Bullectomy for giant bullae in emphysema

Laros, C.D.; Gelissen, H.J.; Bergstein, P.G.M.; Bosch, Jules M.M. van den; Vanderschueren, R. G. J. R. A.; Westermann, C. J. J.; Knaepen, Paul J.

doi:10.1016/s0022-5223(19)38482-x

Cited by 90 publications

(27 citation statements)

References 11 publications

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“…Laros et al noted a mean age of 56 years in those patients who died of respiratory insufficiency after bullectomy compared with those who exhibited favorable long-term responses (mean age < 50 years). 56 Similar results were published by Fitzgerald and colleagues. 55 Some investigative groups have suggested a higher morbidity and worse long-term results in the presence of superimposed chronic bronchitis.…”

Section: Clinical Featuressupporting

confidence: 84%

“…Bullectomy Bullectomy appears to be of short-term benefit in highly selected patients. [54][55][56][57][58][59][60] Snider provided an elegant review of case series published from 1950 to the early 1990s. 61 None of the 22 studies included a control group and the majority were retrospective in nature, such that firm conclusions were difficult to reach.…”

Section: What Are the Short-term Results Of Surgery?mentioning

confidence: 99%

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Surgical Therapy for Chronic Obstructive Pulmonary Disease

Martínez

Chang

2005

Seminars in Respiratory and Critical Care Medicine

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Many patients with severe chronic obstructive pulmonary disease (COPD) experience incapacitating breathlessness and exercise limitation. Multiple surgical techniques have been utilized to achieve resection of giant, localized bullae with documented short-term benefit in pulmonary function and dyspnea in highly selected patients. The poorest long-term outcome has been noted in those with greater degrees of emphysema in the remaining lung, greater underlying chronic bronchitis, and a bulla occupying less than one third of the hemithorax, particularly if compressed normal lung is not evident. Lung volume reduction surgery (LVRS) in the absence of giant bullae has become more widely accepted in selected patients. Bilateral LVRS procedures appear to result in greater short-term improvement than unilateral LVRS, whereas physiological benefits appear similar with video-assisted thoracoscopy (VATS) or median sternotomy (MS) techniques. Improvement in dyspnea and health status after LVRS has been documented and appears to be better preserved over longer-term follow-up than physiological improvement. Clear direction has been provided in identifying optimal candidates for bilateral LVRS; patients with a postbronchodilator forced expiratory volume in 1 second (FEV (1)) < or = 20% predicted and a diffusing capacity for carbon monoxide (DL (CO)) < or = 20% predicted or homogeneous emphysema exhibit a much higher mortality with LVRS than with medical management. Patients with upper-lobe predominant emphysema and a low postrehabilitation exercise tolerance exhibited a decreased risk of mortality after LVRS. Patients with non-upper lobe predominant emphysema on high-resolution computed tomography (HRCT) and a high postrehabilitation exercise capacity exhibit an increased risk of death after LVRS. Patients with upper lobe predominant emphysema and a high postrehabilitation exercise capacity or patients with non-upper lobe predominant emphysema and a low postrehabilitation exercise capacity do not have a survival advantage or disadvantage, whereas those with upper lobe predominant emphysema treated surgically are more likely to improve their exercise capacity after surgery. Lung transplantation is an option for a more limited number of patients. Consistent short-term spirometric improvement after both single- and double-lung transplant has been documented. Long-term results of lung transplantation are limited by significant complications that impair survival; an approximately 80% 1-year, 50% 5-year, and 35% 10-year survival has been reported. Bronchiolitis obliterans is the most important long-term complication of lung transplantation resulting in decreased pulmonary function. In general, a COPD patient can be considered an appropriate candidate for transplantation when the FEV (1) is below 25% predicted and/or the paCO (2) is > or = 55 mm Hg.

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Section: Clinical Featuressupporting

confidence: 84%

Section: What Are the Short-term Results Of Surgery?mentioning

confidence: 99%

Surgical Therapy for Chronic Obstructive Pulmonary Disease

Martínez

Chang

2005

Seminars in Respiratory and Critical Care Medicine

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“…The procedure is most successful where there are very large cysts compressing adjacent apparently normal lung 63 . ‐ 65 …”

Section: Surgerymentioning

confidence: 99%

The COPDX Plan: Australian and New Zealand Guidelines for the management of Chronic Obstructive Pulmonary Disease 2003

McKenzie

Frith

2003

Medical Journal of Australia

155

221

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“…The association of emphysema with large bullae is a well defined clinical entitiy. The surgical treatment strategy and patient selection which is consisted of increasing bullae size, compressing to the normal lung, pneumothorax, pulmonary insufficiency, and infection within the bulla are comprehencively discussed in the literature (1,2). However, the type I giant bullae without existing of emphysema was not discussed in the literature up till now.…”

Section: Discussionmentioning

confidence: 99%

A Giant Bullae Manifesting as Left Pulmonary Arteria Hypoplasia

Kavakli¹,

Tasci²,

Çaylak³

et al. 2014

Gulhane Med J

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Bir hemitoraks hacminin yarısından fazlasını kaplayan büller dev bül olarak tanımlanır. Genellikle ilerleyici bir nefes darlığı olan bu hastalarda altta yatan akciğer parankiminde amfizematöz değişikliklerin olup olmadığı önemlidir. Biz de bu çalışmada, radyolojik olarak sol pulmoner arter hipoplazisini taklit eden dev tip 1 bülü olan bir olguyu sunmayı amaçladık. Hastaya sol torakotomi aracılığı ile bül rezeksiyonu uygulandı ve postoperatif dönemde sağlam parankimin uzun süreli basısına bağlı olarak reekspansiyon pulmoner ödem komplikasyonu gelişti. Hasta sorunsuz olarak taburcu edildi. Cerrahiden iki ay sonra solunum fonksiyon testlerinde mükemmel bir düzelme saptandı.

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Bullectomy for giant bullae in emphysema

Cited by 90 publications

References 11 publications

Surgical Therapy for Chronic Obstructive Pulmonary Disease

Surgical Therapy for Chronic Obstructive Pulmonary Disease

The COPDX Plan: Australian and New Zealand Guidelines for the management of Chronic Obstructive Pulmonary Disease 2003

A Giant Bullae Manifesting as Left Pulmonary Arteria Hypoplasia

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