THORACOPLASTY (TAILORED) REVISITED FOR HIGH RISK PATIENTS WITH NONRESOLVING TUBERCULOUS APICAL LUNG CAVITIES

Abstract

Objective: To evaluate the efficacy of thoracoplasty using thoracic epidural anaesthesia for relief of fever, sputum production and haemoptysis in pulmonary high risk patients with non-resolving apical lung cavities due to tuberculosis.

Study Design: Observational descriptive study.

Place and Duration of Study: PNS Shifa and Combined Military Hospital Peshawar and Rawalpindi, from Jul 2012 to Apr 2018.

Methodology: Patients of all ages of either sex with non-resolving apical lung cavities who had documented medical treatment failure along with functional vital capacity (FVC) and forced expiratory volume in one second (FEV1) less than 40% of predicted for their age, sex, and height were selected. Sample size was 30. It was non-probability convenient sampling. We performed tailored thoracoplasty using epidural anaesthesia only. A maximum of four complete ribs were removed while preserving 1st rib in all cases along with plication of upper lobe. Patients were assessed 4 weeks after surgery as outpatients for quantitative decrease in productive cough and relief of fever and haemoptysis.

Results: The mean age was 47.3 years and SD of 16.6 years. Number of male and female patients were equal. Most of the patients were discharged within first post op week. Overall, 30 (83.3%) showed improvement with thoracoplasty, 83.3% patients had relief of cough, 82.6% had decreased frequency of sputum and 92.6% had relief of haemoptysis. Most common complications associated with epidural analgesia was postoperative hypotension 6 (23.07%) and atelectasis 3 (11.5%). There was no death related to the procedure.

Conclusion: Thoracoplasty is a safe procedure associated with significant improvement in symptoms related to non-resolvingapical cavities.