12 YEARS EXPERIENCE OF SURGICAL MANAGEMENT OF PULMONARY ASPERGILLOMA

Abstract

OBJECTIVE: To analyze the results of surgery in the management of PulmonaryAspergilloma.METHODOLOGY: Computerized records of 450 cases of diagnosed PulmonaryAspergilloma 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 foraspergillus, sputum culture, Computed Tomography, Pulmonary Function Testsand Bronchoscopy were performed in all cases. Type of pulmonary resectiondone according to extent of the disease. All patients underwent preoperativeanesthetic evaluation by anesthetist and one lung ventilation during surgery andspecimen 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 mostcommon symptom was hemoptysis (92%) followed by persistent chest pain(30.7%) and recurrent cough with sputum (23%). The most common underlyinglung disease was tuberculosis in 407 (90.44%), whereas lung abscesswas present in 42 (9.33%) and lung cancer in 1(.22%) case. Simple Mycetomawas observed in 22 (4.88%) cases whereas complex Mycetoma was diagnosedin 428 (95.11%) cases. The procedures performed were Lobectomyin 380 (84.44%) cases, Bilobectomy 36 (8%), wedge resection 22 (4.8%) andPneumonectomy in 12 (2.66%) cases. Postoperative complications occurred in32 (7.11%) patients, of which 15 (3.33%) had prolonged air leak, 4 (.88%) hadsignificant 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 respiratoryfailure and one patient due to pulmonary embolism.CONCLUSION: Even surgical resection for complex aspergilloma can be donewith low morbidity and mortality rate in a high volume center with harmonic and intercostal muscle flap utilization.