Bullectomy

What is a bullectomy?

A bullectomy is a type of surgery that may be used to treat certain people with chronic obstructive pulmonary disease (COPD) who have lung damage caused by emphysema. There are different types of emphysema, and one type mainly affects the upper part of the lungs. As this kind of emphysema progresses, it can destroy the walls of the millions of tiny air sacs in the lungs. These air sacs are called alveoli. When the walls of hundreds of these alveoli are destroyed, it causes the tiny sacs to combine into larger air sacs called bullae.^1,2

These bullae do not play a role in the lungs’ function of absorbing oxygen from the air and transferring it into the bloodstream. Instead, they just take up room in the lungs. They can press down on the surrounding parts of the lungs and can keep blood from flowing to the healthier sections of the lungs, which reduces the lungs' ability to absorb oxygen. This can worsen COPD symptoms, such as breathlessness.^1,2

During a bullectomy, surgeons operate to remove bullae from a patient’s lungs. When they are removed, it can help the healthier parts of the lungs to start working better.^1,2

Which COPD patients may benefit from bullectomy?

Bullectomies are only effective for COPD patients who have the type of emphysema that causes bullae in the upper part of the lungs. Also, the size and location of the bullae affect whether this type of surgery is an option. For instance, if a patient has many smaller-sized bullae, then surgeons might not be able to remove them. Bullectomies are more effective for bullae that are very large.^1,2

To be a candidate for this kind of surgery, patients need to be strong enough to go through surgery. They cannot be current smokers. Patients need to undergo many tests to find out if a bullectomy is a possible treatment option for them. Some of these tests include:

• Chest x-ray
• CT scan
• Lung function testing (spirometry)
• Arterial blood gas tests

What are the possible benefits of a bullectomy for COPD patients?

Removing large bullae can help the healthier sections of the lungs to re-expand, because they are no longer being squeezed by the bullae. It can also help the diaphragm move back into a better position that will make breathing easier. The diaphragm is a large, flat muscle under the lungs that controls breathing.^2,3

By increasing the individual's ability to breathe, blood-oxygen levels can improve and the person may be better able to engage in some exercise.

What are the risks of bullectomy?

Bullectomies can be risky for patients who have later stages of COPD, or whose bodies are too weak for surgery. Bullectomies also carry a higher risk for COPD patients who have:

• Pulmonary hypertension (high blood pressure)
• High levels of carbon dioxide in the blood
• Heart failure or other heart problems^1,2