In this episode of the Pediatric Surgery Update Course Rewind, Dr. Nelson Rosen and Dr. Whit Holcomb discuss advancements in the surgical management of pilonidal disease, emphasizing minimally invasive techniques like the GIPS procedure. Learn how these methods offer faster recovery, fewer complications, and better outcomes for patients.

Key Highlights:

• Minimally Invasive Techniques: The GIPS procedure and hybrid approaches that maximize skin preservation and minimize recovery time.
• EPSIT Technique: A global perspective on endoscopic management, including its benefits and challenges.
• Recurrence Prevention: The importance of ongoing hair removal strategies, including laser treatments, to prevent recurrence and improve long-term outcomes.
• When to Escalate: For cases where minimally invasive approaches fail, off-midline closure options like the Bascom cleft lift offer effective solutions.

This video is essential for understanding the evolving management of pilonidal disease and the role of patient-centered care in achieving lasting results.

Host: Em Gootee, MD

In this engaging episode of the Colorectal Quiz, Drs. Marc Levitt, Jason Frischer, and Erin Teeple dive into the complexities of pelvic floor dyssynergia, an often under-recognized condition impacting bowel and urinary function. Dr. Teeple, the only U.S. surgeon dually trained in pediatric and adult colorectal surgery, shares invaluable insights on diagnosis, treatment, and management strategies.

Key Highlights:

• Patient Case Study: A 17-year-old with unexplained urinary retention and testicular pain leads to a detailed exploration of pelvic floor dysfunction.
• Diagnostic Tools: The role of SITZ marker studies, defecography, and manual assessments in identifying pelvic floor tightness.
• Treatment Approaches: From pelvic floor physical therapy to Botox injections for puborectalis relaxation.
• Collaboration Matters: How pediatric and adult colorectal care intersect for comprehensive management.

This episode underscores the importance of a multidisciplinary approach and innovative techniques for treating pelvic floor dysfunction. Don’t forget to download the Stay Current app to access related images and resources, and subscribe for more pediatric surgery content!

In this Update Course Rewind session, Dr. Greg Tiao, Surgical Director of the Liver Transplantation Program at Cincinnati Children’s, discusses the critical role of MMP-7 as a biomarker in the early diagnosis of biliary atresia. With data showing that every 10-day delay in treatment worsens outcomes by 20%, early detection is essential for improving native liver survival.

Key Highlights:

• Importance of Early Diagnosis: Performing a Kasai procedure before 45 days significantly improves patient outcomes.
• MMP-7 as a Biomarker: Validated in international studies, MMP-7 is proving to be a powerful diagnostic tool.
• Challenges in Diagnosis: Distinguishing BA from other neonatal cholestasis conditions remains complex.
• Global Impact: Lessons from high-incidence regions like China are helping shape best practices in North America.

With the integration of MMP-7 testing, pediatric surgery is moving towards earlier diagnosis and intervention, improving the chances of avoiding liver transplant in affected infants. Don’t forget to like, comment, and subscribe for more updates!

Pediatric empyema pneumonia is a lung infection that occurs when pus collects in the pleural space, the area between the lungs and chest wall. In this video, we cover the management of pediatric empyema, including diagnosis, treatment algorithms, imaging, and surgical versus non-surgical approaches with Dr. Aaron Garrison, a pediatric surgeon at Cincinnati Children’s.

Host: Brittany Levy

Key Takeaways:

• Pediatric empyema pneumonia requires a combination of medical and surgical management, but decision-making can be complex.

• Community-acquired pneumonia is a leading cause of hospitalization in children, yet bacterial pathogens are detected in only 15% of cases.

• Empyema progresses in three stages: exudative, fibrinopurulent, and organizing. The fibrinopurulent stage is when surgical intervention is often needed.

• Ultrasound is more sensitive than CT in detecting septations in pleural effusions and avoids radiation exposure.

• Chest tube drainage with fibrinolytics (such as TPA) has been shown to be a viable alternative to VATS, reducing hospital stays and costs.

• Some children with effusions may not require TPA—clinical improvement within 24 hours of drainage can indicate that it’s unnecessary.

• Inhaled foreign bodies, particularly peanuts, can mimic pneumonia and require a high index of suspicion for proper diagnosis.

• CT scans are now being used to diagnose airway foreign bodies with high reliability, reducing unnecessary bronchoscopies.

Further reading:

https://api.semanticscholar.org/CorpusID:53467976

Module 2 . Hemodynamic Disorders, 2015

https://thoracickey.com/nonmalignant-pleural-effusions/

Nonmalignant Pleural Effusions by John E. Heffner

https://www.ctsnet.org/article/thoracoscopic-decortication

Thoracoscopic Decortication by Christopher Komanapalli

https://publications.aap.org/neoreviews/article-abstract/18/9/e564/91880/A-Newborn-with-a-Cyst-in-the-Lung?redirectedFrom=fulltext

A Newborn with a Cyst in the Lung by Shabih Manzar, MD; Liaqat H. Khan, MD

https://journals.lww.com/ascp/fulltext/2019/07020/management_of_parapneumonic_effusion_and_empyema.1.aspx

