[Lung volume reduction surgery in treatment of diffusion pulmonary emphisema in case of chronic obstructive pulmonary disease].

Lung volume reduction surgery (LVRS) has become a palliative surgical method for selected patients with advanced pulmonary emphysema and disabilitating dyspnea The beneficial effects have been documented by numerous case series and by several randomized controlled trials. In well-selected patients the perioperative mortality does not exceed more than 5% in experienced centers and the expected improvement in FEV1 is a range of 30-60% at 3 to 6 months. Thereafter the lung function steadily declines, but the effect lasts for up to 4 to 6 years. Different approaches and surgical techniques are carried out, and most of the authors recommend bilateral lung volume reduction by video-assisted thoracic surgery. This therapeutic option was used alternatively in patients who were suitable candidates for lung transplantation, and several groups could demonstrate that transplantation could be postponed by 2 to 4 years after bilateral LVRS. The procedure itself does not jeopardize the chances for subsequent successful transplantation.

[Pleural tent after high partial lung resection--prospective randomised research]. / Plevralna palatka sled gorni chastichni belodrobni rezektsii -- prospektivno randomizirano prouchvane.

OBJECTIVE: The aim of this study is to assess the role of the pleural tent in prophylactics of prolonged alveolar air leakage and apical residual pleural cavity formation after upper lobectomy/bilobectomy. METHODS: A total of 40 patients, who underwent upper lobectomy/bilobectomy were prospectively randomized into two homogeneous groups: (1) with pleural tent--20 pts and (2) control group without pleural tent--20 pts. The multivariate analyses were used to compare the chest tubes duration, the length of the hospital stay, the mean quantity of postoperative extravasation and the need of additional interventions to treat the persistent postoperative alveolar leak. RESULTS: No differences were detected between the two groups in terms of preoperative and operative characteristics. No 30-day operative death was faced. A significant reduction (p=0.001) of the number of days the chest tubes were required (7.7 days vs 12.38 days) and the length of the postoperative in-hospital stay (9.7 days vs 13.75 days) was found in pleural tent group compared to control group. The mean quantity of postoperative extravasation in pleural tent group was less compared to control group (1553 ml vs 1722 ml) without statistical significance (p=0.5485). Asymptomatic residual apical pleural cavities were found in 1 patient of pleural tent group and 2 patients of control group. In other 3 patients of the latter group an additional tube drainage was required to treat a residual apical cavity. CONCLUSIONS: Pleural tenting after upper lobectomy/bilobectomy reduces significantly the duration of the intrapleural drainages and the length of the in-hospital stay. It is simple, safe and effective additional method in the prophylactics of persistent alveolar air leakage and apical residual pleural cavity formation.

[Operative procedure for treatment of large and oversize cysts with interlobar location in pulmonary hydatid disease]. / Operativen metod za lechenie na golemi i ogromni kisti s interlobarna lokalizatsiia pri belodrobnata ekhinokokoza.

A procedure for treating large and oversize cysts with interlobar location, consisting in supplementary post-echinococcotomy draining of the respective interlobar groove using No. 18-20 catheter, is developed. It allows for maximal unfolding of the adjoining parenchyma, adherence of the fibrous capsule walls without any risk of a residual cavity formation. The procedure is successfully used in thirteen patients at average postoperative hospitalization 13.4 days. Both the early and long-term results are estimated as very good.

[Methods for aerostasis in pulmonary surgery]. / Metodi za aerostaza v belodrobnata khirurgiia.

Insufficient intraopertive aerostasis is a serious, actual, and yet unsolved problem of pulmonary surgery. It is a frequent cause for the development of postoperative complications that compromise the results of surgery. The authors investigate the development and modification of the contemporary surgical methods for aerostasis--surgical techniques for suturing the lung parenchyma, additional methods for buttressing and hermetization of the suture line, parietal pleurectomy, tissue glues, and fibrine adhesives. The advantages and disadvantages of the different methods for aerostasis are analyzed and their rationality and efficacy in various surgical conditions are discussed.