Posterolateral Thoracotomy Research Articles

A RARE AND INTERESTING PRESENTATION OF LUNG TUMOUR

A 72 year old male presented with a chief complaint of groin swelling and was clinically diagnosed as direct inguinal hernia and was planned for hernioplasty. Patient had no respiratory symptoms like cough or haemoptysis. Incidentally it was found that patient was having mass lesion on the left side in chest x ray and was referred to CTVS department. The patient however had no complaints pertaining to the mass. He underwent CECT and was found to have ?peripheral bronchogenic tumour in left posterior mediastinum. Later left posterolateral thoracotomy was done and intra operatively mass was found originating from left lower lobe of lung and left lower lobectomy was done. Mass was around 10x15x10 cms, stony hard in consistency within the left lower lobe. The entire specimen was sent for HPE. Post operatively the patient was stable and regularly followed up. HPE of the mass was pulmonary hamartoma.

Large posterior mediastinal goiter post total cervical thyroidectomy: a case report

Thoracotomy approach is indicated for a complete and safe posterior mediastinal goitre removal. A 68 years old male was hospitalized due to a right mediastinal mass found in a chest X-ray and confirmed by computed tomography. The patient had undergone total cervical thyroidectomy thirty years ago. A computed tomography (CT) guided percutaneous needle biopsy of the mass revealed thyroid tissue. Subsequently, the mass was completely resected through a right posterolateral thoracotomy. The histopathology confirmed a large mediastinal goitre with no signs of malignancy. The patient had an uncomplicated recovery. We present a relatively rare case of a successful resection of a posterior mediastinal goitre, occurring thirty years post-total cervical thyroidectomy. We advocate lateral thoracotomy to achieve a broad operative field and enhance surgical safety.

Distal tracheal resection and reconstruction through right posterolateral thoracotomy

Many retrospective series have been reported on the outcomes of tracheal resection for adenoid cystic carcinoma. However, demonstration on techniques of surgery and ventilatory management during the procedure are rare. We, herewith demonstrate a surgical video, wherein a distal tracheal resection was performed through right posterolateral thoracotomy.

Giant pulmonary bullae in children

Abstract Background Bullous lung disease in pediatric patients is a rare entity, and reports of Giant Bullae (GB) in pediatric age group are very few in number. Due to scarcity of these reports, management depends on individual patient presentation. Case presentation We present two cases with giant pulmonary bullae. The first one is an 11-year-old male child with two weeks history of cough, right sided chest pain and CT scan showed multiple thin-walled air-filled cysts in the same side with mediastinal shift. Bullaectomy was done through a posterolateral thoracotomy. The patient had uneventful intraoperative and postoperative course and discharged improved. He remained stable on subsequent postoperative follow ups. The second patient was 12 years old female who presented with 2 years history of exertional dyspnea with left sided chest pain, cough, loss of appetite and significant weight loss. Chest CT scan revealed left side giant multiseptated bullae with significant mediastinal shift. Bullaectomy was done through a left posterolateral thoracotomy, however the lung remained collapsed despite increased positive pressure ventilation. Patient improved symptomatically, but the lung showed no improvement on subsequent chest x-rays. There was no air leak through the chest tube, which was removed on the seventh postoperative day and patient discharged. Despite marked clinical improvement, the lung remained collapsed on outpatient follow up. Conclusions These case series represent a rare event in the pediatric population and patients with GB present with compressive symptoms mimicking tension pneumothorax. This series can provide guidance on management of these cases for clinicians.

Cerebrovascular Autoregulation in Preterm Infants During and After Surgical Ligation of the Ductus Arteriosus, a Comparison Between Two Surgical Approaches.

