Surgical treatment of bronchiectasis

Abstract

The role of surgery for the treatment of the localised form of bronchiectasis has changed with the development of more effective antibiotics and conservative treatment options, such as embolisation or effective novel anti-inflammatory treatment approaches in subjects with cystic fibrosis (CF) and non-CF bronchiectasis, as suggested recently. However, surgery is the only option for a potential cure for certain patients with bronchiectasis. Complete resection of bronchiectasis should be intended with the preservation of as much lung function as possible. Incomplete resection is often used for the palliative treatment of life-threatening symptoms, e.g. major haemoptysis. The usual clinical problems in patients undergoing surgery for bronchiectasis are bilateral bronchiectasis, haemoptysis and previous pleural empyema. The outcome for surgical treatment is good, with a low operative mortality and morbidity rate; however, higher than reported for non-infectious pathology. Complications of surgery usually range between 10% and 25% and largely consist of a prolonged air leak, bleeding, empyema and/or respiratory failure. In most series, lobectomy is the commonest type of resection with a rate of approximately 60%. Video-assisted thoracoscopic surgery for pulmonary resection has become an established alternative approach to conventional open surgery for selected patients. The educational aim of this chapter is to provide a comprehensive overview of the possible solutions to the most frequent practical problems encountered by patients who have a localised form of bronchiectasis and are being considered for surgical treatment. © ERS 2013.