The interface between the ganglionic bowel and the a ganglion bowel can be very irregular and can project for 234 centimeters longer along one part of the circumference than the other, so that even if you just look at a longitudinal strip. You could see gangon cells at the proximal margin, but on the opposite side of that margin there may be no gangon cells, and so you may be dealing with a, a low transition zone pull through in that situation.
The interface between the ganglionic bowel and the a ganglion bowel can be very irregular and can project for 234 centimeters longer along one part of the circumference than the other, so that even if you just look at a longitudinal strip. You could see gangon cells at the proximal margin, but on the opposite side of that margin there may be no gangon cells, and so you may be dealing with a, a low transition zone pull through in that situation.
The interface between the ganglionic bowel and the a ganglion bowel can be very irregular and can project for 234 centimeters longer along one part of the circumference than the other, so that even if you just look at a longitudinal strip. You could see gangon cells at the proximal margin, but on the opposite side of that margin there may be no gangon cells, and so you may be dealing with a, a low transition zone pull through in that situation.
I think this paper highlights that this is what happens in an emerging field. You have disparities in what is happening. We're seeing the value of fetal surgery and fetal intervention, and so it's reasonable to expect that there are different levels of what different hospitals do, but it, I think it's great that there are some centers that don't necessarily do interventions, but are having a dedicated team focusing on fetal care.
I think this paper highlights that this is what happens in an emerging field. You have disparities in what is happening. We're seeing the value of fetal surgery and fetal intervention, and so it's reasonable to expect that there are different levels of what different hospitals do, but it, I think it's great that there are some centers that don't necessarily do interventions, but are having a dedicated team focusing on fetal care.
I met Jose Campos at, I think, an IPEG meeting or something and he came up to me and he says, I said, hi, how are you? He goes, yeah, the stuff you're doing is a problem. I was like, nice to meet you too. He said, you're only looking at pediatric surgical journals and pediatric surgical societies, you're missing all of the incredible publications that come out in articles we don't read.
Approach and component separation for suture closure and underlay mesh...
▶Ep 1 · 0:27
quoteI use escharization. I, I paint them and then treat them, I let them epithelialize.↗
▶Ep 1 · 0:27
clinicalspk_0 uses escharotic painting (escharization) followed by epithelialization for giant omphaloceles↗
▶Ep 1 · 1:45
clinicalspk_0 tried silver-impregnated Aquacel which stuck to the sac, became incorporated, and could not be removed - described as a disaster↗
▶Ep 1 · 1:55
quoteI laid the Aqua cell on the silver Aqua cell and it stuck to the, uh, sack and it became incorporated. And could not get it off.↗
▶Ep 1 · 3:16
host_summaryDr. Abello's Duoderm technique involves creating T-shaped Duoderm pieces that form an external silo, which is progressively compressed like gastroschisis reduction over approximately 1-2 weeks↗
▶Ep 1 · 11:07
clinicalComponent separation in small babies is not easy, especially if the omphalocele has been on a silo for a long period and tissues are scarred together↗
▶Ep 1 · 13:10
clinicalComponent separation requires dissection to the mid-axillary line to adequately mobilize tissue↗
▶Ep 1 · 13:22
clinicalspk_0 now uses six-ply Surgisis which has 22 tension lines, allowing tension on the patch while bringing fascia together↗
▶Ep 1 · 21:57
clinicalspk_0 had one massive omphalocele case with muscle only at lateral edge requiring combination of lateral component separation, Gore-Tex attachment, and serial stretching over 3 sessions (like Witzman patch) to achieve muscle-to-muscle closure↗
▶Ep 1 · 22:57
clinicalBiologic dressings are not meant to be bridged - they turn into liquid as temporary material, not muscle, unless permanent↗
▶Ep 1 · 23:10
host_summaryCardiac surgeons report biologic patches in VSD closure turn into cardiac muscle↗
▶Ep 1 · 23:25
clinicalspk_0 observed one pediatric case where biologic patch appeared to turn into muscle or scar↗
quoteI use escharization. I, I paint them and then treat them, I let them epithelialize.↗
▶Ep 3 · 0:36
quoteI use escharization. I, I paint them and then treat them, I let them epithelialize.↗
▶Ep 3 · 1:54
clinicalSilver Aquacel stuck to the omphalocele sac and became incorporated, failing to fall off as expected once it hardened underneath.↗
▶Ep 3 · 1:54
clinicalSilver Aquacel stuck to the omphalocele sac and became incorporated, failing to fall off as expected once it hardened underneath.↗
▶Ep 3 · 2:03
quoteI laid the Aqua cell on the silver Aqua cell and it stuck to the, uh, sack and it became incorporated. And could not get it off.↗
▶Ep 3 · 2:03
quoteI laid the Aqua cell on the silver Aqua cell and it stuck to the, uh, sack and it became incorporated. And could not get it off.↗
▶Ep 3 · 10:56
quotehe's one of these minds that you meet and, and he thinks so creatively, so he's so innovative, and every time I watch his videos, Um, I just am fascinated.↗
▶Ep 3 · 10:56
quotehe's one of these minds that you meet and, and he thinks so creatively, so he's so innovative, and every time I watch his videos, Um, I just am fascinated.↗
▶Ep 3 · 13:20
clinicalComponent separation dissection to the mid-axillary line is necessary to adequately mobilize tissue and achieve closure.↗
▶Ep 3 · 13:20
clinicalComponent separation dissection to the mid-axillary line is necessary to adequately mobilize tissue and achieve closure.↗
▶Ep 3 · 13:31
clinicalSix-ply Surgisis with 22 tension lines works better, allowing tension on the patch while bringing the fascia together.↗
▶Ep 3 · 13:31
clinicalSix-ply Surgisis with 22 tension lines works better, allowing tension on the patch while bringing the fascia together.↗
▶Ep 3 · 16:02
quotewe forget where we, we were, where we've come from sometimes, you know, we look at those great old pictures and, you know, of skin covered in phallos, which still didn't have great techniques to fix them, which we do have now. You can just get out of the way.↗
▶Ep 3 · 16:02
quotewe forget where we, we were, where we've come from sometimes, you know, we look at those great old pictures and, you know, of skin covered in phallos, which still didn't have great techniques to fix them, which we do have now. You can just get out of the way.↗
▶Ep 3 · 16:02
clinicalWith escharization and delayed closure, children go home, play, are active regular kids, epithelialize the whole omphalocele, and can be fixed when older with component separation techniques.↗
▶Ep 3 · 16:02
clinicalWith escharization and delayed closure, children go home, play, are active regular kids, epithelialize the whole omphalocele, and can be fixed when older with component separation techniques.↗
▶Ep 3 · 16:05
quoteThey go home, they're playing, they're active regular kids. They they epithelialize the whole thing and then fix it when they're older with some of these maybe component separation type techniques.↗
▶Ep 3 · 16:05
quoteThey go home, they're playing, they're active regular kids. They they epithelialize the whole thing and then fix it when they're older with some of these maybe component separation type techniques.↗
▶Ep 3 · 25:55
clinicalLivers in small-defect omphaloceles can have a mushroom or dumbbell shape, making reduction very difficult.↗
▶Ep 3 · 25:55
clinicalLivers in small-defect omphaloceles can have a mushroom or dumbbell shape, making reduction very difficult.↗
clinicalFor gastroschisis, bedside reduction can be attempted under sedation (rectal acetaminophen and small-dose fentanyl) without intubation, with success in approximately 80% of cases even when all bowel is eviscerated.↗
▶Ep 4 · 14:20
opinionSpring-loaded Bianchi silos may enlarge the fascial defect because the compressive forces are directed outward at the ring level.↗
▶Ep 4 · 25:19
opinionIf apple-peel bowel is ischemic (not necrotic) and not twisted, waiting until the next day to reassess viability is reasonable before committing to resection.↗
Abdominal Wall Defects with Dr. Jacob Langer
▶Ep 6 · 14:19
clinicalDr. Baird published a paper in JPS showing that patients with flap closure did better in every way than those with sutured fascial closure, including lower rates of umbilical hernia repair↗
▶Ep 6 · 14:19
host_summaryDr. Baird published a paper in JPS showing that patients with flap closure did better in every way than those with sutured fascial closure, including lower rates of umbilical hernia repair↗
▶Ep 6 · 18:10
clinicalSpring-loaded silos (Bentech) create outward pressure forces as you push down, making the defect larger over time↗
▶Ep 6 · 18:10
clinicalSpring-loaded silos (Bentech) create outward pressure forces as you push down, making the defect larger over time↗
▶Ep 6 · 37:22
clinicalCristobal Abello in Colombia uses Duoderm over the sac to compress and reduce omphaloceles over time↗
▶Ep 6 · 37:22
host_summaryCristobal Abello in Colombia uses Duoderm over the sac to compress and reduce omphaloceles over time↗
▶Ep 6 · 42:03
clinicalPhil Gazzetta described the 'flip flop' technique (modification of component separation) for omphalocele closure: lateral incision of anterior sheath only, folding over while attached to posterior sheath, creating single posterior layer↗
▶Ep 6 · 42:03
clinicalPhil Gazzetta described the 'flip flop' technique (modification of component separation) for omphalocele closure: lateral incision of anterior sheath only, folding over while attached to posterior sheath, creating single posterior layer↗
Compiled Sandler Rapid Fire Sessions: Update Course 2015
clinicalFor gastroschisis with inflamed bowel, bedside reduction without intubation is feasible using rectal Tylenol and minimal fentanyl↗
▶Ep 8 · 9:58
clinicalFor gastroschisis with inflamed bowel, bedside reduction without intubation is feasible using rectal Tylenol and minimal fentanyl↗
▶Ep 8 · 14:27
opinionSpring-loaded Bianchi silos may enlarge the fascial defect because the outward forces from the compressed ring push laterally↗
▶Ep 8 · 14:27
opinionSpring-loaded Bianchi silos may enlarge the fascial defect because the outward forces from the compressed ring push laterally↗
Gastroschisis: Advanced Practice Providers
▶Ep 10 · 10:22
clinicalTodd Ponsky has done only non-sutured gastroschisis repair for the last 6 years and has never had a ventral hernia. He reports 10-20% umbilical hernia rate, most resolving by age 3-5 years, with perfect cosmetic results.↗
▶Ep 10 · 10:22
clinicalTodd Ponsky has done only non-sutured gastroschisis repair for the last 6 years and has never had a ventral hernia. He reports 10-20% umbilical hernia rate, most resolving by age 3-5 years, with perfect cosmetic results.↗
▶Ep 10 · 10:26
quoteI have only done this repair, uh, for the last 6 years. I have not done a sutured repair in 6 years.↗
▶Ep 10 · 10:26
quoteI have only done this repair, uh, for the last 6 years. I have not done a sutured repair in 6 years.↗
epidemiologicalIn a pediatric surgery event poll, about 75% of surgeons reported doing non-sutured (Tegaderm) gastroschisis repair.↗
▶Ep 10 · 11:03
epidemiologicalIn a pediatric surgery event poll, about 75% of surgeons reported doing non-sutured (Tegaderm) gastroschisis repair.↗
▶Ep 10 · 11:03
quoteWe did a pediatric surgery event just like this, but for the pediatric surgeons, and we pulled the audience, and I think it was about 75% of the surgeons that did the non-sutured repair.↗
▶Ep 10 · 11:03
quoteWe did a pediatric surgery event just like this, but for the pediatric surgeons, and we pulled the audience, and I think it was about 75% of the surgeons that did the non-sutured repair.↗
▶Ep 10 · 11:53
clinicalFor non-sutured closure, Todd Ponsky places a silo on all patients, reduces at bedside, and if everything reduces he closes it by tying the umbilical cord with suture, laying it in a circle over the hole, applying gauze and Tegaderm, waiting 4 days, then changing dressing every 4 days until sealed (usually 2 weeks).↗
▶Ep 10 · 11:53
clinicalFor non-sutured closure, Todd Ponsky places a silo on all patients, reduces at bedside, and if everything reduces he closes it by tying the umbilical cord with suture, laying it in a circle over the hole, applying gauze and Tegaderm, waiting 4 days, then changing dressing every 4 days until sealed (usually 2 weeks).↗
▶Ep 10 · 29:22
opinionTodd Ponsky does not use bladder pressures for gastroschisis monitoring, finding them not terribly accurate in this patient size. He uses peak airway pressures as primary assessment during reduction, watching them to decide when to stop reducing, and looks at overall baby appearance and urine output.↗
▶Ep 10 · 29:22
opinionTodd Ponsky does not use bladder pressures for gastroschisis monitoring, finding them not terribly accurate in this patient size. He uses peak airway pressures as primary assessment during reduction, watching them to decide when to stop reducing, and looks at overall baby appearance and urine output.↗
▶Ep 10 · 29:25
quoteWe do not use bladder pressures. Uh, I don't find them to be terribly accurate in this size, uh, patient.↗
▶Ep 10 · 29:25
quoteWe do not use bladder pressures. Uh, I don't find them to be terribly accurate in this size, uh, patient.↗
▶Ep 10 · 29:41
quoteWhat I use, Joyce, is, um, usually if they're bad enough that you're wondering what their bladder pressures are, they're often intubated. Um, if they're that sick, and so I look at their peak airway pressures to see, so as I'm reducing them, I watch their peak airway pressures, and that's how I decide when to stop reducing.↗
▶Ep 10 · 29:41
quoteWhat I use, Joyce, is, um, usually if they're bad enough that you're wondering what their bladder pressures are, they're often intubated. Um, if they're that sick, and so I look at their peak airway pressures to see, so as I'm reducing them, I watch their peak airway pressures, and that's how I decide when to stop reducing.↗
▶Ep 10 · 30:03
quoteThere's never a downside to just releasing the silo and letting things back out again, right.↗
▶Ep 10 · 30:03
quoteThere's never a downside to just releasing the silo and letting things back out again, right.↗
▶Ep 10 · 42:18
clinicalFor gastroschisis monitoring, the volume of NG output matters less than the color: even high-volume clear/spitty output may allow feeding, but any bilious output (regardless of volume) means the patient is not ready to feed.↗
▶Ep 10 · 42:18
clinicalFor gastroschisis monitoring, the volume of NG output matters less than the color: even high-volume clear/spitty output may allow feeding, but any bilious output (regardless of volume) means the patient is not ready to feed.↗
▶Ep 10 · 43:11
quoteThe exact opposite is true that you can have a ton of spit coming out, but it doesn't mean that they're not ready to be fed, um, so for some reason in the little kids the volume doesn't seem to be as critical, um, as the color.↗
▶Ep 10 · 43:11
quoteThe exact opposite is true that you can have a ton of spit coming out, but it doesn't mean that they're not ready to be fed, um, so for some reason in the little kids the volume doesn't seem to be as critical, um, as the color.↗
7th Annual Pediatric Surgery Update Course 2019 - FULL SHOW
▶Ep 16 · 0:58
quoteJust two days ago, I had a baby that I was operating on. And because you taught me this, the hemoglobin, they were going to transfuse up to a hematocrit of thoracin. No, I learned from the PDC. We don't have to do that anymore. Transfuse clinically.↗
▶Ep 16 · 2:56
quoteThis single teaching point made the whole update course worth it because he didn't realize this, and it totally changed his practice.↗
▶Ep 16 · 17:16
opinionThe important point in non-operative appendicitis management is not whether it's effective for six months or a year, but what happens 10, 20, or 40 years down the road regarding appendix scarring and future obstruction↗
▶Ep 16 · 17:16
quoteI think the parents are more focused on the here and now. That is what's happening at that moment in the emergency room. Whereas we as their caregivers need to be thinking about what's best for the total life of the patient.↗
▶Ep 16 · 17:16
epidemiologicalParents surveyed for PCORI-funded study said if there was a 50% chance of non-operative appendicitis management being successful, they would enroll in the study↗
▶Ep 16 · 17:16
epidemiologicalIn the APAC trial (adult study), at five years, 41% of the non-operative appendicitis group underwent an appendectomy↗
▶Ep 16 · 17:16
quoteI don't know if any surgeon would look at that and go 41 percent failure rate is a success.↗
▶Ep 16 · 17:16
quoteI use this as something in my back pocket now. So I don't do it, but I have it there. So if someone's not a good surgical candidate, for whatever reason, I don't want it. Then I know I have it as an option, but I don't do it.↗
▶Ep 16 · 23:29
clinicalEnhanced recovery after surgery protocols have been great at reducing opioids both in the inpatient setting and at time of discharge↗
Umbilical Cord Defects with Dr. Kenneth Azarow
▶Ep 21 · 4:54
host_summaryEmerging anesthesia data suggesting risks of operating before age 2–3 provides additional support for delaying umbilical hernia repair.↗
▶Ep 21 · 13:45
host_summaryA Canadian study by Dr. Baird's group showed that gastroschisis patients closed with sutures had higher rates of subsequent umbilical hernia repair compared to sutureless closure.↗
▶Ep 21 · 21:33
epidemiologicalA prospective trial at Dr. Ponsky's institution found triamcinolone (Kenalog) cream superior to silver nitrate for umbilical granulomas, with such a drastic difference the study was stopped early.↗
▶Ep 21 · 29:22
epidemiologicalAnalysis of PHIS (Pediatric Health Information System) data showed the mean age for umbilical hernia repair across U.S. children's hospitals is 4 years.↗
Abdominal Wall Defects with Dr. Jacob Langer
▶Ep 20 · 13:15
host_summaryThe sutureless plastic closure technique was described by Anthony Sandler and doesn't require suturing the umbilical cord↗
▶Ep 20 · 13:15
clinicalThe sutureless plastic closure technique was described by Anthony Sandler and doesn't require suturing the umbilical cord↗
▶Ep 20 · 14:19
host_summaryA study by Dr. Baird published in JPS showed that patients with flap closure did better in every way than those with sutured fascial closure, including lower rates of umbilical hernia repair↗
▶Ep 20 · 14:19
clinicalA study by Dr. Baird published in JPS showed that patients with flap closure did better in every way than those with sutured fascial closure, including lower rates of umbilical hernia repair↗
▶Ep 20 · 18:10
clinicalSpring-loaded silos apply pressure outward as you push down, making the defect larger over time↗
▶Ep 20 · 18:10
clinicalSpring-loaded silos apply pressure outward as you push down, making the defect larger over time↗
▶Ep 20 · 42:06
clinicalThe 'flip flop' technique (modification of component separation) involves incising laterally through anterior sheath only, folding it over while attached to posterior sheath, creating a single posterior sheath closure↗
▶Ep 20 · 42:06
clinicalThe 'flip flop' technique (modification of component separation) involves incising laterally through anterior sheath only, folding it over while attached to posterior sheath, creating a single posterior sheath closure↗
Omphalocele and Gastroschisis With Dr. Foong-Yen Lim
▶Ep 25 · 3:15
host_summaryGastroschisis affects approximately one in every 2,200 live births.↗
▶Ep 25 · 6:34
host_summaryIn the last four and a half years at Cincinnati Children's Hospital, majority of babies are managed using sutureless closure.↗
▶Ep 25 · 8:17
host_summaryAt Cincinnati Children's, Duoderm silo is placed on top of the skin of the patient, formed over the omphalocele, and plastic clips are used to sequentially clip it down until it's flush to the abdominal skin.↗
Journal of Pediatric Surgery Article Review: January 2022 APSA Issue
▶Ep 26 · 5:03
quoteIn Akron, Bob Perry, the way that he structured the bonus was that the entire group has to get a certain RVU, not a single person.↗
▶Ep 26 · 5:03
clinicalAt Akron Children's Hospital under Bob Perry, the bonus structure required the entire group to reach a certain RVU threshold for everyone to receive 50% of their bonus, eliminating competition for cases.↗
▶Ep 26 · 5:19
quoteThat way, there was no competition like trying to steal cases and stuff, because the whole group rose as a group.↗
Omphalocele & Gastroschisis
▶Ep 27 · 1:31
clinicalFor large omphalocele defects, besides intestine, a good amount of the liver is on the outside in the majority of cases.↗
▶Ep 27 · 2:12
clinicalFor omphalocele, besides ultrasound, MRI and echocardiogram are routinely obtained because these patients may have other associated anomalies.↗
▶Ep 27 · 2:12
clinicalFetal growth is tracked monthly in these cases because there is concern for significant growth restriction.↗
▶Ep 27 · 2:12
clinicalFor gastroschisis, only ultrasound is normally obtained to confirm the diagnosis without additional imaging.↗
▶Ep 27 · 3:15
epidemiologicalGastroschisis affects approximately one in every 2200 live births.↗
▶Ep 27 · 8:38
clinicalAfter sequential reduction with plastic clips in omphalocele, the patient is taken to the operating room for delayed primary closure of the fascia and skin.↗
Update Course 2021: UPDATE COURSE 2020: REVIEW OF LAST YEAR'S IMPORTANT T OPICS
▶Ep 28 · 0:00
quoteWe are, we all live in our own little country and we do our own little thing. And it's only when we talk to each other from all over that we do true learning.↗
▶Ep 28 · 1:00
quoteThis is about rapid fire. We're not doing in-depth stuff here. This is rapid fire, important topics that we feel and that a lot, that's why we bring new faculty in every year, that the faculty feel are kind of the real important points that we need to be highlighting all over the world that came up over the last year or so.↗
▶Ep 28 · 1:40
quoteI promise you, I'm making this promise every year, something will glitch. Okay? I've been saying this for nine years. Even a few years ago, the whole power went out in the city and we had to drive to my living room. Something will glitch. Bear with us.↗
▶Ep 28 · 2:20
quoteThis only, as you know, this is free. This is free because, and we've been trying to keep this free as long as we can. We try to believe that knowledge should be free as long as we can do it, as best we can do it.↗
▶Ep 28 · 4:45
epidemiological26% of respondents use intraoperative ICG to visualize the biliary tree, 23% use it in select patients, and 51% do not use it.↗
▶Ep 28 · 10:50
host_summaryDeflux, a compound used by urology for vesicoureteral reflux, has been reported in case reports for rectal prolapse sclerotherapy.↗
▶Ep 28 · 10:50
clinicalGetting phenol into the operating room for sclerotherapy is not always easy due to institutional and pharmacy restrictions.↗
▶Ep 28 · 10:50
host_summaryThere are case reports showing mucosal sloughing with phenol sclerotherapy.↗
▶Ep 28 · 11:20
quoteI think there's also case reports that show mucosal sloughing with phenol.↗
▶Ep 28 · 12:23
epidemiologicalApproximately 50% of respondents always use sutureless abdominal closure for large abdominal wall defects, 40% use it in select patients, and only 11% do not use it.↗
▶Ep 28 · 12:23
epidemiologicalThe adoption of sutureless closure for abdominal wall defects represents a major practice change over nine years, with 90% now using it always or selectively compared to much lower rates previously.↗
▶Ep 28 · 16:42
clinicalImplementing ERAS requires team buy-in, particularly from anesthesiologists, because of practice changes like allowing oral intake two hours preoperatively.↗
▶Ep 28 · 21:50
epidemiologicalMost institutions are either taking steps to address social determinants of health or working on it; few report no action.↗
Update Course 2022 - UPDATES IN GASTROSCHISIS FEEDING PROTOCOLS - Jason Fraser, Beth Rymeski, and Steven Lee
▶Ep 29 · 0:00
host_summarySeveral hospitals have changed their gastroschisis protocols based on recent publications.↗
▶Ep 29 · 0:00
quotewe got feedback that several hospitals have changed their gastro schesis protocols based on recent publications↗
▶Ep 29 · 9:10
quotethe reason these protocols at least in my opinion are important is because there's not variation in care generally speaking they've been tried and true and work all right but the nurses know what it is and you know you don't need to call a doctor every time you want to increase by 10 cc's or whatever↗
quoteWhile most of these audio chapters are recordings between myself and experts in the field, we wanted to try something new this time.↗
▶Ep 1 · 2:34
quoteAmylase and lipase, lipase more sensitive than amylase?↗
Welcome and Introductions: Pancreatic Disease
▶Ep 4 · 0:08
quotewe have a panel of experts who know more than the rest of the world, it seems, uh, from what I've been reading↗
▶Ep 4 · 0:08
quotewe have a panel of experts who know more than the rest of the world, it seems, uh, from what I've been reading↗
▶Ep 4 · 0:28
opinionCincinnati Children's has been leading the world in pediatric surgical education↗
▶Ep 4 · 0:28
opinionCincinnati Children's has been leading the world in pediatric surgical education↗
▶Ep 4 · 1:22
clinicalThe event will be recorded and available after 48 hours↗
▶Ep 4 · 1:22
clinicalThe event will be recorded and available after 48 hours↗
▶Ep 4 · 1:27
clinicalA new video portal will allow users to search by keyword and watch specific segments rather than entire events↗
▶Ep 4 · 1:27
clinicalA new video portal will allow users to search by keyword and watch specific segments rather than entire events↗
▶Ep 4 · 2:00
clinicalThe Center of Telehealth at Cincinnati Children's is used daily by experts to help physicians and patients around the world↗
▶Ep 4 · 2:00
clinicalThe Center of Telehealth at Cincinnati Children's is used daily by experts to help physicians and patients around the world↗
▶Ep 4 · 2:38
clinicalCincinnati Children's Pancreas Care Center is staffed by a large multidisciplinary group rather than one or two specialists↗
▶Ep 4 · 2:38
clinicalCincinnati Children's Pancreas Care Center is staffed by a large multidisciplinary group rather than one or two specialists↗
▶Ep 4 · 3:06
host_summaryDr. Jamie Nathan is assistant professor of surgery and pediatrics, a pediatric and transplant surgeon, and surgical director of the Pancreas Care Center at Cincinnati Children's↗
▶Ep 4 · 3:06
clinicalDr. Jamie Nathan is assistant professor of surgery and pediatrics, a pediatric and transplant surgeon, and surgical director of the Pancreas Care Center at Cincinnati Children's↗
Acute and Acute Recurrent Pancreatitis: Pancreatic Disease
▶Ep 5 · 41:39
clinicalAspiration of pancreatic necrosis to rule out infection should be reserved for cases of true clinical deterioration; in the absence of significant clinical worsening, avoid needle aspiration due to risk of introducing infection into sterile necrosis.↗
▶Ep 5 · 41:39
quoteYou can very much be opening a can of worms if you're starting to stick things into the pancreas. Um, I can tell you that I, I think we've had, um, the need for one in the last 10 years, one necrosectomy for, for, you know, necro truly. Awful necrotizing pancreatitis.↗
▶Ep 5 · 41:39
quoteYou can very much be opening a can of worms if you're starting to stick things into the pancreas. Um, I can tell you that I, I think we've had, um, the need for one in the last 10 years, one necrosectomy for, for, you know, necro truly. Awful necrotizing pancreatitis.↗
▶Ep 5 · 41:39
clinicalAspiration of pancreatic necrosis to rule out infection should be reserved for cases of true clinical deterioration; in the absence of significant clinical worsening, avoid needle aspiration due to risk of introducing infection into sterile necrosis.↗
▶Ep 5 · 41:57
quoteIn the absence of true significant clinical deterioration, we, we really avoid, avoid sticking needles in the pancreas, sticking drains.↗
▶Ep 5 · 41:57
quoteIn the absence of true significant clinical deterioration, we, we really avoid, avoid sticking needles in the pancreas, sticking drains.↗
▶Ep 5 · 42:50
quoteYou stick a needle into a collection that may be sterile, and then you have the risk of introducing infection, and then once you have infected necrosis. Things can can really deteriorate.↗
▶Ep 5 · 42:50
quoteYou stick a needle into a collection that may be sterile, and then you have the risk of introducing infection, and then once you have infected necrosis. Things can can really deteriorate.↗
quotewe have a panel of experts who know more than the rest of the world, it seems, uh, from what I've been reading↗
▶Ep 4 · 0:08
quotewe have a panel of experts who know more than the rest of the world, it seems, uh, from what I've been reading↗
▶Ep 4 · 0:28
opinionCincinnati Children's has been leading the world in pediatric surgical education↗
▶Ep 4 · 0:28
opinionCincinnati Children's has been leading the world in pediatric surgical education↗
▶Ep 4 · 1:22
clinicalThe event will be recorded and available after 48 hours↗
▶Ep 4 · 1:22
clinicalThe event will be recorded and available after 48 hours↗
▶Ep 4 · 1:27
clinicalA new video portal will allow users to search by keyword and watch specific segments rather than entire events↗
▶Ep 4 · 1:27
clinicalA new video portal will allow users to search by keyword and watch specific segments rather than entire events↗
▶Ep 4 · 2:00
clinicalThe Center of Telehealth at Cincinnati Children's is used daily by experts to help physicians and patients around the world↗
▶Ep 4 · 2:00
clinicalThe Center of Telehealth at Cincinnati Children's is used daily by experts to help physicians and patients around the world↗
▶Ep 4 · 2:38
clinicalCincinnati Children's Pancreas Care Center is staffed by a large multidisciplinary group rather than one or two specialists↗
▶Ep 4 · 2:38
clinicalCincinnati Children's Pancreas Care Center is staffed by a large multidisciplinary group rather than one or two specialists↗
▶Ep 4 · 3:06
clinicalDr. Jamie Nathan is assistant professor of surgery and pediatrics, a pediatric and transplant surgeon, and surgical director of the Pancreas Care Center at Cincinnati Children's↗
▶Ep 4 · 3:06
host_summaryDr. Jamie Nathan is assistant professor of surgery and pediatrics, a pediatric and transplant surgeon, and surgical director of the Pancreas Care Center at Cincinnati Children's↗
Acute and Acute Recurrent Pancreatitis: Pancreatic Disease
▶Ep 5 · 41:39
quoteYou can very much be opening a can of worms if you're starting to stick things into the pancreas. Um, I can tell you that I, I think we've had, um, the need for one in the last 10 years, one necrosectomy for, for, you know, necro truly. Awful necrotizing pancreatitis.↗
▶Ep 5 · 41:39
clinicalAspiration of pancreatic necrosis to rule out infection should be reserved for cases of true clinical deterioration; in the absence of significant clinical worsening, avoid needle aspiration due to risk of introducing infection into sterile necrosis.↗
▶Ep 5 · 41:39
clinicalAspiration of pancreatic necrosis to rule out infection should be reserved for cases of true clinical deterioration; in the absence of significant clinical worsening, avoid needle aspiration due to risk of introducing infection into sterile necrosis.↗
▶Ep 5 · 41:39
quoteYou can very much be opening a can of worms if you're starting to stick things into the pancreas. Um, I can tell you that I, I think we've had, um, the need for one in the last 10 years, one necrosectomy for, for, you know, necro truly. Awful necrotizing pancreatitis.↗
▶Ep 5 · 41:57
