# Epigastric Hernia — GCMD Library living collection

Everything in the library about epigastric hernia — built automatically from dossiers that name it.

Updated: n/a · 3 episodes · 66 cited statements

## Episodes
### Not yet categorized
- [Laparoscopic Epigastric Herniorrhaphy-Case and Discussion: Pediatric Surgery...](https://origin-library.globalcastmd.com/watch/laparoscopic-epigastric-herniorrhaphy-case-and-discussion-pediatric-surgery-426) — video · 14:58 · [machine version](https://origin-library.globalcastmd.com/watch/laparoscopic-epigastric-herniorrhaphy-case-and-discussion-pediatric-surgery-426.md)
- [Tricks - Laparoscopic Epigastric Herniorrhaphy](https://origin-library.globalcastmd.com/watch/tricks-laparoscopic-epigastric-herniorrhaphy-633) — video · 15:20 · [machine version](https://origin-library.globalcastmd.com/watch/tricks-laparoscopic-epigastric-herniorrhaphy-633.md)
- [Update Course Rewind: Spontaneous Pneumothorax 2021](https://origin-library.globalcastmd.com/watch/update-course-rewind-spontaneous-pneumothorax-2021-4587) — video · [machine version](https://origin-library.globalcastmd.com/watch/update-course-rewind-spontaneous-pneumothorax-2021-4587.md)

## Chapters
- [0:00](https://origin-library.globalcastmd.com/watch/laparoscopic-epigastric-herniorrhaphy-case-and-discussion-pediatric-surgery-426?t=0) Case presentation: laparoscopic epigastric hernia repair in a 5-year-old (Ep 1)
- [2:41](https://origin-library.globalcastmd.com/watch/laparoscopic-epigastric-herniorrhaphy-case-and-discussion-pediatric-surgery-426?t=161) Debate on the role of laparoscopy for epigastric hernia repair (Ep 1)
- [5:20](https://origin-library.globalcastmd.com/watch/laparoscopic-epigastric-herniorrhaphy-case-and-discussion-pediatric-surgery-426?t=320) Natural history and indications for repair of epigastric hernias (Ep 1)
- [10:59](https://origin-library.globalcastmd.com/watch/laparoscopic-epigastric-herniorrhaphy-case-and-discussion-pediatric-surgery-426?t=659) Age considerations, anesthesia risk, and technical challenges (Ep 1)
- [0:00](https://origin-library.globalcastmd.com/watch/tricks-laparoscopic-epigastric-herniorrhaphy-633?t=0) Case Presentation: Laparoscopic Epigastric Hernia Repair (Ep 2)
- [2:41](https://origin-library.globalcastmd.com/watch/tricks-laparoscopic-epigastric-herniorrhaphy-633?t=161) Initial Faculty Discussion: Role of Laparoscopy and Hernia Classification (Ep 2)
- [5:20](https://origin-library.globalcastmd.com/watch/tricks-laparoscopic-epigastric-herniorrhaphy-633?t=320) Indications for Repair: Asymptomatic Epigastric Hernias (Ep 2)
- [7:58](https://origin-library.globalcastmd.com/watch/tricks-laparoscopic-epigastric-herniorrhaphy-633?t=478) Technical Approaches: Open vs. Laparoscopic Access (Ep 2)
- [11:03](https://origin-library.globalcastmd.com/watch/tricks-laparoscopic-epigastric-herniorrhaphy-633?t=663) Timing of Repair and Supraumbilical Hernias (Ep 2)
- [13:45](https://origin-library.globalcastmd.com/watch/tricks-laparoscopic-epigastric-herniorrhaphy-633?t=825) Laparoscopic Visualization and Closing Remarks (Ep 2)
- [0:00](https://origin-library.globalcastmd.com/watch/update-course-rewind-spontaneous-pneumothorax-2021-4587?t=0) Introduction and Case Presentation (Ep 3)
- [1:22](https://origin-library.globalcastmd.com/watch/update-course-rewind-spontaneous-pneumothorax-2021-4587?t=82) Historical Perspective and Aspiration Techniques (Ep 3)
- [3:31](https://origin-library.globalcastmd.com/watch/update-course-rewind-spontaneous-pneumothorax-2021-4587?t=211) Midwest Pediatric Surgery Consortium Study (Ep 3)
