Surgery For Bronchiectasis Research Articles

Impact of preoperative scores on postoperative process in bronchiectasis surgery.

In this study, we aimed to investigate the relationship between bronchiectasis criteria, scores, and indices used today and surgical interventions due to bronchiectasis. Between January 2009 and December 2018, a total of 106 patients (53 males, 53 females; mean age: 39.1±12.3 years; range, 14 to 68 years) with non-cystic fibrous bronchiectasis were retrospectively analyzed. We determined symptom improvement and complications as main factors. We divided the patients into two main groups: those who had symptom improvement after pulmonary resection (Group 1, n=89) and those who did not (Group 2, n=17). We further analyzed patients who had postoperative complications (n=27) with those who did not (n=79). The following scores and criteria were used in this study: modified Reiff score, Gudbjerg criteria, Naidich criteria, Bronchiectasis Severity Index, and FACED scoring. There was a statistically significant difference between the groups in terms of the modified Reiff scores and FACED scores. As the modified Reiff score increased, there was a higher rate of symptom relief (p=0.04). Contrary to this, an increase in the FACED score predicted a poorer postoperative outcome (p=0.03). Considering complications, a significant difference was observed in the Gudjberg criteria, and higher grade suggested a higher risk of complication (p=0.02). The grading and scoring systems related to bronchiectasis may have some predictive value in terms of surgical outcomes. A high modified Reiff score and a low FACED score can predict postoperative success, whereas Gudbjerg criteria can indicate postoperative complications.

Surgical management of bronchiectasis

Background: Bronchiectasis is the permanent dilatation of the bronchi due to destruction of bronchial wall. Bronchi­ectasis still remains a serious problem in developing countries despite of modern medical facilities.Objectives: This study aims to demonstrate our surgical experience for bronchiectasis and analyze the risk factors related with the surgery outcome.Methods: Hospital based analyses of 39 patients were done who were underwent surgery for bronchiectasis and were on follow up in National Institute of Diseases of Chest hospital (NIDCH) in September 2014 to February 2015 were included in this study. All 39 patients had surgery for the bronchiectasis in the period of January 2014 to December 2014.Results: The mean age of the patients were 22.2 years. Twenty four patients were females and 15 were male. Symptoms were recurrent infection with cough, copious sputum in all patients and hemoptysis in 31 patients. The etiology was recur­rent childhood infection in 17 patients, pneumonia in 11 patients, PTB in 6 patients, Aspiration in 2 patients, foreign body obstruction in 1 patient, and unknown etiology in 2 patients. Chest x-ray, CT scan and rigid bronchoscope were done for all patients. Bronchiectasis was left-sided in 17 patients. It was mainly confined to the lower lobes either alone in 9 patients and in conjunction with middle lobe or lingual in 8 patients. Indications for resection were failure of conservative therapy in 22 patients, hemoptysis in 8 patients, destroyed lung in 9 patients. Surgery was lobectomy in 24 patients, Bilobectomy in 5 patients, and pneumonectomy in 10 patients. Complications occurred in 10 patients with no operative mortality. Thirty four patients had relief of their preoperative symptoms after surgery in follow up periods.Conclusions: Surgical resection for bronchiectasis should be reserved for patients with localised disease who have failed medical management and have persistent symptoms that negatively affect their quality of life.

Video-assisted thoracoscopic superior segmentectomy of the right lower lobe.

A 61-year-old male patient was referred to the thoracic surgery department due to repeated hemoptysis for more than one year. The computed tomography revealed a 5.2 cm × 3.1 cm mass in the right lower lobe and the nature of the mass was confirmed to be chronic inflammation by trans percutaneous lung biopsy. Bronchiectasis of the right lower lobe was considered based on the symptoms, signs, and imaging findings. Surgery for bronchiectasis is used only as part of a multimodality treatment approach. After the adequate pretreatment with a targeted antimicrobial, thoracoscopic resection of superior segment of the right lower pulmonary lobe was finally performed in the order of the superior segmental artery, the superior segmental vein, the superior segmental bronchus, and the pulmonary tissues of the superior segment. Total surgery time was 70 min and blood loss was 100 mL. The chest tube was removed on the 3(th) postoperative day. The patient was discharged home on the 8(th) postoperative day.

