Original article: general thoracic
Videothoracoscopic bleb excision and pleural abrasion for the treatment of primary spontaneous pneumothorax: long-term results

https://doi.org/10.1016/S0003-4975(02)04544-7Get rights and content

Abstract

Background

The goal of this study was to evaluate the long-term efficiency of videothoracoscopic bleb excision and pleural abrasion for the treatment of primary spontaneous pneumothorax.

Methods

From July 1991 to December 1997, 182 patients with primary spontaneous pneumothorax were treated by a single technique at our institution. Seven patients had single-stage bilateral procedures and 11 other patients had staged bilateral procedures. Indications for operation were first episode with prolonged air leak, incomplete lung reexpansion, or job restrictions (n = 59), first ipsilateral recurrence (n = 57), second or third ipsilateral recurrence (n = 34), contralateral recurrence (n = 25), synchronous bilateral pneumothorax (n = 3), hemopneumothorax (n = 3), and tension pneumothorax (n = 1). All patient data were reviewed retrospectively, and 167 patients were available for late follow-up (92%).

Results

Mean operative time was 57 ± 19 minutes Conversion to thoracotomy was required in 1 patient (0.6%). Mean duration of pleural drainage was 5.8 ± 1.2 days (range, 4 to 26 days), and mean postoperative stay was 7.7 ± 1.6 days (range, 6 to 31 days). Postoperative complications occurred in 50 patients (27.4%), the most frequent being prolonged air leak (14.8%), and in-hospital mortality was 0%. After a mean follow-up of 93 ± 22 months (range, 57 to 134 months; median, 84 months), five ipsilateral recurrences were noted (3%). Three recurrences occurred within 12 months of videothoracoscopy and required reoperation. Two patients had partial pneumothorax recurrence at 39 and 58 months, and were treated conservatively with chest tube insertion and tale slurry. After 1 year, 10.7% of patients complained of chronic chest pain or discomfort, although none was taking pain medication after 3 months. Most patients (89.8%) were satisfied or very satisfied of their operation. All patients had returned to sport activities within 2 years.

Conclusions

Videothoracoscopic bullectomy and pleural abrasion is a reliable and safe method to treat primary spontaneous pneumothorax. Long-term recurrences occur with an acceptable rate that compares with results after limited thoracotomy. Chronic chest pain or discomfort is unpredictable and may represent a problem in a few patients.

Section snippets

Patient characteristics

Between July 1991 and December 1997, 182 patients with primary spontaneous pneumothorax have been treated by videothoracoscopy at our institution. Twelve patients were female (7%) and 170 were male (93%). All patients had a preoperative chest computed tomography (CT) to determine the number and location of blebs or bullae. The indications for operation are reported in Table 1. The mean age at operation was 25.1 ± 4.9 years (range, 16 to 37 years). Seventy-eight patients (43%) had a history of

Results

All patients had preoperative chest CT allowing for preventive surgical procedures on the contralateral lung in selected patients. All patients but 19 had blebs or bullae diagnosed on chest CT. Indications for operation are reported in Table 1. Ninety-three procedures were performed on the right side and 71 on the left side; 7 patients had a single-stage bilateral procedure and 11 patients had a staged bilateral procedure. All patients but 8 had at least one bullous area excised. The mean

Comment

There is now compelling evidence that VATS is a viable alternative to limited lateral thoracotomy (LLT) for the treatment of primary spontaneous pneumothorax 6, 7, 8, 9, 10, 11, 12, 13, 14. Videothoracoscopic procedures result in short hospital stay, low morbidity, high patient acceptance, and mid-term rates of recurrence slightly higher than those reported after open procedures 6, 7, 8, 9, 10, 11, 12, 13, 14. Moreover, VATS has been reported to reduce postoperative pain, reduce shoulder

References (25)

Cited by (121)

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    2018, Annals of Thoracic Surgery
  • Pleurectomy versus pleural abrasion for primary spontaneous pneumothorax in children

    2017, Journal of Pediatric Surgery
    Citation Excerpt :

    While some studies have shown equivalent outcomes between these two techniques [11], others have mirrored our finding of a reduced risk of PSP recurrence in patients undergoing pleurectomy [12,13]. Interestingly, our recurrence rate following pleurectomy (8.8%) was similar to other series, while our recurrence rate following pleural abrasion (40%) was significantly higher than most published series [12,14–16]. The reason behind the divergence from published recurrence rates following pleural abrasion in our study remains unclear.

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