Thoracoscopic resection of foregut duplication cysts

Abstract

Background: Foregut duplications are rare entities that include both esophageal and bronchogenic cysts. The diagnosis of foregut duplication cyst is made most often from an incidental finding on chest radiograph, or due to respiratory compromise due to mass effect or infection. Treatment consists of complete resection. Recurrences are associated with incomplete resection. Six cases of foregut duplication cysts are presented that were resected thoracoscopically.

Materials and methods: From May 1998 to April 2003, six patients underwent thoracoscopy for resection of foregut duplication cyst. One patient required conversion to open thoracotomy due to esophageal perforation. The distribution of cysts was 4 on the left and 2 on the right; all procedures were performed with three or four ports. Single lung ventilation was used in three patients. The masses were removed via a port site after intrathoracic decompression. Chest tubes were placed in all patients, and most were removed within 12 hours.

Results: Five of six cases underwent successful thoracoscopic resection. Pathology demonstrated esophageal duplication cyst in three patients and bronchogenic cyst in the other three patients. Average hospital stay was 5.5 days. Complications included aspiration pneumonia and chest tube dislodgment. There were no deaths, and no recurrences.

Conclusion: Thoracoscopic resection is a safe and effective method of treating foregut duplications. Outcomes have been good with little short-term morbidity and no mortality. Morbidity and cosmesis are improved by avoiding thoracotomy. Thoracoscopic resection should be considered the first-line therapy for these benign masses.