Abstract
Background Foregut duplication cysts (FDC) have unpredictable natural course and rarely remain
asymptomatic. We present our large cohort of FDC to highlight surgical learning points
and outcome.
Materials and Methods Review of 41 children with FDC (April 1997–April 2015) included demographics, clinical
presentation, preoperative investigations, surgical management, post-operative complications,
and overall outcome.
Results Forty-one children (26 girls/15 boys; male/female [M/F] ratio 1:1.7) had 43 FDC (two
cases >1 cyst) consisting of antenatally diagnosed 16 (39%), late with symptoms 21
(51.2%), and incidental 4(9.8%) cases. FDC locations were cervical (3), mediastinal
(35), and subdiaphragmatic (5). During all cervical FDC resection, recurrent laryngeal
nerve was required to be dissected off the cyst wall. Thoracoscopic resection was
feasible in 27 cases, with 4 conversions related to infections and adhesions or accidental
injury to trachea/esophagus. Complete resection was achieved in all cases with no
recurrence. There was no mortality and morbidity included, chylothorax (1) esophageal
injury (1), phrenic nerve injury (1), and tracheal injury (2). The minimally invasive
surgery and surgery on asymptomatic lesions significantly affect the outcome by reducing
need for chest drain (p = 0.01) and length of hospital stay (p = 0.04).
Conclusion This retrospective study confirms the efficacy and safety of thoracoscopic surgery;
important learning points were association of common wall with trachea in some superior
mediastinal cysts and association of recurrent laryngeal nerve in cervical FDC.
Keywords
foregut duplication cysts - bronchogenic cysts - esophageal duplications - thoracoscopic
surgery - children
