Objectives: To evaluate the feasibility and outcome of bronchotomy as a surgical management of 13 patients with benign bronchial masses.
Patients & Methods: The study included 13 patients with sessile bronchial masses causing obstruction and easily to bleed on touch by bronchoscope. All patients underwent clinical and radiological work-up and bronchoscopy for evaluation of site and cause of obstruction, biopsy taking and/or management if possible. Through a posterolateral thoracotomy, a longitudinal bronchotomy incision was made along the long axis of the bronchus to expose the mass, which was resected surgically. Then, the bronchus was closed by interrupted PDS or Vicryl 3/0 sutures. The resected mass was sent for histopathological examination.
Results: CT imaging defined unilateral emphysema in all patients and localized the site of obstruction in the left main bronchus in 7 patients, in right main bronchus in 3 patients and in right upper lobe bronchus in 3 patients. Ten patients underwent successful bronchotomy, one patient had right upper lobectomy and two had left pneumonectomy and these three cases were considered as procedural failure. Mean duration of surgery was 145.2±31.7 minutes. One patient had injury of left main pulmonary artery which repaired immediately by direct closure of the injury site and passed uneventfully. Two patients had prolonged air leak for 9 and 11 days and were discharged on the 11th and 13th postoperative (PO) day; after resolution of air leak. Another two patients developed wound infection and were discharged on the 21st and 23rd PO day; after complete wound healing. Throughout follow-up one patient developed recurrent dyspnea and chest wheezes despite of disappearance of emphysema and was managed as asthmatic patient and responded to treatment.
Conclusion: Bronchotomy could be considered as an appropriate safe surgical modality for management of benign bronchial masses non amenable for bronchoscopic resection; with few intra and postoperative complications.
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