Hello, everybody. Welcome back to another episode of the JPS podcast. I'm Cecilia Jigena and I'm Egody. And we are research fellows at Cincinnati Children's Hospital. And along with Stay Current, we are sharing knowledge to improve childhood around the globe. So, today we have another episode of the JPS podcast. Today we have the December issue. And for that, we talked to the editor, Doctor Witt Holcomb. Well, I'm, uh, Witt Holcomb. I'm the editor in chief of the Journal of Pediatric Surgery. So this month, he chose 4 articles. The first one is about how variusolectomy improves the totem motel sperm count in adolescents. Then we are going to talk about the surgical treatment for oesophageal anastomotic strictures after. The surgery for esophageal atricia. Third, we have the role of the ileostomy for patients with ulcerative colitis. And last, we are going to talk about length of stay in hospital readmissions in patients with congenital diaphragmatic hernia. If you'd like to join and read the articles with us, check the links in the description below. Awesome. So let's jump to the first article of today. It is Successful adolescent varicosillectomy Improves total motel sperm count. And this came from New York and what they try to see is what was the impact of varicosillectomy in total motel sperm count. So we talked to the senior author of this paper, Doctor David Diamond. I'm David Diamond. I am a professor of urology and pediatrics. at the University of Rochester School of Medicine and Dentistry. These authors reviewed a database of over 1600 adolescent varicocele patients to find which of them had had preoperative and postoperative semen analysis to try to evaluate the impact of the varicocele correction. And that was Doctor Holcomb. He's the editor that helped us choose these articles. So what they did is a retrospective study of these patients, they found 15 patients kind of stage 5 with a varicocele. They achieved 12 out of 15 complete elimination of the varicocele that gives them 80% of success. 11 of those 12 had significant improvement. In their total motile sperm count, over half of these patients had a sperm count that improved from the abnormal range to the normal range. And that was Dr. Diamond. He's the senior author of this paper. 73% of patients in this group had improvements in sperm morphology. And of all of the semen parameters that we look at, morphology is the one that is felt to improve the least with surgical correction. But this, this finding makes me believe that if morphology is poor, that it may be a good reason to consider surgical correction. And let's hear what Doctor Holcomb had to say. And the mean percentage improvement was 650%. And what they say is that the successful correction, the complete correction of varicocele in patients, adolescents with the Tanner stage 5 improves total motile sperm count, which may improve fertility in these patients. So what do you think, um? So the numbers are pretty high. Then we talked to the author and we asked him, does the increased number also means increased fertility, and he told us about the challenges of watching through a pediatric population become adults. This is where doing this work in a children's hospital has its limitations. We sort of lose these patients to follow up over time. So we don't know. If this is going to have positive impact on fertility, we hope so, but it is very exciting result. I think we're ready for the 2nd 1. The 2nd 1 is the surgical treatment of esophageal anastomatic stricture after repair of esophageal atresia. This is a study from Boston and we talked to the senior author, Doctor Benjamin Zendejas. Well, hello, nice to meet you. My name is uh Benjamin Zendejas. I'm a pediatric surgeon at Boston Children's Hospital and I'm a surgical director of the esophage and airway team. We talked about in this podcast before the anastomatic strip. common complications after esophageal tissue repair. We often treat those with endoscopy, but we don't know a lot about the outcomes of these interventions. So in this study, they took two institutions and they reviewed the treatment of anastomatic strictures in esophageal atresia patients. The duration of the study was from 2011 to 2022. And that was Doctor Holcomb. A surgical repair occurred if the anastomotic stricture was refractory to endoscopic therapy or was clinically symptomatic and the patients were undergoing surgery for another indication. And the evaluated outcomes they looked into included anastomotic leak, repeat surgery for strictures, and need for esophageal replacement. So in this population they had 139 patients. They underwent 148 surgeries with treatments including strictureplasty, segmental resection, or resection with delayed anastomosis after lengthening. Their follow-up was nearly 40 months. That our study results show that that the outcomes of intervening on a non-refractory stricture in the setting of going into the chest for something else are excellent, meaning that it's a no-brainer. That was Doctor Zendejas. He's the senior author in this paper. Risk kids that have truly refractory strictures, our outcomes will pick a 10% leak rate and 90+% esophageal preservation. And there were a few kids, though, very few that that needed a replacement. And according to the study, the risk factors for poor outcomes included leaks, stricture land, hiatal hernia, and lower patient weight, and their conclusion was surgery for refractory anastomatic stricture has low morbidity and a high rate of preserving the esophagus. So, one take-home message is that a second operation or an operation for a refractory anatomic stricture, it does have uh complications, but it has a low morbidity and high rates of esophageal preservation. These are certainly not easy operations. Uh, our intent here was not to just say, oh, hey, hey, everybody go ahead and do a structure resection, uh, but rather to bring that into the possibilities of treatment for these patients. So, as a practicing pediatric surgeon, what would you say about these outcomes and slight change in the management? Yeah, I don't think it's something completely new, the idea of having a procedure that's not a dilation to treat an anastomatic stricture, but I do think that knowing that a surgery for anastomatic strictures, it's not actually that bad and it doesn't lead to poor outcomes. can actually start to consider this before spending 50 dilations in a patient. And I think we're ready for