Our surgical experiences in bronchiectasis

Introduction – Aim: Bronchiectasis is primarily defined as the permanent and abnormal dilation of segmental and/or subsegmental bronchi due to irreversible damage to the muscular and elastic tissues of the bronchial wall. This condition, which is closely related to socioeconomic status, has been decreasing in incidence, especially in developed countries, but continues to be a significant health issue in developing countries like ours. While bacterial and viral infections are the leading causes of bronchiectasis in developing countries, immune system disorders, metabolic defects, and other congenital pathologies (such as primary ciliary dyskinesia, Young syndrome, etc.) are more commonly observed in developed countries. In this study, we aim to investigate the benefits and necessity of surgical treatment by examining the data of 93 adult patients who underwent surgery for bronchiectasis at the Thoracic Surgery Department of Dicle University, and to contribute to the medical literature at national and international levels. Materials and Methods: A retrospective evaluation was performed on 93 patients aged 18 years and older who underwent lung resection for bronchiectasis at the Thoracic Surgery Clinic of Dicle University Hospital, Diyarbakır, between January 1, 2013, and December 31, 2023. A total of 95 lung resection surgeries were conducted on these patients. The patients were retrospectively assessed in terms of age, gender, surgical technique, location, duration of drain removal, length of hospital stay, and complications. Results: A total of 93 patients aged 18 years and older were included in the study. Among them, 53 were female (57%) and 40 were male (43%). The average age was 34.8 ± 12.5 years, with a median age of 33 (range 18-65). The female-to-male ratio was 1.33. The most common presenting complaints, in order of frequency, were cough, sputum, dyspnea, hemoptysis, chest pain, a frequent history of lower respiratory tract infections, fever, weight loss, developmental delay, wheezing, and clubbing. A detailed anamnesis of the patients revealed that the most common complaints were frequent lower respiratory tract infections and continuous medical treatment. Of the patients, 26 (28.4%) underwent VATS (Video-Assisted Thoracoscopic Surgery), 55 (58.9%) underwent posterolateral thoracotomy, and 12 (12.6%) underwent a hybrid procedure, combining VATS with a mini-thoracotomy extended to a lateral thoracotomy. The most common procedure performed for bronchiectasis was left lower lobectomy, followed by segmental resection of the lingula with left lower lobectomy. The average length of hospital stay for our patients was 16.3 days (range 4-42 days) postoperatively. The average drain stay was 8.6 (2-48) days. A comparison of the average length of hospital stay and drain duration by surgical technique (VATS, Thoracotomy, Hybrid) showed that patients who underwent VATS had significantly shorter lengths of stay and drain durations. Conclusion: With appropriate patient selection and the correct surgical technique, favorable outcomes can be achieved in patients undergoing surgery for bronchiectasis. It has been shown that resecting the diseased tissue in the relevant segments during surgery is not a physiological loss for the patient but rather a treatment that helps preserve the remaining lung tissue.