Need for chest tube after video assisted thoracoscopic [VATS] lung biopsy

To observe the effects of early removal of chest tube drain after video assisted thoracoscopic [VATS] lung biopsy. We prospectively evaluated the removal of chest tube drain at six hours or 24 hours after the VATS-lung biopsy in fifty consecutive patients with no evidence of air leak after the lung biopsy. Our results show that removal of chest tube drain at 6 hours was not associated with complications such pneumothorax, atelectasis or pleural effusion as compared to the 24 hours removal of the drain[p>0.05]. Early removal of chest tube drain is safe in patients where air leak has been documented to be absent. Since it was a non-randomized evaluation, further randomized study in our population is needed to confirm these findings

experience of 108 cases of esophagectomy using left thoracolaparotomy and cervical anastomosis with feeding jejunostomy, without gastric drainage procedure

Objective: To study efficacy and safety of esophagectomy using left thoracolaparotomy and left neck anastomosis with feeding jejunostomy, but no gastric drainage procedure

Design: An observational descriptive study

Place and Duration: Department of Cardiothoracic Surgery, Postgraduate Medical Institute, Lady Reading Hospital Peshawar from June 2002 to September 2004

Subjects and Methods: Computerized clinical data of 108 surgically treated patients during twenty eight months was retrospectively analyzed. Detailed scrutiny of record was carried out to determine the suitability and safety of the surgical procedure and surgical outcome

Results: A total of 108 patients underwent esophagectomy through left thoracolaparotomy and left neck incision. Male: Female was 72: 36, age range was 18 - 72 years with a mean age of 42.3 years. The predominant clinical presentation was dysphagia. Tumor level was upper third of thoracic esophagus in 3 [2.7%], middle third in 48 [44.4%] and lower third in 57 [52.7%] patients. Tumor histology was squamous cell carcinoma in 72 [66.6%] and adenocarcinoma in 36 [33.3%] patients. The mean operative time was 155 [25 +/- ] minutes. Postoperative morbidity was 19.4% [21/108]. The complications were anastomotic leak in 7[6.5%], Hoarseness in 6[5.5%], aspiration in 3[2.7%]; reopening in 1[0.9%] and stricture in 4[3.7%] patients. The overall mortality was 8.3% [9/108]. Deaths were due to anastomotic leak in 3[2.7%] tracheal injury in 2[1.85%], respiratory failure in 2[1.85%] and pulmonary embolism in 2[1.85%] patients. 28 patients were lost to follow-up while incisional hernia was seen in 1, hoarseness in 3 and stricture in 3 patients over a last one month to 2 years follow-up. Recurrence occurred in 3/108 [2.77%]; one developed malignant ascities, after 4 months, one developed nodule in hypopharynx after 18 months, and one developed a subcutaneous nodule on the back after 14 months

Conclusion: Left thoracolaparotomy and cervical anastomosis is a safe approach for carcinoma of the esophagus. A 30 day mortality of 8.3% in a large series of 108 oesophagectomies with 2.7% recurrence and 19.4% morbidity speak volumes for the technique. Omitting a gastric drainage procedure does not adversely effect the outcome, while routine placement of a jejunostomy feeding catheter is a safe and cost effective mode of nutrition. Neck anastomosis gives a generous tumor free margin, a s a 11 except one resection margin was free o f tumor. T his i s further consolidated by only 3 cases of recurrence out of 80, with 28 being lost to follow up

Pneumonectomy for benign lung disease

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 and 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 and 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

Evaluation of role of chest physical therapy in thoracic surgery

Study was conducted to evaluate the efficacy of post operative chest physiotherapy in cases of thoracic surgery. Eighty patients who underwent various surgical procedures were divided into two groups: one where adequate physiotherapy was carried out and the other where adequate physiotherapy could not be carried out. It was found that rate of postoperative complications was double in the group where chest physiotherapy could not be carried out due to any reasons

Surgical treatment of pulmonary hydatid disease

To study the outcome of surgical treatment of pulmonary hydatid disease.This study comprised of two hundred patients, operated for pulmonary hydatid disease in Cardiothoracic unit, LRH, Peshawar form 01.07.1990 to 30.06.2000. The preoperative work up, apart from history and examination included FBC, LFTs, Blood grouping, chest X-ray PA and Lateral views, Casoni's test, haemagghitination test. Ultra sound abdomen and chest, and CT thoracic. Patients were operated for cystectomy, lobectomy decortication, thoracoplasty and combined pulmonary and hepatic cystectomy as required. All patients were put on post operatively mebendazole for at least 28 days. Patients were followed up for complication. Two hundred patients underwent surgery for pulmonary hydatid cyst over a ten years period. Operations performed were cystectomy 168, lobectomy 24, [primary 18, revision 6], decortications 13 and 1 thoracoplasty. Mortality was 4/200 i.e. 2%. The main/ major morbidity was air leak for which 9/200 patients were re-explored, with resuturing in 3 cases and secondary lobectomy in 6. Cystectomy, without needle aspiration, was found to be the procedure of choice for pulmonary hydatid