Surgery for foreign body retrieval from airway after failed bronchoscopy intervention-a decade-long experience.

Abstract

Background: Foreign body aspiration is a critical surgical emergency among pediatric patients, carrying a substantial risk of mortality and contributing significantly to respiratory distress in children. Timely intervention by experts is crucial to mitigating cumulative morbidity. This study aims to evaluate the efficacy of bronchotomy as a secure alternative following unsuccessful attempts at bronchoscopic foreign body retrieval.

Methods: A retrospective review of 21 instances involving bronchotomies and resections carried out following unsuccessful bronchoscopic foreign body extraction was conducted between June 2013 and March 2022. The posterolateral thoracotomy approach was employed for surgical interventions.

Results: A total of 21 cases underwent bronchotomy and resectional procedures, with a retrospective follow-up spanning 10 years. Patient ages ranged from 1 to 12 years, predominantly affecting the left lung. Bronchotomy was chosen as the intervention in 85% (18 cases) of instances. The incision was extended towards the foreign body in 8 cases involving the right bronchus and in 13 cases for the left bronchus. Late presenters commonly exhibit hemoptysis. Objects retrieved ranged from pen caps and whistles to metal balls. All enrolled cases underwent preoperative bronchoscopy.

Conclusion: This study underscores the significance of rigid bronchoscopy as the diagnostic and primary intervention for foreign body aspirations in pediatric cases. Bronchotomy emerges as a secure and effective alternative. Retained foreign bodies causing endobronchial obstruction with stasis necessitate resection, while bronchotomy is a safe procedure for non-retrievable foreign bodies without structural changes.

Graphical abstract:

Supplementary information: The online version contains supplementary material available at 10.1007/s12055-024-01845-z.