# Pyloric Stenosis — GCMD Library living collection

Everything in the library about pyloric stenosis — built automatically from dossiers that name it.

Updated: n/a · 9 episodes · 141 cited statements

## Episodes
### Fundamentals
- [History of Pediatric Surgery](https://origin-library.globalcastmd.com/watch/history-of-pediatric-surgery-295) — podcast · 52:36 · [machine version](https://origin-library.globalcastmd.com/watch/history-of-pediatric-surgery-295.md)

### Surgical Management
- [Laparoscopic Pyloromyotomy](https://origin-library.globalcastmd.com/watch/laparoscopic-pyloromyotomy-2253) — video · 7:19 · [machine version](https://origin-library.globalcastmd.com/watch/laparoscopic-pyloromyotomy-2253.md)
- [Peritoneal Access](https://origin-library.globalcastmd.com/watch/peritoneal-access-2294) — video · [machine version](https://origin-library.globalcastmd.com/watch/peritoneal-access-2294.md)

### Evidence & Research
- [Hot New Topics from The Journal Of Pediatric Surgery: Update Course 2017](https://origin-library.globalcastmd.com/watch/hot-new-topics-from-the-journal-of-pediatric-surgery-update-course-2017-404) — video · 27:37 · [machine version](https://origin-library.globalcastmd.com/watch/hot-new-topics-from-the-journal-of-pediatric-surgery-update-course-2017-404.md)
- [RCT for Feeding after Pyloromyotomy](https://origin-library.globalcastmd.com/watch/rct-for-feeding-after-pyloromyotomy-2545) — video · [machine version](https://origin-library.globalcastmd.com/watch/rct-for-feeding-after-pyloromyotomy-2545.md)
- [Todd Ponsky: What is new in Pediatric Surgery? Teaser](https://origin-library.globalcastmd.com/watch/todd-ponsky-what-is-new-in-pediatric-surgery-teaser-13347) — video · 1:05:21 · [machine version](https://origin-library.globalcastmd.com/watch/todd-ponsky-what-is-new-in-pediatric-surgery-teaser-13347.md)

### Case-Based Learning
- [Pyloric Stenosis with Dr. Alex Bondoc](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-with-dr-alex-bondoc-8728) — podcast · 16:20 · [machine version](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-with-dr-alex-bondoc-8728.md)

### In-Depth Reviews
- [Pyloric Stenosis](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-2532) — video · 12:30 · [machine version](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-2532.md)
- [Pyloric Stenosis Guideline Recap](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-guideline-recap-5786) — video · [machine version](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-guideline-recap-5786.md)

## Chapters
- [0:00](https://origin-library.globalcastmd.com/watch/history-of-pediatric-surgery-295?t=0) Introduction and series context (Ep 6)
- [2:00](https://origin-library.globalcastmd.com/watch/history-of-pediatric-surgery-295?t=120) The Halifax explosion and William Ladd's commitment (Ep 6)
- [5:47](https://origin-library.globalcastmd.com/watch/history-of-pediatric-surgery-295?t=347) Children in landmark medical achievements (Ep 6)
- [7:32](https://origin-library.globalcastmd.com/watch/history-of-pediatric-surgery-295?t=452) Nakayama's motivation for studying surgical history (Ep 6)
- [8:57](https://origin-library.globalcastmd.com/watch/history-of-pediatric-surgery-295?t=537) Pyloric stenosis: early descriptions and failed treatments (Ep 6)
- [11:45](https://origin-library.globalcastmd.com/watch/history-of-pediatric-surgery-295?t=705) Pierre Fredet's extramucosal pyloroplasty and perioperative care (Ep 6)
- [14:46](https://origin-library.globalcastmd.com/watch/history-of-pediatric-surgery-295?t=886) Conrad Ramstedt's pyloromyotomy breakthrough (Ep 6)
- [18:04](https://origin-library.globalcastmd.com/watch/history-of-pediatric-surgery-295?t=1084) Hirschsprung disease: misunderstood pathophysiology and failed operations (Ep 6)
- [20:25](https://origin-library.globalcastmd.com/watch/history-of-pediatric-surgery-295?t=1225) Orvar Swenson's physiological insight and the pull-through operation (Ep 6)
- [25:16](https://origin-library.globalcastmd.com/watch/history-of-pediatric-surgery-295?t=1516) Swenson's conflict with Robert Gross and subsequent dismissal (Ep 6)
- [30:36](https://origin-library.globalcastmd.com/watch/history-of-pediatric-surgery-295?t=1836) Patent ductus arteriosus: Gross's 1938 ligation and career consequences (Ep 6)
- [33:30](https://origin-library.globalcastmd.com/watch/history-of-pediatric-surgery-295?t=2010) Helen Tausig's proposal and Gross's refusal of the Blalock-Taussig shunt (Ep 6)
- [37:21](https://origin-library.globalcastmd.com/watch/history-of-pediatric-surgery-295?t=2241) Esophageal atresia: early failures and Thomas Lanman's 1940 review (Ep 6)
- [44:27](https://origin-library.globalcastmd.com/watch/history-of-pediatric-surgery-295?t=2667) Cameron Haight's 1941 first survivor and postoperative complications (Ep 6)
- [49:21](https://origin-library.globalcastmd.com/watch/history-of-pediatric-surgery-295?t=2961) Reflection on surgical progress and the debt to pioneers (Ep 6)
- [0:00](https://origin-library.globalcastmd.com/watch/hot-new-topics-from-the-journal-of-pediatric-surgery-update-course-2017-404?t=0) Introduction and Pneumomediastinum Management (Ep 1)
- [6:39](https://origin-library.globalcastmd.com/watch/hot-new-topics-from-the-journal-of-pediatric-surgery-update-course-2017-404?t=399) Pneumomediastinum Discussion and Pyloric Stenosis Introduction (Ep 1)
- [11:16](https://origin-library.globalcastmd.com/watch/hot-new-topics-from-the-journal-of-pediatric-surgery-update-course-2017-404?t=676) Pyloric Stenosis Fluid Resuscitation Protocol (Ep 1)
- [17:20](https://origin-library.globalcastmd.com/watch/hot-new-topics-from-the-journal-of-pediatric-surgery-update-course-2017-404?t=1040) Esophageal Atresia Leak Management (Ep 1)
- [25:04](https://origin-library.globalcastmd.com/watch/hot-new-topics-from-the-journal-of-pediatric-surgery-update-course-2017-404?t=1504) Glycopyrrolate for Anastomotic Leaks (Ep 1)
- [0:03](https://origin-library.globalcastmd.com/watch/laparoscopic-pyloromyotomy-2253?t=3) Patient presentation and positioning (Ep 2)
- [2:00](https://origin-library.globalcastmd.com/watch/laparoscopic-pyloromyotomy-2253?t=120) Myotomy initiation and marking (Ep 2)
- [4:00](https://origin-library.globalcastmd.com/watch/laparoscopic-pyloromyotomy-2253?t=240) Muscle spreading technique (Ep 2)
- [5:30](https://origin-library.globalcastmd.com/watch/laparoscopic-pyloromyotomy-2253?t=330) Adequacy confirmation and closure (Ep 2)
- [6:30](https://origin-library.globalcastmd.com/watch/laparoscopic-pyloromyotomy-2253?t=390) Safety review and key steps (Ep 2)
- [0:00](https://origin-library.globalcastmd.com/watch/peritoneal-access-2294?t=0) Peritoneal Access Techniques: Polling and Initial Discussion (Ep 3)
- [7:00](https://origin-library.globalcastmd.com/watch/peritoneal-access-2294?t=420) Trocar Insertion Angle and Safety Considerations (Ep 3)
- [15:00](https://origin-library.globalcastmd.com/watch/peritoneal-access-2294?t=900) Neonatal Access: Two-Day-Old with Duodenal Atresia (Ep 3)
- [25:00](https://origin-library.globalcastmd.com/watch/peritoneal-access-2294?t=1500) CO2 Embolization: Clinical Presentation and Emerging Recognition (Ep 3)
- [0:19](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-2532?t=19) Definition, Etiology, and Clinical Presentation of Pyloric Stenosis (Ep 4)
- [1:34](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-2532?t=94) Differential Diagnosis and Diagnostic Workup (Ep 4)
- [3:06](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-2532?t=186) Electrolyte Abnormalities and Pathophysiology (Ep 4)
- [4:09](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-2532?t=249) Resuscitation Protocol and Pre-operative Management (Ep 4)
- [6:05](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-2532?t=365) Surgical Technique: Pyloromyotomy Steps and Adequacy Assessment (Ep 4)
- [8:39](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-2532?t=519) Complications and Management of Mucosal Perforation (Ep 4)
- [9:53](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-2532?t=593) Post-operative Feeding and Management of Persistent Vomiting (Ep 4)
- [0:00](https://origin-library.globalcastmd.com/watch/rct-for-feeding-after-pyloromyotomy-2545?t=0) RCT Comparing Feeding Strategies After Pyloromyotomy (Ep 5)
- [0:00](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-guideline-recap-5786?t=0) Introduction and Diagnosis of Pyloric Stenosis (Ep 7)
- [1:00](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-guideline-recap-5786?t=60) Preoperative Resuscitation and Fluid Management (Ep 7)
- [3:00](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-guideline-recap-5786?t=180) Operative Criteria and Postoperative Feeding (Ep 7)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- Pyloric stenosis is hypertrophy and hyperplasia of the inner circular layer with associated mucosal hypertrophy — Bhargava Muliudi (clinical) [Ep 4 · 0:31](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-2532?t=31)
- Pyloric stenosis leads to gastric outlet obstruction in infants between 2 to 10 weeks of age — Bhargava Muliudi (clinical) [Ep 4 · 0:37](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-2532?t=37)
- Pyloric stenosis is more common in males — Bhargava Muliudi (epidemiological) [Ep 4 · 0:46](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-2532?t=46)
- There is increased risk for first born infants with a positive family history — Bhargava Muliudi (epidemiological) [Ep 4 · 0:49](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-2532?t=49)
- Patients with pyloric stenosis typically present with non-bilious vomiting, usually seen between 2 to 10 weeks of life — Bhargava Muliudi (clinical) [Ep 4 · 1:04](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-2532?t=64)
