Intrathoracic biopsies, pulmonary wedge excision, and management of pleural disease: is video-assisted closed chest surgery the approach of choice?

Few studies define differences between video-assisted thoracic surgery (VATS) over conventional posterolateral thoracotomy (PLT) for limited procedures. We propose that length of hospital stay (LOS), the days of requirement for narcotic analgesia (DNA) by epidural, intravenous, intramuscular, or oral administration, operating time (OT), return to pre-operative functional status (RT), and the achievement of a therapeutic objective are not dependent on the approach taken (VATS or PLT) for selected diagnostic and therapeutic procedures for pleural, pulmonary, or mediastinal disease. A total of 102 consecutive patients (52 males, 50 females, age 48 +/- 16 years) were eligible to undergo (VATS) for diagnosis and/or treatment of lung lesions, pleural disease, persistent pneumothorax or mediastinal lesions. Seventy-two underwent VATS only and 21, conventional posterolateral thoracotomy (PLT). Nine VATS patients were converted to PLT, for completion of lobectomies after VATS staging of resectable malignancy (6), extensive decortication (2), and giant bullectomy (1). VATS and PLT were compared according to OT, LOS, DNA, RT, achievement of diagnostic and/or therapeutic objective, and morbidity and mortality. After VATS only and PLT only, LOS was 4.8 +/- 2.7 and 7.8 +/- 4.6 days, respectively (P < .03). DNA was 3.4 +/- 2.1 and 6.1 +/- 3.6 days after surgery, respectively (P < .01). RT was 12.0 +/- 11.2 and 21.4 +/- 9.5 days, respectively (P < .01). OT was 80 +/- 34 and 95 +/- 32 minutes, respectively (P = ns). Among 9 conversions from VATS to PLT LOS was 11.4 +/- 5.5, DNA 6.9 +/- 4.4 and RT 20.1 +/- 6.0 days.(ABSTRACT TRUNCATED AT 250 WORDS)

Pancreatic denervation for pain relief in chronic alcohol associated pancreatitis.

To denervate the pancreas of sensory afferents, 15 patients with intractable pain of chronic alcohol induced pancreatitis underwent left transthoracic splanchnicectomy with concomitant bilateral truncal vagotomy. All were malnourished and 11 were addicted to opiates. No respite had been obtained from 33 previous operative procedures. Each patient experienced almost immediate pain relief. Five, however, later had return of pain, but only to the right epigastrium. These five then underwent right transthoracic splanchnicectomy, after which four noted complete and apparently permanent disappearance of pain. In those 14 with a successful outcome there has been a 29 per cent mean increase in body weight, break of hard drug addition in ten of the 11 so afflicted, and return to gainful work or a relatively normal lifestyle in all 14 at a mean follow-up of 16 months. Although 11 of the 14 do have delayed gastric emptying, only one has required a drainage procedure. There have been no other late complications. This approach for control of incapacitating pain in chronic pancreatitis is both safe and simple and at the same time it appears to be reasonably reliable.