1 00:00:00,000 --> 00:00:11,680 Hello, pediatric surgery family. 2 00:00:11,680 --> 00:00:16,940 I'm Em Gootee, a research fellow from Cincinnati Children's Hospital Medical Center. 3 00:00:16,940 --> 00:00:23,280 And today, our team is going to deliver the articles that you should know about. 4 00:00:23,280 --> 00:00:30,080 We have three papers today, and all are from the Journal of Pediatric Surgery. 5 00:00:30,080 --> 00:00:37,920 We don't have much time, so let's start. 6 00:00:37,920 --> 00:00:43,260 Our first paper titled, Does Presence of a Vectoral Anomaly Predict an Associated Gynecologic 7 00:00:43,260 --> 00:00:46,760 Anomaly in Females with Anorectal Malformations? 8 00:00:46,760 --> 00:00:51,800 A Pediatric Colorectal and Pelvic Learning Consortium Study by Ahmed et al. 9 00:00:51,800 --> 00:00:54,400 This paper is summarized by Ellen Ansisco. 10 00:00:54,400 --> 00:00:58,800 She was a research fellow at Cincinnati Children's, and as of July, she's back to being a general 11 00:00:58,800 --> 00:01:03,360 surgery resident at Mayo Clinic. 12 00:01:03,360 --> 00:01:08,320 Here the authors wanted to know if a vagatrial anomaly predicted an associated gynecologic 13 00:01:08,320 --> 00:01:13,320 anomaly in pediatric females with anorectal malformations. 14 00:01:13,320 --> 00:01:17,760 Using the database from the Pediatric Colorectal and Pelvic Learning Consortium, they looked 15 00:01:17,760 --> 00:01:22,480 at 384 females with anorectal malformations. 16 00:01:22,480 --> 00:01:28,160 They found that about 27% of the patients had a gynecologic anomaly, and about 46% of 17 00:01:28,160 --> 00:01:32,600 them had the bacterial association, meaning that in addition to the anorectal malformation, 18 00:01:32,600 --> 00:01:39,720 they also had two of a vertebral, cardiac, tracheosophageal, renal, or limb anomaly. 19 00:01:39,720 --> 00:01:43,160 When comparing patients who had a bacterial association to those who didn't, they found 20 00:01:43,160 --> 00:01:49,720 that having the bacterial association was associated with more gynecologic anomalies. 21 00:01:49,720 --> 00:01:54,320 This was especially true when renal anomalies were found and when patients had recto-vestibular 22 00:01:54,320 --> 00:01:57,480 or recto-perineal vestulas. 23 00:01:57,480 --> 00:02:01,440 So for females with anorectal malformations and bacterial association, especially renal 24 00:02:01,440 --> 00:02:08,960 anomalies, we should look carefully for gynecologic anomalies. 25 00:02:08,960 --> 00:02:14,000 In our second paper of the day, Cost and Outcomes of Intercostal Nerve Cryoblation 26 00:02:14,000 --> 00:02:19,560 versus Thoracic Epidural Following the NUS Procedure by Perez Holkwin et al. 27 00:02:19,560 --> 00:02:21,840 And this paper is summarized by Alex Halpern. 28 00:02:21,840 --> 00:02:26,460 He is one of our contributors here at Stacor MD and a general surgery resident at George 29 00:02:26,460 --> 00:02:31,440 Washington University. 30 00:02:31,440 --> 00:02:36,440 Thoracic epidural and intercostal nerve cryoblations are two options for pain control in patients 31 00:02:36,440 --> 00:02:40,120 undergoing a NUS procedure for pectus excavatum. 32 00:02:40,120 --> 00:02:42,240 Now what are the benefits of each? 33 00:02:42,240 --> 00:02:47,120 Dr. Tsai and his team from Penn State conducted a retrospective chart review looking at kids 34 00:02:47,120 --> 00:02:53,040 who underwent a NUS procedure between 2002 and 2020 and comparing the outcomes and costs 35 00:02:53,040 --> 00:02:56,520 of intercostal nerve cryoblation and epidural. 36 00:02:56,520 --> 00:03:02,360 They found that the intercostal nerve cryoblation group had lower rates of PCA use, lower total 37 00:03:02,360 --> 00:03:07,480 morphine milligram equivalent requirement, and the shorter length of stay in the hospital. 38 00:03:07,480 --> 00:03:12,600 This group also had longer operative times and a higher total hospitalization cost than 39 00:03:12,600 --> 00:03:14,640 the thoracic epidural group. 40 00:03:14,640 --> 00:03:19,040 So it seems like both these options have their pros and cons with the intercostal nerve cryoblation 41 00:03:19,040 --> 00:03:23,720 group having a decreased total opioid use and decreased length of stay in the hospital 42 00:03:23,720 --> 00:03:31,200 but increased operating room times and increased total cost. 43 00:03:31,200 --> 00:03:33,400 Let's move to the last paper of the day. 44 00:03:33,400 --> 00:03:37,200 Reconstructing the anal sphincters to reverse iatrogenic overstretching following a pull 45 00:03:37,200 --> 00:03:39,040 through for Hirschsprung disease. 46 00:03:39,040 --> 00:03:41,760 One year outcomes by Bocowa et al. 47 00:03:41,760 --> 00:03:43,680 This one is summarized by Cicely Highena. 48 00:03:43,680 --> 00:03:46,760 She's a research fellow with Cincinnati Children's. 49 00:03:46,760 --> 00:03:54,600 This is a multi-institutional one-year outcome study where they did a reconstruction of the 50 00:03:54,600 --> 00:04:01,520 anal sphincter for patella sphincter in six patients, then an assessment after a year. 51 00:04:01,520 --> 00:04:02,520 They had six patients. 52 00:04:02,520 --> 00:04:09,520 Two of them had Down syndrome and they did a V2 pull through with an anal sphincter reconstruction 53 00:04:09,520 --> 00:04:14,160 and the other four got only an anal sphincter reconstruction. 54 00:04:14,160 --> 00:04:21,600 These four patients got voluntary bowel movements with higher productivity and confidence. 55 00:04:21,600 --> 00:04:27,320 So it seems that we have an option for overstretched anal sphincters in patients with Hirschsprung 56 00:04:27,320 --> 00:04:48,160 disease after a pull through.