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Thoracoscopic treatment of mediastinal cysts in children
J L Michel1, Y Revillon, P Montupet
1Department of Pediatric Surgery, Necker-Enfants Malades Hospital, Paris, France.
Insights
Thoracoscopic surgery is a feasible treatment for pediatric mediastinal cysts, achieving an 86% success rate. However, complex cysts with lung involvement may require open surgery.
Area of Science:
- Pediatric Surgery
- Thoracic Surgery
- Medical Technology
Background:
- Thoracoscopic surgery has advanced pediatric surgical options.
- Mediastinal cysts in children present unique diagnostic and management challenges.
Purpose of the Study:
- To evaluate the efficacy and safety of thoracoscopic surgery for treating mediastinal cysts in pediatric patients.
- To report the authors' experience with thoracoscopic cyst resection between 1992 and 1997.
Main Methods:
- Retrospective analysis of 22 children (1 month to 9 years) undergoing mediastinal cyst resection.
- Diagnosis confirmed via antenatal ultrasound, chest x-ray for symptoms, or tuberculin testing.
- Thoracoscopy was the primary surgical approach in 21 cases.
Main Results:
- Successful thoracoscopic treatment in 18 of 21 cases (86%).
- Common diagnoses included bronchogenic cysts (71%) and pleuropericardial cysts (14%).
- Two postoperative complications: esophageal wound and recurrent pneumothorax; median hospital stay was 3 days.
Conclusions:
- Thoracoscopic resection of pediatric mediastinal cysts is generally feasible and effective.
- Contraindications include compressive cysts with significant lung distension or mediastinal shift.
- Complex or subcarinal cysts may necessitate a conversion to open thoracotomy due to dissection difficulties.
Background/Purpose:
The development of thoracoscopic surgery has made many procedures possible, including the treatment of mediastinal cysts in children. The authors report their experience with this procedure between 1992 and 1997.
Methods:
Surgery was performed on 22 children aged from 1 month to 9 years (median, 27 months), weighing 5 to 49 kg (median, 12.5 kg). Diagnosis was made by antenatal ultrasound scan in six cases (27%), with a chest x-ray performed for respiratory symptoms in 14 cases, and with a chest x-ray performed for positive tuberculin intradermoreaction in two cases. Decision to resect the cyst was determined by thoracoscopy in 21 of the 22 cases, and by open surgery in one case only (subcarinal compressive cyst with left lung distension and a mediastinal shift).
Results:
Eighteen of the 21 (86%) cases were treated successfully by thoracoscopy. In three cases of bronchogenic cysts, we performed an associated thoracotomy because the dissection was too difficult and dangerous. In three cases, a small part of a common wall between the cyst and the bronchus was not removed. The pathological diagnosis was bronchogenic cysts in 15 cases (71%), pleuropericardiat cysts in three cases (14%), esophageal duplication in two cases (10%), and cystic hygroma in one case (5%). Two postoperative complications were observed: one esophageal wound and a case of recurrent pneumothorax after chest tube removal. Patients were discharged after 2 to 11 days (median, 3 days). Follow-up was uneventful.
Conclusions:
Treatment of mediastinal cyst by thoracoscopy is feasible in most cases. Compressive cysts with lung distension and mediastinal shift remain a contraindication. If the cysts have a common wall with the bronchus or esophagus, or if they are subcarinal, the dissection may be difficult and dangerous, and thoracotomy may be preferable.