Objective: During ligation of the ductus arteriosus, cerebrovascular autoregulation (CAR) may deteriorate. It is unknown whether different surgical approaches affect changes in CAR differently. The objective of this study was to compare the potential change in CAR in preterm infants during and after ligation comparing two surgical approaches: sternotomy and posterolateral thoracotomy.Design: This was an observational cohort pilot study.Setting: Level III NICU.Patients: Preterm infants (GA < 32 weeks) requiring ductal ligation were eligible for inclusion.Interventions: Halfway the study period, our standard surgical approach changed from a posterolateral thoracotomy to sternotomy. We analyzed dynamic CAR, using an index of autoregulation (COx) correlating cerebral tissue oxygen saturation and invasive arterial blood pressure measurements, before, during, and after ligation, in relation to the two approaches.Measurements and Main Results: Of nine infants, four were approached by thoracotomy and five by sternotomy. Median GA was 26 (range: 24.9–27.9) weeks, median birth weight (BW) was 800 (640–960) grams, and median post-natal age (PNA) was 18 (15–30) days, without differences between groups. COx worsened significantly more during and after thoracotomy from baseline (Δρ from baseline: during surgery: Δ + 0.32, at 4 h: Δ + 0.36, at 8 h: Δ + 0.32, at 12 h: Δ + 0.31) as compared with sternotomy patients (Δρ from baseline: during surgery: Δ + 0.20, at 4 h: Δ + 0.05, at 8 h: Δ + 0.15, at 12 h: Δ + 0.11) (F = 6.50; p = 0.038).Conclusions: In preterm infants, CAR reduced significantly during and up to 12 h after ductal ligation in all infants, but more evident during and after posterolateral thoracotomy as compared with sternotomy. These results need to be confirmed in a larger population.

An extremely rare case of rapidly growing mediastinal well-differentiated liposarcoma with a sclerosing variant: a case report

BackgroundLiposarcoma arising from the mediastinum is rare, accounting for less than 1% of mediastinal tumors. Furthermore, a rapidly growing well-differentiated liposarcoma is extremely rare. A well-differentiated liposarcoma is usually considered a low-grade malignancy. However, we present an extremely rare case of a sclerosing variant of well-differentiated liposarcoma that grew rapidly within a year.Case presentationA 77-year-old man with a giant mass in the left thoracic cavity was referred to our hospital. This mass measured about 10 cm and occupied the left-sided mediastinum on a chest radiography; however, there was no abnormal finding on the previous year’s chest radiography. Chest-enhanced computed tomography revealed a well-circumscribed 11-cm mass in the left-sided anterior mediastinum. Positron emission tomography showed accumulation of fluorodeoxyglucose uptake in this tumor (maximum standard uptake value = 3.3). The radiological findings of computed tomography and positron emission tomography indicated that this tumor was a benign or low-grade malignancy; therefore, the chest radiographic findings were difficult to explain. To explain this discrepancy and establish the diagnosis, tumor resection was performed via left posterolateral thoracotomy. Intraoperatively, the left phrenic nerve and pericardium were adhered tightly to the tumor, so we resected them. The tumor was well-circumscribed and fibrous; therefore, the initial diagnosis was solitary fibrous tumor. However, based on its histopathological and immunohistochemical patterns, the tumor was diagnosed as a sclerosing variant of well-differentiated liposarcoma. Five years postoperatively, the patient remains alive with no evidence of disease recurrence.ConclusionsA well-differentiated liposarcoma is usually considered a low-grade malignancy. Nevertheless, the giant tumor in the present case appeared within 1 year. Thus, this was an extremely rare case of a sclerosing variant of well-differentiated liposarcoma with rapid growth.

Retrospective evaluation of postsurgical outcomes of patients operated with the diagnosis of pulmonary hydatid cyst

Objective: Hydatid cysts may occur in almost every organ and tissue of human the body. Because they can be found in more than one organ/tissue, sometimes many operations may need for them and surgical intervention may be required due to complications that may develop secondary to hydatid cyst surgery albeit few. Method: Data on patient files retrieved from the hospital information management system or archive were analyzed retrospectively. Surgical results of patients operated with the diagnosis of hydatid cyst between 2008 and 2018 in our clinic were discussed retrospectively. Results: Ninety-three operations were performed in 84 patients due to pulmonary hydatid cysts. Fourty-four of them were male (52.4%), 40 were female and their mean age was 44 (5-85) years. Twenty-two (26.2%) patients were asymptomatic and 62 (73.8%) were symptomatic. Hydatid cysts were located in right hemithorax in 45 (53.6%) patients, in left hemithorax in 30 (35.7%) patients and bilaterally in 9 (10.7%) patients. Twenty-six patients (31%) had both pulmonary and hepatic hydatid cysts. Posterolateral thoracotomy and cystotomy-capitonnage were the most common methods (89.3%), 9 patients (10.7%) underwent wedge resection. Four patients developed atelectasis, 2 patients had hydropneumothorax, 4 patients had isolated prolonged air leak, 1 patient developed massive pulmonary embolism, and 1 patient developed Aspergillus infection the quilted cavity. Conclusions: Hydatid cyst disease has still been a serious health concern in Turkey. When the careful and experienced surgeons perform the operations, the postoperative period is usually uneventful and morbidity is extremely low.

