Thoracoscopic treatment of mediastinal cysts in children

Background/Purpose: The development of thoracoscopic surgery has made many procedures possible, including the treatment of mediastinal cysts in childr en. The authors report their experience with this procedure between 1992 an d 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 m ade by antenatal ultrasound scan in six cases (27%), with a chest x-ray per formed for respiratory symptoms in 14 cases, and with a chest x-ray perform ed for positive tuberculin intradermoreaction in two cases. Decision to res ect the cyst was determined by thoracoscopy in 21 of the 22 cases, and by o pen surgery in one case only (subcarinal compressive cyst with left lung di stension and a mediastinal shift). Results: Eighteen of the 21 (86%) cases were treated successfully by thorac oscopy. In three cases of bronchogenic cysts, we performed an associated th oracotomy because the dissection was tao 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%), pleuropericardial 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 mediastina[ cyst by thoracoscopy is feasible in m ost cases. Compressive cysts with lung distension and mediastinal shift rem ain a contraindication. If the cysts have a common wall with the bronchus o r esophagus, or if they are subcarinal, the dissection may be difficult and dangerous, and thoracotomy may be preferable. J Pediatr Surg 33:1745-1748. Copyright (C) 1998 by W.B. Saunders Company.