# Crohn's Disease — GCMD Library living collection

Everything in the library about Crohn's disease — built automatically from dossiers that name it.

Updated: n/a · 11 episodes · 211 cited statements

## Episodes
### Surgical Management
- [Enhanced Recovery After Surgery (ERAS) Program: Update Course 2016](https://origin-library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913) — video · 44:22 · [machine version](https://origin-library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913.md)
- [Inflammatory Bowel Disease: Update Course 2015](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987) — video · 13:49 · [machine version](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987.md)
- [ERAS - Clinical Practice Updates](https://origin-library.globalcastmd.com/watch/eras-clinical-practice-updates-2995) — video · [machine version](https://origin-library.globalcastmd.com/watch/eras-clinical-practice-updates-2995.md)
- [Update Course Rewind: 2020 ERAS](https://origin-library.globalcastmd.com/watch/update-course-rewind-2020-eras-3718) — podcast · 11:54 · [machine version](https://origin-library.globalcastmd.com/watch/update-course-rewind-2020-eras-3718.md)
- [2025 Pediatric Surgery Update Course - Updates in Enhanced Recovery After Surgery (ERAS) Protocols](https://origin-library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-10886) — video · 32:14 · [machine version](https://origin-library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-10886.md)
- [Trinity Ileal resection w narration](https://origin-library.globalcastmd.com/watch/trinity-ileal-resection-w-narration-11976) — video · 10:50 · [machine version](https://origin-library.globalcastmd.com/watch/trinity-ileal-resection-w-narration-11976.md)

### Evidence & Research
- [Journal of Pediatric Surgery Article Review: September 2021](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2021-4527) — podcast · 11:16 · [machine version](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2021-4527.md)
- [Journal of Pediatric Surgery Article Review: September 2021](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2021-13360) — video · 11:16 · [machine version](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2021-13360.md)

### Case-Based Learning
- [Inflammatory Bowel Disease (IBD) - Samir Pandya: Update Course 2014](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655) — video · 28:36 · [machine version](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655.md)
- [Inflammatory Bowel Disease: Update Course 2014](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042) — video · 28:36 · [machine version](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042.md)
- [Colorectal Quiz Episode 26: Perianal Crohn's Disease](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890) — podcast · 23:58 · [machine version](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890.md)

## Chapters
- [0:00](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=0) Case 1: Imaging modalities for fibrostenotic and fistulizing Crohn's disease (Ep 1)
- [7:00](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=420) Case 1: Surgical management of perianal abscess with ileal stricture (Ep 1)
- [15:00](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=900) Seton techniques and perianal fistula outcomes (Ep 1)
- [20:00](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=1200) Isolated terminal ileal Crohn's as distinct entity (Ep 1)
- [23:00](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=1380) Case 2: Surgical approach to refractory ulcerative colitis (Ep 1)
- [0:00](https://origin-library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=0) Introduction to ERAS Concept and Historical Context (Ep 2)
- [7:00](https://origin-library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=420) ERAS Components and Physiologic Rationale (Ep 2)
- [15:00](https://origin-library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=900) Evidence Base: Adult and Pediatric Outcomes (Ep 2)
- [22:00](https://origin-library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=1320) Implementation Strategy and Team Building (Ep 2)
- [30:00](https://origin-library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=1800) Interactive Discussion: Practical Implementation Questions (Ep 2)
- [0:00](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=0) Crohn's Disease Case: Timing of Surgery and TNF Inhibitor Management (Ep 3)
- [3:05](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=185) Ulcerative Colitis: J-Pouch Reconstruction and Infertility Considerations (Ep 3)
- [8:27](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=507) Surveillance Colonoscopy as Alternative to Prophylactic Colectomy (Ep 3)
- [9:38](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=578) Indeterminate Colitis: Surgical Approach and J-Pouch Controversy (Ep 3)
- [11:31](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=691) Technical Considerations and Volume-Outcome Relationship for J-Pouch (Ep 3)
- [0:00](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=0) Case 1 Introduction: Crohn's with Perianal Abscess - Imaging Modalities (Ep 4)
- [3:47](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=227) Surgical Management of Fistulizing and Fibrostenotic Crohn's Disease (Ep 4)
- [12:45](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=765) Perianal Disease Management and Strictureplasty Indications (Ep 4)
- [18:24](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=1104) Duodenal Crohn's and Isolated Terminal Ileal Disease (Ep 4)
- [20:46](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=1246) Case 2: Severe Ulcerative Colitis - Surgical Approach (Ep 4)
- [0:00](https://origin-library.globalcastmd.com/watch/eras-clinical-practice-updates-2995?t=0) Introduction to ERAS and Speaker Introductions (Ep 5)
- [1:44](https://origin-library.globalcastmd.com/watch/eras-clinical-practice-updates-2995?t=104) Case Presentation: 16-Year-Old Crohn's Patient with Same-Day Discharge (Ep 5)
- [7:10](https://origin-library.globalcastmd.com/watch/eras-clinical-practice-updates-2995?t=430) Discussion of Case Elements and Implementation Challenges (Ep 5)
- [13:57](https://origin-library.globalcastmd.com/watch/eras-clinical-practice-updates-2995?t=837) Key Implementation Strategies and ERAS Definition (Ep 5)
- [18:12](https://origin-library.globalcastmd.com/watch/eras-clinical-practice-updates-2995?t=1092) Multidisciplinary Requirements and Data Supporting ERAS (Ep 5)
- [25:54](https://origin-library.globalcastmd.com/watch/eras-clinical-practice-updates-2995?t=1554) Neonatal ERAS Protocol and Opioid-Sparing Analgesia (Ep 5)
- [0:00](https://origin-library.globalcastmd.com/watch/update-course-rewind-2020-eras-3718?t=0) Introduction to ERAS in Pediatric Surgery (Ep 6)
- [2:15](https://origin-library.globalcastmd.com/watch/update-course-rewind-2020-eras-3718?t=135) Case Presentation: 16-Year-Old with Ileocecal Stricture (Ep 6)
- [4:25](https://origin-library.globalcastmd.com/watch/update-course-rewind-2020-eras-3718?t=265) Discharge Readiness and Family Expectations (Ep 6)
- [5:39](https://origin-library.globalcastmd.com/watch/update-course-rewind-2020-eras-3718?t=339) Anesthesia Buy-In and Pain Management (Ep 6)
- [7:40](https://origin-library.globalcastmd.com/watch/update-course-rewind-2020-eras-3718?t=460) ERAS Definition and Institutional Implementation (Ep 6)
- [9:41](https://origin-library.globalcastmd.com/watch/update-course-rewind-2020-eras-3718?t=581) Data-Driven Implementation and Outcomes (Ep 6)
- [0:08](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2021-4527?t=8) Early feeding versus traditional feeding after neonatal intestinal anastomosis and Meckel diverticulum predictive score (Ep 7)
- [6:53](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2021-4527?t=413) Perianal symptoms and Crohn disease incidence in children (Ep 7)
- [0:05](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890?t=5) Introduction and case presentation setup (Ep 8)
- [1:49](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890?t=109) Case presentation and diagnostic workup discussion (Ep 8)
- [5:12](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890?t=312) Imaging workup and biologic risks (Ep 8)
- [7:51](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890?t=471) Surgical planning and timing (Ep 8)
- [11:21](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890?t=681) Operative findings and surgical technique (Ep 8)
- [15:22](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890?t=922) Postoperative course and endoscopic findings (Ep 8)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- In pediatric patients, unlike adult patients, the first presenting factor for Crohn's disease can often be perianal disease. — Jason Frischer (clinical) [Ep 8 · 9:29](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890?t=569)
- Male gender over the age of 10, and presence of a fistula are risk factors with much higher incidence of Crohn's disease being diagnosed in patients presenting with perianal lesions to the emergency room. — Jason Frischer (epidemiological) [Ep 8 · 9:00](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890?t=540)
- The mucosa heals first compared to skin in perianal disease, so leaving a mucosal opening without a seton risks recurrent abscess when biologics heal the mucosa. — Jason Frischer (clinical) [Ep 8 · 12:31](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890?t=751)
- Making a large cruciate incision and packing a perianal abscess in a child with undiagnosed Crohn's disease may result in non-healing and potentially require colostomy or ileostomy. — Jason Frischer (clinical) [Ep 8 · 13:12](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890?t=792)
- The highest risk factors for lymphoma with biologic therapy are male gender, teenage age, and combination therapy with methotrexate. — Jason Frischer (clinical) [Ep 8 · 6:52](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890?t=412)
- Real risks of biologic agents include infectious complications such as tuberculosis and risk of lymphoma. — Cristine Velazco (clinical) [Ep 8 · 6:29](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890?t=389)
- When the colonoscope cannot intubate the terminal ileum, capsule endoscopy or fecal calprotectin can be used to aid diagnosis. — Cristine Velazco (clinical) [Ep 8 · 3:47](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890?t=227)
- If terminal ileum cannot be intubated, gastroenterologists may treat presumptively and re-scope after a few months of treatment when inflammation has decreased. — Jason Frischer (clinical) [Ep 8 · 4:36](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890?t=276)
- Setons should remain in place for at least 6 months to allow the inflammatory tract to become non-inflammatory. — Lisa McMahon (clinical) [Ep 8 · 17:54](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890?t=1074)
- Before removing a seton, the bottom must look better, drainage must be better, the patient must be symptom-free, and they must have reached steady state of biologic (loading dose plus at least 3 more doses, typically 2-3 months from start). — Jason Frischer (clinical) [Ep 8 · 19:23](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890?t=1163)
