Stay Current in Pediatric Surgery

di StayCurrent: Pediatric Surgery

Improving Outcomes for Congenital Diaphragmatic Hernia (CDH): Protocol Changes at CCHMC

Discover how Cincinnati Children's Hospital implemented protocol changes to significantly improve outcomes for babies with Congenital Diaphragmatic Hernia (CDH). This video details updates in ventilator management, ECMO utilization, blood pressure support, nutrition, and sedation protocols, leading to increased survival rates and reduced mechanical ventilation time. Learn about the evidence-based adjustments that have enhanced care for these complex pediatric patients. For more information on the Fetal Care Center, click here: https://www.cincinnatichildrens.org/service/f/fetal-care

9 giu 2026

5:25

Congenital Diaphragmatic Hernias (CDH): Improving Outcomes with Advanced Imaging & Nutrition

This video provides a comprehensive overview of Congenital Diaphragmatic Hernias (CDH), a significant birth defect. Dr. Paul Kingma from Cincinnati Children's discusses the incidence, prenatal assessment, and key factors influencing prognosis. The presentation highlights novel research using postnatal MRI, including Ultrashort Echo Time (UTE) MRI, to evaluate lung growth and vascular development, underscoring the critical role of nutrition and weight gain in improving respiratory outcomes for affected infants. For more information on the Fetal Care Center at CCHMC, click here: https://www.cincinnatichildrens.org/service/f/fetal-care

9 giu 2026

5:34

Video #6 - Hirschsprung & ARM... Rare but Real

This video, part of the GlobalCastMD series featuring Cincinnati Children's, recaps key highlights from the 13th Annual Pediatric Surgery Update Course. Dr. Jill Knepprath and Dr. Aaron Garrison discuss important updates in colorectal surgery, focusing on Hirschsprung's Disease (HD) and Anorectal Malformation (ARM). The presentation highlights the incidence of these combined conditions, particularly in patients with Trisomy 21, and provides diagnostic considerations for complex cases. For more information on the Colorectal team at CCHMC, visit here: https://cincinnatichildrens.pulse.ly/264pcddqqh

9 giu 2026

1:54

Update Course Rewind 2025: Botox for Hirschsprung’s: Where, When, and Why

This video from GlobalCast MD, featuring Cincinnati Children's, recaps key insights from the 13th Annual Pediatric Surgery Update Course on the use of Botox in Hirschsprung's Disease. It discusses current practices, poll results among pediatric surgeons regarding intrasphincteric botox injection during pull-through procedures, and findings from studies on its efficacy in reducing enterocolitis risk. Experts also delve into the challenges of dosing and the role of ultrasound guidance in these injections. For more information on the Colorectal team at CCHMC, visit here: https://cincinnatichildrens.pulse.ly/264pcddqqh

19 mag 2026

1:56

Update Course Rewind 2025: Hirschsprung’s Pull-Through: Why Family Training May Save Lives

In this Update Course Rewind from the 13th Annual Update Course in Pediatric Surgery, Drs. Annie Le-Nguyen, Jamie Harris, and Elizabeth Speck discuss one of the most debated questions in Hirschsprung disease management: when is the best time to perform a pull-through procedure? Key Highlights: Neonatal vs Delayed Pull-Through: Audience opinions were widely split, reflecting the lack of consensus in the field. Some surgeons favor neonatal repair before NICU discharge, while others prefer waiting several months. What the Literature Shows: A 2021 PCPLC retrospective study comparing neonatal versus delayed primary pull-through procedures found no significant difference in enterocolitis rates, postoperative complications, or long-term fecal continence outcomes. Timing Isn’t the Only Factor: The neonatal cohort underwent surgery at a median age of 11 days, while delayed repairs occurred closer to 98 days—yet outcomes remained comparable. The Importance of Home Irrigations: Panelists emphasized that a family’s ability to safely perform rectal irrigations at home may be more important than patient age when deciding surgical timing. Preventing Serious Complications: Inadequate decompression at home can increase the risk of enterocolitis or perforation, making caregiver education and confidence a critical component of successful Hirschsprung management. Individualized Decision-Making: Surgeons should consider family readiness, follow-up access, and irrigation competency when determining the timing of pull-through surgery. This session highlights that while surgical timing remains flexible, empowering families with proper bowel management skills is essential to achieving safe outcomes in Hirschsprung disease. For more information on the Colorectal team at CCHMC, visit here: https://cincinnatichildrens.pulse.ly/264pcddqqh

14 mag 2026

2:05

Update Course Rewind 2025: Do We Still Need Routine Anal Dilations After PSARP?