quoteIn the absence of true significant clinical deterioration, we, we really avoid, avoid sticking needles in the pancreas, sticking drains.↗
▶Ep 5 · 41:57
quoteIn the absence of true significant clinical deterioration, we, we really avoid, avoid sticking needles in the pancreas, sticking drains.↗
▶Ep 5 · 42:50
quoteYou stick a needle into a collection that may be sterile, and then you have the risk of introducing infection, and then once you have infected necrosis. Things can can really deteriorate.↗
▶Ep 5 · 42:50
quoteYou stick a needle into a collection that may be sterile, and then you have the risk of introducing infection, and then once you have infected necrosis. Things can can really deteriorate.↗
Aerodigestive & Esophageal Surgery - The Unsalvageable Esophagus & Cases
▶Ep 3 · 2:14
quoteSome people believe that you have to use a scope to measure the true gap. I may not be at the end.↗
▶Ep 3 · 2:14
quoteSome people believe that you have to use a scope to measure the true gap. I may not be at the end.↗
▶Ep 3 · 2:21
clinicalIn long-gap atresia, some surgeons use a Hagar dilator to measure the gap, but this may not reach the true end of the distal pouch. A flexible scope is more reliable for accurate gap measurement.↗
▶Ep 3 · 2:21
clinicalIn long-gap atresia, some surgeons use a Hagar dilator to measure the gap, but this may not reach the true end of the distal pouch. A flexible scope is more reliable for accurate gap measurement.↗
clinicalIn experimental porcine models of endoscopic Foker (using olive beads and wire traction), pressure necrosis at the anastomotic site is the suspected cause of death.↗
▶Ep 3 · 6:32
clinicalIn experimental porcine models of endoscopic Foker (using olive beads and wire traction), pressure necrosis at the anastomotic site is the suspected cause of death.↗
▶Ep 3 · 7:00
clinicalIntraluminal magnetic anastomosis is being developed as a minimally invasive approach to long-gap atresia, with the goal of reducing pressure necrosis compared to bead-based traction.↗
▶Ep 3 · 7:00
clinicalIntraluminal magnetic anastomosis is being developed as a minimally invasive approach to long-gap atresia, with the goal of reducing pressure necrosis compared to bead-based traction.↗
▶Ep 3 · 10:52
quoteThe whole big controversial thing is, do, are we trying too hard to save the esophagus?↗
▶Ep 3 · 10:52
quoteThe whole big controversial thing is, do, are we trying too hard to save the esophagus?↗
▶Ep 3 · 19:13
quoteStents don't work in, in scarred, uh, form strictures that are not fresh.↗
▶Ep 3 · 19:13
quoteStents don't work in, in scarred, uh, form strictures that are not fresh.↗
▶Ep 3 · 26:28
clinicalPlacing endoscopes from above and below during thoracoscopic stricture resection allows identification of the stricture by transillumination ('go to the light').↗
▶Ep 3 · 26:28
clinicalPlacing endoscopes from above and below during thoracoscopic stricture resection allows identification of the stricture by transillumination ('go to the light').↗
▶Ep 3 · 30:25
clinicalMagnetic compression anastomosis (magnamosis) has been used successfully for gastrojejunostomy but is unproven in the esophagus. The main limitations are the distance magnets can attract across and the lack of mucosal lining in the resulting anastomosis.↗
▶Ep 3 · 30:25
clinicalMagnetic compression anastomosis (magnamosis) has been used successfully for gastrojejunostomy but is unproven in the esophagus. The main limitations are the distance magnets can attract across and the lack of mucosal lining in the resulting anastomosis.↗
▶Ep 3 · 41:47
clinicalSerial bougie dilation (e.g., Maloney or Savary dilators) is less effective than balloon dilation for esophageal strictures. Balloon dilation applies radial force and can crack scar tissue without requiring needle knife incision.↗
▶Ep 3 · 41:47
clinicalSerial bougie dilation (e.g., Maloney or Savary dilators) is less effective than balloon dilation for esophageal strictures. Balloon dilation applies radial force and can crack scar tissue without requiring needle knife incision.↗
▶Ep 3 · 47:31
quoteI always tease our gastroenterologists that it's impossible to remove the endoscope without bringing out tissue with it.↗
▶Ep 3 · 47:31
quoteI always tease our gastroenterologists that it's impossible to remove the endoscope without bringing out tissue with it.↗
▶Ep 3 · 54:12
clinicalMobilizing the gastroesophageal junction to achieve length for primary esophageal anastomosis effectively creates a hiatal hernia and predisposes to reflux.↗
▶Ep 3 · 54:12
clinicalMobilizing the gastroesophageal junction to achieve length for primary esophageal anastomosis effectively creates a hiatal hernia and predisposes to reflux.↗
▶Ep 3 · 59:46
quoteClearly I had ischemia because it was 100% a technical issue, whether it was ischemia.↗
▶Ep 3 · 59:46
quoteClearly I had ischemia because it was 100% a technical issue, whether it was ischemia.↗
▶Ep 3 · 1:14:05
clinicalFor a spit fistula to avoid recurrent TEF, the distal esophageal stump must be fully mobilized down to the diaphragm and separated from the trachea, not just divided and dropped.↗
▶Ep 3 · 1:14:05
clinicalFor a spit fistula to avoid recurrent TEF, the distal esophageal stump must be fully mobilized down to the diaphragm and separated from the trachea, not just divided and dropped.↗
▶Ep 3 · 1:40:18
quoteIt's been a real pleasure being here today and it's been an honor how much I've learned in one day.↗
▶Ep 3 · 1:40:18
quoteIt's been a real pleasure being here today and it's been an honor how much I've learned in one day.↗
▶Ep 3 · 1:40:28
quoteAbsolutely amazing webinar, some amazing cases with excellent skills that you all brought today. I'm happy that you all are there for us when these cases get beyond the norm.↗
▶Ep 3 · 1:40:28
quoteAbsolutely amazing webinar, some amazing cases with excellent skills that you all brought today. I'm happy that you all are there for us when these cases get beyond the norm.↗
Aerodigestive & Esophageal Surgery - Difficult Tracheal Esophageal Fistula
▶Ep 2 · 25:08
clinicalTrichloroacetic acid (TCA) can be used to demucosalize TEF tracts, but control is less precise than with bugbee cautery; TCA is applied on a pledget and can cause unintended burns if it contacts tissue during insertion.↗
▶Ep 2 · 25:08
clinicalTrichloroacetic acid (TCA) can be used to demucosalize TEF tracts, but control is less precise than with bugbee cautery; TCA is applied on a pledget and can cause unintended burns if it contacts tissue during insertion.↗
▶Ep 2 · 1:50:04
clinicalAnal fistula plugs (biologic, cone-shaped, made of Surgisis) can theoretically be used to occlude distal airway fistulas; they are wrapped with barbed suture and inserted into the tract to promote collagen matrix formation and scarring.↗
▶Ep 2 · 1:50:04
clinicalAnal fistula plugs (biologic, cone-shaped, made of Surgisis) can theoretically be used to occlude distal airway fistulas; they are wrapped with barbed suture and inserted into the tract to promote collagen matrix formation and scarring.↗
TEF Presentations (Extended): Aerodigestive & Esophageal Surgery
▶Ep 4 · 0:00
quoteThis instrument I learned from actually a previous Globalcast and now I use it all the time.↗
▶Ep 4 · 0:00
quoteThis instrument I learned from actually a previous Globalcast and now I use it all the time.↗
▶Ep 4 · 0:04
quoteThe bugbee is so useful and underutilized among us as general surgeons.↗
▶Ep 4 · 0:04
opinionThe bugbee cautery is useful and underutilized among general surgeons for treating recurrent tracheoesophageal fistulas.↗
▶Ep 4 · 0:04
opinionThe bugbee cautery is useful and underutilized among general surgeons for treating recurrent tracheoesophageal fistulas.↗
▶Ep 4 · 0:04
quoteThe bugbee is so useful and underutilized among us as general surgeons.↗
▶Ep 4 · 1:53
quoteWe may underappreciate tracheomalacia or malaysia.↗
▶Ep 4 · 1:53
opinionGeneral surgeons may underappreciate tracheomalacia or laryngomalacia, making collaboration with ENT colleagues valuable for comprehensive airway assessment.↗
▶Ep 4 · 1:53
opinionGeneral surgeons may underappreciate tracheomalacia or laryngomalacia, making collaboration with ENT colleagues valuable for comprehensive airway assessment.↗
▶Ep 4 · 1:53
quoteWe may underappreciate tracheomalacia or malaysia.↗
▶Ep 4 · 12:21
clinicalTrichloroacetic acid (TCA) can be used for TEF demucosalization, but it is difficult to control precisely and leaves white tissue everywhere, whereas the bugbee provides more precise control.↗
▶Ep 4 · 12:21
clinicalTrichloroacetic acid (TCA) can be used for TEF demucosalization, but it is difficult to control precisely and leaves white tissue everywhere, whereas the bugbee provides more precise control.↗
▶Ep 4 · 12:57
quoteI have to tell you what scares me is when I'm done, it's white everywhere because I mean, the whole, it's hard to control it and be precise.↗
▶Ep 4 · 12:57
quoteI have to tell you what scares me is when I'm done, it's white everywhere because I mean, the whole, it's hard to control it and be precise.↗
▶Ep 4 · 13:19
quoteWhen I switched to the bug bee, I have herby bug bee bug beat, um, it's, uh, it absolutely is much more precise.↗
▶Ep 4 · 13:19
quoteWhen I switched to the bug bee, I have herby bug bee bug beat, um, it's, uh, it absolutely is much more precise.↗
▶Ep 4 · 17:52
quoteI'm always afraid because I can't see down that tube, and I wonder not just word in the esophagus, I wonder if I'm really destroying that fistula so much that I'm gonna perforate↗
▶Ep 4 · 17:52
quoteI'm always afraid because I can't see down that tube, and I wonder not just word in the esophagus, I wonder if I'm really destroying that fistula so much that I'm gonna perforate↗
▶Ep 4 · 45:31
clinicalDead button batteries still have about 2 volts and continue to cause damage.↗
▶Ep 4 · 45:31
quoteWhen they're dead, they're still not dead. They're still going. They got about 2 volts↗
▶Ep 4 · 45:31
quoteWhen they're dead, they're still not dead. They're still going. They got about 2 volts↗
▶Ep 4 · 45:31
host_summaryDead button batteries still have about 2 volts and continue to cause damage.↗
▶Ep 4 · 45:37
host_summaryButton batteries can be distinguished from coins on AP X-ray by a visible rim, eliminating the need for a lateral view.↗
▶Ep 4 · 45:37
clinicalButton batteries can be distinguished from coins on AP X-ray by a visible rim, eliminating the need for a lateral view.↗
▶Ep 4 · 1:09:25
clinicalFor TEF repair, all that matters is achieving raw-on-raw tissue contact for healing.↗
▶Ep 4 · 1:09:25
clinicalFor TEF repair, all that matters is achieving raw-on-raw tissue contact for healing.↗
▶Ep 4 · 1:09:33
opinionThoracoscopic diaphragmatic hernia repairs may have a higher recurrence rate than open repairs, possibly because they do not cause enough raw-on-raw tissue contact.↗
▶Ep 4 · 1:09:33
opinionThoracoscopic diaphragmatic hernia repairs may have a higher recurrence rate than open repairs, possibly because they do not cause enough raw-on-raw tissue contact.↗
▶Ep 4 · 1:37:24
clinicalAnal fistula plugs made of biologic material (surgesis) can be used for TEF repair by wrapping them with barbed VOC suture and inserting them into the fistula tract to promote scarring and collagen matrix formation.↗
▶Ep 4 · 1:37:24
clinicalAnal fistula plugs made of biologic material (surgesis) can be used for TEF repair by wrapping them with barbed VOC suture and inserting them into the fistula tract to promote scarring and collagen matrix formation.↗
QUAD #1: Cervical Tracheopexy with Dr. Alessandro de Alarcon
▶Ep 16 · 0:55
host_summaryPreoperative testing includes dynamic CT imaging, pulmonary function tests, microlaryngoscopy and bronchoscopy, and flexible bronchoscopy.↗
▶Ep 16 · 2:01
host_summaryThe cervical approach can assist thoracoscopic procedures by removing residual or regrown large thymus tissue.↗
▶Ep 16 · 2:19
host_summaryIn the lateral approach, the surgical team works on the side of the airway to find the esophagus.↗
▶Ep 16 · 2:23
host_summaryPediatric surgeons identify the recurrent nerve for the ENT team to help prevent injury.↗
▶Ep 16 · 2:43
host_summaryThe esophagus is mobilized above the level where the team aims to perform the pexy, making suture placement easier.↗
▶Ep 16 · 3:02
host_summaryA pulmonologist assists with flexible endoscopy through the endotracheal tube to visualize inside the trachea while stitches are placed.↗
▶Ep 16 · 3:24
host_summaryThe combined approach is valuable for complicated cases or patients needing additional operations for symptom relief.↗
▶Ep 16 · 4:32
host_summaryOtolaryngology involvement is important both during the procedure and in follow-up due to potential complications.↗
quotewe've all been taught over the years that when we do a colostomy for an anal rectal malformation, we should do a divided colostomy, and the main reason to do that is to prevent stool flowing down that could cause a urinary tract infection.↗
▶Ep 1 · 0:08
host_summaryTraditional teaching holds that divided colostomy should be performed for anorectal malformations to prevent stool flowing down that could cause urinary tract infection.↗
▶Ep 1 · 0:24
host_summaryDr. Robert Baird performed a meta-analysis of multiple studies comparing divided colostomy versus loop colostomy for anorectal malformations.↗
▶Ep 1 · 0:27
host_summaryThe meta-analysis found no statistically significant difference in urinary tract infection incidence between divided colostomy and loop colostomy.↗
▶Ep 1 · 0:39
host_summarySome individual studies within the meta-analysis showed a difference in UTI rates, but the overall meta-analysis showed no statistical difference.↗
▶Ep 1 · 0:51
host_summaryLoop colostomies had a significantly higher stoma prolapse rate compared to divided colostomies.↗
▶Ep 1 · 1:05
host_summarySkin excoriation, stoma retraction, peristomal hernia, wound infection, and stoma stricture showed no statistical difference between loop colostomy and divided colostomy.↗
▶Ep 1 · 1:22
quotethere we go, we've challenged dogma, and it seems like dogma necessarily at this point doesn't seem to hold true.↗
Challenging Dogma: Does Colostomy Type Matter?
▶Ep 3 · 0:08
quotewe've all been taught over the years that when we do a colostomy for an anal rectal malformation, we should do a divided colostomy, and the main reason to do that is to prevent stool flowing down that could cause a urinary tract infection.↗
▶Ep 3 · 0:08
host_summaryTraditional teaching advocates for divided colostomy when performing colostomy for anorectal malformation, with the main rationale being prevention of stool flowing down that could cause urinary tract infection.↗
▶Ep 3 · 0:24
host_summaryDr. Robert Baird performed a meta-analysis of multiple studies comparing divided colostomy versus loop colostomy for incidence of UTI.↗
▶Ep 3 · 0:27
host_summaryThe meta-analysis found no statistically significant difference in UTI rates between loop colostomy and divided colostomy, despite some individual studies showing a difference.↗
host_summaryThe standard Hagar dilator size for a newborn is about size 12, so a size 10 is 2 deviations less.↗
▶Ep 44 · 2:16
host_summaryIn the dilation study with 25 children, the types of malformations were evenly distributed and complexity was about equal.↗
Colorectal Quiz: Episode 49 – Collaborating for Kids: Colorectal & Pelvic Solutions (with a Little Help from AI)
▶Ep 59 · 1:20
quoteMark, you're always not only good at anal rectum malformations, but you have been interested in All the tech and the media from the very beginning.↗
▶Ep 59 · 1:35
quoteWhat M and I are working on is how we can mass produce content to equilibrate knowledge around the world, and we know that the only way to do that is to use cutting edge technology, automation tools and AI.↗
▶Ep 59 · 2:16
clinicalNotebook LM is a free offering from Google that can create realistic-sounding podcasts between two AI voices from uploaded documents.↗
▶Ep 59 · 2:31
quoteI would love to hear your thoughts, Mark, on your first experience with Notebook LM.↗
▶Ep 59 · 4:14
quoteNo one has been able to do it as well as Notebook LM.↗
▶Ep 59 · 4:22
opinionThe AI-generated podcast voices are not customizable; users are limited to the same male and female voices.↗
▶Ep 59 · 4:26
quoteThere's actually an incredible video where they uploaded a document telling these two podcast hosts that they were AI and how they reacted. They freaked out.↗
▶Ep 59 · 4:52
quoteDo I think this is the future of podcasting? I don't.↗
▶Ep 59 · 5:03
clinicalNotebook LM's beta version allows users to join the AI conversation interactively.↗
▶Ep 59 · 5:09
quoteYou could click join, and it goes, hey, what's up? And you could say, hey, I heard what you just said about the colostomy. I'm not sure I agree, and then it will talk with you.↗
▶Ep 59 · 7:42
quoteThe AI revolution has happened, and each month, it's blowing up and replacing jobs.↗
opinionHospitals should have teams that continuously bring new AI tools to clinicians every week.↗
▶Ep 59 · 8:11
clinicalEm Gootee triangulates multiple AI platforms to combine the strengths of different tools (intelligence, audio, video).↗
▶Ep 59 · 8:26
opinionHuman oversight is necessary to ensure AI-generated medical content is correct.↗
▶Ep 59 · 8:26
quoteYou have to have human oversight to make sure they're correct.↗
Colorectal Quiz: Episode 49 - Collaborating for Kids: Colorectal & Pelvic Solutions (with a Little Help from AI)
▶Ep 75 · 1:18
quotewhat em and i are working on is how we can mass produce content to equilibrate knowledge around the world and we know that the only way to do that is to use cutting edge technology automation tools and ai↗
▶Ep 75 · 1:18
clinicalNotebookLM is a free offering from Google that can upload any content and create a realistic-sounding podcast between two people.↗
▶Ep 75 · 3:41
quotedo i think this is the future of podcasting i don't i think the voices are great but it's not customizable enough you're stuck with what it decided↗
▶Ep 75 · 6:39
quotethe ai revolution has happened and each month it's blowing up and replacing jobs↗
▶Ep 75 · 6:39
quotethe key thing is to be like you're doing and everyone else you have to be looking at ai and using it in your workflow if you're not you'll get behind↗
▶Ep 75 · 6:39
clinicalA review article that took two weeks to produce five years ago can now be created in minutes using NotebookLM with the same 30 source articles.↗
▶Ep 75 · 7:30
clinicalNotebookLM can identify gaps in knowledge across multiple research articles and recognize when new articles fill those gaps.↗
Colorectal Quiz: Episode 2
▶Ep 85 · 7:09
quoteYou all both looked at this image and said, you can tell, obviously, that this is too low, too posterior. Without a stimulator in the office, what do you look for to immediately tell that the analplasty was done too low?↗
Colorectal Quiz: Episode 2
▶Ep 86 · 7:09
quoteYou all both looked at this image and said, you can tell, obviously, that this is too low, too posterior. Without a stimulator in the office, what do you look for to immediately tell that the analplasty was done too low?↗
quotewhat does the evidence tell us about how we should be managing appendicitis↗
▶Ep 2 · 24:30
quoteI am not gonna use this as a treatment protocol. I'm treating this as, uh, that's good to know that this is an option↗
▶Ep 2 · 29:02
clinicalAt Nationwide, a separate small population with appendicoliths was allowed enrollment, but that arm was stopped based on the failure rate.↗
▶Ep 2 · 29:56
epidemiologicalIn a cohort of patients with post-appendectomy abscesses, outcomes were relatively equivalent between drain and no drain, but the biggest abscesses and worst patients received drains.↗
▶Ep 2 · 30:40
epidemiologicalAfter size-matching to 17.5 cm² (AP versus lateral in axial dimension), there was an advantage to not having a drain.↗
▶Ep 2 · 31:10
clinicalFor abscesses less than 20 cm² (less than 4 x 5 cm), drains are typically discouraged because the advantage is small and drains add an extra anesthetic, procedure, and may increase length of stay.↗
Biliary Atresia, Appendicitis, Intestinal Failure, and Anesthetic...
▶Ep 3 · 42:16
clinicalDr. Ponsky's chief of anesthesiology instituted a 'rule of two': defer elective operations until after age 2 and avoid two anesthetics in one year.↗
▶Ep 3 · 42:31
opinionDr. Ponsky now defers dermoid cyst excision in a 6-month-old until 18 months but does not delay inguinal hernia repair due to known incarceration risk in young infants.↗
Biliary Atresia, Appendicitis, Intestinal Failure, and Anesthetic...
▶Ep 6 · 42:16
clinicalDr. Ponsky's chief of anesthesiology instituted a 'rule of two': defer elective operations until after age 2 and avoid two anesthetics in one year.↗
▶Ep 6 · 42:31
opinionDr. Ponsky now defers dermoid cyst excision in a 6-month-old until 18 months but does not delay inguinal hernia repair due to known incarceration risk in young infants.↗
Evidence-based diagnosis and management of pediatric appendicitis with Dr. Whit Holcomb
▶Ep 8 · 30:23
host_summaryWound infection rate was 3.3% (6/180) for single-incision versus 1.7% (3/180) for three-port, p=0.5, not statistically different↗
Update Course 2021: TOP PUBLICATIONS IN NON - PED SURG JOURNALS
▶Ep 3 · 1:53
host_summaryThe curation process filters approximately 1200 articles per month from 33 pediatric and general surgical journals plus 3 top clinical journals (NEJM, Lancet, JAMA) down to 25-50 relevant pediatric surgery articles, then further narrows to 10-15 through specialty filtering, quality ranking, methodology assessment, and popularity polling among general surgeons.↗
▶Ep 3 · 5:30
clinicalUpper GI contrast study is operator-dependent and requires direct communication with radiologist, readily available at high-volume centers but requires more coordination at community hospitals.↗
▶Ep 3 · 5:30
quoteI would call my radiologist and have him do an upper GI and stand there watching it.↗
▶Ep 3 · 10:22
clinicalThe presence of an appendicolith in appendicitis has about a 50% failure rate with non-operative management, making it a contraindication for non-surgical treatment.↗
▶Ep 3 · 10:22
quotethe studies, uh, currently, I think, uh, you know, what this, uh, is hoping to highlight is the ability to use non-operative management of appendicitis in certain cases, but, um, uh, the studies that we have, uh, show that, uh, having the presence of an appendiculli actually has about a 50% failure rate.↗
▶Ep 3 · 10:43
quoteso, um, that's, uh, you know, uh, not good enough, uh, for me. Uh, so, uh, most of us actually use the presence of that appendicolith as a no go, uh, for, uh, non-operative management.↗
▶Ep 3 · 11:52
host_summaryIn the Annals of Surgery 5-year follow-up study of non-operative appendicitis management, 46% of patients randomized to non-surgical management required appendectomy during follow-up, while the surgical group had no complications or readmissions.↗
▶Ep 3 · 12:08
host_summaryHalf of the non-surgical appendicitis management group presented to the emergency room during 5-year follow-up.↗
▶Ep 3 · 18:16
host_summaryIn the Journal of Trauma study of 135 children aged 1-17 years who received whole blood as adjunct to component therapy, matched to 270 children receiving only component therapy, the whole blood group had decreased transfusion volume at 24 hours and required fewer ventilation days, though mortality, length of stay, and major complications were the same.↗
▶Ep 3 · 19:36
quoteI, I would agree that we should be going with normal sailing based on the ATLS protocols. I, I will tell you though, um, that nationwide in adults we are starting to see ambulance rigs. Travel with whole blood capabilities in adults and people are starting to use whole blood even earlier.↗
▶Ep 3 · 19:40
guidelineCurrent ATLS protocols recommend initial bolus with normal saline or crystalloid solution before moving to blood products in pediatric trauma.↗
▶Ep 3 · 19:40
clinicalNationwide in adults, ambulance rigs are starting to travel with whole blood capabilities and people are using whole blood even earlier in trauma resuscitation.↗
▶Ep 3 · 20:05
quoteI have to tell you this is, I love this course. It's changing. It's an evolution↗
▶Ep 3 · 20:28
clinicalThe challenge for whole blood in pediatrics is availability, and thankfully for children, we don't use a lot of massive transfusion protocols compared to adults.↗
▶Ep 3 · 20:28
quotethe challenge for whole blood is availability↗
▶Ep 3 · 20:40
quotehaving blood bank capabilities, especially. Uh, because thankfully for children, we don't use a lot of massive transfusion protocols. So I, I think you're seeing more of this in adults. Um, some of the pediatric centers are coming along, um, slowly, but, but definitely we're seeing more.↗
▶Ep 3 · 21:13
clinicalSome centers are limiting whole blood use to males and some to children older than 15, depending on institutional protocols and blood bank partnerships.↗
Update Course 2022 - TOP PUBLICATIONS IN NON- PED SURG JOURNALS - Jose Campos
▶Ep 9 · 0:30
quoteI met Jose Campos at, I think, an IPEG meeting or something and he came up to me and he says, I said, hi, how are you? He goes, yeah, the stuff you're doing is a problem. I was like, nice to meet you too. He said, you're only looking at pediatric surgical journals and pediatric surgical societies, you're missing all of the incredible publications that come out in articles we don't read.↗
▶Ep 9 · 16:52
quoteIt was invented before there was widespread laparoscopy. It came first. Then laparoscopic. Because of that order, a lot of people favor PEG, but it's blind. I mean, you're putting something right through the belly without looking, so it makes no sense to me.↗
▶Ep 9 · 17:36
clinicalThe article by Todd Ponsky Sr. and Mike Goddard on PEG tube placement remains the most cited article in the history of the Journal of Pediatric Surgery, with approximately three times the citations of the number two article.↗
▶Ep 9 · 17:36
quoteThe article by Jeff Ponsky and Mike Goddard remains the most cited article in the history of the Journal of Pediatric Surgery by far by like three times the number two article so it's a real landmark paper and we owe dr. Ponsky and Goddard a tip the cap for coming up with this technique when it really was the first minimally invasive way to insert a gastrostomy tube.↗
Biliary Atresia - Robert Parry: Update Course 2014
▶Ep 1 · 4:03
epidemiologicalRich Ricketts' series showed not statistically significant better results with Kasai at 76 days or older compared to 0-75 days, possibly representing a different disease phenotype in late presenters.↗
▶Ep 1 · 4:03
host_summaryRich Ricketts' series showed not statistically significant better results with Kasai at 76 days or older compared to 0-75 days, possibly representing a different disease phenotype in late presenters.↗
▶Ep 1 · 9:19
clinicalReversal of portal flow is a very concerning finding because patients can achieve good biliary drainage and normal bilirubin but still progress to transplant due to profound portal hypertension.↗
▶Ep 1 · 9:19
quotethat reversal of portal flow makes me really concerned because, you know, I've I've had patients that I've done a cassa on have achieved good biliary drainage. They've got a normal bilirubin. But their portal hypertension then continues to ramp up↗
▶Ep 1 · 9:19
quotethat reversal of portal flow makes me really concerned because, you know, I've I've had patients that I've done a cassa on have achieved good biliary drainage. They've got a normal bilirubin. But their portal hypertension then continues to ramp up↗
▶Ep 1 · 9:19
clinicalReversal of portal flow is a very concerning finding because patients can achieve good biliary drainage and normal bilirubin but still progress to transplant due to profound portal hypertension.↗
▶Ep 1 · 10:41
clinicalHepatologists can manage biliary atresia patients medically for up to a year in the absence of Kasai or transplant, though nutritional status suffers.↗
▶Ep 1 · 10:41
clinicalHepatologists can manage biliary atresia patients medically for up to a year in the absence of Kasai or transplant, though nutritional status suffers.↗
▶Ep 1 · 10:41
quotethe hepatologists can actually limp these kids along. They're not nutritionally in a great place, but they can get them out to be, you know, a year in the absence of a cassai and the absence of a transplant↗
▶Ep 1 · 10:41
quotethe hepatologists can actually limp these kids along. They're not nutritionally in a great place, but they can get them out to be, you know, a year in the absence of a cassai and the absence of a transplant↗
▶Ep 1 · 10:56
opinionIn patients with end-stage liver disease signs (profound fibrosis, reversed portal flow), Kasai may not improve outcomes and the operative stress may worsen their condition.↗
▶Ep 1 · 10:56
opinionIn patients with end-stage liver disease signs (profound fibrosis, reversed portal flow), Kasai may not improve outcomes and the operative stress may worsen their condition.↗
▶Ep 1 · 12:00
quoteit's almost like um a race between regeneration of hepatocytes and progression of fibrosis↗
▶Ep 1 · 12:00
quoteit's almost like um a race between regeneration of hepatocytes and progression of fibrosis↗
▶Ep 1 · 12:20
clinicalSome biliary atresia patients show delayed response to Kasai, with bilirubin remaining elevated for months then dropping to normal at 5 months post-op, suggesting a race between hepatocyte regeneration and fibrosis progression.↗
▶Ep 1 · 12:20
clinicalSome biliary atresia patients show delayed response to Kasai, with bilirubin remaining elevated for months then dropping to normal at 5 months post-op, suggesting a race between hepatocyte regeneration and fibrosis progression.↗
▶Ep 1 · 12:20
quoteI've had a patient that I didn't redo, and I thought surely the thing was a failure because the bilirubin remained elevated, and then at 5 months post-op, the bilirubin dropped to normal↗
▶Ep 1 · 12:20
quoteI've had a patient that I didn't redo, and I thought surely the thing was a failure because the bilirubin remained elevated, and then at 5 months post-op, the bilirubin dropped to normal↗
▶Ep 1 · 14:41
quoteif the question is getting them to the OR sooner, now you're going to delay by, you know, however many days, you know, while you're inducing them with phenobarb↗
▶Ep 1 · 14:41
quoteif the question is getting them to the OR sooner, now you're going to delay by, you know, however many days, you know, while you're inducing them with phenobarb↗
▶Ep 1 · 17:35
epidemiologicalA recent paper in Gastroenterology described a scoring system using liver biopsy plus clinical parameters with nearly 100% ability to predict biliary atresia.↗
▶Ep 1 · 17:35
host_summaryA recent paper in Gastroenterology described a scoring system using liver biopsy plus clinical parameters with nearly 100% ability to predict biliary atresia.↗
▶Ep 1 · 18:01
opinionPathologists' understanding of biliary atresia histology has improved significantly compared to 20 years ago.↗
▶Ep 1 · 18:01
opinionPathologists' understanding of biliary atresia histology has improved significantly compared to 20 years ago.↗
▶Ep 1 · 18:10
clinicalInterventional radiologists can perform percutaneous liver biopsy safely and routinely, making it a low-barrier test.↗
▶Ep 1 · 18:10
clinicalInterventional radiologists can perform percutaneous liver biopsy safely and routinely, making it a low-barrier test.↗
Biliary Atresia
▶Ep 2 · 0:00
quoteThis is uh Doctor Greg Tia. Greg is the, uh, congratulations, the new uh chief of pediatric surgery at the Cincinnati Children's Hospital.↗
Biliary Atresia, Appendicitis, Intestinal Failure, and Anesthetic...
▶Ep 6 · 42:16
clinicalDr. Ponsky's chief of anesthesiology instituted a 'rule of two': defer elective operations until after age 2 and avoid two anesthetics in one year.↗
▶Ep 6 · 42:31
opinionDr. Ponsky now defers dermoid cyst excision in a 6-month-old until 18 months but does not delay inguinal hernia repair due to known incarceration risk in young infants.↗
Biliary Atresia, Appendicitis, Intestinal Failure, and Anesthetic...
