Pediatric Hernia Research Articles

Safety and Efficacy of a High-Frequency Radio Wave Scalpel for Pediatric Umbilical Hernia Repair

A high-frequency radio wave (HFRW) scalpel has been reported to achieve a fine smooth incision with good hemostasis and minimizes the surrounding tissue destruction. Since an umbilicoplasty was performed for cosmetic purposes, we introduced the HFRW scalpel for umbilical hernia repair in July 2016. This retrospective study aimed to investigate the safety and efficacy of an HFRW scalpel for umbilical hernia repair in children, compared to a surgical scalpel with electrocautery. We reviewed the medical records of 139 patients who underwent umbilical hernia repair using a surgical scalpel with electrocautery or an HFRW scalpel between January 2013 and November 2018. Patients were divided into two groups: the surgical scalpel with electrocautery (SE) group (n = 62) and the HFRW scalpel (HFRW) group (n = 77), for comparison of surgical outcomes. Umbilical hernia repair using the HFRW scalpel was successful without intraoperative complications in all 77 patients. Although the HFRW scalpel was directly used for skin incision, no burn injury was observed. Procedure duration was significantly shorter in the HFRW group than the SE group (P < 0.01). Two (3.2%) and five (6.5%) patients in the SE and HFRW groups, respectively, developed wound infection, which was not a clinically significant difference. Wound appearance in the HFRW group was well tolerated as well as that in the SE group. The HFRW scalpel is a simple, safe, and feasible device for pediatric umbilical hernia repair, with a shorter operative time.

The Incidence of Recurrence after Laparoscopic Versus Open Inguinal Hernia Repair in Children: a Systematic Review and Meta-Analysis

Inguinal surgery is one of the most common surgical procedures in children. However, whether laparoscopic hernia repair is superior to open hernia repair remains unclear. To undertake a systematic review and meta-analysis of randomized controlled trials evaluating the recurrence rate after laparoscopic hernia repair and open hernia repair in children who underwent repair for pediatric inguinal hernia. The Web of Science Database, Pubmed, Embase, WanFang Data, China National Knowledge Infrastructure, and Cochrane Central Register of Controlled Trials were searched to identify eligible studies. The outcomes evaluated were the recurrence rates including metachronous contralateral inguinal hernia and the complication rates associated with both laparoscopic hernia repair and open hernia repair. Seventeen RCTs including 2122 children (2540 hernia defects) were analyzed. Methodologic quality was unclear in most trials. The recurrence rate after inguinal hernia repair in children was 1.3% (33/2540). Meta-analysis of randomized trials did not reveal significant difference between the 2 techniques in the incidence of recurrence (relative risk [OR] = 0.48, 95% confidence interval [CI] = 0.12–1.82, P = 0.280). Simultaneously, there were no significant differences between laparoscopic hernia repair and open hernia repair in the incidence of metachronous contralateral inguinal hernia (OR = 0.33; 95% CI, 0.05–2.30; P = 0.270) and postoperative complications (OR = 0.58; 95% CI, 0.20–1.71; P = 0.320). Laparoscopic repair of a Pediatric hernia does not offer significant advantage over open hernia repair, therefore a decision to perform laparoscopic and/or open repair is best left to the surgeon, expertise available and parents in respective geographic area.

Laparoscopic inguinal hernia repair in children: To cut or not to cut that is the question?

To compare the results and complications of two techniques of laparoscopic paediatric hernia repair. All the children who had laparoscopic inguinal hernia repair done at AIIMS Jodhpur during the period of Sept 2016 to Nov 2017 were retrospectively studied. Patients were divided in two groups depending on whether the hernial sac was divided or not divided before taking a purse-string suture. Total 39 patients were included as per inclusion criteria. Mean age of the patient was 35.4 months (range is 2 months to 12 years). We had 7 female patients. Side of the hernia was bilateral in 7 patients, left side =13 and right side=19 making a total of 46 hernias. Hernial sac was divided before suturing in 17 patients while the sac was left intact before suturing in 22 patients. Mean follow up was 6.7 months (range: 1 to 14). Age, gender, side of hernia, complications and hospital stay were comparable. There was a significant difference between the mean operating times in patients who underwent division of hernia sac with patients in whom the sac was not divided before putting purse-string suture (92.5 mts vs 65.7 mts) respectively, p= 0.0101). One patient in the division of sac group had injury to testicular vessel while dividing the sac while one patient developed hydrocele on follow-up in the other group. There was no recurrence in either of the group. Repair done with or without dividing the peritoneal sac gives comparable results with lower operating time without sac division.

