Introduction
Lung bullae, also known as pulmonary bullae, are air-filled spaces in the lungs that are larger than normal air sacs. Blebs are air-filled collections within the layers of the visceral pleura and are <1 cm in diameter. Bullae can be caused by conditions such as emphysema, smoking, and genetic predisposition. These spaces can become enlarged, leading to symptoms such as shortness of breath, chest pain, and fatigue, which may require VATS bullectomy or lung bulla surgery.
In India, lung bullae are a prevalent condition, with estimates suggesting that up to 4% of the population may be affected. According to recent studies, lung bullae are found in about 20% of patients with chronic obstructive pulmonary disease (COPD) and about 2% of patients with asthma.
One of the most common treatments for lung bullae is VATS bullectomy surgery. In this article, we will take a closer look at VATS bullectomy surgery in India, including the procedure, indications, advantages, cost, and recovery.
Causes and risk factors for lung bullae
- Emphysema
- Smoking: The most common risk factor for developing lung bullae (90% cases)
- Genetic predisposition
- Air pollution
Symptoms of lung bullae
- Shortness of breath: Difficulty breathing, especially during physical activity
- Chest pain: Pain in the chest, which may be sharp or dull
- Cough: Persistent cough that may produce mucus
- Fatigue: Tiredness and a lack of energy
- Pneumothorax: Sometimes these bullae can burst and can cause a Pneumothorax (air around the lung) and collapsed lung If the lung collapses two or more times, a person may need a bullectomy
Diagnosis of lung bullae
- Imaging tests: Chest X-ray, CT scan, and MRI are used to diagnose lung bullae. These tests can show the size, location, and number of bullae. Bullae can grow up to 20 centimeters across. Those that take up more than one-third of the space in and around the lung are called giant bullae.
- Bronchoscopy: A procedure that allows the doctor to examine the inside of the lungs using a thin, flexible tube with a light and camera.
- Pulmonary function tests: These tests measure lung function and can help diagnose lung bullae.
- Blood gas analysis (ABG): This indicates the adequacy of gas exchange in the lungs
Treatment options for lung bullae
The treatment options for lung bullae vary depending on the size and location of the bulla, and the severity of symptoms.
Medical management: Medical management may include bronchodilators, corticosteroids, and oxygen therapy
Surgical options: Bullectomy surgery and bulla resection are surgical options for treating lung bullae. VATS bullectomy surgery is a popular and effective minimally invasive option that involves the removal of the bulla through small incisions in the chest.
VATS Bullectomy Surgery: A closer look
It is important to understand that not everybody who has bullae requires surgery, and surgery is not appropriate for everyone. VATS bullectomy surgery is typically recommended for patients with large bullae that are causing symptoms.
A thoracic surgeon is most likely to recommend a bullectomy for patients who:
- are young
- have only one bulla or just one area of the lung that contains a group of bullae
- have bullae that are greater than one-third of a lung
- have a ruptured bulla causing an air leak leading to pneumothorax which is preventing the lung from expanding
- has no airway obstructions
- has no pulmonary hypertension
Patients who have multiple bullae throughout the lungs (diffuse disease) may not be good candidates for bullectomy because surgery may cause more damage to surrounding tissue and a lot of lung volume is lost in resection.
The procedure:
Video Assisted Thoracoscopic Surgery (VATS) bullectomy is a minimally invasive procedure that uses small incisions on the chest wall but needs patient to be under General Anaesthesia. The number of incisions can be one (Uniportal VATS) or two/three (Standard VATS). A camera is introduced through one of the cuts to inspect the lungs and pleural cavity. The region of lung containing the bullae is identified. A leak test is also performed to identify any other source of air leak. Surgical staplers are then used to resect the bullous component and/or the area of air leak, with a margin of healthy underlying lung.
Pleurodesis: Bullectomy must always be supplemented with an additional procedure of pleurodesis. It is the process of fusing the two layers of pleura together so as to obliterate the space between the lung and the chest wall. This is very important to reduce the incidence of recurrence of pneumothorax as new bullae and blebs may form lifelong in these patients and may rupture to cause collection of air outside the lungs. Pleurodesis can be:
- Mechanical: e.g Total pleurectomy, apical pleurectomy
- Chemical: By using sterilized talc, autologous blood patch, oxytetracycline, bleomycin, povidone-iodine etc
Recovery and follow-up: Patients typically stay in the hospital for a few days after VATS bullectomy surgery and may need to avoid certain activities for a few weeks while they recover.
After the procedure, the person will have one or two tubes coming from the side of their chest. These tubes attach to a machine that helps suck out air and fluid from this area of the body. Once the drainage has reduced and air leak has stopped, the surgeon will remove the chest tubes safely.
Advantages and disadvantages: Advantages of VATS bullectomy surgery include a shorter recovery time, less pain, and fewer complications compared to traditional open surgery. Disadvantages include the cost of the procedure and the need for general anesthesia.
Cost of VATS Bullectomy Surgery in India
The cost of VATS bullectomy surgery in India can vary depending on factors such as the location of the hospital, the surgeon’s experience, and the patient’s insurance coverage.
VATS Bullectomy requires the usage of surgical staplers. The number of stapler fires would depend on the size of the bulla that needs to be resected. The higher the number of fires, greater the cost of the surgery would be.
Comparison with other countries: The cost of VATS bullectomy surgery in India is typically lower than in other countries.
Insurance coverage: Many insurance plans cover at least a portion of the cost of VATS bullectomy surgery.
Conclusion
VATS bullectomy surgery is an effective and minimally invasive option for treating lung bullae in India. Patients should be well-informed about the procedure and its cost before making a decision. Early diagnosis and treatment can lead to better outcomes and improved quality of life for patients with lung bullae. You can get in touch with Dr. Kamran Ali and his team for any lung bullae related query.
