Abstract
The 59th British Association of Paediatric Surgeons International Congress was held in Aberdeen in July 2010. This report highlights the wide range of topics covered by describing in some detail a number of papers presented.
After two consecutive congresses abroad, the 59th Annual Congress was held in Aberdeen (UK) and was extremely busy since, for the first time, there were numerous extra sessions. The day before the conference, there was a full day of simulation scenarios for trainees, as well as four separate afternoon sessions for consultants, which included the History Club, the Research Club, and joint and separate sessions by the British Association of Paediatric Urologists and British Association of Paediatric Endoscopic Surgeons. Throughout the congress, five ‘Meet the Expert’ sessions were held covering urology, laparoscopic surgery, oncology, short-bowel syndrome and a thoracic session on the Nuss repair. In this article, I will highlight some specific topics covered.
The congress started with an interesting paper that led to much debate regarding a topic that frequently affects pediatric surgeons; that is, how many cases of a specific operation should be performed by one surgeon to state they are adequately trained and competent? Maruthachalam (The Royal Victoria Hospital, Newcastle upon Tyne, UK) and Jaffray (University of Newcastle, Newcastle, UK) presented their results of restorative proctocolectomies in children in a single institute. It is accepted this is not a common procedure in childhood, and the authors presented the various conditions in which they had performed it. Not only did this include ulcerative colitis and familial adenomatous polyposis, which are the main indications to most surgeons, but also Hirschsprung‘s disease and constipation. The results obtained were good but, as reported in other series, there were frequent complications. One part of the debate was whether this is the operation of choice, especially for conditions such as Hirschsprung‘s disease, where a child can develop a postoperative enterocolitis, which some people believe is very similar to that of pouchitis seen in ulcerative colitis patients, for which other established procedures are available. The second point of discussion was whether all surgeons, or even units, should be performing this procedure, as a previous audit suggested there was an average of 0.9 cases per year being performed by pediatric surgeons. I think all would agree this number of cases is not acceptable, but does not take into account the number of surgeons who will treat these cases with either a pediatric surgical or adult colleague to gain the experience required.
Remaining on the same topic of who should operate for certain cases, the experience of the treatment of biliary atresia in children was a topic of much debate in pediatric surgery, as this procedure is now only performed in three UK institutions (Kings College [London, UK], Birmingham Children’s Hospital [Birmingham, UK] and Leeds) with an improvement in outcomes. A paper presented by Ong et al. (Kings College Hospital, London, UK), showed that public awareness of the condition is very important (as well as general practitioner and health visitor awareness). Since September 2007, a ‘Yellow Alert’ campaign was initiated to try and make people aware of the condition and the importance of the early referral of jaundiced babies. What has been proven is that, in biliary atresia, early referral and earlier surgery gives the baby the best chance of being able to clear their jaundice without the need for liver transplantation. The paper presented revealed that, since the Yellow Alert campaign went live, the median age of referral has fallen from 55 to 48 days, but it remains to be seen whether this had led to a fall in children requiring liver transplantation for biliary atresia.
One of the joys of pediatric surgery is the fact that we are always challenging ‘usual’ practice and looking forward at new techniques, and examples of these points are shown in the next two papers described. Tiboni et al. (Birmingham Children’s Hospital), in their presentation, challenged the idea that a child with gastroesophageal reflux, who has failed medical treatment, and is also found to have a malrotation on a barium study, should undergo both a fundoplication (for the reflux) and a Ladd‘s procedure (for the malrotation). The authors wondered whether a Ladd‘s procedure alone would alleviate the symptoms. They retrospectively reviewed 20 cases in which only a Ladd‘s procedure was performed, and found that, in 90%, the symptoms either resolved or improved significantly, and that none of the 20 returned to surgery for an antireflux procedure. Again an interesting debate was held, with one attendee questioning whether the patients they operated on actually had reflux or were partially obstructed by their malrotation, and a second questioner wondered about the delay in timing of the surgery once malrotation had been diagnosed, since, in theory, the patient had a life-threatening congenital abnormality.
A paper presented by Numanoglu and Millar (Red Cross War Memorial Children's Hospital and University of Cape Town, Cape Town, South Africa) looked at a topic that all pediatric surgeons find difficult; that is, when to operate on a neonate with necrotizing enterocolitis. The authors looked at the use of photodynamic diagnosis with fluorescein laparoscopy as an addition to pure laparoscopy in determining whether a formal laparotomy is required. The authors found fluorescein helped identify gangrenous bowel in three patients where laparoscopy alone suggested but did not confirm necrotic bowel. This paper was well received, and is definitely an advancement in the treatment of these very sick neonates. Professor Pierro from Great Ormond Street, London, UK, suggested laparoscopy (and, thus, fluorescein laparocopy) may be very advantageous at viewing the bowel of a baby following cardiac surgery when they present with suspected necrotizing enterocolitis.
Another area of discussion was in children with a short gut who may be considered for a bowel-lengthening procedure. First, a paper presented by Sadiq et al. (Birmingham‘s Children Hospital) suggests that if there are signs of liver compromise at the time of the bowel lengthening (e.g., portal hypertension or falling platelet count), then there may be an increased risk of bleeding and mortality if the procedure proceeds, rather than a primary bowel and liver transplant. Second, a paper presented by Oliveira et al. (Sick Children’s group, Toronto, Canada) looked at the outcome of children 5 years or more after their serial transverse enteroplasty procedure. A third of patients progressed to liver failure and were either transplanted or died but, of the two-thirds that survived without progressive liver disease, nearly all are off parental nutrition, and have not required any further bowel-lengthening surgery.
The British Association of Paediatric Surgeons is an international organization and, therefore, has a strong International Affairs Committee. One poster was that of a circumcision practice in one Nigerian community, presented by Abdur-Rahman et al. (University of Ilorin Teaching Hospital, Ilorin, Nigeria). The results were both dramatic and horrifying. In total, 65.6% of mothers and 46.7% of female daughters had been circumcised. This poster was debated widely, and a joint letter from the British Association of Paediatric Surgeons and International Affairs Committee has been sent to the WHO imploring them to revisit the review of this practice.
On the final afternoon, we introduced a new session on patient safety. In this session, talks were held on the impact of safety failures in clinical care, the legal consequences of noncompliance with the WHO safety checklist, examples of surgical complications seen, and a new checklist for handovers. The debate was very lively, with many attendees stating that this session should be given a higher priority in future meetings.
Over 350 delegates attended the conference and, thus, this conference was one of the liveliest I have attended. The evening entertainment was lively, and the feedback was excellent – helped, no doubt, by the fact that the Aberdeen weather was glorious and the Scottish hospitality was second to none. Next year‘s conference is in Belfast (UK), and we hope that the success of this year‘s congress proves ongoing.
Financial & competing interests disclosure
The author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.
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