Anterior mediastinal plasty during pneumonectomy as prevention of mediastinal hernia in patients with widespread pulmonary tuberculosis

Abstract

After pneumonectomy for widespread pulmonary tuberculosis with total destruction of one lung, the tissue of only lung, often containing TB foci, overstretches and prolapse into opposite hemithorax, so anterior mediastinal hernia is developed. In the overstretched lung tissue ventilation is disrupted, followed by emphysema, but overstretching of TB foci leads to the progression of tuberculosis.

Our purpose is to demonstrate the results of anterior mediastinal plasty (AMP) during pneumonectomy, which consists in the formation of a pleural leaf duplicature in the anterior mediastinal zone what prevents the development of a pulmonary hernia.

We studied the dynamics of X-ray and functional parameters in 71 patients with fibrotic cavernous tuberculosis, of which 36/71 (50,7%) performed AMP during pneumonectomy and 35/71 (49,3%) pneumonectomy was done without AMP.

Results: After surgery in 24/35 (69,0%) patients without AMP during pneumonectomy small and large hernias were formed. In contrast, only 8/36 (22,2%) of patients who had pneumonectomy with AMP a small-volume pulmonary hernia was developed.

In the group of patients without AMP during pneumonectomy in the postoperative period, indicators of FVC, FEV1 were lower, than in group with AMP, and in 27 (79,6%) patients ECG registered sinus tachycardia and extrasystole. In in the group of patients with AMP after surgery sinus tachycardia was registered only in 8 (22,2%).

Conclusion: functional advantages of anterior mediastinal plasty during pneumonectomy allow us to recommend its use in the surgery of widespread pulmonary tuberculosis.