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Summaries Jill gave as host
· 627 summaries
Recaps of other experts' statements, not Jill's own clinical position.
Summaries Jill gave as host · Abdominal Wall Defects
7 summaries
Open the Abdominal Wall Defects collection →
Surgeon annual volume impacts recurrence rates of pediatric inguinal hernia repairs: A multi-institutional study
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Ep 46 · 0:10
host summary
Jill Knepprath summarizing a resource: Heller et al. published a multi-institutional study in the Journal of Pediatric Surgery in 2025 exploring the impact of surgeon volume on patients with inguinal hernias.
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Ep 46 · 0:22
host summary
Jill Knepprath summarizing a resource: Inguinal hernias repaired by lower volume surgeons had a 1.5 fold increase in the odds of recurrence.
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Ep 46 · 0:22
host summary
Jill Knepprath summarizing a resource: The authors found that inguinal hernias repaired by lower volume surgeons had a 1.5 fold increase in the odds of recurrence.
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Ep 46 · 0:30
host summary
Jill Knepprath summarizing a resource: When broken down by surgical approach, there was no difference in recurrence rates for open inguinal hernia repairs based on surgeon volume.
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Ep 46 · 0:35
host summary
Jill Knepprath summarizing a resource: Laparoscopic inguinal hernia repairs done by lower volume surgeons had a 3.3 fold increase in the odds of recurrence.
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Ep 46 · 0:35
host summary
Jill Knepprath summarizing a resource: However, laparoscopic repairs done by lower volume surgeons had a 3.3 fold increase in the odds of recurrence.
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Ep 46 · 0:44
host summary
Jill Knepprath summarizing a resource: The authors of the Heller et al. study recommend maintaining a high volume of laparoscopic repairs, and if that's not possible, to seek help from a higher volume surgeon.
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Summaries Jill gave as host · Aerodigestive / ENT
7 summaries
Open the Aerodigestive / ENT collection →
Surgeon annual volume impacts recurrence rates of pediatric inguinal hernia repairs: A multi-institutional study
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Ep 27 · 0:10
host summary
Jill Knepprath summarizing a resource: Heller et al. published a multi-institutional study in the Journal of Pediatric Surgery in 2025 exploring the impact of surgeon volume on patients with inguinal hernias.
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Ep 27 · 0:22
host summary
Jill Knepprath summarizing a resource: The authors found that inguinal hernias repaired by lower volume surgeons had a 1.5 fold increase in the odds of recurrence.
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Ep 27 · 0:22
host summary
Jill Knepprath summarizing a resource: Inguinal hernias repaired by lower volume surgeons had a 1.5 fold increase in the odds of recurrence.
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Ep 27 · 0:30
host summary
Jill Knepprath summarizing a resource: When broken down by surgical approach, there was no difference in recurrence rates for open inguinal hernia repairs based on surgeon volume.
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Ep 27 · 0:35
host summary
Jill Knepprath summarizing a resource: Laparoscopic inguinal hernia repairs done by lower volume surgeons had a 3.3 fold increase in the odds of recurrence.
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Ep 27 · 0:35
host summary
Jill Knepprath summarizing a resource: However, laparoscopic repairs done by lower volume surgeons had a 3.3 fold increase in the odds of recurrence.
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Ep 27 · 0:44
host summary
Jill Knepprath summarizing a resource: The authors of the Heller et al. study recommend maintaining a high volume of laparoscopic repairs, and if that's not possible, to seek help from a higher volume surgeon.
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Summaries Jill gave as host · Anorectal Malformation
55 summaries
Open the Anorectal Malformation collection →
2025 Pediatric Surgery Update Course - Updates in Pediatric Surgery feat. JPS Articles
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Ep 67 · 2:24
host summary
Jill Knepprath summarizing the discussion: A NSQIP pediatric study from 2017 to 2021 found 6.2% of patients were discharged same day at the highest year, much lower than reported in the presented study
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Patient-reported outcomes of Children with an Anorectal Malformation
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Ep 72 · 0:02
host summary
Jill Knepprath summarizing a resource: Are you using the sacral ratio to counsel them?
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Ep 72 · 0:10
host summary
Jill Knepprath summarizing a resource: A 2024 survey by Witt et al. at Nationwide Children's was published in the Annals of Surgery examining patients with anorectal malformation
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Ep 72 · 0:11
host summary
Jill Knepprath summarizing a resource: The survey looked at over 900 patients with anorectal malformation
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Ep 72 · 0:21
host summary
Jill Knepprath summarizing a resource: There was no difference in continence for patients based on sacral ratio alone in regards to quality of life
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Ep 72 · 0:29
host summary
Jill Knepprath summarizing a resource: Patients who are incontinent had a 20-point lower quality of life compared to patients who were continent or clean on enemas
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Ep 72 · 0:38
host summary
Jill Knepprath summarizing a resource: Bowel management may actually matter more than sacral ratio in predicting continence outcomes
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Ep 72 · 0:38
host summary
Jill Knepprath summarizing a resource: The sacral ratio may not be as strong a predictor of continence as patients age
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Ep 72 · 0:51
host summary
Jill Knepprath summarizing a resource: Quality of life is significantly lower for patients with incontinence compared to those clean on enemas
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Ep 72 · 0:57
host summary
Jill Knepprath summarizing a resource: Does this change this change your practice?
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Update Course Rewind 2025: Perineal Body–Preserving PSARP: The New Standard?
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Ep 75 · 1:01
host summary
Jill Knepprath summarizing the discussion: Two-thirds of patients undergoing perineal body-preserving PSARP went home on postoperative day one.
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Ep 75 · 1:51
host summary
Jill Knepprath summarizing the discussion: Perineal body-preserving PSARP is a good choice for patients but can be a trickier approach than standard PSARP.
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Ep 75 · 2:00
host summary
Jill Knepprath summarizing the discussion: Conversion to the standard PSARP approach is a valid pivot when there is doubt about anatomy during perineal body-preserving PSARP.
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Update Course Rewind 2025: Do We Still Need Routine Anal Dilations After PSARP?
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Ep 69 · 0:21
host summary
Jill Knepprath summarizing the discussion: For decades, every child received anal dilations after PSARP.
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Ep 69 · 0:21
host summary
Jill Knepprath summarizing the discussion: For decades, every child received anal dilations after PSARP.
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Ep 69 · 0:40
host summary
Jill Knepprath summarizing the discussion: A study from Spain followed the historical dilation protocol starting two weeks after PSARP, performing dilations twice a day, with the Hagar size increased by 1 millimeter each week until reaching the optimal size.
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Ep 69 · 0:40
host summary
Jill Knepprath summarizing the discussion: A study from Spain followed the historical dilation protocol starting two weeks after PSARP, performing dilations twice a day, with the Hagar size increased by 1 millimeter each week until reaching the optimal size.
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Ep 69 · 1:12
host summary
Jill Knepprath summarizing the discussion: The Heineke-Mikulicz anoplasty is a procedure for skin-level strictures in PSARP patients.
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Ep 69 · 1:12
host summary
Jill Knepprath summarizing the discussion: The Heineke-Mikulicz anoplasty is a procedure for skin-level strictures in PSARP patients.
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Ep 69 · 1:20
host summary
Jill Knepprath summarizing the discussion: Heineke-Mikulicz anoplasty is done by making incisions at the 12, 3, 6, and 9 o'clock positions, making a rhomboid shape that opens up the strictured area.
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Ep 69 · 1:20
host summary
Jill Knepprath summarizing the discussion: Heineke-Mikulicz anoplasty is done by making incisions at the 12, 3, 6, and 9 o'clock positions, making a rhomboid shape that opens up the strictured area.
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Ep 69 · 1:30
host summary
Jill Knepprath summarizing the discussion: Heineke-Mikulicz anoplasty does not require flaps or any mobilization of the rectum.
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Ep 69 · 1:30
host summary
Jill Knepprath summarizing the discussion: Heineke-Mikulicz anoplasty does not require flaps or any mobilization of the rectum.
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Ep 69 · 1:34
host summary
Jill Knepprath summarizing the discussion: Heineke-Mikulicz anoplasty is safe, effective, and minimally invasive.
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Ep 69 · 1:34
host summary
Jill Knepprath summarizing the discussion: Heineke-Mikulicz anoplasty is safe, effective, and minimally invasive.
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Ep 69 · 1:38
host summary
Jill Knepprath summarizing the discussion: Heineke-Mikulicz anoplasty can be done outpatient as an alternative to long-term dilations after PSARP.
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Ep 69 · 1:38
host summary
Jill Knepprath summarizing the discussion: Heineke-Mikulicz anoplasty can be done outpatient as an alternative to long-term dilations after PSARP.
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Ep 69 · 2:09
host summary
Jill Knepprath summarizing the discussion: Anal dilation after PSARP can cause stress for families.
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Ep 69 · 2:09
host summary
Jill Knepprath summarizing the discussion: Anal dilation after PSARP can cause stress for families.
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Ep 69 · 2:09
host summary
Jill Knepprath summarizing the discussion: There isn't strong evidence to support mandatory anal dilation after PSARP.
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Ep 69 · 2:09
host summary
Jill Knepprath summarizing the discussion: There isn't strong evidence to support mandatory anal dilation after PSARP.
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Ep 69 · 2:17
host summary
Jill Knepprath summarizing the discussion: Age of the patient and access to returning for an outpatient procedure are things to consider when making decisions about anal dilation after PSARP.
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Ep 69 · 2:17
host summary
Jill Knepprath summarizing the discussion: Age of the patient and access to returning for an outpatient procedure are things to consider when making decisions about anal dilation after PSARP.
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Update Course Rewind 2025: Hirschsprung + ARM: Rare but Real
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Ep 76 · 0:34
host summary
Jill Knepprath summarizing the discussion: The correct answer is less than 2%.
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Ep 76 · 0:34
host summary
Jill Knepprath summarizing the discussion: The rate of Hirschsprung disease and anorectal malformation occurring together is less than 2%
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Ep 76 · 0:37
host summary
Jill Knepprath summarizing the discussion: The co-occurrence of Hirschsprung disease and ARM is something to keep in mind for patients with trisomy 21
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Ep 76 · 0:37
host summary
Jill Knepprath summarizing the discussion: It's rare, but something to keep in mind for patients with trisomy 21.
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Ep 76 · 0:58
host summary
Jill Knepprath summarizing the discussion: Hypo or absent ganglion cells were found in the remaining specimens (9%)
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Ep 76 · 0:58
host summary
Jill Knepprath summarizing the discussion: Ganglion cells were found in 91% of rectal fistula specimens
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Ep 76 · 1:05
host summary
Jill Knepprath summarizing the discussion: Absent ganglion cells in fistula tissue does not necessarily mean the patient has Hirschsprung disease
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Ep 76 · 1:05
host summary
Jill Knepprath summarizing the discussion: But absent cells in fistula tissue doesn't necessarily mean it's Hirschsprung's disease.
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Ep 76 · 1:11
host summary
Jill Knepprath summarizing the discussion: Three patients (4% of the cohort) had both Hirschsprung disease and an anorectal malformation
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Ep 76 · 1:15
host summary
Jill Knepprath summarizing the discussion: Two of the three patients with both conditions also had trisomy 21
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Ep 76 · 1:31
host summary
Jill Knepprath summarizing the discussion: Complex anorectal malformation patients with chromosomal anomalies who do not respond to laxatives or enemas should be worked up for Hirschsprung disease
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Update Course Rewind 2025: Hirschsprung + ARM: Rare but Real
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Ep 77 · 0:34
host summary
Jill Knepprath summarizing the discussion: The rate of Hirschsprung disease and anorectal malformation occurring together is less than 2%
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Ep 77 · 0:34
host summary
Jill Knepprath summarizing the discussion: The correct answer is less than 2%.
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Ep 77 · 0:37
host summary
Jill Knepprath summarizing the discussion: The co-occurrence of Hirschsprung disease and ARM is something to keep in mind for patients with trisomy 21
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Ep 77 · 0:37
host summary
Jill Knepprath summarizing the discussion: It's rare, but something to keep in mind for patients with trisomy 21.
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Ep 77 · 0:58
host summary
Jill Knepprath summarizing the discussion: Hypo or absent ganglion cells were found in the remaining rectal fistula specimens
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Ep 77 · 0:58
host summary
Jill Knepprath summarizing the discussion: Ganglion cells were found in 91% of rectal fistula specimens
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Ep 77 · 1:05
host summary
Jill Knepprath summarizing the discussion: But absent cells in fistula tissue doesn't necessarily mean it's Hirschsprung's disease.
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▶
Ep 77 · 1:05
host summary
Jill Knepprath summarizing the discussion: Absent ganglion cells in fistula tissue does not necessarily mean the patient has Hirschsprung disease
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Ep 77 · 1:11
host summary
Jill Knepprath summarizing the discussion: Three patients (4% of the study cohort) had both Hirschsprung disease and anorectal malformation
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Ep 77 · 1:15
host summary
Jill Knepprath summarizing the discussion: Two of the three patients with both conditions had trisomy 21
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Ep 77 · 1:31
host summary
Jill Knepprath summarizing the discussion: Complex anorectal malformation patients with chromosomal anomalies who do not respond to laxatives or enemas should be worked up for Hirschsprung disease
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Summaries Jill gave as host · Colorectal / ARM & Hirschsprung
80 summaries
Open the Colorectal / ARM & Hirschsprung collection →
Patient-reported outcomes of Children with an Anorectal Malformation
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Ep 187 · 0:02
host summary
Jill Knepprath summarizing a resource: Are you using the sacral ratio to counsel them?
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Ep 187 · 0:10
host summary
Jill Knepprath summarizing a resource: A 2024 survey by Witt et al. at Nationwide Children's was published in the Annals of Surgery examining patients with anorectal malformation
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Ep 187 · 0:11
host summary
Jill Knepprath summarizing a resource: The survey looked at over 900 patients with anorectal malformation
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Ep 187 · 0:21
host summary
Jill Knepprath summarizing a resource: There was no difference in continence for patients based on sacral ratio alone in regards to quality of life
↗
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Ep 187 · 0:29
host summary
Jill Knepprath summarizing a resource: Patients who are incontinent had a 20-point lower quality of life compared to patients who were continent or clean on enemas
↗
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Ep 187 · 0:38
host summary
Jill Knepprath summarizing a resource: Bowel management may actually matter more than sacral ratio in predicting continence outcomes
↗
▶
Ep 187 · 0:38
host summary
Jill Knepprath summarizing a resource: The sacral ratio may not be as strong a predictor of continence as patients age
↗
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Ep 187 · 0:51
host summary
Jill Knepprath summarizing a resource: Quality of life is significantly lower for patients with incontinence compared to those clean on enemas
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Ep 187 · 0:57
host summary
Jill Knepprath summarizing a resource: Does this change this change your practice?
