Original article: general thoracicLung wedge resection improves outcome in stage I primary spontaneous pneumothorax
Section snippets
Patients and methods
Between January 1994 and December 2001, 206 consecutive procedures were performed in 182 patients (75% male; mean age, 35.3 years; range, 14 to 80) for recurrent spontaneous pneumothorax. Analysis was by case history, chest computed tomography (CT) scan, operation report, pathologic report, chest tube duration, length of stay and outpatient follow-up. Vanderschueren's classification was used to determine the extent of morphologic alterations: stage I no endoscopic abnormalities, stage II
Clinical outcome
A total of 126 apical pleurectomies were performed in 113 patients. Of these, 13 patients had a second VATS procedure for PSP in the other lung after a mean period of 25 weeks (range, 0 to 114). Three patients (2.4%) required redo VATS, 2 in group A (3.5%) for persistent air leak and 1 (1.4%) in group B for apical hematothorax (p = 0.431). Chest tubes were removed after a mean duration of 1.4 days (range, 1 to 5) in group A and after 1.6 days (range, 1 to 7) in group B (p = 0.259). The mean
Comment
In this selected group of patients without endoscopical abnormalities, VATS offers low recurrence rates through a minimally invasive approach. However, these data suggest that apical pleurectomy should be accompanied by apical lung wedge resection even in this favorable category of patients.
The presence of subpleural blebs is a common finding during chest surgery 1, 14, 15, 16, 17, 18, 19. However, the evidence of bullae during the evaluation of a primary spontaneous pneumothorax (PSP) is not
References (23)
- et al.
Respiratory failure due to insufflated talc
Lancet
(1997) - et al.
Immediate and long-term results after surgical treatment of primary spontaneous pneumothorax by VATS
Ann Thorac Surg
(1996) - et al.
Videothoracoscopic bleb excision and pleural abrasion for the treatment of primary spontaneous pneumothoraxlong-term results
Ann Thorac Surg
(2003) - et al.
The results of thoracoscopic surgery for primary spontaneous pneumothorax
Chest
(2000) - et al.
Three years' experience in video-assisted thoracic surgery (VATS) for spontaneous pneumothorax
J Thorac Cardiovasc Surg
(1994) - et al.
Resection of pulmonary blebs and pleurodesis for spontaneous pneumothorax
Chest
(1993) - et al.
Median sternotomy with bilateral bullous resection for unilateral spontaneous pneumothorax, with special reference to operative indications
J Thorac Cardiovasc Surg
(1988) - et al.
Systemic distribution of talc after intrapleural administration in rats
Chest
(1999) - et al.
Pathogenesis of spontaneous pneumothoraxwith special reference to the ultrastructure of emphysematous bullae
Chest
(1980) - et al.
Current aspects of spontaneous pneumothorax
Eur Respir J
(1997)
Spontaneous pneumothorax
N Engl J Med
Cited by (50)
Can preoperative imaging studies accurately predict the occurrence of bullae or blebs? Correlation between preoperative radiological and intraoperative findings
2013, Respiratory InvestigationCitation Excerpt :However, 9–29% of patients undergoing surgery for PSP do not have ELCs, and these patients have a lower postoperative cure rate [2,3,6]. Intraoperative findings are important for determining the surgical procedure performed and for predicting the prognosis [7], but the usefulness of preoperative imaging studies in PSP patients is unclear. According to guidelines for the management of PSP [8,9], routine chest computed tomography (CT) is not recommended, because it is not useful for predicting the recurrence of pneumothorax, identifying the cause of a persistent air leak, or deciding the type of surgical intervention.
Efficacy of polyglycolic acid sheet after thoracoscopic bullectomy for spontaneous pneumothorax
2013, Annals of Thoracic SurgeryCitation Excerpt :This procedure is performed by partial excision of the apical parietal pleura. However, we do not use this procedure because it can lead to postoperative complications such as bleeding [4, 14, 17, 18]. Intraoperative chemical pleurodesis has an acceptable recurrence rate of 1.9% to 5.7%.
Cause and management of recurrent primary spontaneous pneumothorax after thoracoscopic stapler blebectomy
2011, Asian Journal of SurgeryTreatment specifics for spontaneous pneumothorax in flight personnel
2010, Revue de Pneumologie CliniquePopulation-based study on surgical care for primary spontaneous pneumothorax
2024, European Journal of Cardio-thoracic SurgeryCold coagulation in thoracoscopic treatment of primary pneumothorax: A comparison with apicectomy
2023, Interdisciplinary cardiovascular and thoracic surgery