Bullectomy has been shown to be an effective treatment of severe compressive bullous emphysema. However, persistent air leak is a common complication from this procedure. We report a case of a 48-year-old man with severe bilateral bullous emphysema and disabling dyspnoea treated by bilateral staple resection with bovine pericardial buttress through the median sternotomy approach. Despite a post-operative need for ventilatory support, air leak was not a problem and the patient was able to have both chest drains removed shortly after extubation. The patient had a pre-operative forced expiratory volume in 1 second of 0.5 L/sec, forced vital capacity of 1.25 L and peak expiratory flow rate of 100 L/min. These parameters were increased to 1.4 L/sec (180% increase), 1.9 L (52% increase) and 270 L/min (170% increase), respectively, one month later, in association with a marked clinical improvement. We conclude that bilateral bullectomy in carefully selected patients is useful and bovine pericardium buttress is probably helpful in achieving pneumostasis.