Can pleural packing be an effective solution for uncontrollable intra or post-operative hemorrhage

Background: Uncontrollable bleeding during thoracic surgery has been a challenging problem faced by surgeons. The aim of this study was to clarify the usefulness of pleural packing as a good alternative to control hemorrhage and to deduce the common point between those patients.Methods: This was a retrospective case series study of eight patients who underwent thoracic surgery with uncontrollable intrathoracic haemorrhage and shock which required intrathoracic packing from January 2014 to December 2019.Results: During the study period, eight patients underwent thoracic surgery with uncontrollable intrathoracic haemorrhage and needed packing. Successful hemostasis was achieved in all cases after pleural packing. The mean age was 58.5 years and six patients were males. The common point was the history of pulmonary tuberculosis which was with invasive pulmonary aspergillosis for two patients. Incision was a posterolateral thoracotomy in all cases and six patients required pulmonary resection (five lobectomy and one bilobectomy), one patient required decortication, and one had tumorectomy of a paragonglioma located in the Barety’s space. The unpacking took place right after 48 hours. An arrest of the bleeding was noticed in all the remaining patients. The mean time of the mechanical ventilation was 11 days. Complications included atelectasis and infectious pneumonitis. We noted one case of death.Conclusions: Intrathoracic packing may be an effective and feasible technique in managing uncontrollable post-operative hemorrhage when the life of patients is in danger. This technique should always be considered for patients with tuberculosis history.

ADENOID CYSTIC CARCINOMA PRESENTING LATE WITH INTRAPERICARDIAL EXTENSION

TYPE: Case Report Publication TOPIC: Lung Cancer INTRODUCTION: Adenoid Cystic Carcinoma (ACC), a subtype of adenocarcinoma of the lung, is scarcely understood due to a global dearth of literature and number of cases. This salivary gland type malignant neoplasm accounts for 0.04-0.20% of all primary lung tumors, with airways being the most common site of occurrence. Moreover, this specific report also highlights its extension to the left atrium, a phenomenon that has hardly ever been documented in literature. CASE PRESENTATION: A 33-year-old male with no underlying comorbidities presented with hemoptysis since the past few days and chest pain for four years preceding that. He also had a history of successfully treated TB seven years ago. Based on the triad of clinical presentation, CT scan and transbronchial biopsy, a working diagnosis of ACC was made. Soon after, right posterolateral thoracotomy and right pneumonectomy with partial resection of the left atrium was performed. Histopathology analysis of the excised tissue revealed the tumor to be 4.5x3.5x3 cm in size but non-invasive (T2b), with no nodal involvement or metastasis. DISCUSSION: More commonly found elsewhere in the body (for example breast, skin and uterine cervix), ACC in the lung is commonly misdiagnosed as asthma or bronchitis. Literature suggests that surgical resection is the mainstay of treatment due to limitations with both radiotherapy and chemotherapy. Furthermore, one- and three-year survival rates have been documented at 71.8% and 37.8% respectively. CONCLUSIONS: This report aims to shed light on the unusual clinical pathophysiology, to register its atypical extensions and to navigate surgeons who may encounter this manifestation in the future. DISCLOSURE: No significant relationships. KEYWORDS: Neoplasm, Atypical, Cardiothoracic

HYDATID CYST OF THE PERICARDIUM: UNUSUAL MEDIASTINAL TUMOR

TYPE: Abstract Publication TOPIC: Disorders of the Mediastinum PURPOSE: HYdatid cyst is a parasitic disease known from the time of Hippocrates, and it is still endemic in many places in the world specially in Mediterranean coast.Here We present the case of a patient with an asymptomatic pericardial hydatid cyst with extension to diaphragmatic muscle. METHODS: A 57-year-old man was referred to our hospital after external bulging of the right heart silhouette was noticed at her chest x rays (CXR) during a preoperative check-up examination for stromal tumor of stomach.An axial postcontrast computed tomogram showed mass with multiple cysts surrounding the right cardiac border, with compression and distortion of the right atrium; and compression of the inferior vena cava (IVC). There was no other cystic lesion in the mediastinal or lung areas. Thorax MRI clearly confirmed the echocardiographic finding, showing small cystic structures inside this mass corresponding to vesicules. There were no cysts detected in the heart. Serologic test (agglutination) for Echinococcus granulosus was positive Abdominal ultrasonography was normal. RESULTS: During right Postero-lateral thoracotomy, pericardio- phrenotomy was practiced around the mass; there is not any extension to myocardium; and the cyst was removed totally without effraction.The follow up was uneventful. Findings from postoperative pathologic examination were consistent with the diagnosis of a hydatid cyst. CONCLUSIONS: Pericardial hydatidosis should be suspected in patients from endemic areas, especially if they have signs of cardiac tumor or when a chest roentgenogram or echocardiogram reveals a mass in relation with the cardiac silhouette. CLINICAL IMPLICATIONS: Essentially the difficulty of diagnosis and surgical techniques without dissemination. DISCLOSURE: No significant relationships. KEYWORD: Hydatid disease Pericardium Surgery

