Abstract
Background: Review of the most recent chest re-explorations for lung surgery complications may
show methods by which risks can effectively be reduced. Methods: The data on rethoracotomies following lung surgery over the past 14 years in our
department were retrospectively reviewed. The indication, the type of operation, the
outcome, and various factors influencing the postoperative mortality were analyzed.
From 1983 to 1996, 1960 patients underwent primary thoracotomies for various lung
diseases. Among these, 73 (3.7%) patients required re-exploration for various postoperative
complications. Results: Mean age was 56.8 years (15-80 years). There were 66 (90.4%) men and 7 (9.6%) women.
The most common indication for rethoracotomy was hemorrhage in 38 (52%) patients.
The source of bleeding was a mediastinal and/or bronchial blood vessel in 8 patients
and an intercostal blood vessel in 6 patients. Six patients had to be reoperated because
of hemorrhage from a major artery of the hilus. In 14 cases the postoperative hemothorax
occurred without evident surgical origin. Further indications for rethoracotomy were
bronchopleural fistula (BPF) in 13 (17.8%) patients, and persistent parenchymal leak
in 8 (10.9%) patients. There were 8 additional causes distributed among the remaining
14 (19.3%) patients. The overall mortality rate was 17.8% (13/73), with the highest
(38.4%) among BPF patients. Conclusions: Postoperative complications following lung surgery which require rethoracotomy are
rare. The most common complication is postoperative bleeding. This is followed by
bronchial stump insufficiency which is associated with the highest mortality and morbidity.
Our experence shows that the need for re-exploration can hardly be reduced but the
indication for re-exploration should be established as early as possible to avoid
late complications.
Key words
Rethoracotomy - Postoperative complications - Bronchopleural fistula - Hemorrhage