- Infants with pyloric stenosis are otherwise well appearing and hungry after vomiting — Bhargava Muliudi (clinical) [Ep 4 · 1:12](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-2532?t=72)
- Emesis in pyloric stenosis will progress until it is projectile — Bhargava Muliudi (clinical) [Ep 4 · 1:16](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-2532?t=76)
- Hyperbilirubinemia can occur in up to 14% of patients with pyloric stenosis due to downregulation of hepatic enzymes associated with starvation — Bhargava Muliudi (clinical) [Ep 4 · 1:24](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-2532?t=84)
- Bilious emesis should always be worked up to rule out intestinal malrotation with midgut volvulus — Bhargava Muliudi (guideline) [Ep 4 · 2:00](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-2532?t=120)
- Ultrasound is the gold standard for diagnosing pyloric stenosis — Bhargava Muliudi (clinical) [Ep 4 · 2:50](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-2532?t=170)
- Pyloric stenosis is diagnosed on ultrasound when pyloric muscle is 3 millimeters thick and 14 millimeters long or greater — Bhargava Muliudi (clinical) [Ep 4 · 2:55](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-2532?t=175)
- The classic electrolyte abnormality in pyloric stenosis is hypochloremic, hypokalemic, metabolic alkalosis — Bhargava Muliudi (clinical) [Ep 4 · 3:19](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-2532?t=199)
- Prolonged gastric outlet obstruction leads to persistent vomiting and loss of hydrochloric acid, which leads to hypochloremia and loss of protons leading to metabolic alkalosis — Bhargava Muliudi (clinical) [Ep 4 · 3:29](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-2532?t=209)
- The kidneys compensate for dehydration by increasing the activity of the sodium potassium pump to retain fluid, leading to urinary excretion of potassium to preserve sodium and water — Bhargava Muliudi (clinical) [Ep 4 · 3:41](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-2532?t=221)
- In later stages of pyloric stenosis, excretion of protons leads to paradoxical aciduria, which further worsens metabolic alkalosis — Bhargava Muliudi (clinical) [Ep 4 · 3:56](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-2532?t=236)
- In the US, pyloromyotomy is the standard of care for pyloric stenosis — Bhargava Muliudi (guideline) [Ep 4 · 4:17](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-2532?t=257)
- In some countries, atropine is used as a non-surgical option for pyloric stenosis, with a success rate of about 60 to 90% — Bhargava Muliudi (clinical) [Ep 4 · 4:22](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-2532?t=262)
- Cincinnati Children's follows a resuscitation protocol published by the Children's Mercy Group in Kansas City for pyloric stenosis — Bhargava Muliudi (guideline) [Ep 4 · 4:41](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-2532?t=281)
- If chloride is less than 85, give 3 boluses separated by an hour and then recheck labs — Bhargava Muliudi (guideline) [Ep 4 · 5:01](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-2532?t=301)
- If chloride is between 85 and 97, give two boluses — Bhargava Muliudi (guideline) [Ep 4 · 5:10](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-2532?t=310)
- If chloride is greater than 97, give 1 bolus — Bhargava Muliudi (guideline) [Ep 4 · 5:15](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-2532?t=315)
- If bicarbonate is greater than 40, give 3 boluses — Bhargava Muliudi (guideline) [Ep 4 · 5:24](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-2532?t=324)
- If bicarbonate is greater than or equal to 33, give 2 boluses — Bhargava Muliudi (guideline) [Ep 4 · 5:29](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-2532?t=329)
- Prior to going to the operating room, serum chloride must be corrected to greater than 100 and bicarbonate to less than 30 — Bhargava Muliudi (guideline) [Ep 4 · 5:48](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-2532?t=348)
- The proximal edge of the pylorus can be easily identified as the antrum transitions to a thick pylorus — Bhargava Muliudi (clinical) [Ep 4 · 7:00](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-2532?t=420)
- The distal extent of the pyloromyotomy is generally to the crossing vein of Mayo or the white line, which marks the pyloroduodenal junction — Bhargava Muliudi (clinical) [Ep 4 · 7:07](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-2532?t=427)
- After the pyloromyotomy is completed, the submucosa should bulge into the myotomy site — Bhargava Muliudi (clinical) [Ep 4 · 8:18](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-2532?t=498)
- After adequate pyloromyotomy, each side of the pylorus should move independently — Bhargava Muliudi (clinical) [Ep 4 · 8:25](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-2532?t=505)
- Complications from pyloromyotomy include incomplete myotomy, mucosal perforation, aspiration, wound infection, and incisional hernias — Bhargava Muliudi (clinical) [Ep 4 · 8:42](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-2532?t=522)
- There is a slight increased risk of incomplete myotomy and perforation with a laparoscopic approach, but the overall low incidence of complications decreases the clinical significance of the differences between the two approaches — Bhargava Muliudi (clinical) [Ep 4 · 8:52](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-2532?t=532)
- For mucosal perforation during pyloromyotomy, you can close the mucosa using a low profile needle and suture like Vicryl on a TF needle, or perform a full thickness repair and redo a myotomy about 180 degrees from the first one, usually on the posterior wall — Bhargava Muliudi (clinical) [Ep 4 · 9:17](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-2532?t=557)
- Most infants can be fed immediately after pyloromyotomy — Bhargava Muliudi (clinical) [Ep 4 · 10:05](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-2532?t=605)
- Evidence supports ad-lib feeds after pyloromyotomy; once the infant is alert and awake, these infants achieve full feeds sooner with no increase in readmission rates — Bhargava Muliudi (clinical) [Ep 4 · 10:13](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-2532?t=613)
- Small episodes of emesis after pyloromyotomy are almost to be expected as the stomach recovers from days to weeks of progressive dilation — Bhargava Muliudi (clinical) [Ep 4 · 10:32](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-2532?t=632)
- Odds of emesis is slightly higher in early and ad-lib feedings compared to gradual or delayed feedings, but the length of stay for ad-lib feedings is much shorter — Bhargava Muliudi (clinical) [Ep 4 · 10:44](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-2532?t=644)
- Pyloric stenosis incidence is approximately 4 to 5 in 1000 live births with heavy male preponderance. — Alex Bondoc (epidemiological) [Ep 8 · 3:05](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-with-dr-alex-bondoc-8728?t=185)
- Atropine is traditional medical management but has fallen out of favor because pediatric anesthetists are skilled and there is low concordance between congenital anomalies creating high anesthetic risk. — Alex Bondoc (opinion) [Ep 8 · 7:34](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-with-dr-alex-bondoc-8728?t=454)
- The first pyloromyotomy was performed the year before Ramstedt, who popularized it using a coffee spoon, intending pyloroplasty but performing only myotomy when the baby became unstable. — Alex Bondoc (clinical) [Ep 8 · 8:40](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-with-dr-alex-bondoc-8728?t=520)
- Gastric suction in three positions (head down, right, left) while awake is performed before induction to prevent aspiration from the atonic stomach. — Alex Bondoc (clinical) [Ep 8 · 9:16](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-with-dr-alex-bondoc-8728?t=556)
- For laparoscopic pyloromyotomy, 3-millimeter instruments are used through three incisions: umbilicus, right upper quadrant, and left upper quadrant. — Alex Bondoc (clinical) [Ep 8 · 10:12](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-with-dr-alex-bondoc-8728?t=612)
- The 3-millimeter Maryland grasper when fully opened is 13 millimeters, so a 13mm myotomy on a 15-18mm channel will be incomplete. — Alex Bondoc (clinical) [Ep 8 · 10:57](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-with-dr-alex-bondoc-8728?t=657)
- Air can be insufflated down a suction catheter to look for bubbles indicating mucosal perforation. — Alex Bondoc (clinical) [Ep 8 · 12:05](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-with-dr-alex-bondoc-8728?t=725)
- Omentum is placed on top of the myotomy site. — Alex Bondoc (clinical) [Ep 8 · 12:20](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-with-dr-alex-bondoc-8728?t=740)
- Open pyloromyotomy can be performed through a periumbilical incision with tunneling up to the right upper quadrant, taking advantage of babies' stretchable skin. — Alex Bondoc (clinical) [Ep 8 · 12:27](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-with-dr-alex-bondoc-8728?t=747)
- Incisional hernias can occur because fascia is typically not closed on stab incisions in upper quadrants; omental hernias have been observed. — Alex Bondoc (clinical) [Ep 8 · 13:06](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-with-dr-alex-bondoc-8728?t=786)
- Complication rates after pyloromyotomy are equivalent or better with open approach because laparoscopic pyloromyotomy is an experience and feel operation. — Alex Bondoc (opinion) [Ep 8 · 13:23](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-with-dr-alex-bondoc-8728?t=803)
