EARLY RESULTS OF 100 CASES OF MUSCLE SPARING MID AXILLARY VERTICAL THORACOTOMY

Abstract

Objective: To analyze the surgical outcome of muscle sparing mid axillary vertical thoracotomy.Methodology: Computerized clinical record of 100 cases of different chest pathologies in which muscle sparing mid axillary vertical thoracotomy was carried out at the Department of Cardiothoracic Surgery Unit, Post Graduate Medical Institute, Lady Reading Hospital Peshawar from January 2009 to December 2010 were retrospectively analyzed. Patients of all ages, both sexes and consenting to the procedure with diagnosis of hydatid Lung disease, Bullous Lung diseases, Clotted hemothorax, Foreign Body, Early Empyema, Recurrent pneumothorax, Solitary Pulmonary Nodule, Bronchiectasis and Diagnostic biopsy were included in this study. Patients with diagnosis of Fibro thorax, malignancies, Chronic Empyema, Indication for Emergency Thoracotomy and previous history of Thoracotomy were excluded from this study. Visual analogue scaling for pain was done in patients during stay at hospital where as evaluation of range of motion and cosmetic satisfaction done at one week follow-up.Results: Out of 100 cases evacuation of clotted hemothorax was done in 22 (22%), Lobectomies 12 (12%), Decortications 17(17%), Hydatid Cystectomy 13(13%), removal of Foreign Body 5 (5%), Pleurectomy 10(10%), Bullectomy 5(5%), Wedge resection 10 (10%), Pneumonectomy 1 (1%) and Open Pleural Biopsy was done in 5 (5%) cases. Mean duration of surgery was less than 45 minutes and length of hospital stay was 3 days. Morbidity was 3 % including wound infection 2 cases and Post-Op Pneumothorax in 1 case. There was no mortality. According to visual analogue scale for pain 76% of patients were in 2-3 Visual Analog Scale on day 1, 80% on day 2 and 90% on day 3 before discharge. At one week follow up most of the patients (70%) showed good range of motion and 75% patients satisfied with good cosmesis.Conclusion: Vertical Mid Axillary Muscle Sparing Thoracotomy incision provides acceptable access for most thoracic procedures, lesser operative time, decrease length of hospital stay, reduces post-operative pain, ensure good shoulder mobility and good cosmesis.