TY - JOUR
T1 - Strictly-posterior thoracotomy
T2 - A minimal-access approach for construction of the modified blalock-taussig shunt in west african children
AU - Edwin, Frank
AU - Gyan, Baffoe
AU - Adzamli, Innocent
AU - Tettey, Mark
AU - Entsua-Mensa, Kow
AU - Tamatey, Martin
AU - Sereboe, Lawrence
AU - Aniteye, Ernest
AU - Yao, Nana Akyaa
PY - 2014
Y1 - 2014
N2 - Introduction: In resource-poor settings, the modified Blalock-Taussig shunt (MBTS) is often performed for symptomatic relief of Fallot's tetralogy. From September 2011, we adopted the strictly posterior thoracotomy (SPOT), a minimal-access technique for the MBTS and report the cosmetic advantages in this communication. Methods: We retrospectively analyzed the records of consecutive patients in whom the SPOT approach was used to construct the MBTS. Study end-points were early mortality, improvement in peripheral oxygenation, morbidity, and the cosmetic appeal. Results: Between September 2011 and January 2013, 15 males and 8 females, median age 4 years (1.3 - 17 years) and weight 13 kg (11 - 54 kg) underwent the MBTS through the SPOT approach. The polytetrafluoroethylene grafts used ranged from sizes 4 - 6mm (median 5mm). The median preoperative SpO2 was 74% (55% - 78%), increasing to a postoperative median value of 84% (80% - 92%). Shunts were right-sided in 22 patients and left-sided in one. There were no shunt failures. Hospital stay ranged from 7 - 10 days. There was one early death (4.3%), and two postoperative complications (re-exploration for bleeding and readmission for drainage of pleural effusion). The surgical scars had excellent cosmetic appeal: they ranged from 5-10 cm in length; all were entirely posterior and imperceptible to the patient. Conclusion: The SPOT approach represents a safe and cosmetically superior alternative to the standard posterolateral thoracotomy, the scar being imperceptible to the patient. The excellent cosmetic appeal and preservation of body image makes this approach particularly attractive in children and young adults.
AB - Introduction: In resource-poor settings, the modified Blalock-Taussig shunt (MBTS) is often performed for symptomatic relief of Fallot's tetralogy. From September 2011, we adopted the strictly posterior thoracotomy (SPOT), a minimal-access technique for the MBTS and report the cosmetic advantages in this communication. Methods: We retrospectively analyzed the records of consecutive patients in whom the SPOT approach was used to construct the MBTS. Study end-points were early mortality, improvement in peripheral oxygenation, morbidity, and the cosmetic appeal. Results: Between September 2011 and January 2013, 15 males and 8 females, median age 4 years (1.3 - 17 years) and weight 13 kg (11 - 54 kg) underwent the MBTS through the SPOT approach. The polytetrafluoroethylene grafts used ranged from sizes 4 - 6mm (median 5mm). The median preoperative SpO2 was 74% (55% - 78%), increasing to a postoperative median value of 84% (80% - 92%). Shunts were right-sided in 22 patients and left-sided in one. There were no shunt failures. Hospital stay ranged from 7 - 10 days. There was one early death (4.3%), and two postoperative complications (re-exploration for bleeding and readmission for drainage of pleural effusion). The surgical scars had excellent cosmetic appeal: they ranged from 5-10 cm in length; all were entirely posterior and imperceptible to the patient. Conclusion: The SPOT approach represents a safe and cosmetically superior alternative to the standard posterolateral thoracotomy, the scar being imperceptible to the patient. The excellent cosmetic appeal and preservation of body image makes this approach particularly attractive in children and young adults.
KW - Congenital heart disease
KW - Minimal-access surgery
KW - Modified blalock-taussig shunt
KW - Polytetrafluoroethylene
KW - Tetralogy of fallot
KW - Thoracotomy
UR - http://www.scopus.com/inward/record.url?scp=84894029472&partnerID=8YFLogxK
U2 - 10.11604/pamj.2014.17.106.3791
DO - 10.11604/pamj.2014.17.106.3791
M3 - Article
C2 - 25018841
AN - SCOPUS:84894029472
SN - 1937-8688
VL - 17
JO - Pan African Medical Journal
JF - Pan African Medical Journal
M1 - 106
ER -