Abstract
Three surgical procedures are pertinent to the treatment of end-stage emphysema: giant bullectomy, lung volume reduction surgery (LVRS), and lung transplantation. Patients with localized disease manifesting as a giant bulla that compresses adjacent healthy lung tissues can be offered bullectomy. Patients with diffuse disease can be offered LVRS, lung transplantation, or staged LVRS/lung transplant, depending on multiple factors including age, lung function parameters, lobar predominance, and whether the disease is uni- or bilateral. Since end-stage emphysema is refractory to most medical treatment, surgery is often the only remaining option.
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