▶Ep 10 · 42:16
clinicalDr. Ponsky's chief of anesthesiology instituted a 'rule of two': defer elective operations until after age 2 and avoid two anesthetics in one year.↗
▶Ep 10 · 42:31
opinionDr. Ponsky now defers dermoid cyst excision in a 6-month-old until 18 months but does not delay inguinal hernia repair due to known incarceration risk in young infants.↗
Update Course 2021: UPDATE COURSE 2020: REVIEW OF LAST YEAR'S IMPORTANT T OPICS
▶Ep 11 · 0:00
quoteWe are, we all live in our own little country and we do our own little thing. And it's only when we talk to each other from all over that we do true learning.↗
▶Ep 11 · 1:00
quoteThis is about rapid fire. We're not doing in-depth stuff here. This is rapid fire, important topics that we feel and that a lot, that's why we bring new faculty in every year, that the faculty feel are kind of the real important points that we need to be highlighting all over the world that came up over the last year or so.↗
▶Ep 11 · 1:40
quoteI promise you, I'm making this promise every year, something will glitch. Okay? I've been saying this for nine years. Even a few years ago, the whole power went out in the city and we had to drive to my living room. Something will glitch. Bear with us.↗
▶Ep 11 · 2:20
quoteThis only, as you know, this is free. This is free because, and we've been trying to keep this free as long as we can. We try to believe that knowledge should be free as long as we can do it, as best we can do it.↗
▶Ep 11 · 4:45
epidemiological26% of respondents use intraoperative ICG to visualize the biliary tree, 23% use it in select patients, and 51% do not use it.↗
▶Ep 11 · 10:50
host_summaryDeflux, a compound used by urology for vesicoureteral reflux, has been reported in case reports for rectal prolapse sclerotherapy.↗
▶Ep 11 · 10:50
clinicalGetting phenol into the operating room for sclerotherapy is not always easy due to institutional and pharmacy restrictions.↗
▶Ep 11 · 10:50
host_summaryThere are case reports showing mucosal sloughing with phenol sclerotherapy.↗
▶Ep 11 · 11:20
quoteI think there's also case reports that show mucosal sloughing with phenol.↗
▶Ep 11 · 12:23
epidemiologicalThe adoption of sutureless closure for abdominal wall defects represents a major practice change over nine years, with 90% now using it always or selectively compared to much lower rates previously.↗
▶Ep 11 · 12:23
epidemiologicalApproximately 50% of respondents always use sutureless abdominal closure for large abdominal wall defects, 40% use it in select patients, and only 11% do not use it.↗
▶Ep 11 · 16:42
clinicalImplementing ERAS requires team buy-in, particularly from anesthesiologists, because of practice changes like allowing oral intake two hours preoperatively.↗
▶Ep 11 · 21:50
epidemiologicalMost institutions are either taking steps to address social determinants of health or working on it; few report no action.↗
Biliary Atresia Part I
▶Ep 13 · 22:55
host_summaryIPEG placed a moratorium on laparoscopic Kasai portoenterostomy because of poor outcomes.↗
▶Ep 13 · 22:55
guidelineIPEG placed a moratorium on laparoscopic Kasai portoenterostomy because of poor outcomes.↗
Heat 1 Winner: Dariusz Patkowski, MD, PhD - Best of the Best in Pediatric Surgery 2024
▶Ep 18 · 1:30
opinionThe thoracoscopic procedure for long gap esophageal atresia using sliding knots is beneficial to learn↗
▶Ep 18 · 1:30
opinionThe thoracoscopic procedure for long gap esophageal atresia using sliding knots is beneficial to learn↗
▶Ep 18 · 1:41
quoteI wanna do a whole thing on just sliding knots now.↗
▶Ep 18 · 1:41
quoteI wanna do a whole thing on just sliding knots now.↗
▶Ep 18 · 1:49
host_summaryData was presented suggesting that resecting liver cuts mortality down by 50% in biliary atresia, though the judge expressed uncertainty about the data↗
▶Ep 18 · 1:49
quoteIf it's really true that resecting liver cuts mortality down by 50%, I, I just am curious about the data.↗
▶Ep 18 · 1:49
clinicalData was presented suggesting that resecting liver cuts mortality down by 50% in biliary atresia, though the judge expressed uncertainty about the data↗
▶Ep 18 · 1:49
quoteIf it's really true that resecting liver cuts mortality down by 50%, I, I just am curious about the data.↗
▶Ep 18 · 1:57
quoteI would love to know more about the data, but since we couldn't talk to her, I, I, I, I don't know.↗
▶Ep 18 · 1:57
quoteI would love to know more about the data, but since we couldn't talk to her, I, I, I, I don't know.↗
▶Ep 18 · 2:04
quoteI think that also could be a huge, um, breakthrough in pediatric surgery.↗
▶Ep 18 · 2:04
quoteI think that also could be a huge, um, breakthrough in pediatric surgery.↗
▶Ep 18 · 2:11
quoteDarius, congratulations, you're moving on to the next heat.↗
▶Ep 18 · 2:11
quoteDarius, congratulations, you're moving on to the next heat.↗
Aerodigestive & Esophageal Surgery - Difficult Tracheal Esophageal Fistula
▶Ep 1 · 25:08
clinicalTrichloroacetic acid (TCA) can be used to demucosalize TEF tracts, but control is less precise than with bugbee cautery; TCA is applied on a pledget and can cause unintended burns if it contacts tissue during insertion.↗
▶Ep 1 · 25:08
clinicalTrichloroacetic acid (TCA) can be used to demucosalize TEF tracts, but control is less precise than with bugbee cautery; TCA is applied on a pledget and can cause unintended burns if it contacts tissue during insertion.↗
▶Ep 1 · 1:50:04
clinicalAnal fistula plugs (biologic, cone-shaped, made of Surgisis) can theoretically be used to occlude distal airway fistulas; they are wrapped with barbed suture and inserted into the tract to promote collagen matrix formation and scarring.↗
▶Ep 1 · 1:50:04
clinicalAnal fistula plugs (biologic, cone-shaped, made of Surgisis) can theoretically be used to occlude distal airway fistulas; they are wrapped with barbed suture and inserted into the tract to promote collagen matrix formation and scarring.↗
Patient Testimonial and Experience: Pectus Innovations
▶Ep 3 · 5:41
clinicalPain team protocols eliminate the need to wait for individual physician orders for pain medication↗
▶Ep 3 · 5:41
quoteI think having a pain team and a protocol helps. Helps helps get the patients their their pain medicine faster because they don't have to wait for a doctor to get the order and all that.↗
▶Ep 3 · 5:41
opinionHaving a dedicated pain team with established protocols reduces delays in pain medication administration↗
▶Ep 3 · 12:35
host_summaryCardiac effects of pectus excavatum are clinically significant, not merely cosmetic↗
▶Ep 3 · 12:40
host_summaryMRI is preferred over CT scan for pectus evaluation based on discussion during this session↗
Pectus-Patient Testimonial and Experience
▶Ep 4 · 5:41
clinicalHaving a pain team and protocol helps patients receive pain medicine faster because they don't have to wait for a doctor to write the order↗
▶Ep 4 · 5:41
quoteI think having a pain team and a protocol helps. Helps helps get the patients their their pain medicine faster because they don't have to wait for a doctor to get the order and all that.↗
Journal of pediatric surgery Article Review: April 2023, IPEG issue
▶Ep 4 · 4:43
quoteI love it. And I think it's great to have a measurement tool that actually has use for clinical decision-making rather than just noting the severity is actually will help guide you in surgery.↗
▶Ep 4 · 4:43
quoteI love it. And I think it's great to have a measurement tool that actually has use for clinical decision-making rather than just noting the severity is actually will help guide you in surgery.↗
quoteIt really depends on the patient and the situation.↗
▶Ep 3 · 1:38
quoteI typically do it before they go home, and I have not found that it's prohibitively difficult in most cases to do the operation.↗
▶Ep 3 · 3:44
clinicalEven in patients with no stones remaining, 2% will get recurrent pancreatitis from the initial insult↗
▶Ep 3 · 3:44
quoteSo 2% of the time in patients, even if they have no stones, they will get recurrent pancreatitis from their initial insult, whereas 60% if you wait 6 weeks. That is so provocative. That is so clear cut that nobody should be debating this anymore.↗
▶Ep 3 · 5:01
clinicalWhen patients present with gallstone pancreatitis, most pain and elevated enzymes occur as the stone is passing, and symptoms often resolve overnight as the stone passes↗
▶Ep 3 · 5:36
clinicalIf laboratory values normalize after gallstone pancreatitis, ERCP is not indicated, but intraoperative cholangiogram should be performed to check for additional stones↗
▶Ep 3 · 5:36
quoteSo if your numbers normalize, I do not do ERCP. I will do an intraoperative changiogram to make sure there's not another stone, but I would not do an ERCP if their numbers normalize.↗
▶Ep 3 · 8:58
quoteIf I have a patient that comes in with an impacted stone, and their lipase is elevated, the next day their lipase goes up even more, they're, they're getting more and more jaundiced, they're getting worse, I would send them for ERCP because I don't know how good I am at retrieving impacted stones.↗
▶Ep 3 · 8:58
opinionFor patients with impacted stone, rising lipase, and worsening jaundice, ERCP is preferred because surgeon confidence in retrieving impacted stones intraoperatively is lower↗
▶Ep 3 · 13:07
quoteSo here's an example of where I am old and washed up. The answer to this should be yes. I just don't have as much experience as my younger colleagues.↗
▶Ep 3 · 15:05
quoteI agree with you. I am skeptical of papers that claim that something is now the new standard just because it's become their new standard. It doesn't necessarily mean that it's recommended as the standard of care.↗
▶Ep 3 · 15:21
clinicalICG can be administered intravenously, eliminating the need for instrumentation required by traditional intraoperative cholangiogram↗
▶Ep 3 · 15:56
quoteI think we should be learning about ICG. I mean this is provocative for me to say, Todd, come on, get with it. Like this is something you should probably learn.↗
Biliary Atresia - Robert Parry: Update Course 2014
▶Ep 1 · 4:03
host_summaryRich Ricketts' series showed not statistically significant better results with Kasai at 76 days or older compared to 0-75 days, possibly representing a different disease phenotype in late presenters.↗
▶Ep 1 · 9:19
quotethat reversal of portal flow makes me really concerned because, you know, I've I've had patients that I've done a cassa on have achieved good biliary drainage. They've got a normal bilirubin. But their portal hypertension then continues to ramp up↗
▶Ep 1 · 9:19
clinicalReversal of portal flow is a very concerning finding because patients can achieve good biliary drainage and normal bilirubin but still progress to transplant due to profound portal hypertension.↗
▶Ep 1 · 10:41
quotethe hepatologists can actually limp these kids along. They're not nutritionally in a great place, but they can get them out to be, you know, a year in the absence of a cassai and the absence of a transplant↗
▶Ep 1 · 10:41
clinicalHepatologists can manage biliary atresia patients medically for up to a year in the absence of Kasai or transplant, though nutritional status suffers.↗
▶Ep 1 · 10:56
opinionIn patients with end-stage liver disease signs (profound fibrosis, reversed portal flow), Kasai may not improve outcomes and the operative stress may worsen their condition.↗
▶Ep 1 · 12:00
quoteit's almost like um a race between regeneration of hepatocytes and progression of fibrosis↗
▶Ep 1 · 12:20
quoteI've had a patient that I didn't redo, and I thought surely the thing was a failure because the bilirubin remained elevated, and then at 5 months post-op, the bilirubin dropped to normal↗
▶Ep 1 · 12:20
clinicalSome biliary atresia patients show delayed response to Kasai, with bilirubin remaining elevated for months then dropping to normal at 5 months post-op, suggesting a race between hepatocyte regeneration and fibrosis progression.↗
▶Ep 1 · 14:41
quoteif the question is getting them to the OR sooner, now you're going to delay by, you know, however many days, you know, while you're inducing them with phenobarb↗
▶Ep 1 · 17:35
host_summaryA recent paper in Gastroenterology described a scoring system using liver biopsy plus clinical parameters with nearly 100% ability to predict biliary atresia.↗
▶Ep 1 · 18:01
opinionPathologists' understanding of biliary atresia histology has improved significantly compared to 20 years ago.↗
▶Ep 1 · 18:10
clinicalInterventional radiologists can perform percutaneous liver biopsy safely and routinely, making it a low-barrier test.↗
Biliary Atresia
▶Ep 2 · 0:00
quoteThis is uh Doctor Greg Tia. Greg is the, uh, congratulations, the new uh chief of pediatric surgery at the Cincinnati Children's Hospital.↗
▶Ep 2 · 0:00
quoteThis is uh Doctor Greg Tia. Greg is the, uh, congratulations, the new uh chief of pediatric surgery at the Cincinnati Children's Hospital.↗
clinicalThe sutureless plastic closure technique was described by Anthony Sandler and doesn't require suturing the umbilical cord↗
▶Ep 2 · 14:19
clinicalA study by Dr. Baird published in JPS showed that patients with flap closure did better in every way than those with sutured fascial closure, including lower rates of umbilical hernia repair↗
▶Ep 2 · 18:10
clinicalSpring-loaded silos apply pressure outward as you push down, making the defect larger over time↗
▶Ep 2 · 42:06
clinicalThe 'flip flop' technique (modification of component separation) involves incising laterally through anterior sheath only, folding it over while attached to posterior sheath, creating a single posterior sheath closure↗
quotewe've all been taught over the years that when we do a colostomy for an anal rectal malformation, we should do a divided colostomy, and the main reason to do that is to prevent stool flowing down that could cause a urinary tract infection.↗
▶Ep 1 · 0:08
host_summaryTraditional teaching holds that divided colostomy should be performed for anorectal malformations to prevent stool flowing down that could cause urinary tract infection.↗
▶Ep 1 · 0:24
host_summaryDr. Robert Baird performed a meta-analysis of multiple studies comparing divided colostomy versus loop colostomy for anorectal malformations.↗
▶Ep 1 · 0:27
host_summaryThe meta-analysis found no statistically significant difference in urinary tract infection incidence between divided colostomy and loop colostomy.↗
▶Ep 1 · 0:39
host_summarySome individual studies within the meta-analysis showed a difference in UTI rates, but the overall meta-analysis showed no statistical difference.↗
▶Ep 1 · 0:51
host_summaryLoop colostomies had a significantly higher stoma prolapse rate compared to divided colostomies.↗
▶Ep 1 · 1:05
host_summarySkin excoriation, stoma retraction, peristomal hernia, wound infection, and stoma stricture showed no statistical difference between loop colostomy and divided colostomy.↗
▶Ep 1 · 1:22
quotethere we go, we've challenged dogma, and it seems like dogma necessarily at this point doesn't seem to hold true.↗
Challenging Dogma: Does Colostomy Type Matter?
▶Ep 3 · 0:08
host_summaryTraditional teaching advocates for divided colostomy when performing colostomy for anorectal malformation, with the main rationale being prevention of stool flowing down that could cause urinary tract infection.↗
▶Ep 3 · 0:08
quotewe've all been taught over the years that when we do a colostomy for an anal rectal malformation, we should do a divided colostomy, and the main reason to do that is to prevent stool flowing down that could cause a urinary tract infection.↗
▶Ep 3 · 0:24
host_summaryDr. Robert Baird performed a meta-analysis of multiple studies comparing divided colostomy versus loop colostomy for incidence of UTI.↗
▶Ep 3 · 0:27
host_summaryThe meta-analysis found no statistically significant difference in UTI rates between loop colostomy and divided colostomy, despite some individual studies showing a difference.↗
host_summaryLoop colostomies had a significantly higher stoma prolapse rate compared to divided colostomies.↗
▶Ep 3 · 0:51
quotethe loop colostomies actually had a higher, significantly higher stoma prolapse rate.↗
▶Ep 3 · 1:05
host_summarySkin excoriation, stoma retraction, peristomal hernia, wound infection, and stoma stricture showed no statistical difference between loop colostomy and divided colostomy.↗
Evaluation & Management Of Hirschsprung's Disease
▶Ep 10 · 31:46
opinionDr. Ponsky performs suction rectal biopsy in almost any patient who required a contrast enema to rule out distal obstruction, regardless of whether the enema suggests meconium plug, small left colon, or other diagnosis.↗
▶Ep 10 · 31:46
opinionDr. Ponsky performs suction rectal biopsy in almost any patient who required a contrast enema to rule out distal obstruction, regardless of whether the enema suggests meconium plug, small left colon, or other diagnosis.↗
▶Ep 10 · 38:05
clinicalDr. Collins reports that the Duhamel pouches she has examined pathologically have contained both ganglionic and aganglionic parts.↗
▶Ep 10 · 38:05
clinicalDr. Collins reports that the Duhamel pouches she has examined pathologically have contained both ganglionic and aganglionic parts.↗
Cloaca - Prental Imaging & Diagnosis - Counseling
▶Ep 17 · 29:46
quoteI have never had a patient referred to me with a prenatal diagnosis of any rectum malformations, cloica ever.↗
▶Ep 17 · 29:46
quoteI have never had a patient referred to me with a prenatal diagnosis of any rectum malformations, cloica ever.↗
Radiology and Image Diagnosis of Hirschsprung Disease
▶Ep 18 · 31:46
clinicalDr. Ponsky always performs suction rectal biopsy in almost any patient who needed a contrast enema to rule out distal obstruction, whether meconium plug, small colon, or other cause.↗
▶Ep 18 · 31:46
clinicalDr. Ponsky always performs suction rectal biopsy in almost any patient who needed a contrast enema to rule out distal obstruction, whether meconium plug, small colon, or other cause.↗
▶Ep 18 · 31:51
quoteI always do. So other than the game of am I right at getting question, can I make it even more broad? I would do it. I do it in almost any distal, any patient that needed a contrast enema.↗
▶Ep 18 · 31:51
quoteI always do. So other than the game of am I right at getting question, can I make it even more broad? I would do it. I do it in almost any distal, any patient that needed a contrast enema.↗
▶Ep 18 · 32:15
clinicalDr. Ponsky performs rectal biopsy even in meconium ileus cases.↗
▶Ep 18 · 32:15
clinicalDr. Ponsky performs rectal biopsy even in meconium ileus cases.↗
▶Ep 18 · 32:23
host_summaryIf it is clearly meconium ileus with reflux into terminal ileum and clinical improvement, some surgeons will not do rectal biopsy.↗
▶Ep 18 · 32:23
clinicalIf it is clearly meconium ileus with reflux into terminal ileum and clinical improvement, some surgeons will not do rectal biopsy.↗
▶Ep 18 · 38:05
clinicalDr. Collins has seen resected Duhamel pouches that had both ganglionic and aganglionic parts, but does not know what their contrast enemas looked like.↗
▶Ep 18 · 38:05
clinicalDr. Collins has seen resected Duhamel pouches that had both ganglionic and aganglionic parts, but does not know what their contrast enemas looked like.↗
Surgical Procedures for Hirschsprung Disease
▶Ep 21 · 5:30
clinicalThe concordance between pathology and radiology is 75% in rectosigmoid Hirschsprung patients, meaning 25% are discordant.↗
▶Ep 21 · 5:30
host_summaryThe concordance between pathology and radiology is 75% in rectosigmoid Hirschsprung patients, meaning 25% are discordant.↗
▶Ep 21 · 5:39
host_summaryConcordance between pathology and radiology is only 25% for long-segment Hirschsprung disease.↗
▶Ep 21 · 5:39
clinicalConcordance between pathology and radiology is only 25% for long-segment Hirschsprung disease.↗
▶Ep 21 · 7:07
clinicalWhen starting laparoscopically, you can look at the bowel and often tell what looks normal vs. abnormal, then take a biopsy at that level.↗
▶Ep 21 · 7:07
clinicalWhen starting laparoscopically, you can look at the bowel and often tell what looks normal vs. abnormal, then take a biopsy at that level.↗
▶Ep 21 · 7:57
clinicalIf you start transanally and break through the peritoneum, it can be difficult to maintain pneumoperitoneum when you then go laparoscopically.↗
▶Ep 21 · 7:57
clinicalIf you start transanally and break through the peritoneum, it can be difficult to maintain pneumoperitoneum when you then go laparoscopically.↗
▶Ep 21 · 8:18
opinionLaparoscopic dissection is easy and gives you a head start when doing the transanal portion.↗
▶Ep 21 · 8:18
opinionLaparoscopic dissection is easy and gives you a head start when doing the transanal portion.↗
▶Ep 21 · 1:21:33
clinicalLaparoscopy in Hirschsprung can be used for diagnosis (leveling biopsies, ostomy creation), definitive surgery (mobilization, watching pull-through), and postoperatively (Malone creation).↗
▶Ep 21 · 1:21:33
clinicalLaparoscopy in Hirschsprung can be used for diagnosis (leveling biopsies, ostomy creation), definitive surgery (mobilization, watching pull-through), and postoperatively (Malone creation).↗
▶Ep 21 · 1:34:15
clinicalPitfalls of laparoscopy: difficult with very distended colon (poor visualization), need to de-rotate right colon if pulling transverse/right colon (may require small laparotomy).↗
▶Ep 21 · 1:34:15
clinicalPitfalls of laparoscopy: difficult with very distended colon (poor visualization), need to de-rotate right colon if pulling transverse/right colon (may require small laparotomy).↗
▶Ep 21 · 1:34:53
clinicalBenefits of laparoscopy over pure transanal: decreases stretch of anal sphincters on high dissections, allows dissection to pelvic floor (very short transanal component), prevents twisting of pulled-through bowel.↗
▶Ep 21 · 1:34:53
clinicalBenefits of laparoscopy over pure transanal: decreases stretch of anal sphincters on high dissections, allows dissection to pelvic floor (very short transanal component), prevents twisting of pulled-through bowel.↗
▶Ep 21 · 1:36:36
clinicalCompared to laparotomy, laparoscopy decreases incision size, reduces discomfort, potentially allows earlier bowel function (1-2 days difference), and shorter hospitalization.↗
▶Ep 21 · 1:36:36
clinicalCompared to laparotomy, laparoscopy decreases incision size, reduces discomfort, potentially allows earlier bowel function (1-2 days difference), and shorter hospitalization.↗
▶Ep 21 · 1:36:55
opinionFor transanal alone, laparoscopy doesn't offer much decrease in return of bowel function or postoperative hospitalization compared to pure transanal.↗
▶Ep 21 · 1:36:55
opinionFor transanal alone, laparoscopy doesn't offer much decrease in return of bowel function or postoperative hospitalization compared to pure transanal.↗
CinciHirsch - Pathology of Hirschprung Disease
▶Ep 23 · 6:38
opinionDr. Frykman was trained to stop attempting suction rectal biopsies at about 6 months of age and take patients to the operating room instead.↗
▶Ep 23 · 6:38
opinionDr. Frykman was trained to stop attempting suction rectal biopsies at about 6 months of age and take patients to the operating room instead.↗
Outcomes and Complications in Hirschsprung Disease
▶Ep 20 · 33:44
clinicalMany institutions assess pull-through specimens using only a longitudinal strip rather than examining the full circumference of the proximal margin; the interface between ganglionic and aganglionic bowel can be irregular and project 2-4 cm longer along one part of the circumference.↗
▶Ep 20 · 33:44
quoteMany places still have clung to this idea that the way to assess a pull through specimen is to do a longitudinal strip of the length of the specimen and not look at the full circumference of the proximal margin.↗
▶Ep 20 · 33:44
host_summaryMany institutions assess pull-through specimens using only a longitudinal strip rather than examining the full circumference of the proximal margin; the interface between ganglionic and aganglionic bowel can be irregular and project 2-4 cm longer along one part of the circumference.↗
▶Ep 20 · 33:44
quoteMany places still have clung to this idea that the way to assess a pull through specimen is to do a longitudinal strip of the length of the specimen and not look at the full circumference of the proximal margin.↗
▶Ep 20 · 33:53
quoteThe interface between the ganglionic bowel and the a ganglion bowel can be very irregular and can project for 234 centimeters longer along one part of the circumference than the other.↗
▶Ep 20 · 33:53
quoteThe interface between the ganglionic bowel and the a ganglion bowel can be very irregular and can project for 234 centimeters longer along one part of the circumference than the other.↗
▶Ep 20 · 35:19
epidemiologicalA survey of Canadian pediatric surgeons found nearly half resect 4 centimeters or less from the biopsy site, and about 10% resect right at the site of positive biopsy, creating high risk of pull-throughs in the transition zone.↗
▶Ep 20 · 35:19
host_summaryA survey of Canadian pediatric surgeons found nearly half resect 4 centimeters or less from the biopsy site, and about 10% resect right at the site of positive biopsy, creating high risk of pull-throughs in the transition zone.↗
▶Ep 20 · 1:15:23
quoteLaparoscopy is minimally invasive but gives you actually make even better exposure, so you're not compromising exposure with laparoscopy.↗
▶Ep 20 · 1:15:23
opinionLaparoscopy is minimally invasive but provides even better exposure than open surgery; small umbilical incisions compromise exposure.↗
▶Ep 20 · 1:15:23
opinionLaparoscopy is minimally invasive but provides even better exposure than open surgery; small umbilical incisions compromise exposure.↗
▶Ep 20 · 1:15:23
quoteLaparoscopy is minimally invasive but gives you actually make even better exposure, so you're not compromising exposure with laparoscopy.↗
Hirschsprung Disease: Update Course 2015
▶Ep 35 · 4:22
quoteI don't believe that a pure trans anal is necessarily less invasive. In other words, I believe that putting 3 incisions on the abdomen is actually less invasive in my hands, in my hands, certainly not in your guys' hands, but in my hands, I'm gonna be torquing in that anal canal much more than if I had done it laparoscopically and freed everything up from the abdominal approach.↗
▶Ep 35 · 4:22
opinionPure transanal pull-through may not be less invasive than laparoscopic approach, as prolonged torquing in the anal canal can be more traumatic than three small abdominal incisions.↗
Hirschsprung Disease: Surgical Procedures
▶Ep 39 · 5:30
clinicalThe concordance between pathology and radiology is 75% in rectosigmoid Hirschsprung disease patients, meaning 25% are discordant.↗
▶Ep 39 · 5:39
clinicalThe concordance is only 25% for long-segment Hirschsprung disease between radiology and pathology.↗
▶Ep 39 · 7:57
clinicalWhen starting laparoscopically, if you break the peritoneum transanally first, it becomes hard to maintain pneumoperitoneum.↗
▶Ep 39 · 1:34:53
opinionLaparoscopy decreases the stretch of anal sphincters compared to pure transanal approach when going high, which could affect fecal continence.↗
▶Ep 39 · 1:35:11
clinicalWith laparoscopy, you can dissect way down to the pelvic floor, so the actual transanal dissection is very short with very limited stretch on the sphincters.↗
Prenatal Imaging and Counseling: Cloaca and Complex ARMs 2015
▶Ep 38 · 25:12
quoteI have never had a patient referred to me with a prenatal diagnosis of any rectal malformations, cloica ever.↗
▶Ep 38 · 25:12
quoteI have never had a patient referred to me with a prenatal diagnosis of any rectal malformations, cloica ever.↗
Hirschsprung Disease: Radiology Aspect
▶Ep 42 · 31:01
clinicalRectal biopsy should be performed in almost any patient who needed a contrast enema to rule out distal obstruction, including cases of meconium plug or small left colon.↗
▶Ep 42 · 31:01
clinicalRectal biopsy should be performed in almost any patient who needed a contrast enema to rule out distal obstruction, including cases of meconium plug or small left colon.↗
▶Ep 42 · 31:12
quoteI would do it. I do it in almost any distal, any patient that needed a contrast enema. To rule out a distal obstruction, I'm going to be doing a suction rectal biopsy, whether it's meconium plug or a small colon.↗
▶Ep 42 · 31:12
quoteI would do it. I do it in almost any distal, any patient that needed a contrast enema. To rule out a distal obstruction, I'm going to be doing a suction rectal biopsy, whether it's meconium plug or a small colon.↗
▶Ep 42 · 31:35
clinicalIn clearly documented meconium ileus where reflux into terminal ileum is achieved and the patient clinically improves, rectal biopsy may not be necessary.↗
▶Ep 42 · 31:35
clinicalIn clearly documented meconium ileus where reflux into terminal ileum is achieved and the patient clinically improves, rectal biopsy may not be necessary.↗
Hirschsprung Disease: Cases and Complications
▶Ep 41 · 33:44
quoteThe interface between the ganglionic bowel and the a ganglion bowel can be very irregular and can project for 234 centimeters longer along one part of the circumference than the other, so that even if you just look at a longitudinal strip. You could see gangon cells at the proximal margin, but on the opposite side of that margin there may be no gangon cells, and so you may be dealing with a, a low transition zone pull through in that situation.↗
▶Ep 41 · 33:44
quoteThe interface between the ganglionic bowel and the a ganglion bowel can be very irregular and can project for 234 centimeters longer along one part of the circumference than the other, so that even if you just look at a longitudinal strip. You could see gangon cells at the proximal margin, but on the opposite side of that margin there may be no gangon cells, and so you may be dealing with a, a low transition zone pull through in that situation.↗
▶Ep 41 · 35:19
epidemiologicalA survey of the Canadian Association of Pediatric Surgeons by Jack Langer found that nearly half of surgeons resect 4 cm or less from the biopsy site, and about 10% resect right at the site of positive biopsy, creating high risk for pull-throughs in the transition zone.↗
▶Ep 41 · 35:19
host_summaryA survey of the Canadian Association of Pediatric Surgeons by Jack Langer found that nearly half of surgeons resect 4 cm or less from the biopsy site, and about 10% resect right at the site of positive biopsy, creating high risk for pull-throughs in the transition zone.↗
▶Ep 41 · 1:15:24
opinionLaparoscopy is minimally invasive but provides maybe even better exposure than open surgery, so exposure is not compromised with laparoscopy.↗
▶Ep 41 · 1:15:24
opinionLaparoscopy is minimally invasive but provides maybe even better exposure than open surgery, so exposure is not compromised with laparoscopy.↗
▶Ep 41 · 1:39:29
clinicalEnterocolitis does not occur in pure anorectal malformations without Hirschsprung disease.↗
▶Ep 41 · 1:39:29
clinicalEnterocolitis does not occur in pure anorectal malformations without Hirschsprung disease.↗
Hirschsprung Disease: Update Course 2013
▶Ep 46 · 1:45
opinionIn newborn bowel obstruction with distended abdomen and distal air, start with contrast enema rather than upper GI↗
▶Ep 46 · 2:11
clinicalBilious emesis typically prompts upper GI, but newborn distal obstruction is an exception where contrast enema is more informative↗
▶Ep 46 · 2:40
host_summaryA significant portion of fellows at a Washington DC course said they would get upper GI first in newborn with bilious emesis before contrast enema↗
▶Ep 46 · 4:51
guidelineTissue diagnosis is absolutely required before operating for Hirschsprung disease↗
▶Ep 46 · 28:51
opinionIn older children (age 2-3 and up), suction rectal biopsy should not be performed; instead do open rectal biopsy under general anesthesia↗
▶Ep 46 · 30:06
opinionIn 3-year-old with severely dilated colon from chronic Hirschsprung disease, the dilated segment is unlikely to collapse and should be resected↗
Hirschsprung Disease: Update Course 2013
▶Ep 53 · 1:59
opinionIn newborn bowel obstruction with distal air, contrast enema should precede upper GI unless clinical presentation strongly suggests malrotation↗
▶Ep 53 · 1:59
opinionIn newborn bowel obstruction with distal air, contrast enema should precede upper GI unless clinical presentation strongly suggests malrotation↗
▶Ep 53 · 4:14
quotethe baby's first enema should be a barium enema↗
▶Ep 53 · 4:14
quotethe baby's first enema should be a barium enema↗
▶Ep 53 · 5:06
host_summaryTissue diagnosis is mandatory before surgery for Hirschsprung disease; contrast enema alone is insufficient↗
▶Ep 53 · 5:06
guidelineTissue diagnosis is mandatory before surgery for Hirschsprung disease; contrast enema alone is insufficient↗
▶Ep 53 · 5:30
clinicalIn critically ill patients with enterocolitis, surgery may be necessary before pathology results are available (typically takes until Wednesday if specimen obtained Friday)↗
▶Ep 53 · 5:30
host_summaryIn critically ill patients with enterocolitis, surgery may be necessary before pathology results are available (typically takes until Wednesday if specimen obtained Friday)↗
▶Ep 53 · 9:57
opinionProne positioning for pull-through is easier on surgeon's back and neck compared to lithotomy↗
▶Ep 53 · 9:57
opinionProne positioning for pull-through is easier on surgeon's back and neck compared to lithotomy↗
▶Ep 53 · 16:50
quoteI've never seen really good results from in a 16 year old↗
▶Ep 53 · 16:50
quoteI've never seen really good results from in a 16 year old↗
▶Ep 53 · 17:40
host_summaryHypertrophic nerves should not be present in normal anal canal, even though ganglion cells are absent there↗
▶Ep 53 · 17:40
clinicalHypertrophic nerves should not be present in normal anal canal, even though ganglion cells are absent there↗
▶Ep 53 · 29:11
opinionIn children over age 2-3 years, perform open rectal biopsy under general anesthesia rather than office suction biopsy due to patient cooperation issues↗
▶Ep 53 · 29:11
host_summaryIn children over age 2-3 years, perform open rectal biopsy under general anesthesia rather than office suction biopsy due to patient cooperation issues↗
▶Ep 53 · 34:11
host_summaryManometry is reliable for diagnosing Hirschsprung in older children when biopsies may be unreliable↗
▶Ep 53 · 34:11
opinionManometry is reliable for diagnosing Hirschsprung in older children when biopsies may be unreliable↗
▶Ep 53 · 35:15
clinicalFor enterocolitis 6 months post-pull-through with fever, distention, and diarrhea but no peritonitis, treat with IV fluids, broad-spectrum antibiotics, and rectal irrigations↗
▶Ep 53 · 35:15
host_summaryFor enterocolitis 6 months post-pull-through with fever, distention, and diarrhea but no peritonitis, treat with IV fluids, broad-spectrum antibiotics, and rectal irrigations↗
▶Ep 53 · 36:20
host_summaryIncidence of enterocolitis in children with trisomy 21 is double that of genetically normal children with Hirschsprung disease↗
▶Ep 53 · 36:20
epidemiologicalIncidence of enterocolitis in children with trisomy 21 is double that of genetically normal children with Hirschsprung disease↗
Posterior Sagittal Anorectaplasty in a Female: Pediatric Colorectal...
