Video-assisted thoracic surgery management of giant pulmonary bullae: Insights from a single-centre series of 53 patients

INTRODUCTION: Giant bullae (GB) of the lung are emphysematous air spaces occupying at least one-third of the hemithorax. GB may lead to progressive dyspnoea, compression of adjacent lung and pneumothorax, necessitating surgery as the definitive management in symptomatic patients. PATIENTS AND METHODS: We conducted a retrospective analysis of 53 cases of GB operated at a tertiary care centre in India from December 2020 to December 2024. RESULTS: The study cohort included 42 males and 11 females, with a mean age of 49.8 years (range: 12-74). GB occurred unilaterally in 38 patients (right lung - 20, left - 18), bilateral in 15 patients and 6 patients had extensive emphysematous changes also. The primary procedures performed to take care of the bulla included video-assisted thoracic surgery (VATS) bullectomy (30 patients), VATS bullectomy with wedge resection of additional bullae (8 patients) and lobectomy (15 patients). The adjunct procedures performed included talc pleurodesis (24 patients), pleurectomy (13 patients) and decortication in one patient. Median chest drain duration was 6-7 days with an average hospital stay of 6.4 days. Post-operative complications occurred in 12 patients, including prolonged air leak (8), atrial fibrillation (2), ileus (1) and urinary retention (1). No wound infections or deaths were reported, and there were no recurrences of GB during the follow-up period of 48 months. CONCLUSIONS: VATS is a safe and effective surgical approach for treating symptomatic GB. It has minimal complications, leads to a quick recovery and has very low chances of recurrence.