Perioperative management - Anterolateral thoracotomy

Thoracotomy refers to the surgical opening of the thorax through an intercostal incision. This provides access to the bony chest wall, the pleural space, the lung, the diaphragm, and the mediastinum.

The article demonstrates an anterolateral thoracotomy, which is of particular importance to the visceral surgeon, as it represents the standard approach to the intrathoracic oesophagus in open procedures.

The anterolateral thoracotomy is characterised by a more gentle approach compared with the posterolateral access. The muscle layer to be transected is smaller; in particular, the latissimus dorsi muscle remains largely intact, and the ribs are also less spread.

• Liver cirrhosis Child C
• Severe pulmonary parenchymal diseases (COPD, pulmonary fibrosis)
• Severe heart failure
• Severe coronary heart disease

• Chest CT
• Cardiovascular functions, possibly lung function
• Determination of blood type, blood count, liver and kidney values
• Further diagnostics according to the existing clinical picture

Perioperative antibiotic prophylaxis if necessary (depending on the planned surgery)

Optimisation of the pulmonary condition (breathing exercises, possibly inhalation therapy)

• General surgical risks such as infections or complications with anaesthesia
• Lung injury
• Injury to intercostal nerves and vessels
• Rib fractures
• Fistula formation
• Cardiac arrhythmias
• Postoperative bleeding
• Re-thoracotomy
• Atelectasis
• Heart failure
• Pneumonia
• Respiratory insufficiency
• Subcutaneous emphysema
• Pleural effusion/empyema