In this episode we talk about Kidney transplant with Dr. Jonathan Merola, a transplant surgeon from Cincinnati Children's Hospital. (This content was created from the Grand Rounds lecture at CCHMC)

Host: Cecilia Gigena

We are back with another Update Course Rewind video from the Update Course in Pediatric Surgery 2023.

This time we are presenting you "Who to Send Home from the OR: Partial Thyroidectomy" with Drs. Mark Wulkan, Justin Huntington, Tolulope Oyetunji, & Phillip Ben Ham.

Host: Cecilia Gigena

This video explores the considerations for same day discharge following minimally invasive pectus excavatum repair with intercostal neuro-cryoablation and uncomplicated right thyroid lobectomy. Key Points:

• Pectus Excavatum Repair:

• Discharge Timing: The majority of surgeons prefer a post-op stay of 2-3 days, but up to 20% consider same day discharge. The effectiveness of cryoablation and intercostal nerve blocks plays a significant role in determining discharge timing.
• ERAS Protocol Impact: Combining cryoablation with an Enhanced Recovery After Surgery (ERAS) protocol has shown a reduction in opioid use and length of hospital stay, with many patients able to go home by day two.
• Patient and Family Education: Setting expectations about post-op pain and recovery is crucial for successful same day or early discharge.

• Thyroid Lobectomy:

• Same Day Discharge Feasibility: Approximately 30% of surgeons discharge patients on the same day, with the rest keeping them overnight due to concerns about post-op bleeding and recurrent laryngeal nerve injury.
• ATA Guidelines: The American Thyroid Association supports same day discharge for suitable patients, considering clinical, social, and procedural factors.
• Complication Management: While the risk of post-op hematoma exists, newer technologies and careful monitoring have reduced its occurrence, making same day discharge more viable.

Summary:

• Pectus Excavatum Repair: Same day discharge is possible with cryoablation and ERAS, though most patients are discharged on day two or three based on pain control and patient preference.
• Thyroid Lobectomy: Same day discharge is increasingly accepted, particularly with newer surgical techniques and careful patient selection, but overnight observation remains common due to the risk of complications like post-op bleeding.

We are back with another Update Course Rewind video from the Update Course in Pediatric Surgery 2023.

This time we are presenting you "Who to Send Home from the OR: Pectus Excavatum Repair 2023" with Drs. Mark Wulkan, Justin Huntington, Tolulope Oyetunji, & Phillip Ben Ham.

Host: Cecilia Gigena

In this session we discuss different Cryoanalgesia and pain management protocols that may help with same day discharge after a minimally invasive repair of pectus excavatum (MIRPE).

00:00 Introduction

00:33 Case Scenario

01:15 Cryoablation techniques

01:58 Literature Review

02:44 Dr. Oyetunji’s protocol

03:22 Oral pain medication

03:54 Proper time for Same day discharge

04:22 Summary

In this video, we explore the diagnosis and management of esophageal strictures, focusing on the importance of a patient-centered approach and the various techniques available for dilation.

• Symptom Assessment: Esophageal stricture symptoms vary by age, oral intake, and stenosis severity. Accurate diagnosis involves evaluating nutritional status and secretion management.
• Diagnostic Tools: Endoscopy and esophagram are essential for assessing stricture location, diameter, and extent.
• Dilation Techniques: Learn about different tools like controlled radial expansion balloons, hurricane balloons, and bougienage. Understand when and how to use each method safely.
• Fluoroscopy Guidance: The advantages of using fluoroscopy for pre- and post-dilation esophagrams, ensuring accurate dilation and detecting complications like perforation.
• Incremental Dilation: The importance of cautious, gradual dilation to minimize risks and improve outcomes.
• Choosing the Right Method: Tailor the dilation technique to each patient’s anatomy, with a focus on careful scar remnant removal.

We are back with another Update Course Rewind video from the Update Course in Pediatric Surgery 2023.

This time we are presenting you "Who to Send Home from the OR: Pyloromyotomy 2023" with Drs. Mark Wulkan, Justin Huntington, Tolulope Oyetunji, & Phillip Ben Ham.

