Surgery for Myasthenia Gravis: A Review of Our Experience with VATS
Journal Title: Nepal Journal of Neuroscience - Year 2014, Vol 11, Issue 1
Abstract
thymectomy is gaining acceptance as a approach of choice for patients with Myasthenia Gravis. Lower peri-operative morbidity, superior cosmetic results, shorter ICU and hospital stays and remission rates that are equivalent to transsternal are thought to be the causes. Here we review our initial experience with VATS thymectomies at our institution. Retrospective analysis of prospectively maintained data of all patients who underwent thymectomy for myasthenia between July 2011 and April 2014 was done. Patient demographics, operative time, postoperative ICU/hospital stays were recorded and compared between patients who underwent VATS and those who had sternotomy. Amongst the 18 patients who underwent thymectomy, the age ranged from 24-68 years (41.6 ± 14.6) and females outnumbered males (M:F = 2:1). Dysphagia and diplopia were the commonest symptoms. The average duration of symptoms at the time of operation was 26.58 ± 28.7 months. Thymectomy was completed via VATS approach in 12 patients and via median sternotomy in six. VATS procedures took longer but the difference did not reach statistical signifi cance (P = 0.09) but the post-op ICU stay (P = 0.04) and overall post-op stay (P= 0.04) were shorter amongst VATS group. Three post–operative complications (myasthenic crisis requiring reintubation in two and bleeding in one) were encountered and all occurred in patients who had transternal thymectomy. There were no conversions and no phrenic nerve injury. VATS thymectomy is feasible and is a safe option for thymectomy in MG. It reduces peri-operative morbidity, ICU and overall hospital stays.
Authors and Affiliations
Bibhusal Thapa, MBBS, MS
Keywords
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