- Inflammatory markers including fecal calprotectin, ESR, and CRP should be checked before removing a seton to ensure systemic disease is under control. — Jason Frischer (clinical) [Ep 8 · 19:55](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890?t=1195)
- The initial Remicade paper from 1998 or 1999 in the New England Journal of Medicine was on perianal disease and demonstrated improved healing time and improved length of time between recurrence when combination of seton and infliximab is used versus either separately. — Jason Frischer (clinical) [Ep 8 · 20:49](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890?t=1249)
- Remicade (infliximab) has the most literature on healing perianal disease; Humira also has good evidence but less literature; Stelara and vedolizumab are sometimes used with less information available. — Lisa McMahon (clinical) [Ep 8 · 20:27](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890?t=1227)
- Literature shows about a 10% response rate for perianal fistulas even without biologics if a seton is placed and removed, with much better outcomes with biologics. — Lisa McMahon (epidemiological) [Ep 8 · 19:12](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890?t=1152)
- Source control of infection must be achieved before starting immunosuppressive therapy including steroids and biologics. — Jason Frischer (clinical) [Ep 8 · 17:17](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890?t=1037)
- If an abscess is not adequately drained, reimaging should be performed before giving biologics or steroids. — Jason Frischer (clinical) [Ep 8 · 17:17](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890?t=1037)
- Hydrogen peroxide is preferred over methylene blue for identifying fistula tracts because it is neater; 3% hydrogen peroxide in a syringe with 16-20 gauge angiocath is used with a speculum in the anus. — Jason Frischer (clinical) [Ep 8 · 14:15](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890?t=855)
- When a fistula opening cannot be found despite hydrogen peroxide testing, a seton should not be placed at that time to avoid creating a hole where there isn't one. — Jason Frischer (clinical) [Ep 8 · 14:54](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890?t=894)
- For recurrent patients requiring repeat seton placement, repeat imaging should be obtained before seton removal. — Lisa McMahon (clinical) [Ep 8 · 18:45](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890?t=1125)
- It is common to have perianal disease in Crohn's; this patient had a delay in diagnosis and had perianal disease for quite some time with multiple skin tags and fissures. — Lisa McMahon (clinical) [Ep 8 · 7:24](https://origin-library.globalcastmd.com/watch/colorectal-quiz-episode-26-perianal-crohn-s-disease-4890?t=444)
- Children presenting with Crohn's disease for the first time with a perianal or perirectal abscess often have non-colonic small intestinal disease. — Samir Pandya (clinical) [Ep 1 · 3:00](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=180)
- Perianal abscesses in Crohn's disease are unlikely to heal without fecal diversion because bowel continuity slows healing. — Samir Pandya (opinion) [Ep 1 · 10:00](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=600)
- Modern TNF inhibitor drugs are effective at healing perianal disease in Crohn's, potentially allowing avoidance of fecal diversion in selected patients. — Samir Pandya (clinical) [Ep 1 · 11:00](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=660)
- Patients and parents would rather deal with a chronic perianal problem than manage a stoma. — Samir Pandya (opinion) [Ep 1 · 12:00](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=720)
- Most Crohn's perianal abscesses are not single; when draining a perianal abscess in Crohn's disease, there are usually several fistulas present. — Samir Pandya (clinical) [Ep 1 · 13:00](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=780)
- Setons are very effective for perianal fistulas and should be used more often in pediatric surgery than they currently are. — Samir Pandya (opinion) [Ep 1 · 14:00](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=840)
- It is less morbid to perform laparoscopic diversion in 15% of patients whose perianal disease fails to heal than to give 100% of patients an ostomy upfront. — Samir Pandya (opinion) [Ep 1 · 15:00](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=900)
- Crohn's patients can develop peristomal fistulas as a complication of stoma creation. — Samir Pandya (clinical) [Ep 1 · 16:00](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=960)
- Crohn's disease affects the entire GI tract as a chronic disorder, even when only one segment shows active stricturing disease. — Samir Pandya (clinical) [Ep 1 · 17:00](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=1020)
- A cutting seton requires 360-degree tension on tissue to actively divide it, whereas a non-cutting seton is placed loosely to allow drainage and gradual fibrosis without active cutting. — Samir Pandya (clinical) [Ep 1 · 19:00](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=1140)
- For duodenal Crohn's strictures, endoscopic and fluoroscopic dilation combined with Remicade can be effective, making the stricture more pliable and allowing weight gain. — Samir Pandya (clinical) [Ep 1 · 21:00](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=1260)
- Isolated terminal ileal Crohn's disease may be a separate disease entity from perianal or diffuse Crohn's disease because it behaves very differently, with prolonged remission after resection. — Samir Pandya (opinion) [Ep 1 · 22:00](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=1320)
- Patients with isolated terminal ileal Crohn's disease should be considered for earlier resection before starting Remicade because of the favorable long-term outcomes after resection. — Samir Pandya (opinion) [Ep 1 · 22:00](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=1320)
- Pediatric IBD patients referred for surgery are often in horrible nutritional shape because GI physicians view surgery as failure and carry patients on medical therapy for too long. — Samir Pandya (opinion) [Ep 1 · 23:00](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=1380)
- Patients with severe ulcerative colitis who are emaciated, hypoalbuminemic, on steroids, and in poor nutritional status often require three-stage surgery: subtotal colectomy with end ileostomy, then subsequent J-pouch creation. — Samir Pandya (clinical) [Ep 1 · 24:00](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=1440)
- Patients with ulcerative colitis recover incredibly fast after subtotal colectomy, much faster than after the subsequent J-pouch operation. — Samir Pandya (clinical) [Ep 1 · 25:00](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=1500)
- The best ulcerative colitis patients ever look is when they have their end ileostomy after subtotal colectomy, before J-pouch creation. — Samir Pandya (opinion) [Ep 1 · 26:00](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=1560)
- Ongoing rectal bleeding from the rectal stump after subtotal colectomy for ulcerative colitis is rare but can be managed with local therapy. — Samir Pandya (clinical) [Ep 1 · 27:00](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=1620)
- Endorectal dissection technique (similar to Hirschsprung surgery) can be performed safely for ulcerative colitis J-pouch even in relatively sick patients, as long as a diverting ileostomy is created. — Samir Pandya (clinical) [Ep 1 · 28:00](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=1680)
- Continued bleeding from the rectal stump after subtotal colectomy for ulcerative colitis can force earlier-than-anticipated completion of the J-pouch procedure. — Samir Pandya (clinical) [Ep 1 · 29:00](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=1740)
- Between stage 1 and stage 2 of ulcerative colitis surgery, patients often gain 20 to 30 pounds, which can make the subsequent operation technically harder. — Samir Pandya (clinical) [Ep 1 · 30:00](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=1800)
- Henrik Kehlet published results 20 years ago showing open sigmoidectomy patients discharged within a couple of days with multimodal care, achieving rapid return to work without high readmission rates and with very low complication rates. — Matt Kurt (clinical) [Ep 2 · 0:00](https://origin-library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=0)
- National anesthesia guidelines permit clear carbohydrate liquids until 2 hours before operation, though this is not widely practiced due to concerns about cancellations from patient misunderstanding. — Matt Kurt (guideline) [Ep 2 · 4:00](https://origin-library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=240)
- The sooner an IV is removed and the patient leaves the hospital, the safer the patient becomes, because as long as humans are administering care in hospitals, patients remain at risk for medication errors involving the five rights (right patient, dose, medicine, mode, timing). — Matt Kurt (opinion) [Ep 2 · 5:00](https://origin-library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=300)
- Adult ERAS programs implement 17-20 protocol steps, whereas pediatric studies have only implemented about 5 steps, representing a significant implementation gap. — Matt Kurt (clinical) [Ep 2 · 11:30](https://origin-library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=690)
- Preoperative pain medication cocktail includes gabapentin and acetaminophen in large quantities; adult programs add celecoxib to this regimen. — Matt Kurt (clinical) [Ep 2 · 15:00](https://origin-library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=900)
- Patients receive high-sugar electrolyte solutions until 2 hours before surgery after stopping solids at midnight, avoiding bringing a dehydrated patient to the operating room. — Matt Kurt (clinical) [Ep 2 · 4:00](https://origin-library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=240)
- Foley catheters are removed immediately after surgery for ileocecectomy; for J-pouch procedures they are left overnight and removed in the morning, with no urinary retention issues reported. — Matt Kurt (clinical) [Ep 2 · 17:30](https://origin-library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=1050)
- Patients are fed and given fluids on postoperative day 0; if they drink successfully once, they are advanced to solid food, with the rationale that dexamethasone increases hunger, ondansetron prevents nausea, and avoiding overhydration and narcotics allows the gut to function. — Matt Kurt (clinical) [Ep 2 · 18:30](https://origin-library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=1110)
- A 17-year-old patient with ulcerative colitis had colectomy and was ready for discharge the night of surgery, actually discharged postoperative day 2; same pattern occurred for J-pouch creation and ileostomy closure. — Matt Kurt (clinical) [Ep 2 · 20:00](https://origin-library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=1200)
