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Pulmonary resection in infants for congenital pulmonary malformation
1Department of Surgery, Faculty of Medicine, Kuwait University, Safat, Kuwait. Adel@hsc.kuniv.edu.kw
Insights
Pulmonary resection is a safe and effective treatment for congenital lung malformations in infants. Emergency lobectomy can be safely performed for severe respiratory distress, with good long-term outcomes.
Area of Science:
- Pediatric Surgery
- Thoracic Surgery
- Congenital Lung Diseases
Background:
- Congenital lung malformations are a significant cause of respiratory morbidity in infants.
- Pulmonary resection is a primary treatment modality for these conditions.
Purpose of the Study:
- To evaluate the indications, timing, and outcomes of pulmonary resection in infants.
- To assess the safety and efficacy of emergency pulmonary resections.
Main Methods:
- Retrospective cohort study of 47 infants undergoing pulmonary resection between 1993 and 2000.
- Analysis of patient demographics, diagnoses, surgical procedures, and postoperative outcomes.
Main Results:
- Common diagnoses included congenital lobar emphysema and congenital cystic adenomatoid malformation.
- Respiratory distress was the primary indication for surgery (68%).
- Lobectomy was the most common procedure (89%), with a low mortality rate (2.1%) and manageable complications (9%).
Conclusions:
- Pulmonary resection is a well-indicated procedure for most congenital lung malformations in infants.
- Emergency lobectomy is a safe option for infants experiencing severe respiratory distress.
Study Objectives:
To review our experience with indications, timing, and results of pulmonary resection in infants.
Design:
Retrospective cohort study.
Setting:
Thoracic Surgery Department, Chest Diseases Hospital, Kuwait.
Patients And Intervention:
Forty-seven infants with congenital lung diseases were treated with pulmonary resection from January 1993 to December 2000.
Results:
The mean age at the time of diagnosis was 90 days (range, 7 days to 11 months). Thirty-four patients were male (72%). Congenital lobar emphysema, congenital cystic adenomatoid malformation, pulmonary sequestration, and atelectasis were seen in 26, 10, 6, and 5 patients, respectively. The indications for surgery were respiratory distress in 32 patients (68%), respiratory tract infections in 12 patients (26%), and the presence of asymptomatic chest radiographic findings in 3 patients (6%). A lobectomy was performed in 42 patients (89%), bilobectomy in 2 patients (4%), left pneumonectomy in 1 patient (2%), and excision of a mass in 2 patients with extralobar sequestration (4%). An emergency lobectomy was performed in seven patients (15%). Only one postoperative death occurred following a left pneumonectomy for extensive congenital adenomatoid malformation due to pulmonary hypertension. Four patients (9%) had postoperative complications: atelectasis (n = 2), prolonged air leak (n = 1), and pneumothorax (n = 1). Mean follow-up was 4 years (range, 1 to 5 years) for all patients. None of the patients had any physical limitations.
Conclusion:
Pulmonary resection is indicated for the majority of patients with congenital lung malformations. In case of severe respiratory distress, an emergency lobectomy can be performed safely.