Category Archives: Pediatrics

General Surgery, Global Surgery, Pediatrics, Print Release

PUBLISHED: Pediatric Bilateral Indirect Inguinal Herniotomy

Pediatric Bilateral Indirect Inguinal Herniotomy
Beda Espineda, MD
Philippine Children’s Medical Center

This video presents a case of bilateral open indirect inguinal herniotomy. The patient, a 12-year-old male, presented to the medical facility with complaints of bilateral protruding masses in the inguinal regions. These masses have been causing him discomfort and pain, particularly during physical exertion. Upon palpation, the masses exhibited an elastic consistency, increased in size during bearing in a standing position, and were found to be reducible when the patient was in a supine position. The patient’s mother reported that these bulges have been present since his birth. Following a comprehensive clinical evaluation, a clinical diagnosis of congenital bilateral inguinal hernia was made. Consequently, a decision was made to perform a bilateral open inguinal herniotomy with high ligation of the hernia sac.

This video demonstrates the essential steps of a bilateral indirect inguinal herniotomy in a pediatric patient, highlighting the importance of proper anatomical dissection, identification of crucial structures, and the high ligation technique for successful hernia repair in children. The detailed procedural description, coupled with the emphasis on anatomical landmarks and technical nuances, makes this video a valuable educational resource for surgical trainees, who are learning the principles and techniques of pediatric inguinal hernia repair.

General Surgery, Global Surgery, Pediatrics, Print Release

PUBLISHED: Right Inguinal Hernia Repair on a 1-Year-Old Boy During a Surgical Mission

Right Inguinal Hernia Repair on a 1-Year-Old Boy During a Surgical Mission
Yoko Young Sang, MD1; Domingo Alvear, MD2;
1Louisiana State University Shreveport
2World Surgical Foundation

This comprehensive video is intended to provide a detailed overview of the surgical technique used to repair a right inguinal hernia in Honduras on a 1-year-old boy who presented with a swelling in his scrotum, which had been present since he was two months old. The surgical procedure is narrated by an experienced pediatric surgeon, highlighting the unique challenges and innovative techniques employed in this case, which can be valuable for surgeons facing similar situations. The importance of this video lies in its educational value for surgeons, particularly those involved in surgical missions or practicing in resource-limited settings.

General Surgery, Global Surgery, Pediatrics, Print Release

PUBLISHED: Open Proctocolectomy for Hirschsprung’s Disease

Open Proctocolectomy for Hirschsprung’s Disease
Mudassir Shah Akhter, MD1; Marcus Lester R. Suntay, MD, FPCS, FPSPS, FPALES2
1Oregon Health and Science University
2Philippine Children’s Medical Center

Hirschsprung’s disease is the main genetic cause of functional intestinal obstruction. Most cases are diagnosed in the first few months of life given classical presentation and ease of testing with rectal suction biopsy. The disease is due to the absence of enteric ganglion cells in the distal colon that results in functional constipation. Resection of the affected segment and bringing the normal bowel close to the anus has been the mainstay of treatment. Due to advances in surgical treatment over the past decades, a significant reduction in morbidity and mortality has been observed, and the previously multistage procedure can now be completed in one stage, as presented here.

Fundamentals, Pediatrics, Print Release

PUBLISHED: Pediatric Surgical Treatment of a Wrist Ganglion Cyst in a Resource-Limited Setting

Pediatric Surgical Treatment of a Wrist Ganglion Cyst in a Resource-Limited Setting
Jonathan Sledd1; Marcus Lester R. Suntay, MD, FPCS, FPSPS, FPALES2
1Edward Via College of Osteopathic Medicine
2Philippine Children’s Medical Center

Ganglion cysts are benign, mucinous-filled swellings that overly tendons and joints. They are the most common soft tissue mass found in the hand and wrist but also commonly encountered in the knee and foot. Presenting as a palpable knot, the cyst is asymptomatic until it impinges on local neurovasculature causing pain, numbness, tingling, and/or motor deficits. Pediatric ganglion cysts have different epidemiological characteristics than adults, with the majority found on the volar aspect on the wrist.

