Table 1. Complications of mediastinal cyst resections and their management.
| Complications | Characteristics | Prevention/management |
|---|---|---|
| Postoperative respiratory complications | Atelectasis, pleural effusion, and pneumonia | Optimize patient preoperatively |
| Respiratory function is impaired to varying degrees depending on the approach used | Choose minimally invasive approach when possible | |
| Focus on postoperative care (fluid management, pain management, pulmonary hygiene and chest physiotherapy) | ||
| Postoperative bleeding | Postoperative bleeding can be due to surgical bleeding or coagulopathy | Preoperative embolization of afferent vessels → to reduce surgical bleeding complications when a vascularized cyst is anticipated |
| Most common due to technical complications | Correct coagulopathy | |
| Presents with high chest tube output or hemodynamic instability | Low threshold to take back a patient for re-exploration and control of bleeding | |
| Infection | Rare complication since the chest wall has an excellent blood supply and these procedures are considered clean procedures | Preoperative antibiotics prophylaxis |
| Incidence in the literature varies from 5% to 24.4% | Postoperative infections should be treated with antibiotics | |
| Cardiac complications | Very common complication after any thoracic surgery | Medical management |
| The most common arrhythmia that happens after thoracic surgery is supraventricular tachycardia | ||
| Reperfusion lung injury | Happens after resection of cysts that are compressing the pulmonary artery | Prevent this complication by gradually aspirating cyst before extraction |
| Chylothorax | Reported as the most common postoperative complication after resection of mediastinal cysts | First line of management of chylothorax → conservative treatment (medium chain triglycerides diet) |
| Chylothorax is caused by incomplete ligation of lymphatic channels or direct injury to the thoracic duct during resection of mediastinal cysts | If the chyle leak does not resolve after the use of medium chain triglycerides → total parenteral nutrition should be considered to reduce the chyle flow | |
| If chylothorax does not respond to the conservative management → reoperation is required | ||
| Chylopericardium | Rare complication that happens after mediastinal cyst resection | Management and prevention strategies for chylopericardium are the same as the ones discussed for chylothorax |
| Reported to occur when chyle leaks into the pericardial cavity instead of the thoracic cavity because of a previous pleurodesis | ||
| Injuries to structures surrounding mediastinal cyst | Injuries can occur to surrounding structures (esophagus, phrenic nerve, recurrent laryngeal nerve, azygos vein, aorta, and bronchus) | Detailed anatomic knowledge and meticulous dissection helps to prevent these complications |
| Injuries to surrounding structures are more common when there are adhesions or in redo surgeries. | ||
| Injuries to the phrenic nerve → occur when resecting an anterior mediastinal cyst | ||
| Injury to the vagus nerve | ||
| Injury to the recurrent laryngeal nerve → occur when resecting an anterior mediastinal cyst | ||
| Recurrence | Potential long-term complication | Recurrence is avoided by complete removal of the cyst |
| Most recurrence is due to incomplete surgical resection | If a recurrence occurs → it is advised to resect the cyst before the appearance of symptoms | |
| Recurrence is also more likely to happen when attempting resection of infected cysts, mediastinal lymphangiomas, and multi-loculated cysts and bronchogenic cysts |
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