Practicing Surgeons' Curriculum

Introduction

This collection of infographics is generated by the APSA educational committee as a curriculum to keep currently practicing surgeons up to date.

Please submit your questions, comments and feedback (including suggestions for future topics) to think@eapsa.org.

Critical and Perioperative Care

In which areas of pediatric surgery can you impact the inappropriate use of antibiotics?

antibiotic stewardship
Descriptive text is not available for this image

[1][2][3] (for more see Surgical Infection)

video link Antibiotic Stewardship 2019 Top Educational Content talk

What is the correct transfusion threshold in critically ill or injured children?

conservative transfusion threshold
Descriptive text is not available for this image

[4][5][6][7][8] (for more see Transfusion and Coagulation Therapy)

video links Hemostatic Transfusion and Goal Directed Transfusion from the APSA 2020 virtual meeting

How does hospital acquired hyponatremia occur and what is the best way to prevent it?

isotonic maintenance fluids
Descriptive text is not available for this image

[9][10] (for more see Fluid and Electrolytes)

What are the current pediatric surviving sepsis guidelines?

surviving sepsis guidelines
Descriptive text is not available for this image

[11][12] (for more see Surgical Infection)

video link Surviving Sepsis Guidelines 2019 Top Educational Content talk)

How do you use a viscoelastic assay to guide transfusion requirements in bleeding patients?

viscoelastic assay
Descriptive text is not available for this image

[13][14] (for more see Transfusion and Coagulation Therapy )

Thoracic Disorders

Do asymptomatic patients with a history of esophageal atresia need endoscopic surveillance?

endoscopic surveillance in esophageal atresia
Descriptive text is not available for this image

infographic courtesy of Jay Meisner and Benjamin Zendejas

[15][16][17] (for more see Esophageal Atresia and Tracheoesophageal Fistula)

What is the optimal management of thoracostomy tubes in children with parapneumonic effusions?

chest tubes in empyema
Descriptive text is not available for this image

[18][19][20] (for more see Parapneumonic Effusion and Empyema)

Does every primary spontaneous pneumothorax require an intervention?

spontaneous pneumothorax
Descriptive text is not available for this image

[21][22] (for more see Spontaneous Pneumothorax)

What criteria do you use to determine when an infant with congenital diaphragmatic hernia is ready for surgical repair?

surgery for CDH
Descriptive text is not available for this image

[23][24] (for more see Congenital Diaphragmatic Hernia)

Gastrointestinal Disorders

How does one determine if a patient with inflammatory bowel disease will require surgery?

indications for surgery in IBD
Descriptive text is not available for this image

[25][26][27] (for more see Crohn Disease and Ulcerative Colitis)

video link The effect of biologics in the surgical management of IBD 2020 Top Educational Content talk

How do you prevent, detect and treat neonatal gas embolism during laparoscopy?

gas embolus during infant laparoscopy
Descriptive text is not available for this image

[28][29][30][31]

video link Infant Gas Embolus 2020 Top Educational Content talk

What are the outcomes for nonoperative management of acute appendicitis?

nonoperative appendicitis outcomes
Descriptive text is not available for this image

[32][33] (for more see Appendicitis)

What is the optimal bowel management in children with anorectal malformations?

bowel management
Descriptive text is not available for this image

[34][35][36] (for more see Anorectal Malformations and Bowel Management)

What is the role for screening upper gastrointestinal series in patients with heterotaxy syndromes?

heterotaxy screening
Descriptive text is not available for this image

[37][38][39][40][41][42][43][44][45] (see also Intestinal Rotational Abnormalities)

How does one manage the asymptomatic patient with heterotaxy syndrome and suspected intestinal rotational anomalies?

asymptomatic heterotaxy patients with malrotation
Descriptive text is not available for this image

[37][38][39][40][41][42][43][44][45] (see also Intestinal Rotational Abnormalities)

Genitourinary Disorders

What are the considerations for gonadal preservation in disorders of sex development?

gonadal preservation in DSD
Descriptive text is not available for this image

[46][47][48] (for more see Disorders of Sex Development)

How can we optimize ovarian preservation in patients with ovarian masses?

ovarian preservation
Descriptive text is not available for this image

[49][50][51] (for more see Ovarian Tumors )

