Archives: Hizmetler

Hemo-pneumothorax is a condition where both blood (hemothorax) and air (pneumothorax) accumulate simultaneously in the distance between the lung and the chest wall, called the pleural space.

Under normal conditions, there is a negative pressure in this cavity, and this pressure allows the lungs to remain attached to the rib cage and remain inflated.

When air or blood enters this cavity from outside, the pressure balance is disrupted, the lung begins to deflate and the fluid/air accumulated in the chest cavity puts pressure on the vessels leading to the heart.

This is an emergency surgical condition that can lead to both respiratory failure and circulatory disorder and must be intervened within minutes.

With modern thoracic surgery protocols, these deposits are quickly evacuated, allowing the lung to swell again and eliminating the risk to life.

What is Hemo-Pneumothorax? How Does It Develop?

Hemo-pneumothorax is a leak into the pleural space as a result of damage to the lung tissue or vessels in the chest wall.

“Pneumothorax” develops when air leaks from the lung, and “hemothorax” develops when blood leaks from the vein; When both are together, the lung is under bilateral pressure.

While the air causes the lung to deflate (collapse); The accumulated blood both compresses the lungs and prepares the ground for shock due to blood loss in the body.

The Relationship Between Hemothorax and Pneumothorax

These two conditions usually trigger each other as a result of a trauma; For example, a broken rib can rupture the lung, leading to both air and blood leakage.

Air leakage rapidly fills the pleural space, while blood settles in the lower parts of this space, pushing the base of the lung upwards.

As a result, the lung becomes dysfunctional, as if being compressed by a vice, and gas exchange reaches a standstill.

Pressure Balance in the Chest Cavity and Lung Collapse

The lungs are elastic like a balloon and tend to deflate as soon as the negative pressure on them is removed.

In hemo-pneumothorax, each breath that enters increases the pressure in the pleural space, making the lung even smaller.

If this condition reaches the stage of “blood pressure pneumothorax”, the heart and main vessels are pushed to the opposite side and blood circulation may stop completely.

What are the Symptoms of Hemo-Pneumothorax?

Symptoms start suddenly and worsen rapidly depending on the severity of the trauma or the amount of blood/air accumulated.

Sudden Severe Chest Pain and Shortness of Breath

Patients often describe a sharp pain as if a knife has been stabbed in their chest, and this pain is exacerbated by breathing.

Since the lung is deflated, the patient begins to feel air hunger; Due to shortness of breath, the patient may have difficulty speaking and may breathe rapidly.

Low Blood Pressure, Heart Rate Acceleration and Shock Symptoms

Due to blood loss (hemothorax), the patient’s color fades and his skin becomes cold and moist.

The body accelerates the pulse to balance the decreasing amount of blood; If the intervention is delayed, blood pressure drops and shock symptoms such as confusion occur.

Causes and Risk Factors of Hemo-Pneumothorax

Although there is usually physical damage behind hemo-pneumothorax, sometimes medical processes can also cause it.

Blunt and Penetrating Chest Traumas

Rib fractures caused by hitting the steering wheel or seat belt pressure in traffic accidents are the most common “blunt” cause.

“Penetrating” traumas such as stabbing or gunshot wounds directly open both the air and blood pathway, leading to a severe picture.

Spontaneous Hemo-Pneumothorax Cases

In rare cases, this condition can develop without trauma as a result of the rupture of a vessel in that area with the bursting of small air sacs (blebs/bullae) in the lung.

It can be seen during menstruation (catamenial), especially in young, thin and tall men or women with endometriosis (chocolate cyst).

Iatrogenic Causes (Conditions After Medical Intervention)

These are accidental injuries that occur during central venous catheter insertion, lung biopsy or fluid removal from the chest cavity (thoracentesis).

Hemo-Pneumothorax Diagnosis and Diagnostic Methods

In emergency room conditions, diagnosis is made within seconds with physical examination and rapid imaging.

Physical Examination: Decreased Breathing Sounds

When the doctor listens with the stethoscope, he hears that the breathing sounds on the affected side have completely disappeared or become very reduced.

In addition, when the rib cage is tapped with a finger (percussion), the drum sound (tympanism) is taken in the upper parts where there is air, and the matite (full sound) is taken in the lower parts where there is blood.

Radiological Imaging: Chest X-ray and Chest CT

In the standing chest X-ray, a flat fluid level (hydroaero line) formed by the blood below is clearly seen.

In stable patients, Computed Tomography (CT) gives the most detailed information to see the source of the bleeding and the extent of lung damage.

Emergency Evaluation with Ultrasonography (FAST)

With the ultrasound method called “E-FAST” in trauma centers, it can be determined whether there is blood or air in the chest cavity within seconds without radiation.

Hemo-Pneumothorax Treatment Methods

The priority of treatment is the “ABC” rule: Open the airway, restore breathing and control circulation (blood loss).

Emergency Intervention: Chest Tube Insertion (Tube Thoracostomy)

The definitive treatment for hemo-pneumothorax is the insertion of a drainage tube through the chest wall into the pleural space.

Thanks to this tube, the trapped air is evacuated and the accumulated blood is taken out; As the pressure is removed, the lung instantly begins to inflate again.

Management of Blood Loss and Fluid Replacement

The amount of blood taken out is monitored and the patient is transfused with fluid and, if necessary, blood through the vein.

If the amount of blood coming from the chest tube is more than 200 ml per hour or exceeds 1500 ml in total, an emergency surgical decision is taken.

Surgical Intervention: When is Thoracotomy or VATS Needed?

Surgery is required in cases where the bleeding does not stop or the tear in the lung does not close with the tube.

Today, these operations can be done by entering through small holes with the closed method (VATS); However, open surgery (thoracotomy) is life-saving in heavy bleeding.

Hemo-Pneumothorax Treatment Decision Chart

Prof. Dr. Levent Alpay: Hemo-pneumothorax is a picture in which the surgeon is racing against time. The most critical mistake here is to just release the air and underestimate the bleeding. As soon as we insert the chest tube, we follow the amount of blood coming in millimeters; Because if there is insidious bleeding inside, this can put the patient in shock. Thanks to VATS technology, which is a closed method, we can now find and repair the bleeding foci of these patients with millimetric cameras without stitches and large incisions. Early intervention prevents the lung from deflating and losing function.

Case Experience (Anonymous):

A 22-year-old young man was brought in with severe pain and bruising on his left side after falling from a height. In the X-ray, it was seen that the left lung was completely deflated and approximately 800 ml of blood accumulated. The lung was inflated with an urgently inserted chest tube, but the air leak did not stop for 3 days. In the VATS (closed surgery) procedure, a burst air sac at the top of the lung was detected and closed, and the patient was sent home with full recovery on the 5th day.

If you have suffered a blow to your chest area or are experiencing sudden shortness of breath, it is vital to consult a specialized thoracic surgeon for immediate evaluation and proper treatment management.

Healing Process and Follow-up After Tube Removal

The chest tube is removed when the air leak is completely stopped and the daily blood supply stops (usually 2-5 days).

After the tube is removed, the patient’s chest X-ray is taken again to confirm that the lung remains swollen.

During the healing process, it is critical for the patient to perform blowing exercises (triflo) to remove any remaining fluids from the lungs and prevent infection.

Frequently Asked Questions

Does Hemo-Pneumothorax Cause Death?

Yes, if the pressure in the pleural cavity reaches a level that puts pressure on the heart (blood pressure picture) or if blood loss cannot be controlled, it can be fatal if not intervened.

Is Pain Felt During Chest Tube Insertion?

The procedure is usually performed under local anesthesia in emergency conditions; Since the area is numbed, no severe pain is felt during the insertion of the tube, but there may be a feeling of pressure.

Is There a Risk of Recurrence After Treatment?

In trauma-related cases, the risk of recurrence after repair of damage is low; However, in cases that develop spontaneously, if there is an underlying structural disorder, there is a risk of recurrence and surgical protection may be required.

Scientific Bibliography

• Cleveland Clinic: Hemopneumothorax Diagnosis and Management
• ScienceDirect: Clinical Overview of Traumatic Hemopneumothorax
• Journal of Trauma and Acute Care Surgery: Chest Tube Management Guidelines
• American Association for the Surgery of Trauma: Thoracic Trauma Protocols

Hyperhidrosis is a condition in which the body produces much more sweat than it needs to maintain heat balance.

Excessive sweating, especially in the hands, armpits and face area, can seriously limit a person’s social life, work performance and psychological well-being.

Overactive sweat glands are often a structural condition and are triggered by the sympathetic nervous system sending out of control signals.

ETS surgery, which is a surgical intervention for patients who cannot get results with traditional methods (creams, botox, etc.), offers a permanent and definitive solution.

Thanks to modern surgical techniques, the problem of excessive sweating can now be ended within minutes with closed operations performed by entering through a single small hole.

What is Hyperhidrosis? Why Does It Happen?

Hyperhidrosis is defined as a person “staying in water” not only in hot weather, but even when excited or at complete rest.

The sweating mechanism is the body’s cooling system; However, in hyperhidrosis patients, this system constantly works at the highest speed.

Patients often avoid shaking hands and experience social isolation due to sweat marks on their clothes.

Distinction between Primary and Secondary Excessive Sweating

The first step in diagnosis is to understand whether there is an underlying disease for sweating.

• Primary Hyperhidrosis: It usually starts in childhood or adolescence and only affects specific areas such as the hands, feet, face, or armpits.
• Secondary Hyperhidrosis: It is a symptom of another health problem, such as diabetes, thyroid diseases or menopause, and sweating is usually seen all over the body.

Regional Sweating Areas That Make Social Life Difficult: Hand, Foot and Armpit

Hand sweating (palmar hyperhidrosis) can be severe enough to make it difficult for the patient to hold pen and paper or to impair electronic devices.

Underarm sweating, on the other hand, shakes the self-confidence of the person by leaving a bad odor and permanent wetness on the clothes.

