ABSTRACT
BACKGROUND: No generally accepted gold standard exists for the operative therapy of rectal prolapse in its variety of manifestations. Existing evidence suggests that an individualized choice of procedure provides the best result for each single patient. Knowledge of possible pitfalls and intraoperative management of complications in frequently applied procedures are important prerequisites for reliable treatment of affected patients. MATERIAL AND METHODS: A consecutive series of 233 patients (June 2011-May 2016) with individualized choice of operative procedure in patients with rectal prolapse and rectocele based on an algorithm for a clinical treatment pathway and stapled hemorrhoidopexy were included. Intraoperative pitfalls and complications and their management (iPCM) were prospectively documented and analyzed. RESULTS: The iPCM could be classified into three different categories: group I: iPCM was immediately noted and intraoperatively treated with no impact on the further clinical course (n = 20), group II: iPCM was successfully treated conservatively within a short time after the procedure (n = 9) and group III: iPCM required surgical revision (n = 5). CONCLUSION: Individualized treatment of rectal prolapse and rectocele requires a broad spectrum of methods in specialized coloproctology units. A clinical treatment pathway facilitates the optimal choice of procedure. Overall the complication rates during surgical treatment of transanal rectal prolapse are low; however, available operative procedures hold specific risks and knowledge of these risks helps to avoid them. Once complications occur, measures demonstrated in this study lead to normal clinical courses in the majority of cases.
Subject(s)
Defecation , Hemorrhoids/surgery , Intraoperative Complications/etiology , Intraoperative Complications/surgery , Rectal Prolapse/surgery , Rectocele/surgery , Aged , Aged, 80 and over , Female , Hemorrhoidectomy/instrumentation , Humans , Laparoscopy/instrumentation , Laparoscopy/methods , Male , Middle Aged , Precision Medicine , Prospective Studies , Reoperation/instrumentation , Reoperation/methods , Risk Factors , Surgical Instruments , Surgical Stapling/instrumentationSubject(s)
Adenocarcinoma, Mucinous/diagnosis , Bile Duct Neoplasms/diagnosis , Bile Duct Neoplasms/surgery , Bile Ducts, Intrahepatic/surgery , Carcinoma, Intraductal, Noninfiltrating/diagnosis , Carcinoma, Papillary/diagnosis , Adenocarcinoma, Mucinous/pathology , Adenocarcinoma, Mucinous/surgery , Aged , Bile Duct Neoplasms/pathology , Bile Ducts, Intrahepatic/pathology , Carcinoma, Intraductal, Noninfiltrating/pathology , Carcinoma, Intraductal, Noninfiltrating/surgery , Carcinoma, Papillary/pathology , Carcinoma, Papillary/surgery , Cholangiopancreatography, Magnetic Resonance , Diagnosis, Differential , Humans , Incidental Findings , Magnetic Resonance Imaging , Male , UltrasonographyABSTRACT
Two group I avian adenoviruses implicated as the possible cause of "fading chick syndrome" in ostriches less than 8 wk of age were isolated in primary chicken embryo liver cells. These viruses were identified by virus neutralization and further characterized by a pathogenicity trial in immature ostriches. The results showed that these isolates were noninfectious in ostrich chicks.
Subject(s)
Adenoviridae Infections/veterinary , Bird Diseases/virology , Fowl adenovirus A/pathogenicity , Struthioniformes , Adenoviridae Infections/pathology , Adenoviridae Infections/virology , Animals , Bird Diseases/pathology , Neutralization Tests/veterinaryABSTRACT
Postpneumonectomy empyema represents a frequently lethal complication. It remains unsolved whether prophylactic antibiotics achieve a bactericidal concentration in the pleural cavity after pneumonectomy. 12 patients undergoing pneumonectomy received ciprofloxacin intravenously (2 x 200 micrograms/d) and orally (2 x 500 micromilligrams/d) during the first and second postoperative week, respectively. 1, 6, 9 and 14 days after the operation the ciprofloxacin concentration was measured in the pleural fluid and serum. Already after 24 hours bactericidal levels (0.56 microgram/ml) were found in the pleural fluid, rising to 1.11 micrograms/ml on day 14 under the higher oral dosage. Thus, it could be demonstrated that during the first two weeks after pneumonectomy high concentrations of an antibiotic similar to the levels in the serum can be achieved in the pleural fluid.
