BILATERAL PNEUMECTOMY (VOLUME REDUCTION) FOR CHRONIC OBSTRUCTIVE PULMONARY-DISEASE

We undertook surgical bilateral lung volume reduction in 20 patients w ith severe chronic obstructive pulmonary disease to relieve thoracic d istention and improve respiratory mechanics. The operation, done throu gh median sternotomy, involves excision of 20% to 30% of the volume of each lung. The most affected portions are excised with the use of a l inear stapling device fitted with strips of bovine pericardium attache d to both the anvil and the cartridge to buttress the staple lines and eliminate air leakage through the staple holes. Preoperative and post operative assessment of results has included grading of dyspnea and qu ality of life, exercise performance, and objective measurements of lun g function by spirometry and plethysmography. There has been no early or late mortality and no requirement for immediate postoperative venti latory assistance. Follow-up ranges from 1 to 15 months (mean 6.4 mont hs). The mean forced expiratory volume in 1 second has improved by 82% and the reduction in total lung capacity, residual volume, and trappe d gas has been highly significant. These changes have been associated with marked relief of dyspnea and improvement in exercise tolerance an d quality of life. Although the follow-up period is short, these preli minary results suggest that bilateral surgical volume reduction may be of significant value for selected patients with severe chronic obstru ctive pulmonary disease.