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Update Course Rewind 2025: Timing of PSARP: Early vs. Delayed—Does It Really Matter?
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Ep 194 · 0:23
host summary
Jill Knepprath summarizing the discussion: For patients with rectal vestibular fistulas, some surgeons perform anal rectoplasties immediately while others wait until after discharge.
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Ep 194 · 0:37
host summary
Jill Knepprath summarizes what Dr. Jamie Harris said: Dr. Jamie Harris presents a case of a full-term newborn baby girl with rectal vestibular fistula weighing 3 kg with completely negative VACTERL workup.
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Ep 194 · 1:49
host summary
Jill Knepprath summarizing the discussion: The panel agreed that it's safe to perform the PSARP either early before discharge or later around 1 to 3 months of age.
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Ep 194 · 2:00
host summary
Jill Knepprath summarizing the discussion: The NSQIP study defined early repair as 7 days and delayed repair as between 6 weeks and 8 months.
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Ep 194 · 2:07
host summary
Jill Knepprath summarizing the discussion: The NSQIP study found no difference in overall outcomes, including re-operations and readmissions, between early and delayed PSARP.
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Ep 194 · 2:26
host summary
Jill Knepprath summarizing the discussion: Wound breakdown and dehiscence was the most common complication for both early and delayed repair groups in the PCPLC study.
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Ep 194 · 2:33
host summary
Jill Knepprath summarizing the discussion: There was no significant difference in postoperative complications between early and delayed repair groups in the PCPLC study.
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Ep 194 · 3:07
host summary
Jill Knepprath summarizing the discussion: Early repair during the newborn period avoids an additional admission for the surgery.
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Ep 194 · 3:23
host summary
Jill Knepprath summarizing the discussion: Both early and delayed PSARP repairs are safe for patients with rectal vestibular fistulas.
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Ep 194 · 3:29
host summary
Jill Knepprath summarizing the discussion: What matters most in timing PSARP is the circumstances, family access to care, patient size, and the surgeon's comfort and experience.
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Update Course Rewind 2025: Perineal Body–Preserving PSARP: The New Standard?
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Ep 195 · 1:01
host summary
Jill Knepprath summarizing the discussion: Two-thirds of patients undergoing perineal body-preserving PSARP went home on postoperative day one.
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Ep 195 · 1:51
host summary
Jill Knepprath summarizing the discussion: Perineal body-preserving PSARP is a good choice for patients but can be a trickier approach than standard PSARP.
↗
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Ep 195 · 2:00
host summary
Jill Knepprath summarizing the discussion: Conversion to the standard PSARP approach is a valid pivot when there is doubt about anatomy during perineal body-preserving PSARP.
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Laparoscopic modified percutaneous internal ring suturing - a mesh-free alternative for indirect inguinal hernia repair in adults. a pilot prospective cohort study
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Ep 196 · 0:00
host summary
Jill Knepprath summarizing a resource: High ligation hernia repair, that's for kids.
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Ep 196 · 0:03
host summary
Jill Knepprath summarizing a resource: Or is it?
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Ep 196 · 0:08
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Jill Knepprath summarizing a resource: The study was published in the International Journal of Surgery.
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Ep 196 · 0:12
host summary
Jill Knepprath summarizing a resource: The study used the modified percutaneous internal ring suturing technique to evaluate whether a laparoscopic non-mesh repair works on indirect inguinal hernias in adults.
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Ep 196 · 0:22
host summary
Jill Knepprath summarizing a resource: So did it work?
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Ep 196 · 0:23
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Jill Knepprath summarizing a resource: There were 20 patients in the study.
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Ep 196 · 0:25
host summary
Jill Knepprath summarizing a resource: The majority of patients were male.
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Ep 196 · 0:26
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Jill Knepprath summarizing a resource: No patients had hernia recurrence on follow-up, with a median follow-up of 79 months.
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Ep 196 · 0:31
host summary
Jill Knepprath summarizing a resource: Patients reported a decrease in pain and an improved activity post-operatively.
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Ep 196 · 0:35
host summary
Jill Knepprath summarizing a resource: This is a small single-center study.
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Ep 196 · 0:35
host summary
Jill Knepprath summarizing a resource: The study shows success with the modified PIRS technique in adults.
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Ep 196 · 0:41
host summary
Jill Knepprath summarizing a resource: Would you offer this to your hernia patients?
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Update Course Rewind 2025: Do We Still Need Routine Anal Dilations After PSARP?
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Ep 197 · 0:21
host summary
Jill Knepprath summarizing the discussion: For decades, every child received anal dilations after PSARP.
↗
▶
Ep 197 · 0:40
host summary
Jill Knepprath summarizing the discussion: A study from Spain followed the historical dilation protocol starting two weeks after PSARP, performing dilations twice a day, with the Hagar size increased by 1 millimeter each week until reaching the optimal size.
↗
▶
Ep 197 · 1:12
host summary
Jill Knepprath summarizing the discussion: The Heineke-Mikulicz anoplasty is a procedure for skin-level strictures in PSARP patients.
↗
▶
Ep 197 · 1:20
host summary
Jill Knepprath summarizing the discussion: Heineke-Mikulicz anoplasty is done by making incisions at the 12, 3, 6, and 9 o'clock positions, making a rhomboid shape that opens up the strictured area.
↗
▶
Ep 197 · 1:30
host summary
Jill Knepprath summarizing the discussion: Heineke-Mikulicz anoplasty does not require flaps or any mobilization of the rectum.
↗
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Ep 197 · 1:34
host summary
Jill Knepprath summarizing the discussion: Heineke-Mikulicz anoplasty is safe, effective, and minimally invasive.
↗
▶
Ep 197 · 1:38
host summary
Jill Knepprath summarizing the discussion: Heineke-Mikulicz anoplasty can be done outpatient as an alternative to long-term dilations after PSARP.
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Ep 197 · 2:09
host summary
Jill Knepprath summarizing the discussion: There isn't strong evidence to support mandatory anal dilation after PSARP.
↗
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Ep 197 · 2:09
host summary
Jill Knepprath summarizing the discussion: Anal dilation after PSARP can cause stress for families.
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Ep 197 · 2:17
host summary
Jill Knepprath summarizing the discussion: Age of the patient and access to returning for an outpatient procedure are things to consider when making decisions about anal dilation after PSARP.
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Update Course Rewind 2025: Hirschsprung’s Pull-Through: Why Family Training May Save Lives
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Ep 198 · 0:59
host summary
Jill Knepprath summarizing the discussion: The median age of the delayed pull-through group was 98 days at time of surgery.
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Ep 198 · 0:59
host summary
Jill Knepprath summarizing the discussion: The median age of the neonatal pull-through group was 11 days at time of surgery.
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Ep 198 · 0:59
host summary
Jill Knepprath summarizing the discussion: The median age of the delayed pull-through group was 98 days at time of surgery.
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Ep 198 · 0:59
host summary
Jill Knepprath summarizing the discussion: The median age of the neonatal pull-through group was 11 days at time of surgery.
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Ep 198 · 1:06
host summary
Jill Knepprath summarizing the discussion: The PCPLC study found no difference in postoperative enterocolitis between neonatal and delayed pull-through groups.
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Ep 198 · 1:06
host summary
Jill Knepprath summarizing the discussion: The PCPLC study found no difference in preoperative enterocolitis between neonatal and delayed pull-through groups.
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Ep 198 · 1:06
host summary
Jill Knepprath summarizing the discussion: The PCPLC study found no difference in fecal incontinence at follow-up between neonatal and delayed pull-through groups.
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Ep 198 · 1:06
host summary
Jill Knepprath summarizing the discussion: The PCPLC study found no difference in preoperative enterocolitis between neonatal and delayed pull-through groups.
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Ep 198 · 1:06
host summary
Jill Knepprath summarizing the discussion: The PCPLC study found no difference in postoperative enterocolitis between neonatal and delayed pull-through groups.
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Ep 198 · 1:06
host summary
Jill Knepprath summarizing the discussion: The PCPLC study found no difference in fecal incontinence at follow-up between neonatal and delayed pull-through groups.
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Update Course Rewind 2025: Botox for Hirschsprung’s: Where, When, and Why
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Ep 199 · 0:45
host summary
Jill Knepprath summarizing the discussion: A 2022 multi-center study found that 24% of patients undergoing pull-through procedure also received Botox
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Ep 199 · 1:09
host summary
Jill Knepprath summarizing the discussion: Patients that received Botox had a higher chance of diaper rash
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Ep 199 · 1:37
host summary
Jill Knepprath summarizing the discussion: Injecting Botox during pull-through procedure for Hirschsprung's disease has been shown to reduce enterocolitis risk
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Ep 199 · 1:41
host summary
Jill Knepprath summarizing the discussion: Dosing and guidance for Botox injection varies widely
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Update Course Rewind 2025: Hirschsprung + ARM: Rare but Real
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Ep 200 · 0:34
host summary
Jill Knepprath summarizing the discussion: The rate of Hirschsprung disease and anorectal malformation occurring together is less than 2%
↗
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Ep 200 · 0:34
host summary
Jill Knepprath summarizing the discussion: The correct answer is less than 2%.
↗
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Ep 200 · 0:37
host summary
Jill Knepprath summarizing the discussion: The co-occurrence of Hirschsprung disease and ARM is something to keep in mind for patients with trisomy 21
↗
▶
Ep 200 · 0:37
host summary
Jill Knepprath summarizing the discussion: It's rare, but something to keep in mind for patients with trisomy 21.
↗
▶
Ep 200 · 0:58
host summary
Jill Knepprath summarizing the discussion: Ganglion cells were found in 91% of rectal fistula specimens
↗
▶
Ep 200 · 0:58
host summary
Jill Knepprath summarizing the discussion: Hypo or absent ganglion cells were found in the remaining specimens (9%)
↗
▶
Ep 200 · 1:05
host summary
Jill Knepprath summarizing the discussion: Absent ganglion cells in fistula tissue does not necessarily mean the patient has Hirschsprung disease
↗
▶
Ep 200 · 1:05
host summary
Jill Knepprath summarizing the discussion: But absent cells in fistula tissue doesn't necessarily mean it's Hirschsprung's disease.
↗
▶
Ep 200 · 1:11
host summary
Jill Knepprath summarizing the discussion: Three patients (4% of the cohort) had both Hirschsprung disease and an anorectal malformation
↗
▶
Ep 200 · 1:15
host summary
Jill Knepprath summarizing the discussion: Two of the three patients with both conditions also had trisomy 21
↗
▶
Ep 200 · 1:31
host summary
Jill Knepprath summarizing the discussion: Complex anorectal malformation patients with chromosomal anomalies who do not respond to laxatives or enemas should be worked up for Hirschsprung disease
↗
Update Course Rewind 2025: Hirschsprung + ARM: Rare but Real
▶
Ep 201 · 0:34
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Jill Knepprath summarizing the discussion: The rate of Hirschsprung disease and anorectal malformation occurring together is less than 2%
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Ep 201 · 0:34
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Jill Knepprath summarizing the discussion: The correct answer is less than 2%.
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Ep 201 · 0:37
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Jill Knepprath summarizing the discussion: The co-occurrence of Hirschsprung disease and ARM is something to keep in mind for patients with trisomy 21
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Ep 201 · 0:37
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Jill Knepprath summarizing the discussion: It's rare, but something to keep in mind for patients with trisomy 21.
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Ep 201 · 0:58
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Jill Knepprath summarizing the discussion: Ganglion cells were found in 91% of rectal fistula specimens
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Ep 201 · 0:58
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Jill Knepprath summarizing the discussion: Hypo or absent ganglion cells were found in the remaining rectal fistula specimens
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Ep 201 · 1:05
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Jill Knepprath summarizing the discussion: But absent cells in fistula tissue doesn't necessarily mean it's Hirschsprung's disease.
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Ep 201 · 1:05
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Jill Knepprath summarizing the discussion: Absent ganglion cells in fistula tissue does not necessarily mean the patient has Hirschsprung disease
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Ep 201 · 1:11
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Jill Knepprath summarizing the discussion: Three patients (4% of the study cohort) had both Hirschsprung disease and anorectal malformation
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Ep 201 · 1:15
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Jill Knepprath summarizing the discussion: Two of the three patients with both conditions had trisomy 21
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Ep 201 · 1:31
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Jill Knepprath summarizing the discussion: Complex anorectal malformation patients with chromosomal anomalies who do not respond to laxatives or enemas should be worked up for Hirschsprung disease
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Summaries Jill gave as host · Congenital Diaphragmatic Hernia
39 summaries
Open the Congenital Diaphragmatic Hernia collection →
Improving Outcomes for Congenital Diaphragmatic Hernia (CDH): Protocol Changes at Cincinnati Children's
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Ep 39 · 0:20
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Jill Knepprath summarizes what Dr. Paul Kingma said: Protocol changes began in August 2023 and were implemented in spring of 2024
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Ep 39 · 1:26
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Jill Knepprath summarizes what Dr. Paul Kingma said: Previously, peak pressures were limited to 25 to 26 cmH2O and mean airway pressures to less than 16 to 17 cmH2O
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Ep 39 · 2:12
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Jill Knepprath summarizes what Dr. Paul Kingma said: Previously, babies were fed once they had return of bowel function after repair
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Ep 39 · 2:44
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Jill Knepprath summarizes what Dr. Paul Kingma said: Previously, babies received as-needed sedation
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Ep 39 · 3:31
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Jill Knepprath summarizes what Dr. Paul Kingma said: The new cohort had 36 babies compared to 99 in the previous cohort
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Ep 39 · 3:31
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Jill Knepprath summarizes what Dr. Paul Kingma said: ECMO use increased from 14% to 22% in the new cohort
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Ep 39 · 4:09
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Jill Knepprath summarizes what Dr. Paul Kingma said: Survival for ECMO patients increased from 39% to 55%
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Ep 39 · 4:29
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Jill Knepprath summarizes what Dr. Paul Kingma said: ECMO use was around 41% in the old cohort versus 45% in the new cohort
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Inside a FETO Procedure: Fetoscopic Balloon Tracheal Occlusion with Dr. Beth Rymeski
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Ep 40 · 0:47
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Jill Knepprath summarizes what Dr. Beth Rymeski said: The goal of FETO is to allow fluid to stay in the lungs and allow the lungs to expand and grow.
