RESUMO
In general, giant emphysematous bullae develop within the substance of dystrophic pulmonary parenchyma. The bullae impede normal mechanical ventilation by the volume they occupy and by the compression which they exert. This addition can lead to acute complications. It is for these reason that surgery is often indicated until recently. These patients were always operated on by a thoracotomy or sternotomy. The deleterious affects of thoracotomy are of course added to the existing complications of the disease and are performed on patients with respiratory failure whose general state of health is often very poor. The recent arrival of video surgery has raised the hope that post operative problems will be less painful with fewer functional consequences and a reduction of morbidity and mortality. Since 1992 to 1995 24 of our patients have been operated exclusively by this technique for emphysematous bullae which occupy at least one third of the hemithorax. For 15 patients the bullae occupied half of the hemithorax. The functional constraint which can be assessed by Sadoul's classification enables four groups to be isolated: 6 patients in stage 5; five patients in stage 4; nine patients in stage 3; four patients in stage 1. In the preoperative work up, computered tomography occupies first place in assessing the extent of the disease. In our series the mortality was 4 per cent and the overall morbidity 34 per cent. The mean functional benefit between three and 16 months which was evaluated in 11 patients was an improvement of 500 mls for the FEVI and the Vital Capacity. The average increase in PO2, measured in four patients, was 7 mmHg. In 15 patients on whom information was available twelve were found to have complete autonomy. The initial results show that surgery of giant emphysematous bullae can be done using video surgery. It can be hoped that this technique will diminish the morbidity linked to a thoracotomy. Its place in the therapeutic arsenal for the treatment of emphysematous bullae seems to be justified in our eyes.