- IBD patients on TPN, steroids, and other medications do not go home in 2 days but will go home in 3-4 days with ERAS protocol, compared to longer traditional stays. — Matt Kurt (clinical) [Ep 2 · 21:00](https://origin-library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=1260)
- Individual ERAS components may not have significant evidence bases by themselves, but when bundled together like other care bundles, they create a second-order change in outcomes. — Matt Kurt (opinion) [Ep 2 · 22:00](https://origin-library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=1320)
- Creating a formal multidisciplinary team (anesthesia, perioperative nursing, floor nursing, nurse clinician) dramatically improved protocol compliance; before team formalization, 5-8 components were achieved, afterward compliance increased substantially. — Matt Kurt (clinical) [Ep 2 · 24:00](https://origin-library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=1440)
- Monthly team meetings review compliance for each individual patient, identify upcoming cases, discuss needed improvements, and provide ongoing education; this audit process is critical to program success. — Matt Kurt (clinical) [Ep 2 · 25:00](https://origin-library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=1500)
- Anesthesiologists view ERAS as part of their future through the 'surgical home' concept, making them natural partners in implementation. — Matt Kurt (opinion) [Ep 2 · 26:00](https://origin-library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=1560)
- Engaging partners through data demonstration rather than just advocacy is more effective; showing improved outcomes leads to adoption, whereas simply talking about the protocol has different results. — Matt Kurt (opinion) [Ep 2 · 27:00](https://origin-library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=1620)
- Gabapentin is an anti-seizure medication that influences neurologic pain and works well as part of multimodal analgesia; pediatric dosing is 10 mg/kg. — Matt Kurt (clinical) [Ep 2 · 30:00](https://origin-library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=1800)
- IV lidocaine given intraoperatively attenuates the inflammatory response to surgical wounding, helping patients recover more quickly; this is used in some adult programs. — Matt Kurt (clinical) [Ep 2 · 31:00](https://origin-library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=1860)
- Chewing gum given to school-aged patients generates saliva that goes down the GI tract, stimulating bowel function and gas passage; this is a cheap addition to the protocol. — Matt Kurt (clinical) [Ep 2 · 37:00](https://origin-library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=2220)
- When patients develop complications such as bowel obstruction or anastomotic leak, they come off the ERAS protocol and are treated as traditional patients; this occurred in approximately 10% of cases in the speaker's series. — Matt Kurt (clinical) [Ep 2 · 39:00](https://origin-library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=2340)
- NG tubes prolong ileus because they suction out material that would otherwise go downstream and stimulate bowel function. — Matt Kurt (clinical) [Ep 2 · 43:00](https://origin-library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=2580)
- Patient and family education with goal sheets may be on equal footing with physiologic interventions in terms of impact, as empowering patients and giving them control over their care drives compliance and outcomes. — Matt Kurt (opinion) [Ep 2 · 22:30](https://origin-library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=1350)
- For Crohn's disease with terminal ileum stricture and phlegmonous changes encasing the ureter, laparoscopic ileocystectomy with a lighted ureteral stent for ureter identification is the appropriate surgical approach. (clinical) [Ep 3 · 1:05](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=65)
- If the patient is stable, giving a couple weeks of antibiotics to cool down inflammation before surgery is advisable in Crohn's disease. (clinical) [Ep 3 · 1:26](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=86)
- There is no data to support the exact timing of preoperative antibiotics in Crohn's disease. (clinical) [Ep 3 · 1:35](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=95)
- Based on small literature, surgery should be delayed 2-4 weeks from the last TNF inhibitor infusion preoperatively if possible. (clinical) [Ep 3 · 1:38](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=98)
- Postoperatively, TNF inhibitor can be restarted after about 2 weeks if active disease is seen in other parts of the bowel, or after 4 weeks if disease is less aggressive. (clinical) [Ep 3 · 1:38](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=98)
- The literature on anastomotic complications with TNF inhibitors is mixed; wound complications are the biggest concern in the literature. (clinical) [Ep 3 · 2:34](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=154)
- The decision to perform single-stage versus diverted J-pouch reconstruction depends on intraoperative findings including ease of pouch creation, tissue health, and presence of tension. (clinical) [Ep 3 · 3:59](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=239)
- Patients on steroids and infliximab have risk factors for anastomotic complications. (clinical) [Ep 3 · 3:59](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=239)
- Surgery for ulcerative colitis may be indicated when complications of medical therapy (long-term side effects of anti-TNF drugs, steroids, growth failure) become intolerable, even if the disease is controlled. (clinical) [Ep 3 · 4:38](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=278)
- Only about 20% of patients with ulcerative colitis develop colon cancer by 20 years from the time of original diagnosis. (epidemiological) [Ep 3 · 8:27](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=507)
- Patients with ulcerative colitis can live their entire life with their colons if they undergo yearly surveillance colonoscopy; there is no reason to have a colectomy without other indications beyond cancer risk alone. (clinical) [Ep 3 · 8:27](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=507)
- For indeterminate colitis with patchy disease throughout the colon, the conservative approach is to divert with ileostomy and observe what happens to the colon. (clinical) [Ep 3 · 9:38](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=578)
- For indeterminate colitis with extensively diseased colon, one would consider subtotal colectomy with ileostomy to obtain a large specimen for pathologic determination of disease type. (clinical) [Ep 3 · 9:38](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=578)
- There is literature on doing total proctocolectomy and J-pouch for indeterminate colitis, but it carries more risk. (clinical) [Ep 3 · 9:38](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=578)
- Performing a J-pouch in a patient who turns out to have Crohn's disease creates significant challenges. (clinical) [Ep 3 · 10:35](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=635)
- Thin asthenic females with indeterminate colitis do not do well with J-pouch. (clinical) [Ep 3 · 10:57](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=657)
- A stepwise approach to J-pouch in indeterminate colitis allows time to obtain more diagnostic information between stages. (clinical) [Ep 3 · 11:09](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=669)
- J-pouch is a procedure with a definite learning curve in terms of technical aspects. (opinion) [Ep 3 · 11:31](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=691)
- In pediatric patients, the rectum can be divided laparoscopically, everted or stapled across at the columns, then the J-pouch created externally with anvil placement for EEA anastomosis, as an alternative to the adult technique. (clinical) [Ep 3 · 11:58](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=718)
- J-pouch provides the best operation for control of bowel issues in ulcerative colitis patients, and patients can still carry pregnancies even if natural conception is impaired. (opinion) [Ep 3 · 12:58](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=778)
- Children presenting with Crohn's disease and perianal/perirectal abscess often have non-colonic small intestinal disease. (clinical) [Ep 4 · 1:23](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=83)
- MR enterography provides information about both stricture anatomy and chronicity of disease, helping determine whether a stricture is chronic/fibrotic (unlikely to resolve with medication) or potentially responsive to medical therapy. (clinical) [Ep 4 · 3:51](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=231)
- For a patient with 18-pound weight loss over 4 months and dilated bowel proximal to an 8 cm terminal ileal stricture, these are indications for ileal resection. (clinical) [Ep 4 · 6:42](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=402)
- Perianal abscesses in Crohn's disease may not heal without temporary diversion, even after resection of gross bowel disease. (opinion) [Ep 4 · 7:50](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=470)
- For first-time perianal abscess in Crohn's disease, temporary diversion should be considered via laparoscopic ileal resection with end ileostomy and mucous fistula, with stoma closure planned at 3-6 months. (opinion) [Ep 4 · 8:42](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=522)
- Diversion is typically reserved for patients with distal colon disease as part of perianal disease, not for isolated small bowel Crohn's with perianal abscess. (opinion) [Ep 4 · 9:11](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=551)
- Bowel continuity slows healing of perianal abscesses in Crohn's disease. (clinical) [Ep 4 · 9:24](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=564)
- Patients and parents would rather deal with a chronic perianal problem than a stoma, unless there is extensive distal colonic disease. (opinion) [Ep 4 · 9:52](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=592)
- Setons are very effective for perianal Crohn's disease and are used frequently by colorectal surgeons but rarely by pediatric surgeons, who should use them more often. (opinion) [Ep 4 · 10:40](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=640)
- When draining a perianal abscess in Crohn's disease, there are usually several fistulas present, not just a single one. (clinical) [Ep 4 · 11:07](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=667)
- If resection with primary anastomosis and seton placement fails to heal perianal disease, a subsequent laparoscopic diversion can be performed with low morbidity. — Dan (clinical) [Ep 4 · 12:02](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=722)
- Rectal advancement flap is an option for fistula closure after seton drainage, but only in the setting of no active proctitis. (clinical) [Ep 4 · 12:36](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=756)
- A non-cutting seton can be progressively tightened by adding silk sutures to make the loop smaller as it erodes through tissue, without causing pain to the patient. (clinical) [Ep 4 · 15:57](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=957)