- [5:29](https://origin-library.globalcastmd.com/watch/update-course-rewind-spontaneous-pneumothorax-2021-4587?t=329) Australia/New Zealand Observation Trial (Ep 3)
- [6:47](https://origin-library.globalcastmd.com/watch/update-course-rewind-spontaneous-pneumothorax-2021-4587?t=407) Clinical Approach and Closing (Ep 3)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- Combined optics with a working channel allow repair through the umbilicus alone, using endoclose or percutaneous sutures tied subcutaneously. (clinical) [Ep 1 · 2:58](https://origin-library.globalcastmd.com/watch/laparoscopic-epigastric-herniorrhaphy-case-and-discussion-pediatric-surgery-426?t=178)
- True epigastric hernias contain only preperitoneal fat and are extraperitoneal, not full-thickness defects with omentum or peritoneal sac. — Sharif (clinical) [Ep 1 · 3:35](https://origin-library.globalcastmd.com/watch/laparoscopic-epigastric-herniorrhaphy-case-and-discussion-pediatric-surgery-426?t=215)
- Working on the anterior abdominal wall through the umbilicus is difficult due to poor working angle. — Sharif (opinion) [Ep 1 · 4:00](https://origin-library.globalcastmd.com/watch/laparoscopic-epigastric-herniorrhaphy-case-and-discussion-pediatric-surgery-426?t=240)
- The surgeon opened the peritoneum from inside, accessed the preperitoneal space, and pulled down preperitoneal fat that was residing in the hernia space. (clinical) [Ep 1 · 4:43](https://origin-library.globalcastmd.com/watch/laparoscopic-epigastric-herniorrhaphy-case-and-discussion-pediatric-surgery-426?t=283)
- Finger pressure on the outside pushed the hernia contents inward to aid laparoscopic identification. — Kathy (clinical) [Ep 1 · 5:06](https://origin-library.globalcastmd.com/watch/laparoscopic-epigastric-herniorrhaphy-case-and-discussion-pediatric-surgery-426?t=306)
- For teenage girls with unsightly epigastric hernias, the laparoscopic technique is worth considering for cosmetic reasons. — Kathy (opinion) [Ep 1 · 5:06](https://origin-library.globalcastmd.com/watch/laparoscopic-epigastric-herniorrhaphy-case-and-discussion-pediatric-surgery-426?t=306)
- Some small epigastric hernias in 3-4 year olds enlarge significantly by age 10, with increased preperitoneal fat and larger defects. — Sharif (clinical) [Ep 1 · 5:31](https://origin-library.globalcastmd.com/watch/laparoscopic-epigastric-herniorrhaphy-case-and-discussion-pediatric-surgery-426?t=331)
- The natural history of epigastric hernias is to enlarge over time. — Sharif (clinical) [Ep 1 · 5:55](https://origin-library.globalcastmd.com/watch/laparoscopic-epigastric-herniorrhaphy-case-and-discussion-pediatric-surgery-426?t=355)
- Repairing epigastric hernias when small is a minor procedure. — Sharif (opinion) [Ep 1 · 5:55](https://origin-library.globalcastmd.com/watch/laparoscopic-epigastric-herniorrhaphy-case-and-discussion-pediatric-surgery-426?t=355)
- Asymptomatic epigastric hernias may enlarge into adulthood, especially after pregnancy in females, potentially requiring mesh rather than primary closure. — Todd Ponsky (clinical) [Ep 1 · 6:01](https://origin-library.globalcastmd.com/watch/laparoscopic-epigastric-herniorrhaphy-case-and-discussion-pediatric-surgery-426?t=361)
- Many epigastric hernias remain totally asymptomatic and small in size throughout life. — Jeff (clinical) [Ep 1 · 6:34](https://origin-library.globalcastmd.com/watch/laparoscopic-epigastric-herniorrhaphy-case-and-discussion-pediatric-surgery-426?t=394)
- Epigastric hernias are not a significant health concern like inguinal hernias. — Jeff (opinion) [Ep 1 · 7:00](https://origin-library.globalcastmd.com/watch/laparoscopic-epigastric-herniorrhaphy-case-and-discussion-pediatric-surgery-426?t=420)