Swallowed dentures in thoracic oesophagus

Oesophagus is the second most (46.8%) common site of impaction of foreign body in the gastro-intestinal tract. Dentures constitute the 3rd most common (2.4%) foreign body in oesophagus of adults, following meat bone (76.1%) and coin (3.6%).In our Institute, impacted dentures in esophageal are referred to our department after a failed endoscopic venture at removal by ENT surgeons. Extraction in such a situation calls for judicial planning and careful timing of the procedure to achieve satisfactory results. The present study was done on 11 cases of thoracic oesophageal dentures which were removed surgically in the Department of CTVS Medical College and Hospital, Kolkata over 2 years of period. Between 1st October 2017 to 30st September 2019, 11 dentures were extracted from thoracic oesophagus via right postero-lateral thoracotomy approach. The defect in the oesophagus after denture removal was primarily closed; with reinforcement using intercostals muscle pedicled flap. A defunctioning cervical oesophagostomy and a feeding jejunostomy (FJ) were done in all cases. Surgical leaks were noted in 5 cases, of which 1 lady had fulminant mediastinitis before she died. Pneumonia was observed in 4 cases, superficial surgical wound infection in 2 cases, blocked FJ tube in 1 case and leakage following closure of cervical oesophagostomy in 3 cases. Thoracic esophageal dentures are serious surgical entities which need early diagnosis and management. Pre-operative optimization is very important for avoiding surgical leakage.

Scoliosis after thoracotomy repair of esophageal atresia: a systematic review.

Standard surgical repair of esophageal atresia/tracheoesophageal fistula (EA/TEF) is via a right posterolateral thoracotomy. A recognized complication is the later development of scoliosis. The prevalence and pathogenesis of secondary scoliosis are poorly understood. We, therefore, conducted a systematic review on this topic. All English language articles reporting incidence, outcomes and/or interventions for scoliosis in children after EA repair via thoracotomy were identified. Fourteen relevant articles published between 1969 and 2019 reporting 1338 children were included in the analysis. The aggregate prevalence of scoliosis among 937 children without congenital vertebral anomalies was 13%, but this figure varied widely between studies. Severity of scoliosis was documented in 181 children; eight children had a Cobb angle > 40° and 10 had undergone spinal surgery. The spinal curvature in affected individuals was dominantly or exclusively convex to the left. In conclusion, the reported prevalence of scoliosis varies widely but on average affects about one in eight children after open repair of EA/TEF. Most cases are mild and do not require intervention. It is currently uncertain whether secondary scoliosis is preventable by using meticulous thoracotomy techniques or thoracoscopic repair.Level of evidence IV.

Anesthetic Management of Surgical Repair of Descending Thoracic Aortic Aneurysm

Anesthetic management of surgical repair of descending thoracic aortic aneurysm is a difficult mission for anesthesiologists. The surgical approach is best achieved through left postero-lateral thoracotomy with the use of one lung ventilation. The post-operative outcome is affected by the presence of associated co morbidities such as cardiac and renal diseases, the severe intra-operative hemodynamic fluctuations and the use of mechanical circulatory assisted devices. The severe hemodynamic fluctuations that result from clamping and declamping the descending thoracic aorta require an experienced cardiac anesthesiologist for the proper perioperative management of these patients. The aim of this review is to give new insights on the anesthetic management and the techniques of distal perfusion using partial cardiopulmonary bypass. Anesthetic goals are directed to provide spinal cord and renal protection with controlling the proximal hypertension.

Paravertebral Block Versus Preemptive Ketamine Effect on Pain Intensity after Posterolateral Thoracotomies: A Randomized Controlled Trial.

