[A successful operation of bilateral emphysematous giant bullae in elderly case]

A 77-year-old man who had bilateral giant emphysematous bullae with chronic obstructive lung disease underwent emergent bilateral bullectomy and plication through the median sternotomy approach. He developed critical hemodynamic condition followed by severe hypoxemia (PO2 32.7 Torr) and hypercapnea (PCO2 76.2 Torr) due to the atelectasis of right middle lobe following respiratory infection, which caused the ballooning of the bullae. The operation was done applying Naclerio-Langer's procedures. The postoperative course was excellent without any complications. The patient is doing well fifteen months after the operation. The median sternotomy approach for the simultaneous bilateral pulmonary operation has advantages such as the unnecessity of changing patient's position during the operation, the easiness of operation for bilateral lesion, the possibility of shortening of operation time and reduction of postoperative wound pain compared with the other thoracotomies. In this report, the practical usefulness of this approach, especially in emergency or elderly cases is emphasized.