Pediatric surgery

Question 1

Work up for any baby w NEC or midline defects

Answer 1

Rule out VACTERL: CXR, renal U/S, skeletal XR, 2D Echo

Question 2

Omphalocele management

Answer 2

Tthrough umbilicus, protective membrane, watch out for liver

Associated with genetic disorders (ie BW & hypoglycemia)

Membrane intact → nonadherent dressing, dry compressive gauze, plastic wrap

Membrane violated → Spring-loaded silo

Can usually close defects < 5 cm primarily
If larger, can close skin, place vicryl mesh, or “paint & wait” w silvadene if too unstable for surgery & deal w hernia later

Question 3

Gastroschisis management

Answer 3

Gastroschisis (to R of umbilicus, no membrane)

Associated with atresia

Try to reduce after resuscitation & close primarily vs silo and gradual reduction w delayed primary closure

Question 4

Laparoscopic pyloromyotomy

Answer 4

HYPOCHLOREMIC HYPOKALEMIC METABOLIC ALKALOSIS needs to be corrected before surgery
IVF bolus = 20mL/kg
1.5 x maintenance fluids D5 0.9 NaCl + 20 mEq KCl

Longitudinal seromuscular myotomy across pylorus
Spread to mucosa & ensure full thickness myotomy & no mucosal injury with air leak test
If mucosa injured, convert to open & repair in two layers with absorbable suture & perform myotomy on other side of pylorus