Thoracic surgery in children

Kanngiesser, Peter; Liewald, F.; Halter, G; Sunder‐Plassmann, L.

doi:10.1016/j.ejcts.2005.03.010

Cited by 8 publications

(10 citation statements)

References 14 publications

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“…Although the most common indication for childhood thoracotomies was oncologic diseases in a study performed in Germany [14], infection was the most common indication among our cases, with 71% of patients being operated for hydatid cyst, bronchiectasis, chronic nonspecific pleuritis, or tuberculosis (Figs. 1, 2a, b, 3a, b).…”

Section: Discussionmentioning

confidence: 93%

Thoracotomies in children

et al. 2008

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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.

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Section: Discussionmentioning

confidence: 93%

Thoracotomies in children

et al. 2008

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“…The Qualsyst tool 3 was used to assess the quality of each selected study for meta‐analysis. This tool incorporates ten questions (scored from 0 to 2).…”

Section: Methodsmentioning

confidence: 99%

“…These include procedures like mediastinoscopy, video‐assisted thoracoscopic surgery, thoracotomy, or image‐guided percutaneous biopsy 2 . However, these modalities have inherent risks and potential for severe complications due to the invasive nature of the procedure 3 …”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of EBUS‐TBNA and EUS‐B‐FNA in children: A systematic review and meta‐analysis

Madan

Iyer

Madan

et al. 2020

Pediatric Pulmonology

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Background Endobronchial ultrasound‐guided transbronchial needle aspiration (EBUS‐TBNA) and transesophageal bronchoscopic ultrasound‐guided fine‐needle aspiration (EUS‐B‐FNA) are established modalities for evaluation of mediastinal/hilar lymphadenopathy in adults. Limited literature is available on the utility of these modalities in the pediatric population. Herein, we perform a systematic review and meta‐analysis on the yield and safety of EBUS‐TBNA and EUS‐B‐FNA in children. Methods We performed a systematic search of the PubMed and EMBASE databases to extract the studies reporting the utilization of EBUS‐TBNA/EUS‐B‐FNA in children (<18 years of age). The pooled diagnostic yield and sampling adequacy (proportions with 95% confidence intervals [CIs]) were calculated using meta‐analysis of proportions using the random effects model. Details of any procedure‐related complications were noted. Results The search yielded 12 relevant studies (5 case series and 7 case reports on EBUS‐TBNA/EUS‐B‐FNA, 173 patients). Data from five case series (164 patients) were summarized for the calculation of the sampling adequacy and diagnostic yield. Safety outcomes were extracted from all publications. The pooled sampling adequacy and combined diagnostic yield of EBUS TBNA/EUS‐B‐FNA were 98% (95% CI, 92%–100%) and 61% (95% CI, 43%–77%), respectively. A procedure‐related major complication was reported in one patient (1/173, a major complication rate of 0.6%), and minor complications occurred in six patients (6/173, a minor complication rate of 3.5%). Conclusions EBUS‐TBNA and EUS‐B‐FNA are safe modalities for evaluation of mediastinal lymphadenopathy in the pediatric population. EBUS‐TBNA/EUS‐B‐FNA may be considered as the first‐line diagnostic modalities for this indication, as they have a good diagnostic yield and can avoid the need for invasive diagnostic procedures.

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“…3,4 Children rarely undergo lung resection. [5][6][7][8] The respiratory structures of children and adults differ in size, position, and function. 9 The thoracic cage is highly compliant because the surrounding muscles remain immature and provide weak respiratory structural support.…”

Section: Introductionmentioning

confidence: 99%

Early Respiratory Therapy Reduces Postoperative Atelectasis in Children Undergoing Lung Resection

2013

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BACKGROUND: Early physiotherapy reduces pulmonary complications after lung resection in adult patients. However, the effectiveness and the techniques used in postoperative physiotherapy in children undergoing lung resection have not been well described. Therefore, the standardization of a physiotherapeutic attendance after lung resection in children is necessary. METHODS: This was a retrospective and prospective, interventional, descriptive, and quantitative study. We evaluated 123 pediatric subjects undergoing lung resection. Fifty-two children were prospectively submitted to a standardized physiotherapy protocol that included a mask with a positive expiratory pressure of 10 cm H 2 O, expiratory rib cage compression, coughing, lifting the upper limbs, and ambulation, starting within the first 4 hours after surgery and continuing 3 times each day. A historical control group of 71 subjects received physiotherapeutic techniques without specific standardization and with variability in the start date and number of days attended. We recorded the presence of postoperative complications, prolonged air leak, postoperative bronchoscopy, the time of chest tube removal, and hospital stay following surgery. RESULTS: The group that received a standardized protocol of physiotherapy had fewer instances of atelectasis than the control group (15.4% vs 7.6%, P ‫؍‬ .01). Subjects in the control group were more likely than those in the intervention group to require fiberoptic bronchoscopy for bronchial toilet (n ‫؍‬ 14 [19.7%] vs n ‫؍‬ 5 [9.6%], P < .001). There was no difference in the time of drainage or hospital stay between the groups. CONCLUSIONS: Implementation of a standardized physiotherapeutic protocol after lung resection in children decreases atelectasis but does not reduce the time of chest tube removal or the duration of hospital stay.

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Thoracic surgery in children

Cited by 8 publications

References 14 publications

Thoracotomies in children

Thoracotomies in children

Efficacy and safety of EBUS‐TBNA and EUS‐B‐FNA in children: A systematic review and meta‐analysis

Early Respiratory Therapy Reduces Postoperative Atelectasis in Children Undergoing Lung Resection

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