Optimizing Efficacy of Vacuum Bell Therapy for Pectus Excavatum: Compliance is Key.

Introduction: Pectus excavatum (PE) is the most common congenital chest wall deformity. The vacuum bell (VB) is a nonoperative alternative to surgical correction. We reviewed our center's experience with VB for PE to identify variables associated with improved therapeutic success, with a focus on compliance to prescribed VB therapy.

Low Risk of Clinically Important Traumatic Brain Injury in Children Who Tumble Down Stairs.

Background: Pediatric trauma management seeks to minimize head computed tomography (HCT) while capturing clinically important traumatic brain injuries (ciTBI). The Pediatric Emergency Care Applied Research Network (PECARN) system stratifies patients as high-, intermediate-, or low-risk for ciTBI. Although designed for free falls, we noted that PECARN criteria often are applied to tumbling down stairs (TDS), with steps estimated at 12", though TDS rarely appeared to result in ciTBI.

Effectiveness of intraoperative nerve monitoring in reducing rates of recurrent laryngeal nerve injury in aerodigestive and cardiovascular pediatric surgery.

Objective: To investigate the effectiveness of intraoperative nerve monitoring at decreasing vocal fold movement impairment in children undergoing at-risk procedures.

Background: Children undergoing aerodigestive or cardiovascular procedures are at risk for recurrent laryngeal nerve injury, leading to vocal fold movement impairment. Although intraoperative nerve monitoring has been shown to decrease recurrent laryngeal nerve injury in adults, there is paucity of data in children.

Botulinum Toxin Enhanced Foker Process for Long Gap Esophageal Atresia.

Background: The traction-induced esophageal growth (Foker) process for the treatment of long gap esophageal atresia (LGEA) relies on applying progressive tension to the esophagus to induce growth. Due to its anti-fibrotic and muscle-relaxing properties, we hypothesize that Botulinum Toxin A (BTX) can enhance traction-induced esophageal growth.

Methods: A retrospective two-center cohort study was conducted on children who underwent a BTX-enhanced Foker process for LGEA repair from 2021 to 2023.

Early Graft Loss With Suspected Seventh-Day Syndrome Following Pediatric Liver Transplantation.

Introduction: Allograft dysfunction within the first week posttransplant is an uncommon but known complication following liver transplantation. Seventh-Day Syndrome (7DS) is a rare complication of allograft dysfunction following liver transplantation characterized by the rapid clinical deterioration of a formerly well-functioning allograft within the first week posttransplant. The etiology of 7DS is unknown, and treatment options remain limited.

Effect of citizenship status on access to pediatric liver and kidney transplantation.

Transplantation of non-US citizen residents remains controversial. We evaluate national trends in transplant activity among pediatric noncitizen residents (PNCR). Pediatric liver and kidney transplant data were obtained from the Organ Procurement and Transplantation Network and the Scientific Registry of Transplant Recipients.

Management of Persistent Low-Suspicion Cervical Lymphadenopathy in Pediatric Patients.

Introduction: Cervical lymphadenopathy in children is typically self-limited; however, the management of persistent lymphadenopathy remains unclear. This study aimed to evaluate the management and outcomes of patients with persistent cervical lymphadenopathy.

Methods: Single-institution, retrospective review of children <18 years undergoing ultrasound (US) for cervical lymphadenopathy from 2013 to 2021 was performed.

Cold Therapy for Pain Control in Pediatric Appendectomy Patients: A Randomized Controlled Trial.

Purpose: Topical ice has been shown to reduce pain scores and opioid use in adults with midline abdominal incisions. This study was designed to evaluate the efficacy of a cold therapy system in children following laparoscopic appendectomy.

Methods: Patients 7 years and older who underwent laparoscopic appendectomy at our institution from December 2021-September 2022 were eligible.

Autologous and synthetic pediatric iliofemoral reconstruction: a novel technique for pediatric iliofemoral artery reconstruction.

Pediatric lower extremity arterial catheterization-related injuries can result in significant long-term morbidity. Revascularization is challenging due to concerns for long-term patency and growth accommodation with synthetic grafts. We describe a novel technique for iliofemoral revascularization using common iliac artery transposition and bridging polytetrafluoroethylene grafts.

Metastatic pulmonary calcifications after pediatric liver transplantation.

Background: Pulmonary calcification (PC) is a rare clinical entity observed following liver transplantation (LT). Most often identified in adults or in patients with concomitant renal failure, PC is rarely reported in children. While the clinical course of PC is largely benign, cases of progressive respiratory failure and death have been reported.

Immediate extubation after pediatric liver transplantation: Update on a single-center experience.

