Stay Current In Pediatric Surgery

In this episode of the Colorectal Quiz, Drs. Marc Levitt, Jason Frischer, and Martin Lacher dive into the intricacies of frozen sections and reoperative strategies in Hirschsprung disease. Using a fascinating case of a late-diagnosed Hirschsprung patient, they explore critical decision-making in staged repairs and reoperative pull-through surgeries.Key Highlights:Frozen Section Techniques: Best practices for biopsy marking and pathology review to confirm ganglion cells.Staged Repairs: Why ileostomy followed by a laparoscopic-assisted Swenson pull-through was chosen for this case.Reoperative Strategies: Managing transition zone pull-throughs, early reoperations, and avoiding long-term complications.Surgical Pearls: Insights into laparoscopic port placement, anastomotic site preparation, and collaboration with pathologists for accurate diagnoses.Whether you're a seasoned colorectal surgeon or new to the field, this episode is packed with practical tips and lessons learned. Download the Stay Current app to view

In this episode, Dr. Greg Burg, a pulmonologist at Cincinnati Children’s, discusses the medical management of minor laryngeal clefts, highlighting a comprehensive approach that includes swallow assessments, pulmonary therapies, and long-term monitoring. Learn how a combination of safe swallowing strategies, dietary modifications, and reactive therapies can help manage aspiration risks in pediatric patients.Key Takeaways:Diagnostic Approach: Importance of bronchoscopy, swallow studies, and chest CT scans in identifying aspiration-related issues.Medical Management: Use of inhaled steroids, macrolide therapy, and saline treatments to reduce inflammation and improve airway clearance.Swallowing & Nutrition: Thickened feeds, pacing, and feeding tube strategies to prevent aspiration.Long-Term Monitoring: Vaccination recommendations, environmental risk reduction, and periodic reassessments to guide further intervention.This discussion provides valuable insights into how a multidisciplinary approach can improve ou

We are back with another episode of our Journal of Pediatric Surgery article review podcast. This time we have three publications from the fourth quarter of 2024, October, November and December issues. This time we're talking to editors Drs. Mauricio "Tony" Escobar, Mikko Pakarinen, and Pablo Laje joined by authors Drs. Aodhnait Fahy, Anne-Fleur van Hal, John M. Woodward and Ben Ham III.Host: Em GooteeArticles:Fahy AS, Klima DA, Gillam MM, Aprahamian CJ, Kim SS, Kokoska ER, Teeple EA, Weiss RG, Escobar MA Jr. Locum Tenens and Pediatric Surgery: A Position Statement and Practice Guidelines From the American Pediatric Surgical Association (APSA). J Pediatr Surg. 2024 Oct;59(10):161567. doi: 10.1016/j.jpedsurg.2024.04.021. Epub 2024 May 8. PMID: 38806318.https://pubmed.ncbi.nlm.nih.gov/38806318/van Hal ARL, Aanen IP, Wijnen RMH, Pullens B, Vlot J. The Value of Preoperative Rigid Tracheobronchoscopy for the Diagnosis of Tracheomalacia in Oesophageal Atresia Patients. J Pediatr Surg. 2024 Nov;59(11):161620. doi:

We’re back with sixteenth episode of "Quick Literature Updates" the podcast series that delivers the latest updates in pediatric surgery literature in a quick and digestible format. In each episode, we review articles covering the most interesting and relevant topics in the field.These articles are either chosen by JPS editors or our collaborators. We present these reviews as short news pieces with a summarization of key points.Whether you're a trainee, attending, or an advanced medical professional, tune in to our podcast for a dose of medical knowledge in every episode. Stay up to date on the latest trends and advancements in pediatric surgery with "Quick Literature Updates".Host: Em Gooteehttps://pubmed.ncbi.nlm.nih.gov/36805142/Brandt K, Dukleska K, McKeown M, Brancato J, Grossi V, Schoem S, Sacco T, D'Amato J, Bourque MD, Campbell BT. Utilizing a critical airway response team expedites esophageal button battery removal. J Pediatr Surg. 2023 May;58(5):810-813. doi: 10.1016/j.jpedsurg.2023.01.037. Epub 202

In this episode from the 12th Annual Update Course in Pediatric Surgery, Dr. Nelson Rosen discusses non-surgical approaches to managing pilonidal disease, emphasizing the importance of patient education and hygiene. Learn how techniques like hair removal, meticulous hygiene, and lifestyle adjustments can significantly reduce the need for invasive procedures.Key Highlights:Non-Surgical Success Rates: Up to 60-70% of patients experience improvement with non-surgical interventions alone.Hair Removal Techniques: Options include weekly clipping, waxing, Nair-type agents, and even laser removal for long-term maintenance.Hygiene Best Practices: Showering regularly, using washlets, and debunking myths about bathing restrictions for faster healing.Setting Expectations: How to guide patients and families through treatment while balancing realistic outcomes.Join us to explore how non-surgical management can transform the care and recovery of patients with pilonidal disease. Don’t forget to like, comment, and subscribe f

