Surgical treatment of bronchiectasis in children

doi:10.1016/j.jpedsurg.2004.06.009

Journal of Pediatric Surgery

Volume 39, Issue 10, October 2004, Pages 1532-1536

https://doi.org/10.1016/j.jpedsurg.2004.06.009 Get rights and content

Abstract

Background purpose

Surgical treatment of childhood bronchiectasis has not been discussed extensively because of decline in prevalence and experience with this disease. It remains controversial as to which children would benefit from surgery and surgical points that may affect the outcome. Therefore, a retrospective series was prepared to evaluate the results of surgical treatment of bronchiectasis in children.

Methods

The records of 54 children who underwent surgery for bronchiectasis between 1991 and 2002 were analyzed retrospectively for age; sex; clinical features; radiologic examinations; details of surgery including type of resection, operative morbidity, and mortality; and outcome.

Results

Fifty-four patients underwent 58 pulmonary resections during the study period. The mean ages at diagnosis of bronchiectasis and at the time of surgery were 7.80 ± 3.70 years (range, 1 to 15 years) and 9.25 ± 3.92 years (range, 1.5 to 17 years), respectively, with a male to female ratio of 5:4. The causes of bronchiectasis were lung infection (n = 39), hereditary and inborn diseases (n = 14), and foreign body aspiration (n = 1). Chest X-rays, bronchography (n = 12) or chest computed tomography (n = 43), and ventilation-perfusion scintigraphy (n = 13) were used, and pulmonary function tests (n = 21) and bronchoscopy (n = 54) were performed. The types of resections were lobectomy (63%), pneumonectomy (18.5%), lobectomy with segmentectomy (11.1%), segmentectomy (3.7%), and bilobectomy (3.7%). Four patients required a second operation. Forty-one patients (76%) had complete resection, and 13 patients (24%) had incomplete resection. Intraoperative and postoperative complications were encountered in 4 (7.4%) and 4 patients (7.4%), respectively. The course after surgery was well in 23 (42.5%), improved in 23 (42.5%), and unchanged or worse in 5 patients (9.4%). The mortality rate was 5.6%.

Conclusions

The decision for bronchiectasis surgery should be made in cooperation with the chest diseases unit. Anatomic localization of the disease should be mapped clearly by radiologic and scintigraphic investigations. The morbidity and mortality rates of bronchiectasis surgery are within acceptable ranges. Most of the children benefit from surgery, especially when total excision is accomplished. Pneumonectomy is well tolerated in children without increase in morbidity and mortality. Therefore, pneumonectomy may be preferred instead of leaving residual disease when bronchiectasis is unilateral.

Section snippets

Materials and methods

We reviewed the medical records of all children who underwent surgery for bronchiectasis between 1991 and 2002 at the Hacettepe University Childrens Hospital Department of Pediatric Surgery. The records of 54 patients were analyzed for age; sex; clinical features; radiologic findings; details of surgery including type of resection, operative morbidity, and mortality; and outcome.

Surgical treatment was considered if the symptoms persisted in spite of courses of medical treatment including

Results

Fifty-four patients underwent 58 pulmonary resection operations with the diagnosis of bronchiectasis during the study period.

The mean age at diagnosis was 7.80 ± 3.70 years (range, 1 to 15 years). The male to female ratio was 5:4.

The mean age at the time of pulmonary resection was 9.25 ± 3.92 years (range, 1.5 to 17 years). The predisposing factors of bronchiectasis were lung infection (n = 39, 72%), hereditary and inborn diseases (n = 14, 26%), and foreign body aspiration (n = 1, 2%). The

Discussion

Bronchiectasis was uniformly fatal when it was described in detail by Laennec in 1819. Demonstration of abnormalities of bronchial architecture by using nebulized bismuth powder and iodized oil allowed further understanding of the pathogenesis of bronchiectasis. In modern description, bronchiectasis is characterized by abnormal, irreversible dilatation of the bronchi in association with a variable degree of chronic bronchitis, pneumonitis, or other pathologic changes.1

The common cause of

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Chronic wet cough in children is a common condition for which patients seek medical attention and there are many etiologies. This article will discuss two pediatric causes: protracted bacterial bronchitis, one of the commonest causes, and bronchiectasis, one of the most serious. They are discussed together as it has been proposed that these conditions represent different ends of a spectrum of endobronchial suppuration and understanding the pathobiology of this will aid in early intervention and management. This article further highlights latest evidence-based updates of both conditions with discussion of pathogenesis, diagnosis and management.
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Furthermore, no clear surgical indications for children with BFB were described in the literature. We tend to perform open surgery in the following two conditions: (1) FB cannot be extracted through bronchoscopy; (2) Actelectasis or bronchiectasis with repeated infection sustains over one year [12,13] despite repeated conservative management. Growth retardation and drop in school attendance secondary to the illness are also reported as the surgical indication [14].
Delayed diagnosis of children with Bronchial Foreign Body (BFB) leads to significant pulmonary complications and open surgery may not be avoided. However, surgical management for children with BFB is rarely reported. This study aims to describe our experience in the diagnosis and surgical treatment of late-diagnosed BFB during childhood.
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The diagnosis of BFB should be considered in children who present with repeated pneumonia and agnogenic bronchiectasis and actelectasis despite repeated medical treatment. Surgical treatment is necessary and effective in patients with either unextractable BFB or irreversible damage of lung tissue.
Level IV.
Retrospective study.
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Familial dysautonomia (Riley-Day syndrome, hereditary sensory autonomic neuropathy type-III) is a rare genetic disease caused by impaired development of sensory and afferent autonomic nerves. As a consequence, patients develop neurogenic dysphagia with frequent aspiration, chronic lung disease, and chemoreflex failure leading to severe sleep disordered breathing. The purpose of these guidelines is to provide recommendations for the diagnosis and treatment of respiratory disorders in familial dysautonomia.
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Bronchiectasis is a structural airway disease characterized by dilated bronchi and bronchioles due to severe or recurrent lower airways inflammation. Bronchiectasis can occur as a result of chronic pulmonary aspiration. Bronchiectasis may also be associated with a wide variety of systemic diseases, which should be considered in the differential diagnosis. Children with bronchiectasis typically have a chronic or recurrent productive cough and carry a significant burden of disease with a considerable impact on quality of life. The diagnosis of bronchiectasis is made by high-resolution chest computerized tomography. Aggressive management of bronchiectasis is necessary to reduce the daily symptom burden and frequency of exacerbations. Chronic suppurative lung disease may be a precursor to bronchiectasis, only lacking the defining radiographic features of bronchiectasis. Children with chronic suppurative lung disease may have the same symptoms as children with bronchiectasis and should be treated similarly. Protracted bacterial bronchitis is defined as a cough lasting at least four weeks that responds to antibiotic therapy. Protracted bacterial bronchitis may occur following a viral respiratory tract infection. Protracted bacterial bronchitis can be treated with a prolonged course of empiric antibiotics. Further evaluation is necessary if a child with suspected protracted bacterial bronchitis does not adequately respond to antibiotics as chronic suppurative lung disease or bronchiectasis must be considered.

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¹: F. Cahit Tanyel is supported by the Turkish Academy of Sciences (TUBA).

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Surgical treatment of bronchiectasis in children

Abstract

Background purpose

Methods

Results

Conclusions

Section snippets

Materials and methods

Results

Discussion

Ann Thorac Surg

Ann Thorac Surg

Ann Thorac Surg

Disorders of the Thoracic Cavity and Pleura and Infections of the Lung