Mediastinoscopic extended thymectomy for pediatric patients with myasthenia gravis

• Published in: Journal of pediatric surgery 2015-04, Vol.50 (4), p.528-530
• Main Authors: Kitagawa, N, Shinkai, M, Take, H, Mochizuki, K, Asano, F, Usui, H, Miyagi, H, Kido, T, Kurauchi, N, Osaka, H, Yamashita, S
• Format: Article
• Language: English
• Subjects: Adolescent; Child; Child, Preschool; Children; Endoscopic surgery; Female; Humans; Infant; Male; Mediastinoscopy; Mediastinoscopy - methods; Microsurgery - methods; Myasthenia gravis; Myasthenia Gravis - surgery; Pediatrics; Surgery; Thymectomy - methods; Treatment Outcome
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/j.jpedsurg.2014.08.012

Abstract Background Extended thymectomy is indicated for children with myasthenia gravis (MG) when drug-resistance or dependence is seen. We have employed a technique for mediastinoscopic extended thymectomy (MET) on children with MG. Method A total of 14 children underwent MET at Kanagawa Children's Medical Center between 2005 and 2013. A mediastinal operation field was made by a V-shaped hook infrasternally to extirpate the thymus with adipose tissue around the thymus. Results The operation time and the amount of blood loss were 182 ± 44 minutes and 34 ± 43 ml, respectively. Postoperative complications, in the form of transient paralysis of the right recurrent nerve, occurred in 2 patients. The median length of postoperative hospital stay was 4.5 days. After MET, 6 patients achieved complete remission and 7 patients achieved steroid dose reduction, but no improvement was seen in 1 patient. Conclusions This procedure offers the advantage of good surgical access for dissection around the bilateral phrenic nerves in extended total thymectomy, while achieving good cosmetic results.