Perioperative management - Anterolateral thoracotomy

Thoracotomy is defined as the surgical opening of the chest through an intercostal incision. This gains access to the osseous chest wall, pleural space, lung, diaphragm, and mediastinum.

This presentation illustrates the procedure of anterolateral thoracotomy, which is particularly relevant for the GI surgeon as it represents the standard open approach to the intrathoracic esophagus.

The main benefit in anterolateral thoracotomy is that this procedure is gentler than the posterolateral approach. Less muscles must be divided, the latissimus dorsi in particular remains largely intact, and the ribs also do not have to be spread as much.

• Liver cirrhosis Child C
• Severe interstitial lung disease (COPD, pulmonary fibrosis)
• Severe heart failure

Severe coronary artery disease

• Chest-CT
• Cardiovascular, and possibly also lung function testing
• Blood group, blood count, liver, and renal panel
• Further diagnostic work-up depending on the clinical picture present

If necessary, perioperative prophylactic antibiotic regimen (depending on the planned operation)

Optimization of the pulmonary situation ( breathing exercises, if necessary, inhalation treatment)

• General surgical risks such as infections and complications during anesthesia
• Lung injury
• Injury to intercostal nerves and vessels
• Rib fractures
• Fistula formation
• Cardiac arrhythmias
• Secondary bleeding
• Rethoracotomy
• Atelectasis
• Heart failure
• Pneumonia
• Respiratory failure
• Subcutaneous emphysema
• Pleural effusion/empyema