Subject(s)
Ciprofloxacin/administration & dosage , Empyema, Pleural/prevention & control , Pleural Effusion/metabolism , Pneumonectomy , Postoperative Complications/prevention & control , Administration, Oral , Ciprofloxacin/blood , Ciprofloxacin/pharmacokinetics , Female , Humans , Infusions, Intravenous , Lung Neoplasms/surgery , Male , Middle Aged , Postoperative Care , Time FactorsABSTRACT
New data show that perioperative cytostatic therapy is beneficial in the case of liver transplantation for hepatic cancer. However, it has not been established clearly whether chemotherapy interferes with graft rejection. We therefore studied the interactions between tumor growth and graft rejection, especially with regard to chemotherapy, using a combined tumor/transplantation model. As a tumor model, we used the Novikoff hepatoma, a malignant hepatoma that was injected subcutaneously into the backs of rats. Heterotopic heart grafting served as the transplantation model. In a first step (a), we studied the effect of cytostatic therapy on tumor growth: tumor cells were injected, and in four groups epirubicin, cyclosporine, epirubicin + cyclosporine, and placebo were applied, in corresponding groups, transplantation was additionally performed. Tumor growth was measured and the resected tumors were examined by histology and immunohistology. In a second step (b), we studied the effect of chemotherapy on graft rejection: transplantation was performed and the above-mentioned drugs were applied; in corresponding groups, a solid tumor was additionally induced and resected immediately before transplantation. The results of these procedures were as follows: (a) Epirubicin decreased tumor growth and diminished the volume-increasing effect of cyclosporine significantly. After transplantation, tumor growth was similar. (b) Epirubicin prolonged graft survival significantly, and the combination with cyclosporine had an augmenting effect. In the corresponding groups, graft survival was similar. In conclusions. chemotherapy diminishes the tumor-increasing effect of cyclosporine and does not interfere negatively with graft survival. It might therefore be beneficial after transplantation for malignancy.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/adverse effects , Graft Rejection/chemically induced , Graft Rejection/pathology , Heart Transplantation , Liver Neoplasms, Experimental/drug therapy , Animals , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Cyclosporine/adverse effects , Cyclosporine/therapeutic use , Epirubicin/adverse effects , Epirubicin/therapeutic use , Liver/drug effects , Liver/pathology , Myocardium/pathology , RatsABSTRACT
INTRODUCTION: Abdominal actinomycosis is an uncommon disease. Nevertheless it should be considered in case of unclear tumor-like abdominal masses. METHODS: We report a case of a 49-year-old patient with an intrauterine device. The patient was submitted with a solid and painful tumor in the upper abdomen. After sonography, computerized tomography, gastroduodenoscopy and colonoscopy the preoperative presumptive diagnosis was a carcinoma of the transvers colon invading the abdominal wall. Pathological examination after a right hemicolectomy surprisingly revealed an actinomycosis. RESULTS: Based on this case diagnostic tools and therapeutic options of actinomycosis of the colon are discussed. CONCLUSIONS: This case illustrates the importance to consider the possibility of actinomycosis when finding an unclear abdominal mass. After a surgical excision an abdominal actinomycosis requires antibiotic therapy.
