Chylothorax represents the accumulation of chyle in the pleural cavity due to leakage from the thoracic duct or its tributaries. Intraoperative intrathoracic lymphatic injury is a common cause, but it can also occur on its own. Management of chylothorax involves both medical therapy and, in some cases, surgery for postoperative patients and those who haven't responded to medical therapy. We describe a case of a one-month-old female infant with right-sided chylothorax following primary esophageal atresia repair, who underwent successful thoracic duct ligation by open thoracotomy after unsuccessful medical treatment. Minimally invasive radiology is now the standard treatment for traumatic chylothorax because it is safe and effective. However, surgical ligation of the thoracic duct remains an effective option for treating high-output or recurring chylothorax in countries with limited resources.

Background: Video-assisted thoracic surgery (VATS) for both minor and major thoracic procedures has become routine practice worldwide. In this study, we present our experience with multiportal and uniportal VATS (MVATS and UVATS) in Bosnia and Herzegovina (B&H). MVATS and UVATS procedures were performed in two B&H Clinical Centers: Tuzla and Sarajevo. The first MVATS procedure at Tuzla Clinical Center was conducted in 2004, and the first UVATS lobectomy was performed in 2019. At Sarajevo Clinical Center, the initial MVATS took place in 2005, and the first UVATS lobectomy was carried out in 2020. Methods: We retrospectively analyzed 401 VATS procedures with prospective data, collected between 06/2017 and 04/2023. The VATS technique was employed for wedge resections, partial resections, lobectomies, and other types of resections, including metastasectomy. Results: Out of the 401 patients, 242 (60.34%) were male, and 159 (39.66%) were female, with a mean age of 57.2±23 years. The procedures consisted of 231 UVATS and 170 MVATS. Lobectomy was performed in 61 (15.21%) cases, wedge resections in 216 (51.37%), partial resections in 85 (21.19%), and other types of resections in 39 (9.72%) patients. The median duration of the procedure was 210 minutes for lobectomy, and 77.5 minutes for wedge and other types of resections. Major complications, such as bronchopleural fistula in 22 (5.49%) cases, wound infections in 20 (4.99%), atelectasis in 19 (4.74%), lung infiltrations in 15 (3.74%), and bleeding in 15 (3.74%) patients, were observed. The overall mean hospital stay for all procedures was 6.45 days. Conclusion: Uniportal and multiportal VATS techniques are feasible and safe for various indications in thoracic surgery. VATS can be performed in middle-income countries such as Bosnia and Herzegovina with acceptable results, by thoracic surgeons experienced in general thoracic surgery

Background: Pleural disorders in novel coronavirus disease 2019 (COVID-19), responsible for the deaths of more than 6.7 million people worldwide, are relatively uncommon and underappreciated findings. The severity of the pleural disease in these patients correlates with the treatment outcome and overall prognosis. Objective: We aim to review our experience with treatment modalities and prognosis in 45 patients with COVID-19, who were treated at our Clinic between April 2020 and October 2021. Methods: We conducted a retrospective, single-center, cross-sectional study. Demographic data, the type of thoracosurgical intervention(s), and treatment outcome for 45 patients included in this study were recorded for every patient. We analyzed the type and number of treatment modalities according to the pleural disorder, and the outcome of the treatment. Results: Pneumothorax was the most common COVID-19-related pleural disorder, followed by the pleural effusion. Tube thoracostomy was the mainstay of treatment, performed in 84.4% of patients with unilateral pleural complications. In total, 20% of our patients were on mechanical ventilation, and all of them had a fatal outcome. We found statistical significance in comparison to the percentage of fatal outcomes between patients treated with and without mechanical ventilation (p=0.000). Conclusion: COVID-19-related pleural disorders are prognostic markers of disease progression. Mechanically ventilated patients who require tube thoracostomy have an unfavorable prognosis.

Introduction: Pleural complications in coronavirus disease 2019 (COVID-19) are relatively uncommon findings. Pleural involvement in these patients may directly correlate to disease severity and overall prognosis. We aimed to review clinical features and treatment approaches for pleural complications (accumulation of fluid/air inside the pleural cavity) in 45 patients with COVID-19, who were treated at our institution between April 2020 and October 2021. Methods: Our study was designed as single-center, observational, cross-sectional study of 45 patients with COVID-19 and at least one radiologically verified pleural complication. Demographic data, radiological findings, as well as type and number of thoracosurgical intervention(s) were recorded for every patient. We included patients of both genders and various age groups, with positive RT-PCR assay for COVID-19 and radiologic features of pleural complications, which required single or multiple thoracosurgical interventions. Results: Unilateral pleural complications were more common, right-sided pleural complications were found in 44.4% of patients. Right-sided pneumothorax was reported in 26.7% of patients. Almost one-fourth of our patients required invasive mechanical ventilation. Tube thoracostomy was performed in 84.4% of patients with unilateral pleural complications. A fatal outcome was most common in patients over 60 years old. More than half of patients with bilateral pleural complications died in our study. Conclusions: Pleural complications are a rare finding in patients with COVID-19. Tube thoracostomy is the mainstay of treatment for most symptomatic patients with pleural complications. Future research should be directed toward investigation of long-term pulmonary consequences in patients with COVID-19.

