Bullae are large air pockets that form inside the lung due to certain medical conditions, such as emphysema and chronic obstructive pulmonary disease. Doctors may recommend a bullectomy, which is the surgical removal of the bullae, if they cause breathing problems or other health complications.
Bullae often grow in size once they form. Without treatment, enlarged bullae take up an increasing amount of space in the lungs, causing pressure to build. The pressure can make it difficult for a person to breathe.
Keep reading to learn more about a bullectomy, including its risks and what to expect following the procedure.
A bullectomy is a surgical procedure that involves removing bullae, which are enlarged, damaged air sacs in the lungs. A surgeon will remove one or more bullae through small incisions in the chest.
Bullae can grow up to 20 centimeters across. Those that take up more than one-third of the space in and around the lung are called giant bullae.
Doctors may recommend a bullectomy if the bullae significantly interfere with a person's breathing or cause health complications.
Bullae can cause symptoms of underlying conditions to become more noticeable. For example, a person with chronic obstructive pulmonary disease (COPD) may have exacerbated symptoms, such as:
- coughing up mucus
- tightness or pressure in the chest
- difficulty breathing in
- general fatigue from low oxygen levels
If they burst, bullae can cause a collapsed lung. If the lung collapses two or more times, a person may need a bullectomy.
Bullae are a common complication of COPD and emphysema. Other conditions that may cause bullae include:
- Ehlers-Danlos syndrome, which weakens connective tissue
- sarcoidosis, where inflammation affects various parts of the body, including the lungs
- Marfan syndrome, which involves weakened connective tissue
Who can get a bullectomy?
Not everybody who has bullae requires surgery, and surgery is not appropriate for everyone.
A doctor will perform various tests to determine whether an individual is a good candidate for the surgery. These tests may involve an angiography, X-ray, or CT scan.
Doctors are more likely to recommend a bullectomy for people who meet the following criteria:
- younger in age
- only one bulla or just one area of the lung that contains a group of bullae
- no airway obstructions
Before most doctors will consider a bullectomy, they typically require that:
- the bullae are larger than one-third of a lung
- the bullae prevent the lung from expanding and moving air in and out
Doctors are less likely to recommend a bullectomy if a person has multiple bullae throughout the lungs because surgery may cause more damage to surrounding tissue and create more problems than it solves.
It is important to follow a doctor's advice on how to prepare for a bullectomy. They may advise the following:
- fasting for 8 hours before the procedure
- scheduling time off work for recovery
- arranging for a friend or family member to take the person to and from the procedure
- stopping smoking, if applicable
A bullectomy is a minimally invasive procedure, but it will require the person to be under general anesthesia.
The surgeon will make a small incision near the armpit. They will use a small video camera to help guide the surgery, which is called video assisted thoracoscopic surgery (VATS). They will cut out the affected areas, insert one or two breathing tubes into the chest, and then close the incision wound.
After the procedure, the person will have one or two tubes coming from the side of their chest. These tubes attach to a machine that helps suck out air and fluid from this area of the body. A healthcare professional will remove the chest tubes when it is safe to do so.
People may need to use an oxygen mask after surgery until their lungs are working well enough. They will receive pain medication in the form of an intravenous drip or oral tablets.
Recovery time varies depending on the person's age and overall health, but people can usually go home within 2 to 3 days. Following the hospital stay, people can expect to make a full recovery after a few weeks of rest.
After surgery, it may take some time for a person's appetite and bowel movements to return to normal. Drinking plenty of water and eating high fiber foods can help.
People should avoid driving until they have stopped taking pain relievers, as these can cause drowsiness.
The following steps can help a person speed up their recovery and avoid complications:
- increasing activity gradually over time
- keeping the surgical wounds clean and dry
- avoiding lifting heavy objects, swimming, or playing golf for 2 to 3 weeks
- avoiding smoking
- returning to work only after getting the doctor's approval
- attending all follow-up appointments
- avoiding traveling in an airplane for a month following the procedure
- eating a diet high in fiber to help prevent constipation
- trying any therapies that the healthcare team recommends
Doctors recommend avoiding air travel for 3 months after surgery.
Although a person will be able to return to their normal activities, they should not rush to do so, as the healing process can take some time.
All surgical procedures involve some risk. However, a bullectomy has a relatively low risk of complications.
According to the University of Health Network (UHN), the most common complication is air leaking from the chest tube. This complication affects 2–10 people in 100 and is more likely in people with lung disease. In these cases, the doctor will leave the chest tube in place for longer, and the air leak will heal on its own.
The UHN also report that fewer than one in 100 people will experience bleeding as a result of this surgery.
Complications can include:
- air escaping the chest tube
- weight loss
- a fever
- infections around the incision
- heart disease or heart failure
- pulmonary hypertension, or high blood pressure in the heart and lungs
- abnormal levels of carbon dioxide in the blood
If a person notices any complications or feels unwell following their procedure, they should speak to their doctor.
A bullectomy is a minimally invasive surgical procedure in which a surgeon removes one or more enlarged air sacs from the lung. There are few risks, and recovery is generally good. Following the procedure, a person should expect several weeks of recovery time before returning to normal activities.