Role of physiological lung exclusion in difficult lung resections for massive hemoptysis and other problems

Objectives: Pulmonary tuberculosis and bronchiectasis are the major causes of massive hemoptysis in developing countries. Lung resection remains the s urgical treatment of choice. This may not always be possible and may even b e hazardous in some patients due to fibrosis and dense vascular adhesions b etween the lung and the chest wall. This leads to marked blood loss and con trol of hilar vessels becomes dangerous. Methods: A series of 20 cases is d escribed here. Nineteen presented with massive hemoptysis where control of bleeding was obtained by physiological lung exclusion. One patient had trau matic left main bronchus transection not suitable for repair or resection. Physiological lung exclusion was performed by surgical interruption of the bronchus and pulmonary artery of the involved lobe or lung, keeping pulmona ry veins intact. Results: Hemoptysis could be controlled in all these patie nts without any significant morbidity. There was no mortality. There was no postoperative empyema and recurrence of hemoptysis on long-term follow-up. No patient required anatomical lung resection Inter on. Conclusions: Physi ological lung exclusion is a safe and effective method for control of massi ve hemoptysis in casts where lung resection is technically hazardous or dif ficult. This should be kept as an alternative or adjunct to anatomical lung resection. (C) 2001 Elsevier Science B.V. All rights reserved.