Ultrasound detection and closure of contralateral patent processus vaginalis in pediatric patients with unilateral inguinal hernia and hydrocele: a longitudinal study to prove efficacy in avoiding contralateral hernia development.

Open herniotomy has been the gold standard of pediatric hernia treatment with the advantages of simplicity in surgical technique, fast post operative recovery, and minimal recurrence rate, but its inability to prevent hernia development from a contralateral patent processus vaginalis (PPV) after a unilateral herniotomy is its major drawback. By contrast, laparoscopic hernia repair has the advantage of contralateral internal ring inspection, and, therefore, has become popular in recent years, although open herniotomy is still the favorable surgical technique among many surgeons. A simple and reliable tool to detect contralateral PPV will be valuable to surgeons who practice conventional open hernia surgery on children, although ultrasound has been applied for this purpose, but there is no long-term data to support such application. The author performed a preoperative ultrasound on the contralateral groins of children undergoing unilateral herniotomy or PPV ligation. If the ultrasound showed no evidence of contralateral PPV, no contralateral surgery was performed. Those patients were then followed up after a long period of time to see whether contralateral hernia or hydrocele was developed or not. 322 pediatric patients were studied from 2006 to 2012. In 96 of the cases (30%), contralateral PPV were identified with ultrasound, and 95% of which were affirmed intraoperatively. In the remaining 226 patients who were without evidence of contralateral PPV, only unilateral surgeries were offered. One of these patients later developed contralateral hernia and required another surgery. The remaining patients were phoned up after a median period of 9years. 114 of them could be contacted and none of them had developed contralateral hernia or hydrocele. Ultrasound groin is a valuable tool as an adjunct in pediatric hernia management by detecting contralateral PPV with high accuracy. Surgeon can offer unilateral or bilateral hernia surgery according to the ultrasound finding, and the incidence of contralateral hernia development is negligible. Preoperative ultrasound groin with selective contralateral PPV closure in children can be an alternative to routine laparoscopic hernia repair in avoiding contralateral hernia or hydrocele development. Level 3. Retrospective study.

Pediatric inguinal hernias, are they all the same? A proposed pediatric hernia classification and tailored treatment.

To propose a new clinical classification for pediatric inguinal hernias modified from a similar classification system for adult inguinal hernia and to propose a tailored repair for each type. The impact of this approach on hernia recurrence will be assessed. This prospective and retrospective cross-sectional study was conducted in two tertiary teaching university hospitals in Egypt (Alexandria and Tanta University Children's Hospitals) from January 2013 to December 2014 on children below 12years of age with indirect inguinal hernias who were divided into two groups: (a) prospective group I, classified according to our proposed pediatric hernia classification and tailored treatment (PHCTT) into types: pediatric Nyhus 1 (PNI) assigned for herniotomy alone, pediatric Nyhus II (PNII) assigned for herniotomy plus deep ring narrowing, and type pediatric Nyhus III (PNIII) assigned for herniotomy plus posterior wall repair. (b) Retrospective unclassified group II where all cases were assigned to herniotomy alone (open). Data about patient characteristics, assigned hernia type, operative findings, procedures done, and postoperative complications were documented and analyzed by comparing the outcomes of the two groups. A total of 371 patients were included in this study with 401 hernias (30 bilateral); group I included of 217 patients, while group II included 154patients. There was a male preponderance in group I (173/217 = 80%) and in group II (130/154 = 85%); the majority in both groups were less than 12months of age, in group I (132/217 = 66%) and in group II (120/154 = 85%). The median age was 4months and the median duration of symptoms was 2months. For group I, PNII hernias formed the predominant cluster making40% (94/235) followed by PNI hernias making 34.8% (82/235), while PNIII hernias were the least group being 25% (59/235) only. The mean follow-up period was 9.2months ± 4.8 SD (and 9.1months ± 2 SD in group II). The pooled recurrence rate was 1.9% (8/401) of the whole series, a weighted mean of the individual recurrence rates of 0% (0/235) of group I and 4.8% (8/166) of group II patients, all males. This difference in the recurrence rates between the two groups was statistically significant (P = 0.004). Pediatric inguinal hernias are not the same and there is extreme variation in the presentation regarding the size of the defect. We proposed a nouvelle pediatric hernia classification modified from the original Nyhus classification for adult inguinal hernia with tailored surgical approach to each type (PHCTT). Applying this (PHCTT), it has the benefit of a significant reduction of recurrence rate.

