Surgical treatment of bullous emphysema

Between 1974 and 1981, 20 patients had surgical treatment for bullous emphysema. There were 15 males and five females with a mean age of 40 years. The majority of patients had symptomatic respiratory disease, were smokers and had a past history of lung disease. In all cases bullae were visible on chest X‐ray, the primary diagnostic investigation, and simple spirometry was used to assess lung function pre‐ and postoperatively. Cyst resection was performed in 14 cases (two bi‐laterally) and pleurodesis was added in six of these cases. Lobectomy was performed in four patients and in two a pedunculated cyst was simply ligated and excised. There were no deaths and morbidity was acceptably low. Vital capacity (VC), Forced expiratory volume in 1 s (FEV1) and FEV1:VC ratio were all significantly improved with surgery though the correlation of subjective and objective results was variable. Surgery is appropriate for symptomatic patients with bullae visible on chest X‐ray and asymptomatic patients with rapidly enlarging bullae occupying more than 30% of a hemithorax.