Five surgical experts from Cincinnati Children’s served as leading presenters in September at an international congress on pediatric surgery held in Tuzla, Bosnia and Herzegovina.

More than 160 pediatric surgeons from 34 nations gathered for the annual scientific session hosted by the World Federation of Associations of Pediatric Surgeons (WOFAPS).

“We chose Bosnia, specifically Tuzla, for this congress for a couple of reasons. It is centrally located in the Balkans, so surgeons based in eastern and central Europe would have access. Many surgeons in Hungary, Romania, Bulgaria and other nations in this region do not have the opportunity to come to large conferences in Western Europe or the U.S.,” says Richard Azizkhan, MD, surgeon-in-chief at Cincinnati Children’s and president of WOFAPS.

Azizkhan added that the conference was an opportunity to showcase our long-standing relationship with the University Clinical Center in Tuzla, extending back 15 years, since the civil war in the Balkans.

“The transformation in the health care system in Tuzla has been staggering,” he says. “This institution and this city are shining examples of how institutions can partner and do something extraordinary.”

In addition to his leadership role at the conference, Azizkhan presented a lecture on the need for improved surgical safety.

“The World Health Organization documented a few years ago that more than 1 million deaths per year occur related to surgical errors, most of which were completely preventable,” Azizkhan says. “At Cincinnati Children’s we have been very much engaged in reducing our error rates. We have reduced the risks of wrong-side surgery, wrong-patient surgery, foreign objects left in patients, and so on.  But after a serious event last year, we realized there were other issues at play in terms of causing errors that we had not addressed. I felt this was important to share on an international basis because many physicians, surgeons and institutions are not yet practicing at the level of standards that we have embraced.”

In other presentations:

Daniel von Allmen, MD, director, Division of General and Thoracic Surgery, discussed the latest approaches to treating pediatric neuroblastomas and teratomas;

Lesley Breech, MD, director, Division of Pediatric and Adolescent Gynecology, discussed the value of a team approach to managing disorders of sexual development (DSD).

Marc Levitt, MD, director, Colorectal Center at Cincinnati Children’s, led workshops on complex anorectal malformations and Hirschsprung's disease.

Rebeccah Brown, MD, associate director, Trauma Services, presented data on the importance and impact of pediatric trauma centers. 

The conference in Tuzla offered a chance for surgeons to discuss cases that may be handled quite differently in various cultures, Breech says.

When children are born with complex gender issues, it takes a team approach to address the medical, psychological and social-cultural complications, Breech says.  Few centers offer the comprehensive approach available through Cincinnati Children’s.

“We’ve had surgical expertise for some time in urology and gynecology, plus hormonal expertise from endocrinology,” Breech says. “Now we are organized more formally. Our genetics team is closely involved in the diagnosis. We also offer psychologists so families can be supported from the first day. And we work with an ethics team to address the complex decision-making that families face.”

Levitt, who has worked with a hospital in Ghana for the past three years to train African surgeons to perform advanced colorectal procedures, said the September conference and the 15-year effort to improve medical care in Tuzla reflects an important aspect of Cincinnati Children’s mission to improve outcomes for all children.

Azizkhan’s work with the medical center in Tuzla began in 1996, while he was surgeon-in-chief at Children’s Hospital of Buffalo in New York. He continued the relationship after moving to Cincinnati Children’s in 1998, visiting the country dozens of times and performing hundreds of operations there.  Over the years, more than 200 medical professionals from Bosnia and Croatia have received training in the U.S. as part of the ongoing partnership. Cincinnati Children’s and UCC Tuzla signed a third 5-year cooperative agreement in May 2010.

“Very few centers have been involved for so long in one place,” Levitt says. “It’s fairly easy to visit somewhere for a week, help 20 or so patients, and then leave. But that approach leaves behind no real support or infrastructure. When you look at the number of trainees who have been helped by the effort in Tuzla, and you translate that to the number of patients that they will go on to help, it really has a multiplier effect.”