- A cutting seton requires 360-degree tension on tissue to actually cut through; progressive tightening without tension is a non-cutting seton technique. (clinical) [Ep 4 · 16:47](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=1007)
- For duodenal Crohn's stricture, management with Remicade combined with endoscopic and fluoroscopic dilation can be effective, with stricture becoming more pliable after 3 cycles of Remicade. (clinical) [Ep 4 · 18:30](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=1110)
- Isolated ileocecal Crohn's disease in teenagers may have recurrence-free intervals as long as 10-15 years after resection, allowing symptom-free passage through puberty into adulthood. (clinical) [Ep 4 · 19:20](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=1160)
- Isolated terminal ileal disease may be a separate disease entity from perianal or diffuse Crohn's disease, as it behaves very differently. (opinion) [Ep 4 · 20:04](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=1204)
- For isolated terminal ileal Crohn's disease, early resection before starting Remicade may be a reasonable approach, as these patients do well and can go through teenage years and growth phase successfully. (opinion) [Ep 4 · 20:29](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=1229)
- In Europe, ultrasound is generally advocated for basically everything, and it is increasingly used in sophisticated pediatric radiology departments for chronic inflammatory bowel disease, though MRI remains the standard diagnostic tool. — Philip (clinical) [Ep 4 · 21:01](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=1261)
- For a patient with ulcerative colitis in reasonably good nutrition, subtotal colectomy with pull-through and either J-pouch or straight anastomosis with loop ileostomy (closed at 6 weeks to 2 months) is appropriate. (clinical) [Ep 4 · 23:01](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=1381)
- Patients with ulcerative colitis referred for surgery are often in horrible shape because GI doctors view surgery as failure and carry patients on medical therapy for too long, resulting in emaciation, low albumin, poor nutritional status, and prolonged steroid exposure. (opinion) [Ep 4 · 23:37](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=1417)
- For sick ulcerative colitis patients, a three-stage approach is used: subtotal colectomy with end ileostomy, followed by subsequent J-pouch creation. (clinical) [Ep 4 · 24:29](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=1469)
- Patients with ulcerative colitis recover incredibly fast after subtotal colectomy, much faster than after subsequent J-pouch creation, and often look their best when they have their stoma. (clinical) [Ep 4 · 24:29](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=1469)
- Ongoing rectal bleeding from the rectal stump after subtotal colectomy can occur but is rare and can be managed with local therapy. (clinical) [Ep 4 · 24:47](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=1487)
- Even in relatively sick ulcerative colitis patients, endorectal pull-through can be performed safely using an endorectal technique similar to Hirschsprung surgery, as long as it is backed up with an ileostomy. (clinical) [Ep 4 · 25:00](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=1500)
- A 3-year-old with severe ulcerative colitis (one of the youngest cases seen) had rectum that felt like tissue paper but was successfully treated with endorectal pull-through and J-pouch, with the child blossoming afterward. (clinical) [Ep 4 · 25:48](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=1548)
- Continued bleeding from the rectal stump after subtotal colectomy can force earlier-than-anticipated completion of pull-through, occurring more frequently than realized. (clinical) [Ep 4 · 25:48](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=1548)
- One problem with three-stage ulcerative colitis surgery is that patients often gain 20-30 pounds between stage 1 and 2, making the subsequent operation harder. (clinical) [Ep 4 · 26:17](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=1577)
- Double-staple technique for ileal pouch-anal anastomosis can be performed by everting the rectum and stapling at the top of the columns, requiring a 21mm stapler. (clinical) [Ep 4 · 26:38](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=1598)
- If a patient has received infliximab within the last 6 weeks, there is evidence (both adult and pediatric) that a three-stage procedure should probably be performed due to increased complication risk. (guideline) [Ep 4 · 28:11](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=1691)
- Pediatric surgery knowledge is growing exponentially, making it impossible to stay up to date. — Todd Ponsky (opinion) [Ep 6 · 0:00](https://origin-library.globalcastmd.com/watch/update-course-rewind-2020-eras-3718?t=0)
- The patient was given protein shakes preoperatively for nutritional optimization. — Kurt Heise (clinical) [Ep 6 · 2:15](https://origin-library.globalcastmd.com/watch/update-course-rewind-2020-eras-3718?t=135)
- On the day of operation, the patient came to the hospital drinking high carbohydrate clear liquids, which were stopped one hour before the operation. — Kurt Heise (clinical) [Ep 6 · 2:15](https://origin-library.globalcastmd.com/watch/update-course-rewind-2020-eras-3718?t=135)
- Total IV fluids for the case was less than 4 ccs per kilo per hour. — Kurt Heise (clinical) [Ep 6 · 2:15](https://origin-library.globalcastmd.com/watch/update-course-rewind-2020-eras-3718?t=135)
- Postoperatively, the patient was put on multimodal analgesia with Tylenol, Toradol, and Neurontin. — Kurt Heise (clinical) [Ep 6 · 2:15](https://origin-library.globalcastmd.com/watch/update-course-rewind-2020-eras-3718?t=135)
- The patient was allowed to drink immediately after surgery and started to snack that night. — Kurt Heise (clinical) [Ep 6 · 2:15](https://origin-library.globalcastmd.com/watch/update-course-rewind-2020-eras-3718?t=135)
- The patient went home the evening after a partial colectomy. — Kurt Heise (clinical) [Ep 6 · 2:15](https://origin-library.globalcastmd.com/watch/update-course-rewind-2020-eras-3718?t=135)
- The institution has a protocol to discharge patients when physiologically ready as opposed to waiting for the surgeon to approve discharge. — Kurt Heise (clinical) [Ep 6 · 2:15](https://origin-library.globalcastmd.com/watch/update-course-rewind-2020-eras-3718?t=135)
- Pre-op optimization period and heavy counseling with families about discharge goals is important for setting expectations. — Kurt Heise (clinical) [Ep 6 · 4:53](https://origin-library.globalcastmd.com/watch/update-course-rewind-2020-eras-3718?t=293)
- The pain team tried epidurals for about a year but found that patients were slowed down with their discharge, so they changed to QL blocks, rectus sheath blocks, or TAP blocks. — Kurt Heise (clinical) [Ep 6 · 6:31](https://origin-library.globalcastmd.com/watch/update-course-rewind-2020-eras-3718?t=391)
- Dr. Heise gave grand rounds to the anesthesia department twice with the chair present to secure buy-in for ERAS protocols. — Kurt Heise (clinical) [Ep 6 · 7:40](https://origin-library.globalcastmd.com/watch/update-course-rewind-2020-eras-3718?t=460)
- Although there is evidence that early feeding in adult patients after intestinal surgery is beneficial, the authors did not find any benefit in neonates. — Mick Kakaran (clinical) [Ep 7 · 2:37](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2021-4527?t=157)
- Babies with blood in their stool causing a decrease in hemoglobin has always been a red flag sign for Meckel diverticulum. — Mick Kakaran (clinical) [Ep 7 · 3:06](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2021-4527?t=186)
- A Cincinnati Children's study examined children aged 0-18 within a 15-mile radius who presented with perianal symptoms (abscess, fissure, fistula) to determine how often this represents Crohn disease. — Iris Lim Butel (clinical) [Ep 7 · 7:23](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2021-4527?t=443)
- Overall, 3% of children presenting with perianal symptoms were diagnosed with Crohn disease. — Iris Lim Butel (epidemiological) [Ep 7 · 9:02](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2021-4527?t=542)
- No children under age 1 with perianal abscess ended up having Crohn disease within the study period. — Iris Lim Butel (epidemiological) [Ep 7 · 9:02](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2021-4527?t=542)
- Higher rates of Crohn disease were seen in older children, particularly over age 10, among those presenting with perianal symptoms. — Julian Goddard (epidemiological) [Ep 7 · 9:16](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2021-4527?t=556)
- Many patients in the study had fissures, which are very common in children and may have been managed as outpatients. — Iris Lim Butel (clinical) [Ep 7 · 9:41](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2021-4527?t=581)
- Quite a few children with Crohn disease present with perirectal abscess rather than typical GI symptoms like abdominal pain and diarrhea. (clinical) [Ep 7 · 10:23](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2021-4527?t=623)
- Although there is evidence that early feeding in adult patients after intestinal surgery is beneficial, the authors didn't find any benefit in neonates (clinical) [Ep 11 · 2:53](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2021-13360?t=173)
- In the early feeding group, patients did not have a decompressing nasogastric tube — Todd (clinical) [Ep 11 · 3:11](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2021-13360?t=191)
- Nasogastric decompression is not needed after an anastomosis in neonates — Todd (opinion) [Ep 11 · 3:19](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2021-13360?t=199)
- The two groups had the same outcomes despite one group not having NG decompression, indicating NG tubes are not necessary after baby anastomosis — Todd (clinical) [Ep 11 · 3:55](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2021-13360?t=235)
- Babies with blood in their stool enough to cause a decrease in hemoglobin is a red flag sign for Meckel's diverticulum (clinical) [Ep 11 · 5:07](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2021-13360?t=307)
- If the Meckel's predictive score is high, one could go straight to laparoscopy because even with a negative Meckel scan, it's likely a Meckel's diverticulum — Todd (opinion) [Ep 11 · 5:40](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2021-13360?t=340)
- The Meckel's score could help tip the scale of skipping the Meckel scan in certain subset of patients — Todd (opinion) [Ep 11 · 6:17](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2021-13360?t=377)
- The Cincinnati study included all children from 0 to 18 years who lived within a 15 mile radius of Cincinnati Children's and presented with perianal disease — Julian Goddard (clinical) [Ep 11 · 8:16](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2021-13360?t=496)
- A second cohort included all children within a 50 mile radius who were diagnosed with Crohn's disease — Julian Goddard (clinical) [Ep 11 · 8:42](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2021-13360?t=522)
