SURGICAL OUTCOME OFMYCETOMA: ELEVEN YEARS EXPERIENCE IN A HIGH VOLUME CENTER

OBJECTIVE: to know the demographics, clinical presentation, underlying lung disease, surgical procedure performed and its perioperative outcome in patients with Mycetoma. METHODOLOGY: This retrospective study was carried out in the department of thoracic surgery Lady Reading Hospital Peshawar from June 2002 to June 2013. Computerized medical records of patients operated upon for Mycetoma, were retrieved and reviewed for demographics, clinical presentation, underlying lung disease, investigations performed, operative procedure outcome. RESULTS: Out of 294 total patients, 176 (60%) were males and 118 (40%) females with a mean age of 38.4±11.30 years (range 14 to 71 years). Hemoptysis was present in 92% patients while Tuberculosis was the most frequent underlying lung disease (92.5%). Lobectomy, bi-lobectomy, wedge resection and pneumonectomy were performed in 86.3%, 2.3%, 5.4% and 4% patients respectively. Cavernostomy was performed in 5 patients (1.7%). Supplementary procedure (thoracoplasty or myoplasty) was performed in 5.1% patients. The operative time averaged 91±9.37 minutes (range 78-190 minutes). Operative mortality was 2.3% while morbidity was 14.6% including hemorrhage (4.4%), pleural space problems (6.4%) and others (3.7%). CONCLUSION: Mycetoma is not uncommon in our set up and occurs more frequently in young male patients having underlying tuberculosis. Lobectomy was the commonest surgical procedure for Mycetoma in our set up. Surgery can be performed safely though with increased morbidity including hemorrhage and pleural space problems. Operative mortality rate was 2.3%