We report a case of a giant: bulla in a 16-year-old boy who was oxygen and
wheelchair dependent. He had been diagnosed with Marfan's syndrome and had
severe kyphoscoliosis. The giant bulla occupying his entire left thoracic c
avity compressed the contralateral lung. Until referral to our hospital, a
bullectomy had been deferred during the preceding 5 years because of his po
or pulmonary function and severe chest wall deformity. The patient was cons
idered a candidate for thoracoscopic bullectomy, A stepwise resection techn
ique was used, First, the bulla should be emptied by aspiration or wall per
foration. Second, the redundant wall of the bulla should be resected by a l
ooped Ligation without opening the cavity. Third, a stapled resection of th
e downsized bulla should be performed. After a successful bullectomy, his s
ubjective symptoms and pulmonary function improved. The reduction of the bu
lla makes bullectomy easily and decreases the number of staplers, and reduc
es operating time compared with opening the bulla and suturing it. Therefor
e, when treating a giant bulla, we recommend a stepwise resection technique
.