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The Annals of Thoracic Surgery, Vol 58, 1452-1456, Copyright © 1994 by The Society of Thoracic Surgeons

ARTICLES

Surgical treatment of bullous emphysema: experience with the Brompton technique

SS Shah and P Goldstraw
Department of Thoracic Surgery, Royal Brompton National Heart and Lung Hospital, London, England.

The technique first described by Monaldi has been modified for the treatment of discrete emphysematous bullae. Fifty-eight patients (median age, 56 years) underwent this procedure between 1983 and 1992. The operative mortality was 6.9% (4 patients). Fifty-two patients (89.6%) noted symptomatic improvement, as measured using the modified Medical Research Council of Great Britain dyspnea scale, from a mean value of 3.7 preoperatively to 2.1 postoperatively. Two patients remained unchanged symptomatically. In all patients, amelioration of symptoms was accompanied by an objective improvement in lung function. A mean increase of 28% was noted in the forced expiratory volume in 1 second (p < 0.05), and a 12.3% improvement in the total lung capacity was observed (p < 0.002). The residual lung volume-total lung capacity ratio declined from a mean of 70% to 57% after operation. A forced expiratory volume in 1 second of less than 500 mL (p < 0.05) and carbon dioxide tension of greater than 6.5 kPa (p < 0.05) were significant predictors of poor prognosis. The median follow-up period has been 1.9 years (range, 0.5 to 9 years). Two patients have returned for further drainage of new bullae on the operated side, and this was carried out percutaneously in both. We conclude that this technique offers a simple, safe, and effective method for the treatment of discrete bullous disease in patients with emphysema.

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