OPTIMIZATION OF SURGICAL STRATEGY IN COMPLICATIONS AFTER THORACIC OPERATIONS DEMANDING RECURRENT SURGICAL INTERVENTIONS

Abstract

A frequency of postoperative complications varied from 1-2% after endoscopic thoracal operations to 4-12% after open operations using thoracotomic access. There isn’t any common approach to indications and terms of the recurrent endoscopic intervention. An analysis of postoperative complications was made after 2795 thoracothomies and 3632 videothoracoscopies required the recurrent operation in 139 patients (2,2%). The rethoracoscopies were performed on 62 patients (44,6%), thoracoscopies were carried out after thoracotomies in 40 cases (28,8%) and rethoracotomies were in 37 cases (26,6%). The more frequent indication to recurrent operation was bleeding (26,6%), pleural empyema (20,9%), fragmented pleuritis (11,5%).It was shown that thoracoscopy was an alternative to rethoracotomy as the rethoracoscopy in case of nonmassive intrapleural bleeding, clotted hemothorax, postoperative fragmented pleuritis, non-sanitized empyema region, the presence of sequestrums in this area, limited postoperative pleuritis, chylothorax, bronchopleural fistula of the size of 1-2 mm, leakage of the lung, a foreign body in pleural cavity. The lethality consisted of 35,1% after rethoracotomies and it was 12,7% after recurrent endoscopic operations.