What is thoracotomy?

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Thoracotomy: Overview

A thoracotomy (say "thor-uh-KAW-tuh-mee") is surgery done through a cut in the chest wall. The cut is called an incision. It is made between the ribs. The doctor can operate inside the chest through this incision. A thoracotomy may be used for surgery on the lungs, esophagus, trachea, heart, aorta, or diaphragm. The exact place where the incision is made depends on the reason for the surgery. It is usually across the side of the mid-chest.

Your doctor may need to cut through a rib or the breastbone (sternum). This is done to spread the ribs far enough to do the surgery. When the surgery is finished, the doctor will close the incision with stitches or staples. If a rib or the breastbone was cut, the doctor will use wire to hold the pieces of bone together as they heal.

Most people spend 3 to 7 days in the hospital after this type of surgery. You will be quite sore. You'll get medicine to help with this. Even though you will be sore, make sure that you breathe deeply and are as active as you can after surgery. This will help your lungs expand again. It will help you heal more quickly too. Also, be sure not to smoke after surgery.

The amount of time you will need to recover at home depends on the type of surgery you had. You will probably need to take at least 1 to 2 months off work.

How can you care for yourself after a thoracotomy?

Activity

  • Rest when you feel tired. Getting enough sleep will help you recover.
  • Try to walk each day. Start by walking a little more than you did the day before. Bit by bit, increase the amount you walk. Walking boosts blood flow and helps prevent pneumonia and constipation.
  • Do not smoke or allow others to smoke around you. If you need help quitting, talk to your doctor about stop-smoking programs and medicines. These can increase your chances of quitting for good.
  • Try to avoid being around people who you know have a cold, the flu, or other illness.
  • Avoid strenuous activities, such as bicycle riding, jogging, weight lifting, or aerobic exercise, until your doctor says it is okay. Also avoid swimming, tennis, golf, or other activities that could strain your arm and shoulder muscles, until your doctor says it is okay.
  • Until your doctor says it is okay, avoid lifting anything that would make you strain. This may include a child, heavy grocery bags and milk containers, a heavy briefcase or backpack, cat litter or dog food bags, or a vacuum cleaner.
  • If your incision is in the front or the side of your chest, hold a pillow over the incision when you cough or take deep breaths. This will support your chest and decrease your pain.
  • Ask your doctor when it is safe to you to drive or fly. You probably will not be able to drive for at least 4 weeks. This is because your arm and shoulder muscles may be stiff after surgery and could make it difficult to steer.
  • You may be able to take showers (unless you have a drain near your incision). If you have a drain near your incision, follow your doctor's instructions to empty and care for it. Do not take a bath for the first 2 weeks, or until your doctor tells you it is okay.
  • Ask your doctor when it is okay for you to have sex.
  • You will probably need to take at least 1 to 2 months off from work. It depends on the surgery you had and the type of work you do.

Diet

  • You can eat your normal diet. If your stomach is upset, try bland, low-fat foods like plain rice, broiled chicken, toast, and yogurt.
  • Drink plenty of fluids (unless your doctor tells you not to).
  • You may notice that your bowel movements are not regular right after your surgery. This is common. Try to avoid constipation and straining with bowel movements. You may want to take a fiber supplement every day. If you have not had a bowel movement after a couple of days, ask your doctor about taking a mild laxative.

Medicines

  • Your doctor will tell you if and when you can restart your medicines. He or she will also give you instructions about taking any new medicines.
  • If you stopped taking aspirin or some other blood thinner, your doctor will tell you when to start taking it again.
  • Be safe with medicines. Take pain medicines exactly as directed.
    • If the doctor gave you a prescription medicine for pain, take it as prescribed.
    • If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine.
    • Do not take two or more pain medicines at the same time unless the doctor told you to. Many pain medicines have acetaminophen, which is Tylenol. Too much acetaminophen (Tylenol) can be harmful.
  • If you think your pain medicine is making you sick to your stomach:
    • Take your medicine after meals (unless your doctor has told you not to).
    • Ask your doctor for a different pain medicine.
  • If your doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics.

Incision care

  • If you have strips of tape on the incision, leave the tape on for a week or until it falls off.
  • Wash the area daily with warm, soapy water, and pat it dry. Don't use hydrogen peroxide or alcohol, which may delay healing. You may cover the area with a gauze bandage if it weeps or rubs against clothing. Change the bandage every day.
  • Keep the area clean and dry.

Exercise

  • To help keep your lungs clear, cough and do deep breathing exercises as you are told by your doctor, nurse, or respiratory therapist.
  • Your doctor may send you home with an incentive spirometer. This device helps you practice taking deep breaths, which can help keep your lungs healthy.
  • Ask your doctor about exercises to keep your arm and shoulder muscles strong and flexible while you recover.