Severe postoperative pain affects most patients after thoracotomy and is a risk factor for post-thoracotomy pain syndrome (PTPS). This randomized controlled trial compared preemptively administered ketamine versus continuous paravertebral block (PVB) versus control in patients undergoing posterolateral thoracotomy. The primary outcome was acute pain intensity on the visual analog scale (VAS) on the first postoperative day. Secondary outcomes included morphine consumption, patient satisfaction, and PTPS assessment with Neuropathic Pain Syndrome Inventory (NPSI). Acute pain intensity was significantly lower with PVB compared to other groups at four out of six time points. Patients in the PVB group used significantly less morphine via a patient-controlled analgesia pump than participants in other groups. Moreover, patients were more satisfied with postoperative pain management after PVB. PVB, but not ketamine, decreased PTPS intensity at 1, 3, and 6 months after posterolateral thoracotomy. Acute pain intensity at hour 8 and PTPS intensity at month 3 correlated positively with PTPS at month 6. Bodyweight was negatively associated with chronic pain at month 6. Thus, PVB but not preemptively administered ketamine decreases both acute and chronic pain intensity following posterolateral thoracotomies.

Decortication as an Option for Empyema Thoracis.

To analyse the outcome and morbidity associated with decortication in empyema thoracis. A case series. Departments of Surgery, Combined Military Hospitals (CMH) of Rawalpindi, Quetta and Lahore, from January 2006 to March 2018. This is a retrospective study of 812 cases of open and VATS (video-assisted thoracic surgery) decortication for empyema thoracis, operated by the same consultants. Only patients with established empyema were included. Those who were unfit for one-lung ventilation, undergoing local anesthesia procedures like rib resection, clagget window or tube windows, with clotted hemothorax and malignant pathology were excluded. Posterolateral serratus sparing thoracotomy was used in open decortications. Multiportal or uniport VATS was employed for video-assisted thoracoscopic decortications (VATD). Histopathology and microbiological sampling was also done in all cases. There were 537 (66.1%) males and 275 (33.9%) females. Age ranged from 1 to 80 years with a mean of 37 years. Open decortication was done in 650 (80%), standard decortication with posterolateral thoracotomy in 458 (56.4%), minithoracotomy was done in 69 (8.4%) patients with loculated empyema, thoracotomy and open decortication with conventional thoracoplasty was done in 21 patients. Twenty-two patients required open decortications with tailored thoracoplasty and muscle flap. Open decortication with intercostal muscle (ICM) flap or primary closure of bronchopleural fistula was performed in 55 patients. VATD was done in 162 cases, out of which 120 were early empyema, and 42 were of chronic empyema; of which 22 required a further utility thoracotomy. Decortication with lung resection and muscle flap reinforcement to bronchial stump was done in 25 patients. Blood transfusion was required in 331 (40.7%). Twenty-six (3.4%) patients developed residual space and collection requiring intervention; and 384 (47.3%) patients had a histopathology diagnostic for tuberculosis. There were 11 (1.3%) deaths. Open decortication is still one of the preferred procedures in developing countries. VATD is also increasingly utilised for empyema.

Giant Mediastinal Ganglioneuroma in a Female Child

We report an eight year female patient admitted to the department of pediatrics at Abbasia Pulmonary Hospital at Cairo, Egypt. The child was complaining of pain on the right lower chest and upper abdome. On evaluation by CT of the chest, there was a huge posterior mediastinal mass occupying more than three quarters of the right hemithorx. Preoperative histopathology using CT guided needle biopsy revealed ganglioneuroma. The tumor was resected completely via right standard posterolateral thoracotomy without complications. Postoperative histopathology confirmed the diagnosis of ganglioneuroma.

Change in Pulmonary Function Following Decortication for Chronic Pleural Empyema.

Chronic empyema is the final stage of the triphasic pathogenesis of empyema that is characterized by fibrin deposits in both pleural surfaces, leading to the formation of a thickened pleural peel. This restricts the lung movements, giving rise to a trapped lung and impairment of pulmonary function. The aim of this study was to determine the change in pulmonary function following decortication for chronic empyema. A total of 35 patients with chronic pleural empyema who underwent decortication via a posterolateral thoracotomy between July 2016 and July 2017 were reviewed and followed-up for 6±3 months after surgery. All patients underwent a pulmonary function test using spirometry before and after surgery. Pre-operation spirometry values [mean forced expiratory volume in 1s (FEV1) and mean forced vital capacity (FVC)] were compared with the post-operation data obtained during follow-up and the change was quantified by statistical analysis. FEV1 was 70.51% before surgery vs. 83.43% after surgery (p<0.001). FVC was 69.74% before surgery vs. 85.40% after surgery (p<0.001). There was no influence of bacteriology, side of occurrence of the lesion, smoking habit, or diabetes mellitus present before the operation on the patients' lung function (p>0.01). Decortication and pleurectomy via a posterolateral thoracotomy resulted in significant clinico-functional improvement in patients with chronic empyema, regardless of the bacteriology, side of occurrence of the lesion, smoking habit, or diabetic status of the patient.

