ABSTRACT
Objective: To assess outcome of lobectomy in congenital lobar emphysema in pediatrics group of patients
Methods: This retrospective study was conducted in Department of Thoracic Surgery Nishtar Hospital Multan and Services Hospital Lahore from October 2003 to December 2015.All the patients of pediatric group who underwent lobectomy for congenital lobar emphysema were included in study. Demographic data, operative findings outcome of the procedure in terms of post operative complications and 30 days morbidity and mortality were recorded .All the patients presented with respiratory distress. Standard lobectomy was performed and bronchial stump was buttressed with surrounding lymph nodes, pericardial or pleural flap
Results: Of these 41 study cases, 30 [73.2%] were boys while 11 [26.8%] were girls and male to female ratio was 2.72: 1. Mean age of our study cases was 3.32 +/- 1.59 months [with age range; 15 days to 7 months]. Mean age of the boys was noted to be 3.38 +/- 1.52 months while that of girls was 3.18 +/- 1.84 months [p = 0.405]. Of these 41 study cases, left upper lobectomy was performed in 27 [65.9%] patients, right middle lobectomy in 11 [26.8%] patients, left lower lobectomy in 2 [4.9 %] patients and right upper lobectomy in 1 [2.4%] patients. Out of 41 patients 8 [19.5%] were preoperatively on ventilator. Out of 8 ventilated patients one had left sided chest intubation which was malpositioned and was in the lung parenchyma. Morbidity was superficial wound infection in 2 [4.9%] patients and post lobectomy empyema in 2 [4.9%] patients who required prolonged tube thoracostomy, antibiotics and chest physiotherapy. Mortality was recorded in 1 [2.4%] patient who was preoperatively on ventilator and had misplaced chest tube. That patient died on the 3rd post-operative day due to respiratory failure secondary tolung parenchymal injury
Conclusion: Our study results support surgical management of congenital lobar emphysema as Lobectomy was found to be safe, reliable and effective in these children presenting with respiratory distress due to lobar emphysema. There were no significant morbidities in these patients and clinical outcomes were satisfactory and surgical management is reported to be treatment of choice in pediatric patients with CLE
ABSTRACT
To evaluate the anatomic location of cysts, operative characteristics of intrathoracic extrapulmonary hydatid cyst and to determine the outcome of aggressive surgical interventions.Case series. Thoracic Surgery Unit Lady Reading Hospital Peshawar from 1[st] July 2008 to 30[th] June 2011. All patients admitted to Thoracic unit from July 2008 to June 2011 with intra thoracic hydatid cysts were evaluated prospectively as to age, sex, symptoms, diagnostic procedures, anatomic location of cysts, surgical procedures, complications, and outcomes. Chest radiography, computed tomography, and thoracic and abdominal ultrasonography had been performed preoperatively in all of them. Bronchoscopy and spirometry was also performed in all patients for assessment and operability.Echocardiography had been used in 2 patients to determine the contiguity of the cyst to the pericardium. Cystectomy and wide resection were the chief operative procedures. Most of the patients were having cysts in the pulmonary parenchyma only 10 patients had intrathoracic cysts in extrapulmonary locations. This group of patients was included in the study. We excluded patients who had a parenchymal cyst that had perforated to the pleura, myocardial hydatid and patients who had Total of 149 patients were operated for hydatid cystectomy, out of these 139 patients had pulmonary hydatid and 10 patients had intrathoracic extrapulmonary hydatid cysts. These 10 patients constitute our study group; out of these 7 were men and 3 women whose mean age was 39.14 +/- 16.8 years range, [16-69 years]. Eight [80%] of these were symptomatic, most commonly with chest pain, two patients were asymptomatic. There were 2 [20%] mediastinal hydatid, 2 [20%] diaphragmatic, 2 [20%] pericardial, 2 [20%] oblique fissure, and 1 [10%] each in chest wall and pleural hydatid in our study. Albendazole [10 mg/kg] was prescribed to all patients for as long as 3 months postoperatively. No complication, recurrence, or death occurred during the follow up period of 13 +/- 15.4 months [range, 2-36 months].The extrapulmonary location of Hydatid cysts within the thorax is very rare. This rarity may cause difficulties in diagnosis. To avoid recurrence, it is necessary to resect the affected tissues completely and an anthelmintic medical regimen post operatively