Videothoracosopy in diagnosis and surgical treatment of tuberculosis

From 1993 to May 2001, 795 psychiatric patients were treated including 563 with pleural effusion, 98 with multiple or solitary tuberculoma, 69 with tuberculous empyema, 14 with fibrotic-cavitary tuberculosis, 51 with disseminated tuberculosis. Mean age of the patients was 32 years. Survey of pleural cavity with pleural or lung biopsy was performed in 691 patients. In tuberculoma 14 lobectomies were performed, 23 patients underwent atypical lung resection without stapler (including with precise technique). Bilateral on-stage interventions were made in 32 patients. In empyema necrectomy and lung decortication were performed. 14 patients underwent videocavernoscopy with sequestrectomy and cavity drainage. In disseminated tuberculosis lung biopsy without staplers was usually performed. Aerohemostasis was achieved with plasma stream. One patient with empyema and one patient with pleural effusion died (lethality was 0.25%). Rate of postoperative complications was 7.5% in tuberculoma and 1.5% in disseminated tuberculosis. Conversion to thoracotomy was necessary in 3 (3%) patients with tuberculoma and 12 (17%) patients with empyema. Mean hospital stay was 4 days after diagnostic surgery and 7 days after lung resection. In pleural effusion diagnosis was verified in 98% cases, in disseminated tuberculosis--in 100%. Videothoracoscopy is the best diagnostic method for pleural effusion and disseminated forms of lung tuberculosis and operation of choice in tuberculoma and empyema. Videothoracoscopy in tuberculosis is highly effective and associates with low rate of postoperative complications and lethality.     

Surgical treatment of 'short stump' bronchial fistula.

OBJECTIVE: The optimal management of bronchial fistulae remains a surgical challenge. To assess the relative efficacy of the transsternal approach in the treatment of short stump bronchial fistula we analyzed a cohort of patients who underwent this type of surgery in our department during an almost 19 year period. METHODS: Of a series of 49 patients with short stump bronchial fistula who were treated via the transsternal approach, 15 underwent bifurcational sleeve resection and 34 had tracheal wedge resections. In 19 cases the tracheal defects was up to 30 mm in diameter, in the remaining 30 cases the length was less than 10 mm. In all cases tracheobronchial fistulae were associated with concomitant empyema. Surgical debridement of the empyema cavity was achieved by VATS application. In five patients who underwent primary surgery for lung cancer tumor recurrence was seen in distal margins of the resected defect. RESULTS: There was no intraoperative mortality. Two patients died from acute pneumonia at postoperative day 3 and adult respiratory distress syndrome (ARDS) at postoperative day 7, respectively. Two further patients died due to anastomotic dehiscence from sepsis and respiratory failure the overall hospital mortality being 8 (16%). Major complications included one right pulmonary artery injury (2%), two healing disturbances after tracheal wedge resection and five after sleeve resection of the bifurcation. Late complication occurred in six patients (13.3%) with delayed healing at the suture site who later required treatment, two of these required additional stent applications. CONCLUSIONS: Surgical treatment of patients with short stump tracheobronchial fistulae by means of a transsternal approach allows reliable closure with low mortality and morbidity.