Outcome and Complications of Trans-Sternal Thymectomy for Myasthenia Gravis (original) (raw)
Related papers
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management was administered according to a standardized protocol of anticholinesterase medication, which was withdrawn for the 48 hours of obligatory postoperative mechanical ventilation.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.
Experience of thymectomy by median sternotomy in patients with myasthenia gravis
JPMA. The Journal of the Pakistan Medical Association, 2010
To determine the outcome of thymectomy in patients with myasthenia gravis and safety of median sternotomy approach. An observational descriptive study was conducted in the department of thoracic surgery JPMC from February 2005 to January 2009. Twenty-two patients having persistent generalized or ocular myasthenia gravis referred to our department by neurologists and general physicians, partially or not responding to medical treatment with or without thymoma, were included in the study. Those who were not fit for anaesthesia were excluded. Preoperatively 2 to 3 sessions of plasmapheresis were done and each patient was given anti myasthenia gravis treatment. Clinical staging was done by Modified Osserman classification. Median sternotomy approach was used. Outcome was assessed on the basis of remission of disease in different Osserman groups. All patients were followed for a minimum of 6 months. Out of 22 patients, 16 (72.7%) were females and 6 (27.2%) males. Mean age at presentation ...
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.
Extended transsternal thymectomy for myasthenia gravis: a report of 19 consecutive cases
Acta chirurgica Belgica
Thymectomy is considered as an effective therapeutic option for patients with myasthenia gravis (MG). This study reports the experience of our centre's investigation into the efficacy and the safety of the procedure and the influence of different pre-operative factors on the surgical outcome. A retrospective chart review/interview was made of 19 consecutive patients who underwent extended transsternal thymectomy for MG from 1992 to 2003. The severity of the disease was determined according to the Osserman Classification. Efficacy was measured by determining the change in clinical status, the rate of remission during follow-up, and the reduction in medication requirements after thymectomy. Complete remission (CR) was defined as asymptomatic off medication for 6 months. The CR rate was calculated using the Kaplan-Meyer method. The mean age of the patients at surgery was 34 years (range, 9-63) and 78.9% were female. Mean length of follow up was 86 months (range, 24-163). The overal...
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...
Turkish Journal of Clinics and Laboratory, 2015
Aim: The efficiency of thymectomy for treating patients with Myasthenia gravis is a controversial issue. Thus, this study aimed to investigate the efficiency of thymectomy in the treatment of myasthenia gravis based on long-term follow-up results. Material and Methods: The first and fifth year clinical outcomes of 27 patients who had undergone median sternotomy and extended thymectomy for myasthenia gravis between January 1995 and January 2004 were compared statistically. Results: No statistically significant differences were found between the postoperative first and fifth year clinical outcomes of the patients. Conclusions: Thymectomy is a reliable method in the treatment of myasthenia gravis with respect to its long-term outcomes. The outcomes obtained at the end of the first and fifth year of thymectomy are not different.
Clinical outcome of thymectomy in myasthenia gravis patients: A report from Iran
Iranian journal of neurology, 2018
Myasthenia gravis (MG) is an autoimmune disease affecting acetylcholine postsynaptic receptor of voluntary muscles. Thymectomy is done in these patients and is a mainstay in the treatment of MG; however, the long-term result of surgery is still controversial. This study dealt with the investigation of the results of thymectomy in treatment, recovery and control of the symptoms of these patients. This study was performed through a retrospective method in patients suffering from MG who underwent trans-sternal thymectomy between 2011 and 2016. We conducted thymectomy, excision of mediastinal mass and contents of tissues between the right and left phrenic nerves for all patients. Then, the effect of various variables including age, sex, time interval between onset of disease and surgery, thymus pathology and the dosage of drug on clinical response after surgery was determined using various statistical tests. 47 patients including 26 men and 21 women with the mean age of 33.0 ± 4.6 years...