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BOB Ped Surg 2023 - Fulvia Del Conte, IPEG - Presentation
With Dr. Fulvia Del Conte
Chapter 1 of 3 · Evidence & Research
Study design
Study Design and Patient Population
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What the experts said
There is still no consensus on treatment for pulmonary sequestration
Three pediatric surgery units and four pediatric cardiological units were involved in 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
Thoracoscopy was performed using three or four ports with the first one placed on the anterior axillary line with an open technique
Percutaneous arterial embolization was attempted by transfemoral approach and the aberrant artery was canulated and closed by vascular plug devices
85 patients were included and divided into two groups: Group 1 thoracoscopy with 51 patients, Group 2 embolization with 34 patients
Prenatal diagnosis was significantly higher in the thoracoscopy group as well as asymptomatic patients
There were no differences in procedure time and intensive care unit stay after procedure between the two groups
Hospitalization was significantly shorter in the thoracoscopy group because 24 patients were treated as day case surgery
Conversion to open was necessary in five thoracoscopy group cases
Three hybrid lesions were found in thoracoscopy group patients
Two thoracoscopy group patients were previously approached by embolization
In the thoracoscopy group, follow up was based on clinical examination and chest X-ray, with only two patients performing MRI or CT scan to check complete evolution of the lesion
At one year follow up, one thoracoscopy group patient required surgical revision after two weeks due to an infected intralobar sequestration
In one embolization group patient it was impossible to complete the procedure and the patient was addressed to the surgeon
All symptomatic patients became asymptomatic at the one year follow up
At long-term follow up, only six embolization group patients performed imaging, and two of them required intervention due to recurrence with only one being symptomatic
Surgery and endovascular embolization are both effective and safe treatment for pulmonary sequestration
Surgical approach allows removal of the lesion avoiding the need to monitor pathological tissue and its complete involution over time
Surgical approach must be the preferential choice, especially in case of intralobar sequestration or doubt of complicated lesion
Embolization must be used in case of significant shunt or heart failure
Long-term follow up supported by imaging is recommended after embolization