In this Update Course Rewind from the 13th Annual Update Course in Pediatric Surgery, Drs. Jamie Harris, Elizabeth Speck, Aaron Garrison, and Annie Le-Nguyen revisit a long-standing postoperative practice in colorectal surgery: are routine anal dilations after PSARP truly necessary? Key Highlights: Questioning a Surgical Tradition: For decades, postoperative anal dilations have been considered standard after PSARP—but emerging studies and clinician experience are challenging whether they should be universally required. Emotional Impact on Families: Panelists discussed the significant anxiety and stress dilations can create for caregivers, including concerns about harming the repair and reports of PTSD-like experiences for both families and patients. What the Data Shows: Recent institutional reviews comparing dilation protocols versus no dilations found similar rates of neoanal stricture and reoperation, suggesting mandatory dilations may not always improve outcomes. Alternative Approaches: Heineke-Mikulicz anoplasty (HMA) was highlighted as a safe, minimally invasive outpatient option for managing strictures instead of prolonged dilation regimens. Why Some Surgeons Still Dilate: Many surgeons continue postoperative dilations in neonates, particularly in healthcare systems where rapid access to elective revision procedures may be limited. Individualized Decision-Making: Patient age, anatomy, caregiver comfort, access to follow-up care, and institutional resources all play a role in deciding whether postoperative dilations are appropriate. This session emphasizes that postoperative care after PSARP may not need a one-size-fits-all approach—and that family-centered decision-making is becoming increasingly important in colorectal surgery. For more information on the Colorectal team at CCHMC, visit here: https://cincinnatichildrens.pulse.ly/264pcddqqh

14 mag 2026

2:33

Update Course Rewind 2025: Perineal Body–Preserving PSARP: The New Standard?

In this Update Course Rewind from the 13th Annual Update Course in Pediatric Surgery, Drs. Nelson Rosen, Elizabeth Speck, Aaron Garrison, and Jamie Harris explore a key surgical debate: classic PSARP vs. the perineal body–preserving approach for anorectal malformations. Key Highlights: Technique Comparison: The perineal body–preserving PSARP is gaining traction, with many surgeons adopting it as an alternative to the traditional approach, while classic PSARP remains widely used. Early Outcomes Data: Recent studies (2023) show promising results for the perineal body–preserving technique, including no dehiscence, no prolapse, and relatively low rates of anal stricture requiring revision. Postoperative Recovery: Patients undergoing the perineal body–preserving approach may benefit from shorter hospital stays, with many discharged as early as postoperative day one. Technical Considerations: While effective, the approach can be technically more challenging, particularly when identifying anterior anatomy and protecting the posterior vaginal wall. Flexibility in Approach: Surgeons emphasized that conversion to a standard PSARP is always appropriate if there is any uncertainty about anatomy or safety during the procedure. This session highlights that while newer techniques show promise, surgeon judgment and adaptability remain critical to achieving safe and effective outcomes. For more information on the Colorectal team at CCHMC, visit here: https://cincinnatichildrens.pulse.ly/264pcddqqh

14 mag 2026

2:13

Update Course Rewind 2025: Timing of PSARP: Early vs. Delayed—Does It Really Matter?

