the spring loaded silo works quite well for the majority of patients, but can also lead to very significant complications such as bowel wall necrosis and perforation
In thoracoscopic TEF repair, the first half of the case (dissection and fistula division) feels advantageous, but once starting the anastomosis, the surgeon questions why they chose the thoracoscopic approach.
Hunt-Lawrence pouch has been described for microgastria but in speaker's experience with two patients, they had trouble emptying with significant stasis and poor progression
Transverse colostomy has too many problems including urine absorption, infection, and prolapse; a very small minority of surgeons still use transverse colostomies.
There can be findings on ultrasound that should alert clinicians to closing gastroschisis cases or other complications where a premature delivery may be needed.
Error Traps and Culture of Safety in Abdominal Wall Defects
▶Ep 11 · 0:22
clinicalA culture of safety is a deliberate way of doing things to avoid complications.↗
▶Ep 11 · 0:22
quotea culture of safety is a deliberate way of doing things to avoid complications↗
▶Ep 11 · 1:00
quoteerror traps are things that work well most of the time, but can have certain nuances where sometimes they do not work well↗
▶Ep 11 · 1:00
clinicalError traps are things that work well most of the time, but can have certain nuances where sometimes they do not work well.↗
▶Ep 11 · 1:30
clinicalThe spring loaded silo works quite well for the majority of gastroschisis patients.↗
▶Ep 11 · 1:30
quotethe spring loaded silo works quite well for the majority of patients, but can also lead to very significant complications such as bowel wall necrosis and perforation↗
▶Ep 11 · 2:00
clinicalThe spring loaded silo can lead to very significant complications such as bowel wall necrosis and perforation in gastroschisis cases.↗
▶Ep 11 · 2:30
clinicalGastroschisis cases and omphalocele have really very different issues requiring separation in analysis.↗
▶Ep 11 · 2:30
quotegastroschisis cases and omphalocele have really very different issues↗
▶Ep 11 · 3:00
clinicalOne error trap in gastroschisis is to assume that there would be no reason to do a premature delivery.↗
▶Ep 11 · 3:00
clinicalThere can be findings on ultrasound that should alert clinicians to closing gastroschisis cases or other complications where a premature delivery may be needed.↗
Sherif's statements about Anorectal Malformation5 statements
Laparoscopic Surgery for Male Imperforate Anus and Rectourethral Fistula:...
▶Ep 7 · 18:37
opinionTransverse colostomy has too many problems including urine absorption, infection, and prolapse.↗
Tricks - Imperforate Anus and Rectourethral Fistula
▶Ep 9 · 18:37
quoteI would bet if you polled the audience that a very small minority would still be using transverse colostomies at this point↗
▶Ep 9 · 18:37
opinionTransverse colostomy has too many problems including urine absorption, infection, and prolapse; a very small minority of surgeons still use transverse colostomies.↗
▶Ep 9 · 42:36
opinionIn thoracoscopic TEF repair, the first half of the case (dissection and fistula division) feels advantageous, but once starting the anastomosis, the surgeon questions why they chose the thoracoscopic approach.↗
▶Ep 9 · 42:36
quotemy experience so far has been the first half of the case when I'm doing the dissection and dividing the fistul I'm thinking, oh, this is fantastic. I'm so glad I'm doing it this way. And then as soon as I start to put the esophagus together, I'm thinking, why the heck am I doing it this way?↗
Sherif's statements about Colorectal / ARM & Hirschsprung5 statements
Laparoscopic Surgery for Male Imperforate Anus and Rectourethral Fistula:...