Subject(s)
Actinomycosis/diagnosis , Colonic Diseases/diagnosis , Colonic Neoplasms/diagnosis , Actinomycosis/diagnostic imaging , Actinomycosis/drug therapy , Actinomycosis/surgery , Anti-Bacterial Agents/therapeutic use , Colectomy , Colonic Diseases/diagnostic imaging , Colonic Diseases/drug therapy , Colonic Diseases/surgery , Colonic Neoplasms/diagnostic imaging , Colonoscopy , Diagnosis, Differential , Drug Therapy, Combination/therapeutic use , Female , Humans , Middle Aged , Postoperative Care , Tomography, X-Ray Computed , UltrasonographyABSTRACT
UNLABELLED: The purpose of this study was to investigate whether the "Combi-Effect" is specific for the transplanted lung tissue or not. METHOD: In a Guinea-pig to rat model we compared the heterotopic heart-lung transplantation (HLTx, n = 5) with a second heart transplantation (DHTx, n = 5) and a combined heart-kidney transplantation (HKTx, n = 5). Apart from the heart transplant survival time we determined the concentrations of histamine, CH-50, IgG, IgM, leucocytes and thrombocytes in the blood. At time of rejection all tissues were examined histologically and immunohistologically (ED-11, IgG, IgM, OX-39, W3-13, ED-1, NKR-P1, OX-19). RESULTS: We could achieve a significant prolongation of the heart transplant survival time by combined HLTx compared to HTx (25' to 12', p < 0.01). DHTx showed no effect (7' 53" to 11' 27"). But after HKTx the cardiac survival was even longer than after HTx and HLTx (62.8' to 12' and 25', p < 0.01). CH-50 showed significant lower concentrations after HLTx (180 U/l) and HKTx (178 U/l) than after HTx (260 U/l). Thrombocytes and leucocytes were lower, concentration of histamine higher than after HTx (p < 0.01). Immunohistologically C3 revealed a lower deposition in the rejected heart transplants after combined HLTx/HKTx than after isolated HTx. CONCLUSION: The "Combi-Effect" is stronger after HKTx than after HLTx. He is not specific for the lung tissue.
Subject(s)
Graft Rejection/immunology , Heart-Lung Transplantation/immunology , Transplantation, Heterologous/immunology , Animals , Complement Hemolytic Activity Assay , Guinea Pigs , Heart Transplantation/immunology , Immune Tolerance/immunology , Kidney Transplantation/immunology , Rats , Rats, Inbred LewABSTRACT
We report on a patient who suffered chylothorax 2 months after she had undergone internal fixation of a fracture of her 12th thoracic vertebral body. The pleural effusion was treated by insertion of a chest tube. The chylothorax was managed conservatively. The patient received protein-rich nutrition supplemented with medium-chain triglycerides. As the volume of chylous fluid drained from the pleura had not decreased after 2 weeks, the patient received total parenteral nutrition without any oral intake of calories. Chest X-rays documented the disappearance of the chylothorax. Reexpansion of the lungs was noted, and the costophrenic sinuses could be clearly visualised.
Subject(s)
Chylothorax/diagnostic imaging , Fracture Fixation, Internal , Postoperative Complications/diagnostic imaging , Spinal Fractures/surgery , Thoracic Vertebrae/surgery , Chest Tubes , Chylothorax/therapy , Combined Modality Therapy , Fat Emulsions, Intravenous/administration & dosage , Female , Humans , Middle Aged , Parenteral Nutrition, Total , Postoperative Complications/therapy , RadiographyABSTRACT
METHODS: Three hundred forty-two patients with lung cancer and 99 patients with nonneoplastic lung diseases (control group) underwent intraoperative pleural lavage with 300 ml physiologic saline solution before (lavage I) and after resection (lavage II). RESULTS: Studies of the lavage fluid in all control patients were negative, that is, there were no false positive findings. Tumor cells were found in lavage I in 132 patients (38.6%) and also in lavage II in 99 of them. In stage I (pT1 N0, pT2 N0) lung cancer, tumor cell detection was possible in 47 patients (28.6%). The 4-year survival of patients with resected non-small-cell lung cancer was 24% (95% confidence interval, 16% to 32%) if lavage I results were positive and 52% (95% confidence interval, 45% to 59%) if lavage I results were negative (all stages, p = 0.007). For patients with stage I disease (n = 164) the 4-year survival was 35% (95% confidence interval, 18% to 52%) if lavage I results were positive (n = 47), and 69% (95% confidence interval, 60% to 78%) if lavage I results were negative (n = 117) (p = 0.037). On multivariate analysis the positive cytologic result in intraoperative pleural lavage was an additional prognostic factor for our patients. To prove how the tumor cells enter the pleural cavity, we performed tissue cultures of tumor-free parenchyma in 23 cases of lung cancer. Tumor cell detection by histology and immunohistology was possible in 16 cases (69.6%). Detection of tumor cells in pleural lavage fluid before resection proves that tumor cells have spread into the pleural cavity. CONCLUSION: The positive result in pleural lavage seems to be a prognostic predictor for patients with lung cancer.