- Some women with epigastric hernias experience significant pain during pregnancy. — Jeff (clinical) [Ep 1 · 7:10](https://origin-library.globalcastmd.com/watch/laparoscopic-epigastric-herniorrhaphy-case-and-discussion-pediatric-surgery-426?t=430)
- Inferior epigastric hernias can be repaired through a periumbilical incision by moving the skin incision upward. — Kathy (clinical) [Ep 1 · 7:23](https://origin-library.globalcastmd.com/watch/laparoscopic-epigastric-herniorrhaphy-case-and-discussion-pediatric-surgery-426?t=443)
- Some large adult epigastric hernias require mesh repair. — Todd Ponsky (clinical) [Ep 1 · 7:57](https://origin-library.globalcastmd.com/watch/laparoscopic-epigastric-herniorrhaphy-case-and-discussion-pediatric-surgery-426?t=477)
- Oliver Munster presented the same laparoscopic technique at IPEG in Beijing. — Todd Ponsky (clinical) [Ep 1 · 8:40](https://origin-library.globalcastmd.com/watch/laparoscopic-epigastric-herniorrhaphy-case-and-discussion-pediatric-surgery-426?t=520)
- Scars in young children grow proportionally as the child grows. — Todd Ponsky (clinical) [Ep 1 · 8:50](https://origin-library.globalcastmd.com/watch/laparoscopic-epigastric-herniorrhaphy-case-and-discussion-pediatric-surgery-426?t=530)
- Hiding the scar in the umbilicus offers a cosmetic advantage over midline epigastric scars. — Todd Ponsky (opinion) [Ep 1 · 8:55](https://origin-library.globalcastmd.com/watch/laparoscopic-epigastric-herniorrhaphy-case-and-discussion-pediatric-surgery-426?t=535)
- A supraumbilical or periumbilical incision can reach epigastric hernias located halfway to the xiphoid process, based on experience with pyloric stenosis operations. — Todd Ponsky (clinical) [Ep 1 · 9:30](https://origin-library.globalcastmd.com/watch/laparoscopic-epigastric-herniorrhaphy-case-and-discussion-pediatric-surgery-426?t=570)
- Some abdominal wall hernias 1-1.5 cm above the umbilicus are full-thickness defects with a peritoneal sac, not true epigastric hernias, and may be misdiagnosed. — Sharif (clinical) [Ep 1 · 10:20](https://origin-library.globalcastmd.com/watch/laparoscopic-epigastric-herniorrhaphy-case-and-discussion-pediatric-surgery-426?t=620)
- Multiple small abdominal wall defects (Swiss cheese pattern) can occur in the epigastric region. — Sharif (clinical) [Ep 1 · 10:55](https://origin-library.globalcastmd.com/watch/laparoscopic-epigastric-herniorrhaphy-case-and-discussion-pediatric-surgery-426?t=655)
- Supraumbilical hernias (1 cm above the umbilicus) can be repaired through a supraumbilical incision hidden in the umbilicus. — Kathy (clinical) [Ep 1 · 11:01](https://origin-library.globalcastmd.com/watch/laparoscopic-epigastric-herniorrhaphy-case-and-discussion-pediatric-surgery-426?t=661)
- Epigastric hernias located midway between xiphoid and umbilicus in children over 1 year are difficult to reach through an umbilical or supraumbilical incision. — Kathy (clinical) [Ep 1 · 11:30](https://origin-library.globalcastmd.com/watch/laparoscopic-epigastric-herniorrhaphy-case-and-discussion-pediatric-surgery-426?t=690)
- Anesthesiologists are reluctant to anesthetize children under age 5 for truly elective operations due to soft reports of cognitive problems with general anesthesia. — Jeff (clinical) [Ep 1 · 11:51](https://origin-library.globalcastmd.com/watch/laparoscopic-epigastric-herniorrhaphy-case-and-discussion-pediatric-surgery-426?t=711)
- Most parents requesting epigastric hernia repair report the hernia is symptomatic with pain. (clinical) [Ep 1 · 12:25](https://origin-library.globalcastmd.com/watch/laparoscopic-epigastric-herniorrhaphy-case-and-discussion-pediatric-surgery-426?t=745)
