Successful treatment of descending necrotizing mediastinitis

Tanaka, Yugo; Maniwa, Yoshimasa; Yoshimura, Masahiro; Okita, Yutaka

doi:10.1007/s11748-007-0147-1

Cited by 6 publications

(3 citation statements)

References 10 publications

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“…Simultaneously, the number of institutions performing VATS, which is a minimally invasive procedure, has increased [ 3 , 14–16 ]. Previously, the subxiphoid, parasternal and transcervical approaches were used because of concerns about the invasiveness of thoracotomy [ 5 , 14 , 18 ]. Compared with these approaches, VATS is more advantageous because it could be used to approach the entire mediastinum similar to thoracotomy.…”

Section: Discussionmentioning

confidence: 99%

The efficacy of thoracoscopic surgery for descending necrotizing mediastinitis

Tanaka

Maniwa

Sugio

et al. 2023

Interdisciplinary CardioVascular and Thoracic Surgery

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OBJECTIVES Thoracotomy is a reliable approach for descending necrotizing mediastinitis (DNM), and the use of video-assisted thoracic surgery (VATS), a minimally invasive procedure, has been increasing. However, which approach is more effective for DNM treatment, is controversial. METHODS We analyzed patients who underwent mediastinal drainage via VATS or thoracotomy, using a database with DNM from 2012 to 2016 in Japan, which was constructed bv the Japanese Association for Chest Surgery and the Japan Broncho-esophagological Society. The primary outcome was 90-day mortality, and the adjusted risk difference between the VATS and thoracotomy groups using a regression model, which incorporated the propensity score, was estimated. RESULTS VATS was performed on 83 patients and thoracotomy on 58. Patients with a poor performance status commonly underwent VATS. Meanwhile, patients with infection extending to both the anterior and posterior lower mediastinum frequently underwent thoracotomy. Although the postoperative 90-day mortality was different between the VATS and thoracotomy groups (4.8% vs 8.6%), the adjusted risk difference was almost the same, −0.0077 with 95% confidence interval of − 0.0959 to 0.0805 (p = 0.8649). Moreover, we could not find any clinical and statistical differences between the two groups in terms of postoperative 30-day and 1-year mortality. Although patients who underwent VATS had higher postoperative complication (53.0% vs 24.1%) and reoperation (37.9% vs 15.5%) rates than those who underwent thoracotomy, the complications were not serious, and most could be treated with reoperation and intensive care. CONCLUSIONS The outcome of DNM treatment does not depend on thoracotomy or VATS.

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Section: Discussionmentioning

confidence: 99%

The efficacy of thoracoscopic surgery for descending necrotizing mediastinitis

Tanaka

Maniwa

Sugio

et al. 2023

Interdisciplinary CardioVascular and Thoracic Surgery

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“…Delay of treatment is one reason for the high mortality rate in DNM; therefore, early aggressive surgical drainage and antibiotic therapy are essential. 4 The therapeutic principle in our institution is to perform emergency surgery soon after the diagnosis of DNM.…”

Section: Discussionmentioning

confidence: 99%

“…Ten patients had a thoracotomy thorough the right triangle of auscultation, and one had a right para-mediastinal incision. 4 At the same time, cervical open drainage was carried out by an otolaryngologist in 10 patients, and 9 underwent a tracheotomy in anticipation of laryngeal edema. The mediastinal pleura were opened widely longitudinally in 3 areas: the anterior mediastinum, paratracheal space, and posterior space of the trachea including the subcarinal space ( Figure 3).…”

Section: Methodsmentioning

confidence: 99%

Successful management of descending necrotizing mediastinitis

Wakahara

Tanaka

Maniwa

et al. 2011

Asian Cardiovasc Thorac Ann

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Descending necrotizing mediastinitis is a critical infection and the mortality rate remains high. Early aggressive surgical drainage and antibiotic therapy are essential for treatment. We evaluated the efficiency of transthoracic drainage using a minimally invasive technique in 11 cases of descending necrotizing mediastinitis between May 2002 and March 2008. We performed a right-side minithoracotomy with thoracoscopic assistance, and the mediastinum was thoroughly drained. The length of hospitalization ranged from 30 to 117 days. The postoperative course was good in all patients, and the outcome was favorable. All patients were discharged without major complications. We recommend employing a minithoracotomy with thoracoscopic assistance for aggressive treatment of descending necrotizing mediastinitis.

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Complications of Thoracoscopic-Laparoscopic Esophagectomy and the Treatment

2018

Atlas of Thoracoscopic-Lapacoscopic Esophagectomy

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Successful treatment of descending necrotizing mediastinitis

Cited by 6 publications

References 10 publications

The efficacy of thoracoscopic surgery for descending necrotizing mediastinitis

The efficacy of thoracoscopic surgery for descending necrotizing mediastinitis

Successful management of descending necrotizing mediastinitis

Complications of Thoracoscopic-Laparoscopic Esophagectomy and the Treatment

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