Functional Improvement After Volume Reduction: Sternotomy Versus Videoendoscopic Approach

Background. Volume reduction has been proved to increase ventilatory mechanics in diffuse, nonbullous lung emphysema. However, the best approach is still controversial. Methods. We retrospectively compared the perioperative data of and functional results in 15 patients having sternotomy (group I) with those of 15 patients having a videoendoscopic approach (group II). Results. The 30-day mortality was 2 patients in group I and 1 patient in group II. Mean duration of chest tube drainage was 8.7 ± 1.8 days and 8.0 ± 1.9 days and mean hospital stay, 12.3 ± 1.9 and 12.5 ± 2.1 days in groups I and II, respectively. Work of breathing decreased from 1.89 ± 0.33 J/L and 1.76 ± 0.22 J/L preoperatively to 0.75 ± 0.06 J/L and 0.8 ± 0.06 J/L ( p < 0.01 and p < 0.05, respectively) after 3 months; and intrinsic positive end-expiratory pressure decreased from 7.15 ± 1.31 cm H 2O and 6.24 ± 1.33 cm H 2O to preoperatively 0.79 ± 0.46 cm H 2O and 1.13 ± 0.44 cm H 2O ( p < 0.005 and p < 0.01, respectively) after 3 months in groups I and II, respectively. Forced expiratory volume in 1 second increased from preoperative values of 21.6% ± 2.9% and 25.3% ± 2.4% of predicted to 34.5% ± 5.0% and 40.9% ± 7.5% of predicted after 3 months ( p < 0.05 in both groups) in groups I and II, respectively. Conclusions. Both surgical approaches resulted in similar substantial improvement in lung function and physical fitness. The incidence of air leakage, the duration of chest tube drainage, and the hospital stay were the same for both procedures.