Video-assisted thoracoscopic superior segmentectomy of the right lower lobe

A 61-year-old male patient was referred to the thoracic surgery department due to repeated hemoptysis for more than one year. The computed tomography revealed a 5.2 cm × 3.1 cm mass in the right lower lobe and the nature of the mass was confirmed to be chronic inflammation by trans percutaneous lung biopsy. Bronchiectasis of the right lower lobe was considered based on the symptoms, signs, and imaging findings. Surgery for bronchiectasis is used only as part of a multimodality treatment approach. After the adequate pretreatment with a targeted antimicrobial, thoracoscopic resection of superior segment of the right lower pulmonary lobe was finally performed in the order of the superior segmental artery, the superior segmental vein, the superior segmental bronchus, and the pulmonary tissues of the superior segment. Total surgery time was 70 min and blood loss was 100 mL. The chest tube was removed on the 3(th) postoperative day. The patient was discharged home on the 8(th) postoperative day.

Who Needs to Be Allocated in ICU after Thoracic Surgery? An Observational Study.

Background. The effective use of ICU care after lung resections has not been completely studied. The aims of this study were to identify predictive factors for effective use of ICU admission after lung resection and to develop a risk composite measure to predict its effective use. Methods. 120 adult patients undergoing elective lung resection were enrolled in an observational prospective cohort study. Preoperative evaluation and intraoperative assessment were recorded. In the postoperative period, patients were stratified into two groups according to the effective and ineffective use of ICU. The use of ICU care was considered effective if a patient experienced one or more of the following: maintenance of controlled ventilation or reintubation; acute respiratory failure; hemodynamic instability or shock; and presence of intraoperative or postanesthesia complications. Results. Thirty patients met the criteria for effective use of ICU care. Logistic regression analysis identified three independent predictors of effective use of ICU care: surgery for bronchiectasis, pneumonectomy, and age ≥ 57 years. In the absence of any predictors the risk of effective need of ICU care was 6%. Risk increased to 25–30%, 66–71%, and 93% with the presence of one, two, or three predictors, respectively. Conclusion. ICU care is not routinely necessary for all patients undergoing lung resection.

Surgical treatment of bronchiectasis: A review of 20 years of experience

BackgroundBronchiectasis is defined as an abnormal and irreversible dilation and distortion of the bronchi, which has numerous causes. Surgical treatment of this disease is usually reserved for focal disease and when the medical treatment is no longer effective. We report our center experience and outcomes in bronchiectasis surgery during the last 20 years. MethodsBetween 1994 and 2014, sixty-nine patients underwent surgical resection for bronchiectasis. Patient demographics, presenting symptoms, indications for surgical treatment, type of lung resection, morbidity and mortality, as well as clinical follow-up and outcomes were analyzed. ResultsFrom the 69 patients included, 31 (44.9%) were male and 38 (55.1%) were female. Surgery was indicated because of unsuccessful medical therapy in 33 patients (47.8%), haemoptysis in 22 patients (31.9%), nondiagnostic lung mass in 9 patients (13.0%) and lung abscess in 5 patients (7.3%). The surgical procedures were lobectomy in 45 (65.2%) patients, pneumonectomy in 10 (14.5%) patients, bilobectomy in 8 (11.6%) patients, lobectomy plus segmentectomy in 3 (4.3%) patients and only segmentectomy in 3 (4.3%) patients. Morbidity rate was 14.5% and there was no perioperative mortality. The follow-up was possible in 60 patients, with an outcome reported as excellent in 44 (73.3%) patients, as improved in 11 (18.3%) and as unchanged in 5 (8.3%). ConclusionAlthough the number of patients with bronchiectasis referred for surgical treatment has decreased, pulmonary resection still plays a significant role. Surgical resection of localized bronchiectasis is a safe procedure with proven improvement of quality of life for the majority of patients.

Therapy of bronchiectasis

The prevalence of bronchiectasis not due to cystic fibrosis (NCFB) increases with older age. Because of multifaceted etiology of bronchiectasis an extensive diagnostic approach is essential. This includes in-depth anamnesis and a high resolution CT scan of the chest (HRCT). The pathophysiological mechanism with infection, inflammation, secretion retention and destruction determine the therapeutic options. In patients with high rates of exacerbations and severe diseases physicians should think of inhaled antibiotics and macrolids. In case of localized bronchiectasis and failure of conventional therapy surgery of bronchiectasis is an effective treatment option. In some cases surgery is necessary due to haemoptysis, aspergilloma, lung abscess and pleuraempyema. To improve the treatment options of bronchiectasis results of epidemiological, basically and clinical research trials are expected and needed.