Research of median effective dose of levobupivacaine for ultrasound-guided transversus abdominis plane block in pediatric hernia surgery

Objective To investigate the median effective dose of levobupivacaine for ultrasound-guided transversus abdominis plane(TAP) block in pediatric hernia surgery. Methods Thirty consecutive children scheduled for pediatric hernia surgery were treated by basic anesthesia and ultrasound-guided TAP block.The levobupivacaine dose for a particular patient was determined by the response of the previous patient to a higher or smaller dose (step size of 0.1mg/kg) using Dixon's up-and-down sequential method, starting at levobupivacaine 0.5mg/kg.Block failure was defined as a 20% increase in heart rate(HR) or mean arterial pressure(MAP) from baseline.The ED50 and 95% confidence interval(CI) of levobupivacaine were calculated by the Dixon's up-and-down method and logistic regression analysis. Results The ED50 and 95%CI of levobupivacaine for TAP block obtained by Dixon's up-and-down sequential method were 0.24(0.22~0.27)mg/kg, the ED50 and 95%CI of levobupivacaine obtained through the probit test were 0.17(0.08~0.24)mg/kg.Adverse effects related to TAP block were not found in all children who underwent herniorrhaphy. Conclusion Ultrasound-guided TAP block can reduce local analgesic dosis and adverse effects, the ED50 of levobupivacaine for ultrasound-guided TAP block in pediatric hernia surgery is 0.24mg/kg. Key words: Hernia, inguinal; Levobupivacaine; Anesthetics, local; Ultrasonography; Child

Comparison of the streamlined pharynx airway liner and tracheal intubation in pediatric laparoscopic hernia surgery

Objective To observe the feasibility and safety of the SLIPATM in pediatric laparoscopic hernia surgery. Methods Eighty pediatric patients, who were scheduled to undergo laparoscopic hernia surgery(aged 3-12 y, ASA Ⅰ or Ⅱ), were randomly divided into two groups: SLIPATM group(S group) and tracheal intubation group(T group). Each group had forty patients. HR, SBP and DBP were recorded on time points of before anesthesia induction(T0), before insertion of SLIPATM or tracheal tube(T1), 1 min after the insertion of SLIPATM or tracheal tube(T2), and 1 min after extraction of SLIPATM or tracheal tube(T3). In addition, complications such as cough, hoarseness, pharyngalgia, dysphagia, bleeding and aryngospasm were also recorded after the extraction of SLIPATM or tracheal tube. Results There were totally seventy nine patients enrolled, including thirty nine patients in S group and forty in T group. At T2-T3, the HR, SBP, DBP of S group were significantly lower than T group(P 0.05). After extraction of SLIPATM or tracheal tube, five of the thirty nine patients coughed and four of the thirty nine patients had hoarse throats in S group while fifteen of the forty patients coughed and twelve of the forty patients had hoarse throats in T group. The incidences of cough and hoarseness in S group were significantly lower than the incidences happened in T group(P<0.05). However, there was no statistically difference at the incidence of complications such as pharyngalgia, dysphagia, bleeding and laryngospasm between the two groups. Conclusions SLIPATM has fewer effects on pediatric hemodynamics and lower complication incidence than the incidence of tracheal intubation. Therefore, it can be safely applied in pediatric laparoscopic hernia surgery. Key words: Laryneal mask; Tracheal intubation; Therapeutic laparoscopy; Herniorrhaphy

Laparoscopic Diagnosis of the Elusive Pediatric Femoral Hernia

Abstract Introduction: Femoral hernias comprise <1% of all pediatric groin hernias. They are most commonly missed, with 75% being treated as reoperation. The authors present a 6-year-old boy in who...

