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
ABSTRACT
Introduction: Gastric drainage disorder is one of the complications of gastric pull-up and esophagectomy after surgery which might lead to esophageal cancer and benign strictures. The aim of this study was to determine the role of pyloromyotomy on gastric drainage
Materials and Methods: In this prospective randomized controlled clinical trial study, we studied 51 patients in two matched groups from July 2008 to August 2010 in Imam Reza Hospital, Tabriz,Iran. Twenty-seven patients in group one had no pyloromyotomy and 24 patients in group two had pyloromyotomy after transhiatal esophagectomy and gastric pull-up procedure. The outcomes were measured as the incidence of gastric outlet compromise which was diagnosed 12 months after esophagectomy and gastric pull-up. Regurgitation, fullness, respiratory distress, coughing and, clinical delayed gastric emptying were observed and compared in two groups by radioisotope gastric emptying scanning
Results: A total number of 51 patients, 19 [37.25%] male and 32 [62.75%] female were studied in this research. The overall incidence of delayed gastric emptying was 19 /51 [37.25%]. Pyloromyotomy did not reduce the incidence of delayed gastric emptying. There was no statistically significant difference in the length of hospital stay in study groups [group 1= 11 days versus 12 days in group 2, P=0.41]. There was no statistical difference in anastomotic leak or anastomotic stricture [P= 0.72]. Mortality was two [one patient, 3.7%, in group 1 and one patient, 4.2%, in group 2]. The incidences of regurgitation and increased gastric emptying were not statistically different in two groups
Conclusion: Pyloromyotomy could not reduce the incidence of delayed gastric emptying after transhiatal esophagectomy, and vagotomy