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Ep 40 · 0:53
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Jill Knepprath summarizes what Dr. Beth Rymeski said: FETO helps prevent pulmonary hypoplasia, which is a big factor in poor outcomes for CDH babies.
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Ep 40 · 3:08
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Jill Knepprath summarizes what Dr. Beth Rymeski said: The balloon is filled with around 0.65 to 0.8 mL of water, depending on the size of the trachea.
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Ep 40 · 3:33
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Jill Knepprath summarizes what Dr. Beth Rymeski said: Sometimes the trocar advances into the mouth during the procedure and needs to be backed out.
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Ep 40 · 3:40
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Jill Knepprath summarizes what Dr. Beth Rymeski said: Final confirmation includes advancing the scope one more time to verify the balloon is below the vocal cords and in the main trachea.
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Inside a FETO Procedure: Fetoscopic Balloon Tracheal Occlusion with Dr. Beth Rymeski
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Ep 41 · 0:47
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Jill Knepprath summarizes what Dr. Beth Rymeski said: The goal of FETO is to allow fluid to stay in the lungs and allow the lungs to expand and grow.
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Ep 41 · 0:53
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Jill Knepprath summarizes what Dr. Beth Rymeski said: FETO helps prevent pulmonary hypoplasia, which is a big factor in poor outcomes for CDH babies.
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Ep 41 · 3:08
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Jill Knepprath summarizes what Dr. Beth Rymeski said: The balloon is filled with water, around 0.65 to 0.8 mL, depending on the size of the trachea.
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Ep 41 · 3:40
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Jill Knepprath summarizes what Dr. Beth Rymeski said: After balloon deployment, the scope is advanced one more time to confirm that the balloon is below the vocal cords and in the main trachea.
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Fetoscopic Endoluminal Tracheal Occlusion (FETO) Procedure: Step-by-Step Guide with Dr. Beth Rymeski
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Ep 42 · 0:47
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Jill Knepprath summarizes what Dr. Beth Rymeski said: The goal of FETO is to allow fluid to stay in the lungs and allow the lungs to expand and grow.
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Ep 42 · 0:53
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Jill Knepprath summarizes what Dr. Beth Rymeski said: FETO helps prevent pulmonary hypoplasia, which is a big factor in poor outcomes for CDH babies.
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Ep 42 · 3:08
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Jill Knepprath summarizes what Dr. Beth Rymeski said: The balloon is filled with water, around 0.65 to 0.8 mL, depending on the size of the trachea.
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Ep 42 · 3:40
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Jill Knepprath summarizes what Dr. Beth Rymeski said: After balloon deployment, the scope is advanced one more time to confirm that the balloon is below the vocal cords and in the main trachea.
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Severe Congenital Diaphragmatic Hernia (CDH) Case: FETO Management & Unexpected Findings with Dr. Beth Rymeski
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Ep 43 · 0:18
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Jill Knepprath summarizes what Dr. Beth Rymeski said: FETO uses a fetoscope to insert a balloon into the fetal trachea to temporarily block it, trapping fluid in the lungs to allow expansion and growth.
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Ep 43 · 0:36
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Jill Knepprath summarizes what Dr. Beth Rymeski said: Imaging showed the tip of the liver reaching all the way up to the apex of the chest.
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Ep 43 · 0:52
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Jill Knepprath summarizes what Dr. Beth Rymeski said: The O/E is the observed to expected lung to head ratio.
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Ep 43 · 0:52
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Jill Knepprath summarizes what Dr. Beth Rymeski said: The PPLV on MRI was 7%.
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Ep 43 · 1:02
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Jill Knepprath summarizes what Dr. Beth Rymeski said: The balloon was placed early at 27 weeks and 4 days.
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Ep 43 · 1:06
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Jill Knepprath summarizes what Dr. Beth Rymeski said: This patient was the ideal case for FETO, with not a single hospitalization stay.
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Ep 43 · 1:12
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Jill Knepprath summarizes what Dr. Beth Rymeski said: The balloon was removed at 34 weeks.
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Ep 43 · 1:23
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Jill Knepprath summarizes what Dr. Beth Rymeski said: A non-responder is a fetus with CDH who received FETO but did not show any improvement in lung growth.
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Ep 43 · 1:32
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Jill Knepprath summarizes what Dr. Beth Rymeski said: Post-FETO imaging showed actual lung volume measurement just over 2 mL on the left side (compared to less than 1 mL initially).
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Ep 43 · 1:45
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Jill Knepprath summarizes what Dr. Beth Rymeski said: The patient went into labor at 37 weeks and 3 days and had a vaginal delivery.
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Ep 43 · 1:51
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Jill Knepprath summarizes what Dr. Beth Rymeski said: The Apgars for the baby were 2 and 1.
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Ep 43 · 2:03
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Jill Knepprath summarizes what Dr. Beth Rymeski said: The baby had several unexpected findings after delivery, despite extensive prenatal imaging.
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Ep 43 · 2:21
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Jill Knepprath summarizes what Dr. Beth Rymeski said: Anorectal malformations are rarely diagnosed prenatally.
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Ep 43 · 2:43
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Jill Knepprath summarizes what Dr. Beth Rymeski said: Genetic testing showed only a few variations of unclear significance.
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Ep 43 · 2:58
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Jill Knepprath summarizes what Dr. Beth Rymeski said: The team was not confident they could repair the cardiac defect, especially for a baby who couldn't come off ECMO due to limited lung volume.
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FETO for Late-Diagnosed Severe Congenital Diaphragmatic Hernia (CDH) at Cincinnati Children's with Dr. Beth Rymeski
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Ep 44 · 0:17
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Jill Knepprath summarizes what Dr. Beth Rymeski said: FETO (fetoscopic endotracheal occlusion) uses a fetoscope to insert a balloon into the fetal trachea to temporarily block it, trapping fluid in the lungs to allow expansion and growth.
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Ep 44 · 1:06
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Jill Knepprath summarizes what Dr. Beth Rymeski said: Liver herniation is especially harmful for fetal lung development because the liver is a large and mobile organ, unlike the bowels.
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Ep 44 · 2:13
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Jill Knepprath summarizes what Dr. Beth Rymeski said: Balloon removal after FETO is typically done by week 34.
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Summaries Jill gave as host · Congenital Diaphragmatic Hernia
17 summaries
Open the Congenital Diaphragmatic Hernia collection →
Improving Outcomes for Congenital Diaphragmatic Hernia (CDH): Protocol Changes at Cincinnati Children's
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Ep 16 · 0:20
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Jill Knepprath summarizes what Dr. Paul Kingma said: Protocol changes began in August 2023 and were implemented in spring of 2024
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Ep 16 · 1:26
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Jill Knepprath summarizes what Dr. Paul Kingma said: Previously, peak pressures were limited to 25 to 26 cmH2O and mean airway pressures to less than 16 to 17 cmH2O
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Ep 16 · 2:12
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Jill Knepprath summarizes what Dr. Paul Kingma said: Previously, babies were fed once they had return of bowel function after repair
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Ep 16 · 2:44
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Jill Knepprath summarizes what Dr. Paul Kingma said: Previously, babies received as-needed sedation
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Ep 16 · 3:31
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Jill Knepprath summarizes what Dr. Paul Kingma said: The new cohort had 36 babies compared to 99 in the previous cohort
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Ep 16 · 3:31
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Jill Knepprath summarizes what Dr. Paul Kingma said: ECMO use increased from 14% to 22% in the new cohort
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Ep 16 · 4:09
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Jill Knepprath summarizes what Dr. Paul Kingma said: Survival for ECMO patients increased from 39% to 55%
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Ep 16 · 4:29
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Jill Knepprath summarizes what Dr. Paul Kingma said: ECMO use was around 41% in the old cohort versus 45% in the new cohort
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Inside a FETO Procedure: Fetoscopic Balloon Tracheal Occlusion with Dr. Beth Rymeski
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Ep 17 · 0:47
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Jill Knepprath summarizes what Dr. Beth Rymeski said: The goal of FETO is to allow fluid to stay in the lungs and allow the lungs to expand and grow.
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Ep 17 · 0:53
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Jill Knepprath summarizes what Dr. Beth Rymeski said: FETO helps prevent pulmonary hypoplasia, which is a big factor in poor outcomes for CDH babies.
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Ep 17 · 3:08
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Jill Knepprath summarizes what Dr. Beth Rymeski said: The balloon is filled with around 0.65 to 0.8 mL of water, depending on the size of the trachea.
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Ep 17 · 3:33
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Jill Knepprath summarizes what Dr. Beth Rymeski said: Sometimes the trocar advances into the mouth during the procedure and needs to be backed out.
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Ep 17 · 3:40
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Jill Knepprath summarizes what Dr. Beth Rymeski said: Final confirmation includes advancing the scope one more time to verify the balloon is below the vocal cords and in the main trachea.
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Inside a FETO Procedure: Fetoscopic Balloon Tracheal Occlusion with Dr. Beth Rymeski
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Ep 18 · 0:47
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Jill Knepprath summarizes what Dr. Beth Rymeski said: The goal of FETO is to allow fluid to stay in the lungs and allow the lungs to expand and grow.
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Ep 18 · 0:53
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Jill Knepprath summarizes what Dr. Beth Rymeski said: FETO helps prevent pulmonary hypoplasia, which is a big factor in poor outcomes for CDH babies.
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Ep 18 · 3:08
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Jill Knepprath summarizes what Dr. Beth Rymeski said: The balloon is filled with water, around 0.65 to 0.8 mL, depending on the size of the trachea.
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Ep 18 · 3:40
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Jill Knepprath summarizes what Dr. Beth Rymeski said: After balloon deployment, the scope is advanced one more time to confirm that the balloon is below the vocal cords and in the main trachea.
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Summaries Jill gave as host · Congenital Diaphragmatic Hernia
9 summaries
Open the Congenital Diaphragmatic Hernia collection →
Inside a FETO Procedure: Fetoscopic Balloon Tracheal Occlusion with Dr. Beth Rymeski
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Ep 11 · 0:47
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Jill Knepprath summarizes what Dr. Beth Rymeski said: The goal of FETO is to allow fluid to stay in the lungs and allow the lungs to expand and grow.
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Ep 11 · 0:53
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Jill Knepprath summarizes what Dr. Beth Rymeski said: FETO helps prevent pulmonary hypoplasia, which is a big factor in poor outcomes for CDH babies.
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Ep 11 · 3:08
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Jill Knepprath summarizes what Dr. Beth Rymeski said: The balloon is filled with around 0.65 to 0.8 mL of water, depending on the size of the trachea.
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Ep 11 · 3:33
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Jill Knepprath summarizes what Dr. Beth Rymeski said: Sometimes the trocar advances into the mouth during the procedure and needs to be backed out.
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Ep 11 · 3:40
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Jill Knepprath summarizes what Dr. Beth Rymeski said: Final confirmation includes advancing the scope one more time to verify the balloon is below the vocal cords and in the main trachea.
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Inside a FETO Procedure: Fetoscopic Balloon Tracheal Occlusion with Dr. Beth Rymeski
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Ep 12 · 0:47
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Jill Knepprath summarizes what Dr. Beth Rymeski said: The goal of FETO is to allow fluid to stay in the lungs and allow the lungs to expand and grow.
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Ep 12 · 0:53
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Jill Knepprath summarizes what Dr. Beth Rymeski said: FETO helps prevent pulmonary hypoplasia, which is a big factor in poor outcomes for CDH babies.
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Ep 12 · 3:08
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Jill Knepprath summarizes what Dr. Beth Rymeski said: The balloon is filled with water, around 0.65 to 0.8 mL, depending on the size of the trachea.
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Ep 12 · 3:40
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Jill Knepprath summarizes what Dr. Beth Rymeski said: After balloon deployment, the scope is advanced one more time to confirm that the balloon is below the vocal cords and in the main trachea.
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Summaries Jill gave as host · Congenital Pulmonary Airway Malformation
26 summaries
Open the Congenital Pulmonary Airway Malformation collection →
Congenital Lung Malformations: CPAM, BPS, CLE, and Bronchogenic Cyst Explained
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Ep 28 · 0:07
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Jill Knepprath summarizing a resource: These are some differential diagnoses you should know as you're learning about pediatric surgery.
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Ep 28 · 0:31
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Jill Knepprath summarizing a resource: CPAM (congenital pulmonary airway malformation) is the most common congenital lung malformation.
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Ep 28 · 0:37
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Jill Knepprath summarizing a resource: This is the most common congenital lung malformation.
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Ep 28 · 0:40
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Jill Knepprath summarizing a resource: It is an overgrowth of the terminal bronchioles, and it is most commonly found in just one lobe, usually the lower lobe.
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Ep 28 · 0:40
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Jill Knepprath summarizing a resource: CPAM is an overgrowth of the terminal bronchioles.
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Ep 28 · 0:40
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Jill Knepprath summarizing a resource: CPAM is most commonly found in just one lobe, usually the lower lobe.
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Ep 28 · 0:48
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Jill Knepprath summarizing a resource: CPAM has a direct communication with the lung parenchyma and the blood supply.
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Ep 28 · 1:02
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Jill Knepprath summarizing a resource: Bronchopulmonary sequestration doesn't have a continuation with the tracheobronchial tree.
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Ep 28 · 1:06
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Jill Knepprath summarizing a resource: Bronchopulmonary sequestration has an aberrant systemic artery supplying it, usually coming off of the aorta.
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Ep 28 · 1:20
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Jill Knepprath summarizing a resource: Bronchopulmonary sequestrations can be intralobar or extralobar.
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Ep 28 · 1:27
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Jill Knepprath summarizing a resource: Intralobar bronchopulmonary sequestrations are usually in the lower lobes.
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Ep 28 · 1:27
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Jill Knepprath summarizing a resource: Intralobar bronchopulmonary sequestrations, even though not aerated, get some collateral ventilation from surrounding lung tissue and are prone to infection.
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Ep 28 · 1:27
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Jill Knepprath summarizing a resource: Intralobar bronchopulmonary sequestrations are within the visceral pleura.
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Ep 28 · 1:42
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Jill Knepprath summarizing a resource: Extralobar bronchopulmonary sequestrations are less common than intralobar.
