PURPOSE: Surgery is often required in cases of bullous empyhsema because empyhsema is one of the most prevalent disabling disease, not modified by current medical treatment and physical rehabilitation. Bullectomy represents a surgical option to improve symptoms and exercise tolerance in selected patients. The aim of this report is to investigate and to analyze the results of two different surgical treatment and identify clinical predictor of poor outcome.
METHODS: We performed a case control study to compare and analyze two groups of patients with bullous empyhsema who underwent standard bullectomy with staple line reinforcement in association with bovine pericardium (group I) and bullectomy in association with use of synthetic sealant (Coseal –Baxter) employed for reinforcement (group II). Over the last 4 years 60 patients with severe bullous empyhsema underwent thoracotomic bullectomy. During the same period of time 30 patients underwent standard bullectomy and 30 patients underwent bullectomy in association with synthetic sealant. Both groups were homogeneous in terms of age, degree of respiratory derangement and severity of bullous empysema. In all cases we executed an open surgical approach.
RESULTS: All procedures were accomplished successfully. The operating time ranged from 45 to 180 minutes (in cases we performed a decortication). There was six patients that neeeded blood transfusion in the first group ed three patients in the second group. Improvement in symptoms, respiratory function and exercise tolerance was comparable. Lung-related postoperative complication and peri-operative data (air leaks duration, drain time, in-hospital stay) were less in the group with bullectomy associated with use of synthetic sealant.
CONCLUSION: Our experience supports that both surgical methods are tecnically feasible and safety performed. However, in the group treated with synthetic sealant, we observed significant advantages in terms of reduction of air leaks, drain time and in-hospital stay after pulmonary wedge resection. The use of synthetic sealant can improve aerostasis control in bullectomy with high risk of air leak.
CLINICAL IMPLICATIONS: The prevalent risk of air leaks for surgical bullectomy is significant.
DISCLOSURE: Pierpaolo Bregamassone, No Financial Disclosure Information; No Product/Research Disclosure Information