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.