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. 1988 Dec;43(12):998–1002. doi: 10.1136/thx.43.12.998

Intracavity drainage for bullous, emphysematous lung disease: experience with the Brompton technique.

G E Venn 1, P R Williams 1, P Goldstraw 1
PMCID: PMC461614  PMID: 3238643

Abstract

Twenty two operations have been performed on 20 patients for the relief of symptoms due to bullous lung disease. Open intubation drainage of the bullae was used in all patients, the technique initially devised by Monaldi for the treatment of intrapulmonary tuberculous abscesses having been modified. Three patients died after surgery. Mortality was associated with low preoperative FEV1 (median 350 ml) and higher preoperative arterial carbon dioxide tension (PaCO2) (median 7.8 kPa). Symptomatic improvement was reported by 16 of the remaining 17 patients and was maintained over a median follow up period of 1.6 years. This was accompanied by objective improvement in lung function with a 22% median improvement in FEV1, an 11% median reduction in total lung capacity, and a 26% median reduction in residual volume. In one patient symptoms were unchanged after surgery. The technique described provides a simple method for decompressing bullae by means of a minimally invasive surgical procedure. It also allows for the treatment of further bullae at a later date by closed intubation under local anaesthetic. It has proved a suitable approach for all but those with the poorest lung function and is now our treatment of choice.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. FitzGerald M. X., Keelan P. J., Cugell D. W., Gaensler E. A. Long-term results of surgery for bullous emphysema. J Thorac Cardiovasc Surg. 1974 Oct;68(4):566–587. [PubMed] [Google Scholar]
  2. HEAD J. M., HEAD L. R., HUDSON T. R., HEAD J. R. The surgical treatment of emphysematous blebs and localized vesicular and bullous emphysema. Analysis of 50 cases. J Thorac Cardiovasc Surg. 1960 Oct;40:443–460. [PubMed] [Google Scholar]
  3. HEAD J. R., AVERY E. E. Intracavitary suction (Monaldi) in the treatment of emphysematous bullae and blebs. J Thorac Surg. 1949 Dec;18(6):761-76, illust; Disc, 798-803. [PubMed] [Google Scholar]
  4. Hugh-Jones P., Ritchie B. C., Dollery C. T. Surgical treatment of emphysema. Br Med J. 1966 May 7;1(5496):1133–1138. doi: 10.1136/bmj.1.5496.1133. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. KNUDSON R. J., GAENSLER E. A. SURGERY FOR EMPHYSEMA. Ann Thorac Surg. 1965 May;1:332–362. doi: 10.1016/s0003-4975(10)66764-1. [DOI] [PubMed] [Google Scholar]
  6. MONALDI V. Endocavitary aspiration in the treatment of lung abscess. Dis Chest. 1956 Feb;29(2):193–201. doi: 10.1378/chest.29.2.193. [DOI] [PubMed] [Google Scholar]
  7. Macarthur A. M., Fountain S. W. Intracavity suction and drainage in the treatment of emphysematous bullae. Thorax. 1977 Dec;32(6):668–672. doi: 10.1136/thx.32.6.668. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Parmar J. M., Hubbard W. G., Matthews H. R. Teflon strip pneumostasis for excision of giant emphysematous bullae. Thorax. 1987 Feb;42(2):144–148. doi: 10.1136/thx.42.2.144. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Pearson M. G., Ogilvie C. Surgical treatment of emphysematous bullae: late outcome. Thorax. 1983 Feb;38(2):134–137. doi: 10.1136/thx.38.2.134. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Potgieter P. D., Benatar S. R., Hewitson R. P., Ferguson A. D. Surgical treatment of bullous lung disease. Thorax. 1981 Dec;36(12):885–890. doi: 10.1136/thx.36.12.885. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Pride N. B., Hugh-Jones P., O'Brien E. N., Smith L. A. Changes in lung function following the surgical treatment of bullous emphysema. Q J Med. 1970 Jan;39(153):49–69. [PubMed] [Google Scholar]
  12. Rogers R. M., DuBois A. B., Blakemore W. S. Effect of removal of bullae on airway conductance and conductance volume ratios. J Clin Invest. 1968 Dec;47(12):2569–2579. doi: 10.1172/JCI105939. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Sung D. T., Payne W. S., Black L. F. Surgical management of giant bullae associated with obstructive airway disease. Surg Clin North Am. 1973 Aug;53(4):913–920. doi: 10.1016/s0039-6109(16)40096-4. [DOI] [PubMed] [Google Scholar]
  14. Wesley J. R., Macleod W. M., Mullard K. S. Evaluation and surgery of bullous emphysema. J Thorac Cardiovasc Surg. 1972 Jun;63(6):945–955. [PubMed] [Google Scholar]

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