We share our experience on the implementation of a multidisciplinary aerodigestive program comprising an aerodigestive team (ADT) so as to evaluate its feasibility. We performed a retrospective chart review of the patients discussed at the monthly ADT meetings and analyzed the data. A total of 98 children were referred to the ADT during the study period. The number of cases increased steadily from 3.5 cases per month in 2019 to 8.5 cases per month in 2020. The median age of patients was 34.5 months, and 55% were male. Among the chronic comorbidities, neurologic disease was the most common (85%), followed by respiratory (36%) and cardiac (13%) disorders. The common reasons for consultation were suspected aspiration (56%), respiratory difficulty (44%), drooling/stertor (30%), regurgitation/vomiting (18%), and feeding/swallowing difficulty (17%). Following discussions, 58 patients received active interventions, including fundoplication, gastrostomy, laryngomicrosurgery, tracheostomy, and primary dilatation of the airway. According to the questionnaire of the caregiver, the majority agreed that the main symptoms and quality of life of patients had improved (88%), reducing the burden on caregivers (77%). Aerodigestive programs may provide comprehensive and multidisciplinary management for children with complex airway and digestive tract disorders.

Background: Although percutaneous central venous port (CVP) placement can be quickly performed using minimally invasive surgery, short- and long-term complications can occur. Beginner pediatric surgeons must overcome learning curves influencing operative time and complication rates. However, few studies have been conducted on the learning curve of ultrasound-guided percutaneous CVP placement. This study analyzed the progress, results, complications, and learning curve of ultrasound-guided percutaneous CVP placement in children performed by a single beginner pediatric surgeon. Methods: Data from 30 children who underwent ultrasound-guided percutaneous CVP placement were reviewed. The patient characteristics, procedure indications, access veins, operator positions, operative times, and complication rates were analyzed. Results: Cumulative sum analysis revealed two stages in the learning curve: stage 1 (initial 15 cases) and stage 2 (subsequent cases). There was a correlation between the number of cases and operative time (Pearson correlation = -0.499, p = 0.005); the operative time was significantly longer in the first than in the second stage (p = 0.007). Although surgical complications occurred more frequently in the early (26.7%) than in the late stage, it was not significantly different between the two stages (p = 0.1). During the study period, the operative time was significantly reduced owing to the change in the operator’s position from the patient’s right side to the patient’s head (p = 0.005). Conclusions: Ultrasound-guided percutaneous CVP placement was a safe surgery that allowed a beginner pediatric surgeon to overcome the learning curve after only 15 cases and involved a relatively small number of complications compared with other pediatric surgeries. Additionally, the suitable position of the operator affected the surgical outcomes.

Kim HJ, et al. Adv Pediatr Surg. 2020 Dec;26(2):46-53. https://doi.org/10.13029/aps.2020.26.2.46

Background/Objectives: Foreign body (FB) ingestion is a common occurrence in children. We aimed to investigate the characteristics of patients hospitalized in the pediatric surgery department for FB ingestion and those requiring surgical treatment. Methods: We retrospectively analyzed pediatric patients admitted to the department of pediatric surgery at a single center for FB ingestion from June 2018 to September 2023. Overall, 35 patients were included. Results: The median age was 25.0 months (range: 7–204 months), with male predominance. Forty percent (14/35) of patients presented with symptoms at admission, including abdominal pain, vomiting, and fever; ingestion was unwitnessed in 42.9%. The median number of ingested FBs was 2.0 (range: 1–25), with magnets being the most common type (51.4%). Surgery was required in 51.4% of cases due to complications or impaction. These cases showed significantly higher symptomatic presentation rates (72.2% vs. 5.9%, p < 0.01), unwitnessed ingestion (66.7 vs. 17.6%, p = 0.006), and more ingested FBs (median 5.0 vs. 1.0, p = 0.001). Magnet ingestion was more frequent in these patients. Conclusions: FB ingestion predominantly affects young male children. Magnet ingestion frequently requires surgical intervention, underscoring the importance of preventive measures and safer environments. Surgical treatment should be considered in patients with symptomatic presentation, multiple ingested objects, or an uncertain ingestion history.