have lung metastases by the time of diagnosis, usually picked up on staging chest CT.
Open
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Rod Gerardo summarizing the discussion: With thoracotomy, surgeons can typically remove 15 to 20 nodules, but with thoracoscopy the number is more limited.
Open
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Rod Gerardo summarizing the discussion: A multi-institution study of 200 patients with metastatic osteosarcoma—the largest study ever done—compared outcomes between open resection and thoracoscopy.
Open
Summaries Rod gave as host · Ovarian Teratoma 1 summary
Open the Ovarian Teratoma collection →
What's New in Pediatric Surgery 2020 - FULL SHOW
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Rod Gerardo summarizing the discussion: I was kind of surprised to read from JPS that a lot of these kiddos really don't need opioids after an uncomplicated appendectomy. I'm thinking it's probably more closer to 95, probably almost 100%.
Open
Summaries Rod gave as host · Pancreatic Tumors 1 summary
Open the Pancreatic Tumors collection →
Pancreatic Masses
Host summary
Rod Gerardo summarizes what Dr. Jaimie Nathan said: We all know the three rules of surgery. Eat when you can, sleep when you can, and don't mess with the pancreas.
Open
Summaries Rod gave as host · Perineal Fistula 2 summaries
Open the Perineal Fistula collection →
Colorectal Quiz Episode 13: Newborn ARM Part 2
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Rod Gerardo summarizing the discussion: Don't use your fingers because every surgeon has a different size glove.
Open
Host summary
Rod Gerardo summarizing the discussion: Use Hagar dilators starting low and working up for accurate anal size measurement; do not use fingers because every surgeon has different size glove
Open
Summaries Rod gave as host · Sarcoma (Ewing/Rhabdo) 35 summaries
Open the Sarcoma (Ewing/Rhabdo) collection →
Case-Based Journal Review- Intussusception in 2022
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Rod Gerardo summarizing a resource: Point-of-care ultrasound for intussusception diagnosis achieved 95% sensitivity and 99% specificity in a 2019 American Journal of Emergency Medicine study.
Open
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Rod Gerardo summarizing a resource: Ultrasound-guided hydrostatic reduction had 95.8% success rate versus 93.1% for fluoroscopy-guided air reduction in a 2021 World Journal of Emergency Surgery study from China.
Open
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Rod Gerardo summarizing a resource: Obstructive bowel gas pattern on radiograph is associated with decreased air enema success and increased need for surgical bowel resection in a 2020 Pediatric Radiology study.
Open
Host summary
Rod Gerardo summarizing a resource: A 2018 Journal of Pediatric Surgery prediction model using clinical and sonographic data (free fluid, extension beyond splenic flexure, altered Doppler) identified 80% of failed saline enema reductions before the procedure.
Open
Host summary
Rod Gerardo summarizing a resource: S-ketamine sedation versus morphine analgesia showed non-significant differences in success rate (90% vs 70%) and recurrence (10% vs 15%) with no perforations in either group.
Open
Host summary
Rod Gerardo summarizing a resource: A 2019 JPS systematic review and meta-analysis of 10 studies found no significant difference in ED returns, recurrence, need for operation, or mortality between inpatient and outpatient management after successful air enema reduction.
Open
Host summary
Rod Gerardo summarizing a resource: A 2020 Journal of Pediatric Surgery database study of 8,289 patients found 3.7% readmission and recurrence rate after intussusception reduction.