In this episode, pulmonologist Dr. Cherie Torres-Silva from Cincinnati Children's shares insights on managing pulmonary challenges in patients with CHARGE syndrome. Through a detailed case study, she explores strategies to address chronic aspiration, airway clearance limitations, and recurrent infections.Key Highlights:Challenges in CHARGE Syndrome: Understanding how aspiration, obstructive sleep apnea (OSA), and recurrent infections intersect in CHARGE patients.Management Strategies: Improving airway clearance with therapies like intrapulmonary percussion and thinning secretions using hypertonic saline.Infection Prevention: The role of dental hygiene, prophylactic antibiotics (e.g., inhaled tobramycin), and balancing the risks of antibiotic resistance.Individualized Care: Tailoring treatments based on respiratory cultures and underlying comorbidities such as hypotonia and restrictive lung disease.Learn how a multidisciplinary approach can improve outcomes for CHARGE patients with complex pulmonary issues. Do

In this educational video, Dr. Robin Bowman from Lurie Children’s Hospital in Chicago demonstrates the surgical release of a fatty filum terminale in a patient with tethered cord syndrome. Tethered cord syndrome is a stretch-induced condition that can cause progressive neurological deficits, including gait abnormalities, loss of bladder control, and chronic pain.Key Highlights:Understanding Tethered Cord Syndrome: How abnormal attachment of the filum terminale stretches the spinal cord and impacts function.Preoperative Imaging: The use of spinal MRI to identify the location of the conus, tethering lesions, and spina bifida occulta.Surgical Technique: A step-by-step overview of the untethering procedure, including laminotomy, nerve root stimulation, and filum transection.Postoperative Closure: Ensuring a watertight dura closure and layered wound repair to optimize healing and outcomes.Learn about this critical surgical procedure designed to relieve symptoms and prevent further neurological deterioration in chi

In this episode of the Colorectal Quiz, Drs. Marc Levitt and Jason Frischer are joined by Drs. Jeffrey Avansino and Hira Ahmad to discuss the nuances of the Malone procedure, used for managing fecal incontinence and constipation in pediatric patients. From patient selection to managing complications, this in-depth conversation highlights the importance of collaboration between urology and surgery for optimal outcomes.Key Topics:Understanding the Malone Procedure: Creating a channel to administer enemas for patients with continence challenges.Technical Considerations: When to use a shared appendix, manage leakage, and troubleshoot complex cases.Complication Management: Addressing stenosis, leakage, and rare issues like appendiceal prolapse.Future Approaches: Exploring the importance of teamwork and innovative solutions in colorectal surgery.Whether you're a pediatric surgeon or someone interested in advancing your understanding of colorectal care, this episode is packed with practical tips and insights. Don't

In this podcast, we explore the anatomy, conditions, and treatment strategies related to umbilical disorders in newborns and young children with Dr. Rebeccah Brown from Cincinnati Children's.From umbilical cord anatomy and infections like omphalitis to congenital abnormalities like gastroschisis and umbilical hernias, this comprehensive discussion covers key diagnostic and management approaches. We also highlight treatment guidelines for umbilical granulomas and practical tips for avoiding complications with silver nitrate applications.Host: Em Gootee, MD0:00 Introduction0:59 Omphalitis2:00 Umbilical Hernia6:55 Proboscoid Hernia8:48 Umbilical Granuloma10:18 SummaryZens TJ, Rogers A, Cartmill R, Ostlie D, Muldowney BL, Nichol P, Kohler JE. Age-dependent outcomes in asymptomatic umbilical hernia repair. Pediatr Surg Int. 2019 Apr;35(4):463-468. doi: 10.1007/s00383-018-4413-3. Epub 2018 Nov 14. PMID: 30430281. https://pubmed.ncbi.nlm.nih.gov/30430281/Zens T, Nichol PF, Cartmill R, Kohler JE. Management of asympt

In this video, Dr. Catherine Hart, ENT surgeon at Cincinnati Children’s, discusses the unique airway and aspiration challenges faced by children with CHARGE syndrome. From structural abnormalities like anteriorly positioned arytenoids to feeding difficulties due to cranial nerve impairments, Dr. Hart explores the multidisciplinary approaches required to provide optimal care.Key Highlights:CHARGE Larynx Features: Structural differences leading to upper airway obstruction, foreshortened vocal folds, and difficult intubation.Feeding Challenges: Aspiration risks due to absent cough reflex, high rates of reflux, and swallowing dysfunction in over 60% of CHARGE patients.Medical and Surgical Management: Options including Robinul, Botox, duct ligation, submandibular gland excision, and tympanic neurectomy to reduce aspiration risks.Tracheotomy and Beyond: When tracheotomy or laryngotracheal separation becomes necessary for severe cases with chronic lung impact.Learn how the team at Cincinnati Children’s combines inno

