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How Is a Bullectomy Performed?

What is a bullectomy?

Bullectomy is the surgical removal of a bulla. Bulla or bullae is a pathological condition of the lungs caused by chronic obstructive pulmonary disease (COPD). Bulla of the lung develops when emphysema (COPD) damages the lungs to an extent that air pockets start developing. 

These air pockets increase in size and apply pressure on the lungs since it starts occupying the space within the chest cavity. This results in symptoms like pressure in the chest and difficulty breathing. A bulla that occupies more than 30% of the chest is called a giant bulla.

A bullectomy removes part of a lung in a person with COPD to aid breathing.
A bullectomy removes part of a lung in a person with COPD to aid breathing.

When is a bullectomy done?

Bullectomy is indicated in chronic obstructive pulmonary disease (COPD) and other conditions like alpha-1 antitrypsin deficiency, Marfan’s syndrome, Ehler-Danlos syndrome, cocaine, intravenous drug abuse, sarcoidosis, and HIV.

These conditions typically present with the following:

When should a bullectomy not be done?

Contraindications for bullectomy include the following:

How is a bullectomy performed?

As with any other surgery, there are a few important parts involved with undergoing a bullectomy.

Before surgery

Anesthesia

The surgery

  • The choice of surgical technique depends on the size and number of bullae to be removed which is based on the surgeon’s discretion. 
  • The main options are video-assisted thoracic surgery (VATS) and open thoracotomy/sternotomy. 
  • VATS is less invasive. Small incisions are made on the skin above the chest cavity to insert a thoracoscope (camera with a light source) and surgical instruments. 
  • VATS also allows quicker recovery and is associated with lesser postoperative pain than open thoracotomy. It can be used for bilateral disease as well.

After the surgery

  • The patient is administered painkillers and antibiotics. 
  • The patient is required to stay in the hospital for three to seven days. 
  • Pain, bruising, and swelling may be present in the postoperative period, which usually resolves in one to two weeks. Complete recovery takes a few weeks.

What are the complications of a bullectomy surgery?

Like any major surgery, bullectomy has a risk of complications. 

Some common complications encountered are:

Common cardiac complications are as follows:

Other complications include the following:

QUESTION

COPD (chronic obstructive pulmonary disease) is the same as adult-onset asthma. See Answer

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Reviewed on 7/8/2020
References
Medscape Medical Reference
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