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Open Lobectomy

Christopher Morse, MD
Massachusetts General Hospital

Abstract

Cystic Fibrosis is an inherited disorder that mostly affects the respiratory and digestive systems. It is caused by a mutation in the gene responsible for the production of sweat, digestive fluids, and mucus. This gene controls the movement of salt and water in-and-out of cells, and mutations result in thickened and sticky mucus as well as an increased concentration of salt in sweat. The resulting mucus is difficult to cough out and affects the patient’s breathing, which leads to severe pulmonary infections and eventual respiratory failure. This mucus can also prevent secretions of digestive enzymes from the pancreas into the small intestine, resulting in decreased absorption of nutrients and malnutrition. Male infertility can also result due to mucus blocking the vas deferens. Diagnostic methods for cystic fibrosis include newborn screening, sweat, and genetic testing. Currently, there is no cure for cystic fibrosis, and treatment is aimed at managing the symptoms and reducing complications by loosening and removing mucus from the lungs, preventing and controlling lung infections, and providing adequate nutrition. Patients can be treated medically through antibiotics, anti-inflammatory medications, mucus-thinning drugs, bronchodilators, and oral pancreatic enzymes. When increased resistance to antibiotics and/or life-threatening lung complications result, surgical treatment is often needed. Options include a lung lobectomy in cases where pulmonary function remains adequate and lung transplantation where pulmonary function is inadequate. Here, we present an unusual case of an adult male who was diagnosed with cystic fibrosis. Recurrent bouts of pulmonary infection had damaged the upper lobe of his left lung. Since lung function was moderately preserved, an open left upper lobectomy was done to prevent recurrence of infection and further damage to the left lung.

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