Definition & Overview

Pneumonolysis is a surgical procedure performed to collapse the lungs for the treatment of tuberculosis. During the procedure, the lungs are separated from the pleurae (singular, pleura) causing the lungs to fold.

A pleura is a pair of serous membranes that lines the thorax and envelopes the lungs. Pleurae are an important part of this side of the body because they allow the lungs to somehow glide with other organs without causing any damage to them.

The procedure requires a surgeon to separate the surface of the lung from the surface of the chest cavity. The process used to be a common procedure to treat people suffering from tuberculosis before the introduction of anti-tuberculosis drugs.

Who Should Undergo and Expected Results?

Between 1930 and 1950, when anti-tuberculosis drugs were not yet discovered, tuberculosis (TB) patients were normally treated with a process called plombage or extrapleural pneumonolysis.

Extrapleural pneumonolysis, also commonly known as extraperiosteal, was particularly used to treat patients who were diagnosed with cavitary tuberculosis. Cavitary tuberculosis is a type of tuberculosis that only involves the upper lobes of the lungs. The bacteria that cause TB destroy the tissues in the area leaving a large hole or enlarged spaces in the lungs. This space makes the lung highly oxygenated and gives the bacteria a great environment to thrive. The goal of extraperiosteal pneumonolysis is to fill or pack the space to address the condition.

How is the Procedure Performed?

In extrapleural pneumonolysis, an artificial cavity is surgically created inside the lungs with the ultimate goal to fill or pack that space. The space is then filled with inert materials such as lucite balls of acrylic, gauze, rubber sheets, oils, and sometimes, even ping pong balls. Inert means that the materials used in stuffing the artificial cavity are not chemically reactive, something that will not cause an extreme reaction while inside the body.

The act of putting foreign inert materials inside the lungs would cause the lungs to collapse, which is the fundamental goal of the entire procedure. It is important to emphasise that this procedure will selectively target the upper lobe of the lungs, not both lungs.

Extrapleural pneumonolysis procedure was introduced by a French surgeon, Theodore Tuffier, in 1891. It was the go-to procedure by most surgeons at that time as they respond to the increasing number of people being infected by tuberculosis.

Due to issues stemming from the safest material to use to fill the artificial cavities, the experimental procedure only enjoyed a brief success. However, pneumonolysis was later revived following the discovery of safer filling materials.

This process, coupled with rest, good nutrition, and isolation, has been proven fairly effective for a couple of decades. Following surgery, most patients remain well for about two years.

The introduction of powerful anti-TB drugs provided a more non-invasive approach to treating tuberculosis. Ultimately, the use of such procedure has been altogether disapproved for TB-related cases. While plombage is almost never practiced today, it left an important mark in the history of surgery.

Today, there are only a few cases when a doctor would consider this rather historical and archaic procedure: when a TB patient has become resistant to virtually all kinds of available anti-TB drugs (multi-drug resistance) or when cutting out a part of the lungs would lead to total impairment of the lungs.

Possible Risks and Complications

Some recorded risks and complications arising from this procedure include pleural haemorrhage and fistulisation of the air passageway to the lungs, skin, oesophagus, and other major thoracic vessels. Fistulisation creates a fistula, a passage between an organ, whether hollow or tubular, or between an organ and the surface of the body.

In one rare event in 1996, a 65-year-old male who have undergone extraperiosteal plombage in 1950 showed signs of pneumonia and relapsing haemosputa. This may be due in part to the bronchial fistula and the fluid collected by lucite balls inserted at the time when the procedure was done. The removal of lucite balls and the filling of the empyema space, a space filled with pus, improved the patient’s condition.

A fistula usually occurs as a result of a surgery gone bad but it can also arise spontaneously. Although the risk of death is lower for fistula, it may mean increased health care cost for patients, extended hospital stays, and economic impact due to delayed return to work.

Doctors require patients to report to the doctor’s clinic any complications that may arise immediately during at-home recovery. In addition, a regular outpatient care is needed to carefully monitor the progress of the recovery and check for any subtle complications that may otherwise go unnoticed.

References:

  • US National Library of Medicine National Institutes of Health; “Open Pneumonolysis in the Treatment of Tuberculosis”; http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1520755/

  • The American Journal of Surgery; “Extrapleural pneumonolysis with plombage”; http://www.americanjournalofsurgery.com/article/0002-9610(49)90338-4/abstract

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