Surgeries of thorax
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This document discusses various thoracic surgeries including those of the bony cage, esophagus, thymus, lungs, pleura, pericardium, heart, and aorta. It covers topics like chest wall deformities and hernias, thoracic outlet syndrome, chest wall tumors, reconstruction after chest wall defects, congenital diaphragmatic hernia repair, surgeries for esophageal disorders like achalasia and GERD, esophagectomy, and thymectomy. The various procedures are described along with their indications, techniques, and potential complications.
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Surgeries of thorax
- 2. SURGERIES OF THORAX • SURGERIES OF BONY CAGE • SURGERIES OF ESOPHAGUS • SURGERY OF THYMUS • SURGERIES OF LUNG • SURGERIES OF PLEURA & PERICARDIUM • SURGERIES OF HEART: • CORONARY SURGERY • VALVULAR SURGERY • CONGENITAL HEART SURGERY • SURGERY OF AORTA
- 8. Topics to be discussed 1. Chest Wall Deformities 2. Hernias of the Chest Wall 3. Thoracic Outlet Syndrome 4. Chest Wall Tumors 5. Chest Wall Reconstruction 6. Congenital diaphragmatic hernia 7. Surgery for Esophageal Dysmotility Disorders 8. Surgical Techniques for Reflux Disease (GERD) 9. Esophagectomy 10. Thymectomy
- 9. 1) Chest Wall Deformities: PECTUS EXCAVATUM
- 11. NUSS PROCEDURE
- 13. COMPLICATION • Major • Cardiac perforation • Bar dislodgement (requiring reoperation) • Infection (requiring bar removal) • Minor • Pneumothorax • Pleural effusion • Pericardial injury • Atelectasis • Prolonged pain • Rupture of intercostal muscle • Metal allergy (requiring bar removal) • Overcorrection (“acquired carinatum”)
- 14. PECTUS CARINATUM
- 16. 2) Hernias of the Chest Wall • CONGENITAL HERNIAS • TRAUMATIC HERNIAS • Blunt Trauma: “seatbelt syndrome.” • Penetrating Trauma: stab or gunshot wounds
- 17. Mesh repair
- 18. Infections of the Chest Wall • Necrotizing chest wall infections • Nonnecrotizing infections of the chest wall • Soft tissue abscesses • Chest Wall Actinomycosis: gram-positive anaerobic bacteria • Tubercular Abscesses • Empyema Necessitans • Fungal infections of the chest wall: Aspergillus species and Phycomyces • chest wall osteomyelitis: following cardiac surgery
- 19. NPWT: negative-pressure wound therapy
- 22. 4)Chest Wall Tumors • primary tumors: Primary bone neoplasms : BENIGN OR MALIGNANT • to local extension of adjacent tumors (lung, mediastinum, pleura, or breast), • metastatic tumors
- 23. 5) Chest Wall Reconstruction • The main goals in chest wall reconstruction are • (1) obliteration of dead space, • (2) restoration of skeletal rigidity, • (3) prevention of lung herniation and scapula impaction, • (4) protection of underlying organs, and • (5) maintenance of cosmesis
- 26. 6) CDH: congenital diaphragmatic hernia
- 28. 7) Surgery for Esophageal Dysmotility Disorders • ACHALASIA: • HELLER MYOTOMY
- 29. HELLER MYOTOMY: Complications • Barrett's esophagus • Esophageal cancer • Infection in your esophagus (esophagitis) • GERD • Unintentional puncture (perforation) or tearing in the lining of esophagus
- 30. 8) Surgical Techniques for Reflux Disease (GERD)
- 31. Fundoplication: indications •Failure of medical management •Need for long-term medical therapy •Complications of GERD (eg, Barrett esophagus or peptic stricture) •Patient preference •Extraesophageal manifestations (eg, asthma, hoarseness, cough, chest pain, aspiration) •Juvenile esophagitis of long duration without spontaneous remission or refractory to medical management, esophagitis, failure to thrive, or pulmonary compromise •Mixed and paraesophageal hernia •Recurrent reflux or complications after previous antireflux surgical therapy
- 32. Fundoplication: complications • Bleeding at the surgical site • Difficulty swallowing (dysphagia) because stomach is wrapped too high on esophagus or wrapped too tightly • Difficulty belching • Infection (peritonitis) • Unintentional slipping of the wrapped portion of stomach • Unintentional puncture (perforation) or tearing of esophagus • Pneumothorax
- 33. 9) Esophagectomy Indications • Carcinoma of esophagus, • high-grade dysplasia in Barrett esophagus, • destruction of esophagus by caustic ingestion, • complications of reflux esophagitis failed with other reflux procedures
- 34. transthoracic esophagectomy transthoracic esophagectomy through a right thoracotomy transthoracic esophagectomy through a left thoracotomy
- 36. Complications of Esophageal Resection and Reconstruction • Intraoperative complications • Hemorrhage • Injury to the tracheobronchial tree • Recurrent laryngeal nerve injury • Pneumothorax • Postoperative complications • Delayed hemorrhage • Anastomotic leak • Mediastinitis • Pulmonary complications (atelectasis, pneumonia, adult respiratory distresssyndrome, aspiration bronchiolitis) • Arrhythmia, myocardial infarction, pericardial tamponade • Delayed gastric emptying • Chylothorax • Herniation of abdominal viscera through the hiatus • Functional complications of esophageal replacement • Anastomotic stricture • Redundancy and impaired emptying • Obstruction at the upper thoracic inlet or diaphragmatic hiatus • Reflux esophagitis • Ulceration of the esophageal substitute • Post vagotomy dumping
- 37. 10)Thymectomy: indications • Thymoma, thymic carcinoma, and thymic neuroendocrine tumors • Myasthenia gravis
- 38. Thymectomy: complications • Pulmonary complications — • respiratory failure and prolonged intubation • pleural effusion, pneumonia, atelectasis, pneumothorax, acute lung injury, and decreased thoracic compliance • Nerve Injury — phrenic nerves and recurrent laryngeal nerves • Surgical site infection and mediastinitis