Open
Case Based Journal Review - CPAM in 2022
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Rod Gerardo summarizing the discussion: A 2017 prospective study in Archives of Disease in Childhood followed 119 prenatally diagnosed congenital cystic lung lesions for a median of 10 years
Open
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Rod Gerardo summarizing the discussion: A 2017 prospective study in Archives of Disease in Childhood followed 119 prenatally diagnosed congenital cystic lung lesions for a median of 10 years
Open
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Rod Gerardo summarizing the discussion: A 2021 Pediatrics study by the Midwest Pediatric Surgery Consortium retrospectively examined histology of 521 lung lesions resected across 11 children's hospitals
Open
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Rod Gerardo summarizing the discussion: A 2021 Pediatrics study by the Midwest Pediatric Surgery Consortium retrospectively examined histology of 521 lung lesions resected across 11 children's hospitals
Open
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Rod Gerardo summarizing the discussion: Of 177 children with postnatal diagnosis of CPAM, 15 (8.7%) were classified as having a malignant tumor
Open
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Rod Gerardo summarizing the discussion: Of 177 children with postnatal diagnosis of CPAM, 15 (8.7%) were classified as having a malignant tumor
Open
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Rod Gerardo summarizing the discussion: A 2021 Journal of Pediatric Surgery study examined whether previous infection matters for thoracoscopic surgery outcomes in congenital lung malformations
Open
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Rod Gerardo summarizing the discussion: A 2021 Journal of Pediatric Surgery study examined whether previous infection matters for thoracoscopic surgery outcomes in congenital lung malformations
Open
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Rod Gerardo summarizing the discussion: Patients without prior pulmonary infection had shorter operative time, fewer postoperative fevers, less need for postoperative antibiotics, but no significant difference in postoperative complications or conversion rates
Open
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Rod Gerardo summarizing the discussion: Patients without prior pulmonary infection had shorter operative time, fewer postoperative fevers, less need for postoperative antibiotics, but no significant difference in postoperative complications or conversion rates
Open
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Rod Gerardo summarizing the discussion: A 2018 Journal of Pediatric Surgery study examined optimal timing for elective resection of asymptomatic CPAM, dividing patients under 1 year into three groups: 1-3 months, 4-6 months, and 6-12 months
Open
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Rod Gerardo summarizing the discussion: A 2018 Journal of Pediatric Surgery study examined optimal timing for elective resection of asymptomatic CPAM, dividing patients under 1 year into three groups: 1-3 months, 4-6 months, and 6-12 months
Open
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Rod Gerardo summarizing the discussion: Operative time increased with each increase in age; at younger ages the tissue planes are easier to dissect
Open
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Rod Gerardo summarizing the discussion: Operative time increased with each increase in age; at younger ages the tissue planes are easier to dissect
Open
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Rod Gerardo summarizing the discussion: The 1-3 month group had the shortest operative time at 115 minutes compared to 163 minutes in the 6-12 month group
Open
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Rod Gerardo summarizing the discussion: The 1-3 month group had the shortest operative time at 115 minutes compared to 163 minutes in the 6-12 month group
Open
Update Course Rewind: Thoracotomy vs VATS for Lung Metastases
Host summary
Rod Gerardo summarizing the discussion: About 20% of osteosarcoma patients already have lung metastases by the time of diagnosis, usually picked up on staging chest CT.
Open
Host summary
Rod Gerardo summarizing the discussion: With thoracotomy, surgeons can typically remove 15 to 20 nodules, but with thoracoscopy the number is more limited.
Open
Host summary
Rod Gerardo summarizing the discussion: A multi-institution study of 200 patients with metastatic osteosarcoma—the largest study ever done—compared outcomes between open resection and thoracoscopy.
Open
Commercial Audio Only (1080p)
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Rod Gerardo summarizing a resource: Hi, it's Rod Gerardo from Cincinnati Children's, and we have some brand new content for you.
Open
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Rod Gerardo summarizing a resource: The speaker is Rod Gerardo from Cincinnati Children's
Open
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Rod Gerardo summarizing a resource: No, it's not like our YouTube videos or our podcast where we get deep in the weeds with pediatric surgery.
Open
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Rod Gerardo summarizing a resource: The new content format differs from existing YouTube videos and podcasts that go deep in the weeds with pediatric surgery
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Rod Gerardo summarizing a resource: I and Dr. Jeff Ponsky are going to interview our friends from around the globe, residents, fellows, attendings.
Open
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Rod Gerardo summarizing a resource: Dr. Jeff Ponsky will co-conduct interviews with Rod Gerardo
Open
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Rod Gerardo summarizing a resource: Interview subjects will include residents, fellows, and attendings from around the globe
Open
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Rod Gerardo summarizing a resource: Topics will cover resident wellness, general surgery concepts, and new technologies
Open
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Rod Gerardo summarizing a resource: Episodes will be available on the Stay Current Pediatric Surgery app and social media channels
Open
Summaries Rod gave as host · Short Bowel Syndrome 10 summaries
Open the Short Bowel Syndrome collection →
Intestinal rehabilitation: What is intestinal rehab? - Episode 1
Host summary
Rod Gerardo summarizing the discussion: New guidelines define intestinal failure as requiring parenteral support for at least 60 days due to inadequate intestinal function.
