[Surgical treatment of recurrent spontaneous pneumothorax: what is the optimal timing?]. / Cirugía del neumotórax espontáneo de repetición: cuándo indicarla?

OBJECTIVES: To analyze the impact on the outcome of video-assisted thoracoscopic surgery (VATS) of delaying surgery in patients with previous episodes of pneumothorax. MATERIAL AND METHODS: We studied 57 surgical procedures for recurrent primary spontaneous pneumothorax. The cases were grouped according to the medical history. One group comprised patients treated surgically at the first episode of contralateral pneumothorax or the second episode of ipsilateral pneumothorax. The second group comprised patients treated surgically at the third or successive episode. We compared the 2 groups as to number of thoracotomies, number of conversions from VATS to thoracotomy, presence of adhesions, and length of postoperative hospital stay. RESULTS: Of the total number of procedures, 13.9% were performed during the third or successive episode. In this group the number of pleuropulmonary adhesions and the percentage of thoracotomies (whether initially indicated or conversions from VATS) was significantly higher (P<.05). However, there was no difference between the 2 groups in length of postoperative stay. CONCLUSIONS: VATS is the technique of choice for the surgical treatment of recurrent primary spontaneous pneumothorax. Such treatment should be performed at the first episode of contralateral pneumothorax or the second episode of ipsilateral pneumothorax since delayed surgery gives rise to a higher incidence of technical difficulties that entail thoracotomies.

[Rapid surgical exploration of the mediastinum]. / Cirugía de corta estancia en la exploración quirúrgica del mediastino.

This study aimed to evaluate the morbidity-mortality of surgical exploration of the mediastinum in patients with mediastinal masses or adenopathy in the context of a rapid-surgery program that has been operating over the past 8 years (1985-1993). A total of 93 mediastinal explorations have been carried out. Sixty-five involved transcervical mediastinoscopy, 20 were anterior mediastinotomies, 4 were combined procedures and 4 were video-thoracoscopies. We found 34 cases of lymphoma, 28 of metastasis of bronchopulmonary carcinoma and 16 of mediastinal-ganglionic tuberculosis; the 15 remaining cases were classified as miscellaneous. No deaths were directly related to the surgical procedures; morbidity involved 2 wound infections. Surgical exploration of the mediastinum is a safe diagnostic procedure, provided it is carried out by an experienced team, and allows care givers to take better advantage of therapeutic options with no loss of quality.

[Contribution of transcervical mediastinoscopy and anterior mediastinostomy to the diagnosis of mediastinal lymphomas]. / Aportación de la mediastinoscopia transcervical y mediastinotomía anterior al diagnóstico de los linfomas mediastínicos.

UNLABELLED: The aim of this study has been to assess the profitability of mediastinal explorations (transcervical mediastinoscopy and anterior mediastinostomy) in the diagnosis of mediastinal lymphomas within a short-stay surgery programme. Out of 129 mediastinal explorations conducted within a period of six years, 63 were programmed as short-stay surgery, 24 of which were due to mediastinal lymphomas. Fourteen patients were discharged from the hospital within the first twelve hours and ten patients, after 24 hours. RESULTS: There were 11 cases of Hodgkin's lymphomas and 13 non-Hodgkin's lymphomas. No immediate complications were developed by the patients, with just two minor complications which did not delay hospital discharge. CONCLUSIONS: Mediastinal explorations (transcervical mediastinoscospy and anterior mediastinostomy) can be planned as short-stay surgery without any risks if they are conducted by groups with experience in these surgical techniques and provided with an adequate care infrastructure. This allows a more rationale usage of hospital resources without reducing the quality of care.