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Alexandru M. Botianu, MD*; Petre A. Botianu, RN
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University of Medicine and Pharmacy from Targu-Mures, Romania, Targu-Mures, Romania


Chest. 2005;128(4_MeetingAbstracts):190S. doi:10.1378/chest.128.4_MeetingAbstracts.190S
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PURPOSE:  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.

METHODS:  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.

RESULTS:  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.

CONCLUSION:  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.

CLINICAL IMPLICATIONS:  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.

DISCLOSURE:  Alexandru Botianu, None.

12:30 PM - 2:00 PM




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