Surgical management of bronchiectasis: analysis of 277 patients.

BACKGROUND

Bronchiectasis is a permanent irreversible dilatation of the bronchial wall, often arising from inadequate treatment of a pulmonary infection. In recent years, the incidence of bronchiectasis has decreased mainly due to improved medical treatment of respiratory infections. However, the disease still constitutes a health problem in developing countries.

METHOD

We reviewed 277 patients with bronchiectasis who underwent pulmonary resection in the Ghaem & Omid hospitals affiliated to Mashhad University of Medical Sciences in Iran from 1985 to 2008. The patients were evaluated for age, sex, clinical features, etiology, type of surgical procedure, morbidity, mortality and treatment outcomes.

RESULTS

A total of 277 patients were enrolled in this study [200 males (72.2%) and 77 females (27.7%)]. Mean patient age was 34.7 years. The most common symptom was productive cough (79.4%). The most common etiology was pulmonary infection (77.6%). The disease was bilateral in 62 cases (22.3%) and the most common site of involvement was the left lower lobe (55%). The most common surgical technique for the unilateral form was lobectomy (42.2%) and one-sided lobectomy with segmentectomy of the other side in 25 patients with bilateral bronchiectasis. Mortality and morbidity rates were 0.7% and 15.8%, respectively. The most common complication was wound infection (5.7%). The mean follow-up was 4.5 years. 68.5% of patients were symptom-free at the last postoperative evaluation, 23.8% had an improvement in their symptoms, and 7.5% of patients showed no improvement. Statistically, complete resection had a better outcome.

CONCLUSION

In conclusion, surgery is an acceptable treatment in bronchiectasis and has low mortality and morbidity rates. The best outcomes were observed after complete resection. In selected bilateral cases, resection was used with acceptable outcomes.