Comparison of muscle-sparing and standart posterolateral thoracotomy and applicability of muscle-sparing thoracotomy

2. ABSTRACTCOMPARISON OF MUSCLE-SPARING AND STANDARTPOSTEROLATERAL THORACOTOMY AND APPLICABILITYOF MUSCLE-SPARING THORACOTOMYBackground: Different alternative approaches to thoracotomy have beendeveloped because of the considerable morbidity associated with the standartposterolateral incision. In this study, we aimed to evaluate the advantages anddisadvantages of muscle-sparing and dividing thoracotomy in patients underventsurgery.Materials and Methods: This study was made at Firat University ThoracicSurgery Department between May 2003-2005. 40 patients were randomly selected.Half of them were operated by using standart approach (Group A) and the other oneswere operated by muscle-sparing approch (Grup B). Preoperative and during thepostoperative period the patients were controlled regularly according to the differencesin lung perfusion scintigraphy, view of activity on sholder articulation, decreasing thestrength of the latissumus dorsi and serratus anterior muscle, intensity of the painmeasured by using visual analogous scale, the differences in the respiratory function testand opening-closing time of thoracotomy. The using the results the effectiveness of theboth group was compared statistically..Results: Group A contains 16 male and 4 female patients. Group B contains 15male and 5 female patients. Group A has the avarage age of 53.9 and Group B 41.There was no differences among the results of lung perfusion scintigraphy inpostoperative 1 maunts. Shoulder range of motion at all four activity in postoperativefirst and second week was determined statistically low in group A compared with groupB; the limitation of the activity on shoulder articulation was lower in group B (p<0.05).Strengthness of the serratus anterior and lattissumus dorsi muscles in postoperatve firstweek was determined statistically low in group A compared with group B (p<0.05).The differences among preoperative and postoperative statements of the strengthness ofthis muscles wasn?t meaningfull in group B. There was no importand differences therespiratory function tests in postoperative 1. maunts (p>0,05). The intensity of the pain,as determined by the visual analogue assessment was more important in Group A(p<0,05). There was no significant differences opening-closing time of the thoracotomyand with reference to complications (p>0,05).Conclusion: The early respiratory functions improve and the postoperativecomplications due to division of these muscles decrease, particulary, in resectionalpulmonary procedures, with the preservation of muscles in the thoracic wall.Key Words: Muscle-sparing, muscle dividing