Name of the Procedure:

Thoracotomy; with resection-plication of bullae, includes any pleural procedure when performed
Common name: Thoracotomy with Bullae Resection

Summary

A thoracotomy with bullae resection is a surgical procedure where an incision is made in the chest wall to access and remove large air sacs (bullae) from the lungs. This may also include other pleural procedures. The goal is to improve lung function and relieve symptoms caused by the bullae.

Purpose

This procedure addresses conditions such as emphysema or chronic obstructive pulmonary disease (COPD) where large bullae compress healthy lung tissue, leading to breathing difficulties. The objective is to remove these bullae, allowing the remaining lung tissue to expand and function better, thereby improving the patient's breathing and overall lung health.

Indications

• Severe emphysema or COPD with large bullae
• Underlying lung compression due to bullae
• Recurrent pneumothorax (collapsed lung) caused by bullae
• Ineffectiveness of other treatments such as medication or less invasive procedures

Preparation

• Fasting for at least 8 hours before surgery
• Adjusting or stopping certain medications as advised by the doctor
• Preoperative imaging tests like CT scan or chest X-ray
• Pulmonary function tests to assess lung capacity
• Blood tests to check overall health

Procedure Description

1. The patient is placed under general anesthesia.
2. An incision is made along the side of the chest (thoracotomy) to access the lungs.
3. The surgeon identifies and isolates the bullae.
4. The bullae are removed (resected) or folded and sutured (plicated) to reduce their size.
5. Any additional necessary pleural procedures, such as pleurectomy, are performed.
6. The incision is closed, and chest tubes may be inserted to drain fluids and air.
7. The patient is moved to a recovery area for monitored care.

Duration

The procedure typically takes 2-4 hours, depending on the complexity of the case.

Setting

The procedure is performed in a hospital operating room.

Personnel

• Thoracic Surgeon
• Anesthesiologist
• Surgical Nurses
• Respiratory Therapist (if needed)

Risks and Complications

• Infection
• Bleeding
• Air leaks
• Pneumonia
• Prolonged air leak from the lung tissue
• Recurrent pneumothorax
• Adverse reactions to anesthesia

Benefits

• Improved lung function
• Reduced breathlessness and chest pain
• Enhanced quality of life
• Increased exercise capacity
• Decreased frequency of lung-related hospital admissions

Recovery

• Hospital stay for 5-7 days
• Pain management with medications
• Breathing exercises and physical therapy
• Avoiding heavy lifting or strenuous activities for several weeks
• Follow-up appointments to monitor recovery and lung function

Alternatives

• Medication management (bronchodilators, steroids)
• Pulmonary rehabilitation
• Less invasive procedures such as bronchoscopic lung volume reduction
• Lung transplantation in severe cases

Patient Experience

During the procedure, the patient is under general anesthesia and will not feel anything. Post-procedure, there might be pain at the incision site, managed with pain medications. Patients may experience fatigue and breathlessness initially, improving as recovery progresses. Comfort measures include medications for pain relief, breathing exercises, and support from healthcare providers.