Routine pulmonary wound closure after thoracoscopic sublobar resection for congenital lung malformations in children: impact on early recovery, one-year CT-based lung expansion, and the learning curve.

BACKGROUND: The necessity of routine pulmonary parenchymal wound closure following thoracoscopic sublobar resection for congenital lung malformations (CLMs) in children remains uncertain. This study aimed to evaluate the association of routine wound closure with drainage-related recovery, perioperative outcomes, one-year computed tomography (CT)-based lung re-expansion, and the procedural learning curve.

METHODS: Consecutive children who underwent thoracoscopic sublobar resection for CLMs between January 2021 and March 2025 were retrospectively reviewed. The cohort was divided into a non-closure group and a routine-closure group according to wound management strategy. Pulmonary wound closure was performed using an absorbable barbed suture, generally proceeding from the peripheral or lower-tension side toward the central or higher-tension region. Irregular wounds were managed by initiating closure from multiple peripheral points converging centrally while preserving the natural axis of residual bronchi and vasculature. Outcomes included chest tube duration, drainage volume, prolonged air leak, chest tube reinsertion, postoperative hospital stay, perioperative complications, one-year CT-based volumetric indices, and closure-time learning curve metrics.

RESULTS: A total of 285 children were included, comprising 75 in the non-closure group and 210 in the closure group. Baseline characteristics were comparable between groups. Compared with the non-closure group, the closure group exhibited significantly shorter chest tube duration (0.87 ± 0.74 vs. 2.81 ± 1.99 days, P < 0.001), lower postoperative drainage volume (2.12 ± 0.70 vs. 7.21 ± 2.58 mL/kg/day, P < 0.001), reduced rates of prolonged air leak and drainage failure, and shorter postoperative hospital stay (5.63 ± 0.83 vs. 7.68 ± 2.10 days, P < 0.001). At one-year follow-up, CT-based volumetric assessment revealed no evidence that wound closure restricted residual lung re-expansion. Closure time decreased from approximately 22 min in the early phase to 11 min in the late phase, with learning curve inflection points identified at cases 47 and 135.

CONCLUSIONS: Routine pulmonary wound closure following thoracoscopic sublobar resection for pediatric CLMs was associated with improved drainage-related recovery and shorter hospitalization, without compromising one-year lung re-expansion on CT. Although closure adds a procedural step, efficiency improved substantially with experience, demonstrating a quantifiable learning curve.