Treatment of ganglion cysts is most often observation due to the 50% chance of resolution over time. Activity causes the cyst to increase in size, and thus more aggressive treatment is often desirable. If the cyst recurs or symptoms are not relieved with observation alone, a more aggressive treatment such as surgical excision is often desirable. This article presents a female pediatric patient undergoing surgical excision of a large ganglion cyst on the dorsum of her right wrist. With the treatment options explained to her, she chose excision for the lower rate of recurrence.

General Surgery, Pediatrics, Plastic Surgery, Print Release

PUBLISHED: Split-Thickness Skin Graft for Scar Release, Permanent Pigment Transfer, and Fractional CO2 Laser Therapy

Split-Thickness Skin Graft for Scar Release, Permanent Pigment Transfer, and Fractional CO2 Laser Therapy
Aleia M. Boccardi, DO1; Robert J. Dabek, MD2; Lisa Gfrerer, MD, PhD3; Daniel N. Driscoll, MD, FACS4
1St. John’s Episcopal Hospital
2Massachusetts General Hospital
3Harvard Plastic Surgery Combined Residency Program
4Shriners Hospitals for Children – Boston

Pediatric burns are one of the most common forms of injury affecting children worldwide. Of these, hand involvement occurs in 80–90% of such incidents. With the skin in children already diffusely thinner throughout the body than adults, this provides a particular challenge for areas naturally possessing thinner skin, such as the dorsal hand. There, the cutaneous tissue is the only protection for vital structures in the hand that allow full function, such as extensor tendons, nerves, and vessels. Injury to this area early in life can have a detrimental impact on how the survivor interacts with the physical world, affecting their functional capacity and quality of life.

Here presents a case of burn contractures on the right hand of an 8-year-old boy that will be released using a split-thickness graft, along with a pigment transfer graft for his left knee and fractional CO2 laser therapy over areas of hypertrophic scar tissue on his bilateral upper extremities. The split-thickness graft will greatly decrease the tension built up from the burn contracture, while the fractional CO2 laser procedure can soften the surrounding scar, allowing mild remodeling and increased range of motion.

Pediatrics, Plastic Surgery, Print Release

PUBLISHED: Pulsed Dye and Fractional CO2 Laser Therapy for Treatment of Burn Scars

Pulsed Dye and Fractional CO2 Laser Therapy for Treatment of Burn Scars
Robert Dabek, MD1; Harrison McUmber2; Branko Bojovic, MD1,3
1Massachusetts General Hospital
2Tufts University School of Medicine
3Shriners Hospitals for Children – Boston

Burn injuries are often devastating accidents that result in long-term physical and psychosocial consequences and the formation of hypertrophic scars. Laser treatment is a low risk minimally invasive approach to treating such burn scars.

This video discusses the pulsed dye laser (PDL) and fractional ablative CO2 laser, and demonstrates their use in treating the scars on a pediatric patient who suffered from burn injuries 7 years ago in Vietnam.

General Surgery, Pediatrics, Plastic Surgery, Print Release

PUBLISHED: Contracture Release and Full-Thickness Skin Graft to Volar Index Finger with K-Wire Insertion

Contracture Release and Full-Thickness Skin Graft to Volar Index Finger with K-Wire Insertion
Ryan P. Boyle1; Jonah Poster2; Jonathan Friedstat, MD3
1Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine
2Icahn School of Medicine at Mount Sinai
3Shriners Hospitals for Children – Boston

The complications stemming from a poorly-healed burn wound can lead to functional deficits and overall aesthetically unfavorable results leading to psychological distress. Due to the inquisitive nature of infants and toddlers, and their nature to learn the world with their hands, their sensitive regions like the hands become likely targets for burns.