- Overall, 3% of children presenting with perianal symptoms ended up being diagnosed with Crohn's disease — Julian Goddard (clinical) [Ep 11 · 9:02](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2021-13360?t=542)
- No children under the age of 1 had Crohn's disease within the study period — Julian Goddard (clinical) [Ep 11 · 9:11](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2021-13360?t=551)
- Higher rates of Crohn's disease are seen in older children, particularly over the age of 10 — Iris Limbuel (clinical) [Ep 11 · 9:18](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2021-13360?t=558)
- The study included patients who had their perianal symptoms dealt with as an outpatient, who may not have been seen by the surgical team — Iris Limbuel (clinical) [Ep 11 · 9:54](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2021-13360?t=594)
- Under the age of 10, you do not need to worry about doing a workup for Crohn's disease in children with perianal symptoms — Todd (opinion) [Ep 11 · 10:06](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2021-13360?t=606)
- Over the age of 10, you should do a workup for Crohn's disease in children with perianal symptoms — Todd (opinion) [Ep 11 · 10:14](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2021-13360?t=614)
- Quite a few children with Crohn's disease present with a perirectal abscess rather than GI symptoms like abdominal pain or diarrhea — Todd (clinical) [Ep 11 · 10:17](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2021-13360?t=617)
- ERAS stands for Enhanced Recovery After Surgery and consists of many elements and principles that can be applied to most all elective surgeries. — Ben Hamm (clinical) [Ep 9 · 0:36](https://origin-library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-10886?t=36)
- Successful ERAS implementation requires significant system design, education, and reinforcement of that education. — Ben Hamm (clinical) [Ep 9 · 0:36](https://origin-library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-10886?t=36)
- At the speaker's center, opioid prescribing after appendectomy was reduced from 84% to 0% using ERAS principles. — Ben Hamm (epidemiological) [Ep 9 · 0:36](https://origin-library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-10886?t=36)
- The World Journal of Surgery published consensus guidelines around 2020 for ERAS in neonatal intestinal surgery. — Cassie Hoffman (guideline) [Ep 9 · 4:06](https://origin-library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-10886?t=246)
- Broader ERAS guidelines were developed for essentially all neonatal surgery following the initial intestinal surgery guidelines. — Cassie Hoffman (guideline) [Ep 9 · 4:06](https://origin-library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-10886?t=246)
- The 2020 World Journal of Surgery consensus guidelines for neonatal intestinal surgery include moderate-to-high quality evidence for regional anesthesia and opioid-sparing analgesia. — Cassie Hoffman (guideline) [Ep 9 · 4:06](https://origin-library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-10886?t=246)
- The quadratus lumborum (QL) block provides dermatomal coverage from T6 to L1-L2 depending on dosing and has no limitations with anticoagulation. — Cassie Hoffman (clinical) [Ep 9 · 4:06](https://origin-library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-10886?t=246)
- Caudal blocks can be performed with ultrasound guidance using the 'frog eyes view' (sacral cornua on either side with sacrococcygeal ligament in between) if landmark technique is difficult. — Cassie Hoffman (clinical) [Ep 9 · 4:06](https://origin-library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-10886?t=246)
- Spinal anesthesia in neonates is limited to surgeries under 90–120 minutes and is not appropriate for every abdominal case. — Cassie Hoffman (clinical) [Ep 9 · 4:06](https://origin-library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-10886?t=246)
- Adding preservatives to caudal blocks can prolong their duration, according to a 2021 meta-analysis in children less than one year old. — Cassie Hoffman (clinical) [Ep 9 · 4:06](https://origin-library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-10886?t=246)
- Most institutions now run preservative infusions in the NICU, reducing hesitancy to use preservatives in regional blocks. — Cassie Hoffman (clinical) [Ep 9 · 4:06](https://origin-library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-10886?t=246)
- Neonatology colleagues do not know what ERAS stands for or what enhanced recovery means, making implementation challenging. (opinion) [Ep 9 · 11:02](https://origin-library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-10886?t=662)
- The concepts that underpin enhanced recovery protocols are challenging in a complex environment like a NICU. (opinion) [Ep 9 · 11:02](https://origin-library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-10886?t=662)
- An 18-center step-wedge randomized clinical trial enrolled about 600 patients aged 10–18 years undergoing elective GI surgery to study ERAS implementation. (epidemiological) [Ep 9 · 12:28](https://origin-library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-10886?t=748)
- At Lurie Children's, anesthesia and nursing colleagues worked together to change the enterprise-wide policy to allow clear liquids up until one hour before surgery for all surgeries (horizontal integration). (clinical) [Ep 9 · 12:28](https://origin-library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-10886?t=748)
- Other departments (plastic surgery, orthopedic surgery) adopted the same ERAS preoperative scheduling and order sets after seeing the colorectal surgery implementation. (clinical) [Ep 9 · 12:28](https://origin-library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-10886?t=748)
- At Children's Memorial Hermann Hospital in Houston, patients were motivated to ambulate postoperatively by walking child life support dogs, with social workers documenting ambulation distance in the chart. (clinical) [Ep 9 · 12:28](https://origin-library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-10886?t=748)
- Cohen Children's in New York celebrated the ERAS protocol launch with C-suite buy-in, T-shirts, cake, and balloons in the lobby to change institutional culture. (clinical) [Ep 9 · 12:28](https://origin-library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-10886?t=748)
- In the 18-center trial, the median number of ERAS elements delivered was 13, and reaching this threshold was associated with a significant decrease in length of stay. (epidemiological) [Ep 9 · 12:28](https://origin-library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-10886?t=748)
- Delivering 13 or more ERAS elements decreased the proportion of patients with prolonged length of stay (≥7 days), reduced opioid exposure, and lowered complication rates. (epidemiological) [Ep 9 · 12:28](https://origin-library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-10886?t=748)
- Mechanical bowel prep should not be done without oral antibiotics (e.g., neomycin, flagyl) due to increased surgical site infection and anastomotic leak rates. (clinical) [Ep 9 · 19:48](https://origin-library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-10886?t=1188)
- Mechanical bowel prep causes fluid shifts that may require IV fluid boluses, which can counteract ERAS goals of limiting fluids to enhance recovery. (clinical) [Ep 9 · 19:48](https://origin-library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-10886?t=1188)
- Surgical volume impacts outcomes for thyroidectomy, as shown in the literature. (epidemiological) [Ep 9 · 21:42](https://origin-library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-10886?t=1302)
- At the speaker's institution, one ENT surgeon and the speaker collaborate on thyroid cases as a subspecialist program. (clinical) [Ep 9 · 21:42](https://origin-library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-10886?t=1302)
- The institution developed an Epic order set for thyroid surgery that standardizes care from clinic through postoperative care to facilitate same-day discharge. (clinical) [Ep 9 · 21:42](https://origin-library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-10886?t=1302)
- A key intervention is adding a preoperative selective COX-2 inhibitor (celecoxib) starting the night before and morning of surgery, continued twice daily postoperatively. (clinical) [Ep 9 · 21:42](https://origin-library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-10886?t=1302)
- In a single-center study over one year, 100% compliance with the thyroid ERAS protocol was achieved, with one patient staying overnight due to substance abuse history and postoperative nausea. (epidemiological) [Ep 9 · 21:42](https://origin-library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-10886?t=1302)
- The thyroid ERAS study had no complications, no significant change in emergency room or urgent care visits, and all patients expressed high satisfaction with same-day discharge. (epidemiological) [Ep 9 · 21:42](https://origin-library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-10886?t=1302)
- A multi-center study (Colorado, Cincinnati, St. Jude's) on ERAS for oncology cases showed significant reductions in intraoperative and postoperative opioids, early feeding, and reduced complications. (epidemiological) [Ep 9 · 27:41](https://origin-library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-10886?t=1661)
- The oncology ERAS study showed significantly improved pain scores, particularly in the neuroblastoma subset. (epidemiological) [Ep 9 · 27:41](https://origin-library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-10886?t=1661)
- Over time, postoperative length of stay for large abdominal tumor resections has decreased from 5–7 days to approximately 3 days using ERAS. (clinical) [Ep 9 · 27:41](https://origin-library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-10886?t=1661)
- ERAS is feasible for large abdominal operations including large retroperitoneal dissections and big tumors. (clinical) [Ep 9 · 27:41](https://origin-library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-10886?t=1661)
- Using regional anesthesia and minimizing opioids is key to successful ERAS in oncology cases. (clinical) [Ep 9 · 27:41](https://origin-library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-10886?t=1661)
- For oncology patients, earlier discharge allows patients to get to chemotherapy earlier, which is key to long-term survival in diseases like neuroblastoma. (clinical) [Ep 9 · 27:41](https://origin-library.globalcastmd.com/watch/2025-pediatric-surgery-update-course-updates-in-enhanced-recovery-after-surgery-10886?t=1661)
- Mary Brindell and Kurt Heist have been pediatric ERAS ambassadors, though this is changing as ERAS expands in pediatric surgery — Mary Brindell (opinion) [Ep 5 · 0:23](https://origin-library.globalcastmd.com/watch/eras-clinical-practice-updates-2995?t=23)
- ERAS is relatively familiar in adult general surgical care — Mary Brindell (clinical) [Ep 5 · 0:23](https://origin-library.globalcastmd.com/watch/eras-clinical-practice-updates-2995?t=23)
