Long term results of surgery for bullous emphysema

The authors present long term clinical, radiologic, and physiological data in 84 patients (mean age 46.5±11.7 yr) who underwent 95 surgical procedures for bullous emphysema from 1949 to 1972. Surgical indications were dyspnea (57), pneumothorax (18), prophylaxis (13), infection (6), and hemoptysis (1). Physiological improvement was related to bulla size, type of surgery and degree of chronic obstructive lung disease. The best results, often sustained for 5 yr, generally occurred in patients with giant bullae, those with lesser degrees of chronic obstructive lung disease, and those who underwent simple bulla excision or plication. Worthwhile short term improvement occurred in some patients with cor pulmonale. The poorest results were obtained in patients whose bullae were mere localized exaggerations of diffuse emphysema; in severe bronchitis; in cases in which bullae occupied one third or less of one hemithorax; and after lobectomy. Paraseptal (periacinar) emphysema, a benign disease of the lung cortex, was associated with a high prevalence of pneumothorax. Function was maintained for up to 20 yr following bullectomy, and there was little tendency for the bullae to recur.