▶Ep 63 · 2:10
clinicalTotal body prep from nipples to toes is standard for these patients, allowing flexibility to flip between supine and prone positions↗
▶Ep 63 · 2:10
host_summaryTotal body prep from nipples to toes is standard for these patients, allowing flexibility to flip between supine and prone positions↗
Colorectal - Clinical Practice Updates
▶Ep 71 · 14:14
quoteIs there any evidence for anything that, that y'all have mentioned? I mean, it seems like this is the right topic to try to get some better evidence for it, but I'm just interested to know, is there evidence for what y'all are, for any of these uh suggested treatments.↗
▶Ep 71 · 14:14
quoteIs there any evidence for anything that, that y'all have mentioned? I mean, it seems like this is the right topic to try to get some better evidence for it, but I'm just interested to know, is there evidence for what y'all are, for any of these uh suggested treatments.↗
▶Ep 71 · 43:34
quoteI'll just raise my standard thing that I always raise, which is why are we getting a CAT scan?↗
▶Ep 71 · 43:34
quoteI'll just raise my standard thing that I always raise, which is why are we getting a CAT scan?↗
Biliary Atresia, Appendicitis, Intestinal Failure, and Anesthetic...
▶Ep 76 · 42:16
clinicalDr. Ponsky's chief of anesthesiology instituted a 'rule of two': defer elective operations until after age 2 and avoid two anesthetics in one year.↗
▶Ep 76 · 42:31
opinionDr. Ponsky now defers dermoid cyst excision in a 6-month-old until 18 months but does not delay inguinal hernia repair due to known incarceration risk in young infants.↗
The Colorectal Quiz Episode 3.5: Proximal Hirschsprung Disease
▶Ep 87 · 0:40
host_summaryA one-day-old full-term infant weighing 3.9 kilograms presented with significant abdominal distension and bilious emesis.↗
▶Ep 87 · 0:40
clinicalA one-day-old full-term infant weighing 3.9 kilograms presented with significant abdominal distension and bilious emesis.↗
▶Ep 87 · 4:05
clinicalA baby with bilious emesis and non-classic abdominal x-ray could have had distal air and then had a volvulus, requiring urgent upper GI to rule out malrotation before contrast enema.↗
▶Ep 87 · 4:05
clinicalA baby with bilious emesis and non-classic abdominal x-ray could have had distal air and then had a volvulus, requiring urgent upper GI to rule out malrotation before contrast enema.↗
Journal of Pediatric Surgery Article Review: October 2021
▶Ep 110 · 3:58
opinionThe 85% follow-up rate in child abuse victims is surprising and encouraging.↗
▶Ep 110 · 3:58
quoteAnd the fact that, you know, we're seeing 85% follow-up is surprising to me and, and Encouraging.↗
▶Ep 110 · 8:05
opinionIn NEC, it is easy to make surgical decisions when there is free air, but without definitive protocol for other presentations, surgeons hedge and delay daily about whether to operate.↗
▶Ep 110 · 8:05
quoteThis article points out the problem of Gestalt and necrotizing enterocolitis. You know, it's really easy when they have free air. When they don't, we're all different and we don't have a defined protocol that's been built yet.↗
▶Ep 110 · 13:19
quoteHonestly, a lot of people see the value of this, don't have the volume or the resources to build a formal program, and it's very reasonable to send these kids to a new Nearby bowel management program.↗
▶Ep 110 · 13:19
opinionMany surgeons who see the value of bowel management programs lack the volume or resources to build formal programs, making it reasonable to refer patients to nearby established programs.↗
▶Ep 110 · 16:26
clinicalThere is variability in the use of ultrasound versus MRI for detecting tethered cord in anorectal malformation patients, and radiographs are not a good substitute.↗
clinicalThe standard Hagar dilator size for a newborn is about size 12, so a size 10 is 2 deviations less.↗
▶Ep 122 · 1:57
host_summaryThe standard Hagar dilator size for a newborn is about size 12, so a size 10 is 2 deviations less.↗
▶Ep 122 · 2:16
host_summaryIn the dilation study with 25 children, the types of malformations were evenly distributed and complexity was about equal.↗
▶Ep 122 · 2:16
clinicalIn the dilation study with 25 children, the types of malformations were evenly distributed and complexity was about equal.↗
Update Course 2022 - APSA PDC UPDATES - Mary Edwards, Paul Jeziorczak, Craig Lillehei, and Charles Snyder,
▶Ep 126 · 34:00
quoteThe reason that we switched to this, um, is that there are, if it's clearly if airway aspiration, you go to the operating room. It's the ones you don't know. And what we found is the ones you don't know, it's a suspicious story. They were coughing after eating. Um, more often than not, it's reactive airway and it's not a foreign body.↗
▶Ep 126 · 34:00
quoteThe reason that we switched to this, um, is that there are, if it's clearly if airway aspiration, you go to the operating room. It's the ones you don't know. And what we found is the ones you don't know, it's a suspicious story. They were coughing after eating. Um, more often than not, it's reactive airway and it's not a foreign body.↗
▶Ep 126 · 35:00
quoteCAT scan pretty much almost a hundred percent will direct you to go to the OR or not. So it's very low radiation and it eliminates those that are equivocal of getting an unnecessary instrumentation of their airway in the face of reactive airway disease.↗
▶Ep 126 · 35:00
quoteCAT scan pretty much almost a hundred percent will direct you to go to the OR or not. So it's very low radiation and it eliminates those that are equivocal of getting an unnecessary instrumentation of their airway in the face of reactive airway disease.↗
▶Ep 126 · 59:30
quoteI do believe that working with the neonatology team on the decision to operate is actually prudent. I know you were, but a lot of people get upset about that. And I do have that discussion now. Ultimately, the decision is mine. But oftentimes they do sway me.↗
▶Ep 126 · 59:30
quoteI do believe that working with the neonatology team on the decision to operate is actually prudent. I know you were, but a lot of people get upset about that. And I do have that discussion now. Ultimately, the decision is mine. But oftentimes they do sway me.↗
Journal of Pediatric Surgery Article Review: February 2023, BAPS issue
▶Ep 135 · 4:13
clinicalCenters of excellence for esophageal atresia are showing better outcomes↗
▶Ep 135 · 4:13
clinicalCenters of excellence for esophageal atresia are showing better outcomes↗
▶Ep 135 · 4:26
opinionCentralization of esophageal atresia care would be difficult to implement in the United States healthcare system↗
▶Ep 135 · 4:26
opinionCentralization of esophageal atresia care would be difficult to implement in the United States healthcare system↗
Colorectal Quiz: Episode 49 – Collaborating for Kids: Colorectal & Pelvic Solutions (with a Little Help from AI)
▶Ep 177 · 1:20
quoteMark, you're always not only good at anal rectum malformations, but you have been interested in All the tech and the media from the very beginning.↗
▶Ep 177 · 1:20
quoteMark, you're always not only good at anal rectum malformations, but you have been interested in All the tech and the media from the very beginning.↗
▶Ep 177 · 1:35
quoteWhat M and I are working on is how we can mass produce content to equilibrate knowledge around the world, and we know that the only way to do that is to use cutting edge technology, automation tools and AI.↗
▶Ep 177 · 1:35
quoteWhat M and I are working on is how we can mass produce content to equilibrate knowledge around the world, and we know that the only way to do that is to use cutting edge technology, automation tools and AI.↗
▶Ep 177 · 2:16
clinicalNotebook LM is a free offering from Google that can create realistic-sounding podcasts between two AI voices from uploaded documents.↗
▶Ep 177 · 2:16
clinicalNotebook LM is a free offering from Google that can create realistic-sounding podcasts between two AI voices from uploaded documents.↗
▶Ep 177 · 2:31
quoteI would love to hear your thoughts, Mark, on your first experience with Notebook LM.↗
▶Ep 177 · 2:31
quoteI would love to hear your thoughts, Mark, on your first experience with Notebook LM.↗
▶Ep 177 · 4:14
quoteNo one has been able to do it as well as Notebook LM.↗
▶Ep 177 · 4:14
quoteNo one has been able to do it as well as Notebook LM.↗
▶Ep 177 · 4:22
opinionThe AI-generated podcast voices are not customizable; users are limited to the same male and female voices.↗
▶Ep 177 · 4:22
opinionThe AI-generated podcast voices are not customizable; users are limited to the same male and female voices.↗
▶Ep 177 · 4:26
quoteThere's actually an incredible video where they uploaded a document telling these two podcast hosts that they were AI and how they reacted. They freaked out.↗
▶Ep 177 · 4:26
quoteThere's actually an incredible video where they uploaded a document telling these two podcast hosts that they were AI and how they reacted. They freaked out.↗
▶Ep 177 · 4:52
quoteDo I think this is the future of podcasting? I don't.↗
▶Ep 177 · 4:52
quoteDo I think this is the future of podcasting? I don't.↗
▶Ep 177 · 5:03
clinicalNotebook LM's beta version allows users to join the AI conversation interactively.↗
▶Ep 177 · 5:03
clinicalNotebook LM's beta version allows users to join the AI conversation interactively.↗
▶Ep 177 · 5:09
quoteYou could click join, and it goes, hey, what's up? And you could say, hey, I heard what you just said about the colostomy. I'm not sure I agree, and then it will talk with you.↗
▶Ep 177 · 5:09
quoteYou could click join, and it goes, hey, what's up? And you could say, hey, I heard what you just said about the colostomy. I'm not sure I agree, and then it will talk with you.↗
▶Ep 177 · 7:42
quoteThe AI revolution has happened, and each month, it's blowing up and replacing jobs.↗
▶Ep 177 · 7:42
quoteThe AI revolution has happened, and each month, it's blowing up and replacing jobs.↗
opinionHospitals should have teams that continuously bring new AI tools to clinicians every week.↗
▶Ep 177 · 8:06
opinionHospitals should have teams that continuously bring new AI tools to clinicians every week.↗
▶Ep 177 · 8:11
clinicalEm Gootee triangulates multiple AI platforms to combine the strengths of different tools (intelligence, audio, video).↗
▶Ep 177 · 8:11
clinicalEm Gootee triangulates multiple AI platforms to combine the strengths of different tools (intelligence, audio, video).↗
▶Ep 177 · 8:26
quoteYou have to have human oversight to make sure they're correct.↗
▶Ep 177 · 8:26
opinionHuman oversight is necessary to ensure AI-generated medical content is correct.↗
▶Ep 177 · 8:26
opinionHuman oversight is necessary to ensure AI-generated medical content is correct.↗
▶Ep 177 · 8:26
quoteYou have to have human oversight to make sure they're correct.↗
Colorectal Quiz: Episode 49 - Collaborating for Kids: Colorectal & Pelvic Solutions (with a Little Help from AI)
▶Ep 222 · 1:18
clinicalNotebookLM is a free offering from Google that can upload any content and create a realistic-sounding podcast between two people.↗
▶Ep 222 · 1:18
quotewhat em and i are working on is how we can mass produce content to equilibrate knowledge around the world and we know that the only way to do that is to use cutting edge technology automation tools and ai↗
▶Ep 222 · 1:18
quotewhat em and i are working on is how we can mass produce content to equilibrate knowledge around the world and we know that the only way to do that is to use cutting edge technology automation tools and ai↗
▶Ep 222 · 1:18
clinicalNotebookLM is a free offering from Google that can upload any content and create a realistic-sounding podcast between two people.↗
▶Ep 222 · 3:41
quotedo i think this is the future of podcasting i don't i think the voices are great but it's not customizable enough you're stuck with what it decided↗
▶Ep 222 · 3:41
quotedo i think this is the future of podcasting i don't i think the voices are great but it's not customizable enough you're stuck with what it decided↗
▶Ep 222 · 6:39
quotethe ai revolution has happened and each month it's blowing up and replacing jobs↗
▶Ep 222 · 6:39
quotethe key thing is to be like you're doing and everyone else you have to be looking at ai and using it in your workflow if you're not you'll get behind↗
▶Ep 222 · 6:39
quotethe key thing is to be like you're doing and everyone else you have to be looking at ai and using it in your workflow if you're not you'll get behind↗
▶Ep 222 · 6:39
quotethe ai revolution has happened and each month it's blowing up and replacing jobs↗
▶Ep 222 · 6:39
clinicalA review article that took two weeks to produce five years ago can now be created in minutes using NotebookLM with the same 30 source articles.↗
▶Ep 222 · 6:39
clinicalA review article that took two weeks to produce five years ago can now be created in minutes using NotebookLM with the same 30 source articles.↗
▶Ep 222 · 7:30
clinicalNotebookLM can identify gaps in knowledge across multiple research articles and recognize when new articles fill those gaps.↗
▶Ep 222 · 7:30
clinicalNotebookLM can identify gaps in knowledge across multiple research articles and recognize when new articles fill those gaps.↗
Colorectal Quiz: Episode 2
▶Ep 240 · 7:09
quoteYou all both looked at this image and said, you can tell, obviously, that this is too low, too posterior. Without a stimulator in the office, what do you look for to immediately tell that the analplasty was done too low?↗
▶Ep 240 · 7:09
quoteYou all both looked at this image and said, you can tell, obviously, that this is too low, too posterior. Without a stimulator in the office, what do you look for to immediately tell that the analplasty was done too low?↗
The Colorectal Quiz Episode 4
▶Ep 241 · 17:00
clinicalThe reinforcement layer is critical to lining the two pieces of bowel up so that mucosa edge meets mucosa edge.↗
▶Ep 241 · 17:00
host_summaryThe reinforcement layer is critical to lining the two pieces of bowel up so that mucosa edge meets mucosa edge.↗
Colorectal Quiz: Episode 2
▶Ep 242 · 7:09
quoteYou all both looked at this image and said, you can tell, obviously, that this is too low, too posterior. Without a stimulator in the office, what do you look for to immediately tell that the analplasty was done too low?↗
▶Ep 242 · 7:09
quoteYou all both looked at this image and said, you can tell, obviously, that this is too low, too posterior. Without a stimulator in the office, what do you look for to immediately tell that the analplasty was done too low?↗
Challenges in Diaphragmatic Hernia Repair: Update Course 2016
▶Ep 2 · 20:03
host_summaryAudience poll: 63% would perform thoracoscopic patch repair, 60% would do MIS repair after ECMO, 67% prefer thoracoscopic approach overall.↗
Fetoscopic endoluminal tracheal occlusion and twin-twin transfusion: Fetal...
▶Ep 4 · 1:26:57
clinicalRuben Quintero's 1997 staging system for TTTS actually describes physiologic states: stage 1 reflects initial volume transfer, stage 2 represents cephalization of blood flow, stage 3 represents increasing placental resistance, and stage 4 represents cardiac failure in the recipient.↗
▶Ep 4 · 1:29:21
epidemiologicalOnly 30-35% of stage 1 TTTS progresses to stage 2 or higher; 28% stay at stage 1 throughout pregnancy, and 40% regress completely or resolve.↗
▶Ep 4 · 1:30:22
host_summaryAmnio-reduction in severe polyhydramnios improves fetal hypoxia and reverses acidemia by decreasing amniotic fluid pressure, which reduces placental compression and improves blood flow.↗
▶Ep 4 · 1:32:14
clinicalThe recipient twin in TTTS develops progressive hypertrophic cardiomyopathy due to both preload (volume) and afterload (peripheral vasoconstriction from renin-angiotensin activation) issues.↗
▶Ep 4 · 1:42:07
host_summaryHuber's 2006 study of over 200 laser cases showed 84% survival of at least one twin, 60% both-twin survival, and average delivery at 34 weeks, compared to 29 weeks with amnio-reduction.↗
▶Ep 4 · 1:43:26
host_summaryHigh-volume laser centers achieve 93-94% survival of at least one twin, 88% overall survival, 78% both-twin survival, with average delivery at 34 weeks.↗
▶Ep 4 · 1:44:15
host_summaryMajor and minor neurologic deficits occur in 55% after amnio-reduction versus less than half that rate after laser, with most recent studies showing 5-6% major neurodevelopmental delays and 7-8% minor delays after laser.↗
▶Ep 4 · 1:45:01
clinicalCHOP's cardiovascular score significantly drops within 1 week to 10 days after laser photocoagulation in the vast majority of cases, showing the recipient twin's heart has great potential to heal.↗
▶Ep 4 · 1:47:05
clinicalDiode laser is much safer than argon laser with lower penetration depth and no vessel rupture cases since switching to diode at CHOP.↗
▶Ep 4 · 1:50:00
clinicalCHOP's miss rate for vascular anastomoses is 0.8% based on placental injection studies, compared to 10-15% miss rates reported in literature.↗
▶Ep 4 · 2:08:56
host_summaryEduardo Gratacos classified selective IUGR into three types: Type 1 with positive end-diastolic flow (good prognosis), Type 2 with persistent absent/reversed flow (progressive deterioration), and Type 3 with intermittent cycling (unpredictable with high IUFD and 20% PVL risk in normal twin).↗
▶Ep 4 · 2:11:00
host_summaryType 3 sIUGR fetuses have the smallest placental share and characteristic very large arterio-arterial anastomoses that cause episodic acute fetal-to-fetal transfusions.↗
▶Ep 4 · 2:16:04
host_summaryWith purely expectant management of Type 2 sIUGR, there is 48% loss in the smaller twin and 33% in the normal twin, with only 37% intact survival in the smaller twin.↗
▶Ep 4 · 2:16:36
host_summaryType 3 sIUGR with expectant management shows 38.5% intact survival in the normal twin and 60% in surviving smaller twins, with very high morbidity and mortality in both groups.↗
▶Ep 4 · 2:21:19
clinicalCHOP has performed about 80 bipolar cord cauterizations with 86% singleton survival and over 90 radiofrequency ablations with 83% singleton survival for selective cord occlusion.↗
Stay Current Journal Club: Episode 1 - Ventricular Dysfunction in CDH and...
▶Ep 6 · 8:50
quoteI can't tell if left ventricular dysfunction is a marker or an actual cause of higher mortality.↗
▶Ep 6 · 14:53
opinionCryotherapy is gaining traction in pectus repair, with Kansas City publishing multiple studies showing good results.↗
▶Ep 6 · 15:06
opinionProtocolizing care leads to improved outcomes, as demonstrated by the pectus repair standardization study.↗
Journal of Pediatric Surgery Article Review: November 2021
▶Ep 7 · 1:21
quoteAlmost never. That's what I, that's what I suspected. And that is why I think this is a single institution experience because that's just the way they do it there.↗
▶Ep 7 · 1:21
quoteAlmost never. That's what I, that's what I suspected. And that is why I think this is a single institution experience because that's just the way they do it there.↗
▶Ep 7 · 1:31
clinicalTodd Ponsky has worked at 5 children's hospitals and has had to place a central line at ECMO decannulation only twice, never having to reinsert a line afterwards↗
▶Ep 7 · 1:31
clinicalTodd Ponsky has worked at 5 children's hospitals and has had to place a central line at ECMO decannulation only twice, never having to reinsert a line afterwards↗
▶Ep 7 · 2:49
clinicalIf you just need access, then just use a PICC line rather than a central line↗
▶Ep 7 · 2:49
quoteIf you just need access, then just use a PICC line.↗
▶Ep 7 · 2:49
clinicalIf you just need access, then just use a PICC line rather than a central line↗
▶Ep 7 · 2:49
quoteIf you just need access, then just use a PICC line.↗
▶Ep 7 · 2:53
clinicalLeaving a central line at ECMO decannulation may be reasonable in older patients because they'll need hemodialysis more often↗
▶Ep 7 · 2:53
clinicalLeaving a central line at ECMO decannulation may be reasonable in older patients because they'll need hemodialysis more often↗
▶Ep 7 · 6:17
clinicalThe main reason to operate on congenital lung malformations early is not only that it's easier, but you have a much less chance of having an infection beforehand, so it's clean, pristine virgin plains↗
▶Ep 7 · 6:17
quotethe main reason to, to do it early. not only is it easier, but you have a much less chance of having an infection beforehand, and so it's clean, pristine virgin plains.↗
▶Ep 7 · 6:17
quotethe main reason to, to do it early. not only is it easier, but you have a much less chance of having an infection beforehand, and so it's clean, pristine virgin plains.↗
▶Ep 7 · 6:17
clinicalThe main reason to operate on congenital lung malformations early is not only that it's easier, but you have a much less chance of having an infection beforehand, so it's clean, pristine virgin plains↗
▶Ep 7 · 6:42
clinicalTodd Ponsky was trained to operate on congenital lung malformations at 6 to 8 months of age, but now operates at 3 months↗
▶Ep 7 · 6:42
quoteSo I was trained at 6 to 8 months. Now I'm down to 3 months.↗
▶Ep 7 · 6:42
clinicalTodd Ponsky was trained to operate on congenital lung malformations at 6 to 8 months of age, but now operates at 3 months↗
▶Ep 7 · 6:42
quoteSo I was trained at 6 to 8 months. Now I'm down to 3 months.↗
▶Ep 7 · 10:52
clinicalIf you feel comfortable doing a partial splenectomy, it works 70% of the time (avoiding completion splenectomy)↗
▶Ep 7 · 10:52
quoteOK, so the conclusion of this paper is, if you feel comfortable doing a partial splenectomy. It works 70% of the time.↗
▶Ep 7 · 10:52
quoteOK, so the conclusion of this paper is, if you feel comfortable doing a partial splenectomy. It works 70% of the time.↗
▶Ep 7 · 10:52
clinicalIf you feel comfortable doing a partial splenectomy, it works 70% of the time (avoiding completion splenectomy)↗
Update Course 2022 - APSA PDC UPDATES - Mary Edwards, Paul Jeziorczak, Craig Lillehei, and Charles Snyder,
▶Ep 9 · 34:00
quoteThe reason that we switched to this, um, is that there are, if it's clearly if airway aspiration, you go to the operating room. It's the ones you don't know. And what we found is the ones you don't know, it's a suspicious story. They were coughing after eating. Um, more often than not, it's reactive airway and it's not a foreign body.↗
▶Ep 9 · 35:00
quoteCAT scan pretty much almost a hundred percent will direct you to go to the OR or not. So it's very low radiation and it eliminates those that are equivocal of getting an unnecessary instrumentation of their airway in the face of reactive airway disease.↗
▶Ep 9 · 59:30
quoteI do believe that working with the neonatology team on the decision to operate is actually prudent. I know you were, but a lot of people get upset about that. And I do have that discussion now. Ultimately, the decision is mine. But oftentimes they do sway me.↗
clinicalCT scan can identify multifocal disease in congenital cystic lung lesions, which may change surgical management (e.g., disease in all three lobes of one lung).↗
▶Ep 4 · 9:24
clinicalCT scan can identify multifocal disease in congenital cystic lung lesions, which may change surgical management (e.g., disease in all three lobes of one lung).↗
Panel Discussion: Pediatric Thoracic Surgery Part 1-Lung Lesions 2012
▶Ep 7 · 0:00
quoteI was sitting here thinking I've heard you give so many thoracic talks, but this is the first time I've ever heard you give everything, and watching each lobe at a time is an amazing value because you see it, it just, it all puts it together and makes sense.↗
▶Ep 7 · 0:00
quoteI was sitting here thinking I've heard you give so many thoracic talks, but this is the first time I've ever heard you give everything, and watching each lobe at a time is an amazing value because you see it, it just, it all puts it together and makes sense.↗
Complications and Beyond
▶Ep 22 · 0:11
host_summaryJournal of Pediatric Surgery partners with GlobalCastMD and Stay Current app to share key charts from articles through social media for educational purposes↗
▶Ep 22 · 0:11
guidelineJournal of Pediatric Surgery partners with GlobalCastMD and Stay Current app to share key charts from articles through social media for educational purposes↗
▶Ep 22 · 20:24
host_summaryUntil the true malignancy risk of congenital lung lesions is established, debate between observation (Canadian approach) versus resection (US approach) will continue↗
▶Ep 22 · 20:24
opinionUntil the true malignancy risk of congenital lung lesions is established, debate between observation (Canadian approach) versus resection (US approach) will continue↗
▶Ep 22 · 21:17
clinicalFor flat-surface bleeding from vessel stump, suture is most reliable control method; clips and staplers can worsen bleeding↗
▶Ep 22 · 21:17
clinicalFor flat-surface bleeding from vessel stump, suture is most reliable control method; clips and staplers can worsen bleeding↗
▶Ep 22 · 21:27
clinicalSurgeons performing thoracoscopic lobectomy must be proficient in intracorporeal suturing and tying before attempting the procedure↗
▶Ep 22 · 21:27
clinicalSurgeons performing thoracoscopic lobectomy must be proficient in intracorporeal suturing and tying before attempting the procedure↗
▶Ep 22 · 27:51
clinicalSteve Rothenberg makes relaxing incision on diaphragm and places mesh laterally to prevent esophageal erosion↗
▶Ep 22 · 27:51
host_summarySteve Rothenberg makes relaxing incision on diaphragm and places mesh laterally to prevent esophageal erosion↗
▶Ep 22 · 38:20
clinicalPost-fundoplication obstruction can result from four sites: mesh, top stitch, bottom stitch, or fundus itself↗
▶Ep 22 · 38:20
clinicalPost-fundoplication obstruction can result from four sites: mesh, top stitch, bottom stitch, or fundus itself↗
▶Ep 22 · 43:45
opinionPatients who cycle between reflux and obstruction after multiple fundoplication revisions may never achieve perfect outcome↗
▶Ep 22 · 43:45
opinionPatients who cycle between reflux and obstruction after multiple fundoplication revisions may never achieve perfect outcome↗
▶Ep 22 · 44:57
clinicalVirginia Commonwealth performs gastric disconnects in cognitively normal patients with acceptable outcomes↗
▶Ep 22 · 44:57
host_summaryVirginia Commonwealth performs gastric disconnects in cognitively normal patients with acceptable outcomes↗
▶Ep 22 · 52:48
clinicalGastric distention from large TEF causing respiratory compromise requires emergent decompression, but decompression itself can cause hemodynamic collapse↗
▶Ep 22 · 52:48
clinicalGastric distention from large TEF causing respiratory compromise requires emergent decompression, but decompression itself can cause hemodynamic collapse↗
▶Ep 22 · 52:59
clinicalFor EA/TEF patient decompensating from gastric distention, fastest control is open gastrostomy with immediate esophageal control rather than laparoscopic approach↗
▶Ep 22 · 52:59
clinicalFor EA/TEF patient decompensating from gastric distention, fastest control is open gastrostomy with immediate esophageal control rather than laparoscopic approach↗
▶Ep 22 · 1:04:31
clinicalNottingham UK group is collecting series of esophageal lung cases and seeking collaboration with other institutions↗
▶Ep 22 · 1:04:31
clinicalNottingham UK group is collecting series of esophageal lung cases and seeking collaboration with other institutions↗
Neonatal Lung Lesions with Dr. Steven Rothenberg
▶Ep 23 · 39:28
clinicalIf using the LigaSure device, do not activate the cutting function; seal, remove the device, and cut with scissors to allow partial division and confirmation of hemostasis.↗
▶Ep 23 · 39:28
host_summaryIf using the LigaSure device, do not activate the cutting function; seal, remove the device, and cut with scissors to allow partial division and confirmation of hemostasis.↗
Journal of Pediatric Surgery Article Review: November 2021
▶Ep 26 · 1:21
quoteAlmost never. That's what I, that's what I suspected. And that is why I think this is a single institution experience because that's just the way they do it there.↗
▶Ep 26 · 1:21
quoteAlmost never. That's what I, that's what I suspected. And that is why I think this is a single institution experience because that's just the way they do it there.↗
▶Ep 26 · 1:31
clinicalTodd Ponsky has worked at 5 children's hospitals and has had to place a central line at ECMO decannulation only twice, never having to reinsert a line afterwards↗
▶Ep 26 · 1:31
clinicalTodd Ponsky has worked at 5 children's hospitals and has had to place a central line at ECMO decannulation only twice, never having to reinsert a line afterwards↗
▶Ep 26 · 2:49
clinicalIf you just need access, then just use a PICC line rather than a central line↗
▶Ep 26 · 2:49
quoteIf you just need access, then just use a PICC line.↗
▶Ep 26 · 2:49
quoteIf you just need access, then just use a PICC line.↗
▶Ep 26 · 2:49
clinicalIf you just need access, then just use a PICC line rather than a central line↗
▶Ep 26 · 2:53
clinicalLeaving a central line at ECMO decannulation may be reasonable in older patients because they'll need hemodialysis more often↗
▶Ep 26 · 2:53
clinicalLeaving a central line at ECMO decannulation may be reasonable in older patients because they'll need hemodialysis more often↗
▶Ep 26 · 6:17
clinicalThe main reason to operate on congenital lung malformations early is not only that it's easier, but you have a much less chance of having an infection beforehand, so it's clean, pristine virgin plains↗
▶Ep 26 · 6:17
quotethe main reason to, to do it early. not only is it easier, but you have a much less chance of having an infection beforehand, and so it's clean, pristine virgin plains.↗
▶Ep 26 · 6:17
clinicalThe main reason to operate on congenital lung malformations early is not only that it's easier, but you have a much less chance of having an infection beforehand, so it's clean, pristine virgin plains↗
▶Ep 26 · 6:17
quotethe main reason to, to do it early. not only is it easier, but you have a much less chance of having an infection beforehand, and so it's clean, pristine virgin plains.↗
▶Ep 26 · 6:42
quoteSo I was trained at 6 to 8 months. Now I'm down to 3 months.↗
▶Ep 26 · 6:42
clinicalTodd Ponsky was trained to operate on congenital lung malformations at 6 to 8 months of age, but now operates at 3 months↗
▶Ep 26 · 6:42
quoteSo I was trained at 6 to 8 months. Now I'm down to 3 months.↗
▶Ep 26 · 6:42
clinicalTodd Ponsky was trained to operate on congenital lung malformations at 6 to 8 months of age, but now operates at 3 months↗
▶Ep 26 · 10:52
quoteOK, so the conclusion of this paper is, if you feel comfortable doing a partial splenectomy. It works 70% of the time.↗
▶Ep 26 · 10:52
clinicalIf you feel comfortable doing a partial splenectomy, it works 70% of the time (avoiding completion splenectomy)↗
▶Ep 26 · 10:52
clinicalIf you feel comfortable doing a partial splenectomy, it works 70% of the time (avoiding completion splenectomy)↗
▶Ep 26 · 10:52
quoteOK, so the conclusion of this paper is, if you feel comfortable doing a partial splenectomy. It works 70% of the time.↗
Update Course 2022 - APSA PDC UPDATES - Mary Edwards, Paul Jeziorczak, Craig Lillehei, and Charles Snyder,
▶Ep 28 · 34:00
quoteThe reason that we switched to this, um, is that there are, if it's clearly if airway aspiration, you go to the operating room. It's the ones you don't know. And what we found is the ones you don't know, it's a suspicious story. They were coughing after eating. Um, more often than not, it's reactive airway and it's not a foreign body.↗
▶Ep 28 · 35:00
quoteCAT scan pretty much almost a hundred percent will direct you to go to the OR or not. So it's very low radiation and it eliminates those that are equivocal of getting an unnecessary instrumentation of their airway in the face of reactive airway disease.↗
▶Ep 28 · 59:30
quoteI do believe that working with the neonatology team on the decision to operate is actually prudent. I know you were, but a lot of people get upset about that. And I do have that discussion now. Ultimately, the decision is mine. But oftentimes they do sway me.↗
clinicalCT scan can identify multifocal disease in congenital cystic lung lesions, which may change surgical management (e.g., disease in all three lobes of one lung).↗
Panel Discussion: Pediatric Thoracic Surgery Part 1-Lung Lesions 2012
▶Ep 6 · 0:00
quoteI was sitting here thinking I've heard you give so many thoracic talks, but this is the first time I've ever heard you give everything, and watching each lobe at a time is an amazing value because you see it, it just, it all puts it together and makes sense.↗
Complications and Beyond
▶Ep 17 · 0:11
host_summaryJournal of Pediatric Surgery partners with GlobalCastMD and Stay Current app to share key charts from articles through social media for educational purposes↗
▶Ep 17 · 20:24
host_summaryUntil the true malignancy risk of congenital lung lesions is established, debate between observation (Canadian approach) versus resection (US approach) will continue↗
▶Ep 17 · 21:17
clinicalFor flat-surface bleeding from vessel stump, suture is most reliable control method; clips and staplers can worsen bleeding↗
▶Ep 17 · 21:27
clinicalSurgeons performing thoracoscopic lobectomy must be proficient in intracorporeal suturing and tying before attempting the procedure↗
▶Ep 17 · 27:51
host_summarySteve Rothenberg makes relaxing incision on diaphragm and places mesh laterally to prevent esophageal erosion↗
▶Ep 17 · 38:20
clinicalPost-fundoplication obstruction can result from four sites: mesh, top stitch, bottom stitch, or fundus itself↗
▶Ep 17 · 43:45
opinionPatients who cycle between reflux and obstruction after multiple fundoplication revisions may never achieve perfect outcome↗
▶Ep 17 · 44:57
host_summaryVirginia Commonwealth performs gastric disconnects in cognitively normal patients with acceptable outcomes↗
▶Ep 17 · 52:48
clinicalGastric distention from large TEF causing respiratory compromise requires emergent decompression, but decompression itself can cause hemodynamic collapse↗
▶Ep 17 · 52:59
clinicalFor EA/TEF patient decompensating from gastric distention, fastest control is open gastrostomy with immediate esophageal control rather than laparoscopic approach↗
▶Ep 17 · 1:04:31
clinicalNottingham UK group is collecting series of esophageal lung cases and seeking collaboration with other institutions↗
Neonatal Lung Lesions with Dr. Steven Rothenberg
▶Ep 18 · 39:28
host_summaryIf using the LigaSure device, do not activate the cutting function; seal, remove the device, and cut with scissors to allow partial division and confirmation of hemostasis.↗
opinionDr. Ponsky performs suction rectal biopsy in almost any patient who required a contrast enema to rule out distal obstruction, regardless of whether the enema suggests meconium plug, small left colon, or other diagnosis.↗
▶Ep 1 · 38:05
clinicalDr. Collins reports that the Duhamel pouches she has examined pathologically have contained both ganglionic and aganglionic parts.↗
Radiology and Image Diagnosis of Hirschsprung Disease
▶Ep 4 · 31:46
clinicalDr. Ponsky always performs suction rectal biopsy in almost any patient who needed a contrast enema to rule out distal obstruction, whether meconium plug, small colon, or other cause.↗
▶Ep 4 · 31:51
quoteI always do. So other than the game of am I right at getting question, can I make it even more broad? I would do it. I do it in almost any distal, any patient that needed a contrast enema.↗
▶Ep 4 · 32:15
clinicalDr. Ponsky performs rectal biopsy even in meconium ileus cases.↗
▶Ep 4 · 32:23
host_summaryIf it is clearly meconium ileus with reflux into terminal ileum and clinical improvement, some surgeons will not do rectal biopsy.↗
▶Ep 4 · 38:05
clinicalDr. Collins has seen resected Duhamel pouches that had both ganglionic and aganglionic parts, but does not know what their contrast enemas looked like.↗
Outcomes and Complications in Hirschsprung Disease
