Lobectomy for Congenital Lobar Emphysema, Experience of Two Centers in Pakistan

Abstract

Objective: To assess outcome of lobectomy in congenital lobar emphysema in pediatrics group
of patients.
Methods: This retrospective study was conducted in Department of Thoracic Surgery Nishtar
Hospital Multan and Services Hospital Lahore from October 2003 to December 2015.All the
patients of pediatric group who underwent lobectomy for congenital lobar emphysema were
included in study. Demographic data, operative findings outcome of the procedure in terms of
post operative complications and 30 days morbidity and mortality were recorded .All the patients
presented with respiratory distress. Standard lobectomy was performed and bronchial stump was
buttressed with surrounding lymph nodes, pericardial or pleural flap.
Results: Of these 41 study cases, 30 (73.2%) were boys while 11 (26.8%) were girls and male to
female ratio was 2.72:1. Mean age of our study cases was 3.32 ± 1.59 months (with age range; 15
days to 7 months). Mean age of the boys was noted to be 3.38 ± 1.52 months while that of girls
was 3.18 ± 1.84 months (p = 0.405). Of these 41 study cases, left upper lobectomy was performed
in 27 (65.9%) patients, right middle lobectomy in 11 (26.8%) patients, left lower lobectomy in 2 (4.9
%) patients and right upper lobectomy in 1 (2.4%) patients. Out of 41 patients 8 (19.5%) were
preoperatively on ventilator. Out of 8 ventilated patients one had left sided chest intubation which
was malpositioned and was in the lung parenchyma. Morbidity was superficial wound infection in
2 (4.9%) patients and post lobectomy empyema in 2 (4.9%) patients who required prolonged tube
thoracostomy, antibiotics and chest physiotherapy. Mortality was recorded in 1 (2.4%) patient
who was preoperatively on ventilator and had misplaced chest tube. That patient died on the 3rd
post-operative day due to respiratory failure secondary tolung parenchymal injury.
Conclusion: Our study results support surgical management of congenital lobar emphysema
as Lobectomy was found to be safe, reliable and effective in these children presenting with
respiratory distress due to lobar emphysema. There were no significant morbidities in these
patients and clinical outcomes were satisfactory and surgical management is reported to be
treatment of choice in pediatric patients with CLE.