- There is a gap in knowledge about the optimal timing for repair of epigastric hernias and hydroceles. — Sharif (opinion) [Ep 1 · 13:02](https://origin-library.globalcastmd.com/watch/laparoscopic-epigastric-herniorrhaphy-case-and-discussion-pediatric-surgery-426?t=782)
- Most surgeons repair hydroceles between 1 and 2 years of age, but the rationale for this timing versus waiting until 3-5 years is unclear. — Sharif (clinical) [Ep 1 · 13:20](https://origin-library.globalcastmd.com/watch/laparoscopic-epigastric-herniorrhaphy-case-and-discussion-pediatric-surgery-426?t=800)
- Toddlers recover from surgery with less morbidity and fewer psychological effects than older children (6-7 years) who associate hospital stays with missing school. — Sharif (opinion) [Ep 1 · 13:30](https://origin-library.globalcastmd.com/watch/laparoscopic-epigastric-herniorrhaphy-case-and-discussion-pediatric-surgery-426?t=810)
- It is difficult to visualize true epigastric hernias (epiplocoeles with preperitoneal fat only) laparoscopically. — Todd Ponsky (opinion) [Ep 1 · 13:45](https://origin-library.globalcastmd.com/watch/laparoscopic-epigastric-herniorrhaphy-case-and-discussion-pediatric-surgery-426?t=825)
- There is a risk of future adhesive bowel obstruction from the peritoneal defect created during laparoscopic epigastric hernia repair. — Jeff (opinion) [Ep 1 · 14:37](https://origin-library.globalcastmd.com/watch/laparoscopic-epigastric-herniorrhaphy-case-and-discussion-pediatric-surgery-426?t=877)
- The case involved a 5-year-old girl with swelling and tenderness in the epigastric region that had not been able to be reduced for 6 months. (clinical) [Ep 2 · 0:00](https://origin-library.globalcastmd.com/watch/tricks-laparoscopic-epigastric-herniorrhaphy-633?t=0)
- The technique used a microlaparoscopic approach with a 3 millimeter umbilical port and 2-3 millimeter percutaneous instruments placed in the left anterior axillary line. (clinical) [Ep 2 · 0:40](https://origin-library.globalcastmd.com/watch/tricks-laparoscopic-epigastric-herniorrhaphy-633?t=40)
- Finger pressure on the abdominal wall hernia bulge was used to identify the hernia site laparoscopically. (clinical) [Ep 2 · 1:20](https://origin-library.globalcastmd.com/watch/tricks-laparoscopic-epigastric-herniorrhaphy-633?t=80)
- The peritoneum was opened and fatty tissue was removed to expose the hernia ring. (clinical) [Ep 2 · 1:40](https://origin-library.globalcastmd.com/watch/tricks-laparoscopic-epigastric-herniorrhaphy-633?t=100)
- The repair was completed with interrupted percutaneous 3-0 PDS suture at 2 separated points. (clinical) [Ep 2 · 2:00](https://origin-library.globalcastmd.com/watch/tricks-laparoscopic-epigastric-herniorrhaphy-633?t=120)
- Combined optics with working channel allow use of only the umbilicus for entrance, with endoclose or percutaneous suture technique for closure. — Vanderzee (clinical) [Ep 2 · 2:58](https://origin-library.globalcastmd.com/watch/tricks-laparoscopic-epigastric-herniorrhaphy-633?t=178)
- A true epigastric hernia contains only preperitoneal fat and is extraperitoneal, not full-thickness with omentum protruding. — Sharif (clinical) [Ep 2 · 3:35](https://origin-library.globalcastmd.com/watch/tricks-laparoscopic-epigastric-herniorrhaphy-633?t=215)
- Working on the anterior abdominal wall through the umbilicus is difficult because of inadequate angle. — Sharif (opinion) [Ep 2 · 3:35](https://origin-library.globalcastmd.com/watch/tricks-laparoscopic-epigastric-herniorrhaphy-633?t=215)