How do you prepare for a thoracotomy?

Surgery can be stressful. This information will help you understand what you can expect. And it will help you safely prepare for surgery.

Preparing for surgery

  • Be sure you have someone to take you home. Anesthesia and pain medicine will make it unsafe for you to drive or get home on your own.
  • Understand exactly what surgery is planned, along with the risks, benefits, and other options.
  • If you take a medicine that prevents blood clots, your doctor may tell you to stop taking it before your surgery. Or your doctor may tell you to keep taking it. (These medicines include aspirin and other blood thinners.) Make sure that you understand exactly what your doctor wants you to do.
  • Tell your doctor ALL the medicines, vitamins, supplements, and herbal remedies you take. Some may increase the risk of problems during your surgery. Your doctor will tell you if you should stop taking any of them before the surgery and how soon to do it.
  • Make sure your doctor and the hospital have a copy of your advance directive. If you don’t have one, you may want to prepare one. It lets others know your health care wishes. It’s a good thing to have before any type of surgery or procedure.

After thoracotomy: When to call

Call 911 anytime you think you may need emergency care. For example, call if:

  • You passed out (lost consciousness).
  • You have severe trouble breathing.
  • You have sudden chest pain and shortness of breath, or you cough up blood.

Call your doctor now or seek immediate medical care if:

  • You are sick to your stomach or cannot keep fluids down.
  • You have pain that does not get better after you take pain medicine.
  • You have a fever over 100°F.
  • You have loose stitches, or your incision comes open.
  • Bright red blood has soaked through the bandage over your incision.
  • You have signs of infection, such as:
    • Increased pain, swelling, warmth, or redness.
    • Red streaks leading from the incision.
    • Pus draining from the incision.
    • Swollen lymph nodes in your neck, armpits, or groin.
    • A fever.
  • You cough up a lot more mucus than normal, or your mucus changes color.

Watch closely for changes in your health, and be sure to contact your doctor if you have any problems.

After a thoracotomy: Overview

A thoracotomy (say "thor-uh-KAW-tuh-mee") is a cut (incision) that the doctor makes in the chest wall through your front, side, or back. The doctor is able to do surgery inside the chest through the incision. A thoracotomy may be used to do surgery on the lungs, esophagus, trachea, heart, aorta, or diaphragm. The exact place in the chest where the doctor makes the incision depends on the reason for the surgery.

It is common to feel tired for 6 to 8 weeks after surgery. Your chest may hurt and be swollen for up to 6 weeks. It may ache or feel stiff for up to 3 months. You may also feel tightness, itching, numbness, or tingling around the incision for up to 3 months. Your doctor will give you medicine to help with pain.

You will have stitches or staples in the incision. You may have one or more tubes coming out of your chest to drain fluid and air that can build up after surgery. The tubes are often removed before you leave the hospital. Your doctor will remove the stitches or staples at your follow-up visit.

You may feel short of breath at first after the surgery. Your doctor, nurse, or respiratory therapist will teach you deep-breathing and coughing exercises to help your body get as much oxygen as possible. You also may need to get extra oxygen through a mask or a plastic tube in your nostrils (nasal cannula). This is called oxygen therapy.

The amount of time you will need to recover depends on the surgery you had. You probably will need to take at least 1 to 2 months off work.

What happens on the day of a thoracotomy?

  • Follow the instructions exactly about when to stop eating and drinking. If you don't, your surgery may be canceled. If your doctor told you to take your medicines on the day of surgery, take them with only a sip of water.
  • Follow your doctor's instructions about when to bathe or shower before your surgery. Do not apply lotions, perfumes, deodorants, or nail polish.
  • Do not shave the surgical site yourself.
  • Take off all jewelry and piercings. And take out contact lenses, if you wear them.

At the hospital or surgery center

  • Bring a picture ID.
  • The area for surgery is often marked to make sure there are no errors.
  • You will be kept comfortable and safe by your anesthesia provider. You will be asleep during the surgery.
  • The surgery will take about 2 to 4 hours.
  • You may stay in the ICU for the first 1 or 2 days after surgery.
  • You will have a tube down your throat during surgery to help you breathe. This will probably be removed before you are fully awake.
  • You will probably have one or two tubes coming out of your chest to drain fluid and air so that your lungs can expand again after surgery. The chest tubes will be removed before you go home.
  • You may have an epidural catheter. This is a tiny tube that delivers pain medicine directly into the area in your back around your spinal cord. The epidural will help prevent pain after surgery.

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