Open
Host summary
Rod Gerardo summarizing the discussion: Intestinal rehabilitation requires managing comorbidities including sepsis and liver disease that challenge infant growth.
Open
Host summary
Rod Gerardo summarizing the discussion: Access and availability to intestinal rehabilitation programs is still very rare.
Open
Host summary
Rod Gerardo summarizing the discussion: Overall long-term survival in major intestinal rehabilitation programs is usually over 90%.
Open
Intestinal Rehabilitation, Episode 1: What is intestinal rehabilitation?
Host summary
Rod Gerardo summarizing the discussion: New guidelines define intestinal failure as inadequate intestinal function requiring parenteral support for at least 60 days.
Open
Host summary
Rod Gerardo summarizing the discussion: Intestinal rehabilitation requires managing comorbidities including sepsis and liver disease that challenge infant growth.
Open
Host summary
Rod Gerardo summarizing the discussion: Overall survival in big intestinal rehabilitation programs is usually over 90% long-term.
Open
Quick Literature Updates Episode 7
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Rod Gerardo summarizing a resource: Infants with an ileocecal valve had significantly shorter duration on parenteral nutrition.
Open
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Rod Gerardo summarizing a resource: Peters et al. retrospectively reviewed 55 pediatric patients with small bowel syndrome to examine whether presence or absence of ileocecal valve and/or colon can predict enteral autonomy.
Open
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Rod Gerardo summarizing a resource: Patients with less than 50% of their colon had significantly less time on parenteral nutrition as long as they had their ileocecal valve.
Open
Summaries Rod gave as host · Spina Bifida 11 summaries
Open the Spina Bifida collection →
Fetoscopic Repair of Myelomeningocele (MMC)
Host summary
Rod Gerardo summarizes what Dr. Fung Lim said: Neural tube defects are the most common congenital central nervous system anomaly.
Open
Host summary
Rod Gerardo summarizes what Dr. Fung Lim said: He's the director of the Fetal Care Center at Cincinnati Children's Hospital Medical Center.
Open
Host summary
Rod Gerardo summarizes what Dr. Fung Lim said: Myelomeningocele or spina bifida is the most common neural tube defect.
Open
Host summary
Rod Gerardo summarizes what Dr. Fung Lim said: In myelomeningocele, the patient is born with a cleft in the vertebral column and a defect in the skin, so the meninges and the spinal cord are exposed.
Open
Host summary
Rod Gerardo summarizes what Dr. Fung Lim said: The patient may be left with neural defects based on the level of the spinal cord where the lesion is.
Open
Host summary
Rod Gerardo summarizes what Dr. Fung Lim said: Under ultrasound guidance, the first port is placed.
Open
Host summary
Rod Gerardo summarizes what Dr. Fung Lim said: Anesthesia is induced on the baby via an intragluteal injection.
Open
Host summary
Rod Gerardo summarizes what Dr. Fung Lim said: The first step is to open the sac, then dissect around the sac circumferentially.
Open
Host summary
Rod Gerardo summarizes what Dr. Fung Lim said: The placode is the open area of exposed neural tissue.
Open
Host summary
Rod Gerardo summarizes what Dr. Fung Lim said: A skin flap is created to loosen up the skin, which will help form a watertight closure of the spinal defect.
Open
Host summary
Rod Gerardo summarizes what Dr. Fung Lim said: The mother and the fetus are monitored postoperatively, and if able, the baby is delivered vaginally at term.
Open
Summaries Rod gave as host · Spontaneous Pneumothorax 1 summary
Open the Spontaneous Pneumothorax collection →
What's New in Pediatric Surgery 2020 - FULL SHOW
Host summary
Rod Gerardo summarizing the discussion: I was kind of surprised to read from JPS that a lot of these kiddos really don't need opioids after an uncomplicated appendectomy. I'm thinking it's probably more closer to 95, probably almost 100%.
Open
Summaries Rod gave as host · Thrombosis 5 summaries
Open the Thrombosis collection →
Pediatric Vascular Access in Brief: Preoperative, Operative, and Postoperative Considerations
Host summary
Rod Gerardo summarizing the discussion: In the United States, approximately 5 million central venous catheter lines are placed annually, with several thousand in pediatric surgical patients.
Open
Host summary
Rod Gerardo summarizing the discussion: Central venous catheters are non-tunneled, typically for temporary hospital use, and can have 1 to 3 lumens.