▶Ep 5 · 33:44
host_summaryMany institutions assess pull-through specimens using only a longitudinal strip rather than examining the full circumference of the proximal margin; the interface between ganglionic and aganglionic bowel can be irregular and project 2-4 cm longer along one part of the circumference.↗
▶Ep 5 · 33:44
quoteMany places still have clung to this idea that the way to assess a pull through specimen is to do a longitudinal strip of the length of the specimen and not look at the full circumference of the proximal margin.↗
▶Ep 5 · 33:53
quoteThe interface between the ganglionic bowel and the a ganglion bowel can be very irregular and can project for 234 centimeters longer along one part of the circumference than the other.↗
▶Ep 5 · 35:19
host_summaryA survey of Canadian pediatric surgeons found nearly half resect 4 centimeters or less from the biopsy site, and about 10% resect right at the site of positive biopsy, creating high risk of pull-throughs in the transition zone.↗
▶Ep 5 · 1:15:23
opinionLaparoscopy is minimally invasive but provides even better exposure than open surgery; small umbilical incisions compromise exposure.↗
▶Ep 5 · 1:15:23
quoteLaparoscopy is minimally invasive but gives you actually make even better exposure, so you're not compromising exposure with laparoscopy.↗
Hirschsprung Disease: Update Course 2015
▶Ep 7 · 4:22
opinionPure transanal pull-through may not be less invasive than laparoscopic approach, as prolonged torquing in the anal canal can be more traumatic than three small abdominal incisions.↗
▶Ep 7 · 4:22
quoteI don't believe that a pure trans anal is necessarily less invasive. In other words, I believe that putting 3 incisions on the abdomen is actually less invasive in my hands, in my hands, certainly not in your guys' hands, but in my hands, I'm gonna be torquing in that anal canal much more than if I had done it laparoscopically and freed everything up from the abdominal approach.↗
Hirschsprung Disease: Radiology Aspect
▶Ep 8 · 31:01
clinicalRectal biopsy should be performed in almost any patient who needed a contrast enema to rule out distal obstruction, including cases of meconium plug or small left colon.↗
▶Ep 8 · 31:12
quoteI would do it. I do it in almost any distal, any patient that needed a contrast enema. To rule out a distal obstruction, I'm going to be doing a suction rectal biopsy, whether it's meconium plug or a small colon.↗
▶Ep 8 · 31:35
clinicalIn clearly documented meconium ileus where reflux into terminal ileum is achieved and the patient clinically improves, rectal biopsy may not be necessary.↗
Hirschsprung Disease: Cases and Complications
▶Ep 9 · 33:44
quoteThe interface between the ganglionic bowel and the a ganglion bowel can be very irregular and can project for 234 centimeters longer along one part of the circumference than the other, so that even if you just look at a longitudinal strip. You could see gangon cells at the proximal margin, but on the opposite side of that margin there may be no gangon cells, and so you may be dealing with a, a low transition zone pull through in that situation.↗
▶Ep 9 · 35:19
host_summaryA survey of the Canadian Association of Pediatric Surgeons by Jack Langer found that nearly half of surgeons resect 4 cm or less from the biopsy site, and about 10% resect right at the site of positive biopsy, creating high risk for pull-throughs in the transition zone.↗
▶Ep 9 · 1:15:24
opinionLaparoscopy is minimally invasive but provides maybe even better exposure than open surgery, so exposure is not compromised with laparoscopy.↗
▶Ep 9 · 1:39:29
clinicalEnterocolitis does not occur in pure anorectal malformations without Hirschsprung disease.↗
Hirschsprung Disease: Update Course 2013
▶Ep 10 · 1:45
opinionIn newborn bowel obstruction with distended abdomen and distal air, start with contrast enema rather than upper GI↗
▶Ep 10 · 2:11
clinicalBilious emesis typically prompts upper GI, but newborn distal obstruction is an exception where contrast enema is more informative↗
▶Ep 10 · 2:40
host_summaryA significant portion of fellows at a Washington DC course said they would get upper GI first in newborn with bilious emesis before contrast enema↗
▶Ep 10 · 4:51
guidelineTissue diagnosis is absolutely required before operating for Hirschsprung disease↗
▶Ep 10 · 28:51
opinionIn older children (age 2-3 and up), suction rectal biopsy should not be performed; instead do open rectal biopsy under general anesthesia↗
▶Ep 10 · 30:06
opinionIn 3-year-old with severely dilated colon from chronic Hirschsprung disease, the dilated segment is unlikely to collapse and should be resected↗
Hirschsprung Disease: Update Course 2013
▶Ep 11 · 1:59
opinionIn newborn bowel obstruction with distal air, contrast enema should precede upper GI unless clinical presentation strongly suggests malrotation↗
▶Ep 11 · 4:14
quotethe baby's first enema should be a barium enema↗
▶Ep 11 · 5:06
host_summaryTissue diagnosis is mandatory before surgery for Hirschsprung disease; contrast enema alone is insufficient↗
▶Ep 11 · 5:30
host_summaryIn critically ill patients with enterocolitis, surgery may be necessary before pathology results are available (typically takes until Wednesday if specimen obtained Friday)↗
▶Ep 11 · 9:57
opinionProne positioning for pull-through is easier on surgeon's back and neck compared to lithotomy↗
▶Ep 11 · 16:50
quoteI've never seen really good results from in a 16 year old↗
▶Ep 11 · 17:40
host_summaryHypertrophic nerves should not be present in normal anal canal, even though ganglion cells are absent there↗
▶Ep 11 · 29:11
host_summaryIn children over age 2-3 years, perform open rectal biopsy under general anesthesia rather than office suction biopsy due to patient cooperation issues↗
▶Ep 11 · 34:11
host_summaryManometry is reliable for diagnosing Hirschsprung in older children when biopsies may be unreliable↗
▶Ep 11 · 35:15
host_summaryFor enterocolitis 6 months post-pull-through with fever, distention, and diarrhea but no peritonitis, treat with IV fluids, broad-spectrum antibiotics, and rectal irrigations↗
▶Ep 11 · 36:20
host_summaryIncidence of enterocolitis in children with trisomy 21 is double that of genetically normal children with Hirschsprung disease↗
Colorectal - Clinical Practice Updates
▶Ep 12 · 14:14
quoteIs there any evidence for anything that, that y'all have mentioned? I mean, it seems like this is the right topic to try to get some better evidence for it, but I'm just interested to know, is there evidence for what y'all are, for any of these uh suggested treatments.↗
▶Ep 12 · 43:34
quoteI'll just raise my standard thing that I always raise, which is why are we getting a CAT scan?↗
Glycopyrrolate for Anastomtic Dehiscence in Esophageal Atresia
▶Ep 1 · 0:08
host_summaryThere were 297 patients over a 10 year period that underwent esophageal atresia repair↗
▶Ep 1 · 0:08
quoteThe title of today's article is Role of Glycopyrolate in Healing of Anastomotic dehiscence after Primary Repair of esophageal atresia in a Low Resource setting, a randomized control study.↗
▶Ep 1 · 0:08
host_summaryThe study was a prospective randomized control trial studying the effect of glycopyrolate on patients that had leak after esophageal atresia repair↗
▶Ep 1 · 0:08
host_summaryThe 42 patients with leaks were prospectively randomized into two groups of 21 each, one receiving glycopyrrolate and the other receiving placebo (saline)↗
▶Ep 1 · 0:08
host_summaryOf the 297 patients, there were 42 leaks, approximately 14%↗
▶Ep 1 · 0:08
host_summaryThe observer was blinded to which treatment group the patient was in↗
▶Ep 1 · 1:32
quoteOK, so the results are pretty astounding. The Robinol or the glycopyrolate group really had impressive results compared to the placebo group.↗
▶Ep 1 · 1:56
quoteI think this is a great study to review because it's a novel treatment that can have substantial effect on a very complicated problem we all deal with. I know that I'll change my practice based on this and start giving Roben all to my, uh, leaks after TEF repair↗
▶Ep 1 · 1:56
opinionGlycopyrrolate is a novel treatment that can have substantial effect on the complicated problem of anastomotic leak after esophageal atresia repair↗
Thoracoscopic TEF Repair, Is It Really Better Than Open? Update Course 2018
▶Ep 2 · 0:00
quoteEvery year we try to do a session on technique and um so this year, uh, Doctor Rothenberg is going to talk to us about the thoracoscopic TEF.↗
▶Ep 2 · 14:15
quotethe more shocking thing to me was that I thought that's higher than I would have expected for the world.↗
▶Ep 2 · 17:00
quoteI think I'd be very cautious about a broad paint stroke of all. EA's being repaired thoracoscopically because there's, uh, we selectively choose the ones, so that we can get optimize the outcomes based on the technique and skill of the surgeon.↗
Aerodigestive & Esophageal Surgery - The Unsalvageable Esophagus & Cases
▶Ep 1 · 2:14
quoteSome people believe that you have to use a scope to measure the true gap. I may not be at the end.↗
▶Ep 1 · 2:14
quoteSome people believe that you have to use a scope to measure the true gap. I may not be at the end.↗
▶Ep 1 · 2:21
clinicalIn long-gap atresia, some surgeons use a Hagar dilator to measure the gap, but this may not reach the true end of the distal pouch. A flexible scope is more reliable for accurate gap measurement.↗
▶Ep 1 · 2:21
clinicalIn long-gap atresia, some surgeons use a Hagar dilator to measure the gap, but this may not reach the true end of the distal pouch. A flexible scope is more reliable for accurate gap measurement.↗
clinicalIn experimental porcine models of endoscopic Foker (using olive beads and wire traction), pressure necrosis at the anastomotic site is the suspected cause of death.↗
clinicalIn experimental porcine models of endoscopic Foker (using olive beads and wire traction), pressure necrosis at the anastomotic site is the suspected cause of death.↗
▶Ep 1 · 7:00
clinicalIntraluminal magnetic anastomosis is being developed as a minimally invasive approach to long-gap atresia, with the goal of reducing pressure necrosis compared to bead-based traction.↗
▶Ep 1 · 7:00
clinicalIntraluminal magnetic anastomosis is being developed as a minimally invasive approach to long-gap atresia, with the goal of reducing pressure necrosis compared to bead-based traction.↗
▶Ep 1 · 10:52
quoteThe whole big controversial thing is, do, are we trying too hard to save the esophagus?↗
▶Ep 1 · 10:52
quoteThe whole big controversial thing is, do, are we trying too hard to save the esophagus?↗
▶Ep 1 · 19:13
quoteStents don't work in, in scarred, uh, form strictures that are not fresh.↗
▶Ep 1 · 19:13
quoteStents don't work in, in scarred, uh, form strictures that are not fresh.↗
▶Ep 1 · 26:28
clinicalPlacing endoscopes from above and below during thoracoscopic stricture resection allows identification of the stricture by transillumination ('go to the light').↗
▶Ep 1 · 26:28
clinicalPlacing endoscopes from above and below during thoracoscopic stricture resection allows identification of the stricture by transillumination ('go to the light').↗
▶Ep 1 · 30:25
clinicalMagnetic compression anastomosis (magnamosis) has been used successfully for gastrojejunostomy but is unproven in the esophagus. The main limitations are the distance magnets can attract across and the lack of mucosal lining in the resulting anastomosis.↗
▶Ep 1 · 30:25
clinicalMagnetic compression anastomosis (magnamosis) has been used successfully for gastrojejunostomy but is unproven in the esophagus. The main limitations are the distance magnets can attract across and the lack of mucosal lining in the resulting anastomosis.↗
▶Ep 1 · 41:47
clinicalSerial bougie dilation (e.g., Maloney or Savary dilators) is less effective than balloon dilation for esophageal strictures. Balloon dilation applies radial force and can crack scar tissue without requiring needle knife incision.↗
▶Ep 1 · 41:47
clinicalSerial bougie dilation (e.g., Maloney or Savary dilators) is less effective than balloon dilation for esophageal strictures. Balloon dilation applies radial force and can crack scar tissue without requiring needle knife incision.↗
▶Ep 1 · 47:31
quoteI always tease our gastroenterologists that it's impossible to remove the endoscope without bringing out tissue with it.↗
▶Ep 1 · 47:31
quoteI always tease our gastroenterologists that it's impossible to remove the endoscope without bringing out tissue with it.↗
▶Ep 1 · 54:12
clinicalMobilizing the gastroesophageal junction to achieve length for primary esophageal anastomosis effectively creates a hiatal hernia and predisposes to reflux.↗
▶Ep 1 · 54:12
clinicalMobilizing the gastroesophageal junction to achieve length for primary esophageal anastomosis effectively creates a hiatal hernia and predisposes to reflux.↗
▶Ep 1 · 59:46
quoteClearly I had ischemia because it was 100% a technical issue, whether it was ischemia.↗
▶Ep 1 · 59:46
quoteClearly I had ischemia because it was 100% a technical issue, whether it was ischemia.↗
▶Ep 1 · 1:14:05
clinicalFor a spit fistula to avoid recurrent TEF, the distal esophageal stump must be fully mobilized down to the diaphragm and separated from the trachea, not just divided and dropped.↗
▶Ep 1 · 1:14:05
clinicalFor a spit fistula to avoid recurrent TEF, the distal esophageal stump must be fully mobilized down to the diaphragm and separated from the trachea, not just divided and dropped.↗
▶Ep 1 · 1:40:18
quoteIt's been a real pleasure being here today and it's been an honor how much I've learned in one day.↗
▶Ep 1 · 1:40:18
quoteIt's been a real pleasure being here today and it's been an honor how much I've learned in one day.↗
▶Ep 1 · 1:40:28
quoteAbsolutely amazing webinar, some amazing cases with excellent skills that you all brought today. I'm happy that you all are there for us when these cases get beyond the norm.↗
▶Ep 1 · 1:40:28
quoteAbsolutely amazing webinar, some amazing cases with excellent skills that you all brought today. I'm happy that you all are there for us when these cases get beyond the norm.↗
Aerodigestive & Esophageal Surgery - Difficult Tracheal Esophageal Fistula
▶Ep 6 · 25:08
clinicalTrichloroacetic acid (TCA) can be used to demucosalize TEF tracts, but control is less precise than with bugbee cautery; TCA is applied on a pledget and can cause unintended burns if it contacts tissue during insertion.↗
▶Ep 6 · 1:50:04
clinicalAnal fistula plugs (biologic, cone-shaped, made of Surgisis) can theoretically be used to occlude distal airway fistulas; they are wrapped with barbed suture and inserted into the tract to promote collagen matrix formation and scarring.↗
TEF Presentations (Extended): Aerodigestive & Esophageal Surgery
▶Ep 7 · 0:00
quoteThis instrument I learned from actually a previous Globalcast and now I use it all the time.↗
▶Ep 7 · 0:04
quoteThe bugbee is so useful and underutilized among us as general surgeons.↗
▶Ep 7 · 0:04
opinionThe bugbee cautery is useful and underutilized among general surgeons for treating recurrent tracheoesophageal fistulas.↗
▶Ep 7 · 1:53
opinionGeneral surgeons may underappreciate tracheomalacia or laryngomalacia, making collaboration with ENT colleagues valuable for comprehensive airway assessment.↗
▶Ep 7 · 1:53
quoteWe may underappreciate tracheomalacia or malaysia.↗
▶Ep 7 · 12:21
clinicalTrichloroacetic acid (TCA) can be used for TEF demucosalization, but it is difficult to control precisely and leaves white tissue everywhere, whereas the bugbee provides more precise control.↗
▶Ep 7 · 12:57
quoteI have to tell you what scares me is when I'm done, it's white everywhere because I mean, the whole, it's hard to control it and be precise.↗
▶Ep 7 · 13:19
quoteWhen I switched to the bug bee, I have herby bug bee bug beat, um, it's, uh, it absolutely is much more precise.↗
▶Ep 7 · 17:52
quoteI'm always afraid because I can't see down that tube, and I wonder not just word in the esophagus, I wonder if I'm really destroying that fistula so much that I'm gonna perforate↗
▶Ep 7 · 45:31
quoteWhen they're dead, they're still not dead. They're still going. They got about 2 volts↗
▶Ep 7 · 45:31
host_summaryDead button batteries still have about 2 volts and continue to cause damage.↗
▶Ep 7 · 45:37
host_summaryButton batteries can be distinguished from coins on AP X-ray by a visible rim, eliminating the need for a lateral view.↗
▶Ep 7 · 1:09:25
clinicalFor TEF repair, all that matters is achieving raw-on-raw tissue contact for healing.↗
▶Ep 7 · 1:09:33
opinionThoracoscopic diaphragmatic hernia repairs may have a higher recurrence rate than open repairs, possibly because they do not cause enough raw-on-raw tissue contact.↗
▶Ep 7 · 1:37:24
clinicalAnal fistula plugs made of biologic material (surgesis) can be used for TEF repair by wrapping them with barbed VOC suture and inserting them into the fistula tract to promote scarring and collagen matrix formation.↗
Complications and Beyond
▶Ep 2 · 0:11
guidelineJournal of Pediatric Surgery partners with GlobalCastMD and Stay Current app to share key charts from articles through social media for educational purposes↗
▶Ep 2 · 20:24
opinionUntil the true malignancy risk of congenital lung lesions is established, debate between observation (Canadian approach) versus resection (US approach) will continue↗
▶Ep 2 · 21:17
clinicalFor flat-surface bleeding from vessel stump, suture is most reliable control method; clips and staplers can worsen bleeding↗
▶Ep 2 · 21:27
clinicalSurgeons performing thoracoscopic lobectomy must be proficient in intracorporeal suturing and tying before attempting the procedure↗
▶Ep 2 · 27:51
clinicalSteve Rothenberg makes relaxing incision on diaphragm and places mesh laterally to prevent esophageal erosion↗
▶Ep 2 · 38:20
clinicalPost-fundoplication obstruction can result from four sites: mesh, top stitch, bottom stitch, or fundus itself↗
▶Ep 2 · 43:45
opinionPatients who cycle between reflux and obstruction after multiple fundoplication revisions may never achieve perfect outcome↗
▶Ep 2 · 44:57
clinicalVirginia Commonwealth performs gastric disconnects in cognitively normal patients with acceptable outcomes↗
▶Ep 2 · 52:48
clinicalGastric distention from large TEF causing respiratory compromise requires emergent decompression, but decompression itself can cause hemodynamic collapse↗
▶Ep 2 · 52:59
clinicalFor EA/TEF patient decompensating from gastric distention, fastest control is open gastrostomy with immediate esophageal control rather than laparoscopic approach↗
▶Ep 2 · 1:04:31
clinicalNottingham UK group is collecting series of esophageal lung cases and seeking collaboration with other institutions↗
Tracheoesophageal Fistula with Dr. Daniel von Allmen
▶Ep 8 · 22:03
clinicalProximal pouch dissection is similar to separating rectum and vagina - making two planes out of one without great natural separation↗
▶Ep 8 · 27:00
quoteI will tell you that there's so much debate on this, and I know that from experience people have strong feelings one way or the other.↗
▶Ep 8 · 31:21
clinicalMarcelo Martinez Ferro's 'spaghetti trick' - grabbing and twirling tip of proximal pouch shows the dissection plane nicely↗
▶Ep 8 · 32:10
clinicalBraided suture is safe for all intracorporeal technique↗
▶Ep 8 · 32:10
clinicalVicryl ties down nice and tight but cannot use knot pusher for first stitch under tension as it will tear through esophagus; need monofilament for extracorporeal knots↗
▶Ep 8 · 32:45
clinicalAfter clipping fistula, do not divide it completely until ready to place first stitch so distal esophagus doesn't drop toward diaphragm↗
▶Ep 8 · 33:54
clinicalMust be able to see and incorporate mucosa on every stitch; hanging stitch helps visualize lumen of both proximal and distal ends↗
▶Ep 8 · 34:48
clinicalCan position ET tube after bronchoscopy to selectively ventilate left lung↗
▶Ep 8 · 40:04
clinicalLeak increases risk of postoperative stricture↗
▶Ep 8 · 41:09
opinionPediatric surgeons don't do fantastic job of long-term follow-up with TEF patients↗
Case Based Journal Review: Esophageal Atresia in 2022
▶Ep 9 · 1:58
quoteI would divide the azyous, but that's purely because that's how I was trained.↗
▶Ep 9 · 4:04
quoteI Never like dividing it. You're in this tiny little space and you're cauterizing a vein that you kind of know you don't need to be doing because you could probably still do the operation without doing it.↗
▶Ep 9 · 4:25
quoteI'll tell you what's not convincing me, this paper.↗
▶Ep 9 · 5:16
quoteI don't need someone to prove to me that dividing it hurts the patient. I need someone to prove to me that you don't need to divide it.↗
▶Ep 9 · 5:41
quoteI would say absolutely put it down, but then take it out at the end of the case.↗
▶Ep 9 · 8:39
quoteI used to theorize that you should leave a huge tube across the anastomosis, and that would keep it stented open and it would heal wide open. Boy was I wrong.↗
▶Ep 9 · 9:02
quoteAnd for anyone out there listening, it's hard to do. That's been your safety line, and to let go of it is a little scary, but it certainly did not impact. Uh, any of our outcomes. In fact, it's probably been better↗
▶Ep 9 · 11:23
clinicalIf a leak occurs, it doesn't always drain through the chest tube↗
▶Ep 9 · 11:30
opinionA chest tube may injure, suck on, or increase the chance of disruption of the anastomosis↗
host_summaryGiving acid suppression to neonates increases the risk of necrotizing enterocolitis according to neonatologists' concerns↗
▶Ep 9 · 15:58
quoteIf I were to give a summary of today's selection of articles, the theme is less is more.↗
▶Ep 9 · 16:09
quoteIf I felt like chest tubes hurt the operation or the anastomosis or a patient, I could be convinced to stop using them. It's a little scary, but I think it's probably heading in that direction.↗
Journal of Pediatric Surgery Article Review: February 2023, BAPS issue
▶Ep 10 · 4:13
clinicalCenters of excellence for esophageal atresia are showing better outcomes↗
▶Ep 10 · 4:26
opinionCentralization of esophageal atresia care would be difficult to implement in the United States healthcare system↗
QUAD #1: Cervical Tracheopexy with Dr. Alessandro de Alarcon
▶Ep 13 · 0:55
host_summaryPreoperative testing includes dynamic CT imaging, pulmonary function tests, microlaryngoscopy and bronchoscopy, and flexible bronchoscopy.↗
▶Ep 13 · 2:01
host_summaryThe cervical approach can assist thoracoscopic procedures by removing residual or regrown large thymus tissue.↗
▶Ep 13 · 2:19
host_summaryIn the lateral approach, the surgical team works on the side of the airway to find the esophagus.↗
▶Ep 13 · 2:23
host_summaryPediatric surgeons identify the recurrent nerve for the ENT team to help prevent injury.↗
▶Ep 13 · 2:43
host_summaryThe esophagus is mobilized above the level where the team aims to perform the pexy, making suture placement easier.↗
▶Ep 13 · 3:02
host_summaryA pulmonologist assists with flexible endoscopy through the endotracheal tube to visualize inside the trachea while stitches are placed.↗
▶Ep 13 · 3:24
host_summaryThe combined approach is valuable for complicated cases or patients needing additional operations for symptom relief.↗
▶Ep 13 · 4:32
host_summaryOtolaryngology involvement is important both during the procedure and in follow-up due to potential complications.↗
host_summaryRate of feeding advancement does not correlate with development of necrotizing enterocolitis.↗
▶Ep 3 · 3:11
quoteI think there's pretty good evidence now to show the things that we thought, you had to be really slow with going up on the feeds, that there's really no correlation with that and developing necrotizing enterocolitis.↗
▶Ep 3 · 7:17
quoteAll those relative indications like pneumatosis, a fixed loop, any of those things, they all drive me, but not as single entities. Usually I have to have a couple of things indicating that something is going on.↗
▶Ep 3 · 7:17
clinicalPneumoperitoneum is the only single factor that would prompt operation; otherwise a constellation of findings (pneumatosis, hemodynamic instability, fixed loop, worsening acidosis/ventilation) is required.↗
▶Ep 3 · 16:21
quote30% of those babies never need an operation.↗
▶Ep 3 · 17:44
host_summaryThe Moss New England Journal trial showed no difference in outcomes between peritoneal drainage and laparotomy in extremely low birth weight infants with NEC, but the study population was heterogeneous.↗
▶Ep 3 · 19:06
host_summaryMost panelists use 1 kg as the weight threshold above which they favor laparotomy over peritoneal drainage.↗
▶Ep 3 · 21:55
host_summaryPrimary anastomosis at initial NEC operation is rarely performed (8–10% of audience) due to inability to detect anastomotic leak in a sick neonate.↗
▶Ep 3 · 22:01
host_summaryDr. Miguel Guelfand presented impressive results with primary anastomosis in NEC at a prior conference.↗
▶Ep 3 · 22:01
quoteMiguel Guelfand presented his experience doing primary anastomosis at our necrotizing enterocolitis conference. It was pretty impressive his results.↗
▶Ep 3 · 22:11
quoteMy concern with that is they're still sick when you're operating and how do you know if you're leaking? You just can't evaluate the kid's belly after doing a very scary tenuous anastomosis.↗
▶Ep 3 · 26:26
quotePrior to the Washington DC conference, I would have waited 8 weeks minimum and 2 kg. But the data that Andrew Badillo presented showed that you can do early anastomosis much earlier than I had always done.↗
▶Ep 3 · 26:32
host_summaryStoma takedown is typically performed at 4–6 weeks postoperatively and 2 kg body weight, though recent data (Andrew Badillo) suggest earlier reversal may be safe.↗
Malrotation
▶Ep 1 · 7:42
quoteI think the hardest part for the laparoscopic labs is really dealing with the mesentery in the bowel. I think the laparoscopy is very good for dividing, freeing up the duodenum to obviously taking out the appendix.↗
▶Ep 1 · 11:53
quoteYou see how dilated those loops of bowel are? So, that, that's going to always give you a low lying ligament of trites when you have dilated loops of bowel. And that's exactly why I don't get upper GIs when you're just ruling out for a G tube.↗
▶Ep 1 · 11:53
clinicalWhen bowel loops are dilated, this will always give you a low-lying ligament of Treitz↗
▶Ep 1 · 15:15
host_summaryIn a published study combining experience with Kansas City, the cardiac risk group did not stratify out to be at higher risk for reflux complications; neurologically impaired CP kids maybe, but not cardiac kids↗
▶Ep 1 · 21:23
quotewhat is the color of aspiration through the nos gastric tube? That is crucial. If that is green or slightly green, I think the patient needs, uh, you know, operations.↗
▶Ep 1 · 22:25
quoteI want to repeat, I want to repeat the contrast studies to diagnose malrotation because if you can go ahead and do the laparoscopy, but if you found If you find nothing, what would you do? That is a waste of time.↗
▶Ep 1 · 31:46
quoteI don't need a PH probe to tell me that this kid is vomiting. I don't need a milk scan to tell me that. In fact, you know my feeling on that. I think that none of those studies are very helpful↗
▶Ep 1 · 34:04
quotethe patient is gaining weight, correct? Patient's OK, this kid was throwing up. Yeah, so I, I, I don't do anything. Because the patient is fine, gaining weight and clinically well. Why do I have to operate?↗
▶Ep 1 · 34:30
quoteaspiration of the energy tube is non bilious. So not dangerous.↗
▶Ep 1 · 35:20
host_summaryYama does not operate on asymptomatic malrotation as long as the patient has non-bilious vomiting, is gaining weight, and is clinically well↗
▶Ep 1 · 36:16
host_summaryIf a patient has a narrow pedicle, the patient always has vomiting and is symptomatic↗
▶Ep 1 · 36:39
host_summaryLadd's bands themselves are not risky; the risk is bilious vomiting and narrowing of the pedicle↗
▶Ep 1 · 36:39
quotePersonally, personally, I don't think lap bands cause the valvulus. It can cause compression of the duoden, but that band itself is not risky. The risk is bilious vomiting and the narrowing of the pedicle. That needs operation.↗
epidemiologicalIn heterotaxy syndrome with right atrial isomerism, there is a higher incidence of malrotation compared to left atrial isomerism.↗
▶Ep 6 · 12:12
clinicalMany radiologists have switched from gastrografin to isotonic contrast (such as iohexol) for meconium ileus enemas, which defeats the therapeutic purpose of the enema.↗
▶Ep 6 · 12:29
clinicalRadiologists avoid gastrografin due to concerns about the hypertonicity of the contrast medium.↗
▶Ep 6 · 18:27
quoteI'd say turn around. Treat the patient, not the, not the blush.↗
▶Ep 6 · 23:18
guidelineActivity restrictions after solid organ injury follow the grade plus 2 weeks rule (e.g., grade 3 injury = 5 weeks restriction).↗
▶Ep 6 · 26:19
guidelineIn adults, 2 centimeters is the cutoff size for mesenteric vessel pseudoaneurysms at which intervention is typically considered.↗
clinicalFor gastroschisis, bedside reduction can be attempted under sedation (rectal acetaminophen and small-dose fentanyl) without intubation, with success in approximately 80% of cases even when all bowel is eviscerated.↗
▶Ep 5 · 14:20
opinionSpring-loaded Bianchi silos may enlarge the fascial defect because the compressive forces are directed outward at the ring level.↗
▶Ep 5 · 25:19
opinionIf apple-peel bowel is ischemic (not necrotic) and not twisted, waiting until the next day to reassess viability is reasonable before committing to resection.↗
Malrotation Rapid Fire Session: Update Course 2015
▶Ep 8 · 5:57
opinionIn situs inversus with malrotation, the appendix is in the correct location (a double negative), so appendectomy may not be indicated.↗
▶Ep 8 · 6:04
quoteThe appendix is in the correct location and he's malrotated, so it's a double negative.↗
Necrotizing Enterocolitis with Dr. Gail Besner
▶Ep 9 · 41:06
clinicalA recent Journal of Pediatric Surgery article showed substantial decrease in TPN use with mucous fistula refeeding.↗
Abdominal Wall Defects with Dr. Jacob Langer
▶Ep 10 · 14:19
clinicalDr. Baird published a paper in JPS showing that patients with flap closure did better in every way than those with sutured fascial closure, including lower rates of umbilical hernia repair↗
▶Ep 10 · 18:10
clinicalSpring-loaded silos (Bentech) create outward pressure forces as you push down, making the defect larger over time↗
▶Ep 10 · 37:22
clinicalCristobal Abello in Colombia uses Duoderm over the sac to compress and reduce omphaloceles over time↗
▶Ep 10 · 42:03
clinicalPhil Gazzetta described the 'flip flop' technique (modification of component separation) for omphalocele closure: lateral incision of anterior sheath only, folding over while attached to posterior sheath, creating single posterior layer↗
Compiled Sandler Rapid Fire Sessions: Update Course 2015
clinicalFor gastroschisis with inflamed bowel, bedside reduction without intubation is feasible using rectal Tylenol and minimal fentanyl↗
▶Ep 12 · 9:58
clinicalFor gastroschisis with inflamed bowel, bedside reduction without intubation is feasible using rectal Tylenol and minimal fentanyl↗
▶Ep 12 · 14:27
opinionSpring-loaded Bianchi silos may enlarge the fascial defect because the outward forces from the compressed ring push laterally↗
▶Ep 12 · 14:27
opinionSpring-loaded Bianchi silos may enlarge the fascial defect because the outward forces from the compressed ring push laterally↗
Gastroschisis: Advanced Practice Providers
▶Ep 15 · 10:22
clinicalTodd Ponsky has done only non-sutured gastroschisis repair for the last 6 years and has never had a ventral hernia. He reports 10-20% umbilical hernia rate, most resolving by age 3-5 years, with perfect cosmetic results.↗
▶Ep 15 · 10:26
quoteI have only done this repair, uh, for the last 6 years. I have not done a sutured repair in 6 years.↗
epidemiologicalIn a pediatric surgery event poll, about 75% of surgeons reported doing non-sutured (Tegaderm) gastroschisis repair.↗
▶Ep 15 · 11:03
quoteWe did a pediatric surgery event just like this, but for the pediatric surgeons, and we pulled the audience, and I think it was about 75% of the surgeons that did the non-sutured repair.↗
▶Ep 15 · 11:53
clinicalFor non-sutured closure, Todd Ponsky places a silo on all patients, reduces at bedside, and if everything reduces he closes it by tying the umbilical cord with suture, laying it in a circle over the hole, applying gauze and Tegaderm, waiting 4 days, then changing dressing every 4 days until sealed (usually 2 weeks).↗
▶Ep 15 · 29:22
opinionTodd Ponsky does not use bladder pressures for gastroschisis monitoring, finding them not terribly accurate in this patient size. He uses peak airway pressures as primary assessment during reduction, watching them to decide when to stop reducing, and looks at overall baby appearance and urine output.↗
▶Ep 15 · 29:25
quoteWe do not use bladder pressures. Uh, I don't find them to be terribly accurate in this size, uh, patient.↗
▶Ep 15 · 29:41
quoteWhat I use, Joyce, is, um, usually if they're bad enough that you're wondering what their bladder pressures are, they're often intubated. Um, if they're that sick, and so I look at their peak airway pressures to see, so as I'm reducing them, I watch their peak airway pressures, and that's how I decide when to stop reducing.↗
▶Ep 15 · 30:03
quoteThere's never a downside to just releasing the silo and letting things back out again, right.↗
▶Ep 15 · 42:18
clinicalFor gastroschisis monitoring, the volume of NG output matters less than the color: even high-volume clear/spitty output may allow feeding, but any bilious output (regardless of volume) means the patient is not ready to feed.↗
▶Ep 15 · 43:11
quoteThe exact opposite is true that you can have a ton of spit coming out, but it doesn't mean that they're not ready to be fed, um, so for some reason in the little kids the volume doesn't seem to be as critical, um, as the color.↗
7th Annual Pediatric Surgery Update Course 2019 - FULL SHOW
▶Ep 22 · 0:58
quoteJust two days ago, I had a baby that I was operating on. And because you taught me this, the hemoglobin, they were going to transfuse up to a hematocrit of thoracin. No, I learned from the PDC. We don't have to do that anymore. Transfuse clinically.↗
▶Ep 22 · 2:56
quoteThis single teaching point made the whole update course worth it because he didn't realize this, and it totally changed his practice.↗
▶Ep 22 · 17:16
quoteI don't know if any surgeon would look at that and go 41 percent failure rate is a success.↗
▶Ep 22 · 17:16
epidemiologicalIn the APAC trial (adult study), at five years, 41% of the non-operative appendicitis group underwent an appendectomy↗
▶Ep 22 · 17:16
opinionThe important point in non-operative appendicitis management is not whether it's effective for six months or a year, but what happens 10, 20, or 40 years down the road regarding appendix scarring and future obstruction↗
▶Ep 22 · 17:16
quoteI use this as something in my back pocket now. So I don't do it, but I have it there. So if someone's not a good surgical candidate, for whatever reason, I don't want it. Then I know I have it as an option, but I don't do it.↗
▶Ep 22 · 17:16
epidemiologicalParents surveyed for PCORI-funded study said if there was a 50% chance of non-operative appendicitis management being successful, they would enroll in the study↗
▶Ep 22 · 17:16
quoteI think the parents are more focused on the here and now. That is what's happening at that moment in the emergency room. Whereas we as their caregivers need to be thinking about what's best for the total life of the patient.↗
▶Ep 22 · 23:29
clinicalEnhanced recovery after surgery protocols have been great at reducing opioids both in the inpatient setting and at time of discharge↗
Biliary Atresia, Appendicitis, Intestinal Failure, and Anesthetic...
