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.
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:
- Difficulty breathing
- Chest pain
- Repeated infection
- Hemoptysis (coughing blood)
- Wheezing (whistling sound while breathing)
When should a bullectomy not be done?
Contraindications for bullectomy include the following:
- Significant comorbid conditions
- Poorly defined bullae on chest imaging
- Pulmonary hypertension
How is a bullectomy performed?
As with any other surgery, there are a few important parts involved with undergoing a bullectomy.
Before surgery
- The surgeon performs a complete physical assessment along with radiological tests (X-ray, computed tomography scan, angiography) and laboratory tests.
- The patient is asked to quit smoking before surgery, as smoking delays the healing process.
- The patient will also have to fast for at least 12 hours before surgery.
Anesthesia
- Bullectomy is typically performed under general 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:
- Air leakage
- Respiratory failure
- Pneumonia (lung infection)
- Bleeding
- Atelectasis (collapse of the lung)
Common cardiac complications are as follows:
- Arrhythmia (irregular heartbeat/abnormal heart rhythm)
- Myocardial infarction (heart attack)
Other complications include the following:
- Deep vein thrombosis (DVT): Blood clot in deep-lying veins
- Pulmonary embolism (PE): Blood clot in the lungs
- Pain and/or infection at the incision site
- Reaction to anesthesia