Functional surgery of bullous emphysema

Area of Science:

• Thoracic Surgery
• Pulmonary Medicine
• Critical Care Medicine

Background:

• Chronic Obstructive Lung Disease (COLD) is a progressive condition often characterized by emphysematous changes.
• Surgical intervention for emphysematous bullae aims to improve lung function and quality of life.

Purpose of the Study:

• To evaluate the efficacy of surgical resection of emphysematous bullae in patients with COLD.
• To assess the impact of surgery on pulmonary function, physical work capacity, and hemodynamics.

Main Methods:

• Resection of emphysematous bullae in 27 COLD patients using various techniques including clamp resection, Nissen plication, homologous dura plasty, and pericardial plasty.
• Preoperative and postoperative pulmonary function tests (VC, RV, IGV, Raw, FEV1) were compared in 19 patients.
• Hemodynamic parameters, including pulmonary artery pressure, were monitored.

Main Results:

• Seventeen out of 27 patients showed functional improvement post-surgery, with more pronounced benefits in those with lower preoperative lung function.
• Physical work capacity increased in 16 patients.
• Pulmonary circulation hemodynamics improved in all patients with elevated preoperative pulmonary artery pressure.
• Mortality rate was 4% (1 patient).

Conclusions:

• Surgical resection of emphysematous bullae can lead to significant functional improvement in patients with COLD.
• The study advocates for considering extended criteria for surgical operability based on observed functional improvements.
• While FEV1 showed limited improvement, especially in older patients, the overall benefits suggest a valuable therapeutic option.