- Post-operative vomiting is very common and does not necessarily mean the operation did not work; the atonic stomach does not remodel immediately. — Alex Bondoc (clinical) [Ep 8 · 13:54](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-with-dr-alex-bondoc-8728?t=834)
- Complete intolerance of feeds lasting into days post-operatively raises concern for incomplete myotomy. — Alex Bondoc (clinical) [Ep 8 · 14:13](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-with-dr-alex-bondoc-8728?t=853)
- Pneumomediastinum in trauma is not predictive of injury unless there is a wide mediastinum (clinical) [Ep 1 · 6:41](https://origin-library.globalcastmd.com/watch/hot-new-topics-from-the-journal-of-pediatric-surgery-update-course-2017-404?t=401)
- A high percentage of spontaneous pneumomediastinum patients had comorbidity of asthma (epidemiological) [Ep 1 · 7:20](https://origin-library.globalcastmd.com/watch/hot-new-topics-from-the-journal-of-pediatric-surgery-update-course-2017-404?t=440)
- Historical data about post-operative apnea in pyloric stenosis was based on anesthetics not used in 5 decades (opinion) [Ep 1 · 16:58](https://origin-library.globalcastmd.com/watch/hot-new-topics-from-the-journal-of-pediatric-surgery-update-course-2017-404?t=1018)
- Most esophageal atresia anastomotic leaks will resolve spontaneously with observation if the child is stable — Steve (clinical) [Ep 1 · 17:52](https://origin-library.globalcastmd.com/watch/hot-new-topics-from-the-journal-of-pediatric-surgery-update-course-2017-404?t=1072)
- Complete disruption of EA anastomosis within 2-3 days should be re-operated, unlike small leaks — Steve (clinical) [Ep 1 · 19:05](https://origin-library.globalcastmd.com/watch/hot-new-topics-from-the-journal-of-pediatric-surgery-update-course-2017-404?t=1145)
- The low closure rate in the glycopyrrolate study's control group (29%) may reflect short follow-up period rather than true failure to close (opinion) [Ep 1 · 25:04](https://origin-library.globalcastmd.com/watch/hot-new-topics-from-the-journal-of-pediatric-surgery-update-course-2017-404?t=1504)
- Neonatologists are concerned that glycopyrrolate may cause mucus plugs in EA patients (clinical) [Ep 1 · 27:11](https://origin-library.globalcastmd.com/watch/hot-new-topics-from-the-journal-of-pediatric-surgery-update-course-2017-404?t=1631)
- Pierre Fredet in Paris was the first to describe projectile vomiting and visible peristalsis in pyloric stenosis. — Todd Ponsky (clinical) [Ep 6 · 10:25](https://origin-library.globalcastmd.com/watch/history-of-pediatric-surgery-295?t=625)
- Pierre Fredet's innovation was the extramucosal pyloroplasty—staying outside the mucosa with a longitudinal incision, though he attempted transverse closure and often added gastroenterostomy. — Todd Ponsky (clinical) [Ep 6 · 13:37](https://origin-library.globalcastmd.com/watch/history-of-pediatric-surgery-295?t=817)
- In Hirschsprung disease, the visible lesion (megacolon) is not the cause; the true pathology is aganglionosis of the distal colon and anorectum. — Todd Ponsky (clinical) [Ep 6 · 18:07](https://origin-library.globalcastmd.com/watch/history-of-pediatric-surgery-295?t=1087)
- Aganglionosis in Hirschsprung disease was first described in 1901, but its clinical significance was not fully realized until the 1940s. — Todd Ponsky (clinical) [Ep 6 · 18:40](https://origin-library.globalcastmd.com/watch/history-of-pediatric-surgery-295?t=1120)
- Helen Taussig, a diagnostician, first approached Robert Gross about performing a Blalock-Taussig shunt for tetralogy of Fallot. — Todd Ponsky (clinical) [Ep 6 · 30:36](https://origin-library.globalcastmd.com/watch/history-of-pediatric-surgery-295?t=1836)
- Esophageal atresia with distal tracheoesophageal fistula has been known since the late 17th century, along with associated cardiac, renal, and intestinal anomalies. — Todd Ponsky (clinical) [Ep 6 · 37:31](https://origin-library.globalcastmd.com/watch/history-of-pediatric-surgery-295?t=2251)
- The first attempt to repair esophageal atresia was through upper midline laparotomy in 1888, which was unsuccessful. — Todd Ponsky (clinical) [Ep 6 · 38:05](https://origin-library.globalcastmd.com/watch/history-of-pediatric-surgery-295?t=2285)
- Joseph Brennemann in Chicago tried gastrostomy for esophageal atresia, but it flooded the lungs via the fistula, causing aspiration and death; jejunostomy had the same result. — Todd Ponsky (clinical) [Ep 6 · 38:30](https://origin-library.globalcastmd.com/watch/history-of-pediatric-surgery-295?t=2310)
- Harry Richter, working with Brennemann in Chicago, addressed the fistula itself in 1913 via right chest through a vertical paravertebral incision, sixth interspace, resecting posterior ribs, using open-drop ether and a homemade pump for positive-pressure ventilation. — Todd Ponsky (clinical) [Ep 6 · 39:05](https://origin-library.globalcastmd.com/watch/history-of-pediatric-surgery-295?t=2345)
- Richter's two patients died at 2 and 22 hours postoperatively; he admitted he did not know the anatomy or what he was looking at. — Todd Ponsky (clinical) [Ep 6 · 40:00](https://origin-library.globalcastmd.com/watch/history-of-pediatric-surgery-295?t=2400)
- William Ladd in Boston and Logan Leven in Minneapolis began dividing the tracheoesophageal fistula, performing cutaneous esophagostomy, feeding via gastrostomy, and constructing skin-lined tubes over the anterior chest through multiple staged operations. — Todd Ponsky (clinical) [Ep 6 · 40:30](https://origin-library.globalcastmd.com/watch/history-of-pediatric-surgery-295?t=2430)
- Thomas Lanman's 1940 review of 32 esophageal atresia cases from Boston Children's Hospital—all fatalities—established that surgeons must operate early (within days of birth), diagnose without oral contrast (inability to pass NG tube plus air in GI tract confirms diagnosis), and avoid fluid overload. — Todd Ponsky (clinical) [Ep 6 · 41:20](https://origin-library.globalcastmd.com/watch/history-of-pediatric-surgery-295?t=2480)
- Lanman's team knew aspiration was always a threat and that delay caused malnourishment, dehydration, and pneumonia, necessitating early operation before the child deteriorated. — Todd Ponsky (clinical) [Ep 6 · 42:30](https://origin-library.globalcastmd.com/watch/history-of-pediatric-surgery-295?t=2550)
- Many early esophageal atresia deaths were attributed to 'fluid overload' or 'injudicious fluid administration' because surgeons had no concept of maintenance fluids or resuscitation volumes (the 4-2-1 and 150/20 formulas were unknown). — Todd Ponsky (clinical) [Ep 6 · 43:00](https://origin-library.globalcastmd.com/watch/history-of-pediatric-surgery-295?t=2580)
- Cameron Haight at University of Michigan achieved the first long-term survivor in 1941—case 10 of 15 attempts. — Todd Ponsky (clinical) [Ep 6 · 44:55](https://origin-library.globalcastmd.com/watch/history-of-pediatric-surgery-295?t=2695)
- Haight's survivor was a 12-day-old girl in good condition with IV hydration; she had aspirated barium but did not develop pneumonia, suggesting she was 'indestructible.' — Todd Ponsky (clinical) [Ep 6 · 45:20](https://origin-library.globalcastmd.com/watch/history-of-pediatric-surgery-295?t=2720)
- Haight performed the operation under local anesthesia supplemented with open-drop ether, with the baby prone, via left thoracotomy with vertical paravertebral incision removing posterior segments of ribs 2–6. — Todd Ponsky (clinical) [Ep 6 · 46:00](https://origin-library.globalcastmd.com/watch/history-of-pediatric-surgery-295?t=2760)
- Haight's left-sided approach required working around the aorta and subclavian artery; the field was not fully visible, requiring retraction shifts throughout the operation. — Todd Ponsky (clinical) [Ep 6 · 46:40](https://origin-library.globalcastmd.com/watch/history-of-pediatric-surgery-295?t=2800)
- Postoperatively, Haight gave rectal sulfathiazole (an antibiotic), which was considered inadequate by modern standards (antibiotics should be given before incision, not after). — Todd Ponsky (clinical) [Ep 6 · 47:10](https://origin-library.globalcastmd.com/watch/history-of-pediatric-surgery-295?t=2830)
- Saliva appeared in the drain a few days postoperatively; Haight placed a gastrostomy, then feeding began leaking from the gastrostomy into the drain. — Todd Ponsky (clinical) [Ep 6 · 47:40](https://origin-library.globalcastmd.com/watch/history-of-pediatric-surgery-295?t=2860)
- Haight probed the anastomosis by passing a catheter through the baby's mouth, which exited the wound, confirming a leak. — Todd Ponsky (clinical) [Ep 6 · 48:10](https://origin-library.globalcastmd.com/watch/history-of-pediatric-surgery-295?t=2890)
- Haight photographed his first survivor as a young teenager for his 1957 AATS presidential address; legend holds she was the last patient he saw before his death in 1970. — Todd Ponsky (clinical) [Ep 6 · 47:49](https://origin-library.globalcastmd.com/watch/history-of-pediatric-surgery-295?t=2869)
- Ultrasound criteria for pyloric stenosis include muscle limb thicker than 4 millimeters, channel longer than 17 millimeters, and pyloric muscle shouldering. (clinical) [Ep 2 · 0:03](https://origin-library.globalcastmd.com/watch/laparoscopic-pyloromyotomy-2253?t=3)
- The right upper quadrant incision is placed at or just above the liver margin to allow liver retraction if needed. (clinical) [Ep 2 · 2:00](https://origin-library.globalcastmd.com/watch/laparoscopic-pyloromyotomy-2253?t=120)
- The left upper quadrant incision is placed in a high paramedian position to allow the spreader to approach the pyloris directly rather than tangentially. (clinical) [Ep 2 · 2:20](https://origin-library.globalcastmd.com/watch/laparoscopic-pyloromyotomy-2253?t=140)
- An intraabdominal pressure of 10 millimeters of mercury and a flow rate of 1.5 L per minute are used throughout the procedure. (clinical) [Ep 2 · 2:40](https://origin-library.globalcastmd.com/watch/laparoscopic-pyloromyotomy-2253?t=160)