Open
Host summary
Rod Gerardo summarizing the discussion: Broviac catheters are tunneled lines with cuffs, used for months to years for chemotherapy, parenteral nutrition, or frequent blood transfusions, and can have 1 or 2 lumens.
Open
Host summary
Rod Gerardo summarizing the discussion: For very small neonates, many surgeons prefer a cut-down approach over percutaneous access.
Open
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Rod Gerardo summarizing the discussion: Long-term complications include thrombosis, catheter displacement, kinking, and eventual line degradation over extended periods.
Open
Summaries Rod gave as host · Total Colonic Aganglionosis 3 summaries
Open the Total Colonic Aganglionosis collection →
The Colorectal Quiz Episode 10: Total Colonic Hirschsprung Disease Part 1
Host summary
Rod Gerardo summarizing the discussion: Hey there listeners, it's Rod Gerardo and Amanda Jensen from Cincinnati Children's.
Open
Host summary
Rod Gerardo summarizes what Dr. Jason Frischer said: That's Doctor Jason Fisher, pediatric colorectal surgeon at Cincinnati Children's Hospital.
Open
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Rod Gerardo summarizing the discussion: Common causes of failure to pass meconium include Hirschsprung disease, meconium plug syndrome, meconium ileus, and anorectal malformation
Open
Summaries Rod gave as host · Tracheoesophageal Fistula 8 summaries
Open the Tracheoesophageal Fistula collection →
Treatment for Long Gap Esophageal Atresia: Esophageal Elongation and Replacement
Host summary
Rod Gerardo summarizes what Dr. Daniel von Allmen said: In the Foker technique, the surgeon ties sutures to either end of the esophagus through an open incision, brings them out through the chest wall, ties them together in a knot, and places spacers underneath periodically (about every day) until the ends come together for primary anastomosis.
Open
Host summary
Rod Gerardo summarizes what Dr. Daniel von Allmen said: The Kimura technique involves creating a spit fistula and periodically moving it down the chest wall over time to stretch the proximal pouch closer to the distal pouch, but is not used all that often anymore.
Open
Host summary
Rod Gerardo summarizes what Dr. Daniel von Allmen said: The van der Zee technique uses the same concept as Foker but is done thoracoscopically with no external sutures, so all tension is inside the thorax.
Open
Host summary
Rod Gerardo summarizes what Dr. Daniel von Allmen said: We were all taught the dictum that every effort should be made to conserve the native esophagus as no other conduit can replace its function in transporting food from the oral cavity to the stomach satisfactorily.
Open
Host summary
Rod Gerardo summarizes what Dr. Daniel von Allmen said: In colonic interposition, the piece of colon chosen is based on the blood supply and the diameter needed.
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Rod Gerardo summarizes what Dr. Daniel von Allmen said: In colonic interposition, a pyloroplasty is performed to help with gastric emptying.
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Rod Gerardo summarizes what Dr. Daniel von Allmen said: The short interval between time of traction and anastomosis (less than five days) raises the question of whether the mechanism is stretching or growth, which will impact results and likely reflects on complications.
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Journal of Pediatric Surgery Article Review: December 2021
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Rod Gerardo summarizing the discussion: ERAS protocols are relevant during COVID-19 pandemic for mobilizing hospital beds and reducing hospital stays.
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Summaries Rod gave as host · Trauma 3 summaries
ATLS 2021 Pediatric Surgery Update
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Rod Gerardo summarizes what Dr. Rich Falcone said: Trauma and trauma-related injuries are the number one killer of pediatric patients.
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Rod Gerardo summarizes what Dr. Rich Falcone said: There are validated clinical decision rules for determining when head CT is not necessary in pediatric trauma, with different criteria for children under 2 versus over 2 years old.
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Rod Gerardo summarizes what Dr. Rich Falcone said: In the low-risk abdominal trauma group identified by the algorithm, 0.0% required intervention for intraabdominal injury.
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Summaries Rod gave as host · Trisomy 21 4 summaries
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The Colorectal Quiz Episode 1: ARM - Low Bulbar Fistula
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Rod Gerardo summarizing the discussion: I mean, just me mentioning this, I bet there's a case that popped up in your mind that was a real head scratcher that you've never seen before.
