Bullectomy
Bullectomy refers to the surgical removal of
a bulla, which is a large, distended air space
in the lung greater than half an inch in diameter
that does not contribute to breathing function.
Once the bulla is removed, the healthy air sacs
around it have room to expand, and the muscles
used to breathe can function better. Although
bullectomy is not a cure for emphysema, it does
provide improvement for some patients.
Is Bullectomy
the Same as Lung Volume Reduction Surgery?
You may have heard of lung
volume reduction surgery (LVRS), which is
a surgical technique to remove a piece or pieces
of the lung.
Bullectomy is a different procedure. There is
usually only one large bulla that is removed
during a bullectomy. Patients treated with LVRS
have a different type of emphysema, with smaller,
nonfunctioning air sacs that are distributed
more widely through the lungs. During LVRS, the
surgeon removes a piece of the lung, which includes
many of these smaller, nonfunctioning air sacs.
How is Bullectomy
Performed?
Bullectomy can be performed in two ways:
- either by video thorascosopy, using small
incisions on the side of the chest through
which a scope is placed to remove the bulla;
or
- by muscle sparing thoracotomy, in which a
4-to-6-inch incision is made, usually beneath
the armpit, through which the bulla is removed.
Recovery
Operating on lungs with emphysema is like
operating on tissue paper. After the operation,
the lungs will leak air. Because it is normal
to have some air leakage after surgery, a chest
tube is placed in the patient's chest to prevent
the lung from collapsing. As the lung heals,
the air leaks seal. Most air leaks heal within
a week of surgery, although some patients may
have to remain in the hospital for a longer
period of time before the chest tube can be
removed.
The surgeon or advanced practice nurse
can remove the chest tube in the patient's
hospital room. There is no need to return
to the operating room to have the chest tube
removed. In the weeks and months after a bullectomy,
patients may notice greater ease of breathing
and movement, such as walking.
Will I Need Pulmonary
Rehabilitation?
Pulmonary rehabilitation is the process of
building one's breathing and function back up
to as normal a level as possible through exercise.
All patients with limited pulmonary function
resulting from emphysema may benefit from pulmonary
rehabilitation.
You should discuss with your
doctor whether such a program would benefit
you. Patients entering this type of rehabilitation
should be committed to participating. They
also
should be non-smokers or should enroll in a
quit smoking program.
Risks
Bullectomy is an elective procedure that
may relieve your symptoms, but does involve some
risk. Potential complications can include pneumonia,
respiratory failure requiring use of a ventilator
for a period of time, and prolonged air leak
that may require hospitalization for several
weeks.
Bullectomy also carries the usual risks associated
with any operation requiring general anesthesia.
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