BOB Ped Surg 2023 - Fulvia Del Conte, IPEG - Presentation

Dear colleagues, embolization versus surgical treatment in pulmonary sequestration. Results 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 still no consensus 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 pulmonary sequestration between January 2010 and December 2020 were included. Data regarding preoperative vocal, demographics, intra and postoperative detail and follow up were collected. All the procedure were performed under general anesthesia. Tracoscopy was performed using three or fourers with the first one placed on the anterior axillary line with an open technique. Percutaneous arterial embolization was attempted by transfemoral approach in cases and angiography was performed to identify the aberrant artery which was canulated and closed by vascular plug devices. 85 patients were included and divided into groups. Group one, tocopy with 51 patients, group two, embolization with 34 patients. No difference were founded in sex distribution and infralobar sequestration distribution. prenatal diagnosis was significantly higher in G1 as well as asymptomatic 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. G1 patients were previously approached by embolization. In G1, follow up was based on clinical examination and chest X-ray. Only the two patients perform MRI or CT scan to check the complete evolution of the lesion. At one year follow up, 1 G1 patients require surgical revision after two weeks due to an infected intralobar sequestration. In 1 G2 patients it was impossible to complete the procedure. And the patients was addressed to the surgeon. All symptomatic patients become asymptomatic at the one year follow up. But at the long-term follow up, only six G2 patients perform imaging. Two of them require intervention due to recurrence. 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 involution over time. Surgical approach in our opinion must be the preferential choice, especially in case of intralobar sequestration or doubt of complicated lesion. Embolization must be used in case of fever shunt or heart failure. And this case we recommend a long-term follow up supported by imaging. Thank you for your attention.