989 timestamped statements
across 52 topics
— auto-found in recorded discussions, each timestamp jumps to the exact moment.
Summaries Todd gave as host are listed separately below.
The interface between the ganglionic bowel and the a ganglion bowel can be very irregular and can project for 234 centimeters longer along one part of the circumference than the other, so that even if you just look at a longitudinal strip. You could see gangon cells at the proximal margin, but on the opposite side of that margin there may be no gangon cells, and so you may be dealing with a, a low transition zone pull through in that situation.
I don't believe that a pure trans anal is necessarily less invasive. In other words, I believe that putting 3 incisions on the abdomen is actually less invasive in my hands, in my hands, certainly not in your guys' hands, but in my hands, I'm gonna be torquing in that anal canal much more than if I had done it laparoscopically and freed everything up from the abdominal approach.
early on in the development of laparoscopy and laparoscopic appendectomy, um, when I was still at Vanderbilt, there were 3 children who were brought in, this is in the early 1990s. There were 3 children brought in who had had a cautery used and there were adjacent injuries or secondary injuries to the small bowel. that it required operation.
The reason that we switched to this, um, is that there are, if it's clearly if airway aspiration, you go to the operating room. It's the ones you don't know. And what we found is the ones you don't know, it's a suspicious story. They were coughing after eating. Um, more often than not, it's reactive airway and it's not a foreign body.
What I use, Joyce, is, um, usually if they're bad enough that you're wondering what their bladder pressures are, they're often intubated. Um, if they're that sick, and so I look at their peak airway pressures to see, so as I'm reducing them, I watch their peak airway pressures, and that's how I decide when to stop reducing.
the studies, uh, currently, I think, uh, you know, what this, uh, is hoping to highlight is the ability to use non-operative management of appendicitis in certain cases, but, um, uh, the studies that we have, uh, show that, uh, having the presence of an appendiculli actually has about a 50% failure rate.
Approach and component separation for suture closure and underlay mesh...
▶Ep 1 · 0:27
clinicalspk_0 uses escharotic painting (escharization) followed by epithelialization for giant omphaloceles↗
▶Ep 1 · 0:27
quoteI use escharization. I, I paint them and then treat them, I let them epithelialize.↗
▶Ep 1 · 1:45
clinicalspk_0 tried silver-impregnated Aquacel which stuck to the sac, became incorporated, and could not be removed - described as a disaster↗
▶Ep 1 · 1:55
quoteI laid the Aqua cell on the silver Aqua cell and it stuck to the, uh, sack and it became incorporated. And could not get it off.↗
▶Ep 1 · 11:07
clinicalComponent separation in small babies is not easy, especially if the omphalocele has been on a silo for a long period and tissues are scarred together↗
▶Ep 1 · 13:10
clinicalComponent separation requires dissection to the mid-axillary line to adequately mobilize tissue↗
▶Ep 1 · 13:22
clinicalspk_0 now uses six-ply Surgisis which has 22 tension lines, allowing tension on the patch while bringing fascia together↗
▶Ep 1 · 21:57
clinicalspk_0 had one massive omphalocele case with muscle only at lateral edge requiring combination of lateral component separation, Gore-Tex attachment, and serial stretching over 3 sessions (like Witzman patch) to achieve muscle-to-muscle closure↗
▶Ep 1 · 22:57
clinicalBiologic dressings are not meant to be bridged - they turn into liquid as temporary material, not muscle, unless permanent↗
▶Ep 1 · 23:25
clinicalspk_0 observed one pediatric case where biologic patch appeared to turn into muscle or scar↗
Gastroschisis: Advanced Practice Providers
▶Ep 3 · 10:22
clinicalTodd Ponsky has done only non-sutured gastroschisis repair for the last 6 years and has never had a ventral hernia. He reports 10-20% umbilical hernia rate, most resolving by age 3-5 years, with perfect cosmetic results.↗
▶Ep 3 · 10:26
quoteI have only done this repair, uh, for the last 6 years. I have not done a sutured repair in 6 years.↗
epidemiologicalIn a pediatric surgery event poll, about 75% of surgeons reported doing non-sutured (Tegaderm) gastroschisis repair.↗
▶Ep 3 · 11:03
quoteWe did a pediatric surgery event just like this, but for the pediatric surgeons, and we pulled the audience, and I think it was about 75% of the surgeons that did the non-sutured repair.↗
▶Ep 3 · 11:53
clinicalFor non-sutured closure, Todd Ponsky places a silo on all patients, reduces at bedside, and if everything reduces he closes it by tying the umbilical cord with suture, laying it in a circle over the hole, applying gauze and Tegaderm, waiting 4 days, then changing dressing every 4 days until sealed (usually 2 weeks).↗
▶Ep 3 · 29:22
opinionTodd Ponsky does not use bladder pressures for gastroschisis monitoring, finding them not terribly accurate in this patient size. He uses peak airway pressures as primary assessment during reduction, watching them to decide when to stop reducing, and looks at overall baby appearance and urine output.↗
▶Ep 3 · 29:25
quoteWe do not use bladder pressures. Uh, I don't find them to be terribly accurate in this size, uh, patient.↗
▶Ep 3 · 29:41
quoteWhat I use, Joyce, is, um, usually if they're bad enough that you're wondering what their bladder pressures are, they're often intubated. Um, if they're that sick, and so I look at their peak airway pressures to see, so as I'm reducing them, I watch their peak airway pressures, and that's how I decide when to stop reducing.↗
▶Ep 3 · 30:03
quoteThere's never a downside to just releasing the silo and letting things back out again, right.↗
▶Ep 3 · 42:18
clinicalFor gastroschisis monitoring, the volume of NG output matters less than the color: even high-volume clear/spitty output may allow feeding, but any bilious output (regardless of volume) means the patient is not ready to feed.↗
▶Ep 3 · 43:11
quoteThe exact opposite is true that you can have a ton of spit coming out, but it doesn't mean that they're not ready to be fed, um, so for some reason in the little kids the volume doesn't seem to be as critical, um, as the color.↗
Update Course 2022 - TOP PUBLICATIONS IN NON- PED SURG JOURNALS - Jose Campos
▶Ep 6 · 0:30
quoteI met Jose Campos at, I think, an IPEG meeting or something and he came up to me and he says, I said, hi, how are you? He goes, yeah, the stuff you're doing is a problem. I was like, nice to meet you too. He said, you're only looking at pediatric surgical journals and pediatric surgical societies, you're missing all of the incredible publications that come out in articles we don't read.↗
▶Ep 6 · 16:52
quoteIt was invented before there was widespread laparoscopy. It came first. Then laparoscopic. Because of that order, a lot of people favor PEG, but it's blind. I mean, you're putting something right through the belly without looking, so it makes no sense to me.↗
▶Ep 6 · 17:36
clinicalThe article by Todd Ponsky Sr. and Mike Goddard on PEG tube placement remains the most cited article in the history of the Journal of Pediatric Surgery, with approximately three times the citations of the number two article.↗
▶Ep 6 · 17:36
quoteThe article by Jeff Ponsky and Mike Goddard remains the most cited article in the history of the Journal of Pediatric Surgery by far by like three times the number two article so it's a real landmark paper and we owe dr. Ponsky and Goddard a tip the cap for coming up with this technique when it really was the first minimally invasive way to insert a gastrostomy tube.↗
Todd's statements about Abdominal Wall Defects96 statements
Approach and component separation for suture closure and underlay mesh...
▶Ep 1 · 0:27
quoteI use escharization. I, I paint them and then treat them, I let them epithelialize.↗
▶Ep 1 · 0:27
clinicalspk_0 uses escharotic painting (escharization) followed by epithelialization for giant omphaloceles↗
▶Ep 1 · 1:45
clinicalspk_0 tried silver-impregnated Aquacel which stuck to the sac, became incorporated, and could not be removed - described as a disaster↗
▶Ep 1 · 1:55
quoteI laid the Aqua cell on the silver Aqua cell and it stuck to the, uh, sack and it became incorporated. And could not get it off.↗
▶Ep 1 · 11:07
clinicalComponent separation in small babies is not easy, especially if the omphalocele has been on a silo for a long period and tissues are scarred together↗
▶Ep 1 · 13:10
clinicalComponent separation requires dissection to the mid-axillary line to adequately mobilize tissue↗
▶Ep 1 · 13:22
clinicalspk_0 now uses six-ply Surgisis which has 22 tension lines, allowing tension on the patch while bringing fascia together↗
▶Ep 1 · 21:57
clinicalspk_0 had one massive omphalocele case with muscle only at lateral edge requiring combination of lateral component separation, Gore-Tex attachment, and serial stretching over 3 sessions (like Witzman patch) to achieve muscle-to-muscle closure↗
▶Ep 1 · 22:57
clinicalBiologic dressings are not meant to be bridged - they turn into liquid as temporary material, not muscle, unless permanent↗
▶Ep 1 · 23:25
clinicalspk_0 observed one pediatric case where biologic patch appeared to turn into muscle or scar↗
quoteI use escharization. I, I paint them and then treat them, I let them epithelialize.↗
▶Ep 3 · 0:36
quoteI use escharization. I, I paint them and then treat them, I let them epithelialize.↗
▶Ep 3 · 1:54
clinicalSilver Aquacel stuck to the omphalocele sac and became incorporated, failing to fall off as expected once it hardened underneath.↗
▶Ep 3 · 1:54
clinicalSilver Aquacel stuck to the omphalocele sac and became incorporated, failing to fall off as expected once it hardened underneath.↗
▶Ep 3 · 2:03
quoteI laid the Aqua cell on the silver Aqua cell and it stuck to the, uh, sack and it became incorporated. And could not get it off.↗
▶Ep 3 · 2:03
quoteI laid the Aqua cell on the silver Aqua cell and it stuck to the, uh, sack and it became incorporated. And could not get it off.↗
▶Ep 3 · 10:56
quotehe's one of these minds that you meet and, and he thinks so creatively, so he's so innovative, and every time I watch his videos, Um, I just am fascinated.↗
▶Ep 3 · 10:56
quotehe's one of these minds that you meet and, and he thinks so creatively, so he's so innovative, and every time I watch his videos, Um, I just am fascinated.↗
▶Ep 3 · 13:20
clinicalComponent separation dissection to the mid-axillary line is necessary to adequately mobilize tissue and achieve closure.↗
▶Ep 3 · 13:20
clinicalComponent separation dissection to the mid-axillary line is necessary to adequately mobilize tissue and achieve closure.↗
▶Ep 3 · 13:31
clinicalSix-ply Surgisis with 22 tension lines works better, allowing tension on the patch while bringing the fascia together.↗
▶Ep 3 · 13:31
clinicalSix-ply Surgisis with 22 tension lines works better, allowing tension on the patch while bringing the fascia together.↗
▶Ep 3 · 16:02
clinicalWith escharization and delayed closure, children go home, play, are active regular kids, epithelialize the whole omphalocele, and can be fixed when older with component separation techniques.↗
▶Ep 3 · 16:02
clinicalWith escharization and delayed closure, children go home, play, are active regular kids, epithelialize the whole omphalocele, and can be fixed when older with component separation techniques.↗
▶Ep 3 · 16:02
quotewe forget where we, we were, where we've come from sometimes, you know, we look at those great old pictures and, you know, of skin covered in phallos, which still didn't have great techniques to fix them, which we do have now. You can just get out of the way.↗
▶Ep 3 · 16:02
quotewe forget where we, we were, where we've come from sometimes, you know, we look at those great old pictures and, you know, of skin covered in phallos, which still didn't have great techniques to fix them, which we do have now. You can just get out of the way.↗
▶Ep 3 · 16:05
quoteThey go home, they're playing, they're active regular kids. They they epithelialize the whole thing and then fix it when they're older with some of these maybe component separation type techniques.↗
▶Ep 3 · 16:05
quoteThey go home, they're playing, they're active regular kids. They they epithelialize the whole thing and then fix it when they're older with some of these maybe component separation type techniques.↗
▶Ep 3 · 25:55
clinicalLivers in small-defect omphaloceles can have a mushroom or dumbbell shape, making reduction very difficult.↗
▶Ep 3 · 25:55
clinicalLivers in small-defect omphaloceles can have a mushroom or dumbbell shape, making reduction very difficult.↗
clinicalFor gastroschisis, bedside reduction can be attempted under sedation (rectal acetaminophen and small-dose fentanyl) without intubation, with success in approximately 80% of cases even when all bowel is eviscerated.↗
▶Ep 4 · 14:20
opinionSpring-loaded Bianchi silos may enlarge the fascial defect because the compressive forces are directed outward at the ring level.↗
▶Ep 4 · 25:19
opinionIf apple-peel bowel is ischemic (not necrotic) and not twisted, waiting until the next day to reassess viability is reasonable before committing to resection.↗
Abdominal Wall Defects with Dr. Jacob Langer
▶Ep 6 · 18:10
clinicalSpring-loaded silos (Bentech) create outward pressure forces as you push down, making the defect larger over time↗
▶Ep 6 · 42:03
clinicalPhil Gazzetta described the 'flip flop' technique (modification of component separation) for omphalocele closure: lateral incision of anterior sheath only, folding over while attached to posterior sheath, creating single posterior layer↗
Compiled Sandler Rapid Fire Sessions: Update Course 2015
clinicalFor gastroschisis with inflamed bowel, bedside reduction without intubation is feasible using rectal Tylenol and minimal fentanyl↗
▶Ep 8 · 9:58
clinicalFor gastroschisis with inflamed bowel, bedside reduction without intubation is feasible using rectal Tylenol and minimal fentanyl↗
▶Ep 8 · 14:27
opinionSpring-loaded Bianchi silos may enlarge the fascial defect because the outward forces from the compressed ring push laterally↗
▶Ep 8 · 14:27
opinionSpring-loaded Bianchi silos may enlarge the fascial defect because the outward forces from the compressed ring push laterally↗
Gastroschisis: Advanced Practice Providers
▶Ep 10 · 10:22
clinicalTodd Ponsky has done only non-sutured gastroschisis repair for the last 6 years and has never had a ventral hernia. He reports 10-20% umbilical hernia rate, most resolving by age 3-5 years, with perfect cosmetic results.↗
▶Ep 10 · 10:22
clinicalTodd Ponsky has done only non-sutured gastroschisis repair for the last 6 years and has never had a ventral hernia. He reports 10-20% umbilical hernia rate, most resolving by age 3-5 years, with perfect cosmetic results.↗
▶Ep 10 · 10:26
quoteI have only done this repair, uh, for the last 6 years. I have not done a sutured repair in 6 years.↗
▶Ep 10 · 10:26
quoteI have only done this repair, uh, for the last 6 years. I have not done a sutured repair in 6 years.↗
quoteWe did a pediatric surgery event just like this, but for the pediatric surgeons, and we pulled the audience, and I think it was about 75% of the surgeons that did the non-sutured repair.↗
▶Ep 10 · 11:03
epidemiologicalIn a pediatric surgery event poll, about 75% of surgeons reported doing non-sutured (Tegaderm) gastroschisis repair.↗
▶Ep 10 · 11:03
epidemiologicalIn a pediatric surgery event poll, about 75% of surgeons reported doing non-sutured (Tegaderm) gastroschisis repair.↗
▶Ep 10 · 11:03
quoteWe did a pediatric surgery event just like this, but for the pediatric surgeons, and we pulled the audience, and I think it was about 75% of the surgeons that did the non-sutured repair.↗
▶Ep 10 · 11:53
clinicalFor non-sutured closure, Todd Ponsky places a silo on all patients, reduces at bedside, and if everything reduces he closes it by tying the umbilical cord with suture, laying it in a circle over the hole, applying gauze and Tegaderm, waiting 4 days, then changing dressing every 4 days until sealed (usually 2 weeks).↗
▶Ep 10 · 11:53
clinicalFor non-sutured closure, Todd Ponsky places a silo on all patients, reduces at bedside, and if everything reduces he closes it by tying the umbilical cord with suture, laying it in a circle over the hole, applying gauze and Tegaderm, waiting 4 days, then changing dressing every 4 days until sealed (usually 2 weeks).↗
▶Ep 10 · 29:22
opinionTodd Ponsky does not use bladder pressures for gastroschisis monitoring, finding them not terribly accurate in this patient size. He uses peak airway pressures as primary assessment during reduction, watching them to decide when to stop reducing, and looks at overall baby appearance and urine output.↗
▶Ep 10 · 29:22
opinionTodd Ponsky does not use bladder pressures for gastroschisis monitoring, finding them not terribly accurate in this patient size. He uses peak airway pressures as primary assessment during reduction, watching them to decide when to stop reducing, and looks at overall baby appearance and urine output.↗
▶Ep 10 · 29:25
quoteWe do not use bladder pressures. Uh, I don't find them to be terribly accurate in this size, uh, patient.↗
▶Ep 10 · 29:25
quoteWe do not use bladder pressures. Uh, I don't find them to be terribly accurate in this size, uh, patient.↗
▶Ep 10 · 29:41
quoteWhat I use, Joyce, is, um, usually if they're bad enough that you're wondering what their bladder pressures are, they're often intubated. Um, if they're that sick, and so I look at their peak airway pressures to see, so as I'm reducing them, I watch their peak airway pressures, and that's how I decide when to stop reducing.↗
▶Ep 10 · 29:41
quoteWhat I use, Joyce, is, um, usually if they're bad enough that you're wondering what their bladder pressures are, they're often intubated. Um, if they're that sick, and so I look at their peak airway pressures to see, so as I'm reducing them, I watch their peak airway pressures, and that's how I decide when to stop reducing.↗
▶Ep 10 · 30:03
quoteThere's never a downside to just releasing the silo and letting things back out again, right.↗
▶Ep 10 · 30:03
quoteThere's never a downside to just releasing the silo and letting things back out again, right.↗
▶Ep 10 · 42:18
clinicalFor gastroschisis monitoring, the volume of NG output matters less than the color: even high-volume clear/spitty output may allow feeding, but any bilious output (regardless of volume) means the patient is not ready to feed.↗
▶Ep 10 · 42:18
clinicalFor gastroschisis monitoring, the volume of NG output matters less than the color: even high-volume clear/spitty output may allow feeding, but any bilious output (regardless of volume) means the patient is not ready to feed.↗
▶Ep 10 · 43:11
quoteThe exact opposite is true that you can have a ton of spit coming out, but it doesn't mean that they're not ready to be fed, um, so for some reason in the little kids the volume doesn't seem to be as critical, um, as the color.↗
▶Ep 10 · 43:11
quoteThe exact opposite is true that you can have a ton of spit coming out, but it doesn't mean that they're not ready to be fed, um, so for some reason in the little kids the volume doesn't seem to be as critical, um, as the color.↗
7th Annual Pediatric Surgery Update Course 2019 - FULL SHOW
▶Ep 15 · 0:58
quoteJust two days ago, I had a baby that I was operating on. And because you taught me this, the hemoglobin, they were going to transfuse up to a hematocrit of thoracin. No, I learned from the PDC. We don't have to do that anymore. Transfuse clinically.↗
▶Ep 15 · 17:16
quoteI don't know if any surgeon would look at that and go 41 percent failure rate is a success.↗
▶Ep 15 · 17:16
quoteI use this as something in my back pocket now. So I don't do it, but I have it there. So if someone's not a good surgical candidate, for whatever reason, I don't want it. Then I know I have it as an option, but I don't do it.↗
Abdominal Wall Defects with Dr. Jacob Langer
▶Ep 20 · 13:15
clinicalThe sutureless plastic closure technique was described by Anthony Sandler and doesn't require suturing the umbilical cord↗
▶Ep 20 · 14:19
clinicalA study by Dr. Baird published in JPS showed that patients with flap closure did better in every way than those with sutured fascial closure, including lower rates of umbilical hernia repair↗
▶Ep 20 · 18:10
clinicalSpring-loaded silos apply pressure outward as you push down, making the defect larger over time↗
▶Ep 20 · 18:10
clinicalSpring-loaded silos apply pressure outward as you push down, making the defect larger over time↗
▶Ep 20 · 42:06
clinicalThe 'flip flop' technique (modification of component separation) involves incising laterally through anterior sheath only, folding it over while attached to posterior sheath, creating a single posterior sheath closure↗
▶Ep 20 · 42:06
clinicalThe 'flip flop' technique (modification of component separation) involves incising laterally through anterior sheath only, folding it over while attached to posterior sheath, creating a single posterior sheath closure↗
Umbilical Cord Defects with Dr. Kenneth Azarow
▶Ep 21 · 21:33
epidemiologicalA prospective trial at Dr. Ponsky's institution found triamcinolone (Kenalog) cream superior to silver nitrate for umbilical granulomas, with such a drastic difference the study was stopped early.↗
▶Ep 21 · 29:22
epidemiologicalAnalysis of PHIS (Pediatric Health Information System) data showed the mean age for umbilical hernia repair across U.S. children's hospitals is 4 years.↗
Journal of Pediatric Surgery Article Review: January 2022 APSA Issue
▶Ep 26 · 5:03
clinicalAt Akron Children's Hospital under Bob Perry, the bonus structure required the entire group to reach a certain RVU threshold for everyone to receive 50% of their bonus, eliminating competition for cases.↗
▶Ep 26 · 5:03
quoteIn Akron, Bob Perry, the way that he structured the bonus was that the entire group has to get a certain RVU, not a single person.↗
▶Ep 26 · 5:19
quoteThat way, there was no competition like trying to steal cases and stuff, because the whole group rose as a group.↗
Omphalocele & Gastroschisis
▶Ep 27 · 1:31
clinicalFor large omphalocele defects, besides intestine, a good amount of the liver is on the outside in the majority of cases.↗
▶Ep 27 · 2:12
clinicalFor gastroschisis, only ultrasound is normally obtained to confirm the diagnosis without additional imaging.↗
▶Ep 27 · 2:12
clinicalFetal growth is tracked monthly in these cases because there is concern for significant growth restriction.↗
▶Ep 27 · 2:12
clinicalFor omphalocele, besides ultrasound, MRI and echocardiogram are routinely obtained because these patients may have other associated anomalies.↗
▶Ep 27 · 3:15
epidemiologicalGastroschisis affects approximately one in every 2200 live births.↗
▶Ep 27 · 8:38
clinicalAfter sequential reduction with plastic clips in omphalocele, the patient is taken to the operating room for delayed primary closure of the fascia and skin.↗
Update Course 2021: UPDATE COURSE 2020: REVIEW OF LAST YEAR'S IMPORTANT T OPICS
▶Ep 28 · 0:00
quoteWe are, we all live in our own little country and we do our own little thing. And it's only when we talk to each other from all over that we do true learning.↗
▶Ep 28 · 1:00
quoteThis is about rapid fire. We're not doing in-depth stuff here. This is rapid fire, important topics that we feel and that a lot, that's why we bring new faculty in every year, that the faculty feel are kind of the real important points that we need to be highlighting all over the world that came up over the last year or so.↗
▶Ep 28 · 1:40
quoteI promise you, I'm making this promise every year, something will glitch. Okay? I've been saying this for nine years. Even a few years ago, the whole power went out in the city and we had to drive to my living room. Something will glitch. Bear with us.↗
▶Ep 28 · 2:20
quoteThis only, as you know, this is free. This is free because, and we've been trying to keep this free as long as we can. We try to believe that knowledge should be free as long as we can do it, as best we can do it.↗
▶Ep 28 · 4:45
epidemiological26% of respondents use intraoperative ICG to visualize the biliary tree, 23% use it in select patients, and 51% do not use it.↗
▶Ep 28 · 10:50
clinicalGetting phenol into the operating room for sclerotherapy is not always easy due to institutional and pharmacy restrictions.↗
▶Ep 28 · 12:23
epidemiologicalApproximately 50% of respondents always use sutureless abdominal closure for large abdominal wall defects, 40% use it in select patients, and only 11% do not use it.↗
▶Ep 28 · 12:23
epidemiologicalThe adoption of sutureless closure for abdominal wall defects represents a major practice change over nine years, with 90% now using it always or selectively compared to much lower rates previously.↗
▶Ep 28 · 16:42
clinicalImplementing ERAS requires team buy-in, particularly from anesthesiologists, because of practice changes like allowing oral intake two hours preoperatively.↗
▶Ep 28 · 21:50
epidemiologicalMost institutions are either taking steps to address social determinants of health or working on it; few report no action.↗
Update Course 2022 - UPDATES IN GASTROSCHISIS FEEDING PROTOCOLS - Jason Fraser, Beth Rymeski, and Steven Lee
▶Ep 29 · 9:10
quotethe reason these protocols at least in my opinion are important is because there's not variation in care generally speaking they've been tried and true and work all right but the nurses know what it is and you know you don't need to call a doctor every time you want to increase by 10 cc's or whatever↗
clinicalFlexible fiber optic gastrointestinal endoscopy began around 1958 when Hersowitz at the University of Michigan developed a method using glass fibers to transmit images.↗
▶Ep 8 · 0:34
clinicalIn the 1960s, flexible endoscopy was used only for visualization of the GI tract without therapeutic interventions.↗
▶Ep 8 · 0:45
clinicalIn the early 1970s, Shina, a surgeon in New York, developed the ability to remove polyps from the GI tract endoscopically.↗
▶Ep 8 · 0:48
clinicalEndoscopic polyp removal was significant because it enabled removal of polyps before they became cancer.↗
▶Ep 8 · 1:38
clinicalThe chief of gastroenterology at Case Western Reserve University refused to train surgical residents in endoscopy in the early 1970s.↗
▶Ep 8 · 2:09
clinicalAfter completing approximately 500 endoscopy cases during training in Canton, Ohio, the speaker was again refused permission to participate in endoscopy training at Case Western Reserve because he was a surgeon.↗
▶Ep 8 · 3:02
clinicalBy the end of residency, the speaker had displaced the gastroenterology service at University Hospitals through independent endoscopy practice using a personally owned endoscope.↗
▶Ep 8 · 3:18
clinicalChildren with brain damage often required long-term feeding tubes.↗
▶Ep 8 · 3:18
clinicalThe speaker and Michael Gauderer developed a technique to place feeding tubes endoscopically through the abdominal wall.↗
▶Ep 8 · 3:44
opinionThe PEG tube procedure was probably the beginning of minimally invasive surgery.↗
▶Ep 8 · 3:51
clinicalThe speaker moved to Mount Sinai Hospital in 1979, almost 40 years before this presentation, and began performing PEG tube placement in adults.↗
▶Ep 8 · 4:09
clinicalOlympus, Ross Laboratories, and Eaton Laboratory all declined interest in commercializing the PEG tube when initially contacted.↗
▶Ep 8 · 4:19
clinicalMarlon Yonker owned a small endoscopy company called American Endoscopy and agreed to manufacture the PEG tube.↗
clinicalAmerican Endoscopy was sold to Bard Endoscopy in 1986.↗
▶Ep 8 · 4:53
opinionThe PEG tube is now used and overused throughout the world.↗
▶Ep 8 · 4:56
opinionThe PEG tube was the first minimally invasive surgical procedure.↗
▶Ep 8 · 5:04
clinicalIn the era of PEG development, innovators could directly contact company representatives who would work collaboratively in garages and laboratories to develop prototypes.↗
▶Ep 8 · 5:41
opinionModern medical device innovation faces greater challenges due to FDA regulations compared to the 1970s-1980s era.↗
▶Ep 8 · 6:05
clinicalThe PEG tube has become a standard procedure.↗
▶Ep 8 · 6:18
clinicalSurgical endoscopy now includes procedures to divide muscles for achalasia, a condition where people cannot swallow.↗
▶Ep 8 · 6:26
clinicalSurgical endoscopy is used to treat Zenker's diverticulum, an outpouching of the esophagus causing swallowing difficulty.↗
▶Ep 8 · 6:33
clinicalSurgery is now performed through the endoscope.↗
clinicalPercutaneous drainage was chosen over repeat EUS cystgastrostomy for the mediastinal pseudocyst in Case 2 because introducing a stomach-to-pseudocyst connection might create more retroperitoneal scarring and make the planned TPIAT more challenging.↗
▶Ep 6 · 14:36
clinicalTaking out the tail of the pancreas for a distal duct leak in a child with genetic pancreatitis would compromise islet yield if the patient needs total pancreatectomy in the future.↗
▶Ep 6 · 40:44
clinicalPatients who undergo Puestow followed by total pancreatectomy have compromised islet yield compared to those who undergo total pancreatectomy without prior Puestow.↗
▶Ep 6 · 42:36
opinionWhen considering whether a patient may need total pancreatectomy in the future, this significantly influences the decision to pursue conventional surgical options versus proceeding directly to TPIAT.↗
▶Ep 6 · 46:40
clinicalPuestow is typically considered for isolated large duct disease or chain-of-lakes appearance without an inflammatory mass in the head of the pancreas, and typically not in hereditary pancreatitis.↗
▶Ep 6 · 51:39
clinicalIntraoperative ultrasound can be used during Beger procedure to locate the bile duct, and sometimes the duct can be found by sticking a needle into it under ultrasound guidance.↗
▶Ep 6 · 52:34
opinionIn children with genetic etiology of pancreatitis, we are less likely to consider resectional and drainage procedures because the genetic makeup of the remaining pancreas will not change.↗
▶Ep 6 · 52:58
clinicalWhipple is uncommonly considered in children with head-predominant pancreatic disease and is reserved primarily for cases with suspected malignancy.↗
▶Ep 6 · 55:10
quoteIn children with genetic etiology of pancreatitis, we are less likely to consider resectional and drainage procedures.↗
Acute and Acute Recurrent Pancreatitis: Pancreatic Disease
▶Ep 5 · 41:39
clinicalAspiration of pancreatic necrosis to rule out infection should be reserved for cases of true clinical deterioration; in the absence of significant clinical worsening, avoid needle aspiration due to risk of introducing infection into sterile necrosis.↗
▶Ep 5 · 41:39
quoteYou can very much be opening a can of worms if you're starting to stick things into the pancreas. Um, I can tell you that I, I think we've had, um, the need for one in the last 10 years, one necrosectomy for, for, you know, necro truly. Awful necrotizing pancreatitis.↗
▶Ep 5 · 41:57
quoteIn the absence of true significant clinical deterioration, we, we really avoid, avoid sticking needles in the pancreas, sticking drains.↗
▶Ep 5 · 42:50
quoteYou stick a needle into a collection that may be sterile, and then you have the risk of introducing infection, and then once you have infected necrosis. Things can can really deteriorate.↗
Todd's statements about Acute Recurrent Pancreatitis10 statements
quotewe have a panel of experts who know more than the rest of the world, it seems, uh, from what I've been reading↗
▶Ep 1 · 0:28
opinionCincinnati Children's has been leading the world in pediatric surgical education↗
▶Ep 1 · 1:22
clinicalThe event will be recorded and available after 48 hours↗
▶Ep 1 · 1:27
clinicalA new video portal will allow users to search by keyword and watch specific segments rather than entire events↗
▶Ep 1 · 2:00
clinicalThe Center of Telehealth at Cincinnati Children's is used daily by experts to help physicians and patients around the world↗
▶Ep 1 · 2:38
clinicalCincinnati Children's Pancreas Care Center is staffed by a large multidisciplinary group rather than one or two specialists↗
Acute and Acute Recurrent Pancreatitis: Pancreatic Disease
▶Ep 5 · 41:39
quoteYou can very much be opening a can of worms if you're starting to stick things into the pancreas. Um, I can tell you that I, I think we've had, um, the need for one in the last 10 years, one necrosectomy for, for, you know, necro truly. Awful necrotizing pancreatitis.↗
▶Ep 5 · 41:39
clinicalAspiration of pancreatic necrosis to rule out infection should be reserved for cases of true clinical deterioration; in the absence of significant clinical worsening, avoid needle aspiration due to risk of introducing infection into sterile necrosis.↗
▶Ep 5 · 41:57
quoteIn the absence of true significant clinical deterioration, we, we really avoid, avoid sticking needles in the pancreas, sticking drains.↗
▶Ep 5 · 42:50
quoteYou stick a needle into a collection that may be sterile, and then you have the risk of introducing infection, and then once you have infected necrosis. Things can can really deteriorate.↗
Todd's statements about Aerodigestive / ENT60 statements
Aerodigestive & Esophageal Surgery - The Unsalvageable Esophagus & Cases
▶Ep 3 · 2:14
quoteSome people believe that you have to use a scope to measure the true gap. I may not be at the end.↗
▶Ep 3 · 2:14
quoteSome people believe that you have to use a scope to measure the true gap. I may not be at the end.↗
▶Ep 3 · 2:21
clinicalIn long-gap atresia, some surgeons use a Hagar dilator to measure the gap, but this may not reach the true end of the distal pouch. A flexible scope is more reliable for accurate gap measurement.↗
▶Ep 3 · 2:21
clinicalIn long-gap atresia, some surgeons use a Hagar dilator to measure the gap, but this may not reach the true end of the distal pouch. A flexible scope is more reliable for accurate gap measurement.↗
clinicalIn experimental porcine models of endoscopic Foker (using olive beads and wire traction), pressure necrosis at the anastomotic site is the suspected cause of death.↗
▶Ep 3 · 6:32
clinicalIn experimental porcine models of endoscopic Foker (using olive beads and wire traction), pressure necrosis at the anastomotic site is the suspected cause of death.↗
▶Ep 3 · 7:00
clinicalIntraluminal magnetic anastomosis is being developed as a minimally invasive approach to long-gap atresia, with the goal of reducing pressure necrosis compared to bead-based traction.↗
▶Ep 3 · 7:00
clinicalIntraluminal magnetic anastomosis is being developed as a minimally invasive approach to long-gap atresia, with the goal of reducing pressure necrosis compared to bead-based traction.↗
▶Ep 3 · 10:52
quoteThe whole big controversial thing is, do, are we trying too hard to save the esophagus?↗
▶Ep 3 · 10:52
quoteThe whole big controversial thing is, do, are we trying too hard to save the esophagus?↗
▶Ep 3 · 19:13
quoteStents don't work in, in scarred, uh, form strictures that are not fresh.↗
▶Ep 3 · 19:13
quoteStents don't work in, in scarred, uh, form strictures that are not fresh.↗
▶Ep 3 · 26:28
clinicalPlacing endoscopes from above and below during thoracoscopic stricture resection allows identification of the stricture by transillumination ('go to the light').↗
▶Ep 3 · 26:28
clinicalPlacing endoscopes from above and below during thoracoscopic stricture resection allows identification of the stricture by transillumination ('go to the light').↗
▶Ep 3 · 30:25
clinicalMagnetic compression anastomosis (magnamosis) has been used successfully for gastrojejunostomy but is unproven in the esophagus. The main limitations are the distance magnets can attract across and the lack of mucosal lining in the resulting anastomosis.↗
▶Ep 3 · 30:25
clinicalMagnetic compression anastomosis (magnamosis) has been used successfully for gastrojejunostomy but is unproven in the esophagus. The main limitations are the distance magnets can attract across and the lack of mucosal lining in the resulting anastomosis.↗
▶Ep 3 · 41:47
clinicalSerial bougie dilation (e.g., Maloney or Savary dilators) is less effective than balloon dilation for esophageal strictures. Balloon dilation applies radial force and can crack scar tissue without requiring needle knife incision.↗
▶Ep 3 · 41:47
clinicalSerial bougie dilation (e.g., Maloney or Savary dilators) is less effective than balloon dilation for esophageal strictures. Balloon dilation applies radial force and can crack scar tissue without requiring needle knife incision.↗
▶Ep 3 · 47:31
quoteI always tease our gastroenterologists that it's impossible to remove the endoscope without bringing out tissue with it.↗
▶Ep 3 · 47:31
quoteI always tease our gastroenterologists that it's impossible to remove the endoscope without bringing out tissue with it.↗
▶Ep 3 · 54:12
clinicalMobilizing the gastroesophageal junction to achieve length for primary esophageal anastomosis effectively creates a hiatal hernia and predisposes to reflux.↗
▶Ep 3 · 54:12
clinicalMobilizing the gastroesophageal junction to achieve length for primary esophageal anastomosis effectively creates a hiatal hernia and predisposes to reflux.↗
▶Ep 3 · 59:46
quoteClearly I had ischemia because it was 100% a technical issue, whether it was ischemia.↗
▶Ep 3 · 59:46
quoteClearly I had ischemia because it was 100% a technical issue, whether it was ischemia.↗
▶Ep 3 · 1:14:05
clinicalFor a spit fistula to avoid recurrent TEF, the distal esophageal stump must be fully mobilized down to the diaphragm and separated from the trachea, not just divided and dropped.↗
▶Ep 3 · 1:14:05
clinicalFor a spit fistula to avoid recurrent TEF, the distal esophageal stump must be fully mobilized down to the diaphragm and separated from the trachea, not just divided and dropped.↗
▶Ep 3 · 1:40:18
quoteIt's been a real pleasure being here today and it's been an honor how much I've learned in one day.↗
▶Ep 3 · 1:40:18
quoteIt's been a real pleasure being here today and it's been an honor how much I've learned in one day.↗
▶Ep 3 · 1:40:28
quoteAbsolutely amazing webinar, some amazing cases with excellent skills that you all brought today. I'm happy that you all are there for us when these cases get beyond the norm.↗
Aerodigestive & Esophageal Surgery - Difficult Tracheal Esophageal Fistula
▶Ep 3 · 25:08
clinicalTrichloroacetic acid (TCA) can be used to demucosalize TEF tracts, but control is less precise than with bugbee cautery; TCA is applied on a pledget and can cause unintended burns if it contacts tissue during insertion.↗
▶Ep 3 · 1:50:04
clinicalAnal fistula plugs (biologic, cone-shaped, made of Surgisis) can theoretically be used to occlude distal airway fistulas; they are wrapped with barbed suture and inserted into the tract to promote collagen matrix formation and scarring.↗
TEF Presentations (Extended): Aerodigestive & Esophageal Surgery
▶Ep 4 · 0:00
quoteThis instrument I learned from actually a previous Globalcast and now I use it all the time.↗
▶Ep 4 · 0:00
quoteThis instrument I learned from actually a previous Globalcast and now I use it all the time.↗
▶Ep 4 · 0:04
quoteThe bugbee is so useful and underutilized among us as general surgeons.↗
▶Ep 4 · 0:04
opinionThe bugbee cautery is useful and underutilized among general surgeons for treating recurrent tracheoesophageal fistulas.↗
▶Ep 4 · 0:04
opinionThe bugbee cautery is useful and underutilized among general surgeons for treating recurrent tracheoesophageal fistulas.↗
▶Ep 4 · 0:04
quoteThe bugbee is so useful and underutilized among us as general surgeons.↗
▶Ep 4 · 1:53
quoteWe may underappreciate tracheomalacia or malaysia.↗
▶Ep 4 · 1:53
opinionGeneral surgeons may underappreciate tracheomalacia or laryngomalacia, making collaboration with ENT colleagues valuable for comprehensive airway assessment.↗
▶Ep 4 · 1:53
quoteWe may underappreciate tracheomalacia or malaysia.↗
▶Ep 4 · 1:53
opinionGeneral surgeons may underappreciate tracheomalacia or laryngomalacia, making collaboration with ENT colleagues valuable for comprehensive airway assessment.↗
▶Ep 4 · 12:21
clinicalTrichloroacetic acid (TCA) can be used for TEF demucosalization, but it is difficult to control precisely and leaves white tissue everywhere, whereas the bugbee provides more precise control.↗
▶Ep 4 · 12:21
clinicalTrichloroacetic acid (TCA) can be used for TEF demucosalization, but it is difficult to control precisely and leaves white tissue everywhere, whereas the bugbee provides more precise control.↗
▶Ep 4 · 12:57
quoteI have to tell you what scares me is when I'm done, it's white everywhere because I mean, the whole, it's hard to control it and be precise.↗
▶Ep 4 · 12:57
quoteI have to tell you what scares me is when I'm done, it's white everywhere because I mean, the whole, it's hard to control it and be precise.↗
▶Ep 4 · 13:19
quoteWhen I switched to the bug bee, I have herby bug bee bug beat, um, it's, uh, it absolutely is much more precise.↗
▶Ep 4 · 13:19
quoteWhen I switched to the bug bee, I have herby bug bee bug beat, um, it's, uh, it absolutely is much more precise.↗
▶Ep 4 · 17:52
quoteI'm always afraid because I can't see down that tube, and I wonder not just word in the esophagus, I wonder if I'm really destroying that fistula so much that I'm gonna perforate↗
▶Ep 4 · 17:52
quoteI'm always afraid because I can't see down that tube, and I wonder not just word in the esophagus, I wonder if I'm really destroying that fistula so much that I'm gonna perforate↗
▶Ep 4 · 45:31
clinicalDead button batteries still have about 2 volts and continue to cause damage.↗
▶Ep 4 · 45:31
quoteWhen they're dead, they're still not dead. They're still going. They got about 2 volts↗
▶Ep 4 · 45:37
clinicalButton batteries can be distinguished from coins on AP X-ray by a visible rim, eliminating the need for a lateral view.↗
▶Ep 4 · 1:09:25
clinicalFor TEF repair, all that matters is achieving raw-on-raw tissue contact for healing.↗
▶Ep 4 · 1:09:25
clinicalFor TEF repair, all that matters is achieving raw-on-raw tissue contact for healing.↗
▶Ep 4 · 1:09:33
opinionThoracoscopic diaphragmatic hernia repairs may have a higher recurrence rate than open repairs, possibly because they do not cause enough raw-on-raw tissue contact.↗
▶Ep 4 · 1:09:33
opinionThoracoscopic diaphragmatic hernia repairs may have a higher recurrence rate than open repairs, possibly because they do not cause enough raw-on-raw tissue contact.↗
▶Ep 4 · 1:37:24
clinicalAnal fistula plugs made of biologic material (surgesis) can be used for TEF repair by wrapping them with barbed VOC suture and inserting them into the fistula tract to promote scarring and collagen matrix formation.↗
▶Ep 4 · 1:37:24
clinicalAnal fistula plugs made of biologic material (surgesis) can be used for TEF repair by wrapping them with barbed VOC suture and inserting them into the fistula tract to promote scarring and collagen matrix formation.↗
Todd's statements about Anorectal Malformation47 statements
quoteI have never had a patient referred to me with a prenatal diagnosis of any rectum malformations, cloica ever.↗
Prenatal Imaging and Counseling: Cloaca and Complex ARMs 2015
▶Ep 19 · 25:12
quoteI have never had a patient referred to me with a prenatal diagnosis of any rectal malformations, cloica ever.↗
Posterior Sagittal Anorectaplasty in a Female: Pediatric Colorectal...