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Ep 28 · 1:42
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Jill Knepprath summarizing a resource: Extralobar bronchopulmonary sequestrations have their own pleura.
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Ep 28 · 1:48
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Jill Knepprath summarizing a resource: Infections are less common in extralobar bronchopulmonary sequestrations.
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Ep 28 · 1:52
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Jill Knepprath summarizing a resource: Extralobar bronchopulmonary sequestrations can be under the diaphragm.
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Ep 28 · 1:55
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Jill Knepprath summarizing a resource: Congenital lobar emphysema is a focal cartilaginous abnormality of the bronchial wall which creates a valve effect.
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Ep 28 · 2:07
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Jill Knepprath summarizing a resource: Congenital lobar emphysema causes the subsequent lobe to overinflate.
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Ep 28 · 2:14
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Jill Knepprath summarizing a resource: Congenital lobar emphysema only affects one lobe.
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Ep 28 · 2:18
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Jill Knepprath summarizing a resource: The left upper lobe and the right middle lobe are the most commonly affected in congenital lobar emphysema.
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Ep 28 · 2:23
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Jill Knepprath summarizing a resource: Bronchogenic cyst is a unilocular malformation.
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Ep 28 · 2:28
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Jill Knepprath summarizing a resource: Bronchogenic cyst happens because of an abnormal budding of the primitive ventral foregut.
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Ep 28 · 2:32
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Jill Knepprath summarizing a resource: Bronchogenic cyst contains cartilaginous tissue, smooth muscle, and bronchial glands.
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Ep 28 · 2:36
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Jill Knepprath summarizing a resource: Bronchogenic cyst does not communicate with the tracheobronchial tree unless it's a rarer intrapulmonary form.
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Ep 28 · 2:36
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Jill Knepprath summarizing a resource: Bronchogenic cyst is usually in the mediastinum next to the trachea or the main stem bronchi.
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Summaries Jill gave as host · Enterocolitis
4 summaries
Open the Enterocolitis collection →
Update Course Rewind 2025: Botox for Hirschsprung’s: Where, When, and Why
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Ep 22 · 0:45
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Jill Knepprath summarizing the discussion: A 2022 multi-center study found that 24% of patients undergoing pull-through procedure also received Botox
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Ep 22 · 1:09
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Jill Knepprath summarizing the discussion: Patients that received Botox had a higher chance of diaper rash
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Ep 22 · 1:37
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Jill Knepprath summarizing the discussion: Injecting Botox during pull-through procedure for Hirschsprung's disease has been shown to reduce enterocolitis risk
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Ep 22 · 1:41
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Jill Knepprath summarizing the discussion: Dosing and guidance for Botox injection varies widely
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Summaries Jill gave as host · Enterocolitis
4 summaries
Open the Enterocolitis collection →
Update Course Rewind 2025: Botox for Hirschsprung’s: Where, When, and Why
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Ep 22 · 0:45
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Jill Knepprath summarizing the discussion: A 2022 multi-center study found that 24% of patients undergoing pull-through procedure also received Botox
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Ep 22 · 1:09
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Jill Knepprath summarizing the discussion: Patients that received Botox had a higher chance of diaper rash
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Ep 22 · 1:37
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Jill Knepprath summarizing the discussion: Injecting Botox during pull-through procedure for Hirschsprung's disease has been shown to reduce enterocolitis risk
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Ep 22 · 1:41
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Jill Knepprath summarizing the discussion: Dosing and guidance for Botox injection varies widely
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Summaries Jill gave as host · Esophageal Atresia
22 summaries
Open the Esophageal Atresia collection →
Update Course Rewind 2025: The Recurrent TEF Problem
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Ep 76 · 0:08
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Jill Knepprath summarizes what Dr. Douglas von Allmen said: What do you do if a patient develops a second tracheoesophageal fistula years after repair?
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Ep 76 · 0:08
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Jill Knepprath summarizes what Dr. Douglas von Allmen said: Recurrent tracheoesophageal fistulas can develop years after initial TEF repair.
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Ep 76 · 0:48
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Jill Knepprath summarizes what Dr. Douglas von Allmen said: Esophageal dilations were performed without improvement.
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Ep 76 · 1:03
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Jill Knepprath summarizes what Dr. Douglas von Allmen said: Bronchoscopy revealed granulation tissue along the back wall of the airway.
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Ep 76 · 1:17
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Jill Knepprath summarizes what Dr. Douglas von Allmen said: The recurrent laryngeal nerve is at risk of damage during repair of recurrent TEFs.
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Ep 76 · 1:25
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Jill Knepprath summarizes what Dr. Douglas von Allmen said: A transtracheal approach provides better surgical exposure and reduces the risk of recurrent laryngeal nerve injury.
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Ep 76 · 1:46
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Jill Knepprath summarizes what Dr. Douglas von Allmen said: The transtracheal approach helps minimize injury to the recurrent laryngeal nerve.
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Esophageal Atresia & Tracheoesophageal Fistula (EA/TEF) Types Explained for Pediatric Surgery
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Ep 77 · 0:00
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Jill Knepprath summarizing a resource: Today I'm going to walk through esophageal atresia and tracheoesophageal fistula, or TEF.
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Ep 77 · 0:05
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Jill Knepprath summarizing a resource: EA/TEF is a basic concept in pediatric surgery.
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Ep 77 · 0:10
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Jill Knepprath summarizing a resource: In normal anatomy, the esophagus goes straight down to the stomach with no atresia or interruptions, and the trachea goes straight down to the lungs with no connections between the two.
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Ep 77 · 0:29
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Jill Knepprath summarizing a resource: Type A EA/TEF consists of esophageal atresia proximally and distally in the esophagus, preventing solids and liquids from reaching the stomach, with no connection between esophagus and trachea.
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Ep 77 · 0:45
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Jill Knepprath summarizing a resource: Type B EA/TEF has distal esophageal atresia and a proximal fistula, allowing solids and liquids to enter the trachea while the stomach remains empty.
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Ep 77 · 1:08
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Jill Knepprath summarizing a resource: Type C is the most common
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Ep 77 · 1:08
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Jill Knepprath summarizing a resource: Type C EA/TEF is the most common type.
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Ep 77 · 1:13
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Jill Knepprath summarizing a resource: Type C EA/TEF has proximal esophageal atresia and a distal fistula, allowing air to reach both lungs and stomach while solids and liquids cannot reach the stomach.
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Ep 77 · 1:28
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Jill Knepprath summarizing a resource: Type D EA/TEF has both a distal fistula and a proximal fistula, allowing solids and liquids into the trachea and air into both lungs and stomach.
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Ep 77 · 1:43
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Jill Knepprath summarizing a resource: Type E EA/TEF has no atresia but does have a tracheoesophageal fistula, which is often pretty high.
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Ep 77 · 1:52
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Jill Knepprath summarizing a resource: Type E EA/TEF is also known as H-type because of its anatomical appearance.
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Ep 77 · 1:52
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Jill Knepprath summarizing a resource: This is also known as H. You can see the H right here.
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Ep 77 · 1:56
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Jill Knepprath summarizing a resource: Type E (H-type) EA/TEF has the best results and is usually the easiest to fix.
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Ep 77 · 1:56
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Jill Knepprath summarizing a resource: And this is the one with the best results and usually the easiest to fix.
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Ep 77 · 2:01
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Jill Knepprath summarizing a resource: Children with Type E (H-type) EA/TEF may present with symptoms later because they are still able to get solids and liquids down to the stomach and air to the lungs.
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Summaries Jill gave as host · Esophageal Atresia
15 summaries
Open the Esophageal Atresia collection →
Esophageal Atresia & Tracheoesophageal Fistula (EA/TEF) Types Explained for Pediatric Surgery
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Ep 40 · 0:00
host summary
Jill Knepprath summarizing a resource: Today I'm going to walk through esophageal atresia and tracheoesophageal fistula, or TEF.
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Ep 40 · 0:05
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Jill Knepprath summarizing a resource: EA/TEF is a basic concept in pediatric surgery.
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Ep 40 · 0:10
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Jill Knepprath summarizing a resource: In normal anatomy, the esophagus goes straight down to the stomach with no atresia or interruptions, and the trachea goes straight down to the lungs with no connections between the two.
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Ep 40 · 0:29
host summary
Jill Knepprath summarizing a resource: Type A EA/TEF consists of esophageal atresia proximally and distally in the esophagus, preventing solids and liquids from reaching the stomach, with no connection between esophagus and trachea.
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Ep 40 · 0:45
host summary
Jill Knepprath summarizing a resource: Type B EA/TEF has distal esophageal atresia and a proximal fistula, allowing solids and liquids to enter the trachea while the stomach remains empty.
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Ep 40 · 1:08
host summary
Jill Knepprath summarizing a resource: Type C is the most common
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Ep 40 · 1:08
host summary
Jill Knepprath summarizing a resource: Type C EA/TEF is the most common type.
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Ep 40 · 1:13
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Jill Knepprath summarizing a resource: Type C EA/TEF has proximal esophageal atresia and a distal fistula, allowing air to reach both lungs and stomach while solids and liquids cannot reach the stomach.
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Ep 40 · 1:28
host summary
Jill Knepprath summarizing a resource: Type D EA/TEF has both a distal fistula and a proximal fistula, allowing solids and liquids into the trachea and air into both lungs and stomach.
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Ep 40 · 1:43
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Jill Knepprath summarizing a resource: Type E EA/TEF has no atresia but does have a tracheoesophageal fistula, which is often pretty high.
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Ep 40 · 1:52
host summary
Jill Knepprath summarizing a resource: This is also known as H. You can see the H right here.
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Ep 40 · 1:52
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Jill Knepprath summarizing a resource: Type E EA/TEF is also known as H-type because of its anatomical appearance.
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Ep 40 · 1:56
host summary
Jill Knepprath summarizing a resource: And this is the one with the best results and usually the easiest to fix.
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Ep 40 · 1:56
host summary
Jill Knepprath summarizing a resource: Type E (H-type) EA/TEF has the best results and is usually the easiest to fix.
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Ep 40 · 2:01
host summary
Jill Knepprath summarizing a resource: Children with Type E (H-type) EA/TEF may present with symptoms later because they are still able to get solids and liquids down to the stomach and air to the lungs.
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Summaries Jill gave as host · Favorable Histology Wilms Tumor
23 summaries
Open the Favorable Histology Wilms Tumor collection →
Impact of Pulmonary Tumor Burden in Favorable Histology Wilms Tumor Outcomes: A Report From the Children's Oncology Group Study AREN053
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Ep 1 · 0:00
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Jill Knepprath summarizing a resource: Your patient has a Wilms tumor with favorable histology, but workup shows that they also have lung metastases.
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Ep 1 · 0:14
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Jill Knepprath summarizing a resource: Dick et al. published a report from a Children's Oncology Group study in the Journal of Clinical Oncology in 2025
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Ep 1 · 0:19
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Jill Knepprath summarizing a resource: The study examined factors in patients with favorable histology Wilms tumor and pulmonary metastases and how those factors may affect outcomes
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Ep 1 · 0:30
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Jill Knepprath summarizing a resource: Factors studied included the number of metastases, the size of the metastases, and different biological markers
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Ep 1 · 0:36
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Jill Knepprath summarizing a resource: There was no difference in survival based on the number of metastases
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Ep 1 · 0:41
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Jill Knepprath summarizing a resource: Patients who had a rapid response to chemotherapy with larger nodules showed worse event-free survival
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Ep 1 · 0:41
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Jill Knepprath summarizing a resource: Patients with larger nodules and rapid response to chemotherapy showed no changes in overall survival
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Ep 1 · 0:49
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Jill Knepprath summarizing a resource: In multivariable models, neither the size nor the number of nodules had any effect on survival
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Ep 1 · 0:55
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Jill Knepprath summarizing a resource: 1q gain was associated with worse event-free survival
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Ep 1 · 0:55
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Jill Knepprath summarizing a resource: 1q gain was associated with worse overall survival
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Ep 1 · 1:04
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Jill Knepprath summarizing a resource: One cue gain is the superior prognostic factor when compared to size and number of nodules in patients with favorable histology Wilms and pulmonary metastases.
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Ep 1 · 1:04
host summary
Jill Knepprath summarizing a resource: 1q gain is the superior prognostic factor when compared to size and number of nodules in patients with favorable histology Wilms tumor and pulmonary metastases
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Updated Favorable histology Wilms tumor risk stratification: Rationale for future Children’s Oncology Group clinical trials
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Ep 2 · 0:00
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Jill Knepprath summarizing a resource: Risk stratification for Wilm's tumor has evolved many times over the years, so let's catch up.
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Ep 2 · 0:00
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Jill Knepprath summarizing a resource: Risk stratification for Wilms tumor has evolved many times over the years.
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Ep 2 · 0:09
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Jill Knepprath summarizing a resource: The Children's Oncology Group published updated risk stratification for patients with favorable histology Wilms tumor in Nature in June 2025.
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Ep 2 · 0:19
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Jill Knepprath summarizing a resource: The new risk stratification model includes biological and clinical features that were not in the first generation risk stratification.
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Ep 2 · 0:27
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Jill Knepprath summarizing a resource: The new model changes some of the older features or gets rid of them altogether.
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Ep 2 · 0:32
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Jill Knepprath summarizing a resource: Factors being added are loss of heterozygosity of 11P15, 1Q gain, and lymph node involvement.
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Ep 2 · 0:32
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Jill Knepprath summarizing a resource: Factors that are being added are loss of heterozygosity of 11P15C, 1Q gain. And lymph node involvement.
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Ep 2 · 0:41
host summary
Jill Knepprath summarizing a resource: Tumor nephrectomy weight is no longer included.
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Ep 2 · 0:41
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Jill Knepprath summarizing a resource: Tumor nephrectomy weight is no longer included in the risk stratification.
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Ep 2 · 0:43
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Jill Knepprath summarizing a resource: The model modified how histology and age are used to stratify certain patients.
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Ep 2 · 0:48
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Jill Knepprath summarizing a resource: More changes are expected in the future as ongoing COG trials produce more results.
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Summaries Jill gave as host · Fecal Incontinence
7 summaries
Open the Fecal Incontinence collection →
Update Course Rewind 2025: Sacral Nerve Stimulation for Refractory Pediatric Fecal Incontinence
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Ep 10 · 0:25
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Jill Knepprath summarizes what Dr. Ben Hamm said: What do you do when nothing is working for a child with severe fecal incontinence?
