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.

Contemporary use of fibrinolytics in the management of pediatric empyema.

Background: This study seeks to investigate the contemporary use and effectiveness of fibrinolysis as a first-line option in pediatric empyema.

Methods: The Pediatric Health Information System (PHIS) was queried to identify patients with empyema without fistula (2018-2023). First-line treatments were chest drainage (CD), chest drainage with fibrinolysis (CDF), and video-assisted thoracoscopic surgery/open decortication (VATS/OD).

Management of undescended testis.

Purpose Of Review: Describe why this review is timely and relevant.Undescended testis, or cryptorchidism, is a common diagnosis encountered by pediatricians that requires timely collaboration with pediatric surgical specialists to optimize outcomes for these patients. As this topic continues to be heavily researched, it is imperative to understand current recommendations and emerging management options including new surgical techniques, as well as common pitfalls in care highlighted in the literature.

Use of Ultrasound in the Evaluation of Cryptorchidism: A Single-Institution Analysis.

Introduction: The American Urological Association guidelines recommend against the performance of ultrasound and other imaging modalities in the evaluation of patients with cryptorchidism before expert consultation. We aimed to examine our institutional experience with cryptorchidism and measure adherence to currently available guidelines.

Methods: An institutional review board-approved retrospective review of ultrasound utilization in the evaluation of patients with cryptorchidism was performed from June 1, 2016, to June 30, 2019, at a single tertiary level pediatric hospital.

Evaluation of Post-neonatal Intensive Care Unit Home Irrigations Prior to Pull-through: Implications for Hirschsprung Disease Management.

Background: Pull-through procedures for Hirschsprung disease (HD) can be performed during the Neonatal Intensive Care Unit (NICU) stay or delayed until discharge following home irrigations. This study assesses the safety of a delayed pull-through as an alternative to neonatal reconstruction in infants with successful abdomen decompression with home irrigations based on Hirschsprung-associated enterocolitis (HAEC) development.

Methods: A single-institution retrospective review of neonates with HD who underwent delayed or neonatal pull-through from July 2018-July 2022.

Determining the Optimal Technique for Bar Fixation in the Repair of Pectus Excavatum.

Pectus bar stabilizers are routinely used for bar fixation in the repair of pectus excavatum. We aimed to determine the optimum technique for bar fixation by reviewing our institutional experience with the use of bilateral, unilateral, and no stabilizer placement. Retrospective single pediatric center review of patients who underwent minimally invasive bar placement for pectus excavatum and subsequent bar removal between December 2001 and July 2019 was performed.

Exchange of Extracorporeal Membrane Oxygenation Cannulas for Hemodialysis Catheters in Children Requiring Renal Replacement Therapy.

Background: Pediatric patients requiring extracorporeal membrane oxygenation (ECMO) may require renal replacement therapy even after decannulation. However, data regarding transition from ECMO cannulation to a hemodialysis catheter in pediatric patients is not currently available.

Methods: Patients <18 years old who had an ECMO cannula exchanged for a hemodialysis catheter during decannulation at a tertiary care children's center from January 2011 to September 2022 were identified.

Persistent Pediatric Breast Abscesses Following Initial Treatment at Tertiary and Community Centers.

Introduction: Little data exist on the management of pediatric breast abscesses that fail initial treatment. Therefore, this study aimed to evaluate and report outcomes in these patients.

Methods: All patients <18-year-old treated for a breast abscess between January 2008 and December 2018 were included.

Long-Term Recurrence Rates and Patient Satisfaction after Repair of Pectus Excavatum.

Background:  Pectus excavatum deformities are usually repaired with a minimally invasive approach in which a metal bar is used to correct the chest wall abnormality. We aimed to evaluate long-term outcomes and patient satisfaction after surgical correction.

Methods:  Patients who underwent pectus excavatum repair and subsequent bar removal at a single tertiary care center from January 2000 to December 2020 were identified.

Infliximab Rescue Therapy in Pediatric Severe Colitis.

Introduction: Clinical remission has been achieved with infliximab in patients with refractory ulcerative colitis (UC). However, there is conflicting data regarding its effectiveness as rescue therapy in adult acute severe colitis. Furthermore, pediatric inflammatory bowel disease (IBD) is associated with more severe disease that may be less amenable to attempted rescue.

Duodenal Atresia Repair: A Single-Center Comparative Study.

Background: The use of laparoscopy in the repair of duodenal atresia has been increasing. However, there is no consensus regarding which surgical approach has better outcomes. We aimed to compare the different surgical approaches and types of anastomoses for duodenal atresia repair.

Hypertrophic Pyloric Stenosis Protocol: A Single Center Study.