Skin and Soft Tissue Disorders

What are the advantages of minimally invasive surgical techniques in pilonidal disease?

pilonidal excision
Descriptive text is not available for this image

[52][53][54][55] (for more see Pilonidal Disease)

Trauma

Which children truly need cervical spine imaging after trauma?

cervical spine injury imaging
Descriptive text is not available for this image

[56][57] (for more see Cervical Spine Trauma)

video link Cervical Spine Trauma Imaging 2019 Top Educational Content talk

What is he correct fluid to use when resuscitating a child with a burn?

burn resuscitation
Descriptive text is not available for this image

infographic courtesy of

[58][59] (for more see Burns)

When should injured children receive blood rather than crystalloid?

early use of blood
Descriptive text is not available for this image

[8][60][61][62][63] (for more see Trauma Resuscitation and Initial Evaluation)

What is the baseline management strategy for severe pediatric traumatic brain injury?

management of traumatic brain injury
Descriptive text is not available for this image

[64][65] (for more see Traumatic Brain Injury)

How does one monitor a child with severe pediatric traumatic brain injury?

monitoring in traumatic brain injury
Descriptive text is not available for this image

[64][65] (for more see Traumatic Brain Injury)

What are the most current APSA evidence-based guidelines regarding blunt solid organ injuries in children?

solid organ injury guidelines
Descriptive text is not available for this image

[8][66][67][68] (for more see Liver and Spleen Trauma)

Which pediatric trauma patients should receive venous thromboembolism prophylaxis?

venous thromboembolism prophylaxis in trauma
Descriptive text is not available for this image

[69][70][71][72][73] (for more see Transfusion and Coagulation Therapy)

Oncology

What is the minimum number of lymph nodes to sample for adequate staging during a Wilms tumor resection?

Wilms tumor lymph node sampling
Descriptive text is not available for this image

[74][75][76] (for more see Wilms Tumor)

Competencies

What factors lead to physician burnout and what impact can it have?

surgeon wellness
Descriptive text is not available for this image

[77][78][79]

