Tracheal resection and end-to-end anastomosis for tracheal stenosis: etiology and outcome

To know the etiology of tracheal stenosis and asses outcome of tracheal resection and end-to-end anastomosis for tracheal stenosis. Descriptive prospective case series. Department of Thoracic Surgery, Combined Military Hospital, Rawalpindi and Quetta from May 2005 to March 2010. Twenty two patients were included in the study who underwent tracheal resection followed by primary tracheal reconstruction by same surgical team. Etiology was ascertained on the basis of available history and per-operative findings. End-to-end tracheal anastomosis was done using vicryl 3/0. Outcome of surgical technique was assessed using peak expiratory flow rate [PEFR] and flexible bronchoscopy. Twenty two patients were managed over a period of five years, of which 17 [77.3%] were male and 5[22.7%] female. Mean patient age was 27.31 +/- 9.61 years. Seven [31.8%] patients had New York Heart Association grade [NYHA]-III and 15 [68.2%] had NYHA grade-IV dyspnoea. Seventeen [77.3%] had stridor. All patients were already being managed by pulmonologists, ENT specialists or intensivists. Twelve [54.5%] had grade-V stenosis [91-100% luminal obstruction] and 9 [40.9%] had cervical tracheal stenosis and 3[13.6%] had mediastinal tracheal stenosis. Six [27.3%] patients had partial cricoid resection followed by thyrotracheal anastomosis, 13[59.1%] patients underwent cervical tracheal anastomosis and 3 [13.6%] patients required mediastinal tracheal anastomosis. Patients were followed up post-operatively for the development of immediate and delayed complications. The follow up was carried out for a minimum period of 6 months to a maximum period of 2 years. Postoperative complications included neck pain, lung collapse, and superficial skin infection. Tracheal resection with end-to-end anastomosis is a safe, reliable and permanent procedure for the treatment of tracheal stenosis

Yield of cervical mediastinoscopy in diagnosis of indeterminate mediastinal lymphadenopathy/masses and staging of lung cancer

To determine the yield of cervical mediastinoscopy in indeterminate antero-superior mediastinal lymphadenopathy or masses and in staging of non small cell carcinoma lung. Descriptive prospective study. Thoracic Surgical unit of Combined Military Hospital Rawalpindi from Jan 2007 to June 2009. Patients were placed in group I for diagnostically indeterminate antero superior mediastinal lymphadenopathy/masses and in group II for staging of non small cell lung cancer [NSCLC] with enlarged mediastinal lymph nodes on CT scan [greater than 10 mm on short axis]. All patients underwent the procedure under general anaesthesia. A plane anterior to trachea was developed using blunt finger dissection until carina. Biopsies of the mass or lymph nodes were taken and sent for histopathology. In case of staging for Carcinoma lung, lymph node stations 2L, 2R, 4L, 4R and 7 were searched and biopsied and sent in appropriately labelled containers for histopathology. Patients were usually discharged on the same day. Forty eight cases were included in this study during the course of 2 1/2 years of period. Twenty nine cases were included in group I and nineteen in group II. In group I chronic caseating granulomas due to tuberculosis were the most cause in 45% of cases followed by 24% cases of lymphoma. In group II, 4 [21%] cases revealed no evidence of malignancy in any lymph nodes and in 11 [57.9%] cases only ipsilateral mediastinal lymph nodes were involved by tumor making it N2 disease. In 4 [21%] cases contra lateral mediastinal lymph nodes were involved by tumor making it N3 disease. Mortality in this study was only one case [3 4%] Mediastinoscopy is minimally invasive cost effective and simple procedure in trained hands for both diagnosis and staging purpose

Management of primary spontaneous pneumothorax by video assisted thoracoscopic surgery [VATS]

To evaluate the outcome of treatment of primary spontaneous pneumothorax by VATS. Case Series. Dept. of thoracic Surgery Combined Military Hospital Rawalpindi between April 2007 to Dec 2009. This study included 20 patients with primary spontaneous pneumothorax who were treated by VATS apical stapling and pleural abrasion/ pleurectomy. All patients were operated under one lung ventilation. Three ports of 10mm were used and apical stappling / bullectomy was done with linear cutting stapler [ethicon, autosuture]. This was combined with pleural abrasion/ pleurectomy, Chest was drained via a single chest tube. We had 21 procedures on 20 patients. There were 18 males and 2 females [9:1]. Mean age was 26.4 years. Indications included persistent air leak 7, recurrent attack 12, contralateral recurrence 1 and professional hazard 1. Mean hospital stay was 3.2 days. Complications included minor port site infection 5, intercostals neuralgia 3, delayed lung expansion 2 cases and persistent apical space in 1 case. There is no recurrence. VATS was a reliable approach for managing primary spontaneous pneumothorax with low morbidity