Purpose: Immediate extubation (IE) following liver transplantation (LT) is increasingly common in adult patients. This study reviews our center's experience with IE in children following LT to determine characteristics predictive of successful IE and its effects on post-operative outcomes.

Methods: We performed a retrospective chart review of all patients who underwent LT at our institution between January 2005 and November 2022.

International Hepato-Pancreato-Billiary Association (IHPBA) registry study on COVID-19 infections in HPB surgery patients.

Background: In response to the pandemic, the International Hepato-Pancreato-Biliary Association (IHPBA) developed the IHPBA-COVID Registry to capture data on HPB surgery outcomes in COVID-positive patients prior to mass vaccination programs. The aim was to provide a tool to help members gain a better understanding of the impact of COVID-19 on patient outcomes following HPB surgery worldwide.

Methods: An online registry updated in real time was disseminated to all IHPBA, E-AHPBA, A-HPBA and A-PHPBA members to assess the effects of the pandemic on the outcomes of HPB procedures, perioperative COVID-19 management and other aspects of surgical care.

Bronchoscopic Localization of Tracheoesophageal Fistula in Newborns with Esophageal Atresia: Intubate Above or Below the Fistula?

Purpose: In neonates with suspected type C esophageal atresia and tracheoesophageal fistula (EA/TEF) who require preoperative intubation, some texts advocate for attempted "deep" or distal-to-fistula intubation. However, this can lead to gastric distension and ventilatory compromise if a distal fistula is accidently intubated. This study examines the distribution of tracheoesophageal fistula locations in neonates with type C EA/TEF as determined by intraoperative bronchoscopy.

Outcomes of laparoscopic gastrostomy in children with and without the use of a modified T-fastener technique.

Background: Laparoscopic gastrostomy is commonly performed for durable enteral access in children. T-fasteners have been used intraoperatively to achieve a secure gastropexy, traditionally using external bolsters. We compare the safety profile of a modified paired T-fastener technique to standard laparoscopic-assisted suture gastropexy.

Management of pediatric appendicitis during the COVID-19 pandemic: A nationwide multicenter cohort study.

Background: The COVID-19 pandemic has impacted timely access to care for children, including patients with appendicitis. This study aimed to evaluate the effect of the COVID-19 pandemic on management of appendicitis and patient outcomes.

Methods: A multicenter retrospective study was performed including 19 children's hospitals from April 2019-October 2020 of children (age≤18 years) diagnosed with appendicitis.

Learning to SuRRF: Sustained Engagement and Increased Academic Productivity Over Two Years of a Resident-Led Virtual Laboratory.

Objective: To determine if implementation of a resident-led virtual laboratory can sustain increased engagement and academic productivity in residents and faculty.

Design: We developed and introduced a multimodal virtual Surgery Resident Research Forum (SuRRF) in July 2019. SuRRF utilizes monthly virtual lab meetings, weekly newsletters, a centralized database of projects, project tracking tools, and a shared calendar of deadlines to facilitate research among surgical residents.

Diving Under the SuRRFace: Achieving More Than Just Compliance with ACGME Scholarly Activity Mandate.

Objective: To determine if building a digital technology supported infrastructure improves general surgery residents' confidence to conduct clinical research.

Design: We developed and introduced a multimodal virtual Surgery Resident Research Forum (SuRRF) in July 2019. An anonymized survey asked residents to rate their confidence using a five-point Likert scale in various fields pre- and post-intervention.

Neuroendocrine neoplasms of the gallbladder: early detection and surgery is key to improved outcome.

Purpose: Neuroendocrine neoplasms (NENs) of the gallbladder are very rare. As a result, the classification of pathologic specimens from gallbladder NENs, currently classified as gallbladder neuroendocrine tumors (GB-NETs) and carcinomas (GB-NECs), is inconsistent and makes nomenclature, classification, and management difficult. Our study aims to evaluate the epidemiological trend, tumor biology, and outcomes of GB-NET and GB-NEC over the last 5 decades.

Spinal Epidural Abscess Patients Have Higher Modified Frailty Indexes Than Back Pain Patients on Emergency Room Presentation: A Single-Center Retrospective Case-Control Study.

Objective: Spinal epidural abscess (SEA) patients have increased medical comorbidities and risk factors for infection compared with those without SEA. However, the association between frailty and SEA patients has not been documented.

Methods: A total of 46 SEA patients were randomly paired and matched by age and sex with a control group of patients with back pain who had presented to our emergency department from 2012 to 2017.

Management of air leaks post-surgical lung resection.

Airleaks are one of the most common complications associated with elective lung resection. There have been many techniques and modern advancements in thoracic surgery, however airleaks persist. This review article will discuss several interventions ranging from conservative noninvasive to surgical management of the persistent airleak.