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Pulmonary resection in the prone position for suppurative lung disease in children
Insights
The prone position is a safe surgical approach for pediatric lung resections in children with severe inflammatory lung disease. This method effectively prevents complications during complex pulmonary surgeries.
Area of Science:
- Pediatric Surgery
- Thoracic Surgery
- Pulmonary Medicine
Background:
- Lung resection in children with suppurative inflammatory disease presents challenges due to small airway diameters.
- Standard bronchial separation methods are often unsuitable for pediatric thoracic surgery.
Purpose of the Study:
- To prospectively evaluate the safety and efficacy of the prone position for thoracotomy in pediatric patients.
- To assess the outcomes of lung resections performed in the prone position for severe inflammatory lung disease.
Main Methods:
- A prospective study involving 17 children undergoing pulmonary resections for severe inflammatory lung disease.
- Surgical procedures were performed with the patient in the prone position.
- Preoperative bronchography was used to assess the extent of lung disease (bronchiectasis, destroyed lung).
Main Results:
- Seventeen children underwent various pulmonary resections (pneumonectomy, lobectomy) in the prone position.
- No instances of endobronchial or intrapleural spillage were observed during surgery.
- One patient required reexploration for bleeding, and one developed fatal postoperative empyema.
- Sixteen children were discharged within 8 days, with favorable follow-up outcomes.
Conclusions:
- The prone position is a viable and safe surgical technique for lung resection in children with severe inflammatory lung disease.
- This positioning minimizes the risk of intraoperative complications related to bronchial spillage.
- Further research may explore optimizing this technique for complex pediatric thoracic procedures.
Abstract:
Lung resection for suppurative inflammatory disease is hazardous in children whose small airway diameter precludes the use of standard methods of bronchial separation. A prospective evaluation of the prone position for thoracotomy in 17 children referred for operation with severe inflammatory disease was done. Bronchography showed whole lung bronchiectasis eight, destroyed lung in three, and lobar bronchiectasis five. Pulmonary resections performed with the child prone included left pneumonectomy (nine), right pneumonectomy (four), lingulectomy with lower lobectomy (two), and other lobectomy (two). No endobronchial or intrapleural spillage occurred. One child required reexploration for bleeding and one child developed a postoperative empyema that ultimately caused death. The remaining 16 children were discharged within 8 days of operation, and follow-up of 1 to 18 months records favorable progress.