▶Ep 27 · 2:10
clinicalTotal body prep from nipples to toes is standard for these patients, allowing flexibility to flip between supine and prone positions↗
Colorectal Quiz: Episode 49 – Collaborating for Kids: Colorectal & Pelvic Solutions (with a Little Help from AI)
▶Ep 65 · 1:20
quoteMark, you're always not only good at anal rectum malformations, but you have been interested in All the tech and the media from the very beginning.↗
▶Ep 65 · 1:35
quoteWhat M and I are working on is how we can mass produce content to equilibrate knowledge around the world, and we know that the only way to do that is to use cutting edge technology, automation tools and AI.↗
▶Ep 65 · 2:16
clinicalNotebook LM is a free offering from Google that can create realistic-sounding podcasts between two AI voices from uploaded documents.↗
▶Ep 65 · 2:31
quoteI would love to hear your thoughts, Mark, on your first experience with Notebook LM.↗
▶Ep 65 · 4:14
quoteNo one has been able to do it as well as Notebook LM.↗
▶Ep 65 · 4:22
opinionThe AI-generated podcast voices are not customizable; users are limited to the same male and female voices.↗
▶Ep 65 · 4:26
quoteThere's actually an incredible video where they uploaded a document telling these two podcast hosts that they were AI and how they reacted. They freaked out.↗
▶Ep 65 · 4:52
quoteDo I think this is the future of podcasting? I don't.↗
▶Ep 65 · 5:03
clinicalNotebook LM's beta version allows users to join the AI conversation interactively.↗
▶Ep 65 · 5:09
quoteYou could click join, and it goes, hey, what's up? And you could say, hey, I heard what you just said about the colostomy. I'm not sure I agree, and then it will talk with you.↗
▶Ep 65 · 7:42
quoteThe AI revolution has happened, and each month, it's blowing up and replacing jobs.↗
opinionHospitals should have teams that continuously bring new AI tools to clinicians every week.↗
▶Ep 65 · 8:11
clinicalEm Gootee triangulates multiple AI platforms to combine the strengths of different tools (intelligence, audio, video).↗
▶Ep 65 · 8:26
opinionHuman oversight is necessary to ensure AI-generated medical content is correct.↗
▶Ep 65 · 8:26
quoteYou have to have human oversight to make sure they're correct.↗
Colorectal Quiz: Episode 49 – Collaborating for Kids: Colorectal & Pelvic Care (with Help from AI)
▶Ep 82 · 1:35
quoteWhat M and I are working on is how we can mass produce content to equilibrate knowledge around the world, and we know that the only way to do that is to use cutting edge technology, automation tools and AI.↗
▶Ep 82 · 2:16
clinicalNotebook LM is a free Google offering that can upload any document and create a realistic-sounding podcast between two people↗
▶Ep 82 · 2:16
quoteNotebook LM, a free offering of Google that you can upload anything and it will create an incredibly real sounding podcast between two people.↗
▶Ep 82 · 4:10
opinionNotebook LM has perfected human-sounding conversation better than any other available tools↗
▶Ep 82 · 4:14
quoteWe have been trying to replicate this with different tools. No one has been able to do it as well as Notebook LM.↗
▶Ep 82 · 4:22
clinicalThe limitation of Notebook LM is that it uses the same two voices (one man, one woman) and is not customizable↗
▶Ep 82 · 4:22
quoteThe problem is, it is the same two voices, it's the same man and woman.↗
▶Ep 82 · 4:26
quoteThere's actually an incredible video where they uploaded a document telling these two podcast hosts that they were AI and how they reacted. They freaked out.↗
▶Ep 82 · 4:52
quoteDo I think this is the future of podcasting? I don't. I think the voices are great, but it's not customizable enough.↗
▶Ep 82 · 5:03
quoteWhat Notebook LM does now with the beta version is you can join the conversation. You could click join, and it goes, hey, what's up? And you could say, hey, I heard what you just said about the colostomy. I'm not sure I agree, and then it will talk with you.↗
▶Ep 82 · 5:03
clinicalNotebook LM beta version allows users to join the conversation interactively and engage with the AI hosts↗
▶Ep 82 · 7:42
quoteThe AI revolution has happened, and each month it's blowing up and replacing jobs.↗
▶Ep 82 · 7:50
clinicalAI can now create functional apps from verbal descriptions alone, replacing the need for traditional coding↗
▶Ep 82 · 7:50
quoteM now can make you an app on anything you want just by describing the app, and it's created with code instantly. So developers are really in trouble.↗
▶Ep 82 · 8:01
quoteYou have to be looking at AI and using it in your workflow. If you're not, you'll get behind.↗
▶Ep 82 · 8:11
quoteShe doesn't rely on one AI platform. She will bring 3 or 4 together and use the intelligence of this one with the audio of this one and the video of this one to create the best product.↗
▶Ep 82 · 8:11
opinionEffective AI use requires triangulation across multiple platforms, combining strengths of different tools for intelligence, audio, and video↗
▶Ep 82 · 8:26
opinionHuman oversight and medical writers are necessary to ensure AI-generated medical content is correct↗
▶Ep 82 · 8:26
quoteYou have to have human oversight to make sure they're correct. We have medical writers that make sure that everything we use is correct.↗
Colorectal Quiz: Episode 49 - Collaborating for Kids: Colorectal & Pelvic Solutions (with a Little Help from AI)
▶Ep 88 · 1:18
clinicalNotebookLM is a free offering from Google that can upload any content and create a realistic-sounding podcast between two people.↗
▶Ep 88 · 1:18
quotewhat em and i are working on is how we can mass produce content to equilibrate knowledge around the world and we know that the only way to do that is to use cutting edge technology automation tools and ai↗
▶Ep 88 · 3:41
quotedo i think this is the future of podcasting i don't i think the voices are great but it's not customizable enough you're stuck with what it decided↗
▶Ep 88 · 6:39
quotethe ai revolution has happened and each month it's blowing up and replacing jobs↗
▶Ep 88 · 6:39
clinicalA review article that took two weeks to produce five years ago can now be created in minutes using NotebookLM with the same 30 source articles.↗
▶Ep 88 · 6:39
quotethe key thing is to be like you're doing and everyone else you have to be looking at ai and using it in your workflow if you're not you'll get behind↗
▶Ep 88 · 7:30
clinicalNotebookLM can identify gaps in knowledge across multiple research articles and recognize when new articles fill those gaps.↗
Colorectal Quiz: Episode 2
▶Ep 94 · 7:09
quoteYou all both looked at this image and said, you can tell, obviously, that this is too low, too posterior. Without a stimulator in the office, what do you look for to immediately tell that the analplasty was done too low?↗
Colorectal Quiz: Episode 2
▶Ep 86 · 7:09
quoteYou all both looked at this image and said, you can tell, obviously, that this is too low, too posterior. Without a stimulator in the office, what do you look for to immediately tell that the analplasty was done too low?↗
Todd's statements about Anorectal Malformations & Cloacal Reconstruction1 statement
quoteYou all both looked at this image and said, you can tell, obviously, that this is too low, too posterior. Without a stimulator in the office, what do you look for to immediately tell that the analplasty was done too low?↗
quotewhat does the evidence tell us about how we should be managing appendicitis↗
▶Ep 3 · 24:30
quoteI am not gonna use this as a treatment protocol. I'm treating this as, uh, that's good to know that this is an option↗
▶Ep 3 · 29:02
clinicalAt Nationwide, a separate small population with appendicoliths was allowed enrollment, but that arm was stopped based on the failure rate.↗
▶Ep 3 · 29:56
epidemiologicalIn a cohort of patients with post-appendectomy abscesses, outcomes were relatively equivalent between drain and no drain, but the biggest abscesses and worst patients received drains.↗
▶Ep 3 · 30:40
epidemiologicalAfter size-matching to 17.5 cm² (AP versus lateral in axial dimension), there was an advantage to not having a drain.↗
▶Ep 3 · 31:10
clinicalFor abscesses less than 20 cm² (less than 4 x 5 cm), drains are typically discouraged because the advantage is small and drains add an extra anesthetic, procedure, and may increase length of stay.↗
Biliary Atresia, Appendicitis, Intestinal Failure, and Anesthetic...
▶Ep 5 · 42:16
clinicalDr. Ponsky's chief of anesthesiology instituted a 'rule of two': defer elective operations until after age 2 and avoid two anesthetics in one year.↗
▶Ep 5 · 42:31
opinionDr. Ponsky now defers dermoid cyst excision in a 6-month-old until 18 months but does not delay inguinal hernia repair due to known incarceration risk in young infants.↗
Appendicitis with Dr. Whit Holcomb
▶Ep 6 · 37:40
clinicalRetrospective study of over 700 cases using electrocautery for mesoappendix showed minimal bleeding complications (one patient with factor 8 deficiency)↗
▶Ep 6 · 38:22
clinicalEarly 1990s at Vanderbilt: 3 children had adjacent small bowel injuries from cautery during laparoscopic appendectomy, requiring reoperation↗
▶Ep 6 · 38:22
quoteearly on in the development of laparoscopy and laparoscopic appendectomy, um, when I was still at Vanderbilt, there were 3 children who were brought in, this is in the early 1990s. There were 3 children brought in who had had a cautery used and there were adjacent injuries or secondary injuries to the small bowel. that it required operation.↗
Peritoneal Access
▶Ep 8 · 0:00
clinicalFor extirpative operations like cholecystectomy, spk_0 uses Hasson technique.↗
▶Ep 8 · 0:00
clinicalIn a 10-year-old, spk_0 uses Veress needle through the fascia for peritoneal access.↗
▶Ep 8 · 0:00
clinicalDissection and clamp passage (passing a hemostat through the umbilicus, removing it, then inserting the needle) is used by spk_0 only in four-week-old infants with pyloric stenosis, not in older children.↗
▶Ep 8 · 3:00
clinicalSingle-incision appendectomy can be performed in the obese 90th percentile and above pediatric population with outcomes comparable to three-trocar technique in terms of wound issues.↗
▶Ep 8 · 4:00
clinicalWhen using a wound protector during single-port appendectomy, the appendix never touches tissue as it is extracted, making wound complications comparable to or better than multi-port technique.↗
▶Ep 8 · 7:00
quoteIt's amazing, isn't it? Especially in some uh bigger obese people and teenagers, the distance between the posterior fashion, the umbilicus, and the aorta is about this far and intestines lying on top of that.↗
▶Ep 8 · 7:00
clinicalIn obese teenagers, the distance between the posterior fascia at the umbilicus and the aorta is very short, with intestines lying on top.↗
▶Ep 8 · 8:00
quoteI like the ones that make a very loud audible click after you've passed the peritoneum.↗
▶Ep 8 · 8:00
clinicalVeress needles that produce a loud audible click after passing the peritoneum are preferred by some surgeons for confirmation of entry.↗
▶Ep 8 · 9:00
clinicalVeress needle insertion should not exceed more than a millimeter or two beyond the audible click of peritoneal entry.↗
▶Ep 8 · 11:00
clinicalThe left upper quadrant does not contain iliac vessels, making it a safer access site than midline where iliac vein injury is a risk.↗
▶Ep 8 · 20:00
clinicalStep trocars are not designed to be placed with the sheath in place because the large step-off in diameter can deflect the abdominal wall and cause injury.↗
▶Ep 8 · 21:00
clinicalWhen using step trocars, the Veress needle should be inserted first to safely insufflate, then the Veress needle with sheath should be inserted to place the sheath.↗
▶Ep 8 · 21:00
quoteI think that if you use a step, you should always put the varis needle in first, safely insufflate, then put the varis needle with the sheath in to insert your sheath.↗
▶Ep 8 · 22:00
clinicalThe sheath adds obstruction when inserting the Veress needle, making insertion smoother without the sheath.↗
▶Ep 8 · 23:00
clinicalIn neonates, an infra-umbilical incision is made to avoid cannulating the umbilical vein, which enters through the center of the umbilicus.↗
▶Ep 8 · 24:00
quoteI think the danger is that you're just going to go through the orifice or the the obliterated orifice of the umbilical vein, which is at the base of the umbilicus. So if you go below that, you should be, in theory, outside of the umbilical vein.↗
▶Ep 8 · 24:00
clinicalThe umbilical vein travels up through the center of the umbilicus; an infra-umbilical incision should avoid the obliterated orifice at the base of the umbilicus.↗
▶Ep 8 · 25:00
clinicalLifting the umbilical stump with a clamp and inserting the Veress needle perpendicular to the now-vertical fascia (angled superiorly) is a technique to avoid the umbilical vein.↗
▶Ep 8 · 28:00
clinicalCO2 embolization via the umbilical vein is a recently recognized complication that was not widely known until about a year ago.↗
▶Ep 8 · 28:00
quoteit's it's it's really interesting that we've been doing this for over 20 years and this devastating complication is really just coming to light or or just becoming knowledgeable to to us.↗
▶Ep 8 · 31:00
clinicalCO2 embolization presents with bradycardia, hypotension, and drop in end-tidal CO2.↗
▶Ep 8 · 32:00
epidemiologicalClinically significant CO2 embolization results in 25% mortality.↗
▶Ep 8 · 34:00
clinicalImmediate treatment for CO2 embolization includes desufflation, Trendelenburg positioning, and central venous line placement to aspirate gas.↗
▶Ep 8 · 35:00
clinicalspk_0 now uses a sheathed technique but always inserts the trocar before insufflating, inspects with the telescope to confirm peritoneal entry, then begins insufflation.↗
▶Ep 8 · 35:00
clinicalSeveral cases of CO2 embolization have required emergent ECMO at the start of pyloromyotomy.↗
Perforated Appendicitis
▶Ep 9 · 2:24
quoteso you said there were no abscesses, or did you eliminate cases that had abscesses?↗
▶Ep 9 · 10:31
quoteSome of the criticism that that report has been that the both of the incidences of. Abscess formation are higher than some other studies, the 18 and the 19%.↗
▶Ep 9 · 11:20
quoteWas there a debate about how much irrigation, because there are surgeons who do liters and liters and liters and liters, say that makes a difference↗
▶Ep 9 · 16:25
quoteNo irrigation, but, but do suction out visible pus.↗
▶Ep 9 · 17:03
quoteI never irrigated after yours for years. And then when this came out, now I'm, now I'm irrigating.↗
Biliary Atresia, Appendicitis, Intestinal Failure, and Anesthetic...
▶Ep 10 · 42:16
clinicalDr. Ponsky's chief of anesthesiology instituted a 'rule of two': defer elective operations until after age 2 and avoid two anesthetics in one year.↗
▶Ep 10 · 42:31
opinionDr. Ponsky now defers dermoid cyst excision in a 6-month-old until 18 months but does not delay inguinal hernia repair due to known incarceration risk in young infants.↗
Journal Club: Appendicitis in 2021
▶Ep 14 · 2:53
quoteSo this would be a red herring if this was appendicitis. Whether it's red or blue or otherwise, it certainly seems gray, I'll tell you that much.↗
▶Ep 14 · 2:53
quoteOf course, this podcast is about appendicitis, so we, you know what we're talking about, but we haven't made, the, the, this made up case too clear for you guys. So, uh, to me, the, the history is not completely clear on appendicitis. I would not take this, this patient straight to this child, uh, has a story that doesn't sound that much like appendicitis. He's got diarrhea, and he's got no right lower quadrant tenderness.↗
▶Ep 14 · 11:20
quoteMy issue with this study is when I think of What am I worried about with uh uncomplicated appendectomy that's gonna bite me in the butt? It's not a surgical site infection. It's, did I have it wrong and this kid's gonna come back with a postoperative abscess. That's not even what they looked at.↗
▶Ep 14 · 11:20
opinionThe postoperative antibiotic study did not examine postoperative abscess rates, which is the primary concern after uncomplicated appendectomy rather than surgical site infections.↗
Update Course 2021: TOP PUBLICATIONS IN NON - PED SURG JOURNALS
▶Ep 3 · 5:30
clinicalUpper GI contrast study is operator-dependent and requires direct communication with radiologist, readily available at high-volume centers but requires more coordination at community hospitals.↗
▶Ep 3 · 5:30
quoteI would call my radiologist and have him do an upper GI and stand there watching it.↗
▶Ep 3 · 10:22
clinicalThe presence of an appendicolith in appendicitis has about a 50% failure rate with non-operative management, making it a contraindication for non-surgical treatment.↗
▶Ep 3 · 10:22
quotethe studies, uh, currently, I think, uh, you know, what this, uh, is hoping to highlight is the ability to use non-operative management of appendicitis in certain cases, but, um, uh, the studies that we have, uh, show that, uh, having the presence of an appendiculli actually has about a 50% failure rate.↗
▶Ep 3 · 10:43
quoteso, um, that's, uh, you know, uh, not good enough, uh, for me. Uh, so, uh, most of us actually use the presence of that appendicolith as a no go, uh, for, uh, non-operative management.↗
▶Ep 3 · 19:36
quoteI, I would agree that we should be going with normal sailing based on the ATLS protocols. I, I will tell you though, um, that nationwide in adults we are starting to see ambulance rigs. Travel with whole blood capabilities in adults and people are starting to use whole blood even earlier.↗
▶Ep 3 · 19:40
clinicalNationwide in adults, ambulance rigs are starting to travel with whole blood capabilities and people are using whole blood even earlier in trauma resuscitation.↗
▶Ep 3 · 19:40
guidelineCurrent ATLS protocols recommend initial bolus with normal saline or crystalloid solution before moving to blood products in pediatric trauma.↗
▶Ep 3 · 20:05
quoteI have to tell you this is, I love this course. It's changing. It's an evolution↗
▶Ep 3 · 20:28
quotethe challenge for whole blood is availability↗
▶Ep 3 · 20:28
clinicalThe challenge for whole blood in pediatrics is availability, and thankfully for children, we don't use a lot of massive transfusion protocols compared to adults.↗
▶Ep 3 · 20:40
quotehaving blood bank capabilities, especially. Uh, because thankfully for children, we don't use a lot of massive transfusion protocols. So I, I think you're seeing more of this in adults. Um, some of the pediatric centers are coming along, um, slowly, but, but definitely we're seeing more.↗
▶Ep 3 · 21:13
clinicalSome centers are limiting whole blood use to males and some to children older than 15, depending on institutional protocols and blood bank partnerships.↗
Update Course 2021: DEI – CONCORDANCE AND POST OP COMPLICATION STUDIES
▶Ep 15 · 9:49
quoteour conclusion was wrong now that you're pointing this out to me↗
▶Ep 15 · 9:49
quoteI bet you if we did this paper again in 2023, we would find the same results but with implicit bias being the reason.↗
▶Ep 15 · 9:49
quoteI'm I'm actually very embarrassed to admit this because it's clearly my fault.↗
▶Ep 15 · 9:49
quoteIt was all, oh, maybe it's genetic, maybe it's resistance to care, blaming the patient rather than in any way introspectively saying↗
▶Ep 15 · 15:57
quoteThis is horrible against us as clinicians. I mean, what what does this say about I mean so we're we're isn't educated? I mean there's no there's nothing where we're we're we're in diverse cultures. still, this is happening.↗
Update Course 2022 - TOP PUBLICATIONS IN NON- PED SURG JOURNALS - Jose Campos
▶Ep 17 · 0:30
quoteI met Jose Campos at, I think, an IPEG meeting or something and he came up to me and he says, I said, hi, how are you? He goes, yeah, the stuff you're doing is a problem. I was like, nice to meet you too. He said, you're only looking at pediatric surgical journals and pediatric surgical societies, you're missing all of the incredible publications that come out in articles we don't read.↗
▶Ep 17 · 16:52
quoteIt was invented before there was widespread laparoscopy. It came first. Then laparoscopic. Because of that order, a lot of people favor PEG, but it's blind. I mean, you're putting something right through the belly without looking, so it makes no sense to me.↗
▶Ep 17 · 17:36
clinicalThe article by Todd Ponsky Sr. and Mike Goddard on PEG tube placement remains the most cited article in the history of the Journal of Pediatric Surgery, with approximately three times the citations of the number two article.↗
▶Ep 17 · 17:36
quoteThe article by Jeff Ponsky and Mike Goddard remains the most cited article in the history of the Journal of Pediatric Surgery by far by like three times the number two article so it's a real landmark paper and we owe dr. Ponsky and Goddard a tip the cap for coming up with this technique when it really was the first minimally invasive way to insert a gastrostomy tube.↗
Update Course 2023 - Update Course 2022 and Best of the Best Recap
▶Ep 20 · 0:20
quotewe're gonna be now I just got the approval from my boss we're gonna be opening it up to another fellow starting, uh, next year for taking over Cecilia's position↗
▶Ep 20 · 0:50
quoteThe update course is this one is to make sure each year we know what came out over the past year, what's new and important. Best of the best is since we can't attend every conference, we invite the best conferences once a year to submit their top presentations that they felt were the best.↗
Top 10 AI Websites and Tools for Medical Research and Education
▶Ep 28 · 17:18
quotethe issue that we've run into because I was addicted to it, I needed it because it gives me takeaways and all the key points. Here's what you need to do that tells you our hospital got, people got worried, especially with some of the meetings I was having that it was auto recording everything.↗
▶Ep 28 · 17:26
guidelineCincinnati Children's hospital restricted use of meeting transcription tools due to security concerns about auto-recording, especially for legally sensitive meetings↗
▶Ep 28 · 17:42
guidelineCincinnati Children's now has Microsoft Co-pilot approved by the hospital for meeting transcription and note-taking↗
▶Ep 28 · 20:35
quoteinstead of an audio book, I will drive. I'm about to drive to Cincinnati after this, and I will talk to Chat GPT for an hour about a book. So I'll say, summarize this book and I will go back like a book club. I'll say, tell me now what does it say about this? Tell me, let's go into chapter two. I want to know this. I don't get this, so I will have a conversation while I work out, while I am driving↗
▶Ep 28 · 20:35
clinicalChatGPT can be used conversationally while driving to discuss and summarize books in a book club format↗
▶Ep 28 · 21:49
opinionAI-generated letters of recommendation tend to be overly enthusiastic and require toning down with additional prompts↗
Practical applications of generative AI in medical research and education
▶Ep 29 · 17:26
guidelineCincinnati Children's Hospital restricted use of meeting transcription tools due to security concerns about auto-recording, particularly for legally sensitive or confidential meetings, and now requires use of approved Microsoft Co-pilot↗
▶Ep 29 · 17:42
quoteour lawyers asked me to stop using it on half of my meetings because they're legally sensitive↗
▶Ep 29 · 20:35
quoteI will talk to Chat GPT for an hour about a book. So I'll say, summarize this book and I will go back like a book club. I'll say, tell me now what does it say about this? Tell me, let's go into chapter two↗
▶Ep 29 · 21:13
opinionCreating custom GPTs for repeated prompt sequences is straightforward and allows reuse of complex workflows↗
quotewhat does the evidence tell us about how we should be managing appendicitis↗
▶Ep 2 · 24:30
quoteI am not gonna use this as a treatment protocol. I'm treating this as, uh, that's good to know that this is an option↗
▶Ep 2 · 29:02
clinicalAt Nationwide, a separate small population with appendicoliths was allowed enrollment, but that arm was stopped based on the failure rate.↗
▶Ep 2 · 29:56
epidemiologicalIn a cohort of patients with post-appendectomy abscesses, outcomes were relatively equivalent between drain and no drain, but the biggest abscesses and worst patients received drains.↗
▶Ep 2 · 30:40
epidemiologicalAfter size-matching to 17.5 cm² (AP versus lateral in axial dimension), there was an advantage to not having a drain.↗
▶Ep 2 · 31:10
clinicalFor abscesses less than 20 cm² (less than 4 x 5 cm), drains are typically discouraged because the advantage is small and drains add an extra anesthetic, procedure, and may increase length of stay.↗
Biliary Atresia, Appendicitis, Intestinal Failure, and Anesthetic...
▶Ep 4 · 42:16
clinicalDr. Ponsky's chief of anesthesiology instituted a 'rule of two': defer elective operations until after age 2 and avoid two anesthetics in one year.↗
▶Ep 4 · 42:31
opinionDr. Ponsky now defers dermoid cyst excision in a 6-month-old until 18 months but does not delay inguinal hernia repair due to known incarceration risk in young infants.↗
Appendicitis with Dr. Whit Holcomb
▶Ep 5 · 37:40
clinicalRetrospective study of over 700 cases using electrocautery for mesoappendix showed minimal bleeding complications (one patient with factor 8 deficiency)↗
▶Ep 5 · 38:22
quoteearly on in the development of laparoscopy and laparoscopic appendectomy, um, when I was still at Vanderbilt, there were 3 children who were brought in, this is in the early 1990s. There were 3 children brought in who had had a cautery used and there were adjacent injuries or secondary injuries to the small bowel. that it required operation.↗
▶Ep 5 · 38:22
clinicalEarly 1990s at Vanderbilt: 3 children had adjacent small bowel injuries from cautery during laparoscopic appendectomy, requiring reoperation↗
Biliary Atresia, Appendicitis, Intestinal Failure, and Anesthetic...
▶Ep 7 · 42:16
clinicalDr. Ponsky's chief of anesthesiology instituted a 'rule of two': defer elective operations until after age 2 and avoid two anesthetics in one year.↗
▶Ep 7 · 42:31
opinionDr. Ponsky now defers dermoid cyst excision in a 6-month-old until 18 months but does not delay inguinal hernia repair due to known incarceration risk in young infants.↗
Update Course 2022 - TOP PUBLICATIONS IN NON- PED SURG JOURNALS - Jose Campos
▶Ep 10 · 0:30
quoteI met Jose Campos at, I think, an IPEG meeting or something and he came up to me and he says, I said, hi, how are you? He goes, yeah, the stuff you're doing is a problem. I was like, nice to meet you too. He said, you're only looking at pediatric surgical journals and pediatric surgical societies, you're missing all of the incredible publications that come out in articles we don't read.↗
▶Ep 10 · 16:52
quoteIt was invented before there was widespread laparoscopy. It came first. Then laparoscopic. Because of that order, a lot of people favor PEG, but it's blind. I mean, you're putting something right through the belly without looking, so it makes no sense to me.↗
▶Ep 10 · 17:36
quoteThe article by Jeff Ponsky and Mike Goddard remains the most cited article in the history of the Journal of Pediatric Surgery by far by like three times the number two article so it's a real landmark paper and we owe dr. Ponsky and Goddard a tip the cap for coming up with this technique when it really was the first minimally invasive way to insert a gastrostomy tube.↗
▶Ep 10 · 17:36
clinicalThe article by Todd Ponsky Sr. and Mike Goddard on PEG tube placement remains the most cited article in the history of the Journal of Pediatric Surgery, with approximately three times the citations of the number two article.↗
quoteSo this would be a red herring if this was appendicitis. Whether it's red or blue or otherwise, it certainly seems gray, I'll tell you that much.↗
▶Ep 9 · 2:53
quoteOf course, this podcast is about appendicitis, so we, you know what we're talking about, but we haven't made, the, the, this made up case too clear for you guys. So, uh, to me, the, the history is not completely clear on appendicitis. I would not take this, this patient straight to this child, uh, has a story that doesn't sound that much like appendicitis. He's got diarrhea, and he's got no right lower quadrant tenderness.↗
▶Ep 9 · 11:20
quoteMy issue with this study is when I think of What am I worried about with uh uncomplicated appendectomy that's gonna bite me in the butt? It's not a surgical site infection. It's, did I have it wrong and this kid's gonna come back with a postoperative abscess. That's not even what they looked at.↗
▶Ep 9 · 11:20
opinionThe postoperative antibiotic study did not examine postoperative abscess rates, which is the primary concern after uncomplicated appendectomy rather than surgical site infections.↗
Todd's statements about Biliary Atresia53 statements
Biliary Atresia - Robert Parry: Update Course 2014
▶Ep 1 · 4:03
epidemiologicalRich Ricketts' series showed not statistically significant better results with Kasai at 76 days or older compared to 0-75 days, possibly representing a different disease phenotype in late presenters.↗
▶Ep 1 · 9:19
clinicalReversal of portal flow is a very concerning finding because patients can achieve good biliary drainage and normal bilirubin but still progress to transplant due to profound portal hypertension.↗
▶Ep 1 · 9:19
quotethat reversal of portal flow makes me really concerned because, you know, I've I've had patients that I've done a cassa on have achieved good biliary drainage. They've got a normal bilirubin. But their portal hypertension then continues to ramp up↗
▶Ep 1 · 9:19
clinicalReversal of portal flow is a very concerning finding because patients can achieve good biliary drainage and normal bilirubin but still progress to transplant due to profound portal hypertension.↗
▶Ep 1 · 9:19
quotethat reversal of portal flow makes me really concerned because, you know, I've I've had patients that I've done a cassa on have achieved good biliary drainage. They've got a normal bilirubin. But their portal hypertension then continues to ramp up↗
▶Ep 1 · 10:41
clinicalHepatologists can manage biliary atresia patients medically for up to a year in the absence of Kasai or transplant, though nutritional status suffers.↗
▶Ep 1 · 10:41
quotethe hepatologists can actually limp these kids along. They're not nutritionally in a great place, but they can get them out to be, you know, a year in the absence of a cassai and the absence of a transplant↗
▶Ep 1 · 10:41
quotethe hepatologists can actually limp these kids along. They're not nutritionally in a great place, but they can get them out to be, you know, a year in the absence of a cassai and the absence of a transplant↗
▶Ep 1 · 10:41
clinicalHepatologists can manage biliary atresia patients medically for up to a year in the absence of Kasai or transplant, though nutritional status suffers.↗
▶Ep 1 · 10:56
opinionIn patients with end-stage liver disease signs (profound fibrosis, reversed portal flow), Kasai may not improve outcomes and the operative stress may worsen their condition.↗
▶Ep 1 · 10:56
opinionIn patients with end-stage liver disease signs (profound fibrosis, reversed portal flow), Kasai may not improve outcomes and the operative stress may worsen their condition.↗
▶Ep 1 · 12:00
quoteit's almost like um a race between regeneration of hepatocytes and progression of fibrosis↗
▶Ep 1 · 12:00
quoteit's almost like um a race between regeneration of hepatocytes and progression of fibrosis↗
▶Ep 1 · 12:20
clinicalSome biliary atresia patients show delayed response to Kasai, with bilirubin remaining elevated for months then dropping to normal at 5 months post-op, suggesting a race between hepatocyte regeneration and fibrosis progression.↗
▶Ep 1 · 12:20
quoteI've had a patient that I didn't redo, and I thought surely the thing was a failure because the bilirubin remained elevated, and then at 5 months post-op, the bilirubin dropped to normal↗
▶Ep 1 · 12:20
clinicalSome biliary atresia patients show delayed response to Kasai, with bilirubin remaining elevated for months then dropping to normal at 5 months post-op, suggesting a race between hepatocyte regeneration and fibrosis progression.↗
▶Ep 1 · 12:20
quoteI've had a patient that I didn't redo, and I thought surely the thing was a failure because the bilirubin remained elevated, and then at 5 months post-op, the bilirubin dropped to normal↗
▶Ep 1 · 14:41
quoteif the question is getting them to the OR sooner, now you're going to delay by, you know, however many days, you know, while you're inducing them with phenobarb↗
▶Ep 1 · 14:41
quoteif the question is getting them to the OR sooner, now you're going to delay by, you know, however many days, you know, while you're inducing them with phenobarb↗
▶Ep 1 · 17:35
epidemiologicalA recent paper in Gastroenterology described a scoring system using liver biopsy plus clinical parameters with nearly 100% ability to predict biliary atresia.↗
▶Ep 1 · 18:01
opinionPathologists' understanding of biliary atresia histology has improved significantly compared to 20 years ago.↗
▶Ep 1 · 18:01
opinionPathologists' understanding of biliary atresia histology has improved significantly compared to 20 years ago.↗
▶Ep 1 · 18:10
clinicalInterventional radiologists can perform percutaneous liver biopsy safely and routinely, making it a low-barrier test.↗
▶Ep 1 · 18:10
clinicalInterventional radiologists can perform percutaneous liver biopsy safely and routinely, making it a low-barrier test.↗
Biliary Atresia
▶Ep 2 · 0:00
quoteThis is uh Doctor Greg Tia. Greg is the, uh, congratulations, the new uh chief of pediatric surgery at the Cincinnati Children's Hospital.↗
Biliary Atresia, Appendicitis, Intestinal Failure, and Anesthetic...
