Pediatric Surgery Chest & Thoracic Services

Treatments/Procedures:

Treatment options for achalasia aim to relieve the symptoms by facilitating the passage of food through the lower esophageal sphincter. Options include:

• Pneumatic dilation: A procedure where a balloon is inserted into the esophagus and inflated to widen the lower esophageal sphincter. This method may require repeat procedures over time.
• Laparoscopic Heller myotomy: A surgical procedure that involves cutting the muscles at the lower end of the esophagus to allow easier passage of food. This surgery is often performed minimally invasively and is considered when other treatments have failed or are not suitable.
• Peroral endoscopic myotomy: A newer, minimally invasive endoscopic procedure that involves making an incision in the inner lining of the esophagus to access and cut the lower esophageal sphincter muscles. This technique has shown promising results in both adults and children, with the potential for fewer complications and a shorter recovery time compared to traditional surgery.

Treatment/procedure options:

Treatment for pediatric breast problems is highly dependent on the underlying cause:

• Infections (mastitis or abscess): Often treated with antibiotics. In the case of an abscess, drainage might be required.
• Congenital anomalies (such as supernumerary nipples or asymmetric breast development): Might not require any treatment unless they cause physical discomfort or emotional distress, in which case surgical correction could be considered.
• Benign lumps (such as fibroadenomas): Observation is usually recommended, but surgical removal can be considered if there is significant growth, pain, or concern for malignancy.
• Gynecomastia in boys: This is the development of breast tissue in males and is often related to hormonal changes. It usually resolves on its own; however, in persistent cases, especially if causing psychological distress, surgical intervention might be considered.

Treatment/procedure options:

The treatment approach for mediastinal cysts depends on the type of cyst, its size, the presence of symptoms, and any potential complications. Surgical removal is often recommended for symptomatic cysts, cysts that are at risk of causing complications, or when malignancy cannot be definitively excluded through imaging and diagnostic tests. The surgery aims to completely remove the cyst while minimizing the risk to surrounding structures in the mediastinum. The surgical approach can vary from open surgery (thoracotomy) to minimally invasive techniques (video-assisted thoracoscopic surgery, VATS), depending on the cyst's location, size, and the surgeon's expertise. Minimally invasive techniques are preferred when feasible, as they generally offer shorter recovery times, less pain, and smaller scars than open surgery. For asymptomatic cysts that are unlikely to cause complications, a conservative approach with regular monitoring may be chosen to observe for any changes in size or the development of symptoms that would warrant surgical intervention.

Treatment/procedure options:

Immediate treatment focuses on stabilizing the newborn, often requiring assistance with breathing. Surgery to repair the diaphragmatic hernia is typically performed after the infant is stabilized. The surgical procedure involves returning the protruding organs to the abdominal cavity and repairing the opening in the diaphragm. In some cases, if the diaphragmatic defect is large, a patch may be needed to close it. Post-surgery, the baby will need careful monitoring in the neonatal intensive care unit (NICU) to manage breathing, nutrition, and growth. Advanced treatments, such as extracorporeal membrane oxygenation (ECMO), may be used in severe cases to support the baby’s heart and lungs.

Treatment/procedure options:

The primary goals in treating empyema are to eliminate the infection and remove the pus from the pleural space. Treatment usually involves a combination of antibiotics to treat the underlying infection and surgical intervention to drain the pus. The drainage might be done through needle thoracentesis (using a needle to remove the pus), insertion of a chest tube to continuously drain the pus, or, in more severe cases, surgery to clean out the infected area (decortication). The choice of treatment depends on the severity of the empyema, the child's overall health, and how well the child responds to initial treatments.

Treatment/procedure options:

Surgical correction may be considered for severe cases or when non-surgical treatment is not successful or feasible. Surgical options include the Nuss procedure or the modified Ravitch procedure, which involves removing the abnormal cartilage and reshaping the sternum and rib cartilage to achieve a more normal chest contour.

Treatment/procedure options:

The most common surgical procedure to correct pectus excavatum is the Nuss procedure, which involves inserting one or more curved metal bars under the sternum and flipping them to push the sternum outward, correcting the sunken chest. The bars are usually left in place for several years before being removed. Another surgical option is the Ravitch procedure, which involves removing the abnormal cartilage and repositioning the sternum.