▶Ep 7 · 18:37
opinionTransverse colostomy has too many problems including urine absorption, infection, and prolapse.↗
Tricks - Imperforate Anus and Rectourethral Fistula
▶Ep 11 · 18:37
opinionTransverse colostomy has too many problems including urine absorption, infection, and prolapse; a very small minority of surgeons still use transverse colostomies.↗
▶Ep 11 · 18:37
quoteI would bet if you polled the audience that a very small minority would still be using transverse colostomies at this point↗
▶Ep 11 · 42:36
quotemy experience so far has been the first half of the case when I'm doing the dissection and dividing the fistul I'm thinking, oh, this is fantastic. I'm so glad I'm doing it this way. And then as soon as I start to put the esophagus together, I'm thinking, why the heck am I doing it this way?↗
▶Ep 11 · 42:36
opinionIn thoracoscopic TEF repair, the first half of the case (dissection and fistula division) feels advantageous, but once starting the anastomosis, the surgeon questions why they chose the thoracoscopic approach.↗
Sherif's statements about Gastroschisis11 statements
Error Traps and Culture of Safety in Abdominal Wall Defects
▶Ep 7 · 0:22
clinicalA culture of safety is a deliberate way of doing things to avoid complications.↗
▶Ep 7 · 0:22
quotea culture of safety is a deliberate way of doing things to avoid complications↗
▶Ep 7 · 1:00
clinicalError traps are things that work well most of the time, but can have certain nuances where sometimes they do not work well.↗
▶Ep 7 · 1:00
quoteerror traps are things that work well most of the time, but can have certain nuances where sometimes they do not work well↗
▶Ep 7 · 1:30
quotethe spring loaded silo works quite well for the majority of patients, but can also lead to very significant complications such as bowel wall necrosis and perforation↗
▶Ep 7 · 1:30
clinicalThe spring loaded silo works quite well for the majority of gastroschisis patients.↗
▶Ep 7 · 2:00
clinicalThe spring loaded silo can lead to very significant complications such as bowel wall necrosis and perforation in gastroschisis cases.↗
▶Ep 7 · 2:30
clinicalGastroschisis cases and omphalocele have really very different issues requiring separation in analysis.↗
▶Ep 7 · 2:30
quotegastroschisis cases and omphalocele have really very different issues↗
▶Ep 7 · 3:00
clinicalThere can be findings on ultrasound that should alert clinicians to closing gastroschisis cases or other complications where a premature delivery may be needed.↗
▶Ep 7 · 3:00
clinicalOne error trap in gastroschisis is to assume that there would be no reason to do a premature delivery.↗
Sherif's statements about Gastroschisis11 statements
Error Traps and Culture of Safety in Abdominal Wall Defects
▶Ep 7 · 0:22
quotea culture of safety is a deliberate way of doing things to avoid complications↗
▶Ep 7 · 0:22
clinicalA culture of safety is a deliberate way of doing things to avoid complications.↗
▶Ep 7 · 1:00
clinicalError traps are things that work well most of the time, but can have certain nuances where sometimes they do not work well.↗
▶Ep 7 · 1:00
quoteerror traps are things that work well most of the time, but can have certain nuances where sometimes they do not work well↗
▶Ep 7 · 1:30
quotethe spring loaded silo works quite well for the majority of patients, but can also lead to very significant complications such as bowel wall necrosis and perforation↗
▶Ep 7 · 1:30
clinicalThe spring loaded silo works quite well for the majority of gastroschisis patients.↗
▶Ep 7 · 2:00
clinicalThe spring loaded silo can lead to very significant complications such as bowel wall necrosis and perforation in gastroschisis cases.↗
▶Ep 7 · 2:30
quotegastroschisis cases and omphalocele have really very different issues↗
▶Ep 7 · 2:30
clinicalGastroschisis cases and omphalocele have really very different issues requiring separation in analysis.↗
▶Ep 7 · 3:00
clinicalOne error trap in gastroschisis is to assume that there would be no reason to do a premature delivery.↗
▶Ep 7 · 3:00
clinicalThere can be findings on ultrasound that should alert clinicians to closing gastroschisis cases or other complications where a premature delivery may be needed.↗
Sherif's statements about Omphalocele11 statements
Error Traps and Culture of Safety in Abdominal Wall Defects
▶Ep 6 · 0:22
clinicalA culture of safety is a deliberate way of doing things to avoid complications.↗
▶Ep 6 · 0:22
quotea culture of safety is a deliberate way of doing things to avoid complications↗
▶Ep 6 · 1:00
quoteerror traps are things that work well most of the time, but can have certain nuances where sometimes they do not work well↗
