Closed Intrapleural Pneumonolysis

¹ Sanatorium, Texas

One hundred and thirty consecutive cases in which thoracoscopy was done are presented.

In eight of the cases it was not deemed advisable to attempt to sever the adhesions.

In one hundred and twenty-two either a partial or complete pneumonolysis was done.

In five of the cases the adhesions were cut in two stages.

At the time of discharge, the sputum was negative or absent and no cavity was visible in 48 patients, or 39.3 per cent of the patients who were subjected to pneumonolysis.

In 29 patients (23.8%) no cavity was visible after operation but the sputum remained positive. In fourteen of these it is probable that the sputum was coming from disease in the contralateral lung.

The cavity remained open and the sputum positive despite operation in 34 (27.9%). It is probable that some of these cavities could have been closed by further severence of the adhesions at a later date, had the patients remained in the sanatorium.

Eleven or 9 per cent of the patients remained under observation less than a month and the results in these cases are not included.

There was one death, which occurred twelve days after operation, possibly related to the procedure; the immediate cause of death was spontaneous pneumothorax. No other cases of spontaneous collapse occurred.

Tuberculous empyema developed at some time during the postoperative course in sever patients.

There were two cases in which definite hemorrhage into the pleural space occurred in these two and in one other in which bleeding was not a remarkable feature obliterative pleuritis occurred.

At least a "drop" of fluid developed in practically every case. Before a policy of early and frequent aspirations was followed, a large number of non-expansile lungs resulted. The incidence of this complication was later greatly reduced by earlier aspiration of effusions.

Contralateral spread of the disease following pneumonolysis occurred in a few patients, but in none was there any evidence that operation was a causative factor.

Subcutaneous emphysema of variable degree developed in practically every case.