Abdul Baseer, Aamir Bilal, Muhammad Imran.
12 years experience of surgical management of pulmonary aspergilloma.
Pak J Chest Med Jan ;20(4):142-6.

OBJECTIVE: To analyze the results of surgery in the management of Pulmonary Aspergilloma. METHODOLOGY: Computerized records of 450 cases of diagnosed Pulmonary Aspergilloma were retrospectively analyzed from Jan 2003 to May 2014. Patients of all ages, both sexes, medically fit and unilateral Pulmonary Aspergilloma were included in the study. Medically unfit and bilateral pulmonary aspergilloma were excluded from the study. Routine investigations, serology for aspergillus, sputum culture, Computed Tomography, Pulmonary Function Tests and Bronchoscopy were performed in all cases. Type of pulmonary resection done according to extent of the disease. All patients underwent preoperative anesthetic evaluation by anesthetist and one lung ventilation during surgery and specimen sent for histopathology in all cases. RESULTS: Out of 450 patients, 255 patients were male and 195 were female, age ranges from 16 years to 70 years, mean age was 35.6 years. The most common symptom was hemoptysis (92%) followed by persistent chest pain (30.7%) and recurrent cough with sputum (23%). The most common underlying lung disease was tuberculosis in 407 (90.44%), whereas lung abscess was present in 42 (9.33%) and lung cancer in 1(.22%) case. Simple Mycetoma was observed in 22 (4.88%) cases whereas complex Mycetoma was diagnosed in 428 (95.11%) cases. The procedures performed were Lobectomy in 380 (84.44%) cases, Bilobectomy 36 (8%), wedge resection 22 (4.8%) and Pneumonectomy in 12 (2.66%) cases. Postoperative complications occurred in 32 (7.11%) patients, of which 15 (3.33%) had prolonged air leak, 4 (.88%) had significant postop bleeding out of which two required re-exploration, 2 (0.44%) patients developed Empyema and wound infection occurred in 11 (2.44%) patients. Mortality was 10 (2.2%) of which 09 patients died due to respiratory failure and one patient due to pulmonary embolism. CONCLUSION: Even surgical resection for complex aspergilloma can be done with low morbidity and mortality rate in a high volume center with harmonic and intercostal muscle flap utilization.

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