RESUMEN
Damage to the thoracic sympathic chain is a rare complication of video-assisted thoracic surgery (VATS) pleurectomy. We report our experience with a patient who underwent parietal pleurectomy and bullectomy by VATS and postoperatively suffered from palmar anhydrosis and compensatory controlateral hyperhidrosis. The possible mechanisms of nerve damage and various techniques of performing pleurectomy are discussed.
Asunto(s)
Hiperhidrosis/etiología , Hipohidrosis/etiología , Traumatismos de los Nervios Periféricos/etiología , Neumotórax/cirugía , Sudoración , Nervios Torácicos/lesiones , Cirugía Torácica Asistida por Video/efectos adversos , Adulto , Humanos , Hiperhidrosis/fisiopatología , Hipohidrosis/fisiopatología , Masculino , Traumatismos de los Nervios Periféricos/fisiopatología , RecurrenciaRESUMEN
Much controversy exists regarding the management of chest tubes following pulmonary lobectomy. The objective of this study was to analyse the effect of a new chest tube management protocol on clinical features, such as postoperative air leak, drain characteristics, 30-day postoperative complications and length of hospital stay. We retrospectively analysed 133 patients who underwent pulmonary lobectomy, from January 2005 to December 2008. A new chest tube protocol was introduced on 1 January 2007 and included placement of a single chest tube and early conversion to water seal. The chest tube was removed when air leak had resolved and (non-chylous) fluid drainage was <400 ml/day. The results of patients in the old (n=68) and the new protocol (n=65) were compared. In the new protocol group the median duration of air leak and duration of chest tube drainage declined significantly. Also the length of hospital stay decreased significantly to a median of eight days. The number of reinterventions and 30-day morbidity and mortality rates did not differ significantly. Our data suggest that placement of a single chest tube and early conversion to water seal decreases the duration of air leak and chest tube drainage and length of hospital stay.