Increasingly effective antibiotics have diminished the need for surgical therapy for bronchiectasis. However, drug resistant strains have lessened the impact of antibiotics. Further, rural patients may present with more advanced disease, either because of increased allergen exposure or lesser medical availability. We evaluated our experience with thoracoscopic surgical therapy for bronchiectasis in a predominantly rural community.
Patients with radiologic evidence of bronchiectasis, recurrent pneumonia, and antibiotic resistant organisms underwent thoracoscopic resection. Data were analyzed for typical demographic features, type of surgery and length of stay, and need for subsequent hospitalization. Patients were considered to have died from surgery if they died during the hospitalization for the surgery, or within 90 days of surgery.
Eighteen patients (27–77 years of age), underwent nineteen resections. Three patients had FEV1% < 35% predicted-the average was 60%. Nine underwent segmentectomy and eight lobectomy (one patient underwent two lobectomies). Eleven (58%) underwent thoracoscopic resection. The length of stay was 7.2 days. No patients required intubation nor ICU stay. There was no mortality. While two patients required long-term antibiotics after surgery to clear bronchitis, only one patient (with severe emphysema) required inpatient admission.
Improved antibiotics have decreased the incidence of bronchiectasis and other chronic airway infections. However, surgical therapy for bronchiectasis is still necessary for patients with resistant infections. This surgery can often be done thoracoscopically, with little risk, and decreases the need for inpatient hospitalization.
Patients with recurrent bronchitis and evidence of brconchiectasis should be considered for thoracoscopic resection.
J.R. Roberts, None.