Superficial burns can be managed on an outpatient basis with spontaneous healing expected in 2 or 3 days with minimal scarring. Deep burns, particularly in pediatric populations, need considerable attention to avoid secondary contracture that leads to deformity.

Many treatment options exist, but in sensitive areas like the hands and face, full-thickness skin grafts are favored due to their superior healing and decreased likelihood of secondary contracture. This article aims to guide the surgeon in managing a pediatric burn wound with an arsenal of treatment options with the goal of achieving full mobility and functionality of the hand.

Global Surgery, Orthopedics, Pediatrics, Print Release

PUBLISHED: Bone Graft for Nonunion of Right Thumb Proximal Phalanx Fracture

Bone Graft for Nonunion of Right Thumb Proximal Phalanx Fracture
Sudhir B. Rao, MD1; Mark N. Perlmutter, MS, MD, FICS, FAANOS2; Arya S. Rao3; Grant Darner4
1Big Rapids Orthopaedics
2Carolina Regional Orthopaedics
3Columbia University
4Duke University School of Medicine

In this video, the authors describe and demonstrate a surgical technique for the treatment of an unstable nonunion of a proximal phalangeal fracture of the thumb.

The video describes the surgical exposure, preparation of the nonunion site, harvesting of autogenous iliac corticocancellous bone graft, bone grafting of the defect, and stabilization with K-wire fixation.

General Surgery, Pediatrics, Plastic Surgery, Print Release

PUBLISHED: Bilateral Dorsal Foot Scar Contracture Release with Split-Thickness Skin Grafts from the Anterior Thigh

Bilateral Dorsal Foot Scar Contracture Release with Split-Thickness Skin Grafts from the Anterior Thigh

Jonah Poster
Shriners Hospitals for Children – Boston

Jonathan Friedstat, MD
Shriners Hospitals for Children – Boston
Massachusetts General Hospital

Burn scar contracture of the dorsal foot causes metatarsophalangeal joint hyperextension and interphalangeal joint hyperextension. In children, these issues only intensify over time as a child grows. Here, Dr. Friedstat at Shriners Hospitals for Children in Boston presents the case of a young boy who suffered a 32% total body surface area flame burn to his lower back, bilateral buttocks, legs, and feet. This patient had previously undergone a bilateral contracture release of the dorsum of the foot. Because the contractures recurred, another bilateral dorsal foot scar contracture release was performed using a split-thickness 1:1 meshed skin graft harvested from the anterior left thigh.

Pediatrics, Print Release, Urology

PUBLISHED: Prophylactic Laparoscopic Bilateral Gonadectomy for Complete Androgen Insensitivity Syndrome

Prophylactic Laparoscopic Bilateral Gonadectomy for Complete Androgen Insensitivity Syndrome

J. Corbin Norton
Department of Urology, University of Arkansas for Medical Sciences

Amrit Singh, MD
Department of Pathology, University of Arkansas for Medical Sciences / Arkansas Children’s Hospital

Laura L. Hollenbach, MD
Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences

Georgia Gamble, MD
Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences

Laura A. Gonzalez-Krellwitz, MD
Department of Pathology, University of Arkansas for Medical Sciences / Arkansas Children’s Hospital

Stephen J. Canon, MD
Department of Pediatric Urology, Arkansas Children’s Hospital

The patient in this case is a 15-year-old female who presented with primary amenorrhea and who on work-up was found to have complete androgen insensitivity syndrome. Here, Dr. Canon at the University of Arkansas for Medical Sciences performs a prophylactic laparoscopic bilateral gonadectomy to reduce her future risk for intra-abdominal testicular malignancies. Final pathology results showed a rare case of bilateral germ cell neoplasia in situ and bilateral paratesticular leiomyomas and reinforced the decision to intervene early allowing for the removal of the gonads prior to their conversion to formal germ cell tumors.