Widespread blisters can be removed with a few ...

Surgical treatment of bullous emphysema is technically not difficult, when the correct indications, technique and postoperative management are respected. However, this can lead to serious complications when performed correctly .. This approach is ideal for both unilateral and bilateral bullectomy. In bilateral approach middle sternotomy and simultaneous bilateral anterior thoracotomy may also be considered. In this latter group of patients has put procedures may be performed. Video assisted thoracoscopy can be immediately converted to open thoracotomy when intraoperative results require. VATS bullectomy is performed under general anesthesia with double lumen endotracheal intubation. After the cessation of ventilation after operations side, the first section, usually at 6 or 7 intercostal space in midaxillary line. A thorough review of bullae and main pulmonary parenchyma may be difficult, as large blisters, usually under stress and destroy the pleural cavity. Two other sections are performed to achieve a triangulation approach is used for placement of graspers and staplers. Pleural adhesions coagulation and divided to completely mobilize the lung and bull / bull. Use the stethoscope on the working channel can also help generate additional port for the device. Were embedded and can be deflated for easy manipulation of delicate lungs, it is usually compressed and twisted (spaghetti procedure) to determine the base. Traction on the parenchyma should be carefully executed so as not to damage the lungs, followed by prolonged air leakage in the postoperative period. Bull leg cut easily with endostapling devices. Widespread blisters can be removed with a few applications of endoscopic staplers (Fig. >> << 10-12). Bull is usually cut from the edge of normal lung parenchyma is left open bronchioles. When you remove the bull from the main light emphysematous, line stapler is usually enhanced by using commercially available strips. Additional small blisters and bubbles in light of residual or cut or coagulate. At the end of the procedure special attention is paid leaking air. If they occur, surgical sealant can be used to cover holes and reduce or eliminate this complication. Gentle re-expansion of residual lung is reached to see how it fills the pleural cavity. If the remaining space is expected pleural tents can be designed thoracoscopically for its reduction. Pleural cavity is usually drained with two chest tubes in multifenestrated edge and groove behind the anterior chest wall. Postoperative pain control is usually obtained with continuous intravenous anesthesia, epidural anesthesia may be considered for bilateral bullectomy. Other methods have been described for the treatment of bullous emphysema. For resection of bullae, it may be canceled or create complex and on its placement on a stapler. This method is best done through an open approach and has the potential advantage of allowing the strengthening of the main according to a bull. However, our feeling that the bull should always be fully resection because the risk of cancer at 36 times higher than in normal lung parenchyma. We regularly send bull for histology and random routine sampling has demonstrated the potential of cancer .. CT is used to select the optimal site for surgical incision. Some of the main ribs flogged and pleura opened to reveal a side wall of the dominant bull. Two concentric kisetnyy sutures buy lasix generic are placed and bull carved. Talc insufflated, to identify fibrous reaction and facilitate rapid and permanent reduction in the cavity. 32 Foley catheter is inserted into the cavity and brought thorough cut. Balloon catheter inflated with 30 - 40 ml of air and extend the lines of stitches tied around it. Suction catheter used with the resulting collapse of the bull. Talc free insufflated around the pleural cavity to induce plevrodeza and vnutryplevralnoe catheter drainage placed full cut basal kick. Wounds closed around the foley catheter, which is mounted under a fume hood, which connects the wall bull to the chest wall. Pleural drainage catheter is usually removed within 48 hours, and Foley catheter for 8 days. .