What are the role of surgery in Emphysema patients? Learn in this slides.

1. Surgery for Emphysema
Dr. K Khaing Saw Lwin

2. Emphysema
• Is characterized by abnormal permanent
enlargement of air spaces distal to the
terminal bronchiole
• Accompanied by destruction of the airspace
walls in the absence of obvious fibrosis

3. • surgery  palliate emphysema  Severe
Emphysema Refractory to Medical Treatment
1.Bullectomy  with giant bullae
2.LVRS ( lung volume reduction surgery) diffuse
emphysema without bullae
3.lung transplantation Pt with Alpha1 anti-trypsin
deficiency

4. LUNG VOLUME REDUCTION
SURGERY

5. • INCREASED WORK OF BREATHING & DYSPNOEA
• Non functional volume occupying area of lung
• Increased dispensability
• ( REMAIN pathologically inflated throughout breathing cycle)
• Destruction of lung tissue
• Loss of elastic recoil
LVRS  IMPROVED
V/QMISMATCH & RELIEVE
SYMPTOMS

6. Ideal candidates for LVRS
• marked hyperinflation
• significant regions of severe destruction with
other distinct areas of more well-preserved
lung parenchyma
(areas to be removed “target areas”
contrast CT or nuclear medicine perfusion scans)

9. Methods of surgery
• Median Sternotomy
• Bilateral VATS in the supine patient
(buttressed or unbuttressed staplers)
NETT  National Emphysema Treatment Trial
(pt benefit for LVRS)
• Bronchoscopic LVRS ( VENT trial –
Endobronchial Valve for Emphysema Palliation
Trial)

10. Dyspnoea Survival
Heterogeneous Low exercise capacity + +
Heterogeneous High exercise capacity +
Homogeneous Low exercise capacity +
Homogeneous High exercise capacity -

11. • Adult Chest Surgery 2nd Edition
• Sabiston and Spencer Surgery of Chest ,9th
edition

12. THANK YOU