Giant bullous emphysema resection by VATS. Analysis of laser and stapler techniques.

OBJECTIVE Advances in video-assisted thoracic surgical (VATS) technique led the authors to reconsider the treatment and thoracoscopic management of patients with giant bullous emphysema (GBE). METHODS From January 1993 to December 2001 we treated 40 patients with unilateral GBE: 24 males and 16 females, mean age 51+/-1 years. Thirty patients presented respiratory insufficiency, seven patients a spontaneous pneumothorax and three patients a bullae infection. Excision was performed by using Nd:YAG laser in five patients (12.5%) and stapling device in 35 patients (87.5%). Among the last 35, in 20 patients a partial pleurectomy stripping up to the 5th intercostal space was associated. In 15 patients this technique was modified through the systematic application of polytetrafluoroethylene (PTFE) to reinforce stitches. RESULTS We experienced one conversion to open thoracotomy owing to haemorrhaging, in one patient who underwent a partial pleurectomy stripping. In the stapler resection patients, with PTFE application, the mean duration of air leaks, for type 1 bullae of Wakabayashi was 2.2+/-1.8 days and, for type 4, 5.9+/-1.4 days; the mean length of hospital stay was 6.1+/-0.5 days. CONCLUSIONS The resection in VATS of giant bullous emphysema by stapling device associated to reinforcement in PTFE reduces duration of air leaks and hospitalisation and improves pulmonary function.