▶Ep 6 · 42:16
clinicalDr. Ponsky's chief of anesthesiology instituted a 'rule of two': defer elective operations until after age 2 and avoid two anesthetics in one year.↗
▶Ep 6 · 42:31
opinionDr. Ponsky now defers dermoid cyst excision in a 6-month-old until 18 months but does not delay inguinal hernia repair due to known incarceration risk in young infants.↗
Biliary Atresia, Appendicitis, Intestinal Failure, and Anesthetic...
▶Ep 10 · 42:16
clinicalDr. Ponsky's chief of anesthesiology instituted a 'rule of two': defer elective operations until after age 2 and avoid two anesthetics in one year.↗
▶Ep 10 · 42:31
opinionDr. Ponsky now defers dermoid cyst excision in a 6-month-old until 18 months but does not delay inguinal hernia repair due to known incarceration risk in young infants.↗
Update Course 2021: UPDATE COURSE 2020: REVIEW OF LAST YEAR'S IMPORTANT T OPICS
▶Ep 11 · 0:00
quoteWe are, we all live in our own little country and we do our own little thing. And it's only when we talk to each other from all over that we do true learning.↗
▶Ep 11 · 1:00
quoteThis is about rapid fire. We're not doing in-depth stuff here. This is rapid fire, important topics that we feel and that a lot, that's why we bring new faculty in every year, that the faculty feel are kind of the real important points that we need to be highlighting all over the world that came up over the last year or so.↗
▶Ep 11 · 1:40
quoteI promise you, I'm making this promise every year, something will glitch. Okay? I've been saying this for nine years. Even a few years ago, the whole power went out in the city and we had to drive to my living room. Something will glitch. Bear with us.↗
▶Ep 11 · 2:20
quoteThis only, as you know, this is free. This is free because, and we've been trying to keep this free as long as we can. We try to believe that knowledge should be free as long as we can do it, as best we can do it.↗
▶Ep 11 · 4:45
epidemiological26% of respondents use intraoperative ICG to visualize the biliary tree, 23% use it in select patients, and 51% do not use it.↗
▶Ep 11 · 10:50
clinicalGetting phenol into the operating room for sclerotherapy is not always easy due to institutional and pharmacy restrictions.↗
▶Ep 11 · 12:23
epidemiologicalApproximately 50% of respondents always use sutureless abdominal closure for large abdominal wall defects, 40% use it in select patients, and only 11% do not use it.↗
▶Ep 11 · 12:23
epidemiologicalThe adoption of sutureless closure for abdominal wall defects represents a major practice change over nine years, with 90% now using it always or selectively compared to much lower rates previously.↗
▶Ep 11 · 16:42
clinicalImplementing ERAS requires team buy-in, particularly from anesthesiologists, because of practice changes like allowing oral intake two hours preoperatively.↗
▶Ep 11 · 21:50
epidemiologicalMost institutions are either taking steps to address social determinants of health or working on it; few report no action.↗
Biliary Atresia Part I
▶Ep 13 · 22:55
guidelineIPEG placed a moratorium on laparoscopic Kasai portoenterostomy because of poor outcomes.↗
Heat 1 Winner: Dariusz Patkowski, MD, PhD - Best of the Best in Pediatric Surgery 2024
▶Ep 18 · 1:30
opinionThe thoracoscopic procedure for long gap esophageal atresia using sliding knots is beneficial to learn↗
▶Ep 18 · 1:30
opinionThe thoracoscopic procedure for long gap esophageal atresia using sliding knots is beneficial to learn↗
▶Ep 18 · 1:41
quoteI wanna do a whole thing on just sliding knots now.↗
▶Ep 18 · 1:41
quoteI wanna do a whole thing on just sliding knots now.↗
▶Ep 18 · 1:49
quoteIf it's really true that resecting liver cuts mortality down by 50%, I, I just am curious about the data.↗
▶Ep 18 · 1:49
quoteIf it's really true that resecting liver cuts mortality down by 50%, I, I just am curious about the data.↗
▶Ep 18 · 1:49
clinicalData was presented suggesting that resecting liver cuts mortality down by 50% in biliary atresia, though the judge expressed uncertainty about the data↗
▶Ep 18 · 1:57
quoteI would love to know more about the data, but since we couldn't talk to her, I, I, I, I don't know.↗
▶Ep 18 · 1:57
quoteI would love to know more about the data, but since we couldn't talk to her, I, I, I, I don't know.↗
▶Ep 18 · 2:04
quoteI think that also could be a huge, um, breakthrough in pediatric surgery.↗
▶Ep 18 · 2:04
quoteI think that also could be a huge, um, breakthrough in pediatric surgery.↗
▶Ep 18 · 2:11
quoteDarius, congratulations, you're moving on to the next heat.↗
▶Ep 18 · 2:11
quoteDarius, congratulations, you're moving on to the next heat.↗
Todd's statements about Blunt Abdominal Trauma1 statement
quotethe first thing we do is make sure that they're well decompressed↗
▶Ep 3 · 27:22
clinicalEscharotomies are performed in the first 24–36 hours if circumferential burns risk limb or torso ischemia; pulse oximetry or Doppler checks every 2 hours guide the decision.↗
clinicalEscharotomies are performed in the first 24–36 hours if circumferential burns risk limb or torso ischemia; pulse oximetry or Doppler checks every 2 hours guide the decision.↗
▶Ep 3 · 27:22
quotethe first thing we do is make sure that they're well decompressed↗
Todd's statements about Button Battery Ingestion1 statement
Journal of pediatric surgery Article Review: April 2023, IPEG issue
▶Ep 4 · 4:43
quoteI love it. And I think it's great to have a measurement tool that actually has use for clinical decision-making rather than just noting the severity is actually will help guide you in surgery.↗
Disruptive AI technologies transforming healthcare and medical education
▶Ep 7 · 18:35
opinionChatGPT is much better than Google for information retrieval↗
▶Ep 7 · 18:46
epidemiologicalTodd Ponsky uses ChatGPT 15 times a day↗
▶Ep 7 · 18:50
quoteIt is so much better than traditional forms, but people don't have it in their workflow yet. And it blows my mind.↗
▶Ep 7 · 20:51
epidemiologicalTodd Ponsky has not personally written a letter of recommendation in the last 3 months, using ChatGPT instead by uploading CVs and personal statements↗
▶Ep 7 · 20:51
quoteI think I just wrote your letter of recommendation. So I have not written a letter of recommendation in the last 3 months.↗
▶Ep 7 · 21:30
quoteI take articles and I upload them and say summarize this for me. Give me this in two paragraphs. No, and then I say, no, actually, make this as the level of 1/9 grader. Still too complicated. Make this as a level of a 5th grader.↗
▶Ep 7 · 24:13
quoteI write book chapters now. I say I need to write a book chapter on oesophageal atresia. I want it to be about 3 pages long. It's for the level of a pediatric surgeon.↗
▶Ep 7 · 24:33
quoteThe era of getting it's good to write a book chapter is going to go away, because there's no need to write book chapters anymore because it's better than us.↗
▶Ep 7 · 29:03
quoteYou can't challenge this you cannot challenge this right now. It's there. It's there. You can be as upset as you want. It is there.↗
▶Ep 7 · 29:08
epidemiologicalColleges know that students are using ChatGPT to write their college essays↗
▶Ep 7 · 29:40
quoteIt's going to get to the point where it's unrecognizable from you.↗
▶Ep 7 · 31:48
clinicalCincinnati Children's Hospital can now create videos of every faculty member teaching a topic using deep fake technology with their voice and likeness, without the faculty member doing anything↗
▶Ep 7 · 31:48
quoteWe can make now videos of every single Cincinnati children's faculty teaching a topic, and they never did anything.↗
▶Ep 7 · 32:04
quoteWe can show you videos that you would not be able to tell was a fake.↗
Todd's statements about Cardiac Arrest6 statements
2025 Pediatric Surgery Update Course - Updates in ECMO & eCPR Use
▶Ep 2 · 8:37
quoteIf you don't get real hardcore outcome data back to the world, that not only are you going to have people that will make it not to transfer, but to discharge, but that it's a survivable outcome that anybody would want. That's the argument that I think needs to be made a little bit clearer.↗
▶Ep 2 · 11:10
quoteIt's survival to transfer or discharge, and I would argue that that is a completely useless outcome metric.↗
▶Ep 2 · 14:34
clinicalDuring CPR, patients can be cannulated through the neck and then transitioned to central cannulation once flowing and oxygenating better.↗
▶Ep 2 · 15:45
epidemiologicalCurrent data shows stroke rate of 10% (range 2.2% to 10.4%) with cervical cannulation for ECPR.↗
▶Ep 2 · 16:40
epidemiologicalOver half of patients in a seven-year median follow-up study had some vascular findings after neck cannulation that were perhaps actionable into adulthood, including dilation and narrowing of different percentages.↗
▶Ep 2 · 20:41
clinicalThe younger the patient, the easier it is to cannulate the vessels during ECPR.↗
Todd's statements about Catheter Fracture2 statements
clinicalOne neck CT delivers radiation equivalent to 600 plain films.↗
▶Ep 1 · 4:05
quoteIt takes 600 plane films to equal one neck CT and radiation.↗
▶Ep 1 · 4:12
opinionThe clinical significance of the radiation difference between plain films and CT is unknown; no one knows the true effects.↗
▶Ep 1 · 4:12
quoteThe question is, does it really, is it 600 times such a small number in terms of the radiation exposure that it's, that's the answer nobody knows.↗
▶Ep 1 · 4:41
clinicalIf a lateral C-spine film is inadequate, a CT will be needed, resulting in radiation exposure from both modalities.↗
▶Ep 1 · 5:24
clinicalIn most institutions, an 18-month-old ejected from a vehicle would arrive as a level 2 trauma and automatically receive protocolized imaging including CT.↗
▶Ep 1 · 9:07
quoteIf you get an MRI and it's negative, you're done. I mean, maybe not in if you need the sedation, but if you don't need the sedation, you can get the MRI for sure. It's, I mean, it's well worth everybody's time, right?↗
▶Ep 1 · 12:08
clinicalMRI is obtained in young children who cannot cooperate with voluntary flexion-extension films; older children receive either voluntary or assisted flexion-extension films.↗
▶Ep 1 · 12:08
clinicalThere are two types of flexion-extension films: voluntary patient-directed movement in cooperative older children, and fluoroscopy-assisted movement performed by a physician (neurosurgery or trauma team) to avoid causing paralysis.↗
▶Ep 1 · 13:57
quoteHow accurate is MRI for ligamentous injury? I think it's extremely accurate. It's just the hoops you have to pass through to get it when you need it.↗
▶Ep 1 · 13:57
clinicalMRI is extremely accurate for ligamentous injury; when present, it is visible on MRI.↗
▶Ep 1 · 19:49
clinicalExtending a head CT through the neck takes only an extra 30 seconds and is faster than obtaining a separate plain radiograph.↗
Todd's statements about Cervical Spine Injury12 statements
clinicalOne neck CT delivers radiation equivalent to 600 plain films.↗
▶Ep 1 · 4:05
quoteIt takes 600 plane films to equal one neck CT and radiation.↗
▶Ep 1 · 4:12
opinionThe clinical significance of the radiation difference between plain films and CT is unknown; no one knows the true effects.↗
▶Ep 1 · 4:12
quoteThe question is, does it really, is it 600 times such a small number in terms of the radiation exposure that it's, that's the answer nobody knows.↗
▶Ep 1 · 4:41
clinicalIf a lateral C-spine film is inadequate, a CT will be needed, resulting in radiation exposure from both modalities.↗
▶Ep 1 · 5:24
clinicalIn most institutions, an 18-month-old ejected from a vehicle would arrive as a level 2 trauma and automatically receive protocolized imaging including CT.↗
▶Ep 1 · 9:07
quoteIf you get an MRI and it's negative, you're done. I mean, maybe not in if you need the sedation, but if you don't need the sedation, you can get the MRI for sure. It's, I mean, it's well worth everybody's time, right?↗
▶Ep 1 · 12:08
clinicalThere are two types of flexion-extension films: voluntary patient-directed movement in cooperative older children, and fluoroscopy-assisted movement performed by a physician (neurosurgery or trauma team) to avoid causing paralysis.↗
▶Ep 1 · 12:08
clinicalMRI is obtained in young children who cannot cooperate with voluntary flexion-extension films; older children receive either voluntary or assisted flexion-extension films.↗
▶Ep 1 · 13:57
clinicalMRI is extremely accurate for ligamentous injury; when present, it is visible on MRI.↗
▶Ep 1 · 13:57
quoteHow accurate is MRI for ligamentous injury? I think it's extremely accurate. It's just the hoops you have to pass through to get it when you need it.↗
▶Ep 1 · 19:49
clinicalExtending a head CT through the neck takes only an extra 30 seconds and is faster than obtaining a separate plain radiograph.↗
Todd's statements about CHARGE Syndrome4 statements
Aerodigestive & Esophageal Surgery - Difficult Tracheal Esophageal Fistula
▶Ep 1 · 25:08
clinicalTrichloroacetic acid (TCA) can be used to demucosalize TEF tracts, but control is less precise than with bugbee cautery; TCA is applied on a pledget and can cause unintended burns if it contacts tissue during insertion.↗
▶Ep 1 · 25:08
clinicalTrichloroacetic acid (TCA) can be used to demucosalize TEF tracts, but control is less precise than with bugbee cautery; TCA is applied on a pledget and can cause unintended burns if it contacts tissue during insertion.↗
▶Ep 1 · 1:50:04
clinicalAnal fistula plugs (biologic, cone-shaped, made of Surgisis) can theoretically be used to occlude distal airway fistulas; they are wrapped with barbed suture and inserted into the tract to promote collagen matrix formation and scarring.↗
▶Ep 1 · 1:50:04
clinicalAnal fistula plugs (biologic, cone-shaped, made of Surgisis) can theoretically be used to occlude distal airway fistulas; they are wrapped with barbed suture and inserted into the tract to promote collagen matrix formation and scarring.↗
Patient Testimonial and Experience: Pectus Innovations
▶Ep 3 · 5:41
clinicalPain team protocols eliminate the need to wait for individual physician orders for pain medication↗
▶Ep 3 · 5:41
opinionHaving a dedicated pain team with established protocols reduces delays in pain medication administration↗
▶Ep 3 · 5:41
quoteI think having a pain team and a protocol helps. Helps helps get the patients their their pain medicine faster because they don't have to wait for a doctor to get the order and all that.↗
Pectus-Patient Testimonial and Experience
▶Ep 6 · 5:41
clinicalHaving a pain team and protocol helps patients receive pain medicine faster because they don't have to wait for a doctor to write the order↗
▶Ep 6 · 5:41
quoteI think having a pain team and a protocol helps. Helps helps get the patients their their pain medicine faster because they don't have to wait for a doctor to get the order and all that.↗
Todd's statements about Choledochal Cyst7 statements
quoteMaybe that's what we work on is having better communication and proactive suggestions by the technicians.↗
▶Ep 3 · 2:55
quoteFor me, there were two modes of fluoroscopy on or off. I didn't know there all these other things.↗
▶Ep 3 · 5:49
quoteWhat I'm hearing you say is that it's not that we should be shielding underneath the patient, but that we should be doing all those other things that you were talking about because I think shielding underneath the patient is probably problematic for a lot of reasons, including the increased potential for increased exposure if you're not getting the right image.↗
▶Ep 3 · 5:49
opinionShielding underneath the patient is probably problematic for multiple reasons including increased potential for increased exposure if the right image is not obtained.↗
2025 Pediatric Surgery Update Course - Robotics in Pediatric Surgery: Which indications benefit the most?
▶Ep 5 · 11:42
opinionThe next generation of surgeons will not be proficient in laparoscopy if robotic surgery becomes dominant in training↗
▶Ep 5 · 11:42
quoteWhether we like it or not, the people that are me coming into our field to do pediatric surgery, they are not going to be doing laparoscopy. They're going to be doing robotic surgery.↗
▶Ep 5 · 16:50
epidemiologicalPatients are seeking out centers that offer robotic surgery, particularly in adult centers↗
Todd's statements about Choledochal Cyst / Biliary1 statement
Journal of pediatric surgery Article Review: April 2023, IPEG issue
▶Ep 4 · 4:43
quoteI love it. And I think it's great to have a measurement tool that actually has use for clinical decision-making rather than just noting the severity is actually will help guide you in surgery.↗
Todd's statements about Cholelithiasis13 statements
quoteIt really depends on the patient and the situation.↗
▶Ep 3 · 1:38
quoteI typically do it before they go home, and I have not found that it's prohibitively difficult in most cases to do the operation.↗
▶Ep 3 · 3:44
clinicalEven in patients with no stones remaining, 2% will get recurrent pancreatitis from the initial insult↗
▶Ep 3 · 3:44
quoteSo 2% of the time in patients, even if they have no stones, they will get recurrent pancreatitis from their initial insult, whereas 60% if you wait 6 weeks. That is so provocative. That is so clear cut that nobody should be debating this anymore.↗
▶Ep 3 · 5:01
clinicalWhen patients present with gallstone pancreatitis, most pain and elevated enzymes occur as the stone is passing, and symptoms often resolve overnight as the stone passes↗
▶Ep 3 · 5:36
quoteSo if your numbers normalize, I do not do ERCP. I will do an intraoperative changiogram to make sure there's not another stone, but I would not do an ERCP if their numbers normalize.↗
▶Ep 3 · 5:36
clinicalIf laboratory values normalize after gallstone pancreatitis, ERCP is not indicated, but intraoperative cholangiogram should be performed to check for additional stones↗
▶Ep 3 · 8:58
opinionFor patients with impacted stone, rising lipase, and worsening jaundice, ERCP is preferred because surgeon confidence in retrieving impacted stones intraoperatively is lower↗
▶Ep 3 · 8:58
quoteIf I have a patient that comes in with an impacted stone, and their lipase is elevated, the next day their lipase goes up even more, they're, they're getting more and more jaundiced, they're getting worse, I would send them for ERCP because I don't know how good I am at retrieving impacted stones.↗
▶Ep 3 · 13:07
quoteSo here's an example of where I am old and washed up. The answer to this should be yes. I just don't have as much experience as my younger colleagues.↗
▶Ep 3 · 15:05
quoteI agree with you. I am skeptical of papers that claim that something is now the new standard just because it's become their new standard. It doesn't necessarily mean that it's recommended as the standard of care.↗
▶Ep 3 · 15:21
clinicalICG can be administered intravenously, eliminating the need for instrumentation required by traditional intraoperative cholangiogram↗
▶Ep 3 · 15:56
quoteI think we should be learning about ICG. I mean this is provocative for me to say, Todd, come on, get with it. Like this is something you should probably learn.↗
Todd's statements about Cholelithiasis13 statements
quoteIt really depends on the patient and the situation.↗
▶Ep 3 · 1:38
quoteI typically do it before they go home, and I have not found that it's prohibitively difficult in most cases to do the operation.↗
▶Ep 3 · 3:44
clinicalEven in patients with no stones remaining, 2% will get recurrent pancreatitis from the initial insult↗
▶Ep 3 · 3:44
quoteSo 2% of the time in patients, even if they have no stones, they will get recurrent pancreatitis from their initial insult, whereas 60% if you wait 6 weeks. That is so provocative. That is so clear cut that nobody should be debating this anymore.↗
▶Ep 3 · 5:01
clinicalWhen patients present with gallstone pancreatitis, most pain and elevated enzymes occur as the stone is passing, and symptoms often resolve overnight as the stone passes↗
▶Ep 3 · 5:36
clinicalIf laboratory values normalize after gallstone pancreatitis, ERCP is not indicated, but intraoperative cholangiogram should be performed to check for additional stones↗
▶Ep 3 · 5:36
quoteSo if your numbers normalize, I do not do ERCP. I will do an intraoperative changiogram to make sure there's not another stone, but I would not do an ERCP if their numbers normalize.↗
▶Ep 3 · 8:58
quoteIf I have a patient that comes in with an impacted stone, and their lipase is elevated, the next day their lipase goes up even more, they're, they're getting more and more jaundiced, they're getting worse, I would send them for ERCP because I don't know how good I am at retrieving impacted stones.↗
▶Ep 3 · 8:58
opinionFor patients with impacted stone, rising lipase, and worsening jaundice, ERCP is preferred because surgeon confidence in retrieving impacted stones intraoperatively is lower↗
▶Ep 3 · 13:07
quoteSo here's an example of where I am old and washed up. The answer to this should be yes. I just don't have as much experience as my younger colleagues.↗
▶Ep 3 · 15:05
quoteI agree with you. I am skeptical of papers that claim that something is now the new standard just because it's become their new standard. It doesn't necessarily mean that it's recommended as the standard of care.↗
▶Ep 3 · 15:21
clinicalICG can be administered intravenously, eliminating the need for instrumentation required by traditional intraoperative cholangiogram↗
▶Ep 3 · 15:56
quoteI think we should be learning about ICG. I mean this is provocative for me to say, Todd, come on, get with it. Like this is something you should probably learn.↗
Biliary Atresia - Robert Parry: Update Course 2014
▶Ep 1 · 9:19
quotethat reversal of portal flow makes me really concerned because, you know, I've I've had patients that I've done a cassa on have achieved good biliary drainage. They've got a normal bilirubin. But their portal hypertension then continues to ramp up↗
▶Ep 1 · 9:19
clinicalReversal of portal flow is a very concerning finding because patients can achieve good biliary drainage and normal bilirubin but still progress to transplant due to profound portal hypertension.↗
▶Ep 1 · 10:41
quotethe hepatologists can actually limp these kids along. They're not nutritionally in a great place, but they can get them out to be, you know, a year in the absence of a cassai and the absence of a transplant↗
▶Ep 1 · 10:41
clinicalHepatologists can manage biliary atresia patients medically for up to a year in the absence of Kasai or transplant, though nutritional status suffers.↗
▶Ep 1 · 10:56
opinionIn patients with end-stage liver disease signs (profound fibrosis, reversed portal flow), Kasai may not improve outcomes and the operative stress may worsen their condition.↗
▶Ep 1 · 12:00
quoteit's almost like um a race between regeneration of hepatocytes and progression of fibrosis↗
▶Ep 1 · 12:20
quoteI've had a patient that I didn't redo, and I thought surely the thing was a failure because the bilirubin remained elevated, and then at 5 months post-op, the bilirubin dropped to normal↗
▶Ep 1 · 12:20
clinicalSome biliary atresia patients show delayed response to Kasai, with bilirubin remaining elevated for months then dropping to normal at 5 months post-op, suggesting a race between hepatocyte regeneration and fibrosis progression.↗
▶Ep 1 · 14:41
quoteif the question is getting them to the OR sooner, now you're going to delay by, you know, however many days, you know, while you're inducing them with phenobarb↗
▶Ep 1 · 18:01
opinionPathologists' understanding of biliary atresia histology has improved significantly compared to 20 years ago.↗
▶Ep 1 · 18:10
clinicalInterventional radiologists can perform percutaneous liver biopsy safely and routinely, making it a low-barrier test.↗
Biliary Atresia
▶Ep 2 · 0:00
quoteThis is uh Doctor Greg Tia. Greg is the, uh, congratulations, the new uh chief of pediatric surgery at the Cincinnati Children's Hospital.↗
▶Ep 2 · 0:00
quoteThis is uh Doctor Greg Tia. Greg is the, uh, congratulations, the new uh chief of pediatric surgery at the Cincinnati Children's Hospital.↗
Biliary Atresia - Robert Parry: Update Course 2014
▶Ep 1 · 9:19
quotethat reversal of portal flow makes me really concerned because, you know, I've I've had patients that I've done a cassa on have achieved good biliary drainage. They've got a normal bilirubin. But their portal hypertension then continues to ramp up↗
▶Ep 1 · 9:19
clinicalReversal of portal flow is a very concerning finding because patients can achieve good biliary drainage and normal bilirubin but still progress to transplant due to profound portal hypertension.↗
▶Ep 1 · 10:41
clinicalHepatologists can manage biliary atresia patients medically for up to a year in the absence of Kasai or transplant, though nutritional status suffers.↗
▶Ep 1 · 10:41
quotethe hepatologists can actually limp these kids along. They're not nutritionally in a great place, but they can get them out to be, you know, a year in the absence of a cassai and the absence of a transplant↗
▶Ep 1 · 10:56
opinionIn patients with end-stage liver disease signs (profound fibrosis, reversed portal flow), Kasai may not improve outcomes and the operative stress may worsen their condition.↗
▶Ep 1 · 12:00
quoteit's almost like um a race between regeneration of hepatocytes and progression of fibrosis↗
▶Ep 1 · 12:20
quoteI've had a patient that I didn't redo, and I thought surely the thing was a failure because the bilirubin remained elevated, and then at 5 months post-op, the bilirubin dropped to normal↗
▶Ep 1 · 12:20
clinicalSome biliary atresia patients show delayed response to Kasai, with bilirubin remaining elevated for months then dropping to normal at 5 months post-op, suggesting a race between hepatocyte regeneration and fibrosis progression.↗
▶Ep 1 · 14:41
quoteif the question is getting them to the OR sooner, now you're going to delay by, you know, however many days, you know, while you're inducing them with phenobarb↗
▶Ep 1 · 18:01
opinionPathologists' understanding of biliary atresia histology has improved significantly compared to 20 years ago.↗
▶Ep 1 · 18:10
clinicalInterventional radiologists can perform percutaneous liver biopsy safely and routinely, making it a low-barrier test.↗
Todd's statements about Chronic Pancreatitis9 statements
clinicalTaking out the tail of the pancreas for a distal duct leak in a child with genetic pancreatitis would compromise islet yield if the patient needs total pancreatectomy in the future.↗
▶Ep 3 · 14:36
clinicalPercutaneous drainage was chosen over repeat EUS cystgastrostomy for the mediastinal pseudocyst in Case 2 because introducing a stomach-to-pseudocyst connection might create more retroperitoneal scarring and make the planned TPIAT more challenging.↗
▶Ep 3 · 40:44
clinicalPatients who undergo Puestow followed by total pancreatectomy have compromised islet yield compared to those who undergo total pancreatectomy without prior Puestow.↗
▶Ep 3 · 42:36
opinionWhen considering whether a patient may need total pancreatectomy in the future, this significantly influences the decision to pursue conventional surgical options versus proceeding directly to TPIAT.↗
▶Ep 3 · 46:40
clinicalPuestow is typically considered for isolated large duct disease or chain-of-lakes appearance without an inflammatory mass in the head of the pancreas, and typically not in hereditary pancreatitis.↗
▶Ep 3 · 51:39
clinicalIntraoperative ultrasound can be used during Beger procedure to locate the bile duct, and sometimes the duct can be found by sticking a needle into it under ultrasound guidance.↗
▶Ep 3 · 52:34
opinionIn children with genetic etiology of pancreatitis, we are less likely to consider resectional and drainage procedures because the genetic makeup of the remaining pancreas will not change.↗
▶Ep 3 · 52:58
clinicalWhipple is uncommonly considered in children with head-predominant pancreatic disease and is reserved primarily for cases with suspected malignancy.↗
▶Ep 3 · 55:10
quoteIn children with genetic etiology of pancreatitis, we are less likely to consider resectional and drainage procedures.↗
Todd's statements about CICU / Post-op CHD Care4 statements
clinicalThe sutureless plastic closure technique was described by Anthony Sandler and doesn't require suturing the umbilical cord↗
▶Ep 2 · 14:19
clinicalA study by Dr. Baird published in JPS showed that patients with flap closure did better in every way than those with sutured fascial closure, including lower rates of umbilical hernia repair↗
▶Ep 2 · 18:10
clinicalSpring-loaded silos apply pressure outward as you push down, making the defect larger over time↗
▶Ep 2 · 42:06
clinicalThe 'flip flop' technique (modification of component separation) involves incising laterally through anterior sheath only, folding it over while attached to posterior sheath, creating a single posterior sheath closure↗
opinionDr. Ponsky performs suction rectal biopsy in almost any patient who required a contrast enema to rule out distal obstruction, regardless of whether the enema suggests meconium plug, small left colon, or other diagnosis.↗
▶Ep 10 · 31:46
opinionDr. Ponsky performs suction rectal biopsy in almost any patient who required a contrast enema to rule out distal obstruction, regardless of whether the enema suggests meconium plug, small left colon, or other diagnosis.↗
▶Ep 10 · 38:05
clinicalDr. Collins reports that the Duhamel pouches she has examined pathologically have contained both ganglionic and aganglionic parts.↗
▶Ep 10 · 38:05
clinicalDr. Collins reports that the Duhamel pouches she has examined pathologically have contained both ganglionic and aganglionic parts.↗
Cloaca - Prental Imaging & Diagnosis - Counseling
▶Ep 17 · 29:46
quoteI have never had a patient referred to me with a prenatal diagnosis of any rectum malformations, cloica ever.↗
▶Ep 17 · 29:46
quoteI have never had a patient referred to me with a prenatal diagnosis of any rectum malformations, cloica ever.↗
Radiology and Image Diagnosis of Hirschsprung Disease
▶Ep 18 · 31:46
clinicalDr. Ponsky always performs suction rectal biopsy in almost any patient who needed a contrast enema to rule out distal obstruction, whether meconium plug, small colon, or other cause.↗
▶Ep 18 · 31:46
clinicalDr. Ponsky always performs suction rectal biopsy in almost any patient who needed a contrast enema to rule out distal obstruction, whether meconium plug, small colon, or other cause.↗
▶Ep 18 · 31:51
quoteI always do. So other than the game of am I right at getting question, can I make it even more broad? I would do it. I do it in almost any distal, any patient that needed a contrast enema.↗
▶Ep 18 · 31:51
quoteI always do. So other than the game of am I right at getting question, can I make it even more broad? I would do it. I do it in almost any distal, any patient that needed a contrast enema.↗
▶Ep 18 · 32:15
clinicalDr. Ponsky performs rectal biopsy even in meconium ileus cases.↗
▶Ep 18 · 32:15
clinicalDr. Ponsky performs rectal biopsy even in meconium ileus cases.↗
▶Ep 18 · 32:23
clinicalIf it is clearly meconium ileus with reflux into terminal ileum and clinical improvement, some surgeons will not do rectal biopsy.↗
▶Ep 18 · 38:05
clinicalDr. Collins has seen resected Duhamel pouches that had both ganglionic and aganglionic parts, but does not know what their contrast enemas looked like.↗
▶Ep 18 · 38:05
clinicalDr. Collins has seen resected Duhamel pouches that had both ganglionic and aganglionic parts, but does not know what their contrast enemas looked like.↗
Surgical Procedures for Hirschsprung Disease
▶Ep 21 · 5:30
clinicalThe concordance between pathology and radiology is 75% in rectosigmoid Hirschsprung patients, meaning 25% are discordant.↗
▶Ep 21 · 5:39
clinicalConcordance between pathology and radiology is only 25% for long-segment Hirschsprung disease.↗
▶Ep 21 · 7:07
clinicalWhen starting laparoscopically, you can look at the bowel and often tell what looks normal vs. abnormal, then take a biopsy at that level.↗
▶Ep 21 · 7:07
clinicalWhen starting laparoscopically, you can look at the bowel and often tell what looks normal vs. abnormal, then take a biopsy at that level.↗
▶Ep 21 · 7:57
clinicalIf you start transanally and break through the peritoneum, it can be difficult to maintain pneumoperitoneum when you then go laparoscopically.↗
▶Ep 21 · 7:57
clinicalIf you start transanally and break through the peritoneum, it can be difficult to maintain pneumoperitoneum when you then go laparoscopically.↗
▶Ep 21 · 8:18
opinionLaparoscopic dissection is easy and gives you a head start when doing the transanal portion.↗
▶Ep 21 · 8:18
opinionLaparoscopic dissection is easy and gives you a head start when doing the transanal portion.↗
▶Ep 21 · 1:21:33
clinicalLaparoscopy in Hirschsprung can be used for diagnosis (leveling biopsies, ostomy creation), definitive surgery (mobilization, watching pull-through), and postoperatively (Malone creation).↗
▶Ep 21 · 1:21:33
clinicalLaparoscopy in Hirschsprung can be used for diagnosis (leveling biopsies, ostomy creation), definitive surgery (mobilization, watching pull-through), and postoperatively (Malone creation).↗
▶Ep 21 · 1:34:15
clinicalPitfalls of laparoscopy: difficult with very distended colon (poor visualization), need to de-rotate right colon if pulling transverse/right colon (may require small laparotomy).↗
▶Ep 21 · 1:34:15
clinicalPitfalls of laparoscopy: difficult with very distended colon (poor visualization), need to de-rotate right colon if pulling transverse/right colon (may require small laparotomy).↗
▶Ep 21 · 1:34:53
clinicalBenefits of laparoscopy over pure transanal: decreases stretch of anal sphincters on high dissections, allows dissection to pelvic floor (very short transanal component), prevents twisting of pulled-through bowel.↗
▶Ep 21 · 1:34:53
clinicalBenefits of laparoscopy over pure transanal: decreases stretch of anal sphincters on high dissections, allows dissection to pelvic floor (very short transanal component), prevents twisting of pulled-through bowel.↗
▶Ep 21 · 1:36:36
clinicalCompared to laparotomy, laparoscopy decreases incision size, reduces discomfort, potentially allows earlier bowel function (1-2 days difference), and shorter hospitalization.↗
▶Ep 21 · 1:36:36
clinicalCompared to laparotomy, laparoscopy decreases incision size, reduces discomfort, potentially allows earlier bowel function (1-2 days difference), and shorter hospitalization.↗
▶Ep 21 · 1:36:55
opinionFor transanal alone, laparoscopy doesn't offer much decrease in return of bowel function or postoperative hospitalization compared to pure transanal.↗
▶Ep 21 · 1:36:55
opinionFor transanal alone, laparoscopy doesn't offer much decrease in return of bowel function or postoperative hospitalization compared to pure transanal.↗
CinciHirsch - Pathology of Hirschprung Disease
▶Ep 23 · 6:38
opinionDr. Frykman was trained to stop attempting suction rectal biopsies at about 6 months of age and take patients to the operating room instead.↗
▶Ep 23 · 6:38
opinionDr. Frykman was trained to stop attempting suction rectal biopsies at about 6 months of age and take patients to the operating room instead.↗
Outcomes and Complications in Hirschsprung Disease
▶Ep 20 · 33:44
quoteMany places still have clung to this idea that the way to assess a pull through specimen is to do a longitudinal strip of the length of the specimen and not look at the full circumference of the proximal margin.↗
▶Ep 20 · 33:44
clinicalMany institutions assess pull-through specimens using only a longitudinal strip rather than examining the full circumference of the proximal margin; the interface between ganglionic and aganglionic bowel can be irregular and project 2-4 cm longer along one part of the circumference.↗
▶Ep 20 · 33:53
quoteThe interface between the ganglionic bowel and the a ganglion bowel can be very irregular and can project for 234 centimeters longer along one part of the circumference than the other.↗
▶Ep 20 · 35:19
epidemiologicalA survey of Canadian pediatric surgeons found nearly half resect 4 centimeters or less from the biopsy site, and about 10% resect right at the site of positive biopsy, creating high risk of pull-throughs in the transition zone.↗
▶Ep 20 · 1:15:23
opinionLaparoscopy is minimally invasive but provides even better exposure than open surgery; small umbilical incisions compromise exposure.↗
▶Ep 20 · 1:15:23
quoteLaparoscopy is minimally invasive but gives you actually make even better exposure, so you're not compromising exposure with laparoscopy.↗
▶Ep 20 · 1:15:23
quoteLaparoscopy is minimally invasive but gives you actually make even better exposure, so you're not compromising exposure with laparoscopy.↗
▶Ep 20 · 1:15:23
opinionLaparoscopy is minimally invasive but provides even better exposure than open surgery; small umbilical incisions compromise exposure.↗
Hirschsprung Disease: Update Course 2015
▶Ep 35 · 4:22
opinionPure transanal pull-through may not be less invasive than laparoscopic approach, as prolonged torquing in the anal canal can be more traumatic than three small abdominal incisions.↗
▶Ep 35 · 4:22
quoteI don't believe that a pure trans anal is necessarily less invasive. In other words, I believe that putting 3 incisions on the abdomen is actually less invasive in my hands, in my hands, certainly not in your guys' hands, but in my hands, I'm gonna be torquing in that anal canal much more than if I had done it laparoscopically and freed everything up from the abdominal approach.↗
Hirschsprung Disease: Surgical Procedures
▶Ep 39 · 5:30
clinicalThe concordance between pathology and radiology is 75% in rectosigmoid Hirschsprung disease patients, meaning 25% are discordant.↗
▶Ep 39 · 5:39
clinicalThe concordance is only 25% for long-segment Hirschsprung disease between radiology and pathology.↗
▶Ep 39 · 7:57
clinicalWhen starting laparoscopically, if you break the peritoneum transanally first, it becomes hard to maintain pneumoperitoneum.↗
▶Ep 39 · 1:34:53
opinionLaparoscopy decreases the stretch of anal sphincters compared to pure transanal approach when going high, which could affect fecal continence.↗
▶Ep 39 · 1:35:11
clinicalWith laparoscopy, you can dissect way down to the pelvic floor, so the actual transanal dissection is very short with very limited stretch on the sphincters.↗
Prenatal Imaging and Counseling: Cloaca and Complex ARMs 2015
▶Ep 38 · 25:12
quoteI have never had a patient referred to me with a prenatal diagnosis of any rectal malformations, cloica ever.↗
▶Ep 38 · 25:12
quoteI have never had a patient referred to me with a prenatal diagnosis of any rectal malformations, cloica ever.↗
Hirschsprung Disease: Radiology Aspect
▶Ep 42 · 31:01
clinicalRectal biopsy should be performed in almost any patient who needed a contrast enema to rule out distal obstruction, including cases of meconium plug or small left colon.↗
▶Ep 42 · 31:01
clinicalRectal biopsy should be performed in almost any patient who needed a contrast enema to rule out distal obstruction, including cases of meconium plug or small left colon.↗
▶Ep 42 · 31:12
quoteI would do it. I do it in almost any distal, any patient that needed a contrast enema. To rule out a distal obstruction, I'm going to be doing a suction rectal biopsy, whether it's meconium plug or a small colon.↗
▶Ep 42 · 31:12
quoteI would do it. I do it in almost any distal, any patient that needed a contrast enema. To rule out a distal obstruction, I'm going to be doing a suction rectal biopsy, whether it's meconium plug or a small colon.↗
▶Ep 42 · 31:35
clinicalIn clearly documented meconium ileus where reflux into terminal ileum is achieved and the patient clinically improves, rectal biopsy may not be necessary.↗
▶Ep 42 · 31:35
clinicalIn clearly documented meconium ileus where reflux into terminal ileum is achieved and the patient clinically improves, rectal biopsy may not be necessary.↗
Hirschsprung Disease: Cases and Complications
▶Ep 41 · 33:44
quoteThe interface between the ganglionic bowel and the a ganglion bowel can be very irregular and can project for 234 centimeters longer along one part of the circumference than the other, so that even if you just look at a longitudinal strip. You could see gangon cells at the proximal margin, but on the opposite side of that margin there may be no gangon cells, and so you may be dealing with a, a low transition zone pull through in that situation.↗
▶Ep 41 · 33:44
quoteThe interface between the ganglionic bowel and the a ganglion bowel can be very irregular and can project for 234 centimeters longer along one part of the circumference than the other, so that even if you just look at a longitudinal strip. You could see gangon cells at the proximal margin, but on the opposite side of that margin there may be no gangon cells, and so you may be dealing with a, a low transition zone pull through in that situation.↗
▶Ep 41 · 35:19
epidemiologicalA survey of the Canadian Association of Pediatric Surgeons by Jack Langer found that nearly half of surgeons resect 4 cm or less from the biopsy site, and about 10% resect right at the site of positive biopsy, creating high risk for pull-throughs in the transition zone.↗
▶Ep 41 · 1:15:24
opinionLaparoscopy is minimally invasive but provides maybe even better exposure than open surgery, so exposure is not compromised with laparoscopy.↗
▶Ep 41 · 1:15:24
opinionLaparoscopy is minimally invasive but provides maybe even better exposure than open surgery, so exposure is not compromised with laparoscopy.↗
▶Ep 41 · 1:39:29
clinicalEnterocolitis does not occur in pure anorectal malformations without Hirschsprung disease.↗
▶Ep 41 · 1:39:29
clinicalEnterocolitis does not occur in pure anorectal malformations without Hirschsprung disease.↗
Hirschsprung Disease: Update Course 2013
▶Ep 46 · 1:45
opinionIn newborn bowel obstruction with distended abdomen and distal air, start with contrast enema rather than upper GI↗
▶Ep 46 · 2:11
clinicalBilious emesis typically prompts upper GI, but newborn distal obstruction is an exception where contrast enema is more informative↗
▶Ep 46 · 4:51
guidelineTissue diagnosis is absolutely required before operating for Hirschsprung disease↗
▶Ep 46 · 28:51
opinionIn older children (age 2-3 and up), suction rectal biopsy should not be performed; instead do open rectal biopsy under general anesthesia↗
▶Ep 46 · 30:06
opinionIn 3-year-old with severely dilated colon from chronic Hirschsprung disease, the dilated segment is unlikely to collapse and should be resected↗
Hirschsprung Disease: Update Course 2013
▶Ep 49 · 1:59
opinionIn newborn bowel obstruction with distal air, contrast enema should precede upper GI unless clinical presentation strongly suggests malrotation↗
▶Ep 49 · 9:57
opinionProne positioning for pull-through is easier on surgeon's back and neck compared to lithotomy↗
Posterior Sagittal Anorectaplasty in a Female: Pediatric Colorectal...