References

  1. Fry DE. Prevention of Infection at the Surgical Site. Surg Infect (Larchmt). 2017;18(4):377-378.  [PMID:28541805]
  2. Rogers SO. Surgical Perspective: Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection 2017. Surg Infect (Larchmt). 2017;18(4):383-384.  [PMID:28541803]
  3. Sartelli M, Duane TM, Catena F, et al. Antimicrobial Stewardship: A Call to Action for Surgeons. Surg Infect (Larchmt). 2016;17(6):625-631.  [PMID:27828764]
  4. Valentine SL, Bembea MM, Muszynski JA, et al. Consensus Recommendations for RBC Transfusion Practice in Critically Ill Children From the Pediatric Critical Care Transfusion and Anemia Expertise Initiative. Pediatr Crit Care Med. 2018;19(9):884-898.  [PMID:30180125]
  5. Steiner ME, Zantek ND, Stanworth SJ, et al. Recommendations on RBC Transfusion Support in Children With Hematologic and Oncologic Diagnoses From the Pediatric Critical Care Transfusion and Anemia Expertise Initiative. Pediatr Crit Care Med. 2018;19(9S Suppl 1):S149-S156.  [PMID:30161070]
  6. Rouette J, Trottier H, Ducruet T, et al. Red blood cell transfusion threshold in postsurgical pediatric intensive care patients: a randomized clinical trial. Ann Surg. 2010;251(3):421-7.  [PMID:20118780]
  7. Lacroix J, Hébert PC, Hutchison JS, et al. Transfusion strategies for patients in pediatric intensive care units. N Engl J Med. 2007;356(16):1609-19.  [PMID:17442904]
  8. Notrica DM, Eubanks JW, Tuggle DW, et al. Nonoperative management of blunt liver and spleen injury in children: Evaluation of the ATOMAC guideline using GRADE. J Trauma Acute Care Surg. 2015;79(4):683-93.  [PMID:26402546]
  9. McNab S, Ware RS, Neville KA, et al. Isotonic versus hypotonic solutions for maintenance intravenous fluid administration in children. Cochrane Database Syst Rev. 2014.  [PMID:25519949]
  10. Feld LG, Neuspiel DR, Foster BA, et al. Clinical Practice Guideline: Maintenance Intravenous Fluids in Children. Pediatrics. 2018;142(6).  [PMID:30478247]
  11. Gonzalez E, Moore EE, Moore HB, et al. Goal-directed Hemostatic Resuscitation of Trauma-induced Coagulopathy: A Pragmatic Randomized Clinical Trial Comparing a Viscoelastic Assay to Conventional Coagulation Assays. Ann Surg. 2016;263(6):1051-9.  [PMID:26720428]
  12. Leeper CM, Gaines BA. Viscoelastic hemostatic assays in the management of the pediatric trauma patient. Semin Pediatr Surg. 2017;26(1):8-13.  [PMID:28302286]
  13. Koivusalo AI, Pakarinen MP, Lindahl HG, et al. Endoscopic Surveillance After Repair of Oesophageal Atresia: Longitudinal Study in 209 Patients. J Pediatr Gastroenterol Nutr. 2016;62(4):562-6.  [PMID:26348684]
  14. Krishnan U, Mousa H, Dall'Oglio L, et al. ESPGHAN-NASPGHAN Guidelines for the Evaluation and Treatment of Gastrointestinal and Nutritional Complications in Children With Esophageal Atresia-Tracheoesophageal Fistula. J Pediatr Gastroenterol Nutr. 2016;63(5):550-570.  [PMID:27579697]
  15. Mousa H, Krishnan U, Hassan M, et al. How to Care for Patients with EA-TEF: The Known and the Unknown. Curr Gastroenterol Rep. 2017;19(12):65.  [PMID:29177550]
  16. Islam S, Calkins CM, Goldin AB, et al. The diagnosis and management of empyema in children: a comprehensive review from the APSA Outcomes and Clinical Trials Committee. J Pediatr Surg. 2012;47(11):2101-10.  [PMID:23164006]
  17. Marhuenda C, Barceló C, Fuentes I, et al. Urokinase versus VATS for treatment of empyema: a randomized multicenter clinical trial. Pediatrics. 2014;134(5):e1301-7.  [PMID:25349313]
  18. Livingston MH, Mahant S, Connolly B, et al. Effectiveness of Intrapleural Tissue Plasminogen Activator and Dornase Alfa vs Tissue Plasminogen Activator Alone in Children with Pleural Empyema: A Randomized Clinical Trial. JAMA Pediatr. 2020;174(4):332-340.  [PMID:32011642]
  19. Brown SGA, Ball EL, Perrin K, et al. Conservative versus Interventional Treatment for Spontaneous Pneumothorax. N Engl J Med. 2020;382(5):405-415.  [PMID:31995686]
