Stay Current In Pediatric Surgery

An interactive discussion about pediatric lung lesions between Todd Ponsky, MD and Steve Rothenberg, MD. Dr. Rothenberg is Chief of Pediatric Surgery and the Chairman of the Department of Pediatrics at the Rocky Mountain Hospital for Children in Denver, CO. He is also faculty at Columbia University, College of Physicians and Surgeons in the Division of Pediatric Surgery as a Senior Consultant in Pediatric Minimal Access Surgery. Table of Contents 00:00 Introduction 02:46 Prenatal evaluation 04:11 Role of fetal MRI 04:30 Fetal imaging features 05:11 Choice of delivery location 06:01 Role of fetal intervention 07:09 Administration of corticosteroids 07:49 Cyst volume ratio 08:32 Spectrum of CPAM 11:16 Routine neonatal care 13:45 Role of neonatal MRI 15:15 Institutional variations in management 17:41 Decision to operate 20:10 Too small for thoracoscopic surgery? 21:59 Preoperative preparation 23:31 Anesthetic considerations 25:15 Avoidance of over-ventilation 26:36 Avoidance of high peak venti

An interactive discussion about inguinal hernia between Jeffrey Ponsky, MD and Michael Rosen, MD. Dr. Rosen is professor of surgery at Cleveland Clinic Lerner College of Medicine. Table of Contents 1:00:44 1 Introductions 2:02:45Work up for groin bulge 4:02:16 Role of watchful waiting 5:30:26 Contraindications to repair 7:02:27 Open versus laparoscopic approach 10:48:40 Front door or ceiling: TAPP vs TEP laparoscopic repair 12:11:05 Patient counseling 14:24:46 Incidental contralateral hernia: To fix or not to fix? 15:29:07 Special cases: Check your minimally invasive ego 17:26:17 Laparoscopic repair: technical tenants 21:10:48 You’ve stepped into it now: Which mesh? 24:19:40 Fixation of mesh? 25:21:55 Contaminated field: To mesh or not to 26:15:14 Femoral hernias: Best approach? 28:34:32 Complicated hernias: recurrent, bilateral, incarcerated 30:35:18 Summary

This episode is our first audio journal club. We discuss 5 papers today with our guests, Dr Dan von Allmen, Dr George Whit Holcomb, and Dr Aaron Lipskar. Table of contents: 00:00 Introduction 00:55 Corticosteroids for biliary atresia 05:21 Dr von Allmen’s comments 10:54 Antiseptic agents and surgical site infection 14:15 Dr Holcomb’s comments 20:17 Non-operative management of non-perforated appendicitis 25:19 Dr Holcomb’s comments 30:41 Enteral autonomy after intestinal failure 33:37 Dr Lipskar’s comments 36:41 Anesthesia neurotoxicity 40:27 Dr Lipskar’s comments Use of Corticosteroids After Hepatoportoenterostomy for Bile Drainage in Infants With Biliary Atresia: the START randomized clinical trial Discussed by Dr Dan von Allmen Bezerra JA, et al. Use of Corticosteroids After Hepatoportoenterostomy for Bile Drainage in Infants With Biliary Atresia: the START randomized clinical trial. JAMA. 2014 May 7;311(17):1750–10. Dr von Allmen’s comments: • Dr von Allmen would not use corticosteroids after Kasai p

An interactive discussion about cloacal exstrophy between Todd Ponsky, MD and Alberto Peña, MD. Dr. Peña is is the founding director of the Peña Colorectal Center at Cincinnati Children's Hospital and clinical professor of surgery at the University of Cincinnati Table of Contents 00:00 Introduction 01:24 What is cloacal exstrophy? 06:24 Management of cloacal exstrophy 07:56 Sexual function in males 11:38 Team approach 12:50 Role of the pediatric surgeon 13:21 Differentiating urothelium from intestinal mucosa 13:51 Bladder closure 14:04 End colostomy creation 15:11 Consequences of end ileostomy creation 16:41 Rescue operation 18:51 Common mistake: Failure to separate bowel from bladder 20:15 Pelvic osteotomies for pelvic approximation 21:37 End colostomy complications 23:23 Reversal of colostomy and pull-through 24:09 Bladder augmentation 24:41 Stoma reversal candidates 25:43 Importance of colon length preservation 26:29 Bowel management program through stoma 27:31 Age for stoma reversal