▶Ep 63 · 2:10
clinicalTotal body prep from nipples to toes is standard for these patients, allowing flexibility to flip between supine and prone positions↗
Colorectal - Clinical Practice Updates
▶Ep 71 · 14:14
quoteIs there any evidence for anything that, that y'all have mentioned? I mean, it seems like this is the right topic to try to get some better evidence for it, but I'm just interested to know, is there evidence for what y'all are, for any of these uh suggested treatments.↗
▶Ep 71 · 14:14
quoteIs there any evidence for anything that, that y'all have mentioned? I mean, it seems like this is the right topic to try to get some better evidence for it, but I'm just interested to know, is there evidence for what y'all are, for any of these uh suggested treatments.↗
▶Ep 71 · 43:34
quoteI'll just raise my standard thing that I always raise, which is why are we getting a CAT scan?↗
▶Ep 71 · 43:34
quoteI'll just raise my standard thing that I always raise, which is why are we getting a CAT scan?↗
Biliary Atresia, Appendicitis, Intestinal Failure, and Anesthetic...
▶Ep 76 · 42:16
clinicalDr. Ponsky's chief of anesthesiology instituted a 'rule of two': defer elective operations until after age 2 and avoid two anesthetics in one year.↗
▶Ep 76 · 42:31
opinionDr. Ponsky now defers dermoid cyst excision in a 6-month-old until 18 months but does not delay inguinal hernia repair due to known incarceration risk in young infants.↗
The Colorectal Quiz Episode 3.5: Proximal Hirschsprung Disease
▶Ep 87 · 4:05
clinicalA baby with bilious emesis and non-classic abdominal x-ray could have had distal air and then had a volvulus, requiring urgent upper GI to rule out malrotation before contrast enema.↗
Journal of Pediatric Surgery Article Review: October 2021
▶Ep 110 · 3:58
opinionThe 85% follow-up rate in child abuse victims is surprising and encouraging.↗
▶Ep 110 · 3:58
quoteAnd the fact that, you know, we're seeing 85% follow-up is surprising to me and, and Encouraging.↗
▶Ep 110 · 8:05
opinionIn NEC, it is easy to make surgical decisions when there is free air, but without definitive protocol for other presentations, surgeons hedge and delay daily about whether to operate.↗
▶Ep 110 · 8:05
quoteThis article points out the problem of Gestalt and necrotizing enterocolitis. You know, it's really easy when they have free air. When they don't, we're all different and we don't have a defined protocol that's been built yet.↗
▶Ep 110 · 13:19
opinionMany surgeons who see the value of bowel management programs lack the volume or resources to build formal programs, making it reasonable to refer patients to nearby established programs.↗
▶Ep 110 · 13:19
quoteHonestly, a lot of people see the value of this, don't have the volume or the resources to build a formal program, and it's very reasonable to send these kids to a new Nearby bowel management program.↗
▶Ep 110 · 16:26
clinicalThere is variability in the use of ultrasound versus MRI for detecting tethered cord in anorectal malformation patients, and radiographs are not a good substitute.↗
Update Course 2022 - APSA PDC UPDATES - Mary Edwards, Paul Jeziorczak, Craig Lillehei, and Charles Snyder,
▶Ep 126 · 34:00
quoteThe reason that we switched to this, um, is that there are, if it's clearly if airway aspiration, you go to the operating room. It's the ones you don't know. And what we found is the ones you don't know, it's a suspicious story. They were coughing after eating. Um, more often than not, it's reactive airway and it's not a foreign body.↗
▶Ep 126 · 34:00
quoteThe reason that we switched to this, um, is that there are, if it's clearly if airway aspiration, you go to the operating room. It's the ones you don't know. And what we found is the ones you don't know, it's a suspicious story. They were coughing after eating. Um, more often than not, it's reactive airway and it's not a foreign body.↗
▶Ep 126 · 35:00
quoteCAT scan pretty much almost a hundred percent will direct you to go to the OR or not. So it's very low radiation and it eliminates those that are equivocal of getting an unnecessary instrumentation of their airway in the face of reactive airway disease.↗
▶Ep 126 · 35:00
quoteCAT scan pretty much almost a hundred percent will direct you to go to the OR or not. So it's very low radiation and it eliminates those that are equivocal of getting an unnecessary instrumentation of their airway in the face of reactive airway disease.↗
▶Ep 126 · 59:30
quoteI do believe that working with the neonatology team on the decision to operate is actually prudent. I know you were, but a lot of people get upset about that. And I do have that discussion now. Ultimately, the decision is mine. But oftentimes they do sway me.↗
▶Ep 126 · 59:30
quoteI do believe that working with the neonatology team on the decision to operate is actually prudent. I know you were, but a lot of people get upset about that. And I do have that discussion now. Ultimately, the decision is mine. But oftentimes they do sway me.↗
Journal of Pediatric Surgery Article Review: February 2023, BAPS issue
▶Ep 135 · 4:13
clinicalCenters of excellence for esophageal atresia are showing better outcomes↗
▶Ep 135 · 4:26
opinionCentralization of esophageal atresia care would be difficult to implement in the United States healthcare system↗
Colorectal Quiz: Episode 49 – Collaborating for Kids: Colorectal & Pelvic Solutions (with a Little Help from AI)
▶Ep 177 · 1:20
quoteMark, you're always not only good at anal rectum malformations, but you have been interested in All the tech and the media from the very beginning.↗
▶Ep 177 · 1:35
quoteWhat M and I are working on is how we can mass produce content to equilibrate knowledge around the world, and we know that the only way to do that is to use cutting edge technology, automation tools and AI.↗
▶Ep 177 · 2:16
clinicalNotebook LM is a free offering from Google that can create realistic-sounding podcasts between two AI voices from uploaded documents.↗
▶Ep 177 · 2:31
quoteI would love to hear your thoughts, Mark, on your first experience with Notebook LM.↗
▶Ep 177 · 4:14
quoteNo one has been able to do it as well as Notebook LM.↗
▶Ep 177 · 4:22
opinionThe AI-generated podcast voices are not customizable; users are limited to the same male and female voices.↗
▶Ep 177 · 4:26
quoteThere's actually an incredible video where they uploaded a document telling these two podcast hosts that they were AI and how they reacted. They freaked out.↗
▶Ep 177 · 4:52
quoteDo I think this is the future of podcasting? I don't.↗
▶Ep 177 · 5:03
clinicalNotebook LM's beta version allows users to join the AI conversation interactively.↗
▶Ep 177 · 5:09
quoteYou could click join, and it goes, hey, what's up? And you could say, hey, I heard what you just said about the colostomy. I'm not sure I agree, and then it will talk with you.↗
▶Ep 177 · 7:42
quoteThe AI revolution has happened, and each month, it's blowing up and replacing jobs.↗
opinionHospitals should have teams that continuously bring new AI tools to clinicians every week.↗
▶Ep 177 · 8:11
clinicalEm Gootee triangulates multiple AI platforms to combine the strengths of different tools (intelligence, audio, video).↗
▶Ep 177 · 8:26
opinionHuman oversight is necessary to ensure AI-generated medical content is correct.↗
▶Ep 177 · 8:26
quoteYou have to have human oversight to make sure they're correct.↗
Colorectal Quiz: Episode 49 - Collaborating for Kids: Colorectal & Pelvic Solutions (with a Little Help from AI)
▶Ep 219 · 1:18
quotewhat em and i are working on is how we can mass produce content to equilibrate knowledge around the world and we know that the only way to do that is to use cutting edge technology automation tools and ai↗
▶Ep 219 · 1:18
clinicalNotebookLM is a free offering from Google that can upload any content and create a realistic-sounding podcast between two people.↗
▶Ep 219 · 3:41
quotedo i think this is the future of podcasting i don't i think the voices are great but it's not customizable enough you're stuck with what it decided↗
▶Ep 219 · 6:39
quotethe ai revolution has happened and each month it's blowing up and replacing jobs↗
▶Ep 219 · 6:39
quotethe key thing is to be like you're doing and everyone else you have to be looking at ai and using it in your workflow if you're not you'll get behind↗
▶Ep 219 · 6:39
clinicalA review article that took two weeks to produce five years ago can now be created in minutes using NotebookLM with the same 30 source articles.↗
▶Ep 219 · 7:30
clinicalNotebookLM can identify gaps in knowledge across multiple research articles and recognize when new articles fill those gaps.↗
Colorectal Quiz: Episode 2
▶Ep 230 · 7:09
quoteYou all both looked at this image and said, you can tell, obviously, that this is too low, too posterior. Without a stimulator in the office, what do you look for to immediately tell that the analplasty was done too low?↗
The Colorectal Quiz Episode 4
▶Ep 241 · 17:00
clinicalThe reinforcement layer is critical to lining the two pieces of bowel up so that mucosa edge meets mucosa edge.↗
Colorectal Quiz: Episode 2
▶Ep 242 · 7:09
quoteYou all both looked at this image and said, you can tell, obviously, that this is too low, too posterior. Without a stimulator in the office, what do you look for to immediately tell that the analplasty was done too low?↗
▶Ep 242 · 7:09
quoteYou all both looked at this image and said, you can tell, obviously, that this is too low, too posterior. Without a stimulator in the office, what do you look for to immediately tell that the analplasty was done too low?↗
Todd's statements about Congenital Diaphragmatic Hernia23 statements
clinicalEchocardiography and TR jet measurement are essential to assess pulmonary hypertension in CDH patients, as pre- and post-ductal saturations alone are insufficient.↗
▶Ep 6 · 0:00
quoteyou're not going to be able to tell based on your pre and post ductal SATs and everything else, you know, how much pulmonary hypertension do they have↗
▶Ep 6 · 2:35
opinionScoring the pleura all the way around and unfurling it so that it comes together with more of a scar may reduce recurrence.↗
▶Ep 6 · 2:35
opinionSewing pleura to pleura without creating a raw edge may have a high failure rate analogous to laparoscopic inguinal hernia repair (sewing peritoneum to peritoneum).↗
CDH-ECMO - VV vs. VA - Repair on ECMO: Update Course 2015
▶Ep 5 · 0:00
quoteSo this kid's a little bit sicker than the last one on dopamine. Uh, echo shows super systemic pressures. You mentioned, I mentioned oxygenation index of 45. So the kid's looking like they need to go on ECMO.↗
▶Ep 5 · 1:22
opinionIf an institution is really good at VV ECMO, they should do VV ECMO; if really good at VA ECMO, they should do VA ECMO↗
▶Ep 5 · 1:22
quoteIf you're really good at VV ECMO, do VV ECMO. If you're really good at VA ECMO, do VA ECMO.↗
▶Ep 5 · 7:17
quoteif you have expertise, if you're really good at VA ECMO, you're, you're, you're not going to get as good a results with VV ECMO and and vice versa.↗
▶Ep 5 · 7:17
opinionIf you have expertise in VA ECMO, you will not get as good results with VV ECMO and vice versa↗
▶Ep 5 · 7:17
opinionYou should do what you are good at regarding ECMO modality unless there is overwhelming evidence for one approach↗
▶Ep 5 · 7:17
quoteyou should do what you're good at. I mean, if there's overwhelming evidence that VV ECMO is the way to go, then maybe we should all learn how to do it. But, you know, until then, the evidence is leaning that way.↗
▶Ep 5 · 9:10
clinicalSome institutions will stop ECMO and not repair CDH in patients who cannot be weaned from ECMO↗
▶Ep 5 · 10:09
opinionMuscle flap mobilization and placement can potentially be done laparoscopically↗
Fetoscopic endoluminal tracheal occlusion and twin-twin transfusion: Fetal...
▶Ep 7 · 1:26:57
clinicalRuben Quintero's 1997 staging system for TTTS actually describes physiologic states: stage 1 reflects initial volume transfer, stage 2 represents cephalization of blood flow, stage 3 represents increasing placental resistance, and stage 4 represents cardiac failure in the recipient.↗
▶Ep 7 · 1:29:21
epidemiologicalOnly 30-35% of stage 1 TTTS progresses to stage 2 or higher; 28% stay at stage 1 throughout pregnancy, and 40% regress completely or resolve.↗
▶Ep 7 · 1:32:14
clinicalThe recipient twin in TTTS develops progressive hypertrophic cardiomyopathy due to both preload (volume) and afterload (peripheral vasoconstriction from renin-angiotensin activation) issues.↗
▶Ep 7 · 1:45:01
clinicalCHOP's cardiovascular score significantly drops within 1 week to 10 days after laser photocoagulation in the vast majority of cases, showing the recipient twin's heart has great potential to heal.↗
▶Ep 7 · 1:47:05
clinicalDiode laser is much safer than argon laser with lower penetration depth and no vessel rupture cases since switching to diode at CHOP.↗
▶Ep 7 · 1:50:00
clinicalCHOP's miss rate for vascular anastomoses is 0.8% based on placental injection studies, compared to 10-15% miss rates reported in literature.↗
▶Ep 7 · 2:21:19
clinicalCHOP has performed about 80 bipolar cord cauterizations with 86% singleton survival and over 90 radiofrequency ablations with 83% singleton survival for selective cord occlusion.↗
Stay Current Journal Club: Episode 1 - Ventricular Dysfunction in CDH and...
▶Ep 9 · 8:50
quoteI can't tell if left ventricular dysfunction is a marker or an actual cause of higher mortality.↗
▶Ep 9 · 14:53
opinionCryotherapy is gaining traction in pectus repair, with Kansas City publishing multiple studies showing good results.↗
▶Ep 9 · 15:06
opinionProtocolizing care leads to improved outcomes, as demonstrated by the pectus repair standardization study.↗
Todd's statements about Congenital Diaphragmatic Hernia57 statements
quoteyou're not going to be able to tell based on your pre and post ductal SATs and everything else, you know, how much pulmonary hypertension do they have↗
▶Ep 5 · 0:00
clinicalEchocardiography and TR jet measurement are essential to assess pulmonary hypertension in CDH patients, as pre- and post-ductal saturations alone are insufficient.↗
▶Ep 5 · 2:35
opinionSewing pleura to pleura without creating a raw edge may have a high failure rate analogous to laparoscopic inguinal hernia repair (sewing peritoneum to peritoneum).↗
▶Ep 5 · 2:35
opinionScoring the pleura all the way around and unfurling it so that it comes together with more of a scar may reduce recurrence.↗
CDH-ECMO - VV vs. VA - Repair on ECMO: Update Course 2015
▶Ep 4 · 0:00
quoteSo this kid's a little bit sicker than the last one on dopamine. Uh, echo shows super systemic pressures. You mentioned, I mentioned oxygenation index of 45. So the kid's looking like they need to go on ECMO.↗
▶Ep 4 · 1:22
opinionIf an institution is really good at VV ECMO, they should do VV ECMO; if really good at VA ECMO, they should do VA ECMO↗
▶Ep 4 · 1:22
quoteIf you're really good at VV ECMO, do VV ECMO. If you're really good at VA ECMO, do VA ECMO.↗
▶Ep 4 · 7:17
opinionYou should do what you are good at regarding ECMO modality unless there is overwhelming evidence for one approach↗
▶Ep 4 · 7:17
quoteyou should do what you're good at. I mean, if there's overwhelming evidence that VV ECMO is the way to go, then maybe we should all learn how to do it. But, you know, until then, the evidence is leaning that way.↗
▶Ep 4 · 7:17
opinionIf you have expertise in VA ECMO, you will not get as good results with VV ECMO and vice versa↗
▶Ep 4 · 7:17
quoteif you have expertise, if you're really good at VA ECMO, you're, you're, you're not going to get as good a results with VV ECMO and and vice versa.↗
▶Ep 4 · 9:10
clinicalSome institutions will stop ECMO and not repair CDH in patients who cannot be weaned from ECMO↗
▶Ep 4 · 10:09
opinionMuscle flap mobilization and placement can potentially be done laparoscopically↗
Fetoscopic endoluminal tracheal occlusion and twin-twin transfusion: Fetal...
▶Ep 7 · 1:26:57
clinicalRuben Quintero's 1997 staging system for TTTS actually describes physiologic states: stage 1 reflects initial volume transfer, stage 2 represents cephalization of blood flow, stage 3 represents increasing placental resistance, and stage 4 represents cardiac failure in the recipient.↗
▶Ep 7 · 1:29:21
epidemiologicalOnly 30-35% of stage 1 TTTS progresses to stage 2 or higher; 28% stay at stage 1 throughout pregnancy, and 40% regress completely or resolve.↗
▶Ep 7 · 1:32:14
clinicalThe recipient twin in TTTS develops progressive hypertrophic cardiomyopathy due to both preload (volume) and afterload (peripheral vasoconstriction from renin-angiotensin activation) issues.↗
▶Ep 7 · 1:45:01
clinicalCHOP's cardiovascular score significantly drops within 1 week to 10 days after laser photocoagulation in the vast majority of cases, showing the recipient twin's heart has great potential to heal.↗
▶Ep 7 · 1:47:05
clinicalDiode laser is much safer than argon laser with lower penetration depth and no vessel rupture cases since switching to diode at CHOP.↗
▶Ep 7 · 1:50:00
clinicalCHOP's miss rate for vascular anastomoses is 0.8% based on placental injection studies, compared to 10-15% miss rates reported in literature.↗
▶Ep 7 · 2:21:19
clinicalCHOP has performed about 80 bipolar cord cauterizations with 86% singleton survival and over 90 radiofrequency ablations with 83% singleton survival for selective cord occlusion.↗
Stay Current Journal Club: Episode 1 - Ventricular Dysfunction in CDH and...
▶Ep 9 · 8:50
quoteI can't tell if left ventricular dysfunction is a marker or an actual cause of higher mortality.↗
▶Ep 9 · 14:53
opinionCryotherapy is gaining traction in pectus repair, with Kansas City publishing multiple studies showing good results.↗
▶Ep 9 · 15:06
opinionProtocolizing care leads to improved outcomes, as demonstrated by the pectus repair standardization study.↗
Journal of Pediatric Surgery Article Review: November 2021
▶Ep 7 · 1:21
quoteAlmost never. That's what I, that's what I suspected. And that is why I think this is a single institution experience because that's just the way they do it there.↗
▶Ep 7 · 1:21
quoteAlmost never. That's what I, that's what I suspected. And that is why I think this is a single institution experience because that's just the way they do it there.↗
▶Ep 7 · 1:31
clinicalTodd Ponsky has worked at 5 children's hospitals and has had to place a central line at ECMO decannulation only twice, never having to reinsert a line afterwards↗
▶Ep 7 · 1:31
clinicalTodd Ponsky has worked at 5 children's hospitals and has had to place a central line at ECMO decannulation only twice, never having to reinsert a line afterwards↗
▶Ep 7 · 2:49
clinicalIf you just need access, then just use a PICC line rather than a central line↗
▶Ep 7 · 2:49
clinicalIf you just need access, then just use a PICC line rather than a central line↗
▶Ep 7 · 2:49
quoteIf you just need access, then just use a PICC line.↗
▶Ep 7 · 2:49
quoteIf you just need access, then just use a PICC line.↗
▶Ep 7 · 2:53
clinicalLeaving a central line at ECMO decannulation may be reasonable in older patients because they'll need hemodialysis more often↗
▶Ep 7 · 2:53
clinicalLeaving a central line at ECMO decannulation may be reasonable in older patients because they'll need hemodialysis more often↗
▶Ep 7 · 6:17
clinicalThe main reason to operate on congenital lung malformations early is not only that it's easier, but you have a much less chance of having an infection beforehand, so it's clean, pristine virgin plains↗
▶Ep 7 · 6:17
quotethe main reason to, to do it early. not only is it easier, but you have a much less chance of having an infection beforehand, and so it's clean, pristine virgin plains.↗
▶Ep 7 · 6:17
clinicalThe main reason to operate on congenital lung malformations early is not only that it's easier, but you have a much less chance of having an infection beforehand, so it's clean, pristine virgin plains↗
▶Ep 7 · 6:17
quotethe main reason to, to do it early. not only is it easier, but you have a much less chance of having an infection beforehand, and so it's clean, pristine virgin plains.↗
▶Ep 7 · 6:42
clinicalTodd Ponsky was trained to operate on congenital lung malformations at 6 to 8 months of age, but now operates at 3 months↗
▶Ep 7 · 6:42
quoteSo I was trained at 6 to 8 months. Now I'm down to 3 months.↗
▶Ep 7 · 6:42
quoteSo I was trained at 6 to 8 months. Now I'm down to 3 months.↗
▶Ep 7 · 6:42
clinicalTodd Ponsky was trained to operate on congenital lung malformations at 6 to 8 months of age, but now operates at 3 months↗
▶Ep 7 · 10:52
quoteOK, so the conclusion of this paper is, if you feel comfortable doing a partial splenectomy. It works 70% of the time.↗
▶Ep 7 · 10:52
clinicalIf you feel comfortable doing a partial splenectomy, it works 70% of the time (avoiding completion splenectomy)↗
▶Ep 7 · 10:52
clinicalIf you feel comfortable doing a partial splenectomy, it works 70% of the time (avoiding completion splenectomy)↗
▶Ep 7 · 10:52
quoteOK, so the conclusion of this paper is, if you feel comfortable doing a partial splenectomy. It works 70% of the time.↗
Update Course 2022 - APSA PDC UPDATES - Mary Edwards, Paul Jeziorczak, Craig Lillehei, and Charles Snyder,
▶Ep 9 · 34:00
quoteThe reason that we switched to this, um, is that there are, if it's clearly if airway aspiration, you go to the operating room. It's the ones you don't know. And what we found is the ones you don't know, it's a suspicious story. They were coughing after eating. Um, more often than not, it's reactive airway and it's not a foreign body.↗
▶Ep 9 · 35:00
quoteCAT scan pretty much almost a hundred percent will direct you to go to the OR or not. So it's very low radiation and it eliminates those that are equivocal of getting an unnecessary instrumentation of their airway in the face of reactive airway disease.↗
▶Ep 9 · 59:30
quoteI do believe that working with the neonatology team on the decision to operate is actually prudent. I know you were, but a lot of people get upset about that. And I do have that discussion now. Ultimately, the decision is mine. But oftentimes they do sway me.↗
BOB in Ped Surg 2023 - AAP Winner - Shelby Sferra, MD
▶Ep 18 · 9:00
quoteAre we not making a difference? Are we not seeing Any benefit of all of these uh initiatives to try to decrease. And if it's not working, then how do we change course, or am I reacting too soon?↗
BOB in Ped Surg 2023 - EUPSA Winner - Dr. Rebeca Figueira
▶Ep 17 · 11:44
quoteI'm not smart enough to understand basic science, so I never choose those papers. And and and they keep uh they keep winning. So clearly he was right. People do want to hear about the basic science.↗
quoteI deliver in an ECHO center if it's severe. I don't do feto, so I would refer to a place that knows better than me.↗
▶Ep 24 · 2:43
clinicalSome FETO patients still required ECMO, but some avoided ECMO due to the fetal intervention↗
▶Ep 24 · 5:54
quoteI did one as a fellow and it was a bloody mess.↗
▶Ep 24 · 7:37
clinicalThoracoscopic CDH repair is performed if the baby can go to the operating room, unless a patch is needed or the baby is too sick, in which case open repair in the NICU is preferred↗
▶Ep 24 · 9:57
clinicalPossible explanations for higher thoracoscopic recurrence include: insufficient scar formation, inadequate diaphragm unfurling, taking bites at the same level creating a muscle bundle that pulls away, or insufficient number of sutures↗
▶Ep 24 · 13:06
clinicalBiologic patches should never be used by themselves as they are not designed to be a bridge; they can be used to reinforce a synthetic patch on top↗
▶Ep 24 · 13:06
quoteI would never use a biologic by itself. It's not meant to be a bridge. That's not how it was designed. I do use biologic to reinforce the patch. You can put it on top, but I would not use it instead of a synthetic patch.↗
Todd's statements about Congenital Diaphragmatic Hernia13 statements
Fetoscopic endoluminal tracheal occlusion and twin-twin transfusion: Fetal...
▶Ep 3 · 1:26:57
clinicalRuben Quintero's 1997 staging system for TTTS actually describes physiologic states: stage 1 reflects initial volume transfer, stage 2 represents cephalization of blood flow, stage 3 represents increasing placental resistance, and stage 4 represents cardiac failure in the recipient.↗
▶Ep 3 · 1:29:21
epidemiologicalOnly 30-35% of stage 1 TTTS progresses to stage 2 or higher; 28% stay at stage 1 throughout pregnancy, and 40% regress completely or resolve.↗
▶Ep 3 · 1:32:14
clinicalThe recipient twin in TTTS develops progressive hypertrophic cardiomyopathy due to both preload (volume) and afterload (peripheral vasoconstriction from renin-angiotensin activation) issues.↗
▶Ep 3 · 1:45:01
clinicalCHOP's cardiovascular score significantly drops within 1 week to 10 days after laser photocoagulation in the vast majority of cases, showing the recipient twin's heart has great potential to heal.↗
▶Ep 3 · 1:47:05
clinicalDiode laser is much safer than argon laser with lower penetration depth and no vessel rupture cases since switching to diode at CHOP.↗
▶Ep 3 · 1:50:00
clinicalCHOP's miss rate for vascular anastomoses is 0.8% based on placental injection studies, compared to 10-15% miss rates reported in literature.↗
▶Ep 3 · 2:21:19
clinicalCHOP has performed about 80 bipolar cord cauterizations with 86% singleton survival and over 90 radiofrequency ablations with 83% singleton survival for selective cord occlusion.↗
Stay Current Journal Club: Episode 1 - Ventricular Dysfunction in CDH and...
