Compiled Sandler Rapid Fire Sessions: Update Course 2015

Current standard for bilateral Wilms tumor is to start chemotherapy without biopsy, typically 2 cycles, and continue until tumor shrinkage plateaus (defined as less than 50% size reduction)

Wilms tumors are heterogeneous and biopsy may miss foci of anaplasia

When Wilms tumors stop shrinking with chemotherapy, it is usually due to mesenchymal differentiation rather than anaplastic transformation

Bilateral nephron-sparing surgery is feasible even in large bilateral Wilms tumors by placing kidneys on ice, clamping vessels, and performing sharp dissection

Recurrence of anaplastic Wilms tumor portends a very bad outcome and salvage is difficult despite chemotherapy

Most pathologists believe anaplasia in Wilms tumor is present primarily rather than induced by chemotherapy

Multifocal Wilms tumors raise concern about underlying embryologic abnormalities of the kidney and risk of developing additional tumors

97% of bilateral kidney tumors in children are Wilms tumor, with only a small percentage being other diagnoses

For gastroschisis with inflamed bowel, bedside reduction without intubation is feasible using rectal Tylenol and minimal fentanyl

In many centers, high-risk obstetric teams deliver gastroschisis cases early by C-section, resulting in less thick and matted bowel at birth

For gastroschisis reduction at bedside, babies are intubated and paralyzed, a stitch is placed in the fascia with cord left as a biological patch, and Opsite dressing is applied; patients are kept paralyzed for 1-2 days

Umbilical hernias after gastroschisis closure will close spontaneously if no fascia was cut; if fascia is cut, a permanent defect results

Spring-loaded Bianchi silos may enlarge the fascial defect because the outward forces from the compressed ring push laterally

Tegaderm closure of gastroschisis without fascial closure allows cicatrization over 3 days to 8 weeks, with feeding started when bowel function returns rather than waiting for complete closure

When gastroschisis defect dilates during silo reduction attempts, Tegaderm closure alone can still achieve successful cicatrization without fascial closure

In gastroschisis with intestinal atresia and pristine bowel, creating an ostomy through the umbilical fascial ring is technically favorable because the bowel size matches the ring and provides good tissue for suturing

Primary anastomosis in gastroschisis with atresia is risky because the proximal bowel is massively dilated and distal bowel is decompressed, creating a tenuous anastomosis in bowel that has been outside the abdomen

In vanishing gastroschisis with markedly inflamed bowel, it is impossible to determine bowel viability or the extent of remaining intra-abdominal bowel from external examination

Re-exploration at 2 weeks after gastroschisis closure (rather than the traditional 4-6 weeks) can reveal that inflamed gastroschisis bowel has transformed into functional intestine suitable for anastomosis

Plication of dilated bowel in ileal atresia usually unravels with time, allowing the bowel to be used later for lengthening procedures

Bianchi procedure is preferred over STEP for bowel lengthening because a patient can undergo Bianchi followed by STEP if needed, but once STEP is performed, lengthening options are limited

In neonatal ileal atresia with dilated proximal bowel, plication is preferred over tapering to preserve bowel length for potential future lengthening procedures