Pediatric Surgery

The mission of the Pediatric Surgery Division is to provide high quality family-centered surgical care. The Division of Pediatric Surgery offers a full range of clinical services for pediatric patients from newborns to young adults. This includes prenatal consultations, the treatment of congenital anomalies, head and neck surgery, surgery of the chest and abdomen, pediatric gynecology, non-reconstructive urology, surgical oncology, bariatric surgery, reconstruction of chest wall deformities, and trauma including burn care. Pediatric surgeons currently see patients in Farmington, Glastonbury, and Danbury, allowing easier access for the convenience of our patient families. Some outpatient procedures are performed at the Connecticut Children’s Ambulatory Surgery Center in Farmington. Same-day outpatient visits are available at our Hartford office for urgent problems, and at our satellites when a pediatric surgeon is there. We are committed to offering families outpatient appointments within one week of referral, if desired by the family.

The year 2020 was unlike any other for the Division of Pediatric Surgery. We are proud to say that our division members met the challenge of Covid-19 and quickly adapted to ensure the safety of our staff and patients and to meet the ongoing demand for emergent surgery, which continued throughout the pandemic. Elective surgeries were halted in mid-March for just over two months.

Many of our staff members stepped up to serve on hospital committees that were formed in urgent response to Covid-19. Division chief and Surgeonin-Chief Christine Finck, MD, served as chair of the Personal Protective Equipment (PPE) and Operations Resumption task forces. Richard Weiss, MD, served on the Covid Testing Task Force.

The arrival of the Covid-19 pandemic required rigorous new protocols and new clinical pathways. The division shifted to telemedicine for 80 percent or more of office visits, and we continue to offer telemedicine even as surgeries and office appointments have resumed.

Among the year’s other accomplishments, the division’s Bariatric Surgical Program, under the leadership of Dr. Finck, Melissa Santos, PhD, and James Healy, MD, MHS, continues its national accreditation by the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP), the combined accreditation program of the American College of Surgeons (ACS) and the American Society for Metabolic and Bariatric Surgery (ASMBS). Connecticut Children’s is the first and only pediatric program in the state to receive this honor. The highly prestigious recognition designates Connecticut Children’s as a MBSAQIP Adolescent Center, making Connecticut Children’s bariatric surgeons and clinical staff the most qualified and up-to-date in surgically treating children with metabolic disorders.

Under the leadership of Brendan Campbell, MD, MPH, who holds the Donald W. Hight Endowed Chair, Connecticut Children’s has been continuously verified by the American College of Surgeons as a Level I Pediatric Trauma Center since 2008.

Dr. Campbell continues to serve as the Chief Surgical Quality Officer at Connecticut Children’s, a role in which he oversees quality and patient safety for all surgical divisions. Additionally, he continues to be involved regionally and nationally in advocating for the prevention of firearms injuries. In 2020, he was one of 100 surgeons nationally to be selected to serve as a member of the American College of Surgeons Committee on Trauma, and selected to chair the Injury Prevention and Control Committee. Locally, he leads efforts by the division and the hospital in the American College of Surgeons’ Pediatric National Surgical Quality Improvement Program (NSQIP), which has been highly successful in improving the quality of children’s surgical care. In February 2020, he received the American College of Surgeon’s Arthur Ellenberger Award “in recognition of protecting patient access to high quality surgical care through outstanding leadership, distinguished service, and commitment to state grassroots advocacy.” In June, he was honored by the University of Connecticut Integrated General Surgery Residency Program, which presented him with the Joseph M. Civetta Best Faculty Teacher Award “in recognition for outstanding contributions to Surgical Resident Education.”

Christine Rader, MD, was named assistant dean for Academic Affairs at Connecticut Children’s. In this role, she serves as a liaison for University of Connecticut, overseeing the education of all residents, medical and surgical. She continues as the surgical director of the Extracorporeal Membrane Oxygenation Program (ECMO), which cares for critically ill patients with cardiac and respiratory failure. The Multidisciplinary Thyroid Group, led by Drs. Finck, Weiss, Bilbao, and Riba-Wolman enables children with thyroid diseases to be rapidly and simultaneously evaluated by a surgeon and an endocrinologist. The Chest Wall Deformities Program, led by Dr. Rader, continues to evaluate and treat patients with pectus excavatum and pectus carinatum. Dr. Rader provides surgical expertise to both the Short Gut and Aerodigestive programs. The Multidisciplinary Prenatal Evaluation Program continues to be co-directed by Dr. Weiss. This program is a joint effort with the divisions of Obstetrics and Maternal Fetal Medicine at Hartford Hospital, and multiple medical and surgical divisions at Connecticut Children’s.