Descending necrotizing mediastinitis (DNM) is a rare, life-threatening form of mediastinitis caused by odontogenic, pharyngeal, or cervical infections. The retropharyngeal space is the most common primary site of infection. Given the fulminant course and high mortality rate, early diagnosis and prompt treatment are important predictors of survival in patients with DNM. Appropriate empirical antibiotic treatment, prompt surgical intervention, and proper management of patients in the intensive care unit can be of vital importance. We present the case of a previously healthy 20-year-old male patient who was successfully cured and discharged from the Clinical Center University of Sarajevo after suffering from a severe form of mediastinitis as a complication of the retropharyngeal abscess caused by anaerobes.

Introduction: Lung cancer is a neoplasm with the highest mortality rate in the world. The role of neoadjuvant therapy in patients with initially assessed borderline operable or inoperable lung cancer is to improve survival by downstaging the tumor and allowing surgical resection, as well as the potential treatment of micrometastatic disease. Aim: Establishing the justification and efficacy of neoadjuvant therapy after the initial assessment of operability in patients with borderline operable and inoperable histopathologically verified stage IIIA non-small cell lung cancer. Methods: The retrospective study included 65 patients with initially assessed stage IIIA lung cancer, who underwent neoadjuvant therapy. After the cycles of neoadjuvant therapy, 19 patients who achieved the regression of the tumor underwent surgery. We analyzed the histological type of the tumor, extent, and prevalence of surgical resection, the status of regional lymph nodes, and the achieved R status. Results: Of the total number of patients who underwent neoadjuvant therapy, after reevaluation of the disease, 19 patients (19/65, 29.23% of cases) achieved a clinical response, i.e. tumor downstaging. Of 19 patients who underwent surgery, 16 patients underwent surgical resection, while three patients underwent surgical exploration. The largest number of patients had N0 and N1 status (six patients each). R0 status was achieved in 14 patients (14/16, 87.5% of cases), while R1 in the remaining two. One patient had a fatal outcome. Conclusion: Neoadjuvant therapy plays an important role in the treatment of initially assessed borderline operable or inoperable lung cancers. By downstaging the tumor, it allows surgical resection and potential treatment of micrometastatic disease.

Background: Chemical pleurodesis is generally accepted palliative dyspnea therapy and preventive of re-accumulation of pleural fluid in patients with malignant pleural effusions. Aim: Comparative analyses of efficiency of chemical pleurodesis between Video Assisted Thoracoscopic Surgery (VATS) and standard thoracostomy. Methods: From 01.01.2016-01.01.2017 at the Clinic for Thoracic Surgery of University Clinical Center (UCC) Sarajevo retrospective analysis was performed. Studied patients underwent VATS pleurodesis (G1) and standard thoracostomy pleurodesis (G2), with 60 in each group, respecting defined inclusion and exclusion criteria. Pleurodesis success was examined radiologically over the next three months. Results: Average age of all patients was 63.97±8.75 years. Gender related, 45% were men and 55% were women (F/M=1.47:1). Average hospitalization was 7.22±1.37 (G1: 6.68±1.16; G2: 7.44±1.40; Mann-Whitney U-test: p=0.0016) days. Average thoracic drainage duration was 5.45±1.69, (G1: 4.28±1.15,G2: 6.05±1.58; Mann-Whitney U-test p<0.0001) days. Pleurodesis success after first month was 98.30% in G1, 91.60% in G2 (G1 vs. G2; p=0.2089); after second month was 98.30% in G1, 78.30% in G2 (G1 vs. G2; p=0.0011) and after three months was 91.60% in G1, 63.30% in G2(G1 vs. G2; p=0.0006). Average dyspnea degree (0-5) after the pleurodesis was 0.050±0.22 in G1 and 0.62±0.76 in G2 (Mann-Whitney U-test; p=0.0001). Complication were noticed in 9.2% patients, in G1 3.3%, 15.0% in G2. Conclusion: Difference in pleurodesis efficiency between the G1 and G2 was established after second month and was even more evident after third month in favor of G1. Results show the significant statistical improvement of the degree of dyspnea in G1 as opposite to the G2.