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The Colorectal Quiz: Episode 1
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Rod Gerardo summarizing the discussion: Pediatric colorectal surgery. It just sounds really complex, right? These patients can come with anatomic variances, really rare anomalies. Their care can be complex, dynamic, multidisciplinary, and pose a lot of clinical challenges to your everyday pediatric surgeon.
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Rod Gerardo summarizing the discussion: For cross-table lateral, the baby is positioned prone with a bump under the buttocks to make the buttock the highest point where air will rise
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Rod Gerardo summarizing the discussion: In patients with low rectum, dissecting a little bit of the anterior wall and carefully lifting it off the urinary tract will usually rule out fistula
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Summaries Rod gave as host · Umbilical Hernia 17 summaries
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Gastroschisis and sutureless abdominal wall closure
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Rod Gerardo summarizes what Dr. Jason Fraser said: In 2004, Tony Sandler published the first manuscript about suture disclosures to utilize the natural umbilical properties to closing that defect by itself.
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Rod Gerardo summarizes what Dr. Jason Fraser said: In 2004, Tony Sandler published the first manuscript about sutureless closures utilizing the natural umbilical properties to close the gastroschisis defect by itself.
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Rod Gerardo summarizes what Dr. Jason Fraser said: I didn't know about his article. I found out about it as a fellow when he taught us how to treat gastroschisis that way.
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Rod Gerardo summarizes what Dr. Jason Fraser said: I think it's clearly been a massive change in practice. It's one of the examples of a big change that we don't actually operate on those and they can be done at the bedside. And it also is an example of something that took a while to adopt. And now most people are doing it, I think.
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Rod Gerardo summarizes what Dr. Jason Fraser said: There have been so many articles in the last few years that go back and forth. I mean, one said gastro suture list is better. One said definitely don't do suture list. So my question is now, I don't know. I almost don't read these articles anymore.
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Rod Gerardo summarizes what Dr. Jason Fraser said: I think anytime it's a Kansas City or an NWSPC, NWPSC. Anytime it's an NWPSC article, I pay attention. Anytime it's a Kansas City article, I pay attention. But other than that, I'm tired of seeing all these gastroschisis articles. I'm waiting for someone to give me something that is really meaningful.
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Rod Gerardo summarizes what Dr. Jason Fraser said: Sutureless closure patients had fewer episodes of general anesthetics compared to sutured closure patients.
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Rod Gerardo summarizes what Dr. Jason Fraser said: Sutureless closure patients had less ventilator use compared to sutured closure patients.
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Rod Gerardo summarizes what Dr. Jason Fraser said: The positive outcomes for sutureless repair were observed even when considering patients who required silo use.
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Rod Gerardo summarizes what Dr. Jason Fraser said: Patients who underwent sutureless abdominal wall closure had no difference in days on TPN, time to goal feeds, time to initial feeds, or length of stay compared to sutured closure.
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Rod Gerardo summarizes what Dr. Jason Fraser said: Sutureless closure patients had fewer surgical site and deep space infections compared to sutured closure patients.
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Rod Gerardo summarizes what Dr. Jason Fraser said: The Midwest Pediatric Surgery Consortium study was a retrospective cohort of infants born with gastroschisis between 2013 and 2016, with a total of 315 patients.
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Rod Gerardo summarizes what Dr. Jason Fraser said: The study divided patients into sutured versus sutureless abdominal wall closures and required subgroup analysis because some babies received silos and some did not.
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Rod Gerardo summarizes what Dr. Jason Fraser said: Sutureless closure patients had less antibiotic use compared to sutured closure patients.
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Rod Gerardo summarizes what Dr. Jason Fraser said: Yeah, I think in general, I, I, you're right. I don't know how the pendulum is going to swing, but we are finding more and more. There are things that we don't have to operate on.
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Rod Gerardo summarizes what Dr. Jason Fraser said: Gastroschisis is an abdominal wall defect that used to necessitate a trip to the OR and is now more like a safe bedside procedure.
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Umbilical Pathologies Bonus Episode
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Rod Gerardo summarizes what Dr. Mira Kotigal said: For umbilical hernias, repair is generally deferred until the patient is at least 4 years of age.
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Summaries Rod gave as host · Wilms Tumor 1 summary
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Journal of Pediatric Surgery Article Highlights: April 2022
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Rod Gerardo summarizing the discussion: The third article is titled 'Current Status of Sub-specialization in Pediatric Surgery, a Focus on fetal Surgery' and surveys practice patterns in fetal surgery across the country.
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