The Met Needs for Pediatric Surgical Conditions in Sierra Leone: Estimating the Gap

BackgroundIn low- and middle-income countries, there is a gap between the need for surgery and its equitable provision, and a lack of proxy indicators to estimate this gap. Sierra Leone is a West African country with close to three million children. It is unknown to what extent the surgical needs of these children are met.AimTo describe a nationwide provision of pediatric surgical procedures and to assess pediatric hernia repair as a proxy indicator for the shortage of surgical care in the pediatric population in Sierra Leone.MethodsWe analyzed results from a nationwide facility survey in Sierra Leone that collected data on surgical procedures from operation and anesthesia logbooks in all facilities performing surgery. We included data on all patients under the age of 16 years undergoing surgery. Primary outcomes were rate and volume of surgical procedures. We calculated the expected number of inguinal hernia in children and estimated the unmet need for hernia repair.ResultsIn 2012, a total of 2381 pediatric surgical procedures were performed in Sierra Leone. The rate of pediatric surgical procedures was 84 per 100,000 children 0–15 years of age. The most common pediatric surgical procedure was hernia repair (18%), corresponding to a rate of 16 per 100,000 children 0–15 years of age. The estimated unmet need for inguinal hernia repair was 88%.ConclusionsThe rate of pediatric surgery in Sierra Leone was very low, and inguinal hernia was the single most common procedure noted among children in Sierra Leone.

Ultrasound-guided para-umbilical block: a pediatric case

BackgroundRectus sheath block is a common peripheral nerve block for patients undergoing umbilical hernia repair surgery. However, rectus sheath block alone can affect only anterior branches of intercostal nerves and, therefore, is incomplete for postoperative analgesia for the anterior abdomen, which is innervated by both anterior and lateral branches. We describe a successful perioperative analgesia with ultrasound-guided para-umbilical block after pediatric umbilical hernia surgery.Case presentationA 4-year-old child underwent hernia repair surgery. Following induction of general anesthesia, the anatomy of the umbilical region was observed under ultrasound with a 5–10-MHz linear probe. An ultrasound-guided injection between the rectus abdominis muscle and the posterior lobe of the rectus sheath and an injection into the subcutaneous space around the umbilicus were performed. The peripheral nerve block was effective during surgery, and the patient required no additional rescue analgesia during the perioperative period. There were no complications.ConclusionWe performed ultrasound-guided para-umbilical block with four injections. This peripheral nerve block could be an efficient technique for complete perioperative analgesia.

Pediatric Spigelian hernia: A case report and review of the literature

Pediatric Spigelian hernia: A case report and review of the literature

Uncommon Complication of Paediatric Umbilical Hernia: Spontaneous Evisceration. Case Report and Literature Review

Uncommon Complication of Paediatric Umbilical Hernia: Spontaneous Evisceration. Case Report and Literature Review

The application of the sevoflurane anesthesia via laryngeal mask airway (LMA) composited block in groin area in pediatric hernia surgery

Objective To compare the security between the sevoflurane anesthesia via laryngeal mask airway (LMA) composited nerve block in groin area and ketamine anesthesia in the pediatric hemioplasty. Methods 80 children (aged 2-6, weight 10-25kg, ASAⅠ-Ⅱ) with high ligation of hernia sac were divided into two groups according to the random number table method: group S-sevoflurane combined with inguinal region block under laryngeal airway ventilation; group K-ketamine combined with caudal block.Group S was inhalated with 6%-8% sevoflurane for foundation anesthesia, and then followed with vein induction: fentanyl 2μg/kg and propofol 2mg/kg.The laryngeal mask was placed when the temporomandibular joint was relaxed.Inguinal region was blocked by the surgeon after disinfect and spread towels.Anesthesia was maintained by 3% to 4% sevoflurane with mechanical ventilation interoperation.Group K was adopted the intramuscular ketamine (5mg/kg) for basic anesthesia and then used modified sacral canal blocking.Ketamine 1mg/kg was administered before skin incision.Additional ketamine 0.5mg/kg was intravenously injected when it was appeared with body move, choking cough, etc.The values of MAP and HR in the two groups were recorded respectively at the time point of 1min before skin cutting (T0), 1min after skin cutting (T1), 5min after skin cutting (T2), the end of operation (T3) and awaken time (T4). The body movement was observed intraoperation, the number of SpO2≤95% and awaken restlessness, the recovery time and residence time in anesthesia recovery room were recorded. Results The values of MAP in group S at time points of T1, T2, T3 were (77.6±6.2)mmHg, (77.8±6.4)mmHg, (76.5±4.7)mmHg respectively, and the values of MAP in group K at time points of T1, T2, T3 were (86.9±8.1)mmHg, (88.1±5.3)mmHg, (86.4±6.5)mmHg respectively.The t values at time points of T1, T2, T3 were 5.766, 7.893, 7.806 respectively when the group S compared with group K(P<0.0001), the group S was superior to group K. The values of HR in group S at time points of T1, T2, T3 were (121.3±9.6)times/min, (121.9±8.4)times/min, (120.3±7.8)times/min respectively, and the values of HR in group K at time points of T1, T2, T3 were (138.6±9.4)times/min, (136.5±7.5)times/min, (128.7±6.9)times/min respectively.The t values at time points of T1, T2, T3 were 8.144, 8.200, 5.101 respectively(P<0.0001), the group S was superior to group K. The MAP and HR were more smoothly in group S than in group K. The recovery time in group S and K was (7.5±3.4)min and (16.7±5.5)min respectively(t=8.99, P<0.0001), it was shorter in group S than in group K. The residence time in anesthesia recovery room was (15.4±4.2)min and (23.7±6.3)min respectively(t=6.93, P<0.0001), it was shorter in group S than in group K. Intraoperative body movements was 3 cases and 15 cases respectively in group S and group K(χ2=10.32, P<0.001); Cases of SpO2≤95% was 4 and 12 respectively in group S and group K(χ2=10.32, P<0.001), the occurrence of body movements and SpO2≤95% cases was lower in group S than in group K. Conclusion The sevoflurane anesthesia via LMA composited nerve block in groin area has the advantages of faster induction, faster recovery, the hemodynamics was more stable, adverse reactions was fewer and so on, it can be safely used in pediatric anesthesia. Key words: Laryngeal mask airway; Sevoflurane; Ketamine block in groin area; Pediatric hernia surgery