▶Ep 26 · 42:16
clinicalDr. Ponsky's chief of anesthesiology instituted a 'rule of two': defer elective operations until after age 2 and avoid two anesthetics in one year.↗
▶Ep 26 · 42:31
opinionDr. Ponsky now defers dermoid cyst excision in a 6-month-old until 18 months but does not delay inguinal hernia repair due to known incarceration risk in young infants.↗
Necrotizing Enterocolitis with Dr. Gail Besner
▶Ep 27 · 41:06
host_summaryRecent Journal of Pediatric Surgery article showed substantial decrease in TPN use with mucous fistula refeeding.↗
▶Ep 27 · 41:06
host_summaryRecent Journal of Pediatric Surgery article showed substantial decrease in TPN use with mucous fistula refeeding.↗
Umbilical Cord Defects with Dr. Kenneth Azarow
▶Ep 29 · 4:54
host_summaryEmerging anesthesia data suggesting risks of operating before age 2–3 provides additional support for delaying umbilical hernia repair.↗
▶Ep 29 · 13:45
host_summaryA Canadian study by Dr. Baird's group showed that gastroschisis patients closed with sutures had higher rates of subsequent umbilical hernia repair compared to sutureless closure.↗
▶Ep 29 · 21:33
epidemiologicalA prospective trial at Dr. Ponsky's institution found triamcinolone (Kenalog) cream superior to silver nitrate for umbilical granulomas, with such a drastic difference the study was stopped early.↗
▶Ep 29 · 29:22
epidemiologicalAnalysis of PHIS (Pediatric Health Information System) data showed the mean age for umbilical hernia repair across U.S. children's hospitals is 4 years.↗
Abdominal Wall Defects with Dr. Jacob Langer
▶Ep 30 · 13:15
host_summaryThe sutureless plastic closure technique was described by Anthony Sandler and doesn't require suturing the umbilical cord↗
▶Ep 30 · 13:15
clinicalThe sutureless plastic closure technique was described by Anthony Sandler and doesn't require suturing the umbilical cord↗
▶Ep 30 · 14:19
host_summaryA study by Dr. Baird published in JPS showed that patients with flap closure did better in every way than those with sutured fascial closure, including lower rates of umbilical hernia repair↗
▶Ep 30 · 14:19
clinicalA study by Dr. Baird published in JPS showed that patients with flap closure did better in every way than those with sutured fascial closure, including lower rates of umbilical hernia repair↗
▶Ep 30 · 18:10
clinicalSpring-loaded silos apply pressure outward as you push down, making the defect larger over time↗
▶Ep 30 · 18:10
clinicalSpring-loaded silos apply pressure outward as you push down, making the defect larger over time↗
▶Ep 30 · 42:06
clinicalThe 'flip flop' technique (modification of component separation) involves incising laterally through anterior sheath only, folding it over while attached to posterior sheath, creating a single posterior sheath closure↗
▶Ep 30 · 42:06
clinicalThe 'flip flop' technique (modification of component separation) involves incising laterally through anterior sheath only, folding it over while attached to posterior sheath, creating a single posterior sheath closure↗
Journal of Pediatric Surgery Article Review: October 2021
▶Ep 33 · 3:58
opinionThe 85% follow-up rate in child abuse victims is surprising and encouraging.↗
▶Ep 33 · 3:58
quoteAnd the fact that, you know, we're seeing 85% follow-up is surprising to me and, and Encouraging.↗
▶Ep 33 · 8:05
quoteThis article points out the problem of Gestalt and necrotizing enterocolitis. You know, it's really easy when they have free air. When they don't, we're all different and we don't have a defined protocol that's been built yet.↗
▶Ep 33 · 8:05
opinionIn NEC, it is easy to make surgical decisions when there is free air, but without definitive protocol for other presentations, surgeons hedge and delay daily about whether to operate.↗
▶Ep 33 · 13:19
quoteHonestly, a lot of people see the value of this, don't have the volume or the resources to build a formal program, and it's very reasonable to send these kids to a new Nearby bowel management program.↗
▶Ep 33 · 13:19
opinionMany surgeons who see the value of bowel management programs lack the volume or resources to build formal programs, making it reasonable to refer patients to nearby established programs.↗
▶Ep 33 · 16:26
clinicalThere is variability in the use of ultrasound versus MRI for detecting tethered cord in anorectal malformation patients, and radiographs are not a good substitute.↗
Omphalocele and Gastroschisis With Dr. Foong-Yen Lim
▶Ep 37 · 3:15
host_summaryGastroschisis affects approximately one in every 2,200 live births.↗
▶Ep 37 · 6:34
host_summaryIn the last four and a half years at Cincinnati Children's Hospital, majority of babies are managed using sutureless closure.↗
▶Ep 37 · 8:17
host_summaryAt Cincinnati Children's, Duoderm silo is placed on top of the skin of the patient, formed over the omphalocele, and plastic clips are used to sequentially clip it down until it's flush to the abdominal skin.↗
Journal of Pediatric Surgery Article Review: January 2022 APSA Issue
▶Ep 38 · 5:03
clinicalAt Akron Children's Hospital under Bob Perry, the bonus structure required the entire group to reach a certain RVU threshold for everyone to receive 50% of their bonus, eliminating competition for cases.↗
▶Ep 38 · 5:03
quoteIn Akron, Bob Perry, the way that he structured the bonus was that the entire group has to get a certain RVU, not a single person.↗
▶Ep 38 · 5:19
quoteThat way, there was no competition like trying to steal cases and stuff, because the whole group rose as a group.↗
Omphalocele & Gastroschisis
▶Ep 39 · 1:31
clinicalFor large omphalocele defects, besides intestine, a good amount of the liver is on the outside in the majority of cases.↗
▶Ep 39 · 2:12
clinicalFor omphalocele, besides ultrasound, MRI and echocardiogram are routinely obtained because these patients may have other associated anomalies.↗
▶Ep 39 · 2:12
clinicalFetal growth is tracked monthly in these cases because there is concern for significant growth restriction.↗
▶Ep 39 · 2:12
clinicalFor gastroschisis, only ultrasound is normally obtained to confirm the diagnosis without additional imaging.↗
▶Ep 39 · 3:15
epidemiologicalGastroschisis affects approximately one in every 2200 live births.↗
▶Ep 39 · 8:38
clinicalAfter sequential reduction with plastic clips in omphalocele, the patient is taken to the operating room for delayed primary closure of the fascia and skin.↗
Stay Current Throwbacks Necrotizing Enterocolitis with Dr. Gail Besner
▶Ep 40 · 28:14
clinicalSome babies with peritoneal drains continue to produce stool from the drain for weeks, and if this persists for approximately two weeks, conversion to laparotomy should be considered.↗
▶Ep 40 · 41:06
epidemiologicalA recent Journal of Pediatric Surgery article showed substantial decrease in TPN use with mucous fistula refeeding.↗
Update Course 2021: TOP PUBLICATIONS IN NON - PED SURG JOURNALS
▶Ep 41 · 1:53
host_summaryThe curation process filters approximately 1200 articles per month from 33 pediatric and general surgical journals plus 3 top clinical journals (NEJM, Lancet, JAMA) down to 25-50 relevant pediatric surgery articles, then further narrows to 10-15 through specialty filtering, quality ranking, methodology assessment, and popularity polling among general surgeons.↗
▶Ep 41 · 5:30
quoteI would call my radiologist and have him do an upper GI and stand there watching it.↗
▶Ep 41 · 5:30
clinicalUpper GI contrast study is operator-dependent and requires direct communication with radiologist, readily available at high-volume centers but requires more coordination at community hospitals.↗
▶Ep 41 · 10:22
quotethe studies, uh, currently, I think, uh, you know, what this, uh, is hoping to highlight is the ability to use non-operative management of appendicitis in certain cases, but, um, uh, the studies that we have, uh, show that, uh, having the presence of an appendiculli actually has about a 50% failure rate.↗
▶Ep 41 · 10:22
clinicalThe presence of an appendicolith in appendicitis has about a 50% failure rate with non-operative management, making it a contraindication for non-surgical treatment.↗
▶Ep 41 · 10:43
quoteso, um, that's, uh, you know, uh, not good enough, uh, for me. Uh, so, uh, most of us actually use the presence of that appendicolith as a no go, uh, for, uh, non-operative management.↗
▶Ep 41 · 11:52
host_summaryIn the Annals of Surgery 5-year follow-up study of non-operative appendicitis management, 46% of patients randomized to non-surgical management required appendectomy during follow-up, while the surgical group had no complications or readmissions.↗
▶Ep 41 · 12:08
host_summaryHalf of the non-surgical appendicitis management group presented to the emergency room during 5-year follow-up.↗
▶Ep 41 · 18:16
host_summaryIn the Journal of Trauma study of 135 children aged 1-17 years who received whole blood as adjunct to component therapy, matched to 270 children receiving only component therapy, the whole blood group had decreased transfusion volume at 24 hours and required fewer ventilation days, though mortality, length of stay, and major complications were the same.↗
▶Ep 41 · 19:36
quoteI, I would agree that we should be going with normal sailing based on the ATLS protocols. I, I will tell you though, um, that nationwide in adults we are starting to see ambulance rigs. Travel with whole blood capabilities in adults and people are starting to use whole blood even earlier.↗
▶Ep 41 · 19:40
guidelineCurrent ATLS protocols recommend initial bolus with normal saline or crystalloid solution before moving to blood products in pediatric trauma.↗
▶Ep 41 · 19:40
clinicalNationwide in adults, ambulance rigs are starting to travel with whole blood capabilities and people are using whole blood even earlier in trauma resuscitation.↗
▶Ep 41 · 20:05
quoteI have to tell you this is, I love this course. It's changing. It's an evolution↗
▶Ep 41 · 20:28
quotethe challenge for whole blood is availability↗
▶Ep 41 · 20:28
clinicalThe challenge for whole blood in pediatrics is availability, and thankfully for children, we don't use a lot of massive transfusion protocols compared to adults.↗
▶Ep 41 · 20:40
quotehaving blood bank capabilities, especially. Uh, because thankfully for children, we don't use a lot of massive transfusion protocols. So I, I think you're seeing more of this in adults. Um, some of the pediatric centers are coming along, um, slowly, but, but definitely we're seeing more.↗
▶Ep 41 · 21:13
clinicalSome centers are limiting whole blood use to males and some to children older than 15, depending on institutional protocols and blood bank partnerships.↗
Update Course 2021: UPDATE COURSE 2020: REVIEW OF LAST YEAR'S IMPORTANT T OPICS
▶Ep 42 · 0:00
quoteWe are, we all live in our own little country and we do our own little thing. And it's only when we talk to each other from all over that we do true learning.↗
▶Ep 42 · 1:00
quoteThis is about rapid fire. We're not doing in-depth stuff here. This is rapid fire, important topics that we feel and that a lot, that's why we bring new faculty in every year, that the faculty feel are kind of the real important points that we need to be highlighting all over the world that came up over the last year or so.↗
▶Ep 42 · 1:40
quoteI promise you, I'm making this promise every year, something will glitch. Okay? I've been saying this for nine years. Even a few years ago, the whole power went out in the city and we had to drive to my living room. Something will glitch. Bear with us.↗
▶Ep 42 · 2:20
quoteThis only, as you know, this is free. This is free because, and we've been trying to keep this free as long as we can. We try to believe that knowledge should be free as long as we can do it, as best we can do it.↗
▶Ep 42 · 4:45
epidemiological26% of respondents use intraoperative ICG to visualize the biliary tree, 23% use it in select patients, and 51% do not use it.↗
▶Ep 42 · 10:50
clinicalGetting phenol into the operating room for sclerotherapy is not always easy due to institutional and pharmacy restrictions.↗
▶Ep 42 · 10:50
host_summaryDeflux, a compound used by urology for vesicoureteral reflux, has been reported in case reports for rectal prolapse sclerotherapy.↗
▶Ep 42 · 10:50
host_summaryThere are case reports showing mucosal sloughing with phenol sclerotherapy.↗
▶Ep 42 · 11:20
quoteI think there's also case reports that show mucosal sloughing with phenol.↗
▶Ep 42 · 12:23
epidemiologicalThe adoption of sutureless closure for abdominal wall defects represents a major practice change over nine years, with 90% now using it always or selectively compared to much lower rates previously.↗
▶Ep 42 · 12:23
epidemiologicalApproximately 50% of respondents always use sutureless abdominal closure for large abdominal wall defects, 40% use it in select patients, and only 11% do not use it.↗
▶Ep 42 · 16:42
clinicalImplementing ERAS requires team buy-in, particularly from anesthesiologists, because of practice changes like allowing oral intake two hours preoperatively.↗
▶Ep 42 · 21:50
epidemiologicalMost institutions are either taking steps to address social determinants of health or working on it; few report no action.↗
Update Course 2022 - TOP PUBLICATIONS IN NON- PED SURG JOURNALS - Jose Campos
▶Ep 44 · 0:30
quoteI met Jose Campos at, I think, an IPEG meeting or something and he came up to me and he says, I said, hi, how are you? He goes, yeah, the stuff you're doing is a problem. I was like, nice to meet you too. He said, you're only looking at pediatric surgical journals and pediatric surgical societies, you're missing all of the incredible publications that come out in articles we don't read.↗
▶Ep 44 · 16:52
quoteIt was invented before there was widespread laparoscopy. It came first. Then laparoscopic. Because of that order, a lot of people favor PEG, but it's blind. I mean, you're putting something right through the belly without looking, so it makes no sense to me.↗
▶Ep 44 · 17:36
quoteThe article by Jeff Ponsky and Mike Goddard remains the most cited article in the history of the Journal of Pediatric Surgery by far by like three times the number two article so it's a real landmark paper and we owe dr. Ponsky and Goddard a tip the cap for coming up with this technique when it really was the first minimally invasive way to insert a gastrostomy tube.↗
▶Ep 44 · 17:36
clinicalThe article by Todd Ponsky Sr. and Mike Goddard on PEG tube placement remains the most cited article in the history of the Journal of Pediatric Surgery, with approximately three times the citations of the number two article.↗
Update Course 2022 - APSA PDC UPDATES - Mary Edwards, Paul Jeziorczak, Craig Lillehei, and Charles Snyder,
▶Ep 45 · 34:00
quoteThe reason that we switched to this, um, is that there are, if it's clearly if airway aspiration, you go to the operating room. It's the ones you don't know. And what we found is the ones you don't know, it's a suspicious story. They were coughing after eating. Um, more often than not, it's reactive airway and it's not a foreign body.↗
▶Ep 45 · 35:00
quoteCAT scan pretty much almost a hundred percent will direct you to go to the OR or not. So it's very low radiation and it eliminates those that are equivocal of getting an unnecessary instrumentation of their airway in the face of reactive airway disease.↗
▶Ep 45 · 59:30
quoteI do believe that working with the neonatology team on the decision to operate is actually prudent. I know you were, but a lot of people get upset about that. And I do have that discussion now. Ultimately, the decision is mine. But oftentimes they do sway me.↗
Update Course 2022 - UPDATES IN GASTROSCHISIS FEEDING PROTOCOLS - Jason Fraser, Beth Rymeski, and Steven Lee
▶Ep 46 · 0:00
host_summarySeveral hospitals have changed their gastroschisis protocols based on recent publications.↗
▶Ep 46 · 0:00
quotewe got feedback that several hospitals have changed their gastro schesis protocols based on recent publications↗
▶Ep 46 · 9:10
quotethe reason these protocols at least in my opinion are important is because there's not variation in care generally speaking they've been tried and true and work all right but the nurses know what it is and you know you don't need to call a doctor every time you want to increase by 10 cc's or whatever↗
Update Course Rewind 2025: Updates in NEC Management
▶Ep 75 · 4:18
quoteThey're sick post-op. This is the problem I have. They're sick post-op, whether you do the anastomosis or not.↗
▶Ep 75 · 4:18
clinicalBabies are sick post-operatively whether you perform anastomosis or not↗
▶Ep 75 · 4:28
clinicalIn NEC, diseased bowel is a symptom or result of the illness, not the cause of the illness↗
▶Ep 75 · 4:28
quoteBowel is a symptom, is a result of the illness. It's not the cause of the illness. The disease still progresses, even that's the problem of going too early. You resect, it's still progressing.↗
▶Ep 75 · 4:34
clinicalThe disease still progresses even after resection, which is the problem of operating too early↗
▶Ep 75 · 5:06
quoteThe data shows it's better. If I feel like the baby is well, I would be convinced to do a primary anastomosis cause I do agree, doing a stoma, doing a silo clip and drop, maybe they won't do as well.↗
▶Ep 75 · 5:06
clinicalData shows primary anastomosis is better than stoma in appropriate cases↗
▶Ep 75 · 5:31
quoteThe data shows that right now, I'm a clip and dropper. I would come back 24, 48 hours later, I would not do a stoma. Because I feel like I would have an answer in a couple of days.↗
▶Ep 75 · 5:45
clinicalHemodynamic markers to guide second-look decisions include lactate correction, thrombocytopenia correction, and weaning off inotropes↗
Urologic Fetal Intervention: Cincinnati Fetal Center
▶Ep 3 · 1:06
quoteI think that the challenge is that the data suggests that if you look at the results from the Pluto trial, that renal function is poor in a large number of babies that were thought to be good prognosis.↗
▶Ep 3 · 1:06
quoteI think that the challenge is that the data suggests that if you look at the results from the Pluto trial, that renal function is poor in a large number of babies that were thought to be good prognosis.↗
▶Ep 3 · 1:23
quoteWe're not really able to necessarily fix or alter the renal outcomes and so that's really why we're not fighting as much as probably expected.↗
▶Ep 3 · 1:23
quoteWe're not really able to necessarily fix or alter the renal outcomes and so that's really why we're not fighting as much as probably expected.↗
▶Ep 3 · 5:43
clinicalIntravillous pressure that occludes venous flow in the placenta is approximately 23 mmHg; resting amniotic fluid pressure is 5–8 mmHg.↗
▶Ep 3 · 5:43
clinicalIntravillous pressure that occludes venous flow in the placenta is approximately 23 mmHg; resting amniotic fluid pressure is 5–8 mmHg.↗
▶Ep 3 · 24:57
clinicalFetal anesthesia for fetoscopy includes intramuscular vecuronium, atropine, and fentanyl to prevent fetal movement and mitigate pain response.↗
▶Ep 3 · 24:57
clinicalFetal anesthesia for fetoscopy includes intramuscular vecuronium, atropine, and fentanyl to prevent fetal movement and mitigate pain response.↗
▶Ep 3 · 30:58
quoteI've had trouble justifying doing 3 bladder taps.↗
▶Ep 3 · 30:58
quoteI've had trouble justifying doing 3 bladder taps.↗
▶Ep 3 · 34:19
epidemiologicalThe Pluto trial removed bladder taps from its protocol because data suggested the most powerful effect of shunting is in poor-prognosis fetuses, and even good-prognosis fetuses have ~50% risk of bad renal function postnatally.↗
▶Ep 3 · 34:19
host_summaryThe Pluto trial removed bladder taps from its protocol because data suggested the most powerful effect of shunting is in poor-prognosis fetuses, and even good-prognosis fetuses have ~50% risk of bad renal function postnatally.↗
Pediatric Hernia: Update Course 2013
▶Ep 4 · 2:00
quoteI also thought that I, I also thought, you know, we could Wait, they don't necessarily need to be repaired right away. But then I read your papers about the very high incidence of incarceration in the first few months of life, especially in the preemies.↗
▶Ep 4 · 2:00
quoteI also thought that I, I also thought, you know, we could Wait, they don't necessarily need to be repaired right away. But then I read your papers about the very high incidence of incarceration in the first few months of life, especially in the preemies.↗
▶Ep 4 · 2:08
epidemiologicalJack Langer's data shows very high incarceration rate in newborns and preemies with inguinal hernias↗
▶Ep 4 · 2:08
host_summaryJack Langer's data shows very high incarceration rate in newborns and preemies with inguinal hernias↗
▶Ep 4 · 8:31
host_summaryIf you have a patent processus vaginalis, you have 4 times greater risk than general population of developing a hernia on that side↗
▶Ep 4 · 8:31
epidemiologicalIf you have a patent processus vaginalis, you have 4 times greater risk than general population of developing a hernia on that side↗
▶Ep 4 · 11:44
epidemiologicalVA cooperative study in adults showed 1.7% incidence of incarceration in adults with inguinal hernia↗
▶Ep 4 · 11:44
host_summaryVA cooperative study in adults showed 1.7% incidence of incarceration in adults with inguinal hernia↗
▶Ep 4 · 25:47
clinicalInguinodynia (chronic groin pain) is much more common in older patients than young children after open inguinal hernia repair↗
▶Ep 4 · 25:47
clinicalInguinodynia (chronic groin pain) is much more common in older patients than young children after open inguinal hernia repair↗
▶Ep 4 · 26:59
host_summaryMayo Clinic 50-year follow-up study shows most common cause of recurrence after open pediatric inguinal hernia repair is a direct hernia↗
▶Ep 4 · 26:59
epidemiologicalMayo Clinic 50-year follow-up study shows most common cause of recurrence after open pediatric inguinal hernia repair is a direct hernia↗
▶Ep 4 · 27:16
clinicalLaparoscopic approach allows clear visualization of inguinal floor to distinguish indirect hernia from direct/floor problem↗
▶Ep 4 · 27:16
clinicalLaparoscopic approach allows clear visualization of inguinal floor to distinguish indirect hernia from direct/floor problem↗
▶Ep 4 · 28:16
quotejust so you know, has a 30% incidence of chronic pain that's been validated in multiple studies.↗
▶Ep 4 · 28:16
epidemiologicalMesh inguinal hernia repair has 30% incidence of chronic pain, validated in multiple studies↗
▶Ep 4 · 28:16
host_summaryMesh inguinal hernia repair has 30% incidence of chronic pain, validated in multiple studies↗
▶Ep 4 · 28:16
quotejust so you know, has a 30% incidence of chronic pain that's been validated in multiple studies.↗
▶Ep 4 · 28:27
quoteMost mesh repairs done by the adult surgeons are in patients who are not planning on having any more kids. They're usually older patients.↗
▶Ep 4 · 28:27
clinicalMesh repair has significant risk of vas deferens injury↗
▶Ep 4 · 28:27
clinicalMesh repair has significant risk of vas deferens injury↗
▶Ep 4 · 28:27
quoteMost mesh repairs done by the adult surgeons are in patients who are not planning on having any more kids. They're usually older patients.↗
▶Ep 4 · 33:00
host_summaryFelix Schier's laparoscopic Z-stitch technique has about 6% recurrence rate↗
▶Ep 4 · 33:00
epidemiologicalFelix Schier's laparoscopic Z-stitch technique has about 6% recurrence rate↗
▶Ep 4 · 33:06
host_summarySEAL technique (Craig Albanese, Mike Harrison, Sanjeev Dutta at Stanford) reports 1.2% recurrence rate, but other centers using it report 3-4%↗
▶Ep 4 · 33:06
epidemiologicalSEAL technique (Craig Albanese, Mike Harrison, Sanjeev Dutta at Stanford) reports 1.2% recurrence rate, but other centers using it report 3-4%↗
▶Ep 4 · 33:30
epidemiologicalCK Young's extraperitoneal percutaneous technique has less than 1% recurrence (unpublished data)↗
▶Ep 4 · 33:30
host_summaryCK Young's extraperitoneal percutaneous technique has less than 1% recurrence (unpublished data)↗
▶Ep 4 · 33:43
epidemiologicalTodd Ponsky's laparoscopic series has approximately 2% recurrence rate (unpublished, anecdotal: 1 repair out of several hundred cases)↗
▶Ep 4 · 33:43
epidemiologicalTodd Ponsky's laparoscopic series has approximately 2% recurrence rate (unpublished, anecdotal: 1 repair out of several hundred cases)↗
▶Ep 4 · 36:10
quoteI can tell you 20 right now, there's people in South America that do a laparoscopic excision of the sac and that's it.↗
▶Ep 4 · 36:10
quoteI can tell you 20 right now, there's people in South America that do a laparoscopic excision of the sac and that's it.↗
▶Ep 4 · 37:16
quoteStudies show decreased sperm quality in patients who had bilateral inguinal hernia repairs, but infertility rate did not appear different in most studies↗
▶Ep 4 · 37:16
epidemiologicalStudies show decreased sperm quality in patients who had bilateral inguinal hernia repairs, but infertility rate did not appear different in most studies↗
▶Ep 4 · 37:16
quoteStudies show decreased sperm quality in patients who had bilateral inguinal hernia repairs, but infertility rate did not appear different in most studies↗
▶Ep 4 · 37:16
host_summaryStudies show decreased sperm quality in patients who had bilateral inguinal hernia repairs, but infertility rate did not appear different in most studies↗
▶Ep 4 · 39:51
quotewhat we did in the rabbits is we just did the stitch and waited two months and cut the stitch out, and they all opened. So I don't like the stitch relying on for life. So I like to, we cauterize, then cut the stitch out, and they all closed.↗
▶Ep 4 · 39:51
quotewhat we did in the rabbits is we just did the stitch and waited two months and cut the stitch out, and they all opened. So I don't like the stitch relying on for life. So I like to, we cauterize, then cut the stitch out, and they all closed.↗
▶Ep 4 · 39:51
clinicalIn rabbit model, laparoscopic hernia repair with stitch alone failed when stitch was cut at 2 months; adding cautery before cutting stitch resulted in all repairs staying closed↗
▶Ep 4 · 39:51
clinicalIn rabbit model, laparoscopic hernia repair with stitch alone failed when stitch was cut at 2 months; adding cautery before cutting stitch resulted in all repairs staying closed↗
▶Ep 4 · 49:28
clinicalUmbilical hernia size does not predict need for earlier repair; no data supports operating earlier on larger defects↗
▶Ep 4 · 49:28
clinicalUmbilical hernia size does not predict need for earlier repair; no data supports operating earlier on larger defects↗
Fetoscopic endoluminal tracheal occlusion and twin-twin transfusion: Fetal...
