Prior thoracic surgery has a limited impact on the feasibility of consecutive thoracoscopy in children: a prospective study on 228 procedures.
BACKGROUND
This study aimed to determine the impact of prior thoracic surgery on consecutive ipsilateral thoracoscopic surgery in children.


METHODS
We prospectively analyzed 228 thoracic procedures, which were performed in 190 children (99 male,91 female; mean age, 5.1 years; range, 1 day to 18 years) over a 7-year period (January 2000 to August 2007).Of these, 137 were thoracoscopies and 91 conventional operations. A panel of pediatric pulmonologists, anesthetists,and pediatric surgeons decided whether a thoracoscopy or a conventional approach was indicated. The endpoints were conversion rate, intraoperative events, and complications in subsequent thoracoscopies with regard to the type of prior thoracic surgery. In addition, the reasons for exclusion from thorascopy of those patients,who had a previous thoracic operation, should be identified.


RESULTS
Thirty-two patients (14%) had prior ipsilateral thoracic surgery; 20 of these underwent thoracoscopy,12 after prior thoracotomy and 8 after prior thoracoscopy. The type of initial approach had no significant impact on the conversion rate of subsequent thoracoscopy (1/12 after thoracotomy vs. 0/8 after thoracoscopy; not significant). The conversion rate was not significantly different in patients with or without prior surgery (1/20 vs. 19/117; not significant). However, there was a higher number of reconstructive procedures in patients without prior surgery, which was reflected in conversions due to lack of overview (n 12), bleeding (n 3), tension during reconstruction of a diaphragmatic defect (n 2) and esophageal atresia (n 2), and intraoperative respiratory problems (n 1). Twelve patients with a prior operation underwent thoracotomy due to limited respiratory capacity (n 5), advanced tumor stage, prior sternotomy (n 6), and limited visibility, leading to conversion during initial thoracoscopy (n 1).


CONCLUSIONS
Prior thoracic operation has, independent of the initial approach, a limited impact on the feasibility of ipsilateral consecutive thoracoscopic surgery in children. The feasibility of thoracoscopy after prior operation is excellent.
Metzelder
Martin L
ML
Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany. mmetzelder@yahoo.com
Kuebler
Joachim F
JF
Reismann
Mark
M
Lawal
Taiwo A
TA
Glueer
Sylvia
S
Ure
Benno
B
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011446:Prospective Studies; D019616:Thoracic Surgical Procedures; D013906:Thoracoscopy; D013908:Thoracotomy