the 3rd 1. Awesome. So, the 3rd article for today is the Role of diversion during ileal pouch Anal anastomosis or EPA Creation in Pediatric Ulcerative Colitis. And for this paper, we talked to the 1st and senior author, Doctor Adams Ann Phillips. Hi, I'm Ursula Adams. I am a resident in general surgery at UNC. Chapel Hill. I'm in my 2nd year of research in the labs, and I work with Doctor Phillips doing quality improvement studies. And my name is Mike Phillips. I'm an assistant professor of surgery at UNC. I'm also the surgical director of bioinformatics. My surgical focus is on inflammatory bowel disease and colorectal surgery. This paper comes from uh, uh, University of North Carolina at Chapel Hill. And what they try to see is if patients with ulcerative colitis that needed an ileoanal anastomosis benefit from having a diversion at the same operation. For our data, we use the IBM Watson administrative Claims database. So patients had ulcerative colitis, they got an IPAA, and then if they had a code for closure of enterostomy within 6 months, they went into the diverted cohort. If they didn't have that closure code, they went into the not diverted cohort. So they have 317 patients. From 2000 to 2019. Of them, 238 had an ileostomy, meaning a diversion, and 79 patients only got the ileal pouch anal anastomosis. And what they found is that the rates of surgical site infections, intraabdominal drainage procedure, meaning the development of an abscess that needed drainage. And the rates of 30-day readmissions were not significantly different. And let's hear what Doctor Holcomb had to say. I think it's an interesting study uh showing that at least at a 30,000 ft view, there may not be all the advantages that we think there are with performing the diverting ileostomy. The outcomes were equivalent, and, and for us, that sort of tells me that um there's a population of kids we can save from Additional surgery. And that was Doctor Phillips, the senior author of this paper. And we ask the authors what does the future look like after this paper. We are also currently looking. And just presented our findings at the academic surgical Congress this year about this question of the impact of ileostomy on Crohn's patients who undergo surgery, pediatric Crohn's patients. And that was Doctor Adams, the first author of this paper. This data also need to clarify selection criteria for determining which patients may benefit from the version and I think that's, that's the important part too. Yeah, I think that would be the most important thing to figure out which patient will benefit from an diversion and who wouldn't. OK, so time for the last paper of today. Yeah, the last paper is coming from Philadelphia, birth admission length of stay and hospital readmission in children with congenital diaphragmatic hernia. So in this paper, authors wanted to look at extended birth admission length of stay and their relationship with readmission. Within the year after discharge in patients who have congenital diaphragmatic hernia, is a single center retrospective cohort study. These are the children with isolated CDH born and admitted between April 2008 to August 2019. They divided the hospitalization duration in. Three categories less than 35 days, 36 to 75 days, and more than 76 days. And essentially they found that children hospitalized for more than 76 days had a significantly higher odds ratio of readmission. And also they saw that children discharged with a non-operative feeding tube had. 4 times higher odds of readmission than those without a feeding tube. Their conclusion was extended hospital stays at birth and the presence of a non-operative feeding tube at discharge are significant indicators of increased readmission rates in the year following discharge for children with CDH. Let's hear from Doctor Holcomb. He's the JPS editor in chief and helped us choose articles this month. Uh, so, I just thought it was kind of a, a good study with a pretty straightforward conclusion about management of uh CDH at one of our, our country's leading children's hospitals. So like these results. Oh, not surprising to me. Like if you stay longer in the hospital, there are higher chances that you're going to come back. If you have a feeding tube and you leave the hospital, the chances are you're going to come back. So what is your take on this paper? Yeah, I think it is something that we already know, not only for CDH patients, but for many other patients. If they stay longer, probably they are more complicated patients, right? They can have a lot of associated pathologies, so. I think it is something that we could have already in fear, but it's nice to have it in the paper. Yeah, I think it's like, like Todd would say, like it's not something surprising, but it's also nice to see that it's proven in a study. OK. So, that was everything for today. We had these 4 articles. The first one was about the total modal sperm count and how repairing a varicocele in adolescences can improve this total motile sperm count and eventually help in fertility. Then we talk about the treatment of esophageal anastomatic strictures after uh the esophageal trisia repair. And we've seen that actually, this surgical procedure for these strictures have pretty good outcomes and almost more than 90% of the patients had an esophageal preservation, which is a really good aspect to know. Then we talk about diversion in patients with ulcerative colitis that are in need of an ileal pouch anal anastomosis because of uh Proctocolectomy. And we see that patients with or without diversion had similar outcomes. So it is probably that some patients will never need this diversion at all, and we can spare them from that extra surgery. Finally, we talk about the length of stay and hospital readmissions in patients with CDH and we Seeing how patients that stay longer in the hospital and were discharged with a feeding tube were in higher odds of needing a readmission of patients who were discharged earlier and didn't need a feeding tube. Thank you for listening to this episode. Don't forget to follow us on social media, subscribe to our YouTube channel, and download the Stay Current app for Townsville pediatric surgery content. I'm Cecilia Gena and I'm E Goddy. And we are research fellows at Cincinnati Children's Hospital, and along with Stay Current, we are sharing knowledge to improve child health around the globe.
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