Thoracoscopic sublobar resection for congenital bronchial atresia in adults: a report of three cases

Background: Congenital bronchial atresia (CBA) is a rare bronchial abnormality. Adult patients with CBA generally do not show any symptoms. Although surgical resection is the first-line treatment, the indication for the surgical intervention is controversial, especially in mildly symptomatic or asymptomatic patients. Recently, thoracoscopic surgery is the commonly preferred approach to treat this condition.

Case presentation: Case 1: A woman in her 20s suffered from repeating episodes of fever and cough due to left CBA with the interruption of B9 and B10. Uniportal thoracoscopic left lower lobe wedge resection was performed, following which the symptoms disappeared. Case 2: A woman in her 40s presented to the clinic with dyspnea on exertion, and the computed tomography image revealed the absence of B2. Multiportal thoracoscopic right S2 segmentectomy was performed on her, after which the symptoms of dyspnea improved. Case 3: A woman in her 40s visited the hospital with symptoms of intermittent cough, sputum, and slight fever for 7 months. The examinations identified the absence of B6a. Right S6 segmentectomy and S2 wedge resection were carried out by multiportal thoracoscopic approach. The patient is now asymptomatic.

Conclusions: Based on our experiences in the three adult CBA surgery cases, the three-dimensional image reconstruction system is very useful for diagnosis and surgical decisions with regard to this disease. Even for CBA patients with subtle symptoms, early surgical treatments may be beneficial from the point of view of minimally invasive interventions, and sublobar resection will be sufficient for treatments and preservation of respiratory function.