Subject(s)
Bronchoalveolar Lavage/methods , Intraoperative Care , Lung Neoplasms/complications , Pleural Effusion, Malignant/pathology , Case-Control Studies , Female , Humans , Lung Neoplasms/mortality , Lung Neoplasms/surgery , Male , Middle Aged , Pleural Effusion, Malignant/etiology , Prognosis , Prospective Studies , Reproducibility of Results , Survival Analysis , Tumor Cells, CulturedABSTRACT
Tracheobronchial injuries are rare and associated with other injuries. We report about a traumatic rupture of the left main bronchus into the segmental bronchus of the lower lobe. After resection of the lower lobe a bronchoplastic repair of the main and upper bronchus was performed.
Subject(s)
Bronchi/injuries , Lung Injury , Mediastinal Emphysema/surgery , Adolescent , Female , Humans , Pneumonectomy , Postoperative Care , Respiration, Artificial , Rupture , Suture TechniquesABSTRACT
Subcutaneous adipose tissue from fetal pigs was examined for c-Fos expression in developing adipocytes. Enhanced c-Fos expression was found in the nuclei of adipocytes and cells closely associated with fat cell clusters from 75 and 105 day old fetuses. 50 day old fetuses which had no adipocytes showed no enhanced c-Fos expression in undifferentiated cells. c-Fos expression in adipocytes was not transient, but persisted through the gestational period from 75 to 105 days. The timing of c-Fos induction appears to be closely related to adipocyte differentiation and was found only in developing adipocytes and cells closely associated with fat cell cluster and was not found in independent stromal-vascular cells.
Subject(s)
Adipocytes/metabolism , Adipose Tissue/metabolism , Embryonic and Fetal Development , Gene Expression Regulation, Developmental , Proto-Oncogene Proteins c-fos/biosynthesis , Adipocytes/cytology , Adipose Tissue/cytology , Adipose Tissue/embryology , Animals , Blotting, Western , Cell Differentiation , Cell Nucleus/metabolism , Electrophoresis, Polyacrylamide Gel , Gestational Age , Immunoenzyme Techniques , Immunohistochemistry , Skin , SwineABSTRACT
319 patients with the first manifestation of lung cancer underwent intraoperative pleural lavage (lavage I = after opening the chest; lavage II = after resection of lung cancer). Tumor cells were found in lavage I in 122 patients (38.2%), in 94 of them also in lavage II. In only 9 cases we found tumor cells in lavage II cytologically. The cumulative five-year survival rate of non-small cell lung cancer in stage I (n = 154) was 22.1% if lavage was positive (lavage I and II, n = 44), and 64.3% if lavage was negative (n = 110) (p < 0.05). Additionally, we performed tissue cultures of tumor-free parenchyma in 23 cases of lung cancer. In 16 cases (69.6%) we detected tumor cells by histology and immunhistology. Intraoperative pleural lavage should be done when assessing the final tumor stage. A positive result should be added to the pTNM-classification of lung cancer.