▶Ep 10 · 1:26:57
clinicalRuben Quintero's 1997 staging system for TTTS actually describes physiologic states: stage 1 reflects initial volume transfer, stage 2 represents cephalization of blood flow, stage 3 represents increasing placental resistance, and stage 4 represents cardiac failure in the recipient.↗
▶Ep 10 · 1:29:21
epidemiologicalOnly 30-35% of stage 1 TTTS progresses to stage 2 or higher; 28% stay at stage 1 throughout pregnancy, and 40% regress completely or resolve.↗
▶Ep 10 · 1:30:22
host_summaryAmnio-reduction in severe polyhydramnios improves fetal hypoxia and reverses acidemia by decreasing amniotic fluid pressure, which reduces placental compression and improves blood flow.↗
▶Ep 10 · 1:32:14
clinicalThe recipient twin in TTTS develops progressive hypertrophic cardiomyopathy due to both preload (volume) and afterload (peripheral vasoconstriction from renin-angiotensin activation) issues.↗
▶Ep 10 · 1:42:07
host_summaryHuber's 2006 study of over 200 laser cases showed 84% survival of at least one twin, 60% both-twin survival, and average delivery at 34 weeks, compared to 29 weeks with amnio-reduction.↗
▶Ep 10 · 1:43:26
host_summaryHigh-volume laser centers achieve 93-94% survival of at least one twin, 88% overall survival, 78% both-twin survival, with average delivery at 34 weeks.↗
▶Ep 10 · 1:44:15
host_summaryMajor and minor neurologic deficits occur in 55% after amnio-reduction versus less than half that rate after laser, with most recent studies showing 5-6% major neurodevelopmental delays and 7-8% minor delays after laser.↗
▶Ep 10 · 1:45:01
clinicalCHOP's cardiovascular score significantly drops within 1 week to 10 days after laser photocoagulation in the vast majority of cases, showing the recipient twin's heart has great potential to heal.↗
▶Ep 10 · 1:47:05
clinicalDiode laser is much safer than argon laser with lower penetration depth and no vessel rupture cases since switching to diode at CHOP.↗
▶Ep 10 · 1:50:00
clinicalCHOP's miss rate for vascular anastomoses is 0.8% based on placental injection studies, compared to 10-15% miss rates reported in literature.↗
▶Ep 10 · 2:08:56
host_summaryEduardo Gratacos classified selective IUGR into three types: Type 1 with positive end-diastolic flow (good prognosis), Type 2 with persistent absent/reversed flow (progressive deterioration), and Type 3 with intermittent cycling (unpredictable with high IUFD and 20% PVL risk in normal twin).↗
▶Ep 10 · 2:11:00
host_summaryType 3 sIUGR fetuses have the smallest placental share and characteristic very large arterio-arterial anastomoses that cause episodic acute fetal-to-fetal transfusions.↗
▶Ep 10 · 2:16:04
host_summaryWith purely expectant management of Type 2 sIUGR, there is 48% loss in the smaller twin and 33% in the normal twin, with only 37% intact survival in the smaller twin.↗
▶Ep 10 · 2:16:36
host_summaryType 3 sIUGR with expectant management shows 38.5% intact survival in the normal twin and 60% in surviving smaller twins, with very high morbidity and mortality in both groups.↗
▶Ep 10 · 2:21:19
clinicalCHOP has performed about 80 bipolar cord cauterizations with 86% singleton survival and over 90 radiofrequency ablations with 83% singleton survival for selective cord occlusion.↗
Fetal Surgical Intervention for Myelomeningocele: Fetal Surgery 2012
▶Ep 8 · 2:09:28
quoteIt is absolutely unimaginable how somebody who has no training, who has no expertise, who has not such a fabulous physical assistance of an expert at the table, can do the job professionally and safely.↗
▶Ep 8 · 2:09:28
quoteIt is absolutely unimaginable how somebody who has no training, who has no expertise, who has not such a fabulous physical assistance of an expert at the table, can do the job professionally and safely.↗
▶Ep 8 · 2:12:16
clinicalThere have been three maternal deaths associated with open fetal surgery for MMC in South America (one in Colombia, two in Argentina).↗
▶Ep 8 · 2:12:16
host_summaryThere have been three maternal deaths associated with open fetal surgery for MMC in South America (one in Colombia, two in Argentina).↗
▶Ep 8 · 2:13:43
clinicalIn the US experience with open fetal surgery for MMC, there have been no maternal deaths and no serious maternal complications in recent years.↗
▶Ep 8 · 2:13:43
clinicalIn the US experience with open fetal surgery for MMC, there have been no maternal deaths and no serious maternal complications in recent years.↗
▶Ep 8 · 2:22:11
quoteI think 5 years from now, we won't be doing open fetal surgery for this, and that we'll have a single port early gestation bioengineering solution.↗
▶Ep 8 · 2:22:11
quoteI think 5 years from now, we won't be doing open fetal surgery for this, and that we'll have a single port early gestation bioengineering solution.↗
▶Ep 8 · 2:26:39
epidemiologicalIn Europe, approximately one-third of mothers decline open fetal MMC surgery because it is an open procedure.↗
▶Ep 8 · 2:26:39
epidemiologicalIn Europe, approximately one-third of mothers decline open fetal MMC surgery because it is an open procedure.↗
▶Ep 8 · 2:27:34
clinicalFor proper neurosurgical repair of cystic MMC, it is essential to remove the cyst and excise tissues that don't belong, not simply cover the lesion—a step that may be missing in some fetoscopic approaches.↗
▶Ep 8 · 2:27:34
clinicalFor proper neurosurgical repair of cystic MMC, it is essential to remove the cyst and excise tissues that don't belong, not simply cover the lesion—a step that may be missing in some fetoscopic approaches.↗
▶Ep 8 · 2:30:23
clinicalIn the MOMS trial, 51% of prenatally repaired children met shunt criteria, but only 31 actually received shunts (approximately 65% of those meeting criteria), compared to 66 of 74 (89%) in the postnatal group.↗
▶Ep 8 · 2:30:23
clinicalIn the MOMS trial, 51% of prenatally repaired children met shunt criteria, but only 31 actually received shunts (approximately 65% of those meeting criteria), compared to 66 of 74 (89%) in the postnatal group.↗
▶Ep 8 · 2:43:41
quoteThese results, just between us, are not that good. You know, we need to do better. And to do better, I think we're going to have to do something different.↗
▶Ep 8 · 2:43:41
quoteThese results, just between us, are not that good. You know, we need to do better. And to do better, I think we're going to have to do something different.↗
Neonatal Lung Lesions with Dr. Steven Rothenberg
▶Ep 14 · 39:28
clinicalIf using the LigaSure device, do not activate the cutting function; seal, remove the device, and cut with scissors to allow partial division and confirmation of hemostasis.↗
Journal of Pediatric Surgery Article Review: January 2022 APSA Issue
▶Ep 19 · 5:03
quoteIn Akron, Bob Perry, the way that he structured the bonus was that the entire group has to get a certain RVU, not a single person.↗
▶Ep 19 · 5:03
clinicalAt Akron Children's Hospital under Bob Perry, the bonus structure required the entire group to reach a certain RVU threshold for everyone to receive 50% of their bonus, eliminating competition for cases.↗
▶Ep 19 · 5:19
quoteThat way, there was no competition like trying to steal cases and stuff, because the whole group rose as a group.↗
Update Course 2021: TOP PUBLICATIONS IN NON - PED SURG JOURNALS
▶Ep 20 · 1:53
host_summaryThe curation process filters approximately 1200 articles per month from 33 pediatric and general surgical journals plus 3 top clinical journals (NEJM, Lancet, JAMA) down to 25-50 relevant pediatric surgery articles, then further narrows to 10-15 through specialty filtering, quality ranking, methodology assessment, and popularity polling among general surgeons.↗
▶Ep 20 · 5:30
quoteI would call my radiologist and have him do an upper GI and stand there watching it.↗
▶Ep 20 · 5:30
clinicalUpper GI contrast study is operator-dependent and requires direct communication with radiologist, readily available at high-volume centers but requires more coordination at community hospitals.↗
▶Ep 20 · 10:22
clinicalThe presence of an appendicolith in appendicitis has about a 50% failure rate with non-operative management, making it a contraindication for non-surgical treatment.↗
▶Ep 20 · 10:22
quotethe studies, uh, currently, I think, uh, you know, what this, uh, is hoping to highlight is the ability to use non-operative management of appendicitis in certain cases, but, um, uh, the studies that we have, uh, show that, uh, having the presence of an appendiculli actually has about a 50% failure rate.↗
▶Ep 20 · 10:43
quoteso, um, that's, uh, you know, uh, not good enough, uh, for me. Uh, so, uh, most of us actually use the presence of that appendicolith as a no go, uh, for, uh, non-operative management.↗
▶Ep 20 · 11:52
host_summaryIn the Annals of Surgery 5-year follow-up study of non-operative appendicitis management, 46% of patients randomized to non-surgical management required appendectomy during follow-up, while the surgical group had no complications or readmissions.↗
▶Ep 20 · 12:08
host_summaryHalf of the non-surgical appendicitis management group presented to the emergency room during 5-year follow-up.↗
▶Ep 20 · 18:16
host_summaryIn the Journal of Trauma study of 135 children aged 1-17 years who received whole blood as adjunct to component therapy, matched to 270 children receiving only component therapy, the whole blood group had decreased transfusion volume at 24 hours and required fewer ventilation days, though mortality, length of stay, and major complications were the same.↗
▶Ep 20 · 19:36
quoteI, I would agree that we should be going with normal sailing based on the ATLS protocols. I, I will tell you though, um, that nationwide in adults we are starting to see ambulance rigs. Travel with whole blood capabilities in adults and people are starting to use whole blood even earlier.↗
▶Ep 20 · 19:40
guidelineCurrent ATLS protocols recommend initial bolus with normal saline or crystalloid solution before moving to blood products in pediatric trauma.↗
▶Ep 20 · 19:40
clinicalNationwide in adults, ambulance rigs are starting to travel with whole blood capabilities and people are using whole blood even earlier in trauma resuscitation.↗
▶Ep 20 · 20:05
quoteI have to tell you this is, I love this course. It's changing. It's an evolution↗
▶Ep 20 · 20:28
quotethe challenge for whole blood is availability↗
▶Ep 20 · 20:28
clinicalThe challenge for whole blood in pediatrics is availability, and thankfully for children, we don't use a lot of massive transfusion protocols compared to adults.↗
▶Ep 20 · 20:40
quotehaving blood bank capabilities, especially. Uh, because thankfully for children, we don't use a lot of massive transfusion protocols. So I, I think you're seeing more of this in adults. Um, some of the pediatric centers are coming along, um, slowly, but, but definitely we're seeing more.↗
▶Ep 20 · 21:13
clinicalSome centers are limiting whole blood use to males and some to children older than 15, depending on institutional protocols and blood bank partnerships.↗
Journal of Pediatric Surgery Article Highlights: April 2022
clinicalDr. Todd Ponsky states that in utero repair of myelomeningocele has already shown benefit, and impregnating the repair with mesenchymal stromal cells provides an even larger benefit in the chance of ambulation.↗
▶Ep 21 · 4:08
quoteSo, we already have shown a benefit of repairing these in utero, and now to take it a step further, if you impregnate it with mesenchymal stromal cells, you actually have even a larger benefit in the chance of ambulation.↗
▶Ep 21 · 4:08
clinicalDr. Todd Ponsky states that in utero repair of myelomeningocele has already shown benefit, and impregnating the repair with mesenchymal stromal cells provides an even larger benefit in the chance of ambulation.↗
▶Ep 21 · 4:08
quoteSo, we already have shown a benefit of repairing these in utero, and now to take it a step further, if you impregnate it with mesenchymal stromal cells, you actually have even a larger benefit in the chance of ambulation.↗
▶Ep 21 · 6:38
opinionDr. Todd Ponsky states that disparities in practice patterns are what happens in an emerging field, and it is reasonable to expect different levels of what different hospitals do in fetal surgery.↗
▶Ep 21 · 6:38
quoteI think this paper highlights that this is what happens in an emerging field. You have disparities in what is happening. We're seeing the value of fetal surgery and fetal intervention, and so it's reasonable to expect that there are different levels of what different hospitals do, but it, I think it's great that there are some centers that don't necessarily do interventions, but are having a dedicated team focusing on fetal care.↗
▶Ep 21 · 6:38
opinionDr. Todd Ponsky states that disparities in practice patterns are what happens in an emerging field, and it is reasonable to expect different levels of what different hospitals do in fetal surgery.↗
▶Ep 21 · 6:38
quoteI think this paper highlights that this is what happens in an emerging field. You have disparities in what is happening. We're seeing the value of fetal surgery and fetal intervention, and so it's reasonable to expect that there are different levels of what different hospitals do, but it, I think it's great that there are some centers that don't necessarily do interventions, but are having a dedicated team focusing on fetal care.↗
Update Course 2022 - APSA PDC UPDATES - Mary Edwards, Paul Jeziorczak, Craig Lillehei, and Charles Snyder,
▶Ep 22 · 34:00
quoteThe reason that we switched to this, um, is that there are, if it's clearly if airway aspiration, you go to the operating room. It's the ones you don't know. And what we found is the ones you don't know, it's a suspicious story. They were coughing after eating. Um, more often than not, it's reactive airway and it's not a foreign body.↗
▶Ep 22 · 35:00
quoteCAT scan pretty much almost a hundred percent will direct you to go to the OR or not. So it's very low radiation and it eliminates those that are equivocal of getting an unnecessary instrumentation of their airway in the face of reactive airway disease.↗
▶Ep 22 · 59:30
quoteI do believe that working with the neonatology team on the decision to operate is actually prudent. I know you were, but a lot of people get upset about that. And I do have that discussion now. Ultimately, the decision is mine. But oftentimes they do sway me.↗
quoteIt really depends on the patient and the situation.↗
▶Ep 3 · 1:32
quoteIt really depends on the patient and the situation.↗
▶Ep 3 · 1:38
quoteI typically do it before they go home, and I have not found that it's prohibitively difficult in most cases to do the operation.↗
▶Ep 3 · 1:38
quoteI typically do it before they go home, and I have not found that it's prohibitively difficult in most cases to do the operation.↗
▶Ep 3 · 3:44
clinicalEven in patients with no stones remaining, 2% will get recurrent pancreatitis from the initial insult↗
▶Ep 3 · 3:44
quoteSo 2% of the time in patients, even if they have no stones, they will get recurrent pancreatitis from their initial insult, whereas 60% if you wait 6 weeks. That is so provocative. That is so clear cut that nobody should be debating this anymore.↗
▶Ep 3 · 3:44
quoteSo 2% of the time in patients, even if they have no stones, they will get recurrent pancreatitis from their initial insult, whereas 60% if you wait 6 weeks. That is so provocative. That is so clear cut that nobody should be debating this anymore.↗
▶Ep 3 · 3:44
clinicalEven in patients with no stones remaining, 2% will get recurrent pancreatitis from the initial insult↗
▶Ep 3 · 5:01
clinicalWhen patients present with gallstone pancreatitis, most pain and elevated enzymes occur as the stone is passing, and symptoms often resolve overnight as the stone passes↗
▶Ep 3 · 5:01
clinicalWhen patients present with gallstone pancreatitis, most pain and elevated enzymes occur as the stone is passing, and symptoms often resolve overnight as the stone passes↗
▶Ep 3 · 5:36
quoteSo if your numbers normalize, I do not do ERCP. I will do an intraoperative changiogram to make sure there's not another stone, but I would not do an ERCP if their numbers normalize.↗
▶Ep 3 · 5:36
clinicalIf laboratory values normalize after gallstone pancreatitis, ERCP is not indicated, but intraoperative cholangiogram should be performed to check for additional stones↗
▶Ep 3 · 5:36
quoteSo if your numbers normalize, I do not do ERCP. I will do an intraoperative changiogram to make sure there's not another stone, but I would not do an ERCP if their numbers normalize.↗
▶Ep 3 · 5:36
clinicalIf laboratory values normalize after gallstone pancreatitis, ERCP is not indicated, but intraoperative cholangiogram should be performed to check for additional stones↗
▶Ep 3 · 8:58
quoteIf I have a patient that comes in with an impacted stone, and their lipase is elevated, the next day their lipase goes up even more, they're, they're getting more and more jaundiced, they're getting worse, I would send them for ERCP because I don't know how good I am at retrieving impacted stones.↗
▶Ep 3 · 8:58
opinionFor patients with impacted stone, rising lipase, and worsening jaundice, ERCP is preferred because surgeon confidence in retrieving impacted stones intraoperatively is lower↗
▶Ep 3 · 8:58
quoteIf I have a patient that comes in with an impacted stone, and their lipase is elevated, the next day their lipase goes up even more, they're, they're getting more and more jaundiced, they're getting worse, I would send them for ERCP because I don't know how good I am at retrieving impacted stones.↗
▶Ep 3 · 8:58
opinionFor patients with impacted stone, rising lipase, and worsening jaundice, ERCP is preferred because surgeon confidence in retrieving impacted stones intraoperatively is lower↗
▶Ep 3 · 13:07
quoteSo here's an example of where I am old and washed up. The answer to this should be yes. I just don't have as much experience as my younger colleagues.↗
▶Ep 3 · 13:07
quoteSo here's an example of where I am old and washed up. The answer to this should be yes. I just don't have as much experience as my younger colleagues.↗
▶Ep 3 · 15:05
quoteI agree with you. I am skeptical of papers that claim that something is now the new standard just because it's become their new standard. It doesn't necessarily mean that it's recommended as the standard of care.↗
▶Ep 3 · 15:05
quoteI agree with you. I am skeptical of papers that claim that something is now the new standard just because it's become their new standard. It doesn't necessarily mean that it's recommended as the standard of care.↗
▶Ep 3 · 15:21
clinicalICG can be administered intravenously, eliminating the need for instrumentation required by traditional intraoperative cholangiogram↗
▶Ep 3 · 15:21
clinicalICG can be administered intravenously, eliminating the need for instrumentation required by traditional intraoperative cholangiogram↗
▶Ep 3 · 15:56
quoteI think we should be learning about ICG. I mean this is provocative for me to say, Todd, come on, get with it. Like this is something you should probably learn.↗
▶Ep 3 · 15:56
quoteI think we should be learning about ICG. I mean this is provocative for me to say, Todd, come on, get with it. Like this is something you should probably learn.↗
Esophageal Disconnect for Severe GERD in Neurologically-Impaired Children:...
▶Ep 2 · 7:23
clinicalContinuous gastrostomy feeds may eliminate vomiting but patients can still have severe reflux with erosive esophagitis and discomfort↗
▶Ep 2 · 10:48
host_summaryNeurologically impaired children have a higher incidence of reflux disease and higher failure rate when treated with fundoplication↗
▶Ep 2 · 11:20
quoteyou know, a lot of these kids are quite miserable, as are their care providers.↗
▶Ep 2 · 11:40
host_summaryEsophageal disconnect was introduced by Bianchi in a 1997 paper as a rescue operation for children with failed fundoplication↗
▶Ep 2 · 13:20
host_summaryEuropean results from Manchester show disconnect effectively cures reflux and respiratory complications, improves nutrition, and dramatically improves quality of life for patients and caregivers↗
▶Ep 2 · 14:10
host_summaryRetrospective comparison shows dissociation is associated with increased OR time, increased length of stay, and increased time to full feeds, but improved reflux results and lower failure rates compared to fundoplication↗
▶Ep 2 · 15:00
host_summaryDanielson's Rochester series of 27 patients (mix of children and adults) showed disconnect is definitive treatment, but only 3 had prior fundoplication so 24 were de novo procedures↗
▶Ep 2 · 16:40
clinicalBoth vagus nerves can be preserved during disconnect and no pyloroplasty is needed, with no gastric emptying problems observed↗
▶Ep 2 · 18:54
clinicalMesenteric defects, particularly Peterson's defect, must be closed to prevent internal hernias↗
▶Ep 2 · 19:10
clinicalProphylactic antibiotics for several days post-operatively are used, treating the case like perforated appendicitis, due to theoretical contamination when crossing the esophagus near liver parenchyma↗
▶Ep 2 · 19:40
clinicalContrast study is typically done at 3 days post-operatively, though some de novo patients have been fed without imaging if doing very well↗
▶Ep 2 · 20:01
clinicalLow threshold for re-imaging or returning to OR if concerned about leak, similar to bariatric surgery practice↗
▶Ep 2 · 20:29
clinicalSome patients can start feeds immediately post-operatively since feeds go into stomach and downstream, not past the esophagojejunostomy↗
▶Ep 2 · 22:30
clinicalHand-sewn esophagojejunostomy with interrupted sutures is preferred over stapled anastomosis, especially in smaller children, for security↗
▶Ep 2 · 23:50
clinical4-0 Vicryl suture is used for esophagojejunostomy; PDS or silk could also be used↗
▶Ep 2 · 25:05
clinicalIn neurologically normal patients who want to eat by mouth after disconnect, they will be able to eat but probably cannot maintain weight without supplemental nighttime feeds↗
▶Ep 2 · 25:50
clinicalPatients who have had total gastrectomy with Roux-en-Y reconstruction can still eat by mouth but cannot maintain weight without supplementation↗
▶Ep 2 · 26:45
clinicalIn 24-patient series, average age was 9 years (range 14 months to 17 years), average weight 8-57 kg, average operative time 474 minutes, average length of stay 12 days↗
▶Ep 2 · 26:45
clinicalLong length of stay (12 days average) is related to complex patient population with respiratory issues, need for pulmonary toilet, and mobilization challenges, not the operation itself↗
▶Ep 2 · 28:20
clinicalResults show minimal post-operative retching and vomiting in the series↗
▶Ep 2 · 28:40
clinicalCaregivers report dramatic improvement in quality of life, with some mothers in tears saying 'you've given me my child back'↗
▶Ep 2 · 28:50
quoteI've had lots of moms in tears in my office just saying, uh, you know, you've you've given me my child back.↗
▶Ep 2 · 29:10
clinicalNo patients in the series were readmitted for aspiration-related events or respiratory problems related to reflux↗
▶Ep 2 · 30:00
clinicalComplications in the series include internal hernias (one requiring bowel resection after delayed presentation), one death from gram-negative sepsis with no leak on contrast study, and several readmissions↗
▶Ep 2 · 30:20
clinicalPatients can continue to take food by mouth for pleasure after disconnect, including ice cream and supplemental feeds, though they may not maintain weight on oral intake alone↗
Esophagogastric Dissociation for GERD in Severe Neurodisability
▶Ep 4 · 0:14
host_summaryEsophagogastric dissociation was historically considered a last resort operation when Nissen fundoplication fails.↗
▶Ep 4 · 0:14
quoteThe dissociation was thought of historically as sort of the last resort operation, the big operation when a Nissan won't work, where we dissociate the esophagus from the stomach.↗
▶Ep 4 · 0:24
host_summaryEsophagogastric dissociation is being suggested as an upfront primary operation for a small subset of patients with severe neurologic impairment.↗
▶Ep 4 · 2:12
opinionA multi-center study will likely be needed to fully understand the comparative effectiveness of esophagogastric dissociation versus Nissen fundoplication.↗
▶Ep 4 · 2:15
opinionLeaks and strictures are the primary concerns that prevent most surgeons from performing esophagogastric dissociation.↗
▶Ep 4 · 2:18
quoteAbout leaks and strictures, which are really the concern of why most of us don't do this big operation.↗
Esophagogastric Dissociation for GERD in Severe Neurodisability
▶Ep 6 · 0:14
quoteThe dissociation was thought of historically as sort of the last resort operation, the big operation when a Nissan won't work, where we dissociate the esophagus from the stomach.↗
▶Ep 6 · 0:14
host_summaryEsophagogastric dissociation was historically thought of as a last resort operation when Nissen fundoplication won't work.↗
▶Ep 6 · 0:24
host_summaryEsophagogastric dissociation is now being suggested as an upfront primary operation for a small subset of patients with severe neurologic impairment.↗
▶Ep 6 · 2:12
opinionA multi-center study will probably be needed to really understand the difference between these procedures.↗
▶Ep 6 · 2:12
quoteYeah, so we'll probably need to do a multi-center study to really understand this.↗
▶Ep 6 · 2:16
clinicalThe study did not look at complication rates such as leaks and strictures, which are the main concern for why most surgeons don't perform esophagogastric dissociation.↗
▶Ep 6 · 2:18
quoteAbout leaks and strictures, which are really the concern of why most of us don't do this big operation.↗
host_summaryDr. Baird published a paper in JPS showing that patients with flap closure did better in every way than those with sutured fascial closure, including lower rates of umbilical hernia repair↗
▶Ep 4 · 18:10
clinicalSpring-loaded silos (Bentech) create outward pressure forces as you push down, making the defect larger over time↗
▶Ep 4 · 37:22
host_summaryCristobal Abello in Colombia uses Duoderm over the sac to compress and reduce omphaloceles over time↗
▶Ep 4 · 42:03
clinicalPhil Gazzetta described the 'flip flop' technique (modification of component separation) for omphalocele closure: lateral incision of anterior sheath only, folding over while attached to posterior sheath, creating single posterior layer↗
Gastroschisis: Advanced Practice Providers
▶Ep 5 · 10:22
clinicalTodd Ponsky has done only non-sutured gastroschisis repair for the last 6 years and has never had a ventral hernia. He reports 10-20% umbilical hernia rate, most resolving by age 3-5 years, with perfect cosmetic results.↗
▶Ep 5 · 10:26
quoteI have only done this repair, uh, for the last 6 years. I have not done a sutured repair in 6 years.↗
epidemiologicalIn a pediatric surgery event poll, about 75% of surgeons reported doing non-sutured (Tegaderm) gastroschisis repair.↗
▶Ep 5 · 11:03
quoteWe did a pediatric surgery event just like this, but for the pediatric surgeons, and we pulled the audience, and I think it was about 75% of the surgeons that did the non-sutured repair.↗
▶Ep 5 · 11:53
clinicalFor non-sutured closure, Todd Ponsky places a silo on all patients, reduces at bedside, and if everything reduces he closes it by tying the umbilical cord with suture, laying it in a circle over the hole, applying gauze and Tegaderm, waiting 4 days, then changing dressing every 4 days until sealed (usually 2 weeks).↗
▶Ep 5 · 29:22
opinionTodd Ponsky does not use bladder pressures for gastroschisis monitoring, finding them not terribly accurate in this patient size. He uses peak airway pressures as primary assessment during reduction, watching them to decide when to stop reducing, and looks at overall baby appearance and urine output.↗
▶Ep 5 · 29:25
quoteWe do not use bladder pressures. Uh, I don't find them to be terribly accurate in this size, uh, patient.↗
▶Ep 5 · 29:41
quoteWhat I use, Joyce, is, um, usually if they're bad enough that you're wondering what their bladder pressures are, they're often intubated. Um, if they're that sick, and so I look at their peak airway pressures to see, so as I'm reducing them, I watch their peak airway pressures, and that's how I decide when to stop reducing.↗
▶Ep 5 · 30:03
quoteThere's never a downside to just releasing the silo and letting things back out again, right.↗
▶Ep 5 · 42:18
clinicalFor gastroschisis monitoring, the volume of NG output matters less than the color: even high-volume clear/spitty output may allow feeding, but any bilious output (regardless of volume) means the patient is not ready to feed.↗
▶Ep 5 · 43:11
quoteThe exact opposite is true that you can have a ton of spit coming out, but it doesn't mean that they're not ready to be fed, um, so for some reason in the little kids the volume doesn't seem to be as critical, um, as the color.↗
Umbilical Cord Defects with Dr. Kenneth Azarow
▶Ep 13 · 4:54
host_summaryEmerging anesthesia data suggesting risks of operating before age 2–3 provides additional support for delaying umbilical hernia repair.↗
▶Ep 13 · 13:45
host_summaryA Canadian study by Dr. Baird's group showed that gastroschisis patients closed with sutures had higher rates of subsequent umbilical hernia repair compared to sutureless closure.↗
▶Ep 13 · 21:33
epidemiologicalA prospective trial at Dr. Ponsky's institution found triamcinolone (Kenalog) cream superior to silver nitrate for umbilical granulomas, with such a drastic difference the study was stopped early.↗
▶Ep 13 · 29:22
epidemiologicalAnalysis of PHIS (Pediatric Health Information System) data showed the mean age for umbilical hernia repair across U.S. children's hospitals is 4 years.↗
Abdominal Wall Defects with Dr. Jacob Langer
▶Ep 12 · 13:15
host_summaryThe sutureless plastic closure technique was described by Anthony Sandler and doesn't require suturing the umbilical cord↗
▶Ep 12 · 14:19
host_summaryA study by Dr. Baird published in JPS showed that patients with flap closure did better in every way than those with sutured fascial closure, including lower rates of umbilical hernia repair↗
▶Ep 12 · 18:10
clinicalSpring-loaded silos apply pressure outward as you push down, making the defect larger over time↗
▶Ep 12 · 42:06
clinicalThe 'flip flop' technique (modification of component separation) involves incising laterally through anterior sheath only, folding it over while attached to posterior sheath, creating a single posterior sheath closure↗
Omphalocele and Gastroschisis With Dr. Foong-Yen Lim
▶Ep 15 · 3:15
host_summaryGastroschisis affects approximately one in every 2,200 live births.↗
▶Ep 15 · 6:34
host_summaryIn the last four and a half years at Cincinnati Children's Hospital, majority of babies are managed using sutureless closure.↗
▶Ep 15 · 8:17
host_summaryAt Cincinnati Children's, Duoderm silo is placed on top of the skin of the patient, formed over the omphalocele, and plastic clips are used to sequentially clip it down until it's flush to the abdominal skin.↗
Journal of Pediatric Surgery Article Review: January 2022 APSA Issue
▶Ep 16 · 5:03
clinicalAt Akron Children's Hospital under Bob Perry, the bonus structure required the entire group to reach a certain RVU threshold for everyone to receive 50% of their bonus, eliminating competition for cases.↗
▶Ep 16 · 5:03
quoteIn Akron, Bob Perry, the way that he structured the bonus was that the entire group has to get a certain RVU, not a single person.↗
▶Ep 16 · 5:19
quoteThat way, there was no competition like trying to steal cases and stuff, because the whole group rose as a group.↗
Omphalocele & Gastroschisis
▶Ep 17 · 1:31
host_summaryFor large omphalocele defects, besides intestine, a good amount of the liver is on the outside in the majority of cases.↗
▶Ep 17 · 2:12
host_summaryFetal growth is tracked monthly in these cases because there is concern for significant growth restriction.↗
▶Ep 17 · 2:12
host_summaryFor omphalocele, besides ultrasound, MRI and echocardiogram are routinely obtained because these patients may have other associated anomalies.↗
▶Ep 17 · 2:12
host_summaryFor gastroschisis, only ultrasound is normally obtained to confirm the diagnosis without additional imaging.↗
▶Ep 17 · 3:15
host_summaryGastroschisis affects approximately one in every 2200 live births.↗
▶Ep 17 · 8:38
host_summaryAfter sequential reduction with plastic clips in omphalocele, the patient is taken to the operating room for delayed primary closure of the fascia and skin.↗
Update Course 2022 - UPDATES IN GASTROSCHISIS FEEDING PROTOCOLS - Jason Fraser, Beth Rymeski, and Steven Lee
▶Ep 18 · 0:00
host_summarySeveral hospitals have changed their gastroschisis protocols based on recent publications.↗
▶Ep 18 · 0:00
quotewe got feedback that several hospitals have changed their gastro schesis protocols based on recent publications↗
▶Ep 18 · 9:10
quotethe reason these protocols at least in my opinion are important is because there's not variation in care generally speaking they've been tried and true and work all right but the nurses know what it is and you know you don't need to call a doctor every time you want to increase by 10 cc's or whatever↗
Approach and component separation for suture closure and underlay mesh...
