ABSTRACT
Objective: To assess the efficacy of intercostal nerve protection by intercostal muscle [ICM] flap in post-thoracotomy pain improvement compared to intracostal suturing
Methods: In a randomized controlled trial, ninety-four patients undergoing posterolateral thoracotomy surgery were divided into two subgroups. Intracostal sutures in isolation and in combination with ICM flap techniques were used for thoracotomy closure in both groups. Numeric Pain Scale and Visual Pain Scale as pain scores were assessed on the first, second, third, fourth, fifth, sixth and seventh postoperative days and follow-up visits during the 2[nd] week, 1[st], 2[nd], 4[th] and 6[th] months after thoracotomy
Results: Out of 94 patients, 58 were male and 36 were females. While the mean age of patients in intracostal group was 45.3 +/- 17.6 years, it was 47.4 +/- 16.1 years in intracostal plus ICM flap group. The mean operation time for the first group was 191.0 +/- 74.7 minutes, while it was 219.3 +/- 68.8 minutes in the second [p>0.05]. Numeric rating score and visual pain scale did not demonstrate any significant difference in pain severity on postoperative days and follow-up visits between both groups [p>0.05]. Although the trend of pain reduction was significant in each group [p<0.001], the difference was not statistically significant [p>0.001]
Conclusion: Intracostal sutures in combination with muscle flap did not reduce postoperative pain in thoracotomy compared with intracostal sutures alone in thoracotomy closure
ABSTRACT
Thoracobiliary fistula is a rare complication of hydatid cyst of the liver especially in the calcified form. Surgery is the only medical option. The treatment consists of radical surgical procedures in the majority of the patients. Conservative surgical treatments are performed with high mortality rate. Herein, we will describe two patients of calcified hydatid cysts of the liver whose condition becomes complicated with Thoracobiliary fistula. The first patient was treated with right thoracotomy and resection of pleural hydatid cysts. Then, were evacuated the ruptured laminated membrane and daughter cysts of infected hepatic hydatid cysts through diaphragmatic opening and sub diaphragmatic drainage of the calcified liver hydatid cyst. The second patient was also treated with right thoracotomy, resection of pulmonary hydatid cysts, evacuation of ruptured bile stained laminated membrane and daughter cysts of hepatic hydatid cysts through diaphragmatic opening and sub diaphragmatic drainage of the calcified cyst cavity. Our patients underwent conservative surgery which posed a severe risk. Both cases are discussed together with review of the literature