An interactive discussion about vascular access in the pediatric patient population between Todd Ponsky, MD and Mark Wulkan, MD. Dr. Wulkan is Professor of Surgery and Chief, Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, Emory Children's Center, Atlanta, Georgia Table of Contents 01:15 - Catheter selection 02:48 - Neck cutdown technique 06:38 - Catheter selection, continued 07:02 - Neck cutdown technique, continued 07:18 - Determine catheter length 09:34 - Percutaneous technique 13:24 - Long-term access 15:22 - Utility of vascular studies 17:50 - Choice of vessel 19:17 - Line infections 20:06 - Choice of vessel, continued 22:44 - Groin cutdown technique 23:17 - Preoperative workup 24:38 - Heparin use 25:20 - Ethanol use 26:14 - Line infections, continued 27:35 - Antibiotic-coated catheters 27:47 - Heparin-coated catheters 28:04 - Exhaustion of vessel options 31:15 - Skin preparation 32:37 - Tunneled catheter removal Intro track is adapted from "I dunno" by grape

Discussion with Dr Marc Levitt, Dr Scott Engum and Dr Todd Ponsky regarding the use of BoTox in the post-pullthrough patient as well as management of dilated post-pullthrough colon. Table of contents: 01:17 - Algorithm for BoTox 07:07 - BoTox technique 09:11 - Management of dilated post-pullthrough colon http://www.globalcastmd.com/ soundcloud.com/globalcastmd/hirschsprung-disease-listener Please send any questions or comments to staycurrentpodcast@gmail.com

Discussion with Dr. Andrea Bischoff and Dr. Todd Ponsky regarding evaluation and management of anorectal malformations. Table of contents: 01:19 - Evaluation of the male baby with an anorectal malformation 03:08 - Distinguishing a normal anus from a perineal fistula 04:39 - Associated anomalies 10:19 - Timing of surgical repair 12:45 - Evaluation of the female baby with an anorectal malformation 13:57 - Evaluation of the older child with an anorectal malformation 16:08 - Evaluation of the male baby with a high anorectal malformation 17:38 - What is the ideal colostomy? 19:31 - Distal colostogram 22:19 - Choice of procedure for different anorectal malformations 24:30 - Evaluation of cloacal anomaly 27:28 - Prognosis after repair of anorectal malformations 32:45 - Enema technique 35:58 - Bowel management for incontinence 39:48 - Malone stoma 41:33 - Bowel management for constipation Please send questions and comments to staycurrentpodcast@gmail.com

Dr. Shawn St. Peter and Dr. Todd Ponsky discuss contemporary diagnosis and management of empyema Table of contents: 2:37 - Evaluation of patient with pleural effusion 07:26 - Treatment algorithm for empyema 11:23 - Duration of antibiotic therapy 14:51 - Imaging for empyema 16:03 - Fibrinolysis 23:15 - Post-procedure chest x-ray 23:45 - Determining failure of therapy 26:44 - Pulmonary necrosis 31:57 - Pulmonary abscess 33:44 - Resection for pulmonary necrosis? 34:26 - Agents for fibrinolysis

Continuation of our previous podcast on Hirschsprung disease with Dr Marc Levitt that focuses on the evaluation and management of post-pull-through complications. Table of contents: 04:12 - Evaluation of post-pull-through problems 08:08 - Post-pull-through enterocolitis 12:49 - Contrast enema 15:39 - Exam under anesthesia 17:26 - Repeat biopsy 19:19 - Redo transanal dissection 20:13 - Persistent cuff 21:45 - Myectomy 23:43 - BoTox 27:46 - Twisted bowel 29:40 - Duhamel complications 32:35 - Evaluation for persistent soiling 42:20 - Surgical treatment for soiling