In this educational video, Dr. Catherine Hart, ENT surgeon at Cincinnati Children’s, provides an overview of CHARGE syndrome, a rare genetic disorder that affects multiple organ systems. Learn about its diagnosis, clinical features, and the comprehensive care required for patients with this condition.Key Highlights:What is CHARGE Syndrome? The acronym stands for coloboma, heart defects, atresia of the choanae, retardation of growth and development, genital/urinary anomalies, and ear malformations.Causes and Diagnosis: CHARGE is typically caused by a CHD7 mutation on chromosome 8 but can also be diagnosed clinically with specific major and minor criteria.Multisystem Impact: The syndrome’s highly variable expression means it can affect almost every organ system, requiring coordinated care.Care through an Aerodigestive Center: The Aerodigestive Center at Cincinnati Children’s ensures comprehensive management of airway, feeding, and developmental challenges.Learn how Cincinnati Children’s provides expert care for

In this video, we take you through a Total Pancreatectomy with Islet Autotransplantation (TPIAT)—one of the most complex abdominal surgeries performed in children. Learn about who qualifies for TPIAT, the surgical process, and the critical role of the lab team in isolating islet cells for infusion.From patient evaluation to the OR, lab preparation, and postoperative care, you’ll see how multiple specialists—surgeons, lab physicians, GI experts, and critical care teams—work together to ensure successful outcomes.Join Dr. Juan Gurria for a behind-the-scenes look at TPIAT, brought to you by the Pancreas Care Center at Cincinnati Children’s Hospital.Main TakeawaysTPIAT is a complex procedure for patients with chronic or acute recurrent pancreatitis who have failed all medical and endoscopic therapies. It involves pancreas removal, islet cell processing, and infusion into the liver.A multidisciplinary approach is key to success, involving extensive preoperative planning, precision surgery, lab-based islet cell iso

In this session from the 12th Annual Pediatric Surgery Update Course, Dr. Gloria Gonzalez discusses the innovative use of lipiodol to mark pulmonary nodules for minimally invasive resection in children. Adapted from adult procedures, lipiodol is a promising alternative to traditional localization methods, offering precise marking with minimal complications.Key Points Covered:Challenges in Nodule Localization: High conversion rates during thoracoscopy due to failure to locate small or calcified nodules using CT, ultrasound, or hook wires.Lipiodol Technique: A CT-guided marking procedure where lipiodol dye remains stable for up to three months, allowing for flexible surgery scheduling.Clinical Outcomes: Dr. Gonzalez’s team achieved 100% sensitivity in 33 patients, resecting over 50 nodules with improved accuracy and efficiency.Learn how this novel approach is transforming lung metastasis management in pediatric surgery. Don’t forget to like, comment, and subscribe for more cutting-edge updates!

In this episode of the Colorectal Quiz, Drs. Mark Levitt, Jason Frischer, and Chris Gayer discuss a complex case of persistent constipation in a patient with a history of Hirschsprung’s disease. Despite a successful pull-through surgery in infancy, the patient continued to experience significant symptoms into adulthood, highlighting the importance of long-term management.Key Points Covered:Challenges Post-Surgery: Why constipation persists in some Hirschsprung’s patients despite anatomically successful surgeries.Diagnostic Approach: The use of exams under anesthesia, rectal biopsies, contrast enemas, and motility testing to evaluate potential causes.Segmental Dysmotility Management: How a Malone procedure can provide a minimally invasive solution for improved colon emptying.Multidisciplinary Care: Collaboration between surgeons, gastroenterologists, and therapists to address motility disorders, pelvic floor dysfunction, and behavioral factors.This case highlights the importance of moving beyond the initial di

In this insightful session from the QUAD Conference, Dr. David Lehenbauer, a cardiothoracic surgeon at Cincinnati Children’s, discusses the management of concurrent cardiac pathology in patients undergoing slide tracheoplasty. Learn about the role of ECMO vs. cardiopulmonary bypass, timing of cardiac and tracheal repairs, and the challenges of addressing complex cases with multiple comorbidities.Key Points Covered:Slide Tracheoplasty: A transformative surgical technique for congenital tracheal stenosis.ECMO vs. Cardiopulmonary Bypass: Benefits of ECMO, including reduced inflammation, lower heparin requirements, and better post-op outcomes.Concurrent Cardiac Pathologies: Common conditions such as PA sling, ASDs, VSDs, and Tetralogy of Fallot, often repaired simultaneously with tracheoplasty.Timing of Repairs: Exploring when to combine vs. stage cardiac and tracheal interventions, with insights from recent studies and case reviews.Join us for an in-depth look at how a multidisciplinary approach is transforming

