Muhammad Shoaib Nabi, Aneela Chaudhary, Dawar Mahmood Ayyaz, Muhammad Saquib Musharaf, Fariha Bashir.
Treatment of Pulmonary Aspergilloma- is Surgery a Safe Option? a review of 289 cases at two centers in Pakistan.
Esculapio J Services Inst Med Sci Jan ;15(1):42-6.

Objective: To determine outcome of surgery in adult Pakistani population with Aspergilloma Place and duration of study: Services Institute of Medical Sciences and Surgimed Hospital Lahore, Pakistan from January 2002 to December 2017 Material and Methods: A total of 289 adults of both sexes with unilateral as per gilloma cavity were enrolled in this prospective study spanning 16 years carried out in Services Institute of Medical Sciences and Surgimed Hospital Lahore. Out of 289, only 102 patients were electively fit for surgery. Exclusion criteria involved any patient with extensive bilateral disease, advanced age (65+) and lack of consent. Data was collected on hard copy forms with entry and analysis done in SPSS version 23. Follow up period was of 36 months. Results: Our study consisted of 289 patients with 102 selected for surgical intervention. The median age of the patients was 33.4. The most common presenting complaint was recurrent hemoptysis, seen in 75 patients (73.5%). The most common underlying lung pathologies predisposing to Aspergilloma were Tuberculosis (76.4%) and Bronchiectasis (14.7%). The most common co-morbidities were Hepatitis C 23.5% and Diabetes20.5%.Out of 102 cases postoperative complications were documented in 24 (23.5%) patients of which 9(37%) patients had more than one complications. 10 (9.8%)patients had prolonged air leak, 8 (7.8%) had surgical site wound infection, 8 (7.8%) had mild hemoptysis for couple of weeks, 5(4.9%) had bronchopleural fistula, 5(4.9%) had intra thoracic haemorrhage (>1500 ml blood loss), 4 (3.9%) had post resection loculated empyema and 4(3.9%) had pneumonia. Post-operative mortality was 1.96% with zero per-operative mortality. One patient died due to pulmonary embolism on the 5thpostoperative day and the other patient died of myocardial infarction. Follow up was for 36 months postoperatively. Conclusion: Although surgical intervention for aspergilloma is technically difficult,scrupulous selection of patients, meticulous surgical techniques and good postoperative care can reduce mortality and morbidity and favourable outcome can be achieved.

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