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Ep 10 · 0:49
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Jill Knepprath summarizes what Dr. Ben Hamm said: Contrast enema showed an elongated sigmoid colon, but a previous rectal biopsy was normal.
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Ep 10 · 0:56
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Jill Knepprath summarizes what Dr. Ben Hamm said: Anti-grade colonic enema procedures or sycostomy tubes are traditionally a reasonable next step for refractory pediatric fecal incontinence.
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Ep 10 · 1:14
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Jill Knepprath summarizes what Dr. Ben Hamm said: Overnight, the rate of the child needing a diaper went from 33% to 11% with sacral nerve stimulation.
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Ep 10 · 1:31
host summary
Jill Knepprath summarizes what Dr. Ben Hamm said: A 2023 study showed an improvement in involuntary daytime and nighttime bowel movements with sacral nerve stimulation.
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Ep 10 · 1:49
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Jill Knepprath summarizes what Dr. Ben Hamm said: How is the stimulator placed and how does it work?
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Ep 10 · 2:02
host summary
Jill Knepprath summarizes what Dr. Ben Hamm said: If symptoms improve during the trial, the stimulator can be implanted long term with a battery pack.
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Summaries Jill gave as host · Fetal Surgery
13 summaries
Open the Fetal Surgery collection →
Inside a FETO Procedure: Fetoscopic Balloon Tracheal Occlusion with Dr. Beth Rymeski
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Ep 28 · 0:47
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Jill Knepprath summarizes what Dr. Beth Rymeski said: The goal of FETO is to allow fluid to stay in the lungs and allow the lungs to expand and grow.
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Ep 28 · 0:53
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Jill Knepprath summarizes what Dr. Beth Rymeski said: FETO helps prevent pulmonary hypoplasia, which is a big factor in poor outcomes for CDH babies.
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Ep 28 · 3:08
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Jill Knepprath summarizes what Dr. Beth Rymeski said: The balloon is filled with around 0.65 to 0.8 mL of water, depending on the size of the trachea.
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Ep 28 · 3:33
host summary
Jill Knepprath summarizes what Dr. Beth Rymeski said: Sometimes the trocar advances into the mouth during the procedure and needs to be backed out.
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Ep 28 · 3:40
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Jill Knepprath summarizes what Dr. Beth Rymeski said: Final confirmation includes advancing the scope one more time to verify the balloon is below the vocal cords and in the main trachea.
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Inside a FETO Procedure: Fetoscopic Balloon Tracheal Occlusion with Dr. Beth Rymeski
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Ep 30 · 0:47
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Jill Knepprath summarizes what Dr. Beth Rymeski said: The goal of FETO is to allow fluid to stay in the lungs and allow the lungs to expand and grow.
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Ep 30 · 0:47
host summary
Jill Knepprath summarizes what Dr. Beth Rymeski said: The goal of FETO is to allow fluid to stay in the lungs and allow the lungs to expand and grow.
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Ep 30 · 0:53
host summary
Jill Knepprath summarizes what Dr. Beth Rymeski said: FETO helps prevent pulmonary hypoplasia, which is a big factor in poor outcomes for CDH babies.
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Ep 30 · 0:53
host summary
Jill Knepprath summarizes what Dr. Beth Rymeski said: FETO helps prevent pulmonary hypoplasia, which is a big factor in poor outcomes for CDH babies.
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Ep 30 · 3:08
host summary
Jill Knepprath summarizes what Dr. Beth Rymeski said: The balloon is filled with water, around 0.65 to 0.8 mL, depending on the size of the trachea.
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Ep 30 · 3:08
host summary
Jill Knepprath summarizes what Dr. Beth Rymeski said: The balloon is filled with water, around 0.65 to 0.8 mL, depending on the size of the trachea.
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Ep 30 · 3:40
host summary
Jill Knepprath summarizes what Dr. Beth Rymeski said: After balloon deployment, the scope is advanced one more time to confirm that the balloon is below the vocal cords and in the main trachea.
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Ep 30 · 3:40
host summary
Jill Knepprath summarizes what Dr. Beth Rymeski said: After balloon deployment, the scope is advanced one more time to confirm that the balloon is below the vocal cords and in the main trachea.
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Summaries Jill gave as host · Hepatoblastoma
16 summaries
Open the Hepatoblastoma collection →
Characteristics of Transfusion and Association With Oncologic Outcomes in Hepatoblastoma Resection
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Ep 15 · 0:00
host summary
Jill Knepprath summarizing a resource: It's not uncommon for a patient with hepatoblastoma to need a transfusion during resection.
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Ep 15 · 0:00
host summary
Jill Knepprath summarizing a resource: It is not uncommon for a patient with hepatoblastoma to need a transfusion during resection
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Ep 15 · 0:13
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Jill Knepprath summarizing a resource: The study was multi-institutional and published in Pediatric Blood and Cancer in 2025
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Ep 15 · 0:19
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Jill Knepprath summarizing a resource: The study examined how intraoperative transfusion may affect recurrence and survival in hepatoblastoma resection patients
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Ep 15 · 0:25
host summary
Jill Knepprath summarizing a resource: Only 11% of transfused patients received platelets
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Ep 15 · 0:25
host summary
Jill Knepprath summarizing a resource: Of those transfused, the majority received red blood cells
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Ep 15 · 0:32
host summary
Jill Knepprath summarizing a resource: Intraoperative blood transfusions were associated with increased death
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Ep 15 · 0:32
host summary
Jill Knepprath summarizing a resource: Intraoperative blood transfusions had no effect on recurrence
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Ep 15 · 0:32
host summary
Jill Knepprath summarizing a resource: Intraoperative blood transfusions had no effect on recurrence, however, they were associated with increased death.
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Ep 15 · 0:39
host summary
Jill Knepprath summarizing a resource: There were instances of unnecessary blood transfusions
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Ep 15 · 0:43
host summary
Jill Knepprath summarizing a resource: Patients who were transfused had higher post-op hemoglobin
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Ep 15 · 0:43
host summary
Jill Knepprath summarizing a resource: Transfused patients still required more plasma and platelets postoperatively
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Ep 15 · 0:52
host summary
Jill Knepprath summarizing a resource: The authors think that blood transfusions were mostly red blood cells, and that is what contributed to the post-op coagulopathy
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Ep 15 · 0:52
host summary
Jill Knepprath summarizing a resource: The authors think that blood transfusions were mostly red blood cells, and that is what contributed to the post-op coagulopathy.
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Ep 15 · 1:00
host summary
Jill Knepprath summarizing a resource: The authors recommend a balanced transfusion approach
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Ep 15 · 1:00
host summary
Jill Knepprath summarizing a resource: The authors recommend more careful patient selection for intraoperative transfusions
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Summaries Jill gave as host · Hirschsprung disease
31 summaries
Open the Hirschsprung disease collection →
Update Course Rewind 2025: Hirschsprung’s Pull-Through: Why Family Training May Save Lives
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Ep 82 · 0:59
host summary
Jill Knepprath summarizing the discussion: The median age of the delayed pull-through group was 98 days at time of surgery.
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Ep 82 · 0:59
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Jill Knepprath summarizing the discussion: The median age of the neonatal pull-through group was 11 days at time of surgery.
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Ep 82 · 1:06
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Jill Knepprath summarizing the discussion: The PCPLC study found no difference in fecal incontinence at follow-up between neonatal and delayed pull-through groups.
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Ep 82 · 1:06
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Jill Knepprath summarizing the discussion: The PCPLC study found no difference in postoperative enterocolitis between neonatal and delayed pull-through groups.
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Ep 82 · 1:06
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Jill Knepprath summarizing the discussion: The PCPLC study found no difference in preoperative enterocolitis between neonatal and delayed pull-through groups.
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Update Course Rewind 2025: Botox for Hirschsprung’s: Where, When, and Why
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Ep 83 · 0:45
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Jill Knepprath summarizing the discussion: A 2022 multi-center study found that 24% of patients undergoing pull-through procedure also received Botox
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Ep 83 · 1:09
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Jill Knepprath summarizing the discussion: Patients that received Botox had a higher chance of diaper rash
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Ep 83 · 1:37
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Jill Knepprath summarizing the discussion: Injecting Botox during pull-through procedure for Hirschsprung's disease has been shown to reduce enterocolitis risk
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Ep 83 · 1:41
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Jill Knepprath summarizing the discussion: Dosing and guidance for Botox injection varies widely
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Update Course Rewind 2025: Hirschsprung + ARM: Rare but Real
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Ep 84 · 0:34
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Jill Knepprath summarizing the discussion: The correct answer is less than 2%.
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Ep 84 · 0:34
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Jill Knepprath summarizing the discussion: The rate of Hirschsprung disease and anorectal malformation occurring together is less than 2%
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Ep 84 · 0:37
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Jill Knepprath summarizing the discussion: The co-occurrence of Hirschsprung disease and ARM is something to keep in mind for patients with trisomy 21
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Ep 84 · 0:37
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Jill Knepprath summarizing the discussion: It's rare, but something to keep in mind for patients with trisomy 21.
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Ep 84 · 0:58
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Jill Knepprath summarizing the discussion: Hypo or absent ganglion cells were found in the remaining specimens (9%)
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Ep 84 · 0:58
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Jill Knepprath summarizing the discussion: Ganglion cells were found in 91% of rectal fistula specimens
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Ep 84 · 1:05
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Jill Knepprath summarizing the discussion: Absent ganglion cells in fistula tissue does not necessarily mean the patient has Hirschsprung disease
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Ep 84 · 1:05
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Jill Knepprath summarizing the discussion: But absent cells in fistula tissue doesn't necessarily mean it's Hirschsprung's disease.
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Ep 84 · 1:11
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Jill Knepprath summarizing the discussion: Three patients (4% of the cohort) had both Hirschsprung disease and an anorectal malformation
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Ep 84 · 1:15
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Jill Knepprath summarizing the discussion: Two of the three patients with both conditions also had trisomy 21
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Ep 84 · 1:31
host summary
Jill Knepprath summarizing the discussion: Complex anorectal malformation patients with chromosomal anomalies who do not respond to laxatives or enemas should be worked up for Hirschsprung disease
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Update Course Rewind 2025: Hirschsprung + ARM: Rare but Real
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Ep 85 · 0:34
host summary
Jill Knepprath summarizing the discussion: The rate of Hirschsprung disease and anorectal malformation occurring together is less than 2%
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Ep 85 · 0:34
host summary
Jill Knepprath summarizing the discussion: The correct answer is less than 2%.
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Ep 85 · 0:37
host summary
Jill Knepprath summarizing the discussion: The co-occurrence of Hirschsprung disease and ARM is something to keep in mind for patients with trisomy 21
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Ep 85 · 0:37
host summary
Jill Knepprath summarizing the discussion: It's rare, but something to keep in mind for patients with trisomy 21.
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Ep 85 · 0:58
host summary
Jill Knepprath summarizing the discussion: Ganglion cells were found in 91% of rectal fistula specimens
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Ep 85 · 0:58
host summary
Jill Knepprath summarizing the discussion: Hypo or absent ganglion cells were found in the remaining rectal fistula specimens
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Ep 85 · 1:05
host summary
Jill Knepprath summarizing the discussion: But absent cells in fistula tissue doesn't necessarily mean it's Hirschsprung's disease.
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Ep 85 · 1:05
host summary
Jill Knepprath summarizing the discussion: Absent ganglion cells in fistula tissue does not necessarily mean the patient has Hirschsprung disease
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Ep 85 · 1:11
host summary
Jill Knepprath summarizing the discussion: Three patients (4% of the study cohort) had both Hirschsprung disease and anorectal malformation
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Ep 85 · 1:15
host summary
Jill Knepprath summarizing the discussion: Two of the three patients with both conditions had trisomy 21
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Ep 85 · 1:31
host summary
Jill Knepprath summarizing the discussion: Complex anorectal malformation patients with chromosomal anomalies who do not respond to laxatives or enemas should be worked up for Hirschsprung disease
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Summaries Jill gave as host · Inguinal Hernia
19 summaries
Open the Inguinal Hernia collection →
Surgeon annual volume impacts recurrence rates of pediatric inguinal hernia repairs: A multi-institutional study
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Ep 22 · 0:10
host summary
Jill Knepprath summarizing a resource: Heller et al. published a multi-institutional study in the Journal of Pediatric Surgery in 2025 exploring the impact of surgeon volume on patients with inguinal hernias.
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Ep 22 · 0:22
host summary
Jill Knepprath summarizing a resource: Inguinal hernias repaired by lower volume surgeons had a 1.5 fold increase in the odds of recurrence.
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Ep 22 · 0:22
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Jill Knepprath summarizing a resource: The authors found that inguinal hernias repaired by lower volume surgeons had a 1.5 fold increase in the odds of recurrence.
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Ep 22 · 0:30
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Jill Knepprath summarizing a resource: When broken down by surgical approach, there was no difference in recurrence rates for open inguinal hernia repairs based on surgeon volume.
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Ep 22 · 0:35
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Jill Knepprath summarizing a resource: Laparoscopic inguinal hernia repairs done by lower volume surgeons had a 3.3 fold increase in the odds of recurrence.
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Ep 22 · 0:35
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Jill Knepprath summarizing a resource: However, laparoscopic repairs done by lower volume surgeons had a 3.3 fold increase in the odds of recurrence.
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Ep 22 · 0:44
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Jill Knepprath summarizing a resource: The authors of the Heller et al. study recommend maintaining a high volume of laparoscopic repairs, and if that's not possible, to seek help from a higher volume surgeon.
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Laparoscopic modified percutaneous internal ring suturing - a mesh-free alternative for indirect inguinal hernia repair in adults. a pilot prospective cohort study
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Ep 23 · 0:00
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Jill Knepprath summarizing a resource: High ligation hernia repair, that's for kids.
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Ep 23 · 0:03
host summary
Jill Knepprath summarizing a resource: Or is it?
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Ep 23 · 0:08
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Jill Knepprath summarizing a resource: The study was published in the International Journal of Surgery.
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Ep 23 · 0:12
host summary
Jill Knepprath summarizing a resource: The study used the modified percutaneous internal ring suturing technique to evaluate whether a laparoscopic non-mesh repair works on indirect inguinal hernias in adults.
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Ep 23 · 0:22
host summary
Jill Knepprath summarizing a resource: So did it work?
