PURPOSE: We present our experience with transthoracic approach of the subphrenic abscesses, which is still a matter of controversy because it combines a very good exposure with a specific postoperative care and supplementary morbidity.
METHODS: In a period of 15 years we used a transthoracic approach in 8 patients with subphrenic abscesses. The etiology of the subphrenic abscess was: perforated gastro-duodenal peptic ulcer (5 cases), hepatic abscess after trauma (2 case) and hydatid peritonitis (rupture of a hydatid hepatic cyst) in one case. All the 8 patients presented an associated empyema requiring decortication; one patient presented pericarditis requiring pericardo-pleural window. Two patients had previous abdominal surgery. Both patients with perforated gastro-duodenal peptic ulcer required an associated laparotomy for gastric resection.
RESULTS: In all cases we obtained an excellent exposure of the subphrenic lesions using this transthoracic approach. The reasons why we preffered the thoracic approach was association of intrathoracic lesions requiring surgery combined with difficult abdominal approach due to postero-superior location and/or previous abdominal surgery. We had no morbidity or mortality related to the thoracic approach.
CONCLUSION: Although the indications for thoracic approach in subphrenic abscesses remain limited, in selected patients (particular location, difficult abdominal approach, associated intrathoracic lesions) it gives good results.
CLINICAL IMPLICATIONS: A low morbidity requires a team with significant experience in thoracic surgery and its specific postoperative care.
DISCLOSURE: ALEXANDRU BOTIANU, No Financial Disclosure Information; No Product/Research Disclosure Information