Chronic obstructive pulmonary disease surgery
|
Chronic obstructive pulmonary disease Microchapters |
|
Differentiating Chronic obstructive pulmonary disease from other Diseases |
|---|
|
Diagnosis |
|
Treatment |
|
Case Studies |
|
Chronic obstructive pulmonary disease surgery On the Web |
|
American Roentgen Ray Society Images of Chronic obstructive pulmonary disease surgery |
|
Directions to Hospitals Treating Chronic obstructive pulmonary disease |
|
Risk calculators and risk factors for Chronic obstructive pulmonary disease surgery |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editors-In-Chief: Cafer Zorkun, M.D., Ph.D. [2], Priyamvada Singh, MBBS [3]
Overview
Patients with emphysema may have big bullae ranging from 1-4 cm and may occupy 1/3rd of lung space. These bullae can cause compromise to vetilation and perfusion. Bullaectomy is the surgical removal of these bullae. It is commonly done in patients with FEV1 < 50% of predicted and who are symptomatic. Bullaectomy helps in re-expansion of the lung tissue.
Surgery
Bullaectomy
- The giant bullae (1-4 cm, giant bullae may occupy 1/3rd of lung tissue) seen in patients of emphysema can compress the surrounding lung tissues and cause compromised ventilation and blood flow to unaffected lung.
- Bullectomy is the process of removing these bullae and can help these patients as it causes expansion of the compressed lung
- Patients who are symptomatic and have an FEV1 of less than 50% of the predicted value have a better outcome after bullectomy.
- Postoperative bronchopleural air leak is the major complication.
Resectional surgery
- The ICSI 2011 COPD guidelines state that lung reduction surgery may be an option for patients with severe symptoms that are not responding to maximal medical therapy.
- Surgeons generally resect 20-30% of each lung from the upper zones.
- The surgery can be considered in heterogeneous (upper lobe) disease, low exercise capacity despite optimal medical therapy and cardiopulmonary rehabilitation. It should be avoided in (high risk group). Patients with an FEV1 of less than 20% of predicted and either homogenous disease or DLCO (diffusing capacity of lung for carbon monoxide) of less than 20% of predicted)
- Several studies have demonstrated significant benefit in spirometry, exercise tolerance, dyspnea, health-related quality of life, and mortality in selected group of patients.
- Complications
- Mortality ranges somewhere between 0-18%
- Pneumonia
- Prolonged air leaks