Surgical Treatment of Bronchiectasis

¹ From the Department of Surgery, School of Medicine, Tulane University; and the Ochsner Clinic, New Orleans, La.

1) The rationale of surgical therapy in bronchiectasis is based upon a thorough comprehension of the pathogenesis, irreversible pathologic features, natural prognosis and morbidity, and the limitations of conservative therapy. These features of the disease are briefly considered.

2) During the last two decades the rapid advances and refinements in preoperative preparation, anesthesia, and operative technique have resulted in a steady reduction in mortality until it has now reached the amazingly low level of 3 per cent.

3) The indications for operation are briefly discussed and the significance of an accurate study of the distribution of the disease process in each lobe in permitting a precise assessment of the extent of operation necessary to produce a cure is emphasized.

4) Appropriate measures in the preoperative preparation and postoperative management of the patient are indicated and their importance stressed.

5) The various methods that may be employed in the surgical extirpation of the diseased lung, namely, mass ligation, individual isolation and ligation of the intrahilar structures, and segmental pneumonectomy are briefly described and their advantages, disadvantages, and indications are discussed. Wherever feasible intrahilar lobectomy is considered the most preferable procedure.