BOB in Ped Surg 2023 - IPEG Winner - Fulvia Del Conte, MD

And we are back. All right, hope everyone enjoyed their little five-minute break. That's I think that's the first in 15 years we've ever been ahead of schedule. Uh, all right, so we're going to get going here. Um and I just want to take a 10-second break to thank Cecilia for uh and Isla, who you guys don't see because she's behind the scenes. This is uh a ton of work that they all did. Thank you to Ellen, Brittany, Cecilia, and Isla. But uh great job. All right, let's keep going here. We're going to move on to the next society, which is IPEG. Um and uh so we have three presentations from the IPEG meeting. Uh, first is Wendy Joe Steff, who's a pediatric surgeon at uh Nationwide Children's Hospital and she is going to be talking about a paper uh bringing utilization of enhanced recovery after surgery, ERAS, uh protocols for pediatric metabolic and bariatric surgery. So ERAS for bariatric surgery. Uh, their hospital established an ERAS protocol for patients undergoing a robotic sleeve gastrectomy in 2018. And the aim of this study was to compare length of stay and opioid use before and after their protocol was implemented. So that's the first paper. The second paper was Dr. Fulvia Delconte from Federico University Hospital in Naples with the work embolization versus surgical treatment in pulmonary sequestration. Preliminary results of a retrospective multicenter study. As the title says, this is a multicenter retrospective study done from January 2010 to December 2020 that aimed to evaluate and compare the results of embolization and surgical treatment of pulmonary sequestration. And last but not least, Dr. Dr. Max Marc, who is the chief of surgery at the Pedro Elizalde Children's Hospital and associate in Gahan Children Hospital and his paper was challenging cases of esophagi early in the learning curve. How important specific training, how important is specific training? Uh and this study aim to show clinical and technical performance of a pediatric surgeon mainly trained through simulation in two challenging cases of esophageal and the minimally invasive simulation program used to train the surgeon. So those are the three papers. We're going to uh play a video and go to the polls. What resources do you use in your hospital to best manage your patients? Where do you or your colleagues go to find your hospital protocols? Where do you go to learn more about the disease you're treating? How do you find the most recent publications, technique videos, lectures? There are so many places to go to find information. Well stay current spaces now allows hospitals to have a private space where they can keep all of their key hospital protocols, as well as their favorite other content such as videos, articles, websites, and lectures, all in one place in the palm of your hand. This can be shared across your entire department, and now hospitals with spaces can share and view other hospital spaces. Let us know if your hospital or department would be interested in learning more about a space. All right, and we are back and we have a winner, uh, pretty dominant winner. So, uh, let's see, it's Dr. Fulvia Delconte, uh, who's uh presented the paper on embolization versus surgical treatment in pulmonary sequestration. So let's roll that video and we'll bring uh Dr. Delconte in from uh into the meeting. Dear colleagues, embolization versus surgical treatment in pulmonary sequestration. results of a retrospective multicenter study. The aim of our study was to evaluate and compare the results of embolization and surgical treatments of pulmonary sequestration in pediatric patients. There is in on treatment. Three pediatric surgery units and four pediatric cardiological units were involved into the study. Patients younger than three years old who received embolization or surgical treatment for pulmonation between January 2010 and December 2020 were included. Data regarding preoperative vocal, demographics, intra and post operative detail and follow up were collected. All the procedure were performed under general anesthesia. was performed using three or fourkers with the first one placed on the anterior axillary line with an open technique. Perusaterial embolization was attended by transal approach in all cases, and was performed to identify the aberrant artery which was cannulated and closed byzer vascular plug devices. 