In this Update Course Rewind from the 13th Annual Update Course in Pediatric Surgery, Dr. Jamie Harris—joined by Drs. Nelson Rosen, Annie Le-Nguyen, Aaron Garrison, and Elizabeth Speck—explores one of the most debated questions in colorectal surgery: when is the optimal timing for PSARP in patients with rectovestibular fistula? Key Highlights: Early vs. Delayed PSARP: Both early repair (during the newborn admission) and delayed repair (1–3 months of age) are shown to be equally safe, with no significant differences in complications, reoperations, or readmissions. What the Data Shows: Recent multi-institutional studies (NSQIP and PCPLC) found no difference in 30-day outcomes between early and delayed repairs, reinforcing that timing alone does not determine success. Role of Dilations: Initial dilations can help decompress the bowel, but should be limited (e.g., up to 7 Hegar) to avoid fibrosis and preserve optimal conditions for future repair. Clinical Tradeoffs: Delayed repair: May increase technical difficulty due to fibrosis or rectal distention if not well managed Early repair: Avoids additional hospitalizations and reduces burden on families, especially those facing access or financial barriers What Really Matters: Decision-making should be individualized—taking into account patient size, comorbidities, surgeon experience, and family logistics, rather than a strict timeline. This session highlights that while timing remains flexible, thoughtful, patient-centered decision-making is key to achieving the best outcomes. For more information on the Colorectal team at CCHMC, visit here: https://cincinnatichildrens.pulse.ly/264pcddqqh

14 mag 2026

3:47

Pediatric Obesity Is a Disease: Treatment, Medications, Surgery & Equity in Care w/ Dr. Justin Ryder

In this segment from Lurie Children’s Hospital, Dr. Justin Ryder breaks down the evolving science and treatment paradigm of pediatric obesity—highlighting why it must be approached as a chronic, biologically driven disease rather than a lifestyle issue. Key Highlights: Obesity Is a Disease: Pediatric obesity is multifactorial, shaped by genetics, epigenetics, hormones, environment, stress, and socioeconomic factors. The newest AAP guidelines formally recognize obesity as a disease and recommend active treatment—not watchful waiting. Shift in Clinical Practice: Treatment should be offered to children above the 85th percentile BMI. The model has shifted from prevention-only efforts to a proactive, continuum-based care strategy. Continuum of Care: Management includes Intensive Health Behavior and Lifestyle Treatment (26+ contact hours), FDA-approved pharmacotherapy for adolescents, and bariatric surgery for select patients—each playing a role depending on severity and response. Efficacy & Challenges: GLP-1 medications demonstrate meaningful weight loss, and bariatric surgery shows durable BMI reduction and improvement in comorbidities. However, weight regain remains a significant biological challenge. MASLD & Long-Term Risk: Obesity is strongly linked to metabolic dysfunction–associated steatotic liver disease (MASLD), affecting millions of youth and placing many at risk for cirrhosis, transplant, or hepatocellular carcinoma. Equity & Advocacy: Obesity disproportionately impacts children of color and those in under-resourced communities. Access to effective treatment—including medications—is a health equity issue that demands advocacy. This session reinforces that pediatric obesity requires early, evidence-based intervention, multidisciplinary care, and systemic advocacy to improve lifelong health outcomes.

18 mar 2026

6:48

Pediatric Oncofertility: From Cryopreservation to Future Fertility Solutions

In this educational video from Ann & Robert H. Lurie Children’s Hospital of Chicago, Dr. Monica Laronda explores the rapidly evolving field of pediatric oncofertility—highlighting how fertility preservation is becoming an essential part of care for children at risk of treatment-related infertility. Key Highlights: Why Fertility Preservation Matters: Cancer therapies and certain genetic conditions can lead to premature gonadal failure, significantly impacting future reproductive potential and long-term quality of life. Who Should Be Considered: Fertility preservation extends beyond oncology to include patients with conditions like Turner syndrome and gonadal dysgenesis—emphasizing early counseling regardless of risk level or prognosis. Current Clinical Options: Post-pubertal patients may undergo oocyte or sperm banking, while ovarian and testicular tissue cryopreservation offer options for younger patients who are not yet producing mature gametes. Risk Stratification: Fertility risk is assessed using treatment exposure (e.g., alkylating agents, radiation) and cumulative dosing, helping guide decision-making and timing of intervention. Program Growth & Outcomes: Lurie Children’s has performed hundreds of tissue cryopreservation procedures, demonstrating both feasibility and increasing national awareness of these options. Advances in Fertility Restoration: Ovarian tissue transplantation can restore hormone function and fertility, though risks—such as reintroducing malignant cells—remain a key limitation. Future Innovation: Cutting-edge research in ovarian tissue engineering, including 3D-printed bioprosthetic scaffolds, is paving the way for safer and more effective fertility restoration. This session highlights how multidisciplinary care, research innovation, and early intervention are reshaping the future of fertility preservation for pediatric patients.

18 mar 2026

13:02

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