[Open thoracic surgery of giant bullous pulmonary emphysema in adults]

Ninety-two adult patients underwent open surgery for unilateral (60) or bilateral (32) emphysematous bullae filling at least one third of an hemithorax: 56 were apical, 34 were basal and 2 were apical on one side and basal on the other side. A first group of 18 patients were admitted in critical care medicine, after an acute complication, in a state of respiratory distress which was not controlled by oxygen therapy and/or drainage, 17 of them being mechanically ventilated at time of operation. In this group 9 patients died, 8 of them with bilateral bullae and 5 with cor pulmonale. A second group of 74 patients underwent surgery after a delay during which symptoms appeared or worsened, complications were observed or a radiological opacity was discovered. In this group 5 patients died. During a mean 4.8 year follow-up, 55 patients among the 71 survivors with no associated cancer were in a better functional state and remained clinically stable. The patients history and the results of surgery suggest that: 1) giant bullae should be resected when they increase in volume, when they are bilateral and when symptoms progress; 2) criteria for surgery are not limited to patients having compression of lower lobes from apical bullae; 3) it is necessary to operate on both sides for bilateral disease in elective surgery; 4) when there is a state of respiratory distress after a complication of bilateral bullae, the mortality is prohibitive; 5) cor pulmonale is of poor prognosis; 6) diffuse lung disease and associated diseases add to mortality and morbidity.(ABSTRACT TRUNCATED AT 250 WORDS)