Facial sweating and the accompanying sudden blushing can turn into a psychological burden that makes it impossible for the person to speak in front of a crowd.

Excessive Sweating Treatment Methods

The treatment plan is created in a stepwise manner according to the severity of the patient’s complaints and the width of the affected area.

Non-Surgical Solutions: Iontophoresis, Botox, and Lotions

In mild and moderate cases, non-surgical methods can be tried; However, the results of these methods are usually temporary.

• Botox Application: It blocks the nerve endings going to the sweat glands, its effect lasts for about 6 months and needs to be repeated regularly.
• Iontophoresis: It is the holding of the hands in a water bath in which an electric current is applied; It is difficult to sustain because it requires frequent sessions.
• Clinical Lotions: They are aluminum chloride-based products that temporarily clog pores and can cause skin irritation.

Permanent Solution: ETS Surgery (Endoscopic Thoracic Sympathectomy)

ETS surgery is a technical intervention in the sympathetic nerve chain that controls regional sweating.

The aim of this procedure is not to eliminate the sweat glands, but to stop the nerve signals that lead them to the “sweat” command at a certain level.

The effect of the operation is usually seen while the patient is still on the operating table; Hands instantly become dry and warm.

What is ETS Surgery (Excessive Sweating Surgery)?

ETS is a modern surgical procedure performed under general anesthesia with a closed method and takes about 20-30 minutes.

The sympathetic nerve chain passing through the rib cage is monitored with camera systems and intervened at the targeted level.

Differences Between Clip-On ETS and Sympathectomy Techniques

While cutting or burning nerves was preferred in the past, today the “Clip-on ETS” method is more common.

In the clip-on method, the nerve is not cut; Nerve conduction is suppressed with the help of a titanium clip.

The biggest advantage of this technique is that the operation is reversible due to side effects that may develop in rare cases.

Single-Hole Closed Surgery (VATS) Technology

These surgeries, which used to be performed with large incisions, are now performed through a single 1-centimeter hole opened under the armpit.

Thanks to this technology, called Video-Assisted Thoracoscopic Surgery (VATS), no muscle incision is made and tissue damage is minimal.

Who is ETS Surgery Applied to?

ETS surgery is recommended for suitable candidates whose lives are unbearable and who do not respond to other treatments.

Surgical Success for Hand Sweating and Facial Flushing (Blushing)

The group with the highest success rate of ETS is patients with hand sweating (approximately 98%) and facial flushing.

The success rate of armpit sweating is high; however, ETS surgery performed in the chest area for foot sweating does not offer a direct solution.

Preoperative Sweating Mapping: Minor Test

The “Starch-Iodine Test” (Minor Test) can be used to determine the intensity and area of sweating before surgery.

This test guides the surgeon on which level of the nerve chain needs to be intervened.

ETS Surgery Process and Recovery Stages

The surgical process is fast, effective and has a flow that prioritizes the patient’s comfort.

Surgery Preparation and General Anesthesia Process

Patients are prepared for the operation with routine blood tests and chest X-rays.

Special anesthesia techniques are used to prevent the lungs from deflating during the surgery and the patient does not feel any pain throughout the procedure.

Same Day Discharge and Return to Social Life

A few hours after the operation, the patient can stand up and is usually discharged on the same day.

Small incisions that do not require stitches or use self-dissolving stitches close within 2-3 days and do not leave scars.

Sweating Treatments Comparison Table

Prof. Dr. Levent Alpay: Excessive sweating is not only a skin problem, but also a self-confidence problem. It is one of the greatest comforts offered by medicine that a patient who is afraid to shake hands and always walks around with spare clothes can get rid of this problem with a 20-minute closed surgery. The main reason why we prefer the clip-on ETS method is the sense of trust it offers to the patient as well as surgical success. The warming and drying of the hands as soon as you come out of surgery is the beginning of a new life.

Case Experience (Anonymous):

Our 25-year-old university student patient was wetting the papers during exams and avoiding social environments due to his hands being constantly wet. T2 and T3 levels were intervened with clip-on ETS surgery. Our patient, who saw that his hands were dry and hot as soon as he woke up from the operation, was discharged home in the evening of the same day. In the 2nd postoperative follow-up, it was observed that the patient’s social life was completely improved and he did not experience any side effects.

If your social life is restricted due to excessive sweating and you are looking for a permanent solution, you can make an appointment with our clinic for suitability evaluation for ETS surgery and seek expert opinion.

Frequently Asked Questions

Does Sweating Go Away Completely After ETS Surgery?

Yes, sweating in the intervened area (hands, face or armpits) ends permanently as soon as the surgery is over.

Does Surgery Leave Scars?

Since it is entered through a single hole of approximately 1 cm opened under the armpit, there is no visible surgical scar when the wound heals.

In Which Parts of the Body Does Reflex Sweating Occur?

Reflex sweating (compensatory sweating) is a slight increase in sweating in areas such as the back, belly or back of the legs to maintain the body’s heat balance; In the vast majority of patients, this situation is at a level that does not disturb comfort.

Scientific Bibliography

• Society of Thoracic Surgeons (STS): Clinical Practice Guidelines for Hyperhidrosis
• PubMed (NCBI): Long-term Results of Clipped ETS for Palmar Hyperhidrosis
• Journal of Vascular Surgery: Endoscopic Thoracic Sympathectomy Techniques
• International Hyperhidrosis Society: Surgical Treatments and Outcomes

Chest wall and diaphragm surgery is a specialized specialty that aims to restore the structural integrity of the rib cage, which protects vital organs, and the functions of the diaphragm, the most important muscle of breathing.

While the rib cage protects the heart and lungs from external influences; The diaphragm muscle works like a pump under these organs, allowing us to breathe in and out.

Tumors, deformities, or loss of function in these areas can lead not only to aesthetic concerns but also to severe respiratory and circulatory failures.

Modern thoracic surgery approaches aim to both repair these complex anatomical structures and maximize their function.

Thanks to the advanced surgical techniques applied today, patients recover much faster and regain their respiratory capacity in a short time.

What is Chest Wall Surgery? Which Diseases Does It Cover?

Chest wall surgery; It is the surgical treatment of the area that includes the ribs, sternum and the muscle and soft tissues covering these bones.

This surgical field encompasses a wide range of diseases, from congenital disorders to aggressive tumors that develop later.

The main goal is to ensure that the rib cage continues to act as a protective shield and to create a space where the lungs can expand comfortably.

Chest Wall Tumors and Surgical Treatment

Chest wall tumors can originate directly from the ribs or sternum, or they can spread to this area from surrounding organs such as lung or breast cancer.

The basic principle in the surgical treatment of tumors is the complete removal of the mass along with the surrounding healthy tissue.

After the mass is removed, the cavity formed is reconstructed with the help of the patient’s own tissues or biosynthetic patches, preserving the integrity of the chest.

Chest Wall Deformities (Pectus Excavatum and Carinatum)

Deformities, popularly known as “shoemaker’s chest” (Pectus Excavatum) and “pigeon chest” (Pectus Carinatum), are among the most common areas of chest wall surgery.

These conditions not only lead to psychological problems; In advanced levels, it can put pressure on the heart, causing arrhythmias or fatigue.

In modern treatment, aesthetic and functional improvement is achieved thanks to metal bars placed in the rib cage with minimally invasive (closed) methods such as Nuss and Abramson.

Chest Wall Trauma and Rib Fracture Repair

Multiple rib fractures that occur in situations such as falling from a height or traffic accidents can lead to life-threatening conditions called “flail chest”.

In these patients, who used to be recommended only bed rest, today the process of fixing the ribs (osteosynthesis) is performed using special titanium plates and screws.

This procedure quickly relieves the patient’s pain, shortens the length of stay in the intensive care unit and minimizes the risk of lung collapse.

Diaphragm Surgery and Functional Disorders

The diaphragm is a thin but very strong layer of muscle that separates the chest cavity from the abdominal cavity.

Sagging, paralysis or holes in this muscle, which undertakes 70-80% of the breathing process alone, directly affect the quality of life.

The Relationship Between Diaphragm Paralysis and Shortness of Breath

As a result of damage to the “phrenic nerve” that commands the diaphragm muscle, the diaphragm sags upwards and loses its function.

This condition causes the abdominal organs (liver, stomach) below the diaphragm to go up and compress the lung.

Patients feel severe shortness of breath, especially when they lie on their backs or bend over.

Diaphragm Plication Surgery (Stretching Repair)

The treatment of the paralyzed diaphragm that hangs up like a balloon is a stretching surgery called “plication”.

The diaphragm muscle, which is loosened during the surgery, is folded with special sutures, stretched and lowered.

Thus, the area where the lung can expand is opened again and the patient’s breathing capacity increases instantly.

Diaphragmatic Hernia and Treatment Methods

Diaphragmatic hernias occur when organs in the abdomen pass through a hole in the diaphragm into the chest cavity.

These holes can be congenital (Bochdalek or Morgagni hernias), or they can develop after penetrating or blunt trauma.

The treatment is to push the herniated organs back into the abdomen and close the hole in the diaphragm with intact sutures or patches.

Diagnosis and Diagnostic Process: Radiological Evaluation

Advanced imaging techniques are as critical as physical examination in diagnosing chest wall and diaphragm problems.

• Dynamic Fluoroscopy (Sniff Test): It is used to monitor the movements of the diaphragm during breathing live.
• Computed Tomography (CT): It clarifies fractures in the bone structure, the depth of tumors and the size of hernias.
• MRI (Magnetic Resonance): It is used in the evaluation of soft tissue tumors and nerves.
• Pulmonary Function Tests (PFT): It measures how much diaphragm paralysis restricts lung capacity.

Modern Techniques in Chest Wall and Diaphragm Surgeries

Advances in medical technology have allowed these challenging surgical interventions to be performed with much smaller incisions and less damage.

