LUNG-VOLUME REDUCTION SURGERY FOR EMPHYSEMA - A REVIEW

Lung volume reduction surgery is emerging as a promising treatment opt ion for selected patients with severe, debilitating end-stage emphysem a refractory to medical management. Lung volume reduction surgery invo lves the removal of space occupying severely diseased, slowly ventilat ing and hyperexpanded lung, thus allowing the better conserved adjoini ng lung parenchyma to expand into the vacated space and function effec tively, The operation can be accomplished by unilateral or bilateral t horacoscopy, thoracotomy or median sternotomy, The most emphysematous areas are excised using stapling or laser techniques or both. This rev iew summarises the results of lung volume reduction surgery performed by various operative techniques. Results indicate that in the majority of patients improvement occurs in subjective dyspnoea and objective p ulmonary function while oxygen and steroid dependence are reduced or e liminated at the cost of acceptable mortality and morbidity, Even thou gh bilateral procedures produced much greater improvement, it is empha sized that it is the lung resection and not the operative approach tha t is critical to the success of the operation. Regardless of the techn ique used, the surgical treatment of emphysema is palliative in nature .