- The distal extent of the myotomy is marked at the vein of mayo or junction of the white colored wall of the stomach and the salmon colored wall of the duodenum. (clinical) [Ep 2 · 3:20](https://origin-library.globalcastmd.com/watch/laparoscopic-pyloromyotomy-2253?t=200)
- The surgeon should not extend the myotomy beyond the originally labeled extents. (clinical) [Ep 2 · 3:40](https://origin-library.globalcastmd.com/watch/laparoscopic-pyloromyotomy-2253?t=220)
- Cutting current should be used for the myotomy, not coagulation, in order not to transmit heat to the underlying mucosa. (clinical) [Ep 2 · 3:50](https://origin-library.globalcastmd.com/watch/laparoscopic-pyloromyotomy-2253?t=230)
- The myotomy should be 2 to 3 millimeters deep before the beginning of muscle spreading. (clinical) [Ep 2 · 4:10](https://origin-library.globalcastmd.com/watch/laparoscopic-pyloromyotomy-2253?t=250)
- Deepening the myotomy should always start in the center or proximal extent, never on the duodenal end. (clinical) [Ep 2 · 4:30](https://origin-library.globalcastmd.com/watch/laparoscopic-pyloromyotomy-2253?t=270)
- A controlled but deliberate force should be applied to spread the muscle, observing the muscle layer separating and resulting in visualization of the underlying submucosa. (clinical) [Ep 2 · 4:40](https://origin-library.globalcastmd.com/watch/laparoscopic-pyloromyotomy-2253?t=280)
- The myotomy should start in the middle, then continue proximately towards the stomach and distally towards the duodenum. (clinical) [Ep 2 · 5:00](https://origin-library.globalcastmd.com/watch/laparoscopic-pyloromyotomy-2253?t=300)
- The right angle spreader is preferred on the last few fibers on the duodenal end because the heel of the instrument protects the mucosa while the tip spreads the muscle. (clinical) [Ep 2 · 5:15](https://origin-library.globalcastmd.com/watch/laparoscopic-pyloromyotomy-2253?t=315)
- One should not insist on separating the last few fibers on the duodenal end if the pylorus is stiff, as this is the point at which a duodenal perforation may occur. (clinical) [Ep 2 · 5:30](https://origin-library.globalcastmd.com/watch/laparoscopic-pyloromyotomy-2253?t=330)
- Incomplete myotomies occur on the gastric, not the duodenal end. (clinical) [Ep 2 · 5:45](https://origin-library.globalcastmd.com/watch/laparoscopic-pyloromyotomy-2253?t=345)
- An adequate myotomy should allow each limb of the muscle to move independent of the other. (clinical) [Ep 2 · 5:55](https://origin-library.globalcastmd.com/watch/laparoscopic-pyloromyotomy-2253?t=355)
- Intact duodenal mucosa is best proven by direct visualization. (clinical) [Ep 2 · 6:05](https://origin-library.globalcastmd.com/watch/laparoscopic-pyloromyotomy-2253?t=365)
- The stomach is insufflated with 30 mL of air through an orogastric tube while the duodenal bulb is occluded, and the myotomy site is examined while pressure is applied to the antrum to look for an air leak. (clinical) [Ep 2 · 6:15](https://origin-library.globalcastmd.com/watch/laparoscopic-pyloromyotomy-2253?t=375)
- The air insufflation test is less important than direct visualization for confirming mucosal integrity. (opinion) [Ep 2 · 6:30](https://origin-library.globalcastmd.com/watch/laparoscopic-pyloromyotomy-2253?t=390)
- A missed duodenal perforation is the most serious complication of a laparoscopic pyloromyotomy. (clinical) [Ep 2 · 6:40](https://origin-library.globalcastmd.com/watch/laparoscopic-pyloromyotomy-2253?t=400)
- A few intact muscle fibers may be left on the pyloro-duodenal junction. (clinical) [Ep 2 · 7:00](https://origin-library.globalcastmd.com/watch/laparoscopic-pyloromyotomy-2253?t=420)
- Putting a chest tube for spontaneous pneumothorax is probably an unnecessary step that will eventually be eliminated—either send patients home or go to the operating room. — Todd Ponsky (opinion) [Ep 9 · 5:43](https://origin-library.globalcastmd.com/watch/todd-ponsky-what-is-new-in-pediatric-surgery-teaser-13347?t=343)
- A 1950s study showed larger umbilical hernias have lower spontaneous closure rates, which could justify earlier repair, but recommendation is to wait until after 4 years of age. — Todd Ponsky (clinical) [Ep 9 · 9:51](https://origin-library.globalcastmd.com/watch/todd-ponsky-what-is-new-in-pediatric-surgery-teaser-13347?t=591)
- Traditional pilonidal disease excision with flaps has a recurrence rate of 30-40% published from Kansas City data. — Todd Ponsky (clinical) [Ep 9 · 13:00](https://origin-library.globalcastmd.com/watch/todd-ponsky-what-is-new-in-pediatric-surgery-teaser-13347?t=780)
- In Akron Children's series of 133 patients with suspected airway foreign body, when CT showed a foreign body, findings were confirmed on bronchoscopy 94% of the time. — Todd Ponsky (clinical) [Ep 9 · 20:33](https://origin-library.globalcastmd.com/watch/todd-ponsky-what-is-new-in-pediatric-surgery-teaser-13347?t=1233)
- Patients with negative CT for airway foreign body who were called years later had zero problems—none ever had a foreign body issue. — Todd Ponsky (clinical) [Ep 9 · 21:08](https://origin-library.globalcastmd.com/watch/todd-ponsky-what-is-new-in-pediatric-surgery-teaser-13347?t=1268)
- Bronchoscopy alone for suspected airway foreign body is negative 40% of the time (61% positive rate). — Todd Ponsky (clinical) [Ep 9 · 21:26](https://origin-library.globalcastmd.com/watch/todd-ponsky-what-is-new-in-pediatric-surgery-teaser-13347?t=1286)
- The worst thing you could do with someone with reactive airway disease is instrument their airway—it's a high-risk case that makes them worse. — Todd Ponsky (clinical) [Ep 9 · 17:43](https://origin-library.globalcastmd.com/watch/todd-ponsky-what-is-new-in-pediatric-surgery-teaser-13347?t=1063)
- ATOMAC is a 12-institution prospective trial that produced approximately 15 articles radically changing solid organ injury management, including eliminating grade-based classification in favor of algorithm-based management. — Todd Ponsky (clinical) [Ep 9 · 25:44](https://origin-library.globalcastmd.com/watch/todd-ponsky-what-is-new-in-pediatric-surgery-teaser-13347?t=1544)
- Traditional ATLS teaching was to give two 20cc/kg boluses of crystalloid before giving blood, but this is now changing to earlier blood administration. — Todd Ponsky (guideline) [Ep 9 · 23:53](https://origin-library.globalcastmd.com/watch/todd-ponsky-what-is-new-in-pediatric-surgery-teaser-13347?t=1433)
- Neonatologists are nervous about glycopyrrolate because it slows secretions and could theoretically cause mucus plugs in the airway, though this hasn't been observed yet. — Todd Ponsky (clinical) [Ep 9 · 32:22](https://origin-library.globalcastmd.com/watch/todd-ponsky-what-is-new-in-pediatric-surgery-teaser-13347?t=1942)
- The disposable bouffant cap mandate in many US hospitals came out with no basis behind it, and when data was examined, it didn't make sense—people went back to wearing cloth caps. — Todd Ponsky (opinion) [Ep 9 · 35:35](https://origin-library.globalcastmd.com/watch/todd-ponsky-what-is-new-in-pediatric-surgery-teaser-13347?t=2135)
- Medical publications are growing at an exponential rate, doubling every 73 days due to proliferation of open-access journals, making it impossible to know what to pay attention to. — Todd Ponsky (epidemiological) [Ep 9 · 41:22](https://origin-library.globalcastmd.com/watch/todd-ponsky-what-is-new-in-pediatric-surgery-teaser-13347?t=2482)
- Machine learning algorithm for predicting important pediatric surgery papers has achieved 85% accuracy after one year of training; data scientists predict 95% accuracy after three years of content. — Todd Ponsky (clinical) [Ep 9 · 41:53](https://origin-library.globalcastmd.com/watch/todd-ponsky-what-is-new-in-pediatric-surgery-teaser-13347?t=2513)
- Ultrasound guidance for jugular line placement, combined with fluoroscopy, decreases complications including hematoma and reduces need for multiple sticks, based on Kansas City study. — Todd Ponsky (clinical) [Ep 9 · 53:58](https://origin-library.globalcastmd.com/watch/todd-ponsky-what-is-new-in-pediatric-surgery-teaser-13347?t=3238)
- Micro-pneumothoraces after central line placement or spontaneous pneumothorax are not as scary as previously thought—children with mild symptoms can be followed rather than routinely requiring intervention. — Todd Ponsky (opinion) [Ep 9 · 56:29](https://origin-library.globalcastmd.com/watch/todd-ponsky-what-is-new-in-pediatric-surgery-teaser-13347?t=3389)
- Pyloric stenosis presents with progressive nonbilious emesis and sometimes a palpable olive in the epigastrium. — Meera Kotagal (clinical) [Ep 7 · 0:00](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-guideline-recap-5786?t=0)
- Labs in pyloric stenosis most often demonstrate a hypochloremic, hypokalemic metabolic alkalosis. — Meera Kotagal (clinical) [Ep 7 · 0:00](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-guideline-recap-5786?t=0)
- Ultrasound criteria for pyloric stenosis are muscle width greater than 3 millimeters and length greater than 14 millimeters. — Meera Kotagal (clinical) [Ep 7 · 0:00](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-guideline-recap-5786?t=0)
- Maintenance IV fluid is started at one and a half times the maintenance rate in pyloric stenosis patients. — Meera Kotagal (guideline) [Ep 7 · 2:00](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-guideline-recap-5786?t=120)
- Potassium is added to IV fluids once urine output has been confirmed. — Meera Kotagal (guideline) [Ep 7 · 2:00](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-guideline-recap-5786?t=120)