▶Ep 5 · 8:50
quoteI can't tell if left ventricular dysfunction is a marker or an actual cause of higher mortality.↗
▶Ep 5 · 14:53
opinionCryotherapy is gaining traction in pectus repair, with Kansas City publishing multiple studies showing good results.↗
▶Ep 5 · 15:06
opinionProtocolizing care leads to improved outcomes, as demonstrated by the pectus repair standardization study.↗
Update Course 2022 - APSA PDC UPDATES - Mary Edwards, Paul Jeziorczak, Craig Lillehei, and Charles Snyder,
▶Ep 7 · 34:00
quoteThe reason that we switched to this, um, is that there are, if it's clearly if airway aspiration, you go to the operating room. It's the ones you don't know. And what we found is the ones you don't know, it's a suspicious story. They were coughing after eating. Um, more often than not, it's reactive airway and it's not a foreign body.↗
▶Ep 7 · 35:00
quoteCAT scan pretty much almost a hundred percent will direct you to go to the OR or not. So it's very low radiation and it eliminates those that are equivocal of getting an unnecessary instrumentation of their airway in the face of reactive airway disease.↗
▶Ep 7 · 59:30
quoteI do believe that working with the neonatology team on the decision to operate is actually prudent. I know you were, but a lot of people get upset about that. And I do have that discussion now. Ultimately, the decision is mine. But oftentimes they do sway me.↗
Todd's statements about Congenital Lung Lesions (CPAM)36 statements
clinicalCT scan can identify multifocal disease in congenital cystic lung lesions, which may change surgical management (e.g., disease in all three lobes of one lung).↗
▶Ep 4 · 9:24
clinicalCT scan can identify multifocal disease in congenital cystic lung lesions, which may change surgical management (e.g., disease in all three lobes of one lung).↗
Panel Discussion: Pediatric Thoracic Surgery Part 1-Lung Lesions 2012
▶Ep 7 · 0:00
quoteI was sitting here thinking I've heard you give so many thoracic talks, but this is the first time I've ever heard you give everything, and watching each lobe at a time is an amazing value because you see it, it just, it all puts it together and makes sense.↗
▶Ep 7 · 0:00
quoteI was sitting here thinking I've heard you give so many thoracic talks, but this is the first time I've ever heard you give everything, and watching each lobe at a time is an amazing value because you see it, it just, it all puts it together and makes sense.↗
Complications and Beyond
▶Ep 22 · 0:11
guidelineJournal of Pediatric Surgery partners with GlobalCastMD and Stay Current app to share key charts from articles through social media for educational purposes↗
▶Ep 22 · 20:24
opinionUntil the true malignancy risk of congenital lung lesions is established, debate between observation (Canadian approach) versus resection (US approach) will continue↗
▶Ep 22 · 21:17
clinicalFor flat-surface bleeding from vessel stump, suture is most reliable control method; clips and staplers can worsen bleeding↗
▶Ep 22 · 21:17
clinicalFor flat-surface bleeding from vessel stump, suture is most reliable control method; clips and staplers can worsen bleeding↗
▶Ep 22 · 21:27
clinicalSurgeons performing thoracoscopic lobectomy must be proficient in intracorporeal suturing and tying before attempting the procedure↗
▶Ep 22 · 21:27
clinicalSurgeons performing thoracoscopic lobectomy must be proficient in intracorporeal suturing and tying before attempting the procedure↗
▶Ep 22 · 27:51
clinicalSteve Rothenberg makes relaxing incision on diaphragm and places mesh laterally to prevent esophageal erosion↗
▶Ep 22 · 38:20
clinicalPost-fundoplication obstruction can result from four sites: mesh, top stitch, bottom stitch, or fundus itself↗
▶Ep 22 · 38:20
clinicalPost-fundoplication obstruction can result from four sites: mesh, top stitch, bottom stitch, or fundus itself↗
▶Ep 22 · 43:45
opinionPatients who cycle between reflux and obstruction after multiple fundoplication revisions may never achieve perfect outcome↗
▶Ep 22 · 43:45
opinionPatients who cycle between reflux and obstruction after multiple fundoplication revisions may never achieve perfect outcome↗
▶Ep 22 · 44:57
clinicalVirginia Commonwealth performs gastric disconnects in cognitively normal patients with acceptable outcomes↗
▶Ep 22 · 52:48
clinicalGastric distention from large TEF causing respiratory compromise requires emergent decompression, but decompression itself can cause hemodynamic collapse↗
▶Ep 22 · 52:48
clinicalGastric distention from large TEF causing respiratory compromise requires emergent decompression, but decompression itself can cause hemodynamic collapse↗
▶Ep 22 · 52:59
clinicalFor EA/TEF patient decompensating from gastric distention, fastest control is open gastrostomy with immediate esophageal control rather than laparoscopic approach↗
▶Ep 22 · 52:59
clinicalFor EA/TEF patient decompensating from gastric distention, fastest control is open gastrostomy with immediate esophageal control rather than laparoscopic approach↗
▶Ep 22 · 1:04:31
clinicalNottingham UK group is collecting series of esophageal lung cases and seeking collaboration with other institutions↗
▶Ep 22 · 1:04:31
clinicalNottingham UK group is collecting series of esophageal lung cases and seeking collaboration with other institutions↗
Journal of Pediatric Surgery Article Review: November 2021
▶Ep 26 · 1:21
quoteAlmost never. That's what I, that's what I suspected. And that is why I think this is a single institution experience because that's just the way they do it there.↗
▶Ep 26 · 1:31
clinicalTodd Ponsky has worked at 5 children's hospitals and has had to place a central line at ECMO decannulation only twice, never having to reinsert a line afterwards↗
▶Ep 26 · 2:49
clinicalIf you just need access, then just use a PICC line rather than a central line↗
▶Ep 26 · 2:49
quoteIf you just need access, then just use a PICC line.↗
▶Ep 26 · 2:53
clinicalLeaving a central line at ECMO decannulation may be reasonable in older patients because they'll need hemodialysis more often↗
▶Ep 26 · 6:17
clinicalThe main reason to operate on congenital lung malformations early is not only that it's easier, but you have a much less chance of having an infection beforehand, so it's clean, pristine virgin plains↗
▶Ep 26 · 6:17
quotethe main reason to, to do it early. not only is it easier, but you have a much less chance of having an infection beforehand, and so it's clean, pristine virgin plains.↗
▶Ep 26 · 6:42
clinicalTodd Ponsky was trained to operate on congenital lung malformations at 6 to 8 months of age, but now operates at 3 months↗
▶Ep 26 · 6:42
quoteSo I was trained at 6 to 8 months. Now I'm down to 3 months.↗
▶Ep 26 · 10:52
clinicalIf you feel comfortable doing a partial splenectomy, it works 70% of the time (avoiding completion splenectomy)↗
▶Ep 26 · 10:52
quoteOK, so the conclusion of this paper is, if you feel comfortable doing a partial splenectomy. It works 70% of the time.↗
Update Course 2022 - APSA PDC UPDATES - Mary Edwards, Paul Jeziorczak, Craig Lillehei, and Charles Snyder,
▶Ep 28 · 34:00
quoteThe reason that we switched to this, um, is that there are, if it's clearly if airway aspiration, you go to the operating room. It's the ones you don't know. And what we found is the ones you don't know, it's a suspicious story. They were coughing after eating. Um, more often than not, it's reactive airway and it's not a foreign body.↗
▶Ep 28 · 35:00
quoteCAT scan pretty much almost a hundred percent will direct you to go to the OR or not. So it's very low radiation and it eliminates those that are equivocal of getting an unnecessary instrumentation of their airway in the face of reactive airway disease.↗
▶Ep 28 · 59:30
quoteI do believe that working with the neonatology team on the decision to operate is actually prudent. I know you were, but a lot of people get upset about that. And I do have that discussion now. Ultimately, the decision is mine. But oftentimes they do sway me.↗
Todd's statements about Congenital Pulmonary Airway Malformation9 statements
clinicalCT scan can identify multifocal disease in congenital cystic lung lesions, which may change surgical management (e.g., disease in all three lobes of one lung).↗
Panel Discussion: Pediatric Thoracic Surgery Part 1-Lung Lesions 2012
▶Ep 6 · 0:00
quoteI was sitting here thinking I've heard you give so many thoracic talks, but this is the first time I've ever heard you give everything, and watching each lobe at a time is an amazing value because you see it, it just, it all puts it together and makes sense.↗
Complications and Beyond
▶Ep 19 · 21:17
clinicalFor flat-surface bleeding from vessel stump, suture is most reliable control method; clips and staplers can worsen bleeding↗
▶Ep 19 · 21:27
clinicalSurgeons performing thoracoscopic lobectomy must be proficient in intracorporeal suturing and tying before attempting the procedure↗
▶Ep 19 · 38:20
clinicalPost-fundoplication obstruction can result from four sites: mesh, top stitch, bottom stitch, or fundus itself↗
▶Ep 19 · 43:45
opinionPatients who cycle between reflux and obstruction after multiple fundoplication revisions may never achieve perfect outcome↗
▶Ep 19 · 52:48
clinicalGastric distention from large TEF causing respiratory compromise requires emergent decompression, but decompression itself can cause hemodynamic collapse↗
▶Ep 19 · 52:59
clinicalFor EA/TEF patient decompensating from gastric distention, fastest control is open gastrostomy with immediate esophageal control rather than laparoscopic approach↗
▶Ep 19 · 1:04:31
clinicalNottingham UK group is collecting series of esophageal lung cases and seeking collaboration with other institutions↗
Todd's statements about Congenital Pulmonary Airway Malformation9 statements
clinicalCT scan can identify multifocal disease in congenital cystic lung lesions, which may change surgical management (e.g., disease in all three lobes of one lung).↗
Panel Discussion: Pediatric Thoracic Surgery Part 1-Lung Lesions 2012
▶Ep 6 · 0:00
quoteI was sitting here thinking I've heard you give so many thoracic talks, but this is the first time I've ever heard you give everything, and watching each lobe at a time is an amazing value because you see it, it just, it all puts it together and makes sense.↗
Complications and Beyond
▶Ep 19 · 21:17
clinicalFor flat-surface bleeding from vessel stump, suture is most reliable control method; clips and staplers can worsen bleeding↗
▶Ep 19 · 21:27
clinicalSurgeons performing thoracoscopic lobectomy must be proficient in intracorporeal suturing and tying before attempting the procedure↗
▶Ep 19 · 38:20
clinicalPost-fundoplication obstruction can result from four sites: mesh, top stitch, bottom stitch, or fundus itself↗
▶Ep 19 · 43:45
opinionPatients who cycle between reflux and obstruction after multiple fundoplication revisions may never achieve perfect outcome↗
▶Ep 19 · 52:48
clinicalGastric distention from large TEF causing respiratory compromise requires emergent decompression, but decompression itself can cause hemodynamic collapse↗
▶Ep 19 · 52:59
clinicalFor EA/TEF patient decompensating from gastric distention, fastest control is open gastrostomy with immediate esophageal control rather than laparoscopic approach↗
▶Ep 19 · 1:04:31
clinicalNottingham UK group is collecting series of esophageal lung cases and seeking collaboration with other institutions↗
Todd's statements about CPVT (catecholaminergic Polymorphic Ventricular Tachycardia)6 statements
quotewe talked about pain control we talked about this so that brings a perfect segue into our next session uh which is RAS↗
▶Ep 5 · 2:12
quoteYou have to get a lot of people engaged as they're going to tell us↗
▶Ep 5 · 4:38
quotethe first thing I noticed was the beautiful single sight approach↗
▶Ep 5 · 6:05
quoteat our institution we've instituted a protocol across all surgical patients, which is discharge when physiologically ready as opposed to waiting for some uh for the surgeon to come by and say yes, you're ready to go home↗
▶Ep 5 · 7:10
quoteI think we probably all have and if it's not the patient it may be the parents and uh I I would suggest that as pediatric folk, we tend to uh we tend to be a little more lenient at least I have been with uh saying sure you want to stay overnight, you can stay overnight, we'll send you home in the morning↗
▶Ep 5 · 18:53
quoteall the other things we've talked about up until ERS are things that the surgeon can pretty much decide to change their practice. Um, this one not so much. And this is such a a massive team approach↗
▶Ep 5 · 18:53
opinionERAS is such a massive team approach that it is the ultimate in multidisciplinary change↗
Update Course Rewind: 2020 ERAS
▶Ep 6 · 0:00
opinionPediatric surgery knowledge is growing exponentially, making it impossible to stay up to date.↗
▶Ep 6 · 0:00
quoteIt kind of feels impossible to stay up to date these days in pediatric surgery, and the reason you feel that way is because pediatric surgery knowledge. Is growing exponentially. It is impossible to stay up to date.↗
Todd's statements about Duodenal Atresia3 statements
BOB in Ped Surg 2023 - CIPESUR Winner - Georgina Falcioni, MD
▶Ep 3 · 6:30
opinionTelesimulation allows learners to learn from expert mentors who may not live in their city or country.↗
▶Ep 3 · 7:10
quoteSo high fidelity maybe sometimes requires, I don't know, a pump to uh make the lungs breathe or things like that. So, I think it's possible, but we are not quite there uh to do a telesimulation for high fidelity.↗
▶Ep 3 · 9:00
quoteI know that I'm not going to be nearly as good at teaching uh these these courses as Cecilia who does it all the time. I might get frustrated and say, you you suck and you know, Cecilia will will↗
Venous Thromboembolism Prophylaxis In Trauma Patients: Practice Gap...
▶Ep 1 · 0:31
opinionRecognition of pediatric VTE has increased significantly over the last 10-20 years, possibly to the point of overuse (e.g., SCDs for 30-minute inguinal hernia repairs).↗
▶Ep 1 · 0:31
opinionPediatric surgeons historically did not routinely address VTE prophylaxis, with general teaching some time ago being that kids just didn't get this problem.↗
7th Annual Pediatric Surgery Update Course 2019 - FULL SHOW
▶Ep 2 · 0:58
quoteJust two days ago, I had a baby that I was operating on. And because you taught me this, the hemoglobin, they were going to transfuse up to a hematocrit of thoracin. No, I learned from the PDC. We don't have to do that anymore. Transfuse clinically.↗
▶Ep 2 · 2:56
quoteThis single teaching point made the whole update course worth it because he didn't realize this, and it totally changed his practice.↗
▶Ep 2 · 17:16
opinionThe important point in non-operative appendicitis management is not whether it's effective for six months or a year, but what happens 10, 20, or 40 years down the road regarding appendix scarring and future obstruction↗
▶Ep 2 · 17:16
epidemiologicalIn the APAC trial (adult study), at five years, 41% of the non-operative appendicitis group underwent an appendectomy↗
▶Ep 2 · 17:16
quoteI use this as something in my back pocket now. So I don't do it, but I have it there. So if someone's not a good surgical candidate, for whatever reason, I don't want it. Then I know I have it as an option, but I don't do it.↗
▶Ep 2 · 17:16
epidemiologicalParents surveyed for PCORI-funded study said if there was a 50% chance of non-operative appendicitis management being successful, they would enroll in the study↗
▶Ep 2 · 17:16
quoteI don't know if any surgeon would look at that and go 41 percent failure rate is a success.↗
▶Ep 2 · 17:16
quoteI think the parents are more focused on the here and now. That is what's happening at that moment in the emergency room. Whereas we as their caregivers need to be thinking about what's best for the total life of the patient.↗
▶Ep 2 · 23:29
clinicalEnhanced recovery after surgery protocols have been great at reducing opioids both in the inpatient setting and at time of discharge↗
Pediatric Vascular Access
▶Ep 5 · 25:31
clinicalEthanol lock therapy has substantially decreased line removal rates and has very high success rates for treating line infections.↗
▶Ep 5 · 27:00
quotewhen we started doing that, the number of line removals substantially dropped, and the success rate is just incredibly high with the ethanol lock.↗
Todd's statements about Early Assessment and Management of Trauma2 statements
clinicalCurrent practice is more aggressive, with many surgeons performing VATS on first pneumothorax rather than waiting for recurrence↗
▶Ep 1 · 26:12
clinicalStandard VATS technique for pneumothorax includes apical wedge resection and mechanical pleurodesis by roughing the pleura with a scratch pad↗
▶Ep 1 · 27:02
clinicalSome surgeons perform mechanical pleurodesis on both visceral and parietal pleura, though this may increase air leak risk↗
▶Ep 1 · 27:02
clinicalTalc pleurodesis distributes uniformly throughout the chest during thoracoscopy but creates dense adhesions that make future thoracic surgery extremely difficult, sometimes requiring retropleural approach↗
▶Ep 1 · 27:02
quoteI've gone back on some kids that have had that have been recurrent pneumos that have had the pleural roughed up, and it looks like no one was ever there↗
▶Ep 1 · 29:20
clinicalReliable post-operative nursing surveillance is essential when omitting chest tubes after pneumothorax surgery to detect early re-accumulation↗
▶Ep 1 · 29:20
clinicalA study of 350 patients undergoing lung procedures (not specifically pneumothorax) showed no complications when chest tubes were omitted post-operatively↗
Empyema with Dr. Shawn St. Peter
▶Ep 2 · 11:09
quoteI have to tell you, Sean, after I did my first one, I walked in the next morning in the ICU. He was so sick that we transferred him to the ICU the night before. He was sitting up in bed smiling, gives me the thumbs up.↗
Empyema with Dr. Shawn St. Peter
▶Ep 3 · 17:20
quoteI walked in the next morning in the ICU. He was so sick that we transferred him to the ICU the night before. He was sitting up in bed smiling, gives me the thumbs up.↗
Empyema with Dr. Aaron Garrison
▶Ep 4 · 11:31
clinicalDr. Ponsky's study showed CT scan has 100% reliability to show an airway foreign body, with 100% sensitivity and both positive and negative predictive value.↗
▶Ep 4 · 11:48
quoteNew literature is showing that a CT scan has, um, and our study was 100% reliability to show you a airway foreign body, sensitive uh both positive and negative predictive value.↗
Todd's statements about Enterocolitis25 statements
opinionDr. Ponsky performs suction rectal biopsy in almost any patient who required a contrast enema to rule out distal obstruction, regardless of whether the enema suggests meconium plug, small left colon, or other diagnosis.↗
▶Ep 1 · 38:05
clinicalDr. Collins reports that the Duhamel pouches she has examined pathologically have contained both ganglionic and aganglionic parts.↗
Radiology and Image Diagnosis of Hirschsprung Disease
▶Ep 4 · 31:46
clinicalDr. Ponsky always performs suction rectal biopsy in almost any patient who needed a contrast enema to rule out distal obstruction, whether meconium plug, small colon, or other cause.↗
▶Ep 4 · 31:51
quoteI always do. So other than the game of am I right at getting question, can I make it even more broad? I would do it. I do it in almost any distal, any patient that needed a contrast enema.↗
▶Ep 4 · 32:15
clinicalDr. Ponsky performs rectal biopsy even in meconium ileus cases.↗
▶Ep 4 · 38:05
clinicalDr. Collins has seen resected Duhamel pouches that had both ganglionic and aganglionic parts, but does not know what their contrast enemas looked like.↗
Outcomes and Complications in Hirschsprung Disease
▶Ep 5 · 1:15:23
quoteLaparoscopy is minimally invasive but gives you actually make even better exposure, so you're not compromising exposure with laparoscopy.↗
▶Ep 5 · 1:15:23
opinionLaparoscopy is minimally invasive but provides even better exposure than open surgery; small umbilical incisions compromise exposure.↗
Hirschsprung Disease: Update Course 2015
▶Ep 7 · 4:22
opinionPure transanal pull-through may not be less invasive than laparoscopic approach, as prolonged torquing in the anal canal can be more traumatic than three small abdominal incisions.↗
▶Ep 7 · 4:22
quoteI don't believe that a pure trans anal is necessarily less invasive. In other words, I believe that putting 3 incisions on the abdomen is actually less invasive in my hands, in my hands, certainly not in your guys' hands, but in my hands, I'm gonna be torquing in that anal canal much more than if I had done it laparoscopically and freed everything up from the abdominal approach.↗
Hirschsprung Disease: Radiology Aspect
▶Ep 8 · 31:01
clinicalRectal biopsy should be performed in almost any patient who needed a contrast enema to rule out distal obstruction, including cases of meconium plug or small left colon.↗
▶Ep 8 · 31:12
quoteI would do it. I do it in almost any distal, any patient that needed a contrast enema. To rule out a distal obstruction, I'm going to be doing a suction rectal biopsy, whether it's meconium plug or a small colon.↗
▶Ep 8 · 31:35
clinicalIn clearly documented meconium ileus where reflux into terminal ileum is achieved and the patient clinically improves, rectal biopsy may not be necessary.↗
Hirschsprung Disease: Cases and Complications
▶Ep 9 · 33:44
quoteThe interface between the ganglionic bowel and the a ganglion bowel can be very irregular and can project for 234 centimeters longer along one part of the circumference than the other, so that even if you just look at a longitudinal strip. You could see gangon cells at the proximal margin, but on the opposite side of that margin there may be no gangon cells, and so you may be dealing with a, a low transition zone pull through in that situation.↗
▶Ep 9 · 1:15:24
opinionLaparoscopy is minimally invasive but provides maybe even better exposure than open surgery, so exposure is not compromised with laparoscopy.↗
▶Ep 9 · 1:39:29
clinicalEnterocolitis does not occur in pure anorectal malformations without Hirschsprung disease.↗
Hirschsprung Disease: Update Course 2013
▶Ep 10 · 1:45
opinionIn newborn bowel obstruction with distended abdomen and distal air, start with contrast enema rather than upper GI↗
▶Ep 10 · 2:11
clinicalBilious emesis typically prompts upper GI, but newborn distal obstruction is an exception where contrast enema is more informative↗
▶Ep 10 · 4:51
guidelineTissue diagnosis is absolutely required before operating for Hirschsprung disease↗
▶Ep 10 · 28:51
opinionIn older children (age 2-3 and up), suction rectal biopsy should not be performed; instead do open rectal biopsy under general anesthesia↗
▶Ep 10 · 30:06
opinionIn 3-year-old with severely dilated colon from chronic Hirschsprung disease, the dilated segment is unlikely to collapse and should be resected↗
Hirschsprung Disease: Update Course 2013
▶Ep 11 · 1:59
opinionIn newborn bowel obstruction with distal air, contrast enema should precede upper GI unless clinical presentation strongly suggests malrotation↗
▶Ep 11 · 9:57
opinionProne positioning for pull-through is easier on surgeon's back and neck compared to lithotomy↗
Colorectal - Clinical Practice Updates
▶Ep 12 · 14:14
quoteIs there any evidence for anything that, that y'all have mentioned? I mean, it seems like this is the right topic to try to get some better evidence for it, but I'm just interested to know, is there evidence for what y'all are, for any of these uh suggested treatments.↗
▶Ep 12 · 43:34
quoteI'll just raise my standard thing that I always raise, which is why are we getting a CAT scan?↗
Todd's statements about Enterocolitis25 statements
opinionDr. Ponsky performs suction rectal biopsy in almost any patient who required a contrast enema to rule out distal obstruction, regardless of whether the enema suggests meconium plug, small left colon, or other diagnosis.↗
▶Ep 1 · 38:05
clinicalDr. Collins reports that the Duhamel pouches she has examined pathologically have contained both ganglionic and aganglionic parts.↗
Radiology and Image Diagnosis of Hirschsprung Disease
▶Ep 4 · 31:46
clinicalDr. Ponsky always performs suction rectal biopsy in almost any patient who needed a contrast enema to rule out distal obstruction, whether meconium plug, small colon, or other cause.↗
▶Ep 4 · 31:51
quoteI always do. So other than the game of am I right at getting question, can I make it even more broad? I would do it. I do it in almost any distal, any patient that needed a contrast enema.↗
▶Ep 4 · 32:15
clinicalDr. Ponsky performs rectal biopsy even in meconium ileus cases.↗
▶Ep 4 · 38:05
clinicalDr. Collins has seen resected Duhamel pouches that had both ganglionic and aganglionic parts, but does not know what their contrast enemas looked like.↗
Outcomes and Complications in Hirschsprung Disease
▶Ep 5 · 1:15:23
opinionLaparoscopy is minimally invasive but provides even better exposure than open surgery; small umbilical incisions compromise exposure.↗
▶Ep 5 · 1:15:23
quoteLaparoscopy is minimally invasive but gives you actually make even better exposure, so you're not compromising exposure with laparoscopy.↗
Hirschsprung Disease: Update Course 2015
▶Ep 7 · 4:22
quoteI don't believe that a pure trans anal is necessarily less invasive. In other words, I believe that putting 3 incisions on the abdomen is actually less invasive in my hands, in my hands, certainly not in your guys' hands, but in my hands, I'm gonna be torquing in that anal canal much more than if I had done it laparoscopically and freed everything up from the abdominal approach.↗
▶Ep 7 · 4:22
opinionPure transanal pull-through may not be less invasive than laparoscopic approach, as prolonged torquing in the anal canal can be more traumatic than three small abdominal incisions.↗
Hirschsprung Disease: Radiology Aspect
▶Ep 9 · 31:01
clinicalRectal biopsy should be performed in almost any patient who needed a contrast enema to rule out distal obstruction, including cases of meconium plug or small left colon.↗
▶Ep 9 · 31:12
quoteI would do it. I do it in almost any distal, any patient that needed a contrast enema. To rule out a distal obstruction, I'm going to be doing a suction rectal biopsy, whether it's meconium plug or a small colon.↗
▶Ep 9 · 31:35
clinicalIn clearly documented meconium ileus where reflux into terminal ileum is achieved and the patient clinically improves, rectal biopsy may not be necessary.↗
Hirschsprung Disease: Cases and Complications
▶Ep 8 · 33:44
quoteThe interface between the ganglionic bowel and the a ganglion bowel can be very irregular and can project for 234 centimeters longer along one part of the circumference than the other, so that even if you just look at a longitudinal strip. You could see gangon cells at the proximal margin, but on the opposite side of that margin there may be no gangon cells, and so you may be dealing with a, a low transition zone pull through in that situation.↗
▶Ep 8 · 1:15:24
opinionLaparoscopy is minimally invasive but provides maybe even better exposure than open surgery, so exposure is not compromised with laparoscopy.↗
▶Ep 8 · 1:39:29
clinicalEnterocolitis does not occur in pure anorectal malformations without Hirschsprung disease.↗
Hirschsprung Disease: Update Course 2013
▶Ep 10 · 1:45
opinionIn newborn bowel obstruction with distended abdomen and distal air, start with contrast enema rather than upper GI↗
▶Ep 10 · 2:11
clinicalBilious emesis typically prompts upper GI, but newborn distal obstruction is an exception where contrast enema is more informative↗
▶Ep 10 · 4:51
guidelineTissue diagnosis is absolutely required before operating for Hirschsprung disease↗
▶Ep 10 · 28:51
opinionIn older children (age 2-3 and up), suction rectal biopsy should not be performed; instead do open rectal biopsy under general anesthesia↗
▶Ep 10 · 30:06
opinionIn 3-year-old with severely dilated colon from chronic Hirschsprung disease, the dilated segment is unlikely to collapse and should be resected↗
Hirschsprung Disease: Update Course 2013
▶Ep 11 · 1:59
opinionIn newborn bowel obstruction with distal air, contrast enema should precede upper GI unless clinical presentation strongly suggests malrotation↗
▶Ep 11 · 9:57
opinionProne positioning for pull-through is easier on surgeon's back and neck compared to lithotomy↗
Colorectal - Clinical Practice Updates
▶Ep 12 · 14:14
quoteIs there any evidence for anything that, that y'all have mentioned? I mean, it seems like this is the right topic to try to get some better evidence for it, but I'm just interested to know, is there evidence for what y'all are, for any of these uh suggested treatments.↗
▶Ep 12 · 43:34
quoteI'll just raise my standard thing that I always raise, which is why are we getting a CAT scan?↗
Todd's statements about Epigastric Hernia15 statements
Laparoscopic Epigastric Herniorrhaphy-Case and Discussion: Pediatric Surgery...
▶Ep 1 · 6:01
clinicalAsymptomatic epigastric hernias may enlarge into adulthood, especially after pregnancy in females, potentially requiring mesh rather than primary closure.↗
▶Ep 1 · 7:57
clinicalSome large adult epigastric hernias require mesh repair.↗
▶Ep 1 · 8:40
clinicalOliver Munster presented the same laparoscopic technique at IPEG in Beijing.↗
▶Ep 1 · 8:50
clinicalScars in young children grow proportionally as the child grows.↗
▶Ep 1 · 8:55
opinionHiding the scar in the umbilicus offers a cosmetic advantage over midline epigastric scars.↗
▶Ep 1 · 9:30
clinicalA supraumbilical or periumbilical incision can reach epigastric hernias located halfway to the xiphoid process, based on experience with pyloric stenosis operations.↗
▶Ep 1 · 13:45
opinionIt is difficult to visualize true epigastric hernias (epiplocoeles with preperitoneal fat only) laparoscopically.↗
quoteI, you know, I treat this like an epigastric hernia. I, I have the discussion with the family. I don't have a definitive way.↗
▶Ep 3 · 7:01
opinionUsing a needle for aspiration is risky because as the lung expands, you risk poking a hole in it; an angiocath is preferred.↗
▶Ep 3 · 7:01
quoteFirst of all, a needle scares me cause as soon as it expands, you're gonna poke a hole in it.↗
▶Ep 3 · 7:07
clinicalOne approach is to put in a pigtail catheter and leave it in (rather than using an angiocath), then aspirate, clamp, and obtain an X-ray.↗
▶Ep 3 · 7:18
opinionSpontaneous pneumothorax is a different disease than traumatic pneumothorax, and patients are never seen in extremis from spontaneous pneumothorax.↗
▶Ep 3 · 7:18
quoteI've never seen a patient in extremists from a spontaneous pneumothorax.↗
▶Ep 3 · 7:29
quoteAnd so it's a different disease than a traumatic pneumothorax.↗
▶Ep 3 · 7:32
opinionDespite a 44% recurrence rate after successful aspiration, most patients choose conservative management rather than immediate definitive surgery because the chance of a problem from spontaneous pneumothorax is low.↗
Todd's statements about Esophageal Atresia18 statements
Glycopyrrolate for Anastomtic Dehiscence in Esophageal Atresia
▶Ep 2 · 1:32
quoteOK, so the results are pretty astounding. The Robinol or the glycopyrolate group really had impressive results compared to the placebo group.↗
▶Ep 2 · 1:56
quoteI think this is a great study to review because it's a novel treatment that can have substantial effect on a very complicated problem we all deal with. I know that I'll change my practice based on this and start giving Roben all to my, uh, leaks after TEF repair↗
▶Ep 2 · 1:56
opinionGlycopyrrolate is a novel treatment that can have substantial effect on the complicated problem of anastomotic leak after esophageal atresia repair↗
Thoracoscopic TEF Repair, Is It Really Better Than Open? Update Course 2018
▶Ep 3 · 0:00
quoteEvery year we try to do a session on technique and um so this year, uh, Doctor Rothenberg is going to talk to us about the thoracoscopic TEF.↗
▶Ep 3 · 14:15
quotethe more shocking thing to me was that I thought that's higher than I would have expected for the world.↗
▶Ep 3 · 17:00
quoteI think I'd be very cautious about a broad paint stroke of all. EA's being repaired thoracoscopically because there's, uh, we selectively choose the ones, so that we can get optimize the outcomes based on the technique and skill of the surgeon.↗
Aerodigestive & Esophageal Surgery - The Unsalvageable Esophagus & Cases
▶Ep 1 · 2:14
quoteSome people believe that you have to use a scope to measure the true gap. I may not be at the end.↗
▶Ep 1 · 2:14
quoteSome people believe that you have to use a scope to measure the true gap. I may not be at the end.↗
▶Ep 1 · 2:21
clinicalIn long-gap atresia, some surgeons use a Hagar dilator to measure the gap, but this may not reach the true end of the distal pouch. A flexible scope is more reliable for accurate gap measurement.↗
▶Ep 1 · 2:21
clinicalIn long-gap atresia, some surgeons use a Hagar dilator to measure the gap, but this may not reach the true end of the distal pouch. A flexible scope is more reliable for accurate gap measurement.↗
clinicalIn experimental porcine models of endoscopic Foker (using olive beads and wire traction), pressure necrosis at the anastomotic site is the suspected cause of death.↗
▶Ep 1 · 6:32
clinicalIn experimental porcine models of endoscopic Foker (using olive beads and wire traction), pressure necrosis at the anastomotic site is the suspected cause of death.↗
clinicalIntraluminal magnetic anastomosis is being developed as a minimally invasive approach to long-gap atresia, with the goal of reducing pressure necrosis compared to bead-based traction.↗
▶Ep 1 · 7:00
clinicalIntraluminal magnetic anastomosis is being developed as a minimally invasive approach to long-gap atresia, with the goal of reducing pressure necrosis compared to bead-based traction.↗
▶Ep 1 · 10:52
quoteThe whole big controversial thing is, do, are we trying too hard to save the esophagus?↗
▶Ep 1 · 10:52
quoteThe whole big controversial thing is, do, are we trying too hard to save the esophagus?↗
Todd's statements about Esophageal Atresia6 statements
Glycopyrrolate for Anastomtic Dehiscence in Esophageal Atresia
▶Ep 1 · 1:32
quoteOK, so the results are pretty astounding. The Robinol or the glycopyrolate group really had impressive results compared to the placebo group.↗
▶Ep 1 · 1:56
opinionGlycopyrrolate is a novel treatment that can have substantial effect on the complicated problem of anastomotic leak after esophageal atresia repair↗
▶Ep 1 · 1:56
quoteI think this is a great study to review because it's a novel treatment that can have substantial effect on a very complicated problem we all deal with. I know that I'll change my practice based on this and start giving Roben all to my, uh, leaks after TEF repair↗
Thoracoscopic TEF Repair, Is It Really Better Than Open? Update Course 2018
▶Ep 2 · 0:00
quoteEvery year we try to do a session on technique and um so this year, uh, Doctor Rothenberg is going to talk to us about the thoracoscopic TEF.↗
▶Ep 2 · 14:15
quotethe more shocking thing to me was that I thought that's higher than I would have expected for the world.↗
▶Ep 2 · 17:00
quoteI think I'd be very cautious about a broad paint stroke of all. EA's being repaired thoracoscopically because there's, uh, we selectively choose the ones, so that we can get optimize the outcomes based on the technique and skill of the surgeon.↗
Summaries Todd gave as host
· 511 summaries
Recaps of what the experts said, with Todd as narrator — not Todd's own clinical position, and never cited in answers.
Summaries Todd gave as host · Abdominal Compartment Syndrome2 summaries
Approach and component separation for suture closure and underlay mesh...
▶Ep 1 · 3:16
host summaryTodd Ponsky summarizing the discussion: Dr. Abello's Duoderm technique involves creating T-shaped Duoderm pieces that form an external silo, which is progressively compressed like gastroschisis reduction over approximately 1-2 weeks↗
▶Ep 1 · 23:10
host summaryTodd Ponsky summarizing the discussion: Cardiac surgeons report biologic patches in VSD closure turn into cardiac muscle↗
Summaries Todd gave as host · Abdominal Wall Defects22 summaries
Approach and component separation for suture closure and underlay mesh...
