Bullectomy for COPD

Overview

In people with chronic obstructive pulmonary disease (COPD), the structure of the lung weakens. The alveoli, tiny sacs of air where carbon dioxide is exchanged for oxygen, may become damaged. If the alveoli break down, they may form larger pockets of air called bullae. As bullae become larger, they can burst, causing a collapsed lung (pneumothorax) or serious infections.

Bullectomy is the surgical removal of one or more bullae. Bullectomy can improve lung function in some people with COPD and help them breathe more easily. However, not everyone needs or is a good candidate for bullectomy. Bullectomy may be considered if you have bullae that are larger than one-third of a lung, or if the bullae prevent expansion of the lung to the extent that lung function is severely compromised. Bullectomy is most successful on younger people and people who either have one bulla or several bullae located in one part of the lung. Bullectomy is not advised for people who have bullae scattered throughout the lung.

Bullectomy is not a cure for COPD, but it may treat some symptoms.

What does it involve?
Your doctor may diagnose bullae with x-rays or computed tomography scans. You and your doctor should decide together whether bullectomy may be right for you. Do not be afraid to ask questions about any aspect of the surgery or recovery.

Once your bullectomy is scheduled, spend the weeks before surgery preparing by eating nutritious meals and staying as active as possible, even if you can only take short walks. Stop or cut down your smoking, and limit your consumption of alcoholic beverages to one or two per day. Being in top condition for surgery will shorten your recovery time and help prevent complications.

You will be given instructions to stop eating a few hours or possibly the night before surgery. When you arrive at the hospital, vital signs will be taken, blood will be drawn for testing, and some scans may be taken of your chest. When it is time for the surgery, you will receive an intravenous (IV) line and anesthetic medication to make you sleep.

There are several techniques used in bullectomy surgery, and which you receive will depend on the size and location of your bullae. The surgeon will likely make either a four-to-six-inch incision below your armpit known as a thoracotomy, or several small incisions on the side of your chest to allow video-assisted thoracoscopic surgery.

Depending on your condition and the surgical technique used, you may spend one or more nights in the hospital recovering from bullectomy. A nurse or doctor will explain how to care for your wound. Once you return home, it will take a few weeks to recover completely from surgery before you can return to work and other normal activities.

Intended Outcomes
In the right candidate, a bullectomy can improve breathing and lung function.

Results
According to several long-term follow-up studies, within three to five years after a bullectomy, lung function usually decreases to pre-surgery levels.

Constraints
Any surgery carries risks including blood clots, blood loss, infection, breathing problems, reactions to medication, and heart attack or stroke during the surgery.

Bullectomy surgery can be painful, and you will most likely need pain medication for some weeks during recovery.

Possible complications of bullectomy surgery include parenchymal air leaks, or leaks within your lung, which may prolong your stay in the hospital.

Call your doctor immediately if you notice signs of infection such as swelling, redness, increased pain, or bleeding from the surgical wound.

Even a successful bullectomy may only improve your lung function and breathing for three to five years.