Muhammad Zafar Iqbal Qureshi, Muhammad Imran Zahoor, Erum Fatima.
Outcome and Complications of Trans-Sternal Thymectomy for Myasthenia Gravis.
J Islamic Int Med Coll Jan ;11(1):29-34.

Objective: To determine outcome and postoperative complications of trans-sternal thymectomy for myasthenia gravis. Study Design: Experimental, prospective. Place and Duration of Study: The study was conducted at Department of Surgery, Pakistan Institute of Medical Sciences (PIMS), Islamabad from June 2009 to June 2012. Materials and Methods: We included 30 consecutive patients from all age groups either coming to Surgical outpatient clinic or referred from Neurolgy unit having generalized myasthenia gravis between 12-55 years of age, thymic mass on radiology or poor medical control of disease with no contra indications to surgery. Patients unfit for anaesthesia due to any reason or inoperable thymic tumour were excluded. We studied outcome and post-operative complications in all patients after total thymectomy through trans-sternal approach for 24-40 months. All patients were assessed for haemorrhage, transfusion requirement, shock, myasthenia crisis, respiratory infection, wound infection, delayed healing of wound and dehiscence and pulmonary embolism. Remission of disease was assessed according to De Filippi classification. The data was collected by post graduate trainees on a pre-designed proforma and analysed by SPSS 10. The descriptive statistics were applied and results were shown in percentage. Results: In total 30 patients, mean age was 37±8.6 years. All patients needed at least two units of blood transfusion. We observed pleural damage in 20 patients (66.67%), respiratory infection in 20 (66.67%), myasthenia crisis in 8 (26.7%), minor wound infection in 6 (20%), mortality in 4 patients with th th carcinoma(13.33%). Artificial ventilation discontinued within 24 hours in 22, at 7 day in 4 and at 14 days in 4 patients. Wound dehiscence occurred in 1(3.33%), cardiac arrest in 1 (3.33%). Mean hospital stay was 13.6 (7- 45) days. Six patients (20%) were symptom free without drugs and 9 patients (30%) were symptom free with drugs at 2 years. Conclusion: Trans-sternal total thymectomy provides good results for symptom control in benign thymic conditions. The major complication is haemorrhage needing transfusion. Other complications can be managed successfully by conservative treatment.

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