Bronchiectasis in thoracic surgery

1. Role of Surgery In Bronchiectasis
Dr. K Khaing Saw Lwin
MBBS,MRCSEd,MMedSc(Thoracic Surgery)

2. • first description by Laennec in 1819
• the permanent dilatation of the bronchi and is
caused by a recurrent process of transmural
infection and inflammation

3. 3 types (pathologic or radiographic
appearance of the airways)
1. Cylindrical or tubular bronchiectasis
• dilated, slightly tapered airways
• is seen in patients with tuberculosis infections
2. Varicose bronchiectasis
• Resembles the chronic venous state of the same
name, with areas of dilatation and narrowing.
3. Saccular or cystic bronchiectasis
• is characterized by progressive dilatation of the
airways which end in sac-like cystic structures that
resemble a cluster of grapes
• more common after obstruction or bacterial
infection.

4. 3 types of bronchiectasis

7. Diagnosis and location of
bronchiectasis
• using standard radiographic techniques
• Abnormal CXR -focal areas of consolidation,
atelectasis, occasional evidence of thickened
bronchi
• HRCT - the gold standard for radiologic diagnosis
of bronchiectasis
- bronchial dilation such that the internal
diameter of the affected bronchus > the
accompanying bronchial artery
- a lack of bronchial tapering on sequential slices

10. • Left lung > right lung
• Lower lobes > upper lobes
• Middle lobe and lingular disease (non TB
disease)
• Upper lobe (CF or ABPA)

11. Therapy for bronchiectasis
1. treatment of the underlying disorder (if possible)
2. suppression of the bacterial load through
appropriate use of antibiotics
3. Encouragement of proper pulmonary hygiene
(including the routine use of bronchodilators,
mucolytic agents, and postural drainage)
4. surgery in selected patients

12. Role of surgery
1. patients with focal areas of disease unremitting
symptoms, associated with localized lung
parenchymal destruction Lobectomy
2. patient who presents with massive hemoptysis
3. some patients with end-stage bronchiectasis
sequential double-lung transplantation

13. Ideal candidate for surgery
1. Disease should be truly localized and amenable
to anatomic lung resection
2. Adequate pulmonary reserve for the planned
resection should be present
3. minimal the bacterial load(within the bronchi
and lung tissue at the time of surgery) with
appropriate preoperative antimicrobial therapy

14. Important points in surgery
• Inf Pleural adhesions (+++)care must be
taken to avoid adjacent vital structures such as
the phrenic nerve or great vessels
• Hilar LNs
• Long standing case Hypertrophied bronchial
circulation (clipped enlarged bronchial artery)
• Fissure division line of division just on the
side of uninvolved lobe
• Try not to contaminate while retrieving
specimen

15. The key to successful surgical
intervention
1) complete resection of all affected areas;
2) relatively early intervention to prevent
development of resistant organisms and spread to
adjacent lung segments;
3) pre-operative targeted antimicrobial therapy
based on in vitro sensitivities;

16. 4) continuation of antimicrobial therapy
postoperatively;
5) pre-operative nutritional supplementation when
indicated; and
6) anticipation of potential complications that may
alter the surgical approach

17. Complication of surgery

18. European Respiratory Monograph,Chapter 17 , Surgery for bronchiectasis
(D.C. Mauchley & J.D. Mitchell

19. Prevention of Bronchiectasis
• Commonly starts in Childhood following
measles, whooping cough or primary TB 
adequate prophylaxis and treatment
• Early recognition and treatment of bronchial
obstruction

20. References
• European Respiratory Monograph,Chapter 17 ,
Surgery for bronchiectasis (D.C. Mauchley &
J.D. Mitchell)
• Adult Chest Surgery 2nd Edition
• Sabiston and Spencer Surgery of Chest ,9th
edition
• Davidson’s, Principles and Practice of Medicine

21. CASE REVIEW

22. • 61 yr old lady
• History of moist cough, haemoptysis x 2-3 yrs
• Dx- bronchiectasis (LLL)
• Plan – LLL lobectomy

24. Saccular or cystic bronchiectasis

28. Dense adhesion at RLL

30. Division of fissure
LUL
LLL

32. Big HILAR LN

33. Thank You !