Pneumonectomy for benign lung disease

Abstract

Objective: This study was done to define morbidity and mortality of elective pneumonectomy for benign lung disease, as well as to recommend safety measures. Design: An observational descriptive study. Place and Duration of study: Department of Cardiothoracic Surgery, Postgraduate Medical Institute, Lady Reading Hospital, Peshawar from June 2002 to September 2004. Material & Methods: Thirty six patients received elective pneumonectomy. Male : Female 21 : 15. Age range was 4 months to 72 years. Past recurrent or new pulmonary tuberculosis was seen in 33/36 patients. Thirty one patients had chronic hemoptysis, while 6 had massive hemoptysis while thirty two had end stage destroyed lung. Left Right ratio was 24: 12. Double lumen endotracheal tube was used in 32 cases. Standard transpleural pneumonectomy was done in all cases with slight head down tilt of the table. Bronchial closure was done in 2 layers with interrupted Prolene 2/0 & 4/0. Single unclamped chest drain was put in all cases and removed after 24 hours. Results: Thirty day mortality was 1/36 (2.7%). Morbidity included post pneumonectomy BPF 2, post pneumonectomy empyema 3 and wound infection 1. Both bronchopleural fistula and post pneumonectomy empyema were treated by tube thoracostomy initially, while 2 patients subsequently required additional thoracostoma and later space closure. Of these 1 went on to have thoracoplasty. Conclusion: Pneumonectomy proved effective therapy for end stage destroyed lungs with active / recurrent hemoptysis, but post pneumonectomy empyema and BPF are serious complications. Early clamping of the bronchus and avoiding bearing of bronchus reduce morbidity. There is no need to clamp the chest drain, which should be removed after 24 hours.