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14 - Pulmonary resection and thoracotomy

from Part III - Thorax

Published online by Cambridge University Press:  08 January 2010

By
Frédérique Sauvat  and
Yann Revillon
Edited by
Mark D. Stringer ,
Keith T. Oldham  and
Pierre D. E. Mouriquand
Frédérique Sauvat
Affiliation:
Service de Chirurgie Pediatrique, Paris, France
Yann Revillon
Affiliation:
Service de Chirurgie Pediatrique, Paris, France
Mark D. Stringer
Affiliation:
University of Otago, New Zealand
Keith T. Oldham
Affiliation:
Children's Hospital of Wisconsin
Pierre D. E. Mouriquand
Affiliation:
Debrousse Hospital, Lyon
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Summary

Thoracic surgery in childhood has changed considerably in the last 50 years. In particular, surgical indications and techniques have altered dramatically. At the beginning of the twentieth century, the main indications for thoracic surgery were related to infectious diseases, especially bronchiectasis and tuberculosis, whereas congenital malformations now constitute the commonest reason for lung resection. Thoracic surgery has become more commonplace in younger patients, including neonates. Safe techniques have prompted the development of prophylactic surgery in asymptomatic patients and thoracoscopic techniques offer a minimally invasive approach.

The long-term consequences of pulmonary resection and thoracotomy are related to many different factors: the underlying disease process and its natural history; the effects of loss of parenchymal volume; and the physical sequelae of surgery on the chest wall. In addition, in younger patients there is the added dimension of the effects of somatic growth on future pulmonary function.

As in all branches of pediatric surgery, knowledge of long-term sequelae is limited because of the lack of studies following patients through to adulthood. The late consequences of thoracoscopic procedures and the relative merits of open surgery and thoracoscopic techniques are poorly understood. However, specific data are reported in two broad areas: the functional consequences of pulmonary resection and musculoskeletal abnormalities resulting from thoracotomy.

Lung development and compensatory lung growth

In order to understand the effects of lung resection during childhood, it is helpful to review the process of normal lung development. The human lung is an organ which continues to mature after birth.

Type
Chapter
Information
Pediatric Surgery and Urology
Long-Term Outcomes
 , pp. 184 - 191
Publisher: Cambridge University Press
Print publication year: 2006

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