Thoracotomies in children

Abstract

Thoracotomies in children have been less extensively studied, as the incidence of diseases necessitating thoracotomies is low in the pediatric age group. This study reviews childhood thoracic diseases, thoracotomy approaches, indications, and complications. Surgical procedures and complications of a total of 196 children below 16 years of age who underwent thoracotomy for various reasons at the Department of Thoracic Surgery, Ataturk Chest Diseases and Chest Surgery Training and Research Hospital, between January 2000 and December 2004, were reviewed in this study. Out of the 196 patients, 77 were female (39%) and 119 (61%) were male. The most commonly encountered indications for surgery were hydatid cyst (35%), bronchiectasis (25%), chronic nonspecific pleuritis (13%), chest wall deformities (10%), and mediastinal cystic formations and masses (10%). The other indications included tuberculosis (3%), aspergilloma (0.5%), fibrohyalinized cyst (0.5%), resection of trachea (0.5%), bronchogenic cyst (0.5%), inflammatory pseudo-tumor (0.5%), sequestration (1%), lipoblastoma (0.5%), and eosinophilic granuloma (1%). Out of the 196 patients, 176 underwent lateral thoracotomy and 20 patients with a chest wall deformity underwent midsternal incision. Complications were seen in 35 patients (18%): atelectasia and secretory retention (54%), wound infection (17%), hemorrhage (3%), chylothorax (3%), intrathoracic space (3%), and postoperative extended air leakage (20%). The mean hospital stay was 15 days and we did not encounter any mortality. The physiology and anatomy of the respiratory system and especially the respiratory control mechanism in pediatric patients vary from those of the adults, resulting in a more morbid course after thoracic surgery in children. Despite severe postoperative pain, posterolateral thoracotomy is the preferred approach in adults because of an advanced intrathoracic exposure and easy manipulation. On the other hand, lower pain threshold and the different types of diseases seen in children make lateral thoracotomy a more appropriate choice for thoracotomy, which, at the same time, spares the serratus anterior muscle decreasing its negative impact on postoperative respiratory function.

Cystic adenomatoid malformation of the lung: A diagnostic dilemma

“…It is necessary to confirm the diagnosis before surgery to plan approach. [6,7] CCAM is the second most common congenital lung lesion in children. It is more common in males and is the result of an embryologic insult before the 50 th day of gestation causing maldevelopment of the terminal bronchiolar structures.…”

Pulmonary sublobar resections in pediatric patients

“…We routinely perform lobectomies and/or sublobar resections using VATS on adults and desire to increase our use of VATS with children. In a study by Fındık et al [14] in which pediatric patients were reviewed for thoracotomies, complications were observed in 35 patients (18%), with atelectasia and secretion retention in 54%, postoperative extended air leakage in 20%, wound infections in 17%, hemorrhage in 3%, chylothoraces in 3%, and intrathoracic space in another 3%. In our study, morbidity was seen in two cases who underwent a costal resection together with a pulmonary sublobar resection due to Ewing's sarcoma, but no mortality occurred.…”

The management of postoperative complications in childhood pulmonary hydatid cysts

“…However, unresolved atelectasis warrants a bronchoscopy. [4] The secretions were cleaned via a rigid bronchoscopy under general anesthesia or by a fiberoptic bronchoscopy (FOB) with local anesthesia for those who could tolerate this procedure. After the bronchoscopy, dramatic expansion in the lung was achieved.…”

“…While some studies have presented the complications, the management of morbidities has been discussed less, yet morbidity in pediatric patients can be diminished with proper early intervention. [4] The aim of this study was to review pediatric patients with pulmonary HD by assessing the clinical features, surgical complications, and management of these complications.…”