- There is a trend in the literature that isotonic fluids should be used instead of hypotonic fluids in pediatric patients, though evidence is still developing in this age population. — Meera Kotagal (opinion) [Ep 7 · 2:30](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-guideline-recap-5786?t=150)
- Patients go to the OR for pyloromyotomy once their bicarb level is less than 30, their chloride is greater than 100, and their potassium is normal. — Meera Kotagal (guideline) [Ep 7 · 3:00](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-guideline-recap-5786?t=180)
- Postoperative management includes a short NPO period of around two hours followed by ad lib feeding with breast milk or formula. — Meera Kotagal (guideline) [Ep 7 · 3:30](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-guideline-recap-5786?t=210)
- In a 10-year-old, spk_0 uses Veress needle through the fascia for peritoneal access. — Todd Ponsky (clinical) [Ep 3 · 0:00](https://origin-library.globalcastmd.com/watch/peritoneal-access-2294?t=0)
- Dissection and clamp passage (passing a hemostat through the umbilicus, removing it, then inserting the needle) is used by spk_0 only in four-week-old infants with pyloric stenosis, not in older children. — Todd Ponsky (clinical) [Ep 3 · 0:00](https://origin-library.globalcastmd.com/watch/peritoneal-access-2294?t=0)
- For extirpative operations like cholecystectomy, spk_0 uses Hasson technique. — Todd Ponsky (clinical) [Ep 3 · 0:00](https://origin-library.globalcastmd.com/watch/peritoneal-access-2294?t=0)
- Single-incision appendectomy can be performed in the obese 90th percentile and above pediatric population with outcomes comparable to three-trocar technique in terms of wound issues. — Todd Ponsky (clinical) [Ep 3 · 3:00](https://origin-library.globalcastmd.com/watch/peritoneal-access-2294?t=180)
- When using a wound protector during single-port appendectomy, the appendix never touches tissue as it is extracted, making wound complications comparable to or better than multi-port technique. — Todd Ponsky (clinical) [Ep 3 · 4:00](https://origin-library.globalcastmd.com/watch/peritoneal-access-2294?t=240)
- In obese teenagers, the distance between the posterior fascia at the umbilicus and the aorta is very short, with intestines lying on top. — Todd Ponsky (clinical) [Ep 3 · 7:00](https://origin-library.globalcastmd.com/watch/peritoneal-access-2294?t=420)
- Veress needles that produce a loud audible click after passing the peritoneum are preferred by some surgeons for confirmation of entry. — Todd Ponsky (clinical) [Ep 3 · 8:00](https://origin-library.globalcastmd.com/watch/peritoneal-access-2294?t=480)
- Veress needle insertion should not exceed more than a millimeter or two beyond the audible click of peritoneal entry. — Todd Ponsky (clinical) [Ep 3 · 9:00](https://origin-library.globalcastmd.com/watch/peritoneal-access-2294?t=540)
- The left upper quadrant does not contain iliac vessels, making it a safer access site than midline where iliac vein injury is a risk. — Todd Ponsky (clinical) [Ep 3 · 11:00](https://origin-library.globalcastmd.com/watch/peritoneal-access-2294?t=660)
- Step trocars are not designed to be placed with the sheath in place because the large step-off in diameter can deflect the abdominal wall and cause injury. — Todd Ponsky (clinical) [Ep 3 · 20:00](https://origin-library.globalcastmd.com/watch/peritoneal-access-2294?t=1200)
- When using step trocars, the Veress needle should be inserted first to safely insufflate, then the Veress needle with sheath should be inserted to place the sheath. — Todd Ponsky (clinical) [Ep 3 · 21:00](https://origin-library.globalcastmd.com/watch/peritoneal-access-2294?t=1260)
- The sheath adds obstruction when inserting the Veress needle, making insertion smoother without the sheath. — Todd Ponsky (clinical) [Ep 3 · 22:00](https://origin-library.globalcastmd.com/watch/peritoneal-access-2294?t=1320)
- In neonates, an infra-umbilical incision is made to avoid cannulating the umbilical vein, which enters through the center of the umbilicus. — Todd Ponsky (clinical) [Ep 3 · 23:00](https://origin-library.globalcastmd.com/watch/peritoneal-access-2294?t=1380)
- The umbilical vein travels up through the center of the umbilicus; an infra-umbilical incision should avoid the obliterated orifice at the base of the umbilicus. — Todd Ponsky (clinical) [Ep 3 · 24:00](https://origin-library.globalcastmd.com/watch/peritoneal-access-2294?t=1440)
- Lifting the umbilical stump with a clamp and inserting the Veress needle perpendicular to the now-vertical fascia (angled superiorly) is a technique to avoid the umbilical vein. — Todd Ponsky (clinical) [Ep 3 · 25:00](https://origin-library.globalcastmd.com/watch/peritoneal-access-2294?t=1500)
- CO2 embolization via the umbilical vein is a recently recognized complication that was not widely known until about a year ago. — Todd Ponsky (clinical) [Ep 3 · 28:00](https://origin-library.globalcastmd.com/watch/peritoneal-access-2294?t=1680)
- Clinically significant CO2 embolization results in 25% mortality. — Todd Ponsky (epidemiological) [Ep 3 · 32:00](https://origin-library.globalcastmd.com/watch/peritoneal-access-2294?t=1920)
- CO2 embolization presents with bradycardia, hypotension, and drop in end-tidal CO2. — Todd Ponsky (clinical) [Ep 3 · 31:00](https://origin-library.globalcastmd.com/watch/peritoneal-access-2294?t=1860)
- Immediate treatment for CO2 embolization includes desufflation, Trendelenburg positioning, and central venous line placement to aspirate gas. — Todd Ponsky (clinical) [Ep 3 · 34:00](https://origin-library.globalcastmd.com/watch/peritoneal-access-2294?t=2040)
- Several cases of CO2 embolization have required emergent ECMO at the start of pyloromyotomy. — Todd Ponsky (clinical) [Ep 3 · 35:00](https://origin-library.globalcastmd.com/watch/peritoneal-access-2294?t=2100)
- spk_0 now uses a sheathed technique but always inserts the trocar before insufflating, inspects with the telescope to confirm peritoneal entry, then begins insufflation. — Todd Ponsky (clinical) [Ep 3 · 35:00](https://origin-library.globalcastmd.com/watch/peritoneal-access-2294?t=2100)

## Host summaries
Recaps by a host of what the experts said — not the host's own clinical position.
- A 2017 Journal of Pediatric Surgery study of 584 patients found African American infants with pyloric stenosis presented with higher bicarbonate and lower chloride levels. — Em Gootee summarizes what Dr. Alex Bondoc said [Ep 8 · 3:24](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-with-dr-alex-bondoc-8728?t=204)
- Uninsured families' babies had lower chloride and higher bicarbonate levels at presentation and longer times between diagnosis and OR. — Kim Priban summarizes what Dr. Alex Bondoc said [Ep 8 · 3:44](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-with-dr-alex-bondoc-8728?t=224)
- A large-scale Denmark and Holland study found pyloric stenosis is 87% heritable. — Kim Priban summarizes what Dr. Alex Bondoc said [Ep 8 · 4:13](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-with-dr-alex-bondoc-8728?t=253)
- Researchers have identified a molecular diagnostic marker and can trace specific genetic changes indicating risk for pyloric stenosis. — Em Gootee summarizes what Dr. Alex Bondoc said [Ep 8 · 4:25](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-with-dr-alex-bondoc-8728?t=265)
- Ultrasound diagnostic criteria: muscle thickness greater than 4 millimeters and pyloric channel length greater than 15 millimeters suggest pyloric stenosis. — Kim Priban summarizes what Dr. Alex Bondoc said [Ep 8 · 6:23](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-with-dr-alex-bondoc-8728?t=383)
- A 2008 and 2016 Journal of Pediatric Surgery study identified specific fluid resuscitation pathways that reduced blood draws and did not delay time to surgery. — Kim Priban summarizes what Dr. Alex Bondoc said [Ep 8 · 6:46](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-with-dr-alex-bondoc-8728?t=406)
- Recommended fluid resuscitation: isotonic saline bolus followed by maintenance IV fluids (D5 half-normal saline with 20 mEq/L potassium chloride). — Em Gootee summarizes what Dr. Alex Bondoc said [Ep 8 · 7:04](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-with-dr-alex-bondoc-8728?t=424)
- Nasogastric decompression should be avoided to prevent exacerbation of metabolic alkalosis. — Kim Priban summarizes what Dr. Alex Bondoc said [Ep 8 · 7:18](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-with-dr-alex-bondoc-8728?t=438)
- A 2023 Journal of Pediatric Surgery study suggests antibiotic prophylaxis may be unnecessary for pyloromyotomy and may carry unnecessary long-term side effects. — Em Gootee summarizes what Dr. Alex Bondoc said [Ep 8 · 8:12](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-with-dr-alex-bondoc-8728?t=492)
- To assess myotomy completeness, both ends of separated muscle should move independently; resistance or connected movement indicates incomplete myotomy. — Kim Priban summarizes what Dr. Alex Bondoc said [Ep 8 · 11:49](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-with-dr-alex-bondoc-8728?t=709)
- A flexible feeding protocol (reducing volume if baby vomits 6 times but continuing smaller feeds and increasing as tolerated) decreases length of hospital stay. — Em Gootee summarizes what Dr. Alex Bondoc said [Ep 8 · 14:30](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-with-dr-alex-bondoc-8728?t=870)
- Studies on adults who had pyloromyotomy as children show they do not have major issues like nausea, vomiting, reflux, or other GI problems later in life, and long-term follow-up is usually not necessary. — Kim Priban summarizes what Dr. Alex Bondoc said [Ep 8 · 15:08](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-with-dr-alex-bondoc-8728?t=908)
