Surgery of Giant Bullous Emphysema: Report of 60 Patients

Introduction: Giant bullous emphysema (GBE) is a severe condition that leads to respiratory dysfunction and a range of complications. It is defined as a lesion that exceeds one-third of the lung field. Surgery is the preferred treatment for this condition; however, the surgical indications can be uncertain due to the fragile nature of the patients. Method: This study presents the surgical and perioperative aspects of 60 patients who underwent surgery for giant bullous emphysema between 2010 and 2020. Results: The study population consisted mostly of males with a mean age of 48.8 years. Most patients had a smoking history, with a mean of 40.71 pack-years. Smoking cessation was attempted in 70.9% of patients. Dyspnea and chest pain were the most common symptoms. Mean size of the bullae was 14.2 cm, with a slight right-side predominance in 47% of patients and bilateral in 5%. Complications were reported in 56.7% of cases, with pneumothorax being the most common (33,3%). The surgical approach was thoracotomy in 63.6% of patients, bullectomy was the most common operative procedure, while 4% underwent lobectomy. The mean chest tube duration drainage was 10.1 days, and prolonged air leaks were reported in 66.7% of cases. Chemical pleurodesis with povidone-iodine was performed in 80.9% of patients. Lower respiratory tract infection was the most common postoperative complication (33.3%). No deaths were reported, and 18% of patients reported effective improvement of respiratory function two months after surgery. Conclusion: Surgical treatment of GBE is an effective approach for improving respiratory function and preventing complications.However, surgical indications should be individualized based on the patient9s characteristics.Further studies are needed to evaluate the long-term outcomes.