Kardiochirurgia I Torakochirurgia Polska最新文献

Introduction: Spontaneous pneumothorax is a life-threatening thoracic condition that could be either primary spontaneous pneumothorax (PSP) in the absence of an underlying lung disease or secondary spontaneous pneumothorax (SSP) in the presence of an underlying lung disease. In the case of recurrent, contralateral spontaneous pneumothorax or persistent air leak with a chest drain, surgery with bullectomy associated with pleurectomy or pleurodesis is the gold standard management.

Aim: To compare two different techniques for bullectomy, either by using staplers or by hand sewing.

Material and methods: Retrospective review of all patients with spontaneous pneumothorax who underwent bullectomy and pleurectomy by thoracotomy. Group A (30 patients) had repair by using staplers and group B (30 patients) had repair using the hand sewing technique.

Results: The mean operative cost was 4400 ±433.4 Egyptian pounds (EGP) versus EGP 2733.3 ±253.7 in group A and group B respectively (p = 0.001). Mean post-operative cost was 1000 ±100 EGP in group A compared to EGP 2060 ±154.4 in group B (p = 0.0001). Duration of air leak was 1.8 ±1.095 and 9.1 ±3.2 days in group A and group B, respectively (p = 0.0001). Re-exploration occurred in 1 patient in group A (3.3%) and 2 patients in group B (6.6%) (p = 0.5).

Conclusions: The operative cost was significantly higher in the stapler group compared to the hand sewing technique group. However, the duration of post-operative air leak, post-operative hospital stay and post-operative cost were significantly lower in the stapler group. There was no significant difference between the 2 groups in the re-exploration rate after surgery.

Introduction: Coarctation of the aorta (CoA) patients often experience recoarctation, the reoccurrence of aortic narrowing, presenting a considerable clinical challenge.

Aim: This study aims to investigate the triggers or contributing factors associated with the development of recoarctation (reCoA) following the initial repair of CoA.

Material and methods: The retrospective cohort study includes information about 120 patients, who underwent 4 different types of surgical repairs of coarctation of the aorta through left thoracotomy in the period 2012-2022. Recoarctation was evaluated using the pressure gradient on the coarctation site measured by echocardiography (echoCG). A threshold of more than 20 mm Hg was employed to define recoarctation. All statistical analysis was performed using SPSS and Jamovi applications.

Results: The study revealed that 30 (25%) patients experienced early recoarctation, while 52 (43.7%) patients encountered late recoarctation. Among the 28 (23.3%) patients who had arch hypoplasia, 12 experienced early recoarctation, and 22 exhibited late recoarctation. Correlation tests demonstrated a strong negative correlation of the z-score of the arch size with both early recoarctation (r = -0.229, p = 0.013) and late recoarctation (r = -0.421, p < 0.001). Resection and end-to-end anastomosis (EEA) displayed the highest proportions of early (59%) and late (77%) recoarctation.

Conclusions: Aortic arch hypoplasia emerges as a significant risk factor for both early and late recoarctation. Additionally, while all coarctation repair methods carry some risk of recoarctation, resection and end-to-end anastomosis and prosthetic patch aortoplasty may pose a higher risk compared to extended end-to-end anastomosis.

Introduction: Chest wall tumors, though rare, represent a significant subset of thoracic neoplasms, accounting for approximately 5% of thoracic and 2% of overall body neoplasms. Their management has historically posed challenges for surgeons, often leading to misdiagnosis, incomplete resection, and high complication rates. An individualized surgical approach, tailored to the specific characteristics of the disease, is crucial for optimizing outcomes.

Aim: To evaluate the outcomes of chest wall masses and report on individual cases.

Material and methods: This retrospective cohort study included 131 patients diagnosed with chest wall masses at Ghaem University Hospital between 2011 and 2021. Data on demographics (age, gender), pre- and post-operative pathology, specific surgical procedures performed, duration of hospitalization, need for post-surgical reconstruction (e.g., flap reconstruction), and history of pre-operative chemotherapy/radiotherapy were collected from medical records. Data were analyzed using descriptive statistics and appropriate inferential tests depending on the variable type. Potential limitations such as missing data or selection bias were acknowledged.

Results: A total of 131 patient records were examined, with an average age of 17.35 ±38.51 years. Of these, 50 (38.2%) were female and 81 (61.8%) were male. It was found that 54.2% of patients had benign tumors, while 45.8% had malignant tumors. Sarcoma (26%) and fibromatosis (21.4%) were the most common tumor types. No significant associations were observed between gender or history of chemotherapy and radiotherapy and the type of surgery performed (p > 0.05). However, a significant association was found between tumor histology and the type of surgery performed (p < 0.05).

Conclusions: The majority of procedures performed were for fibromatous and benign tumors, while the most common malignant tumors were sarcomas, with chondrosarcoma being the predominant subtype. Tumor type significantly influenced the extent of resection and need for chest wall reconstruction.