Paediatric Thoracic Surgery

Approximately 1 in every 1,000 children is born with a chest or lung disorder that might need surgical care to ensure healthy breathing and growth. Paediatric thoracic surgery is the process by which paediatric surgeons treat newborns and children. The treatment may involve minor congenital lung abnormalities to severe infections and chest wall deformities. So let’s dive into what paediatric thoracic surgery is.

Paediatric thoracic surgery is a safe and advanced medical procedure that is performed on newborns and children. The surgery focuses on treating various conditions, which include congenital conditions, acquired conditions, and chest wall deformities. Since children's bodies are still developing, they require special care and attention during medical procedures.
Paediatric thoracic surgeons are highly trained and skilled in handling these delicate procedures, with expertise in using child-friendly techniques to ensure the best outcomes. By addressing these issues early on, paediatric thoracic surgery can improve children’s health, comfort, and quality of life, allowing them to grow and thrive.

Paediatric thoracic surgeons diagnose, treat, and manage various lung and chest-related problems in children. The most common conditions treated include:

• Congenital Lung Abnormalities: It is a condition that includes congenital cystic adenomatoid malformation (CCAM) and bronchopulmonary sequestration, which are present at birth and are treated through paediatric thoracic surgery.
• Chest Wall Deformities: It involves pectus excavatum (sunken chest) and pectus carinatum (protruding chest) and can affect the chest’s appearance and function and may require surgery.
• Pulmonary Infections: It is done when lung infections become chronic or severe, such as with empyema (infection in the pleural cavity). This surgery may be necessary to remove infected tissue or drain fluid.
• Airway Issues: It involves tracheomalacia (a soft or weak windpipe). Surgical intervention may also involve supporting normal breathing.

The most common type of paediatric thoracic surgery is the resection of congenital lung lesions. These lesions develop in the lungs before the baby is born and cause infections or breathing problems. Paediatric thoracic surgeons perform this surgery to remove the affected area of ​​the lungs. Not only that, this surgery is also performed for the correction of chest wall deformities, such as pectus excavatum, which can help improve both the appearance and lung function.

Paediatric thoracic surgery is basically for children suffering from chest or thoracic conditions that may involve the lungs, chest wall, diaphragm, or oesophagus. It is a medical field that requires specialised techniques because children’s bodies are still growing and are more delicate. Here is a simple step of what typically happens before, during, and after these surgeries.

1. Preparation Before Surgery

Consultation and Evaluation: Before the surgery, doctors meet with the child and family to discuss symptoms and evaluate the need for surgery. They often do imaging tests, like X-rays, MRIs, or CT scans, to find the accurate root cause of the chest issue.
Preoperative Tests: Different types of tests will be taken, like blood tests, physical exams, and sometimes lung function. This helps to ensure that your child is ready for surgery.
Anaesthesia Plan: For surgery, anaesthesia is mandatory to ensure the procedure is painless. Paediatric anaesthesiologists create a plan to safely keep the child asleep and comfortable during surgery.

2. During the Surgery

Incisions: Depending on the problem, your surgeon may make a small open incision or use a minimally invasive approach, such as thoracoscopy, where they insert a camera and instruments through a small cut.
Procedure: The specific steps vary by condition. In a lung surgery, they may remove a diseased portion; in a diaphragm surgery, they’ll repair the muscle to its proper position.
Monitoring: The team constantly monitors the child’s vital signs to ensure they stay stable.

3. Recovery in the Hospital

ICU or Recovery Room: Children often spend a day or more in the ICU (intensive care unit) to closely monitor breathing, heart rate, and pain levels.
Pain Management: Paediatric specialists carefully manage pain to ensure comfort.
Breathing Support: Some children may need oxygen support or a ventilator until their lungs are strong enough to breathe on their own.
Physical Therapy: Respiratory therapy may help with lung function and prevent complications.

4. Recovery at Home and Follow-up Care

Home Care: Once stable, the child can go home, and parents receive instructions on wound care, activity restrictions, and signs of infection to watch for.
Follow-Up Visits: Regular check-ups help ensure healing is on track, and further imaging tests may be done to check for any issues.
Long-term Monitoring: For some conditions, long-term follow-up is necessary to monitor lung growth or ensure chest wall structure develops properly.

Benefits

• Improved Health: Surgery can correct serious conditions like lung malformations or chest wall deformities, improving the child’s breathing, overall health, and ability to thrive.
• Enhanced Quality of Life: With issues like chest wall deformities corrected, children often experience increased energy levels and greater confidence in their physical abilities.
• Better Development: Fixing problems early can support normal lung growth and chest development, which are crucial as the child grows.
• Reduced Symptoms: Many children see significant symptom relief, such as reduced pain or discomfort, easier breathing, and more endurance for activities.

Risks

• Infection: Like any surgery, there’s a small chance of infection, but hospitals follow strict procedures to minimise this.
• Anaesthesia Reactions: Rarely do children experience side effects from anaesthesia, but paediatric teams take special care to monitor for any issues.
• Recovery Challenges: Some children might take a little longer to regain their strength, which can vary depending on the type of surgery.

After paediatric thoracic surgery, the child will wake up in a recovery room or ICU for close monitoring, likely feeling drowsy with some mild soreness. Pain is managed carefully, and some may need brief oxygen support. Physical activity will be limited for a few weeks, but normal play can resume afterward. Follow-up visits ensure proper healing, and sometimes breathing exercises aid recovery. With support, most children recover well and feel stronger post-surgery.