Thoracotomies in Children in Low to Middle Income Countries: The Indications for Surgery.

Introduction: There is a scarcity of data on the utilization of thoracotomy for lung pathology in children in low- and middle-income countries (LMICs). These countries have high burdens of infectious diseases, especially tuberculosis, hydatic disease and Human immunodeficiency virus (HIV).

Methods: This is a retrospective descriptive study reviewing the indications for thoracotomy in a single center in a LMIC country. The study included all children under the age of 13 who underwent thoracotomy for pulmonary disease or vascular conditions affecting the airways at Tygerberg Hospital between January 2018 and December 2022. The indications for thoracotomy were classified into five groups: infectious, congenital, diagnostic, traumatic or neoplastic. Data collected included age, sex, HIV status, indication for the thoracotomy, procedures performed, complications of surgery and the final diagnosis after surgery.

Results: One hundred seventy-two children who had undergone thoracotomy were studied with 182 thoracotomies performed. Infectious diseases (54.9%) were the most common indication for thoracotomy followed by congenital (35.2%), diagnostic (4.9%), traumatic (3.3%) and neoplastic (1.6%). The most common indication for thoracotomy was airway compression due to tuberculosis (TB) lymph nodes (21.4%), followed by hydatic cysts (20.9%) and vascular malformations (11.5%).

Conclusion: LMICs still face a significant burden of infectious and congenital diseases requiring thoracotomy, as compared to higher-income countries where neoplastic indications are most common. During the study period, hydatid cysts have become more prevalent and is now the most common indication for thoracotomy in the study setting. Thoracotomy can be safely performed in an LMIC setting with low morbidity and mortality, also in HIV-positive children.