Perikardiektomia torakoskopowa. Wskazania i techniki u małych zwierząt. Część II/Thoracoscopic pericardectomy. Indications and techniques in small animals. Part II

Postoperative care

In a study by Walsh et al. (19), seven dogs underwent partial pericardectomy through a standard left lateral thoracotomy at the fifth intercostal space, and seven dogs underwent one-lung ventilation and thoracoscopic partial pericardectomy. Postoperative pain was evaluated using a standard pain score table at 1, 5, 9, 17, 29, and 53 hours after surgery. The dogs that underwent thoracotomy had significantly higher blood glucose concentrations, plasma cortisol concentrations, and pain scores at 1, 5, and 9 hours postoperatively.

In addition, two dogs that underwent open thoracotomy exhibited left forelimb lameness, and two others developed wound dehiscence. Although some authors advise sending patients home after 24 hours of drainage, our experience has shown that some patients continue to produce a relatively large volume of fluid after surgery, making drainage necessary. Longer hospitalization is necessary for such patients.

Conclusion

Pericardectomy is one of the most rewarding procedures that can be achieved thoracoscopically. The technique carries a very low morbidity and can be achieved in easily less that 60 minutes in moderately-trained hands. In comparison to intercostal thoracotomy or sternotomy, the pain scores are much less and recovery is much faster.

Using vessel-sealer or bipolar devices is very helpful to control the bleeding coming from the inflamed pericardium. Wounds are small and although some inflammation can happen around the trocar holes, healing is usually uneventful.

Thoracoscopic pericardectomy is the number one procedure to be achieved by endoscopic surgeons when progressing from the intra-abdominal procedure to intra-thoracic ones.

prof. dr n. wet. Gilles Dupré, Dipl. ECVSKlinik für Kleintierchirurgie, Augen-und ZahnheilkundeVetMedUni ViennaA-1210 Vienna, Veterinaerplatz 1 Österreich

Tłumaczenie: Katarzyna Kulikowska i lek. wet. Wojciech Kujawski

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