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Giant bullae of the lung are rare. Little is known about functional results after surgical treatment.
METHODS: This study retrospectively reviewed all patients who underwent surgical treatment for giant bullae between December 1988 and December 2010.

RESULTS: There were 63 patients (51 men, 12 women) with a median age of 56 years (range, 26 to 85 years). Bullae were a median size of 14 cm (range, 9 to 30 cm). Forty-five patients (71%) had underlying diffuse emphysema. The indication for surgical intervention was symptoms alone in 30 patients (48%) and associated complications in 33 (52%). The operation was a bullectomy in 54 patients, lobectomy in 6, plication in 2, and bilobectomy in 1. Complications occurred in 27 patients (43%), and 2 patients (3.0%) died. At the last follow-up, 19 had died and 44 were alive. Of the 43 patients with shortness of breath preoperatively, 29 (67.4%) were improved. Thirty patients (46.1%) had preoperative and postoperative pulmonary function tests with improvement from a median forced expiratory volume in 1 second (FEV1) of 1.0 L preoperatively to 1.4 L postoperatively (p = 0.002). Increasing bulla size (p = 0.02) and underlying emphysema (p = 0.01) were adversely associated with postoperative morbidity. Dyspnea improved in 21 of 33 patients (64%) with underlying diffuse emphysema compared with 5 of 7 patients (71%) without emphysema (p = 0.70).

CONCLUSIONS: Bullectomy improved pulmonary function in most patients with a symptomatic or complicated giant bulla, or both. However, increasing bulla size and underlying emphysema resulted in increased treatment morbidity. Underlying diffuse emphysema is not a contraindication to bullectomy.