What Is a Bullectomy?

A Surgical Procedure for COPD Patients With Giant Bullae

Surgeons performing surgery
Thierry Dosogne/Stone/Getty Images

 If you have chronic obstructive pulmonary disease or COPD, you may be at risk of developing enlarged bullae, which are thin-walled, air-filled spaces in the lining of the lungs. Bullae are the result of an obstruction within the bronchiole tubes or bronchus. Giant bullae cause substantial compression on the underlying, healthy lung tissue, which in turn, reduces blood flow and oxygen to the lungs.

This causes a worsening of dyspnea, or shortness of breath.

If bullae grow too large (usually greater than one centimeter), your doctor may recommend a bullectomy to treat them and help you breathe better. This surgical procedure removes the enlarged bullae, allowing the healthy air sacs in the lungs to expand properly. This will make breathing easier.

When Is a Bullectomy Needed?

The procedure is considered whenever substantial air-filled bullae are detected on chest x-ray or CT scan. Most patients who are considered for surgery have symptoms including:

Other symptoms, though rare, include bleeding and infection in the bullae. Some patients have no symptoms but may require surgery if the bullae encompass more than half of the pleural cavity—the fluid-filled area between the pleural membranes that surround the lungs.

If your doctor suspects you need a bullectomy, he will evaluate your lung function through one or more tests prior to surgery.

Common tests ordered prior to a bullectomy include:

  • chest x-ray
  • chest CT scan
  • pulmonary function tests
  • ventilation/perfusion scan or VQ scan
  • lung angiography

Patients who have smaller bullae, hypercapnia, corpulmonale, or an FEV1 less than 40 percent of predicted are not candidates for the surgery.

Before surgery is indicated, your doctor may try to manage your enlarged bullae without it.

If you're asymptomatic, quitting smoking may be enough to manage the condition. If you still have symptoms after quitting smoking, medications and care such as bronchodilators, inhaled glucocorticoids, vaccinations, supplemental oxygen or pulmonary rehabilitation may help. If these still don't work, surgery is often the next course of action.

How Is a Bullectomy Performed?

Your surgeon may perform the bullectomy in one of two ways. One is by thoracotomy, where a 4- to 6-inch incision is made below your armpit. The surgeon then inserts a lighted tube called a thoracoscope and surgical tools through catheters to remove the bullae.

The other option is a video thoracoscopy. Similar to traditional thoracotomy, video thoracotomy involves a video screen and console that guides the surgeon. It involves smaller incisions on the side of the chest. Once the bullae are removed, your surgeon will close the incisions.

Regardless of the method of bullectomy your surgeon chooses, the operation is performed under general anesthesia. This means you will need to fast prior to surgery. Be sure to follow all of your doctor's instructions.

Recovery from a bullectomy can take a few weeks until you regain your strength and are able to return to work.

During this time, you should contact your doctor if you experience:

  • bleeding
  • infection in the incision
  • a high temperature
  • signs of an allergic reaction including redness, swelling and trouble breathing
  • pain

 

Source:

Krishnamohan P, Shen KR, Wigle DA, et al. Bullectomy for symptomatic or complicated giant lung bullae. Ann Thorac Surg 2014;97:425–31.

 

 

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