  20. Leys CM, Hirschl RB, Kohler JE, et al. Changing the Paradigm for Management of Pediatric Primary Spontaneous Pneumothorax: A Simple Aspiration Test Predicts Need for Operation. J Pediatr Surg. 2020;55(1):169-175.  [PMID:31706614]
  21. Canadian Congenital Diaphragmatic Hernia Collaborative, Puligandla PS, Skarsgard ED, et al. Diagnosis and management of congenital diaphragmatic hernia: a clinical practice guideline. CMAJ. 2018;190(4):E103-E112.  [PMID:29378870]
  22. Beres AL, Puligandla PS, Brindle ME, et al. Stability prior to surgery in Congenital Diaphragmatic Hernia: is it necessary? J Pediatr Surg. 2013;48(5):919-23.  [PMID:23701760]
  23. Fumery M, Pariente B, Sarter H, et al. Long-term outcome of pediatric-onset Crohn's disease: A population-based cohort study. Dig Liver Dis. 2019;51(4):496-502.  [PMID:30611597]
  24. Gower-Rousseau C, Dauchet L, Vernier-Massouille G, et al. The natural history of pediatric ulcerative colitis: a population-based cohort study. Am J Gastroenterol. 2009;104(8):2080-8.  [PMID:19436273]
  25. Rinawi F, Assa A, Eliakim R, et al. Risk of Colectomy in Patients With Pediatric-onset Ulcerative Colitis. J Pediatr Gastroenterol Nutr. 2017;65(4):410-415.  [PMID:28207474]
  26. Kudsi OY, Jones SA, Brenn BR. Carbon dioxide embolism in a 3-week-old neonate during laparoscopic pyloromyotomy: a case report. J Pediatr Surg. 2009;44(4):842-5.  [PMID:19361651]
  27. DiChiacchio L, Cappiello CD, Greenspon J. Extracorporeal cardiopulmonary resuscitation in a neonate after air embolism during insufflation for laparoscopic peritoneal dialysis catheter placement. J Surg Case Rep. 2018;2018(6):rjy119.  [PMID:29942470]
  28. Taylor SP, Hoffman GM. Gas embolus and cardiac arrest during laparoscopic pyloromyotomy in an infant. Can J Anaesth. 2010;57(8):774-8.  [PMID:20431981]
  29. Olsen M, Avery N, Khurana S, et al. Pneumoperitoneum for neonatal laparoscopy: how safe is it? Paediatr Anaesth. 2013;23(5):457-9.  [PMID:23577821]
  30. Minneci PC, Hade EM, Lawrence AE, et al. Association of Nonoperative Management Using Antibiotic Therapy vs Laparoscopic Appendectomy With Treatment Success and Disability Days in Children With Uncomplicated Appendicitis. JAMA. 2020;324(6):581-593.  [PMID:32730561]
  31. Patkova B, Svenningsson A, Almström M, et al. Nonoperative Treatment Versus Appendectomy for Acute Nonperforated Appendicitis in Children: Five-year Follow Up of a Randomized Controlled Pilot Trial. Ann Surg. 2020;271(6):1030-1035.  [PMID:31800496]
  32. Wood RJ, Halleran DR, Ahmad H, et al. Assessing the benefit of reoperations in patients who suffer from fecal incontinence after repair of their anorectal malformation. J Pediatr Surg. 2020;55(10):2159-2165.  [PMID:32682544]
  33. Baxter KJ, Garza JM, Rollins MD, et al. Multi-institutional review of bowel management strategies in children with anorectal malformations. J Pediatr Surg. 2020;55(12):2752-2757.  [PMID:32616413]
  34. Li C, Shanahan S, Livingston MH, et al. Malone appendicostomy versus cecostomy tube insertion for children with intractable constipation: A systematic review and meta-analysis. J Pediatr Surg. 2018;53(5):885-891.  [PMID:29519574]
  35. Landisch R, Abdel-Hafeez AH, Massoumi R, et al. Observation versus prophylactic Ladd procedure for asymptomatic intestinal rotational abnormalities in heterotaxy syndrome: A systematic review. J Pediatr Surg. 2015;50(11):1971-4.  [PMID:26358665]
  36. Hill SJ, Heiss KF, Mittal R, et al. Heterotaxy syndrome and malrotation: does isomerism influence risk and decision to treat. J Pediatr Surg. 2014;49(6):934-7; discussion 937.  [PMID:24888838]
  37. Elder CT, Metzger R, Arrington C, et al. The role of screening and prophylactic surgery for malrotation in heterotaxy patients. J Pediatr Surg. 2014;49(12):1746-8.  [PMID:25487475]
  38. Abbas PI, Dickerson HA, Wesson DE. Evaluating a management strategy for malrotation in heterotaxy patients. J Pediatr Surg. 2016;51(5):859-62.  [PMID:26968699]