- Some epigastric hernias observed in 3-4 year old patients have enlarged significantly by age 10, with huge amounts of preperitoneal fat and bigger defects. (clinical) [Ep 2 · 5:31](https://origin-library.globalcastmd.com/watch/tricks-laparoscopic-epigastric-herniorrhaphy-633?t=331)
- The natural history of epigastric hernias is to enlarge over time. (clinical) [Ep 2 · 5:31](https://origin-library.globalcastmd.com/watch/tricks-laparoscopic-epigastric-herniorrhaphy-633?t=331)
- When epigastric hernias are fixed when small, it is a pretty minor procedure. (opinion) [Ep 2 · 5:31](https://origin-library.globalcastmd.com/watch/tricks-laparoscopic-epigastric-herniorrhaphy-633?t=331)
- A huge number of epigastric hernias remain totally asymptomatic and small in size. — Jeff (clinical) [Ep 2 · 6:34](https://origin-library.globalcastmd.com/watch/tricks-laparoscopic-epigastric-herniorrhaphy-633?t=394)
- Epigastric hernias are not a health concern like inguinal hernias. — Jeff (opinion) [Ep 2 · 6:34](https://origin-library.globalcastmd.com/watch/tricks-laparoscopic-epigastric-herniorrhaphy-633?t=394)
- The majority of epigastric hernias live quite happily inside the confines of a very small defect. — Jeff (opinion) [Ep 2 · 6:57](https://origin-library.globalcastmd.com/watch/tricks-laparoscopic-epigastric-herniorrhaphy-633?t=417)
- Several women with epigastric hernias have had significant pain at the time of pregnancy. — Kathy (clinical) [Ep 2 · 7:15](https://origin-library.globalcastmd.com/watch/tricks-laparoscopic-epigastric-herniorrhaphy-633?t=435)
- Inferior epigastric hernias can be repaired through a periumbilical incision by moving the skin incision up. — Kathy (clinical) [Ep 2 · 7:15](https://origin-library.globalcastmd.com/watch/tricks-laparoscopic-epigastric-herniorrhaphy-633?t=435)
- Some large adult epigastric hernias require mesh repair. (clinical) [Ep 2 · 7:58](https://origin-library.globalcastmd.com/watch/tricks-laparoscopic-epigastric-herniorrhaphy-633?t=478)
- Oliver Munster presented the same laparoscopic technique at IPEG in Beijing. (clinical) [Ep 2 · 8:40](https://origin-library.globalcastmd.com/watch/tricks-laparoscopic-epigastric-herniorrhaphy-633?t=520)
- Scars grow proportionally as children age, so a scar on a 3-year-old will be twice as big when older. (clinical) [Ep 2 · 8:40](https://origin-library.globalcastmd.com/watch/tricks-laparoscopic-epigastric-herniorrhaphy-633?t=520)
- A periumbilical incision can reach halfway up to the xiphoid process, sufficient for most epigastric hernias. — Kathy (clinical) [Ep 2 · 9:20](https://origin-library.globalcastmd.com/watch/tricks-laparoscopic-epigastric-herniorrhaphy-633?t=560)
- At least half a dozen patients have been observed with hernias 1-1.5 cm above the umbilicus that were true full-thickness abdominal wall hernias with a sac, not epigastric hernias. — Sharif (clinical) [Ep 2 · 10:20](https://origin-library.globalcastmd.com/watch/tricks-laparoscopic-epigastric-herniorrhaphy-633?t=620)
- Some epigastric hernias present as Swiss cheese with multiple defects. (clinical) [Ep 2 · 10:54](https://origin-library.globalcastmd.com/watch/tricks-laparoscopic-epigastric-herniorrhaphy-633?t=654)
- Supraumbilical hernias 1 cm above the umbilicus can be managed through a supraumbilical incision hidden through the umbilicus. (clinical) [Ep 2 · 11:03](https://origin-library.globalcastmd.com/watch/tricks-laparoscopic-epigastric-herniorrhaphy-633?t=663)
- In older kids (one year and above) with epigastric hernias in the midline between xiphoid and umbilicus, it is very hard to reach through an umbilical or supraumbilical incision. (clinical) [Ep 2 · 11:03](https://origin-library.globalcastmd.com/watch/tricks-laparoscopic-epigastric-herniorrhaphy-633?t=663)
