Use of bovine pericardial buttress in bilateral staple resection of emphysematous bullae

APC Yim, JKS Ho, SK Ng, CKW Lai, T Buckley
Cardiothoracic Unit, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong

Bullectomy has been shown to be an effective treatment of severe compressive bullous emphysema. However, persistent air leak is a common complication from this procedure. We report a case of a 48-year-old man with severe bilateral bullous emphysema and disabling dyspnoea treated by bilateral staple resection with bovine pericardial buttress through the median sternotomy approach. Despite a post-operative need for ventilatory support, air leak was not a problem and the patient was able to have both chest drains removed shortly after extubation. The patient had a pre-operative forced expiratory volume in 1 second of 0.5 L/sec, forced vital capacity of 1.25 L and peak expiratory flow rate of 100 L/min. These parameters were increased to 1.4 L/sec (180% increase), 1.9 L (52% increase) and 270 L/min (170% increase), respectively, one month later, in association with a marked clinical improvement. We conclude that bilateral bullectomy in carefully selected patients is useful and bovine pericardium buttress is probably helpful in achieving pneumostasis.

Hong Kong Med J 1996;2:429-32

Key words: Emphysema, pulmonary; Dyspnea; Lung diseases, interstitial; Lung diseases, obstructive