Surgery for bronchiectasis: The effect of morphological types to prognosis

BACKGROUND:Although the incidence has declined over the past years in societies with high socioeconomic status, bronchiectasis is still an important health problem in our country.AIM:To review and present our cases undergoing surgery for bronchiectasis in the past 12 years and their early and late term postoperative outcomes and our experience in bronchiectasis surgery and the effect of morphological type on the prognosis.METHODS:The medical records of 62 cases undergoing surgical resection for bronchiectasis in the Clinics of Thoracic and Pediatric Surgery were evaluated retrospectively. The disease was on the left in 33 cases, on the right in 26 and bilateral in three cases. The most common surgical procedure was lobectomy. Forty one patients underwent pneumonectomy, lobectomy and complete resection including bilobectomy. Twenty-one (33.87%) cases underwent incomplete resection, of whom 11 (17.74%) underwent segmentectomy and 10 (16.13%) underwent lobectomy + segmentectomy.RESULTS:It was found that the rate of being asymptomatic was significantly higher in patients undergoing complete resection compared to those undergoing incomplete resection. Spirometric respiratory function tests were performed to assess the relationship between morphological type and the severity of disease. All parameters of respiratory function were worse in the saccular type and FEV1/FVC showed a worse obstructive deterioration in the saccular type compared to the tubular type.CONCLUSION:The success rate of the procedure increases with complete resection of the involved region. The morphological type is more important than the number and extension of the involved segments in showing the disease severity.

Current strategy for surgical management of bronchiectasis

Background. There are few current reports of surgical management for bronchiectasis because of its decline in prevalence, and it remains controversial as to which subgroups of patients would benefit from surgical management. Methods. We reviewed the medical records of all patients who underwent surgical resection for bronchiectasis between January 1, 1990, and December 31, 1997, at our hospital. Results. Ninety patients underwent 92 operations for bronchiectasis. The mean age was 44.7 years. The presenting symptoms were productive cough in 82 patients, fever in 47 patients, hemoptysis in 35 patients, chest pain in 6 patients, and dyspnea on effort in 4 patients. The disease was bilateral in 13 patients. Complete resection was achieved in 75 patients. There was no operative mortality, and the morbidity rate was 19.6%. Postoperatively the patients were asymptomatic in 45.6%, improved in 38.0%, and showed no improvement in 16.4%. Logistic regression extracted the type of bronchiectasis, the existence of sinusitis, and the type of resection for prognostic discrimination with statistical significance. Conclusions. Surgery for bronchiectasis can be performed with acceptable morbidity and mortality. Patients with cylindrical bronchiectasis are good surgical candidates and chronic sinusitis is a risk factor for surgical resection. Complete resection should be done whenever possible.

Application of Selective Nondependent Lung CPAP during Surgery for Bronchiectasis

Application of Selective Nondependent Lung CPAP during Surgery for Bronchiectasis

Benign oesophagobronchial fistulae

Two patients with recurrent long-standing pulmonary infection underwent surgery for bronchiectasis. At operation an oesophageal communication was observed. The oesophageal fistula was divided and lobectomy performed. Both have done well following surgery. Diagnosis and management of oesophagobronchial fistula is discussed along with a review of relevant literature.

Studies on the surgery of bronchiectasis. I. Bronchiectasis experimentally produced in dog.

With a view to elucidating the origin of bronchiectasis, four series of experiments were performed. When valvular incomplete obstruction was combined with the homolateral resection of the vagus nerve, bronchiectasis was readily produced.

Studies on the surgery of bronchiectasis. II. Histologic study of changes in the mucous membrane of bronchus.

Studies on the surgery of bronchiectasis. II. Histologic study of changes in the mucous membrane of bronchus.

Trends in the Use of Antibiotics in Thoracic Surgery

Antibiotics have revolutionized thoracic surgery. As yet streptomycin and penicillin far outweigh the other antibiotics in their value to the thoracic surgeon. Because resistance to streptomycin develops rapidly and is permanent, this antibiotic should not be used indiscriminately, but should be restricted to specific indications. The use of streptomycin as an adjunct in tuberculosis surgery has extended operative indications, and has made possible safer and more effective pulmonary resection, decortication, cavernostomy, closure of tuberculous sinuses, and pericardectomy. The administration of 1 gram a day, in one or two doses, is recommended for periods of six weeks on less. In the light of present knowledge the use of streptomycin would not seem justified in routine thoracoplasty, inasmuch as complications are already minimal. Its use is rarely justified in other forms of collapse therapy. Penicillin has proved of particular value in the surgery of bronchiectasis and lung abscess, in thoracic trauma, in exploration for intrathoracic tumors, in esophageal surgery, and in surgery of the heart and great vessels. The present trend is toward larger doses of penicillin, with penicillin G potassium the preparation of choice in active infection. In surgery, repository and aerosol penicillin are primarily applicable in prophylaxis.