Sternotomy after retrosternal esophagogastric anastomotic disruption: a case report.

Disruption of cervical esophagogastric anastomosis after retrosternal stomach transposition remains a dangerous complication. We report a case of cervical gastric disruption after retrosternal gastric transposition in a 36-year-old man that required sternotomy for reanastomosis. After sternotomy, gastric mobilization was possible, in order to gain sufficient length for a new cervical esophagogastric anastomosis.

Pulmonary complications following major lung resection for benign and malignant lung diseases.

OBJECTIVE: To assess the incidence and to identify the possible associated risk factors for postoperative pulmonary complications after major lung resection. SUBJECTS AND METHODS: One hundred and sixty-eight consecutive patients undergoing major lung resection for benign and malignant lung disease over a 3-year period were included in the study. Preoperative assessment clinical parameters, intraoperative and postoperative events were recorded. Pulmonary complications were noted according to a precise definition. The risk of complications associated with age, comorbidity, forced vital capacity (FVC), blood transfusion and extended operation was evaluated using logistic regression analysis. RESULTS: The mean age of the patients was 47.1 years (range 16-80 years), 137 (77%) patients underwent lobectomy, 23 (14%) pneumonectomy, and 15 (9%) bilobectomy. Forty-six (27%) patients developed postoperative pulmonary complications and 2 (1.1%) died within 30 days following the operation. Age > or =65 years (OR 3.7, 95% CI: 1.5-8.6, p = 0.002), the presence of comorbid cardiopulmonary disease (OR 0.2, 95% CI: 0.1-0.5, p = 0.001), FVC <50% (OR 0.2, 95% CI: 0.1-0.8, p = 0.02), blood transfusion (OR 0.2, 95% CI: 0.1-0.4, p = 0.0001), and extended operation (OR 0.2, 95% CI: 0.07-0.6, p = 0.005) were the identified factors associated with the development of postoperative pulmonary complications, which necessitated an increased length of hospital stay. CONCLUSION: Postoperative pulmonary complications are more likely to develop in patients with age > or =65 years with comorbid cardiopulmonary disease, FVC <50%, blood transfusion, and extended operation.

Video-assisted thoracoscopic surgery for primary spontaneous pneumothorax: clinicopathological correlation.

OBJECTIVE: To compare the identifiable pulmonary abnormalities during thoracoscopy with the histological findings in patients requiring surgical intervention for recurrent or persistent primary spontaneous pneumothorax (PSP) and correlate these with the postoperative events. METHODS: From January 1999 to December 2002, 94 consecutive patients underwent video-assisted thoracoscopic wedge excision and apical pleurectomy for PSP. Vanderschueren's classification was used for macroscopic staging and histological observation for microscopic features. Clinical data of these patients and the outcome of surgery were described. RESULTS: All patients were successfully treated using video-assisted thoracoscopic technique. Recurrent pneumothorax was the most frequent indication for surgery, occurring in 60 cases. The method of management was stapling of an identified bleb or apex of the upper lobe and apical pleurectomy. In 67 cases (71%), clear bullae were found in types III and IV. In 15 cases (16%), type II pleuropulmonary adhesions were identified and in 12 (13%) cases thoracoscopy failed to reveal any abnormality (type I). The actual site of air leakage could be located during thoracoscopy in 24 (26%) patients. Histologically, 74 patients had subpleural bullae/blebs formation and 20 had emphysema without bullae. Fifty-three patients had cellular infiltration and 82 had pleural fibrosis. In the microscopic examination, the actual site of air leakage could be located at the site of subpleural blebs or bullae in 15 patients and elsewhere at the lung surface in five other patients. Postoperative prolonged air leak occurred in 4 out of 12 patients in type I and in two of the remaining patients, p=0.001. Mean follow-up is 48 months (range, 30-60 months) for all patients. Pneumothorax recurred in three patients (3.1%). Two patients from type I (16.6%) and one patient from the other types (1.2%) had recurrence (p=0.01). CONCLUSIONS: Video-assisted thoracoscopic stapling of an identified bleb or apex of the upper lobe and apical pleurectomy represents the standard treatment for the majority of recurrent or persistent PSP. Most patients with surgically treated PSP have subpleural blebs or bullae or isolated emphysema. In type I cases, simple apical excision and apical pleurectomy are not sufficient and perhaps additional talc poudrage might be indicated.