Experience of thymectomy by median sternotomy in patients with myasthenia gravis (original) (raw)
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Outcome and Complications of Trans-Sternal Thymectomy for Myasthenia Gravis
Journal of Islamic International Medical College, 2016
Objective: To determine outcome and postoperative complications of trans-sternal thymectomy for myasthenia gravis. Study Design: Experimental, prospective. Place and Duration of Study: The study was conducted at Department of Surgery, Pakistan Institute of Medical Sciences (PIMS), Islamabad from June 2009 to June 2012. Materials and Methods: We included 30 consecutive patients from all age groups either coming to Surgical outpatient clinic or referred from Neurolgy unit having generalized myasthenia gravis between 12-55 years of age, thymic mass on radiology or poor medical control of disease with no contra indications to surgery. Patients unfit for anaesthesia due to any reason or inoperable thymic tumour were excluded. We studied outcome and post-operative complications in all patients after total thymectomy through trans-sternal approach for 24-40 months. All patients were assessed for haemorrhage, transfusion requirement, shock, myasthenia crisis, respiratory infection, wound in...
Vojnosanitetski pregled
Background/Aim. Thymectomy is accepted in the surgical treatment of the patients with myasthenia gravis (MG). Earlier thymectomy via sternotomy has recently been replaced by video-assisted thoracoscopic surgery (VATS), which is less invasive. The aim of this study was to determine the effectiveness and reliability of the two methods of surgical removal of the thymus by comparing the neurological outcome in patients with MG. Methods. The study included 60 patients with MG who underwent thymectomy at the beginning of their treatment: 30 patients underwent thymectomy via sternotomy, and the remaining 30 patients via VATS. In order to evaluate the effects of these two operation techniques, we compared the data related directly to the operation ? the number of postoperative hospital days, the incidence of postoperative complications, as well as the data related to the neurological monitoring of these patients: directly after the operation, one year after the surgery and up to three years...
Thymectomy by partial sternotomy for the treatment of myasthenia gravis
Annals of Thoracic Surgery, 2002
Background. Myasthenia gravis is an autoimmune disease characterized by weakness and fatigue of voluntary muscles. Surgical treatment of choice for myasthenia gravis has been thymectomy. However, thymectomy indications and surgical approach are still controversial. The purpose of this study is to evaluate the efficacy of partial median sternotomy approach to the thymus.
European Journal of Cardio-Thoracic Surgery, 2001
We reviewed our overall experience on 163 patients, affected by myasthenia gravis, who underwent thymectomy between 1976 and 1998. A comparison between the oldest series of 72 patients (January 1976±December 1992), referred by various neurologists and operated on through different approaches, and the last 91 patients (January 1993±December 1998), taking part in a strict diagnostictherapeutical programme, was made. Methods: Anagraphic data, duration of symptoms, the surgical approach, necessity of respiratory assistance, the hospital stay, histopathological ®ndings, preoperative and postoperative Osserman classi®cation, as well as medications, were globally analyzed and then compared in the two groups. Results: Signi®cant differences in the length of hospitalization (8.7 days vs.. 4.2 days; P 0:00001) and in the prolonged intubation rate (18 vs. 0; P , 0:000001) were observed in the most recent series. Patients in the preoperative Osserman stage I and operated on in the second period had a higher complete remission rate at the univariate analysis (P , 0:001 and P , 0:0001, respectively). At the multivariate analysis the only parameter which affected the outcome was to be operated on in the second period (P , 0:01). Conclusions: Our experience con®rms the role of the extended thymectomy in the treatment of myasthenia gravis. Whenever an extended thymectomy was performed through a complete sternotomy it was a quick procedure, with short hospitalization and acceptable cosmetic results. A careful pharmacological control of the myastenic symptoms and the presence of teamwork among neurologist, thoracic surgeon and anaesthesist in the peri-operative setting reduce the incidence of complications and might increase the ef®cacy of the thymectomy.
Thoracoscopic thymectomy for myasthenia gravis: a case report
Annals of the Academy of Medicine, Singapore, 1998
Total thymectomy combined with medical therapy is currently the most effective therapeutic strategy for patients with myasthenia gravis. The standard approach for total thymectomy is that of a median sternotomy. Other approaches include the cervical approach and partial sternotomy. We report a patient who underwent video-assisted thoracoscopic thymectomy at our institution. There was no postoperative complications and the patient was discharged on the fifth postoperative day. Video-assisted thoracoscopic thymectomy has proved to be an effective surgical therapy for the treatment of myasthenia gravis. The long-term outcome awaits close follow-up of the patients operated using this technique.
The Annals of Thoracic Surgery, 2001
Background. We studied the incidences and evaluated the management of early postoperative complications after thymectomy for myasthenia gravis. Methods. During the period between 1987 and 1996, 324 thymectomies were performed through median sternotomy access under general anesthesia. Postoperative management was administered according to a standardized protocol of anticholinesterase medication, which was withdrawn for the 48 hours of obligatory postoperative mechanical ventilation. The mean age of patients was 34 years (range, 8 to 71 years). Results. One hundred forty-nine patients made an uneventful recovery; 104 patients had only minor complications, whereas 71 patients had major complications. The mortality rate was 0.6% (2 patients). The major surgical complications were recorded as sternal bleeding (1 patient) and sternal disruption (1 patient). The major general complications were recorded as tracheal stenosis (1 patient), pneumonia (3 patients), heart failure (1 patient), gastric hemorrhage (1 patient), and respiratory insufficiency (71 patients). Forty-six reintubations were performed on 40 patients and 19 tracheostomies (6%) were performed postoperatively. Conclusions. The excessive incidence of respiratory insufficiency and airway-associated morbidity was potentially related, at least partially, to prolonged mechanical ventilation and withdrawal of anticholinesterase medication. Earlier weaning of patients with revision of 48-hour withdrawal of anticholinesterase medication is necessary.