▶Ep 6 · 1:00
clinicalError traps are things that work well most of the time, but can have certain nuances where sometimes they do not work well.↗
▶Ep 6 · 1:30
quotethe spring loaded silo works quite well for the majority of patients, but can also lead to very significant complications such as bowel wall necrosis and perforation↗
▶Ep 6 · 1:30
clinicalThe spring loaded silo works quite well for the majority of gastroschisis patients.↗
▶Ep 6 · 2:00
clinicalThe spring loaded silo can lead to very significant complications such as bowel wall necrosis and perforation in gastroschisis cases.↗
▶Ep 6 · 2:30
quotegastroschisis cases and omphalocele have really very different issues↗
▶Ep 6 · 2:30
clinicalGastroschisis cases and omphalocele have really very different issues requiring separation in analysis.↗
▶Ep 6 · 3:00
clinicalOne error trap in gastroschisis is to assume that there would be no reason to do a premature delivery.↗
▶Ep 6 · 3:00
clinicalThere can be findings on ultrasound that should alert clinicians to closing gastroschisis cases or other complications where a premature delivery may be needed.↗
Sherif's statements about Omphalocele11 statements
Error Traps and Culture of Safety in Abdominal Wall Defects
▶Ep 6 · 0:22
clinicalA culture of safety is a deliberate way of doing things to avoid complications.↗
▶Ep 6 · 0:22
quotea culture of safety is a deliberate way of doing things to avoid complications↗
▶Ep 6 · 1:00
clinicalError traps are things that work well most of the time, but can have certain nuances where sometimes they do not work well.↗
▶Ep 6 · 1:00
quoteerror traps are things that work well most of the time, but can have certain nuances where sometimes they do not work well↗
▶Ep 6 · 1:30
clinicalThe spring loaded silo works quite well for the majority of gastroschisis patients.↗
▶Ep 6 · 1:30
quotethe spring loaded silo works quite well for the majority of patients, but can also lead to very significant complications such as bowel wall necrosis and perforation↗
▶Ep 6 · 2:00
clinicalThe spring loaded silo can lead to very significant complications such as bowel wall necrosis and perforation in gastroschisis cases.↗
▶Ep 6 · 2:30
quotegastroschisis cases and omphalocele have really very different issues↗
▶Ep 6 · 2:30
clinicalGastroschisis cases and omphalocele have really very different issues requiring separation in analysis.↗
▶Ep 6 · 3:00
clinicalThere can be findings on ultrasound that should alert clinicians to closing gastroschisis cases or other complications where a premature delivery may be needed.↗
▶Ep 6 · 3:00
clinicalOne error trap in gastroschisis is to assume that there would be no reason to do a premature delivery.↗
Sherif's statements about Rectourethral Fistula5 statements
Laparoscopic Surgery for Male Imperforate Anus and Rectourethral Fistula:...
▶Ep 1 · 18:37
opinionTransverse colostomy has too many problems including urine absorption, infection, and prolapse.↗
Tricks - Imperforate Anus and Rectourethral Fistula
▶Ep 2 · 18:37
quoteI would bet if you polled the audience that a very small minority would still be using transverse colostomies at this point↗
▶Ep 2 · 18:37
opinionTransverse colostomy has too many problems including urine absorption, infection, and prolapse; a very small minority of surgeons still use transverse colostomies.↗
▶Ep 2 · 42:36
opinionIn thoracoscopic TEF repair, the first half of the case (dissection and fistula division) feels advantageous, but once starting the anastomosis, the surgeon questions why they chose the thoracoscopic approach.↗
▶Ep 2 · 42:36
quotemy experience so far has been the first half of the case when I'm doing the dissection and dividing the fistul I'm thinking, oh, this is fantastic. I'm so glad I'm doing it this way. And then as soon as I start to put the esophagus together, I'm thinking, why the heck am I doing it this way?↗
Sherif's statements about Twin-to-twin Transfusion Syndrome28 statements
clinicalPatient was a twin girl born at 27 weeks weighing just over 1 kg with prenatal diagnosis of twin-to-twin transfusion syndrome (recipient twin)↗
▶Ep 2 · 1:20
clinicalTwin-to-twin transfusion ablation was performed at 22 weeks gestation↗
▶Ep 2 · 1:35
clinicalStat C-section performed due to maternal septic shock from E. coli sepsis (initially thought to be amniotic fluid embolus), vertically transmitted to both neonates↗
▶Ep 2 · 2:10
clinicalApgar scores were 3 at 1 minute and 1 at 5 minutes; patient intubated at birth↗
▶Ep 2 · 2:25
clinicalOn day 3, iatrogenic manipulation of umbilical venous line caused atrial flutter and significant tachycardia with hemodynamic instability requiring cardioversion↗