Dr. Healy now serves as co-site director for the Quinnipiac inpatient pediatrics rotation, including oversight and development of an outpatient pediatrics rotation within the pediatric surgical clinic. Additionally in 2020, he developed a series of educational lectures for advanced practitioners and PAs to improve competency for new hires and provide a reference. He was awarded a Surgical Innovation Grant for his study on “Improving and Tracking Peri-operative Activity for Pediatric Bariatric Patients Using Wearable Fitness-tracking Technology.”

Dr. Weiss continues as an ex officio member of the American Pediatric Surgical Association (APSA) Practice Committee, which monitors the practice of pediatric surgery in North America, reports trends in practice patterns, and offers guidance to APSA members for improvements and optimization of care delivery. He also serves on the APSA History Committee. He continues his role as an advisor for the American Pediatric Surgical Association to the AMA/ Specialty RVS Update Committee (RUC), and is a member of the executive council of the Connecticut chapter of the American College of Surgeons.

Dr. J. Leslie Knod pursued her interest in advocacy as a member of the American Pediatric Surgical Association Health Policy & Advocacy Committee and our institution’s Hospital Public Policy Council. After delivering her grand rounds to engage pediatricians in activism, she also met virtually with State Rep. Lucy Dathan, D-Norwalk, to discuss the impact of Covid-19 on our field as well as access to medicine and the evolving role of telehealth. At an institutional level, as a member of Connecticut Children’s Hospital Venous Thromboembolic Prevention Workgroup, Dr. Knod helped unify surgical input in creating a hospital-wide pathway that is being developed.

Dr. Finck created “From the Eyes of a Surgical Patient,” which was presented to Sen. Richard Blumenthal, D-CT, on June 5, 2020. She participated in the creation of Connecticut Children’s Facebook Live series focused on healthy behaviors during the pandemic and her live virtual walk recorded the highest number of hits.

One of Dr. Finck’s main goals is to promote gender equality and increase diversity across the surgical department. A new Women in Surgery group has been instrumental in talking about gender challenges of being a woman in a predominately male field. A new podcast was launched called “Women in Surgery” that discusses topics such as “Imposter Syndrome” and “Wellness.”

EDUCATION

One of the core missions of the division is to educate future physicians and surgeons. We welcome General Surgery residents from the University of Connecticut School of Medicine, and from Stamford Hospital, Waterbury Hospital, and St. Mary’s Hospital, and this year we added residents from Danbury Hospital. Each year several Connecticut Children’s Pediatric residents participate in elective rotations on the pediatric surgery service. We also host medical students from UConn and Quinnipiac University. A fellowship program in pediatric surgery has been offered at Connecticut Children’s since 2011. Our fellow, Katerina Dukleska, MD, is now in her second year. Jacob Campbell, DO, MPH, who is completing his surgical residency at UConn, will be the next fellow. He is scheduled to start in August of 2021.

Dr. Rader serves as the site director for the University of Connecticut General Surgery Residency Program.

Drs. Weiss, Rader, Campbell, Knod and Healy serve as instructors for the Advanced Trauma Life Support (ATLS) courses that are taught annually for residents, fellows, APs, and physicians from around the region and state.

The Division of Pediatric Surgery is dedicated to the education of the next generation of medical providers, but 2020 brought a number of challenges. While residents in Pediatric Surgery continued as usual, medical students transitioned to virtual learning during the pandemic. All medical learners were able to return to the hospital by summer, and their programs continued without interruption for the remainder of the year. Because not all regional medical centers welcomed their students back, the Division of Pediatric Surgery hosted more than the usual number of medical learners from Quinnipiac University.

