Fig. 280. Lower Bronchoscopy with the Patient in the Dorsal Position.
Results. Removal of foreign bodies by bronchoscopy gives far better results than the older methods of treatment such as tracheotomy, bronchotomy, and thyrotomy. With the last-named operations more than one-third of the cases have been fatal: while on the other hand, taking the 164 cases[45] collected by Killian, it is found that in 159 (leaving out 5 with unknown result) only 21 (or 13%) died, viz. 2 from cocaine; 2 because it was impossible to remove the object on account of bronchial stenosis; 1 from suffocation in spite of upper and lower bronchoscopy; and the remaining 16 of pulmonary complications—5 with the foreign body in the lung, and the others in spite of its removal. Upper bronchoscopy was fully successful in 54 cases, and lower bronchoscopy in 63. The result of the remaining 21 operations is not stated.
Speaking of his own cases, Killian writes: ‘My own statistics give perhaps a better judgment for the future of cases of foreign bodies in the deeper air-passages than the general, since I have gradually acquired a larger experience and more practice. Nevertheless, I have the impression that in many cases my technic has not reached the highest mark, and I hope to obtain better results in the future. As shown by the list of cases, only one death resulted in the eighteen cases, and this was six months after the removal of the foreign body, caused by severe lung complication due to its long sojourn in the air-passages. In only two cases was I unable to find the foreign body and in only one was I unable to remove it on account of its being coughed up.
‘Upper bronchoscopy was performed in twelve cases, upper and lower in five, and lower tracheo-bronchoscopy in one. However, I hope in the future, with improved technic, to be successful with the upper method at the first sitting and to use the lower only in the severest cases.’
To Killian of Freiburg is due the chief credit for having introduced a safe method of treatment, the value of which is at last beginning to be generally recognized in England. As Paterson[46] says, ‘it is earnestly to be hoped that the time has now come when workers in this country will recognize its enormous advantages.’