Subject(s)
Carcinoma, Bronchogenic/pathology , Lung Neoplasms/pathology , Pleural Effusion, Malignant/pathology , Adult , Aged , Carcinoma, Bronchogenic/mortality , Carcinoma, Bronchogenic/surgery , Female , Humans , Lung Neoplasms/mortality , Lung Neoplasms/surgery , Male , Middle Aged , Neoplasm Invasiveness , Pleura/pathology , Pleural Effusion, Malignant/mortality , Pleural Effusion, Malignant/surgery , Prognosis , Survival Rate , Therapeutic IrrigationABSTRACT
In a retrospective study of 157 patients undergoing a curative resection of a gastric carcinoma between 1982 and 1992 the correlation of the lymph node status and histomorphologic parameters of the gastric cancer and the significance of the systematic lymphadenectomy were analysed. The patients were divided into two historical groups (exclusively D1- and systematic D1-/D2-lymphadenectomy). Among the histomorphological parameters only the depth of infiltration (pT) revealed a high correlation with the extent of metastatic lymph node involvement. Tumor form, Laurén-classification and tumor localisation only showed a marginal influence on the nodal status. The overall 5-year survival rate was not significantly changed by the systematic lymphadenectomy, only the subgroup of the UICC-stadium II demonstrated a small benefit. The extended systematic lymph node dissection did not rise the complication rate but lowered the rate of local recurrences. In conclusion, the indication for a systematic lymphadenectomy cannot be deducted from the constellation of different histomorphological parameters, but the feasibility of a systematic lymphadenectomy results from the improvement of staging and survival rate at least for the UICC-II-stadium and the reduction of local recurrences.
Subject(s)
Lymph Node Excision , Stomach Neoplasms/surgery , Adult , Aged , Female , Gastrectomy , Humans , Lymph Nodes/pathology , Male , Middle Aged , Neoplasm Staging , Omentum/pathology , Omentum/surgery , Stomach Neoplasms/mortality , Stomach Neoplasms/pathology , Survival RateABSTRACT
We report about two cases of tumor dissemination after thoracoscopic wedge resection of malignant nodules of the lung. In the first case, a metastasis at the extraction site was observed after thoracoscopic resection of a metastasis of the lung. In the second case we diagnosed a pleural carcinosis after thoracoscopic wedge resection (and additional open lobectomy and lymph node dissection) of a pT2 N0 lung cancer. The patient died 12 months after the operation. The indication for thoracoscopic resection of malignant nodules of the lung should be restricted for peripheral tumors smaller than 2 centimetres.
Subject(s)
Adenocarcinoma/surgery , Carcinoma, Adenosquamous/surgery , Endoscopy , Lung Neoplasms/surgery , Neoplasm Seeding , Solitary Pulmonary Nodule/surgery , Thoracoscopy , Adenocarcinoma/pathology , Aged , Carcinoma, Adenosquamous/pathology , Female , Humans , Lung Neoplasms/pathology , Male , Neoplasm Staging , Reoperation , Solitary Pulmonary Nodule/pathologyABSTRACT
In our department, between 1979 and 1994, 254 patients, thereof 171 male, 83 female with the average age of 48.2 years underwent surgery because of stage 1 (T2) to stage 3 melanoma that was located on the trunk. Our retrospective analysis was based on those 211 patients who had been followed up by the department of dermatology in our medical center. It was the aim of our study-apart from determining the long-term-prognosis-to find out the number of patients in whom a curative resection could be only achieved by elective lymph node dissection. The 5-year survival rate amounted to 79% for all patients. For patients suffering from stage 1-disease (T2) it was 93%, for those with stage 2-disease 89%, and in case of stage 3-disease 49% respectively. After ELND had been performed, no lymph node metastases were found in patients (0/22) suffering from a T2-tumor. In case of T3-tumors, in 13% (11/82) and in case of T4-tumors in 30% (13/43) lymph node metastases were found. However, only 5 out of 11 patients, with the established diagnosis of a T3-tumor in whom positive lymph-nodes had been found by ELND, and merely 6 out of the 13 patients with a T4-tumor, are still alive after a mean follow-up period of 74 months. We conclude that ELND is not indicated in patients with T2-melanoma. In case of T3- and T4-melanoma, some doubts exist whether patients really benefit from this surgical procedure. Randomized prospective studies are necessary to clarify the importance of elective lymph node dissection.
