Collapse therapy in 21st century an experience of 50 cases

Abstract

Objective: To observe the various indications of thoracoplasty and evaluate their management and outcome. Study Design: An observational descriptive study. Place and Duration: Department of Cardiothoracic Surgery, Postgraduate Medical Institute, Lady Reading Hospital from July 2001 to January 2004. Subjects and Methods: During two and a half years study period fifty patients needed thoracoplasty. M: F ratio was 36:14. Aged distribution was 23 - 57 with a mean age of 36.3 years. Indications for surgery were tubercular or parapenumonic empyema in 25(50%) patients, post lobectomy space infection, and broncho pleural fistula (BPF) in 10(20%), destroyed lung with hemoptysis in 8(16%), post pneumonectomy space infection in 4(8%) and upper lobe hemoptysis with poor PFTs in three (6%) cases. A standard subperiosteal extra pleural paravertebral surgical technique was used in all cases. Out of 50 cases 28 (56%) required full thoracoplasty and 22(44%) cases underwent partial thoracoplasty. Postoperatively all patients had a single chest drain on suction for 7 days. Both the drain and stitches were removed after 2 weeks and patients were advised to attend out patient department for follow-up. Results: Patients symptoms index showed remarkable improvement. 100% improvement was needed in patients regarding chest pain, fever, cough, weight loss, hemoptysis and ATT. Postoperative complications were noted in 10 (20%) cases. Four patients had wound infection, 2 had wound dehiscence, residual space in 3 and restricted shoulder mobility in one. There was 1(2%) mortality. This patient had borderline pulmonary functions and had to be ventilated for ventilatory failure. Conclusion: With the persistent problem of pulmonary tuberculosis in the developing countries, thoracoplasty is still an operation of continued relevance for space obliteration in cachectic patients, and as collapse therapy for bleeding lungs with poor PFTs. Most patients are definitively and rapidly cured with limited sequelae.