Pulmonary resection for the treatment of massive hemoptysis in a resource-limited setting: Experience from Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia
Background: There are limited publications regarding patients operated for massive hemoptysis from developing countries. We reviewed a series of patients with massive hemoptysis who are treated surgically in Tikur Anbessa specialized hospital (TASH), Addis Ababa, Ethiopia.
Methods: A retrospective study of 22 patients referred for massive hemoptysis and operated over a period of five years (January 1, 2013-January 31, 2018) was done.
Results: Pulmonary resection for massive hemoptysis was done for 22 patients with mean age of 31.4 +/- 11.4 years. Male to female ratio was 2.1:1. Patients presented after 111.8 +/- 89.7 hours of symptom onset. Post tuberculosis aspergiloma and bronchiectasis were the main cause of massive hemoptysis seen in 16(72.2%) and 5(22.7%) patients respectively. The right lung in 12(54.5%) and left lung in 10(45.5%) patients were involved. In both sides of the lung, upper lobe, 20(90.9%), was the main source of hemoptysis. Pulmonary isolation with double lumen endotracheal tube was used in only14 (63.6%) patients. Upper Lobectomy was done in 12 patients (54.5%), wedge resection in 5 patients (22.7%), pneumonectomy in 4 patients (18.2%) and bi-lobectomy in one (4.5%) patient.
Twelve (54.5%) patients developed one or more complications following surgery. Five (22.7%) patients had to be on prolonged chest tube drainage for air leak, 4(18.2%) patients developed empyema which subsided later with drainage, 4(18.2%) patients had post operative pneumonia, one (4.5%) patient had post thoracotomy neuralgia, one patient had to be re-operated for recurrence, and three (13.6%) had major wound infections. There was one death (4.5%) due to severe postoperative bleeding and coagulopathy. Twenty-one patients were discharged home after an average hospital stay of 15.5 +/-8.5 days.
Conclusions: Since majority of patients with massive hemoptysis in developing countries are post tuberculosis and affect primarily young population, pulmonary resection is still safe and effective life saving procedure that should be performed in selected patients with good lung reserve.