Quick Literature Update Episode 14

Hello, pediatric surgery family. I'm Em Gootee, a research fellow from Cincinnati Children's Hospital Medical Center. And today, our team is going to deliver the articles that you should know about. We have three papers today, and all are from the Journal of Pediatric Surgery. We don't have much time, so let's start.

Our first paper titled, Does Presence of a Vectoral Anomaly Predict an Associated Gynecologic Anomaly in Females with Anorectal Malformations? A Pediatric Colorectal and Pelvic Learning Consortium Study by Ahmed et al. This paper is summarized by Ellen Ansisco. She was a research fellow at Cincinnati Children's, and as of July, she's back to being a general surgery resident at Mayo Clinic.

Here the authors wanted to know if a vagatrial anomaly predicted an associated gynecologic anomaly in pediatric females with anorectal malformations. Using the database from the Pediatric Colorectal and Pelvic Learning Consortium, they looked at 384 females with anorectal malformations.

They found that about 27% of the patients had a gynecologic anomaly, and about 46% of them had the bacterial association, meaning that in addition to the anorectal malformation, they also had two of a vertebral, cardiac, tracheosophageal, renal, or limb anomaly. When comparing patients who had a bacterial association to those who didn't, they found that having the bacterial association was associated with more gynecologic anomalies.

This was especially true when renal anomalies were found and when patients had recto-vestibular or recto-perineal vestulas. So for females with anorectal malformations and bacterial association, especially renal anomalies, we should look carefully for gynecologic anomalies.

In our second paper of the day, Cost and Outcomes of Intercostal Nerve Cryoblation versus Thoracic Epidural Following the NUS Procedure by Perez Holkwin et al. And this paper is summarized by Alex Halpern. He is one of our contributors here at Stacor MD and a general surgery resident at George Washington University. Thoracic epidural and intercostal nerve cryoblations are two options for pain control in patients undergoing a NUS procedure for pectus excavatum. Now what are the benefits of each?

Dr. Tsai and his team from Penn State conducted a retrospective chart review looking at kids who underwent a NUS procedure between 2002 and 2020 and comparing the outcomes and costs of intercostal nerve cryoblation and epidural. They found that the intercostal nerve cryoblation group had lower rates of PCA use, lower total morphine milligram equivalent requirement, and the shorter length of stay in the hospital.

This group also had longer operative times and a higher total hospitalization cost than the thoracic epidural group. So it seems like both these options have their pros and cons with the intercostal nerve cryoblation group having a decreased total opioid use and decreased length of stay in the hospital but increased operating room times and increased total cost.

Let's move to the last paper of the day. Reconstructing the anal sphincters to reverse iatrogenic overstretching following a pull through for Hirschsprung disease. One year outcomes by Bocowa et al. This one is summarized by Cicely Highena. She's a research fellow with Cincinnati Children's. This is a multi-institutional one-year outcome study where they did a reconstruction of the anal sphincter for patella sphincter in six patients, then an assessment after a year. They had six patients.

Two of them had Down syndrome and they did a V2 pull through with an anal sphincter reconstruction and the other four got only an anal sphincter reconstruction. These four patients got voluntary bowel movements with higher productivity and confidence. So it seems that we have an option for overstretched anal sphincters in patients with Hirschsprung disease after a pull through.