12 YEARS EXPERIENCE OF SURGICAL MANAGEMENT OF PULMONARY ASPERGILLOMA

Abdul Baseer, Aamir Bilal, Muhammad Imran

Abstract


OBJECTIVE: To analyze the results of surgery in the management of Pulmonary
Aspergilloma.
METHODOLOGY: Computerized records of 450 cases of diagnosed Pulmonary
Aspergilloma were retrospectively analyzed from Jan 2003 to May 2014.
Patients of all ages, both sexes, medically fit and unilateral Pulmonary Aspergilloma were included in the study. Medically unfit and bilateral pulmonary aspergilloma were excluded from the study. Routine investigations, serology for
aspergillus, sputum culture, Computed Tomography, Pulmonary Function Tests
and Bronchoscopy were performed in all cases. Type of pulmonary resection
done according to extent of the disease. All patients underwent preoperative
anesthetic evaluation by anesthetist and one lung ventilation during surgery and
specimen sent for histopathology in all cases.
RESULTS: Out of 450 patients, 255 patients were male and 195 were female,
age ranges from 16 years to 70 years, mean age was 35.6 years. The most
common symptom was hemoptysis (92%) followed by persistent chest pain
(30.7%) and recurrent cough with sputum (23%). The most common underlying
lung disease was tuberculosis in 407 (90.44%), whereas lung abscess
was present in 42 (9.33%) and lung cancer in 1(.22%) case. Simple Mycetoma
was observed in 22 (4.88%) cases whereas complex Mycetoma was diagnosed
in 428 (95.11%) cases. The procedures performed were Lobectomy
in 380 (84.44%) cases, Bilobectomy 36 (8%), wedge resection 22 (4.8%) and
Pneumonectomy in 12 (2.66%) cases. Postoperative complications occurred in
32 (7.11%) patients, of which 15 (3.33%) had prolonged air leak, 4 (.88%) had
significant postop bleeding out of which two required re-exploration, 2 (0.44%)
patients developed Empyema and wound infection occurred in 11 (2.44%) patients. Mortality was 10 (2.2%) of which 09 patients died due to respiratory
failure and one patient due to pulmonary embolism.
CONCLUSION: Even surgical resection for complex aspergilloma can be done
with low morbidity and mortality rate in a high volume center with harmonic and intercostal muscle flap utilization.


Keywords


Pulmonary Aspergilloma; Tuberculosis; Surgery

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