Closed Methods (VATS and Robotic Diaphragm Surgery)

Diaphragm surgeries, which used to require the rib cage to be opened widely, can now be performed through 3 small holes (VATS) or with the help of robotic arms.

Robotic surgery allows even the deepest points of the diaphragm to be reached with a high-resolution image and the stitches to be placed much more firmly.

Chest Wall Reconstruction and Patch Applications

Highly engineered materials are used to close the cavities formed in the rib cage after major tumor surgeries.

Using titanium bars, synthetic mesh systems or the patient’s own muscle tissues (flaps), the chest wall is rebuilt in a way that is both strong and flexible.

Surgical Method Comparison Table

Postoperative Recovery and Rehabilitation Process

The most important factor in the postoperative period is to ensure that the lungs inflate to full capacity.

Patients are started breathing exercises and walking programs the day after the surgery.

Patients who undergo surgery with the closed method can usually get rid of their drains within a few days and return home.

Prof. Dr. Levent Alpay: Many patients who suffer from shortness of breath due to diaphragmatic paralysis ignore the surgical solution, thinking that this condition is a “sign of aging” or “heart disease”. However, with a correct plication surgery, it is possible to change the patient’s quality of life in one day. The important thing is to analyze the degree of functional loss well and intervene with the least traumatic method.

Case Experience (Anonymous):

Left diaphragmatic paralysis was detected in a 62-year-old male patient who experienced shortness of breath while climbing stairs. After the diaphragm plication performed with the robotic method, the patient’s diaphragm was lowered to its normal anatomical level. The patient, who described an 80% improvement in shortness of breath the day after the surgery, was discharged on the 2nd day.

For your complaints of chest wall deformity, mass or shortness of breath caused by the diaphragm, you can make an appointment with our clinic for a detailed evaluation and modern surgical solutions and seek expert opinion.

Frequently Asked Questions

Does Shortness of Breath Go Away Immediately After Diaphragm Surgery?

Yes, especially after diaphragm plication surgery, patients immediately feel that breathing becomes easier as the pressure on the lung is removed.

Do Chest Wall Tumors Recur After Surgery?

It depends on the type of tumor and the cleanliness of the surgical margins; The risk of recurrence is very low in benign tumors removed with clean surgical margins.

What are the Advantages of Closed Diaphragm Surgery?

Less pain, shorter hospital stay, low risk of infection and small aesthetic scarring are the biggest advantages.

Scientific Bibliography

• The Annals of Thoracic Surgery: Chest Wall Reconstruction: Evolution and Current Concepts
• Journal of Thoracic Disease: Diaphragmatic Plication: Robotic and VATS Approaches
• PubMed (NCBI): Management of primary chest wall tumors
• Journal of Visceral Surgery: Diaphragmatic Hernia: Diagnosis and Surgical Management

Chest traumas are serious injuries that occur as a result of the rib cage, which houses the vital organs of the body, being exposed to an external force.

Since the heart, lungs and large vessels are located in this region, chest traumas are responsible for a significant portion of trauma-related deaths.

While such injuries are sometimes limited to a simple rib crack, they can sometimes reach life-threatening dimensions that require immediate surgical intervention.

Modern thoracic surgery aims to minimize tissue damage with both surgical and interventional methods in these emergencies.

Rapid diagnosis, accurate classification and the intervention of an experienced team are the most basic elements that directly determine the chance of survival in such cases.

What is Chest Trauma? Types and Severity

Chest trauma is a condition in which the chest wall or the organs within it are damaged as a result of a mechanical impact.

The severity of the injury; It varies according to the angle of incidence of the blow, its intensity and the characteristics of the injurious object.

Blunt Chest Traumas (Traffic Accidents, Falls)

Blunt traumas occur as a result of high-energy impacts on the rib cage without compromising the integrity of the skin.

Traffic accidents, falls from heights or assaults are the most common causes of this group.

Even if the skin appears intact on the outside, the shaking and pressure on the internal organs can lead to severe bleeding or lung damage.

Penetrating and Cutting Chest Injuries

Firearm injuries or blows caused by sharp objects fall into this class.

In this type of trauma, a channel is opened between the outside world and the chest cavity, which can cause the lungs to deflate suddenly.

The path followed by the injury channel; It requires intervention within seconds as it can affect critical structures such as the heart, esophagus or main vessels.

Common Chest Trauma Complications

Clinical pictures that occur immediately after trauma can upset the patient’s respiratory and circulatory balance.

Pneumothorax (Lung Collapse) and Hemothorax (Accumulation of Blood in the Chest Cavity)

The accumulation of air between the lung membranes is called “pneumothorax”, and the accumulation of blood is called “hemothorax”.

These conditions cause the lung to shrink and fail to perform its function, resulting in severe shortness of breath.

If air continues to accumulate and pressure increases (blood pressure pneumothorax), pressure on the heart poses a life-threatening risk.

Flail Chest and Respiratory Failure

The independent movement of a part of the chest wall as a result of breaking three or more consecutive ribs in at least two places is called “sail chest”.

This area collapses inward when breathing and comes out when exhaling; This reverse movement can make breathing impossible.

This condition is usually the result of very severe blunt trauma and the patient needs intensive care support.

Lung Contusion (Tissue Crush)

It is the crushing of the lung tissue due to trauma and bleeding/edema in the tissue.

Even if there is no fracture, the lung may not be able to exchange gas only due to contusion; This condition usually worsens 24-48 hours after the accident.

Rib Fractures and Modern Treatment Approaches

Rib fractures are the most common consequence of chest trauma and are usually a very painful process.

While rib fractures were left alone in old approaches, the comfort and safety of the patient are at the forefront in modern surgery.

Fixation with Titanium Plate in Rib Fractures (Osteosynthesis)

In patients with multiple fractures or flail chest, it is a method of fixing the fracture ends with titanium plates and screws.

Thanks to this procedure, the integrity of the rib cage is instantly restored and the severe pain felt by the patient while breathing is minimized.

The fixation process prevents the patient from being connected to the ventilator for a long time and prevents complications such as pneumonia.

Diagnosis and Diagnosis Process in Chest Trauma

Since there is a race against time in trauma patients, the diagnosis process should be carried out quickly and in an organized manner.

Emergency Radiological Evaluation: Chest X-ray and Thorax CT

A chest X-ray is important for initial evaluation but may miss many rib fractures or minor bleeding.

Thorax CT (Computed Tomography) is the most reliable tool in mapping the injury and detecting vital vascular damage.

FAST Ultrasonography and Trauma Management

Ultrasound (FAST) used in emergency rooms shows within seconds whether fluid (blood) has accumulated in the chest or abdominal cavity.

This method gives the surgeon great speed in deciding whether the patient will be taken to the operating room or intensive care.

Emergency Surgical Interventions in Chest Trauma

The goal of surgery in trauma management is to stop bleeding, evacuate escaping air, and preserve organ function.

Tube Thoracostomy (Chest Tube Insertion)

85-90% of chest traumas can be successfully treated with only chest tube insertion.

With the help of a drain, blood and air in the chest cavity are taken out and the lung is reopened.

Bleeding Control with Emergency Thoracotomy and VATS (Closed Method)

If the amount of blood coming from the chest tube is too high or the deflation continues, surgical intervention is essential.

Today, in appropriate cases, bleeding vessels can be sutured or damaged lung tissue can be repaired with the closed method (VATS).

In very severe injuries, vital organs are repaired by direct intervention with open surgery (thoracotomy).

Comparison Table of Treatment Approaches

Prof. Dr. Levent Alpay: The biggest mistake made in chest traumas is to send the patient home with inadequate pain control, saying “the rib fracture will heal on its own anyway”. Especially in elderly patients, the inability to breathe deeply due to pain can lead to the inability to expel the accumulated sputum and fatal pneumonia. Every patient with a rib fracture should be evaluated for lung tissue damage by at least a thoracic surgeon.

Case Experience (Anonymous):

The 55-year-old patient, who was brought to the emergency room after an out-of-vehicle traffic accident, had a comminuted fracture of 5 ribs on the left side and a related “sail chest” picture. The patient had shortness of breath and severe pain and underwent emergency rib stabilization with titanium plates. The patient, who did not need to be connected to a ventilator after the surgery, was discharged painlessly on the 5th day.

If you are experiencing shortness of breath, stinging sensation or severe pain after blows to the chest area, you can make an appointment with our clinic and seek expert opinion to prevent possible complications.

Frequently Asked Questions

Do Rib Fractures Heal on Their Own?

Yes, ribs usually fuse on their own within 4-8 weeks; However, it is vital to control pain and protect the lung during the healing process.

When to See a Doctor After Chest Trauma?

If there is shortness of breath that starts immediately after the blow or within hours, coughing up blood, stinging while breathing and bruising in the chest, it should be applied immediately.

Can Lung Collapse Be Corrected Without Surgery?

Minor deflations (pneumothorax) can be corrected with oxygen therapy and observation, but in deflations above a certain level, a chest tube must be inserted.

Scientific Bibliography

• Journal of Thoracic Disease: Management of Chest Wall Trauma
• The Lancet: Global Trends in Trauma Care and Management
• PubMed (NCBI): Rib Fracture Fixation: Indications and Outcomes
• StatPearls (Bookshelf): Chest Trauma Overview

Esophageal hernia, medically known as hiatus hernia, is a condition in which the upper part of the stomach slides upward through a natural opening in the diaphragm muscle (hiatus) and into the chest cavity.

Under normal conditions, the diaphragm is a strong layer of muscle that separates the rib cage and abdominal cavity and has a small opening for the esophagus to pass through.

As a result of the expansion or stretching of this opening for various reasons, a part of the stomach “herniates” out of this cavity and goes up, disrupting the normal functioning of the digestive system.

Esophageal hernia is not only an anatomical problem, but also the main source of complaints that reduce the quality of life, such as chronic reflux, heartburn and difficulty swallowing.

