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.