Update Course 2023 - Update Course 2022 and Best of the Best Recap

Cecilia is a pediatric surgeon in Argentina, uh, and, uh, in Buenos Aires, and she's been with us for, uh, a year and a little bit more, um, by the way, Cecilia's last day will be in July, so we're gonna be now I just got the approval from my boss we're gonna be opening it up to another fellow starting, uh, next year for taking over Cecilia's position, but Cecilia is gonna run through. The best of the best. So, in last year's update course. So are you going to explain best of the best, or do you want me to explain it? You're gonna, you wanna go, uh, we're starting with update course, but if you want to explain best of the best, two courses we do. The update course is this one is to make sure each year we know what came out over the past year, what's new and important. Best of the best is since we can't attend every conference, we invite the best conferences once a year to submit their top presentations that they felt were the best. And we do a battle of all of these people around the world to say, to give you a quick update of what was the best at each conference, and then we name at the end, who is the best of each conference and who is the best in the world that year in, in pediatric surgery. So, uh, Cecilia, as always, we're going to start off summarizing the main points from last year's update course and best of the best. Thank you. OK, welcome, everybody. Um, we're going to get started. As Todd says, first we are going to cover the topics of the update course from last year. Then we're going to talk about best of the best, and we're going to see today's agenda for those who haven't seen it yet, so. To start last year update course we had uh 1,467 registrants that attended live at that moment and we have 1800 people that watch it immediately after as in currently, as you know, everything is being. Record and so we have the rewinds and every session that it can be available at the app, the stay current app, and also the YouTube channel. So if you ever wanna recap everything from last year, previous years, or this year, you're going to have it there. So for that we got over 8000 people that visit the event page and watch videos. So that's a lot of people. And I'm going to ask you what was your favorite session and to remember everybody we're going to do the recap, so keep this in mind and vote for your favorite session. So the first sessions were about, uh, the review of different literature. We had ABSA PDC committee and we talked about implicit and explicit bias and they show. Us how we have to stand up for people when they're being called or champagne, not leave it for after, not saying like in private places, but to stand up for them because that is the best way to combat the bias that we sometimes get into our in our jobs so that's really important. We also, I'm going to go rapid through this. We also learned about fasting guidelines and how now we are not necessarily need a line for small kids because they can be hydrated by mouth until 2 hours prior to surgery. We also talk about intraoperative radiation safety and this for me was. Life changing because uh they told us they taught us about the collimation and how we can make the things better without needing to just increase the radiation but just to make the. Feel smaller we can get a very better image of that and reduce radiation. And also something really important was that if we are going to shield our patients, that first is not always necessarily. That if we're going to shield them, we have to shield them in the bottom of the table of the OR table because if we do it in the of of the patient, it's not going to be useful for us. So that was really important. Then we talk about the CT for suspected foreign body. In the airway and we realized that for patients that are suspected but have like reactive airway we can do a CT and have like over 94% of sensitivity and specificity so it was really useful for us and also that we mostly the mechanical bowel preparation for example we don't need that to reduce SSI so that was really important and then we have. An old friend of ours that's Jose, he's going to be here with us today, so excited for that we talked about antibiotics for complicated appendicitis and the trial was going on and to see which one was better we talked about the Nest trial for neck and about like drainage or laparotomy that that was a huge discussion as always and he taught us that. If we have a patient with a neck, the drain uh or the laparotomy, the difference is in the neurodevelopmental, uh, progress after that. So laparotomy was a little bit better with that. And so we have him here and hopefully today we have a lot more reviews. Oh, sorry for that. Then we talk about appendicitis. That's a topic that we always need updates and that even though we have it almost every day and we talk about non-perforated appendicitis and how we can discharge them in the same day of the surgery. The perforated appendicitis that we talked about and Doctor Sean Sain Peter told us that the only way they got reduced abscess rates was treating their patients as they are not sick and we learned that so they they went through a 20% abscess rates to a 10% so that's half of it. And also we talk about non-surgical management and if everybody can remember that. It wasn't better than the surgery because it has like a 30% rate um of failure but it's an option that we can have in certain cases and so it was important for that. Then we talk about congenital oesophageal stenosis and we got a presenter from Turkey. It was really interesting because he treats like the CES with dilations and most of them improved and have their. Everything like work up and with no need for resection, so the only thing that it's really important for that is to remember that if we have a cartilage remnant we probably may need a resection, but if we don't dilation might be OK. So then we went for the pediatric gunshot injuries so that's a huge thing here and it's really important and I learned a lot about that. I have to say I'm not from here, from the US, as I told you, and so this was really important for me, the advocacy, the needing for talk to the parents at every meeting, not even after a gunshot injury, but before if they're like how to keep safe the. The guns and how to be safe than in for our children in our houses and to really be aware of that and and be active in that prevention. And of course they also taught us how to deal with gunshot injuries and which ones are um worst and what to consider when we have those after that we have the updates in gastroschisis feeding protocols. And then Meg Lee taught us three things. The first is that after the closure of the gastroschisis, we can feed the patient as soon as possible as long as he's fine. We can have like a feeding protocol is really important to improve patients' outcomes, and I think we've seen that in a lot of places like having protocols improve patients' outcomes and then. It's normal to have emesis, so don't be afraid if you have emesis in a