BOB in Ped Surg 2023 - WOFAPS Winner - Tran Ngoc Son, MD

So, we can start. Okay. Any comments from anyone? If not, we're going to go ahead and get started. All right. So, here we go. So, these are the first three and these come to us from Wolf apps. So, Wolf apps had their Congress and they sent us what they felt were the top three presentations. So, first of all, incredible congratulations to these three authors who submitted these fantastic presentations. But, unfortunately, we're going to have to pick one whose video we play. So, here were the three. Uh the first one was from Dr. Rachel Livergant uh from the University of Alberta and British Columbia, and it was um with postoperative morbidity and mortality in the pediatric indigenous populations, a scoping review and meta analysis. So, this was a review and a meta analysis of 14 studies to assess which inequities exist between surgical outcomes in pediatric, indigenous, and non-indigenous people on the American oceanic continents with regards to post-op complications, morbidities and mortality. So, that is the first one. Amazing job Rachel on an amazing paper. Congratulations for being accepted as to the top presentation from Wolf apps. The second one is Dr. Rustan Yuldachev from the Tashkent pediatric Medical Institute in Uzbekistan. And he presented angiographic patterns of portal Venus system in children with extra hepatic portal hypertension and its etiologic and clinical relevance. The purpose of this study was to study the relationship between angiographic patterns of extra hepatic portal vein obstruction and its etiology and clinical manifestations. All right. So, that was new that was number two. Congratulations Rustan on an amazing paper, really impressive to be selected not only at Wolf apps but also to make it to the best of the best. And last but not least is Professor Tran Knoc Sun from Saint Paul Hospital presenting single incision laparoscopic percutaneous extraperitoneal closure of the process vaginalis without hydrocelectomy in the management of primary hydrocele. So, they looked at the laparoscopic approach of the management of hydrocele without actually performing a hydrocelectomy. They performed a prospective study between June 2016 and December 2021, and their aim was to study the feasibility and effectiveness of the laparoscopic approach for patent process vaginalis without hydrocelectomy for treating hydroceles. So, those were the three. We've got review and meta analysis of inequities in indigenous and non-indigenous. We have the angiographic patterns for portal Venus hypertension and we have the use of the laparoscopic approach for hydroceles without hydrocelectomy. Unfortunately, we're going to have to pick one. So, let's open up the polls. Everybody vote. We'll play a quick video while you vote and we'll see which one advances on to the next round of the best of the best. We'll see you in a minute. That feeling in your heart. It's always been there. It's curiosity, empathy, discovery. It's a love for what we do, but the children we care for and the people we stand side by side with. At Cincinnati Children's, we know it well. It's our purpose. Care drives us. Science moves us. Collaboration empowers us. Discovery inspires us. We are touched by humanity and propelled by compassion. This isn't our job, it's our calling and we answer it every day for every family and every child and every future. To heal, to discover, to teach those who will one day change everything. We are at Cincinnati Children's from one location serving one community in 1883 to patients and employees from around the world. We're 17,000 strong and growing and we are changing the outcome together. Okay. Well, uh it was a close one. Uh it's still changing but I think we can call it. I think it's close enough to call at this point. Uh it looks like the winner was the single incision laparoscopic percutaneous extraperitoneal closure of the process vaginalis without hydrocelectomy in the management of primary hydrocele in children. So, uh if we can, I I don't know. Are we able to bring uh the author to uh discuss this paper? But, um if not, uh um Let's see here. Let's let's go ahead and play the play the video. Well, let's play the video and bring bring the surgeon on to talk about it. So, uh I let's go ahead and roll that this this video. Dear colleagues, ladies and gentlemen, thank Wolf ups and state MD for giving me the opportunity to present our work. Laparoscopic percutaneous closure of patent processes vaginalis without hydrocelectomy for childhood primary hydrocel. The traditional hydrocel repair is open repair with an incision, highlighting the PPV and hydrocelectomy, which can be total or a partial of an expression. Laparoscopic surgery or NS is increasingly used in the treatment of pediatric inguinal hernia, but not yet popular in the treatment of hydrocel. The aim of this study is to evaluate the feasibility and effectiveness of single incision laparoscopic extraperitoneal closure or simpact of PPV with hydrocelectomy in primary hydrocene in children. We perform a prospective study on own children with primary hydrocele treated at our center for five years period with inclusion and exclusion criteria as shown. For our impact procedure, two were placed at the same 10 mm single umbilical incision. Under the laparoscopic vision and with the assistance of the PPV was closed extraly at the internal ring with a two zero suture using a percutaneous needle with a wide lasso. No hydrocelectomy ofration of hydrocene was performed. The hydrocene fluid was pushed back to the peritonal cavity via internal ring before the closure of PPV by external manual pressing. And with this step was successful. The fruit was evacuated by a percutaneous needle puncture. 