Pediatric Thoracic Surgery is a specialized field of pediatric surgery that focuses on the diagnosis and treatment of conditions affecting the chest, lungs, esophagus, diaphragm, and thoracic wall in newborns, infants, and children. These conditions may be congenital (present at birth) or acquired later in life.

Pediatric thoracic surgeons work closely with pediatric pulmonologists, neonatologists, anesthesiologists, and intensive care specialists to ensure the best possible outcomes.

1. Common Pediatric Thoracic Conditions

A. Congenital (Birth) Defects

1. Congenital Diaphragmatic Hernia (CDH)
   • Cause: A hole in the diaphragm allows abdominal organs to move into the chest.
   • Symptoms: Severe breathing difficulties after birth.
   • Treatment: Surgical repair to reposition organs and close the defect.
2. Congenital Pulmonary Airway Malformation (CPAM, formerly CCAM)
   • Cause: Abnormal lung tissue that forms cysts or masses.
   • Symptoms: Respiratory distress, lung infections.
   • Treatment: Surgical removal of the affected lung lobe (lobectomy).
3. Bronchogenic Cysts
   • Cause: Fluid-filled cysts in the lungs or airways.
   • Symptoms: Coughing, breathing difficulties, infections.
   • Treatment: Surgical removal if symptomatic.
4. Esophageal Atresia with Tracheoesophageal Fistula (EA/TEF)
   • Cause: The esophagus is incompletely formed and may connect to the trachea.
   • Symptoms: Difficulty swallowing, choking, breathing problems.
   • Treatment: Surgery to reconnect the esophagus and separate it from the trachea.
5. Chest Wall Deformities
   • Pectus Excavatum (“sunken chest”): The sternum is abnormally depressed.
   • Pectus Carinatum (“pigeon chest”): The sternum protrudes outward.
   • Treatment: Bracing for mild cases, surgery (e.g., Nuss or Ravitch procedure) for severe cases.

B. Acquired Conditions

1. Empyema (Infected Pleural Effusion)
   • Cause: Pus accumulation in the pleural cavity, usually after pneumonia.
   • Symptoms: Fever, chest pain, breathing difficulty.
   • Treatment: Chest tube drainage, antibiotics, surgery in severe cases.
2. Pneumothorax (Collapsed Lung)
   • Cause: Air leaks into the space around the lungs.
   • Symptoms: Sudden breathing difficulty, chest pain.
   • Treatment: Chest tube placement, surgery for recurrent cases.
3. Mediastinal Tumors & Masses
   • Examples: Neuroblastoma, Teratoma, Lymphoma.
   • Symptoms: Difficulty breathing, coughing, chest pain.
   • Treatment: Surgery, chemotherapy, or radiation depending on tumor type.
4. Tracheal Stenosis & Malformations
   • Cause: Narrowing of the airway due to birth defects or injury.
   • Symptoms: Stridor (noisy breathing), difficulty breathing.
   • Treatment: Surgery to widen or reconstruct the airway.

2. Pediatric Thoracic Surgical Treatments

A. Open Surgery (Thoracotomy)

• Traditional method involving a larger incision to access the chest.
• Used for complex cases like large tumors, severe chest wall deformities, or diaphragmatic hernias.

B. Minimally Invasive Surgery (Thoracoscopy/VATS – Video-Assisted Thoracoscopic Surgery)

• Uses small incisions and a camera for precise surgery.
• Benefits: Less pain, faster recovery, minimal scarring.
• Used for: CPAM removal, lung biopsy, empyema drainage, minor chest wall corrections.

C. Robotic-Assisted Thoracic Surgery

• Enhances precision in complex cases.
• Used for: Mediastinal tumors, esophageal surgeries, airway reconstructions.

D. Fetal Thoracic Surgery (Before Birth)

• Used in severe congenital conditions diagnosed in utero (e.g., Congenital Diaphragmatic Hernia, CPAM).
• Involves fetal endoscopic procedures to improve lung development before birth.

3. Postoperative Care & Recovery

A. Immediate Post-Surgical Care

• ICU/NICU Monitoring: Babies with severe conditions (e.g., CDH) may need ventilator support.
• Pain Management: Medications to keep the child comfortable.
• Chest Tube Placement: Used to drain fluid or air from the chest after surgery.

B. Long-Term Recovery & Follow-Up

• Physical Therapy & Breathing Exercises: Helps improve lung function after chest surgery.
• Regular Check-ups & Imaging: Ensures proper healing and function.
• Parental Education: Guidance on home care, activity restrictions, and signs of complications.

4. Advances in Pediatric Thoracic Surgery

1. Minimally Invasive & Robotic Surgery – Reducing pain, recovery time, and hospital stays.
2. Fetal Surgery & In-Utero Interventions – Improving outcomes for severe congenital defects.
3. 3D Imaging & Printing – Assisting in pre-surgical planning for complex cases.