This division offers comprehensive treatment for a spectrum of pediatric and congenital conditions, burns and trauma. Board-certified pediatric surgeons offer compassionate, advanced care in a child-friendly environment at St. Louis Children’s Hospital. The division is a regional center for open fetal surgery, performs minimally invasive surgeries and treats many types of tumors. The division is actively involved in many areas of research, and leads in education, with a pediatric surgery fellowship approved by the American Council for Graduate Medical Education.
Division of Pediatric Surgery | 2020 Annual Report
The Pediatric Colorectal Center at St. Louis Children’s Hospital and Washington University School of Medicine in St. Louis brings together multidisciplinary pediatric experts to provide high- quality care to children with complex colorectal issues like Hirschsprung disease and anorectal malformations. Using state-of-the-art technology, top expertise, multidisciplinary care and goal-setting, the Pediatric Colorectal Center provides personalized solutions to improve the quality of life for children and their families.
Pediatric surgeon Baddr Shakhsheer, MD, established the center to help children like Savannah, who was born with a rare chromosomal deletion that caused several serious health problems, including cerebral palsy, seizures, kidney and heart disease, a compromised immune system and complex bladder and bowel issues. Savannah underwent testing at the Pediatric Colorectal Center, and her family talked with Shakhsheer about their goals and the best solution for their daughter. Ultimately, Savannah had surgery to address her hypofunctioning colon.
“These are serious problems that have lifelong implications,” Shakhsheer says. “In pediatric colorectal care, you’re entering into a long-term relationship with the family. You see them not only for the surgical procedure, but through the postoperative management as well.”
The program at the Pediatric Colorectal Center offers a comprehensive approach to management and treatment of patients with gastrointestinal problems. The team includes gastroenterology, radiology, rehabilitation, nursing and surgery. Patients receive complete evaluation and diagnostic workup, including motility testing, manometry, imaging and pathology, as well as top pediatric care, all at St. Louis Children’s Hospital.
“Dr. Baddr Shakhsheer has been such a blessing,” Savannah’s mother says. She describes him as a gentle giant. “He is very honest and straightforward. He’s smart and dedicated to his profession. Most importantly, he wants to make every child feel so much better.”
Shakhsheer completed general surgery residency at the University of Chicago. He joined the faculty after completing the Pediatric Surgery Fellowship at Washington University and St. Louis Children’s Hospital. Shakhsheer is well-versed in both traditional and minimally invasive approaches to colorectal surgery, and is driven to provide the best possible care to pediatric patients.
“It’s a joy and a privilege to work with children,” he says. “There’s no other way to say it.”
Surgeons at the Fetal Care Center at Barnes-Jewish Hospital are part of a comprehensive team of specialists providing medical care for pregnant women whose unborn babies have fetal conditions. In the past year and a half, the fetal care program has performed nearly 20 open myelomeningocele repairs. Myelomeningocele is a severe form of spina bifida, in which the spinal cord is exposed in utero. Pediatric surgeon Jesse Vrecenak, MD, and pediatric surgery fellow Ryan Antiel, MD, work alongside specialists in maternal fetal medicine, anesthesia and neurosurgery to provide excellent care at the only center in the St. Louis region with the expertise to treat myelomeningocele.
Director of Trauma at St. Louis Children’s Hospital Martin Keller, MD, is investigating differences in outcomes of adolescent trauma patients. A recent study examines the outcomes of patients that go to St. Louis Children’s Hospital compared to patients of the same age that go to an adult hospital. The study found that adolescent patients sent to an adult hospital did not have better outcomes than those sent to St. Louis Children’s Hospital. In fact, the likelihood of recidivism was lower in children with gunshot wounds who went to St. Louis Children’s Hospital, due to the hospital’s in-depth social investigation and counseling resources.
The Pediatric Surgery Fellowship is among the most sought-after training programs in the country, with over 100 applicants each year vying for a single position. Division Chief Brad Warner, MD, has seen a rise in the number of general surgery residents pursuing fellowship training in pediatric surgery in recent years. In response to this growing interest, the division is developing a program to fast-track general surgery residents interested in pediatric surgery early in their residency. Nearly half of the program’s fellows have been women, exceeding national averages. “As a division,” Warner says, “We have worked to develop an inviting and engaging experience for all pediatric surgery trainees, from medical students to residents and fellows.”
A better understanding of what causes pediatric diseases could help physicians treat and prevent these conditions in children. Pediatric surgeons and scientists continue to lead
research in this area with funding in short bowel syndrome (SBS), fetal cell and gene therapy, and Hirschsprung’s disease research.
Division Chief and Jessie L. Ternberg, MD, PhD, Distinguished Professor of Pediatric Surgery Brad Warner, MD, is coinvestigator on National Institutes of Health-funded research on SBS, in partnership with Pathology and Immunology researcher Gwendalyn Randolph, PhD. SBS is a condition that can arise after intestinal resection. The Warner laboratory is studying the effect of SBS on transport of proteins from the intestine to liver. These proteins, normally transported through lymphatics, are deposited directly into the liver through the portal vein in patients with SBS, which can cause liver disease.
“We have identified significant liver injury associated with intestinal resection in our animal model,” says Warner. Current research in the Warner lab seeks to more fully understand this response and advance treatments, ultimately, to permit patients to achieve a more normal lifestyle.
Pediatric surgeon Jesse Vrecenak, MD, has established a research laboratory investigating fetal cell and gene therapy to address diseases in utero. Vrecenak’s lab has received funding from the American Surgical Association, as well as a Faculty Research Award.
Pediatric researchers have also received a Children’s Discovery Institute grant in partnership with the laboratory of developmental biologist Samantha Morris, PhD. The research team is examining ganglion cells from the colon wall. People born without these ganglion cells, which help the bowel to contract, have Hirschsprung’s disease, causing them to have difficulty with bowel movements. Researchers have collected samples from regular colon walls and those
with Hirschsprung’s disease to understand the differences in the cells. General surgery lab resident Paul Kepper, MD, is analyzing data from these samples.
“Why are there no ganglion cells where there should be?” Warner asks. “Are the cells dying out, or are they failing to migrate where they are supposed to?”
Ongoing research efforts in pediatric surgery aim to answer these and other important questions to improve the health of children and address congenital conditions.