Special Pediatric Surgery Forums

quote from "Pediatric Colorectal Conundrums: Case Studies: From Fundamental to Advanced (Pediatric Colorectal Surgery)" by Marc Levitt, Thomas Xu, Hussein Wissanji - "Low ARMs, like recto-vestibular and perineal fistula, tend to be associated with congenital rectal dilation above the fistula. The dilated rectum is prone to constipation, and early bowel management is recommended. Bowel management in this population utilizes laxatives and fiber to keep the rectum empty and avoid distention of the dilated rectum. The pelvic floor and sphincter muscle may be more robust in these distal malformations; however, incontinence is still possible, especially in the setting of an ass…

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March 7Mar 7

quote from "Pediatric Colorectal Conundrums: Case Studies: From Fundamental to Advanced (Pediatric Colorectal Surgery)" by Marc Levitt, Thomas Xu, Hussein Wissanji - "Up to 10% of female infants with ARM have associated gynecologic anomalies, including an absent vagina in less than 1% of cases. Vaginoscopy is helpful to characterize the fistula and check for a vagina. An absent vagina may not be immediately apparent in the setting of a recto-vestibular fistula, especially if the fistula is mistaken for a vagina and a rectovaginal fistula is assumed to be present. In fact, absence of the vagina is only recognized about 50% of the time prior to anorectoplasty. When an absen…

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February 27Feb 27

quote from "Pediatric Surgery (Springer Surgery Atlas)" by Prem Puri, Michael E. Höllwarth - "Augmentation cystoplasty is now commonly performed at most pediatric urological centres. Bladder augmentation has three major goals: to provide a compliant bladder reservoir, to limit bladder contractility, and to increase bladder capacity. Augmentation cystoplasty should allow the urinary tract to remain intact while preserving renal function and providing urinary continence. Various substrates are utilized to augment the bladder; the most commonly used is a segment of ileum, but stomach and large bowel also have been used. Ileum has been demonstrated to be the least contractile…

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February 24Feb 24

quote from "Pediatric Surgery (Springer Surgery Atlas)" by Prem Puri, Michael E. Höllwarth - "The site of the stoma on the skin is selected entirely for the patient’s convenience. The umbilicus provides a good passage and the best cosmetic result, but it is not an option in exstrophy patients. With patients in wheelchairs, the spine tends to become twisted with time, causing progressive abdominal compression, and the abdomen becomes hidden from the patient’s field of vision. For these patients, a stoma site close to the xiphisternum is the best option."

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February 24Feb 24

quote from "Pediatric Surgery (Springer Surgery Atlas)" by Prem Puri, Michael E. Höllwarth - "The technique includes early closure of the bladder, posterior urethra, and abdominal wall, usually with pelvic osteotomy in the newborn period, subsequently followed by an early epispadias repair at 6 months to 1 year of age after testosterone stimulation by intramuscular injection. Around age 4–5 years, when adequate bladder capacity is reached and the child is ready to participate in a very structured preoperative and postoperative voiding program, a competent bladder neck is reconstructed, with bilateral ureteral reimplantation."

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February 23Feb 23

quote from "Pediatric Surgery (Springer Surgery Atlas)" by Prem Puri, Michael E. Höllwarth - "Ureteral reflux in various degrees is seen in 100% of cases after closure. A preoperative ultrasound evaluation of the otherwise usually unaffected upper tracts is mandatory to determine the presence of two normal kidneys"

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February 21Feb 21

video 1

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February 20Feb 20

quote from "Pediatric Surgery (Springer Surgery Atlas)" by Prem Puri, Michael E. Höllwarth - "Consensus is building that the crucial step in postnatal germ cell maturation is transformation of neonatal gonocytes into type A spermatogonia in the second 6 months after birth; hence the current recommendation for orchidopexy is at 6 months of age. Prevention of germ-cell loss is the aim of surgery, although this effect remains unproven."

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February 17Feb 17

quote from "Pediatric Surgery (Springer Surgery Atlas)" by Prem Puri, Michael E. Höllwarth - "The buried penis is an abnormality of peno-scrotal fusion, in which the penile corpora are also tethered to the deep fascia of the lower abdominal wall. It is associated with phimosis, and the appearance of the external skin suggests that the penis is small or even absent. Often the inner preputial space is enlarged and balloons during voiding, with dribbling from the preputial orifice—referred to as megaprepuce."

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February 17Feb 17

quote from "Pediatric Surgery (Springer Surgery Atlas)" by Prem Puri, Michael E. Höllwarth - "The success rates of the P-L and the Cohen (transtrigonal) techniques are similar. The advantage of the P-L is that the ureter is much easier to catheterize for retrograde pyelography and ureteral endoscopy because the ureteral opening of the Cohen is on the opposite side of the bladder. The disadvantage is that in creating the new ureteral hiatus, there is a blind spot behind the bladder, and a peritoneotomy or even bowel injury may occur, particularly in reoperative cases."

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February 14Feb 14

quote from "Pediatric Surgery (Springer Surgery Atlas)" by Prem Puri, Michael E. Höllwarth - "Medical management is based on the principles that VUR often diminishes or resolves over time, and maintaining sterile urine minimizes the risk of reflux nephropathy. Medical management includes bladder training (encouraging regular micturition and treating symptoms of bladder/bowel dysfunction) and possibly antibiotic prophylaxis with a daily dose of an antimicrobial such as nitrofurantoin, trimethoprim, or sulfatrim. Many children undergo regular follow-up assessment with a voiding cystourethrogram (VCUG) and renal ultrasonogram (US) every 12–18 months. Medical management is co…

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February 13Feb 13

quote from "Pediatric Surgery (Springer Surgery Atlas)" by Prem Puri, Michael E. Höllwarth - "In those patients who had prenatal diagnosis of hydronephrosis, ultrasonography is performed in the first week of life. If hydronephrosis is confirmed, radionuclide studies are undertaken when the child is 6–8 weeks old in order to assess renal function and rule out obstruction. In those patients who present with clinical symptoms, a renal ultrasound is performed, and if it shows hydronephrosis without dilated ureters, the diagnosis is confirmed with radionuclide studies. The most commonly used radionuclides are diethylenetriamine pentaacetate (DTPA) and mercaptoacetyltriglycine …

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February 12Feb 12

SAGESThe SAGES Safe Cholecystectomy Program - Strategies for M...This article shows 6 strategies surgeons can employ to adopt a universal culture for safe cholecystectomy and minimize the risk of bile duct injury.Please take care, This is unfortunate and highlights the importance of obtaining a critical view before clipping and taking down any structure. WhatsApp Video 2025-12-16 at 13.10.23.mp4

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December 16, 2025Dec 16