Thoracic approach in hepato-biliary surgery is a debated problem since it has the advantage of a very good access but the disadvantage of a supplementary morbidity and the need of some specific postoperative care. The aim of our study is to evaluate the results of this approach.
In a period of 15 years in our unit, thoracic approach has been used in 15 patients: 8 bilio-thoracic fistulae, 2 hydatid hepatic cysts associated with right pulmonary hydatid cysts (one of which bilateral), 2 hydatid hepatic cysts associated with left pulmonary hydatid cysts solved through left thoracophrenotomy (in one case we also practiced cholecystectomy and transcistic drainage, which seems to be a new approach), 2 hepatic abscesses with subphrenic abscesses, one hepatothorax solved by polipropilene-mesh phrenoplasty associated with intrathoracic cholecystectomy for colesterolosis of the gall-bladder.
In all cases we had a very good access on the hepatic lesion; in some cases we avoided a supplementary laparotomy. The reason why we preferred the thoracic approach was: existence of some severe thoracic lesions, which dominated the clinical course - 8 patients (bilio-thoracic fistulae), association of the hepatic lesions with uncomplicated intrathoracic lesions - 4 patients, difficult abdominal approach due to the location and previous abdominal procedures - 2 patients, one patient with a hepatotorax.
In hepato-biliary surgery the thoracic approach is indicated in patients with associated intrathoracic lesions and in those with a much more difficult abdominal approach - re-operations, peculiar locations.
In the aforementioned situations, co-optation of a thoracic surgeon may be beneficial, since the access is very good and for trained centers this approach poses no special problems.
Alexandru Botianu, None.