Tailored thoracomyoplasty as a valid treatment option for chronic postlobectomy empyema
Copyright © 2012 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved..
BACKGROUND: Chronic post-lobectomy empyema is rare but may require space obliteration for infection control. We report our experience by using a tailored thoracomyoplasty for this specific indication with respect to infection control and functional outcome.
METHODS: We retrospectively analyzed 17 patients (11 men, 6 women) with chronic postlobectomy empyema who were treated by thoracomyoplasty in our institution between 2000 and 2011. All patients underwent an initial treatment attempt by use of chest tube drainage and antibiotics except those with suspicion of pleural aspergillosis (n=6). In 5 patients, bronchus stump insufficiency was identified at preoperative bronchoscopy. A tailored thoracoplasty was combined with a serratus anterior-rhomboid myoplasty, which also served to close a bronchopleural fistula, if present. The first rib was resected in 11 of 17 patients.
RESULTS: The 90-day mortality was 11.7%. Thoracomyoplasty was successful in all surviving patients with respect to infection control, space obliteration, and definitive closure of bronchopleural fistula, irrespective of the type of infection, the presence of a bronchopleural fistula, or whether a first rib resection was performed. Postlobectomy pulmonary function testing before and after thoracoplasty revealed a mean predicted FEV(1) of 63.0%±8.5% and 51.5%±4.2% (p=0.01) and a mean predicted DLCO of 59.8%±11.6% and 54.5%±12.5%, respectively. Postoperative shoulder girdle dysfunction and scoliosis were prevented in patients willing to undergo intense physiotherapy.
CONCLUSIONS: Tailored thoracomyoplasty represents a valid option for patients with chronic postlobectomy empyema without requiring a preceding open window thoracostomy. Space obliteration and infection control were equally obtained with and without first rib resection.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2012 |
|---|---|
| Erschienen: |
2012 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:94 |
|---|---|
| Enthalten in: |
The Annals of thoracic surgery - 94(2012), 2 vom: 27. Aug., Seite 387-93 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Fournier, Ian [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
|---|
| Anmerkungen: |
Date Completed 01.10.2012 Date Revised 23.07.2012 published: Print-Electronic Citation Status MEDLINE |
|---|
| doi: |
10.1016/j.athoracsur.2012.02.089 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM217877427 |
|---|
| LEADER | 01000naa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM217877427 | ||
| 003 | DE-627 | ||
| 005 | 20231224035101.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231224s2012 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1016/j.athoracsur.2012.02.089 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n0726.xml |
| 035 | |a (DE-627)NLM217877427 | ||
| 035 | |a (NLM)22595467 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Fournier, Ian |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Tailored thoracomyoplasty as a valid treatment option for chronic postlobectomy empyema |
| 264 | 1 | |c 2012 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 01.10.2012 | ||
| 500 | |a Date Revised 23.07.2012 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2012 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved. | ||
| 520 | |a BACKGROUND: Chronic post-lobectomy empyema is rare but may require space obliteration for infection control. We report our experience by using a tailored thoracomyoplasty for this specific indication with respect to infection control and functional outcome | ||
| 520 | |a METHODS: We retrospectively analyzed 17 patients (11 men, 6 women) with chronic postlobectomy empyema who were treated by thoracomyoplasty in our institution between 2000 and 2011. All patients underwent an initial treatment attempt by use of chest tube drainage and antibiotics except those with suspicion of pleural aspergillosis (n=6). In 5 patients, bronchus stump insufficiency was identified at preoperative bronchoscopy. A tailored thoracoplasty was combined with a serratus anterior-rhomboid myoplasty, which also served to close a bronchopleural fistula, if present. The first rib was resected in 11 of 17 patients | ||
| 520 | |a RESULTS: The 90-day mortality was 11.7%. Thoracomyoplasty was successful in all surviving patients with respect to infection control, space obliteration, and definitive closure of bronchopleural fistula, irrespective of the type of infection, the presence of a bronchopleural fistula, or whether a first rib resection was performed. Postlobectomy pulmonary function testing before and after thoracoplasty revealed a mean predicted FEV(1) of 63.0%±8.5% and 51.5%±4.2% (p=0.01) and a mean predicted DLCO of 59.8%±11.6% and 54.5%±12.5%, respectively. Postoperative shoulder girdle dysfunction and scoliosis were prevented in patients willing to undergo intense physiotherapy | ||
| 520 | |a CONCLUSIONS: Tailored thoracomyoplasty represents a valid option for patients with chronic postlobectomy empyema without requiring a preceding open window thoracostomy. Space obliteration and infection control were equally obtained with and without first rib resection | ||
| 650 | 4 | |a Journal Article | |
| 700 | 1 | |a Krueger, Thorsten |e verfasserin |4 aut | |
| 700 | 1 | |a Wang, Yabo |e verfasserin |4 aut | |
| 700 | 1 | |a Meyer, Antoine |e verfasserin |4 aut | |
| 700 | 1 | |a Ris, Hans-Beat |e verfasserin |4 aut | |
| 700 | 1 | |a Gonzalez, Michel |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t The Annals of thoracic surgery |d 1965 |g 94(2012), 2 vom: 27. Aug., Seite 387-93 |w (DE-627)NLM000026689 |x 1552-6259 |7 nnns |
| 773 | 1 | 8 | |g volume:94 |g year:2012 |g number:2 |g day:27 |g month:08 |g pages:387-93 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1016/j.athoracsur.2012.02.089 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 94 |j 2012 |e 2 |b 27 |c 08 |h 387-93 | ||