Host: Cecilia Gigena

In this session you will learn when it is safe to discharge a patient after a routine pyloromyotomy, which differs in the gestational age in those who are less or over 37 weeks.

00:00 Introduction

00:41 1st Case Scenario

01:00 Is Same day discharge possible?

01:29 Literature Review

02:51 2nd Case Scenario

04:01 Is Same Day Discharge safe?

05:33 NSQIP data Analysis

06:30 Summary

We are back with another Update Course Rewind video from the Update Course in Pediatric Surgery 2023.

This time we are presenting you "Who to Send Home from the OR: Laparoscopic Cholecystectomy 2023" with Drs. Mark Wulkan, Justin Huntington, Tolulope Oyetunji, & Phillip Ben Ham.

Host: Cecilia Gigena

In this session you will learn when it is safe to discharge a patient after a routine laparoscopic cholecystectomy.

00:00 Introduction

00:37 Case Scenario

01:02 Strategies for Same Day discharge

01:38 Literature Review

02:32 Summary

Learn about the crucial role of ENT surgeons in the multidisciplinary approach to esophageal atresia repair. This video highlights the benefits of a team approach involving pediatric surgeons, ENTs, GIs, pulmonary specialists, speech therapists, and nutritionists.

Key Points:

Team Collaboration: The importance of utilizing diverse skill sets for optimal patient outcomes.

ENT Surgeon's Perspective: Focusing on future swallowing, recurrent laryngeal nerve health, and preventing potential injuries.

Cervical Approach: Isolating the cervical trachea and esophagus, avoiding nerve damage, and creating a tunnel for colonic interposition.

Simultaneous Operations: Coordinated efforts where one surgeon harvests the graft while another prepares the esophagus.

Case Study: Addressing recurrent tracheoesophageal fistulas and achieving successful outcomes with the aid of ENT expertise.

Why ENT Surgeons are Essential: Their knowledge of head and neck anatomy and experience in complex airway management improve care delivery, outcomes, and reduce operative times.

Immediate Involvement: Engaging ENT specialists early in the process to address complications with voice and swallowing.

We are back with another Update Course Rewind video from the Update Course in Pediatric Surgery 2023.

This time we are presenting you "Who to Send Home from the OR: Non-perforated appendicitis 2023" with Drs. Mark Wulkan, Justin Huntington, Tolulope Oyetunji, & Phillip Ben Ham.

Host: Cecilia Gigena

In this session surgeons discuss when a patient should receive antibiotics, if any, after a Laparoscopic appendectomy for non-perforated appendicitis. Non-operative management is also discussed.

00:00 Introduction

00:38 Case Scenario

01:04 Non-operative management

02:31 Same day discharge after surgery

03:08 NSQIP data analysis

04:10 Summary

We are back with another Update Course Rewind video from the Update Course in Pediatric Surgery 2023.

This time we are presenting you "Who to Send Home from the OR: Buttock Abscess 2023" with Drs. Mark Wulkan, Justin Huntington, Tolulope Oyetunji, & Phillip Ben Ham.

Host: Cecilia Gigena

In this session the surgeons discuss about the indications for an uncomplicated buttock

abscess. When to treat with antibiotics, when to make an incision and draining (I&D) or

when it is necessary to do something else.

00:00 Introduction

00:38 Case Scenario

01:09 Is it necessary to keep them overnight?

02:06 Literature Review

02:49 Summary

In this video we’ll talk about pediatric surgeon’s perspective on improving the care of TEF/EA patients with Dr. Dan von Allmen, Surgeon-in-Chief at Cincinnati Children’s.

Here are some highlights:

• Historical Milestones: From the first description in the 1600s to Cameron Haight's primary repair in 1941.

• Challenges and Complications: Addressing associated anomalies and the high morbidity linked to traditional thoracotomy.

• Team Approach: The necessity of a multidisciplinary team, including pediatric surgery, ENT, pulmonary, GI, and more.

• Innovative Techniques: Adapting procedures like the tracheal slide for complex cases and leveraging the expertise of specialized surgeons.

• Collaborative Success: Benefits of dual-team operations for efficiency and better patient outcomes.

• Barriers and Solutions: Overcoming financial and systemic challenges to provide optimal care.