- Anesthetists are reluctant to anesthetize children under age 5 for truly elective operations due to soft reports about cognitive problems with general anesthesia. — Jeff (clinical) [Ep 2 · 11:51](https://origin-library.globalcastmd.com/watch/tricks-laparoscopic-epigastric-herniorrhaphy-633?t=711)
- Toddlers tend to recover with less morbidity than 6-7 year olds who associate hospital stay with psychological components and miss school. — Sharif (opinion) [Ep 2 · 13:02](https://origin-library.globalcastmd.com/watch/tricks-laparoscopic-epigastric-herniorrhaphy-633?t=782)
- Optimal timing for repair of hydroceles and epigastric hernias remains unknown, representing a gap in knowledge. — Sharif (opinion) [Ep 2 · 13:02](https://origin-library.globalcastmd.com/watch/tricks-laparoscopic-epigastric-herniorrhaphy-633?t=782)
- It is difficult to see the defect laparoscopically in true epiploceles (preperitoneal fat hernias). (opinion) [Ep 2 · 13:45](https://origin-library.globalcastmd.com/watch/tricks-laparoscopic-epigastric-herniorrhaphy-633?t=825)
- There is a risk of adhesion formation to the peritoneal defect that could cause bowel obstruction after laparoscopic repair. — Jeff (opinion) [Ep 2 · 14:37](https://origin-library.globalcastmd.com/watch/tricks-laparoscopic-epigastric-herniorrhaphy-633?t=877)
- At Children's Mercy Kansas City, the approach was modified so that if aspiration doesn't work perfectly, they proceed straight to VATS that same day to avoid prolonged hospital stays of 5-6 days. — Shawn St. Peter (clinical) [Ep 3 · 4:49](https://origin-library.globalcastmd.com/watch/update-course-rewind-spontaneous-pneumothorax-2021-4587?t=289)
- The Children's Mercy approach of proceeding directly to VATS after failed aspiration turns cases into a maximum 2-3 day hospital stay instead of 4-5-6 days with back-and-forth management between water seal and suction. — Shawn St. Peter (clinical) [Ep 3 · 5:14](https://origin-library.globalcastmd.com/watch/update-course-rewind-spontaneous-pneumothorax-2021-4587?t=314)
- If a bleb ruptures and then doesn't continue to leak, it may scar down and never require intervention. — Rod (clinical) [Ep 3 · 6:33](https://origin-library.globalcastmd.com/watch/update-course-rewind-spontaneous-pneumothorax-2021-4587?t=393)
- Using a needle for aspiration is risky because as the lung expands, you risk poking a hole in it; an angiocath is preferred. — Todd Ponsky (opinion) [Ep 3 · 7:01](https://origin-library.globalcastmd.com/watch/update-course-rewind-spontaneous-pneumothorax-2021-4587?t=421)
- One approach is to put in a pigtail catheter and leave it in (rather than using an angiocath), then aspirate, clamp, and obtain an X-ray. — Todd Ponsky (clinical) [Ep 3 · 7:07](https://origin-library.globalcastmd.com/watch/update-course-rewind-spontaneous-pneumothorax-2021-4587?t=427)
- Spontaneous pneumothorax is a different disease than traumatic pneumothorax, and patients are never seen in extremis from spontaneous pneumothorax. — Todd Ponsky (opinion) [Ep 3 · 7:18](https://origin-library.globalcastmd.com/watch/update-course-rewind-spontaneous-pneumothorax-2021-4587?t=438)
- Despite a 44% recurrence rate after successful aspiration, most patients choose conservative management rather than immediate definitive surgery because the chance of a problem from spontaneous pneumothorax is low. — Todd Ponsky (opinion) [Ep 3 · 7:32](https://origin-library.globalcastmd.com/watch/update-course-rewind-spontaneous-pneumothorax-2021-4587?t=452)

## Host summaries
Recaps by a host of what the experts said — not the host's own clinical position.