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Ep 23 · 0:23
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Jill Knepprath summarizing a resource: There were 20 patients in the study.
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Ep 23 · 0:25
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Jill Knepprath summarizing a resource: The majority of patients were male.
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Ep 23 · 0:26
host summary
Jill Knepprath summarizing a resource: No patients had hernia recurrence on follow-up, with a median follow-up of 79 months.
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Ep 23 · 0:31
host summary
Jill Knepprath summarizing a resource: Patients reported a decrease in pain and an improved activity post-operatively.
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Ep 23 · 0:35
host summary
Jill Knepprath summarizing a resource: This is a small single-center study.
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Ep 23 · 0:35
host summary
Jill Knepprath summarizing a resource: The study shows success with the modified PIRS technique in adults.
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Ep 23 · 0:41
host summary
Jill Knepprath summarizing a resource: Would you offer this to your hernia patients?
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Summaries Jill gave as host · Liver Tumors (Hepatoblastoma/HCC)
16 summaries
Open the Liver Tumors (Hepatoblastoma/HCC) collection →
Characteristics of Transfusion and Association With Oncologic Outcomes in Hepatoblastoma Resection
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Ep 16 · 0:00
host summary
Jill Knepprath summarizing a resource: It's not uncommon for a patient with hepatoblastoma to need a transfusion during resection.
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Ep 16 · 0:00
host summary
Jill Knepprath summarizing a resource: It is not uncommon for a patient with hepatoblastoma to need a transfusion during resection
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▶
Ep 16 · 0:13
host summary
Jill Knepprath summarizing a resource: The study was multi-institutional and published in Pediatric Blood and Cancer in 2025
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Ep 16 · 0:19
host summary
Jill Knepprath summarizing a resource: The study examined how intraoperative transfusion may affect recurrence and survival in hepatoblastoma resection patients
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Ep 16 · 0:25
host summary
Jill Knepprath summarizing a resource: Only 11% of transfused patients received platelets
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Ep 16 · 0:25
host summary
Jill Knepprath summarizing a resource: Of those transfused, the majority received red blood cells
↗
▶
Ep 16 · 0:32
host summary
Jill Knepprath summarizing a resource: Intraoperative blood transfusions were associated with increased death
↗
▶
Ep 16 · 0:32
host summary
Jill Knepprath summarizing a resource: Intraoperative blood transfusions had no effect on recurrence
↗
▶
Ep 16 · 0:32
host summary
Jill Knepprath summarizing a resource: Intraoperative blood transfusions had no effect on recurrence, however, they were associated with increased death.
↗
▶
Ep 16 · 0:39
host summary
Jill Knepprath summarizing a resource: There were instances of unnecessary blood transfusions
↗
▶
Ep 16 · 0:43
host summary
Jill Knepprath summarizing a resource: Transfused patients still required more plasma and platelets postoperatively
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▶
Ep 16 · 0:43
host summary
Jill Knepprath summarizing a resource: Patients who were transfused had higher post-op hemoglobin
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▶
Ep 16 · 0:52
host summary
Jill Knepprath summarizing a resource: The authors think that blood transfusions were mostly red blood cells, and that is what contributed to the post-op coagulopathy.
↗
▶
Ep 16 · 0:52
host summary
Jill Knepprath summarizing a resource: The authors think that blood transfusions were mostly red blood cells, and that is what contributed to the post-op coagulopathy
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▶
Ep 16 · 1:00
host summary
Jill Knepprath summarizing a resource: The authors recommend more careful patient selection for intraoperative transfusions
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Ep 16 · 1:00
host summary
Jill Knepprath summarizing a resource: The authors recommend a balanced transfusion approach
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Summaries Jill gave as host · Lymphatic Malformation
4 summaries
Open the Lymphatic Malformation collection →
Update Course Rewind 2025: Neck Pathologies - The Diagnostic Challenge
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Ep 5 · 0:50
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Jill Knepprath summarizes what Dr. Douglas von Allmen said: A ranula is a benign cyst that forms under the tongue caused by saliva leaking from a blocked sublingual gland.
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Ep 5 · 0:58
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Jill Knepprath summarizes what Dr. Douglas von Allmen said: Lymphatic malformations are clusters of lymph vessels that are often present at birth.
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Ep 5 · 2:43
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Jill Knepprath summarizes what Dr. Douglas von Allmen said: For lymphatic malformations, there are 3 procedural treatments: laser, sclerotherapy, and excision.
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Ep 5 · 2:49
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Jill Knepprath summarizes what Dr. Douglas von Allmen said: There are 3 medical therapies for lymphatic malformations that are still undergoing clinical trials.
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Summaries Jill gave as host · Metastatic Disease
15 summaries
Open the Metastatic Disease collection →
Malignant peripheral nerve sheath tumors: a report from Children’s Oncology Group study ARST0332
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Ep 4 · 0:00
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Jill Knepprath summarizing a resource: Is there a role for chemo radiation in peripheral nerve sheath tumors, or is excision all that is needed?
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Ep 4 · 0:11
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Jill Knepprath summarizing a resource: The Children's Oncology Group published a prospective trial on malignant peripheral nerve sheath tumors in the Journal of the National Cancer Institute in 2025.
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Ep 4 · 0:24
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Jill Knepprath summarizing a resource: Patients were assigned to four treatment groups: observation, adjuvant radiation, adjuvant chemoradiation, and neoadjuvant chemoradiation.
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Ep 4 · 0:35
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Jill Knepprath summarizing a resource: Overall results confirmed that resection has a major influence on survival for these patients.
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Ep 4 · 0:35
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Jill Knepprath summarizing a resource: Resection has a major influence on survival for patients with malignant peripheral nerve sheath tumors.
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Ep 4 · 0:40
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Jill Knepprath summarizing a resource: Female patients with malignant peripheral nerve sheath tumors had improved outcomes.
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Ep 4 · 0:40
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Jill Knepprath summarizing a resource: Patients without metastatic disease had improved outcomes.
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Ep 4 · 0:40
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Jill Knepprath summarizing a resource: Low-risk patients had improved outcomes.
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Ep 4 · 0:46
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Jill Knepprath summarizing a resource: In patients receiving neoadjuvant therapy, 23% showed a response.
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Ep 4 · 0:46
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Jill Knepprath summarizing a resource: In patients receiving neoadjuvant therapy, 45% were stable.
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Ep 4 · 0:46
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Jill Knepprath summarizing a resource: In patients receiving neoadjuvant therapy, 32% had progressive disease.
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Ep 4 · 0:59
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Jill Knepprath summarizing a resource: There was no difference in survival based on the response to neoadjuvant therapy among patients who went on to have resection.
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Ep 4 · 0:59
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Jill Knepprath summarizing a resource: There was no difference in survival based on the response to neoadjuvant therapy.
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Ep 4 · 1:03
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Jill Knepprath summarizing a resource: Overall, this study confirms that resection should be done for these patients whenever possible, even if they show a good response to chemo radiation.
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Ep 4 · 1:03
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Jill Knepprath summarizing a resource: Resection should be done for patients with malignant peripheral nerve sheath tumors whenever possible, even if they show a good response to chemoradiation.
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Summaries Jill gave as host · Neurofibromatosis
15 summaries
Open the Neurofibromatosis collection →
Malignant peripheral nerve sheath tumors: a report from Children’s Oncology Group study ARST0332
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Ep 1 · 0:00
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Jill Knepprath summarizing a resource: Is there a role for chemo radiation in peripheral nerve sheath tumors, or is excision all that is needed?
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Ep 1 · 0:11
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Jill Knepprath summarizing a resource: The Children's Oncology Group published a prospective trial on malignant peripheral nerve sheath tumors in the Journal of the National Cancer Institute in 2025.
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Ep 1 · 0:24
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Jill Knepprath summarizing a resource: Patients were assigned to four treatment groups: observation, adjuvant radiation, adjuvant chemoradiation, and neoadjuvant chemoradiation.
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Ep 1 · 0:35
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Jill Knepprath summarizing a resource: Overall results confirmed that resection has a major influence on survival for these patients.
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Ep 1 · 0:35
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Jill Knepprath summarizing a resource: Resection has a major influence on survival for patients with malignant peripheral nerve sheath tumors.
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Ep 1 · 0:40
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Jill Knepprath summarizing a resource: Low-risk patients had improved outcomes.
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Ep 1 · 0:40
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Jill Knepprath summarizing a resource: Patients without metastatic disease had improved outcomes.
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Ep 1 · 0:40
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Jill Knepprath summarizing a resource: Female patients with malignant peripheral nerve sheath tumors had improved outcomes.
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Ep 1 · 0:46
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Jill Knepprath summarizing a resource: In patients receiving neoadjuvant therapy, 32% had progressive disease.
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Ep 1 · 0:46
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Jill Knepprath summarizing a resource: In patients receiving neoadjuvant therapy, 23% showed a response.
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Ep 1 · 0:46
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Jill Knepprath summarizing a resource: In patients receiving neoadjuvant therapy, 45% were stable.
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Ep 1 · 0:59
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Jill Knepprath summarizing a resource: There was no difference in survival based on the response to neoadjuvant therapy among patients who went on to have resection.
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Ep 1 · 0:59
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Jill Knepprath summarizing a resource: There was no difference in survival based on the response to neoadjuvant therapy.
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Ep 1 · 1:03
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Jill Knepprath summarizing a resource: Overall, this study confirms that resection should be done for these patients whenever possible, even if they show a good response to chemo radiation.
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Ep 1 · 1:03
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Jill Knepprath summarizing a resource: Resection should be done for patients with malignant peripheral nerve sheath tumors whenever possible, even if they show a good response to chemoradiation.
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Summaries Jill gave as host · Pediatric Oncology
49 summaries
Open the Pediatric Oncology collection →
Impact of Pulmonary Tumor Burden in Favorable Histology Wilms Tumor Outcomes: A Report From the Children's Oncology Group Study AREN053
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Ep 655 · 0:00
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Jill Knepprath summarizing a resource: Your patient has a Wilms tumor with favorable histology, but workup shows that they also have lung metastases.
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Ep 655 · 0:14
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Jill Knepprath summarizing a resource: Dick et al. published a report from a Children's Oncology Group study in the Journal of Clinical Oncology in 2025
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Ep 655 · 0:19
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Jill Knepprath summarizing a resource: The study examined factors in patients with favorable histology Wilms tumor and pulmonary metastases and how those factors may affect outcomes
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Ep 655 · 0:30
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Jill Knepprath summarizing a resource: Factors studied included the number of metastases, the size of the metastases, and different biological markers
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Ep 655 · 0:36
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Jill Knepprath summarizing a resource: There was no difference in survival based on the number of metastases
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Ep 655 · 0:41
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Jill Knepprath summarizing a resource: Patients who had a rapid response to chemotherapy with larger nodules showed worse event-free survival
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Ep 655 · 0:41
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Jill Knepprath summarizing a resource: Patients with larger nodules and rapid response to chemotherapy showed no changes in overall survival
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Ep 655 · 0:49
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Jill Knepprath summarizing a resource: In multivariable models, neither the size nor the number of nodules had any effect on survival
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Ep 655 · 0:55
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Jill Knepprath summarizing a resource: 1q gain was associated with worse overall survival
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Ep 655 · 0:55
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Jill Knepprath summarizing a resource: 1q gain was associated with worse event-free survival
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Ep 655 · 1:04
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Jill Knepprath summarizing a resource: One cue gain is the superior prognostic factor when compared to size and number of nodules in patients with favorable histology Wilms and pulmonary metastases.
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Ep 655 · 1:04
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Jill Knepprath summarizing a resource: 1q gain is the superior prognostic factor when compared to size and number of nodules in patients with favorable histology Wilms tumor and pulmonary metastases
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Characteristics of Transfusion and Association With Oncologic Outcomes in Hepatoblastoma Resection
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Ep 664 · 0:00
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Jill Knepprath summarizing a resource: It is not uncommon for a patient with hepatoblastoma to need a transfusion during resection
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Ep 664 · 0:00
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Jill Knepprath summarizing a resource: It's not uncommon for a patient with hepatoblastoma to need a transfusion during resection.
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Ep 664 · 0:13
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Jill Knepprath summarizing a resource: The study was multi-institutional and published in Pediatric Blood and Cancer in 2025
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Ep 664 · 0:19
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Jill Knepprath summarizing a resource: The study examined how intraoperative transfusion may affect recurrence and survival in hepatoblastoma resection patients
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Ep 664 · 0:25
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Jill Knepprath summarizing a resource: Only 11% of transfused patients received platelets
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Ep 664 · 0:25
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Jill Knepprath summarizing a resource: Of those transfused, the majority received red blood cells
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Ep 664 · 0:32
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Jill Knepprath summarizing a resource: Intraoperative blood transfusions had no effect on recurrence
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Ep 664 · 0:32
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Jill Knepprath summarizing a resource: Intraoperative blood transfusions were associated with increased death
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Ep 664 · 0:32
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Jill Knepprath summarizing a resource: Intraoperative blood transfusions had no effect on recurrence, however, they were associated with increased death.
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Ep 664 · 0:39
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Jill Knepprath summarizing a resource: There were instances of unnecessary blood transfusions
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Ep 664 · 0:43
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Jill Knepprath summarizing a resource: Transfused patients still required more plasma and platelets postoperatively
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Ep 664 · 0:43
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Jill Knepprath summarizing a resource: Patients who were transfused had higher post-op hemoglobin
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Ep 664 · 0:52
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Jill Knepprath summarizing a resource: The authors think that blood transfusions were mostly red blood cells, and that is what contributed to the post-op coagulopathy
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Ep 664 · 0:52
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Jill Knepprath summarizing a resource: The authors think that blood transfusions were mostly red blood cells, and that is what contributed to the post-op coagulopathy.
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Ep 664 · 1:00
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Jill Knepprath summarizing a resource: The authors recommend a balanced transfusion approach
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Ep 664 · 1:00
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Jill Knepprath summarizing a resource: The authors recommend more careful patient selection for intraoperative transfusions
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Updated Favorable histology Wilms tumor risk stratification: Rationale for future Children’s Oncology Group clinical trials
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Ep 667 · 0:00
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Jill Knepprath summarizing a resource: Risk stratification for Wilms tumor has evolved many times over the years.
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Ep 667 · 0:00
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Jill Knepprath summarizing a resource: Risk stratification for Wilm's tumor has evolved many times over the years, so let's catch up.