In modern medicine, this opening can be repaired with laparoscopic (closed) methods and the patient can get rid of stomach acid permanently.

What is Esophageal Hernia? How is it formed?

An esophageal hernia is an unwanted journey of the stomach into the rib cage.

The diaphragm muscle supports a valve mechanism (sphincter) that tightly grips the esophagus and prevents stomach acid from escaping upwards.

But when this opening, called the hiatus, expands, stomach acid and the stomach itself begin to leak up, leading to tissue irritation and inflammation.

Aperture (Hiatus) and Anatomical Disorder

Looking at the anatomy, the junction between the esophagus and stomach should be exactly at or below the diaphragm.

When a hiatus hernia develops, this junction point slides into the chest; This disrupts the body’s pressure balance and prepares the ground for stomach contents to escape freely into the esophagus.

Is Esophageal Hernia the Same as Hiatal Hernia?

The disease, popularly known as “gastric hernia”, is actually called “esophageal hernia” or “hiatal hernia” in medical language.

Unlike an umbilical hernia or inguinal hernia that appears in the abdominal wall, this condition occurs deep in the body, in the muscle layer between the ribcage and the abdominal cavity.

Although both terms refer to the same anatomical problem, the use of hiatus hernia is more common in surgical terminology.

Types of Esophageal Hernias and Their Classification

The shape of the hernia and how much of the stomach goes up determines the treatment method to be applied.

Type 1: Sliding Type (Sliding) Esophageal Hernia

It is the most common type (95% of cases) and occurs when the junction of the esophagus and stomach slides up and down.

It usually manifests itself with heartburn and reflux; small ones can be followed with medication, while large ones may require surgery.

Types 2, 3 and 4: Paraesophageal (Stomach Burn) Hernias

In these species, the upper part of the stomach herniates upwards from the side of the esophagus; The stomach junction may remain in place (Type 2) or it may slide up (Type 3).

In type 4 hernias, other organs such as the intestines or spleen can enter the chest along with the stomach.

Paraesophageal hernias usually have to be repaired surgically because they carry the risk of compression and strangulation of the stomach.

What are the Symptoms of Esophageal Hernia?

Small hernias sometimes cause no symptoms, while large hernias cause symptoms that make daily life difficult.

Heartburn, Chest Pain and Reflux Complaints

The most common symptom is a burning sensation behind the chest, which increases especially after meals or when leaning forward.

This pain can sometimes be so severe that the patient may apply to the emergency room, thinking that he is having a heart attack.

Difficulty Swallowing and Bitter Water in the Mouth

Having the stomach up can mechanically make it difficult for food to descend into the stomach and create a knot sensation in the throat.

In addition, it is common for stomach acid and undigested food to come back into the mouth (regurgitation) when lying down.

Esophageal Hernia Causes and Risk Factors

The development of hernia is often associated with weakening of the diaphragm tissue and increased internal pressure over time.

Conditions That Increase Intra-Abdominal Pressure and Obesity

Excess weight increases intra-abdominal pressure, forcing the stomach upward and causing the diaphragm opening to stretch.

Heavy lifting, straining due to constant constipation or chronic persistent coughing fits are also among the factors that trigger hernia formation.

Aging and Weakening of the Diaphragm Muscle

As age progresses, muscle tissues in the body lose their elasticity; For this reason, the incidence of hiatus hernia increases in individuals over the age of 50.

In addition, previous major abdominal surgeries or blows to the diaphragm area can also disrupt the anatomical structure.

Esophageal Hernia Diagnosis and Diagnostic Methods

During the diagnosis phase, the size of the hernia and the damage caused by stomach acid are clearly revealed.

Upper Gastrointestinal Endoscopy (Gastroscopy)

By entering the esophagus with the help of a lighted camera, the presence of a hernia and the level of irritation (esophagitis) in the esophagus are directly observed.

Barium Gastric X-ray and Manometry Test

X-rays, which are taken by giving the patient a lime-like liquid (barium), show the position of the stomach on the diaphragm like a map.

The manometry test, on the other hand, measures the force of contraction of the esophageal muscles, guiding surgical planning.

Esophageal Hernia Treatment Options

The treatment approach is planned in steps according to the severity of the patient’s complaints and the type of hernia.

Medication and Dietary Habits

In small hernias that only cause reflux, medications that suppress stomach acid (PPIs) and lifestyle changes may be sufficient.

Eating little and often, stopping eating 3 hours before bedtime and sleeping with a high pillow are the basic recommendations.

Surgical Treatment: Laparoscopic Nissen Fundoplication

Laparoscopic surgery is the gold standard for reflux or large hernias that cannot be controlled with medication.

In this surgery, the stomach is pulled back into the abdomen, the opening in the diaphragm is narrowed, and the upper part of the stomach is wrapped around the esophagus (fundoplication) to create a natural valve.

Use of Patch (Mesh) in Hernia Repair

In cases where the diaphragm tissue is too weak or the hernia is too large, special biomedical patches (mesh) are used to support the repair.

These patches significantly reduce the risk of hernia recurrence in the future.

Esophageal Hernia Treatment Methods Comparison

Prof. Dr. Levent Alpay: Esophageal hernia surgeries are operations where surgical precision must be at the highest level. Especially in the repairs we perform with the closed method, it is necessary to balance the length of the esophagus and the tension of the diaphragm very well while taking the stomach to its anatomical place. Our biggest motivation is that our patients say “acid burning is over” as soon as they come out of surgery. Remember that hernia is not just a heartburn but a serious anatomical deformity that can predispose to esophageal cancer over time.

Case Experience (Anonymous):

Our 48-year-old patient, who has been using high-dose reflux medication for 10 years and has recently woken up at night with a feeling of suffocation, was diagnosed with a 6 cm Type 3 hiatal hernia. With the laparoscopic method, the stomach was pulled into the abdomen and the diaphragm was repaired with patch support. Our patient, who started oral feeding the day after the operation, returned to work on the 5th day and it was seen that he stopped all his medications in the 1st month after the operation.

If you are experiencing persistent heartburn or have been diagnosed with esophageal hernia, you can make an appointment with our clinic for closed surgery options and a permanent treatment plan and seek expert opinion.

Postoperative Considerations and Diet

Eating soft foods for the first 2 weeks after surgery is important for the healing of the stitches and the new valve created.

Patients are advised to avoid carbonated beverages and stay away from strenuous exercise for the first few months.

When the recovery is completed, patients can consume foods that they have not been able to eat for years without fear of heartburn.

Frequently Asked Questions

How long does esophageal hernia surgery take?

Laparoscopic (closed) hernia surgery is usually completed between 1.5 and 2.5 hours, depending on the size of the hernia and the degree of anatomical difficulty.

Does Hernia Cause Heart Palpitations?

Yes, large hernias can put pressure on the heart or lungs as they make room for the stomach in the rib cage, which can cause arrhythmia or palpitations in the patient.

Does Esophageal Hernia Go Away Without Surgery?

No, esophageal hernia is a mechanical disorder and medications only hide symptoms by suppressing acid; Physical healing of the hernia is only possible with surgical intervention.

Scientific Bibliography

• Mayo Clinic: Hiatal Hernia Symptoms and Treatments
• PubMed (NCBI): Laparoscopic Nissen Fundoplication Long-term Outcomes
• Journal of Gastrointestinal Surgery: Use of Mesh in Large Hiatal Hernia Repair
• NHS UK: Hiatus Hernia Guide for Patients

Tracheal stent applications are a vital medical intervention that allows the mechanical opening of stenosis or collapses in the trachea (trachea).

Since the trachea is the main pipeline that carries air to the lungs, even the slightest narrowing in this area causes a severe feeling of suffocation and respiratory failure in the patient.

Stents are hollow, tubular supporting devices placed in this narrowed area, and their main job is to ensure that the airway remains open continuously.

Today, with the developing technology, the biocompatibility of stents has increased and placement techniques have been modernized to maximize patient comfort.

This procedure is considered the gold standard for patients, especially those who are not eligible for tracheal surgery or require immediate respiratory support.

What is a Tracheal Stent? Why is it applied?

A tracheal stent is a medical prosthesis that supports the internal structure of the trachea and keeps the wall upright against external pressure.

This application is preferred in cases where surgical removal of the narrowing of the trachea is not possible or when the patient needs to be allowed to breathe during the preparation process for surgery.

Stent application is not just a tube placement procedure, it is an operation to restore the patient’s basic life functions.

Tracheal Stenosis (Tracheal Stenosis) and Stent Relationship

Tracheal stenosis develops when the tissue shrinks by forming scars (scars) as a result of being connected to a ventilator for a long time, traumas or tumors.

When this stenosis reaches a critical level, meaning the trachea diameter narrows by more than 50%, stent placement becomes essential.

The stent expands this annular tissue, which has narrowed, allowing air to reach the lungs unhindered.

The Role of Stents in Achieving Airway Patency

Stents act as an endoskeleton, maintaining the structural integrity of the windpipe.

Especially when there is external tumor pressure or when the cartilage structure of the trachea softens, the stent resists this pressure and prevents the tube from collapsing.

In this way, it becomes easier for the patient to cough up sputum and risks such as lung collapse (atelectasis) are minimized.

In Which Situations Is Tracheal Stent Used?

Stent usage areas are grouped under two main headings according to whether the disease is benign or malignant.

Airway Obstructions Due to Malignant Tumors

Lung cancer, esophageal cancer, or thyroid cancers can directly attack the trachea or block the airway by pressing externally.

In such oncological cases, the stent opens the blockage created by the tumor, allowing the patient to become stable enough to receive radiotherapy or chemotherapy.

Stent application in palliative care helps the patient to breathe comfortably and maintain their quality of life even in the last stages.

Benign Strictures and Tracheomalacia (Tracheal Softening)

Patients who are intubated for a long time in intensive care (put to sleep with a tube in the trachea) may develop “post-intubation stenosis” due to the pressure created by the tube.