Aim The aim was to show rare cases of congenital cystic adenomatoid malformation (CCAM) and the manner of its surgical treatment with video-assisted thoracoscopic surgery (VATS). Methods Two male and one female child, 7, 4 and 3 years of age were treated for symptoms of cough and high temperature in district hospitals. In all three children laboratory blood tests and chest radiography were done. Auscultatory findings showed the presence of pneumonia. Children were treated with appropriate doses of antibiotics. After the rehabilitation of inflammation, they were sent to the University Clinical Center Sarajevo, where video-assisted thoracoscopic lobectomy (VATS) was indicated after computerized tomography (CT). Results Chest CT scan pointed to the CCAM and pulmonary sequestration (PS) changes to the lungs. This has required surgery lobectomy of an affected part of the lungs. In two children with PS, the aberrant systemic artery came from the most proximal part of aorta abdominals, the third patient did not have an anomalous artery. Conclusion VATS lobectomy is an alternative to the traditional thoracotomy for the treatment of CCAM and PS, however, it should be investigated in the future for its safety and effectiveness.

Introduction: Approximately only 20-40% of those who suffer from nonmicrocellular lung cancer at detection of disease are candidates for operational treatment. Pre-operational use of inductive oncological therapy at 6075% of cases “takes” the disease into lower level, while at 50% of cases it is possible to do resectional treatment. The aim of work is to demonstrate efficiency of inductive oncological treatment in relation to possibility of resection. Material and methods: This analysis includes 62 patients who underwent different surgical treatment, and after inductive oncological treatment. Results: There is a ignificant statistical difference in frequency of appearance between the two most common sorts of cancer (χ2=25; p=0), the same as statistically significant difference in frequency of certain sorts of cancer according to gender (p= 0). Using Fisher exact test, there was no statistically defined significant dependence between the sort of cancer and its sensitivity to chemotherapy (p=0,2) the same as there was not statistical dependency of chemo therapeutical sensitivity in relation to gender (p=1). Using chi-square test, there was no defined statistically significant difference in frequency of sort of operation in relation to sort of cancer (χ2=1; p=0,6). There is a presence of statistically significant positive connection between the days spent at intensive care and days spent at the ward of surgically treated patients (rho =0,63; p< 0,01) and also there is statistically significant dependence between the response to chemo therapy and days spent at intensive care (p=0). There is also defined statistically significant dependency between the sort of operational treatment and days spent at intensive care and at ward of standard care (χ2=17; p=0 vs. χ2=11; p=0). Conclusion: There is an evident relation of sort of surgical treatment and operational techniques to duration of post operational treatment.

Introduction. Treatment of rectal cancer needs additional preoperative improvements that would decrease tumor volume and move away the lower edge of the tumor from a dentate line, allowing a higher percentage of operability and higher percentage of AR for APR and sterilize potential locoregional tumor deposits. Surgery can accomplish these improvements by using radio and chemotherapy. Patients and Methods. From September, 2011 to September, 2013, 153 patients with rectal cancer were treated. Neoadjuvant radio and chemotherapy by the Swedish protocol were applied in 20 patients (13.07%) with T 2-4 stages. There were fifteen men (75%) and five women (25%), average age was 59.28 years. Long course therapy occurred in fifteen (75%) and short course in five patients (25%). When compared to the previous two-year period, the percentage of inoperable cancers was decreased by 0.9% (p = 0.61) during the period of application of neoadjuvant therapy. There were also some other differences: a number of APR was 19, i.e. decreased by 3.85% (p = 0.83) or for 10 patients when compared to the previous two-year period, when there was 29 APR. Conclusion. Neoadjuvant therapy may convert up to 60% (3 of 5) of inoperable patients into an operable group. The percentage of APR is lower by 3.5% (p = 0.83), i.e. 10 patients when compared to the previous two-year period and neoadjuvant radio and chemotherapy does not affect the anastomosis healing process and / or the occurrence of fistula and / or abdominal collection.

