Lung volume reduction surgery by bilateral bullectomy through median sternotomy

ABSTRACT

Emphysematous bullae represent a form of emphysematous lung destruction. Surgical resection has traditionally been indicated when there is hyperexpansion of the chest, compromised pulmonary function, and evidence of underlying, relatively normal compressed lung. Different approaches to LVRS have been proposed; these include median sternotomy, thoracosternotomy and video-assisted thoracoscopic surgery [VATS] technique. Nine patients underwent resection of emphysematous bullae at Kasr Elaini hospital between February 2006 and July 2007. All had limiting dyspnea and radiological evidence of hyperinflated bullae compressing adjacent lung parenchyma. All the patients had bilateral lesions. We did median sternotomy, with one-lung ventilation under a standard general anesthetic technique to avoid rupture of bulla, in all patients to do resections bilaterally in the same sitting. Intraoperative complications included arrhythmia in 2 casesm hypoxia in 3 patients and uncontrolled air leak in all patients but with no cases of cardiac arrest or hyperinflation leading to rupture bulla prior to chest opening. Postoperative complications included persistent air-leak, failure of early extubation, readmission to ICU and chest infection. We had two mortalities one due to ARDS and the other due to chest infection. In conclusion we recommend the use of this approach in highly selected patients as it is only subject the patient for one procedure instead of two and we can avoid the possibility of spontaneous pnemothorax on the contralateral side, while doing bulletomy in lateral position through thoracotomy. The described surgical and anesthetic technique in our experience case series showed acceptable outcome compared to the literature and with adequate exposure and accessibility