AN ALTERNATIVE TECHNIQUE IN THE MANAGEMENT OF BULLOUS EMPHYSEMA - THORACOSCOPIC ENDOLOOP LIGATION OF BULLAE

Study objectives: With the improvements in video-assisted thoracoscopi c surgery, more older patients and patients with respiratory impairmen ts are undergoing bulla ablation using new and costly technology. We e valuated the cost-effective technique of thoracoscopic endoloop ligati on of bullae in patients with bullous emphysema. Patients: From March 1992 through January 1996, 79 advanced age (mean age, 64 years) and ox ygen dependency patients underwent thoracoscopic procedure using endol oop ligation for treatment of bullous emphysema. Clinical data were co llected from chart review. Only patients with radiographically confirm ed diagnosis of bullous emphysema were included in this evaluation. Th oracoscopic endoloop ligation of bulla was carried out under general a nesthesia with double-lumen endotracheal tube and single-lung ventilat ion. Results: Sixty-five patients (82%) exhibited subjective improveme nt 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 dyspn ea scale. The mean duration of chest drainage was 6 days (range, 4 to 16 days). Average hospital stay was 9.5 days (range, 5 to 26 days). Th ere was no postoperative death. A comparison of preoperative and posto perative functional evaluation was available in only 16 patients who s howed an increase in FEV(1) (from 0.85 to 1.02 L) and a decline in res idual volume after operation. Complications include persistent airleak over 10 days in seven patients (8.9%), wound infection in three patie nts, and localized empyema in two patients. There was no recurrence af ter a mean follow-up of 21 months. Conclusion: These encouraging resul ts have shown that thoracoscopic endoloop ligation of bulla has proved to be a safe, reliable, and cost-effective technique for bullous emph ysema, With careful preoperative evaluation and meticulous postoperati ve care, many patients could be rehabilitated by endoloop litigation o f the bullae.