gastroschisis patients because that's going to happen. After that we have this amazing, amazing session that was top disruptive technologies in healthcare that we are going to have a second part today. I'm really excited for that and Roy and M. Taught us everything about what's new out there and innovations for the medical field. I don't know if you remember but they told us what's VR and what's AR and augmented reality and virtual reality and innovations in the medical field, um, and how gamification. It's better for us to teach our students and our future um doctors surgeons, pediatric surgeons and also tell us a little bit about some innovations like the wristbands of the patients so that was really cool and then we have this session that we have uh. Something similar today but it was who to send home from the emergency department and we learned that there were a lot of pathologies that don't need to be in hospital like the spontaneous pneumothorax in an asymptomatic patient or this sorry spontaneous pneumo mediastinum. Also asymptomatic patient, there's no need to get them into the hospital, the quick call you ask for appendicitis, the straddle injuries with no active bleeding and. Like interceptions that resolved with um water enema or pressure it's they're not need to keep them in the hospital and also we had a bonus that wasn't inspected in this session that was about the injuries, low grade injuries that can be also, uh, discharged from the ED department. Last but not least, we have the updates in management of esophageal leaks, and we presented 3 cases, and the most important thing was that most of the leaks can be managed by observation or chestra so we don't need to do anything, just be patient and observe, but sometimes it's hard. Then, uh, if we have an external fistula like in the neck or a persistent leak an endov bag, and they taught us how to do that and you can see all the videos in the stay current app how to do an endo bag is a great option. That's the negative pressure there in the leak inside the esophagus and we also learned that after any leaks of. May they have resolved with an endo bag or if they resolve with uh observation or chest drain having a leak increases the stricter rates so be aware of that and check your patients for that. OK. So now you can vote. I don't know if we have any votes right now for the what was your favorite session from last year, and if we have a winner. Oh, that's a good one. So that's a thing we encounter every day. Hey Myron, can you scroll over, uh, the hover or whoever's hovering over it? So it's really, it's fighting there. Hovering expert. We have a lot of like appendicitis and. All right, let's, we'll keep going because we're gonna run out of time because we start, it's my fault, we started late. It's OK. Now we have the best of the best, as Dot says there are 10 societies from all over the world. There were over 2000 registered 800, um. Attended live and we have 116 different countries and that's a really important thing and I think that's because we have 10 different societies from all over the world so the first one was WOFAs and we have this winner that's trying now son that he's from Vietnam and he taught us about the single incision laparoscopic percutaneous closure of the processes vaginalis. It was really interesting. Then we have the PAPSA that's the uh Pan African Pediatric Surgery Association, and we got something about gastroesophageal reflex and the comparative between Nissen and Hilln procedure for that. Then we have the Iberica winner that was Lorenzo rachel. He is from Brazil, so we are seeing like all the international people, and this is really interesting and he taught us about neonatal short intestine syndrome and how they treated them in different, um, Brussel places and it was really interesting the. We have after. Sorry. I'm not Here, so this is the Us winner. It's Rebecca Figueira. She's working at the Hospital for Sick Children in Canada, and they talk about the fetal vascular development and as you see here I show this because. She was the winner of all. She was the world winner for this, and it's the 2nd year in a row that this, um, lab wins. So they're experimenting a lot of things in CDH and so here it's how the vascular development, uh, increases and how we can target that for our next options as a treatment. So this was really interesting for ABS and IPSA we got uh Steven Scottville that talked about the surveillance and ultrasound for the lymph node dissection and how that can and the sentinel node help us with positive cutaneous melanoma so we just need to have that for the sentinel lymph node. Instead of all the notes, then we have the IPA winner that she's from Italy, Fulvia del Conte, and she had the embolization versus surgical treatment in pulmonary sequestrations and they compare a lot of, uh, hospitals from Europe, especially in Italy, and they have um. They resolved that was better, the surgical treatment, uh, comparing to embolization in that in that paper. Then we have the CPAsur that's a South American, um, Association of Pediatric Surgeries and one from Argentina, one that's Georgina Falciani, and she won the for the comparative effectiveness of telessimulation versus standard simulation so. Due to COVID, we had two different, uh, educations like. Before that was everything in person in the hospital as you know and after that we have to just come up with some innovations that say how are we going to do this and so they turned this into a tele simulation and it was really good to know that both people were trained by telesimulation or standard simulation uh it was the same it didn't change and we have a lot of papers published in that so that was really interesting. Then we have the AAP, the American, um, Society of Pediatrics, and the surgical part. Shelby Ferroa, sorry, won that for racial and ethnic disparities in outcomes. This was really interesting to see how it was different. Then we have the cuffs that want this for, um, it's a new patch for CDH and it's really interesting to see how this works and how this can improve the future of our CDH patients. And again, last but not least, we had Jamie Snack from Pubs, uh, with the chest tube management after a lung resection. So To end this, I'm going to ask you which societies do you want to see next year. Please comment in the chat. Send us DMs on Twitter, Instagram, and vote because we have 4 societies the first year, we have 10 the next year. I'm really excited to see how much can we get next year, so please vote. And this is today's agenda. And I'm going to leave you for the next session. Awesome. Thank you, Cecilia. That was great. Um, OK, so, Thank you. So Mira, thank you. Mira started the applause. All right, um, OK, we're gonna take a quick 2-minute break while we bring up the next session on fertility. Um, I'm actually really excited about this because we have a non-pediatric surgeon also, uh, coming to teach us what we don't know, even though I think we know everything. But, uh, so 2 minutes and then we'll come right back. So, thanks, Cecilia.