Tracheomalacia, on the other hand, is a condition in which the tracheal cartilages soften and stick together with each inhalation.

In such cases, a stent is preferred as a permanent or temporary solution in patients where surgical repair is risky.

What are the Types of Tracheal Stents?

The material of the stent to be used should be carefully selected by the specialist physician according to the patient’s diagnosis and life expectancy.

Silicone Stents (Dumont Stent) and Their Advantages

Silicone stents are devices made of biocompatible medical silicone and are generally preferred in benign stenosis.

• Texture Harmony: It has a low risk of reacting with surrounding tissues and has little tendency to form granulation (excessive flesh growth) tissue.
• Removability: They can be easily removed with rigid bronchoscopy when they are no longer needed or need cleaning.
• Cost: They are more economical than metallic stents, but rigid bronchoscopy and general anesthesia are absolutely required for their placement.

Self-Expanding Metallic Stents (Nitinol Stent)

Made of nitinol (nickel-titanium mixture) material, these stents have a memory structure and open spontaneously where they are placed.

They are often used to accommodate the pressure of malignant tumors because they have much thinner walls and provide a larger inner diameter than silicone stents.

Covered metallic stents are covered with a special polymer layer that prevents the tumor from growing through the pores of the stent.

Hybrid Stent Designs

Hybrid stents are modern designs that combine both the tissue-friendly properties of silicone and the flexibility of metal.

These models, which adapt to the shape of the trachea (such as the Y stent), are especially preferred in stenosis (carina) at the separation point of the main bronchi.

How is a Tracheal Stent Inserted? Application Process

Stent placement is an advanced interventional bronchoscopy procedure that requires high experience and specialized equipment.

Stent Placement Under Rigid Bronchoscopy

Rigid bronchoscopy is a metal, tubular device that is inserted through the patient’s mouth and into the windpipe.

This method offers the surgeon a wide working area and allows silicone stents to be folded and placed in the stenosis area.

After the stent is placed, the position of the stent is checked millimetrically through the bronchoscope to ensure full patency.

Preparation and Anesthesia Before Stent Application

Before the procedure, the patient’s tomography and bronchoscopic images are examined and the length and diameter of the stricture are measured.

The operation is performed under general anesthesia and in a fully equipped operating room.

The patient does not feel any pain or shortness of breath because he is completely asleep during the procedure; The operation time is usually between 30-60 minutes.

Advantages of Tracheal Stent Application and Expected Results

A stent placed at the right time and with the right technique can change the patient’s clinical picture in minutes.

Immediate relief from shortness of breath

As soon as the stent is placed and the bronchoscope is removed, the patient can take a deep breath as soon as he wakes up, as the area of stenosis is completely opened.

This rapid recovery allows the patient to leave the intensive care unit or be weaned off the ventilator (weaning).

Increased Quality of Life and Effort Capacity

Patients who become bedridden because they cannot breathe can take short-distance walks after the stent and do their daily work on their own.

Especially in cancer patients, stents also provide psychological relief by eliminating the panic caused by shortness of breath and the fear of dying.

Comparison Table of Stent Types

Prof. Dr. Levent Alpay: Tracheal stent application is one of the most critical interventions in thoracic surgery. The important thing here is not only to insert the stent, but also to choose the type of stent that best suits the patient’s anatomy and the course of the disease. We blend the advantage of silicone stents being removable with the expansion power of metallic stents with the right case selection. It should not be forgotten that; The stent is not a goal, but a tool that allows the patient to breathe comfortably and continue their original treatment.

Case Experience (Anonymous):

Our 65-year-old patient, whose main trachea narrowed by 80% due to advanced lung cancer, was admitted to our emergency department with severe respiratory failure. In the emergency intervention performed with rigid bronchoscopy, a 14 mm diameter coated metallic stent was placed in the area under tumor pressure. The patient, whose bruising recovered after the procedure and his breathing returned to normal, recovered enough to start radiotherapy treatment a day later.

If you complain of shortness of breath due to tracheal stenosis, you can make an appointment with our clinic for stent application and personalized treatment planning and seek expert opinion.

Post-Stent Care and Follow-up Process

Regular monitoring of the patient after stent placement is vital to ensure that the stent does not become blocked or displaced.

Stent Cleaning and Moisturizing Recommendations

A stent is a foreign substance to the body and can cause phlegm (mucus) accumulation on it.

Patients are advised to perform regular saline inhalation (steam therapy) and drink plenty of fluids; In this way, the sputum remains soft and easily expelled from the stent.

Possible Complications: Displacement and Mucus Obstruction

• Migration: The stent can sometimes be replaced by a severe cough; In this case, it must be corrected by bronchoscopy again.
• Mucus Plug: Thick sputum can block the inside of the stent; If this leads to immediate shortness of breath, bronchoscopic cleaning is essential.
• Meat Growth: Flesh growths may occur at the ends of the stent with the body’s reaction; These tissues are cleaned by laser or freezing (cryo) method.

Frequently Asked Questions

How Long Can a Tracheal Stent Stay in the Body?

Silicone stents can remain in the body for years, but it is recommended to check them every 6-12 months or replace them if necessary. Metallic stents are generally designed to remain in malignant diseases for life.

Is Speech or Swallowing Affected After Stent Placement?

Since the stent is placed under the vocal cords, it does not affect speech; However, a short-term hoarseness is normal immediately after the procedure. Stents large enough to compress the esophagus can rarely cause swallowing difficulties.

Can the Inserted Stent Be Removed Later?

Silicone stents are always removable. While coated metallic stents can be easily removed within the first few months, open metallic stents are much more difficult to remove due to their fusion into tissue.

Scientific Bibliography

• Journal of Thoracic Disease: Evolution of Tracheal Stents and Current Trends
• PubMed (NCBI): Complications of Tracheal Stenting in Benign and Malignant Diseases
• Chest (Official Journal of the American College of Chest Physicians): Guidelines for Interventional Pulmonology
• Turkish Thoracic Society: A Guide to Interventional Bronchoscopy and Stent Applications

A diaphragmatic hernia is when organs in the abdominal cavity (usually the stomach) prolapse upward through an opening in the diaphragm muscle that separates the chest cavity and abdominal cavity.

Under normal conditions, the esophagus reaches the stomach by passing through a narrow hole (hiatus) on the diaphragm; However, the expansion of this hole prepares the ground for the displacement of the organs.

This condition is an anatomical disorder that can directly affect not only the digestive system but also respiratory and cardiac functions due to its location in the rib cage.

Diaphragmatic hernia, also known as “gastric hernia” among the people, is one of the main mechanical causes of reflux complaints.

Today, with advanced laparoscopic and thoracoscopic surgical methods, the herniated organs can be placed in place and the opening in the diaphragm can be permanently repaired.

What is Diaphragmatic Hernia? How is it formed?

Diaphragmatic hernia occurs as a result of increased intra-abdominal pressure or age-related weakening of the tissues in the diaphragm muscle.

When the esophageal hiatus, the natural opening in the diaphragm, expands, the upper part of the stomach starts to slide through this space and into the ribcage.

This displacement disrupts the valve mechanism (lower esophageal sphincter) that prevents stomach acid from escaping into the esophagus, leading to severe complaints.

The Relationship Between Diaphragmatic Hernia and Hiatal Hernia

Although these two terms are often used interchangeably in the medical literature, hiatal hernia is actually the most common type of diaphragmatic hernia.

While hiatal hernia refers only to the displacement of the stomach, the term diaphragmatic hernia can sometimes include the passage of the intestines or organs such as the spleen into the chest cavity.

In both cases, the main problem is that the diaphragm cannot fully fulfill its barrier function.

Congenital and Acquired Diaphragmatic Hernias

Diaphragmatic hernias are divided into two main categories based on the time of formation.

• Congenital Hernias: These are serious cases that are noticed in infancy and occur as a result of the diaphragm not closing completely during its development in the womb.
• Acquired (Acquired) Hernias: Generally, in individuals over the age of 50; It occurs due to reasons that increase intra-abdominal pressure, such as obesity, heavy lifting or chronic coughing.

What are the Types of Diaphragmatic Hernia?

Depending on the shape of the hernia and which part of the stomach goes up, the treatment approach changes completely.

Sliding Type Diaphragmatic Hernia

It is the most common type, accounting for about 95% of all cases.

The junction of the stomach and esophagus slides over the diaphragm and is usually displaced as the patient moves.

This type of hernia primarily manifests itself with severe reflux complaints.

Paraesophageal (Stomach Side) Hernias

It is a rarer but more dangerous species.

While the junction of the stomach and esophagus remains in place, a part of the stomach (fundus) herniates from the side of the esophagus into the chest cavity.

Surgical intervention is usually inevitable in this type of hernia, as there is a risk of compression and strangulation of the stomach (strangulation).

Rare Types: Bochdalek and Morgagni Hernias

These hernias usually arise from openings in the sides or front of the diaphragm.

Bochdalek’s hernia is more common in the posterior-lateral part of the diaphragm, while Morgagni’s hernia is in the antero-middle part.

In these cases, sometimes not only the stomach but also the large intestine parts can be observed in the rib cage.

Diaphragmatic Hernia Symptoms and Effects on the Body

Symptoms differ depending on the size of the hernia and the effect of stomach acid on the esophagus.

Severe Reflux, Burning in the Chest and Difficulty Swallowing

The most classic symptom is bitter water and a burning sensation (pyrosis) radiating from the stomach to the throat.

Bending over or lying flat, especially after meals, can make this burning sensation unbearable.

Over time, irritation of the esophagus can cause difficulty swallowing (dysphagia) and a bitter taste with mouth.

The Relationship Between Chest Pain and Shortness of Breath

In large hernias, the stomach can take up space within the rib cage, putting pressure on the lungs and heart.

This condition causes increased shortness of breath after meals and chest pains that can be mistaken for a heart attack.

