After pneumonectomy, there is mobility of the mediastinum, which resonates directly with the ventilation of the remaining lung and with the hemodynamic stability. Complications such as acute respiratory distress syndrome (ARDS), acute lung edema and cardiac arrhythmia may be directly related to mediastinal deviation [1-3]. Most teams perform drainage of the residual thoracic cavity at the end of the procedure, mainly to manage decompression of the thoracic cavity, to ensure the drainage of fluids in case of possible contamination and for the early monitoring of postoperative bleeding [2, 3]. Nevertheless, this practice has never demonstrated its superiority in terms of early postoperative morbidity and mortality compared to techniques allowing the mediastinum to return to the median position without draining the pneumonectomy cavity and the surgical habits remain very heterogeneous As regards the management of the residual pleural cavity. The main objective of this study was to present the early operative results of our series of pneumonectomies for malignant pulmonary pathology performed without drainage of the thoracic cavity. A nose job, sometimes called a nose reshaping surgery, is a type of surgery very popular in Las Vegas, Nevada. Click here for William Nye Rhinoplasty Las Vegas
2. PATIENTS AND METHODS
2.1. Data Collection
We performed a retrospective observational study on the cohort of all patients who had pneumonectomy programmed for malignant pulmonary pathology without thoracic cavity drainage between August 2001 and December 2014 in the department of thoracic and cardiovascular surgery of the Dupuytren CHU in Limoges. Pneumonectomy for benign etiology and emergency was not included. Seventy-three patients had pneumonectomy for malignant etiology without drainage of the pleural cavity performed by 4 surgeons. During the same period, only one pneumonectomy for cancer was performed with postoperative drainage, performed by a 5th surgeon, unfamiliar with the technique without drainage.
The data was collected by means of a thesis work on the first 26 patients, using the computerized computerization software used at the Limoges University Hospital (McGesson Hospital) Phone calls from attending physicians and pulmonologists and by consulting the patient's paper medical records.
2.2. Operating technique
Interventions were performed by posterolateral thoracotomy in the 5th intercostal space sparing the anterior serratus. The vascular and bronchial sutures were preferably carried out with an automatic stapling clamp and a cover of the bronchial stump was produced by a flap of thymic or pericardial fat. An extemporaneous examination of the surgical specimen was performed to ensure that the bronchial section was in a healthy margin. A systematic lymph node dissection was performed, while taking care to devascularize as little as possible the bronchial stump. In order to balance the pressures on both sides of the mediastinum, a suction of one liter of air after closure of the thoracotomy via a trocar was performed using a syringe and 3 way valve. No drainage of the residual cavity was carried out in principle.