Subject(s)
Lymph Node Excision , Melanoma/surgery , Skin Neoplasms/surgery , Adolescent , Adult , Aged , Aged, 80 and over , Female , Follow-Up Studies , Humans , Lymph Nodes/pathology , Lymphatic Metastasis , Male , Melanoma/mortality , Melanoma/pathology , Middle Aged , Neoplasm Staging , Skin Neoplasms/mortality , Skin Neoplasms/pathology , Survival RateABSTRACT
HISTORY AND CLINICAL FINDINGS: A 66-year-old woman was known to have had cholecystolithiasis for at least 4 years. Laparoscopic cholecystectomy was performed at another hospital where histological examination surprisingly revealed middle-grade differentiated carcinoma of the gall-bladder (pT2, G2). A nodular metastasis of the gall-bladder carcinoma was noted on the abdominal wall 3 months later and excised. Lymph-vessel carcinomatosis was already present. The patient again noticed a tumour in the right mid-abdomen and a further tumour was palpated in the epigastrium 5 months after the operation. INVESTIGATIONS: Laboratory and tumour-marker (CEA, CA 19-9) tests were unremarkable, while sonography and computed tomography were highly suspicious for abdominal wall metastases in the epigastrium and right mid-abdomen. TREATMENT AND COURSE: Both metastases were excised. Laparotomy revealed tumour recurrence in the old gall-bladder bed, as well as extensive peritoneal carcinoma. Two months after the operation she developed jaundice, caused by tumour compression of the choledochal duct. An expanding stent was inserted into the stenosed section of the duct. The patient died 13 months after the first operation from the underlying malignancy with multiple liver metastases and malignant ascites. CONCLUSIONS: Indications for minimally invasive surgery in malignant tumour should be narrowly defined. Because tumour seeding is possible after laparoscopic cholecystectomy with incidentally found carcinoma extensive re-excision should be performed.
Subject(s)
Abdominal Neoplasms/secondary , Adenocarcinoma/secondary , Cholecystectomy, Laparoscopic , Gallbladder Neoplasms/pathology , Neoplasm Seeding , Abdominal Muscles/pathology , Abdominal Neoplasms/diagnosis , Abdominal Neoplasms/surgery , Adenocarcinoma/diagnosis , Adenocarcinoma/surgery , Adipose Tissue/pathology , Aged , Cholelithiasis/surgery , Fatal Outcome , Female , Gallbladder Neoplasms/diagnosis , Gallbladder Neoplasms/surgery , Humans , Neoplasm Recurrence, Local/diagnosis , Neoplasm Recurrence, Local/surgery , Reoperation , Time FactorsABSTRACT
Tumor cell detection in lavage fluids might be a prognostic factor in solid tumors. Therefore, 342 patients with the first manifestation of lung cancer underwent intraoperative pleural lavage (lavage I = after opening the chest; lavage II = after resection of lung cancer). Tumor cells were found in lavage I in 132 patients (38.6%), in 99 of them also in lavage II. We found tumor cells in only nine cases in lavage II cytologically. The cumulative 5 year survival rate of non-small cell lung cancer in stage I (n = 164) was 25.9% if lavage was positive (lavages I and II, n = 47), and 69.2% if lavage was negative (n = 117) (p < 0.05). Additionally, we performed tissue cultures of tumor-free parenchyma in 23 cases of lung cancer. In 16 cases (69.6%), we detected tumor cells by histology and immunohistology. Cytologic tumor cell detection in intraoperative pleural lavage in lung cancer seems to be an additional prognostic factor and should be done when assessing the final tumor stage. A positive result should be added to the pTNM classification.
