Introduction The treatment of extralobar pulmonary sequestration (ELS) remains divergent. This study aims to demonstrate the characters of ELS in children for optimal clinical management in the future. Material and Methods A retrospective analysis was conducted for ELS patients' treatment in our center from January 2013 to April 2020. Results In total, 85 patients were included, containing 70 upper‐diaphragmatic, 7 intra‐diaphragmatic, and 8 infra‐diaphragmatic ELS. Eight patients' pathology results showing inflammation without symptoms preoperation and two patients had chest pain for torsion. All the upper‐diaphragmatic and intra‐diaphragmatic ELS patients accepted thoracoscopic surgery resection. The intraoperative operation time and blood loss volume of intra‐diaphragmatic ELS were significantly more than that of the upper‐diaphragmatic (40.14 ± 9.92  vs. 23.07 ± 6.79 min; 9.29 ± 3.45  vs. 3.18 ± 4.94 ml; all p < .05). No chest tubes were inserted in both subgroups. No complications were found in the postoperative follow‐up of operative ELS patients at least 3 months. A total of eight infra‐diaphragmatic ELS patients except for one (7/8) had conservative therapy and follow‐up by the outpatient clinic or phone call eventually. There were no symptoms occurring and no size increasing of observation infra‐diaphragmatic ELS. Conclusions The ELS has the potential risk of infection and torsion in this study. Thoracoscopic surgery might be optimal management of upper‐diaphragmatic ELS for its minimal invasion and low perioperative risks, which could be developed into a day operation with safe and quick recovery. The intra‐diaphragmatic and infra‐diaphragmatic ELS need a larger sample size and multiple center data to get a better management approach.

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BackgroundWhether to operate on asymptomatic patients with congenital lung malformations (CLMs) remains controversial. Our study intended to find out the proportion of hidden infection in CLMs and its effect on surgery, to provide help for the management of asymptomatic CLMs patients.MethodsA retrospective review of the medical records of patients with asymptomatic CLMs from January 2011 to December 2020 was performed in our center. Selected asymptomatic patients were divided into a non-hidden infection group (NHI) and a hidden infection group (HI).ResultsA total of 581 asymptomatic CLMs patients were included in this study. Thirty-two percent of asymptomatic CLMs patients had hidden infection in the lesion. Among various CLMs diseases, intralobular pulmonary sequestration had the highest percentage of hidden infection (48.8%). With age, the proportion of HI gradually increased. Patients in the HI and NHI groups were 223 and 121. The incidence of pleural adhesion and focal abscess in the HI group were 14.9 and 7.4%. Statistical significances were shown between the two groups in intraoperative blood loss (p = 0.002), operation time (p = 0.045), chest tube drainage time (p &lt; 0.001), postoperative hospital stay (p &lt; 0.001), and air leak (p = 0.012).ConclusionThe proportion of HI detected by postoperative pathological results was high and they could increase the difficulty and risk of surgery. Therefore, early surgery may be a more appropriate choice for the management of asymptomatic CLMs patients.

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