▶Ep 2 · 2:55
clinicalAt presentation for cardioversion, patient had significant abdominal distention with large amount of free air on imaging, including unusual shadow in left upper quadrant appearing like loculated free air↗
▶Ep 2 · 3:25
clinicalIntraoperative findings: longitudinal perforation along greater curvature with entire corpus and fundus/cardia necrotic, not holding stitches, with only couple centimeters of good antrum remaining↗
▶Ep 2 · 5:14
clinicalFirst operation: removed necrotic stomach, placed Foley catheter (0.5cc balloon) up distal esophagus, left Penrose drain under left lobe of liver, created ostomy tube from 2.5cm gastric remnant↗
▶Ep 2 · 6:20
clinicalSmall bowel was like wet toilet paper; multiple hematomas developed in wall from handling, several perforated requiring multiple enterorrhaphies↗
▶Ep 2 · 6:20
quotethe small bowel was like wet toilet paper. It was really difficult to handle, even though with utmost care, just from exteriorizing and putting the small bowel back, there were multiple hematomas in the wall↗
▶Ep 2 · 6:50
quoteI wrote this in the chart because I told the parents that, you know, we've taken some heroic steps, but I think this is about as far as we'll go, um, and I said no further procedures planned as high likelihood of futility.↗
▶Ep 2 · 6:50
clinicalPatient was coagulopathic by end of first operation but became hemodynamically stable within 12 hours without pressors and with good urine output↗
▶Ep 2 · 7:25
clinicalOn post-op day 3, bilious drainage appeared from Penrose drain; on day 4, patient distended and became difficult to ventilate with large amount of free air on imaging↗
▶Ep 2 · 7:55
clinicalSecond laparotomy findings: no problem with distal esophagus or gastric remnant, but new intestinal perforations at different sites than previous repairs↗
▶Ep 2 · 8:30
clinicalSecond operation addressed 3cm proximal jejunal necrosis 5cm from ligament of Treitz (resection and primary anastomosis) and spontaneous distal ileal perforation (debridement and repair)↗
▶Ep 2 · 9:10
clinicalPatient required only CPAP after 7 days of mechanical ventilation despite prematurity↗
▶Ep 2 · 9:30
clinicalAt 2 weeks post-op, contrast studies showed esophagus became like atresic esophagus with segment below diaphragm; no leak around Foley balloon as esophagus had fibrosed around catheter↗
▶Ep 2 · 10:10
clinicalDistal contrast study through gastric remnant showed all resections healed without stenosis, with contrast traversing bowel in short period↗
▶Ep 2 · 10:40
clinicalInitial gastric remnant feeding limited by capacity (maximum 34cc); leak around G-tube occurred with larger volumes and poor pyloric emptying↗
▶Ep 2 · 11:10
clinicalGastroduodenal feeding tube advanced through gastrostomy under fluoroscopy successfully weaned patient off TPN; small amounts of sham feeds given orally and suctioned through esophageal tube↗
▶Ep 2 · 12:32
opinionSalvaging remaining 1cm of cardia to create 4 cubic centimeter stomach would result in microgastria with attendant reflux and other problems↗
▶Ep 2 · 13:00
opinionHunt-Lawrence pouch has been described for microgastria but in speaker's experience with two patients, they had trouble emptying with significant stasis and poor progression↗
▶Ep 2 · 13:30
clinicalMichigan group published case report of microgastria treated with Roux-en-Y esophago-fundojejunostomy (approach used for adult gastric cancer)↗
▶Ep 2 · 14:00
clinicalPre-reconstruction contrast study showed small gastric segment remaining with esophagus distending nicely without strictures↗
▶Ep 2 · 14:25
clinicalReconstruction performed at 5 months of age (55 weeks post-conception age, 5kg weight) using Roux-en-Y fundojejunostomy with segment 15cm distal to ligament of Treitz and 25cm limb↗
▶Ep 2 · 15:10
clinicalPost-op day 6 contrast study through esophagus showed good emptying; combination oral and gastrostomy feeds started↗
▶Ep 2 · 15:35
clinicalPatient discharged 52 days after reconstruction with total hospital stay of 207 days↗
▶Ep 2 · 15:55
clinicalAt 2.5 years old, patient takes normal diet for age on full oral feeds with nighttime gastrostomy supplementation (anticipated to discontinue early in new year), and is bigger than unaffected twin↗
Summaries Sherif gave as host
· 1 summary
Recaps of other experts' statements, not Sherif's own clinical position.
Summaries Sherif gave as host · Twin-to-twin Transfusion Syndrome1 summary
host summarySherif Emil summarizing the discussion: my mentor John Masin says pediatric surgery is a collection of case reports, and I think this is really illustrates that.↗