The division staff contributed on a national level with presentations given in person or remotely due to Covid-19. Dr. Campbell was a co-author of two presentations, “Firearm Storage Practices of U.S. Members of the American College of Surgeons,” and “Outcomes of Standardized Non-operative Management of High-grade Pancreatic Trauma in Children: A Study from the Pediatric Trauma Society Pancreatic Trauma Study Group,” which were given virtually at the national 78th Annual Meeting of the American Association for the Surgery of Trauma. Dr. Weiss and Surgery fellow Katerina Dukleska created a video presentation of perforated duodenal ulcer masquerading as acute perforated appendicitis. It was accepted for presentation at the June 2020 International Pediatric Endosurgical Group (IPEG), but the event was canceled due to Covid-19. Dr. Weiss was a discussant on a paper, “Outcomes of Thyroid Surgery at Medium Volume Centers,” which was presented at the American Pediatric Surgical Association (APSA) annual meeting, which was held virtually in May 2020.

RESEARCH

Dr. Finck’s lab focuses on innovation and tissue engineering of organs including the lungs and the esophagus. Over the last year, the laboratory has engaged in pre-clinical trials around an implantable scaffold to repair the esophagus. The NIH awarded this project $1.2 million to continue research in collaboration with a small company, Biostage, based out of Boston. In addition, the Finck laboratory received a Department of Defense Grant in collaboration with the University of Vermont to evaluate an alginate sealant for tracheobronchial injuries. These projects were suspended for a time due to Covid-19, but are back on track. Another grant focusing on the mechanism of Covid-19 and obesity was submitted to the NIH. In addition, due to the generosity of a board member, bioprinters were purchased for the lab. They are instrumental in tissue engineering research, however, they were repurposed during the pandemic to produce face shields, masks, ear connections, and testing swabs for our front-line staff members.

The division is currently participating in several multicenter studies. New this year is the participation in the Eastern Pediatric Surgical Network. This is a consortium of children’s hospitals on the East Coast that are working together to examine low frequency childhood diseases. Connecticut Children’s is the lead site for esophageal atresia with Dr. Finck as the lead investigator and Shefali Thaker, BA, as the coordinator. Connecticut Children’s is also participating in studies on central line infection (Dr. Knod), appendicitis (Dr. Campbell), and pediatric thyroid disease (Dr. Healy). The division also continues to participate in a study to determine the optimal timing of inguinal hernia repair in premature infants; the best treatment for children who sustain blunt injury to their pancreas; and whether receiving firearm safety messaging during outpatient clinic visits improves safe firearm storage in the home. The division is active in other IRB-approved studies as well as health services research, injury prevention research under the leadership of Drs. Campbell and Knod, and basic science research from the lab of Dr. Finck.

THE FUTURE

Operationally, division plans for 2021 include expanding our footprint to Fairfield County with increased satellite clinics in Danbury. We will continue to develop niche programs that leverage our expertise such as chest wall deformities, weight management, and thyroid diseases. Finding the optimal balance of telemedicine and inperson visits to best meet our patient and family needs is a priority. Finally, continuing to offer rapid access for patients is essential.

PUBLICATIONS

Sayej WN, Isakoff MS, DiGiuseppe JA, Moote D, Balarezo F, Finck C, Hyams JS. Primary cutaneous follicle center lymphoma in a 16-year-old male with Crohn’s disease exposed to infliximab and methotrexate. J Pediatr Gastroenterol Nutr. 2019 Nov 26. doi: 10.1097/ MPG.0000000000002578.

Mitchell A, Wanczyk H, Jensen T, Finck C. Human induced pluripotent stem cells ameliorate hyperoxiainduced lung injury in a mouse model. Am J Transl Res. 2020 Jan 15; 12(1): 292-307 eCollection 2020.

Guisto K, Wanczyk H, Jensen T, Finck C. Hyperoxia induced bronchopulmonary dysplasia: improvement of models for effective therapies. 2021. Feb epub ahead of print.

Montgomery AB, Han J, Healy JM, Finck C. Tissue plasminogen activator for a rare case of neonatal empyema. J Pediatr Surg Case Rep. 2020 March; 54: 101374.

Jensen T, Wanczyk H, Thaker S, Finck C. Characterization of mesenchymal stem cells in patients with esophageal atresia. J Pediatr Surg. 2020. doi: 10.1016/j.jpedsurg.2020.09.039. Doucette ML, Dayton H, Lapidus G, Borrup KT, Campbell BT. Firearms, dementia, and the clinician: development of a safety counseling protocol. J Am Geriatr Soc. 2020 Sep;68(9):2128-2133.

