32906 Thoracoplasty, Schede type or extrapleural (all stages); with closure of bronchopleural fistula

Name of the Procedure:

Thoracoplasty, Schede type or extrapleural (all stages); with closure of bronchopleural fistula

Summary

Thoracoplasty is an intricate surgical procedure aimed at reshaping or removing portions of the ribs to collapse a diseased part of the lung. The Schede type or extrapleural approach involves working outside the pleural cavity and includes closing any bronchopleural fistulas—abnormal connections between the bronchi and the pleural space.

Purpose

This procedure addresses issues related to chronic lung infections, collapsed lungs, or non-healing bronchopleural fistulas. The goal is to close the fistula, prevent further infections, and improve lung function and overall respiratory health.

Indications

• Persistent bronchopleural fistula
• Chronic empyema (pus in the pleural cavity) unresponsive to other treatments
• Complicated lung infections
• Patients with a history of tuberculosis

Preparation

Before the procedure, patients may need to:

• Fast for 8 hours prior to surgery
• Adjust or stop certain medications (e.g., anticoagulants)
• Undergo a series of diagnostic tests like chest X-rays, CT scans, or lung function tests to assess suitability for the surgery and plan the approach

Procedure Description

1. Anesthesia: The patient is administered general anesthesia.
2. Incision: The surgeon makes an incision to access the ribs and pleural space.
3. Resection: Portions of several ribs are resected to allow the lung to collapse intentionally.
4. Fistula Closure: The surgeon identifies and meticulously closes the bronchopleural fistula.
5. Extrapleural Approach: The extrapleural membrane is handled outside the pleural space to prevent contamination.
6. Drain: Surgical drains may be placed to facilitate fluid removal.
7. Closure: The incision is closed in layers.

Tools include scalpels, rib retractors, and specialized clamps.

Duration

The procedure can take anywhere from 3 to 6 hours, depending on the complexity and stage.

Setting

Performed in a hospital setting, typically in an operating room equipped for thoracic surgery.

Personnel

• Thoracic surgeon
• Surgical assistants
• Anesthesiologist
• Operating room nurses

Risks and Complications

• Infection
• Bleeding
• Prolonged air leak
• Respiratory failure
• Pain
• Need for further surgeries in rare cases

Benefits

• Effective closure of bronchopleural fistulas
• Reduced recurrent infections and improved lung function
• Enhanced quality of life post-procedure

Recovery

• Hospital stay for about 1 to 2 weeks
• Post-operative pain management
• Restricted physical activity for several weeks
• Follow-up appointments to monitor lung function and healing
• Gradual return to normal activities over 4 to 6 weeks

Alternatives

• Antibiotic therapy and chest drainage (less invasive)
• Pleurodesis (injection of a substance to prevent fluid buildup)
• Lobectomy or pneumonectomy (removal of lung portions)
• Each alternative has its own risk, efficacy, and recovery profile

Patient Experience

Patients can expect to wake up with surgical drains and experience some level of pain, which is managed through medications. There may be initial discomfort and breathing challenges as the body adjusts. Post-surgery, pain management and respiratory physiotherapy play a crucial role in recovery and comfort.