▶Ep 1 · 3:16
host summaryTodd Ponsky summarizing the discussion: Dr. Abello's Duoderm technique involves creating T-shaped Duoderm pieces that form an external silo, which is progressively compressed like gastroschisis reduction over approximately 1-2 weeks↗
▶Ep 1 · 23:10
host summaryTodd Ponsky summarizing the discussion: Cardiac surgeons report biologic patches in VSD closure turn into cardiac muscle↗
Abdominal Wall Defects with Dr. Jacob Langer
▶Ep 6 · 14:19
host summaryTodd Ponsky summarizes what Dr. Jack Langer said: Dr. Baird published a paper in JPS showing that patients with flap closure did better in every way than those with sutured fascial closure, including lower rates of umbilical hernia repair↗
▶Ep 6 · 37:22
host summaryTodd Ponsky summarizes what Dr. Jack Langer said: Cristobal Abello in Colombia uses Duoderm over the sac to compress and reduce omphaloceles over time↗
7th Annual Pediatric Surgery Update Course 2019 - FULL SHOW
▶Ep 15 · 2:56
host summaryTodd Ponsky summarizing the discussion: This single teaching point made the whole update course worth it because he didn't realize this, and it totally changed his practice.↗
▶Ep 15 · 17:16
host summaryTodd Ponsky summarizing the discussion: I think the parents are more focused on the here and now. That is what's happening at that moment in the emergency room. Whereas we as their caregivers need to be thinking about what's best for the total life of the patient.↗
▶Ep 15 · 17:16
host summaryTodd Ponsky summarizing the discussion: The important point in non-operative appendicitis management is not whether it's effective for six months or a year, but what happens 10, 20, or 40 years down the road regarding appendix scarring and future obstruction↗
▶Ep 15 · 17:16
host summaryTodd Ponsky summarizing the discussion: In the APAC trial (adult study), at five years, 41% of the non-operative appendicitis group underwent an appendectomy↗
▶Ep 15 · 17:16
host summaryTodd Ponsky summarizing the discussion: Parents surveyed for PCORI-funded study said if there was a 50% chance of non-operative appendicitis management being successful, they would enroll in the study↗
▶Ep 15 · 23:29
host summaryTodd Ponsky summarizing the discussion: Enhanced recovery after surgery protocols have been great at reducing opioids both in the inpatient setting and at time of discharge↗
Umbilical Cord Defects with Dr. Kenneth Azarow
▶Ep 21 · 4:54
host summaryTodd Ponsky summarizes what Dr. Kenneth Azarow said: Emerging anesthesia data suggesting risks of operating before age 2–3 provides additional support for delaying umbilical hernia repair.↗
▶Ep 21 · 13:45
host summaryTodd Ponsky summarizes what Dr. Kenneth Azarow said: A Canadian study by Dr. Baird's group showed that gastroschisis patients closed with sutures had higher rates of subsequent umbilical hernia repair compared to sutureless closure.↗
Abdominal Wall Defects with Dr. Jacob Langer
▶Ep 20 · 13:15
host summaryTodd Ponsky summarizes what Dr. Jack Langer said: The sutureless plastic closure technique was described by Anthony Sandler and doesn't require suturing the umbilical cord↗
▶Ep 20 · 14:19
host summaryTodd Ponsky summarizes what Dr. Jack Langer said: A study by Dr. Baird published in JPS showed that patients with flap closure did better in every way than those with sutured fascial closure, including lower rates of umbilical hernia repair↗
Omphalocele and Gastroschisis With Dr. Foong-Yen Lim
▶Ep 25 · 3:15
host summaryTodd Ponsky summarizes what Dr. Fung Lim said: Gastroschisis affects approximately one in every 2,200 live births.↗
▶Ep 25 · 6:34
host summaryTodd Ponsky summarizes what Dr. Fung Lim said: In the last four and a half years at Cincinnati Children's Hospital, majority of babies are managed using sutureless closure.↗
▶Ep 25 · 8:17
host summaryTodd Ponsky summarizes what Dr. Fung Lim said: At Cincinnati Children's, Duoderm silo is placed on top of the skin of the patient, formed over the omphalocele, and plastic clips are used to sequentially clip it down until it's flush to the abdominal skin.↗
Update Course 2021: UPDATE COURSE 2020: REVIEW OF LAST YEAR'S IMPORTANT T OPICS
▶Ep 28 · 10:50
host summaryTodd Ponsky summarizing the discussion: There are case reports showing mucosal sloughing with phenol sclerotherapy.↗
▶Ep 28 · 10:50
host summaryTodd Ponsky summarizing the discussion: Deflux, a compound used by urology for vesicoureteral reflux, has been reported in case reports for rectal prolapse sclerotherapy.↗
▶Ep 28 · 11:20
host summaryTodd Ponsky summarizing the discussion: I think there's also case reports that show mucosal sloughing with phenol.↗
Update Course 2022 - UPDATES IN GASTROSCHISIS FEEDING PROTOCOLS - Jason Fraser, Beth Rymeski, and Steven Lee
▶Ep 29 · 0:00
host summaryTodd Ponsky summarizing the discussion: Several hospitals have changed their gastroschisis protocols based on recent publications.↗
▶Ep 29 · 0:00
host summaryTodd Ponsky summarizing the discussion: we got feedback that several hospitals have changed their gastro schesis protocols based on recent publications↗
Summaries Todd gave as host · Achalasia5 summaries
host summaryTodd Ponsky summarizes what Dr. Jaimie Nathan said: Dr. Jamie Nathan is assistant professor of surgery and pediatrics, a pediatric and transplant surgeon, and surgical director of the Pancreas Care Center at Cincinnati Children's↗
host summaryTodd Ponsky summarizing the discussion: Approximately 50% of chronic pancreatitis patients will eventually require surgery, with the most common indication being debilitating pain that fails to respond to medical and endoscopic treatment.↗
▶Ep 6 · 43:20
host summaryTodd Ponsky summarizing the discussion: There is no clear consensus on optimal timing for surgical intervention in chronic pancreatitis; some advocate earlier surgery to avoid progressive inflammatory destruction, while others prefer a watch-and-wait approach due to variable surgical success rates.↗
▶Ep 6 · 45:50
host summaryTodd Ponsky summarizing the discussion: Puestow procedure provides short-term pain relief in 75% of patients, but greater than 50% have recurrent pain, largely related to inability to fully decompress the duct or continued inflammation in the pancreatic head.↗
▶Ep 6 · 48:20
host summaryTodd Ponsky summarizing the discussion: Whipple procedure for chronic pancreatitis provides good pain relief at 4-6 years but results in late endocrine and exocrine dysfunction in approximately 50% of patients.↗
▶Ep 6 · 49:10
host summaryTodd Ponsky summarizing the discussion: Duodenum-preserving pancreatic head resections (Beger, Frey) achieve benefits of head resection and duct decompression while preserving bile duct and GI continuity.↗
▶Ep 6 · 49:40
host summaryTodd Ponsky summarizing the discussion: The Beger procedure provides good pain relief in 80-85% of patients maintained at 5 years with minimal endocrine and exocrine insufficiency compared to Whipple, based on adult data.↗
▶Ep 6 · 50:50
host summaryTodd Ponsky summarizing the discussion: The Frey procedure shows equivalent pain relief (85-90%) and quality of life outcomes compared to Beger procedure in adults.↗
▶Ep 6 · 51:20
host summaryTodd Ponsky summarizing the discussion: For conventional surgical procedures in chronic pancreatitis, about 50% of patients have recurrence of pain over the long term based on adult data, with no long-term pediatric data available.↗
Summaries Todd gave as host · Acute Recurrent Pancreatitis1 summary
host summaryTodd Ponsky summarizes what Dr. Jaimie Nathan said: Dr. Jamie Nathan is assistant professor of surgery and pediatrics, a pediatric and transplant surgeon, and surgical director of the Pancreas Care Center at Cincinnati Children's↗
Summaries Todd gave as host · Advances in Pediatric Surgery1 summary
2025 Pediatric Surgery Update Course - Updates in Pediatric Surgery feat. non-JPS Journals
▶Ep 2 · 0:00
host summaryTodd Ponsky summarizing the discussion: Jose came up to me at a conference and said, Todd, it's nice to meet you. Thank you for this uptakes course, but it's not very good. Because you only talk about stuff that's in the pediatric journals. And you're missing all the publications that are in the non-pediatric surgery journals.↗
Summaries Todd gave as host · Aerodigestive / ENT12 summaries
Aerodigestive & Esophageal Surgery - The Unsalvageable Esophagus & Cases
▶Ep 3 · 1:40:28
host summaryTodd Ponsky summarizing the discussion: Absolutely amazing webinar, some amazing cases with excellent skills that you all brought today. I'm happy that you all are there for us when these cases get beyond the norm.↗
TEF Presentations (Extended): Aerodigestive & Esophageal Surgery
▶Ep 4 · 45:31
host summaryTodd Ponsky summarizing the discussion: Dead button batteries still have about 2 volts and continue to cause damage.↗
▶Ep 4 · 45:31
host summaryTodd Ponsky summarizing the discussion: When they're dead, they're still not dead. They're still going. They got about 2 volts↗
▶Ep 4 · 45:37
host summaryTodd Ponsky summarizing the discussion: Button batteries can be distinguished from coins on AP X-ray by a visible rim, eliminating the need for a lateral view.↗
QUAD #1: Cervical Tracheopexy with Dr. Alessandro de Alarcon
▶Ep 16 · 0:55
host summaryTodd Ponsky summarizes what Dr. Alessandro de Alarcon said: Preoperative testing includes dynamic CT imaging, pulmonary function tests, microlaryngoscopy and bronchoscopy, and flexible bronchoscopy.↗
▶Ep 16 · 2:01
host summaryTodd Ponsky summarizes what Dr. Alessandro de Alarcon said: The cervical approach can assist thoracoscopic procedures by removing residual or regrown large thymus tissue.↗
▶Ep 16 · 2:19
host summaryTodd Ponsky summarizes what Dr. Alessandro de Alarcon said: In the lateral approach, the surgical team works on the side of the airway to find the esophagus.↗
▶Ep 16 · 2:23
host summaryTodd Ponsky summarizes what Dr. Alessandro de Alarcon said: Pediatric surgeons identify the recurrent nerve for the ENT team to help prevent injury.↗
▶Ep 16 · 2:43
host summaryTodd Ponsky summarizes what Dr. Alessandro de Alarcon said: The esophagus is mobilized above the level where the team aims to perform the pexy, making suture placement easier.↗
▶Ep 16 · 3:02
host summaryTodd Ponsky summarizes what Dr. Alessandro de Alarcon said: A pulmonologist assists with flexible endoscopy through the endotracheal tube to visualize inside the trachea while stitches are placed.↗
▶Ep 16 · 3:24
host summaryTodd Ponsky summarizes what Dr. Alessandro de Alarcon said: The combined approach is valuable for complicated cases or patients needing additional operations for symptom relief.↗
▶Ep 16 · 4:32
host summaryTodd Ponsky summarizes what Dr. Alessandro de Alarcon said: Otolaryngology involvement is important both during the procedure and in follow-up due to potential complications.↗
Summaries Todd gave as host · Anorectal Malformation19 summaries
host summaryTodd Ponsky summarizing a resource: we've all been taught over the years that when we do a colostomy for an anal rectal malformation, we should do a divided colostomy, and the main reason to do that is to prevent stool flowing down that could cause a urinary tract infection.↗
▶Ep 1 · 0:08
host summaryTodd Ponsky summarizing a resource: Traditional teaching holds that divided colostomy should be performed for anorectal malformations to prevent stool flowing down that could cause urinary tract infection.↗
▶Ep 1 · 0:24
host summaryTodd Ponsky summarizing a resource: Dr. Robert Baird performed a meta-analysis of multiple studies comparing divided colostomy versus loop colostomy for anorectal malformations.↗
▶Ep 1 · 0:27
host summaryTodd Ponsky summarizing a resource: The meta-analysis found no statistically significant difference in urinary tract infection incidence between divided colostomy and loop colostomy.↗
▶Ep 1 · 0:39
host summaryTodd Ponsky summarizing a resource: Some individual studies within the meta-analysis showed a difference in UTI rates, but the overall meta-analysis showed no statistical difference.↗
▶Ep 1 · 0:51
host summaryTodd Ponsky summarizing a resource: Loop colostomies had a significantly higher stoma prolapse rate compared to divided colostomies.↗
▶Ep 1 · 1:05
host summaryTodd Ponsky summarizing a resource: Skin excoriation, stoma retraction, peristomal hernia, wound infection, and stoma stricture showed no statistical difference between loop colostomy and divided colostomy.↗
▶Ep 1 · 1:22
host summaryTodd Ponsky summarizing a resource: there we go, we've challenged dogma, and it seems like dogma necessarily at this point doesn't seem to hold true.↗
Challenging Dogma: Does Colostomy Type Matter?
▶Ep 3 · 0:08
host summaryTodd Ponsky summarizing a resource: Traditional teaching advocates for divided colostomy when performing colostomy for anorectal malformation, with the main rationale being prevention of stool flowing down that could cause urinary tract infection.↗
▶Ep 3 · 0:08
host summaryTodd Ponsky summarizing a resource: we've all been taught over the years that when we do a colostomy for an anal rectal malformation, we should do a divided colostomy, and the main reason to do that is to prevent stool flowing down that could cause a urinary tract infection.↗
▶Ep 3 · 0:24
host summaryTodd Ponsky summarizing a resource: Dr. Robert Baird performed a meta-analysis of multiple studies comparing divided colostomy versus loop colostomy for incidence of UTI.↗
▶Ep 3 · 0:27
host summaryTodd Ponsky summarizing a resource: he found no difference.↗
▶Ep 3 · 0:27
host summaryTodd Ponsky summarizing a resource: The meta-analysis found no statistically significant difference in UTI rates between loop colostomy and divided colostomy, despite some individual studies showing a difference.↗
▶Ep 3 · 0:51
host summaryTodd Ponsky summarizing a resource: the loop colostomies actually had a higher, significantly higher stoma prolapse rate.↗
▶Ep 3 · 0:51
host summaryTodd Ponsky summarizing a resource: Loop colostomies had a significantly higher stoma prolapse rate compared to divided colostomies.↗
▶Ep 3 · 1:05
host summaryTodd Ponsky summarizing a resource: Skin excoriation, stoma retraction, peristomal hernia, wound infection, and stoma stricture showed no statistical difference between loop colostomy and divided colostomy.↗
Posterior Sagittal Anorectaplasty in a Female: Pediatric Colorectal...
▶Ep 27 · 2:10
host summaryTodd Ponsky summarizing the discussion: Total body prep from nipples to toes is standard for these patients, allowing flexibility to flip between supine and prone positions↗
host summaryTodd Ponsky summarizing the discussion: The standard Hagar dilator size for a newborn is about size 12, so a size 10 is 2 deviations less.↗
▶Ep 45 · 2:16
host summaryTodd Ponsky summarizing the discussion: In the dilation study with 25 children, the types of malformations were evenly distributed and complexity was about equal.↗
Summaries Todd gave as host · Appendicitis40 summaries
Appendicitis Irrigation Technique with ZERO Abscesses!
▶Ep 1 · 0:00
host summaryTodd Ponsky summarizes what Dr. Maria Libertin said: So they decided to do a review to show him that this was overkill. However, the results may surprise you.↗
▶Ep 1 · 0:00
host summaryTodd Ponsky summarizes what Dr. Maria Libertin said: His partners thought it was crazy.↗
▶Ep 1 · 0:00
host summaryTodd Ponsky summarizes what Dr. Maria Libertin said: A prior study from Kansas City showed no difference in outcomes between irrigation and no irrigation in perforated appendicitis↗
▶Ep 1 · 2:16
host summaryTodd Ponsky summarizes what Dr. Maria Libertin said: The technique has drawbacks including tediousness and time added to the operation↗
▶Ep 1 · 2:16
host summaryTodd Ponsky summarizes what Dr. Maria Libertin said: The main takeaway from this study is that previous studies have told us that irrigation has no difference in the outcome. And here we have a study that's reopening that discussion for us to look further into.↗
▶Ep 1 · 3:04
host summaryTodd Ponsky summarizes what Dr. Maria Libertin said: The group that did not use the intensive irrigation technique had approximately 6% post-operative abscess rate↗
Standardization of Care for Pediatric Perforated Appendicitis
▶Ep 2 · 0:06
host summaryTodd Ponsky summarizing a resource: The new pathway established criteria for the use of postoperative TPN in perforated appendicitis.↗
▶Ep 2 · 0:06
host summaryTodd Ponsky summarizing a resource: The new pathway established criteria for the use of postoperative imaging in perforated appendicitis.↗
▶Ep 2 · 0:06
host summaryTodd Ponsky summarizing a resource: The new pathway established criteria for the use of postoperative invasive procedures such as draining an abscess.↗
▶Ep 2 · 0:06
host summaryTodd Ponsky summarizing a resource: The study prospectively evaluated outcomes of all children treated on the new standardized protocol over 20 months.↗
▶Ep 2 · 0:06
host summaryTodd Ponsky summarizing a resource: Median follow-up time post-discharge was 14 days in the pre-standardized group.↗
▶Ep 2 · 0:06
host summaryTodd Ponsky summarizing a resource: Median follow-up time post-discharge was 25 days in the post-standardized group.↗
▶Ep 2 · 0:06
host summaryTodd Ponsky summarizing a resource: Standardization significantly reduced postoperative abscess in perforated appendicitis.↗
▶Ep 2 · 0:06
host summaryTodd Ponsky summarizing a resource: Standardization of Care for Pediatric Perforated Appendicitis Improves Outcomes.↗
▶Ep 2 · 0:06
host summaryTodd Ponsky summarizing a resource: The study compared prospective outcomes to all patients treated in the 58 months prior to standardization.↗
▶Ep 2 · 0:06
host summaryTodd Ponsky summarizing a resource: The hospital had a clinical pathway in place for about 30 years before implementing a new pathway in 2015.↗
▶Ep 2 · 0:06
host summaryTodd Ponsky summarizing a resource: The new pathway initiated a disease severity classification for perforated appendicitis.↗
▶Ep 2 · 0:06
host summaryTodd Ponsky summarizing a resource: The new pathway refined discharge criteria for perforated appendicitis.↗
▶Ep 2 · 0:06
host summaryTodd Ponsky summarizing a resource: The new pathway standardized the operative technique for perforated appendicitis.↗
▶Ep 2 · 0:06
host summaryTodd Ponsky summarizing a resource: Standardization reduced the odds of developing a postoperative abscess by 4 times.↗
▶Ep 2 · 0:06
host summaryTodd Ponsky summarizing a resource: Standardization significantly reduced hospital stay in perforated appendicitis.↗
Peritoneal Access
▶Ep 8 · 1:00
host summaryTodd Ponsky summarizing a resource: Optical trocar (Optiview) is useful when not accessing through the umbilicus.↗
▶Ep 8 · 6:00
host summaryTodd Ponsky summarizing a resource: Keith Jorgenson taught the technique of inserting the trocar angled toward the spleen.↗
▶Ep 8 · 10:00
host summaryTodd Ponsky summarizing a resource: All these things are great. All these things are important. The the key to success is that when you keep doing the same thing over and over and over again is how you minimize. It's when you start trying new tricks and techniques is when you end up getting injuries.↗
▶Ep 8 · 10:00
host summaryTodd Ponsky summarizing a resource: Scott Bollinger stated that performing the same technique repeatedly minimizes complications, while trying new techniques increases injury risk.↗
▶Ep 8 · 27:00
host summaryTodd Ponsky summarizing a resource: Steve Rothenberg states that two months is the age after which the umbilical vein is no longer a concern, though the source of this cutoff is unclear.↗
▶Ep 8 · 30:00
host summaryTodd Ponsky summarizing a resource: Steve Rothenberg presented 12 cases of CO2 embolization at IPEG, and he reports knowing of 15 total cases.↗
▶Ep 8 · 33:00
host summaryTodd Ponsky summarizing a resource: Transesophageal echocardiography has been discussed as an urgent diagnostic tool for suspected CO2 embolization.↗
▶Ep 8 · 36:00
host summaryTodd Ponsky summarizing a resource: Steve Rothenberg believes CO2 embolization can occur even without direct needle or trocar placement in the vein, possibly by damaging the vein during passage and allowing CO2 to enter the venous system during peritoneal insufflation.↗
▶Ep 8 · 36:00
host summaryTodd Ponsky summarizing a resource: He believes somehow there's a way to damage the vein on the way in and insufflate into the peritoneum like you're supposed to, but have the CO2 rush back up and go through the vein.↗
▶Ep 8 · 37:00
host summaryTodd Ponsky summarizing a resource: Steve Rothenberg's opinion is that infra-umbilical Hasson approach is safer, and all other techniques (not using infra-umbilical incision) are at risk for CO2 embolization.↗
Perforated Appendicitis
▶Ep 9 · 8:30
host summaryTodd Ponsky summarizing the discussion: When patients with stool in the abdomen or a hole in the appendix were grouped together as perforated, those without either finding had an abscess incidence of less than 5%.↗
▶Ep 9 · 8:50
host summaryTodd Ponsky summarizing the discussion: the way Sean explained it to me is in the it when they grouped stool in the abdomen or a hole in the appendix, when they took all of those patients that didn't have either of those, the incidence of abscess was less than 5%.↗
Evidence-based diagnosis and management of pediatric appendicitis with Dr. Whit Holcomb
▶Ep 12 · 30:23
host summaryTodd Ponsky summarizes what Dr. Whit Holcomb said: Wound infection rate was 3.3% (6/180) for single-incision versus 1.7% (3/180) for three-port, p=0.5, not statistically different↗
Journal Club: Appendicitis in 2021
▶Ep 14 · 9:56
host summaryTodd Ponsky summarizes what Dr. Jose Campos said: These four intraoperative findings were associated with higher adverse effects, higher length of stay, higher emergency visits, and higher use of hospital and patient resources after adjusting for all variables.↗
Update Course 2021: TOP PUBLICATIONS IN NON - PED SURG JOURNALS
▶Ep 3 · 1:53
host summaryTodd Ponsky summarizing the discussion: The curation process filters approximately 1200 articles per month from 33 pediatric and general surgical journals plus 3 top clinical journals (NEJM, Lancet, JAMA) down to 25-50 relevant pediatric surgery articles, then further narrows to 10-15 through specialty filtering, quality ranking, methodology assessment, and popularity polling among general surgeons.↗
▶Ep 3 · 11:52
host summaryTodd Ponsky summarizing the discussion: In the Annals of Surgery 5-year follow-up study of non-operative appendicitis management, 46% of patients randomized to non-surgical management required appendectomy during follow-up, while the surgical group had no complications or readmissions.↗
▶Ep 3 · 12:08
host summaryTodd Ponsky summarizing the discussion: Half of the non-surgical appendicitis management group presented to the emergency room during 5-year follow-up.↗
▶Ep 3 · 18:16
host summaryTodd Ponsky summarizing the discussion: In the Journal of Trauma study of 135 children aged 1-17 years who received whole blood as adjunct to component therapy, matched to 270 children receiving only component therapy, the whole blood group had decreased transfusion volume at 24 hours and required fewer ventilation days, though mortality, length of stay, and major complications were the same.↗
2025 Pediatric Surgery Update Course - Updates in Pediatric Surgery feat. non-JPS Journals
▶Ep 25 · 0:00
host summaryTodd Ponsky summarizing the discussion: Jose came up to me at a conference and said, Todd, it's nice to meet you. Thank you for this uptakes course, but it's not very good. Because you only talk about stuff that's in the pediatric journals. And you're missing all the publications that are in the non-pediatric surgery journals.↗
Summaries Todd gave as host · Appendicitis16 summaries
Standardization of Care for Pediatric Perforated Appendicitis
▶Ep 1 · 0:06
host summaryTodd Ponsky summarizing a resource: Standardization of Care for Pediatric Perforated Appendicitis Improves Outcomes.↗
▶Ep 1 · 0:06
host summaryTodd Ponsky summarizing a resource: The new pathway refined discharge criteria for perforated appendicitis.↗
▶Ep 1 · 0:06
host summaryTodd Ponsky summarizing a resource: The new pathway initiated a disease severity classification for perforated appendicitis.↗
▶Ep 1 · 0:06
host summaryTodd Ponsky summarizing a resource: The new pathway established criteria for the use of postoperative invasive procedures such as draining an abscess.↗
▶Ep 1 · 0:06
host summaryTodd Ponsky summarizing a resource: The hospital had a clinical pathway in place for about 30 years before implementing a new pathway in 2015.↗
▶Ep 1 · 0:06
host summaryTodd Ponsky summarizing a resource: The study prospectively evaluated outcomes of all children treated on the new standardized protocol over 20 months.↗
▶Ep 1 · 0:06
host summaryTodd Ponsky summarizing a resource: The study compared prospective outcomes to all patients treated in the 58 months prior to standardization.↗
▶Ep 1 · 0:06
host summaryTodd Ponsky summarizing a resource: Median follow-up time post-discharge was 14 days in the pre-standardized group.↗
▶Ep 1 · 0:06
host summaryTodd Ponsky summarizing a resource: The new pathway standardized the operative technique for perforated appendicitis.↗
▶Ep 1 · 0:06
host summaryTodd Ponsky summarizing a resource: Median follow-up time post-discharge was 25 days in the post-standardized group.↗
▶Ep 1 · 0:06
host summaryTodd Ponsky summarizing a resource: Standardization significantly reduced postoperative abscess in perforated appendicitis.↗
▶Ep 1 · 0:06
host summaryTodd Ponsky summarizing a resource: The new pathway established criteria for the use of postoperative imaging in perforated appendicitis.↗
▶Ep 1 · 0:06
host summaryTodd Ponsky summarizing a resource: Standardization significantly reduced hospital stay in perforated appendicitis.↗
▶Ep 1 · 0:06
host summaryTodd Ponsky summarizing a resource: The new pathway established criteria for the use of postoperative TPN in perforated appendicitis.↗
▶Ep 1 · 0:06
host summaryTodd Ponsky summarizing a resource: Standardization reduced the odds of developing a postoperative abscess by 4 times.↗
Evidence-based diagnosis and management of pediatric appendicitis with Dr. Whit Holcomb
▶Ep 9 · 30:23
host summaryTodd Ponsky summarizes what Dr. Whit Holcomb said: Wound infection rate was 3.3% (6/180) for single-incision versus 1.7% (3/180) for three-port, p=0.5, not statistically different↗
Summaries Todd gave as host · Appendicitis2 summaries
Evidence-based diagnosis and management of pediatric appendicitis with Dr. Whit Holcomb
▶Ep 7 · 30:23
host summaryTodd Ponsky summarizes what Dr. Whit Holcomb said: Wound infection rate was 3.3% (6/180) for single-incision versus 1.7% (3/180) for three-port, p=0.5, not statistically different↗
Journal Club: Appendicitis in 2021
▶Ep 9 · 9:56
host summaryTodd Ponsky summarizes what Dr. Jose Campos said: These four intraoperative findings were associated with higher adverse effects, higher length of stay, higher emergency visits, and higher use of hospital and patient resources after adjusting for all variables.↗
host summaryTodd Ponsky summarizing the discussion: I think, uh, a lot of what we're doing is guessing, uh, like everything we do in pediatric surgery.↗
Summaries Todd gave as host · Biliary Atresia7 summaries
Biliary Atresia - Robert Parry: Update Course 2014
▶Ep 1 · 4:03
host summaryTodd Ponsky summarizing the discussion: Rich Ricketts' series showed not statistically significant better results with Kasai at 76 days or older compared to 0-75 days, possibly representing a different disease phenotype in late presenters.↗
▶Ep 1 · 17:35
host summaryTodd Ponsky summarizing the discussion: A recent paper in Gastroenterology described a scoring system using liver biopsy plus clinical parameters with nearly 100% ability to predict biliary atresia.↗
Update Course 2021: UPDATE COURSE 2020: REVIEW OF LAST YEAR'S IMPORTANT T OPICS
▶Ep 11 · 10:50
host summaryTodd Ponsky summarizing the discussion: Deflux, a compound used by urology for vesicoureteral reflux, has been reported in case reports for rectal prolapse sclerotherapy.↗
▶Ep 11 · 10:50
host summaryTodd Ponsky summarizing the discussion: There are case reports showing mucosal sloughing with phenol sclerotherapy.↗
▶Ep 11 · 11:20
host summaryTodd Ponsky summarizing the discussion: I think there's also case reports that show mucosal sloughing with phenol.↗
Biliary Atresia Part I
▶Ep 13 · 22:55
host summaryTodd Ponsky summarizing the discussion: IPEG placed a moratorium on laparoscopic Kasai portoenterostomy because of poor outcomes.↗
Heat 1 Winner: Dariusz Patkowski, MD, PhD - Best of the Best in Pediatric Surgery 2024
▶Ep 18 · 1:49
host summaryTodd Ponsky summarizing a resource: Data was presented suggesting that resecting liver cuts mortality down by 50% in biliary atresia, though the judge expressed uncertainty about the data↗
Summaries Todd gave as host · Blunt Abdominal Trauma1 summary
host summaryTodd Ponsky summarizing the discussion: There is huge variability across institutions in laboratory evaluation practices for pediatric blunt abdominal trauma↗
Disruptive AI technologies transforming healthcare and medical education
▶Ep 7 · 3:49
host summaryTodd Ponsky summarizing the discussion: You're not going to be replaced by AI. You're going to be replaced by someone who knows how to use AI.↗
Summaries Todd gave as host · Catheter Fracture4 summaries
host summaryTodd Ponsky summarizes what Dr. Ian Glenn said: Multiple studies of patients with retained catheter fragments followed for months to the order of 5 years found no complications.↗
▶Ep 2 · 2:31
host summaryTodd Ponsky summarizes what Dr. Ian Glenn said: No infections associated with retained catheter fragments have been reported in follow-up studies.↗
▶Ep 2 · 2:31
host summaryTodd Ponsky summarizes what Dr. Ian Glenn said: No thrombosis associated with retained catheter fragments has been reported in follow-up studies.↗
▶Ep 2 · 2:54
host summaryTodd Ponsky summarizes what Dr. Ian Glenn said: There has never been a report of a problem by leaving a retained catheter tip in, although long-term data are lacking.↗
Summaries Todd gave as host · Catheter Retention4 summaries
host summaryTodd Ponsky summarizes what Dr. Ian Glenn said: Multiple studies of patients with retained catheter fragments followed for months to the order of 5 years found no complications.↗
▶Ep 2 · 2:31
host summaryTodd Ponsky summarizes what Dr. Ian Glenn said: No infections associated with retained catheter fragments have been reported in follow-up studies.↗
▶Ep 2 · 2:31
host summaryTodd Ponsky summarizes what Dr. Ian Glenn said: No thrombosis associated with retained catheter fragments has been reported in follow-up studies.↗
▶Ep 2 · 2:54
host summaryTodd Ponsky summarizes what Dr. Ian Glenn said: There has never been a report of a problem by leaving a retained catheter tip in, although long-term data are lacking.↗
Summaries Todd gave as host · Cervical Spine Injury1 summary
host summaryTodd Ponsky summarizes what Dr. Rich Falcone said: I personally have changed my practice over the last few years. And I don't do leveling colostomies anymore. I have done permanent biopsies, but a diversion at the at an ileostomy and wait for permanent section, which is much more accurate, and then at some point down the road, do your pull-through.↗
Summaries Todd gave as host · Cervical Spine Injury1 summary
host summaryTodd Ponsky summarizes what Dr. Rich Falcone said: I personally have changed my practice over the last few years. And I don't do leveling colostomies anymore. I have done permanent biopsies, but a diversion at the at an ileostomy and wait for permanent section, which is much more accurate, and then at some point down the road, do your pull-through.↗
Summaries Todd gave as host · Chest Pain2 summaries
Biliary Atresia - Robert Parry: Update Course 2014
▶Ep 1 · 4:03
host summaryTodd Ponsky summarizing the discussion: Rich Ricketts' series showed not statistically significant better results with Kasai at 76 days or older compared to 0-75 days, possibly representing a different disease phenotype in late presenters.↗
▶Ep 1 · 17:35
host summaryTodd Ponsky summarizing the discussion: A recent paper in Gastroenterology described a scoring system using liver biopsy plus clinical parameters with nearly 100% ability to predict biliary atresia.↗
Summaries Todd gave as host · Cholestasis2 summaries
Biliary Atresia - Robert Parry: Update Course 2014
▶Ep 1 · 4:03
host summaryTodd Ponsky summarizing the discussion: Rich Ricketts' series showed not statistically significant better results with Kasai at 76 days or older compared to 0-75 days, possibly representing a different disease phenotype in late presenters.↗
▶Ep 1 · 17:35
host summaryTodd Ponsky summarizing the discussion: A recent paper in Gastroenterology described a scoring system using liver biopsy plus clinical parameters with nearly 100% ability to predict biliary atresia.↗
Summaries Todd gave as host · Chronic Pancreatitis8 summaries
host summaryTodd Ponsky summarizing the discussion: Approximately 50% of chronic pancreatitis patients will eventually require surgery, with the most common indication being debilitating pain that fails to respond to medical and endoscopic treatment.↗
▶Ep 3 · 43:20
host summaryTodd Ponsky summarizing the discussion: There is no clear consensus on optimal timing for surgical intervention in chronic pancreatitis; some advocate earlier surgery to avoid progressive inflammatory destruction, while others prefer a watch-and-wait approach due to variable surgical success rates.↗
▶Ep 3 · 45:50
host summaryTodd Ponsky summarizing the discussion: Puestow procedure provides short-term pain relief in 75% of patients, but greater than 50% have recurrent pain, largely related to inability to fully decompress the duct or continued inflammation in the pancreatic head.↗
▶Ep 3 · 48:20
host summaryTodd Ponsky summarizing the discussion: Whipple procedure for chronic pancreatitis provides good pain relief at 4-6 years but results in late endocrine and exocrine dysfunction in approximately 50% of patients.↗
▶Ep 3 · 49:10
host summaryTodd Ponsky summarizing the discussion: Duodenum-preserving pancreatic head resections (Beger, Frey) achieve benefits of head resection and duct decompression while preserving bile duct and GI continuity.↗
▶Ep 3 · 49:40
host summaryTodd Ponsky summarizing the discussion: The Beger procedure provides good pain relief in 80-85% of patients maintained at 5 years with minimal endocrine and exocrine insufficiency compared to Whipple, based on adult data.↗
▶Ep 3 · 50:50
host summaryTodd Ponsky summarizing the discussion: The Frey procedure shows equivalent pain relief (85-90%) and quality of life outcomes compared to Beger procedure in adults.↗
▶Ep 3 · 51:20
host summaryTodd Ponsky summarizing the discussion: For conventional surgical procedures in chronic pancreatitis, about 50% of patients have recurrence of pain over the long term based on adult data, with no long-term pediatric data available.↗
Summaries Todd gave as host · Colorectal / ARM & Hirschsprung39 summaries
host summaryTodd Ponsky summarizing a resource: Traditional teaching holds that divided colostomy should be performed for anorectal malformations to prevent stool flowing down that could cause urinary tract infection.↗
▶Ep 1 · 0:08
host summaryTodd Ponsky summarizing a resource: we've all been taught over the years that when we do a colostomy for an anal rectal malformation, we should do a divided colostomy, and the main reason to do that is to prevent stool flowing down that could cause a urinary tract infection.↗
▶Ep 1 · 0:24
host summaryTodd Ponsky summarizing a resource: Dr. Robert Baird performed a meta-analysis of multiple studies comparing divided colostomy versus loop colostomy for anorectal malformations.↗
▶Ep 1 · 0:27
host summaryTodd Ponsky summarizing a resource: The meta-analysis found no statistically significant difference in urinary tract infection incidence between divided colostomy and loop colostomy.↗
▶Ep 1 · 0:39
host summaryTodd Ponsky summarizing a resource: Some individual studies within the meta-analysis showed a difference in UTI rates, but the overall meta-analysis showed no statistical difference.↗
▶Ep 1 · 0:51
host summaryTodd Ponsky summarizing a resource: Loop colostomies had a significantly higher stoma prolapse rate compared to divided colostomies.↗
▶Ep 1 · 1:05
host summaryTodd Ponsky summarizing a resource: Skin excoriation, stoma retraction, peristomal hernia, wound infection, and stoma stricture showed no statistical difference between loop colostomy and divided colostomy.↗
▶Ep 1 · 1:22
host summaryTodd Ponsky summarizing a resource: there we go, we've challenged dogma, and it seems like dogma necessarily at this point doesn't seem to hold true.↗
Challenging Dogma: Does Colostomy Type Matter?
▶Ep 3 · 0:08
host summaryTodd Ponsky summarizing a resource: we've all been taught over the years that when we do a colostomy for an anal rectal malformation, we should do a divided colostomy, and the main reason to do that is to prevent stool flowing down that could cause a urinary tract infection.↗
▶Ep 3 · 0:08
host summaryTodd Ponsky summarizing a resource: Traditional teaching advocates for divided colostomy when performing colostomy for anorectal malformation, with the main rationale being prevention of stool flowing down that could cause urinary tract infection.↗
▶Ep 3 · 0:24
host summaryTodd Ponsky summarizing a resource: Dr. Robert Baird performed a meta-analysis of multiple studies comparing divided colostomy versus loop colostomy for incidence of UTI.↗
▶Ep 3 · 0:27
host summaryTodd Ponsky summarizing a resource: The meta-analysis found no statistically significant difference in UTI rates between loop colostomy and divided colostomy, despite some individual studies showing a difference.↗
▶Ep 3 · 0:27
host summaryTodd Ponsky summarizing a resource: he found no difference.↗
▶Ep 3 · 0:51
host summaryTodd Ponsky summarizing a resource: the loop colostomies actually had a higher, significantly higher stoma prolapse rate.↗
▶Ep 3 · 0:51
host summaryTodd Ponsky summarizing a resource: Loop colostomies had a significantly higher stoma prolapse rate compared to divided colostomies.↗
▶Ep 3 · 1:05
host summaryTodd Ponsky summarizing a resource: Skin excoriation, stoma retraction, peristomal hernia, wound infection, and stoma stricture showed no statistical difference between loop colostomy and divided colostomy.↗
Radiology and Image Diagnosis of Hirschsprung Disease
▶Ep 18 · 32:23
host summaryTodd Ponsky summarizing the discussion: If it is clearly meconium ileus with reflux into terminal ileum and clinical improvement, some surgeons will not do rectal biopsy.↗
Surgical Procedures for Hirschsprung Disease
▶Ep 21 · 5:30
host summaryTodd Ponsky summarizing the discussion: The concordance between pathology and radiology is 75% in rectosigmoid Hirschsprung patients, meaning 25% are discordant.↗
▶Ep 21 · 5:39
host summaryTodd Ponsky summarizing the discussion: Concordance between pathology and radiology is only 25% for long-segment Hirschsprung disease.↗
Outcomes and Complications in Hirschsprung Disease
▶Ep 20 · 33:44
host summaryTodd Ponsky summarizing the discussion: Many places still have clung to this idea that the way to assess a pull through specimen is to do a longitudinal strip of the length of the specimen and not look at the full circumference of the proximal margin.↗
▶Ep 20 · 33:44
host summaryTodd Ponsky summarizing the discussion: Many institutions assess pull-through specimens using only a longitudinal strip rather than examining the full circumference of the proximal margin; the interface between ganglionic and aganglionic bowel can be irregular and project 2-4 cm longer along one part of the circumference.↗
▶Ep 20 · 33:53
host summaryTodd Ponsky summarizing the discussion: The interface between the ganglionic bowel and the a ganglion bowel can be very irregular and can project for 234 centimeters longer along one part of the circumference than the other.↗
▶Ep 20 · 35:19
host summaryTodd Ponsky summarizing the discussion: A survey of Canadian pediatric surgeons found nearly half resect 4 centimeters or less from the biopsy site, and about 10% resect right at the site of positive biopsy, creating high risk of pull-throughs in the transition zone.↗
Hirschsprung Disease: Cases and Complications
▶Ep 41 · 35:19
host summaryTodd Ponsky summarizing the discussion: A survey of the Canadian Association of Pediatric Surgeons by Jack Langer found that nearly half of surgeons resect 4 cm or less from the biopsy site, and about 10% resect right at the site of positive biopsy, creating high risk for pull-throughs in the transition zone.↗
Hirschsprung Disease: Update Course 2013
▶Ep 46 · 2:40
host summaryTodd Ponsky summarizing the discussion: A significant portion of fellows at a Washington DC course said they would get upper GI first in newborn with bilious emesis before contrast enema↗
Hirschsprung Disease: Update Course 2013
▶Ep 49 · 4:14
host summaryTodd Ponsky summarizing the discussion: the baby's first enema should be a barium enema↗
▶Ep 49 · 5:06
host summaryTodd Ponsky summarizing the discussion: Tissue diagnosis is mandatory before surgery for Hirschsprung disease; contrast enema alone is insufficient↗
▶Ep 49 · 5:30
host summaryTodd Ponsky summarizing the discussion: In critically ill patients with enterocolitis, surgery may be necessary before pathology results are available (typically takes until Wednesday if specimen obtained Friday)↗
▶Ep 49 · 16:50
host summaryTodd Ponsky summarizing the discussion: I've never seen really good results from in a 16 year old↗
▶Ep 49 · 17:40
host summaryTodd Ponsky summarizing the discussion: Hypertrophic nerves should not be present in normal anal canal, even though ganglion cells are absent there↗
▶Ep 49 · 29:11
host summaryTodd Ponsky summarizing the discussion: In children over age 2-3 years, perform open rectal biopsy under general anesthesia rather than office suction biopsy due to patient cooperation issues↗
▶Ep 49 · 34:11
host summaryTodd Ponsky summarizing the discussion: Manometry is reliable for diagnosing Hirschsprung in older children when biopsies may be unreliable↗
▶Ep 49 · 35:15
host summaryTodd Ponsky summarizing the discussion: For enterocolitis 6 months post-pull-through with fever, distention, and diarrhea but no peritonitis, treat with IV fluids, broad-spectrum antibiotics, and rectal irrigations↗
▶Ep 49 · 36:20
host summaryTodd Ponsky summarizing the discussion: Incidence of enterocolitis in children with trisomy 21 is double that of genetically normal children with Hirschsprung disease↗
Posterior Sagittal Anorectaplasty in a Female: Pediatric Colorectal...