- The 16-year-old Crohn's patient was given protein shakes preoperatively for nutritional optimization — Kurt Heist (clinical) [Ep 5 · 2:12](https://origin-library.globalcastmd.com/watch/eras-clinical-practice-updates-2995?t=132)
- The patient came to the operating room drinking high carbohydrate clear liquids on the day of operation — Kurt Heist (clinical) [Ep 5 · 2:12](https://origin-library.globalcastmd.com/watch/eras-clinical-practice-updates-2995?t=132)
- Day surgery nurses gave the patient clear liquids during the afternoon and stopped one hour before the operation — Kurt Heist (clinical) [Ep 5 · 2:12](https://origin-library.globalcastmd.com/watch/eras-clinical-practice-updates-2995?t=132)
- Total IV fluids for the ileocecal resection case were less than 4cc per kilogram per hour — Kurt Heist (clinical) [Ep 5 · 2:12](https://origin-library.globalcastmd.com/watch/eras-clinical-practice-updates-2995?t=132)
- Postoperative multimodal analgesia included Tylenol, Toradol, and Neurontin — Kurt Heist (clinical) [Ep 5 · 2:12](https://origin-library.globalcastmd.com/watch/eras-clinical-practice-updates-2995?t=132)
- The patient was allowed to drink immediately postoperatively and started to snack that night — Kurt Heist (clinical) [Ep 5 · 2:12](https://origin-library.globalcastmd.com/watch/eras-clinical-practice-updates-2995?t=132)
- The patient was hep-locked the following morning and put on a regular diet — Kurt Heist (clinical) [Ep 5 · 2:12](https://origin-library.globalcastmd.com/watch/eras-clinical-practice-updates-2995?t=132)
- Physical therapy walked the patient every two hours starting the morning after surgery — Kurt Heist (clinical) [Ep 5 · 2:12](https://origin-library.globalcastmd.com/watch/eras-clinical-practice-updates-2995?t=132)
- The patient went home the evening after partial colectomy after meeting all preoperative goals — Kurt Heist (clinical) [Ep 5 · 2:12](https://origin-library.globalcastmd.com/watch/eras-clinical-practice-updates-2995?t=132)
- Not all patients go home in one day at Kurt's institution; he had a 10-day colectomy with complications a couple weeks prior — Kurt Heist (clinical) [Ep 5 · 5:07](https://origin-library.globalcastmd.com/watch/eras-clinical-practice-updates-2995?t=307)
- Kurt gave grand rounds to the anesthesia department twice at the beginning of ERAS implementation, with the chair present and supportive — Kurt Heist (clinical) [Ep 5 · 13:57](https://origin-library.globalcastmd.com/watch/eras-clinical-practice-updates-2995?t=837)
- Enhanced recovery after surgery is a multidisciplinary, multimodal, evidence-based way of delivering care to patients — Mary Brindell (clinical) [Ep 5 · 15:40](https://origin-library.globalcastmd.com/watch/eras-clinical-practice-updates-2995?t=940)
- The goals of ERAS are to optimize patient physiology throughout the entire perioperative pathway — Mary Brindell (clinical) [Ep 5 · 15:40](https://origin-library.globalcastmd.com/watch/eras-clinical-practice-updates-2995?t=940)
- ERAS strategies are to decrease operative trauma, inflammatory response, and stress — Mary Brindell (clinical) [Ep 5 · 15:40](https://origin-library.globalcastmd.com/watch/eras-clinical-practice-updates-2995?t=940)
- Typical ERAS tactics include optimizing fluid and analgesia, mobilizing early, and feeding early, which act synergistically when bundled — Mary Brindell (clinical) [Ep 5 · 15:40](https://origin-library.globalcastmd.com/watch/eras-clinical-practice-updates-2995?t=940)
- The whole of ERAS is greater than the sum of its parts — Mary Brindell (opinion) [Ep 5 · 15:40](https://origin-library.globalcastmd.com/watch/eras-clinical-practice-updates-2995?t=940)
- ERAS outcomes include faster healing, earlier discharge, and fewer complications — Mary Brindell (clinical) [Ep 5 · 15:40](https://origin-library.globalcastmd.com/watch/eras-clinical-practice-updates-2995?t=940)
- The adult world has a huge amount published on the benefits of ERAS, including decreased surgical and non-surgical complications — Mary Brindell (clinical) [Ep 5 · 15:40](https://origin-library.globalcastmd.com/watch/eras-clinical-practice-updates-2995?t=940)
- Fast track surgery programs have shown reduced length of stay after surgery — Mary Brindell (clinical) [Ep 5 · 15:40](https://origin-library.globalcastmd.com/watch/eras-clinical-practice-updates-2995?t=940)
- A concern with fast track programs has been increased readmission rates, but ERAS's holistic approach should decrease readmission rates when done well — Mary Brindell (clinical) [Ep 5 · 15:40](https://origin-library.globalcastmd.com/watch/eras-clinical-practice-updates-2995?t=940)
- ERAS is such a massive team approach that it is the ultimate in multidisciplinary change — Todd Ponsky (opinion) [Ep 5 · 18:53](https://origin-library.globalcastmd.com/watch/eras-clinical-practice-updates-2995?t=1133)
- ERAS implementation has to come from leadership above, where heads of surgery, anesthesia, nursing, and patient relations all meet together — Kurt Heist (clinical) [Ep 5 · 18:53](https://origin-library.globalcastmd.com/watch/eras-clinical-practice-updates-2995?t=1133)
- There is no way a surgeon can use ERAS without all the other disciplines being on board and doing ERAS — Mary Brindell (opinion) [Ep 5 · 18:53](https://origin-library.globalcastmd.com/watch/eras-clinical-practice-updates-2995?t=1133)
- Kurt's institution collected data for six months on the one-hour NPO time — Kurt Heist (clinical) [Ep 5 · 23:03](https://origin-library.globalcastmd.com/watch/eras-clinical-practice-updates-2995?t=1383)
- Data showed that one-hour NPO time did not slow cases down, contrary to institutional anxiety — Kurt Heist (clinical) [Ep 5 · 23:03](https://origin-library.globalcastmd.com/watch/eras-clinical-practice-updates-2995?t=1383)
- The neonatal intestinal surgery ERAS protocol was published earlier in 2024 — Mary Brindell (clinical) [Ep 5 · 28:49](https://origin-library.globalcastmd.com/watch/eras-clinical-practice-updates-2995?t=1729)
- It is exceptionally hard to limit ERAS practice to the subset of patients for which it was initially intended — Mary Brindell (opinion) [Ep 5 · 28:49](https://origin-library.globalcastmd.com/watch/eras-clinical-practice-updates-2995?t=1729)
- Once teams get invested in ERAS, they naturally want to start adopting other elements of enhanced recovery after surgery care — Mary Brindell (opinion) [Ep 5 · 28:49](https://origin-library.globalcastmd.com/watch/eras-clinical-practice-updates-2995?t=1729)

## Host summaries
Recaps by a host of what the experts said — not the host's own clinical position.
- In a review study published recently, CT enterography is more accurate than MR enterography for Crohn's disease, though institutional radiologist expertise determines which modality performs better in practice. — Samir Pandya summarizing a resource [Ep 1 · 0:00](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=0)
- Contrast-enhanced ultrasound has sensitivity and specificity as high as 100% for Crohn's disease in previously undiagnosed patients, and above 95% in patients with known diagnosis, according to the Peloda study published in Pediatrics 2013. — Samir Pandya summarizing a resource [Ep 1 · 4:00](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=240)
- Contrast-enhanced ultrasound is only available for clinical use in Europe at present and has not been approved by the FDA. — Samir Pandya summarizing a resource [Ep 1 · 4:00](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=240)
- In Europe, ultrasound is the first-line imaging choice for Crohn's disease, followed by MR or CT enterography, whereas in the US, MR/CT enterography is first-line. — Samir Pandya summarizing a resource [Ep 1 · 5:00](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=300)
- MR enterography provides information about the chronicity of Crohn's disease strictures, helping determine whether a stricture is chronic and fibrotic (unlikely to resolve with medication) or potentially responsive to medical therapy. — Samir Pandya summarizing a resource [Ep 1 · 6:00](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=360)
- Rectal advancement flap for Crohn's perianal fistula is only appropriate in the setting of no active proctitis, and results diminish with time. — Samir Pandya summarizing a resource [Ep 1 · 18:00](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=1080)
- Even with permanent fecal diversion, as high as 40% of Crohn's patients have recalcitrant perianal disease as they reach adulthood. — Samir Pandya summarizing a resource [Ep 1 · 20:00](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=1200)
- Isolated ileocecal Crohn's disease in teenagers can have recurrence-free intervals as long as 10 to 15 years after resection, allowing symptom-free passage through puberty into adulthood. — Samir Pandya summarizing a resource [Ep 1 · 22:00](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=1320)
- If a patient has received infliximab within the last 6 weeks before surgery for ulcerative colitis, there is evidence (both adult and pediatric) that a three-stage approach should probably be used due to increased complication risk. — Samir Pandya summarizing a resource [Ep 1 · 28:36](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=1716)
- At 2 years follow-up, there is hardly any difference in bowel frequency between straight ileoanal anastomosis and J-pouch (10 cm J-pouches) for ulcerative colitis, based on a series of 120-130 straight and 110-115 J-pouch patients. — Samir Pandya summarizing a resource [Ep 1 · 28:36](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-samir-pandya-update-course-2014-655?t=1716)
- Traditional intraoperative fluid administration delivers 3 times the IV volume compared to enhanced recovery protocols, as demonstrated by studies monitoring fluid administration. — Matt Kurt summarizing a resource [Ep 2 · 3:00](https://origin-library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=180)
- Adult colorectal surgery has a large number of randomized controlled trials demonstrating ERAS reduces complications and length of stay without causing increased readmissions. — Matt Kurt summarizing a resource [Ep 2 · 6:00](https://origin-library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=360)
- Meta-analysis from adult colorectal surgery demonstrates significant decrease in length of stay, significant decrease in non-surgical complications (VTEs, urinary tract infections, surgical site infections), without increase in readmissions when ERAS protocols are used. — Matt Kurt summarizing a resource [Ep 2 · 9:00](https://origin-library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=540)
- Pediatric ERAS literature consists of only 5-6 articles, most written by Ben-Oni Mathai, showing decreased length of stay with similar complication rates and no increase in readmissions, but each study implemented only about 5 of 20 protocol components (approximately 25% compliance). — Matt Kurt summarizing a resource [Ep 2 · 10:30](https://origin-library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=630)
