In this article, we provide information about Bronchiectasis, how it develops, and its symptoms. Based on this information, the diagnosis, treatment, surgical methods, risks, and hospital stay duration after surgery are discussed.
What is Bronchiectasis?
Bronchiectasis is the permanent widening of the airways (bronchi) inside the lungs due to damage. Since the widened bronchi lose their elastic structure, it becomes difficult to expel accumulated materials (such as dust, smoke, particles, microorganisms) through coughing. Over time, these accumulations lead to infections in the lungs. Patients experience frequent respiratory infections, coughing, and excessive sputum production.
Causes of Bronchiectasis
- Generally caused by bronchial damage from childhood infections (e.g., measles and whooping cough).
- Past tuberculosis (TB) infections
- Immune system disorders (e.g., hypogammaglobulinemia)
- Congenital bronchial abnormalities (e.g., Kartagener syndrome)
- Cystic fibrosis
- Foreign objects aspirated into the trachea (e.g., nuts, erasers, pins)
- Some rare benign bronchial tumors (e.g., carcinoid tumors)
- In some patients, no specific cause can be identified.
Symptoms of Bronchiectasis
- Coughing
- Excessive sputum production
- Frequent respiratory infections
- Fatigue
- Weight loss
- Shortness of breath
- Bad breath
- Growth retardation in children
Diagnosis of Bronchiectasis
The video below provides information on the symptoms, diagnosis, and treatment of bronchiectasis.
- Bronchiectasis is typically diagnosed based on the patient’s symptoms and physical examination findings.
- Frequent respiratory infections and excessive sputum production are prominent symptoms in patients.
- Standard chest X-rays are insufficient for diagnosis.
- The most important diagnostic tool is High-Resolution Computed Tomography (HRCT).
- Bronchoscopy is not required in every case.
CT scan of a patient with bronchiectasis in the lower lobe of the left lung.
Treatment of Bronchiectasis
- Treated initially with antibiotics and bronchodilators.
- Postural drainage is used to facilitate bronchial clearance by encouraging patients to cough out sputum in specific positions, preferably in the morning.
- Respiratory physiotherapy strengthens the lungs and increases their capacity.
- If treatment is ineffective, surgery may be necessary.
- Lung transplantation may be required in cases where both lungs are severely affected.
When is Surgery Required for Bronchiectasis?
- If it cannot be treated with medications
- If the patient’s quality of life deteriorates
- In cases of coughing up blood
- If there is inflammation in the lung cavity
- If frequent hospitalizations are required
Surgical Methods for Bronchiectasis
Open surgery (thoracotomy), which involves opening the ribs, has been replaced by the closed (VATS – Thoracoscopy) method. The preferred surgical method for bronchiectasis is the closed surgery technique called SINGLE PORT VATS. The surgery aims to improve the patient’s quality of life, so the minimally invasive method is preferred.
Closed Surgery for Bronchiectasis (Single Port VATS)
This method involves a single incision of 3 or 4 cm through which a camera and surgical instruments are inserted. The diseased lobe of the lung is removed without expanding the ribs.
The surgery takes approximately 2 hours. Most patients are discharged 4 or 5 days after surgery.
Since there is significantly less pain after surgery, recovery to normal life is much faster compared to open surgery.
Bronchiectasis – postoperative view of closed surgery
The bronchiectasis surgery performed through a 3.5 cm incision was selected as one of the most innovative and educational operations of 2014 by the U.S.-based Thoracic Surgery Organization CTSNET.
Risks of Bronchiectasis Surgery
Postoperative risks include bleeding, pneumonia, infection, and air leaks from the lungs. These complications occur in 5-7% of patients. The 30-day mortality rate after lobectomy for bronchiectasis ranges from 0.08% to 1.5%. In cases where bronchiectasis affects the entire left or right lung, postoperative complication rates are higher.
