Journal of Pediatric Surgery Article Review: December 2021

The systematic review included 9 studies examining ERAS protocols after minimally invasive surgery (thoracoscopy, laparoscopy, or retroperitoneoscopy) in pediatric patients, searching literature back to 1975.

ERAS protocols after minimally invasive surgery showed decreased length of stay and decreased 30-day readmission rates compared to standard care.

ERAS protocols after minimally invasive surgery showed no increase in complication rates compared to standard care.

ERAS protocols have shown that hospital stays for many surgical patients can be abbreviated, which is relevant for mobilizing hospital beds during the COVID-19 pandemic.

For the Paris group, the ultimate goal of ERAS is same-day discharge, with the most important outcome being that the child can return to normal life at home the night after or day after surgery.

The Johns Hopkins study examined neonates who underwent operative repair for esophageal atresia and tracheoesophageal fistula from 2014 to 2018, comparing open approach, thoracoscopy, and conversions to open.

The study included almost 900 neonates with EA/TEF.

Only about 16% of EA/TEF operative approaches were thoracoscopic, with the vast majority approached through traditional open thoracotomy.

The conversion rate from thoracoscopic to open EA/TEF repair was approximately 50%.

Despite the high conversion rate from thoracoscopic to open EA/TEF repair, there was no increased rate of complications in converted patients.

Increasing adoption of thoracoscopic EA/TEF repair requires regular practice and mentorship with someone who performs the procedure, ideally as part of fellowship training.

A mentorship program involving in-person mentorship followed by telementoring is probably the only way to measurably get practicing surgeons performing thoracoscopic EA/TEF repair.

Simulators for practicing thoracoscopic anastomosis in a 3 kg chest are improving and may help increase utilization of thoracoscopic EA/TEF repair.

Long-term outcomes are likely to be better with thoracoscopic approach for EA/TEF repair.

The Children's Mercy Hospital study was a retrospective chart review of patients with slipping rib syndrome from 2006 to 2020, including 49 patients who underwent 67 operations.

Slipping rib syndrome is being recognized more frequently and patients are typically not going to get better with conservative management.

Patients with slipping rib syndrome are frequently symptomatic for years and have often seen multiple physicians across multiple disciplines, sometimes traveling from city to city.

A reasonable surgical candidate for slipping rib syndrome is a patient who had a reasonable result from local injection but then had pain recur.

On physical examination for slipping rib syndrome, the area between ribs 9 and 11 in the anterolateral costal margin is typically tender and palpation can replicate the pain.

In some slipping rib syndrome cases, the rib pop can be felt on examination, patients can replicate it themselves by turning to the side or flexing their abdomen, or the rib movement can be seen.

Pressing on the sides of the chest simultaneously will frequently replicate the anterior pain in slipping rib syndrome patients.