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EJTC: Giant bullous emphysema resection by VATS. Analysis of laser and stapler techniques

Duilio Divisi*, Carmelo Battaglia, William Di Francescantonio, Guido Torresini, Roberto Crisci
Department of Thoracic Surgery, University of L'Aquila – ‘G. Mazzini’ Hospital, Hospital of Teramo, Circonvallazione Ragusa 39, 64100 Teramo, Italy

Received 23 May 2002; received in revised form 21 July 2002; accepted 30 July 2002.

* Corresponding author. Tel.: +39-861-241-518; fax: +39-861-211-626
e-mail: duiliodivisi@virgilio.it

Objective:

Advances in video-assisted thoracic surgical (VATS) technique led the authors to reconsider the treatment and thoracoscopic management of patients with giant bullous emphysema (GBE).

Methods:

From January 1993 to December 2001 we treated 40 patients with unilateral GBE: 24 males and 16 females, mean age 511 years. Thirty patients presented respiratory insufficiency, seven patients a spontaneous pneumothorax and three patients a bullae infection. Excision was performed by using Nd:YAG laser in five patients (12.5%) and stapling device in 35 patients (87.5%). Among the last 35, in 20 patients a partial pleurectomy stripping up to the 5th intercostal space was associated. In 15 patients this technique was modified through the systematic application of polytetrafluoroethylene (PTFE) to reinforce stitches.

Results:

We experienced one conversion to open thoracotomy owing to haemorrhaging, in one patient who underwent a partial pleurectomy stripping. In the stapler resection patients, with PTFE application, the mean duration of air leaks, for type 1 bullae of Wakabayashi was 2.21.8 days and, for type 4, 5.91.4 days; the mean length of hospital stay was 6.10.5 days.

Conclusions:

The resection in VATS of giant bullous emphysema by stapling device associated to reinforcement in PTFE reduces duration of air leaks and hospitalisation and improves pulmonary function.