▶Ep 63 · 2:10
host summaryTodd Ponsky summarizing the discussion: Total body prep from nipples to toes is standard for these patients, allowing flexibility to flip between supine and prone positions↗
The Colorectal Quiz Episode 3.5: Proximal Hirschsprung Disease
▶Ep 87 · 0:40
host summaryTodd Ponsky summarizing the discussion: A one-day-old full-term infant weighing 3.9 kilograms presented with significant abdominal distension and bilious emesis.↗
host summaryTodd Ponsky summarizing the discussion: The standard Hagar dilator size for a newborn is about size 12, so a size 10 is 2 deviations less.↗
▶Ep 122 · 2:16
host summaryTodd Ponsky summarizing the discussion: In the dilation study with 25 children, the types of malformations were evenly distributed and complexity was about equal.↗
The Colorectal Quiz Episode 4
▶Ep 241 · 17:00
host summaryTodd Ponsky summarizing the discussion: The reinforcement layer is critical to lining the two pieces of bowel up so that mucosa edge meets mucosa edge.↗
Summaries Todd gave as host · Congenital Diaphragmatic Hernia14 summaries
Challenges in Diaphragmatic Hernia Repair: Update Course 2016
▶Ep 2 · 20:03
host summaryTodd Ponsky summarizing the discussion: Audience poll: 63% would perform thoracoscopic patch repair, 60% would do MIS repair after ECMO, 67% prefer thoracoscopic approach overall.↗
CDH-ECMO - VV vs. VA - Repair on ECMO: Update Course 2015
▶Ep 5 · 1:22
host summaryTodd Ponsky summarizing the discussion: there is some evidence. That the, the, you know, that the, the complication rate with VA ECMO is higher than VV ECMO.↗
▶Ep 5 · 1:22
host summaryTodd Ponsky summarizing the discussion: There is evidence that the complication rate with VA ECMO is higher than VV ECMO↗
▶Ep 5 · 6:34
host summaryTodd Ponsky summarizing the discussion: There is some data suggesting VV ECMO is probably advantageous over VA ECMO↗
▶Ep 5 · 6:34
host summaryTodd Ponsky summarizing the discussion: there is some, some data that VV ACM probably is advantageous.↗
▶Ep 5 · 9:27
host summaryTodd Ponsky summarizing the discussion: After ECMO, most people will do open CDH repair↗
Fetoscopic endoluminal tracheal occlusion and twin-twin transfusion: Fetal...
▶Ep 7 · 1:30:22
host summaryTodd Ponsky summarizing the discussion: Amnio-reduction in severe polyhydramnios improves fetal hypoxia and reverses acidemia by decreasing amniotic fluid pressure, which reduces placental compression and improves blood flow.↗
▶Ep 7 · 1:42:07
host summaryTodd Ponsky summarizing the discussion: Huber's 2006 study of over 200 laser cases showed 84% survival of at least one twin, 60% both-twin survival, and average delivery at 34 weeks, compared to 29 weeks with amnio-reduction.↗
▶Ep 7 · 1:43:26
host summaryTodd Ponsky summarizing the discussion: High-volume laser centers achieve 93-94% survival of at least one twin, 88% overall survival, 78% both-twin survival, with average delivery at 34 weeks.↗
▶Ep 7 · 1:44:15
host summaryTodd Ponsky summarizing the discussion: Major and minor neurologic deficits occur in 55% after amnio-reduction versus less than half that rate after laser, with most recent studies showing 5-6% major neurodevelopmental delays and 7-8% minor delays after laser.↗
▶Ep 7 · 2:08:56
host summaryTodd Ponsky summarizes what Dr. Eduardo Gratacos said: Eduardo Gratacos classified selective IUGR into three types: Type 1 with positive end-diastolic flow (good prognosis), Type 2 with persistent absent/reversed flow (progressive deterioration), and Type 3 with intermittent cycling (unpredictable with high IUFD and 20% PVL risk in normal twin).↗
▶Ep 7 · 2:11:00
host summaryTodd Ponsky summarizing the discussion: Type 3 sIUGR fetuses have the smallest placental share and characteristic very large arterio-arterial anastomoses that cause episodic acute fetal-to-fetal transfusions.↗
▶Ep 7 · 2:16:04
host summaryTodd Ponsky summarizing the discussion: With purely expectant management of Type 2 sIUGR, there is 48% loss in the smaller twin and 33% in the normal twin, with only 37% intact survival in the smaller twin.↗
▶Ep 7 · 2:16:36
host summaryTodd Ponsky summarizing the discussion: Type 3 sIUGR with expectant management shows 38.5% intact survival in the normal twin and 60% in surviving smaller twins, with very high morbidity and mortality in both groups.↗
Summaries Todd gave as host · Congenital Diaphragmatic Hernia17 summaries
Challenges in Diaphragmatic Hernia Repair: Update Course 2016
▶Ep 2 · 20:03
host summaryTodd Ponsky summarizing the discussion: Audience poll: 63% would perform thoracoscopic patch repair, 60% would do MIS repair after ECMO, 67% prefer thoracoscopic approach overall.↗
CDH-ECMO - VV vs. VA - Repair on ECMO: Update Course 2015
▶Ep 4 · 1:22
host summaryTodd Ponsky summarizing the discussion: There is evidence that the complication rate with VA ECMO is higher than VV ECMO↗
▶Ep 4 · 1:22
host summaryTodd Ponsky summarizing the discussion: there is some evidence. That the, the, you know, that the, the complication rate with VA ECMO is higher than VV ECMO.↗
▶Ep 4 · 6:34
host summaryTodd Ponsky summarizing the discussion: There is some data suggesting VV ECMO is probably advantageous over VA ECMO↗
▶Ep 4 · 6:34
host summaryTodd Ponsky summarizing the discussion: there is some, some data that VV ACM probably is advantageous.↗
▶Ep 4 · 9:27
host summaryTodd Ponsky summarizing the discussion: After ECMO, most people will do open CDH repair↗
Fetoscopic endoluminal tracheal occlusion and twin-twin transfusion: Fetal...
▶Ep 7 · 1:30:22
host summaryTodd Ponsky summarizing the discussion: Amnio-reduction in severe polyhydramnios improves fetal hypoxia and reverses acidemia by decreasing amniotic fluid pressure, which reduces placental compression and improves blood flow.↗
▶Ep 7 · 1:42:07
host summaryTodd Ponsky summarizing the discussion: Huber's 2006 study of over 200 laser cases showed 84% survival of at least one twin, 60% both-twin survival, and average delivery at 34 weeks, compared to 29 weeks with amnio-reduction.↗
▶Ep 7 · 1:43:26
host summaryTodd Ponsky summarizing the discussion: High-volume laser centers achieve 93-94% survival of at least one twin, 88% overall survival, 78% both-twin survival, with average delivery at 34 weeks.↗
▶Ep 7 · 1:44:15
host summaryTodd Ponsky summarizing the discussion: Major and minor neurologic deficits occur in 55% after amnio-reduction versus less than half that rate after laser, with most recent studies showing 5-6% major neurodevelopmental delays and 7-8% minor delays after laser.↗
▶Ep 7 · 2:08:56
host summaryTodd Ponsky summarizes what Dr. Eduardo Gratacos said: Eduardo Gratacos classified selective IUGR into three types: Type 1 with positive end-diastolic flow (good prognosis), Type 2 with persistent absent/reversed flow (progressive deterioration), and Type 3 with intermittent cycling (unpredictable with high IUFD and 20% PVL risk in normal twin).↗
▶Ep 7 · 2:11:00
host summaryTodd Ponsky summarizing the discussion: Type 3 sIUGR fetuses have the smallest placental share and characteristic very large arterio-arterial anastomoses that cause episodic acute fetal-to-fetal transfusions.↗
▶Ep 7 · 2:16:04
host summaryTodd Ponsky summarizing the discussion: With purely expectant management of Type 2 sIUGR, there is 48% loss in the smaller twin and 33% in the normal twin, with only 37% intact survival in the smaller twin.↗
▶Ep 7 · 2:16:36
host summaryTodd Ponsky summarizing the discussion: Type 3 sIUGR with expectant management shows 38.5% intact survival in the normal twin and 60% in surviving smaller twins, with very high morbidity and mortality in both groups.↗
host summaryTodd Ponsky summarizes what Dr. Fernando Bullettin said: We decrease the Epirin and use Amicar previous, during, and after the surgery.↗
▶Ep 24 · 5:37
host summaryTodd Ponsky summarizes what Dr. Fernando Bullettin said: For on-ECMO CDH repair, anticoagulation is managed by decreasing heparin and using Amicar before, during, and after surgery↗
▶Ep 24 · 16:36
host summaryTodd Ponsky summarizes what Dr. Fernando Bullettin said: The decision to perform fundoplication at time of CDH repair is based on knowing from the defect type that fundoplication will eventually be needed in a baby who just had very difficult surgery↗
Summaries Todd gave as host · Congenital Diaphragmatic Hernia8 summaries
Fetoscopic endoluminal tracheal occlusion and twin-twin transfusion: Fetal...
▶Ep 3 · 1:30:22
host summaryTodd Ponsky summarizing the discussion: Amnio-reduction in severe polyhydramnios improves fetal hypoxia and reverses acidemia by decreasing amniotic fluid pressure, which reduces placental compression and improves blood flow.↗
▶Ep 3 · 1:42:07
host summaryTodd Ponsky summarizing the discussion: Huber's 2006 study of over 200 laser cases showed 84% survival of at least one twin, 60% both-twin survival, and average delivery at 34 weeks, compared to 29 weeks with amnio-reduction.↗
▶Ep 3 · 1:43:26
host summaryTodd Ponsky summarizing the discussion: High-volume laser centers achieve 93-94% survival of at least one twin, 88% overall survival, 78% both-twin survival, with average delivery at 34 weeks.↗
▶Ep 3 · 1:44:15
host summaryTodd Ponsky summarizing the discussion: Major and minor neurologic deficits occur in 55% after amnio-reduction versus less than half that rate after laser, with most recent studies showing 5-6% major neurodevelopmental delays and 7-8% minor delays after laser.↗
▶Ep 3 · 2:08:56
host summaryTodd Ponsky summarizes what Dr. Eduardo Gratacos said: Eduardo Gratacos classified selective IUGR into three types: Type 1 with positive end-diastolic flow (good prognosis), Type 2 with persistent absent/reversed flow (progressive deterioration), and Type 3 with intermittent cycling (unpredictable with high IUFD and 20% PVL risk in normal twin).↗
▶Ep 3 · 2:11:00
host summaryTodd Ponsky summarizing the discussion: Type 3 sIUGR fetuses have the smallest placental share and characteristic very large arterio-arterial anastomoses that cause episodic acute fetal-to-fetal transfusions.↗
▶Ep 3 · 2:16:04
host summaryTodd Ponsky summarizing the discussion: With purely expectant management of Type 2 sIUGR, there is 48% loss in the smaller twin and 33% in the normal twin, with only 37% intact survival in the smaller twin.↗
▶Ep 3 · 2:16:36
host summaryTodd Ponsky summarizing the discussion: Type 3 sIUGR with expectant management shows 38.5% intact survival in the normal twin and 60% in surviving smaller twins, with very high morbidity and mortality in both groups.↗
Summaries Todd gave as host · Congenital Lung Lesions (CPAM)5 summaries
host summaryTodd Ponsky summarizing the discussion: Journal of Pediatric Surgery partners with GlobalCastMD and Stay Current app to share key charts from articles through social media for educational purposes↗
▶Ep 22 · 20:24
host summaryTodd Ponsky summarizing the discussion: Until the true malignancy risk of congenital lung lesions is established, debate between observation (Canadian approach) versus resection (US approach) will continue↗
▶Ep 22 · 27:51
host summaryTodd Ponsky summarizing the discussion: Steve Rothenberg makes relaxing incision on diaphragm and places mesh laterally to prevent esophageal erosion↗
▶Ep 22 · 44:57
host summaryTodd Ponsky summarizing the discussion: Virginia Commonwealth performs gastric disconnects in cognitively normal patients with acceptable outcomes↗
Neonatal Lung Lesions with Dr. Steven Rothenberg
▶Ep 23 · 39:28
host summaryTodd Ponsky summarizes what Dr. Steven Rothenberg said: If using the LigaSure device, do not activate the cutting function; seal, remove the device, and cut with scissors to allow partial division and confirmation of hemostasis.↗
Summaries Todd gave as host · Congenital Pulmonary Airway Malformation5 summaries
host summaryTodd Ponsky summarizing the discussion: Journal of Pediatric Surgery partners with GlobalCastMD and Stay Current app to share key charts from articles through social media for educational purposes↗
▶Ep 19 · 20:24
host summaryTodd Ponsky summarizing the discussion: Until the true malignancy risk of congenital lung lesions is established, debate between observation (Canadian approach) versus resection (US approach) will continue↗
▶Ep 19 · 27:51
host summaryTodd Ponsky summarizing the discussion: Steve Rothenberg makes relaxing incision on diaphragm and places mesh laterally to prevent esophageal erosion↗
▶Ep 19 · 44:57
host summaryTodd Ponsky summarizing the discussion: Virginia Commonwealth performs gastric disconnects in cognitively normal patients with acceptable outcomes↗
Neonatal Lung Lesions with Dr. Steven Rothenberg
▶Ep 20 · 39:28
host summaryTodd Ponsky summarizes what Dr. Steven Rothenberg said: If using the LigaSure device, do not activate the cutting function; seal, remove the device, and cut with scissors to allow partial division and confirmation of hemostasis.↗
Summaries Todd gave as host · Congenital Pulmonary Airway Malformation5 summaries
host summaryTodd Ponsky summarizing the discussion: Journal of Pediatric Surgery partners with GlobalCastMD and Stay Current app to share key charts from articles through social media for educational purposes↗
▶Ep 19 · 20:24
host summaryTodd Ponsky summarizing the discussion: Until the true malignancy risk of congenital lung lesions is established, debate between observation (Canadian approach) versus resection (US approach) will continue↗
▶Ep 19 · 27:51
host summaryTodd Ponsky summarizing the discussion: Steve Rothenberg makes relaxing incision on diaphragm and places mesh laterally to prevent esophageal erosion↗
▶Ep 19 · 44:57
host summaryTodd Ponsky summarizing the discussion: Virginia Commonwealth performs gastric disconnects in cognitively normal patients with acceptable outcomes↗
Neonatal Lung Lesions with Dr. Steven Rothenberg
▶Ep 20 · 39:28
host summaryTodd Ponsky summarizes what Dr. Steven Rothenberg said: If using the LigaSure device, do not activate the cutting function; seal, remove the device, and cut with scissors to allow partial division and confirmation of hemostasis.↗
Summaries Todd gave as host · CPAM (congenital Pulmonary Airway Malformation)1 summary
host summaryTodd Ponsky summarizes what Dr. Steven Rothenberg said: If using the LigaSure device, do not activate the cutting function; seal, remove the device, and cut with scissors to allow partial division and confirmation of hemostasis.↗
Summaries Todd gave as host · CPVT (catecholaminergic Polymorphic Ventricular Tachycardia)143 summaries
Top Ten Things to Remember from the 2017 Stay Current Annual Update Course...
▶Ep 1 · 0:00
host summaryTodd Ponsky summarizing a resource: Reynaldo Garcia from Akron Children's Hospital presented gastric stimulation results showing significant symptom improvement in patients with persistent nausea and vomiting unresponsive to medical therapy↗
▶Ep 1 · 0:00
host summaryTodd Ponsky summarizing a resource: Sophia Abdulhai and John Clark presented cardiac sympathectomy technique using clips and scissors for partial stellate ganglion resection, avoiding electrocautery to prevent Horner's syndrome↗
▶Ep 1 · 0:00
host summaryTodd Ponsky summarizing a resource: Sympathectomy provides 100% compliance for arrhythmia management as patients cannot skip the intervention once performed↗
▶Ep 1 · 0:00
host summaryTodd Ponsky summarizing a resource: Gastric stimulation for pediatric gastroparesis can be tested temporarily via endoscopic placement before permanent laparoscopic or open implantation↗
▶Ep 1 · 0:00
host summaryTodd Ponsky summarizing a resource: Cardiac sympathectomy for CPVT (catecholaminergic polymorphic ventricular tachycardia) and hypertrophic cardiomyopathy involves high thoracoscopic approach to the lower stellate ganglion to prevent fatal arrhythmias↗
▶Ep 1 · 2:00
host summaryTodd Ponsky summarizing a resource: The benefits of sympathectomy is there is 100% compliance. Once they've had it, they can't not take their sympathectomy that day↗
▶Ep 1 · 3:00
host summaryTodd Ponsky summarizing a resource: Ray Anders from University Hospitals of Cleveland demonstrated diaphragm pacing for spinal cord injury, transverse myelitis, acute flaccid myelitis, and brain stem tumors, with youngest implant at one year of age↗
▶Ep 1 · 3:00
host summaryTodd Ponsky summarizing a resource: Laparoscopic gastroesophageal disconnection can take 6 to 8 hours↗
▶Ep 1 · 3:00
host summaryTodd Ponsky summarizing a resource: David Lanning from Virginia Commonwealth presented gastroesophageal disconnection (esophageal division with Roux-en-Y jejunal interposition) for severe reflux after failed Nissen fundoplication↗
▶Ep 1 · 3:00
host summaryTodd Ponsky summarizing a resource: Gastroesophageal disconnection may be appropriate as primary repair for high-risk patients predicted to fail fundoplication↗
▶Ep 1 · 3:00
host summaryTodd Ponsky summarizing a resource: Patients who took full feeds by mouth preoperatively can continue oral feeding after gastroesophageal disconnection↗
▶Ep 1 · 3:00
host summaryTodd Ponsky summarizing a resource: Posterior component separation has less wound morbidity than anterior component separation while providing space for wide mesh overlap and minimal fixation↗
▶Ep 1 · 3:00
host summaryTodd Ponsky summarizing a resource: Retrorectus repair with mesh is superior to laparoscopic underlay for ventral hernia repair↗
▶Ep 1 · 3:00
host summaryTodd Ponsky summarizing a resource: The best mesh for ventral hernia repair is macroporous monofilament lightweight polypropylene synthetic mesh such as Marlex, which performs well in contaminated fields in retromuscular space↗
▶Ep 1 · 3:00
host summaryTodd Ponsky summarizing a resource: Dave Carpata from Cleveland Clinic stated biologic mesh is not appropriate for bridging gaps in ventral hernia repair, only for temporary solution or reinforcement↗
▶Ep 1 · 3:00
host summaryTodd Ponsky summarizing a resource: Diaphragm pacing requires intact phrenic nerve and motor neurons; diaphragm contraction with neurostimulation must be confirmed before implantation↗
▶Ep 1 · 4:00
host summaryTodd Ponsky summarizing a resource: The best mesh to use is probably a macroporous monofilament, lightweight polypropylene synthetic mesh such as Marlex↗
▶Ep 1 · 7:00
host summaryTodd Ponsky summarizing a resource: Patients with abnormal physical exam findings such as handlebar injury have approximately 15% chance of abdominal injury↗
▶Ep 1 · 7:00
host summaryTodd Ponsky summarizing a resource: The low-risk group (55% of trauma population) has less than 5% risk of any injury and less than 0.3% risk of injury requiring acute intervention↗
▶Ep 1 · 7:00
host summaryTodd Ponsky summarizing a resource: Patients with solid organ injury who do not respond to 20 cc/kg crystalloid bolus should receive 10-20 cc/kg blood bolus rather than second crystalloid bolus↗
▶Ep 1 · 7:00
host summaryTodd Ponsky summarizing a resource: Patients with only abdominal pain after trauma have approximately 5% risk of abdominal injury and nearly 0% chance of requiring intervention↗
▶Ep 1 · 7:00
host summaryTodd Ponsky summarizing a resource: Chris Druck published a five-variable prediction rule identifying low-risk population for intra-abdominal injury after blunt trauma to guide CT scan decisions↗
▶Ep 1 · 7:00
host summaryTodd Ponsky summarizing a resource: Patients requiring 40 cc/kg blood (4 units) or with hemoglobin less than 7 after blood transfusion should go to the operating room as this indicates non-operative management failure↗
▶Ep 1 · 7:00
host summaryTodd Ponsky summarizing a resource: Stable solid organ injury patients can be admitted to the floor with vitals every 2-4 hours and hemoglobin at 6 hours, and discharged the next day if they never required blood transfusion↗
▶Ep 1 · 7:00
host summaryTodd Ponsky summarizing a resource: The ATOMAC prospective multi-institutional solid organ injury protocol de-emphasizes injury grade in favor of clinical predictive factors↗
▶Ep 1 · 7:00
host summaryTodd Ponsky summarizing a resource: Sean Saint Peter's group demonstrated stable solid organ injury patients can be discharged much more quickly than traditional prolonged admissions based on injury grade↗
▶Ep 1 · 7:00
host summaryTodd Ponsky summarizing a resource: Patients without abdominal wall trauma, tenderness or distention, with normal chest X-ray, no abdominal pain complaints, normal AST, and normal pancreatic enzymes probably do not need CT scan and can be sent home↗
▶Ep 1 · 10:00
host summaryTodd Ponsky summarizing a resource: The big magic number that David mentioned, was 4 units of blood or 40 ccs per kilo. If a patient is transfused with 40 ccs per kilo of blood or 4 units of blood, that is probably an indication of failure↗
▶Ep 1 · 13:00
host summaryTodd Ponsky summarizing a resource: Eliminating oral contrast speeds up CT acquisition time and prevents nausea and vomiting in bowel obstruction patients↗
▶Ep 1 · 13:00
host summaryTodd Ponsky summarizing a resource: Mike Rubin from Akron Children's Hospital recommends chest CT for suspected airway foreign bodies in unclear cases, with nearly 100% sensitivity for detecting radiolucent and radiopaque foreign bodies↗
▶Ep 1 · 13:00
host summaryTodd Ponsky summarizing a resource: Unsuccessful intussusception reduction should be reattempted if there is movement to the ileocecal valve, with second attempts mostly successful↗
▶Ep 1 · 13:00
host summaryTodd Ponsky summarizing a resource: Modern pediatric hospital CT scans deliver 1-10 millisieverts of radiation, equivalent to one year of natural background radiation on Earth↗
▶Ep 1 · 13:00
host summaryTodd Ponsky summarizing a resource: CT scan for suspected airway foreign body eliminates unnecessary bronchoscopies in children with respiratory virus symptoms↗
▶Ep 1 · 13:00
host summaryTodd Ponsky summarizing a resource: Oral contrast is unnecessary for suspected bowel obstruction CT scans as intraluminal fluid serves as adequate contrast↗
▶Ep 1 · 17:30
host summaryTodd Ponsky summarizing a resource: The average range of a normal CT scan in a pediatric hospital is about 1 to 10 millisievers. So, a lot of times it's easy if you're getting a SCT that may be 1 or 2 or 3 millisiever, which is basically the same amount of radiation you get from being on the Earth for 1 year.↗
▶Ep 1 · 18:00
host summaryTodd Ponsky summarizing a resource: Richer's paper showed traumatic or non-traumatic pneumomediastinum requires only chest X-ray without further imaging↗
▶Ep 1 · 18:00
host summaryTodd Ponsky summarizing a resource: Glycopyrrolate achieved leak resolution in 76% of treatment group versus 29% of placebo group after TEF repair↗
▶Ep 1 · 18:00
host summaryTodd Ponsky summarizing a resource: Vella's randomized trial of 42 patients with post-TEF repair leaks showed glycopyrrolate group had 124 mL chest tube output versus 370 mL in placebo group↗
▶Ep 1 · 18:00
host summaryTodd Ponsky summarizing a resource: Dalton's pyloric stenosis resuscitation protocol: chloride less than 85 requires 3 fluid boluses, chloride less than 97 requires 2 boluses, chloride greater than 97 with bicarbonate less than 33 requires 1 bolus↗
▶Ep 1 · 21:00
host summaryTodd Ponsky summarizing a resource: The Gips procedure for pilonidal disease involves trephine excision of pits, mosquito extraction of granulation tissue and hair, curettage with smaller trephine, and irrigation with saline then peroxide↗
▶Ep 1 · 21:00
host summaryTodd Ponsky summarizing a resource: Pilonidal disease Gips procedure takes 3-5 minutes with no packing, no sutures, no drains, and no activity restrictions except avoiding swimming for 2 weeks↗
▶Ep 1 · 22:00
host summaryTodd Ponsky summarizing a resource: Understanding segmental pulmonary anatomy allows prediction of vessel relationships to bronchus, such as superior segmental artery location above lower lobe bronchus↗
▶Ep 1 · 22:00
host summaryTodd Ponsky summarizing a resource: Steven Rothenberg recommends thoracoscopic lobectomy scope placement anterior to scapula tip at mid-axillary line, not posterior, to avoid working in paradox during anterior fissure dissection↗
▶Ep 1 · 22:00
host summaryTodd Ponsky summarizing a resource: Contralateral main stem intubation is the best and easiest technique for single lung ventilation during thoracoscopic lobectomy, superior to double lumen tube, bronchial blocker, or CO2 collapse↗
▶Ep 1 · 22:00
host summaryTodd Ponsky summarizing a resource: Incomplete fissure during thoracoscopic lobectomy should be managed by layer-by-layer sealing like finger fracture technique until structures are identified↗
▶Ep 1 · 22:00
host summaryTodd Ponsky summarizing a resource: For thoracoscopic lobectomy vessel division, seal proximally and distally separately, make test incision between seals to confirm hemostasis, then complete division rather than using seal-and-divide device↗
▶Ep 1 · 23:00
host summaryTodd Ponsky summarizing a resource: This is probably the biggest mistake that I see surgeons make when they're doing these procedures is they put their scope port posterior to the tip of the scapula↗
▶Ep 1 · 24:35
host summaryTodd Ponsky summarizing a resource: I think a main stem innovation on the contralateral side is by far the best and easiest thing to do.↗
Top Ten Things to Remember: Update Course 2017
▶Ep 2 · 0:00
host summaryTodd Ponsky summarizing a resource: Patients can receive a temporary endoscopic gastric stimulating test, and if symptoms improve, they can proceed to permanent laparoscopic or open gastric stimulator placement.↗
▶Ep 2 · 0:00
host summaryTodd Ponsky summarizing a resource: Gastric stimulation is now being used in children with persistent gastroparesis who do not respond to medical therapy.↗
▶Ep 2 · 2:00
host summaryTodd Ponsky summarizing a resource: Partial resection of the stellate ganglion should be performed using clips and scissors; electric cautery should be avoided as it may damage the remaining ganglion and cause Horner's syndrome.↗
▶Ep 2 · 2:00
host summaryTodd Ponsky summarizing a resource: Sympathectomy provides 100% compliance as an intervention because once performed, the effect cannot be reversed or skipped like medication.↗
▶Ep 2 · 2:00
host summaryTodd Ponsky summarizing a resource: Thoracoscopic sympathectomy extending to the lower stellate ganglion can reduce arrhythmias in patients with CPVT (catecholaminergic polymorphic ventricular tachycardia) and hypertrophic cardiomyopathy who have ICDs.↗
▶Ep 2 · 4:00
host summaryTodd Ponsky summarizing a resource: It is important to avoid the use of electric cautery on the stellate ganglion as it may damage the remaining portion of it and result in Horner's syndrome.↗
▶Ep 2 · 5:00
host summaryTodd Ponsky summarizing a resource: The benefits of sympathectomy is there is 100% compliance. Once they've had it, they can't not take their sympathectomy that day.↗
▶Ep 2 · 6:00
host summaryTodd Ponsky summarizing a resource: Diaphragm pacing requires an intact phrenic nerve and phrenic motor neurons; diaphragm contraction with neurostimulation must be verified prior to implantation.↗
▶Ep 2 · 6:00
host summaryTodd Ponsky summarizing a resource: Diaphragm pacing is a reasonable option for children with spinal cord injury, transverse myelitis, acute flaccid myelitis, or brain stem tumors, with the youngest implant performed at one year of age.↗
▶Ep 2 · 8:00
host summaryTodd Ponsky summarizing a resource: The current best repair for ventral hernias is retro-rectus repair with mesh, not laparoscopic underlay.↗
▶Ep 2 · 8:00
host summaryTodd Ponsky summarizing a resource: Posterior component separation has less wound morbidity than anterior component separation while providing space for wide mesh overlap and minimal fixation.↗
▶Ep 2 · 8:00
host summaryTodd Ponsky summarizing a resource: Biologic mesh is not appropriate for bridging gaps in abdominal wall reconstruction; it is only a temporary solution or reinforcement.↗
▶Ep 2 · 8:00
host summaryTodd Ponsky summarizing a resource: The best mesh for abdominal wall reconstruction is macroporous monofilament, lightweight polypropylene synthetic mesh such as Marlex, which performs well even in contaminated fields when placed in the retromuscular space.↗
▶Ep 2 · 9:00
host summaryTodd Ponsky summarizing a resource: The best mesh to use is probably a macroporous monofilament, lightweight polypropylene synthetic mesh such as Marlex, and that that actually has been shown to do well in contaminated fields in a retromuscular space.↗
▶Ep 2 · 11:00
host summaryTodd Ponsky summarizing a resource: Gastroesophageal disconnection may be considered as a primary repair in patients thought to be at high risk for fundoplication failure.↗
▶Ep 2 · 11:00
host summaryTodd Ponsky summarizing a resource: Gastroesophageal disconnection with Roux-en-Y esophagojejunostomy is effective for children with severe reflux who have failed Nissen fundoplication.↗
▶Ep 2 · 11:00
host summaryTodd Ponsky summarizing a resource: Patients who were taking full feeds by mouth preoperatively can continue to do so after gastroesophageal disconnection.↗
▶Ep 2 · 11:00
host summaryTodd Ponsky summarizing a resource: Laparoscopic gastroesophageal disconnection can be a long and difficult operation, taking 6 to 8 hours.↗
▶Ep 2 · 14:00
host summaryTodd Ponsky summarizing a resource: Children with no abdominal wall trauma, tenderness or distention, normal chest X-ray, no abdominal pain complaints, normal AST, and normal pancreatic enzymes probably do not need CT scan and can be sent home.↗
▶Ep 2 · 14:00
host summaryTodd Ponsky summarizing a resource: Children with abnormal physical exam findings such as handlebar injury have about 15% chance of abdominal injury.↗
▶Ep 2 · 14:00
host summaryTodd Ponsky summarizing a resource: Children with only abdominal pain after trauma have approximately 5% risk of abdominal injury and almost 0% chance of needing intervention.↗
▶Ep 2 · 14:00
host summaryTodd Ponsky summarizing a resource: A five-variable prediction rule can identify children at low risk for intra-abdominal injury after blunt trauma: abdominal pain, physical exam findings, chest X-ray, AST level, and pancreatic enzymes.↗
▶Ep 2 · 14:00
host summaryTodd Ponsky summarizing a resource: A low-risk group comprising 55% of trauma patients has less than 5% risk of any injury and less than 0.3% risk of injury requiring acute intervention.↗
▶Ep 2 · 17:00
host summaryTodd Ponsky summarizing a resource: In the ATOMAC solid organ injury protocol, injury grade is de-emphasized in favor of clinical predictive factors.↗
▶Ep 2 · 17:00
host summaryTodd Ponsky summarizing a resource: Patients who do not respond to initial 20cc/kg crystalloid bolus should receive 10-20cc/kg blood bolus rather than additional crystalloid.↗
▶Ep 2 · 17:00
host summaryTodd Ponsky summarizing a resource: Stable solid organ injury patients who never required blood transfusion can be discharged the next day.↗
▶Ep 2 · 17:00
host summaryTodd Ponsky summarizing a resource: Patients requiring 40cc/kg total blood transfusion (4 units) likely cannot be managed non-operatively and should go to the operating room.↗
▶Ep 2 · 19:00
host summaryTodd Ponsky summarizing a resource: The big magic number that David mentioned was 4 units of blood or 40 ccs per kilo. If a patient is transfused with 40 ccs per kilo of blood or 4 units of blood, that is probably an indication of failure in someone who can probably not be managed non-operatively and should go to the operating room.↗
▶Ep 2 · 21:00
host summaryTodd Ponsky summarizing a resource: Modern pediatric hospital CT scans deliver 1-10 millisieverts of radiation, equivalent to one year of background radiation exposure on Earth.↗
▶Ep 2 · 21:00
host summaryTodd Ponsky summarizing a resource: Eliminating oral contrast speeds up CT acquisition time and prevents nausea and vomiting in patients with bowel obstruction.↗
▶Ep 2 · 21:00
host summaryTodd Ponsky summarizing a resource: Oral contrast is not needed for suspected bowel obstruction; luminal fluid serves as adequate contrast material.↗
▶Ep 2 · 21:00
host summaryTodd Ponsky summarizing a resource: Using chest CT to screen for airway foreign bodies can eliminate many unnecessary bronchoscopies in children with unclear history.↗
▶Ep 2 · 21:00
host summaryTodd Ponsky summarizing a resource: Chest CT has nearly 100% sensitivity for airway foreign bodies, including radiolucent objects.↗
▶Ep 2 · 21:00
host summaryTodd Ponsky summarizing a resource: Repeat attempts at intussusception reduction are worthwhile if there is movement all the way to the ileocecal valve.↗
▶Ep 2 · 22:24
host summaryTodd Ponsky summarizing a resource: I think it should almost never be given for anything.↗
▶Ep 2 · 24:00
host summaryTodd Ponsky summarizing a resource: For pyloric stenosis resuscitation, if chloride is less than 85, give 3 fluid boluses; if less than 97, give 2 boluses; if greater than 97 but bicarbonate less than 33, give 1 bolus.↗
▶Ep 2 · 24:00
host summaryTodd Ponsky summarizing a resource: Glycopyrrolate reduces chest tube output in TEF leak patients from 370mL (placebo) to 124mL (treatment).↗
▶Ep 2 · 24:00
host summaryTodd Ponsky summarizing a resource: Intravenous glycopyrrolate (Robinol) significantly improves leak closure rates after tracheoesophageal fistula repair: 76% resolution in treatment group versus 29% in placebo group.↗
▶Ep 2 · 24:00
host summaryTodd Ponsky summarizing a resource: Pneumomediastinum (traumatic or non-traumatic) requires only chest X-ray for imaging; further imaging is not necessary.↗
▶Ep 2 · 25:04
host summaryTodd Ponsky summarizing a resource: Placing the thoracoscope posterior to the scapula tip causes the surgeon to look back on themselves when working in the anterior fissure, creating a paradoxical working angle.↗
▶Ep 2 · 25:04
host summaryTodd Ponsky summarizing a resource: When dividing vessels during thoracoscopic lobectomy, use a sealing device (not seal-divider) to seal proximally and distally, make a small nick between seals to verify hemostasis, then complete the division.↗
▶Ep 2 · 25:04
host summaryTodd Ponsky summarizing a resource: Understanding segmental pulmonary anatomy allows prediction of vessel locations and their relationship to bronchi during thoracoscopic lobectomy.↗
▶Ep 2 · 25:04
host summaryTodd Ponsky summarizing a resource: Incomplete fissures during thoracoscopic lobectomy should be approached layer-by-layer with a sealing device until structures are identified.↗
▶Ep 2 · 25:04
host summaryTodd Ponsky summarizing a resource: Contralateral mainstem intubation is the best and easiest technique for single-lung ventilation during thoracoscopic lobectomy.↗