- The case involved a 5-year-old girl with epigastric swelling and tenderness that had not reduced for 6 months. — The host summarizing a resource [Ep 1 · 0:00](https://origin-library.globalcastmd.com/watch/laparoscopic-epigastric-herniorrhaphy-case-and-discussion-pediatric-surgery-426?t=0)
- The technique used a 3mm umbilical port and 3mm percutaneous instruments in the left anterior axillary line. — The host summarizing a resource [Ep 1 · 0:30](https://origin-library.globalcastmd.com/watch/laparoscopic-epigastric-herniorrhaphy-case-and-discussion-pediatric-surgery-426?t=30)
- Finger pressure on the abdominal wall hernia bulge was used to identify the hernia site laparoscopically. — The host summarizing a resource [Ep 1 · 1:00](https://origin-library.globalcastmd.com/watch/laparoscopic-epigastric-herniorrhaphy-case-and-discussion-pediatric-surgery-426?t=60)
- The peritoneum was opened, fatty tissue removed, and the hernia ring exposed and closed with interrupted percutaneous 3-0 PDS sutures. — The host summarizing a resource [Ep 1 · 1:30](https://origin-library.globalcastmd.com/watch/laparoscopic-epigastric-herniorrhaphy-case-and-discussion-pediatric-surgery-426?t=90)
- The laparoscopic approach avoids a non-cosmetic incision and scar in the epigastric region. — The host summarizing a resource [Ep 1 · 2:20](https://origin-library.globalcastmd.com/watch/laparoscopic-epigastric-herniorrhaphy-case-and-discussion-pediatric-surgery-426?t=140)
- Dr. Abello confirmed the hernia was a true epigastric hernia with fat, not omentum. — Todd Ponsky summarizing the discussion [Ep 1 · 4:34](https://origin-library.globalcastmd.com/watch/laparoscopic-epigastric-herniorrhaphy-case-and-discussion-pediatric-surgery-426?t=274)
- Dr. Abello does not repair all asymptomatic epigastric hernias but does repair them in female patients due to pregnancy concerns. — The host summarizing the discussion [Ep 1 · 7:49](https://origin-library.globalcastmd.com/watch/laparoscopic-epigastric-herniorrhaphy-case-and-discussion-pediatric-surgery-426?t=469)
- Adult surgeons report needing to take down the falciform ligament and open the peritoneum to visualize epigastric hernias laparoscopically. — Todd Ponsky summarizing the discussion [Ep 1 · 14:10](https://origin-library.globalcastmd.com/watch/laparoscopic-epigastric-herniorrhaphy-case-and-discussion-pediatric-surgery-426?t=850)
- Dr. Abello does not repair all asymptomatic hernias but does repair them in female patients because of pregnancy concerns. — The host summarizing the discussion [Ep 2 · 7:49](https://origin-library.globalcastmd.com/watch/tricks-laparoscopic-epigastric-herniorrhaphy-633?t=469)
- Adult surgeons report needing to take down the falciform ligament and open the peritoneum to visualize epigastric hernias laparoscopically. — The host summarizing the discussion [Ep 2 · 14:17](https://origin-library.globalcastmd.com/watch/tricks-laparoscopic-epigastric-herniorrhaphy-633?t=857)
- The Midwest Pediatric Surgery Consortium conducted a multi-center prospective study enrolling 33 children with first presentation of spontaneous pneumothorax, managed with aspiration through a pigtail catheter ≤12 French followed by 6-hour observation with the tube clamped. — Rod summarizing the discussion [Ep 3 · 3:44](https://origin-library.globalcastmd.com/watch/update-course-rewind-spontaneous-pneumothorax-2021-4587?t=224)
