Thoracoscopic Decortication in Curing Pott’s
A patient with a history of empyema with hydrothorax of the left lung for
which he was diagnosed as TB infected was admitted to Nanavati Super
Speciality Hospital. He was taking anti-tubercular drugs but was plagued
with intermittent fever and breathlessness for which ICD had been
inserted two months back at another hospital. MRI studies revealed L3-
L4 Spondylodiskitis and concentric bulge with posterocentral protrusion
of L4-L5 disc, ligamentum flavum thickening and facetal arthropathy
and paravertebral collections. All these conditions suggested that the
patient was suffering from a case of Pott’s Spine.
After the initial workup, which also revealed loculated collection in the
left lung and worsening symptoms despite ICD insertion, the patient
was posted for therapeutic thoracoscopy and decortication of the left
lung. Using 3 ports, 1 – 10mm and 2 – 5mm in 3rd, 5th, 7th inter costal
spaces, extensive slough and septations responsible for loculated
collection was located and removed. Complete decortication of visceral
pleura was performed and haemostasis was achieved. Comprehensive
lung expansion was seen intraoperative, after which no. 32 drain was
placed in the left lung. The whole procedure was performed without
administering a single lung anaesthesia. Patient withstood the
procedure very well and the recovery was quite uneventful.
Post surgery, the patient’s symptoms and overall condition improved
significantly. The drain was removed on the 4th postoperative day after
lung expansion was seen on consecutive X-rays. He was discharged on the
6th day post-operation. The patient was followed up with no recurrence
of symptoms like fever and breathlessness, and is doing well now.
Thoracoscopic Decortication is a procedure well established to have
distinct advantages over the conventional procedure. As in this case,
we have seen excellent recovery with great results and minimum pain.
The patient was able to resume day-to-day activities very soon.