▶Ep 1 · 0:27
clinicalspk_0 uses escharotic painting (escharization) followed by epithelialization for giant omphaloceles↗
▶Ep 1 · 0:27
quoteI use escharization. I, I paint them and then treat them, I let them epithelialize.↗
▶Ep 1 · 1:45
clinicalspk_0 tried silver-impregnated Aquacel which stuck to the sac, became incorporated, and could not be removed - described as a disaster↗
▶Ep 1 · 1:55
quoteI laid the Aqua cell on the silver Aqua cell and it stuck to the, uh, sack and it became incorporated. And could not get it off.↗
▶Ep 1 · 3:16
host_summaryDr. Abello's Duoderm technique involves creating T-shaped Duoderm pieces that form an external silo, which is progressively compressed like gastroschisis reduction over approximately 1-2 weeks↗
▶Ep 1 · 11:07
clinicalComponent separation in small babies is not easy, especially if the omphalocele has been on a silo for a long period and tissues are scarred together↗
▶Ep 1 · 13:10
clinicalComponent separation requires dissection to the mid-axillary line to adequately mobilize tissue↗
▶Ep 1 · 13:22
clinicalspk_0 now uses six-ply Surgisis which has 22 tension lines, allowing tension on the patch while bringing fascia together↗
▶Ep 1 · 21:57
clinicalspk_0 had one massive omphalocele case with muscle only at lateral edge requiring combination of lateral component separation, Gore-Tex attachment, and serial stretching over 3 sessions (like Witzman patch) to achieve muscle-to-muscle closure↗
▶Ep 1 · 22:57
clinicalBiologic dressings are not meant to be bridged - they turn into liquid as temporary material, not muscle, unless permanent↗
▶Ep 1 · 23:10
host_summaryCardiac surgeons report biologic patches in VSD closure turn into cardiac muscle↗
▶Ep 1 · 23:25
clinicalspk_0 observed one pediatric case where biologic patch appeared to turn into muscle or scar↗
quoteI use escharization. I, I paint them and then treat them, I let them epithelialize.↗
▶Ep 2 · 1:54
clinicalSilver Aquacel stuck to the omphalocele sac and became incorporated, failing to fall off as expected once it hardened underneath.↗
▶Ep 2 · 2:03
quoteI laid the Aqua cell on the silver Aqua cell and it stuck to the, uh, sack and it became incorporated. And could not get it off.↗
▶Ep 2 · 10:56
quotehe's one of these minds that you meet and, and he thinks so creatively, so he's so innovative, and every time I watch his videos, Um, I just am fascinated.↗
▶Ep 2 · 13:20
clinicalComponent separation dissection to the mid-axillary line is necessary to adequately mobilize tissue and achieve closure.↗
▶Ep 2 · 13:31
clinicalSix-ply Surgisis with 22 tension lines works better, allowing tension on the patch while bringing the fascia together.↗
▶Ep 2 · 16:02
clinicalWith escharization and delayed closure, children go home, play, are active regular kids, epithelialize the whole omphalocele, and can be fixed when older with component separation techniques.↗
▶Ep 2 · 16:02
quotewe forget where we, we were, where we've come from sometimes, you know, we look at those great old pictures and, you know, of skin covered in phallos, which still didn't have great techniques to fix them, which we do have now. You can just get out of the way.↗
▶Ep 2 · 16:05
quoteThey go home, they're playing, they're active regular kids. They they epithelialize the whole thing and then fix it when they're older with some of these maybe component separation type techniques.↗
▶Ep 2 · 25:55
clinicalLivers in small-defect omphaloceles can have a mushroom or dumbbell shape, making reduction very difficult.↗
Journal of Pediatric Article Review: June 2023, AAP Issue
▶Ep 8 · 4:01
quoteThis is a great study, but this is just in mice. So, obviously, the next thing that needs to be done is a, a clinical assessment.↗
▶Ep 8 · 8:40
quoteWe always try to balance aggressiveness with With outcomes, and cause the, the pendulum keeps swinging. We, Halstead was incredibly aggressive, and, and the Halsteadian approach was go big, and then we got minimally invasive, and now we're trying to find this balance of aggressiveness and survival, and sometimes you unfortunately do have to be aggressive.↗
▶Ep 8 · 12:20
opinionHaving a formal aerodigestive team is the way to ensure esophageal atresia surveillance gets done↗
opinionDr. Ponsky performs suction rectal biopsy in almost any patient who required a contrast enema to rule out distal obstruction, regardless of whether the enema suggests meconium plug, small left colon, or other diagnosis.↗
▶Ep 2 · 31:46
opinionDr. Ponsky performs suction rectal biopsy in almost any patient who required a contrast enema to rule out distal obstruction, regardless of whether the enema suggests meconium plug, small left colon, or other diagnosis.↗
▶Ep 2 · 38:05
clinicalDr. Collins reports that the Duhamel pouches she has examined pathologically have contained both ganglionic and aganglionic parts.↗
▶Ep 2 · 38:05
clinicalDr. Collins reports that the Duhamel pouches she has examined pathologically have contained both ganglionic and aganglionic parts.↗
Malrotation
▶Ep 3 · 7:42
quoteI think the hardest part for the laparoscopic labs is really dealing with the mesentery in the bowel. I think the laparoscopy is very good for dividing, freeing up the duodenum to obviously taking out the appendix.↗
▶Ep 3 · 11:53
quoteYou see how dilated those loops of bowel are? So, that, that's going to always give you a low lying ligament of trites when you have dilated loops of bowel. And that's exactly why I don't get upper GIs when you're just ruling out for a G tube.↗
▶Ep 3 · 11:53
clinicalWhen bowel loops are dilated, this will always give you a low-lying ligament of Treitz↗
▶Ep 3 · 15:15
host_summaryIn a published study combining experience with Kansas City, the cardiac risk group did not stratify out to be at higher risk for reflux complications; neurologically impaired CP kids maybe, but not cardiac kids↗
▶Ep 3 · 21:23
quotewhat is the color of aspiration through the nos gastric tube? That is crucial. If that is green or slightly green, I think the patient needs, uh, you know, operations.↗
▶Ep 3 · 22:25
quoteI want to repeat, I want to repeat the contrast studies to diagnose malrotation because if you can go ahead and do the laparoscopy, but if you found If you find nothing, what would you do? That is a waste of time.↗
▶Ep 3 · 31:46
quoteI don't need a PH probe to tell me that this kid is vomiting. I don't need a milk scan to tell me that. In fact, you know my feeling on that. I think that none of those studies are very helpful↗
▶Ep 3 · 34:04
quotethe patient is gaining weight, correct? Patient's OK, this kid was throwing up. Yeah, so I, I, I don't do anything. Because the patient is fine, gaining weight and clinically well. Why do I have to operate?↗
▶Ep 3 · 34:30
quoteaspiration of the energy tube is non bilious. So not dangerous.↗
▶Ep 3 · 35:20
host_summaryYama does not operate on asymptomatic malrotation as long as the patient has non-bilious vomiting, is gaining weight, and is clinically well↗
▶Ep 3 · 36:16
host_summaryIf a patient has a narrow pedicle, the patient always has vomiting and is symptomatic↗
▶Ep 3 · 36:39
quotePersonally, personally, I don't think lap bands cause the valvulus. It can cause compression of the duoden, but that band itself is not risky. The risk is bilious vomiting and the narrowing of the pedicle. That needs operation.↗
▶Ep 3 · 36:39
host_summaryLadd's bands themselves are not risky; the risk is bilious vomiting and narrowing of the pedicle↗
Radiology and Image Diagnosis of Hirschsprung Disease
▶Ep 6 · 31:46
clinicalDr. Ponsky always performs suction rectal biopsy in almost any patient who needed a contrast enema to rule out distal obstruction, whether meconium plug, small colon, or other cause.↗
▶Ep 6 · 31:46
clinicalDr. Ponsky always performs suction rectal biopsy in almost any patient who needed a contrast enema to rule out distal obstruction, whether meconium plug, small colon, or other cause.↗
▶Ep 6 · 31:51
quoteI always do. So other than the game of am I right at getting question, can I make it even more broad? I would do it. I do it in almost any distal, any patient that needed a contrast enema.↗
▶Ep 6 · 31:51
quoteI always do. So other than the game of am I right at getting question, can I make it even more broad? I would do it. I do it in almost any distal, any patient that needed a contrast enema.↗
▶Ep 6 · 32:15
clinicalDr. Ponsky performs rectal biopsy even in meconium ileus cases.↗
▶Ep 6 · 32:15
clinicalDr. Ponsky performs rectal biopsy even in meconium ileus cases.↗
▶Ep 6 · 32:23
host_summaryIf it is clearly meconium ileus with reflux into terminal ileum and clinical improvement, some surgeons will not do rectal biopsy.↗
▶Ep 6 · 32:23
clinicalIf it is clearly meconium ileus with reflux into terminal ileum and clinical improvement, some surgeons will not do rectal biopsy.↗
▶Ep 6 · 38:05
clinicalDr. Collins has seen resected Duhamel pouches that had both ganglionic and aganglionic parts, but does not know what their contrast enemas looked like.↗
▶Ep 6 · 38:05
clinicalDr. Collins has seen resected Duhamel pouches that had both ganglionic and aganglionic parts, but does not know what their contrast enemas looked like.↗
Surgical Procedures for Hirschsprung Disease
▶Ep 8 · 5:30
clinicalThe concordance between pathology and radiology is 75% in rectosigmoid Hirschsprung patients, meaning 25% are discordant.↗
▶Ep 8 · 5:39
clinicalConcordance between pathology and radiology is only 25% for long-segment Hirschsprung disease.↗
▶Ep 8 · 7:07
clinicalWhen starting laparoscopically, you can look at the bowel and often tell what looks normal vs. abnormal, then take a biopsy at that level.↗
▶Ep 8 · 7:57
clinicalIf you start transanally and break through the peritoneum, it can be difficult to maintain pneumoperitoneum when you then go laparoscopically.↗
▶Ep 8 · 8:18
opinionLaparoscopic dissection is easy and gives you a head start when doing the transanal portion.↗
▶Ep 8 · 1:21:33
clinicalLaparoscopy in Hirschsprung can be used for diagnosis (leveling biopsies, ostomy creation), definitive surgery (mobilization, watching pull-through), and postoperatively (Malone creation).↗
▶Ep 8 · 1:34:15
clinicalPitfalls of laparoscopy: difficult with very distended colon (poor visualization), need to de-rotate right colon if pulling transverse/right colon (may require small laparotomy).↗
▶Ep 8 · 1:34:53
clinicalBenefits of laparoscopy over pure transanal: decreases stretch of anal sphincters on high dissections, allows dissection to pelvic floor (very short transanal component), prevents twisting of pulled-through bowel.↗
▶Ep 8 · 1:36:36
clinicalCompared to laparotomy, laparoscopy decreases incision size, reduces discomfort, potentially allows earlier bowel function (1-2 days difference), and shorter hospitalization.↗
▶Ep 8 · 1:36:55
opinionFor transanal alone, laparoscopy doesn't offer much decrease in return of bowel function or postoperative hospitalization compared to pure transanal.↗
CinciHirsch - Pathology of Hirschprung Disease
▶Ep 9 · 6:38
opinionDr. Frykman was trained to stop attempting suction rectal biopsies at about 6 months of age and take patients to the operating room instead.↗
▶Ep 9 · 6:38
opinionDr. Frykman was trained to stop attempting suction rectal biopsies at about 6 months of age and take patients to the operating room instead.↗
Acute Pancreatitis
▶Ep 12 · 0:00
quoteWhile most of these audio chapters are recordings between myself and experts in the field, we wanted to try something new this time.↗
▶Ep 12 · 2:34
quoteAmylase and lipase, lipase more sensitive than amylase?↗
Hirschsprung Disease: Update Course 2015
▶Ep 16 · 4:22
quoteI don't believe that a pure trans anal is necessarily less invasive. In other words, I believe that putting 3 incisions on the abdomen is actually less invasive in my hands, in my hands, certainly not in your guys' hands, but in my hands, I'm gonna be torquing in that anal canal much more than if I had done it laparoscopically and freed everything up from the abdominal approach.↗
▶Ep 16 · 4:22
opinionPure transanal pull-through may not be less invasive than laparoscopic approach, as prolonged torquing in the anal canal can be more traumatic than three small abdominal incisions.↗
Hirschsprung Disease: Surgical Procedures
▶Ep 19 · 5:30
clinicalThe concordance between pathology and radiology is 75% in rectosigmoid Hirschsprung disease patients, meaning 25% are discordant.↗
▶Ep 19 · 5:39
clinicalThe concordance is only 25% for long-segment Hirschsprung disease between radiology and pathology.↗
▶Ep 19 · 7:57
clinicalWhen starting laparoscopically, if you break the peritoneum transanally first, it becomes hard to maintain pneumoperitoneum.↗
▶Ep 19 · 1:34:53
opinionLaparoscopy decreases the stretch of anal sphincters compared to pure transanal approach when going high, which could affect fecal continence.↗
▶Ep 19 · 1:35:11
clinicalWith laparoscopy, you can dissect way down to the pelvic floor, so the actual transanal dissection is very short with very limited stretch on the sphincters.↗
Hirschsprung Disease: Radiology Aspect
▶Ep 17 · 31:01
clinicalRectal biopsy should be performed in almost any patient who needed a contrast enema to rule out distal obstruction, including cases of meconium plug or small left colon.↗
▶Ep 17 · 31:01
clinicalRectal biopsy should be performed in almost any patient who needed a contrast enema to rule out distal obstruction, including cases of meconium plug or small left colon.↗
▶Ep 17 · 31:12
quoteI would do it. I do it in almost any distal, any patient that needed a contrast enema. To rule out a distal obstruction, I'm going to be doing a suction rectal biopsy, whether it's meconium plug or a small colon.↗
▶Ep 17 · 31:12
quoteI would do it. I do it in almost any distal, any patient that needed a contrast enema. To rule out a distal obstruction, I'm going to be doing a suction rectal biopsy, whether it's meconium plug or a small colon.↗
▶Ep 17 · 31:35
clinicalIn clearly documented meconium ileus where reflux into terminal ileum is achieved and the patient clinically improves, rectal biopsy may not be necessary.↗
▶Ep 17 · 31:35
clinicalIn clearly documented meconium ileus where reflux into terminal ileum is achieved and the patient clinically improves, rectal biopsy may not be necessary.↗
Hirschsprung Disease: Update Course 2013
▶Ep 24 · 1:59
opinionIn newborn bowel obstruction with distal air, contrast enema should precede upper GI unless clinical presentation strongly suggests malrotation↗
▶Ep 24 · 1:59
opinionIn newborn bowel obstruction with distal air, contrast enema should precede upper GI unless clinical presentation strongly suggests malrotation↗
▶Ep 24 · 4:14
quotethe baby's first enema should be a barium enema↗
▶Ep 24 · 4:14
quotethe baby's first enema should be a barium enema↗
▶Ep 24 · 5:06
host_summaryTissue diagnosis is mandatory before surgery for Hirschsprung disease; contrast enema alone is insufficient↗
▶Ep 24 · 5:06
guidelineTissue diagnosis is mandatory before surgery for Hirschsprung disease; contrast enema alone is insufficient↗
▶Ep 24 · 5:30
host_summaryIn critically ill patients with enterocolitis, surgery may be necessary before pathology results are available (typically takes until Wednesday if specimen obtained Friday)↗
▶Ep 24 · 5:30
clinicalIn critically ill patients with enterocolitis, surgery may be necessary before pathology results are available (typically takes until Wednesday if specimen obtained Friday)↗
▶Ep 24 · 9:57
opinionProne positioning for pull-through is easier on surgeon's back and neck compared to lithotomy↗
▶Ep 24 · 9:57
opinionProne positioning for pull-through is easier on surgeon's back and neck compared to lithotomy↗
▶Ep 24 · 16:50
quoteI've never seen really good results from in a 16 year old↗
▶Ep 24 · 16:50
quoteI've never seen really good results from in a 16 year old↗
▶Ep 24 · 17:40
clinicalHypertrophic nerves should not be present in normal anal canal, even though ganglion cells are absent there↗
▶Ep 24 · 17:40
host_summaryHypertrophic nerves should not be present in normal anal canal, even though ganglion cells are absent there↗
▶Ep 24 · 29:11
host_summaryIn children over age 2-3 years, perform open rectal biopsy under general anesthesia rather than office suction biopsy due to patient cooperation issues↗
▶Ep 24 · 29:11
opinionIn children over age 2-3 years, perform open rectal biopsy under general anesthesia rather than office suction biopsy due to patient cooperation issues↗
▶Ep 24 · 34:11
host_summaryManometry is reliable for diagnosing Hirschsprung in older children when biopsies may be unreliable↗
▶Ep 24 · 34:11
opinionManometry is reliable for diagnosing Hirschsprung in older children when biopsies may be unreliable↗
▶Ep 24 · 35:15
clinicalFor enterocolitis 6 months post-pull-through with fever, distention, and diarrhea but no peritonitis, treat with IV fluids, broad-spectrum antibiotics, and rectal irrigations↗
▶Ep 24 · 35:15
host_summaryFor enterocolitis 6 months post-pull-through with fever, distention, and diarrhea but no peritonitis, treat with IV fluids, broad-spectrum antibiotics, and rectal irrigations↗
▶Ep 24 · 36:20
epidemiologicalIncidence of enterocolitis in children with trisomy 21 is double that of genetically normal children with Hirschsprung disease↗
▶Ep 24 · 36:20
host_summaryIncidence of enterocolitis in children with trisomy 21 is double that of genetically normal children with Hirschsprung disease↗
The Colorectal Quiz Episode 3.5: Proximal Hirschsprung Disease
▶Ep 35 · 0:40
clinicalA one-day-old full-term infant weighing 3.9 kilograms presented with significant abdominal distension and bilious emesis.↗
▶Ep 35 · 0:40
host_summaryA one-day-old full-term infant weighing 3.9 kilograms presented with significant abdominal distension and bilious emesis.↗
▶Ep 35 · 4:05
clinicalA baby with bilious emesis and non-classic abdominal x-ray could have had distal air and then had a volvulus, requiring urgent upper GI to rule out malrotation before contrast enema.↗
▶Ep 35 · 4:05
clinicalA baby with bilious emesis and non-classic abdominal x-ray could have had distal air and then had a volvulus, requiring urgent upper GI to rule out malrotation before contrast enema.↗
Journal of Pediatric Surgery Article Review: January 2022 APSA Issue
▶Ep 50 · 5:03
quoteIn Akron, Bob Perry, the way that he structured the bonus was that the entire group has to get a certain RVU, not a single person.↗
▶Ep 50 · 5:03
clinicalAt Akron Children's Hospital under Bob Perry, the bonus structure required the entire group to reach a certain RVU threshold for everyone to receive 50% of their bonus, eliminating competition for cases.↗
▶Ep 50 · 5:19
quoteThat way, there was no competition like trying to steal cases and stuff, because the whole group rose as a group.↗
clinicalThe standard Hagar dilator size for a newborn is about size 12, so a size 10 is 2 deviations less.↗
▶Ep 51 · 2:16
clinicalIn the dilation study with 25 children, the types of malformations were evenly distributed and complexity was about equal.↗
Journal of Pediatric Surgery Article Review: February 2023, BAPS issue
▶Ep 55 · 4:13
clinicalCenters of excellence for esophageal atresia are showing better outcomes↗
▶Ep 55 · 4:13
clinicalCenters of excellence for esophageal atresia are showing better outcomes↗
▶Ep 55 · 4:26
opinionCentralization of esophageal atresia care would be difficult to implement in the United States healthcare system↗
▶Ep 55 · 4:26
opinionCentralization of esophageal atresia care would be difficult to implement in the United States healthcare system↗
Colorectal Quiz: Episode 49 – Collaborating for Kids: Colorectal & Pelvic Solutions (with a Little Help from AI)
▶Ep 77 · 1:20
quoteMark, you're always not only good at anal rectum malformations, but you have been interested in All the tech and the media from the very beginning.↗
▶Ep 77 · 1:20
quoteMark, you're always not only good at anal rectum malformations, but you have been interested in All the tech and the media from the very beginning.↗
▶Ep 77 · 1:35
quoteWhat M and I are working on is how we can mass produce content to equilibrate knowledge around the world, and we know that the only way to do that is to use cutting edge technology, automation tools and AI.↗
▶Ep 77 · 1:35
quoteWhat M and I are working on is how we can mass produce content to equilibrate knowledge around the world, and we know that the only way to do that is to use cutting edge technology, automation tools and AI.↗
▶Ep 77 · 2:16
clinicalNotebook LM is a free offering from Google that can create realistic-sounding podcasts between two AI voices from uploaded documents.↗
▶Ep 77 · 2:16
clinicalNotebook LM is a free offering from Google that can create realistic-sounding podcasts between two AI voices from uploaded documents.↗
▶Ep 77 · 2:31
quoteI would love to hear your thoughts, Mark, on your first experience with Notebook LM.↗
▶Ep 77 · 2:31
quoteI would love to hear your thoughts, Mark, on your first experience with Notebook LM.↗
▶Ep 77 · 4:14
quoteNo one has been able to do it as well as Notebook LM.↗
▶Ep 77 · 4:14
quoteNo one has been able to do it as well as Notebook LM.↗
▶Ep 77 · 4:22
opinionThe AI-generated podcast voices are not customizable; users are limited to the same male and female voices.↗
▶Ep 77 · 4:22
opinionThe AI-generated podcast voices are not customizable; users are limited to the same male and female voices.↗
▶Ep 77 · 4:26
quoteThere's actually an incredible video where they uploaded a document telling these two podcast hosts that they were AI and how they reacted. They freaked out.↗
▶Ep 77 · 4:26
quoteThere's actually an incredible video where they uploaded a document telling these two podcast hosts that they were AI and how they reacted. They freaked out.↗
▶Ep 77 · 4:52
quoteDo I think this is the future of podcasting? I don't.↗
▶Ep 77 · 4:52
quoteDo I think this is the future of podcasting? I don't.↗
▶Ep 77 · 5:03
clinicalNotebook LM's beta version allows users to join the AI conversation interactively.↗
▶Ep 77 · 5:03
clinicalNotebook LM's beta version allows users to join the AI conversation interactively.↗
▶Ep 77 · 5:09
quoteYou could click join, and it goes, hey, what's up? And you could say, hey, I heard what you just said about the colostomy. I'm not sure I agree, and then it will talk with you.↗
▶Ep 77 · 5:09
quoteYou could click join, and it goes, hey, what's up? And you could say, hey, I heard what you just said about the colostomy. I'm not sure I agree, and then it will talk with you.↗
▶Ep 77 · 7:42
quoteThe AI revolution has happened, and each month, it's blowing up and replacing jobs.↗
▶Ep 77 · 7:42
quoteThe AI revolution has happened, and each month, it's blowing up and replacing jobs.↗
quoteThis is our bread and butter. It's what we do. It's what sort of defines us, and we all are pretty confident about our hernia repairs.↗
▶Ep 1 · 2:14
quoteThis is our bread and butter. It's what we do. It's what sort of defines us, and we all are pretty confident about our hernia repairs.↗
▶Ep 1 · 2:43
quoteI think any type of hernia repair is probably fine. There's just different. I'm not going to state that one is substantially better than the other. It's that this is a new option. It's a nice option. It's an option that I prefer.↗
▶Ep 1 · 2:43
quoteI think any type of hernia repair is probably fine. There's just different. I'm not going to state that one is substantially better than the other. It's that this is a new option. It's a nice option. It's an option that I prefer.↗
▶Ep 1 · 4:52
quoteI am not as comfortable that my assessment of that silk glove sign is as good as others have said.↗
▶Ep 1 · 4:52
quoteI am not as comfortable that my assessment of that silk glove sign is as good as others have said.↗
▶Ep 1 · 5:58
quoteI think it's often the testicle in a boy that's riding up into their groin and they see a bulge, but they don't at the same time evaluate if the testicle is there.↗
▶Ep 1 · 5:58
quoteI think it's often the testicle in a boy that's riding up into their groin and they see a bulge, but they don't at the same time evaluate if the testicle is there.↗
clinicalPatent processus vaginalis may close spontaneously even years after initial identification; one case showed complete closure 3 years after documented patent processus on prior laparoscopy.↗
▶Ep 1 · 10:18
host_summaryPatent processus vaginalis may close spontaneously even years after initial identification; one case showed complete closure 3 years after documented patent processus on prior laparoscopy.↗
▶Ep 1 · 11:05
host_summaryContralateral patent processus vaginalis presents in 30-40% of children with unilateral hernia (Holcomb 1994), with 4× greater risk of developing symptomatic hernia and 3-11% metachronous hernia rate.↗
▶Ep 1 · 11:05
epidemiologicalContralateral patent processus vaginalis presents in 30-40% of children with unilateral hernia (Holcomb 1994), with 4× greater risk of developing symptomatic hernia and 3-11% metachronous hernia rate.↗
▶Ep 1 · 17:03
quoteIn a rabbit, if you just grab the vase once with the pickups, it obliterates it.↗
▶Ep 1 · 17:03
clinicalIn a rabbit model, grabbing the vas deferens once with pickups obliterates it.↗
▶Ep 1 · 17:03
clinicalIn a rabbit model, grabbing the vas deferens once with pickups obliterates it.↗
▶Ep 1 · 17:03
quoteIn a rabbit, if you just grab the vase once with the pickups, it obliterates it.↗
▶Ep 1 · 18:00
epidemiologicalZendejas 50-year follow-up (Journal of American College of Surgeons) found 5% infertility rate after hernia repair, matching general population—no evidence of infertility problem from hernia surgery.↗
▶Ep 1 · 18:00
host_summaryZendejas 50-year follow-up (Journal of American College of Surgeons) found 5% infertility rate after hernia repair, matching general population—no evidence of infertility problem from hernia surgery.↗
▶Ep 1 · 18:23
epidemiologicalAndrologia study of 8500 fertility clinic patients showed markedly reduced semen quality and morphology problems in men with prior hernia repair compared to fertile controls.↗
▶Ep 1 · 18:23
host_summaryAndrologia study of 8500 fertility clinic patients showed markedly reduced semen quality and morphology problems in men with prior hernia repair compared to fertile controls.↗
▶Ep 1 · 19:20
opinionThe 'ocean argument': laparoscopic hernia repair difficulty remains constant regardless of external complexity (incarceration, prematurity, inflammation), unlike open repair where external factors significantly increase difficulty.↗
▶Ep 1 · 19:20
opinionThe 'ocean argument': laparoscopic hernia repair difficulty remains constant regardless of external complexity (incarceration, prematurity, inflammation), unlike open repair where external factors significantly increase difficulty.↗
▶Ep 1 · 19:36
quoteIf you look under the ocean, it's flat. It's nice and calm. If you go on the ocean on a horrible day with terrible weather and the waves are crashing, and it's the outside of the surface of the water is dangerous, if you look under the ocean, it's still flat and calm. And that is the argument for the hernia.↗
▶Ep 1 · 19:36
quoteIf you look under the ocean, it's flat. It's nice and calm. If you go on the ocean on a horrible day with terrible weather and the waves are crashing, and it's the outside of the surface of the water is dangerous, if you look under the ocean, it's still flat and calm. And that is the argument for the hernia.↗
▶Ep 1 · 20:37
quoteNo matter how bad it is on the outside, it will still always be very easy on the inside. So there is no really hard hernia repair on the inside.↗
▶Ep 1 · 20:37
quoteNo matter how bad it is on the outside, it will still always be very easy on the inside. So there is no really hard hernia repair on the inside.↗
▶Ep 1 · 22:28
opinionWith laparoscopic approach, waiting 24-48 hours after reducing an incarcerated hernia may be unnecessary since inflammation does not complicate the laparoscopic repair as it does open surgery.↗
▶Ep 1 · 22:28
opinionWith laparoscopic approach, waiting 24-48 hours after reducing an incarcerated hernia may be unnecessary since inflammation does not complicate the laparoscopic repair as it does open surgery.↗
▶Ep 1 · 24:51
clinicalThe most common cause of recurrence after open pediatric hernia repair is development of a direct hernia, not indirect recurrence.↗
▶Ep 1 · 24:51
clinicalThe most common cause of recurrence after open pediatric hernia repair is development of a direct hernia, not indirect recurrence.↗
▶Ep 1 · 25:35
opinionDirect hernias after initial indirect repair may be iatrogenic: pulling up the cord during open dissection in premature infants with see-through thin floors may take fibers of the floor and cause a direct defect.↗
▶Ep 1 · 25:35
opinionDirect hernias after initial indirect repair may be iatrogenic: pulling up the cord during open dissection in premature infants with see-through thin floors may take fibers of the floor and cause a direct defect.↗
▶Ep 1 · 27:28
epidemiologicalEarly laparoscopic hernia repairs using Z-stitch technique (Felix Shear era) had 6% or higher recurrence rates; modern techniques with modifications have reduced this substantially.↗
▶Ep 1 · 27:28
host_summaryEarly laparoscopic hernia repairs using Z-stitch technique (Felix Shear era) had 6% or higher recurrence rates; modern techniques with modifications have reduced this substantially.↗
▶Ep 1 · 27:39
host_summaryCurrent large studies from multiple countries (mostly China) report laparoscopic pediatric hernia recurrence rates of approximately 1% or less.↗
▶Ep 1 · 27:39
epidemiologicalCurrent large studies from multiple countries (mostly China) report laparoscopic pediatric hernia recurrence rates of approximately 1% or less.↗
▶Ep 1 · 34:20
clinicalSEAL technique (Harrison/Albanese/Novahara, Stanford) uses large CT needle to capture substantial tissue in single pass; very fast (<1 minute) but Ponsky found high postoperative pain, possibly from capturing nerves or excessive tissue.↗
▶Ep 1 · 34:20
clinicalSEAL technique (Harrison/Albanese/Novahara, Stanford) uses large CT needle to capture substantial tissue in single pass; very fast (<1 minute) but Ponsky found high postoperative pain, possibly from capturing nerves or excessive tissue.↗
▶Ep 1 · 35:01
quoteI found that they would be really crying in the recovery room and I feel like I got way too much tissue. And I probably got, who knows if I got nerves in there. I mean, you just get so much tissue.↗
▶Ep 1 · 35:01
quoteI found that they would be really crying in the recovery room and I feel like I got way too much tissue. And I probably got, who knows if I got nerves in there. I mean, you just get so much tissue.↗
▶Ep 1 · 35:19
quoteIt's easy, it's fast, but I feel like it's not as delicate of a repair. You're getting a whole lot more than just a peritoneum.↗
▶Ep 1 · 35:19
quoteIt's easy, it's fast, but I feel like it's not as delicate of a repair. You're getting a whole lot more than just a peritoneum.↗
▶Ep 1 · 38:14
quoteNot seeing them is OK as long as you've lifted the perineum up. If you're passing under the cord, you won't see your needle like that. They're thick enough to cover the needle. So if you see some cord thing running over your needle, then that means you've gone under the cord. If you see just peritoneum, it's safe.↗
▶Ep 1 · 38:14
clinicalWhen performing laparoscopic hernia repair, if cord structures are visible between peritoneum and needle, the needle has passed under the cord—safe passage shows only peritoneum over the needle.↗
▶Ep 1 · 38:14
quoteNot seeing them is OK as long as you've lifted the perineum up. If you're passing under the cord, you won't see your needle like that. They're thick enough to cover the needle. So if you see some cord thing running over your needle, then that means you've gone under the cord. If you see just peritoneum, it's safe.↗
▶Ep 1 · 38:14
clinicalWhen performing laparoscopic hernia repair, if cord structures are visible between peritoneum and needle, the needle has passed under the cord—safe passage shows only peritoneum over the needle.↗
▶Ep 1 · 40:00
clinicalBernia technique (Godoy/Varela/Guelfand, Chile): in girls, grasp and invert the patent processus sac, then cauterize extensively to obliterate it without suture; two-center study (with Navotny) reported no recurrences.↗
▶Ep 1 · 40:00
host_summaryBernia technique (Godoy/Varela/Guelfand, Chile): in girls, grasp and invert the patent processus sac, then cauterize extensively to obliterate it without suture; two-center study (with Navotny) reported no recurrences.↗
▶Ep 1 · 42:14
host_summaryMunther Haddad (Leeds, UK) published series on open hernia repair with sac division but no ligation, achieving same recurrence rate as traditional ligation; argues ligation creates a smaller hernia sac rather than eliminating it.↗
▶Ep 1 · 42:14
clinicalMunther Haddad (Leeds, UK) published series on open hernia repair with sac division but no ligation, achieving same recurrence rate as traditional ligation; argues ligation creates a smaller hernia sac rather than eliminating it.↗
▶Ep 1 · 42:36
quoteThe key to a good hernia repair is injury, not the stitch.↗
▶Ep 1 · 42:36
quoteThe key to a good hernia repair is injury, not the stitch.↗
▶Ep 1 · 44:16
clinicalIn rabbit hernia model, suture ligation alone without peritoneal injury resulted in 75% failure at 2 weeks and 83% failure at 4 weeks when suture was removed.↗
▶Ep 1 · 44:16
clinicalIn rabbit hernia model, suture ligation alone without peritoneal injury resulted in 75% failure at 2 weeks and 83% failure at 4 weeks when suture was removed.↗
▶Ep 1 · 44:16
quoteAt 2 weeks out, the suture was removed, and 75% of them popped right open when you cut out the stitch. But on the side where we caused injury, 87% stayed closed.↗
▶Ep 1 · 44:16
quoteAt 2 weeks out, the suture was removed, and 75% of them popped right open when you cut out the stitch. But on the side where we caused injury, 87% stayed closed.↗
▶Ep 1 · 44:33
clinicalIn rabbit model, anterior peritoneal injury plus suture resulted in 87% closure at 2 weeks and 100% reperitonealisation at 4 weeks even after suture removal.↗
▶Ep 1 · 44:33
clinicalIn rabbit model, anterior peritoneal injury plus suture resulted in 87% closure at 2 weeks and 100% reperitonealisation at 4 weeks even after suture removal.↗
▶Ep 1 · 44:46
quoteEven when we cut the stitch out, 100% of them were reperitalized.↗