- In patients with spontaneous pneumomediastinum, esophagrams never showed any leak or injury in a 16-year retrospective review — Todd Ponsky summarizing the discussion [Ep 1 · 4:36](https://origin-library.globalcastmd.com/watch/hot-new-topics-from-the-journal-of-pediatric-surgery-update-course-2017-404?t=276)
- 55% of spontaneous pneumomediastinum patients had CT scans and none showed positive findings — Todd Ponsky summarizing the discussion [Ep 1 · 5:10](https://origin-library.globalcastmd.com/watch/hot-new-topics-from-the-journal-of-pediatric-surgery-update-course-2017-404?t=310)
- In traumatic pneumomediastinum, esophagrams never showed findings in patients who looked clinically well — Todd Ponsky summarizing the discussion [Ep 1 · 5:25](https://origin-library.globalcastmd.com/watch/hot-new-topics-from-the-journal-of-pediatric-surgery-update-course-2017-404?t=325)
- For pyloric stenosis with chloride <85, give three 20 cc/kg normal saline boluses before rechecking labs — Todd Ponsky summarizing the discussion [Ep 1 · 14:10](https://origin-library.globalcastmd.com/watch/hot-new-topics-from-the-journal-of-pediatric-surgery-update-course-2017-404?t=850)
- For pyloric stenosis with chloride ≤97, give two 20 cc/kg normal saline boluses before rechecking labs — Todd Ponsky summarizing the discussion [Ep 1 · 14:30](https://origin-library.globalcastmd.com/watch/hot-new-topics-from-the-journal-of-pediatric-surgery-update-course-2017-404?t=870)
- For pyloric stenosis with chloride >97 but bicarbonate <33, give one 20 cc/kg normal saline bolus — Todd Ponsky summarizing the discussion [Ep 1 · 14:45](https://origin-library.globalcastmd.com/watch/hot-new-topics-from-the-journal-of-pediatric-surgery-update-course-2017-404?t=885)
- The pyloric stenosis resuscitation study used 20 cc/kg boluses of normal saline, not 10 cc/kg — Todd Ponsky summarizing the discussion [Ep 1 · 16:40](https://origin-library.globalcastmd.com/watch/hot-new-topics-from-the-journal-of-pediatric-surgery-update-course-2017-404?t=1000)
- Midwest Pediatric Surgery Consortium review of 400+ EA patients found trans-anastomotic tube associated with increased stricture and complication risk — Dan summarizing the discussion [Ep 1 · 19:57](https://origin-library.globalcastmd.com/watch/hot-new-topics-from-the-journal-of-pediatric-surgery-update-course-2017-404?t=1197)
- Great Ormond Street does not leave nasogastric tubes or chest tubes after EA repair and routinely feeds on day 2-3 without contrast study, with great results for 20 years — The host summarizing the discussion [Ep 1 · 21:54](https://origin-library.globalcastmd.com/watch/hot-new-topics-from-the-journal-of-pediatric-surgery-update-course-2017-404?t=1314)
- In glycopyrrolate RCT for EA leaks, chest tube output was 124 mL in treatment group vs 370 mL in placebo group — Todd Ponsky summarizing the discussion [Ep 1 · 23:50](https://origin-library.globalcastmd.com/watch/hot-new-topics-from-the-journal-of-pediatric-surgery-update-course-2017-404?t=1430)
- Leak resolution in glycopyrrolate RCT was achieved in 76% of treatment group vs 29% of placebo group — Todd Ponsky summarizing the discussion [Ep 1 · 24:10](https://origin-library.globalcastmd.com/watch/hot-new-topics-from-the-journal-of-pediatric-surgery-update-course-2017-404?t=1450)
- Oral feeding after EA leak was achieved in 71% of glycopyrrolate group vs 14% of placebo group — Todd Ponsky summarizing the discussion [Ep 1 · 24:25](https://origin-library.globalcastmd.com/watch/hot-new-topics-from-the-journal-of-pediatric-surgery-update-course-2017-404?t=1465)
- The Halifax explosion on December 6, 1917, was the most powerful man-made blast until the Trinity atomic bomb test in 1945. — Em Gootee summarizing a resource [Ep 6 · 2:00](https://origin-library.globalcastmd.com/watch/history-of-pediatric-surgery-295?t=120)
- William Ladd organized a convoy of 40 physicians and nurses to Halifax, arriving 2 days after the blast and staying for a month during December 1917–January 1918. — Em Gootee summarizing a resource [Ep 6 · 4:00](https://origin-library.globalcastmd.com/watch/history-of-pediatric-surgery-295?t=240)
- The first smallpox vaccination in 1796 was administered to an 8-year-old by Edward Jenner, a surgeon trained by John Hunter. — Em Gootee summarizing a resource [Ep 6 · 5:56](https://origin-library.globalcastmd.com/watch/history-of-pediatric-surgery-295?t=356)
- One of Crawford Long's first patients to receive ether anesthesia was a teenager undergoing finger amputation. — Em Gootee summarizing a resource [Ep 6 · 6:20](https://origin-library.globalcastmd.com/watch/history-of-pediatric-surgery-295?t=380)
- Joseph Lister's first patient to receive carbolic acid in 1865 was a 7-year-old with a compound fracture; 4 of his first 11 patients (reported 1867) were children. — Em Gootee summarizing a resource [Ep 6 · 6:35](https://origin-library.globalcastmd.com/watch/history-of-pediatric-surgery-295?t=395)
- The first splenectomy for blunt trauma was performed on a 14-year-old laborer who fell from a scaffold and ruptured his spleen. — Em Gootee summarizing a resource [Ep 6 · 7:00](https://origin-library.globalcastmd.com/watch/history-of-pediatric-surgery-295?t=420)
- Pyloric stenosis was first described by Hezekiah Beardsley in 1788 and later by Harald Hirschsprung in Denmark in 1888. — Em Gootee summarizing a resource [Ep 6 · 9:05](https://origin-library.globalcastmd.com/watch/history-of-pediatric-surgery-295?t=545)
- Hirschsprung's first two reported cases of pyloric stenosis were female infants, despite the disease predominantly affecting males. — Em Gootee summarizing a resource [Ep 6 · 9:35](https://origin-library.globalcastmd.com/watch/history-of-pediatric-surgery-295?t=575)
- Early treatment for pyloric stenosis included belladonna (for presumed pyloric spasm), bicarbonate gastric lavage (for acid secretions), and refeeding the child with vomited material. — Em Gootee summarizing a resource [Ep 6 · 9:55](https://origin-library.globalcastmd.com/watch/history-of-pediatric-surgery-295?t=595)
- The first operations for pyloric stenosis were gastroenterostomy and Heineke-Mikulicz pyloroplasty, adapted from adult operations for obstructing gastric cancer and peptic strictures. — Em Gootee summarizing a resource [Ep 6 · 11:45](https://origin-library.globalcastmd.com/watch/history-of-pediatric-surgery-295?t=705)
- Early pyloric stenosis operations had 50–65% mortality due to aspiration (full stomach, open-drop ether), gastric contents flooding the abdomen, and lack of resuscitation. — Em Gootee summarizing a resource [Ep 6 · 12:40](https://origin-library.globalcastmd.com/watch/history-of-pediatric-surgery-295?t=760)
- Fredet achieved 17% mortality through preoperative gastric decompression with a catheter, intraoperative warming, and postoperative fluid resuscitation by clysis (subcutaneous fluids). — Em Gootee summarizing a resource [Ep 6 · 14:46](https://origin-library.globalcastmd.com/watch/history-of-pediatric-surgery-295?t=886)
- Conrad Ramstedt performed the first modern pyloromyotomy in 1911 in Münster, Germany, on a nobleman's son. He attempted transverse closure but found the pylorus too stiff; when the channel gaped open, 'the thought shot through my head' that leaving it open was the correct approach. — Em Gootee summarizing a resource [Ep 6 · 15:42](https://origin-library.globalcastmd.com/watch/history-of-pediatric-surgery-295?t=942)
- Ramstedt's pyloromyotomy has been described as 'the most consistently successful operation ever described.' — Em Gootee summarizing a resource [Ep 6 · 16:41](https://origin-library.globalcastmd.com/watch/history-of-pediatric-surgery-295?t=1001)
- Ramstedt's operation was slow to be adopted in England, only gaining acceptance in 1918 after World War I. — Em Gootee summarizing a resource [Ep 6 · 17:12](https://origin-library.globalcastmd.com/watch/history-of-pediatric-surgery-295?t=1032)
- Early operations for Hirschsprung disease included colectomy, sigmoid straightening, and sympathectomy—all based on incorrect understanding of pathophysiology. — Em Gootee summarizing a resource [Ep 6 · 19:06](https://origin-library.globalcastmd.com/watch/history-of-pediatric-surgery-295?t=1146)
- The first edition of Ladd and Gross's 'Abdominal Surgery of Infancy and Childhood' advocated sympathectomy for Hirschsprung disease, with impressive before-and-after photos showing distended-to-scaphoid abdomen. — Em Gootee summarizing a resource [Ep 6 · 19:40](https://origin-library.globalcastmd.com/watch/history-of-pediatric-surgery-295?t=1180)
- Mary Elizabeth Tiffin, a pathologist at Stanford, rediscovered aganglionosis in the myenteric plexus in 1940 in a patient with short-segment Hirschsprung disease. — Em Gootee summarizing a resource [Ep 6 · 20:25](https://origin-library.globalcastmd.com/watch/history-of-pediatric-surgery-295?t=1225)
- Orvar Swenson was hired by William Ladd to set up a research lab at Boston Children's Hospital and became interested in megacolon patients who were dying without effective treatment. — Em Gootee summarizing a resource [Ep 6 · 21:10](https://origin-library.globalcastmd.com/watch/history-of-pediatric-surgery-295?t=1270)
- Swenson borrowed equipment from Sidney Farber to measure intestinal peristalsis and found that colon above a diverting colostomy had active peristalsis, while colon below the colostomy did not contract. — Em Gootee summarizing a resource [Ep 6 · 21:40](https://origin-library.globalcastmd.com/watch/history-of-pediatric-surgery-295?t=1300)
- Swenson concluded that Hirschsprung obstruction was functional, not mechanical, demonstrating the physiological consequences of aganglionosis that Tiffin had found pathologically. — Em Gootee summarizing a resource [Ep 6 · 22:30](https://origin-library.globalcastmd.com/watch/history-of-pediatric-surgery-295?t=1350)
