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, MD

0:00 Introduction

0:59 Omphalitis

2:00 Umbilical Hernia

6:55 Proboscoid Hernia

8:48 Umbilical Granuloma

10:18 Summary

Zens 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 asymptomatic pediatric umbilical hernias: a systematic review. J Pediatr Surg. 2017 Nov;52(11):1723-1731. doi: 10.1016/j.jpedsurg.2017.07.016. Epub 2017 Jul 24. PMID: 28778691. https://pubmed.ncbi.nlm.nih.gov/28778691/

Halleran DR, Minneci PC, Cooper JN. Association between Age and Umbilical Hernia Repair Outcomes in Children: A Multistate Population-Based Cohort Study. J Pediatr. 2020 Feb;217:125-130.e4. doi: 10.1016/j.jpeds.2019.10.035. Epub 2019 Nov 8. PMID: 31711762. https://pubmed.ncbi.nlm.nih.gov/31711762/

He K, Graham DA, Vernacchio L, Hatoun J, Patane L, Cramm SL, Rangel SJ. Age and Probability of Spontaneous Umbilical Hernia Closure. JAMA Pediatr. 2024 May 1;178(5):497-498. doi: 10.1001/jamapediatrics.2024.0087. PMID: 38466296; PMCID: PMC10928535. https://pubmed.ncbi.nlm.nih.gov/38466296/

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 innovative treatments and surgical expertise to improve the quality of life for children with CHARGE syndrome. Don’t forget to like, comment, and subscribe for more expert insights!

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 patients with CHARGE syndrome, helping them overcome complex challenges and improve quality of life. Don’t forget to like, comment, and subscribe for more pediatric insights!

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 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 Takeaways

1. TPIAT 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.
2. A multidisciplinary approach is key to success, involving extensive preoperative planning, precision surgery, lab-based islet cell isolation, and meticulous postoperative care.

0:08 Introduction

0:49 What is Total Pancreatectomy with Islet Autotransplantation?

1:02 Who are the candidates for TPIAT?

1:23 Pre-op evaluation

2:13 Step-by-step overview of TPIAT surgery

7:42 Post-op Care

9:07 Summary

Host: Cecilia Gigena, MD

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 diagnosis and surgery to focus on the patient’s current symptoms for better quality of life. Don’t forget to like, comment, and subscribe for more insights into colorectal surgery!

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 care for children with complex cardiac and airway conditions. Don’t forget to like, comment, and subscribe for more expert insights!

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-class surgical team. Like, comment, and subscribe for more pediatric surgery insights!

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, and emphasizes the importance of technique to minimize these complications.

Learn how Cincinnati Children's ENT team ensures successful outcomes for kids with minor laryngeal clefts and why endoscopic repair is often preferred.