Thoracoscopic Thymectomy for Myasthenia Gravis With and Without Thymoma: A Single-Center Experience
The Annals of Thoracic Surgery, 2012
Background. The treatment of patients with myasthenia gravis (MG) may include thymectomy. The objective of this study was to analyze the outcome of videoassisted thoracoscopic surgical (VATS) extended thymectomy and to compare characteristics of patients with MG with and without thymoma. Methods. Between 2002 and 2009, 247 patients with MG underwent VATS thymectomy in our department and were subdivided into 2 groups: MG without thymoma (n ؍ 176) and MG with thymoma (n ؍ 71). Complete stable remission (CSR) was the primary endpoint for efficacy. Results. There were no intraoperative deaths and 4 cases required conversion to median sternotomy. There was a significant difference between the 2 groups regarding preoperative and postoperative myasthenic crisis. Two hundred nineteen patients were followed for 4 months to 9 years: 152 had thymoma and 67 did not have thymoma. The cumulative probabilities of reaching CSR were 37.5% in patients with MG without thymoma and 28.3% in patients with thymoma, respectively. Forty months after surgery there was no significant difference in CSR between the 2 groups. Two years after surgery, 30 patients without thymoma achieved CSR and disease was exacerbated in 2 patients after CSR had been achieved. Ten patients with thymoma achieved CSR, and exacerbation occurred in 5 patients with thymoma. Two patients without thymoma died of myasthenic crisis, whereas 3 of 4 patients with thymoma died of myasthenic crisis, and 1 death was attributable to recurrent disease. Conclusions. Video-assisted thoracoscopic surgery thymectomy can produce a satisfactory long-term result. MG with thymoma seems more severe and its prognosis after thymectomy is not as optimistic as that of MG without thymoma. Special perioperative attention should be paid to patients with MG and thymoma to decrease the possibility of postoperative myasthenic crisis and reduce postoperative death.
Thymectomy for myasthenia gravis: a 27-year experience 1
2010
Objective: Thymectomy is considered an effective therapeutic option for patients with myasthenia gravis (MG). We reviewed our 27year experience with surgical treatment of MG with respect to long-term results and factors affecting outcome. Methods: Between 1970 and 1997, we performed 232 thymectomies for MG. Fifteen patients were lost to follow-up; the remaining 217 form the object of our study. Sixty-two patients (28.4%) had thymoma. Myasthenia was graded according to a modified Osserman classification: 51 patients (23.5%) were in class I, 81(37.3%) in class IIA, 52 (24%) in class IIB, 26 (12%) in class III and seven (3.2%) in class IV. Mean duration of symptoms before the operation was 12 ± 10 months. Fifty-eight thymectomies for thymoma were performed through a median sternotomy and four through a clamshell incision. Forty-six thymectomies for non-thymomatous MG were performed through a standard cervicotomy, 101 procedures through a partial upper sternal-splitting incision and eight through a complete median sternotomy. Results: Operative mortality was 0.92% (two patients). After a mean follow-up of 119 months, 71% of all patients improved their clinical status (25% without medications and asymptomatic; 46% with a reduction of medications and/or clinically improved); 39 (18%) have a stable disease with no clinical modifications; 12 (5%) presented a deterioration of their clinical status with worse symptoms, required more medications, or both. Thirteen patients (6%) died because of MG (mean survival 34.3 ± 3.6 months). The presence of a thymoma negatively influenced the prognosis. Younger patients showed a more favorable outcome as well as patients with a shorter duration of symptoms before the operation; patients with lower classes of myasthenia showed a higher rate of remission. Conclusions: Thymectomy is effective in the management of patients with MG at all stages with low morbidity. Patients with thymoma present a less favorable outcome.
European Journal of Cardio-Thoracic Surgery, 2005
Objective: In a prospective study, the effect of thymectomy on the pulmonary status of 50 consecutive patients with myasthenia gravis was evaluated over a time range of 4 years in the Chest and Chest surgery departments in the Cairo University Clinics and Thoracic Surgery Department of the Evangelisches Krankenhaus Duisburg-Nord. Methods: The patients were divided into two groups: Group I included 26 patients who underwent thymectomy through median sternotomy. The mean age of the patients in this group was 24.8G10.5 (5-41) years. They were 19 females and seven males. Thirteen of the patients were in Myasthenia Gravis Foundation of America (MGFA) class IIa, and 12 were in class IIb, and one was in class IIIa. Group II included 24 patients who underwent thymectomy through manubriotomy. The mean age of the patients in this group was 25.2G9.2 (12-41) years. They were 13 females and 11 males. Eight of the patients were in MGFA class 2a, 14 were in class IIb, and two were in class IIIa. Results: When compared to group I in which postoperative ventilation was required in 15.4% of patients, postoperative ventilation was not necessary in patients of group II with a statistically significant difference (PZ0.04). The mean duration of stay in the intensive care unit was 111.4 h in group II, and 169.7 h in group I (PZ0.03). The peak inspiratory flow rate and the forced vital capacity were also statistically significantly better in group II. There was no mortality in both groups, and the morbidity was higher in the median sternotomy group. Conclusion: Thymectomy through a manubriotomy, which allows extensive removal of ectopic thymic tissue in addition to the thymus through a less invasive approach than a full median sternotomy, is associated with a significantly smoother postoperative course and less pulmonary complications, when compared with thymectomy through a full median sternotomy.