▶Ep 2 · 25:04
host summaryTodd Ponsky summarizing a resource: The main explored variables were chest tube output, which was 124 mL in the treatment group, compared to 370 mL in the placebo group.↗
▶Ep 2 · 25:04
host summaryTodd Ponsky summarizing a resource: This is probably the biggest mistake that I see surgeons make when they're doing these procedures is they put their scope port posterior to the tip of the scapula.↗
▶Ep 2 · 25:04
host summaryTodd Ponsky summarizing a resource: And we make one seal and then we seal distally. It's like having two ligatures and then we cut partway between the seals, makes you see an open lumen, and when we see that and there's no bleeding, then I know it's safe to complete the division of the vessel.↗
▶Ep 2 · 25:04
host summaryTodd Ponsky summarizing a resource: It's really a very simple procedure. It really takes about 3 to 5 minutes.↗
▶Ep 2 · 25:04
host summaryTodd Ponsky summarizing a resource: The Gips procedure for pilonidal disease involves coring out pits with trephine, extracting granulation tissue and hair, curettage with smaller trephine, and flushing with saline then hydrogen peroxide, leaving wounds open and unpacked.↗
▶Ep 2 · 25:04
host summaryTodd Ponsky summarizing a resource: The Gips procedure for pilonidal disease is minimally invasive, takes 3-5 minutes, requires no activity restrictions except avoiding swimming for two weeks, and has superior results to traditional approaches.↗
▶Ep 2 · 25:04
host summaryTodd Ponsky summarizing a resource: For thoracoscopic lobectomy, the scope should be positioned anterior to the scapula tip, nearly at the mid-axillary line, directly over the major fissure, not posterior to the scapula.↗
Top Ten Things to Remember: Update Course 2017
▶Ep 4 · 0:00
host summaryTodd Ponsky summarizing a resource: Gastric stimulation reduces symptoms of gastroparesis in pediatric patients with persistent nausea and vomiting unresponsive to medical therapy↗
▶Ep 4 · 0:00
host summaryTodd Ponsky summarizing a resource: Patients can receive temporary endoscopic gastric stimulation testing; if symptoms improve, they can proceed to permanent laparoscopic or open placement↗
▶Ep 4 · 3:00
host summaryTodd Ponsky summarizing a resource: Partial stellate ganglion resection should use clips and scissors; electric cautery may damage the remaining ganglion and cause Horner's syndrome↗
▶Ep 4 · 3:00
host summaryTodd Ponsky summarizing a resource: Thoracoscopic sympathectomy extending to the lower stellate ganglion can reduce arrhythmias in CPVT and hypertrophic cardiomyopathy patients with ICDs↗
▶Ep 4 · 3:00
host summaryTodd Ponsky summarizing a resource: Sympathectomy provides 100% compliance as patients cannot skip the intervention once performed↗
▶Ep 4 · 7:00
host summaryTodd Ponsky summarizing a resource: Diaphragm pacing is a reasonable option for pediatric patients with spinal cord injury, transverse myelitis, acute flaccid myelitis, or brain stem tumors who can be weaned from mechanical ventilation↗
▶Ep 4 · 7:00
host summaryTodd Ponsky summarizing a resource: Diaphragm pacing requires intact phrenic nerve and phrenic motor neurons; diaphragm contraction with neurostimulation must be confirmed prior to implantation↗
▶Ep 4 · 7:00
host summaryTodd Ponsky summarizing a resource: The youngest patient to receive diaphragm pacing implantation was one year of age↗
▶Ep 4 · 9:00
host summaryTodd Ponsky summarizing a resource: Macroporous monofilament lightweight polypropylene synthetic mesh (such as Marlex) is the best mesh for bridging gaps and performs well in contaminated fields in the retromuscular space↗
▶Ep 4 · 9:00
host summaryTodd Ponsky summarizing a resource: Biologic mesh is not appropriate for bridging gaps in ventral hernia repair; it is only a temporary solution or reinforcement↗
▶Ep 4 · 9:00
host summaryTodd Ponsky summarizing a resource: Posterior component separation has less wound morbidity than anterior component separation while providing space for wide mesh overlap and minimal fixation↗
▶Ep 4 · 9:00
host summaryTodd Ponsky summarizing a resource: Retro-rectus repair with mesh is now preferred over laparoscopic underlay for ventral hernia repair↗
▶Ep 4 · 12:00
host summaryTodd Ponsky summarizing a resource: Gastroesophageal disconnection (dividing esophagus from stomach and creating Roux-en-Y esophagojejunostomy) has good results for severe reflux after failed Nissen fundoplication↗
▶Ep 4 · 12:00
host summaryTodd Ponsky summarizing a resource: Laparoscopic gastroesophageal disconnection can be a long and difficult operation, taking 6 to 8 hours↗
▶Ep 4 · 12:00
host summaryTodd Ponsky summarizing a resource: Patients who were taking full feeds by mouth preoperatively can continue to do so after gastroesophageal disconnection↗
▶Ep 4 · 12:00
host summaryTodd Ponsky summarizing a resource: Gastroesophageal disconnection may be appropriate as a primary operation for patients at high risk for fundoplication failure↗
▶Ep 4 · 15:00
host summaryTodd Ponsky summarizing a resource: A five-variable prediction rule identifies pediatric blunt abdominal trauma patients at very low risk for intra-abdominal injury who can safely avoid CT imaging↗
▶Ep 4 · 15:00
host summaryTodd Ponsky summarizing a resource: Children with handlebar injury and abnormal abdominal exam findings have approximately 15% chance of abdominal injury↗
▶Ep 4 · 15:00
host summaryTodd Ponsky summarizing a resource: The low-risk group (no abdominal pain, normal physical exam, normal chest X-ray, normal AST, no abdominal wall trauma, no abnormal pancreatic enzymes) comprises 55% of the trauma population with less than 5% risk of any injury and less than 0.3% risk of injury requiring acute intervention↗
▶Ep 4 · 15:00
host summaryTodd Ponsky summarizing a resource: Patients with only abdominal pain after blunt trauma have approximately 5% risk of abdominal injury and almost 0% chance of requiring intervention↗
▶Ep 4 · 18:00
host summaryTodd Ponsky summarizing a resource: In solid organ injury management, injury grade is falling by the wayside in favor of clinical predictive factors↗
▶Ep 4 · 18:00
host summaryTodd Ponsky summarizing a resource: 40 cc/kg of blood or 4 units of blood is the magic number indicating probable failure of non-operative management↗
▶Ep 4 · 18:00
host summaryTodd Ponsky summarizing a resource: Stable solid organ injury patients who never require blood transfusion can be discharged the next day↗
▶Ep 4 · 18:00
host summaryTodd Ponsky summarizing a resource: If hemoglobin drops below 7 and total blood transfusion reaches 40 cc/kg (4 units), the patient likely cannot be managed non-operatively and should go to the operating room↗
▶Ep 4 · 18:00
host summaryTodd Ponsky summarizing a resource: Patients who receive 20 cc/kg crystalloid and do not respond should receive 10-20 cc/kg bolus of blood rather than additional crystalloid↗
▶Ep 4 · 22:00
host summaryTodd Ponsky summarizing a resource: Luminal fluid in bowel obstruction serves as the contrast agent on CT↗
▶Ep 4 · 22:00
host summaryTodd Ponsky summarizing a resource: Chest CT has almost 100% sensitivity for airway foreign body detection, including radiolucent objects↗
▶Ep 4 · 22:00
host summaryTodd Ponsky summarizing a resource: Using chest CT for suspected airway foreign bodies can eliminate unnecessary bronchoscopies in children with unclear history who may have respiratory viral illness↗
▶Ep 4 · 22:00
host summaryTodd Ponsky summarizing a resource: Oral contrast is not needed for suspected bowel obstruction; CT can be read just as well without it, and eliminating it speeds up imaging and prevents nausea and vomiting↗
▶Ep 4 · 22:00
host summaryTodd Ponsky summarizing a resource: Modern pediatric CT scans deliver 1-10 millisieverts of radiation, equivalent to living on Earth for one year↗
▶Ep 4 · 22:00
host summaryTodd Ponsky summarizing a resource: Repeat enema reduction attempts for intussusception are appropriate if there is movement all the way to the ileocecal valve↗
▶Ep 4 · 25:04
host summaryTodd Ponsky summarizing a resource: Operating ports for thoracoscopic lobectomy should be at the anterior axillary line↗
▶Ep 4 · 25:04
host summaryTodd Ponsky summarizing a resource: Placing the thoracoscope posterior to the scapula tip causes the surgeon to look back on themselves when working in the anterior fissure, creating a paradoxical working angle↗
▶Ep 4 · 25:04
host summaryTodd Ponsky summarizing a resource: When sealing blood vessels during thoracoscopic lobectomy, use a sealer (not sealer-divider) to seal proximally and distally, make a small nick between seals to confirm hemostasis, then complete the division↗
▶Ep 4 · 25:04
host summaryTodd Ponsky summarizing a resource: Understanding segmental anatomy helps predict vessel locations during lobectomy; for example, the superior segmental artery comes off the lower lobe with the bronchus directly below it↗
▶Ep 4 · 25:04
host summaryTodd Ponsky summarizing a resource: For incomplete fissures during lobectomy, use a sealing device to proceed layer by layer until structures are identified↗
▶Ep 4 · 25:04
host summaryTodd Ponsky summarizing a resource: Contralateral main-stem intubation is the best and easiest technique for single-lung ventilation during thoracoscopic lobectomy↗
▶Ep 4 · 25:04
host summaryTodd Ponsky summarizing a resource: In the Gips pilonidal procedure, all punch openings are left unpacked and unsutured, drains are not required, and the procedure takes 3-5 minutes↗
▶Ep 4 · 25:04
host summaryTodd Ponsky summarizing a resource: The Gips procedure for pilonidal disease involves coring out pits with trephine or punch biopsy, extracting granulation tissue and hair with mosquito forceps, curetting the cavity with a smaller trephine, and flushing with saline then hydrogen peroxide↗
▶Ep 4 · 25:04
host summaryTodd Ponsky summarizing a resource: For thoracoscopic lobectomy, the scope should be placed anterior to the tip of the scapula, almost at the mid-axillary line, directly over the major fissure↗
▶Ep 4 · 26:00
host summaryTodd Ponsky summarizing a resource: Glycopyrrolate treatment reduced chest tube output to 124 mL compared to 370 mL in the placebo group for TEF repair leaks↗
▶Ep 4 · 26:00
host summaryTodd Ponsky summarizing a resource: For pyloric stenosis resuscitation: if chloride is less than 85, give 3 fluid boluses; if chloride is less than 97, give 2 boluses; if chloride is greater than 97 but bicarbonate is less than 33, give 1 bolus↗
▶Ep 4 · 26:00
host summaryTodd Ponsky summarizing a resource: For non-traumatic or traumatic pneumomediastinum, chest X-ray alone is sufficient; no further imaging is needed↗
▶Ep 4 · 26:00
host summaryTodd Ponsky summarizing a resource: In a study of 42 patients with esophageal atresia repair leaks, IV glycopyrrolate (Robinul) resulted in 76% leak resolution compared to 29% in the placebo group↗
Summaries Todd gave as host · Crohn's Disease28 summaries
host summaryTodd Ponsky summarizing the discussion: whole just published a paper recently about um multi-disciplinary engagement and how important it is↗
▶Ep 5 · 2:12
host summaryTodd Ponsky summarizing the discussion: Whole recently published a paper about multidisciplinary engagement and its importance in ERAS↗
▶Ep 5 · 5:37
host summaryTodd Ponsky summarizing the discussion: Two FAP patients went home in two days after proctocolectomy and colectomy at Kurt's institution a month prior↗
▶Ep 5 · 7:10
host summaryTodd Ponsky summarizing the discussion: having this pre-op optimization period and heavy counseling is really important↗
▶Ep 5 · 7:10
host summaryTodd Ponsky summarizing the discussion: about 10 years ago the adult enhanced recovery group um did a really nice study where it talked about the parts of the ERS protocol that were most influential and they identified mobilization and oral intake as being the most important↗
▶Ep 5 · 7:10
host summaryTodd Ponsky summarizing the discussion: they found that about half their cases were ready to go home physiologically, one to two days before they actually would agree to go home because they were afraid↗
▶Ep 5 · 7:10
host summaryTodd Ponsky summarizing the discussion: Preoperative optimization period and heavy counseling are important for patient readiness for early discharge↗
▶Ep 5 · 7:10
host summaryTodd Ponsky summarizing the discussion: About half of ERAS cases were ready to go home physiologically one to two days before they actually agreed to go home because they were afraid↗
▶Ep 5 · 7:10
host summaryTodd Ponsky summarizing the discussion: The adult enhanced recovery group did a study about 10 years ago identifying mobilization and oral intake as the most important parts of the ERAS protocol↗
▶Ep 5 · 7:10
host summaryTodd Ponsky summarizing the discussion: A nurse at Kurt's institution calls patients several times before their operation to go over discharge goals and reassure them↗
▶Ep 5 · 9:16
host summaryTodd Ponsky summarizing the discussion: the preoperative education is key because, you know, like a lot of these patients and a lot of your patients when you do this are going to be like, well, wait a second, you know, I'm not ready up here, not physiologically and having those conversations ahead of time is very important↗
▶Ep 5 · 9:16
host summaryTodd Ponsky summarizing the discussion: Getting the anesthesiologist to buy into giving the preoperative carbohydrate load is one of the hardest things in obese patients↗
▶Ep 5 · 9:16
host summaryTodd Ponsky summarizing the discussion: Over half of bariatric patients are able to go home on the first postoperative day after sleeve gastrectomy with ERAS↗
▶Ep 5 · 9:16
host summaryTodd Ponsky summarizing the discussion: One of the hardest things in the obese patients is getting the anesthesiologist buy to giving the the preoperative carbohydrate load↗
▶Ep 5 · 9:16
host summaryTodd Ponsky summarizing the discussion: in our bariatric population after sleeve gastrectomy, we're able to get over half of our patients out on the first post-operative day↗
▶Ep 5 · 11:07
host summaryTodd Ponsky summarizing the discussion: Early in ERAS practice, Kurt's institution did epidurals for a year but it was a disaster because epidurals slowed patients down dramatically↗
▶Ep 5 · 11:07
host summaryTodd Ponsky summarizing the discussion: after eight years of doing enhanced recovery and not having aspiration events, we uh in our quality council went to the anesthesia teams on all of our campuses and asked them to change our NPO times from this 20-year-old arrangement which said two hours was okay to making it one hour NPO time↗
▶Ep 5 · 11:07
host summaryTodd Ponsky summarizing the discussion: on March 1st uh for all of the 43,000 procedures that are done in our institution on an annual basis, the NPO time for clear liquids became one hour↗
▶Ep 5 · 11:07
host summaryTodd Ponsky summarizing the discussion: early in our practice we uh had a a marginally functioning pain team and we invited them into the ERS club and uh got them involved↗
▶Ep 5 · 11:07
host summaryTodd Ponsky summarizing the discussion: for a year we did epidurals. It was a disaster. The epidurals uh slowed the patients down dramatically so we just went to QL blocks, rectus sheath blocks or tap blocks↗
▶Ep 5 · 11:07
host summaryTodd Ponsky summarizing the discussion: We can do colectomies or uh cranio facial operations with no narcotics becomes really big deal for the family↗
▶Ep 5 · 11:07
host summaryTodd Ponsky summarizing the discussion: Colectomies and craniofacial operations can be done with no narcotics using ERAS protocols↗
▶Ep 5 · 11:07
host summaryTodd Ponsky summarizing the discussion: By giving premeds on the morning of operation or day before and giving a block, then scheduling medications postop, Kurt's institution can do a good job at pain control↗
▶Ep 5 · 11:07
host summaryTodd Ponsky summarizing the discussion: After eight years of doing enhanced recovery without aspiration events, Kurt's institution changed NPO times for clear liquids from two hours to one hour for all 43,000 annual procedures as of March 1st↗
▶Ep 5 · 11:07
host summaryTodd Ponsky summarizing the discussion: After abandoning epidurals, Kurt's institution switched to QL blocks, rectus sheath blocks, or TAP blocks, which made it easier for patients to ambulate↗
▶Ep 5 · 20:39
host summaryTodd Ponsky summarizing the discussion: Kurt did ERAS subversively on his own for a few years in Atlanta, collecting his own readmission rates, then presented the data showing it worked↗
▶Ep 5 · 20:53
host summaryTodd Ponsky summarizing the discussion: Kurt did a fantastic job in in Atlanta where uh he got anesthesia involved and and Kurt actually sort of did it subvertly uh on his own for a few years to and and was collecting his own return to the system and repeat, you know, uh readmission rates so that he could then kind of come up and show us, look, I've been doing this for five years, it's all fine and it all works↗
Update Course Rewind: 2020 ERAS
▶Ep 6 · 10:56
host summaryTodd Ponsky summarizes what Dr. Kurt Heise said: Dr. Brindle authored a recent paper explaining a neonatal ERAS bundle created from scratch.↗
Summaries Todd gave as host · Cryptorchidism3 summaries
host summaryTodd Ponsky summarizing the discussion: The median time for orchiopexy is between four and five years of age.↗
▶Ep 2 · 3:30
host summaryTodd Ponsky summarizing the discussion: The AUA recommends making the diagnosis of undescended testicle at six months of age with repair by 18 months.↗
▶Ep 2 · 3:30
host summaryTodd Ponsky summarizing the discussion: Patients with palpable testicles who had orchiopexy at a later age had completely normal semen.↗
Summaries Todd gave as host · Duodenal Atresia2 summaries
BOB in Ped Surg 2023 - CIPESUR Winner - Georgina Falcioni, MD
▶Ep 3 · 7:20
host summaryTodd Ponsky summarizing the discussion: Low-fidelity simulation involves practicing skills of movement such as moving a peg from one place to another, cutting, and sewing.↗
▶Ep 3 · 7:45
host summaryTodd Ponsky summarizing the discussion: High-fidelity simulation involves replicas of actual tissue where surgeons try to simulate procedures like esophageal atresia or duodenal atresia repair.↗
Venous Thromboembolism Prophylaxis In Trauma Patients: Practice Gap...
▶Ep 1 · 0:31
host summaryTodd Ponsky summarizing the discussion: the general teaching some time ago was that kids just didn't get this problem and it didn't exist and you didn't really need to worry about it↗
▶Ep 1 · 4:37
host summaryTodd Ponsky summarizing the discussion: The theoretically correct answer for the case is screening ultrasound on ICU day 7, because pharmacologic prophylaxis is contraindicated due to significant head bleed.↗
▶Ep 1 · 4:37
host summaryTodd Ponsky summarizing the discussion: In adult trauma patients, VTE incidence is about 3-5%.↗
▶Ep 1 · 4:37
host summaryTodd Ponsky summarizing the discussion: VTE incidence in pediatric trauma patients is estimated between 0.16% and 1%, probably on the order of 1% or less in general.↗
▶Ep 1 · 4:37
host summaryTodd Ponsky summarizing the discussion: For high-risk patients who are not candidates for pharmacologic prophylaxis, treatment is SCDs until ambulatory plus screening ultrasound on day 7.↗
▶Ep 1 · 4:37
host summaryTodd Ponsky summarizing the discussion: For high-risk patients without bleeding concerns, treatment is low molecular weight heparin plus SCDs until ambulatory.↗
▶Ep 1 · 4:37
host summaryTodd Ponsky summarizing the discussion: According to the Landish schema, high-risk patients are defined as those greater than 12 years with one or more risk factors, or less than 12 years with more than 4 risk factors.↗
▶Ep 1 · 4:37
host summaryTodd Ponsky summarizing the discussion: A 2017 seminars summary by Dr. Perry (current chair of the Abstinence trauma Committee) provides a comprehensive review of pediatric VTE prophylaxis in trauma.↗
▶Ep 1 · 4:37
host summaryTodd Ponsky summarizing the discussion: Pediatric VTE risk factors include central catheters, inflammatory bowel disease (chronic inflammatory states), blood transfusion, and obesity.↗
▶Ep 1 · 4:37
host summaryTodd Ponsky summarizing the discussion: In adult neuro trauma patients, VTE incidence is significantly higher at 10-15%.↗
host summaryTodd Ponsky summarizing the discussion: I think everybody agrees that This would be the standard uh initial evaluation for MIEA↗
▶Ep 1 · 10:10
host summaryTodd Ponsky summarizing the discussion: Length of stay is identical between TPA and VATS groups even though TPA numbers include intention-to-treat analysis with all failures who required subsequent VATS↗
▶Ep 1 · 17:08
host summaryTodd Ponsky summarizing the discussion: A 5–10% apical pneumothorax in a minimally symptomatic patient should be observed with oxygen supplementation↗
Summaries Todd gave as host · Enterocolitis16 summaries
Radiology and Image Diagnosis of Hirschsprung Disease
▶Ep 4 · 32:23
host summaryTodd Ponsky summarizing the discussion: If it is clearly meconium ileus with reflux into terminal ileum and clinical improvement, some surgeons will not do rectal biopsy.↗
Outcomes and Complications in Hirschsprung Disease
▶Ep 5 · 33:44
host summaryTodd Ponsky summarizing the discussion: Many places still have clung to this idea that the way to assess a pull through specimen is to do a longitudinal strip of the length of the specimen and not look at the full circumference of the proximal margin.↗
▶Ep 5 · 33:44
host summaryTodd Ponsky summarizing the discussion: Many institutions assess pull-through specimens using only a longitudinal strip rather than examining the full circumference of the proximal margin; the interface between ganglionic and aganglionic bowel can be irregular and project 2-4 cm longer along one part of the circumference.↗
▶Ep 5 · 33:53
host summaryTodd Ponsky summarizing the discussion: The interface between the ganglionic bowel and the a ganglion bowel can be very irregular and can project for 234 centimeters longer along one part of the circumference than the other.↗
▶Ep 5 · 35:19
host summaryTodd Ponsky summarizing the discussion: A survey of Canadian pediatric surgeons found nearly half resect 4 centimeters or less from the biopsy site, and about 10% resect right at the site of positive biopsy, creating high risk of pull-throughs in the transition zone.↗
Hirschsprung Disease: Cases and Complications
▶Ep 9 · 35:19
host summaryTodd Ponsky summarizing the discussion: A survey of the Canadian Association of Pediatric Surgeons by Jack Langer found that nearly half of surgeons resect 4 cm or less from the biopsy site, and about 10% resect right at the site of positive biopsy, creating high risk for pull-throughs in the transition zone.↗
Hirschsprung Disease: Update Course 2013
▶Ep 10 · 2:40
host summaryTodd Ponsky summarizing the discussion: A significant portion of fellows at a Washington DC course said they would get upper GI first in newborn with bilious emesis before contrast enema↗
Hirschsprung Disease: Update Course 2013
▶Ep 11 · 4:14
host summaryTodd Ponsky summarizing the discussion: the baby's first enema should be a barium enema↗
▶Ep 11 · 5:06
host summaryTodd Ponsky summarizing the discussion: Tissue diagnosis is mandatory before surgery for Hirschsprung disease; contrast enema alone is insufficient↗
▶Ep 11 · 5:30
host summaryTodd Ponsky summarizing the discussion: In critically ill patients with enterocolitis, surgery may be necessary before pathology results are available (typically takes until Wednesday if specimen obtained Friday)↗
▶Ep 11 · 16:50
host summaryTodd Ponsky summarizing the discussion: I've never seen really good results from in a 16 year old↗
▶Ep 11 · 17:40
host summaryTodd Ponsky summarizing the discussion: Hypertrophic nerves should not be present in normal anal canal, even though ganglion cells are absent there↗
▶Ep 11 · 29:11
host summaryTodd Ponsky summarizing the discussion: In children over age 2-3 years, perform open rectal biopsy under general anesthesia rather than office suction biopsy due to patient cooperation issues↗
▶Ep 11 · 34:11
host summaryTodd Ponsky summarizing the discussion: Manometry is reliable for diagnosing Hirschsprung in older children when biopsies may be unreliable↗
▶Ep 11 · 35:15
host summaryTodd Ponsky summarizing the discussion: For enterocolitis 6 months post-pull-through with fever, distention, and diarrhea but no peritonitis, treat with IV fluids, broad-spectrum antibiotics, and rectal irrigations↗
▶Ep 11 · 36:20
host summaryTodd Ponsky summarizing the discussion: Incidence of enterocolitis in children with trisomy 21 is double that of genetically normal children with Hirschsprung disease↗
Summaries Todd gave as host · Enterocolitis16 summaries
Radiology and Image Diagnosis of Hirschsprung Disease
▶Ep 4 · 32:23
host summaryTodd Ponsky summarizing the discussion: If it is clearly meconium ileus with reflux into terminal ileum and clinical improvement, some surgeons will not do rectal biopsy.↗
Outcomes and Complications in Hirschsprung Disease
▶Ep 5 · 33:44
host summaryTodd Ponsky summarizing the discussion: Many places still have clung to this idea that the way to assess a pull through specimen is to do a longitudinal strip of the length of the specimen and not look at the full circumference of the proximal margin.↗
▶Ep 5 · 33:44
host summaryTodd Ponsky summarizing the discussion: Many institutions assess pull-through specimens using only a longitudinal strip rather than examining the full circumference of the proximal margin; the interface between ganglionic and aganglionic bowel can be irregular and project 2-4 cm longer along one part of the circumference.↗
▶Ep 5 · 33:53
host summaryTodd Ponsky summarizing the discussion: The interface between the ganglionic bowel and the a ganglion bowel can be very irregular and can project for 234 centimeters longer along one part of the circumference than the other.↗
▶Ep 5 · 35:19
host summaryTodd Ponsky summarizing the discussion: A survey of Canadian pediatric surgeons found nearly half resect 4 centimeters or less from the biopsy site, and about 10% resect right at the site of positive biopsy, creating high risk of pull-throughs in the transition zone.↗
Hirschsprung Disease: Cases and Complications
▶Ep 8 · 35:19
host summaryTodd Ponsky summarizing the discussion: A survey of the Canadian Association of Pediatric Surgeons by Jack Langer found that nearly half of surgeons resect 4 cm or less from the biopsy site, and about 10% resect right at the site of positive biopsy, creating high risk for pull-throughs in the transition zone.↗
Hirschsprung Disease: Update Course 2013
▶Ep 10 · 2:40
host summaryTodd Ponsky summarizing the discussion: A significant portion of fellows at a Washington DC course said they would get upper GI first in newborn with bilious emesis before contrast enema↗
Hirschsprung Disease: Update Course 2013
▶Ep 11 · 4:14
host summaryTodd Ponsky summarizing the discussion: the baby's first enema should be a barium enema↗
▶Ep 11 · 5:06
host summaryTodd Ponsky summarizing the discussion: Tissue diagnosis is mandatory before surgery for Hirschsprung disease; contrast enema alone is insufficient↗
▶Ep 11 · 5:30
host summaryTodd Ponsky summarizing the discussion: In critically ill patients with enterocolitis, surgery may be necessary before pathology results are available (typically takes until Wednesday if specimen obtained Friday)↗
▶Ep 11 · 16:50
host summaryTodd Ponsky summarizing the discussion: I've never seen really good results from in a 16 year old↗
▶Ep 11 · 17:40
host summaryTodd Ponsky summarizing the discussion: Hypertrophic nerves should not be present in normal anal canal, even though ganglion cells are absent there↗
▶Ep 11 · 29:11
host summaryTodd Ponsky summarizing the discussion: In children over age 2-3 years, perform open rectal biopsy under general anesthesia rather than office suction biopsy due to patient cooperation issues↗
▶Ep 11 · 34:11
host summaryTodd Ponsky summarizing the discussion: Manometry is reliable for diagnosing Hirschsprung in older children when biopsies may be unreliable↗
▶Ep 11 · 35:15
host summaryTodd Ponsky summarizing the discussion: For enterocolitis 6 months post-pull-through with fever, distention, and diarrhea but no peritonitis, treat with IV fluids, broad-spectrum antibiotics, and rectal irrigations↗
▶Ep 11 · 36:20
host summaryTodd Ponsky summarizing the discussion: Incidence of enterocolitis in children with trisomy 21 is double that of genetically normal children with Hirschsprung disease↗
Summaries Todd gave as host · Epigastric Hernia2 summaries
Laparoscopic Epigastric Herniorrhaphy-Case and Discussion: Pediatric Surgery...
▶Ep 1 · 4:34
host summaryTodd Ponsky summarizing the discussion: Dr. Abello confirmed the hernia was a true epigastric hernia with fat, not omentum.↗
▶Ep 1 · 14:10
host summaryTodd Ponsky summarizing the discussion: Adult surgeons report needing to take down the falciform ligament and open the peritoneum to visualize epigastric hernias laparoscopically.↗
Summaries Todd gave as host · Esophageal Atresia21 summaries
Neonatal Thoracotomy Has 25% Chance of Chest Wall Deformity
▶Ep 1 · 0:00
host summaryTodd Ponsky summarizing a resource: one major argument for minimally invasive thoracic surgery is that open thoracotomies in neonates can lead to long-term chest wall deformities↗
▶Ep 1 · 0:00
host summaryTodd Ponsky summarizing a resource: One major argument for minimally invasive thoracic surgery is that open thoracotomies in neonates can lead to long-term chest wall deformities.↗
▶Ep 1 · 1:00
host summaryTodd Ponsky summarizing a resource: the actual incidence of this has never really been shown↗
▶Ep 1 · 1:00
host summaryTodd Ponsky summarizing a resource: The actual incidence of chest wall deformities following neonatal thoracotomy has never really been shown prior to this study.↗
▶Ep 1 · 1:30
host summaryTodd Ponsky summarizing a resource: The study explored musculoskeletal deformities in patients who underwent open repair of esophageal atresia between 1997 and 2012 at Montreal Children's Hospital.↗
▶Ep 1 · 2:00
host summaryTodd Ponsky summarizing a resource: None of the patients in the study had any other predisposition to musculoskeletal deformities.↗
▶Ep 1 · 3:00
host summaryTodd Ponsky summarizing a resource: The study cohort consisted of 52 patients with a median follow-up of eight years.↗
▶Ep 1 · 3:30
host summaryTodd Ponsky summarizing a resource: Musculoskeletal deformities developed in 25% of patients following neonatal thoracotomy for esophageal atresia repair.↗
▶Ep 1 · 4:00
host summaryTodd Ponsky summarizing a resource: Non-muscle-sparing thoracotomy had a 55% chance of causing musculoskeletal deformity.↗
▶Ep 1 · 4:20
host summaryTodd Ponsky summarizing a resource: Muscle-sparing thoracotomy had a 16% chance of causing musculoskeletal deformity.↗
▶Ep 1 · 4:40
host summaryTodd Ponsky summarizing a resource: Division of the serratus anterior muscle was associated with significantly higher probability of developing musculoskeletal deformities even after adjusting for possible confounding variables.↗
▶Ep 1 · 5:20
host summaryTodd Ponsky summarizing a resource: A muscle-sparing technique decreases the incidence of musculoskeletal deformities following neonatal thoracotomy.↗
▶Ep 1 · 5:20
host summaryTodd Ponsky summarizing a resource: Musculoskeletal deformities develop in a significant portion of neonates following thoracotomy↗
▶Ep 1 · 5:50
host summaryTodd Ponsky summarizing a resource: Minimally invasive thoracoscopic surgery probably also decreases the incidence of musculoskeletal deformities compared to open thoracotomy.↗
Glycopyrrolate for Anastomtic Dehiscence in Esophageal Atresia
▶Ep 2 · 0:08
host summaryTodd Ponsky summarizes what Dr. Abdul Raoof Lamoshi said: There were 297 patients over a 10 year period that underwent esophageal atresia repair↗
▶Ep 2 · 0:08
host summaryTodd Ponsky summarizes what Dr. Abdul Raoof Lamoshi said: Of the 297 patients, there were 42 leaks, approximately 14%↗
▶Ep 2 · 0:08
host summaryTodd Ponsky summarizes what Dr. Abdul Raoof Lamoshi said: The title of today's article is Role of Glycopyrolate in Healing of Anastomotic dehiscence after Primary Repair of esophageal atresia in a Low Resource setting, a randomized control study.↗
▶Ep 2 · 0:08
host summaryTodd Ponsky summarizes what Dr. Abdul Raoof Lamoshi said: The 42 patients with leaks were prospectively randomized into two groups of 21 each, one receiving glycopyrrolate and the other receiving placebo (saline)↗
▶Ep 2 · 0:08
host summaryTodd Ponsky summarizes what Dr. Abdul Raoof Lamoshi said: The study was a prospective randomized control trial studying the effect of glycopyrolate on patients that had leak after esophageal atresia repair↗
▶Ep 2 · 0:08
host summaryTodd Ponsky summarizes what Dr. Abdul Raoof Lamoshi said: The observer was blinded to which treatment group the patient was in↗
Posterior Tracheopexy during Primary Esophageal Atresia Repair
▶Ep 5 · 1:57
host summaryTodd Ponsky summarizes what Dr. Stephan Derhauf said: Tracheomalacia is so prominent in patients with esophageal atresia that the Utrecht group performs posterior tracheopexy proactively during primary repair instead of requiring a second operation.↗
Summaries Todd gave as host · Esophageal Atresia6 summaries
Glycopyrrolate for Anastomtic Dehiscence in Esophageal Atresia
▶Ep 1 · 0:08
host summaryTodd Ponsky summarizes what Dr. Abdul Raoof Lamoshi said: The title of today's article is Role of Glycopyrolate in Healing of Anastomotic dehiscence after Primary Repair of esophageal atresia in a Low Resource setting, a randomized control study.↗
▶Ep 1 · 0:08
host summaryTodd Ponsky summarizes what Dr. Abdul Raoof Lamoshi said: The observer was blinded to which treatment group the patient was in↗
▶Ep 1 · 0:08
host summaryTodd Ponsky summarizes what Dr. Abdul Raoof Lamoshi said: The 42 patients with leaks were prospectively randomized into two groups of 21 each, one receiving glycopyrrolate and the other receiving placebo (saline)↗
▶Ep 1 · 0:08
host summaryTodd Ponsky summarizes what Dr. Abdul Raoof Lamoshi said: Of the 297 patients, there were 42 leaks, approximately 14%↗
▶Ep 1 · 0:08
host summaryTodd Ponsky summarizes what Dr. Abdul Raoof Lamoshi said: There were 297 patients over a 10 year period that underwent esophageal atresia repair↗
▶Ep 1 · 0:08
host summaryTodd Ponsky summarizes what Dr. Abdul Raoof Lamoshi said: The study was a prospective randomized control trial studying the effect of glycopyrolate on patients that had leak after esophageal atresia repair↗
