The Management of Some Difficulties in Pulmonary Resection

The problem of the residual cavity after pulmonary resection is discussed. Examples of cases which do not need any additional procedure, when the remaining lung expands satisfactorily and the space is filled by the mediastinal structures and the lung itself are presented. Post-resection thoracoplasty is also discussed and it is claimed that usually it is not necessary to do this operation immediately after resection. Delayed thoracoplasty is preferred if at all. In other cases delayed filling of the space is advocated by means of material like celluloid balls or plastics. The "short stump" in pneumonectomy, particularly in cancer, is considered as a problem which can be dealt with by isolating the large vessels within the pericardial sac.

Examples of each procedure are given. Also the controlateral spread is presented as the most dreadful complication. The treatment of the remaining lung when the disease takes a destructive appearance, should be the collapsing procedures with the pertinent limitations.

An example of extrapleural pneumothorax on the left side after total pneumonectomy on the right is presented.