In this recap from the 12th Annual Pediatric Surgery Update Course, Drs. Regan Williams and Katie Russell delve into the latest approaches to deep vein thrombosis (DVT) prophylaxis in pediatric trauma patients. Learn when to start chemical prophylaxis, how to balance bleeding risks, and the best options for discharge medication.Key Points Covered:Timing is Critical: Start chemical DVT prophylaxis within 24 hours of admission for stable trauma patients to reduce the risk of venous thromboembolism (VTE).Guideline Recommendations: Follow EAST guidelines and assess factors like Injury Severity Score (ISS) to determine risk levels.Discharge Medications: Recent studies show aspirin is as effective as Lovenox for DVT prevention and offers easier compliance for pediatric patients at home.Join us as we explore how new evidence is shaping DVT prevention strategies in pediatric trauma care. Don’t forget to like, comment, and subscribe for more updates from the Pediatric Surgery Update Course!

In this episode of the Colorectal Quiz, research fellow Filipa Jalles from Children's National Hospital is joined by Dr. Marc Levitt, Dr. Jason Frisher, and Dr. Paola Midrio to discuss a challenging case involving perineal hypospadias and anorectal malformation. Together, they explore the intricacies of diagnosis, the emotional impact on families, and the detailed surgical approach required for successful outcomes.Key Topics Covered:Prenatal Diagnosis: How advancements in imaging are reshaping prenatal counseling for conditions like hypospadias.Surgical Strategy: The decision-making process around colostomy, PSARP, and collaboration with pediatric urologists.Anoplasty Techniques: Detailed discussion on the mobilization of the rectum and management of the fistula in these rare and complex cases.Multidisciplinary Collaboration: The importance of teamwork between pediatric surgeons and urologists to ensure optimal care.Join us for an in-depth look at this fascinating case and learn from the expertise of a world-

In this video, Dr. Catherine Hart, ENT surgeon at Cincinnati Children’s, discusses the endoscopic repair of minor laryngeal clefts, highlighting key surgical techniques and considerations. She explains the importance of accurately diagnosing these subtle clefts using combined evaluations and the criteria for deciding when surgery is necessary.Key Points Covered:When to Operate: Indications include persistent respiratory symptoms, aspiration, or recurrent infections in children.Surgical Technique: The procedure involves removing the interarytenoid mucosa, using precise suturing to prevent issues like inverted edges, and ensuring complete demucosalization at the apex.Postoperative Care: Patients are monitored overnight and follow a preoperative diet until a follow-up evaluation 6-8 weeks later, which includes a video swallow study and endoscopy.Outcomes and Complications: While endoscopic repair shows a high success rate, Dr. Hart discusses the potential risks, including scarring and supraglottic infections, an

In this educational video, experts from Cincinnati Children’s Pancreas Care Center discuss the complexities of diagnosing and managing chronic pancreatitis. Dr. Maisam Abu-El-Haija and Dr. Andrew Trout cover the condition’s impact on pancreatic function, imaging techniques, genetic testing, and treatment options.Key Topics:What is Chronic Pancreatitis? A progressive inflammatory condition leading to fibrosis, loss of pancreatic function, and complications like diabetes and malnutrition.Diagnosis: The role of imaging (MRI, CT) and genetic testing in identifying and understanding the disease.Treatment Strategies: From nutritional management and pancreatic enzyme replacement to endoscopic therapy and a multidisciplinary approach to pain management.Pain Management: A stepwise approach involving pain specialists, psychologists, and physical therapists to address both the physical and emotional aspects of chronic pain.Learn how the team at Cincinnati Children’s is transforming care for patients with chronic pancrea

In this insightful podcast, Drs. Marc Levitt, Jason Frischer, and Chris Westgarth-Taylor discuss the challenging anatomy and surgical strategies for complex female anorectal malformations. They walk us through a unique case involving a cloacal malformation with a high blind-ending rectum, highlighting the importance of detailed preoperative planning, multidisciplinary collaboration, and a tailored surgical approach.Key Topics Covered:Case Presentation: A young patient with a rare cloacal anomaly presenting with a single perineal orifice and absent Mullerian structures.Surgical Strategy: Using laparoscopic-assisted PSARP, considerations for colostomy, and preserving future options for gynecological reconstruction.Anatomy & Vascular Concerns: Managing unexpected vascular anomalies and protecting critical structures.Future Planning: Long-term follow-up for continence, bladder function, and possible tissue engineering solutions for gynecologic needs.Join us for a fascinating discussion on managing rare anorec