Thoracic Surgery Complications

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Thoracic SurgeryComplications
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Complications

• ?

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Complications

• Air Leak
• Atalectasis
• Sputum Retention
• Chest Infections
• Atrial Fibrillation
• Bleeding
• Wound Infections
• MRSA
• Bronchopleural Fistula
• Post Pneumonectomy Problems
• Post Pneumonectomy Empyema
• Lobectomy Space Problems
• Medical Problems
• Recurrent Disease
• Inadequate Resection

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AIR LEAK
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AIR LEAK

• What operation
• Aetiology
• Conservative
• Talc
• Tetracycline
• Blood
• Flutter bag
• Sort out in Theatre saline, bagging and prolene

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Atelectasis

• Obstructive tumour, mucous or foreign
  body
• Non obstructive effusion or mass
• Pain
• Double lumen tube malposition
• Temperature
• WCC
• TNF alpha
• Nebs
• Physio
• Bronch

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Sputum Retention

• Pain
• Phrenic nerve block
• Anatomical stenosis
• Surgical,
• Foreign body,
• Tumour
• Preoperative sputum and smoking
• Physio, Nebs, stop smoking, pain relief-
  epidural, pre op admission for a week

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Chest Infections

• Frequent
• Pre op PFTs and performance predict
• Medical and surgical causes
• Pre op cultures from bronch
• Pain relief, Nebs, Antibiotics and Physio

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Atrial Fibrillation

• pO2, K
• Intrapericardail dissection
• Pneumonectomy gt lobectomy gt wedge
• Chest infection / Atelectasis
• Role digoxin prophylaxis
• Beta blockers
• Oesophageal leak

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Bleeding

• Should be rare unless on anticoagulants
• Usually massive or from chest wall
• Probably little role for platelets, FFP or
  Aprotinin
• CXR most helpful, if collecting TAKE BACK

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Wound Infections

• Rare with thoracotomies
• Empyema not unusual
• MRSA
• Surgical technique
• Haemostasis
• Suture tension
• Diathermy on skin

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Bronchopleural Fistula

• Usually pneumonectomy
• 2 peaks early and late
• Technical
• Post radiotherapy
• Recurrence
• Infection
• Lie on operated side
• Drain
• ? Clagget procedure

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Post Pneumonectomy Problems

• Cardiac herniation / torsion
• Haemorrhage
• Pulmonary oedema
• Chylothorax
• Bronchopleural Fistula
• Stump Clot
• Empyema
• Post-pneumonectomy Syndrome
• Recurrent neoplasm

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Post Intra Pericardial Pneumonectomy Cardiac
Herniation
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Post Pneumonectomy Empyema

• Clinical suspicion
• Temperature
• WCC
• Wound
• Needle space
• Drain
• Irrigate
• Instil antibiotics

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Lobectomy Space Problems

• Space in thorax after resection
• Adhesions
• Stiff lung
• Pleural tent
• Muscle flap
• Thoracoplasty

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Medical Problems

• MI / Angina
• Pain
• CVA
• Renal
• GIT
• MRSA
• Isolate
• Screen outside patients
• ? Change antibiotic prophylaxis
• Admit electively if possible

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Recurrent Disease

• Bronch and biopsy
• ? Restage if fit
• Further surgery
• Chemo large field recurrence
• Radio local recurrence

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Inadequate Resection

• Positive resection margins
• Different types
• Obvious tumour
• Microscopic Ve
• Odd cell
• Nothing
• Radiotherapy
• Repeat Bronch and CT scan
• No role for chemo

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Any Questions ?