  39. Yu DC, Thiagarajan RR, Laussen PC, et al. Outcomes after the Ladd procedure in patients with heterotaxy syndrome, congenital heart disease, and intestinal malrotation. J Pediatr Surg. 2009;44(6):1089-95; discussion 1095.  [PMID:19524722]
  40. Tashjian DB, Weeks B, Brueckner M, et al. Outcomes after a Ladd procedure for intestinal malrotation with heterotaxia. J Pediatr Surg. 2007;42(3):528-31.  [PMID:17336193]
  41. Choi M, Borenstein SH, Hornberger L, et al. Heterotaxia syndrome: the role of screening for intestinal rotation abnormalities. Arch Dis Child. 2005;90(8):813-5.  [PMID:15890694]
  42. Pockett CR, Dicken B, Rebeyka IM, et al. Heterotaxy syndrome: is a prophylactic Ladd procedure necessary in asymptomatic patients? Pediatr Cardiol. 2013;34(1):59-63.  [PMID:22644418]
  43. Graziano K, Islam S, Dasgupta R, et al. Asymptomatic malrotation: Diagnosis and surgical management: An American Pediatric Surgical Association outcomes and evidence based practice committee systematic review. J Pediatr Surg. 2015;50(10):1783-90.  [PMID:26205079]
  44. Lee P, Schober J, Nordenström A, et al. Review of recent outcome data of disorders of sex development (DSD): emphasis on surgical and sexual outcomes. J Pediatr Urol. 2012;8(6):611-5.  [PMID:23158651]
  45. Pyle LC, Nathanson KL. A practical guide for evaluating gonadal germ cell tumor predisposition in differences of sex development. Am J Med Genet C Semin Med Genet. 2017;175(2):304-314.  [PMID:28544305]
  46. Weidler EM, Linnaus ME, Baratz AB, et al. A Management Protocol for Gonad Preservation in Patients with Androgen Insensitivity Syndrome. J Pediatr Adolesc Gynecol. 2019;32(6):605-611.  [PMID:31233832]
  47. Renaud EJ, Sømme S, Islam S, et al. Ovarian masses in the child and adolescent: An American Pediatric Surgical Association Outcomes and Evidence-Based Practice Committee systematic review. J Pediatr Surg. 2019;54(3):369-377.  [PMID:30220452]
  48. Lawrence AE, Fallat ME, Hewitt G, et al. Understanding the Value of Tumor Markers in Pediatric Ovarian Neoplasms. J Pediatr Surg. 2020;55(1):122-125.  [PMID:31677824]
  49. Abbas PI, Elder SC, Mehollin-Ray AR, et al. Ovarian lesion volumes as a screening tool for malignancy in adolescent ovarian tumors. J Pediatr Surg. 2015;50(11):1933-6.  [PMID:26242572]
  50. Grabowski J, Oyetunji TA, Goldin AB, et al. The management of pilonidal disease: A systematic review. J Pediatr Surg. 2019;54(11):2210-2221.  [PMID:30948198]
  51. Di Castro A, Guerra F, Levi Sandri GB, et al. Minimally invasive surgery for the treatment of pilonidal disease. The Gips procedure on 2347 patients. Int J Surg. 2016;36(Pt A):201-205.  [PMID:27989917]
  52. Gips M, Melki Y, Salem L, et al. Minimal surgery for pilonidal disease using trephines: description of a new technique and long-term outcomes in 1,358 patients. Dis Colon Rectum. 2008;51(11):1656-62; discussion 1662-3.  [PMID:18516645]
  53. Kallis MP, Maloney C, Lipskar AM. Management of pilonidal disease. Curr Opin Pediatr. 2018;30(3):411-416.  [PMID:29553956]
  54. Hale DF, Fitzpatrick CM, Doski JJ, et al. Absence of clinical findings reliably excludes unstable cervical spine injuries in children 5 years or younger. J Trauma Acute Care Surg. 2015;78(5):943-8.  [PMID:25909413]
  55. Rosati SF, Maarouf R, Wolfe L, et al. Implementation of pediatric cervical spine clearance guidelines at a combined trauma center: Twelve-month impact. J Trauma Acute Care Surg. 2015;78(6):1117-21.  [PMID:26151510]
  56. Romanowski KS, Palmieri TL. Pediatric burn resuscitation: past, present, and future. Burns Trauma. 2017;5:26.  [PMID:28879205]
  57. Advanced Trauma Life Support® Student Course Manual,v10. Chapter 9 Thermal Injuries, pp 169-176. American College of Surgeons. 2018, Library of Congress Control Number: 2017907997. ISBN 78-0-9968262-3-5.
  58. Leeper CM, McKenna C, Gaines BA. Too little too late: Hypotension and blood transfusion in the trauma bay are independent predictors of death in injured children. J Trauma Acute Care Surg. 2018;85(4):674-678.  [PMID:29389838]