Two-center Analysis of Long-term Outcomes after High Ligation Inguinal Hernia Repair in Adolescents

High ligation of the inguinal hernia sac is standard practice for many pediatric surgeons in postpubertal adolescents. Most adult surgeons do not use this technique to repair indirect inguinal hernias because of concerns for higher recurrence rates compared with mesh repairs. Therefore, we examined long-term outcomes of adolescent high ligation hernia repair performed by pediatric surgeons. Telephone surveys were conducted on children over 12 years old at the time of repair, and patients and/or their parents were contacted 18 months postrepair. Patients were identified from two institutions between 1998 and 2010. The incidences of reoperation, recurrence, presence of bulge, chronic pain, or numbness were determined. A total of 210 patients (40.7% response rate) were available for phone interviews at 18.6 to 159.5 months postrepair. Mean age was 14.6 ± 1.8 (range: 12.0-19.0 years). Fourteen patients had pain (6.7%) and five had numbness (2.4%). There were four (1.9%) patients with a second operation, two of which confirmed a recurrent hernia. Three patients expressed concern about possible recurrence. Two report a bulge, but have not been evaluated. Pediatric hernia repair with high sac ligation appears effective in patients anatomically similar to adults with low recurrence rate and low incidence of chronic symptoms. These data suggest that prospective trials on the adequacy of high ligation in adults are warranted.

Clinical study of small incision operation and traditional operation in treatment of infantile hernia

Objective To analyze the clinical effect of small incision operation and traditional operation in treatment of pediatric hernia, and to provide a theoretical basis for the clinical treatment of pediatric hernia. Methods 68 children with pediatric hernia were treated as the research subjects, they were randomly divided into control group and observation group, 34 children in each group.The control group adopted the traditional operation treatment, while the observation group was taken small incision.The clinical efficacy and complications of both two groups were compared. Results The operation time, bleeding volume, hospitalization time and incision length of the observation group were (10.45±1.35)min, (5.21±0.78)mL, (1.98±0.76)d, and (1.04±0.23)cm, which were better than those of the control group [(15.67±3.24)min, (8.56±1.87)mL, (3.78±1.12)d, and (2.54±0.65)cm, respectively], the differences were significant (t=5.760 0, 5.747 7, 4.171 7, 7.986 8, all P<0.05). The incidence rate of complications of the observation group was 2.94%, which was significantly lower than that of the control group (11.76%), the difference was significant (χ2=5.7118, P<0.05). Conclusion The clinical curative effect of using small incision in the treatment of pediatric hernia is significant, this method has the advantages of small operation wound, less pain, faster postoperative recovery, less complications and other advantages, it is worthy of clinical application. Key words: Hernia, inguinal; Children; Surgical operation

25th Anniversary State-of-the-Art Expert Discussion With Todd A. Ponsky, MD, FACS, on the Advances of Surgical Practice in Pediatric Hernia Repair.

