Preoperative determinants of normative postoperative recovery rate following minimally invasive repair of pectus excavatum.

Purpose: Recovery after minimally invasive repair of pectus excavatum (MIRPE) is prolonged. The purpose of this prospective study was to enhance our understanding of post-MIRPE recovery by following patients' recovery through postoperative day (POD) 60 using wearable devices and determine if recovery rate is impacted by PE severity and preoperative physical activity (PA) level.

Methods: Children ≤ 18 years who underwent MIRPE with cryoablation between 8/2023 and 1/2024 wore a Fitbit™ for ≥ 3 days preoperatively to determine preoperative PA and through POD 60.

A Retrospective Nationwide Comparison of Laparoscopic vs Open Inguinal Hernia Repair in Children.

Background: Utilization of the laparoscopic approach for inguinal hernia repair has increased significantly over the past decade. The purpose of this study is to compare rates of second hernia operation and same side recurrence following open and laparoscopic inguinal hernia repair in a large national cohort.

Methods: This retrospective analysis utilized the Pediatric Health Information System database to identify children <18 years-old who underwent laparoscopic or open primary inguinal hernia repair from 2017 to 2021.

Necrotizing Enterocolitis Detection in Premature Infants Using Broadband Optical Spectroscopy.

Necrotizing enterocolitis (NEC) is a devastating disease affecting premature infants. Broadband optical spectroscopy (BOS) is a method of noninvasive optical data collection from intra-abdominal organs in premature infants, offering potential for disease detection. Herein, a novel machine learning approach, iterative principal component analysis (iPCA), is developed to select optimal wavelengths from BOS data collected in vivo from neonatal intensive care unit (NICU) patients for NEC classification.

Trends and Outcomes in Elective Pediatric Surgery During Weekends.

Purpose: Limited operating room availability constrains hospital scheduling capacity for elective surgical cases. Leveraging weekends for elective surgical cases could increase operative capacity but must be balanced with practical considerations. Our study aimed to characterize trends and outcomes for elective pediatric surgeries performed during weekends.

Clinical Consensus Statement on the Use of Indocyanine Green Fluorescence-guided Surgery in Pediatric Patients.

Background And Aims: Indocyanine Green Fluorescence (ICG-F)- guided surgery is becoming an increasingly helpful tool in pediatric surgical care. This consensus statement investigates the utility of ICG-F in various pediatric surgical applications, primarily focusing on its evidence base, safety, indications, use across different surgical specialties and dosing strategies. The aim is to establish an international consensus for ICG-F use in pediatric surgery.

Thymectomy for juvenile myasthenia gravis: a narrative review.

Background And Objective: Thymectomy as a management strategy for juvenile myasthenia gravis (JMG) has been increasingly adopted with the advent of minimally invasive surgical techniques. This review evaluates existing evidence regarding the surgical management of JMG, including the benefits of surgical compared to medical therapy, important considerations when evaluating surgical candidacy and determining optimal timing of intervention. In addition, we provide an overview of the open, thoracoscopic and robotic surgical approaches available for thymectomy and compare the existing data to characterize optimal surgical management.

Scoring System to Evaluate Risk of Nonoperative Management Failure in Children With Intussusception.

Introduction: Typical first-line management of children with intussusception is enema reduction; however, failure necessitates surgical intervention. The number of attempts varies by clinician, and predictors of failed nonoperative management are not routinely considered in practice. The purpose of this study is to create a scoring system that predicts risk of nonoperative failure and need for surgical intervention.

Percutaneous Drainage of Pediatric Pulmonary Abscesses: An Effective Therapy.

Introduction: Pulmonary abscess is a complication of lung infection with localized necrosis and purulent cavity formation. Pulmonary abscesses are typically managed using antibiotic therapy with anatomic surgical resection reserved as a rescue. Percutaneous drainage is considered relatively contraindicated in some centers due to perceived risk of bronchopleural fistula.

Utility of White Light Scanning as an Alternative to Computed Tomography to Evaluate Severity of Pectus Excavatum Deformity.

Background: Pectus excavatum (PE) severity and surgical candidacy are determined by computed tomography (CT)-delineated Haller Index (HI) and Correction Index (CI). White light scanning (WLS) has been proposed as a non-ionizing alternative. The purpose of this retrospective study is to create models to determine PE severity using WLS as a non-ionizing alternative to CT.

Chest Wall Dermatitis Patterns Following Thoracoscopic Intercostal Nerve Cryoablation for Surgical Correction of Pectus Excavatum.

Background: Intercostal nerve cryoablation (INC) has been shown to reduce postoperative pain and length of stay following surgical correction of pectus excavatum (SCOPE). Some patients have developed chest wall dermatological symptoms after INC that can be mistaken for metal allergy or infection. The purpose of this study is to report the symptoms, severity, incidence, and treatment of post-cryoablation dermatitis.

Comparison of Vital Sign Cutoffs to Identify Children With Major Trauma.

Importance: Vital signs are essential components in the triage of injured children. The Advanced Trauma Life Support (ATLS) and Pediatric Advanced Life Support (PALS) physiologic criteria are frequently used for trauma assessments.

Objective: To evaluate the performance of ATLS and PALS criteria vs empirically derived criteria for identifying major trauma in children.

Framework for pediatric robotic surgery program development.

Pediatric robotic surgery has seen increasing implementation for its many benefits over the past two decades. As more pediatric surgeons gain exposure to robotic surgery, the interest in utilizing this technology is growing. However, there are no guidelines or existing framework for developing pediatric general surgery robotic programs.

