Thoracoplasty: Not an obsolete procedure in developing countries

Abstract

OBJECTIVETo assess that thoracoplasty is still a useful space obliterating collapse procedure.MATERIAL AND METHODSThis retrospective observational study was conducted in Thoracic surgery unit Lady Reading Hospital, Peshawar from Jan 2003 to Sep 2010. One hundred and seventy four patients who had thoracoplasty done as a collapse therapy in these seven years and nine months were included in this study. Patients who had other space obliteration procedures like muscle interposition, pleural tenting, were excluded from the study. The demographic data, operative findings, outcome of procedure in terms of postoperative complications, 30 day mortality and duration of ICU and hospital stay were recorded from the data base of patient’s record of the ward. The data was entered and processed on the SPSS10 version.RESULTSStudy included 110 male and 64 female patients, whose age ranged from 12 years to 70 years (mean age 31 years). Out of 174 patients, 114 had complete thoracoplasty, while 60 had partial. Nineteen patients had post operative complications (10.9%). One patient had complete break down of wound, 12 patients had wound infection, 2 patients with partial thoracoplasty were re-opened to do complete thoracoplasty and 4 patients had persisting sinus. Four patients expired (2.2%); 2 did not recover from anesthesia, and 2 of them had persistent sepsis, septicemia and cachexia. Mean ICU stay was 2 days and mean hospital stay was 5 days.CONCLUSIONThere is still a role for this obsolete procedure in selected cases of persistent infected pleural space, with little or no viable lung tissue. The indications are very selective and its use should in no way undermine the role of more conventional procedures, like decortications, lung resection, pneumonectomy, muscle flaps etc.