Dr. Todd A. Ponsky is currently Associate Professor of Surgery and Pediatrics at Northeast Ohio Medical University and a Pediatric Surgeon at Akron Children's Hospital. He attended medical school at Case Western Reserve University in Cleveland, OH, from 1995 to 1999, Residency in General Surgery at The George Washington University in Washington, DC, from 1999 to 2005, Pediatric Surgery Fellowship at Children's National Medical Center in Washington, DC, from 2005 to 2007, and an Advanced Minimally Invasive Pediatric Surgery Fellowship at The Rocky Mountain Hospital for Children in Denver, CO, from 2007 to 2008. Dr. Ponsky has a particular interest in minimally invasive pediatric surgery. He has trained over 200 surgeons in single-port and needlescopic surgery. He has written over 60 manuscripts and almost 20 book chapters. He has a strong focus on surgical education and virtual education and has directed over 20 national/international courses. He has won numerous teaching awards, including “The Faculty Teaching Award” at Case Western Reserve University's Department of Surgery in his first year as a faculty member. He is a reviewer for over 15 medical journals and is on four editorial boards. He is on the leadership of four national societies and has been Program Chair and is currently serving as Secretary on the Executive Committee of The International Pediatric Endosurgery Group (IPEG). He is involved in both outcomes and animal research with a focus on inguinal hernia physiology, foregut motility, and gastric stimulation, as well as endoscopic repair techniques for pure esophageal atresia. He has a wife, Diana, and three daughters, Sasha, Josie, and Ella.

The study of totally transumbilical single-port laparoscopic herniorrhaphy and traditional surgery in treat-ment with pediatric indirect inguinal hernia

Objective To compare the effect and safety of totally transumbilical single-port laparoscopic herniorrhaphy and traditional surgery in treatment with pediatric indirect inguinal hernia. Methods 100 children with indirect inguinal hernia were divided into control group(n＝50)and observation group(n＝50). The control group was given to traditional surgery. The observation group was given to totally transumbilical single-port laparoscopic herniorrhaphy. The operation related index, postoperative complications and hernia recurrence rate were compared between the two groups. Results The intraoperatve bleeding, incision length, operation time and hospital stays of the observation group respectively were(18.1±5.9)mL,(1.3±0.3)cm,(27.4±7.9)min and(4.5±1.2)d,those of the control group respectively were(38.7±8.1)mL,(2.2±0.4)cm,(46.7±9.2)min and(7.4±1.3)d,the difference was statistically significant(t＝3.439,3.811,2.872,2.878,P＝0.026,0.019,0.045,0.049).The postoperative complications rate of observation the group and the control group were respectively 8.0%(4／50)and 24.0%(12／50),the difference was statistically significant(χ2＝4.762,P＝0.029). Postoperative follow-up of 1 year,the hernia recurrence rate of the observation group and the control group respectively was 0(0／50)and 12% (6／50),the difference was statistically significant(χ2＝6.383,P＝0.012). Conclusion Using totally transumbili-cal single-port laparoscopic herniorrhaphy treat with pediatric indirect inguinal hernia is safe and effective. It is ben-eficial to prevent recurrence, and is worth clinical promotion. Key words: Hernia; Inguen; Laparoscope; Child; Single-port

Targeted needs assessment for a transitional “boot camp” curriculum for pediatric surgery residents

IntroductionTransition periods in medical education are associated with increased risk for learners and patients. For pediatric surgery residents, the transition to training is especially difficult as learners must adjust to new patient populations. In this study we perform a targeted needs assessment to determine the ideal content and format of a pediatric surgery boot camp to facilitate the transition to residency. MethodsA needs assessment survey was developed and distributed to pediatric surgery residents and staff across North America. The survey asked participants to rank 30 pediatric surgical diagnoses, 20 skills, and 11 physiological topics on “frequency” and “importance”. Items were then ranked using empirical methods. The survey also evaluated the preferred boot camp format. ResultsIn total, 12 residents and 23 staff completed the survey. No significant differences were identified between staff and residents in survey responses. The top 5 topics identified for inclusion in a boot camp were: (1) fluid and electrolyte management, (2) appendicitis, (3) pediatric hernias, (4) nutrition and (5) pain management. The preferred format for a boot camp was 3–4days in duration applying a blend of educational methods. ConclusionsBased on the results of the needs assessment survey, a novel pediatric surgery boot camp curriculum can be developed.

AKT answer relating to paediatric hernias

AKT answer relating to paediatric hernias

AKT question relating to paediatric hernias

AKT question relating to paediatric hernias