ABSTRACT
AIM: To clarify the indications for reconstructive surgery in patients with diaphragmatic hernia. MATERIAL AND METHODS: Retrospective trial has included 36 patients with diaphragmatic hernia for the period 1963-2017. There were 23 (63.9%) women and 13 (36.1%) men. The majority of patients (83%) underwent surgery at able-bodied age (18-60 years). 27 (75%) patients had hernia of weak diaphragmatic zones, 9 (25%) - posttraumatic hernia. Diaphragm repair was performed with primary suture. In 2 cases of posttraumatic hernia mesh endoprosthesis was used. RESULTS: All patients were discharged. Postoperative complications arose in 4 (11.1%) patients, including 2 cases of mesh endoprosthesis deployment. Long-term outcome was followed-up in 15 patients from 6 months to 17 years. Recurrent hernia was absent in all cases. CONCLUSION: Primary suture is acceptable for diaphragmatic hernia repair. Alloplastic repair is indicated for large defect, when primary suture is impossible or risk of its failure is high.
Subject(s)
Hernia, Diaphragmatic/surgery , Adolescent , Adult , Female , Hernia, Diaphragmatic/etiology , Hernia, Diaphragmatic, Traumatic/surgery , Humans , Male , Middle Aged , Prosthesis Implantation , Retrospective Studies , Surgical Mesh , Young AdultABSTRACT
AIM: To develop examination algorithm and to determine the indications for various options for surgical treatment. MATERIAL AND METHODS: It is presented analysis of surgical treatment of 25 patients with unilateral diaphragm relaxation for the period from 1963 to 2016. There were 15 men and 10 women aged from 39 to 65 years. Diagnosis included predominantly radiological methods. All patients were operated openly through thoracotomy. Procedure consisted of creation of new diaphragmatic cupola at the usual level with two flaps of diaphragm and prosthesis between them. In 12 (48%) patients who were operated before 1990 xenopericardial patch was used. Further, synthetic materials (Teflon, polypropylene) were preferred. RESULTS: Postoperative morbidity and mortality was 20% (n=6) and 4% (n=1) respectively. Long-term results were followed-up within terms from 8 months to 12 years. Recurrent relaxation was absent. Most of patients had improved dyspnea, increased vital capacity and FEV1 in long-term period. Certain and general values of SF-36 life quality questionnaire were high in long-term postoperative period and similar to those in general population.
Subject(s)
Diaphragm/surgery , Respiratory Paralysis/surgery , Adult , Aged , Algorithms , Dyspnea/etiology , Dyspnea/surgery , Female , Humans , Male , Middle Aged , Respiratory Paralysis/complications , Surgical Flaps , ThoracotomySubject(s)
Anti-Bacterial Agents/administration & dosage , Aorta, Thoracic/surgery , Aortic Aneurysm, Thoracic , Blood Vessel Prosthesis Implantation , Hemothorax , Pleurisy , Surgical Wound Infection , Acinetobacter baumannii/isolation & purification , Aged , Aorta, Thoracic/pathology , Aortic Aneurysm, Thoracic/diagnostic imaging , Aortic Aneurysm, Thoracic/physiopathology , Aortic Aneurysm, Thoracic/surgery , Blood Vessel Prosthesis Implantation/adverse effects , Blood Vessel Prosthesis Implantation/methods , Combined Modality Therapy , Enterobacter cloacae/isolation & purification , Female , Hemothorax/etiology , Hemothorax/physiopathology , Hemothorax/surgery , Humans , Pleurisy/etiology , Pleurisy/physiopathology , Pleurisy/therapy , Radiography , Reoperation/methods , Severity of Illness Index , Surgical Wound Infection/etiology , Surgical Wound Infection/physiopathology , Surgical Wound Infection/surgery , Treatment OutcomeABSTRACT
The rigidity of the chest wall, thank to its bone framework, determines the variety of operative access in thoracic surgery, both thoracoscopic and open. The posterior thoracotomy on the bed of the resected rib in ventral decubitus is traditionally but gratuitously rarely used access. The method permits comfortable access to trachea, bifurcation, main bronchi and thoracic esophagus. It can also be used in cases of foregoing thoracothomy. Authors own the experience of 111 cases with the use of posterior thoracotomy in ventral decubitus. The access proved to be preferable for the operations on the membranous part of the trachea and main bronchi, some localizations of thoracic tracheoesophageal fistula. The access suggests fast mobilization of the root of the lung without foregoing pneumolisis, which is important in cases of pleural cavity obliteration after tuberculosis or pleural empyem.
