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Bullectomy

Overview

A bullectomy is a surgery performed to remove large areas of damaged air sacs in the lungs that combine and form larger spaces within your pleural cavity, which contains your lungs.

Normally, the lungs are made up of many little air sacs called alveoli. These sacs help transfer oxygen from the lungs into your bloodstream. When alveoli are damaged, they form larger spaces called bullae that simply take up space. Bullae can’t absorb oxygen and transfer it into your blood.

Bullae often result from chronic obstructive pulmonary disease (COPD). COPD is a lung disease commonly caused by smoking or long-term exposure to gas fumes.

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Uses

What is a bullectomy used for?

A bullectomy is often used to remove bullae bigger than 1 centimeter (just under half an inch).

Bullae can put pressure on other areas of your lungs, including any remaining healthy alveoli. This make it even harder to breathe. It can also make other COPD symptoms more pronounced, such as:

  • wheezing
  • tightness in your chest
  • frequent coughing up of mucus, especially early in the morning
  • cyanosis, or lip or fingertip blueness
  • feeling tired or exhausted often
  • feet, leg, and ankle swelling

Once bullae are removed, you’ll usually be able to breathe more easily. Some symptoms of COPD may be less noticeable.

If bullae start releasing air, your lungs can collapse. If this happens at least twice, your doctor will likely recommend a bullectomy. A bullectomy may also be necessary if the bullae take up more than of your lung space.

Other conditions that can be treated by a bullectomy include:

  • Ehlers-Danlos syndrome. This is a condition that weakens connective tissues in your skin, blood vessels, and joints. 
  • Marfan syndrome. This is another condition that weakens connective tissues in your bones, heart, eyes, and blood vessels.
  • Sarcoidosis. Sarcoidosis is a condition in which areas of inflammation, known as granulomas, grow in your skin, eyes, or lungs.
  • HIV-associated emphysema. HIV is associated with an increased risk of developing emphysema.

Preparation

How do I prepare for a bullectomy?

You may need a full physical examination to make sure you’re in good enough health for the procedure. This may include imaging tests of your chest, such as:

  • X-ray. This test which uses small of amounts of radiation to take images of the inside of your body.
  • CT scan. This test uses computers and X-rays to take pictures of your lungs. CT scans take more detailed images than X-rays.
  • Angiography. This test uses a contrast dye so doctors can see your blood vessels and measure how they’re working with your lungs.

Before you have a bullectomy:

  • Go to all preoperative visits that your doctor schedules for you.
  • Quit smoking. Here are some apps that can help.
  • Take some time off work or other activities to allow yourself recovery time.
  • Have a family member or close friend take you home after the procedure. You may not be able to drive right away.
  • Don’t eat or drink at least 12 hours before the surgery.
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Procedure

How is a bullectomy performed?

Before a bullectomy is performed, you’ll be put under general anesthesia so you asleep and not feel any pain during the surgery. Then, your surgeon will follow these steps:

  1. They’ll make a small cut near your armpit to open your chest, called a thoracotomy, or several small cuts on your chest for a video-assisted thoracoscopy (VATS).
  2. Your surgeon will then insert surgical tools and a thoracoscope to see the inside of your lung on a video screen. VATS might involve a console where your surgeon performs the surgery using robotic arms.
  3. They’ll remove bullae and other affected parts of your lung.
  4. Lastly, your surgeon will close the cuts with sutures.

Recovery

What’s recovery like from a bullectomy?

You’ll wake up from your bullectomy with a breathing tube in your chest and an intravenous tube. This can be uncomfortable, but pain medications can help manage the pain at first.

You’ll stay in the hospital about three to seven days. Full recovery from a bullectomy usually takes a few weeks after the procedure.

While you’re recovering:

  • Go to any follow-up appointments that your doctor schedules.
  • Go to any cardiac therapy that your doctor recommends.
  • Don’t smoke. Smoking can cause bullae to form again.
  • Follow a high-fiber diet to prevent constipation from pain medications.
  • Don’t use lotions or creams on your incisions until they’re healed.
  • Gently pat your incisions dry after bathing or showering.
  • Don’t drive or return to work until your doctor says it’s OK to do so.
  • Don’t lift anything over 10 pounds for at least three weeks.
  • Don’t travel by plane for a few months after your surgery.

You’ll slowly get back to your normal activities over a few weeks.

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Risks and complications

Are there any risks associated with a bullectomy?

According to the University of Health Network, only about who get a bullectomy have complications. Your risk of complications may increase if you smoke or have late stage COPD.

Possible complications include:

  • fever over 101°F (38°C)
  • infections around the surgical site
  • air escaping the chest tube
  • losing a lot of weight
  • abnormal levels of carbon dioxide in your blood
  • heart disease or heart failure
  • pulmonary hypertension, or high blood pressure in your heart and lungs

See your doctor right away if you notice any of these complications.

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Takeaway

The takeaway

If COPD or another respiratory condition is disrupting your life, ask your doctor if a bullectomy may help treat your symptoms.

A bullectomy carries some risks, but can help you breathe better and give you a higher quality of life. In many cases, a bullectomy can help you regain lung capacity. This can allow you to exercise and stay active without losing your breath.

Article resources
  • Bullectomy. (2014).
  • Krishnamohan P, et al. (2014). Bullectomy for symptomatic or complicated giant lung bullae. DOI:
  • Mayo Clinic Staff. (2017). COPD: Symptoms and causes.
  • Meyers BF, et al. (2003). Chronic obstructive pulmonary disease. 10: Bullectomy, lung volume reduction surgery, and transplantation for patients with chronic obstructive pulmonary disease. DOI:
  • Walker S. (2015). Apical bullectomy surgery.
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