ANTERIOR MEDIASTINAL PLASTICS DURING PNEUMONECTOMY AS PREVENTION AND TREATMENT OF A MEDIASTINAL HERNIA IN FIBROUS CAVERNOUS PULMONARY TUBERCULOSIS PATIENTS

The objective is to study the efficiency of prevention of a mediastinal hernia and efficiency of its treatment through anterior mediastinal plastics performed during pneumonectomy.

Subjects and Methods. Results of pneumonectomies in 30 patients (22 men and 8 women at the age varying from 20 to 56 years old) with fibrous cavernous pulmonary tuberculosis with multiple or extensive drug resistance.

Group 1 included 17 patients who had pneumonectomy with anterior mediastinal plastics, of them 10 (58.8%) had no mediastinal hernia and 7 (41.2%) patients had a minor one. Group 2 included 13 patients who had pneumonectomy without anterior mediastinal plastics.

Results. When pneumonectomy was performed, no mediastinal hernia developed in 82.4% (95% CI 59.0-93.8%) of patients who had anterior mediastinal plastics and in 7.7% (95% CI 1.4-33.3%) of patients with no plastics, p < 0.01.

Anterior mediastinal plastics performed during pneumonectomy repaired a minor mediastinal hernia in 71.4% (95% CI 35.9-91.8%) of patients.

After pneumonectomy with anterior mediastinal plastics due to fibrous cavernous tuberculosis, the risk of mediastinal hernia made 10.0% (95% CI 1.8-40.4%) in the patients who had no hernia before surgery, while in the patients who had this type of hernia before surgery, the risk of it made 28.6% (95% CI 8.2-64.1%). If no plastics was applied this risk made 90.0% (95% CI 59.6-98.2%).

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