The surgical considerations of bullous emphysema.

Increasing surgical interest in bullous emphysema has been manifest in recent years. Justification for surgery in many series of cases has been vague but there is more and more agreement on the necessity for considering an increasing number of these patients for surgery. The first American reference on this subject was in 1925 when Koontz reviewed the literature and collected 105 cases. The surgical program was somewhat vague at this early date due to the undeveloped status of resection surgery. By 1937, Schenck had collected 381 cases and presented five of his own. Of these, four were subjected to local excision and one was lobectomized. He remarked that cysts easily herniated from the wound facilitating excision. In fact, he stated that bullae might continue to increase in size with each breath, necessitating opening them to facilitate dissection. Tyson, in discussing this presentation, emphasized the short life expectancy in many of these patients and related a case operated 11 years previously who expired with cor pulmonale.