Causes and Risk Factors of Diaphragmatic Hernia

Both genetic predisposition and lifestyle factors play a role in the development of diaphragmatic hernia.

• Obesity: Excess weight constantly increases intra-abdominal pressure, forcing the opening in the diaphragm.
• Aging: As age progresses, the elasticity of the diaphragm muscle decreases.
• Chronic Pressure: Straining due to constant constipation, severe coughing fits or heavy sports.
• Genetics: Individuals with connective tissue weakness are at a higher risk of hernias.

Diaphragmatic Hernia Diagnosis and Diagnostic Methods

The diagnosis is made by tests to see both the anatomical defect and the damage to the esophagus.

Medicated Gastric X-ray and Endoscopy

The x-ray (passage radiography), which is taken by giving the patient a barium liquid, clearly shows how much of the stomach goes up.

Gastroscopy (Endoscopy) is the most reliable method to directly observe irritation in the esophagus (esophagitis) and the internal structure of the hernia.

Detailed Imaging with Computed Tomography (CT)

Especially in large and complex hernias, CT of the Thorax and Abdomen is used to assess the condition of other organs (intestine, spleen).

CT images are vital for the surgeon to draw the preoperative roadmap.

Diaphragmatic Hernia Treatment Options

Lifestyle changes may be sufficient for small hernias, while surgery is the only solution for large and risky hernias.

Medication and Lifestyle Changes

Acid-suppressing drugs (PPIs) do not destroy the hernia, but they reduce the damage and pain caused by acid to the esophagus.

Eating little and often, stopping eating 3 hours before bedtime and lying with the head elevated are the main measures that relieve symptoms.

Surgical Treatment: Laparoscopic and Thoracoscopic Repair

Today, diaphragmatic hernia surgeries are performed with the closed (laparoscopic) method over 90%.

The stomach is pulled into the abdominal cavity by entering through small holes opened in the abdomen and the hole in the diaphragm is narrowed with stitches.

Patch (Graft) Use and Nissen Fundoplication

In cases where the diaphragm tissue is weak, special patches (mesh) can be used to secure the hole.

In addition, the upper part of the stomach is wrapped around the esophagus (Nissen Fundoplication) to create a new valve mechanism; This process permanently ends the reflux.

Treatment Approaches Comparison Table

Prof. Dr. Levent Alpay: Diaphragmatic hernia should not be taken as just “heartburn”. Especially in paraesophageal hernias, the risk of gastric strangulation can be a vital emergency. If your reflux complaints do not go away despite medications or if you experience shortness of breath after meals, surgical repair of this mechanical problem in the diaphragm will radically change your quality of life. With modern closed surgery, we can leave this problem behind in a very short time.

Case Experience (Anonymous): Our 62-year-old patient presented with severe reflux that had been going on for years and palpitations that had been added recently. In the examinations, it was determined that more than half of his stomach protruded into the chest cavity and put pressure on the heart. The stomach was pulled into place by laparoscopic method and repaired with a diaphragm patch (mesh). The patient, whose reflux complaints completely stopped the day after the surgery, returned to his normal diet and sports activities on the 10th day.

If you are experiencing recurrent reflux complaints or a feeling of getting stuck in the esophagus, you can make an appointment with our clinic and seek expert opinion for the evaluation of hernia risk and the appropriate treatment plan for you.

Frequently Asked Questions

Is Diaphragmatic Hernia Surgery Necessary?

In small slip-type hernias, surgery may not be necessary if the complaints are under control with medication; However, surgery is recommended for large hernias and paraesophageal types that carry a risk of strangulation.

Is Diaphragmatic Hernia Confused with Heart Pain?

Yes, the chest pain and pressure sensation caused by a hernia can mimic a heart attack. Therefore, in patients with chest pain, heart problems should be excluded first, and then the diaphragm should be examined.

Does Hernia Recur After Surgery?

The risk of recurrence is very low in surgeries performed by experienced surgeons, using patch support and adding the Nissen technique.

Scientific Bibliography

• SAGES (Society of American Gastrointestinal and Endoscopic Surgeons): Guidelines for Management of Hiatal Hernia
• The New England Journal of Medicine: Hiatal Hernia and Gastroesophageal Reflux
• PubMed (NCBI): Laparoscopic Repair of Paraesophageal Hernias
• Journal of Thoracic and Cardiovascular Surgery: Thoracic Approaches to Diaphragmatic Hernia

Diaphragm paralysis is a condition in which the diaphragm, which is the most basic respiratory muscle that separates the chest cavity and the abdominal cavity, loses its function.

Under normal conditions, when we breathe, the diaphragm contracts and descends, creating space for the lungs to fill with air; However, in the event of a stroke, this muscle cannot move.

The failure of the diaphragm to function leads to a significant decrease in lung capacity and severe shortness of breath, which reduces the patient’s quality of life.

This condition, which is usually unilateral, can rarely affect both diaphragm muscles and become severe enough to make the patient dependent on a ventilator.

Modern thoracic surgery techniques make it possible to open up breathing space for the lungs by re-tightening the dysfunctional and relaxed diaphragm muscle.

What is Diaphragm Paralysis? Why Does It Happen?

Diaphragmatic paralysis occurs as a result of interruption of the conduction of the phrenic nerve, which provides the movement of this muscle, or direct damage to muscle tissue.

The paralyzed diaphragm muscle loses its normal tense and dome-like structure, relaxes and is pushed upwards into the chest cavity by the pressure of the intra-abdominal organs.

This elevation causes the lung on that side to deflate and fail to expand sufficiently during breathing.

Main Respiratory Muscle: The Function of the Diaphragm

The diaphragm is like the main engine of our body and involuntarily contracts thousands of times a day to perform breathing.

During inhalation, it creates a vacuum effect, drawing air into the lungs, and during exhalation, it relaxes and allows carbon dioxide to be expelled.

Paralysis of this muscle causes the respiratory load to be placed only on the intercostal muscles, which causes the body to tire quickly.

Unilateral and Bilateral (Bilateral) Diaphragm Paralysis

Diaphragmatic paralysis presents with two different clinical pictures depending on the extent of involvement.

• Unilateral Paralysis: Usually only one of the right or left diaphragm is affected; While patients do not have problems at rest, they become blocked when they exert effort.
• Bilateral Paralysis: It occurs when the phrenic nerve on both sides is damaged; This is a very severe respiratory failure that requires urgent medical attention.

Unilateral paralysis is more common and is often detected incidentally on chest X-rays taken while investigating another disease.

Causes and Risk Factors of Diaphragm Paralysis

The causes of paralysis of the diaphragm are very diverse and can sometimes be the first harbinger of another underlying disease.

Phrenic Nerve Injury and Traumas

The phrenic nerve, which carries the movement order of the diaphragm, leaves the neck region, passes past the heart and reaches the diaphragm; It can be damaged at any point along this long route.

Neck hernias, tumor compressions or severe blows to the neck area can interrupt nerve conduction and lead to paralysis.

Additionally, trauma that shakes the rib cage, such as traffic accidents or falling from a height, can also damage the nerve structure of the diaphragm.

Postoperative Diaphragmatic Paralysis

Especially after heart and lung surgeries, temporary or permanent paralysis of the phrenic nerve can be seen due to the surgical procedure or cold application (ice water).

This condition is usually noticed after surgery when the patient breathes more difficult than expected or cannot leave the ventilator.

Some viral infections and neurological diseases (e.g. ALS or MS) can also trigger diaphragm paralysis by causing nerve damage.

What are the Symptoms of Diaphragm Paralysis?

Symptoms vary depending on whether the paralysis is unilateral or bilateral and the patient’s current lung capacity.

Shortness of Breath Increasing When Lying Down (Orthopnea)

The most typical symptom of diaphragmatic paralysis is that the patient stops breathing when lying flat.

When the patient lies down, the intra-abdominal organs slide upwards with the effect of gravity and push the already loose diaphragm towards the lung.

For this reason, patients usually prefer to sleep with a high pillow or complain that they feel pressure in their breasts when they lie down.

Fatigue During Exertion and Respiratory Distress

A healthy person uses their diaphragm more actively when climbing hills or climbing stairs; However, the paralyzed patient does not have this capacity.

Palpitations, fatigue and the feeling of “I can’t breathe” that occur even in simple daily activities are classic findings of diaphragm paralysis.

Diaphragmatic Paralysis Diagnosis and Diagnostic Methods

The diagnostic process is clarified by tests based on monitoring the movement of the diaphragm live, rather than a physical examination.

Movement Analysis with Fluoroscopy (Sniff Test)

The gold standard in diagnosis is the fluoroscopic examination known as the “Sniff Test” (sniff test).

Under radiology, the patient is asked to breathe quickly through his nose; The diaphragm, which should normally go down, shoots upwards (paradoxical movement) if it is paralyzed.

This test definitively shows whether the diaphragm is just at rest or is working in the opposite direction.

Pulmonary Function Tests (PFT) and Electromyography (EMG)

Pulmonary function tests measure the patient’s capacity while sitting and lying down; A decrease in capacity of more than 20% while lying down is in favor of paralysis.

EMG (nerve measurement), on the other hand, is used to assess the electrical activity of the phrenic nerve to determine the extent of damage and the potential for healing.

Diaphragm Paralysis Treatment Options

Not all diaphragmatic paralysis requires surgery; However, if the patient’s shortness of breath interferes with his daily life, surgical solution is the most effective way.

Surgical Treatment: Diaphragm Pilation (Stretching Surgery)

Pilation surgery is the process of folding and tightening the loosened and ballooning diaphragm muscle with special sutures.

In this way, the diaphragm is pulled down, the chest cavity expands and the deflated lung tissue can be filled with air again and expand.

Since the tense diaphragm muscle can no longer run up, other healthy respiratory muscles begin to work more efficiently.