  59. Magoteaux SR, Notrica DM, Langlais CS, et al. Hypotension and the need for transfusion in pediatric blunt spleen and liver injury: An ATOMAC+ prospective study. J Pediatr Surg. 2017;52(6):979-983.  [PMID:28363471]
  60. Duchesne JC, Heaney J, Guidry C, et al. Diluting the benefits of hemostatic resuscitation: a multi-institutional analysis. J Trauma Acute Care Surg. 2013;75(1):76-82.  [PMID:23778442]
  61. Acker SN, Ross JT, Partrick DA, et al. Injured children are resistant to the adverse effects of early high volume crystalloid resuscitation. J Pediatr Surg. 2014;49(12):1852-5.  [PMID:25487499]
  62. Kochanek PM, Tasker RC, Bell MJ, et al. Management of Pediatric Severe Traumatic Brain Injury: 2019 Consensus and Guidelines-Based Algorithm for First and Second Tier Therapies. Pediatr Crit Care Med. 2019;20(3):269-279.  [PMID:30830015]
  63. Kochanek PM, Tasker RC, Carney N, et al. Guidelines for the Management of Pediatric Severe Traumatic Brain Injury, Third Edition: Update of the Brain Trauma Foundation Guidelines, Executive Summary. Pediatr Crit Care Med. 2019;20(3):280-289.  [PMID:30830016]
  64. Gates RL, Price M, Cameron DB, et al. Non-operative management of solid organ injuries in children: An American Pediatric Surgical Association Outcomes and Evidence Based Practice Committee systematic review. J Pediatr Surg. 2019;54(8):1519-1526.  [PMID:30773395]
  65. Ingram MC, Siddharthan RV, Morris AD, et al. Hepatic and splenic blush on computed tomography in children following blunt abdominal trauma: Is intervention necessary? J Trauma Acute Care Surg. 2016;81(2):266-70.  [PMID:27257698]
  66. St Peter SD, Aguayo P, Juang D, et al. Follow up of prospective validation of an abbreviated bedrest protocol in the management of blunt spleen and liver injury in children. J Pediatr Surg. 2013;48(12):2437-41.  [PMID:24314183]
  67. Mahajerin A, Petty JK, Hanson SJ, et al. Prophylaxis against venous thromboembolism in pediatric trauma: A practice management guideline from the Eastern Association for the Surgery of Trauma and the Pediatric Trauma Society. J Trauma Acute Care Surg. 2017;82(3):627-636.  [PMID:28030503]
  68. Hanson SJ, Faustino EV, Mahajerin A, et al. Recommendations for venous thromboembolism prophylaxis in pediatric trauma patients: A national, multidisciplinary consensus study. J Trauma Acute Care Surg. 2016;80(5):695-701.  [PMID:26881487]
  69. Connelly CR, Laird A, Barton JS, et al. A Clinical Tool for the Prediction of Venous Thromboembolism in Pediatric Trauma Patients. JAMA Surg. 2016;151(1):50-7.  [PMID:26422678]
  70. Allen CJ, Murray CR, Meizoso JP, et al. Risk factors for venous thromboembolism after pediatric trauma. J Pediatr Surg. 2016;51(1):168-71.  [PMID:26547285]
  71. Landisch RM, Hanson SJ, Cassidy LD, et al. Evaluation of guidelines for injured children at high risk for venous thromboembolism: A prospective observational study. J Trauma Acute Care Surg. 2017;82(5):836-844.  [PMID:28430759]
  72. Ehrlich PF, Ritchey ML, Hamilton TE, et al. Quality assessment for Wilms' tumor: a report from the National Wilms' Tumor Study-5. J Pediatr Surg. 2005;40(1):208-12; discussion 212-3.  [PMID:15868587]
  73. Saltzman AF, Smith DE, Gao D, et al. How many lymph nodes are enough? Assessing the adequacy of lymph node yield for staging in favorable histology wilms tumor. J Pediatr Surg. 2019;54(11):2331-2335.  [PMID:31255328]

  74. Heaton TE, Nathan JD, Doski JD, Ehrlich PF. Handbook for Children with Renal Tumors. Cancer Committee of the American Pediatric Surgical Association. 2018


  75. Dyrbye L, Shanafelt T. A narrative review on burnout experienced by medical students and residents. Med Educ. 2016;50(1):132-49.  [PMID:26695473]
  76. Shanafelt TD, Noseworthy JH. Executive Leadership and Physician Well-being: Nine Organizational Strategies to Promote Engagement and Reduce Burnout. Mayo Clin Proc. 2017;92(1):129-146.  [PMID:27871627]
  77. Shanafelt TD, Schein E, Minor LB, et al. Healing the Professional Culture of Medicine. Mayo Clin Proc. 2019;94(8):1556-1566.  [PMID:31303431]