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Ep 667 · 0:09
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Jill Knepprath summarizing a resource: The Children's Oncology Group published updated risk stratification for patients with favorable histology Wilms tumor in Nature in June 2025.
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Ep 667 · 0:19
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Jill Knepprath summarizing a resource: The new risk stratification model includes biological and clinical features that were not in the first generation risk stratification.
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Ep 667 · 0:27
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Jill Knepprath summarizing a resource: The new model changes some of the older features or gets rid of them altogether.
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Ep 667 · 0:32
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Jill Knepprath summarizing a resource: Factors that are being added are loss of heterozygosity of 11P15C, 1Q gain. And lymph node involvement.
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Ep 667 · 0:32
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Jill Knepprath summarizing a resource: Factors being added are loss of heterozygosity of 11P15, 1Q gain, and lymph node involvement.
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Ep 667 · 0:41
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Jill Knepprath summarizing a resource: Tumor nephrectomy weight is no longer included.
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Ep 667 · 0:41
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Jill Knepprath summarizing a resource: Tumor nephrectomy weight is no longer included in the risk stratification.
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Ep 667 · 0:43
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Jill Knepprath summarizing a resource: The model modified how histology and age are used to stratify certain patients.
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Ep 667 · 0:48
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Jill Knepprath summarizing a resource: More changes are expected in the future as ongoing COG trials produce more results.
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Update Course Rewind 2025: Nerve Monitoring in Pediatric Thyroid Surgery
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Ep 684 · 0:39
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Jill Knepprath summarizing the discussion: TIRRADS (Thyroid Imaging Reporting and Data System) is a scoring system developed for adults to stratify the risk of thyroid nodules based on ultrasound findings
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Ep 684 · 1:35
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Jill Knepprath summarizing the discussion: Thyroid nodules are more common in adults than in children, so there are not many centers that have a pediatric surgeon with high volume of these cases
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Ep 684 · 2:14
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Jill Knepprath summarizing the discussion: In thyroid surgery, intraoperative nerve monitoring is a technique to localize the recurrent laryngeal nerves which control the vocal cords using an electric probe to stimulate the nerve and EMG electrodes to monitor vocal cord movement
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Ep 684 · 2:36
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Jill Knepprath summarizing the discussion: In a recent survey, 80% of pediatric thyroid surgeons use nerve monitoring
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Ep 684 · 3:28
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Jill Knepprath summarizing the discussion: Nerve monitoring detects injury early, allowing surgeons to stage the operation and avoid bilateral injury, paralysis, and subsequent tracheotomy
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Ep 684 · 3:58
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Jill Knepprath summarizing the discussion: Nerve monitoring devices were often too big for pediatric patients
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Ep 684 · 4:18
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Jill Knepprath summarizing the discussion: Nerve monitoring can be considered in all pediatric thyroid surgeries because adhesive electrodes can be applied to even a 3.0 endotracheal tube
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Ep 684 · 4:50
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Jill Knepprath summarizing the discussion: Radiologists say that TIRRADS is not really reliable for pediatrics since it was originally developed for adults
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Ep 684 · 5:27
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Jill Knepprath summarizing the discussion: When criteria was based on the size of the thyroid relative to the size of the patient, no malignancies were missed
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Ep 684 · 5:33
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Jill Knepprath summarizing the discussion: Dr. Aldrin's 2025 study showed that the PES-TIRRADS eliminated unnecessary biopsies while not missing a single thyroid malignancy compared to adult and 2015 pediatric guidelines
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Summaries Jill gave as host · Pediatric Robotic Surgery
13 summaries
Open the Pediatric Robotic Surgery collection →
Update Course Rewind 2025: Robotics in Pediatric Surgery: Which indications benefit the most?
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Ep 7 · 0:33
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Jill Knepprath summarizing the discussion: All pediatric surgical patients are good candidates for robotic surgery.
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Ep 7 · 1:02
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Jill Knepprath summarizing the discussion: Robotic surgery reduces postoperative pain and infection risk, leading to faster recovery.
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Ep 7 · 2:09
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Jill Knepprath summarizing the discussion: Robotic surgery improves depth perception compared to laparoscopic surgery.
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Ep 7 · 2:14
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Jill Knepprath summarizing the discussion: Robotic surgery reduces surgeon fatigue compared to laparoscopic surgery.
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Ep 7 · 2:23
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Jill Knepprath summarizing the discussion: In colorectal surgery, robotic operative time is longer than laparoscopic.
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Ep 7 · 2:23
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Jill Knepprath summarizing the discussion: Laparoscopy has a higher conversion rate to open surgery than robotic surgery in colorectal cases.
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Ep 7 · 2:32
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Jill Knepprath summarizing the discussion: Both robotic and laparoscopic surgery have comparable oncologic results.
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Ep 7 · 2:57
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Jill Knepprath summarizing the discussion: It takes half the number of cases to become proficient in robotic surgery versus laparoscopy.
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Ep 7 · 3:14
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Jill Knepprath summarizing the discussion: Robotics can be indicated for surgeries in the chest, pelvic reconstruction, abdominal tumors, and urology.
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Ep 7 · 3:24
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Jill Knepprath summarizing the discussion: In smaller patients, ports should be measured 3 centimeters apart.
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Ep 7 · 3:38
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Jill Knepprath summarizing the discussion: Robotic surgery in pediatric patients is ideal in select cases including adrenal masses, polyoco cysts, and nephrectomies.
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Ep 7 · 3:52
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Jill Knepprath summarizing the discussion: Reported cons of robotic surgery include cost, setup time, the size of the ports, and a steep learning curve.
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Ep 7 · 4:06
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Jill Knepprath summarizing the discussion: Once proficiency is achieved, operative times and conversions to open surgery are lower for robotic surgery compared to laparoscopy.
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Summaries Jill gave as host · Pediatric Surgery Essentials
29 summaries
Open the Pediatric Surgery Essentials collection →
Surgeon annual volume impacts recurrence rates of pediatric inguinal hernia repairs: A multi-institutional study
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Ep 1 · 0:10
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Jill Knepprath summarizing a resource: Heller et al. published a multi-institutional study in the Journal of Pediatric Surgery in 2025 exploring the impact of surgeon volume on patients with inguinal hernias.
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Ep 1 · 0:22
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Jill Knepprath summarizing a resource: Inguinal hernias repaired by lower volume surgeons had a 1.5 fold increase in the odds of recurrence.
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Ep 1 · 0:22
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Jill Knepprath summarizing a resource: The authors found that inguinal hernias repaired by lower volume surgeons had a 1.5 fold increase in the odds of recurrence.
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Ep 1 · 0:30
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Jill Knepprath summarizing a resource: When broken down by surgical approach, there was no difference in recurrence rates for open inguinal hernia repairs based on surgeon volume.
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Ep 1 · 0:35
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Jill Knepprath summarizing a resource: Laparoscopic inguinal hernia repairs done by lower volume surgeons had a 3.3 fold increase in the odds of recurrence.
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Ep 1 · 0:35
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Jill Knepprath summarizing a resource: However, laparoscopic repairs done by lower volume surgeons had a 3.3 fold increase in the odds of recurrence.
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Ep 1 · 0:44
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Jill Knepprath summarizing a resource: The authors of the Heller et al. study recommend maintaining a high volume of laparoscopic repairs, and if that's not possible, to seek help from a higher volume surgeon.
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Update Course Rewind 2025: Robotics in Pediatric Surgery: Which indications benefit the most?
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Ep 2 · 0:33
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Jill Knepprath summarizing the discussion: All pediatric surgical patients are good candidates for robotic surgery.
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Ep 2 · 1:02
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Jill Knepprath summarizing the discussion: Robotic surgery reduces postoperative pain and infection risk, leading to faster recovery.
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Ep 2 · 2:09
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Jill Knepprath summarizing the discussion: Robotic surgery improves depth perception compared to laparoscopic surgery.
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Ep 2 · 2:14
host summary
Jill Knepprath summarizing the discussion: Robotic surgery reduces surgeon fatigue compared to laparoscopic surgery.
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Ep 2 · 2:23
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Jill Knepprath summarizing the discussion: In colorectal surgery, robotic operative time is longer than laparoscopic.
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Ep 2 · 2:23
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Jill Knepprath summarizing the discussion: Laparoscopy has a higher conversion rate to open surgery than robotic surgery in colorectal cases.
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Ep 2 · 2:32
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Jill Knepprath summarizing the discussion: Both robotic and laparoscopic surgery have comparable oncologic results.
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Ep 2 · 2:57
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Jill Knepprath summarizing the discussion: It takes half the number of cases to become proficient in robotic surgery versus laparoscopy.
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Ep 2 · 3:14
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Jill Knepprath summarizing the discussion: Robotics can be indicated for surgeries in the chest, pelvic reconstruction, abdominal tumors, and urology.
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Ep 2 · 3:24
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Jill Knepprath summarizing the discussion: In smaller patients, ports should be measured 3 centimeters apart.
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Ep 2 · 3:38
host summary
Jill Knepprath summarizing the discussion: Robotic surgery in pediatric patients is ideal in select cases including adrenal masses, polyoco cysts, and nephrectomies.
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Ep 2 · 3:52
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Jill Knepprath summarizing the discussion: Reported cons of robotic surgery include cost, setup time, the size of the ports, and a steep learning curve.
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Ep 2 · 4:06
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Jill Knepprath summarizing the discussion: Once proficiency is achieved, operative times and conversions to open surgery are lower for robotic surgery compared to laparoscopy.
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Update Course Rewind 2025: Robotics in Pediatric Surgery: Which indications benefit the most?
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Ep 3 · 0:33
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Jill Knepprath summarizing the discussion: All of these patients are good candidates for robotic surgery.
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Ep 3 · 1:02
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Jill Knepprath summarizing the discussion: Robotic surgery reduces postoperative pain and infection risk, leading to faster recovery.
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Ep 3 · 2:09
host summary
Jill Knepprath summarizing the discussion: Robotic surgery improves depth perception compared to laparoscopic surgery.
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Ep 3 · 2:14
host summary
Jill Knepprath summarizing the discussion: Robotic surgery reduces surgeon fatigue compared to laparoscopic surgery.
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Ep 3 · 2:23
host summary
Jill Knepprath summarizing the discussion: In colorectal surgery, robotic operative time is longer than laparoscopic, but laparoscopy has a higher conversion rate to open surgery.
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Ep 3 · 2:32
host summary
Jill Knepprath summarizing the discussion: Both robotic and laparoscopic surgery have comparable oncological results.
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Ep 3 · 3:14
host summary
Jill Knepprath summarizing the discussion: Robotic surgery can be indicated for surgeries in the chest, pelvic reconstruction, abdominal tumors, and urology.
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Ep 3 · 3:24
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Jill Knepprath summarizing the discussion: In smaller patients, ports should be measured 3 centimeters apart.
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Ep 3 · 3:38
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Jill Knepprath summarizing the discussion: Robotic surgery is ideal in select pediatric cases including adrenal masses, polycystic kidneys, and nephrectomies.
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Summaries Jill gave as host · Peritoneal Dialysis Access
7 summaries
Open the Peritoneal Dialysis Access collection →
Surgeon annual volume impacts recurrence rates of pediatric inguinal hernia repairs: A multi-institutional study
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Ep 8 · 0:10
host summary
Jill Knepprath summarizing a resource: Heller et al. published a multi-institutional study in the Journal of Pediatric Surgery in 2025 exploring the impact of surgeon volume on patients with inguinal hernias.
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Ep 8 · 0:22
host summary
Jill Knepprath summarizing a resource: Inguinal hernias repaired by lower volume surgeons had a 1.5 fold increase in the odds of recurrence.
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Ep 8 · 0:22
host summary
Jill Knepprath summarizing a resource: The authors found that inguinal hernias repaired by lower volume surgeons had a 1.5 fold increase in the odds of recurrence.
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Ep 8 · 0:30
host summary
Jill Knepprath summarizing a resource: When broken down by surgical approach, there was no difference in recurrence rates for open inguinal hernia repairs based on surgeon volume.
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Ep 8 · 0:35
host summary
Jill Knepprath summarizing a resource: However, laparoscopic repairs done by lower volume surgeons had a 3.3 fold increase in the odds of recurrence.
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Ep 8 · 0:35
host summary
Jill Knepprath summarizing a resource: Laparoscopic inguinal hernia repairs done by lower volume surgeons had a 3.3 fold increase in the odds of recurrence.
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Ep 8 · 0:44
host summary
Jill Knepprath summarizing a resource: The authors of the Heller et al. study recommend maintaining a high volume of laparoscopic repairs, and if that's not possible, to seek help from a higher volume surgeon.
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Summaries Jill gave as host · Pulmonary Hypoplasia
12 summaries
Open the Pulmonary Hypoplasia collection →
Inside a FETO Procedure: Fetoscopic Balloon Tracheal Occlusion with Dr. Beth Rymeski
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Ep 6 · 0:47
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Jill Knepprath summarizes what Dr. Beth Rymeski said: The goal of FETO is to allow fluid to stay in the lungs and allow the lungs to expand and grow.
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Ep 6 · 0:47
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Jill Knepprath summarizes what Dr. Beth Rymeski said: The goal of FETO is to allow fluid to stay in the lungs and allow the lungs to expand and grow.
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Ep 6 · 0:53
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Jill Knepprath summarizes what Dr. Beth Rymeski said: FETO helps prevent pulmonary hypoplasia, which is a big factor in poor outcomes for CDH babies.
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Ep 6 · 0:53
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Jill Knepprath summarizes what Dr. Beth Rymeski said: FETO helps prevent pulmonary hypoplasia, which is a big factor in poor outcomes for CDH babies.
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Ep 6 · 3:08
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Jill Knepprath summarizes what Dr. Beth Rymeski said: The balloon is filled with water, around 0.65 to 0.8 mL, depending on the size of the trachea.
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Ep 6 · 3:08
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Jill Knepprath summarizes what Dr. Beth Rymeski said: The balloon is filled with water, around 0.65 to 0.8 mL, depending on the size of the trachea.
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Ep 6 · 3:40
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Jill Knepprath summarizes what Dr. Beth Rymeski said: After balloon deployment, the scope is advanced one more time to confirm that the balloon is below the vocal cords and in the main trachea.
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Ep 6 · 3:40
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Jill Knepprath summarizes what Dr. Beth Rymeski said: After balloon deployment, the scope is advanced one more time to confirm that the balloon is below the vocal cords and in the main trachea.
