Surgery and Trauma Research

The Surgical Scholar Program provides surgery residents with the opportunity to diverge from clinical duties to engage in comprehensive clinical research training, culminating in a master’s degree or certificate in clinical research. This initiative fosters the next generation of academic pediatric surgeons and enhances the program’s research portfolio, including investigator-initiated studies, randomized controlled trials (RCTs), and active participation in various pediatric surgery consortia. Through these efforts, the program aims to train the next generation of surgeon-scientists, improve surgical outcomes and contribute significantly to the field of pediatric surgery.

If you are interested in joining the Surgical Scholar Program, please email Dr. Padilla at bpadilla [at] phoenixchildrens.com (bpadilla[at]phoenixchildrens[dot]com) for information on how to apply.

The Pediatric Inguinal Hernia Study

The work of the Pediatric Inguinal Hernia Study Group exemplifies the significant impact of the Surgical Scholar Program at Phoenix Children's. Brielle Ochoa, MD, a recent graduate of the program, led an ambitious research initiative to address critical questions in managing pediatric inguinal hernia. The study sought to evaluate several key aspects, including:

• Recurrence rates between laparoscopic and open hernia repairs
• Techniques to optimize laparoscopic procedures
• Incidence of apnea and bradycardia in newborns undergoing hernia repair
• Role of mesh in adolescent hernia repairs

This comprehensive study, which enrolled over 7,000 pediatric patients from 20 children's hospitals nationwide, has garnered significant attention. Dr. Ochoa's findings were accepted for numerous podium presentations at major national and international conferences as well as multiple original manuscripts. The extensive and detailed data from this study will serve as a valuable resource for future Surgical Scholars, paving the way for continued advancements in pediatric hernia management.

A prime example of innovative research is our extensive program dedicated to treating congenital chest wall malformations. For example, pectus excavatum, a condition characterized by depression of the sternum, can have both physiological and aesthetic impacts on children and adolescents. Surgical correction of pectus excavatum involves repositioning the sternum. This procedure can be highly painful, leading to extended hospital stays, increased opioid use and prolonged recovery periods. Phoenix Children's surgeons have pioneered the use of intercostal nerve cryoablation, a novel technique that reduces chest pain by freezing the nerves responsible for sensation.

Phoenix Children’s published the largest single experience of this technique. The study involved 500 children and demonstrated significant efficacy in reducing postoperative pain. The use of cryoablation shortened hospital stays to just one night and cut opioid use by over 80%. Detailed sensory exams confirmed that the sensory effects of cryoablation are temporary. Sensation typically returns to the chest wall within about five months with a low incidence of abnormal sensation or neuropathic pain. Ongoing research focuses on optimizing cryoablation techniques, including exploring shorter durations of cryoablation to decrease operative times and transitioning the procedure to an ambulatory setting.

Pediatric Surgery and Trauma Research Program

Justin Lee, MD, has made significant contributions to the Pediatric Surgery and Trauma Research Program with his focus on quality improvement and clinical trials. Dr. Lee spearheaded the IMPPACT trial, a multicenter randomized controlled trial that examined optimal antibiotic therapy following perforated appendicitis. This pivotal study, presented at the American Surgical Association Annual Meeting in 2021, revealed that monotherapy with zosyn reduced postoperative intraabdominal abscess formation to 6%, compared to 23% with the more commonly used ceftriaxone and flagyl combination.

Currently, Dr. Lee serves as the principal investigator for a randomized controlled trial within the Western Pediatric Surgery Research Consortium, which explores the impact of transanastomotic feeding tubes on stricture formation in infants with esophageal atresia. This study has enrolled nearly 150 infants across ten children's hospitals. The results may transform the management and treatment of this rare condition, potentially setting new standards of care nationwide.

Phoenix Children's pediatric surgeons are at the forefront of major research organizations nationwide, significantly shaping the field of pediatric surgery. David Notrica, MD, FACS, FAAP, a founding member of the ATOMAC study group, has made transformative contributions to the management of pediatric trauma. His work has revolutionized the treatment of blunt solid organ injuries and enhanced our understanding of blunt cerebrovascular injuries in children.

Additionally, the visionary leadership of Daniel Ostlie, MD, led to the formation of the Western Pediatric Surgery Research Consortium (WPSRC). The WPSRC is a collaborative network of major academic children’s hospitals across the Western United States.

WPSRC is a leader in pediatric surgical research, with notable presentations at major national and international conferences. WPSRC is also published in prestigious journals like Annals of Surgery and the Journal of the American College of Surgeons.

Under the chairmanship of Dr. Padilla, WPSRC’s ongoing projects are diverse. The projects range from the role of enteral contrast in the management of small bowel obstruction to evaluating the optimal methods for assessing potential cervical spine injuries. To date, the WPSRC C-spine injury study has enrolled nearly 7,000 patients, with a goal of enrolling nearly 22,000 patients.

Additionally, Kathleen Van Leeuwen, MD and Jamie Harris, MD, lead Phoenix Children’s contributions to the Pediatric Colorectal and Pelvic Learning Consortium (PCPLC). The longitudinal colorectal program advances our knowledge and clinical care for complex congenital conditions such as Hirschsprung disease, anorectal malformations and cloaca.