INTRODUCTION Isolated thoracic injuries are relatively common and they are on the second place as a cause of death overall trauma. Most patients with isolated thoracic injuries are treated on an outpatient basis while only serious cases are hospitalized. The basis of the treatment of thoracic trauma is efficient cardiopulmonary reanimation followed by an early detection and treatment of life threatening injuries. Less than 15% of patients with thoracic trauma require thoracotomy. PATIENTS Only the patients with exclusively isolated thoracic trauma were analyzed. RESULTS Based on initial diagnostic procedures initial conservative treatment was indicated and sufficient for 63.75% (204/320) cases while initial surgery treatment was necessary in 36.25% (116/320) of the injured. In relation to the type of surgery the thoracic drainage was performed in 81.03% (94/116) while thoracotomy and VATS procedure was necessary for 7.75% (9/116) of the injured. After the secondary examination or shorter monitoring of the status of the injured, the additional diagnostic procedure was suggested and performed in only 5% (16/320) of the injured. The average period of the hospitalization for all injured with isolated thoracic trauma was 5.9 +/- 4.0 days (from 6 hours to 16 days). In cases of patients with blunt injuries the average period of hospitalization was 6.07 +/- 4.26 days, while for the patients with penetrating trauma it was 5.4 +/- 3.36 days. The calculated value oft-student test (0.2766 > 0.05) indicates that there is no statistically significant difference in the period of the hospitalization in relation to the type of trauma (blunt vs. penetrating). The average period of thoracic drainage was 5.58 +/- 3.3 days (from 3 to 17 days). The average duration of thoracic drainage in the patients with blunt trauma was 5.81 +/- 2.67 days, while in the patients with penetrating trauma it was 5.08 +/- 1.99 days. The calculated value of the probability of t-test (0.1478 > 0.05) shows that there is no significant difference in the period of drainage in cases of blunt and penetrating trauma. Out of total number of patients, 98.0% (315/320) of the injured were successfully treated. The complications were found in 1.25% (4/320) cases. Death was the outcome in 1.5% (5/320) of injured. CONCLUSION Based on the results of the initial diagnostic treatment, in majority of injured with isolated thoracic trauma, it was possible to conduct the relevant and appropriate therapeutic procedures. On the basis of relatively short period of thoracic drainage, hospitalization and low rates of morbidity and mortality, it may be confirmed that the application of initial diagnostic and therapeutic protocols of the Clinic for thoracic surgery resulted in the achievement of the successful treatments in majority of the injured for this type of the

Lung cancer is responsible for 40% mortalities from malignant diseases in man and exhibits an extremely infiltrating way of growing. It does not respect the lobes' or the organs' borders and spreads by blood system, lymph system and per continuitatem. According to its biological characteristics and response to treatments it may be divided in to small cell lung cancer (SCLC) and non small cell lung cancer (NSCLC), which also includes other histological types. Lung cancer treatment includes surgical treatment, chemotherapy, radiotherapy, the combination of the former three as well as symptomatic treatment. In this study, we analyzed 125 patients with lung cancer, that were hospitalized at the Clinic for Thoracic Surgery in KCU Sarajevo. The difference according to gender is statistically significant because we had 111 (88,8%) male patients in comparison with 14 (11,2%) female patients. The average age of male patients was 60,3 years while female patients were 61,9 years old on average. Thus, the difference in average age is not statistically significant. In diagnostic procedures: chest radiography was the most significant in peripheral lesions (60, 8%). CT of the thoracic organs has a statistical significance because the tumor changes were confirmed in 123 patients (98,4%). In bronchoscopy, we had 120 patients (96,0%). The number of patients with preformed lobectomy (63) is statistically significantly greater in the observed group (125) then the number of patients with other operative procedures preformed. From the postoperative complications we had exitus letalis 2 (1,6%), wound infection 19 (15,2%), and 104 without complications (83,2%). The results of testing the significance of differences according to the cancer types in non small cell lung cancer were planocellular, adenocarcinoma, and macrocellular. Comparing the preoperative staging and operative findings through stages we obtained to the following results: in stage ST0 the deviation was 16,7%, STIA the deviation was 40,1%, STIB the deviation was 16,1%, STIIA the deviation was 11,1%, STIIB the deviation was 12,5%, STIIIA the deviation was 33,33%, STIIIB the deviation was 33, 3%. From the overall number of patients, who were in preoperatively graded stage STIA, operative findings confirmed STIA, which makes the most important statistically significant difference. In 36 patients or 28,8% the status was changed in operative finding. In 89 patients preoperative status or 72,2% remained unchanged following the operation.

Penetrating chest injuries are the most frequent causes of serious demage and death in wounded indivisuals. In reports from the last wars where wounds caused by high velocity projectiles predominated, thoracotomies were perfomed in about 15% of the wounded individuals, mostly encompassing injuries of the heart and great vessels, accomanied by massive bleeding that could not be resolved by chest tube insertion. This retrospective analysis was performed on the medical records of 477 patients tretaed for isolated penetrating chest injuries in Department of Thoracic Surgery Clinical Center of the University in Sarajevo between april 1992 - june 1995. We analised the ways of their menagement with special view on pleural drainage, indication for this method and results of treatment. 398 (83,4%) wounded individuals have been treated with pleural tube inserting as definitive mesaure and for the urgent thoracotomy there were 79 (16,6%) patients left. Average hospital treatment in wounded drained patients was 7,68 days. With shrapnels there were 357 (74,84%) wounded individuals, and with bullet 120 (25,16%) wounded individuals. The complications of plaural tube inserting were - empyema in 34 (7,13%) patients and there were no other complications. Chest tube inserting as definitive mesaure was used in 398 (83,44%) patients. Chest tube inserting as preoperative measure (urgent thoracotomy) was used in 79 (16,56%) patients. There were 460 (96,44%) healed patients. Death occurred in 17 (3,56%) patients.