100 CONSECUTIVE THYMECTOMIES FOR MYASTHENIA-GRAVIS

Background. Between June 1977 and November 1993, 100 consecutive thyme ctomies for myasthenia gravis were performed at University of North Ca rolina Hospitals in Chapel Hill. Methods. A consistent, planned protoc ol involving preoperative, intraoperative, and postoperative care was followed. All thymectomies were performed through a median sternotomy with removal of all visible thymus and perithymic fat in the anterior mediastinum. Results. There was no perioperative mortality or long-ter m morbidity. Mean postoperative hospital stay was 6.3 days (range, 3 t o 18 days). Ninety-six percent of the patients were extubated the day of the operation, and all patients were extubated within 24 hours. Mea n postoperative intensive care unit stay was 1.2 days (range, 1 to 4 d ays). After a mean follow-up of 65 months (range, 1 to 199 months), 78 % of all patients are improved by at least one modified Osserman class ification when their current status is compared with their worst preop erative disease severity. In fact, 69% of patients with mild disease p reoperatively (class I, II, or III maximal severity) are in pharmacolo gic remission (asymptomatic without regular medication), whereas 29% o f patients with severe disease (class IV or V) are in remission (p = 0 .0001). Conclusions. Our programmatic approach to thymectomy through a sternotomy has shown minimal morbidity and mortality, It is beneficia l to myasthenics at both ends of the age and severity spectrum.