85 patients were included and divided into groups. Group one, with 51 patients, group two, with 34 patients. No difference were found in sex distributions and and extrabar distribution. Preratal diagnosis was significantly higher in G1 as well as symptomatic patients. There were no differences in procedure time and intensive care unit stay after procedure. hospitalization was significantly shorter in G1 because 24 patients were treated as day case surgery. Conversion to open was necessary in five G1 cases. Three hybrid lesion were founded in G1 patients. Two G1 patients were previously approached by embolization. In G1 follow up was based on clinical examination and chest. Only G2 patients perform MRI or CT scan to check the complete evolution of the lesion. At one year follow up, one G1 patients required surgical revision after two weeks due to an infected infrabarstration. In one G2 patients, it was impossible to complete the procedure and the patients was addressed to the surgeons. All symptomatic patients become asymptomatic at the one year follow up, but at the long term follow up, only six patients perform imaging. Two of them require a intervention due to. Only one of them was symptomatic. In conclusion, we can affirm that surgery and endovascular embolization are both effective and safe treatment for pulmonary sequestration. The main difference is that surgical approach allows to remove the lesion avoiding the need to monitor pathological tissue and its complete evolution over time. Surgical approach, in our opinion, must be the preferential choice, especially in case of infrabartion or doubt of complicated lesion. Embolization must be used in case of severet or heart failure, and this case we recommend a long-term follow up supported by imaging. Thank you for your attention. Thank you for the paper. Uh, so, uh, see we have Dr. Delconte, thank you for joining us. Um, I I uh, I love that paper. I actually really liked your conclusion because it was a very measured uh response there. Um, I I just have a question. Sorry, I'm talking too much. Hello, can you hear us now? I think there's a delay. Um, so, um Yes. Yes now, yes. Yeah, there's a bit of a delay, probably 10 second delay. So, um, so Yes. One question you have is when we look at ovarian uh torsion. We used to remove them uh because we thought it was all dead because it looked dead. But then we find that actually although it looks dead, we know that over time there's viability to the ovary. Is the same thing true here that you do the imaging and it looks like you've ablated the sequestration, but in fact if there's any um malignant uh risk in the future, that may not have really been destroyed. So, uh it's I I guess along your recommendations you'd have to keep following it. So I'm not sure if it's much of an advantage. I'm curious of your thoughts about the accuracy of assessment of viability after embolization. Yeah. So um in our study only six patients um perform of the embolization group perform the MRI at the long follow up and within them two presented occurrence. So we think it's very important to perform it in all patients to really check the complete evolution and to check that not can can become again. Um in all the study that was not performed. So that's the big difference. And um that's the big difference also with the surgery because with surgery we we don't need it. So um the follow up it's it's quite important in patients who performed the embolization and um it's invasive. So also if the intervention is less invasive that our surgical intervention um the follow up it's heavy also for the parents because they still remain with the um with the doubt that the lesion was it's not complete um disappear. Uh I I guess one of the, I don't know Tony if you have a comment or question or we can go to the audience. Ellen, were you about to read some audience questions? Yeah, um I was just about to ring the bell too. It's about time but just um one quick question I guess from a couple people are asking about kind of this risk of malignancy in the um in the uh lesions and you know, if you just embolize then do you need to biopsy or you know, what's the um thoughts there? And also it's in regarding that is the need for follow-up, this is Miguel was asking for life. Is it a lifelong need for follow-up. Tony, we'll get to your question after that. All right, can you hear us? I don't know I think there's a delay. Sorry. Yes. Can you repeat the question? Um let let's do this. Tony, why don't you uh go ahead and ask your question? So, I don't know the latest statistics, but I know that strations have a very, very low malignancy rate. So my question for you, if you're going to have to follow these kids up for a long time, why would you just do nothing rather than ize, especially if there's no vascular uh issues related to the flow into the stration. I for one prefer to remove them because of the perhaps minute risk of malignant transformation. Yeah, at the conclusion we concluded it that um we suggest that surgery it's better for that problem. You have to follow the patients in all cases because also if is the a small, small rate of malignancy, you have in all cases to follow it. And uh embolization can not um um the problem, resolve the problem. So uh you have to reserve it only in case who um you can perform surgery. Perfect timing. Um all right, so uh interesting I'm learning here from Paul Oty and and I was always under the impression. I know that we've debated this so many times that strations are a minuscule chance of malignancy, but I always thought they had a chance of malignancy and and I think we're hearing from Paul that that it's close to zero, which which I did not know it was close to zero. I thought that there was malignant potential of stration. Um but uh great discussion, great conversation. I just learned a lot. So uh thank you and we're going to uh move on to the next uh the next section. Thank you.