- Goal-directed fluid therapy using pressors and albumin helps limit fluid administration; the most important inflection point in MD Anderson's program was preventing residents from bolusing patients postoperatively. — Matt Kurt summarizing a resource [Ep 2 · 16:00](https://origin-library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=960)
- The most recent literature on mechanical bowel preparation suggests that combining both mechanical prep and oral antibiotics provides the best outcomes, though this recommendation has changed yearly. — Matt Kurt summarizing a resource [Ep 2 · 35:00](https://origin-library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=2100)
- Sleeve gastrectomy patients implementing ERAS components, particularly gabapentin, have gone home on postoperative day 1 in all but one case, compared to previous average of closer to 2 days. — Matt Kurt summarizing a resource [Ep 2 · 41:00](https://origin-library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=2460)
- A Journal of Pediatric Surgery study showed that 70% of patients are NPO longer than necessary when coming to the operating room, arriving dehydrated despite standard NPO guidelines. — Matt Kurt summarizing a resource [Ep 2 · 34:00](https://origin-library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=2040)
- Gawande's checklist manifesto demonstrated that a 30% compliance rate with a protocol dropped mortality in half, suggesting that partial ERAS compliance still provides benefit. — Matt Kurt summarizing a resource [Ep 2 · 40:00](https://origin-library.globalcastmd.com/watch/enhanced-recovery-after-surgery-program-update-course-2016-913?t=2400)
- In Sweden, 50% of facilities are doing ileorectal anastomosis instead of ileal pouch-anal anastomosis due to concerns about infertility in females. — The host summarizing the discussion [Ep 3 · 5:57](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=357)
- Infertility rates after J-pouch are as high as 60% in some series. — The host summarizing the discussion [Ep 3 · 5:59](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=359)
- The infertility rate in the United States general population is around 10-11%. — The host summarizing the discussion [Ep 3 · 5:59](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=359)
- Infertility rate after laparoscopic J-pouch procedures is about 20-30%, compared to 50-60% with open procedures. — The host summarizing the discussion [Ep 3 · 5:59](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=359)
- Fecundity rate (ability to carry a pregnancy) is the same after J-pouch; patients may need assistance with conception but can carry pregnancies. — The host summarizing the discussion [Ep 3 · 5:59](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=359)
- In some European practices, performing a pull-through operation on a patient before the end of their childbearing years is considered unacceptable. — The host summarizing the discussion [Ep 3 · 5:59](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=359)
- It is no longer necessarily true that the colon must be removed in all ulcerative colitis patients; surveillance colonoscopy is an acceptable alternative. — The host summarizing the discussion [Ep 3 · 8:02](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=482)
- Some surgeons perform total proctocolectomy with J-pouch reconstruction in selected Crohn's patients with good results, as presented in adult literature. — The host summarizing the discussion [Ep 3 · 10:48](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2015-987?t=648)
- CT enterography may be more accurate than MR enterography according to a recent review study, though institutional radiologist expertise determines which modality performs better locally. — The host summarizing the discussion [Ep 4 · 0:54](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=54)
- Contrast-enhanced ultrasound in Europe has sensitivity and specificity as high as 100% for Crohn's disease in previously undiagnosed patients, and above 95% in those with known diagnosis, according to a 2013 Peloda study in Pediatrics. — The host summarizing the discussion [Ep 4 · 2:19](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=139)
- Peristomal complications are unique to Crohn's patients, including fistulas around the stoma. — The host summarizing the discussion [Ep 4 · 12:45](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=765)
- Crohn's disease affects the entire GI tract, though one particular segment may be strictured at a given time. — The host summarizing the discussion [Ep 4 · 13:11](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=791)
- Current adult literature recommendations for perianal Crohn's include non-cutting setons, with Remicade exposure ranging from 25-100% of patients. — The host summarizing the discussion [Ep 4 · 14:31](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=871)
- Endorectal advancement flap results for perianal fistulas diminish with time. — The host summarizing the discussion [Ep 4 · 15:16](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=916)
- Even with permanent diversion, as high as 40% of Crohn's patients have recalcitrant perianal disease as they reach adulthood. — The host summarizing the discussion [Ep 4 · 17:27](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=1047)
- A study of approximately 120-130 straight ileal-anal anastomoses and 110-115 J-pouches (10 cm pouches) showed hardly any difference in bowel frequency at 2 years. — The host summarizing the discussion [Ep 4 · 27:28](https://origin-library.globalcastmd.com/watch/inflammatory-bowel-disease-update-course-2014-1042?t=1648)
- In the adult population, literature supports that mobilization and early PO intake are the most important drivers to early discharge. — Kurt Heise summarizing a resource [Ep 6 · 4:53](https://origin-library.globalcastmd.com/watch/update-course-rewind-2020-eras-3718?t=293)
- In the bariatric population after sleeve gastrectomy, over half of patients are discharged on the first post-operative day. — The host summarizes what Dr. Kurt Heise said [Ep 6 · 5:52](https://origin-library.globalcastmd.com/watch/update-course-rewind-2020-eras-3718?t=352)
- With regional blocks and multimodal pain control, big surgeries including colectomies and craniofacial reconstructions can be done without the use of narcotics. — Kurt Heise summarizing a resource [Ep 6 · 6:31](https://origin-library.globalcastmd.com/watch/update-course-rewind-2020-eras-3718?t=391)
- ERAS is a multidisciplinary, multimodal, evidence-based way of delivering care to patients. — The host summarizes what Dr. Kurt Heise said [Ep 6 · 8:20](https://origin-library.globalcastmd.com/watch/update-course-rewind-2020-eras-3718?t=500)
- The goals of ERAS are to optimize patient physiology throughout the entire perioperative pathway. — The host summarizes what Dr. Kurt Heise said [Ep 6 · 8:20](https://origin-library.globalcastmd.com/watch/update-course-rewind-2020-eras-3718?t=500)
- The strategy of ERAS is to decrease operative trauma, inflammatory response, and stress. — The host summarizes what Dr. Kurt Heise said [Ep 6 · 8:20](https://origin-library.globalcastmd.com/watch/update-course-rewind-2020-eras-3718?t=500)
- ERAS tactics include optimizing fluid and analgesia, mobilizing early, and feeding early, which work synergistically. — The host summarizes what Dr. Kurt Heise said [Ep 6 · 8:20](https://origin-library.globalcastmd.com/watch/update-course-rewind-2020-eras-3718?t=500)
- ERAS outcomes include faster healing, earlier discharge, and fewer complications of all types, not just surgical complications. — The host summarizes what Dr. Kurt Heise said [Ep 6 · 8:20](https://origin-library.globalcastmd.com/watch/update-course-rewind-2020-eras-3718?t=500)
- When ERAS is done well, it should decrease readmission rates. — The host summarizes what Dr. Kurt Heise said [Ep 6 · 8:20](https://origin-library.globalcastmd.com/watch/update-course-rewind-2020-eras-3718?t=500)
- Dr. Heise's team at Emory found that ERAS implementation did not slow cases down, contrary to initial concerns. — Kurt Heise summarizing a resource [Ep 6 · 10:03](https://origin-library.globalcastmd.com/watch/update-course-rewind-2020-eras-3718?t=603)
- Over years of ERAS implementation, there were decreases in intraoperative fluids, intraoperative and postoperative narcotics, and time to getting on a full diet. — The host summarizes what Dr. Kurt Heise said [Ep 6 · 10:18](https://origin-library.globalcastmd.com/watch/update-course-rewind-2020-eras-3718?t=618)
- Dr. Brindle authored a recent paper explaining a neonatal ERAS bundle created from scratch. — Todd Ponsky summarizes what Dr. Kurt Heise said [Ep 6 · 10:56](https://origin-library.globalcastmd.com/watch/update-course-rewind-2020-eras-3718?t=656)
- A Chinese randomized multi-center trial of 156 neonates who underwent surgery for gastrointestinal malformation with intestinal anastomosis compared early internal feeding versus traditional nasogastric decompression. — Rod Gerardo summarizing the discussion [Ep 7 · 0:44](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2021-4527?t=44)
- The early feeding group started feeds at 2 days compared to 6 days in the traditional feeding group. — Rod Gerardo summarizing the discussion [Ep 7 · 0:44](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2021-4527?t=44)
- There was no significant difference between early and traditional feeding groups in length of stay, time to full feeds, postoperative complications, 30-day mortality, or 30-day readmissions. — Rod Gerardo summarizing the discussion [Ep 7 · 0:44](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2021-4527?t=44)
- In the early feeding group, patients did not have a decompressing nasogastric tube, suggesting nasogastric decompression is not needed after neonatal intestinal anastomosis. — Rod Gerardo summarizing the discussion [Ep 7 · 3:06](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2021-4527?t=186)
- A Utah study examined patients under age 18 who presented with hematochezia to identify which factors predict Meckel diverticulum and created a risk score. — Rod Gerardo summarizing the discussion [Ep 7 · 3:06](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2021-4527?t=186)
- The Meckel score could help clinicians skip the Meckel scan and go straight to laparoscopy in high-score patients, even with a negative scan. — Rod Gerardo summarizing the discussion [Ep 7 · 3:06](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2021-4527?t=186)
- Under age 10, clinicians do not need to worry about doing a workup for Crohn disease in children with perianal symptoms; over age 10, they should. — Rod Gerardo summarizing the discussion [Ep 7 · 10:06](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2021-4527?t=606)
- In the Chinese study, the early feeding group started feeds at 2 days compared to 6 days for the traditionally fed group — Ellen Encisco summarizing the discussion [Ep 11 · 2:00](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2021-13360?t=120)
- There was no significant difference between early and traditional feeding groups in length of stay, time to full feeds, postoperative complications, 30-day mortality, or 30-day readmissions — Ellen Encisco summarizing the discussion [Ep 11 · 2:14](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2021-13360?t=134)
