Is VATS
Bullectomy and Pleurectomy an Effective Method for the Management of Spontaneous Pneumothorax?
(6) For patients with severe disease, surgical options include
bullectomy (for patients with very severe illness and large upper lobe bullae), lung volume reduction surgery, or lung transplantation.
of Cases Polypectomy 6 Polypectomy + Uncinectomy 3 Polypectomy + Uncinectomy +
Bullectomy + 1 Ethmoidectomy Polypectomy + Uncinectomy + Ethmoidectomy 2 Polypectomy + Uncinectomy + Septoplasty 2 Polypectomy + Septoplasty 2 Uncinectomy +
Bullectomy + Ethmoidectomy + 1 Sphenoidotomy Polypectomy + Ethmoidectomy + Septoplasty 1 Uncinectomy + Ethmoidectomy 1 Uncinectomy + MMA 1 Figure 3.
Giant pulmonary bulla (GPB) or giant emphysematous bulla (GEB), a bulla occupying more than one-third of the involved hemithorax, usually requires removal by surgical procedures such as
bullectomy or lobectomy.
After thorough inspection of the entire lung with particular attention to the apical and basal lung fields,
bullectomy is then performed utilizing linear cutting staplers.
Lung volume reduction surgery, bronchoscopic lung volume reduction, lung transplantation, and
bullectomy are surgical options for appropriately selected patients with advanced COPD.
Although some authors suggest that ruptured preexisting bullae are the causes of all spontaneous pneumothoraces, others consider recurrences after
bullectomy as evidence that ruptured bullae are not always the site of an air leak.
Apical pleurectomy together with
bullectomy, apical pleural abrasion/pleurectomy and pleurodesis was performed in 36 patients with bullous lung disease.
Conlan, "Mechanisms of relief of exertional breathlessness following unilateral
bullectomy and lung volume reduction surgery in emphysema," Chest, vol.
This is attributed to their 'paper bag' compliance making them easier to inflate than normal lung up to a certain volume.2 The bulla enlarge as the surrounding tissue retracts away by elastic recoil.3 The bullae do not participate in gas exchange and as they grow, this fact together with their space occupying nature increases the work of breathing with associated exercise limitation and dyspnoea.1 Surgical
bullectomy is the treatment of choice in patients with giant bullae occupying more than half of the hemithorax.4 It has also been observed that patients with a preoperative FEV1 of approximately half the predicted value gain the most from
bullectomy.2
For chronic obstructive pulmonary disease (COPD), in particular, non-pharmacological treatments include smoking cessation strategies, pulmonary rehabilitation, ventilatory support, endobronchial treatments and various forms of surgical treatments including
bullectomy, lung volume reduction surgery and lung transplantation.
Quantitative assessment of dyspnea during exercise before and after
bullectomy in giant bulla.