Robotic and Closed (VATS) Diaphragm Surgery

Today, we can now perform diaphragm surgeries with closed methods (thoracoscopic or robotic) without making large incisions.

In this procedure, which is performed through small holes, blood loss is minimal and the patient’s recovery rate is much higher than open surgery.

Closed surgery provides a great advantage, especially for these patients with limited respiratory capacity, due to the low postoperative pain.

Treatment Options and Expectations Table

Prof. Dr. Levent Alpay: Patients with diaphragmatic paralysis can often waste time in the wrong branches by saying “Is there a problem with my heart?” or “Do I have asthma?”. If your shortness of breath becomes evident only when you lie flat, you should definitely see a thoracic surgeon and have your diaphragm movements checked. Early pilation surgery can bring your deflated lung back to life and give you a deep breath.

Case Experience (Anonymous):

A 58-year-old patient presented with complaints of panting while climbing a hill and not being able to lie flat at night after a viral infection. In the Sniff test, it was seen that his left diaphragm was completely paralyzed and he went up and deflated his lung by 40%. After the diaphragm pilation we performed with the robotic method, our patient’s lung was completely opened and he started to sleep comfortably without using a high pillow only 2 weeks after the operation.

If you experience increased shortness of breath or an unexplained decrease in your effort capacity while lying down, you can make an appointment with our clinic and seek expert opinion for a detailed evaluation of your diaphragm functions.

Frequently Asked Questions

Does Diaphragm Paralysis Go Away on Its Own?

If the paralysis is caused by exposure to cold or a temporary inflammatory condition, it may resolve spontaneously within 6-12 months; however, in traumatic or surgical damage, it is likely to be permanent.

Is Diaphragm Surgery Risky?

Every surgical procedure has risks; However, diaphragm pilation performed with modern closed methods is a procedure with a very low complication rate and a high chance of success.

Who is Diaphragm Battery (Pacemaker) Applied to?

Diaphragm pacemaker is a special method preferred to stimulate the nerve, usually in patients who are paralyzed on both sides due to cervical spinal cord injury and live on a ventilator.

Scientific Bibliography

• The Society of Thoracic Surgeons: Surgical Plication for Diaphragm Paralysis
• Journal of Thoracic and Cardiovascular Surgery: Minimally Invasive Diaphragm Plication
• PubMed (NCBI): Etiology and Pathophysiology of Diaphragmatic Paralysis
• Cleveland Clinic: Diaphragm Paralysis Diagnosis and Management

Myasthenia Gravis is a chronic and autoimmune neuromuscular disease that occurs as a result of impaired communication between the nervous system and muscles.

The disease is characterized by the body’s immune system producing faulty antibodies against its own tissues.

This picture, which means “severe muscle weakness” in the medical literature, manifests itself as fatigue and weakness, especially in the muscles we control voluntarily.

Today, Myasthenia Gravis is a disease that can be successfully managed with the joint work of neurological drug treatments and thoracic surgery (thymectomy) disciplines.

Early diagnosis and correct surgical intervention can improve patients’ quality of life and provide long-term complete recovery (remission).

What is Myasthenia Gravis? Why Does It Happen?

For a normal muscle contraction, a substance called acetylcholine, released from nerve endings, must bind to receptors (receptors) on the muscle.

In patients with Myasthenia Gravis, the immune system produces abnormal antibodies that target these receptors.

These antibodies invade or destroy the areas where acetylcholine will bind, preventing the “move” command from the nerve from reaching the muscle.

Although it is not known exactly why the disease develops in some individuals, it has been proven that the thymus gland, located in the chest cavity, plays a central role in the production of this faulty antibody.

The disease can be seen at any age; However, it is usually more commonly diagnosed in young women (20-30 years) and older men (over 60 years).

Myasthenia Gravis Symptoms and Clinical Findings

The most characteristic feature of Myasthenia Gravis is that muscle weakness improves with rest and increases with movement or later in the day.

Symptoms may differ from person to person and may progress as attacks (flare-ups) that vary in severity over time.

Weakness in the Eye and Facial Muscles (Ocular Myasthenia)

In more than 50% of patients, the first symptoms appear in the eye muscles and this picture is called “Ocular Myasthenia”.

• Droopy Eyelid (Ptosis): It usually starts unilaterally, becomes evident towards the end of the day and may restrict the patient’s field of vision.
• Double Vision (Diplopia): It occurs as a result of the incompatible functioning of the muscles that move the eyes.
• Change in Facial Expression: Due to weakness in the facial muscles, a “growling”-like expression may occur during smiling or facial expressions may become dull.

Chewing, Swallowing and Speech Disorders

When the disease affects the muscles of the face and throat, basic functions in daily life begin to become difficult.

• Speech Change: Speech gradually begins to come from the nose (nasal speech) or the words roll in the mouth.
• Difficulty Swallowing: Fatigue while eating, food getting into the throat or fluids coming back up through the nose may occur.
• Fatigue in Chewing Muscles: When chewing hard foods, the jaw muscles quickly become tired and the patient may have to stop eating halfway.

Myasthenic Crisis: Risk of Respiratory Failure

The most feared picture of Myasthenia Gravis that requires urgent intervention is the “Myasthenic Crisis”.

In this case, the respiratory muscles (diaphragm and intercostal muscles) become too weak to continue breathing.

Infections, stress, side effects of certain medications, or inadequate treatment can trigger this crisis.

When the patient starts to suffer from shortness of breath, he should be treated in intensive care conditions without delay and respiratory support should be provided.

The Relationship Between Myasthenia Gravis and the Thymus Gland

The thymus gland is an organ located in the center of the chest cavity and is considered the “training center” of the immune system.

Scientific research shows that in patients with Myasthenia Gravis, the thymus gland produces erroneous signals that command the immune system to “attack its own receptors”.

Therefore, surgical removal of the thymus gland (thymectomy) is one of the most effective steps towards drying out the source of the disease.

Thymic Hyperplasia and Thymoma Presence

In the vast majority of patients diagnosed with Myasthenia Gravis, abnormalities are detected in the thymus gland.

• Thymic Hyperplasia: The thymus gland is more active and larger than normal. This picture is observed in approximately 70% of MG patients.
• Thymoma: They are tumors that develop on the thymus gland. Thymoma is detected in approximately 15% of MG patients and these tumors must be surgically removed.

Prof. Dr. Levent Alpay: One of the first things to be done in every patient diagnosed with Myasthenia Gravis is to examine the thymus gland with a high-resolution chest tomography. If there is a growth or tumor (thymoma) in the thymus, the surgical option is no longer a choice but becomes the cornerstone of treatment. With surgery, we not only remove the tumor, but also aim to reduce the patient’s neurological dependence on medication.

Myasthenia Gravis Diagnosis and Diagnostic Methods

The diagnosis of Myasthenia Gravis (MG) is made by combining the patient’s clinical history with specific neurological and radiological tests.

In the diagnostic process, the main goal is to prove that the muscle weakness is caused by a conduction disorder at the nerve-muscle junction.

Edrophonium (Tensilon) Test and Antibody Tests

The edrophonium test is the observation of a sudden increase in muscle strength by administering a short-acting drug intravenously to the patient; however, it is rarely applied today due to its side effects.

One of the most reliable methods in diagnosis is to measure the level of “Acetylcholine Receptor Antibodies” (AChR) with a blood test.

In the vast majority of patients, these antibodies are positive; In negative cases, rarer antibodies such as “MuSK” are investigated.

Electromyography (EMG) and Radiological Imaging

In the EMG test, low-dose electrical impulses given to the muscles clearly reveal the fatigue (discharge) in conduction.

Radiological imaging determines the surgical dimension of the work; Chest Tomography (CT) should be performed on every MG patient to see if there is a tumor (Thymoma) in the thymus gland.

Myasthenia Gravis Treatment Options

MG treatment is a long-term process based on controlling symptoms and suppressing the immune system.

Drug Treatments and Plasmapheresis Applications

In first-line treatment, pyridostigmine-based drugs that increase nerve-muscle conduction are usually used.

Cortisone or other immunosuppressive drugs may be added to the treatment to suppress the immune system.

During periods when the disease is severe or preoperative preparation is required, “Plasmapheresis” or “IVIG” (Intravenous Immunoglobulin) methods are used to clear harmful antibodies from the blood.

Surgical Intervention in Myasthenia Gravis: Thymectomy

Thymectomy is the surgical complete removal of the thymus gland in the center of the rib cage.

This surgery aims to permanently change the course of the disease by eliminating the faulty production center of the immune system.

Which Patients Is Thymectomy Surgery Applied To?

Surgery is mandatory in all MG patients with a tumor (Thymoma) in the thymus gland.

Even if there is no tumor, it has been scientifically proven that surgery provides great benefits in patients with diffuse MG under the age of 65 and with antibody positivity.

Thymectomy performed early in the disease (within the first 1-2 years) maximizes the chances of recovery.

Closed Thymectomy Methods (VATS and Robotic Surgery)

Today, complete cleaning, which we call “maximal thymectomy”, is successfully performed with closed methods (VATS or Robotic) instead of large incisions.

These surgeries, which are performed through small holes, preserve the patient’s breathing capacity and minimize the risk of infection.

MG Treatment Methods Comparison Table

Effects of Surgery on Neurological Recovery

The effect of thymectomy surgery is usually not seen the next day; It may take months or even years for the immune system to reorganize.

The following healing processes are usually observed in patients:

• Significant reduction of drug doses.
• In some patients, complete cessation of drugs (Complete remission).
• Significant reduction in the frequency and severity of attacks.

Preoperative Preparation and Postoperative Follow-up Process

The surgical process for MG patients requires full compliance of neurology and thoracic surgery.

Before surgery, the patient’s clinical condition is stabilized; muscle strength is supported by IVIG or plasmapheresis if necessary.

Thanks to closed methods after surgery, the patient is discharged in 2-3 days, but the follow-up of neurological drugs is carried out meticulously.