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Fetoscopic Endoluminal Tracheal Occlusion (FETO) Procedure: Step-by-Step Guide with Dr. Beth Rymeski
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Ep 7 · 0:47
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Jill Knepprath summarizes what Dr. Beth Rymeski said: The goal of FETO is to allow fluid to stay in the lungs and allow the lungs to expand and grow.
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Ep 7 · 0:53
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Jill Knepprath summarizes what Dr. Beth Rymeski said: FETO helps prevent pulmonary hypoplasia, which is a big factor in poor outcomes for CDH babies.
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Ep 7 · 3:08
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Jill Knepprath summarizes what Dr. Beth Rymeski said: The balloon is filled with water, around 0.65 to 0.8 mL, depending on the size of the trachea.
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Ep 7 · 3:40
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Jill Knepprath summarizes what Dr. Beth Rymeski said: After balloon deployment, the scope is advanced one more time to confirm that the balloon is below the vocal cords and in the main trachea.
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Summaries Jill gave as host · Thyroid Nodule
10 summaries
Open the Thyroid Nodule collection →
Update Course Rewind 2025: Nerve Monitoring in Pediatric Thyroid Surgery
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Ep 3 · 0:39
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Jill Knepprath summarizing the discussion: TIRRADS (Thyroid Imaging Reporting and Data System) is a scoring system developed for adults to stratify the risk of thyroid nodules based on ultrasound findings
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Ep 3 · 1:35
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Jill Knepprath summarizing the discussion: Thyroid nodules are more common in adults than in children, so there are not many centers that have a pediatric surgeon with high volume of these cases
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Ep 3 · 2:14
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Jill Knepprath summarizing the discussion: In thyroid surgery, intraoperative nerve monitoring is a technique to localize the recurrent laryngeal nerves which control the vocal cords using an electric probe to stimulate the nerve and EMG electrodes to monitor vocal cord movement
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Ep 3 · 2:36
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Jill Knepprath summarizing the discussion: In a recent survey, 80% of pediatric thyroid surgeons use nerve monitoring
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Ep 3 · 3:28
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Jill Knepprath summarizing the discussion: Nerve monitoring detects injury early, allowing surgeons to stage the operation and avoid bilateral injury, paralysis, and subsequent tracheotomy
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Ep 3 · 3:58
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Jill Knepprath summarizing the discussion: Nerve monitoring devices were often too big for pediatric patients
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Ep 3 · 4:18
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Jill Knepprath summarizing the discussion: Nerve monitoring can be considered in all pediatric thyroid surgeries because adhesive electrodes can be applied to even a 3.0 endotracheal tube
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Ep 3 · 4:50
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Jill Knepprath summarizing the discussion: Radiologists say that TIRRADS is not really reliable for pediatrics since it was originally developed for adults
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Ep 3 · 5:27
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Jill Knepprath summarizing the discussion: When criteria was based on the size of the thyroid relative to the size of the patient, no malignancies were missed
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Ep 3 · 5:33
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Jill Knepprath summarizing the discussion: Dr. Aldrin's 2025 study showed that the PES-TIRRADS eliminated unnecessary biopsies while not missing a single thyroid malignancy compared to adult and 2015 pediatric guidelines
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Summaries Jill gave as host · Tracheoesophageal Fistula
22 summaries
Open the Tracheoesophageal Fistula collection →
Update Course Rewind 2025: The Recurrent TEF Problem
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Ep 32 · 0:08
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Jill Knepprath summarizes what Dr. Douglas von Allmen said: What do you do if a patient develops a second tracheoesophageal fistula years after repair?
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Ep 32 · 0:08
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Jill Knepprath summarizes what Dr. Douglas von Allmen said: Recurrent tracheoesophageal fistulas can develop years after initial TEF repair.
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Ep 32 · 0:48
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Jill Knepprath summarizes what Dr. Douglas von Allmen said: Esophageal dilations were performed without improvement.
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Ep 32 · 1:03
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Jill Knepprath summarizes what Dr. Douglas von Allmen said: Bronchoscopy revealed granulation tissue along the back wall of the airway.
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Ep 32 · 1:17
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Jill Knepprath summarizes what Dr. Douglas von Allmen said: The recurrent laryngeal nerve is at risk of damage during repair of recurrent TEFs.
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Ep 32 · 1:25
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Jill Knepprath summarizes what Dr. Douglas von Allmen said: A transtracheal approach provides better surgical exposure and reduces the risk of recurrent laryngeal nerve injury.
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Ep 32 · 1:46
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Jill Knepprath summarizes what Dr. Douglas von Allmen said: The transtracheal approach helps minimize injury to the recurrent laryngeal nerve.
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Esophageal Atresia & Tracheoesophageal Fistula (EA/TEF) Types Explained for Pediatric Surgery
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Ep 33 · 0:00
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Jill Knepprath summarizing a resource: Today I'm going to walk through esophageal atresia and tracheoesophageal fistula, or TEF.
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Ep 33 · 0:05
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Jill Knepprath summarizing a resource: EA/TEF is a basic concept in pediatric surgery.
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Ep 33 · 0:10
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Jill Knepprath summarizing a resource: In normal anatomy, the esophagus goes straight down to the stomach with no atresia or interruptions, and the trachea goes straight down to the lungs with no connections between the two.
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Ep 33 · 0:29
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Jill Knepprath summarizing a resource: Type A EA/TEF consists of esophageal atresia proximally and distally in the esophagus, preventing solids and liquids from reaching the stomach, with no connection between esophagus and trachea.
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Ep 33 · 0:45
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Jill Knepprath summarizing a resource: Type B EA/TEF has distal esophageal atresia and a proximal fistula, allowing solids and liquids to enter the trachea while the stomach remains empty.
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Ep 33 · 1:08
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Jill Knepprath summarizing a resource: Type C is the most common
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Ep 33 · 1:08
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Jill Knepprath summarizing a resource: Type C EA/TEF is the most common type.
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Ep 33 · 1:13
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Jill Knepprath summarizing a resource: Type C EA/TEF has proximal esophageal atresia and a distal fistula, allowing air to reach both lungs and stomach while solids and liquids cannot reach the stomach.
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Ep 33 · 1:28
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Jill Knepprath summarizing a resource: Type D EA/TEF has both a distal fistula and a proximal fistula, allowing solids and liquids into the trachea and air into both lungs and stomach.
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Ep 33 · 1:43
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Jill Knepprath summarizing a resource: Type E EA/TEF has no atresia but does have a tracheoesophageal fistula, which is often pretty high.
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Ep 33 · 1:52
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Jill Knepprath summarizing a resource: Type E EA/TEF is also known as H-type because of its anatomical appearance.
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Ep 33 · 1:52
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Jill Knepprath summarizing a resource: This is also known as H. You can see the H right here.
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Ep 33 · 1:56
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Jill Knepprath summarizing a resource: Type E (H-type) EA/TEF has the best results and is usually the easiest to fix.
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Ep 33 · 1:56
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Jill Knepprath summarizing a resource: And this is the one with the best results and usually the easiest to fix.
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Ep 33 · 2:01
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Jill Knepprath summarizing a resource: Children with Type E (H-type) EA/TEF may present with symptoms later because they are still able to get solids and liquids down to the stomach and air to the lungs.
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Summaries Jill gave as host · Tracheoesophageal Fistula
15 summaries
Open the Tracheoesophageal Fistula collection →
Esophageal Atresia & Tracheoesophageal Fistula (EA/TEF) Types Explained for Pediatric Surgery
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Ep 23 · 0:00
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Jill Knepprath summarizing a resource: Today I'm going to walk through esophageal atresia and tracheoesophageal fistula, or TEF.
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Ep 23 · 0:05
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Jill Knepprath summarizing a resource: EA/TEF is a basic concept in pediatric surgery.
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Ep 23 · 0:10
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Jill Knepprath summarizing a resource: In normal anatomy, the esophagus goes straight down to the stomach with no atresia or interruptions, and the trachea goes straight down to the lungs with no connections between the two.
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Ep 23 · 0:29
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Jill Knepprath summarizing a resource: Type A EA/TEF consists of esophageal atresia proximally and distally in the esophagus, preventing solids and liquids from reaching the stomach, with no connection between esophagus and trachea.
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Ep 23 · 0:45
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Jill Knepprath summarizing a resource: Type B EA/TEF has distal esophageal atresia and a proximal fistula, allowing solids and liquids to enter the trachea while the stomach remains empty.
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Ep 23 · 1:08
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Jill Knepprath summarizing a resource: Type C EA/TEF is the most common type.
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Ep 23 · 1:08
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Jill Knepprath summarizing a resource: Type C is the most common
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Ep 23 · 1:13
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Jill Knepprath summarizing a resource: Type C EA/TEF has proximal esophageal atresia and a distal fistula, allowing air to reach both lungs and stomach while solids and liquids cannot reach the stomach.
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Ep 23 · 1:28
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Jill Knepprath summarizing a resource: Type D EA/TEF has both a distal fistula and a proximal fistula, allowing solids and liquids into the trachea and air into both lungs and stomach.
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Ep 23 · 1:43
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Jill Knepprath summarizing a resource: Type E EA/TEF has no atresia but does have a tracheoesophageal fistula, which is often pretty high.
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Ep 23 · 1:52
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Jill Knepprath summarizing a resource: This is also known as H. You can see the H right here.
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Ep 23 · 1:52
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Jill Knepprath summarizing a resource: Type E EA/TEF is also known as H-type because of its anatomical appearance.
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Ep 23 · 1:56
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Jill Knepprath summarizing a resource: And this is the one with the best results and usually the easiest to fix.
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Ep 23 · 1:56
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Jill Knepprath summarizing a resource: Type E (H-type) EA/TEF has the best results and is usually the easiest to fix.
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Ep 23 · 2:01
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Jill Knepprath summarizing a resource: Children with Type E (H-type) EA/TEF may present with symptoms later because they are still able to get solids and liquids down to the stomach and air to the lungs.
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Summaries Jill gave as host · Vestibular Fistula
3 summaries
Open the Vestibular Fistula collection →
Update Course Rewind 2025: Perineal Body–Preserving PSARP: The New Standard?
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Ep 6 · 1:01
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Jill Knepprath summarizing the discussion: Two-thirds of patients undergoing perineal body-preserving PSARP went home on postoperative day one.
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Ep 6 · 1:51
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Jill Knepprath summarizing the discussion: Perineal body-preserving PSARP is a good choice for patients but can be a trickier approach than standard PSARP.
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Ep 6 · 2:00
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Jill Knepprath summarizing the discussion: Conversion to the standard PSARP approach is a valid pivot when there is doubt about anatomy during perineal body-preserving PSARP.
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Summaries Jill gave as host · Wilms Tumor
23 summaries
Open the Wilms Tumor collection →
Impact of Pulmonary Tumor Burden in Favorable Histology Wilms Tumor Outcomes: A Report From the Children's Oncology Group Study AREN053
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Ep 19 · 0:00
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Jill Knepprath summarizing a resource: Your patient has a Wilms tumor with favorable histology, but workup shows that they also have lung metastases.
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Ep 19 · 0:14
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Jill Knepprath summarizing a resource: Dick et al. published a report from a Children's Oncology Group study in the Journal of Clinical Oncology in 2025
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Ep 19 · 0:19
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Jill Knepprath summarizing a resource: The study examined factors in patients with favorable histology Wilms tumor and pulmonary metastases and how those factors may affect outcomes
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Ep 19 · 0:30
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Jill Knepprath summarizing a resource: Factors studied included the number of metastases, the size of the metastases, and different biological markers
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Ep 19 · 0:36
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Jill Knepprath summarizing a resource: There was no difference in survival based on the number of metastases
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Ep 19 · 0:41
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Jill Knepprath summarizing a resource: Patients who had a rapid response to chemotherapy with larger nodules showed worse event-free survival
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Ep 19 · 0:41
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Jill Knepprath summarizing a resource: Patients with larger nodules and rapid response to chemotherapy showed no changes in overall survival
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Ep 19 · 0:49
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Jill Knepprath summarizing a resource: In multivariable models, neither the size nor the number of nodules had any effect on survival
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Ep 19 · 0:55
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Jill Knepprath summarizing a resource: 1q gain was associated with worse overall survival
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Ep 19 · 0:55
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Jill Knepprath summarizing a resource: 1q gain was associated with worse event-free survival
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Ep 19 · 1:04
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Jill Knepprath summarizing a resource: 1q gain is the superior prognostic factor when compared to size and number of nodules in patients with favorable histology Wilms tumor and pulmonary metastases
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Ep 19 · 1:04
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Jill Knepprath summarizing a resource: One cue gain is the superior prognostic factor when compared to size and number of nodules in patients with favorable histology Wilms and pulmonary metastases.
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Updated Favorable histology Wilms tumor risk stratification: Rationale for future Children’s Oncology Group clinical trials
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Ep 20 · 0:00
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Jill Knepprath summarizing a resource: Risk stratification for Wilms tumor has evolved many times over the years.
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Ep 20 · 0:00
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Jill Knepprath summarizing a resource: Risk stratification for Wilm's tumor has evolved many times over the years, so let's catch up.
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Ep 20 · 0:09
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Jill Knepprath summarizing a resource: The Children's Oncology Group published updated risk stratification for patients with favorable histology Wilms tumor in Nature in June 2025.
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Ep 20 · 0:19
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Jill Knepprath summarizing a resource: The new risk stratification model includes biological and clinical features that were not in the first generation risk stratification.
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Ep 20 · 0:27
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Jill Knepprath summarizing a resource: The new model changes some of the older features or gets rid of them altogether.
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Ep 20 · 0:32
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Jill Knepprath summarizing a resource: Factors that are being added are loss of heterozygosity of 11P15C, 1Q gain. And lymph node involvement.
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Ep 20 · 0:32
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Jill Knepprath summarizing a resource: Factors being added are loss of heterozygosity of 11P15, 1Q gain, and lymph node involvement.
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Ep 20 · 0:41
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Jill Knepprath summarizing a resource: Tumor nephrectomy weight is no longer included.
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Ep 20 · 0:41
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Jill Knepprath summarizing a resource: Tumor nephrectomy weight is no longer included in the risk stratification.
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Ep 20 · 0:43
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Jill Knepprath summarizing a resource: The model modified how histology and age are used to stratify certain patients.
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Ep 20 · 0:48
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Jill Knepprath summarizing a resource: More changes are expected in the future as ongoing COG trials produce more results.
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