[Surgical treatment of giant emphysematous lung bullae]

Lack of Brazilian publications regarding this disease in Brazil led us to perform the current work to describe the historical evolution and to analyze results of the surgical treatment of Giant Emphysematous Lung Bullae at the Santa Casa de São Paulo.

We have retrospectively assessed, between January 1979 and June 2005, the medical records of 83 patients submitted to one of four surgical modalities: the thoracoscopic bullectomy, VATS bullectomy, VATS bullae drainage and bullae drainage with local anesthesia, totaling 92 surgeries. Parameters analyzed were hospitalization time, post-surgical complications, perioperative and late mortality in addition to clinical and functional pre- and post- surgical parameters.

Morbidity was 40.2% and early post-surgical mortality 4.3%. Post-surgical complications were associated to the patient's morbid history. Factors such as diffuse pulmonary emphysema, multiple bullae and age did not influence early complications. There was an improvement in the symptomatology and functional results in 94.5% of the patients. There was no return on he operated bullae. Mortality five years after surgery was of 18.3% and arose, primarily from clinical progression of the diffuse pulmonary emphysema.

Several surgical modalities were performed to treat the emphysematous lung bullae, from bullectomy to thoracotomy, at the initial phase until drainage of the bullae with local anesthesia and sprayed talc, the currently preferred modality. Regardless of the method used, however, notwithstanding the relatively high morbidity, post-surgical results are highly favorable with low mortality and uncontestable clinical-functional improvement of the operated patients.