- In the Midwest Consortium study, 48% of patients were successfully managed with aspiration alone and the rest failed. — Rod summarizing the discussion [Ep 3 · 4:07](https://origin-library.globalcastmd.com/watch/update-course-rewind-spontaneous-pneumothorax-2021-4587?t=247)
- Among patients who failed initial aspiration in the Midwest Consortium study, recurrence was 83%. — Rod summarizing the discussion [Ep 3 · 4:13](https://origin-library.globalcastmd.com/watch/update-course-rewind-spontaneous-pneumothorax-2021-4587?t=253)
- Of patients successfully managed with aspiration in the Midwest Consortium study, 44% had recurrence. — Rod summarizing the discussion [Ep 3 · 4:17](https://origin-library.globalcastmd.com/watch/update-course-rewind-spontaneous-pneumothorax-2021-4587?t=257)
- The Midwest Consortium study authors proposed changing the algorithm to proceed directly to VATS if initial aspiration fails. — Rod summarizing the discussion [Ep 3 · 4:30](https://origin-library.globalcastmd.com/watch/update-course-rewind-spontaneous-pneumothorax-2021-4587?t=270)
- The Australia/New Zealand study was a multi-center non-inferiority trial that enrolled 316 patients aged 14-50 years old with moderate to large pneumothoraces (approximately 32% collapse). — Rod summarizing the discussion [Ep 3 · 5:45](https://origin-library.globalcastmd.com/watch/update-course-rewind-spontaneous-pneumothorax-2021-4587?t=345)
- In the Australia/New Zealand trial, the success rate was 98.5% in the intervention group versus 94.4% in the observation group. — Rod summarizing the discussion [Ep 3 · 6:13](https://origin-library.globalcastmd.com/watch/update-course-rewind-spontaneous-pneumothorax-2021-4587?t=373)
- In the Australia/New Zealand trial, the observation group had lower rates of both adverse events and one-year recurrence compared to the intervention group. — Rod summarizing the discussion [Ep 3 · 6:20](https://origin-library.globalcastmd.com/watch/update-course-rewind-spontaneous-pneumothorax-2021-4587?t=380)
- The Australia/New Zealand study demonstrates that even patients with moderate to large spontaneous pneumothoraces can be managed with observation alone. — Rod summarizing the discussion [Ep 3 · 6:25](https://origin-library.globalcastmd.com/watch/update-course-rewind-spontaneous-pneumothorax-2021-4587?t=385)
- Conservative management definitions vary: some consider tube thoracostomy as conservative, while current literature defines it as observation with oxygen and pain management without any invasive intervention including needle aspiration or tube thoracostomy. — Rod summarizing the discussion [Ep 3 · 3:12](https://origin-library.globalcastmd.com/watch/update-course-rewind-spontaneous-pneumothorax-2021-4587?t=192)
- Aspiration can be performed with a needle or with a pigtail catheter less than 12 French. — Rod summarizing the discussion [Ep 3 · 2:42](https://origin-library.globalcastmd.com/watch/update-course-rewind-spontaneous-pneumothorax-2021-4587?t=162)

## Changelog
- Sep 23: 3 items added automatically

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