Journal of Pediatric Surgery Article Review: December 2021

ERAS protocols after minimally invasive surgery showed decreased length of stay and decreased 30-day readmission rates compared to standard care.

ERAS protocols after minimally invasive surgery showed no increase in complication rates compared to standard care.

For institutions hesitant about ERAS, a recommended first step is to implement ERAS strategies and evaluate whether patients would meet discharge criteria without actually discharging them initially.

The ultimate goal of ERAS protocols is same-day discharge, allowing children to return to normal life at home rather than staying in hospital beds.

The Johns Hopkins study examined neonates who underwent operative repair for esophageal atresia and tracheoesophageal fistula from 2014 to 2018, comparing open approach, thoracoscopy, and conversions to open.

Only approximately 16% of esophageal atresia repairs in the study were performed thoracoscopically, with the vast majority approached through traditional open thoracotomy.

The conversion rate from thoracoscopic to open approach for esophageal atresia repair was approximately 50%.

Despite the high conversion rate from thoracoscopic to open, there was no increased rate of complications in converted patients.

Increasing adoption of thoracoscopic esophageal atresia repair requires regular practice and mentorship, ideally during fellowship training, rather than one-day courses.

A mentorship program involving in-person mentorship followed by telementoring is likely the only way to measurably increase practicing surgeons performing thoracoscopic esophageal atresia repair.

Simulators for thoracoscopic esophageal atresia repair have been available for over a decade and are improving in quality, with anastomosis in a 3 kg chest being one of the most technically challenging exercises in pediatric surgery.

Long-term outcomes are likely to be better with thoracoscopic approach for esophageal atresia repair.

The Children's Mercy Hospital study was a retrospective chart review of slipping rib syndrome patients from 2006 to 2020, including 49 patients who underwent 67 operations.

Slipping rib syndrome is being recognized more frequently and patients are typically not going to improve with conservative management.

Patients with slipping rib syndrome are frequently symptomatic for years and have often seen multiple physicians across multiple disciplines, sometimes traveling from city to city.

A reasonable candidate for slipping rib syndrome surgery is a patient who had a reasonable result from local injection but then had pain recurrence.

Slipping rib syndrome can typically be diagnosed by palpating the anterolateral costal margin between ribs 9 and 11 to replicate the pain, with the area being tender.

In some slipping rib syndrome cases, the rib pop can be felt or even seen, and pressing on both sides of the chest simultaneously will frequently replicate the anterior pain.