Emphysema surgery--loop ligation approach.
OBJECTIVE
To demonstrate the efficacy of using thoracoscopic endoloop ligation of bullae in patients with bullous emphysema.


METHODS
From 1992 to 1997, 93 advanced age (mean age, 66 years) and oxygen dependency patients underwent thoracoscopic procedure using endoloop ligation for treatment of bullous emphysema. Clinical data were collected from chart review. Thoracoscopic loop ligation of bulla was carried out under general anesthesia with double lumen endotracheal tube and single lung ventilation.


RESULTS
Eighty-two patients (88%) exhibited subjective improvement in their symptom status at 3-month follow-up (from grade 2 or 3 to grade 1 or 2) according to the modified Medical Research Council dyspnea scale. The mean duration of chest drainage was 7.5 days (range, 4-19 days). Average hospital stay was 9.5 (range, 5-26) days. There was no post-operative death. A comparison of pre-operative and post-operative functional evaluation was available in 27 patients who showed an average increase in FEV1 (from 0.89 to 1.12 l) and declined in residual volume after operation. Complications include persistent airleak over 10 days in nine patients (9.7%), wound infection in three patients and localized empyema in five patients. There was no recurrent after a mean follow-up of 37 months.


CONCLUSIONS
Thoracoscopic loop ligation of bulla has proven to be a safe, reliable and cost effective means of technique for bullous emphysema.
Liu
H P
HP
Department of Anesthesiology, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan.
Chang
C H
CH
Lin
P J
PJ
Cheng
K S
KS
Wu
Y C
YC
Liu
Y H
YH
D000368:Aged; D003365:Costs and Cost Analysis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008026:Ligation / Q000379:methods; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000379:methods; D011656:Pulmonary Emphysema / Q000175:diagnosis / Q000601:surgery*; D012720:Severity of Illness Index; D020775:Thoracic Surgery, Video-Assisted / Q000191:economics / Q000379:methods*; D016896:Treatment Outcome