Intercostal spinal nerve cryoablation for analgesia following pectus excavatum repair.

Pectus excavatum is a common chest wall deformity, most often treated during adolescence, that presents a significant postoperative pain control challenge for pediatric surgeons following surgical correction. The purpose of this article is to review the technique and outcomes of intercostal spinal nerve cryoablation for postoperative analgesia following surgical correction of pectus excavatum. Contemporary and historic literature were reviewed.

Intercostal nerve cryoablation reduces opioid utilization after thoracotomy in children with cancer.

Background: Intercostal nerve cryoablation (INC) has shown promise as an adjunct method for analgesia in adults undergoing thoracotomy, but has yet to be widely used in children for this indication. We hypothesize that INC decreases opioid utilization in children undergoing thoracotomy for cancer operations.

Methods: A retrospective review was performed of children who underwent thoracotomy for cancer diagnosis at a freestanding children's hospital from 2018 to 2023.

Demographics of Anterior Chest Wall Deformity Patients: A Tertiary Children's Hospital Experience.

Introduction: Anterior chest wall deformities consist of abnormal development of the chest, with the most common congenital deformities being pectus excavatum (PE) and pectus carinatum (PC). Surgical series are common, but less research is present assessing the demographics of all who present for initial evaluation. The purpose of this study is to describe the patient characteristics of those who present for ambulatory surgical evaluation.

Evaluating Skeletal Maturity at Time of Surgical Correction of Pectus Excavatum Based on Medial Clavicle Epiphyseal Ossification.

Background: Surgical correction of pectus excavatum (SCOPE) is dependent upon chest wall pliability with optimal timing prior to complete skeletal maturation. Measures of skeletal maturity are not readily available for operative planning; therefore, surgeons use age as proxy despite patient-specific rates of skeletal maturation. We aimed to determine whether preoperative skeletal maturity is associated with postoperative pain as surrogate for chest wall pliability.

Measurement and Thermodynamic Modeling of Energy Flux During Intercostal Nerve Cryoablation.

Introduction: Intercostal nerve cryoablation is an increasingly adopted technique to decrease postoperative pain in patients undergoing surgical correction of pectus excavatum (SCOPE). Concerns regarding cryo-induced systemic hypothermia have been raised in pediatric patients; however, assessment of a cooled cryoprobe on body temperature has not been performed. We aimed to determine the energy flux from a maximally cooled cryoprobe and model the possible effects on a whole-body system.

Intercostal Nerve Cryoablation Reduces Opioid Use and Length of Stay Without Increasing Adverse Events: A Retrospective Cohort Study of 5442 Patients Undergoing Surgical Correction of Pectus Excavatum.

Objective: To examine differences in opioid use, length of stay, and adverse events after minimally invasive correction of pectus excavatum (MIRPE) with and without intercostal nerve cryoablation.

Background: Small studies show that intraoperative intercostal nerve cryoablation provides effective analgesia with no large-scale evaluations of this technique.

Methods: The pediatric health information system database was used to perform a retrospective cohort study comparing patients undergoing MIRPE at children's hospitals before and after the initiation of cryoablation.

Measuring the Efficacy of Thymectomy for Pediatric Myasthenia Gravis Across Tertiary Children's Hospitals.

Background: Thymectomy is a treatment for pediatric myasthenia gravis, but the efficacy over time is unknown. Multi-institutional data are also lacking. Therefore, the objective of this study was to determine the efficacy of thymectomy for pediatric myasthenia gravis using medication burden and health care utilization as proxies for disease severity.

Consumer Wearables Define a Normative Recovery Trajectory Following the Modified Nuss Procedure.

Introduction: The modified Nuss procedure is an elective procedure associated with a lengthy recovery, uncontrolled pain, and risk of infrequent, yet life-threatening complications. The absence of objective measures of normative postoperative recovery creates uncertainty about the postdischarge period, which remains highly dependent on the patients' and their caregivers' expectations and management of recovery. We aimed to describe an objective-normative, physical activity recovery trajectory after the modified Nuss procedure, using step counts from the Fitbit.

Agminated presentation of fusion-driven melanocytic neoplasms.

Background: The conventionally understood pathogenesis of agminated Spitz nevi includes a mosaic HRAS mutation followed by copy number gains in 11p. However, we have recently observed agminated presentations of fusion-driven melanocytic neoplasms.

Methods: We retrieved cases from our database of benign fusion-induced melanocytic neoplasms with an agminated presentation.

Innovation versus Experimentation: An Application of Ethical Frameworks to the Acceptance of Fluorescence-Guided Pediatric Surgery.

Innovation is essential to the advancement of the field of pediatric surgery. The natural skepticism toward new technologies in pediatrics leads to frequent confusion of surgical innovation and research. Using fluorescence-guided surgery as an archetype for this ethical discussion, we apply existing conceptual frameworks of surgical innovation to understand the distinction between innovation and experimentation, acknowledging the spectrum and "grey zone" in between.

Timing of pediatric pyloromyotomy on hospital length of stay.

Introduction: Pyloromyotomy timing is predicated upon correction of electrolyte abnormalities. Among infants who presented with normal electrolytes, we hypothesized that pyloromyotomy the evening of presentation, rather than waiting until morning, would confer shorter length of stay (LOS).

Methods: This single-center retrospective cohort study included patients who underwent pyloromyotomy from 2012 to 2021.