Thymectomy for myasthenia gravis: Peshawar experience of 27 cases in five years

ABSTRACT

To determine the safety and efficacy of Thymectomy for myasthenia gravis. This observational descriptive study was conducted at Departments of Cardiothoracic Surgery and Neurology Lady Reading Hospital Peshawar from January 2002 to December 2006. Computerized clinical data of 27 diagnosed cases of myasthenia gravis that underwent thymectomy were retrospectively analyzed. Patients who were unfit for surgery were excluded from the study. CT scan was done in all patients apart from routine investigations. Preoperative medication included anticholinesterase drug. They all underwent Thymectomy via median sternotomy. A total of 27 patients [09 males and 18 females] with a mean age of 30.5 years [range 15-50 years] were analyzed. The preoperative duration of the disease ranged from 0.5 to 120 months [mean=25.72 +/- 30.68 months]. According to the Myasthenia Gravis Foundation of America [MGFA] clinical classification, 20 [74.07%] patients were in stage two while 7 [25.925%] patients were in stage three. The histology of thymus glands consisted of hyperplasia in 12 [44.4%] patients, normal in 10 [37.1%], atrophic thymus in 3 [11.1%] and thymoma in 2 [7.4%] patients. Hospital mortality was 7.4% [n=2/27] while morbidity was 3.7% [n=1/27]. The mean follow up period was 31.5 months [3-63 months]. Complete remission was achieved in 55.55% [n=15/27] patients, and marked improvement in 25.92% [n=7/27], for a total benefit rate of 80%. Five [18.51%] patients remained unchanged and had no clinical improvement. Thymectomy is a safe and effective treatment for patients with myasthenia gravis