Prof. Dr. Levent Alpay: Myasthenia Gravis surgery is not a simple “organ removal” procedure. The surgeon needs to remove all fat tissues around the thymus gland to the millimeter (maximal resection). Because even a small thymus tissue left behind can continue to produce faulty antibodies. This sensitivity directly determines the neurological benefit the patient will receive from surgery.

Case Experience (Anonymous):

Robotic thymectomy was performed in a 28-year-old patient who frequently experienced difficulty in swallowing and droopy eyelids despite drug treatment, in the 8th month of his illness. In the 1st year after the surgery, our patient’s drug doses were reduced by half and he was able to do his daily activities without any restrictions.

To get more information about Myasthenia Gravis surgery or to evaluate your condition, you can make an appointment with our clinic and seek expert opinion.

Frequently Asked Questions

Can Medications Be Completely Discontinued After Thymectomy Surgery?

In approximately 30-40% of patients, drugs can be completely discontinued; In the remaining patients, a significant decrease in drug doses and symptom relief is achieved.

Should Every Myasthenia Gravis Patient Have Surgery?

If thymoma is present, surgery is essential. If there is no thymoma, the patient’s age, antibody status and duration of the disease are evaluated and the decision for surgery is made individually.

What is the Success Rate of the Surgery and When Does It Take Effect?

The positive effects of thymectomy are usually most pronounced between the 6th month and 2nd year after surgery. The success rate is higher in the early stages.

Scientific Bibliography

• New England Journal of Medicine (NEJM): Thymectomy Trial in Non-Thymomatous Myasthenia Gravis
• Neurology: Practice guideline update summary: Thymectomy in Myasthenia Gravis
• PubMed: Long-term results of robotic thymectomy for Myasthenia Gravis
• The Lancet Neurology: Current treatments and future perspectives in MG

Mediastinum and thymus surgery encompasses specialized operations of a critical area located in the very center of the chest cavity and home to vital organs.

This region is between both lungs; It is a narrow but extremely complex space that houses the heart, major vessels, esophagus, and trachea.

Mediastinal surgery utilizes the most advanced techniques of modern thoracic surgery in treating both benign cysts and malignant tumors.

Today, these surgical interventions are performed with closed methods instead of large incisions thanks to developing technology, optimizing the patient’s recovery process.

What is Mediastinum? Mediastinum Region and Anatomical Significance

Mediastinum is the name given to the anatomical space between the right and left lungs in the rib cage.

This area, which is bounded by the sternum in the front and the spine in the back, is like the traffic center of the body.

The main vessels coming out of the heart (such as the aorta), the main airways, the esophagus and the lymph nodes are in very close neighborhoods to each other in this narrow area.

Due to this anatomical compression, even a small mass that develops in the mediastinum area can put pressure on vital organs, leading to serious symptoms.

Surgeons use the mediastinum to better analyze this area; They divide it into three virtual regions: anterior, middle and posterior mediastinum.

What are Mediastinal Masses and Tumors?

Masses seen in the mediastinum originate from cells with different characteristics according to their location.

Some of these masses are congenital cysts, while others are tumors originating from gland tissues or nerve sheaths.

Anterior Mediastinal Masses (Thymoma, Teratoma, Lymphoma)

The anterior mediastinum is the area located just behind the breastbone and is the most common area where masses are seen.

• Thymoma: It is the most common anterior mediastinal tumor originating from the thymus gland.
• Teratoma: They are germ cell tumors that are common in young adults and can contain different types of tissues (hair, teeth, etc.).
• Lymphoma: They are masses that originate from the lymphatic system and usually require systemic treatment (chemotherapy).
• Thyroid Appendages: The growth of the goiter in the neck into the rib cage (plonjan goiter) can be observed as a mass in this area.

Middle and Posterior Mediastinal Tumors (Neurogenic Tumors and Cysts)

The middle mediastinum usually houses lymph nodes and congenital bronchogenic or pericardial cysts.

The posterior mediastinum is the main center of “neurogenic tumors” originating from the nerve tissues in the anterior part of the spine.

Although these tumors are generally benign, they require technically precise surgical planning due to their proximity to the spinal canal.

Thymus Gland Diseases and Thymoma

The thymus gland is an organ that plays a role in the development of the immune system and is active in childhood and shrinks in adulthood.

However, in some individuals, this gland may enlarge (hyperplasia) instead of shrinking or tumoral structures may develop on it.

What is Thymoma? Symptoms and Stages

Thymoma is a tumor that originates from the epithelial cells of the thymus gland and is usually detected between the ages of 40-60.

Although the tumor tends to grow slowly, it has the potential to invade the surrounding tissues (pleura, vessels).

Staging is done according to the degree to which the tumor has exceeded its capsule; While surgery alone is sufficient in the early stages, radiotherapy support may be required in advanced stages.

The Relationship Between Myasthenia Gravis and the Thymus Gland

Myasthenia Gravis (MG) is a neurological disease characterized by fatigue and weakness in the muscles.

Approximately 15% of MG patients have a thymoma focus, while 30-45% of patients with thymoma have Myasthenia Gravis symptoms.

Surgical removal of the thymus gland (thymectomy) plays a critical role in reducing drug dependence and controlling disease symptoms in MG patients.

Symptoms and Clinical Findings in Mediastinal Tumors

Most of the masses are detected incidentally on lung x-rays taken for another reason.

However, when the mass reaches a certain size or presses on surrounding tissues, the following symptoms are observed:

• Breast Pain and Feeling of Fullness: A blunt pain felt behind the breastbone.
• Cough and Shortness of Breath: It occurs as a result of pressure on the trachea.
• Difficulty Swallowing: Compression of the esophagus by the mass from the outside.
• Hoarseness: The nerve going to the vocal cords is affected by the mass.
• Vena Cava Superior Syndrome: Swelling in the face and arms due to pressure on the main vein, prominence in the veins.

Diagnosis and Diagnostic Methods

Modern diagnostic methods clearly reveal not only the location of the mass, but also its character and its relationship with the surrounding vessels.

Computed Tomography (CT) and MRI Examinations

Medicated (contrast) Chest Tomography is the most basic and indispensable diagnostic tool for mediastinal masses.

MRI (Magnetic Resonance), on the other hand, provides superiority in determining the relationship of nerve-derived tumors, especially in the posterior mediastinum, with the spinal cord.

Biopsy with Mediastinoscopy and EBUS

Tissue diagnosis may be required to understand the character of the mass and to stage it before surgery.

“Mediastinoscopy” or bronchoscopic ultrasonography (EBUS), which is entered through a small incision in the neck, determines whether the treatment will be surgical or oncological by taking a biopsy of the lymph nodes.

Prof. Dr. Levent Alpay: The key to success in mediastinal surgery is “anatomical dominance” and “technological adaptation”. The lesions in this area are in millimeter proximity to the heart and main vessels. Therefore, our priority is not only to remove the mass, but also to preserve these vital structures and ensure the patient’s neurological comfort after surgery.

Mediastinum and Thymus Surgery Methods

These surgeries, which used to require cutting the sternum from one end to the length (sternotomy), are now performed with minimally invasive techniques.

Closed Thymus Surgery (VATS and Robotic Surgery)

Video-Assisted Thoracoscopic Surgery (VATS) is performed with 1-3 small holes drilled from the side of the rib cage.

The wide image taken with the help of the camera allows the surgeon to meticulously clean the thymus gland and surrounding fatty tissues.

Robotic surgery, on the other hand, provides a high level of success in mediastinal masses with its high maneuverability in narrow spaces.

Thymectomy (Thymus Gland Removal) Surgery

It is the process of completely removing the thymus gland, especially in patients diagnosed with Myasthenia Gravis or Thymoma.

Simply removing the tumor is not enough; In order to prevent the risk of recurrence, all “peritimic” fat tissues must be removed (maximal thymectomy).

Mediastinal Mass Extirpation (Open and Closed Techniques)

Open surgery (sternotomy or thoracotomy) may still be required for very large masses or tumors surrounding the main vessels.

However, in most cases saved by surgical margins, closed techniques are considered the “gold standard”.

Mediastinal Surgery Methods vs. Recovery

Postoperative Recovery Process and Follow-up

Patients who undergo surgery with the closed method usually start walking and eating normally the day after the operation.

The chest tube is usually withdrawn within 24-48 hours and the patient is discharged in a short time.

In thymoma cases, regular tomography checks and, if necessary, oncological follow-ups are planned according to the pathological stage of the mass.

Case Experience (Anonymous):

In a 32-year-old female patient with complaints of drooping eyelids and arm weakness (Myasthenia Gravis), 3 cm thymus enlargement was detected on tomography. Closed (Uniportal VATS) thymectomy was performed through a single hole. In the 1st postoperative year, the patient’s need for medication decreased by 70% and his neurological findings stabilized.

For detailed information about the surgical treatment of mediastinal masses and thymus diseases, you can seek expert opinion and make an appointment with our clinic.

Frequently Asked Questions

Is Mediastinal Surgery Risky?

Although every surgical procedure has general risks, vital complication rates are very low thanks to modern closed techniques and anesthesia methods.

Does the Disease Recur After Thymoma Surgery?

The risk of recurrence is very low in early-stage thymomas that are completely removed; However, it is an oncological rule to follow the patient radiologically for many years.

How Much Do Myasthenia Gravis Patients Benefit from Surgery?

After thymectomy, most patients experience a significant reduction in complaints; Full recovery or transition to a drug-free period may vary from patient to patient and the duration of the disease.

Scientific Bibliography

• Journal of Thoracic Oncology: Masaoka-Koga staging system and ITMIG recommendations
• The Annals of Thoracic Surgery: VATS Thymectomy for Myasthenia Gravis
• PubMed: Outcomes of robotic-assisted mediastinal mass resection
• Lancet Neurology: Thymectomy in Myasthenia Gravis: Clinical Trials