- Swenson's pull-through operation was essentially a very low anterior resection, everting the rectum through the anus to complete the anastomosis outside the body. — Em Gootee summarizing a resource [Ep 6 · 23:00](https://origin-library.globalcastmd.com/watch/history-of-pediatric-surgery-295?t=1380)
- Swenson asked radiologist Edwin Neuhauser to perform lateral (not AP) barium enema X-rays to visualize the transition zone, enabling preoperative diagnosis. — Em Gootee summarizing a resource [Ep 6 · 23:40](https://origin-library.globalcastmd.com/watch/history-of-pediatric-surgery-295?t=1420)
- After Swenson's sixth patient remained obstructed post-operatively, he said 'Well, hell, let's do a biopsy,' discovering residual aganglionosis and establishing rectal biopsy for diagnosis and verification of adequate resection. — Em Gootee summarizing a resource [Ep 6 · 24:10](https://origin-library.globalcastmd.com/watch/history-of-pediatric-surgery-295?t=1450)
- Robert Gross opposed Swenson's pull-through operation, fearing urinary incontinence and sexual dysfunction from extensive pelvic dissection. — Em Gootee summarizing a resource [Ep 6 · 25:16](https://origin-library.globalcastmd.com/watch/history-of-pediatric-surgery-295?t=1516)
- Gross prohibited Swenson from performing rectal biopsies, fearing pelvic infections. — Em Gootee summarizing a resource [Ep 6 · 25:45](https://origin-library.globalcastmd.com/watch/history-of-pediatric-surgery-295?t=1545)
- When Swenson proceeded with his operations despite Gross's opposition, he was forced out of Boston Children's Hospital within months; subsequent reports came from the Floating Hospital for Children and Tufts University. — Em Gootee summarizing a resource [Ep 6 · 26:00](https://origin-library.globalcastmd.com/watch/history-of-pediatric-surgery-295?t=1560)
- The next edition of 'Surgery of Infancy and Childhood,' written solely by Gross after Ladd's retirement, credited Swenson's outstanding work and included diagrams of the Swenson procedure but attributed the lateral barium enema to Neuhauser and omitted mention of rectal biopsy. — Em Gootee summarizing a resource [Ep 6 · 26:40](https://origin-library.globalcastmd.com/watch/history-of-pediatric-surgery-295?t=1600)
- The Soave endorectal pull-through procedure was first described by David Sabiston and Mark Ravitch at Hopkins in 1947 (for ulcerative colitis/familial polyposis in dogs), then performed in an adult with Hirschsprung disease by Asa Yancey in Tuskegee, Alabama, in 1952—11 years before Franco Soave's 1963 infant operation. — Em Gootee summarizing a resource [Ep 6 · 27:30](https://origin-library.globalcastmd.com/watch/history-of-pediatric-surgery-295?t=1650)
- The Duhamel procedure was described in 1956, Keith Jorgenson performed the first laparoscopic pull-through in 1995, and de la Torre in Mexico City performed the first completely transanal pull-through in 1998. — Em Gootee summarizing a resource [Ep 6 · 28:40](https://origin-library.globalcastmd.com/watch/history-of-pediatric-surgery-295?t=1720)
- Evarts Graham, Chair of Surgery at Washington University, was offered a 50-year-old man in cardiac failure as a PDA candidate by the pediatrics department, illustrating how little pediatricians valued surgery at the time. — Em Gootee summarizing a resource [Ep 6 · 31:10](https://origin-library.globalcastmd.com/watch/history-of-pediatric-surgery-295?t=1870)
- Robert Gross and pediatric cardiologist John Hubbard, who trained as fellows together, agreed that PDA ligation was a solution for patent ductus arteriosus. — Em Gootee summarizing a resource [Ep 6 · 31:50](https://origin-library.globalcastmd.com/watch/history-of-pediatric-surgery-295?t=1910)
- William Ladd absolutely forbade Gross from performing PDA ligation. — Em Gootee summarizing a resource [Ep 6 · 32:20](https://origin-library.globalcastmd.com/watch/history-of-pediatric-surgery-295?t=1940)
- Gross waited until Ladd's August vacation, obtained permission from acting chief Thomas Lanman, and performed the first successful PDA ligation in 1938 on a 7-year-old under open-drop ether by anesthetist Betty Lank. — Em Gootee summarizing a resource [Ep 6 · 32:35](https://origin-library.globalcastmd.com/watch/history-of-pediatric-surgery-295?t=1955)
- The PDA ligation took one hour in complete silence; the murmur was so loud it could almost be heard in the room, and it stopped after ligation was confirmed with a sterilized stethoscope. — Em Gootee summarizing a resource [Ep 6 · 33:30](https://origin-library.globalcastmd.com/watch/history-of-pediatric-surgery-295?t=2010)
- When Ladd asked Gross 'How are things at the hospital?' at a club, Gross replied 'Nothing special,' concealing that he had just invented cardiac surgery. — Em Gootee summarizing a resource [Ep 6 · 34:10](https://origin-library.globalcastmd.com/watch/history-of-pediatric-surgery-295?t=2050)
- Ladd fired Gross for insubordination and lying; Gross was reinstated only after hospital board intervention, but their relationship never recovered. — Em Gootee summarizing a resource [Ep 6 · 34:40](https://origin-library.globalcastmd.com/watch/history-of-pediatric-surgery-295?t=2080)
- Helen Taussig heard Gross speak about PDA ligation and proposed creating a systemic-to-pulmonary fistula to palliate tetralogy of Fallot ('blue babies'). — Em Gootee summarizing a resource [Ep 6 · 35:10](https://origin-library.globalcastmd.com/watch/history-of-pediatric-surgery-295?t=2110)
- Gross had performed the exact operation Taussig proposed—anastomosing left pulmonary artery to aorta in dogs—as preparation for PDA ligation, the same experimental work Vivian Thomas did for Alfred Blalock. — Em Gootee summarizing a resource [Ep 6 · 35:45](https://origin-library.globalcastmd.com/watch/history-of-pediatric-surgery-295?t=2145)
- Gross refused Taussig's proposal, stating 'I'm in the business of ligating PDAs, not creating them,' a psychological flaw that prevented him from recognizing the next great cardiac operation. — Em Gootee summarizing a resource [Ep 6 · 36:25](https://origin-library.globalcastmd.com/watch/history-of-pediatric-surgery-295?t=2185)
- Gross became the William Ladd Professor of Surgery but never reconciled with Ladd; the next edition of 'Ladd and Gross' was authored by Gross alone. — Em Gootee summarizing a resource [Ep 6 · 36:46](https://origin-library.globalcastmd.com/watch/history-of-pediatric-surgery-295?t=2206)
- Lanman's approach—resecting the fourth rib, resecting posterior aspects of ribs above and below, and staying extrapleural to confine leaks outside the pleural cavity—incorporated principles still used today (though modern surgeons use intercostal approach without rib resection). — Em Gootee summarizing a resource [Ep 6 · 43:36](https://origin-library.globalcastmd.com/watch/history-of-pediatric-surgery-295?t=2616)
- Lanman had two patients survive 8 and 9 days, leading him to believe eventual success was inevitable—'just a question of who was going to succeed first.' — Em Gootee summarizing a resource [Ep 6 · 44:27](https://origin-library.globalcastmd.com/watch/history-of-pediatric-surgery-295?t=2667)
- At 3 weeks postoperatively, the baby burped evaporated milk, indicating the anastomosis was patent; contrast study confirmed the leak had sealed, and oral feedings were started. — Em Gootee summarizing a resource [Ep 6 · 48:30](https://origin-library.globalcastmd.com/watch/history-of-pediatric-surgery-295?t=2910)
- The only long-term esophageal complication was a stricture at 17 months of age. — Em Gootee summarizing a resource [Ep 6 · 49:05](https://origin-library.globalcastmd.com/watch/history-of-pediatric-surgery-295?t=2945)
- Between Lanman's and Haight's series, there were 47 deaths and 1 survivor; modern survival for esophageal atresia without extreme prematurity, cardiac disease, or major chromosomal problems approaches 100%. — Em Gootee summarizing a resource [Ep 6 · 48:26](https://origin-library.globalcastmd.com/watch/history-of-pediatric-surgery-295?t=2906)
- Modern esophageal atresia success is attributed to technical maturation of pediatric surgery (including minimally invasive techniques), advances in neonatology, anesthesiology, and pediatric critical care. — Em Gootee summarizing a resource [Ep 6 · 49:21](https://origin-library.globalcastmd.com/watch/history-of-pediatric-surgery-295?t=2961)
- In the Midwest Pediatric Surgery Consortium prospective trial of spontaneous pneumothorax, 83% of patients who failed aspiration and received a chest tube eventually required VATS procedure. — The host summarizing the discussion [Ep 9 · 4:25](https://origin-library.globalcastmd.com/watch/todd-ponsky-what-is-new-in-pediatric-surgery-teaser-13347?t=265)
- After aspiration protocol for spontaneous pneumothorax with 6-hour observation, 44% of patients sent home had recurrence, with no episodes of tension pneumothorax. — The host summarizing the discussion [Ep 9 · 4:31](https://origin-library.globalcastmd.com/watch/todd-ponsky-what-is-new-in-pediatric-surgery-teaser-13347?t=271)
- Riley Hospital randomized controlled trial (2016) found relaxed ad-lib feeding after pyloromyotomy decreased time to goal feeds and overall length of stay without significant differences in post-operative vomiting or readmissions compared to incremental feeding protocol. — Todd Ponsky summarizing the discussion [Ep 9 · 7:00](https://origin-library.globalcastmd.com/watch/todd-ponsky-what-is-new-in-pediatric-surgery-teaser-13347?t=420)
- Patients with serum chloride less than 100 on admission after pyloromyotomy took significantly longer to reach feeding goal. — Todd Ponsky summarizing the discussion [Ep 9 · 7:25](https://origin-library.globalcastmd.com/watch/todd-ponsky-what-is-new-in-pediatric-surgery-teaser-13347?t=445)