553 patients were enrolled in this study with a median age of 34 months, ranged 2 years to 14 years. If lateral PPV was found in own the patient and in nearly 30%, there was no obvious communication between the hydrocene with the peritonal cavity. The median operative time was 17 minutes and the median post operative stay was one day. There were no major complications and at a follow up of 41 months, the recurrence rate was 0.36%. The post operative cosmetics was excellent. Some meta analysis showed that laparoscopic surgery has the advantages of less trauma, reduced post operative pain, faster recovery, improved cosmetics and fewer complications than conventional open surgery with the advantages of ability for exploration of the lateral internal ring. We know that simple puncture and fluid aspiration alone is ineffective in the management of hydrocel. The principle of laparoscopic management of pediatric hydrocele are seen in controversion. While some authors use the same principles as open surgery, closer the PPV of the internal ring and hydrocelectomy or whitestration of the cyst. Other order perform high PPV ligation without hydrocelectomy with good results. In this study, we perform simpact for PPV without hydrocelectomy. We found that lateral PPV or open internal ring was present in own cases. In nearly 30% of our patients, the hydrocene has no obvious connection with the peritoneal cavity. In these cases, we still ligated the PPV and evacuated the fluid in the cyst with a percutaneous needle. No recurrence was recorded. We suggest that's in such cases, there is a still discrete one way passage of the fluid towards the scrotum but not the opposite. The fluid in the primary hydrocel is actually the fluid, not fluid produced by the hydro itself. So, there's no need of hydrocelectomy. You can see in this slide that laparoscopic management of pediatric hydrocel without hydrocelectomy had comparable outcomes in term of recurrence compared to other reports with hydrocelectomy. In conclusions, if lateral PPV was present in own cases with primary hydrocene in our series. Our technique of simpact PPV without hydrocelectomy is feasible, safe, with excellent post operative cosmetics in the management of primary hydrocel in general. Thank you for your attention. Okay. All right. This so welcome uh Dr. Sun, thank you for for joining us. For your paper. Yeah, fantastic paper. Remember, we have three minutes and at the end of the three minutes, we will um hear a sound of a ring. So, let's start talking. All right, perfect. Uh Tony, thoughts. I know I have a ton of comments, but I want to hear yours. We got three minutes. Very interesting and I think people are doing it and it was a very good thing to study. Um the question I have for you is when you don't see a patent processes, I believe you still it. Is that absolutely necessary? Um and I assume then by virtue of that if you just aspirate a hydroseal and it recurs, there's always a patent processes. Is that correct? Dr. Sun, can you hear us? Yeah. Did did you hear uh hear his question? So, uh let me go ahead and address that Tony. I um had the same. So, first of all, I I think and maybe I'm wrong about this Tony. So, since you taught me, if I don't understand it correctly, I blame you. But uh basically, uh I think of hydro seals there's two etiologies. Either it's a opening, so it's fluid going in or in the non communicating hydro seals, there's either a micro hole or somehow it's is it secretory lining and that's where it's coming from. And and my question is if in the latter, this wouldn't work. So, that is why what I do is I laparoscopically bring the sack in, remove part of it and then it um laparoscopically. What's your thought uh Tony or or Dr. Sun on on these non-communicating hydro seals. Dr. Sun? All right. I think Tony Todd, I think you're absolutely right. Most of the neonatal ones though, I believe do have some kind of access. They may seal off with a flutter valve so you can't push the fluid back up. The of course, you do get hydro seals of the cord, which are different and I don't think communicate. And I predict that those ones uh will not necessarily need ation of the processes vaginalis but really decompression of the cord. I'd be good question to see whether those ones actually reoccur. Yeah. Yeah. I agree. Go ahead. if you say if you have recurrence, you may have a chance that that process vaginalis was still open even if it was like a really small. So, if you every time you enter, you close that um opening even if you don't see it clear open. Okay. Okay. And you're uh addressing all those that will recur because you didn't see the opening. Okay. So, your point is it's always an opening. Hydro seal Okay. All right, we got cut off. All right. Okay. Thank you Dr. Sun. Uh hopefully we'll we'll see you again. All right. Take care. Thank you. Well done. Okay.