The Objective and Subjective Outcome of Bullectomy in Patients of Bullous Lung Disease: A Prospective Study

Background: This study aimed to evaluate the outcome of bullectomy in patients with bullous lung by comparative analysis of their preoperative and postoperative pulmonary function parameters and subjective dyspnea score.

Materials and Methods: The study included 42 cases of bullous lung disease, who underwent open or video-assisted thoracoscopic surgery (VATS) bullectomy at our hospital from November 2019 till January 2022. All patients were subjected to set protocol which included preoperative comprehensive history and physical examination, chest X-ray, lung CT, and pulmonary function tests. Postoperative evaluation included 3 monthly follow-up for three visits, with clinical assessment for subjective dyspnea score and pulmonary function tests (PFTs). Preoperative and postoperative comparisons of parameters were made using the student’s paired t-test to calculate the statistical significance.

Results: Primary bullous lung disease was the most common underlying lung pathology in our population, followed by COPD. Spontaneous pneumothorax was the most common presenting feature, and the most patients presented in their fourth decade of life with a history of smoking.

All cases underwent VATS/open bullectomy. Most patients were discharged on the 4th postoperative day. Statistically, significant improvement was seen in mean FEV1 (forced expiratory volume in 1st second), FVC (forced vital capacity), and FEV1/FVC. FEV1 appeared to be the most reliable indicator of postoperative progress. The subjective dyspnea score improved in a statistically meaningful way. Diffuse parenchymal disease patients had a higher rate of complications. Our research found no evidence of mortality.

Conclusion: We conclude that surgery remains the standard treatment for bullous lung disease. Most of the patients who got benefitted are those having localized disease with remaining normal parenchyma. Statistically significant improvement in subjective and objective parameters is seen in all cases. Those with the diffuse emphysematous disease need careful selection given their high complication rate.