Subject(s)
Carcinoma, Bronchogenic/pathology , Lung Neoplasms/pathology , Pleural Effusion, Malignant/pathology , Carcinoma, Bronchogenic/mortality , Carcinoma, Bronchogenic/surgery , Female , Humans , Lung/pathology , Lung Neoplasms/mortality , Lung Neoplasms/surgery , Male , Middle Aged , Neoplasm Staging , Pleural Effusion, Malignant/mortality , Pleural Effusion, Malignant/surgery , Pneumonectomy , Prognosis , Survival Rate , Therapeutic IrrigationABSTRACT
It was the aim of this study to evaluate the results of surgical therapy in patients with bronchial carcinoma aged younger and older than 70 years. From 1985 to 1995, 130 patients older than 70 years (group 1) and 572 patients younger than 70 years (group 2) underwent thoracotomy for bronchial carcinoma. The 5-year survival rate was significantly worse in the older group (25%) as compared to group 2 (39%). Postoperative complications such as atelectases, pulmonary insufficiency and cardiac problems were more frequent in group 1. Thirty-day mortality was almost double (9.2%) in the older group.
Subject(s)
Carcinoma, Bronchogenic/surgery , Lung Neoplasms/surgery , Pneumonectomy/mortality , Postoperative Complications/mortality , Aged , Aged, 80 and over , Carcinoma, Bronchogenic/mortality , Carcinoma, Bronchogenic/pathology , Cause of Death , Female , Follow-Up Studies , Geriatric Assessment , Humans , Lung Neoplasms/mortality , Lung Neoplasms/pathology , Male , Risk Factors , Survival RateABSTRACT
Since January 1990 we have treated 49 patients with spontaneous pneumothorax (35 primary and 14 secondary cases) by thoracoscopic operation. All patients entered a prospective trial. Those with secondary pneumothorax are discussed here. There have been no major complications. Conversion rate however has been high with 4/14 (29%). Three more patients (21%) not suitable for thoracotomy suffered from persistent air leaks. The other 7 patients needed postoperative drainage for less than 6 days in average. VATS could nevertheless be an alternative to thoracotomy for avoiding prolonged suction treatment in patients with secondary pneumothorax as patients showed no complications or disadvantage after conversion to thoracotomy.
Subject(s)
Endoscopy , Pneumothorax/surgery , Thoracoscopy , Adult , Aged , Aged, 80 and over , Female , Humans , Intraoperative Complications/etiology , Intraoperative Complications/mortality , Intraoperative Complications/pathology , Intraoperative Complications/surgery , Male , Middle Aged , Pleura/pathology , Pleura/surgery , Pneumothorax/etiology , Pneumothorax/mortality , Pneumothorax/pathology , Postoperative Care , Postoperative Complications/etiology , Postoperative Complications/mortality , Postoperative Complications/pathology , Postoperative Complications/surgery , Prospective Studies , Suction , Survival Rate , ThoracotomyABSTRACT
Since May 1990 we have treated 35 patients with spontaneous pneumothorax and without underlying lung disease by thoracoscopic operation. All patients entered a prospective trial. There have been four recurrences during a minimum follow-up of 7 months (median 19 months). Two complete collapses had had only fibrin glue sealant without any resection of bullae. The others were partial relapses not requiring any treatment. There was a striking high incidence of pain complaints and sensory disturbances (13 out of 29) even months after pleurodesis by coagulation or pleurectomy. Reduced trauma and less postoperative restriction of pulmonary function together with low recurrence rates suggest a more liberal indication in patients with their first manifestation of the disease. Nevertheless indication and choice of pleurodesis should be restrictive and be studied further for its specific complications.