Singh, S et.al. Management of parapneumonic effusion and empyema. The Journal of Association of Chest Physicians

https://pubmed.ncbi.nlm.nih.gov/23164006/

Islam S et.al. The diagnosis and management of empyema in children: a comprehensive review from the APSA Outcomes and Clinical Trials Committee

https://pubmed.ncbi.nlm.nih.gov/31973927/

Derderian SC et.al. Pediatric empyemas - Has the pendulum swung too far?

https://pubmed.ncbi.nlm.nih.gov/26382287/

Long AM et.al. 'Less may be best'-Pediatric parapneumonic effusion and empyema management: Lessons from a UK center

In this QUAD Conference presentation, Dr. Doug von Allmen from Cincinnati Children’s shares groundbreaking research on using ultrashort echo-time MRI to evaluate tracheomalacia in neonates with esophageal atresia (EA). This innovative imaging technique offers a non-invasive, sedation-free, and radiation-free way to assess airway weakness and create detailed 3D models for better surgical planning.

Key Highlights:

• New Diagnostic Tool: Ultrashort echo-time MRI offers high-resolution imaging without the need for sedation or radiation.
• Study Findings: Patients with long gap esophageal atresia showed more severe tracheomalacia than those with short gap EA.
• Pre- and Post-Surgical Analysis: Repair improves upper trachea eccentricity but may worsen the distal trachea postoperatively.
• Clinical Implications: Long gap EA patients are at higher risk for respiratory complications and require close post-operative monitoring.

This research sheds light on how advanced imaging can lead to better diagnosis, treatment, and follow-up care for infants with esophageal atresia and tracheoesophageal fistula (TEF).

In this recap from the 12th Annual Pediatric Surgery Update Course, Dr. Carlos Colunga highlights the potential of CO2 lasers in pediatric surgery. From circumcisions to frenulectomies and pilonidal cyst ablations, CO2 lasers are gaining traction for their precision, reduced pain, and shorter operating times.

Key Highlights:

• Clinical Applications: Successfully used for circumcision, frenulectomy, perianal fistulas, pilonidal cysts, and more.
• Benefits of CO2 Lasers: Reduced bleeding, lower complication rates, shorter operative times, and improved cosmetic outcomes.
• Evidence-Based Insights: Meta-analyses show CO2 laser-assisted surgeries have better results than traditional techniques in specific cases.
• Challenges: High equipment cost, steep learning curve, and the need for specialized training remain barriers to adoption.

Join us to explore how CO2 lasers are transforming pediatric surgery and learn about the exciting possibilities for the future!

Host: Lizzy Lee, PA-C

We’re back with seventeenth 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 Gootee

https://pubmed.ncbi.nlm.nih.gov/37983822/

Zhang M, Huang J, Jin Z, Zhang X, Zhou Y, Chi S, Rong L, Zhang Y, Cao G, Li S, Tang ST. Comparison of robotic versus thoracoscopic repair for congenital esophageal atresia: a propensity score matching analysis. Int J Surg. 2024 Feb 1;110(2):891-901. doi: 10.1097/JS9.0000000000000889. PMID: 37983822; PMCID: PMC10871573.

https://pubmed.ncbi.nlm.nih.gov/38677965/

Ullrich S, Austin K, Avansino JR, Badillo A, Calkins CM, Crady RC, Durham MM, Fuller MK, Rana A, Reeder RW, Rentea RM, Rollins MD, Saadai P, Speck KE, Wood RJ, van Leeuwen K, Frischer JS; Pediatric Colorectal and Pelvic Learning Consortium. Does Delayed Diagnosis of Hirschsprung Disease Impact Post-operative and Functional Outcomes? A Multi-Center Review From the Pediatric Colorectal and Pelvic Learning Consortium. J Pediatr Surg. 2024 Jul;59(7):1250-1255. doi: 10.1016/j.jpedsurg.2024.03.034. Epub 2024 Mar 18. PMID: 38677965.

https://pubmed.ncbi.nlm.nih.gov/37978002/

Ameer A, Mirza MB, Talat N. The Outcome of Purse-string Versus Conventional Wound Closure Techniques in Patients Undergoing Stoma Reversal: A Randomized Controlled Trial. J Pediatr Surg. 2024 Jun;59(6):1186-1189. doi: 10.1016/j.jpedsurg.2023.10.062. Epub 2023 Oct 30. PMID: 37978002.

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 related images, X-rays, and resources discussed in the episode.

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 outcomes for children with minor laryngeal clefts. Don’t forget to like, comment, and subscribe for more expert discussions!

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 Gootee

Articles:

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: 10.1016/j.jpedsurg.2024.07.005. Epub 2024 Jul 14. PMID: 39089893.

https://pubmed.ncbi.nlm.nih.gov/39089893/

Woodward JM, Chunco C, Brierley SF, Bittner K, Osei H, Harmon CM, Ham PB 3rd. Same-Day Discharge for Elective Pediatric Laparoscopic Gastrostomy Tube Insertion is Safe and Increasing in Frequency; A NSQIP Pediatric Retrospective Review 2017 to 2021. J Pediatr Surg. 2024 Dec;59(12):161665. doi: 10.1016/j.jpedsurg.2024.08.005. Epub 2024 Aug 6. PMID: 39261186.

https://pubmed.ncbi.nlm.nih.gov/39261186/