- A 19 year old male presented with a 3 year history of medically managed Crohn's disease with increasing abdominal pain and intermittent vomiting — The host summarizing a resource [Ep 10 · 0:00](https://origin-library.globalcastmd.com/watch/trinity-ileal-resection-w-narration-11976?t=0)
- MRI showed a fixed stricture of the terminal ileum with gross proximal dilatation — The host summarizing a resource [Ep 10 · 0:30](https://origin-library.globalcastmd.com/watch/trinity-ileal-resection-w-narration-11976?t=30)
- There was approximately a 10 centimeter length of ileum proximal to the ileocecal valve which remained pliable and not grossly involved — The host summarizing a resource [Ep 10 · 1:30](https://origin-library.globalcastmd.com/watch/trinity-ileal-resection-w-narration-11976?t=90)
- The decision was made to preserve the ileocecal valve based on finding 10 cm of relatively uninvolved distal ileum — The host summarizing a resource [Ep 10 · 1:50](https://origin-library.globalcastmd.com/watch/trinity-ileal-resection-w-narration-11976?t=110)
- The 5 millimeter Cool Seal Trinity device can be used to dissect through thick mesentery and create mesenteric windows — The host summarizing a resource [Ep 10 · 2:20](https://origin-library.globalcastmd.com/watch/trinity-ileal-resection-w-narration-11976?t=140)
- When mesentery is very thick, it can be taken in two separate leaflets (one proximal and one distal) while maintaining complete hemostasis — The host summarizing a resource [Ep 10 · 3:00](https://origin-library.globalcastmd.com/watch/trinity-ileal-resection-w-narration-11976?t=180)
- A useful technique for thick mesentery is to make a proximal seal on the mesenteric base and then a more distal seal near the bowel wall, dividing tissue at this level to ensure no incomplete seal and maintain proximal vascular control — The host summarizing a resource [Ep 10 · 3:30](https://origin-library.globalcastmd.com/watch/trinity-ileal-resection-w-narration-11976?t=210)
- The mesentery was almost 2 centimeters thick in this case — The host summarizing a resource [Ep 10 · 4:05](https://origin-library.globalcastmd.com/watch/trinity-ileal-resection-w-narration-11976?t=245)
- By using the 5 mm device for mesenteric division, trocars could be limited to two 5 millimeter ports and one 12 millimeter port, which is cosmetically superior to requiring larger ports for 10 mm sealer or 12 mm stapler — The host summarizing a resource [Ep 10 · 4:30](https://origin-library.globalcastmd.com/watch/trinity-ileal-resection-w-narration-11976?t=270)
- The mesenteric division portion of the operation took approximately 20 minutes with no significant blood loss and no unsealed vessels — The host summarizing a resource [Ep 10 · 5:20](https://origin-library.globalcastmd.com/watch/trinity-ileal-resection-w-narration-11976?t=320)
- The 5 mm device has no heat spread and is immediately cool, allowing manipulation of bowel and surrounding structures using the grasper function without needing to exchange for a different grasping tool — The host summarizing a resource [Ep 10 · 7:20](https://origin-library.globalcastmd.com/watch/trinity-ileal-resection-w-narration-11976?t=440)
- EndoGIA tan loads were used to divide the bowel both proximally and distally — The host summarizing a resource [Ep 10 · 7:00](https://origin-library.globalcastmd.com/watch/trinity-ileal-resection-w-narration-11976?t=420)
- Two loads of the endoGIA were required to completely divide the grossly dilated proximal bowel — The host summarizing a resource [Ep 10 · 8:05](https://origin-library.globalcastmd.com/watch/trinity-ileal-resection-w-narration-11976?t=485)
- A 60 millimeter load of the endoGIA was used to perform the side-to-side anastomosis — The host summarizing a resource [Ep 10 · 8:40](https://origin-library.globalcastmd.com/watch/trinity-ileal-resection-w-narration-11976?t=520)
- The resultant enterotomy was closed with a running 2-0 Vicryl suture — The host summarizing a resource [Ep 10 · 9:00](https://origin-library.globalcastmd.com/watch/trinity-ileal-resection-w-narration-11976?t=540)
- The operation took approximately 90 minutes — The host summarizing a resource [Ep 10 · 9:15](https://origin-library.globalcastmd.com/watch/trinity-ileal-resection-w-narration-11976?t=555)
- The patient was left with an NG tube overnight which was removed the next morning — The host summarizing a resource [Ep 10 · 9:25](https://origin-library.globalcastmd.com/watch/trinity-ileal-resection-w-narration-11976?t=565)
- The patient was started on a clear liquid diet on the 2nd postoperative day — The host summarizing a resource [Ep 10 · 9:40](https://origin-library.globalcastmd.com/watch/trinity-ileal-resection-w-narration-11976?t=580)
- The patient was discharged to home on the 3rd postoperative day — The host summarizing a resource [Ep 10 · 9:55](https://origin-library.globalcastmd.com/watch/trinity-ileal-resection-w-narration-11976?t=595)
- There was no blood loss during the procedure — The host summarizing a resource [Ep 10 · 10:30](https://origin-library.globalcastmd.com/watch/trinity-ileal-resection-w-narration-11976?t=630)
- The patient weighs approximately 62 kg — The host summarizing a resource [Ep 10 · 6:45](https://origin-library.globalcastmd.com/watch/trinity-ileal-resection-w-narration-11976?t=405)
- Whole recently published a paper about multidisciplinary engagement and its importance in ERAS — Todd Ponsky summarizing the discussion [Ep 5 · 2:12](https://origin-library.globalcastmd.com/watch/eras-clinical-practice-updates-2995?t=132)
- Two FAP patients went home in two days after proctocolectomy and colectomy at Kurt's institution a month prior — Todd Ponsky summarizing the discussion [Ep 5 · 5:37](https://origin-library.globalcastmd.com/watch/eras-clinical-practice-updates-2995?t=337)
- 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 — Todd Ponsky summarizing the discussion [Ep 5 · 7:10](https://origin-library.globalcastmd.com/watch/eras-clinical-practice-updates-2995?t=430)
- 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 — Todd Ponsky summarizing the discussion [Ep 5 · 7:10](https://origin-library.globalcastmd.com/watch/eras-clinical-practice-updates-2995?t=430)
- Preoperative optimization period and heavy counseling are important for patient readiness for early discharge — Todd Ponsky summarizing the discussion [Ep 5 · 7:10](https://origin-library.globalcastmd.com/watch/eras-clinical-practice-updates-2995?t=430)
- A nurse at Kurt's institution calls patients several times before their operation to go over discharge goals and reassure them — Todd Ponsky summarizing the discussion [Ep 5 · 7:10](https://origin-library.globalcastmd.com/watch/eras-clinical-practice-updates-2995?t=430)
- Getting the anesthesiologist to buy into giving the preoperative carbohydrate load is one of the hardest things in obese patients — Todd Ponsky summarizing the discussion [Ep 5 · 9:16](https://origin-library.globalcastmd.com/watch/eras-clinical-practice-updates-2995?t=556)
- Over half of bariatric patients are able to go home on the first postoperative day after sleeve gastrectomy with ERAS — Todd Ponsky summarizing the discussion [Ep 5 · 9:16](https://origin-library.globalcastmd.com/watch/eras-clinical-practice-updates-2995?t=556)
- 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 — Todd Ponsky summarizing the discussion [Ep 5 · 11:07](https://origin-library.globalcastmd.com/watch/eras-clinical-practice-updates-2995?t=667)
- Early in ERAS practice, Kurt's institution did epidurals for a year but it was a disaster because epidurals slowed patients down dramatically — Todd Ponsky summarizing the discussion [Ep 5 · 11:07](https://origin-library.globalcastmd.com/watch/eras-clinical-practice-updates-2995?t=667)
- After abandoning epidurals, Kurt's institution switched to QL blocks, rectus sheath blocks, or TAP blocks, which made it easier for patients to ambulate — Todd Ponsky summarizing the discussion [Ep 5 · 11:07](https://origin-library.globalcastmd.com/watch/eras-clinical-practice-updates-2995?t=667)
- 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 — Todd Ponsky summarizing the discussion [Ep 5 · 11:07](https://origin-library.globalcastmd.com/watch/eras-clinical-practice-updates-2995?t=667)
- Colectomies and craniofacial operations can be done with no narcotics using ERAS protocols — Todd Ponsky summarizing the discussion [Ep 5 · 11:07](https://origin-library.globalcastmd.com/watch/eras-clinical-practice-updates-2995?t=667)
- 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 — Todd Ponsky summarizing the discussion [Ep 5 · 20:39](https://origin-library.globalcastmd.com/watch/eras-clinical-practice-updates-2995?t=1239)
- In Atlanta, Epic was involved to put a little ERAS icon on the OR board so everybody knows the patient is on ERAS — Kurt Heist summarizes what Dr. Mary Brindell said [Ep 5 · 21:31](https://origin-library.globalcastmd.com/watch/eras-clinical-practice-updates-2995?t=1291)
- A study by Kurt, Mulan, and team at Emory showed that over years with additional ERAS elements adopted, there were decreased intraoperative fluids, decreased intraoperative and postoperative narcotics, and decreased time to getting on a full diet — Mary Brindell summarizes what Dr. Kurt Heist said [Ep 5 · 23:03](https://origin-library.globalcastmd.com/watch/eras-clinical-practice-updates-2995?t=1383)
- ERAS in newborns works well for most principles, but feeding immediately is not a great idea for kids with motility problems like imperforate anus — Mary Brindell summarizes what Dr. Kurt Heist said [Ep 5 · 28:16](https://origin-library.globalcastmd.com/watch/eras-clinical-practice-updates-2995?t=1696)
- There is a paper in publication in JPS on duodenal atresia repairs and enhanced recovery showing excellent recovery rate without increased return rate — Mary Brindell summarizes what Dr. Kurt Heist said [Ep 5 · 28:16](https://origin-library.globalcastmd.com/watch/eras-clinical-practice-updates-2995?t=1696)

## Common questions
### Where do experts disagree on Crohn's Disease?
Experts disagree on surgical management of terminal ileal Crohn's disease. One position holds that isolated terminal ileal disease may represent a separate disease entity warranting earlier resection before biologic therapy, citing favorable long-term outcomes. Another view emphasizes that Crohn's disease affects the entire GI tract as a chronic disorder regardless of which segment shows active disease, suggesting medical management should precede surgery. Additionally, experts differ on J-pouch reconstruction in Crohn's patients: some argue against it due to significant challenges when Crohn's is discovered postoperatively, while others support selective total proctocolectomy with J-pouch in carefully chosen cases with good results.

## Changelog
- Sep 24: 4 items added automatically
- Sep 17: 2 items added automatically
- Sep 16: 4 items added automatically
- Sep 16: Published again automatically — condition is back above threshold
- Sep 16: 7 items no longer name Crohn's disease
- Sep 7: Unpublished automatically — folded or below threshold
- Sep 7: 1 item added automatically
- Sep 7: 7 items added automatically

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