Treatment by VATS of giant bullous emphysema: results

Abstract

Objective: In selected patients with giant bullous emphysema GBE and in those with specific complications, surgery may be the treatment of choice. Methods: In the period January 1993 -February 1996 we performed 34 VATS treatments in 29 patients affected by GBE. There were 22 (76%) males and 7 (24%) females, with a mean age of 54 years (range 24 -74). In 23 cases, a pneumothorax (PNX) was present at admission, while 6 patients were treated by choice. Altogether, we performed 23 resections of sessile bullae (type 2 of Reid) by using a linear endoscopic stapling device (Endo-path 35 and 45 mm) and 11 ligatures of pedicled bullae (type 1 of Reid) by loop (Endo-loop 'PDS'). The mean number of charges for every treatment was 8 (range 4-21). The largest bullae were perforated and deprived of incarcerated air. They were then twisted on the axis perpendicular to the base in order to improve the manoeuvrability of the lesion and favour the correct placement of the Endo-path or Endo-loop. GBE was bilateral in 7 cases: one of these was treated bilaterally in the same surgical stage, other 4 were treated by staged operations. Results: We experienced two conversions to open thoracotomy (one sessile giant bulla inside the fissura; 1 case of strong tuberculous pleural adhesions). Two patients, underwent a second operation by open thoracotomy because of a prolonged air leak. We have two peri-operative deaths, both to respiratory failure. Altogether, in 23 out of 29 (79%) cases VATS was effective and the mean hospital stay was 6 days (range 3-16). At a mean follow up of 16 months (range 1 -36) no recurrence of PNX was observed. Conclusions: VATS may be considered as a suitable surgical technique to approach GBE and, in most cases, it is effective.

Intraoperative, Postoperative and Long-Term Complications of VATS Treatment of Pneumothorax and Bullous Disease. A Review

“…To resect blebs or bullae and to achieve pleurodesis several techniques have been described. The majority of the surgeons prefers endoscopic staplers to remove bullous parenchyma, but also endoscopic suturing [11,12], endoloop ligation [2,[11][12][13][14] and cautery [15][16][17][18] have been employed. Talc poudrage [19][20][21], pleural abrasion [15,[22][23][24][25], pleural argon beam coagulation [26] and partial pleurectomy [18,[27][28][29][30][31] are commonly performed to achieve pleurodesis.…”

“…When the adhesions are extensive or very thick, proceeding by VATS is very tough and therefore open surgery is more expedient. Few authors [14,35] report an initial thoracosopic approach to treat sessile large bullae, but they are usually obliged to convert it for a complete resection. There are no significant correlations between the type of pleurodesis performed and the conversion rate to thoracotomy: talc poudrage, abrasion or partial pleurectomy do not affect a potential intraoperative change of approach.…”

“…In the postoperative course there are some sporadic cases of death [14,17,34]: they were not consequences of VATS technique, but they were directly correlated to the poor preoperative conditions of the patients. The mean hospital stay ranges between 2.4-7.7 days and the morbidity rate ranges from 0 to 27.4% ( Table 1).…”

“…Re-operation has also been reported in cases of persistent air leak or early pneumothorax recurrence [14,15,17,24,26,28,30,34,36]. In secondary pneumothorax the failure of VATS is due to an incomplete suture of the endostapler or a poor pleurodesis.…”

Vanishing Lung Syndrome: A Brief Report

“…In the last decade the application of VATS bullectomy with endoscopic staple resection is considered as a suitable and safe treatment of choice [10].…”