Background: Initial treatment of hypertrophic pyloric stenosis (HPS) is correction of electrolyte disturbances with fluid resuscitation. In 2015, our institution implemented a fluid resuscitation protocol based on previous data that focused on minimizing blood draws and allowing immediate ad libitum feeds postoperatively. Our aim was to describe the protocol and subsequent outcomes.

Satisfaction With Same-Day Discharge After Laparoscopic Appendectomy for Nonperforated Appendicitis.

Introduction: Same-day discharge (SDD) after laparoscopic appendectomy for acute nonperforated appendicitis is safe, without an increased rate of postoperative complications, emergency department visits, or readmissions. We aimed to evaluate caregiver satisfaction with this protocol.

Methods: Patients discharged on the day of laparoscopic appendectomy for nonperforated acute appendicitis were identified between January 2022 and August 2022.

Management of Primary Spontaneous Pneumothorax in Children: A Single Institution Protocol Analysis.

Background: The Midwest Pediatric Surgery Consortium (MWPSC) suggested a simple aspiration of primary spontaneous pneumothorax (PSP) protocol, failing which, Video-Assisted Thoracoscopic Surgery (VATS) should be considered. We describe our outcomes using this suggested protocol.

Methods: A single institution retrospective analysis was conducted on patients between 12 and 18 years who were diagnosed with PSP from 2016 to 2021.

Laparoscopic Repair of an Incarcerated Left Ovary, Hemi-Uterus, and Salpinx Within A Left Inguinal Hernia.

Inguinal hernia repair is one of the most common operations performed by pediatric surgeons. These hernias typically present as asymptomatic or symptomatic swellings in the groin, extending into the labia in girls or the scrotum in boys. Surgical repair is indicated as these hernias do not spontaneously close and carry a risk of incarceration.

Institutional outcomes of blunt liver and splenic injury in the Arizona-Texas-Oklahoma-Memphis-Arkansas Consortium era.

Background: The Arizona-Texas-Oklahoma-Memphis-Arkansas Consortium practice management guideline was created to standardize management of blunt liver or spleen injury across pediatric trauma centers. We describe our outcomes since guideline adoption at our institution and hypothesize that blunt liver or spleen injury may be managed more expeditiously than currently reported without compromising safety.

Methods: A retrospective cohort study was conducted on patients younger than 18 years presenting with blunt liver and/or splenic injuries from March 2016 to March 2021 at one participating center.

Diversity and demographics of APSA members: Understanding our identity.

Introduction: There are existing healthcare disparities in pediatric surgery today. Identity and racial incongruity between patients and providers contribute to systemic healthcare inequities and negatively impacts health outcomes of minoritized populations. Understanding the current demographics of the American Pediatric Surgical Association and therefore the cognitive diversity represented will help inform how best to strategically build the organization to optimize disparity solutions and improve patient care.

APSA Members experience bias and discrimination in training and practice.

Introduction: Bias and discrimination remain pervasive in the medical field and increase the risk of burnout, mental health disorders, and medical errors. The experiences of APSA members with bias and discrimination are unknown, therefore the APSA committee on Diversity, Equity and Inclusion conducted a survey to characterize the prevalence of bias and discrimination.

Methods: 1558 APSA members were sent an anonymous survey, of which 423 (27%) responded.

Evaluating caretaker satisfaction with same-day discharge after gastrostomy tube placement.

Background: Same-day discharge (SDD) after laparoscopic gastrostomy tube (G-tube) placement, using written and video-based preoperative education, has been our standard institutional practice since 2017. We aim to evaluate caretaker satisfaction with this protocol.

Methods: All patients planned for SDD after G-tube placement from February 2021-February 2022 were identified.

Pre-hospital CPR after traumatic arrest: Outcomes at a level 1 pediatric trauma center.

Background: The survival of traumatic cardiopulmonary arrest (TCA) requiring pre-hospital cardiopulmonary resuscitation (P-CPR) is abysmal across age groups. We aim to describe the mechanisms of injury and outcomes of children suffering from TCA leading to P-CPR at our institution.

Methods: A retrospective review was conducted to identify children ages 0-17 years who suffered TCA leading to P-CPR at our institution between 5/2009 and 3/2020.

Testicular torsion disparities in the pediatric population.

Background: There are disparate findings in the literature on the impact of race and insurance status on gonadal loss in testicular torsion. We sought to determine if race or levels of social vulnerability influence the rate of torsion or gonadal loss.

Methods: Retrospective cross-sectional review between December 2017 and September 2019.

Laparoscopic Gastrostomy in Infants During an Open Abdominal Procedure: A Novel Approach.

Infants with intra-abdominal pathology necessitating open abdominal surgery may also require placement of a gastrostomy tube (GT). Use of laparoscopy provides better visualization for gastrostomy placement and lowers the risk of complications compared with an open approach. We describe a series of patients who underwent laparoscopic GT placement at the time of an open abdominal procedure.