- Multi-state retrospective cohort study (Journal of Pediatrics 2019) showed umbilical hernia repair before age 4 doubled the recurrence rate and doubled the readmission rate. — Todd Ponsky summarizing the discussion [Ep 9 · 9:15](https://origin-library.globalcastmd.com/watch/todd-ponsky-what-is-new-in-pediatric-surgery-teaser-13347?t=555)
- Prospective multi-center study (Journal of Crohn's and Colitis, February 2019) found appendix removal in refractory ulcerative colitis resulted in sustained symptomatic improvement in 30% of patients, pathologic improvement in 50%, and complete endoscopic remission in 17%. — Todd Ponsky summarizing the discussion [Ep 9 · 11:22](https://origin-library.globalcastmd.com/watch/todd-ponsky-what-is-new-in-pediatric-surgery-teaser-13347?t=682)
- The Gips procedure for pilonidal disease involves coring out pits with trephine, extracting granulation tissue and hair, curetting the cavity, and flushing with saline then peroxide, leaving holes unpacked and unsutured. — Todd Ponsky summarizing the discussion [Ep 9 · 13:59](https://origin-library.globalcastmd.com/watch/todd-ponsky-what-is-new-in-pediatric-surgery-teaser-13347?t=839)
- The Gips procedure for pilonidal disease has the same recurrence rate as traditional flaps but with less pain and fewer sick days away from school. — Todd Ponsky summarizing the discussion [Ep 9 · 15:41](https://origin-library.globalcastmd.com/watch/todd-ponsky-what-is-new-in-pediatric-surgery-teaser-13347?t=941)
- Volumetric chest CT for suspected airway foreign body has almost 100% sensitivity and incredibly high ability to detect foreign bodies whether radiolucent or not. — Todd Ponsky summarizing the discussion [Ep 9 · 18:46](https://origin-library.globalcastmd.com/watch/todd-ponsky-what-is-new-in-pediatric-surgery-teaser-13347?t=1126)
- ATOMAC protocol recommends that patients who receive 20cc/kg crystalloid and don't respond should get 10-20cc/kg bolus of blood rather than a second crystalloid bolus. — Todd Ponsky summarizing the discussion [Ep 9 · 24:23](https://origin-library.globalcastmd.com/watch/todd-ponsky-what-is-new-in-pediatric-surgery-teaser-13347?t=1463)
- The magic number in pediatric trauma is 40cc/kg of blood or 4 units—if a patient is transfused this amount, it indicates probable failure of non-operative management and need for operating room. — Todd Ponsky summarizing the discussion [Ep 9 · 24:54](https://origin-library.globalcastmd.com/watch/todd-ponsky-what-is-new-in-pediatric-surgery-teaser-13347?t=1494)
- Kansas City study of 622 fluoroscopy-guided central lines: 504 patients had no chest X-ray and no symptoms with no adverse outcomes. — Todd Ponsky summarizing the discussion [Ep 9 · 28:40](https://origin-library.globalcastmd.com/watch/todd-ponsky-what-is-new-in-pediatric-surgery-teaser-13347?t=1720)
- In the central line study, 25 patients were symptomatic and received chest X-ray; 4 had pneumothorax managed non-operatively and sent home next day, and 1 had pleural effusion requiring chest tube. — Todd Ponsky summarizing the discussion [Ep 9 · 29:00](https://origin-library.globalcastmd.com/watch/todd-ponsky-what-is-new-in-pediatric-surgery-teaser-13347?t=1740)
- Out of 622 central line patients, only 1 required a chest tube, and that patient was symptomatic—conclusion is routine chest X-ray after every line placement is not needed. — Todd Ponsky summarizing the discussion [Ep 9 · 29:11](https://origin-library.globalcastmd.com/watch/todd-ponsky-what-is-new-in-pediatric-surgery-teaser-13347?t=1751)
- Randomized controlled trial of glycopyrrolate for esophageal atresia anastomotic leak: treatment group had chest tube output of 124mL compared to 370mL in placebo group. — Todd Ponsky summarizing the discussion [Ep 9 · 31:45](https://origin-library.globalcastmd.com/watch/todd-ponsky-what-is-new-in-pediatric-surgery-teaser-13347?t=1905)
- Glycopyrrolate treatment for EA leak achieved leak resolution in 76% versus 29% in placebo group, and oral feeding in 71% versus 14% in placebo group. — Todd Ponsky summarizing the discussion [Ep 9 · 31:55](https://origin-library.globalcastmd.com/watch/todd-ponsky-what-is-new-in-pediatric-surgery-teaser-13347?t=1915)
- Riley Hospital Hats Off study found disposable bouffant caps had the highest microbial and particle shedding on the surgical field. — Todd Ponsky summarizing the discussion [Ep 9 · 34:36](https://origin-library.globalcastmd.com/watch/todd-ponsky-what-is-new-in-pediatric-surgery-teaser-13347?t=2076)
- Cloth skull caps had the lowest permeability and lowest porous material with very low shedding compared to disposable bouffant caps. — Todd Ponsky summarizing the discussion [Ep 9 · 34:44](https://origin-library.globalcastmd.com/watch/todd-ponsky-what-is-new-in-pediatric-surgery-teaser-13347?t=2084)
- The Dalton et al. framework from Kansas City predicts the number of fluid boluses needed based on the original chloride level, so labs do not need to be rechecked between each bolus in children likely to require two or three saline boluses. — Meera Kotagal summarizing a resource [Ep 7 · 1:00](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-guideline-recap-5786?t=60)
- Randomized controlled trials by Markel et al. and Adebe et al. found that ad lib feeding compared to protocolized feeding is associated with equivalent or shorter hospital stays. — Meera Kotagal summarizing a resource [Ep 7 · 3:30](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-guideline-recap-5786?t=210)
- Ad lib feeding may result in more emesis but there were no complications associated with that emesis in the Markel and Adebe trials. — Meera Kotagal summarizing a resource [Ep 7 · 3:30](https://origin-library.globalcastmd.com/watch/pyloric-stenosis-guideline-recap-5786?t=210)
- Dr. Markel and his team at Riley Hospital for Children performed a randomized controlled trial to assess feeding after surgery for pyloric stenosis, published in the Journal of Pediatric Surgery in 2016 — The host summarizing a resource [Ep 5 · 0:00](https://origin-library.globalcastmd.com/watch/rct-for-feeding-after-pyloromyotomy-2545?t=0)
- The trial compared a relaxed feeding strategy that was mostly ad lib to a standard incremental feeding protocol of scheduled Pedialyte half and full strength feeds — The host summarizing a resource [Ep 5 · 0:00](https://origin-library.globalcastmd.com/watch/rct-for-feeding-after-pyloromyotomy-2545?t=0)
- A relaxed feeding strategy decreased the time to goal feeds after pyloromyotomy — The host summarizing a resource [Ep 5 · 0:00](https://origin-library.globalcastmd.com/watch/rct-for-feeding-after-pyloromyotomy-2545?t=0)
- A relaxed feeding strategy decreased overall length of stay after pyloromyotomy — The host summarizing a resource [Ep 5 · 0:00](https://origin-library.globalcastmd.com/watch/rct-for-feeding-after-pyloromyotomy-2545?t=0)
- There were no significant differences in post-operative vomiting between relaxed and incremental feeding strategies after pyloromyotomy — The host summarizing a resource [Ep 5 · 0:00](https://origin-library.globalcastmd.com/watch/rct-for-feeding-after-pyloromyotomy-2545?t=0)
- There were no significant differences in readmissions between relaxed and incremental feeding strategies after pyloromyotomy — The host summarizing a resource [Ep 5 · 0:00](https://origin-library.globalcastmd.com/watch/rct-for-feeding-after-pyloromyotomy-2545?t=0)
- Patients with serum chloride less than 100 on admission took significantly longer to reach their feeding goal after pyloromyotomy — The host summarizing a resource [Ep 5 · 0:00](https://origin-library.globalcastmd.com/watch/rct-for-feeding-after-pyloromyotomy-2545?t=0)
- Optical trocar (Optiview) is useful when not accessing through the umbilicus. — Todd Ponsky summarizing a resource [Ep 3 · 1:00](https://origin-library.globalcastmd.com/watch/peritoneal-access-2294?t=60)
- Keith Jorgenson taught the technique of inserting the trocar angled toward the spleen. — Todd Ponsky summarizing a resource [Ep 3 · 6:00](https://origin-library.globalcastmd.com/watch/peritoneal-access-2294?t=360)
- Scott Bollinger stated that performing the same technique repeatedly minimizes complications, while trying new techniques increases injury risk. — Todd Ponsky summarizing a resource [Ep 3 · 10:00](https://origin-library.globalcastmd.com/watch/peritoneal-access-2294?t=600)
- Steve Rothenberg presented 12 cases of CO2 embolization at IPEG, and he reports knowing of 15 total cases. — Todd Ponsky summarizing a resource [Ep 3 · 30:00](https://origin-library.globalcastmd.com/watch/peritoneal-access-2294?t=1800)
- Transesophageal echocardiography has been discussed as an urgent diagnostic tool for suspected CO2 embolization. — Todd Ponsky summarizing a resource [Ep 3 · 33:00](https://origin-library.globalcastmd.com/watch/peritoneal-access-2294?t=1980)
- Steve Rothenberg believes CO2 embolization can occur even without direct needle or trocar placement in the vein, possibly by damaging the vein during passage and allowing CO2 to enter the venous system during peritoneal insufflation. — Todd Ponsky summarizing a resource [Ep 3 · 36:00](https://origin-library.globalcastmd.com/watch/peritoneal-access-2294?t=2160)
- Steve Rothenberg's opinion is that infra-umbilical Hasson approach is safer, and all other techniques (not using infra-umbilical incision) are at risk for CO2 embolization. — Todd Ponsky summarizing a resource [Ep 3 · 37:00](https://origin-library.globalcastmd.com/watch/peritoneal-access-2294?t=2220)
- Steve Rothenberg states that two months is the age after which the umbilical vein is no longer a concern, though the source of this cutoff is unclear. — Todd Ponsky summarizing a resource [Ep 3 · 27:00](https://origin-library.globalcastmd.com/watch/peritoneal-access-2294?t=1620)

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