Effects of Transcutaneous Electrical Nerve Stimulation on Pain, Pulmonary Function, and Respiratory Muscle Strength After Posterolateral Thoracotomy: A Randomized Controlled Trial.

To evaluate the effects of transcutaneous electrical nerve stimulation (TENS) compared to placebo TENS and a control group on pain, pulmonary function, respiratory muscle strength, and analgesic medications in the postoperative period of thoracotomy in an Intensive care unit (ICU). Patients who had undergone posterolateral thoracotomy were randomly allocated to receive TENS during ICU stay, or placebo TENS, or into the control group. All groups received conventional physiotherapy. We analysed the intensity of pain, pulmonary function, respiratory muscle strength, and use of analgesia medications. Outcomes were evaluated before surgery, immediately after, 24 and 48h after ICU admission. Forty-five patients were included. Regarding pain perception, there was no difference between groups (p = 0.172), but there was a significant reduction in pain intensity for patients receiving TENS after first physiotherapy session compared to baseline (4.7 ± 3.2 vs 3.3 ± 2.6; p < 0.05). All groups had a decrease in forced vital capacity (FVC) after surgery (p < 0.001). There was no difference between the groups regarding the use of analgesic medications, but a higher intake of morphine and acetaminophen were observed for the control (p = 0.037) and placebo group (p = 0.035), respectively. The use of TENS provides a little benefit of pain (in the first 12h) but failed to demonstrate any improvement in the recovery of ICU patients after 48h of posterolateral thoracotomy. NCT02438241.

Giant Mediastinal Ganglioneuroma in a Female Child

We report an eight year female patient admitted to the department of pediatrics at Abbasia Pulmonary Hospital at Cairo, Egypt. The child was complaining of pain on the right lower chest and upper abdome. On evaluation by CT of the chest, there was a huge posterior mediastinal mass occupying more than three quarters of the right hemithorax. Preoperative histopathology using CT guided needle biopsy revealed ganglioneuroma. The tumor was resected completely via right standard postero-lateral thoracotomy without complications. Postoperative histopathology confirmed the diagnosis of ganglioneuroma. Keywords: Ganglioneuroma; Posterior mediastinum; Pediatrics

Pediculated Intercostal Muscle Flaps in Bronchiactasis Resectional Surgery for Bronchial Stump Reinforcement.

To determine the outcome of muscle flap to cover the bronchial stump in the resectional surgery for bronchiectasis for prevention of bronchopleural fistula. Case series. Combined Military Hospitals of Quetta, Lahore, and Rawalpindi from January 2006 to August 2017. Patients with localised bronchiectatic changes were included. Patients with carcinoma and without flap resection were excluded. Resectional surgery was performed through posterolateral thoracotomy approach, under general anesthesia with one lung ventilation. Pediculated or bipediculated intercostal muscle flap (ICM) was used to reinforce the bronchial stump. Pediculated ICM flaps were utilised for reinforcement of bronchial stump and bipediculated flaps were used over lesser. Three hundred and ninety-eight cases of bronchiectasis with average age of patients 38.5 ±19.8 years and male to female ratio of 2:1 were included. Bronchiectasis was unilateral in 377 cases. Tuberculous was found in 278 of the cases. Thirty-five had poor lung function tests (FEV1 <1.5%). Eighty-two patients underwent pneumonectomy, 228 patients had lobectomy and 88 patients underwent segmentectomy. Posterior-based pediculated ICM flap was used in 365 patients, and bipediculated ICM flaps in 30 cases. The most common complication was post-thoracotomy neuralgia 53. Bronchopleural fistula, despite transposition of intercostal muscle flap on bronchial stump, was present in 4 patients. Application of muscle flap over bronchial stump after resection surgery for bronchiectasis, is simple, safe and effective surgical option to avoid complication of bronchopleural fistula.