Duncan TK, Weaver JL, Zakrison TL, Joseph B, Campbell BT, Christmas AB, Stewart RM, Kuhls DA, Bulger EM. Domestic violence and safe storage of firearms in the Covid-19 era. Ann Surg. 2020;272(2):e55-e57.

Kuhls DA, Falcone RA Jr, Bonne S, Bulger EM, Campbell BT, Cooper Z, Dicker RA, Duncan TK, Kuncir EJ, Lamis DA, Letton RW Jr, Masiakos PT, Stewart RM, Knudson MM. Prevention of firearm injuries: it all begins with a conversation. J Trauma Acute Care Surg. 2020 Feb;88(2):e77-e81.

Campbell BT, Thaker S, Fallat ME, Foley DS, McClure E, Sakran JV, Nasr IW, Ziegfeld S, Ehrlich PF, Snodgrass M, Levy M, Naik-Mathuria BJ, Johnson B, Demello AS, Jones S, Watters JM, Burke P, Allee L, Kozyckyj T, Letton RW, Kuhls DA, Bulger EM, Stewart RM. A multicenter evaluation of a firearm safety intervention in the pediatric outpatient setting. J Pediatr Surg. 2020 Jan;55(1):140-145.

Nicolson NG, Healy JM, Korah R, Carling T. Whole-exome sequencing of syndromic adrenocortical carcinoma reveals distinct mutational profile from sporadic ACC. J Endocr Soc. Oct, 2019. PMID: 31555752.

Sinha R, Knod JL, Dukleska K, Mello D. Congenital sternal cleft with absence of anterior pericardium. CTSNet. 2020 Nov. doi: 10.25373/ctsnet.13249931.

Knod JL. Physician opportunities to prevent deaths by firearms. Conn Med. 2020 March;84(3):101-105.

Sharma I, Moote D, Campbell BT. Concussion of the colon: paediatric patient with traumatic cecal haematoma. BMJ Case Rep. 2020 Dec 12;13(12):e236066. doi: 10.1136/bcr-2020-236066. PMID: 33310827. Flaherty MR, Raybould T, Savarino J, Yager P, Mooney DP, Farr BJ, Giuliano JS Jr, Neeman E, Campbell BT, Thaker S, McKiernan C, Lewis D, Epp TK, Baertschiger RM, Jackson CA, Rideout L, Shah A, Falank C, Ontengco J, Cairo S, McLoughlin RJ, Aidlen JT, Watson-Smith D, Wills H, Masiakos PT. Unintentional window falls in children and adolescents. Acad Pediatr. 2020 Jul 9:S18762859(20)30428-9. doi: 10.1016/j.acap.2020.07.008. Online ahead of print. PMID: 32653687.

BOOK CHAPTERS

Campbell BT. Meckel’s diverticulum and other omphalomesenteric duct remnants. In: Wyllie R, Hyams JS, editors. Pediatric gastrointestinal and liver disease. 6th ed. Philadelphia: Elsevier Saunders; 2020.

Rader CM. Inguinal hernias and hydroceles. In: Wyllie R, Hyams JS, Kay M, editors. Pediatric gastrointestinal and liver disease 6th ed. Philadelphia: Elsevier; 2020. p. 555-558.

STAFF

Christine Finck, MD, FACS, Surgeon-in-Chief, Division Chief Michael Bourque, MD, FACS, emeritus Brendan T. Campbell, MD, MPH, FACS, FAAP Medical Director Pediatric Trauma Program; Chief Surgical Quality Officer James Healy, MD, MHS Donald W. Hight, MD, emeritus J. Leslie Knod, MD Christine Rader, MD, FACS Surgical Director, Extracorporeal Membrane Oxygenation Program Shefali Thaker, BA, Research Associate Richard Weiss, MD, FACS, FAAP Medical Director, Pediatric Surgery Division

Elisabeth Campbell, PA Nicole Dietzel, PA Evan Fusaro, PA Miranda Lange, PA Samantha Pelow, APRN Allison Schilling, APRN